Schizophrenia

Schizophrenia Schizophrenia has been known by many names before becoming the widely popular name that is known by now. Schizophrenia is a disorder that can cause problems with emotion, thoughts, perception, language and behavior. Those with schizophrenia can normally still be able to operate in daily life. Yet, schizophrenic people can be so severe sometimes that they are out of touch with reality, which is classified as a psychosis (Huffman, 2009). However, schizophrenia is not just one disorder but rather a group of disorders. Schizophrenia, which is literally translated to split mind, was coined by Eugen Bleuler in 1908. Before then it was known as lunatic, hebephrenia, catatonia, délire chronique and démence précoce (Louter, 2010). After German psychiatrist, Emil Kraepelin, published the sixth edition of his handbook, A Compendium of Psychiatry, he brought it down to just three disorders: ‘manic depressive’, ‘dementia praecox’ and ‘paranoia’, which coincides with the schizoid personality disorder (Louter, 2010). However, schizophrenia meaning split mind is not to be confused with split personality. Even though these two disorders can be found together in some patients, it is technically not considered the same thing as thought in the past. According to the book Psychology in Action, “approximately 1 out of every 100 persons will develop schizophrenia in his or her lifetime. And approximately half of all people admitted to mental hospitals are diagnosed with this disorder” (Huffman, 2009). Schizophrenia has been classified as a group of disorders, not just one, that is identified by some kind of disturbance in one or more of the areas of perception, language, thought, emotions (affect), and behavior (Huffman, 2009). Starting with perception, people with schizophrenia can have their sense of perception go enhanced or even get numbed. With this agitation to their perception, it can cause people with schizophrenia to hallucinate. Hallucinations are “imaginary sensory perceptions that occur without stimuli” (Huffman, 2009). Hallucinations can be in any of the senses, like visual, but mainly auditory hallucinations, or hearing voices, are the most common among schizophrenics. Sometimes people with schizophrenia will hurt others from what they are hearing or seeing. This is seen quite a bit on the news, but more commonly, a person with schizophrenia is more prone to hurt themselves and be suicidal than to hurt others. The next dimensions are thought and language, which can range from mild to highly severe. On the milder side, it can cause someone with schizophrenia to jump from topic to topic. In a more severe case, they can jumble their words and phrases together, which is referred to as word salad, or they can create words of their own by putting two words together in conjunction, called neologisms, like saying “splisters” or splinters and blisters (Huffman, 2009). As stated before with the disturbance in thought, the most common is not being in contact with reality or psychosis. Delusions are also an example of thought disturbance. With this, there can be three different dimensions of delusions. The first is delusion of persecution, meaning that they feel that others are out to “get” them or kill them. Then it is the delusion of grandeur, which means that they believe that they are not only someone else but someone of importance, such as Jesus Christ. Finally there is the delusion of reference. This is where someone with schizophrenia will think that a TV show or maybe a news article is sending them a message. Finally the last two areas to be looked at are emotion and behavior. Emotion in those with schizophrenia can be exaggerated or can rise so quickly, even in inappropriate ways. On the other end of the scale, a person with schizophrenia can seem to have no emotion since it has been reduced immensely or deadened. This is called flattened affect when they have almost no emotional response (Huffman, 2009). As for behavior, it can come in the form of unusual actions, such as shaking the head to try to get rid of the thoughts or voices, or any other sort of unusual mannerisms. Sometimes these mannerisms can be side effects of the medication that is given to help the disorder (Huffman, 2009). Unfortunately, schizophrenia can cause a person to become cataleptic, meaning that they will assume a rigid posture and loss of contact with their environment. Along with this can also come what is called waxy flexibility, which is a tendency to keep whatever posture is dictated to them (Huffman, 2009). Classification of schizophrenia has been divided into five categories: paranoid, catatonic, disorganized, undifferentiated, and residual subtypes. People with paranoid schizophrenia have delusions, like of persecution and grandeur, and hallucinations, normally hearing voices. Catatonic schizophrenia is when a person has motor disturbances, such as being immobile or wild activity, along with echo speech, which is the repeating of other’s speech. Disorganized schizophrenia is distinguished by unintelligible speech, low or amplified emotions and withdrawal in social situations. Undifferentiated is where it meets the criteria for being schizophrenic but is in none of the classifications. Lastly is residual where it meets