Chapter I
Introduction
Schizophrenia is a disorder characterized by significant disorganization of thinking
manifested by problems with communication and cognition; impaired perceptions of reality
manifested by hallucinations and delusions; and sometimes in significant decreases in
functioning.
Approximately 2.2 million people, or 1% of the world population, suffer from
schizoprenia . Statistics indicate that approximately 40% of these individual (1.8 million people)
do not receive psychiatric treatment on any given day, resulting in homelessness, incarceration,
or violence.(National Advisory Mental Health Council,2005).
The onset of schizoprhenia may occur late in adolescence or early in adulthood, usually
before the age of 30. Although the disorder has been diagnosed in children, approximately 75%
of person diagnosed as having schizoprhenia develop the clinical symptoms between ages of 16
and 25 years. Schizoprhenia usually first appears earlier in men, in their late teens or early
twenties, than in women, who are generally affected in their twenties or early thirties.
( shives,2008)
Age at onset appears to be an important factor in how the client fares: those who develop
the illness earlier show worse outcomes than those who develop it later. Younger clients display
a poorer premorbid adjustment, more prominent negative sign, and greater cognitve impairment
than do older clients. Those who experience a gradual onset of the disease (about 50%) tend to
have both poorer immediate and long term course than those who experience an acute and
sudden onset (Buchanan and Carpenter, 2005)
, Schizoprenia are classified into four types: Paranoid Schizoprhenia, Disorganized
Schizophrenia, Catatonic Shizophrenia, Residual schizophrenia and Undifferentited type was
charcterized by mixed shizoprhenic symptoms along with disturbances of thought, affect and
behavior.
This was a case of a 39 years old, female client from Sorsogon City, with an early onset
of undifferentiated shizophrenia since 1990 and admitted at National Center for Mental Health in
Pavillion 2 accompanied by her father, later on she was transferred in Unit 2, Pavillion 5 because
of agitation and assultive behavior to other client.
Theoretical Framework
Different theorist in the past proposed theories to explain the possible cause and
development of schizophrenia:
Psychoanalysis theory by Sigmund freud postulated that shizophrenia resulted form
development of fixation that occurred earlier that those culminating in the development of
neuroses. These fixations produced defects in ego development and freud postulated that such
defects contributed to the symptoms of schizophrenia. Ego intergration in schizoprhenia
represent a return to the time when the ego was not yet , or had just begun to be established.
Because the ego affects the interpretation of reality and control the inner drives such as sex and
agression. These ego functions are impaired, thus , intrapsychic conflict arising from the early
fixation and the ego defects which may resulted from early object relations, full of psychotic
symptoms. (Kennedy,2007)
Genetic predisposition theory suggest that the risk in inheriting schizophrenia is 10% to
20% in those who have one immediate family member with the disease, and approximately 40%
if the disease affects both parents or an identical twins. (Shives, 2008).
, Biochemical and neurostuctural theory includes the dopamine hypothesis: that an
excessive amount of neurotransmitter dopamine allows nerves impulses to bombard the
mesolimbic pathway, thye part of the brain normally involved in arousal and motivation. Normal
cell communication is disrupted, resulting in the development of hallucinations and delusions,
symptoms of schizoprhenia. The abnormalities of neurocircuitry or signals from nuerons are
being studied as well. A defective circuit can result in bombardment of infiltered information,
possibly causing negative and positive symptoms. Overwhelmed the mind makes errors in
perception and hallucinates, draws incorrect conclusion, and becomes delusionals. To
compensate for this barrage , the mind withdraws and negative symptoms develop. (Beuer,2006)
Organic or Pathophysiologic Theory suggest schizophrenia is a functional deficit
occuring in the brain caused by stressors such as viral infection, toxins, trauma or abnormal
substances.( Well-connected,2006)
Perinatal Theory suggest that the risk of schizophrenia exist if the developing fetus or
newborn is deprived of oxygen during pregnancy or if the mother suffers from malnutrition or
starvation during first trimester of pregnancy . The development of schizoprhenia may occur
during fetal life at critical points in the brain development generally the 34th or 35th week
gestation. The incidence of trauma and injury during the second trimester and birth also been
considered in the development of schizoprenia. ( Well-connected,2006)
Schisms and Skewed families by Theodore Lidz described two abnormal patterns of
family behaviors. In one family type, with a prominant schism between the parents, one parent is
overly close to a child of the opposite gender. In the other family type a skwed relationship
between a child and one parent involves a power struggle between one parent. These dynamics
stress the tenuous adaptive capacity of schizoprenic person.( Balllard 2009)
, Pseudomutual and Psuedohostile families by Lyman Wynne, some families supress
emotional expression by consistently using pseudomutual or psuedohostile verbal
communication. In such families, a unique verbal communication develops and when child
leaves home and must relate to other persons, problems may arise the verbal communication may
be incomprehensive to outsider( Brien 2007).
