Issues in Interdisciplinarity 2019-20/Evidence in the Diagnosis and Treatment of Schizophrenia

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Introduction[edit]

Ever-increasing neuroscientific paradigms within the field of mental health have brought to light both the shortcomings of psychology’s past as well as the obstacles which doctors, researchers, and patients alike will face as the field moves forward.[1]

These obstacles, and perchance their solutions, lie in the trench which divides standard quantitative evidence gathering and more controversial qualitative evidence gathering practices. This tension is perhaps no more evident than in the challenges presented by the nosology of schizophrenia, which must attempt to reconcile “objective knowledge of brain functioning with the subjective experiences of schizophrenia”[1]

The following article endeavours to outline the most prominent approaches to evidence gathering in the diagnosis and treatment of schizophrenia, before posing an interdisciplinary framework which shows promise in bridging the current divide between quantitative and qualitative inquiry via the phenomenological method.


The scientific diagnosis[edit]

Diagnosing schizophrenia with completely reliable evidence is complex. Proof of this illness consists mostly in the patient’s empirical experience. The psychiatrist's conclusion relies on the DSM-V indicators regarding the patients' symptoms and their integration in a work or social environment.
However, these evidences cannot be completely trustworthy. Firstly, they are based on the subjects' perception, while schizophrenia is linked to anosognosia and thus these symptoms feel ordinary to them.

Secondly, these criteria represent the consequences of this disease and not the cause, which is still unclear to this day[2]. In addition, the symptoms that characterize the disorder are very broad with different aspects. Therefore, they often correspond to other mental illnesses: hearing voices can be a hint for anxiety as well as schizophrenia[3]. It results in this psychological illness being over-diagnosed. For example, a study led by the Early psychosis intervention clinic showed that out of 43 patients primarily diagnosed with schizophrenia, 22 had a different diagnosis and 18 were found to without primary mental disorder after a second consultation[4]. As a result, some studies have tried to find evidence on the cause of this sickness mostly in the genetics department. Researchers found over 10 genes mutations linked to the illness[5]. Nonetheless, as schizophrenia is such a heterogeneous disorder these genes are not related to all the cases and as of now simply represent increased risk factors[2][6].

Finally, the disease presents many phenotypes. As a result, many different treatments are developed to treat it: they can be pharmacological or non pharmacological[6]. As the symptoms represent evidence for schizophrenia we can say its treatment is related to the diagnosis’s evidence. The treatment’s efficacy is therefore difficult to prove as it is completely dependent on specific symptoms which can be absent.


The anthropological approach[edit]

Anthropology as a socio-cultural study provides both quantitative and qualitative evidence. Therefore humans, subject to their cultural surroundings,[7] intend to understand and solve those issues that inevitably propose a different perspective from the scientific/biological one.


Culture/Ethnicity[edit]

According to ‘The British Institute of psychiatry (2000)’ black people in the UK are six times more likely to develop schizophrenia than the average. The suspected cause was migration and the stress of adjusting to a new culture, but was later debunked as the high rate persisted in second generation migrants.

A cognitive explanation suggests that British African and Afro Caribbeans express their thoughts differently from caucasian patients. Psychiatric clinicians fail to identify the cultural idioms and are more likely to diagnose patients from ethnic minorities with severe mental disorders. This elicits the question of what behaviour is considered to be abnormal and if the criteria is dependent on the cultural norms of the society surrounding the individual. Therefore false pathological diagnosis could be avoided through a better awareness of the significance of culture[8].

A social explanation of this higher rate is that ethnic minorities are exposed to more risk factors such as discrimination and poverty, hence are more susceptible to developing schizophrenia. An ethnographical explanation claims that collectivist cultures offer a greater level of support. For this reason, when individuals live in individualist western culture they become more prone to the mental illness (Geert Hofstede). Evolutionary psychology proposes that eastern countries have a greater genetic susceptibility but have developed a collectivist culture as a way of reducing it (Chio et al 2009 study)[9].


Gender differences[edit]

When it comes to diagnosing schizophrenia, there does not seem to be one definite answer as to why there are differences in gender.

Age is a great factor to take into consideration. Men are more prone to developing the disorder earlier than women, and therefore are hospitalised before.[10] It could also mean that there is a delay in diagnosing women; what's more, they have generally shown a better response towards the medication and treatment.[11] There are various explanations for this, the most relevant in the grounds of epidemiological evidence. Women experience a release of oestradiol and oestrogen due to their menstrual cycle, and therefore many studies that imply that the hormone is indeed neuroprotective have been carried out. However, further research is required for it to be used as a form of therapy. [12]

A social aspect then becomes relevant to this issue: the marital status of the patients, which is inevitably linked to age. Studies, some of the most significant taking place in Denmark and Mayhem through their Case Registers, have shown that single young men are more likely to suffer the mental illness.[13] Nevertheless, there is no evidence that indicates that marriage is in any way a preventative method to schizophrenia.[14]

Another issue to take into consideration is the symptoms that both genders show when hospitalised. Even though there is fluidity in them, (for instance, depression, generally more attributed to women, can be found equally in men and women when linked to schizophrenia)[11] men have predominantly shown more ‘negative symptoms’, while women have been diagnosed with more ‘affective’ and ‘positive’ symptoms.[15]



The psychopathological approach[edit]

As behavioural and operational psychology have gained steady prominence through their adherence to more recognisable evidence gathering practices, as seen in the above-mentioned section on scientific diagnosis, an inverse correlation may be seen in the consideration of subjective phenomenal experience as a nosographic tool in much of “mainstream psychology”[16]; the exception perhaps being in that of Philosophy of Mind and philosophical or experimental psychology.

