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Schizophrenia

Theresa Lowry-Lehnen RGN, BSc (Hon’s) Nursing Science, PG Dip CC, Dip Counselling, Dip Advanced Psychotherapy,

BSc (Hon’s) Clinical Science, PGCE (QTS), H.dip Ed, MEd,

MHS accredited (Level 9) Emotional Intelligence (Assessor)

PhD Health Psychology

Schizophrenia is a psychotic disorder in which a person loses contact with reality,

experiencing grossly irrational ideas or distorted perceptions. Although there is no cure for

schizophrenia, the treatment success rate with antipsychotic medications and psycho-social

therapies can be high. Today the leading theory of why people get schizophrenia is that it is

a result of a genetic predisposition combined with an environmental exposures and / or

stresses during pregnancy or childhood that contribute to, or trigger, the disorder. Already

researchers have identified several of the key genes - that when damaged - seem to create

a predisposition, or increased risk, for schizophrenia. The genes, in combination

with suspected environmental factors - are believed to be the factors that result in

schizophrenia.

Schizophrenia occurs in all societies regardless of class, colour, religion or culture - however there are some variations in terms of incidence and outcomes for different groups of people. It ranks among the top 10 causes of disability in developed countries worldwide. (source: The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and ri sk

factors in 1990 and projected to 2020. Cambridge, MA: Published by the Harvard School of Public Health on behalf of the World Health Organization and the World Bank, Harvard University Press)

Schizophrenia

(If depression is the common cold of psychological disorders, chronic schizophrenia is the cancer)

Around 1 in 100 people will develop schizophrenia.

It typically strikes during adolescence or young adulthood.

Affects genders equally but men tend to be struck earlier and more severely.

Schizophrenia is a psychotic disorder in which a person loses contact with reality,

experiencing grossly irrational ideas or distorted perceptions.

Literally translated, schizophrenia means split mind.

It refers not to a multiple personality split (common misconception), but rather to a split

from reality that shows itself in disorganised thinking, disturbed perceptions and

inappropriate emotions and actions.

They can communicate in an illogical order

Summary of DSM 5 changes- Schizophrenia spectrum and other psychotic disorders

All subtypes of schizophrenia were deleted (paranoid, disorganized, catatonic, undifferentiated, and residual).

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A major mood episode is required for schizoaffective disorder (for a majority of the disorder's

duration after criterion A [related to delusions, hallucinations, disorganized speech or behavior,

and negative symptoms such as avolition] is met).

Criteria for delusional disorder changed, and it is no longer separate from shared delusional

disorder.

Catatonia in all contexts requires 3 of a total of 12 symptoms. Catatonia may be a specifier for

depressive, bipolar, and psychotic disorders; part of another medical condition; or of another

specified diagnosis.

DSM 5 Criteria for Schizophrenia (APA, 2013)

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5), to meet

the criteria for diagnosis of schizophrenia, the patient must have experienced at least 2 of the following symptoms.

Delusions Hallucinations Disorganized speech Disorganized or catatonic behavior Negative symptoms

At least 1 of the symptoms must be the presence of delusions, hallucinations, or disorganized speech.

Continuous signs of the disturbance must persist for at least 6 months, during which the patient must

experience at least 1 month of active symptoms (or less if successfully treated), with social or occupational deterioration problems occurring over a significant amount of time. These problems must

not be attributable to another condition.

The American Psychiatric Association (APA) removed schizophrenia subtypes from the DSM-5 because they did not appear to be helpful for providing better-targeted treatment or predicting treatment

response.

Prevalence Rate for schizophrenia

The Prevalence Rate for schizophrenia is approximately 1% of the population over the age of 18 (source: NIMH).

At any one time as many as 70 million people worldwide suffer from schizophrenia, including;

6 to 12 million people in China (a rough estimate based on the population) 4.3 to 8.7 million people in India (a rough estimate based on the population)

2.2 million people in USA 285,000 people in Australia Over 280,000 people in Canada Over 250,000 diagnosed cases in Britain People with schizophrenia are more likely to have serious physical health problems

compared to the general population.”

