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Symptoms Of Disorganized Schizophrenia Psychology Essay

Schizophrenia is a severe mental disorder characterized by delusions, hallucinations and physical agitation; which typically causes such patients to severely misjudge the distinction between reality and their imagination. Schizophrenia's prevalence on the globe was highlighted as 26th in the set of diseases, ranked according with their contribution with their overall burden to society all together according to a report done by Murray and Lopez, 1996. For instance, it is estimated to get cost the NHS a superb £4. 7 billion in the united kingdom during 2004/05 [25]. In addition in this essay I'll discuss a range of elements, from what factors boost the susceptibility of inducing schizophrenia and the current treatments on offer that will help alleviate common symptoms. The condition itself has a wide influence on several other prominent factors, involving both individuals themselves but also the global community, which will be later discussed, in regards to their social and economic context. Schizophrenia is this enormous problem since no long term cure currently exists.

Types of schizophrenia

There are 3 specific classes of schizophrenia [2]:

Paranoid schizophrenia

Disorganized schizophrenia

Catatonic schizophrenia

Symptoms of paranoid schizophrenia

The dominant feature of paranoid schizophrenia is excessive suspicion and delusions to be oppressed.

Symptoms of disorganized schizophrenia

Disorganized schizophrenia usually becomes noticeable at a youthful age compared to the other styles of schizophrenia.

Individuals with disorganized schizophrenia have a problem with the responsibility of supporting themselves. Therefore may be not capable of fulfilling basics needs, for example, being able to feed themselves.

The following includes additional symptoms of disorganized schizophrenia:

Weakened ability to communicate

Slurred speech

Immature behaviour

Expression of inappropriate feelings, in the incorrect situation.

Symptoms of catatonic schizophrenia

The interference in movement summaries catatonic schizophrenia: This can either be considered a decline in motor neuron activity (stupor state) or a growth in motor neuron activity (excited state).

Stuporous (a state of unresponsiveness) motor signs. Sudden stoppage of most intentional movement and dialogue.

Excited motor signs. Occasionally, schizophrenics may drastically differ from a state of stupor to circumstances of extreme exhilaration. Throughout this hyperactive phase, they could illustrate rapid speech or uncontrollable movement and even act out in violence, either self-inflicting or even to someone else

Example of the Symptoms of Schizophrenia [6]

The following summarises common symptoms that arise in schizophrenics:

Hallucinations

Sudden changes in behaviour

Depression

Delusions

Loss of insight

What causes schizophrenia?

The cause for schizophrenia has been the subject of vigorous debate, with numerous elements being proposed, discounted or amended. In unlike this, it must this day not yet been diagnosed by scientists to be solely induced by one particular factor. It really is however regarded as due to a blend of elements, which differ in every patient.

Recent studies have suggested that the next have been significant contributor's comprising a complex interaction between genetic and environmental factors, for example, prenatal development, genetics, psychology and neurobiology. [3]

Genetic causes of schizophrenia

Schizophrenia has a solid hereditary component which is proven to run in families, but no individual gene is accountable. It has been said that a combo of genes pose the potential to make people more vunerable to the disorder. In addition, people genetically predisposed to the problem have not always illustrated its symptoms, meaning that the biology of it will not guarantee having the condition. Studies imply genes take into account half (estimate) the risk of developing schizophrenia.

Individuals with a parent or sibling who is suffering from schizophrenia have a 10% chance of developing the illness, compared to the 1% potential for the overall population. Identical twins who have exactly the same genetic make-up as one another, if one of the two siblings has schizophrenia, their twin has a 48% possibility of developing it too. For example, Gottesman (1991) obtained data from the Maudsley twin register and then examined the records of 40 schizophrenic's studies between 1948 and 1964. Through statistical analysis he determined that 48% of the twins who had been monozygotic (identical - developed from one oocyte) been concordant (when both have or both lack confirmed trait) and for dizygotic (not identical - developed from two oocyte) only 16%. This further demonstrates that schizophrenia is not solely genetic; otherwise the concordance for MZ twins would be 100%.

