Causes of schizophrenia and treatment
Schizophrenia is one of the most severe psychotic disorders as it involves a vast range of symptoms. It is a complex disorder and is not easily understood. Different theories about its development, causes, and treatment exist. Here we will discuss the various biological, psychological, and environmental factors that cause schizophrenia and the treatment of schizophrenia.
What are the causes of schizophrenia? (Etiology of Schizophrenia)
Just like other medical and mental disorders, genetic predisposition plays a huge role in determining whether a person will develop symptoms of schizophrenia or not. Early genetic studies show that the risk of schizophrenia is higher in people who have an identified case of schizophrenia within his/her relatives than in people who do not. The risk is highest in monozygotic twins (48%) and then in children with two schizophrenic parents (46%).
NEUROTRANSMITTERS/ DOPAMINE HYPOTHESIS:
Abnormalities in several different neurotransmitters are associated with schizophrenia. It is majorly associated with the neurotransmitter dopamine. The Dopamine Hypothesis suggests that people with schizophrenia have either an excessive amount of dopamine secretion or the receptors at the neural synapses being over sensitive to normal amounts of dopamine. Chemical compounds like amphetamines and levodopa increase the amount of dopamine in the neural synapse which worsens the psychotic symptoms. Excessive amounts of dopamine in the limbic area of the brain are responsible for the positive symptoms of schizophrenia, whereas, too little dopamine may be responsible for the negative symptoms.
Symptoms of depression in schizophrenia are related to low levels of serotonin.
The third category of symptoms,i.e., Cognitive impairments include reduced ability to learn and remember new materials which are related to neurotransmitters GABA and glutamate.
Schizophrenia results from brain abnormalities that may be structural or functional which in turn cause dramatic abnormalities in perception, thought, and behavior. One common neuroanatomical abnormality which is usually found in people with schizophrenia is the enlargement of the brain ventricles. Along with that they also have a reduction in the cortical(gray matter) areas of the brain. Mild structural disorganization at the basic cellular level of the brain also exists with altered neural connections in multiple brain areas.
Various prenatal triggers, be biological or environmental, have an influence on the onset of schizophrenia. Pregnancy and delivery complications like the ones in which the supply of oxygen to the newborn is affected cause subtle brain damage which increases the risk of schizophrenia. Other than that, factors like viral infections and maternal stress also facilitate the onset of schizophrenia.
PSYCHOANALYTIC EXPLANATION FOR SCHIZOPHRENIA:
According to Sigmund Freud Schizophrenia is caused due to developmental fixations in early life which defect ego development. Ego disintegration in schizophrenia means patients return to the time when ego was not developed due to this the functions of ego like the interpretation of reality and control of inner drives, such as sex or aggression, are impaired. These intrapsychic conflicts fuel the psychotic symptoms.
According to Margaret Mahler, distortions in the relationship between infant and mother, like the child being unable to separate from the mother or complete dependence of the child on the mother in the oral phase of development facilitate psychotic symptoms.
Dysfunctional families might as well have an influence on the onset of schizophrenia. It is important to be noted that pathological family behavior can significantly increase the emotional stress that is generally faced by schizophrenia patients. There are different kinds of dysfunctional families like Double Bind families where children receive conflicting parental messages or Schisms and skewed families where one parent is overly close to a child of the opposite gender.
Can schizophrenia be Cured?
Antipsychotic medications are the choice of treatment for schizophrenia however psychosocial interventions including psychotherapy can help improve symptoms of schizophrenia as well. Therefore, it is safe to say that combined use of medicines and psychotherapy will be more beneficial to patients than the use of either alone. Some of the common treatment plans for schizophrenia are discussed below:
Just like any other disorder, hospitalization is the most important step for treatment. The purpose of hospitalization could be the diagnosis, stabilization of medicines, safety for suicidal or homicidal patients, or grossly disorganized behavior like the inability to take basic care of oneself.
Pharmacological Approaches in Treatment of Schizophrenia:
As already mentioned, medication is the choice of treatment for schizophrenia. For treating schizophrenia antipsychotics are commonly used which block the dopamine receptors at four different receptor sites which are D1, D2, D3, and D4.
