The Worldwide Impacts of Schizophrenia

Introduction Schizophrenia is a serious brain disorder that distorts the way a person thinks, acts, expresses emotions, perceives reality, and relates to others. People with schizophrenia (in the cases of the most chronic and disabling of the major mental illnesses) often have problems functioning in society, at work and at school, and in relationships. Schizophrenia can leave its sufferer frightened and withdrawn. Symptoms of schizophrenia may include: Hallucinations -- hearing or seeing imaginary things Delusions -- wildly false beliefs Paranoia -- the fear others are plotting against you

Some symptoms, such as lack of enjoyment in everyday life and withdrawal from social activities, may mimic depression. People with schizophrenia often have abnormal ways of thinking. They may have trouble organizing their thoughts or making logical connections. They may feel like the mind is racing from one unrelated thought to another. Sometimes they experience "thought blocking," a feeling that thoughts are removed from their head. A public survey conducted in the U.S. showed that while the public is more concerned about schizophrenia than some other illnesses, schizophrenia falls in the middle of a ranked list when comparing the proportion of people who say they are "very concerned" about a given illness.

Cancer: 82%

HIV/AIDS: 81% Multiple sclerosis: 70% Heart disease: 65%

Lou Gehrig's disease: 77% Schizophrenia: 60%

Diabetes: 50%

Bipolar Disorder: 46% Asthma: 26%

High blood pressure: 37%

Depression: 33%

Causes of schizophrenia The causes of schizophrenia are not fully known. However, it appears that schizophrenia usually results from a complex interaction between genetic and environmental factors. Genetic causes of schizophrenia Schizophrenia has a strong hereditary component. Individuals with a first-degree relative (parent or sibling) who has schizophrenia have a 10 percent chance of developing the disorder, as opposed to the 1 percent chance of the general population. But schizophrenia is only influenced by genetics, not determined by it. While schizophrenia runs in families, about 60% of schizophrenics have no family members with the disorder. Furthermore, individuals who are genetically predisposed to schizophrenia dont always develop the disease, which shows that biology is not destiny. Environmental causes of schizophrenia Twin and adoption studies suggest that inherited genes make a person vulnerable to schizophrenia and then environmental factors act on this vulnerability to trigger the disorder. As for the environmental factors involved, more and more research is pointing to stress, either during pregnancy or at a later stage of development. High levels of stress are believed to trigger schizophrenia by increasing the bodys production of the hormone cortisol. Research points to several stress-inducing environmental factors that may be involved in schizophrenia, including: Prenatal exposure to a viral infection Low oxygen levels during birth (from prolonged labor or premature birth) Exposure to a virus during infancy Early parental loss or separation Physical or sexual abuse in childhood

Abnormal brain structure In addition to abnormal brain chemistry, abnormalities in brain structure may also play a role in schizophrenia. Enlarged brain ventricles are seen in some schizophrenics, indicating a deficit in the volume of brain tissue. There is also evidence of abnormally low activity in the frontal lobe, the area of the brain responsible for planning, reasoning, and decision-making. Some studies also suggest that abnormalities in the temporal lobes, hippocampus, and amygdala are connected to schizophrenias positive symptoms. But despite the evidence of brain abnormalities, it is highly unlikely that schizophrenia is the result of any one problem in any one region of the brain.

HERE IS AN EXAMPLE OF EXTENT TO WHICH SCHIZOPHRENIA CAN AFFECT AN INDIVIDUALS LIFE:

How does Schizophrenia affect peoples lives? (Case study) Jack is a 27 year old man diagnosed with schizophrenia. He has been referred to Top Quality Rehabilitation (TQP) to provide supported employment services. Jack graduated from high school and got a job working in a video store. After working for about 6 months Jack began to hear voices that told him he was no good. He also began to believe that his boss was planting small video cameras in the returned tapes to catch him making mistakes. Jack became increasingly agitated at work, particularly during busy times, and began "talking strangely" to customers. For example one customer asked for a tape to be reserved and Jack indicated that that tape may not be available because it had "surveillance photos of him that were being reviewed by the CIA". After about a year Jack quit his job one night, yelling at his boss that he couldn't take the constant abuse of being watched by all the TV screens in the store and even in his own home. Jack lived with his parents at that time. He became increasingly confused and agitated. His parent took him to the hospital where he was admitted. Jack kept flipping through various types of medicines and eventually, due to severe side effects such as painful twisting and contractions of his muscles, he stopped taking his medication and the voices and concerns over being watched became stronger and during the past 7 years, Jack was hospitalized 5 times. He is currently living on his own in an apartment and receives SSI as aid as he cannot find a job or get married due to his severe condition.

