The Recent Publication Of The
The recent publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V, 2013) is expanding among clinicians as a new diagnostic tool, although its use is not fully established. This new edition, where the new diagnostic category in which schizophrenia is collected, is entitled "Schizophrenic Spectrum Disorder and Other Psychotic Disorders", introduces some important changes in the diagnosis of this disorder, compared to previous editions of the manual. Before going on to comment on the main changes that affect, above all, the diagnostic criteria, we must underline that the introduction of the chapter has been extended to define in a more concrete way the different domains of psychotic psychopathology and describe more widely the organization of various psychotic disorders. (Carpenter et al., 2009). In the first instance, to establish the diagnosis of schizophrenia two of the symptoms of criterion A exhibited by the patient are required, and one of these two symptoms must be one of the first three lists: delusions, hallucinations, and disorganized speech.
Other changes made in relation to the diagnostic criteria of schizophrenia are, on the one hand, the clarification of negative symptoms in the same criterion A and, on the other hand, the clarification of the criterion F. Experts have considered that abulia and diminished emotional expression are key aspects of negative symptoms, and that the latter describes much better the nature of the affective abnormality, than the affective flattening. Thus, the fifth characteristic of criterion A will be negative symptoms (such as abulia or diminished emotional expression). Criterion F, which referred to the addition of the diagnosis of schizophrenia, in case of clinical history of autism or generalized developmental disorder only if delusions or hallucinations are also maintained for at least 1 month (or less if successfully treated), we have also included "any childhood communication disorder" as a pre-condition to the addition of the diagnosis.
In the Middle Ages, mental patients were burned believing it was witchcraft, in the Age of Enlightenment recruited by force to those who were called without reason, the famous retirement homes started by Pinel and Tuckey with professional treatment until they eliminated therapies biological as the electroconvulsive or Comas of insulin, it is not until the middle of the last century that psych pharmaceuticals appear.
However, with the widespread use of psychotropic drugs, it was found that the improvement of patients was relative, to achieve functional independence of people with mental illness was not enough to administer a good drug, but it was demonstrated the need to promote alternatives of psychosocial rehabilitation. Thus the understanding of mental illnesses, over time was evolving to reach the concepts used today, in this tonic is found that in 1899 Kraepelin formulated his concept of mental illness which he called early dementia, he used the expression " basic disorder ", not in the strict sense, but in the sense of" frequent characteristic symptoms ", for Kreapelin the definition of schizophrenia was concise and restricted, with age of beginning in the first decade or beginning of the second. (Insel, 2010).
With the appearance of neuroleptic drugs in the mid-twentieth century there was a drastic change. Schizophrenia was considered a "dopamine disorder" based on the psychosis-inducing effects of dopamine-releasing drugs, such as amphetamine and the antipsychotic efficacy of a large number of drugs that changed the procedure of psychosis. that caused patients to take the treatment out of hospitals and in certain cases provide the remission of important symptoms of the disease.
Early neuroleptic drugs such as chlorpromazine and haloperidol have been changed for more "atypical" antipsychotics that have fewer secondary effects such as tremor and rigidity, but which are more effective than the original dopamine. Although the usual antipsychotics significantly reduce delusions and hallucinations has not improved functional recovery for example: people who suffer from this disease, but who have a job, an explanation for disability is largely due to cognitive deficiencies tend to have problems to concentrate and memorize. Healthy people who received a lower dose of NMDA receptor antagonist such as ketamine demonstrated select aspects of schizophrenia including some problems to concentrate. (Insel, 2010).
Millions around the world have been diagnosed with schizophrenia, a disease characterized by delusions and hallucinations. The medicines available for treatment mitigate some of their symptoms, but do not fight the cause that causes them. Schizophrenia is the result of the interaction of numerous factors. The theory on which scientists are currently based is that there would be an alteration in the development of the central nervous system, already from prenatal life, which could explain the later anomalous functioning. (Carey, 2016).
