Psychological Disorder Research Paper- Schizophrenia

This research paper explores the history, prevalence, cause, treatment, and prognosis of schizophrenia. It discusses the criteria for diagnosis and the different approaches to treatment, including the psychodynamic, behavioral, humanistic, and cultural approaches.

Running head: ABNORMAL PSYCHOLOGY
Psychological Disorder Research Paper- Schizophrenia
Name of the Student
Name of the University
Author Note

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Abstract
Mental illness is an umbrella terms that comprises of conditions responsible for altering the
feelings, moods, thinking and behviour of the patients. These mental disorders may be chronic
(long-lasting) or occasional. Schizophrenia is one such chronic mental disorder that appears
during adolescence or adulthood and is characterized by hallucinations, delusions and cognitive
problems. The assignment found that the condition results in lifelong struggle of the affected
people and is typically diagnosed by following the DSM-V criteria. Schizophrenia was also
found to be widely prevalent in the United States and can be effectively managed with the
humanistic, behavioural, cultural and/or psychodynamic approaches.
Keywords: schizophrenia, illness, mental, chronic, DSM-V

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Introduction
Schizophrenia refers to a severe and chronic mental disorder that usually affects the way
an individual feels, behaves and thinks. People affected with this disorder often seem to lose
touch with their reality and perceive unreal things as real. The most common manifestations of
the condition are strange speech, abnormal behavior, and reduced capability to perceive reality.
There is mounting evidence for the fact that people suffering from schizophrenia often report
additional behavioral problems as depression, anxiety, and substance abuse (Comer, 2015). The
condition usually begins in childhood, and fails to resolve, even in the later years. Several
researchers have elaborated on the fact that both genetic and environmental factors play a vital
role in the onset of the disorder (Meehl, 2017). According to Leutwyler et al. (2014) the
diagnosis is typically based on the pragmatic behavior, the individual's reported understanding
and information of others well-known to the affected person. Individuals affected with
schizophrenia commonly experience delusions that are persecutory or bizarre in nature, and
hallucinations, most often voices.
Disorganized speech and thinking usually ranges from loss of thought trains to sentences
that already connected to each other, than meanings, and also encompasses speech, which is
incomprehensible, commonly referred to as ‘word salad’ (Mitchell, M., Hollingshead &
Coppersmith, 2015). The patients also report signs of social withdrawal, loss of judgment and
motivation, accompanied with sloppiness of hygiene and dress. Another common presenting
complaint is distortions related to their self-experience, when the patients feel as if they are
thoughts are not originated in their mind, rather are being inserted by some external force. This
essay will discuss the history, prevalence, cause, treatment and prognosis of the disorder.

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History of the disorder
The term schizophrenia was coined by Eugen Bleuler, a Swiss eugenicist and
psychiatrists in 1908, with the intention of separating the function between memory, thinking,
perception and personality. The term was formally introduced at the psychiatry conference held
at Berlin in 1908, and simultaneously in a publication (Maatz, Hoff & Angst, 2015). The history
of schizophrenia has been found to be multifaceted. Some people hold the view that the disease
always existed, but was discovered during the 20th century, depending on retrospective diagnosis
success of earlier madness cases as schizophrenia. According to another school of thought, the
term implies to several mental symptoms that are culturally determined. By the late 20th century
the initial concept of insanity got categorized into different terms namely, paranoia, epilepsy, and
dementia praecox, when the latter term got reconstituted schizophrenia. There are very few
reports of schizophrenia like disorders in historical accounts published before the 19th century
(Owen, 2014). Although certain interpretations emphasize on discussion of schizophrenia in
Ebers papyrus, review of ancient Roman and Greek literature suggests that while there was
prominent information about psychosis, none of the circumstances matched the criterion for
diagnosing schizophrenia.
The earliest cases of the condition can be traced back to 1809, where a detailed report on
James Tilly Mathews, and the discrete account by Philip Pinel elaborated on the term. This was
followed by use of the term first in 1893 by Kraepelin who distinguished between mood disorder
and dementia praecox. In popular culture, people considered the term schizophrenia to be
associated with people who had split personality, therefore leading to a stigmatizing
mystification between the two conditions. The Mendelian inheritance of the mental disorders
was recognised by Ernest Rudin and Feanz Kallman during 1933, following which several

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theories related to ‘Rasenhygiene’ were proposed in order to explain the underlined factors that
govern the development of this mental disorder (Pow & Stahnisch, 2016). All controversies
eventually led to the development of the DSM manual that is now considered imperative for
diagnosing the disorder, based on the criteria.
Criteria for diagnosis
The Diagnostic and Statistical Manual of Mental Disorders (5th edition) is an update to
the 4th edition and is widely used in the United States for psychiatry diagnosis.
Recommendations to treatment, as well as payment by the healthcare professionals are most
often defined by classifications placed in this manual. The DSM 5 outlines several criteria for
making a successful diagnosis of schizophrenia. Presence of two or more of symptoms such as,
hallucinations, delusions, disorganized speech, negative symptoms like diminished emotional
expression, and catatonic grossly disorganized behavior, for a month or longer time helps in
diagnosis (American Psychiatric Association, 2015). Furthermore, the patients must have
impairment in the major functioning areas such as, self care, interpersonal relations, or work for
a long time since the onset of the illness. Some signs and symptoms of the disorder must be
present for a continuous time (6 months) for affirming the presence of this mental disorder.
Hence, presence of two of the five symptoms mentioned above, and at least one symptom from
the first three, helps in identifying people who has been affected with schizophrenia. One major
change enforced in the DSM 5 criteria is that all the different types of schizophrenia such as,
catatonic, undifferentiated, disorganized, paranoid, and residual kinds, have been removed from
the manual.

