Brain changes in schizophrenia - doctor's blog for a minute. Psychoactive substances and schizophrenia

Drama and Mystery: Schizophrenia

The origin of schizophrenia has also still not been established for certain. The onset of this disease has little to do with the age of the patient. But some optional patterns of its course and treatment prognosis can be traced, depending on the age at which it first appears.

It should be noted right away that schizophrenia cannot be treated in our time. However, in most cases it is possible to slow down its progress or completely relieve symptoms. At the same time, refusal of drug regulation will certainly entail a resumption of symptoms, regardless of the period for which they were taken.

The aura of mystery that shrouds schizophrenia is formed and maintained by several features of this disease that greatly distinguish it from other mental disorders. And these features, in turn, purely outwardly contain a significant amount of mystery. Sounds intriguing? Now it will become clear what the essence of the intrigue is...

Schizophrenics, unlike other “mature” people, are one of the last to lose the skill of engaging communication. They have almost no signs of neuralgia characteristic of many disorders - twitching, grimacing, tics, unnatural movements. Speech is practically never impaired in terms of syntax. The first and only thing that can often be alarming when communicating with a patient with schizophrenia is the logic of the judgments themselves, which he communicates in a syntactically completely correct form.

The fact is that the very essence of schizophrenia is the loss of relationships between individual parts of what is called personality. In such patients, for example, emotions do not depend in any way on external stimuli, mental activity, life experience, or subjective interests.

The situation is exactly the same with their thinking and other components of the brain - cut off from everything else, without any directional vectors, and in no way connected with the current situation. That is, while each function is preserved separately almost intact, their mutual coordination with each other is completely absent.

How does this translate in practice? Very peculiar. From this moment the elusive mystery of the image of a schizophrenic begins. Let's take speech as an example. When a person talks to someone, how does he communicate?

Firstly, depending on the personality of the interlocutor - his age, status, degree of acquaintance with him, the presence or absence of official or other relationships. Example:

It is clear that in the presence of parents, a teenager will not use profanity, even if he is fluent in it and uses it throughout the main part of the day outside the home...

Secondly, depending on the topic of conversation and your position on this issue. Example:

The same person, talking about football with a friend in the evening, will probably have very little similarity in his speech characteristics to the one who explained to his boss the reasons for making some decision in the morning.

Thirdly, the environment in which the conversation takes place will play a significant role: a telephone dialogue, even with an extremely unpleasant person, if the call finds the subscriber in a public place, will probably turn out to be more neutral than if it took place face to face.

Fourthly, based on all these subtleties, the speaker will additionally try to structure his speech in such a way as to be most correctly understood by this particular interlocutor.

And this is not all of what we take into account unconsciously, almost automatically, every time we find ourselves in a situation of verbal communication! The milestones from which a schizophrenic bases his speech behavior are of a completely different kind and kind. First of all, due to his illness, he does not perceive the image of his interlocutor as such. He sees the old age of the grandmother, her faded green coat, the color of her eyes, how many teeth she has, and is even able to understand which political party she has been supporting since perestroika. But in his head these disparate features cannot form a common speech picture. Like this, to assent that pensions are not enough, to offer to hold her bag or help her read what is written on the store window, etc.

Any healthy person, when talking with a representative of the older generation, would definitely do something of this - albeit for the sake of gracefully “rounding out” an unnecessary conversation. This is not possible for a schizophrenic. Most likely, he will quickly seize the initiative from his grandmother and lead the conversation in such a way that she will not be able to get a word in. The fact is that patients with schizophrenia, along with the unity of mental manifestations, lose the ability to distinguish between the main and minor details of an object. Therefore, in addition to their misfortune, they receive an almost genius inclination. This tendency is to create completely unexpected mental moves by combining objects according to properties that are quite real, truly inherent in them... But usually not those that are considered a reason for comparison.

The embodiment of such a feature sometimes looks very bizarre. For example, a healthy person can hardly name offhand the common property of a sword, an airplane, a computer, and a truck. The boldest assumption would be that they are all made, at least for the most part, of iron. A schizophrenic can easily determine that all these objects demonstrate the power and greatness of human civilization, symbolize high technology and the superiority of mind over nature - etc., etc.

In fact, after the first two phrases a whole stream of associative considerations will flow. And he will very quickly jump to anything else. Behind the “greatness of human civilization” a consideration in the spirit of “however, what difference does it make if all these things are just an accumulation of atoms that have received their form” can easily appear.

It is almost impossible to stop the associative series along which the patient’s thoughts jump. Moreover, if the dialogue does not take place in a clinic, where orderlies and a syringe with a powerful sedative are within reach, you should neither argue with such a patient nor interrupt it. Not only his speech is divorced from reality, but also his emotions. Schizophrenics rarely demonstrate reactions of this kind that are adequate to the stimulus.

In other words, any carelessly spoken word may be followed by an attack. And people with mental disorders, as is known, are distinguished by physical strength that exceeds even some sports indicators. That's why medical staff in psychiatric hospitals are armed with rubber batons as normal. This is not a manifestation of sadism or callousness, but an objective condition of their work. Patients in such institutions are capable of injuring even armed, specially trained and athletic nurses.

We tried to describe the behavioral features of a schizophrenic as clearly as possible in order to more clearly emphasize their originality. The speech of such a patient is not incoherent at all. On the contrary, formal logic runs through all his actions and words. But he cannot concentrate on one, the most important, topic, he continuously moves from one subject to another - including something that is in no way connected with the previous one...

The behavior of a schizophrenic does not correspond either to his previous life experience, or to current circumstances, or to the norms and rules common to all people. But, no matter how paradoxical this combination may seem, there is also clear meaning in it. This is where schizophrenia is so closely related to genius.

Deprived of the ability to recognize the integral properties of something and focus attention on them, a schizophrenic easily finds other, unusual and yet quite possible connections between things. And – what a coincidence! – genius is defined precisely as the ability to find a common basis that unites facts that are well known individually, but have not previously been compared!