“As a result their life expectancy is reduced by approximately 20%

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Prevalence of schizophrenia compared to other well-known diseases

Source: BCSS

The Risks of Getting Schizophrenia

Source: Treatment Advocacy Center

A person with schizophrenia may perceive things which are not there.

Such hallucinations are usually auditory. The person may hear voices that make insulting

statements or give orders.

Less commonly people see, feel, taste or smell things which are non existent.

Such hallucinations have been compared to dreams breaking into waking consciousness.

When the unreal seems real, the resulting perceptions are at best bizarre and at worst

terrifying

The emotions of a schizophrenic are often utterly inappropriate.

Motor behaviour may also be inappropriate. The person may perform senseless compulsive

acts such as continuous rocking or arm rubbing.

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Those who exhibit catatonia may remain motionless for hours on end and then become

agitated.

Disorganised thinking, disturbed perceptions and inappropriate emotions and actions

disrupt social relationships.

During the most severe episodes people with schizophrenia live in a private inner world,

preoccupied with illogical ideas and unreal images.

Some suffer intermittently while others remain socially isolated and withdrawn for most of

their lives.

Types of schizophrenia

Schizophrenia is not a single disorder. It is a cluster of disorders that have common features but also some distinguishing

symptoms. The symptoms of schizophrenia may be divided into the following 4 domains:

Positive symptoms - Psychotic symptoms, such as hallucinations, which are usually auditory; delusions; and disorganized speech and behaviour

Negative symptoms - Decrease in emotional range, poverty of speech, and loss of interests and drive; the person with schizophrenia has tremendous inertia

Cognitive symptoms - Neurocognitive deficits (eg, deficits in working memory and attention and in executive functions, such as the ability to organize and abstract); patients also find it difficult to

understand nuances and subtleties of interpersonal cues and relationships Mood symptoms - Patients often seem cheerful or sad in a way that is difficult to understand; they

often are depressed Risk Factors- Schizophrenia

Drug use – especially cannabis

Brought up in an urban environment

Higher rates of schizophrenia among certain ethnic groups.

Afro-Caribbean (higher than in other ethnic groups)

Previous stressful or traumatic life events

Schizophrenia and Cannabis

Use of cannabis has been linked with significant increase of developing psychosis and

schizophrenia. Documented in over 30 different scientific studies (UK, Australia and

Sweden) over the past 25 years.

In one example, a study interviewed 50,000 members of the Swedish Army about their drug

consumption and followed up with them later in life. Those who were heavy consumers of

cannabis at age 18 were over 600% more likely to be diagnosed with schizophrenia over the

next 15 years than those who did not take it.

Experts estimate that between 8% and 13% of all schizophrenia cases are linked to cannabis

use during teen years.

The increase in evidence during the past decade could be linked to the increased potency of

marijuana. A review by the British Lung Association says that the cannabis available on the

streets today is 15 times more powerful than that being smoked three decades ago.

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Researchers in New Zealand found that those who used cannabis by the age of 15 were

more than three times (300%) more likely to develop illnesses such as schizophrenia.

Other research in the UK and Sweden has backed this up, showing that cannabis use can

increases the risk of psychosis by up to 700% for heavy users, and that the risk increases in

proportion to the amount of cannabis used (smoked or consumed).

Additionally, the younger a person smokes/uses cannabis, the higher the risk for

schizophrenia, and the worse the schizophrenia is when the person does develop it.

Professor Robin Murray (London Institute of Psychiatry)(2005) completed a 15-year study of

more than 750 adolescents in conjunction with colleagues at King's College London and the

University of Otago in New Zealand.

Findings: individuals were 4.5 times more likely to be schizophrenic at age 26 if they were

regular cannabis smokers at 15, compared to 1.65 times for those who did not report

regular use until age 18.

Many researchers now believe that using cannabis while the brain is still developing boosts

levels of the chemical dopamine in the brain, which can directly lead to schizophrenia.

Cannabis impacts on neurotransmitters. It takes a long time to metabolise, and can quickly

build up to high levels in the body leading to a real risk of depression or schizophrenia being

triggered. (London Institute of Psychiatry 2005)

Schizophrenia – Models

Medical / Biological

Genetics-certain people can have an increased vulnerability to schizophrenia as a result of

the genes that they inherit from their parents.

