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Block 4 Unit 1 Schizophrenia: Etiology, Neurocognitive Functioning and Interpersonal Aspects

1. Define schizophrenia and bring out its important features.

• Schizophrenia is a severe psychotic disorder.
• It is characterised by symptoms that can include hallucinations (such as hearing voices or seeing things that aren't there) and delusions (false beliefs).
• People with schizophrenia may also experience disordered thinking, and believe that others are controlling or reading their minds.
• The disorder also includes negative symptoms such as flat or blunted affect, apathy and social withdrawal, as well as cognitive impairments.
• It is important to note that schizophrenia is not the same as "split personality" or dissociative identity disorder.
• Schizophrenia is considered a disorder of cognition, behaviour and emotion.

2. Describe the onset of schizophrenia.

• The onset of schizophrenia typically occurs in young adulthood, often in the late teens and early 20s for men.
• The disorder's symptoms usually emerge during the adolescent years to young adulthood.

3. Give the neurocognitive explanations of schizophrenia.

• Schizophrenia is associated with cognitive impairments that are considered central and enduring features of the disorder.
• These cognitive deficits can involve difficulties with volitional attention, selective attention, shifting attention, and encoding relevant information.
• Neurocognitive approaches are used to understand the genetic components of schizophrenia.
• Some researchers link schizophrenia to dysfunction in various brain regions.
• Cognitive deficits directly correlate to social deficits and functional outcomes for people diagnosed with schizophrenia.

4. What is meant by comorbidity? What are the disorders associated with schizophrenia?

• Comorbidity refers to the presence of additional conditions or disorders alongside a primary condition.
• People with schizophrenia are likely to have comorbid conditions, such as:
  • Major depression and anxiety disorders.
  • Substance abuse (lifetime occurrence of almost 50%).
• Social problems such as long-term unemployment, poverty, and homelessness are also common.

5. Describe the tests for schizophrenia.

• Cognitive functions are investigated using experimental and clinical tests.
• These tests may involve examining the patient's performance on tasks related to attention.
• Specifically, tests may include the assessment of selective attention, shifting attention, and bias.
• Neuropsychological tests to examine abilities like speed of information processing, attention, memory, and language.
• A specific example of a neuropsychological test involves asking the patient to name as many words beginning with a particular letter as possible in one minute.
• There are no definitive neural correlates that diagnose schizophrenia.

6. Define the etiology for schizophrenia from a genetic, hereditary and biological point of view?

• Genetic Vulnerability: Research indicates a multifactorial genetic vulnerability to schizophrenia, caused by the interaction of several genes.
• Hereditary Factors: There is a significant link between genetics and the risk of developing schizophrenia.
• Biological Factors: Research is focused on the role of neurobiology, though no single, isolated organic cause has been identified.

7. What are the environmental factors that cause schizophrenia?

• Prenatal Factors: These are factors before birth.
• Fetal Growth: Abnormalities in fetal growth may contribute to the development of schizophrenia.
• Hypoxia: Lack of oxygen during birth can be a contributing factor.
• Infections: Infections during childhood are a possible environmental factor.
• Social Adversity: Social adversity in an urban environment has been linked to schizophrenia.
• Close Relationships: Relationships within a family are seen as potential causes.
• Environment: The general environment of an individual is a potential cause.

8. How do neurofunctioning deficits affect the life of an individual and cause schizophrenia?

• Neurocognitive deficits are a central feature of schizophrenia and are associated with the disorder's outcome.
• These deficits can include impaired volitional attention and difficulties with selective attention, shifting attention, and encoding relevant information.
• Cognitive impairments are also linked to a patient's ability to perform daily living tasks.
• There is evidence that poor cognitive flexibility and verbal memory are linked to poor interpersonal problem-solving ability.
• Cognitive impairments are directly related to social deficits and functional outcomes.

9. Discuss some of the treatment approaches to schizophrenia.

• Hospitalisation is a possible treatment approach.
• Medication is a core component of treatment.
• Cognitive Behavioural Therapy (CBT) is also an approach.
• Metacognitive Training.
• Family Therapy or Education can be beneficial for patients and families.
• There is some evidence that social skills training, music therapy, and other creative therapies may also be beneficial.

