Order from us for quality, customized work in due time of your choice.
Schizophrenia is a serious and mental illness in which emotional disorders, inappropriate behavior, impaired thinking, and the inability to lead a social life are observed. It usually develops in men aged 1825 years and in women aged 2645 years. The given disorder is sometimes inherited, but the main risk factors are experienced events that caused stress. It is important to note that gender does not matter. The disease occurs among representatives of different cultures and affects about one in a hundred people in the world. However, there are effective pharmacological approaches to treating the disease, such as Clozapine, and non-medical methods, such as psychoeducation.
Illness Description
The term schizophrenia is sometimes erroneously designated personality disorder. The disease leads to a violation of a persons sensation of reality, which is accompanied by the inadequacy of his behavior and confusion of emotional reactions. People with schizophrenia can hear voices, which can contribute to the appearance of strangeness in their behavioral patterns. They usually need support and constant attention, are unable to work or maintain relationships with other people. Approximately one in ten people diagnosed with schizophrenia commits suicide (Allen, Fung, & Shannon, 2016). So far, not a single cause has been identified that causes this disease, but it is known that a genetic predisposition plays a role here. In a person who has been in close contact with a patient with schizophrenia for a long time, the risk of disease is significantly increased. In addition, experienced stressful events, such as a serious illness or bereavement, can serve as a trigger for the development of a disease for a person who is predisposed to it. There is evidence that there is an abnormality in the structure of the brain during schizophrenia, such as cysts or cavities filled with fluid, formed by the destruction of brain tissue.
Usually, the disease manifests itself gradually, starting with the patients loss of vitality. In other cases, it occurs more unexpectedly, and the cause of its occurrence may be transferred stress. Sometimes the course of schizophrenia is divided into episodes in which the disease manifests itself in all evidence, but between which the patient may show a complete absence of the disease, and sometimes the disease proceeds more or less continuously. According to the neuroanatomical theory, schizophrenia is considered a brain disease in which the frontal lobe, limbic system, and basal ganglia are affected (Zhang, Catts, & Shannon, 2018). It was found that produce symptoms of schizophrenia are due to dysfunction of the caudate nucleus of the brain and limbic system. A mismatch in the work of the hemispheres, malfunction of the frontal cerebellar connections is recorded. Expansion of the anterior and lateral horns of the ventricular system, which correlated with the severity of negative symptoms, was detected by computed tomography (Cromby, 2016). On the EEG, the voltage from the frontal leads is reduced, left-side pathology prevails, and several pathological phenomena are recorded.
According to the immunological concept, immunological disorders play an important role in the pathogenesis of schizophrenia (Maller et al., 2017). The importance of autoimmune processes in the pathogenesis of schizophrenia is indicated by the identification of atypical lymphocytes, a decrease in the number of killer cells, a variable level of immunoglobulins, and the presence of autoantibodies against brain tissue. The data obtained can be interpreted either as an indicator of the presence of an infection that causes both a mental disorder and impaired immunity or as an autoimmune reaction in certain brain regions.
The revealed immunological mechanisms in the pathogenesis of schizophrenia served as the rationale for the use of immuno-pharmacological drugs in the treatment of resistant cases of schizophrenia. In addition, the antibodies detected in the blood serum of patients with schizophrenia to the psychotropic drugs used by them made it possible to explain the pathological immune reactions to these drugs in severe complications.
Antipsychotic drugs may be prescribed to help the patient regain organization (Maller et al., 2017). It may take about three weeks to rid a person of the most obvious symptoms of the disease. Some medications can cause serious side effects, and in this case, their doses may need to be adjusted or other drugs added to weaken this undesirable effect. After the examination and treatment, patients are usually discharged home, but it should be remembered that they need support and a calm, safe atmosphere in the family. People who have schizophrenia should be protected from stressful situations, as excitement can lead to symptoms of the disease (Allen et al., 2016). They also need frequent and regular contacts with employees of the socio-psychological service that monitor their condition.
Both patients and their family members may benefit from counseling psychotherapy. People close to the patient should notice signs of a relapse that is beginning and indicate that the patient is immersed in a general state of apathy and a self-neglected attitude. For most people with schizophrenia, their disease is chronic (Cromby, 2016). However, in about one in 5 patients, a moment suddenly comes when their return to normal life begins. Most of them experience many episodes of acute symptoms, during which their hospitalization may be required, alternating with periods of recovery. The use of modern medicines improves the prognosis, but to prevent relapse of the disease, these people need adequate care and support from society (Cromby, 2016). The forecast is less favorable for patients whose disease gradually developed from a young age.
