In the course of medical history, the association between physical and mental health remains a magnet for research. At the core of this interest is the essential role that mental health plays in promoting the physical well-being of individuals. According to the World Health Organization (WHO), mental health is a state of wellbeing in which individuals are capable of coping with life stress and asserting themselves as productive members of a particular community (Nordqvist, 2017). In essence, an individual lacking this psychological wellbeing characterized by emotional, behavioral, or social normality perceivably has a mental disorder. Cockerham (2016) estimates that mental ailment constitutes about 10% of all diseases incidences globally. More so, assessments indicate that one in every four people is likely to suffer from a mental condition in their lifetime (Cockerham, 2016). These facts show that mental disorders are a significant challenge to sustainable global health. The most prevalent mental disorders include schizophrenia, dementia, epilepsy, depression, and bipolar disorders (Worku & Shiferaw, 2014). This essay provides an in-depth analysis of the symptoms, prevalence, etiology, prognosis, and treatment of schizophrenia. It also offers a differential diagnosis between schizophrenia and Autism Spectrum Disorder. Schizophrenia poses a major threat to the physical and mental wellbeing of individuals across the world.
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Schizophrenia is one of the most chronic mental disorder attributed to impaired functionality in work, self-care, and in interpersonal relations. Rosenberg (2012) observes that as a persistent and often chronic disorder, schizophrenia affects behavior, thinking, and emotions of an individual. Symptoms of the disorder include positive and negative psychosis as well as cognitive effects. Positive symptoms begin at young adult years and include delusional thoughts, hallucinations, and disorganized thoughts (Khan, Montanez, and Muly, 2013). Hallucinations refer to disturbances in sensory perception such as visual or auditory where one sees or hears things not perceived by others (Khan et al, 2013). Delusions such as paranoia may include a false personal belief not subject to reason or contrary to evidence leading to made-up beliefs like persecution, cheating, poisoning, or harassment (Khan et al, 2015). Negative symptoms can be understood as a reduction of what is usually commonly present in an individual. The symptoms include monotony in voice, immobility in facial expressions, lack of pressure, reduced quantity and quality of speech (Khan et al, 2013). Henceforth, a patient may appear as lazy and introverted. Lastly, cognitive damage affects memory and execution of functions leading to the failure to achieve expected personal, academic, or career goals (Rosenberg, 2012). As a result, people with schizophrenia may have a lower quality of life compared to the general population.
Statistics reveal that schizophrenia constitutes a major disease burden across the globe. Schizophrenia ranks in the WHO assessment as the tenth most prevalent non-fatal disease in the world (Sie, 2011). According to the WHO, the disorder causes 1.1 percent of all total disability-adjusted life years and accounts for 2.8 percent of disability life years (Altamura et al., 2014). Barrow (2016) puts the number of schizophrenia patients in the world at 24 million. Global epidemiologic studies show that the disease incidence varies from between 0.11 to 0.69 per 1,000 while prevalence ranges from 0.6 to .08 percent (Altamura et al., 2014). Importantly, 98% of all reported schizophrenia cases affect individuals below the age of 40 (Altamura et al., 2014). Thus, statistically the risk of getting schizophrenia declines as an individual ages beyond forty years. For example, in Europe estimates indicate that over 5 million people suffer from schizophrenia while 1.5% to 3% of the all health expenditure in developed countries healthcare goes to manage the disease (Altamura et al., 2014). Accordingly, the prevalence has a global reach that transcends the economic status of a country.
Schizophrenia effects cuts across demographic divides. The disease is predominant in early adulthood. Sie (2011) observes the average commencement age for the ailments in men is 18 years and 25 for women. The ailment onset appears early in men compared to women and their symptoms are negative with worse outcomes and limited chances of recovery (Picchioni & Murray, 2007). More so, studies reveal that the disorder rates are higher among people born in cities with risk increasing based on how long one dwells in an urban environment (Picchioni & Murray, 2007). One study conducted in the UK disclosed that the disease affects more immigrants especially African-Caribbean individuals (Picchioni & Murray, 2007). These facts reveal that though the illness is common among young people, it affects people across gender, race, and social status.
The cause and risk factors of schizophrenia range from biological, psychosocial, cultural to the environment. Firstly, research suggests a genetic cause to the ailment though there is no attribution to a single gene Sie (2011). Therefore, facility history may explain transmission. Secondly, individuals experiencing excess complications in fetal life and at birth have a high tendency of developing the disorder (Khan et al, 2015). These incidences may link to complicated pregnancies, abnormality in fetal growth, or challenges during delivery. Research also shows a high predominance of babies born in winter and spring to get schizophrenia due to maternal respiratory infections or malnutrition (Khan et al, 2015). Thus, risk factors can predate birth. Secondly, old men with schizotypal personality are likely to father children with schizophrenia (Khan et al, 2015). Thirdly, schizophrenia is more common in urban poor localities (Khan et al, 2015). Fourthly, there is a high incidence for the sickness among migrants non-white groups (Khan et al, 2015). Both the urban poor and migrant incidences may relate to lack of social support and discrimination that intensify vulnerability to the disease. Fifthly, evidence shows that persistent abuse of amphetamine, cannabis, cocaine, and methamphetamine can induce paranoid schizophrenia (Khan et al, 2015). The delusion and hallucination effect the drugs cause may explain the association with the disorder. Sixth, psychosocial adversities like physical and sexual abuse, bullying, and harassment increase risk of suffering schizophrenia later in life (Khan et al, 2015). Arguably, the genetic predisposition of schizophrenia may increase exposure to these social adversities.
