Schizophrenia Discussion 2022

Running head: SCHIZOPHRENIA 1
Schizophrenia
Name
Institutional Affiliation

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SCHIZOPHRENIA
Introduction
The main focus of this paper is to present a comprehensive discussion about
schizophrenia, its symptoms, and impacts on an individual and significant others as well as
examine the strengths and limitations of clozapine as a medical strategy and psycho-education as
a non-medical strategy in supporting the schizophrenic patient's recovery.
Discussion
Part A: Schizophrenia, Symptoms, and Impacts on Person and Significant Others
Schizophrenia
This is a chronic disorder of the brain which disrupts how an individual thinks, behaves,
and perceives the globe. The furthermost shared type of Schizophrenia is called the paranoid
schizophrenia or schizophrenia with paranoid. Schizophrenic individuals with paranoid have a
change discernment or view of reality (Henderson, Vincenzi, Andrea, Ulloa & Copeland, 2015).
Such people can see or hear things which do not exist, speak in a confusing and strange manner,
believe that other individuals are attempting to injure them, and feel as if they are being observed
continually.
This might trigger relationship difficulties, disrupting regular everyday undertakings such
as running errands, bathing, and earing, and even culminate in drug abuse and alcohol to self-
medicate (Henderson et al., 2015). Several paranoid schizophrenic patients will always withdraw
from socialization with other people including friends and families, acting out in confusions as
well as fear, and remain at surged risks of suicidal attempts, specifically in the course of
psychotic episodes, depression periods, and in the 1st six months following the beginning of
treatment (Stevens, Dawson & Zummo, 2016).

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Symptoms:
Five types of symptoms which characterize schizophrenia including so-called ‘negative’
symptoms, hallucinations, delusions, disorganized behavior, and disorganized speech
(Henderson et al., 2015). Nonetheless, these symptoms always dramatically vary from an
individual to another, both in severity and pattern. Not every schizophrenic individual shall have
the symptoms mentioned above, and the schizophrenia symptoms might further alter over a
period (Vancampfort et al., 2016)).
Delusion is a strongly-held notion that an individual has notwithstanding clear and
unhidden proof that it is never factual. Delusions are highly shared amongst schizophrenic
persons, happening in over ninety percent of people with this disorder. Usually, such delusions
encompass bizarre or illogical fantasies and ideas. The delusion of persecution is a belief that
other people, typically an ambiguous ‘they,' are out to get one. Such persecutory delusions
usually entail bizarre plots and ideas (Vancampfort et al., 2015).
Hallucinations remain the sounds or new sensations encountered as actual when they
occur solely in schizophrenic individual’s mind. Whereas hallucinations might encompass any of
the five senses, auditory ones like hearing voices remain common, usually happening when one
misinterprets his own inner self-talk as arising from external sources. Schizophrenic
hallucination is often significant to hallucinated individual (Vancampfort et al., 2015). Often, the
voices are the ones of another person you know, and always they are vulgar, abusive, or critical.
Visual hallucination remains comparatively shared, while all hallucination incline towards being
worse when the individual is unaccompanied.

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Disorganized speech results from schizophrenia leading to challenges concentrating
alongside maintaining a train of thought, extrinsically displaying itself in a manner that one
speaks. A person might react to questions with unrelated responses, begin sentences with a single
topic and end somewhere fully different, incoherently speak, or say something illogical.
Common signs include loose associations; neologisms, perseveration, and clang (Karran, Yau,
Hillier & Moseley, 2018).
Disorganized behavior results from schizophrenia disorder, which disturbs the person’s
goal-oriented, activities, impairing the ability to take care of a person’s self, his work, and
interactions with other people (Karran et al., 2018). Such disorganized behaviors appear as a
drop in overall everyday functioning, random or unsuitable reactions emotionally, inexplicable
and purposeless behaviors, and deficiency of impulse and inhibition control (Mwangi, 2018).
Negative symptoms or so-called ‘negative’ symptoms of this disorder are the absence of
normal behavior present in healthy persons like lack of emotional expression, lack of
enthusiasm/curiosity, seeming nonexistence of interest in the globe, and speech challenges
alongside aberrations (Karran et al., 2018).
Impacts on Person and Significant Others
Behaviors of schizophrenia severely impact the person at the workplace, school, and
home. At home and social life, the person tends withdrawing from other members of the family
and exhibiting inappropriate mood behaviors which make relationships hard. When a person is
hearing voices or being delusional, the schizophrenic individual is probably to be unable to
partake in family and home chores and life (Karran et al., 2018). A family usually begin to
revolve around schizophrenic individual since the symptoms take substantial effort to manage
from every stakeholder.

