Prevalence and Characteristics of Schizophrenia - Research Paper Example

?Topic: Schizophrenia Introduction History Prevalence Characteristics of disorder Recommended pharmacotherapy Drugs used to overcome it Riskfactors Nursing considerations Conclusion Abstract: Healthy life is a gift of God and all the activities in routine life depend on the health and wellbeing of mankind. Even the smallest of diseases and disturbances can result in distortion of entire life and its activities. Schizophrenia is one of them; it is a kind of disorder that affects everything during the life time. The aim of this paper is to look into the various aspects of it, how it affects individuals, how it can be overcome, what impact it can have on an individual, how the course and nursing procedure should be conducted . Schizophrenia in general as a disorder has a peculiar symptom, namely that the affected person may hear sounds that surrounding people don’t hear. They have a curious feeling that other people are trying to read their minds or in other words are gaining control of their thoughts. They are superstitious enough to harm themselves as well. This can frighten people with the illness and exclude them from the society because of extreme agitation. This brain disorder is considered to be costly and time consuming due to the behavior of the patient. Superstitions are common feelings of the patient which are caused by low intake of the medicine. First generation and second generation medicines are introduced for the patients who deal with certain types of the syndrome. Trust should be developed while treating a patient with schizophrenia. Introduction: Schizophrenia is basically a brain disorder which is found to be persistent, severe, and even disabling the brain and it has affected people throughout history. About 1 percent of Americans have this illness. People with schizophrenia may give a feeling as if they are lost in thoughts. Such person can sit for hours without moving or talking. One cannot judge a person until he/she speaks about what they are really thinking. Depending upon the conditions and causes families and society are affected by schizophrenia too. It has been found that people suffering from schizophrenia have difficulty within their social circle, maintaining a job or even taking care of themselves, so they rely on others for help. With developing research and more effective medications, researchers are finding solutions to this brain disorder. Use of medicine and treatment helps relieve many symptoms of schizophrenia, but often people fight with symptoms throughout their lives. However, many people with schizophrenia can lead rewarding and meaningful lives in their communities. (Regier DA, 1993) Prevalence of the Disease Several factors affect the prevalence of schizophrenia, such as the recognition and reaction to treatment. The prevalence of schizophrenia can be calculated either from cases registered or field surveys. Researchers report that figures have been hypothesized that prevalence estimates would differ between lifetime, period, and point prevalence. Estimates were calculated as a proportion by dividing the total number of individuals who had the disorder by the total population at risk including those with the disorder. It is predicted that males from urban areas and migrants would have a larger proportion as compared to females. (Bhugra, 2005) Schizophrenia rarely occurs in children but affects men and women equally. It occurs regardless of religion and ethnic groups around the world. Mainly symptoms such as hallucinations and delusions usually commence between ages 16 to 30. Men are exposed more to symptoms a little earlier than women. Most of the time, people do not get schizophrenia after age 45. (SR, 2004) Schizophrenia in teens can be difficult to diagnose, because some of the first signs can include a change in emotional behavior, change of friends, low performance in education, sleep problems, and bad temper that are common among teens. However, a series of factors can forecast the disorder for up to 80 percent of youth who are at high risk of developing the illness. Such factors are isolating one and withdrawing from others, an increase in unusual thoughts and superstitions, and a family history of psychosis. Table 1: WHO Collaborative study Place Incident per 1000 Aarhus, Denmark .18 Chandigarh, India ( in rural) .42 Chandigarh, India ( in Urban) .35 Dublin, Ireland .22 Honolulu, Hawaii .16 Moscow, Russia .28 Nagasaki, Japan .21 Nottingham England. .22 Adapted from Sartorius, et al. (1986), PsycholMed. symptoms of schizophrenia The symptoms of schizophrenia can be categorized into three parts: +ive symptoms -ive symptoms Cognitive symptoms. Positive symptoms These are psychotic behaviors rarely seen in healthy