Describe the symptoms of schizophrenia

University Degree Medicine and Dentistry

Describe the symptoms of schizophrenia and consider the factors that play a role in its occurrence

We will look at the three main categories of symptoms in schizophrenia, positive symptoms, negative symptoms and disorganization symptoms, also environmental and genetic factors that contribute and play a role in the occurrence of schizophrenia.

Hallucinations are a Positive symptom, in most cases the hallucinations suffered by schizophrenic’s are not the usual visual hallucinations I would imagine most people experience when ill with a temperature. The most common hallucinations in schizophrenics are auditory hallucinations, usually consisting of one or more voices, which may speak to them directly, but quite often the voices are not directed to them, but do concern them, usually in a derogatory way, making suggestions to harm themselves or others, criticizing, or giving a running commentary on their own thoughts and actions. Hallucinations can involve any of the senses, such as visual, olfactory and tactile hallucinations, but auditory are the most common in schizophrenics (Ming et al 1997).

Delusions, which are false irrational beliefs, not based on reality, can take many forms, the schizophrenic may be deluded that they are more powerful or important than any other human, that they have god like powers or knowledge, they may believe they are a person from history; these delusions are referred to as delusions of grandeur (Carlson 2004) They may experience paranoid delusions, that they are being persecuted and that someone or something is conspiring against them, or trying to harm them.

Negative symptoms include flattened emotional response, where almost no stimuli will provoke an emotional response; they will continue to speak in a flat toneless voice, this affect appears to only affect a schizophrenic’s external emotional appearance and not their internal emotions and feelings. (Carlson 2004) schizophrenics may suffer with poverty of speech and be restricted in the spontaneity and information in their speech (Stefan et al 2002) Schizophrenics may suffer with anhedonia, an inability to experience any pleasure from activities that may have previously been pleasurable, leading to a lack of interest in recreational activities. They fail to develop close relationships and become socially withdrawn; they lack social skills and lack an interest in being with people. The schizophrenic may find that they lack energy and motivation and have no interest in the way they look and their personal hygiene. (Carlson 2004)

Disorganised symptoms include bizarre behaviour, thought disorders and disorganised speech. Irrational and disorganised thoughts are probably the most important symptoms of schizophrenia, they will have difficulty in organizing their thoughts (Davison et al 2004), and find it difficult to sort out from logical thoughts and non logical thoughts that any non schizophrenic would know where unreal and ridiculous (Stefan et al 2002)

This is a preview of the whole essay

Thought possession or insertion, the schizophrenic patient believes that thoughts are not his own and are being placed in his mind by someone or something else such as aliens or god. Thought withdrawal, Schizophrenic patients may also believe that their thoughts are being removed by some kind of phonological machinery, aliens or God and that these thoughts may be broadcast or read by others. The schizophrenic patient may also suffer with thought blocking, where they may have a thought, and be talking about it, and then suddenly stop and not remember what they were saying or thinking. (Stefan et al 2002) They may have problems with learning and will find it harder to concentrate whilst reading or watching television.

A schizophrenic whilst in conversation will change from one subject to another, Words may take on special meanings to them, either because they trigger private associations or because they pay particular attention to individual sounds rather than whole words for example “Psychiatry” Might be heard as “sigh kaya tree” so the schizophrenic will change the subject from psychiatry to mystical trees (http://www.schizophrenia.com/family/delusions.html) also they may avoid some words because they sound abusive or evil. A Schizophrenics speech may seem incomprehensible to a non schizophrenic; they will make up meaningless words, or use words which rhyme rather than making any sense (Carlson 2004).

Schizophrenics seem to lack the ability to behave in a socially acceptable way, they may collect and hoard items, sometimes even rubbish, some dress in a strange way and some are known to behave in a childlike manner or even behave in a sexually inappropriate way (Davison et al 2004).

Symptoms that don’t seem to belong to the three categories such as catatonia, which is a motor symptom, such as positioning themselves into a strange bodily position and remaining motionless (smith et al 2003) and waxy flexibility, where their limbs can be molded into position like a statue and remain motionless for a long period of time. Negativism, which is resisting attempts and suggestions, for no apparent reason, to move or be moved or doing the exact opposite to what is requested. (Stefan et al 2002) A patient with ambitendence will begin a movement such as going to shake a persons hand and then appear to change their mind and take the hand back (http://www.gpnotebook.co.uk/simplepage.cfm?ID=2140799015&linkID=8547&cook=yes). Echopraxia, constant mimicking of a person when requested not to. Stereotypies, regular repetitive movements for no apparent reason “e.g. moving the arm backwards and outwards repeatedly while saying “but not for me” (Stefan et al 2002).

