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Produce an informative document that will inform non-specialist readers of the causes and treatment of schizophrenia

1.0 INTRODUCTION

The term Schizophrenia was first used by Bleuler (1911). It was intended to mean ‘Split Mind’ or ‘Divided Self’. Clare (1976) stated that a person can be said to be suffering from Schizophrenia if they have at least one of the ‘first rank’ symptoms which are outlined below:

• Passivity experiences and thought disturbances (e.g. they may feel that they are not in control of their own behaviour)
• Auditory hallucinations in the third person (e.g. they hear voices in their head)
• Primary delusions or false beliefs (e.g. they may believe that they are being targeted by a certain group of people)

The potential consequences of Schizophrenia are both serious and wide ranging for the sufferer and those around them. As a result of this, a great deal of research has been conducted in order to investigate the different causes of, and the most appropriate treatments for, this mental illness. These will now be outlined in the following discussion.

2.0 CAUSES OF SCHIZOPHRENIA

The different factors which have been theorised to have a causal or contributory effect on the development of Schizophrenia will now be considered. In order to structure the discussion, the factors will be grouped with reference to Genetic/Biological factors, Individual factors and Environmental factors.

2.1 GENETIC/BIOLOGICAL FACTORS

Relatively early research in this field demonstrated that people may be genetically pre-disposed to suffering with Schizophrenia. For example, Kallman (1938) found that a person whose parents both suffered with Schizophrenia had a 68% probability of also suffering with Schizophrenia. However, a person whose parents did not suffer with Schizophrenia only has a 1% chance of suffering themselves. Kallman (1938) also reported that research which focused on monozygotic twins, i.e. identical twins which came from the same egg. If one twin has Schizophrenia and the twins are brought up together then the second twin has a 92% chance of also suffering with Schizophrenia. If the twins are brought up apart then the figure falls to 78%. Therefore, there does appear to be a genetic influence but the fact that there is a difference based on whether or not twins are brought up together demonstrates that other non-genetic factors have a significant part to play.

Biological causes of Schizophrenia have also been studied. Andreasen (1990) studied the MRI brain scan images of people with and without Schizophrenia and revealed that organic differences in these individuals’ brains do exist. Furthermore, Murray et al (1992) found that Schizophrenia was linked with perinatal brain injuries. This shows that biological factors do have a part to play in the development of Schizophrenia. However, they do not explain the whole story and other factors need to be considered.

2.2 INDIVIDUAL FACTORS

Other research has demonstrated that certain individual characteristics are associated with the subsequent development of Schizophrenia. One such project was conducted by Jones (1994) who studied 5362 people who were born in 1946. The following risk factors were identified:

• Delayed psychomotor development
• Speech problems
• Poor educational scores on verbal and non-verbal tests at ages 8, 11 and 15
• Preferred to play alone at ages 4 and 6
• Rated themselves as less socially confident
• Rated by teachers as being more anxious

Therefore, these individual factors appear to contribute and cause the subsequent development of Schizophrenia. They may be based on a combination of genetic/biological and environmental factors. When combined they are likely to increase a given individual’s chance of suffering with Schizophrenia.

2.3 ENVIRONMENTAL FACTORS

Factors which relate to the environment around an individual, and their family in particular, have also been shown to facilitate the development of Schizophrenia. Lidz and Fleck (1985) discussed the Double Bind Theory with reference to Schizophrenia and the family. It is argued that mixed messages are given to children and that this may lead to confusion and communication difficulties which ultimately increase the chance that an individual will suffer with Schizophrenia. Further research with the family was conducted by Rosenfarb et al (1995). This research found that ‘expressed emotions’ are a key consideration. The more expressive the family environment is, the more likely it is that a child within that environment will subsequently suffer with Schizophrenia. Therefore, these environmental factors have the potential to cause Schizophrenia.

3.0 TREATMENT OF SCHIZOPHRENIA

As a result of the various potential causes of Schizophrenia, a variety of different treatments have been developed. The structure of grouping the options into Genetic/Biological, Individual and Environmental approaches will again be adopted.

3.1 GENETIC/BIOLOGICAL TREATMENTS

Since the introduction of Phenothiazines in the 1960s, medication has played a central role in the treatment of Schizophrenia (Fenton 2000). They attempt to tackle the symptoms of Schizophrenia at the biological level with the ultimate aim of having a positive effect on the patient’s behaviour. A more drastic approach which is still used today is Electro-Convulsive Therapy (Greenblatt 1977). This involves sending electrical shocks through the patient’s brain with the objective of ‘re-setting’ the brain and to try and remove the Schizophrenic tendencies. Therefore, two of the treatments which relate to this category are medication and Electro-Convulsive Therapy. The future may also provide treatments which are based on genetics but as yet such approaches remain at the preliminary and theoretical stage.

