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Schizophrenia: Diagnosis and Treatment Approaches Essay


Introduction

Schizophrenia: Past Theories

The concept of schizophrenia as the means of embracing a specific set of disorders causing hallucinations and delusions in patients is not new. A range of theories regarding the nature of the disorder, as well as its effects on the patient and the means of addressing it, have been suggested over time.

Despite the fact that schizophrenia is currently referred to as the disorder that people are supposedly predisposed to genetically, there is a viral theory thereof, which can be considered quite viable. According to a recent study, there is a possibility that schizophrenia can be caused partially by the influenza virus or PolyI:C (Fatemi et al. 1).

One might argue that the research in question did not prove that there was a direct correlation between the contraction of the virus and the development of schizophrenia in patients: “Prenatal viral infection at E7 led to gene expression and morphological changes in the placenta at E16” (Fatemi et al. 9). However, the fact that there might be a connection between the identified variables needs to be borne in mind.

Research Question

How can schizophrenia be diagnosed in a patient, and what methods of treatment can be considered the most efficient ones?

Strengths

A detailed analysis of the factors that affect the patient’s condition, including the internal and the external ones, must be mentioned as one of the essential strengths of the studies that have been conducted on the subject matter so far. The use of the evidence-based approach as the means of locating the essential information about schizophrenia and its nature can be considered the obvious strength of the existing studies.

Finally, the fact that the identified area currently receives significant investments on a regular basis should be viewed as an essential strength. Since the disease has recently become prevalent among the rest of the psychological disorders (Khan et al. E2), there is a consistent need to continue studying the subject matter extensively. Furthermore, the fact that the medications currently used to prevent the patient from having hallucinations, as well as any other symptom of schizophrenia shows that further studies are necessary to improve the quality of the treatment. Therefore, the fact that the target area receives an impressive amount of funding can be listed among the primary strengths.

Limitations

It should be noted that the existing studies on schizophrenia have an array of limitations, which are predetermined primarily by the choice of their methods. Furthermore, because of the lack of understanding of what the nature of schizophrenia is, a range of studies are restricted to reiterating the facts that are already known and making the assumptions that can be deemed as rather far-fetched. Indeed, as Kane et al. explain, “We still do not understand the etiology and pathophysiology of schizophrenia although this remains true of many major illnesses in general medicine as well” (Kane et al. 2).

It would be wrong to assume that the current research has the information that other studies do not. However, the paper aims at reviewing the outcomes of not only one study but a range of clinical trials, therefore, creating the knowledge base that will serve as the foil for making more detailed and accurate conclusions.

Omissions

Past research shows that the process of diagnosing schizophrenia may become rather complicated. Furthermore, the treatment of schizophrenia is likely to become a problem because of the level of denial shown by the patients. Indeed, studies point to the fact that very few people, in fact, manage to admit the problem and be willing to address it (Morrison et al. 1). As a result of the lack of responsiveness, the treatment becomes ineffective.

Moreover, the fact that some of the agents used to manage the disorder are associated with side effects deserves to be mentioned. For instance, weight gain and the following development of diabetes needs to be listed among the most common negative effects of using the antipsychotics that have been designed comparatively recently (e.g., clozapine (Clozaril), quetiapine (Seroquel), etc.) (Leucht et al. 1).

Significance of the Topic, Research Question, and Investigation

Seeing that there are a plethora of gaps in the past studies in the issue of schizophrenia, there is a pressing need to carry out an all-embracive study that will provide an overview of the innovative techniques and suggest that possible tools for managing the problem. Particularly, the improvement of the communication techniques used to help the patient acknowledge the problem and accept the suggested treatment framework although its side effects will have to be considered as the primary goal of the study. By considering the most recent studies along with the primary resources on the subject of schizophrenia, one will be able to draw the essential conclusions and design the framework of communication that will lead to efficient treatment.

Literature Review

According to DSM-V, schizophrenia can be defined as a “prototypical psychotic disorder” (Chapter 2. Schizophrenia Spectrum and Other Psychotic Disorders DSM.PsychiatryOnline.org). However, when considering the identified definition, one must view it with a grain of salt since it was provided by an internet resource. Granted that the identified site is known as the DSM library and, therefore, contains the essential data that is also represented in the DSM-V manual, it is hosted at the.org domain, which devalues the quality of the information to a considerable degree. Therefore, the identification of other resources that provide the definition of the subject matter will have to be considered.

Diagnosis

As stressed above, the very definition of schizophrenia lacks precision. As a result, diagnosing the problem implies running a range of tests. The process of diagnosing, however, relies primarily on the symptoms and the way in which they manifest themselves in the patient. Although the destructive effects that it has on people’s personalities, such as the inability to make decisions, control emotions, maintain positive relationships, etc., are rather hard to identify at the earliest stages of the disorder development, the existing tests are likely to help determine the problem in a comparatively accurate manner.