However, there are a number of reservations here that make it possible to consider schizophrenia to be a disease - useless both for discoveries and for the patient himself.

Firstly, geniuses, in contrast to “definitely” sick people, invariably retain the basic ideas necessary for successful contact with their own kind. But the ability to distinguish a smart or promising thought from a stupid one is also one of the conditions for discovery. A schizophrenic, having accidentally stumbled upon a paradigm worthy of attention, will not be able to distinguish it from any other. But to develop, refine, prove, test in practice... No, none of the other components of genius are simply not typical for this disorder - the disease simply destroys everything else!

Further. Schizophrenia, if left untreated, quickly leads to the degradation of most of the parts into which the personality has broken up. The emotions of a schizophrenic in their basic state are dulled, since there is not enough information from the outside for their active production. Why? We remember that loud music in the neighborhood may not seem loud to him. He could easily not even hear her! And the reactions under the influence of a stimulus that has reached his brain are initially not distinguished by their complexity - persistence, absolute confidence in one’s rightness, aggression... The only thing that looks most complex here is their inadequacy to the circumstances. But, of course, a healthy brain has nothing to work on solving here - the person is simply sick and his illness has the ability to lose focus on the notorious circumstances. That's all.

A personality that is unable to develop, maintain and draw on the complexity of the processes of one part of itself in the work of another quickly degrades. Emotional dullness (in the meaning of the term) is accompanied by a number of defects in other areas. In particular, passivity, lack of will and desire for the simplest actions, increased sensitivity to insignificant little things.

The symptom of sensitivity is explained by the fact that for a schizophrenic nothing is small or large. And to form goals in life you need the ability to prioritize.

The body movements of patients gradually become pretentious, unnatural and intricate postures are used, but without compromising the precision of coordination. The latter is associated with the loss of distinction as to how to move naturally and how not. The patient's speech becomes increasingly poor in terms of the lexical means used. The process ends with characteristic schizophrenic dementia.

In addition, the pure, classic type of schizophrenia is quite rare. Complications in the form of mania, paranoid elements, and psychosis are commonplace for her. Moreover, psychosis often takes the form of manic-depressive because schizophrenics are generally prone to a minor mood due to a general lack of information, impressions, sensations, etc. Almost 40% of patients with schizophrenia commit suicide.

There is nothing Freudian or even simply unusual about this. All mental illnesses, except schizophrenia, manifest themselves as a symptom of the degradation of some part of the personality. In schizophrenia, the scenario is initially different, but it develops in exactly the same way. First, the personality of a schizophrenic breaks up into separate fragments, and any relationship between them disappears. Next, the process of degradation of the resulting fragments starts. But as it increases, individual symptoms of diseases appear that are associated not with schizophrenia and not with former complexes, but with the disintegration of certain fragments of the personality.

It is interesting that schizophrenia can, in addition to being irreversible, be sluggish and, so to speak, rapid. The first develops gradually, making itself felt obvious only during exacerbations with individual symptoms. Most often, this is the patient’s isolation, detachment, combined with increased sensitivity and capriciousness. It is also accompanied by neglect of the rules of personal hygiene and appearance, especially noticeable during an exacerbation period. During improvements, many of the primary symptoms disappear completely. But the clear periods of time are becoming shorter and shorter, and each subsequent exacerbation is more and more difficult. And so on until the brakes completely fail.

You can live next to a latent schizophrenic for years, believing him to be nothing more than a person with quirks (who doesn’t?) or prone to depression. Certain features of schizoid (literally “schizophrenia-like”) behavior are characteristic of creative and gifted people, those with a melancholic temperament, as well as people in advanced stages of stress. And, of course, for children. Their thinking on the basis of the most unimaginable associations, an actively working imagination, the spontaneity of mental reactions - all this is nothing more than the attributes of schizophrenia “blooming in all its glory.” Fortunately, they disappear with age. And in schizophrenics they appear again. Just like in childhood!

Rapidly progressive schizophrenia develops over several months, sometimes years. It is more typical for her to transition to hallucinations and delusional ideas as if immediately - bypassing the symptoms of sloppiness and irritability. The most common hallucination for schizophrenia is the so-called voices in the head. Science has not yet found a comprehensive explanation for this feature, but there are theoretical conclusions on this matter. Schizophrenic “voices” have one significant difference from hallucinations as such. The fact is that the patient himself describes them as if they were “made.” What is meant by this phrase is that a person perceives any true hallucination as a completely real image, sound, sensation. Including if it contains absolutely incredible elements.

The curious thing here is that the brain is not able to distinguish a true hallucination from the effects of reality. And schizophrenics retain the impression that the sounding voices do not belong either to their personality or to objective reality. They have a touch of “artificiality” due to the fact that the “voices” do not merge in the patient’s brain with any of its categories. He does not consider them to be something fantastic (again, he has no evaluation criteria for this), however, he clearly realizes that the source of the “voices” is not in his head.

This strangeness of the “voices” has given rise to the assumption in the scientific world that, strange as it may sound, hallucinations are not characteristic of schizophrenia at all. Underneath phenomena similar to them lies a modified, highly distorted, but ongoing “communication” of those disparate processes that once made up a single personality. The echoes of such a “dialogue” take the form of visions, voices, sensations, which the patient perceives as something alien.

If we talk about proven facts, then in the brains of schizophrenics, scientists have discovered a number of structural abnormalities characteristic of this disease. First of all, we are talking about changes in the structural organization of the so-called. prefrontal cortex. On the hemispheres, this is the most convex visually, the frontal part. If you show the head “from the outside,” then the prefrontal region begins directly above the eyebrows, makes up the entire area of ​​the forehead and ends a centimeter and a half above the hairline. In humans, it is approximately responsible for retrieving the necessary knowledge from memory. And the development of that, according to P.K. Anokhin, mode of action in which the brain first creates an order of actions and compares it with memory for effectiveness. Yes, and only after that he puts it into practice. In addition, the prefrontal cortex generates the emotional part of a person's assessment of an event about which he intends to act.

