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183 Schizophrenia Essay Topics & Examples

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🔝 Top 10 Schizophrenia Research Topics for 2024

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• Brain Abnormalities in Schizophrenia
• Risk Factors of Adolescent Schizophrenia
• Cognitive Impairment in Schizophrenia Patients
• Family Support in Schizophrenia Management
• Ways of Enhancing Social Skills in Schizophrenia
• Schizophrenia and Comorbid Medical Conditions
• Early Detection and Intervention in Schizophrenia
• Genetic and Environmental Factors in Schizophrenia
• The Relationship between Schizophrenia and Substance Use
• Efficacy of Antipsychotic Medicines and Side Effects
• Schizophrenia: An Informative View It discusses the symptoms of the disorder, the cause, and the impact it has on both the individual suffering from it and the people surrounding the victim, both within and outside the family unit.
• Schizophrenia in The Center Cannot Hold by Elyn Saks Nevertheless, in college, Saks faced stress due to the need to study, communicate, and care about herself and was left without the support of the Center, which led to the first episode of acute psychosis.
• Schizophrenia Explained by “A Beautiful Mind” It is a disease which can emotionally devastate the [patient as well as the relatives and the loved ones of the patient causes the patients to have hallucinations as well as delusions and even in […]
• The Movie “A Beautiful Mind” and Display of Schizophrenia This paper offers an in-depth analysis of the movie A Beautiful Mind to ascertain its display of schizophrenia as well as societal and cultural attitudes towards the disorder.
• Schizophrenia in ‘A Beautiful Mind’ Film The main symptom of a schizophrenic patient depicted in the film is the patient’s inability to distinguish between the real world and the subconscious pattern created within the imaginations of his mind.
• Freud’s Psychoanalysis for Schizophrenia Patients In this paper, the author’s approaches to this ailment are considered, and the ways of applying the specific observations of human behavior are discussed. Freud’s contribution to the development of psychoanalysis is significant, and his […]
• A Beautiful Mind: Understanding Schizophrenia and Its Impact on the Individual and the Family The psychological disorder presented in the movie refer to one of the most common of schizophrenia paranoia. The disorder, however, is still subjected to experimental treatments by means of medications and psychotherapy.
• Schizophrenia Symptomatology and Misdiagnosis Although it was previously believed that the incidence and prevalence of schizophrenia in men and women were approximately the same, newer studies point out that the use of more restrictive criteria for diagnosis results in […]
• Schizophrenia Patients Using Atypical Medication The research procedure follows a timed experiment with several trials beginning with a fixation point displayed in the middle of the black rectangle. A participant’s task is to identify accurate locations of the stimuli after […]
• Schizophrenia and Its Effects on the Brain This shows that functional variations are not a product of long consequences of the condition or therapy for the disorder, just like the structural alterations in gray matter and white matter.
• Negative versus Positive Symptoms of Schizophrenia Schizophrenia is a condition that hinders the ability of a person to think, feel, and act. In Schizophrenia, a decrease or absence of normal motivational and interest-related behaviors or expressions are referred to as negative […]
• The Brief Psychotic Disorder, Schizophreniform Disorder, and Schizophrenia People with “delusions, hallucinations, and disorganized behavior, with a return to normal functioning over a short time span” are diagnosed with a brief psychotic disorder.
• Schizophrenia and Schizoaffective Disorder He is calm and cooperative. There is no evidence of any suicidal or homicidal ideation, and he denies them as well.
• Schizophrenia: Causes and Symptoms People with this condition can live full lives and perform independently because of the accessibility of medicine, counseling, and support. Additionally, the ideal way to perceive Schizophrenia is when it is promptly diagnosed and treated.
• Schizophrenia: Neurochemical Theories and Medications The dopamine theory regarding schizophrenia, the serotonin theory of depression, and the glutamate theory will get discussed in detail in this paper. The dopamine hypothesis of schizophrenia holds that the overall neurotransmitters associated with dopamine […]
• Schizophrenia and Bipolar Disorder Portrayal in Mass Media Thus, the portrayal of the disorder in the media is the mix of symptoms that belong to bipolar I and II disorders in the textbook.
• Indian, Chinese, and American Approaches to Treating Schizophrenia Thus, the perception of mental illnesses in Chinese traditional medicine should be discussed it will benefit the patients and reduce the destructive effects such disorders as schizophrenia may have on one’s life.
• Health Information: Schizophrenia The critical components that I used to evaluate the sites are the owners, mission, references, and information review. The benefits of WebMD are that it mentions the author’s name and the person who medically reviewed […]
• Schizophrenia Spectrum and Psychosis Disorders Management The psychopharmacology of risperidone shows the correlation between the drug’s impact on the brain and the behavior of patients. The FDA addresses the management of risperidone based on its class and its mechanism of action.
• Schizophrenia: Case Analysis Paper The purpose is to inform the reader about a comprehensive case study with a schizophrenia diagnosis and the rationale for a nursing care plan.
• The Current Concept of Schizophrenia Is Neither Valid and Useful The primary research question is ‘Is the current concept of schizophrenia valid and useful?’ Hence, it is crucial to evaluate the empirical basis to answer the question and discuss the alternative system.
• Plan for Management of Patient with Schizophrenia and Heart Disease About 1% of the world’s population suffers from schizophrenia About 0. 7% of the UK population suffers from schizophrenia Schizophrenia can manifest any time from early adulthood onwards, but rarely when a person is below […]
• Quality of Life With Schizophrenia The main difference between the former and new guidelines in patients’ professional and personal life will only be that people with schizophrenia will have to consider the symptoms of their illness and maintain a distance […]
• Schizophrenia: The Etiology Analysis Disrupted epigenomic regulation in response to environmental triggers leads to decreased brain function and the onset of schizophrenia. The Khavari & Cairns, article focuses on the epigenomic factors that contribute to the development of the […]
• Schizophrenia as a Chronic Mental Disorder The first signs of the disease began to appear at the age of 28, which, according to his friend, coincided with the patient’s loss of a loved one.
• Schizophrenia and Its Effects on the Lives of Patients Schizophrenia is a mental disorder that affects the lives of patients diagnosed with the condition on multiple levels, as evident from the individual in question.
• Schizophrenia Diagnostics and Its Challenges In addition to the core symptoms of hallucinations, delusions, or persistent disorganized speech, schizophrenia may be manifested through psychosis, which accounts for the majority of acute admissions to the inpatient setting.
• Schizophrenia: Symptoms and Therapy Schizophrenia is a complex condition involving a number of cognitive, behavioral and emotional symptoms, all of which can present differently depending on the person. In addition, there are a number of symptoms that can help […]
• Schizophrenia Disorder: Definition, Treatment, and Medication Schizophrenia is linked to anatomical and functional alterations in the pallium, the layer of the unmyelinated neurons, as well as variations in the networks in the middle of cortical areas.
• Schizophrenia: Cause, Consequence, Care Considering the assessment above, the diagnosis of paranoid schizophrenia can be established due to Caroline’s concerns about being a target for her social environment.
• Social Risk Factors for Schizophrenia However, genetic predisposition is not the only risk factor for psychoses in general and schizophrenia in particular. One of them is possibly social isolation, as most patients used to be somewhat reserved in their childhood […]
• Analysis of Article Related to Schizophrenia Treatment The objective of the study is to evaluate the effectiveness and safety application of cannabidiol as an adjunctive treatment for patients with schizophrenia.
• Neuroscience: Schizophrenia and Neurotransmitters From the definition of neurotransmitters, it is clear that schizophrenia is caused by the irregular functioning of neurotransmitters. Physical abnormalities in the brain have been suspected to be causes of schizophrenia.
• Treatment Plan For Schizophrenia Patient Bill will fully recover and be in a position to perform the activities of the daily living on his own. Bill complies with the treatment regimen because treatment will help him recover and be in […]
• Mental Health: Analysis of Schizophrenia In the early years, signs related to the disease were said to be resulting from possession of evil spirits. The history of development in respect to mental health can be traced to antiquity.
• Paranoid Schizophrenia: Psychosocial Rehabilitation The behavior of being a social loner is reinforced by the indoor equipments that motivate his stay in the house. Barhof et al, explains that recognition of the value or importance of change is wholly […]
• Principles and Practice of Psychosocial Rehabilitation: Schizophrenia The objective of this study was to evaluate the literature accumulated so far and address the issues surrounding the principles and practice of Psychosocial Rehabilitation.
• Schizophrenia and Primary Care in Britain The illness causes distress in the form of severe suffering for the patient, his family and friends. The annual costs for care and treatment of schizophrenia in the United Kingdom in the 1990s were 397 […]
• Impact of Drug Use on Schizophrenia and Its Treatment The basis for the behaviors exhibited by schizophrenics, described in particular in the current case: paranoia, severe excitation coupled with periods of gloom and darkness, and a desire to commit suicide, are signs of drug […]
• The Schizophrenia Drugs: Lithium and Abilify Lithium overdose affects primarily two systems of the human body: the central nervous system and the kidneys since it is through the latter that the drug is excreted from the body.
• Collaborative Care in a Schizophrenia Scenario For example, the social worker will be in a position to emphasize the human dimensions of the problem, such as Simon’s preferences and social aspirations.
• Alcoholism and Schizophrenia: Interconnection In addition to its physical effects on the chronic drinker’s body, alcohol is associated with a variety of mental impairments. Alcoholic dementia and Wernicke-Korsakoff syndrome are among the most prominent concerns in the matter. The former is a blanket term for a variety of cognitive deficiencies caused by the substance. The latter is a two-stage […]
• “Schizophrenia: A Sibling’s Tale” by Stephan Kirby The primary purpose of this article seems to inform the readers about the effective strategies that can be implemented in order to help the families of the affected people to go through a number of […]
• Schizophrenia and Workplace Behaviors Besides, their condition and performance at work may be significantly improved in case of a proper help from the company’s leadership.
• Schizophrenia and Health Strategy Proposal The use of qualitative analysis is thus justified, since the amount of detail and quality of information required would only be provided using this method.
• Schizophrenia and Biological Therapeutic Approach The level of social stigma associated with this condition has been identified as a major obstacle to the recovery of patients from this condition.
• Schizophrenia: An Abnormal Human Behavior Despite there not being a cure for the disorder as yet, there are current treatments available and meant to eliminate the majority of symptoms associated with the disorder thus enabling such individuals to live healthy […]
• Schizophrenia & Neurosis and Lifespan Development The learning objectives are to comprehend worrying conduct in the scope of the growth missions, series, and procedures that show human development.
• Schizophrenia Diagnostic Assessment As is mentioned above, the client does not understand or is not able to see the original appearance of objects and people around her.
• Analyzing Psychological Disorders: Schizophrenia Nevertheless, the damage to the brain as a result of this disorder seems to target two main areas: the frontal lobe, and the parietal cortex.
• Schizophrenia Study and Rehabilitation Outcome In fact, the results of this prospective study can reasonably be projected to the universe of Germans with mental disorders only if Rehabilitation Psychisch Kranker in the city of Halle is a kind of secondary […]
• Theme of Schizophrenia in “Slaughterhouse-Five” by Kurt Vonnegut The Tralfamadorian subplot includes a vision of the end of the world and the perpetuation of war, but these seem distant threats compared with the miseries of battlefield.
• Schizophrenia in Adults: Causes, Diagnosis, and Management Among the usual characteristics of schizophrenia is low motivation; which consequently makes the victim withdraw from other members of the society.”Although studies have shown that, women are equally likely to develop the mental disorder as […]
• Schizophrenia Causes, Symptoms, and Risk Factors This paper aims to research and analyze the causes, symptoms and the risk factors associated with the mental disease and discuss some of the prevention measures of the disease.
• Haldol and Negative Symptoms of Schizophrenia Very often this disease is treated with the help of haloperidol, a kind of injection used as a medicine against brain disorders and psychotic states.
• Schizophrenia: The Role of Family and Effect on the Relations The role of family members and other social support is essential and form part of the management of this illness. The illness causes the others in the family to have stress.
• Schizophrenia as a Common Mental Disorder Before a patient is diagnosed to have schizophrenia, the person must have two or more of the following symptoms for at least a month according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth […]
• Delusional “Pseudotranssexualism” in Schizophrenia But it was in the middle of the twentieth century that the name transsexualism was fixed for this disorder for the first time by Cauldwell and after a few years Benjamin in the US and […]
• Schizophrenia Symptoms, Etiology, and Treatment The treatment as well as the prognosis for recovery is highly dependent on the stage in which schizophrenia is diagnosed and the age of first onset.
• Schizophrenia Causes and Treatment Analysis There exist several theories about the causes of schizophrenia, the most convincing of them are: the theory of genetic predispositions, the theory of prenatal or vital antecedents and the theory of social and environmental causes.
• Schizophrenia: Characteristics, Types and Symptoms This disease is a type of brain disease which if remain unnoticed affects the entire personality and life of the patient.
• Schizophrenia: Biological & Environmental Causes The indications of schizophrenia are varied but the results are the same, causing a breakdown of individuality and the consequent inability of the personage to purpose in reality.
• Schizophrenia and Its Special Symptoms Talking to the patients in a way that could enhance their hopes in life and activities they usually engage in is one way of reducing patients’ overwhelmed, as well as keeping them with the hope […]
• Can Cannabis Cause Schizophrenia? Regarding this assignment, I am going to address the importance of this topic in the field of addiction and healthcare, assessing the research that suggests that cannabis plays a role in schizophrenia and the strengths […]
• People With Schizophrenia Diagnosis in Prisons As a result, the behavior of the individuals with the condition is a threat to the members of the family and the society.
• Schizophrenia Symptoms and Treatment Complications Schizophrenia is one of the most complex examples of these disorders because it leads to the inability to live independently and hold a job.
• Paranoid Schizophrenia in “A Beautiful Mind” The film A Beautiful Mind depicts the impact of progressive paranoid schizophrenia on the mathematician John Nash and the burden that it places on social and personal relationships.
• Schizophrenia: History and Diagnosis The process of diagnosing involves a comprehensive assessment of the patient’s symptoms, in which a specialist searches for the symptoms of schizophrenia and other disorders, which need to be ruled out for the diagnosis to […]
