Schizophrenia is a mental disorder which usually starts between the ages of 15 35 and affects about 1 in 100 people

Assessment Criterion 1

The Problem

Schizophrenia is a mental disorder which usually starts between the ages of 15 – 35 and affects about 1 in 100 people during their lifetime. Men and women are equally affected by this illness however in men schizophrenia usually occurs earlier than women. Doctors have described schizophrenia as a psychotic illness, this is because patients with this illness may not be able to distinguish their own thoughts and ideas from reality. [1, 3] People which suffer from this disease, experience various symptoms such as delusions, difficulty thinking, disorganised speech, catonic behaviour, hallucinations and the feeling of being controlled. The causes of schizophrenia has never been established however it is likely that many different factors may have had an effect such as genetics, drug abuse, stress or damage to the brain during birth. [1 – 3] MRI scans show subtle differences in people with schizophrenia. Fig.1 shows an MRI scan of a normal male without the disease while Fig 2 shows an MRI scan of a schizophrenic male.

Taken from
Scan by Professor Nancy Andreasen

Overcoming the Problem

Schizophrenia seems to be a combination of thought disorder, mood disorder and anxiety disorder which often requires a combination of medical treatment such as antipsychotic, antidepressant and antianxiety medication. Because the causes of schizophrenia hasn't yet been established, current treatments focus on removing the symptoms of the disease.

Antipsychotic Medications

Antipsychotic medications are effective in lightening the symptoms of schizophrenia. Even though these drugs has proven to improve the lives of people with this disease, it does not cure it. Individuals respond differently to antipsychotic drugs which is why doctors work with them to find one which controls their symptoms the best with the least side effects.

Antipsychotic drugs are divided into two groups, conventional and atypical. Conventional antipsychotics where introduced in the mid 1950s, they varied in the side effects they produced. These included shaking, trembling, muscle twitches and muscle spasms. Many antipsychotic drugs have a similar chemical structure but vary slightly producing the different side effects. Fig. 3 shows two chemical structures of antipsychotic drugs, Promazine and Chlorpromazine. [6] Conventional drugs are broken down into low potency and high potency classifications, Fluphenazine and haloperidol are examples of high-potency typical antipsychotics, and chlorpromazine is an example of a low potency antipsychotic. Potency referred to the ability of the drug to bind to dopamine receptors, and not to the effectiveness of the drug. High-potency antipsychotics such as , in general, have doses of a few milligrams and cause less sleepiness and calming effects than low-potency antipsychotics such as and , which have dosages of several hundred milligrams. [8 – 11]

Fig.3 Chemical Structure of Antipsychotics http://www.google.co.uk/imgres?imgurl=http://www.medicinescomplete.com/mc/martindale/2009/images/CLK0383C001.

In the last decade, atypical antipsychotic medication was introduced, these drugs have less rigorous side effects than the older ones. Drugs launched were medications such as risperidone (Risperdal), olanzapine (Zyprexa), quietiapine (Seroquel), sertindole (Serdolect), and ziprasidone (Geodon).[11 – 12] When people first start to take atypical antipsychotics, they may become drowsy, experience dizziness when they change positions, have blurred vision, or develop a rapid heartbeat, menstrual problems, sensitivity to the sun, or skin rashes. Many of these symptoms will go away after the first days of treatment. [12 – 13]

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Antipsychotic medication works by influencing how information is transmitted between individual brain cells, each neuron in the brain has a single long fibre called an axon, which transmits information to other neurons. [6] Information travels down a cell's axon as an electrical impulse and when the impulse reaches the end of the axon, a chemical called a neurotransmitter is released to pass information on to the next cell down the line. A receptor on the receiving cell detects the neurotransmitter, which causes the receiving cell to generate a new impulse. Symptoms of psychosis appear to be caused by extreme activity of cells sensitive to the neurotransmitter dopamine. [10] As a result antipsychotic medications works by blocking receptors so that communication between groups of cells is reduced. All antipsychotic drugs block in the dopamine pathways of the brain. Conventional antipsychotics also block dopamine receptors in other pathways, this is thought to produce some of the unwanted side effects that the conventional antipsychotics can produce. Atypical antipsychotic drugs have a similar blocking effect on , they can also block serotonin receptors. The extra effects on serotonin levels may be why some patients can experience the negative symptoms of schizophrenia. [13 – 15] Fig. 4 shows a graph displaying the results of an experiment carried out; the bar chart shows the effectiveness of antipsychotic drugs compared to no treatment at all.

Fig. 4 Results of Experiment on Drug Effectiveness

http://www.flyfishingdevon.co.uk/salmon/year1/phenoth.gif

Assessment Criterion 2

Consequences of Schizophrenia

Social

Relationships of a person with schizophrenia may suffer because people with schizophrenia often withdraw and isolate themselves. Paranoia can also cause an individual to be suspicious of friends and family. This illness also causes disruptions to normal day activities due to everyday activities becoming hard and even because of social difficulties. Symptoms associated with schizophrenia such as hallucinations, delusions and disorganized thoughts prevent them from socialising normally. People with schizophrenia have a high risk of attempting suicide; this is especially likely when an individual is experiencing psychotic episodes. [18] Nowadays there is a huge emphasis on community care which means that people with schizophrenia are no longer being institutionalised but instead being accommodated in the community within the family setting. Research carried out in the past has indicated that specific types of family environment can be harmful to the individual. The environment which had a higher rate of relapses is called a high expressed emotion environment. [17] This sort of environment involves hostility, negative criticism towards the patient and more than 35 hours of face to face contact per week. There is no single factor which is a consequence of this disease but a combination of many. [18]

Economic

People with schizophrenia will have a huge economic burden as they will constantly need medical treatment which is very expensive and because of their condition it is unlikely that they would be working. This will also put a burden on the caregiver as they will also have the stress of looking after the patient.

