Schizophrenia Research Paper

1 Introduction

Schizophrenia is a complex and chronic mental disorder in which the illness prevents individuals from living a full and cohesive quality of life. The debilitating cognitive disorder affects how a patient thinks, feels and acts, where they can have difficulty in determining reality from fiction. The disorder is a long-term and acute illness that is undoubtedly disabling for each individual. Schizophrenic symptoms usually arise in males at an earlier age than females. Psychotic symptoms are a common occurrence for patients, in the form of hallucinations and delusions. Schizophrenia is a severe disturbance in an individual’s cognition. Its psychotic symptoms differs in each person, where they may see or hear things others do not,

and may have delusions which cannot be understood to others. Individuals might lose their functioning to care for themselves and undertake simple tasks. Symptoms are most likely to occur between 15-25 years and schizophrenia does not have a conclusive cause. Treatments continue improving and require certain medication, counselling and in particular cases hospitalisation. Whilst the illness is devastating, recovery and improvement exists. Over time, individuals who are contained with schizophrenia will have a reduced quality of life to a significantly adverse extent. Quality of life is the standard of health, comfort and satisfaction experienced by an individual. There are many factors which affect one’s life quality, such as occupational status, physical activity, medication and side effects amongst others.
2 Definition of quality of life and schizophrenia
Quality of life (QOL) can be described by the Australian Centre of QOL as a primary resource for many disciplines, such as social sciences and medicine. Its focus is centred on the positive features of individual’s lives. QOL is objective and subjective. Objective aspects comprise of the culturally relevant measures of well-being, whilst subjective components are “measured through questions of satisfaction.” The definition of quality of life regarding the question refers to the focus of the factors influencing lifestyle. Schizophrenia severely diminishes cognition, emotion and behaviour. Patients usually are unable to distinguish sensory stimuli and their sounds, colours and other social aspects’ perceptions may be enhanced. Schizophrenia by definition is a “psychotic illness characterised by a loss of contact with the environment, by noticeable deterioration in functioning levels in everyday life.”
3 Schizophrenia – A breakdown
It is a common misconception amongst society that schizophrenia means “split personality”, which is untrue. Psychiatrists consider this as “thought disorder” as it is more specific. Individuals with schizophrenia are challenged with many functional impairments such as independent living, social functioning and occupational/educational performance. Only 10-20% can maintain full or part-time competitive employment.
3.1 – Causes
It is unknown what precisely causes schizophrenia however, it has been identified that no single causes triggers the disorder. The most likely reasoning is that an interaction between the individual’s “biological vulnerability, stress or change in the environment and the ability to deal with these environmental factors” regarding their social skills and support are probable determinants for schizophrenia. Genetic factors and predispositions can run in families, where if one parent has schizophrenia, then the offspring has a 10% chance of contracting the disorder. Certain biochemical substances in the brain, particularly dopamine, are potentially associated with schizophrenia. One possible outcome of the chemical imbalance is the predisposition, where pregnancy or birth complications may cause structural brain damage.

Figure 1: The cognitive processes of schizophrenia developing
As shown in Figure 1, schizophrenia can develop at a youthful age where the illness gradually builds. As mentioned, the link between the genetic predisposition and the environmental factors are the most likely causes that influence the diagnosis of schizophrenia. Studies conducted have found that an association exists where smoking whilst pregnant increases the risk of schizophrenia in infants.
3.2 – Symptoms
It is agreed upon experts that the illness develops as a result between biological predisposition and the certain environment an individual is exposed to. The symptoms of schizophrenia can be classified into positive, negative and cognitive. Positive symptoms do not necessarily mean “good”, it tends to increase the severity of the illness and daily life; adding adverse characteristics to one’s personality.
Positive symptoms include:
• Hallucinations
• Delusions
• Thought and movement disorders
Whilst negative aspects do not mean bad, it suggests features lost in life because of schizophrenia. These can be linked with disruptions to normal thoughts, feelings and behaviours. Together, these symptoms are known as psychosis. This can be defined via the Oxford Dictionary, as “a severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality.”
Negative symptoms include, but are not limited to:
• Decreased levels of will in general life and speaking
• Difficulty starting and maintaining activities
Some other symptoms are shown through apathy, speech and thought poverty and loss of motivation.
Cognitive symptoms vary in each individual from indistinct to memory or thinking alterations. Poor cognition associates with low unemployment levels and social outcomes and can be adverse on the patient, thus a quality of life impairment.
Cognitive symptoms include:
• Difficulty focusing or giving attention
• Issues in using information immediately after learning it
• Poor ability to understand information and use it to make decisions
It is thought that those with schizophrenia are unlikely to report physical symptoms involved and may be ignorant to these issues as a result of the cognition deficiency schizophrenia possesses.
3.3 – Schizophrenia Subtypes
Schizophrenia affects 1% of the world’s population, and it has been established that five methods exist; paranoid, catatonic, disorganised, residual and schizoaffective disorder. Each of these types of the illness affects a person’s life quality and the extent of this is varied.
Paranoid: A combination of false beliefs (delusions) and hallucinations (hearing voices). Suicidal or aggressive behaviour are risks patients may confront under the delusional influence, however these individuals function at an increased level compared to other subtypes.
Catatonic: Movement disturbances are prominent features. Individuals may display activity reduction and increase which can include agitation, unusual posturing and repetitive mimicking of others. They are at risk for malnutrition, exhaustion or self-injury and is often related with mood disorders which affects the quality of life.
Disorganised: speech, thinking and behaviour, along with inappropriate emotional responses. Disorganised behaviour involves the inability or inspiration for a set task, or to finish one already started.
Residual: when a patient ceases showing positive symptoms. Individual’s impairment of life varies, where some require hospitalisation and help from external support services, affecting quality of life.
Undifferentiated: Classified by general symptoms in which do not necessarily fit a specific form of schizophrenia. Individuals may show positive and negative symptoms although they can vary over time.

