Schizophrenia can affect anyone, but the typical age of diagnosis is from the late teenage years to the mid-30s. There is an incidence of schizophrenia in about 1-out-of-100 people. More schizophrenia facts include: Men and women have equal odds of schizophrenia (Broyd et al. 2009). Men may manifest symptoms of schizophrenia earlier than women. Usually 1-2 years pass after the initial symptoms of schizophrenia before diagnosis. Children and individuals over 45 rarely get schizophrenia. All races show equal incidence of schizophrenia. Schizophrenia was once more diagnosed in people of colour, but this is attributed to cultural bias.
The vast majorities of people with schizophrenia respond to treatment and live normal lives in the community (Broyd et al. 2009). Figures on people ten years after their initial psychotic break include: 25% of people have experienced recovery, 25% are much improved and living independently, 25% are improved but require constant support, Children and people over 45 rarely get schizophrenia, 15% are hospitalized, 10% are dead, mostly of suicide (Broyd et al. 2009).
7. Genetic contributions
Research shows that a combination of genetic vulnerability and environmental factors can lead to schizophrenia (Harrison and Owen 2003), and that the genetic problems leading to this disease are caused by different factors and different genes (Owen et al. 2005). However, the heritability of schizophrenia has been hard to estimate because of the difficulty of separating genetic and environmental causes (O’Donovan et al. 2003). Research made on twins has found a high level of heritability and suggested that gene factors are the main cause of the disease. The theory of genetic causation also argues that schizophrenia is an illness of complex inheritance; subsequently, research has focused on finding the group of genes that may cause this mental disorder (Owen et al. 2005).
In some patients, schizophrenia may be caused by deletions or duplications of DNA sequences in genes that are responsible for neuronal signalisation or brain development (Walsh et al. 2008). This leads to neural processes that may cause psychotic disorders such as schizophrenia. For example, a structural abnormality of the brain, such as differences of the volume of grey matter in some areas of the brain, leads to reduction in the number of neurons, which can cause psychotic syndromes (Hoffman and McGlashan 2001). Research shows that such abnormality can be present from the birth of the subject, or it may develop later because of causes other than gene vulnerability Other research shows that the problem may be in the neural network and will affect the functioning of the brain. Using brain imaging technologies, it has been observed that abnormal connection between different gene networks is something common for schizophrenic patients (Broyd et al. 2009). Such observations show that there is a rivalry between different neural networks that may lead to the deactivation of one of them and thus, disrupt the function of some area of the brain. This explains most of the symptoms related to schizophrenia, such as memory loss, attention disorder, social cognition and problems with executive functions.
The function of dopamine in the mesolimbic and mesocortial pathways of the brain has been given particular attention in research on the causes of schizophrenia. Based on drug experiments, the “dopamine hypothesis of schizophrenia” proposes that a malfunction in this area causes the disorder’s symptoms (Seeman et al. 2005). Evidence includes findings that genes coding for mechanisms involved in dopamine function may be more prevalent in schizophrenics (Arguello and Gogos 2008). However, later research suggests that excessive dopamine function not be the sole cause of schizophrenia symptoms. In particular, low levels of glutamate, another neurotransmitter like serotonin, have been found to produce similar effects (Lahti et al. 2001).
8. Social contributions
Social environmental causes Childhood experiences of social adversity, abuse and urbanicity have been credited with contributing to schizophrenia. Adversities, evidence suggests, may alter dopamine neurotransmission in a process termed “sensitisation”; and may lead to cognitive biases. Krabbendam and van Os (2005) suggest a gene-environment interaction. Based on observed within-city variation of the effects of urbanicity, and an independent association of experiences of urban living and social isolation, they propose that the degree of “social capital” impacts children’s development. Studies suggest that higher number of adverse social factors such as socio-economic disadvantage and social exclusion present in childhood relates with an increased risk of developing schizophrenia in later life ( Mueser et al. 2004). Significantly, personal or recent family history of migration, which is linked to socially adverse factors such as racial discrimination, family dysfunction, unemployment and poor housing conditions, has been found a considerable risk factor (Cantor-Graae and Selten 2005; Selten et al. 2007). More specifically, childhood experiences of abuse and trauma have been found to be linked with an increased risk of developing schizophrenia in later life (Janssen et al. 2004; Read et al. 2001;). Recent findings indicate a causal relationship exhibiting a dose-effect (Read et al. 2005).