So, in patients with schizophrenia, there is an abnormally low number of mitochondria in the neurons and processes of this area of ​​​​the cortex. Let us remember that mitochondria are intracellular formations in which energy is produced to power the cell itself. Or, in the case of neurons, to produce electrical impulses. A decrease in the number of mitochondria, simply put, reduces the overall electrical potential of brain cells, which slows down and disrupts information processing in this area.

In addition, the brain of schizophrenics is characterized by a decrease in the number of synapses in the hippocampus, which is responsible for converting short-term memory into long-term memory. Moreover, difficulties with the formation of synaptic connections are explained by a violation of the structure of myelin molecules - the protein that makes up the white “sheaths” of axons. In schizophrenics, in other words, the braid of the wires for transmitting the impulse is damaged.

To put it even more directly, cortical neurons in schizophrenics are formed with congenital defects. These defects are somewhere on the border between incompatibility with life and a healthy norm. From this it follows that the cortical cells of schizophrenics are weaker than those of healthy people. But not so weak that you can’t work at all. And the patient’s brain, finding itself in the position of a person with a weakened immune system, begins to take measures to prevent severe disorders as mental stress increases. And to do this, he “maximizes” all the mechanisms available to him to inhibit the activity of the cortex. Just as a chronically ill person protects cold-prone areas of the body from the cold. You have to understand that he forms schizophrenia out of fear that epilepsy will develop...

But jokes aside, from this point of view, schizophrenia is just a means of self-defense for malformed brain cells! Indeed, the EEG of cortical activity of an unmedicated schizophrenic is strikingly similar to the EEG of a person under hypnosis. It turns out, relatively speaking, that schizophrenia is a state of chronic hypnotism! Impressive, isn't it?

Indirectly, the fact that the neurons of a schizophrenic have a reduced performance is indicated by a fact recently discovered by a group of American scientists. They conducted experiments with the memory of patients with schizophrenia. And we found out one interesting feature of the process of operation of this mechanism. It turned out that schizophrenics, when trying to remember something, use many times more cortical areas than people without deviations. Moreover, they much more often experience the phenomenon of synchronization of the efforts of the right and left hemispheres where in healthy subjects only one of them is activated, as it should be “traditionally”.

This means, in effect, that in schizophrenics, each simple mental effort produces twice as much brain activity and creates a greater number of synapses. But this also means that their brains, it turns out, are not as strictly differentiated by the functions they perform as others. homo sapiens. Which can equally be a sign of both immaturity (underdevelopment) of the entire brain substance and a way for the brain to reduce the load on each zone or neuron individually.

The currently widely and relatively successfully used drug therapy is based on an understanding of at least part of the mechanisms of schizophrenia. At the end of the last century, antipsychotics and antidepressants gained great popularity. Currently, as medical knowledge about the characteristics of schizophrenia advances, this series has been expanded and supplemented with atypical antipsychotics, which do not cause drowsiness and suppress only specific cortical reactions to the normal threshold. And also stimulants for the production of the mediator (a substance that activates synapses) dopamine in the cells of the cortex.

A real solution to the problem has not yet been found, as eloquently indicated by cases of schizophrenia resistant to any type of therapy and combinations of drugs, against which, accordingly, medicine is powerless.

Attention, mystery!

Not all blind people can develop skin-optical vision. However, it is quite possible. Modern science cannot find a convincing explanation of how the blind, regardless of the causes of vision loss, age and gender, are able to learn to recognize colors using the skin of their hands in the absolute majority. Experiments to develop a methodology for teaching this skill began in the middle of the 20th century. At different times, relevant experiments were carried out by the most prominent Soviet scientists. The interest of Russian neurophysiology in the hidden capabilities of the brain was explained, of course, not only by medical prospects, but now this is no longer important.

The earliest large-scale work in this direction was carried out by A. N. Leontiev, an academician of the USSR Academy of Sciences, a scientist whose main activity was in the field of psychology. Together with one of the most prominent physiologists of their time, Academician L.A. Orbeli (we have already mentioned him above), they obtained the first positive results in their group of subjects. A. N. Leontiev made a complete description of the experiment, observations and methods in his monograph “Problems of Psyche Development” (M.: Moscow State University, 1981). No, in fact, this work, of course, saw the light much earlier - in 1959, but since then it has been reprinted three more times. Here is information about the latest edition.

And then the amazing women Roza Kuleshova (led by I.M. Goldberg, a neuropathologist) and Ninel Kulagina, trained in skin-optical vision by a team of physicists under the leadership of Academician Yu.V. Gulyaev, repeatedly demonstrated their talents to the entire Soviet Union. The results of the experiments allowed both the organizers themselves and outside scientists to conclude that the phenomenon of skin-optical sensitivity can be developed to a very high accuracy. That is, right up to reading ordinary printed (not embossed, printed in Braille!) texts with your fingers.

However, with the collapse of the Soviet Union, further purely scientific work in this direction ceased. And this was connected not only with socio-historical changes, but also with an ambivalent attitude towards the problem, which over the past time has not become unambiguous. In the USA, some of these studies have been criticized due to proven cases of violation of experimental conditions. And in the mid-1980s, attempts at a similar critical approach were made in the USSR.

There are several problems in assessing the reality of the existence of optical-cutaneous hypersensitivity. First, it is relatively easy to simulate simply because of the experimental methodology itself, which creates more possibilities for “foul play” than any other. The second problem: this property has made tricks with imitation of skin-optical vision a popular part of the world circus art. That is, many professional illusionists are able to easily demonstrate similar “phenomena”, at least from a purely external perspective. The third problem is that science has not been able to detect any special points of sensitivity or receptors that differ in the degree of sensitivity from other skin sensors in the skin of the fingers. Which, however, is quite natural...

Nevertheless, there are plenty of obvious refutations that optical-cutaneous vision is impossible.

Firstly, a number of other cases could already be observed above, which could only be objectively recorded, but have not yet been subject to scientific explanation. Most likely, no one will ever find particularly susceptible receptors, since the brain does not really need them. Why does he need them if the essence of the signal he receives from a simple skin receptor and a complex organ like the eye is the same? That's the same...

