Schizophrenia Pathophysiology: Understanding The Unknown

Medically reviewed by Nikki Ciletti, M.Ed, LPC
Updated October 18, 2024by BetterHelp Editorial Team

In general, pathophysiology involves how diseases work, including what happens in the body that leads to an illness and how those events affect how we feel. For example, the pathophysiology of the flu might look at how the virus enters the body, how it spreads, and how the body’s immune response causes symptoms like fatigue and fever. 

The pathophysiology of schizophrenia

There’s still a lot we don’t understand about the pathophysiology of schizophrenia, a mental illness that can affect people’s thoughts and behaviors. That said, research has uncovered several possible causes, as well as differences in the brain, that may explain some of its symptoms. While we may not know everything about schizophrenia, research suggests that treatment, usually involving therapy and doctor-prescribed medication, can improve symptoms and overall quality of life.

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What is schizophrenia as a mental illness?

Schizophrenia is a complex mental illness that often emerges during young adulthood. Schizophrenia can cause changes in the way a person thinks, feels, and acts. These changes can be significant, to the point where they may make it hard to function in daily life. They can even cause a person to become disconnected from reality, a state usually referred to as “psychosis.” People with schizophrenia may experience multiple periods of psychosis throughout their lives. 

Positive symptoms and negative symptoms of schizophrenia psychosis

Types of schizophrenia symptoms

There are generally two widely recognized types of schizophrenia symptoms: “positive” and “negative.” According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person must experience at least two of these to qualify for a schizophrenia diagnosis

Positive symptoms of schizophrenia

Positive symptoms can be seen as behaviors and ways of thinking that are present in people with schizophrenia but absent in people without it. Some examples can include the following:

  • Delusions (false beliefs that can’t be changed)
  • Hallucinations 
  • Confused, scattered, or illogical thought patterns
  • Ways of speaking that don’t make sense or are hard for others to understand

Negative symptoms of schizophrenia

On the other hand, negative symptoms can be defined as thoughts and behaviors that are absent in people with schizophrenia, but present in people without it. These may include the following:

  • A lack of motivation to do daily tasks
  • A lack of pleasure 
  • A lack of desire to interact with other people
  • A lack of emotional expression

Cognitive dysfunction in the brain

Beyond positive and negative symptoms, some researchers have also pointed to a third type of symptom: cognitive dysfunction. Up to 98% of patients with schizophrenia have been estimated to experience some form of cognitive impairment. This usually means they tend to have trouble with certain mental functions, such as those listed below:

  • Planning
  • Abstract thinking
  • Reasoning
  • Memory
  • Attention
  • Visual and verbal learning
  • Problem-solving

These cognitive deficits may be one reason why people with schizophrenia often experience challenges at work and in their daily lives. 

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What we know about schizophrenia pathophysiology

Despite ongoing research, we still don’t know exactly what happens in the body and brain to make people develop schizophrenia.

Risk factors in schizophrenia pathophysiology

However, scientists have been able to pinpoint a few risk factors, including the following:

  • A low birth weight
  • Maternal health issues during pregnancy, like diabetes
  • Complications during birth
  • Maternal malnutrition during pregnancy
  • Being born in the winter
  • Growing up in an urban environment
  • Using cannabis early in life

It’s likely that a combination of genetic and environmental factors plays a role in a person developing schizophrenia, but questions may still remain. For example, what exactly happens in the brains of individuals with schizophrenia? What sets them apart from the brains of people who don’t have schizophrenia? 

Abnormal brain development in people with schizophrenia

Researchers have put forward a few hypotheses in an attempt to answer this question. Some scientists believe that abnormal brain development may be to blame. Research has found that people with schizophrenia usually have a lower brain volume in certain areas, like the dorsolateral prefrontal cortex. This is a structure at the front of the brain that typically plays a role in memory and reasoning. 

Neurobiological factors in people with schizophrenia

Other brain regions, like the temporal lobe, have also been found to frequently have a lower volume in people with schizophrenia. This is an area of the brain near the ears. The superior temporal gyrus, which is part of the temporal lobe, usually plays a role in processing sound. This area also tends to be smaller in people with schizophrenia. 

Other researchers believe that schizophrenia symptoms may be due to the chemicals in the brain, rather than the brain itself. Dopamine, a chemical that normally plays a role in motivation, pleasure, and movement, can serve as one example. Some research suggests that high levels of dopamine in the brain can cause psychotic symptoms in certain people. However, scientists still don’t have enough evidence to confirm this theory.

The unknowns in schizophrenia brain pathophysiology

Ultimately, there’s a lot we still don’t know about schizophrenia pathophysiology, including its root causes, the exact mechanisms behind its symptoms, and what can be done to prevent it. As research continues to evolve, more clues may emerge about how genetics, brain differences, and environmental factors come together to shape this mental illness. 

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Managing schizophrenia

Usually considered chronic, schizophrenia tends to affect people throughout their lives. That said, schizophrenia can often be treated for greater well-being and a higher quality of life. If you’ve recently been diagnosed, you may want to talk to your doctor about finding a treatment plan that’s right for you. They may recommend a combination of medication, lifestyle changes, and mental health support. Never start, stop, or change the way you take medication without consulting your doctor.

Therapy and support

Therapy is often a useful form of treatment. Working with a therapist can be a way to receive support, advice for managing symptoms, tools for shifting negative thought patterns, and more. 

However, schizophrenia symptoms like low motivation and a low urge to socialize may make it harder to leave the house. This can make it challenging to attend in-person therapy, but online therapy may be another option. Internet-based platforms generally enable you to talk to a licensed therapist from the comfort of your own home. This may make them an easier alternative if you’re living with schizophrenia, although individuals experiencing acute psychosis may need to seek care in person.

Benefits of online therapy for schizophrenic mental illness

Studies show that online therapy may be a useful resource for people with schizophrenia. In one 2016 study, a group of veterans living with schizophrenia and suicidal ideation received ongoing remote telehealth support. Researchers found that the internet-based program usually led to improvements in symptoms, as well as positive responses from the majority of the participants. 

If you are experiencing suicidal thoughts or urges, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988 to talk to someone over SMS. Support is available 24/7. 

Takeaway

Pathophysiology typically looks at the ways diseases affect the body and how these effects contribute to symptoms. Scientists are still trying to understand the pathophysiology of schizophrenia, a mental illness that can cause hallucinations, delusions, and changes in mood and behavior. Research has found some risk factors, like genetics and substance use, and there are several theories about what may happen in the brain to trigger these symptoms. That said, the exact causes of the disorder are still unknown. While we don’t know everything about schizophrenia, we do know that it’s often treatable. Working with your doctor and seeking mental health support through in-person or online therapy may be the first step toward improving schizophrenia symptoms and overall quality of life.
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