Some people have a tough character and have trouble establishing close relationships with other people. However, sometimes the inability to relate to the environment and others is linked to managing emotions and making decisions. There may be hallucinations or even a complete lack of emotions. In this case, it may be a symptom of a serious mental illness. Schizophrenia, because that's what we are talking about, affects the personal way of thinking, feeling, and behaving. How do you recognize it?
Image credit: Magdalena Osial
Important note: The following article aims to introduce and explain some concepts related to schizophrenia. It should NOT be treated as a diagnosis nor a treatment plan. In case you think you might be affected by depression, immediately contact your doctor!
What is schizophrenia?
You have probably come across the situation either in movies, books, or daily life moments when you heard about people who can hear or see things that do not exist. If a person is not under the influence of any substances, nor is it not a result of sleepless nights, the symptoms experienced by this person are one of the most commonly occurring symptoms in schizophrenia [1].
Schizophrenia is a very serious mental illness, which can be defined as continuous or episodic psychosis (a state of mind in which, due to distortions in the perception of reality, and sometimes also disturbances in consciousness, a person has difficulty distinguishing what is real and what is not) [2]. During psychosis, people can experience positive or negative symptoms.
Symptoms expand the reality we perceive by adding non-existent images, sounds. To most common positive symptoms belong hallucinations, delusions, and disorganized thinking. The first one is connected with seeing things, which do not exist. The second one believes in something or someone that does not exist; for example, my son is dead, but I believe he is still alive. The last one manifested as disturbances in communication such as fast or slow speech, uttering meaningless content, or jumping from topic to topic. In turn, negative symptoms describe symptoms associated with the loss of joy and the ability to live. People typically have a lack of motivation, presenting no interest in the surrounding world, and lack of emotions.
As you see, schizophrenia is a very serious and complicated to treat the condition, which often has serious consequences. The suicide rate within schizophrenic people is very high, and despite the effort, this disease remains untreatable. Same as with the cure, the reason behind schizophrenia is still under investigation. Schizophrenia likely develops by a combination of genetic and environmental factors. Let's look at how the schizophrenic mind works and the possible reason behind it.
How does schizophrenia affect the human brain?
Schizophrenia is associated with changes in brain structures [3]. It causes changes not only in the cerebral cortex but also in the connections between various brain parts. As is known, the brain consists of gray matter (its density is responsible for a variety of skills, including academic and musical efficiency) and white matter (which creates structural connections between brain regions).
Schizophrenia causes a decrease in the volume of the gray matter and impaired integrity of the white matter. The fluid-filled spaces inside the temporal lobes are often enlarged while the temporal lobe tissue is reduced. The greater the abnormalities, the stronger the auditory hallucinations and the disorder of logical thinking are in a person suffering from schiosophrem.
If we go deeper into the brain's structure, it is a network of neurons. A current impulse transmits information between neurons through molecules called neurotransmitters. In our brain are many types of neurons responsible for different processes in the whole body. Each of them has different neurotransmitters. Schizophrenia causes changes in the structure of neurons responsible for releasing the neurotransmitter dopamine [4]. Dopamine is reliable for our energy, well-being, and motivation to action. Too much dopamine can lead to psychosis.
Schizophrenia Spectrum
Schizophrenia is a complex disease that has many varieties, such as paranoid schizophrenia, hebephrenic schizophrenia, catatonic schizophrenia, residual schizophrenia, simple schizophrenia, cenesthopathic schizophrenia, and unspecified schizophrenia [5]. You can see for yourself what a wealth of forms. First one is probably the most common one that manifests itself with delusions and hallucinations. It can even take paranoid forms, such as tracking an individual through a UFO or throwing dust through a window by a neighbor.
This type of mental illness is often the protagonist of movies and series. The second is associated with the disorganization of behavior and thoughts. A person may also rub against short-term delusions and hallucinations. Speech disorders appear frequently. There may also be a lack of emotion in speech. The next one is unusual and extreme movements: fast or no gesturing speech, hyperactive or very calm. It is the rarest form of this mental illness.
Residual schizophrenia is the residual form of this disease. You only have negative symptoms of schizophrenia, including slow movement, poor memory, lack of concentration, and poor hygiene, while simple schizophrenia links these negative symptoms with rare positive symptoms like hallucinations, delusions, or disorganized thinking. Cenesthopathic schizophrenia are mainly bodily symptoms. Unspecified schizophrenia is schizophrenia and does not fall into any of the above groups.
How to diagnose schizophrenia?
A doctor can diagnose schizophrenia through observation for at least six months. He will look for both negative and positive symptoms. The doctor considers whether the symptoms were caused by alcohol or drugs. He is interviewing the family. Your doctor will also evaluate to rule out these other mental health conditions. Only then does he make a diagnosis. Schizophrenia cannot be cured; it can be alleviated pharmacologically. To enable those affected to live in some sense normally.
Summary
Schizophrenia is a serious mental disorder. It can develop very slowly, and sometimes it appears suddenly and without warning. Its first symptoms usually start between ages 16 and 30 and may be difficult to diagnose. The reasons for its appearance are still not a secret. Genetic factors are involved (it can occur when the body undergoes hormonal and physical changes, such as the maturation process), chemical factors (inappropriate dopamine levels), and environmental factors (viral infections and immune disorders). Even problems with the development of connections and pathways in the brain in the womb can cause it. However, no one is entirely sure where it comes from.
This article is a joint work of Agnieszka Pregowska (Institute of Fundamental Technological Research, Polish Academy of Sciences) and Ewa Klejman (Faculty of Chemistry, University of Warsaw) as a part of the Science Embassy project. Image Credit: Magdalena Osial
REFERENCES
[1] Legge, S., Santoro, M., Periyasamy, S., Okewole, A., Arsalan, A., & Kowalec, K. (2021). Genetic architecture of schizophrenia: A review of major advancements. Psychological Medicine, 1-10. DOI:10.1017/S0033291720005334
[2] Cowan, H. R., Mittal, V. A., McAdams, D. P. (2021). Narrative identity in the psychosis spectrum: A systematic review and developmental model, Clinical Psychology Review, 88, 102067. DOI: 10.1016/j.cpr.2021.102067.
[3] Karlsgodt, K. H., Sun, D., Cannon, T. D. (2010). Structural and Functional Brain Abnormalities in Schizophrenia. Curr. Dir. Psychol. Sci. 19(4), 226-231. DOI:10.1177/0963721410377601
[4] Iritani, S. (2013) What happens in the brain of schizophrenia patients?: an investigation from the viewpoint of neuropathology. Nagoya J. Med. Sci. 75(1-2), 11-28.
[5] Feinstein, A., Goldberg, T. E., Nowlin, B., Weinberger, D. R. (1998). Types and characteristics of remote memory impairment in schizophrenia. Schizophrenia Research 30 (2), 155-163. DOI: 10.1016/S0920-9964(97)00129-1