In the previous article I have discussed in detail about all the important things about schizophrenia that you need to know including its introduction and symptoms so in this article you will come to know that what are the possible causes of schizophrenia and how can we treat the person with schizophrenia.
Etiology/Causes of Schizophrenia
1. Inherent (genetic) Causes
Biological tendency sets a stage for schizophrenia in some people when they face extreme stress later in their lives, usually during late adolescence or early adulthood. There are 3 studies support the genetic view;
- Twins with schizophrenia
- Relatives of people with schizophrenia
- Schizophrenic people who are adopted
2. Role of neurotransmitters (Dopamine hypothesis)
Dopamine hypothesis explain the findings of researchers on schizophrenia. Positive symptoms of schizophrenia produced due to neurotransmitter Dopamine. Dopamine fire too often by some neurons and transmit too many messages that produces hallucinations and delusions.
L-dopa is a medication used to treat Parkinson’s disease so, some people with Parkinson’s disease develop schizophrenia-like symptoms if they take too much L-dopa, because this medication raises Parkinson’s patients’ dopamine levels.
Dopamine hypothesis has also supported by the research on amphetamines. Amphetamines are drugs that excites or stimulates the CNS (central nervous system). High doses of amphetamines may develop amphetamine psychosis (a syndrome very similar to schizophrenia). Amphetamine psychosis can be reduced by antipsychotic drugs just as symptoms of schizophrenia reduces by antipsychotic drugs. Ultimately investigators learned that amphetamines and similar stimulant drugs increase dopamine activity in the brain, thus producing schizophrenia-like symptoms.
There are five kinds of dopamine receptors in the brain called the D-1, D-2, D-3, D-4, and D-5 receptors and traditional antipsychotic drugs like phenothiazine’s mostly binds with D-2 receptor.
Precise role of dopamine:
Researchers later found a new group of antipsychotic drugs, initially referred to as atypical antipsychotic drugs and now called second-generation antipsychotic drugs, which are consider more effective than the traditional ones. These new atypical antipsychotic drugs bind not only to D-2 dopamine receptors, like the traditional antipsychotic drugs, but also to many D-1 receptors and to receptors for other neurotransmitters such as serotonin. So, it may be consider that schizophrenia is related to abnormal activity or interactions of both dopamine and serotonin and possibly other neurotransmitters (glutamate and GABA) as well, rather than to only abnormal dopamine activity.
Some theoreticians claim that excessive dopamine activity contributes primarily to the positive symptoms of schizophrenia such as delusions and hallucinations. So, it turns out that positive symptoms respond well to the conventional antipsychotic drugs, which bind so strongly to D-2 receptors, whereas some of the negative symptoms (such as loss of volition and restricted affect) respond best to the second-generation antipsychotic drugs, which bind less strongly to D-2 receptors. Still other studies suggest that negative symptoms may be related primarily to abnormal brain structure, rather than to dopamine over activity.
Abnormal Brain Structure
Schizophrenia cases dominated by negative symptoms, have been linked to abnormalities in brain structure. Brain scans reports have found that many people with schizophrenia have enlarged ventricles. Although, patients who have enlarged ventricles tend to be more poorly adjusted socially and have more cognitive disturbances before the onset of schizophrenia, and to respond less well traditional antipsychotic drugs. In some cases of schizophrenia people also have smaller frontal and temporal lobes than other people, smaller amounts of gray and white matter and abnormal blood flow either heightened or reduced in certain areas of the brain. Still other studies have linked schizophrenia to abnormalities of the amygdala, hippocampus and thalamus.
3. The Psychodynamic Reasons
Freud proposed two psychological processes that causes schizophrenia. These are:
- Regression to a pre-ego stage
- Attempts to rebuild ego control.
He believed that some people regress to the earliest point in their development, to the pre-ego state of primary narcissism, in which they recognize and meet only their own needs when their world has been extremely harsh or withholding. For example, when their parents have been or un-nurturing and cold or when they have experienced severe traumas. This sets the stage for schizophrenia. Regression to earlier stage leads to self-centered symptoms such as, loose associations, neologisms and delusions of grandeur. After some time when they then try to reestablish ego control and contact with reality, their struggles give rise to yet other psychotic symptoms. When person’s attempt to substitute for a lost sense of reality, they may experience auditory hallucinations.
Other studies have also found that people with schizophrenia went through severe traumas or stress early in their lives. People who develop schizophrenia have mothers who may appear domineering, cold and dispassionate in their children’s needs. Mother may appear overprotective and rejecting, they puzzle their children and set the stage for schizophrenic functioning. Those mothers are called schizophrenogenic (schizophrenia-causing) mothers by the researchers. Elsewhere these findings, however, Freud’s explanation for the disorder has received little research support.
