“Schizophrenia is defined as functional psychotic condition characterized by disturbances in thinking, emotion, volition and perception in presence of clear consciousness, which usually leads to social withdrawal.” (Comer, R. J. 2005) Schizophrenia is most common among lower social classes. The psychological disorder of schizophrenia represents at once the misconceptions of the past, the solutions of the present, and the promise of the future. Indeed, Nevid & Rathus (2005) admit that the expression “schizophrenia” is a broad term that can be used to describe a wide variety of human behavior and psychological dysfunctioning. The variety of symptoms that represent this disorder range from hallucinations to paranoia. There are also several different types of diagnosed schizophrenia, including the catch-all category of undifferentiated schizophrenia. Furthermore, the biological, psychological, and sociocultural approaches to psychology aid in the understanding of the underlying causes associated with the disorder. Lastly, the treatment, or in some cases attempted treatment, of schizophrenia encompasses a wide range of solutions including antipsychotic drugs and in the past the use of asylums. As it is, schizophrenia is a complex disorder caused by a yet unknown combination of factors that underlie an obvious set of symptoms which can usually be treated successfully through the combination of drug therapy and psychotherapy/community treatment.
Causes of Schizophrenia
No one knows the exact causes of Schizophrenia, but multiple possible factors have been discovered. But, as is the case for many other illnesses, it is believed to result from a combination of environmental and genetic factors. Scientists have long known that schizophrenia runs in families. It occurs in 1 percent of the general population, but is seen in 10 percent of people with a first-degree relative (a parent, brother, or sister) with schizophrenia. People who have second-degree relatives (aunts, uncles, grandparents, or cousins) with the disease also develop schizophrenia more often than the general population. The identical twin of a person with schizophrenia is most at risk, having a 40 to 65 percent chance of developing the condition. So, although there is a genetic risk for schizophrenia, genes are unlikely to cause the disease on their own. It is believed that interactions between genes and the environment are necessary for schizophrenia to develop. Many environmental factors have been suggested as risk factors for schizophrenia, such as: Exposure to viruses, malnutrition in the womb, problems during birth, psychosocial factors, like stressful environmental conditions. The brains of people with schizophrenia look a little different from the brains of people without it, but the differences are small. Sometimes, the fluid-filled cavities at the center of the brain, called ventricles, are larger in people with schizophrenia. Also, the overall gray matter volume is lower, and some areas of the brain have less or more metabolic activity than normal.
Schizophrenia Major Divisions of Symptoms
Hallucinations a Positive Symptom of Schizophrenia
The symptoms of schizophrenia can be categorized into three wide-ranging groups. The first group comprises the positive symptoms which are usually characterized as pathological excess (Nevid & Rathus, 2005). This group is characterized as a pathological excess because the symptoms in this group add to a person’s behavior rather than subtract from a person’s behavior. Positive symptoms include delusions; specifically delusions of persecutions, delusions of reference, delusions of grandeur, and delusions of control. The first category of symptoms also include disorganized thinking and speech expressed as loose associations (derailment), neologisms or made-up words, preservation, and clang (rhyming). Furthermore, positive symptoms can be expressed through heightened perceptions, hallucinations, and memory loss. Lastly, some that suffer from schizophrenia exhibit a behavior called inappropriate affect which is characterized by emotions that are inappropriate for a given situation. The second division of the symptoms of schizophrenia include the negative symptoms or pathological deficits. These symptoms inhibit a person’s behavior significantly and include poverty of speech (alogia), blunt and flat affect characterized by blunted emotional responses or no emotional response, loss of volition (avolition), and social withdrawal. Lastly, the category of psychomotor symptoms entail awkward movements, repeated gestures, and even catatonia. The symptoms for schizophrenia seem to be pretty straightforward; however, the diagnosis of this disorders is not always so cut-and-dry. “Hallucinations and delusional ideas often occur together.A man with delusions of persecution may hallucinate the smell of poison in his bedroom or the taste of poison in his coffee. Might one symptom cause the other? Whichever comes first, the hallucination and delusion eventually feed into each other.” (Comer, R. J. 2005)
Diagnosis Types of Schizophrenia
