This article provides research and policy recommendations for AI integration and assesses its implications on the Indian labour market, creative sector and national security.
ABSTRACT
The expansion of BRICS, with the inclusion of key economies like Saudi Arabia and Iran, is reshaping global geopolitical and economic landscapes. With strategic partnerships focusing on energy security and resource-rich nations, BRICS aims to position itself as a strong alternative to Western-led alliances. The group’s growing influence in international organizations underscores its importance in global policymaking, enhancing its geopolitical clout and economic significance.
France is emerging as a global leader in AI governance, green technology, and scientific diplomacy. With major investments in AI, renewable energy, and international trade, France is shaping the future of innovation, sustainability, and diplomacy on the world stage.
Introduction (Paiman Riazat) The question of Palestinian statehood is and has been a for decades controversial matter. The main conclusion is that Palestine seems to satisfy all the four traditional criteria mentioned in the issues of recognition such as people, land, government, and capacity (Montevideo Convention, 1933). However, Palestine has these requirements; its legal status remains in vogue for the sake of political and historical conditions. As January 2025 begins the situation in Palestine is still unknown. The war between Israel and Palestinian groups in Gaza has resulted in significant casualties and destruction. The United Nations has reported that over 46,000 Palestinians have lost their lives and many more have been injured or displaced (United Nations, 2024). Gaza is home to approximately 2.3 million people and continues to endure a strict blockade imposed by Israel since 2007 (Amnesty International, 2024). In 2012, the United Nations General Assembly granted Palestine non-member observer state status (United Nations General Assembly, 2012). This recognition has allowed Palestine to join international organizations and participate in international legal proceedings, such as the International Criminal Court (ICC) (International Criminal Court, 2021). This paper aims to effectively analyze the recognition of Palestine’s statehood in international law, discovering the legal arguments for and against its recognition. By bringing up the Montevideo criteria and the current situation on the ground, this research seeks to provide an extensive understanding of Palestine’s legal status in international law. Background (Cherry Wong) International law is a set of rules and principles that governs the relations between states and other international actors (Legal Information Institute, n.d.). It comprises treaties, customary practices, legal precedents etc. that establish obligations and rights for states to adhere to (Butchard, 2020). The aim of international law is to maintain global peace and security, addressing issues such as human rights, trade, and environmental protection (United Nations, n.d.). It is enforced through various mechanisms, emphasizing both state responsibility and the roles of international institutions (Iwasawa, 2023). Palestine’s historical context is characterized by a long struggle for self-determination amidst colonial and geopolitical challenges. The Palestinian national movement began in the early 20th century, with significant events such as the 1920 Palestinian National Council demanding independence from British rule, which was largely ignored due to the British commitment to the Balfour Declaration favoring Jewish immigration and settlement (Boulos & Abu Eid, 2024). The 1947 UN Partition Plan proposed separate Jewish and Arab states, leading to the 1948 Arab-Israeli War and the Nakba, which resulted in the displacement of hundreds of thousands of Palestinians (Utrecht University, 2024). The quest for statehood continued with the establishment of the Palestine Liberation Organization (PLO) in 1964, which became the representative body for Palestinians (Powell & Strug, 2016). The PLO declared the State of Palestine in 1988, gaining recognition from numerous countries and the UN General Assembly, which granted it non-member observer state status in 2012 (Powell & Strug, 2016). Despite this, the ongoing Israeli occupation and settlement policies complicate the realization of Palestinian statehood (Boulos & Abu Eid, 2024). International law defines statehood criteria primarily through the Montevideo Convention, which stipulates that a state must possess a permanent population, a defined territory, a government, and the capacity to engage in relations with other states (Fang, 2023). Recognition by other states is essential, as international relations are built upon the acknowledgment of a state’s sovereignty. While Palestine has been recognized by approximately 146 countries, its quest for full statehood remains hindered by geopolitical dynamics, particularly the influence of the United States and the ongoing Israeli-Palestinian conflict (The Hindu, 2024). The significance of recognition in international law (Tasnuba Tasnim Anita) Recognition refers to the formal acknowledgment by one state of the existence and sovereignty of another state within the global community. In international law, statehood is traditionally determined by the