Provided below is a table illustrating more information regarding the risk of developing schizophrenia for different individuals [4].

Relatives with schizophrenia

Chance of developing schizophrenia

None

1 in 100

1 parent

1 in 10

1 identical twin (same genetic make-up)

1 in 2

1 non-identical twin (different genetic make-up)

1 in 80

Table 1: This table illustrates the risk of individuals developing schizophrenia if someone in their family has been diagnosed.

Environmental causes of schizophrenia

As discussed previously inherited genes make an individual greater subjected to schizophrenia and furthermore environmental factors can too then act on this vulnerability to trigger the problem.

In regards to environmentally friendly aspects involved, on-going research is indicating the contribution of stress, either throughout pregnancy or at a further phase of life. High levels of stress activate schizophrenia by increasing the body's manufacture of the steroid hormone cortisol. Cortisol normally controls the bodies fight or flight response, although long-term exposure can damage and decrease the quantity of nerve cells in the hippocampus, the brain's primary memory centre. As a result there's a decline in the transmission of nerve impulses for memory recall, this damage leads to memory loss and impaired learning, features from the mental disorder.

Pregnancy where maternal stress is likely to be induced could possibly affect the development of the baby according to Gilmore & Murray's study in 2006 [8] [23]. To ascertain whether prenatal stress alters neural, hormonal, and behavioural processes, in an experiment they completed, pregnant rhesus monkeys were deliberately stressed frequently for 6 weeks of their pregnancy with various stimuli. Between 2-3 years of age, hippocampal volume, neurogenesis (generation of neurons), and cortisol levels were monitored in the offspring created from both stressed and control pregnancies. Prenatal stress caused a lower hippocampal volume and an inhibition of neurogenesis. These findings indicate that the prenatal environment can transform behaviour and affect the hippocampal structure of primates in a persistent manner.

Furthermore if the mother is actually anxious (stressed) while pregnant, there have been noticeable results suggesting reduced blood flow to the baby via the uterine arteries; arteries supplying nutrition and blood to the uterus. This may justify abnormalities in the introduction of the infant and the mothers high cortisol levels (a dominant stress hormone) could too pass onto the foetus. If satisfactory cortisol transports through the placenta from the mother to the foetus. Therefore could potentially affect the development of the mind and the future stress responses of the infant, thereby enhancing the chance of schizophrenia arising.

Studies indicate numerous stress-inducing environmental influences which may be related to schizophrenia, for example [22]:

Inadequate oxygen levels during labour (due to prolonged labour or premature birth)

Exposure to a virus during infancy e. g. T Gondi

Drug abuse - A relationship between marijuana use and the disorder has been suggested in the past (Andreasson, Allebeck et al. 1987). These conclusions have been validated by additional research. Fundamentally, the deductions drawn from many of these reports were that marijuana use can induce psychosis.

For example, according to Thomas H, he explained the occurrence of psychotic symptoms among marijuana users in a random selection of volunteers from New Zealand. Fourteen percent of cannabis users described "strange, unpleasant activities such as hearing voices or becoming convinced that someone is trying to harm you or that you will be being persecuted" after consuming the substance. Such symptoms are frequent with schizophrenics too. [29]

In addition Mather's DC conducted a report of patients surviving in two London hospitals whose urine was investigated for the presence of cannabinoids (the active constituents of cannabis). They found a connection between the presence of cannabinoids in urine and the disorder. This suggests a potential correlation rather than entirely causual link, either that cannabis use escalates the likely hood to be predisposed to a mental illness or that substance abuse is often adopted with post diagnosis [28]. The reliability of the data can be disputed though it is a published study, an example size consisting of two individuals is notably small, in particular when schizophrenia affects 1% of the global population, hence it might not exactly be appropriate in statistical representation of the entire population because fewer risk factors can be studied into account to generate sound data, prove a correlation exists and therefore make any hypothesis meaningful.

