History of Schizophrenia
The term Schizophrenia was proposed by a Swiss psychiatrist called Eugene Bleuler in 1907 (Berrios & Luque, 2003). Eugene aimed at describing the separation of function between personality, perception thinking and memory (Berrios & Luque, 2003). Some people argue that the disease has been in existence for centuries and was only discovered in the 20th century. Others argue the disease represents mental symptoms that are culturally determined. The earliest case of schizophrenia was discovered in 1797 owing to the symptoms that were presented by James Tilly (Berrios & Luque, 2003). This disorder is characterized by a lot of uncertainties regarding its origin, cause symptoms, diagnosis and treatment (Berrios & Luque, 2003). Later in 1853, French physician Benedict Morel suggested that schizophrenia is a disorder that mainly affects teenagers and young adults. Benedict referred to this disorder as dementia pracaecox (early dementia) (Berrios & Luque, 2003). However, in 1983 an expanded classification of mental disorders was proposed by Emily Kraepelin. Emily’s definition distinguished early dementia from mood disorders (Berrios & Luque, 2003). According to Emily, dementia pracaecox was a disease of the brain and represents a form of dementia that is different from other forms of dementia like Alzheimer’s disease (Berrios & Luque, 2003).
Schizophrenia is derived from two Greek words that simply mean ‘splitting of the mind’. After a comprehensive analysis of the patients’ symptoms, Bleuler stated that schizophrenia is not dementia because some patients did not deteriorate, but they improved. Bleuler coined the four main symptoms as 4’As (Berrios & Luque, 2003). The 4 A’s include Ambivalence, Autism, Association of Ideas and flattened Affect. Currently, different scholars have various definitions (Frith & Johnstone, 2003). However, most of the definitions agree on one thing; schizophrenia is a complex clinical syndrome that involves disruptive psychotic experience as well as other core elements of psychopathology (Frith & Johnstone, 2003). This paper endeavors to discuss various aspects related to schizophrenia.
Stigma and Discrimination
Experts remind us that people with schizophrenia are people, not merely a collection of psychiatric symptoms. Adequate treatment of this disorder must focus not only on symptom management, but also on helping the affected individuals, as far as possible, to live a happy, socially connected and fulfilling life. Snyrder, Gur, and Andrews (2007) note that people with schizophrenia are often viewed with fear and animosity. A report published by General Social Survey’s Mental Health Module in 1996, indicated that 60 percent of the respondents viewed people with schizophrenia as violent individuals. A significant number of the respondents stated that people with schizophrenia should be forced to go for psychiatric care. In addition, a majority of the respondents indicated that they are unwilling to interact with persons suffering from schizophrenia. Snyrder, Gur, and Andrews (2007) argue a number of factors can be used to reduce the stigma associated with schizophrenia. They include effective treatment regimes; increased openness about mental illness generated by the family movement, and increased knowledge biological of etiological factors. The two scholars note that these factors improve optimism (Snyrder, Gur, & Andrews 2007).
Patients and experiences
Patients with schizophrenia often find it challenging to cope with the stigma and discrimination associated with their condition. However, counseling can be very beneficial in assisting such individuals to cope with stigma and discrimination.
Family members and Schizophrenia
According to Snyrder, Gur, and Andrews (2007), the family movement which is exemplified by groups by the National Alliance for the mental health Ill, has strongly championed the idea that mental illness is a disease like any other, and not a cause for shame or secrecy. Thus, family members should lead by example and show love and care to their relatives who might be suffering from schizophrenia.
Social and biological Issues
Media hyperbole and biased reporting tend to perpetuate negative attitudes toward schizophrenia (Shore & Keith,1996). Entertainment and news media in the U.S, UK and other parts of the world portray the mentally ill as dangerous, evil and funny. However, modern communication technology can be helpful in reducing the stigma associated with schizophrenia. This can be achieved through audience segmentation which partitions a mass audience into sub audiences that are relatively homogenous, and devising promotional strategies and about biological contributors of schizophrenia has been proven to be destigmatizing (Shore & Keith,1996). Thus, stakeholders need to promote a biological understanding of this syndrome. When the general public is aware of the biological factors that cause schizophrenia, they are less likely to discriminate against people with schizophrenia (Shore & Keith,1996).
