Schizophrenia disorder

Introduction

Schizophrenia is a severe mental disorder that affects how a person thinks, perceives reality, acts and relate to others. In the United States, the disorder affects less than one percent of its population. People having schizophrenia have problems interacting with the society, in relationships, at school or even at work. The disorder is a long term ailment that cannot be cured but with proper treatment, it can be controlled. According to Bishay (2018), schizophrenia is a psychosis type of mental illness where the patient can hardly differentiate reality from what is imagined. The disorder that affects millions of people in the United States and the world in general. Unfortunately, Current research has not yet found treatment for the schizophrenia. Much research has been done regarding the symptoms and treatment of schizophrenia and this essay will emphasize on the symptoms, physiology and treatment of schizophrenia

Symptoms of schizophrenia

Symptoms for schizophrenia differ in different people. Researchers consider schizophrenia as a group of conditions rather than a single disorder that alter people experience reality, thoughts, perceptions, and behavior (Bishay, 2018). Schizophrenia symptoms are alienated into three main classifications that include; positive symptoms, negative symptoms, and cognitive systems.

Positive symptoms

Positive symptoms are characterized by delusions, hallucinations and racing thoughts. When hallucinations occur, the person with schizophrenia hears, feels, tastes or sees things that are inexistent or outside the mind. Hearing voices is the most common form of hallucinations. Things are precisely real for the person undergoing the hallucinations even though people cannot experience the sensations or hear them. According to Bishay (2018), individuals with schizophrenia show some alterations in the speech area of their brains when they are hearing voices. The experience of hearing voices is thus a real one and the brain is considered to mistake real voices with thoughts. However, some patients have described the sounds they hear as being pleasant and friendly but in most cases, the sounds are annoying, insulting, critical and rude. The voices might be talking straight to the person, give instructions, discourse the listener views and behavior or describe actions that are happening.

Delusions

A delusion is a conviction held with a comprehensive belief even though it is centered on the idealistic, strange or mistaken view. Delusion affects the way in which a person behaves and can change over weeks or months. People with schizophrenia can develop a delusion to elucidate the hallucination they are experiencing. For example, if a person is hearing sounds that are describing their activities, they might experience a delusion that someone is observing their activities. A person with a paranoid delusion believes that someone is persecuting or harassing them and feel like they are being plotted against, poisoned, watched or followed by a friend or a family friend. Other individuals with delusions might find diverse meanings in ordinary incidences. For example, they might be certain that people in the television or newspapers are talking to them alone.

Negative symptoms

Negative symptoms comprise of poor or nonexistent social functioning, apathy and lack of emotion. Someone with schizophrenia might experience lack of interest in things they used to or not even be capable to do them any longer. A good instance is the lack of awareness in hygiene and grooming. However, such symptoms are hard to spot particularly in teens since they experience very big emotional fluctuations between highs and lows. An individual with schizophrenia can appear very emotionless like they are having awful cases of blahs and might not talk or demonstrate any feelings. They also show withdrawal where they give flat answers and may seem uninterested to even make plans. In such a case, someone might work really hard to get an answer from the person (Muntean, 2018). People with schizophrenia might also have difficulties staying on a schedule or even finishing what they started. They struggle with the daily life basics like taking care of themselves or even bathing. Patients may show lack of interests and motivation in social activities like sex and relationships, change in sleep patterns and lack of concentration like spending the whole day inside the house and they are less likely to pledgee for a conversation and feel uncomfortable around other people (Muntean, 2018). The negative symptoms of schizophrenia can result in correlation problems between family and friends and at times this can be interpreted as rudeness or laziness.

Cognitive symptoms

These symptoms elaborate on how well the brain learns, stores and uses information. Cognitive symptoms include memory complications, difficulty completing tasks, difficulty concentrating or following instructions and disorganized thoughts. People having psychosis find trouble with keeping track of their thoughts and conversation. The patients also experience difficulty in concentrating or drifting from one idea to the other or even reading newspapers or watching television programs. They label their feelings as hazy or misty when this is happening and their opinions become disorderly or jumbled making it challenging to make a conversation and when they do, it becomes difficult for other people to understand.

Psychosis

Schizophrenia is referred to as a type of psychosis. However, the first phase of the psychosis is very difficult to cope with for the patient, family or even friends following the drastic changes in behavior. The person undergoing psychosis can become upset, anxious, confused, angry or suspicious of those around them and they don’t think like they need help and persuading them to visit a doctor is also a hard task.