people. Such people often “lose touch” with reality. These symptoms are temporary. It may sometimes be very intense and sometimes hardly noticeable. They include the following: Hallucinations are things a person may see, hear, smell or feel that others can’t. The most common is “Voices”. Often people with the disorder hear voices. The voices may talk with the person about their behavior, may command the person to do things or even advise the person of danger. Sometimes the voices talk to each other. Such people with disorder may hear voices for a long time before someone notices it (Health, Revised 2009). Negative symptoms These are associated with hindrance to normal emotions and behaviors. These symptoms are difficult to identify as a part of the disorder and can be mistaken for those of depression or other emotional conditions. These symptoms include the following: “Flat affect” (a person’s face does not move or he or she talks in a dull or monotonous voice) Being short of pleasure in everyday life Inability to begin and sustain planned activities Being less talkative, even when forced to interact. Such people with negative symptoms seek help with everyday tasks. They often neglect basic personal hygiene. They appear lazy or unwilling to help themselves, but the problems are symptoms caused by the schizophrenia (Health, Revised 2009). Cognitive symptoms Cognitive symptoms are slight. Similar to negative symptoms, cognitive symptoms are hard to recognize as part of the disorder. Often, they are noticed when other tests are performed. Cognitive symptoms include the following: Meager “executive functioning” i.e., the ability to understand information and to make decisions Trouble focusing Problems with “working memory” (the ability to use information immediately after learning it). (Health, Revised 2009) A cognitive symptom often makes intense emotional stress, lack of confidence and makes it hard to lead a normal life and earn a living. Table 2: General signs and occurance Sign or Symptom Consistency of Finding Early psychotic like symptoms + Few friends, schizoid +++ Language impairment + Abnormal social behavior +++ Poor School Achievement ++ Neurological soft signs ++ Adapted Source: ( D. John, In Gattaz, W.F. and Hafner, H., 2004) Pharmacotherapy There is no doubt schizophrenia has been recognized for many years, but its pathophysiology is yet to be researched further and understood. It has been assumed by researchers that the positive and negative symptoms of the mental disorder are resultant from hyperdopaminergic activity. (Cortese, 2003) Patients with schizophrenia characteristically show consistent defunct pinpointing of damage to forebrain areas, where fibers emerging from the cell bodies of the mesolimbic and mesocortical systems end. The hyperdopaminergic supposition has been supported by the finding that patients with schizophrenia release more dopamine at the synaptic junction in response to amphetamine stimulation than do patients without schizophrenia. This increase in dopamine release has been associated with a worsening of positive symptoms. (Breier A, 1997) TREATMENT of Schizophrenia The present thought for the cause of schizophrenia is the dopamine hypothesis, which concludes that schizophrenia is the end product due to over activity of dopamine systems in the brain. This was concluded in the study of Rauwolfia Serpentina, a shrub used for several remedies in India; it is a folk medicine for diarrhea, snake bites and delayed labor. Present day researchers concluded that it could be a tool for care for insanity and maniacal symptoms, as well as dropping blood pressure and sedating in general. The treatment lessons of treatment for a person having mental disorder of schizophrenia requires attention to many critical issues including the present clinical condition of the person, the family past experience and timing of the occurrence of disease. It is very crucial to notice the available therapeutic options for the betterment of patient’s health and future quality of life. In 1910 Dopamine was first discovered but it was soon forgotten for the reason of its low sympathomimetic effects, and with increasing research it was considered for its mediating effects on reserpine. It was observed that areas of the brain that have large amount of dopamine have little norepinephrine, but surprisingly areas containing huge quantity of norepinephrine (such as the medulla oblongata) have little dopamine. (Waterman 2003) The use of Antipsychotic drugs are a major tool in the healing of persons with this mental disorder and these drugs are used to treat minor episodes. Also it helps to avoid future attacks and improve residual symptoms of the disorder, for example impaired cognitive functioning, alogia, and avolition, as well as