Figure 1: The developmental origins of schizophrenia
3.4 – Diagnosis and Treatment
There is no cure for schizophrenia, however the illness can be treated in several ways. There is no specific diagnosis for schizophrenia, as it is recognised as an illness that is difficult to completely control. Diagnosis from a psychiatrist can be made when the following aspects are true:
• Symptoms have been present for a minimum of six months
• Individual is largely affected by these symptoms; e.g. difficulty in social relationships
• Symptoms cannot be explained by another diagnosis, such as another mental illness.
It becomes unclear for doctors to diagnose the issues when a patient with schizophrenia might also have depression or consume drugs.

A psychiatrist can only diagnose schizophrenia reliably by observing the individual over time. Many schizophrenics frequently having a decline in reasoning and memory abilities, anxiety, depression and suicidal thoughts. General psychopathology (e.g. anxiety, depression) has shown to have been linked with schizophrenia where patients may experience these conditions; and along with negative symptoms, these have a negative relationship with quality of life. Antipsychotic medications and psychosocial therapy can aid the severity of schizophrenia, whilst in extreme situations hospitalisation may be required to ensure safety, sufficient sleep, hygiene and nutrition. Some patients may also be reluctant to take the medication because of the rare but serious side

effects.
4 Lifestyle Impairment
Schizophrenia and its treatment for patients are contributions to significantly high levels of ailment and mortality, which is associated with the individual’s lifestyle. Poor diets, decreased physical activity and smoking are vulnerabilities to patients than those of the general population. Hence, these factors are predispositions to poor physical health and disorders. It seems rather obvious that individuals with schizophrenia have a significantly lesser lifestyle than those without the disorder. A patient can have episodes where disconnections from society can occur and have their experiences frightened together with the inability to think clearly and coherently. Side effects of the medicine with sedation and metabolic consequences also exist. Generally, many people associate schizophrenia with violence and danger, where the public seem ignorant about the illness and are cautious of those with it. The result of this condition is the individual being chronically plagued through fear and disaffection from reality. Schizophrenic patients will often smoke purely for boredom leisure to counteract the sedating medication effects. Thus, it is recurrent that an individual with schizophrenia also presents themselves with obesity and diabetes.
5 Quality of life Reduction
A study conducted shows that quality of life impairment was high for schizophrenia patients and that it was associated with factors such as having children, marital status, race, types of symptoms and occupation, amongst others.
Quality of life has been also found to be associated with functional outcomes such as employment status, independent living, daily activity engagement and personal relationships maintained. By obtaining and keeping an occupation, which can be classified as social functioning, is associated with an increased levels of subjective quality of life for individuals with schizophrenia, and this is through traits such as increased degrees of motivation and energy. According to a United Nations report, Australia has been ranked second globally for quality of life, which assesses economic, education and life-expectancy data. The UN states these are “three basic dimensions of human development.” Life expectancy in Australia is approximately 82.5 years, and patients with schizophrenia unfortunately have a reduced life span by 10-20 years. This can be due to the direct effects of medication on weight, blood sugar and lipids along with schizophrenia itself affecting motivation for a healthy lifestyle, or the physical illnesses, cardiovascular, metabolic and infectious diseases.

Figure 2: Disorganisation symptoms impact on QoL in schizophrenia
Figure 2 represents a study conducted determining the effects of disorganised symptoms regarding quality of life in schizophrenia and the mediating impact of neurocognitive deficits and cognitive dysfunction.

It was found that the disorganised severity associated with worse QOL for schizophrenics, and that verbal memory deficiencies were linked. Accentuating the emphasis of developing and implementing treatment strategies addressing neurocognitive insufficiencies to improve QOL in schizophrenia patients and maximise recovery efforts are essential to a better life quality.

The quality of life cannot be measured precisely using a common method, however a general consensus exists that it is multidimensional (physical, psychological, social), subjective (QOL defined differently by individuals) and dynamic. Due to these features, quantifying QOL is complicated. The relationship between physical performance and disability has a significant association to activities in daily life reductions, where the limitations reduces the quality of life and independence within an

individual.