Schizophrenia: Causes and Treatments

This assignment delves into the multifaceted nature of schizophrenia, examining its complex causes, encompassing both genetic predisposition and environmental influences. It analyzes various treatment options available, including pharmacological interventions and psychosocial therapies. Furthermore, it highlights the role of community-based services in supporting individuals with schizophrenia and their families. The provided resources offer insights into research findings, clinical perspectives, and support networks.

Running head: SCHIZOPHRENIA
Schizophrenia
Name of the Student
Name of the University
Author note

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Schizophrenia is a severe mental and chronic disorder that affects the thinking, feeling
and behaviour of an individual. The patients with schizophrenia seem to lose touch with reality.
Schizophrenia is a neuropsychiatric disorder that affects the three main areas: two areas in the
frontal lobe and CA1 area in the hippocampus that comprises of a small region. Although it is
not a terribly common disease, it is a severe one. Globally, about 1% of the population is
diagnosed with this disease mainly 1.2% (3.2 million) suffer from schizophrenia (Farmer &
Chapman, 2016). The lifetime prevalence of schizophrenia is 0.87% and incidence is 15.2 in
100,000 persons that show prominent variation. Epidemiological studies show that lifetime
prevalence is around 1% according to National Institute for Mental Health, 2015 (National
Institute for Mental Health (2015). In a recent Singapore study on mental health, Multi-
Disciplinary Team (MDT) is required for care delivery by different healthcare professionals in
providing care to the schizophrenic patients. Therefore, the following assignment will discuss the
development of MDT, identification of interventions in providing best care while working with
clients suffering from mental health conditions in Singapore.
Schizophrenia is a severe and challenging disorder in which a person is unable to
distinguish between unreal and real, clearly think, manage motions and function normally. There
is fear, confusion experienced in schizophrenic patients and seem to withdraw from the social
world. There is also disruption of normal daily activities like eating, bathing, dressing or running
errands. Schizophrenia is likely to develop more in males than females at an earlier age between
16 and 25 years and average onset age is 25 in women and 18 in men. The peak onset of the
disease in males is 20-28 years and in females, 26-32 years (Chong et al., 2017). The onset is
rare in childhood as compared to middle or older age groups. According to World Health
Organization (WHO), schizophrenia affects more than 21 million people globally; however, it is

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not common as compared to other mental health disorders (World Health Organization, 2010).
There is stigmatization, discrimination and violation of rights of people living with
schizophrenia. Schizophrenia is a clinical diagnosis that is differentiated from other medical
illnesses where there is requirement of integration of medical, psychosocial and psychological
inputs carried out by MDT. Antipsychotic medications help in the prevention of relapses or in
diminishing the positive schizophrenic symptoms.
The exact etiology of schizophrenia is still unknown. However, research suggests that it
is a combination of causes including genetics and environmental factors. According to Ripke et
al., (2013) the genomic experiments suggest that schizophrenia is mainly associated with SNPs
with alleles and uncommon copy number variations (mainly deletions). Recently, researchers
have identified a gene named C4 or complement component 4 that is involved in immune system
that increases the risk of the mental illness (Sekar et al., 2016). After the conduction of tests in
mice and humans, this identified gene is involved in the elimination of connections between
neurons called “synaptic pruning”. The strongest genetic predictor that increases schizophrenia
risk is located on chromosome 6 on DNA (Ripke et al., 2014).
According to Reichenberg et al., (2016) although genetic factors are involved in the
disease etiology, environment also plays an important role in the development of the illness
affecting gene expression. In the early life, factors like maternal nutrition, obstetric
complications, maternal stress and postnatal or prenatal infections increases the risk of
schizophrenia as proposed by EU-GEI, 2014. In the later life, drug abuse, ethnicity or migration,
social adversity, urbanization is also the environmental factors that might increase the risk of this
illness. The contributing factors that increases schizophrenia risk has a great impact on the life of
the people suffering from the disease. It affects their everyday life and overall quality of life. It is