Treatment
Clozapine
Among the events significant for psychiatry of the 20th century, the creation of psychopharmacological drugs, and among them antipsychotic medications, was revolutionary. One of the significant events in the history of antipsychotic medicines was the appearance of clozapine. This antipsychotic deserves a separate description in connection with the role that it played in the treatment of schizophrenia patients and its importance in the development of psychopharmacology. The mechanism of action of clozapine is different from the mechanism of action of many antipsychotics (Vasudev, Choi, Norman, Kim, & Schwarz, 2017). These differences determine significant profile features of its psychotropic effects. The antipsychotic activity of clozapine is usually explained by its ability to block dopamine (D2) and serotonin (5-HT2) brain receptors.
The effectiveness of clozapine in the treatment of schizophrenia has been studied in many studies: non-comparable observational, blind, placebo-controlled, open and blind comparisons with other antipsychotics (Higgins, San, Lagnado, Chua, & Mihic, 2019). The value of these studies is to determine the effect of therapy on productive, negative, and cognitive disorders in general, aggression and suicidal behavior, and the frequency of repeated exacerbations. The data from these studies usually give an idea of overall effectiveness the strength of the antipsychotic effect of clozapine, but do not allow a detailed assessment of the profile of its psychotropic activity. This gap is filled by the results of well-planned domestic studies evaluating the relationship of the effectiveness of therapy with various clinical features of schizophrenia (Williams et al., 2017). Of great importance in interpreting the results of individual studies are data from meta-analyses generalizing them and systematic reviews.
The first large-scale study indicates that the use of clozapine significantly improves the condition of patients in whom therapy with typical antipsychotics has been ineffective (Williams et al., 2017). In other studies, similar results were obtained, which showed that the number of patients with a significant improvement in a condition when taking clozapine is about twice as high as when treated with traditional means. It is widely believed that clozapine therapy leads to a weakening of productive symptoms in 30-60% of cases of resistance to typical antipsychotics (Vasudev et al., 2017). Clozapine is called the only antipsychotic drug with proven efficacy in resistant cases of the disease. Recently, many authors have suggested that the combination of clozapine with other atypical antipsychotics is even more effective than clozapine monotherapy. This is due to the expansion of the profile of the neurochemical activity of combination antipsychotic therapy. However, this point of view needs further verification.
Several studies are devoted to evaluating the effectiveness of clozapine in the maintenance treatment of schizophrenia. The use of clozapine at this stage of the disease leads to a further weakening of psychopathological symptoms. At the same time, the incidence of recurrent exacerbations during treatment with clozapine is lower than with traditional antipsychotic drugs. The results show that after the weakening of the manifestations of psychosis in a paroxysmal or continuous course of schizophrenia, the condition of patients taking maintenance or continuous active therapy with clozapine continues to improve slowly. The final formation of the structure of remission, the maximum recovery of social adaptation occurs half a year or a year after the main manifestations of exacerbation disappear, and the patients are discharged from the hospital, which indicates the rationality of long-term aftercare and maintenance therapy with clozapine (Higgins et al., 2019). Only in this case is its efficiency as high as possible.
Thus, an analysis of the results of various studies shows that the spectrum of psychotropic activity of clozapine is determined by pronounced incisive antipsychotic and powerful sedative effects, a wide range of specific antipsychotic effects, and, presumably, antitermination effect. This spectrum of activity distinguishes clozapine from other antipsychotics. It turned out that among all antipsychotics, clozapine occupies a leading position the most weakening of the severity of productive, negative, and affective symptoms.
The great advantage of clozapine therapy is the rapid interruption of the acute phase of the disease, the prevention of its active development, which significantly improves the short-term and long-term prognosis of the course of the endogenous process. The best result is achieved if clozapine treatment begins already at the stage of disease manifestation and is carried out continuously for many years. Clozapine is the only antipsychotic whose use is effective in cases of failure of therapy with other antipsychotic drugs (Vasudev et al., 2017). In instances where clozapine therapy in these cases no longer allows the formation of high-quality therapeutic remissions, it often leads to a weakening of psychopathological disorders so that patients can live outside the hospital. Of course, clozapine therapy cannot be considered as a panacea in the treatment of schizophrenia, and an individual approach to the choice of antipsychotic strategy is necessary.
Psychoeducation
Currently, the paradigm of psychiatric care is changing with the transition from the biological to the biopsychosocial model and its implementation by a team of specialists. This contributes to the fact that psychosocial therapy and psychosocial rehabilitation are becoming more widespread and universally recognized, becoming a real and necessary component of helping mentally ill patients (De Souza et al., 2016). Psycho-education is considered to be perhaps the most significant type of psychosocial intervention in the multifaceted system of psychosocial rehabilitation of patients with schizophrenia and their relatives. Despite this, for the country, the experience of conducting psycho-educational work is quite new and not widespread. In addition, there is insufficient research on the basic mechanisms of adaptation, in particular, coping in patients with schizophrenia, especially in patients with the first psychotic episode (Mirsepassi, Tabatabaee, Sharifi, & Mottaghipour, 2018). The available information is fragmentary, and coping mechanisms are most often considered in isolation from specific types of psychosocial effects. This applies, in particular, to psycho-education, which is a phased system of psychotherapeutic influences aimed at both informing the patient and his relatives about a mental disorder, and teaching them how to cope with specific problems caused by the manifestations of the disease.
