Schizophrenia

What is schizophrenia? Are there different causes of schizophrenia? What are the symptoms of schizophrenia? Are there different treatment options available for schizophrenia? According to the World Health Organisation (2022), schizophrenia affects approximately 24 million people worldwide. It affects patients' thoughts, emotions, language use and comprehension, and they lose their sense of self and reality. It may also affect their friends and family members. It usually impacts people between the ages of 15 and 45 and more men than women.

• First, we will discuss the meaning of schizophrenia and defining schizophrenia.
• Then, we will cover how schizophrenia is diagnosed, highlighting schizophrenia symptoms.
• We will go over what we mean by the reliability and validity in diagnosing and classifying schizophrenia.
• Following on, we will analyse the biological and psychological explanations of schizophrenia, discussing the schizophrenia causes.
• Finally, we cover the treatment and therapies available for schizophrenia.

Schizophrenia Meaning

Schizophrenia is a mental health disorder affecting how a person thinks and perceives the world. We can define schizophrenia as:

How is Schizophrenia Diagnosed?

Clinicians, psychologists, or psychiatrists diagnose schizophrenia using the ICD (International Classification of Diseases) or the DSM (Diagnostic and Statistical Manual of Mental Disorders).

Most of the world uses ICD, especially in Europe, whilst the DSM is used in America. The ICD often collaborates with the DSM, as both establish a similar classification system for schizophrenia and its requirements for diagnosis, although they do differ.

The ICD requires the patient to have:

• At least two or more of the following:

  • Incoherent speech, catatonic behaviours, abolition, delusional perceptions and hallucinations, i.e., hearing voices, disorganised thoughts, and feelings of being influenced not generated by oneself.

• Symptoms last for at least one month consistently.

The DSM requires a patient to have:

• At least two symptoms, such as:

  • Delusions, hallucinations, and disorganised speech – are prioritised in the diagnosis, and the following symptoms are also considered (although one of the first three must be present), disorganised behaviour and catatonic behaviour.

• Symptoms last for at least one month consistently.

Both diagnostic tools require that the symptoms not result from substance use or misuse (e.g., if a patient had taken drugs with hallucinogenic effects).

What are the Symptoms of Schizophrenia?

Symptoms of psychosis are characteristics of schizophrenia:

• Positive symptoms (adding an experience):

  • Hallucinations (sensory experiences, usually auditory and or visual).

  • Delusions (e.g., delusions of grandeur and paranoia).

  • Disorganised speech (incoherent or digressive).

  • Psychomotor disturbances (rocking back and forth or staying completely still, known as catatonia).

• Negative symptoms (taking away an experience):

  • Avolition (a state of apathy).

  • Alogia (speech poverty).

  • Affective flattening (lack of facial expressions).

  • Anhedonia (unable to fully feel positive emotions, feeling little or nothing).

However, using these tools can cause problems with stigma (most people still negatively perceive schizophrenia) and lead to self-fulfilling prophecies (patients begin to show increased symptoms after diagnosis because they have been told about it).

Paranoid Schizophrenia

Paranoid schizophrenia was considered a subtype of schizophrenia according to the ICD-10. However, it was dropped from the DSM-5 and ICD-11 as it related too closely to the paranoid symptom of schizophrenia.

Paranoid schizophrenia was characterised by consistent, stable paranoid symptoms such as delusions and hallucinations of an auditory and perceptual nature.

Catatonic Schizophrenia

Catatonic schizophrenia, like paranoid schizophrenia, is also now considered an outdated subtype by both diagnostic manuals.

Catatonic schizophrenia was characterised by psychomotor disturbances, namely uncontrollable or lack of muscle movement. People with catatonic schizophrenia were said to remain still, for instance, for long periods or have extreme moments of excited movement.

What is Reliability and Validity in the Diagnosis and Classification of Schizophrenia?

When you use a diagnostic tool or classification system, it must be reliable and valid.

Factors that affect the reliability and validity of schizophrenia diagnosis are:

• Co-morbidity — when two or more disorders co-exist within one individual, e.g., depression and anxiety.

