Patient portfolio

Patient’s Background

Disorder Name

Schizophrenia

List of diagnostic criteria that the patient meets (based on the DSM-5)

Schizophrenia which is a psychological disorder is characterized by wide range of emotional and cognitive dysfunctions. For one to be termed as schizophrenic there has to be more than two of the following signs and symptoms lasting for at least one month; Hallucinations, delusions, disorganized speech, catatonic or grossly disorganized behavior and negative symptoms, for instance, diminished emotional expression. The individual must also exhibit significant impairment in crucial areas of function for example self-care, work and interpersonal relationships. Equally, several signs of the disorder must be present for at least six months and bipolar, schizoaffective or depressive disorders presenting with psychotic features must be ruled out. The disturbance must not be attributable to any other medical condition or substance abuse. In the presence of a history of communication or autism spectrum disorder, schizophrenia is only confirmed with among other symptoms, prominent hallucinations lasting for at least one month (American Psychiatric Association & American Psychiatric Association, 2013).

Psychological Approach

According to Freud’s psychodynamic theory which is one of the cognitive theories, the trauma emanating from the unresolved conflict during the early stages of growth and development is the primary source of psychological problems in adulthood. Often the conflict between the ego, superego and the id results in issues most of which are suppressed within the unconscious component of the mind. Sometimes the unresolved problems can lead to regression or fixation to previous psychosexual developmental stages. For instance, in the absence of sufficiently functional ego, the personality may be dominated by either superego or the id thereby weakening the basis for sound reality and rational judgment. The poorly developed id can be as a result of poor upbringing for instance harsh childhood environment including unsupportive and cold parenting approaches. As a result, people may opt to regress to earlier developmental stages that are manageable and ego-friendly. According to the theory, schizophrenia is closely associated with the oral stage of the psychoanalytic theory, and more precisely a stage referred to as the primary narcism. During this stage, the ego component of the human mind is not yet fully developed therefore dependent on id. Given that the ego operates on the reality principle and consequently rational. If one regresses to the primary narcism stage, then the reality and facts about life become eroded. The regression could be responsible for the symptoms exhibited in schizophrenia more specifically delusions, hallucinations as well as disorganized speech and thought (Roberts & Penn, 2013).

Biological Approach

Under the biological approach to schizophrenia, the biological model is a widely held concept in attempting to explain the psychological disorder. The idea looks at the natural faults such as brain abnormalities, neurological factors, viral infections and genetic factors as the possible causes of schizophrenia. Genetic factors are also critical in explaining the cause of the disease. According to some psychologists, schizophrenia is hereditary and therefore can be passed from one generation to the other. It implies that some individuals end up inheriting the disease from parents. In studies involving twins, evidence has emerged that, the risk of developing schizophrenia is higher in identical than in non-identical twins. According to Roberts and Penn, the concordance rate amongst monozygotic twins stands at 48% while that of dizygotic twins stands at 17%. Despite the definite correlation between the risk of developing schizophrenia and genetics, no study has proven 100% concordance rate, and as a result, it becomes impossible to conclude that schizophrenia is a direct result of susceptible or defective genes. While this is true, some psychologists still argue that the high concordance rate is attributable to the schizophrenic environment and behavior that children tend to mimic and not to the various genetic factors. According to the psychologists, children who are brought up in families with one or more schizophrenia cases may end up exhibiting similar symptoms because children learn and develop behavior primarily through observation and imitation. However, the mere fact that schizophrenia runs in families is a significant pointer to the role played by the genes in determining the cause and course of the disease (Roberts & Penn, 2013).

