The Medical Basis of Psychiatry - Essay Example

? Schizophrenia of the of the This research work deals with schizophrenia and the issues associated in dealing with this problem. In this regard several academic journals and books were consulted. Schizophrenia is an intricate biochemical brain disorder. It prevents the person afflicted with it, from arriving at a proper conclusion regarding what is reality and what is illusionary. Individuals suffering from this disease are subject to delusions, hallucinations, disturbed thinking and social withdrawal. Despite the unprecedented developments in psychiatry and medical science, determining the causes for this disorder has proved to be elusive. A holistic approach has to be adopted in the treatment of this condition. Although schizophrenia cannot be cured, its symptoms can be considerably mitigated by medication with antipsychotic drugs. To a significant extent, this condition is genetic. However, it is also caused by stress, abuse of drugs and trauma. Schizophrenia Introduction This work deals with the disorder of schizophrenia and the methods of dealing with the problem. Initially, clinical features of the disease were taken up for a discussion. Subsequently, implications of the disorder were discussed. Moreover, the psychopathology of this ailment had been analysed. In this regard, role of the health care professionals in implementing the pathological interventions related to the patient, had been examined. Thereafter, the impact of the disease on the psychological condition of the patient were examined. The extant medical treatments and their effectiveness have been analysed. Pharmacological treatments, and psychological interventions provided by the health professionals, as a part of the treatment of this disorder, were taken up for a brief discussion. Subsequently, genetic issues relating to the problem were examined. Finally conclusions were arrived at stating that family support and psychological interventions are essential, n addition to the available medical treatments, in containing the degenerative disorder schizophrenia. Schizophrenia is a condition that can be correlated to many factors, and constitutes the result of a combination of genetic and environmental factors. Although the exact causes of this disorder have not been established, it is now evident that some of the genetic conditions have a causal relationship with schizophrenia, as depicted in the research conducted by Tandon, Keshavan, and Nasrallah. This can be established by family, twin and adoption studies (Tormoehlen & Lessick, 2011, p. 486). Individuals afflicted with schizophrenia exhibit excess mortality, in comparison to the general population. All the same, several of the people with this disease will survive and suffer from it in their later life. This makes it clear that schizophrenia among the old will emerge as a major public health issue in the future. Consequently, treatment of schizophrenia that is based on evidence will become a major issue, with regard to the older patients. All the same, the absence of adequate data to guide the selection of antipsychotics for those suffering from schizophrenia in their later life (Suzuki, et al., 2011, p. 961). There is an absence regarding the essential criteria necessary for arriving at a diagnosis of schizophrenia. However, there is consensus regarding the general clinical aspects of this syndrome (Tandon, Nasrallah, & Keshavan, 2009, p. 3). Clinical Features of Schizophrenia Patients diagnosed with schizophrenia have a higher mortality rate, in comparison to the normal population. Even though these heightened mortality rates seem to be on an increasing trend, many of the patients afflicted with schizophrenia survive until old age and continue to suffer from the disorder. Hence, geriatric schizophrenia needs to be addressed in the near future, as one can expect the number of patients affected by it to increase substantially (Suzuki, et al., 2011, p. 662). Patients affected with an early onset of schizophrenia and who do not show adequate response to the antipsychotic drugs, have to be subjected to a multidisciplinary approach. Such approach requires abundant resources, as these patients experience a myriad of symptoms related to both the body and the mind. These individuals also require intensive community support. On the other hand, people who show symptoms of schizophrenia in their later years are troubled in the cognitive as well as functional areas of the brain, by the acute symptoms and the side – effects of using anti – psychotic drugs (Suzuki, et al., 2011, p. 662). Schizophrenia diagnosed in a person, significantly increases the risk of the disease among that person’s relations, and this risk increases as the degree of genetic relation with the affected person increases. For instance, when one of the parents is schizophrenic, the recurrence rate in the children is about 9 to 16%, which is ten times the risk faced by the general population (Tormoehlen & Lessick, 2011, p. 486). As demonstrated by Tandon et al, this rate increases drastically, when both the parents depict symptoms of schizophrenia. Moreover, the second