Schizophrenia is a widely recognized chronic and severe psychiatric disorder which according to the National Institute for Health and Care Excellence (NICE, 2009) guidelines, affects one per-cent of the UK population. Schizophrenia can be classified as an overall category for the mental illness; however, diagnostic tools such as the International Classification of Diseases (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) reveal the variations of the psychiatric disorder.
This essay will explore and focus on one specific subtype of the mental illness. Paranoid Schizophrenia. According to T. Davies and T. Craig (2009, p45), paranoid schizophrenia is one of the most common subtypes of the psychotic illness which affects the individuals variation of emotion, thinking and behaviour. Through extensive research, this essay will uncover the definition of paranoid schizophrenia, its manifestations and possible causes.
Key issues such as symptoms, epidemiology, prevalence, co-morbidity, prognosis, treatment and interventions will also be critically reviewed and discussed. Lastly, this essay will also analyse guidelines, policies and regulations that influence interventions and the effects of paranoid schizophrenia on the individual, their families, carers and friends. There are various subtypes of schizophrenia such as undifferentiated, residual, simple, other and unspecified schizophrenia with the three most common being Paranoid, Hebephrenic and Catatonic Schizophrenia (C.
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Gamble and G. Brenan 2006, p100).
Prior to the diagnosis of schizophrenia and/or its subtypes, the ICD-10 diagnostic criteria of paranoid schizophrenia initially requires the general criteria for diagnosing schizophrenia are met and signs and symptoms should be evident for at least one consecutive month. The characteristics involved are poverty of thought, a confined and limited range of emotional expression otherwise known as the blunted affect.
Distinctive diagnostic traits also affect the individuals self-perception as one may be believe that their thoughts are being broadcasted or known to others whilst the belief of mysterious external forces are the cause of their illness by influencing their actions. Hallucinations become prominent with the disturbance of various perceptions. Their speech may become incomprehensible whilst the process of thought deteriorates. Characteristics such as Neologisms and breaks in the train of thought are also common.
Without the interference of neuroleptic medication or the diagnosis of depression, the presence of negative symptoms such as paucity of speech or incongruity of affect may cause the individual to appear withdrawn. The specific diagnosis of Paranoid schizophrenia is confirmed when there is a presence of auditory hallucinations and hallucinations of bodily sensations. Delusions of persecution and/or grandeur may be present with the addition of delusional themes such as jealousy, bodily change and/or exalted birth.
Symptoms of catatonia and incomprehensible speech may also be evident without overruling the clinical presentation. The general criteria for diagnosing schizophrenia requires at least one very clear symptom and/or sign, and at least two additional symptoms and/or signs that are less obvious (World Health Organisation, 1994).
The DSM-IV, which is extensively used in the United States, highly correlates to the general and subtype diagnostic criteria in the ICD-10.
However, unlike the ICD-10 where a diagnosis can be made after a month based on relative signs and symptoms, the DSM-IV defines schizophrenia as a disturbance that requires an endurance of at least six months with at least two or more progressive signs and/or symptoms for at least one month (American Psychiatric Association, 2000).
... of schizophrenia. Paranoid type- is the presence of prominent delusions or auditory hallucinations in the context of relative preservation of cognitive functioning and affect. ... range of normal experiences. Criterion B These one or more signs and symptoms are associated with marked social or occupational dysfunction. Interpersonal ...
However, it can be put into consideration that some symptoms such as persecutory delusions may bear minimal diagnostic weight in people from different countries due to cultural beliefs.
In paranoid schizophrenia, signs and symptoms may vary in different cases however the common signs and symptoms include delusions and hallucinations. Negative symptoms include disorganised behaviour, the decline in function such as social withdrawal, apathetic, poor thought process and lack of self-care. Positive symptoms include disorganized speech which may also be associated with additional changes in behaviour such as neologisms, blunted affect, lack of emotion and apathy. Hoffman (citied by A. M. Kuller and T.
