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When these symptoms begin to occur an observer will begin to notice a slow and painful spiral into schizophrenia. The psychiatric world has taken a physiological and psychological approach to the disease; utilizing assessing the disease. The organic pathology of schizophrenia can be expressed in different ways. However, one can make a clear connection between the organic pathology of this disease and parallel this with its mental behavioral symptoms. The treatment of schizophrenia can be organic or psychological in process, and the debate on its treatment rages on; however, evidence will show that a high pharmacological treatment is the most successful route to dealing with this illness. The diagnosis of schizophrenia had its own evolution. The disease was very difficult to diagnose, because of the complexity of its symptoms. It was often mistaken for a personality or anxiety disorder. Often the patient was labeled as "crazy", and unable to be helped. Obviously, now there is more structure to attempting to diagnose the disease. First there is a full physical and mental examination, partly just to separate its symptoms from those of other personality disorders and phobias. Part of the problem was the lack of a clear set of criteria to classify a person as schizophrenic. However, that has changed, in the 50s there was the creation of the DSM III and DST IV checklists, these are refined checklists that identify those symptoms. These lists are accepted by the psychiatric world to be indications and a basis for the diagnosis of schizophrenia. A key sign and alarm of the onset of the disease is an unrelenting inability to form clear and complete thoughts. Schizophrenics often are simply enable of focusing their attention on a specific idea and thought process. The incapacity to have thought, conversations, and ideas , without getting rid of excess information, and keeping what is important focused is indicative of the disease. Another indication is the patients removal from an active social life. A schizophrenic is often displaced from society. Their inability to communicate clearly and concisely frustrates them, and they tend to have less and less interaction with others. With that comes the unfortunate fact that they simply to do not have a test audience for their thoughts. Their ideas are considered "weird" and "abnormal" because they have never shared their expressions with others. This begins the patient on a slippery-slope. The patient often then becomes very introspective, using their own mind and thoughts as their audience. They begin to interact with themselves and create different characters inside their mind to entertain themselves. As the patient does this the lines between the ideas, thoughts, and audience becomes more and more blurred. As those lines become hazy, the patient recedes further and further into the set of vicious cycles and ill recede into a painful and powerful archives of their brain. These symptoms are often classified as positive (psychotic hallucinations and delusions) and negative (apparent loss of emotional expressiveness and responsiveness, lack of spontaneity and curiosity, difficulty in initiating purposeful actions). In the case of withdrawal from society the patient will remove themselves from society, which would be indicative of a negative symptom. Once they begin to separate and exhibit the delusions and personality separation the patient begins to exhibit positive symptoms. This slippery-slope is a initiator of the disease. They begin to organize different personalities and thoughts in the brain. They begin believing and listening to people inside their hands that are figments of their imagination. They move from having simple hallucinations and into having delusions. Delusions are more defined and garish hallucinations. Now the schizophrenic is convinced that they believe in those internal voices and that those voices are real. At the same time the delusions become more and more eccentric ( involving situations that occur in real life such as being followed, being poisoned, or having a secret admirer). Hallucinations are slightly different. Hallucinations occur without any outside stimulation. It is somewhat an unsupported and random figment of the imagination. After a thorough discussion of the symptoms, one can begin to dissect why this happens. There are some ultimate and immediate causes of the disease. There is some evidence that heredity has something to due with one getting schizophrenia. Often, just as most diseases, most children of schizophrenics are simply predisposed to the disease. And although there is no direct correlation between schizophrenia in a child and a parent, the probability of a child getting the disease , is about 5% higher than the average person. There is also some evidence that there is some "neurodevelopment disorder" which says that the person with schizophrenia may have genes that produce abnormalities in the brain during development in the fetus. "Paul Eugene Bleeder, one of the great early authorities on schizophrenia, concluded that its symptoms were the result of several different disease processes rather than a single one. New