Schizophrenia

Stacey Troup

PSY-275

July 25, 2015

University of Phoenix

Schizophrenia2

This Week 5 Final Exam paper on schizophrenia will cover different aspects of

schizophrenia including range of impairment, implications on society and treatment options.

This topic was chosen following inspirational lectures in previous weeks given by Elyn Saks,

Associate Dean at the University of Southern California (USC). Having been diagnosed with

schizophrenia during her college years, she struggles daily with the condition yet manages to

hold a highly coveted position while educating others on the condition she, herself, suffers from.

Range of Impairment

As we begin to examine schizophrenia, knowing what types of symptoms present in the

condition and the impact they have on the people who suffer from the condition is an important

first step.

While symptoms vary between participants, some of the more common impairments

include delusions, hallucinations, disorganized thinking, extremely disorganized or abnormal

motor behavior and negative symptoms. (Mayo Clinic Staff, NA)

Delusions

Affecting 4 out of 5 people who are diagnosed with schizophrenia, this condition causes

confusion between thought and reality. It can vary in its context but causes a split of sorts in the

ability to decipher fact from fiction in their reality/everyday life. (Mayo Clinic Staff, NA)

Hallucinations

Another condition which interferes with reality is that of experiencing hallucinations.

Seeing things or people that are not there or hearing voices are common among participants.

Hearing voices is by far the most common hallucination among patients. (Mayo Clinic Staff,

NA)

Schizophrenia3

Disorganized Thinking

Disorganized thinking is a condition whereby sentences or words are put in to order that

make little or no sense. This can cause impairment in the ability to communicate effectively

with others. Mixed thoughts put into sentences seem to make sense to the person speaking them

but appear discombobulated to the recipient. (Mayo Clinic Staff, NA)

Disorganized Motor Behavior

This can be the most difficult symptom to diagnose. Starting in childhood it can consist

of things like resistance to follow instructions, inappropriate and/or bizarre posture, complete

lack of response and useless or excessive movement. (Mayo Clinic Staff, NA)

Negative Symptoms

This symptom refers to the “reduced ability or lack of ability to function normally.”

(Mayo Clinic Staff, NA) This can include things like failure to make eye contact when speaking

to someone, lack of emotion or facial expressions, speech lacking tone or emotion and lacking

hand or head movements considered normal for emotional emphasis of a statement during

conversation. In addition to these social issues, the person can also experience a lack of interest

in things they once took an interest in, hygiene issues and finally, lack of ability to experience

pleasure. (Mayo Clinic Staff, NA)

Age Based Symptoms

While conditions typically begin to show in men during their early to mid 20’s and

women in their late 20s, teens are often affected by symptoms of the condition. (Mayo Clinic

Staff, NA)

Symptoms in teenagers can include things like withdrawal from friends and family, drop

in performance at school, trouble sleeping, irritability or depressed mood and lack of motivation.

Schizophrenia4

However, compared to their same sex elders, teens are less likely to experience delusions but are

more likely to experience hallucinations. (Mayo Clinic Staff, NA)

Impairments – Thoughts

Keeping in mind that symptoms vary between different people, cognitive impairments

affect up to 75% of patients. Memory, attention, motor skills, executive function and

intelligence are all affected by the condition in some way or another. Suicidal thoughts or

actions often accompany onset of symptoms and it is important to seek professional help or

admit the patient into an emergency room for the safety of themselves and those around them.

(O'Carroll, 2000)

Social Implications

Schizophrenia can be costly to families and those afflicted with the condition. According

to a 2002 study, costs were “estimated to be $62.7 billion, with $22.7 billion excess direct health

care cost ($7.0 billion outpatient, $5.0 billion drugs, $2.8 billion inpatient, $8.0 billion long-term

care)”. (Schizophrenia Facts and Statistics, NA)

With state hospitals closing, more prisons are filled with people who have committed

crimes during the onset of a schizophrenic symptom outburst and belong rather in hospitals

where they can become medicated and treated rather than in the prison system. The United

States has failed the mentally ill residents of the country through the closure of these facilities

and forcing these people into dangerous hospitals where they are likely put into seclusion,

shackled and mistreated.

In addition to the medical costs associated with this condition, these patients are rarely

able to work and must be upheld through social service programs such as Medicare for

sustainable living solutions (food, housing, insurance). (Schizophrenia Facts and Statistics, NA)

Schizophrenia5

Causes

It is thought that schizophrenia is brought on through stresses during pregnancy which

contribute to (or trigger) the condition. In addition, it is widely thought that genetic

predispositions are responsible for the onset of the condition. Identifying specific gene

misalignments during pregnancy may assist in the prevention of the condition as science furthers

its research. (Schizophrenia Facts and Statistics, NA)

Treatments

Treatments for this condition vary (or have varied) through the ages. During the middle

ages, causes for schizophrenia were thought to be witchcraft or demonic possession and

therefore, exorcisms were performed to help rid the patient of the symptoms. (Korn, N.A.) In

10,000 B.C., medical practitioners would bore holes into the skulls of patients to release the evil

spirit from the bodies (believing as well that the condition was the result of demonic possession).

