Schizophrenia: Causes and Treatments
Schizophrenia is often misconstrued to mean split personality. Split personality, which is now called dissociative identity disorder, is categorized as a dissociative disorder and differs completely from schizophrenia.
Karl Jaspers, a psychiatrist and philosopher, played a major role in developing existential psychoanalysis. In his view, psychopathology had no fixed concepts of basic principles. His theories of schizophrenia were free of traditional concepts like subject and object, cause and effect, and reality and fantasy. His philosophic attitude led to an interest in the content of psychiatric patients’ delusions.
According to the Diagnostic and Statistical Manual of Mental Disorders, schizophrenia affects about 1% of the population. About 0.025 to 0.05 percent of the total population in the United States is treated for schizophrenia in any single year. The cause of schizophrenia is unknown. However, an increasing amount of research has indicated a pathophysiological role for certain areas of the brain, including the limbic system, the frontal cortex, and the basal ganglia. These three areas are interconnected, so that dysfunction in one area may involve a primary pathological process in another.
A wide range of genetic studies suggests that there is a genetic component to the inheritance of schizophrenia. Also, the likelihood of the person’s having schizophrenia is correlated with the closeness of the relationship of the relative. In studies of adopted monozygotic twins, twins reared by adoptive parents are seen to have schizophrenia at the same rate as their twin siblings bought up by their biological parents. This finding suggests that the genetic influence outweighs the environmental influenced.
Schizophrenia is equally prevalent in men and women. Onset is earlier in men than women. The peak ages of onset are 15 to 25 years for men and 25 to 35 years for women. Onset of schizophrenia before age 10 or after age 50 is rare. In general, the outcome for female schizophrenic patients is better than the outcome for male patients
A finding in schizophrenia research is that people who later have the disorder are more likely to have been born in the winter and early spring. In the United States, people with schizophrenia are more often born in the months from January to April. Various hypotheses explain these observations. One is that a season-specific risk factors, such as a virus or seasonal change in diet, may cause the person to have the disorder
Paranoid type schizophrenia is characterized by preoccupation with one or more delusions of frequent auditory hallucinations, and the presence of delusions of persecution or grandeur. The most common hallucinations are auditory, with voices that are often threatening, obscene, accusatory, or insulting. Patients with paranoid schizophrenia usually have their first episode of illness at an older age than do patients with catatonic or disorganized schizophrenia. Patients who develop schizophrenia in their late 20s or 30s have usually established a social life that may help them through their illness. They usually show less regression of their mental faculties, emotional responses, and behavior than patients with other types of schizophrenia. Paranoid schizophrenics are typically tense, suspicious, guarded, reserved and sometimes hostile or aggressive. However, they can occasionally conduct themselves adequately in social situations. Their intelligence in areas not affected by their psychosis usually remains intact.
Suicide is a common cause of death among schizophrenics. About 50 percent of all patients attempt suicide at least once in their lifetimes, and 10 to 15 percent die by suicide during a 20-year follow-up period. The major risk factors for suicide include the pressure of depressive symptoms, young age, and high levels of functioning, especially a college education. They may realize the devastating significance of their illness and see suicide as a reasonable alternative.
Treatment
Hospitalization is primarily for diagnostic purposes, for stabilization of medications, for patients’ safety because of suicidal or homicidal tendencies and for serious disorganized or inappropriate behavior, including the inability to take care of basic needs such as food, clothing and shelter. Although two thirds of treated patients require hospitalization, only about half of all patients obtain treatment, in spite of the severity of the disorder.
The antipsychotic drugs used for schizophrenia include two major classes: dopamine receptor antagonists, such as chlorpromazine (Thorazine, haloperidol (Haldol), and sulpiride); and serontonin-dopamine antagonists, such as risperidone (Risperdal) and clozapine (Clozaril). These medications are the primary treatment for schizophrenia and have been found to be safe, especially when used over a short period of time. Most patients benefit from the combined use of antipsychotic drugs and psychosocial treatments such as behavior therapy, family-oriented therapy, group therapy, and individual psychotherapy.
