Schizophrenia

According to schizophrenia.com, schizophrenia is a complex, debilitating mental disorder

that 1-2% of the world population experience. It is a disorder of the brain that affects how people
think, feel, and perceive, which translates to mainly auditory and visual hallucinations,
paranoia and delusions.
A popular but erroneous myth about schizophrenia is that it means a split
personality. Instead, schizophrenia is an illness that affects a variety of mental functions as
well as a persons ability to think clearly and feel intensely.
Signs and Symptoms
Early signs of schizophrenia include personality changes that involve abnormal emotional
responses, mood disturbance, or depression, as well as cognitive changes (Schizophrenia
Societyof Canada, 2012). Symptoms of schizophrenia can be classified as positive symptoms, or
negative symptoms.
Positive Symptoms. Positive symptoms are those that represent an excessive or distorted version
of normal functions and may include delusions, hallucinations, and overall unusual behavior.
Hallucinations can be described as perceiving something that is not actually there. In people with
schizophrenia, auditory hallucinations are the most common. Delusions are beliefs that are false
and resistant to reason and fact. The most common types of delusions in people with
schizophrenia are grandiose and persecutory delusion (Lepage, Bodnar, and Bowie, 2014).

Negative Symptoms. Negative symptoms of schizophrenia can be described as deficits of

healthy, normal behavior. The negative symptoms that are considered diagnostic of schizophrenia
are affective flattening (a lack of emotional response), poverty of content/speech, and the loss of
motivation or interests.
For doctors to diagnose schizophrenia, the symptoms must be causing a person
significant impairment at work, at school, or in personal relationships. The natural course of
schizophrenia can vary, but it typically starts with a person becoming somewhat more apathetic
and withdrawn. During this phase of the illness the patient may be misdiagnosed as suffering
from depression or a personality disorder. At some point clear symptoms of schizophrenia
appear, and doctors recognize the condition. Delusions, hallucinations, and some other symptoms
of schizophrenia occur in other illnesses as well, such as mood disorders (depression, bipolar
disorder), substance abuse and alcoholism, and dementia (Alzheimer's disease, dementia).
However, it is rare for young people without schizophrenia to experience a decline in their
cognitive abilities; this negative symptom is the characteristic and defining feature of this illness.
After onset, people with schizophrenia usually go through a rather rocky period lasting a few
months and up to a few years, during which their positive symptoms remain severe or wax and
wane in a series of episodes. The underlying negative symptoms tend to persist throughout. The
negative symptoms are the most common signs of schizophrenia, but no single characteristic is
present in all forms of the disorder.
Etiology and Pathophysiology
The precise cause or causes of schizophrenia have not yet been determined, however,
researchers claim that the development of schizophrenia involves genetic and prenatal/perinatal
factors.
Genetic Factors
Although some people with schizophrenia have no family history of the disorder,
research has shown that there is a strong genetic predisposition for developing schizophrenia.
The risk of developing schizophrenia if a first-degree family member has it is 10%, and if both
parents have schizophrenia, the risk of their child developing schizophrenia is between 40-65%
(University of Maryland Medical Center, 2014). Concordance for schizophrenia is about 12% for
dizygotic twins and 30-50% for monozygotic twins (2014).
Prenatal and Perinatal Factors

There are environmental factors, that when exposed prenatally, could increase the childs
risk of later developing schizophrenia. Women who have poor nutrition or certain viral infections
during pregnancy may have an increased risk of giving birth to children who later develop
schizophrenia (Brown, Derkits, 2010). Perinatal complications such as neonatal hypoxia may be
linked to a higher incidence of schizophrenia. According to research, children born in the winter
and early spring to women lacking in vitamin D throughout pregnancy, had a greater chance of
developing schizophrenia.
Structural Brain Abnormalities
Certain neuroanatomical alterations are said to lead to some of the symptoms of
schizophrenia. The amount of white matter and grey matter in the brain is decreased in people
with schizophrenia, and there is enlargement of the lateral and third ventricles as well as the
frontocortical fissures and sulci. This is associated with cognitive impairments and negative
symptoms something that does not respond well to treatment (Moncrieff, 2009). The size of the
thalamus and temporal lobe, which are important in emotional regulation and memory, are
decreased, and so communication between broad regions of the cortex and primary sensory and
motor areas may be altered. Changes in the temporal lobe may be responsible for positive
symptoms.
Dopamine Hypothesis
The current dopamine hypothesis suggests that schizophrenia is a result of dysregulation
of dopaminergic activity there is an increase in dopamine D2 binding sites and there are
prefrontal D1 deficits (Moncrieff, 2009). This means that there is over activity of dopamine in
certain areas of the brain possibly leading to positive symptoms and there is also under
activity of dopamine in other areas of the brain possibly leading to negative symptoms. The
original dopamine hypothesis claimed that, rather than dysregulation, there was simply too much
dopaminergic activity (2009). Schizophrenia has been associated with the dysregulation of
additional neurotransmitter systems such as serotonin and glutamate (2009).
Drug Treatments