Secondly, the purposes for which an illusionist studies tricks and an academician studies a blind patient are a little (literally, a little!) different. There is no reason for a world-famous scientist to train a subject for years and record hundreds of the smallest details for unscientific purposes. Holders of an academic degree do not even need to acquire world fame through magic tricks - they already have it. Thirdly, it should be noted that when trying to demonstrate optical-cutaneous vision as a scientific fact, a serious methodological error was nevertheless made. It was made with good intentions to emphasize the accessibility of developing this skill for almost every person, but still...

We are talking about unsuccessful selection of subjects. In their purely scientific work, A. N. Leontyev and L. A. Orbeli developed sensory skills in blind patients, that is, patients who were in principle unable to peep. The fact of the patient’s medically provable blindness would immediately negate half of the “methodological features” of the demonstration. However, after Leontiev and Orbeli, scientists became interested in the possibility of developing the same supersensitivity in people with healthy vision. From the position that the ability or inability of a normally functioning brain to adapt to the desired mode can explain a lot in the features of its compensation mechanism. That is, the thought of scientists is understandable in itself. But purely scientific premises played a cruel joke on them - doubts arose that might not have existed...

Plus, it is possible that if further experiments had also been carried out on blind people, this entire campaign would not have happened at all. The Soviet media, being an extremely ideological structure, would hardly have allowed the demonstration on air of any unique abilities by people, the presence of which was never particularly emphasized in the USSR. Soviet ideology really sought to develop among countries and citizens of the rest of the world the idea that communist states do not have most of the social and medical problems that burden the budgets of capitalist countries.

One way or another, in the matter of studying optical skin vision, mistakes were undoubtedly made. And they caused their harm - as much as they could. Nevertheless, modern rules of scientific ethics make it possible to open this issue from new positions. Indeed, since 2006, Western science has increasingly expressed an opinion about the need to resume work with this mechanism. For example, you can trace the history of fluctuations in scientific views on a problem and assess the relevance of its solution today using the work of Dr. A. J. Larner.

This author supports the most recent version - about the relationship of cutaneous-optical vision with the phenomenon of synesthesia. Synesthesia is not a disease and, to a certain extent, is characteristic of any person. This is the perception of stimuli of one type through stimuli of another - color through sound or taste, or in any other combination. The healthy phenomenon of synesthesia is association. Blue seems cold to us, red – hot, orange – sweet, etc. The disease is when a person does not hear the sound itself at all, but sees a whole palette before his eyes, which changes in accordance with the melody. Separately, this phenomenon practically does not occur, but it can accompany some brain pathologies.

There is an opinion that cutaneous-optical vision manifests itself in the blind due to the inclusion of synesthetic associations. And A. J. Larner reflected this concept in his article. This study uses other, scientifically proven mechanisms of brain function to substantiate the possibility of the real existence of alternative ways of seeing. Which indicates a growing new wave of interest in one brain phenomenon among many others waiting in the wings...

It’s strange how we manage to explore space and study the depths of the Earth if we still know practically nothing about our own brain... Don’t you think?..

About once a year, and sometimes a little more often, another fighter against psychiatry appears on the Internet. In general, they are very stereotypical people with a standard set of claims and a complete reluctance to read any information, much less look for it, if it does not confirm the fact that psychiatry is a pseudoscience created for the personal enrichment of psychiatrists, pharmaceutical companies and the fight against dissidents. One of the main trump cards of the fighters is the fact that people with schizophrenia turn into “vegetables” and psychiatrists with haloperidol are solely to blame for this. More than once, my colleagues, both here and in my journal, have said that the process of becoming a vegetable is inherent in the disease itself. For this same reason, it is better to treat schizophrenia than to admire the amazing and unique world of a sick person.

The idea that schizophrenia is associated with changes in the brain is not new. This was written about back in the 19th century. However, at that time, the main research tool was post-mortem autopsies, and for quite a long time nothing special and distinctive from all other “brain” diseases was found in the brains of patients. But with the advent of tomography in medical practice, it was nevertheless confirmed that brain changes occur in this disorder.

It has been found that people with schizophrenia lose cortical volume. The process of cortex loss sometimes begins even before the onset of clinical symptoms. It is present even when the person is not receiving treatment for schizophrenia (antipsychotics). Over five years of illness, the patient can lose up to 25% of the volume of the cortex in some areas of the brain. The process usually begins in the parietal lobe and spreads throughout the brain. The faster the volume of the cortex decreases, the faster the emotional-volitional defect occurs. A person becomes indifferent to everything and has no desire for anything - the very thing that is called a “vegetable”.

I have a little bad news. We are constantly losing nerve cells. This is actually a natural process and it goes quite slowly, but in patients with schizophrenia this process accelerates. So, for example, normally teenagers lose 1% of the cortex per year, and with schizophrenia 5%, adult men lose 0.9% of the cortex per year, patients 3%. In general, a malignant form of schizophrenia is very common in adolescence, where in just a year you can lose everything you can, and even after the first attack this process is visible to the naked eye.

For those interested, here is a picture showing how the brain loses its cortex over the course of 5 years of illness.

In addition to a decrease in the volume of the cortex, an increase in the lateral ventricles of the brain was also found. They are enlarged not because there is a lot of water there, but because the brain structures that lie in the walls are reduced in size. And this is observed from birth.

Here are pictures of twins - the first has schizophrenia (a “hole” in the middle of the brain in the image and there are dilated lateral ventricles), the second does not have the disease.

People with schizophrenia, even before developing the disease and even before using medications, had cognitive problems, including problems with information processing and language memory. All these symptoms deepened as the disease progressed. among other things, they have a reduced (also even before the disease) function of the frontal cortex, which is responsible for criticism (i.e., correct perception of oneself, one’s actions, comparing them with the norms of society), planning and forecasting activities.

Nobody really knows for sure why this happens to the brain. There are 3 theories that have fairly strong grounds.

