Category: Mental Illness

A psychotic disorder involves a disconnection from reality (Bowie, et. Al, 2016). Whereas, a psychosis is a group of cohesive symptoms that can shape the way one can feel, think or behave (Fioravanti, et. Al, 2015). Psychotic episodes and the feeling attached to this can interfere with your work, family, friends and everyday tasks. People with psychosis tend to have hallucinations; this can involve seeing or hearing things around you that may seem present and ‘real’ but others are unable to sense this. Whereas, others may have delusions, in which one holds a strong sense of belief on things that aren’t true. Psychosis can be a one-off event, short or long event which is caused by a trigger (Bowie, et. Al, 2016), such as substance misuse or uncomfortable, provoking experiences (Fioravanti, et. Al, 2015).

The most common type of psychotic disorder is known as schizophrenia. Schizophrenia is a complex disorder that is characterised by impairment in a number of domains, all of which contribute to disability (Fioravanti, et. Al, 2015). People with schizophrenia can experience a range of cognitive deficits. These deficits in cognitive functioning are classified as one or two standard deviations below the mean of normal healthy individuals (Fioravanti, et. Al, 2015).

For healthy functioning, the brain and body work together to exhibit cognition that can make experiences and functioning normal. Abnormalities in cognition can affect the way the brain works and can demonstrate psychosis and psychotic episodes. Cognition has manifested a key role in schizophrenia as it reveals what a lack of or disabled cognition can illustrate. Common symptoms of schizophrenia include hallucinations, delusions, paranoia, and thought disorder (Bowie, et. Al, 2016). These experiences are manifest in multiple sensory modalities and include abnormalities in all aspects of ones thought, cognition and emotion (Gold, et. Al, 2003).

The impact of cognition therefore stages a key role in schizophrenia and normal sensory functioning. This paper aims to analyse cognitive impairment in schizophrenia and the effects this can carry on the brain and body of an individual. In psychosis, functions such as logic, intent and customary association are impaired. It is the malfunction of these roles that characterises psychosis, as opposed to the loss of it. These features can fluctuate in severity and across sensory substrates throughout the illness (Sharma and Antonova, 2013). In various contemporary studies collated, patients who are diagnosed with schizophrenia have reported to perform more poorly on neuropsychology tasks than normal individuals (Insel, 2010). This performance defect can be categorised as a result of two factors: a. ongoing psychotic symptoms and b. a set of specific deficits associated with the pathophysiology of schizophrenia (Medalia, 2008). Individuals with schizophrenia have shown consistent inability when performing tasks that are associated with ones executive function, memory and attention. A recent study depicts in monozygotic twins for discordant for schizophrenia, the schizophrenic twin inevitably has a poorer performance in comparison to the other twin in attention, memory, verbal fluency, and pattern recognition (Insel, 2010).

Another study collectively analysed required sustained attention, which can be referred to as vigilance. Results highlighted that persons diagnosed with schizophrenia consistently performed poorly in these tasks (Insel, 2010). This was concluded by finding that the “working memory” which can often be referred to as the mechanism which keeps task-relevant information active (Gold, et. Al, 2003), for short periods, it is completely deficient in persons with schizophrenia. Multiple studies share common themes and results with the outcome of schizophrenia and the inhibition of cognitive ability in these persons (Polimeni, et. Al, 2016).

A vast majority of contemporary and older studies suggest the same implications and factors. A change in internal representation of the brains background intelligence can suggest the extensive disruptions in attention, memory and language (Fioravanti, et. Al, 2015). Cognitive scientists have suggested that the circuitry of the Central Nervous System (CNS) may be altered, but not the internal organisation of the module itself (Polimeni, et. Al, 2016). Although the cognitive deficits of schizophrenia are coherent with a widespread disturbance in cerebral functions and cognition, it is important to note that symptoms can fluctuate over time and change. This can make it hard to pinpoint permanent cerebral changes that propagate schizophrenia as the basis of cerebral malfunctions can vary from person to person.

Cognitive decline in people with schizophrenia can also be assessed through the measures of brain response to graded external stimuli. Studies indicate what primary eye movements in response to smooth pursuit stimulus should look like; arc slow eye movements used to track a small moving object. Participants of this test who are not diagnosed with schizophrenia are able to locate the moving target on their retinal fovea and move their eye in correspondence with the moving target (Gold, et. Al, 2003). In a normal eye and brain, this is done by using a predicative smooth pursuit movement which allows an individual to keep up with a moving target. Persons with schizophrenia are unable to cascade smooth pursuit eye movements. Many studies hypothesise that the reason for this is motion processing (Fioravanti, et. Al, 2015).

Different studies conclude varying reasons for the abnormal motion processing. However, the prime reasoning can settle to the link between eye movements and motor information and/or in capacity of holding motor information in the short term memory (Polimeni, et. Al, 2016). In addition to this, saccadic eye movements have also been noted to appear irregular in schizophrenia. The context of this irregularity could also translate to potential frontal cortical dysfunction in the illness.

By observing the structures of the brain between a person with schizophrenia, and a healthy individual, cognitive impairment was analysed. Johnstone and Crow (Insel, 2010), discovered these structural abnormalities first and later, Weinberger (Insel, 2010), also noticed this. The structure was described as having large ventricles (Rund, Borg, 2009). With time, this has been confirmed through multiple studies that have used modern imaging technologies to attest this difference. Typically, the ventricular size is an uncommon example that would link cerebral dysfunction to schizophrenia. Nonetheless, this observation has served the notion that people with this illness share this malfunction in common as opposed to those of healthy brain. A more specific example of structural change in the brain for people with schizophrenia is their structure of superior temporal gyrus (STG) (Rund, Borg, 2009). It is reported through high resolution imaging techniques that the volume of this structure in a person with schizophrenia is decreased (Gold, et. Al, 2003). As the STG contains the auditory cortex, it is responsible for the ability to understand and hear sound (Insel, 2010). As people with schizophrenia have an abnormal STG, it can suggest an impairment in cognition, hence the disconnection from reality.

Further, the medial temporal cortex is also reduced in size when compared to a normal brain (Fioravanti, et. Al, 2015). Although the decrease of size is as little at 5% (Polimeni, et. Al, 2016), this is accountable and consistent within multiple subject populations. As the middle temporal cortex plays a vital role in mediating ones memory (Rund, Borg, 2009), an abnormality to this region, corresponds positively to the symptoms of schizophrenia. Regional cerebral blood flow reports in schizophrenia have been used to analyse the CNS areas of irregular processing in this illness. Despite not finding a common single region amongst all laboratories, several clear abnormalities are present in all persons of schizophrenia and can suggest that several systems in the brain constitutes this illness (Rund, Borg, 2009).

Both functioning magnetic resonance imaging and regional cerebral blood flow have formulated a large sum of results that conflict with each other (Rund, Borg, 2009). These differences can occur due to augmented spatial resolution of this methodology. One study conducted an experiment where persons with schizophrenia and healthy individuals both have to perform an auditory recognition task in a practised condition. The results showed discrepancies, concluding to a concept of circuit failure, potential limbic cortex and some areas of the prefrontal cortex. This reinstates the notion of an apparent impairment of cognition in those with schizophrenia.

Reasoning to explain manifestations of schizophrenia have been commonly linked and supported by dopamine. Dopamine is a neurotransmitter that transmits messages in the brain and body (Savilla, et. Al, 2008). Dopamine is linked to schizophrenia as dopamine has a reputation of being blocked when an individual takes antipsychotic drugs (Savilla, et. Al, 2008). The dopamine receptors are blocked by this drug and therefore constitute to the idea that an overactive dopamine system could be the cause for psychotic episodes. Although, multiple studies (Savilla, et. Al, 2008, Rund, Borg, 2009), are unable to conclude if increase dopamine release is broadly influential or negative in cognitive manifestations.

For normal brain functioning, the neural systems in the body work complexly to ensure body functioning is maintained. A study by DeLong suggests that the frontal cortex and the subcortical areas comprise of long-tract pathways in which the basal ganglia and thalamus use to influence the function of the frontal cortex (Polimeni, et. Al, 2016). In schizophrenia, it is apparent that a majority of the abnormalities that occur involve the frontal cortex. Multiple papers suggest that a change in these pathways/feedback systems can account for partial symptoms in schizophrenia (Sharma and Antonova, 2013). As the basal ganglia contains multiple neurotransmitters, its importance in normal functioning is vital. If there is any active malfunction in dopamine levels or the neurotransmitters in the basal ganglia, it can suggest a possible alteration to the functions of the frontal lobe; propagating conclusions for cognitive impairment in schizophrenia.

Although a majority of studies are in favour for cognitive decline in schizophrenia, there are counter studies to suggest schizophrenia and cognition are not related. In a paper by Alptekin, he designed a study in which healthy individuals were compared to persons with schizophrenia. The study involved examining possible changes in cognition, behavioural changes, social changes and an overall quality of life. The results of this study concluded that majority of the participants with schizophrenia matched equally to the healthier participants in cognition. The study found that the cognitive results were not as drastic in relation to the social and overall quality of life. Results showed, that those with schizophrenia had a more likely chance social decline and social exclusion. It is clear that there will be a gap between current studies and papers due to different variables present, history of patients and the validity of the study. Ultimately, these papers can only notify researchers of continuous trends that are occurring in people of schizophrenia, rather than justifying the ultimate underlying cause.

This paper aims to identify the relation of cognition to schizophrenia and analyse if there is a decline in cognitive ability. In majority of the relevant studies discussed, it can be assumed that schizophrenia does have an impact on the cognition of a human being to a great extent. This is supported through the noticeable changes impairment in logic, executive functions, working memory and attention. Although the root of these abnormalities could derive from other causes, these effects were common in all persons with schizophrenia. This allows researchers to conclude that in fact, there is a cognitive decline for people with schizophrenia.

