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Schizophrenia

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Abstract

Schizophrenia is a devastating disorder that affects the individual's day-to-day activities.

Schizophrenia is a genetic disorder, meaning it is inherited from the parents, although

environmental factors also play a huge role in determining whether a person gets the disease.

Technology advancements have led to better management options for schizophrenic patients, but

the disease still presents challenges to many. This paper examines the causes, pathophysiology,

clinical symptoms, and nursing implications of the complex mental health illness schizophrenia.

The relevance of evidence-based therapies is emphasized in this research, which also looks at

how nurses play in the comprehensive care of schizophrenia.

Aetiology and Risk Factors

Schizophrenia is a psychological disorder mainly caused by inheriting certain genes from

the parents, neurodevelopmental issues, and environmental factors. Studies on brain imaging

done on children with schizophrenia show that schizophrenic patients experience loss of their

grey matter. During adolescence, the grey matter loss spreads to the brain's frontal, parietal, and

temporal regions. Such early developmental issues are the reason for early onset schizophrenia.

Numerous genetic sites, or loci, have been linked to the disorder in a study encompassing

thousands of people with schizophrenia. These loci have minor effects, yet they significantly

raise the risk when combined. Numerous of these loci are connected to genes that play a role in

how the brain works, such as genes involved in the development of the brain. Schizophrenic

individuals have mutated genes that do not contain certain DNA since it was deleted or have

duplication of DNA (De Berardis et al., 2021).

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Environmental causes of schizophrenia include complications during birth or pregnancy,

the father's old age, trauma, the economic status of the parents, migration, living in urban areas,

and drug abuse. Complications such as the baby being born with low birth weight, hypertension

in pregnancy, and spontaneous cesarean section are risk indicators for schizophrenia. Mothers

acquiring some viruses such as genital herpes when pregnant or during birth also increases the

risk of a child developing schizophrenia. Childhood trauma, such as sexual or physical abuse,

neglect, and the parent's death, is linked to intense positive symptoms among schizophrenic

patients. The link between a child developing schizophrenia and the parent's economic status is

not definitive, although there are some positive results. An elevated risk of schizophrenia is

frequently linked to being raised in a city environment. Schizophrenia risk doubles when a child

moves from a rural to an urban environment as a young child, and the risk increases the longer a

youngster lives in a city. Increased prenatal influenza exposure and social fragmentation account

for the link between urbanicity and the development of schizophrenia. Drug abuse, especially

cannabis use, has been highly linked with schizophrenia development (Stilo & Murray, 2019).

Pathophysiology

The pathophysiology of schizophrenia involves neurotransmitters such as serotonin,

glutamate and especially involves dopamine. Elevated dopamine production and activation of the

dopamine receptor in the limbic system cause delusions, hallucinations, and paranoia, which are

positive symptoms of schizophrenia. Reduced dopamine receptor stimulation leads to decreased

dopamine production, causing a lack of motivation, inability to feel pleasure, and being

withdrawn from society, which are negative symptoms of schizophrenia. Schizophrenia also

affects the ability of the brain to think, which is also a result of decreased dopamine in the brain.

Another mechanism explaining the pathophysiology of schizophrenia includes a decrease in pH

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in the brain. Brain pH affects significant factors such as dopamine, glutamate, mitochondria, and

noradrenaline. Mitochondrial respiration synthesizes energy which is necessary for proper brain

function. Hence, mitochondrial malfunction can cause issues with neurological development and

neuropsychiatry in the brain which is present in schizophrenia. Mitochondrial malfunction is also

associated with decreased brain cell pH because of increased lactic acid. Decreased pH also leads

to elevated levels of dopamine and reduced glutamate levels. Reduced glutamate activity impairs

transmission in the brain hence causing schizophrenia symptoms. Interfering with the function of

the N-methyl-d-aspartate receptor (NMDA) is another essential effect of reduced pH. In

schizophrenia development, the receptors of NMDA are very crucial (Park et al., 2021).

Clinical Manifestations

Clinical manifestations of schizophrenia can be divided into positive, negative, and

cognitive effects. Among the defining symptoms of schizophrenia, which affects 75–80% of

patients, is cognitive deficiency, which is frequently correlated with low quality of life and

everyday functioning. Memory deficits, slow processing speed, difficulties in concentration,

disorganized speech, and difficulties in solving problems are some of the cognitive symptoms of

schizophrenia. Hallucinations, delusions, and completely disorganized or catatonic behaviour are

the positive signs of schizophrenia (Habtewold et al., 2020). Early Onset Schizophrenia (EOS)

exhibits an onset between 13 and 18, whereas Very Early Onset Schizophrenia (VEOS) is

defined by the beginning of psychotic symptoms before age 13. Hearing hallucinations and

delusions are the most common positive symptoms of VEOS, but doctors are very cautious

before making the diagnosis since it is a kid. (De Berardis et al., 2021).