none of the criteria for schizophrenia but there are symptoms of the disorder (Huffman, 2009). However, researchers have suggested a different classification for symptoms that involve just two groups: positive and negative symptoms. Positive symptoms would be if there was an addition or exaggerations to the thought process or behavior. This would include delusions and hallucinations. These symptoms are more common when schizophrenia develops very quickly. This is called acute or reactive schizophrenia. The positive symptoms are connected to a better adaptation before the disorder and a better forecast for recovery. Negative symptoms are the opposite with the loss or lacking of the thought process or behavior. This includes withdrawal in social situations, decreased attention, and restricted speech and as mentioned before flattened affect. These symptoms are found in schizophrenia that develops slowly, also called chronic or process schizophrenia. Along with this, another classification for disorganization of behavior has been considered to be added. This would include the rambling speech, unpredictable behavior and improper feelings (or affect) (Huffman, 2009). This would be beneficial since it would acknowledge that schizophrenia is more than one disorder and has many causes. Schizophrenia is a disorder that is still being researched on how it develops and there different theories of biological and psychosocial, called the biopsychosocial model. With the biological theory, there is an immense amount of research containing the possible biological factors to schizophrenia. Most of the biological theories on schizophrenia focus on three main aspects: genetics, neurotransmitters, and brain abnormalities. With genetics, it does play a dominant role in the development of schizophrenia. Scientific research has even begun to identify the genes related to schizophrenia, along with the chromosomal locations of a few of them. Heritability for schizophrenia is around 48% for twins and 46% for a child who has both parents with schizophrenia. The risk of schizophrenia increases when there are similar genes within a person with the disorder. This means that people who share genes are more likely to develop schizophrenia. These percentages are quite high when the percentage of people in the general population who are diagnosed with schizophrenia is only around 1%. With this, the factor of genes can definitely been seen in schizophrenia. Even though neurotransmitters have been considered to play a role in the development of schizophrenia, it is unclear on how they do. The most popular belief is that schizophrenia creates a dopamine imbalance. Called the dopamine hypothesis, it states that “overactivity of certain dopamine neurons in the brain may contribute to some forms of schizophrenia” (Huffman, 2009). Two decisive observations are what this hypothesis is based on. The first is that large doses of amphetamines increase dopamine in the brain. With the excess dopamine, the positive symptoms of schizophrenia can develop, like having delusions of persecution. When these symptoms are brought on by amphetamines, they can occur in someone with no history of any psychological disorder. Those who already have schizophrenia when taking low doses of amphetamines can worsen symptoms. Additionally, “an amphetamine-induced psychosis is more likely to occur in individuals who have a genetic predisposition to but no signs of active schizophrenia” (Huffman, 2009). Drugs prescribed to help with treating schizophrenia often block or reduce the dopamine in the brain, which as anticipated by the dopamine hypothesis, this leads to a reduction in the positive symptoms of schizophrenia, like the delusions and hallucinations. The third biological theory is that of having brain abnormalities in patients with schizophrenia. This is within the brain function and structure. Researchers have found larger cerebral ventricles (the normal, fluid-filled spaces in the brain) in some people with schizophrenia. Enlarged cerebral ventricles were found in the brain of John Hinckley Jr. This was the man who attempted to assassinate President Ronald Reagan, and remains in prison under treatment for schizophrenia (Huffman, 2009). Along with this, there is also another type of brain abnormality that is shown by a position emission tomography (PET) brain scan, which shows there is a lower level of activity in the frontal and temporal lobes in those with schizophrenia (Huffman, 2009). Since the frontal and temporal lobes help control language, attention, and memory, when there is injury or decreased activity it coincides with the thought and language disruption that are characteristics of schizophrenia. Schizophrenia and lack of brain activity can cause a loss of grey matter in the brain. It is stated well in Psychology in Action when it says, In each of these cases of brain abnormalities, keep in mind that correlation does not mean causation. Abnormalities in the brain may indeed cause or worsen schizophrenia. But the disease itself could also cause the abnormalities. Furthermore, some people with schizophrenia do not show brain abnormalities, and these same abnormalities are often found in other psychological disorders (Huffman, 2009). As schizophrenia is still being