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Schizophrenia

INTRODUCTION

Schizophrenia is a chronic, severe mental disorder affecting people over time and that may require lifelong diagnosis characterised by abnormal social behaviour coupled with a failure to recognise what is real. The term originated from Greek words skhizeinand phren which are translated as “split” and “mind” respectively, a “split mind”. This implies the disruption of normal thinking and emotions rather than split personality or multiple personality. The symptoms that can be associated with this condition include hallucinations where someone may hear voices that other people do not hear, unclear thinking, false beliefs, reduced social behaviour, inactivity or even emotional expression. Reduced social behaviour or inactivity is usually due to the fear by the person that other people may be reading or controlling their mind and thoughts or even plotting to cause harm to them. This condition can be diagnosed basing on observable behaviour and persons expressed experiences over time. During our lifetime, about 0.3-0.7% of people is affected[1]. There are major contributing factors that can be associated with this condition and this includes but not limited to genetic, psychological and social process and environmental factors. These major factors are not limited because researches are still going on and others may come up to include more major factors, as some drugs are also attributed to be a major cause of schizophrenia. To date, schizophrenia is still one of the most mysterious and costly mental disorders in terms of human suffering and societal expenditure.[2] Its combination of symptoms has sparked debates on whether its diagnosis represents a single disorder or a series of syndromes.

CAUSES OF SCHIZOPHRENIA

The causes of schizophrenia may remain unclear as there is no conclusive research on the same. The following are the theories surrounding the causative factors of the disease;

Genetics

Scientists examining the condition established that up to 1% of the general population have the occurrences of the condition. However, schizophrenia occurs in 6% of the people whose first degree relatives has the disorder and more common on people whose second degree relatives with the condition than the general population. Genes are inherited from both parents, if one parent is affected the risk is at 13% whereas if both are affected the chances are at 50%.[3] Recently, research established that several genes increases susceptibility to schizophrenia and that no single gene causes the disease by itself. People with schizophrenia are said to have higher rates of rare gene mutations, the differences which probably disrupt brain development. Malfunctioning of key genes to making important brain chemicals which in the end may affect the part of the brain responsible in developing higher functioning skills may also cause schizophrenia.

Environment

The environmental factors range from the living environment, drug and substance use and prenatal factors.[4]The interaction between the genes and the environment is said to be necessary for schizophrenia to develop. The environmental factors that may be involved include exposure to viruses, prenatal malnutrition, birth related complications, highly stressful situations among other psychosocial factors. It is difficult to separate the effects of the environment and genetics as the effects are seen to be pegged on each other.[5]

Brain structure difference

Malfunctioning of key gene or even imbalance in the complex, interrelated chemical reactions of the brain are thought to play a role in schizophrenia. This is because, the malfunction of the gene or the imbalance of the chemical reactions may detour the communications of the brain cells through the neurotransmitters. It is established that people with schizophrenia have imbalanced brain activity, less grey matter but larger ventricles, the fluid filled cavity of the brain than the people without the illness. Changes of brain cell distribution may be associated with complications before birth which may in turn lead to faulty connections within the brain. During puberty, the brain undergoes major changes which in turn could trigger psychotic symptoms.

Developmental factors

These may be prenatal or postnatal factors. The foetal development is considered a crucial factor as far as schizophrenia is concerned. Obstetric complications, foetal development, hypoxia and other prenatal events are considered to be associated the increased chance of a child later developing schizophrenia. These factors however contribute a small effect in the development of schizophrenia and can be said to be disease non-specific factors. For instance, either people who had experienced obstetric complications majority do not develop schizophrenia or those who develop the condition have no detectable earlier obstetric event. These factors however are able to moderate other causative factors such as the genetic and environmental.

Slowed foetal growth mediated by genetic effects can be associated with birth weight that is below average. A study of low birth weight, schizophrenia and enlargement of brain ventricles suggestive of cerebral atrophy established that lower birth weight are usually accompanied by enlarged ventricles which is associated with schizophrenia symptoms.[6]

Low oxygen levels in the brain (hypoxia) immediately after or before child birth is considered to be a risk factor for the development of schizophrenia.[7].

