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SCHIZOPHRENIA

Schizophrenia is a chronic and severe form of a psychological condition affecting the

thought process, feelings and behaviors of an individual. Most of the time the patients with this

problem presents like they have lost touch with the real life situation. Schizophrenia is not

common as other mental diseases, but its characteristic early onset, as well as long-lasting

course, qualifies it to be a disabling condition (Clay Baugh& Stone, 2017).

It is important to understand this condition due to its nature. First, those affected the

condition is a life problem with severe impact of disconnection from the world. The

understanding by the patient, caregivers, and physicians help in the management of the patient

since despite being treated the patient will always experience social and occupational impairment

throughout their lives (Clay Baugh& Stone p 588, 2017). How the disease presents is important

to be knowledgeable even at the community level to prove wrong the misconception that most

people have been having the condition being of the split of personality instead of psychosis.

Frequent hospitalization of the patient should be understood.

Epidemiology

The condition is experienced all over the world. However, the prevalence is reported to be about

one percent of the international level. New cases are around 1.5 for every 10000 people. The age

of onset has been found to be more during puberty and childhood and rarely later in life over

forty-five years. More men are diagnosed than women with the ratio of 1.4:1 although women

tend to be diagnosed later in life (American Psychiatrist Association, 2013).

SCHIZOPHRENIA

Causes

There many factors that leads to the development of this mental condition. Report from

the National Institute of Mental Health indicates that genetic and environmental factors play a

crucial role. It has been found out that schizophrenia is familial as it could be found in individual

families whereas others are free of it (Clay Baugh& Stone p 589, 2017).However there is no a

single gene that can be said to cause the disease, but different genes increase the chance of

developing the disease. More importantly, the interactions between genetic and environmental

factors such as viral exposure, intrauterine malnutrition, problems during delivery and

psychosocial problems are thought to cause the development of schizophrenia.

The role of genetics and inheritance

Genetics has been strongly implicated by researchers as a cause of schizophrenia. The

incidence of developing schizophrenia for the general population is at one percent and this risk

increases significantly in individuals would have genetic relations. This risk is highest among

twins who are identical at forty-eight percent. The potential in twins who are fraternal is at 17

percent while among siblings it is at nine percent (Schizophrenia Working Group of the

Genomics Consortium, 2014). The risk in relatives such as cousins’ aunts and uncles is very

small. This shows that individuals whose first-degree relatives have schizophrenia are more

likely to develop the disease compared to second or third-degree relatives. Taking into

consideration these statistics, it is evident that the factors of genetics and inheritance have the

upper hand in schizophrenia. Also the results from a number of studies have shown that

inheritance and genetics are linked to the development of schizophrenia. Less support has been

given to inheritance on a single locus (Schizophrenia Working Group of the Genomics

SCHIZOPHRENIA

Consortium, 2014) .The identification of the one hundred and eight loci has paved a way to a

possibility of a cure for schizophrenia. The risk of development of schizophrenia is more in

individuals who are more genetically related. There is also a possibility of environmental factors

from adoptees studies.

Diagnosis

Current diagnosis is based on DSM -IV and ICD-10. The latter is important in the

diagnosis of various subtypes of this condition due to its nature of describing symptoms in

cluster form. Although for some subtypes it calls for clarity in psychotic symptoms presentation

for one month without involving the period of nonspecific impaired symptoms that comes before

the acute episode. Unfortunately, the evidence of decreasing and impairment of functioning as

well as a continuous presentation of symptoms is crucial to the diagnosis of the condition

(American Psychiatric Association p 315, 2013). Surprisingly the isolated mental illness

symptoms lacking function impairment are very common in the general population as well as in

individuals with disorders affecting emotions such as anxiety and depression. On the other hand,

DSM-IV method of diagnosis was brought into place with the aim of attaining three things in

particular. One is to identify groups of patients with a full range of same clinical presentation and

outcome of the disease.

Treatments and therapies

Since schizophrenia has no specific causes, the aim of the treatment is to control the symptoms.

Antipsychotics are medications commonly taken every day in either pill or liquid formulations.

Others are injectable give once not twice every month. These drugs have side effects upon taking

SCHIZOPHRENIA

them although a majority of them disappear within few days. Over time doctors have worked for

hand in hand with the patients to identify the best choice of medication that is suitable for the

patient condition as well as those that are least likely to cause pronounced side effects (Kulkarni

et al. p 992, 2013).

Following the patient's diagnosis with schizophrenia, the decision is to commence Zyprexa

(olanzapine) treatment. The patient has to take 10 mg of the drug orally at bedtime.

