Professional Documents
Culture Documents
The individuals suffering from schizophrenia seems they are not living in reality; however it is
the underlying mechanism of the disease that affects their thought and motor process. The
disabling effect of the disease warrants understanding the pathophysiology of the disease.
PATHOPHYSIOLOGY
The pathophysiology of Schizophrenia is complex like the disease symptoms and signs.
Anatomic, immune system and neurotransmitters play simultaneous role in manifesting the
disease.
Neuroimaging studies carried out to study anatomic differences in brain of schizophrenic patients
and normal patients have shown larger ventricles, reduced brain volume in temporal areas,
changes in hippocampus region are reported in patients suffering from schizophrenia unlike
normal people. Similarly, researchers have taken much interest in different parts of the brain
against a single portion of the brain. Magnetic Resonance imaging (MRI) studies have revealed
existence of anatomic abnormalities in limbic and neocortical network region and
interconnecting white matter tracts.
Studies have shown people with schizophrenic condition have metabolic disorders like insulin
resistance that complements inflammation in this population. Thus inflammation might be linked
with psychopathology of schizophrenia and metabolic disorders very often seen in patients of
schizophrenia.
.
SIGNS AND SYMPTOMS OF THE DISEASE
The onset of schizophrenia occurs in between ages 16-30 and in some rare cases children gets
schizophrenia. The symptoms of schizophrenia can be classified into three broad categories i.e.
positive, negative and cognitive.
Positive Symptoms- Symptoms that is unusual in healthy subjects and people with positive
symptoms at times seems to stay away from reality. The symptoms include – delusions,
hallucinations, and movement disorders, thought disorders (cognitive disorders). The second
category is Negative Symptom. Negative symptoms implicate disturbances in normal behaviour
and emotion. The symptoms are reduction in expression that can be inferred from flat facial
expression or voice. Reduction of senses to pleasure (emotional sense), reduced communication,
difficulty in sustaining and leading life.
Cognitive Symptoms- The symptoms that are related to thought process are categorized under
cognitive symptoms. The severity and expression of the symptoms are different in each suffering
i.e. change in memory and perceptions. The symptoms include- reduced executive functioning,
issue with working memory, trouble in attention and focusing.
There is no cure to the illness however current treatment and therapies are restricted to
symptomatic management. In this section different treatment considerations will be discussed in
brief. Treatment of schizophrenia is multidisciplinary that warrants intervention medical,
psychosocial and psychological
Antipsychotics
Antipsychotics are taken either in pill form or in liquid form. Certain antipsychotics are taken in
inject able form once in a month. The first antipsychotic medications used in the treatment of
schizophrenia involve haloperidol and chlorpromazine. The drugs belonging to this category are
known as first generation antipsychotic drugs. The other anti-psychotic that starts with clozapine
is known as second generation antipsychotics. But both the generation of anti-psychotic drugs
have adverse effects such as first generation of anti-psychotics can cause high level of prolactin
level and extra pyramidal effects. The second generation anti-psychotic drugs can lead to poor
glucose and lipid control as well as weight gain.
Psychosocial Interventions
The adverse effects of second generation anti-psychotic medication are weight gain and
disturbed glucose and lipid control. At times, the patient develops odd food habits . Similarly
patients having less funds or inability to manage their funds usually stay near fast food outlets.
Therefore, the chance of getting poor nutrition further worsens the condition. In such condition
nutritional and diet counseling is required. Since psychotropic medications can lead to increase
in weight, therefore exercise can be recommended to reduce co-morbidities associated with the
disease.
Vocational rehabilitation
Many patients suffering from this disease want to work, but to disabling effect of this disease
they are not competitive for day to day work. But people with disease or condition must be
facilitated with supported employment opportunities. Such therapies can improve the self
confidence in them.
The primary health care strategy must not be limited symptomatic management of the disease but
also address the disease from public health perspective. Therefore based on evidences, the
primary healthcare strategy can be developed as follows
Along with anti-psychotics the schizophrenic population along with the family must be imparted
psychoeducation that can reduce the disability and improve the adherence of patients to
treatment regimen. The psychoeducation must be of low intensity and regular follow ups can
improve the quality of life of schizophrenic patients.
Another primary health care strategy should be training of general healthcare professionals and
nursing professionals to address the schizophrenia patients. Since most of the psychiatric
specialist, psychiatric nurses and psychiatric social workers are urban centered based. Thus, the
mental health patients suffering from this condition living in rural area must be attended by
trained professionals. The main work of such trained professionals would be identifying the
patients and bringing them to care settings for getting specialized care in a recovery oriented
model.
BIPOLAR DISORDER.
According to the current research studies, the collaborative practice developed to address the
depression in mental health can be employed to address the bipolar disorder in community health
settings. Several studies have evaluated the effect of collaborative practice and effect on bipolar
disorder patients. Based on such studies, the following primary health care strategies in
community settings are recommended to improve the quality of life in bipolar disorder patients.