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Prevalence of the disorder
Schizophrenia has been identified to be one of the major leading causes that result in
disability worldwide. People suffering from schizophrenia display an increased likelihood of
premature mortality, when compared to the general population. The average estimated potential
life that gets lost for people who have schizophrenia, residing in the United States is 28.5 years.
Certain co-occurring medical conditions that usually affect these people are liver diseases,
cardiovascular problems, and diabetes, which in turn contribute to the sudden increase premature
mortality. Conduction of several diagnostic interviews and household surveys suggest that the
prevalence rate of schizophrenia in the United State ranges between 0.25 to 0.64%. Estimates of
institutionalized and some people who are not institutionalized are approximately 0.33-0.75%
(NIMH, 2018). On a global scale, it affects one percent of the total population (almost 21 million
person) and approximately 1.2 people living in the United States, which accounts for roughly 3.2
million. 1.5 million individuals are expected to be diagnosed with the condition the following
year, which would translate to 7.2 people per 1000 (Mentalhelp.net, 2018).
According to research estimates, the indirect and direct costs for schizophrenia diagnosis
and treatment to the US society range between $155 billion - $44,773 for all individuals.
Schizophrenia has been found more prevalent among males, when compared to female and it
usually starts earlier among male. More than 50% of the individuals diagnosed with
schizophrenia do not receive accurate care services and 90% of the individuals live with
untreated schizophrenia in middle and low income countries (WHO, 2018). Lack of access to
appropriate mental health care services can be cited as a major contributor factor to this high
rate.

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The psychodynamic approach
The psychodynamic theory is principally concerned with disintegration of ego.
According to the theory it is the job of ego to keep control of the impulses of an individual, while
striking a compromise between the model restrictions of superego and demand of id. According
to Freudians, several types of abnormal upbringing such as, rejecting schizophrenic mother are
largely responsible for a fragile and week ego, whose capability to control the desires of id are
restricted. This directly results in the ego been broken apart by the tendency for containing the id,
thus leaving the latter in complete control of psyche (Gabbard, 2014). However, this theory is not
highly regarded any more, owing to the fact that no confirming association was established
between mother's personality and onset of the disorder in children. In the words of Ogden (2014)
psychodynamic treatments of schizophrenia involve psychoanalysis that focuses on cathartic
release of some suppressed matter, helping it reach its definite significance and restructuring the
mechanisms of ego resistance, for allowing a person to deal with the past in an effectual manner.
Supportive psychotherapy is one such treatment approach that involves several components
namely, cognitive-behavioral, psychodynamic, and interpersonal conceptual model that helps in
nurturing change and development in the affected person.
Behavioural approach
Behaviorist hold the belief that apart from certain unit reflexes present in an individual,
the behavior is most commonly learnt through interaction of the person with the surrounding
environment. It has also been suggested that the disorder schizophrenia runs through families
hence, increases the possibility of making the affected people learn exhibiting the signs and
symptoms, through imitating or observing others (Hence, 2015). The symptoms are also
expected to be exhibited by the first person who acquired it in the family, through a range of

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operant processes, which in turn might be positively reinforced, when others pay attention or
negatively reinforced, under situations that encompass avoidance of adverse situations. The
treatment that largely focuses on this theory is cognitive behavioral therapy that places an
emphasis on establishing links between feelings, actions, and thoughts in an accepting and
collaborative atmosphere. According to Shonin, Van Gordon and Griffiths (2014) the duration of
the therapy usually depends on the needs and preferences of the individual and proceeds through
phases of assessment, engagement, ABC model, goal setting, normalization, critical
collaborative analysis, and development of alternative explanation. Hence, the primary aim of
this treatment approaches not to cure the disorder, but improve the ability of the person to
function independently, reduce stress and help in self-management of schizophrenia.
Humanistic approach
According to the humanistic theory it was asserted that the society applies to all people
two conditions, which allows them to behave in certain pre-determined ways for receiving
rewards. Receipt of the rewards helps the people to behave in a manner that is considered
acceptable. The conditions of rewards in the life of a person affected with schizophrenia leads to
stigmatization, owing to the fact that the psychotic individual do not behave in manners that lead
to rewards without intentionality (Schrank et al., 2014). Hence, schizophrenics are considered
parasites, in relation to the wider society and lack of acceptance adds to their suffering. The
primary goal of humanistic therapy is to allow all patients suffering from schizophrenia to attain
congruence, in relation to their ‘actual self’ and ‘ideal self’. The therapy helps the individuals to
attain self-esteem that elevates the sense of personality, and allows the affected person to be less
than some type of ‘ideal self’. Active listening technique is an effective humanistic treatment
strategy that engages the patient in the therapy session, with the use of simple phrases and facial

