Cobbers on the Brain

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/

What is Schizophrenia:

Schizophrenia is a long-term mental disorder where an individual has an inability to interpret reality. This is often characterized by hallucinations, delusions, extremely disorganized thinking and behavior that impairs daily functioning. Schizophrenia affects different individuals differently as the severity can range from mild to more extreme in some cases.

Toxic Media:

The media is dangerous in that it portrays only the extreme cases of any disease, Schizophrenia in this case, and often inaccurately. This creates false stereotypes and unnecessary fears surrounding this disease. Not all schizophrenics are violent, in fact only a very small portion of the population are. People with schizophrenia are normal people who just struggle with a disease just like anyone else. We as a society need to learn to better understand this disease and its implication so that we can better help those around us who struggle with this disease.

What is happening in the Brain:

The problem occurring in the brain of individual who suffers from schizophrenia is the disruption of what we call the dopamine pathway, a pathway that has a large impact on proper brain functioning. In this pathway where is a molecule called glycogen synthase kinase 3 (GSK3) which has been found to be highly overactive in individuals who suffer from schizophrenia. When dopamine binds to a D2 receptor, it activates Akt which then phosphorylates GSK3 rendering it inactive. However, this and many other checks and balances, are disrupted causing GSK3 to avoid its inhibition and thus disrupt the transcription of certain, necessary genes crucial to proper development due to it being vastly overactive in the brain.

Treatment:

Due to the complexity of the pathway, treating this disease has been difficult for scientists to figure out. Just like many mental diseases, finding a cure is difficult. Most treatments today strive to only alleviate the symptoms as we work to better understand what exactly is happening in the brain. These medications work to inhibit GSK3 and make it less active. Lithium is the most common as it directly inhibits GSK3, but hopefully more advanced treatment will continue to surface as we work to understand better how to help these individuals.

What can you do?

Making a difference in the lives of individuals who suffer from schizophrenia can seem impossible as we aren’t all scientist who study pathways on a molecular level. However, there is something very important that we can all do to make a difference. This involves getting educated, educating those around, and treating those will schizophrenia as normal people as they are. It should be our goal to erase the stereotypes and fears surrounding schizophrenia that the media and lack of education has created. We can all make a difference in this way and you should strive to do just that.

 

The Story of Schizophrenia

With symptoms ranging from quietness to experiencing hallucinations or delusions, schizophrenia is a mental health illness that is difficult to diagnose and difficult to biologically analyze. Generally, the symptoms of schizophrenia are manifested in individuals who are in their late teens to early twenties, but brain development before being born can cause varying susceptibility to the disorder.

It is thought that certain messenger chemicals in the brain (neurotransmitters) causing an imbalance of communication between neurons play a large role in the development of schizophrenia. The image below represents the hypothesized neurotransmitters/pathways responsible for the three classes of symptoms seen in schizophrenia: positive, negative, and cognitive.

Certain drug treatments target or act with these neurotransmitters to alleviate symptoms of the disorder. One example of this is a drug that blocks the receptor that dopamine (a neurotransmitter) would normally bind to. How would this help alleviate symptoms? After dopamine is bound to it’s receptor, Wnt, a signaling pathway in the brain can’t function properly. The final affect of this inhibited signaling is gene expression that is improperly regulated.

Artstract: The story of Wnt. This image depicts the Wnt signaling pathway including two scenarios, one with Wnt ligand binding and one without binding. Wnt binding is implicated in regulated gene transcription through TCF/LEF mediated transcription.

This is not a specific picture of schizophrenia, but does help to explain the large variety of symptoms and irregularities seen in the brains of individuals diagnosed with the disorder.

