What Is Schizophrenia? Research Paper Example

Introduction

According to a comprehensive review by the WHO (Barbato, 1988), schizophrenia affects between 1 and 17 of 1000 adults worldwide. The variations in prevalence lies in the different study designs and focus populations. The below paper is designed to review the causes of the mental illness, the definitions commonly accepted by researchers and health care professionals, and to find effective interventions to be implemented in evidence-based practices.

Schizophrenia, according to Ruiz-Iriondo et al. (2013, p. 56) is “a serious mental illness that leads to alteration in perception, thinking, affects and behavior”. The author of the current study will use the above definition when assessing the significance, prevalence, treatment options, and outcomes of the condition. The below review will focus on patient experiences, contributing factors, such as environment, socio-economic status, and personal  relationships, and treatment outcomes from a clinical perspective. Research studies and statistics will be reviewed in order to support the development of an effective intervention and treatment framework for schizophrenia sufferers.

Significance

Jablensky et al. (1992) analyzed the findings of the e WHO International Pilot Study of Schizophrenia, a 2-year, 10-country follow up research. The authors found that patient outcomes in developing countries were better than in the developed world. This indicates that culture and social environment, as well as treatment approaches have a great impact on patients’ lives and mental health. The report found that developed countries had a higher frequency of good outcome. This finding implies that there are cultural differences that have an impact on treatment and intervention plans, determining patient outcomes.

According to Barbato (1998), there are different phases of schizophrenia development in humans: thought disorder, delusions, hallucinations, abnormal effect, and disturbances in motor behavior. Each phase signifies a stage of the illness, and consequently the earlier the condition is detected, the more chance the individual has for full recovery. The most commonly accepted symptoms of schizophrenia, according to Barbato (1998, p. 5) are “reality distortion, disorganization and psychomotor poverty”.  The above list of symptoms indicates that the mental illness does not only affect human relationships and mood, but directly influences life quality of those suffering from the condition, as well. The WHO 10-country study (quoted by Jablensky et al., 1992)  found that the worldwide incidence rate of schizophrenia is between 0.1 and 0.4 per a population of 1000. This low incidence rate implies that there are several limitations to researching the condition, as the sample available is of limited size.

Socio-economic status has been found to be one of the determinants of incidence. The WHO study (Barbato, 1998) found that “high incidence figures have recently been reported in some disadvantaged social groups – especially ethnic minorities in western Europe, such as AfroCaribbean communities in the United Kingdom and immigrants from Surinam in the Netherlands”. This indicates that marginalization and low socio-economic status can be viewed as one of the risk factors of schizophrenia. The same study ( Barbato, 1998, p. 9) lists the main risk factors of the mental illness as: sociodemographic characteristics, predisposing factors, and percipating factors. Regarding sociodemographic factors, the authors found an interesting trend: while in the Western, developed world lower socio-economic status predicts higher risk for schizophrenia, in developing countries, such as India, higher social groups are at a greater risk.

Studies related to marital status have also produced interesting findings: unmarried people’s risk of developing schizophrenia was 4 times of their married counterparts’. This finding indicates that interpersonal relationships can reduce the risk of developing schizophrenia. Apart from personal circumstances, resarchers have examined the impact of genetics on risks, and determined that genetics contribute up to 60 percent of risks.

Researching risk factors and treatment outcomes of schizophrenia  is extremely important, as the illness has a high comorbidity rate (Barbato, 1998, p. 10). People who suffer from the condition are also more likely to develop substance dependence, and the “impact of comorbidity with substance abuse is significant in reducing treatment effectiveness, worsening positive psychotic symptoms, increasing social disability and raising the likelihood of violence” (p. 11).

Reviewing further related research, the author (Barbato, 1998) concluded that even though schizophrenia is not a fatal condition, those suffering from it are twice as likely to die than those who do not have this mental health problem. It is estimated that ten percent of patients who suffer from schizophrenia are at risk of committing suicide.

The final impact of schizophrenia on people’s lives examined by the author is that it causes social disability. The study defines this type of disability as “a restriction or lack of ability to perform an activity in the manner or within the range considered normal for an individual in his or her socio-cultural setting”. This finding implies that people who suffer from the condition are likely to have their overall life quality impacted by the illness, therefore, schizophrenia should not only be studied from the symptoms perspective, but also in terms of how it affects individuals’ life outcomes. Being unable to function in society would prevent young people from attending school,  obtaining a qualificaction, or succeeding in the life of work. Further, people with this condition are less likely to be able to develop supportive links with the society or engaging in interpersonal relationships.

The combination of social disability and disturbing symptoms often results in stigmatization of patients. Stigmatization can further escalate the illness, and make it almost impossible for patients to recover. The responsibility of caregivers and health care professionals to effectively deal with the impact of stigmatization is non negotiable.