Reasons for choosing the decision

Olanzapine is a first-line antipsychotic agent in the treatment of schizophrenia, and its

recommended starting dose is 10 mg daily (Eli Lilly and Company Limited, 2017). It is effective

in reducing the symptoms of the disease as well as managing the early onset of the illness and

preventing acute exacerbations. Invega Sustenna is also indicated for schizophrenia. However, it

is imperative to consider its tolerability. Additionally, the drug is delivered intramuscularly, and

as such, it would present a challenge of compliance. Ability, on the other hand, is used in the

treatment of schizophrenia-related agitation. Nevertheless, it is less effective compared to

Zyprexa despite having fewer sedative and metabolic side effects.

Anticipated results of the decision

The patient would record general improvement whether partial or total. The drug reduces

hallucinations, decrease agitation, reverse delusions, and enable a person to adopt a clearer and

more positive thought. Zyprexa is known to cause sedation, weight gain, and glucose intolerance

(Muench, 2010). As such, these unwanted effects were also anticipated.

Difference in expected results and the real initial results of the decision

SCHIZOPHRENIA

The patient is supposed to exemplify some change following the initiation of Zyprexa therapy.

During her follow-up visit four weeks later, she presented with a partial response (25%) to the

treatment as evidenced by her PANSS. Additionally, the patient reports a weight gain of five

pounds. However, an unanticipated outcome is appreciated when the patient states that he or she

has a problem getting full from her meals and has to snack regularly throughout the day. This

effect was probably due to the influence of olanzapine on the serotonin receptors leading to

increased appetite and consequent weight gain (Jain, Bhargava, & Gautam, 2006).

The second decision is to decrease the patient's dosage of olanzapine from 10 mg to 7.5 mg PO

at bedtime.

Reason for Choosing the Decision

This decision is guided by the presentation of the patient with unintentional weight gain and

increased appetite. As such, decreasing the dosage of the drug would possibly lead to a reduction

in the unwanted effects that manifest with its usage at higher doses. Zyprexa has linear and dose-

proportional pharmacokinetics within the recommended range of dosage. Reducing the dose of

the drug, therefore, should reduce its unwanted effects.

Anticipated Results of the Decision

With a reduction in the dosage of olanzapine, the patient's appetite is expected to reduce. As such

she would be able to obtain satisfaction from her regular meals without the urge to eat every so

often. Additionally, reduced plasma levels of the drug would mean a reduction in the drug-

receptor interactions between the olanzapine and the serotonin receptors. Therefore, the

unintentional weight gain would be abated. All in all, despite the decline in the side effects, the

SCHIZOPHRENIA

patient's symptoms of schizophrenia are still expected to be under control as 7.5mg of olanzapine

is effective pharmacologically.

Psychosocial Treatment

From the findings of the symptoms of the disease and its effects on social life, it is important to

help the patient to overcome the effect of being disconnected with real life as well as social life.

This kind of therapy is useful especially for the correct diagnosis, and best treatment option has

been given. The use of coping tactics is crucial in facing the day to day problems in which

schizophrenic patients go through (Kulkarni et al. p 992, 2013). It is, therefore, good to teach

coping skills to these patients for them to overcome all the challenges they meet along as well as

appreciating their selves. Psychosocial treatment enables patients to pursue their goals and also it

prevents constant recurrence of this condition.

SCHIZOPHRENIA

Reference

American Psychiatric Association. Diagnostic and Statistical Manual of Mental

Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013. Schizophrenia and

other psychotic disorders; pp. 89–122.a

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental

disorders (DSM-5®). American Psychiatric Pub;p 315

Claybaugh, Z., & Stone, C. (2017). Open Educational Resource 2017 Textbook List.

Ettinger, U., Meyhöfer, I., Steffens, M., Wagner, M., & Koutsouleris, N. (2014).

Genetics, cognition, and neurobiology of schizotypal personality: a review of the overlap with

schizophrenia. Frontiers in Psychiatry, 5, 18.

Lindenmayer JP, Liu-Seifert H, Kulkarni PM, et al. Medication non-adherence and

treatment outcomes in patients with schizophrenia or schizoaffective disorder with a suboptimal

prior response. J Clin Psychiatry. 2013;70(7):990–996. [PubMed

Schizophrenia Working Group of the Psychiatric Genomics Consortium. (2014).

Biological insights from 108 schizophrenia-associated genetic loci. Nature, 511(7510), 421-427.

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