3.2 INDIVIDUAL FACTORS

A range of one-to-one approaches for the treatment of Schizophrenia have been developed. Social Skills training is intended to train and re-train the patient’s motor and interpersonal skills (Bradshaw 1995). This can help them manage their symptoms and to play a more effective role in society. Other therapeutic techniques have been advocated. The Psychodynamic approach has been used to address issues within the patient’s sub-conscious and to change the factors which under-pin the illness. Cognitive Behavioural Therapy has also been used to treat Schizophrenia (Thornicroft and Susser 2001). By changing the way in which a patient thinks about different situations, it aims to change their behaviour and to help them cope with their distressing symptoms. Thus, a range of one-to-one techniques are available to treat the individual who suffers with Schizophrenia.

3.3 ENVIRONMENTAL TREATMENTS

These treatments are aimed at addressing the environmental factors which effect a patient with Schizophrenia. Beels (1981) discussed Social Support which aims to provide the appropriate backing for the patient to help them better manage and cope with their mental illness. Also, Family Therapy has been advocated as a more effective therapeutic approach than those which focus on the patient (McFarlane et al 1995). By taking a family focussed approach, those around the individual can be educated such that they can help them with their mental illness. These approaches help to change the environmental factors which can help cause and contribute to their mental illness.

4.0 CONCLUSIONS

This discussion has considered the topic of Schizophrenia. It has demonstrated that a range of Genetic/Biological, Individual and Environmental factors all have a part to play. It is difficult to accurately assess the size of the effects which are associated with these factors but they all appear to have the potential to increase a person’s chances of suffering with Schizophrenia. As a result of these different causes, a range of different treatments have been developed. Although medication currently plays a key role within treatment programmes, it does not appear to address all of the relevant problems (Garety et al 2000). The most appropriate approach is likely to create a treatment programme which includes elements from those discussed within the Genetic/Biological, Individual and Environmental treatment sections. The causes and treatments of Schizophrenia need to be considered via a multi-disciplinary approach if the most comprehensive and accurate understanding is to be facilitated.

5.0 REFERENCES

Andreasen, N (1990) Magnetic resonance imaging of the brain in schizophrenia. Archive of Genetic Psychiatry, 47, 35-44.
Beels C. (1981) Social support and schizophrenia. Schizophrenia Bulletin. ;7:58-72.
Bleuler, E. (1911) Dementia Praecox or the group of Schizophrenias. New York: International University Press

Bradshaw, T (1995) Psychological Interventions with psychotic symptoms: a review, Mental Health Nursing, Vol 15, No.4

Clare, A. (1976) What is Schizophrenia? New Society, 4, pp 10-12

Fenton, W.S. (2000) Evolving perspectives on individual psychotherapy for schizophrenia. Schizophrenia Bulletin, 26(1): 47-72.
Garety, P. A., Fowler, D., & Kuipers, E. (2000) Cognitive-behavioural therapy for medication-resistant symptoms. Schizophrenia Bulletin, 26(1): 73-86.
Jones, P. (1994) Child development risk factors for adult schizophrenia in the British 1946 birth cohort. Lancet, 344, 1398-402.
Kallman, F. (1938) The Genetics of Schizophrenia. Locust Valley, New York: J J Austin Inc.

Lidz, T. and Fleck, S. (1985) Schizophrenia and the Family. New York: International Universities

McFarlane, W.R. (1995) Multiple-Family Groups and Psycho education in Treatment of Schizophrenia. Archive of Genetic Psychiatry, 52, 679-687.

Murray, RM, Jones, P, O' Callaghan, E (1992) Genes, viruses and neurodevelopmental schizophrenia. Journal of Psychiatric Research. 26 (4), 225-35.
Rosenfarb, I. S., Goldstein, M. J., Mintz, J., & Nuechterlein, K. H. (1995). Expressed emotion and sub-clinical psychopathology observable within the transactions between schizophrenic patients and their family members. Journal of Abnormal Psychology, 104, 259-267.
Thornicroft, G. & Susser, E. (2001) Evidence-based psychotherapeutic interventions in the community care of schizophrenia. British Journal of Psychiatry, 178: 2-4.