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Schizophrenia is a severe mental disorder that has affected people since time immemorial (Schultz, North, & Shields, 2007). Individuals who are suffering from this disorder sometimes hear voices that other people do not hear. Moreover, these individuals might believe that other people are planning to harm them, controlling their thoughts or reading their minds. As a result, schizophrenics may be terrified and become extremely excited or withdrawn from the society. In fact, the speech of individuals suffering from this condition might be completely meaningless. Sometimes, they may sit for hours without talking or moving. In other cases, they look perfectly fine until you hear them speaking their thoughts (Schultz, North, & Shields, 2007).
Schizophrenia affects the families as well as society because most of the people suffering from this disorder find it hard to care for themselves or perform a job. Therefore, they are dependent on others and crave assistance. Although treatment of schizophrenia may help relieve its symptoms, but most of schizophrenics cope with those symptoms throughout their lives. Nevertheless, most people with this disorder may lead either meaningful or rewarding lives in their societies. More effective medications are been developed by researchers, and the current research tools aid in understanding the causes of schizophrenia. The current research might help to prevent and better treat this disorder (Hasan et al., 2013).
The schizophrenia symptoms can be grouped into three categories; they are cognitive symptoms, negative symptoms, and positive symptoms (Schultz, North, & Shields, 2007).
Positive symptoms refer to those psychotic modes of behavior that are not characteristic of healthy people. Individuals with positive symptoms often do not know what is happening in reality. In fact, these symptoms may come and then disappear. In some cases, symptoms are severe, while in other cases, they are barely noticeable, which is dependent on whether the person is receiving treatment. Some of the positive symptoms include hallucinations, delusions, thought disorders, and movement disorders (Schultz, North, & Shields, 2007). Hallucinations are things that an individual feels, smells, hears, or sees that other people cannot feel, smell, hear or see. The most common hallucination type in people suffering from schizophrenia is voices.
These individuals hear voices which may talk about their behavior, warn them of hazard, or tell them to do things. In other cases, these voices may talk to each other. Apparently, individuals with this disorder can hear voices for a long period before their friends and family notice the condition. Other types of hallucinations that are experienced by individuals with schizophrenia are feelings of someone touching them when no one is near, smelling odors that nobody else detects, and seeing objects or people that are not there (Lakhan & Vieira, 2009).
Delusions refer to false beliefs that are not associated with someone’s culture and do not change. An individual with schizophrenia believes in delusion despite the fact that other people have proved those beliefs to be wrong or not logical. Thus, schizophrenics may have delusions that seem strange such as believing that somebody can control their behavior through incomprehensible means. Sometimes, they may experience paranoid delusions and believe that other people are trying to hurt them by spying, poisoning, harassing, and cheating, among others. In some cases, they believe that they are someone else such as a famous person. Such beliefs experienced by people with schizophrenia are referred to as delusions of persecution (Schultz, North, & Shields, 2007).
Thought disorders refer to dysfunctional or unusual ways of thinking. Hereby, disorganized thinking is one of the types of thought disorder, which means that someone has difficulty in organizing their thoughts or connecting them in a logical manner. Individuals with disorganized thinking disorder can talk in a garbled manner that is difficult to comprehend. Thought blocking is another type of thought disorder, which happens when an individual stops talking abruptly in the middle of a thought (Lakhan & Vieira, 2009). Furthermore, an individual with a thought disorder may devise meaningless words.
Talking about movement disorder, it may look like restless body movements. An individual with movement disorder can repeat some motions again and again. In an extreme case, an individual can become catatonic. Catatonia refers to a condition when an individual does not move or respond to others. Fortunately, the available treatments have made catatonia very rare (Schultz, North, & Shields, 2007).
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Negative symptoms of schizophrenia are connected with disruptions to normal behavior and emotions. Negative symptoms are difficult to recognize and associate with schizophrenia disorder, and it is likely to confuse them with depression or other conditions. Some of these symptoms include talking little even when forced to do so, lacking ability to start and sustain planned activities, “flat affect”, and lacking pleasure in everyday life (Schultz, North, & Shields, 2007). Individuals with these symptoms need assistance in daily activities. Sometimes, they neglect basic personal hygiene, appearing to be unwilling or lazy to take care of themselves; however, these problems are normally caused by this disorder.
Similar to negative symptoms, cognitive symptoms can be hard to detect as part of the schizophrenia disorder. In most cases, they are only detected when other tests are conducted. Some of the cognitive symptoms associated with schizophrenia include trouble paying attention or focusing, poor “executive functioning,” and problems with “working memory” (Schultz, North, & Shields, 2007). Thus, it is very hard for someone experiencing cognitive symptoms to earn a living or lead a normal life. These symptoms normally cause much emotional distress.
Schizophrenia is highly influenced by genetics. People with a first-degree family member who is suffering from this disorder have a 10% likelihood of developing schizophrenia as compared to 1% likelihood of the general population (Tsuang, Bar, Stone, & Faraone, 2004). Though this disorder is significantly influenced by hereditary component or genetics, it is not determined by it. Despite the fact that schizophrenia occurs in certain families, around 60% of individuals suffering from it have no relatives with the disorder (Tsuang, Bar, Stone, & Faraone, 2004). In addition, people who are genetically predisposed to the disorder do not always develop it.
