Definition of Schizophrenia
Schizophrenia is a major mental disorder with many symptoms such as like delusions (the belief in something that is not real) and hallucinations (the belief in seeing or hearing something that does not exist or is not real). There are 3 negative symptoms that recognized in DSM-IV :
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| Illustration of Schizophrenia |
Affective flattening
Loss of emotional responses toward the environment around. (facial expression does not change for long time, speaking with a monotonous intonation, and the patients have no eye contact when talking to other people).
Alogia
Reduced or loss of speaking ability. (the patients do not have initiative or start to communicate with others, if they are asked, they will answered with a brief answers or it may be not the right answer).
Avolition
Inability to focus in an activity that leads to the goal of that activity, it may be in work, school, etc. (the patient may only sit all day without doing something, withdrew from the social, social isolation).
Schizophrenia Types
There are 3 types of schizophrenia:
- Paranoid Type (Absurd thoughts, illogical, delusional changing, unpredictable, over thinking about important things, power, knowledge, or identity).
- Catatonic type (Extreme withdrawal from social life, the most common behavior in this type of schizophrenia is silent for the long term).
- Disorganization Type (Over thinking in doing something, focus on the religious and philosophical problem. This type does not have clear delusions or hallucinations, the patients mind and behavior are very disorganized. For instance: the way they talk is difficult to understand, not systematic, emotional blowing such as laughing or crying so hard).
Based on DSM-IV-TR, schizophrenia criteria are:
- There are two or more symptoms with a significant symptoms at least one month: delusions, hallucinations, disorganized speech, disorganized behavior or catatonic behavior, negative symptoms.
- Social and working function is decrease since the onset of these disorders.
- The symptoms of disorders occur for at least six months; at least one month of mild symptoms on the first point above, mild negative symptoms or other symptoms on the first point.
Etiology
Heredity
There are abnormal genes that increase the schizophrenia development and increase the severity of the disorder.
Abnormal Brain Structure
Scientists believe that there is a different in the people brain with schizophrenia with normal one. The main structure of the brain is abnormal ventricular part of the brain, it tends to be ventricle enlargement (enlarged ventricle). Ventricle is a fluid-filled cavities in the brain. This enlargement triggered atrophy and deterioration in other brain tissues. People with schizophrenia tend to show an abnormality in social function, emotion and behavior before they develop primary symptoms of schizophrenia (core symptoms).
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| Schizophrenia Brain Abnormality |
Birth Complications
Serious complications during the prenatal period and pregnancy problems is like a common history of people with schizophrenia.
Cross-Cultural Perspective
Culture is very diverse in explaining schizophrenia. There is a belief that this problem is caused by a biological disorder and stress, lack of knowledge of spiritual and family dynamics.
Neurotransmitters
dopamine neurotransmitters plays a role in schizophrenia. The symptoms of schizophrenia is caused by dopamine level in the brain, especially in the frontal lobes and the limbic system.
Schizophrenia Theories
Psychodynamic
Earlier psychodynamic theorists assume that schizophrenia is the result of various negative experiences that occurred in the early days of life (childhood) between a child and her or his primary caregiver (mother). Nowadays, there are many researches that examine the family interaction and schizophrenia which focuses on a family stress whether it can increase or reduce the disorder schizophrenia.
Cognitive and Behavioral Perspectives
Behaviorism belief that this mental disorder is caused by a wrong caring that makes the patient does not know how to respond toward a stimulus that is socially acceptable. Some experts consider that the cognitive deficit is a fundamental in the perception and attention as a basic biology.
Learning Perspectives
Ullman and Krasner believe in patients with schizophrenia is probably grow in a nonreinforcing environment because of the influence of bad parenting patterns or environmental influences. According to Sullivan, schizophrenia is caused by the social rejection because the "weird" label. This weird behavior pattern can be strengthened by a reinforcement that is accidentally received from the environment as an attention and sympathetic expression.
Psychosocial Factors
Psychosocial factors shows a hereditary factors that are getting powerful along of the day, psychological trauma, the parent and child relationship are pathogenic, and pathogenic interactions within the family.
