Schizophrenia Final

Running Head: SCHIZOPHRENIA

Schizophrenia: a Case Study, and a Brief History and Overview of the Disorder

Ashleigh L. De Palma

Oakland University


Introduction

Mental illness has always been a subject that has fascinated me. The human brain is a

mysterious organ and it never fails to amaze me how both resilient and fragile it is. I love to

research topics of interest, and throughout the years, I have done my fair share of investigations

on various mental illnesses. I have read numerous medical journals and books on dissociative

identity disorder, mood disorders, autism, posttraumatic stress disorder, and other types of

mental disorders. Schizophrenia however, has always eluded my studies and when we were

assigned this project, I knew instantly that I wanted to learn more about this unusual and

uncommon mental illness. Though schizophrenia is relatively uncommon, it is a crippling

disorder that to date, has no known cure. Its victims vary in gender, ethnicity, and age, and

though there appears to be a strong genetic link, there is no test that can determine whether or not

a person will develop the disorder. It is an ailment worthy of study and discussion and my goal is

to learn as much about it as I possibly can.

Definition

Schizophrenia is a group of severe brain disorders in which people interpret reality

abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and

disordered thinking and behavior.

History

The term schizophrenia is less than 100 years old but despite this, it has probably

accompanied humankind throughout its entire history in all cultures. Early in history, people

used to believe that peculiar behavior was a result of possession by demons or spirits, or

punishments from the gods for immoral behavior. Treatment for these unusual behaviors ranged

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from exorcisms to physical mutilation. Prehistoric human skulls have been discovered that

contain holes that were presumably inflicted when people were attempting to extract evil spirits

from people displaying behavior that they believed had been caused by malevolent forces. At

around 400 BC, Greek physician Hippocrates expressed his belief that mental illnesses were

diseases, not curses by the gods.

Emil Kraeplin first identified schizophrenia as a medical disorder in 1887, though he used

the word dementia praecox to define it. In 1891, dementia praecox was used to described

symptoms of schizophrenia but Kraeplin later noted that dementia praecox was primarily a

disease of the brain similar to dementia, though dementia praecox had a much earlier onset.

Kraeplin divided the disorder into four subtypes that include: simple, paranoid, bephrenic, and

catatonic.

The term schizophrenia was first used in 1911 and the term was coined by Eugen Bleuler.

After Bleuler noticed that some of his patients that were displaying symptoms of dementia

praecox began to improve instead of worsen, he realized the disorder was not dementia after all,

and searched for a term that would better describe the disorder. The word itself has Greek origins

and literally means “to split” and “mind.” The word was intended to describe the separation of

function between perception, personality, thinking, and memory.

In the 1930’s people afflicted with schizophrenia no longer underwent exorcisms and

debilitating physical mutilations. Instead, they were commonly treated with insulin-induced

comas, electroshock therapy, and lobotomies. It wasn’t until 1952 that the first drug with

antipsychotic properties was discovered. Chloropromazine was first discovered in France, and

was the first oral drug used to treat schizophrenia. In 1989 clozapine was approved by the FDA

and was the first in a succession of second-generation antipsychotic medications. These

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medications have fewer side effects than their predecessors and were are as effective (though

neither first or second generation antipsychotics have any effects on the negative symptoms of

the disorder).

First Cases

The first known case of schizophrenia occurred in the late 1700s in London, England. A

man by the name of James Tilly Matthews who had at one point been a successful tea broker

began to behave abnormally and developed paranoia and hallucinations. He believed he was

being controlled by a mysterious “air loom” and believed that the government was under its

influence. Tilly was eventually arrested and confined at Bedlam Hospital and he then became the

subject of the first psychiatric case study.

Another early case of what was then called dementia praecox occurred in the 1860s and

was documented by Benedict Augustin Morel (who was also the first to use the term dementia

praecox). He wrote of previously symptom free adolescent boy who grew increasingly

withdrawn and spiraled downward into a state of unrelenting dementia. The boy expressed

homicidal idealizations toward his father and shortly after, his mental capacity began to decline.

