Nonspecific Concept of Madness to Mental Illness - Schizophrenia

In honor of suicide awareness month, we are dedicating September to discussing mental illnesses. Our first topic is schizophrenia, a disorder that affects thousands of people worldwide. Please check out the donation links and volunteer websites at the end of this article to help fund research for schizophrenia treatments/cures!

Schizophrenia is a mental disorder that affects more than 200,000 Americans every year. Because of the impact the disease has on the prefrontal and medial temporal lobe regions of our brain, the way people think and behave is altered, which can cause the individual to suffer from psychosis, delusions, hallucinations, disorganized speech, trouble with thinking, and amnesia. While the disease was officially identified as a mental illness by German Doctor Emile Kraepelin only in 1887, most researchers agree that schizophrenia has accompanied humankind throughout its history. Prior to its identification, symptoms of schizophrenia were regarded as results of the nonspecific concept of madness and the possession of the body by an evil spirit. Thus, early patients were often treated through exorcisms, lobotomies, innocuous treatments, and in some extreme cases, the drilling of holes in the individual’s skull. The years-old idea of schizophrenia being a nonspecific concept of madness has contributed to the misconceptions and myths that unfortunately still surround this disease. However, in the past two decades, the production of scientific evidence proving schizophrenia is a biological disease has increased greatly.

In fact, recent research has indicated low levels of SV2A (the human synaptic vesicle glycoprotein 2A), a protein that is expressed in neurons and involved in the regulation of neurotransmitter release, in the front regions of the brain in schizophrenia patients when compared to healthy subjects (Howes ‘14). This study comes after years of the scientific community believing that the disease may be caused by dysfunctional synapses (the place where nerve signals are transmitted). The scientists who conducted this research assert that their findings could be used to develop new treatments for schizophrenia that involve using SV2A as a target protein. Like this study, others have developed new ways to detect psychosis using the neuromelanin-sensitive magnetic resonance imaging (NM-MRI), found specific risk genes for the disease, and identified similarities between risk genes in autism, schizophrenia, and bipolar disorder. Created within dopamine neurons in the brain, neuromelanin is a dark pigment that acts as a marker for the neurotransmitter. The novel MRI’s signal proved to be a dopamine marker in this study and because one hypothesized cause for schizophrenia is disrupted levels of dopamine, this tool could help professionals easily diagnose the disorder.

With increased funding for research relating to this chronic mental disorder, novel therapies and treatments could be developed in the near future. Until then, individuals diagnosed with this disease have no choice but to live with their symptoms for the duration of their lifetime.

Figure 1 (from E. Onwordi at MRC London Institute of Medical Sciences). PET scan that shows healthy subjects had higher synaptic marker (SV2A) levels than subjects with schizophrenia.

All patients generally go through three stages of symptoms:

Positive Symptoms: These symptoms are abnormally present and include hallucinations (such as hearing voices or seeing things), paranoia, and altered perceptions, behaviors, and beliefs.

Negative Symptoms: These symptoms are abnormally absent and include the individual’s loss or decrease in their ability to speak, plan, find pleasure, or express emotion.

Disorganized Symptoms: These symptoms include disordered speech and thinking, abnormal movements, and interferences with logical thinking.

Generally, the severity of symptoms decreases as one’s age increases with the help of medications. While professionals encourage early diagnosis for most diseases, symptoms for schizophrenia need to persist for at least 6 months for psychiatrists to make an accurate diagnosis. This is why the development of the neuromelanin-sensitive MRI is crucial; it helps detect psychosis, a common symptom, early on.

Here is a list of the most common symptoms of schizophrenia and their definitions:

Hallucinations: the experience of seeing, hearing tasting, or feeling things that are not reality. For schizophrenia patients, these experiences are as vivid and clear as normal perceptions. Auditory hallucinations are the most common in this disease.

Psychosis: a set of symptoms characterized by a loss of touch with reality as a result of alterations to the brain’s ability to process information. When one experiences a psychotic episode, their thoughts and perceptions are impacted.

