Abstract
Schizophrenia is a persistent, severe, and disabling mental condition that influences how individuals think and behave. The condition is among the driving reasons for incapacity globally. Studies conducted in the United States suggest that the disease prevalence is 0.26% to 0.62%. Furthermore, they approximate the pervasiveness of schizophrenia among non-institutionalized people to be around 0.32%. Despite its low pervasiveness, it is inherent in notable health, social, and economic agitations. The following paper presents an essay on schizophrenia and related disorders in adults. Moreover, it provides a literature review on its etiology, DSM 5 classification, the diagnostic process, and treatment interventions.
Introduction
Schizophrenia is one of the most severe mental disorders in terms of impact on individuals and healthcare systems. It manifests through delusions, hallucinations, grandiosity, memory problems, emotional withdrawal, disorganized thinking (speech), negative symptoms, and abnormal motor behavior. Schizophrenia and related disorders have a high management cost compared to other mental conditions. Due to the high cost incurred during the management of the condition, it has caught most of the medical personnel’s attention hence the need to conduct more research on the topic. Individuals with the disease have an increased risk of premature death. It is diagnosed primarily in the early teens and seems to emerge earlier in men than women. A positive family background of schizophrenia is a predisposing factor for its development. Despite the challenges posed by the condition, it can be managed through several strategies to reduce the occurrence of the symptoms.
Etiology
The fundamental cause of schizophrenia is unclear, and it is considered multifactorial. Worldwide researchers suggest that a combination of physical, genetic, environmental, and psychological factors contribute to the condition’s occurrence. The following neurotransmitters are compromised in schizophrenia; dopamine, glutamatergic, and Gamma-Aminobutyric acid (GABA). The interaction between these neurotransmitters and receptors contributes to the pathogenesis of the condition. According to Sonnenschein et al. (2020), down-regulation of the midbrain is principal to the development of the disease. The former is driven by the disruption of the upstream circuit, which provides afferent control to the dopamine receptors and neurons.
Clinical studies provide support for dopamine involvement in the development of the condition. Imaging in clinical studies shows schizophrenic patients increase dopamine in response to low-dose amphetamine. This biochemical hypothesis suggests that increased activity at dopaminergic synapses results in schizophrenic-like symptoms. The mesombolic part is responsible for controlling emotions; hence an increase in dopamine leads to delusions and hallucinations, which are positive symptoms. Negative symptoms such as anhedonia flat affect arise from the prefrontal cortical area.
The occurrence of schizophrenia is in stages, for instance, prodromal phase, active set, and residual. The prodromal stage is characterized by deterioration in function, which should not be due to disturbances in mood substance. Individuals may find it challenging to concentrate and keep track of their thoughts at this stage. As a result, they may feel suspicious, overloaded, disconnected, and irritable (Lieberman et al., 2018). The consequential prodromal phase results in the acute stage of psychotic symptoms such as loosening of association, delusions, and hallucinations. The acute phase gives rise to the residual phase when at least two noted symptoms persist at the prodromal stage.
DSM 5 Classification
Schizophrenia has no single test, but diagnosis is made through medical history, physical examination, and evaluation of DSM 5 criteria. The diagnostic process involves using scans and blood tests to rule out physical illnesses. Scans are used to create images that provide a clear view of the structure of the brain and blood tests to rule out drug abuse such as alcohol which is linked to hallucinations. Therapists use specially designed tools, interviews, and diagnostic checklists to diagnose and treat mental illnesses such as schizophrenia. Interviews are used to collect patient data where questions are asked to evaluate the severity of the symptoms presented. The therapists ask the patient to describe any distressing experiences and perceptions. Interviewing children may be problematic since they have a higher chance of expressing themselves. If they are not expressing themselves fully, the therapist may recruit an informant.
The DSM 5 criteria are used for making an actual diagnosis of schizophrenia. According to the criteria, diagnosing schizophrenia in adults is achieved if an individual has two or more core symptoms especially hallucinations, delusions, and disordered speech occurring for more than a month (Dutschke et al., 2018). The criteria also state that for a symptom to be graded for schizophrenia, it must cause significant social or occupational functional deterioration. The symptoms presented should not be caused by medical, neurological, or substance-induced disorders. Other DSM 5 criteria for making a diagnosis include; level of work and self-care significantly below what it was before the onset of the symptoms and signs of disturbances lasting at least six months. However, the system presents strengths such as standardization of billing, coding, and diagnoses across different treatment providers, research guidance, and therapeutic guidance. Its weaknesses include oversimplification of behavior, increased risk of misdiagnosis, and provision of labels that can be stigmatizing.
Treatment
Pharmacological
Despite the efforts made by scientists globally, no cure has been found for the elimination of schizophrenia. Studies suggest that medications can help control symptoms affecting dopamine levels in the brain. Several therapies target symptoms and prevent relapse of the condition. They include social skills training, vocational rehabilitation, individual, Cognitive behavior, family, and medications therapies. Four reviews of antipsychotic medication treatment have been published over the last five years. McDonagh et al. (2018) examined both non-pharmacological and pharmacological treatment interventions among grown-ups. Opare-Addo et al. (2020) argue that medicines are fundamental in treating schizophrenia, where antipsychotics are the drugs of choice. This implies that schizophrenia requires a lifelong treatment plan even when the symptoms subside.
Various researchers have conducted two reviews on atypical psychotic drugs among adults, examining the adverse effects of the drugs. The two studies mentioned above discovered that atypical antipsychotics were more effective at reducing positive and negative symptoms (Olagunju et al., 2019). Other studies could not locate the difference between atypical and typical antipsychotics, with reviewers stating methodology limitations as to the cause. Both the studies noted an increase in glucose levels for patients with no history of diabetes, seizures for patients with no history of epilepsy, sun sensitivity, and rapid weight gain. The authors noted that treatment with these drugs effectively relieved symptoms, but the doses needed to be individualized and gradually increased. However, the authors have not indicated the efficacy of the drugs.
