They are likely to have common pathogenetic mechanisms of endogenous development in the form of hereditary abnormalities that do not appear until a certain period of life. Without treatment, it usually ends with the same type of picture personality changes (defects) with disorganization of mental functions (thinking, emotions, and psychomotor mental activity). The persons who are close to the patient are able to detect the onset of the disease at its earliest stages that is very helpful in early diagnosing of schizophrenia. It could play an important role in reducing the overall number of cases and the difficulties associated with the treatment of schizophrenia. It is well-known that the earlier the sickness is detected, the bigger is the possibility of its successful treatment. To diagnose it, psychiatric science and clinical medicine need to disseminate simple and effective knowledge about the illness, which would contribute to more effective preventive work among the population in alliance with psychiatrists and clinicians.
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Schizophrenia is the most important clinical and social problem of psychiatry throughout the world. It affects about 1% of the Earth’s population; annually, 2 million people are registered to be diagnosed with this illness. Schizophrenia takes one of the first places among mental disorders in terms of prevalence and is the most common cause of disability because of psycho diseases. There are no known ways to prevent schizophrenia. However, timely diagnosis and therapy assist to prevent or reduce the frequency of relapses and hospitalizations and help to minimize the destruction of a person’s life, his/her friendship and family relations.
General Description of Schizophrenia
Schizophrenia is characterized by disorders of thinking and perception as well as inadequate or base emotion. Violation of thought arises when small features of objects or phenomena usually muted in a person during a normal purposeful mental activity start to dominate and replace adequate thinking in a particular situation. Such a patient is thinking fuzzy, vague and intermittent with the sense of interruption or seizure of their thoughts. Disease onset may be acute with a severe behavioral or a gradual progressive development of painful events. The condition (continuous or periodic) is accompanied by changes in a person, the growth of specific schizophrenic defects, arising of different symptoms and syndromes (Varcarolis, 2014).
Neither consciousness during the disease is interrupted, nor are many intellectual processes changed. Although, the long-term course of schizophrenia disrupts the process of perception, attention, and memory. Schizophrenia is characterized by the loss of the sense of personality, its cleavage, the loss of differentiation of the identical "I" (Varcarolis, 2014). Periods of exacerbation and remission are usual for schizophrenia. The real causes of the disease are still unknown; however, genetic predisposition, neurobiological disorders, conditions in early childhood, social and psychological interaction play a role in the development of schizophrenia.
Symptoms of Schizophrenia
Precursors of schizophrenia are alienation, irritability, and mood disorder (Varcarolis, 2014). Schizophrenia is characterized by peculiar disorders (Varcarolis Halter, 2010). There are productive symptoms (delusions, hallucinations), negative symptoms (apathy, apathy, abulia), and cognitive disorders (disturbances in thinking, attention, perception). Schizophrenia is manifested by such symptoms as echo thoughts, insertion or withdrawal of thinking, openness and broadcast minds, delusional perception, and delusions of control.
Schizophrenia patients may experience hallucinations, imaginary perception without an object, frequent pseudohallucinations, and auditory hallucinations. Schizophrenia has different symptoms manifested by a decrease in the energy potential of the individual, negativism, isolation, and apathy. According to the recent studies, schizophrenia causes neurocognitive deficits and dysfunction of the autonomic nervous system.
The symptoms of schizophrenia are combined and play a considerable role in diagnosing the disease. Patients experience echo thoughts and delirium of body movements, limbs, opinions, and feelings. Also, they suffer from the delusional perception of the environment and auditory hallucinations that influence the behavior of the patient. Continuous delusions such as identification with religious or political figures, statements about superhuman abilities (such as the ability to regulate the windstorms or communicate with UFO) could appear in schizophrenic patients. Persistent hallucinations in any sensory field (gustatory, olfactory, visual, tactile, visceral), delusional unformed or overvalued ideas without an expressive emotional content may occur daily for weeks or even months. Illness can lead to dissociated pronunciation or coining of neologisms.
Forms of Schizophrenia
There are different forms of schizophrenia and various types of its course. Paranoid schizophrenia is characterized by persistent delusions often combined with auditory hallucinations (Varcarolis, 2014). Violations in the volitional or emotional sphere are expressed more clearly than in other forms of schizophrenia. Disorganized form of schizophrenia usually begins in adolescence. This form includes affective disorders (emotions are superficial and inadequate); delusional and hallucinatory experiences are fragmented, and the behavior is unpredictable, mannered, and pretentious (Varcarolis, 2014). Negative indications, affective and desire disorders are found relatively quickly. Catatonic form of schizophrenia is often combined with psychomotor deterioration that extends from stupor to intense (Varcarolis, 2014). In this form of schizophrenia, automatic resignation and nothingism often take place. Frilly posture can be maintained for a long time (Hare, Glahn, Dassori, 2010). Residual (depreciated) schizophrenia is a chronic stage that is mainly manifested with negative symptoms such as psychomotor retardation, decreased activity, blunting of emotions, passivity and lack of initiative, volitional disorders, and poor speech (Picardi, Viroli, Tarsitani, 2012). Simple schizophrenia is a form of schizophrenia with a keen but advanced increase of eccentricities, incapacity to meet the social requirements, and reduced activity (Varcarolis, 2014). In this case, typical residual symptoms of schizophrenia are formed without acute psychotic episodes (Picardi, Viroli, Tarsitani, 2012).
