Schizophrenia: characteristics, symptoms, and treatment approaches

¶ … etiology of schizophrenia and the ways in which researchers, psychologists, philosophers, and different cultures in different ages have attempted to understand the disease. It also examines the prevalence of schizophrenia on both a global and domestic front and discusses it in terms of individual patients according to age, gender and ethnicity. Finally it examines the disease from the standpoint of diagnostic criteria as well as evidence-based treatments and what the dropout rate of each might signify. It concludes by asserting that researchers may benefit from approaching schizophrenia from a sociological perspective since the psychosocial therapy appears to have the best clinical results and lowest dropout rate among the various treatments available.

Schizophrenia

Introduction

Eugene Blueler first used the term "schizophrenia" in the early 20th century as a means of re-defining what earlier psychologists had described as a form of dementia. Blueler's term described a "split mind" -- a phenomenon that was not new to the world but in fact had existed for thousands of years (Kyziridis, 2005). Cultures and societies as disparate as the ancient Chinese and the ancient Romans had attempted to identify, understand and treat the mental or, as some philosophers called it, spiritual sickness. Thus, techniques, treatments, and discussions of the phenomenon that today is classified as "schizophrenia" have differed over time and place throughout all history. This paper will discuss what researchers now state regarding the etiology of schizophrenia, the prevalence of the sickness, the modern diagnostic criteria, and the evidence-based treatments used.

Etiology

The most comprehensive etiological examination of schizophrenia will incorporate the historical perspective as well as the modern academic perspective. To limit one's analysis to the Bleuler or Kraepelin school is to dismiss the thousands of years of critical scrutiny prior.

The ancient Egyptians viewed mental disease as a physical illness, while Plato and the ancient Chinese understood psychotic episodes as a consequences of spiritual disturbances (Kyziridis, 2005, p. 42-3). The ancient Hindu texts associate mental health with a balance of spiritual and physical health, and the Middle Ages saw various approaches to mental disorders, indicating that causes were believed to be physical, psychological, and spiritual.

Freud attempted to interpret a cause for the split mind phenomenon by stressing a relationship "between family dynamics and schizophrenia" (Kyziridis, 2005, p. 46), while modern researchers, such as Dr. Nimgaonkar (2006) at the University of Pittsburgh, focus on genetic causes, and others, like Marenco and Weinberger (2000) focus on schizophrenia's cause being found in utero (p. 501). Nimgaonkar (2006) states that "literally hundreds of causes have been proposed" but that the best theory of etiology is hereditary, suggesting that the root cause of schizophrenia is biological.

McGuire, David, et al. (1995), state that "auditory verbal hallucinations ('voices') are thought to arise from a disorder of inner speech (thinking in words)," indicating that this particular sign of schizophrenia points to a physiological cause. The "predisposition to verbal hallucinations is associated with a failure to activate areas concerned with the monitoring of inner speech," which is situated in the physiology of the brain (p. 596). When looking at the "the neural correlates of tasks which involve inner speech in subjects with schizophrenia who hear voices (hallucinators)," as well as nonhallucinators, McGuire et al. determined that the flow of blood in the brain differed in the two during thought processes.

Thus, the etiology of schizophrenia continues to be unknown, though theories vary widely about its origins and causes.

Prevalence

Part of the problem of discussing the prevalence of schizophrenia is that it can often be misdiagnosed. Because its symptoms at various stages of development are similar to those of other mental diseases, the diagnosis of schizophrenia can be hard to make. Different cultures as well have a different view of diagnosis and treatment, and therefore there is no uniform approach schizophrenia across the globe.

For instance, a study based on the long-term survey of schizophrenia in over a dozen countries by the World Health Organization found "that patients in countries outside Europe and the United States have a more favorable short- and medium-term course of the disease than those seen in developed countries" (Sartorius, Gulbinat, Harrison, Laska, Siegel 1996, p. 249). The study indicates that the prevalence of schizophrenia at the end of the 20th century appears to be far greater in the Western world than in the non-Western world, where cultural norms and values are different, and diagnostic methods and treatments are not approached as uniformly or as institutionally as in the West.

