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Schizophrenia is a mental health disorder that involves psychosis and is known for its positive (adding an experience) and negative (taking away an experience) symptoms.
According to the World Health Organisation (2021), schizophrenia affects approximately 20 million people worldwide. It affects patients' thoughts, emotions, language use and comprehension, and they lose their sense of self and reality. It may also affect their friends and family members. It usually affects people between 15 and 45, and more men than women.
Clinicians, psychologists, or psychiatrists diagnose schizophrenia using the ICD (International Classification of Diseases) or the DSM (Diagnostic and Statistical Manual of Mental Disorders).
The majority of the world uses ICD, especially in Europe, whilst the DSM is used in America. The ICD often collaborates with the DSM, as both establish a similar classification system for schizophrenia and its requirements for diagnosis, although they do differ.
The ICD requires the patient to have:
Negative symptoms, with one or more of the following:
Incoherent speech, catatonic behaviours, avolition, and some positive symptoms, such as delusional perceptions and hallucinations, i.e., hearing voices.
Symptoms last for at least one month consistently.
The DSM requires a patient to have:
Positive symptoms, such as:
Delusions, hallucinations, disorganised speech – these are prioritised in the diagnosis, and the following symptoms are also considered (although, the first three must be present), disorganised behaviour, catatonic behaviour.
Symptoms last for at least one month consistently.
Both diagnostic tools require that the symptoms do not result from substance use or misuse (e.g., if a patient had taken drugs with hallucinogenic effects).
Symptoms of psychosis are characteristics of schizophrenia:
Positive symptoms (adding an experience):
Hallucinations (sensory experiences, usually auditory and/or visual).
Delusions (e.g., delusions of grandeur and paranoia).
Disorganised speech (incoherent or digressive).
Psychomotor disturbances (rocking back and forth or staying completely still, known as catatonia).
Negative symptoms (taking away an experience):
Avolition (a state of apathy).
Alogia (speech poverty).
Affective flattening (lack of facial expressions).
Anhedonia (unable to fully feel positive emotions, feeling little or nothing).
However, using these tools can cause problems with stigma (most people still negatively perceive schizophrenia) and lead to self-fulfilling prophecies (patients begin to show increased symptoms after diagnosis because they have been told about it).
When you use a diagnostic tool or classification system, they must be reliable and valid.
Reliability is the degree of agreement different psychiatrists can reach on a single diagnosis for an individual, both over time and across cultures, provided the symptoms of the disorder do not change.
Validity is the legitimacy of a test, that is, whether what the psychiatrist uses to diagnose a patient measures what it claims to measure. The diagnosis represents something real and distinct from other disorders if it is valid.
Factors that affect the reliability and validity of schizophrenia diagnosis are:
Co-morbidity — when two or more disorders co-exist within one individual, e.g., depression and anxiety.
There are three primary biological explanations for schizophrenia: genetics, the dopamine hypothesis, and neural correlates. Biological reasons for disorders stem from the biological approach to psychology, which holds that our thoughts and behaviours are due to certain aspects of our biology. For example, a genetic disorder such as autism spectrum disorder correlates with certain mental health conditions such as anxiety.
Genes are small pieces of DNA that instruct our cells on doing their jobs. Some genetic differences have been are known to cause disorders:
Cystic fibrosis is caused by a mutation of the CF gene (responsible for a protein regulating salt and fluid flow in and out of cells) on the 7th chromosome.
One biological explanation for schizophrenia is that certain genetic differences predispose to the development of schizophrenia, as in cystic fibrosis. Twin studies investigate this explanation.
The dopamine hypothesis was developed in the 1960s and 1970s following research into the effects of amphetamines on the brain. These drugs caused psychotic symptoms such as hallucinations, which are usually associated with schizophrenia.
This hypothesis states that too much or too little dopamine (a neurotransmitter) correlates with positive and negative symptoms of schizophrenia and contributes to the development of antipsychotic drugs.
Neural correlates are instances where brain structure differences correlate with specific psychological disorders or symptoms. You may have come across the word 'correlate' in your research methods lessons, which means to have a mutual relationship.
This theory suggests that abnormalities in certain brain areas, particularly the ventricles, may be responsible for the onset of schizophrenia.
Psychological explanations for schizophrenia trace the origin and development of schizophrenia to psychological causes. Thoughts, emotions, and external experiences patients go through are the primary focus and their relationships with peers and family members.
There are two main types:
Family dysfunctions involve the schizophrenogenic mother, the double-bind theory (contradictory messages given to a child), and expressed emotions (EE, hostile environments within a household).
Cognitive explanations involve dysfunctional thought processing and attention deficit theory. Patients poorly manage their thoughts and cannot spot errors in cognitive processing (cannot filter preconscious or automatic thoughts correctly). It includes issues with meta-representation (missing parts of a thought process, so patients cannot adequately reflect on their thoughts and behaviours) and central control (unable to suppress automatic thoughts and resist the urge to act on thoughts).
Schizophrenia is a complex disorder with multiple treatment options.
Biological therapies, or drug treatments, are known as antipsychotics. There are two types, typical and atypical antipsychotics. Both forms of drug treatments have side effects.
Typical antipsychotics: The first generation of antipsychotics only address positive symptoms and are known as dopamine antagonists because they only affect dopamine levels.
Atypical antipsychotics: The second generation, which acts on both positive and negative symptoms and affects dopamine, serotonin, acetylcholine, and glutamate neurotransmitters.
Psychological therapies aim to change the patient's negative thought processes about their personal and social life.
Family therapy.
Token Economy (management of the disorder).
The interactionist approach combines biological and psychological therapies to treat schizophrenia.
The Diathesis-stress Model assumes an internal vulnerability (a diathesis) and an external, environmental factor (stressor) exist in an illness.
Schizophrenia is a mental health disorder that involves psychosis and is known for its positive (adding an experience) and negative (taking away an experience) symptoms. It affects the patient’s emotions, thoughts, language, and comprehension, disturbing their sense of reality.
Schizophrenia may be genetic. One biological explanation for schizophrenia is that specific genetic differences make someone predisposed to schizophrenia, like cystic fibrosis.
Schizophrenia is a term used to describe a mental health disorder involving a breakdown between a person and their sense of reality.
Paranoid schizophrenia is where a patient experiences predominantly positive symptoms.
Schizophrenia has biological and psychological origins and is said to run in families, although we cannot ascribe it to one gene. Instead, it may be that a person is more vulnerable to schizophrenia.
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