Negative symptoms of schizophrenia severely affect the patient’s life. Loss of thinking,

altered actions, a lack of desire, a muted effect, a strong withdrawal from social situations, and a
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shortage of speech and communication are examples of schizophrenia's negative symptoms. The

positive symptoms of schizophrenia easily respond to treatment, unlike the negative symptoms,

which do not respond to drug treatment. Little research has been done on negative symptoms

despite their criticality in schizophrenia. Many diagnostic parameters are based on positive

symptoms because they respond better to drug treatment. Negative symptoms have been divided

into primary and secondary. Secondary negative symptoms are believed to rely on other things,

such as mood disorders, drug abuse, and cognitive impairment, whereas primary negative

symptoms are innate in schizophrenia. Physicians may benefit from knowing the difference

between primary and secondary causes to discover the best course of therapy for negative

symptoms (Cerveri et al., 2019).

Nursing implications

Nursing assistance for people with schizophrenia involves a thorough strategy

considering their physical, psychological, social interactions, and emotional requirements.

Nurses have various roles when attending to schizophrenic patients, including enhancing their

dignity, assessing people with schizophrenia, and reducing the stigma towards schizophrenia.

Proper communication and maintaining a patient's rights are some practices nurses must adopt to

enhance the patients' dignity. This also means the nurse will uphold confidentiality and not

divulge the patient's condition to other unwarranted members. Nursing education should

encompass assessing the traits and behaviours of schizophrenic patients, including social

interaction skills, reduced patient confidence, and enthusiasm for medication adherence. Nurses

need to encourage people to stop the public stigma towards schizophrenia. This stigma causes

other people who need medical help not to come out for fear of being victimized. Nurses should

lead by example with a positive belief towards mental disorders (Rentala, 2022).
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Nurses also have a role in schizophrenia management, managing their families, providing

physical care, and offering psychiatric rehabilitation. Nurses should work with other healthcare

workers to better care for schizophrenic patients. Nurses working in mental health can be trained,

equipped, and given the authority to assist in managing schizophrenia. To improve outcomes for

those who work with schizophrenic patients, mental health nurses ought to create therapy

strategies and targets, practice with empathy, cooperate with medical doctors and patients,

minimize referral complications, get involved with psychodynamic treatment methods, and assist

in rehabilitating patients. Nurses should encourage and inform relatives and members of society

on how to maximize their abilities and seek society-based recovery programs.

Additionally, nurses need to provide them with psychological counselling and training in

social skills so they may better understand schizophrenia as a whole and alter their behaviour in a

tolerant and supportive way. To provide physical health care, nurses can work with psychiatrists.

Lastly, nurses can offer psychiatric rehabilitation to schizophrenic patients. The goals of

psychiatric rehabilitation include enhancing the standard of living, improving symptoms and

well-being, fostering integration into society, and encouraging independence. Psychiatric

rehabilitation can be offered alongside drug treatment for a better comprehensive approach

(Rentala, 2022).

Conclusion

In conclusion, schizophrenia is a complicated disease affecting many stigmatized people

despite being an inherited disorder. This paper clearly explains the aetiology, which is majorly

due to genetic factors, and the pathophysiology of schizophrenia, mainly due to increased

dopamine production. The clinical manifestations of schizophrenia involving positive and

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negative symptoms are also discussed in great detail. Lastly, the paper offers great insight into

the roles that nurses can adopt in managing schizophrenia.

References

Cerveri, G., Gesi, C., & Mencacci, C. (2019). <P>pharmacological treatment of

negative symptoms in schizophrenia: Update and proposal of a clinical algorithm</p>.

Neuropsychiatric Disease and Treatment, Volume 15, 1525–1535.

https://doi.org/10.2147/ndt.s201726

De Berardis, D., De Filippis, S., Masi, G., Vicari, S., & Zuddas, A. (2021). A

neurodevelopment approach for a transitional model of early onset schizophrenia. Brain

Sciences, 11(2), 275. https://doi.org/10.3390/brainsci11020275

Habtewold, T. D., Rodijk, L. H., Liemburg, E. J., Sidorenkov, G., Boezen, H. M., Bruggeman,

R., & Alizadeh, B. Z. (2020). A systematic review and narrative synthesis of data-driven

studies in schizophrenia symptoms and cognitive deficits. Translational Psychiatry, 10(1).

https://doi.org/10.1038/s41398-020-00919-x

Park, H.-J., Choi, I., & Leem, K.-H. (2021). Decreased brain ph and pathophysiology in

schizophrenia. International Journal of Molecular Sciences, 22(16), 8358.

https://doi.org/10.3390/ijms22168358

Rentala, S. (2022). Severe mental illness: Rehabilitation need and role of Mental Health Nurse.

Journal of Medical Pharmaceutical and Allied Sciences, 11(6), 5382–5388.

https://doi.org/10.55522/jmpas.v11i6.4480
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Stilo, S. A., & Murray, R. M. (2019). Non-genetic factors in schizophrenia. Current

Psychiatry Reports, 21(10). https://doi.org/10.1007/s11920-019-1091-3