Bjorgvinsson, 2010), reveals that during an acute episode, 60% to 80% of individuals affected by paranoid schizophrenia report experiencing auditory hallucinations. Statistics also reveal that 90 % of individuals affected by paranoid schizophrenia report experiencing delusions of either, persecution, grandeur, reference or control. (M. Smith and J. Segal 2013).
M. Bengston (2006) defines paranoid schizophrenia as the presence and dominance of auditory hallucinations and consistent delusional perceptions of persecution or conspiracy.
Over the years, numerous researches have been conducted with the aim to establish the primary causes of the psychotic illness. The reasons and causes of paranoid schizophrenia remain relatively unclear, however, I. Peate and S. Chelvanayagam (2006, p145) states there is no definitive cause for the development of paranoid schizophrenia, however, there are numerous postulations supported by evidential statistics based within the United Kingdom that reveal possible causes.
Speculations of possible causes include genetic, biological, environmental and psychological factors. Fontaine (citied by I. Peate and S. Chelvanayagam 2006, p151), states that the likelihood of the development of paranoid schizophrenia is more likely to occur within a family where a person has been previously diagnosed with the mental illness. The likelihoods are 8% if a sibling is diagnosed, 13% if one parent is diagnosed and 40% if both parents have been diagnosed with paranoid schizophrenia.
Schizophrenia 'In my senior year of high school, I began to experience personality changes. I did not realize the significance of the changes at the time, and I think others denied them, but looking back I can see that they were the earliest signs of illness. I became increasingly withdrawn and sullen. I felt alienated and lonely and hated everyone. I felt as if there were a huge gap between me ...
However, Eby and Brown (citied by I. Peate and S. Chelvanayagam 2006, p151), suggest that the evidence is not substantial enough to determine that paranoid schizophrenia is a genetic disorder, however it is possible that genes may have some significance in the development of the mental disorder. According to Eby and Brown (citied by I. Peate and S. Chelvanayagam 2006, p151), individuals who suffer from paranoid schizophrenia possess different variations of structural, chemical and functional balances in the brain.
A reinforced speculation of the possible primary cause of paranoid schizophrenia could be due to the production of excessive amounts of the brain chemical, Dopamine. In addition, Rethink (2013), reveal that there has been an overwhelming discovery disclosing that the use of drugs such as cannabis, highly influences the development of paranoid schizophrenia by increasing the dopamine levels within the brain. Despite only being postulations, Kaupers and Raune (citied by Caroline. K and Connor. K 2006,
p22) argue that paranoid schizophrenia is rather a psychological and social phenomenon that in fact requires specific attention to tackle the underlying issues causing illness rather than the perception of imbalance of brain chemicals. Further postulations suggests that individuals with paranoid schizophrenia bear genetic and biological vulnerabilities which make them susceptible to environmental stress factors such as prenatal and infancy exposure to viral infections, loss of a parent(s) in early years and physical or sexual abuse in childhood.
It is believed this theory accounts for the possible development and subsequent relapse in in paranoid schizophrenia. M. Smith and J. Segal (2013), claim that people that are born and raised in urban areas, people that experience social difficulties and trauma, people that engage in recreational drugs or misuse substances and people that encounter distressing life events are more likely to be at risk in developing paranoid schizophrenia. However, it can argued that possible genetic and biological factors already make certain individuals susceptible to the illness regardless of their socio-economic status.
Therefore meaning, even though a person who may have been raised without stressors that may have contributing factors to the development of the illness, susceptible individuals who do become ill, may even possibly self-inflict the downward drift to lower socio-economic classes. Research studies claim that psychological factors that can influence the onset of paranoid schizophrenia can be triggered by underlying issues surrounding basic cognitive functions such as learning, attention, memory or planning, and biases in emotional and reasoning processes.