• Schizophrenia Diagnosis, Planning and Treatment Peter is 18 years old He lives at home with his parents. The patient has gained 20 pounds without any diet changes His glucose is at 145 He has not been taking his Olanzapine […]
• Schizophrenia Research: Ethical Principles and Steps The issue of beneficence is also put into consideration to ensure the research is done to improve the well being of the subjects and the society at large.
• Prevention of Suicide in People with Schizophrenia As a strategy to prevent suicide in schizophrenic patients, the drugs are aimed at controlling the symptoms associated with the condition.
• Readmissions in Schizophrenia and Reduction Methods After this, the regression model will be developed applying the variables associated with predictors of readmission and the dichotomous variable as the outcome.
• Schizophrenia Therapy: “People Matter” by Marley The study indicates how the targeted respondents supported the “use of different interpersonal interactions towards reducing the symptoms associated with schizophrenia”. This author supports the use of interpersonal interactions in every patient with schizophrenia.
• Schizophrenia Effects on Patient Development This essay explores schizophrenia in a bid to understand what it really is, how it affects the development and relational abilities of its victims, and why these effects qualify it as a mental disorder.
• Courtesy Stigma: Relatives of Schizophrenia Patients The quota sampling method was used in the research survey. In regards to the analytic strategy, the inductive formation of categories was used to analyze the transcripts.
• Schizophrenia and Cognitive Therapy Interventions The onset of the mental disorder usually occurs in the first half of life; however, many episodes of schizophrenia have been registered beyond the age of 60 years.
• Schizophrenia and Bipolar Disorder in Children and Adolescents It is acknowledged by the researchers that the symptoms indicate the possibility of bipolar disease and not schizophrenia. Psychiatric and physiological factors, among others, contribute to the prevalence of self-harm in children and young people.
• Schizophrenia Drugs’ Mechanism of Action In the case of M.Y.is can be useful to prescribe a second-generation antipsychotic, and if it proves to be ineffective, clozapine can be used.
• Schizophrenia Treatment: 25-Year-Old Male Patient The symptom of social isolation also contributes to the development of schizophrenia in Mr. Dashiell to identify the cause of the condition.
• Schizophrenia Hypothesis and Treatment The dopamine theory hypothesizes that the activation of post-synaptic dopamine receptors in the mesolimbic pathway of the brain increases dopaminergic activity, resulting in positive symptoms delusions and hallucinations.
• The Diagnostic Concept of Schizophrenia Cultural and historical contexts have largely influenced the perception of this mental disorder, and the assessment of this disease and its features in different cultures is not the same.
• Schizophrenia: Diagnosis and Treatment Approaches A detailed analysis of the factors that affect the patient’s condition, including the internal and the external ones, must be mentioned as one of the essential strengths of the studies that have been conducted on […]
• Schizophrenia in Young Men and Women Thus, the research of the problem among the young people is the primary task. The feelings of people with schizophrenia are contradictory and uncertain.
• Paranoid Schizophrenia in “A Beautiful Mind” Movie John Nash is the protagonist in the movie, A Beautiful Mind. The movie did a good job of depicting the disorder in John Nash.
• Schizophrenia, Ethical and Multicultural Issues For instance, the assumption that the absence of evidence implies the same outcomes as the actual absence of the disorder symptoms often hinders the process of determining and addressing schizophrenia in patients.
• Schizophrenia, Its Symptoms, Prevalence, Causes Noteworthy, hallucinations and delusions are reflections of the distortions of the human mind, which in turn causes distortions of the person’s perceptions and interpretations of reality.
• Pharmacological & Psychotherapeutic Schizophrenia Interventions The use of clozapine is a medical intervention that targets the biological functioning of patients by blocking serotonin receptors and thus bringing about the release of dopamine receptors in specific parts of the brain.
• Schizophrenia Effects on Patient, Caregiver, Society The purpose of this paper is to discuss the effects of schizophrenia on the victim, caregiver, as well as the society.
• Schizophrenia and the Reduction of Readmissions Thus, this research will be rather useful because it will discuss the effectiveness of self-management programs for people with schizophrenia and their influence on the reduction of readmissions.
• Self-Management Programs for Schizophrenia Therefore, the significance of the problem that is reviewed in this paper consists in the fact that the approaches to the treatment of schizophrenia can be optimized.
• Schizophrenia and Frequent Readmission Rates This literature review is focused on the exploration of self-management programs for patients with schizophrenia and their effectiveness in terms of the reduction readmission rates and the overall management of the condition.
• Schizophrenia and Its Functional Limitation The situation advances in severity with the age of the patient. This condition may affect work, social, training, and interpersonal relations and skills among people with the schizophrenia condition.
• Schizophrenia and Self-Management Programs In order to collect the data for further analysis that will help to answer the defined research question, it will be necessary to conduct the study allowing the researchers to track changes in behavior and […]
• Schizophrenia Readmissions Reduction: Data Analysis A simple random sampling technique will be used to select participants, and it implies that each respondent will be randomly chosen to take part in the study to avoid bias and ensure the validity of […]
• Readmission Rates in Schizophrenia Patients The purpose of this paper is to propose a research analyzing the frequency of admission rates among patients with schizophrenia treated with long-acting injectable antipsychotics or with oral antipsychotics.
• Eating Disorders, Insomnia, and Schizophrenia Of course, this readiness does not exclude the necessity to identify such people and provide the necessary treatment to them, which is proved to be effective.
• Schizophrenia as an Extreme Form of Schizotypy The use of Meehl’s model to expose extreme forms of schizotypy as a manifestation of schizophrenia also informs the findings of this paper. Nonetheless, the similarities between schizophrenia and schizotypy do not show that one […]
• Schizophrenia: Psychiatric Evaluation and Treatment Plan The purpose of this paper is to examine the symptoms characteristic for Oscar in order to determine whether it is necessary to conduct the psychiatric evaluation for the young man and propose the plan of […]
• Schizophrenia – Mental Health Disorder The neurotransmitters at the ending of the nerve cells transmit messages from one area to another nerve cell in the body.
• Schizophrenia: Symptoms and Treatment The positive symptoms of the disease incorporate hallucinations associated with hearing, illusions, and disordered language and behavior. The symptoms of schizophrenia captured in the DSM IV TR includes illusions, hallucinations, and disordered language.
• Undifferentiated Schizophrenia: Sally’s Case Sally could have inherited some patterns of the disease from her maternal grandfather and her mother’s continued smoking patterns and flu during her pregnancy.
• Schizophrenia Patients Biochemical and Behavioral Changes It is also important to note that microscopic studies on the tissues of brain have shown slight variations in the number of cells of the brain and their distribution patterns. Biochemical changes in the brain […]
• Schizophrenia and Delusional Disorder For example, a range of scholars have attempted to identify schizophrenia and the delusional disorder as phenomena. Therefore, the instances of delirium must be viewed as possible indicators of schizophrenia.
• Psychiatric Issues: Schizophrenia’s Demystify The web is an internet community that is dedicated to the provision of high-quality data, elucidation, and assistance to the kin, providers, and persons that have been impacted by the condition.
• Non-Clinical Indicators in Patients with Schizophrenia The collaboration between the clinicians and the family is beneficial to the patient especially in administering the daily routines of the patient.
• Schizophrenia: Pathophysiology and Treatment The treatment methods commonly in the application are based on a clinical research that has been conducted on the disease as well as on the experience of the physician on the treatment of the disease.
• Schizophrenia: Description, Development and Treatment According to Van Dyke, schizophrenia begins to develop in the early adulthood years of the victim from the age of 15 to 30 years.
• A Critical Examination of the Link between Nicotine Dependence and Schizophrenia Over the years, there have been strong indications that heavy cigarette smoking can be linked to schizophrenia and that smoking may have a connection to the neurobiology of schizophrenic illness.
• Schizophrenia Genetic and Environmental Factors The research paper explores schizophrenia by providing a general overview, a comprehensive discussion of clinical synopsis, genetics and environmental factors in relation to schizophrenia, limitations of the methods of analyses, and a clear demonstration of […]
• Childhood Schizophrenia: Causes and Management of This Mental Disorder Hardman et al.are of the view that the risk of a child suffering from this condition is one percent when there are no recorded cases of the condition in the family.
• Dimensional Approaches to Schizophrenia and their Inclusion in the DSM-V The inclusion of the dimensional diagnosis of schizophrenia and other disorders to DSM-V will help to avoid some of the problems that are currently faced by the system.
• Smoking as Activity Enhancer: Schizophrenia and Gender Once learning the effects which nicotine has on people’s health and the relation between gender and schizophrenia, one can possibly find the ways to prevent the latter and to protect the people in the high-risk […]
• Clinical and Neuropsychological Characteristics in Subjects With Schizophrenia The need to understand the complex interplay between a number of variables, including genetics, environmental factors, clinical, psychological and social processes, in the development of brain disorders and the resultant behavioural and cognitive deficiencies informed […]
• Psychological Classification of Schizophrenia The paper is composed of a matrix that gives detailed information on the major DSM IV-TR categories of schizophrenia and psychosis, and lifespan development as well as the various classifications of schizophrenia and psychosis, and […]
• Cognitive Behavioural Therapy in Schizophrenia The basic idea in cognitive therapy is the fact that the cognitive aspect of esteem, the way we perceive problems, the world, and other mundane aspects of life like expectations and beliefs are chief determinants […]
• Schizophrenia a Psychological Disorder The main purpose of this research study was to investigate the relationship between Schizophrenia and reading impairments that are usually experienced by individuals when assessed in terms of Oculomotor Control and phonological Processing The research […]
• Homelessness and Schizophrenia It is essential to consider that lack of a proper home can exert pressure in an individual, to the extent of mental burdening.
• Should Persons Suffering From Schizophrenia Be Forced to Take Medications? Though many studies have pointed out that its causes are poorly understood, Dora is of the view that it results from the interplay of the immediate environment that a person is exposed to and the […]
• Bipolar Disorder and Schizophrenia Genetically, an alteration in the serotonin, dopamine and glutamate genes may be the cause of the disease. Therefore, the close interactions of genetic, psychological and environmental factors lead to severe cases of bipolar disorder.
• Schizophrenia, Psychosis and Lifespan Development Schizophrenia is a complicated condition not only due to its nature but also due to the fact that it results from a wide range of factors.
• Diagnosis and Treatment of the Schizophrenia The prevalence rate of the disease is around 1% in the whole world and despite the fact that its rate is higher among the poor; there is no much difference from one culture to another. […]
• Physical Health and Its Relations to Schizophrenia Smith is the fact that the disease got him at a time in life when he wanted to settle in marriage and due to the changes brought about by the mental disorder, he lost his […]
• Neurological Disorder: Effects of Schizophrenia on the Brain and Behavior Furthermore, as identified earlier, the neurological basis of the disorder may also involve abnormalities in the structure of the forebrain, the hindbrain and the limbic system.
• What Makes Schizophrenia One of the Worst Mental Illnesses?
• Are Bipolar Disorder and Schizophrenia Neuroanatomically Distinct?
• What Predicts Stigmatization About Schizophrenia?
• How and Why Affective and Reactive Virtual Agents Will Bring New Insights on Social Cognitive Disorders in Schizophrenia?
• What Do Visual Illusions Teach Us About Schizophrenia?
• Can Neurostimulation Prevent the Risk of Alzheimer’s Disease in Elderly Individuals With Schizophrenia?
• How Can Nurses Deal With a Patient With Paranoid Schizophrenia?
• What Is Connection Between Schizophrenia and Social Isolation?
• Are Continuum Beliefs About Psychotic Symptoms Associated With Stereotypes About Schizophrenia?
• What Is the Link Between Drug Addiction and Underdiagnosed Schizophrenia?
• How Does Gray Matter Effect Schizophrenia and Bipolar?
• What Is Schizophrenia Disorder?
• Can N-Methyl-D-Aspartate Receptor Hypofunction in Schizophrenia Be Localized to an Individual Cell Type?
• How Should People With Schizophrenia Be Treat?
• Are Patients With Schizophrenia Impaired in Processing Non-emotional Features of Human Faces?
• How Does Schizophrenia Affect Development and Aging?
• Did Andrea Yates Have Schizophrenia?
• How Does Schizophrenia Affect the Lifespan?
• Are Patients With Schizophrenia Spectrum Disorders More Prone to Manifest Nocebo-Like-Effects?
• How Does the Environment Influence Schizophrenia and Possible Prevention?
• Does Co-morbid Obsessive-compulsive Disorder Modify the Abnormal Language Processing in Schizophrenia Patients?
• How Will the Mild Encephalitis Hypothesis of Schizophrenia Influence Stigmatization?
• Are People With Schizophrenia Dangerous and Unpredictable?
• Does Non-adherence Increase Treatment Costs in Schizophrenia?
• What Are the Major Main Barriers to Treatment of Schizophrenia?
• Is Schizophrenia an Incurable Mental Illness?
• How Do Genetic Factors Contribute to the Development of Schizophrenia?
• Is Any Particular Race More Vulnerable to Schizophrenia?
• How Does Schizophrenia Affect People Who Live In States That Opted Out of the State Healthcare Exchanges?
• Is Schizophrenia a Genetically Transmittable Illness?
• How Do Environmental Factors Contribute to the Development of Schizophrenia?
• What Are the Most Effective Pharmacological Interventions for Managing Positive and Negative Symptoms of Schizophrenia?
• How Does Early Intervention Impact the Long-Term Outcomes of Individuals with Schizophrenia?
• What Are the Most Common Cognitive Deficits Experienced by Schizophrenia Patients?
• How Can Dual Diagnosis Treatments for Substance Use and Schizophrenia Be Optimized?
• What Are the Treatment Considerations for Managing Schizophrenia in Young Adults?
• How Can Family Psychoeducation and Support Programs Help Improve Treatment and Outcomes in Schizophrenia?
• What Are the Social Functioning Difficulties Faced by Individuals with Schizophrenia?
• How Can Holistic Care Approaches Help Address Physical Health Comorbidities Associated with Schizophrenia?
• How Can Neuroimaging and Brain Research Advancements Contribute to Our Understanding of Schizophrenia?
• A Multimedia Presentation Explaining the Neurobiological Basis of Schizophrenia
• An infographic that Educates the Public about Early Warning Signs and Symptoms of Schizophrenia.
• A Survey Assessing the Awareness and Understanding of Schizophrenia in the School Community.
• Video Simulation Demonstrating the Experiences of Individuals Living with Schizophrenia
• Plan of a Mental Health Awareness Event to Reduce the Stigma Surrounding Schizophrenia
• Research Paper on the Impact of Family Support on Improving Outcomes of Schizophrenia Patients
• Interviews with Schizophrenia Patients and Their Families
• A Classroom Presentation on the Connection Between Creativity and Schizophrenia
• Literature Review on the Effectiveness of Cognitive Remediation Interventions for Schizophrenia
• Mental Health Awareness Campaign Focused on Schizophrenia
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Schizophrenia Research Paper

