Schizophrenia its Criteria of Diagnosis and Management

Schizophrenia its Criteria of Diagnosis What is Schizophrenia?

Schizophrenia is one of the most severe and persistent brain disorders in psychiatry, affecting at least one in every hundred people. Approximately 1.3% of the global population develops schizophrenia, irrespective of race, ethnic group, gender, or country of origin. In the United States alone, between two and three million people suffer from schizophrenia and the stigma that often accompanies it. The illness typically manifests between the ages of 17 and 25 in three out of four cases, robbing its victims of their most productive young adult years. The average lifespan of a person with schizophrenia is approximately 20% shorter than that of the general population.

Schizophrenia and Its Statistics

Schizophrenia is a chronic illness that is far more prevalent than many other serious medical conditions. It is five times more common than multiple sclerosis, six times more common than insulin-dependent diabetes, 60 times more common than muscular dystrophy, and 80 times more common than Huntington’s disease. Despite its prevalence, schizophrenia remains unpreventable, with no known exact cause or reliable cure. The term “schizophrenia” originates from the Greek words “schizein” (to split) and “phren” (mind), referring to a split from reality rather than a split personality.

Globally, approximately 400,000 acute episodes of schizophrenia occur annually in the United States and three million worldwide. In terms of the burden of illness, schizophrenia ranks fourth among all diseases worldwide, following unipolar depression, alcohol use disorder, and bipolar disorder. Among women aged 14-44, schizophrenia is the second most burdensome illness worldwide. By 2020, neurobiological illnesses like schizophrenia were projected to account for nearly 15% of all illnesses globally.

In terms of healthcare resources, schizophrenia accounts for 40% of all long-term care days, with $104 billion (3% of total U.S. healthcare expenditure) spent annually on schizophrenia-related costs, excluding loss of productivity. Furthermore, 25% of all U.S. hospital beds are occupied by someone diagnosed with schizophrenia. Alarmingly, 20-50% of patients with schizophrenia attempt suicide, with 10% succeeding.

Recent research using advanced technological tools has redefined schizophrenia as a major neurobiological disease, replacing outdated psychological theories of causation. There is now irrefutable evidence of anatomical, neurophysiological, biochemical, and electrical abnormalities in the brains of individuals with schizophrenia, including loss of gray matter in the frontal and prefrontal lobes and enlarged ventricles. Additional biological evidence supporting the brain disease model of schizophrenia has emerged from studies in genetics, epidemiology, neuroimmunology, and neuroradiography.

Criteria for Diagnosis

The diagnosis of schizophrenia is based on criteria outlined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR, 2000). For a diagnosis of schizophrenia, at least two of the following symptoms must be present for a significant portion of time during a one-month period:

1. Delusions: False beliefs that are not based in reality.
2. Hallucinations: Seeing or hearing things that are not present.
3. Disorganized Speech: Incoherence or derailment of thought.
4. Grossly Disorganized or Catatonic Behavior: Extreme agitation or immobility.
5. Negative Symptoms: Cognitive deficits such as alogia (poverty of speech), avolition (lack of motivation), and flattened affect (reduced emotional expression).

Furthermore, for a significant portion of the time since the onset of the disturbance, one or more major areas of functioning, such as work, interpersonal relations, or self-care, must be markedly below the level achieved before the onset. Continuous signs of the disturbance must persist for at least six months.

Qualitative and Quantitative Research

Research on schizophrenia is diverse, encompassing both qualitative and quantitative studies aimed at understanding the complex nature of the disease and improving treatment and outcomes.

1. Qualitative Research: This type of research explores the subjective experiences of individuals with schizophrenia, their families, and caregivers. It provides insights into the personal, social, and emotional aspects of living with the disease.
2. Quantitative Research: This involves the use of measurable data to identify patterns, correlations, and causal relationships. It includes clinical trials, epidemiological studies, and surveys to evaluate the effectiveness of various interventions and treatments.

Current research is being conducted at institutions worldwide, such as the University of Washington in Seattle, which focuses on symptom management and relapse prevention. Additional research in this area is being conducted in the Netherlands, South Africa, and other countries. A significant body of literature also addresses family and caregiver burden, with research being conducted in the United States, Great Britain, Canada, Germany, Korea, Thailand, China, and other countries.

Management of Hallucinations and Nursing Care

Hallucinations are a common symptom of schizophrenia and are a major focus of nursing care. The management of hallucinations has been a concern for psychiatric nurses throughout the history of the profession. Recent research includes randomized controlled trials of specific psychoeducational interventions, such as those conducted at the University of California at San Francisco (Buccheri et al., 2004; Trygstad et al., 2002). Similar research is ongoing in Great Britain and other countries.

