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Schizophrenia
Introduction
As a debilitating mental illness, schizophrenia affects an estimated one percent of the world’s population, as previous studies show. Although it affects equal numbers of men and women, the onset is often later in women than in men. Over the years, the disorder has caused a vast and intricate body of literature. The article analyses existing literature on schizophrenia, including the pathophysiology, medical treatment, nursing intervention, and recommendation of the illness. The global load of schizophrenia is enormous. It is therefore crucial that any intervention is apt, cost-effective, and efficient.
Literature Review
Schizophrenia is fundamentally a self-disorder that is characterized by complementary distortions of the act of awareness: hyper-reflexivity and reduced self-affection. Hyper-reflexivity is a type of exaggerated self-consciousness whereby an individual regards himself as an external object. Diminished self-affection is a weakened sense of existence as a source of awareness. Schizophrenia involves extreme changes of the self. One’s ego undergoes modifications, such as splitting of the self, inactivity, or the capacity to direct thoughts. Even though self-disorders are recognized, they are rarely thought as playing a central role. Time and again, self-disorders have been deemed to be on the same level with other features of the diverse illness, such as the numerous anomalies of thought, perception, and belief.
Pathophysiology
The regions of interest in schizophrenic patients include the temporal cortex, the striatum, the frontal cortex, and the thalamus. Schizophrenia increases the cerebrospinal fluid and decreases the volume of the temporal cortex. Patients and relatives of patients with schizophrenia have often reported a decrease in the medial temporal region, together with the amygdala and the hippocampal complex. The thalamus functions as a crucial node link that incorporates diverse brain circuits. As part of the circulatory, it plays a significant function in the pathophysiology of schizophrenia. The nuclei that have somewhat different connectivity patterns to the brain regions decrease in patients with schizophrenia. Dopamine acts as a crucial neurotransmitter in the striatum and the cortex. When subjected to altered dopaminergic activity, any variations in striatal volume may reflect dopaminergic activity.
Symptoms
Schizophrenia causes distorted thoughts, perceptions, emotions, perceptions, and behavior. Considered a syndrome or disease process with varied symptoms, most individuals diagnosed with schizophrenia are in their early childhood or late adolescence, or an onset 15 to 35 years. Schizophrenia symptoms are categorized into two: positive symptoms and negative symptoms. Positive symptoms include paranoid delusions, hallucinations, grossly disorganized thinking, as well as voices that speak with the patient. Negative symptoms include social withdrawal, loss of will, and flattened effect. Since the symptoms affect both the patient and his family, it is essential for physicians to offer guidance and counseling to all individuals affected by the disease. While medications can manage the symptoms, naturally all antipsychotics have physical and neurological side effects, such as weight gain and diabetes.
Prevalence
The occurrence of schizophrenia depends on various aspects, including the availability of treatment and response to medication. As with other mental disorders, the frequency of schizophrenia can be calculated from various sources such as case registers and field surveys. Researchers Saha, Chant, and McGrath differentiate between traditional prevalence studies and studies in specific sub-groups. Traditional prevalence studies reveal an estimate derived from the population existing within a distinct catchment area. Specific sub-group studies, conversely, consist of migrant studies and studies in other special groups.
Using all-inclusive case ascertainment methods, Saha and colleagues conducted 132 primary studies. The findings of the study revealed that there were no noteworthy variations between urban, rural, and mixed sites, or males and females. As expected, developing countries registered lower prevalence rates while migrants registered higher rates of schizophrenia. Several important findings emerge from the analysis. Firstly, the finding is essential for clinicians as it reveals a lifetime frequency of 4 in 1000, rather than the previously documented one percent. Secondly, the length of the prodrome of the illness will affect the new number of cases appearing in the population, and longer delays of the treatment will affect the rates.
An important question raised by the researchers is whether the cases counted as positive included patients with positive and negative symptoms, those with underlying cognitive deficits, and those whose disease was treatment resistant. A crucial point to consider is how the outcome of schizophrenia seems to be lower in developing countries than in developed countries. Despite the apparent differences in the progression of schizophrenia in some cultures, cross-cultural research in psychiatry emphasizes on similarities rather than differences. While prevalence studies may help further the understanding the etiology of schizophrenia, psychodynamic matters such as cultural identity or attachment should also be studied. The study should be carried out particularly among migrant groups, since ethnic density and cultural congruity may affect the introduction of ailing individuals to psychiatric services.
Treatment
Treating schizophrenia entails meeting the physical and psychological needs of the patient. Treatment consists of drug therapy, psychotherapy, vocational counseling, as well as the utilization of community resources. Antipsychotic drugs are the primary treatment for schizophrenia and work by jamming postsynaptic dopamine receptors. They also reduce the occurrence of psychotic symptoms like hallucinations and delusions. Likewise, they relieve anxiety and agitation.