The first step in getting the treatment for schizophrenia is getting a correct diagnosis. According to Muntean (2018), patients do a lot better when they are diagnosed and treated earlier. However, schizophrenia symptoms are likely to be mistaken for other disorders like bipolar disorder

Physiology of Schizophrenia

The physiology of schizophrenia is guiding research and generating new treatment possibilities for the condition. Many people do not experience the substantial recovery regardless of receiving their substantial recovery. This lies primarily to the reason that the traditional treatment is based on the positive symptoms rather than exploring to mend patients effectiveness and quality of life. Clinicians should, therefore, consider all factors like cognitive impairment (e.g. abnormal memory, executive function, and attention), negative symptoms (e.g. blunted effect, anhedonia, apathy, avolition, and alogia) and medical morbidities (e.g. inflammation and diabetes) (Oishi, 2017). Cognitive damage is a major factor of schizophrenia and is not secondary to psychotic signs. Clinicians should thus understand the functioning of schizophrenia to effectively evaluate and treat patients with schizophrenia.

Dopamine system.

Schizophrenia is a multifaceted disorder connected with both environmental and genetic factors. Following its multiple consequences, the treatment of the disorder should, therefore, be multilayered. All antipsychotics work by inhibiting the dopaminergic action in the brain. In his research, Oishi (2017) found that the drugs that are originally used to serendipitously lessen the psychotic symptoms also block the dopamine receptors. Historically, the composition of schizophrenia has engrossed on specific neurotransmitter schemes in the brain particularly the dopamine system. Research shows that patients having schizophrenia experience atypical dopaminergic systems in their brain which impacts on the effectiveness of antipsychotic drugs.

The positive signs of schizophrenia are effectively reduced by the antipsychotic largely because of the normalize dopamine hyperactivity.

The negative symptoms can bring side effects because the over activity of dopamine neurons in the mesolimbic dopamine trail can bring both cognitive and negative symptoms in schizophrenia. Negative symptoms have therefore been treated with adjunctive a2-adrenergic antagonists (Gillespie, 2017). However, no matter how the treatment for reducing both the positive and negative symptoms might be, patients with psychotic symptoms and treated with antipsychotics still undergo many other symptoms which limit their occupational and social success. According to Gillespie (2017), certain areas of physiologic abnormalities subsidize to dopamine abnormalities and take account of the acetylcholine, the serotonin, and the glutamate systems. These systems contribute to the negative systems and impairment of cognitive effectiveness which are the main contributors to poor functioning and poor quality of life in patients with schizophrenia.

Glutamate system

Glutamate receptors act as mediators between the excitatory synaptic transmissions in the central nervous system and thus controlling the process of the brain, peripheral nervous system, retina, and the spinal code. The two glutamate broad groups of receptors are ionotropic and metabotropic. For schizophrenia, therapies with metabotropic glutamate drugs have shown promising results. However, ionotropic glutamate receptors are less effective in reducing schizophrenia and include AMPA, kainite and NMDA receptors. In a recent research by Gillespie (2018), NMDA receptors in charge of regulating dopamine neurons show some relation to the functioning of schizophrenia. Hypofunction of the NMDA receptors can, therefore, lead to dopamine action and hence the symptoms of schizophrenia. For strong individuals, low dosages of NMDA receptor antagonist can lead to cognitive impairments and negative symptoms associated with schizophrenia and patients may exacerbate cognitive and psychotic symptoms. Research shows that agents that activate the NMDA receptor in the glycine modulatory reduce both the positive and negative symptoms while also improving cognition in schizophrenia patients. However, explicit genes like SAP97 and GRIN2B in the glutamate system are associated in the pathophysiology of schizophrenia and might be the vulnerability factors for specific subcategories of patients.

Serotonin system

Serotonin is also involved in the pathophysiology of psychosis. Dopamine is released in specific parts of the brain when 5-HT2A receptors are blocked while the combination of both D2 antagonism and 5-HT2A improves positive, negative and cognitive symptoms. As research shows, certain serotonin-related genes like 5-HTT and TPH1 variants increase an individual susceptibility to schizophrenia. Cognitive processes like sustained attention and executive function can also be linked to 5-HTT polymorphism. However, numerous genes are related to the physiology of schizophrenia but pharmacologic treatments targeting particular serotonin receptor subtypes can be established.

Acetylcholine system

Since all the Serotonergic, glutamatergic and dopaminergic are all involved in the physiology of schizophrenia, the structures can also be regulated by an a7-nicotinic acetylcholine receptor. A-7 nicotinic acetylcholine functions abnormally leading to hippocampal functions that impair cognition. Evidence shows that a7-nicotinic receptor agonists can reduce both the negative and cognitive symptoms in schizophrenia.

