Schizophrenia
Schizophrenia is most commonly
characterized by both 'positive symptoms' (those additional to normal experience
and behavior) and 'negative symptoms' (the lack or decline in normal experience
or behavior). Positive symptoms are grouped under the umbrella term psychosis
and typically include delusions, hallucinations, and thought disorder. Negative
symptoms may include inappropriate emotional displays or flat emotional affect,
poverty of speech, and lack of motivation. Some models of schizophrenia include
thought disorder and planning problems in a third grouping, the 'disorganization
syndrome'. Additionally, neurocognitive deficits may be present. These take the
form of reduction or impairment in basic psychological functions such as memory,
attention, problem solving, executive function and social cognition. The onset
is typically in late adolescence and early adulthood, with males tending to show
symptoms earlier than females.
Psychiatrist Emil Kraepelin was
first to make the distinction between what he called dementia praecox and other
forms of madness. This classification was later renamed 'schizophrenia' by
psychiatrist Eugen Bleuler in 1911 as it became clear Kraepelin's name was not
an adequate description of the condition.
The diagnostic approach to
schizophrenia has been opposed, most notably by the anti-psychiatry movement,
who argue that classifying specific thoughts and behaviors as illness allows
social control of people that society finds undesirable but who have committed
no crime.
More recently, it has been argued
that schizophrenia is just one end of a spectrum of experience and behavior, and
everybody in society may have some such experiences in their life. This is known
as the 'continuum model of psychosis' or the 'dimensional approach' and is most
notably argued for by psychologist Richard Bentall and psychiatrist Jim van
Os.
Although no definite causes of
schizophrenia have been identified, most researchers and clinicians currently
believe that schizophrenia is primarily a disorder of the brain. It is thought
that schizophrenia may result from a mixture of genetic disposition (genetic
studies using various techniques have shown relatives of people with
schizophrenia are more likely to show signs of schizophrenia themselves) and
environmental stress (research suggests that stressful life events may precede a
schizophrenic episode).
It is also thought that processes
in early neurodevelopment are important, particularly those that occur during
pregnancy. In adult life, particular importance has been placed upon the
function (or malfunction) of dopamine in the mesolimbic pathway in the brain.
This theory, known as the dopamine hypothesis of schizophrenia largely resulted
from the accidental finding that a drug group which blocks dopamine function,
known as the phenothiazines, reduced psychotic symptoms. These drugs have now
been developed further and antipsychotic medication is commonly used as a first
line treatment. However, this theory is now thought to be overly simplistic as a
complete explanation.
Differences in brain structure
have been found between people with schizophrenia and those without. However,
these tend only to be reliable on the group level and, due to the significant
variability between individuals, may not be reliably present in any particular
individual.