Psychology
Introduction
Schizophrenia is a chronic progredient (malignant) mental illness with undefined etiology that leads to a change in the patient's personality. The word "schizophrenia" comes from the Greek words "schizo" – fission, split and "fran" - soul that indicates the splitting of mind, disharmony of thinking, emotions and will. The term was first introduced by Paul Eugen Bleuler, so the disease is sometimes called Bleuler’s disease.
Schizophrenia is considered to be one of the most important public health problems in the world. According to modern surveys, from 0.5 to 1% of world’s population is affected by it. Moreover, this disease affects the essence of patient’s identity, brain and it’s most complex functions. Schizophrenia affects ability to think clearly, to express and experience emotions, to have normal interpersonal relationships (Weinberger & Harrison, 2011. p. 22).
The diagnosis of schizophrenia is becoming a shock for many patients and their relatives. Of course, realize and accept this diagnosis is not easy.
Etiology and Pathogenesis of Schizophrenia
Currently, there is no defined concept in etiology and pathogenesis of schizophrenia, which would be accepted by the majority of mental health schools in the world. At the present stage of development of psychiatry there are three main views on causes of schizophrenia: biological, psychological and sociocultural. All these theories are not absolute, they often complement each other.
Psychological theories of schizophrenia have rather historical significance. Generally, these theories consider the influence of emotions, behavior and thoughts on the development of disorder.
According to psychodynamic model of schizophrenia, the cause of disease hidden is in violation of interpersonal relationships. One of the Sigmund Freud’s assumptions can be counted as variation of this model. Freud assumed that disease appears as subconscious reaction that originates in early childhood. He viewed schizophrenia as result of regression on the pre-ego stage and attempts to re-establish ego control. There is only a little evidence to support author’s ideas, except later psychoanalysts claiming that schizophrenia is caused to disordered family patterns. Fromm and Reichmann in 1948 stated that mothers (or families) who are rejecting, overprotective, dominant or moralistic make the biggest influence. It is supported by the further evidence that parents of schizophrenic patients show behave differently from parents of healthy people.
Cognitive explanation of schizophrenia recognises the role of biological factors in emerge of the initial sensory experiences of schizophrenia, but claims that further characteristics of the disease appear as individuals attempt to understand those experiences.
For example, when person experiences first symptoms of schizophrenia, he is trying to share his concerns with friends and family to understand and validate them. Usually, they fail to do so, and as a result patient begins to think they are hiding something from him (paranoia) – it causes the person to reject the feedback and develop beliefs that he is being manipulated.
It should be emphasized that psychological theories of schizophrenia are not yet supported by scientific observations.
Dopamine theory takes one of the main places among the biological theories of schizophrenia. It proves existence of relation between changes of dopamine levels in brain and abnormal behavior characteristics of schizophrenia. In line with this hypothesis, it is assumed that schizophrenia increases the activity of dopamine system with an increase in dopamine release, increased dopamine neurotransmission and dopamine receptor hypersensitivity, so it is assumed that dopamine neurons are in overactive state.
However, the negative symptoms of schizophrenia are associated with a reduction in the activity of the mesocortical part of dopamine system, and positive - with hyperactivity of subcortical dopaminergic structures (Murray, Jones, Susser, Os & Cannon, 2002).
Symptoms of Schizophrenia
The positive symptoms of schizophrenia include delusions, hallucinations, movement and affective disorders.
1. Delusions
Delusion is a belief held with complete convection, even though it is based on a mistaken, strange or unrealistic view. They can begin suddenly or may develop over weeks and months. No matter how illogical delusions are, it is impossible to persuade the patient in their falsity.
2. Hallucinations
While experiencing a hallucination, patient sees, hears or feels something that does not exist in reality. Hearing voices are a group of common symptoms of schizophrenia. They may be simple (single sounds) and complex (voices sounding outside or inside the patient's head). Hallucinations can also include other senses. Tactile hallucinations may appear in the form of tingling or burning sensations. During visceral hallucinations patients feel that something is going on inside their bodies. Visual hallucinations may be experienced as a vague of color changes, distinct images of people and objects. People with a taste hallucinations often find that their food or drink have a strange taste and people with olfactory hallucinations smell something that others do not, such as smell of smoke.
