Biopsychological Analysis of a Neuropsychological Disorder

Schizophrenia
Student’s Name
Institution

Introduction
The study of how the brain, neurotransmitters and the nervous system affect emotions and thoughts in humans and animals is referred to as biopsychology (Frith, 2014). This is a field involving an analysis delving deep into the anatomy and physiology of the involved subject. Though researchers have obtained data from human subjects, it is, however, experiments involving monkeys, rats, mice and other primates that have contributed most (Naber, Hansen, Forray, Baker, Sapin, Beillat, & Eramo, 2015). This being contentious, the alternative is, on the other hand, unethical and highly impractical by all standards. Researchers dealing with schizophrenia, the subject of this paper, use animal models as tools in the study of psychotic disorders due to the condition (Frith, 2014). Schizophrenia is a complex mental disorder likely to affect anyone with lengthy and expensive recovery management. This is a factor that has led to research on this condition seeking to explore its reality and the understanding amongst health practitioners. In addition, the prevalence of unnoticed mental situation in the society today is a personal drive for seeking to understand the condition. This is in a bid to better the society.
Schizophrenia is a chronic psychiatric disorder characterized by a failure in understanding the reality and an apparent social abnormality (Kavanagh, Tansey, O’Donovan, & Owen, 2015). As with any other disease, the duration, frequency, and severity of symptoms vary from person to person.

However, the severity of psychotic symptoms decreases with an individual’s lifetime though substance use and failure to use prescribed medicine are an accelerant (Frith, 2014). The symptoms usually appear during early adulthood with men experiencing them earlier than women.
Though the exact causes of schizophrenia are not known, it is suggested that a combination of factors such as genetic, environmental and physical predispose individuals (Frith, 2014). For those prone to it, leading a stressful and emotional life may trigger psychosis. If a patient displays a minimum of two of the symptoms stipulated in the Diagnostic and Statistical Manual, 5th Edition, (DSM-5), then they are diagnosed as schizophrenic. Continuity of these signs for a period of 6 months, persisting alongside active symptoms lasting for a month or more, fundamentally ensures a conclusive diagnosis (Jensen, Vendsborg, Hjorthøj& Nordentoft, 2017).
Discussion
What is Schizophrenia?
Schizophrenia is a brain disorder visible in symptoms inclusive of delusions, hallucinations and disorganized thought patterns. These behaviors are socially abnormal, and the affected individual is usually out of tune with reality. People suffering from this condition usually experience the occurrence of other mental disorders such as anxiety and depressive disorders (Jensen, Vendsborg, Hjorthøj& Nordentoft, 2017). The symptoms of this condition are gradual beginning in young adults and typically developing and lasting a long time. Though research is still ongoing on better management, the causes of this disorder are attributed to genetic and environmental factors. For this reason, the diagnosis of a patient is effectively completed after an analysis of their environmental situation both the familial and societal upbringing, substance use and the psychiatric status of the family members.
Signs and Symptoms
Though it rarely occurs in children, the disorder starts, usually, in the 16-30 years age gap. This is seen through a display of symptoms classified into three categories.
• Positive symptoms
• Negative symptoms
• Cognitive symptoms
The positive symptoms usually are psychotic tendencies absent in healthy individuals. They are characterized by a loss of touch with reality. They include delusion and hallucination (Frith, 2014). Negative ones involve disruptions of normal emotional state and behavior such as withdrawal social and demotivation. Finally, the cognitive behaviors manifest subtly in some but are severe in others. These include memory problems and poor functioning stemming from impaired decision making.
Epidemiology
Worldwide, the disorder is found to have an effect on 0.3 to 0.7 percent of people in various stages of their life (Buckley & Gaughran, 2014). As at 2011, this number was 24 million people. The disorder, research has shown, has gripped men more than women. Besides appearing earlier in men, they are 1.4 times more susceptible. Though specialist used to assume a similar rate across the world, more research has squashed this notion. Migrants and those living in urban areas are more prone (Buckley & Gaughran, 2014). The point prevalence of the disorder is at five persons in every thousand. In addition, there is a variation in the onset of schizophrenia. Studies of prodrome offer a suggestive view that negative symptoms tend to manifest 5 years before the first psychotic episode.
What are its subtypes?
