The Causes Effects and Treatments of Schizophrenia

Schizophrenia is a very complex, chronic mental health disorder. It is often characterized by displaying multiple symptoms which may include, but are not limited to, delusions, hallucinations, disorganized behavior and/or speech, and impaired cognitive ability. Schizophrenia affects about 1% of the population at some point in their lifetime (Patel, Cherian, Gohil, & Atkinson, 2014).

The current Diagnostic and Statistical Manual of Mental Disorders (DSM-V) describes schizophrenia as an illness that displays psychotic symptoms and significant interpersonal or occupational dysfunction that persists for a period of at least six months.

The term psychotic refers to symptoms that impair an individual's ability to comprehend reality. This includes beliefs that have no basis in reality. Usually, these beliefs are immune to corrective feedback (delusions), and sensory perceptions that have no identifiable external source (hallucinations).

Delusions are the primary example of abnormal thoughts in schizophrenia. There are many different types of delusions. "Delusions of control" refer to the belief that one is being manipulated by an external force, often a powerful individual or organization with malicious intent. "Delusions of grandeur" pertain to an individual's belief that they possess unique qualities or powers.

Other beliefs that some hold include thinking that they are victims of persecution or part of an organized plot. These beliefs are referred to as "delusions of persecution." More specific examples of delusions include "thought broadcasting", where an individual believes their thoughts are transmitted so others can know them, and "thought withdrawal", which describes the belief that an external force has stolen one's thoughts.

Hallucinations are some of the most distressing symptoms experienced by schizophrenia patients. These perceptual distortions vary between individuals and can be auditory, visual, tactile, or a combination. However, the most common type of hallucination is auditory, often hearing voices. Those who have reported hearing voices describe various scenarios such as hearing someone threatening or chastising them, a voice repeating their own thoughts, two or more voices arguing, or voices simply commenting. The second most common form of hallucination is visual, often involving perception of distortions in the physical environment, especially in the faces and bodies of other people.

Other distortions reported by schizophrenia patients include feeling as if parts of the body are the wrong size or shape, feeling objects being closer or farther than they actually are, experiencing numbness, tingling, or burning, and perceiving objects as flat and colorless. People suffering from schizophrenia also often report difficulties in focusing their attention.

The DSM-V uses the term "disorganized speech" to refer to abnormalities in the form or content of an individual's verbalizations. These abnormalities presumably reflect underlying distortions in the person's thought processes. The term "thought disorder" is frequently used by researchers and practitioners to refer to this type of disorganized speech seen in schizophrenia. Speech problems occur in the organization and expression of ideas to others. Incoherent speech refers to unrelated fragments of thoughts that are incomprehensible to the listener. Another example of disorganized speech is "loose association", which refers to the tendency to abruptly switch to a topic unrelated to the one previously discussed.

The symptoms of schizophrenia can usually be classified into the general categories of positive and negative. Positive symptoms involve behavioral excesses, and most of its symptoms (previously described above) fall into this category. Examples of negative symptoms include blunt expressions of emotion, apathy, and social withdrawal.

Due to the broadness in the diagnostic criteria for schizophrenia, there is a large gray area of variability among patients. Because of this, multiple causes for schizophrenia can be proposed. Those who meet criteria for the diagnosis are significantly impaired in everyday functioning. For many individuals diagnosed with schizophrenia, independent functioning is never achieved.

During the late 1800s and early 1900s, Emil Kraepelin and Eugen Bleuler provided the first interpretations of schizophrenia. Kraepelin termed schizophrenia as "dementia praecox," which meant "an endogenous psychosis characterized by intellectual deterioration (dementia) and early onset (praecox)." Kraepelin included negativism, hallucinations, delusions, stereotyped behaviors, attentional difficulties, and emotional dysfunction as major symptoms of the disorder. Kraepelin's work focused on description and phenomenology, leaving later researchers to investigate the cause(s) of the disorder.

In contrast to Kraepelin, Bleuler proposed a broader theoretical view of "dementia praecox." Bleuler questioned two of Kraepelin's defining assumptions: that psychosis was typically characterized by early onset and intellectual deterioration. Bleuler concluded that all of the patients suffered from a "breaking of associative threads," causing a "disharmony" among communication and thought processes. He believed this abnormality accounted for the problems of thought, emotional expression, decision making, and social interaction associated with schizophrenia. Guided by the defining principle of disharmonious mental structures, Bleuler renamed the disorder "schizophrenia," meaning "split mind."

During the early to mid-1900s, some clinicians and researchers viewed the specific diagnostic criteria for the major mental illnesses (schizophrenia, bipolar disorder, major depression) as artificial and discretionary, and instead used flexible and inconsistent standards for diagnoses. Studies that compared the rates of disorder across nations revealed that schizophrenia was diagnosed at a much higher rate in the United States than in Great Britain and other countries.

This national difference resulted from the use of broader criteria for diagnosing schizophrenia in the United States. Many patients who were diagnosed as having depression or bipolar disorder in Great Britain were diagnosed with schizophrenia in the United States. Because subsequent revisions in the DSM have included more restrictive criteria for schizophrenia, U.S. diagnostic rates are now comparable with other countries.

