Schizophrenia is among the most frightening and severe mental illnesses that arouse intense anxiety in the healthcare industry, the media, and the public. Although effective treatment modalities are available, many patients and affected families have difficulties accessing excellent health care (Picchioni & Murray, 2007). Such challenges arise due to the provision of inadequate health care services and widespread misinformation. The present study, therefore, examines current literature on schizophrenia with the aim of promoting an understanding of the disease’s presentation, statistics, and management.
What is Schizophrenia?
Schizophrenia is considered as a disabling psychiatric disorder that involves disruptions in occupational, psychosocial, emotional, and cognitive functioning. Persons with the illness experience auditory hallucinations or voices that often abuse or criticize the patients (Picchioni & Murray, 2007). Typically, people with the hallucinations attempt to comprehend the experiences, and their effort may cause the development of strange delusions or beliefs.
Current Statistics
The frequently quoted datum that one in every one hundred individuals suffers from schizophrenia may be founded on LMR (lifetime morbid risk) statistics. Researchers have reported that the average “value of the distribution of LMR estimates was 11.9 per 1000,” which remains “consistent with the ‘one in a hundred’ dogma” (McGrath & Susser, 2009). A 2004 study determined that schizophrenia varied between females and males at a ratio of 1.2: 1.4, respectively, which agreed with a previous review of the disease’s prevalence (McGrath & Susser, 2009). According to the earlier study, “the risk ratio for men to develop schizophrenia relative to women was 1.42 (95% CI, 1.30–1.56)” (McGrath & Susser, 2009). Although the analysis was adjusted to cater for biases such as age range and quality of research, the difference between females and males persisted. The findings suggest that schizophrenia lacks an equal impact on women and men. Thus, “for every three men who develop schizophrenia, there are two women affected” (McGrath & Susser, 2009). Various meta-analyses have also associated schizophrenia with elevated rates of suicide and heightened risk of untimely death due to the presence of several comorbid somatic problems (McGrath & Susser, 2009).
Symptoms
Schizophrenia has been associated with negative and positive symptoms. Negative signs include “paucity of speech,” emotional blunting, lack of motivation, self-neglect, and social withdrawal (Picchioni & Murray, 2007). Positive symptoms include hallucinations or perceptions that lack a stimulus, delusions based on themes like passivity, and thought disorders that manifest as illogical speech. Although negative signs appear less troubling to patients, the symptoms can be extremely distressing to the patients’ relatives. Typically, psychiatrists classify the disease into subtypes based on the manifested symptoms.
Disease Subtypes
Paranoid schizophrenia is a common illness characterized by positive symptoms such as hallucinations and delusions. The second type, hebephrenic schizophrenia, is associated with prominent thought disorders, an absence of goal-oriented behaviors, and incongruous or sustained flattened affect (Picchioni & Murray, 2007). Catatonic schizophrenia is the third subtype and shows an over two-week sustained evidence of catatonic behavior that includes rigidity, posturing, excitement, and stupor. The other typical disease type is simple schizophrenia, which is characterized by a marked decline in employment, social, and academic performance, in addition to the progressive compounding of the negative symptoms and a considerable lack of personal motivation (Picchioni & Murray, 2007).
Risk factors
The most common risk factor associated with schizophrenia involves “a positive family history” (Picchioni & Murray, 2007) due to the influence of genes (Porteous et al., 2014). Typically, “the lifetime risk in the general population” is lower than one percent whereas the risk “is 6.5% in first degree relatives of patients, and it rises to more than 40% in monozygotic twins of affected people” (Picchioni & Murray, 2007). Schizophrenia has also been linked to several risk factors such as prenatal nutritional deficiency and antepartum exposure to infections like Toxoplasma gondii, rubella, and influenza (McGrath & Susser, 2009). Studies have also demonstrated an association between birth or pregnancy complications and the risk of mental disorders like schizophrenia. In particular, research has identified the following exposures as major risk factors: emergency caesarean delivery, asphyxia, uterine atony, congenital malformations, pre-eclampsia, and antepartum hemorrhage (McGrath & Susser, 2009). Finally, data collected from different longitudinal investigations show a link between the use of cannabis and the development of schizophrenia (McGrath & Susser, 2009).
Diagnostics criteria
The techniques employed in the diagnosis of schizophrenia are outlined in “the ICD-10 (international classification of diseases, 10th revision) diagnostic criteria” (Picchioni & Murray, 2007). According to the criteria, a case of schizophrenia is identified when a patient presents with at least one of the primary symptoms continuously for one month. The signs investigated include persistent bizarre delusions, hallucinatory voices, delusional perceptions, and thought echo (Picchioni & Murray, 2007). Alternatively, patients may be diagnosed with schizophrenia if they show two or more of the following symptoms for about a month: negative symptoms, catatonic behavior, incoherent speech, and persistent hallucinations followed by delusions. Initially, nonetheless, few patients show such florid signs (Picchioni & Murray, 2007). Instead, most patients experience vague symptoms like social withdrawal, behavioral changes, social problems, depression, and anxiety.