Physiologic abnormalities

Regardless of the brain dysfunction involved in the physiology of schizophrenia, the physiologic aberrations of the body can also compound to the ailment. According to Muntean (2018), schizophrenia patients are 2.5 times higher at risk of dying as compared to the over-all public. The amplified mortality is facilitated not only by the suicidal thoughts but also other factors like inflammation and diabetes. People with schizophrenia are highly vulnerable to diabetes while those with the preexisting condition experience some newer antipsychotics. In a study by Muntean (2018), antipsychotic naïve patients with non-affective psychosis were found to have abnormal glucose tolerance in that were attributed to age, smoking, aerobic conditioning, BMI, the neighborhood of residence, socioeconomic status, ethnicity, gender, and cortisol concentration. The studies also revealed that the increased vulnerability to diabetes and abnormal glucose tolerance by patients with schizophrenia impacts the patient’s families, substance abuse, independent access to health care and diet/self-care. Clinicians, therefore, should monitor recently diagnosed patients with no effective psychosis for diabetes. Increased inflammation also implicate the pathology of schizophrenia. However, COX-2 inhibitor and aspirin are used as add-on therapy to antipsychotics to reduce the schizophrenia symptoms. Since schizophrenia is a multisystem disease, increased inflammation is consistent.

Treatment of schizophrenia

Unfortunately, there is no known cure for schizophrenia since the causes of the disorder are not fully understood.  The disorder is typically treated with an independently tailored amalgamation of treatment and medication. According to a research done by Shangchao (2018), up to 3 in every 10 schizophrenia patients may have a long-lasting recovery while 20 % show significant improvement. However, the experience with schizophrenia is different with different people and a patient should seek the most appropriate medication depending on their condition. In according to Gureja (2018), the most effective treatment for schizophrenia patients is typically through amalgamation of physiological counseling, self-help means, and medication.

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 Majority of patients can now stay live in the community comfortably instead of hospitals. Majority of patients with schizophrenia are treated by Community mental health teams (CMHTs). CMHTs aims at providing day-to-day sustenance and treatment to the patients while guaranteeing they also partake as much freedom as possible (Gureja, 2018). CMHT comprises of psychologists and psychiatrists with the psychiatrist being the senior clinician, councilors and psychotherapists, pharmacists, occupational therapists, community and mental health nurses having specialist training in mental health conditions and social workers. The specialist teams are made up of support workers, social workers, mental health nurses, psychologists, and psychiatrists. Schizophrenia can, therefore, be handled through numerous methods that include:

Antipsychotics

Antipsychotics are primarily used as the preliminary conduct for indications of severe schizophrenic episodes and act by controlling the influence of dopamine substance in the brain. Antipsychotics decrease the feelings of aggression and nervousness a few hours after their use and takes much time to reduce other symptoms like delusional thoughts and hallucinations. Before a patients start taking the antipsychotics, a physical examination is essential (Shangchao, 2018). Antipsychotics can be taken orally as pills or through an injection known as depot are require the patient to have the injection every two to four weeks. Antipsychotics are only needed when the severe schizophrenic period has passed but most patients take the medications one or two years after their first episode has passed in order to thwart critical schizophrenic episodes from taking place. The two core types of antipsychotics are typical antipsychotics and atypical antipsychotics. Both can lead to negative side effects like muscle spasms, muscle twitches, trembling and shaking but the magnitude varies from person to person. Other associated symptoms include dry mouth, lack of sexual drive, constipation, blurred vision, weight pain, and drowsiness.

Care Programs Episodes (CPA)

People experiencing complex mental health conditions are enrolled to a program known as care program approach.  The CPA program ensures that the patient receive the right treatment he or she needs and comprises of four stages that include; assessment, care plan, key worker appointed and reviews (Shangchao, 2018). The program first assess the social needs of the patient and thereafter develop a plan that meets the patient health and social needs. A key worker is the assigned to the patient usually a nurse or a social worker and the final step is reviews of the patient progress. However, not all patients with schizophrenia uses the CPA program and some may be favored by specialists or their GP (Wang, 2017). However, this program involves combined healthy eating and physical activity program and the coordinator ensures all affiliates of the healthcare crew have a copy of the progress.

