SCHIZOPHRENIA: THE RISING SCURGE

schizophrenia

With the rising numbers of depression among the youth and young adults in Kenya today, recurrence rates of schizophrenia and schizophrenic disorders are on the rise. About 24million people are affected by the condition with 50% not receiving appropriate care and the highest number of untreated schizophrenia being in developing countries. The recurrence rates are high among populations in the low socioeconomic class. The stigma that comes about with the disease leads most patients into not seeking appropriate medical care in the notions of it being a curse and lack of support from the family and community which is an integral part of management of the disease. This has led to the formation of the Schizophrenic Foundation of Kenya (SFK) that seeks to increase knowledge; understanding and compassion thus reduce stigma, discrimination and fear that accompany this condition.

Schizophrenia is a form of mental illness that inhibits the judgment, thought process interpreting reality and bizarre behavior affecting seven per thousand of the adult population, mostly between 15-35 years and with a low incidence due to its chronic nature (WHO, 2013). . The cause of schizophrenia is unknown though it’s associated with abnormally high levels of dopamine and serotonin. The prevalence of this disorder among the public today:

  • General population 1%
  • One parent with the disorder 12%
  • Both parents with the disorder 40%
  • First degree relative with disorder 12%
  • Second degree relative with the disorder 6%
  • Monozygotic twin 47% and Dizygotic twin 12%

 

Diagnosis is based on the presence of signs and symptoms for at least six month. This condition presents with: hallucinations (mostly auditory), catatonic behavior, bizarre delusions, disorganized speech and/behavior. The cause of schizophrenia is unknown though it’s associated with abnormally high levels of dopamine and serotonin. Schizophrenia has majorly four types:

  1. Disorganized type-characterized by speech and behavior that is difficult to understand and inappropriate emotions. They make illogical statements or laugh for no reason; this type may disrupt normal routines and activities.
  2. Paranoid type-this usually presents with auditory hallucinations and delusions (feeling that people are out to get them, harassing or targeting them) but spares the person’s intellectual functions and emotional expressions. They may express anger, anxiety and can be argumentative.
  3. Residual type-a past history of at least one episode of schizophrenia but the patient doesn’t demonstrate any positive symptoms at the time. It maybe a transition to complete remission, to full blown schizophrenia or may continue this way for years without any psychotic episode.
  4. Undifferentiated type-is seen in some symptoms seen in all of the above types but not enough to define it as a particular type of schizophrenia.

Approach consideration in management and treatment of this condition involves integration of medical, psychological and psychosocial entities. Medical approach involves first generation antipsychotics (Dopamine D2 antagonists); Haloperidol and Chlopromazine and second generation drugs such as Clozapine. Psychosocial treatment includes cognitive behavior therapy and social skills training. Other forms of treatment involve transcranial magnetic stimulation (TMS) where induction of an electromagnetic field in the brain to stimulate neurons and can affect brain cells up to 6cm deep, it’s safe with few adverse effects. Despite TMS being mostly used for patients with depression, its reported to be useful in decreasing auditory hallucinations and negative symptoms associated with schizophrenia.

There are no clear measures of completely preventing schizophrenia though genetic counseling is however advised for couples seeking to have children and taking proactive steps to avoid drugs and drug abuse, getting enough sleep, reducing stress and antipsychotic medications to minimize symptoms or prevent them.

 

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