Detailed note on Schizophrenia 1

Detailed Note in Schizophrenia

Devanshi Jadeja

PRN: 8023021433

Department of psychology, Maharaja Sayajirao University

Major 3: Psychology

Date: 15/04/2024
Detailed note on Schizophrenia 2

Introduction

Schizophrenia is a mental illness characterized by disturbances in thinking processes,

perceptions, emotional responsiveness, and social interactions. The severity and impact of
schizophrenia can vary from person to person, but it is typically a chronic condition that can
have significant disabling effects

The symptoms of schizophrenia include hallucinations, delusions, and disordered thinking,

which are known as psychotic symptoms. Additionally, individuals with schizophrenia may
experience reduced expression of emotions, lack of motivation to achieve goals, difficulties in
forming and maintaining social relationships, motor problems, and cognitive impairments. While
these symptoms usually emerge during late adolescence or early adulthood, schizophrenia is
often seen as a disorder that develops over time. Cognitive impairments and unusual behaviors
may be present in childhood, and the persistence of multiple symptoms indicates a later stage of
the illness. This developmental perspective suggests that disruptions in brain development and
environmental factors, such as stress during prenatal or early life stages, may contribute to the
onset of schizophrenia.

Casual Factors for Schizophrenia

Biological factor

Various factors have been proposed to be associated with schizophrenia, including

genetic, psychological, endocrinological, metabolic, environmental, virological, and

auto-immunological factors, as well as abnormalities in neurotransmitter systems and structural

disorders of the brain. These factors may act as predisposing, triggering, or functionally

modulating factors in what is likely a condition composed of multiple types of disorders with

different causes. Neuroanatomical and neuromorphological data have shown that some patients

with schizophrenia have enlarged ventricles and reduced volume in the frontal and temporal

lobes. These changes are primarily found in the hippocampus, parahippocampal gyrus, and

amygdala, but they are relatively small and overlap with findings in healthy individuals. Twin
Detailed note on Schizophrenia 3

studies suggest that some of these changes may be influenced by factors other than genetics.

Functional abnormalities in the brain have also been observed in the frontal and temporal

structures of certain individuals with schizophrenia. Among the various neurotransmitters,

dopamine and serotonin are believed to play a role in maintaining mental stability, and

understanding how they interact with other neurotransmitters such as noradrenaline,

acetylcholine, GABA, and glutamate may provide a more comprehensive understanding of both

normal and disrupted brain function.

Psychological Factors

The exact reasons behind schizophrenia are still a mystery. Numerous elements may play a role
in increasing a person's vulnerability to developing this disorder, encompassing physical, genetic,
psychological, and environmental factors.

It is possible that you may have a predisposition to schizophrenia, and a significant or emotional
life event could potentially trigger a psychotic episode. However, the reasons why some
individuals exhibit symptoms while others do not are still unclear.

Risk Factors

Several factors can increase the likelihood of developing schizophrenia.

Genetics

Individuals with a family history of schizophrenia may have a higher risk of developing the
disorder.

However, having a genetic predisposition does not guarantee that schizophrenia will manifest.
Other factors may also play a role in the development of the condition.

Brain Development

Structural differences in the brains of individuals with schizophrenia have been observed.

While not all individuals with schizophrenia exhibit these brain changes, they can occur in
individuals without mental illness. These differences suggest that schizophrenia may involve
abnormalities in brain function.
Detailed note on Schizophrenia 4

Neurotransmitters

There is a connection between neurotransmitters and schizophrenia. Medications that alter

neurotransmitter levels can help alleviate certain symptoms of the disorder.

Pregnancy and Birth Complications

Individuals with schizophrenia are more likely to have experienced complications during
pregnancy and birth.

These complications may include low birth weight, premature labor, or lack of oxygen during
birth. These factors could potentially impact brain development.

History of Trauma

Early traumatic experiences can increase the risk of developing psychosis.

Examples of traumatic events include childhood sexual abuse, physical abuse, and bullying.
However, not everyone who experiences trauma will develop psychosis, and not all individuals
with psychotic experiences have a history of childhood abuse.

Triggers

Triggers are events that can precipitate the development of schizophrenia in individuals at risk.

Stress

Psychological stressors, such as significant life events, are common triggers for schizophrenia.

Socio-Cultural Factors

There are various environmental factors that have been linked to an elevated risk of developing

schizophrenia. For instance, complications during pregnancy such as heightened stress levels,

infections, malnutrition, and/or diabetes have been associated with an increased likelihood of

schizophrenia. Furthermore, complications during birth that result in hypoxia (oxygen

deprivation) have also been linked to a higher risk of schizophrenia in the child (M. Cannon,

Jones, & Murray, 2002; Miller et al., 2011). Additionally, children born to older fathers have a

slightly higher risk of developing schizophrenia. Moreover, the use of cannabis increases the risk
Detailed note on Schizophrenia 5

of developing psychosis, particularly when other risk factors are present (Casadio, Fernandes,

Murray, & Di Forti, 2011; Luzi, Morrison, Powell, di Forti, & Murray, 2008). These factors may

indicate higher levels of social and environmental stress in these settings. Unfortunately, none of

these risk factors are specific enough to be particularly useful in a clinical setting, and most

individuals with these risk factors do not develop schizophrenia. However, when considered

collectively, they provide insights into the neurodevelopmental factors that may contribute to an

increased risk of developing this disorder.

