Schizophrenia
Schizophrenia
Schizophrenia refers to a group of mental disorders with unknown etiology. Their development might be conditioned by common endogenous pathogenic mechanisms in the form of a hereditary anomaly that does not manifest until a certain period of life. Without treatment, there is a continuously progressive or paroxysmal course of the disorder, usually ending with the same pattern of personality change and disorganization of mental functions such as thinking, emotions, psychomotorics, behavior, memory, and acquired knowledge. Schizophrenia is equally represented at all cultural levels of human society, accounting for approximately 1% of the total world population (Crump, Winkleby, Sundquist, & Sundquist, 2012). A genetic predisposition is almost equal among men and women, although some studies note a slightly higher prevalence of schizophrenia in women than in men (Ochoa, Usall, Cobo, Labad, & Kulkarni, 2012). This paper will explore the societal and lifestyle impact of the disease, its symptoms, causes, mechanism, and treatments in order to argue that schizophrenia is a serious social and medical issue accompanied by severe intellectual, behavioral, and emotional disorders.
Societal and Lifestyle Impact of the Disease
Schizophrenia is not fatal; however, its psychopathological features can lead to the most tragic outcomes. It is primarily associated with the increased possibility of suicide.
Suicide
Patients with schizophrenia often think about their death. Almost a third of them cannot cope with those thoughts and make suicide attempts. Unfortunately, up to 10% of patients suffering from schizophrenic spectrum disorders die from suicide (Bope & Kellerman, 2016). Factors that increase suicidal risk include frequent hospitalizations, long-term and non-curable disorders, delayed diagnosis and treatment initiation, insufficient doses of drugs, or too short periods of treatment (Bope & Kellerman, 2016). The risk of suicide increases due to the appearance of the feeling of uncertainty in patients, for example, in case hospital discharge takes place when the patient still displays the main signs and symptoms of the disorder. The incidence of suicide attempts among inpatients is much lower than among outpatients; however, unfortunately, such cases sometimes occur even in hospitals.
Several conditions can increase the risk of suicide. First, most suicidal attempts take place during the active period of the disease, namely in the state of psychosis, under the influence of delusional beliefs, imperative hallucinations, confusion, fear, and anxiety, especially when the latter leads to agitation (Bope & Kellerman, 2016). In this situation, urgent hospitalization is necessary to save the patient’s life (Bope & Kellerman, 2016). The second condition is depression. It also often leads patients to make suicidal attempts, which sometimes lead to fatal consequences. Depressed schizophrenic patients experience the painful perception of the social and personal consequences that the disease carries (Bope & Kellerman, 2016). Patients are overwhelmed by oppressive thoughts about the future, the likelihood of new hospitalizations, possible disability, and the need to take medications throughout life (Bope & Kellerman, 2016). Severe depression is very dangerous because it can provoke thoughts about unwillingness to live and suicidal readiness (Bope & Kellerman, 2016). If there are no health care professionals or relatives capable of providing support and explaining what is happening nearby, the patient may fall into despair and make a fatal step. Suicidal attempts are often made at night or early morning hours, when no one and nothing distracts the patient from painful thoughts and relatives sleep or lose their vigilance. In most cases, the decision to commit suicide is not sudden (Bope & Kellerman, 2016). It is preceded by attempts to get help from family members or medical personnel (Bope & Kellerman, 2016). Talking about despair and hopelessness without even expressing intentions to commit suicide is a direct signal about the threat of suicide. Therefore, it requires the most serious attitude.
Alcohol and Drugs Abuse
Substance abuse is another lifestyle impact of the disease. Many patients regard psychoactive substances as a cure for despair, anxiety, depression, and loneliness. The proportion of patients using these drugs as self-treatment reaches 50% of all schizophrenic patients. Substance abuse makes it difficult to diagnose and treat schizophrenic diseases, complicating the process of rehabilitation. For example, the similarity of the symptoms caused by drug use and the symptoms of schizophrenic disorders can lead to improper diagnosis and a delay in the appointment of treatment. Drugs also have an adverse effect on the course of the disease. If drug abuse begins at an earlier age, the frequency of exacerbations increases, the capacity for any activity sharply decreases, and a pronounced tendency to violence appears. Thus, patients who try to cope with a sense of uncertainty and fear of the future with alcohol and drugs risk making their condition and the outcome of treatment much worse.
