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What is Schizophrenia?

Schizophrenia is another much misunderstood disorder which often leads people to believe that those who suffer from it have a ‘split personality’, which is not at all accurate. What definitely is accurate though, is the fact that it is a chronic and often debilitating disorder that has a wide range of symptoms.

It is thought to affect approximately 1 person in every 100 and so is much more common than people may believe. More men than women are affected by schizophrenia and its onset is more likely at an earlier age for men (aged 18) as opposed to women.

The symptoms of schizophrenia vary from person to person and they can become very severe and unpredictable. They are typically divided into two types – positive and negative. Positive symptoms are those which make normal functions appear distorted or excessive and negative symptoms reflect a loss of normal functions. The DSM-5 specifies that in order for a diagnosis of schizophrenia to be made, symptoms must have been present for at least six months, with active symptoms present for one month.

 

Positive symptoms

Negative symptoms

Delusions: These are strange beliefs that seem very real to the person with schizophrenia but they are not. Some sufferers mistakenly believe that inanimate objects such as their curtains or their toothbrush are capable of killing them. They might also believe that any message that comes from their TV or radio is meant just for them. Affective flattening: This term refers to a reduction in emotional expression so less facial expression, eye contact and general body language for example.
Experiences of control: The person may believe that they are under the control of someone or something else. They may think that an alien has overtaken them and that they have been implanted with transmitters. In this case, many also believe that they have been overtaken by the spirit of someone else, which then dictates their behaviour. Alogia: This is the clinical term for lessening of speech, where individuals’ speech fluency is lessened, possible due to impaired thought processes.
Hallucinations: These are often auditory, i.e. the person hears things that are not real. But they can also be visual or involve taste and smell. Hearing voices is one of the most common symptoms reported and, for sufferers, one of the most frightening as well. Avolition: This simply means that the individual appears to have lost interest in anything they previously enjoyed. It may involve them simply sitting in the house every day, doing nothing.
Disordered thinking: Here, individuals believe that thoughts have been inserted or deleted from their minds. Sometimes they also believe that their thoughts are being broadcast out loud for everyone else to hear.

 

The general onset of schizophrenia usually occurs after a traumatic incident. This will likely be followed by negative thoughts and a probable episode of psychosis. This can then develop into depression and social isolation, at which point, more symptoms of the disorder are likely to occur. This can increase anxiety, which confounds irrational thoughts and the whole cycle begins again.

Historically, schizophrenia has been very difficult to diagnose with methods of doing this lacking in both reliability and validity. Reliability means how far professionals can agree on the same diagnosis when assessing clients independent. Would the same person get the same diagnosis from two professionals? Validity means agreeing on what schizophrenia actually is, therefore reliability and validity are inextricably linked.

Rosenhan’s (1973) study highlighted the unreliability of diagnosis when he asked five associates who did not have schizophrenia to present themselves at hospitals claiming to have symptoms of the disorder. All said they were unfamiliar hearing voices in their heads (someone saying the words ‘hollow’, ‘empty’ and ‘thud’) and all were admitted into hospital with a diagnosis of schizophrenia despite them all being perfectly fine. None of the staff recognised that these associates were perfectly healthy throughout their stays, which were, on average 19 days long.

In a follow up study, Rosenhan told hospitals that he was going to send ‘pseudopatients’, who were claiming to have schizophrenic symptoms when in fact they did not. This resulted in hospitals claiming to have recognized 21% of these pseudopatients, when in fact, Rosenhan sent none.

Women suffering from negative symptoms of Schizophrenia

Explanations of schizophrenia

As we mentioned in a previous unit, a strong explanation for schizophrenia is the possibility that those who suffer from it have higher than normal levels of the neurotransmitter dopamine. Since dopamine plays a key role in guiding attention, it stands to reason that disturbances in its levels may cause problems with attention and perception, as seen in schizophrenic symptoms. Differences in brain anatomy have also been put forward as an explanation for schizophrenia with brain imaging techniques revealing that those with the condition have enlarged brain ventricles by as much as up to 15%. It is also argued that in this case, the poor brain development and tissue damage are what lead to schizophrenia.

Schizophrenia is another disorder where it is argued that genetics play a big part in its development. Gottesman, (1991) found that children with parents who both have schizophrenia, have a concordance rate of 46%. A concordance rate refers to the presence of a similar trait amongst people where one or more of them have that trait. The concordance rate for a child with one parent who has schizophrenia is 13% and a sibling 9%. For identical twins, where identical DNA is shared the concordance rate is 40% and for non-identical twins, it falls to just 7.4%.

What this evidence suggests is that, for people with schizophrenia, the closer their biological link to someone, the more likely the other person is to developing the disorder.

Another possible explanation for schizophrenia is life events. Research by Brown and Birley (1968) found that those people who had a schizophrenic episode reported twice as many stressful life events to those who were in the control group.

Finally, the labeling theory suggests that those people whose behaviour deviates from social norms are labelled as schizophrenic, even when they may not be. Once this labelled is applied to someone, it becomes very difficult to shift and can result in a self-fulfilling prophecy that promotes the development of other symptoms of schizophrenia.

Treatments for schizophrenia

Medication in the form of anti-psychotic drugs is commonly used to treat schizophrenia. These work by balancing out what may be chemical imbalances in the brain by elevating levels of neurotransmitters that are low and lowering ones that are too high. This kind of medication seems to work better for positive symptoms than negative ones, although some anti-psychotics that affect serotonin levels as well as dopamine give some improvement to negative symptoms as well. Improvement in serotonin levels can reduce anxiety and, as such, reduce the possibility of recurring psychotic episodes.

Psychoanalysis

Psychoanalysis is thought to help schizophrenia by bringing about any unconscious thoughts, beliefs and conflicts into the conscious mind that may be causing the sufferer to have symptoms of schizophrenia. For example, schizophrenia has been linked to childhood trauma and psychoanalysis is very effective at bringing about resolution to childhood issues, many of which are completely unknown to the sufferer who has repressed them into their unconscious mind so as they do not cause them emotional pain. Psychoanalysis is also effective in building a trusting relationship with the individual leading eventually to clients taking a more active part in their recovery and behaviour modification.

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