Schizophrenia should be distinguished from schizophrenic psychosis. The latter includes a group of mental disorders with a relatively favorable flow (Hare, Glahn, Dassori, 2010). During the clinical flow of the ailment, there are only a few symptoms of schizophrenia, which are likely to appear as additional signs of the disease rather than its main manifestations. Schizophrenic psychosis is usually dominated by delusions and hallucinations. In terms of delimitation of schizophrenia and similar disorders, schizotypal disorder is manifested by eccentric behavior, impaired thinking and emotions that resemble the symptoms of schizophrenia (Hare, Glahn, Dassori, 2010). Schizotypal disorder is similar to personality disorder since it is difficult to determine when it begins to form. Applying differential diagnosing of schizophrenia allows distinguishing it from a schizoaffective disorder, including both the affective and schizophrenic symptoms (Varcarolis, 2014). Isolated manic, depressive and mixed types of schizoaffective disorder should also be differentiated from schizophrenia.
Diagnostics of Schizophrenia
Diagnosis of schizophrenia is based on a psychiatrist’s investigation due to the complaints about the patient's behavior (with possible additional information from family, friends, or co-workers) (Varcarolis, 2013). During the interview, a physician reveals some characteristic signs of schizophrenia such as productive symptoms (delusions, hallucinations, and mood disorders), negative outcomes (emotional depletion, reduction drives, isolation, decreased energy potential), as well as the severity of neurocognitive deficits (impaired memory, attention, and thinking). Also, paraclinical methods of investigation are often used, which helps to determine the structure and functioning of the nervous system, the presence of comorbidities, as well as identify the pathology in the nervous and endocrine systems. It allows assessing the severity of the disease more accurately, applying differential diagnosis, and navigating in the selection of drugs for the most effective treatment with minimal side effects. Paraclinical examination methods consist of magnetic resonance imaging of the brain, encephalogram, transcranial duplex scanning of cerebrovascular pathology, and check of the hormonal status. Paraclinical tests also include neuropsychological (identification of pathology by the means of psychological tests pathology in various cortical centers of the brain) and pathopsychological study (identification of disturbances in thinking, attention, and memory) (Varcarolis, 2014). Currently, there is no laboratory diagnostics of schizophrenia.
Treatment and Complications of Schizophrenia
Treatment is usually carried out by the means of pharmacotherapy. Among other methods, there are insulin therapy and electroconvulsive therapy. The choice of psychotropic drugs is determined by the type and characteristics of the disease’s symptoms.
Malignant schizophrenia is cured with neuroleptics using continuous flow with powerful antipsychotic effect (chlorpromazine, levomepromazine, promazine, haloperidol, trifluoperazine, clozapine). To impede the rigorous complications in the treatment of a typical neuroleptics, doctors prescribe anticholinergics (trihexyphenidyl, biperiden). In the treatment of simple schizophrenia with neuroleptics stimulants such as trifluoperazine, perphenazine, and perphenazine are often used. Also, atypical antipsychotics (risperidone, quetiapine, olanzapine) are used during the treatment of a severe form of schizophrenia (Townsend, 2011). The treatment of paranoid schizophrenia is combined with a continuous use of typical neuroleptics (perphenazine, trifluoperazine, haloperidol) that decrease hallucinations. In the treatment of hallucinatory delirium, perphenazine or trifluoperazine are used. In the later stages of the treatment, fluphenazine is used. Tranquilizers (phenazepamum, tofisopam, lorazepam, bromazepam) are used in combination with neuroleptics (Varcarolis Halter, 2010). To eliminate hyperthermia that can occur during schizophrenic episodes, artificial cooling is conducted through placing ice packs on blood vessels encased by wet sheets and towels. In order to prevent cerebral edema osmotic diuretics (mannitol) are administered intravenously; at the same time, diazepam or hexenal anesthesia is applied.
Schizophrenia is often accompanied by the following complications: the inability to carry out social interaction, impairment of the functions of the brain, neuroleptic extrapyramidal disorders caused by the use of neuroleptics.
Conclusion
Modern medicine does not know the accurate causes of schizophrenia. Psychiatrists say that there is no single factor, which contributes to the emergence of schizophrenia. The incentives for diagnosing the ailment include a whole range of factors: a mentally vulnerable person, heredity, alcohol abuse, drugs, fetal hypoxia, seasonality, etc. The disease can be manifested through various symptoms. These are autism at an early age, auditory and visual hallucinations, obsessive-compulsive disorder, delirium, speech disorder, emotional poverty, the lack of concentration, mania. Modern medicine allows the patients to achieve a certain harmony with themselves and others. Moreover, the disease can allow the patients to lead a normal life thanks to a permanent and adequate treatment.
References
Hare, E., Glahn, C., Dassori, A. (2010). Heritability of age of onset of psychosis in schizophrenia, The American Journal of Medical Genetics, 153(1), 298-302.
Picardi, A., Viroli, C., Tarsitani, L. (2012). Heterogeneity and symptom structure of schizophrenia, Psychiatry Research, 198(3), 386-394.
Townsend, M. C. (2011). Nursing diagnosis in psychiatric nursing: Care plans and psychotropic medication (8th ed.). Philadelphia, PA: F.A.
Varcarolis, E. M., Halter, M. J. (2010). Foundations of psychiatric mental health nursing (6th ed.). St Louis, MO: Elsevier.
Varcarolis, E. M. (2013). Foundations of psychiatric mental health nursing: A clinical approach (7th ed.). St Louis, MO: Elsevier.
Varcarolis, E. M. (2014). Essentials of psychiatric mental health nursing (2nd ed.). St Louis, MO: Elsevier Health Sciences.