The DSM-IV allows the diagnosis of schizophrenia only after six or more months of continued symptoms (Nevid & Rathus, 2005). A decay in work, social relations, and the ability to take care of oneself must also be observed in order to issue a diagnosis of schizophrenia. There are five distinct types of schizophrenia which can be diagnosed and include disorganized schizophrenia, catatonic schizophrenia, paranoid schizophrenia, undifferentiated schizophrenia, and residual schizophrenia. The first category of disorganized schizophrenia entails the symptoms of incoherence, confusion, and inappropriate affect. On the other hand, catatonic schizophrenia is characterized mainly by either catatonic stupors or catatonic excitement. Maybe the most well known form of schizophrenia, paranoid schizophrenia includes, “an organized system of delusions and auditory hallucinations that may guide [the patient’s life]” (Nevid & Rathus, 2005, p. 360). Next, the diagnosis of undifferentiated schizophrenia is used for a person whose symptoms do not fall neatly into one of the aforementioned categories. The category of undifferentiated schizophrenia is however sometimes vaguely defined and as a result can be overused. Lastly, residual schizophrenia refers to a person whose symptoms have lessened in strength and number. (i.e. residual symptoms) Furthermore, separate from these categories someone suffering from schizophrenia can be classified with either Type I schizophrenia or Type II schizophrenia. Type I schizophrenia is reserved for those that are subject to mostly positive symptoms, and Type II schizophrenia is set aside for those that are subject to more negative symptoms. Now that the foundation of symptoms and diagnosis has been satisfied a more inclusive look at the different psychological perspectives can be appreciated…
“[When schizophrenia investigators began to identify genetic and biological factors during the 1950s and 1960s, many clinicians abandoned the psychological and sociocultural theories of the disorder.]” As with most psychological disorders, the first person to offer an intact theoretical framework from which to understand schizophrenia was Freud (Nevid & Rathus, 2005). His psychodynamic theory suggests that schizophrenia is caused by a cycle of regression to primary narcissism and the restoration of ego control/connection with reality. However, as is the case with most psychodynamic theories Freud does a superb job of explaining the situation but has only limited success in the treatment of the disorder. On the other hand, the biological view has had great success in explaining schizophrenia through genetic factors, biochemical abnormalities, abnormal brain structure, and viral problems. Furthermore, the cognitive approach hypothesizes that most of the characteristics of schizophrenia are produced when a person tries to compute or understand the unusually sensations that usually accompany the onset of the disorder. Lastly, the sociocultural view takes into account the factors of social labeling and family dysfunctioning when considering the disorder. Of particular interest is the social labeling aspect of the sociocultural view of schizophrenia. Social labeling explains that some of the symptoms of schizophrenia might be a result of the diagnosis itself, thereby affecting how a diagnosed person views themselves and how other people treat that person. Collectively, the diathesis-stress view suggests that schizophrenia is caused by a biological predisposition coupled with certain types of stress. With an understanding of the symptoms, the possible diagnosis, and the viewpoint of different psychological perspectives in hand all that is left are the possible treatments…
Methods of Treatment Common Misconceptions… Types of Treatment
The Community Approach
Schizophrenia treatment has advanced considerably in recent years. However, since the causes of schizophrenia are still unknown, current treatment focuses on: Eliminating the symptoms of the disease, improving quality of life, and restoring productive lives. Treatment and other service interventions are often linked to the clinical phases of schizophrenia: Acute phase, stabilizing phase, stable (or maintenance) phase and the recovery phase. Achieving optimal treatment for schizophrenia across all phases of the disorder generally requires some form of medical therapy with antipsychotic medication, usually combined with a variety of psychosocial interventions (e.g., therapy, rehabilitation). Antipsychotic medications for schizophrenia have been available since the mid-1950s. These drugs alleviate the positive symptoms of schizophrenia. While antipsychotic medications have greatly improved the lives of many patients, they do not cure schizophrenia. Everyone responds differently to antipsychotic medications. In some cases, several different drugs must be tried before the right one is found. People with schizophrenia should work in partnership with their doctor to find the medications that best control their symptoms with the fewest side effects. Like diabetes or high blood pressure, schizophrenia is a chronic disorder that needs constant management. At this time, schizophrenia cannot be cured, but the number of psychotic episodes a person experiences can be decreased significantly by staying on the prescribed medications. Although responses vary from person to person, most people receiving schizophrenia treatment need to take some type of medication for the rest of their lives and use other approaches, such as supportive therapy or rehabilitation, as well. Antipsychotic medications can produce unpleasant or dangerous side effects when taken with certain other drugs. For this reason, the doctor who prescribes the antipsychotics should be told about all medications (over-the-counter and prescription) and all vitamins, minerals, and herbal supplements the patient takes. The use of alcohol or other drugs should also be discussed. Patients who receive regular psychosocial treatment for schizophrenia also adhere better to their medication schedule and have fewer relapses and hospitalizations. A positive relationship with a therapist or a case manager gives the patient a reliable source of information, sympathy, encouragement, and hope -- all of which are essential for recovery. By explaining the nature and causes of schizophrenia and the need for medication, the therapist can also help patients acknowledge the reality of their disorder and adjust to the limitations it imposes.