Schizophrenia is not a single disease, but a broad category of mental illnesses. Schizophrenia is a psychiatry disorder where several structural disturbances occur in the brain. It normally takes place in the temporal and frontal lobes, changing the neural systems and affecting the neurotransmitters in charge of controlling the functioning that takes place in these areas. It is not a structural ...
Conditions such as depression and anxiety in the past have been ruled out as possible causes to paranoid schizophrenia, however in recent studies, they have been discovered to be likely components to symptom developments of paranoid schizophrenia (I. Peate and S. Chelvanayagam 2006, 156).
Paranoid schizophrenia is equally common between men and women with men proven to have earlier onsets than women; however the age of onset between both sexes differs significantly. In the United Kingdom, the majority of those affected develop the illness in adolescence or in early adulthood.
The age of onset in men is between 15 and 25 years of age, and in women it is between 25 and 35 years of age. Only 10-15% of the population develop the mental illness over the age of 45. In the UK, research studies have made evident the affiliation between paranoid schizophrenia and low social class particularly in urban areas (Dr. P. Walters 2006, p20).
According to R. Newell & K. Gournay (2008, p65), it is estimated that the lifetime prevalence of paranoid schizophrenia exists between 0.
5 and 1% of cases per 10,000 population. G. Lewis (citied by R. Newell and K. Gournay 2008, p66), also reveals there is no particular ethnic group that has a higher occurrence rate for the illness, however it has been proven that certain areas have high prevalence rates for the mental disorder such as the west of Ireland. F. Torrey (1998) states that a young man in raised in West Ireland has a 1 in 25 chance to be hospitalized for paranoid schizophrenia compared to a 1 in a 100 chance if he were raised in Japan.
An epidemiological area study revealed that the likelihood of individuals who have paranoid schizophrenia were proven to be 10 times more probable to come from lower socio-economic groups. (R. Newell & K. Gournay 2008 p66).
Counseling has a major emphasis on prevention. Mental health counselors work with individuals and groups to promote optimum mental and emotional health. Counselors may help individuals deal with issues associated with addictions, substance abuse, family, parenting, marital problems, stress management, self-esteem and aging. Mental health counseling brings a unique approach to the mental health ...
D. Gill (2007), states due to the nature of the illness, patients with paranoid schizophrenia are more likely to be self-neglectful and possess co-morbidities. According to the NICE (2009) guidelines on schizophrenia, it is agreeable that those affected by the illness have poor rates of physical health, morbidities and mortality rates with those affected living 10-17 years less than the average UK population.
The Disability Rights Commission (DRC, 2006), revealed those with the paranoid schizophrenia have high prevalence in co-morbidities such as diabetes, obesity, respiratory diseases and cardiovascular diseases because they are more likely to engage in substance misuse, heavy smoking, unusual eating habits, lack of exercise and also suffer the side effects of antipsychotic drugs. Due to the nature of the mental illness, signs and symptoms of poor physical health are often ignored by those affected with illness due to lack of awareness.
However, the uses of preventative measures to overcome this epidemic are also often being ignored by healthcare professionals. According to J. Sin and G. Bonner (2010), there is a decline in the basic level of assessment and treatment for physical problems in patients with paranoid schizophrenia and comorbid physical conditions compared to patients without mental illness. Psychiatrists and general practitioners more often than not, fail to recognize and treat physical conditions in those affected by the illness henceforth, possibly jeopardising the prognosis of good physical recovery.
To overcome this epidemic, the NICE introduced scoping exercises which recommended physical health screening to all service users prescribed with antipsychotics to prevent and reduce possible comorbidities and to also promote physical wellbeing by offering blood pressure, body mass index, blood glucose and lipids measures at least once per year (J. Sin and G. Bonner 2010).
Evolutionary systems such as these would enable persistent monitoring, early detection, follow up treatment and most importantly, possible prevention in comorbid physical health issues in service users with paranoid schizophrenia.
