Paranoid Type of Continuous Schizophrenia - Essay Example

Shonda: Continuous Schizophrenia: Paranoid Type – Final Introduction of the Disorder: The psychiatric diagnosis of Schizophrenia relates to the psychological disorder which typifies abnormalities in the expression of the realities of the world and the case of Shonda exemplifies this situation. Through the case study of Shonda, it was concluded that the person suffers from chronic psychological disorder of schizophrenia of the paranoid type. The self-reported experiences as well as the observed behavior of the person suggest the incidence of schizophrenia. The bio psychological disorder of schizophrenia which affects the human mind and causes brain abnormalities in the individual has left Shonda in a determining situation. Biological factors and genetic factors mainly contribute to this psychological disorder. However, an account of the psychological factors affecting this mental disorder will be valid in coping with the situation. Several studies on the topic have pointed out the different central contributory factors of the disease and they include genetics, early environment, neurobiology, and social and psychological processes etc. There are several possible combinations of symptoms affecting this disorder and thus there are various types of schizophrenia. It is notable that the five acknowledged subtypes of this psychological disorder are paranoid, disorganized, catatonic, undifferentiated, and residual. Schizophrenia of paranoid type will be the focus of this discussion as Shonda’s case corresponds to this. Paranoid schizophrenia is distinguished by high-flying delusions and auditory hallucinations which wax and wane across persistent psychotic episodes. As suggested by Rashmi Nemade and Mark Dombeck, “Multiple delusions may be present but generally all will share a coherent theme (e.g., delusions may be persecutory or grandiose, or religious in nature, etc.) There may be command hallucinations that drive patients to complete odd or bizarre goals. Affected individuals tend to be anxious, frightened, angry, aloof, and argumentative; they may have a superior and patronizing manner and formal or extremely intense interpersonal interactions. The combination of delusions and anger can lead to violence towards self and/or others, although this is not a common occurrence.” (Nemade & Dombeck, 2008). People who are lately diagnosed with paranoid schizophrenia exhibit little or no impairment on brain scans and psychologically tests. Through timely and apposite medical treatment, the diagnosis of such people will be effectively managed. It is also relatable that many of the individuals with paranoid schizophrenia can persist with their works. For the diagnosis of Schizophrenia, there are several diagnostic criteria that must be guaranteed and the following are some of these according to the DSM-IV. Rashmi Nemade and Mark Dombeck point out the attributed symptoms of the disorder include delusions, hallucinations, disorganized speech such as frequent derailment or incoherence, grossly disorganized or catatonic behavior, negative symptoms, i.e., affective flattening, alogia, or avolition. If two or more of these symptoms are exhibited by the person for a consistent period of time, it will result in the diagnosis of schizophrenia. According to Maj & Sartorius, “The characteristic features of schizophrenia are hallucinations and delusions, disorders of thought and speech, disorders of behavior, disturbance of emotions and affect, cognitive deficits and avolition. Hallucinations and delusions are frequently observed at some time during the course of schizophrenia… Particular diagnostic importance has been attributed to specific delusions and hallucinations.” (Maj & Sartorius, 2002, p. 3). Some of the investigations concerning the disorder suggested that visual hallucinations take place in 15%, auditory in 50% and tactile in 5% of all subjects, and delusions in more than 90%. The result of such studies which are of different types has great implications in the diagnosis of the disorder. The main studies in the area are in the form of developmental research and family studies. Throughout the researches and analyses on the topic of schizophrenia bring out the various factors affecting the disorder and the biological as well as environmental aspects are the foremost aspects among these. The researchers in the area arrive at the conclusion that an amalgamation of biological, psychological and social factors contribute to the disorder of schizophrenia, and any mental illness for that matter. Thus, the bio-psycho-social model of the disorder concludes on the researches concerning schizophrenia. “Experts now agree that schizophrenia develops as a result of interplay between biological predisposition… and the kind of environment a person is exposed to. These lines of research are converging: brain development disruption is now known to be the result of genetic predisposition and environmental stressors early in development, leading to subtle alterations in the brain that make a person susceptible to developing schizophrenia.” (The Causes of Schizophrenia, 2004). In the later stages of life, these environmental factors may either damage the brain further and thus amplify the possibility of schizophrenia, or diminish the appearance of genetic defects and decrease the risk of schizophrenia. Biological aspects of Schizophrenia: The severe mental disorders of schizophrenia which is persistent and disabling may be concluded as the result of various factors and the biological aspects play a prominent role in the disorder. The gravity of the Schizophrenia is clear when one identifies that more than 2 million people in the United States are affected by this serious mental disorder. The biological aspects of schizophrenia are emphasized throughout various researches on the topic. As Vicki M. Spitzer maintains, initially the pathophysiology of schizophrenia was related to dysregulation of the dopaminergic pathways in the brain. However, in the recent studies, it is associated