Sociocultural Approach

Several studies agree to the fact that life events and social relationships can trigger not only psychological disturbances but also determine the course of the illness and treatment in schizophrenia and this is according to the labeling theory. According to the theory, stress is an essential component of the disease because the brain stimulation from the stress can alter the delicate neurotransmitter balance. Stress can be as a result of many factors, and these include education, loss of a loved one, divorce, functional changes among others. The relationships at the family level are also a significant determinant in schizophrenia, and this may be explored regarding expressed emotion and the double-blind theory and expressed emotion. Concerning the double-blind theory, it is argued that families can be a source of two conflicting ideas thereby evoking a sense of mixed feelings and reactions which may consequently trigger schizophrenic symptoms. Expressed emotion, on the other hand, refers to the high emotional environments that may sometimes engulf families and this does not only act as a trigger to schizophrenia but also lead to relapses. The labeling theory, on the other hand, maintains that certain social groups craft rules that need to be adhered to by every member of the team. The failure to conform to the set standards according to the theory renders an individual schizophrenic which then provokes these individuals to deteriorate and exhibit the other symptoms of schizophrenia (Roberts & Penn, 2013).

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Treatment

The effective management of schizophrenia requires a collaborative approach that combines both the psychosocial and medical therapies. While antipsychotics are used to bring the various signs and symptoms under control and more specifically the positive signs of schizophrenia, the psycho-social support, on the other hand, assists the patient to function maximally in the society. The individual need to be helped in building and maintaining relationships, secure a job and device appropriate stress coping mechanisms. However, it is essential to note that schizophrenia is a chronic mental illness and therefore the patient may benefit from lifelong antipsychotics or neuroleptics. The drugs act by regulating the various neurotransmitters primarily in the brain and are maintained at the lowest doses possible. Mood stabilizers, antidepressants or anxiolytics can also be prescribed alongside neuroleptics. Occupational therapy, group therapy and behavioral therapy are some of the supportive psychosocial approaches that can be employed. The schizoaffective form of schizophrenia may also require electroconvulsive therapy (ECT) as an intervention therapy (van Os & Kapur, 2009).

Neuroleptics especially the typical ones are associated with several side effects that touch on almost every system in the body. The side effects significantly impact on adherence leading to relapses. The side effects include weight gain, uncoordinated movements- such as tremors, dizziness/drowsiness, muscle spasms or tics, restlessness. Others may involve the dry mouth, constipation, nausea/vomiting, low white blood cell count, seizures, blurred vision, low blood pressure and sexual dysfunction. The symptoms may vary from one person to the other, and it is because of these side effects that baseline lab investigations need to be carried out before initiating and during treatment. Some of the investigations include the liver function tests, complete blood count and the kidney function tests (van Os & Kapur, 2009).

The cognitive behavior therapy would be recommended for a patient who has schizophrenia. The technique is widely accepted psychosocial interventions because it is evidence-based. The main aim of the cognitive behavior therapy is to help improve the emotional well-being as well as social functioning. To achieve this goal, the cognitive behavior therapy tries to critically look at various thoughts, attitudes, and beliefs linked to the psychological disturbance with a view of modifying them through empirical experiments and critical analysis. The technique seeks to alter perceptions and beliefs about self, others and the future (Dobson & Dobson, 2017).

Given that schizophrenia is a chronic mental illness calling for long-term treatment proper plans should be in place to facilitate adherence and prevent relapse. With appropriate regimen and good adherence, the disease is manageable and significant improvement in symptoms and behavior should be recorded within a short period of treatment. The treatment goals and behavior modifications once the symptoms are fully managed and the right dosages of neuroleptics is established. With minimal symptoms and an excellent psychosocial support, the individual should be in a position to function normally and lead a healthy life as similar to the premorbid state as possible (National Institute for Health and Care Excellence (NICE), 2014).

Conclusion

Managing chronic illnesses such as schizophrenia is not an easy task and patients may find it hard to accept the fact that they need to live and maintain the condition for eternity. Never the less, with appropriate prevention and treatment measures the disease can be managed and those suffering from the condition lead a normal life just like any member of the society. The collaborative management combining the use of neuroleptics, psychotherapy and proper management of side effects associated with the treatment options available can help bring the psychological disturbance under control. However, the patient may continue experiencing the symptoms of the disease until dosage stabilization is achieved. Good adherence in schizophrenia is essential in managing the symptoms and preventing relapse. More research is required to help develop better ways of handling the condition and devising newer and better drugs with fewer side effects compared to the current regimen.