Theories and classifications
Symptoms of schizophrenia come in two basic varieties; positive and negative. Positive symptoms include abnormal perceptions, thoughts and behaviors that are produced by the disease (Tsuang, Faraone, & Gatt, 2011). These symptoms represent the type of break with reality that many people associate with severe mental illness. Psychosis is used to refer to the positive signs of schizophrenia. Positive symptoms include delusions, hallucinations, disorganized thoughts and speech, disorganized behavior and catatonic behavior (Tsuang, Faraone, & Gatt, 2011). On the contrary, negative symptoms are normal emotions and behaviors that are reduced by schizophrenia (Taylor, 2006). Such symptoms usually involve gradual withdrawal from the world and loss of interest in caring for oneself (Boyle, 2002). Negative symptoms include lack of emotional expression, a reduction in the quality and quantity of speech, lack of initiative and motivation, and loss of pleasure in activities that one once enjoyed (Taylor, 2006). Schizophrenia is also associated with cognitive symptoms that involve deficits in thinking abilities such as paying attention, making decisions and remembering (Taylor, 2006).
Issues surrounding classifications and diagnosis
The problem of classification has been the greatest impediment to the investigative work in schizophrenia. The efforts of classification have focused on the genetic elements, chemical imbalances in the body, environment, family and socioeconomic factors (Boyle, 2002). However, when all these elements are put together, they do not constitute a unified picture of the illness.
Schizophrenia may occur in various forms. Paranoid schizophrenia refers to fear as a result of the perceptions of an individual with schizophrenia (Boyle, 2002). Individuals with catatonic schizophrenia have psychomotor disturbance (Boyle, 2002). On the other hand, those with undifferentiated schizophrenia have prominent psychotic symptoms that are not linked to the other subtypes (Boyle, 2002). Those with residual schizophrenia normally encounter psychotic episodes but quickly recover. Disorganized schizophrenia is characterized by disorganized and incoherent thought and speech (Boyle, 2002).
Diagnostic and Statistical Manual of Mental Health Disorders (DSM)
In DSM III, each of the mental disorders is seen as a “clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and is typically associated with distress or impairment of functioning (disability) of one or more important areas” (Boyle 2002, p. 45). On top of that, there is an inference that the disorder involves behavioral, biological or psychological dysfunction and that the dysfunction is not only in the relationship between the individual and the society.
International Statistic Classification of Disease and Related Health Problems (ICD)
The classification of schizophrenia is organized according to the traditional division of psychoses, neurotic disorders, and personality disorders, and it does not provide a general definition of mental disorders (Boyle, 2002). This model of classification defines psychosis in which schizophrenia is listed as mental; “disorders in which impairment of mental function has developed to an extent that grossly interferes with insight, and ability to meet with some basic requirements of life or maintain positive contact with reality” (Boyle 2002, p. 46).
Neurogenesis, chemical imbalance and depression
Experts acknowledge that Schizophrenia has a multifactorial etiology with multiple susceptible genes interacting with environmental insults to yield a range of phenotypes in the schizophrenia spectrum (Abb-i-Dargham, 2007). Cholinergic innervations of cortical and striatal brain areas are extensive and diffuse, as are both pre and post-synaptic targets for acetylcholine (ACh) interaction (Abb-i-Dargham, 2007). Receptors for ACH (AChRs) are categorized into two classes; ionotropic (nicotinic) and metabotropic (muscarinic) (Abb-i-Dargham, 2007). Each class has multiple subtypes with each opposing and synergistic actions. Activation of these receptors regulates the excitability of neurons by interaction with pre and post-synaptic localized Ach receptor binding sites. Ach acts as a tonic, diffuse signal modulating the release of ACH and other transmitters including dopamine, GABA and glutamate. ACH can exert its effects via highly localized and directed interactions with neuronal AChRs, to increase or decrease neuronal firing. Ach released from cholinergic inputs of the basal forebrain, striatal, and the pontomesencephalic (PM) areas play a vital role in regulating neurocognitive and motivational functions of the prefrontal cortical, hippocampal and ventral tegmental projections of the stratum (Abb-i-Dargham, 2007). On the other hand, central cholinergic circuits play a significant role in memory formation, motivational and volitional behaviors, and effects (Abb-i-Dargham, 2007). Each of these functions is altered in neuropsychiatric disorders including, schizophrenia.