An individual with chronic illness can be healthy. This is quite a positive thought since most of those who suffer from chronic illness can be able to carry on well with their duties like any other person. The well being of an individual living with chronic illness can be facilitated by eating well balanced food and those which are recommended by the doctor to cope with the disease condition. Also ...
In the past, many psychiatrists and other healthcare professionals have taken a cynical perspective in the prognosis of paranoid schizophrenia often regarding it as a chronic, irreversible and debilitating permanent illness (NICE,2010).
However, Rethink (2013) reveals that with the prognosis of good recovery, 3 in 10 service users may have a lasting commendable recovery and 1 in 5 people show significant improvement after their first encounter with paranoid schizophrenia.
The crucial aspects to a good prognosis include early diagnosis and a treatment regime, absence of family history, service user being female, patient awareness of symptoms as signs of a problem, sudden onset and onset of illness occurring at a later age, strong support networks from either family or the community, short periods of severe symptoms and long intervals of a decline in symptoms between chronic psychotic episodes and normal structure of the brain following a brain scan. These factors have been proven to enable a better chance of stabilisation, recovery and response to treatment (R.
Nemade and M. Dombeck 2009).
There are numerous treatment interventions in the management of paranoid schizophrenia with the first and foremost effective treatment being atypical antipsychotic medication which suppresses symptoms such as paranoia, hallucinations and delusions. They are also proven to have fewer extrapyramidal side effects (SANE 2013).
Despite the evolution and production of second generation antipsychotic drugs, 30% of patients in the UK disliked metabolic side effects such as excessive weight gain.
Understandably, weight gain could lead to comorbidities such as diabetes and high blood pressure (DRC, 2006).
The Independent Nurse (2005) also revealed that in the UK, 53% of patients diagnosed with schizophrenia felt embarrassed or upset in having to take antipsychotic medication on a daily basis. T. Gillian and R. William (2008) states that pharmacological treatment alone is not sufficient enough to help overcome the psychological and social impact of the psychotic illness on the patient themselves, their families and carers.
Henceforth, the intervention of psychological and social services such as cognitive behavioural therapy (CBT), occupational therapy, Day hospital admissions, crisis resolution teams, supportive counselling, home/community treatment teams, individual/family/group work with patient and their carers are also vital in treatment. Talking treatments in CBT utilise a holistic approach which also aim to provide emotional support so individuals affected by the illness can to come to terms with the illness, how to manage their illness, to develop relapse prevention strategies and to develop coping strategies (SANE, 2013).
However, the effectiveness of CBT can be questioned as CBT does not provide instant results which can be particularly frustrating to individuals not responding well to treatment and individuals experiencing severe negative symptoms as it could be difficult to concentrate or to even be motivated. In regards to the treatment of paranoid schizophrenia, NICE (2002), recommends the use of atypical antipsychotic medication as an initial phase of treatment in both primary and secondary care.
NICE (2002) also produced guidelines which encourages a co-productive approach in the treatment of paranoid schizophrenia as it enables an opportunity for healthcare professionals to provide information and to discuss with the service user the benefits and possible side effects of each possible choice of drug. This applaudable pharmacological intervention has been proven to be of great benefit to service users for several reasons. Pumariega and Winters (citied by J.
Sage 2006) stated that since the approval of nurse prescribers have been in effect, the availability of antipsychotic medications continues to be on the increase, henceforth service users with paranoid schizophrenia are more probable to be overmedicated making them easy targets for overzealous prescribers. In cases where service users live in isolation and are withdrawn with no close family to advocate for them, there is a high chance that they are unable to unravel their discontent with prescribed medication increasing the likelihood of non-compliance of medication, possible relapse or further mental deterioration.
Further interventions are seen in key policies such as the ‘mental health Policy Implementation Guide’ produced by the Department of Health (DH 2001), and the ‘no health without mental health’ policy produced by the Mental Health Foundation (MHF, 2012).
