Attempts to identify changes in the brain in people with schizophrenia have been made since the 1920s. Such studies are aimed at finding the causes of this mental disorder, which still remain unknown. Let us tell you what scientists have already managed to find out on this issue.
The Challenge of Schizophrenia
Schizophrenic spectrum disorders are diagnosed in about one person out of a hundred. In some regions where population density is high, it is diagnosed more frequently, and in sparsely populated cities, less frequently. Often the pathology affects people aged 25-30 years. In men, the signs of schizophrenia appear earlier, and in women – 5-7 years later. But the disorder can also be detected in children, including pre-school children. In rare cases, it is detected after 50-60 years of age.
These are just a few of the patterns scientists have determined by studying mental pathologies. There is much more evidence. But they do not answer the main question – of why schizophrenia occurs. Its etiology and pathogenesis remain a mystery to doctors, which becomes an insurmountable obstacle to treating the disease.
Today doctors can only relieve the symptoms of schizophrenia, help the patient to socialize, and maintain remission for as long as possible. But it is not possible to get rid of the disorder completely. Moreover, it is so unpredictable that no doctor can give a 100% guarantee its development.
Some patients suffer from schizophrenia exacerbation only once in their life and do not manifest themselves afterward. Others, on the contrary, have attacks every few years. There are also extremely severe cases where the patient’s personality disintegrates during the disease’s 1-2 positive phases. As a result, he loses touch with reality and becomes incompetent.
“Schizophrenia” is a lifelong diagnosis. It is virtually impossible to remove it from the medical history.
Schizophrenia can also be fatal, for example, due to suicide or an accident, which is not so rare. In general, people with schizophrenia live 8-10 years shorter than others and often die of heart, vascular, and other systemic pathologies.
In other words, schizophrenia causes many problems, many of which science is not yet able to solve. Scientists believe that first, it is necessary to identify the true cause of the disease.
Then it will be possible to act not on the symptoms but directly on the source of the development of the disorder. Perhaps etiological research aimed at studying the brain of schizophrenic patients will answer some questions.
Before discussing the changes in the brain of a person with schizophrenia, we should take a moment to consider the symptoms of schizophrenia. There are many forms of courses in psychopathology. It is a polymorphic disease that can develop according to different scenarios. But, in general, all of its signs are divided into two types:
- Negative: apathy, abulia (lack of willpower), lack of motivation, suicidal moods, and other symptoms of the depressive type. Their presence is indicative of a passive mental apparatus.
- Positive (productive): delirium, compulsive actions, hallucinations, and catatonic disorders. Their occurrence indicates the activity of the psyche.
Usually, before an attack, there is an increase in negative symptoms. Then an active phase with positive signs begins. If it is possible to bring the patient into remission, delirium and hallucinations are replaced by residual negative symptoms.
In severe cases, one phase overlaps with another so that the patient is both numb and, for example, hearing voices or delirious. It usually happens in resistant schizophrenia, when the patient develops resistance to drug therapy. But often, the alternation of active and negative disease phases occurs. The first is also called an acute exacerbation or seizure.
Changes in the brain
The advent of new research methods, mainly MRI, CT and EEG, has provided quite a bit of interesting information about schizophrenia. In simple terms, scientists have been able to find out what the brain of a person with schizophrenic disorder looks like.
It turned out that almost all schizophrenics have atrophic processes in the following areas:
- Medial temporal lobes;
- The superior temporal gyrus;
- Parahippocampal Gyrus.
In addition, all patients showed enlargement of the lateral ventricle and reduction of gray matter in the prefrontal cortex, temporal lobes, and anterior cingulate gyrus.
This information allows to explain some symptoms of schizophrenia. For example, damage to the hippocampus, which is responsible for short-term memory and spatio-temporal orientation, accounts for the development of dementia in schizophrenia. Disorders in the prefrontal cortex affect cognitive functions, etc.
Thus, doctors were finally able to see what happens to the brain of a patient who has schizophrenia. But the answer to the main question related to the etiology of the disease has not yet been obtained. Unless doctors are now able to identify schizophrenic disorder at an early phase, i.e. before its exacerbation, which leads to major problems in the life of a schizophrenic patient.