Interventions
Current systematic reviews indicate that psychosocial and pharmacological treatment approaches can ameliorate the prognosis of schizophrenia and prevent its chronicity (Chien, Leung, Yeung, & Wong, 2013). Picchioni and Murray (2007) pointed out that “the first line drug for a patient with a first episode of psychosis is an oral atypical antipsychotic, such as risperidone or olanzapine.” Usually, pharmaceutical companies emphasize the efficacy of such drugs, but studies have demonstrated that atypicals may have debilitating side effects (Picchioni & Murray, 2007). Clinical trials have also shown that typical drugs are equally effective when compared to most atypicals (Picchioni & Murray, 2007).
Moreover, evidence shows that interventions based on psychosocial techniques can effectively relieve the symptoms of psychosis and improve the patients’ functioning. Therefore, the approach is recommended as an essential component of treatment options that can promote the recovery of patients suffering from schizophrenia (Chien et al., 2013). Furthermore, psychosocial techniques offer a less costly intervention, when compared to the standard approach to treating schizophrenia. Typically, community-based interventions employ five principal psychosocial techniques, which have demonstrated efficacy in the prevention of relapse and the control of symptoms. The methods used are case management models, training programs on social skills, family intervention, psychoeducation programs, and cognitive therapies (Chien et al., 2013).
Other Management Considerations
General practitioners play a central role in ensuring that schizophrenic patients receive adequate and excellent physical healthcare (Picchioni & Murray, 2007). Current guidelines require all health care practices to maintain mental health registers and provide regular health checks that are tailored to meet the patients’ needs. In particular, there is a need to pay special attention to the screening of endocrine disorders like hyperprolactinemia and hyperglycemia, as well as cardiovascular risks like hypertension and the side effects associated with various medications (Picchioni & Murray, 2007).
Since family members constitute the primary caregivers for schizophrenic patients in community settings, they experience challenges like socioeconomic, psychological, emotional, and physical problems (Chien et al., 2013). However, the patients’ relatives are encouraged to learn skills in behavioral, psychoeducational, and psychosocial management techniques because the methods foster beneficial interactions between family members and the patients. Such an approach helps to minimize “patient relapse and readmission” (Chien et al., 2013).
Evidence-based practice guidelines
Chien et al. (2013) provided an analysis of various treatment modalities that have implications for guiding evidence-based practices in the management of schizophrenia. First, the combined use of antipsychotics and other psychotropic medications is effective in minimizing psychiatric symptoms and relapse. Nevertheless, significant variations in targeting and adverse effects, as well as treatment responsivity, exist among schizophrenic individuals (Chien et al., 2013). Therefore, there is a need to carry out clinical trials aimed at confirming and selecting the most suitable drugs. Secondly, the current practice of restricting “the first-line treatment to medications” fails to capitalize on emerging knowledge concerning the clinical, neuropathological, and etiological aspect of schizophrenia (Chien et al., 2013). New pharmacological approaches that target particular phases of pathogenesis might prevent disease progression at specific stages and, thus, provide possibilities of conducting personalized treatments founded on the illness condition of each patient. Therefore, there is a need to examine the ability of such novel techniques to overcome various pitfalls in the prevailing treatment modalities. Lastly, the increasing evidence of the efficacy of psychosocial interventions suggests that the approaches are indispensable to the treatment of schizophrenia. Nevertheless, their application has been obstructed by the inadequate preparation in mental health clinics for their appropriate and consistent utilization (Chien et al., 2013). Hence, greater effort is needed to ensure that the interventions are well-integrated into the current health care services.
Thus, schizophrenia is a frightening and severe mental illness that arouses intense anxiety in the healthcare sector, the media, and the public. Although effective treatment modalities are available, most of the affected people lack access to adequate health care. The challenge arises due to the provision of poor health services and widespread misinformation. The present study has examined current literature on schizophrenia and offered a greater understanding of the disease’s presentation, statistics, and management. It is hoped that increased public awareness about the disorder will promote the care given to the patients and enhance the management of the disease.
References
Chien, W. T., Leung, S. F., Yeung, F. K. K., & Wong, W. K. (2013). Current approaches to treatments for schizophrenia spectrum disorders, part II: psychosocial interventions and patient-focused perspectives in psychiatric care. Neuropsychiatric Disease and Treatment, 9, 1463–1481. doi: 10.2147/NDT.S49263.
McGrath, J. J. & Susser, E. S. (2009). New directions in the epidemiology of schizophrenia. Medical Journal of Australia, 190 (4): 7. Retrieved from https://www.mja.com.au/journal/2009/190/4/new-directions-epidemiology-schizophrenia
Picchioni, M. M. & Murray, R. M. (2007). Schizophrenia. BMJ, 335(7610), 91–95. doi: 10.1136/bmj.39227.616447.BE
Porteous, D. J., Thomson, P., J. Millar, J. K., Evans, K. L., Hennah, W., Soares, D, & Blackwood, D. (2014). DISC1 as a genetic risk factor for schizophrenia and related major mental illness: response to Sullivan. Molecular Psychiatry, 19(2), 141–143. doi: 10.1038/mp.2013.160
