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Ch. 18 Section 6: Schizophrenia Obj: Describe the subtypes of schizophrenia. • Schizophrenia – usually considered the most serious of the psychological disorders, is characterized by loss of contact with reality. Schizophrenia can be very disabling, and even lead to the affected person’s inability to function independently. Typically, schizophrenia first appears in young adulthood, but it may occur at other ages. Although it usually develops gradually, it can also appear suddenly. Schizophrenia can now be treated more effectively, although if untreated it can worsen over time. The most obvious symptoms of schizophrenia include hallucinations, delusions, and thought disorders. In most cases, the hallucinations are auditory – voices may tell the individual what to do or comment on the individual’s behavior. Sometimes the voices may tell the individual to harm herself or himself or others. Individuals with schizophrenia may experience delusions of grandeur – beliefs that they are superior to other people. For example, such individuals may believe that they are famous or on a special mission to save the world. Sometimes the delusions are of persecution. For example, a person with schizophrenia might believe that he or she is being pursued by the CIA, FBI, or some other government agency. Other delusions may include beliefs that one has committed unpardonable sins or even that one does not really exist. Thought disorders involve problems in the organization or the content of mental processes. The thoughts of a person with schizophrenia may skip from topic to topic in an apparently illogical way. This is reflected in the person’s speech, which sounds disorganized and confused. A person with schizophrenia may also repeat the same word or phrase over and over, repeat words or phrases that another person has spoken, or invent new words. People with schizophrenia experience other symptoms that result in a decreased ability to function. These symptoms include social withdrawal, loss of social skills, and loss of normal emotional responsiveness. Some people with schizophrenia may even go into a catatonic stupor – an immobile, expressionless, comalike state. Understandably, these symptoms cause tremendous stress to individuals with schizophrenia and their families. It has been estimated that as many as 20 percent of people with schizophrenia attempt suicide and that 10 percent actually do kill themselves. Schizophrenia is found in all cultures and has been recognized for several thousand years. A large number of people have schizophrenia – an estimated 2 million in the US alone. Types of Schizophrenia Individuals with schizophrenia vary greatly in symptoms they exhibit, although virtually all have thought disorders. Most people with schizophrenia exhibit a combination of symptoms. The DSM-IV classification of schizophrenia and other psychotic disorders is based on the duration and recurrence of symptoms. The types of schizophrenia include paranoid, disorganized, and catatonic schizophrenia. • Paranoid Schizophrenia – People with paranoid schizophrenia have delusions or frequent auditory hallucinations, all relating to a single theme. These people may have delusions of grandeur, persecution, or jealousy. For example, an individual with paranoid schizophrenia may be convinced that people have been plotting against him or her even when there is no evidence of such. Although people with this type of schizophrenia tend to have less disordered thoughts and bizarre behavior than do people with other types of schizophrenia, they may be agitated, confused, and afraid. • Disorganized Schizophrenia – People with disorganized schizophrenia are incoherent in their thought and speech and disorganized in their behavior. They usually have delusions or hallucinations as well, but these tend to be fragmentary and unconnected, unlike the more ordered and systematic delusions of those with paranoid schizophrenia. People with disorganized schizophrenia are also either emotionless or show inappropriate emotions. Typically, they act silly and giddy, and they tend to giggle and speak nonsense. They may neglect their appearance and hygiene and even lose control of their bladders and bowels. • Catatonic Schizophrenia – The most obvious symptom of catatonic schizophrenia is disturbance of movement. Activity may slow to a stupor and then suddenly switch to agitation. Individuals with this disorder may hold unusual, uncomfortable body positions for long periods of time, even after their arms and legs swell and stiffen. They may also exhibit waxy flexibility, a condition in which other people can mold them into strange poses that they continue to hold for hours. Explaining Schizophrenia Many different theories have been proposed to explain schizophrenia. These theories include both psychological and biological views. • Psychological Views – According to the psychoanalytic perspective, schizophrenia is the result of the overwhelming of the ego by urges from the id. The urges threaten the ego and cause intense conflict. In response, the individual regresses to an early phase of the oral stage of development in which the infant has not learned that it is separate from the mother. In this condition, fantasies become confused with reality, leading to hallucinations and delusions. Like many psychoanalytic theories, this one has fallen into disfavor over the years. Other psychological views focus on the family environment as the root of schizophrenia. One such theory suggests that a family environment in which a parent frequently expresses intense emotions and has a pushy, critical attitude puts children at risk of developing schizophrenia. It is possible, however, that such a family environment may only increase the chances of relapse in individuals who have schizophrenia. That is to say the family environment does not actually produce schizophrenia. • Biological Views – schizophrenia appears to be a brain disorder, and many studies have been done to determine how the brains of schizophrenic people differ from those of other people. One avenue of brain research connects the major problems found in schizophrenia – problems in attention, memory, abstract thinking, and language – with differences in the frontal part of the brain. Schizophrenic people have smaller frontal region. Research suggests that the difficulties may reflect a loss of synapses, the structures that connect neurons to communicate with one another. What might cause the loss of synapses? Research evidence suggests that there are three biological risk factors: heredity, complications during pregnancy and birth, and birth during winter. Schizophrenia, like many other psychological disorders, runs in families. People with schizophrenia constitute about 1 percent of the population. However, children with one parent who has been diagnosed as schizophrenic have about a 10 percent chance of being diagnosed as schizophrenic themselves. Children with two such parents have about a 35 to 40 percent chance of being so. When one identical twin has it, the other has about a 40 to 50 percent chance of being diagnosed with it. Many studies have been carried out to try to isolate the gene or genes involved. Some studies have found locations for multiple genes on several chromosomes. Recent research suggests that particular genes may provide the vulnerability to schizophrenia. Many people with schizophrenia have experienced complications during pregnancy and birth. For example, the mothers of many people with schizophrenia had influenza during the sixth or seventh month of pregnancy. People with the disease are also somewhat more likely to have been born during the winter than would be predicted by chance. Maternal starvation has also been related to schizophrenia. These biological risk factors suggest that schizophrenia involves abnormal prenatal brain development. Problems in the central nervous system may involve neurotransmitters as well as brain structures, and research has focused on one particular neurotransmitter: dopamine. According to the dopamine theory of schizophrenia, people with schizophrenia use more dopamine than other people do, although they may not produce more of it. Why? They may have more dopamine receptors in the brain than other people, or their dopamine receptors may be hyperactive. • A Multifactorial Model of Schizophrenia – The multifactorial model of schizophrenia illustrates how several biological and psychological factors may interact in the development of the disorder. In this model, genetic factors create a vulnerability, or susceptibility, to schizophrenia. Among people who are genetically vulnerable, other factors, such as trauma during birth, may lead to brain injury and the subsequent development of schizophrenia. Once the disorder develops, its course may be negatively affected by the family environment. The model also suggests that environmental factors alone are not enough to lead to the development of schizophrenia. Thus, people who are not genetically vulnerable are unlikely to develop the disorder, regardless of the environmental risk factors to which they are exposed.