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Introduction
There are many issues in medicine that still do not have a definite interpretation. With the development of new technologies, people began to understand the physical processes of the human body better. On the contrary, it is still not clear what happens inside the human mind. The examination of the human brain and psychology can be challenging for medical specialists, as they are complex and inaccessible research areas. There is not much known about different kinds of mental disorders, and schizophrenia is considered one of such issues that still draws the attention of researchers.
This paper is aimed at discussing schizophrenia as a mental illness from the perspective of various biopsychological approaches. Among research methods, genetics and brain imaging will be discussed. As for treatment methods, the paper will focus on antipsychotic medications and electroconvulsive therapy. The analysis of scholarly resources and books, as well as the discussion of different opinions, practices, and real medical cases, will help understand the causes of schizophrenia and approaches to its treatment.
Schizophrenia
Brief Overview
To analyze possible methods of research and treatment of schizophrenia, it is necessary to provide a brief overview of this medical issue. Schizophrenia is described as a broad spectrum of cognitive and emotional dysfunctions (Durand et al., 2018, p. 445). The identification of the illness is a complicated task since its symptoms are not shared by all the affected people. Positive signs of the disorder, such as hallucinations and delusions, are connected to a distorted reality. Negative symptoms may include deficits like apathy or lack of pleasure and refer to the typical behavior of the patient. The disorder is also connected with speech problems, disorganized behavior, and inverted emotional reactions (Durand et al., 2018). It is important to note that certain symptoms may show themselves in different periods of life.
The more severe signs of schizophrenia often appear in late adolescence or early adulthood, though sometimes they can also be evident in childhood. It may take up to ten years until the combination of all the symptoms proves the development of schizophrenia. Patients themselves and their families are, therefore, negatively affected in emotional and even financial ways (Durand et al., 2018). As a result, the high prevalence rate of the condition and the negative physical and psychological consequences became the reasons why schizophrenia is an important subject of many modern medical studies.
The researchers confirm that there is no specific cause of schizophrenia onset. The disorder is often associated with abnormalities in brain chemical composition and structure. Bernstein et al. (2017), for example, emphasize that the biological cause of schizophrenia is connected with the shrinkage of tissue in thalamic regions, prefrontal cortex, and some subcortical areas (p. 730). According to the researchers, tissue loss causes the enlargement of the brain spaces filled with fluid (Bernstein et al., 2017). Other opinions include genetic, social, and environmental causes of the disorder.
To sum up, schizophrenia is a condition of psychological distress that is described as the disorganization of thought processes and emotional reactions. The disorder is characterized by a wide number of symptoms that are often individual and unpredictable. At the same time, medical science is constantly developing, and there are different biopsychological approaches to identify the causes of schizophrenia and treat the illness. Further, the issue of schizophrenia will be studied from the perspective of these approaches.
Research Methods
Schizophrenia and Genetics
The genetic approach is one of the most widespread methods of studying the issue. According to the supporters of this research method, the vulnerability of some individuals to the disorder depends on genetics (Durand et al., 2018). Studies have been conducted within families to analyze the genetic causes of schizophrenia. For example, research by Franz Kallman (1938) confirmed that the risk of schizophrenia for a child positively correlates with the severity of the disorder of a parent (Durand et al., 2018, p. 458). All forms of the illness may be present within one family. Moreover, the relatives of schizophrenic patients are also likely to be affected by any kind of psychotic disorder.
Other results are connected with the examination of one of the most unbelievable cases in this sphere of medicine. The case of Genain quadruplets, who were all affected by the disorder, was studied in the National Institute of Mental Health. The results showed that genetic predisposition was the same for all sisters; however, the condition developed differently in every individual case (Durand et al., 2018). It proves that genetics is not the only possible cause of schizophrenia, and the environment of patients also plays an essential role and can influence the progress of the disorder.
While the described research defines the patterns of genetic spread of schizophrenia, modern studies allow exploring the issue more profoundly. According to Liu et al. (2019), who studied the biological causes of schizophrenia in terms of genetics, the investigation of genome-wide association (GWA) proved that this psychiatric disorder is polygenic. There are more than 100 genetic loci associated with the disorder, and future studies are likely to demonstrate their more significant number (Liu et al., 2019, p.1). As a result, the SzGene database was developed to examine and evaluate the genetic nature of the disorder.
The researchers accessed the database and collected the participants genetic information, with the help of which they evaluated what genes can be responsible for higher vulnerability to the disorder. The result of the study demonstrates that schizophrenia can be associated with specific genes, namely twenty-one Bonferroni-signicant SNPs found in fourteen LDindependent loci (Liu et al., 2019, p.5). The researchers conclude that this genetic risk can be shared across particular populations (for example, the CNNM2 gene in Caucasian and Asian populations).
To sum up, according to this approach, the cause of schizophrenia lies in genetics and can be defined by studying hereditary factors. The genetic method of research implies studies conducted within families of schizophrenic patients. Furthermore, the approach is connected with a more profound examination of certain genes responsible for the susceptibility and patterns of their spread. Genetics, however, cannot be the only cause of the illness, as environment, biological characteristics, and other aspects are also responsible for its development.
