Psy/410 - Schizophrenia Case Analysis

Schizophrenia Case Analysis

            Schizophrenia is a disorder displaying prominent symptoms of psychosis or lost touch with reality, hallucinations, and possibly delusions, along with declining adaptive functions. A subtype of schizophrenia is Undifferentiated Schizophrenia (Hansell & Damour, 2008, p. 454). The case of Sally explains common behavior of an individual with undifferentiated schizophrenia. An overview of Sally’s case will be addressed as well as how biological, psychodynamic, cognitive, and behavioral theories can be applied to developing her treatment to her disorder.

Case Overview

            Sally’s start in life was quite poor. During her mother’s pregnancy, she smoked two packs of cigarettes per day, despite her doctor’s warnings against it. During the fifth month of her mother’s pregnancy, she caught the flu. There were also reasons to think Sally inherited schizophrenia. Her mother’s father was thought to suffer from mental instability and was referred to as eccentric, nuts, or crazy. Compared to most, Sally developed slowly. She talked later than most children and walked later than most children. Sally was overly active but not considered by her doctor to be hyperactive.

            When Sally was only two, her parents were separated for about 10 months, but got back together to continue their struggling marriage. Her parent’s marriage was not peaceful nor was it consistent. They tried to be good parents to Sally, because they could not have more children. Her father played with her often despite his job’s requirement to travel. However, at times he was extremely critical because he believed she was behind. Sally’s mother on the other hand, had a deep relationship with her.

            Sally withdrew from studying and displayed fantasy behavior despite that she was smarter than average and her mother strongly encouraged her. She showed to be below average in many subjects, as if her thinking was not normal. Sally had few friends because her mother was overprotective, and Sally’s odd behaviors did not allow her to keep friends or establish deep relationships with the friends she did have. Because she did not get the feedback within friendships, or have an active social life, she began to establish additional unusual mannerisms and interests, which resulted in even more distance to social activity.

            When Sally completed high school, her parents let her board at a collage nearby, but the new environment caused her stress, and she began talking to herself. Her counselor witnessed her odd behavior. She was unresponsive, sitting in her room, staring at the ground. When the counselor tried to move her arms, the limbs stayed in place. In this catatonic state, called waxy flexibility, Sally had to be put in the hospital, but her condition quickly returned to normal. Upon her return to school, she skipped class. Therefore, her mother took her back home so she could look after her. Sally’s condition only worsened, and she began to show patterns of unresponsive behavior with bouts of rocking and laughing. Sally’s father was persistent in getting Sally admitted to a hospital, but they released her once she showed improvement, and her mother did not follow through with the doctor’s orders of aftercare.

            Eventually, Sally obtained a part-time job in a small store nearby, as a clerk. She spent her time off at home, mostly in her room. At this time, her father died of a heart attack, and her mother became more dependent on Sally. She began to wander around on her way from work back home, likely to avoid her mother. Sally’s behaviors became even stranger, and a police officer found her in a park, walking around in a shallow pond, talking to herself. He took her into the hospital once again. Sally was transferred to a mental hospital.

            Sally experienced many relapses. She was diagnosed with Undifferentiated Schizophrenia and given a poor prognosis for a cure. Sally was likely to continue this pattern and be admitted and released from hospitals repeatedly with recommendations of treatment to follow so that she could cope.

Biological Theory

            The biological perspective or genetic aspect of schizophrenia has been the most researched. Researchers believe there is a biological process at work in schizophrenia development. Researchers have linked genetic predisposition with occurrences of stress in late adolescence and early adulthood. Researchers have proposed that schizophrenia is inherited and in Sally’s case, her grandfather was thought to have schizophrenia but was never properly diagnosed.

            Within the last decade, scanning techniques have shown that type II schizophrenic people have a larger brain cavity and cerebrospinal fluid and smaller temporal lobes, frontal lobes, and an abnormal blood flow to specific parts of the brain. There is other research that indicates other genetic factors as well such as complications at birth, immune reactions, fetal development, and toxins may play a role in the development of schizophrenia. In the case of Sally, during her mother’s pregnancy, she had a severe case of the flu. Researchers have proven that trauma from a virus in the second trimester of pregnancy can increase the risk of the unborn child developing schizophrenia. The theory is that when pregnant in the second trimester, a severe virus can disrupt the migration of cells resulting from the breaking up of the neural sub-plate (Hansell & Damour, 2008). Any potential brain disorder such as genetic problems, birth disorder, and trauma, viral or infectious disorder may be contributing factors in displaying symptoms of schizophrenia (Hansell & Damour, 2008).

            In Sally’s case, her treatment was given to her after the third time she was hospitalized, thus her treatment was not effectively treated until late in the process of her disorder, which is not uncommon with schizophrenic’s (Hansell & Damour, 2008). Her treatment included medication, which was Thorazine, Sally also went to inpatient group therapy as well as talking to a psychiatrist twice a week. With the exception of counseling for families with known high risks of schizophrenic offspring, no preventative measures are currently available. There are somatic treatments that are available, it is also noted that biological treatments work best when they are combined with psychosocial intervention (Wyatt, Apud, & Potkin, 1996).

Psychodynamic Theory

            The psychodynamic theory focuses on unconscious motivation, struggles between the id, ego, the superego, and the importance of the first few years of life in determining lifelong behavior (Feist & Feist, 2009).  If Sally were to see a psychoanalyst, her therapist would focus on Sally’s relationship with her parents. Her mother’s overdependence on Sally and her father’s rejection both work together to create feelings of hostility in Sally. 

