University Nursing Assignment: Exploring Schizophrenia Aetiology

This nursing assignment analyzes the aetiology of schizophrenia, focusing on a 26-year-old female named Jess. The report explores the multifactorial nature of the disorder, examining genetic predispositions, substance abuse history, and childhood trauma as contributing factors. The assignment references various studies to support the theories of schizophrenia onset, including neurodevelopmental abnormalities, obstetric complications, and prenatal exposure to infections. It emphasizes the significance of family history, supported by genetic studies, and the impact of substance abuse, particularly during adolescence, on increasing the risk of schizophrenia. Additionally, the report highlights the role of post-traumatic stress disorder (PTSD) stemming from childhood abuse, in the development of the condition. The assignment integrates these factors to provide a comprehensive understanding of Jess's diagnosis and the potential causes of her schizophrenia, referencing supporting research and case studies to explain the aetiology of schizophrenia. The assignment follows APA referencing style.

Running head: NURSING
Assignment Number Two
Name of the Student
Name of the University
Author Note

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Introduction
Schizophrenia is a complex mental disorder that is primarily characterized by recurrent
episodes of psychosis. In the year 2017, according to findings from the Global burden of Disease
Study, there were approximately 1.1 million novel cases of schizophrenia, in addition to a total
of 19.8 million diagnosed cases, all across the world (James et al., 2018). This chronic mental
health disorder is manifested by a plethora of symptoms that include hallucination, and delusion,
disorganised behaviour or speech, and impairment in cognitive ability. The early onset of the
mental disorder, together with its chronic progress often makes it a disabling illness for several
patients, in addition to their family members (Searles, 2018). Disability is a consequence of both
negative symptoms that are characterized by deficit or loss, in addition to cognitive symptoms
like and impairment in working memory, attention, and executive functioning.
Other signs and symptoms that are usually manifested by schizophrenia patients are
reduced emotional expression, social withdrawal, and absence of motivation (Bilderbeck et al.,
2019). The symptoms generally begin during young adulthood and often fail to resolve if left
untreated. Many individuals diagnosed with the condition suffer from other mental disorders as
well as panic disorder, substance abuse disorder, obsessive compulsive disorder, and depressive
disorder. This assignment will describe theories of aetiology that provide an explanation for
schizophrenia, in relation to a 26 year old female client Jess, who had been diagnosed with the
condition, approximately 6 years ago, and is currently under the assistance of the NDIS.
Theories of aetiology
The aetiology of schizophrenia is generally believed to be multifactorial, with a range of
small-effect and large-effect propensity genes demonstrating an interaction with countless

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environmental factors. These factors often result in modifications in neuroplasticity that are
developmentally mediated, thus leading to a cascade of dysfunctions in neuronal circuit and
neurotransmitters, eventually leading to impairment in connectivity (Wynn et al., 2019). Several
researchers support the theory of schizophrenia onset due to neurodevelopmental abnormalities
in temporal lobe that has been associated to delusions, hallucinations, and thought disorder
(Café-Mendes et al., 2017). Obstetric complications like preeclampsia, low birth weight,
premature birth, and hypoxia, in addition to winter-spring births are also encompassed in the
aetiology theories (Clarke & Kelleher, 2017). The theories also elaborate on exposure of a foetus
to microbial infections like genitourinary disease and toxoplasmosis, during gestational period
that leads to a compromise in normal neurodevelopment (Severance & Yolken, 2019). There is
strong evidence that prenatal exposure of foetus to infection and genetic risk might
synergistically interact, to expand the likelihood of developing schizophrenia.
Family history
Jess was reported to have a family history of schizophrenia. According to Käkelä et al.
(2017) schizophrenia is an extremely heritable mental disorder, and the early onset of the
disorder is correlated with high genetic loading. Schizophrenia outcomes have also been
associated with the age of disorder onset, in addition to the presence of a family history of the
psychotic disorder. Hence, families having schizophrenia patients are considered subpopulations
for genetic studies. As claimed by Nuhu et al. (2016) uncorrelated dizygotic and monozygotic
concordances of 29% and 88.7% have also been associated with schizophrenia. In addition, the
researchers elucidated that adolescent and child onset of schizophrenia carries a significantly
great familial risk, when compared to adult onset. Approximately 20% of adolescents and child
onset schizophrenia reports the presence of at least one primary family member affected with the

