Running Head: Schizophrenia

Schizophrenia Heather Harris SUNY IT April 26, 2011

Schizophrenia Schizophrenia is a disorder that is cause for great debate and concern. The stigma associated with any mental health disorder is traumatic however the stigma attached to schizophrenia is surrounded by misunderstandings and many myths. The disorder was first diagnosed as early as 1887 by Dr. Kraepelin who referred to the disorder as early dementia or dementia praecox (Schizophrenia, 2012). The name associated with the disorder was changed to Schizophrenia in 1911 by Dr. Bleuler. The name was changed to more accurately reflect the disorder. The term schizophrenia is derived from the Greek term Schizo meaning to split and phrene means of the mind. This term was not to be confused with multiple personality but more closely related to the disorders characteristics of an individuals inability to determine what is real and what isnt. (Schizophrenia, 2012) In the United States 2.2 million people are suffering from the life changing effects of Schizophrenia. The prevalence rate in the U.S is 7.2 per 1000 people. The incidence rate is one in 4,000 which translates to 100,000 new diagnoses in the US this year (Schizophrenia, 2012). Schizophrenia is typically diagnosed in men between the ages of teens and 20s and women between the ages of 20s and 30s (Mayo Clinic, 2012). There are three different types of Schizophrenia; Paranoid which is classified with auditory hallucinations and delusions associated with conspiracies, Disorganized which is displayed by an inability to control emotions and manage daily activities, Catatonic which is associated with a unusual body movement, Undifferentiated whose characteristics do not meet any of the criteria of any other form of Schizophrenia, and Residual which is seen in an individual who no longer has symptoms or has a lesser degree of symptoms than previously diagnosed.(Tartakovsky, 2009) The symptoms associated with this disorder are divided into 3 categories positive, negative and cognitive. Positive symptoms are represented by a deviation in normal functions and can include delusion,

Schizophrenia hallucinations, disorganized behavior and thought disorders. Negative symptoms are represented by a variation in normal activities such as lack of emotion, social withdrawal, loss of motivation, and inability to carry out daily activities. Cognitive symptoms are associated with complications of the thought processes. Examples of cognitive symptoms include memory loss, and difficulties in comprehension. Diagnosis of this disorder is verified during assessment when evaluated by a trained medical professional and these symptoms are present for at least a month with persistent disturbances noted for 6 months or more. (Grohol, 2011) Since the disorder can occur early in men the symptoms in teenagers are similar to that of adults but symptoms may mirror those of typical teenagers during this time such as irritability, social struggles and trouble sleeping. The causes of schizophrenia are unknown but thought to be linked to genetic, brain chemistry and environmental causes. There are factors that increase the risks of developing the disorder such as stressful life events, increased paternal age, and exposure to viruses or chemicals while a fetus (Mayo Clinic, 2012).Additional risk factors include paranoia, social impairment and substance abuse (Tartakovsky, 2009). Complications of this disorder can include depression, family conflicts, and inability to work, poverty, substance abuse, and suicide. There is no diagnostic test for schizophrenia. Before a diagnosis of schizophrenia is made lab tests and psychiatric evaluation is completed to ensure that the cause for the disordered functioning is mental health related and not associated with a physiological cause such as a metabolic conditions or a neurological conditions (Mayo Clinic, 2012). Treatment is focused on lifelong maintenance. Many healthcare providers are involved in a patients care. Examples of providers included in patient care are psychiatrists, psychologists, social workers and case managers. It also consists of a combination of medication and psychotherapy. Each medication affects each individual in a different way so it is important that

Schizophrenia the patient works closely with the prescribing physician for medication changes. There are two different classifications for medication administered for Schizophrenia; Typical and Atypical. Typical antipsychotics were developed in the early 1950s and are primarily effective in reducing the delusions and hallucinations. Examples of these medications include Thorazine, Haldol and Prolixin. The challenges that are associated with drug compliance usually surround the side effects. For typical antipsychotics side effects include extrapyramidal actions which include restlessness, muscle spasms and pacing. Long term side effects of these medications include tardive dyskenesia which is involuntary movements of the body and facial grimacing. The second classification of medication is called atypical antipsychotics which were created in the 1990s as an alternative to the typical antipsychotics and their side effects. The Atypical antipsychotics were effective in treating not only the positive effects of the disorder but additional negative ones as well. Examples of these medications included Abilify, Risperidal, Zyprexa and Clozaril. Side effects associated with these medications included weight gain, increased risk for diabetes and heart disease.(Tartakovsky, 2009) Medications can take several weeks before symptom improvement is noticed (Mayo Clinic, 2012) People who suffer from psychotic or paranoid symptoms can risk worsening of symptoms and violent behavior if medications are stopped abruptly.(Grohol,J.M,2006) The challenges associated with medication adherence are abundant. The side effects are sometimes more difficult than the disease itself. In order to have an effect course of treatment it is essential for the medical profession to have an open and interactive relationship with the patient. Patient physician relationships have evolved over the past century. The traditional paternalistic model is a sign of the past where all care was determined by the physician and the patient had little or no say in the recommended treatment. In a recent study conducted regarding