Social Danger
The issue of social danger that people with schizophrenia may represent develops due to the outdated treatment of schizophrenic patients. Recent studies have shown that the frequency of aggressive behavior and violence among patients is similar to the rest of the population, and aggressive behavior manifests in patients only in a certain period. For example, these are the days when exacerbation began but the patient was not yet hospitalized. Social danger disappears during treatment in the hospital but may occur again after discharge. After leaving the hospital, the patient feels vulnerable, and unprotected, and suffers from uncertainty, insecurity, and the wrong attitude of the members of society toward him. These are the main reasons for the manifestation of aggression. At the same time, books and films describing schizophrenic patients as serial killers or rapists are very far from reality. Aggressiveness is inherent only in a small part of the patients and is directed, as a rule, only against family members, especially parents.
Disease Symptoms
Schizophrenia differs in a variety of clinical forms. The main manifestation of the disease in most cases is psychosis (Lieberman, Stroup, & Perkins, 2012). Psychoses are the most vivid and severe manifestations of the disease when the patient’s mental activity does not correspond to the surrounding reality (Lieberman et al., 2012). At the same time, the reflection of the real world in the patient’s mind is sharply distorted, which is manifested in behavior disorders and the ability to correctly perceive reality and give a correct explanation of what is happening (Lieberman et al., 2012). The main symptoms of schizophrenia include hallucinations, delusions, thinking and mood disorders, and catatonic disorders (Lieberman et al., 2012). Hallucinations and delusions are the most severe symptoms.
Hallucinations are one of the most common symptoms of schizophrenia and represent impairments in the sensory perception of the surrounding world. Depending on the senses involved, hallucinations can be auditory, visual, olfactory, and tactile (Lieberman et al., 2012). They can be simple, such as calls or noise, and complex, such as speech and different scenes. The most common hallucinations are auditory ones. People who suffer from schizophrenia can occasionally or constantly hear so-called ‘voices’ inside their heads, their own bodies, or from outside (Lieberman et al., 2012). In most cases, voices are perceived so brightly that the patient does not have the slightest doubt about their reality. A number of patients are fully convinced that the voices they hear are due to a sensor implanted in the brain, a microchip, hypnosis, telepathy, etc. Voices can cause severe suffering in some patients; they can command them, comment on each of their actions, mock them and make them feel miserable (Lieberman et al., 2012). Imperative voices are considered the most unfavorable ones since the patients can commit acts that are dangerous to themselves and others while obeying their instructions. Patients can mechanically obey voices, answer them or argue with them (Lieberman et al., 2012). In some cases, voices become much more important than the real external world, leading to detachment and indifference to the latter.
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Delusions are persistent beliefs or inferences arising on a painful basis. They are not amenable to correction, reasonable arguments, or evidence (Lieberman et al., 2012). The delusional idea arises from misinterpretation of the surrounding reality caused by the disease and, as a rule, does not correspond to reality (Lieberman et al., 2012). Therefore, attempts to reassure the patient make his delusions become even stronger. The content of delusional ideas can be very diverse; however, most often there are delusions of persecution and influence (Lieberman et al., 2012). For example, patients believe that someone watches them, wants to kill them, organizes conspiracies against them, etc. They blame all their problems on someone’s intrigues, most often on close people and neighbors, and they perceive each external event as relating personally to them (Lieberman et al., 2012). Patients often claim that their thoughts or feelings arise under the influence of any supernatural forces, are controlled from outside, stolen, or broadcasted publicly (Lieberman et al., 2012). They can complain about instances of intrusion, go to the police, and move from apartment to apartment, from city to city, but each time ‘persecution’ continues in the new place (Lieberman et al., 2012). The deliriums of invention, greatness, and reformism are also very common.
Cause and Mechanism
Despite the fact that the nature of most mental illnesses is still largely unclear, schizophrenic diseases are traditionally referred to as so-called endogenous mental illnesses. Schizophrenia does not have distinct external causes, unlike a group of exogenous mental illnesses that are caused by external negative influences such as craniocerebral trauma, infectious diseases, or various intoxications (Mosiolek, Gierus, Koweszko, & Szulc, 2016). According to modern scientific views, schizophrenia is associated with impairment of the processes of transmission of nerve impulses in the central nervous system and the special nature of damage of certain structures of the brain (Mosiolek et al., 2016). Although the hereditary factor certainly plays a role in the development of diseases of the schizophrenic spectrum, it is not decisive (Mosiolek et al., 2016). Many researchers believe that one can inherit only a predisposition to schizophrenia, which can only be realized under certain circumstances, as in the case of cardiovascular diseases, cancer, diabetes, and other chronic diseases (International Congress on Schizophrenia Research [ICOSR], 2015). As a rule, there is no clear connection between the psychotraumatic situation and mental disorders in the clinical picture of schizophrenia (ICOSR, 2015). Usually, a trauma only provokes a hidden schizophrenic process, which would eventually manifest itself without any external influence (ICOSR, 2015). Thus, psychotrauma, stress, infection, and intoxication can only accelerate the onset of the disease, but they do not cause it.
