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  • [My good fortune is not that I've recovered from mental good fortune lies in having found my life.]

  • [Dr. Emile Kraepelin's office, 1887.]

  • Schizophrenia was first identified more than a century ago, but we still don't know its exact causes.

  • It remains one of the most misunderstood and stigmatized illnesses today.

  • So, let's walk through what we do know from symptoms to causes and treatments.

  • Schizophrenia is considered a syndrome, which means it may encompass a number of related disorders that have similar symptoms but varying causes.

  • Every person with schizophrenia has slightly different symptoms.

  • And the first signs can be easy to misssubtle personality changes, irritability, or a gradual encroachment of unusual thoughts.

  • Patients are usually diagnosed after the onset of psychosis, which typically occurs in the late teens or early twenties for men and the late twenties or early thirties for women.

  • A first psychotic episode can feature delusions, hallucinations, and disordered speech and behavior.

  • These are called positive symptoms, meaning they occur in people with schizophrenia but not in the general population.

  • It's a common misperception that people with schizophrenia have multiple personalities.

  • But these symptoms indicate a disruption of thought processes, rather than the manifestation of another personality.

  • Schizophrenia also has negative symptoms.

  • These are qualities that are reduced in people with schizophrenia, such as motivation, expression of emotion, or speech.

  • There are cognitive symptoms as well, like difficulty concentrating, remembering information, and making decisions.

  • So what causes the onset of psychosis?

  • There likely isn't one single cause, but a combination of genetic and environmental risk factors that contribute.

  • Schizophrenia has some of the strongest genetic links of any psychiatric illness.

  • Though about 1 percent of people have schizophrenia, children or siblings of people with schizophrenia are ten-times likelier to develop the disease.

  • And an identical twin of someone with schizophrenia has a 40 percent chance of being affected.

  • Often, immediate relatives of people with schizophrenia exhibit milder versions of traits associated with the disorder, but not to an extent that requires treatment.

  • Multiple genes almost certainly play a role, but we don't know how many, or which ones.

  • Environmental factors like exposure to certain viruses in early infancy might increase the chance that someone will develop schizophrenia.

  • And use of some drugs, including marijuana, may trigger the onset of psychosis in highly susceptible individuals.

  • These factors don't affect everyone the same way.

  • For those with very low genetic risk, no amount of exposure to environmental risk factors will lead them to develop schizophrenia.

  • For those with very high risk, moderate additional risk might tip the balance.

  • The antipsychotic drugs used to treat schizophrenia have helped researchers work backwards to trace signatures of the disorder in the brain.

  • Traditional antipsychotics block dopamine receptors.

  • They can be very effective in reducing positive symptoms, which are linked to an excess of dopamine in particular brain pathways.

  • But the same drugs can make negative symptoms worse.

  • And we've found that negative symptoms of schizophrenia may be tied to too little dopamine in other brain areas.

  • Some people with schizophrenia show a loss of neural tissue.

  • And it's unclear whether this atrophy is a result of the disease itself or drug-induced suppression of signaling.

  • Fortunately, newer generations of antipsychotics aim to address some of these issues by targeting multiple neurotransmitters, like serotonin in addition to dopamine.

  • It's clear that no one transmitter system is responsible for all symptoms.

  • And because these drugs affect signaling throughout the brain and body, they can have other side effects like weight gain.

  • In spite of these complications, antipsychotics can be very effective, especially when combined with other interventions like cognitive-behavioral therapy.

  • Electroconvulsive therapy, though it provides relatively short-lived relief, is also reemerging as an effective treatment, especially when other options have failed.

  • Early intervention is also extremely important.

  • After months or years of untreated psychosis, certain psychoses can become embedded in someone's personality.

  • And yet, the dehumanizing stigma attached to this diagnosis can prevent people from seeking help.

  • People with schizophrenia are often perceived as dangerous, but are actually much more likely to be the victims of violence than the perpetrators.

  • And proper treatment may help reduce the likelihood of violence associated with schizophrenia.

  • That's why education for patients, their families, and their communities helps erode the stigma and improves access to treatment.

  • Continue to educate yourself about the symptoms, causes, and treatments of different mental health conditions with this playlist.

[My good fortune is not that I've recovered from mental good fortune lies in having found my life.]

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What is schizophrenia? - Anees Bahji

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    林宜悉 posted on 2020/05/11
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