Schizophrenia refers to a mental disorder that is usually characterized by atypical social behavior and inability to distinguish reality (Fleischhacker & Stolerman, 2011). Schizophrenia has been in existence in the course of human history. People suffering from such disease often hear voices that others do not hear. In addition, schizophrenic individuals are likely to believe that others are scheming to hurt them, manipulating their thoughts, or analyzing their mind. It is also imperative to note that schizophrenia is a form of chronic illness; as a result, it needs lifelong treatment. Schizophrenia does not only affect the individual suffering from the disorder, but also society and families owing to the fact that schizophrenic individuals often have difficulties with securing and maintaining employment and taking care of themselves. Consequently, they depend on care from other people.
The global prevalence of schizophrenia is estimated to be 1%. In the United States, about 1.2 percent (3.2 million people) have been diagnosed with schizophrenia. There are no significant variations regarding the prevalence of schizophrenia between countries, with variations ranging between 0.5% and 1% (Warner, 2013). The disorder can occur throughout a person’s lifespan; however, new occurrences of schizophrenia are common during the early stages of adulthood. Schizophrenia is uncommon among older adults and children. In addition, the rate of diagnosis for new instances of schizophrenia is high during teenage years, with people aged 16-25 having peak vulnerability to mental disorder development. There are differential vulnerabilities to developing schizophrenia in terms of gender. In this regard, men are extremely susceptible to developing schizophrenia during the age of 18-25 whereas the peak susceptibility for women occurs during 25-30 years and then when they are about 40 years (Ritsner, 2011). Statistics on recovery shows that after 10 years, about 25% of individuals diagnosed with schizophrenia recover completely, 25% report significant improvement and are relatively autonomous, 25% report improvement although still need support, 15% do not report any improvement and are under hospitalization, whereas 10% die mainly due to suicide. Statistics also shows that majority of those diagnosed with schizophrenia (28%) live independently, 25% live with relatives, 20% are found in supervised housing, 10% are found in nursing homes, 5-6% are hospitalized, 6% are imprisoned, and 6% live in either shelters or are homeless (Warner, 2013). The cost to society in the US associated to schizophrenia is estimated to be $ 63 billion annually, which covers family and societal costs and direct treatment costs. Direct treatment of schizophrenia costs about $ 19 billion whereas the remaining cost is attributed to lost productivity (Warner, 2013).
Signs and Symptoms
Schizophrenia is marked by diverse problems linked to emotions (behavior) and cognitive thinking. Despite the fact that people are likely to have various symptoms, these symptoms result in a person’s inability to properly function. The symptoms for schizophrenia include delusions, hallucinations, disorganized thinking, extreme abnormal motor behavior, and other negative symptoms. Delusions refer to made-up beliefs that are not consistent with reality and often occur in 80% of schizophrenic individuals (Fleischhacker & Stolerman, 2011). Delusions associated with schizophrenia are usually inexplicable. For instance, a schizophrenic person may believe that others are trying to manipulate his/her behavior using magnetic waves or that the voices heard on the radio are conveying their thoughts. Hallucinations often entail hearing or seeing inexistent things. Schizophrenic individuals hallucinate in any of their senses; however, the most prevalent form of hallucination is hearing voices that do not exist. Disorganized thinking refers to a thought disorder characterized by one’s inability to organize his/her thoughts and link them in a logical manner (Ritsner, 2011). Consequently, it impairs effective communication resulting in garbled speech, and providing incomplete or irrelevant responses to questions. Extreme abnormal motor behavior movement disorder, such as repeated motions and inability to move, is another symptom of schizophrenia. In addition, a schizophrenic individual is incapable of focusing his/her behavior, which results in difficulties in completing tasks. Abnormal motor behavior is also typified by excessive and useless movements, and inappropriate posture. Negative symptoms denote the inability or lessened ability for normal functioning. This may be exhibited through lacking emotions, losing pleasure in daily activities, inability to start and maintain planned chores, and reduced speaking even in instances of forced interactions (Ritsner, 2011).
Schizophrenic adults and teenagers usually exhibit the same symptoms; however, it is more problematic to identify the disorder among teenagers. It can be partly attributed to the fact that some early signs associated with schizophrenia are the same developmental characteristics exhibited in the course of teen years including lacking motivation, irritation, sleeping trouble, reduced school performance, and withdrawal from family and peers. Studies have shown that schizophrenic teenagers are less likely to exhibit delusions and more likely to hallucinate when compared to schizophrenic adults (Fleischhacker & Stolerman, 2011).