SIGNS AND SYMPTOMS OF SCHIZOPHRENIA

There are different types of symptoms that are associated with schizophrenia which includes delusions, hallucinations, disorganised speech and behaviour. These symptoms may vary from person to person in pattern and severity. Not every person suffering from schizophrenia has all these symptoms and the symptoms may vary or change from time to time.

Physical symptoms

Inability to smile or express emotions through face or vacant facial expression is so common on people suffering from the disease. The person will be seen to be staring in deep thought without blinking. Sleep disturbances are also associated with it. This presents fluctuations in sleep with experience of insomnia or excessive sleeping. Odd movements of the tongue or grimacing of the mouth may also present as a physical symptom. Involuntary movement of the limbs and jerking of the limbs may also be experienced.[8]

Feelings and emotions

Anhedonia, the inability to experience joy or pleasure from activities is also a symptom. The person may sometimes not feel anything at all, appearing to be seeking or wanting nothing, hypersensitivity to criticism insults or hurt of feelings. The person may also experience sudden irritability, suspicion, recentness or hostility. Normally, loss of hope and discouragement, loss of motivation or enthusiasm are also categorised here in.

Change of behaviour

People with the disease tend to drop out of activities and life in general, lack the ability to form and keep relationships hence few close friends if any with little interaction with people from the immediate family. When an individual acquire the disease, they tend to be loners or even being introverts, neglecting self-care and start to be unhygienic and not wanting any human contact or disturbances. Deterioration of job or academic related performance and functional impairment of interpersonal relationships is also common. Drug and substance abuse or preoccupation with religion is also a factor together with frequent moves or wanders without a purpose.[9]

Delusion

These are false beliefs firmly held by a person, which occur in almost 90% of the people with this disorder with illogical fantasies or ideas. Someone may feel that others or a person is out to undermine or do away with him or her maybe through poisoning or causing harm. These people may also feel that a message from a communication media is specifically meant for them or that they are important or famous figure or with powers that no one else has.

Hallucinations

This can be visual, or audio which are as real as any other experience to a person with this disorder experience deeply inside the persons head or outside as real actual voices from no apparent source normally negative. Hallucination can as well involve any of a person’s five senses. The person will tend to misinterpret their own inner self talk and tend to think that they are coming from an outside source, normally from someone they know.[10]

SUBTYPES OF SCHIZOPHRENIA

The types of schizophrenia identified by the DSM-5 work group are the simple schizophrenia where there is no traceable history of psychotic episodes but there is progressive development of negative behaviour in the person. The other is the paranoid type where only delusion and hallucinations are present without either disorganized thoughts or behaviour. The other is the catatonic type where the person is completely almost immobile or with purposeless movements and agitation. And finally the disorganised type where there is the disorganisation of thoughts. Other subtypes are simply a combination of the characteristics of these major subtypes.

PREVENTION

The prevention of this disorder is almost difficult as there are no reliable identifiable factors for the development of the disease. Early intervention of psychotic episodes and cognitive behavioural therapy are recommended as they may reduce the risk of psychosis among the most at risk. Avoiding the use and misuse of drugs and substances that are associated with the development of the condition is also highly recommended.[11]

MANAGEMENT AND TREATMENT

Treatment and controlling of the disorder seems to be improving with medication, therapy and strong network helping the persons with the disorder to control the symptoms. The management of the condition depends majorly on the treatment designs and psychosocial interventions as there is no single common approach established for the patients. Psychiatric medication is a common intervention.[12]

The management and improving symptom functions of this disorder have proven to be effective than a permanent cure. Antipsychotics which have been the main means of cure have drawn varied reactions due to its adverse effects on the patients. Hospitalization is not common neither necessary for the people with this disorder unless specified or demanded. Hospitalisation may also coincide with the admission on the basis of other conditions or reasons other than the disorder and care may be provided along for the condition. There have been developments and changes in the management and treatment of this disorder since the 20^th century, with the first introduction of antipsychotic drugs taking place in 1950s.[13]There are alternative drugs that may be availed which may serve the same as the anti-psychotics.

