Schizophrenia can be understood as a chronic form of mental health disorder that affects how an individual behaves, thinks or feels. Schizophrenic patients often seem distant or disconnected with reality, and even though it is not a common disorder, the effects can be very debilitating (Nimh.nih.gov 2018). Individuals suffering from Schizophrenia might often experience auditory hallucinations (‘hearing voices’), and develop paranoia (thinking someone is trying to hurt them). It can also affect their communication, emotions and thought process, and also reduce their ability to take care of themselves or to retain their jobs (Medlineplus.gov 2018).
Schizophrenia affects about 1% of the global population. Till date the exact cause(s) of schizophrenia or schizoid disorders have not been fully identified, however studies do show that such conditions can develop through a complex interaction between environmental, genetic physical and psychological factors. It might be possible that some people to be more prone to develop this condition, where certain events can trigger an episode of psychosis (nhs.uk 2018; Cunningham and Peters 2014). Tsoi, Hunter and Woodruff (2008) pointed out those genetic factors can play a crucial role in the aetiology of schizophrenia. This is justified by the fact that early brain development pattern of the brain and its neurotransmitter receptor system is highly regulated by genetic codes, and that environmental stress and ‘expressed emotion’ can cause an onset of the disorder. Other environmental factors that can also lead to the development of this disorder include exposure to viruses, malnutrition before birth, birth complications and psychosocial factors (Nimh.nih.gov 2018). Difference in brain chemistry and structures, involving the neurotransmitters dopamine and glutamate is also being linked with schizophrenia, while other studies shows such dysfunction can also occur during the development of the brain during puberty, caused by genetic and environmental factors (Steiner et al. 2015).
Onset of schizophrenia can occur between the ages of 16 to 30 years, but can also occur in children in rare cases. The symptoms caused due to schizophrenia can be classified into two categories: positive symptoms (like delusions or hallucinations that can alter thought processing, behaviour and cause detachment from reality) and negative symptoms (that can lead to withdrawal, disruptions to normal emotions and lack of function). Hallucinations can include seeing, hearing, feeling smelling or tasting something that does not exist out of the mind, and auditory hallucination (hearing voices) is the most common among them. The voices heard in these episodes of hallucination generally describe events or activities, discuss the thoughts or behaviour of the individual, instruct on specific actions, and also engage in active communication. The voices can also seem to come from different sources. Delusional symptoms include having a false or wrong conviction about something, based on an unrealistic or mistaken idea. This can severely affect the behaviour of the person. The episodes of hallucination can also lead to paranoid delusions (feeling that someone is, or attempting to watch, follow or even chase or persecute them). Though Disorders can also occur in schizophrenia that can affect their though process and cognition, leading to confusion. Though disorders can also reduce the ability to concentrate or communicate, and subsequently make the person more erratic and disorganized, and cause mood swings. The negative symptoms can cause a loss of motivation to care for themselves, and severity affect the memory, attention span, and can also cause depression and withdrawal and reduce cognitive and executive functioning as well as coherence (nimh.nih.gov 2018; nhs.uk 2018).
The patient, Mr X (name withheld to maintain confidentiality), a 21 year old male have already exhibited a reclusive behaviour, quit his job, showed inappropriate suspiciousness and stopped answering the door when his friends came. He even expressed suspicion that he was being used for experimentations on thought control by the government (delusional thought), where electrodes were being placed in his brain to receive specific signals. He was further assured of this when he heard the neighbour’s dog bark in the middle of the night, and he started receiving ‘coded messages’ and ‘covert signals’ from the radio all the time (hallucinations and paranoia). However, the patient did not show any signs of mood swings or dysfunction, his speech was understandable and was coherent, and did not exhibit any loss of disturbance in motor functions. The auditory hallucinations, reclusive behaviour, paranoid delusions and suspicions point out towards many of the ‘positive’ schizophrenic symptoms. Negative symptoms seem to be limited to the reclusive behaviour of the patient, and could potentially get aggravated over time if not treated.