This sample schizophrenia research paper features: 6600 words (approx. 22 pages), an outline, and a bibliography with 6 sources. Browse other research paper examples for more inspiration. If you need a thorough research paper written according to all the academic standards, you can always turn to our experienced writers for help. This is how your paper can get an A! Feel free to contact our writing service for professional assistance. We offer high-quality assignments for reasonable rates.

Schizophrenia is a psychotic disorder characterized by disturbances in thought, emotion, and behavior. This research paper discusses the symptoms, etiology, treatment, and other pertinent issues concerning this mental illness.

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Get 10% off with 24start discount code, i. description and classification, a. symptoms, 1. delusions, 2. hallucinations, 3. disorganized speech, 4. disorganized or catatonic behavior, 5. negative symptoms, b. variability of symptoms among patients, c. subtypes of schizophrenia, ii. history, iii. demographic characteristics of schizophrenia, a. sex differences, b. social class differences, iv. life functioning and prognosis, a. long-term course, b. premorbid characteristics of schizophrenia, v. etiology: theories and research findings, a. brain abnormalities in schizophrenia, b. biochemical factors, c. genetics, d. obstetrical complications, e. viral infection, f. diathesis-stress model, vi. treatment and therapy, a. antipsychotic medication, b. psychological treatment, vii. summary.

Delusions are the primary example of abnormal thought content in schizophrenia. Delusional beliefs conflict with reality and are tenaciously held, despite evidence to the contrary. There are several types of delusions. Delusions of control is the belief that one is being manipulated by an external force, often a powerful individual or organization (e.g., the FBI) that has malevolent intent. Delusions of grancleur refers to patients’ beliefs that they are especially important and have unique qualities or powers (e.g., the capacity to influence weather conditions). In contrast, some patients express the conviction that they are victims of persecution or an organized plot, and these beliefs are referred to as delusions of persecution. Examples of more specific delusions include thought broadcasting, the patient’s belief that his or her thoughts are transmitted so that others know them, and thought withdrawal, the belief that an external force has stolen one’s thoughts.

Hallucinations are among the most subjectively distressing symptoms experienced by schizophrenia patients. These perceptual distortions vary among patients and can be auditory, visual, olfactory, gustatory, or tactile. The majority of hallucinations are auditory in nature and typically involve voices. Examples include the patient hearing someone threatening or chastising him or her, a voice repeating the patient’s own thoughts, two or more voices arguing, and voices commenting. The second most common form of hallucination is visual. Visual hallucinations often entail the perception of distortions in the physical environment, especially in the faces and bodies of other people.

Other perceptual distortions that are commonly reported by schizophrenia patients include feeling as if parts of the body are distorted in size or shape, feeling as if an object is closer or farther away than it actually is, feeling numbness, tingling, or burning, being hypersensitive to sensory stimuli, and perceiving objects as flat and colorless. In addition to these distinctive perceptual abnormalities, persons suffering from schizophrenia often report difficulties in focusing their attention or sustaining concentration on a task.

It is important to note that in order for an unsubstantiated belief or sensory experience to quality as a delusion or hallucination, the individual must experience it within a clear sensorium (e.g., unsubstantiated sensory experiences that occur only upon awaking from sleep or when falling asleep would not qualify as delusions). Thus, for example, if a patient reports hearing something that sounds like voices when alone, but adds that he or she is certain that this is a misinterpretation of a sound, such as the wind blowing leaves, this would not constitute an auditory hallucination.

The DSM uses the term disorganized speech to refer to abnormalities in the form or content of the individual’s verbalizations. It is assumed that these abnormalities reflect underlying distortions in the patient’s thought processes. Thus the term thought disorder is frequently used by researchers and practitioners to refer to the disorganized speech that often occurs in schizophrenia.

Problems in the form of speech are reflected in abnormalities in the organization and coherent expression of ideas to others. One common abnormality of form, incoherent speech, is characterized by seemingly unrelated images or fragments of thoughts that are incomprehensible to the listener. The term loose association refers to the tendency to abruptly shift to a topic that has no apparent association with the previous topic. In general, the overall content of loosely associated speech may be easier to comprehend than incoherent speech. In perseverative speech, words, ideas, or both are continuously repeated, as if the patient is unable to shift to another idea. Clang association is the utterance of rhyming words that follow each other (e.g., “a right, bright kite”). Patients choose words for their similarity in sound rather than their syntax, often producing a string of rhyming words.

The overt behavioral symptoms of schizophrenia fall in two general areas: motor functions and interpersonal behavior. Motor abnormalities, including mannerisms, stereotyped movements, and unusual posture, are common among schizophrenia patients. Other common signs include bizarre facial expressions, such as repeated grimacing or staring, and repeated peculiar gestures that often involve complex behavioral sequences. As with other symptoms of the psychosis, the manifestation of motor abnormalities varies among individuals. Schizophrenia patients sometimes mimic the behavior of others, known as echopraxia, or repeat their own movements, known as stereotyped behaviors. Although a subgroup of patients demonstrate heightened levels of activity, including motoric excitement (e.g., agitation or flailing of the limbs), others suffer from a reduction of movement. At the latter extreme, some exhibit catatonic immobility and assume unusual postures that are maintained for extended periods of time. Some may also demonstrate waxy flexibility, a condition in which patients do not resist being placed into strange positions that they then maintain. Catatonia has decreased dramatically in recent decades, so that it is now rare. Several researchers have attributed this decline to the introduction of antipsychotic medication (described later).

In the domain of interpersonal interactions, schizophrenia patients frequently demonstrate behaviors that are perceived as bizarre or inappropriate by others. For example, it is not uncommon for patients to use socially unacceptable language and unusual tones of voice, or to show overly dependent or intrusive behavior. Another common symptom, inappropriate affect, involves unusual emotional reactions to events and experiences. For example, patients may laugh at a sad or somber occasion, or be enraged by insignificant events. Finally, many patients manifest increasingly poor hygiene as their illness progresses. Their appearance may also be marked by disheveled clothing or inappropriate clothing, such as gloves and coats in the summer.

The symptoms of schizophrenia can be classified into the general categories of positive and negative. Positive symptoms involve behavioral excesses and most of the symptoms described earlier fall in to this category (e.g., delusions, hallucinations, and bizarre behaviors). In contrast, negative symptoms involve behavioral deficits. Examples include fiat affect (blunted expressions of emotion), apathy, and social withdrawal. In the domain of verbal expression, schizophrenia patients who manifest a very low rate of verbal output are described as showing poverty of speech. Patients whose speech is normal in quantity, but lacks meaning, suffer from poverty of content. Recently, some researchers have suggested that positive and negative symptoms may be caused by different neural mechanisms.

It is important to mention that a reduction in overt displays of emotion does not necessarily imply that patients have less intense subjective emotional experiences than the average person. In fact, recent findings indicate that blunted emotional expressions can coexist with intense subjective feelings of emotion.

According to DSM-IV, patients must show two or more of the preceding five symptoms to meet the diagnostic criteria for schizophrenia. Thus, no one of these symptoms is required for the diagnosis. Furthermore, the following four criteria must also be met: (1) the patient shows marked deterioration in occupational, interpersonal, or domestic functioning; (2) the patient manifests continuous signs of symptoms or dysfunction for at least 6 months; (3) the patient does not manifest predominant signs of mood disturbance (e.g., depression or mania); and (4) the symptoms are not caused by substance abuse or a primary medical condition.

Because the diagnostic criteria for schizophrenia are relatively broad, with no one essential symptom, there is a great deal of variability among patients in their symptom profiles. It has therefore been proposed that schizophrenia is a heterogeneous disorder with multiple causes. It is also the case, however, that patients must show a marked and persistent impairment to meet the diagnostic criteria for schizophrenia. Thus, those who meet criteria for the diagnosis are significantly impaired in everyday functioning. For many individuals who are diagnosed with schizophrenia, independent functioning is never achieved.