The cannabinoids found in cannabis, once consumed are believed to interfere with normal neural transmissions. The standard release of neurotransmitters, such as acetylcholine and dopamine (chemicals that help transmit impulses) from post synaptic neurons have emerged to be inhibited (Gill et al, 1970). In turn excitatory postsynaptic currents in neurons were drastically reduced. If this process becomes perpetual prominent ramifications of cannabinoids include disruption of psychomotor behaviour (such as speech and coordination) and shortâterm memory impairment [33]. Furthermore psychomotor retardation involves several symptoms that contain been acknowledged in schizophrenia. However there is miniscule evidence that such impairments are long term explained by Manuel Morrens study in 2006.

Abnormal brain structure

Due to the progression in neuroimaging, technology now allows scientists to look at functions in living organisms and in particular brain structure. Investigations involving schizophrenics have discovered irregularities in brain structure according to Johnstone (1976) [27]. Like the expansion of the ventricles (fluid-filled cavities), the decline in size and metabolic activity in particular brain regions. These brain ventricles signify an insufficiency in the quantity of brain matter. In addition evidence of abnormally low activity in the frontal lobe; the area of the mind in charge of higher order functioning including; speech and decision-making has too been gathered. Which could describe why schizophrenics experience slurred speech. Regardless of the evidence of brain abnormalities, it is doubtful that schizophrenia is caused by a single issue in any one area of the brain. Moreover microscopic studies of dead brain tissue in schizophrenics have also illustrated slight alterations in the distribution of brain cells. However these defects are not characteristic of all people who have schizophrenia, neither do they happen solely in people with the disorder. [7][8]

This image is of 28-year-old identical twins, one with schizophrenia and the other well. Hence it evidently illustrates two points: (1) schizophrenia is a brain disease with measurable structural and functional abnormalities in the mind; and (2) it isn't solely a genetic disease, and this other biological elements contribute in its etiology. C:\Users\Rahman\Documents\Schizophernia\schizophrenia-brains-identical-twins. jpg

Figure 1 - MRI scans of 28-year-old identical male twins showing the enlarged brain ventricles in the twin with schizophrenia (right) compared to his well brother (left)

Neurotransmitters

Brain cells need messages to be transported between them; neurotransmitters will be the chemicals that carry out this requirement. Neurotransmitters and schizophrenia show to demonstrate a relationship since medicines that modify the degrees of neurotransmitters in the mind are proven to alleviate a few of the symptoms of schizophrenia.

Therefore schizophrenia could possibly be triggered by a modification in the level of both neurotransmitters serotonin and dopamine - chemicals that help transmit nerve impulses in one nerve cell (neurone) to some other across a synapse (gap between two neurones), investigations have suggested [7][8]. Lastly the antipsychotic drug chlorpromazine thought to reduce relapse time (suffer deterioration over time of improvement), which too blocks dopamine-receptor complexes forming suggests that an imbalance of the two is most likely the foundation of the trouble.

Genes

In addition in 2006 a Gene associated with schizophrenia had been found, a University team from Edinburgh found people predisposed with what is named Neuregulin (gene) had a higher chance of developing similar psychotic symptoms. The longitudinal study followed several 200, of the same age and gender, for an interval of 10 years. [9][10][11]

This study could be deemed reliable to a extent, since though a decade is an extremely substantial amount of time, hence a huge amount of data could be collected to either support or disprove the theory. Furthermore by following individuals of the same age and gender, further risk factors which could influence the results were controlled. Meaning the data would be valid, because any results would be more apt to be influenced by genes alone.

"Neuregulin 3 is plainly yet another gene to add to the few currently recognized to contribute to schizophrenia, " says David Valle, director of the McKusick-Nathans Institute of Genetic Medicine at Hopkins.

Pregnancy and birth complications

The following circumstances improve the risk of the kid developing schizophrenia later in life [8]:

Exposure to a virus while in the womb

Asphyxia (Lack of oxygen) during birth

Malnutrition during pregnancy (Susser et al. 1996)

How is schizophrenia treated?

Due to the cause for schizophrenia still being undetermined, treatments target alleviating the symptoms. These include the utilization of both antipsychotic medication and different other psychosocial management techniques. Antipsychotic drugs assist in normalizing the biochemical imbalances that cause schizophrenia.

