Causes of Schizophrenia

Definition

          The functional psychosis in which individual loses connectivity with reality.

     Schizophrenia is a descriptive term for a group of psychotic disorders characterized by gross distortions of reality; withdrawal from social interaction, and the disorganization and fragmentation of perception, thought, and emotion (Coleman, 1988).

Distortions in

(i)       Thinking,

(ii)      Perception,

(iii)     Language,

(iv)     Sense of self and behaviour.

 

Diagnostic Criteria

          In a WHO Sponsored study 12 signs and symptoms were earmarked for diagnosing an individual with schizophrenia.

(i)       Restricted affect (Blank, expressionless face)

(ii)      Poor insight (overall rating of insight)

(iii)     Thought aloud (Do you feel your thoughts are being broadcast, transmitted, so that everyone knows what you are thinking? do you ever seem to hear your thoughts spoken aloud?

(iv)     Walking early (1-3 hours than usual)

(v)      Poor rapport (was it easy to make rapport during interview?)

 

Defining Criteria (DSM V)

          Schizophrenia and other Psychotic disorders are defined by abnormalities in one or more of the following five domains:   

(i)       delusions,

(ii)      hallucinations,

(iii)     disorganized thinking (speech),

(iv)     grossly disorganized or abnormal motor behavior (including catatonia), and

(v)      negative symptoms

(vi)     Depressed faces (Facial expressions sad, depressed)

(vii)    Elation (Elated, Joyous mood)

(viii)   Widespread delusions (How widespread are patient’s delusions are?)

(ix)     Incoherent speech (Free and spontaneous flow of incoherent speech?)

(x)    Unreliable information (Was the information obtained during the interview credible or not?)

(xi)     Bizarre delusions (Are the delusions comprehensible?)

(xii)    Nihilistic delusions (Do you feel that some part of your body such as head, brain or heart?)

 

Causes

(i)      Genetic factors

          (a)      Twin studies - Identical (60-75%), Fraternal (10-15%) – The           schizophrenia rate for identical twins is over 30 times greater than the      general population.

(b)      Children reared apart from their schizophrenic mothers – The children born to schizophrenic mothers, even when reared without contact with them, were more likely not only to become schizophrenic but also to suffer a wide spectrum of other disorders. 

(c)      Family studies – The children of schizophrenic parents showed high incidence of schizophrenia.

(ii)     Psychological factors – The following factors lead to development of schizophrenia.

(a)      Early psychic trauma and increased vulnerability

(b)      Pathogenic parent-child and family interactions –  Schizophrenogenic parents, destructive marital interactions, pseudo-mutuality and role inflexibility, faulty communication and undermining of personal authenticity.

(c)      Faulty learning and exaggerated defenses – Deficient self-structure and exaggerated use of ego-defence mechanisms –

(d)      Destructive social roles and interpersonal patterns - Inflexibility in own role behaviour and uncomprehending the role of others resulting in confusion regarding appropriate role of his own.

(e)      Excessive stress and decompensation – The schizophrenics have been defeated by their life situations and difficulties in close relationships.

(iii)    Biochemical factors – The schizophrenics have different biochemical set up which converts certain chemicals into psychogenic agents under stressful conditions. An enzyme has been found in brain that can convert normal neurotransmitters into hallucinogenic compounds. Excessive activity of dopamine can lead to symptoms similar to the schizophrenia.

(iv)    Neuro-physiological factors – The stress induces certain disturbances in the brain that influences the excitatory and inhibitory properties of neurons.

(a)      Excitatory and inhibitory processes – Pavlov (1941) suggested that schizophrenics have excitable nervous system. Under intense stimulation  individual’s response pattern of excitability and reactivity system is   protected by a phenomenon called ‘transmarginal’ (protective inhibition) occurs. If the stimulation remains for longer period of time it alters the process of protective inhibition. The level of excitation earlier achieved by  strong stimulation is achieved by even weak stimulus resulting indifferentiating between appropriate and inappropriate between fact and fantasy which makes him experience delusions and hallucinations.

(b)      Arousal and disorganization – Autonomic nervous system predisposes an individual to overarousal and under-arousal in the event of stress. Post arousal state schizophrenics are slower in returning to normal state due to alteration in several neurological and biochemicals.

(v)     Other factors – Exposure of virus during prenatal development, use of substances such as LSD and marijuana during adolescence, socio-cultural factors such as lower socio-economic status, urbanization, interaction genes and environment, build-up of abnormal proteins in the brain etc.

 

Onset

          Occurs during childhood and most likely during late teenage years to early adulthood (15 to 30 years).

 

Organic Outcomes

          Concludingly the overall impact of schizophrenia is on the neural mechanism. The ensuing outcomes: -

          (i)       Reduction in brain volume due to loss of    brain tissues

          (ii)      Imbalance of biochemicals

          (iii)     Disturbance in neural activity

          (iv)     Lesser density of synaptic connections

          (v)      Inflammation in the brain cells

 

Management of Schizophrenia

           The therapeutic goal is significantly to reduce the excess morbidity and mortality associated with depressive symptoms.

(i)       Psycho-social support

(ii)      Community and after care treatment

(iii)     Family therapy

(iv)     Yoga and relaxation techniques in association with pharmacological treatment

 

सन्दर्भ:

1.       Coleman, C. J. (1988). Abnormal psychology and modern life. Bombay, India: D. B. Taraporevala Sons & Co.

2.       NCERT. (XII). Psychology Book.

3.       DSM V Manual. Published by APA.

 

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