Over the last few decades, schizophrenia has gained popularity owing to its increased prevalence and its relationship with various social issues such as drug abuse. In fact, colossal amounts of resources have been utilized in research work aimed at coming up with effective diagnostic and treatment methods. In view of the research, concerted efforts targeting the early identification of the condition particularly at the prodromal stage have received wide interest. Researchers concur that a greater understanding of the varying risks and the protective factors is important in devising effective preventive as well as treatment strategies aimed at reducing the incidences in this risk group. Psychological interventions play a major role in the management of schizophrenia in the target population. The nature of research and the interventions has brought about ethical implications with regard to the involvement of the affected individuals in terms of their age and other factors. This essay will delve into understanding the biological issues coupled with psychological and ethical implications regarding schizophrenia.
Schizophrenia is among the most prevalent mental condition affecting slightly above 1% of the American population which translates to around 1.99 million. Schizophrenia is also referred to as split personality disorder owing to the differential effects it has on the affected individuals. Statistics depict a more prevalence in men than in women. About 60 % of the cases affect males in the United States with minimal variation across the other continents. Schizophrenia is among the psychotic disorder that brings about uncharacteristic symptoms in terms of behavior, thought, and problems in social problems (Goldner, 2002, p. 884). The problems are usually termed psychosis, owing to the skewness in the person’s thinking in relation to reality. For example, individuals suffering from the condition have the tendency of hearing voices which others cannot decipher. In other instances, the individuals have the belief that other persons interfering with their thinking while others become paranoid in the face of their failures. They fail to admit their failures while scorning on other people’s successes (National Institute of Mental Health, NIMH, 2010). Sick individuals undergoing this crisis usually feel withdrawn and terrified about the present and the future. More importantly, they fail to make sense especially when involved in open dialogues and conversations. In fact, the majority of the affected spend most of their time alone while indulging in unconstructive thinking. With this regard, members of the family and the society at large have difficulty in executing responsibilities in the workplace and usually rely on other people to guide and carry the activities for them. In comparison with the general population, schizophrenia patients have lowered life expectancy owing to the fact that slightly above 10% and roughly 30% suffering individuals commit and attempt suicide respectively (NIMH, 2010).
Symptoms of schizophrenia are mainly broad and fall into several categories. The majority of sick individuals experience positive symptoms with others reporting negative and cognitive-related symptoms. The nature and extent of symptoms make it difficult to differentiate schizophrenia from other psychotic disorders. The fact that only a few of the symptoms appear in the affected individuals makes diagnosis and subsequent treatment impossible. Nonetheless, the appearance of these symptoms usually heralds the development of psychotic disorders, particularly schizophrenia. To start with, positive symptoms represent the psychotic behaviors not observed in healthy individuals. Although these usually are sporadic, they make the affected lose touch with the happenings in the vicinity. Without treatment, the symptoms are easily noticeable. For instance, hallucinations occur in the majority of the cases with voices representing the commonest form whereby they report episodes of voices directing them what to do or reprimanding them about their behaviors (NIMH, 2010). Seeing figures of unusual objects such as dead people is not uncommon. Other symptoms include delusions as well as thought disorders and conditions regarding the affected individual movement. Delusions mainly refer to a set of false beliefs that are not part of the culture of the society the person is living. Thought disorders represent an uncharacteristic and deviated way of thinking whereby the individual suffers from a form of disorganized thinking making it hard for them to articulate their thoughts in a logical manner. Movement disorders mainly occur when certain agitated motions are repeated severally while a state of catatonia may occur in some instances. Negative symptoms usually result in the disruption in the individual normal emotions and other behaviors. They usually include a flat affect, limited pleasure in daily life activities, lack of commitment in sustaining planned activities, and lack of the desire to interact with other people. Cognitive symptoms result in executive functioning and other trouble focussing on tasks (NIMH, 2010).
