There is no universal definition of psychiatric disorders. Most scholars and individuals merely give a list of disorders that fit into this category without giving a clear scope of the definition. This list is assembled by identifying the existence or non-existence of different concepts such as the degree of distress, dyscontrol, disadvantage, disability, inflexibility, irrationality, the nature of the syndromal pattern, its etiology, and statistical deviation (Stein et al., 2010) . For the purposes of this paper, Schizophrenia, which is universally accepted as a psychiatric disorder, will be analyzed. The following sections will delve into its clinical manifestation, theories of origin as well as the treatment program for diagnosed patients.
schizophrenia is a disease of the mind which can only be described based on its symptomatic manifestation. It is one of the most researched psychiatric disorders as it affects upwards of 51 million people in the world with over 2 million of these individuals residing in the USA (Schizophrenia.com, n.d.) . Adding to the complexities of its definition is the evolution of the most accepted definition given by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders with DSM -I having a broad definition which progressively narrowed down following the release of DSM-II and III which then broadened again in DSM-III, DSM-II-R, and DSM-IV which is retained in DSM-5 with the exception of subtypes (Tandon et al., 2013) . The symptom range was a major difference between DSM-I and DSM-IV, with the latter acknowledging negative symptoms as a sign of schizophrenia. Tandon et al. contend that DSM-IV scope of schizophrenia is the most reliable means to make a diagnosis in comparison to the rest. According to DSM-5, for a patient to be conclusively diagnosed as schizophrenic, they must, at a minimum exhibit two of the following symptoms: disorganized behavior or catatonia ,delusions, disorganized speech, hallucinations, and negative symptoms (Barnhill, 2013) .
Delegate your assignment to our experts and they will do the rest.
There are several theories on the causes of schizophrenia. Although there is no absolute clarity on the exact cause, there are a few theories that may explain the origin. The problem in reaching consensus on the origin has been attributed to the fact that schizophrenia may not be one single disease (Keshavan, Tandon, Boutros, & Nasrallah, 2008) . The causes can be broadly classified into genetics causes, drug use, prenatal factors, the dopamine hypothesis, the schizophrenic spectrum hypothesis, and the diathesis-stress model. The following section outlines some of the theories behind the etiology of the disease.
Genetics has been widely discussed as a possible cause of schizophrenia in individuals whose family member/s have been previously diagnosed. When combined with environmental factors, and a gene inheritance of genes linked to schizophrenia, offspring have a chance of inheriting the disease. This combination of factors makes it extremely difficult to pinpoint the exact cause and even to zero in on the particular environmental factors that may trigger the development of the disease. Another challenge is in identifying the exact genes that predispose individuals. Sanders et al. disputed the notion that a group of fourteen genes is the cause of the disease in a published study on An European population, showing the lack of consensus by scholars (Sanders et al., 2008) . What is agreeable is that genetic predisposition when a relative has the disease increases the chances of the offspring having the same. Statistics have shown that a child who has a biological parent that has been diagnosed with the disease has approximately a one in eight chance of developing it (Berger, 2011) .
Another theory is the disconnection hypothesis. It initially claimed that schizophrenia originates from the anatomical disconnection of the white matter, disrupting the neuronal pathway (Friston, Brown, Siemerkus, & Stephan, 2016) . Modern understanding of this hypothesis moves away f rom the physical anatomical disconnection to a functional understanding of the disconnection. To illustrate this, Friston gives an analogy of a radio which is not working well (Friston, 2017) . For the classical proponents of the disconnection hypothesis, the fault would be blamed on the physical severing of wires. For the modern proponents, this would be explained by transistors being broken, moving away from physical disconnection into the broader sense of disconnection from proper functioning that hinders the passage of stimuli correctly, causing the clinical manifestation of the disease.
A third theory is Dopamine hypothesis which contends that hyperactivity of dopamine D2 receptors and hypofunctionality of the dopamine D1 receptors leads to positive symptoms of schizophrenia and negative and cognitive symptoms of the disorder respectively (Gründer & Cumming, 2016) . links drug use to triggering schizophrenia or causing a relapse. Dopamine is an inhibitory neurotransmitter whose interference may cause schizophrenia. Studies have shown that alterations of other neurotransmitters such as serotonin, acetylcholine, GABA, and glutamate have been linked to the development of schizophrenia (Brisch et al., 2014) . This theory links the disease to drug use. Drugs such as amphetamines and cocaine increase levels of dopamine in the brain, causing symptoms similar to those experienced during psychosis (Brisch et al., 2014) . Evidence has not conclusively shown that drug use causes the disorder directly, but it has been shown as a trigger, especially when coupled with other factors such as socioeconomic hardships. Similar to the dopamine hypothesis is the serotonin hypothesis which when enhanced, causes symptoms of psychosis (Schmetzer, 2008) .