Based on the more predominant symptoms experienced by a patient, there are five subtypes of the disorder. However, these the subtype may change over the course of an illness. For this reason, the American Psychiatrist Association has excluded them from the DSM (Jensen, Vendsborg, Hjorthøj& Nordentoft, 2017). Simply stated, they are not enough for a conclusive for a patient’s analysis. The subtypes are:
• Paranoid schizophrenia
This subtype is characterized by unfounded suspicions and symptoms positive to the condition. The warning signs that psychosis is imminent are such as seeing things, the decline in self-care, difficult in clear thinking and hearing things. However, these do not necessarily indicate schizophrenia. They are simply an indicator for the need of mental evaluation. The paranoiac nature has its roots from delusions and hallucinations. These usually tend to be persecutory in nature. In this case, the other symptoms such as disorganized speech are absent.
• Disorganized schizophrenia
This subtype, also known as hebephrenic schizophrenia, is associated with a general state of disorganization in behavior, speech and the emotional expressions (Jensen, Vendsborg, Hjorthøj& Nordentoft, 2017). Though hallucinations and delusions do occur, they are less pronounced. This type of disorder makes it difficult for an individual to concentrate and maintain a train of thought. People manifesting disorganized speeches usually speak incoherently, shift though topic frequently and give answers unrelated to the questions. This disorganization also makes it difficult to carry out functions independently. Beginning and finish a task becomes difficult, and it eventually results in apparent lack of purpose.
• Catatonic schizophrenia
Though a rarity, this subtype is largely brought about by untreated schizophrenia. Its infrequency is due to early intervention and management of the disorder (Frith, 2014). An individual diagnosed with this is usually immobile and maintains rigidity. In other words, there is a considerable decrease in movement and other times the symptoms involve an increase in movement. This brings movement seems excessive and without a purpose. Additionally, the individual may display strange acts such as stereotypic movements like nail biting and hand waving.
• Undifferentiated schizophrenia
This is a subtype that categorizes people outside the bounds of the three aforementioned categories. Though these symptoms are also severe, they are not as specific. These symptoms change so often takin resemblance of different subtypes. These, though identifiable, defy classification. On the other hand, though these symptoms may be stable, they usually do not fall within the descriptions of schizophrenia. Researchers believe that the symptoms in this result from several different disorders.
• Residual schizophrenia
Individuals with a history of evident schizophrenic symptoms may be diagnosed with this subtype when none of the current symptoms are qualified as clinical schizophrenia. Though the individual may be displaying delusions, auditory hallucination and other positive symptoms, they are at a decreased intensity. In spite of these being part of the picture, they are mild and have no strong emotional association. Residue schizophrenia may occur as a transition from acute episodes to full remission.
History of schizophrenia
Though psychiatric conditions have been affecting humanity for as far back as their existence began, it is not until 1911 that Schizophrenia was officially defined. The past says it being classified differently (Jensen, Vendsborg, Hjorthøj& Nordentoft, 2017). Owing to the bizarre manifestation of the systems, earlier civilizations believed it was a result of spiritual possession. This is a fact that resulted in the flogging, starving and even burning of the schizophrenic individuals. Such was the fate suffered by mentally ill members of the society.
Around 1970, the criteria used for diagnosis were subject to controversy. This is a situation that led to the operation criteria finding application today. During this period, the research found that there was more diagnosis in the American region compared to Europe. This was partially attributed to the loose nature of the DSM manual in use when contrasted with the ICD. Studies conducted later on proved that the US diagnosis was both subjective and unreliable. This was a contributing factor to the manual’s revision.
There, however, exist common misperceptions that schizophrenia causes “split personalities” in individuals. Though some of those diagnosed may have auditory hallucinations with distinct voices, there is, however, no evidence showing shifts between multiple distinct personalities. This, simply, is confusion emanating from a direct interpretation of the word. From its Greek roots, schizophrenia means a “splitting of the mind.”
Schizophrenia’s Development with treatment
Though there has been a widespread belief that there is no hope for recovery, reality paints a different picture. Through medication, therapies, and self-care, individuals suffering from this disorder have hope for recovery. This is despite the fact that there is no cure for the condition. Majorly, the aim of managing is to ensure a quality life for the affected (Jensen, Vendsborg, Hjorthøj& Nordentoft, 2017). This is an esteem-boosting move whose eventual result is watering down depressive tendencies. Additionally, the prescription drugs have an effect of balancing the brain chemicals resulting in an assumption of normalcy in brain functions. As such, there is a high chance of full recovery when treatment is involved.
Schizophrenia’s Development without treatment
Schizophrenia is a psychotic disorder. As such, the condition has both positive and negative symptoms. Without any treatment effort, the affected individuals get demoralized and greatly depressed. This is due to the awareness of the disorder (Jensen, Vendsborg, Hjorthøj& Nordentoft, 2017). The resultant effect of this is a deterioration of the individual’s functionality. In addition, there will be tension in relationships. Due to this, the essential role of support will be amiss driving the individual deeper in disorder.