It is thought that an overproduction of dopamine is responsible for the positive symptoms whilst low levels of dopamine has been found in schizophrenics with negative symptoms (Wagner 2004) research has failed to provide concrete evidence. Post-mortem studies show an increase in the densities of dopamine D2 receptors in schizophrenics, but whether this is caused by schizophrenia or antipsychotic drugs used in the treatment of schizophrenia is not known, the answer can only be confirmed by examining the brains of schizophrenics that have never been treated with antipsychotic drugs; (Frith et al 2003) Which is not possible because it would be unethical not to treat a schizophrenic patient when drugs are available to alleviate their suffering. Research is being conducted using positron emission tomography but the results are not conclusive, there is some evidence of excessive D2 receptors, yet other research has found no difference between schizophrenics and controls (Frith et al 2003). Further research needs to be done, to conclude, what, if anything is wrong with the dopamine system in schizophrenics

Cannabis has caused some controversy as to whether it its usage can cause the development of schizophrenia, it has long been known that it can cause psychotic symptoms, but research has shown that cannabis is a major risk factor in the onset of schizophrenia. There is strong evidence from a study on heavy cannabis users in Sweden who where conscripted into the army, when followed up 15 years later it was found that they where six times more likely to develop schizophrenia than non using conscripts (Frith et al 2003). It has also been proven that relatives of schizophrenics who use cannabis are at a higher risk of developing schizophrenia (Frith et al 2003)

Early environmental factors are thought to be a factor in the development of schizophrenia; maternal starvation has been known to increase the rate of schizophrenia, after the second world war in Holland, women who were deprived of food in the first three months of pregnancy, when it is thought to affect the brain at a critical stage, influenza can also have an affect. It has been considered that difficulties at birth could be a possible cause but there is no conclusive evidence (Frith et al 2003).

Abnormalities found in the brains of schizophrenics may be due to genetic factors or due to the effects from environmental factors, (Wagner 2004) studies have found that the lateral ventricular in a schizophrenic patient is around 25% larger than normal, although their actual brain is fractionally smaller and has a reduced cortical volume mostly in the temporal lobes, basal ganglia and limbic structures and also sulcal widening. (Davison et al, 2004) It has been found that schizophrenic patients have structural faults in the temporal cortex, hippocampus, basal ganglia and the prefrontal cortex which also has a reduction in grey matter and a slow metabolic rate. It has been suggested that during the second trimester of the foetal development that there is some failure in neuronal migration. (Davison et al, 2004)

The largest risk factor for developing schizophrenia is genetic. The main studies on twins by Gottesman (1991) show that monozygotic twins have a greater risk at 48% of both developing schizophrenia compared to dizygotic twins which have 17% chance of developing schizophrenia(Cited in Letts 2001), although this can not be proved without doubt because monozygotic twins would be treated similarly by parents and would share the same environmental influences Adoption studies backup the theory (Stefan et al 2002) Tienari (1991) studied 155 adopted children whose natural mothers were schizophrenic. When followed up years later he found that 10.3% had developed schizophrenia, compared with only 1.1% of those without schizophrenic mothers. Parnaset (1993) backs up this theory; he studied 207 children with schizophrenic mothers and followed them up nearly 30 years later 16% developed schizophrenia compared to a low risk group which only 2% developed schizophrenia (Cited in Letts 2001). Evidence has been found by Sherrington et al (1988) of a group of genes on chromosome 5 that might be the reason for a person being susceptible to developing schizophrenia, but it has yet to be confirmed (Cited in Letts 2001).

Modern methods of genetic Gene research using restriction fragment length polymorphisms find that faulty genes can sometimes be identified in many hereditary diseases. With schizophrenia the pattern of inheritance is irregular it could be down to one gene or many but evidence shows that it is probably several all with a small affect interacting with each other (Frith et al 2003). It is not all down to genetics as the Diathesis stress model shows mental disorders develop when a person is genetically vulnerable and are triggered by certain environmental conditions and stress (Letts 2001).

The symptoms of schizophrenia are so varied from self neglect and social withdrawal, to delusions and hallucinations, and not all being present in every case. The wide range of abnormalities in the brain could possibly explain why there is such a wide range of symptoms. Considering all of the genetic and environmental factors that play a role in its occurrence research seems to point towards genetics being the main factor and environmental factors playing a part in triggering the onset of schizophrenia.

1635 words plus references

References

Carlson, N, R. (2004). Physiology of behaviour, 8th edition. Boston: Pearson.

Christopher, F. Johnstone, E. (2003). Schizophrenia a very short introduction. New York: Oxford university press.

Davison, G, C. Neale, J, M. Kring, A, M. (2004). Abnormal Psychology 9th edition. USA: John Wiley & sons, Inc.

Merrell, D. (1996). Schizophrenia .com. Retrieved April, 16th, 2005. http://www.schizophrenia.com/family/delusions.html.

Ming T, T. Faraone, S, V. Johnson, P, D, C. (1997). schizophrenia the facts 2nd edition. New York: Oxford university press.

Smith, E, E. Nolen-Hoeksema, S. Fredrickson, B, L. Loftus, G, R. (2003). Atkinson & Hilgard’s introduction to psychology 14th edition. Belmont: Thomson Wadsworth.

Stefan, M. Travis, M. Murray, R, M. (2002). An atlas of schizophrenia. New York: The Parthenon publishing group.

Wagner, H. Silber, k.(2004). Physiological psychology. Oxon: Garland science/bios scientific publishers.

Written by various examiners, not listed. (2001). Revise A2 psychology. London: Letts educational.

No author. (2004). G P notebook. Retrieved April, 16th, 2005. http://www.gpnotebook.co.uk/simplepage.cfm?ID=2140799015&linkID=8547&cook=yes, Oxbridge Solutions Ltd.