Download 1 SCHIZOPHRENIA Schizophrenia: A Review of Literature

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Running Head: SCHIZOPHRENIA
Schizophrenia: A Review of Literature
Mariaitzel Favela
English 1312
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Abstract
Schizophrenia is not a very well-known illness, and most people believe it deals with
depression or split personality. Even though it affects millions of people worldwide
schizophrenia is still known to be one of the most misunderstood disorders. This literature
review will explain in full detail what schizophrenia really is, how it is diagnosed, and the
different treatments that are available. Both primary and secondary research will be used thought
out the paper in order to get a better understanding of schizophrenia.
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Introduction
“It’s so weird waking up and not really knowing where I am, not knowing who’s around
me, seeing things that aren’t really there, and hearing things that are in my head but aren’t in
front of me.” (Caldwell, 2009) Reading this, someone might believe that this person is describing
a nightmare, but the actuality is that this person has schizophrenia. This description was posted
on a schizophrenia help website just as so many are. Troubled schizophrenics from around the
world seek for an explanation of their diagnosis, help for a treatment, or even a cure to this
disorder. Schizophrenia can affect anyone and sees no age, gender, or ethnicity. In order to have
a better understanding of what schizophrenia really is, these three questions will be answered:
1.
What is schizophrenia and what are the subtypes?
2.
How is schizophrenia diagnosed?
3.
What types of treatments are offered?
The following review of literature will answer these following questions and will give a full and
detailed understanding of this disorder.
What is Schizophrenia and what are the different subtypes?
Schizophrenia is a mental disorder that affects the brain and impairs thinking, emotion,
behavior, how one acts, thinks, and feels. This disorder makes it difficult to differentiate between
what is real and what is not. Schizophrenia can cause people to hear or see things that do not
exist, speak in confusing or bizarre ways, and believe that others are trying to harm them, or feel
like they’re being continually watched. With a distorted line between reality and imagination,
schizophrenics find it difficult to live a normal, daily life. Schizophrenia can also cause problems
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in expressing and managing emotions and making decisions. Because of this many people with
this disorder isolate themselves and withdraw from the outside world. Hallucinations, delusions,
hearing voices, paranoia, the removal of ambitions, and motivation are just some of the terrifying
symptoms. Schizophrenia is claimed to be one of the most misunderstood mental disorders.
Although schizophrenia literally means a split mind, it does not consist of split personality.”
Instead, it means that all the attributes that go into the makeup of the human personality - logical
thinking, feelings and expression, perception, and relating to others - become separated from one
another.” (What is Schizophrenia? 2012)
Schizophrenia can appear in early adulthood or late teens, but is can even show up around
middle life. Schizophrenia is also more common within men than women. Nevertheless, you
have a higher chance of developing the illness, if you are a male between the ages of fifteen and
twenty four, a female between the ages of twenty five and thirty four, have a close relative with
schizophrenia, or had a medical problem during birth. In rare instances children and adolescents
can be affected by it, however, the symptoms tend to be a bit different. “In general, the earlier
schizophrenia develops, the more severe it is.” Schizophrenia affects about one percent of the
population, about one out of one hundred people. This illness can be found all across the world
and effect all social classes and ethnicities.
An interview with a psychology major at the University of Texas at El Paso, conducted
by the author, explained the hardships her uncle with schizophrenia had to endure. Lucia
Rodriguez talked about her uncle who would now be 45, and began by describing his childhood.
Her uncle was born the youngest of nine children, and within the first few months of his life he
was given away to an aunt after the passing of his mother. Lucia’s uncle had a tough childhood
as his cousin was involved in gangs and drugs. One day the violence led Lucia’s uncle to witness
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his cousin’s death. Lucia see’s this tragic event and believes that, “that was his turning point, that
incident is what triggered his schizophrenia.” (Favela, 2013) As a teenager Lucia’s uncle
returned to his brothers and sisters, and within time noticed something was wrong. “My uncle
began making strange noises and stopped speaking”, (Favela, 2013) Lucia said. She also
mentions how her uncle could not remember where he was. When he would go off on his own,
away from the house, he could never recall where he spent his time. Lucia also remembers her
parents explaining that she could never be left alone with him, seeing as how he was not acting
like himself, which worried them. They then took him to a clinic where he was diagnosed with
schizophrenia. He was hospitalized once and had run away from home three times. After the
fourth time he ran away, he never returned. To this day Lucia’s uncle still has not been found,
and he is just one example of what schizophrenia can do, and how it can change the lives of
many.
Schizophrenia can be broken down to five different types that include paranoid,
disorganized, residual, catatonic, and schizoaffective. The different symptoms that are used to
diagnose schizophrenia vary between people and may change form one year to the next. The
diverse subtypes are according to Dr. Michael Bengston “defined according to the most
significant and predominant characteristics present in each person at each point in time.”
