The Pathophysiology Of Schizophrenia In Patients

Schizophrenia can be seen as a severe and chronic brain disorder that impacts how a person functions in the world. Individuals with schizophrenia may experience positive or psychotic symptoms like hallucinations or negative symptoms like social withdrawal, cognitive deficits, or loss of motivation. These symptoms may affect interpersonal relationships and can be challenging to manage without help from a mental health professional. 

To manage schizophrenia symptoms, it may be useful to understand the pathophysiology of schizophrenia—in other words, how the disease develops. Several risk factors may lead to the development of schizophrenia, including genetic factors, abnormalities related to brain development, and changes in neurotransmitters. In addition to the biological risk factors, environmental factors may also play a role in the development of schizophrenia. A person may be diagnosed with schizophrenia when they meet the required symptoms as outlined by the Diagnostic and Statistical Manual, 5th Edition (DSM-5).

Pathophysiology of schizophrenia

Epigenetic factors and developing schizophrenia

In addition to genetic factors, it is also possible that epigenetic factors play a role in the development of schizophrenia in some individuals. Epigenetics generally refers to changes in gene expression rather than changes in the genetic code itself. Studies have shown that changes in various genetic loci and expressions may be present in individuals with schizophrenia, but more research may be needed in this area. 

Neurodevelopmental factors that contribute to schizophrenia

In addition to genetic factors, neurodevelopmental factors may contribute to schizophrenia. Older research shows that schizophrenia may be linked to other neurodevelopmental disorders that can impact cognitive impairment, such as attention-deficit/hyperactivity disorder, intellectual disabilities, and autism spectrum disorder. This connection is thought to demonstrate that these mental disorders may exist on a spectrum linked by neurodevelopmental factors. 

Development of psychosis during prenatal and perinatal stages

Neurodevelopmental factors connected to cognitive dysfunction may begin during prenatal and perinatal stages. During these stages, maternal infections, such as influenza, may lead to a higher rate of schizophrenia in children as they become adults. These infections can cause changes in cytokine-related inflammation, which may be attributed to inducing schizophrenia-like behaviors in adolescents and young adults. 

Neuroimaging techniques have begun to uncover more in terms of how neurodevelopmental factors may cause psychotic disorders, including schizophrenia. Brain imaging studies have shown links between delayed maturation of connections in the nervous system and brain and schizophrenia, although updated evidence may be necessary. Additional studies and research into the neurodevelopmental factors may lay the groundwork for preventing schizophrenia in some people. 

Neurotransmitter abnormalities affect the symptoms of schizophrenia

Neurotransmitters can be defined as chemicals that signal various functions to happen within the human body. These chemicals typically serve as messengers, sending information from one cell to another, and they allow different parts of the body to communicate. Some neurotransmitters include acetylcholine, glutamate, GABA, glycine, dopamine, norepinephrine, and serotonin. 

It is believed that abnormalities in some neurotransmitters and their production levels may impact schizophrenia symptoms. Two neurotransmitters that have potential links to schizophrenia are dopamine and glutamate. 

Dopamine hypothesis and positive symptoms

The dopamine hypothesis usually refers to the belief that individuals with schizophrenia may experience abnormal production of the neurotransmitter dopamine in various brain regions, including the prefrontal cortex. Studies have shown that positive schizophrenia symptoms, such as hallucinations and delusions, may be linked to the excess production of dopamine in the brain.

Dopamine hypothesis and pathophysiology of schizophrenia

In addition to excess dopamine, individuals with schizophrenia may also have a higher density of dopamine receptors, meaning that they may be more sensitive to changes in dopamine levels. 

Although the dopamine hypothesis may be influential in understanding the neurobiology of schizophrenia, dopamine dysfunction may be just one of many factors contributing to the complex pathophysiology of the disorder. Other neurotransmitters, as well as environmental and structural components, may also play a role in the development of schizophrenia. 

