Complex Etiology of Schizophrenia: Factors, Diagnosis, Treatment, and Prognosis

Introduction

According to Gray and Zide (2013), Schizophrenia is characterized by a broad range of behaviors marked by a loss of a person’s sense of self, significant impairment in reality testing, and disturbances in feelings, thinking, and behavior. There are five subtypes of Schizophrenia: paranoid, catatonic, disorganized, undifferentiated, and residual type. The causes of the disorder are still unknown. In the story of Mary and Gina Thomas, it is believed to have occurred because of a mental breakdown and high-stress levels.

For example, Gina did not exhibit high signs of Schizophrenia until she divorced her husband and was stuck raising two daughters with a low-paying job and a high cost of living. She had never been placed in this situation before. Therefore, her stress levels were high, which is believed to have triggered severe episodes of hallucinations and paranoia. Betensky (2009) found “that there is an interplay between domestic environmental stressors, a need to act constructively, and resulting depressive symptoms in patients recently diagnosed with schizophrenia.”

Subtypes and Complex Symptoms

According to the American Psychiatric Association (2013), Schizophrenia is diagnosed when two or more of the following, each present for a significant portion of time during a 1-month period: delusions, hallucinations, disorganized speech, grossly recognized or catatonic behavior, and or negative symptoms (diminished emotional expression or avolition). Gina met the criteria and was diagnosed with Schizophrenia. She had auditory hallucinations for many years prior to being diagnosed, and she would scream, “Get the cameras off me.” She would exhibit catatonic behavior, such as banging the broom against the ceiling at two o’clock in the morning. At one point, she became so paranoid that she bought a gun and carried it everywhere, including in the bathroom while she took baths. Gina was an educated woman with two degrees. It took a highly trained expert to recognize her disorganized speech.

Many people who are diagnosed with Schizophrenia are in denial. APA (2013) found:

Some individuals with psychosis may lack insight or awareness of their disorder. This lack of “insight” includes unawareness of the symptoms of Schizophrenia and It may be present throughout the entire course of the illness.

Gina being in denial about her mental health disorder made it hard to receive treatment. Although the cause of Schizophrenia is unknown, recognizing the signs is key to receiving treatment and living a normal life.

Assessment tools related to Schizophrenia

Schizophrenia is a lifelong mental health disorder. It is a strain on not only the person with the disorder but families, co-workers, and friends. When diagnosed, the disorder must be monitored to determine which treatments are effective. There are many assessment tools used to measure the negative and positive symptoms of Schizophrenia. The main assessment tool used is the Diagnostic and Statistical Manual of Mental Disorders. The DSM-V measurement scale is an extraordinary and dependable guide utilized by mental health professionals.

Sadly, a major issue utilizing the DSM-V measurement scale is that Metal Health professionals provide the test, but many individuals who experience depression would prefer not to go to a mental health provider because they are afraid they may be viewed as a disgrace or maybe ashamed to admit to other people that they are in need of mental health treatment. There are other tools used to assess Schizophrenia and its symptoms. According to Kumari (2017):

There are relatively fewer articles on the utility of newer scales like CAINS (Clinical Assessment Interview for Negative Symptoms) and the BNSS (Brief et al.) that compare them to the older scales PANSS (Positive and Negative Symptoms Scale), SAPS (Scale for the Assessment of Positive Symptoms) SANS (the Scale for the Assessment of Negative Symptoms), NSA-16 (Negative Symptom Assessment-16) and CGI-SCH (Clinical Global Impression Schizophrenia.

The Scale for the Assessment of Negative Symptoms or Positive Symptoms (SANS) (SAPS) are the most frequently used tools to assess Schizophrenia. These tools were developed in 1980 to measure the severity of symptoms, whether positive or negative. Both SANS and SAPS use a point scale. SANs use a 6-point scale to measure negative symptoms. The symptoms are rated on 25 items to include emotional response, alogia, motivation or avolition, anhedonia, and attention. The SAPS uses a 6-point scale measurement as well. Symptoms are rated on 34 items to include delusions, hallucinations, bizarre behaviors, and positive thoughts. Both tools have rating scales that are clearly defined.

The Positive and Negative Symptoms Scale (PANSS) is another scale used to measure the positive and negative symptoms of Schizophrenia. According to Giesbrecht (2016), “The Positive and Negative Syndrome Scale (PANSS) is a clinical instrument principally developed for use in schizophrenia to identify the presence and severity of psychopathology symptoms.” During a study, Giesbrecht determined that PANSS is an appropriate and valid clinical measure for more heterogeneous marginalized persons in which substance misuse is ubiquitous. The PANSS is made up of 30 items and placed into sub-categories in which scores range from 30 to 210 points.

The NSA-16 is a semi-organized interview containing 16 items that thoroughly survey the negative disorder of Schizophrenia, and it incorporates the accompanying components: correspondence, feeling/influence, social association, inspiration, and hindrance. These elements are surveyed through an organized meeting and are broad and well-defined to help institutionalize evaluation. The assessments use a 6-point scale that rates five factors. The higher the score reflects the severity of Schizophrenia.

Clinical Global Impression Schizophrenia is a tool used to assess five different symptoms: depressive, negative, cognitive, and positive. The CGI-SCH is a less difficult scale as it comprises just two classes: seriousness of illness and level of progress. There has been great criticism when using this scale. Many critics believe that the scale lacks reliability.