Brain cells, and neurons, communicate with each other using neurotransmitters – serotonin, dopamine, adrenaline, etc. One hypothesis that tries to explain the origin of schizophrenia is based on the description of the functioning of these hormones. The most common of these theories is the dopamine theory.
Dopamine plays a key role in shaping skills and motivation. Suppose a person has done or thought about action. If it is positive, the brain produces dopamine, which binds to the pleasure center. This information is fixed, encouraging the person to do the action or think about doing it again. It is how habits are formed. In addition, this mechanism is a source of motivation.
Studies show that schizophrenic patients have problems with dopamine production. During the negative phase, it is secreted too little. As a result, the person is apathetic and lacking in willpower. He doesn’t aspire to anything and doesn’t want anything. He has neither the strength nor the desire to do anything. And we are talking about even basic self-care.
Dopamine levels spike during the positive phase of schizophrenia, i.e., exacerbation. As a result, the brain receives too many signals without time to process them. Perhaps this is the reason for the development of delusions and hallucinations.
Neurons die and are renewed daily, but people with schizophrenia lose gray matter too quickly.
The dopamine theory is popular and has been confirmed by many studies. But even in this case, what exactly causes neurotransmitter and brain dysfunction remains unknown.
The genetic theory of the origin of schizophrenia is also actively developing. It is one of the main ones in modern science. Practice shows that the risk of developing a mental disorder increases if it has already been diagnosed in a relative. Thus, a child with two schizophrenic parents is about 50% likely to get schizophrenia.
But even this theory cannot explain why morphological changes in the patient’s brain occur. Genetic predisposition is considered to be one of the factors that can trigger the development of mental illness. However, not everyone with “bad” heredity is doomed to schizophrenia. Moreover, about 10% of patients have no genetic predisposition to it.
The benefits of research
Neurobiological research has not solved the problem of schizophrenia. It prevents not only its prevention but also its complete cure. However, doctors now can predict the possibility of developing an exacerbation and treat the symptoms of the disease quickly.
Unless this requires constant prevention, a person who has already had an attack or has a genetic predisposition to mental disorders should be examined periodically. By the way, his brain works, doctors can understand whether to expect a worsening shortly or not. If necessary, appropriate treatments are prescribed.
There are two main directions in the treatment of schizophrenia. The first is medication. It is used both during the active and negative phases. During the excitement, the patient is prescribed neuroleptics, which help to suppress the increased production of dopamine and other neurotransmitters. It eliminates delirium, hallucinations, and movement disorders.
During the negative phase, the person may need antidepressants that increase neurotransmitter levels. It makes it easier for patients to motivate themselves to take certain actions.
Drug therapy continues even when the patient is not in the hospital and feels no signs of illness. It is necessary to adhere clearly to the dosage and not to cancel medications arbitrarily. But the problem is that about 75% of patients stop therapy within two years of being discharged from the hospital. As a result, resistance to medications is formed, and the risk of an exacerbation increases. And the second time, it proceeds more severely than the first.
Resistance to medications is observed in an average of 20% of patients.
The second line of treatment is psychotherapy. Cognitive-behavioral methods are often practiced. The first thing is to help the patient accept the disease. Only after that can he learn to live with it. Next, rehabilitation begins. The doctor looks for factors that may provoke an exacerbation and teaches the patient to cope with them.
The patient’s relatives also consult with the psychiatrist. They will have to learn how to interact with the schizophrenic person correctly and determine the onset of an exacerbation at the first symptoms. Their task also includes motivating the patient. They have to encourage him to lead a healthy lifestyle, take his medications, work, and try to improve the quality of his life.
Schizophrenia is not completely curable, but it is not a sentence for a person. Only severe forms of schizophrenia, such as hebephrenic, lead to personality disintegration. In other cases, it is possible to achieve stable remission. To do this, you need to follow the psychotherapist’s recommendations accurately.
Often patients manage to avoid disability. The disease no longer returns in quite frequent cases where after one exacerbation. Much depends on the type of pathology, the characteristics of the body, and directly on the patient’s actions.