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Mental Health Series

Schizophrenia is a complex mental disorder affecting how a person thinks, feels, and behaves. People with schizophrenia may seem detached from reality, experience hallucinations, and exhibit disorganized thinking. While it is often misunderstood, schizophrenia affects millions of people globally. This post delves into its causes, historical context, medical treatments, and practical, non-pharmacological approaches to managing the disorder.

A Brief History of Schizophrenia

The term schizophrenia was coined by Swiss psychiatrist Eugen Bleuler in 1908. Derived from the Greek words “schizo” (split) and “phren” (mind), it refers to a “splitting” of mental functions. Schizophrenia has often been confused with conditions like bipolar disorder or major depression, and treatments have ranged from trepanning (drilling holes in the skull) in ancient times to the asylum model of the 18th and 19th centuries.

In the 1950s, we saw the rise of antipsychotic medications, especially chlorpromazine or Thorazine, which revolutionized schizophrenia treatment. However, during this period, there was an increase in controversy. Some people viewed the disorder through a strictly biological lens, while others, influenced by the anti-psychiatry movement of the 1960s, criticized the medicalization of schizophrenia, arguing that societal oppression and trauma played a more significant role.

Some spiritual psychologists even think that those with mental illness like schizophrenia, ADHD, and other mental health disorders are actually indigo children. Some believe that these children are being energetically blocked by being overmedicated and hospitalized. See more of what this doctor has to say here.

Controversies and Misconceptions

Schizophrenia has historically been a source of stigma and misunderstanding. One of the main controversies is its portrayal as a “split personality” disorder, which is incorrect. Schizophrenia refers to a fragmentation of thought processes, not the coexistence of multiple personalities (which is a hallmark of dissociative identity disorder).

The anti-psychiatry movement of the 1960s, led by figures like Thomas Szasz, argued that schizophrenia was a social construct rather than a biological illness. Szasz believed that labeling individuals as schizophrenic was a way for society to control deviance and abnormal behavior.

More recently, the neurodiversity movement has called for a more humane understanding of mental illnesses like schizophrenia. Some advocates argue that instead of focusing solely on symptoms and deficits, the medical community should recognize the strengths and unique perspectives of those living with schizophrenia.

Causes and Theories of Schizophrenia

Genetics: Schizophrenia has a genetic component. Studies show that people with a family history of schizophrenia are more likely to develop the condition. This does not mean that even if you have the genetic predisposition for schizophrenia, you will get it. For example, having one schizophrenic parent increases the risk to about 10%, compared to a 1% risk in the general population. This number translates to over 20 million people worldwide, making schizophrenia one of the most common severe mental health disorders.

Brain Structure and Chemistry: Researchers have found structural abnormalities in the brains of those with schizophrenia, including enlarged ventricles and reduced gray matter. Additionally, dopamine dysregulation (the brain’s neurotransmitter responsible for pleasure and reward) is strongly linked to the disorder. An excess of dopamine activity in certain brain regions is believed to contribute to hallucinations and delusions.

Environmental Factors: Environmental influences like prenatal exposure to viruses, malnutrition, and psychosocial stressors have been associated with schizophrenia. For example, maternal influenza in the second trimester of pregnancy has been linked to a higher risk of developing schizophrenia later in life. Take extra care of those expectant mothers in your life and spread the word. The quicker one seeks treatment, even for something as minor as a flu during pregnancy, the better.

Psychosocial Factors: Chronic stress, trauma, and substance abuse (especially cannabis use during adolescence) are also believed to increase the likelihood of developing the disorder. While these factors alone are not causal, they may trigger the onset of schizophrenia in genetically predisposed individuals.

When comparing schizophrenia between men and women, there are notable differences in onset, symptoms, and outcomes.

Here are the key statistical differences:

1. Age of Onset: Schizophrenia tends to manifest earlier in men than in women. The average age of onset for men is 18-25 years, while for women, it is typically 25-35 years. Men are more likely to experience their first psychotic episode in their late teens or early 20s, whereas women often see onset in their 30s or even later.
2. Prevalence: Schizophrenia is slightly more common in men than women. Research shows that men are about 1.4 times more likely to be diagnosed with schizophrenia than women. However, women may experience a second peak in incidence around menopause, potentially balancing the overall gender difference in older age.
3. Symptom Severity and Outcomes: Men tend to experience more severe negative symptoms (such as emotional blunting and lack of motivation) and have poorer outcomes overall. Women generally have better social functioning, fewer negative symptoms, and are more likely to respond well to treatment. However, women tend to have higher rates of mood disturbances and may experience more affective symptoms.

These gender-related differences highlight how schizophrenia can vary in its presentation and impact, necessitating tailored approaches to treatment and care for men and women.

Theories of Schizophrenia

Dopamine Hypothesis: This longstanding theory suggests that schizophrenia is largely due to an overactive dopamine system in the brain. This hypothesis was formed based on the effectiveness of dopamine-blocking antipsychotic drugs in treating positive symptoms (hallucinations and delusions).