Causes

Though the precise cause of schizophrenia remains unknown, scientists do know that

there is a strong relationship between genetics, environment, and family systems. According to

the World Health Organization, schizophrenia occurs in 10 percent of people who have a first-

degree relative with the disorder. People who have second-degree relatives with the disorder also

develop schizophrenia more often than the general population. It is worthwhile to note that the

risk for developing schizophrenia is highest for an identical twin of a person with the disorder.

She or he has a 40 to 65 percent chance of developing the illness.

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Scientists speculate that more than one gene is associated with schizophrenia, and that no

single one is responsible for causing the disorder. Research done in recent years has found that

people who have schizophrenia often have higher rates of uncommon genetic mutations.

Scientists believe it is possible that these mutations disrupt the development of the brain. Other

recent studies have suggested that schizophrenia may be a result of a malfunction in a gene that

is important for making brain chemicals. Though genetics likely play a large role in the

development of schizophrenia, it is still not possible to use genetic information to predict who

will develop the disorder.

Though genes undoubtedly play a large role in the development of schizophrenia,

scientists speculate that environment also plays a role in its progression. It is believed that an

interaction between genes and environment is necessary for schizophrenia to appear. Several

environmental factors may pave the way for schizophrenia, and these include: exposure to

viruses or malnutrition while in the womb, complications during birth, families with high

expressed emotion, and strained family relationships.

Theoretical Perspective

The causes of schizophrenia are generally viewed through the biological paradigm.

Because there is a strong link between genetics and the development of schizophrenia, much of

the research done on the subject is focused on biology. Treatments too are aimed toward this

paradigm and patients are generally given antipsychotic medications as first line management.

The cognitive behavioral paradigm however, is utilized when viewing the course of

schizophrenia, as the family environment does appear to have an impact on it. Patients with

families that have high expressed emotion, tend to have more difficulties with their illness than

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patients with families that have low expressed emotions. It is important to acknowledge that

families with high expressed emotion do not cause schizophrenia.

Classification

Both Eugen Bleuler and Emil Kraeplin divided the symptoms of schizophrenia into

separate categories. These categories were based upon evident symptoms and prognoses.

Schizophrenia is listed as a cluster A personality disorder in the DSM-IV. Periodically,

individuals working in the field of psychology have made attempts at identifying and classifying

the different varieties of schizophrenia. In the DSM-III, five types were identified and these

included: catatonic disorganized, paranoid, residual, and undifferentiated. Though these

classifications are still listed in the newer DSM-IV, they have not been helpful in predicting the

outcome of the disorder. Numerous other researchers have begun using other methods to classify

the different types of schizophrenia. They base their classifications on “positive” and “negative”

symptoms of the disorder, its progression over time, and the co-occurrence of other mental

disorders and syndromes.

There are five subtypes of the schizophrenia, though not every patient will fit easily into a

specific category. A patient’s symptoms may change as the disorder progresses. The different

subtypes are defined according to the most predominant characteristics present in each patient at

each point in time. The outcome is that one patient may be diagnosed with different subtypes

over the course of their illness. Some of these subtypes include: paranoid, undifferentiated,

residual, disorganized, and catatonic.

Former Classification

Schizophrenia wasn’t classified until the 1900’s. Initially, systems of classification were

rejected and psychological disorders were lumped together as “insanity.” At the turn of the

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century however, efforts to properly classify mental disorders continued and Eugen Bleuler and

Emil Kraeplin subdivided schizophrenia into distinct categories. Five types were included in the

DSM-III and these included: disorganized, catatonic, paranoid, residual, and undifferentiated.

These classifications still exist today and are currently employed in the DSM-IV.

Current Classification in DSM-IV-TR

Schizophrenia is still divided into different subtypes in the DSM-IV. It is considered a

cluster A personality disorder. The previous five categories are still being utilized, though some

researchers have found a more effective way of classifying the symptoms of the disorder. Many

researchers classify the disorder based on “positive” and “negative” symptoms, the progression

of the disease, and the co morbidity with other mental disorders.

Assessment

A licensed physician usually assesses a patient suspected of having schizophrenia and

employs a variety of examinations, tests, and interviews. The patient frequently undergoes a

thorough physical examination, drug tests, an assortment of psychological tests, and answers

questions pertaining to symptoms, medical history, and family history. These tests and

interviews are designed to rule out other conditions that may imitate the symptoms of

schizophrenia.

