Schizophrenia

woman-mirrors 22Jan2019

Did You Know That…  John Nash had schizophrenia?  Of course you did.  If you have not heard of or read Sylvia Nasar’s biography of him, A Beautiful Mind, you likely have heard of the movie.  You might even have seen the movie, with Russell Crowe playing the character of John Nash.  Dr. Nash was a mathematician whose studies covered game theory, differential geometry, and partial differential equations.  Though it sounds abstract, his work explained reasons behind chance occurrences and decision-making in the everyday life of ordinary people.  His theories became useful for economists and were widely applied.  In 1994 he won the Nobel Memorial Prize in Economic Sciences, sharing the prize with two other game theorists.  His paranoid schizophrenia was first evidenced in 1959 when he was 31 years old.  The initial psychotic break was followed by years and years of treatment in psychiatric hospitals.  During the 1970s he was more able to think and function with treatment and in the 1980s he was even able to return to academic work.  Dr. Nash was killed in a car crash while riding in a taxi in 2015.

Articles related to Schizophrenia:

Schizophrenia is Complex and Heterogeneous  

Schizophrenia is caused by a mixture of genetic and environmental influences (such as in utero; see below).  As these several factors come into play, schizophrenia in one person might well be somewhat different from supposedly the same condition in another.  Thus, the biology would indicate that the term “schizophrenia” refers to a number of disorders, appearing similar to each other in ways, but really not the same.  Hence, the term “heterogenous”.  The schizophrenias are a heterogenous set of medical conditions.

In Utero

Many assaults on the developing fetus can occur during pregnancy.  In utero damage is one possible contributing factor to the emergence of schizophrenia in adolescence and young adulthood.  These insults to fetal integrity include gestational diabetes, bleeding during pregnancy, and obstetric complications (asphyxia, emergency cesarean section, low birth weight).  Infections and high maternal stress experiences during the particularly important 2nd trimester might lead to additional fetal disturbances.  These 2nd trimester influences on the fetus could double the risk of developing schizophrenia in adulthood.

It Does At Times Run in Families

Schizophrenia can and sometimes does run in families.  Families with one family member with schizophrenia are more likely to have other family members with it.  Adopted children born to biological parents with a genetic loading for schizophrenia seem to have this same risk for developing schizophrenia in their new, adoptive home as they would have had if they had stayed in the home of their biological parents.  Schizophrenia also runs in families that have family members with bipolar disorder (manic depression).  Thus, these 2 conditions are biologically linked in some way.

A Brain-based Condition

Schizophrenia is a condition that affects the brain.  As is discussed on our page Your Mind & Your Brain (https://www.neuroscirandd.com/your-mind-your-brain/), all our body areas are interconnected.  Thus, schizophrenia affects many other organ systems, too, like the immune system and the endocrine system (e.g., diabetic tendencies).  But the brain is likely at the center of the condition, where most of the pathophysiology resides.

A Common Problem

Schizophrenia is really common.  Worldwide, about 77 million people have schizophrenia.  It crosses all the artificial social distinctions that we construct, affecting rich and poor, intelligent and challenged, all ethnicities, and any genders.  The prevalence is about equal, male to female.

It Lasts a Lifetime

Schizophrenia a chronic, life-long condition.  Though the Swiss psychiatrist and early schizophrenia researcher Eugen Bleuler believed that those with the condition showed an improvement over time, in truth, before the availability of our current medications, when someone was sent to an asylum with a diagnosis of schizophrenia they usually stayed for life.   With today’s medications and other treatments the condition can wane to almost no symptoms.  Often people feel so well that they stop their medications at times and, as a result, their clinical status deteriorates.  it will improve again when they restart their medication.  But each episode of psychosis is toxic to the brain, so the improvement with restarting medication will likely not bring them back to the place they were before the medicine was discontinued.

Diagnose and Treat It Immediately and It Might Go Away

Starting and stopping medications is an exceptionally bad idea.  It is likely that schizophrenia makes itself worse, that is, psychosis is toxic to the brain and causes more psychosis.  Allowing any psychosis to persist for very long can condemn the person to a lifetime of worse illness than need be.  This means that if the first early symptoms of schizophrenia start and the condition is quickly and aggressively treated immediately, it might go away.  At a minimum, the person is likely to quickly medically improve and have a milder course throughout their life.

