What is Schizophrenia?
Schizophrenia is a serious mental disorder that affects an individual’s interpretation of reality, affecting everything from the way they think to what they feel. It is characterized by episodes of psychoses associated with hallucinations, delusions, and confusion.
It is a mental illness that makes it difficult for patients’ to realize what is real and what is not. It can decrease the quality of life and requires a lifetime of treatment to prevent symptoms. It is also very common, affecting approximately 20 million individuals worldwide in 2019.
What are the causes of schizophrenia?
Schizophrenia is a multifactorial disorder, with genetics, environmental factors, substance abuse, and many other risk factors playing an important role in the development of this mental illness.
Having a first degree relative with schizophrenia is the greatest risk for an individual to get schizophrenia. Various genes are also linked with high risk for schizophrenia. However, it is believed that several little changes in the different alleles of a person’s genetic makeup result in the development of this mental illness. Furthermore, they also believe there is a high involvement of CNVs which are responsible for other genetic disorders like Digeroge syndrome and Burnside-Butler Syndrome. These CNVs can increase the risk by 20 fold and usually result in an individual with autism and schizophrenia.
Microdeletions and duplications of various genes together can result in schizophrenia in most cases.
Many genes have been found associated with schizophrenia and the different symptoms of the disorder. Suicidal tendencies and their severity can be analyzed by the CRHR1 and CRHBP genes.
The question scientists are now trying to answer is the extent of genetic involvement in the development of the disorder and if the percentage of involvement is high, what is the inheritance pattern of the disorder.
Many risk factors fall under this category but it is important to note that all these risk factors are only associated with a slight increase in risk for the development of schizophrenia.
- ACE (Adverse Childhood Experiences): Childhood trauma, whether its bullying or death of a loved one, can result in the development of toxic stress and mental illnesses as an adult. Schizophrenia has been associated with ACEs, although further studies are being performed.
- Infections during pregnancy: Pregnant women with Chlamydia or Toxoplasma gondii can give birth to infants with a 5-8% higher risk of developing schizophrenia than infants born to healthy mothers.
- Oxygen deprivation
- Prenatal infections
- Malnutrition: Mothers that are malnourished during pregnancy also give birth to infants with a higher risk of schizophrenia than normal mothers.
- Social isolation or dysfunctional families: Although this can be classified as ACEs.
- Vitamin D deficiency.
Some of the risk factors that are yet under research but show a positive relation are pollution, fathers older than 40, parents younger than 20, and even racial discrimination from a young age. The latter can also be classified under ACEs, however, more studies need to be conducted for that to be done.
Schizophrenia incidence is higher in individuals using recreational drugs, including cigarette smoking, and cannabis smoking. Hard drugs like cocaine and meth may result in a temporary psychosis that resembles schizophrenia. Alcohol can cause mental and cognitive dysfunction like that seen in Wernicke-Korsakoff Syndrome.
Cannabis use can increase the risk of developing schizophrenia, especially if genetic alterations are present. Further studies need to be performed to understand the mechanism of schizophrenia associated with drug use.
What is the pathophysiology of schizophrenia?
Schizophrenia is a mental disorder involving the dysfunction of dopaminergic, glutamatergic, and GABAergic pathways. Misfiring of dopaminergic neurons and misinterpretation of these signals by the brain is the most commonly accepted model for psychosis in schizophrenia. This also causes hallucinations.
Working memory deficit seen in schizophrenia can also be explained by D1 receptors in the prefrontal cortex. However, abnormal activity at D2R is more associated with schizophrenia symptoms that D1R. The extrapyramidal, motor symptoms seen in schizophrenia can also be explained by low dopamine levels.
Researchers also found a link between the most important excitatory neurotransmitter, glutamate, and schizophrenia. They made the link between these two after noticing the effect of glutamate blocking drugs on the brain. Most patients taking drugs like ketamine and phencyclidine start presenting with symptoms similar to those of schizophrenia, indicating a link between glutamate levels and pathophysiology of glutamate.
