Cobbers on the Brain

The opioid epidemic has become an enormous issue nationally. In the United States, a public health emergency was declared in 2017 in relation to the opioid crisis. Based on data from 2016 and 2017, more than 130 people die each day from opioids, 11.4 million people have abused prescription opioids, and 42,249 people have died from opioid overdose. This issue is harming individuals all over the country and has everlasting effects. In order to combat this issue, there must be more knowledge, less stigma, and a greater understanding of addiction as a whole in order to fight this crisis.

There are many misconceptions about addiction, specifically opioid addiction, including “Why don’t they just quit?” or “Why do something that causes you so much harm when you could just choose not to?”. Even though it may seem easy to choose a life without opioids to an outsider, it becomes less and less of a choice when looking at the brain of an addicted individual. Addiction vulnerability of each individual is 50% accounted for by genetic factors, made up of hundred of genetic variations. The remaining 50% is accounted for by various combinations of environmental factors, causing an individual to be more vulnerable to addiction. Some risk factors that contribute to opioid addiction are:

• “gateway” drugs such as prescription medication, marijuana, alcohol, and nicotine
• anxiety or depression
• other psychiatric disorders
• exposure to abuse or trauma
• family or friends addicted to drugs
• access to addictive drugs
• starting substance abuse at a young age
• poverty

There are many reasons why an individual may be more predisposed to becoming an addict. In addition, there are specific changes in the brain that occur in order to cause specific symptoms of addiction to occur if an addicted individual tries to “quit”, such as craving, withdrawal, and relapse.

These changes in the brain include changes to certain nerve cells due to drug exposure, causing the neurons to respond differently to drugs, changes that occur in response to addiction, such as altered gene transcription, synaptic plasticity, and neurotrophic mechanisms, and changes in key neural substrates or brain regions of behavioral memory. These alterations cause caring and relapse as there are differences in the memory circuits due to addictive drugs.

Since it is clear that addiction is not necessarily a “choice”, the U.S. population as a whole must become more aware of the opioid crisis in order to begin finding solutions.  In order to target the opioid epidemic, there must be a greater awareness of how addiction occurs, what is happening in the brains of addicted individuals, and how to target therapies and treatments to each specific individual. Stated in the facts above, the opioid epidemic is affecting millions all over the nation and must be addressed. By understanding the factors that play in to addiction and gaining knowledge about each addict’s personal situation, treatments and solutions may become more accessible.

https://www.centeronaddiction.org/addiction/addiction-risk-factors
https://www.hhs.gov/opioids/about-the-epidemic/index.html

Addiction is an issue continuously growing worldwide. This disease is most commonly associated with drug use but it can also entail other activities that can have addictive characteristics as well, such as social media, video games, gambling and many other things of that nature. When one becomes addicted to drugs or any activity, the reward pathways in their brain are being altered which is when the addiction sets in.

What’s changing in the brain?

In a person that is not suffering from addiction, the reward pathways reinforce behaviors that are beneficial and necessary for survival (eating, drinking, sex and social interactions). Drugs that are abused or other sources of addiction alter this system so that using the drug becomes a necessary behavior. In the regular function of this pathway, dopamine is transmitted from the ventral tegmental area (VTA) of the midbrain to the limbic system and pre-frontal cortex where it binds to dopamine receptors to give the pleasurable or rewarding effect of these necessary behaviors.

An increase in dopamine levels is what is common to all forms of addiction.  This continuous overstimulation is what causes the prolonged and stronger sensation of euphoria. The constant exposure to this higher level of dopamine desensitizes the reward pathway which then becomes no longer sensitive to the everyday stimuli leading to the drug being the only stimulus to create this feeling of pleasure. The drug then eventually becomes less effective in creating this pleasure feeling and higher doses are needed to achieve the same feeling which can lead to overdose.

D1 and D2 dopamine receptors are affected in this disease. These rapid increases of dopamine activate the reward pathway through the D1 receptors which amplifies the reward pathway. On the other hand, this dopamine surge also activates the D2 receptors which inhibits the ‘punishment’ pathway. Therefore, this doubles the effect by producing reward and also removing punishment.

