Nowadays, humanity has made significant progress in the medical area. However, some aspects remain challenging to study. One of these aspects is mental disorders, which include many different diseases and syndromes. The complexity of the research of mental illnesses is formulated by the specific symptoms and the intricacy of the affected organ, namely the brain. Schizophrenia also includes disorders of thinking and perception, many aspects of which are still poorly understood. One of these disorders is delirium, and it is a controversial issue whether it is a separate disease or a group of syndromes. This paper aims to analyze the complexity of schizophrenia and its possible ways of treatment.
The variety of symptoms of schizophrenia creates uncertainty in the classification of this disorder and the difficulty in implementing the necessary interventions. Although it has been possible to identify similar symptoms and the disorder’s progress today, there is still no single effective treatment. There are several cure options for schizophrenia, and they can be divided into several groups, from medication to social therapy. In some cases, only symptomatic treatment is possible, thus reducing negative symptoms by taking sedatives.
Fundamentals
The first accounts of schizophrenia date back to the 17th century Before Christ, precisely speaking, the description of similar symptoms. Even then, such symptoms as hallucinations, false perception of reality, delirium, and obsessive thoughts were mentioned. However, today there is a clear definition of this disorder, which most capaciously describes the disease. Schizophrenia is an endogenous polymorphic mental disorder, or a group of mental disorders characterized by the disintegration of thought processes and emotional reactions (Lieberman et al., 2020). Among the most common symptoms are confabulations, false memories, auditory and, in some cases, visual hallucinations, and paranoid disturbances (Lieberman et al., 2020). Speech disorder, disability, and significant social dysfunction are also characteristic of the illness.
The word’s etymology, namely the splitting of the mind, often causes confusion with a split personality, although these are different diseases. The latter is a dissociative personality disorder and has other symptoms and features of the course of the disease. Some studies question the difference between these disorders, although the diversity of their symptoms shows that one is not part of the other. People with schizophrenia are often susceptible to social problems such as unemployment, poverty, or a homeless lifestyle. Additionally, alcoholism, drug addiction, or abuse of other substances is also frequently observed. In some cases, it can serve as the trigger for schizophrenia, and there are cases when this disorder developed after alcoholism or drug addiction.
There is evidence about the gender unevenness of the disorder, namely in the number of cases. Thus, researchers identified that schizophrenia is more common in men than in women (Lieberman et al., 2020). Although, the degree of prevalence varies according to study type and region (Lieberman et al., 2020). Moreover, the environment and stress influence the onset of the disease. People exposed to stress or social pressure are more subject to schizophrenia. It was determined that immigrants and their children are 2.5 times more likely to have a psychotic disorder than the majority ethnic group (Lieberman et al., 2020). It is due to a sharp reaction to an unfamiliar, often perceived as a hostile environment, a different language, and a lack of social assistance for migrants. Moving also provokes difficulties in obtaining education, work, and establishing social ties, which promotes stress and, consequently, schizophrenia.
Patients with schizophrenia are more likely to be diagnosed with comorbidities such as anxiety disorders, depression, and obsessive-compulsive disorder. Besides, there is a high chance of developing somatic diseases, which include heart and lung illnesses, diabetes, and infectious sicknesses. There is a decrease in life expectancy compared to people who do not have schizophrenia by 10-12 years, which is formulated by frequent suicides and health problems. It is also constituted by a decrease in the quality of life, the impossibility of hospitalization and treatment of schizophrenia, and an increased risk of domestic injuries.
The course of the disease is characterized by a variety of options, ranging from a progressive variant to complete/almost complete recovery. The view that schizophrenia is an exclusively progressive disorder is now being challenged by many scientific groups (Lieberman et al., 2020). It depends on many factors, and it is still not exactly clear which of them influences the course of schizophrenia primarily. However, a favorable outcome is usually observed in the presence of the patient’s awareness of the sickness, positive symptoms, and acceptance by relatives and friends. Relatives play an essential role in-home treatment, as they are “anchors” in the patient’s subconscious, thus, people whom one knew well before the onset of the disease.