Abnormal brain chemistry together with abnormalities in brain structure can also contribute to the development of such mental disorder as schizophrenia. Some schizophrenics have been seen to have enlarged brain ventricles, suggesting a deficit in the brain tissue volume. Moreover, abnormally low activity in the frontal lobe has been associated with the disorder. Furthermore, some studies indicate that abnormalities in the amygdala, hippocampus, and temporal lobes are related to this disorder (Tsuang, Bar, Stone, & Faraone, 2004).
A number of studies have pointed that stress, either during pregnancy or at a later stage of growth, is the main environmental factor that contributes to schizophrenia (Lakhan & Vieira, 2009). High levels of stress are considered to trigger the development of schizophrenia because they increase the secretion of hormone cortisol in the body. Studies have identified a number of stress-inducing environmental factors that may contribute to the development of schizophrenia. Thus, some of these environmental factors include sexual or physical abuse in childhood, prenatal exposure to a viral infection, early parental separation or loss, low oxygen level during birth, and exposure to a virus during birth (Schultz, North, & Shields, 2007).
The Relationship between Biology and Environmental Factors in the Development of Schizophrenia
The development of schizophrenia is a dynamic process that occurs as a result of a constant interaction between environmental and genetic determinants. The combination of the two factors starts early, with a significant problem for psychopathology developing when genetic susceptibility interplays with severe biological effects of harmful environmental events in prenatal and perinatal period (Tsuang, Bar, Stone, & Faraone, 2004). Such etiology may lead to a number of outcomes, taking into account the severity of both environmental and genetic factors for a given disorder in addition to the absence or presence of other environmental and genetic ‘protective factors’, which might reduce the risk of ensuing psychopathology (Tsuang, Bar, Stone, & Faraone, 2004). In general, it is possible for the environmental factors to interact with the genetic liability in a negative way to produce schizophrenia. In other words, inherited genes make an individual vulnerable to schizophrenia and then environmental factors interact with this vulnerability to initiate the disorder.
There are four procedures that should be conducted to fully diagnose schizophrenia. They include full psychiatric assessment, physical exam, medical history, and laboratory tests (Schultz, North, & Shields, 2007). During the psychiatric evaluation, a psychiatrist or a doctor will ask a series of questions concerning the patient or first-degree relatives’ symptoms, family history of mental illnesses and psychiatric history. While taking medical history, the doctor will ask about patient’s personal and family health. Afterward, the doctor will conduct a complete physical examination to search for medical problems that may cause the problem. Although there are no laboratory tests that may diagnose schizophrenia, simple urine and blood test may exclude other medical causes of symptoms. The doctor may also consider ordering brain imaging studies such as a CT scan or an MRI so as to search for brain abnormalities connected with schizophrenia (Schultz, North, & Shields, 2007).
The following criteria are used by mental health professionals to diagnose schizophrenia: a) the existence of hallucinations, delusions, disorganized speech, disorganized or catatonic behavior and negative symptoms for at least one month; b) significant problems taking care of oneself, relating to other people, and functioning at school or work; c) continuous symptoms of schizophrenia for about half a year, with active symptoms for at least 30 days; and d) no substance abuse problem, medical issue, or another mental health disorder that is causing the symptoms (Lakhan & Vieira, 2009; Schultz, North, & Shields, 2007).
The most frequently prescribed drugs for the treatment of schizophrenia is the antipsychotic medications (Hasan et al., 2013). In fact, they control the symptoms of schizophrenia by affecting the brain neurotransmitters, namely serotonin and dopamine. Apparently, the second generation of antipsychotics (atypical antipsychotics) is more desirable because they have a lower risk of severe side effects as compared to typical antipsychotics. The examples of atypical antipsychotics include clozapine, aripiprazole, lloperidone, and quetiapine, among others. On the other hand, the examples of typical antipsychotics include perphenazine, haloperidol, fluphenazine, and chlorpromazine (Hasan et al., 2013).
Other treatments for schizophrenia include psychosocial therapy or interventions and electroconvulsive therapy (ECT) (Hasan et al., 2013). Talking about psychosocial interventions, they include individual psychotherapy, social skills training, family therapy, vocational rehabilitation, self-help groups, supported employment, and cognitive remediation. Although ECT is normally used for the treatment of severe depression, it can also be used to treat schizophrenia and other mental illnesses. ECT is a therapy in which an electric current is applied to the scalp for a short time while the patient is sleeping (Schultz, North, & Shields, 2007).
Short- and Long-Term Prognosis
Potential predicting factors of a short- and long-term prognosis of schizophrenia include premorbid functioning, mode of onset (MoO), and duration of untreated psychosis (DUP) (Kanahara et al., 2013). A shorter DUP seems to act as a critical predictor of a better outcome of schizophrenia even in a long-term prognosis.