Due to these changes in the brain, even one time using an addictive substance  can lead to the development of addiction. When the brain changes, it is re-wired to crave these addictive things as a necessity like it should crave food, water and other stimuli required for survival. It is because of this it is a disease, not a decision to continue using these drugs of abuse. Additionally, addicts are likely to relapse because the pathways in their brain have been changed, so re-exposure to the substance of abuse could lead them back down that path of addiction.

Risk Factors

Social and environmental pressures are very common surrounding drug use. It is seen on TV and in movies and even at school for some adolescents . People can become exposed to these substances of abuse through pressure from peers, being bullied and feeling lonely. However, genetic factors, depression, lack of confidence and other illnesses can increase the risk of developing an addiction. About 10% of people who experiment with drugs become addicted at some point. Therefore, it is important to know and recognize the risk factors, because it is so easy to become hooked even if a person only tries something once or twice.

How can addiction be treated?

Addiction is usually treated with a combination of medication and behavioral therapies. There is also a new medical device called the NSS-2-Bridge which is a device that gets placed behind the ear and sends electrical pulses to stimulate certain nerves to help reduce opioid withdrawal symptoms.

Methadone– an opioid agonist which impacts the same type of neurotransmitter and therefore stimulates it in the same way an opioid drug would, but in a more controlled safer way. This is used in detoxifying a person suffering from addiction.

Naltrexone-an opioid antagonist which specifically blocks opioids at their receptors and used in patients who are already detoxified. This medication can also be used to treat alcohol addiction because it blocks the opioid receptors in the reward pathway which helps suppress the craving to drink.

 

Schizophrenia is commonly portrayed in media as its more severe cases, resulting in illusions of the individual leading to them hearing and seeing things that aren’t reality. The range of Schizophrenia cases vary, however I found the developmental factors of Schizophrenia is rather intriguing. The potential implications of other environmental factors on an individual that could result as an increased risk for developing Schizophrenia. As with most cases individuals see onset of Schizophrenia in their early adulthood. During this period there is an increased amount of the many factors that could result in the potential for transcription of Schizophrenic genetic factors. Some of these factors being stress and substance abuse. These factors act on epigenetic regulation of genes, this results from activation/regulation of genes via environmental factors. The degree of these factors can also be present during conception, for example individuals with older fathers are at a higher risk for Schizophrenia, other pregnancy complications can also increase chances for development of Schizophrenia.

I find this interesting, as for most parents, they attempt to control the environment to the best of their extent. However based on these factors, this increases the amount of parameters out of ones control. The results of epigenetic factors create in major implications for development of Schizophrenia and other major impacts on mental developmental processes. The encoding of various hidden environmentally triggered life changing genes is a startling thought, as there are so many factors that we are unable to control in our lives. There are some factors that can be limited or omitted completely, avoiding substance abuse, and finding outlets for stress are factors that can be directly controlled, thus decreasing potential risk for Schizophrenia.

A Developmental Issue?

While majority of Schizophrenia causation is a mystery to current scientists, the most prominent theory is one of brain development. People with schizophrenia have statistically shown delays in cognitive milestones, have smaller brain size, and are below the general population in cognitive ability. In addition, the majority of schizophrenia’s environmental factors interfere with proper brain development. These can include prenatal infection, prenatal famine, pre-eclampsia, infant infection, low birth weight, and even maternal depression.

Fig 1.  A chart displaying numerous types of environmental factors listed for schizophrenia

Biological Support:

With a new emphasis on brain development, scientists found a strong correlation between decreased Wnt pathway activity and schizophrenia. When active, the Wnt pathway increases cellular levels of a molecule called beta-catenin which activates genes critical for development. When the pathway is inactive, the body naturally creates a destruction complex that breaks down beta-catenin, reducing its concentration, and preventing developmental genes from being expressed. In conclusion, it is important for this pathway to be active during critical developmental periods.

Fig 2. The left column shows the accumulation of beta-catenin when the Wnt pathway is active and the left column depicts the breakdown of beta-catenin when the pathway is inactive.

