Schizophrenia

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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, thetreatment success ratewith 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. Itranks among the top 10 causes of disability in developed countries worldwide.
(source: The global burden of disease:a comprehensive assessmentof mortality and disability fromdiseases,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- Schizophreniaspectrumandother 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 todelusions, 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 psychoticdisorders; part of another medical condition; or of another
specified diagnosis.
DSM 5 Criteriafor 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