with dysregulation of other neurotransmitter pathways also, with particular stress on the serotonergic pathways. It is already maintained that hallucinations and delusions are the positive symptoms of schizophrenia and these are related to disturbances in the mesolimbic dopaminergic system. Similarly, the negative symptoms of schizophrenia, such as apathy and social withdrawal, crop up due to the alterations in the mesocortical system. Thus, Vicki M. Spitzer conclude: “The delicate interplay between the neurotransmitters dopamine and serotonin is now believed to be associated with the symptoms of schizophrenia. Structural brain abnormalities, including enlarged ventricles and cortical atrophy, may also play a role in schizophrenia.” (Spitzer, 1995). The biological aspects of schizophrenia also cover the genetic peculiarities and the genetic causes of the disorder are often concluded in research studies. Research evidences suggest that there is a significant genetic component to schizophrenia. Schizophrenia, along with other psychiatric diseases such as schizoaffective disorder, bipolar disorder, depression, etc, can cause hereditary acquirement of this disorder. However, it does not give the complete picture as there are studies that suggest that schizophrenia is not completely genetic. According to the twin studies simple genetic transmission cannot be considered as the exact reason for schizophrenia. Accordingly, in the case of identical twins, if one of them has schizophrenia, the other twin with the accurately same genes as the first has only about 50% of possibility for the disorder. The result of the study has significant implication as it suggests that the convolution of genetics and environment cannot be clearly comprehended. To find the fact concerning the contribution of genes to the occurrence of schizophrenia, it is significant to depend on the current research evidences on the topic. “For almost as long as scientists have pondered how nature and nurture shape personality, intelligence, health (or disease) and other traits, theyve assumed that each contributes some percentage to the trait. Maybe intelligence is 55% genes and 45% environment… Rather than nature (i.e. genes) and nurture (i.e. environment) each kicking in a fraction of the influences that nudge traits in one or another direction, new studies show the innate potential we call nature becomes reality only when exposed to a certain kind of nurture or environment.” (The Causes of Schizophrenia, 2004). It is primary to recognize that there are various models of treatment that deal with the mental disorder of schizophrenia. Lora Humphrey Beebe suggests the biological models of the disorder which emphasize neurochemical dysregulation or anatomical alterations in the brain. Beebe finds evidences for include the neurotransmitter model and the executive function model which are the most widely disseminated and thoroughly developed biological models. Accordingly, the neurotransmitter model deals with the chemical diffusion in the prefrontal cortex, hippocampus, and temporal lobes of the brain etc. It also proposes that the enlarged dopamine receptor activity in the given areas causes the positive symptoms of hallucinations and delusions. Further, the “typical antipsychotic medications act primarily to block dopamine receptors and increase dopamine destruction, while the atypical medications have an antagonist function against dopamine in addition to serotonin. This dopamine antagonism is thought to explain the effectiveness of these medications in reducing the positive symptoms of schizophrenia.” (Beebe, 2003, p 67+). Environmental aspects of Schizophrenia: Researches on schizophrenia and the factors affecting the disorder conclude that environmental aspects, along with biological aspects, can contribute to it, though there is ongoing debate upon this. There is great consensus on the familial susceptibility to schizophrenia, although it is complicated to pin down the exact genes involved. The role of the environment on the possibility of schizophrenia is still hotly disputed. Some of the researches as well as several service users, social scientists and clinicians confirm the effect of social factors on schizophrenia. On this basis, it is often concluded that behavioral or environmental aspects can affect the prevention of schizophrenia more tangibly compared to the gene manipulation. Several of the studies in the area concentrated on the intricate interactions between genes, lifestyle and the environment and the findings of these studies suggested the scope of environmental aspects in the research and treatment of schizophrenia. In one of the studies on the debate concerning the influence of environmental aspects on schizophrenia, Jim van Os and Peter McGuffin listed out the various arguments for and against their impacts. Accordingly, the role social environment in the onset of psychotic mental states has been stressed. They maintain that “the assertion that psychotic states are not somehow generated from ‘within’, in isolation from environmental experience, is perfectly compatible with the belief that part of the vulnerability to develop mental states diagnosed as schizophrenia is genetic… [N]ot only common sense but also research findings suggest that the mental states associated with schizophrenia algorithms are not an exception to the rule that psychological and environmental experience go hand in hand.” (Van Os & McGuffin, 2003). The effect of environmental aspects on the mental disorder of schizophrenia is often debated and there is an argument that environment does not have a pertinent impact on the disorder. It is primary to recognize that there are roughly two types of schizophrenia, i.e. the genetic disorder and the environmentally affected disorder. Concluding on the hypothesis that the impact of environment on the disorder cannot be justified, Jim van Os and Peter McGuffin make some relevant remarks. “The hypothesis that some cases of schizophrenia are entirely socially determined cannot be supported. Although we cannot