Schizophrenia: What Really Goes On Inside That Head
By Bob Singer, BS, NHA, PCHA
Schizophrenia is a mental illness that affects approximately one out of
one hundred or one percent of adult individuals worldwide. Schizophrenia
has been proven to be a physiological condition that affects the brain
of those individuals inflicted. This paper will introduce this problem,
discuss its symptoms and physiology, present some more popular theories
about its causation, and then discuss some more common treatments.
Schizophrenia is a psychiatric disorder characterized by periods of psychosis.
It is “psychiatric” because it affects the brain in a physiologic manner.
The psychosis is when an individual seems to experience things that are
not real or loses touch with reality. These experiences may be in combination
with the real world or totally independent of the real world. Symptoms
may include delusions, hallucinations, disorganized thinking, and bizarre
thoughts. The word “Schizophrenia” was introduced in 1911 by a Swiss psychiatrist
named Bleuler. Schizophrenia is frequently combined with Depression. When
this occurs it is referred to as Schizoaffective disorder. For everyone
inflicted with this disease, three or more relatives and close friends
may also experience the disruption of their lifestyles. Schizophrenia usually
develops in young adults sixteen to twenty-five years of age. Rarely does
it begin after age thirty-five. However in some situations it may not be
diagnosed until later years. This disease does affect men and women equally,
but usually shows up in men earlier in years and women later in years.
SYMPTOMS AND PHYSIOLOGY
Common symptoms for those diagnosed with Schizophrenia can include one
or more of the following: Talking to themselves as if talking to another
person, who is not there;
Believing in the ideal that others are plotting against them in some way
or following them, much like a paranoia;
Believing that their thoughts are being interfered with or that they can
influence another’s thoughts;
They may talk about or write things that does not make sense;
They may feel that they are famous people or associated with famous people;
They sometimes withdraw completely from family and friends.
Thoughts, feelings, and actions are all transmitted in the Central Nervous
System as electrochemical impulses. These impulses reach the ends of presynaptic
neurons. Neurotransmitter chemicals are released that cross the synaptic
cleft and bind to specific receptor sites onto postsynaptic neurons. The
binding action triggers electrical changes. These changes either inhibit
or continue the conduction of that impulse. After the neurotransmitter’s
function has been completed, messages are either inactivated or stored
for some future use, called an uptake. Alterations or decrease of neurotransmitters
at postsynaptic receptors is associated with the many different forms of
neuropathologic conditions.
Major categories of neurotransmitters are cholinergics, monoamines, and
neuropeptides. Each type of neurotransmitter is associated with the conduction
of impulses in different areas of the Central Nervous System. Serotonim
is a monoamine transmitter that innervates receptors in the pons, medulla,
thalamus, and limbic system. A decrease in serotonim levels is connected
with clinical depression. Another example is the amino acid inhibitory
transmitter, a type of GABA. GABA innervates receptors in the hypothalamus,
cortex, cerebellum, basil ganglia, and hippocampus. Decrease in GABA availability
is associated with anxiety disorders and Schizophrenia.
Researchers at the University Of Pennsylvania have determined through their
research that there are three major types of Schizophrenia categories.
These are mildly impaired for which they label as the Cortical Group, heavily
impaired for which they label as the Subcortical Group, and the Relatively
Unimpaired Group. On MRI and PET scans of the brain, patients in the Cortical
Group suffer from smaller than normal temporal lobes and relatively low
metabolic rates in those same temporal lobes. These patients suffer mild
memory problems and disorganized thoughts. On MRI and PET scans of the
brain, patients in the Subcortical Group suffer from enlarged ventricles
and some reductions in frontal lobe gray matter. These individuals showed
no evidence of temporal lobe problems. These patients were considered to
have suffered the greatest degree of Psychiatric impairment. These individuals
suffered from delusions and more negative types of symptoms such as Apathy
and lack of enjoyment from life. The third group of Relatively Unimpaired
Individuals revealed the beginning stages of either Cortical or Subcortical
events with structural abnormalities as mentioned previously. These individuals
just were not showing signs yet.
THEORIES OF ORIGIN
One theory or hypothesis is that growth factors in a special brain cell
called the glia are altered by genes and sometimes further weakened by
viruses that may develop during a mother’s pregnancy. These glia are important
in the connectivity between brain cells as children grow into adulthood.
They maintain a maintenance function during adulthood through old age.
Some believe that viruses may lay dormant for twenty to thirty years and
then are activated by body changes as individuals go from adolescence to
young adulthood. The breakdown of connections between brain cells eventually
leads to Schizophrenia and some of the conditions mentioned earlier in
the Physiology section of this paper.
In 2001, Debby Tsuang, MD and Associates did a study that revealed Chromosomes
13 and 15 in European Americans were connected with Schizophrenia. They
did a study on one hundred sixty-six families with two to six Schizophrenics
in each family looking at heredity factors. They found that those same
genes in African American families did not cause the same conditions as
European Americans leading to a conclusion that these genes can cause different
results depending on Ethnic background.
In November of 2001, WebMD Health reported on a study of 3000 women from
Rhode Island that gave birth between 1959 and 1966. From the study, twenty-seven
of those otherwise healthy babies eventually developed Schizophrenia. Many
of these babies were born to women who had genital herpes. Other conditions
for these women were compatible including education levels, smoking habits,
dietary habits, prenatal care, and giving birth during the same seasons
of the year. This study showed that the genital herpes virus may have played
a role in the later development of Schizophrenia.
