Schizophrenia Definition Essay
The scientists all over the world have studied psychological disorders, since the humanity must be able to identify and explain the abnormal behavior and consequently help those who have it. In the ancient times, people with deviant actions were exposed to various “treating” methods, primarily aimed at exorcising the demons. Only in the 18th century, the problem was first classified as a mental illness. Nowadays, the healthcare specialists have created a reliable system that helps to classify and represent a wide range of psychological disorders. The system is known as the Diagnostic and Statistical Manual of Mental Disorders (DSM). Anxiety disorders, eating disorders, schizophrenia, sexual or gender identity disorders and many other mental abnormalities are included in the abovementioned specification. This research paper is to concentrate attention on schizophrenia as one of the existing psychological troubles.
Schizophrenia is a psychological disorder, which affects the ability of the individual to express oneself intelligibly, show positive emotions, build close contacts, and make plans for the future. Nearly 1% of the population suffers from the disease (Ray, 2014, p.208). This psychopathology affects more men than women and first appears in patients’ late teens. Schizophrenia is observed in people living in different parts of the world. The symptoms of this illness may vary in different patients. Some individuals can hear voices or have surreal thoughts while the others see non-existed images, expect the harm from anybody, or experience a low mood. On some occasions, the affected patients may spend much time sitting quietly, without making any sound. In other cases, they may seem quite adequate, until they begin to explain what they really think. Many experts define the disease as a thought disorder, whereby the abnormal functioning of the brain of the injured person has an impact on his or her way of thinking. In other words, the messaging system between the nerve cells in the brain of a person who has schizophrenia, does not work in the right way. Schizophrenia is one of the heaviest chronic and brain disabling disorders. It is ranked third among the most disenabling conditions after dementia and quadriplegia. The danger of schizophrenia is not exaggerated, since depression and thoughts of suicide may be the constant followers of the affected patient. Additionally to the studying of the features and peculiarities of this disorder, the reader might be interested in learning about the origin of the word ‘schizophrenia’. Thus, the above term comes from the Greek words skhizein and Phrenos (phren), which mean ‘to split’ and ‘heart, mind,’ respectively (Nordqvist, 2014). For the first time, the name of the disease was coined in 1910 by the Swiss psychiatrist Eugen Bleuler in his speech in Berlin (Nordqvist, 2014). Despite the fact that the term ‘schizophrenia’ is known only about a hundred years, the malady itself is believed to have accompanied humanity through its history. Thought disturbances along with dementia and depression that are typical symptoms of schizophrenia were mentioned yet in written documents of the old Pharaonic Egypt. Roman and Greek sources indicated the presence of psychotic disorders in those times, as well. However, earlier, there had been no classification how to determine the disease. Physical deformities, mental illness or mental retardation were usually taken as abnormalities and expected the same treatment. Back then, therapy included different approaches, ranging from harmless to dangerous ones. With the lapse of time, mankind made progressive steps in getting the treatment methods and classifying the mental anomalies, taking into considerations to their symptoms and signs. Emile Kraepelin, a German physician, classified brain disorders into different categories, as one of the first. He named the disability, known nowadays as schizophrenia, dementia praecox or early dementia, herewith distinguishing it from other dementia forms that occur in late years of life (Ray, 2014, p.212). Notwithstanding, Bleuler, as it was mentioned earlier in this paper, changed the name of the disorder to schizophrenia, since Kraepelin’s term conflicted with some characteristics of the latter. In contradiction with dementia, schizophrenia does not always lead to mental deterioration and can occur at different ages. Since the times of Bleuler’s studies on schizophrenia, the definition of it has proceeded to change. In schizophrenia, many illnesses may masquerade as one and occur together. The stated fact makes the scientists ground their classifications with the regard on it. Both Kraepelin and Bleuler made their contributions to subdividing schizophrenia into categories. Over time, in DSM-III, as well as in DSM-IV, the experts detached catatonic, disorganized, residual, paranoid, and undifferentiated types of the discussed disease. However, the classification turned out to be not considerably helpful in diagnostics; furthermore, it expressed uncertain treatment prognoses, poor validity, and low reliability. Hereupon, in 2013, the American Psychiatric Association (APA) approved the removal of schizophrenia subtypes from DSM-V. The main accent in diagnosing schizophrenia is, contrariwise, made on distinguishing the domination of positive or negative symptoms, illness progression in terms of severity of symptoms during a long period of time, and the simultaneous occurrence of other mental syndromes. Additionally, DSM-V offers to identify a person as schizophrenic if he or she has at least two of the following symptoms: delusions, hallucinations, and disorganized speech, disorganized or catatonic behavior, and negative symptoms (Ray, 2014, p.215).
