Many people throughout the United States exhibit atypical behavior. However, some people exhibit greater symptoms than others. Many of these symptoms are severe enough to interfere with their daily lives. One mental disorder which involves this type of symptoms is Schizophrenia. Schizophrenia is a brain disorder which affects approximately one percent of the population in the United States (National Institute of Mental Health, 2009). It is characterized by hallucinations, delusions, and general atypical behavior. Although many things are known about this disabling disorder, many other aspects about it, such as causes and treatment options, are still being debated by mental health professionals.
Schizophrenia involves many bizarre symptoms. The first group of symptoms people with Schizophrenia exhibit is called positive symptoms. These are behaviors that are not seen in healthy people. Hallucinations and delusions fall into this category. Hearing voices that other people do not hear is the most common hallucination people with Schizophrenia experience. Other symptoms, such as thought disorders and movement disorders, are also evident. Thought disorders involve dysfunctional ways of thinking, such as thought blocking, disorganized thinking, or making up neologisms. Movement disorders involve agitated body movements such as repeating certain body movements multiple times or becoming catatonic (National Institute of Mental Health, 2009). Positive symptoms generally respond better to treatment and people who exhibit positive symptoms tend to experience better outcomes than those who exhibit mostly negative symptoms (Hansen 173).
People with Schizophrenia also experience negative symptoms. Negative symptoms involve “disruptions to normal emotions and behaviors” (National Institute of Mental Health, 2009). This may include having a flat affect or not enjoying everyday life. It may also include the inability to participate in planned activities or speaking very little. People with negative symptoms may even begin to neglect personal hygiene. All of these symptoms are characteristic of depression, and so may be hard to recognize as symptoms of Schizophrenia (National Institute of Mental Health, 2009).
The third group of symptoms people with Schizophrenia experience is cognitive symptoms. Cognitive symptoms may also be difficult to recognize as part of Schizophrenia because tests are often needed in order to detect these problems. These symptoms include disabilities in executive functioning, which is the ability to make decisions based on an understanding and processing of information. The inability to focus or pay attention is also a cognitive symptom. Another cognitive symptom is difficulty with working memory, which is the ability to use information directly after learning it. All of these symptoms indicate problems with thought processes (National Institute of Mental Health, 2009).
One obvious symptom of Schizophrenia is the inability to correctly display emotion. According to Kring (1999), “Schizophrenia patients display fewer observable positive and negative facial expressions of emotion in response to a variety of emotion-eliciting stimuli” (p.160). This is not to say that people with schizophrenia do not experience emotion, though. In fact, they seem to experience the same amount of positive emotions as people without Schizophrenia and even greater amounts of unpleasant emotions when presented with stimuli (Kring, 1999, p. 161). However, Kring (1999) says that “schizophrenia patients may exhibit observable facial expressions only when experiencing very intense emotional experiences” (p.161).
In order to be diagnosed with Schizophrenia, a person cannot have just a few of these symptoms. The Diagnostic and Statistical Manual of Mental Disorders, commonly called the DSM-IV, has very specific criteria for diagnosing Schizophrenia. To be diagnosed, the person must display at least two of the following symptoms for a significant period of time during a one-month period: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, or negative symptoms. However, only one of these symptoms is required for diagnosis if the delusions are bizarre. Additionally, only one symptom is required if the hallucination is a voice which keeps a running commentary on the patient’s behavior or thoughts, or if there are two voices conversing. Since the onset of the disorder, the patient must also experience a significant portion of time in which he or she experiences a marked drop in achievement in “major areas of functioning such as work, interpersonal relations, or self-care” (Burckhardt, n.d.). Signs of the disorder must be present for at least six months in order for Schizophrenia to be diagnosed. At least one month of active-phase symptoms must be present as well. Schizoaffective Disorder and Mood Disorder must be ruled out. General medical conditions and substance abuse must be ruled out as causes for the symptoms as well. If a Pervasive Development Disorder is present, Schizophrenia can only be diagnosed if delusions or hallucinations are present for at least one month (Burckhardt, n.d.).
