Schizophrenia: A Neuropsychological Disorder
Analysis of Schizophrenia
“Schizophrenia is one of the most devastating neurological conditions. While current medications can control most psychotic symptoms, their side effects can leave individuals so severely impaired that the disease ranks among the top ten causes of disability in developed countries. Part of the terror of schizophrenia is that the brain can't properly integrate sensory information, so the world is a disorientating series of unrelated bits of input, says Albright, the Conrad T. Prebys Chair in Vision Research, Salk Institute for Biological Studies” (2013, p. 1).
This disorder is also a psychotic syndrome which was first described during the early twentieth century by two psychiatrists, Kraepelin (Germany) and Bleuler (Switzerland). Kraepelin first called this disorder “dementia praecox.” He determined that the cause of this syndrome was due to deterioration of the brain. Bleuler is the psychiatrist who gave this syndrome the name, schizophrenia. Blueler concluded that schizophrenia was caused by a “transient physiological dysfunction in the brain” (Wilson, 2013a, p. 12.4).
Even today, the cause of this debilitating syndrome remains unknown. There are scholars who consider this syndrome to be a collection of several psychological illnesses. “According to the DSM-V, the criteria for a diagnosis of schizophrenia include a decline of functioning and any two of the following symptoms: delusions, hallucinations, disorganized speech or behavior, blunted mood or apathy. However, a person is diagnosed as schizophrenic only after all other organic causes of psychosis are ruled out” (Wilson, 2013b, p. 12.4). Childhood trauma and dissociation are both associated with schizophrenia (Pec & Lysaker, 2015). The focal point of this paper is to inform the public of past and present research. Also, discussed in this research paper: the role of the brain in the etiology of schizophrenia as a rationale for beneficial treatment options, the symptoms of this disorder, the effect schizophrenia has on one’s life, their family’s lives, and on society as a whole, the costs, the help that a person or family needs, and the demographic data of this debilitating disorder.
Type of disorder: Neuropsychological disorder. There is a tremendous amount of evidence showing that compromised neurological function and cognitive impairment is present in people who have a schizophrenic disorder. There is evidence of neuropsychological dysfunctions associated with schizophrenia (Reichenberg, 2010).
Diagnostic criteria: “Schizophrenia (DSM-IV-R). Two (or more) of the following, each present for a significant portion of time during a one-month period (or less if successfully treated): delusions, hallucinations, disorganized speech (e.g., frequent derailment or incoherence), grossly disorganized or catatonic behavior, negative symptoms, i.e., affective flattening, alogia, or avolition. Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person’s behavior or thoughts, or two or more voices conversing with each other” (Biological Psychiatry Institute, 2015, p. 1).
Approximately 1.1% of the U.S. populace will have schizophrenia. The age of onset comes on a little younger in males than females. Otherwise, schizophrenia does not discriminate. It hits people in all walks of life: males and females, rich and poor, rural or urban living, educated or not educated, in all countries, in all human races, and in all cultures. Except in the cases of brain trauma or brain injury, schizophrenia does not first appear before the age of 10 or after the age of 40. It normally strikes between the ages of 15 and 25. Males who develop this disorder usually do so between the ages of 16 years and 25 years. Females who develop schizophrenia usually do so between the ages of 18 years and 25 years of age. This neuropsychological disorder is noticed more often in females over the age of 30 years. Schizophrenia tends to cause more of a disturbance in young males who have this syndrome (Schizophrenia, 2010a).
Once someone has developed schizophrenia (being more than just one episode), there is no cure, but there is ongoing treatment available for the treatment of symptoms (both positive and negative symptoms). Once schizophrenia has developed, the symptoms can and do dissipate at times, but they always come back. Suicide attempts among people with schizophrenia are about 50 times that of the general population without schizophrenia. It is a very costly disorder to the person with the syndrome, the family, and to society. The best outcome for the patient is early intervention, begin early with the latest medications, and therapy. Then, the patient should follow through with staying on their medication to prevent symptoms from returning or becoming worse (Schizophrenia, 2010b).
With schizophrenia, people may have full blown episodes of psychotic behavior with full remission before the next flow blown episode. Other people with this disorder display symptoms that are continuous, but rise and fall in severity, while other people with schizophrenia may have just a little variation in their symptoms over time. Violence is not a symptom of schizophrenia. People with this disorder are more likely to cause themselves harm than being violent to others. If a sibling has this disorder, it is approximately 7% to 9% that another sibling will develop the disorder. If a person has one parent who has the disorder, there is approximately 10% to 15% likelihood that the child will develop schizophrenia during his or her lifetime. The percentage increases if there are more than one family member with this syndrome.
