Content information:
Psychology Course – Brain and Behavior
Premorbid factors are those associated with, but not necessarily causal to the later development of schizophrenia.
1. A schizophrenic parent or parents or (a less potent variable the presence of other schizophrenic blood relatives).
2. A history of prenatal disruption, birth problems, viral or bacterial infections, malnutrition in the mother, exposure to Toxoplasma gondi (in cat feces), or toxic situation in pregnancy, especially if these occur in the second trimester.
3. Slowed reaction times in perception or very rapid recovery rate of autonomic nervous system after some stress or novel stimulus.
4. Any early signs of developmental and/or CNS dysfunction, hyperactivity, decreased size of temporal lobes, or evidence of enlarged, lateral cerebral ventricles.
5. Low birth weight and/or low IQ relative to siblings.
6. Early role as odd member of family or scapegoat.
7. Parenting marked by inconsistency and by emotionally extreme (both positive and negative) responses and double message; parental rejection particularly when on parent’s negative effect is not countered by corrective attention and care from the other parent.
8. Rejection by peers, especially if accompanied by odd thinking patterns, ambivalent and labile emotional responses, or a lack of response to standard pleasure sources.
9. Early behavioral problems, especially noted in play and school; being perceived by both teachers and peers as more irritable and more unstable than other children.
10. An inability to form stable, committed relationships, especially for men.
Meet Sally
Sally did not start life with the best roll of the dice. In spite of physicians’ warnings, Sally’s mother persisted in her two-pack-a-day smoking habit, even while she was carrying Sally. Also, during her fifth month of pregnancy, Sally mother suffered a severe bout of the flu. Additionally, there is reason to believe Sally may have inherited some vulnerability to schizophrenia. Her maternal grandfather had always been known in the family as an “eccentric”, but people less fond of him preferred to call him “crazy or “nuts” He had developed a number of unique religious beliefs and also was known in the community for having placed unusual mechanisms on the roofs of his barns, supposedly to bring in “electromagnetic energy” to help his livestock grow. Farming in those days did not demand the organizational and financial skills that it does today, so it provided plenty of room for odd and/or person-avoidant behaviors. He was never brought to the attention of any mental health professionals – indeed, he thought they were “nuts.”
In general, Sally was slow to develop. She both walked and talked late, but at the same time was an active child. She was never formally diagnosed as “hyperactive” but she clearly was above average on this dimension.
Sally’s parents had a marriage filled with conflict, even separating for almost 10 months when Sally was 2 years old. But they did reunite, to enter into what would best be termed a long-term conflict-habituated marriage. They were both devoted to Sally, especially since after two miscarriages after Sally’s birth they were advised not to have any more children. Sally’s father traveled quite a bit because of his position as a sales coordinator for a farm machinery company. When he was home, he played with Sally a lot. But he could be quite critical if he thought she was not behaving (and later achieving) at the level he thought she should be. Her mother, on the other hand developed an intense, almost symbiotic relationship with Sally.
Sally was of above-average intelligence. However, in spite of her mother’s intense coaching and Sally’s withdrawal into studying (and fantasy behavior), she was only average or lower in most subjects. It was always as if her thought processes were, as one teacher put it, “just a bit off center.”
Sally did have an occasional friend. But her mother’s overprotection and Sally’s occasional odd behaviors and thought processes kept her out of the flow of activities, and she never made long-term, deep friendships. In fact, when it appeared that Sally had a possibility of having a deep friendship, her mother’s intrusions became more pronounced, and the promise of that relationship was destroyed. Essentially, Sally was a quiet and mildly shy child. Also, because she did not have the feedback inherent in friendships and an active social life, she developed even more odd interests and mannerisms. These in turn served to further distance her socially.
Upon graduation from high school, Sally was allowed to board at a nearby college. However, the stress of being in new surroundings was too much for her. She started talking to herself, and her assigned roommate quickly managed to be moved to another room. One afternoon the dorm counselor found Sally in her room sitting in a chair, staring at the floor. Sally was unresponsive, and her limbs could be moved about and would then stay in place, almost as if she were a plastic doll.
Sally was in a withdrawn catatonic state, marked by a condition referred to as “waxy flexibility.” She was hospitalized and improved fairly rapidly. She tried to return to school but became more and more reclusive, now often skipping classes. Her mother brought her back home “to take care of her,” and Sally degenerated even further, at one point showing a pattern of almost total unresponsive behavior, interrupted occasionally by periods of giggling and rocking behavior, traditionally termed a hebephrenic pattern.
Finally, Sally’s father insisted that Sally return to the hospital. She did, but when she showed some improvement, her mother again brought her home and did not continue the recommended outpatient treatment. Sally was able to get a part-time job as a clerk in a nearby store that did a low-volume business, which did not place great demands on her. She spent almost all of her free time at home, doing some jobs around the house and spending the rest of the time in her room. About this time, her father suffered a fatal heart attack, making Sally’s mother even more dependent on her daughter. Sally had now taken to wandering about on her way home from work, possibly as a defense against the intensity of her mother’s needs. Her behaviors were also becoming more bizarre. One day the police found her walking in the shallows of a pond in the town park, muttering to herself. They took her to the local hospital, and she was then transferred to a nearby hospital.
Sally’s mother subverted any real treatment at the time of Sally’s first two hospitalizations. Thus, Sally was not effectively treated until late in the process of her disorder – not an uncommon occurrence with schizophrenics. In her third hospitalization, Sally was immediately put on pharmacotherapy – in this case, Thorazine. She was included in an inpatient therapy group and talked to her psychiatrist for a half-hour or so about twice a week.
Fairly rapid improvement was seen in Sally’s more obvious symptoms, such as talking constantly to herself, sometimes in an obvious response to voices she heard. However, some of her “negative” symptoms – specifically, her disturbances in attention and thinking – remained. Eventually, she was released back to her mother’s care, which meant that in spite of attempts to deal with her large overlay of social deficits through outpatient therapy procedures, Sally made little progress.
There were several relapses; indeed the relapses began to be more common. The symptoms were now many and varied, although not always so flamboyant as in some of the earliest episodes, thus now earning her the diagnosis of Undifferentiated Schizophrenia. At the last contact with her therapists, Sally was in the hospital. The prognosis for any substantial cure was poor, and it is probably that she will continue the pattern of going in and out of hospitals and aftercare.
Assignment
Consider Sally (above story) and put yourself in the place of her mental health provider.
1. Research the common modalities for treatment for Schizophrenia and other psychotic disorders.
2. Then, approach your conceptualization of Sally’s illness from a bio-psychosocial perspective, and discuss what your revised treatment recommendations would be for her.
