Final Paper on Schizophrenia

Running Head: SCHIZOPHRENIA 1
Schizophrenia
Connie Butts
PSY 350 Physiological Psychology
Instructor: John Cosma
July 6, 2016

Schizophrenia
We live in a complex world with complex issues we face on a daily basis. We have to
juggle work, family life, friendships and casual acquaintances in a positive and respectful
manner although in many instances they may not do the same in return. It gets very perplexing
and confusing at times trying to keep things in a positive light when dealing with all of the stress
it can cause. These complexities become overwhelming at times for everyone but especially so
with those who suffer mental illness. There are a multitude of mental illnesses that could be
addressed and how they affect the sufferer and those around them, but I will be discussing the
one I consider most devastating to the sufferer and the people who care for them. The
neurophysiological disorder that will be discussed at this time is Schizophrenia. “Schizophrenia
refers to a major mental disorder, or group of disorders, whose causes are still largely unknown
which involves a complex set of disturbances of thinking, perception, affect and social behavior”
that is found worldwide thus presenting a serious public health problem (Barbato, n.d.). This
complex disorder fractures the mind of its sufferers and is difficult to diagnose in early stages
because it shares symptomology with other mental health disorders. Personally witnessing the
devastation it can cause in a patient’s life and those of family members has prompted me to
evaluate this disorder and its complexities. In discussing Schizophrenia I will investigate key
aspects of this psychological disorder, the diagnostic criteria that must be met before diagnosis,
why I chose to cover this disorder, the epidemiology of the disorder. Suspected causative factors
will also be discussed, nervous system systems affected by the disorder will be outlined along
with current treatment options that are available. Discussing Schizophrenia in this detailed
manner can enable more understanding of the disorder, alert loved ones of a potential mental

disorder in a person close to them, and thus help others to be more accepting of those affected by
Schizophrenia and their families.
Schizophrenia is a Psychological or psychotic disorder which results in the patient losing
contact with the environment due to deterioration in their level of function in everyday life. This
results in the disintegration of their personality, thoughts and feelings because they develop
delusions or hallucinations, resulting in their losing grip on reality which results in disturbances
in their behavior (Wilson, 2013). Since Schizophrenia is such a complex disorder diagnostic
criteria must be met before a patient can be assumed to suffer from the disorder.
In order for Schizophrenia to be diagnosed, according to the ICD-10 there must be a
minimum of one clear symptom from of the group of symptoms listed in sections A to D, or
symptoms from at least two of the groups listed from E to I and the symptoms must have been
present for one month or more. According to the DSM-IV, “there must be two or more of the
following, each present for a significant period of time for one month, or less if successfully
treated including delusions, hallucinations, disorganized speech, grossly disorganized or
catatonic behavior, or negative symptoms such as affective flattening, alogia or avolition
according to Schizophrenia and public health (Barbato, n.d.).
According to the ICD-10, the physical and psychological signs and symptoms that are
associated with Schizophrenia in sections A through D which require one clear symptom
include: a) Thought echo, thought insertion or withdrawal and thought broadcasting, b) delusions
of control, influence or passivity, clearly referred to body or limb movements or specific
thoughts, actions, or sensations; delusional perception, c) hallucinatory voices giving a running
commentary on the patient’s behavior or discussing the patient among themselves, or other types

of hallucinatory voices coming from some part of the body, d) persistent delusions of other kinds
that are culturally inappropriate and completely impossible, such as religious or political identity,
or superhuman powers and abilities such as being able to control the weather, or being in
communication with aliens from another world (Barbato, n.d.).
According to the ICD-10, the psychological symptoms that are associated with
Schizophrenia that require a combination of two or more for diagnosis to be made are found in
sections E thru I and include: e) persistent hallucinations in any modality, when accompanied
either by a fleeting or half-formed delusions without clear affective content or by persistent over-
valued ideas, or when occurring every day for weeks or months on end, f) breaks or
interpolations in the train-of-thought, resulting in incoherence or irrelevant speech, or
neologisms, g) catatonic behavior, such as excitement, posturing, or waxy flexibility, negativism,
mutism, and stupor, h) ‘negative symptoms’ such as marked apathy, paucity of speech and
blunting or incongruity of emotional responses, usually resulting in social withdrawal and
lowering of social performance; it must be clear that these are not due to depression or
neuroleptic medication, i) a significant and consistent change in the overall quality of some
aspects of personal behavior, manifest as loss of interest, aimlessness, idleness, a self-absorbed
attitude and social withdrawal.
According to the DSM-IV, the class A characteristic symptoms of Schizophrenia involve
two or more of the following, each present for a significant portion of time during a one-month
period, or less if successfully treated; 1) delusions, 2) hallucinations, 3) disorganized speech,
such as frequent derailment or incoherence, 4) grossly disorganized or catatonic behavior, 5)
negative symptoms such as affective flattening, alogia or avolition. Only one criterion A