Research has shown that people suffering from schizophrenia have limited chances of being violent. However, several symptoms have great relationships with violence. More importantly, substance abuse increases exponentially the likelihood of a person suffering from schizophrenia becoming overly violent, with the bulk of it directed towards the most intimate and close individuals such as family members (Goldner, 2002, p. 886). Predictive factors of the occurrence of violent behaviors generally include male gender and defaulting in antipsychotic medication coupled with younger age and prior involvement in violence. Although the risk of violence recorded among the cases is minimal, slightly above 10% of the young men lose their lives as a result of suicide. Schizophrenia cases have a greater likelihood of abusing one of the substances when compared to the general population. Treatment is usually complicated by substance abuse owing to the similarity in symptoms and the failure to adhere to the treatment plan. Understanding the link between smoking and schizophrenia is difficult since cases seem to be driven by biological factors that ensure smoking persists. In addition, evidence denotes that anti-psychotic drugs are ineffective when the affected indulge in smoking (NIMH, 2010).
After many years of studying the etiology of schizophrenia, no conclusive research study has provided a clear pointer on the main causative factor. Several factors are believed to bring about the condition. Genetic factors and environment predominantly explain the causation much better since there is a higher incidence in families where a parent suffers from schizophrenia. 10% of individuals with a sick member in the first family develop the condition depicting a ten-fold risk when compared to 1% risk in the general population (Goldren, 2002, p. 881). Several genes contribute to the development of the disease, with schizophrenia cases experiencing unusual and higher rare genetic mutations that are responsible for causing disruption during overall brain development. Other studies depict that the disease develops as a result of malfunctioning of a crucial gene in the making of vital chemicals in the brain hence affecting the maturing of brain functioning skills. Genetic factors in combination with environmental factors are usually responsible for causing the disorder. Scientists have associated exposure to organisms such as viruses and periods of maternal malnutrition prenatally, medical complications during birth, and undocumented psychosocial factors. Individuals suffering from schizophrenia have a higher likelihood of being born during winter, especially in the northern hemisphere. Moreover, living in urban centers in combination with social disadvantage has emerged as a major risk factor. Other factors such as poverty, racial discrimination, migration due to social upheavals, and dysfunction within the family greatly increase the chances of developing the disorder. Trauma and abuse, particularly during the early developmental stages of a child, occasioned by the collapse in the family institution contribute significantly to an increased risk. Substance abuse has consistently been mentioned as a major contributor to increased risk with alcohol and cannabis showing greater association than other drugs. Despite uncertainty in the findings, a 2007 meta-analysis depicted a statistical association between cannabis consumption with an elevated risk of experiencing psychotic disorders (Hudson, 2008, p. 74).
Although studies are still ongoing, initial evidence indicates that the structure and chemistry of the brain can explain the causation of schizophrenia. In fact, imbalances in the neurotransmitter-dependent chemical reactions in the brain result in the disorder. Complex reactions involving glutamate and dopamine largely contribute owing to the roles they play in the overall communication process of the brain. The brain structure may also explain the causation with noticeable differences observed in cases and the general population, with many changes occurring during gestation. Scientists are of the view that faulty connections may result from the problems experienced during brain development. More importantly, the brain undergoes characteristic developments especially during adolescence that are believed to bring about psychotic symptoms (NIMH, 2010).
Diagnosis and treatment
Diagnosis of schizophrenia is complex due to the similarity of the symptoms with other co-morbid conditions. Diagnosis is mainly achieved through Occam’s razor principle where it entails explaining the occurrence of various disparage symptoms that eventually result in the prescription of an effective single treatment. There is no diagnostic test that has been found to be effective in schizophrenia. However, several noon-diagnostic features entailing neurological abnormalities may assist in identifying the disorder. Scans revealing decreased brain tissue coupled with enlarged brain ventricles and decreased temporal lobe are useful in concluding the condition. In addition, no laboratory tests have proved effective in the overall diagnosis of the condition (Hudson, 2008).