Brain Imaging Techniques
Today, modern technologies are frequently used in medicine, and schizophrenia can also be studied through technological methods. As it was emphasized in the previous part of the paper, the genetic approach allows seeing the cause of the disorder and tracing it within a family. However, the immediate dysfunctions and the individual characteristics of separate schizophrenia cases can be examined through brain imaging. The main aspects of this approach are going to be discussed further.
In general, brain imaging, or neuroimaging, is a process of photographing the brain of the patient that helps detect neuronal signals and the activity of different parts of the brain. Besides recording processes happening in the human mind, this method can help identify abnormal activity or brain dysfunction (Orrison et al., 2017). There is a wide range of brain imaging techniques that include magnetic resonance imaging (MRI), positron emission tomography (PET), magnetoencephalography (MEG), single-photon emission tomography (SPECT), etc. (Orrison et al., 2017, p.3). Many of these methods are frequently used in schizophrenia-related studies.
It is important to mention that these techniques allow measuring different processes of the human brain. This idea is demonstrated in the research of Mouchlianitis et al. (2016), who analyzed many brain imaging studies focused on treatment-resistant patients diagnosed with schizophrenia. Functional MRI, for example, allowed to measure the overall gray matter volume in specific brain regions. In PET and SPECT, radiotracers are used to measure the cerebral metabolic rate or blood flow (Mouchlianitis et al., 2016). According to these studies, the increased cerebral blood flow and metabolic activity in speech-processing areas of the brain are common to patients who had treatment-resistant auditory hallucinations (Mouchlianitis et al., 2016). Such technologies can also evaluate the perfusion level in different brain areas.
It is necessary to understand that during brain imaging, patients are often given different tasks that lead to the increased activity of specific brain areas. For example, during SPECT, individuals can do the Wisconsin Card Sorting Test, which would help evaluate their cerebral blood flow (Mouchlianitis et al., 2016). Another example is the word-generation task, which can be done during MRI (Mouchlianitis et al., 2016). As a result, the cause of the disorder may be identified from the analysis of certain brain areas and their possible dysfunction.
To sum up, the principle of the brain imaging method is that it records micro-processes of the brain and measures some of its physical and chemical characteristics. In comparison to the genetic approach that is focused on the causes of the disorder connected with heredity and patients environment, brain imaging is based on the individual peculiarities of every schizophrenia case. Metabolic activity, cerebral blood flow, the volume of gray matter, and the concentration of acids are only some of the characteristics that can be measured with the help of neuroimaging. The main advantage of the method is that it is especially useful in defining the immediate abnormalities of the brain.
Treatment Methods
Antipsychotic Medications
So far, the issues of schizophrenia-related research, namely the genetic factors and the advantages of neuroimaging, have been analyzed. This part of the paper is going to be focused on the ways to treat the disorder. Antipsychotic medications are considered to be the prevalent way of treatment. They are frequently used in clinical trials and are widespread among pharmaceutical companies (Glatt et al., 2019). However, there are still some aspects of this approach, such as its side effects, which need careful consideration. The major principles of this method of treatment will be discussed with the use of recent studies.
The effect of antipsychotic medications varies and may be associated with different brain processes. Among specific effects, Galderisi et al. (2019) mention cellular effects, cortical and subcortical structural change, and the influence on gray matter volume. The medical studies found that there are certain areas of the brain that are especially susceptible to antipsychotic-related changes, namely volumetric decrease (Galderisi et al., 2019). It is possible to notice that the treatment is mainly associated with morphometric brain changes.
Although general brain changes are typical for antipsychotic medications, some outcomes of the treatment can significantly vary. Qualitative reviews confirmed that the effects may be highly individual and may depend on the dosage of the drug (Galderisi et al., 2019). For example, the loss of gray matter is common to patients who took a higher dose of medications during the follow-up period. Another factor that influences the effect of the drugs is the type of drug. For example, first-generation antipsychotics are responsible for increasing basal ganglia volume and reducing cortical gray matter in different regions of the brain. Second-generation medications are characterized by a less significant impact on longitudinal gray matter. Therefore, Galderisi et al. (2019) emphasized that antipsychotic treatment has a local effect rather than global. They influence particular brain areas and structures differently, depending on the patients characteristics and the peculiarities of medications themselves.
It is confirmed that antipsychotic medications treatment is often followed by certain side effects. For example, Glatt et al. (2019) emphasize that patients may experience a change in the electrical activity of the heart. This side effect is common to all antipsychotics, excluding lurasidone, aripiprazole, paliperidone, and asenapine. There are some less severe effects such as weight gain, sedation, and the increase in prolactin levels that lead to sexual dysfunction. The authors conclude that all the antipsychotic medications are almost equally effective, with clozapine slightly prevailing. They encourage psychiatrists and their patients to try different methods of treatment to minimize side effects because the effectiveness of treatment will be guaranteed.