Historical Review

Walker et al. (2004) reviews the development of schizophrenia research and diagnosis. The authors find that back in the 19^th Century, schizophrenia was misdiagnosed as tertiary syphilis, and overall, mental illnesses were viewed as a side effect of a physical illness. The first researcher who successfully identified schizophrenia was Emil Kraepelin, who called it “dementia praecox” (dementia of the young) (Walker et al. 2004, p. 403). The term of schizophrenia was first  introduced in health care by Bleuler, who defined the mental illness as a condition manifesting symptoms of “ambivalence, disturbance of association, disturbance of affect, and a preference for fantasy over reality” (p. 403). In the 1980-s, some researchers started categorizing the positive and negative symptoms of the illness. Today, a complete diagnostic system is available for researchers and practitioners to successfully identify the symptoms and diagnose schizophrenia. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a standardized diagnostic tool used by mental health professionals, and it offers standard, clear criteria. The existence of this system is extremely beneficial for the health care community, as mental illnesses often have overlapping symptoms, making it extremely challenging to clearly identify the diagnosis. The current symptom criteria determined by DSM for schizophrenia includes: hallucinations, delusions, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms. For a positive diagnosis of schizophrenia, at least two of the above symptoms need to be present for at least a period of one month   (Walker et al., 2004, p. 404). Standardizing the definition and diagnosis of the illness can support researchers in developing further evidence-based intervention methods and frameworks.

Literature Review

Current literature related to schizophrenia research focuses on different areas: prevention, treatment, and health promotion. One of the main problems identified by Barbato (1998) is that it is currently hard to identify at-risk populations who are the most likely to encounter schizophrenia. As it has been previously revealed, there are different risk factors contributing towards the development of illness, but there are no clear predictors. Genetics are important, but not all children whose parents have suffered from the same condition are going to have schizophrenia. Likewise, people who are marginalized in the western society are at a higher risk, however, those with a higher socio-economic status living in developing countries, like India show a higher prevalence. This means that secondary prevention methods are more suitable for application regarding schizophrenia sufferers. Barbato (1998, p. 16) defines secondary prevention as “early identification of individuals with prodromal or early symptoms of an illness to reduce morbidity through prompt treatment”.

Prevention

As there are no clear risk identification methods, it is recommended that monitoring of early symptoms is in the focus of health care interventions. The author (Barbato, 1998) clearly states that currently there is no reliable method to assess individuals’ vulnerability to the condition. The main strategies that are recommended by the researcher (Barbato, 1998, p. 16) are community education programs integrated with primary care service delivery, training general practitioners to learn how to detect the mental health condition early, and home-based interventions.

Drug Treatments

Conventional approaches of treating schizophrenia involve drugs and family interventions. Anti-psychotic drugs have been used for over 40 years to treat and control the mental illness. While drugs have been proven to be effective for reducing acute positive schizophrenia symptoms, they were less useful for preventing recurrence.  Barbato (1998, p. 17) mentions a study that compared the risk of relapse of a group treated with antipsychotic medication and placebo. The placebo group’s risk of relapse was reduced by 60 percent, compared with only 20 percent for the group that received antipsychotic medication. This finding highlights the fact that drug treatment alone does only delay relapses, but does not prevent them.

The research related to drug therapy has found that the effect of antipsychotic medication is limited to some symptoms. Further, according to Barbato (1998), most of the drugs have serious and potentially dangerous side effects. Some of the most common side effects associated with medication used to treat and control schizophrenia are: sedation, stiffness and acute dystonias, tardive dyskinesia (involuntary movements), blurred vision, cardiovascular problems, hypotension, endocrynological symptoms, weight gain, skin conditions, and neuroleptic malignant syndrome. The above list of potential side effects and the low relative potency of drugs indicates that drug treatment alone is not suitable for reducing the symptoms and curing schizophrenia long term. Given that – according to Barbato (1998, p.  19) side effects occur in as many as 70 percent of patients, alteranative solutions and intervention methods should be researched.

The final problem identified regarding drug treatment is that around 20-30 percent of patients receiving one or more antipsychotic medicines are resistant to the treatment. While new drugs, such as Clozapine work for up to 60 percent of patients with previously treatment-resistant schizophrenia, these drugs also have several side effects, and are extremely expensive.

Psychosocial Interventions

Family interventions are more complex than drug prescriptions, and include building social and family engagement, education of patients and caregivers about schizophrenia, providing communication training, crisis intervention, and training on problem solving and conflict handling (Barbato, 1998). It is evident that family interventions are more suitable for improving the lives of patients and their loved ones. Indeed, by providing support and building self-awareness and self-reliance, strengthening family relationships and social skills positively impacts the lives of patients and caregivers and well.

