What is Schizophrenia?
The risk of developing schizophrenia is 1%, and the incidence is 1 case per 1000 population per year. The risk of developing schizophrenia increases with consanguineous marriages, with burden of the disease in families of relatives of the first degree of kinship (mother, father, brothers, sisters). The ratio of women to men is the same, although the detection of the disease in men is higher. Fertility and mortality of patients does not differ from the average population. The highest risk of developing the disease for the age of 14-35 years.
Causes of Schizophrenia
- The most recognized is the genetic nature of schizophrenia, which is justified as a result of studies of the risk of developing the disease in mono- and dizygotic twins, in siblings, parents and children, as well as as a result of the study of adopted children from parents suffering from schizophrenia. However, there is equally convincing evidence that schizophrenia is due to a single gene (monogenic theory) with varying expressivity and incomplete penetrance, a small number of genes (oligogenic theory), many genes (polygenic theory), or multiple mutations. Hopes are assigned to studies of translocations in the 5th chromosome and pseudo-autosomal region of the X chromosome. Therefore, the hypothesis of genetic heterogeneity of schizophrenia, in which, among others, there may also be sex-linked options, is most popular. Patients with schizophrenia probably have a number of advantages in natural selection, in particular, they are more resistant to pain, temperature and histamine shock, as well as to radiation. In addition, the average intelligence of healthy children in patients with schizophrenia is higher than the population for similar ages. Probably, the basis of schizophrenia is the schizotype – the carrier of schizotaxia markers, which, being a neutral integrative defect, manifests itself under the influence of environmental factors as a pathological process. One of the markers of schizotaxia is a violation of slow eye movements when observing a pendulum, as well as special forms of evoked brain potentials.
- Constitutional factors are involved in shaping the degree of expression and reactivity of the process. So, in women and male gynecomorphs, schizophrenia proceeds more favorably and with a tendency to periodicity, and after 40 years the course of the disease is also more favorable. In men of asthenic constitution, the disease proceeds more often continuously, and in women of a picnic constitution more often periodically. However, the constitution itself does not determine the susceptibility of the disease. Morphological dysplasia usually indicates a possible atypia of the process, and such patients are less susceptible to treatment.
- According to neurogenetic theories, the productive symptoms of the disease are due to dysfunction of the caudate nucleus of the brain, the limbic system. There is a mismatch in the work of the hemispheres, dysfunction of the fronto-cerebellar connections. On CT, expansion of the anterior and lateral horns of the ventricular system can be detected. With nuclear forms of the disease on the EEG, the voltage from the frontal leads is reduced.
- Rather, of historical interest are attempts to link schizophrenia with infectious (streptococcus, staphylococcus, tuberculosis, E. coli) and viral (slow infections) pathologies. However, in patients with schizophrenia, there is a clear distortion in the immune responses with the development of an infectious pathology.
- Biochemical studies have linked schizophrenia to excess dopamine. Blocking dopamine with productive symptoms of antipsychotics promotes patient relaxation. However, with a defect, there is a deficiency not only of dopamine, but also of other neurohormones (norepinephrine, serotonin), and with productive symptoms, not only the amount of dopamine increases, but also cholecystokinin, somatostatin, vasopressin. A variety of changes are noted in carbohydrate, protein metabolism, as well as in the metabolism of lipoproteins. Indirect evidence of metabolic disorders in schizophrenia is the presence of a specific odor in nuclear forms of the disease, chondrolysis (destruction and deformation with a defect in the cartilage of the auricle), earlier puberty with a rapid increase in the loss of libido.
- Theories of psychology explain the development of the disease from the point of view of reviving archaic (paleolithic, mythopoetic) thinking, the impact of a deprivation situation, selectively split information that causes semantic aphasia. Pathopsychologists find in patients: a) the diversity and ambivalence of judgments, b) egocentric fixation, in which judgments are made on the basis of their own motives, c) “latent” signs in judgments.
- Psychoanalytic theories explain the disease as childhood events: exposure to a schizophrenogenic, emotionally cold and cruel mother, a situation of emotional dissociation in the family, fixation or regression on narcissism, or latent homosexuality.
- Ecological theories explain the fact of predominant birth of patients with schizophrenia in the cold season due to prenatal vitamin deficiency, mutagenic exposure during the spring conception of a child.
- Evolutionary theories view the genesis of schizophrenia as part of the evolutionary process, either as a “fee” for increasing the average intelligence of a population and technological progress, or as a “hidden potential” of progress that has not yet found its niche. The biological model of the disease is the reaction of freezing-flight. Patients suffering from the disease have a number of selective advantages, they are more resistant to radiation, pain, and temperature shock. The average intelligence of healthy children in parents with schizophrenia is higher.
Diagnosis of Schizophrenia
The diagnosis is made on the basis of identifying the main productive symptoms of the disease, which are combined with negative emotional-volitional disorders, leading to the loss of interpersonal communications with a total follow-up of up to 6 months. The most important in the diagnosis of productive disorders is the identification of symptoms of effects on thoughts, actions and mood, auditory pseudo-hallucinations, symptoms of open thoughts, gross formal thinking disorders in the form of tearing, catatonic movement disorders. Among the negative violations pay attention to the reduction of energy potential, alienation and coldness, unjustified hostility and loss of contacts, social decline. The diagnosis is also confirmed by the data of a pathopsychological study, clinical and genetic data on the burden of schizophrenia of relatives of the first degree of kinship are of indirect importance.