Schizophrenia: The Dopamine Hypothesis

Dopamine, a major excitatory neurotransmitter, may play a key role in schizophrenia. According to the dopamine hypothesis, the symptoms of schizophrenia - particularly positive symptoms (e.g. delusions and hallucinations), are produced by over-activity of the dopamine in areas of the brain that regulate emotional expression, motivated behaviour and cognitive functioning.

 

Having "too much" of this neurotransmitter is probably too simplistic; the better term is a functional excess (Lieberman, 1990). This may be caused by a failure of any of the many processes involved in breaking down and re-creating the neurotransmitter, or disruption to the receptor system (such as the receptor functioning "too well"), or there may be problems with re-uptake into the presynaptic membrane.

 

Dopamine Pathways

People diagnosed with schizophrenia have more dopamine receptors on neuron membranes than do non-schizophrenics, and these receptors seem to be over-active to dopamine stimulation (Wong, 1986). Additional support comes from the finding that the effectiveness of antipsychotic drugs used to treat schizophrenia is positively related to their ability to reduce dopamine-produced synaptic activity (Green, 1997).

 

The hypothesis that dopamine and dopaminergic mechanisms are central to schizophrenia has been one of the most enduring ideas about the illness. It was not until the 1970's, however, that the dopamine hypothesis was finally crystallized with the finding that the clinical effectiveness of antipsychotic drugs was directly related to their affinity for dopamine receptors. To date, their have been more than 6800 articles on the topic of dopamine and schizophrenia since 1991.

 

In summary, molecular imaging studies show that presynaptic striatal dopaminergic function is elevated in patients with schizophrenia; however blockade of this heightened transmission, either by decreasing dopamine levels or blocking dopamine transmission, leads to a resolution of symptoms for most patients (Howes, 2009).  

The Matrix: Was Neo Psychotic?





Auditory Hallucinations

Psychosis is a mental health problem that can  stop the person from thinking clearly, telling the difference between reality and their imagination, and acting in a normal way.

Morpheus: What is "real"? How do you define "real"?

It is a loss of contact with reality that usually includes delusions and hallucinations. Delusions are false beliefs about what is taking place or who one is, such as thinking that someone is plotting against you or that the TV is sending you secret messages. Hallucinations are false perceptions, such as hearing, seeing, or feeling something that is not there. 

Neo: What did she tell you?

Morpheus: That I would find the One. 

Signs of Psychosis

The early stage of psychosis is marked by a difficulty in concentrating, depressed mood, sleep changes - sleeping too much or not enough, anxiety, suspiciousness, withdrawal from family and friends and on-going unusual thoughts and beliefs. While the later stages involve being confused and having impaired reality testing; that is, people are unable to distinguish personal, subjective experiences from the reality of the external world. This can progress onto delusions, hallucinations, disorganized speech (switching topics erratically), difficulty functioning, depression and even suicidal thoughts or actions.

 

Morpheus: I see it in your eyes. You have the look of a man who accepts what he sees because he is expecting to wake up. Ironically, that's not far from the truth.

Causes:


A Psychoactive Aetiology?

A number of medical problems can cause psychosis, including:

- Alcohol and certain illegal drugs (or blue and red pills?)

- Brain diseases, such as Parkinson's  
- Huntington's disease, and certain chromosomal disorders

- Brain tumours or cysts

- Dementia (including Alzheimer's disease)

- HIV and other infections that affect the brain

- Some prescription drugs, such as steroids and stimulants

- Some types of epilepsy

- Stroke

Symptoms:

Psychotic symptoms may include: disorganized thought and speech, false beliefs that are not based in reality (delusions), especially unfounded fear or suspicion, and thoughts that "jump" between unrelated topics (disordered thinking).

Neo: I thought it wasn't real

Morpheus: Your mind makes it real

Exams and tests:

Psychiatric evaluation and testing are used to diagnose the cause of the psychosis. Laboratory testing and brain scans may not be needed, but sometimes can help pinpoint the diagnosis. The type of tests may include; blood tests for abnormal electrolyte and hormone levels, blood tests for syphilis and other infections, drug screens, and sometimes an MRI of the brain.



''Yeah...ehmm...sorry about that''

Possible Complications:

Psychosis can prevent people from functioning normally and caring for themselves. If the condition is left untreated, people can sometimes harm themselves or others (or Trinity).



 Morpheus: You've been living in a dream world, Neo.

 

 

''Your 50 minutes are up young man''

 

Treatment often depends on the cause of the psychosis. It might involve drugs to control symptoms and talk therapy, which can help address the underlying cause of the psychosis.

For example the talking therapy cognitive behavioural therapy has proved successful in helping people with schizophrenia.  Hospitalization is an option for serious cases where a person might be dangerous to himself or others.