symptom is required if the patient is experiencing delusions are bizarre or hallucinations that
consist of a voice keeping a running commentary on the behavior or thoughts of the patient or
two or more voices are conversing with one another (Barbato, n.d.).
In the DSM-IV the class B symptoms involve social/occupational dysfunction. For a
significant portion of the time since the onset of the disturbance, one or more major areas of
functioning such as work, interpersonal relations, or self-care are markedly below the level
achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve
expected levels of interpersonal, academic, or occupational achievement). In order for diagnosis
to be made there must be continuous signs of the disturbance for six months and during the six
month period there must be at least one month of symptoms, or less if successfully treated that
meet the criteria A symptoms which indicate the active phase of the disorder. Schizoaffective
and mood disorder must have been ruled out, relationship or pervasive developmental disorder
such as autism spectrum disorder must be ruled out, and substance abuse or medically induced
symptoms must be ruled out before diagnosis can be made (Barbato, n.d.).
Schizophrenia has a devastating effect on the sufferer, their families and the communities
to which they belong. It is pervasive in nature and difficult to diagnose in the early stages of the
illness, and those who happen to fall into the inner circle of those affected share the stigma and
exclusion that the patient suffers. It is sad, but people fear what they do not understand and thus
separate themselves emotionally and physically from it. Schizophrenia falls into the category of
things people fear because they do not understand the illness and how desperately those dealing
with it need support from their communities. This falls close to my heart because I had a close
family member who suffered from the disorder and thus have experienced firsthand the stigma

and exclusion it brings to the sufferer and their family members. This exemplifies the need to
bring clarity and understanding about the disorder as well as the epidemiology that is associated
with it.
According to the National Institute of Mental Health, Schizophrenia occurs in all ethnic
groups, occurs slightly more in males than females, and the symptoms usually start between the
ages of 16 and 30. Schizophrenia most commonly occurs in late adolescence and early
adulthood, uncommonly diagnosed after the age of 45 and rarely occurs in children (NIH, n.d.).
This shows Schizophrenia to be an indiscriminate attacker of male and female, young and old.
The incidence rate of Schizophrenia worldwide ranges between 0.1 and 0.4 per 1,000 in the
population and the incidences of Schizophrenia are remarkably similar in different geographical
areas. Since the incidence of Schizophrenia is found to be similar in different areas it is
commonly measured in terms of incidence and prevalence (Barbato, n.d.). Although it is a
condition commonly seen in young adults it has been diagnosed in young children and in adults
older than 45 years of age (Every Day Health, 2008). The only groups that seem to have a higher
incidence rate seem to be those who belong to disadvantaged social groups. Some of these
groups include ethnic minorities in Western Europe, such as Afro-Caribbean communities in the
United Kingdom and immigrants from Surinam in the Netherlands. Small groups showing a high
rate of prevalence were found in areas of northern Europe, in some segregated groups in North
America on the margin of the industrialized world such as indigenous peoples in Canada or
Australia. Higher incidences of Schizophrenia were also found in isolated areas where genetic
isolation is suspected or selective outmigration of healthier people may be found (Barbato, n.d.).
Since the epidemiology has been discussed we will proceed with a detailed description of the
disorder.