Living in an urban area has repeatedly been found to be a strong risk factor in developing schizophrenia, even after controlling for other factors such as drug use or migration (van Os 2004). The chance of being diagnosed with the disorder has been found to increase with the number of years spent living in urban environments in childhood and adolescence; as well as with the degree of urbanicity (Pedersen and Mortensen 2001). In Sweden, people living in the most urbanised areas were found to have a (68%-77%) increased risk of developing psychosis, a proportion of which is thought to be schizophrenia (Sundquist et al, 2004). These findings suggest that constant, cumulative, or repeated exposures during upbringing to factors occurring more frequently in urban environments may cause schizophrenia (Pedersen and Mortensen 2001).
9. Psychological contributions
Individual factors include children identified as high risk for developing schizophrenia on the basis of their mothers having been diagnosed with the condition. Psychological stress involves various high pretense of stressful life events preceding the onset of the disorder. Similar results were identified in a study that predicts relapses in people with a diagnosis of schizophrenia (MacMillan et al. 2001). A number of studies have indicated that stress accosted with difficulties in close personal relationships so a precipitating factor for this disorder. South Africa research findings have suggested a link between exposure to trauma and the clinical presentation of the first episode in South Africa. More specifically, there researchers found that previous traumatic experiences are associated with positive affect symptoms in patients expienancing a first psychotic episode.
Faulty learning is a behavioral perspective that relate to the role of the family is the idea that faulty learning occurs within the family context. This happens when the child is being conditioned into believing that the world is an unfriendly and threating place. This happens through being exposed to early traumatic expiences, such as disruptions in parenting (Baumann, 2015). Faulty learning could result from disturbed social interaction, learning from observing role models behaving in grossly inappropriate ways, and from efforts to meet inappropriate parental expectations (Baumann, 2015). Such faulty learning manifest in the faulty assumptions about reality, difficulties regarding a sense of self and self-worth, emotional immaturity, and a lack of effective coping skills.
Family influences, the “schizophrenogenic mother” is a psychoanalytic concept first used by Frieda Fromm-Reichmann (Daubenton ; Van Resburg, 2010). This concept refers to a style of parenting which could serve to hinder childhood ego development. Behaviors and attitude which were typically ascribe to schizophrenogentic mothers were being cold, rejecting, dominating, overprotective, and insensitive to the needs of others. This is often liked to mother and son relationships(Baumann, 2015). Families with schizophrenia are characterized by communications that present the identified patient with mixed messages that would put them in a no-win situation. For example, “a mother pays a surprise hospital visit to her son diagnosed. When he sees her, he is excited and puts his arms out to greet her (Daubenton & Van Resburg, 2010). She stiffens and draws back from him. He in turn, draws back from her. She responds by asking if he is not going to greet her and weather he is not happy to see her”. Together with the mixed messages, there are also suble non-verbal messages that prohibit the identified patient from either commenting on the situation or leave the situation (Daubenton ; Van Resburg, 2010). The double-bind theory was extremely important to the development of family systems therapy because it represents a coherent and sophisticated explanation for the link between abnormal behavior
10. Drug use contributions
Strong evidence indicates that use of certain drugs can act as a trigger for either the onset or relapse of schizophrenia in some people. Cannabis has been linked to schizophrenia most frequently; other suspected triggers include amphetamines and hallucinogens. The relationship between schizophrenia and drug use, however, has been found to be complex. A clear causal connection between substance use and disorder has thus not been established yet. Most evidence for a link between drug use and schizophrenia has been found in research on the effects of cannabis. Studies suggest that the drug significantly increases the risk of developing schizophrenia but, found that it is neither a sufficient nor a necessary factor in developing the disorder (Arsenault, Cannon, Witton, ; Murray, 