Chemical imbalance and depression
In chemical terms, a number of molecules have been found to be associated with the development of schizophrenia. One such molecule is dopamine. Dopamine acts as a neurotransmitter in the brain. Theories that link dopamine to the development of schizophrenia indicate that this could be a result of dopamine overactivity (Abb-i-Dargham, 2007). Another chemical is serotonin. Serotonin is also a neurotransmitter. Several serotonin metabolites have been linked to the development of schizophrenia. However, the mechanisms involved have not been identified. Serotonin is also known to be involved in the development of depression. People who are depressed have low serotonin levels. The connection between schizophrenia, depression and serotonin is still under investigation. However, it is important to mention that serotonin malfunction plays a significant role in the development of both depression and schizophrenia (Abb-i-Dargham, 2007). Other chemicals that are believed to be involved in the development of schizophrenia include GABA, glutamate, essential fatty acids, adenosine, neuropeptides and reproductive hormones (Abb-i-Dargham, 2007). The neurochemical basis of schizophrenia and psychosis, in general, remains unclear and poorly understood.
Genetics and environmental factors
Schizophrenia is widely viewed as a neurodevelopment disease, resulting from a combination of environmental challenges acting on susceptible genotypes (Abb-i-Dargham, 2007). A good number of studies have identified several environmental and genetic risk factors. However, little progress has been made in understanding how these factors lead to the development of schizophrenia. Experimental studies have shown that during development, the cholinergic system is particularly sensitive to environmental risk factors. These environmental insults include tobacco smoke, ethanol, lead and organophosphates (Abb-i-Dargham, 2007). These risk factors and other environmental insults have the potential to interact with genetic vulnerabilities. This affects brain development thus produces deficits that may contribute to various subtypes of schizophrenia.
Drug Abuse causing paranoid schizophrenia
The use of marijuana has been associated with the risk of developing schizophrenia. According to Taylor (2006), the classic study was conducted in 1970 which involved Swedish conscripts aged 18-20 provided significant results. 97 percent of the surveyed group admitted that they had used marijuana before. Cases of schizophrenia were then investigated in the surveyed group. The researchers found out that increased use of marijuana enhances the chances of developing schizophrenia (Taylor, 2006). They noted that the risk of developing the disease depended on the magnitude of marijuana use. However, the mechanism through which marijuana leads to the development of schizophrenia has not been fully documented.
Research has not been able to explain how cocaine use leads to the development of schizophrenia. However, studies have shown that cocaine use has been found to be high in patients with schizophrenia (Taylor, 2006). Studies have shown that schizophrenia patients take cocaine as a medication. They believe that cocaine has a curative effect (Taylor, 2006).
Amphetamine is a derivative of dopamine and it is linked to the dopamine theory of schizophrenia. However, studies have indicated that amphetamine psychosis does not completely resemble the symptoms of schizophrenia. Amphetamine psychosis however is known to resemble some of the so-called ‘first rank’ symptoms of schizophrenia, and indeed individuals suffering from amphetamine psychosis have been misdiagnosed with schizophrenia (Taylor, 2006).
The treatment of this condition depends on the medical and psychosocial interventions employed. However, psychiatric medication is the primary course of treatment. Other models that endeavor to emphasize hope, social inclusion and, empowerments are also considered (Taylor, 2006). Most of the treatment regimes aim at alleviating the symptoms and improving function. There is no particular treatment that guarantees a complete cure of the disorder.
Nutrient, dietary and vitamin therapy
Schizophrenia has been associated with malfunctions of various neurotransmitters like GABA, glutamate and serotonin. These neurotransmitters are derivatives of amino acids. Dietary therapy aims at replenishing most of these amino acids. On top of that, vitamins provide essential micronutrients that assist in the proper functioning of the nervous system and the brain (Taylor, 2006). Thus, dietary therapy is very essential in patients with schizophrenia. Dietary therapy supplements social and therapeutic therapy.
Social firms and Schizophrenia
Social firms play a significant role in assisting patients with schizophrenia. The general public has negative perceptions with regard to patients with schizophrenia. This discrimination puts immense psychological pressure on the patients. However, social firms have played a great role in sensitizing the general public about this disorder. Research has shown that many people have negative perceptions with regard to patients with schizophrenia because such individuals lack proper information on the disease (Burke, 1986). Thus, when the general public is educated on the causes and management of schizophrenia, the psychological pressure exerted on the patients will significantly reduce (Burke, 1986).
