Schizophrenia:
The Disease, Treatment, and Management
The Russian View of Mental Illness
Schizophrenia: The Disease, Treatment, and Management
Schizophrenia is a mental disorder that affects how a person thinks, feels, and behaves. It can be
debilitating and cause rifts in relationships, as well as issues with employment. While schizophrenia can
be treated, there is no known cure. During this presentation, we will discuss the pathophysiology, signs
and symptoms, treatment, complications, nursing interventions, and health promotion of schizophrenia.
Schizophrenia is most likely a result of a combination of inherited genetic factors and nongenetic
factors that impact the brain. There are several hypotheses about the neurotransmission system in the
brain and disruptions that may cause schizophrenia. A major neurotransmitter hypothesis is the revised
dopamine hypothesis. This hypothesis proposes that there is hyperactive dopamine transmission in the
mesolimbic areas and hypoactive dopamine transmission in the pre-frontal cortex in patients with
schizophrenia. There are also hypotheses around abnormal levels of serotonin, hypo-functioning of
receptors for the amino acid, N-methyl-D-aspartate, and insufficient or excess activity of glutamate.
Researchers have also formed hypotheses about the pathophysiology of schizophrenia based on an
understanding of the mechanism of action of antipsychotics used to treat this disorder.
Genetic studies have shown that having a first-degree family member with schizophrenia
increases the risk of being diagnosed with schizophrenia, with the largest risk being an identical twin.
There are eight known genetically different types of schizophrenia. There is also research that states that
the C-4 gene can cause some of the cognitive symptoms of schizophrenia.
Other risk factors associated with schizophrenia include prenatal viral infections, poor maternal
nutrition or starvation, advanced paternal age, and exposure to toxins. Complications and injuries at birth,
as well as closed head injuries, are also significant risk factors. When drugs such as cannabis, lysergic
acid diethylamide (LSD), and methamphetamine are used by those who are already susceptible to the
disease, there is an increased risk of developing schizophrenia. Stressors can cause a manifestation of
symptoms.
There are no diagnostic tests for schizophrenia. It is diagnosed by cataloging the symptoms a
patient is exhibiting. People with schizophrenia are usually diagnosed between the ages of 16 and 30,
after the first episode of psychosis. Symptoms of schizophrenia are divided into four different categories:
positive, negative, cognitive, and mood.
Positive symptoms of schizophrenia are ‘add-on’ symptoms. These symptoms are alterations in
thinking (delusions, concrete thinking), alterations in speech (associative looseness, circumstantiality,
tangentiality, neologisms, word salad, echolalia, clang association), alterations in perception
(hallucinations, illusions), personal boundary difficulties (depersonalization, derealization), and
alterations in behavior (grossly disorganized or catatonic).
Negative symptoms of schizophrenia are ‘deficit’ symptoms. They are: Apathy, lack of
motivation, anhedonia, blunted or flat affect, poverty of speech, and social withdrawal. Cognitive
symptoms are some of the most debilitating and include impairment of memory, disruption in social
learning, and inability to reason, solve problems, or focus attention. Mood symptoms are alterations in
mood that include depression, anxiety, demoralization, suicidality, excitability, and agitation.
Schizophrenia can also include other clinical manifestations, particularly paranoia and disorganization.
Treatments for schizophrenia help to manage the disease but cannot cure it. There are therapy
based, nonpharmacological treatments, and pharmacological treatments. Nonpharmacological treatments
include milieu therapy, which is used for acute cases in the hospital setting and psychotherapy and
psychoeducation. Psychotherapy and psychoeducation have several different programs that help a patient
learn coping skills, prevent relapse, and provide support. These programs include the Program of
Assertive Community Treatment, Family Psychoeducation/Therapy, Cognitive-Behavioral Therapy,
Cognitive Remediation, Social Skills Training, and The Recovery Model and Recovery-Oriented Care.
Pharmacological treatment is used in combination with therapy. The first line treatment is
antipsychotics, particularly second-generation antipsychotics. First generation antipsychotics tend to be
used less frequently, as they have more and harsher side effects. As depression is common with
schizophrenia, antidepressants are commonly prescribed along with an antipsychotic. Benzodiazepines
are no longer used for long-term treatment but are used during acute episodes to reduce panic levels of
anxiety and aggression.
