Homicidal Schizophrenia - Literature review Example

Homicidal Schizophrenia Student’s Name Institutional Affiliation Date Homicidal Schizophrenia It is estimated that about one percent of the population in the United States is affected by Schizophrenia. Schizophrenia is a complex and chronic mental disorder that affects one’s thoughts, speech and their ability to have meaningful contacts with people (Mehta et al., 2016). Most studies show that this mental disorder begins in early adulthood, though research encourages parents and communities to look for early schizophrenia symptoms in children who may display certain behavior associated with the condition. This literature review, focuses on genetic predisposition of schizophrenia, the link between the condition and homicide, and a relapse. Literature Review Genetic predisposition of schizophrenia Different studies have been conducted to understand the cause of schizophrenia because of the significant human burden that the condition causes. According to Millier and colleagues (2013) the condition has complex impact on a patient’s health, their wellbeing and their surrounding environment. For instance, the cost of the disease’s management remains prohibitive to most families and individuals. Because of this burden, various research studies have been carried out to understand the cause and how the condition develops for better management. Imperatively, an array of studies has established the relationship between genetics and the schizophrenia. Experts now agree that the condition develops because of genetic interplay in the human brain and environmental factors. However, for the purpose of this review, the paper shall focus on the genetic predisposition. According to Vereczkei and Mirnics (2011), genetic predisposition plays a significant role in the etiology of the condition with hereditary accounting for over eighty percent of the causes. In his article Makin (2014) states that one of the largest- ever genetic study of mental disorder shows that a complex set of genetic factors are associated with schizophrenia. According to Makin, the study found about 128 gene variants that are linked to schizophrenia in one hundred and eight different locations in the human genome. The Schizophrenia Working Group of the Psychiatric Genomics Consortium carried out the study by comparing the whole genomes of about thirty-seven thousand people with schizophrenia and over one hundred and ten thousand without the condition. The study notes that variants that show up in higher proportions in people with the disorder are linked to the condition. However, their technique could not identify the exact mutations that cause the condition or specify the particular genes associated with schizophrenia (Makin, 2014). The study only shows areas of genome that contribute to the condition and suggest that more research on genes in these locations needs to be carried out to determine the biological processes underlying the condition. In another study carried out by Divya Mehta and colleagues (2016), children of older parents are more likely to be born with health disadvantage that include the area of mental health. The study states that old fathers are likely to produce children with increased risk of developing schizophrenia. According to Susan Scutt, after a recent study had suggested that psychosis, a common sign of schizophrenia, is linked to the age of a mother and not just a father’s, another team of scientists decided to study these findings. The outcomes from their study revealed that some shock impact of the DNA by indicating that women that are genetically predisposed to schizophrenia are highly likely to have their first born at either early or late age (Scutt, 2016). The team proposed that a U-shaped relationship exists between the mother’s age at first birth and the risk of a child developing schizophrenia. Divya et al. states that on average women who give birth at an early age, for instance, twenty years or older age, for instance, over thirty five years, have increased genetic predisposition or risk of passing schizophrenia onto their children compared to those who give birth during their intermediate age. Since schizophrenia is linked to genetic predisposition, it usually runs in families. Imperatively, scientists are studying the underlying genetics and believe that various genes together with environmental and other risk factors play a significant role in the genesis of the condition. Because no single gene or its mutation causes the disorder, it is impossible for a genetic test to determine or predict who, in a family will develop schizophrenia (Vereczkei & Mirnics, 2011). However, genetics will continue to be the focus of studies into the condition. Past research shows a strong link between schizophrenia in children born to older fathers. The experts have explained that the connection is as a result o spontaneous gene mutations that occur in older genes which the fathers pass onto their children. However, recent studies have indicated that a mother’s genes could also be inherited by children leading to the development of the condition. According to the study, women with high genetic predisposition to the condition have a tendency to have their first child at an early or late age compared to the general population. The study suggests