The signs and symptoms of Schizophrenia include a “decline in functioning and any two
of the following symptoms: delusions, hallucinations, disorganized speech or behavior, blunted
mood, or apathy after all organic causes of psychosis are ruled out” (Wilson, 2013). There are
five subtypes of schizophrenia which are diagnosed based on the most prominent symptoms
demonstrated. They are paranoid schizophrenia, disorganized schizophrenia, catatonic
schizophrenia, undifferentiated schizophrenia and residual schizophrenia which are included in
the DSM-IV. People are diagnosed on their most prominent symptoms (schizophrenic.com).
The characteristic features of Paranoid Schizophrenia are hallucinations and delusions.
These are typically auditory hallucinations and delusions of persecution or conspiracy that
usually revolve around a consistent theme. Those with Paranoid Schizophrenia generally have a
higher level of functioning than those of other subtypes and exhibit less disordered thinking and
behavior, therefore it is less obvious than the other subtypes of the disorder
(schizophrenic.com).
In Disorganized Schizophrenia the classic features are disorganization of the thought
processes, difficulty communicating effectively and is often seen in conjunction with emotional
impairment. Hallucinations and delusions may be absent or less pronounced than in Paranoid
Schizophrenia, and it develops gradually and at a younger age than the other subtypes. They may
have a great deal of difficulty with tasks related to daily living, such as bating and dressing
(schizophrenic.com).
The classic features seen in Catatonic Schizophrenia are disturbances in movement or
dramatic increase in activity. This subtype is very rare and sufferers may assume odd positions or

exhibit symptoms of echolalia where they repeat what others say, or echopraxia where they
mimic movements that others make. (schizophrenic.com).
In Undifferentiated Schizophrenia, the symptoms include positive symptoms such as
hallucinations or delusions but they are not specific enough to be classified as a subtype. This
subtype may be diagnosed in people with fluctuating or atypical symptoms. And Residual
Schizophrenia is diagnosed when the symptoms are less severe than those experienced when a
patient has Acute Schizophrenia (schizophrenic.com).
Once a person is diagnosed, treatment options should be presented to the patient.
According to the Mayo Clinic findings if schizophrenia is left untreated it can lead to severe
emotional, behavioral and health problems as well as legal and financial problems (mayo
clinic.org). When left untreated it is commonly seen that these patients become homeless, are
incarcerated, and tent to wander aimlessly without any clear purpose in life. With treatment and
therapy many of the positive and negative symptoms can be managed. Anti-psychotics that are
prescribed can alleviate positive symptoms such as delusions and hallucinations (National
Institute of Mental Health) as well as the negative symptoms and cognitive symptoms can be
reduced or eliminated. However, before they are treated they must undergo testing to make sure
an accurate diagnosis is made.
When presenting for an initial diagnosis for Schizophrenia the doctor will want to run
some tests that may rule out any medical conditions that have similar symptoms as those of
schizophrenia. Some tests that are done include a complete blood count (CBC), screens for
alcohol or drugs, and imaging studies such as an MRI or CT scan. Genetic testing may also be
ordered by the doctor. Then the patient undergoes a psychological examination to assess the

patient’s mental status by observing their appearance and demeanor and asking questions about
their thoughts, mood, delusions, hallucinations, substance abuse, and potential for violence and
suicide (mayo clinic.org). Most patients are not violent but many are suicidal. Risk factors for
suicide include delusions in major depression, hopelessness, loss of pleasure or interest, panic
attacks, anxiety symptoms, expression of suicidal ideation, presence pf paranoid delusions
together with apathy, and cognitive deficits in Schizophrenics (Singareddy, & Balon, 2001).
Ongoing management of schizophrenia include specialists offering recovery-oriented
psychotherapy, low doses of anti-psychotic medications, family education and support, case
management, and work or education support, depending on the needs and preferences of the
patient (Nauert, 2015). MRI or CT scans may be repeated at the discretion of the doctor,
dependent upon patient progress and prognosis. Although the exact cause or causes of
Schizophrenia are unclear, risk factors have been identified that are associated with the disorder.
For many years genetics have been a suspected risk factor in schizophrenia due to the
tendency of the disorder to run in families (Wilson, 2013). Studies have recently linked together
how a specific genome variant produces increased risk of developing the disorder. The C4 gene,
which encodes the complement protein C4, may increase risk by influencing synaptic pruning
during critical periods of brain development (Miller, 2016). Studies of endophenotypes have
termed schizophrenia as a complex genetic disorder in which multiple genes contribute to the
total risk of developing the disorder (Meaney, Szyf, Light, & Preston, 2005). However, genetics
alone cannot be identified as a defining cause. Lifestyle has also been linked to the development
of the disorder.

