February 09, 2010
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Schizophrenia and Stress
Cheryl Corcoran, M.D., and Dolores Malaspina, M.D., M.S.P.H.
Dr. Corcoran is Assistant Professor of Clinical Psychiatry and Director, Center of Prevention and Evaluation, New York State Psychiatric Institute; Dr. Malaspina is the Anita Steckler and Joseph Steckler Professor of Psychiatry and Chairman of the Department of Psychiatry, New York University School of Medicine.
The more we learn about stress, the more we understand how great a role it plays in a wide range of diseases and conditions. Not surprisingly, this is especially true of psychiatric problems such as psychosis, affective illness (a category that includes manic-depression and major depression)(1)(2)(3)(4) and alcoholism.(5)(6) Stress seems to be particularly harmful for those suffering from the psychiatric disorder schizophrenia. For a patient with schizophrenia, the death of a parent or other loved one, a change in therapist, moving from one apartment to another; these events can trigger acute anxiety, depression and psychotic episodes, which may lead to hospitalization. Even seemingly mildly stressful events such as a job interview or a date can have a devastating effect. This increased susceptibility to stress fits the current thinking that schizophrenia is fundamentally related to a combination of difficulty in filtering out what is happening in the outside world and misattribution of internal thoughts and feelings, along with an inability or lessened ability to interpret social cues, all of which make it difficult for individuals with schizophrenia to cope. This is backed up by research showing that patients with schizophrenia are more affected by stress physically as well as emotionally; for instance they show different changes in heart rate under stress and a greater overall risk of cardiovascular disease.(7) Schizophrenia Is a Group of Disorders
Schizophrenia is best understood not as a single disease, but rather as a group of related psychiatric disorders. Each of these is characterized by various combinations of the following symptoms:
Individuals with schizophrenia may sit quietly, make little or no eye contact and speak very little, or conversely may be agitated or suffer from elaborate hallucinations and delusions. The causes of schizophrenia have been shown to be as varied as its symptoms. Genetic abnormalities, environmental factors and interactions of the two have all been implicated. A strong hereditary component for schizophrenia has been confirmed in scores of family, twin and adoption studies, although no particular gene has yet been identified as a cause. The same studies have demonstrated the role of environmental factors; for example, if one identical twin has schizophrenia, the other twin will develop schizophrenia only about half of the time.(8) Among the environmental factors that have been implicated as risk factors for schizophrenia are exposure to infection while in the womb, problems during delivery, adversity in childhood and brain injury. These exposures may cause illness directly, but they also appear to interact with some genetic vulnerability. Understanding the environmental risk factors for schizophrenia is key for both prevention and treatment. While little can be done at present to treat purely genetic causes, environmental factors may be modified and individuals may be taught strategies to manage stress. For instance, if stress can cause or worsen schizophrenia, measures can be taken to protect those at risk and to better manage those who are already ill. This would include reducing exposure to stress as well as countering the effects of stress by training in stress management and social skills, fostering positive relationships, increasing social support and encouraging exercise. The "Two-hit" Theory of the Origin of Schizophrenia
The leading theory about the origins of schizophrenia is that the disease results, in part, from abnormal early development.(9) Evidence for this theory comes from studies showing the existence of structural brain abnormalities long before the appearance of any psychiatric symptoms;(10)(11)(12)(13)(14) and an increased incidence of certain minor physical anomalies (for example, high arched palate, multiple hair whorls, abnormal head circumference, asymmetrical ears, curved fifth finger, webbed toes) in people with schizophrenia.(15)
However, many individuals who have these abnormalities do not go on to develop schizophrenia. This has led to the so-called "two-hit" hypothesis of schizophrenia: that genetic vulnerability or problems in the womb set the stage for schizophrenia, but that a second event in adolescence or early adulthood leads to the development of schizophrenia. This "second hit" may be a major life event or episode of stress.
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Comment by: Marie
Thu., Jan. 28, 2010 at 8:54 pm EST My son was diagnosed with schizophrenia nearly two years ago. After many different drugs and visits to hospital he is now on Clozopine and doing extremely well. Chris is 22 in February he is the singer songwriter and lead guitarist in a band that is about to release their first album in February 2010. He has just finished with distinctions,an Open Foundation course that gives him an entry score into University. Chris is a truly beautiful person and I have to agree with all that has been written about stress, that it is a big factor in this disease.Chris just cannot deal with stress he finds any kind of confrontation difficult to deal with. This disease carries with it a stigma that has come from ignorance...hopefully my son will eventually help to break down these barriers to those people that think scizophrenics are axe wielding psychos who want nothing more than to cause damage.As it has been stated in the article many factors bring on this disease and I'm afraid it is the luck of the drawer. Positive affirmation and a good family structure goes along way to helping people who suffer form this illness, although this is just brushing the surface. An immediate diagnoses also lessens the affects as treatment can be swift and enable the person to adjust to life in society. This illness is something that unless one suffers from it or is intouch with it every day, it should not be taken lightly or gossiped about by those who, frankly, have no idea what they are talking about. To those sufferers and their families/carers I say this, be strong ask questions all the time and leave no stone unturned. Dont settle for less...follow your heart because it is probably right. Good luck on your journey.
Comment by: Valentin Cavazos
Wed., Dec. 30, 2009 at 9:01 pm EST I believe that Schizoprenia also occurs when parents don't teach their kids on how to behave ,have manners etc.Which neglect is one of the leading causes of Schizoprenia so it all depends on the child's parents on how they are towards their child as well so Parents need to change for the best for themselves and their kids by learning on how to not neglect their kids. |
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