Classification and diagnosis of schizophrenia essay
A study of Finnish women supported an interaction between genetic and environmental influences on causation of schizophrenia. A new study suggests that heavy marijuana use in teenagers aged 15—17 years may hasten the onset of psychosis in those at high risk for developing a psychotic disorder. In an analysis of hospitalized patients who had experienced first-episode psychosis, the Allied Cohort on the Early course of Schizophrenia ACES II project found that the onset of psychosis in those who used cannabis from age 15 to 17 years occurred at a mean age of However, the researchers could not say whether marijuana use may actually cause psychosis to develop early or whether people who have a predilection for earlier onset of psychosis also may be more likely, owing to various factors, to use marijuana.
The onset of schizophrenia usually occurs between the late teens and the mids. The first 5—10 years of the illness can be stormy, but this initial period is usually followed by decades of relative stability though a return to baseline is unusual. Positive symptoms are more likely to remit than are cognitive and negative symptoms see Presentation.
Although some variation by race or ethnicity has been reported, no racial differences in the prevalence of schizophrenia have been positively identified. Some research indicates that schizophrenia is diagnosed more frequently in black people than in white people; this finding has been attributed to cultural bias of practitioners. The prevalence of schizophrenia is about the same in men and women. The onset of schizophrenia is later in women than in men, and the clinical manifestations are less severe.
This may be because of the antidopaminergic influence of estrogen. The prognosis is guarded. Full recovery is unusual. Early onset of illness, family history of schizophrenia, structural brain abnormalities, and prominent cognitive symptoms are associated with a poor prognosis. The prognosis is better for people living in low-income and middle-income countries. Symptoms usually follow a waxing-and-waning course and their nature may change over time. Positive symptoms respond fairly well to antipsychotic medication, but the other symptoms are quite persistent. Because of vocational difficulties, many patients with schizophrenia also have to cope with the burdens of poverty.
These include limited access to medical care, which may lead to poor control of the disease; homelessness; and incarceration, typically for minor offenses. Women with schizophrenia may have higher rates of breast cancer than women in the general population. In a meta-analysis of more than , women, this increased risk was significant in studies in which breast cancer occurred before the diagnosis of schizophrenia was excluded.
However, the association between schizophrenia and breast cancer incidence was not significant in studies that did not specify the exclusion of breast cancer cases that occurred prior to the diagnosis of schizophrenia. Researchers suggest factors such as obesity, nulliparity, and potentially even increased prolactin levels may raise the risk for breast cancer. It is important to note that significant heterogeneity exists among the included studies, and it is possible that a future study will show a decreased breast cancer risk in women with schizophrenia compared with the general population.
The nature of schizophrenia makes it a potentially difficult illness for patients to understand.
Nevertheless, teaching the patient to understand the importance of medication compliance and of abstinence from alcohol and other drugs of abuse is important. It is helpful to work with the patient so that both patient and family can learn to recognize early signs of a decompensation eg, insomnia or increased irritability.
A review of 44 studies showed that education of patients about the nature of their illness and treatment, when added to standard care, led to reductions in rehospitalization and symptoms. These groups can provide education and support. People with schizophrenia have also championed self-help recovery-based approaches to care, with an emphasis on developing the personal strengths and resilience needed to combat this illness. Because other illnesses are common in schizophrenia, education about the importance of a healthy lifestyle and regular health care is helpful.
Counseling with respect to sexuality, pregnancy, and sexually transmitted diseases is important for these patients. Mayo Clinic - Schizophrenia. National Institute of Mental Health - Schizophrenia. Medline Plus - Schizophrenia. For patient education resources, see the Schizophrenia Health Center , as well as Schizophrenia. American Psychiatric Association. Meta-analysis of regional brain volumes in schizophrenia. Am J Psychiatry.
The hippocampal formation in schizophrenia. Hippocampal volume development in healthy siblings of childhood-onset schizophrenia patients. Structural abnormalities in frontal, temporal, and limbic regions and interconnecting white matter tracts in schizophrenic patients with prominent negative symptoms.
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Ellison-Wright I, Bullmore E. Meta-analysis of diffusion tensor imaging studies in schizophrenia.
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A brief history of the DSM
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issues of reliability/validity associated with the classification/diagnosis of Schizophrenia (16)
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Expanding the range of ZNFA variants conferring risk of psychosis.