Schizophrenia - Definition, Impact and Prevalence - Research Paper Example

A report on Schizophrenia: definition, impact and prevalence A report on Schizophrenia: definition, impact and prevalence Introduction Schizophrenia is a mental disorder that can be caused by contributing factors such as genetics, early environment and psychological and social processes. The mental disorder is most often distinguished by its effect on social behavior and cognitive abilities. Patients often have difficulty in deciding what is real and what is not (McGrath et al ,2008). The disease has a direct impact on the patient’s quality of life and their ability to function productively in civilized society. There is some debate in the medical circles regarding whether the multitude of symptoms present actually signify different syndromes or can they all still be categorized under schizophrenia. The disease is often described in terms of negative and positive symptoms, positive symptoms are those which are only present in people with schizophrenia such as delusions, auditory and visual hallucinations and scattered thought patterns, the hallucinations can be considered as the onset of psychosis. Negative (deficit) symptoms signify the lack of certain responses or cognitive abilities mostly related to expressions of emotions, motivation, and communication. The negative symptoms are the ones that increase the burden of the disease and they also have a limited response to available medicines (Malaspina, 2013).. As of now the mechanism for Schizophrenia is categorized between ‘Psychological’ and ‘Neurological’. The complexity of schizophrenia stems from the fact that it has multi-faceted causes. There is difficulty in separating the effects of genetics and environment on the onset of schizophrenia but both are regarded as the major contributing factor (Pickard, 2011). Research shows that people with a history of schizophrenia in the family have an increased chance of 20-40% of being diagnosed for the disease after experience any symptom of transient psychosis. The greatest risk is present when a first-degree relative suffers from schizophrenia; if one parent is affected then the risk is around 13% but it increases to almost 50% if both parents are patients. It is hypothized that multiple genes are responsible for the various symptoms of schizophrenia. Environmental factors that contribute to the onset of schizophrenia can be categorized under living environment, drug use and prenatal stressors (McGrath et al ,2008). Rates of schizophrenia are slightly elevated in people who were exposed to stressful conditions during fetal development such as hypoxia and infection or malnutrition with the increased risk of 5-8%. Children exposed to harmful events such as trauma, family conflicts, bullying or abuse (emotional or physical) are at an increased risk for psychosis. It would appear that social stressors like isolation, poverty and social discrimination based on either race or status can also factor in the development of schizophrenia. At this point there is not a significant correlation or causation between substance abuse and schizophrenia. While a lot of people who suffer from the disease use various substances like alcohol, cannabis or hard drugs as a coping mechanism against their symptoms, the drugs themselves cannot cause schizophrenia alone. Amphetamines or cocaine use can induce psychosis similar in nature to the one experienced by schizophrenia patients but it not a cause of the illness as defined by medical practitioners. Impact of the illness Schizophrenia symptoms occur around young adulthood; making the transition period very difficult for the patients and their caretakers. The disorder impacts the ability to think and also has adverse impact on social behavior and emotions but the patients still have to function within and navigate the cultural, economic and political factors of the society. Difficulties in social relationships are one of the major problems for people with schizophrenia who often lack the basic communications skills to be proficient at that; the delusions and negative and positive symptoms also interfere with their perception of the world around them making interactions harder to manage. These problems are made more pronounced by the fact that people have misconceptions about the disorder, considering sufferers to be violent and unsuitable for normal social life. Schizophrenia sufferers face social prejudice and bias that excludes them from participating in normal social activities especially in communities which lack awareness about the disorder. The biases can take shape from subtle isolations and exclusions to an increase in unemployment rate as potential employers may be hesitant to hire a person with known schizophrenia. Hallucinations and erratic behavior from schizophrenic persons contribute to these misconceptions and biases, causing them to suffer emotionally and socially (Hadlich, 2010). People with schizophrenia are at higher risk for additional problems including depression and anxiety disorders, with almost 50% suffering from acute substance abuse. Their life expectation is lower by almost 12-15 years compared to national average and suicide rates are higher as