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troublesome to life alteration that affects personal, professional and social life. There is tendency
of the individuals to withdraw themselves from others and exhibit mood behaviors that are
inappropriate making relationships difficult. Symptoms associated with the disease like delusions
or hallucinations hinder them from participating their family chores and social life. There is also
reduced physical performance due to worsening of physical health exacerbating Activities of
Daily Living (ADL) disability (Patel et al., 2014). The resultant impairments are witnessed
across ADL from basic activities to mobility and job skills. Concisely, schizophrenia has a
potential impact on the motor abilities, cognition and physical capacity hampering overall quality
of life.
Schizophrenia is a complex disorder that involves the multiple pathways dysregulation
where dopaminergic, GABAergic and glutamatergic neurotransmitter are affected. Anatomic,
immune system and neurotransmitter abnormalities have implications on the schizophrenia
pathophysiology. There is identification of deficits in the acetylcholine muscarinic receptors
where inflammation has been found to be the major contributor to the development, exacerbation
of schizophrenia.
Neuroimaging studies shows that there is decrease in brain volume, enlarged ventricles in
the medial temporal areas along with changes witnessed in hippocampus. Anatomic
abnormalities are seen in the limbic and neocortical regions and in the interconnection of white-
matter tracts that are reduced in the brains of schizophrenic patients. There are abnormalities
seen in the dopaminergic systems exhibiting hypodopaminergic activity in mesocortical system
that leads to negative symptoms and hyperdopaminergic activity that lead to positive symptoms
(Jenkins, 2013). There is also over activation and disturbance in the immune system that may
result in inflammatory cytokines over expression and alteration in function and structure of brain.

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For example, elevated proinflammatory cytokine level activates kynurenine pathway where
tryptophan is metabolized into quinolinic and kynurenic acids. These acids cause regulation of
NMDA receptor activity involved in the regulation of dopamine. Metabolic disturbances and
insulin resistance are common in schizophrenia linked to inflammation (Lee et al., 2014).
Therefore, inflammation may be related to the schizophrenia psychopathology and metabolic
disturbances.
The complications of schizophrenia are devastating as it affects the human emotion,
thought and expression. There are only 20% of the full recovery chances after a first
schizophrenic episode that improves their quality of life. Among the medical illnesses, diabetes
occurs in schizophrenia as the anti-psychotic drugs elevate the blood sugar levels. In addition,
depression is also common because of negative social impact common in the later adulthood. It
also affects the social status, as there is decline in the inability to perform the ADLs and earn a
living. The long-term effects include relationships and professional life that leads to social
exclusion. Intelligence is also affected, as there is decline in IQ reflecting early nerve damage,
however, it is not an inevitable cause for schizophrenia disease progression. Suicide is also a
complication due to the frightening behavior and they tend to withdraw themselves from others
or causes self-harm. An estimated, 9-14% of people commit suicide out of 20-50% schizophrenic
patients and behave violently as compared to the general population (Howes & Murray, 2014).
The above description shows that schizophrenia is a serious mental health problem that is
occurring widely, frequently causing severe disability, and diminishing quality of life. There is
high incidence and prevalence of schizophrenia worldwide that is contributing to the burden of
disease. Schizophrenia is a psychotic condition that is affecting the overall quality of life
indicating lower quality of life, loss of productivity, distress and secondary mental health

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problems like depression for the patients, their families and caregivers. Therefore, the above
discussion shows that this mental health problem of schizophrenia is worth investigating and
requires MDT approach for the care delivery to the patients.
For the treatment of schizophrenia, MDT approach that integrates psychopharmacologist,
therapist, physicians, clinical pharmacists, nurses being the valuable members of the team. This
MDT comprises of consultant who would discuss the medical problems related to schizophrenia
along with prescribed medication. The psychiatrist would discuss the aspects of the illness so
that the patient has a better look in overall life. The psychiatrist would discuss with the doctors
and help in the recovery process for the clinical and social functioning of the schizophrenia
patient. Social worker is also important who would encourage the patient for social integration
and cope with environmental life aspects. Among this MDT, nurses play the most important role
that provide all aspects of care in every phase of the disease in the psychiatric setting.
Psychotherapist provides effective therapy for the best management of the unhealthy thinking in
schizophrenia and develops new patterns that can help patient learn best ways to manage
symptoms. The interventions are discussed in the next section.
Antipsychotic treatment is the first pharmacological intervention that is used for the
prevention of relapses and positive symptoms of schizophrenia (Kishimoto et al., 2013).
Approximately, relapses occur within 1 year in around 80% of the patients if the medications are
suddenly stopped. The choice of drug for schizophrenia treatment depends on the factors like
cost, effectiveness, method of delivery, side-effect burden, tolerability and availability. The best
choice of drug is the second-generation antipsychotics (SGAs), major tranquilizers or neuroleptic
medications helps in diminishing the symptoms and in reducing the chances of relapses. SGAs
have minimal extrapyramidal side effects (EP) as compared to the first generation counterparts.