The October 2001 issue of the British Journal of Psychiatry reported on
a study of one hundred adult men and women born in Nottingham County in
England compared with another group of one hundred individuals also born
in that same county, but of a different social class. In this study, researchers
found that those raised in poorer socioeconomic areas and where fathers
had more menial jobs were twice as likely to develop Schizophrenia than
those of more affluent classes. This then suggests that environmental impacts
such as childhood deprivation may also lead to adult mental disorders because
of more likely exposure to long lasting viruses, toxins, and stress normally
associated with those poorer living conditions.
Medical scientists do know that too much Dopamine in the synapses of the
nerve cells of the brain and the D2 receptors are the most common implications
leading to Schizophrenia. The work of viruses in utero that lay dormant
for twenty years appears to be a leading suspect from a physiological point
of view with some of the theories mentioned working as contributing factors.
When combined with diagnosis of Depression, low serotonin levels have been
found in those individual’s brains. Exercise is known to increase endorphins,
which increase serotonin. So exercise can be used to aid as part of treatment
programs. Scientists also know that families with Schizophrenia are more
likely to produce children with Schizophrenia than those with no other
prior history. Studies have revealed that as the disease progresses, brains
of Schizophrenics do actually tend to lose mass. Spaces in the ventricles
tend to become enlarged making normal daily functioning more difficult.
Cognitive techniques have been proven to slow down this process, but cannot
reverse the process once begun.
SOME COMMON TREATMENTS
Common medication categories for treatment of Schizophrenia include anxiolytics,
sedative-hypnotics, antidepressants, and antipsychotics. Some common medications
include Haldol, Risperidane, Seroquel, Zyprexa, and Clozaril. These medications
target specific symptoms. Olanzapine, Clozapine, and Quetiapine are used
to target a wider range of symptoms. Antipsychotic drugs are used in general
to help lower dopamine levels in the brain. Neurontin and Welbutrin are
used to alleviate symptoms of Depression. Ativan is used to ease anxieties.
Dosages for drug therapies start low then build-up gradually under supervision
until symptoms are relieved at the lowest possible dosage. Side effects
of these medications may include parkinsonism or akathisia such as a restlessness
of the legs and body; acute dystonia or tardive dyskinesia such as involuntary
movements of tongue, face, fingers, hands, legs, and trunk. Cogentin, for
example, would be taken to prevent side effects from Haldol. Only as little
as five percent of all Schizophrenics ever get cured in that they never
experience another episode of symptoms.
PET Scans and MRIs can be used to review damage to the actual brain and
monitor physiologic progression of the disease. Polypharmacology in combination
with psychotherapy is the preferred treatment over psychotherapy alone.
Drug treatment is not considered a cure, but more of an aid for Schizophrenics
to cope better. These medicines help to relieve the symptoms. Psychotherapy
helps to teach individuals about their disease and how to best handle specific
episodes.
Random controlled studies have determined that social skills training can
improve social competence. Supported employment programs result in higher
competitive employment rates. Cognitive behavior therapy may reduce delusions
and hallucinations in medication resistant patients and compliment pharmacotherapy
in acute psychosis. Family therapy works for frequent relapsers in family
settings. Assertrive community treatment programs help for patients with
high rates of service.
REFERENCES
Burling, S. (2002). Schizophrenia may be many ailments. Philadelphia Inquirer, October 24. Retrieved 11/02/02 from mailto:infoweb@newsbank.com infoweb@newsbank.com. Bustillo, J.R., Lauriello, J., Horan, W.P., & Keith, S.J. (2001). The psychosocial treatment of schizophrenia: An update. The American Journal of Psychiatry, 158; 163-175. Retrieved 10/25/02 from http://ajppsychiatryonline.org . Bustillo, J.R., Lauriello, J., Horan, W.P., & Landeen, J. (2001). Review: Social skills training, supported employment programs, and cognitive behavior therapy improves some outcomes in schizophrenia. EBN Online. Retrieved 10/25/02 from http://ebn.bmjjournals.com . Hochman, G. (2002). When your mother is crazy. Philadelphia Inquirer, September 11. Retrieved 11/02/02 from HYPERLINK mailto:infoweb@newsbank.com infoweb@newsbank.com. Maltin, L.J. (2001). Genital Herpes in mom linked to schizophrenia in baby. WebMD Health. Retrieved 09/28/02 from http://mywebmd.com. Maltin, L.J. (2001). Schizophrenia linked to childhood poverty. WebMD Health. Retrieved 09/28/02 from http://mywebmd.com. McCuistion, L.E. & Gutierrez, K.J. (2002). Psychotherapeutic Agents. In Pharmacology (2, pp.107-111). Philadelphia: W.B. Saunders Company. McGrath, J. (1999). Treatment of schizophrenia. British Medical Journal, October 16. Retrieved 10/25/02 from http://www.findarticles.com . N. A. (2002). Schizophrenia. Retrieved 10/25/02 from http://ajppsychiatryonline.org . N. A. (2002). Schizophrenia and Bipolar disorder. Brighter Beginnings In Mental Health. Retrieved 09/25/02 from http://www.brighterbeginnings.com. NewsEdge Staff. (2002). Schizophrenia – cause may be interaction of genes and viruses in glia cells. Psychiatry 24X7.Com. Retrieved 09/28/02 from http://www.psychiatry24x7.com/news/. Smith, M. (2001). Study fingers schizophrenia genes. WebMD Health. Retrieved 09/28/02 from http://mywebmd.com. The Schizophrenia Fellowship of South Australia, Inc. Staff. (2002). The Schizophrenia Fellowship of South Australia, Inc. is here to help people with schizophrenia and their families. Retrieved 10/25/02 from http://www.span.com.au/schizophrenia/. WebMD Staff. (2002). WebMD chat transcript: Talking about Schizophrenia with Judy Kendall, RN, PhD. WebMD Health. Retrieved 09/28/02 from http://mywebmd.com.
© By Bob Singer 11/2002, BS, NHA, PCHA, Author.