well. Families of the patients have to play an important role in their lives, rehabilitation and treatments and as such they need to go through extensive educational programs that will let them support and accommodate their loved ones. Supportive families can prevent relapses for a patient and provide care giving against potential problems such as depression as well as guiding them towards social cues. The families have to be aware of the individual needs of the patients and respond accordingly; recognizing symptoms of the disorder and making themselves comfortable with occurrences of psychosis can let families create a comfortable and unbiased environmental for patients. The challenge for many caregivers is to provide mental help and support while at the same time allowing the sufferer a degree of autonomy and fostering self reliance. It is a difficult task for the families who also have to bear the brunt of social prejudice leveled against people against schizophrenia while trying to help their loved ones. However, medical and government support programs can offer much needed refuge and guidance for the families who have to learn how to live with and adjust to the behavior and responses of the person with schizophrenia Potential Treatments for Schizophrenia Schizophrenia needs to be treated using an all encompassing approach utilizing medication as well as rehabilitation support which should be devised according to the needs of each individual patient (Galuppi et al, 2010). Because of the variety of symptoms associated with the disease, patients respond to treatments differently and often the cultural context is an important source of support. Schizophrenia is currently treated using a combination of antipsychotic or or neuroleptic medicine and psychological treatments. The medication is primarily intended to control the activity of dopamine receptors in the brain which impacts the psychosis symptoms; antipsychotic medicines for schizophrenia were introduced were first introduced in 1950 but they had severe adverse side effects (Hadlich, 2010). The second generation antipsychotics now available with relatively lower risk of causing the movement disorder associated with the first generation drugs. However all of these medications do have typical side effects of causing obesity and metabolic syndromes. Recent advances in the treatment of schizophrenia have began to focus on identifying and treating the “Prodormal (pre-onset)” phase of the illness which has been detected up to 30 months before actual symptoms surface; the disease starts to show in early adulthood if treatment and timely support is provided before that the patient will be able control their own functions and the psychotic symptoms may be minimized. Patients are also provided psychological treatments such as counseling, job training, soft skill training and social rehabilitation work on improving the patient’s quality of life. These programs allow the patients to focus on school, life and career goals and create plan of action for their lives. ‘Peer Support’ is a growing area in these programs where patients help support each other through the rehabilitation process. These programs are especially important when considering that patients often turn towards hard drugs or nicotine and cannabis as a remedy for their psychosis leading to further health problems including substance abuse. This can be dangerous because it may decrease the effectiveness of the treatment programs or inhibit the patients from following their necessary health regime. A proper monitoring and support system can go a long way towards keeping the patient’s lifestyle balanced (Galuppi et al, 2010). The need for schizophrenia patients is for an integrated care system that includes socializing, diet, exercise and other healthy supplements in coordination with the medical treatments to ensure the best quality of life possible. In the past when medicine couldn’t recognize Schizophrenia and viable treatments were not available, the major respite for patients for hospitalization which could even be involuntary. The delusions of the disease can make a patient dangerous towards self and others and brief periods of hospitalization may be necessary even today. Incidence and Prevalence of the disease Extensive research and data collection has been done on a global scale in order to understand the disorder and its occurrence. Incidence of the disorder, defined as ‘the number of instances of illness commencing, or of persons becoming ill during a given period in a specified population’ (Shields, 2003) on a global scale reach 7 per thousand of the adult population, mostly in the age group 15-35 years making the incidence low at (3-10,000) (WHO, 2014). The prevalence of the disorder is much higher given the fact that is a chronic disorder. Prevalence of a disorder gives a figure for the factor at one point in time. Schizophrenia affects 24 million people worldwide (WHO, 2014). Discussing national average, schizophrenia is estimated to affect 1% of the Canadian population which his slightly higher than the global figures. But there are no conclusive national statistics on the prevalence of schizophrenia in Canada at this point (Blackwell, 2013). An extensive study