The DSM lists five subtypes of schizophrenia. In schizophrenia of the paranoid type, delusional concerns about persecution and/or preoccupation with threat dominate the clinical presentation, although delusions of grandeur are also often present. Disorganized schizophrenia is distinguished by extremely incoherent speech and behavior, as well as blunted or inappropriate affect. In catatonic schizophrenia, the clinical picture is dominated by abnormalities in movement and posture, such as those described earlier. Patients classified as having undifferentiated schizophrenia do not meet criteria for any of the previous subtypes. Finally, the diagnosis of residual schizophrenia is applied to patients who have had at least one episode of schizophrenia and who continue to show functional impairment, but who do not currently manifest any positive symptoms.

During the late 1800s and early 1900s, Emil Kraepelin and Eugen Bleuler provided the first conceptualizations of schizophrenia. Kraepelin defined “dementia praecox,” the original term for schizophrenia, as an endogenous psychosis characterized by intellectual deterioration (dementia) and early onset (praecox). Kraepelin included negativism, hallucinations, delusions, stereotyped behaviors, attentional difficulties, and emotional dysfunction as major symptoms of the disorder. Kraepelin’s work focused on description and phenomenology, leaving subsequent researchers to investigate the cause or causes of the disorder.

In contrast to Kraepelin, Eugen Bleuler, a Swiss psychiatrist, proposed a broader view of dementia praecox, with a more theoretical emphasis. Bleuler contested two of Kraepelin’s defining assumptions: specifically, that the psychosis was typically characterized by early onset and intellectual deterioration. Bleuler attempted to identify an underlying commonality among the diverse variations of what Kraepelin referred to as dementia praecox and concluded that all of the patients suffered from a “breaking of associative threads,” causing a disharmony among communicative and thought processes. He believed this abnormality accounted for the problems of thought, emotional expression, decision making, and social interaction associated with schizophrenia. Guided by the defining principle of disharmonious mental structures, Bleuler renamed the disorder “schizophrenia,” meaning “split mind.”

In the early to mid-1900s, American psychiatrists continued to use a broad definition of schizophrenia. The distinction between process and reactive schizophrenia was considered important, however, because it was assumed to distinguish between cases characterized by gradual deterioration (process) and cases that were precipitated by acute stress (reactive).

During this time, some clinicians and researchers viewed the specific diagnostic criteria for the major mental illnesses (schizophrenia, bipolar disorder, major depression) as artificial and discretionary, and used instead flexible and inconsistent standards for diagnoses. Studies that compared the rates of disorder across nations revealed that schizophrenia was diagnosed at a much higher rate in the United States than in Great Britain and some other countries. This national difference resulted from the use of broader criteria for diagnosing schizophrenia in the United States. Many patients who were diagnosed as having depression or bipolar disorder in Britain were diagnosed with schizophrenia in the United States. Because subsequent revisions in the DSM have included more restrictive criteria for schizophrenia, U.S. diagnostic rates are now comparable with other countries.

In addition to a more restrictive definition of schizophrenia, subsequent editions of the DSM have included additional diagnostic categories that contain similar symptoms. Thus the range of “schizophrenia spectrum disorders” continue to broaden with the description of variants of schizophrenia, such as schizoaffective disorder, which is characterized by a mix of affective and psychotic symptoms. The diagnostic category of schizophreniform disorder was also added. This diagnosis is given when the patient shows the typical symptoms of schizophrenia, but does not meet the criterion of 6 months of continuous illness.

Estimates of the prevalence of schizophrenia converge at around 1% of the population. Although there is evidence of cross-national differences in the rate of schizophrenia, the differences are not large (i.e., 1 to 2% difference). It is, in fact, striking that the rate of occurrence is so consistent across cultures.

The modal age at onset of schizophrenia is in early adulthood, usually before 25 years of age. Thus most patients have not had the opportunity to marry or establish a stable work history before the onset of the illness. As a result of this, and the often chronic nature of the illness, many patients never attain financial independence. It is relatively rare for preadolescent children to receive a diagnosis of schizophrenia. Similarly, it is rare for individuals beyond the age of 40 to experience a first episode of the illness.

Although it has traditionally been assumed that there is no sex difference in the rates of schizophrenia, some recent research findings indicate that a somewhat larger proportion of males than females meet the DSM-IV criteria for the disorder. Nonetheless, the overall rates do not differ dramatically for men and women. It is well established, however, that women are more likely to have a later onset of illness, as well as a better prognosis. Women also show a higher level of interpersonal and occupational functioning during the period prior to illness onset. The reasons for this sex difference are not known, but it has been proposed by several theorists that the female sex hormone, estrogen, may function in attenuating the severity of the illness.

Compared with the general population averages, schizophrenia patients tend to have significantly lower incomes and educational levels. Poor urban inner city districts, inhabited by the lowest socioeconomic class, contain the largest proportion of schizophrenia patients. There is a sharp contrast between the rates of schizophrenia in the lowest socioeconomic class and all other levels, including the next higher level. Findings from various cultures suggest that rates of schizophrenia are almost two times higher in the lowest social class group compared with the next lowest.

These social class differences appear to be a partial consequence of the debilitating nature of the illness. The social-drift theory suggests that during the development of schizophrenia, people drift into poverty. When the incomes and educational levels of the parents of patients are compared with those of the general population, the differences are not as striking.

There is, nonetheless, evidence that patients do come from families where the incomes and educational backgrounds of the parents are slightly below the average. These findings have led researchers to conclude that there may be a causal link between social class and risk for the illness. The sociogenic hypothesis posits that situational factors associated with low social class, such as degrading treatment from society, low levels of education, and few opportunities for achievement and reward, produce stress that contributes to the risk for schizophrenia.

Before the introduction of antipsychotic medications in 1950, the majority of patients spent most of their lives in institutional settings. There was little in the way of programs for rehabilitation. But contemporary, multifaceted treatment approaches have made it possible for most patients to live in community settings.

Of course, during active episodes of the illness, schizophrenia patients are usually seriously functionally impaired. They are typically unable to work or maintain a social network, and often require hospitalization. Even when in remission, some patients find it challenging to hold a job or to be self-sufficient. This is partially due to residual symptoms, as well as to the interruptions in educational attainment and occupational progress that result from the illness. However, there are many patients who are able to lead productive lives, hold stable jobs, and raise families. With the development of greater community awareness of mental illness, some of the stigma that kept patients from pursuing work or an education has diminished.

For about one third of patients, the illness is chronic and is characterized by episodes of severe symptoms with intermittent periods when the symptoms subside but do not disappear. For others, there are multiple episodes with periods of substantial symptom remission. About one third of those who receive the diagnosis eventually show a partial or complete recovery after one or two episodes.

Several factors have been linked with a more favorable prognosis for schizophrenia. Early treatment seems to be important in that the shorter the period between the onset of the patient’s symptoms and the first prescribed medication, the better the clinical outcome. Another indicator of better prognosis is a high level of occupational and interpersonal functioning in the premorbid period. Also, as noted earlier, women and patients who have a later onset of symptoms have a better long-term outcome.

Some of the difficulties experienced by individuals with schizophrenia can be observed before the onset of the clinical symptoms. Deficits in social skills, concentration, emotional expression, motivation, and occupational or academic performance often precede the first clinical symptoms. This period of gradual decline in functioning before the first illness episode is referred to as the prodromal phase.

However, there are often more subtle signs of dysfunction long before the onset of the prodromal period. Controlled studies using archival data sources, such as medical and school records or childhood home-movies, indicate that subtle differences are discernible as early as infancy in some patients. Individuals who succumb to schizophrenia in adulthood sometimes have abnormal motor development and show deficits in emotional expression and interpersonal relationships in early childhood. Cognitive impairment and difficult temperament have also been observed. During middle childhood and adolescence, researchers have found evidence of neurological abnormality, poor emotional control, social immaturity, and academic performance deficits. Premorbid behavioral problems often become marked through the adolescent years, and many exhibit behavioral disturbances and cognitive abnormalities that resemble the clinical symptoms of schizophrenia.

The causes of schizophrenia are unknown, but it is now widely accepted by both researchers and clinicians that schizophrenia is biologically determined. This is in striking contrast to the early and mid-1900s, when many subscribed to the theory that faulty parenting, especially cold and rejecting mothers, caused schizophrenia in offspring.

There are several sources of evidence for the assumption that schizophrenia involves an abnormality in brain function. First, studies of schizophrenia patients have revealed a variety of behavioral signs of central nervous system impairment, including motor and cognitive dysfunctions. Second, when the brains of patients are examined with in vivo imaging techniques, such as magnetic resonance imaging (MRI), many show abnormalities in brain structure. Similarly, postmortem studies of brain tissue have revealed irregularities in nerve cell formation and interconnections.

Laboratory studies of schizophrenia patients have revealed a variety of abnormalities, including irregularities in smooth pursuit eye movements, psychophysiological responses to sensory stimuli, and concentration. Research on the neuropsychological performance of schizophrenia patients was first conducted in the 1950s and continues to the present time. Individual neuropsychological tests are designed to measure functions subserved by specific regions or systems of the brain. An early finding in this area was that schizophrenia patients were the one psychiatric group whose performance on neuropsychological tests was indistinguishable from people with known brain damage. The findings suggested a generalized cerebral dysfunction in schizophrenia. However, patients show the most consistent deficits on tests of attention and memory, indicating dysfunction of the frontal and temporal lobes and the hippocampus. Further evidence of dysfunction in these brain regions is derived from poor performance on tests of executive functions: the ability to formulate, maintain, and adapt appropriate responses to the environment.

Brain-imaging studies of schizophrenia have yielded results that mirror those obtained from neuropsychological research. Some relatively consistent findings are that the brains of schizophrenia patients have abnormal frontal lobes and enlarged ventricles. Enlarged ventricles suggest decreased brain mass, particularly in the limbic regions, which are intimately involved in emotional processing. Furthermore, ventricular size correlates with negative symptoms, performance deficits on neuropsychological tests, poor response to medication, and poor premorbid adjustment. These associations between ventricular enlargement and both premorbid and postmorbid characteristics suggest that the brain abnormalities are long-standing, perhaps congenital.

In addition to brain structure, investigators have examined biological indices of brain function in schizophrenia. Functional brain-imaging studies, with procedures such as positron emission tomography (PET) and measurement of regional cerebral blood flow, reveal that schizophrenia patients have decreased levels of blood flow to the frontal lobes, especially while performing cognitive tasks.

Researchers are now pursuing the question of what causes the brain abnormalities observed in schizophrenia. Although as yet there are no definitive answers, investigators have made continuous progress in identifying factors that are associated with risk for the disorder.

The structural brain abnormalities that have been observed in schizophrenia support the assumption that it is a disorder of the central nervous system. But it has also been shown that similar structural abnormalities (i.e., ventricular enlargement and volume reductions) are present in other disorders, both neurological and psychiatric. It is therefore assumed that specific abnormalities in brain biochemistry may play a role in schizophrenia.

The functioning of the central nervous system is dependent on a host of chemicals that serve as the “messenger substances” among neurons. These chemicals or neurotransmitters have been the subject of intense investigation. Among the various neurotransmitters that have been implicated in the neuropathophysiology of schizophrenia is dopamine. Dopamine is viewed as a likely candidate for two main reasons: (1) drugs that act to enhance the release or activity of dopamine can produce psychotic symptoms, and (2) drugs that have been established to have antipsychotic properties (i.e., reduce psychotic symptoms) reduce the activity of dopamine in the brain. Current theories of the role of dopamine in schizophrenia have focused on dopamine receptors. There is evidence that there may be an abnormality in the number or sensitivity of certain dopamine receptors in the brains of schizophrenia patients. To date, however, this evidence remains inconclusive.

Several other neurotransmitters have also been hypothesized to play a role in schizophrenia. Current theories under investigation include a malfunction of the receptors for a neurotransmitter called glutamate and an abnormality in the balance between dopamine and serotonin (another neurotransmitter which, like dopamine, has been implicated in the pathogenesis of schizophrenia). As research findings on the biochemical aspects of schizophrenia accumulate, it increasingly appears that the illness may involve multiple neurotransmitters, with different biochemical profiles for different patients.

