Biochemical Factors
Neurotransmitters, substances that allow communication between nerve cells, are also involved in the development of schizophrenia. It is thought that the disorder is associated with some imbalance of the chemical systems of the brain, involving the neurotransmitters, dopamine and glutamate.
The dopamine theory believes that Schizophrenia is caused when there is excess dopamine activity at certain synaptic sites. But, this theory has been found inadequate to completely understand the causes of Schizophrenia.
Neurophysiological Factors
Neurophysiological disturbances also play a role in Schizophrenia. There will be imbalances in various neurophysiologic processes which affect the normal attention and information-processing capabilities of the individual.
Many studies of people with schizophrenia have found abnormalities in brain structure or function of the brain, which contribute to the causes of the disease.
But, it should be known that these abnormalities are not characteristic of all people with schizophrenia, nor do they occur only in individuals with this illness. But, research has shown that these neurophysiological disturbances do play a role in Schizophrenia.
Psychosocial factors also contribute alongside with biological factors in causing Schizophrenia.
It is generally seen that among genetically vulnerable individuals, those who are exposed to a highly critical or stressful environment are more likely to succumb to schizophrenia than those who are not. The illness is often triggered by a traumatic event in the person's life. The death of a loved one, some deeply felt failure, rejection or disappointment can lead to schizophrenia in a susceptible individual. Other psychosocial causal factors are:
Damaging parent-child and family interactions
Destructive parental interactions
Faulty communication
External stress, family and intense social pressures can also work on a vulnerable individual and lead to schizophrenia.
But, it should be noted that these factors only are contributory factors and affect only genetically vulnerable individuals.
Evidence shows that sociocultural factors also contribute in causing Schizophrenia. Evidence shows that lower the socio-economic status, higher will be the prevalence of Schizophrenia.
Research has shown that while 0.32% of the population is affected by Schizophrenia in Africa, in Europe it is 0.78% and it is 0.72% in America.
(Source: WHO Study –1995)
1.3 SYMPTOMS
Schizophrenia is a psychotic disorder (or a group of disorders) marked by severely impaired thinking, emotions, and behaviors.
Some of the symptoms may come and go while others are constant. The symptoms of Schizophrenia are often organized into five distinct groups:
Delusions, hallucinations, disorganized speech, unusual behavior, agitation, bizarre behaviour, derailment of associations…..etc.
Lack of emotion, inability to speak, lack of motivation, no pleasure from activities that would normally be fun, slow movements.
- Symptoms Involving Thoughts:
Decreased attention span and memory, difficulty making decisions, trouble using well-known skills.
Depression, unpleasant feelings, hopelessness, low self-esteem.
- Social and Job Difficulties:
Social isolation, difficulty holding a job, lack of attention to appearance, difficulty maintaining relationships.
Schizophrenic patients are also differentiated into type I and type II categories.
People with Type I, or positive schizophrenia, have a rapid (acute) onset of symptoms and tend to respond well to drugs. They also tend to suffer more from the "positive" symptoms, such as delusions and hallucinations. They have normal brain ventricles.
People with Type II, or negative schizophrenia, are poorly adjusted before their schizophrenia slowly overtakes them. They have predominantly "negative" symptoms, such as withdrawal from others and a slowing of mental and physical reactions (psychomotor retardation). They have frontal lobe abnormalities and enlarged brain ventricles.
It should be noted that most patients exhibit both positive and negative signs during the course of their disorders.
2.0 DIAGNOSIS
There are no specific laboratory tests that can be used to diagnose schizophrenia. Some routine tests using CT scans are done on the patients to rule out organic disorders. Later, after other conditions (apart from organic disorder) like mood disorders, delusional disorders are ruled out, the patient should meet a set of criteria specified by DSM-IV.
To be diagnosed with schizophrenia, a patient must have psychotic, "loss-of-reality" symptoms for at least six months and show increasing difficulty in functioning normally. Before the six-month period is reached, the person is diagnosed as having a schizophreniform disorder.
2.1 DSM IV CRITERIA FOR THE DIAGNOSIS OF SCHIZOPHRENIA
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Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):
- delusions
- hallucinations
- disorganized speech (e.g., frequent derailment or incoherence)
- grossly disorganized or catatonic behavior
- negative symptoms, i.e., affective flattening, alogia, or avolition
Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other.
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Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).
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Duration: Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).
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Schizoaffective and Mood Disorder exclusion: Schizoaffective Disorder and Mood Disorder With Psychotic Features have been ruled out because either no Major Depressive, Manic, or Mixed Episodes have occurred concurrently with the active-phase symptoms; or if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.
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Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
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Relationship to a Pervasive Developmental Disorder: If there is a history of Autistic Disorder or another Pervasive Developmental Disorder, the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated).
3.0 TYPES OF SCHIZOPHRENIA
There are five subdivisions of schizophrenia as listed by DSMIV. Of these, the undifferentiated and the paranoid are the most common.
Undifferentiated type
This type of Schizophrenia is characterized by a pattern of symptoms, which change rapidly. There will be indications of perplexity, confusion, emotional turmoil, delusions of reference, excitement, dream-like autism, depression and fear.
Paranoid type
The symptoms of this type of Schizophrenia are- absurd, illogical and changeable delusions, hallucinations and impairment of critical judgement.