Schizophrenia the patient provider relationship it was identified that patients are more complaint with medication regimens if they are an active part in the decision making process. This process includes sharing treatment options, identifying the pros and cons of each method, and discussing possible side effects and convenience related matters. During the study 45,700 participants were studied to determine what barriers were identifying in achieving the patients treatment goal. Some of the issues that were found included the patients reluctance to ask the physicians questions, the physician did not clarify questions and answers posed by the patient which only left the patient confused, and patients feeling that the physician was not always acting for their benefit or was not telling the complete truth. In order for physicians and healthcare providers to effectively aid their patients they need to explain reasons for and against medicine treatment options as well as treating the patient with respect and dignity. This is key when the patient has identified a non adherence to the treatment plan. Providers can utilize a variety of therapies in aiding their patient in medication compliance. One of these treatments includes adherence therapy which can be defined as a joint structured approach to cognitive-behavioral therapy in addition to compliance therapy, and motivational interviewing. Collaboration with the patient is key to effective treatment and disorder management for achieving personal goals. (Simos, 2012) With such an important part of treatment being medication administration and adherence there is countless research and information regarding better adherence. When a decision has been made that the current medication is no longer effective there is little research to aid providers in the transition between old and new. Based on the initial medication compounds the transition if done incorrectly can cause withdrawal symptoms and unnecessary adverse reactions. Information regarding this recommends a cross taper with a slow titrations over the course of a couple weeks and should eliminate most adverse effects. (Sue, 2012)

Schizophrenia Sexual dysfunction is a common side effect reported by patients. It is determined that approximately 50% of patients suffer from this complication. It is a very important aspect of life and should be addressed by the healthcare professional. (Altamura, 2000) As noted with the atypical antipsychotic medication weight gain is also a reported side effect. In a study conducted to evaluate alternatives in medication and their related side effects encouraging news has been obtained. The study was conducted with a group of 636 participants. The participants who were studied had switched from Zyprexa to Abilify or Seroquel . The results showed a decrease in BMI as well as weight loss. (Mukundan & Faulkner et. al, 2010) However other studies have shown that from 2005 to 2009 there has been a decrease in the prescribing of atypical medications such as Zyprexa by 8% and an increase in prescribing of typical antipsychotics by 38%. (Pringsheim & Lam et.al,2011) The second major component to treatment is psychotherapy. It has different approaches but each aim at allowing the patient ability to return to a functional status of living. Recent analyses of the effectiveness of psychological treatment were evaluated. The findings indicated that a combination of cognitive and coping oriented therapy approaches were effective in reducing the number of relapses that a patient suffered from. Cognitive behavioral therapy was also shown to be effective in reducing the number of inpatient days as well as the severity of positive symptoms that are associated with the disease. (Brenner & Pfammater, 2000) In evaluation of the effectiveness of treatment a self assessment and self reporting tool is utilized. There are extensive debates to which tool provides the most accurate information. A target study looked at the Bonn Scale of the Assessment of Basic Symptoms (BSABS) and determined that it did provide an effective means for screening and diagnosis however further studies should be completed to determine its validity within a larger population sample. (Jong-Hoon & Jinyoung,

