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1 Running Head: SCHIZOPHRENIA Schizophrenia: A Review of Literature Mariaitzel Favela English 1312 2 SCHIZOPHRENIA 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. 3 SCHIZOPHRENIA 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 4 SCHIZOPHRENIA 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 5 SCHIZOPHRENIA 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 6 SCHIZOPHRENIA 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 7 SCHIZOPHRENIA 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 8 SCHIZOPHRENIA 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 9 SCHIZOPHRENIA 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. 10 SCHIZOPHRENIA 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 11 SCHIZOPHRENIA 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. 12 SCHIZOPHRENIA 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