During the 1950s, mentally disordered people who were harmful to society and themselves could be treated with medications and were able to return safely to their communities. During the 1980s, the cost of health care increased more than any other cost in our national economy. As a result, strategic planning has been made to reduce costs. “The political decision made to deinstitutionalize chronic mental patients started with the appearance of phenothiazine medications. Dramatically reducing the instability influenced by psychosis, these medications were of great significance to many individuals with serious mental disorders. At both the state and federal levels, legislators looked at the high cost of long-term psychiatric hospitalization. Social scientists guaranteed them that community-based care would be in the best interests of all concerned: the mentally ill and the general, tax-paying public.” It was believed that a social breakdown syndrome would develop in chronically mentally ill persons who were institutionalized. The characteristics of this syndrome were submission to authority, withdrawal, lack of initiative, and excessive dependence on the institution (Seeds).
Schizophrenia is the most common psychoses in the United States affecting around one percent of the United States population. It is characterized by a deep withdrawal from interpersonal relationships and a retreat into a world of fantasy. This plunge into fantasy results in a loss of contact from reality that can vary from mild to severe. Psychosis has more than one acceptable definition. The psychoses are different from other groups of psychiatric disorders in their degree of severity, withdrawal, alteration in affect, impairment of intellect, and regression (Insight). In psychotic disorders, the intellect is involved in the actual psychotic process, resulting in derangement of language, thought, and judgment. Schizophrenia is called a formal thought disorder. Thinking and understanding of reality are usually severely impaired. The most severe and prolonged regressions are seen in the psychoses, regression. There is a falling back to earlier behavioral levels. In schizophrenia this may include returning to primitive forms of behavior, such as curling up into a fetal position, eating with one’s hands, and so forth. The symptoms of schizophrenia usually occur during adolescence or early adulthood, except for paranoid schizophrenia, which usually has a later onset.
The process of schizophrenia is often slow, with the exception of catatonia, which may have an abrupt onset. As an adolescent, a person who later develops schizophrenia is often antisocial with others, lonely, and depressed. Plans for the future may appear to others as vague or unrealistic (Seeds). It is possible that there may be a preschizophrenic phase a year or two before the disorder is diagnosed. This phase may include neurotic symptoms such as acute or chronic anxiety, phobias, obsessions, and compulsions or may reveal dissociative features. As anxiety mounts, indications of a thought disorder may appear. An adolescent may complain of difficulty with concentration and with the ability to complete school work or job-related work. Over time there is severe deterioration of work along with the deterioration of the ability to cope with the environment. Complains such as mind wandering and needing to devote more time to maintaining one’s thoughts are heard. Finally, the ability to keep out unwanted intrusions into one’s thoughts becomes impossible. As a result, the person finds that his or her mind becomes so confused and thoughts so distracted, that the ability to have ordinary conversations with others is lost (Insight).
The person may initially feel that something strange or wrong is going on. He or she misinterprets things going on in the environment and may give mystical or symbolic meanings to ordinary events. The schizophrenic may think that certain colors hold special powers or a thunderstorm is a message from God. The person often mistakes other people’s actions or words as signs of hostility or evidence of harmful intent. As the disease progresses, the person suffers from strong feelings of rejection, lack of self-respect, loneliness, and feelings of worthlessness. Emotional and physical withdrawal increase feelings of isolation, as does an inability to trust or sociate with others.
The withdrawal may become severe, and withdrawal from reality may be noticeable from hallucinations, delusions, and odd mannerisms. Some schizophrenics think their thoughts are being controlled by others or that their thoughts are being broadcast to the world. Others think that people are out to harm them or are spreading rumors about them. Voices are usually heard in the form of commands or belittling statements about his or her character. These voices may seem to appear from outside the room, from electrical appliances, or from other sources (Insight). There are many different factors that lead to schizophrenia.
The main way to acquire schizophrenia is through heredity. A person has a 46% chance of getting schizophrenia if his or her mother and father has it. One identical twin has a 46% chance of getting schizophrenia if the other twin acquires it. There are also some environmental factors that lead to schizophrenia. One is if the mother gets the flu during the second trimester of pregnancy causing brain damage to the unborn child. Another factor is complications at birth that could affect the child mentally. Another factor causing schizophrenia is stress because the mind is overworked and eventually can’t function properly. An important factor concerning schizophrenia is how a child is raised. If the child has abusive parents, he or she will have serious mental problems in the future (Cognitive). Early in this disease, there may be obsession with religion, matters of the supernatural, or abstract causes of creation. Speech may be characterized by unclear symbolisms. Later, words and phrases may become puzzling, and these can only be understood as part of the person’s private fantasy world.
People who have been ill with schizophrenia for a long time often have speech patterns that are disoriented and aimless and deficient of meaning to the casual observer. Sexual activity is frequently altered in mental disorders. Homosexual concerns may be associated with all psychoses but are most prominent with paranoia. Doubts concerning sexual identity, exaggerated sexual needs, altered sexual performance and fears of intimacy are prominent in schizophrenia. The process of regression in schizophrenia is accompanied by increased self-fixation, isolation, and masturbatory behavior (Insight). The schizophrenic person finds himself or herself in a painful dilemma.
He or she retreats from personal intimacy or closeness because of the intense fear that closeness will be followed by ensuing rejection or harm. This retreat from intimacy leaves the person lonely and isolated. This dilemma often becomes the nurse’s dilemma. The nurse wishes to form a productive emotional bond but at the same time seeks to lessen the client’s anxiety. For the schizophrenic person, moves toward emotional closeness will eventually increase anxiety (Cognitive). The dopamine theory of schizophrenia is based on the action of the neuroleptic drugs, better known as antipsychotic drugs.
Neuroleptics are the drugs of choice for treating the symptoms of schizophrenia. The neuroleptics are believed to block the dopamine receptors in the brain, limiting the activity of dopamine and reducing the symptoms of schizophrenia. Amphetamines, just the opposite, enhance dopamine transmission. Amphetamines produce an excess of dopamine in the brain and can provoke the symptoms of schizophrenia in a schizophrenic client. In large doses, amphetamines can simulate symptoms of paranoid schizophrenia in a nonschizophrenic person. Some symptoms of schizophrenia are due basically to hyperdopaminergic activity. Other symptoms, such as apathy and poverty of thought, are related to neuronal loss (Insight). Although the therapy and drugs help the schizophrenics deal with their problems tremendously there is not enough to go around because states are closing their mental institutes for financial reasons.
Even though the cost of mental institutes are high, the schizophrenics are better off being kept in them because they could cause a huge uproar on the streets. Without the mental institutes the schizophrenics will get worse because they are unable to live independently. Many schizophrenics might even be harmful to society because their brain is out of control. The paranoid schizophrenics could go on a rampage and try to kill everyone in sight because they think that everyone is out to hurt them. This could be the future of our world if we don’t take time to treat these schizophrenics who desperately need it no matter what the cost (Cognitive).
Glasiusz, Josie. “Seeds of Psychosis” Discover, October 2001, page 33,2p. EBSCO. Online. 27 February 2002. http://www.search.epnet.com. McGorry, Patrick D.; McConville, Scott B. “Insight in Psychosis” Harvard Mental Health Letter, November 2000, page 3,3p. EBSCO. Online. 27 February 2002. http://www.search.epnet.com. Beck, Aaron T.; Rector, Neil A. “Cognitive Therapy for Schizophrenic Patients” Harvard Mental Health Letter, December 1998, page 4,3p. EBSCO. Online 27 February 2002. http://www.search.epnet.com.
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