One day, I arrived at work and saw a patient pointing up into space talking about the lights that he could see dancing around and the voices he heard talking to him coming from the lights. I was immediately taken aback by this man as this is not a usual occurrence. Even as I was working in an inpatient psychiatric treatment facility, rarely would anyone be this visibly confused and disoriented to this extent. Later, I found out that this man had schizophrenia. When his parents arrived at the hospital to see him I had the opportunity to speak with them as they told me he usually has a relapse like this at least once a year, “it’s just part of the season.”
Although, I saw this patient with schizophrenia, I had never thought about the implications in the brain. It had never occurred to me to wonder about how this man had become so mentally distraught. In an article from clinical genetics, they discuss how the Wnt signaling pathway is implicated in schizophrenia. This pathway, when activated, is responsible for turning on certain transcription factors that usually promote cell growth. Therefore, this pathway is highly active during embryological development. The article discusses how the Wnt pathway is shut down or does not run as smoothly in patients with schizophrenia. Glycogen synthase kinase 3 (GSK3) is an important molecule in the Wnt pathway as it binds to ß-catenin. When GSK3 is bound to ß-catenin, it keeps ß-catenin from going to the nucleus and eliciting transcription for cell growth. Normally, when Wnt is present it binds to a frizzled receptor on the cell membrane and causes ß-catenin to go to the nucleus and begin transcription.
Although this pathway seems to contribute to schizophrenia, there are so many other factors involved in the disease. Environmental stressors like abuse are also known to cause schizophrenia along with other genetic markers like at risk genes which can be passed down from generation to generation. The total process behind the cause of schizophrenia is not yet known. We do know that it impacts the brain and changes it in such a way that cannot be fully understood. The treatments that are in place now are not always effective and can have very debilitating side effects like tardive dyskinesia that can impact a patient for their whole life. Like my patient in the hospital, psychotic breaks are often a part of having the disease and non-compliance when taking the medications is a huge issue. I hope that one day we will be able to determine a better option for those suffering from this disease. However, at this point I think it is best to keep an open mind about those suffering from mental illness. We cannot truly understand the struggle they are going through, and often there is not any good options for them. I know that my patient recovered to a normal state and was able to leave the hospital, however, I hope one day, hospitalization is not part of his yearly routine.
For access to this article and more information about the wnt pathway go to:
https://www.ncbi.nlm.nih.gov/pubmed/23379509
Featured image from:
http://www.pbs.org/wgbh/nova/body/brain-transplants.html
Into the Brain of Schizophrenia
