Schitzophrenia

Exploring Schizophrenia Schizophrenia is a serious brain disorder. It is a disease that makes it difficult for a person to tell the difference between real and unreal experience, to think logically, to have normal emotional responses to others, and to behave normally in social situations. (Landau, 2004) Approximately one percent of the population develops schizophrenia during their lifetime, and more than two million Americans suffer from the illness in a given year. (Lundy, 1990).
Schizophrenia is not unique to the United States. It occurs in countries world-wide, effecting patients of all race, religions, and income levels (Landau, 2004). The Phenomenology of patients is similar. However, the prognosis is variable both internationally and within national groups of patients (Lundy, 1990). Men in the 45-to-49 age group who fathered children where twice as likely to have offspring with schizophrenia as compared to fathers age 25 and under. Men in the 50-plus age range were three times more likely to produce offspring with schizophrenia. Making more than one-quarter of the schizophrenia cases were due to the father. The mother’s age appeared to play no role in the development of schizophrenia. (Kern, 2010). Two main types of symptoms occur for schizophrenia positive and negative symptoms. Positive symptoms reflect an excess or distortion of normal functioning. This includes delusions, hallucinations, and severely disorganized absence or reduction of normal functions, such as greatly reduced motivation, emotional expressiveness, or speech. Schizophrenic delusions are not simply unconventional or inaccurate beliefs. Rather, they are bizarre and far-fetched notions. Hallucinations often are tied to the person’s delusional beliefs. For example, if a woman harbors delusions of grandeur, hallucinated voices may reinforce her grandiose ideas by communicating instructions from God, the devil, or angels. According to DSM-IV-TR, schizophrenia is diagnosed when two or more of these characteristic symptoms are actively present for a month or longer. (Hockenbury, D., & Hockenbury, S. 2011 p.563-564). Negative Symptoms on the other hand are completely different. Negative symptoms include flat affect, alogia, and avolition. Flat affection is when a person responds in an emotionally, “flat” way, showing a dramatic reduction in emotional responsiveness and facial expressions. Alogia, greatly reduces production of speech, while verbal responses are limited to brief, empty comments. Avolition, refers to the inability to initiate or persist in even the simplest day-to-day tasks. For example, dressing, bathing, or even engaging in social activities. (Hockenbury, D., & Hockenbury, S, 2011). Researchers have identified four primary types of schizophrenia, these consist of: Paranoid, Catatonic, Disorganized, or Undifferentiated type. Paranoid type, which is the most common from all of the types, (Lundy, 1990) includes behaviors of having well organized delusional beliefs reflecting persecutory or grandiose ideas, often frequent hallucinations, usually voices, and finally little or no disorganized behavior, speech, or flat affect. (Hockenbury, D., & Hockenbury, S. 2011). Catatonic type includes highly disturbed movements or actions, such as extreme excitement, bizarre postures or grimaces, or being completely immobile. Also hearing voices, but instead of hallucinated voices, it will be encountering echoes of words spoken by others, or imitation of movement of others (Hockenbury, D., & Hockenbury, S. 2011). Disorganized type normally deals with flat affect or inappropriate emotional expressions, severely disorganized speech and behavior, and fragmented delusional ideas and hallucinations. This type manly focuses on the negative symptoms rather than the positive. The undifferentiated type shows a display of characteristic symptoms of schizophrenia but not in a way that fits the pattern for paranoid, catatonic, or disorganized types (Hockenbury, D., & Hockenbury, S. 2011). Signs of mental illness may be obvious even to the untrained observer, or they may be subtle, nothing more than a few peculiarities of behavior. There is no secret formula for diagnosis. The therapist simply observes the patient’s behavior closely and knows the right kinds of questions to ask in order to draw forth the patient’s unique patterns of thought. It is not enough simply to classify a patient as “psychotic,” “depressed,” “anxious,” or the like. The clinician strives to define more precisely the underlying pathology. The task is frequently difficult. For example, a large dose of cocaine or amphetamines can produce symptoms of psychosis identical to those of paranoid schizophrenia. (Lundy, 1990 ) A thorough medical examination should also include a medical history and physical exam. The date of the first occurrence of symptoms is important in the diagnosis of many mental illnesses, not just schizophrenia. (Rasmussen, 2011). Researchers have found that about half of the people with schizophrenia show some type of brain structure abnormality. The most consistent finding has been the enlargement of the fluid-filled cavities, called ventricles, located deep within the brain. (Hockenbury, D., & Hockenbury, S. 2011). According to the dopamine hypothesis, schizophrenia is related to excessive activity of the neurotransmitter dopamine in the brain. (Rasmussen, 2011). Two pieces of indirect evidence support this notion. First, antipsychotic drugs, such as Haldol, Thorazine, and Stelazine, reduce or block dopamine activity in the brain. These drugs reduce schizophrenic symptoms, especially positive symptoms, in many people. Second, drugs that enhance dopamine activity in the brain, such as amphetamines and cocaine produces symptoms in normal adults or increase symptoms in people who already have schizophrenia. (Riedel, M. I. 2010).
Studies of families, twins and adopted individuals have firmly established that genetic factors play a significant role in many cases of schizophrenia. When you have an identical twin with schizophrenia you have a 48 percent chance of developing the disorder. When both of your parents have schizophrenia you have a 46 percent chance of developing schizophrenia. (Hockenbury, D., & Hockenbury, S. 2011). Three particularly interesting results stand out. First, some of the same unique genetic patterns associated with schizophrenia were also found in DNA samples from people with bipolar disorder but were not associated with any other psychological or physical disorder. This finding suggests that bipolar disorder and schizophrenia might share some common genetic origins. Second, also implicated were several chromosome locations that are associated with genes that influence variants development, memory, and cognition. Finally, a large number of the gene variants were found to occur on a specific chromosome that is also known as harbor genes involved in the immune response. (Kern, R. H. 2010).
Lithium, the first effective drug for treating schizophrenia was known before its psychoactive properties were discovered. Phenothiazine was first synthesized in 1883, but it was not until 1934 that it was sold commercially. In 1950, a related drug called chlorpromazine was developed in France. (Lundy, 1990). Within two years researchers discovered that this drug calmed agitated psychotics and reduced aggressiveness and delusions. Many schizophrenics regained contact with reality, to the great joy of their families and to the relief of their physicians. Later, it was discovered that chlorpromazine had an additional ability: It could sometimes rouse withdrawn schizophrenics. This showed that the drug was not merely a sedative but actually affected the neurological causes of the disease. Over the years, many similar drugs have been developed and sold under such trade names as Thorazine, Compazine, and Mellaril. (Lundy, 1990).
Most of the neurons that use dopamine as a transmitter are buried deep within the brain. This group of neurons controls two main aspects of psychological functioning. The first is the regulation of psychological functioning. The first is the regulation of emotional behavior. Researchers now suspect that it is this function of the dopamine neurons that affects schizophrenic symptoms (Lundy, 1990).
The second function of the dopamine neurons is to control areas of the brain responsive for coordinated movements of the arms and legs. If phenothiazine blocks the action of the dopamine neurotransmitter, it naturally follows that they should affect coordination as will. The principal side effects of these drugs are trembling and a lack of muscular coordination. (Rasmussen, 2011). (Remember that a lack of dopamine neurotransmitters is the cause of Parkinson’s disease. (Hockenbury, D., & Hockenbury, S. 2011)) These effects are noticeable mainly during activities in which no conscious attention is paid to the muscles, such as walking or writing (Riedel, M. I. 2010).
A more serious side effect appears after years of phenothiazine treatment. Apparently, the dopamine neurons that control smooth movement begin to compensate for the blocked receptors by growing new receptors sites. This produces oversensitivity to stimulation in the facial muscles. A condition called tardive dyskinesia is the result; its symptoms include involuntary movements such as protruding the tongue, smacking and sucking the lips, frowning, grimacing, and grunting. Unfortunately, this condition, which can interfere with speaking, eating, and breathing is often permanent, even after drug treatment stops. (Lundy, A. 1990).