1. Brain development disorder. It is assumed that already in utero, something goes wrong. For example, patients with schizophrenia have some problems with substances that are very important for brain development - the same Reelin, which should regulate the process of cell movement during brain development. As a result, the cells do not reach the places where they should and form incorrect and rare connections among themselves. There are many more described mechanisms of the same type, which say that a certain congenital defect causes a disease.

2. Neurodegeneration - increased cell destruction. Here we consider cases when certain reasons, including various metabolic disorders, cause their premature death.

3. Immune theory. The newest and most promising. It is believed that this disease is the result of inflammatory processes in the brain. Why they arise is now difficult to say reliably - maybe the body arranges it on its own (an autoimmune disease) or it is the result of some kind of infection (for example, there are facts that the flu suffered by the mother during pregnancy increases the risk of developing the disease). However, patients with schizophrenia have various inflammatory substances in the brain that can be quite aggressive to surrounding cells. About similar mechanisms, but for depression
No one claims that antipsychotics are a panacea for schizophrenia. To some extent, the situation with them now is obvious: we will no longer be able to squeeze out of them any greater benefit than we have now. It is possible to improve the safety profile of a drug, but neuroleptics do not radically solve the problem. We need some new ideas and discoveries in the field of schizophrenia, a new breakthrough in understanding the disease. The latest immune theory sounds very promising. However, at the moment, antipsychotics are all we have. These medications allow patients to live in society for a long time, rather than being confined to a psychiatric hospital. Let me remind you that just less than 100 years ago, mental illness was a death sentence and treatment was limited to keeping patients in hospitals. Now only a small proportion of patients are in hospitals and it is thanks to antipsychotics that this is possible. In fact, in practice, and any psychiatrist will tell you this, it is the lack of treatment that leads to a faster transformation into a vegetable. Destruction of the brain... it is destroyed by disease even without neuroleptics, and in some people this happens very quickly.

There are a great many questions about schizophrenia that scientists still cannot answer. But first, let's talk about the most important thing.

Schizophrenia is a very common mental illness. Statistics show that around one in 100 people in Australia will suffer from it at some stage in their lives. Thus, almost everyone has friends or relatives with schizophrenia.

Schizophrenia is a complex condition that is difficult to diagnose, but the listed symptoms are usually identified: mental activity, perception (hallucinations), attention, will, motor skills are impaired, emotions are weakened, interpersonal relationships are observed, streams of incoherent thoughts are observed, perverted behavior, a deep feeling of apathy and sensation arises. hopelessness.

There are two main types of schizophrenia (acute and chronic), and at least six subtypes (paranoid, hebephrenic, catatonic, simple, nuclear and affective). Fortunately, schizophrenia is treated with cognitive therapy, but most often with medication.

There are many myths associated with schizophrenia. One of them is the point of view that this disease occurs more often in rural areas than in cities. Moreover, according to outdated information, schizophrenics from rural areas often move to cities to find privacy. However, scientists refute this myth.

A study of schizophrenia among Swedes indicates that urban residents are more susceptible to the disease and they do not move anywhere. Scientists say that the environment can push people towards illness.

But myths aside, the true source of schizophrenia is still a mystery. Previously, it was believed that the cause was the parents’ poor attitude towards the child - usually they blamed mothers who were too restrained and cold in their treatment. However, this point of view is now rejected by almost all experts. Parents are much less to blame than is commonly believed.

In 1990, researchers at Johns Hopkins University found a link between shrinkage of the superior temporal gyrus and intense schizophrenic auditory hallucinations. It has been theorized that schizophrenia results from damage to a specific area on the left side of the brain. Thus, when “voices appear” in a schizophrenic’s head, there is increased activity in the part of the brain that is responsible for thinking and speech.

In 1992, this hypothesis was supported by a major Harvard study that found a link between schizophrenia and shrinkage of the left temporal lobe of the brain, especially the part responsible for hearing and speech.

Scientists have found a connection between the degree of thought disorder and the size of the superior temporal gyrus. This part of the brain is formed by a fold of the cortex. The study was based on a comparison of magnetic resonance imaging of the brains of 15 patients with schizophrenia and 15 healthy controls. It was found that in patients with schizophrenia this gyrus is almost 20% smaller than in normal people.

Although this work does not result in new treatments, the scientists believe that their discovery provides an opportunity to “further study this serious disease.”

Nowadays, new hope arises every now and then. A 1995 study from the University of Iowa suggests that schizophrenia may result from pathology of the thalamus and areas of the brain anatomically associated with this structure. Previous evidence indicated that the thalamus, located deep in the brain, helps focus attention, filter sensations, and process information from the senses. Indeed, “problems in the thalamus and related structures, extending from the top of the spine to the back of the frontal lobe, may create the full range of symptoms seen in schizophrenics.”

Perhaps the whole brain is involved in schizophrenia, and certain psychological ideas, for example about oneself, may have a certain connection with it. Dr. Philip McGuire says: "The predisposition [to hearing voices] may depend on abnormal activity in areas of the brain associated with the perception of internal speech and the assessment of whether it is one's own or someone else's."

Is there a specific time for such brain disorders to occur? Although symptoms of schizophrenia usually begin during adolescence, the damage that causes it can begin in infancy. "The exact nature of this neural disorder is unclear, but [it reflects] disturbances in brain development that appear before or shortly after birth."

There are experts who believe that schizophrenia can be caused by a virus, and a well-known one at that. A controversial but very intriguing version of the causes of the disease was put forward by Dr. John Eagles of the Royal Cornhill Hospital in Aberdeen. Eagles believes that the virus that causes polio can also influence the onset of schizophrenia. Moreover, he believes that schizophrenia may be part of the post-polio syndrome.

Eagles bases his belief on the fact that since the mid-1960s. in England, Wales, Scotland and New Zealand, patients with schizophrenia decreased by 50%. This coincides with the introduction of polio vaccination in these countries. In the UK, the oral vaccine was introduced in 1962. That is, when polio was stopped, the number of cases of schizophrenia decreased - no one imagined that this could happen.