The first and most obvious, the development of hallucinations, including not only visual but also auditory ones, need to be determined. Afterward, the patient must be checked for possible delusions. The latter is typically defined as the beliefs that do not coincide with the objective reality and that the patient strives to maintain despite the fact that they are clearly false.

Speech issues, such as the lack of consistency in the communication process, the fact that the patient’s statements do not make sense, etc., should also be considered a possible symptom of schizophrenia. One might also add that bizarre behavior can be viewed as the manifestation of schizophrenia; however, the identified characteristic of the disorder does not necessarily apply to all conditions, and vice versa – the development of weird and asocial behavior does not necessarily imply that the patient has schizophrenia (Bull et al. 194).

Nevertheless, the identified characteristics serve as major indicators of the disorder, especially when observed simultaneously. At present, the American Psychiatric Association (APA) suggests in DSM-V that hallucinations and delusions should be considered primary indicators of schizophrenia (American Psychiatric Association, 2012). Therefore, observations can be considered the primary tool for diagnosing the disorder.

It should be noted, though, that some of the recent theories explaining the nature of schizophrenia deserve a closer look. For instance, the suggestion to scrutinize the factors affecting the development of the disorder from the perspective of the Theory of Mind seems rather sensible. Promoting the analysis of changes in the patient’s social behavior as opposed to the cognitive issues that they are likely to have later, the identified approach can be considered a new and improved tool for diagnosing the problem and addressing it at its onset. As a result, the effects of the proposed treatment are going to be much more spectacular than they would be otherwise.

The Theory of Mind (ToM) is often used as the means of considering the factors that contribute to the development of schizophrenia. To be more accurate, the theory suggests that the nature of schizophrenia should be correlated to the social impairments in the patient as opposed to cognitive ones. Put differently, the framework suggests that ToM should be viewed as the primary marker for determining schizophrenia in patients, especially at its onset.

Despite the fact that further studies must be carried out to provide the ultimate proof of the connection between the variables in question, it is safe to say that ToM serves as the foundation for the identification of schizophrenia development in patients along with the symptoms such as delusions and hallucinations (Bora and Pantelis 34).

At present, however, the theory that suggests a biological predisposition to schizophrenia receives extensive support as the most viable framework. Indeed, the specified approach toward understanding schizophrenia has the most substantial evidence and the greatest amount of support. Nevertheless, the idea of using social indicators as the markers for identifying the early symptoms of schizophrenia can be considered a new and promising approach.

Particularly, it is suggested that the idea of using cognitive markers of schizophrenia as the tools for defining the threat of schizophrenia development should be introduced into the contemporary psychiatry realm. As a result, the issue can be addressed within a comparatively short amount of time. To be more accurate, the use of the identified framework is likely to result in addressing the problem when it has not yet developed into a major issue.

When diagnosing the disorder, one must also bear in mind that there are different types of schizophrenia. As stressed above, the disorder manifests itself in a variety of shapes and types; as a result, the process of diagnosing the issue may become rather convoluted. It should be noted, though, that a number of schizophrenia subtypes have been rejected by the American Psychiatric Association (APA). For instance, in DSM-V, only three essential subtypes of schizophrenia are identified (schizoaffective disorder, delusional disorder, and catatonia) (Arciniegas 715-716).

Treatment

As far as the treatment options for schizophrenia are concerned, one must bear in mind that the patient cannot be cured. In other words, it is necessary that the strategy for lifelong treatment must be designed. One must not be mistaken by the fact that the obvious symptoms of schizophrenia subside significantly after the first several sessions of treatment. Instead, one must bear in mind that the symptoms are recurrent and that the improvements in the patient’s well-being are temporary.

In light of the facts mentioned above, a psychiatrist must focus on the following goals when addressing the needs of a patient: addressing the symptoms so that the patient could get rid of them entirely or control them to a greater extent; improving the patient’s quality of life, and reinforcing the process of recovery from the disorder in a manner as efficient as possible (Mental Health Medications NIMH.NIH.gov). The identified objectives are met with the help of a combination of therapy and the use of medications.

As a rule, when addressing the needs of patients with schizophrenia, one must consider the use of antipsychotic drugs. As stressed above, with the discovery of new methods of tending to the needs of people with schizophrenia, new medications were prescribed to manage the disorder and improve the quality of the patients’ lives. The following medications belong to the first generation of drugs for managing schizophrenia and improving the quality of patients’ lives: Chlorpromazine, Haloperidol, Perphenazine, and Fluphenazine (Mental Health Medications NIMH.NIH.gov). Understandably enough, the identified methods of managing the disorder leave much to be desired in terms of not only their efficacy but also the negative effects that they have on the patients’ well-being (Kimhy et al. 865).

