Essay Sample on Stable Chronic Schizophrenia

Introduction

This study explores the relationship between depressive symptoms affecting patients who have suffered chronic schizophrenia and how these symptoms relate to the psychopathology and treatment of the condition. The study begins by introducing schizophrenia and providing extensive literature on schizophrenia, its associated depressive symptoms, and depression rating scales. For the investigation of the research topic, a sample of 350 outpatient schizophrenia patients from Taif hospital was randomly selected and investigated on the DSM-III qualification. Out of this population, 175 Patients were eligible for the Beck Depression Inventory (BDI), while 101 patients were eligible for the Positive and Negative Syndrome Scales.

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Background

Based on information released by the World Health Organisation (WHO) 2019, Schizophrenia is a severe chronic mental disorder, with a worldwide total of 20 million patients infected. The significant signs of this disease include distorted perception, emotions, thinking, behavior, language, and sense of self. Patients often experience delusions (fixed and false beliefs) and hallucinations (seeing things and hearing voices that do not exist in the real sense). Other symptoms of the disease include abnormal behavior such as self-neglect, mumbling at self, wandering aimlessly, and appearing unkempt. Further, incoherent and irrelevant speeches are some features of patients with the disease. A considerable percentage of schizophrenia patients have marked empathy and disconnected observed and reported emotion. Global analysis of the condition shows that the disease results in considerable disability, shoddy work, and academic performance. Further, according to WHO, schizophrenia patients have a 2 or 3 higher death prevalence than the rest of the population, resulting from metabolic infections and cardiovascular complications associated with the disease. Medicines and psychosocial support are essential for schizophrenia patients who are often victims of violation, discrimination, and stigmatization.

In Saudi Arabia, mental health is an unexplored research area, with most of the research papers on the issue providing scanty information. According to WHO 2020, 22% of health clinic patients in the city of Al-Khobar had mental disorders such as anxiety and depression. The percentage was 30%-40% of patients who visited hospitals. 18% of the adults in central Saudi Arabia had cases of minor mental morbidity, with the rates increasing for younger adults, widows, and divorcees. The nation experiences low suicide rates, with immigrants and men aged 30-39 being the primary suicide victims. The mental health facilities include Taif Hospital, general private hospitals for psychiatric care, university, national guard and military hospitals, hospitals for the treatment of drug dependence or alcohol, psychiatric clinics and departments attached to general hospitals, and rehabilitation centers in non-governmental and private organization sectors. According to Al-Subaie et al. (2020), Saudi Arabia lags behind other nations in healthcare spending on mental health disorders, with a 2% financial commitment, which is lower than the 6% global financial commitment to the same. One thousand six hundred and eighty-six outpatient mental health visits occur per 100 000 patients, with the global patient number being 8176 in high-income nations. However, 3747 people with a mental health condition visit the psychiatrist hospitals annually, compared to an average of 3555 for high-income nations globally. Studies on psychiatric morbidity show that mental disorders prevalence in the nation is 48%.

Chronic Schizophrenia

The diagnosis of most psychiatric disorders relies on combining an observer's results with the patient's self-report measures. The research on the subjective assessment of schizophrenia is inconclusive, following less research into the relationship between the observer report and the self-report on depression due to schizophrenia. This often results from the incongruity and affective flattening, which serve as labels when describing schizophrenia's affective state. Affective flattening manifests low emotional reactivity, mood measurement, expression, and feeling. Based on the studies, there is no significant difference between depressed chronic inpatient schizophrenics and matched samples of non-depressed patients. This implies that negative symptoms do not always imply the coexistence of depression. The studies on the association between observer reports and self-reporting depression measures show that significant relationships exist between these groups.

Some scholars regard schizophrenia as a heterogeneous entity, and they continuously seek the consistent patterns of the complex disorder. According to Anderson and Olsen 1982, schizophrenia has two distinct syndromes resulting from phenomenological profiles. The positive syndrome consists of characteristics such as disorganized thinking, hallucinations, and delusions, superimposed on the patient's mental status (type I syndrome). On the other hand, the negative syndrome consists of features such as passive withdrawal, blunting of affect, and deficits in social, affective, and cognitive functions (Type II)

Since time immemorial, the most recurring symptoms of chronic schizophrenia are a depression of moods. Several studies on the illness have established depressive subtypes of schizophrenia and symptoms that distinguish manic depressive illnesses and dementia praecox. One of the most accepted ideologies is that the core symptomatology of schizophrenia of depression. However, some studies show little agreement to the etiology that depression of mood is a common symptom of schizophrenia and has an association with suicides. The depressive symptoms occur during the acute stage of the illness, with a prevalence of 22%-80% (WHO, 2019).

