Schizophrenia is a psychotic disorder affecting all people, worldwide. Its prevalence is higher among males than females in which its onset is 25 years and 27 years in men and women, respectively.
The causes of this disorder are associated with genetic and environmental factors. Some genetic factors increase vulnerability of an individual to the disease, whereas environmental factors trigger the disease in vulnerable individuals.
Its main signs and symptoms include delusions, disorganized speech, catatonic behavior, and hallucinations.
Diagnosis of schizophrenia is based on DSM and ICD-10 criteria, and it involves differential diagnosis of other psychotic and medical issues.
Overall, the pathophysiology of this illness is related to abnormalities in brain structure, neurotransmitter and immune system. As such, treatment aims at addressing the symptoms of the disorder in which antipsychotic medication and psychosocial interventions serve as the main treatment approaches.
Regarding prognosis of schizophrenia, inadequate access to healthcare increases mortality. Suicide is one of the main causes of mortality among people with schizophrenia.
Conclusively, schizophrenia presents immense challenges, but research has been instrumental in improving its diagnosis and treatment.
Schizophrenia is a psychotic disorder that presents immense challenges to psychiatrists, as well as, other public health personnel. The complexity of this disorder is attributable to its debilitating effects. It affects an individual’s social functioning, behavior and thoughts, thus making it difficult for social interactions. Epidemiological data indicate that 0.3 to 0.7% of the global population is affected by Schizophrenia (Van Os & Kapur, 2009). However, its prevalence exhibits demographic inequalities in which the disorder occurs 1.4 times among males compared to females (Picchioni & Murray, 2007). Similarly, its onset occurs at different peak ages. This condition is report to occur early in men with the peak age of onset being 25 years compared to females whose peak age of onset is 27 years (Cascio, Cella, Preti, Meneghelli & Cocchi, 2012). According to Kumra, Shaw, Merka, Nakayama & Augustin (2001), onset of schizophrenia is rare during childhood. Overall, schizophrenia exhibits similar trends in incidence and prevalence, worldwide. On the other hand, schizophrenia causes many deaths and it is also responsible for 1% of disability adjusted life years (Picchioni & Murray, 2007). For instance, 20,000 schizophrenia-related deaths occurred in 2010 (Lozano, Naghavi & Foreman, 2012). Concisely, schizophrenia has immense clinical and psychosocial implications. This is why this term paper is intended to provide a comprehensive overview of schizophrenia.
Causes of Schizophrenia
From a critical analysis, the causes of schizophrenia remain unclear. However, it is apparent that the onset of the disorder is related to a mystic interplay between environmental and genetic factors. Over the decades, schizophrenia has been found to exhibit hereditary traits. This implies that hereditary factors are involved in the occurrence of the disorder. The hereditary component of schizophrenia is evidenced by genetic studies in which first-degree relatives have been found to develop the disorder more than the general population. It is reported that the risk of developing schizophrenia is 1% and 10% in general population and first-degree relatives, respectively. However, it is worth noting that genetic predisposition only influences schizophrenia’s onset, because there are not hereditary genes that links genetics with the cause of the disorder. These revelations are based on actual epidemiological data that shows that 60% of people with schizophrenia do not a family history of the disorder.
On the other hand, environmental factors are believed to have an immense impact on the onset of schizophrenia. Clinical studies reveal that environmental factors triggers schizophrenia in vulnerable individuals, especially those who possess inherited genetic components that increase the disorder’s vulnerability. This phenomenon has been confirmed by twin and adoption studies, and extensive research on the same is ongoing, in order to unravel the underlying pathological factors. Another significant environmental factor that has been found to cause schizophrenia is psychosocial stress. Ordinarily, stress and anxiety have been found to impair cognitive functioning. In this context, increases in cortisol levels which are caused by stress are believed to trigger schizophrenia. Similarly, other stress-inducing environmental factors have been linked with the development of schizophrenia. Some of these factors include exposure to viral infections, especially during prenatal or infancy, childhood sexual or physical abuse, and oxygen insufficiency during birth. Family issues such as early parental separation or death have also been found to play key roles in the development of schizophrenia among adults.
Abnormalities in brain structure and chemistry have also been associated with the development of schizophrenia. The fact that schizophrenia affects cognition implies that the respective brain regions are affected. For instance, the enlargement of brain ventricles among most schizophrenics reveals that abnormalities in the volume of brain tissue are linked to schizophrenia (Wright, Rabe-Hesketh & Woodruff, 2000). Another correlation is obtained from the abnormalities in the frontal lobe. Most schizophrenics exhibit low activity in this lobe which is responsible for decision-making, reasoning and planning. Moreover, abnormalities in amygdale, hippocampus and temporal lobes have been associated with the development of schizophrenia.
Signs and Symptoms of Schizophrenia
Ordinarily, the onset of schizophrenia occurs gradually through different phases. It begins with early warning signs before the occurrence of the initial severe episode. However, some individuals experience an abrupt appearance of the disorder without warning signs.
Early Warning Signs
During the early warning phase, most people are observed to exhibit behavioral changes. In most cases, they seem emotionless, unmotivated, eccentric, and reclusive. Some of the most common early signs of this disorder are social withdrawal, hostility, depression, expressionless gaze, forgetfulness, extreme reaction, especially to criticism, and problems in personal hygiene.
On the other hand, full-blown schizophrenia is characterized by five main types of symptoms: delusions, disorganized speech, negative symptoms, disorganized behavior, and hallucinations.
Delusions are the most common occurring symptoms of schizophrenia with over 90% of schizophrenics showing delusions. However, the natures of delusions are diverse although they reflect bizarre or illogical ideas. For instance, some people experience delusions of persecution, whereas others experience delusions of reference, grandeur or control.
