schizophrenia is a mental disorder that is sometimes confused with psychosis. However, it only presents with psychosis as one of its cardinal symptoms. Also, both genetic and environmental factors have been implicated in its development. Some genetic markers have been identified that determine if individuals will come down with schizophrenia or not. Certain antipsychotic agents have also been employed in the treatment of the positive symptoms of schizophrenia..
Schizophrenia is a psychotic disorder that takes a chronic course. It can either be persistent of episodic (Frankenburg, 2013). The hallmarks of the disease include symptoms such as delusions, hallucinations, disturbance in the thinking process, flattening of the individual's affect and behavioral abnormalities (Frankenburg, 2013). Schizophrenia affects about 1% of the population globally. It is a disease that has catastrophic consequences both on the social and economic fortunes of the individual affected (Gerstein, 2013).
It is important to make a distinction between psychosis and schizophrenia (Frankenburg, 2013). Psychosis is a disorder of thinking and perception. In Psychosis, there is impairment in the process of information processing and reality testing. This results in the inability of the individual to distinguish between fantasy and reality which leads to the development of delusions and hallucinations (Gerstein, 2013). In schizophrenia, however, psychosis is a major feature. (Frankenburg, 2013) Although schizophrenia is not the only psychiatric disorder that has psychosis as a major feature. Other close differential diagnoses include bipolar disorder, delusional disorders, borderline psychotic disorder to mention a few.
In about half of all patients, the onset of schizophrenia is insidious. It starts with a prodomal phase that commences some years before the full-blown syndrome sets in. The prodomal phase includes symptoms like loss of functioning in home, society and occupation (Gerstein, 2013). The individual may be having poor school or work performance, decreasing emotional connections with other people. The individual could also develop odd behaviors which would have been out of place for that particular individual in the past (Frankenburg, 2013).
A gradual onset of symptom often indicates a more severe and prolonged illness. however, an abrupt onset of symptoms like delusions and hallucinations in individuals who have hitherto been performing optimally in their daily lives may result in a better intermediate and long term outcome if they get treated early enough (Frankenburg, 2013), (Gerstein, 2013).
For a diagnosis of schizophrenia to be made in an individual, two or more of the following must be present over a period of more than one month (Gerstein, 2013). Delusions which are false beliefs that are not logical. They may be paranoid, grandiose, religious, and persecutory in nature or even a false interpretation of normal perceptions (Frankenburg, 2013), (Gerstein, 2013). Hallucinations which are usually auditory in nature. the theme of the hallucination often involved malevolent voices commenting on the patient's actions or character, sometimes with a sexual theme, voices giving command to the patient, two or more voices discussing or arguing with each other, though withdrawal, though broadcasting or thought insertion by an external agent (0r force) (Frankenburg, 2013). Disorganized speech which could be tangential to the theme being discussed, incoherent, neologisms, loosening of associations or rambling speech. Behavior could be disorganized grossly or catatonic.
The symptoms of schizophrenia can be divided into Positive symptoms, negative symptoms, cognitive symptoms and mood symptoms. Positive symptoms include hallucinations which are usually auditory, delusions and disorganized speech and behaviors. Negative symptoms include a reduction in the emotional range, poverty of speech, loss of interest and drive. Cognitive symptoms include neurocognitive deficits like deficiencies in the working memory, reduction in attention span and impairment of executive functions. The patient may also find it difficult to decipher subtle messages and also have a problem understanding interpersonal cues and relationships. Mood symptoms include the feeling of being cheerful or even sad in an inappropriate way that does not make sense to others. Schizophrenics sometimes come down with depression.
Treatment includes the use of antipsychotic medications. These medications aid in the diminishing of positive symptoms and also in the prevention of relapses. Psychosocial treatment is also important in individuals with schizophrenia. This includes social skills training, cognitive-behavioral therapy, social cognition training and cognitive remediation.
Schizophrenia has been described as a disorder that has its etiology rooted in development. It is said to result from some neurological adverse events that occur during the fetal period onward. Both genetic and environmental factors have been implicated in this.
Strong evidence is being discovered that account for a possible association between schizophrenia and genetics as some chromosomal loci have been mapped that suggest genetic involvement in the development of schizophrenia (Picker, 2005).
Twin studies have provided some insight into the contribution of genetics to schizophrenia. concordance on monozygotic twins stand in the range of 50% even when such twins were separated from childhood and raised by in different homes under different economic and environmental conditions. However, the concordance level of 50% is still low if the genetic link of schizophrenia is to be taken seriously. However, some explanation has been made for this. Some influences which are described as being epigenic tend to alter the process of gene expression. This process includes gene methylation and histone deacylation, among other regulatory mechanisms (Picker, 2005).
Risk genes for the development of schizophrenia have been identified. The genes dysbyndin and neuroglin 1 (NRG1) have both been implicated. Dysbyndin is located on the short arm of chromosome 22 at locus 3. The gene is widely found throughout the brain. A reduction in the level of this gene protein and mRNA expression have been discovered in the dorsal portion of the prefrontal cortex of brain of patients who have developed schizophrenia. This discovery was at post-mortem examination. A function has been suggested for the gene which is that it may be involved in the release of glutamate at the synapse of neurons.
Neuroglin 1 is another gene that has also been linked with schizophrenia in some populations. The gene expresses multiple proteins which functions in the development of the neural system including the development of neural plasticity and activity of transmitters.
In the treatment of mental disorders, it is important to take into cognizance alterations in the pathways that function in signaling stimuli intracellularly. These signaling pathways include phosphatidates and several protein kinases. These two groups of compounds serve as targets of medications used in the treatment of psychiatric disorders. Research has shown that some genes which are involved in the alterations in these pathways may be implicated in the Pathophysiology of some mental disorders, in which schizophrenia is one. Emanian et al (2004) found alterations in the brain activity and levels of phosphorylases and protein kinases that may contribute in one way or the other to the susceptibility of an individual to develop schizophrenia.
The outlook of a schizophrenic also depends on the mode of development of the symptoms: either insidious or abrupt. The prognosis depends on this. Generally, the research into the causes of schizophrenia continues as more genetic markers are unraveled and their real functions determined
References
F Frankenburg (2013). Schizophrenia. Medscape Reference. retrieved on 3rd december, 2013 from <http://emedicine.medscape.com/article/288259-overview#showall>
P Gerstein (2013). Emergency treatment of Schizophrenia. Medscape Reference. retrieved on 3rd december, 2013 from http://emedicine.medscape.com/article/805988-overview#showall
J Picker (2005). The Role of Genetic and Environmental Factors in the Development of Schizophrenia. Psychiatric Times. Retrieved on 3rd December, 2013 from http://www.psychiatrictimes.com/schizophrenia/role-genetic-and-environmental-factors-development-schizophrenia/page/0/1
MNT (2013). What causes schizophrenia? Gene discoveries offer clues. Retrieved on 3rd November, 2013 from http://www.medicalnewstoday.com/articles/265284.php
E Emanian et al (2004). Convergent evidence for impaired AKT1-GSK3bold beta signaling in schizophrenia. Nature Genetics 36, 131 - 137. retrieved on 4th of December, 2013 from <http://www.nature.com/ng/journal/v36/n2/full/ng1296.html>