Another cause of schizophrenia is in prenatal factors caused by in utero complications. During pregnancy, the fetus's brain is developing. Any stress caused may interfere with this process, causing grave consequences. Stress factors such as gestational diabetes, asphyxia, bleeding during pregnancy and low birth weights have been shown to cause schizophrenia in the individual later in life (Dean & Murray, 2005) . This is particularly crucial during the second trimester (Patel, Cherian, Gohil, & Atkinson, 2014a) .
The understanding of the cause of the illness influences the course of treatment taken. There are several options for treatment of schizophrenia. These include; non-pharmacological treatment and pharmacological treatment. Following diagnosis, the medical practitioner should prescribe the best form of treatment. In most cases, both courses of treatment are undertaken concurrently. It is important to note that there is no cure per se, the only effect of treatment is in making the condition manageable and allowing the individual to live a normal life. Non-pharmacological treatment, as the name suggests, is devoid of pharmaceutical drugs. Psychotherapy, a non-pharmacological approach, can either be individual, group, and/or cognitive behavioral (Patel et al., 2014) . There are several forms of psychotherapy, but studies have shown that cognitive behavior therapy (CBT) has the strongest benefit for symptom reduction (Dickerson & Lehman, 2011) . Other forms of psychotherapy include mindfulness therapy, narrative therapies, and meta-cognitive training (Patel, Cherian, Gohil, & Atkinson, 2014) . This approach cannot be used in isolation but is only effective when used in conjunction with pharmacological drugs.
Pharmacological treatment approaches involve the use of medication to alleviate symptoms. Following a major psychotic episode, the medication must be administered as soon as possible to the patient. Kane and Correll suggest that the choice of drug is influenced by considering the patient's symptoms, the history of therapeutic response ,comorbid conditions, and adverse effects, as well as patient choice and expectations (Kane & Correll, 2010) . The efficacy of the drug is also an important consideration as different drug classes have different efficacy levels. The response rate for individuals who have just had their first major psychotic episode is usually very high with all drugs. This efficacy gradually reduces as the illness progresses (Robinson et al., 2006) . Over time, the effectiveness of the drug of choice should be monitored. Some symptoms may reduce or even permanently disappear, meaning the patient is in remission. This concept of remission has not been universally accepted. If a patient is not responding well to treatment, another course must be selected. For example, the physician may advise that the patient switch to a medication that bins to a different target receptor other than the one previously targeted. The efficacy of this the new treatment is then assessed.
Pharmacological drugs have known side effects. If these side effects are not monitored and handled, they will eventually affect the recovery process of the patient and their overall health. These side effects are brought about by the breakdown of the drugs in the system. metabolic side effects of these drugs include elevations in fasting blood glucose and lipids, drowsiness , dizziness , restlessness , dry mouth , constipation , nausea among others. Some of these side effects may be life-threatening . For example, in comparison to the general population, people with schizophrenia have been found to have elevated risk factors for cardiovascular linked deaths and an increase in blood glucose and lipids would ultimately increase their chances of death (Correll, 2007) .Organ systems such as the cardiovascular system and the central nervous system may also be affected (Patel et al., 2014) . An example of this is the electrocardiographic changes that occur in some patients treated with antipsychotics such as ziprasidone, iloperidone, clozapine and thioridazine (Patel et al., 2014) . There are medications that may be taken to alleviate some of the side effects such as drugs which cause a Histaminergic rebound to counter drugs that cause an antihistaminergic anxiolytic effect. This would have a calming effect on the patient, induce sleep, reducing insomnia, anxiety, agitation, EPS, and restlessness (Kane & Correll, 2010) .
In conclusion, schizophrenia is a complex disease with a lot of stones yet to be unturned. Much is known about the disease, but at the same time, there are still more lingering questions. This is more so on the definite cause of the illness. On discovery of signs of the illness, physicians must act quickly to formulate a suitable treatment plan which they will observe over time or its efficacy. As previously mentioned, it is important to use both pharmacological and non-pharmacological means to treat the illness. This is an illness that can be managed throughout a patient’s lifetime, allowing them to live a full, healthy life.
References
Barnhill, J. (2013). Schizophrenia Spectrum and Other Psychotic Disorders. In DSM-5? Clinical Cases (Vols. 1–0). American Psychiatric Publishing . https://doi.org/10.1176/appi.books.9781585624836.jb02
Berger, K. (2011). The Developing Person Through the Life Span . New York: Worth Publishers.
