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Several factors may contribute to Schizophrenia,
including:
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Genes, because the illness runs in families
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The environment, such as viruses and nutrition
problems before birth
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Different brain structure and brain chemistry.
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Scientists have learned a lot about Schizophrenia.
They are identifying genes and parts of the brain
that may play a role in the illness. Some experts
think the illness begins before birth but doesn't
show up until years later. With more study,
researchers may be able to predict who will develop
Schizophrenia.
Some Details
Experts think Schizophrenia is caused by several
factors.
Genes and Environment. Scientists have long known
that Schizophrenia runs in families. The illness
occurs in 1 percent of the general population, but
it occurs in 10 percent of people who have a
first-degree relative with the disorder, such as a
parent, brother, or sister. People who have
second-degree relatives (aunts, uncles,
grandparents, or cousins) with the disease also
develop Schizophrenia more often than the general
population. The risk is highest for an identical
twin of a person with Schizophrenia. He or she has a
40 to 65 percent chance of developing the disorder.
We inherit our genes from both parents. Scientists
believe several genes are associated with an
increased risk of Schizophrenia, but that no gene
causes the disease by itself. In fact, recent
research has found that people with Schizophrenia
tend to have higher rates of rare genetic mutations.
These genetic differences involve hundreds of
different genes and probably disrupt brain
development.
Other recent studies suggest that Schizophrenia may
result in part when a certain gene that is key to
making important brain chemicals malfunctions. This
problem may affect the part of the brain involved in
developing higher functioning skills. Research into
this gene is ongoing, so it is not yet possible to
use the genetic information to predict who will
develop the disease.
Despite this, tests that scan a person's genes can
be bought without a prescription or a health
professional's advice. Ads for the tests suggest
that with a saliva sample, a company can determine
if a client is at risk for developing specific
diseases, including Schizophrenia. However,
scientists don't yet know all of the gene variations
that contribute to Schizophrenia. Those that are
known raise the risk only by very small amounts.
Therefore, these "genome scans" are unlikely to
provide a complete picture of a person's risk for
developing a mental disorder like Schizophrenia.
In addition, it probably takes more than genes to
cause the disorder. Scientists think interactions
between genes and the environment are necessary for
Schizophrenia to develop. Many environmental factors
may be involved, such as exposure to viruses or
malnutrition before birth, problems during birth,
and other not yet known psychosocial factors.
Different Brain Chemistry and Structure. Scientists
think that an imbalance in the complex, interrelated
chemical reactions of the brain involving the
neurotransmitters dopamine and glutamate, and
possibly others, plays a role in Schizophrenia.
Neurotransmitters are substances that allow brain
cells to communicate with each other. Scientists are
learning more about brain chemistry and its link to
Schizophrenia.
Also, in small ways the brains of people with
Schizophrenia look different than those of healthy
people. For example, fluid-filled cavities at the
center of the brain, called ventricles, are larger
in some people with Schizophrenia. The brains of
people with the illness also tend to have less gray
matter, and some areas of the brain may have less or
more activity.
Studies of brain tissue after death also have
revealed differences in the brains of people with
Schizophrenia. Scientists found small changes in the
distribution or characteristics of brain cells that
likely occurred before birth. Some experts think
problems during brain development before birth may
lead to faulty connections. The problem may not show
up in a person until puberty. The brain undergoes
major changes during puberty, and these changes
could trigger psychotic symptoms. Scientists have
learned a lot about Schizophrenia, but more research
is needed to help explain how it develops.
A Combination of Genetic and Environmental Factors
play a role in the development of Schizophrenia.
People with a family history of Schizophrenia who
have a transient psychosis have a 20–40% chance of
being diagnosed one year later.
Genetic
Estimates of heritability vary because of the
difficulty in separating the effects of genetics and
the environment. The greatest risk for developing
Schizophrenia is having a first-degree relative with
the disease (risk is 6.5%); more than 40% of
monozygotic twins of those with Schizophrenia are
also affected. It is likely that many genes are
involved, each of small effect and unknown
transmission and expression. Many possible
candidates have been proposed, including specific
copy number variations, NOTCH4, and histone protein
loci. A number of genome-wide associations such as
zinc finger protein 804A have also been linked.
There appears to be significant overlap in the
genetics of Schizophrenia and bipolar disorder.
Evidence is emerging that the genetic architecture
of Schizophrenia involved both common and rare risk
variation.
Assuming a hereditary basis, one question from
evolutionary psychology is why genes that increase
the likelihood of psychosis evolved, assuming the
condition would have been maladaptive from an
evolutionary point of view. One idea is that genes
are involved in the evolution of language and human
nature, but to date such ideas remains little more
than hypothetical in nature.
Environment
Environmental factors associated with the
development of Schizophrenia include the living
environment, drug use and prenatal stressors.
Parenting style seems to have no major effect,
although people with supportive parents do better
than those with critical or hostile parents. Living
in an urban environment during childhood or as an
adult has consistently been found to increase the
risk of Schizophrenia by a factor of two, even after
taking into account drug use, ethnic group, and size
of social group. Other factors that play an
important role include social isolation and
immigration related to social adversity, racial
discrimination, family dysfunction, unemployment,
and poor housing conditions.
