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Schizophrenia: A Comprehensive Explanation

Schizophrenia is a major therapeutic issue nowadays because it is one of the most problematic mental illnesses known to modern psychiatry. Its most common symptoms include visual and audial hallucinations, delusions, inability to organize the thinking process and express emotional reactions adequately. Moreover, patients with schizophrenia often have social disfunction and cannot behave correctly among other people, even though they do not have harmful intentions. This mental disorder usually starts developing in young adulthood, and people do not always recover from it. Schizophrenia is a research object of many scholarly studies that explore this mental disorder more profoundly and seek various solutions and treatment options. Many researchers conduct surveys and experiments, propose theories, test them, and then share their findings to help the world health care system find new practical approaches to the problem. Additionally, professionals introduce new methods and techniques in their medical practices to help their patients more efficiently. Schizophrenia is a severe concern of the modern health care system because it is highly complicated and associated with mental and physical health and reduced life expectancy.

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Schizophrenia cannot have a simple and apparent definition since it is a multifaceted, inconstant mental condition that can manifest differently. Wilson et al. (2021) state that “schizophrenia is typified by an apparent fundamental breakdown in reality-testing” (p. 1), which is a primary attribute of psychosis. Most conceptions of the disorder describe similar sets of experiences, including perceptions in the absence of an external correlate called hallucinations and fixed false beliefs called delusions (Wilson et al., 2021). Earlier concepts suggest that schizophrenia is a brain-based condition that has a pathognomonic trajectory or that it is correlated with the process of weakening the associations of psychic functions (Wilson et al., 2021). However, schizophrenia is a severe psychic disease that negatively influences the patients’ mental health condition.

As for the disorder’s manifestations, they differ from each other because similar symptoms of schizophrenia might make patients experience different things. For instance, “an interference of clear thinking due to the intrusion of objectively trivial thoughts, difficulties distinguishing between perceptions and ideas, and a sense of disconnectedness from one’s surroundings” (Wilson et al., 2021, p. 3). The researchers also claim that these experiences can be grouped into three levels, which can be reversible and may prove the existence of a psychopathological continuum (Wilson et al., 2021). For example, a specific somatic hallucination is a level 3 experience, but it may revert to a level 2 synesthetic feeling and then to a non-particular somatic feeling of level 1 (Wilson et al., 2021). Therefore, manifestations of schizophrenia can both vary for different patients and alter on the interior level.

Coping with schizophrenia is a difficult challenge for the modern health care system. On the global level, this disorder contributes as much as 7.4% of all years of life lost to all disabilities (Huang et al., 2018, p. 238). Furthermore, schizophrenia relapse, which is associated with a time of increased suicide risk, is prevalent, and only about 20% of all patients have an episode of psychosis only once (Huang et al., 2018, p. 238). The researchers also report that “predictors of relapse include medication non-adherence and comorbid substance misuse” (Huang et al., 2018, p. 238). The indicators mentioned above illustrate the significance of the disorder and the importance of investigating it and providing proper treatment for the patients.

Several significant factors contribute to significant physical problems caused by schizophrenia. As Kendall et al. (2020) state, patients with this psychiatric condition have life expectancy reduced by 20 years on average because of various physical health conditions, such as metabolic, cardiovascular, and respiratory diseases. Moreover, according to the research, individuals with schizophrenia have increased rates of epilepsy, intellectual disability, type 2 diabetes, congenital disorders, ischaemic heart disease, and smoking compared to the general population (Kendall et al., 2020). Thereby, this mental illness is associated with many physical health conditions and has a critical impact on the patient’s health, even leading to reduced life expectancy.

Aside from that, schizophrenia also correlates with various genetic liabilities. Wilson et al. (2021) report that genetic liability to schizophrenia is highly heritable, with an approximate score of 0.81, and identical twins’ concordance is almost 50% (p. 3). The study mentioned above reports that genetic factors contribute significantly to schizophrenia risk, which arises from shared genetic variation and rare genetic variants (Kendall et al., 2020). Although, according to the study results, the authors “did not find evidence that the increased rates of poor physical health outcomes in schizophrenia were associated with genetic liability for the disorder” (Kendall et al., 2020). It means that, though genetic factors can directly affect both schizophrenia risk and physical health conditions, genetic liability for the disorder does not cause the increased risks for different physical illnesses.

The negative symptoms of schizophrenia are critical and can significantly affect many aspects of patients’ lives. According to Galderisi et al. (2021), the negative core symptoms of schizophrenia include reduced emotional expression and motivation loss. These symptoms “are associated with low remission rates, poor real-life functioning, and quality of life and place a substantial burden on patients, relatives, and health care systems” (Galderisi et al., 2021, p. 1). The mentioned symptoms demonstrate that schizophrenia is a typical manifestation of a cognitive-behavioral abnormality. Therefore, patients suffer the consequences of schizophrenia’s negative symptoms that make their lives much more complex, reducing its quality and negatively affecting their relatives’ lives.