References

1. Bowie, C. R., & Harvey, P. D. (2016). Cognitive deficits and functional outcome in schizophrenia. Neuropsychiatric disease and treatment, 2(4), 531.
2. Fioravanti, M., Carlone, O., Vitale, B., Cinti, M. E., & Clare, L. (2015). A meta-analysis of cognitive deficits in adults with a diagnosis of schizophrenia. Neuropsychology review, 15(2), 73-95.
3. Gold, J. M., & Harvey, P. D. (2003). Cognitive deficits in schizophrenia. Psychiatric Clinics, 16(2), 295-312.
4. Insel, T. R. (2010). Rethinking schizophrenia. Nature, 468(7321), 187.
5. Medalia, A., Thysen, J., & Freilich, B. (2008). Do people with schizophrenia who have objective cognitive impairment identify cognitive deficits on a self report measure?. Schizophrenia Research, 105(1-3), 156-164.
6. Polimeni, J., & Reiss, J. P. (2016). Humor perception deficits in schizophrenia. Psychiatry Research, 141(2), 229-232.
7. Rund, B. R., & Borg, N. E. (2009). Cognitive deficits and cognitive training in schizophrenic patients: a review. Acta Psychiatrica Scandinavica, 100(2), 85-95.
8. Savilla, K., Kettler, L., & Galletly, C. (2008). Relationships between cognitive deficits, symptoms and quality of life in schizophrenia. Australian & New Zealand Journal of Psychiatry, 42(6), 496-504.
9. Sharma, T., & Antonova, L. (2013). Cognitive function in schizophrenia. Deficits, functional consequences, and future treatment. Psychiatric Clinics of North America.
10. Singh, T., Kurki, M. I., Curtis, D., Purcell, S. M., Crooks, L., McRae, J., … & Pietiläinen, O. (2016). Rare loss-of-function variants in SETD1A are associated with schizophrenia and developmental disorders. Nature neuroscience, 19(4), 571. (Singh, et. Al, 2016)
11. Sitskoorn, M. M., Aleman, A., Ebisch, S. J., Appels, M. C., & Kahn, R. S. (2014). Cognitive deficits in relatives of patients with schizophrenia: a meta-analysis. Schizophrenia research, 71(2-3), 285-295. (Sitskoom, et. Al, 2014)

Introduction

My playlist is compiled with the aim of aiding a physical exercise routine that I would typically do to maintain my physical health. I wanted to create a music listening experience that would enable me to have increased motivation and energy as I undertook moderate to high-intensity exercise, as well as elicit a calmer mood as I finished the exercise portion and entered the cool down/relaxation portion of my routine. I have an extensive playlist that I frequently use when exercising, and from this, I first chose 8 high-energy and lively songs, to use as part of this playlist. The 8 songs are fast-paced and of the hip-hop genre, forming a cohesive theme of heavy percussive beats, energetic instrumentals and rap throughout my cardio and strength training. The theories I used to test the effectiveness of these 8 songs explore the range of possible benefits associated with improving the physical exercising experience: increased engagement, motivation, and enjoyment, as well as improved focus and discomfort relief. I concluded the playlist with an uplifting soul/R&B song for my stretching routine and a slow classical piece for a final moment of relaxation, both of which I chose for their relaxing and calming properties.

My exercise routine began with a cardio warmup – jogging – which has the purpose ofpreparing my body and mind for the physical exertion to be undertaken over the next 25-30 minutes. Placing ‘Money in the Grave’ first in the playlist, came about from the sense of familiarity and structure this song offered from the outset. The simple, repeating riff that continues throughout the entire song became a predictable sequence of notes that induced a sense of excitement and heightened attentiveness as I eased into the exercise. These feelings were consistent with the proposal of Daniel Berlyne, who suggests that music can help stimulate engagement and arousal with our surrounding environments and activities (Berlyne, D. E., 1971). The feeling of anticipation was further compounded by the introduction of the song’s percussion sequence; the juxtaposition of a heavy bass drum and crisp hi-hats created an energetic, “bounce-like” pattern that matched the pace of my exercise and allowed the song to successfully motivate my movements.

‘Road Run’ immediately follows ‘Money in the Grave’, and the music seamlessly continued to aid my jogging exercise with a similar tempo and bounce-like rhythmic sequence. The short and sharp hi-hat pattern, layered under the staccato-like rapping, helped to strengthen my focus on the repetition of my footwork. Music that uses rhythmic elements in a repeated pattern can aid the brain in gaining a sense of time passing along with the flow of music (Thaut, M., 2005). Indeed, listening to music with a strong percussive emphasis seemed to help me garner a better sense of rhythm, as I found myself paying close attention to the movement of my steps and its alignment with the beat of the music.

Top Dawg Entertainment/Interscope Records

‘Wow Freestyle’ entered with a faster, livelier tempo of around 150 BPM. I added some more intensity by transitioning into an interval sprint exercise, despite the fatigue beginning to settle in my lower limbs. Listening to motivational music during moderate-intensity exercise can increase attentional focus on performance and help individuals distract from feelings of fatigue (Bertuzzi, R., Lima-Silva, A. E., Lopez-Silva, J. P. & Silva-Cavalcante, M. D., 2015). With respect to this, by focusing on the dynamic pitch variations and rhythmic nuances, I was able to motivate myself to overcome some feelings of tiredness. This response to higher intensity exercise is also consistent with the findings of Karageorghis and Priest (2012), who suggest that music can help divert feelings of discomfort and improve athletic endurance. At the stage of moderate-level exercise, music is effective in alleviating some feelings of fatigue, however the studies from Bertuzzi et. al (2015) do not show any evidence of alleviation of fatigue for subjects with significant preceding fatigue from prior exercise – suggesting that there are still limitations on how effectively music can aid heavy, prolonged exercise.

As I returned to a jogging pace during the final minutes of my cardio exercise, I found myself concentrating intensely on the rhythmic and vocal textures of the next song ‘DNA.’ in an effort to combat the depletion in energy I was beginning to experience. As part of Lamar’s Pulitzer prize-winning album DAMN., ‘DNA.’ is a fast-paced, high-energy song with a complex layering of beats, sampled recordings and lyrics littered with his political commentaries. A particular moment of interest is the inclusion of an audio sample of a Fox News Host criticising Lamar’s influence on African American adolescence: the audio sample replaces the typical rhythmic percussion line for a brief period before the underlying beat returns a few seconds later. This temporary deviation from the predictable rhythmic sequence, provided a state of heightened attention as some suspense was built before the return of the song’s main rhythm. As described by Huron (2006), excitement and energy can be generated by moments of suspension from the predictable structure, allowing the feeling of sweet anticipation to induce interest and stimulation.

‘No Wave’ marks the introduction of the strength training portion of my exercise routine. This song holds some of the bragging qualities of a typical hip-hop song, with the artists incorporating dynamic ad-libs and background shouting, exuding a sense of confidence and pride. Being quite familiar with this song, I would find myself anticipating the lyrics and feeling confident and self-asserting as I listened to the song and exercised. This behaviour may be supported by findings which describe familiar, self-selected songs with emotive attachments having some effect on altering the behaviour of individuals (Schneck & Berger, 2006). I found myself less focused on the weight I was holding and instead more engaged with the song and my emotions, an outcome that may prove the success of this song in allowing physical activity to be more enjoyable (Boutcher & Trenske, 1990). This response is further substantiated by Murrock & Higgins (2009), who assert that music can lead to a more enjoyable exercise experience through its mood-altering effects and movement cues.

‘Gospel’ began to play as the fatigue from my muscles began to settle in from the strength training exercises. This song is very dynamic with its varying intensities and tempos throughout – for example, there are moments of eerie piano solos and moments of fast-paced, angered rapping over heavy percussion. The increase in speed during the introduction of the rap sequence is also quite notable, and I found myself exerting extra effort in order to keep up my momentum and reduce my need to take unnecessarily long breaks in between sets. The variation of music tempo can act as a factor of motivation, particularly through prolonged periods of exercise (Lucaccini, L. F., & Kreit, L. H., 1972). ‘Gospel’, with its increased tempo, was ultimately successful in maintaining my level of motivation despite my exercise level plateauing and my muscles fatiguing.

‘Off Deez’ incorporates a repetitive melodic riff that underlies its energetic and lively hi-hat and snare sequence. I chose this song to succeed the previous, ‘Gospel’, in an effort to maintain a similar level of energy, motivation and enjoyment. Dyrlund & Winiger (2008) suggest that music listening could allow for greater enjoyment experienced during exercise.

My experience mirrored this finding, but only to a limited extent: while it was somewhat enjoyable to listen to the dynamic rhythm and chopping (fast-paced rapping), I felt less enjoyment in comparison to previous moments of exercise, and found it more difficult to sustain my exercise movements with the same intensity as before. This less successful attempt to increase enjoyment could be a result of the selection of music or the change inexercise difficulty and intensity, the latter of which is supported by the finding that more enjoyment may be experienced when exercising at moderate levels as opposed to high intensities (Dyrlund, A. K., & Winiger, S. R., 2008).

‘WIN’, despite its slower tempo than preceding songs, is still very high-energy with vibrant textures of percussion, brass and vocals. The repeating brass accents are loud, bright and exude a sense of triumph, which I thought would be fitting for the final training stage of my exercise routine. By selecting music that evoked a sense of vigour and positivity, I was able to better align the anticipation of my movements with the actual exercise. This is consistent with findings from De Nora (2000), who suggests that by self-selecting music to evoke vigour or enjoyment, individuals can appropriate music to help anticipate physiological and emotional states. Thus, in finishing the strength training portion of my exercise routine with this song, I was able to end with a sense of joy and enthusiasm.

‘Smile’ marks the introduction of the stretching portion of my exercise routine. It has a dramatically slower tempo and allows for a more relaxing mood than any of the energetic hip-hop songs heard previously. This dramatic shift in mood is further emphasised by the uplifting melody and bright vocal harmonies, as well as the repeated lyrical reminder to “just smile”. I chose this song because the slower rhythm guided the slower movement of stretching and I wanted the positive message of the song to help guide positive emotions. Believing that uplifting music would improve my mood, is a response consistent with McFerran and Saarikallio’s findings (2014) that suggest young people, in many cases, can be successful in depending on music to improve their mood. However, this outcome may not always hold, particularly during times of initial distress, and as such, it is still important to acknowledge the limitations of using music to feel better (McFerran, 2016).

I concluded my exercise session with a period of relaxation and practice of mindfulness, where I lie down and let my body relax. ‘The Swan’ is the eighth movement of this Saint-Saëns’s suite; it is around half the speed of other songs in this playlist, eliciting a feeling of ease with its ‘adagio’ tempo. The soft piano accompaniment helps to drive the calm pace of the piece and enables the music to offer a space to relax. This is supported by Baker, Clark and Taylor (2016), who suggest that musical tempo and melody can be manipulated to stimulate certain neurological processes, such as a slow tempo helping one to relax. Low arousal classical pieces can also help support a shift into a relaxed state (Lynar, Cvejic, Schubert, Vollmer-Conna, 2017). ‘The Swan’ can be described as a low arousal piece, with its mellow accompaniment and smooth dynamic transitions of the cello, and I would ultimately deem it a successful piece in helping me achieve a final state of relaxation

Conclusion

The playlist I created was generally successful in providing some of the benefits I hoped to gain from this exercise. To others who may be wanting to create a similar musical playlist to aid physical exercise, I would recommend including songs that they enjoy listening to – in order to increase their enjoyment (Dyrlund & Winiger, 2008), and songs with appropriate rhythms and tones to match the intensity of their exercise – to help improve focus (Bertuzzi, R., Lima-Silva, A. E., Lopez-Silva, J. P. & Silva-Cavalcante, M. D., 2015). I found the relaxation portion of the routine quite successful as well, and further research into the effects of listening to classical music may reveal even greater association of classical pieces with states of relaxation. It is key to note that despite the significant effects music seemed to have on my mood and physiological response – the type of music chosen, the type of physical activity undertaken, and the mental and physical state of individuals may also be important factors that must be considered when evaluating the role of music in promoting one’s health.