that most of these women have a family history of the condition. As a result, they develop poor social interactions, and increase time to get a mate (Scutt, 2016). Further, the researchers suggest that it is possible that the schizophrenia risk predisposes them to impulsive conduct, which is associated with becoming pregnant at a younger age for the first time. Imperatively, past studies associated with schizophrenia due to a mother’s old age suggest that older women usually have children with older men and mutations in the men’s genes were the cause of the condition. In another study by Robert Power and colleagues, genetic predisposition to schizophrenia may be associated with certain behaviors and lifestyle. Specifically, these researchers link genetic predisposition to schizophrenia to increased use of cannabis (Power et al., 2014). In their study, the researchers sampled over two thousand healthy individuals and demonstrate that one’s burden or risk of schizophrenia is associated with use of the drug. Therefore, the research suggests that the association between the condition and cannabis is because of shared genetic etiology. Imperatively, the study emphasizes that while genetic predisposition is associated with increased risk of developing schizophrenia, the need to understand enabling factors within the environment cannot be ignored in finding the real causes of the condition. Therefore, the interactions between risk variants and an individual’s use of cannabis partly explain why some people experience psychosis yet others do not. The use of cannabis is inherited but no genetic variants have been associated or identified to ascertain this observation. While the study emphasizes the relationship between these two issues, it is categorical that the extent of such heritability in the use of cannabis is unclear, especially in behavioral phenotypic situations like predicting schizophrenia (Scutt, 2016). The study by Power and his colleagues demonstrate that environment and gene correlation is essential in determining how the condition develops due to environmental factors as much as it is linked to genes in over eighty percent of the cases. Past and current studies make it clear that schizophrenia is largely an inherited condition that runs in families as those with close relatives with the condition are highly likely to develop the disorder than those without such relatives. For instance, a child whose parent has the disorder has about a ten percent chance of developing the condition, with identical (monozygotic) twin having the highest risk at between forty and sixty percent (Scutt, 2016). Scientists continue to study and get better understanding of the genetic predisposition factors linked to schizophrenia. They believe that several genes are linked to the condition, with recent studies indicating that people with the condition tend to have higher rates of unique gene mutations. Additionally, biological process linked to genes like prenatal difficulties may influence the development of schizophrenia. Conversely, these scientists are yet to understand how the genetic predisposition occurs and if one can develop the disorder. II. Schizophrenia and Homicide Various studies demonstrate that people suffering schizophrenia are more likely to show aggressive behavior compared to the general population. The converging evidence from different international studies shows that the increased risk of anti-social behavior and violence, especially leading to homicides, is more profound in people with schizophrenia compared to the general population. These findings suggest that the risk of a person with psychosis, particularly schizophrenia, committing a violent offence is two to six times higher in men and two to eight times more in women of the same age in comparison to the general population. Again, between five to twenty-eight percent of those charged with murder in the West have had a schizophrenia spectrum disorder diagnosis. Therefore, these statistics imply that the association between homicide and schizophrenia is strong, and that people with the condition are more likely to be violent than those without it. However, contrary studies on the association between schizophrenia and violent behavior, particularly homicide, state that such behavior is comparatively rare. For the purpose if this paper, this section examines the link between schizophrenia and homicide, which is the highest level of manifestation of violent behavior among individuals. In their article, Maurizio Pompili and Andrea Fiorillo argue that while the prevalence of violence is the same in psychiatric patients and the general population, patients suffering from schizophrenia have often been portrayed as unpredictably aggressive and impulsive. Consequently, the stereotypic portrayal of these patients by the media and research findings increase stigmatization and leads to poor treatment outcomes. The two researchers argue that violent behavior like homicide among these patients arises due to co-morbidity of factors (Pompili & Fiorillo, 2015). They cite various situations that include insufficient social support, substance abuse and exacerbation of the symptoms as some of the co-morbidity factors. Further, failure to treat these people is a major risk factor for aggression that researchers fail to highlight