Causes of schizophrenia... is there really a debate?

[Nanon]

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I was kind of blown away today in my medical anthropology class when the teacher stated that the causes of schizophrenia aren't known (she dismissed genetics and the idea that it might be a brain disorder), and that the psychoanalytic theorys of lack of attachment of the mother to the child were still being debated...

Um, really? I thought it was pretty well settled that schizophrenia was a genetic disorder that can be exacerbated by stressful events and environment, but that psychotherapy wasn't effective.

She then went on to describe how many therapists and psychiatrists use holding therapy on schizophrenics. She described it as a rigid adherance to the timing of therapy, but my online search shows that this is a contraversial treatment for autistics whereby the pt. is held for prolonged periods of time.

I am really shocked. Is this lady cracked? Or is this really going on?

Nanon

 

[Sanman]

Well, as far as I was aware, schizophrenia has been found to be caused by an oversupply of dopamine in certain brain pathways. Hence, the reason why schizophrenics on medication have parkison's like symptoms as side effects of the medication. Though I'm sure there are people still trying therapy, I'm sure its controversial and hardly mainstream as far as I know. It sounds like your professor is into the psychoanalytic perspective than the modern biopsychosocial theory. Though in her defense there is no definite answer that I'm aware of to the cause of schizophrenia, just the prevailing theory based on scientific evidence.

 

[flighterdoc]

I was kind of blown away today in my medical anthropology class when the teacher stated that the causes of schizophrenia aren't known (she dismissed genetics and the idea that it might be a brain disorder), and that the psychoanalytic theorys of lack of attachment of the mother to the child were still being debated...

Um, really? I thought it was pretty well settled that schizophrenia was a genetic disorder that can be exacerbated by stressful events and environment, but that psychotherapy wasn't effective.

She then went on to describe how many therapists and psychiatrists use holding therapy on schizophrenics. She described it as a rigid adherance to the timing of therapy, but my online search shows that this is a contraversial treatment for autistics whereby the pt. is held for prolonged periods of time.

I am really shocked. Is this lady cracked? Or is this really going on?

Nanon

LOL. Thats why it's not really a science.

 

[lazure]

There's also the issue of whether schizophrenia is one disorder or a cluster of many disorders - we still don't know that. But do tell your prof that blaming the mother is out of date .... I hope she has nothing to do with real patients...

 

[PublicHealth]

Neurosci Biobehav Rev. 2004 Mar;28(1):41-53.

Schizophrenia-an evolutionary enigma?

Brune M.

Centre for Psychiatry and Psychotherapy, University of Bochum, Alexandrinenstr, Bochum, Germany. [email protected]

The term 'schizophrenia' refers to a group of disorders that have been described in every human culture. Two apparently well established findings have corroborated the need for an evolutionary explanation of these disorders: (1) cross-culturally stable incidence rates and (2) decreased fecundity of the affected individuals. The rationale behind this relates to the evolutionary paradox that susceptibility genes for schizophrenia are obviously preserved in the human genepool, despite fundamental reproductive disadvantages associated with the disorders. Some researchers have therefore proposed that a compensatory advantage must exist in people who are carriers of these genes or in their first-degree relatives. Such advantages were hypothesised to be outside the brain (e.g. greater resistance against toxins or infectious diseases), or within the social domain (e.g. schizotypal shamans, creativity). More specifically, T.J. Crow has suggested an evolutionary theory of schizophrenia that relates the disorders to an extreme of variation of hemispheric specialisation and the evolution of language due to a single gene mutation located on homologous regions of the sex chromosomes. None of the evolutionary scenarios does, however, fully account for the diversity of the symptomatology, nor does any one hypothesis acknowledge the objection that the mere prevalence of a disorder must not be confused with adaptation. In the present article, I therefore discuss the evolutionary hypotheses of schizophrenia, arguing that a symptom-based approach to psychotic disorders in evolutionary perspective may improve upon the existing models of schizophrenia.

 

[Yahweh]

I was kind of blown away today in my medical anthropology class when the teacher stated that the causes of schizophrenia aren't known (she dismissed genetics and the idea that it might be a brain disorder), and that the psychoanalytic theorys of lack of attachment of the mother to the child were still being debated...

Um, really? I thought it was pretty well settled that schizophrenia was a genetic disorder that can be exacerbated by stressful events and environment, but that psychotherapy wasn't effective.

She then went on to describe how many therapists and psychiatrists use holding therapy on schizophrenics. She described it as a rigid adherance to the timing of therapy, but my online search shows that this is a contraversial treatment for autistics whereby the pt. is held for prolonged periods of time.