The unfortunate truth for schizophrenia is that there is still a long way to go before the full mechanism of the disorder is understood. For now, there is no real way to “cure” schizophrenia, and treatment options focus on alleviating the symptoms of faulty brain wiring, and hopefully leading to a more manageable and independent life. In future research, exploring treatment options including the Wnt signaling molecules as target cells could provide some relief from the wide range of symptoms. Overall, more understanding of specific mechanisms detailing the schizophrenia story is needed to truly unpack how the disorder is manifested and experienced.

References/Further research

• https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml
• https://www.placesforpeople.org/hear-our-voices/
• http://www.mentalhealthamerica.net/conditions/schizophrenia
• https://youtu.be/6Qpl-3eR6eE
• https://www.placesforpeople.org/hear-our-voices/

WARNING: If you or your family have a history of mental illnesses or vertigo, we strongly advise that you DO NOT participate in this simulation as it could potentially trigger those illnesses to begin.

Image References

• https://progress.im/en/content/dopamine-synthesis-common-factor-genetic-and-environmental-risks-schizophrenia
• https://www.inspiremalibu.com/blog/drug-addiction/schizophrenia-and-the-risks-of-substance-abuse/
• https://www.mdpi.com/1422-0067/18/8/1689/htm

 

 

 

 

 

 

Schizophrenia is a severely debilitating disease for one’s psyche. Unfortunately, the only thing we have to separate reality from nightmares for individuals with this disease is constant use of mind-numbing anti psychotics.

 

What is the disease?

Schizophrenia is a psychiatric disease that results in severe impairments in daily life. Some common positive symptoms of schizophrenia are delusions, hallucinations, and disorganized thinking. This means that the person has a difficult time producing a normal perception of the world. Many see or hear things that are not there and have abnormal beliefs or paranoia. Some common negative symptoms of schizophrenia are lack of hygiene, reduced eye contact, and lack of emotion. The combination of all of these symptoms make it very difficult to live a normal life and people with schizophrenia are often medicated all of their life to improve these symptoms.

 

Looking beyond the symptoms

Recent research on the neural cause of schizophrenia has uncovered some clues as to why this disease occurs. The Wnt pathway in neurochemistry is a sequence of cellular events often used to facilitate the development of the central nervous system. It controls the amount of β-catenin in the cytosol of neurons which is a useful molecule for the transcription of developmental genes. It is believed that this Wnt pathway is abnormal in schizophrenia patients causing abnormalities in brain development. Neurons end up connecting incorrectly in the pre-frontal cortex and result in many of the common schizophrenic symptoms.

 

How should this disease be addressed in the future?

Reducing the severity of schizophrenic symptoms is all we have at this point in the treatment of schizophrenia. Anti psychotics are used to essentially “numb” the person from their positive symptoms to better help them to connect to reality. However, these drugs to not treat the disease at its source. The abnormal brain connections seen in schizophrenia still exist while anti psychotics are being used leaving the person still susceptible to emotional and social impairments. Although the use of anti psychotics is helpful for some symptoms, it is in no way a cure.

In the future, it may be beneficial to look deeper into the underlying causes of this disease. Recent research has uncovered many things that we did not know about schizophrenia but has created just as many new questions. What genes are involved? How is development changed from abnormal Wnt signaling? What specific brain regions are impacted? All of these questions need to be answered more entirely to begin developing a cure for this disease. Rewiring an adult brain is a tall order and perhaps we will never get to the point of curing this disease but will find effective ways at preventing it. Targeting the Wnt pathway specifically may bring new light in the treatment of schizophrenia. Perhaps at an early age everyone would get a checkup on their risk of getting the disease based on gene expression tests. We would then know if Wnt would need to be inhibited or activated to prevent abnormal development.

It has become very apparent that the neural mechanism of schizophrenia is unimaginably complex. No one in the world can tell you exactly what is going on in the brains of schizophrenic patients but one thing is certain; further research is necessary to effectively treat and prevent this disease. Treatments we have today do help but have limits. People on anti psychotics essentially have their personalities taken away from while being numbed with schizophrenic drugs. Sure their positive symptoms improve but they are stripped of who they are as a person. It is important for us to understand how treatments of complex diseases like schizophrenia have consequences that we do not always think about.

