Medical explanations of schizophrenia

1. BY-DR. ARMAAN SINGH

2. The psychological disorder of schizophrenia represents at once the
misconceptions of the past, the solutions of the present, and the
promise of the future. Indeed, Nevid & Rathus (2005) admit that the
expression “schizophrenia” is a broad term that can be used to
describe a wide variety of human behavior and psychological
dysfunctioning. The variety of symptoms that represent this disorder
range from hallucinations to paranoia. There are also several different
types of diagnosed schizophrenia, including the catch-all category of
undifferentiated schizophrenia. Furthermore, the biological,
psychological, and sociocultural approaches to psychology aid in the
understanding of the underlying causes associated with the disorder.
Lastly, the treatment, or in some cases attempted treatment, of
schizophrenia encompasses a wide range of solutions including
antipsychotic drugs and in the past the use of asylums. As it is,
schizophrenia is a complex disorder caused by a yet unknown
combination of factors that underlie an obvious set of symptoms which
can usually be treated successfully through the combination of drug
therapy and psychotherapy/community treatment.

3. 2.5 Million
Currently in
U.S.
2.5 Million
Currently in
U.S.
Current Stats on Schizophrenia…
1 Out of 100
Worldwide
1 Out of 100
Worldwide
Affects Men and
Women Equally
Affects Men and
Women Equally
3% of
Divorced or
Separated
3% of
Divorced or
Separated
1% of Married1% of Married
2% of Singles2% of Singles

4. In laymen’s terms schizophrenia is most closely associated
with what most people would consider insanity (i.e.
hallucinations, delusions, etc…). Currently an estimated 2.5
million people suffer from schizophrenia in the U.S. and nearly
1% worldwide (Nevid & Rathus, 2005). Additionally, more
divorced and separated people suffer from schizophrenia than
single and married individuals. Of course it is difficult to
ascertain whether schizophrenia is a cause or effect in a
divorce or separation. Oddly enough equal numbers of both
men and women are affected by schizophrenia. I say oddly
enough because higher numbers of women suffer from
depression and higher numbers of men suffer from substance
abuse, both implicated as correlates to schizophrenia.
Moreover, the most telling sign of schizophrenia is psychosis or
the loss of contact with reality (Nevid & Rathus, 2005).
However, before a discussion of the diagnosis and treatment of
schizophrenia can progress a solid foundation of symptoms
must be constructed…

5. Hallucinations a Positive
Symptom of Schizophrenia
Major Divisions of Symptoms
 Positive Symptoms
 Negative Symptoms
 Psychomotor Symptoms

6. The symptoms of schizophrenia can be categorized into three wide-ranging
groups. The first group comprises the positive symptoms which are usually
characterized as pathological excess (Nevid & Rathus, 2005). This group is
characterized as a pathological excess because the symptoms in this group
add to a person’s behavior rather than subtract from a person’s behavior.
Positive symptoms include delusions; specifically delusions of persecutions,
delusions of reference, delusions of grandeur, and delusions of control. The
first category of symptoms also include disorganized thinking and speech
expressed as loose associations (derailment), neologisms or made-up words,
preservation, and clang (rhyming). Furthermore, positive symptoms can be
expressed through heightened perceptions, hallucinations, and memory loss.
Lastly, some that suffer from schizophrenia exhibit a behavior called
inappropriate affect which is characterized by emotions that are inappropriate
for a given situation. The second division of the symptoms of schizophrenia
include the negative symptoms or pathological deficits. These symptoms
inhibit a person’s behavior significantly and include poverty of speech (alogia),
blunt and flat affect characterized by blunted emotional responses or no
emotional response, loss of volition (avolition), and social withdrawal. Lastly,
the category of psychomotor symptoms entail awkward movements, repeated
gestures, and even catatonia. The symptoms for schizophrenia seem to be
pretty straightforward; however, the diagnosis of this disorders is not always
so cut-and-dry…

7. Schizophrenia Presentation 4
Undifferentiated Schizophrenia
Types of Schizophrenia
 Disorganized
 Catatonic
 Paranoid
 Undifferentiated
 Residual

8. The DSM-IV allows the diagnosis of schizophrenia only after six or more months of
continued symptoms (Nevid & Rathus, 2005). A decay in work, social relations, and
the ability to take care of oneself must also be observed in order to issue a diagnosis
of schizophrenia. There are five distinct types of schizophrenia which can be
diagnosed and include disorganized schizophrenia, catatonic schizophrenia,
paranoid schizophrenia, undifferentiated schizophrenia, and residual schizophrenia.
The first category of disorganized schizophrenia entails the symptoms of
incoherence, confusion, and inappropriate affect. On the other hand, catatonic
schizophrenia is characterized mainly by either catatonic stupors or catatonic
excitement. Maybe the most well known form of schizophrenia, paranoid
schizophrenia includes, “an organized system of delusions and auditory
hallucinations that may guide [the patient’s life]” (Nevid & Rathus, 2005, p. 360).
Next, the diagnosis of undifferentiated schizophrenia is used for a person whose
symptoms do not fall neatly into one of the aforementioned categories. The category
of undifferentiated schizophrenia is however sometimes vaguely defined and as a
result can be overused. Lastly, residual schizophrenia refers to a person whose
symptoms have lessened in strength and number. (i.e. residual symptoms)
Furthermore, separate from these categories someone suffering from schizophrenia
can be classified with either Type I schizophrenia or Type II schizophrenia. Type I
schizophrenia is reserved for those that are subject to mostly positive symptoms, and
Type II schizophrenia is set aside for those that are subject to more negative
symptoms. Now that the foundation of symptoms and diagnosis has been satisfied a
more inclusive look at the different psychological perspectives can be appreciated…