Glutamate hypothesis and negative symptoms

Another neurotransmitter that may play a role in the development of schizophrenia is glutamate. The glutamate hypothesis generally refers to the idea that glutamate levels could be higher in individuals with schizophrenia due to various interactions and receptor blockers. The increase in glutamate could serve to over-excite or overstimulate nerve cells and may be associated with negative symptoms of schizophrenia, such as social withdrawal and lack of motivation.

As a widely varied disorder, the glutamate hypothesis may hold for some individuals with schizophrenia, but not for others. 

Structural and functional brain abnormalities of patients with schizophrenia

Using advanced imaging techniques, scientists have discovered that several structural brain abnormalities may contribute to the development of schizophrenia. The root of these abnormalities may lie in neural connectivity disruption that can be caused by environmental or genetic risk factors during prenatal or adolescent stages. These changes or abnormalities may lead to structural changes in the cortical or other brain regions in people with schizophrenia. 

New advancements in functional neuroimaging technology have also revealed changes in gray and white matter in individuals with schizophrenia. These changes may lead to abnormalities in cognitive functioning and could impact memory, focus, and motivation. 

In some individuals, these changes in brain activity can continue throughout the progression of schizophrenia. Managing schizophrenia symptoms may start by continuing to understand how the disorder impacts the brain. This can help professionals identify the disorder sooner and begin treatment before symptoms progress and intensify. 

Environmental factors that contribute to psychosis

While genetic and structural factors likely play a role in the development of schizophrenia, environmental factors may also impact how the disorder develops. Environmental factors that may impact schizophrenia can include the following: 

• Pregnancy and birth complications: Complications during pregnancy, such as hypoxia, influenza, premature birth, and malnutrition, may increase the chance of developing schizophrenia later in life. 
• Stress: Anxiety and related stress may cause an increase in schizophrenia symptoms, such as psychosis. Older studies report that approximately 46% of individuals with a schizophrenia diagnosis experienced a stressful life event within three months of receiving their diagnosis. 
• Substance use disorder: The use of some substances may trigger schizophrenia symptoms. For example, stimulants like cocaine and methamphetamine may induce psychosis in some individuals. 
• Childhood trauma: Trauma during childhood, such as abuse, neglect, bullying, and other traumatic events, may play a role in the development of positive schizophrenia symptoms as an adult.
• Growing up in an urban setting: There may be an association between city living and schizophrenia, and studies show that moving from a rural environment to a city environment may substantially increase the risk of developing schizophrenia. It is unclear as to the exact mechanism for the increased rate of schizophrenia in urban areas. However, it has been hypothesized that social adversity, increased substance use, and discrimination may play a role. 

As with other factors related to the pathophysiology of schizophrenia, environmental factors may be only one piece of the puzzle. With this in mind, it may be beneficial to view treating and managing schizophrenia with a holistic approach.

If you or a loved one are witnessing or experiencing any form of abuse, please know that help is available. You can call the National Domestic Violence Hotline anytime at 1-800-799-SAFE (7233).

Treatment for managing schizophrenia and related mental illness

The management of schizophrenia can be multifaceted and may require cooperation from a full team of medical and mental health professionals. In many cases, medication in the form of antipsychotics may be used in conjunction with cognitive behavioral therapy (CBT) sessions to manage symptoms and improve daily function. Always speak to your doctor before starting, stopping, or changing the way you take any form of medication.

Cognitive behavioral therapy as treatment for navigating mental illness

Online cognitive behavioral therapy techniques may be effective at treating symptoms of schizophrenia. A therapist may use a variety of techniques in an online setting to identify and manage symptoms and to provide individuals with tools and resources to manage schizophrenia. However, those experiencing acute positive or psychotic symptoms may need to seek care in person.

For individuals with schizophrenia, finding a local therapist who can meet their needs can be challenging. Online therapy generally enables individuals to choose therapists who meet their needs, even if they are not located nearby. This added flexibility can help to ensure that the client and therapist are a good fit for a long-term therapeutic relationship.