and investigate. These researchers postulate that aggressive and impulsive behaviors are found in paranoid schizophrenia patients. Again, they note that such occurrences happen during acute and chronic states of the illness. Patients with schizophrenia may demonstrate dysfunctional impulsivity and impulsive aggression (Pompili & Fiorillo, 2015). However, the neurobiological aspects of aggression in patients with the condition have not been determined or well understood by researchers. In this research, such aggression leading to homicidal acts may be linked to frontal and temporal brain abnormalities. Again, psychotic symptom like delusions and hallucinations with hostilities may lead to the manifestation of aggressive behavior among these patients. What these researchers emphasize is that aggression arises from impulsive and environmental factors that affect schizophrenia patients and does not come naturally as part of their condition (Nielssen et al., 2011). Imperatively, homicidal schizophrenia occurs when aggressive and impulsive factors in the patients’ environment frustrate their wellbeing or functioning. Therefore, patients demonstrate increased aggression and violence during acute episodes. Further, people must understand that schizophrenic patients have less insight, and experience enhanced thought disturbances or disorders (Lodge, 2009). Again, they have reduced control of their aggressive impulses, but despite all these factors violent behavior remains comparatively rare. It is important to note that most of the time, aggression to violent behavior, especially homicide, occurs because of co-morbidity. The co-morbidity may be as a result of substance abuse or alcohol. Such co-morbidity complicates the impulsion to aggressive conduct among these patients. Studies have demonstrated that among schizophrenic patients, and those with other psychoses like MDD, and bipolar disorder, homicidal risk increases with alcohol abuse or dependence co-morbidity. It suffices to note that various studies demonstrate that the prevalence of people with schizophrenia committing homicide among all the homicide incidences is higher than in the general population. While the prevalence of the condition in the general population stands at about one percent, a three-year pilot study showed that about eight-five individuals diagnosed with the condition in a population of 1594, had committed suicide. These figures show that the rate of homicidal schizophrenia is higher than those in the general population. As a consequence, questions arise concerning features in these persons with the condition who have committed homicide that differentiate them from the other schizophrenic patients (Belli & Ural, 2012). One issue that arises from most of the studies is the evaluation of the risk factors for schizophrenic homicidal patients. Imperatively, most of the findings postulate that the average incidence of homicide by severely mental ill patients, including schizophrenia, stands at 0.13 in every one hundred thousand per year in a majority of countries surveyed. However, nations with higher rates of total homicides, for instance, the United States, recorded increased rates than the rest (Martone et al., 2013). Again, different systematic reviews assert that schizophrenia increases risk to violence by between two to seven fold and homicidal risk by about twenty times. For one, the risk of homicide in individuals with the condition is significantly higher compared to the general population. While prevalence in the general population stood at 0.02 percent, homicidal schizophrenia stood at 0.3 percent. Therefore, studies have attempted to link homicide to aggravated aggression and impulsive situations in the patient’s environment. Again, most studies link risk factors to socio-demographic features in general population that mentally ill patients have to endure even those with no criminal responsibility. These factors revolve around unemployment, young single male with a history of violence, and presence of serious psychiatric disorders among other issues (Golenkov, Nielssen & Large, 2014). Female patients have always demonstrated reduced risk activities than their male counterparts, partly due to lower presence of co-morbidity in drug and substance abuse. Therefore, any violence among female patients is usually over-represented because of the peculiarity associated with such positions. Again, homicidal incidences among schizophrenia patients are more likely to be manifested in urban populations as compared to those in the rural areas. Further, most of these cases will consist of mainly the uneducated and unemployed young people. It suffices to note that about a quarter of patients presenting with homicidal schizophrenia that commit homicide have never presented to a psychiatric clinic before. Despite the lack of clinical presentation, these patients manifest the clinical signs of schizophrenia for an elongated duration (Pompili & Fiorillo, 2015). Furthermore, in other findings, persons with schizophrenia who show violent behaviors and commit homicide have enhanced rates of getting or being diagnosed with a personality disorder, especially the antisocial type. Therefore, schizophrenic homicide is linked to several risk factors originating from the environment, especially socio-demographic