When you hear the world schizophrenia what comes to mind? Crazy? Violent? Perhaps unpredictable? In the world we live in media influences our idea of what metal illness is, and how it affects a person.

In order to understand this metal illness, let’s dive into the science behind schizophrenia.

What’s going on in the brain?

There is a pathway in the brain called the dopamine pathway, which plays a large role in the function of the brain. In a properly working dopamine pathway the enzyme, GSK3 or glycogen synthase kinase 3, plays a key role in the regulation of the dopamine pathway. GSK is activated by the dopamine pathway with the help of the molecule Akt, which phosphorylates GSK to its active form.  However, in schizophrenia GSK3 becomes overactive due to too much signaling of the dopamine pathway. This over-activation leads to behaviors associated with this mental illness.

There is another pathway, the Wnt pathway, where GSK is affected in a brain with schizophrenia. Dopamine receptors are also shown to inhibit Wnt signaling. This pathway works to regulate the enzyme GSK, by inactivation through the presence of  ß-Catenin. If the balance of  ß-Catenin is off, GSK becomes overactive, and much like the previous example leads to the symptoms of schizophrenia.

Risk Factors

There are many different risk factors associated with schizophrenia. Having a family history of illness is the highest risk factor for schizophrenia, however there are also many environmental factors that can cause an increased risk of the disorder. Childhood trauma is another risk factor schizophrenia. Dopamine plays a large part in the interpretation of threat-related stimuli. When a person experiences trauma they have increased levels of dopamine. These increased levels puts an individual at a higher risk.

Maternal infection, along with other prenatal risks increase the odds of developing schizophrenia. During the first trimester if the mother is exposed to influenza, or during the second or third trimester is exposed to rubella or a respiratory infection, that child is at an increased risk for the development of schizophrenia. Birth month is also a risk factor. If a child is born in late winter, or early spring they are at an increased chance of developing the disease. This is thought to be caused by the mother suffering from seasonal depression.

 

While these are not all of the risk factors, these are some of the biggest, and or most unique risk factors associated with schizophrenia.

Treatments

As with many mental illnesses, current treatments of schizophrenia focus on treating the symptoms of the disease rather than the cause. Due to the fact little is know about the cause of schizophrenia there are no medications that treat the mechanisms behind the disease. Medications that are used to help with symptoms of schizophrenia focus on inhibiting GSK. Lithium is most often used due to the fact it directly inhibits the activation of GSK. In addition, dopamine blockers are also used to help inhibit the dopamine pathway, which in turn inhibits GSK.

 

What does this have to do with preconceived notions?

It is important to remember that media does not always accurately portray schizophrenia. For many people their only information about this disease comes from movies, and TV shows. This leads to the stigma surrounding schizophrenia, such as a person with this disease is violent, delusional, and experience intense hallucinations. By educating the public about the science behind schizophrenia it can help end the negative stigma surrounding mental illness. It is also important to remember that a person is more than their diagnosis. By proving empathy for those dealing with schizophrenia you can help play a role in ending the stigma surrounding mental illness.

 

Image 1: https://newroadstreatment.org/signs-of-schizophrenia/

Image 2: http://schizophrenia.com/hypo.php#

In the DSM V, a diagnosis of Schizophrenia involves a range of cognitive, behavioral, and emotional symptoms–including delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms such as diminished emotional expression. These symptoms must be persistent for a consistent period of time, as defined in the DSM V depending on the symptom category, prior to diagnosis.

