Schizophrenia as a Public Health Concern 1

Schizophrenia as a Public Health Concern

Brooklyn Swearingen

Mel and Enid Zuckerman College of Public Health, University of Arizona

HPS 405: Biology in Public Health

Dr. Jennifer King

March 1, 2024
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Biology:

Schizophrenia is a very complex condition, with the root cause being unknown. This

being said, scientists have hypothesized many causes and brain processes that may impact this

disease occurring and being triggered. Dopamine, in addition to how illness presents in the

integral nervous system and the limbic system, has been tied to generating symptoms. One of the

symptoms of Schizophrenia is psychosis. The idea of antipsychotic drugs reducing psychotic

symptoms led scientists to hypothesize that an overactive dopaminergic system could be a

leading cause of this illness. There is a theory surrounding a cerebral defect underlying abnormal

eye movement being the cause of this side effect. This implies that both the posterior parietal

cortex and the middle frontal cortex may be dysfunctional with this illness, which can be backed

up by the lack of smooth pursuit movements and saccadic eye movements (Tamminga; Medoff,

2000). Once again, there is a lot of information unknown of whether it is a cause or simply a

byproduct of Schizophrenia, however, it has been researched that those with this illness have

enlarged cerebral ventricles, and structural imaging has found volume decreases in the superior

temporal gyrus and reduced prefrontal cortical blood flow. Antipsychotics targeting the

prefrontal regions have been shown to reduce the negative symptoms of Schizophrenia

(Tamminga; Medoff, 2000).

The basal ganglia contains neurotransmitters significant to frontal cortical function. An

abnormality in this process could easily alter function, and in turn, cause this illness in patients

(Tamminga; Medoff, 2000). Once again, this biology has been linked to Schizophrenia, however,

the known cause has not been proven, only hypothesized. There may be future progress

discovered using brain imaging and conducting experiments with human postmortem tissue.
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Stress is a main trigger of psychological events, and matters such as divorce, loss of a

job, abuse, and workplace issues could all be a reason for Schizophrenic patients to have their

condition worsen, or become prevalent. (NHS, 2023) Nutrition is another factor to take into

consideration, specifically during fetal development. Data from the Dutch Hunger Winter

showed a nearly two-fold increase in the number of offspring that were later diagnosed with this

condition, with a controlled study excluding variables such as education and ethnicity from being

factors. (McGrath, 2016)

Epidemiology of Condition:

As discussed in the biology of Schizophrenia, the cause of this condition is unknown.

Scientists speculate that it may be caused by a combination of genetic conditions, in addition to

brain chemistry and environmental issues (Mayo Clinic Staff, 2020). Specifically tied to brain

chemistry, the cause may be related to improper neurotransmitter function in the basal ganglia or

other dysfunction within the nervous system in terms of the prefrontal cortex and the superior

temporal gyrus (Tamminga; Medoff, 2000). The studies surrounding the causes of Schizophrenia

focus on genetics, however, scientists are still working on knowledge progression, with hopes to

discover more data on the human genome’s genetic information to progress treatment and

diagnosis (Tamminga; Medoff, 2000). A study was done on both identical twins and fraternal

twins to see if identical genetic information was tied to the likelihood of developing

Schizophrenia. This test determined that if one identical twin had this condition, the odds of the

other twin having it was one in two. This was compared to non-identical twins, where the

likelihood decreased to one in eight. It is assumed that the cause relates to a specific combination
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of genes, not a single one, however, the genes present that would lead to this illness have yet to

be discovered. (NHS, 2023).

Schizophrenia occurs in one in every 300 people (0.32%) worldwide, making it not as

prevalent as other mental disorders, yet its effects are devastating (WHO, 2022). Some risk

factors include having a family history of this condition, irregularities during fetal development,

pregnancy complications, and psychoactive drug use during teenage years and young adulthood

(Mayo Clinic Staff, 2020). There is some information surrounding whether or not drug use

causes Schizophrenia, however, it is not proven. It is a possibility that those with this illness may

be more susceptible to addiction, and more likely to participate in drug experimentation and

abuse (NHS, 2023).

A study done by Taiyuan University of Technology showed abnormal spatiotemporal

patterns within Schizophrenic patients, indicating that there are irregularities and inconsistencies

within communication between brain regions. A majority of these patients had lower spatial

overlap than those not diagnosed with Schizophrenia. Lastly, there was lower temporal overlap

in nodal pairs (Xiang, 2023).

Low-income populations face larger disparities in terms of affording treatments and

diagnosis, however, there are a large number of communities more at risk for this illness to

develop. Those who experience childhood trauma in the form of the loss of a parent, childhood

abuse, parental substance abuse, and poverty are three times as likely to develop Schizophrenia

and episodes of psychosis later in life. Childhood trauma, although not present in all individuals

with this disease, can cause worsened symptoms, and a decreased likelihood of remission. The

Social Defeat Theory has also connected immigrants as having a higher risk of obtaining

Schizophrenia, as they face social isolation, are not integrated into communities, and are more
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likely to face poverty, alienation, and social uprooting. This is similarly the case with individuals

in a school environment who are of a different ethnicity than the majority of the school’s

population, as this mimics the social uprooting and lack of integration. (Davis, 2016)

Implications of the socioecological model on the condition:

Diagnosis of Schizophrenia has many consequences for a patient. Looking first at

mortality, the life expectancy for someone with this condition is 15 years lower than for someone

without it. With time, this statistic has remained the same, meaning that all public health impacts

have failed to improve the length of the individual’s life. With this, the person with

Schizophrenia is also very likely to face hardships in their day-to-day life, even while on a

treatment plan. Only 10% of patients are employed, and they are rarely able to start a family due

to external judgment, internal self-consciousness, fertility problems, etc (Kahn, 2020). Delusions

and Hallucinations pose difficulty for those close to these patients. It can be difficult to navigate

these symptoms and remain close to their loved ones. This illness also results in increased

self-esteem issues and confidence, as well as causes concern for suicidal ideation. With stigma, it

is hard to get and maintain a job and relationships following a diagnosis and symptom onset,

specifically in times of psychosis. It is vital to encourage patients to follow treatment plans and

stick to medication and therapy schedules (Arthur, 2021).