Psychological treatment

The psychological treatment aids schizophrenia patients to cope with symptoms of delusions and hallucinations better. The treatment can aid the patient to reduce the negative symptoms of schizophrenia like absence of pleasure and apathy. However, the program work best when combined with antipsychotic treatment. Communal psychological treatments include arts therapy, family therapy and cognitive behavioral therapy.

In cognitive behavioral therapy, the patients thinking patterns that cause the patient the unwanted feelings and behaviors are identified. The patient is then equipped with knowledge on how to control this thoughtful feelings with a more convincing and beneficial thoughts (Wang, 2017). This is accomplished by training the patient to recognize examples of delusional thoughts and how to avoid them. On the other hand, most patients with schizophrenia depend on on their family supporters for sustenance and care. However, while family is willing to support, handling patients with schizophrenia can place anxiety to the family and family therapy can significantly help the patient together with his or her family to cope up with the disorder. Family therapy comprises of a sequence of casual meetings for a period of more than six months to discuss information about schizophrenia, explore ways to support the person suffering from the illness and determining on how to resolve the problems initiated by the symptoms of schizophrenia (Wang, 2017). Finally, arts therapies are created to indorse creative expression and the group allows the patient to share his/her experiences with schizophrenia. Arts therapy have proved to be effective in alleviating the negative symptoms of schizophrenia since some patients can express things in a non-verbal way. This aids patients with schizophrenia to develop new ways of relating to others.

Conclusion

Overall, it’s clear that the disorder impacts negatively the daily life of individuals. People with schizophrenia might experience positive, negative of cognitive symptoms. Positive symptoms are the most common like hallucinations and delusions. Other symptoms include social withdrawal, loss of interest in hygiene, loss of appetite, loss of speech and a sense that the patients are being controlled by the outside forces. The negative symptoms of schizophrenia can completely ruin relationships. Currently, research on the physiology of schizophrenia is done past the dopamine classification. Acetylcholine, serotonin, and glutamate systems are all involved in causing schizophrenia. Furthermore, other abnormalities outside the brain like inflammation and diabetes facilitate the etiology of the disorder. Although the cure for the disorder has not been found yet, there are numerous treatment medications that can aid to reduce the effects brought by schizophrenia. The use of antipsychotics, care program episodes and psychological treatment all aid to control the symptoms of schizophrenia.

References

Bishay, M., Palasek, P., Priebe, S., & Patras, I. (2018). SchiNet: Automatic Estimation of Symptoms of Schizophrenia from Facial Behaviour Analysis. Retrieved from http://165.193.178.96/login?url=http%3a%2f%2fsearch.ebscohost.com%2flogin.aspx%3fdirect%3dtrue%26db%3dedsarx%26AN%3dedsarx.1808.02531%26site%3deds-live

Gillespie, A. L., Samanaite, R., Mill, J., Egerton, A., & MacCabe, J. H. (2017). Is treatment-resistant schizophrenia categorically distinct from treatment-responsive schizophrenia? a systematic review. BMC Psychiatry, 17, 1–14. https://doi.org/10.1186/s12888-016-1177-y

Gureja, G. K. (2013). Organisational Schizophrenia : Impact on Customer Service Quality. New Delhi: Sage Publications Pvt. Ltd. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=1194673&site=ehost-live

Muntean, M., Marinescu, I., Marinescu, D., Hogea, L., Suru, C., & Enătescu, V.-R. (2018). Difficulties in functional recovery in schizophrenia: negative and cognitive symptoms. Psihiatru.Ro, 54(3), 30–38. Retrieved from http://165.193.178.96/login?url=http%3a%2f%2fsearch.ebscohost.com%2flogin.aspx%3fdirect%3dtrue%26db%3daph%26AN%3d132533643%26site%3deds-live

Oishi, K., Kanahara, N., Takase, M., Oda, Y., Nakata, Y., Niitsu, T., … Iyo, M. (2018).

Shangchao Zhang, Na Zhou, Rui Liu, Wenwang Rao, Mingjia Yang, Bonan Cao, … Qiong Yu. (2018). Association Between Polymorphisms of the Complement 3 Gene and Schizophrenia in a Han Chinese Population. Cellular Physiology and Biochemistry, Vol 46, Iss 6, Pp 2480-2486 (2018), (6), 2480. https://doi.org/10.1159/000489654

Wang, S., Zhan, Y., Zhang, Y., Lv, L., Wu, R., Zhao, J., & Guo, W. (2017). Abnormal functional connectivity strength in patients with adolescent-onset schizophrenia: a resting-state fMRI study. European Child & Adolescent Psychiatry, 26(7), 839–845. https://doi.org/10.1007/s00787-017-0958-2