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Even if the person with schizophrenia does not withdraw from other people, others might
withdraw from him because of his severe symptoms. At work and school, early symptoms might
easily lead to a failure to thrive at school and work (Vancampfort et al., 2015). The
schizophrenic individual will push away all his friends and become withdrawn entirely, ceases to
take part in things they used to enjoy like music and sport. The cognitive impairment alongside
challenges in thinking might culminate in declining grades at school.
The symptoms get severe with age and become a full-blown disease which makes work
infeasible and might culminate in a time of joblessness and homelessness. The symptoms affect
family members due to difficulty in effective communication with people distracted by
hallucinations and delusions (Vancampfort et al., 2015). Moreover, members of the family get
frightened and confused, seeing a schizophrenic person talking to himself and responding to
invisible stimuli. Schizophrenic persons are susceptible to human right breaches both in
communities and inside mental health facilities. They face high stigma, which leads to
discrimination hence limiting their access to general healthcare, housing, employment, and
education. Family members also suffer the high cost of treatment and management of the
disorder while the individual might have all his savings drained in management (Vancampfort et
al., 2015).
Part B: Strengths and Limitations of a Medical Strategy (Clozapine) and Non-Medical
Strategy (Psycho-Education) is Supporting the Recovery of A Person with Schizophrenia
Medical Strategy: Clozapine
Clozapine is the antipsychotic medication for the treatment of schizophrenic patients. It is
a life-saving medication for several patients with schizophrenia that include the people with
schizophrenia spectrum disorder with treatment-resistant illness or cidality; however, clinicians'

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discomfort with the management of its risk profile has culminated to underutilization of
clozapine (Correll, Detraux, De Lepeleire & De Hert, 2015). Clinicians who are ready to discuss
the benefits or effectiveness and risks or limitations of clozapine-and alternatives, including the
no treatment-with patients might face less reluctance when they recommend a time-constrained
drug trial.
Clozapine works by blocking the brain dopamine receptors, and the conventional wisdom
amongst the psychiatrists hold that most antipsychotics remain nearly equally good with the
exemption of Clozapine that stays better (Vancampfort et al., 2015). Psychiatrists prefer
clozapine as an antipsychotic and in treatment of schizophrenia since it has an increased efficacy
going parallel with more significant side effects. Clozapine is distinctively effective; some
studies have shown that it is a combination of NMDAergic + antipsychotic. This implies that
NMDA glycine site agonist does not add anything to clozapine since clozapine is already
agonizing glycine site (Vancampfort et al., 2015).
Clozapine was discovered to trigger a characteristic alteration in the rates of the firing of
some rat neurons, which is reversed by glycine site antagonist kynurenic acid (Vancampfort et
al., 2015). Clozapine “inhibited transport of MeAIB and glycine in rats, however, no inhibition
on other amino acids, at the concentration linked to preferential clinical response. They found
that other antipsychotics never had any such inhibitions. This implies that clozapine surges
natural extracellular glycine levels and hence a direct analogue of administering medicinal
glycine. Clozapine facilitates the neurotransmission of NMDAergic via something known as
protein kinase C (Kalin et al., 2015).
Clozapine is FDA-approved for treating the resistant schizophrenia and schizophrenia
spectrum disorders that have recurrent suicidality. This medication strategy can be best anti-

