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.

Brain anomalies
Schizophrenia


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