A. Definition

Schizophrenia is a condition that causes bizarre and distorted thoughts, perceptions, emotions, behavior, and strange movements. It is not and cannot be defined as a single illness. Rather, it is a syndrome with varying symptoms and different subtypes.

The general public has, for many years, misunderstood schizophrenia and caused a stigma to be created. People fear that individuals afflicted by the disease are violent, uncontrollable, and are dangerous. Medicine has so far done so much into educating the large public about the syndrome; and now, people with the syndrome live free, normal lives with society

B. Etiologies

The cause of schizophrenia has largely been a debate for many years. Researchers have gone through depths of research to find organic cause of the disease, and some have indeed been found. However, interpersonal theories have also suggested that it may have resulted from trauma and dysfunctional relationships. Here are some of the etiologies that risen from research thus far:

1. Genetics

It has been found out that genetics play a huge factor in causing schizophrenia. Identical twins have a 50% risk, while fraternal twins have a 15% risk. Further research has been established and it pointed out that having one biological parent has a 15% risk of syndrome acquisition, and if both parents are afflicted, the risk rises to 35%. Although genetics is a factor, it cannot be the only factor that determines causality.

2. Neuro-anatomic and Neuro-Chemical factors

Schneider-Axmann et.all, 2006: It has been found out that people with schizophrenia have less brain tissue and less cerebrospinal fluid than those without the syndrome. This could be due a failure in development or loss of tissue. CT scans have showed brain ventricle enlargement and atrophy of the cortex. PET scans have determined diminished glucose and oxygen metabolism in frontal area of the brain. The research has concluded that there is decreased brain function in the frontal and temporal areas of the brain in persons with the syndrome.

In people with schizophrenia, research has pointed out that there is an imbalance in the neurotransmitters of the nervous system. Dopamine and Serotonin are the primary neurotransmitters involved with the disease. Research found out that excess of these neurotransmitters may trigger development of schizophrenia. A decrease in dopamine levels via treatment managed to reduce symptoms of positive schizophrenia, and serotonin is believe to further increase dopamine levels.

3. Immunovirologic factors

It has been believed that exposure to a virus, which is still unknown as to which, causes alterations in the brain physiology of people affected with Schizophrenia. Cytokines, inflammatory mediators for pain seem to produce behavioral and neurochemical changes needed to maintain homeostasis (Brown, et al. 2005). Children born in the midst of cold weather have an increased risk for the syndrome as viral infections are quite more possible during this condition. (Brown et al, 2005)

C. Symptoms

The Symptoms of Schizophrenia vary from Negative and Positive Symptoms. Positive symptoms include delusions, hallucinations and grossly disorganized thoughts. Negative symptoms include lack of volition, flat affect, discomfort, and social withdrawal (DSM IV-TR; APA, 2000)

Diagnostic and Statistical Manual of Mental Disorders (4th Edition) Text Revision (DSM IV-TR; American Psychiatric Association, 2000 Symptoms of Schizophrenia:

Positive Symptoms:

1. Associative looseness– poorly related thoughts or ideas

2. Delusions– fixed, false beliefs with no realistically applicable basis

3. Ambivalence– holding contradictory beliefs about people, events, objects and situations

4. Flight of Ideas– jumping from one topic to another where there is a free-flow of ideas

5. Echopraxia– mimicry of another person’s movements

6. Hallucinations– false sensory perceptions that are not existing in reality

7. Ideas of Reference– false impressions that external events bear meaning for the person

8. Perseveration– persevering in a single topic

Negative Symptoms:

1. Alogia– a tendency to speak with very little meaning, or to speak very little

2. Apathy– indifference to people, events, situations, or things

3. Blunt Affect– restricted emotional mood, tone, and feelings

4. Catatonia– marked by a feeling of either agitation, or lack of motion

5. Flat affect– absence of facial expression

6. Lack of volition– absence of will, drive and motivation

7. Anhedonia– feeling of no joy from any activity

D. Types

The DSM-IV TR APA, 2000 recognizes the following different types of Schizophrenia:

1. Paranoid type– this is marked by persecutory delusions, or grandiose delusions, hallucination, sometimes excessive religiosity, or hostile and aggressive behavior.

2. Disorganized type– this type is marked by grossly flat or inappropriate affect, loose associations, extremely disorganized behavior, and incoherence.

3. Catatonic type– this is characterized by psycho-motor disturbance, either motionless or excessive motor activity. Catalepsy (waxy flexibility) or stupor may be manifested. Excessive motion is purposeless and is not influenced by stimuli.

4. Undifferentiated type– this type of schizophrenia has mixed symptoms of other types and has disturbances of thought, behavior, and affect.

5. Residual type– this is characterized by at least one previous episode of social withdrawal, flat affect, and loose associations.

E. Management

Management of schizophrenia is complex as it may be a combination of different methods. Treatment includes:

Psychopharmacotherapy is used to treat the specific symptoms of the syndrome, either positive (hard), or negative (soft) symptoms. Treatment uses various drugs that address specific symptoms.

Psychosocial treatment includes group sessions, individual therapy sessions, drawing, the use of music, cognitive-behavioral therapies, social skills training, cognitive enhancement therapy, and family education. These therapies may be used depending as to which will be effective for the client. These methods are often combined with psychopharmacotherapy in an effort to reduce symptoms

There is no cure for schizophrenia, but, there is hope. There is always hope.

Schizophrenia Pathophysiology & Schematic Diagram