A convincing body of research supports the notion of a genetic predisposition to schizophrenia. Behavioral genetic studies of families, twins, and adopted offspring of schizophrenia patients indicate that an inherited vulnerability is involved in at least some cases of the disorder.

There is an elevated risk of schizophrenia for individuals with a biological relative who suffers from the disorder, and the risk rates increase as a function of the genetic closeness of the relationship. For example, it has been estimated that children of schizophrenia patients have a 9 to 15 % likelihood of developing the illness, siblings of patients have an 8 to 14% likelihood, and cousins have a 2 to 6% likelihood of being diagnosed with schizophrenia. Given the general population rate of approximately 1%, relatives of patients are at statistically increased risk. It must be noted, however, that relatives share common experiences as well as common genes. Therefore, examinations of the prevalence of schizophrenia in the relatives of patients cannot elucidate the relative contributions of environmental and genetic factors.

Some investigators have studied the development of adopted children whose biological mothers had schizophrenia. This approach has the potential to provide more conclusive information than family studies. The results of these investigations show that when biological offspring of schizophrenic mothers are reared from infancy in adoptive homes they are more likely to develop schizophrenia than are adopted children from healthy mothers. Furthermore, these children also exhibit a higher rate of other adjustment problems when compared with controls. Studies of this type have clearly illustrated that vulnerability to schizophrenia can be inherited.

Research on twins examines differences in concordance rates between identical (monozygotic or MZ) and fraternal (dizygotic or DZ) twins. Twin studies rely on the fact that MZ twins essentially share 100% of their genes. Thus, environmental influences account for any behavioral differences between MZ twins. In contrast, DZ twins are no more genetically similar than regular siblings; DZ twins do, however, share more similar environmental factors than do nontwin siblings. To date, the results of twin studies have consistently shown that MZ twins are significantly more likely to be concordant for schizophrenia than are DZ twins.

At the same time, it is important to note that in at least 50% of the cases in which one member of an MZ twin pair has schizophrenia, the other does not. Such “discordant” pairs have been the subject of a recent, comprehensive investigation in the United States. Among the most important findings from this research project are those from the MRI scans conducted on the twins. The ill twins in the pairs showed significantly more brain abnormalities than the healthy twins. Most notable were reductions in the volume of certain brain regions, especially the hippocampus, and increases in the size of the ventricles. These results clearly indicate the importance of environmental factors in the etiology of schizophrenia.

As is the case with many other disorders that involve brain dysfunction, there is evidence that schizophrenia is associated with exposure to prenatal and delivery complications. Obstetrical complications (OCs) are defined as physical deviations from the normal course of events during pregnancy, labor, or the neonatal period. Estimates of OCs in schizophrenics have been as high as 67%, significantly higher than the rate of OCs found in normal controls.

Among the prenatal factors that have been found to be associated with increased risk for schizophrenia are prenatal maternal nutritional deficiency, viral infection, bleeding, and toxemia. Complications of delivery that can result in hypoxia have also been linked with heightened risk for the disorder. Hypoxia, a deficiency in the amount of oxygen available to the fetus, can affect the development of various parts of the brain. Some researchers argue that hypoxia results in hippocampal damage, thus contributing to vulnerability for schizophrenia. Low birth weight, a neonatal complication, is another potential early factor contributing to schizophrenia. There is evidence that low birth weight is related to increased ventricular size, which is a common characteristic of schizophrenia patients.

The findings on prenatal complications support the notion that fetal brain development may be disrupted in individuals who later manifest schizophrenia. A central question raised by these findings concerns the nature of the etiologic role of OCs. Some hypothesize that OCs produce the neural predisposition to schizophrenia, whereas others posit that OCs exacerbate or interact with an existing genetic predisposition.

Findings from prospective, high-risk research projects lend support to the hypothesis that OCs interact with genetic vulnerabilities in the etiology of schizophrenia. High-risk studies involve the repeated assessment of children of schizophrenia patients, based on the expectation that a larger percentage of these children will eventually develop the illness than individuals in the general population. The high-risk method offers some advantages when compared with retrospective studies of the precursors of schizophrenia. One advantage is that it allows for the direct assessment of subjects in the premorbid period, as well as the selection and study of variables that are thought to have prognostic relevance. Furthermore, because a significant portion of the data collection takes place during the premorbid period, this reduces confounds that often occur in the study of diagnosed patients (e.g., medication and institutionalization).

Studies using the high-risk method have shown an interactive effect of genetic risk and exposure to OCs in predicting adult psychiatric outcome. In other words, the correlation between OCs and adult psychiatric symptoms was greater for offspring of schizophrenia parents than for children of healthy parents. The same pattern was apparent for the relation between OCs and adult brain morphology, suggesting that pre- and perinatal factors contribute to brain abnormalities.

As noted earlier, prenatal exposure to maternal viral infection has also been linked with schizophrenia. Specifically, the rate of schizophrenia is increased for cohorts who were in the second trimester during flu epidemics. Another source of evidence for the viral hypothesis is the finding that the births of schizophrenia patients do not seem to be randomly distributed throughout the course of the year. Instead, the births of schizophrenia patients occur more frequently in winter months.

Some researchers have suggested that postnatal viral infection may also be relevant to schizophrenia, and that the illness may be caused by a long-acting virus. This hypothesis claims that “slow viruses,” which are active over a long period of time, interact with a genetic predisposition to produce schizophrenia. Various findings are cited in support of this hypothesis. Some researchers have identified a viral infection in fatal catatonia, a disorder characterized by schizophrenia-like symptoms, suggesting that a similar viral infection may be found for schizophrenia. Other researchers have found signs of viral activity in the cerebrospinal fluid of patients with schizophrenia.

The diathesis-stress model has dominated theories about the etiology of schizophrenia for several decades. This model assumes that certain individuals inherit or acquire a vulnerability to schizophrenia (the diathesis), and that the behavioral expression of this vulnerability is determined or triggered by environmental stressors. Although “stress” was originally conceptualized as psychosocial in origin, contemporary versions of this model broaden the definition of stress to include prenatal and postnatal insults to the central nervous system. Thus the diathesis, combined with exposure to environmental stressors, can produce schizophrenia.

Exposure to stress within the context of the family has been the focus of researchers in the field. Families in which there is a schizophrenia patient show more conflict and abnormalities in communication than do other families. However, it has also been shown that there is greater conflict and more abnormalities of communication in families in which any member has a severe debilitating illness. Thus, family communication styles are unlikely to play a unique causal role in schizophrenia.

There is good evidence, however, that exposure to high levels of criticism from family members can increase the likelihood of relapse in schizophrenia patients. The number of critical comments, expressions of hostility, and emotional overinvolvement comprise a construct referred to as expressed emotion (EE). Recovering schizophrenia patients in families high in EE are much more likely to have a relapse compared with patients in families low in EE. There is also evidence from studies of the adopted offspring of schizophrenia patients suggesting that familial stress can hasten the onset of symptoms.

Before 1900, knowledge of the nature and causes of mental disorders was limited. Individuals with psychiatric symptoms, particularly psychotic symptoms, were typically viewed by others with disdain or amusement. However, social trends and advances in medical knowledge converged to produce greater sympathy for those with mental illness. This led, especially during the early part of the century, to the construction of public and private hospitals devoted to the care of the mentally ill.

Today, most schizophrenia patients experience at least one period of inpatient treatment. This is typically precipitated by the first psychotic episode. During this initial hospitalization, an extensive assessment is usually conducted to determine the most appropriate diagnosis. Treatment is then initiated to reduce symptoms and stabilize patients so that they can return to the community as soon as possible.

In the past, periods of hospitalization were longer in duration than they are today. This is due, in part, to the availability today of better medical treatments. Another factor that has contributed to shorter hospital stays is the deinstitutionalization movement. Initially spurred by concerns that too many of the mentally ill were becoming “institutionalized” and were losing their ability to function in the community, financial support for state psychiatric hospitals was gradually cut. But community support services and transitional living arrangements were not readily available to many patients. As a result, former psychiatric inpatients now constitute a substantial proportion of the homeless found in U.S. cities.

Introduced in the 1950s, antipsychotic medication has since become the most effective and widely used treatment for schizophrenia. Research indicated that the “typical” antipsychotics, such as haloperidol, decreased the symptoms of schizophrenia, especially positive symptoms, and reduced the risk of relapse. However, they were not as effective in reducing the negative symptoms. Furthermore, some patients showed no response to antipsychotic drugs.

Chlorpromazine (Thorazine) was among the first antipsychotic commonly used to treat schizophrenia. Since the 1950s, many other antipsychotic drugs have been introduced. Like chlorpromazine, these drugs reduce hallucinations, delusions, and thought disorder, and engender more calm, manageable, and socially appropriate behavior. As mentioned, all currently used antipsychotic drugs block dopamine neurotransmission. Thus it has been assumed that their efficacy is due to their capacity to reduce the overactivation of dopamine pathways in the brain.

Unfortunately, the benefits of standard or typical antipsychotic drugs are often mitigated by side effects. Minor side effects include sensitivity to light, dryness of mouth, and drowsiness. The more severe effects are psychomotor dysfunction, skin discoloration, visual impairment, and tardive dyskinesia (an involuntary movement disorder that can appear after prolonged use of antipsychotics). It is especially unfortunate that tardive dyskinesia is sometimes irreversible when patients are withdrawn from neuroleptics. Many of these physical signs are known to be caused by chronic blockade of dopamine pathways. Although additional medications can counter some of the negative effects of the typical antipsychotics, schizophrenia patients often resist taking them because of an aversion to the side effects.

Within the past decade, some new, “atypical” antipsychotic drugs have been introduced. It was hoped that these drugs would be effective in treating patients who had not responded to standard antipsychotics. Also, researchers hoped to identify medications that had fewer side effects. One example is Clozapine, released in 1990, which seems to reduce negative symptoms more effectively than typical antipsychotic drugs. Clozapine not only offers hope for patients who are nonresponsive to other medications, but it also has fewer side effects than typical antipsychotics. However, clozapine can produce one rare, but potentially fatal, side effect, agranulocytosis, a blood disorder. Consequently, patients who are on this medication must be monitored on a regular basis. It is fortunate that several other new antipsychotic medications have recently become available, and some of these appear to have no serious side effects.

It appears that it is important to begin pharmacological treatment of schizophrenia as soon as possible after the symptoms are recognized. The longer patients go without treatment of illness episodes, the worse the long-term prognosis. Medication also has the benefit of lowering the rate of mortality, particularly suicide, among schizophrenia patients. Patients who are treated with antipsychotic medication generally require maintenance of the medication to obtain continued relief from symptoms. Medication withdrawal often results in relapse. At the same time, the associated long- and short-term side effects of antipsychotics, especially the typical antipsychotics, are of continuing concern to patients, their families, and physicians. It is possible that future research on the neural mechanisms involved in schizophrenia will lead to the development of novel treatments that eliminate the need for maintenance medication.

Many schizophrenia patients also suffer from depression and, as noted, are at elevated risk for suicide. The reason or reasons for the high rate of co-occurance of depression with schizophrenia is not known. Given the debilitating and potentially chronic nature of schizophrenia, however, it is likely that some patients experience depressive symptoms in response to their condition. For others, depressive symptoms may be medication side effects or a manifestation of a biologically based vulnerability to depression.

Clinicians have used various forms of psychological therapy in an effort to treat schizophrenia patients. Early attempts to provide therapy for schizophrenia patients relied on insight-oriented or psychodynamic techniques. The chief goal was to foster introspection and self-understanding in patients. Research findings provided no support for the efficacy of these therapies in the treatment of schizophrenia.

It has been shown, however, that supportive therapy can be a useful adjunct to medication in the treatment of patients. Similarly, psychoeducational approaches that emphasize providing information about symptom management have proven effective in reducing relapse. Among the most beneficial forms of psychological treatment is behavioral therapy. Some psychiatric hospitals have established programs in which patients earn credits or “tokens” for appropriate behavior and then redeem these items for privileges or tangible rewards. These programs can increase punctuality, hygiene, and other socially acceptable behaviors in patients.

In recent years, family therapy has become a standard component of the treatment of schizophrenia. These family therapy sessions are psychoeducational in nature and are intended to provide the family with support, information about schizophrenia, and constructive guidance in dealing with the illness in a family member. In this way, family members become a part of the treatment process and learn new ways to help their loved one cope with schizophrenia.