Symptomatic Features
Symptoms can also include various behavioral features, ranging from extreme calmness to aimless arousal. The patient may suddenly freeze for a long time in an unnatural position, then causeless excitement and restlessness may be observed (Lieberman et al., 2020). Unnatural plasticity, non-organizational speech, mannerisms of gestures, and facial expressions are characteristic, and the patient can suddenly remain silent for a long time. Paranoid ideas and thoughts are common, such as megalomania and persecution. Sometimes symptoms can be rooted in the type of patient’s activity or desire to connect one’s life with certain professions. In other cases, there may be obsessive thoughts about connection with famous people and the belief that they want to kill the patient. Besides, a patient with schizophrenia may be imbued with confidence in a certain person for a number of reasons and ask one for help and protection.
Diagnosis
Nowadays, there is no laboratory test for schizophrenia, and symptoms may often be confused with other illnesses. However, diagnosis consists in telling the patient about his experiences and complaints. In order to exclude delirium, or the effect of drugs, a complete physical examination, including a blood test, is necessary. Next, a detailed conversation is conducted with the patient to rule out brief psychoses, bipolar disorder, borderline psychosis, and major depressive disorder. To achieve greater efficiency, one needs to involve a commission of several people in order to have a collective decision.
When diagnosing schizophrenia, it is also important to rule out diseases that can sometimes lead to symptoms similar to current sickness. It includes syphilis, metabolic disorders, HIV, systemic infections, brain damage, epilepsy, and prolonged severe insomnia. Further, one needs to exclude side effects from one drug or mix several medical drugs. Schizophrenia may often be confused with delirium, which has similar symptoms. These include fluctuations in the level of consciousness, the presence of visual hallucinations, delusions, and paranoid disorders.
DSM-5 Criteria
In order to assist in the diagnosis of schizophrenia, mandatory criteria have been identified that must be met for a diagnosis to be made. According to the Diagnostic and Statistical Manual of mental disorders, fifth edition (DSM-5), there are several criteria groups that should be fulfilled (Lieberman et al., 2020). The first group is formulated by distinctive symptoms, which include delusional ideas, hallucinations, disorganized speech, catatonic behavior, and negative symptoms, such as avolition (Lieberman et al., 2020). Two or more of above mentioned should be present for more than half a month.
Further, there should be a decline in the work success level, social ties, or self-servicing in a prolonged period of time. Symptoms should be present for at least half a year. Moreover, one month from this period should be formulated by an active phase. The active phase usually is constituted by the strengthening of the abovementioned symptoms. Further, one should ensure that the reason for such behavior does not lie in the drug usage or medications side effects.
Possible Reasons and Treatment
Currently, one reveals more and more causes and mechanisms of schizophrenia. However, they still remain unclear and confusing. Several groups formulate important factors, including genetic predisposition, early childhood living conditions, neurobiological impairments, and psychological and social interactions. A separate group is the intake of alcoholic or narcotic substances. In some cases, poisoning or a negative experience of taking psychoactive drugs can serve as a trigger for the onset of schizophrenia. However, today there is debate about the root cause, in other words, whether the negative experience of taking drugs is only an acceleration of the process of the disorder or not.
There is no currently unified view on the effective treatment of schizophrenia. The medicinal approach involves taking drugs based on histone deacetylases, as they improve the condition of certain parts of histones’ acetylation. One may also imply the social and psychological therapy, which is formulated by the social and professional rehabilitation of the patient. There is evidence of the family therapy’s effectiveness, thus, involving family members of the individual.
Reference
Lieberman, J. A., Stroup, S. T., Perkins, D. O., & Dixon, L. B. (2020). (Eds.). The American Psychiatric Association Publishing textbook of schizophrenia. (2nd ed.). American Psychiatric Pub.