            It is understandable to a person observing that Sally would feel angry at her mother for depending on Sally, not allowing her to be a child with friends, not taking care of herself when pregnant with Sally, and for not protecting Sally from her emotionally abusive father. Sally would repress these feelings because after all her mother is the only person she can depend on. Anger toward her mother might alienate the one companion she has, so she directs the anger inward. Her disorder functions as a constant punishment for things that she may have done wrong while having the dual purpose of punishing her mother, and allowing her to avoid the next stage in life because she never mastered the earliest stages.

            If Sally were well, she would have to deal with many of life’s stressors, such a paying her own bills, finding a potential life partner, and raising children, all of which Sally has been poorly prepared for. Her sickness prevents her from having to participate in the real-world and has a function because she can escape the chaotic nature of emotion, such as the emotion she had to endure watching from her parents when they fought during her childhood. She never has to make choices, fall in love or be a prisoner of love like her parents because she is unwell. Her id, remains unseen, and unacknowledged, but continues to influence her thought process and allows her to embrace conflicting ideas, she is sick, but it serves a purpose and protects her from the harsher alternative (Feist &Feist, 2009).

Cognitive Theory

            Cognitive psychology tries to understand how individuals process information, react to stimuli, and create responses. In other words, this theory focuses on the many variables that can outcome from the relationship between stimulus/input and response/output. Internal processes like perception, language, attention, thinking, and memory are part of this theory’s focus. The cognitive theory suggests that most disorders are consequences of negative thoughts and behaviors, which are commonly based on false assumptions made by the patient. This approach tries to understand how psychological disorders are affected by the individual’s thoughts, reasoning, and perceptions (Meyer & Weaver, 2009).

            In the case of Sally, as in most schizophrenia cases, many cognitive symptoms can be listed, as cognitive functioning is always impaired in patients, either moderately or severely. These symptoms include poor executive functioning, or in other words, the individual’s ability to make decisions based on his or her interpretation of information; inability to pay attention in certain situations for long periods; inability to store recently learned information and use it right away (Keefe & Harvey, 2012).

            Researchers from the University of Pennsylvania discovered that cognitive therapy can improve the daily functioning and the life quality of those patients suffering from schizophrenia, even the lowest-functioning cases. Cognitive therapy, which was introduced by Aaron Beck in the 1970s, tries to help patients by identifying and changing disruptive thinking as well as dysfunctional behavior and emotional responses. It was originally developed as a method to provide treatment for residual symptoms. The technique involves emphasis on the normal processes of dealing with adversity, the use of over learning, stimulation, and role playing, the practice of behavioral coping skills, and other techniques to promote the well-being and mental stability of patients dealing with schizophrenia (Paulette, 2009).

Behavioral Theory

            Behaviorism believes that most individuals are born without any knowledge, and acquire new skills and learn new behaviors throughout live through classical conditioning and operant conditioning processes, which assimilate stimuli and provoke learning. This approach also believes that most psychological disorders are results to maladaptive learning. For instance, classical conditioning, which involves learning by association, can explain the cause for most phobias; operant conditioning, on the other hand can explain abnormal behaviors like eating disorders because it is based on an intricate system of rewards and punishments (Meyer & Weaver, 2009).

            In the case presented above, the behavioral theory would explain that although researchers suggest neurological factors contribute to schizophrenia, Sally may have learned many abnormal behaviors from her inconsistent parents. Because of the instability in her house growing up, Sally became more sensitive to the influences from the environment that normal. However, the behavioral approach believes that the same way behaviors can be learned and unlearned.

            As a treatment, behavioral therapy could help Sally tremendously in the way of living with her disease and adapting to it. Therapy could not cure Sally’s schizophrenia, but it would teach her to focus on current behaviors and problems instead of on the underlying causes of her disorder. Following the premise that behavior is learned, by using methods like systematic desensitization, Sally could learn to remove the fear factor from her responses and focus on relaxation methods to walk her through unpleasant episodes (McLeod, 2010).

            In conclusion, the theories addressed can be applied to the treatment of Sally’s disorder. The biological theory is the genetic aspect and believed to be a strong link to how schizophrenia is developed. In Sally’s case genetics is thought to be significant to her treatment process. The psychodynamic theory involves struggles in early years. Had Sally received treatment sooner, this theory would suggest therapy that focuses on the impact of issues with her parent’s marriage, her mother’s extreme dependence on Sally, and her father’s criticalness. The cognitive theory suggests that treatment involving the understanding of how Sally processes information, reacts to stimuli, and creates responses. Cognitive therapy is said to help improve the lives of schizophrenics by identifying and changing certain thinking, dysfunctional behavior, and emotional responses. The behavioral theory says that Sally could have learned her way to abnormality because of her upbringing and her environment growing up. Therefore, this theory would indicate that treatment should include unlearning undesired behaviors. Sally’s treatment came late and was not as effective as wanted. Medication was used along with group therapy and seeing a psychiatrist weekly. Sally was given a poor prognosis for a complete cure and was likely to continue her pattern of repeated hospitalizations. However, treatment will help Sally learn to live with her disease and arm her with techniques in adapting.

References

Feist, J., & Feist, G. (2009). Theories of personality (7^th ed.). New York: McGraw Hill.

Hansell, J. & Damour, L. (2008). Abnormal Psychology (2^nd ed.). Hoboken, NJ: Wiley

McLeod, S. A. (2010). Behavioral Therapy - Simply Psychology. Retrieved from             http://www.simplypsychology.org/behavioral-therapy.html

Meyer, R., Chapman, L. K., & Weaver, C. M. (2009). Case studies in abnormal behavior. (8^th       ed.). Boston: Pearson/Allyn & Bacon.

Paulette, M. (2009). Cognitive behavior therapy for people with schizophrenia. Retrieved from             http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811142/

Wyatt; Apud; Potkin. Interpersonal and biological Processes, Vol 59(4), Nov. 1996, 357-370