Introduction/Background of Disease, Paranoid
Schizophrenia
Patient Information of Disease, Paranoid Schizophrenia
The name of the patient is Ms.
Atheer. She is a 22 years old girl, and she is a dependent daughter. It has
been known that she is dealing with the disease named Paranoid Schizophrenia.
Las time she was admitted to the hospital in 2013. In her recent visit to an
outpatient clinic, the chief complaint is that she is suffering from sleep
disturbance as well as severe anxiety.
History of Present Illness (HPI)
It is mentioned earlier that Ms.
Atheer is having Paranoid Schizophrenia, and it was first identified in 2013.
But lately, she was going well due to regular follow up check-ups as well as
good compliance. It is important to mention here that Atheer is studying at
Dammam University as a final year student in Islamic Studies. It has been
observed that Atheer has been good in her social as well as academic
performance. She lives at her home with her mother, and her father works
somewhere in the remote area. It was noticed by her mother that Atheer was
having sleep disruption, continuous anxiety as well as lack of focus in her
studies. Moreover, she was also having a poor appetite. She was actually afraid
of her father that her mother will explain the situation to father when he gets
back home. When her father came back home, and she came to know about it, she
got more afraid and emotional. She was not feeling well so she was brought to
an outpatient clinic, where her check-up was done. The clinic offered that if
her mother wants a safe and controlled environment to manage the emotions and
anxiety of her daughter, then they can admit her in the clinic. It is important
to mention here that Atheer was not found with any hallucinatory experience,
suicidal ideas or death wish.
ROS of Patient of Disease, Paranoid Schizophrenia
As per reports, Atheer was
dealing with issues such as concentration, sleep, appetite, and energy, which
have been mentioned above. However, it is noted here that she had not reported
any issues such as nausea, chest tightness, muscle tension, headache, and
difficulty in breathing or a racing heart.
Past Medical & Family History
of Disease, Paranoid
Schizophrenia
As per her past psychiatric
history, for the last 6 years, she is diagnosed with Paranoid Schizophrenia.
Previously, she had been admitted to a Basic Health Unit. It is important to
mention that Paliperidone 6 mg was being used to maintain her. It has also been
observed that she has shown great compliance with her treatment, that’s why she
has been extremely stable as compared to many other patients in this similar
situation. As per family history, she denied any psychiatric issues earlier in
any other family member. She is a dependent daughter of her parents and she has
2 sisters and 2 brothers as well. She has not been involved in any kind of drug
or substance use.
Mental State Examination of Disease, Paranoid Schizophrenia
It is vital to elaborate that she
looks well dressed and appropriate in her appearance. Her behavior is very
normal and she used to speak softly. As far as her mood is concerned, she has
been tearful and anxious. Her thought processes, as well as thought content
both, have been identified as normal. Her insight, as well as judgment, is
good, and she has grossly intact with regards to her cognition.
Medication and Discharge Plan
As per current admission in the
clinic facility, she is given a variety of medicines. Around 9 types of
medicines are given to her so that she can be kept normal. It is estimated that
she will remain under observation for around one to two weeks. She will only be
discharged from the clinic, once it is made sure that she is physical and
mentally stable, and can handle the real-world situations as a normal person.
Pathophysiology of Disease, Paranoid Schizophrenia
It is important to understand
what pathophysiology is, before understanding the pathophysiology of Paranoid
Schizophrenia. It is basically developed due to the convergence of physiology
and pathology. It is a kind of study, where any patient is dealing with
disordered physiological processes due to any injury or disease. So, basically,
it is a concept, which explains the abnormal or disturbed condition of a
patient, which he/she has developed due to any particular disease (Orlov, Churilov, & Stroev, 2011). It is important to
know that there are different types of symptoms associated with Schizophrenia.
The first category is its positive symptoms. In this category, the patient may
feel hallucinations or delusions; it means that the individual has lost a sense
of reality. The second category is called negative symptoms, where an
individual having Schizophrenia will be identified with acts such as social
withdrawal, loss of spontaneous speech, and impaired motivation. The third
category of Schizophrenia deals with cognitive weakening. It is often observed
in some patients that their positive symptoms may start to remit or relapse,
but for some patients, the issue remains the same with regards to psychotic
symptoms. It has also been observed that cognitive and negative symptoms tend
to stay longer, having severe effects on the patient, and his/her capability of
performing societal functions (Fatani, et al., 2017)
It has been observed that various
research studies have been trying to find a relationship between Schizophrenia
signs and functions performed by specific regions of the brain. The research
has observed that grey matters had seen reductions, as well as white matter,
and have also seen irregularities with regards to various areas of the brain.