studies of the brain are now confirming Bleeder's insight. In some cases schizophrenia appears to result from a failure of development in the middle three months of pregnancy that leaves the brain vulnerable in early adulthood, when the programmed elimination of redundant neuronal connections (papooses) exposes the maldevelopment." (Garver) These children begin to exhibit these symptoms very early in life, and they may continue that behavior until they exhibit that into actual schizophrenic manifestations. There are other environmental circumstances that factor into the development of schizophrenia. There are really no definite cause of the schizophrenia due to sheer environment. However, there are some main points that have been explored. The first point is the social placement or class of a person. The amount of lower class people that are afflicted with schizophrenia is totally disproportional to the entire population. There are many more people afflicted with disease in the lower class that the upper class. Most of the rational for this is the stress and angst that comes with the "struggle" in a lower class lifestyle. This in many ways perpetrates itself. If the person is schizophrenic then they will be unable to reach the upper rankings of society. As this perpetuates itself the situation only worst. The back and forth and constant battle with only worsen the patients condition. The next environmental cause stems from the actual environment that the patient actually grows up around. Most of the families that the patient comes from are highly unstable and not conducive to a healthy state of mind. When the schizophrenic is growing up, they have to deal with many outside resources and family instability may contribute to their personal instability as well. However, this is another case of it not being a definite cause of the disease but more of a factor and it certainly will not help the disorder. On the other side of things, family members' lack of support and blatant cruelness or brutality toward the patient after the onset of the disease contribute to the continuing degeneration of the disease. There are other disorders that accompany schizophrenia that have to do with the patient's behavior once his/her mental state has disintegrated. With these come several changes in behavior patterns. There are different types of behavior one called catatonic schizophrenia which is a mode of behavior that puts the patient in a sputtering and inactive state, and the other being disorganized schizophrenia, putting the person in a state of chaotic emotional behavior. The patient has unpredictable, unexpected and random emotional reactions. These patterns will only occur once the patient has a real disintegration of condition. Now, to get to the critical points, which is the organic pathology of the disease. As mentioned in the introductory paragraph the goal is to relate the organic pathology of the disease to the treatment of the disease. There is evidence that schizophrenia is a chemical disorder that is a result of a chemical imbalance in the neurotransmitters. These chemicals are the same ones that allow the neurons to communicate with the brain. When these transmitters are imbalanced it sends the entire systems into a tailspin. The main suspect for the malfuction is the neurotransmitter called dopamine. This theory says that the cause of schizophrenia is onslaught of increased dopamine activity in the brain. The strongest evidence that supports is the most common treatments of schizophrenia. The treatment of dopamine activity is most often used to treat schizophrenia. Doctors prescribe anti-psychotic drugs to block out some sort of neurotransmitter. In use with schizophrenia, the anti-psychotic blocks the release of dopamine to the synapse, the more of the release of the dopamine is blocked, the more effective the anti-psychotic treatment. For about the last 40 years the most prevalent and successful treatments have stemmed from anti-psychotics. The drug chlorpromazine (Thorazine) and has decreased the psychotic systems and stifled their recurrence. This is certainly not a cure, as finding say that 20-30% of the patients are not helped by this and some others have relapses. They also can produce painful side effects that effect everyday neurological functions. In 1990 a drug called clozapine (Chloral) was introduced. This drug does not produce the same dangerous neurological side effects that other anti-psychotics due and has been shown to be able to decrease the chances of suicide in the patient. Although, clorazine doesn't not have the same side effects as other anti-psychotics, it does have the some problematic side effects, and is often used as a drug of last resort. It does not have the sever neurological effects as thorazine does however, it does have its own serious side effects. It has been known to cause bed-wetting, drooling, and a drop in blood pressure. Patients have also reacted with seizures to the drug. The major difference between clozapine and others is its outstanding results at blocking dopamine release into the mesolimbic area. The anti-psychotics that have an effect on the brain in the limbic region and the cortex aid the treatment by