Psychology: Schizophrenia - Term Paper Example

Schizophrenia Schizophrenia is a chronic psychotic disorder of thinking, behaviour and perception. It is commonly known as insanity or madness. The disease is actually not well understood. The course of the disease is usually fluctuating. It either gradually deteriorates or is relatively stable. The disease can be mild and subtle wherein the individual adapts very well to everyday life or can be severe with full expression of symptoms. These symptoms can be either positive or negative as discussed below. The hallmark symptoms are auditory hallucinations and delusions (Gerstein, Emedicine). The most harmful symptom of schizophrenia is impaired information processing (Frankenburg, Emedicine). Schizophrenia is now considered a broad syndrome expressed by various brain disorders. Infact, it is considered as the most severe end of a spectrum of schizophrenia related disorders. The primary abnormalities in schizophrenia are in brain neurochemistry, neuroanatomy, and development (Gerstein, Emedicine). Emotion- related abnormalities occur in schizophrenia as a result of disjunction between the experience and expression of affect. The capacity to express a level of emotion that is commensurate with subjective experience is lost. Of the emotional abnormalities associated with schizophrenia, the most prominent one is blunted effect. This means that the individual has severe reduction in emotion expressivity along with apparently normal emotion experience. Blunted affect is associated with poor prognosis in schizophrenia. It is mainly due to overuse of suppression. Many theories have been proposed to describe the cause of emotional disjunction. In 2004, Kring and Werner (2004) (cited in Henry et al, p.473) proposed a model for emotional dysregulation. They suggested that the dysregulation involved a deficiency in regulatory process and also a maladaptive use of intact process. Henry et al (2008, p. 473- 478) studied use of suppression and reappraisal in individuals with schizophrenia and compared the finding in those without the disease. Their study concluded that "relative to controls, individuals with schizophrenia did not differ with regard to their reported use of suppression and reappraisal, and reported use of both strategies was unrelated to clinical ratings of blunted affect." Even though schizophrenics express emotion and talk about emotional life events, how far these expressions are appropriate is a debatable question in the wake of blunted affect. Gruber & Kring (2008, p.520- 533) investigated schizophrenia patients renderings of their emotional life events. The study reported that "Although schizophrenia patients are capable of recounting life events that trigger different emotions, the telling of these life events is fraught with difficulty." Schizophrenics not only have emotional dysregulation, the patients also suffer from deficits in learning and memory. Horan et al (2008, p. 606- 617) performed a study wherein the researchers evaluated learning in schizophrenics who were already on medication. The tasks which were used as tools of evaluation are procedural habit learning and artificial grammar task. The study concluded that schizophrenics have poor explicit learning skills, but they do have a preserved ability to acquire complex rule- based knowledge in the absence of performance feedback. Prevalence Worldwide, the prevalence of schizophrenia is estimated to be 1%. The disease affects all races and religions equally. Both the sexes are affected equally. Symptoms usually appear during adolescence and clinical deterioration occurs during the first 5- 10 years of disease onset. However, in women, the onset of the disease is later and the severity of clinical symptoms is less when compared to men. This difference has been attributed to the antidopaminergic effects of estrogen. After the initial deterioration, the disease lies considerably stable for many years (Gerstein, Emedicine). Pathophysiology Various neuroimaging studies have demonstrated anatomical abnormalities in schizophrenic patients. These abnormalities include bilateral ventriculomegaly and decreased brain volume in certain regions like hippocampus and amygdala. Anatomic abnormalities have also been detected in neocortical and limbic regions and their interconnecting white matter tracts (Frankenburg, Emedicine). Various neurotransmitter theories have been put forward to explain the symptoms in schizophrenia. According to the dopamine hypothesis, overactivity of the dopamine system in the brain, especially those involving D2 receptors causes the symptoms (Gerstein, Emedicine). Negative symptoms are caused due to hypodopaminergic activity in the mesocortical system and positive symptoms are caused due to hyperdopaminergic activity in the mesolimbic system Causes The causes of schizophrenia are not known properly. However, perinatal and genetic factors have been considered in the etiology in many cases. Genetic factors Genetic factors probably play a role in the development of schizophrenia because studies have demonstrated that there is an increased incidence of this disease in the biological, but not adapted relatives of the patient. Infact, it has been estimated that the risk of schizophrenia in first- degree relatives is about 10%. In cases where both the parents are schizophrenic, the risk of development of the disease is as high as 40% in their child. Amongst dizygotic