Shock therapy implies low temperature and low blood pressure (Burke, 1986). This can occur during exposure to harsh weather conditions, particularly when the body is both wet and cold, or surgically as a result of blood loss. Constance Pascal, a psychiatrist, introduced this technique in 1926 (Burke, 1986). In her book titled ‘shock treatment’, she deplored the previous therapeutic nihilism of psychiatry. Pascal argued that mental disorders stem from mental anaphylactic reactions (Burke, 1986). To overcome it, one needs to shock the brain and the autonomic nervous system back into equilibrium (Burke, 1986). According to Pascal, this shock should be able to prevent, suspend or cure mental these mental anaphylactic reactions (Burke, 1986). The body can be shocked by various substances like colloidal gold, milk, vaccine or any fever therapy (Sorter, & Healey, 2007).
At the University of Budapest psychiatry clinic, somatotherapies for schizophrenia had been underway since World War I. In 1927, a researcher at the clinic conducted several experiments on the therapy by administering insulin to patients. The researcher later published a report suggesting that psychosis can be treated by combining shock and insulin (Sorter & Healey, 2007). By the late 1920s, researchers came across the general idea of deliberately putting psychiatric patients into hypoglycemic insulin commas.
There are so many uncertainties that surround the causes, classification and treatment of schizophrenia. A lot of studies are required to unravel the uncertainties surrounding this disorder. Many aspects of the disorder require intensive research, especially the cause of schizophrenia. Many theories which aim at explaining the chemical malfunctions which lead to the development of schizophrenia are not exhaustive. They leave many questions unanswered.
This paper has noted that schizophrenia is characterized by a lot of uncertainties regarding its origin, cause symptoms, diagnosis and treatment. The term Schizophrenia was proposed by a Swiss psychiatrist called Eugene Bleuler in 1907. Eugene aimed at describing the separation of function between personality, perception thinking and memory (Berrios & Luque, 2003). The earliest case of schizophrenia was discovered in 1797 owing to the symptoms that were presented by James Tilly (Berrios & Luque, 2003). Schizophrenia is derived from two Greek words that simply mean ‘splitting of the mind’ (Berrios & Luque, 2003). After a comprehensive analysis of the patients’ symptoms, Bleuler stated that schizophrenia is not dementia because some did not deteriorate but they improved. Bleuler coined the four main symptoms as 4’As. The 4 A’s include Ambivalence, Autism, Association of Ideas and flattened Affect (Berrios & Luque, 2003).
Schizophrenia may occur in various forms. Paranoid schizophrenia refers to fear as a result of the perceptions of an individual with schizophrenia (Boyle, 2002). Individuals with catatonic schizophrenia have psychomotor disturbance (Boyle, 2002). On the other hand, those with undifferentiated schizophrenia have prominent psychotic symptoms that are not linked to the other subtypes (Boyle, 2002). Those with residual schizophrenia normally encounter psychotic episodes but quickly recover. Moreover, disorganized schizophrenia is characterized by disorganized and incoherent thought and speech (Boyle, 2002). Currently, different scholars have various definitions. However, most of the definitions agree on one thing; schizophrenia is a complex clinical syndrome that involves disruptive psychotic experience as well as other core elements of psychopathology (Frith & Johnstone, 2003). The treatment of this condition depends on the medical and psychosocial interventions employed. However, psychiatric medication is the primary course of treatment.
Abb-i-Dargham, A. (2007). Integrating the Neurobiology of Schizophrenia. New York: Academic Press.
Berrios,G., and Luque, R. (2003). “Schizophrenia: a conceptual history”. International Journal of Psychology and Psychological Therapy,3,111-140.
Boyle, M. (2002). Schizophrenia; A Scientific Delusion? London: Routledge.
Burke, R. (1986). Lack of Discretion of Judgment Because of Schizophrenia: Doctrine and Recent Rotal Jurisprudence. Rome: Gregorian&Biblical BookShop.
Frith, C., and Johnstone, E. (2003). Schizophreania: A very Short Introducation. New York: Oxford University Press.
Shore, D., and Keith, S. (1996). Schizophrenia, 1993. Darby: Diane Publishing.
Snyrder, K., Gur, R., and Andrews, L. (2007). Me, Myself, and Them: A Firsthand Account of One Young Person’s Experience With Schizophrenia. Oxiford: Oxiford University Press.
Sorter, E., and Healey, D. (2007). Rutgers University Press: A History of Electroconvulsive Treatment in Mental Illness. New Jersey: Rutgers University Press.
Taylor, D. (2006). Schizophrenia in Focus. London: Pharmaceotical Press.
Tsuang, M., Faraone, S., and Gatt, S. (2011). Schizophrenia. New York: Oxiford University Press.