SL Psychology/The Schizophrenias

General Information
Schizophrenia, a term coined by Eugen Bleuler in 1911 by combining the Greek words for "split" and "mind," is "a group of disorders characterized by loss of contact with reality, marked disturbances of thought and perception, and bizarre behavior." Hallucinations and/or delusions are also coupled with the disorders. Onset of schizophrenia usually occurs during the adolescent years during puberty, possibly due to the apoptosis that occurs throughout that time, or in early adulthood. In men, the disorder occurs in the late teens or early 20s; women, in the mid-20s to early 30s. Rare cases occur after the age of 45 or before puberty. Often, the symptoms that occur during the teen years can be attributed to normal teen behavior, so a diagnosis is difficult during that period of time. The disease was first identified by Emil Kraeplin in 1896, who said that the disorder, then named "dementia praecox," was a premature deterioration of the brain that occurred early in life and continued throughout. However, Bleuler found in 1911 that the disorders stemmed from initial deterioration, but the deterioration did not continue. That is, the patients "stabilize[d] and remain[ed] at the same point in their psychosis for extended periods of time." Nevertheless, schizophrenia is a debilitating and burdensome disorder that impacts the lives of about one percent of the world's population.

Symptoms
The symptoms of schizophrenia are categorized into three sections: positive, negative, and cognitive. Of the three, positive symptoms are easier to recognize, but cognitive symptoms are the most harmful to the livelihood of the sufferer as they prevent the patient from participating effectively in the workplace or in society. Negative symptoms, on the other hand, can be misinterpreted as depression or laziness. However, schizophrenics are not usually violent unless substance abuse is involved or if the patient is a paranoid schizophrenic, in which case, the violence occurs in the home. Schizophrenics are more likely to attempt suicide, 10 percent of which succeed.

Positive Symptoms
Any behavior not seen in healthy people that correlate with a loss of contact with reality. These include:
 * Hallucinations - perceiving a sensory stimuli that no one else can. In schizophrenia, sufferers most often hear voices that tell them what to do, warn of danger, or talk to each other about the patient.
 * Delusions - false beliefs that are not of the culture of the patient that are unchanging even after being proven incorrect. The type of delusion depends on the type of schizophrenia. Those who suffer from paranoid schizophrenia have delusions that other people want to harm them (called "delusions of persecution"), whereas other schizophrenics may think themselves famous or that the television is communicating with them.
 * Thought Disorder - unusual thought processes. This is characterized by disorganized thinking, problems articulating, sudden loss of thought, and the formation of unintelligible words.
 * Disorders of Movement - lack of coordination. Disorders of movement can range from involuntary movements to catatonia.  Thanks to newer treatments, catatonic states due to schizophrenia are rare.

Negative Symptoms
Any behavior that healthy people have that is lacking in the non-healthy person. These include:
 * Monotony in tone and facial expression
 * Lack of pleasure in life
 * Lacking initiative in activities
 * Infrequent vocal interaction with others
 * Neglect of hygiene, which leads to the misconception that the sufferer is lazy or does not want to take care of him/herself to better the life. Therefore, negative symptoms alone are not perceived as a psychiatric illness.

Cognitive Symptoms
Subtle differences in cognitive ability that are normally only discovered after neuropsychological tests are given. Examples are:
 * Poor ability to absorb and act upon information (executive functioning)
 * Lack of attention
 * An inability to utilize working memory

Possible Causes
As with all psychological theories on disorders or brain function, schizophrenia can be a result of a natural or nurtured environment. The root causes of the disorder are unknown; however, research is always being conducted to determine them.

Genetic Factors
Schizophrenia runs in families. The chances of a person in the general populace of having the disorder are 1 in 100. If a person has a parent, brother, or sister with schizophrenia, the chance increases to 60%. An increase also occurs if grandparents, aunts, uncles, or cousins have the disorder. An identical twin has the most risk(45 to 65 percent). While this research can be evidence enough that the disorder has a basis in genetics, there is no way to determine who would have the disorder through gene mapping. Even so, a genes are not believed to be enough to cause the disease; therefore, it is assumed that the environment plays a role as well. Common ideas for the environmental factors are viral exposure or malnutrition in the womb, complications during birth, or stressful psychosocial conditions.

Brain Chemistry and Structure
Research into the role of neurotransmitters and schizophrenia is still somewhat new and is a "promising area of research." It is believed now that dopamine and glutamate play a role in schizophrenia, and further research is needed to determine if other chemicals are involved.

Schizophrenic brains are slightly different than normal brains. The ventricles - fluid-filled cavities in the center of the brain - are larger. Also, the volume of gray matter is lower and metabolic activity is lessened.

Further research has shown that the damage done to the brain is prenatal because glial cells are not present, which should be present if an injury occurred after birth. This supports the hypothesis that the original cause of the disorder occurs before birth, but lies dormant until the brain changes during puberty.

Types and Classes of Schizophrenia

 * Catatonic Type
 * Patients may exhibit catatonia (rare), but all behaviors are just as extreme. Catalepsy or "waxy flexibility" may occur, when the sufferer rearranges their posture and holds it for periods of time.  Mimicking of sounds (echolalia) or movements (echopraxia) of others often occurs.  Patients can also explode into manic patterns of repetitious movements that have no purpose.
 * This type of schizophrenia has almost been eliminated thanks to modern medicine.
 * Disorganized Type
 * Patients are unable to communicate due to problems with thinking or speaking. Also, patients with this type are eccentric in style and mannerisms.
 * Paranoid Type
 * Hallucinations or delusions of personal persecution are prevalent, but cognitive function is intact. The patient seems normal until suspicions become entangling.
 * Paranoid schizophrenia is considered to be the most debilitating.
 * Residual Type
 * There is a previous diagnosis of schizophrenia, but prominent symptoms are absent. Some symptoms remain, including eccentricity or social withdrawal.
 * One episode of schizophrenia must have occurred. Hallucinations may be present, but they are not strong.
 * Undifferentiated Type
 * These patients exhibit some psychotic symptoms, but do not fall into any subcategory of schizophrenia. They are considered to definitely have the disorder.
 * Schizophreniform Disorder
 * A schizophrenic "episode" that lasts for more than two weeks but less than six months. The patient is likely to move back into society.

Treatment
Because the root cause is unknown, treatment focuses on the symptoms.

Antipsychotic drugs have been largely used for treatment since the 1950s and assist with the positive symptoms. Such drugs include haloperidol, clozapine, or resperidone, among others. Even though the drugs improve quality of life, the side effects were disruptive as well. The older drugs - haloperidol among them - caused rigidity, muscle spasms, tremors, or restlessness. Clozapine, the second in the round of medication, did not cause the aforementioned symptoms, but did cause a reduction in white blood cells, resulting in the need for costly repetitive blood tests. The third set did not cause any previous set of symptoms, but did cause weight gain and, in some cases, high cholesterol and diabetes. Because schizophrenia is a chronic disease, the medication would have to be taken for life.

Psychosocial treatments are for patients who are on a stable medication. Patients learn coping mechanisms to deal with symptoms that hold them back from participating in daily social activity. Studies have shown that patients who regularly attend psychosocial sessions are less likely to relapse and are more likely to stay on a medication schedule. Types of sessions include illness management skills, integrated treatment for substance abuse, rehabilitation, cognitive behavioral therapy, family education, and self-help groups.