Schizophrenia

The word "schizophrenia" is not even 100 years old, however, the disease has plagues people for years. The disease itself was first identified as a discrete mental illness by German physician Dr. Emile Kraepelin in 1887.1 Dr. Kraepelin developed the term "dementia praecox" for people who had symptoms which we now know as schizophrenia.2 The word schizophrenia, roughly translates to the "splitting of the mind". It was coined by Eugen Bleuler in 1908 and was intended to describe the separation of function between thinking, personality, memory, and perception.3 He described the main symptoms as the four A's: flattened Affect, Autism, impaired Association of ideas, and Ambivalence.4 Because patients improved with this illness, Bleuler realized it was not dementia, therefore producing the term schizophrenia instead.

This term is also commonly misunderstood to mean that schizophrenics have a split personality. Although some people diagnosed with it may hear voices or even experience these voices as distinct personalities, schizophrenia does not change the person among multiple personalities. The confusion is due to the fact that the meaning is to literally be "split" or a "shattered mind".

1 http://www.schizophrenia.com/history.htm

2 Kraepelin E. (1907) Text book of psychiatry (7th ed) (trans. A.R. Diefendorf). London: Macmillan.

3 Kuhn R; tr. Cahn CH (2004). "Eugen Bleuler's concepts of psychopathology". Hist Psychiatry

4 Stotz-Ingenlath G (2000). "Epistemological aspects of Eugen Bleuler's conception of schizophrenia in 1911" (PDF). Medicine, Health Care and Philosophy

Schizophrenia is one of the most serious, most common, and most mysterious mental illnesses. Even over 50 years of research has there not been a completely effective cure or prevention. This may also be due to the fact that research has also failed to uncover any definite cause. But the overarching message, from research, is that the onset and course of schizophrenia are most likely the result of an interaction between environmental and genetic influences.

Many theories stress unfavorable social and emotional experiences as the probable cause. In particular, the schizophrenic may have been the victim of harmful family influences or faulty child-rearing practices during their formative years. For example, some therapists have described the "double-bind" situation as critical: the patient's mother was always ready to criticize him for doing one thing and reject him for doing the opposite, resulting in constant frustration.

Other researchers see schizophrenia as a physical disease of the nervous system. For example, the patient may be "intoxicated" by some chemical (possibly similar to LSD, DMT, or mescaline) which the body may be producing due to a genetically inherited error in metabolism. Certain forms of mental retardation are known to be passed on genetically. Perhaps the same thing could be true of schizophrenia.

Heston, L.I. The genetics of schizophrenia and schizoid disease. Science, 1970, 67, 249.

Katy, S.S. Genetic-environmental interactions in the schizophrenia syndrome. In Cancro, R. (Ed.), The Schizophrenia Reactions, 1970.

http://samiam.colorado.edu/~mcclella/expersim/introschizophrenia.html

Current research also says that schizophrenia is caused by a genetic vulnerability coupled with environmental and psychosocial stressors. Family studies suggests that people have varying levels of inherited genetic vulnerability, from very low to very high, to schizophrenia.1 Whether or not the person develops schizophrenia is partly determined by this vulnerability. At the same time, the development of schizophrenia also depends on the amount and types of stresses the person experiences over time. How the interaction works in schizophrenia is unknown, yet is still the subject of ongoing research. But despite the evidence for genetic vulnerability to schizophrenia, scientists have not yet identified the genes responsible. The current consensus is that multiple genes are responsible. 2

The epidemiology of schizophrenia occurs equally between males and females, but typically appears earlier in men. The peak ages of onset are 20-28 years for males and 26-32 years for females.3 Onset is much more rare through childhood as well as people in their middle or old age. The lifetime prevalence of the disease is generally given from 0.5-1.5%. But despite all of the knowledge that schizophrenia occurs at similar rates worldwide, its prevalence varies across the world, within countries, and in local neighborhoods. The most reliable finding is the association in an urban environment and having a schizophrenia diagnosis.4 There

1 Zubin & Spring, 1977; Russo et al., 1995; Portin & Alanen, 1997

2 http://www.surgeongeneral.gov/library/mentalhealth/chapter4/sec4_1.html

3 Castle D, Wesseley S, Der G, Murray RM (1991). "The incidence of operationally defined schizophrenia in Camberwell 1965-84". British Journal of Psychiatry

4 Kirkbride JB; Fearon P, Morgan C, Dazzan P, Morgan K, Murray RM, Jones PB (2007). "Neighbourhood variation in the incidence of psychotic disorders in Southeast London". Social Psychiatry and Psychiatric Epidemiology

is a substantial elevated risk among urban-born individuals as well as the use of drugs, ethnic groups, and the size social groups. Schizophrenia is known as one of the major causes of disabilities.

Schizophrenia is also usually described in terms of positive and negative symptoms. Symptoms on the positive side include thought disorder, delusions, and auditory hallucinations. The negative symptoms are having a flattened affect in emotion, lack of pleasure (anhedonia), alogia, and avolition. Eventhough many patients may feel symptoms of flattened emotion, the disease can cause severe levels of emotion, especially when put in a stressful environment receiving negative news. Other symptoms consist of chaotic speech, thought, and behavior.1

The diagnosis for this disease is based on self-reported experiences of the person, abnormalities in behavior observed by family and friends. Once this is established, a doctor's clinical assessment is then taken. A psychiatrist, social worker, or any other mental health professional also qualify.

The most common used standard criteria for diagnosing schizophrenia comes from the American Psychiatric Association's DSM-IV-TR