''Perhaps we are asking the wrong questions'' ~ Agent Brown 

 

Social support should also be addressed, so as to help support the person with psychosis, who may have social needs such as education, employment or accommodation.

 

 

 

 

 

  

 

 

Agent Smith: It seems that you've been living two lives. One life, you're Thomas A. Anderson, program writer for a respectable software company. You have a social security number, pay your taxes, and you... help your landlady carry out her garbage. The other life is lived in computers, where you go by the hacker alias "Neo" and are guilty of virtually every computer crime we have a law for. One of these lives has a future, and one of them does not.

''The need to prove who you are will vanish once you know who you are''
~ Pierre

 

 

 

 

Similar to Parkinson's Disease and Schizophrenia, dopamine levels are thought to be too high during psychosis, or better, there is a 'functional excess' of dopamine in the person's brain. This can affect memory, emotion, social behaviour and self-awareness.

Bizarre delusions are often experienced during psychosis.

Examples of psychotic delusions include the paranoid type - more likely to be associated with schizophrenia - and delusions of grandeur.



''Sure ye do''



Delusions of grandeur: clearly false but strongly held beliefs in having a special power or authority - the person with psychosis may, as examples, believe that they are a world leader, very rich, that they are able to bring dead people back to life, or that they can control the weather.

 

While the classic hallmarks of psychosis are hallucination and delusion, other symptoms persist in disorders such as schizophrenia - known as negative symptoms. That is, cognitive and motivational impairments, which can be disabling and do not respond to drug treatment.



I think he saw me...

 

 

Paranoid delusions: these may cause the person with psychosis to be unduly suspicious of individuals or organisations, believing them to be plotting to cause them harm. Such delusions can be very frightening and may result in unusual behaviour to avoid things - for example, staying out of a room with certain devices in it, believing them to be controlling thoughts, or locking up the front door with an excessive number of padlocks.

 

Similar to Eric Bui and colleagues examining Borderline Personality Disorder and Darth Vader (2010), it is interesting to compare a disorder with something relevant, in an attempt to try and identify with it. While one is the work of fiction and the other a real life debilitating disorder, slight overlap can be seen and the crude comparisons hopefully elucidate the disorder a little.

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Freudenreich O, Weiss AP, Goff DC. Psychosis and schizophrenia. In: Stern TA, Rosenbaum JF, Fava M, Biederman J,    Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 28.

 

Katherine Darton, Mind. Psychotic experiences. London, UK: Mind, 2011. Information published online, accessed November 21st, 2013.

MedlinePlus. Psychosis. Bethesda, MA, US: National Library of Medicine, National Institutes of Health, Department of Health and Human Services.

 

NHS Choices. Causes of psychosis. London, UK: National Health Service.

 

Van Os J, Kapur S. Schizophrenia. The Lancet, 2009, volume 374, number 9690, pages 635-645 (DOI: 10.1016/S0140-6736(09)60995-8).

WHO. Chapter V: Mental and behavioural disorders. In: International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Geneva, Switzerland: World Health Organization, 2010.

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''Minds that have withered into psychosis are far more terrifying than any character of fiction''
                                                                                                                                   ~ Christian Baloga

Schizophrenia

Unlike the disruptions of mental tranquillity that disturb everyone from time to time, schizophrenic episodes represent a severe departure from normal mental functioning. The disorder has a distinctly biological character, suggesting that its fierce psychotic episodes reflect physiological alterations in normal brain function.

Schizophrenia is the diagnostic term for a family of severe mental disorders that involve psychotic features - a loss of contact with reality - and a widespread deterioration of the level of mental functioning affecting multiple psychological processes (Kandel, 1991). The disorder always involves delusions, hallucinations, or characteristic disturbances in the form of thought. By definition, schizophrenic disorders are relatively long lasting: brief, isolated psychotic episodes are not classified as schizophrenic. Schizophrenia, strictly defined, has an incidence of approximately 1 in 200. Rates of schizophrenia are generally similar from country to country - about 1 percent of the population. There are variations - but the variance is difficult to track due to differing measuring standards in many countries, etc. It is equally common in men and women.

Delusions are a major abnormality in the content of thought. Schizophrenic delusions - false beliefs about external reality - are often persecutory, as in the belief that a television newscaster is making fun of the viewing individual. Other typical delusions are more bizarre: The individual may believe that his or her thoughts are being broadcast so that everyone nearby can hear them, or that other people are inserting thoughts and their behaviour is controlled by others, perhaps by radio waves. Such delusional beliefs represent a marked failure in assessing reality.