In society, the stigma surrounding Schizophrenia and mental illness as a whole can lead

to isolation from social groups and family members. Public health professionals should ensure

that there is no misinformation adding to this stigma, and support educational programs that can

lead to patients being able to successfully integrate into society. Public health professionals must
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also reduce barriers to access to treatments, and ensure that they are both affordable and

attainable to all patients, regardless of ability to pay for services.

Two programs or interventions:

One program that assists with addressing this health condition and the disparities that

occur in patients with a low income is the PAN Foundation. This organization is beginning a

partnership with the Schizophrenia & Psychosis Action Alliance, which would help patients find

support services. Other than this partnership, this program provides immense support financially

to individuals. PAN’s Schizophrenia Assistance Program gives patients a 12-month grant to pay

for treatments such as co-pays, out-of-pocket medication costs, deductibles, etc. This grant totals

$3,100 per year for those who qualify. The benefit of this program is providing individuals with

the ability to maintain and obtain treatments without financial barriers. Having this program is

better than previously, where the co-pay and medication costs would have to be paid out of

pocket by the patient. A downside of this program is the eligibility guidelines. Patients must be

already receiving treatments, be insured by Medicare, and fall at or below 400% of the federal

poverty level (PAN Foundation, 2021). This excludes those who do not fall into this category and

does not assist individuals who have difficulty affording an initial diagnosis or beginning

treatment out of pocket. This has been effective at the individual level of the socioecological

model, as access to therapy improves areas of well-being and overall mental health and

confidence in building and maintaining relationships.

On the public policy and societal side of the socioecological model, there are policies in

place allowing individuals to apply to receive disability pay if they cannot work due to their

condition. The benefits of this program are allowing the patient to receive financial assistance,

for them to continue affording housing and life expenses. This is progress, as it recognizes
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mental health conditions as diseases, rather than just physical conditions. There are a lot of

downsides to this intervention, however, to qualify, there are a lot of criteria. First, the patient

must have a condition that affects their ability to work, and they must have worked enough in the

past, and recently, to receive Social Security Administration (SSA) benefits. In addition to this,

there are Blue Book criteria specifically for those with Schizophrenia. Everyone who receives

assistance must experience either delusions or hallucinations, disorganized thinking, or grossly

disorganized behavior. They also need to fall into one of the next two categories. First, they must

have extreme limitations in interactions, memory, concentrating, applying information, or

self-adapting. Secondly, they could receive assistance if they have a documented medical history

of Schizophrenia over the past two years including related medical treatment, mental health

treatment, or psychosocial support (Santhakumar, 2022). The barriers with this criteria are the

difficulty a patient could face if undiagnosed, or if the SSA warrants the patient’s condition to be

not severe enough. Then, the patient would be without benefits, yet unable to work.
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References:

Arthur, S. (2021, February 8). Tips for parents and friends of people with schizophrenia. Psych

Central.

https://psychcentral.com/schizophrenia/helpful-hints-about-schizophrenia-for-family-members-a

nd-others

Davis, J., Eyre, H., Jacka, F. N., Dodd, S., Dean, O., McEwen, S., Debnath, M., McGrath, J.,

Maes, M., Amminger, P., McGorry, P. D., Pantelis, C., & Berk, M. (2016a, June). A review of

vulnerability and risks for schizophrenia: Beyond the two hit hypothesis. Neuroscience and

biobehavioral reviews. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876729/

Kahn, R. S. (2020, April 1). On the origins of schizophrenia. American Journal of Psychiatry.

https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.20020147

Mayo Foundation for Medical Education and Research. (2020, January 7). Schizophrenia. Mayo

Clinic.

https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443

NHS. (2023). Causes - Schizophrenia. NHS choices.

https://www.nhs.uk/mental-health/conditions/schizophrenia/causes/

Santhakumar, S. (2022). Is schizophrenia a disability? how to claim benefits and more. Medical

News Today.

https://www.medicalnewstoday.com/articles/is-schizophrenia-a-disability#is-it-a-disability

Tamminga, C. A., & Medoff, D. R. (2000, December). The Biology of Schizophrenia. Dialogues

in clinical neuroscience. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181617/

The pan foundation opens new schizophrenia patient assistance fund . PAN Foundation. (2021,

August 9). https://www.panfoundation.org/schizophrenia-fund-partnership/

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World Health Organization. (2022). Schizophrenia. World Health Organization.

https://www.who.int/news-room/fact-sheets/detail/schizophrenia

Xiang, J., Sun, Y., Wu, X., Guo, Y., Xue, J., Niu, Y., & Cui, X. (2023a, December 31). Abnormal

spatial and temporal overlap of time-varying brain functional networks in patients with

schizophrenia. MDPI. https://www.mdpi.com/2076-3425/14/1/40