It stands for reason that the complexity of diagnosing and treating schizophrenia makes the scientists explore the phenomenon more thoroughly. Many surveys are being conducted in order to improve therapies for this psychopathology. Undoubtedly, the objective cannot be achieved without a profound studying of causes and principles that promote the disorder’s development. Exact reasons of schizophrenia still remain unknown, but many investigations indicate that there is a combination of genetic, physical, environmental and psychological factors as possible provokers for developing the condition. The current belief is that if some people are predisposed to the illness, stress or upsetting event may trigger a schizophrenic episode. This theory, as well as the other ones, requires scientific confirmation. Therefore, the men of science use different tools of modern biomedical research to seek for critical moments in brain development, genes, and other elements that may lead to the dysfunction. Some researches that were used in treatment concepts will be exemplified to some extent further in this paper.
Scientific models on schizophrenia’s etiology range dependently on the disorder’s provoking factors. Biological and sociological theories of psychosis can be identified through the features of contributors. Genetic, developmental, biochemical, environmental and psychological models of these theories are usually applied while investigating the causes of the illness. All listed components will be discussed in this paper in detail.
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One of the commonly known facts in schizophrenia study is that a vulnerability to the disease can be inherited (Walker, Kestler, Bollini, &Hochman, 2004, p.407). Many genetic studies indicate on increasing risks of the illness in people who have a biological relatedness to a schizophrenic. A monozygotic twin of a person with schizophrenia has the highest risk — a 40% to 50% chance of developing the illness (Tamminga, & Medoff, 2000). The lifetime risk for schizophrenia reduces if genetic closeness between relatives and patients becomes more distant. Investigators have found that no single gene is responsible for predisposition to schizophrenia. Instead, it is believed that several genes produce gene mutations and presumably break the brain development. However, genes are not the only developers of schizophrenia. Scientists emphasize that the interactions between the environment and genes may favor the development of the disorder. Drugs and marijuana use, traumas, viruses or stresses have been suggested as environmental risks for the pathology (Tamminga, & Medoff, 2000). Thus, infectious agent (virus) while affecting the individual genetically prone to the pathology may cause schizophrenia. The suggestion is sufficiently convincing, since viruses have an evident influence onto the brain. Recent studies have shown a correlation between the development of the debated disorder and herpes or cytomegalovirus infection. Thus, after catching these viruses, a patient with a particular set of genes will be more likely to become a schizophrenic. Stressful situations hold the significant place in the environmental theory’s list of schizophrenia provokers. According to Walker et al., “several lines of research provide support for the hypothesis that stresses can worsen the course of schizophrenia” (2004, p. 414). It is proved that the patients are more likely to relapse when experiencing negative attitudes from family members. It can be explained by activation of hypothalamic-pituitary-adrenal (HPA) axis in the brain as a response to stress. This process can lead to the growth of cortisol in the blood. As a consequence, “structural brain changes can occur when stress hormones are chronically elevated” (Walker et al., 2004, p. 414). Developmental theory of schizophrenia is based on the early disruptions, which cause the disorganization of the brain. In other words, it may be such a disorder when neurons form false connections during the fetal’s development of the brain. An error in genetic encoding, season of birth, a nutritional stress, prenatal complications or stressful events during pregnancy might be the reasons for schizophrenia to occur on a non-genetic basis. However, the developmental theory has not enough evidence that changes in the brain of adults are generated by the elements that developmental theory predicts. Biochemical model is based on the conviction that schizophrenia may be a result of an abnormality in neurotransmission. About fifty years ago, it was found “that antipsychotic drugs block dopamine receptors in brain and thereby reduce psychotic symptoms. It was strongly supported that an overactive dopaminergic system causes schizophrenia” (Tamminga, & Medoff, 2000). However, overabundance of dopamine should not be taken as a complete explanation for this disorder. Some facts evidence against dopamine theory. For example, the effects of the dopamine obstructers may act with the other systems, which induce schizophrenic symptoms more dramatically. Glutamate is presently known as another neurotransmitter that causes psychosis resembling schizophrenia. This fact argues that the disease can be explained not only in terms of dopamine function, but also involves other neurotransmitters. Psychological theory includes three approaches for understanding schizophrenia: psychodynamic, cognitive, and socio-cultural. The psychodynamic approach suggests that most schizophrenics experienced very strict childhood environments, often having careless and unsupportive parents. According to this explanation, abnormality takes place if one comes under regression in psychosexual development, what is caused by the conflict of ego, id, and superego. The situation, as follows, may lead to losing touch with reality and demonstrate symptoms of schizophrenia. Socio-cultural explanations are based on patient’s life events and interpersonal communication within families. According to the cognitive approach, psychosis patients show deficits in all domains of cognitive functioning (Walker et al., 2004, p. 405). It is believed that