Treatment

Medical interventions

There exist various interventions aimed at assisting individuals with schizophrenia in managing

their symptoms and leading a satisfying life. These interventions encompass the use of

medications, psychotherapy, and a strong support system to aid patients in navigating the

challenges associated with living with schizophrenia.

Pharmacotherapy, specifically the use of atypical antipsychotic medications like risperidone or

olanzapine, is considered the first-line treatment option for schizophrenia. These medications are

preferred due to their favorable efficacy profiles and lower incidence of side effects compared to

other medication choices.

It is important to note that antipsychotic medications are particularly effective in managing the

positive symptoms of schizophrenia, such as hallucinations experienced during acute psychotic

episodes. However, they may be less effective in addressing negative symptoms, such as

disorganized thinking and behavior.

Detailed note on Schizophrenia 6

In addition to medication management, psychotherapy is often recommended to assist patients in

coping with daily activities and improving their overall quality of life. Psychotherapy plays a

crucial role in enhancing patient adherence to medication regimens and facilitating their

integration into society by providing support and teaching social and occupational skills.

Individuals with schizophrenia often face challenges related to unemployment and social

acceptance, especially if they lack a strong support network. This underscores the importance of

psychotherapy, as it provides a safe environment for patients to address these issues and receive

assistance in achieving their small goals with the guidance of a therapist.

Cognitive-behavioral therapy (CBT) is sometimes utilized as an intervention for individuals with

schizophrenia. It can help improve symptoms and enhance self-confidence by addressing

cognitive distortions and maladaptive behaviors.

CBT is a therapeutic approach that involves individual sessions aimed at helping patients

establish connections between their thoughts, emotions, actions, and how these factors impact

their symptoms. This form of therapy also encourages patients to reevaluate their lifestyle

choices and actively monitor their thoughts and behaviors to minimize the recurrence of

symptoms. In practical terms, CBT provides practical solutions to assist patients in reducing

stress and enhancing overall functioning.

On the other hand, family intervention is a different therapeutic approach that includes therapy

sessions with the individual diagnosed with schizophrenia, as well as their family and friends

who play a role in their life. Research has demonstrated that a strong support network is

particularly beneficial in helping individuals cope with symptoms of schizophrenia, and family

intervention capitalizes on this knowledge.

Detailed note on Schizophrenia 7

Family intervention primarily focuses on improving the patient's relationship and involvement

within the family unit. This, in turn, allows the patient to experience the positive benefits of

having a stronger support system when facing challenges associated with living with the

condition.

Furthermore, family intervention also takes into consideration the mental health of all family

members and caregivers involved, providing them with strategies to manage the stress and

negative consequences that can arise from caring for a loved one with a mental illness.

Electroconvulsive therapy

Electroconvulsive therapy is typically seen as a last resort when other treatments have failed to

show any improvement. It is particularly helpful for patients experiencing symptoms of

catatonia. However, due to the serious side effects linked to this therapy, it is not commonly used

for patients with schizophrenia.

Therapeutic intervention

Psychosocial treatment may not be considered successful if it is solely measured by the

remission of acute episodes, symptom control, and prevention of relapses. However, these

criteria alone should not be the only factors used to evaluate an intervention for this complex

disease. Schizophrenia is a chronic disorder that significantly impairs social role functioning,

such as being a spouse or a worker, and is associated with higher rates of medical illness and

poor quality of life. While medication is an important part of treatment, it is often not enough

due to the residual neurocognitive impairment and the history of social and functional failures

that are common in adolescents and adults with schizophrenia. Psychosocial interventions are
Detailed note on Schizophrenia 8

crucial in a comprehensive treatment program and should be considered in relation to the

patient's overall functioning, quality of life, and adherence to prescribed treatments.

According to current thinking, patients with schizophrenia require more than just medication for

effective care and management. They also need problem-specific psychosocial treatment, family

psychoeducation, day hospital/vocational rehabilitation and educational opportunities, access to

crisis counseling, easily available inpatient psychiatric care, supervised residential living

arrangements, and case management to coordinate various aspects of treatment and obtain

entitlements. When designing and implementing psychological treatment programs for

schizophrenia, it is important to consider that progress may be slow and marked by setbacks and

periods of regression. Therefore, treatment should be long-term, spanning months and years, and

guided by concrete, short-term goals that are achievable, such as attending day hospital at least

twice a week for a month.

While there are common illness characteristics among most patients, there are also individual

variations that need to be taken into account.