Walker et al. (2004) lists several psychosocial treatments used for improving lives of those living with schizophrenia. The authors agree with the findings of Barbato’s (1998) study that drug based interventions often cause motor side effects, even pseudoparkinsonism (Walker et al., 2004, p. 419). On the contrary, psychosocial and psychoeducational treatments – while they usually take longer to produce positive effects – have no side effects, and have been proven more effective long term than drug treatments. The author also states that these interventions used alongside with medication can improve patient outcomes. Combining drug treatment with psychosocial therapy can also significantly reduce the risk of relapse. As the authors conclude (Walker et al., 2004): “family therapy has been shown to reduce caregiver burden and improve family members’ coping and knowledge about schizophrenia, thus reducing the risk of relapse”. The study also examines the success rate of cognitive behavioral therapy (CBT), and reports that – while research is limited to a handful of randomized controlled trials  – it is effective in reducing disturbing symptoms, such as hallucinations and delusions, even for patients who are otherwise medication-resistant. A final treatment option mentioned by Walker et al. (2004) is enrollment to a stress-management program. Vocational rehabilitation programs have also been found effective for improving patients’ social and occupational functioning (p. 421). It has already been  revealed by the current study that schizophrenia patients often experience social disability, and stress related to being marginalized and stigmatized are potentially increasing the severity of problems. This is the reason why community, family, and work environments should be involved in individual treatment plans.

The final treatment approach reviewed by Walker et al. (2004) is assertive community treatmtne (ACT). This intervention requires close collaboration between multidisciplinary team members. The treatment has been proven effective to reduce time spent in hospital, improving social ties, housing stability, and family relationships.

Intervention Frameworks

Ruiz-Iriondo et al. (2013) introduced an intervention plan for each stage of schizophrenia. According to the authors, every stage of schizophrenia calls for a different intervention plan. The framework designed to stop and prevent the progression of the illness clearly defines the intervention steps and methods assigned to each stage. The four stages of schizophrenia identified by the authors are Premorbid-prepsychotic phase, Acute phase, Remission phase, and Stable phase (chronic phase). In the early stage, the author does not recommend any medication, only psychoeducation, social skills, and habits training. Drugs are only introduced in the acute phase, and all the way through the acute, remission, and subcrhonic phases, medication is combined with psychosocial therapies. This framework confirms the finding of previous studies that medication alone is unable to successfully control, prevent, and treat schizophrenia.

Findings

The above review of schizophrenia-related literature and research has revealed that it is indeed hard to effectively diagnose the condition. There are no clearly identifiable risk factors, and this makes research and early detection problematic. Only secondary prevention methods have been found effective, as it is almost impossible to identify at-risk populations based on simple factors, such as socioeconomic status or family history. This finding has revealed that there is a need for creating programs that help individuals, family members, and general practitioners detect the symptoms of schizophrenia. The recently developed Diagnostic and Statistical Manual of Mental Disorders (DSM) has been proven effective in not only diagnosing patients, but also differentiating between different mental illnesses. It has been found that symptoms of mental illnesses and  psychotic conditions often overlap, making it problematic to clearly diagnose the illness.

Regarding treatment options, research has found that medication prescribed for schizophrenia sufferers has low potency, and high prevalence of side effects. Some 20-30 percent of patients are medication-resistant. The most effective framework for intervention identified in related literature is combining drug based treatment with psychosocial interventions designed to improve the everyday lives of patients and family members. Family therapy, cognitive behavioral therapy, and social skills training have been found effective in reducing relapse rates and severity of the illness. When psychosocial interventions are combined with drug treatment, the effectiveness of therapies was increased.

Conclusion

Based on the above review, it is evident that schizophrenia research is limited to a few controlled trials, and no large scale study has been carried out apart from the WHO 10-country study. Even the findings of that large scale follow up research have not produced clear findings regarding early signs, effectiveness of treatment, and risk factors. The relatively low prevalence of schizophrenia makes research challenging. However, practitioners should consider studying and implementing the intervention framework created by Ruiz-Iriondo et al. (2013) when dealing with early and acute stages of schizophrenia.

References

Barbato, A. (1998) Schizophrenia and public health. Division of Mental Health and Prevention of Substance Abuse World Health Organization Geneva.

Jablensky, A., Startorious, N., Enberg, G., Anker, M., Cooper, J., Day, R. & Bertelsen, A. (1992) Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychological Medicine. Monograph Supplement. 1992; 20:1-97.

Ruiz-Iriondo, M., Salaberria, K.  & Echeburúa, E. (2013) Schizophrenia: Analysis and psychological treatment according to the clinical staging. Actas Espanolas de Psiquitaria 2013 Jan-Feb;41(1):52-9. Epub 2013 Jan 1.

Walker, E., Kestler, L., Bollini, A. & Hochman, K. (2004) Schizophrenia: Etiology and course. Annual Review of Psychology. 2004. 55:401–30