people prone to schizophrenia have the lack of self-monitoring, and consequently they look for external sources embodied through hallucinations or delusions. The breakdown between perception and memory is another peculiarity of schizophrenics. Impaired insight is also an “important feature of schizophrenia occurring in 50%–80% of schizophrenia patients” (Meer, Vos, Stieckema, Pijnenborg, van Tol, Nolen, David, & Aleman, 2013). It is believed that impaired insight may be caused by an inability of the individual to self-reflect. Self-reflection is the ability to represent traits and attitudes after deciding whether the currently accepted norms are applicable to the self. Recent researches point onto the correlation between the cognitive defects (impaired insight) and cerebral functioning. In other words, there is “a relationship between impaired insight and smaller brain volumes in medial, lateral, and orbitofrontal cortex and temporal and parietal areas” (Meer et al., 2013). In their study, Meer and colleagues provide evidence of the relation of self-reflective processing to the level of insight. It will be emphasized in the following discussion that this discovery and others may help find new treatment ways for schizophrenia.
Unfortunately, schizophrenics do not experience a complete regression of the disorder’s symptoms. Treatment of schizophrenia is one of the large-scale challenges in modern medicine because of its severity and chronic manner. The other factor explaining the difficulty is that the treatment requires valid integration of psychological, biological and environmental perspectives. The clinicians should consider and assimilate these aspects in planning treatment strategies. Medications along with psychosocial theories can be efficient tools in managing the disease. Antipsychotic medication remains the main method in the treatment of various displays of schizophrenia. However, in recent years, the focus has been placed on minimizing the risks and maximizing the benefits of drugs through establishing minimum effective dosage degrees and providing alternative policies for those patients who fail to feel better from antipsychotic medication. The medical planning should include a combination of antidepressant, anti-anxiety and antipsychotic drugs. The fact that many people with schizophrenia stop taking medications earlier than a prescribed term is a challenge in today’s treatment. It happens either because the therapies do not facilitate the patient’s condition, or they have unbearable side effects. Typical antipsychotics belong to the first- generation drugs aimed at minifying the appearances of schizophrenia. They operate through blocking the neurochemical dopamine traditionally accepted as the culprit in the pathology. Many side effects of typical antipsychotics served as an impetus for inventing the medications of the second generation, known as atypicals. These drugs block not only dopamine, but also serotonin, which is deemed to be the second neurochemical associated with schizophrenia. Atypical antipsychotics provoke fewer tremors, muscular rigidity, or involuntary, repetitive movements. Nowadays, Seroquel, Zyprexa, Risperidone, Geodon, and some others act in the USA as newer medicines on the stage (Walker et al., 2004, p.420). It is worth noting that Clozapine is a single medication for schizophrenia that enhances positive, negative, as well as cognitive symptoms, while the other atypicals do not cover all three categories. However, it can reduce the number of blood cells. All these details witness to the fact that doctors should pay regard to individual’s different reaction to drugs and consequently choose the neuroleptic that minimizes side effects and provides considerable relief of symptoms. Not less attention should be paid to the duration of drug intake and its dosage range. With regard to the display of the disease, pharmacological treatment may consist of acute, continuous and prophylactic phases. During the acute phase, medications should help eliminate the signs associated with a severe condition of schizophrenia. After having observed the maximal improvement, doctors prescribe the therapy intended to continue the treatment until they get persuaded that the acute episode is over. The further phase of medical cure is used for preventing the occurrence of new episodes. The implementation of the mentioned treatment system faces some difficulties, in fact. It may occur because some patients do not achieve a complete remission; the others have intolerable side effects or even doubt the necessity to take pills. However, according to different studies, the non-adherence to a treatment course may induce the more symptomatology in patients. In order to avoid discontinuation, it is important to create a treatment plan supported by a doctor and family members. A successful adherence means fulfilling the clinic appointments, taking a prescribed dose at the proper times, and carefully following other cure procedures. Electronic timers, medication calendars, or labelled drug boxes can help patients adhere to their dosing schedule. Engaging the family into the adherence monitoring can help clinicians identify the episodes of problematic pill taking and, consequently, manage them. If speaking about a dosage of the drug, it remains evident that clinicians adjust to the range for the latter according to a clinical response. Nevertheless, such an approach can be misleading. The improvement of symptoms received through increasing the dose does not always indicate on the efficacy of a high dosage. The benefit can occur, as well, because of allowing more time on the primary volume of medication. Hence, the psychotherapists should better start from smaller volumes and begin to cognize full therapeutic effects in three or more weeks. Further medical control may afford ground to prescribe a high-dose treatment. In addition to the prior tips, it is worth mentioning that some medications that contain fluphenazine, haloperidol, or perphenazine are presently used in the long-functioning injective forms. Medications of such a group eliminate the need to take pills daily.