References

1. Baker, F., Clark, I., & Taylor, N. (2016). The modulating effects of music listening on health-related exercise and physical activity in adults: a systematic review and narrative synthesis, ​Nordic Journal of Music Therapy, ​25(1), 76-104.
2. Berger, D. S., & Schneck, D. J. (2006). ​The music effect: music physiology and clinical applications.​ London; Philadelphia: Jessica Kingsley Publishers.
3. Berlyne, D. E. (1971). ​Aesthetics and psychobiology.​ New York: Appleton-Century-Crofts. Bertuzzi, R., Lima-Silva, A. E., Lopez-Silva, J. P. & Silva-Cavalcante, M. D. (2015)
4. Influence of music on performance and psychophysiological responses during moderate-intensity exercise preceded by fatigue. ​Physiology & Behavior, 139(2015), 274-280.
5. Boutcher, S. H., & Trenske, M. (1990). The effects of sensory deprivation and music on perceived exertion and affect during exercise. ​Journal of Sport & Exercise Psychology,​ 12(2), 167-176.
6. Cvejic, E., Lynar, E., Schubert, E., Vollmer-Conna, U. (2017). The joy of heartfelt music: An examination of emotional and physiological responses. ​Elsevier B.V, ​120, 118-125.
7. DeNora, T. (2000). ​Music in everyday life. ​United Kingdom: Cambridge University Press.
8. Dyrlund, A. K., & Winiger, S. R. (2008). The effects of music preference and exercise intensity on psychological variables. ​Journal of Music Therapy,​ XVL(2), 114-134.
9. Higgins, P. A., & Murrock, C. J. (2009). The theory of music, mood and movement to improve health outcomes. ​Journal of Advanced Nursing, ​65(10), 2249-2257.
10. Huron, D. (2006). ​Sweet anticipation: music and the psychology of expectation. ​Cambridge, MA: MIT Press.
11. Karageorghis, C. I., & Priest, D. L. (2012). Music in the exercise domain: A review and synthesis (Part I). ​International Review of Sport Exercise Psychology,​ 5(1), 44-66.
12. Kreit L.H., Lucaccini L.F. (1972). ​Ergogenic aids and muscular performance. New York: Academic Press.
13. McFerran, K. S. (2016). Contextualising the relationship between music, emotions and the well-being of young people: A critical interpretive synthesis. ​Musicae Scientiae, 20(1), 103–121.
14. McFerran, K. S., & Saarikallio, S. (2014). Depending on music to make me feel better: Who is responsible for the ways young people appropriate music for health benefits. ​The Arts in Psychotherapy, ​41(1), 89-97. doi:10.1016/j.aip.2013.11.007
15. Thaut, M. (2005). ​Rhythm, music, and the brain.​ New York: Routledge.

Definition- ‘a long-term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behaviour, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.” (oxford dictionary)

Schizophrenia is a mental illness that causes some to have an altered experience of reality. People with schizophrenia experience psychosis, which means they cannot think, express their emotions, sympathize with other people and differentiate between truth and false reality hence making people who suffer from this see hallucinations. There has been plenty of scientific research on investigating the causes for this illness, but till this day there has not been a conclusion on the exact reason for schizophrenia. However, research has shown that certain factors can contribute to increasing the chance of developing schizophrenia. Some of these include:

• family history
• injuries to the brain
• chemical imbalance in the brain such as dopamine
• alcohol and drug use, especially cannabis and amphetamine. These effects the level of neurotransmitters in the brain which releases some of the symptoms of schizophrenia.
• depression- leads to a chemical imbalance in the brain
• 6extreme stress or stress over a certain extent leads to depression

Types of schizophrenia

• Paranoid schizophrenia-most common form of schizophrenia. people who suffer from this belief that an individual or a group of people are plotting against them or anyone they know or are close to example: An assassin is trying to kill your mum. Individuals who are diagnosed with this suffer from hearing voices
• Disorganized schizophrenia-A person with Disorganized schizophrenia will portray illogical thinking and behaviour, also purposeless actions will be shown. This type of schizophrenia is said to be the most severe type. patients will find it extremely difficult to do everyday activities such as cleaning and feeding themselves.
• Catatonic schizophrenia- changes in behaviour and actions in extreme measures. Someone who suffers from this might not be showing anybody gestures for a period or they could be moving everywhere showing uncontrollable behaviour. They could also stay silent, showing no sign of talking or they could talk to an extent where they would repeat anything someone says.
• Undifferentiated schizophrenia- when someone fits into two or more categories of the different types of schizophrenia.
• Residual schizophrenia-When a person has a history of schizophrenia, but they currently have no symptoms. The person may be in suspension from the illness or may later resume to showing symptoms

Signs and Symptoms

Signs -for some individuals the illness appears suddenly without a clue or a sign. But in most cases, it comes gradually, with warnings. Due to the different types of schizophrenia, the signs and symptoms can vary from person to person. However, some of the general signs for Schizophrenia are- trouble paying attention, unemotional gaze, difficulty sleeping, lack of personal hygiene, or irrational beliefs.

Symptoms-Symptoms are typically divided into positive and negative symptoms Positive symptoms are those that appear to show excess or misuse of normal functions and negative symptoms are those that lack important abilities.

Positive symptoms

Delusions -Delusion refers to a strongly held belief despite the evidence. Example You might believe that someone is trying to plot and kill you just because they are walking behind you.

Hallucinations -Thoughts and experience your mind makes up, e.g. hearing voices and seeing objects that are not present around you. Example: you might be talking to your grandparents even though they are not alive.

Disorganized speech/thinking-Disorganized speech typically arises from abnormal thought processes. A person might quickly jump from related subject to another, repeat words or phrases that someone else might say.

Disorganized behaviour- Behavior which people might find unnecessary, which include disruptive/ violent and unpredictable.

Negative Symptoms

Lack of emotional expression – expressionless face, monotone voice,

Lack of interest or enthusiasm – Problems with motivation; lack of self-care.

low interest on what is happening around you – unconscious of the environment; social withdrawal.

The extent of the problem

• Aboriginal people have a higher chance of suffering from schizophrenia. They are 1.5 times higher to suffer from schizophrenia than non-aboriginal.
• In 2016, more than 1 in 4 (27%) Indigenous Australians used an illicit drug in the last 12 months. This was 1.8 times higher than for non-Indigenous Australians (15.3%). (aihw)
• In 2016, the most commonly used illicit drug by Indigenous Australians was cannabis (16.7%), (aihw)

1,2,3 trend analysis- The reason that Aboriginal and Torres Strait Islanders have a higher chance (1.5x more) of being diagnosed with schizophrenia compared to non-aboriginal, is for the reason being that aboriginal life choices are not appropriate example intake of drugs. Aboriginals have a higher consumption rate of drugs in comparison to others (1.8 times higher) because of recreational use but mostly due to stress relief which is caused by unemployment and living in underdeveloped areas. To get away from these issues, they resolve to use drugs like cannabis, which increases the chance of depression according to McGill University and the University of Oxford. Also, problems like racial discrimination and child removals cause depression which leads to a chemical imbalance in the brain which is one of the main factors which contribute to increasing the chance of having schizophrenia.

*4. There is a higher chance of getting Schizophrenia below age 25(health.gov) Analysis- The reason being for this is that below the age 25 an individual goes through their high school and university life. During this period, the stress level is extremely high because of exams like hsc or vce (depending on which state) which will increase the chance of relying on drugs to get away from these problems which yet again increases the chance of depression and chemical imbalance. This is also the time frame where a person looks to get married, have kids, look for a job to financially support the family which all are factors that increases the burden and stress on an individual. At age 18, an individual becomes independent hence allowing them to go to places like clubs and parties. These places are where drugs are most common to be found and also teenagers believe that drugs are only for recreational use, but they do not see the side effects of them making them ignorant leading them to use drugs, not knowing the harm it has on the body.

*5. Schizophrenia incidence is slightly higher in males than females at a younger age- Men having a slightly higher incidence rate of schizophrenia than females below at a young age could be possibly due to the reason that boys have a higher chance of taking risks, meaning more injuries are common in males. Example not wearing a seat belt while driving. Injuries also include damage to the brain which is another factor that increases the chances of being diagnosed with schizophrenia. Females are more emotional and sensitive to topics like these ,which makes them not wanting to talk about their illness if any signs or symptoms are shown.Also, males are supposed to be the ‘Alpha’ of the family meaning that they are supposed to be the one who should look after the family putting more stress on them which could potentially lead to drug use as a stress reliever.

*6. humans who experienced birth complications have a higher chance of getting schizophrenia (NCBI) Analysis- a complication in birth could lead to underdevelopment of the brain which is another factor leading to mental illness.

Risk and protective factors

What is a risk factor?

According to the World Health Organization ‘A risk factor is any attribute, characteristic or exposure of an individual that increases the likelihood of developing a disease or injury. Some examples of the more important risk factors are underweight, unsafe sex, high blood pressure, tobacco and alcohol consumption, and unsafe water, sanitation and hygiene.’

According to public safety, ‘protective factors are positive influences that can improve the lives of individuals or the safety of a community. These may decrease the likelihood that individuals engage in crime or become victims. Building on existing protective factors makes individuals and communities stronger and better able to counteract risk factors.’

Individuals need to be aware of the protective and risk factors to prevent the risk of developing any mental illness. In some cases, even if you follow the protective factors, you might end up still having schizophrenia. However, most of the time if you follow the protective factors and stay away from any risks, you will be distant from this mental illness.

Risk factors

Protective factors

Head injury may trigger hallucinations and delusions. Take precaution when doing any activity where the head is at risk. Example where a seat belt or don’t for over the speed limit to prevent you from having severe brain injuries which if were to happen, chance of brain damage is possible (Modifiable

• Living a healthy lifestyle with reduced stress. Make good life choices and don’t be lazy to do anything . Example look for jobs if unemployed, taking studies seriously which will help you in later stages of life.(Modifiable)
• Use of drugs can affect brain activity and can bring about psychosis (Modifiable Avoiding smoking, drinking, and tobacco to avoid any possible effects on the brain (Modifiable)
• Family member with schizophrenia as the condition is found to run in genes (Non-modifiable)

Not being financially stable is another risk factor as it is one of the biggest contributions to stress and depression(Modifiable)

Having a supportive and understanding family to support individuals through tough times. (Non-modifiable). In some cases this might not be possible, so the best option would be relying on friends or seeking help from a trustworthy individual like teachers or the counsellor(Modifiable)

Going to places where drugs are most likely to be available. You might end up being peer pressured by friends hence increasing the chance of schizophrenia (Modifiable)

Having a hobby to focus on. Hobby to focus on will help you put your attention on the activity. Most people have a hobby as a solution to reducing stress example playing soccer for a club to help reduce stress on school studies (Modifiable)

Sociocultural, socioeconomic and environmental determinants

Sociocultural

Sociocultural determinants include family, friends and media. Individuals need to surround themselves with positive-minded and supportive people because they will influence your actions, thoughts, mentality etc. In some cases, you might be surrounded by family members who harm you, in this case, you should resolve to have good friends. Example- If your dad and mum have had a divorce and have decided to live with your dad but he abuses drugs and alcohol, you will most likely end up like him if you do not act upon it. Sometimes you might be stuck with him and cannot do much about it if so, having good friends should be your number one priority. If you decide not to have good peers and are stuck with your dad until you are stable enough to move out, your life choices will be similar or identical to his hence increasing the chances of schizophrenia as drug use like cannabis, affect neurotransmitters which cause chemical imbalance leading to mental illness. Media- Now a day’s media has a positive impact on spreading awareness of mental issues like schizophrenia. 20 years ago, mental illness was not prioritized this may be due to the lack of media, but currently, the media is doing an amazing job at spreading awareness of schizophrenia. On YouTube, there are videos and advertisements regarding schizophrenia also twitters/Instagram users use their social media platform to spread awareness of what schizophrenia is and how it is an illness that people should be more conscious about.