Treatment
In most cases, patients with schizophrenia need hospitalization. The latter pursues several goals. The main one is the possibility to organize constant monitoring of the patient, allowing doctors and medical personnel to catch the slightest changes in his or her condition. The doctor clarifies the clinical picture of the disease and does some laboratory and psychological tests (Stern, Fava, Wilens, & Rosenbaum, 2016). These measures are necessary to exclude other mental illnesses with similar symptoms. At the end of the examination, the doctor prescribes medication, medical personnel constantly monitor the effectiveness of the therapy, and the doctor makes the necessary adjustments and controls the occurrence of side effects (Stern et al., 2016). As a rule, inpatient treatment of the psychotic state lasts from one and a half to two months (Stern et al., 2016). During this period, the doctor has to treat acute symptoms of the disease and choose the optimal treatment therapy. If the symptoms are resistant to the drugs used, it may be necessary to change several courses of therapy (Stern et al., 2016). However, it may lead to an increase in the length of stay in the hospital.
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Although medical science has not yet developed a complete cure for endogenous diseases of the schizophrenic spectrum, there are various types of therapy that can reduce the risk of relapses of the disorder and completely restore patient’s efficiency (Stern et al., 2016). Medications occupy the main place among treatment measures. If pharmacological agents are regularly and correctly administered, they can significantly weaken the symptoms of the disease and provide the patient with a full-fledged lifestyle in many cases (Stern et al., 2016). Antipsychotics are commonly used for the treatment of schizophrenia (Stern et al., 2016). The second group of drugs most frequently used in the treatment of schizophrenia is antidepressants (Stern et al., 2016). Some of them have a predominantly calming effect, whereas others have a stimulating effect. Hence, some antidepressants do not reduce the manifestations of psychosis but, on the contrary, strengthen it. Therefore, doctors have to select antidepressants carefully, taking into account the clinical features of each specific case of schizophrenia (Stern et al., 2016). Sometimes, one must use a combination of several drugs to achieve the desired effect.
Significant progress in the treatment of schizophrenia occurred in the last 30 years with the introduction of a new generation of antipsychotics, so-called atypical antipsychotics, such as risperidone, olanzapine, quetiapine, and ziprasidone (Ropper, Samuels, & Klein, 2014). These drugs can have a powerful impact on the symptoms with a minimum of side effects (Ropper et al., 2014). Therefore, the modern stage of fighting diseases of the schizophrenic spectrum is characterized by the constant development and introduction of new drugs, including those with prolonged action, which allows for improving treatment, ensuring differentiated prescription of certain medications, minimizing their side effects, and achieving large success in overcoming therapeutic resistance to medications (Ropper et al., 2014). When choosing suitable medicines, doctors are guided by the achievements in biochemistry and the collective experience of pharmacologists and clinician-researchers that was accumulated during the last decades (Ropper et al., 2014). Investigation of the structure of the human brain and its diseases using the latest techniques is a direction in which scientists from all over the world have invested many efforts and resources in recent years (Ropper et al., 2014). It has already produced positive results in the form of new medications, which are more selective, effective, and better tolerated by patients.
Conclusion
Schizophrenia leads to severe health problems associated with emotional blunting, intellectual deterioration, social isolation, and disorganized speech and behavior. Schizophrenia makes the everyday life of a person suffering from this disorder complicated and even frightening by eliminating the boundary between reality and fantasy. A patient with schizophrenia tries to escape from the outside world and hide from it; fear and embarrassment spur the patient into inadequate actions. In most cases, schizophrenia occurs in late adolescence. However, the disorder can overtake a person both in adulthood and in old age. In rare cases, schizophrenia occurs in children and adolescents, although the symptoms at this age are slightly different. The earlier the disease develops, the harder it is to treat it.
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