researched, these are still just theories. It is not consistent within all patients, so it is still in the correlation stage. With the psychosocial theory, it is true that genetics play a role in schizophrenia but it going deeper on the scale that there has to be “other” factors that contribute to schizophrenia. These are the nonbiological contributors that they believe to be stress and family communication. Stress plays a part in schizophrenia since high amounts of stress can trigger schizophrenic episodes. This means that if they experience more stress than they can handle, it is more than likely that a schizophrenic episode will be activated. Family communication is the other factor. This is a disorder that can cause “unintelligible speech, fragmented communication, and contradictory messages sent by parents to their children” (Huffman, 2009). In cases like this, the child is known to withdraw into an imaginary world which can start the onset of schizophrenia. Family communication has also been known to affect the recovery of a schizophrenic patient. Schizophrenia is sometimes met by hostility and criticism by family members of those with the disorder. The family members also are known to have emotional over involvement and high levels of expressed emotion (EE). And based on these levels, patients who went home to high EE families had greater relapse and their symptoms got worse (Huffman, 2009). The main treatment for schizophrenia today is with pharmaceutical drugs. In the early 1900’s not much was known about schizophrenia, therefore being sent to an institution and shock therapy were the main treatments. However, as research has advanced so had the treatments and medications. The treatment of schizophrenia with drugs really began in 1952 with chlorpromazine (Thorazine). The drug suppressed the hallucinations and delusions of acute schizophrenia (Harvard Mental Health Letter, 2004). There are nearly two dozen alternatives for treatment of schizophrenia, with new advances every day. However, the newer drugs aren’t much better than the older drugs as the negative symptoms of schizophrenia, like social withdrawal and problems with attention and memory. When they do have an episode, one of the first steps is to prescribe one of five drugs, all which came into effect since 1990 and known as “second-generation drugs”, which are risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), and aripiprazole (Abilify) (Harvard Mental Health Letter, 2004). If the symptoms have not improved within a short period, like a couple of weeks, the dose of medication is normally increased and then wait to see the progress before prescribing a new drug if applicable. A newer drug, Clozapine (Clozaril), is thought about for prescription if two other have not been responded to by the patient. It is also not recommended to prescribe more than one antipsychotic drug due to cost and side effect risks (Harvard Mental Health Letter, 2004). Normally if the response to the medication is good, the patient will stay on it for six months. Within a year if they show no signs of symptoms, the patient will gradually be withdrawn off of the medication. If two relapses happen within five years, it is recommended for the continuation of medication (Harvard Mental Health Letter, 2004). In an article on the value of treating schizophrenia, it states Schizophrenia is often severely disabling, with about two-thirds of cases being either continuously symptomatic or suffering predominantly from negative symptoms. Even among those with an episodic course, the majority experience only partial remission and have continuing residual disability, including cognitive dysfunction. Antipsychotic drugs are partially efficacious for positive symptoms but provide only marginal benefits for negative symptoms and cognitive impairment. Atypical antipsychotics are currently the popular choice for medication for schizophrenia. However, as stated before these drugs mainly help positive symptoms but don’t really affect negative symptoms and cognition. Schizophrenia is a very complicated psychological disorder. Since it is technically a group of disorders, there are many levels to research. As schizophrenia is still an enigma, hopefully one day we can understand it and have it become manageable or even cured. However, until that day comes research is the best course of action. References Carr, V. J., Lewin, T. J., & Neil, A. L. (2006). What is the value of treating schizophrenia'. Australian & New Zealand Journal of Psychiatry, 40(11/12), 963-971. doi:10.1111/j.1440-1614.2006.01919.x Drug treatment of schizophrenia: What experts are recommending. (2004). Harvard Mental Health Letter, 21(4), 4-7. Retrieved from EBSCOhost. Huffman, K. (2009). Schizophrenia. In Psychology in Action (pp. 370-377).      Hoboken, New Jersey: John Wiley & Sons, Inc. Louter, M. (2010). Schizophrenia: what's in a name'. Mental Health Practice, 13(7), 28-30. Retrieved from EBSCOhost. O'Grada, C., & Dinan, T. (2007). Executive function in schizophrenia: what impact do antipsychotics have'. Human Psychopharmacology: Clinical & Experimental, 22(6), 397-406. doi:10.1002/hup.861 Seeman, M. V. (2007). An Outcome Measure in Schizophrenia: Mortality. Canadian Journal of Psychiatry, 52(1), 55-60. Retrieved from EBSCOhost.