Methods Used to Diagnose, Evaluate and Manage Schizophrenia
Though the world has seen great advances in the field of medicine, the procedures used for the detection and screening of other diseases are not applicable for psychiatric disorders. Schizophrenia is regarded as the most serious psychiatric condition. Is a factor that has resulted in a lot of research being conducted concerning its screening and detection. Presently, diagnosis is founded on clinical symptoms (Buckley & Gaughran, 2014). This diagnosis is based on criterions set by the APA’s DSM-5 or the World Health Organization’s International Statistical Classification of Diseases (ICD-10) (Buckley & Gaughran, 2014). These two use the experiences reported by a person. The diagnosis involves a ruling out of the other mental health disorders and a thorough determination that the apparent symptoms are not side effects of medication or substance abuse.
For the patient to meet the diagnosis criterion, the following must be considered:
A chronic disorder characterized by instances of psychosis and behavioral disturbances resulting in a decline in social activity
The person must show at the very least two of the following:
Delusion
Hallucinations
Disorganized speech
Catatonic behavior
Negative symptoms:
Flat affect
Social withdrawal
Lack of motivation
Lack of speech or thoughts
The person must have experienced the criteria for a month with social or occupational impacts lasting at least six months. The ICD-10 is usually used in the European region while DSM-5criteria finds application in the US (Buckley & Gaughran, 2014). However, they do have high agreements.
Initial Diagnosis
For diagnosis, the medical practitioner must rule out the possibility of any other disease having similar manifestations. Initially, they are required to analyze a patient’s history and conduct physical examinations. These laboratory tests, alongside brain imaging via CT scans or MRI, lead to a conclusive finding (Frith, 2014). This could be a positive presence of a schizophrenic disorder or other neurological disorders such as epilepsy and encephalitis. Additionally, psychological testing follows. The primary focus of these is usually personality, cognitive and projective tests.
Ongoing Management
Recovering from a mental health issue is an ongoing process. Beyond the pharmacological care, a patient needs access to counseling facilities and rehabilitative therapy (Buckley & Gaughran, 2014). Following the prescribed treatment and a healthier nutrition works towards enhancing an efficient recovery with minimal relapses. Joining support groups is an essential step in this timely endeavor. In addition, there is also a role played by family and close ones. Their support brings an aspect of positivity boosting the patient’s esteem.
Risk Factors
Scientists have been pursuing schizophrenia for a long time. Usually, the scientific research is in a bid to determine the causes and factors complicating the disorder. Though there are no specific causes determined, there are factors seen to predispose individuals. The exposition is as follows:
1. Genetics
Though it runs in families, there is no gene taken to be responsible. The likely conclusion, it is believed, is that different gene combinations make people prone to the condition. Evidence shows that for identical twins if one is schizophrenic, the other has a 50% of developing it (Buckley & Gaughran, 2014). This is because they share the same genes. However, for non-identical twins, the probability of one being schizophrenic, after the other is diagnosed, is about 14%. Though the general population has a chance of 1%, having a schizophrenic parent increases the risk to 10 percent. These odds rise to about 40 if both parents have been diagnosed (Buckley & Gaughran, 2014).
Lifestyle
The lifestyle choices of schizophrenic individuals may contribute positively or negatively to their morbidity and mortality. Poor dietary habits, lack of physical exercise and excessive body weights are some of the predisposing elements (Frith, 2014). Compared to the larger population, these schizophrenic individuals are at a higher risk of medical illnesses. This indicates that the quality of life in individuals may lead to an acceleration of conception of the disorder.
Environment
Seeing environment is a broad and ambiguous term, scientists usually define it to mean the social, hormonal, and the chemical state of a mother during pregnancy. Additionally, the societal situation, education, and any substance use are featured. Individuals who experienced birth-related complications are usually more predisposed. These include:
• Low birth weight
• Premature labor
• Lack of oxygen during birth
Additionally, nutritional deficiencies during pregnancy play a major role in originating schizophrenia. In the early gestation period, the risk is increased two-fold if there is exposure to famine. Though still a contentious matter, central nervous system defects occurring congenitally are usually associated with antenatal famine. There are studies that also suggest a relationship between the disorder and antenatal stress.