Brisch, R., Saniotis, A., Wolf, R., Bielau, H., Bernstein, H.-G., Steiner, J., … Gos, T. (2014). The Role of Dopamine in Schizophrenia from a Neurobiological and Evolutionary Perspective: Old Fashioned, but Still in Vogue. Frontiers in Psychiatry , 5 . https://doi.org/10.3389/fpsyt.2014.00047
Correll, C. U. (2007). Balancing efficacy and safety in treatment with antipsychotics. CNS Spectrums , 12 (10 Suppl 17), 12–20, 35.
Dean, K., & Murray, R. M. (2005). Environmental risk factors for psychosis. Dialogues in Clinical Neuroscience , 7 (1), 69–80.
Dickerson, F. B., & Lehman, A. F. (2011). Evidence-based psychotherapy for schizophrenia: 2011 update. The Journal of Nervous and Mental Disease , 199 (8), 520–526. https://doi.org/10.1097/NMD.0b013e318225ee78
Friston, K. (2017, October 10). Disconnection Hypothesis of Schizophrenia. Retrieved November 18, 2017, from http://serious-science.org/dysconnection-hypothesis-of-schizophrenia-8625
Friston, K., Brown, H. R., Siemerkus, J., & Stephan, K. E. (2016). The disconnection hypothesis (2016). Schizophrenia Research , 176 (2), 83–94. https://doi.org/10.1016/j.schres.2016.07.014
Gründer, G., & Cumming, P. (2016). Chapter 7 - The Dopamine Hypothesis of Schizophrenia: Current Status. In The Neurobiology of Schizophrenia (pp. 109–124). San Diego: Academic Press. https://doi.org/10.1016/B978-0-12-801829-3.00015-X
Kane, J. M., & Correll, C. U. (2010). Pharmacologic treatment of schizophrenia. Dialogues in Clinical Neuroscience , 12 (3), 345–357.
Keshavan, M. S., Tandon, R., Boutros, N. N., & Nasrallah, H. A. (2008). Schizophrenia, “just the facts”: what we know in 2008 Part 3: neurobiology. Schizophrenia Research , 106 (2–3), 89–107. https://doi.org/10.1016/j.schres.2008.07.020
Patel, K. R., Cherian, J., Gohil, K., & Atkinson, D. (2014a). Schizophrenia: Overview and Treatment Options. Pharmacy and Therapeutics , 39 (9), 638–645.
Patel, K. R., Cherian, J., Gohil, K., & Atkinson, D. (2014b). Schizophrenia: Overview and Treatment Options. Pharmacy and Therapeutics , 39 (9), 638–645.
Robinson, D. G., Woerner, M. G., Napolitano, B., Patel, R. C., Sevy, S. M., Gunduz-Bruce, H., … Kane, J. M. (2006). Randomized comparison of olanzapine versus risperidone for the treatment of first-episode schizophrenia: 4-month outcomes. The American Journal of Psychiatry , 163 (12), 2096–2102. https://doi.org/10.1176/ajp.2006.163.12.2096
Sanders, A. R., Duan, J., Levinson, D. F., Shi, J., He, D., Hou, C., … Gejman, P. V. (2008). No significant association of 14 candidate genes with schizophrenia in a large European ancestry sample: implications for psychiatric genetics. The American Journal of Psychiatry , 165 (4), 497–506. https://doi.org/10.1176/appi.ajp.2007.07101573
Schizophrenia.com. (n.d.). Schizophrenia Facts and Statistics. Retrieved November 18, 2017, from http://www.schizophrenia.com/szfacts.htm#
Schmetzer, A. D. (2008). Clinical Handbook of Schizophrenia. Annals of Clinical Psychiatry , 20 (4), 241–242. https://doi.org/10.3109/10401230802362282
Stein, D. J., Phillips, K. A., Bolton, D., Fulford, K. W. ., Sadler, J. Z., & Kendler, K. S. (2010). What is a Mental/Psychiatric Disorder? From DSM-IV to DSM-V. Psychological Medicine , 40 (11), 1759–1765. https://doi.org/10.1017/S0033291709992261
Tandon, R., Gaebel, W., Barch, D. M., Bustillo, J., Gur, R. E., Heckers, S., … Carpenter, W. (2013). Definition and description of schizophrenia in the DSM-5. Schizophrenia Research , 150 (1), 3–10. https://doi.org/10.1016/j.schres.2013.05.028