“Schizophrenia occurs in all societies regardless of class, color, religion, culture – however, there are some variations regarding incidence and outcomes for different groups of people (Source: Dr. Robin Murray)” (Schizophrenia, 2010c, p. 1). Schizophrenia is a neuropsychological disorder. Symptoms of this syndrome are considered to be a disorder here in the U.S. and other developed countries. The symptoms that are displayed at times with schizophrenia are not seen as a disorder or out of the norm in some of the undeveloped countries. In some undeveloped countries, the people who display the positive symptoms of schizophrenia may be seen as gifted, or spirited, or as having healing abilities, or as having the ability to predict the future, or called witch doctors. Many people look to these people for advice or help in many undeveloped countries.
Theories of Etiology (Genetic, Environmental, Familial, Lifestyle)
There are genes that are present in some people that predispose them to schizophrenia (Avissar & Schreiber, 2002; Knight et. al. 2009; Lichtenstein et. al. 2009; Sims et. al. 2009). This does not mean that everyone with this genetic predisposition will develop schizophrenia, but that those with this genetic predisposition have a higher likelihood than other people to develop this disorder. Genetics and environment are causal factors for developing schizophrenia. “The powerful genome-wide association studies (GWAS) revealed common mutations that increase susceptibility to schizophrenia. The involvement of multiple genes, their varied levels of penetrance and expression (epigenetics), their interaction with one another (epistasis), the influence of environment, and the highly heterogeneous clinical presentations, make the elucidation of a clear-cut genetic architecture for SZ and BD particularly challenging (Petronis et al., 2000; Arseneault et al., 2004; Bebbington et al., 2004; Moore et al., 2007; Must et al., 2011; Kirkbride et al., 2012; Pelayo-Teran et al., 2012)” (Gurung & Prata, 2015, p. 1).
Genetic predisposition along with adverse environmental effects or stressors work together in triggering schizophrenia. Some people can have this genetic predisposition and never have schizophrenia. This is a case of schizophrenia being caused by genetics, environment, familial, and/or lifestyle. Familial and/or lifestyle stress can be a factor for many people who develop this disorder, but they would also have the genetic predisposition. Researchers have been successful in identifying several of the genes, that when those genes become damaged, can create an increased risk of developing schizophrenia (Schizophrenia, 2010d).
Diagnostic and Research Technologies Employed
CT and MRI scans have proven to be very beneficial for studying this disorder. These scans have found that the third and lateral ventricles were enlarged in the brains of people who have schizophrenia (Wilson, 2013c). MRI scans have been employed for clinical diagnosis and basic science research. Genotyping has been conducted for basic science research (Kido, Nakamura, Takahashi, Aleksic, Furuichi, Nakamura, Ikeda, Noguchi, Kaibuchi, Iwata, Ozaki & Suzuki, 2014).
PET scans are also employed for science research. In one research study, researchers monitored glucose in the brains of 18 participants with schizophrenia and 12 participants who did not have the syndrome (Wilson, 2013). Findings showed that activity in the frontal lobes of participants with schizophrenia was decreased and that activity in the frontal lobes of normal participants was increased, while the activity in the subcortical areas of participants with schizophrenia was increased and the activity in the subcortical areas of participants without the disorder was decreased.(Wilson, 2013d).
Through research, dopamine (an inhibitory neurotransmitter) has been found to be linked to schizophrenia. A hypothesis stated that there are abnormalities in dopamine levels present in the prefrontal and mesolimbic regions of the brain in people who have this disorder. “Recent research has indicated that glutamate, GABA, acetylcholine, and serotonin alterations are also involved in the pathology of schizophrenia” (journal.frontiersin.org, 2014, p. 1).
Schizophrenia is a multifactorial syndrome with solid hereditary commitments alongside noticeable quality × environmental associations. Schizophrenia shows as an illness with inconspicuous auxiliary and useful variations from the norm of different mind structures, for example, the hippocampus, prefrontal cortex, and the striatum. At the atomic level, numerous neurotransmitter frameworks seem, by all accounts, to be anomalous. Dopamine is customarily connected with schizophrenia, attributable to the penchant of dopamine D2 receptor enemies to reduce and dopamine-discharging medications to fuel positive side effects of schizophrenia. The dopamine speculation of schizophrenia proposes that subcortical dopamine over activity is a typical element brought on by different contributing components from qualities and environment and by dysfunctions of numerous cerebrum circuits. Additionally, the cortical dopamine neurotransmission is recommended to be broken. Dopamine variations from the norm are firmly intertwined with glutamate and GABA deficiencies that are guessed to assume a part in schizophrenia (Hirvonen, J., & Hietala, 2011).
