Psychological disorders like Schizophrenia show extreme subtleties in their etiology, prognosis, and manifestations. The disorder becomes even more complex due to the role of non-biological factors like psychosocial and personal experiences. Schizophrenia shows significant and identifiable differences in its prognostic and symptomatic manifestations based on gender, culture, and regions. These themes within the study of schizophrenia are explored in the upcoming sections.
Schizophrenia has a chronic course, and the onset age of this disorder is between late adolescents and early 30s, where onset before puberty is a rare phenomenon. The lifetime prevalence of schizophrenia has been reported to be about 0.3% to 0.7 % globally, but regional variation exists, implying regions like urban regions, socioeconomically backward regions, regions facing famine, etc. may have a greater prevalence rate. The prevalence of this disorder varies greatly based on culture, gender, and sometimes age, which have been taken up in the next sections.
Schizophrenia differs in etiology, prognosis, course, and treatment based on the patient's age. For starters, it is a well-accepted fact that the onset of this disorder is prevalent in certain age ranges from late teens to mid-30s. Further, the kind of symptoms experienced vary across age groups. Children, for example, are less likely to experience elaborate hallucinations and delusions than adults. Further visual hallucinations, disorganized speech, and behavior are more common symptoms of schizophrenia among children. Childhood-onset is also associated with delay in social, cognitive, and motor development and comorbidity with intellectual, developmental, and learning disorders. There is less difference in the context of old age, only that the psychotic symptoms reduce in late life. In the context of treatment and diagnosis, the pedagogies used for children and adults may differ a little given the physical, mental, and social maturation and development which impacts their response to the treatment.
Sex, or gender in general terms, is a significant variable impacting the features of schizophrenia inpatients. These gender differences can be understood based on disorder prevalence, prognosis, diagnostic symptoms, and impacts of the disorder.
Prevalence and Onset: Males are more prone to schizophrenia than females. For males, the peak onset age is early to mid-20s, while for females, it is the late 20s. Further, late-onset cases (where age is in the late 40s) are mostly married females. These differences have both physiological and psychological causes.
Prognosis: Men have been reported to have a longer duration of psychosis and a lack of adjustment to comorbid disorders that often follow schizophrenia. Meanwhile, females have been reported to have a shorter presentation of psychosis.
Symptoms: Males report more negative symptoms, cognitive impairments, and social dysfunction. At the same time, females show a higher incidence of positive and psychotic symptoms. Females also experience a lesser number of disorganized thinking and social impairments. Further, they also show a greater propensity to mood disturbances and susceptibility to comorbidity.
Effects of estrogen: Females' estrogen levels are variant during their menses and pregnancy, and this variation has been reported to be associated with schizophrenia symptomatic severity. It has been observed that psychotic symptoms get worse during pre-menstruation when estrogen level is low, and these symptoms improve during pregnancy when estrogen level is high. While postpartum, the estrogen level decrease, leading to the worsening of psychotic symptoms. Interestingly, menopause has also been associated with midlife being the second peak age for onset and worsening schizophrenia due to decreased estrogen levels post-menopause.
Gender and sexual minority: The LGBTQIA+ community is hugely neglected, and less literature is available on them in academics. Psychotic symptoms and schizophrenic risk may increase in these individuals due to hormonal imbalance or hormonal therapies, socio-cultural neglect and discrimination they face, and many other factors. Further, the severity of symptoms in such patients is high due to a lack of resources and ineffective treatment.
Culture is a collective of norms, beliefs, practices, customs, and other social behaviors characteristic of a society. Schizophrenia has been reported to differ in many domains based on culture, and culture may impact the prevalence, prognosis, specific symptomatic expression, perception of the disorder, and treatment paradigms of schizophrenia.
Prevalence: Schizophrenia exists across all cultures, but some cultures are more prone to this disorder as compared to others due to the environment they provide. In comparison, it is not a new fact that urban dwelling provides a more fertile breeding ground than rural areas to breed schizophrenia. So cultures more urban in nature are likely to have more prevalence of this disorder. The socioeconomic state of the culture also has a role to play in it.
Symptoms: Incidence of different symptoms of schizophrenia and their severity vary across cultures. Cultures differ in perception and attention processes, which encourage differences in delusion and hallucination among cultures. For example, cultures with a context-dependent and holistic perception prominence (like most Asian countries) are more prone to experiences of visual hallucination than Western cultures, which have a prevalence of auditory hallucinations. The content of delusion may also differ based on culture, like religious and traditional cultures are more prone to the delusion of religiosity.
Perception of disorder: Schizophrenia is seen differently by different cultures. Traditional and highly spiritual cultures often associate schizophrenia with paranormal activities, soul, etc., whereas developed and educated cultures often see it as a disorder or disease that must be treated. Further, the treatment pedagogies may also differ, and some cultures may go for shamans and spiritual treatment while others for medical and psychiatric treatment.
Treatment for schizophrenia should also be based on cultural consideration as with culture - the language, body language, gestures, and beliefs change, and so do the concepts of what is normal and abnormal. Diagnosis and treatment, thus, require a sensitivity to the culture of the patient to identify and manage the disorder effectively.
Schizophrenia varies greatly in its prevalence across cultures, age groups, gender, and regions. These differences are attributed to a variety of factors ranging from psychosocial to physiological. These differences also account for the difference in treatment and therefore are an important theme of study for clinicians to prevent and treat a chronic disorder like Schizophrenia.
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