Another critical component of effective treatment is the provision of rehabilitative services. These services take the form of structured residential settings, independent life-skills training, and vocational programs. Such programs often play a major role in helping patients recover from their illness.

It is now firmly established that schizophrenia is caused by an abnormality of brain function that in most cases has its origin in early brain insults, inherited vulnerabilities, or both. But the identification of the causal agents and the specific neural substrates responsible for schizophrenia must await the findings of future research. There is reason to be optimistic about future research progress. New technologies are available for examining brain structure and function. In addition, dramatic advances in neuroscience have expanded our understanding of the brain and the impact of brain abnormalities on behavior. We are likely to witness great strides in our understanding of the causes of all mental illnesses within the coming decades.

It is hoped that advances will also be made in the treatment of schizophrenia. New drugs are being developed at a rapid pace, and more effective medications are likely to result. At the same time, advocacy efforts on the part of patients and their families have resulted in improvements in services. But a further expansion of services is greatly needed to provide patients with the structured living situations and work environments they need to make the transition into independent community living.

Bibliography:

• Breier, A. (Ed.). (1996). The new pharmacotherapy of schizophrenia. Washington DC: American Psychiatric Press.
• Keefe, R. S., & Harvey, P. (1994). Understanding schizophrenia: A guide to the new research on causes and treatment. New York: Free Press.
• Miller, G. A. (Ed.). (1995). The behavioral high-risk paradigm in psychopathology. New York: Springer.
• Shriqui, C. L., & Nasrallah, H. A. (Eds.). (1995). Contemporary issues in the treatment of schizophrenia. Washington DC: American Psychiatric Press.
• Torrey, E. F. (1994). Schizophrenia and manic-depressive disorder: The biological roots of mental illness as revealed by the landmark study of identical twins. New York: Basic Books.
• Walker, E. F. (1991). Schizophrenia: A life-course developmental perspective. New York: Academic Press.

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My Schizophrenia Heroes: Elyn Saks and John Nash

A personal perspective: after i was diagnosed with schizophrenia, recovery stories inspired me..

Posted May 12, 2024 | Reviewed by Devon Frye

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When I was diagnosed with schizophrenia in 2007, I was adamantly opposed to the diagnosis and convinced it was absolutely wrong. I thought I was too strong and too smart to ever have schizophrenia.

However, several weeks following my diagnosis, slowly, I began to see my need for medication, realizing that the prescribed medicine actually cleared my mind and changed my behavior. At that time, I resolved to learn as much about schizophrenia as I could, and I am always still learning.

The fundamental and important things I learned were that schizophrenia is a brain disorder (not an emotional problem or a sign of weakness) and that schizophrenia is actually treatable. Thanks to some very encouraging conversations with one of my first doctors, I decided that I wanted treatment as much as I wanted the renewed life I was told it would bring.

Ever since then, I have been medication adherent. Treatment adherence brought me to a level of wellness that enabled me to graduate from college magna cum laude. Ten years ago, I published my memoir, and I established a charitable foundation in 2016 with my former psychiatrist.

Looking back, it would have been hard to move forward in my life without role models who had once been profoundly psychotic but had still found the treatment they needed to thrive academically and personally. I remember finding helpful blogs written by a young man living in California who graduated with his physics degree despite schizophrenia, as well as essays by other obscure authors who were doing very well thanks to faithful adherence to treatment.

I am grateful that these young people choose to share their triumphs online. Their stories gave me hope for recovery. In my work today, I often connect with persons who are thriving despite schizophrenia, and share their recovery stories on my foundation’s website (1).

Of these exceptional people I have discovered over the years, there were two who inspired me the most. They helped me confirm my decision to stay on medication and served as the role models I needed while I recovered and prepared to return to college in 2009. I greatly admire University of Southern California Law Professor Elyn Saks and the late mathematician John Nash.

Elyn Saks has worked as a law professor at USC since 1989, against all odds. She graduated from Yale Law School, following multiple very severe psychotic breaks. Before law school, she attended Vanderbilt University, graduating summa cum laude and as valedictorian. However, in her memoir, she describes that early signs of schizophrenia significantly affected her as an undergraduate, and she often neglected her personal hygiene.

During a hospitalization that took place soon after the start of law school, her treatment team contacted Yale to confirm that she would not be returning to school (which would have been illegal, by some standards, today). Elyn Saks struggled to find a medication that would enable her to focus on her studies, as the first antipsychotic medication that helped her mind left her unable to read, or even walk normally.

In her memoir, Elyn Saks describes periodic psychotic episodes throughout the course of her life, even many years after becoming a professor at the University of Southern California. Today, she also holds an honorary Ph.D. for her successful research and advocacy over many years. I wish I could personally thank Professor Saks and let her know that her story allowed me to see that it was possible to thrive at a high level despite schizophrenia.

John Nash was diagnosed with schizophrenia not long after the release of the very first antipsychotic medication in the world. Chlorpromazine (first released in France in 1952) was groundbreaking, but, unfortunately, came with many unwelcome side effects. Many people on the medication improved significantly but experienced involuntary movement disorders, sedation, a feeling of a mental “fog,” and other serious problems.

Like me, when John Nash was diagnosed with schizophrenia, he had no insight, believing that government officials were following him constantly and that he was a part of a complex conspiracy. But in his recovery, John Nash returned to his studies of mathematics. In 1994, he traveled to Norway to accept a Nobel Prize for groundbreaking mathematics work he had done in economics as a young man. Despite struggling with symptoms of schizophrenia for the rest of his life, he continued to remain a part of the elite mathematics community and make a contribution, until he passed away in 2015.

In my opinion, John Nash serves as a beacon of hope to everyone living with schizophrenia. Despite schizophrenia, even the greatest ambitions are still possible.

Grateful for My Treatment

I am grateful to have been diagnosed with schizophrenia in 2007 when newer medications for psychosis were available. I struggled and suffered on my first antipsychotics , but I am certain that if I had taken the medications Elyn Saks and John Nash were mandated to take, my suffering would have been considerably worse.

And I am still deeply grateful to have found an antipsychotic that gives me a great life with very few side effects. I found this medication one year after I began searching for the best schizophrenia treatment tailored to me.

There is hope for schizophrenia. Even those of us who suffer the most can achieve the most unexpected and remarkable things. I have found that you never know what life may bring, but the foundational acceptance of treatment is the key to a recovered life and boundless purpose.

(1) Schizophrenia Survivors. https://curesz.org/survivors/ Retrieved May 12, 2024

Bethany Yeiser is the author of Mind Estranged: My Journey from Schizophrenia and Homelessness to Recovery.

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Why writing by hand beats typing for thinking and learning

Jonathan Lambert

If you're like many digitally savvy Americans, it has likely been a while since you've spent much time writing by hand.

The laborious process of tracing out our thoughts, letter by letter, on the page is becoming a relic of the past in our screen-dominated world, where text messages and thumb-typed grocery lists have replaced handwritten letters and sticky notes. Electronic keyboards offer obvious efficiency benefits that have undoubtedly boosted our productivity — imagine having to write all your emails longhand.

To keep up, many schools are introducing computers as early as preschool, meaning some kids may learn the basics of typing before writing by hand.

But giving up this slower, more tactile way of expressing ourselves may come at a significant cost, according to a growing body of research that's uncovering the surprising cognitive benefits of taking pen to paper, or even stylus to iPad — for both children and adults.

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In kids, studies show that tracing out ABCs, as opposed to typing them, leads to better and longer-lasting recognition and understanding of letters. Writing by hand also improves memory and recall of words, laying down the foundations of literacy and learning. In adults, taking notes by hand during a lecture, instead of typing, can lead to better conceptual understanding of material.

"There's actually some very important things going on during the embodied experience of writing by hand," says Ramesh Balasubramaniam , a neuroscientist at the University of California, Merced. "It has important cognitive benefits."

While those benefits have long been recognized by some (for instance, many authors, including Jennifer Egan and Neil Gaiman , draft their stories by hand to stoke creativity), scientists have only recently started investigating why writing by hand has these effects.

A slew of recent brain imaging research suggests handwriting's power stems from the relative complexity of the process and how it forces different brain systems to work together to reproduce the shapes of letters in our heads onto the page.

Your brain on handwriting

Both handwriting and typing involve moving our hands and fingers to create words on a page. But handwriting, it turns out, requires a lot more fine-tuned coordination between the motor and visual systems. This seems to more deeply engage the brain in ways that support learning.

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"Handwriting is probably among the most complex motor skills that the brain is capable of," says Marieke Longcamp , a cognitive neuroscientist at Aix-Marseille Université.

Gripping a pen nimbly enough to write is a complicated task, as it requires your brain to continuously monitor the pressure that each finger exerts on the pen. Then, your motor system has to delicately modify that pressure to re-create each letter of the words in your head on the page.

"Your fingers have to each do something different to produce a recognizable letter," says Sophia Vinci-Booher , an educational neuroscientist at Vanderbilt University. Adding to the complexity, your visual system must continuously process that letter as it's formed. With each stroke, your brain compares the unfolding script with mental models of the letters and words, making adjustments to fingers in real time to create the letters' shapes, says Vinci-Booher.

That's not true for typing.

To type "tap" your fingers don't have to trace out the form of the letters — they just make three relatively simple and uniform movements. In comparison, it takes a lot more brainpower, as well as cross-talk between brain areas, to write than type.

Recent brain imaging studies bolster this idea. A study published in January found that when students write by hand, brain areas involved in motor and visual information processing " sync up " with areas crucial to memory formation, firing at frequencies associated with learning.

"We don't see that [synchronized activity] in typewriting at all," says Audrey van der Meer , a psychologist and study co-author at the Norwegian University of Science and Technology. She suggests that writing by hand is a neurobiologically richer process and that this richness may confer some cognitive benefits.

Other experts agree. "There seems to be something fundamental about engaging your body to produce these shapes," says Robert Wiley , a cognitive psychologist at the University of North Carolina, Greensboro. "It lets you make associations between your body and what you're seeing and hearing," he says, which might give the mind more footholds for accessing a given concept or idea.

Those extra footholds are especially important for learning in kids, but they may give adults a leg up too. Wiley and others worry that ditching handwriting for typing could have serious consequences for how we all learn and think.

What might be lost as handwriting wanes

The clearest consequence of screens and keyboards replacing pen and paper might be on kids' ability to learn the building blocks of literacy — letters.

"Letter recognition in early childhood is actually one of the best predictors of later reading and math attainment," says Vinci-Booher. Her work suggests the process of learning to write letters by hand is crucial for learning to read them.

"When kids write letters, they're just messy," she says. As kids practice writing "A," each iteration is different, and that variability helps solidify their conceptual understanding of the letter.

Research suggests kids learn to recognize letters better when seeing variable handwritten examples, compared with uniform typed examples.

This helps develop areas of the brain used during reading in older children and adults, Vinci-Booher found.

"This could be one of the ways that early experiences actually translate to long-term life outcomes," she says. "These visually demanding, fine motor actions bake in neural communication patterns that are really important for learning later on."

Ditching handwriting instruction could mean that those skills don't get developed as well, which could impair kids' ability to learn down the road.

"If young children are not receiving any handwriting training, which is very good brain stimulation, then their brains simply won't reach their full potential," says van der Meer. "It's scary to think of the potential consequences."

Many states are trying to avoid these risks by mandating cursive instruction. This year, California started requiring elementary school students to learn cursive , and similar bills are moving through state legislatures in several states, including Indiana, Kentucky, South Carolina and Wisconsin. (So far, evidence suggests that it's the writing by hand that matters, not whether it's print or cursive.)

Slowing down and processing information

For adults, one of the main benefits of writing by hand is that it simply forces us to slow down.

During a meeting or lecture, it's possible to type what you're hearing verbatim. But often, "you're not actually processing that information — you're just typing in the blind," says van der Meer. "If you take notes by hand, you can't write everything down," she says.

The relative slowness of the medium forces you to process the information, writing key words or phrases and using drawing or arrows to work through ideas, she says. "You make the information your own," she says, which helps it stick in the brain.

Such connections and integration are still possible when typing, but they need to be made more intentionally. And sometimes, efficiency wins out. "When you're writing a long essay, it's obviously much more practical to use a keyboard," says van der Meer.