It is seen that when the progress of grey matter decreases, then it is related
to the illness. In addition to that brain imaging as well as pharmacological
literature has revealed that when a patient starts to feel hallucination or
delusions, it means that his/her dopaminergic neurotransmission is in the state
of dysfunction. It is also a fact that such type of condition is not only
associated with schizophrenia, but various other psychiatric conditions are
also attached to it. Looking at these facts as well as important information,
it is evident that brain areas are related to schizophrenia in so many
different ways (Fatani, et al., 2017)
Etiology of Disease, Paranoid Schizophrenia
It is vital to know that research
has been extensive in nature to identify the actual causes associated with
schizophrenia, but investigators are still trying to get precise information in
this regard. It is true that a lot of progress has been made in this regard,
but still, there is a lot more to investigate. However, it is agreed that
multiple factors can play a part in developing schizophrenia in patients. The
two most important relevant factors are environmental influences as well as
genetics. As far as schizophrenia’s development is concerned, it is found that
utero is the origin of this disorder. There are various issues, which have been
linked with schizophrenia, and some of these issues are low birth weight,
asphyxia, the emergency section of cesarean, gestational diabetes, as well as
bleeding at the time of pregnancy. The researchers have taken a keen interest
in the disturbances of fetal at the time of 2nd trimester. It has been observed
that when there is an excessive level of stress and infections issue is also
there, then the development of schizophrenia is the most likely thing to happen
(Patel, Cherian, Gohil, & Atkinson, 2014)
The scientific research has also
proved the fact that schizophrenia can happen due to genetic factors. The
research studies have come with evidence that if a 1st-degree relative had this
issue, then the person will have 10% chance of developing schizophrenia, and if
a person is a 2nd-degree relative, then chances of developing schizophrenia is
3%. If there are monozygotic twins, and one of them is having schizophrenia,
then there are 48% chances that the second one will also develop schizophrenia.
If parents of a child are having the disease of schizophrenia, then there are
around 40% chances that the child will also get this disease. It shows that
genetic part is very important to understand the causes of schizophrenia.
However, genetic factors are not the only one to associate with schizophrenia,
rather social & environmental factors can also play a major part. The
individuals, who are having vulnerability towards schizophrenia, they can
develop it due to social factors. There are various stressors linked with
environmental factors such as social isolation, resident of urban region,
minority ethnicity, and childhood trauma; and these stressors can be a reason
to develop schizophrenia. There are various stressors associated with social
elements such as economic adversity or discrimination, which can develop
schizophrenia (Patel, Cherian, Gohil, & Atkinson, 2014)
Prevalence Statistics
It is crucial to look at some
prevalent statistics associated with schizophrenia all around the globe as well
as in the Kingdom of Saudi Arabia. It is a well-known fact that schizophrenia
is one of the severe diseases and mental disorders. So, here are some of the
major facts & figures:
·
According to the World Health
Organization, around 21 million people all over the world are affected by
schizophrenia.
·
It is essential to know that schizophrenia
is also considered to be a disability all over the world, which means that it
can have a serious negative impact on professional and educational performance.
·
It is quite shocking to know that a person
having schizophrenia will likely to die 2-3 times earlier than a normal person,
which shows its severity. It has also been observed that rate of schizophrenia
in males is more than females all around the globe (World Health Organization, 2018).
·
It is vital to explain here that when
statistics are analyzed to see the prevalence of schizophrenia in Saudi Arabia,
the evidenced-based data is lacking. There have been various research studies
to see the prevalence of mental illness in different regions, and each study
came up with different results, but it is quite unfortunate that Saudi Arabia
has not been able to get accurate numbers in this regard, which is necessary to
get, otherwise considerable measures cannot be taken to deal with schizophrenia
(Almutairi, 2015)
·
However, different studies have been
conducted regarding mental illness. For instance, one study was conducted to
observe the mental illness issue in high school students, and result showed
that 48% observed population had mental illness issues (Almutairi, 2015)
·
One more study was conducted to know about
the psychiatric diagnoses related to inpatient as well as outpatient settings
for psychiatric issues. The data shows that out of these psychiatric patients,
55.8% inpatients were dealing with the issue of schizophrenia, whereas 28.9%
outpatients were having the issue of schizophrenia (ALOSAIMI, et al., 2017)
Signs and Symptoms of Paranoid
Schizophrenia
There are various symptoms, which
are associated with schizophrenia, and it is vital to notice such symptoms in
people living around so that they can be helped in treating the disease. The
patient having schizophrenia will always face difficulty in his/her thought
process, which means that he/she will lack clarity in thoughts, and confusion
will always be in his/her mind. The thought process is not the only affected
thing, but feelings, emotions as well as the capability to communicate with
others are also negatively affected by schizophrenia. A person can look for
various symptoms such as having hallucinations, delusions, lack of motivation,
disorganized & disturbed thought process, slow movement, disturbance in
sleep, lacking attention & focus, low sex drive as well as lacking interest