Diagnosis

To be diagnosed with Schizophrenia, a person must meet three of the DSM-IV-TR’s

criteria for characteristic symptoms. The patient must display two or more of the following

symptoms lasting one month or more: delusions, hallucinations, disorganized speech, grossly

disorganized behavior, or negative symptoms. The patient must also display social and/or

occupational dysfunction and the symptoms must persist for at least six months (this six month

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period must also include at least one month of characteristic symptoms). Some of the social and

occupational disturbances include emotional deficit, apathy, avolition, and alogia.

Often, individuals that are suspected of having schizophrenia will undergo physical

examinations and laboratory tests to rule out other conditions that may mimic the symptoms of

schizophrenia.

Prevalence

According to the Centers for Disease Control and Prevention, the global prevalence for

schizophrenia ranges between 0.5% and 1%. The World Health Organization estimates that

schizophrenia affects approximately 24 million people worldwide and though the incidence is

low, the prevalence is high due to chronicity. Of the patients diagnosed with schizophrenia, by

age 30, 9 out of 10 men and 2 out of 10 women will manifest the illness. Some recent studies

have found that of women and men, men are 30-40% more likely to be diagnosed with

schizophrenia than women.

Case Studies

One of the most fascinating cases of schizophrenia seen in recent years is the case of

January Schofield, a little girl diagnosed with schizophrenia at the age of six. She has visual and

auditory hallucinations, very violent tendencies, and suicidal thoughts. She has spent much of her

childhood in various psychiatric hospitals and is on a variety of antipsychotic medications,

notably clozapine. Her parents have elected to keep their daughter living with them at home and

keep her under careful observation throughout the day. Though she cannot function in a normal

learning environment, she does attend a four hour school session three days a week with the help

of an aide.

Empirical Research

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A recent study conducted by researchers from the University of Bristol and the Lilly

Center for Cognitive Neuroscience has indicated that sleep deprivation may trigger symptoms in

patients with schizophrenia. They discovered that during NREM (non-rapid eye movement)

sleep, waves of brain activity generally rise and fall between the hippocampus and frontal cortex

areas of the brain. Both the hippocampus and the frontal cortex play roles in the creation of

memories and decision-making. When NREM sleep was disrupted, researchers found that the

wave like brain activity was no longer synchronized. This lack of synchronization between the

aforementioned parts of the brain may contribute to the symptoms of the disorder.

Treatment

Because there is no cure, and no known way to prevent the disorder, treatments for

schizophrenia focus on reducing the symptoms. Antipsychotic medications are commonly used

to treat schizophrenia, and they have been available since the mid-1950s. There are two types of

antipsychotic medications, and the older or “conventional” medications include:

Chlorpromazine, Haldol, Etrafon, and Prolixin. In the 1990s, many new antipsychotic

medications were developed and these are commonly referred to as “second generation

antipsychotics.” Some “second generation antipsychotics” include: risperidone, olanzapine,

quetiapine, ziprasidone, aripiprazole, pallperidone, and clozapine. Antipsychotic medications are

known to have several side effects, though not every patient experiences the same ones, and they

vary in degree. Most side effects from these medications disappear after a few days. Side effects

of many antipsychotics include: drowsiness, dizziness, blurred vision, rapid heartbeat, sun

sensitivity, skin rashes, and menstrual irregularities.

Psychosocial treatments are also valuable and they can help a patient live a more

satisfying life despite their diagnosis. Family based treatment programs are helpful in improving

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the coping skills of family members and can give them the tools to care for a loved one that has

been diagnosed with schizophrenia. Patients that are able to remain in the community but

continue to experience residual symptoms may benefit from social skills training. This type of

training helps patients improve their social skills. Cognitive behavioral therapy and assertive

community treatments are also used along with antipsychotic medications to help the patient

function in the community. Often as a last resort, patients with severe or chronic symptoms will

be institutionalized, often on a long term basis.

Schizophrenia is a serious disorder and is therefore, somewhat difficult to treat. Patients

diagnosed with schizophrenia, will be schizophrenic for the rest of their lives, as there is no cure

for the affliction. Recovery rate (though it will never be in full) and response to treatment

depends on several factors including: current symptoms, support system, comorbid disorders,

and the patient’s ability to function in a work and social settings.