Although the exact cause of the development of schizophrenia has not been determined, most experts in the field of mental health are the cause of several factors. These factors are described in more detail below:
Genetic factors: For a long time, it has been known that schizophrenia is a familiar disease. Although schizophrenia occurs in 1% of the population, this condition occurs in 10% of people who have a first-degree relative with this disorder. In addition, scientists believe that several of our genes are associated with an increased risk of developing schizophrenia, but there is no single gene that causes this disease.
Physical factors: through continuous research, the same, also, the factors of balance in reactions, emotions, the brain, the involves, the neurotransmitters, the role, development, schizophrenia. In addition, neuroimaging studies have shown that the brains of people with schizophrenia look different from healthy people.
Environmental factors: Patients who have experienced obstetric complications, premature births, low birth weight and perinatal hypoxia are more likely to develop this disease. People who throughout their lives have had the support of their parents are not as likely to develop this disease compared to those with hostile parents. (Picchioni., Murray, 2010).
The blockade of the D2 receptor remains at the top of the psycho-pharmaceutical treatment of schizophrenia, after 60 years that was discovered in the first antipsychotic agent in 1952.
The treatment will be designed to help achieve the goals that the person with schizophrenia considers important. In addition to pharmacological treatments, psychotherapy and psychosocial interventions, they can also be considered appropriate in your case. At present it is known that following an effective pharmacological treatment can control the symptoms of the disease and achieve stability. For this it is very important that the person with schizophrenia understand and accept that medication is essential to avoid relapses in their disease, so that there is no worsening in their prognosis and can have a life as normal as possible. Currently there are effective medications to treat many of the symptoms of the disease.
Antipsychotics are drugs that protect the brain against the chemical imbalance that occurs in it, normalize altered brain functions and prevent relapse by regulating the central nervous system. Currently, there is a wide variety of antipsychotics and the goal is to get the optimal dose of a drug, which produces greater clinical improvement with fewer side effects.
For a better recovery of schizophrenia and that, together with pharmacological strategies, are specified in the following: (a) psychoeducational family interventions, (b) training in social skills, (c) cognitive-behavioral treatments, directed both towards the positive symptoms of the disease as well as the alterations of the underlying basic cognitive processes, and (d) the multimodal integrated packages. The de-institutionalization of patients during the last two decades favored the incorporation of their relatives as an important therapeutic resource; especially after investigations that had highlighted the influence of certain characteristics of the family context on the evolution of schizophrenia, such as emotion expressed. Consequence of this was also the impulse experienced by family associations of self-help, whose objective was to reduce the feelings of guilt, increase the knowledge of the disease and develop educational procedures for the management of the patient. (Kristensen., Myatt, 2011).
As a result of psychological research, it is now possible to detect those patients who are at greater risk for the development of a first psychotic episode, often the starting point for schizophrenia. Important investigations have shown that, by detecting deficiencies in information processing, through specific brain wave patterns, we can better predict the appearance of a first psychotic episode in subjects with risk symptoms, such as mild paranoia. Through this method, psychologists were able to determine a risk group with up to 75% chance of developing a first psychotic episode. Once the risk group was detected, the next step would be to begin preventive psychological treatment with these people. Psychological treatment protocols used in this risk group reduce the possibility of a first psychotic episode by up to 50%.
People with schizophrenia have unhealthy lifestyle habits, 70% smoke, many abuse other substances, exercise poorly, lead a sedentary lifestyle and have an unbalanced diet. In fact, their life expectancy is 10 years less than that of they do not suffer from this pathology also taking into account the high incidence of suicides.
The union of these bad habits with the adverse effects of treatment with antipsychotics causes a great increase in the risk of cardiovascular disease. "Among schizophrenia sufferers there are almost twice as many prevalence of obesity, diabetes and metabolic syndrome.
It has been suggested that the best strategy to try to prevent the cardiovascular problems of these patients is to work with them and decide which is the best pharmacological treatment, as well as trying to convince the patient to improve their diet and abandon certain harmful habits such as consumption of alcohol and tobacco, it is very difficult for a person with schizophrenia to stop smoking. It is also essential that patients exercise. With a walk is enough. For this the families of the patient have to do their part since most tend to have the patient in bed, listening to the music and quiet. (Ward et, al. 2017).