4. The Behavioral View
According to behaviorists usually operant conditioning and principles of reinforcement are the cause of schizophrenia. They explain that some people are not reinforced for their attention to social cues, either because important figures in their lives are socially inadequate or because of unusual circumstances. As a result, they stop attending to such cues and focus instead on irrelevant cues as a bird flying, brightness of light in a room, or the sound of a word rather than its meaning. Their responses become increasingly bizarre, as they show up more and more to inappropriate cues. Because the inappropriate or bizarre responses are rewarded with attention or other types of reinforcement, they are likely to be recurrent again and again.
5. The Cognitive View
The brains of people with schizophrenia are actually producing strange and unreal sensations during hallucinations and related perceptual difficulties. These people turn to friends and relatives when first confronted by voices or other troubling sensations. Logically, the relatives and friends deny the reality of the sensations and ultimately the victims conclude that the others are trying to hide the truth. They start to reject all feedback and some acquire beliefs (delusions) that they are being persecuted. According to this theory, in short people with schizophrenia take a “rational path to madness.”
Treatments
Schizophrenia can be treated in three ways:
1. Institutional Care or Milieu therapy
On the basis of humanistic approach to institutional treatment, institutions can help patients recover by creating a climate that promotes responsible behavior, self-respect and meaningful activity.
2. Antipsychotic Drugs
- Phenothiazines
- Chlorpromazines
- Neuroleptic drugs or Conventional antipsychotic drugs
The conventional drugs are also said to be neuroleptic drugs because they often produce undesired movement effects similar to the symptoms of neurological diseases. Among the best known conventional drugs are
- Thioridazine (Mellaril)
- Fluphenazine (Prolixin)
- Trifluoperazine (Stelazine)
- Haloperidol (Haldol)
Second-generation (atypical) antipsychotic drugs
The most widely used of these newer drugs are:
- Risperidone (Risperdal)
- Clozapine
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- Aripiprazole (Abilify)
- Ziprasidone (Geodon)
Second-generation antipsychotic drugs appear to be more effective than the conventional drugs. Because the new drugs decrease not only the positive symptoms of schizophrenia, but also the negative one.
3. Psychotherapy
Psychotherapy is successful in many more cases of schizophrenia now a days. By helping to relieve perceptual disturbances, antipsychotic drugs allow people with schizophrenia to learn about their disorder, think more openly about themselves and their relationships, make alterations in their behavior and cope with stressors in their lives. The most useful practices of psychotherapy include cognitive-behavioral therapy and two sociocultural interventions: family therapy and social therapy. These various approaches often used in combination.
Cognitive-behavioral therapy
A growing number of clinicians now pay a cognitive-behavioral treatment for schizophrenia that is designed to help change how people and react and view to their hallucinations. The therapists use a combination of cognitive and behavioral techniques:
1. Therapist offer clients with education and proof about the biological causes of hallucinations.
2. They help clients learn more about the “comings and goings” of their own hallucinations and delusions. The clients acquire to identify which kinds of situations and events trigger the voices in their heads.
3. Therapist challenge the Clients’ incorrect ideas about the power of their hallucinations, such as the idea that the voices are uncontrollable and powerful and must be obeyed. Therapist challenge the client’s idea for example by saying ‘what happens, for example, if the clients occasionally repel following the orders from their hallucinatory voices?
4. The therapists teach clients to interpret their hallucinations more accurately. Clients may, for example, adopt and apply alternative conclusions such as “It’s not a real voice, it’s my illness.”
5. Clients learns techniques for coping with their unpleasant sensations (hallucinations). They may, for example, acquire ways to ease the physical arousal that accompanies hallucinations—using special breathing and relaxation techniques, positive self-statements. Similarly, they may learn to distract or refocus themselves whenever the hallucinations happen.
These cognitive and behavioral techniques often help schizophrenic people feel more control over their hallucinations and reduce their delusional ideas. But they do not eliminate the hallucinations.
Family therapy
Over 50 percent of those who are getting better from schizophrenia and other severe mental disorders live with their families: spouses, parents, siblings or children. Such situations create special pressures; even if family stress was not a factor in the onset of the disorder, a patient’s recovery may be strongly influenced by the behavior and reactions of his or her relatives at home. Generally speaking, people with schizophrenia who feel positive toward their relatives do better in treatment.
The families of people with schizophrenia and other severe mental disorders may also turn to family support groups and family psycho-educational programs for encouragement and advice. In such programs, family members meet with others in the same situation to share their thoughts and emotions, provide mutual support, and learn about schizophrenia.
Social therapy
Numerous clinicians consider that the treatment of people with schizophrenia should include practices that discourse personal and social difficulties in the clients’ lives. These clinicians offer practical advice; work with clients on memory enhancement, problem solving, decision making, and social skills. They also make sure that the clients are taking their medications properly and may even help them find work, appropriate health care, and proper housing.
Among the patients on medication, those who also received social therapy adjusted to the community and avoided re-hospitalization most successfully. Clearly, social therapy played an important role in their recovery