According to Eagles, Connecticut scientists found that patients hospitalized with schizophrenia were “significantly more likely to be born during polio years.”

Eagles also points out that among unvaccinated Jamaicans who came to the UK, "the prevalence of schizophrenia is significantly higher compared to the local [English] population."

Eagles notes: in recent years, the existence of post-polio syndrome has been established. In this syndrome, approximately 30 years after the onset of paralysis, people begin to suffer from severe fatigue, neurological problems, joint and muscle pain, and increased sensitivity (especially to cold temperatures). Post-polio syndrome occurs in approximately 50% of polio patients. According to Eagles, “the average age of onset of schizophrenia is approaching thirty years, and this is consistent with the concept of schizophrenia as a post-polio syndrome that develops after perinatal poliovirus infection.”

Doctors David Silbersweig and Emily Stern of Cornell University believe that schizophrenics are unlikely to have serious brain problems, but nevertheless they were able to discover something very interesting. Using PET, they developed a method for detecting blood flow during schizophrenic hallucinations. They conducted a study of six either untreated or treatment-resistant schizophrenics who heard voices. One experienced visual hallucinations. During the scan, each patient was asked to press a button with their right finger if they heard sounds. It was found that during hallucinations, superficial areas of the brain involved in processing auditory information were activated. Moreover, all patients had a rush of blood to several deep areas of the brain: the hippocampus, hippocampal gyrus, cingulate gyrus, thalamus and striatum. Do schizophrenics really hear voices? Their brain data shows that this is true.

The speech of schizophrenics is often illogical, incoherent and confused. They used to think that such people were possessed by demons. Researchers have discovered a much less fantastic explanation. According to Dr. Patricia Goldman-Rakic, a neurologist, the speech problems of schizophrenics may reflect short-term memory deficits. It has been discovered that the prefrontal cortex of schizophrenics is significantly less active. This area is considered the center of short-term memory. Goldman-Rakic ​​says, “If they are unable to retain the meaning of a sentence before moving on to a verb or object, the phrase becomes devoid of content.”

In addition to all of the above, there are many questions about schizophrenia that are still unanswered.

Is schizophrenia caused by the mother's immune response or poor nutrition?

Some scientists believe that schizophrenia is caused by damage to the developing fetal brain. A study from the University of Pennsylvania, which included medical data from the entire Danish population, found that severe malnutrition in the mother early in pregnancy, as well as her body's immune response to the fetus, may influence the onset of schizophrenia.

Thanks to the memories

As the body ages, the enzyme prolyl endopeptidase increasingly destroys neuropeptides associated with learning and memory. In Alzheimer's disease, this process accelerates. It causes memory loss and a reduction in active attention time. Scientists from the city of Suresne in France have discovered medicinal compounds that prevent the destruction of neuropeptides by prolyl endopeptidase. In laboratory tests with rats that had amnesia, these compounds almost completely restored the animals' memory.

Notes:

Juan S. Einstein’s brain was doing the washing // The Sydney Morning Herald. 8 February 1990. R. 12.

McEwen B., Schmeck H. The Hostage Brain. N.Y.: Rockefeller University Press, 1994. pp. 6–7. Dr. Bruce McEwan is head of the Hutch Neuroendocrinology Laboratory at The Rockefeller University in New York. Harold Schmeck is a former national science columnist for The New York Times.

An interview with M. Merzenich is given by I. Ubell. Secrets of the brain // Parade. 9 February 1997. P. 20–22. Dr. Michael Merzenich is a neurologist at the University of California, San Francisco.

Lewis G., David A., Andreasson S., Allebeck P. Schizophrenia and urban life // The Lancet. 1992. Vol. 340. P. 137–140. Dr Glyn Lewis and colleagues are psychiatrists at the Institute of Psychiatry in London.

Barta P., Pearlson G., Powers R., Richards S., Tune L. Auditory hallucinations and smaller superior gyral volume in schizophrenia // American Journal of Psychiatry. 1990. Vol. 147. P. 1457–1462. Dr. Patrick Barta and colleagues work at Johns Hopkins University School of Medicine in Baltimore.

Ainger N. Study on schizophrenics – why they hear voices // The New York Times. 22 September 1993. P. 1.

Shenton M., Kikins R., Jolesz F., Pollak S., LeMay M., Wible C., Hokama H., Martin J., Metcalf D., Coleman M., McCarley R. Abnormalities of the left temporal lobe and thought disorder in schizophrenia // The New England Journal of Medicine. 1992. Vol. 327. P. 604–612. Dr. Martha Shenton and colleagues work at Harvard Medical School.

Flaum M., Andreasen N. The reliability of distinguishing primary versus secondary negative symptoms // Comparative Psychiatry. 1995. Vol. 36.No. 6. P. 421–427. Doctors Martin Flaum and Nancy Andresen are psychiatrists at the University of Iowa Clinics.

An interview with P. McGuire is conducted by B. Bauer. Brain scans seek roots of imagined voices // Science News. 9 September 1995. P. 166. Dr. Philip McGuire is a psychiatrist from the Institute of Psychiatry in London.

Bower B. Faulty circuit may trigger schizophrenia // Science News. 14 September 1996. P. 164.

Eagles J. Are polioviruses a cause of schizophrenia? // British Journal of Psychiatry. 1992. Vol. 160. P. 598–600. Dr John Eagles is a psychiatrist at the Royal Cornhill Hospital in Aberdeen.

A study by D. Silbersweig and E. Stern is presented by K. Leutweiler. Schizophrenia revisited // Science from American. February 1996. P. 22–23. Doctors David Silbersweig and Emily Stern work at Cornell University Medical Center.

Research by P. Goldman-Rakic ​​is presented by K. Conway. A matter of memory // Psychology Today. January - February 1995. P. 11. Dr. Patricia Goldman-Rakic ​​is a neurologist at Yale University.

Juan S. Schizophrenia – an abundance of theories // The Sydney Morning Herald. 15 October 1992. P. 14.

