Schizophrenia & Cognition

Abstract

Schizophrenia is more than just a serious mental disorder in which people interpret an abnormal version of reality. Hallucinations, delusions, and extremely disordered thinking and sometimes bizarre behavior is a part of the schizophrenic's everyday life, impairing their daily functions. Religious delusions are a common form of schizophrenic psychosis and are particularly difficult to treat. This paper will present information from the articles, Psychological Characteristics of Religious Delusions and Religion, Spirituality, and Schizophrenia: A Review, and Religious Delusions. It will summarize how a patient's psychosis and religious delusions affect their daily functioning. A further look into how schizophrenics intertwine their paranoia and delusions with religion and how it affects their outlook, opinions and possible resistance to treatment will be reviewed.

Key Words: Schizophrenia, Religious Delusions, Psychosis

Introduction

My whole mental power has disappeared, I have sunk intellectually below the level of a beast (a patient with schizophrenia, quoted by Kraepelin, 1919).

This quote may be over 100 years old but it still adequately describes schizophrenia in a way that leaves us in contemplation over what everyday life might feel like coping with a mental disorder of this capacity. With all of today's physiological advances, it is unfortunate that there is still no known cause of schizophrenia. However, researchers believe that a combination of genetics, brain chemistry and environmental factors contributes to development of the disorder (Mayo Clinic, 2018). Problems with naturally occurring brain chemicals may also contribute to schizophrenia. While researchers aren't certain about the significance with differences in the brain structure changes, they concluded that schizophrenia is a brain disease. There are a couple contributing factors believed to be connected with increased risk or possible development of the disease. These include; family history of schizophrenia, pregnancy and birth complications, such as malnutrition or exposure to toxins or viruses that may impact brain development, and taking mind-altering (psychoactive or psychotropic) drugs during teen years and young adulthood (Mayo Clinic, 2018).

Schizophrenia involves a range of problems with cognition, behavior or emotions. Signs and symptoms may vary, but usually involve delusions, hallucinations or disorganized speech, and reflect an impaired ability to daily functioning (Mayo Clinic, 2018). Delusions are false beliefs that are not based in reality. Religious delusions are a common occurrence in schizophrenia patients. Hallucinations usually involve seeing or hearing things that don't exist, yet for the person with schizophrenia, they have the full force and impact of a normal experience. Hallucinations can be in any of the senses, but hearing voices is the most common hallucination. Extremely disorganized or abnormal behavior may show in a number of ways for a schizophrenic. This could range from childlike silliness to unpredictable agitation (Mayo Clinic, 2018). Behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement. Symptoms can vary in type and severity over time, with periods of worsening and remission of symptoms. Some symptoms may always be present (Mayo Clinic, 2018).

Schizophrenia is not a common disease but it can be a serious and chronic one. Worldwide about 1% of the population is diagnosed with schizophrenia, and approximately 1.2% of Americans (3.2 million) have the disorder (Schizophrenia Symptoms, Patterns And Statistics And Patterns, 2015). More commonly the rate of diagnosis of new cases of schizophrenia increases in the teen years, reaching a peak of vulnerability between the ages of 16 and 25 years. Men and women show different patterns of susceptibility for developing schizophrenia symptoms. Males reach a single peak of vulnerability for developing schizophrenia between the ages of 18 and 25 years. In contrast, female vulnerability peaks twice; first between 25 and 30 years, and then again around 40 years of age. It is uncommon for children to be diagnosed with schizophrenia and rare for those older than age 45 (Schizophrenia Symptoms, Patterns And Statistics And Patterns, 2015) .

Schizophrenia requires lifelong treatment, even when symptoms have subsided. Treatment with medications and psychosocial therapy can help manage the condition. In some cases, hospitalization may be needed. Medications are the foundation of schizophrenia treatment, and antipsychotic medications are the most commonly prescribed drugs (Mayo Clinic, 2018). They're thought to control symptoms by affecting the brain neurotransmitter dopamine. Other forms of treatment include: individual therapy, which may help to normalize thought patterns and learn to cope with stress; social skills training, which focuses on improving communication and social interactions and improving the ability to participate in daily activities; family therapy, which provides support and education to families dealing with schizophrenia; and finally, vocational rehabilitation and supported employment, which focuses on helping people with schizophrenia prepare for, find and keep jobs (Mayo Clinic, 2018).

Summary

The research articles presented in this paper are, Religious Delusions by, Professor Andrew Sims, Religion, Spirituality, and Schizophrenia: A Review by, Sandeep Grover, et al., and Psychological Characteristics of Religious Delusions by, Robel Iyassu, et al.