(Bengston 2006) So this means that a person can be diagnosed with more than one subtype
during their illness. The first subtype, paranoid schizophrenia has the essential feature of
hallucinations and delusions about conspiracy or prosecution. Yet, people with this subtype are
often the ones who are able to sustain a relationship and a job. Paranoid schizophrenics do not
exhibit symptoms until later in life and seem to live happy normal lives; by the way they
successfully manage their disorder. The disorganized subtype has the main feature of a
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disorganized thought process. These schizophrenics have a hard time with everyday tasks such as
getting dressed, brushing their teeth, or bathing. They can also be seen as emotionally unstable,
and not evoke the proper emotional response. The third subtype is residual which is diagnosed
when symptoms are not as prominent. Delusions and hallucinations can still be present but the
symptoms have greatly diminished. Catatonic is the next subtype which involves disturbances in
movement. People with this subtype show a drastic reduction in activity. They can be in the same
position for hours without ever moving. The final subtype is known as schizoaffective which is
when a person’s symptoms are not sufficient enough to be classified into a schizophrenic
subtype. Their symptoms can jump from one subtype to another or their illness can even stabilize
for some time.
How is Schizophrenia diagnosed?
Schizophrenia is an extremely difficult illness to diagnose; the very first signs may be
irritability, lower grades, or a change in friends, none of which are usual signs of psychotic
symptoms. Schizophrenia is diagnosed depending on the symptoms that appear and the selfreported experiences. Psychiatric evaluation is also needed and it consists of the patient’s
psychiatric history and some sort of mental examination. The most commonly used criteria for
diagnosing this illness is the American Psychiatric Association's Diagnostic and Statistical
Manual of Mental Disorders (DSM). According to the fourth edition of the DSM, “three
diagnostic criteria must be met” in order to diagnosed with schizophrenia.
The first of the three criteria’s would be characteristic symptoms, which requires that two
or more symptoms need to be present throughout more than a months’ time. These symptoms
include hallucinations consisting of one voice, such as a commentary, or two voices conversing
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with each other. Delusions, disorganized speech, which has to be to the point to impair
communication, disorganized behavior, that includes crying often, or dressing inappropriately,
and negative symptoms which are lacking motivation and lacking emotional response. The
second part of the criteria consists of social and occupational dysfunction. For the majority of the
time since the illness striked, one or more of the major areas of functioning, whether it would be
the work place, self-care, or a relationship, are below the area attained prior to the onset of the
disorder. The final step needed is duration, which involves six months of “continuous signs of
the disturbance.” (Schizophrenia Diagnosis, 2012)) One month of symptoms must be present
during this six month period. Schizophrenia, however, cannot be diagnosed if a mood disorder is
also present or if the patient is abusing drugs or medication.
There are other factors that come into play when diagnosing schizophrenia, one is the
confusing of other conditions as psychotic symptoms that are also found in bipolar disorder,
multi personality disorder, or obsessive compulsive disorder, also known as OCD. Obsessive
compulsive disorder complicates schizophrenia which can only be explained by chance, but it is
very difficult to distinguish both of these disorders. More general medical and neurological tests
might be needed in order to rule out the slightly similar psychotic symptoms. Schizophrenia can
also be imitated by the use of illicit drugs which can be found in methamphetamines, which is a
stimulant that helps treat attention deficit hyperactivity disorder or ADHD. Another difficulty in
the diagnosing process is that people who might have schizophrenia believe that they are not
living with this disease. Evidence from the DSM shows “that poor insight, or awareness, is an
expression of the illness rather than a coping strategy.” (Symptoms, Causes, 2011) Anosognoia is
the name given to the lack of awareness, that according to studies show about fifty to eighty
percent of schizophrenics have. It is vastly important that schizophrenia be diagnoses as quickly
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as possible. Just like cancer, the earlier it is caught, the better chance there is of managing and
recovering from schizophrenia.
What treatments are offered?
Because the symptoms and progression of schizophrenia differ from person to person,
treatment must be individualized. Unfortunately schizophrenia cannot be completely cured, but
there are many ways in order to treat and manage this disorder successfully. One form of
treatment includes the use of medication. One type of medication is the Atypical medication
which first appeared in the 1990’s, and were used to treat the different parts of the brain that
were not affected by the antipsychotic drugs. Another type of medication that is used is
antipsychotic medication which has been used since the 1950’s and has created a better outlook
for schizophrenics. Antipsychotic’s reduce the symptoms of psychosis and allow the patient to
function normally once again. This medications work by blocking the dopamine receptors which
is believed to have a part in schizophrenia. These drugs seem to have the greatest impact on
delusions and hallucinations. However, some people worry about the long-term side effect that
can appear and the addiction that might occur. Because of this, some people might decide that
they would rather not take medication, luckily for them, other treatments are available.
