Schizophrenia and the effect of the condition on the individual service user, carer, and family.

Su et al (2015) defined schizophrenia as a mental illness that exhibits positive symptoms of hearing voices, hallucination, paranoia, seeing things that are not present and delusion (these are symptoms added to the individual after they became ill); and negative symptoms of impaired emotional response, withdrawal from friends and families, depressed mood (these are normal behaviours taken away from the individual). It is estimated that about 22 million people of the world population have schizophrenia reported that schizophrenia as a mental disorder was first discovered in 1887 by a German psychiatrist named Dr Emile Kraepelin. The name schizophrenia was finally coined by Swiss psychiatrist Eugene Bleuler in 1908, which literally translates as “splitting of the mind”  in reality it does not mean split personality or multiple personalities, but can be understood as “the mind split or impaired from reality” (Abbott, 2009). This is consistent with the explanation from Gilmore (2010) who reported that schizophrenics believe that their minds and thoughts are been controlled by an unknown external convincing voice or force, so they act irrationally and delusional, which in turn makes them become unresponsive and withdrawn from their environment. the effects of schizophrenia reach far beyond the person suffering from the illness, it can socially paralyse the individual and deteriorate relationships with family members causing emotional challenges or perhaps cause mental illness for the family members themselves. This essay will be discussing schizophrenia as a mental disorder and its effects on the relationship of the individual with their families, friends and carers. Within this diagnosis, this essay will emphasise the cluster of the symptoms and medical understanding of schizophrenia. This essay will further explore the diagnostic criteria of schizophrenia using the world health organisation's international statistical classification of diseases and related health problems (ICD-10). This essay will also indicate the epidemiology of schizophrenia, that is, the causation, prevalence, co-morbidity and prognosis. Recovery and prevention of the major breakdown will also be analysed in the essay, as to how to empower the patient, give them hope and help them achieve what they want in life. Finally, Treatment and interventions will be discussed with reference to NICE guidelines (2014) (National Institute for Health and Care Excellence).  

According to Frith and Johnstone (2003), schizophrenia is a challenging mental disorder that distorts the way a person thinks, behaves and sees the world. Khan et al (2013), reported schizophrenia as a complex syndrome with three major characteristics, namely, positive symptoms, negative symptoms and cognitive dysfunction. Positive symptoms makes the patient exhibit thought disorder, delusions and makes them hallucinate; negative symptoms include demotivation and social withdrawal; cognitive dysfunction includes problems with memory processing, problem solving and impaired perception.

Schizophrenia has always been a complicated mental illness, and it continues to be a challenging psychotic disorder with a long life effect on the individual (Meltzer, 2004). It is not a rare condition as each individual has a risk of developing this mental illness sometimes in their lifetime. Schizophrenia occurs mostly in the late adolescence (20’s) and early adulthood (45’s) (Pickard, 2011). Kapur and Van (2009) states that it makes the individual unable to differentiate between what is reality and not reality, it confuses their mind, affects their emotions and relationship with others, and destabilises their functionality. People with schizophrenia are characterised by hearing strange and convincing voices telling them to do something, they think they are been controlled by a strange spirit dictating how they think and act, and sometimes see things that are not in existence (Young et al, 2010). Schizophrenia is almost like our dreams taking over, it is when somebody believes in something that is not in existence (Kerr, 2003). According to Holder and Wayhs (2014), delusion, hallucination and impaired speech are the most characteristics symptoms of schizophrenia. The individuals have strong unrealistic beliefs, and this is irrelevant of their culture, level of intelligence or religious background They are shut out of reality and makes it difficult for them to lead a meaningful healthy daily life, and hard to convey their message to people around them, this will be very distressing on the individuals with this illness and the families and carers (Montero, 2006). This results in withdrawal from their environment, makes them paranoid and act out in fear and confusion.

Agreeing with Khan et al (2013) definition of schizophrenia, Kapur (2009) also suggested that the symptoms can be clustered into four main categories, namely: The positive symptoms (Psychosis), the negative symptoms, neurocognitive dysfunction, and bipolar symptoms. The positive symptoms are characterised by delusion and hallucination, while the negative symptoms encompasses impaired speech, lack of motivation and withdrawal from social life. The neurocognitive dysfunctions exhibits difficulties in attention and loss of memory, whilst the bipolar symptoms represents depressive and manic episodes. There are early warning signs of schizophrenia, such as depression, insomnia, social withdrawal, unable to put the right words together, unable to manage personal hygiene, unnecessary arguments and isolation. Although these signs are not exclusive to schizophrenia as an illness, it is best to seek medical advice when these signs are noticed (Abbott, 2009).

