Understanding Schizophrenia: Symptoms, Causes, And Treatment

Schizophrenia: Symptoms and Prevalence

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Psychotic disorders refer to a group of serious diseases or illnesses that are found to affect the human mind. These psychotic disorders often make it difficult for the individuals to make good judgments, think apropriately, communicate effectively, respond emotionally, behave appropriately, and understand reality. Presence of severe symptoms, results in extreme difficulties for the people to remain in contact with the reality. This in turn leads to severe impairment in carrying out daily activities (Heckers et al., 2013). Major psychotic disorders result in an abnormal condition of the state of mind that makes it difficult for the individuals to distinguish between things and events that are real and not real.

Major symptoms include false belief, observing or hearing things that others fail to perceive, incoherent speech, sleep difficulties, social withdrawal and lack of motivation. The most common psychotic disorders include bipolar disorder, schizophrenia, general anxiety disorder, and postpartum psychosis. This report will elaborate on schizophrenia, a prevalent psychotic disorder.

Schizophrenia is a highly prevalent psychotic disorder that is primarily characterized by manifestation of an abnormal social behavior that makes the individuals display a failure to understand basic reality (Hallak et al., 2013). The major symptoms of the disorder include confused or unclear thinking, false beliefs, auditory hallucinations, lack of emotional expression, reduced social engagement and complete loss of motivation. Furthermore, the individuals suffering from schizophrenia report additional mental health problems namely, depressive, anxiety, or substance-use disorders (Shinn et al., 2013).

Distortions of self-experience that manifests in  the form of one’s feelings or thoughts lead to passivity phenomena, one of the most common symptom of schizophrenia. Social isolation also occurs. This in turn leads to difficulties in long-term and working memory, executive functioning, processing speed and attention. Furthermore, visual and auditory hallucinations are the most commonly reported symptoms of schizophrenia. These symptoms are also accompanied by delusions, persecutory or bizarre thinking and disordered speech.

Schizophrenic disorder is found to affect individuals during their early childhood and late adolescents that act as crucial years in the vocational and social development. Research studies have provided evidence that correlates occurrence of schizophrenia among people aged above 19 years of age. In other words, it affects young adults. The psychotic symptoms related to schizophrenia are commonly found to emerge in individuals in early 20s and late teens, primarily in their mid-20s to their early 30s (Agnew-Blais & Seidman, 2013). In addition, schizophrenia seldom occurs after before puberty or after the age of 45 years. However, researchers have provided evidence for the onset of schizophrenia related symptoms among children, as young as 5 years. The high prevalence of the psychotic disorder in adolescents are generally manifested in the form of first signs that include drop in grades, change of friends, irritability and sleep problems. Hence, unlike other psychotic disorders, schizophrenia occurrence is fairly unique in young adulthood (De Herdt et al., 2013). Hence, the age group of 19-26 years can be considered at an increased likelihood of suffering from this condition.

Treatment of Schizophrenia

Sex differences do exist in the aforementioned psychotic disorder that is more commonly found in men, compared to women. The male to female ratio of schizophrenia is found to be 4:1. Women exhibit more susceptibility to experience range of symptoms that pertain to this psychotic disorder in their life (Eranti et al., 2013). More emotional and psychotic problems are displayed by women, than men. Furthermore, women diagnosed with schizophrenia also have fewer offspring, than females who are not affected (Wischhof et al., 2015).

Treatment of the disorder should involve administration of antipsychotic medications to the individuals, in combination with social and psychological support. This might also require voluntary or forced hospitalization. Antipsychotic medications are considered as the first-line psychiatric treatment for schizophrenic symptoms. They play a crucial role in reducing the positive symptoms related to psychosis in approximately 7-14 days (Leucht et al., 2013). Furthermore, the antipsychotics also bring about significant improvements in cognitive dysfunction and negative symptoms. Thus, continuous administration of antipsychotics reduces the risks of relapse. However, prolonged use of antipsychotics often result in dopamine hypersensitivity, which in turn increases the risks of recurrence of major psychotic symptoms, upon stopping the medicines (Mueser et al., 2013). The major antipsychotics that are used for treating schizophrenic individuals include olanzapine, riserpidone, clozapine and amisulpride. In addition, certain psychosocial interventions that include family therapy, supported employment, cognitive remediation and assertive community treatment are also considered useful (Morrison et al., 2014).

• H1- Antipsychotic medications will improve the symptoms that are associated with high prevalence of schizophrenia among young adults aged 18-26 years.
• H2- Women belonging to the young adult age group, suffering from schizophrenia will benefit more from the antipsychotic treatment, upon comparison to men

All participants, recruited for the study were diagnosed with schizophrenia and/or schizoaffective disorder, according to the DSM-V criteria, in addition to a confirmation of their psychotic disorder by family informants, direct assessment, and medical history (Tandon, Bruijnzeel & Rankupalli, 2013). The participants were recruited from the psychology wards across five major hospitals, located in the city by randomisation. Detailed brochures that contained information about the purpose of the study were sent to the hospitals, following which the participants were selected based on the following criteria:

• Must be within 18-26 years of age
• Must not suffer from any developmental disabilities
• Must have normal auditory skills
• Must not gave history of any other severe neurological problems, except those associated with the disorder

A total of 66 participants met the eligibility criteria, of whom 27 were males, and 39 females. All of them belonged to the age group 18-26 years. The participants were initially subjected to antipsychotic medications for 3 months, followed by placebo effect for the following three months.