Prevention

Unfortunately, there is no known cure for schizophrenia, and there is no way to determine

whether or not a person will develop the disorder later in life. There are however, ways to

successfully manage the disorder and keep the symptoms under control. For people who are

genetically predisposed to developing the schizophrenia, avoiding illegal drug use, reducing

stress, getting an adequate amount of sleep, and seeking medical attention if psychological

problems arise is recommended.

Conclusion

Schizophrenia is a disorder that affects approximately 24 million people globally. It is

marked by positive and negative symptoms that may include delusions, hallucinations, social

withdrawal, and impaired occupational and social functioning. It appears primarily in young

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adulthood and is rare in young children and the elderly. There is a strong link between genetics

and schizophrenia, though there is no way to determine whether or not a person will develop the

disorder. There is no known cure for schizophrenia, but there are biological treatments and

therapies that can reduce the symptoms of the disorder. The search for a cause and more

effective treatments are ongoing and

Case Study: Identification of Subject

Trent Cooper is a 22-year-old heterosexual Caucasian male.

Information Sources

Information was obtained using interviews with the patient, parents, siblings, friends, and

significant other. Periodic observations were also employed both in the workplace and in social

settings.

Background Information

Disclaimer: the following is based on actual events. Some names and identifying characteristics

have been changed in order to protect the privacy of the individuals.

Trent Cooper was born to a low-income mother with egotistical and neurotic tendencies,

though to date, she has never sought treatment. During Trent’s early childhood, his mother

engaged in prostitution and routinely brought men back to her home. Trent was often in the

home during his mother’s engagements. Though his mother loved her son, she frequently

withheld affection and when she wasn’t with strange men, she was tending to her dogs that she

displayed in competitive shows. Trent’s father lived in a nearby city with his mother, though he

never saw his son on any regular basis. His father was a quiet, socially awkward introvert.

Trent has one older sister, one older brother, and one younger brother. His sister began

prostituting shortly after she reached adolescence. She has been married twice, is the mother of

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two children, and takes professional photographs on the side. Trent’s older brother has been

using drugs since early adolescence and currently has four warrants out for his arrest. He has

been in trouble with the law on numerous occasions for breaking and entering and as a youth,

spent several months in a juvenile facility, though he never completed a program. He moved to

California in early adulthood where he currently lives. He is addicted to meth and has been

diagnosed with Hepatitis C. Trent’s youngest brother began smoking marijuana in adolescence

and continues to do so today. He holds a job washing dishes at a restaurant and has never been in

trouble with the law. He maintains a good sense of humor.

Trent was always the smallest of his siblings and from childhood all the way through

adulthood, he was thin and never grew past 5’4” tall. He was insecure about his height and

weight and lifted weights for several months in early adulthood, but never saw any change in his

physique. He was self-conscious about his build, and dressed in large clothing, hoping to make

his small frame look a little bit larger. He never mentioned being ridiculed for his small stature.

He is an average looking young man and has no features aside from his size that make him stand

out way against others.

The subject’s mother could not recall any difficulties during the time she was pregnant

with Trent, nor could she recall any extreme difficulties during his childhood. She did mention

on more than once during the interview however, that Trent frequently wandered off during

school field trips and that she was called to collect him on several occasions. His mother did not

appear to remember very much about Trent’s childhood and had little more to add to this portion

of the interview.

Trent was an average student and did not excel in or fail any of his courses. Due to his

family’s frequent moves, Trent changed schools often but still managed to make friends and get

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involved in some extracurricular activities. He was well liked by his peers and in high school he

joined the wrestling team and fared well in it. Though Trent enjoyed socializing with his peers,

he had some difficulties staying awake during his classes (presumably due to his mother’s

nightly male visitors) and he began to miss school more frequently. During the middle his senior

year, he was informed that because he had missed so many days of school, he would have to

repeat his senior year in order to graduate. Unwilling to stay behind while his peers moved

forward, he dropped out of school at the age of seventeen. He never obtained his GED and

subsequently, never attended a college or university. He did however begin working as a cook in

an Italian restaurant at the age of 19.

Characteristics Leading to Diagnosis

Shortly after Trent’s 21st birthday, he grew less outgoing and became more withdrawn.