continuing negative symptoms. The normal course of treatment is that treatment with antipsychotic medications is continued with oral or depot formulations at least for a year in the beginning after the first episode. Chlorpromazine and some other first-generation antipsychotic medicines have core duty of antidopaminergic activity. These compounds alleviate and avoid the recurrence to a maximum of the positive symptoms of schizophrenia. (Ballus, 1997). Many patients with schizophrenia find typical antipsychotic agents ineffective or only partially beneficial, but this may be due to the limited action of first generation antipsychotic agents on negative and cognitive symptoms. (Cortese, 2003) Initially the term used atypical antipsychotic agent was applied to clozapine, which creates significantly lower extrapyramidal symptoms at therapeutic doses as compared to typical antipsychotic agents. Risperidone, olanzapine, quetiapine, and ziprasidone are also considered improved ability to tolerate than are the first-generation antipsychotic agents, and increase patient compliance because of improved subjectivity. (Voruganti L, 2000) Advancement of Second-generation antipsychotic agents is that it affects both symptoms i.e., positive and negative symptoms of schizophrenia and has illustrated major advantages over first generation drugs in the treatment of the disorder. Relevant clinical features of second-generation antipsychotic agents are described below and are summarized in table below: Table 3: Features of Major Antipsychotic Medications Drug Efficacy Production of EPS Other features Chlorpromazine Standard treatment for patients with psychoses some Some anticholinergic activity; sedation a common critical effect Clozapine Linked with little risk of degeneration than are normal antipsychotics; higher frequent clinically critical positive changes than with conventional antipsychotics* exceptional Sedation common, increased weight gain, possibility of agranulocytosis Risperidone Increased share of patients depicting clinical Positive changes than with normal antipsychotics unusual Little sedative effect; some weight gain and tachycardia, increased prolactin Olanzapine considerably enhanced upgrading of patient with dosages of 10 mg/day to 20 mg/day on Positive and Rare Cases of gaining weight Quetiapine important clinical development against placebo, with excellent tolerability; at least as useful as haloperidol and chlorpromazine relating to positive symptoms. It showed better efficiency regarding the negative symptoms, appreciably more patient retort to quetiapine specifically (Seroquel) than to haloperido; similarly having better response tempo compared with haloperidol for partial responders; equivalent to risperidone in efficacy; seems to as good as olanzapine (Data on file with AstraZeneca, Wilmington, DE) Placebo levels crosswise the full dosage series Not linked with raise in prolactin across the complete dosage range; no association with weight changes across the dosage range; significantly better acceptability with respect to Extra polymeric substances than with chlorpromazine or haloperido; it is also recorded having minimum incidence of substantive EPS compared with risperidone (Data on file with AstraZeneca, Wilmington, DE) Ziprasidone Relatively High effective ratio than placebo and as equivalent as haloperidol for patients having positive symptoms but even higher usefulness with negative symptoms Production of EPS than with haloperido Some cases of Nausea and vomiting have been recorded Source : (Cortese, 2003) Clozapine: Clozapine, belongs to the 2nd generation antipsychotics. It was formulated and introduced in Europe in 1966. It is the first of the serotonin receptor/dopamine receptor antagonists. Clozapine has a high likeness for a wide range of neurotransmitter binding sites. This binding profile accounts for the advantageous effects of clozapine on positive as well as negative symptoms of schizophrenia, furthermore, it decreased incidence of extrapyramidal symptoms. Clozapine is quite good in treating at least 30% of patients previously described as treatment resistant. The drawback of the chemical is its high toxicity and that it causes agranulocytosis in 0.6% of patients, which has led to mandatory hematologic monitoring. Some other adverse effects that are commonly noticed are weight gain, sedation, sialorrhea and an increased risk for seizures with dosages greater than 600 mg/day. Risperidone: Risperidone acts as a D2 antagonist and has been considered a potent 5-HT2 receptor antagonist specifically for high doses. A research study has shown that it is more effective in reducing the negative symptoms of schizophrenia as compared reducing of the positive symptoms and it is found better than the first-generation