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Case Study on Schizophrenia

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The Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) by the American Psychiatric Association or APA (2000) describes Schizophrenia as a disorder with duration of six months and the symptoms observed to be at least one month in active-phase.   Symptoms such as delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behaviour, negative symptoms. Two broad categories include positive and negative; where, the former pertains to symptoms that reflect a “distortion of normal functions”, while the latter pertains to symptoms that “reflects loss of normal functions” (APA, 2000).

Browsing through the database PubMed Central for current research trends on schizophrenia resulted to around 96912 articles as of 2012. The Schizophrenia Research Forum (2012) is conducting research on computerized technology to aid neural and cognition training among schizophrenics.  The Stanley Medical Research Institute (SMRI, 2012) shows a collection of 61 research materials done in the USA on awarded treatment trials and drug development.  Some of the treatment modalities mentioned in the list by SMRI (2012) include research on the use of Repeated Transcranial Magnetic Stimulation, Cognitive Behaviour Therapy for Auditory Hallucination, Errorless Learning, and use of Probiotic Organisms.

The WPA (World Psychiatric Association) in 2011 funded research projects that deal with  careers on psychiatry, stigma attached to psychiatry and psychiatrist, its adaptation to cancer treatment, holistic care regimes, and social status of persons with mental illness.  Current technological advancements and constant research on prediction and prevention of schizophrenia with a focus on early diagnosis and treatment strategies would entail that the number of emerging cases would dwindle or at the very least lessen.  Nonetheless, Bechdolf et al (2011) states otherwise that treatments modalities in schizophrenia may have made significant advances in the last decades, but a great number of patients still show unfavourable response, which tantamount to schizophrenia ranking number eight worldwide as a common cause of disability among persons age 15-34 years old. 

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The current trend of research into schizophrenia from early diagnosis, prodromal investigations, and therapeutic modalities indicates that there is a significant need to address the mental state of individuals and its effect on their daily living. 

Levitt and Veague (2007) illustrate five types of delusion in schizophrenia which are a) delusions of grandeur, b) delusions of guilt, c) somatic delusions, d) persecutory delusions, and e) delusion of reference.  Persons with delusions of grandeur believe that they are famous like a movie star or a god.  Persons with delusions of guilt have a false belief in regards to them committing a heinous crime or sin.  Persons with somatic delusions believe that certain physical symptoms of illness are present in their body even if no medical examination would prove its presence.  Persons with delusions of persecution believe that there is a person or an unidentifiable object which is out of the world to cause them harm or worse to kill them.  Persons with delusions of reference believe that they are the subject being referred to in television, radio, or newspaper.

The DSM-IV (APA, 2000) presented the subtypes of schizophrenia as follows: a) Paranoid, b) Disorganized, c) Catatonic, d) Undifferentiated, and e) Residual type.  

Discussion

In this study, Sarah’s assertion of her perception that imaginary people are conversing with her within the room indicates auditory and visual hallucinations.  Her communication with her informant through the television manifests delusions of reference.  Moreover, her department store outburst regarding people conniving against her is a forewarning of delusions of persecution.   The psychiatrist assessment fits the criteria in the DSM-IV-TR.   There is ambiguity regarding the onset and length of her supposed schizophrenic attacks yet her other symptoms confirmed the diagnosis.  Levitt and Veague (2007) explicate the diagnosis in schizophrenia is possible based on two things.  First, patient must exhibit two symptoms with duration of six months (or less if in the active phase) from the criteria in DSM-IV and second, in the absence of other symptoms, one bizarre auditory hallucination must be present.  In Sarah’s case, the auditory and visual hallucinations, delusions of persecution, and delusions of reference justified the prison psychiatrists’ diagnosis.   Sarah displays symptoms of the paranoid type of schizophrenia.   Levitt and Veague (2007) explained that paranoid-schizophrenics’ common symptom is delusions and hallucinations. Accordingly, persons under this category often appear normal and engage in daily activities without perplexity.  In Sarah’s case, she was innocently shopping until she noticed the television outside the fitting room. 

Diagnostic criteria if evaluated by trained clinicians promote positive prognosis of an illness.  APA (2000) reminds us that the diagnostic manual is a professional’s reference and not a “cookbook guide” [sic].  A viable and valid assessment for schizophrenia includes the patients’ personal and medical history.  It is neither safe nor appropriate to base judgments on presumptions. Other behavioural characteristics are dismissed to ascertain the probability of a mental illness.  Inadequate information leads to a discrepant diagnosis and poor prognosis.

Sarahs’ treatment includes exploring the evolution of her delusions and hallucinations.  According to Levitt and Veague (2007), early behaviours are precursors to paranoid-schizophrenic attacks.  Levitt and Veague (2007), Bechdolf et al (2011), and the SMRI (2012) confirmed that primary treatment for schizophrenia includes neuroleptic medications.   Continuous adherence to therapeutic regimens and constant engagement in daily activities would enable persons with mental illness to rejoin society.

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