In addition, a person may also be diagnosed with one of the five Schizophrenia subtypes. These subtypes are Paranoid, Catatonic, Disorganized, Undifferentiated, and Residual. Paranoid type involves frequent auditory hallucinations or delusions, but disorganized speech, disorganized or catatonic behavior, and flat affect are not persistent. Catatonic Type is diagnosed when two of the following are evident: motoric immobility, excessive motor activity, extreme negativism or mutism, inappropriate postures, stereotyped movements, prominent mannerisms, or prominent grimacing, and echolalia or echopraxia. Disorganized Type is diagnosed when the Catatonic Type criteria are not met and disorganized speech, disorganized behavior, and flat or inappropriate affect are all prominent. Undifferentiated Type is diagnosed when characteristic symptoms are present, but the patient does not meet the criteria for Paranoid, Catatonic, or Disorganized Type. Residual Type is diagnosed when prominent delusions, hallucinations, disorganized or catatonic behavior, and disorganized speech are absent. There must also be “continuing evidence of the disturbance, as indicated by the presence of negative symptoms or two or more [characteristic] symptoms… for Schizophrenia, present in an attenuated form” (Burckhardt, n.d.).
According to the National Institute of Mental Health, Schizophrenia affects all types of people. It affects men and women equally. Ethnic groups around the world also experience about the same rates of the disorder. Typically, though, the onset of Schizophrenia occurs between the ages of 16 and 30, but rarely after 45. It also rarely occurs in children (National Institute of Mental Health, 2009).
Although much is known about Schizophrenia, the etiology of the disorder is greatly debated. Opler and Susser (2005) discussed the possibility of lead exposure during prenatal development (Opler & Susser, 2005, p. 1240). It is widely known that lead exposure can cause serious adverse effects, and it makes sense that exposure to such a harmful substance during such a critical time for development would cause severe disabilities. However, it does not make sense that these effects do not appear until young adulthood instead of early childhood. Researchers have also explored evidence of a link between the influenza virus and Schizophrenia. When the influenza virus appeared during the first trimester of pregnancy, the child was at a greater risk of developing Schizophrenia later in life (Opler & Susser, 2005, p. 1240). This also makes sense because fetal development is extremely sensitive. Brain development that occurs before birth could be greatly influenced due to infections such as the influenza virus, as well as anything that manipulates the fetal environment. This could include exposure to harmful substances, infections, malnutrition, or possibly even substance abuse. Another risk factor could be “hypoxia-associated obstetric complications” (Conklin & Iacono, 2002, p. 34). Lack of oxygen obviously could cause severe disabilities. According to Opler and Susser (2005), “Both lack of specific micronutrients and general nutritional deprivation have been previously implicated as risk factors for broad developmental disruption and for schizophrenia specifically” (p.1240).
In addition to prenatal complications, genes have been implicated as a cause for Schizophrenia as well. The disorder seems to have a genetic link, although it is more of a genetic predisposition as opposed to the sole cause for the disorder. Conklin and Iacono (2002) discussed findings that show a susceptibility for Schizophrenia on Chromosome 1 (p.34). However, they also indicated that the “genetic predisposition involves multiple genes” (Conklin & Iacono, 2002, p. 34). Sherrington et al. (1988) indicated that there may also be a link between Schizophrenia and Chromosome 5 (Holzman & Matthysse, 1990, p. 280). Genetic linkage analysis can be possible by restriction fragment length polymorphisms, or RFLP. According to Holzman and Matthysse (1990), “The RFLP technique… rests upon the existence of bacterial enzymes that cut DNA at points where they encounter precisely specified nucleic acid sequences” (p. 280) This allows researchers to examine how bacterial enzymes may cause certain people to be predisposed to Schizophrenia. All of these theories could be true, but research does not completely back them up. Research seems to be widely inconsistent.
However, the most likely theory for the cause of Schizophrenia is a combination of genetics and environment. Some people may be genetically predisposed to inherit the disorder, but if certain triggers are not in the environment, the person will not end up with Schizophrenia. Something in the environment must trigger the person’s genes to behave differently. This makes sense, but it still does not completely explain why people typically do not experience symptoms of Schizophrenia until early adulthood. In order to know this answer, much more research needs to be conducted. More research also need to be done in order to determine the true cause of Schizophrenia. Currently, research is inconclusive to the vast amounts of inconsistencies from one experiment or study to another.