Bhugra (2005) states that the prevalence of schizophrenia in the "developing world" is actually far less than in the industrialized Western world. This finding indicates that etiology of schizophrenia may have more to do with cultural and social surroundings than genetics or physiology. The fact that mental disorders are greater in the unnatural settings of the industrialized West may be an example of how split mind can arise from the split between man and nature. At the same time, the disparity may also be accounted for by the fact that diagnostic methods are different. 1% of schizophrenia cases in the developed world were diagnosed as catatonia, compared to 10% in undeveloped territories. Hebephrenia was diagnosed in 13% of cases in developed countries, as opposed to 4% in developing regions.

One argument against these findings is that most cases, whether in developed or undeveloped countries, were diagnosed in Western-style facilities, perhaps off-setting the actual number of cases -- for "hospital-based data collection reflects cultural processes that have little to do with the true prevalence and incidence rates of schizophrenia" (Bhugra, 2005, p. 151). Another argument is that acute onset schizophrenia in developing countries is actually double that of the Industrialized world, thus indicating that schizophrenia is just as prevalent in the developing world and that its diagnosis is simply slow in coming.

Bhugra notes that cross-cultural studies have been effective in helping to better understand the etiology of schizophrenia -- but that cultural identities might contribute to the lack of authenticity of such surveys in where individuals are less likely to be observed in Western-style facilities.

Smith (2007) states that "schizophrenia is the clinical centerpiece of psychiatry" (p. 76). Illustrating how prevalent schizophrenia is in the United States, Smith shows that the disease "accounts for half of all admissions to psychiatric hospitals, costs $40 billion a year to treat in the United States, and is one of the top ten causes of disability worldwide" (p. 77). As more and more nations go through the process of Industrialization, it may be significant that the number of cases of schizophrenia have risen.

On the other hand, Messias, Chen, and Eaton (2007) have found that in England, "those immigrating from Africa or the Caribbean, and their second generation offspring, have rates of schizophrenia up to ten times higher than those in the general population" (p. 327). Messias, Chen, and Eaton assert that the disease is not likely to be caused by the stress of immigration or of trying to fit into a foreign culture, though they do argue that the etiology in these cases is likely to be found in the psychological effects of being a racial minority in an ethnically white nation. Again, this finding suggests that the split mind phenomenon may be a result of the split between persons and their surroundings, a mirroring of the environment.

According to the World Health Organization's latest findings, about 24 million people around the globe are affected by schizophrenia at least at some time in their lives. Castle, Wessely, Der, and Murray (1991) note that schizophrenia is 1.4 times more likely to be found in men than it is in women and that the most likely ages for it to be found in either sex is during the young adult years of 20-28 for men and 26-32 for women. Schizophrenia is not typically found in children or in older aged individuals.

Diagnostic Criteria

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) states that schizophrenia is a mental disorder that causes the patient to experience hallucinations, delusions, irrational speech patterns, anti-social behavior, a loss of willpower/motivation, a possible catatonic state at times, and more. This broad spectrum of symptoms should be seen for at least a month, with behavior being monitored for up to six months. Thus, schizophrenia is classified as a chronic behavior that is deeply ingrained in the individual's personality.

Kyziridis (2005) shows that in the past, philosophers such as Plato stated that "if head and body are to be well, you must begin by curing the soul," (p. 43), and today such a view is taken up by counselors and psychologists who wish to incorporate a life of prayer or a spiritual approach to counseling into the treatment of diseases like schizophrenia. Such a throwback to more ancient approaches coincides with the rise of alternative medicine as a type of rejection of institutionalized treatments. The fact that DSM-V has been protested by practicing physicians for its influence under Big Pharma only serves to illustrate how potentially corrupted the Diagnostics of the Western world has become (if the claim that diagnoses have been broadened in order to be able to prescribe more drugs to patients).

Between 20 and 40% of patients diagnosed as schizophrenics attempt suicide, but whether this is understood as an adverse affect of pharmaceutical treatments or a symptom of the disease itself is unknown. The relationship between pharmaceutical drugs that affect the brain and the disease in the brain itself is complex and therefore treatments as with etiology are based on trial-and-error. Youth and a solitary lifestyle are also attributed to a greater risk of suicide among schizophrenics, as the impulsive and erratic behavior is more likely to be demonstrated in such a demographic.

