Schizophrenia is a psychotic disorder that is defined by severely impaired thinking, emotions, and behaviors. Those individuals diagnosed with this illness tend to lose contact with reality and start to experience manifestations such as hallucinations and delusions (Rajesh & Tampi, 2018, p. 82). Psychosis is the main feature of this disorder and can cause an individual to experience a crisis during psychotic episodes. Schizophrenia is a lifelong and widespread disorder that contains no cure, however, it is treatable. The main goal of treatments is to help these people control their illness and help them back into reality so they can live normal lives.
Schizophrenia is one of the most common psychotic disorders diagnosed (Pearson, 2015, p.1610). According to Rajesh and Tampi (2018), “approximately every seven in 1000 people will develop the disorder in their lifetime (p. 82).” Abnormal brain development has been found in patients diagnosed with schizophrenia. Pearson (2015) states, during early childhood development the migration of neurons and abnormal brain development can lead to miscommunication between these neurons and the brain (p.1611). These rogue neurons affect the so-called “wiring” of the brain and then cause the brain to function improperly (Pearson, 2015, 1611). Neurotransmitters such as dopamine and glutamate are also believed to play a role in the pathophysiology of schizophrenia. The manifestation of cognitive dysfunction in schizophrenia is said to be linked to dysfunctional glutamate function. According to Fatani et al. (2017), “glutamatergic dysfunction in schizophrenia is associated to dysfunction of parvalbumin-positive interneurons inside the cerebral cortex and hippocampus (p. 2642).” These interneurons are what cause the production of gamma oscillations, which are important and produce proper cognitive functioning (Fatini et al., 2017, p.2642). Glutamate receptors are also responsible for the migration of the neurons during early development of the brain, which then leads to what was previously stated about cognitive dysfunction. The neurotransmitter dopamine is stated to be linked to the symptoms of schizophrenia. According to Fatani et al. (2017), there are four dopaminergic pathways involved; the nigrostriatal pathway, the mesolimbic pathway, the mesocortical pathway, and the tuberoinfundibular pathway (p.2642). Low dopamine levels in all but the mesolimbic pathway, cause symptoms such as extrapyramidal symptoms, negative symptoms, and cognitive deficits (Fatani et al., 2017, p.2642). If there is an excess of dopamine in the mesolimbic pathway, positive symptoms have linked to that (Fatani et al., 2017, p.2642). Research has yet to prove that these neurotransmitters are held accountable for this disorder but further research is still being conducted. Genetics is another factor that can predispose someone to this disorder. Those who have a family member diagnosed with schizophrenia are ten times more likely to inherit this disorder than those who don’t have a family history of schizophrenia (Pearson, 2015, p.1612). The specific cause of schizophrenia has yet to be discovered and is still not understood entirely but research is constantly being conducted to try and uncover the cause.
Symptoms, Diagnosis, and Treatment
Manifestations of schizophrenia are defined as either positive or negative symptoms. Positive symptoms are seen as psychotic behaviors and are easily observed in the individual. These symptoms include hallucinations, delusions, thought disorders, disorganized behaviors, and movement disorders. Hallucinations vary based on the five senses; sight, sound, taste, touch, or smell, but auditory hallucinations are the most common (Pearson, 2015, p.1613). Auditory hallucination can become dangerous for either the person with schizophrenia or for those around them. In some cases, they can turn into command hallucinations and instruct the individual to cause harm to themselves or others. Delusions are beliefs that hold no place in reality which mainly lead to paranoia. For example, schizophrenics may believe that the government is spying on them or they are placing thoughts into their heads. Thought disorders involve unusual thinking and also altered speech patterns. Disorganized behavior leads to the inability to live a normal life such as, hold down a job or relationship (Pearson, 2015, p.1614). Negative symptoms are said to be more difficult to observe in the individual because their behaviors can be seen as other mental illness symptoms. These individuals usually show a flat affect, neglect of personal hygiene, lack of focus, anhedonia, and memory impairment (Pearson, 2015, p.1614).