According to NICE guideline (2014), there are 2 major diagnostic criteria for schizophrenia, namely the American psychiatric association’s diagnostic and statistical manual of mental disorders (DSM-5), and the world health organisation’s international statistical classification of diseases and related health problems (ICD-10), which are mostly used in the European countries. This essay will discuss about the DSM-5 which is widely used than the ICD-10. For an individual to be diagnosed with mental condition of schizophrenia, they need to meet the criteria set out in the DSM-5 (Wang, 2015). To be diagnosed as schizophrenic, the doctor must be sure that the symptoms developed by the individual are not that of any other mental health disorders, drug abuse, reaction to medication, and all other mental health disorders must be ruled out, e.g. psychosis, depression, bipolar disorder, etc. (Holder and Wayhs, 2014). In addition to this, the individual must exhibit a minimum of two of the following symptoms continuously most of the time in a four-weekly period, with continuous signs of disturbance (suspicious beliefs) present for minimum of six months (Buadze et al, 2010). The symptoms include, delusions, hallucinations, impaired speech, irrational behaviour, disorganised thinking, and lack of ability to function properly, and hyperactive behaviour. Holder and Wayhs (2014) indicates that delusion, hallucination and impaired speech must be present as one of the two symptoms exhibited.

Mental illness is complex, there is a whole lot of issues that contributes to the major mental breakdown. The causes of schizophrenia are not known fully but yet the illness is treatable by tracing it back to its causes acknowledged that a lot of research has been undertaken to pinpoint the cause of schizophrenia, generally, it results from drug and alcohol abuse, biological, genetic and environmental factors. Sex abuse, family dysfunction, social exclusion in childhood and over protective parents are also factors that contributes to the risk of developing psychosis and schizophrenia in later life. Schizophrenia has strong hereditary links and the percentage of having schizophrenia is about 10% when the parents or siblings of the individual has it (Meyer, 2012). The risk of any individual naturally developing schizophrenia is 1% (Kapur and Van, 2009). But according to Okpokoro et al (2014), genetics only influences schizophrenia, it does not solely determine the cause, only 40% of people with schizophrenia are linked with genetics. Montero (2006) pointed out that people with both parents suffering from schizophrenia has a 40% chance of getting the illness, this also applies even when the individual is adopted by parents who do not have schizophrenia. There is a 50% chance of identical twin having schizophrenia if one of the twin has it (Gilmore, 2010). In the development of the brain, duplication or deletion of certain DNA chain in the genes can lead to psychotic disorders that develops into schizophrenia (Abbott, 2009). Attention disorder and memory loss has been linked with the size of the brain and malfunctioning of the brain due to failure in neural networks, and these are symptoms of schizophrenia (Meyer, 2012).

Seeman (2013) stated that a high level of dopamine in the brain causes excessive activity in the brain which may also be a cause of schizophrenia. Although, Perreault (2011) argued that the brain has hundreds of neurotransmitters and dopamine may just be an exaggeration of the cause of what might be more a complex cause of the illness.

Research has also linked cannabis with schizophrenia. The abuse of cannabis is not sufficient by itself to develop into schizophrenia, but it contributes to the risk with other complex factors that causes schizophrenia (Pushpa-Rajah, 2015). It has been found that cannabis can double the tendency of getting schizophrenia (Buadze et al, 2010). Abuse of amphetamines have also been found to trigger the release of dopamine which in turn increases the risk of developing schizophrenia (Young et al, 2010).

For the environmental factors, these can be due to stress sometimes during pregnancy or at a later stage of the illness. The hormones called hydrocortisone are produced in the body when high level of stress is present and this triggers the development of schizophrenia. Environmental factors include sex abuse or physical abuse in childhood, early loss of parents and depression (Morgan and Fisher, 200.

Recovery is about empowerment, giving hope, to help the patient achieve what they want in life. According to Su et al, (2015) the first step of recovery for an individual suffering from schizophrenia should be to let them understand and accept they have this illness, and then getting them into treatment and supporting them to adhere with the treatment routine and medication. After agreeing to treatment, family members and carers should closely work with patients to note the side effects of their medication, their mood change and make sure they do not have interaction with alcohol or drug abuse as this triggers risk of schizophrenia, this helps to prevent symptom relapse and promote functional recovery. Pickard (2011) states that, the cause and what contributed to the development of schizophrenia in patients should be traced back to its root. family health background, hereditary, early life predicaments, drug abuse and family loss. This will help and guide the psychiatrist in the best way to manage and treat patients. Social inclusion is very important, not making the person with the illness feel isolated from the community. Find them an environment that is friendly and supportive to their recovery (Morgan and Fisher, 2007). Awareness of sex education in the media for young adults will help prevent early life sex abuse and will reduce the risk of developing schizophrenia in later life. Also, one of the major political party in the UK is supporting the legalisation of cannabis, claiming this will reduce drug related crime and raise money for tax revenue. Legalising cannabis will only worsen the risk of people developing schizophrenia and other mental health related illness. The government should be made aware of this and stop the legalisation of cannabis.