Stress, as it is understood, lays a major role in a wide range of conditions. More so, its apparent effects are felt in psychiatric issues like psychosis. Amongst the individuals prone to the disorder, there are stressful triggers that accelerate its occurrence. These include:
• Divorce
• Sexual or abuse
• Emotional abuse
• Losing a job
• Bereavement
Besides the above, the other causative factors are:
Brain Development
Brain development starts at the antenatal stage and carries on through childhood and adolescence. The structure of the brain depends on a combination of psychosocial factors and biological events (Frith, 2014). An abnormality experienced early may adversely affect neurodevelopment and neural circuitry resulting in psychopathology. Characteristic disorders associated with these are referred to as neurodevelopmental disorders. Later on, there emerged evidence showing the presence of psychotic symptoms in schizophrenia dating from early childhood and adolescence. This prompted scientists to propose a neurodevelopmental model for pathogenesis. In addition, studies of schizophrenic individuals have also shown subtle differences in their brain structures. Though the changes are not at all, they still suggest that the condition may be, partly, a brain disorder.
Drug Abuse
Drugs and other substances used or abused do not cause schizophrenia directly. However, their continued use increases the risk of developing the condition. Dysfunctions of serotonergic, dopaminergic and glutamatergic neurotransmissions are some of the resultant effects of substance use (Hjelm, Rollin, Mamdani, Lauterborn, Kirov, Lynch& Vawter, 2015). In addition, the use of cannabis has conclusively been found to raise the risk factor of psychotic symptoms. Research indicates that teenagers under 15 using cannabis are 4 times more susceptible to schizophrenia by age 26. Drugs are especially stronger for individuals who have shown a predisposition to psychosis.
The Nervous System Structure Involved
The area of the brain responsible for handling executive functions is referred to as the prefrontal cortex (Buckley & Gaughran, 2014). Decision making, the creation of strategies and relative behavior adjustments are handled in this region. The impaired functionality of this region results from the release of dopamine excessively. In addition, the auditory and visual cortices of the brain are similarly affected. This explains the tendency to hallucinate. Again, schizophrenia affects the basal ganglia, the part of the brain concerned with thinking skills and movements. Schizophrenic individuals have a larger region than normal people.
Neurotransmitters and Receptor Systems Involved
These are chemicals carrying messages between brain cells. Studying these reveals structural and functional differences in schizophrenic brains (Buckley & Gaughran, 2014). Complexities brought about by the disorder involve dysfunctions spread across neurotransmitter system and multiple circuits. This is seen in reported biochemical changes indicative of such especially in dopamine and serotonin (Buckley & Gaughran, 2014). A change in the level of the two is suggested to cause Schizophrenia. Some of the drugs altering the levels of neurotransmitters also do offer relief for schizophrenics
Treatment and Management
This mental disorder is one that requires lifelong treatment. Though the symptoms may subside, the management of the condition should still carry on. Use of antipsychotic medication alongside psychosocial therapy is the most common method though hospitalization becomes necessary in some severe cases. The antipsychotic treatment is usually the first line of treatment, and it is essential in reducing the positive symptoms in 7 to 14 days (Buckley & Gaughran, 2014). They, however, fail to improve the patient when it comes to the negative and cognitive dysfunction. As such, their continued use places the patient at the risk of a relapse. Their use results in dopamine hypersensitivity increasing the risks if their use is terminated.
Pharmacological Treatment
Following the professional diagnostic of the disorder, it is imperative to carefully consider the type of medication to use. This is determined by factors such as the benefits, costs and the associated risks of use. This medication is vital in its management as it assists in the control of the psychotic impulses lowering them to their lowest. A psychiatrist may prescribe different drug combinations and therapy depending on the progress of the disorder. These antipsychotic drugs are essential for symptom reduction (Buckley & Gaughran, 2014). The two most frequent are:
1. Second generation antipsychotic
These are usually the most preferred due to their lower risk of side effects. They include
• Asenapine
• Iloperidone
• Brexpiprazole
• Cariprazine
• Clozapine
2. First generation antipsychotics
These have significant and frequent side effects including potentially causing movement disorders. The effects may turn out to be irreversible (Naber, Hansen, Forray, Baker, Sapin, Beillat & Eramo, 2015). However, they are cheaper, which is considerable in the case of long-term treatment. They include:
• Haloperidol
• Chlorpromazine
• Perphenazine
• Fluphenazine
Non-pharmacological therapies
When it is determined that there has been a recession of the psychotic tendencies, social and psychological interventions should become a necessity. These will involve:
• Individual therapy
• Social skills training
• Family therapy
• Vocational rehabilitation
These are daily activities aimed at offering support for the individual psychologically while at the same time enhancing integration into the society (Buckley & Gaughran, 2014). However, in the worst case scenario, the patient may be hospitalized. This usually happens when the disorder is severe there is need to ensure proper nutrition, safety, and basic hygiene. For those patients, adults in this case, unresponsive to drug therapy, electroconvulsive therapy may be considered. This is a controversial method that involves passing currents through the brain.