9. Schizophrenia Presentation 5

10. As with most psychological disorders, the first person to offer an intact theoretical
framework from which to understand schizophrenia was Freud (Nevid & Rathus, 2005). His
psychodynamic theory suggests that schizophrenia is caused by a cycle of regression to
primary narcissism and the restoration of ego control/connection with reality. However, as
is the case with most psychodynamic theories Freud does a superb job of explaining the
situation but has only limited success in the treatment of the disorder. On the other hand,
the biological view has had great success in explaining schizophrenia through genetic
factors, biochemical abnormalities, abnormal brain structure, and viral problems.
Furthermore, the cognitive approach hypothesizes that most of the characteristics of
schizophrenia are produced when a person tries to compute or understand the unusually
sensations that usually accompany the onset of the disorder. Lastly, the sociocultural view
takes into account the factors of social labeling and family dysfunctioning when considering
the disorder. Of particular interest is the social labeling aspect of the sociocultural view of
schizophrenia. Social labeling explains that some of the symptoms of schizophrenia might
be a result of the diagnosis itself, thereby affecting how a diagnosed person views
themselves and how other people treat that person. Collectively, the diathesis-stress view
suggests that schizophrenia is caused by a biological predisposition coupled with certain
types of stress. With an understanding of the symptoms, the possible diagnosis, and the
viewpoint of different psychological perspectives in hand all that is left are the possible
treatments…

11. Common Misconceptions…
 Institutional Care
 Antipsychotic Drugs
 Psychotherapy
 The Community Approach
Types of Treatment

12. Prior to 1793, when Pinel “unchained the insane”, those that suffered from schizophrenia were
considered beyond help (Nevid & Rathus, 2008). Asylums were used before Pinel to house and take
care of the insane rather than to attempt any time of rehabilitation. In fact, one of the main focuses of
the asylum was to simply keep the insane off the streets. However, that all changed with the
introduction of the mental hospital or state hospital. These facilities viewed those with psychological
disorders as people that were to be treated with sympathy and kindness rather than just discipline
and containment. Unfortunately by 1955 these hospitals were overcrowded and understaffed which
led to chronic wards (basically asylums) and even lobotomies. Fortunately it was during the 1950’s
and 60’s that the treatments of milieu therapy and token economy programs were developed. Milieu
therapy, which is based mostly on the precepts of the humanistic approach, puts the patients in a
situation where they are expected to make their own decision within the framework of an institutional
organization. Token economy therapy on the other hand encourages a system of rewards
represented by tokens which can be used by the patients to buy things or to purchase preferred
activities. Furthermore, during this same time period antipsychotic drugs were discovered. These
first antipsychotic drugs (neuroleptics or convention antipsychotics) carried with them many side-
effects, such as extrapyramidal effects and tardive dyskinesia, and did not treat Type II
schizophrenic symptoms well. Nonetheless, these drugs were moderately affective in treating the
symptoms of and even in some cases curing schizophrenia. In recent years though new
antipsychotic (atypical) drugs have been developed that have far fewer side-effects and treat a wider
range of Type I and Type II schizophrenic symptoms. The success rates are also much higher with
atypical antipsychotics than with conventional antipsychotics. In addition, certain types of
psychotherapy, such as insight therapy, family therapy, family support groups, family
psychoeducation programs, and social therapy (personal therapy), have been successful when used
in conjunction with antipsychotic drugs. Lastly, a more modern extrapolation of psychotherapy and
state hospitals is the community approach. By using assertive community treatments, such as
coordinated services, short-term hospitalization, supervised residences, and occupational training,
the number of people in institutional care in the U.S. has dropped from close to 600,000 in 1955 to
60,000 today (Nevid & Rathus, 2005). Even though these programs have their drawbacks when
coupled with psychotherapy and/or antipsychotics they seem to be the most effective approach to
long-term psychological disorders to date. The progression of the treatment of schizophrenia has
progressed over the centuries from simple straight-jackets and beatings to long-term, community-

13. “If you talk to God,
you are praying;
if God talks to you,
you have schizophrenia”
(Szasz, n.d., p. 1).
“If you talk to God,
you are praying;
if God talks to you,
you have schizophrenia”
(Szasz, n.d., p. 1).

14. It is clear now, through the use of genetic linkage studies and
microbiology, that schizophrenia does indeed have a biological
explanation (Nevid & Rathus, 2005). However, the biological explanation
is only part of the story. A yet unknown combination of intense stress,
sociocultural situations, and cognitive processes may lead to the actual
onset of schizophrenia aided by biological precursors. The most
compelling explanation seems to be that a genetically inherited biological
abnormality gives rise to hallucinations/delusions as a result of intense
stress and eventually leads to other negative symptoms in reaction to the
hallucinations/delusions. At any rate, the current understanding of
schizophrenia explains that the symptoms, however easily identifiable,
are the result of a complex interaction between nature and nurture that
can be treated adequately through the use of atypical antipsychotic
drugs and psychotherapy/community treatment.