To fully
understand the causes and treatments of schizophrenia or any psychological disorder
there are many areas that must be reviewed.
The relationships between the biological factors, environmental stimuli,
and behavioral contributions are but a few.
Symptoms of psychological issues are often difficult to identify, as
they can be associated with other symptoms leading to misdiagnosis or a delay
of diagnosis. Another consideration is the
neural basis of the disorder or disease; where the functioning has gone
awry. Finally in the healing process,
consideration of appropriate drug therapies that can be used to treat a
specific psychological disorder must be identified. As a Biopsychologist, analyzing a psychological
disorder requires the consideration of not just one aspect but all elements
internal and external.
Part A
Causes and Treatments of Schizophrenia
Although no one
cause has been identified, schizophrenia appears to be a combination of genetics,
environmental, and psychological factors.
While still in the early stages, recent studies have found changes in
non-hereditary genetic code, or mutations may be the key to uncovering the underlying
cause of schizophrenia (DeNoon, 2011). The
genetic factor, called the diathesis-stress model, suggests that while schizophrenia
may have an inherited vulnerability, unless combined with additional sources of
environmental factors (e.g. stress) to activate the genetic vulnerability, the
illness would lie dormant. Environmental
factors have been identified as early as the prenatal stages; when, according
to Jonathan Picker (2005), exposure to influenza, rubella, and respiratory
infections, among other socioeconomic deprivations cause risk for
schizophrenia. Psychological and social
issues can also heighten factors that contribute to the development of
schizophrenia. Children and teens are
very sensitive to stress, and each person’s brain reacts differently; what an
adult might consider a mild amount of stress a child might find extremely
difficult to comprehend. Take the
following situation; if a child, genetically predisposed to schizophrenia’s
mother were to have been exposed to the flu (or other environmental condition)
during pregnancy, then the child had a very stressful period at some point in his
or her life, the chances of that one child developing schizophrenia are about
100%. The reason is because all all
factors were present (e.g. genetics, environment, and psychological); this is
not to say he or she would not have developed schizophrenia with only one or
two of the factors in place.
The implicated
areas of the brain involved with schizophrenia are the forebrain, hindbrain,
and mesolimbic system. According to
researchers Hao-Yan Tan, Joseph Callicott, and Daniel Weinberger (2009) the dopaminergic
systems relevant to schizophrenia are known to affect the “prefrontal brain
systems associated with working memory and executive function” (p. 277). The left hemispheric region of the brain can
be associated with many of the verbal or central language circuitry roles of
schizophrenia (e.g. verbal hallucination, language functions)
("Abstracts," 2009). The
hindbrain as a continuation of the central nervous system contains
cerebrospinal fluid; breakdown of these cerebrospinal fluids may account for indication
of decreased brain volume. Whereas, recent
studies of the mesolimbic system reflect
“reduced memory performance on free recall tasks;” although “this study
provides the first evidence directly linking positive symptoms and memory
deficits to dysfunctional hippocampal hyperactivity” (“Abstracts,” 2009, pp.
S95-S96).
Diagnostic
symptoms of schizophrenia are hallucinations (e.g. hearing voices), delusions,
inappropriate affect (e.g. laughing at funerals, shouting in church),
incoherent thought, and odd behavior (e.g. statuesque poses, echolalia). Although only two of these symptoms need to be
present in a one month period for a diagnosis, only one need be present if a
person exhibits what Pinel (2009) refers to as “delusions that are particularly
bizarre” or running commentary hallucinations (p. 457). As mentioned earlier several genes have been
linked to schizophrenia; however, the genetic basis to which these genes can be
identified suggests that experiential contributions significantly contribute to
the development of schizophrenia. This
does not discount; however, the heritability of schizophrenia between close
biological relatives; parent, child, sibling.
Other factors that may produce the onset of schizophrenia in genetically
susceptible individuals are heavy use of marijuana, birth complications,
autoimmune reactions, traumatic injury, and stress (Pinel, 2009).
Although there are
still yet unidentified factors involved in schizophrenia over activity at the D2
receptors play a major role. According
to Pinel (2009) there are four discoveries to the neural basis of
schizophrenia; other than the D2 receptors are involved in
schizophrenia, it takes several weeks of neuroleptic therapy to alleviate
schizophrenic symptoms, schizophrenia is associated with widespread brain
damage, and neuroleptics are only marginally effective. Currently there are several antischizophrenic
drugs known as receptor blockers; chlorpromazine was the first. Chlorpromazine binds to the dopamine synapses
or receptors (D1 and D2) acting as a blocker so that
dopamine metabolites can increase.
Haloperidol another form of antischizophrenic drug binds effectively to
only the D2 receptor. According
to Tan, Callicott, and Weinberger (2009), antipsychotic drugs are designed to
target the dopamine system and remain the primary target in the treatment of
schizophrenia; however, continued study on brain mechanisms such as gene
related impact and cognitive impairment remain equally important.