The disorder course has three stages namely premorbid, prodromic, and florid. The premorbid stage describes the period where a patient demonstrates relative normality before the onset of psychotic symptoms (Altamura et al., 2014). Indicators at this level may only include anxiety and depression (Altamura et al., 2014). Hence, it may be problematic to distinguish the signs from other syndromes to allow for early treatment. Premorbid affects 75% of patients, lasts for up to 5 years and results in psychosocial deficits (Altamura et al., 2014). Prodromic phase is identified by deteriorating global functioning as well as the emergence of psychosis. Symptoms include a reduction in functionality, concentration, and motivation as well as insomnia (Sie, 2011). One is likely to suffer severe long-term positive and negative symptoms if the diagnosis and treatment for the first episode are not timely (Sie, 2011). Thus, these two phases occur before the onset of the first episode of schizophrenia psychosis.
Lastly, florid phase describes the emergence of the distinctive symptoms for the disorder. The phase between prodromic and florid lasts for about one year (Altamura et al., 2014). Prolonged duration of untreated psychosis (DUP) may lead to delayed remission, long hospitalization, recurrences, depression, suicides, and delinquency (Altamura et al., 2014). Consequently, intervention at the first stage of the illness may reduce DUP. Prognosis studies illustrate that 80 percent of patients who experience their first episode of psychosis will recover whereas recurrence is less than 20%. Thus, schizophrenia has a positive prognosis.
There are varied methods of treating and managing schizophrenia. The two main methods of treating the disorder are antipsychotic medicine psychological. The first generation of treatments in the 1950s relied on antipsychotic drugs that worked by blocking the D2 dopamine receptors (Khan et al, 2013). These first-generation antipsychotics drugs such as haloperidol and chlorpromazine are effective against positive psychosis but have no effect on negative psychosis and cognitive impairment (Khan et al, 2013). Moreover, they have neurological side effects. The existence of the side effects contributed to the development of second-generation antipsychotics. The second generations antipsychotic include clozapine, risperidone, amisulpride, and aripiprazole all with the same efficacy as their predecessors (Khan et al, 2013). Majority of them act on more receptors such as serotonin and cholinergic (Khan et al, 2013). The new generation of antipsychotics is inspired by lack of drugs that are valuable for negative and cognitive symptoms. These new drugs such as xanomeline targets non-dopamine neurotransmitter systems (Khan et al, 2013). Consequently, the evolution of schizophrenia drugs resulted from the need to act beyond the dopamine system while overcoming variation in symptoms.
Several psychological treatments help manage symptoms, improve functioning and prevent psychosis relapse in schizophrenia patients. Firstly, empirical review demonstrates that cognitive behavior therapy can reduce the persistence of the ailment. Medical guidelines recommend about 10 therapy sessions over a period of three months (Picchioni & Murray, 2007). Secondly, family therapy can also support patients and their caregivers. Family therapy enhances communication with family members while reducing distress and symptoms (Picchioni & Murray, 2007). Finally, reviews allude to the benefits of psycho-education reducing relapse and readmission (Picchioni & Murray, 2007). Though the methods require a trained therapist, they can help bolster the outcomes of drug treatment.
Autism Spectrum Disorder (ASD) can be considered in the differential diagnosis of schizophrenia. Kokurcan and Atbasoglu (2016) maintain that mild autistic disorder if not diagnosed at childhood can appear as psychiatric syndromes such as mood and psychosis during adulthood. For that reason, behavioral symptoms can be a manifestation of ASD rather than psychosis disorders. Symptoms shared by schizophrenia and ASD include disorganization, excitation, and social adaptation challenge (Kokurcan & Atbasoglu, 2016). More so, the two conditions share a commonality in inadequate social interactions and communication (Kokurcan & Atbasoglu, 2016). Social withdraw due to discrimination can also be common between the two. While disorganization in schizophrenia has a more constant course in most behaviors, it does not depict a ritualistic pattern in the case of ASD (Kokurcan & Atbasoglu, 2016). Individuals who show special interest in a specific issue and know everything about it may have ASD rather than psychotic disorder (Kokurcan & Atbasoglu, 2016). Moreover, ASD patients show social communication difficulty with low anxiety while schizophrenic people have paranoid delusions and high social anxiety (Kokurcan & Atbasoglu, 2016). Consequently, it is essential to evaluate behavioral attributes to differentiate between the two disorders to avoid comorbid diagnosis.
In summary, it emerges that schizophrenia is a major threat to the mental health in the society. Individuals suffering from the disorder are likely to be dysfunctional and unproductive in their personal and social life due to the psychosis symptoms. The prevalence of the disease reveals that the disease is not only common globally but also affects people across age, gender, and race. However, the incidences display the need to reduce the risk factors among men, youth, and poor non-Caucasian urban dwellers. Based on the etiology, it is hard to prevent genetic schizophrenia but proper management of pregnancies and delivery can reduce the early life disorder. Besides, offering social support for marginalized groups and controlling social factors like drug and physical abuse may prevent the illness. Prognosis shows that intervention to prevent prolonged duration of untreated psychosis may reduce chronic cases of admission, recurrence, or relapses. Although past treatment relied on antipsychotic drugs working on the dopamine system, current medicine targets more neurotransmitters. Increasingly, modern drugs must not only reduce side effects but also work on negative and cognitive symptoms. Moreover, psychological methods such as therapies can better alleviate the suffering of patients and their families during medication. Progressively, misdiagnosis of schizophrenia can be avoided through differential diagnosis of related diseases such as Autism Spectrum Disorder.
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Schizophrenia Disorder. (2019, Jul 31).
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