antipsychotic drug haloperidol. (Cortese, 2003) Risperidone is well tolerated in doses less than 10 mg daily; however, higher dose requirement increases the risk for Parkinsonism in patients. The most reported recurrent adverse effects are sedation, anxiety, headache, nausea, and weight gain to some extent. Risperidone has also been related to sexual dysfunction in some patients due to elevation in prolactin levels. (Chouinard G, 1993) Olanzapine: Olanzapine chemical structure is similar to clozapine and bears a high similarity for a large area spectrum of neurotransmitter binding sites. It has shown good and improved positive as well as negative symptom efficacy, therefore it is associated with a low risk of tardive dyskinesia. The suggested optimal dosage for the person having brain disorder is 10 to 20 mg/day; however, it carries a risk of giving a byproduct of orthostatic changes in blood pressure in parallel to a rise in parkinsonism and akathisia at higher dosages than 20 mg/day. Nevertheless a minimum dosage of 2.5 mg or 5 mg a day should be considered at the start for medication-sensitive persons. Other often reported adverse belongings include sedation, dizziness, excessive appetite with weight gain and anticholinergic effects. So for the patients affected, olanzapine treatment may show some variant changes in asymptomatic hepatic transaminase level elevations and also some minor elevation in prolactin levels. Olanzapine resettlement is linked to resistance of insulin and rise in level of insulin, leptin, and blood lipids. (Fulton B, 1997) Quetiapine. It is like olanzapine structerd, the structure of quetiapine is a clozapine analogue shown in a similar receptor binding profile. The occurrence of xtrapyramidal symptoms is as good as to placebo throughout the entire dosage boundary but also lower than that of haloperidol and orpromazine. This chemical named Quetiapine shows less increase in levels of prolactin, therefore, it offers better fulfillment compared to other antipsychotics. (Cortese, 2003) The adverse effects related to quetiapine are somnolence which normally resolves with the continued administration of quetiapine and orthostatic hypotension, which can happen between the starting dose titration period. (Borison RL, 1996) Ziprasidone: This treatment medicine has a high sensitivity for 5-HT2 and D2 receptors, as in parallel property of other second-generation antipsychotic agents; significantly it has shown to be useful antipsychotic reaction on positive as well as negative symptoms. Similarly, its side effect profile is quite favorable with respect to extra pyramidal symptoms and weight gain. (Daniel DG, 1999) Important Considerations for Nursing: The aim of nursing is the building up of trust with the helping member so as to be able to cope, while on the other hand in the long run the disordered person will be more adaptive to coping skills as well as experience willingness to interact in the community. The following should be considered: Need to develop trust Minimize the physical contact. Avoid any gesture that may confuse the disordered person like smiling, murmuring, or talking in low tone. Superstitions are a common issue for patients of this nature. Some persons feel they are being poisoned so they should be encouraged for food intake. . Indulge the person into activities giving confidence in relationship with the nurse. The client should be allowed to verbalize true feelings. (Townsend, 2003) Outcome Criteria Person with the disorder gains confidence to evaluate situations realistically. Disordered person evaluates and understands possible misinterpretations of the behaviors that are resulting in lessening of superstitions. This results in the building of patient’s confidence and willingness to eat at regular intervals. Client decently talks and cooperates with staff and peers in therapeutic community setting. (Townsend, 2003) Conclusion: Schizophrenia is a severe disease and can have really serious impact on an individual, however it can be overcome through proper medication, nursing and training and counseling. It can result from many factors yet proper therapy and counseling can help overcome it in an appropriate manner and make a person completely fit and healthy to live his or her life with a purpose and objective. References Ballus, C. (1997). Effects of anti-psychotics on the clinical and psychosocial behavior of patients with schizophrenia. Schizophr Res, 247–55. Bhugra, D. (2005). The Global Prevalence of Schizophrenia. PLoS Med. Borison RL, A. L. (1996). 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U.S. Department of health and human services. Waterman, B. (2003). Treatments of schizophrenia, the past, present, and Future of Schizophrenia Treatment. Retrieved from www.bedrugfree.net. Read More