Socioeconomic

socioeconomic factors include income and education. Having a high paying job can have a major impact on a person and can influence the mental illness, schizophrenia. example – If a man has a family of four and is working as a surgeon, getting paid well, he will not have to worry about anything related to money like paying bills and mortgage, reducing the stress level which decreases the risk of developing depression. Also, if a person suffers from schizophrenia and needs medication that is not under the pharmaceutical benefits scheme, they will end up paying the whole amount which in most cases are expensive. If the same person has a high income he obviously will buy it, helping his illness become better. However, if the person is unemployed, the chances of purchasing the medication are low, worsening the condition. Also, the high-income worker can pay for extra visits to the psychologist whereas the low-income worker won’t be able to.

Education- having the right education on the effects of drug use, risk and preventative factors for schizophrenia will most certainly influence the person’s lifestyle choice. If a teenager doesn’t have the right education on drugs, he might end up using them for ‘recreation’ but his actions will lead him to increase the chances of obtaining schizophrenia

Environmental

living in a good environment will most certainly grant you better access to health facilities, however living in an underdeveloped area can worsen your illness or increase the chances of obtaining it. Example- John and Steve both suffer from schizophrenia. John lives in a high-end area with a psychologist 20km away from him, but Steve lives in the middle of Australia where the closest phycologist is 100 km away from him. John will most likely end up going to the psychologist to seek for some help, but Steve needs to consider the travel distance, discouraging Steve to seek for some help worsening the conditions of schizophrenia.

Also having access to technology allows an individual to approach information related to the illness which was not known previously example risk and protective factors. This allows the individual to have variety and the capability to make better choices ,for example not to take drugs which will decrease the chance of developing schizophrenia.

Groups at risk

Aboriginal Torres Strait islanders- Most of them live in rural areas where access to health facilities is low and also the cannabis use rate is much higher compared to others because of stress level which arises from unemployment rates, lifestyle, area living in.

16-25 – This is the time frame where a person goes through their highschool,university and work life. For a young adult or teenagers, this is one of the most stressful life events that take place which increases the chances of being diagnosed with depression which are one of the risk factors involved in schizophrenia people who have been through birth complications- Scientists have proved that birth complication usually results in underdeveloped brain which causes biochemical imbalance hence increasing the probability of being diagnosed with schizophrenia

Females – Females tend not to talk about topics like these as they are more emotional and sensitive about it . This will result in them not seeking any help from professionals,l increasing the severity of the illness.Males with a diagnosis of Schizophrenia received services at a higher rate (101.8 service contacts per 1,000) than females (42.8 service contacts per 1,000) in 2017. Also females go through hormonal change during pregnancy which increases stress level,contributing towards schizophrenia.

Past experiences- some people go through experiences which leads to dramatic and severe depression and anxiety. Example could be a couple that just had broken up after a 6 year relationship. A study by psychologists at the University of Liverpool has found that traumatic life events are the biggest cause of anxiety and depression, but how a person thinks about these events determines the level of stress they experience.

Low socioeconomic status

People who fall under the low ses is for the reason being that they are not financially stable. This contributes to schizophrenia as it restricts access to health services, treatment and medication. Being stable with money is one of the biggest concerns a person has in their lives as it one of things you need in life to get to where you want. Example, paying for university/school, food, mortgage bills and etc.

Living in rural areas- People who live in rural areas is usually because of their low economic status. These remote areas have limited access to health services such as psychologists,gp and psychiatrist. Without the help of these professionals , conditions of schizophrenia will not recover or become better

Executive function with a focus on working memory in schizophrenia Schizophrenia is a complex disorder with a large heterogeneity within its clinical handbook. Categorised as a disorder of psychosis, it remains an abstract chronic illness that affects one percent of the global population (Nordqvist, C. 2017). With a vast variety of clinical presentations, the exact nature of the neuropsychology of schizophrenia continues to remain elusive. Ongoing research and continuous technological advances, however, brings clarity to a multifactorial aetiology and the spectrum of symptoms the patient’s display. Divided into 3 categories, schizophrenia manifests into positive, negative and cognitive symptoms, and arise as the fundamental aspects of the disorder.

Positive symptoms, the addition of a behaviour, thought or feeling seemingly coincides with emotional and social reactivity in schizophrenia (Mueser & Jeste, 2011). This is presented as delusions and hallucinations. Negative symptoms, which take away a behaviour thought or feeling can include, specific impaired motivation, drop in spontaneous speech and social withdrawal (Fatani, Aldawod & Alhawaj, 2017). Cognitive symptoms can include deficits in executive functioning, attention, and working memory (Glausier & Lewis, 2013). In this review, cognitive dysfunction has been highlighted as a core domain of schizophrenia, reported in almost 98% (Tripathi, Kar, & Shukla, 2018) of schizophrenic patients. Impairments can include disorganized speech, attention and thought, poor memory and higher-order functions eventually impairing the capacity to communicate effectively (Fatani, Aldawod & Alhawaj, 2017).

Through an exploration of a possible pathway, the light will be shed on executive dysfunction and more specifically working memory, a limited capacity that temporarily holds information available for processing, in schizophrenia. Disrupted component processes and underlying abnormalities in neural architecture and connectivity in combination with altered functional activity forms the basis to explain such changes (Eisenberg & Berman, 2009). However due to it heterogeneous nature, sometimes broad or specific, and manifested by different patterns of performance (Kuperberg & Heckers, 2000) there remains no general consensus. Executive function refers to the ability to coordinate thought and action and directing it toward obtaining a set of goals. Simply it allows us to invoke voluntary control of our behavioural responses to allow human beings to develop and carry out plans, obey social rules, solve problems, adapt to unexpected circumstances, multitask and locate episodes in time and place (Orellana & Slachevsky, 2013).

Deficits in executive function can occur in various stages over the progression of schizophrenia. Adolescent at risk of developing the disease, patients with their first episode of schizophrenia, relatives and aged patients with more severe cognitive impairment all present signs of executive dysfunction (Breton et al., 2011; Kuperberg & Heckers, 2000). Based on the traditional medical model, executive function was construed as a single construct as a central executive in charge of high-level cognitive skills (Della Sala et al., 1998; Shallice, 1990).

However, as our understanding continues to evolve, executive function is a model of multiple process related systems that is inter-related, inter-dependent and work together as an integrated supervisory system (Stuss & Alexander, 2000). Working memory (WM) is a limited capacity system that enables us to temporarily hold, update and work with relevant information, playing a significant component in higher-order thinking, language and goal directed behaviour (Baddeley, 2003). It confers the ability to direct behaviour by the sole representations of the outside world rather than by immediate stimulation and thus to base behaviour on ideas and thoughts (Lichter & Cummings, 2001). Noted by (Salzinger, 1984), schizophrenic behaviour was excessively dominated by immediate stimulation rather than by a balance of current, internal and past information. Well-documented in several researches are deficits in WM of patients with schizophrenia (Barch, Csernansky, Conturo & Snyder, 2002; (Callicott et al., 2000)

Deficits shown by schizophrenic patients on a variety of neuropsychological tests become the foundation to illustrate such points. The PFC mediated tasks on which schizophrenic patients perform poorly share a common feature, the involvement of working memory (Goldman-Rakic, 1987). Most widely recognised is the Wisconsin Card Sorting Test which is particularly sensitive to dorsolateral prefrontal cortex (DLPFC) abnormalities. Patients are reported to have difficulties in switching from one category to another, where they preserve the choice even when it is no longer correct. Further illustrated by (Weinberger, Berman, & Zec, 1986), they observed the blood flow of medication free schizophrenic patients under various conditions (at rest, during performance of WCST). It was seen blood flow to the DLPFC did not increase in comparison to the control. Similar findings are seen while performing the Tower of London task (Andreasen et al., 1992).

However, more studies are needed to integrate structural and functional imaging to further investigate WM abnormalities and their relationship to other variables like age and medication effects. Anatomically these functions are linked to the prefrontal cortex as deficits in executive skills often are correlated to damage to the PFC (Grattan & Eslinger, 1991).Supporting this comes a plethora of functional neuroimaging studies (Honey, Bullmore, & Sharma, 2002) that have observed increased activation of the prefrontal cortex when performing tasks specifically designed for executive functioning (Morris, Ahmed, Syed, & Toone, 1993). In addition negative symptoms are frequently linked to symptoms of patients with lesions of the DLPFC and related structures (Freedman & Brown, 2011). The PFC is subdivided into four main regions, the ventromedial PFC, largely involved in the integration of emotional information kept in memory and external stimuli, the dorsolateral PFC related to working memory, reasoning and thematic understanding, the medial PFC involved in attentional control and planning and the frontal pole involved in adaptive planning and self-awareness (Orellana & Slachevsky, 2013). As demonstrated above schizophrenic patients most commonly show deficits in tasks (working memory) related to the DLPFC (Manoach et al., 2000; Perlstein, Carter, Noll, & Cohen, 2001).

Described not as an anatomical structure, but rather defined by its functional attributions it is located in the middle of the frontal gyrus of the cortex (BA9+46) with its main functions including conceptualization, cognitive flexibility and working memory (McCabe, Roediger, McDaniel, Balota, & Hambrick, 2010). Although this has been highly replicated, behavioural abnormalities in schizophrenia remain poorly understood (Yoon et al., 2008). With numerous lines of evidence continuing to point towards abnormalities of the DLPFC, it does not implicate degeneration or to a possible lesion, but instead highlights alterations in neuronal and dendritic spine density and/or decreases in the neuropil (axons+ dendrites+ glia) (Boksa, 2012). Therefore suggests there is no loss of axons or cortical neurons but rather a decline in neuronal processes (Garey, 2010). The disturbances in the molecular mechanisms that underlie neuronal processes; spine formation, pruning, and/or maintenance(Glausier & Lewis, 2013) consequently impact the circuitry with multiple cortical regions. These processes are vital to streamline neural circuits through their shared function for an effective neural network.