Montevideo Convention of 1933, which outlines four criteria: a permanent population, a defined territory, a government, and the capacity to enter into relations with other states (Montevideo Convention, 1933). However, recognition by other states often solidifies and legitimizes a state’s legal standing in the international arena. But recognition is not a prerequisite for statehood, it facilitates the newly established state’s ability to participate in international organizations, treaties, and diplomatic engagements (Roth, 2010). Diplomacy often revolves around recognizing states to foster alliances, resolve disputes, and promote stability. Conversely, withholding recognition can serve as a form of protest or leverage in international negotiations. The process of recognition is rarely free of political influence. States may base their recognition decisions on strategic interests, ideological alignments, or economic incentives. This selective approach can lead to inconsistencies (Christopher J Borgen, 2009). Recognition of states in international law can take two primary forms: de jure and de facto recognition (Cochran, C. L.1968). De jure recognition is often permanent and implies that the recognized state satisfies all the criteria of statehood, including effective control and governance. It refers to the formal and unequivocal acknowledgment of a state’s sovereignty and legal personality under international law. De facto recognition often occurs in situations where a state has effective control over a territory but faces unresolved issues regarding its legitimacy or sovereignty (Briggs, H. W. 1939). It implies that while the recognizing state acknowledges the factual existence of the entity as a governing authority, it does not grant full legal legitimacy or permanence (Houghton, N.D, 1932). The case of Palestine illustrates the nuanced application of de jure and de facto recognition in international law. Over 130 UN member states have granted Palestine de jure recognition, acknowledging its sovereignty and right to statehood under international law (Ghaedi, M. 2024). Conversely, many states, including major powers like the United States, have limited their acknowledgment to de facto recognition, if at all (Al Jazeera, 2024). The recognition of Palestine is often viewed through the lens of the broader Arab-Israeli dispute, making it a symbol of regional and global political divisions (Palestine Unbound, 2016). The case of Palestine highlights the significance of recognition in shaping the legal and political realities of statehood under
Corporate Liability For Environmental Damage : A Critical Review Of Legal Principles By: Jayshree Patnaik & Manshi Abstract: In India, an increase in the number of industries has resulted in pollution of the air, water, land, and noise. Rapid industrialization of this kind has had a negative impact on our nature. The Environmental Protection Act of 1986 and the Companies Act are two of the laws that the Indian legal system has established to address environmental challenges and under which corporations are held accountable. Even if a firm doesn’t purposefully destroy the environment, they are nonetheless held accountable under the Indian legal system. This is a well-established strict liability principle that is included in Indian law. The industries that are now operating in India must take all required precautions to prevent environmental harm. Be it Corporate infrastructure, the workers commuting to and fro daily ,the multimodal transport usage to transfer goods, each of them makes a significant contribution to ravage the environment. Here’s a wager, many of us are unaware that sending mail also emits carbon dioxide up to 50 grams per mail with large attachments. In this mixed-method research we present various viewpoints, case laws, existing policies to curb the environmental blight and aim to provoke your thoughts as an individual to combat the problem. Also, a few suggestions of what collaborative approach should the government enforce along with the existing ones. Certain damages which can never be undone are the Plasticrust (when plastic melts and fuses with the natural materials like rock/corals, etc.), Nanomaterial pollution (comes from the paints, cosmetics, electronics, textiles, etc.) and the “forever chemicals”. All of these pollutants have been accumulated in the environment and the wildlife is now carrying these toxins in their tissues. How profound and urgent detoxification does the Earth require to restore itself? Introduction: The concept of holding businesses responsible for environmental damage has attracted a lot of attention worldwide, highlighting the growing recognition of businesses’ role in environmental deterioration and the need for accountability measures. The topic of corporate responsibility for environmental harm is particularly pertinent in India, a country dealing with complex environmental problems that range from deforestation and climate change to air and water pollution. This preamble establishes the framework for a comprehensive analysis of the legal rules governing Indian corporations’ liability for environmental damage. With laws like the Environment (Protection) Act of 1986 and the Companies Act of 2013 acting as pillars for monitoring business behavior with regard to the environment, India’s legal