Case study Analysis

A 14-year-old adolescent, who has completed education up to the sixth grade, hails from

a family with a middle socioeconomic status and resides in an urban area. He was brought to

attention due to a decline in academic performance over the past three years and the presence of

auditory hallucinations for the past two years. The child was born from a non consanguineous

marriage, which was unplanned but desired, and proceeded without any complications. He

achieved developmental milestones in accordance with his age. Throughout his early childhood,

he was exposed to his father's aggressive behavior, as his father frequently attempted to
Detailed note on Schizophrenia 9

discipline him, sometimes resorting to abusive and aggressive actions. Marital issues and

domestic violence persisted since the time of the parents' marriage, ultimately resulting in their

divorce when the child turned ten years old.

Subsequently, the child and his mother relocated to the maternal grandparents' residence

the following year, prompting a change in his school as well. Within a year of this transition, a

noticeable decline in his academic performance, coupled with deteriorating handwriting, and

irritable and despondent behavior, was observed. The mother frequently received complaints

from the school regarding the child's engagement in physical altercations and other undesirable

behaviors. He displayed a preference for solitary activities and exhibited reluctance to dine with

the rest of the family. Furthermore, a decrease in the performance of daily routine tasks was

evident. Notably, there were no indications of depressive thoughts during this period.

Subsequently, a private psychiatrist was consulted, who prescribed sodium valproate at a dosage

of up to 400 mg/day for nearly two months. This treatment resulted in a reduction in the child's

irritability and aggression. However, a definitive diagnosis was not made, and the medications

were gradually tapered off and discontinued. Over the course of the following year, the child

began experiencing auditory hallucinations of a commanding nature. He harbored suspicions that

his family members, including his mother, were colluding with unknown individuals, whose

voices he heard, in order to torment him. Consequently, he dropped out of school, stayed awake

late into the night, engaged in self-directed muttering, and shouted at imaginary individuals,

leading to further deterioration in his social interactions and self-care. Subsequently, another

psychiatrist was consulted, and the child was diagnosed with schizophrenia. He was admitted as

an inpatient for two weeks and treated with risperidone at a dosage of 3 mg, olanzapine at 2.5

mg, and oxcarbazepine at 300 mg/day, resulting in some improvement in his symptoms.
Detailed note on Schizophrenia 10

However, significant weight gain associated with the medication led to poor compliance,

ultimately resulting in a relapse within three months of discharge.

Additional investigations were conducted to assess the patient's condition. The results of

rubella antibodies (serum IgG = 64.12 U/mL, IgM = 2.44 U/mL) and polymerase chain reaction

for Fragile X syndrome (repeat size = 24) were within normal limits. It is worth noting that the

patient's intelligence quotient was measured at 90 a year ago, but due to non-cooperation during

the present admission, a recent assessment could not be obtained.

Initially, the patient's medication was adjusted, and he was maintained on aripiprazole 30

mg/day while lurasidone 40 mg was added twice a day. Upon discharge, the patient exhibited

residual negative symptoms. However, within two weeks of discharge, the patient experienced a

recurrence of hallucinations and aggression, leading to readmission.

During the subsequent admission, the patient underwent eight sessions of bilateral

modified electroconvulsive therapy. In terms of medication, the patient was prescribed

aripiprazole 30 mg/day, chlorpromazine 600 mg/day, sodium divalproex 1000 mg/day, and

trihexyphenidyl 4 mg/day. The family was provided with psychoeducation regarding the illness,

and specific attention was given to addressing the mother's expressed emotions and

overinvolvement through supportive psychotherapy. Additionally, an activity schedule was

established for the child, and occupational therapy was initiated. Dietary modifications were also

recommended to address weight gain concerns.

Over the past six months, there have been no reported episodes of violence. However, the

patient continues to exhibit persistent irritability when his demands are not met. Furthermore,

unresolved issues include poor socialization, lack of motivation, apathy, weight gain resulting
Detailed note on Schizophrenia 11

from psychotropic medications, and reluctance to start school. Another concern that needs to be

addressed is the potential impact of the patient's multiple medications on bone marrow function.

Conclusion

It is important to note that when left untreated, schizophrenia can have a profound impact

on a person's life, causing significant disability. However, there is hope that early interventions

can improve the course of the illness. By addressing symptoms and providing support at an early

stage, it is possible to mitigate the disabling effects of schizophrenia.

References

Lin A, Wardennar KJ, Pontillo M, Crescenzo FD, Mazzone L, Vicari S, et al. Is it still

correct to differentiate between early and very early onset psychosis? Schiz Res.

2016;170:211–6. [PubMed] [Google Scholar]

Kao YC, Liu YP. Effects of age of onset on clinical characteristics in schizophrenia

spectrum disorders. BMC Psychiatry. 2010;10:63. [PMC free article] [PubMed] [Google

Scholar]

Masi G, Mucci M, Pari C. Children with schizophrenia: Clinical picture and

pharmacological treatment. CNS Drugs. 2006;20:841–66. [PubMed] [Google Scholar]

Abidi S. Psychosis in children and youth: Focus on early-onset schizophrenia. Pediatr

Rev. 2013;34:296–305. [PubMed] [Google Scholar]