and third degree relatives of individual affected with schizophrenia are at a reduced risk of developing this condition, which further vindicates the claim (Tormoehlen & Lessick, 2011, p. 486). The treatment of females affected with schizophrenia, by means of antipsychotic drugs has depicted a varying rate of success. The two main courses open to the physician in such cases, are treatment with the traditional or typical antipsychotics, such as chlorpromazine (Thorazine), and haloperidol (Haldol); and the more recent atypical antipsychotics such as clozapine (clozaril), and risperidone (Risperdal). Although different antipsychotics possess different properties, they all work by decreasing the amount of dopamine produced (Tormoehlen & Lessick, 2011, p. 488). The newer atypical antipsychotics reduce the positive symptoms of schizophrenia, and in this regard are similar to the older drugs. However, these drugs are believed to be more effective in treating the associated negative symptoms. In addition, the newer drugs depict fewer adverse effects, when compared to the older drugs (Tormoehlen & Lessick, 2011, p. 488). Some of the traditional pharmacologic therapies employed with schizophrenia are the use of first and second – generation antipsychotics. Algorithms published by the Texas Department of State Health Services and the American Psychiatric Association, recommend the utilisation of electro convulsive or antipsychotic therapy. To this intervention, a non – antipsychotic may be included; after all other alternatives have proved unsuccessful (Richard & Brahm, 2012, p. 762). It has not been possible to employ immunologically targeted schizophrenia therapies, because of the dearth of reliable and adequate data from clinical trials that support such therapies. From the literature on this issue, it can be surmised that the immune system dysfunction pertaining to environmental, genetic and neurobiological influences could be significant in the etiology of this illness in a subset of patients (Richard & Brahm, 2012, p. 763). Implications of Schizophrenia Amongst the psychiatric disorders, schizophrenia is considered to be one of the most debilitating. The mental health services face a number of serious challenges, whilst managing this disease. It has been believed that Schizophrenia occurs all over the world and that it is to be found in 1% of the population, above the age of 18 years (Fatemi & Clayton, 2008, p. 392). With regard to Canada, there were around 230, 000 people with this ailment, as of the year 2004. In the US, a fourth of the psychiatric patients have been diagnosed with this disease. In addition, half of the people admitted with psychiatric problems to hospitals are those suffering from schizophrenia (Goeree, et al., 2005, p. 2017). The symptoms of schizophrenia are classified into positive symptoms, negative symptoms, and cognitive impairment. Positive symptoms include not being in touch with reality, abnormal behaviours, delusions or false beliefs, perceptual experiences that are not shared by other or what are also termed as hallucinations. These symptoms tend to be sporadic over time (Mueser & McGurk, 2004, p. 2063). On the other hand, the negative symptoms associated with schizophrenia can be classified as an absence of or substantially decreased state of displaying emotions. Some examples of these negative symptoms are; lack of facial expressions and pleasure in engaging in activities, diminished ability to communicate clearly, and withdrawal from activities involving others. Cognitive impairment includes problems with attention and concentration, decreased ability to learn, memory loss, and other impairments of the various functions (Mueser & McGurk, 2004, p. 2063). Role of Health professionals Over the years, several collaborative approaches have emerged, in the area of mental healthcare, from the initiatives undertaken by the federal and provincial authorities of Canadian healthcare. These endeavours have as their objective, significant improvement in diagnosis, evaluation, and treatment of individuals with mental ailments (Austin & Boyd, 2010, p. 389). Moreover, these developments are believed to enhance efficiency in the utilisation of healthcare resources. This salutary effect will be the outcome of perceptive identification of psychosomatic complaints, which in turn will improve diagnosis. Subsequently, suitable remedial measures can be implemented, thereby preventing aggravation of the illness (Austin & Boyd, 2010, p. 389). There is considerable scope for suicide in ailments incorporation mood disorders. This necessitates adequate psychological and pharmaceutical treatment. In this regard, it is crucial to obtain an accurate diagnosis of the patient’s condition. Consequently, nurses in healthcare environments have to acquire the necessary competence in evaluating patients and determining if they are undergoing or developing mood disorders (Austin & Boyd, 2010, p. 389). On establishing the presence or inception of this malaise, nurses should provide the required clinical and educational interventions, or resort to appropriate referral. When it comes to improving daily