Schizophrenia

About one in 100 people will develop schizophrenia at some point in their lives, with most of those persons developing symptoms in their late teens or early 20s.

Symptoms of schizophrenia include inaccurate perceptions and beliefs, disordered thoughts, and speech patterns that may be hard to follow. During a psychotic episode, a schizophrenic may hear voices that are not there, or feel, taste, or smell something non-existent. Low motivation, changed feelings, and unusual conduct can impair day-to-day functioning.

Treatment generally includes antipsychotic medications, psychological counseling to improve behavior and insight, plus community programs, such as psychosocial rehabilitation, work assistance, and support groups. First-line medications include amisulpiride, risperidone, quetiapine, olanzapine. The medications do carry side-effects, and prior to receiving a prescription, patients need to be screened for issues such as diabetes, cardiovascular problems, or neurological disorders. Side effects may include dry mouth, blurred vision, flushing, constipation, and weight gain. Antipsychotic medications also present a risk of causing movement disorders, although this may be more prevalent with older, first-generation compounds. The newer, so-called atypical antipsychotics are thought to be less likely to produce that side effect.

Many patients have a lifelong vulnerability to recurrent episodes, and will be maintained on preventive medication and care for one to two years after an acute episode. Generally, with early treatment, about 80% of patients will recover for some length of time. Less than 20% of people only experience a single schizophrenic episode.

The causes of schizophrenia are not fully understood. It is possible that an imbalance in neurotransmitters, or change in the body’s response to them, plays a role.

Diagnosis is mainly based on the behavior and experiences reported by the individual and family members, friends, or co-workers, as well as observations by the clinician. It is believed there may be a biological predisposition to schizophrenia, with stress or environmental factors potentially contributing to its development.

A few small studies have looked at different types of neuromodulation in schizophrenia. Transcranial direct current stimulation was reported by Jerome Brunelin, PhD and colleagues from France and Tunisia in 2012 in the American Journal of Psychiatry to reduce auditory hallucinations by an average of 31% in 30 patients who had not been able to control daily symptoms through medication. In addition, in 2011, the Israeli Ministry of Health granted approval for a transcranial magnetic stimulation system to be marketed for the treatment of neurological and psychiatric disorders, including schizophrenia-related cognitive impairment.

Neuromodulation has been considered as a potential future intervention for schizophrenia in part because it has been hypothesized that persons who have schizophrenia possess an excess of receptors for neurotransmitters. The opposite occurs in the neurodegenerative process of Parkinson’s disease, in which deep brain stimulation has been used in select patients since the 1990s to rebalance neural circuits, counteract that loss, and manage movement symptoms.

Reviewed Feb. 5, 2013
Bomin Sun, MD
Member, International Neuromodulation Society
Department of Stereotactic and Functional Neurosurgery, Shanghai Jiaotong University School of Medicine Ruijin Hospital, Shanghai, China

Last Updated on Friday, June 16, 2017 08:36 AM