3. Movement disorders
This symptom of schizophrenia can appear as the catatonic irritation or catatonic stupor. Catatonic irritation develops suddenly. The patient becomes turbulent, behaves abnormally, starts speaking and shouting. Such attack is accompanied by anger, which may alternate with periods of apathy and indifference. During catatonic stupor patient can keep awkward position of the body due to increased muscle tone.
4. Affective disorders
Affective disorders appear in form of mania or depression. Symptoms of depression include mood decrease, motor and mental retardation. During mania phase patient demonstrates mood increase and hyperactivity.
The negative symptoms of schizophrenia usually appear gradually and slowly get worse.
Negative symptoms of Schizophrenia usually include:
The most common negative symptoms include alogia (poverty of speech), emotional flattening, avoliton (lack of will) and social isolation. This deficiency has a profound impact on patient’s lives and activities.
Alogia. Some people with the symptom of poverty of speech think and speak very little. Others speak a few more, but their speech is usually meaningless.
Emotional flattening. Many patients demonstrate anger, sadness, joy and other feelings in a less extent than others. Such individuals usually have empty eyes and monotonous voice. There is a possibility that these patients continue experiencing emotions, but they are not able to express them.
Avolition (lack of will). Patients with schizophrenia experience loss of desire or apathy, energy depletion and lack of interest in life activities. These difficulties are the most typical for people who for years suffer from the mental disorder they seem to be exhausted from it.
Social isolation. Patients may move away from their environment and fully disappear in their own ideas and fantasies. They may distance themselves from other people and avoid talking to them. Due to the fact that their ideas are illogical and confusing, isolation contributes to the further retreat from reality.
Treatment of Schizophrenia
Some of the more commonly used typical medications include:
Stelazine (Trifluoperazine)
Flupenthixol (Fluanxol)
Loxapine (Loxapac, Loxitane)
Perphenazine (Etrafon, Trilafon)
Chlorpromazine (Thorazine)
Haldol ( Haloperidol)
Prolixin (Fluphenazine Decanoate, Modecate, Permitil).
These medications help patients to reduce psychotic symptoms, hallucinations and stay connected with reality (Gattaz & Bussato, 2010).
Psychological treatment is applied only in combination with antipsychotic medication. This type of treatment may help patients to deal with everyday challenges connected with the illness, such as difficulties in communication, self-care and occupation.
A therapist may help patients to understand disorder better and to adjust living with schizophrenia. Therapy usually includes:
1. Cognitive behavioral therapy (CBT). It is a type of psychotherapy that helps patients with symptoms that do not vanish even if they take medications. The therapist shows patients how to stay connected with reality, how to ignore voices and how to cope with symptoms overall.
2. Self-help groups. This type of help for people with schizophrenia and their families is becoming more common. Professional therapists are not usually involved, and group members mostly support and comfort each other.
Conclusion
The diagnosis of schizophrenia is becoming a shock for many patients and their relatives. Of course, realize and accept this diagnosis is not easy. Some of the patients are experiencing depression and irritation. Some of them feel needless, thrown out of life. The rest of the patients are trying to deny the existence of such at diagnosis. As a result, people sometimes "drop out" of life not because of the disease itself, but because of the wrong attitude towards it.
At the present stage of development of psychiatry there are three main views on causes of schizophrenia: biological, psychological and sociocultural. Schizophrenia has a number of specific features, such as hallucinations, delusions, thought and movement disorders, combined with affective flattening, alogia and avolition. The first step in treatment of schizophrenia is a correct diagnosis. However, in today’s medicine there is no physical or lab test with help of which schizophrenia can be diagnosed.
In schizophrenia there is no more or less effective treatment. Both methods of treatment are effective if they are used in conjunction. Therapy without medications will not have needed effect, as well as antipsychotic medications without any personal approach and group support.
References
- Gattaz, Wagner F. & Geraldo Busatto (2010). Advances in schizophrenia research. New York, NY: Springerverlag.
- Murray, Robin M. Murray Peter B. Jones, Ezra Susser, Jim Van Os, & Mary Cannon (2002). The epidemiology of schizophrenia. Cambridge University Press.
- Noll, Richard Noll (2009). The encyclopedia of schizophrenia and other psychotic disorders. Infobase Publishing.
- Sawa, Akira (2009). Gene models of schizophrenia. Elsevier Science.
- Weinberger, Daniel R. Weinberger & Paul Harrison (2011). Schizophrenia. Wiley-Blackwell.