twics, the concordance for schizophrenia is about 10% and for monozygotic twins it is 40-50% (Frankenburg, Emedicine). Another important aspect which goes in favour of genetic relation to schizophrenia is the fact that the condition is associated with left and mixed handedness. Perinatal factors Research points to the fact that schizophrenia is a neurodevelopmental disorder, probably beginning in utero. Maternal malnourishment and viral infections in pregnancy increase the risk of schizophrenia in the offspring (Frankenburg, Emedicine). While the above discussed factors are considered important risk factors, various social stressors can precipitate or exacerbate the symptoms. Clinical presentation The main symptom in schizophrenia is auditory hallucination. This means that the patients hear voices which others dont hear. The patients may also suffer from other type of hallucinations wherein they believe that others are reading their mind, or trying to control their thoughts or plotting harm against them. Such hallucinations may cause terror, fearfulness, withdrawal or even agitation. Schizophrenics may not make sense when they talk. Sometimes they may sit for hours together without talking much. These individuals have disturbed social relations, are often school drop-outs and are thrown out of job on and off. The symptoms of schizophrenia can be divided into 3 categories namely, positive symptoms, negative symptoms and cognitive symptoms (Duckworth, 2007). Positive symptoms are those which have lost touch with reality. They are actually pathological excesses of emotion, thought and behavior (Comer, 2007). They include hallucinations, delusions, heightened perceptions and disorganized thinking and speech. Hallucinations are perceptions in the absence of a stimulus. When the person hears or sees things that are not present, they are known as hallucinations. Hallucinations can be visual, auditory, olfactory, tactile, proprioceptive and thermoceptive. Delusions are pathological fixed false beliefs. When the person believes that other people (who actually exist) are reading his thoughts and plotting against him, the person is said to suffer from delusions. Heightened perception is said to be present when the person feels that his senses are flooded with all the sights and sounds that surround him. Disorganized thinking and speech is said to be present when the person can not think logically and speaks peculiarly. Loose associations, perseveration and neologisms are all manifestations of disorganized thinking and speech (Comer, 2007). Negative symptoms are actually pathological deficits of emotion, thought and behavior. They include poverty of speech or alogia, emotional flatness or lack of expression, loss of volition, anhedonia and social withdrawal. A person is said to have alogia when his speech is brief and devoid of content. In other words, the person talks little and means little or he talks more and still means little. Symptom manifestations of blunt effect include showing less anger, sadness, joy and other feelings than most people. When the person shows no emotions at all, it is known as flat affect. Anhedonia means general lack of pleasure or enjoyment. Avolition means marked apathy or inability to start or complete a course of action. Cognitive symptoms include disorganized thoughts, difficulty concentrating and/or following instructions, difficulty completing tasks, memory problems. Diagnosis To arrive at a diagnosis of schizophrenia according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), the symptoms must last atleast for 6 months, with atleast one month of active symptoms and there must be significant impairment of social and occupational functioning (Frankenburg, Emedicine). Treatment Antipsychotic drugs are the main stay of treatment for schizophrenia (Frankenburg, Emedicine). These are also known as neuroleptic medication or major tranquilizers. These medications diminish positive symptoms and prevent relapses. The problem with most of the antipsychotic drugs is side effects. Common side effects include akathisia, dystonia, hyperprolactinemia, parkinsonism, tardive dyskinesia and neuroleptic malignant syndrome. Common antipychotics include risperidone, haloperidol and fluphenazine decanoate. Anticholinergic agents are frequently used with antipsychotics to prevent dystonic or extrapyramidal symptoms. The most effective antipsychotic is clozapine but it is rarely associated with agranulocytosis (Frankenburg, Emedicine). Some schizophrenics may even require other drugs like antidepressants, mood stabilizers and anxiolytics. Works Cited Comer, RJ. Abnormal Psychology. (6th ed.). 2007. New York: Worth Publishers. Duckworth, K. "Schizophrenia." National Alliance on Mental Illness. 28 Nov 2008 Frankenburg, FR. "Schizophrenia." Emedicine from WebMD. Jul 25, 2007. 28 Nov 2008 Gerstein, PS. "Schizophrenia." Emedicine from WebMD. Jan 23, 2007. 28 Nov 2008 Gruber, J & Kring, AM. "Narrating Emotional Events in Schizophrenia." Journal of Abnormal Psychology. 2008. 117(3): 520- 533. Henry, JD, Green, MJ, Rendell, PG, ODonnell, M & McDonald, S. "Emotion Regulation in Schizophrenia: Affective, Social, and Clinica lCorrelates of Suppression and Reappraisal." Journal of Abnormal Psychology. 2008. 117(2): 473- 478. Horan, WP., Green, MF., Knowlton, BJ, Wynn, JK, Nuechterlein, KH, & Mintz, J. 2008. "Impaired Implicit learning in Schizophrenia" Neuropsychology. 2008. 22(5): 606- 617 Read More