2004). Rather, it is assumed that it is only one of a complex combination of factors causing the disorder. According to a review of studies conducted by Arsenault et al), cannabis doubles the risk of developing schizophrenia on the individual level, and could, a causal relationship assumed, account for 8% percent of cases in the overall population. Besides cannabis, hallucinogens and stimulant drugs such as amphetamines have been linked to causing schizophrenia. Amphetamines may worsen schizophrenia symptoms, since the drug triggers the release of dopamine (Laruelle et al. 1996). Heavy use of hallucinogens as also been found to sometimes trigger schizophrenia (Mueser at al. 1990). However, both amphetamines and hallucinogenic drugs, like cannabis, have been found to be neither sufficient nor necessary factors in explaining the disorder’s development. Nevertheless, when a predisposition exists, these drugs may trigger the onset or relapse of schizophrenia (Laruelle et al. 1996).
Appropriate, comprehensive and integrated management of the patient with schizophrenia requires attention to the biological and psychosocial dimension of the predisposing, precipitating, perpetuating and protective factor. Remediable predispositions factors may include, eg; hostile and conflictual relationships within the family, precipitating events may be substance abuse and the discontinuation of treatment. Perpetuating factors frequently include non-adherence or irregular us of antipsychotic medication, and a supportive and stable family and community may represent protective factors. Treatment may be usefully separated into acute and maintains phase. The principal objectives of the acute phase are the control of symptoms and the initiation of a management pal. The objectives of a maintains phase include the support of the patients and his family, monitoring symptoms, and devising various strategies to improve the quality of life, restoration of function and the prevention of relapse. First episode should, if possible, be managed as a specialist level, where management plan can be formulated to continue at the primary or secondary levels of care.
Ziprasidone, sold under the brand name Geodon among others, is an atypical antipsychotic which is used for the treatment of schizophrenia as well as acute mania and mixed states associated with bipolar disorder (Baumann, 2015). Its immediate release intramuscular injection form is approved for acute agitation in people with schizophrenia. Ziprasidone is also used off-label for depression, bipolar maintenance, and post-traumatic stress disorder. Aripiprazole, sold under the brand name Abilify among others, is an atypical antipsychotic. It is recommended and primarily used in the treatment of schizophrenia and bipolar disorder.
The initiation of treatment should be commenced as soon as the diagnosis is made with a degree of confidence (Baumann, 2015). A debate developed regarding early intervention, either to prevent the emergence of the high-risk individuals or to improve the outcome by intervening in the early or prodromal stages.
11.3 Cognitive- Behavioral therapy (CBT)
Patients may experience a number of cognitive deficits that have significant impact on their level of functioning. These include attention and working memory deficits and an impairment of executive functioning, or planning and evaluating and acting in a flexible, appropriate and effective way (Baumann, 2015). Cognitive intervention addresses these difficulties, but also aim, through reasoning strategies, to diminish the impact of delusions and hallucinations. The assumptions are that these psychotic phenomena arise from errors in the cognitive evaluation of the self and the self in relation to the environment, and that these errors may be modifiable through relearning (Baumann, 2015). This method involves the identification of the target symptoms and the associated behaviors, the analysis of antecedents and consequence, and the formulations in collaboration with the patients of more appropriate and effective ways of both understanding and coping with the symptoms.
11.4 Psycho-education, family therapy and social skills training
Psychoeducation is very different from CBT in that it does not aim to modify beliefs but rather impart information to patients and families to help them cope more effectively with the illness. Important topics are likely to include behavioral problems and problems associated with substance and adherence to the prescribed medication (Baumann, 2015). Information about the illness can educate the family and the patient to understand that the apathy associated with the negative forms of schizophrenia is likely to be part of the illness rather than mere laziness.