The main subjects of psycho-education are individuals, families, and couples. Based on this, it is possible to distinguish the individual, family, group psycho-education, and psycho-education of couples. Individual psycho-education, being part of the treatment process and socio-psychological rehabilitation, allows the client to form a certain set of knowledge about his disease, treatment tactics, and strategies, as well as a set of skills that help him/her cope with the disorder and build effective interpersonal relationships (De Souza et al., 2016). Family psycho-education involves the involvement of all family members in the treatment and socio-psychological rehabilitation process, and it is aimed at transferring knowledge about the characteristics of their relatives illness, the consequences of medication and/or other types of treatment, the ability to recognize the symptoms of the disease and strategies for interacting with the patient.
Psycho-education of couples is an effective tool for spouses to understand the features of building interpersonal relationships in a couple, the formation of conflict resistance of each, the development of their social skills (Mughairbi, Abdulaziz, & Hamid, 2019). Group psycho-education involves the transfer of knowledge to everyone both from the trainer and from other members of the group, its goal is to solve the psychological problems of each participant based on the use of teaching methods and technologies, including interactive ones.
Conclusion
In conclusion, clozapine is perceived by specialists as an antipsychotic with a more unfavorable profile of side effects and complications compared to other antipsychotic drugs. This often leads to a restriction of its use in some countries, including domestic psychiatrists. However, recent studies have shown that clozapine therapy, contrary to popular belief, is quite safe. It is noteworthy that in some countries, clozapine is considered a first-line antipsychotic in the treatment of schizophrenia at various stages of its course and is prescribed much more often than traditional or other atypical antipsychotic drugs. The main focus of psycho-education in medical practice, firstly, identifying and eliminating the side effects of treatment and rehabilitation, secondly, explaining the course of the disease to patients and removing barriers to recovery, and, thirdly, reduction of negative experiences of both the patient himself and his family members. When constructing the route of a psycho-educational program in the practice of treating and rehabilitating people with mental and bodily disorders, it is vital to take into account such specific features as the nature of the disease and its course. It also includes the involvement in the process of treatment and rehabilitation of the patients family members, participation of various specialists in psycho-education, the availability of administrative resources, and the patients psycho-emotional state.
References
Allen, K. M., Fung, S. J., & Shannon, W. C. (2016). Cell proliferation is reduced in the hippocampus in schizophrenia. Australian & New Zealand Journal of Psychiatry, 50(5), 473-480.
Cromby, J. (2016). Developing schizophrenia. Theory & Psychology, 26(5), 607-619.
De Souza, M. S., Da Silva, R. A., Molina, M. A. L., Jansen, K., De Lima Ferreira, L., Kelbert, E. F., & De Mattos Souza, L. D. (2016). Six-session caregiver psychoeducation on bipolar disorder: Does it bring benefits to caregivers? International Journal of Social Psychiatry, 62(4), 377-385.
Higgins, J. M., San, C., Lagnado, G., Chua, D., & Mihic, T. (2019). Incidence and management of Clozapine-induced myocarditis in a large tertiary hospital. The Canadian Journal of Psychiatry, 64(8), 561-567.
Maller, J. J., Anderson, R. J., Thomson, R. H., Daskalakis, Z. J., Rosenfeld, J. V., & Fitzgerald, P. B. (2017). Occipital bending in schizophrenia. Australian & New Zealand Journal of Psychiatry, 51(1), 32-41.
Mirsepassi, Z., Tabatabaee, M., Sharifi, V., & Mottaghipour, Y. (2018). Patient and family psychoeducation: Service development and implementation in a center in Iran. International Journal of Social Psychiatry, 64(1), 73-79.
Mughairbi, F. A., Abdulaziz, A. A., & Hamid, A. (2019). Effects of psychoeducation and stress coping techniques on posttraumatic stress disorder symptoms. Psychological Reports, 2(4), 5-17.
Vasudev, K., Choi, Y. H., Norman, R., Kim, R. B., & Schwarz, U. I. (2017). Genetic determinants of Clozapine-induced metabolic side effects. The Canadian Journal of Psychiatry, 62(2), 138-149.
Williams, R., Malla, A., Roy, M.-A., Joober, R., Manchanda, R., Tibbo, P., & Agid, O. (2017). What is the place of Clozapine in the treatment of early psychosis in Canada? The Canadian Journal of Psychiatry, 62(2), 109-114.
Zhang, Y., Catts, V. S., & Shannon, W. C. (2018). Lower antioxidant capacity in the prefrontal cortex of individuals with schizophrenia. Australian & New Zealand Journal of Psychiatry, 52(7), 690-698.
Order from us for quality, customized work in due time of your choice.