factors. However, aggression and impulsive conduct are the biggest links to the manifestation of homicidal schizophrenia compared to other factors. III. Schizophrenia Relapse According to research findings, schizophrenia relapses can be dangerous and should be avoided at all times since a relapse hinders full recovery and better outcomes. Different results demonstrate that relapse rates are higher when treatment is discontinued even in a single psychotic episode. Again, longer treatment time before discontinuation doe not reduce the risk of a relapse occurring (Emsley, Chiliza &Asma, 2013). It suffices to note that relapse rates are influenced by individual and other environmental factors. For instance, younger and more acute patients tend to have higher relapse rates than older and chronic patients. Again, in family circumstances where emotion is readily expressed, especially negative emotions, exacerbates the situation and increase the risk schizophrenic relapse. Accordingly, average quality evidence postulates that the rate of relapse is about twenty-eight percent at one year post-treatment and close to fifty-four percent after three years of post-treatment. These studies also state that most patients and family members can detect changes in behavior and experience that precede a psychotic relapse. In most cases, higher rates of relapse are linked to substance use disorders, poor adherence to medicine, high levels of family commentary, especially critical and negative comments; and a poor pre-morbid adjustment (Emsley et al., 2013). Imperatively, the available low quality evidence suggests that early warning signs for schizophrenic relapse include hallucinations, changes in sleep patterns (insomnia), suspiciousness, and cognitive inefficiencies among others. Therefore, a relapse will lead to a return to levels similar to the initial psychotic episode. In most cases, patients respond well to the re-introduction of antipsychotic treatment after the occurrence of a relapse. Findings demonstrate that only one in every six patients records a treatment failure when a relapse occurs. References Belli, H. And Ural, C. (2012). “The association between schizophrenia and violent or homicidal behaviour: the prevention and treatment of violent behaviour in these patients.” West Indian Medical Journal, vol.61, no.5, pp.538-43. Bressert, S. (2017). Causes of Schizophrenia. Psych Central. Retrieved on February 28, 2017, from https://psychcentral.com/disorders/schizophrenia/causes-of-schizophrenia/ Emsley, R. Chiliza, B. and Asma, L. (2013). “The evidence for illness progression after relapse in schizophrenia, Schizophrenia Research, vol.1-3, no.148, pp. 117-121. Emsley, R., Chiliza, B., Asma, L., and Harvey, B.H. (2013). The nature of relapse in Schizophrenia, BMC Psychiatry, 2013; 13: 50. doi:  10.1186/1471-244X-13-50 Golenkov, A., Nielssen, O., and Large, M. (2014). “Systematic review and meta-analysis of homicide recidivism and Schizophrenia.” BMC Psychiatry, vol. 24, no.46. Lodge, G. J. (2009) Schizophrenia, homicide and long-­term follow up. The British Journal of Psychiatry. Vol.195, pp.553-­554. Makin, S. (2014, November). “Massive Study Reveals Schizophrenia's Genetic Roots.” Accessed on March 3, 2017, from https://www.scientificamerican.com/article/massive-study-reveals-schizophrenia-s-genetic-roots/ Martone, C.A., Mulvey, E.P., Yang, S., Nemoianu, A., Shugarman, R., Soliman, L. (2013). Psychiatric characteristics of homicide defendants. American Journal of Psychiatry, vol.170, pp.994–1002. Mehta, D., Tropf, F.C., Gratten, J., Bakshi, A., et al. (2016). Evidence for Genetic Overlap Between Schizophrenia and Age at First Birth in Women. JAMA Psychiatry. Miller, C. L. (2013). Evidence for phenotypic plasticity in response to photic cues and the connection with genes of risk in schizophrenia. Front. Behav. Neurosci. 7:82. doi: 10.3389/fnbeh.2013.00082 Nielssen, O., Bourget, D., Laajasalo, T., Liem, M., Labelle, A., Häkkänen-­‐Nyholm, H., & Large, M. M. (2011). Homicide of strangers by people with a psychotic illness. Schizophrenia bulletin, vol.37, no.3, pp.572-­579. Pompili, M. and Fiorillo, A. (2015). “Aggression and Impulsivity in Schizophrenia,” Psychiatric Times. Accessed on March 2, 2017, from http://www.psychiatrictimes.com/schizophrenia/aggression-and-impulsivity-schizophrenia Power, R.A., Verweji, K.J.H., Zuhair, M., Montgomery, G.W., Henders, A.K., Heath, A.C., Madden, P.A.F., Medland, S. E., Wray, N.R., and Martin, N.G. (2014). “Genetic predisposition to schizophrenia associated with increased use of cannabis.” Mol Psychiatry, vol.19, no.11, pp.1201-1204. Putkonen, A., Kotilainen, I., Joyal, C. C., & Tiihonen, J. (2004). Co-morbid personality disorders and substance use disorders of mentally ill homicide offenders: A structured clinical study on dual and triple diagnoses. Schizophrenia Bulletin, vol.30, no.1, pp.59 Scutt, S. (2016). “A Genetic Predisposition For Schizophrenia Aligns With Timing Of First Birth.” Accessed on March 1, 2017, from http://www.medicaldaily.com/genetic-predisposition-schizophrenia-first-child-379121 Vereczkei, A., and Mirnics, K (2011). “Genetic predisposition to schizophrenia: what did we learn and what does the future hold?”Accessed on March 2, 2017, from http://epa.niif.hu/02400/02454/00044/pdf/EPA02454_neurohun_2011_205-210.pdf Read More