stabilizing the chemical imbalance. However, there is some difference in theory about how schizophrenia should be treated. Once one understands, the causes, symptoms, and diagnosis of this disease one can see how debilitating the disease can and will be. Many of those with schizophrenia feel that they are destined for an interminable life of pain, suffering, and frustration. That is why there is such a high rate of suicide among patients with schizophrenia. That is why effective treatment is so important. Some researchers have the opinion that in order to mitigate the degeneration of the patient there would need to be intense psychotherapy and a drastic decrease in the use of anti-psychotic drugs. There is the point of view that in short says that the doses of these anti-psychotic drugs must be decreased, and the use of cognitive behavioral treatment must be increased. Cognitive behavioral treatment is a way to change the patients thoughts by changes in their behavior. This treatment encompasses education for the patient about their problem while incorporating response prevention and exposure. Exposure is putting the patient in contact with something that they would traditionally avoid. In the case of Schizophrenia, the patient would be put in contact with other human beings and be forced to interact with them. Response prevention, is simply limiting the reaction of the patient to the negative stimulus. For example, when a schizophrenic is intimidated by a situation, they tend to run away or revert to a inactive or even catatonic state. The response prevention treatment would try to pull the patient out of that reaction. This type of treatment has been most effective in the treatment of Obsessive-Compulsive Disorder (OCD), and is being looked at in combination with the dosage treatments. However, the most important thing to remember is that Schizophrenia is a organic disease and that its most effective treatments will be ones that effect the chemistry of the brain and not necessarily the behavior that the patient exhibits as a result of the patient's brain chemistry. Although, behavioral treatment is important, the most important aspect of the treatment has to be controlling the release of dopamine, and the other factors in the treatment must be secondary. Another point of difference in the theory of treatment of schizophrenia is the dosage. Some doctors and researchers say that a low-dose strategy is the one that works. "After 30 years of what might be called guesswork, researchers have finally found the optimal starting dose for the most popular anti-psychotic drug on the market, and it's much lower than is often prescribed. Using positron emission tomography (PET) scans and clinical observations, investigators at the Clarke Institute of Psychiatry have determined that the best starting dose of haloperidol is from 2 mg to 5 mg daily, a far cry from the 10 mg, 20 mg and even 50 mg some doctors use. " says Pauline Anderson of the Medical Post. This new way of looking at the treatment of schizophrenia is in conflict with some of the other more traditional methods of treatment. The mere severity of the disease is enough to shy away from this type of treatment. As shown in explanations above the way that these anti-psychotics work, is to block the release of overactive and overproduced neurotransmitters in the brain. For example, the drugs that were described earlier function is to block the neurotransmitter dopamine. With lower drug doses that is allowing for more dopamine to be released into the brain. One doctor that supported the claim, says that the disease does not warrant a standard dosing plan. "In one case study, there were 50 patients that were started on a low dose plan of 10mg. These patients are "happy" on these doses and their compliance is "much higher" than with more potent doses," said Dr. Wong. Of the 10 who did not respond to lower doses, seven were maintained on 10 mg of the drug and only three patients had to be raised to 20 mg. Dr. Wong said it's "unethical" to go beyond 20 mg although she recognizes that this is sometimes the practice. "Doctors sometimes just keep drugging patients until they're quiet." This is one of the purest perspectives on the matter. Dr. Wong's point of view perpetrates that fact that lower doses should be the treatment and is the most effective and safe. Her belief is that most patients are simply over-drugged. However, this is not always the case for any given situation and to sat that "over-drugging until the patient is quiet" is an over statement of the case. For every case study that is put forth that says the we can have another case that someone other patient needs optimal dosing. As referenced in the above explanations we can see that the main reason that optimal dosing is absolutely necessary is the degenerative effects of schizophrenia. Something that is ignored in Dr. Wong's analysis is the fact that as the schizophrenic gets older the condition worsens. As the condition worsens the dosing must increase. Often, through childhood symptoms are ignored and left to get worst, by the time a doctor tries actually diagnosis the situation they must use optimal dosing to counteract the degenerative effect of the