Therefore, functional connectivity abnormalities may constitute a final common pathway for executive dysfunction and WM impairment. Suspected to occur during adolescence from a deficit of synaptic elimination programmed to occur during adolescence (Feinberg, 1982) , disruptions in neurodevelopment may bring about these deficits (Ho et al., 2003). Imaging studies of high-risk adolescent reveal an enhanced grey matter volume reduction in prefrontal cortex (Gogtay, Vyas, Testa, Wood, & Pantelis, 2011). Consistent with this, is evidence suggesting that the brains of adult patients have decreased grey matter, such that synaptic pruning may be analogous to the decline (Andreasen et al., 2011; Feinberg, 1982). Post-mortem brain studies (Moyer, Shelton, & Sweet, 2015) have similarly reported decreased spine density on cortical pyramidal cells from patients with schizophrenia compared with controls. Pyramidal spine density, small protrusions joined to the main dendrite, are often targeted during elimination in developmental synaptic pruning (Gogtay et al., 2011).

The vast majority of excitatory synapses (80-95%), which facilitates the transmission of an action potential, provide input to dendritic spines. They serve to specifically connect inputs in circuitry and therefore underlies the disruption of normal connectivity (Yuste & Majewska, 2001). The prefrontal cortex is a component of a larger network of cortical areas with numerous synapses translating the signal across, with dysfunction in any part of the network it gives rise to aberrant functional outcomes. The application of newly developed techniques and electron microscope studies has revealed a strong correlation between spine size and efficacy of synaptic transmission (Lee, Soares, & Béïque, 2012). Dendritic spine alterations have been identified in multiple brain regions in schizophrenia but are best characterized in cortical layer 3 (Glausier & Lewis, 2013). Parallel studies have both reported that small spine density had significantly reduced pyramidal neurons in layer 3 of the PFC in the schizophrenic brains. Small spines, due to its empirical link with synaptic function, correlates with neural plasticity, therefore effective circuitry involving PFC (Hung et al., 2008).

Seen in several experimental models, spine deficits are also associated vastly with impairments in working memory, attention and sociability (Brennaman et al., 2011; Liston et al., 2006)further suggesting deficits in dendritic spines may be contributors to the clinical features of schizophrenia. In neuropsychological testing, impaired cognitive flexibility demonstrated on the Wisconsin Card Sorting Test (Milner, 1963)is linked to spine density. Though less well studied, the ventrolateral prefrontal cortex (VLPFC), is noted to be involved in working memory storage and rehearsal processes (Wager & Smith, 2003). With less cellular abnormalities than DLPFC, patients have still shown increased VLPFC activation in conjunction with reduced DLPFC activation in a verbal working memory task (Tan, Choo, Fones, & Chee, 2005). There is no conclusive agreement as to whether the cognitive impairments can be attributed to a single or multiple disrupted system. The prefrontal cortex receives many connections from other cerebral structures. To carry out its functions it requires interactions between a complex array of anatomically and functionally related areas(Goldman-Rakic, 1987; Selemon, Rajkowska, & Goldman-Rakic, 1995).

Patients with schizophrenia have shown altered activity in the DLPFC, anterior cingulate cortex, basal ganglia, hippocampus and mediodorsal nucleus of the thalamus (Eisenberg & Berman, 2009;(Unschuld et al., 2013).Hence it is important to understand how information processing within PFC influences and is influenced by activity of other regions and how disconnection of these neural networks such as white matter damage or impairment to other brain regions (Stuss & Alexander, 2000) may explain cognitive deficits and neuroimaging findings. Functional neuroimaging of patients during EF tasks shows abnormal activation not only in the frontal lobes, but in other distributed brain regions typically recruited by executive task demands (Jansma, Ramsey, van der Wee, & Kahn, 2004). Moreover, working memory tasks; nonmatching to sample are associated with lesions of the hippocampus(Yoon, Okada, Jung, & Kim, 2008), observed in a rat study. In studies on WM in schizophrenia there was seen abnormal connectivity among different circuits connected to the frontal lobes (parietal, cerebellum, hippocampus) (Ruiz, Birbaumer, & Sitaram, 2013).

Therefore, suggests executive function requires the integration of prefrontal and subcortical activity where disrupted PFC function and related aberrant interactions contribute to executive dysfunction in schizophrenia. It is however a concern that functional connectivity measures are unable to differentiate between whether abnormal functional is due to abnormal function in anatomical connections or within regions. Due to the profound interconnectivity between the thalamus and PFC, the subcortical structure must play a large role in cognition. The thalamus facilitates connections and filters input and output from cortical and sub cortical regions. It has various connections with the prefrontal cortex and additionally, the mediodorsal nucleus of the thalamus provides projections to and from various regions of the PFC, serving as the major relay station to the PFC (Andreasen, 1997). As a filter, the thalamus receives sensory information from multiple sources, simplifies it by excluding redundant stimuli, and forwarding or receiving the relevant information to the PFC to formulate the appropriate decisions or responses in a rapid and well-coordinated manner required in executive skills. Through the application of stereology techniques obtained relatively precise quantitative estimates of cell loss in the medial dorsal nucleus of the thalamus. Observed was both a decrease in neuronal density and a reduction in volume (Alelú-Paz & Giménez-Amaya, 2008).

Working memory tasks, have also provided support for thalamic abnormalities. In one study comparing schizophrenic patients with healthy volunteers during practised and novel recall of complex narrative material, we observed decreased thalamic flow in patients suffering from schizophrenia (Cohen & Yurgelun-Todd, 2001). In summary, schizophrenia continues to remain a convoluted mystery. Through an exploration of changes seen in executive function and working we are able to begin to recognise and understand the complex pathophysiology. Indicated by series of converging evidence on the neuronal processes, neural architecture and connectivity of the prefrontal cortex it forms the basis to explain such dysfunction.

Poetry has been around for centuries. Going back to the 2nd century. As poetry has been around for some time now. Poetry has a tendency of helping soothe the pain, suffering of mental illness and so much more. In “Will a poem a day keep the Doctor away?”, talks about the use of poetry and how today it continues to help people, especially women. So, I come to say that poetry is beneficial to helping people with mental health. Poetry can guide people to jungle their mental illness into the words they hear and write. While as other people may argue that poetry is not beneficial because it can bring up old memories that cause a mental breakdown. Poetry is a guide to the people that have conflicts with their selves or others

So, what is poetry therapy? Poetry Therapy is the use of the written or spoken word to further therapeutic goals and enhance the well-being of individuals, families, couples, or groups. A type of expressive arts therapy, poetry therapy promotes growth and healing through expressive writing activities and through the reading and facilitated discussion of literary material. The term, poetry therapy encompasses journal therapy, therapeutic storytelling, film, as well as performance poetry. The article “Will a poem a day keep the doctor away” it states, “Today, some therapists use poetry reading or writing to facilitate healing or promote personal growth in their clients. And many more English teachers exhort their students to express themselves in a poem.” This quote is saying that poetry is more than just a therapeutic method it’s a teaching method for teachers.

In the text Linda started to talk about the first piece of writing, that she had sold was a poem “Elegy for the loss” back in 1982. At the time Linda was going through a mental and very devastating part of her life because she just had lost a baby due to a miscarriage. So, her writing this poem made her get through it emotionally. However, when her poem was published, she wasn’t the only one taken by the pieces she had written, it also spoke to a lot of other women who injured the same circumstances. In the article, it states, “…this poem was my way of mourning it. Apparently, the poem spoke to other women as well, because it has been widely republished ever since…” This quote is saying that poetry is help people that go through such tragic thing intake on a different writing piece to help them heal. So, this does help my argument of does poetry helps mental illness. So, as I say to an instinct because the memories are still there, but the words are guiding people to live on.

Who is Linda Wasmer Andrews? Linda is a writer that partakes in health, medicine, mental health, and psychology. Her articles have been published on major websites and in national magazines. She’s also the author and co-author of 15 books for groups of all ages. Linda also attended the University of New Mexico between 1975 – 1979. She also has a master’s degree in health psychology. Now Linda has a blog pertaining to Minding the Body for Psychology Today. She also tends to write frequently for StayWell and other wellness content providers. Linda also partners with brands, like Mattress Firm and Philips Sleep and Respiratory Care, to create health and well-being content that engages the audiences they want to reach.

Another thing bought up in the article is that over the past 200 years research has proven that poetry for mental illness is a good effect on people with mental illness. In the article, it states, “Over the past 25 years, more than 200 studies have investigated the mental and physical health benefits of expressive writing. This research is rooted in the belief that disclosing emotions – a core component of much psychotherapy – is beneficial even without the aid of a therapist. Studies have shown that disclosing challenging experiences in personal writing can lead to improvements in a wide range of health outcomes, such as self-reported moods and symptoms, doctor visits, immune cell counts, liver enzyme levels, and antibody response to vaccines. These studies have generally looked at structured, narrative prose, however, so it’s unclear whether waxing poetic would have similar effects.” This will also help me because this quote is not just saying that it helps with mental health but also physical health, and poetry is shown in statistics that poetry can help reframe thoughts about a difficult or challenging experience, especially when multiple poems share the same point of view from different angles.

What is the issue concerning poetry? The issue that continues to pop up in poetry history…. poetry is not worth being taught because it’s not beneficial to the young minds and many others and figuring out a poem’s meaning is difficult, and Reading poetry is hard work. However, I fight that poetry is beneficial to the young mind. And how it has been shown that people use poetry to cope with traumatic situations: by writing certain poems, hearing them or reading poems people have posted. However, not everyone in the poetry audience seen poetry as a negative thing. poetry is words that are helping young people and others to get their stories out. It also helps educational for helping people develop their skills. Another thing is poetry has a significant audience pertaining to people that are incarcerated and by its words giving a person body certain.

One way why poetry is beneficial is because it can be used as a therapeutic mechanism to help cope with traumatic situations. In the article “Using poetry to heal” states poetry therapy is used in three major domains… The receptive-prescriptive uses preexisting poetry or literature to elicit responses. The expressive-creative gives a client or group the chance to write, whether it’s poetry or letters. “This is an effective way to cope with spontaneous tragedy,” he says. “There’s a lot of hard research about the health effects of writing—for example, in the writings of James Pennebaker.” A third usage is a symbolic ceremonial, which is connected to the power of ritual or symbols. “If someone is struggling with a loss, that person might write a letter to the person who’s gone,” Mazza explains. “It also works with community tragedies. A lot of people wrote and drew after Columbine, but it became ceremonial when they posted it.” So, this article, it’s saying that poetry is helping people go through traumatic situations just by the words that are being written on a piece of paper to help express the pain they have experienced.

However, poetry is more than healing. Poetry is typed of language that speaks to people not just mentally but physically also. In other words, saying a person can listen to a poem and be speechless because of how well they can relate to it. And how by the rhythm of the poem can In another article (‘How Poetry Helps People to Live Their Lives”) it states, “I believe that poetry began as language did–that the impulse that made it was in fact the beginning of language… It is not primarily concerned with… conveying information, even with communication, although it may fulfill a succession of purposes… But not always, and not inevitably, whereas prose is always about something if it makes sense at all. Poetry is physical. It enlists the participation of the senses, beginning with the sense of hearing, of vibration, and its pace derives from and attends the body’s motions… The source that rises unbroken from the unsayable speaks to us of the impulse and mystery that we share with every living creature. The urge is measureless, like the unknown itself, and in the end remains, by nature, unsayable.” In other words, this quote is saying that poetry doesn’t always have meaning it can be a poem that a person can listen to a poem and be speechless because of how well they can relate to it.