10. Discuss hospitalisation and medication as treatment techniques for schizophrenia.

• Hospitalisation: The source notes that hospitalisation is a treatment method, but does not elaborate on the specific situations where it is needed or the benefits of hospitalisation.
• Medication: The source material mentions medication as a treatment for schizophrenia, but does not go into further detail about the types of medications that are used, or how they work.

11. Describe family therapy and education as an important treatment programme for schizophrenia.

• Family therapy or education has been consistently found to be beneficial when the intervention is longer term.
• This approach addresses the whole family system of an individual diagnosed with schizophrenia.
• Family therapy also recognises the impact of schizophrenia on families and the burden on careers, as seen with the increasing availability of self-help books on the subject.

12. What is the prevalence and incidence rate of schizophrenia?

Prevalence and Incidence of Schizophrenia

• The incidence of schizophrenia is estimated to be 1% to 1.5% of the U.S. population being diagnosed with it over the course of their lives.
• In India, it is estimated that 4.3 to 8.7 million people suffer from schizophrenia, with a prevalence rate of 1%.

13. Discuss the etiology of schizophrenia.

Etiology of Schizophrenia

• The causes of schizophrenia are complex and involve multiple factors.
• Genetics plays a significant role, with research suggesting a multifactorial genetic vulnerability caused by interactions of several genes.
  • Twin studies estimate the heritability of risk to be around 80%.
  • The probability of developing schizophrenia as the offspring of two parents, neither of whom has the disease, is 1 percent.
  • The probability of developing schizophrenia as the offspring of one parent with the disease is approximately 13 percent.
  • The probability of developing schizophrenia as the offspring of both parents with the disease is approximately 35%.
• Prenatal factors also contribute, including:
  • Obstetric complications or events.
• Lower than average birth weight.
• Hypoxia (low oxygen levels) before, at, or immediately after birth.
• Prenatal stress, intrauterine malnutrition, and prenatal infection.
• Increased paternal age.
• Other factors include maternal-fetal rhesus or genotype incompatibility and potential links to celiac disease.
• Childhood infections have been associated with increased risk.
• Neurobiological factors are under study, though no single isolated organic cause has been found.
• Environmental factors are considered important, and include drug use, social factors, family relationships and personality type.

14. What are the childhood antecedents that cause schizophrenia?

Childhood Antecedents of Schizophrenia

• The antecedents of schizophrenia are often subtle.
• Individuals who go on to develop schizophrenia do not form a readily identifiable subgroup in childhood.
• Birth cohort studies have indicated some subtle, non-specific behavioural features.
  • These include reaching milestones of motor development at a later age.
  • More speech problems, and lower educational test results.
  • Solitary play preferences at ages four and six.
  • Increased social anxiety at age 13.

15. Discuss social adversity and urbanicity as causes of schizophrenia.

Social Adversity and Urbanicity as Causes

• The chance of developing schizophrenia increases with the number of adverse social factors present in childhood, such as socioeconomic disadvantage.
• Stressful life events generally precede the onset of schizophrenia.
• A personal or recent family history of migration is a considerable risk factor, linked to psychosocial adversity, social defeat, racial discrimination, family dysfunction, unemployment and poor housing.
• Childhood experiences of abuse or trauma are risk factors.
• There is an association between living in an urban environment and the development of schizophrenia, even after controlling for other factors.
• A Swedish study found a 68-77% increased risk of diagnosed psychosis for people living in the most urbanised environments.
• Negative attitudes from others increase the risk of relapse.

16. Discuss etiology of schizophrenia in terms of substance use.

Etiology of Schizophrenia in Terms of Substance Use

• The relationship between schizophrenia and drug use is complex, and a clear causal connection has not been definitively found.
• Certain drugs can trigger the onset or relapse of schizophrenia in some people.
• People with schizophrenia may use drugs to overcome negative feelings.
• Cannabis use may increase the risk of developing schizophrenia.
  • Some studies suggest cannabis use can statistically double the risk of developing the disorder.
• Amphetamines can worsen schizophrenia symptoms due to their effect on dopamine.
• Hallucinogens like ketamine and PCP can mimic schizophrenia symptoms.
• People with schizophrenia tend to smoke significantly more tobacco than the general population.

17. Describe the neurocognitive functioning aspects of schizophrenia.