• Cultural and social bias.
• Symptom overlap (not to be confused with co-morbidity) — the considerable overlap between symptoms of schizophrenia and other disorders. For example, schizophrenia and bipolar disorder both have symptoms of delusions. The issue here is that the same patient may receive different diagnoses.
• Gender bias.

Schizophrenia Causes

There are different explanations for schizophrenia that psychologists and researchers have explored. Each theory can typically fall into two categories; a biological explanation for schizophrenia or a psychological explanation for schizophrenia. Some explanations delve into both sides of the argument. Let's explore biological and psychological explanations.

Biological Explanations for Schizophrenia

There are three primary biological explanations for schizophrenia: genetics, the dopamine hypothesis, and neural correlates. Biological reasons for disorders stem from the biological approach to psychology, which holds that our thoughts and behaviours are due to certain aspects of our biology.

Genetics

Genes are small pieces of DNA that instruct our cells on doing their jobs. Some genetic differences have been are known to cause disorders:

One biological explanation for schizophrenia is that certain genetic differences predispose to the development of schizophrenia, as in cystic fibrosis. Twin studies and adoption studies often are used to investigate genetic explanations.

The Dopamine Hypothesis

The dopamine hypothesis was developed in the 1960s and 1970s following research into the effects of amphetamines on the brain. These drugs caused psychotic symptoms, such as hallucinations, usually associated with schizophrenia.

Neural Correlates

Neural correlates are instances where brain structure differences correlate with specific psychological disorders or symptoms. You may have come across the word 'correlate' in your research methods lessons, which means to have a mutual relationship.

Psychological Explanations for Schizophrenia

Psychological explanations for schizophrenia trace the origin and development of schizophrenia to psychological causes. Patients' thoughts, emotions, and external experiences are the primary focus and their relationships with peers and family members.

There are two main types:

1. Family dysfunctions involve the schizophrenogenic mother, the double-bind theory (contradictory messages given to a child), and expressed emotions (EE, hostile environments within a household).

2. Cognitive explanations involve dysfunctional thought processing and attention deficit theory. Patients poorly manage their thoughts and cannot spot errors in cognitive processing (cannot filter preconscious or automatic thoughts correctly). It includes issues with meta-representation (missing parts of a thought process, so patients cannot adequately reflect on their thoughts and behaviours) and central control (inability to suppress automatic thoughts and resist the urge to act on them).

Treatments and Therapies for Schizophrenia

Schizophrenia is a complex disorder with multiple treatment options. Research into both suggests various advantages and disadvantages of each.

1. Biological therapies, or drug treatments, are known as antipsychotics. There are two types, typical and atypical antipsychotics. Both forms of drug treatments have side effects.

   1. Typical antipsychotics: The first generation of antipsychotics only address positive symptoms and are known as dopamine antagonists because they only affect dopamine levels.

   2. Atypical antipsychotics: The second generation acts on positive and negative symptoms and affects dopamine, serotonin, acetylcholine, and glutamate neurotransmitters.

2. Psychological therapies aim to change patients' negative thought processes about their personal and social lives.

   1. Cognitive Behavioural Therapy (CBT).

   2. Family therapy.

   3. Token Economy (management of the disorder).

3. The interactionist approach combines biological and psychological therapies to treat schizophrenia.

   1. The Diathesis-stress Model assumes an internal vulnerability (a diathesis) and an external, environmental factor (stressor) exist in an illness.

Schizophrenia - Key takeaways

• Schizophrenia is a mental health disorder involving issues like psychosis, with positive and negative symptoms. It is diagnosed using the ICD and the DSM. Both have to be reliable and valid for effective diagnosis and treatments.
• There are three main biological explanations for schizophrenia: genetics, the dopamine hypothesis, and neural correlates.
• Psychological explanations for schizophrenia describe the origins of schizophrenia, which develop from family dysfunctions and cognitive explanations.
• Treatments include biological therapies with antipsychotic medications (typical and atypical), psychological therapies with CBT, family therapy, token economies, and a combination of both, known as the interactionist approach.
• The best-known interactionist approach is the diathesis-stress model.