Schizophrenia 2011) Other treatment and screening tools have been developed and evaluated for evaluation purposes. One tool is the Perceived Rehabilitation Needs Questionnaire for people with Schizophrenia (PRNQ-S) which was tested. 219 participants were studied and tested and overall the tool was felt to be a comprehensive aid in assessing the perceived as well as actual needs of people suffering from Schizophrenia. Although there is concern regarding the definition of what a need is there is considerable understanding obtained from this tool that helps identify the needs of these individuals. Needs which help aid in developing and providing evidence based rehabilitation services (Wong &Tsang et. al, 2010) With the high rate of relapse in Schizophrenia the evaluation of each patients progress should be continually evaluated and assessed. This assessment should be not only be symptom driven but also include social functioning as well as a review of quality of life. During a study conducted of 103 patients and utilizing the Personal and Social Performance Scale (PSP) there was a confirmed association between psychopathology and social functioning.(Schaub&Brune et. al, 2009) Substance abuse can also play a very important role in recovery. Individuals who use cocaine or amphetamines can experience worsening of symptoms when using these drugs. Nicotine is the most common substance utilized by patients with Schizophrenia. It is reported that approximately 75-90% of the patients diagnosed with Schizophrenia smoke. Research believes that this is a result of patients attempts to self medicate their symptoms as Nicotine interferes with the bodys response to the anti-psychotic medications. Nicotine withdrawal can also cause a worsening of symptoms making it more of a challenge for patients to quit. (Grohol, 2006)

Schizophrenia Recent studies of first episode psychosis have shown an average time between onset of psychotic symptoms and first effective treatment is often one year or more with some patients indicating 3 or more years. First episode schizophrenia patients had an average of nine contacts with healthcare professionals before finally receiving treatment. (Altamura, 2000) Gender differences were also studied in the first episode of psychosis and a study of 269 individuals. Findings showed that women were able to obtain better social functionality and a higher level of compliance in treatment than men. However women were found to have a higher level of medication administration and a longer duration in illness before receiving treatment. Men were found to have more associated negative symptoms and a greater incidence of substance abuse and associated social isolation. These findings recommend that more specific interventions be made in treatment plans associated with gender for better compliance. (Koster, 2008) Schizophrenia is one of the ten leading causes of disability in the world. Percentages of individuals who suffer from the disorder receiving treatment are approximately 80% in the United States. This number is much higher than other countries such as Beijing where only 58% of the people with this disorder receive care. (Wong &Tsang et. al, 2010) Studies of patients with Schizophrenia have also looked at the effects of the duration of untreated illness, number of previous hospitalizations, number of psychotic episodes and the age of onset to determine the patients psychosocial functioning level. In using the Global functional Scale 114 patients were studied. Findings showed that the number of psychotic episodes was the strongest indicator in lower level of functioning. Age of onset was also a strong factor. The level of a patients support from family and friends is also a key indicator of how well they are able to function. (Stefanopoulou & Lafuente et. al, 2011)

Schizophrenia The future of research and improvement in medications and therapy provide hopeful news to the people suffering from this disorder. Research in diagnostics for schizophrenia is currently reviewing markers found in blood samples for two key symptoms hallucinations and delusions which may help in detecting the disorder sooner resulting in quicker and more effective treatment.(Knaresboro, 2011) Patients improvement is also supported by their team of healthcare providers and their avocation for the improved health and wellbeing of each individual. (Bengston, 2011) There are many myths and stereotypes associated with Schizophrenia. The resources and information on the internet provide a mix of information that can be contradictory and inaccurate. Although the internet is a primary resources for information on schizophrenia (Guada &Venable, 2011). To ensure patients are getting the most accurate information healthcare providers need to educate patients and their families regarding the internet and how to evaluate and indentify the validity and quality of the information online. In an effort to better understand the validity of the information online a study was conducted of the major intranet sites i.e. Google, Yahoo, and MSN. Schizophrenia was placed as a search subject and the validity of information was reviewed. The results showed that of the For Profit sites the information was 84% correct whereas the Non-profit sites were 59% accurate. These scores show the sites offered good quality information and features on the disorder (Guada &Venable, 2011). With so much information available on the Internet and within social media the statistics that 85% of Americans are aware that Schizophrenia is a disorder but only 24% truly understand the disorder. Some of the myths include; Individuals with Schizophrenia all have the same symptoms, people with Schizophrenia are dangerous, unpredictable and out of control, there are psychotic and nonpsychotic people and people with Schizophrenia cant lead productive lives. All of these

Schizophrenia statements are myths because individuals who suffer from this disorder are individuals who each suffer in their own way from the effects of this disorder, they are not dangerous when on prescribed treatments and can lead active productive lives. (Grohol, 2010) Demystification of the illness along with recent insights in neuroscience and neuropsychology gives new hope for finding more effective treatments for an illness that previously carried such grave prognosis (Bengston, 2012)

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