References
Hockenbury, D., & Hockenbury, S. (2011). Psychological Disorders, Schizophrenia. Discovering Psychology (fifth edition ed., pp. 563-572). Madison: Worth Publishers.
Landau, E. (2004). Schizophrenia. Canada: Scholastics Library Publishing.
Lundy, A. (1990). Psychological Disorders And Their Treatment: Diagnosing And Treating Mental Illness. Philadelphia: Chelsea House Publishers.
Kern, R. H. (2010). Declarative and nondeclaritive memory in schizophrenia: what is impaired? What is spared? . Journal Of Clinical & Experimental Neuropsychology, 32(9) , 1017-1027.
Rasmussen, H. (2011). Serotonin2A receptor blockade and clinical effect in first-episode schizophrenia patients treated with quetiapine. Psychopharmacology, 213(1/3), 583-592.
Riedel, M. I. (2010). Neurocognition and its influencing factors in the treatment of schizophrenia –effects of aripiprazole, olanzapine, quetiapine and risperidone. Human Psychopharmacology: Clinical& Experimental, 25(2), 116-125

References: Hockenbury, D., & Hockenbury, S. (2011). Psychological Disorders, Schizophrenia. Discovering Psychology (fifth edition ed., pp. 563-572). Madison: Worth Publishers. Landau, E. (2004). Schizophrenia. Canada: Scholastics Library Publishing. Lundy, A. (1990). Psychological Disorders And Their Treatment: Diagnosing And Treating Mental Illness. Philadelphia: Chelsea House Publishers. Kern, R. H. (2010). Declarative and nondeclaritive memory in schizophrenia: what is impaired? What is spared? . Journal Of Clinical & Experimental Neuropsychology, 32(9) , 1017-1027. Rasmussen, H. (2011). Serotonin2A receptor blockade and clinical effect in first-episode schizophrenia patients treated with quetiapine. Psychopharmacology, 213(1/3), 583-592. Riedel, M. I. (2010). Neurocognition and its influencing factors in the treatment of schizophrenia –effects of aripiprazole, olanzapine, quetiapine and risperidone. Human Psychopharmacology: Clinical& Experimental, 25(2), 116-125