A self-administered questionnaire was provided to the participants to demonstrate the effects of antipsychotic medications (injections) compared to placebo treatment (saline injection) on manifestation of schizophrenia symptoms. The questionnaire was kept close ended that made the participants provide responses in either ‘yes’ or ‘no’.  Questions such as, “do you hear or see things that are unreal after taking medicines?”, or “has the medicines increased your ability to control your thoughts?” were presented. The responses were given scores, based on which the final scores for the baseline treatment and the placebo group were computed. The questionnaires were provided at the beginning and end of treatment of both the treatment periods.

Research Hypotheses

Prior to the recruitment, the participants were provided consent forms in sealed envelope that also contained detailed information on the nature and purpose of the study. They were enlisted for the study after obtaining their informed consent that demonstrated their voluntary participation. Prior approval was obtained from the ethics committee for conducting the study on human subjects. Furthermore, signed documents were presented to the hospital authorities and the participants to show that adequate efforts would be taken to protect the privacy of the subjects and maintain confidentiality of the obtained data.

Table 1 Comparison of the baseline treatment and placebo treatment
Pa	Total	Males	Females
Mean age for whole sample	21.151515
Age range for whole sample	8
Total number	66	27	39
Range of baseline scores	36
Range for end of treatment scores	8
Final scores for active treatment groups	2623
Final scores for placebo treatment group	1404
Mean scores for baseline treatment group	50.65 (active), 51.42 (placebo)
Mean score for end of treatment group	10.91 (active), 30.15 (placebo)
Mean final scores for active treatment group	39.74424
Mean final score for placebo treatment group	21.2727

At the end of the study, all patients could not be accounted for, since some refused to show compliance to the treatment and some withdrew. Thus, a total of 66 participants were analysed at the end of both treatments. More number of females was recruited for the study. The end of treatment scores were subtracted from the initial scores obtained from the baseline treatment, which in turn provided the final scores. The final scores suggested that participants reported less symptoms related to auditory of visual hallucinations, delusions, disorganized thoughts, sleeping problems and apathy, at the end of placebo treatment (saline injections). The data presented above indicates that lower scores were obtained in the placebo group, which in turn establishes the fact that the treatment was considered by the patients as real medical treatment. This fake treatment did not contain any active substance that might have altered the functions of the neurotransmitters and affected development of schizophrenia symptoms (Loebel et al., 2013). Thus, the data in table 1 demonstrates that the placebo was successful in changing the perceptions of the participants regarding the potential benefits experienced by them, thereby making them provide responses that indicated lower scores and better health status.

Females were found to report more symptoms and had scores that ranged from 24-61, at the end of treatment, upon administration of antipsychotics. On the other hand, males reported fewer symptoms that can be deciphered from the low score range of 22-56, at the end of treatment. In addition, the males present in placebo group showed higher scores (range 5-45). However, the females having received placebo treatment demonstrated lower scores (range 0-38). This establishes the fact women were more affected by the placebo treatment, which in turn made them perceive fewer events that were related to schizophrenia symptoms. Thus, the data in graph 1 demonstrates a large reduction in symptoms associated with hallucinations, delusions, and trouble in concentrating. Moreover, upon receiving the placebo treatment, lower rates of symptoms related to confused speech and disoriented thoughts were observed. These lowered symptoms were more common in females, than males. Hence, the placebo treatment showed more significant effects on females.

Participants

An interpretation of the results suggested that the placebo treatment that involved administration of saline injections were more effective than the antipsychotic medications in reducing perceived presence of schizophrenia symptoms in young adults. The results helped to determine that all kinds of antipsychotic medications that were administered such as, risperidol, clozapine and olanzapine were not able to induce feelings in the participants that were associated with fewer experiences of acute schizophrenic symptoms. The saline injection placebo treatment was given to all participants to deceive them into thinking that the antipsychotics were being administered. The patients failed to distinguish between the differences in the two treatments that they were subjected to, and considered an enhancement of their health status, after the placebo treatment.

Although, the scores obtained at end of treatment in the active treatment group and the placebo group support the hypothesis that antipsychotic medications will improve the symptoms among the participants, the final scores do not support the hypothesis. The final scores suggest that the placebo treatment was able to improve the schizophrenia symptoms, upon comparison to active treatment.  However, the second hypothesis that stated women will experience more improvement of symptoms, in comparison to men was supported by the final result scores. Women gave responses that added up to less scores, thereby indicating fewer symptoms.