Psychological or Experiential theory found that prefrontal lobes of the brain are
extremely responsive to stress. Individuals with schizophrenia experiences stress when family
members and acquaintances respond negatively to the individual’s emotional needs. These
negative responses already vulnerable neurologic state, possibly trigerring and excerbating
existing symptoms. Stressors that have been thought to contribute to the onset of schizophrenia
include poor mother-child relationships, deeply disturbed family intrepersonal relationships,
impaired sexual identity and body image, rigid concept of reality, and repeated exposure to
double bind situation. A double-bind stuation is a no win experience, one in which there is no
correct choice. (kolb,2005).
Double bind concept by Gregory Bateson and Donald Jackson is to described the
hypothetical family in which children receive conflicting parental messages about their behavior,
attitudes and feelings. Children withdraw into a psychotic sate to escape the unsolvable
confusion of double bind. (Ballard 2009).
Environmental or cultural Theory state that person who develops schizoprhenia has a
faulty reaction to the environment, being unable to respond selectively to numerous social
stimuli. Theorist also believe that person who come from low socioeconomic areas or single-
Introduction
Schizophrenia is a disorder characterized by significant disorganization of thinking
manifested by problems with communication and cognition; impaired perceptions of reality
manifested by hallucinations and delusions; and sometimes in significant decreases in
functioning.
Approximately 2.2 million people, or 1% of the world population, suffer from
schizoprenia . Statistics indicate that approximately 40% of these individual (1.8 million people)
do not receive psychiatric treatment on any given day, resulting in homelessness, incarceration,
or violence.(National Advisory Mental Health Council,2005).
The onset of schizoprhenia may occur late in adolescence or early in adulthood, usually
before the age of 30. Although the disorder has been diagnosed in children, approximately 75%
of person diagnosed as having schizoprhenia develop the clinical symptoms between ages of 16
and 25 years. Schizoprhenia usually first appears earlier in men, in their late teens or early
twenties, than in women, who are generally affected in their twenties or early thirties.
( shives,2008)
Age at onset appears to be an important factor in how the client fares: those who develop
the illness earlier show worse outcomes than those who develop it later. Younger clients display
a poorer premorbid adjustment, more prominent negative sign, and greater cognitve impairment
than do older clients. Those who experience a gradual onset of the disease (about 50%) tend to
have both poorer immediate and long term course than those who experience an acute and
sudden onset (Buchanan and Carpenter, 2005)
, Schizoprenia are classified into four types: Paranoid Schizoprhenia, Disorganized
Schizophrenia, Catatonic Shizophrenia, Residual schizophrenia and Undifferentited type was
charcterized by mixed shizoprhenic symptoms along with disturbances of thought, affect and
behavior.
This was a case of a 39 years old, female client from Sorsogon City, with an early onset
of undifferentiated shizophrenia since 1990 and admitted at National Center for Mental Health in
Pavillion 2 accompanied by her father, later on she was transferred in Unit 2, Pavillion 5 because
of agitation and assultive behavior to other client.