SOLUTIONS Schizophrenia usually first appears in a person during their late teens or throughout their twenties. It affects more men than women, and is considered a life-long condition which rarely is "cured," but rather treated. The primary treatment for schizophrenia and similar thought disorders is medication. Unfortunately, compliance with a medication regimen is often one of the largest problems associated with the ongoing treatment of schizophrenia. Because people who live with this disorder often go off of their medication during periods throughout their lives, the repercussions of this loss of treatment are acutely felt not only by the individual, but by their family and friends as well. Successful treatment of schizophrenia, therefore, depends upon a life-long regimen of both drug and psychosocial, support therapies. While the medication helps control the psychosis associated with schizophrenia (e.g., the delusions and hallucinations), it cannot help the person find a job, learn to be effective in social relationships, increase the individual's coping skills, and help them learn to communicate and work well with others. Poverty, homelessness, and unemployment are often associated with this disorder, but they don't have to be. If the individual finds appropriate treatment and sticks with it, a person with schizophrenia can lead a happy and successful life. But the initial recovery from the first symptoms of schizophrenia can be an extremely lonely experience.

Individuals coping with the onset of schizophrenia for the first time in their lives require all the support that their families, friends, and communities can provide. However, a sudden stopping of treatment will most often lead to a relapse of the symptoms associated with schizophrenia and then a gradual recovery as treatment is reinstated.

Psychotherapy Psychotherapy is not exactly a treatment for schizophrenia. Used as an adjunct to a good medication plan, however, psychotherapy can help maintain the individual on their medication, learn needed social skills, and support the person's weekly goals and activities in their community. This may include advice, reassurance, education, modeling, limit setting, and reality testing with the therapist. Encouragement in setting small goals and reaching them can often be helpful. People with schizophrenia often have a difficult time performing ordinary life skills such as cooking and personal grooming as well as communicating with others in the family and at work. Therapy or rehabilitation therapy can help a person regain the confidence to take care of themselves and live a fuller life. Psychotherapy may include: Group therapy focuses on real-life plans, problems, and relationships, social and work roles and interaction, cooperation with drug therapy and discussion of its side effects; or on some practical recreational or work activity. Family therapy encourages the family to convene a family meeting whenever an issue arises, in order to discuss and specify the exact nature of the problem, to list and consider alternative solutions, and to select and implement the consensual best solution. A supportive family therapy can reduce relapse rate to below 10 percent from 50-60% in high-stress families.

What medications are used to treat schizophrenia? Antipsychotic medications are used to treat schizophrenia and schizophrenia-related disorders. Some of these medications have been available since the mid-1950's. They are also called conventional "typical" antipsychotics. Some of the more commonly used medications include: 1. 2. 3. 4. Chlorpromazine (Thorazine) Haloperidol (Haldol) Perphenazine (generic only) Fluphenazine (generic only).

In the 1990's, new antipsychotic medications were developed. These new medications are called second generation, or "atypical" antipsychotics. One of these medications was clozapine (Clozaril). It is a very effective medication that treats psychotic symptoms, hallucinations, and breaks with reality, such as when a person believes he or she is the president. But clozapine can sometimes cause a serious problem called agranulocytosis, which is a loss of the white blood cells that help a person fight infection. Therefore, people who take clozapine must get their white blood cell counts checked every week or two. This problem and the cost of blood tests make treatment with clozapine difficult for many people. Still, clozapine is potentially helpful for people who do not respond to other antipsychotic medications. Other atypical antipsychotics were developed. All of them are effective, and none cause agranulocytosis. These include: 1. 2. 3. 4. 5. 6. Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Ziprasidone (Geodon) Aripiprazole (Abilify) Paliperidone (Invega).

The antipsychotics listed here are some of the medications used to treat symptoms of schizophrenia. Additional antipsychotics and other medications used for schizophrenia are listed in the chart at the end. What are the side effects? Some people have side effects when they start taking these medications. Most side effects go away after a few days and often can be managed successfully. People who are taking antipsychotics should not drive until they adjust to their new medication. Side effects of many antipsychotics include: Drowsiness Dizziness when changing positions Blurred vision Rapid heartbeat Sensitivity to the sun Skin rashes Menstrual problems for women.

Atypical antipsychotic medications can cause major weight gain and changes in a person's metabolism. This may increase a person's risk of getting diabetes and high cholesterol .A person's weight, glucose levels, and lipid levels should be monitored regularly by a doctor while taking an atypical antipsychotic medication.