The article Religious Delusions begins with how a schizophrenic's religious delusions played an important role in the birth of British psychiatry. It then continues to answer the question, what is a delusion? According to this article, a delusion has no perfect definition, however it gives the explanation of a delusion as a false, unshakable idea or belief, creating a phenomenon that is outside normal experiences. This article discusses how delusions are always self-referent, meaning the belief or notion always has something to do with oneself. Delusions are held without any insight, if someone wonders if they are deluded or not, they almost certainly are not. Glenn Roberts (1991) states that schizophrenic delusions may be an adaptive response to whatever initiates the psychotic break. This article further talks about how a schizophrenic case can be made for considering delusions to be a disorder of the mental state affecting the boundaries of self, this is a disturbance in knowing where I ends and not I begins. With the loss of ego boundaries, there is a merging between self and not self that the patient is not aware of. Michael Trimble has stated in this article that there is a slow accumulation of evidence in favor of religious experience being more closely linked with the right hemisphere of the brain. This is due to self-awareness, empathy, identification with others, and more generally intersubjective processes, are largely dependent on right hemisphere resources. The article concludes by saying that when a person becomes mentally ill, his delusions reflect, in their content, his predominant interests and concerns.

The article Religion, Spirituality, and Schizophrenia: A Review, introduces schizophrenia as a chronic, disabling condition that impairs one's ability to function. An interesting find this article presents is that religious delusions are help with more conviction and pervasiveness than other delusions with data suggesting that patients with religious/spiritual delusions value religion as much as those without these types of delusions, but patients presenting these delusions receive less support from religious communities. Regarding socio-demographic variables, reports suggest that the religious content of delusions is related to the marital status and education of schizophrenic patients. Occasional studies suggest a relationship between religious delusions and cognitive defects. Research suggests in this article that those with religious delusions are not satisfied with psychiatric treatment and are more likely to not adhere to their treatment plan. Evidence also shows that those with religious delusions have poor outcomes and more frequently indulge in violence and self-harm. The authors of this article reported that 30 out of the 70 studies (43%) have found a relationship between delusions and hallucinations, and religious beliefs. This article concludes by saying that existing data shows religion has an influence on the expression of psychopathology, treatment-seeking behavior, as well as treatment outcomes. Given the importance of religion for many patients, the schizophrenia treatment model should integrate religion in order to achieve a whole-person approach to treatment.

The final article being discussed in the paper is Psychological Characteristics of Religious Delusions. This article describes religious delusions as common but particularly difficult to treat. A study was conducted with 383 adult participants with delusions and a schizophrenic spectrum diagnosis. The results showed that religious delusions were associated with having internal evidence for their delusion and being willing to consider alternatives to their delusion. Levels of negative symptoms were lower. No differences were found in delusional conviction, insight or attitudes toward treatment. Their conclusion revealed that there wasn't any evidence found that people with religious delusions would be less likely to engage in any form of help. According to this article, delusions are a cardinal feature of psychotic illness, presented an around ?? of people with a schizophrenia spectrum diagnosis. Religious themes are common across delusion categories, with between 1/5 to 2/3 of all delusions reflecting religious content. Levels of disability, distress and conviction have all been reported to be higher in people with religious delusions compared to other types of delusions. People with religious delusions appear to be a particularly problematic group to treat effectively and are targeted for psychological therapies. This article concludes by stating that approximately 1/5 of people with delusions have religious delusions. Their attitudes to and levels of engagement with treatment are similar to those with any kind of delusion. Cognitive therapy may be a good fit for patients with these types of delusions to promote a personally meaningful recovery.

Method

The study involved 383 adult participants who suffered from religious delusions and a schizophrenia diagnosis somewhere on the spectrum. The information studied and concluded was drawn two large studies of cognitive behavioral therapy for psychosis.

Results

The study referenced was trying to determine whether religious delusions affect a patient's outlook on treatment and whether they were less likely to engage in treatment. They hypothesized that they would be have more of a negative outlook on treatment and be more resistant to it. The study could not find any evidence that patients were less likely to engage in treatment.

Suggested Follow up Research

If further research on this subject were to be studied, cultural considerations and variations may be something that should be included at a more in depth focus. We know that depending on the background, culture and country a person resides in, certain religious beliefs, practices and understanding is more or less culturally acceptable. Some things viewed as socially acceptable or religiously acceptable in one culture may be disregarded, looked down or even outlawed in other countries and cultures. Tying cultural beliefs and background in to the patient's views and positive or negative reception towards treatment might provide more of an understanding on the individual's outlook regarding accepting and taking part in behavioral therapies.

Conclusion

Approximately 20 percent of schizophrenics suffer religious delusions (Psychological Characteristics of Religious Delusions, 2013). The studies suggest that up to 80% of patients use religion and spirituality as a coping mechanism to navigate their illness. The feedback varies as to whether religion and spirituality is helpful, largely depending on whether they experience positive or negative anomalous experiences. What we can conclude is schizophrenia and religion sometimes have a symbiotic relationship. While it can be said that you can find religion without schizophrenia, it is often hard to find schizophrenia without religion injected somewhere in either part of the problem or an effective everyday coping mechanism. As science continues to evolve and we continue to study and understand schizophrenia, it is with great anticipation that not only a cure is found but that we strive to have a better understanding of helping patients cope with such a intricate and mentally debilitating disease.

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