Prevention
Primary Prevention
This primary prevention is to prevent the patients with schizophrenia by encouraging the development of effective treatment in health and behavior, biological, psychosocial and sociocultural. These program should be considered well such as like health care, prenatal and postnatal care, and public education about mental health.
Secondary Prevention
Prevention of this stage is to emphasis on early detection and handling maladaptive behaviors in families and communities.
Tertiary Prevention
Tertiary Prevention is after the mental health disorder, this prevention is better to engage support and appropriate treatment to patients, the purpose is to prevent mental disorder become chronic and allow individuals to have a healthy mental as soon as possible.
Treatment for Schizophrenia
Schizophrenia treatment usually takes long term of treatment, even if the symptoms have already gone . It is because the symptoms of schizophrenia can back again at any time.
Schizophrenia is treated with a combination between medication and therapy (psychological treatment). In acute symptoms of schizophrenia, hospitalization in a psychiatric hospital may be necessary to ensure the nutrition, hygiene, rest, and provide the personal safety of patients and the people around them.
Drugs Treatment
Drugs are the first treatment of schizophrenia. The drugs are prescribed by doctors, and its drugs are antipsychotics. Antipsychotics involve the performance of dopamine and serotonin in the patients brain. This medication can prevent, reduce, and even eliminate the hallucinations, delusions, agitation, and anxiety in patients with schizophrenia.
Patients who use antipsychotic, their behavior is not as aggressive as other patients who did not use these drugs. Moreover, according to a research, those antipsychotics prescription can not be recurrence after his condition improved.
Anti-psychotic can be used in two ways, namely by mouth or injected. For patients with schizophrenia who have been through a period of acute administration of antipsychotics should be administered as a preventive measure.
There are two categories of antipsychotic drugs, those are antipsychotics old generation (fluphenazine, perphenazine, chlorpromazine and haloperidol) and the new generation (clozapine, ziprasidone, quetiapine, olanzapine, risperidone, aripiprazole, and paliperidone)
Side effects those drugs are only in the old antipsychotics generation, the common side effects are muscle twitching, trembling body, and muscle spasms. There are side effects on both types of antipsychotics are weight gain, constipation, drowsiness, blurred vision, dry mouth, and decreased sex desire.
Currently a new antipsychotics generation are the most common and recommended by doctors because it has fewer side effects than the old one.
Psychological Treatment
After schizophrenia symptoms is gone or during the drugs treatment, patients need psychological treatment. There are some things that are included in this psychological treatment.
Individual Therapy
The first is individual therapy. At this therapy the patient is taught how to cope to stress physical or psychological and they need to control schizophrenia by identifying signs of early recurrence. This therapy is also useful to restore their confidence. Individual therapy is also useful to re-develop their ability to work in next the routine life.
Moreover, in individual therapy, patients with schizophrenia will also be taught about the ways to control emotion and thought patterns. The goal is to replace negative thinking with positive thinking.
Social Skill Therapy
The second is social skills therapy. In this therapy the patient is taught how to improve communication and interaction with other people.
Family Counseling
And the third is dedicated to family counseling. This therapy is to provide education and same perception on families of schizophrenics, it is about how to resolve problems due to the symptoms that appear sometime, and how to provide support for people with schizophrenia.
Summary
In summary, Schizophrenia is a severe mental disorder and chronic classification of mental disorder(psychotic). Generally this mental disorder characterized by distorted thinking, and affective disorders. Schizophrenia is caused by many things, such as like an imbalance of neurotransmitters in the brain, education and mental development since childhood, psychosocial stress, chronic mental disorder, and it is easy to be recurrent. It is like the patients can not be normal again along of their life. The symptoms of chronic schizophrenia has made schizophrenia treatment become monotonous and boring for the patients. The psychiatry and health care workers love to give drugs treatment than electric convulsive therapy (ECT). In the development of drugs treatment, this medicine is capable to provide a better quality of healing, especially for those who are resistant to certain drugs. However, these drugs coast is so high. It becomes a big problem and a huge obstacle for the patients with schizophrenia who generally come from lower socioeconomic society.
Some surprising thing is in a psychiatric congress and seminar on an international scale have demonstrated the superiority of the usefulness of psychotherapy for psychiatric cases. Apparently there is a new hope and optimism to cure schizophrenia in the whole world with comprehensive treatment.
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