performed Marie-José Dealberto, a Queen’s University psychiatrist in 2013 provided evidence that occurrences of Schizophrenia are increasing in Canada. The study concluded that 3.86 of every 1,000 Canadians — about 115,000 people — suffer from schizophrenia compared to global rate of 2.55 and there are 25.9 new schizophrenia cases per 100,000 (Vanesse et al, 2013) people every year more than double the rate in the rest of the world. The study goes on to suggest the need for further research into studying this alarming trend (2013). An assessment tool for Schizophrenia In most of North America, Schizophrenia is diagnosed using the criteria provided in the American Psychiatric Associations fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5). He newest edition of the manual has made some notable changes in the diagnosis of the disorder, removing subtypes that were used for characterization due to the heterogeneity between them and their failure in reliability and validity tests for diagnosis (Tandon, 2013). Instead DSM 5 utilizes a dimensional approach that focuses on the severity of varying symptom clusters. The psychometric characteristics of the symptom severity scale are evaluated using reliability, internal consistency and diagnostic ability. A study by Ritsner (2011) researched these factors to check the validity and reliability of DSM 5 as a diagnostic tool. “Reliability refers to the extent to which an assessment tool produces stable and consistent results. Validity refers to how well a test measures what it is purported to measure.” (Drost, 2012). The study used the kappa reliability test and Convergent validity and inter-rater reliability were measured using respectively Pearson’s correlation coefficients and intraclass correlation coefficients; the results showed that DSM 5 was more consistent and reliable than DSM 4. The criteria in DSM 5 use self-reported experiences and observed abnormalities in behavior as preclude to a clinical assessment that will then diagnose the disorder if it exists; at this point here is no objective test available to identify the incidence of schizophrenia. The symptoms associated with schizophrenia have a reach a certain severity before the diagnoses can be made. Two necessary diagnostic criteria to be met include: positive symptoms such as delusions, hallucinations or disorganized speech and negative symptoms included disorganized or apathetic behavior (Malaspina, 2013). References Shields, L., and Twycross, A., (2003). The difference between incidence and prevalence. Paediatric Nursing, vol 15, no 7, September 2003, p50. WHO, (2014). Schizophrenia. Mental Health. Available at: http://www.who.int/mental_health/management/schizophrenia/en/ Vanasse, A., Courteau, J., Fleury, M-J., Grégoire, J-P., Lesage, A., and Moisan, J., (2011). Treatment prevalence and incidence of schizophrenia in Quebec using a population health services perspective: different algorithms, different estimates. Social Psychiatry and Psychiatric Epidemiology, April 2012, Volume 47, Issue 4, pp 533-543. McGrath, J., Sah, S., Chant, D. and Welham, J., (2008). Schizophrenia: A Concise Overview of Incidence, Prevalence, and Mortality. Epidemiologic Reviews, Vol. 30, 2008, 67-76. Blackwell, T., (2013). Immigration, lack of sunshine cited as possible culprits behind eyebrow-raising spike in Canadian schizophrenia cases. National Post, Canada. Available at: http://news.nationalpost.com/2013/03/05/immigration-lack-of-sunshine-cited-as-possible-culprits-behind-spike-in-canadian-schizophrenia-cases/ Dealberto, M-J., (2013). Are the rates of schizophrenia unusually high in Canada? A comparison of Canadian and international data. Department of Community Health and Epidemiology, Carruthers Hall, Queens University, Kingston, Ontario, Canada K7L 3N6.  Ritsner, M. et al. (2013). Symptom severity scale of the DSM5 for schizophrenia and other psychotic disorders: diagnostic validity and clinical feasibility. Psychiatry Research. 208, 1-8. Tandon, R. et al. (2013). Definition and description of schizophrenia in the DSM-5. Schizophrenia Research. 150, 3-10. Malaspina, D. (2013). Negative symptoms, past and present: A historical perspective and moving to DSM-5. European Neuropsychopharmacology. Avaialbe at: http://dx.doi.org/10.1016/j.euroneuro.2013.10.018.  CMHA, (2014). Fast Facts about Schizophrenia. Canadian Mental Health Association.  Available at: http://www.cmha.ca/media/fast-facts-about-mental illness/#.UzTE5a1dW0Z  Drost, E.A., (2012). Validity and Reliability in Social Science Research. Education Research and Perspectives, Vol.38, No.1, 105-123. Hadlich, S.J., Kirov, A. and Lampinen, T., (2010). What Causes Schizophrenia? Big Questions in Science, Cor Zonneveld. Available at: http://www.simoncolumbus.com/wp-content/2011/04/BQSCI-CZonneveld-Essay-What-Causes-Schizophrenia-SJHadlich-AKirov-TLampinen.pdf Pickard, B., (2011). Progress in defining the biological causes of schizophrenia. Expert Reviews in Molecular Medicine / Volume 13 / 2011, e25 (21 pages). Galuppi, A.,   Turola, M.C., Nanni, M.G., Mazzoni, P.,  and  Grassi, L., (2010). Schizophrenia and quality of life: how important are symptoms and functioning? International Journal of Mental Health Systems, 2010, 4:31  Read More