Still, given our long history of using our hands to mark meaning in the world, some scientists worry about the more diffuse consequences of offloading our thinking to computers.

"We're foisting a lot of our knowledge, extending our cognition, to other devices, so it's only natural that we've started using these other agents to do our writing for us," says Balasubramaniam.

It's possible that this might free up our minds to do other kinds of hard thinking, he says. Or we might be sacrificing a fundamental process that's crucial for the kinds of immersive cognitive experiences that enable us to learn and think at our full potential.

Balasubramaniam stresses, however, that we don't have to ditch digital tools to harness the power of handwriting. So far, research suggests that scribbling with a stylus on a screen activates the same brain pathways as etching ink on paper. It's the movement that counts, he says, not its final form.

Jonathan Lambert is a Washington, D.C.-based freelance journalist who covers science, health and policy.

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• v.14(4); 2022 Apr

Neurobiology of Schizophrenia: A Comprehensive Review

Enkhmaa luvsannyam.

1 Surgery, Avalon University, School of Medicine, Willemstad, CUW

2 Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA

Molly S Jain

3 Medicine, Saint James School of Medicine, Park Ridge, USA

Maria Kezia Lourdes Pormento

4 Medicine, Ateneo de Manila School of Medicine and Public Health, Quezon City, PHL

Hira Siddiqui

5 Medicine, Windsor University School of Medicine, Cayon, KNA

Angela Ria A Balagtas

6 General Medicine, Global Health Medical Center, Canlubang, PHL

Bernard O Emuze

7 Emergency Medicine, St. James School of Medicine, Fort Worth, USA

Teresa Poprawski

8 Psychiatry and Behavioral Sciences, St. James Medical School, Oakbrook, USA

Schizophrenia is a debilitating disease that presents with both positive and negative symptoms affecting cognition and emotions. Extensive studies have analyzed the different factors that contribute to the disorder. There is evidence of significant genetic etiology involving multiple genes such as dystrobrevin binding protein 1 (DTNBP1) and neuregulin 1 (NRG1). There is no clear link between neurotransmitter changes and the pathophysiology of schizophrenia; however, studies have shown that subcortical dopamine dysfunction is the key mechanism. Specific regions of gray and white matter changes are observed in patients with schizophrenia; gray matter changes being more significant after the onset of psychosis. These pathological changes may be implicated in the impairment of executive functioning, attention, and working memory. The disease can be managed with pharmacological treatments based on individual patient profile, patient compliance, and disease severity. The challenge of disease management sometimes persists due to the side effects. A better understanding of the pathological processes in schizophrenia may lead to more specific and effective therapies.

Introduction and background

Schizophrenia is a chronic illness that causes psychosis with a decline in functioning. It is a multifactorial disorder affecting millions worldwide. Diagnosis of schizophrenia requires at least two or more symptoms, and at least one of the two symptoms must be a positive symptom. Positive symptoms are hallucinations, delusions, disorganized speech, and abnormal movements. Negative symptoms are flattened affect, social withdrawal, anhedonia, apathy, and lack of emotions [ 1 ]. As described in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), the diagnosis of schizophrenia requires presenting symptoms that cause a decline in both social and occupational functioning for at least six months [ 2 ].

Positive symptoms reflect the presence of exaggerated ideas, perceptions, or actions, whereas negative symptoms reflect the lack of normal mental functioning. The occurrence of these symptoms reflects the interplay of the neurotransmitters, especially dopamine, in the frontal, temporal, and mesostriatal brain regions [ 3 ]. The neurotransmitter release and production is the target of current medical management. Additionally, neuroanatomical changes are seen in the brain of patients with schizophrenia. These changes are seen in the prefrontal, medial, and superior temporal lobes as reduced gray matter volume [ 4 ]. MRI studies of the brain reveal structural changes in the same brain regions that are believed to affect overall functioning in patients with schizophrenia.

The pathophysiology of schizophrenia is complex, and it has been studied for years with many factors yet to be discovered. Genetic studies show that schizophrenia involves different genetic loci and is highly pleiotropic [ 5 ]. Among all neurotransmitters involved in the pathophysiology of schizophrenia, dopamine plays a major role in psychosis.

This review on the neurobiology of schizophrenia aims to explore the current studies on the genetics, neurotransmitters, and neuroanatomy involved in the disease.

Schizophrenia has a complex mode of inheritance involving multiple genes, biological processes, and environmental factors [ 6 ]. There is a significant contribution of genetic factors to the etiology of schizophrenia. The link between multiple genes and specific DNA and protein alterations involved in the etiology of schizophrenia has not yet been identified fully [ 7 ]. However, recent large-scale genomic studies have shown specific DNA variants and how various risk alleles contribute to the disease [ 5 ].

Based on genetic studies, schizophrenia is a highly polygenic syndrome with hundreds or even thousands of distinct genetic loci involved. There are more than 100 distinct genetic loci with common alleles of various effects identified by genomic-wide association studies (GWAS). The genetic risk of the disease appears to be highly pleiotropic; for example, there are common risk variants between schizophrenia and bipolar disorder, major depressive disorder, and an autism spectrum disorder. Another genomic study shows different biological processes where genes encode a variety of synaptic proteins, such as components of the postsynaptic density (PSD) and voltage-gated calcium channel family of proteins. It also involves genes encoding glutamate receptors and dopamine receptor D2 (DRD2) with common variations. Moreover, there is a significant finding from GWAS of schizophrenia that there are multiple correlated variants in the major histocompatibility complex (MHC). These MHC variants are associated with acquired immunity, suggesting that the immune and inflammatory processes are involved in the developmental stages of schizophrenia, such as in utero, adolescence, and adulthood [ 5 ]. Components of brain development such as synapse formation, neurite outgrowth, and homeostatic plasticity are regulated by MHC class I molecules [ 8 ].

The findings from GWAS studies allow us to identify possible genes for targeted treatment and future research regarding the immune mechanisms of schizophrenia [ 9 ]. There are still a number of shortcomings, such as clarification of the pathogenesis, early diagnosis, and the treatment of schizophrenia; hence, the extent of genomics in the treatment of schizophrenia is unclear [ 9 , 10 ].

'Endophenotype' is an alternative approach to investigate phenotypic variation in the identification of the genes involved in schizophrenia [ 6 ]. In epidemiology, endophenotypes are quantitative biomarkers of heritable illness in the population. They are used to connect behavioral symptoms with specific phenotypes and risk genes [ 6 ]. There is extensive central nervous system involvement in the pathology of schizophrenia. These include frontal lobe changes responsible for memory and executive processes and temporal lobe changes responsible for language comprehension, auditory perception, and episodic memory [ 6 ]. These neurological disturbances in schizophrenia are predisposed by many suspected genetic loci. Studies have identified a promising association with candidate genes, including COMT, DISC1, RGS4, PPP3CC, ZDHHC8, AKT1, neuregulin, dysbindin, G72/G30, TRAR4, and alpha-7 nicotinic receptor genes [ 6 , 7 ]. These genes are associated with the regulation of dopamine, contributing to the underlying cause of schizophrenia. Although identifying the exact mechanism of these genetic associations is challenging, the evidence of linkage is strongest for two of these genes: dystrobrevin binding protein 1 (DTNBP1) and neuregulin 1 (NRG1). Both DTNBP1 and NRG1 are expressed at central nervous system synapses and have an impact on glutamate neurotransmission involved in schizophrenia [ 7 ].

Pathophysiology

The primary positive, negative, and cognitive symptoms of schizophrenia have been associated with many neurotransmitters, but the subcortical dopamine dysfunction remains to be the key factor in psychotic symptoms. Presynaptic dopamine dysfunction appears to mediate psychosis in schizophrenia. Stimulants such as amphetamines enhance the dopamine effect and may induce psychotic symptoms in healthy individuals. When people with schizophrenia take stimulants, they are more sensitive to psychotic effects due to increased subcortical synaptic dopamine content, dopamine synthesis, and abnormally high dopamine release following amphetamine administration. Positron emission tomography (PET) studies have shown that the increased synaptic dopamine content is localized in the striatum. In patients with schizophrenia, alterations in dopamine function within the striatum cause delusions and psychosis [ 3 ].

Thalamus is the central relay station that transmits all information from and to the cerebral cortex. The primary circuit responsible for psychotic symptoms forms between the thalamus, cerebral cortex, and associative striatum, where changes in any of these regions can impair the whole network (Figure ​ (Figure1). 1 ). There are many more pathways involved directly or indirectly with this circuit, such as the amygdala and hippocampus, which are responsible for perception and emotion regulation. Dysfunction of the thalamus and cerebral cortex largely affects the striatum and D2 receptors, causing hallucinations and delusional symptoms [ 3 ].

Original image created by the authors.

D1 - dopamine D1 receptor in the excitatory pathway; D2 - dopamine D2 receptor in the inhibitory pathway; SNc - substantia nigra pars compact; GPe - globus pallidus externus; GPi - globus pallidus internus; STN - subthalamic nucleus

Studies have shown that dopamine neurons not only release dopamine in a synaptic signal mode but also release co-transmitters glutamate and gamma-aminobutyric acid (GABA). Glutamate in the excitatory pathway and GABA in the inhibitory pathway transmits various patterns of dopamine neuron activity to the striatum. The N-methyl-D-aspartate (NMDA) receptor antagonists such as ketamine and phencyclidine (PCP) can disrupt the thalamus circuit and lead to cognitive dysfunction and psychotic symptoms [ 11 ]. Similar to amphetamine, individuals with schizophrenia are more sensitive to the effect of these medications. Hypofunction of NMDA receptors may be associated with the pathogenesis of schizophrenia; therefore, treatment with D-serine, glycine, and sarcosine, which modulates NMDA receptors, can be beneficial, especially for negative symptoms [ 12 ]. GABA interneurons such as chandelier neurons have reduced immunostaining for the GABA transporter, which is related to decreased brain-derived neurotrophic factor (BDNF) signaling or NMDA receptor hypofunction. BDNF enhances glutamatergic transmission and reduces GABAergic transmission causing alterations in neuron survival and central nervous system (CNS) function [ 13 ]. The extent to which these changes contribute to the pathophysiology of schizophrenia remains unclear.

Neuroanatomical changes

Schizophrenia is a disorder known for neuroanatomical changes over time. There are various regions of the brain that have been implicated in patients with schizophrenia. In particular, the gray matter of the brain is consistently affected in schizophrenia [ 14 ]. The widespread use of MRI has shown evidence of reduced gray matter volumes within the prefrontal, medial, and superior temporal lobes. This can explain the episodic memory decline and fluctuations in decision-making as the disease progresses [ 4 ].

Along with the respective gray matter changes, the white matter gets affected as well as schizophrenia becomes chronic [ 14 ]. Diffusion tensor imaging (DTI) is used to visualize the structural integrity of white matter using water diffusion patterns in the neural tissue. Specifically, fractional anisotropy (FA) uses the shape of the water diffusion area to assess the integrity of white matter myelination [ 15 ]. Studies on schizophrenia have shown evidence of decreased FA in major tracts such as superior longitudinal fasciculus, cingulate bundle, uncinate fasciculus, inferior longitudinal fasciculus, and hippocampus [ 16 ]. Moreover, as these pathways collaborate in neuronal networks, the increased demyelination observed in schizophrenia can also impact many cognitive abilities. A recent article proposes that the defective differentiation of glial cells is implicated in the deterioration of the working memory in schizophrenia [ 17 ]. However, a study by Dische et al. states that the brains of patients with chronic schizophrenia should be investigated carefully due to the confounding effects of antipsychotics [ 18 ]. The study confirms the decrease in the gray matter within the brain but reported less evidence of white matter abnormalities [ 17 ]. Similarly, a study by Liang et al. on the classification of schizophrenia with neuroimaging also showed significant gray matter changes compared to white matter [ 19 ].

Furthermore, CT imaging has demonstrated generalized brain tissue loss along with ventricular enlargement in schizophrenic patients as compared to controls [ 15 ]. The lateral and third ventricles progressively enlarge in size with the duration of the disease [ 16 ]. Changes associated with negative symptoms are also related to volume loss in the superior temporal lobe, medial temporal lobe, and thalamus [ 4 ]. Additionally, executive function impairment has been related to structural abnormalities in the striatum, thalamus, cerebellum, anterior cingulate gyrus, hippocampus, medial temporal lobe, medial frontal, and posterior parietal cortex [ 18 ]. Finally, it is concluded that the brain dysfunction in schizophrenic patients is due to a range of brain networks rather than a single brain region [ 16 , 18 ].