Neurotransmitters - Dopamine-it is thought that either the levels of dopamine in their

brain become too high, or that their brain is particularly sensitive to the effects of dopamine

Early development -result of an infection that interferes with the early development of the

brain.

The stress vulnerability model :The stress vulnerability model theory of schizophrenia states that

every individual has a certain vulnerability to schizophrenia which is determined by a combination

of biological, psychological, and environmental factors. A stressful, or traumatic, incident can

sometimes trigger the symptoms of schizophrenia in particularly vulnerable people.

Psychological model

Adopt a dimensional view of the disorder and attempt to understand the psychological

processes that contribute to the experiences of people diagnosed with schizophrenia rather

than to identify to a condition in which the individual differs from the norm.

Cognitive theories focus on the cognitive deficits and biases present in schizophrenia Cognitive explanations of delusions suggest they may form an attribution process, to help

people cope with negative self evaluation

Diathesis stress theories argue that schizophrenia emerges when biologically vulnerable individuals are exposed to particular types of environmental stresses.

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Schizophrenia – Diagnosis

If a diagnosis of schizophrenia is suspected, the GP will refer the patient to the mental

health team.

A member of the team, usually a psychologist, or psychiatrist, will carry out a more

detailed assessment of the symptoms. They will also want to know about the personal

history and current circumstances.

There is no single test for schizophrenia. Mental health care professionals use a

'diagnostic checklist',- DSM or ICD 10 where the presence of certain symptoms and signs

indicate that a person has schizophrenia.

Schizophrenia – Treatment

Treatment for schizophrenia usually involves using a combination of antipsychotic

medicines and psychological therapies – counselling /Cognitive Behavioural Therapy (CBT)

/ Family therapy and occupational therapy.

New Treatments: There are over 15 new medications for the treatment of schizophrenia

currently in development by different biotech and pharmaceuticals companies. Additionally,

there are many new and improving psycho-social treatments and cognitive therapies for

schizophrenia that are being rolled out with significant success. Together these new treatments

hold significant promise of a better life in the future for people who have schizophrenia.

Outlook

The outlook for people with schizophrenia has improved over the last 25 years.

Wide-ranging research effort, including studies on the brain, continue to illuminate

processes and principles important for better understanding the causes of schizophrenia

and for developing more effective treatments.

One of the most positive areas of schizophrenia research today is in the area of

identification of early risk factors for development of schizophrenia, and prevention of

schizophrenia in those people who are predisposed to the disease.

Shine (Support groups)

Shine previously known as Schizophrenia Ireland is an Irish national organisation

dedicated to upholding the rights and addressing the needs of all those affected by

enduring mental illness including, schizophrenia and schizo-affective disorder.

Shine has offices in Dublin, Cork, Galway, Kilkenny, Tullamore and Dundalk.

Theresa Lowry-Lehnen RGN, BSc (Hon’s) Nursing Science, PG Dip CC, Dip Counselling, Dip Advanced Psychotherapy,

BSc (Hon’s) Clinical Science, PGCE (QTS), H.dip Ed, MEd,

MHS accredited (Level 9) Emotional Intelligence (Assessor)

PhD Health Psychology

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References

American Psychiatric Association (2013), Diagnostic and statistical manual of mental

disorders, 5th Edition, Washington, DC: American Psychiatric Publishing.

American Psychiatric Association (APA) (2000), Diagnostic and statistical manual of

mental disorders, 4th Edition, text revision (DSM-IV-TR) Washington, DC: American

Psychiatric Publishing.

Bennett, P (2007) Abnormal Clinical Psychology; An Introductory Textbook (Second

edition). Maidenhead: Open University Press

Carr, A (2001) Abnormal Psychology. New York; Psychology Press

Eysenck, M.W. (2005) Psychology: A Students Handbook. New York; Psychology Press

Myers, D. (2002) Exploring Psychology, fifth edition, New York; Worth publishers

www.medscape (2014) Schizophrenia.

www.nhsdirect.co.uk

www.psychnet.co.uk

www.shine.ie

www.schizophrenia.com/szfacts.htm

http://www.youtube.com/watch?v=0riyGUwOHdI&feature=channel