Lifestyle factors greatly into the risk factors for schizophrenia. Stress appears to be a
lifestyle factor that increases the risk of schizophrenia (Wilson, 2013). Living in a disadvantaged
social group increases stress and thus increases the possibility of developing the disorder
according to the Nations for Mental Health. Although lifestyle and genetics play a role in the
development of the disorder, environmental factors have also been identified as a risk factor.
Environmental factors in lower class neighborhoods present an increased possibility of
encountering occupational hazards, receiving poor maternal and obstetric care, higher possibility
of complications at birth, poor nutrition and high psychosocial stressors and can increase the risk
of developing schizophrenia. Also, the family environment if not conducive to good mental
health can increase the risk according to the Nations for Mental health. People and children
living under high stress conditions develop Schizophrenia at a higher rate than those who do not.
However, other contributors have been identified. The risk factors identified can be grouped into
three categories, which are predisposing factors, precipitating factors, and sociodemographic
characteristics.
Other than genetic factors there are other causative or risk factors which include alcohol
and substance abuse, smoking and non-genetic factors such as; fetal oxygen deprivation during
labor, exposure to certain viruses in utero or as an infant, such as rubella, flu, herpes and others. ,
early loss of a parent, childhood exposure to lead, childhood exposure to X-rays, childhood
isolation, growing up in stressful environments, such as urban areas, a stressful life situation, and
head injury or central nervous system injury can also contribute to the development of
Schizophrenia (Every day health, 2008). In order to understand why and how these causative

factors affect the brain we also need to understand which areas of the brain are affected and how
they are affected.
The nervous system structures and/or pathways involved include the increased size in
ventricles that hold the CSF which indicate brain structures are smaller, the prefrontal cortex,
hippocampus, and amygdala are smaller and have a decreased number of cells, gliosis, and a
disarray of pyramidal cell orientation in the hippocampus, and the thalamus is smaller (Wilson,
2013). These systems and structures can either be damaged by the progression of Schizophrenia
itself, or in utero after being exposed to disease, damaged by autoantibodies, toxins or x-rays.
It is widely known that autoimmune diseases can be triggered by environmental toxins.
Once the immune system engages to destroy those toxins sometimes it goes awry and the body
starts attacking its own tissues through the use of autoantibodies. “Schizophrenia and
autoimmune diseases have well established genetic propensities, and a combination of genes that
are thought to be responsible for their manifestations” and three autoimmune diseases that have
been associated with Schizophrenia are celiac disease, thyrotoxicosis, and hemolytic anemia
(Pandarakalam, 2015). Considering these commonalities, it is easy to understand how brain
structures can be damaged during growth in pregnancy that would make one susceptible to
Schizophrenia later in life. Then there is the damage that can be caused by toxins such as
alcohol, nicotine and various other sources such as x-rays. Although structural changes can be
seen in the brains of those with Schizophrenia, these systems are connected by neurotransmitters
and receptor systems that acquire regional imbalances in the dopamine system due to the
weakening of the system because the mesolimbic dopamine system is overactive in the
schizophrenic state. The overall dopamine levels found in those with Schizophrenia are within

normal limits but are severely imbalanced, between the mesocortical, mesolimbic, and the
nigrostriatal systems. Dopamine influences emotion and motivation in the mesolimbic system,
thinking and other cognitive processes in the mesocortical system, and movement in the
nigrostriatal system. (Wilson, 2013). Now that the brain structures and in areas include have
been discussed, we will now consider treatment options that are currently available.
When considering current treatment options for treating the symptoms of Schizophrenia,
prevention cannot be overlooked. Preventative interventions that are available include illness
prevention and health promotion. Illness prevention focuses on establishing specific
interventions for disorders by modifying one or more risk factors and aims at early identification
of individuals with prodromal or early symptoms in order to reduce morbidity through prompt
treatment. Health promotion models a psychosocial approach by combining the strategies of
community education programs about psychoses, integration of mental health services in primary
care, detection of Schizophrenic disorders by general practitioners and other community
agencies, and intensive home based assessment and interventions targeted toward people at risk
of developing the disorder (Barbato, n.d.).
Once the illness has been identified, Antipsychotic medications are prescribed to alleviate
or control the symptoms (NIH, n.d.). Conventional antipsychotic drugs are used to block
dopamine D2 receptors mostly in the mesolimbic and nigrostriatal brain areas to control
psychotic symptoms. These drugs induce side effects which include sedation and extrapyramidal
side-effects such as tremors, acute dystonias, akathisia, akinesia, stiffness and a shuffling gait.
They also cause tardive dyskinesia and anticholinergic effects such as dry mouth, blurred vision,
urinary hesitancy, and constipation. They can also cause cardiovascular effects such as

