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There is usually a gap of one or two years between the appearance of vague symptoms and the patient's visit to a psychiatric clinic. Neurological examination may reveal a link between schizophrenia and Wilson's disease and Huntington's disease before treatment starts. The disorder has also been associated with left and mixed handedness, some physical abnormalities and mild neurological signs (Frankenburg).
Mental status examination often reveals odd and poorly understood behaviors, such as drinking water to the point of intoxication; staring at oneself in the mirror, gathering and keeping useless items, self-mutilation and disturbed sleep-wake patterns (Frankenburg, 2009). The patient has difficulty coping with change. Other observations gathered during detailed interaction with the patient include odd dressing, undue suspiciousness or social awkwardness, lack of personal hygiene, odd beliefs or delusions, small range of emotional expressions, acknowledged hallucinations or response to un-apparent auditory or visual stimuli, long pauses because of thought blocking, difficult speech because of loose associations, lack of initiative to begin conversation, difficulty in abstract thinking, meaningless or idiosyncratic interpretation, the use of too many words to answer a question without actually answering it, poor attention, disorganized or stereotyped thinking, odd movements, and limited insight into his own problems. According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, the patient must have experienced at least 2 of the symptoms for a diagnosis of schizophrenia. Only 1 is required if the delusions are bizarre or if the auditory hallucinations are voices talking with each other. The symptoms must have been experienced for at least a month in a 6-month period and deterioration of social or work function has occurred after a reasonable amount of time. And these conditions must not be accounted for by other conditions (Frankenburg).
Effects on Family
Statistics say that 25% of persons with schizophrenia live with a family member
(Schizophrenia.com, 2009). Among those living with their families, 7.9% of their siblings are likely to develop the disorder and 10-15% if a parent has it. The risk increases with the number of afflicted family members (Schizophrenia.com). These risks and the painful adjustment family members of a person with schizophrenia must confront call for separate intervention for them (Perlick et al., 2006). These interventions are aimed at adjusting their affective response and behavior towards the sufferer. Studies revealed that expressed emotion in family members predicts relapse in the sufferer. They and caregivers should be made aware of, and to understand, the importance of their efforts at reducing the burden of the illness and creating a more positive environment. The findings supported the recovery philosophy. This philosophy encourages the patient's ability to contribute to the order and welfare of the household and his own care or recovery. These interventions will enhance the quality of life of both the sufferer and his family (Perlick, et al.).
Recent studies said that about half of all persons who suffer from severe mental illness do not receive treatment (Schizophrenia.com, 2004). Their findings agreed with previous ones, which revealed that 55% of those who did not receive treatment were not aware of their illness. The 45% who were aware and wanted treatment did not obtain it for various reasons. They wanted to solve their problem themselves, believed their problem would resolve itself, treatment was too expenses, did not know where to get help, were not confident of results of treatment and the lack of health coverage (Schizophrenia.com).
The mental health specialist decides appropriate treatment according to the patient's age, extent of the disorder, medical history, tolerance for therapies and procedures, his expectations and preference (Schizophrenia.com, 2004). Treatment will be a combination of medications, psychotherapy for both the patient and his family, specialized educational or some structured activity, self-help and support groups. Medications include neuroleptics and antipsychotic medications. Neuroleptics treat the patient's pervasive, intrusive and disturbing thoughts and minimize the severity of delusions and hallucinations. Antipsychotic medications reduce symptoms without curing the illness (Schizophrenia.com).
Clinical trials showed that this new and atypical antipsychotic agent is effective in treating both positive and negative symptoms of schizophrenia (Cassano et al., 2007). It is well-tolerated and has no significant side effects, like weight gain. Dosage depends on the presence or absence of agitation. Shifting to aripirazole from maintenance therapy to another anti-psychotic may be done gradually (Cassano, et al.).
New Approach to Long-term Treatment
This considers both a reduction in psychopathological symptoms and successful psychosocial reintegration (Juckel and Morossini, 2008). The effectiveness of anti-psychotics is no longer confined to the reduction of symptoms but now includes the patient's improved psychosocial function and quality of life. The interest in psychosocial function level has been the goal of new treatment strategies. In addition, health service providers, such as insurance companies in damage claims, for example, have found the monitoring of therapy of increasing relevance. Psychosocial functioning, has thus been considered an important criterion in determining the successful management of schizophrenia. But to-date, the improvement of psychosocial functioning with anti-psychotic treatment has not been adequately evaluated (Juckel & Morossini). #
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Perlick, D.A., et al. (2006). Components and correlates of family burden…[continue]
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