In its consideration of the clinical realities of schizophrenia, the DSM-IV warns readers that the evaluation of the symptoms of this mental illness "in cultural or socioeconomic situations different from their own, should take into account these cultural differences". Furthermore, "ideas that may seem delusional in one culture (for example, magic and witchcraft) may well be common in another. In some societies, visual or auditory hallucinations with religious content may be a normal part of religious experience. (For example, seeing the Virgin Mary or hearing the voice of God.) These warnings appear in a specific section of the discussion around the symptoms of schizophrenia: "Specific traits of culture, age and gender" The problem is much more complex than this pair of extreme positions. As is known, a series of studies promoted by the World Health Organization since the 1960s has shown that schizophrenia belongs to this group of mental disorders present around the world. This group also includes other organic disorders of the brain, manic-depressive psychosis (in the DSM-IV, bipolar affective disorder), certain anxiety disorders, and perhaps major depression (2). This is to say that schizophrenia is a universal category, and as such it is a phenomenon to some extent independent of the society in which patients live (3). However, certain symptoms of schizophrenia occur more frequently in some regions of the world, with a core of symptoms that appear in all societies. Likewise, the course of this disease seems to be more benevolent in the less developed regions of the planet (like Colombia that participated in these studies), and much more severe in the industrialized societies of the First World. In this way, everything points in the direction that next to a universality in the symptomatology of schizophrenia based on an undoubted nucleus of biological dysfunctions, there is also a great variation. And this variation can only be attributed to important socio-cultural factors, and even of the life history of the sufferer, intervening in the disease (4). Which means that not everything in schizophrenia is neuro-physiological, although part of the psychiatric opinion clung to the postulate of the biological basis of this disorder.
Schizophrenia is a disease and not a spiritual condition, although undoubtedly this disease affects the individual in all his being, including his soul. It is necessary to understand that it is not necessary to be an expert in order to be of help and, as will be seen later, in the process of counseling and accompaniment of those suffering from schizophrenia should be involved as many members of the local church as possible. The first thing we should do is to urge that you are under the care and supervision of a psychiatrist. The fact that there is continuity in the treatment makes it possible to talk with the patient who is better able to receive help. Another factor to keep in mind is that there is a need for the company in the adaptation process. It must be remembered that many schizophrenics debut with hallucinations or delusions, so they are hospitalized in psychiatric institutions. It is in the process of going back home and learning to live with this crippling chronic disease that it is necessary for the church to be present. This is where the resources that God has given us as a community are of incredible benefit. Our God has placed in the church individuals with different gifts for the edification of his body. In cases with schizophrenia, it is where the mercy and contention of the congregation must sustain the patient. Here applies the exhortation made by Paul in the first letter to the Thessalonians: "And we exhort you, brethren, to admonish the undisciplined, encourage the discouraged, support the weak and be patient with all" (1 Thessalonians 5: 14). Another issue to keep in mind is that the person, despite being incapacitated by his illness, is still a sinner who must be warned and who is in the process of sanctification. The fact that he has been diagnosed with schizophrenia does not make him morally irresponsible before God. He or she needs the rebuke or timely advice from the people around them with the goal of advancing their maturation process in the Christian life. Schizophrenia is a disease that has disabled you, but this does not give you an excuse or a free pass to behave as you want.
The conclusion that has been gained from studying and analyzing all the material on schizophrenia is that it is a disease that in fact is not yet known enough, and for which no cure has been found or is believed to be non-existent.
The schizophrenics are people who can lead a normal life like others, but you never know to what extent they have another world around which other are not really aware, they see, they hear, they are not and that is something that intrigues a lot, that’s why I wanted to do this job.
They are people who need a lot of help from the health staff as well as in their own home with their family and friends, you need understanding and patience, and above all, be alert to any situation as they sometimes feel intimidated or persecuted for no reason.
But with help, support and a lot of love and above all faith, everything can be done, and we must not forget that they are people and that they are not aware, since all the experiences that live because of the disease live them as real.