Glutamate Hypothesis: Emerging research has pointed to the neurotransmitter glutamate’s role in schizophrenia. This theory proposes that an imbalance in glutamate activity contributes to cognitive deficits and negative symptoms of schizophrenia, such as emotional blunting or lack of motivation.

Neurodevelopmental Theory: This theory posits that schizophrenia results from abnormal brain development, which may begin in utero but only manifests in late adolescence or early adulthood. This view integrates genetic, environmental, and neurological factors, suggesting a more holistic understanding of the disorder.

Medical Interventions for Schizophrenia

Schizophrenia is typically treated with a combination of medication, therapy, and support services.

1. Antipsychotic Medications: These are the cornerstone of treatment. Typical antipsychotics (like haloperidol) and atypical antipsychotics (like risperidone and clozapine) help manage symptoms by regulating dopamine activity in the brain. While effective for reducing hallucinations and delusions, these medications can have side effects, such as weight gain, drowsiness, and tardive dyskinesia (involuntary muscle movements).
2. Clozapine: For treatment-resistant schizophrenia, clozapine is considered the gold standard. However, it requires regular blood monitoring due to the risk of agranulocytosis, a potentially life-threatening reduction in white blood cells.
3. Adjunctive Medications: In some cases, mood stabilizers or antidepressants are prescribed alongside antipsychotics to manage mood symptoms or anxiety that may accompany schizophrenia.

NOTE: It is very difficult for patients with schizophrenia to consistently take the medication that is the most helpful for them. Many times, these patients are noncompliant with the medication plan and thus can make their illness worse. This is a vicious cycle when seeking help for loved ones and can be very frustrating for both the family and the patient themselves. Because schizophrenia distorts the patient’s reality it may also be very difficult for them to realize they are perceiving reality differently than everyone else and thus, they oftentimes do not believe they need medication at all. Additionally, we hear a lot that the side effects of these medications are also troublesome and therefore prevents more people from taking the medications appropriately and thus effectively.

Non-Pharmacological Management of Schizophrenia

While medication is crucial, non-pharmacological approaches can complement medical treatment and significantly improve quality of life.

1. Cognitive Behavioral Therapy (CBT): CBT helps individuals challenge and manage distorted thoughts and beliefs. It’s particularly useful for managing hallucinations and delusions by teaching patients to question the validity of their perceptions and develop healthier ways to interpret their experiences.
2. Family Therapy: Family involvement is essential in managing schizophrenia. Psychoeducation for families can reduce relapse rates by providing relatives with coping strategies, improving communication, and reducing familial stress.
3. Social Skills Training: Schizophrenia can impair social functioning, making it difficult for individuals to form and maintain relationships. Social skills training focuses on teaching practical communication skills, improving self-awareness, and fostering greater independence.
4. Mindfulness and Relaxation Techniques: Mindfulness-based therapies (like Mindfulness-Based Stress Reduction, or MBSR) and relaxation exercises can help manage anxiety, stress, and depression, all of which may exacerbate schizophrenia symptoms.
5. Exercise and Diet: Regular physical activity has been shown to improve mental health by reducing anxiety and depression symptoms. Additionally, a healthy diet can mitigate some side effects of antipsychotic medications, such as weight gain and metabolic syndrome. Following something like the Mediterranean Diet would be ideal because it encourages eating foods that are high in omega-3 fatty acids, berries, leafy greens, whole grains, probiotics and fermented foods.
6. Occupational Therapy and Vocational Support: These services assist individuals with schizophrenia in finding employment or engaging in meaningful activities, boosting self-esteem and promoting recovery.

The Latest Research

Recent research in schizophrenia treatment has brought some promising advancements. One of the major breakthroughs is the development and FDA approval of Cobenfy (xanomeline/trospium chloride), a novel drug that targets schizophrenia symptoms in a different way than traditional antipsychotics. This medication indirectly affects the dopamine system via cholinergic receptors, altering acetylcholine activity, which has shown to reduce hallucinations and paranoia. Unlike older drugs, Cobenfy avoids many of the metabolic side effects like weight gain and sluggishness that are commonly associated with dopamine-targeting treatments. However, gastrointestinal side effects such as nausea and indigestion have been noted, and long-term effects remain to be evaluated beyond the five-week trials conducted so far (Brain & Behavioral Research) (HealthDay).

Another exciting area of research has been in the genetic underpinnings of schizophrenia. A recent study mapped cell-type-specific genetic risk factors, shedding light on how certain genetic mechanisms can impair synaptic plasticity, a key feature in schizophrenia. This kind of insight could lead to more targeted therapies, potentially correcting or compensating for these genetic disruptions (ScienceDaily).

Additionally, a new drug, KarXT, is being tested in phase 3 trials. It focuses on both positive and negative symptoms, targeting muscarinic acetylcholine receptors rather than the traditional dopamine pathway. Results so far indicate significant reductions in both types of symptoms, with fewer of the traditional side effects like motor issues or weight gain seen in dopamine-related treatments (Brain & Behavior Research).