When patients are to be discharged back into the community, the Multidisciplinary team must carry out assessment about where to discharge the patient, the patient should not be discharged to the same area and council flats where their old friends and lifestyle contributed to the development of the illness in the first place

The NICE guideline (2014) (National Institute for Health and Clinical Excellence), has provided guidelines for how individuals diagnosed with schizophrenia should be cared for. This includes working in partnership with the individuals diagnosed with schizophrenia and their family and carers; giving hope and treatment to patients in our care; build empathic and supportive relationship with people in our care. Clinical outcomes for individuals diagnosed with psychosis or schizophrenia are improved by early interventions in psychosis or schizophrenia services. Outcomes such as symptoms and relapse, admission rates for individuals with first episode of schizophrenia. Evidence-based treatments are provided such as social, psychological, pharmacological, education and occupation interventions. Early interventions should include culturally sensitive psychological and psychosocial treatments to accommodate people from diverse ethnic and cultural background (Khan et al, 2013). The NICE guidelines (2014) ensures that proper working system are in place for people with the first episode of schizophrenia to be able to access the service for early intervention to receive treatments. This early intervention helps to treat people early and stop further symptoms from reappearing, this in turn reduces the number of admissions to the hospital freeing bed space (Montero, 2006).

Wang (2015) reported that Cognitive Behavioural Therapy should be delivered to patients for them to reassess their current and past symptoms and re-evaluate their perception. Encouraging people to monitor their own thoughts, behaviour, managing stress and promoting alternative ways to cope with their symptoms. NICE guideline (2014), established that clozapine reduces symptoms and risk of relapse in adults diagnosed with schizophrenia. Clozapine should be recommended when patients have used 2 different antipsychotic drugs and are unresponsive to the medications.

Care Programme Approach (CPA) is usually used as a treatment path for people with schizophrenia (Seeman, 2013). CPA consists of assessment, care plan, care coordinator and reviews. Assessment assesses the health and social needs; care plan states is to meet the stated needs; care coordinator is the key worker, nurse or a social worker reviews; is to review how effective the treatment is and make changes to care plan.Generally, antipsychotics are used to treat schizophrenia, this includes Aripiprazole, clozapine, olanzapine, risperidone and quetiapine. All these improves and balances the mood, thinking and behaviour. They work in the brain where it blocks the excessive activity of the neurotransmitter, dopamine stored in the nerve cell, to control psychotic illness (Wang, 2015).

Schizophrenia does not only affect the individual suffering from the illness, it also affect their family, friends and carers (Su et al, 2015). Schizophrenia causes the sufferer to be argumentative, withdraw and isolate themselves from their environment thus develops into paranoia (Arguello and Gogos, 2008). Paranoia makes the patient form suspicious stories about their families through the voices that speaks to them, and makes them become violent and sometime suicidal Frith and Johnstone, 2003). These makes relationship with family members very difficult. Even when family and carers try to get close and talk to the patient it is almost impossible as the patient’s acts frustrates the efforts of their carers and family members, and makes it hard for them to understand the patient and they run out of options to interact with the patient. It’s like a wall built between the patient and their carers and family members. Holder and Wayhes (2014) indicated that family and carers are exposed to aggressive behaviours, lack of good communication, patients refusing medications, all these deteriorates the health of the carers and families aswell. It drains their efforts and energy, exhausts them financially, sometimes leading to anxiety and depression, increased emotional and physical burdens, divorce and breakdown in relationships (Kapur and Van, 2009).

Whilst on placement on a mental health ward, there’s this particular service user that was diagnosed with schizophrenia, she had a family history of mental disorder, this lady would wake up in the morning and come down to the ward singing and dancing in a very happy mood. After some while, her mood changes and she will be very paranoid and start talking in mumbled voice about wars in different countries and how she wants peace to reign in the world. Her mood then switches and she will complain of loud voices in her head and she will shout at the voices to stop talking to her. Then is some cases, she will be very quiet and withdrawn from the other service users for days, wanting to be by herself, she does not want anything to eat or drink and will not comply with her medications. All these symptoms she exhibited pointed out that she is schizophrenic (Su et al, 2015). When her family visits, she sometimes have to be reminded who they are and she will talk to them atimes and sometimes she will not say anything throughout the visit.

Although, when families and carers are better educated about their patient’s illness, including the symptoms, the side effects of their medications, how to manage stress and skills on how to cope with the disturbing behaviour, there are benefits gained by the carers and families on how to best manage their patients and this also has a positive effect on the quality of life of the person with the illness. A lot of patience is needed, and a lot of time should be spent with the patient to understand their moods, and when their moods are better, their families can talk to them, and play games with them to take their minds away from the illness and the strange voices. Family, carers and patients should all be involved and updated about the care plan and discharge plan for the patient, this encourages the patient and them to have a goal to work towards in getting discharged.

In conclusion, schizophrenia as a mental health disease has been around for about 130 years. The disease itself is not fatal but can result in death when the individual is having a maniac episode. There is a good prognosis for the disorder, as about 20% of the people diagnosed with the illness will be able to live a normal life in the community after being discharged from the hospital. Due to continuous medical research, there are now early interventions and treatments for individuals suffering from the illness, which means there will be better treatments in the future and people do not need to be hospitalised all the time. The carers, family and friends play an important role in the treatment and recovery of individuals diagnosed with schizophrenia. There is advantage and disadvantage for a family caring for their loved ones.