Previous literature review suggested that antipsychotic treatments are generally used as the first line of medications for treating symptoms, presented by patients, suffering from schizophrenia (Frances, 2013). These medications have shown considerable benefits in managing psychosis such as, hallucinations, delusions, paranoia and disordered thoughts (Mueser et al., 2013). However, the final scores did not provide sufficient evidence to confirm the previous findings. Considerable benefits were demonstrated by the participants, on receiving the placebo treatment. Furthermore, the literature evidence also indicated the fact that women were more likely to experience psychotic disorders and emotional problems, later on in their lives. This finding was validated by the final scores that helped in drawing conclusion that women reported greater rates of improved or lowered symptoms (Eranti et al., 2013). The fact that more number of females had been recruited in the sample, might have resulted in a bias in the final scores.

The major limitations are associated with recruitment of small sample and obtaining scores based on self-reports. This could have been improved by conducting an assessment of the mental state, with the use of the DSM-V criteria, which in turn would have facilitated better assessment of any improvement in the presenting complaints. Implications of the findings suggest that further research on placebo treatment, with the use of saline injection should be conducted, to determine its direct effects on schizophrenia symptoms.

Materials

To conclude, it can be stated that the placebo treatment effect is more than reinforcing a positive thinking, which makes the patients believe that the procedure or treatment will work. Placebo effect creates a stronger connection with the neural networks that gives rise to perceptions, related to less schizophrenia symptoms.

References

Agnew-Blais, J., & Seidman, L. J. (2013). Neurocognition in youth and young adults under age 30 at familial risk for schizophrenia: a quantitative and qualitative review. Cognitive neuropsychiatry, 18(1-2), 44-82.

De Herdt, A., Wampers, M., Vancampfort, D., De Hert, M., Vanhees, L., Demunter, H., … & Probst, M. (2013). Neurocognition in clinical high risk young adults who did or did not convert to a first schizophrenic psychosis: a meta-analysis. Schizophrenia research, 149(1), 48-55.

Eranti, S. V., MacCabe, J. H., Bundy, H., & Murray, R. M. (2013). Gender difference in age at onset of schizophrenia: a meta-analysis. Psychological medicine, 43(1), 155-167.

Frances, A. (2013). Saving normal: An insider’s revolt against out-of-control psychiatric diagnosis, DSM-5, big pharma and the medicalization of ordinary life. Psychotherapy in Australia, 19(3), 14.

Hallak, J. E., Maia-de-Oliveira, J. P., Abrao, J., Evora, P. R., Zuardi, A. W., Crippa, J. A., … & Dursun, S. M. (2013). Rapid improvement of acute schizophrenia symptoms after intravenous sodium nitroprusside: a randomized, double-blind, placebo-controlled trial. JAMA psychiatry, 70(7), 668-676.

Heckers, S., Barch, D. M., Bustillo, J., Gaebel, W., Gur, R., Malaspina, D., … & Van Os, J. (2013). Structure of the psychotic disorders classification in DSM?5. Schizophrenia Research, 150(1), 11-14.

Leucht, S., Cipriani, A., Spineli, L., Mavridis, D., Örey, D., Richter, F., … & Kissling, W. (2013). Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. The Lancet, 382(9896), 951-962.

Loebel, A., Cucchiaro, J., Sarma, K., Xu, L., Hsu, C., Kalali, A. H., … & Potkin, S. G. (2013). Efficacy and safety of lurasidone 80 mg/day and 160 mg/day in the treatment of schizophrenia: a randomized, double-blind, placebo-and active-controlled trial. Schizophrenia research, 145(1), 101-109.

Morrison, A. P., Turkington, D., Pyle, M., Spencer, H., Brabban, A., Dunn, G., … & Grace, T. (2014). Cognitive therapy for people with schizophrenia spectrum disorders not taking antipsychotic drugs: a single-blind randomised controlled trial. The Lancet, 383(9926), 1395-1403.

Mueser, K. T., Deavers, F., Penn, D. L., &Cassisi, J. E. (2013). Psychosocial treatments for schizophrenia. Annual review of clinical psychology, 9, 465-497.

Shinn, A. K., Baker, J. T., Cohen, B. M., & Öngür, D. (2013). Functional connectivity of left Heschl’s gyrus in vulnerability to auditory hallucinations in schizophrenia. Schizophrenia research, 143(2), 260-268.

Tandon, R., Bruijnzeel, D., & Rankupalli, B. (2013). Does change in definition of psychotic symptoms in diagnosis of schizophrenia in DSM-5 affect caseness?. Asian journal of psychiatry, 6(4), 330-332.

Wischhof, L., Irrsack, E., Osorio, C., & Koch, M. (2015). Prenatal LPS-exposure–a neurodevelopmental rat model of schizophrenia–differentially affects cognitive functions, myelination and parvalbumin expression in male and female offspring. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 57, 17-30.