Schizophrenia is one of the most incapacitating and chronic psychological disorders. Between 50% and 80% of the persons who were hospitalized for an episode of schizophrenia are lately admitted in hospital again because of the same reasons. Nevertheless, not all persons suffering from this disorder present a progressive deterioration of their functioning. Between 20% and 30% of the persons treated can substantially recover from this disorder after 10 or 20 years.
It seems that culture plays a major role in the evolution of schizophrenia. Those who suffer from it and live in less developed countries, such as India, Nigeria or Columbia are less predisposed to stay disabled for a long period of time in contrast to the persons living in well developed countries such as the United States, Great Britain or Denmark. One reason in explaining this fact can be the gene differences between these cultural groups. But this can be only a partial explanation. Another stronger reason can be the differences in the method that these countries use in treating their schizophrenics. So, in the least developed countries, the persons suffering from schizophrenia are treated at home, by the members of their own family. This facilitates the reintegration in the society and the support coming from their families seems to be of great help in stopping the evolution of this disease. But the great responsibility of taking care of a schizophrenic person is not taken by the small and busy families living in well developed countries. They admit their schizophrenic member in a psychiatric clinic in which they receive medical and psychiatric care, but don?t receive emotional support.
Sociological studies have shown that the process of institutionalization leaves significant marks in the patients? emotional, cognitive and social marks that make almost impossible their reintegration in the real society. And this fact can exacerbate the schizophrenic symptoms.
Furthermore, schizophrenia can also be explained from the following two perspectives: the biological one and the social and psychological one. According to the biological point of view, the structure of the brain and its biochemistry are significantly altered for the persons affected by this chronic disease. Firstly, the prefrontal cortex is smaller and it presents reduced activity. This part of the brain plays a major role in the using of language, in expressing the emotions, in planning and producing new ideas and in the mediation of social interactions. Secondly, the schizophrenics have larger than normal ventricles and spaces filled with liquid. Regarding the biochemistry alteration, the most important neurotransmitter is dopamine. There is a severe lack of balance in the levels of dopamine is several parts of the brain. In the mesolimbic system there is an excess of dopamine which leads to the following symptoms: hallucinations, illusions and inconsistent thoughts. On the other hand, in the prefrontal region of the brain there is a reduced activity of this neurotransmitter which leads to altered attention, motivation and behavior.
The other perspective in explaining schizophrenia is linked to a social and psychological point of view. The persons suffering from this disorder whose families express their emotions in a very powerful way are 4 times more predisposed to suffer a new psychotic episode than those coming from a family which does not express their emotions in such a strong manner. This fact can cause stress and can lead to the further incapacitation in adapting to the family condition. Maybe the stronger evidence that the intense expression of emotions significantly influences the evolution of this disorder is found in the fact that the treatments which work on reducing the emotional expression tend to reduce the rate of recurrence of those suffering from schizophrenia.
To conclude, schizophrenia can be understood as being a sum of various factors: cultural influences, biological elements, psychological and social factors. Altogether, these factors cause this disorder and then seriously contribute to its evolution. They can facilitate the recovering of the suffering patient or they can accentuate its condition. Even though the biological background determines in a great proportion the debut of this disorder, the environment can significantly worsen schizophrenia and can also contribute to the recurrent episodes. It is important to notice that family support can be of great help, but institutionalization can lead by contrast to the almost impossibility to recover.
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