These policies influence psychological and social interventions for service users from a government to a national level. Both policies utilise approaches to promote positive mental health and strategic methods with realistic expectations in aims to improve mental health and overall well-being in affected service users.
In a recent research study, it was reported that there was an overall increase in the amount of crisis resolution and home treatment teams, assertive community treatment/outreach teams and Early Intervention in Psychosis Services across the country with the implementation of interventional policies (NICE, 2009).
Though these changes are still in progress, the implementations of policies formulate a fundamental element particularly in the overall health management of service users affected by paranoid schizophrenic.
On the contrary, despite there being the numerous beneficial interventions in the treatment of paranoid schizophrenia, the concept of consent must always be acknowledged by healthcare professionals involved in treatment and care of the service user (Mental Health Act, 2007).
Despite best efforts by mental health charities and government interventions to educate the public on schizophrenia as a whole, it has been acknowledged that a minority of the population affected by the illness will deny or refuse treatment or psychosocial intervention due to the stigma the condition once entailed or just lack of awareness (R.
Newell & K. Gournay, 2008, p69).
B. Dimmond (2003), reports that regardless of one’s mental illness, it does not make them incapable of making his/her own decisions even in cases where refusal of treatment may result in life threatening consequences. In fact, the Mental Capacity Act (MCA, 2005) supports this view and also implements empowerment and protection for both those who can and cannot make informed decisions for themselves.
In exceptional circumstances where a patient is sectioned under the Mental Health Act, the MCA (2005), states that deprivation of liberty must be conducive to the persons best interest. Understandably this could be a distressing event to the individual especially if they are possibly being detained against their wishes. However, it could also be equally distressing to the individuals’ carers, family and friends. The effect of paranoid schizophrenia on an individual can be devastating as the condition can quickly deteriorate ones quality of life especially without early detection and psychosocial intervention.
A person diagnosed with the illness can at times lose their jobs as everyday task become merely impossible to complete due to hallucinations, delusions and disorganized thoughts. They may lose family and friends as people with the illness often become withdrawn and self-isolate. The paranoia aspect of the illness may also cause the person affected with the illness to be suspicious family members and friends. One may also turn to alcohol and substance misuse as an attempt to relieve their symptoms or to self-medicate possibly making matters worse.
More so, there is an increased risk that an individual affected by the illness may attempt suicide especially during psychotic episodes and periods of depression (M. Smith and J. Segal, 2013).
Family, friends and carers usually experience emotions of loss, anxiety, worry and sometimes even guilt as the mental health of their loved ones’ disintegrate (P. Corry, 1998).
Family, friends and carers of a person diagnosed with schizophrenia often prioritise and worry about preventing their loved one from relapsing, and keeping them healthy.
This burden of constant worry is equally unhealthy for family, friends and carers as this may result in them ignoring their own individual needs possibly leading to the development of depression and anxiety. As a result, family members or carers of those affected by paranoid schizophrenia often find themselves lonely and estranged (H. B. Veague, 2009).
It is evident that paranoid schizophrenia is one of the most common subtypes of the condition affected more people than the neighbouring subtypes.
The condition encompasses a mentally and socially debilitating illness that can have devastating effects on those affecting and their loved ones especially without the right treatment and beneficial interventions. However, unfortunately for some, the illness will remain a lifelong battle. Despite innumerable years of research methods and postulations, no single aetiology has been discovered in the cause of paranoid schizophrenia and the likely hood of discovery remains relatively unclear sustaining the fact that the cause of the illness is remains highly complex.
Pharmacological evolvement in the production of atypical antipsychotics has indeed been a legendary intervention as the drugs have fewer extrapyramidal side effects henceforth, possibly increasing compliance rates in service users. It is agreeable that the production of policies are a fundamental aspect in the promotion of good mental health and gradually lifting the historic stigma attached with the condition and gradually allowing more people affected by the illness to come to terms with their condition. Bibliography M. Bengston. (2006).
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