Part B
Anorexia: Body image distortion
The patient, while
raised in a well-balanced home with caring parents is suffering from body image
distortion and low self-esteem that began as a teenager. According to Erik Erikson this is called the
identity versus role confusion stage; the teenage years are the first stage in
which a young person begins to “confront the identity issue” and can be both
exciting and intimidating (McAdams, 2006, p. 353). In western society the slender body image is
extremely popularized in the media.
Because of her low self-esteem she may be using her “starvation as a way
to feel more in control of life and to ease tension, anger, and anxiety”
(womensheatlh.gov, 2009, para. 1). As
she continued to restrict her intake of food her weight dropped to dangerous
levels causing amenorrhea (i.e. missed menstrual cycles). She is highly likely to have an
obsessive-compulsive disorder and depression associated with her anorexia. Concerns of her starvation are “a reduced
metabolism, bradycardia (slow heart rate), hypotension (low blood pressure), hypothermia
(lower body temperature), and anemia (deficiency of red blood cells)” (Pinel,
2009, p. 317). Rightly so, her parents
are deeply concerned over their daughter’s health, but do not know what to do
for her.
Treating Anorexia
is different for everyone and may change throughout treatment, according to
Maria Gentile (2010) obtaining permission from the patient to speak with the family
about the illness, treatment, and outcome is useful.
Gentiles (2010)
treatment goals for anorexia nervosa include: “Preventing morbidity and
mortality by restoring body weight and correcting biological and psychological
sequelae of malnutrition, correcting dysfunctional behaviors and thinking,
treating depression and obsessive thinking, restoring autonomy and preventing
relapse and disablement, and supporting family or partner’ (p. 189).
WebMD (2011)
indicates there are no psychotropic drugs for anorexia; however, associated
symptoms such as obsessive-compulsive disorder, depression, or anxiety can be
treated with antidepressants or antianxiety medications. Because of severely malnourished states
medications can have adverse effects on the patient’s heart or blood pressure and
therefor is ill advised (Gentiles, 2010; WebMD, 2011). Treatment should focus on the psychological
aspects of the eating disorder itself; nutritional rehabilitation (i.e. correct
body weight), reducing psychological symptoms (e.g. OCD, depression, anxiety), and
helping the patient to realize an appropriate body weight (e.g. BMI) and body
image to control complications (e.g. amenorrhea, weight loss, and morbidity).
Insomnia: Mommy just needs a good night’s
sleep
Female patient complaining
of difficulty sleeping over the last month; she is a single mother of one child,
this puts her in the high risk group for sleep disorders, according to the American
Academy of Sleep Medicine and is currently experiencing daytime fatigue which
is causing significant impairment of possible executive function (e.g. thinking
and memory) in her professional and social life (AASM, 2008). Because the patient has no history of mental
disorders (e.g. depression) nor does she take any medications, alcohol, or
drugs that would cause her to have cognitive impairment, she consulted her
family physician about the issue; however, he is reluctant to provide her with
medication for her insomnia, as he is concerned about her becoming overly
dependent on the medication. Because the patient was checked by a
physician one can only assume that she does not have any underlying conditions
such as sleep apnea or hypersomnia. The patient just wants a good night’s
sleep.
When sleep deprivation moves beyond the
annoying stages of a few fitful nights to the weeks, and months of wakefulness
and fatigue sets in, it is time to be concerned. Sleep deprivation can cause mood issues,
performance issues, and health issues: irritability, lack of concentration, longer
reaction times, high blood pressure, and heart attacks (AASM, 2008). Preparing and blocking out the time for sleep
is just as important to the sleeping process. Treatment recommendations for
sleep deprivation and insomnia can come in helpful routines, an ideal sleep environment,
going to bed early, or taking short naps if need be; the idea is to not keep
running at both ends (Improving Sleep: A Guide to Getting a good Night's Rest,
2010). Hypnotic drugs (i.e.
benzodiazepines) aka sleeping pills increase periods of sleep. Originally developed for the treatment of
anxiety and prescribed in short term uses, these medications decrease the time
it takes to fall asleep, reduce the number of awakenings, and increase total
sleep time (Pinel, 2009). Use of
benzodiazepine is addictive, it distorts normal sleep patterns and can cause
insomnia, exacerbating the very reason it is taken in the first place.
Conclusion
Analyzing
psychological disorders as a Biopsychologist makes it easier to consider all
aspects of the situation, symptoms, basis, and therapies. In viewing the causes and treatments of
schizophrenia; a mixture of genetics, environment, and psychological factors
entwine to create psychosis. Current
antipsychotic drugs effectively target the dopamine system to reduce symptoms;
whereas with anoxia, low self-image and low self-esteem issues can cause body
distortion and self-inflicted morbidity.
The sufferer is using food as “a way to feel more in control of life”
(womensheatlh.gov, 2009, para. 1).
Informing family and friends about the illness, treatment, and outcome
is useful in treating anorexia as most methods focus on psychological factors
of the disorder. Insomnia disorders in
the early stages can cause fatigue, irritability, lack of concentration;
however, if not resolved can create severe issues. Although medication is available it is not
recommended unless alternate forms of resolution have been tried (e.g.
alternate sleep pattern). As such, looking
at all the aspects of each situation can provide the information and capacity to
accurately assess the patient from a biopsychologists point of view.
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