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BioPsychoSocial Health
March 28, 2006

Vulnerability-Stress-Coping Model for Schizophrenia

By Shaheen E Lakhan, MD, PhD, MEd, MS | 2 Comments | Share | Print | Email | Tweet | Like | 1+

BioPsychoSocial_Health2.jpgSchizophrenia is a multifaceted disorder that manifests by both genetic and environmental factors. A plethora of twin and adoption studies suggest major genetic influences on the pathogenesis of schizophrenia; however, a MZ concordance of 50% also suggests environmental factors (Cardno et al., 1999). [Note, a concordance of 100%, or absolute probability that both "identical" twins are afflicted or not, would suggest a single gene disorder, as in sickle cell anemia and cystic fibrosis.] These family studies reveal that schizophrenia is a complex genetic disorder, akin to diabetes and most cancers, where not but multiple causative genes contribute to susceptibility — a polygenetic disease. Moreover, there are presumably environmental factors that contribute to the onset.

An emerging vulnerability-stress-coping model attempts to frame psychotic and affective disorders based on a biopsychosocial perspective (Nuechterlein & Dawson, 1984; Nuechterlein et al., 1994; Yank, Bentley, & Hargrove, 1993). Vulnerabilities may predispose individuals for the disorder, while environmental stressors can potentially modulate (trigger) the expression of symptoms in vulnerable bodies and minds.

The vulnerability-stress-coping model.

In schizophrenia, vulnerability may include genetic predisposition, birthing complications, and CNS viral infections. Stressful life events (e.g. being fired from work, terminating a relationship, or moving to a foreign environment) and biological stressors (e.g. substance abuse) may exacerbate the illness by triggering the emergence or reoccurrence of symptoms. However, protective coping mechanisms may safeguard vulnerable persons by weakening or eliminating symptoms.

The vulnerability-stress-coping model demonstrates the composite mechanism of schizophrenia and provides a useful diagram for optimal combination therapy for clinical management.

References

Cardno, A. G., Marshall, E. J., Coid, B., Macdonald, A. M., Ribchester, T. R., Davies, N. J., et al. (1999). Heritability estimates for psychotic disorders: the Maudsley twin psychosis series. Arch Gen Psychiatry, 56(2), 162-168.Nuechterlein, K. H., & Dawson, M. E. (1984). A heuristic vulnerability/stress model of schizophrenic episodes. Schizophr Bull, 10(2), 300-312.

Nuechterlein, K. H., Dawson, M. E., Ventura, J., Gitlin, M., Subotnik, K. L., Snyder, K. S., et al. (1994). The vulnerability/stress model of schizophrenic relapse: a longitudinal study. Acta Psychiatr Scand Suppl, 382, 58-64.

Yank, G. R., Bentley, K. J., & Hargrove, D. S. (1993). The vulnerability-stress model of schizophrenia: advances in psychosocial treatment. Am J Orthopsychiatry, 63(1), 55-69.

Shaheen E Lakhan, MD, PhD, MEd, MS

Shaheen E Lakhan, MD, PhD, MEd, MS, is executive director of the Global Neuroscience Initiative Foundation (GNIF). He is a published scholar in protein biomarkers, bioethics, biotechnology, education technology, and neurology. He serves on the editorial board of several scholarly publications and has been honored by the U.S. President and Congress.

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2 Responses

  1. Preventing Schizophrenia: State of the Art, Part 1: Overview | Brain Blogger says:
    March 29, 2011 at 4:43 am

    [...] BackgroundNo single intervention will eliminate schizophrenia because there are numerous causes and vulnerabilities. There are many ways to develop schizophrenia. There are physical vulnerabilities such as genetic [...]

    Reply
  2. Integrating Schizophrenia Management | Brain Blogger says:
    April 29, 2012 at 7:02 pm

    [...] a combination of pharmacological (neuroleptic) and psychosocial interventions according to the vulnerability-stress-coping model. The first line of coping is usually medicinal options for the suppression of symptoms and control [...]

    Reply

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