Types of Schizophrenia Catatonic Disorganized Paranoid Residual Undifferentiated
A person who has been diagnosed with Catatonic Schizophrenia can be clumsy and uncoordinated. They may also show involuntary movements, grimacing, or unusual mannerisms. They may repeat certain motions over and over or, in extreme cases, may become catatonic. People with Disorganized Schizophrenia often have unusual thought processes. One dramatic form is disorganized thinking, where the person may have difficulty organizing thoughts or connecting them logically. Speech may be garbled or hard to understand. Another form is "thought blocking," where the person stops abruptly in the middle of a thought. When asked, the person may say it felt as if the thought had been taken out of his or her head. Finally, the individual might make up unintelligible words, or "neologisms.“Paranoid schizophrenia is the most common form. With this type of schizophrenia, the primary symptoms are delusions or auditory hallucinations. People with paranoid schizophrenia usually do not have thought disorder, disorganized behavior, or affective flattening. People with this condition have grandiose delusions. For example, they may believe that others are deliberately: Cheating them, harassing them, poisoning them, spying upon them, plotting against them or the people they care about. Auditory hallucinations can include hearing "voices" that may: Comment on the person's behavior, order him or her to do things, warn of impending danger, talk to each other (usually about the affected person).Residual schizophrenia can occur in people with long-term schizophrenia. With this schizophrenia type, a person no longer shows positive symptoms (hallucinations, delusions, disorganized speech, and grossly disorganized or catatonic behavior), but still shows negative symptoms, which can include: Flat affect (for example, immobile facial expression and monotonous voice), lack of pleasure in everyday life, diminished ability to initiate and sustain planned activity, speaking infrequently, even when forced to interact. People with residual schizophrenia often neglect basic hygiene and need help with everyday living activities. When a person is diagnosed with the Undifferentiated type of schizophrenia, a person meets the criteria to be diagnosed with schizophrenia, but his or her symptoms are not consistent with any of the other forms of the disease.
Conclusion: “If you talk to God, you are praying; if God talks to you, you have schizophrenia” (Szasz, n.d., p. 1).
It is clear now, through the use of genetic linkage studies and microbiology, that schizophrenia does indeed have a biological explanation (Nevid & Rathus, 2005). However, the biological explanation is only part of the story. A yet unknown combination of intense stress, sociocultural situations, and cognitive processes may lead to the actual onset of schizophrenia aided by natural precursors. The most compelling explanation seems to be that a genetically inherited biological abnormality gives rise to hallucinations/delusions as a result of intense stress and eventually leads to other negative symptoms in reaction to the hallucinations/ delusions. At any rate, the current understanding of schizophrenia explains that the symptoms, however easily identifiable, are the result of a complex interaction between nature and nurture that can be treated adequately through the use of atypical antipsychotic drugs and psychotherapy/community treatment.
Reference Page: Comer, R. J. (2005). Fundamentals of abnormal psychology (4th ed.). New York: Worth. Nevid, J.S., & Rathus, S.A. (2005). Psychology and the challenges of life: Adjustment in the new millennium (9th ed.). Hoboken, NJ: John Wiley & Sons. Szasz, T. (n.d.). Retrieved September 5, 2008, from The Quotations Page Web site: http://www.quotationspage.com/search.php3?homesearch=schizophrenia&startsearch=Search
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