Benefits and Risks

Although there is no cure for schizophrenia, it is successfully treatable with antipsychotic medication which reduces the risk of future psychotic episodes, makes symptoms less mild and even shortens the course of an episode. Studies have shown that 70% of patients improve while on these drugs, 25% show only minimal improvement and about 5% actually deteriorate.[18] However not all medications are equal, different patients respond differently to the types and dosages of the medicine so this must be individually determined by a psychiatrist which takes time to get right. Antipsychotic medicine while very beneficial, can take weeks or even months to start working at full strength.

Also like any other drugs, antipsychotic medicine comes with unwanted side effects, in the early stages of treatment side effects include blurring of vision, dry mouth drowsiness muscle spasms and restlessness. These can be corrected by lowering the dosage or controlled by other medications however other symptoms may cause a more serious problem to occur. Tardive Dyskinesia (TD) is a disorder which involves involuntary movements often affecting the mouth, lips, tongue and sometimes even other parts of the body such as the arms and legs. This occurs in about 15 – 20% who have been receiving the older conventional antipsychotic drugs, in most cases, the symptoms are mild and the patient may be unaware of the movements. [19] The more recent atypical antipsychotic drugs have a much lower risk of causing TD, however they produce other side effects of their own such as weight gain. If patients are given high doses, this may lead to problems such as social withdrawal. The first of the atypical antipsychotic drugs were clozapine (Clozaril), it treats symptoms efficiently even in people who do not respond to other treatments however it can produce a serious problem called agranulocytosis. This is a loss of white blood cells which fight infection so patients who take clozapine have to have their white blood cell counts checked every week. Despite this their optimal use in people with schizophrenia is a subject of current research. These newer drugs are a significant advance in medical treatment. [19 – 20]

Fig 5. Visual Image of Clozapine (Clozaril)

Alternative Techniques

Cognitive Behavioural Therapy (CBT)

The National Institute of Mental Health reports that many studies show that cognitive behavioural therapy helps people with schizophrenia in combination with medication. This type of therapy is aimed at helping people with schizophrenia understand better and to learn how to cope and live independently. This is done by changing how you think and act, CBT encourages patients to talk about themselves, the world and other people and how their actions affects their thoughts and feelings. By doing this, it helps to change cognitive thoughts and behaviour which is meant to help the patient feel better about life. [21 – 22]

Unlike other psychosocial techniques of schizophrenia, it does not involve talking freely, or dwell on events in the past to gain insight into the patient’s emotional state of mind.

Cognitive behavioural therapy focuses on problems and difficulties which arise at the present time and looks for practical ways in improving the patient’s state of mind on a daily basis. This type of therapy usually takes place weekly or even daily depending on the individual patient, treatment, the time which the treatment lasts is also dependent on each patient lasting from six weeks to six months. [23] An individual’s therapist will help them find ways to change their thought patterns and behaviour so that they can cope with their problems better, however CBT cannot eliminate the problems but can only help the patient manage them in a more positive way.

Electroconvulsive Therapy (ECT)

Electroconvulsive therapy is a medical treatment which has been used since the 1930’s yet it remains one of the most controversial treatments used in psychiatry. This treatment involves placing electrodes on the temples, on one or both sides of the patient's head, and delivering a small electrical current across the brain, with the patient under full general anaesthetic so that the patient is unaware. The aim is to produce a seizure lasting up to a minute, after which the brain activity should return to normal. Fig.4 shows a picture of this procedure.Patients may have one or more treatment a week and perhaps more than a dozen treatments in total. The precise way in which ECT works is still unknown but is still proven to be effective. This technique is used when other forms of medication have either not worked or caused severe side effects. Although ECT has been used for treating schizophrenia in the past, it is not used as often today. [24 – 26]

Illness Management

Illness management involves teaching patients ways to handle social situations appropriately. It often involves the person thinking through or role-playing situations that occur in social settings in order to prepare for those situations when they actually occur. This treatment type has been found to help people with schizophrenia resist using drugs of abuse, as well as improve their relationships with health-care professionals and with people at work. People with schizophrenia can take an active role in managing their own illness. Once they learn basic facts about schizophrenia and the principles of schizophrenia treatment, they can make informed decisions about their care. If they are taught how to monitor the early warning signs of relapse and make a plan to respond to these signs, they can learn to prevent relapses. Patients can also be taught more effective coping skills to deal with persistent symptoms. [27 – 28]

Assessment Criterion 3

Evaluation of Sources

I have found references [6; ], [14; , [22; ] and [26; ] very useful as I gained the fundamentals of the topic I was searching. These four are from the same founded website, it is a free web based encyclopedia supported by a nonprofit foundation. However despite this, Wikipedia has been criticized to be systemic biased and inconsistent. This source is not particularly reliable as the articles given do not always prove to be recognizable.

Reference [25;http://www.elsevier.com/wps/find/journaldescription.cws_home/506091/description] was very insightful; it is an International Multidisciplinary Journal of the (SIRS). I have found this to be very reliable as the articles in this journal are subject to peer review so has been tested on its reliability and validity before being published. Also this is a very well know journal which has been published by international researchers and clinicians which gives me more confidence in this source. In addition to this I have found the same information from this journal in many other websites including reference [4] which is a published book Biology Seventh Edition By Campbell Reece.