So What Went Wrong?

There is a molecule in everybody’s brain called Akt that aids in disassembling the natural destruction complex. This means that high levels of Akt increase levels of beta-catenin and result in increased expression of developmental genes. However, postpartum schizophrenic patients were found to have significantly lower levels of Akt in their brains. People with schizophrenia, therefore, have decreased Wnt pathway activity resulting in developmental problems. Most antipsychotics prescribed to schizophrenic patients target the Wnt pathway to alleviate symptoms. They usually increase the activity of Wnt signaling by increasing Akt activity, decreasing inhibitors of Akt, or directly inhibiting the destruction complex formation. While these drugs do a phenomenal job of treating the symptoms they still do not cure or reverse the permanent damage done to their brain.

Problems of Developmental Diseases:

The hard part about developmental disorders, like schizophrenia, is that majority of the damage is completed early in life. The devastation on the brain is then usually cemented after the individual reaches adulthood and brain development has ceased. This means that even if we did know how to treat schizophrenia, the treatment would have to be done early in a patient’s life to catch the developmental periods. This would have to lead to an intensive pre-natal screening and tests made specifically for diagnosing schizophrenia. Unfortunately, these options would probably be incredibly expensive which would prevent them from reaching their true at-risk population.

Another problem is that schizophrenia is usually not diagnosed until the late teens to early twenties making it impossible to catch the disease early. Many of schizophrenia’s positive symptoms, including delusions and hallucinations, can be attributed to normal childhood behavior like imaginary friends and make-believe games. Then in the teenage years, most parents and doctors correlate symptoms to hormone imbalances and puberty. There is also a lot of maturing and development that occurs during this time so many doctors don’t want to diagnose a patient prematurely.

Together these current problems make it hard to intervein early for schizophrenic patients. Future research should focus on finding early warning signs for the disease and its progression throughout early childhood and into adolescence. Majority of our research is only on adults since they are the only ones diagnosed, but much more could be learned from researching younger patients. Additionally, more extensive research must be found about the specific genes affected by decreased Akt activity.

Source: https://www.apa.org/helpcenter/recognizing-schizophrenia.aspx

Recently in popular culture is has become a movement of acceptance and understanding when thinking about mental health. More often than not this just ends up including the more well know deviations from the norm and other disorders are left forgotten. One of the most misunderstood disorders is schizophrenia. Whether it be word of mouth, culturally, socially, or taught to us through the media there is a large misconception about what schizophrenia really is.

Dissociative Identity Disorder vs Schizophrenia

It is important to start here because this is the idea that many people have in their head when they think of schizophrenia. This tends to be one of the most common misconceptions, instead regarding schizophrenia as someone having multiple personalities. Multiple personalities, called Dissociative Identity Disorder (DID), is coupled in with three other types but of dissociative disorders but DID is characterized through the thought that one individual has multiple personalities. This stands in contrast to schizophrenia which often is disorganized speech, delusions, and hallucinations. An individual may also exhibit lesser known symptoms including abnormal behavior, unclear and confused thinking, and lack of motivation. Schizophrenia may also be presented with other mental illnesses as well, often observed in individuals with depression, anxiety, OCD, or substance abuse disorders. At its core, schizophrenia is a very different disorder from DID and it is critical to work toward understanding of both.

 

 

 

 

 

 

 

 

 

 

 

Figure 1: Here is a small table that briefly goes into more detail about the differences between DID and schizophrenia Source:http://www.differencebetween.net/science/health/difference-between-dissociative-identity-disorder-did-and-schizophrenia/

Hearing Voices

Although schizophrenia is often diagnosed through observing symptoms of delusions and hallucinations these behaviors are not exhibited 24/7. Along with the thought that schizophrenia is multiple personalities, many people also think that those with this disorder constantly hear other voices. Some people with schizophrenia do experience episodes that may include voices but about one fourths of individuals do not experience voices (auditory hallucinations). The diagnostic criteria of schizophrenia state that the patient must have at least one of the symptoms stated above, hallucinations and delusions, or disorganized speech for a period of one month.