Individuals with schizophrenia are at high risk for relapse of their psychotic symptoms. This can be due to poor medication regimen compliance, environmental stressors, or comorbid disorders. According to Velligan et al. (2017), relapse of psychosis in schizophrenics is at a rate of 3.5% a month and can be as high as 80% within a year if treatment is not closely monitored (p.232). Individuals going through a relapse are at high risk for suicide. Research has shown that between 2-12% of all suicides are related to schizophrenia relapse (Popovic et al., 2014, p.419). According to Rajesh and Tampi (2018), the prevalence of suicide attempts in schizophrenics is 20-40% and about 5% commit suicide (p.85).
In order to diagnose a person with schizophrenia, they need to meet criteria on the Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Fatani et al. (2017) state that a full assessment of the patient’s signs and symptoms needs to be evaluated first (p.2643). The DSM-5 states that a person needs to have two or more of active symptoms either positive or negative, the person also needs to show decreased functioning in work, relationships, or self-care, and this all has to be continuous for a minimum of six months (Fatani et al., 2017, p. 2643).
Schizophrenia is a treatable disorder. The most effective approach includes a combination of medications, psychological treatment, and social support groups. There are two main classes of medications that are used for schizophrenics, first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs). SGAs are usually the first drug of choice when treating this disorder. This is because FGAs are associated with extrapyramidal effects which can lead to noncompliance with medication regimen (Fatani et al., 2017, p. 2644). Antipsychotics are said to be the most effective treatment for this disorder but when combined with adjunctive treatments the outcomes are much greater. Individuals with this disorder should be offered cognitive behavior therapy, family interventions, group therapy, and social skills training. These alternative therapies teach the individual how to realize the reality of their thoughts, ignore auditory hallucinations, and motivate themselves, which in return reduces the severity of the manifestations (Pearson, 2015,p. 1619).
As nurses, there is a possibility of an encounter with a patient with schizophrenia. Pearson (2015) states, the main goal of nursing care for these patients is to promote symptom control and help in the process of effective coping and achieving optimal functioning (p. 1620). Preventing injury and providing a safe environment is a priority of care for these individuals. Being a client advocate is also an important aspect of nursing care. Educating the client and their families about this illness and treatments for it will not only encourage the client to be compliant but help the family understand what the client is experiencing.
Impact on family, culture, and community
Individuals with schizophrenia and their families usually endure a lifetime of social, emotional, and financial ramifications. When an individual gets diagnosed as a child the parents are usually the main caregivers. They are educated on the disorder, its symptoms, and treatments. This disorder can possibly put a strain on a family. The schizophrenic will need more time and attention while getting used to the treatments prescribed and this leads to burnout because the caregiver may not care for themselves or the other family members. Sometimes stresses in families can lead to interpersonal conflicts and can also result in families splitting up. Family therapy is recommended for people who are diagnosed with this disorder. They are educated about coping skills, outpatient services, and their family members specific treatment program (Pearson, 2015, p.1619). This type of therapy is said to help families that are overly emotional and critical. This disorder can also have an effect on an individual’s culture and community. The community they live in may see them as “the crazy person” and this may embarrass them and isolate them. Most people in the community are not educated on this disorder so they just make assumptions and judge that person based on their disorder. Cultural practices and beliefs can also affect how people view and interpret manifestations of schizophrenia. Pearson (2015) provides an example stating that in some cultures hearing voices or seeing visions are normal and desirable and can be viewed as a religious experience (p. 1616).
Schizophrenia is a chronic condition in which recovery is a lifelong process. An exact cause of this disorder has not been clearly identified but there are multiple factors that seem to influence the development of it. Genetics, biological, environmental, and social factors all seem to play a role in the growth of this disorder. Identifying the risk factors and symptoms early on in life can increase better outcomes with treatment plans and compliance. This is a disorder that needs to be closely monitored not only by the individual but by the families and healthcare providers as well. Although there is no cure for schizophrenia, there are treatments and there have been stories of success. These individuals don’t let their disorder define them and they are able to live normal lives.
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