As poetry has been coming more into the new era so has mass incarceration. And written word helps a lot of people that are in a prison speak because their voice is hard to be heard. And after a while, they are afraid to speak up. So basically, they are using their state of mind. In this article, it states, “…. To approach another’s writing with a genuine desire to learn… So, when people become incarcerated, we often lose their voices, and because we lose their voices, we lose a sense of the fact that these are people with stories far more complicated than the two-dimensional narratives about them would have you believe.” This quote is helping me say poetry is a good thing because people that are behind bars can have that literature aspect of learning and be able to use those skills once they get out.

Another thing poetry is also good for the teaching of young minds. In the article it states, “Sixty-eight percent of the respondents who studied poetry in a school rated that experience as mostly favorable (80 percent rated their out-of-school experiences as “mostly positive”). Twenty-seven percent had a neutral experience with studying poetry in school and 5 percent rated their in-school experiences as “mostly negative”. The current poetry audience was significantly more likely to report that their in-school experiences were “mostly positive” than were potential members.” This quote is saying that most of the kids in school thought poetry was beneficial but the others not so much. And that is mostly based on two main groups for those who were involved with poetry and the others that may have encountered poetry but weren’t involved. In the article, it states, “Eligible respondents were classified into two major groups – the ‘poetry audience’ and the ‘potential audience’. The Poetry Audience is comprised of those individuals who have read poetry, listened to poetry, or both within the last five years. The Potential Audience consists of those individuals who read for pleasure but have never read or listened to poetry or who have not read or listened to poetry within the last five years.” this is helping me define my issue because people are quick to assume that poetry is not good. But at the same time haven’t taken the chance to endure poetry.

Over the past couple of years, statistics have shown that poetry is indeed beneficial. But since people are unaware and more uninformed people just tend to say that poetry is not helping them. More saying that poetry is too difficult for a young child to endure. Or for a person to take poetry because it is too difficult to understand. However, if you start the mind of young poetry wouldn’t be as hard to comprehend the meaning behind a poem. Also, things that a teacher may be teaching poetry will give them a better skill set to learn another concept better. Also helping the mind to intellectually grow from situations that may have occurred. Poetry is not just for one person to use. Poetry is a piece of writing that helps mentally and physically. And as the article has been pointing out that pieces of writing tend to expand at a rapid pace if someone is going through the same circumstances of what the poem or piece of writing is talking about. So, how is poetry beneficial and not a troublesome piece of writing that just makes the mental health issue worst? When someone or you write poetry, the words tend to form the outcome of what you want to happen at the end. Also helping you look forward instead of looking back.

Schizophrenia, a term introduced by Bleuler, names a persistent, often chronic and usually serious mental disorder affecting a variety of aspects of behavior, thinking, and emotion. Biopsychology analyzes how the brain influences behavior, feelings, and thoughts (Kalat, 2016). Peculiar behaviors may be associated with social withdrawal and disinterest. “A Beautiful Mind” is a 2001 biographical drama films about the life of John Nash, a mathematical genius that suffering schizophrenia (Howard, 2001). The film is a great illustration to the topic Biopsychology Movie Analysis as discussed in the 14.3: Schizophrenia as displayed online. The film is begun when John Nash arrives at Princeton University because of the prestigious Carnegie scholarship for mathematics. He meets some new friends and some fellow Carnegie scholarship receiver, but he rather deals with numbers than with people According to the National Institute of Mental Health, schizophrenia is a “chronic and severe mental disorder that affects how a person thinks, feels, and behaves” and causes people to seem as if they are “out of touch with reality” (Michael 2005). Multiple symptoms are associated with schizophrenia, but some of the most common are hallucinations, delusional behavior, and trouble focusing. These effects may make the victim to be violent from time to time but not always; some may not show signs of violence. The movie begins with John introducing himself to other math graduate students, where he tries to make jokes with good intentions but ends up offending other students and left. After this confrontation, he heads back to his room, where he meets his roommate, Charles, who is supposedly a graduate student studying English. This is the first time that John’s schizophrenic delusions become apparent to the audience as his room is made for one person.

The peak of John Nash’s schizophrenic delusions occurs while he is giving a speech about his current mathematical research. During this speech, he sees men in suits in the aisles of the lecture room, who he thinks are Soviet spies who have been ordered to capture him. As a result of this delusion, he runs out of the room and is chased by these supposed Soviet spies. They capture him, and it becomes apparent that these men are not Soviet spies but are men sent to get him and bring him to a psychiatric hospital. John’s delusions have made him believe that he is working for the Department of Defense under a mysterious government agent. In the hospital, his wife, Alicia, reveals to him that there is no agent and she even goes on to show him that she was able to track down these top-secret documents. John is ordered to under insulin shock therapy and take medication on the side to help cure his debilitating schizophrenia. These shock therapy sessions are very violent and required restraints to hold him down while watched by a team of nurses and doctors. After his relapse, John is faced with the decision that he will have to return to the psychiatric hospital and take medicine, which will hinder his research or he can learn to deal with his disability so that he can do what he loves: math. He can return to Princeton and agrees to work out of the library. While starting to work at Princeton, he still had to learn to deal with his delusions in a new environment, which proved to be difficult but manageable. It is during this period of John Nash’s life that he was able to resume his research and when he wins him the Nobel Prize in economics for work that he did for his dissertation. Advocacy, government, and public-service groups rely on a variety of strategies to diminish the impact of stigma on persons with severe mental illness. These strategies include protest, education, and promoting contact between the general public with these disorders. The domains for the cognitive battery were initially selected through careful examination of factor analytic studies of cognition in schizophrenia, and they include the speed of processing, attention, vigilance, working memory, verbal learning, visual learning, and reasoning and problem-solving. The movie Beautiful Mind analyzes Dr. John Nash as a mathematical genius and a natural code breaker, at least in his mind. He was diagnosed with paranoid schizophrenia, which is a psychological disorder. According to Baird, paranoid schizophrenia is when a person has “delusions of grandeur and persecution often accompanied by hallucinations” (Charles 2011). The person has a split from real life circumstances, where their new reality becomes fact to them.

According to Physicians’ Review Network (PRN) (2016), It is estimated to affect about 1.1% of the world population suffer from the disease. About 3.5 million Americans are victims and commonly attack individuals of age between 16 to 25 years. Study directly links the condition to stress, making men more vulnerable compared to women. The condition is rare among children, and in rarely starts to show at 13 years. The article relates well with the film because of the symptom and signs outlined in the article are in line with the characteristics displayed in the “A Beautiful Mind” film.

According to the hospital, John Nash was diagnosed with paranoid schizophrenia because of certain criteria he showed, hallucinations and delusions. Dr. Nash had a break from reality when he thought he was working for the government to break codes sent from Russia in the newspapers across the county. In this instance, he was delusional because he created an alternate reality for himself. He showed signs of hallucinations by “hearing” people he regularly talked to and gave them names, although, in the movie, they were visual as well.

The development of Nash’s mental illness was acquired over some time. It probably started when he first arrived at Princeton. He was a solitary fellow and didn’t make friends easily. Even with a group of classmates, he tended to be in his world, with his thoughts, solving some type of problem. He had the anxiety to get a paper published when other classmates were continuously getting published in journals. This probably escalated his symptoms because of the stress placed on him and produced some form of negativity in his mind. He wanted to be thought successful, even though he was an introverted type of person. As one of the films that has brought more attention to mental illness than most others in recent years, “A Beautiful Mind” had the potential to change attitudes and increase people’s understanding of schizophrenia ultimately though it fails both as an artistic endeavor and as a form of public consciousness-raising.

According to Khan et al., (2013), individuals suffering from the disease loose connection with reality and are often misunderstood as a split personality. It is known to affect the occupation and interpersonal relationships, mobility, and death rates. Although Nash does not succumb in the film, the disease is associated with increased death rates compared to normalcy. An individual becomes confused; this is illustrated in the film where Nash thinks the people following him want to harm him. The condition is characterized by a high sense of paranoia with the victim losing trust with what they know and see. This article is elaborate and informative, borrowing significant biological and physiological theories without data collection and analysis. The article definition and illustrations perfectly fit Nash’s behavior in the film, and the film got it right according to illustrations of this article.

Conclusion

In conclusion “A Beautiful Mind” in a great way demonstrates the Biopsychological; Schizophrenia and how it affects an individual’s brain and behavior. The definition for the disease may be different, but generally, it involves abnormal behavior resulting from individual losing connection with reality. Nash shows most of what the disease is known to cause.

Around the world, many mothers have very smooth postpartum experiences, but on the other hand, some tend to have unfavourable physical or mental health complications. When it comes to mental health and postpartum, a common disorder that affects mothers and their infants is postpartum depression. According to Bicking and Moore (2012), about 15 percent of women experience symptoms of postpartum depression while they are pregnant or within the first year after giving birth. It is very important for nurses to provide adequate care for these mothers so they can prevent much harm to the infants and themselves when going through this stage. Postpartum Depression can cause less attachment from mothers and infants and nurses play an important role when facilitating care for them and their family by assessing and implementing care. For this essay I will first discuss the risk factors and negative effects of the disorder along with how to assess for it in mothers. I will also outline what different interventions can be put into place to improve the symptoms of this disorder and how to evaluate these interventions.

In order for nurses to provide care for a mother with postpartum depression, they must first know what the risk factors and negative effects for this disorder are. This will help when assessing and promoting health for the patient. According to a study done by Frey, Hidalgo, Krawczak, Minuzzi, and Simpson (2016), sleep correlates with postpartum depression as the group of women who were at highest risk for the disorder expressed that they had the worst overall sleep cycles. Activity, eating habits and social behavior were the other factors that were found to contribute to the causes of postpartum depression. (Frey et al., 2016). It is also explained by Bicking and Moore (2012), that a very strong factor contributing to postpartum depression is whether the mother has had struggles with her mental health in the past, has high stress levels or insufficient support (Bicking & Moore, 2012). The negative effects of this disorder in infants include weaker results on cognitive-linguistic assessments, less language expression later on in their life, and it is also proven that it could cause deficits in the cognitive functions of preterm babies (Bicking & Moore, 2012). The possible adverse effects for the mother consist of negative parenting actions along with behavior that expresses less attachment to the infant (Bulaevskaya, Mischel, Munsen, & Scheans, 2016). Without the understanding of how extreme these effects are, the mothers may not see a need for seeking help if they are exhibiting postpartum depression so it is critical for nurses to provide this type of education to mothers before this can happen.