Figure 2: An artist’s illustration of what it is like living with her bipolar disorder. Although a difference disorder than schizophrenia, the overlying message is the same: sometimes there are voices but this is not something that is experienced by everybody.

Artist: Stumbling Mind — Katie

Source: https://stumblingmind.com/2017/02/06/doubting-myself-hearing-voices/

Other behaviors that are common with schizophrenia are diminished emotional responses, depersonalization, disturbed sleep pattern, and inappropriate responses. It is the case with some individuals that they may experience voices and hallucinations frequently but that may not be the same from case to case. Because of this lack of knowledge about schizophrenia and how it affects the people who have been diagnosed it causes a general sense of fear from the public, which tends to be exacerbated by media portrayal. This misunderstanding of the disorder is also linked to the thought that those who have schizophrenia tend to be dangerous.  

People with Schizophrenia are Dangerous

Something that appears to be ingrained in human nature is to be afraid of things that we do not know. It is why people are afraid of the ocean and some fear the infinite depth of space. This is not only seen in phenomenons of nature but also throughout society. We do not understand those who are different from us in great degrees and so often the way that we view those types of people is tainted. As mentioned above, this includes the way that media shows us what is different influences our thoughts. It is far too common in movies and television shows that individuals who are behind the crime are affected by disorders such as schizophrenia. This adds to the stereotype that people with schizophrenia are violent and dangerous, which is not the case. Although schizophrenia may be unpredictable in actions most of the individuals who are affected live normal lives do not engage in violent activity. Even those who are receiving treatment for the disorder, according to one study, are no more dangerous than those who are not. It is essential to remember that the way that schizophrenia impacts someone is a spectrum and does not ring true for the next person.

Figure 3: This is a compiled image of Patrick Bateman (played by Christian Bale) in the film American Psycho. Although Bateman’s mental health is not addressed, some speculate that he suffered from undiagnosed schizophrenia and adds to the stigma of those with schizophrenia being dangerous.

Source: https://www.chess.com/clubs/forum/view/playing-chess-benefit-schizophrenia-patients

It’s an Uncommon Disorder Caused by Bad Parenting

1 out every 100 people develop schizophrenia in the general population. There is a role of genetics as well in the disorder, the risk increasing to in regards to family members. Many people think that schizophrenia is uncommon, mostly because only the very sparse extreme cases are reported on and told to the public, but it is much more common than you may think. Although symptoms don’t begin to persist and become diagnosable until early to late twenties there is another myth that coupled with genetic factors, schizophrenia is due to bad parenting. This idea was proposed by a group of researchers in the 1950s with most of the blame falling on the mother. The claim today holds no ground but like what was observed with the falsifying of vaccine records, the public tends to hold on to things even though they might not be correct. High stress situations that take place at home may make the symptoms of schizophrenia but are not the cause of the disorder.

Figure 4: The myth that bad parenting causes mental illnesses such as schizophrenia has been discredited although some still refer to it.

Source: https://wundersameslernen.de/wieviel-ungehorsam-darf-s-denn-sein/

There are many rumors that cause the idea of what schizophrenia to be distorted but it is important to know the reality of the disorder. Understanding this group of our population allows for more education about the topic and ultimately to acceptance.

 

Figure 5: A quote from someone who lives with schizophrenia. It is his, and my, aim to inform everybody about schizophrenia to end the stigma attached.

Source: https://www.rtor.org/2016/08/23/quotes-on-schizophrenia/

 

Sources:  

http://www.schizophrenia.ca/docs/Myths%20Half-truths%20and%20Common%20Misconceptions%20about%20Schizophrenia%20and%20Severe%20and%20Persistent%20Mental%20Illness%20(SPMI).pdf

 

https://www.webmd.com/schizophrenia/guide/schizophrenia-myths-and-facts#1

 

https://mentalillnesspolicy.org/medical/schizophrenia.html

 

https://www.verywellmind.com/dissociative-disorder-vs-schizophrenia-4160180

https://www.psycom.net/schizophrenia-dsm-5-definition/