Behavior therapy for hospitalized patients involves social skills training to increase social abilities, self-sufficiency, practical skills and interpersonal communication. Adaptive behaviors are reinforced by praise or tokens that can be redeemed for desired items, such as hospital privileges and passes.In family-oriented therapy, the patient’s relatives work with a therapist. They work together in providing long-range applications of stress-reducing and coping strategies and towards the patient’s gradual integration into everyday life.
Group therapy focuses on real-life plans, problems and relationships. Group therapy is effective in reducing social isolation, and increasing the patient’s sense of cohesiveness. Individual psychotherapy is a beneficial treatment. Research indicates that patients who are able to form a strong therapeutic relationship with their therapists are likely to remain in psychotherapy, comply with taking their medication and have good outcomes at a 2-year follow-up evaluation.
Recovery rates from schizophrenia range from 10 to 60 percent. Twenty to 30 percent of all patients are able to lead somewhat normal lives. About 20 to 30 percent continue to experience moderate symptoms and 40 to 60 percent remain significantly impaired for the rest of their lives.
Real Life Cases
John F. Nash, one of the most promising young mathematician in the world. experienced symptoms of schizophrenia. Despite spending many periods in the hospital because of his mental condition, his mathematical work continued to have success. In 1974 Nash made a recovery from schizophrenia. Nash was awarded, jointly with Reinhard Selten, the 1994 Nobel Prize in Economic Science for his work on game theory. The 2001 movie, “A Beautiful Mind,” is based on his life.
One of the 20th century’s finest male dancers, Vaslav Nijinsky, might have become known as the greatest ballet choreographer of the modern era had his career not ended early. When he was 29, Ninjinsky began suffering from chronic schizophrenia. As a result, he was unable to care for himself for the rest of his life. His diaries chronicle six weeks (January 19-March 4, 1919) of this period. The publication is an autobiography of a great artist during his psychological decline.
Psychologist, Ronald Bassman, a former schizophrenic offers sound advice to his patients. He terms them “The Basics of Recovery”:
1. Remaining hopeful and envisioning a future of growth and development.
2. Having the right to choose – without it there is no motivation.
3. Knowing that you are not a label or a diagnosis. You are a living, changing person – not an object.
4. Speaking for ourselves. When others speak for us we are devalued.
5. Establishing our own homes in the community where we can choose our
roommates or live alone.
6. Acknowledging the need for friends, peers and intimate relationships.
7. Realizing that peer support and self-help keeps us grounded and connected.
8. Protecting and nurturing the spirit within us.
9. Knowing that all things are possible and that to be alive is a miracle.(p. 40)
REFERENCES
Acocella, J. (Ed.) (1999). The Diary of Vaslav Nijinsky. Tr. by Kyril Fitzlyon. New York: Farrar.
American Psychiatric Association: Practice guidelines for the treatment of patients with schizophrenia. (1997). American Journal of Psychiatry 154, 1-4.
Andreasen, N. C. (1991). Schizophrenia: The characteristic symptoms. Schizophrenia Bulletin 17, 27.
Bassman, R. (February 2001). Overcoming the impossible: My journey through schizophrenia. Psychology Today 34, 34-40.
Diagnostic and statistical manual of mental disorders. (2000). Washington DC: American Psychiatric Association.
Kapur S & Remington G. (December 2000) Atypical antipsychotics. British Medical Journal 321, 1360-1361.
Kendler, K.S. (1993). The genetics of schizophrenia: A current, genetic-epidemiologic perspective. Schizophrenia Bulletin 19, 261.
Kuhn, H.W. et al. (1995) The work of John F Nash, Jr. in game theory: A celebration of John F Nash, Jr. Duke Mathematics Journal 81, 1-29.