Neurobiology of first onset, late-onset, and relapse

A meta-analysis by Hajima et al. of medication-naive schizophrenic patients found intracranial volume decrease with chronic and recent-onset schizophrenia. The meta-analysis demonstrates that schizophrenic patients start having brain volume abnormalities in the early teenage with the first episode, which continues to a larger extent after the onset of the disease [ 20 ]. However, gray matter changes do seem more significant after the onset of psychosis and show a direct relationship with medication use and psychotic relapse [ 21 ]. Specifically, with the first episode of schizophrenia, there was evidence for both white and gray matter changes at different rates [ 20 , 21 ]. In both patients with or without antipsychotics, white matter changes were reflected by FA studies suggesting axonal damage or demyelination in the uncinate and arcuate fasciculi [ 22 ]. Furthermore, the most significant gray matter changes were found in the frontal and temporal lobes, including the insula, anterior cingulate gyrus, and superior temporal gyrus [ 23 ].

Late-onset schizophrenia is associated with increased ventricle-to-brain ratio, structural abnormalities in the frontal, subcortical and temporal areas, along with white matter demyelination [ 23 ]. Interestingly, late-onset schizophrenia presents with a heterogeneous set of symptoms ranging from delusions and hallucinations to cognitive impairment associated with memory declines and executive dysfunction compared to early-onset schizophrenia [ 24 ]. Studies report persecutory delusions, misidentification, and visual hallucinations as initial symptoms of late-onset schizophrenia. Other studies found an association of hallucinations representing neurocognitive disorders such as Lewy body dementia and Alzheimer's disease [ 25 ]. Memory dysfunction and cognitive abilities precede paranoid delusions. Visual and auditory hallucinations often occur concurrently with misidentification delusions, and these symptoms are associated with parietal, medial temporal, and frontal lobes dysfunction. Overall, frontotemporal abnormalities are implicated in late-life schizophrenia [ 24 ].

Schizophrenia relapse is multifactorial in nature, involving several genetic, biological, and environmental factors. It can be idiopathic or secondary to medication non-compliance or substance abuse. Clozapine seems to be an exception that has worked well for patients with relapse and treatment resistance. Overall, relapse as a whole cannot be explained by a single brain anatomical abnormality or by medication non-adherence, but it requires detailed patient history and clinical picture to account for specific reasons [ 26 ].

Neuropsychology

To understand neuropsychological impairments of schizophrenia, various psychological processes, their relativity to the area of the brain affected, and its functions need to be considered. Negative symptoms along with cognitive dysfunction are the primary reason for functional disability [ 27 ]. Even though there are various overlapping symptoms, not everyone with schizophrenia displays identical symptoms as there are distinct subtypes. This can be observed through the research conducted on paranoid versus non-paranoid schizophrenics. The patients in the paranoid group performed significantly better than those in the non-paranoid group on measures of executive functions and learning/memory [ 27 ]. When testing cognitive functions, it is evident there is impairment in working memory, verbal memory, learning, executive functions, attention, processing speed, and general intellectual disability when compared to individuals not affected by schizophrenia. Some theories state that these cognitive dysfunctions are due to impairment in connectivity between the cortices and neurotransmitter inputs [ 28 , 29 ].

Executive functioning is a multifaceted process where different areas of the brain function together to accomplish goal-directed behavior [ 30 ]. A study by Orellana and Slachevsky demonstrated neuroimaging with a prefrontal cortex dysfunction and further concluded that patients with schizophrenia scored relatively low on conceptualization, planning, cognitive flexibility, verbal fluency, and the ability to solve complex problems [ 31 ]. Another study explains that patients with schizophrenia exhibit reality distortion, disorganization, and psychomotor poverty, which were strongly correlated to the occupational and social impairment seen with the illness [ 32 ]. Four subtypes of attention include sustained attention, selective attention, alternating attention, and divided attention [ 33 ]. A study found that schizophrenic patients scored lower in tests such as the Stroop test for attention compared to the control group [ 29 ]. The Stroop Color-Word Test has three components: word reading, color naming, and interference (color names printed in conflicting colors), and patients with schizophrenia scored lower, possibly due to their inability to selectively focus and filter [ 34 ]. Working memory functions to gather information, code it for short or long-term storage, and apply information to attain tasks that require learning, reasoning, and comprehension [ 28 , 35 ]. According to a study by Perry et al., the following five measures of working memory were administered in patients with schizophrenia: digital span forward and backward, spatial span forward and backward, and letter-number sequencing, where the patients scored significantly below average [ 36 ]. Several studies have shown severe deficits in phonological, visuospatial, and central executive areas of the working memory in schizophrenia patients. However, it is still unclear if the dysfunction is due to a specific region of the brain or the inability to synchronize the system of complex networks [ 28 ].

The neuropsychology underlying the positive and negative symptoms of schizophrenia is quite complex. The negative symptoms demonstrate a lack of initiation of emotions causing withdrawal, while positive symptoms are due to abnormal internal monitoring systems for thought and voluntary actions. The prefrontal cortex, basal ganglia, and the hippocampus are major brain regions involved in the neuropsychology of positive and negative symptoms seen in schizophrenia [ 37 ].

Pharmacology

Among many clinical trials of antipsychotic medications for schizophrenia management, the history began with first-generation antipsychotics (FGAs). The mechanism of action of the FGA is predominantly blocking the D2 receptor in the mesolimbic pathway antagonizing dopamine. Additionally, it blocks noradrenergic, cholinergic, and histaminergic actions. Moreover, first-generation antipsychotics are effective in treating positive symptoms but have no effect on negative symptoms [ 38 ]. The most common side effects of FGAs are extrapyramidal symptoms which are associated with antagonism of D2 receptors in the nigrostriatal pathway. Acute extrapyramidal symptoms include acute dystonia, akathisia, and parkinsonism, while prolonged use can lead to tardive dyskinesia [ 39 ].

Second-generation antipsychotics (SGAs) were developed for the management of both positive and negative symptoms of schizophrenia. SGAs have the added effect of antagonizing 5HT serotonin receptors along with D2 receptors causing fewer extrapyramidal symptoms in comparison to the FGAs [ 38 ]. However, there are still limitations in terms of side effects such as metabolic syndrome and hypotension. Due to metabolic syndrome, especially with olanzapine, patients with diabetes mellitus, increased BMI, and dyslipidemia should be monitored regularly [ 39 ]. Clozapine is reserved for treatment-resistant schizophrenia. It has undesirable side effects of agranulocytosis and leukopenia that may cause severe infections. The therapeutic treatment with clozapine should be halted immediately if the absolute neutrophil count drops below 1,000 cells/mm 3 or below 500 cells/mm 3 in those with benign neutropenia. Other possible side effects of both FGAs and SGAs include hyperprolactinemia, anhedonia, sedation, cardiac arrhythmias such as QT prolongation, and disturbances of thermoregulation. The neuroleptic malignant syndrome is a rare phenomenon that can occur within 24 to 72 hours and presents with increased temperature, severe muscular rigidity, confusion, elevation in white blood cell count (WBC), elevated creatine phosphokinase, and myoglobinuria [ 39 ].

Multiple articles report that the effect of SGAs on managing negative symptoms is debatable [ 40 ]. Clinical trials evaluating SGAs for patients with both positive and negative symptoms eventually found that the effect of these antipsychotics on negative symptoms was quite unclear. Although SGAs have more advantages for treating patients with negative symptoms compared to FGAs, it is still not the most promising treatment [ 40 ]. Lumateperone is a recently developed atypical antipsychotic that modulates serotonin, dopamine, and glutamate neurotransmission simultaneously [ 41 ]. It inhibits serotonin reuptake, antagonizes the 5-HT2A receptor and postsynaptic D2 receptor. It also acts as a partial agonist of presynaptic D2 receptors and a modulator of D1 receptor-dependent glutamate. The long-term side effects of lumateperone are currently unknown. However, it has the advantage of having fewer adverse effects due to the lack of interaction with other receptors that cause common side effects seen in most antipsychotics [ 41 , 42 ]. Moreover, a new drug, SEP-36385 with agonistic action on the trace amine-associated receptor 1 (TAAR1) and 5-hydroxytryptamine type 1A (5-HT1A) receptor is under investigation [ 43 ]. The SEP-363856 medication exhibited a significant decrease in psychotic symptoms in comparison to the placebo group. In a randomized controlled trial, the SEP-363856 group had gastrointestinal symptoms; however, there is no significant difference in the incidence of extrapyramidal symptoms, change in lipids, HbA1c, and prolactin level compared to the control group [ 43 ]. Therefore, longer and larger trials will be needed to confirm the potential side effects of SEP-363858 along with its efficacy in relation to the existing treatment for schizophrenia.

A new atypical antipsychotic, pimavanserin, was FDA approved in 2016 in the U.S. for Parkinson's disease psychosis (PDP), including management of hallucinations and delusions. Pimavanserin is the first drug with antipsychotic actions without dopamine D2 blocking activity. The mechanism of action of this drug involves an antagonist and an inverse agonist at the 5HT2A and 5HT2C receptors. Pimavanserin is also being studied for the management of schizophrenia, Alzheimer's disease psychosis, and major depressive disorder [ 44 ]. 

Conclusions

Although schizophrenia is a complex syndrome that is difficult to manage, recent advances in ongoing research studies and clinical trials are contributing to the management of schizophrenia. Investigating the neurobiological processes behind behavioral disorders, including schizophrenia, will facilitate a better understanding of the pathogenesis and targeted therapy. Numerous genes have yet to be identified and may be associated with the variations in the disease, severity of cognitive impairment, and effectiveness of treatment. Further studies should integrate different domains, including genetics, biochemistry, and anatomy. A combination of all these factors will provide a deeper understanding of the pathophysiology of schizophrenia for clinicians, therefore, will contribute to the development of treatment for the illness.

Acknowledgments

Enkhmaa Luvsannyam and Molly S. Jain contributed equally to the work and should be considered co-first authors.

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

The authors have declared that no competing interests exist.

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• Published: 14 May 2024

2023 summer warmth unparalleled over the past 2,000 years

• Jan Esper   ORCID: orcid.org/0000-0003-3919-014X 1 , 2 ,
• Max Torbenson   ORCID: orcid.org/0000-0003-2720-2238 1 &
• Ulf Büntgen 2 , 3 , 4  

Nature ( 2024 ) Cite this article

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We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

• Climate change
• Palaeoclimate

Including an exceptionally warm Northern Hemisphere (NH) summer 1 ,2 , 2023 has been reported as the hottest year on record 3-5 . Contextualizing recent anthropogenic warming against past natural variability is nontrivial, however, because the sparse 19 th century meteorological records tend to be too warm 6 . Here, we combine observed and reconstructed June-August (JJA) surface air temperatures to show that 2023 was the warmest NH extra-tropical summer over the past 2000 years exceeding the 95% confidence range of natural climate variability by more than half a degree Celsius. Comparison of the 2023 JJA warming against the coldest reconstructed summer in 536 CE reveals a maximum range of pre-Anthropocene-to-2023 temperatures of 3.93°C. Although 2023 is consistent with a greenhouse gases-induced warming trend 7 that is amplified by an unfolding El Niño event 8 , this extreme emphasizes the urgency to implement international agreements for carbon emission reduction.

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Department of Geography, Johannes Gutenberg University, Mainz, Germany

Jan Esper & Max Torbenson

Global Change Research Institute of the Czech Academy of Sciences, Brno, Czech Republic

Jan Esper & Ulf Büntgen

Department of Geography, University of Cambridge, Cambridge, United Kingdom

Ulf Büntgen

Department of Geography, Masaryk University, Brno, Czech Republic

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Esper, J., Torbenson, M. & Büntgen, U. 2023 summer warmth unparalleled over the past 2,000 years. Nature (2024). https://doi.org/10.1038/s41586-024-07512-y

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Received : 16 January 2024

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Published : 14 May 2024

DOI : https://doi.org/10.1038/s41586-024-07512-y

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