tachycardia and postural hypotension and endocrine effects such as amenorrhea, galactorrhea,
and breast enlargement in women and gynecomastia in men. Other side effects include weight
gain, skin and eye effects such as cutaneous rash, phototoxic shin reactions, pigmentary skin
changes, and granular deposits in the cornea and lens and neuroleptic syndrome which can be
fatal (Barbato, n.d.). Atypical antipsychotic medications such as Clozapine, Risperidone,
Olanzapine and Quetiapine can cause side effects related to physical movement such as rigidity,
persistent muscle spasms, tremors, and restlessness according to the National Institute of Mental
Health (NIH, n.d.).
Nonpharmacological therapies that are available are integrated cognitive and behavioral
interventions such as the Integrated Therapy Program (ITP) which address disordered cognitive
functions. It is divided into five subprograms which include cognitive differentiation, social
perception, verbal communication, social skills, and interpersonal problem solving. This program
is based on the need for psychosocial treatment for those with Schizophrenia to address the
deficiencies found in the disorder in order to educate them so they can function in a more normal
fashion (Brenner, Hodel, & Roder, 1990). Programs like this use a cognitive approach which
focuses on subjective response to dysfunctional thoughts or perceptions in order to modify the
beliefs that are associated with the delusions experienced by the patient. It aids the patient in
developing coping skills needed to manage the symptoms when they reoccur (Barbatos, n.d.).
These programs are organized and conducted by licensed Psychologists, Psychiatrists, and
Therapists. Many patients undergo diagnosis and initial care outpatient but in the most severe
cases diagnosis and initial treatment may take place in an inpatient setting. Although research of
Schizophrenia has led to more effective and safer ways to treat the disorder, advances are still
needed.

Imaging techniques such as the MRI, PET, CT scans and the fMRI are playing a crucial
role in identifying Schizophrenia, its metabolic processes and progression of the disease (Wilson,
2013). Future research will continue in order to more clearly identify the disorder before it
progresses along with Diffusion Tensor Imaging which has the ability to investigate the
structural integrity of white matter bundles in vivo (Whitford, Kubicki, & Shenton, 2011).
Genetic research will continue to determine the connection between Schizophrenia and
the C4 gene and other genes that are involved in cortical maturation, synaptic pruning,
neurotransmission, and other environmental tasks as well as genomic variants which increase the
risk of Schizophrenia (Miller, 2016), also more research will continue to fully understand how
the CHRNA5 allele is related to nicotine addiction in those with Schizophrenia (Hong, Wang,…
& Thaker, 2011).
A great deal of information has been covered regarding Schizophrenia. There was a clear
definition of what Schizophrenia is, Why it is important to understand the disorder, what it does
to the patient, the criteria that must be met to make a diagnosis and why that is important, how it
affects others as well as the sufferer, who gets it and how often, the characteristics of the
different subtypes of the disorder, how it progresses if not treated, the tests one can expect to
have done if Schizophrenia is suspected, the current treatment options that are available, the risk
factors that make a person susceptible to developing the disorder, causative factors were
discussed, the nervous system structures and neurological pathways affected, preventative
measures and education that is available, and the expected areas in which research can be
expected. Through education and discussions that enable understanding and insight into
Schizophrenia will cause the unknown to become known and alleviate the fear that causes

society to stigmatize the patients and their families and thus open up the way for acceptance
within societies throughout the world.

References
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Barbato, Angelo (n.d.) Schizophrenia and Public Health. Nations for Mental health. World
Health Organization. Retrieved from http://www.who.int/mental_health/media/en/55.pdf
Brenner, H. D., Hodel, B., & Roder, V. (1990). Integrated cognitive and behavioral interventions
in treatment of schizophrenia. Psychosocial Rehabilitation Journal, 13(3), 41-43. Doi:
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Health Talk staff (2008). 10 Key Questions about Schizophrenia. Every Day Health (2008
January 18). Retrieved from http://www.everydayhealth.com/schizophrenia/10-key-
questions-about-schizophrenia/what-is-schizophrenia.aspx
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