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Schizophrenia example #2

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I) Abstract- In this paper I will be discussing schizophrenia. We will review what it is, its causes, symptoms, and the history of the disorder, any treatments available and a long-term prognosis of the Illness.

A)Schizophrenia is defined by the DSM-IV as “ the chronic debilitating illness characterized by perturbations in cognition, affect and behavior, all of which have a bizarre aspect.” It may also cause delusions, often bizarre, and usually auditory hallucinations.

B) Symptoms are separated into two categories positive and negative. Positive symptoms are an excess or distortion of normal functions these include Hallucinations, delusions and disorganized speech. Negative symptoms are restrictions of the range and intensity of emotions, Alogia, avolition and the flat affect are all negative symptoms of schizophrenia.

C) The DSM-IV criteria for diagnosis are having two of the above symptoms within a one year period or less if successfully treated. Social/occupational dysfunction for a significant portion of the time since onset. Persistence of disturbance for a period in excess of six months. Schizoaffective and mood disorders have been ruled out. Disturbance is not due to the direct physiological effects of a substance or general medical condition. Finally how the disturbance relates to pervasive developmental disorders.

III) Schizophrenia is believed to be widely caused by a biological element. Current research of the disorder proposes that it is caused by a genetic vulnerability coupled with environmental and psychosocial stressors. The neurodevelopmental theory developed by Daniel R. Weinberger states that schizophrenia develops from “ a subtle defect in cerebral development and disrupts late-maturing, highly evolved neocortal functions, and fully manifests later in adult life.”

IV) Antonio is a 24 year old adopted single unemployed Hispanic bilingual, He has been committed to the hospital four times in as many years for psychosis, bizarre behavior and agitation. Antonio is a minor user of alcohol and marijuana using each twice a week for the last five to six years as way to cope with his psychosis. He dropped out of school at age 12. Antonio Believes that up to 40 people have taken up residence within his body and are sapping him of his strength, he keeps a yellow string in his mouth so he does not “ fall apart”. He spits in a cup because the people within him spit in his mouth and he needs to get rid of it. Antonio suffers persecutory auditory hallucinations, calling him a “ faggot” telling him “ We don’t care about you” and belittling him in saying “ He’s not a man”.

He had lost 20 lbs in the last three months because the voices would not let him eat. He was also seen talking to himself loudly and inappropriately laughing. Antonio also shows signs of depression. All family psychiatric history that could be acquired show that his genetic mother’s alcohol dependence and the neglect and abandonment that followed. He may have developed a deep seated anxiety of the subject of his adoption. He worked hard for acceptance with staff after he was committed but could not integrate the explanations and recommendations.

V) Family therapy and assertive community treatment have had great effects in preventing psychotic relapse and rehospitalization, but have not been consistent in dealing with other outcome measures. Social skill training has raised improved social interactions of patients but no clear effect on relapse rates. Supportive employments that use the place and train model have improved employment. Personal therapy may improve social functioning. Anti-psychotic Drugs have been available since the mid 1950s, and a large percentage of patients that take the drugs show substantial improvement.

The anti-psychotic Clozapine has shown to be more effective than others at the cost of possible side effects including Agranulocytosis. Risperidone and Olanzapine are two newer drugs that are safer and better tolerated; it is unclear whether they are as effective as Clozapine. Anti-pyschotics are usually very effective at treating certain symptoms such as hallucinations and delusions, while not being as effective against reduced motivation and emotional expressiveness.

VI) Long term prognosis – due to the heavy dependence of results on clinical definitions of end states, no clear long term prognosis can be found. But the extreme end states of schizophrenia have long term prognoses and those are full remission verses characteristic residues in the narrower sense; total unemployment, simple courses to mixed residues or typical schizophrenic defect psychoses. No real long term prognosis can be reached if the end states are not more reliably defined.

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