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Symptoms and Causes: Schizophrenia Paper

Maybelle Santana Allen, Jessica Lara, Stephanie Rivera, and Aaron Williams University of Phoenix PSYCH/650 8/30/21 Dr. Harry Beaman

2 Symptoms and Causes: Schizophrenia Schizophrenia is a severe and chronic mental disorder affecting approximately 20 million individuals globally (WHO, 2019). According to the American Psychiatric Association (2013, p.99), schizophrenia is characterized by two or more of the following: delusions, disorganized speech (such as incoherent speech and constant derailment), hallucinations, disorganized or catatonic behavior, and negative symptoms (such as avolition and diminished expression of emotions). Schizophrenia is linked to a significant level of disability which may affect both occupational and educational performance (WHO, 2019) of schizophrenia, and the current best practice treatments for schizophrenia. This paper will discuss schizophrenia according to the diathesis-stress model, the impact of schizophrenia on the family, how the individual and family can cope with schizophrenia, and current best practices for treating schizophrenia. Schizophrenia According to the Diathesis-stress Model The diathesis-stress model is a model of psychopathology that suggests that psychological disorders develop due to an individual's vulnerability to the disorder's development and the stressful events in the environment that the individual is exposed to (Broerman, 2020). This means that every individual has a varied level of vulnerability for different psychological conditions. The amount of environmental stress required to trigger the onset of a mental health condition depends on how vulnerable an individual is to the condition (Broerman, 2020). Therefore, the greater the individual’s vulnerability to a mental health condition, the lower the environmental stress required to trigger the onset of the mental health condition, and vice versa (Broerman, 2020). The relationship between the development or progression of mental illness and the social environment is a relationship that has long been studied over a long time in relevance to the

3 history of medicine. Similarly, the social climate is linked to the pathogenesis of schizophrenia. This is referred to as the diathesis-stress hypothesis (Howes & McCutcheon, 2017). The extent of the effect of these environmental stressors is determined by the individual vulnerability and the development of the disorder. There are two primary forms of environmental factors that influence the outcome of schizophrenia: chronic and acute stress, and perinatal factors, and infection. A variety of psychosocial factors are linked to the development of schizophrenia. They include a history of first or second-generation migration, urbanicity, and childhood trauma (Howes & McCutcheon, 2017). Such social stressors contribute significantly to the risk of developing psychosis because exposure to such factors results in both acute and chronic psychosocial stress (Howes & McCutcheon, 2017). Acute stress is known to result in clinical psychosis. The diathesis-stress model links the development of psychosis to increased vulnerability to stress. Longitudinal studies have shown that psychotic elapses often follow stressful life events. Therefore, individuals who are more susceptible to stress are more likely to develop mental health illnesses, such as schizophrenia (Howes & McCutcheon, 2017). According to Howes & McCutcheon (2017), prenatal infection, obstetric complications, maternal inflammation, and childhood infections increase one's chances of developing schizophrenia. Maternal stress during pregnancy is also linked to the development of schizophrenia, and male children experience a higher risk of developing this condition. There is a synergistic relationship between adolescent stress and prenatal infection, which increases one's risk of developing schizophrenia (Howes & McCutcheon, 2017). In this case, males are also more susceptible to the development of this mental health condition. Therefore, the presence of such perinatal factors and infection influences the level of stress an individual is exposed to and