framework for environmental preservation has grown over time. India’s legal framework for corporate accountability for environmental harm is based on the Water (Prevention and Control of Pollution) Act of 1974 and the Environmental Protection Act of 1986. The Environmental Protection Act establishes the legal framework for both environmental protection and pollution prevention and control laws. The law states that both the federal and state governments are empowered to take action to protect and enhance the environment and to prosecute violators. The Indian judiciary has been essential in holding companies responsible for environmental harm by interpreting and enforcing the provisions of these Acts. In numerous instances, the courts have held companies liable for environmental damage, even when it was unintentional or the result of suppliers’ or subcontractors’ negligence. Furthermore, courts have ruled that companies must take steps to protect the environment or face liability for future damages. Even though India has the required legal framework, it is nevertheless very difficult to hold corporations accountable for environmental harm. The absence of strong enforcement measures is one of the main problems. The Water (Prevention and Control of Pollution) Act is enforced by State Pollution Control Boards, however oftentimes they lack the resources to carry out this duty. Furthermore, the fact that fines imposed on companies that violate environmental regulations are usually insignificant means that there is insufficient deterrence. It is also difficult for citizens to hold corporations responsible for environmental destruction because of a weak legal system and a lack of public understanding of environmental issues. “Greenwashing and Corporate Commitments: The Clash Between Sustainability Goals and Industrial Expansion” Corporate industries in other words the “mega-polluters” take Sustainability-linked loans (SLL) in billions with a fake commitment to reduce carbon pollution and target sustainability. Shell, Enbridge and Drax are a few of many other companies which made it to the news for getting SLLs. Fossil fuel and mining companies have reaped billions in SLLs, many researches suggest that greenwashing in SLLs is widespread. Upon investigation, it was found that these loans are rather used in business expansion and not for reducing environmental harms. In India, Central Consumer Protection Authority (CCPA) issued the guidelines under the Consumer Protection Act, 2019 for prevention and regulation of “greenwashing” and “misleading environmental claims”. It was an addition to the guidelines for prevention of misleading advertisements and endorsements issued in 2022. These guidelines prohibit use of generic terms like ‘eco-friendly’, ‘green’, ‘cruelty free’, ‘carbon-neutral’, ‘sustainable’ and similar assertions without adequate substantiation by the manufacturers/industrialists. Illustration 1: If a company makes a statement that “its growth will be based on sustainability principles”. For the purpose of these guidelines this will not be treated as an environmental claim. However, if a company further makes a statement that “that all its products are made in a sustainable manner”, then such an environmental claim will be examined for greenwashing. Illustration 2: A marketer advertises on the bottle of its hand wash as “biodegradable” without qualification. The advertisement shall make clear that only the hand wash is biodegradable and not the bottle. The latest in occurrence was the Biological Diversity Rules, 2024 which supersedes the 2004 rules. The Ministry of Environment, Forest and Climate Change (MoEF&CC) announced rules to make India’s waste management system more comprehensive; previously, liquid waste was not classified as a separate category. The Draft Liquid Waste Management Rules will become effective from 1 October 2025. A bigwig tech company published that AI could help expedite decarbonization, simultaneously selling AI tools to ExxonMobil and Chevron
By Bhavya Gupta, Sanjna & Siddhii Abstract Caregiving for older adults, particularly those with chronic illnesses, often leads to significant physical, emotional, and financial strain, called caregiver burden. The burden has an inherent connection with social isolation, emotional discomfort, and the deterioration of physical health, further impacting the quality of care given. This article discusses how interventions like caregiver training, telehealth services (Tele-MANAS), and community-based programs (Atmiyata) can alleviate this burden. Addressing caregiver stress through emotional and instrumental support and policy measures such as financial aid and awareness campaigns is essential to improve outcomes for caregivers and older adults. Introduction Caregiver is referred to as someone who provides support and adheres to the needs of someone who is not fully independent, individuals such as an infants, disabled and elderly are usually in need of assistance (American Psychological Association, 2023). Support for caregivers is a key intervention to enhance the care of older adults and thereby reduce the mental health risk to caregivers. It has been observed that mental health conditions, such as depression and anxiety, among older adults are common because of the impact of chronic illnesses (G. & V., 2022). A