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Schizophrenia and Stress
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) and alcoholism.
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.
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.
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:
- "positive" or psychotic symptoms such as hallucinations and delusions;
- "negative" symptoms such as apparent lack of emotion ("flat affect") and motivation (" passivity");
- cognitive impairments such as problems with working and short-term memory.
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. 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. Evidence for this theory comes from studies showing the existence of structural brain abnormalities long before the appearance of any psychiatric symptoms; 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.
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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(12) Comments have been made
My brother in law is schizophrenic. In a few months my inlaws and brother in law are moving a thousand miles to live near us so that they can be closer to our three kids. The situation makes me so nervous. I am scared for my brother in law due to his mental and physical issues and nervous for my young children who will now be spending more time with their uncle if they are around their grandparents. What should I expect? I am truly scared he is going to have a nervous breakdown over the move. My husband and inlaws are in denial about How stress will affect him. I don't want him around my kids until he is stabilized. Am I wrong for thinking this way?
Posted Mon, Jul. 11, 2011 at 3:21 pm EDT
Would like to discuss clozapine as an option for my 25 year old nephew.
Posted Sat, Jan. 1, 2011 at 11:21 pm EST
My mother has schizophrenia, it is very sad; her sister does also. She was diagnosed after a divorce when stress had induced an already visible disease to become worse. My mother has never been able to hold a job and refuses to get help she never goes out of the house and can't watch TV or deal with anyone on a daily basis because anything you say to her sets her into "stress mode" and on the border of a break. Her brother also suffers from severe disabling depression.
Posted Wed, Dec. 1, 2010 at 2:49 pm EST
Dr Cororan cites five studies "studies showing the existence of structural brain abnormalities long before the appearance of any psychiatric symptoms".
Does it not follow, logically, that the ABSENCE of any "structural brain abnormalities" allows the diagnosis of schizophrenia to be ruled out?
Why then is requesting a brain scan of one's GP, likely to lead to a refusal to prescribe a brain scan, and a diagnosis of schizophrenia?
Posted Sun, Nov. 28, 2010 at 10:15 am EST
Valentin: your belief went out with the ark. Psychiatry thankfully has progressed since this theory was banded about in the 60's. I have 3 son's, one who has schizophrenia, he is well mannered and very caring, also considerate of others. If your belief were true and it was to do with parenting, I would have three sons with schizophrenia not one. There is no doubt that children who experience neglect in their childhood, often have issues of their own when they grow up...not necessarily schizophrenia! "Neglect" also involves not being armed with the facts and making derogatory assumptions about others.
Posted Sun, Nov. 28, 2010 at 9:27 am EST
I suffer from schizophrenia and my 23 year old niece has just been diagnosed also. I find it very difficult to cope with change of any kind. My condition deteriates when I am stressed about family and friends. My daughter has just completed her year 12 exams. I stressed about getting sick and damaging her exam chances, I worried for her completeing the exams, and now they are complete I cannot help but stress about how she will go. I left my current employment due to the fact that I am not dealing well with everything and I'm finding it hard to move back into a working environment. This makes it difficult for my husband and my children. I wish there were more groups out there that could assist in this type of situation, but I know there are so many people who need help in different situations some of which are a higher priority.
Posted Thu, Nov. 11, 2010 at 7:42 pm EST
Psychological stress has physiological effects and is implicated in causing or contributing to psychiatric disorders including post-traumatic stress disorder. Psychological stress also aggravates diseases like high blood pressure and heart disease. Stress does play a significant role in the control of the illness, however. People with schizophrenia become very sensitive to stress and change. Psychological stress alone can be enough to trigger an episode. Developing and maintaining a routine is one of the most important aspects of avoiding relapse.
Posted Fri, Oct. 8, 2010 at 2:28 am EDT
what the !!!
Valentin cavazo,all i can say is VERY UNLIKELY.I even question the GENIUNITY of ALL personality disorders/so-called illnesses.What about freedom of THOUGHT,INDIVIDUALITY,ECCENTRICITY/BEING DIFFERENT,OWNING YOURSELF.There seems to be a very STREAMLINED ideal when it comes to what is considered NORMAL.In fact according to the DSVM manual,there is NO SUCH THING AS NORMAL,yep thats right,NO SUCH THING,NO TEMPLATE/CRITERIA To compare against..pppffttt!!I remember going to the doctors one day for trouble sleeping and after a while he asked if i hear voices (i do have internal dialogue,but to me thats MY conscience,not gods or whoever,MINE)all i had to say was yes from his suggestion and i probably would have been doctorhandled ;) and feed this, that and the other like a guinea pig.I think a severe LOSS OF SENSE OF SELF is a BIG factor in ending up a test rat for the docs,shrinks and the like,who merely THINK they know you better than yourself (not to understate their knowledge/credentials but....)As for genes,are genes responsible for homosexuality,pedophilia,psychopathy???? What about the IDEA that we all learn DIFFERENTLY,even if we are/were taught the same (like school)Everybody has different interpretations when it come to learning ,morals,ethics,etc.....
people are JUST different.Is that so bad,it seems so............:(
Posted Tue, Mar. 2, 2010 at 1:42 pm EST
after reading your report it help me and it helped me understand my son behavour better.
Posted Thu, Feb. 18, 2010 at 4:38 pm EST
My daughter was diagnosed with schizophrenia following a psychotic episode just days before her 21st birthday. Stress featured highly in her life and always did as she has severe dyslexia and was her own worst critic. School were not terribly supportive and family tried hard to counteract this but the break up with a boy friend of 3 years I feel was the 'second hit'. My daughter has tried a great number of treatments and only Clozopine really worked but unfortunately the side effects were too great to continue with treatment. 9 years on she is on a cocktail of medications and is able, with support from carers, to live by herself and do voluntary work on an almost full time basis. None the less, her 'voices' still play a big part in her life and she is not always able to stop 'chatting' to them (muttering or silent mouthing) which leaves her open to people, at best, giving her a wide berth. The 'chatting' is always more evident during times of stress-real or perceived. We continue to boost her self esteem and try to avoid stressful situations but will always live in hope of at least finding medication which will give her a better quality of life.
Posted Sat, Feb. 13, 2010 at 7:24 am 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.
Posted Thu, Jan. 28, 2010 at 8:54 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.
Posted Wed, Dec. 30, 2009 at 9:01 pm EST