Antipsychotic medications

Medications used to treat schizophrenia are known as antipsychotics. Antipsychotics are 'dopamine antagonists' - they block receptors on the top of neurons.

How do antipsychotic drugs work?

Neurons (nerve cells) carry electrical impulses through their branches.

Neurons communicate 'chemically' by sending out 'bursts' of chemical signals (neurotransmitters - NT's) in to the synapse (space between neurons) and then 'sticking' to receptors on receiving neuron.

Receptors are 'shaped' to 'fit' with specific NTs and generate a fresh signal/change in the acquiring cell.

Molecules of antipsychotic drugs are deliberately 'shaped' in order that they stick to the dopamine receptors first; therefore protecting against the binding of NTs so no signal goes through to the post-synaptic/receiving cell. [30]

G:\BlackBerry\pictures\IMG00079-20130303-1521. jpg

Figure 2 - The picture above illustrates how the antipsychotic drug works by blocking the receptors on the post-synaptic neuron.

The following include commonly used medicine [13]:

Chlorpromazine C:\Users\Rahman\Documents\Schizophernia\Chlorpromazine 2D skeletal. png

Figure 3 - This picture illustrates the chemical composition of the antipsychotic Clozapine. Haloperidol

Ondansetron

Clozapine

Clozapine as stated above is a powerful drug utilized in treating psychotic symptoms, for example, hallucinations or long breaks with reality. Because antipsychotic drugs inhibit neurotransmitter and receptor complexes forming, such nerve impulses cannot be passed on through the neural pathway. Subsequently this prevents such thoughts from being processed by the CNS (central nervous system), like the brain and hence the individual doesn't encounter similar problems as before.

However it too has its drawbacks, it can on occasion result in the increased loss of white blood cells which assist the immune system to fight off infection. Because of this clozapine users require regular weekly blood tests in order to get their white blood cell count checked [26]. Moreover such a side-effect can become a concern where health services are limited in availability, as well as the condition of being in a position to cope with the price of blood tests and medicine, making treatment with clozapine demanding for a sizable most individuals. However clozapine is potentially valuable for individuals who are suffering from a resistance to alternative antipsychotic medication.

What are the side effects?

Further side effects might occur when schizophrenics get started taking their medication.

Side effects of many antipsychotics include [14]:

Tiredness

Light-headedness

Obscured vision

Increased heart rate

Inflammation

Menstrual complications for women.

One of the challenges with any form of medication is that a minority of individuals struggling to tolerate the adverse side ramifications of the drug prescribed for their condition terminate its use into several months of their treatment.

Furthermore in reference to a more serious medical note, persistent use (over several years) of antipsychotic drugs pose the risk of developing tardive dyskinesia (TD), a disorder categorised by involuntary movements. This may involve jerk movements of the limps (arms or legs) and certain other top features of the body. Nonetheless it only occurs in between 15-20% of all cases. The symptoms of TD are minor, to the extent where patients may be unaware [13]. Its cause is meant to be a result of prolonged inhibition of dopamine D2 receptors (a cell that dopamine binds to) which is thought to result in a surge in the quantity of D2 receptors in the striated section of the mind (regulates muscle contraction). This increase of D2 receptors enhances the chance of dopamine-receptor complexes forming, thereby resulting in further impulsive muscle contraction. [34]

Moreover typical antipsychotics can lead to severe obesity and alterations in someone's metabolism. Therefore can boost the likelihood of diabetes and high cholesterol levels forming (therefore there is a need for doctors to regularly monitor someone's weight, sugar levels and liquid levels).

Psychosocial Treatments (Alternative Treatment)

Along with the more common psychotic symptoms of schizophrenia, for example, hallucinations, which antipsychotic drugs have demonstrated to alleviate. Patients are still left dealing with the behavioural difficulties of the condition. This treatment aims to ease psychological distress through a more personal and interactive process, as opposed to the use of medication.