What are the signs and symptoms of schizophrenia?
Schizophrenia is a mental disorder that can affect the way a person perceives reality. They can produce a variety of symptoms, which are usually classified as positive, negative, and cognitive symptoms:
- Negative Symptoms: It refers to the lack of a normal emotional response and includes avolition, anhedonia, and alogia. Attentional deficit and poor attention span are usually considered negative symptoms as well.
- Cognitive Symptoms: These are the earliest symptoms of schizophrenia and usually include memory loss, loss of reasoning, and problem-solving skills along with increased time for processing of information.
- Positive symptoms: Also known as psychosis symptoms, these are the symptoms seen during a psychotic episode. These types of symptoms can be further divided into positive psychotic symptoms and positive disorganization symptoms.
a. Psychotic symptoms: This includes hallucinations, whether auditory, visual or tactical, olfactory and/or gustatory, and delusions with distortion of one’s self. Hearing voices or auditory hallucinations are the most common.
b. Disorganization symptoms: Also known as thought disorders, it can include disorganized thoughts, language, speech or behavior
How is schizophrenia diagnosed?
The onset of schizophrenia is usually during the third decade of an individual’s life. Onset before that is referred to as early-onset, and onset after, in the 40s to 60s is called late-onset schizophrenia.
If schizophrenia symptoms appear before the age of 13, it is known as childhood-schizophrenia.
Diagnosis of schizophrenia can be made using the criteria with either the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association or the International Statistical Classification of Diseases and Related Health Problems (ICD) published by the World Health Organization. For DSM, two diagnostic criteria much be met within one month, one of which should be a positive symptom and the other can either be cognitive or negative symptoms.
DSM, after recent studies, have included a dimensional assessment that helps with treatment and diagnosis.
Differential diagnosis of schizophrenia
Psychosis is one of the prominent symptoms of schizophrenia and is usually associated with many other diseases, making diagnosing schizophrenia difficult.
- Bipolar disorder
- Borderline personality disorder
- Substance-induced psychosis
- Drug withdrawal syndromes
- Alzheimer’s disease
- Huntington’s disease
- Frontotemporal dementia
- Lewy body dementia
How is schizophrenia treated?
Treatment of schizophrenia depends on antipsychotic medications and psychosocial interventions.
Due to the active role of dopamine in the development of schizophrenia, the use of typical antipsychotic drugs like dopamine antagonists can be very beneficial. There are also atypical antipsychotic medications that affect serotonin and help in the treatment of schizophrenia. These drugs reduce the positive symptoms, however, they have no effect on negative or cognitive symptoms. In 2019, the FDA approved a new drug named lumateperone, that affects multiple neurotransmitter systems and is beneficial in treating schizophrenia.
It is important to note that these medications can produce strong side-effects like movement disorders, tiredness and fatigue, and weight gain and should be taken only when prescribed with close follow-ups.
Psychotherapy: It can be really beneficial for behavioral problems associated and usually include; family therapy, group therapy, CBT, metacognitive therapy.
Assertive Community Treatment (ACT): This usually includes helping affected individuals find housing, managing finances and also providing assistance with daily life tasks like medication management, shopping, and so on. It has shown great results.
Exercise Therapy: it has shown some positive results, especially with cognitive symptoms like memory and attention deficit
Schizophrenia is a mental disorder that can affect individuals that are genetically predisposed and have risk factors like smoking and nutritional deficits. It is important to quit smoking and avoid cannabis smoking as they can, in the long run, both cause serious consequences and negatively impact the quality of life. Since genetic predisposition to schizophrenia can result in the disorder in the presence of other risk factors, living a healthy life can prevent the development of schizophrenia and should be highly recommended.
Warning: Some symptoms require emergency care. If someone is thinking about hurting themselves or others or trying to kill themselves, look help immediately:
- Call 911 for emergency services or go to the nearest emergency room.
- Call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255) or text the Crisis Text Line (text HELLO to 741741).
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