The second-generation medications represent a significant improvement in the framework for tending to the needs of patients with schizophrenia and the associated disorders. Although they also imply severe consequences for patients, their effects are considerably milder (Rummel-Kluge et al. 170). The specified property, however, results in the reduction of the medications’ efficacy. Nevertheless, the second-generation drugs should be viewed as preferable to the ones belonging to the first generation because of the opportunity to not only block the production of dopamine in the patient’s body but also increase the levels of serotonin (Hartling et al. 499).

It seems that the promotion of second-generation drugs as the means of managing schizophrenia seems to be a rather legitimate strategy at present. However, in o0rder to improve the quality of the patients’ lives and create an environment in which they can be proactive and retain their mental and cognitive abilities, one will have to consider the adoption of innovative medicine. Granted that the identified step requires further testing so that the efficacy of the medications could be determined, it opens a range of new opportunities to both patients and psychiatrists. However, one must admit that the identified process is fraught with numerous difficulties, the lack of financial resources being the key one (Priebe 2).

Furthermore, according to a recent study on the subject matter, the second-generation medicine, which aligns with the dopamine theory of schizophrenia, may have an adverse effect on the patient due to the inconsistency in the theoretical framework. The theory in question states that the development of the disorder occurs because of the excessive activity of dopaminergic neurons: “The dopamine hypothesis is based on the observation that antipsychotics block D2 receptors, and their affinity for these receptors highly correlates with their ability to ameliorate some psychotic symptoms” (Rubio et al. 9). Therefore, there is a strong need in focusing on studying the nature of schizophrenia so that the factors that contribute to its development could be eliminated successfully.

Among possible medications that can be used in the future, the following medication types need to be mentioned: ABT-107, ABT-126, etc. (Ahnalen 4). However, apart from an update in the use of medicine, psychiatrists will have to consider an improvement of the therapy approach. According to the guidelines suggested by the American Psychiatric Association, four essential stages must be completed so that the treatment process could be accomplished successfully.

Particularly, there is the design of the treatment plan, the process of establishing a therapeutic alliance between the psychiatrist and the patient, the acute phase treatment, the stabilization phase, and the stable phase. To make sure that every single phase is completed, one will have to apply the appropriate assessment system.

Treatment Plan

Therapeutic Alliance

The process of drafting a treatment plan and implementing it includes the identification of the specific factors that affect the patient’s well-being, the stage of the disorder, and the identification of the tools that may help the patient. Another important component of schizophrenia treatment, the identified stage involves the process of communicating with the patient, as well as their parents or guardians.

Although the essential medical records required to diagnose the problem and determine the treatment framework that will, later on, be used to inhibit the development of the disorder can be acquired from the family members successfully, it is crucial that the psychiatrist should engage the patient in conversation and create the foil for successful cooperation. As stressed above, the therapist is likely to face a range of impediments on their way to enhancing the cooperation process, mainly because patients are prone to a denial of their problem (Jonsodottir et al. 24).

To make sure that the patient is aware of the issue and is willing to comply with the guidelines provided by the therapist, one will have to consider the use of techniques such as inviting the family members to support the patient extensively and the perceived daily benefit. According to a recent study, the use of the identified strategy is likely to help in cases of the patient non-compliance: “As per ROMI, perceived daily benefit was the most significant contributing factor to the compliance of medication in our study, which was followed by positive family belief, relapse prevention and pressure or force by the family members” (Chandra et al. 297).

Acute Phase Treatment

As a rule, the acute phase treatment involves the use of medication. At this point in addressing the needs of the patient, a psychiatrist aims at controlling the patient’s aggressive behavior, encourage the patient to return to the functioning that helps sustain the routine activities and facilitate the enhancement of communication between the patient and the family members or legal guardians. At this point, one might argue that the ToM framework mentioned above aligns with the identified goals since it also implies that the patient should regain their ability to socialize and communicate efficiently.

Therefore, it can be assumed that the postulates of the ToM theory can be used in the identified phase. Indeed, a close look at the identified phase will show that it requires that the process of communication between the patient and the family members should be promoted actively; in other words, it is necessary that the patient should regain the essential communication skills: “The acute phase is also the best time for the psychiatrist to initiate a relationship with family members, who tend to be particularly concerned about the patient’s disorder, disability, and prognosis during the acute phase and during hospitalization” (Lehman et al. 12).

Stabilization Phase

The identified stage involves creating the environments in which the threat of relapse could be reduced to zero. The patient is encouraged to engage in active communication with their family members. Furthermore, at the identified stage of recovery, the patient is provided with a fewer number of directions from the psychiatrist; instead, they are invited to engage in a conversation independently. As the Acute Phase described above, the process in question is in line with the provisions of the ToM framework, which suggests that schizophrenia affects primarily the social aspects of the patient’s life.