high-risk group, owing to stress and mental health issues, is caregivers themselves, who can also suffer from caregiver burnout (Boisvert et al., 2022). Proper caregiver support may mitigate stress and improve caregivers’ and care recipients’ mental health outcomes (Hall et al., 2022). Areas of focus for support include resource provision, care for the caregiver, and respite-any of these would be critical in promoting the caregiver’s well-being (Hall et al., 2024). Many caregivers, however, are left without support, which ultimately corrupts their mental health and delivers a poor-quality service for older adults. Therefore, addressing these gaps is vital for the improved health of caregivers and care recipients alike. Impact of Caregiver’s Support Emotional Support For human beings, a social species, social relations are crucial to ensure safety, reproductive success, and survival. From an evolutionary perspective, social relations with a mate or a tribe improve the chances of survival in hostile environments (Reinwarth et al., 2024). Emotional support is the key to improving the conditions of older adults who live in a community with a lack of emotional support (Devkota et al., 2023). Along with a lack of emotional support, older adults live with a lack of financial aid, which makes them ineligible for healthcare use. Due to this older adults not only suffer financially but suffer psychologically. According to a study by Yon and colleagues (2017), it is estimated that 5.7% of individuals aged 60 years and older are victims of EA (elder abuse). Additionally, 28.5% of this population experiences loneliness in their last years of life, and 28.4% suffer from depression. Social isolation and loneliness are significant health risks for older adults and due to the COVID-19 pandemic, the number of social isolations among older adults has increased. This not only destroys the mental health of older adults but their physical health also deteriorates (Czaja et al., 2021). Social relationships are important aspects of one ‘s personal life. As age increases the depressive symptoms are most common in older adults. Factors like loneliness, physical illness, and lack of purpose affect older adult’s mental health. Studies indicate that older adults experience illness and low levels of happiness. Mental health issues in older adults require attention and support. Research conducted in China examined the impact of social activities on the mental health of older adults. Participants engaged in various activities, such as joining clubs, visiting friends, and playing games, which positively influenced their mental well-being (Gao et al., 2024). Such activities help lessen loneliness and foster a sense of belonging. Consistent emotional support from family members, peers, and caregivers can play a crucial part in diminishing depressive episodes and can help enhance resilience (Upasen et al., 2024c) Instrumental Support Instrumental support or Tangible support refers to the assistance that is provided by caregivers to help older adults carry out essential day-to-day activities (Schultz et al., 2022). These activities include: Bathing Toileting Eating Preparing meals throughout the day Medical Care Transportation Research findings indicate that anticipated instrumental support from various sources significantly reduces the odds of depressive symptoms. Specifically, anticipated support from spouses and children lowers the risk by 52% and 46%, respectively, compared to those without such anticipation (Fu et al., 2024c). Along with psychological stressors, older adults also face numerous challenges such as physical weakness, and chronic illness, which make them dependent on others. Instrumental support therefore helps to elevate such problems (Fu et al., 2024c): Encourage self-governance: Caregivers assist older adults, fostering independence and control over their lives, ultimately reducing the risk of future psychological issues. Strengthening Relationships: Support systems, such as emotional and instrumental support, can strengthen the connection and bond between caregivers and older adults. Helps in reducing the daily hassles: Providing support for older adults in managing their daily activities, including medication management, significantly enhances their overall quality of life. Caregiver Burden and Mental Health Outcomes Caregiver burden is a concept of understanding the physical, emotional and financial strain or stress experienced by caregivers, while they care for patients with chronic diseases or disabilities. It is manifested in different forms such as social isolation, psychological distress and physical health deterioration that further affects the quality of care that is provided to the patient (Bakkali & Renzulli, 2023; Parvizi & Ay, 2024). Standardized tools such as the Zarit Burden Inventory and the Burden Scale for Family Caregivers are often used in the assessment of caregiver burden and quantify their impact on caregivers, by helping in its measurement (Baysal & Corabay, 2024). Caregiver burden comprises different dimensions such as objective, subjective, and social burdens. All of them are quite relevant and affect caregivers’ lives, as well as the effectiveness of their caregiving. Objective Burden: The objective burden is all about objective things associated with the process of caregiving. These may include: Time Expenditure: Time expenditure has been identified as the most significant burden reported by care partners in