I am really shocked. Is this lady cracked? Or is this really going on?

Nanon

Do not be troubled. Science is not always the pursuit of truth.

 

[MHTech]

While I know the title of this thread relates to the causes... Several of you alluded to ways of helping the disease slow.

If you ever have the time, Check out Dante's Cure by Doctor Daniel Dorman. Website: http://dantescure.com

The premise behind the book is of a late teens girl-Katherine Penney Dr.Dorman treats while a resident at UCLA and he forces her,the attendings,nurses..etc to take her off her meds and how it would be helpful much to their chagrin. She ends almost getting 'worse' for a long period. She does eventually get better,ends up becoming a strong mental health advocate as well as a succesful Psychiatric RN. Very fasicnating, well written book that I suggest all interested check out. It's obviously an isolated story and not all can or while work out in the way her's does. It gives those of you entering into practice a thing to think about however in this drug friendly enviorment -psychotheraputic talk, we call Psychiatric care.

And in his book Dr.Dorman does relate problems between Katherine and her mother as a contributing factor to her illness. Never does he specify one problem as the leading cause.

Good reading. 🙂

 

[Yomi]

Schizophrenias is a collection of disorders with similar presentation. some of these disorders have no relationship except that the clinical features look alike.I am not really sure what this person was driving at.However Schizophrenia is still an "enigma"

 

[cara susanna]

God, that attachment theory kills me. It's hard enough having a schizophrenic son or daughter and I'm sure they already blame themselves enough without the therapist saying that they had a "rejecting breast" or something.

 

[starsinnight]

I think it is still controversial in some ways. Although the attachment theory is mainly rejected nowadays, it does seem to be a combination of nature and nurture - and that "nurture" part is what becomes controversial. Similar to the theories behind antisocial personality disorder being created by a lack of mothering and nurturance (also highly controversial).

After doing therapy for 1 year with a client with schizophrenia, I can say that therapy is beneficial but mostly what we call "maintenance" to make sure they maintain their meds, are functioning in multiple areas of their lives, encouraging progressive behaviors (like becoming more social, working on family dynamics, own grooming, goals and motivation, etc.). But what creates schizophrenia in one person versus another isn't completely known in the scientific manner. My client definitely had some family dysfunctions but I wouldn't argue it was all due to that.

This also goes into the theory and explanation behind the "schizo" spectrum, which newest research has been discussing - where there is a spectrum of disorganized thinking ranging from schizoid personality disorder, to schizotypal personality disorder, to schizophrenia. My client in particular, it appears, was schizoid in high school (whereas many people with schizophrenia seem like everyone else, my best friends brother went to high school with me and never showed symptoms) and while my client, was a social outcast and had many of the schizoid symptoms, its not always the case. But a thought that needs more research.

BTW back in undergrad I had a professor who debated whether or not schizophrenia even existed at all and I was blown away! Sadly enough, professors don't know everything!!

 

[AcronymAllergy]

I think it is still controversial in some ways. Although the attachment theory is mainly rejected nowadays, it does seem to be a combination of nature and nurture - and that "nurture" part is what becomes controversial. Similar to the theories behind antisocial personality disorder being created by a lack of mothering and nurturance (also highly controversial).

After doing therapy for 1 year with a client with schizophrenia, I can say that therapy is beneficial but mostly what we call "maintenance" to make sure they maintain their meds, are functioning in multiple areas of their lives, encouraging progressive behaviors (like becoming more social, working on family dynamics, own grooming, goals and motivation, etc.). But what creates schizophrenia in one person versus another isn't completely known in the scientific manner. My client definitely had some family dysfunctions but I wouldn't argue it was all due to that.

This also goes into the theory and explanation behind the "schizo" spectrum, which newest research has been discussing - where there is a spectrum of disorganized thinking ranging from schizoid personality disorder, to schizotypal personality disorder, to schizophrenia. My client in particular, it appears, was schizoid in high school (whereas many people with schizophrenia seem like everyone else, my best friends brother went to high school with me and never showed symptoms) and while my client, was a social outcast and had many of the schizoid symptoms, its not always the case. But a thought that needs more research.

BTW back in undergrad I had a professor who debated whether or not schizophrenia even existed at all and I was blown away! Sadly enough, professors don't know everything!!

Was the professor arguing that schizophrenia/psychosis didn't exist, or that the diagnostic category of schizophrenia didn't/shouldn't exist? I would see the former as being very difficult to justify, especially if the professor was in the psychology department. Conversely, there are many who would argue that the latter may be the case, just as there are those who have great difficulty accepting schizoaffective as a "stand-alone" diagnostic entity.

