First of all, let’s talk about what is not schizophrenia.
People with schizophrenia do not have multiple personalities. In 1911, Eugen Bleuler was the first to use the term “schizophrenia.” Although the term “schizophrenia” comes from the Greek words “split” and “mind,” people with schizophrenia do not suffer from personality splitting.
This misunderstanding has led to the misuse of the term by many people. The “split mind” refers to the way people with schizophrenia are broken by reality; they can not say what is real and what is not real.
Who has schizophrenia?
Schizophrenia is one of the most common mental illnesses. Approximately 1 in 100 people (1% of the population) is affected by schizophrenia. This disorder is found all over the world and in all races and cultures.
Schizophrenia also affects men and women, although on average men develop schizophrenia earlier than women. Generally, men show the first signs of schizophrenia around the age of 20, and women show the first signs later than 20 years. Schizophrenia represents a huge cost to society, estimated at $ 32.5 billion a year in the US (according to statistics by Brain Facts, Society for Neuroscience in 2002).
What are the symptoms of schizophrenia?
The behavior of schizophrenic people is often very strange and shocking. This change in behavior, when people can not make the difference between what is real and what is not, is called “psychosis” or “psychotic episode.” The American Psychiatric Association has published guidelines that are used in the classification of people with mental disorders.
The most recent milestones are contained in the book called “Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition” (known as DSM-IV as an abbreviation). DSM-IV describes some symptoms that a person needs to have to be diagnosed as having schizophrenia. These symptoms include two or more of the following behaviors lasting at least one month:
- Delirium – strange, false beliefs. This beliefs seem real to the schizophrenic person, but they are not real. For example, a person may think that aliens or spies control her or her behavior, mind and thoughts. Sometimes this delusion may be by nature paranoid.
People with paranoia have an unreal fear or suspicion that someone “wants to catch them.” Delusion can also be of grandeur. In these cases, people think they are important people, such as the president, the king, or the prime minister.
- Hallucinations – oddities, unreal perceptions of the environment.
These hallucinations can be:
- A. Auditive (I hear voices) – sometimes the voice tells the person to do something
B. Visual (see lights, objects or faces)
C. Olfactory (smell all kinds of things)
D. Tactile (for example, feel that cockroaches are crawling on or under the skin)
- Disordered thinking / speechUnnatural thoughts are usually measured by disorganized speech. Schizophrenic people speak very little; when they do, the speech is incoherent. Sometimes the person changes the theme of a sentence at her half.
- Symptoms negative – no normal behaviorDelusions, hallucinations and incoherent speech indicate the presence of abnormal behavior. Negative symptoms include social withdrawal, lack of emotions and expressions, energy, motivation and reduced activity. Sometimes schizophrenic people have hygiene and poor care habits.
- Catatonia – immobility and “wax flexibility”Catatonia is a negative symptom by which the person remains fixed in one position for a long time. “Wax flexibility” describes the situation where the person’s arms remain stuck in a certain position even if they are moved by someone.When people show any of these five symptoms they are considered to be in the “active phase” of the disorder. Typically, schizophrenics exhibit lighter symptoms before and after this active phase.There are three basic types of schizophrenia. All those who suffer from schizophrenia have lost contact with reality.
The three types of schizophrenia are:
- Disorganized schizophrenia (formerly called hebephrenic schizophrenia) – lack of emotion, disordered speech.
- Catatonic schizophrenia – wax flexibility, low movements, rigid posture, sometimes excess movement.
- Paranoid schizophrenia – strong delirium or hallucinations.
What happens in the brain?
A common finding about a schizophrenic brain is that the lateral ventricles are larger. The lateral ventricles are part of the ventricular system containing the cerebrospinal fluid.
The picture below shows the magnetic resonance imaging (MRI) image of two twins: one with schizophrenia, the other not. Note that cerebral ventricles (red arrows) are larger in the case of schizophrenia glaucoma. (Image courtesy of NIMH Clinical Brain Disorders Branch)
A small hippocampus, a larger basal ganglion, and anomalies in the prefrontal cortex are present in some schizophrenics. However, these changes are not present in all schizophrenic patients and may occur in people who do not have this disease.
What are the causes of schizophrenia?
Probably there are multiple causes of schizophrenia, and researchers do not know all the factors that cause this mental illness.
Schizophrenia “is inherited from the family”. In other words, schizophrenia has an important genetic component.
