Schizophrenia: characteristics, symptoms, and treatment approaches

Schizophrenia is a form of mental illness first identified about a century ago by Emil Krepelin. Kraepelin noticed young adults who became mentally confused. Sometimes they could think clearly, but other ties they experienced hallucinations, odd delusions involving themselves or others, confused thought processes, and emotions inappropriate to the circumstances. He called this condition "dementia praecox" because it occurred at a young age. He noted that the condition worsened significantly over time (Bower, 1996).

This devastating, psychotic mental disorder occurs in about 1% of all adults. Most typically it becomes apparent during late adolescence or in early adulthood. Stress makes it worse, and certain kinds of medications often help it (Kelli, 2001), but those medications do not eliminate all symptoms (Kelli, 2001). Today, dementia praecox is called schizophrenia, which means "divided mind" in German (Bower, 1996). This has caused some people to mistake it for multiple personality disorder, but schizophrenia involves marked distortions of reality in one personality. Schizophrenics have often-impossible beliefs, or delusions that do not reflect reality as other people perceive it (Kelli, 2001). These distortions fall into two categories: routine and supervisory (Humphrey-Beebe, 2003). At the routine level, we participate in life using responses we have learned in the past. At the supervisory level, we participate in life without the use of learned responses, for instance, if we have a job to do but do not immediately know how to complete it. In schizophrenia, individual have marked difficulty following steps, setting goals, maintaining focus on tasks, the ability to modulate behavior to adapt to changing circumstances, and connecting knowledge to a specific situation. These problems are especially disabling when a situation requires a novel response (Humphrey-Beebe, 2003).

CAUSES

Given the devastating nature of schizophrenia, researchers have put considerable effort into trying to determine the cause or causes of schizophrenia. Is it caused by nature (genetics, head injury, etc.) or nurture - how we are raised? This nature vs. nurture debate has gone on throughout part of the 19th century and virtually all of the 20th (Kelli, 2001). Kraepelin, who first described the disorder, believed that it was organic in origin. However, with the advent of Freudian thought, belief swung to the idea that our childhoods determined whether we would have mental illnesses as an adult or not (Kelli, 2001).

However, current thinking today suggests that people with schizophrenia have a genetic predisposition. The schizophrenia may or may not develop depending whether other aggravating conditions are present. Called the "Vulnerability Model" (Humphrey-Beebe, 2003), this would mean that both nature and nurture might be involved. However, a third circumstance also has to be factored in - environment, especially the prenatal environment. This view has one advantage in that it goes toward explaining why the same general disease - schizophrenia - can vary significantly from person to person. The Vulnerability Model suggests to us that schizophrenia is caused by a combination of interacting factors including physical, psychological and environmental events that work dysfunctionally together to produce what we call "schizophrenia."

This does not mean the brains of schizophrenics are identical to those without schizophrenia, however. Some evidence persuasively points to brain development that goes wrong before a baby is ever born. During gestation, brain cells have to migrate from one central location to become the different parts of the brain. In the process, some brain cells are redundant, and the brain "prunes," or destroys them. Some researchers believe that in some people who later develop schizophrenia, brain cells group together that should not be together, resulting in a baby that is born with a dysfunctional brain from the beginning (Bower, 1996).

Research suggests that fetal development of the brain malfunctions about halfway through the pregnancy, when large numbers of neurons are traveling to the place they belong in the baby's brain. Research has found disorganized clumps of neurons both in the cerebral cortex and in other parts of the brain (Bower, 1996). Whether this problem is caused or worsened by viral infections during pregnancy isn't known, but some studies suggest that schizophrenia is more common in babies whose mothers had some kind of viral illness during pregnancy. For example, in a Finnish study, schizophrenia was more common in babies when their mothers had influenza during the second trimester of their pregnancies (Bower, 1996). Other researchers have noted schizophrenia occurring more commonly in people who were born prematurely (Bower, 1996), (Ratey, 2001).