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Schizophrenia

Overview

Schizophrenia is one of the most severe psychopathologies involving a major disturbance in a person’s emotions, thoughts and behavior. These disturbances are so serious that they lead a person to completely withdraw from their social and occupational world and interfere with everyday normal functioning. Though the diagnosis of schizophrenia has been quite old and it is one of the most widely researched topics, psychologists are still far from understanding this serious mental disorder. A schizophrenic usually requires clinical treatment and care owing to the disorder’s severity. Schizophrenia sometimes begins in early childhood but its symptoms are manifested only during late adolescence or early adulthood.

The range of problems experienced by a schizophrenic is extensive although a patient suffers from only some of these symptoms at a given time. Schizophrenia involves disturbances in several major areas of functioning such as thought, emotion, perception, attention, behavior and life functioning.


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Causes

A heavy amount of research focuses on the causes of this disorder. A good body of study indicates that there exists a genetic component in the transmission of schizophrenia. However, family studies cannot be completely relied on as relatives of a schizophrenic share not only genes but also similar experiences which might have led to the disorder. For instance, the behavior of a schizophrenic parent might have been disturbing for the child raised under them. However, more recent studies involving adoption studies have supported the genetic transmission of the disorder. Also, the effect of various biochemicals has also been studied. Although a lot of evidence supports the activity of dopamine, it does not provide a complete explanation in the cause of schizophrenia.
 
Post mortem analysis of the brains of schizophrenia has constantly shown some abnormalities in various areas of the brain. The most consistent finding is the enlargement of ventricles which demonstrate a loss of brain cells. Research has also shown reduced metabolism and structural abnormalities in the frontal and limbic areas. However, these may be a result of maternal viral infection during the second trimester of pregnancy or from damages owing to a difficult birth.

Also, besides biological causes, research has also pointed to the effect of psychological stress which along with biological strainers may produce a vulnerability to this illness. For example, one study focuses on the fact that living in the social low class may be a very stressful experience which may contribute to the development of this disorder. In contrary another study suggests that the relationship between schizophrenia and social class may be reverse. During the course of development, a patient may move towards socially backward areas as their increasing occupational and social impairments may make life elsewhere difficult. Also, family influence may also be critical in analyzing this disorder. Growing up in a rejecting, over-dominating or excessively strict environment may prove difficult for the child.


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Signs & Symptoms

The symptoms of this disorder are divided into many categories, thus it is possible that patients with schizophrenia differ from one another. These symptoms can be categorized as follows:

•    POSITIVE SYMPTOMS
These are characteristic of the acute episode of schizophrenia. These are additions or excesses and distortions, i.e. some additional unusual behavior in a schizophrenic patient. These include delusions, hallucinations and other perceptual disorders. Delusions are beliefs which are held in contrary to reality. For example the patient may believe that his or her thoughts are not their own but have been placed in their mind by an external source. Patients may believe that their feelings are controlled by someone else or that someone is ‘listening’ to his thoughts. Hallucinations, on the other hand, involve seeing or hearing something which is actually not there in reality. For example, patients report having heard their thoughts in another voice’ or they can hear some voices commenting on their behavior. Like delusions, hallucinations can be a very frightening experience.

•    NEGATIVE SYMPTOMS
Symptoms involving some behavioral deficits or some absence in normal behavioral functioning due to this disorder are known as negative symptoms. These are quite important in diagnosis as several negative symptoms demonstrate a poor functioning in life. These may involve avolition (lack of energy or interest in usual activities), alogia (amount of speech is greatly reduced or sometimes the patients content of speech becomes vague or repetitive), anhedonia (inability to experience pleasure), flat affect (extreme lack of an emotional response) and asociality (impairment in social relationships). It is important to note that during flat effect one refers to only the outward expression of emotion and not how the patient actually feels within. Asociality leads a patient to become socially inactive, aloof, having few friends and absolutely no interest in being with other people.

•    DISORGANIZED SYMPTOMS
This involves disorganized speech and bizarre behavior. Disorganization in speech refers to the vague and incoherent pattern in which a schizophrenic speaks. They may have difficulty in sticking to one topic and others are not able to understand what the patient is trying to tell. The patient may seem to drift on to other ideas while speaking. Bizarre behavior takes many forms. Patients may dress unusually, collect garbage, hoard food or maybe even engage in sexually inappropriate behavior. They have difficulty in sticking to the norms of the community and also have problems in everyday functioning.

•    OTHER SYMPTOMS
Two important symptoms which do not fit neatly into the mentioned categories are catatonia and inappropriate effect. Catatonia involves several motor abnormalities. Gesturing inappropriately, peculiar sequential movement of finger, hand and arm movements usually without purpose fall under catatonia. Some patients show an abnormally high activity level with much excitement while other patients show catatonic immobility in which patients assume unusual, difficult postures and maintain them for long hours. For example, a patient may lie down and raise one arm and leg in the air and maintain this for virtually the whole day.

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Prevention
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Treatments
Antipsychotic Drug Treatment Modern Medicine

There exists a wide range of therapies available for schizophrenia; however the appropriateness of a given therapy depends on the stage of illness that the patient is in. For example, when the patient is in a acute psychotic stage, social skills training may prove useless as the patient is too distracted to listen to what the therapist is saying. In such a case, psychoactive medication would be more appropriate and necessary. The most important development in the treatment was the advent of antipsychotic drugs also referred to as neuroleptics. Commonly used antipsychotic drugs are phenothiazines, clozapine and risperidone. However, drugs alone are not an effective treatment as patients need to re-taught the affective ways of everyday functioning. Also, these drugs may have serious long-term side effects. Besides these there are various cognitive – behavioral therapies and social skills training that have proved beneficial and have helped patients meet the stressful needs of everyday functioning.

Psychosocial Intervention Psychotherapy

The most promising treatment approach involves use of both pharmacological and psychosocial intervention. However, such integrated treatment programs are not widely available.

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