SCHIZOPHRENIA – A LIVING NIGHTMARE
Images of schizophrenia are easy to conjure – a dishevelled person, alone, talking to himself or yelling at someone else that only he seems to see. This is a frightening image, for the symptoms it portrays are extremely odd and disconcerting. Indeed, schizophrenia can be a frightening disorder to deal with, not only for those involved with schizophrenic people, but for the sufferers themselves. Schizophrenia is a severe mental disorder, experienced by many sufferers as a living nightmare, a fact highlighted by the high rate of suicide among schizophrenics (Caldwell & Gottesman, 1992; ). As you read this section, try to imagine what it might feel like to experience some of the things schizophrenic people experience. For example, many schizophrenic people hear voices. Have you ever heard someone call your name, only to find there was Facts about suicide Risk factors for suicide n Suicide occurs across the world, but rates vary by culturen Self-inflicted injuries, including suicide, were the 12th leading cause of death in the world in 1998 Facts about suicide Suicide occurs across the world,but rates vary by culture n Self-inflicted injuries, including suicide, were the 12th leading cause of death in the world in 1998 n In all cultures, men are more likely than women are to complete suicide Rates of suicide in children and adolescents are on the rise n People with mental disorders, especially depression, substance use disorders, schizophrenia,and borderline personality disorder, are at high risk for suicide Risk factors for suicide
Past history of attempted suicide
Talking about committing suicide
A clear plan to commit suicide
Available means (e.g.firearms, drugs)
Depression
Substance abuse
Hopelessness
Impulsivity
Stressful life events
Lack of social support
Saying goodbye to people
Giving away personal items
The symptoms of schizophrenia are grouped into two categories: positive and negative symptoms. Positive symptoms indicate the presence of something unusual (such as hallucinations, delusions, odd speech and inappropriate affect) and negative symptoms indicate the absence of something normal (such as good social skills, appropriate affect, motivation and life skills).
The course of schizophrenia Schizophrenia is a chronic disorder. Although some people have brief episodes of schizophrenic-like behaviour (called brief reactive psychoses), most people with schizophrenia suffer from symptoms for their entire lives. One common course of schizophrenia is a period of negative symptoms and odd behaviour during which the person’s functioning slowly deteriorates (the prodromal phase), followed by a ‘first break’ – the first episode of positive symptoms. Some people experience an episode of positive symptoms with a few warning signs beforehand. The manifestation of symptoms can also take a number of different forms. For example, some people may be delusional but still be able to take basic care of themselves, carry on a conversation and succeed in school and work, whereas others may be completely debilitated by the disorder.
Schizophrenia typically has its onset in late adolescence or early adulthood. Although it can start in childhood, this is quite rare. Sufferers don’t necessarily deteriorate over time, but they do have relapses into episodes of positive symptoms. Causes of schizophrenia and factors affecting ts course 1 Genetic and biological factors These account for our initial vulnerability to schizophrenia, although exactly how they do so is unclear.
What is clear is that schizophrenia tends to be inherited. For example, monozygotic twins have the highest concordance rates for schizophrenia (Gottesman, 1991), meaning that they are more likely to both have schizophrenia if one of them has it, compared to people who share less genetic material (such as dizygotic twins or siblings). Interestingly, schizophrenics paranoid delusions elaborate set of beliefs, commonly experienced by schizophrenics, characterized by significant distrust of others and feelings of persecution positive symptoms in schizophrenia, symptoms that indicate the presence of something unusual, such as hallucinations, delusions, odd speech and inappropriate affect negative symptoms in schizophrenia, symptoms that indicate the absence of something normal, such as good social skills, appropriate affect, motivation and life skills concordance rates the extent to which people show the same disorders Pioneer Emil Kraepelin (1856–1926), a German psychiatrist and one of the founding fathers of modern psychiatry, made three primary contributions to the field of mental illness. First, Kraepelin believed that mental illness was caused by biological factors. His work in this area helped define the field of biological psychiatry and research now supports a strong biological basis for some of the disorders in which Kraepelin was most interested (e.g. schizophrenia and bipolar disorder). Second, Kraepelin laid the foundation for modern classification systems used to diagnose mental disorders, which use patterns of symptoms rather than any one symptom in isolation. This led to his third contribution, which was the classification of and distinction between schizophrenia and bipolar disorder.and their close family members show some similar types of neuropsychological functioning, even if these family members do not
suffer from the illness itself. This suggests that it may be the biological risk factors for schizophrenia that are inherited from family members, rather than the disorder itself (Cannon et al., 1994).