 

[DrGero]

It's pretty untenable to say that it's clear what the cause of Schizophrenia is when it's also clear that we're not entirely sure what Schizophrenia is aside from the unreliable, constantly-shifting diagnostic criteria featured in every successive update of the DSM. The medical anthropologist has a good point, in other words.

 

[Knights24]

To make matters of the "cause" of schizophrenia more muddled - has anyone read about orthomolecular medicine. This is "mega" doses of vitamins to treat certina medical/psychiatric disorders.

When used in schizophrenia, specifically the B vitamin Niacin, it has shown VERY promising results. But in case studies only...not sure if there have been randomized, controlled studies. Anyway, this topic seems to be looked down upon by medical/psychological professions as bologna - however the case studies I've seen published have been shocking as to just how well this seems to work for schizophrenia. I'm talking about a complete return to funtionality in some cases.

 

[MightyMoose]

To make matters of the "cause" of schizophrenia more muddled - has anyone read about orthomolecular medicine. This is "mega" doses of vitamins to treat certina medical/psychiatric disorders.

When used in schizophrenia, specifically the B vitamin Niacin, it has shown VERY promising results. But in case studies only...not sure if there have been randomized, controlled studies. Anyway, this topic seems to be looked down upon by medical/psychological professions as bologna - however the case studies I've seen published have been shocking as to just how well this seems to work for schizophrenia. I'm talking about a complete return to funtionality in some cases.

Case studies are fairly worthless when examining treatments for Sz. Also, I find it very unlikely that that mega doses of any vitamin, mineral or drug currently known will return anyone with Sz to societal definitions of "complete functionality," or whatever you mean by that. Most will never work again, and if they do they will be volunteers or work for a group that is very friendly towards those with mental illness, such as NAMI, VA, or some other group.

It is also helpful, if you're trying to support claims made by a study to add a citation or a link.

 

[DrGachet]

I was kind of blown away today in my medical anthropology class when the teacher stated that the causes of schizophrenia aren't known (she dismissed genetics and the idea that it might be a brain disorder), and that the psychoanalytic theorys of lack of attachment of the mother to the child were still being debated...

Um, really? I thought it was pretty well settled that schizophrenia was a genetic disorder that can be exacerbated by stressful events and environment, but that psychotherapy wasn't effective.

She then went on to describe how many therapists and psychiatrists use holding therapy on schizophrenics. She described it as a rigid adherance to the timing of therapy, but my online search shows that this is a contraversial treatment for autistics whereby the pt. is held for prolonged periods of time.

I am really shocked. Is this lady cracked? Or is this really going on?

Nanon

You should not be shocked. At this point, everything is on the table, including modified version of psychoanalytic theories of schizophrenia.

Based on my limited knowledge, genetics do play a role, a very complicated one. Schizophrenia may be a cluster of a number of different diseases/disorders. Dopamine theory is embarrassingly simple minded as is "blaming the mother" but that does not mean that they are both "wrong." There are correlations between having an overbearing/dominant mother and schizophrenia, but this is not about "blaming" really. It's not clear if the father's or the child's behavior demands such behavior from the mother. The dynamics are complex.

If we are to think in terms of blame, dopamine theory is the safest conceptualization because it's hard to "blame" a "chemical imbalance." Yet, that also is a correlation. I have read anti-psychiatry debates re existence of schizophrenia, sociological explanations of the illness/disorder, biological, psychological, and even neurological explanations, so I would suggest that you look at them all with a true sense of curiosity and also skepticism, but do not discount older theories because many do seem to contain a bit of truth somewhere in there.

 

[Evidence Based]

If we want to talk biology, there's actually a lot of evidence coming to the fore about the role of glutamate in schizophrenia. It appears that problems in glutamatergic neurons may dysregulate both the mesolimbic system (mygdala, hippocampus, nucleus accumbens, etc) and the mesocortical system (cerebral cortex). Incidentally, these are the two areas thought to be responsible for positive and negative/cognitive symptoms, respectively.
For those who are curious, here are some links for further reading:

Glutamate and Dopamine Dysregulation in Schizophrenia- a synthesis and selective review

http://jop.sagepub.com/content/21/4/440.short

Altered Relationship Between Hippocampal Glutamate Levels and Striatal Dopamine Function in Subjects at Ultra High Risk of Psychosis

http://www.biologicalpsychiatryjournal.com/article/S0006-3223(10)00569-X/abstract


Secondly, when talking about the usefulness of therapy in Sz, there has actually been a good deal of evidence for the usefulness of CBT as an adjunct to anti-psychotic treatment, with studies showing decreased positive symptomatology and increased medication adherence. The results have been mixed with regards to non-specific therapy (ex. supportive therapy), but the results at least look promising.