Typical antipsychotic medications can cause side effects related to physical movement, such as: Rigidity Persistent muscle spasms Tremors Restlessness.

Long-term use of typical antipsychotic medications may lead to a condition called tardive dyskinesia (TD). TD causes muscle movements a person can't control. The movements commonly happen around the mouth. TD can range from mild to severe, and in some people the problem cannot be cured. Sometimes people with TD recover partially or fully after they stop taking the medication. Every year, an estimated 5 percent of people taking typical antipsychotics get TD. The condition happens to fewer people who take the new, atypical antipsychotics, but some people may still get TD. People who think that they might have TD should check with their doctor before stopping their medication.

How do antipsychotics interact with other medications? Antipsychotics can produce unpleasant or dangerous side effects when taken with certain medications. For this reason, all doctors treating a patient need to be aware of all the medications that person is taking. Doctors need to know about prescription and over-the-counter medicine, vitamins, minerals, and herbal supplements. People also need to discuss any alcohol or other drug use with their doctor. To find out more about how antipsychotics work, the National Institute of Mental Health (NIMH) funded a study called CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness). This study compared the effectiveness and side effects of five antipsychotics used to treat people with schizophrenia. In general, the study found that the older medication perphenazine worked as well as the newer, atypical medications. But because people respond differently to different medications, it is important that treatments be designed carefully for each person.

Schizophrenia is a horrible mental disease which can undoubtedly ruin ones life. However, the public is constantly being educated on the serious impacts of this condition and questionnaires such as the one below to ensure that the disease may be diagnosed and treated as soon as possible:
1. I feel that others control what I think and feel. o o o o o o Not at all Just a little Somewhat Moderately Quite a lot All the time

2. I hear or see things that others do not hear or see. o o o o o o Not at all Just a little Somewhat Moderately Quite a lot All the time

3. I feel it is very difficult for me to express myself in words that others can understand. o o o o o o Not at all Just a little Somewhat Moderately Quite a lot All the time

4. I feel I share absolutely nothing in common with others, including my friends and family. o o o o o o Not at all Just a little Somewhat Moderately Quite a lot All the time

5. I believe in more than one thing about reality and the world around me that nobody else seems to believe in. o o o o o o Not at all Just a little Somewhat Moderately Quite a lot All the time

6. Others don't believe me when I tell them the things I see or hear. o o o o o o Not at all Just a little Somewhat Moderately Quite a lot All the time

7. I can't trust what I'm thinking because I don't know if it's real or not. o o o o o o Not at all Just a little Somewhat Moderately Quite a lot All the time

8. I have magical powers that nobody else has or can explain. o o o o o o Not at all Just a little Somewhat Moderately Quite a lot All the time

9. Others are plotting to get me. o o o o o o Not at all Just a little Somewhat Moderately Quite a lot All the time

10. I find it difficult to get a hold of my thoughts. o o o o o o Not at all Just a little Somewhat Moderately Quite a lot All the time

11. I am treated unfairly because others are jealous of my special abilities. o o o o o o Not at all Just a little Somewhat Moderately Quite a lot All the time

12. I talk to another person or other people inside my head that nobody else can hear. o o o o o o Not at all Just a little Somewhat Moderately Quite a lot All the time

Bibliography 1. Schizophrenia Survery Analysis: Public Attitudes http://www.nami.org/Content/NavigationMenu/Schizo phreniaSurvey/Analysis_Public_Attitudes.htm 2. Helpguide: Causes of Schitzophrenia http://www.helpguide.org/mental/schizophrenia_sympt om.htm 3. Psych Central http://psychcentral.com/quizzes/schizophrenia.htm http://psychcentral.com/disorders/sx31t.htm#drugs 4. National Institute of Mental Health: Antipsychotic Medicine http://www.nimh.nih.gov/health/publications/mental-health-medications/whatmedications-are-used-to-treat-schizophrenia.shtml 5. Jacks Story http://www.google.lk/url?sa=t&rct=j&q=schizophrenia%20case%20study&source=web &cd=2&cad=rja&ved=0CDYQFjAB&url=http%3A%2F%2Fiws.collin.edu%2Fmrose%2FHan douts%2FAbnormal%2520Handouts%2FCase%2520Study.doc&ei=maVpUcJJ8e_rgfuq4CYDw&usg=AFQjCNH5_tavQM5vagJub34MGlCkrMiQUg

By Madusha Perera- L6th