The cognitive element, however, is not to be underrated, either (Grant et al. 122; Granholm et al. 10). Thus, the emphasis must be put on helping the person suffering from the disorder to regain a connection with their family and community members. As a result, faster recovery is expected. However, one must bear in mind that the patient will still require medications that will sustain their condition and prevent a relapse.

Stable Phase

The Stable Phase implies that the process of treatment is nearly over and that the patient is ready to reenter the community. As stressed above, though, antipsychotic medications must be taken on a regular basis; otherwise, relapse will be inevitable. More importantly, when evaluating the patient’s progress and their ability to produce adequate responses, the psychiatrist must also determine whether the trial of the prescribed antipsychotic medication has been completed.

Complications

When considering the design of the approach that will help convince the target audience to follow the prescribed treatment plan, one must bear in mind that schizophrenic patients are prone to developing severe depression and even suicidal thoughts (Weiden et al. 735). In other words, as a protest against the proposed treatment, the patient may make an attempt of committing suicide (Fleishhacker et al. 185). Therefore, it is crucial to make sure that the communication process should not occur in a persuasive manner and that the arguments of the psychiatrist, though convincing, must not pressure the patient into making a decision.

In fact, it is worth noting that some of the medicine types currently used as the means of addressing episodes of schizophrenia may contribute to the development of suicidal attitudes among patients. Although a study conducted lately of the subject matter did not find the direct correlation between the two factors, it states that there might be a link between the depression rates and the use of the medicine that affects the production of the thyroid hormone:

Though apparently this finding does not appear to be of much significance, in about 40% patients TSH was normal, and a significant number of patients did not attempt suicide, if these are the same patients who had normal TSH without a suicide attempt in early psychosis, then it would be an argument to investigate this relationship further to examine where normal or high TSH level can indicate the presence of risk for suicide in early psychosis. (Shrivastava et al. 65)

Therefore, a more elaborate approach toward the assessment of suicide tendencies among the patients is strongly recommended. As a result, not only the threat of the patient suffering death or an injury because of a suicide attempt will be prevented successfully but also the recovery process may start due to successful communication between the psychiatrist and the target audience. The problem concerning the likelihood of side effects development should also be addressed.

Conclusion

As the analysis of recent studies has shown, the process of determining the symptoms of schizophrenia in patients requires further improvement since it currently implies defining the existence of hallucinations and delusions inpatients only. While other factors are taken into account, the two variables mentioned above serve as the primary means of detecting the problem. Therefore, it is strongly suggested that other opportunities for diagnosing disorder at its onset will have to be introduced.

Among the most recent innovative solutions, the application of ToM as the tool for diagnosing the disorder needs to be mentioned. In other words, although hallucinations and delusions are viewed as the primary markers of schizophrenia, the disorder can be identified at comparatively earlier stages once the ToM framework is applied and the changes in the social behavior of an individual are identified.

Furthermore, the ToM framework must be included in the treatment process as well. Seeing that the theory in question places a very heavy emphasis on the significance of restoring the patient’s social functions, whereas the rest of the theories focus on the cognitive development, it aligns with the principles of efficient schizophrenia treatment. In other words, the framework is crucial to the efficacy of the diagnosis, as well as the success of the treatment process.

Despite the fact that a combination of medicine and therapy remains the primary tool for managing the disorder, new suggestions regarding the means of managing the problem have emerged. Particularly, the reconsideration of the medications used to prevent hallucinations and delusions in patients and the focus on managing the social skills along with the restoration of cognitive functions need to be mentioned as the essential change.

Works Cited

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Jonsodottir, Hans, et al. “Predictors of Medication Adherence in Patients with Schizophrenia and Bipolar Disorder.” Acta Psychiatrica Scandinavica, vol. 127, no. 1, 2012, pp. 23–33.

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Priebe, Stephan. “Effectiveness of Financial Incentives to Improve Adherence to Maintenance Treatment with Antipsychotics: Cluster Randomised Controlled Trial.” BMJ, vol. 347, no. f5847, pp. 1-10.

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Shrivastava, Amresh, et al. “Serum Thyroid Stimulating Hormone Levels and Suicidal Tendency in patients with First‑Episode Schizophrenia: An Exploratory Study.” Indian Journal of Palliative Care, vol. 21, no. 1, 2015, pp. 105-15.

Weiden, Peter J., et al. “A Randomized Trial of Iloperidone for Prevention of Relapse in Schizophrenia: The REPRIEVE Study.” CNS Drugs, vol. 30, no. 8, 2016, pp 735–747.

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