First Generation or Typical Antipsychotics:
Typical or conventional antipsychotics that were available before the 1990s helped reduce the symptoms of schizophrenia however produced severe side effects as well. These include medicines like chlorpromazine (Thorazine) and Haloperidol (Haldol) which are also known as neuroleptics. These medications work by blocking the action of dopamine which helps in reducing the positive symptoms of schizophrenia.
Some side effects of these medications are drowsiness, weight gain, dry mouth, and tremors. Many patients experienced extrapyramidal side effects including Tardive Dyskinesia in which involuntary movements of the face, mouth, limbs, and trunk occur that resemble Parkinson’s Disease. Neuroleptic Malignant syndrome which includes high fever and extreme muscle rigidity was also experienced by a few patients although it was rare.
Second Generation or Atypical Antipsychotics:
Around the 1980s a new class of medicines known as the second generation antipsychotics became available. They are known as second-generation antipsychotics because they cause fewer extrapyramidal side effects compared to previously available antipsychotics. Atypical antipsychotics work by affecting dopamine and serotonin but they do not affect the motor areas of the brain. Examples of second-generation antipsychotics are Clozapine (Clozaril), Risperidone (Risperdal), Olanzapine (Zyprexa), Quetiapine (Seroquel), Ziprasidone(Geodon), Aripiprazole (Abilify) and Lurasidone (Latuda).
Atypical medicines are now the most commonly used medication for treating schizophrenia because they reduce the symptoms of comorbid anxiety and depression, improve daily functioning and cause lesser side effects. Some of the side effects of atypical neuroleptics are weight gain, increased heart problems, drowsiness, diabetes, and agranulocytosis (life-threatening drop in white blood cells).
Electroconvulsive therapy and Transcranial magnetic stimulation have some positive effects in treating schizophrenia. However, they are not more effective compared to antipsychotic medications or psychosocial interventions hence they have limited use.
Psychological and Social Approaches in Treatment of Schizophrenia:
Although medications are the most helpful in treating schizophrenia, they don't completely eliminate the psychotic symptoms. Psychological and social intervention techniques along with medicines are believed to produce better results altogether.
According to Sullivan (1953), schizophrenia arises due to problems in personal and social relationships and unsatisfactory personal experiences. Therefore treatment of schizophrenia must focus on the individual's life history and the current maladaptive interpersonal relationships.
According to him, schizophrenia arises from the conflict of craving a close relationship while being terrified of the same. The resolution of this conflict improves the symptoms of psychosis. However, this approach is no longer used because it was not as effective as anticipated.
Two types of cognitive-behavioral therapy namely stress management and belief modification are majorly used for the treatment of schizophrenia. Stress management helps patients cope with the stress that leads to psychotic experiences. Belief modification works by changing the delusional beliefs that a person may have. Initially, CBT gained a lot of popularity for the treatment of psychosis however its effectiveness for treating schizophrenia is now a debatable topic.
People with schizophrenia often have neurocognitive deficits that interfere with their ability to function properly. Cognitive rehabilitation training can help patients overcome these neurocognitive deficits and improve their memory, attention, reasoning, executive functioning, and social functioning skills. But neurocognitive remediation has its limitations. It is an expensive process and its effects are minimal too.
Group therapy majorly involves social skills training. Most people with schizophrenia show impaired social functioning like social isolation and withdrawal. The main objective of social skills training is learning to read others’ behaviors, learning what behaviors are expected in particular situations, and learning to respond to others in a more adaptive way. Social skills training is not a comprehensive treatment for schizophrenia but it helps patients to a great extent by improving their social functioning.
Family Therapy and Psychoeducation:
Psychoeducation basically educates the patients and their family members about the disorder. Psychoeducation does not improve the symptoms but having an insight into the disorder helps family members and caregivers deal with the patient and the illness properly. Psychoeducation helps the family members recognize early signs of relapse, side effects of medication, and how to manage crises that may arise. In addition, family therapy provides emotional support for family members as well.