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condition, in addition to 50% that reports presence of first degree relative affected with
schizophrenia.
The same has been affirmed by Lu et al. (2018) who stated that family history is a long
standing risk factor for being affected with schizophrenia. Large genetic studies that focus on
schizophrenia have been made possible due to genotypic technologies that are of a low cost. The
researchers analysed 5959 schizophrenia cases, in comparison to 8717 controls that had been
recruited from four Nordic nations. Findings suggested that family history of schizophrenia and
genetic risk score for the condition were the major risk factors that increase the susceptibility of
an individual to suffer from the psychotic disorder. In a joint model, all the impacts of genetic
risk score remained unchanged, thus highlighting the possibility of amalgamating family history
and genetic score for predicting schizophrenia at early stages. The fact that the family history of
Jess is significant for schizophrenia can be directly associated with her diagnosis of the psychotic
disorder. This can be further supported by findings from genome-wide association studies
(GWAS) that have produced not less than hundred susceptibility variants, which strongly
confirm a substantial contribution, in relation to allelic effects.
Schizophrenia has been identified to be a direct consequence of inherited factors. On
analysing single nucleotide polymorphism in patients who reported a family history of the
aforementioned psychotic illnesses, a significant increase was observed for the effect SNP
amongst those who had a positive family history, in comparison to those without any family
history (Nagelkerke's R2 = 0.0021; P = 0.00331; P‐value threshold <0.4). Apart from the fact that
aggregate effect of the SNPs was substantially higher for positive family history, detectable
allelic effects were identified in particular family subgroups (Bigdeli et al., 2016). Family history
can be further established as the cause for schizophrenia diagnosis in Jess through the

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findings presented by Chou et al. (2017) who investigated the heritability and familial
aggregation of schizophrenia. It has been found that in comparison to the general population,
individuals who had a first degree relative affected with schizophrenia demonstrated a relative
risk of 6.00 [(5.79–6.22), (95% CI)]. However, the relative risk was found to be 14.66 (13.00–
16.53), which was comparatively greater amongst individuals who had two or more relations
affected with schizophrenia (95% CI). Accountability for different phenotyping variants that
were associated to schizophrenia was found to be 15.5% for environmental factors, 47.3% for
genetic factors, and 37.2% for environmental factors that were not shared. Hence it can be
suggested that, presence of a first degree relative increases the likelihood of suffering from
schizophrenia manifold, thus providing an explanation for Jess being diagnosed with the
condition during the early 20s.
Substance abuse
An analysis of the case study suggests that during her teenage years, Jess was involved in
substance abuse and also had to be hospitalized due to excess consumption of cannabis and
alcohol, which might have triggered the onset of schizophrenia. It has been found by Ryan et al.
(2020) that individuals diagnosed with schizophrenia demonstrated a significantly greater
likelihood of having a history of trauma (66% vs. 41%, p < 0.001), in addition to a family history
of drug related problems (53% vs 42%, p = 0.007). Schizophrenia patients were found to be
more likely to have consumed alcohol (37% vs 28%, p = 0.023), and cannabis (38% vs 22%, p =
0.001), in addition to other drugs prior to 16 years of age. Consumption of cannabis during
adolescence was substantially associated with an increase in risk of schizophrenia (OR 2.02, CI
1.35e3.01, p = 0.001). In addition, consumption of cigarettes both during late and early
adolescence was correlated with a manifold augmentation in the psychotic disorder. Even after