Cognitive Behavior Therapy for Schizophrenia

http://ajp.psychiatryonline.org/cgi/reprint/163/3/365.pdf

So just as an aside, one can think that schizophrenia has a strong biological and genetic basis, yet still see the efficacy of psychosocial interventions.

 

[phillydave]

God, that attachment theory kills me. It's hard enough having a schizophrenic son or daughter and I'm sure they already blame themselves enough without the therapist saying that they had a "rejecting breast" or something.

Oversimplifying one piece of a theory to make it sound silly is easy.

 

[PETRAN]

One very good book on psychosis is "Madness Explained" by Bentall. Well, the title is a bit over the top and the book is sometimes labelled in the "anti-psychiatry" movement. Far from it, Bentall who is both a clinical and a cognitive/experimental psychologist builds a very complex bio-psycho-social model focusing on many aspects, from the problems people with psychosis have with extreme emotions (proposing a "psychotic continuum" with bipolar disorder) to attributions (who caused something?), to faulty theory of mind, to the generation of hallucinations due to reduced executive monitoring and to loose associations due to faulty neurodevelopmental semantics. Bentall reincarnates the old theory of "grand-psychosis", in which there is a psychotic continuum ranging from bipolar to extreme "negative-symptom" schizophrenia and that biological, psychological and social factors have a more major or minor role depending on the case.


Also, a lot of modern researchers hold the assumption that the more "poorly-functioning-negative-symptom-cognitive-deficit-type-schizophrenia" could have a stronger neurodevelopmental basis-including birth complications and serious childhood sickness-in comparison to the "better-functioning-positive-symptom-dominant-paranoid-schizophrenia" type which is highly corellated with childhood trauma and very "bad" emotional events during development. So the "bio", "psycho" and "socio" could differ in their influence depending on the person and the manifestation of the disorder(s?). More "cognitive/negative-deficit" schizophrenia could result in hallucinations and faulty assumptions because the person has difficulty perceiving, associating and controlling the various stimuli whereas hallucinations and faulty assumptions in the more "positive/paranoid" types could result from the extreme emotional dysregulation and the over-flooding of executive functions (this type could be more closer to bipolar-1 type). Still, many cases could be a "mix" of all these.


Plus, very good research on the "cognitive deficits" and the "neurocognition" on schizophrenia has been done by the neuropsychologist Michael Foster Greene who also models "schizophrenia" as the collection of various (dys-)functional continua.

 

[cara susanna]

Oversimplifying one piece of a theory to make it sound silly is easy.

Apparently I haven't grasped the entire theory then.

 

[nitemagi]

Great discussion. In the spirit of the collection of disorders rather than one thing, I think therapy plays roles in a couple of areas:
1) Misdiagnosed patients with more of a mood component to their illness
2) Prodromal psychosis patients (CBT has been shown to reduce symptoms as well as antipsychotic meds)
3) Misdiagnosed patients with a dissociative psychosis presentation
4) Development of a secure relationship to encourage, as mentioned above, med compliance.

The schizophrenogenic mother hypothesis I think IS dismissed in most professional circles. Most scientists consider it a brain disorder of some form, but a heterogeneous illness likely with multiple different genetic abnormalities affective different parts of different pathways in different patients. Thus the one treatment fits all doesn't seem to apply. Therapy affects the brain and chemistry and most likely genetic activation, just like meds and stressors and many other things do as well.

We all fall too easily into the hammer/nail mentality, which I believe misses the bigger picture.

 

[nitemagi]

This also goes into the theory and explanation behind the "schizo" spectrum, which newest research has been discussing - where there is a spectrum of disorganized thinking ranging from schizoid personality disorder, to schizotypal personality disorder, to schizophrenia. My client in particular, it appears, was schizoid in high school (whereas many people with schizophrenia seem like everyone else, my best friends brother went to high school with me and never showed symptoms) and while my client, was a social outcast and had many of the schizoid symptoms, its not always the case. But a thought that needs more research.

I think you're misapplying the DSM (which we all know is incomplete). You technically can't have a personality disorder before adulthood, d/t ongoing development. Your observation, though, of the social isolation and social outcast, is more likely representative of the prodromal period of schizophrenia before the first break, usually involving a deterioration in multiple domains, especially social functioning.