(Lobotomy)

In 1934, ECT (electronic convulsive therapy) was introduced. This practice has come

under fire due to the method used for administration of the ECT therapy, including a lack of

patient’s rights, loss of memory and fractured or broken bones from lack of proper methods to

secure the patient before administration of the ECT. These improper treatments have led to

numerous deaths in patients. (Tartakovsky, N.A.)

Pharmaceutical therapies were introduced by a team of French scientists in the 1950’s.

Major drug advancements and scientific research has improved the strains of these drugs to assist

with the offset symptoms as well as improve quality of life have been introduced since that initial

introduction in the 50’s. (Korn, N.A.)

Schizophrenia6

Frontal lobotomy was introduced in 1936 by psychiatrist Walter Freedman. He

performed his first lobotomy for the purpose of alleviation of psychological symptoms on

January 17, 1946. His procedure led to more than 2500 lobotomy’s being performed by the

physician including the lobotomy of a 12 year old boy. Dr. Freedman was banned from the

medical practice and from performing such procedures as lobotomies in 1967 due to insufficient

medical treatment following the procedure. (Tartakovsky, N.A.)

The U.S. leads the world in lobotomies performed (around 50,000) between the late

1940’s and early 1950’s. Several countries have banned the procedure as inhumane and the ban

on this procedure continues in countries today. Within the U.S., certain states have banned the

procedure but it is not widely banned. (Lobotomy)

Modern Treatments

Antipsychotics have been often prescribed to help with the symptoms of schizophrenia.

(Korn, N.A.) Along with antipsychotic medication therapies is in-patient or out-patient therapy,

behavioral therapy, and constant monitoring. It is important to remember that not all APD

(antipsychotic drugs) are the same. (Luh, 2003) Different APD’s have different receptive

binding agents that offer different results. By grouping these medications into one class or

referring to them as the same types of medications can be dangerous to the patient and have

adverse reactions to the patient. (Luh, 2003)

In recent years, a drug called Ivega® Sustenna® has been introduced. (Invega Sustenna -

Information, NA) This drug is part of a family of drugs referred to as atypical antipsychotics and

is administered via a shot in a psychiatrist’s office once a month. (Invega Sustenna -

Information, NA) This family of drugs is still under great debate among medical professionals

because of the side effects which aren’t being discussed.

Schizophrenia7

This drug is designed to alleviate symptoms such as hallucinations and voices and return

the patient to a more normal existence. (Invega Sustenna - Information, NA) However, when

you have a patient who is used to solitude and their only friends are the voices in their head, what

happens when you take the voices away? The result we may experience is a significant increase

in suicidal thoughts and actions. The destitute nature of the solitude the patient is now

experiencing is so depressing to them that they often have nothing left in their lives worth living

for. By way of comparison, it would be like someone dropping you in the middle of a deserted

island with no friends or anyone around you. The loss you would feel would cause a great

depression and likely lead to suicide.

Suicide rates are at an alarming level among patients diagnosed with schizophrenia.

(Limosin, Lozec, Casadebaigd, & Rouillonc, 2007) According to a 1993 study which included

vital statistic data of schizophrenic patients over a 10 year period, an alarming 53.9% of patients

had committed suicide. In addition to these high rates, it was also determined that of first year

diagnosed patients exhibited at 31.8% suicide rate. (Limosin, Lozec, Casadebaigd, & Rouillonc,

2007) Statistics such as these make you wonder if the shot that is available to patients is really

worth the risk. With an already high suicide rate, I would be curious to see what clinical data

experiences in another 10 years as to the rate of suicide among patients who received these shots.

Some therapists and doctors believe that behavioral therapies, in addition to medication,

will help with auditory hallucinations and subsequent symptoms. (Buccheri, Trysgstad, Dowling,

Hopkins, & White, 2004) A 1997 study determined that 25-30% of patients had little or no

positive response to antipsychotic medications in an attempt to alleviate their auditory

hallucinations. Behavioral therapies were given to patients to help alleviate both the auditory

symptoms and the resulting symptoms of schizophrenia, including anxiety and depression.

