How Schizophrenia Affects the Brain, Person, and Family

Introduction and Historical Background

Schizophrenia is one of a range of mental conditions that is widely misunderstood. Many see it as a relatively recent disease, and the term has only been in use for about a century. However, the condition is not new. This disease—one of the most disabling of all mental conditions—can be traced back for millennia. The first documented cases appear to have occurred in Ancient Egypt, where a description of the condition is found in the Eber Papyrus, in the Book of Hearts (Okasha, 1999). The condition was not well understood, and the treatment was usually incubation: spending the night in a temple, after which dreams would be interpreted in seeking the cause of the illness (Okasha, 1999).

Hippocrates viewed the condition as a hormonal imbalance, and through the subsequent work of figures such as Kraepelin and Bleuler, the understanding of the disease developed greatly. The illness is now divided into five subcategories: catatonic, paranoid, disorganized, undifferentiated, and residual (National Institute of Mental Health, 2002). Typically, the disease becomes evident before the age of forty-five, and symptoms must be present for at least six months. There are a range of symptoms, and these present in different combinations—only some, but not all, may be evident in any given individual.

Diagnosis and Symptom Categories

There are some difficulties with diagnosing schizophrenia. The onset may be gradual in industrialized nations, whereas in developing nations the same condition tends to appear more suddenly (National Institute of Mental Health, 2002). One tool used for diagnosis is the DSM assessment. Here the symptoms are considered, and there must be a history of six months with at least two of the following symptoms present during the last month:

Delusions: beliefs that are false and do not appear to have any logical grounding or basis in reality (Anonymous, 2002).

Hallucinations: seeing, feeling, or hearing things that are not there (Anonymous, 2002).

Disorganized speech (Anonymous, 2002).

Disorganized or catatonic behavior: unusual motor behavior marked by a decline in reactivity to the environment, or hyperactivity unrelated to any stimulus (Anonymous, 2002).

Negative symptoms: a lack of reactions or an apparent absence of emotions (Anonymous, 2002).

Diagnosis may also be complicated by the gradual nature of onset, since increasing isolation and withdrawal from society can reduce the opportunities for symptoms to be observed and identified (National Institute of Mental Health, 2002).

The different categories of schizophrenia are differentiated by their symptoms. Catatonic schizophrenia is characterized by motor disturbances, stupor, rigidity and negativism, lack of personal care, excitement, and potentially a decreased response to painful stimuli (National Institute of Mental Health, 2002). As noted, not all symptoms will be present in any single patient.

Paranoid schizophrenia is marked by delusional thoughts—such as persecution or grandiosity—along with anger, anxiety, and/or violence, and a tendency to be argumentative (National Institute of Mental Health, 2002). Disorganized schizophrenia involves regressive behavior, incoherence, delusions and/or hallucinations, inappropriate laughter, unusual mannerisms, and social withdrawal (National Institute of Mental Health, 2002). Undifferentiated schizophrenia involves symptoms drawn from more than one subcategory, while residual schizophrenia describes a state in which the most dominant symptoms have diminished, but some symptoms—such as hallucinations—may persist (National Institute of Mental Health, 2002).

Causes, Onset, and Prognosis

Schizophrenia has an incidence rate of roughly 1% of the population, spread equally between men and women. In terms of prognosis, some individuals may recover completely, and for the majority there can be sufficient improvement to allow independent living. However, ten percent of sufferers will commit suicide (National Institute of Mental Health, 2002).

The causes of schizophrenia are not fully known, but there is a strong genetic component. Where both parents are unaffected, the likelihood of a child developing the condition is 1%. Where one parent has the disease, this probability rises to 13%; where both parents are affected, it increases to approximately 35% (National Institute of Mental Health, 2002). Twins also show a higher likelihood of incidence: the probability increases by 17% for dizygotic twins and between 40% and 60% for monozygotic twins, though these figures are not fully conclusive (National Institute of Mental Health, 2002).

In most cases, the initial psychotic episode occurs in late adolescence or early adulthood. Onset after the age of thirty is unusual, and after forty it is very rare (Anonymous, 2002). In men, onset typically occurs between ages 16 and 25, with a higher prevalence in males during this period. Among females, a higher appearance of the disease is noted in the 25–30 age group (National Institute of Mental Health, 2002). By age thirty, the disease is spread roughly equally across genders.

Recovery rates vary considerably. Only 20%–30% of sufferers achieve recovery sufficient to resume a normal life. The same percentage applies to those who experience only moderate symptoms, while 40%–60% remain significantly impaired (National Institute of Mental Health, 2002).

References

Anonymous. (2002). The schizophrenia home page. Retrieved from http://www.schizophrenia.com/newsletter/buckets/intro.html

Barnes, M. (1990). [As cited in text regarding thought disorders and family impact.]

National Institute of Mental Health. (2002). Retrieved from www.nimh.nih.gov

Okasha, A. (1999). Mental health in the Middle East: An Egyptian perspective. Clinical Psychology Review, 19(8), 917–933.

RXlist. (2002). Retrieved from http://www.rxlist.com/