 

[medical geek5]

Two main things,first for nitemagi: not sure what is meant by "dissociative psychosis presentation" and for everyone,i'm not sure how accurate the belief that most schizophrenics cannot function independently(and I don't mean merely volunteer for NAMI,etc...). The reason I say the latter is b/c what if many ,over time,as they get older(like from 20's to40's)become functional like "normal " people? How easy(or noneasy)do you think it would be for them to have become part of the opposing statistics(meaning those who do recover and blend in w/ "normals")? In addition,many people in the 40's now did not have the electronic media(ie records)that we have today.I read one study ?I think by a Courtenay Harding who looked at how "backward" patients years ago were 20 years after their hospitalizations. Many were functioning fine. I also don't think much of the data on those who have recovered are available.

 

[MightyMoose]

Two main things,first for nitemagi: not sure what is meant by "dissociative psychosis presentation" and for everyone,i'm not sure how accurate the belief that most schizophrenics cannot function independently(and I don't mean merely volunteer for NAMI,etc...). The reason I say the latter is b/c what if many ,over time,as they get older(like from 20's to40's)become functional like "normal " people? How easy(or noneasy)do you think it would be for them to have become part of the opposing statistics(meaning those who do recover and blend in w/ "normals")? In addition,many people in the 40's now did not have the electronic media(ie records)that we have today.I read one study ?I think by a Courtenay Harding who looked at how "backward" patients years ago were 20 years after their hospitalizations. Many were functioning fine. I also don't think much of the data on those who have recovered are available.

This can depend on a number of different factors, such as family support, drug compliance, nutrition, lifestyle, etc.. It's a more complicated question than simply saying that with time people with schizophrenia become more functional in society. Overall, I would say that with our current understanding of the disease and with current atypical antipsychotics, cbt, etc., it would be very unlikely for someone with schizophrenia to end up holding a regular 9-5 job.

I do agree that someone who has had the illness for years can gain more insight into their illness and can realize that the delusions/hallucinations are not real (or at least that they are told they are not real), which can help them function in a number of social and work situations that wouldn't have been possible closer to their initial psychotic break, but I still don't think that would equate to a regular 9-5 job.

 

[KillerDiller]

I do agree that someone who has had the illness for years can gain more insight into their illness and can realize that the delusions/hallucinations are not real (or at least that they are told they are not real), which can help them function in a number of social and work situations that wouldn't have been possible closer to their initial psychotic break, but I still don't think that would equate to a regular 9-5 job.

For anyone interested in the topic, I recommend the autobiography The Center Cannot Hold by Elyn Sacks. Although far from a typical case, the author deals with schizophrenia and her psychotic breaks while pushing herself through undergrad and law school. She ends up with a prestigious academic position, though still occasionally has to take leave due to her illness.

 

[medical geek5]

Not sure how "nontypical" a fulltime job would be to a person diag.w/schizophrenia. After all,not sure if the count of those unable to work vs. those able to work(using work for example as onecriteria)can ever be accurate since I believe most of these folks at this point would not disclose. So maybe there are more Ellyn Sakses out there than what we think. What are your ideas on this?

Didn't want my other question to get lost:to nitemagi what is meant by "Misdiagnosed patients with a dissociative psychosis presentation"?thanks

 

[AcronymAllergy]

Not sure how "nontypical" a fulltime job would be to a person diag.w/schizophrenia. After all,not sure if the count of those unable to work vs. those able to work(using work for example as onecriteria)can ever be accurate since I believe most of these folks at this point would not disclose. So maybe there are more Ellyn Sakses out there than what we think. What are your ideas on this?

Didn't want my other question to get lost:to nitemagi what is meant by "Misdiagnosed patients with a dissociative psychosis presentation"?thanks

I'd be interested to hear about the last part as well. Perhaps nitemagi meant a situation in which dissociative symptoms (e.g., numbing, detachment) are mistaken for negative schizophrenia symptoms which, when combined with psychotic features, could be misdiagnosed as schizophrenia?

 

[medical geek5]

to anyone: any ideas?

 

[aventurine]

While I do believe med management is critical in working with individuals with schizophrenia, I believe therapy can be useful for some as an adjunct. I've effectively used both psychodynamic and CBT interventions in therapy with this population.

In addition to the book already recommended, I'd suggest checking this one out:

http://www.amazon.com/Cognitive-Del...=sr_1_1?s=books&ie=UTF8&qid=1300000090&sr=1-1