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Schizophrenia - Etiology

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Some of the causes of schizophrenia have been considered in the other sections


Contents

[edit] Environmental

Considerable evidence indicates that stressful life events cause or trigger schizophrenia.[1] Childhood experiences of abuse or trauma have also been implicated as risk factors for a diagnosis of schizophrenia later in life.[2][3][4]

Evidence is also consistent that negative attitudes towards individuals with (or with a risk of developing) schizophrenia can have a significant adverse impact. In particular, critical comments, hostility, authoritarian and intrusive or controlling attitudes (termed 'high expressed emotion' by researchers) from family members have been found to correlate with a higher risk of relapse in schizophrenia across cultures.[5] It is not clear whether such attitudes play a causal role in the onset of schizophrenia, although those diagnosed in this way may claim it to be the primary causal factor. The research has focused on family members but also appears to relate to professional staff in regular contact with clients.[6] While initial work addressed those diagnosed as schizophrenic, these attitudes have also been found to play a significant role in other mental health problems.[7] This approach does not blame 'bad parenting' or staffing, but addresses the attitudes, behaviors and interactions of all parties. Some go as far as to criticise the whole approach of seeking to localise 'mental illness' within one individual - the patient - rather than his/her group and its functionality, citing a scapegoat effect.

Factors such as poverty and discrimination also appear to be involved in increasing the risk of schizophrenia or schizophrenia relapse, perhaps due to the high levels of stress they engender, or faults in diagnostic procedure/assumptions. Racism in society, including in diagnostic practices, and/or the stress of living in a different culture, may explain why minority communities have shown higher rates of schizophrenia than members of the same ethnic groups resident in their home country. The "social drift hypothesis" suggests that the functional problems related to schizophrenia, or the stigma and prejudice attached to them, can result in more limited employment and financial opportunities, so that the causal pathway goes from mental health problems to poverty, rather than, or in addition to, the other direction. Some argue that unemployment and the long-term unemployed and homeless are simply being stigmatised.

One particularly stable and replicable finding has been the association between living in an urban environment and schizophrenia diagnosis, even after factors such as drug use, ethnic group and size of social group have been controlled for.[8] A recent study of 4.4 million men and women in Sweden found an alleged 68%–77% increased risk of diagnosed psychosis for people living in the most urbanized environments, a significant proportion of which is likely to be described as schizophrenia.[9]

[edit] See also

[edit] References & Bibliography

  1. ↑ Day R, Nielsen JA, Korten A, Ernberg G, Dube KC, Gebhart J, Jablensky A, Leon C, Marsella A, Olatawura M et al (1987). Stressful life events preceding the acute onset of schizophrenia: a cross-national study from the World Health Organization. Culture, Medicine and Psychiatry, 11 (2), 123–205
  2. ↑ Harriet L. MacMillan, Jan E. Fleming, David L. Streiner, Elizabeth Lin, Michael H. Boyle, Ellen Jamieson, Eric K. Duku, Christine A. Walsh, Maria Y.-Y. Wong, William R. Beardslee. (2001) Childhood Abuse and Lifetime Psychopathology in a Community Sample. American Journal of Psychiatry,158, 1878-83.
  3. ↑ Schenkel, L.S., Spaulding, W.D., Dilillo, D., Silverstein, S.M. (2005) Histories of childhood maltreatment in schizophrenia: Relationships with premorbid functioning, symptomatology, and cognitive deficits. Schizophrenia Research
  4. ↑ Janssen I., Krabbendam L., Bak M., Hanssen M., Vollebergh W., De Graaf R., Van Os, J. (2004) Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatrica Scandinavica, 109, 38-45.
  5. ↑ Bebbington P E, Kuipers E (1994) The predictive utility of expressed emotion in schizophrenia: an aggregate analysis. Psychological Medicine, 24, 707-718.
  6. ↑ Van Humbeeck G, Van Audenhove C. (2003) Expressed emotion of professionals towards mental health patients. Epidemiologia e Psychiatria Sociale, 12(4), 232-235. (full text)
  7. ↑ Wearden AJ, Tarrier N, Barrowclough C, Zastowny TR, Rahill AA. (2000) A review of expressed emotion research in health care. Clinical Psychology Review, 20, 633-66.
  8. ↑ Van Os J. (2004) Does the urban environment cause psychosis? British Journal of Psychiatry, 184 (4), 287–288.
  9. ↑ Sundquist K, Frank G, Sundquist J. (2004) Urbanisation and incidence of psychosis and depression: Follow-up study of 4.4 million women and men in Sweden. British Journal of Psychiatry, 184 (4), 293–298.

[edit] Key texts

[edit] Books

[edit] Papers

  • Walker,Elaine, Kestler,Lisa, Bollini,Annie and Hochman,Karen M. (2004)­Schizophrenia: Etiology and Course. Annual Review of Psychology.Vol. 55: 401-430

Abstract

[edit] Additional material

[edit] Books

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