Hallucinations are strange sounds or sensations in one’s mind that are not real. In theory, hallucinations involve the five principal senses, although auditory and visual hallucinations are common among schizophrenics. It has been found out that hallucinations often occur when the person is solitude or alone. In most cases, auditory hallucinations involve voices or sounds that are abusive, vulgar or critical, and this can explain the aggressiveness among schizophrenics.
Schizophrenics are observed to show a high degree of cognitive impairment. This is demonstrated by the disruption of goal-oriented activities such as work, social interactions and personal hygiene. In most cases, disorganized behavior is shown by lack of impulse or inhibition control, bizarre behaviors, unpredictable emotional responses, and decline in daily functioning.
Disorganized speech is another main characteristic of schizophrenia. Ordinarily, schizophrenics experience fragmented thinking which is shown by difficulties in maintaining a line of thought or adequate attention span. The key speech disorganization signs include loose associations between thoughts, neologism, perseveration, and clanging.
Schizophrenics express the absence of normal behaviors that are expressed by resilient individuals. Some of the most common negative symptoms associated with schizophrenia include social withdrawal, lack of enthusiasm, speech difficulties or absence of emotional expression including restricted facial expression, blank staring and flat voice.
Diagnosis of Schizophrenia
Diagnosis of schizophrenia exhibits difficulties due to its close resemblance to other psychotic disorders. In practice, diagnosis of schizophrenia is based on several aspects. Foremost, a comprehensive psychiatric evaluation and physical examination are essential in effective diagnosis of the disorder. In addition, medical history and clinical laboratory tests aid in the diagnosis of schizophrenia. Psychiatric evaluation involves an inquiry on the psychiatric history, individual’s symptoms, and history of mental health problems. On the other hand, medical history and physical examination focus on identifying any underlying medical issues that may be linked to the disorder. Finally, laboratory tests aim at identifying abnormalities in brain structure and chemical balance. It also plays a key role in differential diagnosis to rule out other medical conditions that express similar symptoms with schizophrenia (Lehman, Lieberman, Dixon, McGlashan, Miller, Perkins & Kreyenbuhl, 2010).
In order to ensure accurate diagnosis, comprehensive diagnostic criteria have been developed. Diagnosis can be based, either on the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) criteria developed by the American Psychiatric Association or the WHO’s ICD-10 (International Statistical Classification of Diseases and Related Health Problems) criteria. In the United States, DSM-5 criteria has gained widespread acceptance by psychiatrists. These criteria aim at determining certain severity for diagnosis (Picchioni & Murray, 2007).
Overall, diagnosis is made if two or more of the main symptoms are present for at least 30 days. These symptoms include delusions, negative symptoms, disorganized speech, hallucinations, and catatonic or disorganized behavior. Other key symptoms that should be present include functioning problems such as poor personal hygiene, impaired social interactions and working or schooling problems. In addition, history of continuous occurrence of schizophrenia signs for at least 6 months with the active symptoms persisting for at least 1 month is used in these criteria. Finally, there should be no other medical condition and psychotic disorder diagnosed or substance abuse problem (American Psychiatric Association, 2000).
Conditions with Similar Symptoms with Schizophrenia
In practice, it is recommended that other medical and psychological conditions are ruled out before schizophrenia diagnosis, in order to avoid misdiagnosis. Some of these conditions include other mental health disorders, substance abuse, mood disorders, and Post-traumatic stress disorder (PTSD).
There are several psychotic disorders that mimic schizophrenia symptoms. Some of these disorders include brief psychotic disorder, schizophreniform and schizoaffective disorder. Due to the complexity involved in differentiating these disorders from schizophrenia, correct diagnosis may be achieved after more than 6 months.
Addictive substances are known to trigger psychotic symptoms. For instance, drugs such as heroin, cocaine, alcohol, and amphetamines are associated with psychotic symptoms. On the other hand, some prescription and over-the-counter drugs are known to cause psychotic reactions. Therefore, toxicology screening aids in diagnosis substance abuse.
Mood Disorders and PTSD
Mood disorders are believed to mimic schizophrenia, especially mania and depression. In most cases, diagnosis of schizophrenia is complicated by bipolar disorder and depressive disorder because they show similar positive and negative symptoms. For instance, bipolar disorder is characterized by disorganized speech, hallucination and delusions, the main symptoms of schizophrenia. On the other hand, depressive disorder shows social withdrawal, apathy and reduced activity as the key symptoms. These features are considered as negative symptoms for schizophrenic episodes.
Pathophysiology of Schizophrenia
From a clinical perspective, schizophrenia progresses through a particular pathophysiological course. Overall, clinical studies indicate that the pathophysiology is associated to abnormalities in immune system, neurotransmitters and anatomical changes. Anatomical abnormalities have been identified in schizophrenics through neuroimaging techniques in which decreased brain volume, changes in hippocampus and larger ventricles are the main anatomical abnormalities (Mattai, Hosanagar, Weisinger, Greenstein, Stidd & Clasen, 2010). Recent studies indicate that changes in prefrontal lobes among people with schizophrenia are responsible for increased severity of the main symptoms (McIntosh, Owens, Moorhead, Whalley, Stanfield & Hall, 2011). On the other hand, abnormalities in the dopaminergic system have been found to be responsible for the pathophysiology of schizophrenia. For instance, neurotransmitter substances, especially N -methyl-D-aspartate (NMDA) and its antagonists such as ketamine and phencyclidine are linked to the development of schizophrenic negative symptoms (Cioffi, 2013). Moreover, abnormalities in the immune system, especially its overactivation by stress or prenatal infection, play key roles in the pathophysiology of schizophrenia. Drexhage et al. (2011) report that schizophrenics show disturbed immune function with an active kynurenine pathway which is responsible for inflammation responses.