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SGAs class of drugs includes clozapine, aripiprazole, iloperidone, olanzapine, risperidone,
olanzapine, paliperidone. These class of drugs have prominent serotonin 5HT2A combined with
D2 antagonism along with a unique receptor-binding profile for muscarinic, histamine and α and
serotonin receptors (Fonseka, Richter & Müller, 2014).
SGAs work principally by antagonizing or blocking the dopamine action at its receptors
that in turn decreases the chemical signals that drives the violent or psychotic behaviour. The
rationale for choosing this class of drugs is that EPS risk is less that are characterized by tremors,
muscular rigidity, restlessness, shuffling movement and muscular spasms that result in abnormal
posture (Nielsen et al., 2015). This new generation of antipsychotics are better tolerated and
superior in the treatment of negative schizophrenic symptoms. It also reduces the tardive
dyskinesia having more clinical efficacy in treatment-resistant schizophrenia. The areas of brain
where cognition and emotion balance are affected by dopamine and serotonin; SGAs perform
dual function to reset the balance when altered. Therefore, this class of drugs balances the
disturbances in neurotransmitters that are manifested in schizophrenia being the best
pharmacological treatment option.
However, SGAs can cause side effects and bad interactions when used with other
medications. It may cause uncontrollable movements like tremors, muscle spasms, weight gain,
drowsiness, dizziness, restlessness, dry mouth, vomiting. The safe administration is important
and among the MDT, nurses play the vital role in understanding the medication pharmacology,
side effects and contraindications in a hospital setting. According to Divac et al., (2014) nurses
lack in-depth knowledge about antipsychotics and fail to identify the potential adverse side effect
of antipsychotics. Therefore, nurses have to consider parameters like patient safety,
Extrapyramidal Syndromes, metabolic considerations, QTc Prolongation and Torsades de

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Pointes and employ patient education. Routine assessment of neurological status, ambulatory
status and orthostatic vital signs is important for patient safety. Nurse should look for the EPS
via early detection and look for serum glucose, weight, serum lipids and cholesterol levels in the
patient. Finally, for the safe use of drugs and reduce side effects, patient should be educated to
look for the adverse effects and encourage them to continue with the prescribed medications.
Another intervention is cognitive behavioural therapy (CBT) that treats the schizophrenia
residual symptoms (both positive and negative types). CBT help the patients to learn them to live
better, avoid relapse and reduction in certain symptoms. A psychotherapist helps the patient to
change their perspectives of harmful or destructive beliefs and reduce suicidal ideation in an
outpatient setting. The therapist helps the patient in transforming the negative or harmful
cognitive patterns into positive and healthy beliefs (Subramaniam et al., 2012). The rationale for
choosing CBT is that it helps patients to identify the triggering symptoms and handle their
stresses and responsibilities better while living with the disease. The role of a psychotherapist is
not to cure the disease, but to improve the functional ability of the person, independence, better
management and reduction of stress that they experience in their daily life. Behavioural
experiments, cognitive restructuring, coping skill training and self-monitoring are the CBT
approaches that help patients to lead a normal life while living with the disease.
Community services are also helpful that work in conjunction with the psychiatric care
for the schizophrenic patients that minimize the social impact of the disease. Community-based
mental health services provide full range of mental health care that are dedicated in the treatment
and helping patients to relieve them from distress and enhance social inclusion. There is
stigmatization and discrimination regarding mental health disorders and so, community care
services emphasize on the improvement of quality of life, de-stigmatization of mental illness and

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promotion of self-sufficiency. Silver Ribbon in Singapore reaches out to the schizophrenic
patients to help them build positive mental health. The community resources provide them an
opportunity for the patients to reintegrate into the local community and help them lead a normal
life. Singapore Association for Mental Health (SAMH), SACS that provide peer support, illness
management and recovery program for schizophrenia. Club Heal aims to empower and assist
schizophrenic patients to regain confidence and help them in community reintegration. National
Council of Social Service provides support to schizophrenic patients for community integration
by providing support services for seamless recovery.
In Singapore, schizophrenia is the ninth leading cause of disability (2.7% since 2007,
disability-adjusted life-years) and has been incorporated in the National Chronic Disease
Management for the enhancement of patients’ care suffering from schizophrenia. It requires
MDT approach for care delivery by different healthcare professionals in providing care to the
schizophrenic patients. Researchers have identified a gene named C4 or complement component
4 that is involved in immune system that increases the risk of the mental illness. Antipsychotic
treatment is the first pharmacological intervention and CBT improve the functional ability of the
person, independence, better management and reduction of stress that they experience in their
daily life. Community-based mental health services provide full range of mental health care for
social inclusion and improve their quality of life.

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Community-based services in Singapore
http://sacs.org.sg/
http://www.clubheal.org.sg/
http://www.silverribbonsingapore.com/
https://www.samhealth.org.sg/

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