in several other things. It is critical to mention that a person having
schizophrenia will not experience all of the above-mentioned symptoms, rather a
combination of symptoms will be observed in variety of patients. These symptoms
will most likely start to emerge from the age of 16 years old to age 30 years
old. It is interesting to mention some examples like how a patient may start
thinking due to schizophrenia. For instance, a person may have fixed delusion
in his/her mind that life partner is having an affair with someone else, where
in reality, it is totally untrue. But still, a patient of schizophrenia will
continue to believe this untrue fact due to his/her abnormality and delusion,
where a belief is fixed regardless of its actual state. It has been observed
that patients having schizophrenia have not been associated with violence, but
still, the risk will always be there (WebMD, 2019)
Diagnostic Procedure of Paranoid
Schizophrenia
It is quite critical for everyone
to know that there are no laboratory tests available to diagnose paranoid
schizophrenia. A doctor will try to diagnose schizophrenia by completing a
detailed medical history of the individual. A physical examination along with
some diagnostic tests will also be conducted so that schizophrenia is
identified, and any other physical illness problems are ruled out. If a doctor
sees that there are no physical pieces of evidence to find a disease, then
he/she will refer the patient to a psychiatrist or mental illness experts so
that they can talk to the patient, and diagnose what kind of mental illness
he/she has. In this process of diagnosis, the mental health experts and
psychiatrists will get to know by analyzing symptoms, whether someone is
suffering from schizophrenia (Cleveland Clinic, 2018)
Prevention and Medical Treatment
It may not be possible to
completely prevent schizophrenia, but still, there are various prevention
methods, which can be adopted to at least lower the risk of developing
schizophrenia. It has been observed that different environmental and social
stressors are there, which can be a reason to cause schizophrenia in
individuals, especially when they are going through childhood and adolescence
period. A vulnerable person will easily develop schizophrenia; if these
stressors will put more stress on his/her mind. For instance, if a person is
having a genetic risk of developing schizophrenia, then his genes can get
active in social environments, where relevant stressors are present. If
relevant stressors will not affect that person, then he/she may be prevented
from schizophrenia. Both primary and secondary level measure should be taken by
the people so that they can avoid schizophrenia and they can also help their
loved ones to stay safe from this disease (Brown & McGrath, 2011)
Once the prevention was not made
sure, and a person has been diagnosed with paranoid schizophrenia, then it is
important to get medical treatment, otherwise, the situation can get worse.
First of all, antipsychotic medicines will be given to the patient as
prescribed by the relevant doctor or psychiatrist. It is important to know that
long term based injections are available to treat schizophrenia in patients.
Such long term medication is useful in situations, where a patient is not ready
to accept that his disturbing thoughts and delusions are actually due to
schizophrenia, and he/she refuses to take regular medicines. The positive
symptoms of schizophrenia can only be treated with these antipsychotic
medicines. So, in terms of negative symptoms of schizophrenia, the
psychotherapy can play a major role. This therapy can help patients to get back
to normal life, and socialize so that they can get back to reality. The role of
friends and family will also be crucial during the treatment of schizophrenia
because they work like a support system, which helps patients to get back to
normal relations (Cagliostro, 2019)
Conclusion of Disease, Paranoid Schizophrenia
It can be concluded in the end
that Ms. Atheer is having paranoid schizophrenia, which is basically a mental
disorder, and that’s why she is afraid of her father without any reason. It is
something that a patient of schizophrenia will always have like they will
develop a false belief in their mind. There are various factors such as
environmental and genetic factors, which can be a major cause of schizophrenia
in the patients. So, they should be properly treated by experts and doctors,
otherwise, the situation can get worse.
References of
Disease, Paranoid Schizophrenia
Almutairi, A. F. (2015). Mental illness in Saudi
Arabia: an overview. Psychology Reseacrh Behavior Management , 8,
47–49.
ALOSAIMI, F. D., ALZAIN, N., ASIRI, S., FALLATA, E., ABALHASSAN, M.,
QRMLI, A., et al. (2017). Patterns of psychiatric diagnoses in inpatient and
outpatient psychiatric settings in Saudi Arabia. Archives of Clinical
Psychiatry (São Paulo) , 44 (3).
Brown, A. S., & McGrath, J. J. (2011). The Prevention of
Schizophrenia. Schizophr Bulletin , 37 (2), 257–261.
Cagliostro, D. (2019). Paranoid Schizophrenia. Retrieved December
2, 2019, from https://www.psycom.net/paranoid-schizophrenia
Cleveland Clinic. (2018). Schizophrenia: Diagnosis and Tests.
Retrieved December 2, 2019, from
https://my.clevelandclinic.org/health/diseases/4568-schizophrenia/diagnosis-and-tests
Fatani, B. Z., Aldawod, R., Alhawaj, F. A., Alsadah, S., Slais, F. R.,
Alyaseen, E. N., et al. (2017). Schizophrenia: Etiology, Pathophysiology and
Management - A Review. The Egyptian Journal of Hospital Medicine ,
69 (6), 2640-2646.
Orlov, S., Churilov, L., & Stroev, I. (2011). [What is
pathophysiology nowadays? The reflections of the participants of ISP-2010
Congress in Montreal]. Patol Fiziol Eksp Ter. , 3-12.
Patel, K. R., Cherian, J., Gohil, K., & Atkinson, D. (2014).
Schizophrenia: Overview and Treatment Options. P&T , 39
(9), 638–645.
WebMD. (2019). What Is Paranoid Schizophrenia? Retrieved December
2, 2019, from https://www.webmd.com/schizophrenia/schizophrenia-paranoia#1
World Health Organization. (2018). Schizophrenia. Retrieved
December 2, 2019, from https://www.who.int/news-room/fact-sheets/detail/schizophrenia