Family therapy takes many forms, ranging from support to therapy aimed at changing the attitude and relationships within family system that predispose to relapse. Family groups create the possibility of mutual shared support and problem-solving (Baumann, 2015).
Social difficulties are experienced in patients with schizophrenia and may persist in remission and compound disability (Baumann, 2015). Social skills training employs arrange of strategies to improve self-care, foster independent and enable people to adjust as best as possible to living in the community.
11.5 Social Intervention
When a person with a severe mental illness does not respond to traditional outpatient therapy, other approaches may be necessary in order to provide the best care (Baumann, 2015). There are a variety of treatment options available to Dual Diagnosis patients but sometimes an individual needs all-around care that focuses on more than the illness and addiction.
Assertive community treatment (ACT) does just that but takes therapy a step farther than integrated treatment. Combining the interdisciplinary fields that deal with mental illness and substance abuse, ACT helps a person outside the hospital or rehabilitation center (Baumann, 2015). This approach can be ideal for those with severe mental illness and addiction, or for those who have not typically responded well to outpatient therapy.
12. Cultural Factors of the South African perspective
In South Africa, the symptoms presentation may also vary across cultures (Daubenton & Van Resburg, 2010). The core symptoms of schizophrenia and the presence of positive and negative symptoms appear to remain the same across South Africa cultural groupings (Emsley, et al, 2001). However, significant differences in the clinical presentation of non-core symptoms of schizophrenia have been found between Xhosa-speaking and English-speaking South Africans. The differences reported include higher prevalence of aggressive and disruptive behavior in the Xhosa-speaking patients. Xhosa-speaking patients also appear to expience more symptoms of a persecutory, sexual and fantastic nature, as well as more self-neglect and irritability. The content of the positive symptoms also appears affected by culture in South African context (Maslowski, Janse van Rensburg, & Mthoko, 1998). Specifically, the content of delusions is often associated with the life experiences and culture of the patient. In South Africa, these themes often center on traditional beliefs systems, political realities, and famous individuals. A typical example is that patient’s belief that they are Nelson Mandela or are related to him (Daubenton ; Van Resburg, 2010). Little variation in Sotho speaking was found, but the content of hallucinations and delusions was found to be strongly influenced by cultural aspects. The participants the study reported frequent somatic symptoms such as headaches, palpitations, dizziness, and excessive sweating.
In South Africa, the clinical presentations of schizophrenia is often complicated by the use of substance, such as cannabis, alcohol, and Mandrax, used in various combination (Daubenton ; Van Rensburg, 2010). Schizophrenia share a number of symptoms with some indigenous forms of illness in South Africa, such as ukuhwasa, an ancestral calling for one to become a spiritual healer or a sangoma and amafufunyana, when a person is bewitched and are possessed with a sprit. Attitudes and beliefs about schizophrenia may differ substantially from Western assumptions in patients, family members, and mental-health care workers in South Africa (Mbanga et al, 2001). Treatment of schizophrenia with antipsychotics is further complicated by cost factors in SA. Newer antipsychotic drugs are available by the cost of these drugs puts them beyond reach of large sectors of the world’s population. Other issues are the chronic under resourcing of mental health services and the consequences of de-institutionalize policies specifically the rise of the revolving door phenomena. Relapses are considered a general problem in SA concerning diagnoses. Relapses has many potentially negative consequences, such as hospitalization, the development of treatment resistance, progressive structural brain damage and consequent cognitive impairment, personal distress, incarceration, and financial implications. Factors associated with relapses among South Africans with diagnosis of schizophrenia are comorbid depressed mood, poor treatment compliance due to limited insight on the part of the patient and to unpleasant medication side effects (Kazadi, Moosa & Jeenha, 2008).