International Labour Law Labor Law and Mental Health: Addressing Workplace Stress and Psychological Safety Abstract This paper examines how labour laws address mental health, including psychological safety and workplace stress. As mental health issues become more prominent, many countries are beginning to integrate mental health protections into labour legislation. The discussion will cover existing legal frameworks, the challenges of enforcement, and future directions to ensure that mental health is adequately protected in the workplace. The goal is to present a comparative analysis of labor laws, highlighting specific reforms to make workplaces more supportive environments. Introduction The prevalence of workplace stress and mental health issues, such as anxiety and burnout, is increasing across the globe. The COVID-19 pandemic amplified these issues, as many employees transitioned to remote work, blurring work-life boundaries. While labor laws have traditionally focused on physical safety, psychological well-being has historically been less addressed. However, mental health conditions have significant effects on employee productivity and retention, underscoring the need for robust legal protections. Labour laws in some countries, particularly in regions such as Europe and North America, have begun to adapt, offering frameworks to support mental health in the workplace. This paper explores these adaptations and considers reforms that could enhance psychological safety globally. Current Legal Frameworks for Mental Health in Labor Law 1. International Standards and Guidelines The International Labour Organization (ILO) provides guidelines for managing mental health at work and advocates that member countries adopt policies that protect workers’ mental health. The World Health Organization (WHO) has developed frameworks promoting mental health awareness and resources in workplaces, encouraging companies to consider mental health as part of employee welfare. 2. Country-Specific Labor Laws European Union: EU labor law includes provisions under the Framework Directive on Health and Safety at Work (Directive 89/391/EEC) that require employers to assess and mitigate workplace stress. United States: While the U.S. does not mandate mental health protection under federal labor laws, the Americans with Disabilities Act (ADA) indirectly supports employees with mental health conditions by prohibiting discrimination and requiring reasonable accommodations. Australia: Australia’s Work Health and Safety Act mandates employers to create mentally healthy workplaces and acknowledges psychological health alongside physical health. 3. Corporate Mental Health Programs Many companies now voluntarily include mental health programs, such as Employee Assistance Programs (EAPs), to support workers. These are often encouraged through government incentives, though not always required by law. Challenges in Implementing Mental Health Protections in Labor Law Recognition and Stigma Mental health issues are often misunderstood or stigmatized, making it difficult for employees to seek help without fear of judgment or job loss. Lack of awareness among employers also creates challenges in identifying and appropriately managing mental health issues. Enforceability Even when laws require psychological safety, enforcement can be inconsistent. Inspectors and regulatory bodies may lack the tools to assess psychological risk effectively. Proving mental health harm or unsafe conditions is more complex than physical injuries, making compliance difficult to measure. Workplace Culture and Remote Work A lack of supportive workplace culture can undermine legal protections. Companies must foster environments where mental health concerns are treated as seriously as physical safety. Remote work has increased psychological risks, including isolation and burnout, which require novel legal approaches to ensure protections. Case Studies in Mental Health Protections Sweden: The Work Environment Act Sweden’s labor law includes explicit protections for mental health, including the obligation for employers to prevent workplace stress. This proactive approach is highly regarded for reducing burnout. Canada: Mental Health Commission of Canada (MHCC) The MHCC promotes the National Standard for Psychological Health and Safety in the Workplace, which serves as a guideline for employers to create mentally safe work environments. The adoption of this voluntary standard has led to positive outcomes, as more companies are embedding psychological health in workplace policies. Japan: Mental Health in the Workplace Act Japan mandates annual stress checks for employees in large companies, aiming to identify psychological risks early. While not enforceable for all companies, this law highlights a structured approach to address mental health proactively. Future Directions for Mental Health in Labor Law Mandating Mental Health Policies More countries could adopt mental health-specific requirements as part of labor codes, obligating companies to offer mental health services, regular stress evaluations, and training for managers. Enhanced Employer Accountability Policies could include metrics for mental health