Judith Pratt is a Neuroscience Research Professor at the University of Strathclyde and an MQ Ambassador. Ahead of #SchizophreniaAwearness day we asked Judith to explain a bit more about this often misunderstood condition.
Schizophrenia Awareness day stems from a ‘plea for action’ in a 1970 article by Professor John Pringle which detailed the lack of support for those living with schizophrenia and for those who cared for them. Progress since then has been made regarding treatment, rights and support, yet many misconceptions around schizophrenia remain, leading to stigma and discrimination.
Common Symptoms of Schizophrenia
Each person's experience of schizophrenia is unique. Diagnosis is based on the presence of a range of symptoms. These include symptoms of psychosis where people experience strong beliefs that other’s don’t share (delusions) or voices that others can’t hear (auditory hallucinations). This results in people finding it difficult to distinguish what is reality for everyone from what is reality just for them. Some people experience a loss of motivation and interest (negative symptoms) which can lead to social withdrawal. Others may experience cognitive difficulties which can affect attention and the ability to think flexibly. At an individual level, the range and severity of symptoms vary considerably.
Stephanie was diagnosed with Schizophrenia 11 years ago.
“I was diagnosed with schizophrenia in 2010. I was very lucky to receive care and support from an early intervention team in Glasgow and I credit them with giving me the hope and confidence to pursue a career (many years later) as a psychosis researcher. I think what gets called psychosis is complex and we should always think holistically about symptoms and experiences such as hearing voices.”
What factors predispose to schizophrenia ?
1 in 100 of us develop schizophrenia. But why? From a neuroscience perspective, research has shown that both genetic (nature) and environmental (nurture) factors interact to affect the way our brains develop and function in adulthood. Schizophrenia is in part an inherited condition. But by no means do genetics compose the entire story. The likelihood of developing schizophrenia is also impacted by a wide range of environmental factors including viral infections acquired in the womb, living in urban areas, being a member of an ethnic minority and drug misuse. Researchers are only just beginning to unravel how and which genetic and environmental factors interact to heighten the risk of developing schizophrenia, which often commences in late adolescence. Given the wide range of factors that increase the risk of developing schizophrenia, it is not surprising that symptoms can vary considerably from person to person.
How is the brain altered in schizophrenia ?
To begin to understand how changes may occur in the brain which lead to schizophrenia, it is important to first understand how the brain operates. Our brains consist of around 100 billion neurons which communicate with each other by electrical signals and by chemical messengers (also known as neurotransmitters) such as dopamine. Each individual neuron may have thousands of connections (called synapses) with other neurons and, where they connect, chemical messengers are released. Neurons become organised in well-defined networks during our development and these networks engage with each other to operate different functions like memory, sensory experiences, emotions and behaviours. Understanding how they do this has been the focus of neuroscience research for decades.
Historically, it was thought that schizophrenia was caused by increased amounts of the chemical messenger dopamine. Dopamine acts in a part of the brain called the striatum which plays a role in guiding our attention to what is relevant or salient. If the amount of dopamine here is different than usual, it can give rise to the perception of some events and internal thoughts seeming more significant than they should be, leading to psychosis. To think that only dopamine is involved is an oversimplification.
The striatum is part of a brain network which involves the thalamus and prefrontal cortex. Changes in the development and activity of this network can lead to schizophrenia. Experts have shown that genetic and environmental factors can affect other chemical messengers such as GABA and glutamate which alter the balance of excitation and inhibition in this network, leading to schizophrenia.
Hope for the future
Has this understanding of schizophrenia led to new treatments? Sadly not yet, but there is room for optimism. MQ has supported a number of different research studies into schizophrenia.
Stephanie is also now working in the field, putting her own lived experience to good use.
“My day job is as a research assistant on the AVATAR2 study which involves the innovative use of digital technology to allow ‘face-to-face’ dialogue between the voice-hearer and a computerised representation of their voice (the avatar), with a therapeutic focus on increasing power and control over the voice. As someone living with schizophrenia, I am grateful to those who dedicate their careers to research which helps me, and others like me.”
Our current medications such as antipsychotic drugs (which block the actions of dopamine) can help in alleviating psychosis symptoms such as delusions and hallucinations but they have side effects and don’t treat the negative symptoms such as loss of motivation nor the cognitive difficulties. Improving these latter symptoms is a large part of improving care, treatment, and support options for those living with schizophrenia, to enable them to lead meaningful lives with purpose. Research into new medications and early intervention therapies are being undertaken in young people who are at risk, to prevent the transition into developing schizophrenia. Cognitive remediation therapies are also advancing including innovative adaptions to be digital with options to be delivered at home. Both drug and cognitive therapies can impact on affected brain networks and improve symptoms. Whilst there are still many advances that need to be made to support the recovery of people living with schizophrenia, the road to prevention is underway.
If you are living with schizophrenia, and would like some help, advice or more information you can visit the Get Help page here or Mind Infoline can connect you to support available in your local area: 03001233393