He spoke less, saw his friends less frequently, and began chain-smoking cigarettes. He did

however; get involved in a relationship with someone from his work, which seemed to engage

him. Approximately three months after his relationship began, he grew increasingly paranoid and

began to have delusional thoughts. He believed the government had his phone lines and

computers monitored and began to warn those that came into his home that they had to be

cautious about the things they said over the phone or did on the computer. Though his beliefs

were slightly unusual, they weren’t cause for concern until they began to involve his significant

other Alisha, who began to grow fearful as time passed. Trent believed other men were after his

girlfriend and he soon began to try to restrict the time she spent away from him.

Trent’s delusions continued for several months and were soon followed by auditory and

visual hallucinations that tended to revolve around Trent’s relationship with his girlfriend. He

began to see other men following her when they drove in the car together, and began to hear

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voices that shouted obscenities that revolved around other men. Alisha’s concern turned into fear

when she realized he was seeing and hearing things that she could not. She urged him to seek

psychiatric help, but he adamantly refused, stating instead that his hallucinations were real and

that men were in fact after his girlfriend.

Trent’s relationship with his girlfriend began to suffer and she began to withdraw from

him both physically and emotionally. This caused Trent a great deal of distress, and his moods

began to shift rapidly and his hallucinations and delusions continued. He began to cry at peculiar

times, especially at work. He often found himself unable to complete his tasks and was often sent

home before his shift was over.

Five months into his relationship, Trent’s girlfriend finally ended their connection. She

explained that she couldn’t contend with his mood swings and that his hallucination and peculiar

beliefs were beginning to frighten her. She again suggested he seek professional help, and again

he denied any need for it. Several days after their relationship ended, Trent expressed a desire to

end his life and he was then admitted to an inpatient psychiatric hospital. He has been released

from his job and will remain in the hospital until his symptoms are under control.

Appraisal, recommendations, and Predictions

Trent’s suicidal tendencies make his case severe and in need of immediate and aggressive

treatment. He should remain in an inpatient facility until his symptoms are under control with an

antipsychotic medication. The side effects should be monitored closely, and Trent should be kept

under close observation until his response to the medication is known. Along with the

antipsychotic medication, he will need to undergo weekly group therapy sessions with similar

patients in the hospital. When Trent is finally released, it is recommended that he stay with a

stable family member who can help monitor his progress and support him when needed. While

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out of the hospital, Trent should continue attending group therapy sessions and it is suggested

that once a week he see a cognitive behavioral therapist who can help him adjust to life with his

diagnosis.

With effective medication, and therapies, Trent’s prognosis is average to good. His

average intelligence and ability to work and get along with others will help him maintain some

semblance of a normal life. His greatest downfall is his support system, which is severely

lacking. With no close stable relatives, he will have to find solace in his friends and therapists.

Intervention: Prevention and Treatment

Schizophrenia is a severe lifelong disorder that affects approximately 24 million people

around the world. It is marked by delusions, hallucinations, disorganization, and negative

symptoms. To date, there is no known cure for schizophrenia nor is there any way to predict or

prevent the disorder. It is suspected that genetics, difficulties during pregnancy, and strained

familial relationships play roles in the appearance of schizophrenia, though how this happens

remains unclear. Medications and various forms of therapy can help manage the symptoms of

schizophrenia and can help the patient lead a more satisfying life.

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References

CDC - Burden of Mental Illness - Mental Illness - Mental Health Basics - Mental Health. (2011,

July 1). Centers for Disease Control and Prevention. Retrieved from

http://www.cdc.gov/mentalhealth/basics/burden.htm

Oltmanns, T., & Emery, R. (2011). In Abnormal Psychology (7th ed.). United States: Pearson

College Div.

Schofield, M. (2012). January first: A child's descent into madness and her father's struggle to

save her (1st ed.). New York, United States: Crown Publishers.

Sleep, Schizophrenia Link Strengthened In Animal Study. (2012, November 8). Breaking News

and Opinion on The Huffington Post. Retrieved from

http://www.huffingtonpost.com/2012/11/30/sleep-schizophrenia-symptoms-

triggered_n_2198915.html

WHO | Schizophrenia. (n.d.). World Health Organization. Retrieved from

http://www.who.int/mental_health/management/schizophrenia/en/

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Schizophrenia Final