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adjustment of covariates, the correlation remains significant (early use OR 2.44, CI 1.75e3.4, p <
0.001; late use OR 2.12, CI 1.37e3.26, p = 0.001). Furthermore, consumption of alcohol prior to
16 years of age was also allied with increased schizophrenia risk, in comparison to late
consumption, thus offering a likely explanation for the psychotic disorder in Jess.
This was in accordance to Mallard, Harden and Fromme (2019) who postulated that
emerging adulthood has been identified the specific period for illicit drug consumption and
alcohol use. The researchers investigated the effect of genetic risk for schizophrenia on substance
used behaviour in non-Hispanic European adults, and found that individuals who had a greater
score for schizophrenia reported experiencing higher age-associated augmentation in the
likelihood of consuming drugs across emerging adulthood (p < 0.005). Findings of the research
also highlighted that there exists a significantly positively association between polygenic score
and the overall propensity of the participants to engage in illicit drug consumption.
However, lack of correlation was found in relation to alcohol associated substance abuse. Hence,
findings from the study suggested that genetic risk for acquiring schizophrenia can be
suggestively accredited to substance abuse behaviour in young adults. According to Murray and
Di Forti (2016) cocaine and cannabis are the most common illegal drugs that individuals
consume. Cannabis has been consistently correlated with an increase susceptibility to psychosis.
It had also be mentioned by the researchers that persons affected with schizophrenia often begin
consumption of cannabis with the aim of dealing with prodromal symptoms, or for coping
against the unpleasant symptoms associated with the psychotic disorder itself. Cannabis
consumption has been associated with a dopamine D2 receptor gene variant that augments the
risk of being affected with the psychotic disorder.

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The same has been confirmed by Libuy et al. (2018) who conducted a study amongst
22,615 individuals who had been provided treatment for illicit substance abuse. Findings from
the studies suggested that prevalence of schizophrenia was approximately 1.1% amid individuals
with cocaine use disorder. However, schizophrenia prevalence was significantly high, with an
estimated 5.2% occurrence in those who suffered from cannabis use disorders (OR 4.9; p <
0.01). Nielsen et al. (2017) affirmed the aforementioned findings and aimed to explore the
impact of substance abuse on risk of being affected with schizophrenia. On conducting a
nationwide longitudinal study among 204505 individuals, diagnosed with substance abuse and
21305 schizophrenia patients, the researchers found that substance abuse diagnosis increased the
general risk of being affected with schizophrenia [hazard ratio (HR) 6.04, 95% confidence
interval (CI) 5.84–6.26]. Alcohol consumption (HR 3.38, 95% CI 3.24–3.53) and cannabis
consumption (HR 5.20, 95% CI 4.86–5.57) presented the maximum association. In addition,
abuse of sedatives, hallucinogens, and other substances also significantly increased the risk.
Thus, substance abuse during teenage years might have made Jess more susceptible to the
disorder.
PTSD
The case study also reported that Jess had been abused by her grandmother, who was her
primary caretaker. It has been mentioned by Okkels et al. (2017) that traumatic stress disorders
are extremely prevalent in schizophrenia patients. Findings from prospective cohort study that
focused on Danish population suggested that individuals with traumatic stress disorder
demonstrated a significantly elevated risk of suffering from schizophrenia (IRR 3.80, CI 2.33–
5.80). Not only were they most susceptible to suffer from schizophrenia spectrum disorder (IRR
2.34, CI 1.46–3.53), but also reported the likelihood of being diagnosed with bipolar disorder