4 the level of vulnerability that one has concerning the development of schizophrenia (Howes & McCutcheon, 2017). The individual level of susceptibility coupled with perinatal factors and infection (environmental stress) contributes significantly to the development of mental health conditions such as schizophrenia. Now that we have discussed schizophrenia according to the diathesis-stress model, we will discuss the impact on the family. The Impact of Schizophrenia on the Family The relationship in the family with schizophrenia patients is affected, forcing them to restructure their functions in the family, social, and work-life (Caqueo-Urízar et al., 2017). When the individual receives the diagnosis, he loses autonomy and perceives feelings of depression and sadness, generating stress of guilt in the family (Caqueo-Urízar et al., 2017). Families who are diagnosed with schizophrenia show changes in daily routine (Caqueo-Urízar et al., 2017). The family lives according to the needs of the family member with schizophrenia diagnosis (Caqueo-Urízar et al., 2017). The caregiver has overload symptoms because he feels that it is his obligation to take care of him (Caqueo-Urízar et al., 2017). The diagnosis of schizophrenia generates conflicts in the family, physical and verbal confrontations destroying the family in many cases (Caqueo-Urízar et al., 2017). Usually, the mother of the schizophrenia patient tends to be the primary caregiver and take care of the home. The mother has a feeling of guilt, overload, stress, and physical fatigue (Caqueo-Urízar et al., 2017). Now that we have discussed the impact of schizophrenia on the family, we will discuss how the individual and family can cope with this disorder. How the Individual and Family can Cope with Schizophrenia Most people who are diagnosed with schizophrenia recover completely. However, many will continue experiencing a relapse of the symptoms (NHS, 2019). Caring for one's health may

5 make it easier to treat one's condition by reducing fatigue, anxiety, and depression. Self-care improves one's quality of life by becoming more active and independent (NHS, 2019). Different forms of self-care include maintaining good physical and mental health, preventing accidents or illnesses, and effectively addressing long-term medical conditions and minor ailments (NHS, 2019). To make this process easier, one should remain in constant communication with one's healthcare team. Maintaining a good relationship with these professionals may help one raise any concerns about any symptoms, learn how to identify warning signs of a schizophrenic episode, and stick to one's medicine prescription (NHS, 2019). People diagnosed with schizophrenia must also avoid using and abusing alcohol and other drugs because they promote the deterioration of one's health (NHS, 2019). Therefore, people with schizophrenia must maintain a healthy lifestyle by remaining physically active, eating well, adhering to prescriptions, and avoiding drugs. When a family member is diagnosed with a mental health disorder, the entire family is also affected (APA, 2015). Often, the family members, especially the parents, of an individual diagnosed with schizophrenia experience a range of unpleasant emotions such as anger, shame, guilt, grief, and self-blame (APA, 2015). Both the parents and other family members must adjust their expectations for the future of the family member diagnosed with schizophrenia (APA, 2015). Clear communication is also essential to avoid sidelining ill children or family members. Communication will also help preserve and promote relationships between and among different family members (APA, 2015). Maintaining a positive attitude is also instrumental in ensuring that the family encourages the recovery process. If the process of adjusting proves to be difficult, the family should seek support from qualified professionals who will guide how to maneuver the entire situation (APA, 2015). Now that we have discussed how the individual and family can cope with schizophrenia, we will discuss current best practice treatments.

6 Current Best Practices for Treating Schizophrenia There are various treatment options when it comes to treating Schizophrenia. “Low to moderate dosage of antipsychotic monotherapy is the first line of treatment for schizophrenia" (Barnes et al., 2020). When an individual is first diagnosed with Schizophrenia, initial doses of the antipsychotic should be below those typical in established illness (Barnes et al., 2020). It is believed that "Differences in efficacy (rather than effectiveness) of antipsychotic medications are not well evidenced in first episodes of schizophrenia, though some agents (e.g. olanzapine, amisulpride, risperidone) might perform slightly better than others" (Barnes et al., 2020). Also used in the treatment of Schizophrenia are various forms of psychotherapy. Some of the therapies include "Cognitive Behavioral Therapy (CBT), META Cognitive Therapy (MCT), Metacognitive Training (MCTR), Metacognitive Reflection and Insight Therapy (MERIT)" (Rakitzi et al., 2020). "Cognitive Behavioral Therapy (CBT) proved to be superior in terms of the improvement of primary and secondary outcomes" (Rakitzi et al., 2020). It is believed that having “effective treatment components include psychoeducation, medication strategies, careerbased stress management training, community-based intensive treatment, living skills training, and specific drug and cognitive-behavioral strategies for residual symptoms” (Falloon et al., 1998). Conclusion In conclusion, schizophrenia is a severe mental illness. This mental illness affects how a person thinks, feels, and behaves (NIMH, 2020). Globally, about 20 million individuals are diagnosed with schizophrenia. This condition is linked to a significant level of disability which may affect both occupational and educational performance. According to the diathesis-stress model, an individual's vulnerability to a mental health condition and the level of environmental