Persistent Psychosis Makes It Worse

The pathophysiology that underlies psychosis seems to damage the brain in a way that makes ongoing and worsening psychosis more likely.  As a result, if early signs of psychosis start and it is not treated quickly, it will get worse.  And, the longer it goes untreated, the worse the condition will become and the more difficult it is to treat.  In such a situation it certainly will likely never remit completely.

It’s a Medical Condition

Though hopefully clear from the above discussion, but to make it crystal clear for emphasis, schizophrenia is physical.  It is physical as a missing limb is physical.  It is real, based in tissue, brain tissue.  Here’s the problem.  Many people use the word “mental”, as in mental illness, to mean not real.  Schizophrenia is not a “mental” illness by this meaning.  It’s not some ethereal thought or emotion just floating about in someone’s mind or head.  It is corrupted brain circuitry, hard wiring and circuits gone wrong in a person’s brain.

Seeing Schizophrenia Before It Hits

People have early behavioral changes for a time before the first real schizophrenic signs of the illness appear.  There is debate among schizophrenia experts about how soon before full schizophrenia psychosis the early signs can be seen.  Maybe years before.  Maybe even in toddler years or infancy.  Schizophrenia researchers are working actively in in this area.  If we could tell early enough who is going to develop schizophrenia we might be able to prevent it all together.

We Need Better Medications

Anyone with schizophrenia, and anyone who knows anyone with schizophrenia, will agree that we need better medications.  Today’s best medications are huge advances over the medications of 10 years ago.  And those medicines were better than the ones of 20 years ago.  And those 20-years-ago medicines were again incredibly better than the ones of 50 years ago.  But today’s medicines are still not good enough.  Most people with schizophrenia never return to the way they were before the illness.  We need to fix that.

We Do Live in our Brain

Schizophrenia is a brain problem.  That’s a big problem because we live in our brain.  Schizophrenia can be not so bad (which is unusual) or very, very bad (which is more typical).  People with schizophrenia may hear voices that others don’t hear.  (That is, that are not really there.)  They may not understand what’s going on around them.  And because of this way their brain works they might make social mistakes that others don’t like.  So they stay away from people.  People with schizophrenia get nervous, afraid, and upset.  They might accidently upset others by talking in a way or about things that people around then think are strange or make little sense.  While there are good medications that help, being able to be in a secure, safe place also helps.

And Now for a Bit of Medical History – The medical diagnosis of schizophrenia is a more recent invention, when compared to other diagnoses recognized in the ancient world such as mania and melancholia.  In the mid-1800s physicians began observing and recording a cognitive/mental deterioration in young adults that was chronic and progressive.  Various diagnostic names were assigned by different physicians in different countries of Europe, such as adolescent insanity, démence précoce (premature dementia), hebephrenia, or catatonic syndrome.  The diagnostic term that then came forward in history lumped all the others into one, dementia praecox, put forth by Emil Kraepelin in 1893.  The syndromes lumped together, however, were diverse and heterogenous.  Dr. Kraepelin tried to deal with this by enumerating nine different forms of dementia praecox.  He was stumped to go any further, and recognized his dilemma, saying later explorations by pathophysiologists, neuropathologists, and others might find the etiology.  The term “schizophrenia” was coined by Eugen Bleuler in 1908 to replace the dementia praecox label.  Bleuler said that schizophrenia was not a disease but a group of diseases, and that the term should be plural, the schizophrenias.  He named all the different schizophrenias of Dr. Kraepelin and added several more.  There followed decades of sorting and naming one or another aspect of schizophrenia by prominent academic psychiatrists during the 20th Century.

Helpful links:

National Institutes of Health, National Institute of Mental Health

https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtm

U. S. National Library of Medicine, Medline Plus

https://medlineplus.gov/schizophrenia.html

The Mayo Clinic

https://www.mayoclinic.org/diseases-conditions/schizophrenia/diagnosis-treatment/drc-20354449

American Psychiatric Association

https://www.psychiatry.org/patients-families/schizophrenia/what-is-schizophrenia

National Alliance on Mental Illness

https://www.nami.org/Learn-More/Mental-Health-Conditions/Schizophrenia