exclude the possibility that social factors contribute to the aetiology of schizophrenia in those with a genetic predisposition, the non-genetic proportion of variance in liability is small and is more likely to be explained by physical stressors or even by stochastic processes.” (Van Os & McGuffin, 2003). In the case of Shonda, it is clear that her mental disorder was more of psychological than genetic and contribution of the environment to the disorder is evident. The amount of mental stress and strain she had to undergo as the member of a broken family and as a person lacking emotional support from her family members contribute to the environmental aspects of the disorder. The environmental impact is also suggested by the fact that her brother did not have an emotional relationship with her after his marriage and that her mother had a mere peripheral relationship with her. The amount of her mental agony and psychological strain is clear in the realization that her father was an alcoholic who used to beat his children after drinking. These environmental aspects caused the disorder and Fred Bemak & Lawrence R. Epp suggest Schizophrenia is not only a disease of the body; rather it is both mind and body related. “High dopamine levels thought to contribute to schizophrenia are viewed as a biological reflection of loosened thought incited by psychological stress contributing to the mind-body interaction and, at times, creative processes.” (Bemak & Epp, 2002). Thus, the impact of the environment becomes evident. In an understanding of the environmental models of schizophrenia, it is vital to relate that they stress on interpersonal relationships or adaptation processes. According to Lora Humphrey Beebe, stress and coping theory provides a paradigm of an environmental adaptation model. “The model specifies stressors and moderators that may influence the course of schizophrenia. Stressors may be neurological, psychobiological, environmental, or interpersonal. Stress mediating factors are postulated to exert protective effects against stressors. Mediators may include hardiness characteristics, personal knowledge, learned skills, or various environmental supports.” (Beebe, 2003, p 67+). Treatment Approaches of schizophrenia: The treatment approaches to schizophrenia are of many types corresponding to the different conditions and causes of the mental disorder. The modern treatment approaches mainly concentrate on clinical research as well as experience and the capacity of the various approaches to condense the symptoms of schizophrenia determine the type of treatment approach to be used. The most commonly used treatment approaches in the recent time are the following and they are mostly used in combination with each other. These treatment approaches of schizophrenia include medication treatment, psychological treatment, individual psychotherapy, cognitive behavioral psychotherapy, antipsychotic medication list, community and social support, rehabilitation, family education, and self help groups. According to available research evidences, the psychological and behavioral techniques are found effective. However, the studies also suggest the superiority of cognitive behavioral psychotherapy in the treatment of schizophrenia. Thus, it is established that “cognitive psychotherapy, often incorporating behavioral therapy techniques, has been found to be more effective than other types of psychotherapy in treating several specific types of psychological problems, including depression and panic attacks… The basic premise of cognitive therapy is that beliefs, expectations, and cognitive assessments of self, the world, and the nature of personal problems in the world affect how we perceive ourselves and others, how we approach problems, and ultimately how successful we are in coping in the world and in achieving our goals.” (Franklin, 2004). Conclusion: Through the case study of Shonda who suffers from chronic psychological disorder of schizophrenia, the biological and environmental aspects of the disorder as well as the diverse treatment approaches of schizophrenia have been analyzed. The paper also has been instrumental in an understanding of the role of genetics, neurotransmitters and brain chemistry on the mental disorder of schizophrenia. The paper also has been invaluable in the selection of the best possible medication for the mental disorder and in the successful implementation of the treatment approach. Therefore, psychological therapies such as the antipsychotic medications provide the best medication alternative for the disorder. However, in the ultimate conclusion, it becomes evident that the treatment approach of cognitive psychotherapy incorporating behavioral therapy techniques will provide the most effective strategy. References Nemade, Rashmi., & Dombeck, Mark. (2008). Symptoms of schizophrenia. Austin Travis County Mental Health Mental Retardation Center. Retrieved Aug 26, 2008, from http://resources.atcmhmr.com/poc/view_doc.php?type=doc&id=8823&cn=7 The causes of schizophrenia. (2004). Schizophrenia.com. Retrieved Aug, 2008, from http://www.schizophrenia.com/hypo.php Spitzer, Vicki M. (1995). Biological aspects of schizophrenia. Sage Journals online. Vol. 1. Retrieved Aug 26, 2008, from http://jap.sagepub.com/cgi/content/abstract/1/6/204 Van Os, Jim., & McGuffin, Peter. (2003). In Debate: Can the social environment cause schizophrenia? BJ Psych. Retrieved Aug 26, 2008, from http://bjp.rcpsych.org/cgi/content/full/182/4/291 Franklin, Donald J. (2004). Cognitive therapy for schizophrenia: Cognitive-behavioral psychotherapy. Psychology Information Online. Retrieved Aug 26, 2008, from http://psychologyinfo.com/schizophrenia/cognitive.htm Maj, Mario., & Sartorius, Norman (2002). Schizophrenia, New York: Wiley, p. 3. Beebe, Lora Humphrey. (2003). Theory-based research in schizophrenia. Perspectives in Psychiatric Care, 39(2), p. 67+. Bemak, Fred., & Epp, Lawrence R. (2002). Transcending the Mind-Body Dichotomy: Schizophrenia Reexamined. Journal of Humanistic Counseling, Education and Development 41(1). Read More