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(IRR 4.22, CI 2.25–7.13). The risks of being diagnosed with schizophrenia significantly
increased after more than 5 years of being subjected to the stress. According to Vallejos et al.
(2017) individuals who have encountered experiences of traumatic events during their childhood
are more vulnerable to developing aggressive behaviour and psychotic disorders like
schizophrenia during adulthood. Schizophrenia patients report an increased rate of traumatic
experiences, in comparison to the general population. Additionally, those who have been victims
of repeated traumatic events are more likely to show a relapse.
Findings from the cross-sectional, observational, descriptive study suggested that 94% of
schizophrenia patients had experienced at least one traumatic childhood event. An estimated
63% reported the presence of four or more events that word disruptive, and majority of these
traumatic incidents occurred within their family. This is in accordance to the findings presented
by Barker et al. (2016) who stated that there exists a well-established association between
schizophrenia and childhood adversities. On examining the correlation between surface area or
cortical thickness with schizophrenia amongst familial high-risk patients, it was found that
cortical surface area of the schizophrenia patients who had referral to children panel was
substantially smaller, in comparison to those who did not have any referral. However, there was
no significant alteration in cortical thickness. The fact that childhood abuse incidents
encountered by Jess might have triggered schizophrenia can be explained by the structural
changes that childhood adversity creates in the brain, which in turn increases the likelihood of
suffering from schizophrenia.
Mohammadzadeh et al. (2019) also confirmed the association between childhood
traumatic events and schizophrenia by conducting an investigation on 82 inpatients. Patients who
reported lifetime suicide attempts were found to you have highest scores, in relation to sexual

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abuse. Additionally, patients who were at a high risk of committing suicide also reported high
scores for physical neglect during childhood. Logistic regression analysis provides an indication
of the fact that sexual abuse and physical neglect during childhood acted as a unique predictors
of suicidal ideations amongst schizophrenia patients.
Implications
Mental health nursing not only encompasses appropriate planning and delivery of
medical and nursing care, together with offering support to individuals who suffer from a
plethora of mental health issues, but also requires the nurses to provide assistance to patients in
order to cope with their situation (Townsend & Morgan, 2017). The difficulty in understanding
the aetiology and symptomatology of schizophrenia by nurses have been identified as a major
impediment to the process of nursing. Taking into consideration the fact that is genetic
factors, history of substance abuse and trauma might have triggered the condition in Jess, it is
essential to deliver nursing interventions that identify the underlying reasons behind the
psychotic disorder. Nursing care should focus on establishment of a therapeutic relationship with
the patient that can be accomplished by demonstrating trust and empathy (Pinho, Pereira &
Chaves, 2017). Presence of a therapeutic association will directly contribute to a curative and
healing environment, which in turn will not only promote recovery of the patient but also help
her overcome the stressors of life. Caring for the schizophrenia patient requires the capability to
demonstrate an understanding and non-stigmatising attitude (Harris & Panozzo, 2019).
Mental health nursing should be able to identify the fact that the client lives in unreal
world that makes it difficult to distinguish reality from hallucinations and delusions. Treatment
options should not only focus on medication administration, but also include cognitive

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behavioural therapy that will effectively help in stress management (Jones et al., 2019). Group
therapy of the patient, along with her family members will facilitate establishment of a social
network, and provide her the much needed support and care. Teaching life skills training will
also promote her to work towards independence (Lee et al., 2018). Additionally, there is a need
to emphasize on social skills training that will help her cope with the underlying symptoms,
which in turn will create an impact on relationship building and social interactions (Granholm &
Harvey, 2018).
Conclusion
Thus, it can be concluded that the client Jess is suffering from schizophrenia that is a
chronic mental illness, characterized by different symptoms like disorganisation of behaviour
and thought, hallucination and delusion. The symptomatology not only affects social functioning
but also adds to disability of the patient. The client suffering from schizophrenia has problems in
perceiving the surrounding world. Three risk factors have been identified from the case study,
which might have predisposed her to the psychotic disorder. These are familial history of
schizophrenia, exposure to traumatic childhood event, and history of substance abuse during
teenage years. While there exists strong correlation between consumption of cannabis and
alcohol with increased risk for schizophrenia, individuals who have been subjected to physical
neglect or sexual abuse during their childhood, are also found to be more susceptible to the
psychotic disorder. The findings discussed in the previous sections also suggest that presence of
first degree relatives with schizophrenia increases the susceptibility to the disease manifold.
Therefore, while delivering nursing care to the client, it is essential to empower the client, which
can be achieved by establishing a therapeutic rapport. This might help in the recovery process.

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