Another mystery involving Schizophrenia concerns the best way to treat it. Since the cause is unknown, it is difficult to treat. Therefore, only the symptoms are treated instead of the root cause. There is no argument concerning whether or not patients should be treated, though; Schizophrenia is a disabling disorder with severe social and cognitive effects. People with Schizophrenia often have difficulty living normal lives. However, medicine can be used to reduce these effects on the patient’s life. Patients are often given antipsychotics in order to treat their symptoms. Conventional and novel or atypical antipsychotics can be prescribed, and patients often switch their medication throughout their treatment. In fact, during a 12-month period, 24.7 percent of patients studied during one study switched their medication during treatment (Javor, Johnstone, Kesterson, Schmetzer, & Williams, 1999, p. AS86). Hansen, Francois, Lancon, and Toumi (2002) described a study comparing zuclopenthixol with haloperidol and risperidone (p. 173-179). They found that patients taking zuclopenthixol were 1.59 times more likely to experience a significant reduction in symptoms than patients who were taking haloperidol or risperidone (Hansen et al., 2002, p. 177). In patients that were studied, zuclopenthixol seemed to be clinically more effective than haloperidol and risperidone. It was also cheaper, which can have a great influence on the success of the patients because their quality of life would be hampered due to the high costs of medication. In addition, zuclopenthixol also seemed to allow patients to experience a greater amount of time between relapses (Hansen et al., 2002, p. 177). However, this does not indicate that zuclopenthixol is the best method for treating Schizophrenia because many more antipsychotics are available besides those three. Each person is different, so one person may respond to medications differently than others as well.
For people who do not respond to conventional antipsychotics, clozapine can be helpful. It treats psychotic symptoms, hallucinations, and “breaks with reality” (National Institute of Mental Health, 2009). However, this medication can cause a loss of white blood cells, a condition known as agranulocytosis. White blood cells help people fight infection, so they are a vital part of everyday life. People on clozapine must get their white blood cell count checked about every two weeks. This obviously inhibits their quality of life and can become quite costly (National Institute of Mental Health, 2009). However, other atypical antipsychotics have been developed that do not cause agranulocytosis. As stated previously, though, each person is different and only a doctor can decide which medication is right for which person, based on the doctor’s knowledge base of the medication.
Another beneficial method of treatment is psychosocial treatment. People with Schizophrenia can be taught illness management skills. They can help prevent their own relapse and how to cope with their symptoms. Rehabilitation can be used to help patients gain social and vocational skills so that they can be active members of their community. Cognitive behavioral therapy can also be helpful. Therapists can challenge patients with Schizophrenia to ignore the voices and to test the reality of their thoughts. This can reduce the effects of symptoms and help prevent relapses (National Institute of Mental Health, 2009).
A combination of medication and psychosocial treatments is probably best, though. In order to minimize symptoms and help prevent relapses, medication is needed, but psychosocial treatments can be very beneficial as well. Just like most mental disorders, therapy in combination with medication is most likely the best way to treat Schizophrenia for the majority of the Schizophrenic population.
http://www.psychologynet.org/dsm/schiz.html
In conclusion, much more research needs to be done in order to truly understand Schizophrenia. This is a disabling disease with severe consequences. The vast array of symptoms can cause terrible social, academic, and other problems. If more, accurate research could be conducted, the cause may become more evident. If the cause were evident, treatment could get even better. Then instead of merely treating the symptoms, the root cause of the disorder could be eliminated. People with Schizophrenia could then live happy, normal lives. However, advancements in research need to be accomplished first.
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Hansen, K., Francois, C., Lancon, C., & Toumi, M. (2002). A Pharmacoeconomic Evaluation of Zuclopenthixol Compared with Haloperidol and Risperidol in the Treatment of Schizophrenia. The European Journal of Health Economics, 3(3), 173-179.
Holzman, Philip S., & Matthysse, Steven (1990). The Genetics of Schizophrenia: A Review. Psychological Science, 1(5), 279-286.
Javor, Kimberly A., Johnstone, Bryan M., Kesterson, Joseph G., Schmetzer, Alan D., & Wiliams, Cara L. (1999). Evaluation of Antipsychotic and Concomitant Medication Use Patterns in Patients with Schizophrenia. Medical Care, 37(4), AS81-AS86.
Kring, Ann M. (1999). Emotion in Schizophrenia: Old Mystery, New Understanding. Current Directions in Psychological Science,
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Opler, Mark G. A. & Susser, Ezra S. (2005). Fetal Environment and Schizophrenia. Environmental Health Perspectives,http://www.nimh.nih.gov/health/publications/schizophrenia/index.shtml