disease over the years. An example of this disintegration is seen in this excerpt , "...Beeby speaks with disarming candor - her way of dealing with the horror that befell her family. It began in 1979, when Beeby's 17-year-old son, Matthew, started to hallucinate. Diagnosed as schizophrenic, the boy stayed at home in Toronto as his condition worsened. In his madness, Matthew believed that God wanted his mother and his sister Susan, to die. Frightened, Beeby tried to have Matthew committed so that he could be treated. But, she discovered that this was virtually impossible without Matthew's consent - which he would not give. Then on a dark, cold day in February, 1981, Beeby arrived home to discover her son dead in a pool of blood. "He had taken two ordinary dinner knives," says Beeby, "and plunged them into his eyes until they pierced his brain." (Buchanan) The horror of Beeby's tragedy may be hard to fathom, but the affliction behind it is all too common. "I live in a totally different world, a different reality," says Gus Boudens, a 30-year-old schizophrenic in Montreal who has been hospitalized frequently. "I've been through lots of different hells." (Buchanan) This example shows the problem with the acceptance of lower doses. This sort of degenerative problem is indicative of the disease. Although, there is an abuse of the drugs, cases like the aforementioned are denotative of a constant need to further the treatment of schizophrenia and not shy away from aggressive treatment to prevent tragedy, versus complacent treatment that can promote tragedy. It would be incorrect to say that there may not be benefits to using lower doses of the drugs. That would obviously decrease the side effects that are severe in the use of the drugs, and it can also make for a more cohesive and coherent patient. It is not completely false that when a patient is diagnosed with schizophrenia there can be a tendency to abuse anti-psychotics and not fully explore all of the options for treatment. However, in most cases of schizophrenia, there is very little hope unless there is aggressive treatment early. Much, like a virus that infects you, your chances of recovery and optimal health rests with the how early you catch and diagnose the disease. Since, schizophrenia has a slow onset and many of early symptoms can be mistaken for something else, it is critical to mitigate the condition before the case gets any worst. Another point to unearth is the role that the environmental factors have in conjunction with the treatment. For most patients, they are either in a state institution, a local hospital's outpatient program or in someone's care at their home. Most patients do not have an abundance of money and because of their symptoms they can rarely hold down a job. These patients are desperately in need of results to alleviate some of the symptoms. There is no cure for Schizophrenia so the most effective treatment in mitigating the symptoms, must be used. Optimal dosing used to help bring balance to brain chemistry is statistically the best treatment, so that the best course of action. The causes and treatment of schizophrenia are all cumulative in effect. Schizophrenia can be treated using anti-psychotics and intensive therapy. The way that it can be treated can range from no dosage to extremely high dosages of anti-psychotics that can reduce the symptoms and the malfunctions of the disease. The theory that less dosage can be most effective is a bit of an overstatement of a set of good results. The problem with this thinking is the mere structural and organic causes of schizophrenia. If we can accept the fact that schizophrenia is caused by the increased release of the neurotransmitter and the evidence of all of that supports the evidence that the most effective drugs that help the patient is those that most effectively blocks the production and release of those neurotransmitters, then it must be inferred that the decrease in dosage is not the most effective treatment of schizophrenia. An analyses into the causes and treatment have come a long way in just the last 40 years. As society moves into the next millennium there has been a bloom in the cases of schizophrenia diagnosed. That can be for several reasons, one because of an awareness about the disease and another that psychiatrists are quicker to diagnose the disease and read more into other comments or symptoms that are related to the disease. A combination of factors had led to the prevalence of a disease that is painful and horrible for any who have it and those that love them. This is why the treatment of Schizophrenia is so important. When there are new theories are presented it is important to embrace them, with the knowledge that most of the successful results from treatment has come from optimal dosing of anti-psychotics, that the patient is weaned off of over time. As the psychiatric and society otherwise looks into the future about this disease no one must forget that our first priority is the patient. If there is a certainty a treatment, although each patient is different, perhaps there can start to be a road toward true resolution. Bibliography: Word Count: 3447
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