answer
- Introduction
Schizophrenia is a major mental disorder which has been recognized as a top public health issue in the US and around the world. It is a chronic and severe disabling brain disorder which affects the way a person thinks, feels, and acts. This disorder causes people to have an abnormal perception of reality, often described as a type of psychosis. People with schizophrenia are more likely to die, as much as an average of 15 years earlier than the general population. This disorder has a devastating effect on many areas of an individual’s life such as education, employment, finances, overall health, and importantly, suicide. Schizophrenia is not split or multiple personality. These are common misconceptions about schizophrenia. It is a complex disorder characterized by a constellation of distinctive and predictable symptoms. Schizophrenia is not rare. It affects roughly one percent of the world’s population and runs a chronic course. Although the disorder has been around since ancient times, it was first identified as a discrete mental illness by Dr. Emile Kraepelin in 1887 and the illness itself is named after the Swiss psychiatrist Eugen Bleuler who coined the term in 1911.
1.1 Definition and Overview
The onset of schizophrenia typically occurs in adolescence or early adulthood, and the illness is characterized by a chronic course of recurring symptoms. These often include delusions (fixed false beliefs that are not affected by reasoning), hallucinations (perceiving things that are not there), disordered thinking and speech, and negative symptoms such as affective flattening (lack or decline in the expression of emotions), alogia (diminished speech output and poverty of thought) or avolition (inability to carry out goal-directed activities). Clearly, symptoms have severe implications in terms of the individual’s level of functioning and can thus cause a significant decrease in quality of life for both the individual and their caregiver. Full recovery from an episode of schizophrenia is unusual, and many will continue to experience residual symptoms to a certain extent in between acute episodes. Suicide is unfortunately a popular end for those suffering from schizophrenia, and it has been suggested that between 4-10% of individuals with schizophrenia die by suicide, most commonly in association with depressive symptoms, which can also sometimes appear as a result of the awareness of the severity of the illness. Life expectancy for those with schizophrenia is thought to be between 12-15 years less than the general population, due to both suicide and an increase in deaths from natural causes such as cancer and heart disease. It should be noted that many factors can influence the course and outcome of schizophrenia, including sex, genetic factors, social factors such as social support or integration, and of course, the accessibility of treatment which continues to improve. The clinical presentation and ultimately the course of schizophrenia can vary greatly between individuals, and it has long been noted that the symptoms outlined above are seen to manifest themselves in a comparable way to the widely accepted description of ‘dementia praecox’ by Emil Kraepelin, who is seen by some as the father of modern scientific psychiatry. Kraepelin’s description would translate to an early onset of a progressive dementing illness, and it is therefore clear to see where the name ‘schizophrenia’ meaning ‘split mind’ has caused much confusion since its initial coinage by Eugen Bleuler, who interestingly was attempting to replace the term ‘dementia praecox’ with something that is reflected in the current understanding of the illness. Given that the current understanding suggests that there is no direct link of the misinterpreted ‘split mind/split personality’ to the symptom of disordered thinking and the fact that dementia praecox itself is no longer recognized as a valid diagnosis, it should be kept in mind that schizophrenia and its history are an evolutionary concept and ongoing change to current understanding is essential.
1.2 Prevalence and Incidence
According to the World Health Organisation, schizophrenia is a mental disorder affecting seventeen million people worldwide. However, although its occurrence is far smaller in developing countries, varying dramatically by place and ethnicity, it affects all social groups. Regardless of this disparity, the illness strikes young people when they are most vulnerable, and that time of life often determines the appearance of this illness. Unsurprising remembering the complexity and ambiguity of the illness, many individuals and policymakers are convinced that schizophrenia has been on an increase, particularly in urban areas, though the evidence suggests otherwise. The best available data, provided by three cohort studies, from 1965 through to 1997, in people aged 15-34 in Camberwell, south London, has shown a steady decrease in incidence: from 24.1 per 100,000 person years in the first study, to 17.6 in the second study, to 10.7 in the last. This trend is mirrored in Sweden, where national data analysis has reported a decrease in the incidence of schizophrenia. Furthermore, the Swedish study supported the observed association between non-affective psychosis and cannabis use. Data for the whole of Finland also suggests that incidence is stabilising. These studies counter the general feeling that schizophrenia is on the increase and may lead to a deeper understanding of the causes of schizophrenia and how best it could be prevented. The increase in the prevalence of treated schizophrenia in developing countries, predicted by the Sartorius group, has not occurred in any simple uniform way.
1.3 Historical Background
The early 20th century can be seen as a pivotal point in schizophrenia history, as it was during this time that Emil Kraepelin attempted to categorize independent lines of mental illness. Kraepelin believed that mental illnesses were as a result of biological factors and thus used observable clinical course and outcome to identify separate conditions. It was this that led to the dichotomy of schizophrenia and manic depression (now bipolar disorder). Kraepelin very much conceived schizophrenia as biology’s destiny and its diagnosis as a death sentence. Despite this, it is said that he held optimistic expectations for patients with schizophrenia as he believed more mild forms would revert to other illnesses. This was an early example of the pessimistic optimism debate surrounding schizophrenia’s potential for recovery. Schizophrenia being recognized as a long-term illness with frequent deterioration of functioning, and an inevitable decline into severe dementia. Kraepelin’s distinctions between the mental illnesses at the time were widely accepted and in time led to the international recognition of schizophrenia as a mental illness.
The recorded study of schizophrenia dates back to the 19th century, at a time when mental illness in general was poorly understood. It is during this period that conceptualizations of the condition shifted towards a disease model. Very little is known about the earliest pre-19th century conceptualizations of schizophrenia. The terminology schizophrenia, however, was coined by Swiss psychiatrist Eugene Bleuler in 1911. Bleuler replaced the previously used term dementia praecox (premature dementia), as he believed the term misled the public and was not an accurate description of the disorder’s symptoms. It was Bleuler who proposed a return to an earlier understanding of the splitting of mental associations and thought disorder. This split was evident in the double bookkeeping theory: people with schizophrenia kept a real and an alternative set of books due to their inability to filter their thoughts.
- Causes and Risk Factors
2.1 Genetic Factors
2.2 Environmental Factors
2.3 Neurochemical Imbalances
- Symptoms and Diagnosis
3.1 Positive Symptoms
3.1.1 Hallucinations
3.1.2 Delusions
3.2 Negative Symptoms
3.2.1 Flat Affect
3.2.2 Social Withdrawal
3.3 Cognitive Symptoms
3.3.1 Impaired Memory
3.3.2 Disorganized Thinking
3.4 Diagnostic Criteria
3.4.1 DSM-5 Criteria
3.4.2 Differential Diagnosis
- Treatment Options
4.1 Medications
4.1.1 Antipsychotic Drugs
4.1.2 Side Effects
4.2 Psychotherapy
4.2.1 Cognitive Behavioral Therapy
4.2.2 Family Therapy
4.3 Psychosocial Interventions
4.3.1 Rehabilitation Programs
4.3.2 Supported Employment
- Living with Schizophrenia
5.1 Coping Strategies
5.2 Support Networks
5.3 Managing Daily Life
- Research and Future Directions
6.1 Advances in Understanding
6.2 Novel Treatment Approaches
6.3 Prevention Strategies