Due to the portrayal of Schizophrenia in the media, many individuals incorrectly assume that all individuals with Schizophrenia experience intense hallucinations, delusions, and violent outbursts. Although often inaccurate, these portrayals are usually the only exposure to psychiatric disease that an individual may experience–especially Schizophrenia. Research has shown that the movies which include a character with a severe psychiatric illness also tend to be the movies with the most inaccurate portrayals of mental illness. A content analysis on movies depicting at least one character with Schizophrenia was found to most frequently display the negative symptoms of the illness, including delusions and violent behaviors toward self and others. The perpetuation of these negative stereotypes regarding Schizophrenia misinform the public and contribute to the stigma preventing further research into the condition.

Although delusions and hallucinations are symptoms of Schizophrenia, other symptoms exist too. And despite the media’s portrayal of violent individuals with Schizophrenia, very few individuals with the condition become violent. Additionally, these individuals are not “psycho” or “crazy.” Every symptom that an individual with Schizophrenia experiences is due to their neurological functioning. Educating the public remains an important step in humanizing and de-stigmatizing Schizophrenia. Likewise, it is important to note that Schizophrenia can be successfully treated and managed. Just because someone has been diagnosed with Schizophrenia doesn’t mean that they cannot have a fulfilling life.  

https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201100371

https://www.helpguide.org/articles/mental-disorders/schizophrenia-signs-and-symptoms.htm

The Basics

Symptoms of Schizophrenia can vary greatly in the ways they present themselves in different people. This mental disorder is defined as the abnormal interpretation of reality.  The symptoms displayed in Schizophrenia include, hallucinations, delusions, extremely disordered thinking and behavior that impairs daily functioning. Hearing voices, impaired communication by disorganized speech, and lack of emotion or eye contact are common signs of Schizophrenia.

            A major sign of Schizophrenia in the brain is a significant loss of gray matter in the medial and superior temporal regions as well as in the prefrontal region of the brain. Gray matter is crucial to the function of episodic memory, processing auditory information and short-term memory.

What’s going wrong in the brain?

In a properly functioning dopamine pathway, there is an enzyme that plays an important role in regulation and ensuring the desired outcomes of the pathway are occurring. This enzyme is called glycogen synthase kinase 3 (GSK3). The main problem in schizophrenia is the overactivation of GSK which leads to the symptoms experienced in the disorder. The dopamine pathway functions to activate GSK through with the help of another molecule, Akt which phosphorylates GSK to its active form. However, when there is too much dopamine signaling, it leads to the overactivation of GSK in this pathway.

The Wnt pathway is another place where GSK is being affected in schizophrenic brains.  The dopamine receptors were also shown to inhibit Wnt signaling. This pathway works to regulate GSK by inactivating through the presence of ß-Catenin. When the balance of GSK is off and causing GSK to be overactive, that is when schizophrenia symptoms begin to develop.

Risk Factors

            Having a family history of Schizophrenia is the highest risk factor and significantly increases the chances of developing this disorder. However, other environmental factors can also influence the likelihood of developing Schizophrenia. Experiencing trauma during one’s childhood can increase the risk for the development of Schizophrenia. Dopamine plays a role in interpreting threat-related stimuli, which can lead to the formation of delusions observed in schizophrenia. The increase of dopamine levels in people that have experienced traumatic events puts them at a higher risk of developing this disorder.

Additionally, there are some prenatal risks associated with the development of schizophrenia. If the mother is exposed to influenza during the first trimester, or acquires rubella or a respiratory infection, the chances of the child developing schizophrenia significantly increase. Migration is also a significant risk factor if people are migrating to regions where they are exposed to viruses that their bodies have not previously been exposed to.

Treatments

Current treatments of schizophrenia focus on treating the symptoms rather than the cause. This is because there is a significant deficit in the understanding of the biological mechanisms of the disease. Therefore, it is difficult to come up with something that targets what is still unknown. Medications used to treat schizophrenia work to inhibit GSK. Lithium is most commonly used because it directly inhibits the activation of GSK. Additionally, dopamine receptor blockers are used because too much dopamine is being produced so through inhibiting the dopamine pathway, the activation of GSK is inhibited.