The following include methods in helping to treat these behavioural issues [5]:

Individual/Group Psychotherapy - consists of repeated scheduled talks between the patient(s) and a psychiatrist. Giving him/her the possibility to discuss the difficulties that leave them feeling distressed within an intimate and protected climate. Subsequently the weight off suffering the situation alone can be removed, the psychiatrist can then offer an explanation for the suffering that is progressive - that is, the individual understands something can be done to mend the situation. This leads these to conducting themselves in a healthier and active manner, whether it is thinking more positively or they learn how to keep better relationships. This appears to be effective because the individual is given the self-belief that any improvements are down to their own merit.

Family Education - This calls for teaching several coping techniques to families for the purpose of dealing better with their ill relative.

Relatives can be crucial tools when dealing with schizophrenics, with their support and guidance patients will get some form of normality and alleviate the consequences of solitude, one among the countless symptoms of the condition. Generally with the combination of medicinal and psychosocial treatment, patient's quality of life of can be drastically improved. However you shouldn't be deceived, the procedure process for a few individuals can be difficult to follow, in mention of drug side effects treatment may be discontinued. That's where relatives can be vital in assisting that patients do not relapse. C:\Users\Rahman\Documents\Schizophernia\psychiatry-couch2. jpg

Figure 4 - this picture illustrates an appropriate environment, typically in a psychiatrics place of practice where the patient can discuss his feelings on matters that cause concern and thereby hopefully reduce his psychological suffering. This should improve his quality of life.

Electroconvulsive remedy (ECT)

ECT is scarcely implemented in the treating schizophrenia (e. g. exceptions may include when there is a high risk of suicide). The following describes how the treatment would typically be conducted [32];

The patient will have a pulse oximeter linked to them, in order to monitor blood oxygen levels. Electrodes will be put onto the recipient's chest so that the electrical activity across the patient's heart can be observed using an electrocardiogram (ECG)

In addition an electroencephalogram (EEG) will too be simultaneously utilized to monitor brain activity

The monitoring of blood pressure is imperative, so that any faults during the treatment can be identified immediately; hence a blood circulation pressure cuff is put onto the recipients arm.

Using a sharp hollow needle connected to a transparent tube, access to the blood vessel is obtained for the administration of drugs

A sedated state is induced using the appropriate drugs to avoid erratic movement and a frequent way to obtain oxygen is provided throughout the task.

Next a bite block is placed in the patient's mouth because the jaw tightens through the treatment and weakened teeth could break.

Additional electrodes are positioned onto the head; the electrical current is then applied through the scalp of the mind triggering a seizure to occur.

What the seizures are believed to do vary, recommendations include triggering alterations in brain chemistry, especially in the balance of neurotransmitters, and therefore the brain can function normally because nerve impulses are neither slowed down or too fast. An alternative solution theory suggests that ECT can stimulate the growth of new cells and nerve pathways in certain areas of the mind, as a resultâ. . . which can easily inverse the symptoms of this illness, the specifics yet remain unknown (Wahlund B & Von Rosen D, 2003). Evidence from randomised control trials (RCTs) show restricted success, lasting short term (Cochrane Schizophrenia Group, 1999). The typical side effects that arise seem to be to include; muscle aches, headaches and memory loss instantly after the procedure.

Disadvantages of Psychosocial Treatments

With any form of treatment, certain limitations will always follow; this includes that psychotherapy will naturally take a significantly longer span of your time, in order for noticeable improvements to be observed in patients in comparison to drug remedy [24]. This is because psychotherapy very much depends on the utilization of the patients own mental experience to bring about the required changes, whereas drugs will work regardless.

Moreover in regards to the financial facet of the treatment, it can too place a severe burden on health services to facilitate either group or individual remedy sessions at the tax payers' expense, it's been estimated to cost society £2 Billion in direct cost of treatment in 2004/05 (Mangalore R, Knapp M, 2007). Furthermore psychotherapy alone is not completely successful and effective in people who have a severe psychological state, so drugs can sometimes be the only form of treatment.

Research into Stem Cell Treatment for Schizophrenia (Potential Treatment in the foreseeable future)

Stem cells are unspecialized cells that hold the potential to differentiate into any kind of cell found within the human body [19].

