Schizophrenia
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Schizophrenia is a psychotic disorder characterized by the profound disruption of basic psychological processes, a distorted perception of reality, altered or blunted emotion, and disturbances in thought motivation, and behavior (Schacter et al., 2015). Symptoms of schizophrenia usually start between ages 16 and 30. The disorder typically strikes with full fury in young adults, but warning signs are often evident before then, offering the possibility of earlier intervention. In rare cases, children have schizophrenia too. Many people with schizophrenia have difficulty holding a job or taking care of themselves, so they rely on others for help. Schizophrenia is a chronic condition and those who have it will have to manage it their entire life. Although there is no cure, many lead rewarding lives with treatment.
The symptoms of schizophrenia fall into three categories: positive, negative, and cognitive. “Positive” symptoms are psychotic behaviors not generally seen in healthy people. Positive symptoms include hallucinations, delusions, disordered thinking and speech, and agitated body movements. Hallucinations include seeing, feeling, tasting, hearing or smelling something that doesn’t really exist. The most common experience is hearing imaginary voices that give commands or comments to the individual. The delusions a schizophrenic may have are false ideas. This can show up as a schizophrenic believing they are someone they are not, or believing someone or something is trying to kill them. Disordered thinking and speech is moving from one topic to another, in a nonsensical fashion. Individuals may also make up their own words or sounds, rhyme in a way that doesnt make sense, or repeat words and ideas. Disorganized behavior associated with schizophrenia can range from having problems with routine behaviors like hygiene or choosing appropriate clothing for the weather, to unprovoked outbursts, to impulsive and uninhibited actions. A person may also have movements that seem anxious, agitated, tense or constant without any apparent reason. People with positive symptoms may “lose touch” with some aspects of reality.
“Negative” symptoms are associated with disruptions to normal emotions and behaviors. Examples of negative symptoms are social withdrawal, lack of interest or enthusiasm, and lack of drive, “flat affect” or reduced expression of emotions via facial expression or voice tone, reduced feelings of pleasure in everyday life, difficulty beginning and sustaining activities, and reduced speaking (Adam, 2014). Negative symptoms tend to persist longer than positive symptoms and are more difficult to treat. Some even suggest that the medication used to treat the positive symptoms may have caused negative symptoms. People with schizophrenia who have negative symptoms often need help with everyday tasks and with taking care of themselves. It can appear like the person with schizophrenia isn’t trying or doesn’t want help, but this is just a manifestation of his or her negative symptoms.
Cognitive symptoms of schizophrenia are disruptions in cognitive abilities like poor executive functioning, inability to sustain attention, and problems with short term memory. The cognitive symptoms of schizophrenia are largely resistant to current treatment and are thus a lifelong burden of the illness. Studies of cognitive symptoms have commonly focused on prefrontal cortex because of its demonstrated importance for executive function and working memory (Grohol, 2017). The cognitive deficits are not unique to schizophrenia, but because they affect mental abilities needed for day-to-day functioning as well as planning for the future. The cognitive symptoms are usually present long before the positive symptoms arise.
The risk of schizophrenia is higher in people who have relatives with the disorder. Studies indicate that the closer a person is related to someone with the disorder, the more likely that person is to develop the disorder (Moritz, 2017). The disease typically begins in early adulthood; between the ages of 15 and 25. Men tend to get develop schizophrenia slightly earlier than women (Adam, 2014). The average age of onset is 18 in men and 25 in women (Adam, 2014). Schizophrenia is a devastating disorder for most people who are afflicted, and very costly for families and society. The overall U.S. 2002 cost of schizophrenia was estimated to be $62.7 billion, with $22.7 billion excess direct healthcare cost (Foster, 2014). This affects approximately 1.1% of the population over the age of 18 in other words, or 51 million people worldwide. Approximately 200,000 individuals with schizophrenia or manic-depressive illness are homeless, making one-third of the approximately 600,000 homeless people in the United States alone. Unemployment is staggeringly high at 80–90%, and life expectancy is reduced by 10–20 years (Foster, 2014).
Successful treatment of schizophrenia depends on a lifelong regimen of both drug and psychosocial or support therapies. Schizophrenia is a combination of a thought disorder, mood disorder, and anxiety disorder, so the management of schizophrenia often requires a combination of medications, which may include antipsychotic, antidepressant, and antianxiety medications (Grohol, 2017). One of the biggest challenges of treatment is that many people don’t keep taking the medications prescribed for the disorder. After the first year of treatment, most people will discontinue their use of medications, especially if the side effects are difficult to tolerate (Grohol, 2017).
Antipsychotic medications help to normalize the biochemical imbalances that cause schizophrenia. There are two major types of antipsychotics, traditional and new. Traditional antipsychotics effectively control the hallucinations, delusions, and confusion of schizophrenia. Examples of traditional antipsychotic drugs are haloperidol, chlorpromazine, and fluphenazine. They work primarily by blocking dopamine receptors and are effective in treating the “positive” symptoms of schizophrenia (Schacter et al., 2015). The effectiveness of schizophrenia medications led to the dopamine hypothesis which suggested schizophrenia was caused by excess dopamine in the brain. The problem with this is that overactivity of dopamine in the brain is only associated with the positive symptoms of schizophrenia like hallucinations (Schacter et al., 2015). The negative symptoms of schizophrenia such as emotional numbing and social withdrawal may be related to underactivity of dopamine in the brain. As a result of this they do not treat the negative symptoms well. The “new” antipsychotics such as Seroquel, Risperdal, Zyprexa, and Clozaril block both the serotonin and dopamine receptors, thereby treating both the positive and negative symptoms of schizophrenia (Park, 2017).
While most people believe that psychotherapy doesn’t play