Differential Diagnosis

Differential Diagnosis is the procedure of determining the difference between two conditions that have similar symptoms and signs. Schizophrenia mimics depressive disorder, bipolar with psychotic features, schizoaffective disorder, delusional disorder, schizotypal personality disorder, obsessive-compulsive disorder, and body dysmorphic disorder. According to APA (2013), “The Diagnosis of Schizophrenia is made when the psychotic episode is persistent and not attributable to the physiological effects of a substance or medical condition.

Prevalence

Prevalence is the number of people with a certain characteristic at any given time. Prevalence is estimated by a sample of people to help identify the characteristic. The data is determined by the number of people with the characteristic divided by the number of people randomly selected. A review of most literature shows that only around 1% of adults have Schizophrenia. There is a higher percentage of males versus females that have Schizophrenia. Studies have shown that Schizophrenia has had an effect throughout one’s lifespan. According to Dombeck and Nemade (2013):

It is fairly rare for children and older adults to develop Schizophrenia, but it does happen. The rate of Diagnosis of new cases increases in the teen years, reaching a peak of vulnerability between the ages of 16 and 25 years. Men and women show different patterns of developing the disorder. Males are more likely to have their first episode in the early to mid-20s. Females have two points where the first episodes are most likely to happen. The first is in the late-20s, and the second is after 40 years of age.
Studies have shown that many of the people diagnosed with Schizophrenia go without treatment.

Evidence-Based Treatment

An Evidence-Based treatment is a treatment that is backed by scientific research that proves effectiveness. Although, the patient must be willing to participate in their treatment in order for any treatment to work. There are few evidence-based treatments. The main evidence-based treatments that are used in society are Family Psychoeducation, Psychotherapy, and Pharmacotherapy.

Family members tend to play an important role in the treatment of someone with Schizophrenia. Many people diagnosed with Schizophrenia may present as ashamed and in denial about the disorder. They may even distance themselves from family due to being embarrassed. Family Psychoeducation is an evidence-based treatment that provides families with education and knowledge about mental illness. During this treatment program, families are taught coping, problem-solving, and communication skills to manage someone with mental illness.

In the story of Gina, the family may have been able to help Mary if they had more knowledge about Schizophrenia. Gina, on the other hand, had a daughter who was young but willing to attend the educational classes. It appeared that Gina was less of a burden on the family once they were able to recognize the signs and symptoms of Schizophrenia. According to Dasousa (2012), “It has been estimated across studies that 30-85% of adults with schizophrenia have a family member as a caregiver.”
Psychotherapy is individual counseling to help an individual address the signs and symptoms of the illness. Most sessions last anywhere between 30 to 60 minutes. According to APA (2016):

Research shows that most people who receive psychotherapy experience symptom relief and are better able to function in their lives. About 75 percent of people who enter psychotherapy show some benefit from it. 1 Psychotherapy has been shown to improve emotions and behaviors and to be linked with positive changes in the brain and body. The benefits also include fewer sick days, less disability, fewer medical problems, and increased work satisfaction. Psychotherapy also can have therapy sessions that include family members.

Pharmacotherapy is an evidence-based treatment that entails the use of prescription drugs. In many instances, antipsychotic medications are prescribed to assist with controlling the symptoms of Schizophrenia. During Genevieve’s acute episode of Schizophrenia, she was prescribed Abilify to manage her auditory hallucinations and paranoia. There are other oral medications for Schizophrenia, such as Olanzapine, Aripiprazole, Asenapine, and Paliperone. If a patient is uncooperative with oral antipsychotics, there are intramural injections. Like any other Evidence-Based treatment, the patient must be aware and understanding of a Schizophrenic diagnosis.

Course of Treatment

In the story of Gina, it has been proven with proper treatment and family support, a person with Schizophrenia may live a normal life outside of psychotic episodes. Gina exhibited signs of Schizophrenia in her early thirties. She went without treatment for many years. When she was diagnosed with Schizophrenia, she was in denial. Her family enabled her disorder to the point that it destroyed relationships. Gina was in the hospital involuntarily several times during psychotic episodes. It was Gina’s lack of cooperation that led her to live in a homeless shelter for nearly a year before deciding to get help. She is currently receiving psychotherapy and medications to manage the symptoms. She lives in her own apartment and has a full-time job.

Schizophrenia is not truly recognized until after severe odd behaviors occur. Many people are able to receive treatment and live normal lives. According to APA (2013), “Approximately 5%-6% of individuals with Schizophrenia die by suicide, 20% attempt suicide on more than one occasion, and many more have suicidal ideations.

Conclusion

According to research, there is not a cure for the schizophrenia disorder. Schizophrenia requires treatment throughout one’s life. Many people with the disorder are able to live a meaningful life. Studies have shown that many people with Schizophrenia struggle with social and occupational skills. They tend to make lower wages than their parents. According to APA (2013), “There is a strong contribution of genetic factors in determining risk for Schizophrenia, although most individuals who have been diagnosed with Schizophrenia have no family history of psychosis.

Reference

1. Gray, S. & Zide, M. (2013). Psychopathology: A Competency-Based Assessment Model for Social Workers (4th Ed.) Brooks/Cole.