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expressions (Rowan, 2016). It operates under the assumption that the patient is good enough to
overcome all kinds of challenges and can live healthily, and also acknowledges the power of the
patient to decide for oneself.
Cultural approach
Most mental disorders including schizophrenia are considered to be highly disabling
diseases and cultural factors often influence the diagnosis and treatment of such illnesses. The
clinical expression of the mental disorder shows dissimilarity across different culture. According
to Faris (2017) phenomenology of schizophrenia has been recognized in all regions of the world
and cultural plays a patho-plastic impact on the central biological pathogenesis of the condition.
Culture is found to be a direct causative reason that leads to the generation or origin of the
disease, and also contributes to the shaping or modeling of the signs and symptoms, thus
governing the reactions and perceptions. While some cultures do not stigmatize mental disorders,
others are found to discriminate and stereotype the people suffering from any such illneses,
therefore aggravating their condition. Cultural treatment encompasses increasing the knowledge
and awareness among a wider population, preventing stereotyping attitude, and eliminating all
forms of stigmatization across community (Hofer et al., 2016). Altering the local beliefs about
mental health disorders, and providing care services that are in alignment with the cultural values
and beliefs of the affected person, are major treatment strategies.
Comorbidity of the disorder
Comorbidity refers to a condition where a disorder exists along with a primary diagnosis,
which is the reason for a patient seeking treatment of obtaining referral services. In other words,
occurrence of two or more illnesses together is referred to as comorbidity. There is some
evidence for the fact that patients having schizophrenia also report signs and symptoms of

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depression, substance abuse, post traumatic stress disorder, and obsessive compulsive disorder.
Patients diagnosed with the mental condition have an increase the rate of avoidable risk factors
such as, high consumption of alcohol, smoking, sedentary lifestyle, and poor dietary patterns
(Nathan & Gorman, 2015). A substantial proportion of the comorbidities have been found to
exacerbate the primary mental illness. In addition to psychiatric symptoms, several patients also
report physical illness, diabetes and poor cardiovascular health and these cases are usually less
reported (Schoepf et al., 2014). The diagnostic criteria have also form a significant correlation
between onset of schizophrenia and manifestation of symptoms related to panic disorder. In the
words of Hoptman et al. (2014) other signs commonly reported by the patients are a significant
improvement in their cognitive function and display of aggressive behavior. Thus, it can be
suggested that cognitive deficits in schizophrenia might result directly due to the disorder.
Prognosis of the disorder
Schizophrenia is associated with significant economic and human costs and results in a
reduction in life expectancy by 10-27 years (Hjorthøj et al., 2017). The primary reason can be
credited to its relationship with poor diet, smoking, sedentary lifestyle, obesity, and an increase
in the rate of suicidal ideations. Antipsychotic medications administered for management of the
condition also increases the risk. Several people suffering from schizophrenia report ongoing
disability with recurrent episodes, while very few of them recover completely and are able to
function well in the society (Manrique-Garcia et al., 2014). Owing to the fact that most
schizophrenia patients need community support and a large proportion of them are unemployed,
occupational functioning and independent living are hampered to a large extent. Several factors
have been allied with an increased prognosis such as, female gender, older age at the beginning
of first episode, manifestation of predominantly positive symptoms, appearance of mood

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symptoms, rapid onset, and better pre-illness functioning (Boyle, 2014). Schizophrenia has also
been coupled with violence, in relation to the presence of commands, hallucination, perceptions
of threat, and delusional jealousy. Thus, preventing all kinds of socio-demographic variables that
might lead to violent behavior are essential for easy recovery.
Conclusion
To conclude, Schizophrenia is a chronic brain disorder that in symptoms of hallucination,
delusion, lack of motivation, and trouble with concentration and thinking. There are several
theories that provide an explanation for the underlying factors that might lead to the onset of the
mental condition. However, environmental factors and genetics play a crucial role in the disease.
It does not merely refer to multiple personality or split personality. Nonetheless, people suffering
from the condition have a greater susceptibility to die younger, owing to the high rates of
comorbid conditions such as, diabetes and heart disease. The symptoms fall into four major
categories namely, positive, negative, disorganization, and impact cognition. While hallucination
to hearing voices, paranoid delusions, and distorted beliefs and perception are some positive
symptoms, the patients often report a decrease or loss in the ability to speak, initiate plans, find
pleasure or express emotions.
Disordered and confused speech and thinking is often accompanied by trouble with
logical thinking that leads to abnormal movements and beside behavior amid the affected people.
They also face difficulties and concentration, attention and memory that results in a decline in
their work related or educational performance. Hence, the primary aim of all treatment strategies
should be to assist the patients to lead a greatly productive and rewarding life. Although there is
no definite cure for schizophrenia, adoption of several treatment strategies has been found
successful in reducing severity of the symptoms.

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