Early recognition and treatment are very important because they may save a person
from subsequent psychotic episodes, which have a devastating effect on self-esteem and the
ability to perform normally at work or school. The primary treatment for schizophrenia
symptoms consists of neuroleptic medications. Sometimes these drugs are referred to as
antipsychotic medications, but that implies that the treatment is targeting only a persons
psychotic symptoms when, in fact, treating the negative symptoms may be even more
important. Antipsychotics are split into two main groups: 1) first generation antipsychotics
(older, conventional); and 2) second generation antipsychotics (newer, atypical).
The brand names of medications commonly used to treat schizophrenia include
Risperdal (risperidone), Zyprexa (olanzapine), Seroquel (quetiapine), Zeldox (ziprasidone),
Clozaril (clozapine), Haldol (haloperidol), and Thorazine (chlorpromazine). All these
examples, except Thorazine and Haldol, which have long been standard treatments, are of the
more atypical or second generation antipsychotics.
First generation antipsychotics such as Haldol (haloperidol) are dopamine D2 antagonists.
The most common side effects include increased prolactin levels and extrapyramidal effects.
Second generation antipsychotics are serotonin dopamine antagonists. The most common side
effects include weight gain and abnormalities in glucose and lipid metabolism. Both groups of
these antipsychotics work by reducing the positive symptoms of schizophrenia. The positive
symptoms of schizophrenia tend to be very responsive to these medications, while the
negative symptoms are more difficult to treat; the newer second generation antipsychotics
appear to have a small effect on reducing the negative symptoms, whereas the first do not.
Most people with schizophrenia need to continue to take medications in order to keep
their symptoms under control. In addition to taking medication, people with schizophrenia
tend to do best if they can strike a balance between returning to the routines of daily life (that
is, going back to work or school) and not doing more than their condition permits.
Prognosis
There is no cure for schizophrenia, however recovery is possible, especially with an early
diagnosis and intervention, proper support and education, and good compliance with an effective
drug treatment plan (Schizophrenia Society of Canada, 2012). Ideally, people should remain as
active and engaged in daily life activities as possible. In the era of deinstitutionalization, we
are seeing that most people with schizophrenia can live successfully in the community. When

psychiatrists first defined schizophrenia, they thought the prognosis for anyone with the
disorder was grim. Recent research indicates, however, that after the initial intense period of
illness, most people stabilize at a level of functioning slightly below their original status
only mild negative symptoms. Both family members and clinicians can play an important role
in maintaining a persons confidence that things will get better, thus reducing relapse.
It is the long-term goal of researchers to find better treatments and, ultimately, to identify
ways to intervene early and prevent the illness from arising.

References
1. British Columbia Schizophrenia Society http://www.bcss.org
2. Brown A., Derkits E. (2010). Prenatal infection and schizophrenia: a review of
epidemiologic and translational studies. American Journal of Psychiatry. 167(3):261-80.
3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.).
4. Lehne (2013). Pharmacology for Nursing Care (8th ed.). Maryland Heights, Missouri:
Mosby Elsevier.
5. Lepage, M., Bodnar, M., & Bowie, C. (2014). Neurocognition: clinical and functional
outcomes in schizophrenia. Canadian Journal Of Psychiatry. Revue Canadienne De
Psychiatrie, 59(1), 5-12.
6. Schizophrenia Simulation https://www.youtube.com/watch?v=KYHVbLLO2bU
7. Schizophrenia Society of Canada. (2012). Learning about schizophrenia: A reference
manual for families and caregivers. Winnipeg, MB: Schizophrenia Society of Canada.
8. University of Maryland Medical Center. (2014). Schizophrenia. Retrieved from
http://umm.edu/health/medical/reports/articles/