Treatment occurs in several ways depending on the extent and severity of the disorder. Since no causative factors are known, treatment mainly entails the elimination of the symptoms. In fact, treatment usually entails taking antipsychotic medications in combination with a wide array of psychosocial treatments. Anti-psychotics medications have been on the shelves for 60 years with the older types being referred to as conventional antipsychotics. Moreover, a new regimen of antipsychotic medications was developed in the mid-1990s representing the second generation of the medications. Clozapine is the most popular medication with the capability of treating psychotic symptoms and forms of hallucinations despite causing a serious side effect referred to as agranulocytosis. Although it has proved expensive, it is useful to individuals who fail to respond to other types of antipsychotics. Medications have a generally higher success rate, especially when dealing with positive symptoms. Second-generation medications are recommended owing to their rapidity in working particularly when compared to other treatment methods, although they bring about several but common side effects such as weight gain and dizziness. Antidepressants have proved useful in the management of moods and depression in patients. Bupropion and serotonergic medications are the most commonly prescribed antidepressants with the ability to regulate the flow of dopamine and serotonin respectively. Although its utilization has received wide condemnation, electroconvulsive therapy has shown to act as a last-line treatment option for individuals who have failed to improve after going through alternative treatment methods. Antipsychotics serve to reduce the duration under which the person suffers from psychosis hence preventing the recurrence of the condition, although psychotic relapses may occur after a duration ranging from several weeks to a few years especially when medications are withdrawn. More importantly, medications reduce the chances of indulgence in suicidal thoughts, minimize hospitalization and eventually result in gradual improvement in social functioning. The medication should be taken as a lifetime therapy in order to cushion the individual from the bad effects occasioned by their withdrawal. Doctors must take into consideration the harmful effects the medication may have on the fetus before initiating any treatment on pregnant mothers. The balance between the benefits of stabilizing the mother’s thoughts must be balanced with due care to protect the unborn from health risks (NIMH, 2010).
The fact that schizophrenia is not treatable has made scientists devise a wide array of psychosocial treatments that go a long way in reducing the detrimental effects of the disorder. Psychosocial treatment assist affected individuals to cope with day-to-day challenges while ensuring communication and socialization are greatly enhanced. Adherence to medications is boosted while the probability of relapses occurring is minimized by psychosocial treatment. It is important to understand that several forms of therapies are intertwined in order to achieve higher success rates of treatment. Health education on the prognosis is crucial in sustaining and encouraging adherence in the therapy. Equipping the patients with the basic facts can enhance the development of illness management skills that are vital in countering relapses in the future. More importantly, they become responsible for the treatment plans and work towards their eventual recovery. In addition, management of co-morbid conditions especially substance abuse is essential since it enhances the achievement of better treatment results. Initiation of rehabilitation programs, that place much emphasis on social and vocational activities, not only help affected individuals to function better but also socialize effectively in society. Rehabilitation may sometimes entail job counseling coupled with money management skills that ensure the individuals learn to utilize the existing public amenities. Greater emphasis on providing opportunities to nurture communication skills should be put in place with a view of improving the overall cognitive skills (Andreasen & Black, 2001). Family education with regard to the prognosis and the management of the condition needs to take center stage since the affected patient will reunite and spend most of the time at home. Health-seeking behavior with regard to the availability and accessibility of vital clinical services must be emphasized. In addition, the formation of self-help groups has proved instrumental in creating a bond between the affected and their families through sharing of experiences while comforting each other. Networking and interaction between individuals from various sectors generate advocacy that is instrumental in drawing public and government attention in continuing research on schizophrenia. Lastly, cognitive behavior therapy is imperative in shaping the behavior and improving the thinking capacity in the face of failed medications. This form of therapy is complex and requires a lot of concentration. Realignment of thoughts and perception to normal is emphasized thus empowering the individuals to act hence lessening the severity and relapse risk (Andreasen & Black, 2001).