Images of schizophrenia are easy to conjure – a dishevelled person, alone, talking to himself or yelling at someone else that only he seems to see. This is a frightening image, for the symptoms it portrays are extremely odd and disconcerting. Indeed, schizophrenia can be a frightening disorder to deal with, not only for those involved with schizophrenic people, but for the sufferers themselves. Schizophrenia is a severe mental disorder, experienced by many sufferers as a living nightmare, a fact highlighted by the high rate of suicide among schizophrenics (Caldwell & Gottesman, 1992; ). As you read this section, try to imagine what it might feel like to experience some of the things schizophrenic people experience. For example, many schizophrenic people hear voices. Have you ever heard someone call your name, only to find there was Facts about suicide Risk factors for suicide n Suicide occurs across the world, but rates vary by culturen Self-inflicted injuries, including suicide, were the 12th leading cause of death in the world in 1998 Facts about suicide Suicide occurs across the world,but rates vary by culture n Self-inflicted injuries, including suicide, were the 12th leading cause of death in the world in 1998 n In all cultures, men are more likely than women are to complete suicide Rates of suicide in children and adolescents are on the rise n People with mental disorders, especially depression, substance use disorders, schizophrenia,and borderline personality disorder, are at high risk for suicide Risk factors for suicide
Past history of attempted suicide
Talking about committing suicide
A clear plan to commit suicide
Available means (e.g.firearms, drugs)
Depression
Substance abuse
Hopelessness
Impulsivity
Stressful life events
Lack of social support
Saying goodbye to people
Giving away personal items
The symptoms of schizophrenia are grouped into two categories: positive and negative symptoms. Positive symptoms indicate the presence of something unusual (such as hallucinations, delusions, odd speech and inappropriate affect) and negative symptoms indicate the absence of something normal (such as good social skills, appropriate affect, motivation and life skills).
The course of schizophrenia Schizophrenia is a chronic disorder. Although some people have brief episodes of schizophrenic-like behaviour (called brief reactive psychoses), most people with schizophrenia suffer from symptoms for their entire lives. One common course of schizophrenia is a period of negative symptoms and odd behaviour during which the person’s functioning slowly deteriorates (the prodromal phase), followed by a ‘first break’ – the first episode of positive symptoms. Some people experience an episode of positive symptoms with a few warning signs beforehand. The manifestation of symptoms can also take a number of different forms. For example, some people may be delusional but still be able to take basic care of themselves, carry on a conversation and succeed in school and work, whereas others may be completely debilitated by the disorder.
Schizophrenia typically has its onset in late adolescence or early adulthood. Although it can start in childhood, this is quite rare. Sufferers don’t necessarily deteriorate over time, but they do have relapses into episodes of positive symptoms. Causes of schizophrenia and factors affecting ts course 1 Genetic and biological factors These account for our initial vulnerability to schizophrenia, although exactly how they do so is unclear.
What is clear is that schizophrenia tends to be inherited. For example, monozygotic twins have the highest concordance rates for schizophrenia (Gottesman, 1991), meaning that they are more likely to both have schizophrenia if one of them has it, compared to people who share less genetic material (such as dizygotic twins or siblings). Interestingly, schizophrenics paranoid delusions elaborate set of beliefs, commonly experienced by schizophrenics, characterized by significant distrust of others and feelings of persecution positive symptoms in schizophrenia, symptoms that indicate the presence of something unusual, such as hallucinations, delusions, odd speech and inappropriate affect negative symptoms in schizophrenia, symptoms that indicate the absence of something normal, such as good social skills, appropriate affect, motivation and life skills concordance rates the extent to which people show the same disorders Pioneer Emil Kraepelin (1856–1926), a German psychiatrist and one of the founding fathers of modern psychiatry, made three primary contributions to the field of mental illness. First, Kraepelin believed that mental illness was caused by biological factors. His work in this area helped define the field of biological psychiatry and research now supports a strong biological basis for some of the disorders in which Kraepelin was most interested (e.g. schizophrenia and bipolar disorder). Second, Kraepelin laid the foundation for modern classification systems used to diagnose mental disorders, which use patterns of symptoms rather than any one symptom in isolation. This led to his third contribution, which was the classification of and distinction between schizophrenia and bipolar disorder.and their close family members show some similar types of neuropsychological functioning, even if these family members do not
suffer from the illness itself. This suggests that it may be the biological risk factors for schizophrenia that are inherited from family members, rather than the disorder itself (Cannon et al., 1994).
Adoption studies also support the notion of genetic transmission of vulnerability to schizophrenia. Children born to a schizophrenic parent and adopted away to a non-schizophrenic
parent are more likely to have schizophrenia, compared to children born to a non-schizophrenic parent (Kety et al., 1994). However, one study has shown that adopted-away children with a genetic predisposition to schizophrenia are more likely to become schizophrenic if they are also raised in a disturbed family environment. This supports a diathesis–stress model of schizophrenia (Tienari et al., 1987).