Schizophrenia has some common comorbid conditions that make it even more complicated to
treat. With a diagnosis of schizophrenia, there is an increased risk for other psychiatric disorders. The
rates of cooccurring anxiety disorders, obsessive-compulsive disorder, and panic attacks are significantly
higher in this population compared with the general population. Depression is common, with suicide
being a leading cause of premature death in this population. There is an increased risk for cardiovascular
disease, respiratory disease, influenza, pneumonia, and diseases associated with alcohol and drug use for
those diagnosed with schizophrenia, which also leads to an increased risk for premature death. Treatment
for schizophrenia can have the side effect of causing metabolic syndrome, mostly associated with the use
of antipsychotics. Those with schizophrenia also have an increased risk for substance use.
Nurses have an important role in caring for a patient with schizophrenia. Patients who suffer from
schizophrenia do not always realize that they need help, especially during the acute phase when their
mind is in turmoil. During the acute phase of the illness, safety is of utmost importance for the patient,
staff, and other patients. Nurses must also administer ordered pharmacological treatment, practice crisis
intervention, support the patient, consult with other specialties such as psychiatric, medical, and
neurological, provide a therapeutic milieu, support the family and involve them in the patient’s care, if
possible, and intervene during hallucinations, delusions, and paranoia by acknowledging what the patient
is going through, but presenting reality.
After the acute phase comes the stabilization phase. The nurse must support and teach the patient
and their family about medication and side effect management, illness management, relapse prevention,
and continue psychoeducational work with families as needed. Nurses should be aware of community
resources to which they can direct patients and families to, such as home health services, work support
programs, day hospitals, social skills training and support groups, family educational skills groups, and
respite care.
The maintenance phase is the best phase for a patient, as schizophrenia has the least impact on a
patient’s life during this phase. Nurses must continue to support and teach the patient, as well as their
family, especially about coping skills and medication adherence. The nurse should also encourage the
patient to participate in therapy for cognitive and social skills enhancement and vocational rehabilitation
(if needed), and to be involved in recovery and support groups.
The biggest intervention that promotes wellbeing in those with schizophrenia is psychoeducation.
This should include the patient and their family and/or other support persons in their life. Providing
practical education can increase a person’s ability to manage symptoms of the disease, instill hope,
promote wellness, and increase a person’s self-esteem. Educating the patient and family should start by
helping them to understand the illness, the symptoms, and the treatment. Effective family education leads
to better outcomes for the individual struggling with symptoms associated with schizophrenia. Not
understanding the disease and its symptoms can lead others to judge the patient and fosters hostility and
tension in relationships with family and friends and has a negative impact on employment.
In conclusion, schizophrenia affects many people, but they can live full and vibrant lives. It takes
a lot of work, an awareness of the treatment, and the support of others, but it is possible. People who live
with this disease should embrace this hope and move forward, knowing that there may be setbacks, but
that this disease does not define who they are as a person.
The Russia View of Mental Illness
Russian public opinion about mental illness has long been controlled by what the government
portrays. Those who are mentally ill are perceived by the Russian public as dangerous, incurable, useless,
and harmful. Public opinion of the whole field of psychology is negative, and that is perpetuated by the
media and government. Traditionally, those who suffered from mental illness were hidden away, to reduce
the shame they brought the family. Russians are more likely to view those with depression as 'weakwilled' and leading an 'immoral lifestyle’, therefore those suffering with mental illnesses are more likely
to deal with their own problems than to turn to anyone else, even those whom they trust. There seems to
be a serious underdiagnosis of mental health disorders in Russia that may be associated with complex
factors that include, but are not limited to, the current stigma associated with the state-operated
psychiatric service.
The Russian government has long used mental health issues as a political tool to put away those
that disagree with them. Abuse of psychiatry was in the Soviet Union, for several decades, a State policy
to quell dissent, and was carried out in collaboration with the then leadership of Soviet psychiatry.
Approximately one-third of all political prisoners were subjected to this practice. The Russian State has
total control and has centralized mental health services. This leads to an overall authoritarian management
style and is ultimately most destructive to patient care with manageability of patients being prioritized
over efficiency of treatment. The government is constantly trying to save money in treating those with
mental illness, and patients’ rights are openly being ignored. Human rights activists have warned of a
growing use of punitive psychiatry in Russia as the Kremlin intensifies crackdowns on dissent in recent
days.
A nurse must address all concerns held by a Russian patient and their family. An explanation of
the pathophysiology of the disease will help mold a more realistic view of the disease and help a patient
and their family shed stigmatized views, allowing them to be more willing to seek help and treatment.
This process may take time, and the patient and their family’s views will not change overnight, but as the
nurse and health care team patiently works with them, change will hopefully come, and treatment can be
implemented to allow the patient to improve and live a full and happy life.