Since the aetiology of this disorder is unclear, treatment options are aimed to reduce or remove the symptoms of the disease, and can involve antipsychotics, psychosocial treatment, coordinated specialty care (CSC) (Nimh.nih.gov 2018). The psychosocial treatment can further include several aspects like family education, illness management, Cognitive Behaviour and substance abuse (nimh.nih.gov 2018). O’Brien (2018) pointed out that social Therapy (CBT), rehabilitation, self help and advocacy groups, and interventions for addiction stigmatization have affected the health promotion needs for individuals with schizophrenia and their families, ignoring the need for symptom stabilization, prevention of relapse, and support to the caregivers. A sense of guilt, fear, grief or isolation felt by the family members or caregivers also renders them less proactive and capable of providing proper care. Moore et al. (2015) suggests that equity of access to all levels of healthcare like acute care, long term care and management, preventative medicine and health promotion can reduce the mortality risk due to schizophrenia. Carney, Bradshaw and Yung (2015) also added that intervention strategies should be investigated for individuals identified at risk for developing psychosis, and prevention of cardio metabolic risk factors in such individuals should be considered. Additionally, increasing physical activity, reduce sedentary lifestyle, and encouraging cessation of smoking can help to alleviate or even prevent the effects of schizophrenia. The importance of physical activity has also been highlighted by many other authors (Vancampfort et al. 2015; Stubbs et al. 2016; Rosenbaum, Tiedemann and Ward 2014; Stubbs et al. 2017)
Conclusion:
Schizophrenia and schizoid disorders have a complex aetiology, involving several causative factors in a complicated interplay. Genetic propensity, combined with environmental triggers can cause an early onset in susceptible individuals. Since the specific causes of schizophrenia are not well understood, treatment and management of this disorder aims to reduce or remedy the effects of the disorder on the individual, and health promotions are aimed to eliminate the risks that can trigger an onset of the disorder or promote recovery of affected individuals.
References:
Carney, R., Bradshaw, T. and Yung, A. (2015). Physical health promotion in people with schizophrenia: why we should consider the ultra high-risk state. Acta Psychiatrica Scandinavica, 133(2), pp.166-167.
Cunningham, C. and Peters, K. (2014). Aetiology of Schizophrenia and Implications for Nursing Practice: A Literature Review. Issues in Mental Health Nursing, [online] 35(10), pp.732-738. Available at: https://www.tandfonline.com/doi/full/10.3109/01612840.2014.908441 [Accessed 7 Feb. 2018].
Medlineplus.gov (2018). Schizophrenia: MedlinePlus. [online] Medlineplus.gov. Available at: https://medlineplus.gov/schizophrenia.html [Accessed 7 Feb. 2018].
Moore, S., Shiers, D., Daly, B., Mitchell, A. and Gaughran, F. (2015). Promoting physical health for people with schizophrenia by reducing disparities in medical and dental care. Acta Psychiatrica Scandinavica, 132(2), pp.109-121.
nhs.uk (2018). Causes. [online] nhs.uk. Available at: https://www.nhs.uk/conditions/schizophrenia/causes/ [Accessed 7 Feb. 2018].
nimh.nih.gov (2018). NIMH » Psychotherapies. [online] Nimh.nih.gov. Available at: https://www.nimh.nih.gov/health/topics/psychotherapies/index.shtml [Accessed 7 Feb. 2018].
Nimh.nih.gov (2018). NIMH » Schizophrenia. [online] Nimh.nih.gov. Available at: https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml [Accessed 7 Feb. 2018].
Nimh.nih.gov (2018). NIMH » Schizophrenia. [online] Nimh.nih.gov. Available at: https://www.nimh.nih.gov/health/publications/schizophrenia-basics/index.shtml [Accessed 7 Feb. 2018].
O’Brien, S. (2018). Health promotion and schizophrenia: the year 2000 and beyond. – PubMed – NCBI. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pubmed/9429351 [Accessed 7 Feb. 2018].
Rosenbaum, S., Tiedemann, A. and Ward, P.B., 2014. Meta-Analysis Physical Activity Interventions for People With Mental Illness: A Systematic Review and Meta-Analysis. Journal of Clinical Psychiatry, 75(0), pp.1-11.
Steiner, J., Schiltz, K., Bernstein, H.G. and Bogerts, B., 2015. Antineuronal antibodies against neurotransmitter receptors and synaptic proteins in schizophrenia: current knowledge and clinical implications. CNS drugs, 29(3), pp.197-206.
Stubbs, B., Chen, L.J., Chung, M.S. and Ku, P.W., 2017. Physical activity ameliorates the association between sedentary behavior and cardiometabolic risk among inpatients with schizophrenia: A comparison versus controls using accelerometry. Comprehensive psychiatry, 74, pp.144-150.
Stubbs, B., Firth, J., Berry, A., Schuch, F.B., Rosenbaum, S., Gaughran, F., Veronesse, N., Williams, J., Craig, T., Yung, A.R. and Vancampfort, D., 2016. How much physical activity do people with schizophrenia engage in? A systematic review, comparative meta-analysis and meta-regression. Schizophrenia research, 176(2), pp.431-440.
Tsoi, D., Hunter, M. and Woodruff, P. (2008). History, aetiology, and symptomatology of schizophrenia. Psychiatry, 7(10), pp.404-409.
Vancampfort, D., De Hert, M., Stubbs, B., Ward, P.B., Rosenbaum, S., Soundy, A. and Probst, M., 2015. Negative symptoms are associated with lower autonomous motivation towards physical activity in people with schizophrenia. Comprehensive Psychiatry, 56, pp.128-132.
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