Another new trend in medicines that is directed to fight a severe flow of schizophrenia is the creation of drugs, which would be tailored according to people’s genetic profiles. Modern pharmacogenetics and pharmacogenomics make efforts in order to assess the genetic basis of differences concerning toxicity and drug response. With the help of DNA chip expertise, the analytics in the field of pharmacogenomics may elucidate changes in the reaction of genes that have been caused by medication. Specialists in pharmacogenetics focus on studying DNA variations in genes induced by different influential agents, thereby determining the drug response to toxicity. In the future, the noted researches should help in predicting optimal doses for patients. Medical science believes that new genetic information of a human genome will be of great value in the process of discovering a disorder mechanism. Techniques of brain-imaging made it possible to inspect schizophrenic brain with regard to neurochemistry, structure, and operation. Such inspections confirm that schizophrenics have a number of anomalies, such as changes in grey matter density and temporal lobes. Therefore, it appears that among multiple causes of psychosis anatomical lesions and gene mutations can be seen, as well. Additionally, through neuroimaging, analyzing and testing the experimental group patients, molecular physics attained evidence that there is a relationship between self-reflection and insight in schizophrenics. Further experimentation should find out whether teaching patients to closely evaluate their qualities, personality and characteristics may favour achieving insight in their disorder (Meer et al., 2013). This treatment strategy is currently under evaluation by Pijneborg and colleagues; and the procedure is based on the model of social-cognitive group treatment that attempts to enhance self-reflection through increasing insight (Meer et al., 2013). The discussed method may be attributed to the psychological way in schizophrenia treatment. Though the latter cannot be suggested as a substitute for antipsychotic medication, it makes a significant contribution to the treatment framework. In psychological therapy patients are intended to deal directly with the manifestations of the disease. Controlled efforts of cognitive behaviour therapy (CBT) towards schizophrenics denote that this approach may benefit in reducing delusions and hallucinations in patients. Individual psychotherapy, as a part of CBT, involves systematic talks between the ill person and a mental health professional. While sharing experiences, schizophrenics can acquire problem-solving skills and learn how to sort out the real affairs from the unreal ones. The vulnerability-stress model is another technique of specific training destined to help psychotic people. A recently conducted study reports that patients participating in the stress management program have fewer visits to the hospital in the year following cure (Walker et al., 2004, p.421). Among therapies of the psychological field, there is also occupational admittance. Through the supportive employment programs, schizophrenics might produce better results in comparison with the traditional rehabilitation modes. In most complicated cases, patients must be assigned to a multifaceted team including nurses, physicians, and psychiatrists. Such a model will help in treating a patient without hospitalization and raising patient and family comfort. As for family, it is an entity that plays an important role in accessing anti-schizophrenic benefits within the treatment timeline. Family “psychoeducation” should include getting aware of schizophrenia phenomenon and difficulties associated with the illness by family members. This concept may promote the ability to act more effectively towards the sick relative and may contribute to an improved outcome of the latter.
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In summary, as it is clear from the discussed afore, the combination of methods for schizophrenia therapy has to be regarded by the clinician during the treatment prescription. It should also be considered that whilst treatment with antipsychotics can be associated with adverse effects, it is of great importance to be cautious in choosing a therapy until the medical industry finds innocuous medications.