Neuroscience of Schizophrenia
It's easy to assume that the brain functions differently for someone with schizophrenia... but you'll never guess why...
And in this month's episode, Laine reports it to us short and sweet.
(If you want to learn more about the extent of the science on your own time, be sure to check out the reference list below for more details.)
But in addition to our usual content rundown for season two, Laine and I share space to discuss
some of the uncertainty and fear around this disorder
how we can approach it with a new perspective
what impact that can have on developing research, supporting those affected by it, and changing how we view the disorder entirely
Enjoy this shorter episode, and be on the lookout for our last two episodes (and mini-episodes) coming out in September & October!
If you want to know more ways to be part of our Brain Blown Community, head to www.patreon.com/brainblownpodcast to learn about our offers!
REFERENCES
Charan Ranganath, Michael J. Minzenberg, and J. Daniel Ragland -- The Cognitive Neuroscience of Memory Function and Dysfunction in Schizophrenia
Michael F. Green and David L. Braff -- Translating the Basic Clinical Cognitive Neuroscience of Schizophrenia to Drug Development and Clinical Trials of Anipsychotic Medications
Werner Strik, Katharina Stegmayer, Sebastian Walther, Thomas Dierks -- Systems Neuroscience of Psychosis: Mapping Schizophrenia Symptoms on Brain Systems
Katherine H. Karlsgodt, Daquiang Sun, Tyrone D. Cannon -- Structural and Functional Brain Abnormalities in Schizophrenia
General Outline of Episode
On the podcast, we’ve been covering the DSM - broader pieces
Depression bipolar anxiety
Personality
Trauma
schizophrenia
This is the neuroscience of Schizophrenia.
LAINE
Prevalence - according to the World Health Organization Schizophrenia “affects approximately 24 million people or 1 in 300 people (0.32%) worldwide. This rate is 1 in 222 people (0.45%) among adults (2)
Schizophrenia (colloquially)
These words have gotten feedback from the disability community, are not kind, and we are not going to repeat them.
Best known media version has been stated by Health Central as “A Beautiful Mind”
More negative versions have been portrayals of murders and serial killers
Schizophrenia (clinically) - Schizophrenia is both a diagnosis and a category in the DSM - specifically Schizophrenia spectrum and other psychotic disorders
Schizophrenia is seen as having delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, and negative symptoms (less emotional expression or less motivation)
Need two of those, a large part of the time over a month
Level of care is impacted by work, interpersonal, self-care, etc
Disturbances for at least 6 months
Is not bipolar and is not a schizoaffective disorder, not becuase there is a substance, and if there has been a history of autism, then requires delusions or hallucinations are present
Schizoaffective is similar but over two or more weeks
WHO - usually occurs late teens or early 20s, seen more in men
“People with schizophrenia are 2 to 3 times more likely to die early than the general population (3). This is often due to physical illnesses, such as cardiovascular, metabolic, and infectious diseases.”
We do not know why this occurs though theories of an interaction between genetics and environmental factors. “Heavy use of cannabis is associated with an elevated risk of the disorder.”
Also stating that a large majority of people with this diagnosis are not receiving care
About half of people in mental hospitals have this diagnosis
But only 31% of people receive specialized care
There is a lot of research to show that the resources spent on this diagnosis are spent ineffectually in mental hospitals, not providing appropriate or helpful care and a lot of documentation of violating the rights of people with this diagnosis.
PART 1: Terms & Background Info (5-10 minutes)
Mid 19th century - documents of a disorder of unknown chauses called adolescent insanity
Emil Kraeplin - he also showed up in our episode about Bipolar as he is the one who labeled it manic-depressive insanity in the early 1900s. Also around the early 1900s, he came up with Dementia Praecox based on these clinical cases. But he was cited in the 1920s for saying “Our formulation of the problem may be incorrect”
Eugene Bleuler slightly later is the one who coined schizophrenia. It has been a diagnosis since the DSM’s inception
PART 2: What About Neuroscience (5 minutes)
Strik, Stegmayrer, Walter, and Dierk “Schizophrenia research has been in a deadlock for many decades.” They state we’ve made some advances but there is still a lot we are learning and concerns about “long-term psychosocial reintegration and disease management, biological heterogeneity, unsatisfactory predictors of individual course and treatment strategies, and a confusing variety of controversial theories about its etiology and pathophysiological Mechanisms.”