To sum up, antipsychotic medications are one of the easiest and the most frequent ways of schizophrenia treatment. These drugs work on the cellular level, changing the structure of different parts of the brain. Certain factors are defining the effectiveness of treatment; they are usually connected with the type and dosage of the drug, as well as the part of the brain they are designed to influence. However, there can be various side effects of such treatment, which should be considered when prescribing medications.
Electroconvulsive Therapy
Electroconvulsive therapy (ECT) is a relatively new method of treatment that is considered highly effective and is used worldwide. The name of the method implies the principle of its action. ECT uses electrical stimulus in the form of electrodes attached to the patients head to produce brain convulsions (Keith & Rasmussen, 2019). Besides schizophrenia treatment, ECT can be used in the case of other psychological disorders, such as depression and catatonia (Keith & Rasmussen, 2019). The primary factor that makes this method very effective is that it works faster than medications and can be used for patients with severe schizophrenia cases.
ECT treatment is provided in a series of regular and standardized sessions, which are conducted two or three times a week for a month or longer. Before applying the treatment, psychiatrists need to evaluate the overall health condition of the patient to avoid possible complications. During the procedure, the patient is anesthetized, and oxygen is given through a mask. Psychiatrists use muscle-paralyzing medication to avoid involuntary movements of the limbs caused by the electrical stimulus applied (Keith & Rasmussen, 2019). It is also important to control the overall condition of the patient during the procedure.
Although many investigations have been conducted on animals, there is no definite explanation of how exactly the treatment works. However, it is believed that ECT is associated with a cascade of neurobiological events, beginning with the first induced seizure, involving molecules, cells, and neural circuits (Keith & Rasmussen, 2019, p. 5). Some of the studies show that ECT has anticonvulsant effects and is connected with the mechanism of action in the condition of depression. This theory is based on the inhibitory amino acid GABA, which serves as a neurotransmitter in the human brain (Keith & Rasmussen, 2019). Moreover, it is suggested that the positive outcomes of the treatment depend on the intensity of the anticonvulsant effect.
The most recent theory of neuroplasticity implies that ECT causes cellular changes in the brain. Through the brain imaging technique, researchers found out that such changes occur at the limbic level in areas like the amygdala and hippocampus (Keith & Rasmussen, 2019). The process of ECT is also characterized by neural connectivity, which means that different parts of the brain communicate with each other (Keith & Rasmussen, 2019). However, this communication still cannot be fully described due to insufficient samples.
To sum up, ECT is an example of how modern technologies can be applied to treat disorders like schizophrenia. The principle of its action is complicated, and researchers still argue about how this method works. However, psychiatrists agree that this technique can be more effective than medications. It influences the human brain directly and immediately, and the course of this treatment is relatively short. However, the approach requires careful preliminary analysis to make ECT as safe and effective as possible.
Conclusion
To sum up, researchers still doubt the causes of schizophrenia, as its symptoms and course can vary greatly. However, multiple studies still allow defining the basic characteristics of the condition. Schizophrenia is described as the dysfunction of the cognitive, behavioral, and emotional activity of a patient. The major symptoms may be connected with the aberrant perception of reality (for example, hallucinations), and abnormalities in the patients typical behavior. Among the causes of schizophrenia, researchers mention genetics, biological dysfunctions, social environment, and other factors.
Besides, the paper analyzed some of the basic ways to study and treat schizophrenia with the use of recent medical discoveries. The genetic approach, for example, is the way to investigate the susceptibility of patients to the illness and define certain responsible genes. Brain imaging techniques help investigate the chemical condition of the brain and record its activity, which is another way of describing the nature of schizophrenia.
The analysis of antipsychotic treatment and ECT showed that it is possible to affect the structure and chemistry of the brain, provided that possible side effects are taken into account. However, it is necessary to notice that none of these methods is studied fully. As the human mind is one of the most complicated aspects of medicine, the disorder is not studied enough. However, with the development of psychiatric science and new technologies, discoveries in this sphere are likely to be made in the future.
References
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Durand, M.V., Barlow, D.H., & Hofmann, S.G. (2018). Essentials of abnormal psychology (8th ed.). Cengage Learning.
Galderisi, S., DeLisi, L.E., & Borgwardt, S. (Eds.). (2019). Neuroimaging of schizophrenia and other primary psychotic disorders: Achievements and perspectives. Springer.
Glatt, S.J., Faraone, A.T., & Tsuang, M.T. (2019). Schizophrenia (4th ed.). Oxford University Press.
Keith, G., & Rasmussen, M.D. (2019). Principles and practice of electroconvulsive therapy. American Psychiatric Association Publishing.
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Mouchlianitis, E., McCutcheon, R., & Howes, O. D. (2016). Brain-imaging studies of treatment-resistant schizophrenia: A systematic review. The Lancet Psychiatry, 3(5), 451463. doi:10.1016/s2215-0366(15)00540-4
Orrison, W.W., Lewine, J., Sanders, J., & Hartshorne, M. (2017). Functional brain imaging. Elsevier Health Sciences.
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