Types of caregivers
Though the aforementioned is true, primary care-providers have the resultant effect of creating substantial differences, overall, in the patient’s health. The common members composing the basic treatment teams are inclusive of:
• Psychiatrist
• Therapist
• Case manager
• Outreach worker
• Visiting nurse
• Legal guardian
Status of Existing Healthcare Setting
The poor physical health of schizophrenic individuals is contributed by both lifestyle factors and the side effects of medication (Naber, Hansen, Forray, Baker, Sapin, Beillat, & Eramo, 2015). The apparent inequality in healthcare provision is attributed to systematic separation of mental health service from the other medical system by healthcare providers. In addition, the prevalent stigma makes it difficult to navigate the management barriers. These barriers can be grouped into system level issues, patient-related factors, and provider issues. The geographical and resource separation of facilities are systemic issues hindering better service delivery. In addition, stigma and time constraints do affect the service providers negatively affecting the affected persons. Again, these patients may be leading lifestyles such as dietary or substance abuses that have negative effects on recovery.
Future Area of Research
Despite the fact that enormous steps have been made in the treatment and management of this condition, there still exist challenges and unmet needs. To begin with, the advantageous second-generation antipsychotics have unclear long-term implications in addition to their cost. A large number of patients either can’t afford to maintain treatment or are not in a position to manage their side effects. In addition to this, the results of their usage remain still inconsistent calling for more research. While still undergoing treatment, there are noncompliance challenges from the patient’s side (Naber, Hansen, Forray, Baker, Sapin, Beillat, & Eramo, 2015). This usually is due to the difficulties experienced during medication. Drugs with “better” side effect profiles would auger cope efficiently with this. However, there has been positivity due to psychosocial strategies working to raise compliance levels.
Conclusion
In conclusion, it is apparent there is a myriad of factors resulting in the initiation or deterioration of schizophrenia. This has led researchers to focus more on recovery as opposed to the previous approach of managing a lifelong disability. As shown in the paper, the disorder has various and complex stages of manifestation. These have resulted in inconsistencies in the treatment. The medication available is also under more review is a bid to eliminate the undesirable side effects. This is an indication of the complexity of this disorder, which is coupled with barriers to service provision.
Additionally, there is involved a variety of components in the management of the condition. These include antipsychotic medication, emergency psychiatric services, individual therapy and day treatment. Coupled with a schizophrenic’s inability to hold a job, these services tend to raise the financial burden of the individual concerned and the caregivers. On top of that, the diagnosis of the disorder might involve CT scan And MRI. These are relatively expensive procedures. Besides these, therapeutic services for efficient analysis involve a great deal of time. These, however, are necessities for a better recovery. Therefore, it is evident that the disorder is wrought in complexities. Its management, on the other hand, is financially demanding.
References
Buckley P. F., & Gaughran, F. (Eds.). (2014). Treatment–Refractory Schizophrenia: A Clinical Conundrum. Springer Science & Business Media.
Frith, C. D. (2014). The cognitive neuropsychology of schizophrenia. Psychology press.
Hjelm, B. E., Rollins, B., Mamdani, F., Lauterborn, J. C., Kirov, G., Lynch, G., … & Vawter, M. P. (2015). Evidence of mitochondrial dysfunction within the complex genetic etiology of schizophrenia. Molecular neuropsychiatry, 1(4), 201-219.
Jensen, K. B., Vendsborg, P., Hjorthøj, C., & Nordentoft, M. (2017). Attitudes towards people with depression and schizophrenia among social service workers in Denmark. Nordic journal of psychiatry, 71(3), 165-170.
Kavanagh, D. H., Tansey, K. E., O’Donovan, M. C., & Owen, M. J. (2015). Schizophrenia genetics: emerging themes for a complex disorder. Molecular psychiatry, 20(1), 72.
Naber, D., Hansen, K., Forray, C., Baker, R. A., Sapin, C., Beillat, M., … & Eramo, A. (2015). Qualify: a randomized head-to-head study of aripiprazole once-monthly and paliperidone palmitate in the treatment of schizophrenia. Schizophrenia research, 168(1), 498-504.