Theoretical Framework
Different theorist in the past proposed theories to explain the possible cause and
development of schizophrenia:
Psychoanalysis theory by Sigmund freud postulated that shizophrenia resulted form
development of fixation that occurred earlier that those culminating in the development of
neuroses. These fixations produced defects in ego development and freud postulated that such
defects contributed to the symptoms of schizophrenia. Ego intergration in schizoprhenia
represent a return to the time when the ego was not yet , or had just begun to be established.
Because the ego affects the interpretation of reality and control the inner drives such as sex and
agression. These ego functions are impaired, thus , intrapsychic conflict arising from the early
fixation and the ego defects which may resulted from early object relations, full of psychotic
symptoms. (Kennedy,2007)
Genetic predisposition theory suggest that the risk in inheriting schizophrenia is 10% to
20% in those who have one immediate family member with the disease, and approximately 40%
if the disease affects both parents or an identical twins. (Shives, 2008).
, Biochemical and neurostuctural theory includes the dopamine hypothesis: that an
excessive amount of neurotransmitter dopamine allows nerves impulses to bombard the
mesolimbic pathway, thye part of the brain normally involved in arousal and motivation. Normal
cell communication is disrupted, resulting in the development of hallucinations and delusions,
symptoms of schizoprhenia. The abnormalities of neurocircuitry or signals from nuerons are
being studied as well. A defective circuit can result in bombardment of infiltered information,
possibly causing negative and positive symptoms. Overwhelmed the mind makes errors in
perception and hallucinates, draws incorrect conclusion, and becomes delusionals. To
compensate for this barrage , the mind withdraws and negative symptoms develop. (Beuer,2006)
Organic or Pathophysiologic Theory suggest schizophrenia is a functional deficit
occuring in the brain caused by stressors such as viral infection, toxins, trauma or abnormal
substances.( Well-connected,2006)
Perinatal Theory suggest that the risk of schizophrenia exist if the developing fetus or
newborn is deprived of oxygen during pregnancy or if the mother suffers from malnutrition or
starvation during first trimester of pregnancy . The development of schizoprhenia may occur
during fetal life at critical points in the brain development generally the 34th or 35th week
gestation. The incidence of trauma and injury during the second trimester and birth also been
considered in the development of schizoprenia. ( Well-connected,2006)
Schisms and Skewed families by Theodore Lidz described two abnormal patterns of
family behaviors. In one family type, with a prominant schism between the parents, one parent is
overly close to a child of the opposite gender. In the other family type a skwed relationship
between a child and one parent involves a power struggle between one parent. These dynamics
stress the tenuous adaptive capacity of schizoprenic person.( Balllard 2009)
, Pseudomutual and Psuedohostile families by Lyman Wynne, some families supress
emotional expression by consistently using pseudomutual or psuedohostile verbal
communication. In such families, a unique verbal communication develops and when child
leaves home and must relate to other persons, problems may arise the verbal communication may
be incomprehensive to outsider( Brien 2007).
Psychological or Experiential theory found that prefrontal lobes of the brain are
extremely responsive to stress. Individuals with schizophrenia experiences stress when family
members and acquaintances respond negatively to the individual’s emotional needs. These
negative responses already vulnerable neurologic state, possibly trigerring and excerbating
existing symptoms. Stressors that have been thought to contribute to the onset of schizophrenia
include poor mother-child relationships, deeply disturbed family intrepersonal relationships,
impaired sexual identity and body image, rigid concept of reality, and repeated exposure to
double bind situation. A double-bind stuation is a no win experience, one in which there is no
correct choice. (kolb,2005).
Double bind concept by Gregory Bateson and Donald Jackson is to described the
hypothetical family in which children receive conflicting parental messages about their behavior,
attitudes and feelings. Children withdraw into a psychotic sate to escape the unsolvable
confusion of double bind. (Ballard 2009).
Environmental or cultural Theory state that person who develops schizoprhenia has a
faulty reaction to the environment, being unable to respond selectively to numerous social
stimuli. Theorist also believe that person who come from low socioeconomic areas or single-