The National Institutes of Health states that stem cells "hold the remarkable potential to develop into various cell types in the body during early life and growth. " [15]

Stem cells contain the potential of great breakthroughs in the science community, in this case the possibility of an effective cure being produced in the future. However since our current limitations with the study, for example, issues with deliberate cell differentiation and the undetermined cause for schizophrenia such research has been delayed not till another 50-100 years so our knowledge of stem cells is at an enough level.

However there are ethical conditions that would arise in treating schizophrenia with stem cell remedy once scientifically possible. For the predominant reason that the pluripotent stem cells necessary for research are solely within embryos and the extraction of these would cause its death. For those people who believe life starts at conception, this can be regarded as murder, seeing as though a viable life had been forcefully refused and to destroy it is immoral [15]. Furthermore like any other new technology, because we've not had a vast timeframe to review it to assemble sufficient information on its broad impact; it is completely unknown what the long-term effects of this intrusion with nature could mean to society. Such as will patients grow an extra arm in 10 years from the point of its use? Lastly stem cells produced from embryos that aren't a patient's own may be recognized as a foreign body, so may be rejected. Therefore stem cell therapy may not continually be appropriate.

Although in order to balance the argument, stem cell remedy could be substantially beneficial to our society, it might potentially mean a cure, where patients would no longer suffer from the problem after treatment, leading to a better standard of living. It could therefore replace conventional types of treatment e. g. medicine that are prescribed on the regular/life time basis. Thereby removing the pain inflicted on people's lives caused by side effects and limits they can place such as, not being able to work from being too tired but more importantly reducing the responsibility positioned on society by schizophrenia, for example, the financial expense of producing drugs. Furthermore if the development of new drugs in this field are no longer as important, a by-product could mean fewer pressures to experiment on animals, which is a constituent of the drug development cycle. Hence animals would be subject to less brutality such experiments hold. With anything, the professionals and cons must be weighted out, so a decision suiting the majority is made.

C:\Users\Rahman\Documents\Schizophernia\Stem cells. jpg

Figure 5 - This illustration depicts pluripotent stem cells ability to differentiate into a range of cells within our bodies, for example, neurons.

Modelling schizophrenia using human induced pluripotent stem cells

Research carried out by Professor Fred Gage, a specialist in genetics has successfully been able to induce pluripotent stem cells (iPSCs) created from schizophrenic patients. Sage's study published in the journal "Nature" (April 13, 2011) suggests both that neurons formed from such individuals made fewer links with the other person compared to neurons within non-sufferers of the problem. Such research will have a number of beneficial impacts, including as explained by Gage [20][21]:

With further research there is potential of possibly replacing such abnormal neurons related to the condition with healthy ones. "This model not only affords us the possibility to take a look at live neurons from schizophrenia patients and healthy individuals to comprehend more about the condition mechanism, but also to screen for drugs that may be effective in reversing it. "

C:\Users\Rahman\Documents\Schizophernia\stem cells from schizophrenics. jpg

Figure 6 - This picture illustrates the healthy neural pathway in the mind generated from schizophrenia patient-derived induced pluripotent stem cells.

The Cost of Schizophrenia to Society:

Economical Implication

Also, for the federal government, especially in the UK where health care is provided cost-free, people with schizophrenia can be a severe financial constraint. Because such patients suffer from numerous debilitating symptoms, including depression and hallucinations. Doctors will prescribe medication in order to combat this, in this situation antidepressants (e. g. prozac) or antipsychotics of which both need to be payed for. This cost is financed by the tax payers, the condition doesn't stop there. With any drug, side effects can be found consequently of its usage; doctors too prescribe further medicine to treat these symptoms. The domino aftereffect of over scribing medicine leaves the united states with an overwhelming financial cost. In regards to Mangalore and Knapp's study in 2007 indirect societal charges for schizophrenia were estimated to once experienced an expenditure of £4. 7 billion in the UK in 2004/05 [25].