The British Association of Psychopharmacology’s 2011 guidelines suggested that there should first be a trial with second-generation antipsychotic (SGA), along with therapy for the treatment of primary depression. SGAs had been recommended because they have shown to be more robust in the treatment of associated, key symptoms of depression. SGAs have been found to usually be more robust adversaries of 5-HT2 receptors than dopamine receptors. Reports have indicated some achievement with SGAs in comparison with that of the first-generation antipsychotics. Also, it was found that a big percentage of people with this disorder never achieve a good outcome from the use of SGA therapy. Still, there is a crucial need for the management of the negative symptoms. More than twenty years of research studies have gone into this glutamatergic suggestion in trying to come up with a successful anecdote for the treatment of the negative symptoms. Despite setbacks, the treatment that looks promising is in the drug class called glycine reuptake inhibitors (Thomas, Baker, Dursun, Todd, Dhami, Chue, & Chue, 2014). Dopamine antagonists (neuroleptics) are the most commonly used prescription drugs today for treating schizophrenia (Davis, Kahn, Ko, & Davidson; 1991; Seeman, 2010). Neuroleptics work by increasing levels of serotonin and by blocking out dopamine in the regions of the brain (Wilson, 2013e).
One-on-one psychotherapy talk sessions with a mental health therapist who is trained in the field of schizophrenia help tremendously in learning to cope and for learning the best ways to handle day-to-day life situations and also the symptoms of the illness. It is also important for a person who has this disorder to see his or her psychiatrist regularly to evaluate how the person is doing on the prescription medications if there needs to be a dosage adjustment or a change in medication. This is because these are very serious medications that require monitoring. Also, it is beneficial to ensure that the person keeps on his medication in the correct manner. Vocational and job rehabilitation is beneficial in getting the person to be as self-sufficient and productive as possible. There are volunteer opportunities at many non-profit organizations which can provide them with the opportunity to be productive, help others, socialize, be around others, and feel better (WebMD, 2015a).
Cognitive remediation is also beneficial and can be done with paper and pencil or on a computer. It is important to keep the brain functioning through cognitive methods. Educating the family is also extremely beneficial. This is a disorder that is extremely difficult for others to understand why it is happening and why the person cannot control the symptoms on their own. This is so true. Young people, especially, do not understand why it is happening. Some children may even take it personally. For these reasons and more, the family should be educated on the illness and best ways to help the loved one who has the disorder. People with the disorder and the family benefits by knowing what exactly is going on with their loved one and the loved one needs a family that is understanding, loving, and there for them. The person who has schizophrenia is at a tremendous disadvantage; and the ones without family support normally do not fare as well or may meet with problems like homelessness, vandalism, violence to them, or even death. Self-help groups, such as outreach programs and community care programs, are beneficial in helping to avoid relapse, non-compliance, legal matters, housing matters, and in avoiding repeated trips back to the hospital (WebMD, 2015b).
Future Direction of Research in Schizophrenia
The future direction in neuropsychology echoes the universal inclination toward an active method that embodies the workings of brain-behavior communications. In psychiatry, this idea has become dominant since many psychiatric disorders present themselves with understated subtlety (structurally) and vigorous working mind variations. Luria’s method, initially presented in neurology, made a significant impact to the diagnostics of rational indications, to the advancement of neuro-rehabilitation plans, and also initiated a theoretical idea of thinking as an active system. The rising need for operationalized mental benchmarks in psychiatry, the main part in the assessment of mental tasks were given to psychometric tools that could afford a complete measurement of the rigorousness of cerebral dysfunction (Zaytseva, Chan, Pöppel, & Heinz, 2015a).
In addition to the deficits in cognitive ability, the networks of the brain in patients with schizophrenia are vigorously repeated, indicating a possible significance of the schizophrenia connectome. It is crucial in psychopathology to study exchanges between systems, as the complexity and depth of impairments that are existent in this syndrome are rarely due to damages in a single structure. Luria’s neuropsychological trials help in building extrapolations about the cerebral processes linked to certain cerebral networks. Luria’s theoretical basis of interconnections and its use for evaluating measures signify possible beneficial contributions to existing psychiatric study of this disorder (Zaytseva, Chan, Pöppel, & Heinz, 2015b).
In the last decade or so, research has progressively looked more and more at how people with schizophrenia make sense of their challenges, their capabilities, their past, and their future as a key component that helps to determine their progress on the road to recovery. This method puts people with the disorder into an active role (replacing a previous passive role). It has highlighted the importance of the mental processes that enable people to understand and that allows people to make sense of and respond to multifaceted psychiatric disorders. (Mehta, & Thirthalli, 2013a)
Social cognition and metacognition are two such interests. Research is yet to find exactly what it is that makes “social cognition and metacognition possible. Presumably, both require multiple and dissociable components that cannot be reduced to one another, but the nature of those components remains unclear” (Mehta, & Thirthalli, 2013b, p. 495).
Conclusion: Schizophrenia: A Neuropsychological Disorder
This research paper contains beneficial material for people who have the disorder and for their families, and for family members who have lost loved ones who lived with this syndrome. Further research needs to be conducted to find better ways of healing people who have schizophrenia. The public needs to be educated correctly about schizophrenia. Also, the finding of a way to eradicate this disorder would be beneficial for everyone, especially for the people whose lives are changed forever by having this distressing, debilitating disorder.
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