functioning, enhancing knowledge, the acquisition of skills, and increasing independent living the contribution of the nurse is unparalleled. This ensues from the unique placement of nurses, Vis – a – Vis patients and their families (Austin & Boyd, 2010, p. 404). As is evident, the family of a patient with a mental health disorder requires substantial support and education, both during and subsequent to the treatment of the patient. In this context, the services of the nurse become indispensable, as she is best suited to provide timely advice, education and support to the family members. Schizophrenia is a recurrent disorder, and this makes it essential for the family members of the patient to be aware of the steps to be taken, when the symptoms recur. Dimensions of Schizophrenic Psychopathology Some of the characteristic signs of schizophrenia are distorted perception and thinking, cognitive impairments, motor abnormalities, apathy and avolition, and difficulty in communication. These symptoms are usually classified into positive, negative, cognitive, disorganisation, and motor symptom dimensions. The related psychopathology is differentially expressed across patients and the duration of the disorder. These groups of symptoms have been seen to recur across a large number of patient cohorts (Tandon, Nasrallah, & Keshavan, 2009, p. 3). Some of the maternally facilitated variables, such as infections, nutritional deficiencies, severe stress, and obstetric and perinatal complications, comprise the prenatal and perinatal environmental attributes that result in an increased danger of contracting schizophrenia. In addition, season of birth and more advanced paternal age have also been seen to contribute to an increased risk of schizophrenia (Richard & Brahm, 2012, p. 758). The cause of this disorder has been attributed to autoimmunity or dysfunction of the immune system. Pharmacological Treatments Schizophrenia is a chronic disorder whose symptoms at times improve or at other times worsen. It results in a diminished lifespan, with conspicuous deficiencies in social and vocational functioning. Comprehensive treatment for this disorder involves a multi modal process that consists of medication, psychosocial interventions, and support in the areas of housing and finance (Tandon, Nasrallah, & Keshavan, 2009, p. 2). The fundamental objective of the treatment interventions is to reduce the sickness and mortality of the disorder. To this end, doctors attempt to reduce the frequency and severity of episodes of psychotic aggravation of the patients. They also try to enhance the functional capacity and quality of life of schizophrenic patients. Medical scientists have developed several antipsychotics for the treatment of this illness. Prior to the advent of these drugs, patients had to rest content with a safe and supportive environment, which was provided by requiring the patient to stay for a long period, in the facility providing the treatment (Tandon, Nasrallah, & Keshavan, 2009, p. 2). The National Institute of Mental Health has disclosed that nearly 1% of the Americans suffer from schizophrenia. However, it is an onerous task to arrive at an accurate estimate of those who have been affected by it. As such, it is extremely difficult to determine the prevalence of this disease in an accurate manner, due to the vast diversity depicted by the signs and symptoms of this disorder. It has been conjectured by Tandon and other research scholars that schizophrenia is neither a limited syndrome, nor a single disease entity. The possibility, according to these scholars, is that it could be a composite of phenotypically similar disease entities and syndromes (Richard & Brahm, 2012, p. 757). The nature of recovery involved has to be understood from the views held by the mental health professionals, if recovery from schizophrenia is to be expeditious. A number of initiatives have been commenced at the international level, in order to identify the elements influencing recovery from schizophrenia (Kaewprom, Curtis, & Deane, 2011, p. 324). Thus, several factors have been identified, which are expected to facilitate recovery. Some of these are acceptance of the illness, optimal hope, optimal treatment, self – responsibility, and supportive environments. Moreover, recovery has been hindered due to unwanted side effect of the medication, and stigma towards mental illness (Kaewprom, Curtis, & Deane, 2011, p. 324). Practice that does not include these essential recovery oriented and interpersonal skills stands to be endangered, by the acceptance of a genetic cause for schizophrenia. A person presented with a diagnosis of schizophrenia could develop the feeling of having been marginalised, due to the absence of attention to partnership and combined working, joint decision – making and the promotion of self – determination. Environmental and psychosocial causation factor can be potentially altered. This convinces nurses that they can instil hope for recovery, development and achievement of goals in people, instead of labouring under a cynical outlook ensuing from a faulty notion regarding the causes of schizophrenia (Fleming & Martin, 2011, p. 