Schizophrenia is considered to be one of the most critical mental illnesses. We will be looking at the causes of schizophrenia whether it is nature or nurture, the symptoms- looking at the different types and sub-types of schizophrenia, the diagnosis and lastly how to treat this illness.
Schizophrenia is a syndrome that causes the splitting of the mind. This splitting of the mind tampers with the thought process, perception and behavior.
This chronic illness affects 1% of the population. According to World Health Organization, schizophrenia occurs more in men than in women. Being early and mid-twenties for men and late twenties for women. It is said that the clinical signs of schizophrenia are less severe on women due to estrogen regulation of dopamine systems.
Signs and Symptoms
The schizophrenia symptoms are in three categories; the positive symptoms which include the behavior changes that is added by the disorder and is not normally found in a healthy person. They include agitation, hallucination, disorganized thinking and delusions.
Agitation is one of the positive symptoms which are a state of irritability and tension.
Hallucinations also occur where the patient hears voices which do not exist. Disorganized thinking is the inability to keep track of thoughts and conversations. Delusions are false beliefs caused when one cannot differentiate real from unreal experiences.
The negative symptoms are the abilities lacking in schizophrenics but are present in normal people. They include lack of emotional response showing neither sadness nor happiness. Social withdrawal also occurs where the schizophrenic isolates themselves, lack of drive having no motivation and apathy where one experiences emptiness and not being able to follow through with any plans.
Cognitive symptoms are related to memory and concentration. They include difficulty with concentration, difficulty understanding information and in making decisions.
According to Fenton WS, McGlashan TH(Natural history of schizophrenia) , there are also classic subtypes of schizophrenia are paranoid, catatonic, udifferentiated, disorganized and residual. Each have different prognoses making it easier for one to know how to diagnose a patient.
Diagnosing a Schizophrenic?
How It Starts?
The person is interviewed by a mental health profession such as a psychiatrist. As the psychiatrist interviews the patient, they have to observe the patients movements, concentration levels and basically look out for any of the symptoms. Relatives and friends are interviewed thereafter to get an in-depth report of the patient. Once this is done, the next step to rule out the other causes and disorders before diagnosing the person.
The following should be evident when diagnosing:
- Present should be two or more of these symptoms: delusions, hallucinations, disorganized speech, disorganized behavior, negative symptoms and cognitive symptoms.
- Constant signs of schizophrenia for a period of six months with at least five symptoms active for one month. Major decline in academic and work performances and lastly change in attitude to others and to self.
Is Schizophrenia Caused by Nature or Nurture?
After looking at the symptoms, we can look at what causes schizophrenia. According to research, it has stated that schizophrenia is a result of increase in dopamine.
The Danish Twin Register study done in 1954 on twins to determine if identical and non-identical twins who are in similar conditions are more likely to get schizophrenia. The results were about 78% of the sample had schizophrenia. This shows that the humans are carriers of the genes that can result to schizophrenia. Research also shows that the risk of having the disorder increases in people who have a relative with the illness.
Looking at the nurture aspect, there are environmental factors such as social, hormonal, nutritional and the chemical environment. It also includes stress developed while growing i.e. education, substance abuse and social dynamics which affect in advancing the symptoms.
During the developmental stage of pregnancy, so many environmental factors together with genetic predisposition causes disturbance in brain development which makes the individual prone to develop schizophrenia. Based on the environmental factors this determines whether the symptoms will reduce or increase.
According to World Health Organization, more than 50% of people with schizophrenia are not receiving appropriate care. This is because they live in low income areas and are less likely to access mental health services.
This leads to the condition becoming more chronic.
According to Lehman. A, Lieberman. J et al the treatment plan for schizophrenia has three agendas; to reduce or eliminate the symptoms, to maximize the quality of life & adaptive functioning and to promote and maintain recovery from the weakening effects of the illness.
Schizophrenia can be treated using medication such as antipsychotics.
They are usually categorized as Typical drugs which are first generation drugs which include Haldol, Etrafon, and Thorazine There are also atypical drugs which are second generation drugs that are comparatively new. They include Saphris, Invega, Geodon and Clozapine.
Most of these drugs are known to cause frequent side effects such as seizures, allergic effects, hypotension, and weight gain. Therefore the use of ECT (Electroconvulsive therapy) started increasing, for medication resistant patients. According to Sanghani. S et al who did a study on ECT in schizophrenia, results found that the therapy showed a great improvement in reducing the symptoms especially the cognitive ones.
There are also psychosocial interventions that help the patient further in day to day life such as work, school and general communication. Patients who follow through this treatment are less likely to relapse. Such psychosocial interventions include social skills training, individual therapy, family therapy, cognitive behavior therapy and early intervention. Looking at Tarrier N et al (prodromal signs of relapse in schizophrenia) they found that especially when one notices the prodromal symptoms such as tension, nervousness and low concentration and acts on the early intervention, relapse is likely to be prevented.
Lastly, by offering supported employment to train the patients to understand how to work and cope with people as a way of preparing them for the real world.
Schizophrenia has been identified to have many causes both genetic and environmental factors but majorly that the environmental factors determine even gene carriers of this illness, whether the symptoms will increase or not. Even if they are not present now, they can occur later on in life especially for women.
Many social factors can lead to schizophrenia such as social status, education level, jobs and at the same time the social set up is also a treating element. It is with that to say that schizophrenics have been able to live a healthy life reducing the symptoms with proper treatment, right medication and a great support system.
- Sanghani SN, Petrides G, Kellner CH: Electroconvulsive therapy (ECT) in schizophrenia: a review of recent literature.Curr Opin Psychiatry. 2018 May; 31(3):213-222. doi: 10.1097/YCO.0000000000000418
- Tarrier N, Barrowdough C, Bramah J: Prodromal signs of relapse in schizophrenia. Soc Psychiatry Psychiatr Epidemiol.1991; 26:157-161
- Lehman. A, Lieberman. J et al: Practice Guideline for the Treatment of Patients with Schizophrenia (2nd edition). American Psychiatric Association. 2004 February
World Health Organization: Schizophrenia; https://www.who.int/news-room/fact-sheets/detail/schizophrenia
- Fenton WS, McGlashan TH. Natural history of schizophrenia subtypes. I. Longitudinal study of paranoid, hebephrenic, and undifferentiated schizophrenia. Archives of General Psychiatry 1991; 48:969–977