Paranoid schizophrenic persons show increasing persecutory suspiciousness and have difficulties in interpersonal relationships. The most frequent type of delusion they experience is the persecutory delusion where the feel that everybody else are their enemies and want to kill them. Another kind of delusion they experience is delusions of grandeur where they think that they are of great importance.
Catatonic type
This kind of schizophrenia is characterized by alternating periods of extreme withdrawal and extreme excitement. In withdrawal reaction there is a sudden loss of all animation and the person tends to remain motionless for hours. In the Excitement State, the individual talks incoherently, paces rapidly and engages in impulsive and frenzied behavior.
Disorganized type
It involves severe disintegration of personality. There is emotional distortion, inappropriate laughter, silliness, and bizarre behaviour. It occurs at an earlier age as compared to other kinds of schizophrenia. It is also called as the hebephrenic type. Auditory hallucinations and delusions are also common. There is also use of neologisms-use of words, which have no meaning.
Residual type
There is absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior but other mild indications of schizophrenia like odd beliefs, unusual perceptual experiences. The patients have at least one acute schizophrenic episode but do not presently have strong positive psychotic symptoms, such as delusions and hallucinations.
4.0 STATISTICS
The chance of developing schizophrenia during one's lifetime is about one in 100.
Statistics varies among both schizophrenic men and women, and their home environment. Researchers have also shown that men outnumber women in diagnostic studies of schizophrenia.
"In the 16-25 year old age group, schizophrenia affects men more than women. In the 25-30 year old group, the incidence is higher in women that in men"
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- Studies show that, the development of schizophrenia is greater among first-degree relatives than it is among the second degree relative. (Oltmanns & Emery, 476).
Childhood Schizophrenia:
Children over the age of five can develop schizophrenia, but it is very rare before adolescence. It affects one or two children in every 10,000; the male/female ratio is 2:1.
Prevalence:
The number of people with schizophrenia at a specific point in time is about one in 255.
Incidence:
The number of people who will be diagnosed as having schizophrenia in a year is about one in 4,000
UnitedNation's WHO 1995 study
- According to the National Institute of Mental Health (NIMH), part of the National Institutes of Health (NIH):
- Approximately 2.2 million American adults are affected by schizophrenia each year.
- One in 10 person with schizophrenia commits suicide.
- 30% of patients diagnosed with schizophrenia recover completely and the majority experiences some improvement.
Studies have shown that nearly 6 – 7 million Indians suffer from this disorder.
- There is an estimated 45 million people with schizophrenia in the world, more than 33 million of them in the developing countries.
- Individuals with schizophrenia die at a younger age than do healthy people. Males have a 5.1 greater than expected early mortality rate and females have a 5.6 greater risk of early death than the general population.
- Suicide is the main cause of death among schizophrenics, which is 10 to 13 percent higher in schizophrenia than the general population. Other causes for high mortality among schizophrenics are:
Accidents, diseases and homelessness.
5.0 TREATMENT
There is no known cure for Schizophrenia; but a significant number of people with the condition may benefit from the use of medication involving pharmacological and non-pharmacological treatments.
Because Schizophrenia tends to be a chronic (long-term) condition, lifelong treatment is often given to the patients. However, many people with the condition live full and productive lives, including re-establishing social relationships and employment.
TREATMENT
It has been found that the best approach to treating schizophrenia comprises Medical Treatment, Psychotherapy and Social Rehabilitation.
Medical Treatment:
Medical treatment is the most important part of the program. The main treatment for Schizophrenia is use of antipsychotics. The antipsychotic drugs aim at controlling the acute symptoms of the illness and suppressing distortions in perception. Sometimes, ECT-Electro convulsive therapy or shock treatment - is advised during a schizophrenic episode but usually in conjunction with the drugs.
TYPES OF DRUGS AND THEIR EFFECTS
Other treatments:
Psychotherapy
Focuses on establishing a relationship between the patient and the therapist, which encourages open discussion and promotes self-understanding and personal development.
Cognitive Therapy
Helps patients to understand the source of their own negative beliefs, how it affects their behavior, and how to challenge them.
Family Support Therapy
A good family support system can provide an important role in allowing the patient to share emotional difficulties with those around them.
Social Rehabilitation:
Rehabilitation programs can provide vocational counseling, money management, and social skills for those who have difficulty in coming to terms with everyday problems.
6.0 CONCLUSION
Schizophrenia is one of the most baffling mental illnesses known. It is not present at birth but develops during adolescence or young adulthood.
Though it has a specific set of symptoms, this illness varies in its severity from individual to individual, and even within any one afflicted individual from one time period to another.
Schizophrenia can be controlled with treatment and, in more than 50 percent of individuals recovery is possible if proper treatment is given. Though the causes of the disorder is not known, researchers have developed treatments that allow most persons with schizophrenia to work, live with their families and enjoy friends. There are many non governmental organizations and support groups to help the patients of schizophrenia and also their family into leading a normal life.
7.0 REFERENCES
-
Abnormal Psychology And Modern Life- 11th Edition
(Carson, Butcher and Mineka)
- A textbook on Psychology
( Prof. P. Natraj)
- Web sites
http//ccat.sas.upenn.edu
http://scarfindia.org/schizo.htm