A study by J. Megginson Hollister et al. is cited by B. Bauer. New culprit cited for schizophrenia // Science News. 3 February, 1996. P. 68. Dr. J. Megginson Hollister and colleagues are psychologists from the University of Pennsylvania.

Sciencefi c American. Making memories // Scientific American. August 1996. P. 20.

The book by American authors outlines modern ideas about how the brain works. Issues of the structure and functioning of the nervous system are considered; homeostasis problem; emotions, memory, thinking; specialization of the hemispheres and the human “I”; biological basis of psychoses; age-related changes in brain activity.

For biology students, medical and psychological students, high school students and anyone interested in the science of brain and behavior.

Another group of data obtained as a result of post-mortem studies also confirms the idea that with some disturbances in dopaminergic synapses, the function of the latter is excessively enhanced (see Fig. 181). According to autopsy data, patients with schizophrenia have slightly increased amounts of dopamine in areas of the brain rich in this substance. In these same zones, changes were noted indicating that, along with an increase in dopamine content, sensitivity to this substance also increased inappropriately. These changes may be partly caused by chronic use of antipsychotics, however, even taking this into account, the noted changes seem impressive. Changes in the dopamine system are much more noticeable in patients who died at a young age. In general, antidopamine antipsychotic drugs give the best effect when treating younger people with type I schizophrenia.

However, like all partially acceptable hypotheses, this one has its weaknesses. Changes in the dopamine system, regularly noted in some studies, were not found in a number of other similar studies. In addition, dopamine transmits information in many parts of the brain, so it is difficult to explain why the primary changes that lead to disturbances in perception, thinking and emotion do not also manifest themselves in more obvious sensory and motor disturbances. Although antipsychotic drugs cause improvement in the patient's condition in direct proportion to their antidopamine effect, other, “atypical” drugs that are not related to dopamine also give good results. Finally, in many cases of type II schizophrenia, all currently available medications are not particularly effective. Many brain systems appear to be involved in behavioral disorders in schizophrenia, and it remains to be seen whether the dopamine neurotransmitter system is essentially the main culprit.

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Previously, schizophrenia was listed as dementia praecox. So, in the 17th century. T. Vallisy described cases of loss of talent in adolescence and the onset of “grumpy dullness” in adolescence. Later, in 1857, B.O. Morrel identified dementia praecox as one of the forms of “hereditary degeneration.” Then hebephrenia (a mental illness that develops during puberty), chronic psychoses with hallucinations and delusions, also ending in dementia, were described. Only in 1908, the Swiss psychiatrist E. Bleuler discovered the most significant sign of dementia praecox - a violation of unity, a splitting of the psyche. He gave the disease the name “schizophrenia,” which comes from the Greek roots “split and soul, mind.” Since that time, the term “schizophrenia” has been used to designate a group of mental disorders manifested in disorders of perception, thinking, emotions, and behavior, but most often translated as split personality. The etiology of schizophrenia is still not understood; this disease still remains one of the most mysterious and often destructive mental illnesses.

Specialists (psychiatrists, neurophysiologists, neurochemists, psychotherapists, psychologists) are tirelessly trying to understand the nature of schizophrenia, this fairly common and, alas, still incurable disease. To resist schizophrenia, it is not enough to know the symptoms and try to eliminate them; it is necessary to find out the reasons that lead to the splitting of consciousness, to establish the mechanism that causes such catastrophic mental disorders.

Clinically, schizophrenia is divided into two main types - acute and chronic. Currently, this division seems to be the most correct from the point of view of the biological basis of this disease. What characteristics characterize such varieties?

In patients with acute schizophrenia, so-called positive symptoms predominate, and in chronic patients, negative symptoms predominate. In medicine, positive symptoms are usually understood as those additional signs in patients that are absent in healthy people. A tumor, for example, from this point of view is a positive sign. The most obvious symptoms of an acute, first-time attack of schizophrenia are most often two: hallucinations - the perception of non-existent visual, sound or any other images, or, as experts say, sensory stimuli, and delusion - a false, uncorrectable belief or judgment of the patient that does not correspond real reality. These symptoms are associated with disorders that make up the cognitive, cognitive, sphere: the ability to perceive incoming information, process and respond appropriately to it. Due to delusions and hallucinations, the behavior of patients with schizophrenia seems absurd and often looks like obsession. Since the disease, as a rule, begins with these symptoms, the famous German psychiatrist K. Schneider considers them primary, specifically associated with the schizophrenic process. Negative symptoms usually appear later and already include significant emotional distortions, in particular the patient’s indifference to loved ones and to himself, impaired spontaneous speech, and general suppression of the motivational sphere (wants and needs). All this is considered as a personality defect, from which, as it were, characteristic traits for a normal person have been taken away. Patients are also characterized by a reluctance to communicate with others (autism), apathy, and an inability to assess their condition. However, these signs are already secondary, and are a consequence of primary cognitive impairment.

It is natural to assume that schizophrenic psychoses, being diseases of the brain, must be accompanied by serious anatomical, physiological or some other disorders in this organ. Such anomalies are what specialists are trying to detect in various studies. But before we talk about this, let us describe very briefly and schematically the structure of the brain.

It is known that the bodies of nerve cells, neurons, form the cortex - a layer of gray matter covering the cerebral hemispheres and the cerebellum. Clusters of neurons are present in the upper region of the trunk - in the basal ganglia (assemblies lying at the base of the cerebral hemispheres), the thalamus, or thalamus optic, subthalamic nuclei and hypothalamus. Most of the rest of the brain, lying in the brain stem below the cortex, consists of white matter - bundles of axons that stretch along the spinal cord and connect one area of ​​​​gray matter to another. The hemispheres are connected to each other by the corpus callosum.