outcomes, like tracking stress-related absences, and mandate that employers report and mitigate causes of workplace stress. Legal Support for Remote Work Mental Health Issues As remote work becomes more common, labor laws may need to establish new guidelines for mental health protection outside traditional workplaces, emphasizing boundaries and mental well-being. Conclusion Addressing mental health in labor law is essential for creating a supportive, productive workforce. Although some countries have made strides toward integrating mental health protections, further reforms are needed to ensure comprehensive support. This includes reducing stigma, enforcing compliance, and addressing unique challenges of modern workplaces like remote work. A global approach to labor law, emphasizing psychological safety, can help shift corporate cultures and contribute to healthier, more sustainable workplaces. References International Labour Organization. (ILO) on managing mental health at work. World Health Organization (WHO). Frameworks for mental health in the workplace. European Commission. Directive 89/391/EEC on Health and Safety at Work. Americans with Disabilities Act (ADA). Protections for mental health in the workplace. Safe Work Australia. Work Health and Safety Act and psychological health. National Institute for Occupational Safety and Health (NIOSH). Psychological safety. Sweden’s Work Environment Act on mental health. Mental Health Commission of Canada (MHCC). National Standard for Psychological Health and Safety. Japan’s Mental Health in the Workplace Act and stress checks. European Agency for Safety and Health at Work. Research on workplace stress. Centers for Disease Control and Prevention (CDC). Workplace mental health programs.American Psychological Association (APA). Employer support for mental health. National Alliance on Mental Illness (NAMI). Stigma and mental health in the workplace.Harvard Business Review. Workplace culture and mental health. National Institute for Mental Health (NIMH). Data on workplace mental health. Occupational Safety and Health
This article explores the often-overlooked psychological consequences of the climate crisis, particularly among vulnerable populations. It examines how climate-related disasters, displacement, and socio-economic challenges exacerbate mental health issues, including anxiety, depression, PTSD, and eco-anxiety. Focusing on low-income groups, Indigenous communities, and children, the article highlights the disproportionate mental health burden these groups face. It emphasizes the need for equitable mental health care, community resilience programs, and climate education to mitigate the crisis’s psychological impacts and promote a just and sustainable future.
This article explores the intersection of climate change, forced migration, and gender, highlighting the unique vulnerabilities faced by displaced women and girls. It examines the impacts of climate-induced displacement, including heightened risks of gender-based violence, health challenges, economic insecurity, and barriers to education. Emphasizing the urgent need for gender-sensitive humanitarian aid, the article calls for targeted interventions to address these challenges and foster resilience among displaced populations.
BY HUMAIRA HASAN, PALAK, AND UPASANA KOUL INTRODUCTION WHAT IS SCHIZOPHRENIA? Schizophrenia is a serious brain disorder affecting around 1% of the global population and is one of the top 10 causes of disability worldwide (Marder & Cannon, 2019). This condition is characterized by symptoms such as hallucinations (e.g., seeing or hearing things that aren’t there), delusions (false beliefs), disorganized speech, and abnormal behavior. Additionally, individuals with schizophrenia often experience a lack of motivation, reduced emotional expression, and cognitive difficulties, including problems with thinking, memory, and decision-making (Jauhar, Johnstone, & McKenna, 2022). The impact on daily life can be significant, leading to severe disability and incomplete recovery. Even individuals who show improvement may still struggle with social isolation, stigma, and limited opportunities for building close relationships. Unemployment rates are high among those with schizophrenia, and lifestyle factors such as poor diet, weight gain, smoking, and substance use contribute to a reduced life expectancy of 13 to 15 years (Hjorthøj, Stürup, McGrath, & Nordentoft, 2017; Kahn, 2020). The lifetime risk of death by suicide for individuals with schizophrenia ranges from 5% to 10% (McCutcheon, Reis Marques, & Howes, 2020). Current diagnosis and treatment primarily target psychotic symptoms, but negative and cognitive symptoms are equally important due to their significant impact on social and professional functioning. These symptoms often do not respond well to conventional antipsychotic medications (Kahn, 2020; Jauhar, Johnstone, & McKenna, 2022). Historically, schizophrenia was conceptualized by Emil Kraepelin as “dementia praecox,” a term later renamed “schizophrenia” by Eugen Bleuler. Notably, both Kraepelin and Bleuler did not consider positive symptoms like delusions and hallucinations as the primary characteristics of the disorder. This historical perspective supports the view that a more comprehensive approach is needed for understanding and treating schizophrenia (Kahn, 2020). PREVALENCE AND ONSET Schizophrenia is a genetic neurocognitive disorder that affects approximately 1% of the population, typically appearing between the ages of 21 and 25 in males and 25 and 30 in females. (Zhan et al., 2023) Extensive research suggests that from 1990 to 2019, global schizophrenia cases rose by over 65%, new diagnoses by 37%, and health impacts (DALYs) by 65%, while age-adjusted rates stayed stable. (Solmi et al., 2023) TREATMENT Schizophrenia treatment is lifelong and combines medications with psychosocial support, guided by a psychiatrist and a care team. Antipsychotic medications, including both first- and second-generation options, are the primary treatment, with long-acting injectables available for better adherence. Additional medications, such as antidepressants or mood stabilizers, may be used based on individual needs. Psychosocial approaches like therapy, social skills training, family support, and vocational rehabilitation enhance coping, communication, and daily life skills. Severe cases may require hospitalization for stabilization, while electroconvulsive therapy (ECT) is considered for those unresponsive to other treatments. With proper care, many people with schizophrenia can manage their symptoms effectively. (Mayo Clinic, n.d.) DIAGNOSIS Schizophrenia diagnosis involves a detailed psychiatric history and mental status examination, ruling out other potential medical and psychiatric causes of psychosis. Risk factors for developing schizophrenia include birth complications, being born in a specific season, maternal malnutrition, maternal influenza during pregnancy, a family history of the disorder, childhood trauma, social isolation, cannabis use, minority ethnicity, and living in urban environments (Messias, Chen, & Eaton, 2007; Davis et al., 2016). The exact cause and biological mechanisms of schizophrenia remain unclear due to its complexity and variability. Despite being relatively uncommon, schizophrenia has a significant impact on the global burden of disease, with more than half of those diagnosed experiencing multiple coexisting psychiatric and medical conditions (Chong et al., 2016). PRESCRIBED DRUGS First-Generation Antipsychotics First-generation antipsychotics (FGAs), also known as typical antipsychotics, primarily work by blocking dopamine receptors to alleviate symptoms of various mental health conditions. These medications are commonly prescribed for issues such as acute mania, agitation, and bipolar disorder. Some examples of FGAs include Chlorpromazine (Thorazine), Fluphenazine (Prolixin), Haloperidol (Haldol), and Loxapine (Loxitane), among others. (Mayo Clinic, n.d.) Mechanism: Both first- and second-generation antipsychotics block dopamine in the ventral tegmentum to reduce positive symptoms. However, first-generation drugs also affect the nigrostriatal dopamine system, leading to extrapyramidal side effects, which second-generation drugs cause less frequently. (Grace & Uliana, 2023) Efficacy: Studies revealed minimal differences in efficacy between First Generation Antipsychotics and Second Generation Antipsychotics, but haloperidol was less effective than amisulpride and clozapine. Additionally, olanzapine showed greater improvement in functional capacity compared to quetiapine and ziprasidone. (Pike et al., 2009) Second Generation Antipsychotics Second-generation antipsychotics (SGAs), also known as atypical antipsychotics, are newer medications that work differently from first-generation antipsychotics. Instead of fully blocking dopamine receptors, SGAs partially block them and may also influence other neurotransmitters like serotonin. Examples of SGAs include Aripiprazole (Abilify), Clozapine (Clozaril), Olanzapine (Zyprexa), Risperidone (Risperdal), and Quetiapine (Seroquel). (Mayo Clinic, n.d.) Mechanism: These medications inhibit some serotonin and dopamine receptors and stimulate other serotonin and dopamine receptors. (Cleveland Clinic, 2024) Efficacy: Patients with schizophrenia who were treated with SGAs showed significantly greater improvement in self-reported quality of life compared to those on FGAs, particularly when treatment was individualized. (Gründer et al., 2016) Side Effects: Studies show that olanzapine and risperidone are associated with the greatest weight gain, with olanzapine causing the largest increase in BMI. Paliperidone leads to the highest rise in total cholesterol but is the only drug to increase HDL cholesterol. Quetiapine XR shows the greatest reduction in fasting glucose, while lurasidone has the lowest weight gain, a reduction in BMI, and is the only treatment that decreases total cholesterol and triglycerides. Additionally, quetiapine XR is linked to the highest increase in both systolic and diastolic blood pressure. (Gründer et al., 2016b) Clozapine Clozapine is an FDA-approved atypical antipsychotic used for treatment-resistant schizophrenia. It is more effective than other antipsychotics for managing treatment-resistant schizophrenia and schizoaffective disorder. However, it is not the first-line treatment due to its potential for various adverse effects. (Haidary & Padhy, 2023) (Gammon et al., 2021) Mechanism: Clozapine acts as an antagonist by inhibiting dopamine D2 receptors and interacts with various serotonin receptors, such as 5-HT1A, 5-HT2A-C, 5-HT6, and 5-HT7.