The study notes that variants that show up in higher proportions in people with the disorder are linked to the condition. However, their technique could not identify the exact mutations that cause the condition or specify the particular genes associated with schizophrenia (Makin, 2014). The study only shows areas of genome that contribute to the condition and suggest that more research on genes in these locations needs to be carried out to determine the biological processes underlying the condition.

In another study carried out by Divya Mehta and colleagues (2016), children of older parents are more likely to be born with health disadvantage that include the area of mental health. The study states that old fathers are likely to produce children with increased risk of developing schizophrenia. According to Susan Scutt, after a recent study had suggested that psychosis, a common sign of schizophrenia, is linked to the age of a mother and not just a father’s, another team of scientists decided to study these findings.

The outcomes from their study revealed that some shock impact of the DNA by indicating that women that are genetically predisposed to schizophrenia are highly likely to have their first born at either early or late age (Scutt, 2016). The team proposed that a U-shaped relationship exists between the mother’s age at first birth and the risk of a child developing schizophrenia. Divya et al. states that on average women who give birth at an early age, for instance, twenty years or older age, for instance, over thirty five years, have increased genetic predisposition or risk of passing schizophrenia onto their children compared to those who give birth during their intermediate age.

Since schizophrenia is linked to genetic predisposition, it usually runs in families. Imperatively, scientists are studying the underlying genetics and believe that various genes together with environmental and other risk factors play a significant role in the genesis of the condition. Because no single gene or its mutation causes the disorder, it is impossible for a genetic test to determine or predict who, in a family will develop schizophrenia (Vereczkei & Mirnics, 2011). However, genetics will continue to be the focus of studies into the condition.

Past research shows a strong link between schizophrenia in children born to older fathers. The experts have explained that the connection is as a result o spontaneous gene mutations that occur in older genes which the fathers pass onto their children. However, recent studies have indicated that a mother’s genes could also be inherited by children leading to the development of the condition. According to the study, women with high genetic predisposition to the condition have a tendency to have their first child at an early or late age compared to the general population.

The study suggests that most of these women have a family history of the condition. As a result, they develop poor social interactions, and increase time to get a mate (Scutt, 2016). Further, the researchers suggest that it is possible that the schizophrenia risk predisposes them to impulsive conduct, which is associated with becoming pregnant at a younger age for the first time. Imperatively, past studies associated with schizophrenia due to a mother’s old age suggest that older women usually have children with older men and mutations in the men’s genes were the cause of the condition.

In another study by Robert Power and colleagues, genetic predisposition to schizophrenia may be associated with certain behaviors and lifestyle. Specifically, these researchers link genetic predisposition to schizophrenia to increased use of cannabis (Power et al., 2014). In their study, the researchers sampled over two thousand healthy individuals and demonstrate that one’s burden or risk of schizophrenia is associated with use of the drug. Therefore, the research suggests that the association between the condition and cannabis is because of shared genetic etiology.

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