We are struggling to have people with this diagnosis in society
Struggling to know how to manage it
Don’t understand where biology is impacting this
Can’t predict treatment
Don’t know what causes it
And are all little all over the place about it
Why neuroscience? Why not?
Strik, Stegmayrer, Walter, and Dierks will also use schizophrenia to discuss the serious disconnect and problems between mental health and what is going on in the brain stating “Medical diagnoses should be reliable and combine valid information about the conditions and causes, pathophysiological cascades, treatment, and prognosis of diseases.” and state that mental health inability to understand causes, treatment prognosis and cost is a problem. They cite significant issues with DSM and state that issues with this specifically for Schiphic caused the US National Institute of Mental Health to introduce the Research Domain Criteria project RDoC, which we discussed in the takeaway section for the Autism episode. RDOC is working to identify links between neuroscience and what we see a person do.
Why Neuroscience? Because we need to do better.
**BREAK**
PART 3: The Science (30-35 minutes)
Karlsgot, Sun, And Cannon state that schizophrenia is connected to changes in both the structure and behavior of key brain systems (not areas) that are involved with memory.
“Structural deficits, such as reduced gray matter volume and disrupted white matter integrity, have been observed”.
Specifically in studies, we have observed the brains of people with this diagnosis doing tasks where they need to access short-term memory, long term memory, make decisions and process emotions and the brain behaves abnormally
Strik, Stegmayrer, Walter, and Dierks state that we are looking at this under the idea that
A big part of this diagnosis is a breakdown in communication
Communication means a breakdown of sensorimotor (which is that band in your head that we discussed in phantom limbs - responsible for sensation and movement) and corticostriatal brain systems
Corticostriatal - cortex (top part, outside, fingers of your skin), basal ganglia (deep in your fist, around your thumb -motor control, body learning, and executive function), and thalamus (also near your thumb - deep midbrain) body’s processing center - all information except smell- important in sleep, learning and memory) communicate directionally cortex communicates the midbrain parts, and your midbrain parts communicate indirectly and only through “polysynaptic downstream circuits”. This all gets complex quickly - essentially your brain’s communication is short-circuited
How our brain connects together in major circuit connections - so we are discussing choral pieces again. For example, to understand that someone is waving at you, you would need your occipital cortex to see to sing with your limbic system to help process someone's facial expression, you would need motor to understand hand gestures, and also to remember what significance a wave has. This is processing a lot together for you to understand a simple action.
Green and Braff cite the same issue but state it involves the hippocampus (midbrain - brain’s filing cabinet), prefrontal cortex (fingers), basal ganglia (mid-brain), and thalamus and cite it to be a ‘circuit dysfunction’.
This is the problem with schizophrenia- it's a breakdown of these communication parts.
A complex part to fully understanding this diagnosis, which we are not there yet, is its harder-to-read communication and we see different results from different studies with different areas impacted, however, a consistent part seems to be that different parts of the brain not communicating well
Green and Braff also discuss an important part about Bleuer (the person who named schizophrenia) and that he argued that what we think of as the worst parts of this diagnosis (delusions and hallucinations) were like accessory or accidental but not the core part of what is going on.
They also cite Bunny et all stating that there is an argument for a circuit imbalance in the brain between “cortico-striato-pallido-thalamic”. It was also argued not long after that there is a need to understand the different imbalances stating that “we are likely going to end up with multiple circuit neurocognitive dysfunctions paralleling the heterogeneity of the group of schizophrenia disorders”
We want to learn WHY we do what we do as humans, and we’ve looked to the brain for explanations…
**BREAK**
PART 4: TAKEAWAYS (10-15 minutes)
Strik, Stegmayrer, Walter, and Dierks need to look at a better way of classification for the diagnosis and want to look at three specific domains that allow to better group what could be occurring. Stating a distinction between these different patterns of communication deficits can be extraordinarily useful” helping us to better understand brains that are struggling with communication to better focus care.
Stating “a recognition and distinction of different patterns of dissociated behavior allows shifting the attention from the disordered to the intact communication domains, and using the latter for de-escalation and therapeutic alliance” They state this can improve therapy and medication and help a lot more than we are currently seeing.
Ranganth, Minzenbgerg, and Raglan state that we need to understand schizophrenia more, not only for the patients and families living with this but also stress the impact of schizophrenia on memory - specifically different types of memories in the brain. They state understanding this more could greatly open up our understanding of the brain and memory, which is needed for everyone.
