“Schizophrenia is the most crippling of the psychiatric disorders.” (Blaney & Millon, 2009, p. 298) That’s a bold first statement. I was curious as to the reason why typical onset times are younger (sooner) for males as compared to females. The developmental perception I am accustomed to generally indicate that females “grow up” sooner than males… I am the slightest bit curious what could cause this phenomenon to flip-flop. Any insight there readers?
Although I was alive during the 1980’s, I was so young that I was wholly unaware of the de-institutionalization that took place during that era. The statement that prisons have become the de factor health care provider reaffirms my belief that working with that population is absolutely critical to our success as a society.
Typical schizophrenia characteristics include hallucinations, delusions, disorganized speech, grossly disorganized or catatonic behavior, and/or negative affective symptoms. The text states that the most common types of hallucination consist of hearing voices, one or several, typically making commentaries about the individual or conversing with each other. One word… WOW. Persecutory, grandiose, or somatic delusions are most common. The first person accounts depict individuals who are very disturbed to say the least. In particular, an individual who believed that they were controlled by someone (the “controller”) and the persistent belief that other people have external controllers was beyond comprehension.
Regarding the etiology of the disorder, it is increasingly evident that there is some kind of genetic link involved in schizophrenia. The diathesis-stress theory of illness is the predominant theory, suggesting that a predisposition may not be sufficient in itself to cause schizophrenia, but probably requires some kind of “trigger” such as exposure to prenatal insults. (Blaney & Millon, 2009, p. 302)
This is my first exposure to “genotype” and “phenotype.” Genotype represents the underlying genetic constitution of the individual (genetic predisposition?). Phenotype refers to the observable traits, characteristics, or behaviors of an individual. It is entirely possible to have a genotype that suggests a predisposition to a disorder like schizophrenia, but the disorder will not be expressed behaviorally by the phenotype. “In other words, what the individual inherits is a liability or predisposition for developing the disease, not the disease itself.” (Blaney & Millon, 2009, p. 305)
With regard to prenatal and perinatal insult, the critical period of exposure appears to be the 2nd trimester (4th-6th month of pregnancy). Examples might include toxemia, preeclampsia, or labor delivery complications. Fetal hypoxia (oxygen deprivation) was strongly linked with later schizophrenia. Prenatal stress, inclining losing a spouse or being exposed to a military invasion, has been implicated in the predisposition of schizophrenia. Maternal viral infection, including influenza, was also implicated. Unlike influenza studies, increased risk for offspring exposed to prenatal nutritional deficiencies was primarily attributed to growth and development during the 1st trimester, not the second.
Cognitive impairments are considered to be central, or primary, in schizophrenia. Typically, they predate the more typical outward signs of the illness (hallucinations, delusions, etc.). The cognitive impairments can occur in the absence of the other clinical symptoms. “It is estimated that 90% of patients have clinically meaningful deficits in at least one cognitive domain and that 75% have deficits in at least two.” (Blaney & Millon, 2009, p. 309)
Neurocognitive assessment is used in contemporary practices to quantify the severity of impairment in clinically relevant domains of cognitive functioning. Relevant domains are speed of processing, attention/vigilance, working memory, verbal learning, visual learning, reasoning and problem solving, and social cognition. Typically, a patient with schizophrenia will struggle with verbal learning and vigilance, and have lesser impairments in visual organization and vocabulary.
A neuro-developmental view of schizophrenia is the foundation of high-risk research. “The majority of individuals who succumb to schizophrenia and other psychotic disorders manifest prodromal signs of behavioral disturbance” in adolescence, and they get progressively worse as they approach young adulthood. (Blaney & Millon, 2009, p. 321) The prodromal period represents a clinically significant opportunity for intervention, with high potential to shed light on the etiological origins of schizophrenia.
Blaney, P. H., & Millon, T. (2009). Oxford textbook of psychopathology (2nd ed.). New York, New York: Oxford University Press.