Progress towards the identification of a single cure has been ongoing for several decades with a breakthrough expected that will ensure the affected individuals enjoy a satisfying life. Continued research in areas of genetics, behavioral science, and the aspects of neuroscience will unravel the mystery surrounding the etiology of the disorder hence resulting in the development of a treatment that will ensure the affected individuals achieve optimum potential.
The inadequacy in medications as a form of treatment has made psychological interventions receive popularity from researchers and scientists. In fact, the focus has shifted largely towards the impact occasioned by current and supportive psychotherapies carried out either at the individual or group level. In addition, training on psychosocial skills is also imperative in improving the overall social and clinical outcomes in affected individuals. The three forms of psychological interventions have achieved varying success and efficacy depending on the demographic characteristics, adherence levels, and the level of the diagnosis. Their onset was informed by the fact that pharmacological treatment had proved rarely insufficient in offering the best outcomes when dealing with this disorder. The issue of compliance resulted in the integration of social and cognitive therapy in the overall treatment process. In addition, pharmacological treatment has been faulted due to the development of resistance especially after the introduction of clozapine (NIMH, 2010). The change in terms of perception of the usefulness of the psychological interventions occasioned by the limited impact pharmacological treatment had on the eventual development of social skills that enhanced reunion with the society. Studies on the impact of the environment in the management of mental illnesses occasioned the integration of the concept of expressed emotion in addition to enhancing the participation of the family in the overall treatment. Improvement in the manner of communication is greatly enhanced since the clinicians understand the importance of informal carers towards recovery. Although there is considerable variation in terms of application of the various interventions, their effectiveness is inherently dependent on the development of a flexible positive therapeutic alliance with the affected individual (NIMH, 2010).
Psychotherapy is rife in the majority of the treatment of the disorder although there is the propensity of the utilization of pharmacotherapy due to the nature of prevailing medical schemes that fail to recognize psychological approaches. Psychotherapy takes a similar approach where a gathering of people in the presence of a professional expert is available to help with the group and the utilization of the interactions among the group as tools and means of effecting change in behavior and motivation. The application of the format occurs across the individual and group settings where positive and supportive outcomes have occurred thereby ensuring support for the individuals. Individual psychotherapy is bent on increasing insight that typically tries to reinforce ego strength. despite its wide application, evidence depicts that individual treatment does not play a major role in minimizing symptoms, enhancing the eventual reunion with the community, or decrease in the level of hospitalization. moreover, the benefits of this approach are inconsistent and hence not reliable and encouraged since it fails to exert any meaningful benefit to the overall outcomes regardless of whether it’s applied alone or in combination with pharmacological treatment (Butler, 2006). Modification of this approach to an adaptive supportive therapy has shown reinforced benefits particularly on outcomes such as rehospitalization and subsequent social and vocational adjustment. Individual therapy should be tailored depending on the needs of the individual to ensure concerted benefits are achieved at the end of the day. To enhance the psychotherapies, attention is required on enacting environmental interventions in addition to providing advice and encouragement to those undergoing the treatment (Moore, 2007). Moreover, the therapist must set the limits and prohibitions while ensuring maladaptive defenses are undermined and emphasizing the individual strengths and talents. Re-evaluation and periodic monitoring of the individual therapy are crucial in achieving positive outcomes.
On the other hand, group therapy serves as an avenue whereby several people suffering from schizophrenia receive due attention by putting into focus their experiences. sharing of the coping mechanisms and concomitant challenges not only revitalize the group but also ensure the individuals gain skills that eventually result in better outcomes in terms of socialization. The majority of studies on group psychotherapy depict significant positive outcomes that have occurred in patients on the program unlike in instances where the patient undergoes medical treatment alone. More importantly, this approach proved effective when compared with individual therapy due to group-related factors that encourage the perpetuation of positive behaviors. Significant success is overly achieved particularly when more interaction-oriented approaches focus much on interpersonal problems and issues regarding relationships unlike when insight-oriented approaches bent on unearthing psychodynamic issues are utilized. Based on the above premises, it has become imperative to consider integrating programs that enhance the capability of schizophrenic patients dealing with psychotic experiences and issues surrounding interpersonal relationships. Group therapies are useful to family members since it enhances their ability to recognize and also cope with the symptoms at the earliest possible chance. In addition, corrective actions in the face of crisis are bolstered since they receive training on the urgent steps to be taken in case of complications in the patient. Provision of psychological support and motivation takes place during the interaction periods. Involvement also confers assurance and support hence gaining the courage to articulate their sentiments (Moore, 2007, p. 367).
