Schizophrenia Pathophysiology: Understanding The Unknown
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.
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.
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.
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.
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
What is the pathophysiology of schizophrenia?
There is still a lot about the pathophysiological mechanisms that experts don’t know about schizophrenia, and while researchers have identified multiple changes in the brains of people with this serious mental illness, no present model can explain all of the changes that have been observed.
One factor that may contribute to schizophrenia is neurotransmitter abnormalities. Specifically, serotonin, glutamate, dopamine, and gamma-aminobutyric acid (GABA) are believed to play a role. For example, excessive dopamine in certain parts of the brain, like the basal ganglia, is thought to contribute to the positive psychotic symptoms of schizophrenia, and reduced dopamine levels may contribute to negative symptoms and severe cognitive impairments. Other evidence suggests that glutamine and glutamate receptors may contribute to the symptoms of schizophrenia patients, though more research is needed.
Another possible contributing factor to schizophrenia may be abnormalities in brain structure and function. For example, people with schizophrenia may have structural brain abnormalities that include a reduction and gray matter, predominantly in the frontal and temporal lobes, which control higher-level cognitive function and memory formation.
What is the pathophysiologic basis of schizophrenia?
Researchers do not completely understand the pathophysiologic basis of schizophrenia, but they believe it results from a complex interplay of multiple factors. One of the earliest theories, the neurodevelopmental hypothesis, proposed that this condition may begin as a result of childhood trauma and a disturbed development of the nervous system in childhood.
More recently, studies using diffusion tensor imaging of the brain have supported the theory that schizophrenia may result, in part, from disrupted connectivity. Other studies have identified structural abnormalities in the left amygdala that may be associated with negative symptoms of schizophrenia and that there are often functional, structural, and metabolic abnormalities in the frontal lobe.
Studies have also determined that altered inhibitory neurons in the central nervous system may cause the cognitive impairment seen in schizophrenia.
Genetics may also be a significant factor, and genome-wide association studies are being used to identify the disease's genetic architecture, which may lead to personalized medication.
What physiologically causes schizophrenia?
Experts don’t know the exact cause of schizophrenia, but they believe that it may be a combination of multiple factors, which are detailed above.
How does schizophrenia start off?
Serious mental health conditions like schizophrenia, schizophrenia spectrum disorders (for example, schizotypal personality disorder or schizoaffective disorder), and depressive or bipolar disorder rarely appear out of the blue.
According to the American Psychiatric Association, early symptoms of a mental health condition may include sleep or appetite changes, mood changes, social withdrawal, problem thinking, decrease in functioning, apathy, or other abnormal behavior.
These symptoms cannot predict psychiatric disorders, but they may indicate the need for further investigation, particularly for someone who has genetic factors that put them at risk for schizophrenia or other conditions.
It can be beneficial to remember that only a qualified mental health professional can distinguish between schizophrenia disorders and other psychotic disorders, like major depressive disorder or bipolar disorder, and give a clinical diagnosis. Some symptoms of schizophrenia may resemble some neurodevelopmental disorders like autism spectrum disorder, especially in cases with early onset.
Trained professionals use specific diagnostic criteria to determine if symptoms fit schizophrenia compared to other conditions to ensure the person gets the support and treatment they need.
In schizophrenia, doctors use various screening tools to assess symptoms and evaluate the effectiveness of treatment. For example, the Positive and Negative Syndrome Scale allows practitioners to determine baseline functioning and how a patient’s symptoms evolve over time. It may also be used in a randomized clinical trial or randomized controlled trial to assess patient symptoms and response to treatment.
What goes on in the mind of someone with schizophrenia?
It can be challenging to tell what goes on in the mind of someone with schizophrenia. A diagnosis of schizophrenia suggests many symptoms that can change how someone thinks and perceives reality, including cognitive symptoms, auditory hallucinations, and disorganized speech. They may have thoughts that jump from one topic to another or be suspicious of those around them. However, everyone with schizophrenia experiences it in their own way, and the treatment response to antipsychotic drugs and other interventions varies, so this may not be the experience of everyone with this condition.
Are people with schizophrenia self-aware?
People with schizophrenia have varying levels of self-awareness, and a significant portion can accurately estimate their cognitive skills.
Who is most prone to schizophrenia?
Having multiple risk factors can make someone more prone to schizophrenia. These include environmental factors, like certain illnesses, infections, and autoimmune diseases; challenges during fetal development and the birthing process, like preeclampsia, malnutrition, or gestational diabetes; and recreational drug use. Experts have not located a specific genetic cause, but there may be some genetic risk factors, as having a family member with schizophrenia leads to an increased risk.
Can someone with schizophrenia be high-functioning?
People with schizophrenia have varying levels of functioning. There are a range of treatment options available that can help people with this condition improve their quality of life, including medication, therapy, community programs, support groups, and training to improve occupational functioning. With treatment, many people regain some functioning over time, and about a third achieve complete remission.
That said, some of the symptoms of schizophrenia can be difficult to overcome. This condition is characterized by positive symptoms like delusions, hallucinations, and catatonic behavior; negative symptoms, like cognitive impairment and flat affect; and disorganized thinking and behavior. Antipsychotic medications and other treatments can help, but not everyone responds to treatment in the same way.
What do people with schizophrenia find hard to do?
People with schizophrenia face a number of challenges. They may have difficulty following conversations or staying focused on a task, and maintaining social relationships can be challenging. They may be suspicious and worry about the motives of the people around them, and symptoms, like hallucinations and delusions, can make it difficult to engage with other people in a social setting.
In addition to coping with and learning to manage their symptoms, many medications for this condition have various complications, including tardive dyskinesia, painful muscle contractions, and antipsychotic-induced weight gain. People with schizophrenia are also more prone to metabolic syndrome, which can cause high blood pressure, high blood sugar, and high cholesterol, and are more likely to engage in substance abuse.
Do people with schizophrenia feel love?
Yes, people with schizophrenia do feel love, but they may have a difficult time expressing and receiving love or maintaining a relationship due to paranoia, trust issues, and other challenges.
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