Some negative effects of antipsychotic drugs trigger adverse reactions that may be irreversible. Patients may develop withdrawal behaviors, or become isolated and apathetic during drug the process of treatment by drugs. Fluphenazine and haloperidol are high-potency antipsychotic drugs, while chlorpromazine and thioridazine are low-potency antipsychotic drugs. Patients who fail to respond to standard treatment are prescribed clozapine, a chemically different antipsychotic drug that effectively regulate a wider range of symptoms without the typical adverse effects. However, clozapine causes drowsiness, excessive salivation, dizziness, sedation, and seizures. Routine blood monitoring is necessary for detecting agranulocytosis, a condition that affects an estimated two percent of all schizophrenic patients taking clozapine.
Intervention and Recommendation
Schizophrenic patients have an estimated twenty percent shorter life expectancy than non-schizophrenic individuals do. Additionally, they are more vulnerable to illnesses such as diabetes, hypertension, and coronary heart disease. One of the reasons behind their susceptibility to illnesses includes the lifestyles of individuals suffering from severe mental illnesses. Poor dietary habits, use of alcohol, drugs, and smoking, and obesity are associated with people suffering from serious mental illnesses. Some antipsychotic medications results in weight gain, development of cataracts, sexual dysfunction, and movement disorders, which contribute to increased vulnerability of patients to illnesses.
Mental health providers typically monitor the body mass index of every patient diagnosed with schizophrenia irrespective of the antipsychotic drug prescribed. As a result, clinics that offer treatment for schizophrenic patients should have equipment for weighing and tracking weight for patients during their regular visit. Secondly, for patients who register a body mass index of 25 or higher, drug selection must be considered to avoid excessive weight gain.
Any weight gain of at least one body mass index unit means that there is an immediate need for intervention, unless the patient has a BMI of less than 18.5 units. Additionally, men who register a waist circumference of 40 inches or more and women who register 35 inches or more need immediate intervention. Intervention may include engagement in weight management programs, keener monitoring of weight, or a change of the patient’s antipsychotic medication. Mental healthcare providers may switch to medications that are less likely to cause weight gain.
There are also various risk factors associated with diabetes for schizophrenic patients. Before starting any antipsychotic drugs, healthcare providers should collect a baseline measure of glucose levels of schizophrenic patients. Patients with a family history of diabetes or BMI of 25 or more should have their glucose levels checked four months after starting antipsychotic drugs, and then yearly. On the other hand, patients who continually gain weight should have their glucose levels checked every four months.
Hyperlipidemia may result from the use of certain antipsychotic drugs. Healthcare providers should thus obtain and review a lipid panel for the patient. The lipid panel consists of measurement of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, total cholesterol, and triglyceride levels. If the LDL level exceeds the normal level, the patient must be referred to a primary care provider or take measures to reduce fat intake in everyday diet. In extreme cases, a cholesterol-lowering drug may be necessary.
Sexual dysfunction in men and menstrual irregularities in women are common in schizophrenia patients. The cause behind sexual side effects and menstrual irregularities is an increase in plasma prolactin levels. Health providers should therefore monitor any issues with libido, erectile, or ejaculatory functions for male patients or changes in menstruation and libido for female patients. If there are changes, the patient’s prolactin level should be measured. Increased plasma prolactin levels should trigger a workup to highlight the cause of the upsurge.
Summary and Conclusion
As a self-disorder, schizophrenia is characterized by distortions of the act of awareness. The illness causes distortions in perception, thought, emotions, perceptions, and behavior. Previously conducted studies reveal a one percent prevalence of schizophrenia in the world’s population. However, more recent studies conducted by researchers Saha, Chant, and McGrath show conflicting data. 132 primary studies conducted by Saha and colleagues reveal new information on prevalence of schizophrenia. The findings challenge the previously acclaimed one-in-one thousand prevalence of the illness. Apart from that, developing countries registered lower prevalence rates while migrants registered higher rates of schizophrenia. Although the study may help further the understanding the etiology of schizophrenia, psychodynamic matters such as cultural identity or attachment should also be studied. Although the data in the literature reviews may be unstable, more studies that are pragmatic need to be done to settle the arguments that surface from the prevalence of schizophrenia.
Considered a varied disease process, schizophrenia symptoms are categorized into two: positive symptoms and negative symptoms, all of which can be managed by antipsychotic drugs. The drugs, however, have severe physical and neurological side effects and healthcare providers need to intervene and recommend alternative medications or combination of therapy. Individuals diagnosed with schizophrenia have an estimated twenty percent shorter life expectancy than healthy individuals. Additionally, they are more susceptible to illnesses such as diabetes, hypertension, and coronary heart disease. Mental health providers should collaborate with primary care providers to monitor the patient’s overall health and lifestyle.