In addition to a more restrictive definition of schizophrenia, newer editions of the DSM have included additional diagnostic categories that contain similar symptoms. Due to these changes, the range of "schizophrenia disorders" continues to broaden with the changing description of schizophrenia.

Estimates of the commonality of schizophrenia are around 1% of the population. The most common age of onset for schizophrenia is in early adulthood, usually before 25 years of age. This early onset implies that most patients have not had the opportunity to marry or establish a stable work history before the onset of the illness. As a result of this, and the often chronic nature of the illness, many patients never attain financial independence. It is relatively rare for older children to receive a diagnosis of schizophrenia. Similarly, it is rare for individuals beyond the age of 40 to experience a first episode of the illness.

Although it has traditionally been assumed that there is no sex difference in the rates of schizophrenia, some recent research findings indicate that a somewhat larger proportion of males than females meet the DSM-V criteria for the disorder. Nonetheless, the overall rates do not differ dramatically between men and women. It is well established that women are more likely to have a later onset of the illness, as well as a better prognosis.

Women also show a higher level of interpersonal and occupational functioning during the period prior to illness onset. The reasons for this sex difference are not known, but several theorists have proposed that the female sex hormone, estrogen, may function in attenuating the severity of the illness. When compared with the general population, schizophrenia patients tend to have significantly lower incomes and educational levels. The lowest socioeconomic class contains the largest proportion of schizophrenia patients.

Before the introduction of antipsychotic medications in 1950, the majority of patients spent most of their lives in institutional settings. There were hardly any programs for rehabilitation. Today, contemporary and multifaceted treatment approaches have made it possible for most patients to live in community settings.

During active episodes of the illness, patients are usually functionally impaired. They are typically unable to work or maintain a social network and often require hospitalization. Even if recovered, patients find it challenging to hold a job or be self-sufficient. This is partially due to residual symptoms, as well as the interruptions in educational attainment and occupational progress that result from the illness. However, there are many patients who are able to lead productive lives, hold stable jobs, and raise families. With the constant ongoing development of community awareness of mental illness, some of the stigma that kept patients from pursuing work or education has diminished.

The causes of schizophrenia are still very much unknown, but it is now widely accepted by researchers and clinicians that schizophrenia is biologically determined. During the mid-1900s, many associated the cause with faulty parenting, especially cold and rejecting mothers. There are several sources of evidence that schizophrenia involves an abnormality in brain function. Studies of schizophrenia patients have revealed a variety of behavioral signs of central nervous system impairment, including motor and cognitive dysfunctions. When the brains of patients are examined with imaging techniques, such as magnetic resonance imaging (MRI), many show abnormalities in brain structure.

Prior to the 1900s, knowledge of the nature and causes of mental disorders was limited. Individuals with psychiatric symptoms were typically viewed by others with amusement. However, social trends and advances in medical knowledge have greatly improved to produce sympathy for those with mental illnesses. This helped lead to the construction of many hospitals devoted to the care of the mentally ill. Today, most schizophrenia patients experience at least one period of inpatient treatment. During this hospitalization, an assessment is usually conducted to determine the most appropriate diagnosis. Treatment is then initiated to reduce symptoms and stabilize patients so that they can return to the community as soon as possible.

In the past, periods of hospitalization were longer in duration than they are today. This is due to the availability of better medical treatments present today. Another factor that has contributed to shorter hospital stays is the "deinstitutionalization movement". Concerns that too many mentally ill individuals were becoming "institutionalized" and were losing their ability to function in the community, caused financial support for state psychiatric hospitals to be gradually cut. Many community support services and transitional living arrangements were not available to patients. As a result, psychiatric inpatients are now a large part of the homeless population found in U.S. cities.

Many clinicians have used various forms of psychological therapy in an effort to treat schizophrenia patients. Early attempts to provide therapy for schizophrenia patients relied on psychodynamic techniques. The goal was to foster self-understanding in patients. It has been shown that supportive therapy can be a useful alternative to medication in the treatment of patients.

In recent years, family therapy has become a standard component of the treatment of schizophrenia. Family therapy sessions are intended to provide the family with support, information about schizophrenia, and constructive guidance in dealing with the illness in the family member. In this way, family members become a part of the treatment process and learn new ways to help their loved one cope with schizophrenia.

It is believed that schizophrenia is caused by an abnormality of brain function that stems from its origin in early brain insults and inherited vulnerabilities. However, the exact causes for schizophrenia must await the findings of future research. There is a lot of reason to be optimistic about future research progress. New technology is available for examining the brain's structure and function. In addition, advances in neuroscience have expanded the understanding of the brain and the impact of brain abnormalities on behavior. Great discoveries for the understanding of the causes of all mental illnesses within the coming decades will continue.

It is also hoped that advances will be made in the treatment of schizophrenia. New drugs are being developed at a much faster rate, and more effective medications are likely to result. At the same time, advocacy efforts on the part of patients and their families have resulted in improvements in services. However, more community awareness and a further expansion of services are greatly needed to provide patients with the structured living situations and work environments they need to make the transition into independent community living.

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