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However, the researchers provide various treatment options for the negative symptoms mentioned above. As Galderisi et al. (2021) state, evidence that is currently available in the research field allows formulating definite recommendations regarding the treatment of schizophrenia. The authors mention antidepressants and antipsychotics, training of social skills, exercise interventions, and more (Galderisi et al., 2021). Additionally, another crucial aspect of treating a patient with negative symptoms of schizophrenia is ensuring access to psychosocial rehabilitation for them (Galderisi et al., 2021). Although this mental illness is highly complex, it can still be appropriately treated to ease the patients’ struggle and give them a chance to recover.

There are several clusters of symptoms that modern psychiatry defines when addressing schizophrenia and related matters. The recent research illustrates that many approaches consider three groups of schizophrenia symptoms: positive symptoms, including delusions and hallucinations; negative symptoms, including low mood and emotion; cognitive symptoms, including insufficient attention (Rolls et al., 2021). The authors also divide positive symptoms into two subgroups: disorganization and reality distortion (Rolls et al., 2021). Nevertheless, other studies provide evidence that there are five clusters of symptoms: reality distortion, negative symptoms mentioned previously, disorganization, excitation, and depression (Rolls et al., 2021). In any case, all these symptoms should be considered in the investigation of schizophrenia to come to more definite and pervasive results.

Though the negative core symptoms of schizophrenia are usually similar for patients, there are specific individual differences. According to Rolls et al. (2021), different negative symptoms, such as conceptual disorganization, disturbance of volition, and motor retardation, are correlated with each other; however, they also appear as a significant source of individual differences. Schizophrenia is a chronic psychiatric condition, and there are first-episode patients (FEP) and multiple-episode patients (MEP) who may differ from each other (Rolls et al., 2017). The researchers claim that “the severity of the negative symptoms has a continuous unimodal distribution supporting a dimensional description of the heterogeneity of the illness” (Rolls et al., 2021, p. 272). Thereby, schizophrenia is a condition of high complexity and diversity, meaning that the treatment requires various approaches and should involve different medications.

It is crucial to investigate the negative and the individual differences in schizophrenia mentioned above because a better understanding of the problem leads to more efficient solutions. The study of Rolls et al. (2021) considers two approaches to describing the heterogeneity of the mental illness under discussion. The first of them is “an examination of the pattern of correlation between symptoms to identify underlying symptom communities (or dimensions), presumed to reflect specific pathological processes” (Rolls et al., 2021, p. 265). The second approach concerns examining patients’ correlations to identify their subtypes (Rolls et al., 2021). Thus, exploring the problem using these methods helps the researchers collect the required data and develop effective programs for individual psychiatric treatment.

Then, medical experts further investigate the programs mentioned in the previous section and apply them to medical practice. The recent research of Hamann et al. (2020) considers different techniques of treating patients with either schizophrenia or schizoaffective disorder, including the use of coercive measures, which is a controversial problem in psychiatric care. The authors present the model of shared decision making (SDM), which “aims to strengthen patients’ autonomy and encourage a more equal relationship between patients and doctors” (Hamann et al., 2020, p. 1). In this study, the researchers oppose SDM to use of coercive measures in the treatment of schizophrenia, claiming that SDM promotes patients’ rights and autonomy (Hamann et al., 2020). Therefore, it is vital to apply the most effective methods in treating schizophrenia, but medical experts also want psychiatry to be more ethical.

Summing up, schizophrenia is a severe concern for modern psychiatry and psychopathology because it is a highly complex disorder involving mental and physical health issues. There are no boundaries that can be applied to the definition of schizophrenia; still, it is a severe mental illness that has many negative consequences for the patients’ health. Schizophrenia can manifest diversely for different patients, making them experience feelings that are not always the same in different cases; besides, the disorder can alter on the inner level, meaning that it can have various manifestations in several periods. Furthermore, the disorder is associated with poor physical reduced life expectancy, causing many physical illnesses and taking many years of patients’ lives. Those who are ill cannot always express their emotions appropriately, suffer from the absence of motivation, have problems with social behavior, and cannot function in society correctly. The current health care system has defined many symptoms of schizophrenia and developed many treatment options applicable in medical practice. Nevertheless, there is still much to investigate to fight the disorder effectively.

References

Galderisi, S., Kaiser, S., Bitter, I., Nordentoft, M., Mucci, A., Sabé, M., & Gaebel, W. (2021). EPA guidance on treatment of negative symptoms in schizophrenia. European Psychiatry, 64(1), E21.

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Hamann, J., John, M., Holzhüter, F., Siafis, S., Brieger, P., & Heres, S. (2020). Shared decision making, aggression, and coercion in inpatients with schizophrenia. European Psychiatry, 63(1), E90.

Huang, H., Taylor, M., & Carmichael, A. (2018). The outcomes of home treatment for schizophrenia. BJPsych Bulletin, 42(6), 238-242.

Kendall, K., John, A., Lee, S., Rees, E., Pardiñas, A., Banos, M., & Walters, J. (2020). Impact of schizophrenia genetic liability on the association between schizophrenia and physical illness: Data-linkage study. BJPsych Open, 6(6), E139.

Rolls, E., Lu, W., Wan, L., Yan, H., Wang, C., Yang, F., & Feng, J. (2017). Individual differences in schizophrenia. BJPsych Open, 3(6), 265-273.

Wilson, P., Humpston, C., & Nathan, R. (2021). Innovations in the psychopathology of schizophrenia: A primer for busy clinicians. BJPsych Advances, 1-11.

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