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psychotic for sensitive patients to Extrapyramidal symptoms (EPS) and individuals with tardive
dyskinesia (TD). Antipsychotic efficacy can usually be established in a two to three-month
duration-limited trial, though, practically, one might require to wait six to twelve months to
observe how effective clozapine is through the accrued benefits (Geretsegger et al., 2017).
The limitation of clozapine in treating schizophrenic patients can be understood via the
risks associated with its administration, including the severe side effects. Clinicians must be
aware of both serious/severe adverse effects which might take place when clozapine is to be
interrupted or discontinued and the common side-effects linked to the continued utilization of
clozapine which might be managed without discontinuation (Porcelli et al., 2016). The common
side effects which might be experienced by the patients following the initiation of treatment
encompass orthostatic, sedation, hypotension, drooling, constipation, tachycardia besides
metabolic side effects like weight gain hyperlipidemia, diabetes, that are increasingly
challenging in the long-run (Chiesa et al., 2015).
Constipation remains common upon clozapine administration which might culminate in a
severe and significant bowel ileus. EPS include Parkinsonism, akathisia, and dystonia are,
however, uncommon (clozapine was 1st ‘atypical' antipsychotic for this reason); however,
neuroleptic malignant syndrome (NMS) might ensue. Even though TD remains a small risk,
clozapine shall enhance established TD in various patients upon being switched to the clozapine.
Clozapine might lead to blood dyscrasias, which entail granulocytopenia alongside the rare risk
of agranulocytosis that must be closely monitored through the prescribing registry.
Myocarditis and pancreatitis remain probably idiosyncratic immune-associated side-
effects which are distinct to clozapine, unlike other antipsychotics. Clozapine also leads to other
dangerous side-effects, including a dosage-link risk of seizure, diabetic ketoacidosis, and severe

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hyperglycemia (Fenwick et al., 2015). All these limitations can explain the ineffectiveness of
clozapine. However, clozapine has proved to be effective than other antipsychotic drugs used to
treat schizophrenia. This is because it has a low rate of discontinuation, which makes the patients
view its risk-benefit favorably.
Psycho-Educational Treatment
Psychoeducational remains one of the most effective evidence-based practice to support
the schizophrenic patient recovery. This model is highly flexible and hence incorporates both
schizophrenic-specific information alongside tools to manage associated scenarios. This makes
this strategy to be effective in treating and managing schizophrenic disorder and its resultant life
changes (Vancampfort et al., 2015). The programs of psycho-education help both schizophrenic
patients, other people affected by the condition and their caregivers and partners whether both
psychological and physical influence of the schizophrenic disorder.
The psychoeducational strategy has the potential of extending the impact of care
provision beyond the immediate condition by activating as well as reinforcing informal and
formal support system and teaching the community and the individuals how to anticipate
alongside manage transmission and crisis period (Vancampfort et al., 2015). A well-developed
psycho-educational program or intervention will facilitate the recovery from schizophrenia. This
is because effective psycho-educational intervention increases the schizophrenic patient's
knowledge of, and insight into, his disorder and subsequent treatment and management (Hillis et
al., 2015).
Such an augmented insight and knowledge shall allow individuals with schizophrenia to
cope adequately with their disorder hence improvement in prognosis easily (Mwangi, 2018). The
nurses play a great role in ensuring effective implementation of pyschoeducational programs to

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ensure patient, caregivers, family and friends have the desired knowledge and information on the
treatment and management of the disorder (Mwangi, 2018). Psychoeducational also lowers
relapse, re-admission as well as encourage compliance with medication and decrease the length
of stay in the hospital in such hospital-oriented studies of restricted quality (Chiesa et al., 2015).
Teaching families and patients to improve treatment adherence remains a crucial goal in
psychiatric nursing, which help develop effective programs to promote adhering to treatment
hence minimizing relapse (Mwangi, 2018). However, some limitations of the psycho-educational
strategy have been noted (Chiesa et al., 2015). Whereas several studies have shown positive
impacts of psycho-educational on the reduction of symptoms and minimization relapse, other
studies have shown that such interventions surged the knowledge of the patients regarding
schizophrenia, however, never affected different outcomes or behaviors (Chiesa et al., 2015).
Another limitation of psycho-educational is that it is only valid when the programs are
well developed. Where the development of programs is never focused on the problems facing the
schizophrenic individuals, their families, and carers, the outcomes will not be sufficient. Such
programs must thus focus on increasing treatment compliance, reduction of relapse and
readmission, increasing knowledge about the disorder, positive behavior change, and service
utilization amongst others (Berlim, Tovar-Perdomo & Fleck, 2015).
Conclusion
Schizophrenia has been discussed in this paper in terms of meaning, symptoms, and
impacts to both schizophrenic individual and significant others and how it is treated both using
both clozapine and psycho-educational programs. The paper has concluded that both clozapine
and psycho-education have both limitations and strengths in supporting the recovery of a patient.
It is further noted that clozapine is the most effective medical strategy to be used in treating

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schizophrenia amongst other antipsychotic drugs (Hayes, Marston, Walters, King & Osborn,
2017). This paper concludes that both medical and non-medical strategies should be combined
for the maximum potential when treating and managing schizophrenia.

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