Drug use
Amphetamine, cocaine, and to a lesser extent
alcohol, can result in psychosis that presents very
similarly to Schizophrenia. Although it is not
generally believed to be a cause of the illness,
people with Schizophrenia use nicotine at much
greater rates than the general population. About
half of those with Schizophrenia use drugs or
alcohol excessively. Evidence supports a link
between earlier onset of psychotic illness and
cannabis use; alcohol use is not associated with an
earlier onset of psychosis. Other drugs may be used
only as coping mechanisms by individuals who have
Schizophrenia to deal with depression, anxiety,
boredom, and loneliness. There is evidence that
alcohol abuse via a kindling mechanism can
occasionally cause the development of a chronic
substance induced psychotic disorder, i.e.
Schizophrenia. The more often cannabis is used; the
more likely a person is to develop a psychotic
illness, with frequent use being correlated with
twice the risk of psychosis and Schizophrenia.
Whether cannabis use is a contributory cause of
Schizophrenia, rather than a behavior that is simply
associated with it, remains controversial.
Developmental Factors
Factors such as hypoxia and infection, or stress and
malnutrition in the mother during fetal development,
may result in a slight increase in the risk of
Schizophrenia later in life. People diagnosed with
Schizophrenia are more likely to have been born in
winter or spring (at least in the northern
hemisphere), which may be a result of increased
rates of viral exposures in utero. The increased
risk is about 5 to 8%.
Mechanisms
A number of attempts have been made to explain the
link between altered brain function and
Schizophrenia. One of the most common is the
dopamine hypothesis, which attributes psychosis to
the mind's faulty interpretation of the misfiring of
dopaminergic neurons.
Psychological
Many psychological mechanisms have been implicated
in the development and maintenance of Schizophrenia.
Cognitive biases have been identified in those with
the diagnosis or those at risk, especially when
under stress or in confusing situations. Some
cognitive features may reflect global neurocognitive
deficits such as memory loss, while others may be
related to particular issues and experiences.
Despite a demonstrated appearance of blunted affect,
recent findings indicate that many individuals
diagnosed with Schizophrenia are emotionally
responsive, particularly to stressful or negative
stimuli, and that such sensitivity may cause
vulnerability to symptoms or to the disorder. Some
evidence suggests that the content of delusional
beliefs and psychotic experiences can reflect
emotional causes of the disorder, and that how a
person interprets such experiences can influence
symptomatology. The use of "safety behaviors" to
avoid imagined threats may contribute to the
chronicity of delusions. Further evidence for the
role of psychological mechanisms comes from the
effects of psychotherapies on symptoms of
Schizophrenia.
Neurological
Functional magnetic resonance imaging (fMRI) and
other brain imaging technologies allow for the study
of differences in brain activity in people diagnosed
with Schizophrenia. The image shows two levels of
the brain, with areas that were more active in
healthy controls than in Schizophrenia patients
shown in orange, during an fMRI study of working
memory.
Schizophrenia is associated with subtle differences
in brain structures, found in 40 to 50% of cases,
and in brain chemistry during acute psychotic
states. Studies using neuropsychological tests and
brain imaging technologies such as fMRI and PET to
examine functional differences in brain activity
have shown that differences seem to most commonly
occur in the frontal lobes, hippocampus and temporal
lobes. Reductions in brain volume, smaller than
those found in Alzheimer's disease, have been
reported in areas of the frontal cortex and temporal
lobes. It is uncertain whether these volumetric
changes are progressive or preexist prior to the
onset of the disease. These differences have been
linked to the neurocognitive deficits often
associated with Schizophrenia. Because neural
circuits are altered, it has alternatively been
suggested that Schizophrenia should be thought of as
a collection of neurodevelopmental disorders.
Particular attention has been paid to the function
of dopamine in the mesolimbic pathway of the brain.
This focus largely resulted from the accidental
finding that phenothiazine drugs, which block
dopamine function, could reduce psychotic symptoms.
It is also supported by the fact that amphetamines,
which trigger the release of dopamine, may
exacerbate the psychotic symptoms in Schizophrenia.
The influential dopamine hypothesis of Schizophrenia
proposed that excessive activation of D2 receptors
was the cause of (the positive symptoms of)
Schizophrenia. Although postulated for about 20
years based on the D2 blockade effect common to all
antipsychotics, it was not until the mid-1990s that
PET and SPET imaging studies provided supporting
evidence. The dopamine hypothesis is now thought to
be simplistic, partly because newer antipsychotic
medication (atypical antipsychotic medication) can
be just as effective as older medication (typical
antipsychotic medication), but also affects
serotonin function and may have slightly less of a
dopamine blocking effect.
Interest has also focused on the neurotransmitter
glutamate and the reduced function of the NMDA
glutamate receptor in Schizophrenia, largely because
of the abnormally low levels of glutamate receptors
found in the postmortem brains of those diagnosed
with Schizophrenia, and the discovery that
glutamate-blocking drugs such as phencyclidine and
ketamine can mimic the symptoms and cognitive
problems associated with the condition. Reduced
glutamate function is linked to poor performance on
tests requiring frontal lobe and hippocampal
function, and glutamate can affect dopamine
function, both of which have been implicated in
Schizophrenia, have suggested an important mediating
(and possibly causal) role of glutamate pathways in
the condition. But positive symptoms fail to respond
to glutamatergic medication.
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