Cognitive-behavioral therapy is useful especially when targeting a specific category of symptoms while resulting in improved outcomes in self-esteem, insight, and overall social functioning. Its application has recorded improved treatment outcomes, particularly when dealing with positive and negative symptoms. In fact, the majority of the family interventions are reliant on principles revolving around cognitive behavioral therapy. Although cognitive behavior therapy results in better outcomes when compared with other models, it is imperative to enhance research into all the models to enhance the chances of developing an effective treatment approach (Butler, 2006, p. 18). Treatment through this approach is usually modified to reflect the needs and preferences of each individual depending on the severity and the time limitations. Its application in individual as well as a group setting with the techniques modified to each case. The fact that it combines cognitive and behavioral aspects makes the approach more applied by researchers and clinicians. Evidence-based research favors cognitive-based therapy in relation to other approaches. Evaluation of its efficacy and overall effectiveness has revealed greater success in alleviating the symptoms while hindering the occurrence of relapses in the future. Positive outcomes in the affected individuals are occasioned by the fact that cognitive-behavioral therapy serves to improve the person’s capabilities to understand their roles in the recovery process (Goldner, 2010).
The medical field has transformed greatly in the last half-century owing to the developments in technology and research. During the same period, the debate surrounding ethical issues especially in schizophrenia research has continually evolved in some aspects. In fact, the majority of the discussions revolving around the most important issues regarding ethical implications have been propelled majorly by developments in psychiatry and schizophrenia (NIMH, 2010). Furthermore, the evolution of standards with regard to the protection and respect of human research participants has gained prominence. Current scientific developments have brought into fore the need for reconsideration of complicated ethical conundrums regarding the researchers. In addition, other ethical issues from the previous years remain hanging. With World War II came the ethical considerations particularly when dealing with human subjects in experiments. Competency and requirement for informed consent have become entrenched in research involving individuals dealing with mentally ill patients. Until a few decades ago, informed consent was ignored since the participants were believed to lack the capacity to consent. However, federal intervention through policies has since then required the protection of research participants owing to their vulnerability and susceptibility to exploitation. Varying opinions on the issue of including suicidal patients have been in the limelight in the last few years. The exclusion of suicidal patients has a basis for their high-risk status. Several researchers have questioned the wisdom behind the assertion, thereby resulting in the review of soft eh policies hence allowing for controlled research protocols on suicidal patients in schizophrenia. The exclusion of this category of participants has denied the researchers the right to generalize interventions and other basic biological research. Ethical issues also occur in those forms of research that rely on medication withdrawal owing to the fact that they predispose the patients to harmful effects or death. In fact, a handful of participants charged researchers for not informing them of the expected risks of relapse before they consented to participate in the studies (Wilson & Stanley, 2007). In addition, medication-free research has necessitated the implementation of several safeguards aimed at protecting the participants in placebo-controlled studies. A breakthrough on placebo trials meant that it was ethical to carry on provided no form of coercion is used and the participant is well informed of the risks and consequences of participating. Research in this field has shown that researchers have received many benefits in terms of the scope of the studies while the participants become more predisposed to higher chances of experiencing discomfort and relapses. Recent controversy has occurred in the debate especially considering the developments in the field of early interventions. Of paramount concern is the issue of false positives and the risks conferred by the interventions, the definition of those at risk of contracting the disorder, issues of stigma, and the length of the intervention or treatment procedures. The fact that genetics play a crucial role in understanding schizophrenia has occasioned increased interest in molecular genetics. With regard to genetics, several issues have surfaced especially in areas of genetic testing and screening in addition to discrimination on the basis of genetic influences and the issue of sharing of information regarding the participants for research purposes (Wilson & Stanley, 2007).