Several biological problems may cause schizophrenia, as various forms of brain dysfunction occur among sufferers, including enlarged ventricles, reduced blood flow to frontal brain regions
and an excess of dopamine (Andreasen et al., 1992; Davis et al., 1991; Flaum et al., 1995). But we don’t know for sure whether these problems are a cause or a consequence of the disorder. A current debate focuses on the neurodegenerative hypothesis (that schizophrenia leads to progressively deteriorating brain functioning) versus the neurodevelopmental hypothesis (that brain deficits are present at birth, influence the onset of schizophrenia and remain fairly stable). Research supports the neurodevelopmental hypothesis, but there is also evidence that the brains of some schizophrenic people show greater deterioration over time than would otherwise be expected.
parent are more likely to have schizophrenia, compared to children born to a non-schizophrenic parent (Kety et al., 1994). However, one study has shown that adopted-away children with a genetic predisposition to schizophrenia are more likely to become schizophrenic if they are also raised in a disturbed family environment. This supports a diathesis–stress model of schizophrenia (Tienari et al., 1987).
Several biological problems may cause schizophrenia, as various forms of brain dysfunction occur among sufferers, including enlarged ventricles, reduced blood flow to frontal brain regions
and an excess of dopamine (Andreasen et al., 1992; Davis et al., 1991; Flaum et al., 1995). But we don’t know for sure whether these problems are a cause or a consequence of the disorder. A current debate focuses on the neurodegenerative hypothesis (that schizophrenia leads to progressively deteriorating brain functioning) versus the neurodevelopmental hypothesis (that brain deficits are present at birth, influence the onset of schizophrenia and remain fairly stable). Research supports the neurodevelopmental hypothesis, but there is also evidence that the brains of some schizophrenic people show greater deterioration over time than would otherwise be expected.
2 Psychosocial factors An early hypothesis of the ‘schizophrenogenic mother’ suggested that inadequate parenting causes schizophrenia (e.g. Arieti, 1955). There is absolutely no evidence of this, nor that any psychosocial factors cause schizophrenia. The evidence overwhelmingly points to genetic and biological factors as providing the initial vulnerability.
But there is evidence, consistent with a diathesis–stress model, that psychological and social factors influence the course of schizophrenia, such as the timing of onset and the likelihood of relapse. The most well researched psychosocial predictor of the course of schizophrenia is a phenomenon called expressed emotion (EE). This doesn’t refer to the level of emotion the sufferer expresses, as the name implies, but to a specific set of feelings and behaviours directed at people with schizophrenia by their family members. A family that is high in EE tends to be critical and resentful of their schizophrenic relative and may be overprotective or over-involved in his life (Brown et al., 1962). A family that is low in EE tends to be more caring and accepting, and less enmeshed in the sufferer’s life.
The level of EE in the family plays an important role in what happens to the schizophrenic person. Schizophrenic people who have families that are high in EE are more likely to suffer a relapse of symptoms (figure 15.6). This association between EE and relapse is also true for a number of other disorders. Caring for a schizophrenic family member is a stressful, tiring undertaking, which can, in itself, lead to high EE behaviours. Fortunately, psycho-educational programmes can help families and their schizophrenic relatives learn better ways of communicating. These programmes, in conjunction with appropriate medication for the sufferer, can lower relapse rates (e.g. Leff et al., 1982; McFarlane et al., 1995).
But there is evidence, consistent with a diathesis–stress model, that psychological and social factors influence the course of schizophrenia, such as the timing of onset and the likelihood of relapse. The most well researched psychosocial predictor of the course of schizophrenia is a phenomenon called expressed emotion (EE). This doesn’t refer to the level of emotion the sufferer expresses, as the name implies, but to a specific set of feelings and behaviours directed at people with schizophrenia by their family members. A family that is high in EE tends to be critical and resentful of their schizophrenic relative and may be overprotective or over-involved in his life (Brown et al., 1962). A family that is low in EE tends to be more caring and accepting, and less enmeshed in the sufferer’s life.
The level of EE in the family plays an important role in what happens to the schizophrenic person. Schizophrenic people who have families that are high in EE are more likely to suffer a relapse of symptoms (figure 15.6). This association between EE and relapse is also true for a number of other disorders. Caring for a schizophrenic family member is a stressful, tiring undertaking, which can, in itself, lead to high EE behaviours. Fortunately, psycho-educational programmes can help families and their schizophrenic relatives learn better ways of communicating. These programmes, in conjunction with appropriate medication for the sufferer, can lower relapse rates (e.g. Leff et al., 1982; McFarlane et al., 1995).
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