How exactly does schizophrenia start and develop?



What exactly happens in the brain?

In: Biology

You don’t get schizophrenia… you’re born with it.

So I’m going to treat your question as: When do you start to see the symptoms of schizophrenia and what are the call signs?

You can actually see symptoms occur in any stage of a persons life. From childhood to late adulthood; although most recorded starts of schizophrenia occurs mid teen to early adulthood, we actually can’t conclusively give you a point in life that says… Yes this is when it occurs. Symptoms generally are…

* Delusions
* Hallucinations
* Disorganized speech
* catatonic behavior
* emotional numbness.

And not your average joe kind of examples of emotional numbness or delusions… No to the level that it is severely impacting your life. You cannot go home because your mind is telling you your parents are trying to kill you kind of level.

Unfortunately nobody can tell you conclusively everything that happens in your brain as a result of schizophrenia… We aren’t quite there yet. But we can say there is evidence that shows the following.

* There is a sudden change in the structure of white and grey matter in the brain.
* There is deterioration in grey matter in the brain.
* There is progressive ventricular enlargement.

All of which boils down to… There are rather dramatic changes to the structure of the brain as a result of schizophrenia. Why this happens… or how this truly impacts a person… or will reversing changes lead to symptom relief… Those are all projects in the work to my knowledge.

That is not exactly known. There are a bunch of theories and models that try to explain schizophrenia but there is not a consensus among scientists.

1. Firstly Schizophrenia probably refers to a number of neurologically distinct diseases which we group together under the term Schizophrenia. This is because diagnostic methods aren’t that sophisticated and we have a narrow range of treatments.

2. How it starts and develops is highly varied. There used to be a misconception that the person’s parents played a major role in causing it, which is not the case. People are at higher risk if they:

(A) Have a family history of Schizophrenia
Are a second generation immigrant
up in a household with a lot of overt conflict
Had a complicated delivery at birth
If their mother suffered certain viral illnesses when pregnant

(B) The most recent evidence suggests that smoking cannabis can cause (as opposed to merely correlating with) people with a predisposition to Schizophrenia to develop symptoms :

Some people thought that people were smoking cannabis *because* they were already hearing voices, in order to calm themselves down, but this appears to be an insufficient explanation.

(C) For males, symptoms will almost always have started to manifest by their mid twenties. For females that threshold is in their early thirties. We don’t really know if there is any “trigger event” which reliably pushes people over the edge, but any stressful event, medical illness or drug taking could potentially do so.

3. Sometimes the first indication is the person becoming more socially withdrawn and demotivated. This is referred to as ‘negative symptoms’. For others, ‘positive symptoms’ such as hallucinations and/or delusions will be the first indication of Schizophrenia. In the textbook pattern of emergence, which doesn’t always match real life, negative symptoms arise early (eg in late teens), and are followed after 1-3 years by the development of positive symptoms.

4. (A) Hallucinations are extremely common. This is where at least one of the five senses is being triggered, but with “No Apparent Stimulus.” By far the most common in schizophrenia are auditory hallucinations (ie hearing voices). Other kinds of hallucinations (eg seeing pink elephants, feeling things crawling under your skin) usually suggest a different diagnosis.

(B) Delusions (beliefs which are provably false, and which do not change despite contrary evidence) are also extremely common. The specific beliefs vary, but often have a paranoid flavour (eg “someone put a microchip in my brain”).

(C) Other features can arise, less commonly than the above, such as:

Disorganised behaviour/thought. Where the person behaves or speaks erratically, with no logical sequence from one act to another, or where they speak unintelligbly, jumping between unrelated subjects. It usually occurs at a later stage of illness, and tends to suggest more severe version of the disease.

Catatonic behaviour. This is a rare feature.

5. None of the above is by itself diagnostic of Schizophrenia. It could be Bipolar Disorder, severe Depression, a different kind of psychotic disorder, or the results of drug intoxication. The person needs to be assesed by a Psychiatrist and it can take months of gathering information and observing the person to be sure that they have Schizophrenia.

6. The events in the brain vary (see point 1 re Schizophrenia as an umbrella term for different diseases). Important to say, there is no definitive explanation for what happens in the Schizophrenic brain. Fundamentally however, Dopamine pathways are thought to be altered. The drugs that treat Schizophrenia target these pathways.

Dopamine is important in how our brain forms models of the external world. Many people have heard of its role in the feeling of “reward”. But Dopamine doesn’t just come in after a pleasurable event : it is also involved in anticipation. By extension, it plays a part in assigning importance to external stimuli. So sex or nice food is more important than info about the economy, etc. Hence alterations in Dopamine transmission can disrupt how we assign importance; over time, so the theory goes, this can lead to the consolidation of irrational thought patterns.

– For more info I suggest Robert Sapolsky’s YouTube lecture on schizophrenia. Contains some upsetting stories of patients, but is an extremely lucid and compassionate introduction.

I share my personal experience from my family members. They are normal but start develop very anti-social behaviors, like disliking random strangers in public(e.g not wanting to get into elevators, or don’t want to be friendly or socialize in social environment) Couple years later develope some disillusions then have psychotic experiences(halluciation).

This is not medical or textbook explantion. It is story of two ppl I love who were diagnosied with schizophrenia.

We don’t quite know how schizophrenia develops. What we know about is a lot of individual risk factors, and the prevailing scientific theory is that it’s a disorder acquired through one’s development, and that it’s precipitated by certain biological risk factors.

Now, we’re also not too sure about what constitutes as “schizophrenia” proper. Diagnostically, psychotic episodes for a certain period of time not obviously triggered by substance use is enough for a diagnosis of schizophrenia. But psychotic breakdowns can occur in a lot of mental states, and schizophrenic psychoses tend to have a distinct quality as compared to other psychoses.

What we know about the development of schizophrenia is that it tends to develop during a long period before people become ill. The symptoms are very subtle, and for this reason has often gone undetected and the eventual descent into psychosis has appeared sudden and acute. This period before overt schizophrenia is called the “prodromal phase”. This phase typically lasts for years, and is characterized by subtle alterations in subjectivity. That is, the experience of actually being a person.

These alterations are surely very strange and current qualitative research has called these symptoms “self-disorder”, and they are unique to schizophrenia. There is a vast amount of manifestations of this disturbed subjectivity, manifesting in disturbance in the thinking process itself, disturbed self-awareness and presence, strange bodily experiences, issues with being a demarcated subject of experience (for example, a person might look at themselves in the mirror and see a stranger on the opposite end, or wonder at which side of the mirror they are, etc), and existential themes.

One model to collect these experiences is the “ipseity disturbance” model. In this theory, subjective alterations is explained by two core processes–hyperreflexivity (to think excessively about self-evident aspects of our experience) and diminished self-affectivity (to feel one’s self as not quite existing, or only weakly interacting with the world). This eventually develops into full-blown psychotic episodes but the feeling of disturbed subjectivity is reported to linger in between psychotic episodes.