Characteristic abnormalities in the form of thought also frequently occur. Most common is a loosening of associations , in which ideas shift from one topic to another in an apparently unrelated manner. When this is severe, speech becomes incoherent.

Hallucinations - perception without external stimulation of the sensory systems - are also characteristic of schizophrenia. Most hallucinations are auditory, involving voices that may make insulting statements or provide a continuing critical commentary on the individual's behaviour. Tactile and somatic hallucinations, such as the perception of snakes crawling inside the abdomen, also occur. However, visual hallucinations are less common.

The emotions of the schizophrenic patient are usually flattened or inappropriate. ''Flattened'' means a loss of emotional intensity: the patient speaks in a monotone, the face is expressionless, and the patient reports that normal feelings are no longer experienced. At other times, emotion may be present but is inappropriate to the circumstance.

The combination of symptoms leads to a gross distortion of the person's interactions with the real world. There is a deterioration in functioning, resulting in part from a preoccupation with internal thoughts and fantasies. In many cases, the acute active phase of florid schizophrenic symptoms persists for a prolonged period. It may be followed by a relative remission of symptoms, but a complete return to normal function is extremely unusual. In fact, such a recovery calls into question the original diagnosis of schizophrenia.

Despite the bizarre and florid nature of the schizophrenic symptoms, there is still considerable controversy as to the nature of the disorder. Many investigators believe that schizophrenia is not a single disease but forms a group of related psychotic disorders.

In schizophrenia, there seems to be an inheritable predisposition or susceptibility to the disorder. In the general population, the risk of schizophrenia is less than 1 percent. However, this risk is much greater for relatives of schizophrenics. The parents of a schizophrenic child have about a 5 percent risk of schizophrenia, the siblings of a schizophrenic have about a 10 percent risk, and the children of a schizophrenic parent have about a 14 percent chance of developing the disorder. If both parents are schizophrenic, the child has a risk factor of about 50 percent.

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''If you talk to God, you are praying; If God talks to you, you have schizophrenia.''
                                                                                                         ~ Thomas Szasz

Christmas Carol Favourites - The Therapist and his Client

Schizophrenia ~ Do You Hear What I Hear?

Depressed ~ Driving Off A Cliff For Christmas...

Post Traumatic Stress Disorder ~ Grandma Got Run Over By A Reindeer...

Compulsive Gambler ~ Run Rudolph Run!!!

Passive Aggressive ~ All of the other reindeer used to laugh and call him names...

Agoraphobia ~ Hiding Behind The Christmas Tree, At The Christmas Party Hop...

Multiple Personality Disorder ~ We Three Queens Disoriented Are...

Alcoholic ~ All I Want For Christmas Is........To Get Sh*t-Faced!

Dementia ~ I Think I'll Be Home For Christmas...

Pyromaniac ~ Later on...we'll conspire...as we dream by the fire...

Tourette's ~ Jingle F**K! Jingle B****CKS!

Morbidly Obese ~ It's Beginning To Look A Lot Like...Diabetes !

Narcissistic ~ Hark The Herald Angels Sing About Me...

Body Dysmorphic ~ All I Want for Christmas.......is 6% Body-Fat And A Nose Job

Paranoid ~ Santa Claus Is Coming To.....Get Me !

Hypochondriac ~ He's making a complaint, He's checking it twice, He's not very happy with his doctor's advice...

Erotomania ~ The Twelve Dicks of Christmas...

Sadistic ~ Jingle Bells, Baseball Bats With Holes, The Safety Word is Sleigh...

Masochistic ~ Rudolph the Red-Arsed Reindeer...

Antisocial Personality Disorder ~ Last Christmas, I gave you my heart, the very next day you called me a scumbag, a maggot...

Social Phobia ~ Here Comes Santa Claus...Hide!

Borderline Personality Disorder ~ Thoughts Of Roasting On An Open Fire...

Personality Disorder ~ You Better Watch Out, I'm Gonna Cry, I'm Gonna Pout, Maybe I'll Tell You Why...

Insomniac ~ I'm.....Dreaming About....Sh*t All...

Manic ~ Deck The Halls and Walls and House and Lawn and Streets and Stores and Offices....

Obsessive Compulsive Disorder ~ Jingle Bells One, Jingle Bells Two, Jingle Bells Three, Jingle Bells Four, Jingle Bells Five, Jingle Bells Six, Jingle Bells Eight...Sh*t!...Jingle Bells One...

ADHD ~ He's Making A List, And Checking It Twice, Gonna Find Out...Do I Want Chicken Curry And Rice?

Exhibitionist ~ All I Want For Christmas...Is A Full Frontal !
 

 

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 ''The main reason Santa is so jolly is because he knows where all the bad girls live''                                                                                                                ~ George Carlin