Management strategies for hallucinations typically involve a combination of medication, psychoeducation, and therapeutic communication. Nurses play a crucial role in providing reassurance, helping patients differentiate between reality and hallucinations, and teaching coping strategies to manage distressing symptoms. Additionally, nurses often collaborate with other healthcare professionals to develop individualized care plans that address the unique needs of each patient.

Substance abuse can complicate the management of hallucinations and delusions. Research in Britain and Holland (Baguley & Davies, 1999a, 1999b) examines these complexities, while other studies focus on patient beliefs about their hallucinations and their effects on coping strategies (Sayer, Ritter, & Gournay, 2000).

Psycho-Social Rehabilitation

Psychosocial rehabilitation is a critical component of managing schizophrenia, focusing on enhancing the overall quality of life and promoting community-based care. This approach aims to help individuals with schizophrenia develop the skills needed to live independently, maintain relationships, and participate in meaningful activities.

Several studies have explored various aspects of psychosocial rehabilitation. AntaiOtong (2003) provided a comprehensive review of psychiatric rehabilitation, while Williams and Collins (2002) examined the social construct of disability. Other research has focused on social functioning and quality of life for persons with schizophrenia (McDonald & Badger, 2002; Walton, 2000), comparing beliefs about interventions between psychiatric nurses, psychiatrists, and the public (Caldwell & Jorm, 2000).

Cognitive aspects of activities of daily living are being studied at the University of Kansas, while research in the United States, Australia, Sweden, Taiwan, and Hong Kong examines various aspects of community functioning, quality of life, and cost-effectiveness of care. For example, researchers in Taiwan are studying social skills training, while studies in Japan focus on client empowerment by public health nurses (Kayama et al., 2001). Anger management is another area of research in Hong Kong (Chan et al., 2003).

Management of Schizophrenia: A Multidimensional Approach

Managing schizophrenia requires a comprehensive, multidimensional approach that addresses both the symptoms and the underlying causes of the disease. This approach typically includes a combination of medication, psychotherapy, and psychosocial interventions.

1. Medication: Antipsychotic medications are the cornerstone of treatment for schizophrenia, helping to manage symptoms such as hallucinations, delusions, and disorganized thinking. Newer atypical antipsychotics are often preferred due to their lower risk of side effects compared to older drugs. However, managing medication side effects is a significant concern, as adverse effects can impact adherence to treatment. Research in Berkshire, England (Sin & Gamble, 2003) and Scandinavia (Svedberg et al., 2000) addresses the management of medication side effects to improve compliance.
2. Psychotherapy: Various psychotherapeutic techniques are employed to help individuals with schizophrenia cope with their symptoms and improve their quality of life. Cognitive-behavioral therapy (CBT), transactional analysis, sense of coherence, and other psychosocial interventions have shown promise in this regard. The nurse-patient relationship is crucial in this context, providing support, fostering trust, and encouraging adherence to treatment plans.
3. Psychoeducation: Psychoeducation involves teaching patients and their families about schizophrenia, its symptoms, and the importance of adherence to treatment. This approach has been shown to reduce relapse rates and improve overall outcomes. Current nursing research in Hong Kong and Australia focuses on the effectiveness of psychoeducational programs (Chien et al., 2003; Fung & Fry, 1999).
4. Social Skills Training: Social skills training helps individuals with schizophrenia develop the necessary skills to interact effectively with others, maintain relationships, and navigate daily challenges. Research in Taiwan and other countries demonstrates the importance of social skills training in promoting community integration and reducing social isolation.
5. Community-Based Care: Community-based care models emphasize providing support in the least restrictive environment possible, enabling individuals with schizophrenia to live independently and participate in community life. Studies in Australia, Sweden, and Hong Kong highlight the benefits of community-based care, including improved quality of life and reduced healthcare costs.

Conclusion

Schizophrenia is a complex, chronic illness that poses significant challenges for individuals, families, and healthcare systems worldwide. Effective management requires a multidimensional approach that addresses both the symptoms and the underlying causes of the disease. While antipsychotic medications are central to treatment, psychosocial interventions, psychoeducation, and community-based care are also essential components of a comprehensive treatment plan.

Ongoing research continues to shed light on the most effective strategies for managing schizophrenia, improving patient outcomes, and enhancing the quality of life for those affected by this debilitating illness. By integrating the latest evidence-based practices into clinical care, healthcare professionals can better support individuals with schizophrenia and their families in achieving their fullest potential.