To those who are interested in consciousness and the subtle nuance of schizophrenia, this forms a blind spot in our understanding of the disease, which, in turn, forms a blind spot in our ability to treat it.

Sharply refuting claims against the validity, transferability, and reliability of introspective accounts of schizophrenia, these interdisciplinary envoys have begun to turn to the phenomenological method to provide both a deeper understanding of the disease as well as an actionable and replicable framework for future use which aims to satisfy both quantitative and qualitative diagnostic criterion.


References[edit]

  1. a b www.ncbi.nlm.nih.gov. 2019. Person-Centered Psychopathology of Schizophrenia: Building on Karl Jaspers’ Understanding of Patient’s Attitude Toward His Illness. [ONLINE] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576158/. Invalid <ref> tag; name ":" defined multiple times with different content
  2. a b OUP Academic. 2019. At Issue: Assessment of Schizophrenia: Getting Closer to the Cause | Schizophrenia Bulletin | Oxford Academic. [Online] Available at: https://academic.oup.com/schizophreniabulletin/article/29/3/405/1928570.
  3. Johns Hopkins Medicine Newsroom. 2019. Study Suggests Overdiagnosis of Schizophrenia . [Online] Available at: https://www.hopkinsmedicine.org/news/newsroom/news-releases/study-suggests-overdiagnosis-of-schizophrenia.
  4. LWW. 2019. Specialized Consultation for Suspected Recent-onset Schizoph... : Journal of Psychiatric Practice® . [Online] Available at: https://journals.lww.com/practicalpsychiatry/Fulltext/2019/03000/Specialized_Consultation_for_Suspected.2.aspx#pdf-link.
  5. Genetics Home Reference. 2019. Schizophrenia - Genetics Home Reference - NIH. [Online] Available at: https://ghr.nlm.nih.gov/condition/schizophrenia#sourcesforpage.
  6. a b www.ncbi.nlm.nih.gov. 2019. Schizophrenia: Overview and Treatment Options. [Online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4159061/.
  7. Daniel, E. Valentine. Charred Lullabies: Chapters in an Anthropography of Violence. Princeton University Press, 1996. JSTOR, www.jstor.org/stable/j.ctt7srks.    
  8. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5, 2013.
  9. PSYCHOLOGY WIZARD. (2019). Mental Health Differences AO1 AO2 AO3. [online] Available at: http://www.psychologywizard.net/mental-health-differences-ao1-ao2-ao3.html
  10. Heinz Häfner, Wolfram an der Heiden, Stephan Behrens, Wagner F. Gattaz, Martin Hambrecht, Walter Löffler, Kurt Maurer, Povl Munk-Jørgensen, Birgit Nowotny, Anita Riecher-Rössler, Astrid Stein, Causes and Consequences of the Gender Difference in Age at Onset of Schizophrenia, Schizophrenia Bulletin, Volume 24, Issue 1, 1998, Pages 99–113, https://doi.org/10.1093/oxfordjournals.schbul.a033317   
  11. a b Elizabeth H. Nassar, Natalie Walders, Janis H. Jankins, The Experience of Schizophrenia: What's Gender Got To Do With It? A Critical Review of the Current Status of Research on Schizophrenia, Schizophrenia Bulletin, Volume 28, Issue 2, 2002, Pages 351–362.   
  12. Estrogens and gonadal function in schizophrenia and related psychoses Anita Riecher-Rössler1 , Jayashri Kulkarni.
  13. Häfner, H., Riecher, A., Maurer, K., Löffler, W., Munk-Jørgensen, P., & Strömgren, E. (1989). How does gender influence age at first hospitalization for schizophrenia? A transnational case register study. Psychological Medicine, 19(4), 903-918. doi:10.1017/S0033291700005626
  14. Riecher, A., Maurer, K., Löffler, W. et al. Eur Arch Psychiatr Neurol Sci (1989) 239: 210. https://doi.org/10.1007/BF01739655
  15. Shtasel, D. L., Gur, R. E., Gallacher, F., Heimberg, C., & Gur, R. C. (1992). Gender differences in the clinical expression of schizophrenia. Schizophrenia Research, 7(3), 225-231.   
  16. Parnas, J., Sass, L. and Kendler, K., 2008. Philosophical issues in psychiatry: Explanation, nosology and phenomenology.[Online]. 2008 [cited 02 Dec. 2019]; Available from: https://books.google.co.uk/books?hl=en&lr=&id=I5t3CgAAQBAJ&oi=fnd&pg=PP1&dq=Philosophical+issues+in+psychiatry:+Explanation,+nosology+and+phenomenology&ots=HNXChhc5Nt&sig=o39F_mVwU4VkkTPymsWcRkzJR0c&redir_esc=y#v=onepage&q=Philosophical%20issues%20in%20psychiatry%3A%20Explanation%2C%20nosology%20and%20phenomenology&f=false