The mentioned brain structures are “responsible” for various functions of our body: the basal ganglia coordinate the movements of body parts; thalamic nuclei switch external sensory information from receptors to the cortex; the corpus callosum carries out interhemispheric information transmission; The hypothalamus regulates endocrine and autonomic processes. Note that this structure, together with the hippocampus, anterior thalamus, and entorhinal (old) cortex, are located mainly on the inner surface of the hemispheres and form the limbic system, which “guides” our emotions and is basically similar in all mammals. It also includes the cingulate gyrus, whose anterior end is in contact with the frontal, or frontal, cortex and, according to modern views, also plays a role in the regulation of emotions. The limbic system is essentially the emotional center of the brain, with the amygdala associated with aggression and the hippocampus associated with memory.

In fundamental studies of schizophrenia, along with traditional methods, different types of tomography are now used (positron emission tomography, functional magnetic resonance, single-photon magnetic emission), and electroencephalographic mapping is carried out. These new methods make it possible to obtain “images” of a living brain, as if to penetrate inside it without damaging its structures. What was it possible to discover with the help of such a powerful arsenal of instruments?

So far, only stable changes in brain tissue have been found in the anterior parts of the limbic system (especially noticeable in the tonsils and hippocampus) and the basal ganglia. Specific deviations in these brain structures are expressed in increased growth of glia (“supporting” tissue in which neurons are located), a decrease in the number of cortical neurons in the frontal cortex and cingulate gyrus, as well as in a decrease in the size of the amygdala and hippocampus and an increase in the ventricles of the brain - cavities filled with cerebrospinal fluid. Computed tomography and post-mortem examination of the patients' brains also revealed pathological changes in the corpus callosum, and with the help of functional magnetic resonance imaging - a decrease in the volume of the left temporal lobe and an intensification of metabolism in it. It turned out that in schizophrenia, as a rule, the ratio of the mass of the hemispheres is disturbed (normally, the volume of the right hemisphere is larger, but the amount of gray matter in it is less). But, such changes can sometimes be observed in people who do not suffer from schizophrenia and be features of individual development.

There is also evidence of morphological damage to brain tissue caused by infectious, degenerative and traumatic processes. Previously, it was believed that schizophrenia is the result of atrophy of brain tissue, but now some experts, for example R. Gur, are inclined to think that the disease is caused by tissue degeneration due to abnormal development, including a violation of hemispheric specialization.

In addition to the mentioned instrumental methods, other methods are used in schizophrenia research, including biochemical and neurochemical. According to biochemical data, patients have immunological disorders, which are not identical in different psychoses, combined into the group of schizophrenic ones. Neurochemists discover molecular pathology, in particular changes in the structure of certain enzymes, and as a result of this, metabolic disorders of one of the biogenic amines, namely the neurotransmitter dopamine. True, some researchers studying neurotransmitters (substances that serve as chemical messengers at the points of contact between neurons) find no changes in the concentration of dopamine or its metabolites, while others find such disturbances.

Many experts note an increase in the number of specific receptors in the basal ganglia and limbic structures, especially in the hippocampus and amygdala.

Even a very cursory listing of disorders in the morphology and functioning of the brain in schizophrenia indicates the multiplicity of damage and indicates the heterogeneous nature of the disease. Unfortunately, all this so far brings specialists little closer to understanding its roots, much less its mechanisms. It is only clear that the patients have impaired interhemispheric transmission of information and its processing. In addition, the role of the genetic factor is undoubted, i.e. predisposition. Because of it, apparently, the frequency of familial schizophrenia is higher than in the general human population.

It is hoped that the unprecedented increase in knowledge about neurophysiological processes in the brains of patients with schizophrenia, observed in the last decade, will help to understand this mental illness.

The task of the brain is to perceive, process and transmit information by stimulating certain structures and establishing connections between them. In nerve cells, neurons, information is transmitted in the form of electrical signals, the meaning of which depends on the role that specific neurons play in the functioning of the nervous system. In sensory neurons, such a signal conveys information, for example, about a chemical acting on an area of ​​the body or the strength of light perceived by the eye. In motor neurons, electrical signals serve as commands for muscle contraction. The nature of the signals is a change in the electrical potential on the neuron membrane. A disturbance that occurs in one part of a nerve cell can be transmitted to other parts without changes. However, if the strength of the electrical stimulus exceeds a certain threshold value, an explosion of electrical activity occurs, which in the form of an excitation wave (action potential, or nerve impulse) propagates through the neuron at high speed - up to 100 m/s. But from one nerve cell to another, the electrical signal is transmitted indirectly, with the help of chemical signals - neurotransmitters.

The brain's electrical activity is its only natural language, which can be recorded in the form of an electroencephalogram (EEG). This recording reflects potential fluctuations in several frequency ranges, called rhythms or spectra. The main one is the alpha rhythm (frequency 8-13 Hz), which is believed to arise in the thalamo-cortical region of the brain and is most pronounced in a person at rest with his eyes closed. The alpha rhythm could only be considered a resting rhythm if the brain did not process information in its frequency range and compare it with what is already in memory and cognitive functions.

Oscillations with a frequency greater than 13 Hz belong to the beta rhythm, generated by the cerebral cortex and called activation, since it intensifies during vigorous activity. Theta rhythm (frequency 4-7 Hz) is largely determined by the limbic system and is associated with emotions. Oscillations whose frequency is less than 4 Hz belong to the delta rhythm and, as

As a rule, they are registered in the presence of organic brain damage - vascular, traumatic or tumor in nature.

Today, schizophrenia is one of those brain diseases that has not been studied the most, although it is studied the most. And, most likely, we should expect an even more significant breakthrough in research on schizophrenia in the near future, which will naturally affect specific results in treatment. Already now, in advanced clinics around the world, special neurometabolic methods for treating schizophrenia are successfully used, which give an amazing effect in treatment.

For example:

1. In 80% of cases, outpatient treatment is possible
2. The period of acute mental state (schizophrenic psychosis) has been significantly reduced.
3. A stable and long-lasting treatment effect is created.
4. There is virtually no decline in intelligence.
5. The so-called “neuroleptic defect” is significantly reduced or completely absent.
6. In most cases, brain function is largely restored.

People socialize and return to society, continue their studies, work successfully and have their own families.