Between delusion and reality: Schizophrenia a complex disorder

Introduction
Schizophrenia is a complex disorder

Behavior

Intracellular processes

Much effort has been made on the research on schizophrenia

Schizophrenia is a brain disease.

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Introduction
History and Phenomenology

Treponema pallidum

A psychological syndrome can be produced by an infectious agent Schizophrenia may have multiple etiologies
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Introduction

Emil Kraepelin (18561926) Hebephrenia Paranoia Catatonia

Eugen Bleuler (18571939) Schizo Phren

(, "to split") (, -; "mind")

Dementia praecox

Splitting or tearing of the mind and emotional stability of the patient

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Introduction
The Diagnostic and Statistical Manual of Mental Disorders (DSM).

Disorganized speech(delirant or incoherence) Catatonic behavior

Symptoms of the disorder have been present for six months or more.

Introduction
The four subtypes of schizophrenia Paranoid Catatonic Disorganized Undifferentiated Disorganized

Undifferentiated

Paranoid

Boundaries between schizophrenia and mood disorders are obscure

Schizoaffective disorder

Catatonic

Introduction

THE ORIGINS OF VULNERABILITY

The Genetics of Schizophrenia
One of the most well-established findings in schizophrenia research is that vulnerability to the illness can be inherited (Gottesman 1991). Monozygotic (MZ) Dizygotic (DZ) Disorder involves multiple genes, rather than a single gene There is significant overlap in the genes that contribute to schizophrenia, schizoaffective disorder, and maniac syndromes With the heritability of the disorder estimated to range from 7085%, about 60% of all persons with schizophrenia HAVE NEITHER a first- nor seconddegree relative with the disorder (Gottesman & Erlenmeyer-Kimling 2001). 9 25% to 50% 10% to 15%

The Genetics of Schizophrenia

Genes statistically associated with schizophrenia susceptibility
Symbol
MTHFR DRD4 DRD2 DRD1 DAO IL1B TPH1

Full Name
5,10-methylenetetrahydrofolate reductase Dopamine D4 receptor dopamine receptor D2 dopamine receptor D1 D-amino-acid oxidase interleukin 1, beta proprotein Tryptophan hydroxylase 1

Chromosome
1 11 11 5 2 2 11

TP53
HP DAOA DTNBP1 COMT

Tumor protein p53

Haptoglobin D-Aminoacid Activator Dystrophin binding (Dystrobrevin) protein 1

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16 13 6 22
10

Catechol O-methyltransferase

Environmental factors
Environmental traumas associated with schizophrenia
Event
Influenza infection Starvation Traumatic brain injury

Age at event
In utero second trimester of pregnancy In utero second trimester of pregnancy Throughout life

A NEURODEVELOPMENTAL DISORDER

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Neurotransmitters

Synapse

Brain circuit activity is driven by neurotransmitters.

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Neurotransmitters
Dopamine + Glutamate GABA Behavior, cognition, motivation, punishment, reward, sexual gratification, sleep, mood attention, learning

Dopamine

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Neurotransmitters

Glutamate

N-methyl-D-aspartic acid (NMDA)

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Neurotransmitters
Antagonist

PhencyclidinePCP (Angel dust) Ketamina

Blockade of NMDA receptors produces the symptomatic manifestations of schizophrenia in normal subjects, including negative symptoms and cognitive impairments.

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Neurotransmitters

GABA

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Perspectives
Schizophrenia in 2030
Prevention: sensitive and specific diagnostic tools
combination of approaches

Reducing cognitive deficits : The disability of

schizophrenia in 2010 results more from the cognitive deficits Alzheimers disease Pharmacological Nonpharmacological

Integration of care
Stigma: In contrast to many other medical disorders, schizophrenia today too often DEFINES A PERSON rather than describing the illness.
Seishin-Bunretsu-Byo (mind-split disease) change by TogoShitcho-Sho (integration disorder)
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