Depending on the degree of schizophrenic behavior displayed and the prognosticator involved in the case, various treatments or diagnoses may be made. Diagnostic criteria, especially since the controversial DSM-V, depends largely on the avenues taken by the patient: not every practitioner of medicine or alternative medicine is likely to approach schizophrenic symptoms in the same homogenous way. Nonetheless, in general signs and symptoms are identifiable if one follows the DSM-V classifications.

Alternative approaches recommended may be through holistic practitioners or family counseling. Because of the nature of schizophrenia, which remains elusive for researchers, there is no one absolute directive for diagnosing the disease, even though the DSM-V puts out a broad spectrum for diagnosis. The relationship between institutional medicine and treatments and business in the Industrialized world suggests that such classifications are not always in the primary interest of the patient but rather in the profitable interests of the pharmaceutical manufacturers, whose drugs are recommended as possible treatments. Thus, discretion is recommended for all seeking advice on schizophrenia diagnoses, and multiple avenues for opinion should be utilized, including those in alternative medicine.

Treatments

Treating mental disorders like schizophrenia does not depend on any one method but rather on a number of methods. Antipsychotic mood stabilizers are often prescribed along with support group therapy, depending on the degree to which the schizophrenia is seen to be advanced.

Prevention of the disorder depends upon early intervention and usually relies on the administering of an antipsychotic. Therapy is also encouraged to facilitate behavioral adjustments and stress reduction.

Depending on the treatments utilized, dropout rates differ. For psychosocial treatments, the dropout rate is 13%, which is actually lower than the rate of dropout for pharmacotherapy treatments (Villeneuve, Potvin, Lesage, Nicole, 2010).

Nonetheless, current treatment of the disorder ordinarily involves the use of antipsychotic pharmaceuticals, also called neuroleptics. Treating Schizophrenia, published by the American Psychiatric Association (APA), provides a number of steps that practitioners may take to treat schizophrenics. By identifying the goals of each step, the APA weighs and considers a variety of implications for each treatment procedure.

The first step in the treatment of schizophrenia, which the APA calls the Acute Phase, has only a very wide, general goal: the intention of clinicians is to prevent the patient from harming his or herself, return the patient to functionality, and form an alliance between the patient and his/her family. This alliance is often viewed as a crucial step in the rehabilitation and treatment of patients who suffer from schizophrenia. It acts as a bond of support for both family and self.

Yet, to further facilitate treatment in the Acute Phase, APA also advocates the use of over a dozen antipsychotic agents, including atypical neuroleptics (which are meant to have fewer side effects) to aid in this process. APA also recommends reducing stress levels through the assistance of psychiatric management. Awareness is raised concerning environments that might factor into a patient's illness. Mood stabilizers and anti-depressants are also recommended -- even electroconvulsive therapy (in extreme cases) for those who suffer from severe psychosis.

The benefits of treatment in the Acute Phase are seen in the Stabilizing Phase. Here, schizophrenics are taught to minimize stress. They are encouraged to adapt to communal living. Signs of negative side effects to medication are also looked for. Interventions, if necessary, are carried out.

Alternative treatment of schizophrenia includes the facilitation of support groups and residential or day programs. Likewise, dietary supplements, such as Glycine, have proven to be beneficial by allaying the negative symptoms of schizophrenia.

There are also psychoanalytic approaches that can be used, but these have multiplied through the years since Freud's initial formulation. All over the world, each approach attempts to define its strengths and point out the limitations of other approaches. Often a combination of approaches is studied in the hope of formulating a cohesive form of psychoanalysis. Moreover, the multicultural analyses performed by Hofstede and Minkov (2010) in their seminal cross-cultural sociological studies suggests that the theory of psychoanalysis is a limited avenue towards understanding what every culture has attempted to understand about the human psyche and the human soul. The Hofstede Model of Cultural Dimensions has supported the work of psychoanalysts who claim that culture is a factor in the formation of individual wills, attitudes, and desires. It also supports, however, the notion of universality -- that what Socrates identified as the one, the good, and the true (the transcendental virtues) are known (or can be known) in all cultures and by all individuals. Thus, the final analysis of the theory of psychoanalysis suggests that there is more to the psyche and the soul than the thrust of unconscious desires. It suggests that an even greater mystery -- one that may be called a spiritual mystery, in fact -- is at play.