Schizophrenia8

(Buccheri, Trysgstad, Dowling, Hopkins, & White, 2004)Patients in this study exhibited a 40%

improvement in both hallucinations and the underlying symptoms of anxiety and depression

through the use of both medication and behavioral therapies in conjunction with each other.

(Buccheri, Trysgstad, Dowling, Hopkins, & White, 2004)

When we look at the costs on a worldwide basis, we can see that the U.S. is significantly

behind in its costs associated with treating schizophrenia. (Mangalore, Judit, & Napp, 2004).

Without information relating to the increase of costs vs the implementation of a national health

plan (such as exists in Canada), we are less able to render this data to determine the true position

the U.S. is in comparitively to other countries and the true costs. Could our position in costs be

related to our unwillingness to treat these patients but rather put them behind prison walls? Only

proper data will compel these true results.

Conclusion

With schizophrenia come a lot of confusion, fright and lack of education for the people

around the patient. We have all seen someone walking down the street talking to themselves and

been afraid of how they might react to us if we get too close. The U.S., through its closures of

nearly all government funded psychiatric wards, has effectively pushed these people out on to

the streets. They commit crimes they are unknowing of committing due to their symptoms and

end up in the most inhumane conditions while incarcerated.

If the U.S. would examine the cost of preventative care and that of hospitalizations under

the new Obama Care Act (requiring everyone to have insurance of some sort in the U.S.) and

requiring the Medicare and Medicaid plans to cover these conditions could greatly reduce the

number of homeless, institutionalized and otherwise lost members of our society who may be,

Schizophrenia9

one day, returned to being a productive member of society if we just gave them the opportunity

to get well rather than jump to conclusion and incarcerate them.

While this condition is brought on usually at a young age, some symptoms can be

confused for normal childhood issues and defiance related teen behavior. It is important that if

you suspect tendencies of schizophrenia in children that you get them help immediately. With

the use of a 24 hour psych hold (for observation) you may end up saving a life rather than blindly

looking another direction.

Dr. Elyn Saks has proven that through the loving support of family and the proper

medication combined with hospital stays (as needed) one can lead a productive (or in her case, a

better than productive) life. It is important that these people have the loving support of family

and friends and accept the inpatient therapies and medications as needed. Stressing maintenance

of medication rather than avoidance and combining these medications with behavioral therapies

can present a winning combination to alleviate symptoms and return the patient to a non-

dangerous status in their condition.

Let’s turn a blind eye no more, let’s do something about the status in our country and

demand that facilities be built to assist these patients with their recovery.

Schizophrenia10

References

Buccheri, D. R., Trysgstad, D. R., Dowling, P. R., Hopkins, M. R., & White, F. M. (2004). Presistent Auditory Hallucinations in Schizophrenia. Journal of Psychosocial Nursing & Mental Health Services , 42.1, pp. 18-27.

Green, M. F., & Horan, W. P. (2010). Social Cognition in Schizophrenia. Current Directions in Psychological Science , 19 (4), 243-248.

Invega Sustenna - Information. (NA). Retrieved 07 25, 2015, from Invega Sustenna: http://www.invegasustenna.com/about-invega-sustenna

Korn, M. M. (N.A.). Historical Roots of Schizophrenia. Retrieved 07 25, 2015, from Medscape: http://www.medscape.org/viewarticle/418882_6

Limosin, F., Lozec, J.-Y., Casadebaigd, F., & Rouillonc, F. (2007). Ten-year prospective follow-up study of the mortality by suicide in schizophrenic patients. Elseiver Schizophrenia Research , 94 (1-3), pp. 23-28.

Lobotomy. (n.d.). Retrieved 07 25, 2015, from Wikipedia: https://en.wikipedia.org/wiki/Lobotomy

Luh, J. Y. (2003). Atypical antipsychotic drugs for schizophrenia. Mayo Clinic Proceedings , 78 (3), pp 381-382.

Mangalore, R., Judit, S., & Napp, M. (2004). The Global Costs of Schizophrenia. Schizophrenia Bulletin , 30 (2), pp 27-293.

Mayo Clinic Staff. (NA). Schizophrenia Symptoms - Diseases and Conditions. Retrieved 07 25, 2015, from Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/schizophrenia/basics/symptoms/con-20021077

O'Carroll, R. (2000). Cognitive impairment in schizophrenia. Advances in Psychiatric Treatment , 6 (3), 161-168.

Schizophrenia Facts and Statistics. (NA). Retrieved 07 25, 2015, from Schizophrenia.com: http://www.schizophrenia.com/szfacts.htm

Tartakovsky, M. M. (N.A.). The Surprising History of Lobotomy. Retrieved 07 25, 2015, from Psych Central: http://psychcentral.com/blog/archives/2011/03/21/the-surprising-history-of-the-lobotomy/