According to Marwaha & Johnson's journal published in 2004, it showed that amongst people that have long-term mental health problems in particular schizophrenia, only 24% were employed [18]. Because of this, in order for such visitors to maintain a standard of living, such to be able to purchase food and pay rent on their homes, they will usually claim an incapacity benefit entitling them to some money weekly. This cost will be supplemented by the government once again, increasing the full total financial burden left by mental disorder patients.

Social Implication

The improper treatment and dismissal of the symptoms of schizophrenia can be overwhelming for the individual and the ones surrounding him/her. Examples of the possible ramifications of schizophrenia are the following:

Suffering from schizophrenia can make working and retaining relationships immensely challenging, because such patients frequently suffer from relapses, typically involving hallucinations; whereby the individual claims to see things that are not really there. This can lead them to develop trust issues and communication problems, sometimes feeling that they are being persecuted by the individuals themselves. Because of this, the patients keep themselves isolated, disregarding their support or even presence. This may finally lead to the loss of relationships, which can have a psychological toll on the family members too who look after the person, realizing that they may never truly embrace the "same" person again. In addition schizophrenics are usually prescribed with antipsychotics to help alleviate their symptoms; these have various side effects much like any drug, including tiredness. Hence any form of additional work load for the patient from the place of work will be extremely difficult to handle; this explains why a large proportion of schizophrenics rely on welfare for money due to unemployment.

Moreover schizophrenics can be characterised as being very erratic, this may stem from any of the hallucinations they see, where they become very sceptical of individuals around them. In turn, they could act out violently because they no more have a sound mind-set, rarely being physical but this might lead to them being a danger to society so may be institutionalised, so that their needs can be met in a far more controlled environment.

Substance abuse. Alcoholism and drug abuse commonly develop in people who have schizophrenia, such intoxicating substances will be consumed to help ease the symptoms encountered by patients so that they can escape their reality. Over time the individuals could become tolerant (they need to consume more to attain the same feeling), which could lead to frequent overdoses where these are no longer in a position to make conscious decisions. Further reinforcing their inability to live a standard life even with the problem, such as maintaining employment as mentioned before.

Increased suicide risk. In schizophrenia suicide is the predominant reason for premature death. Schizophrenia can lead to suicide, although before someone can commit suicide they need to initially form suicidal intentions. Such intents are thought to be instigated by depression, another symptom of schizophrenia since it causes the victim to face emotional lows when it comes to their mood. Therefore these affects accumulate and can reach their ultimatum where the victims kill themselves to relieve the pain. This particularly happens during the influence of intoxicating substances while they are in their most vulnerable moment. The common life expectancy is estimated to fall 12-15 years for people that have the condition. It's been estimated that 10% of schizophrenics die by suicide (Caldwell and Gottesman, 1992) [16].

Evaluation of Validity

The sources obtained and listed below in the bibliography have been gathered from numerous websites for some I am going to now evaluate, for example;

One included the National Health Service (NHS) which is governmentally funded and the website itself has mentioned to obtain been last updated in the current year, 2013. Because of this any information provided is up to date, reliable and unlikely to be partial for somebody else's gain because societies best interests will prevail another agenda, since though it is paid for by the tax payers. [6]

Such sources have too been from journals, like the "US National Library of Medicine National Institutes of Health", where the information could have gone through a series of peer reviews among scientists of that field and who would have too repeated any experiments to ascertain if the same finding were collected before being publishing, in order to reduce misinformation and establish its accuracy.

Furthermore the quotes mentioned in this report, such as from Professor David Valle, who is undoubtedly a highly qualified academic that specialise in his particular field of choice, completed his research over many years (longitudinal study). This broad time span would have allowed for the researchers to form an in-depth understanding and gather a vast range of data, thereby increasing its reliability.

However on the other hand, some sources aren't as dependable. For instance, the web page netplaces. com [22] lacks credible information such as where the data originated from, how it was collected and was last updated in '09 2009. As a result, any current advances in the field would not be mentioned and then the data could be misleading for anyone utilizing it. Lastly no governing board is at location to control what appears on the site; therefore the data is flawed for an extent.

In conclusion in most of sources mentioned, the validly of the info provided has been established before being employed in this report.

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