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[My good fortune is not that I've recovered from mental illness...my good fortune lies in having found my life.]
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[Dr. Emile Kraepelin's office, 1887.]
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Schizophrenia was first identified more than a century ago, but we still don't know its exact causes.
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It remains one of the most misunderstood and stigmatized illnesses today.
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So, let's walk through what we do know from symptoms to causes and treatments.
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Schizophrenia is considered a syndrome, which means it may encompass a number of related disorders that have similar symptoms but varying causes.
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Every person with schizophrenia has slightly different symptoms.
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And the first signs can be easy to miss—subtle personality changes, irritability, or a gradual encroachment of unusual thoughts.
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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.
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A first psychotic episode can feature delusions, hallucinations, and disordered speech and behavior.
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These are called positive symptoms, meaning they occur in people with schizophrenia but not in the general population.
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It's a common misperception that people with schizophrenia have multiple personalities.
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But these symptoms indicate a disruption of thought processes, rather than the manifestation of another personality.
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Schizophrenia also has negative symptoms.
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These are qualities that are reduced in people with schizophrenia, such as motivation, expression of emotion, or speech.
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There are cognitive symptoms as well, like difficulty concentrating, remembering information, and making decisions.
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So what causes the onset of psychosis?
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There likely isn't one single cause, but a combination of genetic and environmental risk factors that contribute.
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Schizophrenia has some of the strongest genetic links of any psychiatric illness.
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Though about 1 percent of people have schizophrenia, children or siblings of people with schizophrenia are ten-times likelier to develop the disease.
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And an identical twin of someone with schizophrenia has a 40 percent chance of being affected.
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Often, immediate relatives of people with schizophrenia exhibit milder versions of traits associated with the disorder, but not to an extent that requires treatment.
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Multiple genes almost certainly play a role, but we don't know how many, or which ones.
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Environmental factors like exposure to certain viruses in early infancy might increase the chance that someone will develop schizophrenia.
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And use of some drugs, including marijuana, may trigger the onset of psychosis in highly susceptible individuals.
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These factors don't affect everyone the same way.
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For those with very low genetic risk, no amount of exposure to environmental risk factors will lead them to develop schizophrenia.
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For those with very high risk, moderate additional risk might tip the balance.
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The antipsychotic drugs used to treat schizophrenia have helped researchers work backwards to trace signatures of the disorder in the brain.
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Traditional antipsychotics block dopamine receptors.
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They can be very effective in reducing positive symptoms, which are linked to an excess of dopamine in particular brain pathways.
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But the same drugs can make negative symptoms worse.
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And we've found that negative symptoms of schizophrenia may be tied to too little dopamine in other brain areas.
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Some people with schizophrenia show a loss of neural tissue.
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And it's unclear whether this atrophy is a result of the disease itself or drug-induced suppression of signaling.
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Fortunately, newer generations of antipsychotics aim to address some of these issues by targeting multiple neurotransmitters, like serotonin in addition to dopamine.
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It's clear that no one transmitter system is responsible for all symptoms.
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And because these drugs affect signaling throughout the brain and body, they can have other side effects like weight gain.
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In spite of these complications, antipsychotics can be very effective, especially when combined with other interventions like cognitive-behavioral therapy.
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Electroconvulsive therapy, though it provides relatively short-lived relief, is also reemerging as an effective treatment, especially when other options have failed.
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Early intervention is also extremely important.
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After months or years of untreated psychosis, certain psychoses can become embedded in someone's personality.
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And yet, the dehumanizing stigma attached to this diagnosis can prevent people from seeking help.
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People with schizophrenia are often perceived as dangerous, but are actually much more likely to be the victims of violence than the perpetrators.
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And proper treatment may help reduce the likelihood of violence associated with schizophrenia.
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That's why education for patients, their families, and their communities helps erode the stigma and improves access to treatment.
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Continue to educate yourself about the symptoms, causes, and treatments of different mental health conditions with this playlist.