When providing care for patients with postpartum depression, the nurse needs to collaborate with the patient and her family when making decisions in order to implement proper care. While focusing on the family-centred care model, neonatal nurses must centre their care on not only the infants, but the parents as well (Bicking & Moore, 2012). In doing this, nurses must engage in therapeutic relationships with the family, respect the decisions of the family, and understand what their goals and options are when seeking care (RNAO, 2015). This will encourage the patient and their family to stay engaged in the health care system and look for help when they need it in the future.

Essential steps when working with mothers who have postpartum depression are assessment and intervention. It is very crucial that postpartum depression is detected early on in the postpartum stage due to the possible risk factors for the mother and infant. When assessing mothers for this disorder, nurses must be familiar with the symptoms of this depression so that they can identify symptoms when the patient is exhibiting them (Bicking & Moore, 2012). The symptoms for postpartum depression consist of a lack of energy, depressed mood most of the day and almost everyday, sleeping problems, decreased appetite, significant weight loss without a diet, or significant weight gain (German, Lantiere, & Umylny, 2017). These symptoms must persist longer than two weeks and affect the mothers functions as if they were having a considerable episode of depression (Bicking & Moore, 2012). If a nurse suspects that their patient may be experiencing these symptoms or if their infant has been in the NICU for two weeks, one month, two months, or four months after birth, the mother must be screened for the disorder (Bulaevskaya et al., 2016).This is because the mothers of infants who are hospitalized in the NICU are more at risk of developing postpartum depression (Bicking & Moore, 2012). When screening for postpartum depression, a common tool that is used is the Edinburgh Postnatal Depression Scale (EPDS) which is a series of questions that can inform you of how high of a risk you are to the disorder (Bulaevskaya et al., 2016). Once it is known that someone has a high risk for the disorder, nurses must add interventions to their care. If the mother has had a child before and has experienced postpartum depression it is a good idea to find out what she used to improve it before (Curtis, Jacques, Lasher, Robertson, & Tom, 2013). This is due to a study that found that 60.6% of women who had the symptoms in their first child also had it in their second and many women expressed that treatment from their first experience helped during the second (Curtis et al., 2013). Some interventions that nurses can implement into the mother’s care include promotion of self-care strategies such as more sleep, relaxation, time for themselves, and exercise (RNAO, 2018). Nurses can also educate the mother on the risk factors of the disorder and how important it is to get the help they need as part of their interventions (Bicking & Moore). Another intervention that could help with creating better attachment between the mother and the infant during this time is infant massage (Lindensmith, 2018). The nurse can teach the mother how to do this and evaluate how the mother does it to her own infant (Lindensmith, 2018).

Upon implementing care to mothers with postpartum depression, nurses must also evaluate whether the interventions have been proving successful or whether they need to change the plan of care. For promotion of self-care strategies implemented toward the mother, the nurse should assess whether or not any symptoms are improved and how they are feeling overall after they participate in these strategies. If the mother is overall happier with her life and living a healthier lifestyle after, that intervention would prove successful for that patient. For the infant massage intervention, it is important to assess whether the mother conducted this task properly and whether or not the mother and infant bond is any stronger than when it was first discovered that she had postpartum depression. If the mother expresses that she is happy with her relationship to her infant and there is a good sense of attachment, this is a positive factor and this intervention helped to improve the conditions of both the mother and infant.

Neonatal nurses have a very important role when assessing, implementing, and evaluating care for mothers and their infant because postpartum depression can cause negative effects such as less attachment, cognitive deficits, and poor parenting actions if it is left untreated. Nurses must know the symptoms, risk factors, and negative effects of postpartum depression, they must respect and include the mother and her family when making decisions and promoting care, they must assess the patients, implement interventions along with evaluating their care afterwards. Without the help of nurses, the mother’s symptoms of fatigue, depressed mood, sleeping problems, decreased appetite, significant weight loss or gain may cause them to exhibit negative parenting behaviours toward their infant in which could cause cognitive deficits, and issues expressing language in the future, along with more stress in the infant. Although these effects don’t seem very destructive, they are very concerning effects that can be prevented by nurses.

Mental illness as a general term is defined as “any of numerous disorders categorised by impairment of an individual’s thoughts, emotions, or social functioning”. Types of mental illnesses may include bipolar disorder, schizophrenia, ADHD, psychotic disorder etc. It has been discussed that mental illness is linked to crime. As public opinion surveys highlight that mentally ill people are professed as violent and unsafe. Especially those suffering from schizophrenia. Whilst others believe that it could be related to other factors such as: the effects of medication (psychiatric drugs that may have side effects), the importance of stress caused by bad housing or financial difficulties. Or even the fact that some head injuries may raise the risk of violence, for example injury to the temporal or frontal lobe that may encourage aggressive behaviours.

In this essay I will be discussing how mental illness and crime is important and how they are both linked drawing upon different case studies and research.

Howitt (2017) states there is considerable evidence that “schizophrenia and other psychotic disorders are associated with violent behaviour”. Schizophrenia is a plain long-standing mental health condition. Which causes a range of different psychological signs. It’s shown that it is twice as probable a person with psychosis will commit criminal violence as opposed to someone who doesn’t have psychosis. For example, an “paranoid schizophrenic killed young woman with screwdriver”, this case highlights the fact violence can be associated with such a disorder. It hinders the ability for the individual to differentiate what’s right and wrong. As in the case mentioned, William’s (the defendant) mum added just days before the killing he said the “voices were back “and also added that his head wasn’t right”.

However, schizophrenia violence is said to be a related feature, while not a diagnostic characteristic. As some researchers have suggested that violence is not a symptom of schizophrenia. As there are several factors of why crime is committed. For instance, according to Howitt (2017) psychiatric drugs are arranged to mentally ill individuals to regulate the signs of their illness. In which case, these drugs may have side effects. Subsequent to violent behaviour. It’s also said such drugs that are taken by individuals suffering from mental illness to relieve their symptoms, is the actual source of their aggressiveness/behaviour not the mental illness itself. Furthermore, according (Van Dorn, Volavka and Johnson, 2012), there are other factors, these include: childhood abuse and neglect, household anti-social behaviour, binge drinking and stressful situations. These were all based on past and current conditions that violence was associated with. Therefore, it’s not always the case of mental illness being linked to crime as other factors can contribute just as much.

In contrast to this, a very prevalent case of Ed Gein (also known as the butcher of Plainfeild) “served as the inspiration of for some of Hollywood’s most sadistic murderers”. Gein who had been recalled as “shy and strange” by his elementary school teachers, had been found guilty for the murder of his brother Henry. When the police found his farmhouse had been filled with human body parts, kitchen utensils made from skulls, chairs sewed with human skin along with other house-hold items. Although he had left countless trail of bodies, he was only charged for the murder of Bernice Worden (local hardware owner). Furthermore, Gein had plead not guilty on the grounds of insanity, therefore incompetent to stand trial. He was referred to an “Central State Hospital for the Criminally Insane, where he was diagnosed with schizophrenia”. This case advises that such mental illnesses, can be linked to crime. It’s no coincidence that patients of schizophrenia commit crimes.

In opposition, mass media can also play huge part in influencing the public’s views and opinions on mental illness and crime. According to Baun (2009) negative and inaccurate illustrations of mental health information in the media, results to misinterpretations and consequences. For instance, particularly with schizophrenia, inaccurate representations can regularly get confused in the media. Thus, leading to confusion and conflict. One reason why the mentally ill “continue to receive” negative attention from the media may be due to “fear and prejudice”. With studies that have shown even just one “shocking media image of mental illness” amplified the notion that mentally ill are more likely to do bodily harm to others. Also “to make the media consumer more fearful of such individuals”. Resulting in them feeling excluded from society. Hence why the mass media can be a prevailing source of information, in shaping the public’s views, positive or negative.

This however does not change the fact, that mentally ill people are a “particularly high-risk group”. As they show symptoms of unsystematic thought processes, uncontrollable behaviour, poor planning and problem solving. These can impair one’s ability to notice risk and protect oneself, which can result to crime. According to Varshney et al. (2015) 10% of patients with schizophrenia or other psychotic disorders behave violently, which proposes that mental illness does subsidise to the risk of violence. This shows the relationship between mental illness and crime is significant.

Nevertheless, mentally ill patients can also be victims of violence. Showing clear dangers of physical trauma with past distressing and victimisation experiences, which have found to be “significantly associated with patients symptom severity and illness course”. Already in a helpless state, it’s said that they are more significantly impacted by the crime and may get fewer support than they need, to deal with the repercussion. Hence, it’s found that violent victimisation of patients happens more often than violent offending. Varshney et al. (2015) suggests that risk factors such as: Age (young) substance use and homelessness contributes to victimisation.

Although some may be victims, according to Hodgins (1992) individuals with schizophrenia were found to be 2.6 times more likely to have been sentenced of a criminal offence compared to healthy people. They were also accounted for crime of every type. A reason why schizophrenic patients are more likely to be convicted may be, that their perceptions of reality are distorted and highly affected. Therefore, violence may signify a comeback to frustration and “the loss of power and control”. Hence why mental illness and crime can be closely linked.

As mentioned above, other factors other than mental illness can be linked to crime. For instance, head injuries. These may include mild wounds such as: bumps/ bruises, or severe injuries such as fractured skull bones or damage to the brain. An example may be, the Fred West murders. It’s said, an earlier motorcycle incident left him “with serious head injuries. According to some experts, a metal plate was placed in his head that may have affected his behaviour and compulsion control”. Furthermore, West had experienced another head injury which resulted in permanent brain damage.

In contrast to this view, individuals with mental illness show psychological symptoms which may explain their violent behaviour and shows how it can be linked to crime. Teasdale (2009) listed psychological symptoms such as: hallucinations, delusions and treatment as “predictors of violence” mid the mentally ill. Hence why he conducted a study with the consideration of psychological features, in view of gender nature of coping with delusional beliefs. The study concluded that men and women retort differently to the experience of psychopathological symptomatology, and for this reason, it may affect their contribution in violent acts.

That may be the case, however majority of studies and research point towards other factors, such as medical conditions. It’s supposed that certain medical conditions can be linked with violent behaviour. Conditions such as: trauma, infections, neoplasms and brain injuries can cause irritability and aggression. This could eventually lead to violence and then to crime. It doesn’t necessarily mean the individual has to be mentally ill to commit a crime. As certain medical conditions (listed above) can have a similar outcome.

On the contrary, medical conditions may cause aggressive behaviour, yet it’s no coincidence, those suffering from a mental illness show higher levels of violence. Taylor et al (1998) recognised higher rates of assaults committed by people with severe mental illness during hospitalisation. This shows a clear link between mental illness and violent behaviour, yet there may be other explanations for the seemingly high rates of violence in hospitals.

It could be argued that violent behaviour is not always associated with mental illness. As past experiences, such as a family history of violence can cause violent behaviour. Green and Kowalick (2018) found that variables such as parental resentment, maternal permissiveness and absence of parental affection could lead to anti-social behaviours. As well as other factors, which may include child abuse, poor parental modelling/ lack of a role model figure and poor school experiences, homelessness and witnessing or experiencing violence, can all contribute to crime.