Other treatments that could help with schizophrenia include electroconvulsive therapy,
psychotherapy, family support, or rehabilitation. Electroconvulsive therapy, or shock therapy, is
low voltage shock that can cause seizures. “It is the seizure, not the shock that is therapeutic.”
(Schizophrenia Treated, 2012)The approach of using electroconvulsive therapy has been
adjusted over the years, and now some physicians prefer using it, since it is safer than drugs.
The next option is psychotherapy which is any method that is used to treat mental or emotional
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disorders, not by a physical mean, but rather psychological practices. Some nurses, social
workers, psychiatrists, and psychologists are those who are trained to conduct psychotherapy. A
psychotherapy session can involve talking about one’s thoughts, feelings, relationships,
problems, and experiences. Sharing all this can help schizophrenics grasp a better understanding
of who they are and even more about their condition. Some sessions can even allow for learning
and differentiating between what is real and unreal. Using medication along with psychotherapy
is known to most experts, as being extremely important for long-term improvement of
schizophrenia. The next treatment includes Family support which can be crucial in improving
one’s health. Some research has shown that schizophrenics tend to be worse if their family is not
around, too emotional, negative, or judgmental. Another treatment is rehabilitation which is a
nonmedical intervention for schizophrenics. These programs specialize in social and
occupational training.
According to ABC’s 20/20 short documentary on schizophrenia, Dr. Hoffman from
Yale’s psychiatric institute believes he has found another treatment. He calls it transcranial
magnetic stimulation or TMS which sends “short pulses of magnetic stimulation to the left side
of the brain that activates speech.” (2011) The doctors focus the TMS on the left side of the brain
because they think this area may be involved in hearing voices. Dr. Hoffman began his research
by testing the TMS on twelve patients for forty minutes a day, four days a week. Eight of his
patients responded positively, some right away, others within a few days. Those eight patients
reported not hearing any voices, and for the first time in a long time, all they heard was silence.
One patient named Barbra went a total of three months without hearing any voices, although,
after those three months, the voices came back again. Determined to once again hear nothing,
Barbra decided to go back for further treatment in order to once again, have peace and quiet.
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Another patient named Donald, who graduated with a PhD in chemistry, was diagnosed with
schizophrenia when he was thirty eight with his career at its prime. Once he was diagnosed
Donald needed extensive care, and after the treatment and weeks without hearing voices, his
counselors noticed Donald was acting like his old self again. Donald’s brother even believed that
one day, with more TSM treatments, perhaps his brother will gain his brilliant mind and return to
his career that he loved so much. If Dr. Hoffman continuous to show results, he will have
founded a new non-drug alternative for schizophrenia.
Transcranial Magnetic Stimulation
Conclusion
Schizophrenia is a disease where the mind can deceive. The disorder can affect anyone
and will be found in about one and half million people this year. It has been around no more
than a hundred years which makes it a fairly new illness, but it has already affected not only the
millions of people with this disorder but all their loved ones as well. This illness can be one of
the most difficult to diagnose, but once done it fills those with hope. Although there is no cure
for schizophrenia, there are plenty of treatments that may be individualized and help sustain a
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once again normal life. With the future ahead and more research, better understanding, and
possible new treatments, there can only be hope that schizophrenia may one day no longer exist.
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Reference List
(2011) Symptoms, Causes, and Diagnosis. NAMI. Retrieved from
http://www.nami.org/Template.cfm?Section=Schizophrenia9&Template=/ContentManag
ement/ContentDisplay.cfm&ContentID=117959
(2012). How is Schizophrenia Treated?. EhealthMD. Retrieved from
http://ehealthmd.com/content/how-schizophrenia-treated#axzz2Pi8xXCkN
(2012). What is Schizophrenia? EhealthMD. http://ehealthmd.com/content/whatschizophrenia#axzz2Pi8xXCkN
(2012) Schizophrenia Diagnosis. News Medical. Retrieved from http://www.newsmedical.net/health/Schizophrenia-Diagnosis.aspx
Bengston, Michael. (2006). Types of Schizophrenia. Psych Central. Retrieved on April 6, 2013,
from http://psychcentral.com/lib/2006/types-of-schizophrenia/
Caldwell, James. (2009) The Beginning. Schizophrenia Diaries. Retrieved from
http://schizophreniadiaries.com/category/afraid/
Favela, Mariaitzel. (2013). Interview with a Schizophrenic
May 11, 2010. Schizophrenia Documentary part 1 and 2. ABC’s 20/20. Retrieved from
http://www.youtube.com/watch?v=74vTftboC_A