Schizophrenia is a chronic condition that affects the brain. The condition manifests through both negative and positive symptoms. Some of the symptoms include disorganized speech, decreased expression of emotions, peculiar behavior, loss of touch with reality, disorganized thinking, and social withdrawal (Psyweb, 2008). The symptoms of schizophrenia fall into three major categories. These are negative symptoms, positive symptoms, and cognitive symptoms. Positive symptoms are usually the easiest to identify, and they include thought disorders, hallucinations, delusions, speech disorders, and movement disorders. Hallucinations common in schizophrenia are auditory hallucinations where the patient hears voices ordering him/her to do something or talking about him/her. Other hallucinations also occur, such as tactile hallucinations where the patient may feel invisible fingers touching them. Delusions are false beliefs that the patient has which are illogical and out of line with the patient’s culture. They include delusions of grandeur in which the patient believes they are a person of great importance or delusions of persecution where the patient is convinced that people are out to get them by making deliberate attempts to harm them. Negative symptoms include anhedonia, a flat affect, decreased ability to start and continue with activities (abulia), and decreased desire to interact with others (NIMH, 2007). Cognitive symptoms are usually detected following neuropsychological tests and include difficulty in maintaining attention, difficulty with working memory, and poor executive functioning (for example making poor judgments, lack of insight).
There are different types of schizophrenia, and these are classified depending on the predominant symptoms. They are paranoid schizophrenia, disorganized schizophrenia or hebephrenic schizophrenia, residual schizophrenia, and undifferentiated type (Mueser and Mcburk, 2004 pp2063-2072|). In paranoid schizophrenia, the individual has delusions of persecution, and they are constantly talking about other people being jealous of them or wanting to punish them. This may include both relatives and friends. Other symptoms may not be exhibited much. The patient with disorganized schizophrenia usually has cluttered speech, inappropriate responses (for example laughing when asked a question) and difficulty in maintaining their own hygiene; they may not shower and usually eat with a lot of difficulties. Catatonic schizophrenia is characterized by a nonresponsive and immobile physical position. The patient usually assumes a very awkward and uncomfortable position and stays that way for hours on end. Residual schizophrenia is characterized by the presence of all symptoms, but the degree of severity of the symptoms is low compared to the time of diagnosis. The undifferentiated type occurs when the patient displays many of the symptoms of the other types of schizophrenia, making it difficult to classify the schizophrenia (Muser and Mcburk, 2004 pp 2063-2072).
Schizophrenia affects people all around the world, and in America, its prevalence is estimated at about 1 percent of the population (NMIH, 2007). The disorder manifests in males during the period of late teens and early twenties, while in females, it begins to emerge at the mid-twenties and early thirties. The condition has familial tendencies. Brain biochemistry exists as proof of schizophrenia, with research showing that an imbalance in the neurotransmitters dopamine and glutamate have a role in the etiology of the condition. Further, the brains of schizophrenics have several differences from those of normal individuals. Often the ventricles (fluid-filled cavities within the brain) of schizophrenics are larger than those of healthy people. Schizophrenics also have a reduced volume of gray matter in some areas of the brain and some areas of decreased metabolism in the brain compared to normal individuals (Mueser and Mcburk, 2004 pp2069-2070).
Heredity is a risk factor for the development of schizophrenia, as evidenced by research from twin studies. Research shows that schizophrenia has an occurrence rate of about 10% in people with first-degree relatives who had the disorder compared to a 1% incidence rate in the general population (Cardno and Gottesman, 2000, pp 12). Monozygotic twins have higher concordance rates of schizophrenia (up to 3 times more) than dizygotic twins. The twins, even when discordant for schizophrenia, have a greater likelihood for the development of schizophrenia than the general population. Even when identical twins are separated and brought up in different environments, the risk for developing schizophrenia remains the same as those brought up in the same environment.
Schizophrenia has various treatment modalities, with antipsychotic medication being the most commonly used treatment method. Often, various methods are used so that they can complement each other. Drugs are mainly used for the reduction of positive symptoms, but this is as far as they go as they do not cure the condition. The major setback with the use of drugs is the occurrence of side effects which make it necessary for the patient to experiment with various drugs until they find one that suits them with minimal side effects. The medications, especially the older ones, such as haloperidol. Chlorpromazine and fluphenazine, among others, have extrapyramidal side effects, which include restlessness, rigidity, muscle spasms, and tremors. The new drugs such as clozapine that do not have extrapyramidal side effects have the problem of agranulocytosis, which impairs the patient’s immune system. Others that do not have extrapyramidal side effects or cause agranulocytoses like risperidone, sertindole, and olanzapine cause an increase in weight and changes in metabolism that predispose to high cholesterol levels and diabetes (Lieberman et al., 2005). The use of drugs is, therefore, a bit like trial and error to find the most suitable drug. It also requires compliance to a long duration of treatment. However, once a suitable drug is found, the schizophrenic has fewer episodes of relapse and decreased the severity of symptoms.
Talking treatment for schizophrenia has also been found to eliminate symptoms of psychosis, especially where the patient’s condition has been stabilized by the use of drugs. Psychosocial treatments help the patient to develop coping mechanisms leading to better adherence to medication and fewer incidences of relapse (NIMH, 2007). Cognitive Behavior Therapy is a talking treatment that helps the patient to test how real their perceptions and thoughts are. The patient is also taught how to ignore the voices in their heads and shake off apathy. In self-help groups, even without a therapist, networking provides social action and support, and comfort that helps the patients to manage their conditions better.
The existence of schizophrenia as a mental disorder cannot be denied due to the prevalence of the disorder not only in America but also across cultures all around the world. Its diagnosis goes back as far as the seventeenth century when Kurt Schneider made a list of symptoms that made schizophrenia a distinct disorder from other psychotic symptoms (Bertelsen, 2002 pp89). Research from then on has led to a DSMIV Diagnostic Criteria for schizophrenia as well as possible explanations for the etiology of schizophrenia. Biological treatments and talking treatments all have a role to play in the management of schizophrenia. No one method can be said to be 100% effective all the time. The importance and effectiveness of bio treatments cannot be overemphasized as they have been in use since the 1950s to stabilize patients. Talking treatments also ought not to be ignored as they are important for the patient’s understanding of their condition as well as maintenance of compliance to drugs. As such, no one treatment method would be effective independently, and the patient with schizophrenia benefits the most from a combination of biotreatment and talking treatment.
Bertelsen A, 2002, Schizophrenia & Related Disorders: Experience with Current Diagnostic System, Psychopathology vol 35 pp 89-93.
Gottesman II and Cardno GA, 2000 Twin studies of schizophrenia: from bow-and-arrow concordances to star wars Management and functional genomics American Journal of Medical Genetics, 97(1):pp 12-17.
Lieberman JA, Perkins DO, McEvoy JP et al, 2005, Clinical Antipsychotic Trials of Intervention Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal Med, 22;353(12), pp 1209-23.
Mueser KT and McGurk SR, 2004, Schizophrenia, Lancet 19;363(9426) pp 2063-72.
Twin studies. Web.
National Institute of Mental Health, NMIH, Schizophrenia. Web.
Regier DA, Rae DS, Manderscheid RW, Locke BZ, Narrow WE, Goodwin FK, 1993, The de facto US mental and addictive disorders service system, Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services, Arch Gen Psychiatry, 50(2) pp85-94.
Schizophrenia, Psyweb. Web.