Evidence of the genetic component comes from the study of twins. Monozygotic twins (identical twins) are those that have exactly the same genetic fingerprint; twin zigzag twins (fraternal twins) are those that have only half the same genetic fingerprint. If genetic factors were the only cause in the development of schizophrenia, then both monozygotic twins should have always developed this disease.
Trials on twins
Studies on twins show that the probability that both monozygotic (identical) twins develop schizophrenia is between 30-50%. The probability that both twins (fraternal) twins develop schizophrenia is 15%. This probability for non-twin siblings (like brothers of different ages) is also about 15%.
Do not forget that the rate at which we find schizophrenia in the population is about 1%. Therefore, because the probability of monozygotic twins is not 100%, genetic factors can not be the only cause. However, since the probability of monozygotic twins to make schizophrenia is much higher than in the case of dizzy twins, genetic factors play an important role.
Some studies have focused on the history of families of children who were adopted at an early age and who developed schizophrenia later. One of the studies (Kety et al., 1968) showed that 13% of the biological relatives of Schizophrenia adopters also had schizophrenia, but only 2% of the “normal” adoptive relatives had schizophrenia. These studies support the role of genetic factors in triggering schizophrenia.
To learn more about the role of genetic factors in schizophrenia, see the Genetics and Mental Disorders page of the National Institute of Mental Health.
Among the non-genetic factors that can influence the development of schizophrenia are: family stress, weak social interactions, infections or viruses contracted at an early age, or traumas produced at infancy. In one way or another, the genetic fingerprint of individuals is combined with non-genetic (environmental) factors to trigger schizophrenia.
Many studies have investigated the possible role of brain neurotransmitters in the development of schizophrenia. Most of them focused on the neurotransmitter called dopamine. “Dopamine Theory in Schizophrenia” states that schizophrenia is caused by a superactive dopamine system in the brain. There is strong evidence that supports dopamine theory, but also a number of other data that do not support it:
Evidence for Dopamine Theory in Schizophrenia:
- Dopamine-blocking medication reduces schizophrenic symptoms.
- Dopamine-blocking medication has side effects similar to Parkinson’s syndrome.
- Parkinson’s syndrome is caused by the lack of dopamine in a part of the brain called the basal ganglion.
- The best drugs in the treatment of schizophrenia resemble dopamine and completely block dopamine receptors.
- High doses of amphetamines trigger schizophrenic symptoms – such as those in the “amphetamine psychosis” disorder.Amphetamine psychosis is a model for schizophrenia because medication that blocks amphetamine psychosis also reduces the symptoms of schizophrenia. Also, amphetamines worsen the symptoms of schizophrenia.
- Children at risk of schizophrenia exhibit the same pattern of brain waves as adults with schizophrenia. This abnormal pattern of brain waves in children can be reduced by drugs that block dopamine receptors.
Evidence against dopamine theory in schizophrenia:
- Amphetamines do more than just increase dopamine levels. They also change the level for other neurotransmitters.
- Drugs that block dopamine receptors act rapidly on the receptors. However, sometimes it takes many days to change the behavior of people with schizophrenia.
- The effect of drugs that block dopamine may be indirect. They could actually influence other systems that have a greater impact on the symptoms of schizophrenia.
- New drugs for schizophrenia, such as clozapine, block receptors for both serotonin and dopamine.
Treatment in schizophrenia
Medications that treat schizophrenia are called antipsychotic medications. This type of medicine was introduced for the first time in 1950. It has proven to be a great success in treating the symptoms of schizophrenia. Different types of antipsychotics work well on various disease symptoms and do not add dependency. The medicine is not a remedy for the disease but to reduce the
Possible side effects of antipsychotic medicines
1. Parkinson’s disease – as symptoms – tremor, muscle rigidity, loss of facial expressio
2. Dystonia – the contraction of the muscles
3. Do not worry
4. Tardive dyskinesia – involuntary gestures, abnormal movements of the face, mouth and / or body. These include licking the lips and the chewing movement. Approximately 25-40% of patients taking antipsychotic medication for several years develop these side effects.
5. Weight gain
6. Skin problems
Often antipsychotic medication does not reduce all the symptoms of schizophrenia. Also, since schizophrenic sufferers may become ill when they have to develop professional skills and careers, they may not have the ability to become useful members of society.
Therefore, psychological therapy, family and occupational
therapy can be used in conjunction with antipsychotic medication to help these people return to the community.
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