Different people with schizophrenia exhibit different symptoms. In addition, symptoms change with the progression of disease. The subtype classification of schizophrenia depends on the symptoms that are predominant and most significant for each individual at a particular time. As a result, an individual is likely to be diagnosed with various subtypes of schizophrenia as the disease progresses (Fleischhacker & Stolerman, 2011). Five subtypes have been identified including the paranoid-type, disorganized-type, undifferentiated type, residual-type, and catatonic-type. In paranoid-type schizophrenia, voice hallucinations and delusions are dominant although the person can exhibit normal functioning (intellectual) and emotions. As a result, the signs of paranoid-type schizophrenia include anxiety, unfriendliness, anger and state of belligerence. In disorganized schizophrenia, a person exhibits disorganized speech and behavior that cannot be understood (Searles, 2012). The signs of this type including laughing for no reason, preoccupation with one’s own thoughts, and making irrational statements. Catatonic-type schizophrenia involves the patient exhibiting near immobility, agitation, and useless movements. In undifferentiated-type schizophrenia, a person exhibits some symptoms associated with disorganized, catatonic and paranoid schizophrenia although not adequate to differentiate them as those which belong to one type of schizophrenia. Residual-type schizophrenia refers to the patient exhibiting positive symptoms albeit at low intensities (Ritsner, 2011).
Like other mental disorders, the factors causing schizophrenia are yet to be comprehensively understood. None of the causes of schizophrenia has been distinguished. However, a number of factors have been identified to enhance the risk associated with the development of schizophrenia. They include having a family member with the disorder; being exposed to malnutrition, toxins and viruses while still in the womb especially during the first and second trimesters; having an old age father; consuming mind-altering drugs in the course of adolescence and young adulthood; and higher levels of activation of the immune system (Fleischhacker & Stolerman, 2011).
Diagnostic Criteria / Nursing Assessment
When a person is suspected to be suffering from schizophrenia, the doctor usually requests the psychiatric and medical histories of the person, after which a physical examination, psychological evaluation and medical tests are conducted. The medical tests used is the Complete Blood Count (CBC). Other tests may be performed in order to rule out illnesses having the same signs. Moreover, imaging studies like CT and MRI scan can be performed. Psychological evaluation involves checking the person’s mental status (Fleischhacker & Stolerman, 2011).
Diagnosis of schizophrenia involves satisfying the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The diagnosis entails ruling out the possibility of other mental illnesses and ascertaining that the symptoms are not attributed to a particular medical condition, medication or substance use. Moreover, it is imperative for the individual to exhibit at least two of the symptoms of schizophrenia in the course of one month together with disturbance during six months. There have to be disorganized speech, hallucinations and delusions among the symptoms (Fleischhacker & Stolerman, 2011).
Schizophrenia needs lifetime treatment even in instances when the symptoms are reduced. Interventions that can be used to help in managing the disorder include the use of medications as well as psychosocial therapy. Hospitalizations is a likely necessity when the person exhibits severe symptoms. Medication is considered the primary intervention method used in managing schizophrenia; nevertheless, medication is likely to result in severe albeit occasional side effects. Antipsychotic drugs are often used in the treatment of schizophrenia and work by controlling schizophrenic symptoms through influencing the neurotransmitters in the brain. Some of the most commonly prescribed antipsychotics include perphenazine, haloperidol, fluphenazine, and chlorpromazine (Fleischhacker & Stolerman, 2011). Apart from medications, psychosocial interventions have been found to be effective in managing schizophrenic symptoms when used together with medications, which include family therapy, social skills training, individual therapy, supported employment and vocational rehabilitation (Ritsner, 2011).
Other Considerations in the Management of Schizophrenia
Apart from the abovementioned interventions, supporting and coping are crucial while managing schizophrenia. There is no doubt that coping with the mental disorder can be a difficult task, both for the individual with the disorder and his/her family and friends. A number of ways have been suggested that can help in coping with the disease, for example, learning about the disorder, joining a support group, remaining focused on the treatment goals, and learning how to manage stress as well as relaxation. According to Ritsner (2011), education regarding the disorder helps in motivation the individual with the disorder to maintain the treatment plan while at the same time helping family and friends to have an understanding of the condition.
Evidence-Based Practice Guidelines
In the course of the 1990s, there was a consensus relating to evidence-based practices developed for managing schizophrenia as well as psychosocial functioning (Fleischhacker & Stolerman, 2011). The Chronic Care Model has been identified as representing an effective approach with respect to the management of schizophrenia. The model comprises of six elements including tackling the healthcare organization at the leadership level; enhancing access to the resources of the community like nurse education, self-management and self-help classes; developing self-management reports like assisting individuals to develop action plans and goals; setting up care monitoring; offering decision support; and implementing clinical information systems. With respect to medication guidelines for schizophrenic patients, empirical research has established that antipsychotic treatment is the most effective form of treatment for the disorder (Ritsner, 2011). Owing to the fact that medication prescription in an important element of treating schizophrenia and is easy to execute when compared to other approaches, such as community treatment teams, researchers and administrators have placed emphasis on efforts aimed at improving the compliance to the treatment guidelines (Ritsner, 2011).
From the discussion, it is evident that schizophrenia has significant economic and health costs to society; as a result, effective treatment and management approaches are required. Treatment plays a significant role in relieving most symptoms associated with schizophrenia. However, the majority of individuals suffering from the illness are compelled to cope with its symptoms in the course of their entire lives. Some people with schizophrenia have been able to live meaningful and productive lives. Nevertheless, research is needed to develop more effective treatment medications. In addition, novel research tools are being used in an attempt to better understand the causes of the mental disorder.