The DSM-III diagnostic criteria are a consensus-based classification with an operationalized protocol and multiaxial evaluation. According to the DSM-III, the traditional dichotomies such as psychotic versus neurotic and organic versus functional are dismissed. The medics assign a patient to one of the 15 disease categories. Some of the psychotic disorders qualify to be paranoid or schizophrenic disorders. According to the American Psychiatric Association 1987, a psychotic patient has mental disorders which makes them inaccurately evaluate their thoughts and perceptions, and often infer wrong information about their external reality despite the provided evidence.

The definition does not apply to minor realities' distortion on relative judgment issues. For instance, a depressed person who constantly undermines their capabilities and achievements do not qualify to be psychotic (Thomas, 2001). However, those who would believe that they were responsible for a natural catastrophe qualify for the disorder. Delusions and hallucinations are the first direct evidence of psychotic disorders. DSM-III-R replaced DSM-III using minor modifications which suited the psychotic disorders. The term schizophrenia replaced schizophrenia disorders; delusional, paranoid disorder replaced paranoid disorders. Further, the term mood disorders replaced affective disorders, and induced psychotic disorders replaced shared paranoid disorders.

Common Symptoms

One of the most common symptoms associated with schizophrenia is comorbid obsessive-compulsive symptoms (OCSs). The prevalence of the condition is 31.7% higher for schizophrenia patients than the general population. A study on shared etiology of the two phenotypes, obsessive-compulsive disorders (OCDs) and OCSs and psychosis liabilities in unaffected siblings and patients, increases depending on their clinical causes and neuroimaging findings. Furthermore, second-generation antipsychotics (SGAs) increase the prevalence of OCSs in schizophrenia. The knowledge on the presence of OCSs in isolated psycho-pathological dimensions is paramount when investigating on the shared mechanism of OCD and schizophrenia. Several studies prove the positive and lack of association between psychotic or positive symptoms and OCS.

The impairment levels in patients with OCS result from psychosocial functioning. There is no significant relationship between cognitive functioning and OCS/OCD. Patients with OCD and schizophrenia have more affective depressive symptoms, an expected result following the fact that depression is the primary comorbid disorder in OCD. The studies on schizophrenia and its associated symptoms and conditions vary in conclusions due to variability in sample sizes, assessment tools, recruitment settings, and methodological differences. Moreover, other limitations that often affect the study include (1) lack of evidence of the sensitivity of drug-related change monitoring (2)lack of a conclusive measure of the general psychopathology of the condition and its influence on the harshness of negative and positive syndromes (3) inadequate measure of the relative positive and negative symptoms preponderance (4) lack of adequate capability of dimensional and typological syndrome assessments (5) imbalance in the representation of negative and positive facets of the disease and (6) evaluating the presence but ignoring the severity of the symptoms of the disease.

Depression Rating Scales

There have been several studies investigating how depression rating scales behave, their strengths and weaknesses in determining a patient's health condition. Adequate and right assessment of the symptoms of depression is an evidence-based practice that is necessary for establishing the right treatment to administer to a patient. The rating scales have two primary uses. First, they quantify the patient-related outcomes and symptoms in clinical research, and secondly, they are adequate in monitoring the clinical practice treatment outcomes. Most schizophrenia patients rely on the scales in the evaluation of the symptoms, and a vast discrepancy in the role of the scales exists due to the time consumed and length of the measurement scales.

Conclusion

The study utilized the Arab version of these assessment tools. The study shows that 33 patients had critical depressive symptoms, and the symptoms were correlated with some factors such as hostility, social support, and sources of finance. However, there was no significant correlation between the symptoms and demographic variables such as age, marital status, gender, and alcohol intake. These results imply that the persistent depressive symptoms of patients in a community are subject to antipsychotic treatment, patient's perception of social support, and positive psychotic symptoms.