Another review provided information on the most appropriate antipsychotic medication for schizophrenic patients. The researchers explored the efficiency of both atypical and typical antipsychotics in relieving schizophrenia symptoms. They examined the risk of death among adults who were administered either of the two types of drugs mentioned. The authors discovered that more than 14% of adults administered with typical antipsychotics died compared to less than 9.7% who took atypical antipsychotics (Olagunju et al., 2019). An increase in mortality was noted for patients who took a higher dose in the initial days of the regimen. Therefore, there is a need to individualize medical management among adults, and doses should be slowly increased.
Dopamine is a neurotransmitter responsible for relying on information around the brain. Antipsychotics such as clozapine and lurasidone block dopamine receptors in the brain, reducing the flow of messages hence lowering the severity of psychotic symptoms in adults. However, prescribing children and teenagers drugs is controversial due to insufficient proof for the efficacy of the medicines in these age groups. According to research conducted by Dennis et al. (2020), American grown-ups who take antipsychotic drugs reveal more continued medical services access and a reasonable commonness of comorbid infections in comparison with those who fail to use the medications. The study further highlighted that individuals who take antipsychotics would sleep more hours, reducing the symptoms experienced.
Non-pharmacological
Few studies examine the effectiveness of pharmacological intervention over non-pharmacological ones in managing schizophrenia among adults. Most non-pharmacological interventions among adults are adopted from those meant for children. Cognitive behavior therapy (CBT) can be used for treating schizophrenic patients. CBT helps individuals to adjust beliefs or practices that lead to pessimistic feelings. The techniques utilized include reality testing, self-monitoring, and coping skills training. This therapy has two components; the cognitive part and the behavioral part. A cognitive component is concerned with aiding people to change their thinking about a situation (McDonagh et al., 2018). A short-term problem-focused approach equips people with coping skills since they learn how their thoughts influence others.
Schizophrenic patients are also taught strategies of modifying negative reviews and responding to them differently. Schizophrenic adults utilize this therapy to develop better problem-solving and decision-making skills that reduce the severity of the condition compared to teenagers. The behavioral component enables them to change their reactions to events in their lives. This helps adult patients have insight, cope with the symptoms, and adhere to medication regimens. Several studies have been done by researchers seeking to determine the effectiveness of CBT. Bon et al. (2018) suggest that CBT should be an intensive training targeting impaired functions and compensation for the impairment. Since schizophrenia affects cognitive functioning among individuals, the study concluded that Cognitive Behavior Therapy was effective in recovering reduced cognitive ability.
Individual therapy for schizophrenic patients involves teaching the patient how to manage thoughts and behaviors. For effective outcomes, it is often used together with family therapy. Family is essential in coping with an illness of the immense support provided. Environmental interactions affect the severity of the symptoms and the recovery process. According to McDonagh et al. (2018), family therapy for schizophrenia involves working with significant others and the patient to manage the disease. Some of the components of family therapy are education, stress reduction, problem-solving, and emotional processing.
The group works together with the therapist to get enough information about the condition and the management required. This advances compassion and full-feeling support while changing pointless forms of communication. Families work with therapists and patients to support and prevent escalations of symptoms presented. Studies conducted indicate by sharing information; families educate themselves on the illness and how it affects the person they care about. Schizophrenia impacts children more than adults since they are young and do not know how it influences their lives. Family involvement in managing the disease offers a sense of belonging and support, which reduces the stress and loneliness encountered.
The other essential therapy is social skills training involves equipping the schizophrenic patient with skills to deal with life events. Evidence indicates that social skill training is effective in managing negative schizophrenia symptoms. Stressors are known to trigger social decompensations, hence the need for training to adopt social skills. The latter involves a collection of practices that uses a behavioral approach. Among children, the process consists of communication, self-management, and awareness creation on creating and maintaining peer relations. Among adults, it involves decision-making techniques essential in problem-solving (Granholm et al., 2018). The therapist also teaches them how to live a healthy lifestyle to eliminate comorbidities. For instance, adults are encouraged to refrain from alcohol use, eat a balanced diet, and indulge in regular exercises.
Finally, there is a unique therapy for adults known as vocational rehabilitation. The latter involves aiding schizophrenic patients in training before giving them an employment opportunity. Several studies among schizophrenic patients have shown work rehabilitation is essential in recovery from the disease. A study conducted by Gjerdalen et al. (2022) suggests that most patients experience a high unemployment rate despite experiencing the urge to work. The author concludes that the initiation of supported employment schemes has produced higher employment rates than traditional vocational rehabilitation. Therefore, they require daily living support; hence they are offered jobs. Prevocational training is a method of helping these patients since they are taught skills that can help them secure a job. After getting employed, they are preoccupied with work which together with medication therapy reduces the relapse of the symptoms and eliminates stress due to increased financial pressure.
Conclusion
Schizophrenia is a mental condition that inhibits a person’s ability to determine actual and imagined. It has a high prevalence among adults as compared to children. Nonetheless, the specific etiology of the illness has not been known, but studies suggest a shift in the dopamine levels results in the onset of the symptoms. A diagnosis for the condition is made utilizing blood tests, scans, interviewing, physical examination, and confirmed with the DSM 5 criteria. It has no cure, but the symptoms are managed through several therapies such as medication, social skill training, vocational rehabilitation, family, individual, cognitive, and behavioral therapies.
References
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