476). Genetic Issues Genetic factors have a substantial effect in enhancing the risk of schizophrenia, and there is convincing evidence in this regard. Since the year 2000, several studies that employ the association and linkage approaches have been conducted, and these have served to isolate a number of putative schizophrenia risk genes (Haraldsson, Ettinger, & Sigurdsson, 2011, p. 82). However, in most of these identifications, evidence of association with schizophrenia has not been strong and replication attempts have been neither successful nor easy to understand. A number of multiple family studies have been conducted, and these have consistently discovered a higher risk of schizophrenia among the relatives of individuals affected with this disease than in the general population (Haraldsson, Ettinger, & Sigurdsson, 2011, p. 82). Thus, studies based on operational diagnostic criteria and fastidiously garnered samples have discovered that the first – degree relatives of a person with schizophrenia are at a 3 to 15% risk of developing this disorder, whilst the corresponding risk for the relatives of individuals who are not afflicted with schizophrenia is 0.5 to 1% (Haraldsson, Ettinger, & Sigurdsson, 2011, p. 82). From adoption and twin studies the comparative contributions of genetic and environmental factors can investigated, and it was determined that the schizophrenia concordance rate was 45 to 75% form the monozygotic twin pairs, while just 4 to 15% among the dizygotic pairs. From this it can be deduced that genetic factors have a significant influence in the development of schizophrenia. Furthermore, the proportion of phenotypic variation or heritability that results from genetic variation can be assessed from twin studies (Haraldsson, Ettinger, & Sigurdsson, 2011, p. 83). In a dozen schizophrenia twin studies a meta – analysis was conducted. This disclosed that the risk of contracting schizophrenia was 81%, and this is higher than the risk involved in most of the complex diseases with established genetic risk, such as breast cancer and type II diabetes (Haraldsson, Ettinger, & Sigurdsson, 2011, p. 83). Adoption studies make it possible to assess the role of genetic factors in schizophrenia that are not dependent on the family environment. These studies have revealed that there is 10 times higher life time prevalence of the disorder among those adopted from a parent with schizophrenia, in comparison to those adopted from healthy parents (Haraldsson, Ettinger, & Sigurdsson, 2011, p. 83). Conclusion This work dealt with the disorder of schizophrenia and the role of nurses, from the Canadian perspective. Characteristics of this disorder were taken up for discussion. Treatment with psychosomatic medicines and psychological interventions have proved to be effective in controlling the disorder. Genetic factors were identified to have a significant effect on the development of this disorder. Psychological impairments resulting in communication problems, and cognitive impairments are the most diagnosed difficulties associated with this disorder. Many psychotic medications have been developed, with a view to contending with this problem. In addition, the participation of health care professionals in alleviating mood disorders has been identified as providing considerable help to these patients. In addition to medication, psychosocial interventions, and family support have proved to be very effective in the treatment of this disorder. List of References Austin, W., & Boyd, M. A. (2010). Psychiatric and Mental Health Nursing for Canadian Practice. Lippincott Williams & Wilkins. Fatemi, S. H., & Clayton, P. J. (2008). The Medical Basis of Psychiatry. Springer. Fleming, M. P., & Martin, C. R. (2011). Genes and schizophrenia: a pseudoscientific disenfranchisement of the individual. Journal of Psychiatric & Mental Health Nursing, 18(6), 469 – 478. Goeree, R., Farahati, F., Burke, N., Blackhouse, G., O'Reilly, D., & Pyne, J. (2005). The economic burden of schizophrenia in Canada in 2004. Current Medical Research & Opinion, 2017 – 2028. Haraldsson, M. H., Ettinger, U., & Sigurdsson, E. (2011). Developments in schizophrenia genetics: From linkage to microchips, deletions and duplications Developments in schizophrenia genetics: From linkage to microchips, deletions and duplications. Nordic Journal of Psychiatry, 65(2), 82 – 88. Kaewprom, C., Curtis, J., & Deane, F. P. (2011). Factors involved in recovery from schizophrenia: A qualitative study of Thai mental health nurses. Nursing & Health Sciences, 13(3), 323 – 327. Mueser, K. T., & McGurk, S. R. (2004). Schizophrenia. The Lancet, 363, 2063 – 2272. Richard, M. D., & Brahm, N. C. (2012). Schizophrenia and the immune system: Pathophysiology, prevention, and treatment. American Journal of Health – System Pharmacy, 757 – 766. Suzuki, T., Remington, G., Uchida, H., Rajji, T. K., Graff – Guerrero, A., & Mamo, D. C. (2011). Management of Schizophrenia in Late Life with Antipsychotic Medications. Drugs & Aging, 961 – 980. Tandon, R., Nasrallah, H. A., & Keshavan, M. S. (2009). Schizophrenia, “just the facts”. 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