7 stress one is exposed to play a critical role in developing and progressing a mental health condition. Therefore, the social environment is linked to the pathogenesis of schizophrenia. A variety of psychosocial factors are connected to the development of schizophrenia. They include a history of first or second-generation migration, urbanicity, and childhood trauma. Additionally, prenatal infection, obstetric complications, maternal inflammation, and childhood infections increase the risk of developing schizophrenia. People with schizophrenia must maintain a healthy lifestyle by remaining physically active, eating well, adhering to prescriptions, and avoiding drugs. The family of people diagnosed with schizophrenia often experience a range of unpleasant emotions. However, they should adjust their expectations for the family member's future, maintain clear communication, a positive attitude, and seek additional support from qualified professionals. In this paper, we have discussed schizophrenia according to the diathesis-stress model, the impact of schizophrenia on the family, how the individual and family can cope with schizophrenia, and current best practices for treating schizophrenia.

8 References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th Ed.). https://dsm.psychiatryonline.org/doi/book/10.1176/... American Psychological Association (APA). (2015). How to cope when a loved one has a serious mental illness. Retrieved from https://www.apa.org/topics/mental-health/serious-mentalillness Barnes, T. R., Drake, R., Paton, C., Cooper, S. J., Deakin, B., Ferrier, I. N., & Yung, A. R. (2020). Evidence-based guidelines for the pharmacological treatment of schizophrenia: updated recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology, 34(1), 3-78. Doi:10.1177/0269881119889296. Broerman, R. (2020). Diathesis-stress model In Shackelford, T. D. & Zeigler-Hill, V. (eds.) Encyclopedia of personality and individual differences. Springer: Cham. DOI: https://doi.org/10.1007/978-3-319-24612-3_891 Caqueo-Urizar, A., Rus-Calafell, M., Craig, T.K.J. et al. Schizophrenia: Impact on Family Dynamics. Curr Psychiatry Rep 19, 2 (2017). https://doi.org/10.1007/s11920-017-0756-z Falloon, I. R. H., Held, T., Roncone, R., Coverdale, J. H., & Laidlaw, T. M. (1998). Optimal Treatment Strategies to Enhance Recovery from Schizophrenia. Australian & New Zealand Journal of Psychiatry, 32(1), 43– 49. https://doi.org/10.3109/00048679809062704 Howes, O. D., & McCutcheon, R. (2017). Inflammation and the neural diathesis-stress hypothesis of schizophrenia: A reconceptualization. Translational Psychiatry, 7(e1024). DOI: https://doi.org/10.1038/tp.2016.278

9 National Health Service (NHS). (2019). Living with Schizophrenia. Retrieved from https://www.nhs.uk/mental-health/conditions/schizophrenia/living-with/ National Institute of Mental Health (NIMH), (2020). Schizophrenia. Retrieved from https://www.nimh.nih.gov/health/topics/schizophrenia Rakitzi, S., Georgila, P., & Becker-Woitag, A. P. (2020). The Recovery Process for Individuals with Schizophrenia in the Context of Evidence-Based Psychotherapy and Rehabilitation. European Psychologist. https://doi.org/10.1027/1016-9040/a000400 World Health Organization (WHO). (2019). Schizophrenia. Retrieved from https://www.who.int/news-room/fact-sheets/detail/schizophrenia...