Though, cases such as Aileen Wuornos prove otherwise. “After a childhood with abuse and neglect”, Wuornos became America’s most notorious female serial killer. Working as a prostitute, Wuornos killed seven men while working the highways of state in 1989 and 1990. She was convicted, and on trial for the murder of Richard Mallory (whom she had shot several times). As time went on, she plead guilty to three more murders. It was found she was diagnosed as a psychopath, suffering from anti-social personality disorder. This case supports the idea, the relationship between mental illness and crime is significant.

It could be argued the relationship between mental illness and crime is not significant as it’s likely that mentally ill come across barriers to treatment, this insufficient treatment of their condition leads to patients being arrested for both violent and non-violent crimes. According to Marie E. Rueve (2008) these charges are founded on untreated symptoms, for instance paranoia, resulting in trespassing or breaking and entering. As a result of these untreated symptoms, it allows the condition to manifest, impairing the individual’s abilities, to distinguish what’s considered right and wrong.

In contrast to this, the relationship between mental health and crime is significant. Another prevalent case proves this. David Berkowitz (aka son of Sam) was known for going on killing spree from 1976-1977. Berkowitz confessed to six murders, with the claim his neighbour’s dog told to kill them. As well as confessing to murders, he also set 1,500 fires in and around New York City. Furthermore, forty years later Berkowitz “continues to draw significant attention due to the thrilling nature of his crimes, his claims of demonic possession and his ability to taunt and avoid the NYPD”. He was later diagnosed with paranoid schizophrenia. And remains as America’s infamous murderer.

In conclusion, there is a considerable amount of research and studies that point towards the idea, the relationship between mental illness and crime is significant. Well-known cases of Aileen Wuornos, Ed Gein and David Berkowitz all suffered mental illness (mainly schizophrenia) which resulted in the murders. It’s no coincidence, that each one of these individuals suffered from a mental illness which led to crime. Some researcher’s believe it could also be down to other factors such as: bad housing, financial difficulties, stress, history of family violence, alcohol and substance use, head injuries and untreated symptoms from medical conditions. Although mentally ill show higher levels of aggressive behaviour and violence. Their impaired ability to differentiate what is considered right and wrong, results in crime and consequences.

Additionally, media also shapes the public’s opinion on how the mentally ill are perceived. For instance, they can be represented in a negative way, therefore portraying them as violent and dangerous. Or it may simply be the effects of medication. Yet majority of research and studies point towards the statement, the relationship between mental illness and crime is significant but other factors can contribute just as much.

Bibliography

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Losing a job or dropping out of college is one of the most stressful events of life. But witnessing your career declining or being not able to work and study as a result of mental disease is surely a very big emotional and psychological trauma for one. Schizophrenia is one kind of mental illness that can lead to unemployment and discontinuing education. Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. It can be caused by genetics, neurobiological, environmental, and substance abuse causes. Worldwide about 1 percent of the population is diagnosed with schizophrenia. About 1.5% of the population in Pakistan is suffering from this condition.

People attach stigmas with mentally ill patients, these lead to joblessness and discontinuing education, there is a perception that people with mental illness are violent, look different from others, and can never get better or can not be productive members of society. In my personal opinion, environmental triggers like unemployment, dropping out of college or school can exaggerate the symptoms, studying, working, or engaging in activities help them to support themselves, there can be a decrease in stress which can help them lower their symptoms.

I think that working and being able to take care of yourself in such a mental illness can reduce agitation and aggression and can boost self-esteem which can also lower the triggers for symptoms. So my reason to select this topic for my scholarly article is to create awareness that schizophrenic patients can work and get an education if given proper therapies, teaching, and support. Causes of how schizophrenia affects functioning especially in professional life. Affects emotional, social, personal, cognitive, family aspects of life ( in scholarly will explain in detail).

The below-mentioned causes make it difficult for patients to continue with their careers:

• Unpredictable behavior
• Socially isolated
• Loss of social and communication skills
• Being perceived as violent
• The decline in memory especially working memory
• Poor judgments and insight
• Picking up fights
• Difficulty being organized.
• Impaired attention
• Apathy
• Lethargy

Views and Theories Regarding Cause of Schizophrenia

The psychodynamic view of schizophrenia

Schizophrenia is a result of the disintegration of the ego. As per Freudians, a weak ego can be a result of an abnormal upbringing. This causes the ego to be finished resulting in handing over powers to the id. They then lose contact with the real world and leave their fantasies out for the world to see

The behaviorist view of schizophrenia

Interaction with the environment teaches a person behavior. It is possible that people learn to show symptoms by observing other schizophrenic people. Operant processes play a role that is this behavior might be positively reinforced or it might be negatively

Studying and working as a schizophrenic patient

Schizophrenia is associated with considerable disability and may affect educational and occupational performance (WHO, 2018). Focusing and maintaining attention is difficult for such patients due to symptoms such as delirium and disorganized thinking. Many people find that returning to study is a useful transition between living on benefits and the world of work and provides a way of re-discovering their sense of value in themselves. It can help you to rebuild your self-esteem and self-worth. Stigma in Pakistan suggests that holding onto education and job is too much for a schizophrenic patient. However, WHO supports that employment is an effective management strategy. People feel better about themselves if they’re doing something productive. Working hard, receiving a paycheck, and being able to support themselves can improve quality of life and reduce the risk of suicide for people with schizophrenia, Dr. Frederick J. Frese and Cecilia McGough are famous examples of schizophrenic patients who achieved their goals

Prevalence

International: According to a study in Norway there were 817 individuals out with schizophrenia who were employed and 413 who received age care pension. The employment rate (full time and part-time) among those of working age was 10.24%–10.5% of the men and 9.8% of the women.

A survey-based study of 4684 schizophrenia patients in Norway receiving outpatient care found that 5% had paid employment. Other Norwegian studies based on smaller samples have found employment rates between 4% and 13%.

Surveys suggest that the majority of Americans with schizophrenia want to be employed, but aren’t: Currently, around 85 percent are unemployed, while research shows that as many as 70 percent would prefer to work. The 45 percent acknowledged that they needed treatment but still were not receiving treatment cited many reasons for this, 20% of these said that it’s too expensive and they can’t afford it due to unemployment.

A recent survey reports that 47% of adults living with schizophrenia drop out of college, compared to the 27% college dropout rate in the U.S. overall.

Reflecting on these case scenarios and experiences from experts I understand that rehabilitation and therapies can help such patients to bring their lost skills back to some extend or learn new skills in order to be self-sufficient for themselves and in order to keep their confidence and self-worth intact.

Some therapies that can be useful are:

1. Social recovery therapy: to help improve social skills and confidence in adolescents and young adults with early symptoms of, SRT help people adjust to work, education and leisure activities, include problem solving, improving verbal and nonverbal communication, respond to everyday social situations, and understanding and expressing appropriate emotions;
2. Social skills training. This can train the patient for different kind of jobs by enhancing their communication and socialization skills;
3. Rehabilitation may include job counseling, problem-solving support, and education in money management.

Recommendations

As a clinician, we play an important role in helping schizophrenic patients identify their interest, in helping them adjust to work and study environment. We can arrange workshops for patients as well as their families to educate them regarding the job opportunities in our country for the schizophrenic patients.

My recommendations are as follows:

1. Stick with the medication regimen;
2. The types of jobs or courses people with schizophrenia choose should be based on their personal skill sets and ability to function in the work environment;
3. Tell your boss/teacher andclose coworkers about your condition so they can help you with symptom management in working hours. Avoid disclosing your diagnosis to every colleague to avoid feeling of discrimination, such things can trigger delusions;
4. Family members and caregivers should support patients in adjusting to work and study environments.

Recommendation from literature:

1. Whether or not a person discloses his or her diagnosis of schizophrenia to an employer is a decision that must be made by the individual on a case-by-case basis. Some employers may be willing to make special arrangements to fit the circumstances if they’re aware of such a diagnosis;
2. Maintain contact with students and families after a diagnosis, and encourage the student’s return to school when their symptoms are stable;
3. Ensure that there is a person with expertise/experience with mental illness on their disability services staff;
4. Provide counseling and support services to assist in a student’s success when they re-enter school.

Conclusion

Schizophrenia affects the functioning of an individual, having a great impact on his or her professional life and development. It is difficult for patients to work and study as they used to before their disease process but proper therapies and care can help them work in an excellent manner and they can achieve their goals like any other normal person. As mentioned in the above content that proper therapies and care have been shown to be effective. A disease like schizophrenia should not come in way of your dreams and goals

Schizophrenia is a serious mental illness, characterised by symptoms affecting the patient’s perception of reality, emotions, thoughts and behaviour. TraditionalThere is a range of symptoms such as delusion, disturbed and illogical thoughts, irrational behaviour, hallucinations, such as hearing voices, disruption of verbal communication and negative symptoms such as emotional disengagement, social disconnection and absence of normal behaviour.

Paragraph about schizophrenia, types of schizophrenia more about symptoms and what is involved in which one. Among people diagnosed with schizophrenia, 65% describe hearing voices telling them things that no one else can hear (Frith and Fletcher, 1995). Researchers have found that there are two determinants, or ‘causes’ to the disorder, these are referred to as biological and psychological factors. The first one to be discussed is biological factors.

Biological factors are described as the role biology has in schizophrenia. Studies on genetics, neuroanatomy and prenatal and perinatal environments show evidence for the biological determinants. Studies have shown that genetics has an influence on the likelihood of a person developing schizophrenia. Family history is known as the strongest risk factor for schizophrenia, as it increases the risk of developing the disorder by about 5-50 times depending on the extent of genetic similarity (Gottesman, 1991).

While examining the brain structure and activity of closest relatives of patients with schizophrenia, it was found that they share roughly 50% of their genome (Sullivan et al, 2003). Another area of influence in the likelihood of developing schizophrenia is prenatal and perinatal factors. Being exposed to environmental variations during a critical period of brain development, and environmental situations that cause stress can lead to impaired neuronal responses and symptoms of malfunctioning of the prefrontal cortex (the prefrontal cortex is an area of the brain located in the frontal lobe responsible for a variety of complex behaviours and it contributes to the development of the individual’s personality), which provides a link between the environment and the symptoms observed in psychological disorders (Arnsten, A. F., 2009). Finally, another biological area to be emphasised as evidence for the causes of schizophrenia is neuroanatomy.

As soon as neuroimaging techniques were discovered, researchers started to look for anatomical characteristics of the brain in patients with schizophrenia. Observations revealed that in some of the patients, the ventricles were abnormally enlarged, which suggested that there was loss of brain tissue, probably because of an anomaly during the prenatal brain development (Arnold et al., 1998). However, there are some limitations to this theory. Firstly, enlarged ventricles were only found in a minority of patients with schizophrenia. Secondly, it was found that this type of abnormality could be caused by the medications that were prescribed for schizophrenia patients (Gur et al 1998). In addition, it should be noted that there are psychological factors that contribute to schizophrenia.