Research Paper on Epidemiology of a Chronic Disease

Introduction

A chronic disease is a long-term, slowly progressing, and non-communicable medical conditions (Reynolds et al., 2018). Chronic illness accounts for most premature deaths in adults across the world. According to Dennis (2016), the multi-mobility of chronic conditions is high in most developed countries and its prevalence increases with age. Healthcare systems in most countries have put much focus on acute episodic care, making it very challenging to deal with most chronic illnesses. To add, chronic diseases usually require long-term care, supervision, and observation, thereby adding to the technicality of dealing with most chronic illnesses. While chronic illness is a slow and long-term developing syndrome, acute illness, by contrast, is a severe medical condition at the onset. This paper presents a research on the epidemiology of schizophrenia and its impact.

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Schizophrenia

Schizophrenia is among the serious world's public health issues ranked among the most incapacitating diseases (Szkultecka-Debek et al., 2015).Generally, the disease is characterized by three psychopathology domains namely, negative and positive symptoms, and cognitive deficits. The positive symptoms include hallucination and delusions among others, while lack of motivation, emotional reactivity, and social withdrawal are some of the negative symptoms. The cognitive deficits impair patients' attention executive functions and the working memory. The researchers Szkultecka-Debek et al. (2015) report that 60 percent of schizophrenia patients experience negative symptoms and 30 percent of these patients usually have sufficient prominent symptoms to warrant medical attention. The negative symptoms impair the ability of patients to have an independent life, be socially active, maintain a personal relationship, carry out work or studies, and perform daily life activities. The loss of social life puts schizophrenia patients at a relatively higher risk of committing suicide. It has estimated that 4.9 percent of a patient suffering from schizophrenia will commit suicide (Szkultecka-Debek et al., 2015).

Schizophrenia patients require constant encouragement and support from the community around them. Therefore, the family plays an important role in helping schizophrenia patients to get back to their normal life. The risk of developing the illness is highest in individuals aged 15-30 years (Janoutova et al., 2016). Its course varies among patients and the disease usually manifests itself in a number of episodes. It is approximated that a third of schizophrenia patients usually return to their normal life after several episodes of the illness. The other two-thirds of patients are reported to experience recurrent episodes characterized by alternating minimal to frequent symptoms (Janoutova et al., 2016). The researchers, Janoutova et al., (2016), further report that schizophrenia patients may have their lives shortened by up to 20 percent, in comparison with the mean life expectancy of the healthy population. Jaaskelainen et al. (2013) assert that only 1 out 7 schizophrenia patients may recover after treatment indicating that improvements in the treatment options have not been very effective.

Pathophysiology of Schizophrenia

Despite being heterogeneous in nature, the etiopathogenesis of schizophrenia has not been well understood. Several hypotheses have been put across in an attempt to explain the etiology of the illness. Among these hypotheses are the neurodevelopmental and dopamine hypotheses. Neurodevelopmental hypothesis postulates that the development of schizophrenia is as a result of several neuro-disorders (Bakirhan, Sahiner, Sahiner, Safak, & Goka, 2017). These disorders specifically affect neuronal connections, neuroplasticity, and neuronal migration. Brain-derived neurotrophic factor (BDNF) is believed to have an important contribution to these disorders. Though the hypothesis is debatable, there is substantial evidence to prove the link between schizophrenia and BDNF. In their study, Fernandes et al. (2015) established that there was a significant reduction in BDNF level among schizophrenia patients and the decrease becomes more pronounced as the illness progresses. It is believed that the first and second trimesters mark the onset of pathological neurodevelopment process of the illness. These processes result in a neuronal circuit that leads to the generation of psychotic symptoms especially during young adulthood (Nour & Howes, 2015). A study conducted by Bakirhan et al. (2017) reported that schizophrenia patients showed significantly lower serum BDNF levels in comparison to those of healthy persons, used as controls. However, some studies have generated conflicting results concerning the BDNF levels in schizophrenia patients. Results from such studies indicate higher BDNF levels in patients diagnosed with schizophrenia (Bakirhan et al., 2017). However, the high BDNF levels have been attributed to genetic backgrounds, the intensity of illness, treatment profiles thereby rendering it nonconflicting evidence.