The psychiatrists are required to observe some basic ethics when dealing with patients. In fact, the issue of telling the truth to the patients has biome a thorny issue although a significant number of psychiatrists are advocating the utilization of advanced directives in determining in earnest whether it’s beneficial to reveal the truth about the disorder to the patients. Physicians are always in conflict on the issue of telling the truth or helping the patient with regard to withholding vital information on the likely psychodynamics and other emotional needs. Ethically, the duration and manner under which the psychiatrist withholds the information may act as a form of disrespect of the patient’s autonomy. Another ethical issue arises when the patient holds ambitious career plans that are beyond their capabilities. While the physicians are bent to relieve the symptoms, the patients may insist on putting more effort to fully recover with the aim of pursuing their career goals. The psychiatrist will be forced to help him achieve the career knowing well that doing so will only worsen the condition. During the course of treatment, the psychiatrist may persuade the patient to allow the family members to become an integral part of the program. Ethically, persuasion may look as a form of coercion or as an act of providing false information by the manner of omission meant to influence the outcome of the treatment in the patient. However, the psychiatrists can navigate through this by justifying the morality behind the persuasion. Ethical dilemmas also occur especially when the psychiatrists realize that an individual has an elevated level of contracting the disorder. In addition, the initiation of medical treatment brings into fore another dilemma especially when the patient is of the contrary opinion. Initiation of treatment is controversial since the majority of the cases end up becoming false positives (Wilson & Stanley, 2007).
Researchers concur that a greater understanding of the varying risks and the protective factors is important in devising effective preventive as well as treatment strategies aimed at reducing the incidences in this risk group. Schizophrenia takes many forms with a wide range of symptoms that make it hard to diagnose and subsequently initiate treatment. In addition, people suffering from the disorders are easily identified through positive symptoms owing to the inadequacy in the laboratory tests. Treatment occurs in several ways depending on the extent and severity of the disorder. Since no causative factors are known, treatment mainly entails the elimination of the symptoms. In fact, treatment usually entails taking antipsychotic medications in combination with a wide array of psychosocial treatments. The inadequacy in medications as a form of treatment has made psychological interventions receive popularity from researchers and scientists. In fact, the focus has shifted largely towards the impact occasioned by current and supportive psychotherapies carried out either at the individual or group level. Psychiatrists are continually faced with varying ethical conflicts that are based on assisting the patient to achieve maximum benefits while ensuring that their autonomy is duly respected.
Andresen, N. & Black, D. (2001). Introductory Textbook of Psychiatry, Third Edition. Washington, DC: American Psychiatric Publishing, Inc.
Butler, A., Chapman, J., Forman, E.M. & Beck, A. (2006). The empirical status of cognitive-behavioural therapy: a review of meta-analyses. Clinical Psychology Review, 26 (1), 17–31.
Goldner, E.M., Hsu, L., Waraich, P. & Somers, J.M. (2002). Prevalence and incidence studies of schizophrenic disorders: a systematic review of the literature. Canadian Journal of Psychiatry, 47(9), 833–43.
Hudson, T., Owen, R., Thrush, C., Armitage, T.L. & Thapa, P. (2008). Guideline implementation and patient-tailoring strategies to improve medication adherence for schizophrenia. Journal of Clinical Psychiatry, 69, 74–80.
Moore, T.H., Zammit, S., Lingford-Hughes, A., Barnes, T., Jones, P., Burke, M. & Lewis, G. (2007). Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet, 370(9584), 319–328. Web.
National Institute of Mental Health. (2010). Schizophrenia. Washington D.C: National Institute of Health. Web.
Wilson, S. & Stanley, B. (2007). Ethical Concerns in Schizophrenia Research: Looking Back and Moving Forward. Schizophrenia Bulletin, 2(1), 3036. Web.