5) Psychiatric Disorder Choose any psychiatric disorder and write how it can be developed from the environment (experiences or biological) or genetics. If it is genetics, what may trigger the gene to synthesize?

Glendale Community College

Schizophrenia – The Result of Genes Triggered by the Environment; Case of Thomas Holmes

One of the hardest parts of helping those who suffer from a mental disorder is that it is difficult to give them the correct diagnosis (Pinel & Barnes, 2017, pp. 474-475). It is sometimes very arduous for a psychiatrist and/or a clinical psychologist to diagnose their patients, because their symptoms might just be an extreme of a normal human emotion/feeling. “I have schizophrenia. I am not schizophrenia. I am not my mental illness. My illness is a part of me” (Boll, 2016). This is a quote by Jonathan Harnisch, a famous artist, novelist and filmmaker, who provided insight into the feelings of a person suffering from schizophrenia. As psychiatrist Neel Burton M.D. (2017) stated in his article A Brief History of Schizophrenia: Schizophrenia through the ages, “The term ‘schizophrenia’ was coined in 1910 by the Swiss psychiatrist Paul Eugen Bleuler, and is derived from the Greek words ‘schizo’ (split) and “phren” (mind)”. In their textbook, Biopsychology, J. Pinel and S. Barnes (2017) state that schizophrenia is a psychological disorder, which typically onsets in an individual during adolescence or early adulthood (p. 475). They described the disorder with two types of symptoms: positive symptoms (delusions, odd behavior, hallucinations, disorganized speech or thought, inappropriate affect) and negative symptoms (avolition, affective flattening, catatonia; p. 476). The research question to be answered is whether this illness comes from the person’s genes or is it created by the environment the sufferer lives and develops in. It is argued that schizophrenia is developed epigenetically –it is a genetic disorder, however the expression of it may depend on the environment in which the individual develops/onsets the disorder. This paper hypothesizes that Thomas Holmes suffers from schizophrenia and the best treatment approach is pharmaceutical: the use of typical and atypical antipsychotics, such as chlorpromazine and reserpine.

Schizophrenia certainly has genetic basis, as we have seen in the results of different researches pertaining to the illness (Pinel & Barnes, 2017). Pinel and Barnes (2017) state, “… [I]t was discovered that the concordance rates for schizophrenia are higher in monozygotic twins (45-50 percent) than in dizygotic twins (10-17 percent)” (p. 476). Even though genes play a substantial role in the expressions, we can see in many other illnesses (both psychological and non-psychological), there is no single factor that has been proven to cause that illness alone. There is typically an interplay between genes and the environment in the development of most illnesses. In their article, Schizophrenia: a consequence of gene-environment interactions?, Tim Karl and Jonathon C. Arnold (2014) claimed,

It is the combined action of multiple genes of small effect size and a number of environmental risk factors, which causes the development of this mental disorder. This is conceptualized in the “Two-Hit Hypothesis” of schizophrenia, which predicts that genetic and environmental risk factors interactively (G x E interaction) cause the development of the disorder. G x E interactions occur when the expression of an individual's genetic predisposition is dependent on the environment they are living in or when environmental influences on a trait differ according to an individual's genome (p. 1).

This interpretation of Karl and Arnold (2014) clearly helps us conclude that if an individual has a genetic predisposition to schizophrenia, then the environmental factors might trigger the expression of the illness. On the other end, if the environment caused schizophrenia, then we can say that the person’s genes were already predisposed to the expression of the disorder. Thus, the authors try to show us that schizophrenia is a disorder that is a combination of multiple factors, to include genetic and environmental factors.

There are several symptoms characteristic of schizophrenia, which can be observed in an individual suffering from the illness (Pinel & Barnes, 2017). However, as Pinel and Barnes state, there is also a lot of overlap between the symptoms of schizophrenia and other mental illnesses (2017, p. 476). That is why medical professionals need to refer to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association, 2013) to diagnose a patient with schizophrenia. Thomas Holmes, a 30-year-old man, was diagnosed with schizophrenia at the age of 18. He was taken to a medical professional after his parents noticed that Thomas talked to non-existent people, who, as he described, wanted to kill him. This represents the delusions, one of the positive symptoms of schizophrenia. He was saying that the employees of the 7-Eleven store were talking about him all the time and were trying to come up with a plan to kill him. In the description of his illness, Thomas was saying that he has thoughts of being killed and chased all the time - non-stop, and for him, the only way to stop those thoughts was to commit suicide. He had made several attempts of suicide; however, he also stated that he asked people for help to avoid the suicidal attempts. Thomas once told his brother that the aliens had already come to take him to a new planet far from the earth, which was a sign of delusion. Thomas’ parents also told the doctor that he could not perform everyday simple tasks like washing his hands and taking shower – evidence of odd behavior. According to Pinel and Barnes (2017), if an individual is having any two of the positive/negative symptoms of schizophrenia described in DSM-5 for one month, provided one of those symptoms is hallucinations, disorganized speech or delusions, then that person can be considered suffering from the illness (p. 476). So, Thomas’ family had already noticed in him delusions, hallucinations and odd behavior for almost two months. This was the reason I confidently diagnosed him with schizophrenia.

When it comes to the treatment of schizophrenic patients, there are still people who think that it is possible to cure those people with drugs like chlorpromazine and/or reserpine, however, as Pinel and Barnes state, the drugs only alleviate the symptoms of the illness, allowing the patients to live outside the walls of hospitals, they do not cure the illness (2017, p. 477). The symptoms never go away forever, unless some magic happens. The treatment used for a patient with schizophrenia would be the use of antipsychotic drugs. As described by M. Richard and N. Brahm (2012) in their article Schizophrenia and the immune system, “Traditional pharmacologic therapies for schizophrenia include first- and second-generation antipsychotics” (p. 762). These drugs help to decrease the levels of dopamine in patients, which helps to alleviate their symptoms, thus allowing them to live their lives at least by not harming themselves, or others, and not forced to live in an asylum. As the clinical psychologist who is currently treating Thomas Holmes with antipsychotic drugs (in this case chlorpromazine), in the future I expect my patient to be able to live a normal life with his family outside of hospitals. I expect and hope that he will not have suicidal thoughts and that he will not be considered a danger to himself and/or to the society he lives in. As supported in this paper, even though genetic factors greatly determine the presence of schizophrenia in an individual, the environment also plays a key role in its expression. This means that our life is the interplay between nature and nurture, which is between our genes that we inherit from our parents and the environment that we grow up and develop in…

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.