Schizophrenia is a disorder characterized by disturbances in thought, emotion, behaviour and perception. In the previous article, we discussed its symptoms. Today, we look at its etiology and treatment.
Etiology of Schizophrenia. This category can be broadly divided into biological, environmental and psychological factors.
Biological Factors. Family, twin and adoption studies favour the idea that genes contribute to the development of schizophrenia (especially the negative symptoms). Relatives of people with schizophrenia are at an increased risk and this risk increases as the genetic relationship between the proband and relative becomes closer. Molecular genetics studies focus on genome-wide association (GWAS) and association studies. The former have pointed out to copy number variations (CNVs) that are linked to genetic vulnerability to schizophrenia. The latter have focused on the role of DTNBP1 (impacts the dopamine and glutamate neurotransmitter systems), NGR1 (impacts myelination), BDNF (impacts cognitive functioning) and COMT (linked to executive functioning) genes, but more replication is required here. (Kring, Johnson, Davison, & Neale, 2012)
Neurotransmitters also have a role here. Dopamine theory suggests that schizophrenia (mainly the positive symptoms) develops from an excess activity in dopamine nerve tracts. Other neurotransmitters like serotonin, glutamate and GABA are also being linked to the development of schizophrenia. (Kring et al., 2012)
The brain is affected in those with the illness in the following ways – they have enlarged ventricles, reduced activation in prefrontal cortex and dysfunction in the temporal cortex. (Kring et al., 2012)
Environmental Factors. Obstetric complications and prenatal infections (influenza and parasite toxoplasma, for instance) can put the developing brain at higher risk for the illness. The use of cannabis has been linked to a greater risk for schizophrenia in adolescents, especially for those with a genetic disposition. (Kring et al., 2012)
Psychological Factors. People with schizophrenia are unlikely to experience more stress as compared to those without it, but they are more reactive to the stressors than the latter. When it comes to the role of socioeconomic status in schizophrenia, research supports the social selection hypothesis over sociogenic hypothesis. Conflict and poor communication is found in families of people with schizophrenia. Higher expressed emotion in family members of those suffering from the illness (critical comments, hostility and emotional overinvolvement) has been linked to relapse in schizophrenia. (Kring et al., 2012)
Treatment of Schizophrenia. In terms of medical treatment, antipsychotic drugs (especially the phenothiazines) have been used since the 1950s. These first-generation drugs can be somewhat effective and are tied with some serious side effects. The second-generation drugs (clozapine and risperidone) are as effective as the first-generation one but have their own set of side effects. (Kring et al., 2012)
Drugs in themselves are not an effective treatment, psychological treatment is needed as well. Social Skills Training aims at teaching patients how to manage a variety of interpersonal situations like filling a job application or ordering at a restaurant, through role playing and other group exercises, in therapy and actual life situations. It works towards increasing social functioning and a higher quality of life. Family Therapies work on educating high Expressed Emotion (EE) families about schizophrenia, antipsychotic medication, how to avoid blame and avoidance, how to communicate and problem solve, social network expansion and developing hope. Some maladaptive beliefs of people with the illness can benefit from cognitive behaviour therapy (CBT), which in combination with medications has helped reduce hallucinations and delusions. Cognitive Remediation Training or Cognitive Enhancement Therapy aims at enhancing basic cognitive functions of those suffering. Psychoeducation comes in handy when educating someone and those around about the illness, including its symptoms and their expected time course, etiology of symptoms and treatment. A very interesting development has taken place in the form of AVATAR therapy wherein people who have auditory hallucinations have a dialogue with the digital representation (avatar) of their presumed persecutor, voiced by the therapist who makes the avatar seem less hostile and eventually concede power over the course of therapy. Residential treatment homes or “halfway houses” come in handy for those who do not need to be in the hospitals but are not fully equipped to be on their own or even with their family. Here, people discharged from hospitals live, eat meals and slowly return to normal community life by holding a part-time job or attending school. (Kring et al., 2012)
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