These advances offer new hope for managing schizophrenia, especially for patients who have not responded well to conventional treatments or have been burdened by their side effects.

Cannabis and THC

The relationship between THC (tetrahydrocannabinol) and schizophrenia is a topic of increasing interest, especially as cannabis becomes more widely used. Research indicates that using THC can exacerbate symptoms of schizophrenia, particularly in individuals who are genetically predisposed to the disorder.

Here’s how THC plays into schizophrenia:

1. Triggering Onset in Vulnerable Individuals

THC use, especially during adolescence, has been linked to a higher risk of developing schizophrenia. Studies suggest that early cannabis use may accelerate or trigger the onset of the disorder in those who are genetically vulnerable. THC affects the brain’s endocannabinoid system, which regulates processes like cognition, mood, and memory. In susceptible individuals, THC can disrupt these processes, potentially contributing to the development of psychosis (ScienceDaily).

2. Worsening Symptoms

For individuals already diagnosed with schizophrenia, THC use can worsen symptoms, particularly hallucinations and delusions. This is due to THC’s impact on dopamine regulation, which is already dysregulated in schizophrenia. Increased dopamine activity, particularly in areas like the striatum, can lead to heightened positive symptoms, such as paranoia, auditory hallucinations, and other forms of psychosis (HealthDay).

3. Impact on Treatment

THC use can interfere with the effectiveness of antipsychotic medications, which are designed to stabilize dopamine levels in the brain. Some studies have shown that patients who use cannabis while undergoing treatment for schizophrenia experience more frequent relapses, higher hospitalization rates, and poorer overall outcomes (ScienceDaily). Additionally, THC can counteract the sedative effects of antipsychotic medications, making symptoms harder to manage.

4. THC vs. CBD

Interestingly, the psychoactive component of cannabis (THC) has negative associations with schizophrenia, but CBD (cannabidiol), another cannabinoid, has been studied for its potential antipsychotic properties. Some research suggests that CBD might reduce psychotic symptoms, though its effects are less understood compared to THC. This has led to the exploration of CBD-based treatments for schizophrenia, which could offer benefits without the risks posed by THC (HealthDay).

While cannabis use, specifically THC, may worsen schizophrenia or trigger its onset in at-risk individuals, more research is needed to fully understand the role of different cannabinoids, like CBD, in mitigating symptoms. Caution is advised for anyone with a family history or personal risk of schizophrenia when it comes to cannabis use.

Conclusion

Schizophrenia is a multifaceted disorder, shaped by genetic, environmental, and neurochemical factors. While medications are vital for managing symptoms, non-pharmacological interventions play an equally important role in improving the quality of life for individuals with schizophrenia. As our understanding of this condition evolves, so too should our approaches to treatment—balancing scientific research with compassionate care. People with schizophrenia have a 10–25-year reduced life expectancy compared to the general population. This is often due to the increased risk of suicide, cardiovascular disease, and other comorbidities​. If someone you know is in need of help or you think you might have schizophrenia, please reach out because it more manageable than ever before in history.

Written with the aid of ChatGPT for efficiency and brevity.

Helplines and support

India: Call the Vandrevala Foundation Helpline at 1860 2662 345 or 1800 2333 330

In the U.S.: Call 1-800-950-6264 or visit NAMI.org

UK: Call 0300 5000 927 or visit Rethink: Schizophrenia

Australia: Call 1800 18 7263 or visit Sane Australia

Canada: Visit Canadian Mental Health Association for links to helplines and services

Do you or someone you know need help?

If you would like to seek help for yourself for any mental health issues, please contact someone. If you think you may hurt yourself, someone else or attempt suicide, call 911 in the U.S. or your local emergency number immediately.

Also consider these options if you’re having suicidal thoughts:

• Call your doctor or mental health professional. Or 211 to speak to a live person about mental health options.
• Contact a suicide hotline.
  • In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential.
  • U.S. veterans or service members who are in crisis can call 988 and then press “1” for the Veterans Crisis Line. Or text 838255. Or chat online.
  • The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1-888-628-9454 (toll-free).
• Numerous Apps are now available to talk with someone in the privacy of your own home. Click here for a free app list. Other Apps include: Talkspace, BetterHelp, and Sanvello.
• Reach out to a close friend or loved one.
• Contact a spiritual leader or someone else in your faith community.

If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room. DO NOT leave them alone.

For readers interested in deeper research on this topic, the following references provide a robust foundation:

van Os, J., & Kapur, S. (2009). Schizophrenia. The Lancet, 374(9690), 635-645.

National Institute of Mental Health (NIMH). (2023). Schizophrenia: Overview and Treatment.

Owen, M. J., & O’Donovan, M. C. (2017). Schizophrenia and the Neurodevelopmental Continuum: Evidence from Genomics. World Psychiatry, 16(3), 227-235.