Delusions: fixed (false) beliefs that are held true despite evidence proving that it is not. Paranoid delusions, where a person is under the impression that a person or a group of people is harassing them. This is most common in schizophrenia patients.

Disorganized thinking and speech: when thoughts and speech are jumbled and usually do not make sense. This symptom may lead to substantial problems with normal communication.

Disorganized or abnormal behavior: movements range from childlike behavior to unpredictable fidgets. When this symptom becomes severe, it can lead to disruptions in daily activities. Symptoms also include catatonia, which is when the person behaves as if in a daze, unaware of their movements.

As mentioned previously, there is no cure for schizophrenia but medications are critical for alleviating symptoms. Like most mental illnesses, going to therapy and support groups can improve living conditions for patients. When it comes to schizophrenia, however, symptoms must be made less severe by the regular intake of antipsychotic/anti-tremor medication. Antipsychotic drugs improve symptoms by changing the intake of the neurotransmitter, dopamine. Only after severe symptoms of hallucinations and psychosis are decreased can patients start attending therapy and psychosocial support groups that can help build social skills and hold a job.

The following types of therapy are the most efficient in assisting schizophrenia patients:

Support groups

Rehabilitation

Cognitive therapy

Psychoeducation

Family/behavior therapy

Now, we come to arguably the most important question - what exactly causes schizophrenia?

If scientists knew the definitive answer to this question, they would have developed a cure for it by now. But, as with most diseases, we haven’t been lucky enough yet. However, there is a list of possible causes produced by a large variety of research. These possible causes can be organized into 2 main categories: Genetic and Environmental.

Genetic

As discussed earlier, autism, bipolar disorder, and schizophrenia have multiple risk genes/mutations in common. One of these mutations includes the microdeletions of chromosome 22 in a region called 22q11. However, previous research indicates that the disease is not completely caused by genetic abnormalities.

Figure 2 (from the Scientist). This figure shows a high correlation between the relatedness between family members and schizophrenia; individuals with 3rd-degree relatives diagnosed with schizophrenia were twice as likely to get schizophrenia than individuals in the general population and individuals with 2nd-degree relatives with schizophrenia had a multiple-fold increase in the incidence of schizophrenia than the general population. However, there is a less than 50% correlation between schizophrenia and identical twins, which implies that the disease is not completely caused by genetic factors.

Environmental

Some environmental risk factors could facilitate disease development even before birth; when the father is of advanced age and/or the mother is malnourished or had infections, such as coxsackie B meningitis, during pregnancy, the risk for developing the disease is significantly increased. Traumatic experiences and life stressors, such as the loss of a parent, bullying, witnessing domestic violence, neglect, or going through abuse are also risk factors. Research indicates that individuals from minority groups who face discrimination are more at risk for developing schizophrenia when there are fewer members of the ethnic group in the neighborhood. Addiction, which we will discuss in the coming weeks, to drugs such as marijuana, amphetamines, and hallucinogens are often associated with individuals who develop symptoms of this disorder.

The bottom line of both categories of factors is that they lead to biological alterations in the brain. Most research finds that people with schizophrenia have abnormalities in dopamine levels (possibly caused by trauma, drug use, and/or genetic factors) and lower brain matter in some regions.

Schizophrenia is a highly intriguing mental disorder that is still surrounded by misconceptions influenced by beliefs of the past. We hope that by writing these articles, we bring awareness to what people diagnosed with this disorder actually go through and pique your interest in furthering research in this field. If you would like to get involved/donate to organizations that give their funds to research groups dedicated to finding a cure for schizophrenia, please refer to the links below!

Donations:

Brain and Behavior Research Foundation (BBR) https://www.bbrfoundation.org/research/schizophrenia

National Alliance on Mental Illness (NAMI)

https://www.nami.org/About-NAMI/Donate-to-NAMI

Schizophrenia International Research Society (SIRS)

https://schizophreniaresearchsociety.org/about-us/donate/

Schizophrenia and Related Diseases Foundation (SARDAA)

https://sardaa.org/donate/

Volunteers of America’s Behavioral Health Services

https://www.voa.org/mental-health

Volunteer:

Schizophrenia and Related Diseases Foundation (SARDAA)