The dopamine hypothesis asserts that psychotic conditions similar to those in schizophrenia are induced by increased concentration of dopamine in the extracellular region (Howes, McCutcheon, & Stone, 2015). A further proof for this is that drugs such as alpha-methyl-para-tyrosine and reserpine reduce psychotic conditions by depleting dopamine levels (Howes et al., 2015). These observations have led to the conclusion that schizophrenia results from dopamine receptor abnormalities. Post-modern studies reveal an increase in D2 receptor densities and striatal dopamine level as causes for neuropathological changes in schizophrenia patients. A study by Howes, Williams, Ibrahim, and Leung (2013) indicates a considerably high concentration of a rate-limiting enzyme, tyrosine hydroxylase, in the dopamine synthesis within the substantia nigra of schizophrenia patients. It is believed that dimerization of dopamine receptors play a vital role the development psychotic symptoms of schizophrenia. According to Howes et al. (2015), schizophrenia patients show a significant increase in D2 dimmers. Additionally, there is a close link between increase D1-D2 heteromers, found in the globus pallidus, and schizophrenic conditions. Therefore, changes in D1 and D2 dimerization can have a great impact on schizophrenia although this analogy is yet to be tested in vivo (Howes et al., 2015).

Evidence-Based Diagnosis and Treatment of Schizophrenia

Diagnosis

Psychotic symptoms are used as the primary indicators of schizophrenia. However, not all psychotic symptoms are indicators of the illness. Therefore, these psychoses are broadly categorized into two groups namely, primary and secondary psychoses (Rajesh & Tampi, 2018). Primary psychoses consist of mild disorders which include schizoaffective, brief psychotic, delusional, schizophreniform, and mood disorders. These disorders closely resemble one another in terms of symptoms and therefore a patient may be referred to a psychiatrist. Rajesh and Tampi (2018) explain that secondary psychoses include dementia, delirium, and other medical illnesses that cause psychotic symptoms as listed below:

• seizures
• neuropsychiatric disorders
• endocrine disorders
• cerebrovascular accidents
• autoimmune diseases(such as Hashimoto encephalopathy)
• narcolepsy
• metabolic disease such as Niemann
• Pick disease

It is advisable to carry out a detailed physical and historical examination in order to conduct a rule out on other causes of the psychotic symptoms as evident in a patient. If a patient is having a recent psychosis, then the patient should go through a renal function and complete blood count testing in the laboratory (Rajesh & Tampi, 2018). Further, the patient should be subjected to urine toxicology and urine culture sensitivity. Other measurements to be taken include blood glucose level, thyroid stimulating hormone, folic acid, HIV antibody, antinuclear antibodies, and erythrocyte sedimentation rate. It is advisable to use magnetic resonance imaging or cranial computed tomography for patients with focal neurological deficits or typical cases that are linked to schizophrenia, for example, old age.

Treatment

Most primary care physicians are more likely to encounter schizophrenia patients that are still in their first psychosis episodes. However, it is always more likely that patients expressing signs and symptoms of schizophrenia have been experiencing these conditions for quite some time has never received any psychiatric care. Therefore, a psychiatric coordinated management is preferred up to a time when the symptoms are stabilized. Urgent psychiatric referrals are always recommended although, hospitalization is not always necessary for psychosis. Collaborative and inter-professional approach to schizophrenia treatment is always effective and preferred (Rajesh & Tampi, 2018). This approach should include the provision of medication, clinical management for primary care, psychological treatment, and moral and social support. Both first and second generation antipsychotics are recommended for patients diagnosed with schizophrenia. First-generation antipsychotics include drugs such as perphenazine, haloperidol, and chlorpromazine among others. On the other hand, secondary-generation antipsychotic drugs include clozapine, asenapine, olanzapine, and risperidone among others. Antipsychotic drugs are effective in curing the positive symptoms but show little effect on cognitive or negative symptoms (Fusar-Poli et al., 2014). Patients should be given adequate time of at least 4 weeks during therapy before changing medication. Patients reporting sufficient relief from symptoms should be subjected to maintenance therapy (Fusar-Poli et al., 2014).

Schizophrenia Mortality Rate among Men and Women

Olfson et al. (2015) summarize mortality rates among patients diagnosed with schizophrenia in the United States in table 1 below.

Table 1. A summary of mortality rate among patients diagnosed with schizophrenia in the USA.

The study by Olfson et al. (2015) reports a higher mortality rate in schizophrenia patients than that of the average population, translating to more deaths in schizophrenia patients than in non-schizophrenia patients. The number of deaths due to natural causes was generally higher in Schizophrenic patients than in other patients. Among schizophrenia patients, a higher rate of natural death was reported in men than in females. The natural causes of death considered in the study include cardiovascular diseases, cancer, and other causes such as diabetes, and influenza. Unnatural causes of death such as poisoning, suicide, homicide, and accidents accounted for more deaths in men than in women.

Remarkably, schizophrenic women have a better prognosis than their male counterparts. Ran et al. (2015) explain that schizophrenic women are more likely to receive better support from the community than their fellow ill men. To add, women tend to have more family members than men translating into a large support base for female patients. Furthe...