Psychotherapy is widely recommended and not just a confinement to psychiatric medications. Cognitive behavioural therapy may be used to target specific symptoms and improve related issues such as self-esteem and social functioning. Remediating neurocognitive deficits may also be an effective way of dealing with this disorder basing on the techniques of neuropsychological reforms which has so much proved to be effective. Family education is also important and serves a major role in recuperation of the person diagnosed with schizophrenia.

COURSE OF ACTION

A counsellor handling schizophrenia from biblical perspective really needs to have in-depth understanding of the person and the knowledge of the biblical context. On biblical perspective, a person with this disorder may be seen to be controlled by other forces both internal and external with misleading idea subjected to vanity by God because of rebellion. It is seen that such people are wicked and flee when no one is pursuing them.[14] God only subjects people to affliction because they violate His laws and sin, and on Christian perspective, sin has both direct and indirect consequences that may be dire as the behaviour of schizophrenics. Impairment of each human being at birth is associated with the corruption of mankind as it is written that the righteousness of the righteous shall be upon himself and the wickedness of the wicked upon himself.[15] The counsellor will seek to redeem the afflicted and will seek to know if the person is redeemed by the Grace of God, so as to renew the person into who he or she should be.[16]

CONCLUSION

Schizophrenia is a condition that may be seen by different people from different perspectives differently depending on the approach they employ. Theological or Biblical approach understand the disorder in the Biblical way and its causes, and thus will design Theological solutions where as if the disorder is approached from non-theological perspective then non theological solutions will be designed. The Christian counselling approach will often begin with establishing whether the behaviour of the client stems from organic effects or the sinful nature. If it is organic effect, the counsellor suggests careful medical examination but if the sinful nature, then the client will be discouraged from the sinful behaviour and convinced to desist from such. Irrespective of the approach, signs and symptoms and effects of the disorder remains common. The approaches may bring differences on the cause and effects of the disorder.

 

BIBLIOGRAPHY

1.      Van jimOs, ShitijKapur. “Schizophrenia”. Lancet 374 (2009)

2.      Herson M. “Etiological Considerations”. Adult psychopathology and diagnosis. John Wiley & Sons.(2011)

3.      O’Donavan MC, Williams NM, Owen MJ. “Recent advances in the genetics of schizophrenia”. Hum. Mol. Genet. 12 spec no. 2: R125-33.  NCBI Oxford university Press (2013)

4.      Leigh Silverton,Finelo Karen M. et al. “Low birth weight and ventricular enlargemet in a high risk sample”. Journal of Abnormal Psychology. (1984)

5.      Hanford HA. “Brain hypoxia, minimal brain dysfunction and schizophrenia”. Am J psychiatry (1975)

6.      Verna Benner Carson. “mental health nursing: The nurse-patient journey”. W.B Saunders p. 638. Philadelphia, London (2000)

7.      Velligan Dawn, Alphs Larry D. “Negative symptoms in schizophrenia: The importance of identification and treatment”. Psychiatry times. UBM MEDICA, USA. (2008).

8.      American Psychiatric Association. Taskforce on DSM-IV. “Diagnostic and statistical manual of mental disorders: DSM-IV-TR”. American Psychiatric Pub (2000).

9.      Stanford Robert, Mayo Wilson et-al. “Early intervention to prevent psychosis: systematic review and mete-analysis”. BMJ Clinical research 386:f185(2013).

10.  Alan S. Bellack. “Scientific and consumer models of recovery in schizophrenia: concordance, contrasts and implications”. Schizophrenia bulletin. (2006) 

11.  Trevor Turner. “unlocking psychosis.” BJ MED 334. (2007).

12.  The Holy Bible, New King James Version

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