Schizophrenia is a chronic disorder affecting nearly 1% of the total world’s population with high social, economic and personal impact on the lives of the affected individuals (Knapp et al. 2004; Schizophrenia Commission, 2012). The onset of Schizophrenia is usually during the late adolescence or early adulthood characterizing positive and negative symptoms including hallucinations, delusions, emotional blunting, disorganised speech and loss of drive. Along with this individuals with schizophrenia also experience cognitive impairments mainly involving executive functions and memory (Kurtz, 2005). The aetiology of schizophrenia mainly involves abnormal glutamate and dopamine transmission along with functional and structural abnormalities in subcortical and cerebral cortical areas (Carpenter, Jr and Buchanan, 1994). A lot of treatment methods are available including medications and psychotherapies mainly for schizophrenia. Researchers are now focusing on improving the life quality of these individuals by focusing on individual specific treatment and better rehabilitation opportunities.
Evolutionary Theory of Schizophrenia
Evolutionary changes can mould any phenomenon which is genetically rooted and that has a history. Owing to this fact the theory of evolution is relevant to psychiatric disorders. Evolutionary forces are present in the conditions which have a long history and genetic underpinnings. Schizophrenia also possesses the considerable genetic component and is among the most heritable psychiatric disorder with heritability around 70% [Sullivan et al., 2003; Lichtenstein et al., 2009]) and also among the most severe. It has been known since long that schizophrenia aggregates in families. This fact cannot be explained totally by the environmental influences because adoption studies show the high risk of schizophrenia in children having parents with schizophrenia [Sullivan et al., 2000, 2003; McGuffin et al., 2003; Bulik et al., 2006; Lundstrom et al., 2012; Kan et al., 2013]. Schizophrenia is either considered as a disadvantageous by-product of normal brain evolution or an evolutionary advantageous condition. The genetics properties of any population are a result of random drift, together with mutation and selection in the past (Fisher,1930). Many authors have suggested that schizophrenia must have evolved due to unfavourable brain evolution. It is believed that there is a link between language dysfunction, cerebral flexibility and schizophrenia which hypothesises that schizophrenia reflects extreme.
End of variation underlying language capacity (Crow, 1995, 1997, 2000). According to crow by product of cerebral flexibility is the associated variation which results in schizophrenia and personality disorders at the extremes. According to Dodgson and Gordon(2009) certain types of hallucinations are an evolutionary by-product of cognitive system in order to detect threat. According to randall the establishment of novel connections during development might produce misconnections giving rise to behavioural variants including schizophrenia. It also has been proposed that schizophrenia results from delayed cerebral maturation which might represent disadvantageous phenotype (Saugstad, 1999). Thus supporting the research further Kenneth states that schizophrenia exists in humans due to the evolution of prefrontal cortex and its connectivity with temporal and parietal cortices. All these regions according to him constitute the social brain of an individual. The evolutionary approach to understand schizophrenia is very useful because it is open to empirical testing and provides the scientific framework to integrate findings from various subspecialties.
Interventions for Schizophrenia
As schizophrenia is a chronic disorder, the treatment for it is also complex. the patient himself and the family members have to go through a lot during the pre-treatment and the post treatment phase. Earlier the psychiatrists used to rely just on anti-psychotic drugs and ECTs to treat people with schizophrenia but there has been a recent change in the treatment of this disorder as now the importance is also given to the non-pharmacological treatment apart from the medications which mainly focused on the physical symptoms of the disorder. Many patients were even found to be resistant to the medications or might relapse from it as the same type of drugs do not work for everyone with the disorder. In order to decrease the relapse rate mental health professionals started accompanying medications with various kinds of therapies like dialectical behaviour therapy which is a step wise procedure which begins by addressing more severe behaviour initially in order to improve the quality of life of an individual. The various techniques in the therapy like mindfulness helps the patient to focus on the reality and live in the moment mainly when they are experiencing hallucinations or delusions, interpersonal effectiveness helps the patients regulate their unwanted emotions and interact in a better way with others hence improving their interpersonal relations. Distress tolerance can help these individuals learn impulse control and help in self soothing (Neacsiu et al., 2012; Swales, 2009). Overall these skills are
effective in helping these individuals better handle their symptoms. Another recent technique used for treatment is transcranial direct current stimulation is effective in reducing auditory hallucinations when applied over fronto temporal regions and if it is applied over prefrontal cortices it reduces negative symptoms and catatonia. Along with this positive effects were reported on working memory, learning and attention.
As it is mentioned in the evolutionary theory of schizophrenia that positive symptoms like certain hallucinations and delusions can be due to the evolutionary by product of cognitive system in order to detect threat. So by targeting these cognitive biases and modulations in patients with schizophrenia these symptoms can be reduced. An important therapy known as metacognitive training can be used for this by making them aware of their own cognitive distortions which leads to maintanence and formation of their delusional beliefs (Bell et al., 2006; Freeman, 2007: Garety and Freeman, 1999; Woodward et al., 2006). It can be used during the rehabilitation phase as It is believed to improve insight and quality of life of these patients by reducing the delusional ideation and improving the social functioning of affected patients (Briki et al., 2014). All these techniques can be used in combination of medications to have a better effect on the individuals suffering from schizophrenia. Along with all the treatment methods psychoeducation can also be used with the patient and the caretakers so that their perceived burden is less and they become aware of the condition of their loved one and become more acceptable towards them and the problem they are going through.
Awareness about schizophrenia has now considerably increased in the society and people are becoming more acceptable towards it. There are a lot of hypothesis concerning the evolutionary aspects of schizophrenia but no studies have till time identified the exact gene which predisposes an individual towards attaining schizophrenia. New interventions are evolving overtime to improve the success rates.
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