sailor girlSchizophrenia: What Really Goes On Inside That Head
By Bob Singer, BS, NHA, PCHA

Schizophrenia is a mental illness that affects approximately one out of one hundred or one percent of adult individuals worldwide. Schizophrenia has been proven to be a physiological condition that affects the brain of those individuals inflicted. This paper will introduce this problem, discuss its symptoms and physiology, present some more popular theories about its causation, and then discuss some more common treatments.

Schizophrenia is a psychiatric disorder characterized by periods of psychosis. It is “psychiatric” because it affects the brain in a physiologic manner. The psychosis is when an individual seems to experience things that are not real or loses touch with reality. These experiences may be in combination with the real world or totally independent of the real world. Symptoms may include delusions, hallucinations, disorganized thinking, and bizarre thoughts. The word “Schizophrenia” was introduced in 1911 by a Swiss psychiatrist named Bleuler. Schizophrenia is frequently combined with Depression. When this occurs it is referred to as Schizoaffective disorder. For everyone inflicted with this disease, three or more relatives and close friends may also experience the disruption of their lifestyles. Schizophrenia usually develops in young adults sixteen to twenty-five years of age. Rarely does it begin after age thirty-five. However in some situations it may not be diagnosed until later years. This disease does affect men and women equally, but usually shows up in men earlier in years and women later in years.


Common symptoms for those diagnosed with Schizophrenia can include one or more of the following: Talking to themselves as if talking to another person, who is not there;

Believing in the ideal that others are plotting against them in some way or following them, much like a paranoia;

Believing that their thoughts are being interfered with or that they can influence another’s thoughts;

They may talk about or write things that does not make sense;

They may feel that they are famous people or associated with famous people;

They sometimes withdraw completely from family and friends.

Thoughts, feelings, and actions are all transmitted in the Central Nervous System as electrochemical impulses. These impulses reach the ends of presynaptic neurons. Neurotransmitter chemicals are released that cross the synaptic cleft and bind to specific receptor sites onto postsynaptic neurons. The binding action triggers electrical changes. These changes either inhibit or continue the conduction of that impulse. After the neurotransmitter’s function has been completed, messages are either inactivated or stored for some future use, called an uptake. Alterations or decrease of neurotransmitters at postsynaptic receptors is associated with the many different forms of neuropathologic conditions.

Major categories of neurotransmitters are cholinergics, monoamines, and neuropeptides. Each type of neurotransmitter is associated with the conduction of impulses in different areas of the Central Nervous System. Serotonim is a monoamine transmitter that innervates receptors in the pons, medulla, thalamus, and limbic system. A decrease in serotonim levels is connected with clinical depression. Another example is the amino acid inhibitory transmitter, a type of GABA. GABA innervates receptors in the hypothalamus, cortex, cerebellum, basil ganglia, and hippocampus. Decrease in GABA availability is associated with anxiety disorders and Schizophrenia.

Researchers at the University Of Pennsylvania have determined through their research that there are three major types of Schizophrenia categories. These are mildly impaired for which they label as the Cortical Group, heavily impaired for which they label as the Subcortical Group, and the Relatively Unimpaired Group. On MRI and PET scans of the brain, patients in the Cortical Group suffer from smaller than normal temporal lobes and relatively low metabolic rates in those same temporal lobes. These patients suffer mild memory problems and disorganized thoughts. On MRI and PET scans of the brain, patients in the Subcortical Group suffer from enlarged ventricles and some reductions in frontal lobe gray matter. These individuals showed no evidence of temporal lobe problems. These patients were considered to have suffered the greatest degree of Psychiatric impairment. These individuals suffered from delusions and more negative types of symptoms such as Apathy and lack of enjoyment from life. The third group of Relatively Unimpaired Individuals revealed the beginning stages of either Cortical or Subcortical events with structural abnormalities as mentioned previously. These individuals just were not showing signs yet.


One theory or hypothesis is that growth factors in a special brain cell called the glia are altered by genes and sometimes further weakened by viruses that may develop during a mother’s pregnancy. These glia are important in the connectivity between brain cells as children grow into adulthood. They maintain a maintenance function during adulthood through old age. Some believe that viruses may lay dormant for twenty to thirty years and then are activated by body changes as individuals go from adolescence to young adulthood. The breakdown of connections between brain cells eventually leads to Schizophrenia and some of the conditions mentioned earlier in the Physiology section of this paper.

In 2001, Debby Tsuang, MD and Associates did a study that revealed Chromosomes 13 and 15 in European Americans were connected with Schizophrenia. They did a study on one hundred sixty-six families with two to six Schizophrenics in each family looking at heredity factors. They found that those same genes in African American families did not cause the same conditions as European Americans leading to a conclusion that these genes can cause different results depending on Ethnic background.

In November of 2001, WebMD Health reported on a study of 3000 women from Rhode Island that gave birth between 1959 and 1966. From the study, twenty-seven of those otherwise healthy babies eventually developed Schizophrenia. Many of these babies were born to women who had genital herpes. Other conditions for these women were compatible including education levels, smoking habits, dietary habits, prenatal care, and giving birth during the same seasons of the year. This study showed that the genital herpes virus may have played a role in the later development of Schizophrenia.

The October 2001 issue of the British Journal of Psychiatry reported on a study of one hundred adult men and women born in Nottingham County in England compared with another group of one hundred individuals also born in that same county, but of a different social class. In this study, researchers found that those raised in poorer socioeconomic areas and where fathers had more menial jobs were twice as likely to develop Schizophrenia than those of more affluent classes. This then suggests that environmental impacts such as childhood deprivation may also lead to adult mental disorders because of more likely exposure to long lasting viruses, toxins, and stress normally associated with those poorer living conditions.

Medical scientists do know that too much Dopamine in the synapses of the nerve cells of the brain and the D2 receptors are the most common implications leading to Schizophrenia. The work of viruses in utero that lay dormant for twenty years appears to be a leading suspect from a physiological point of view with some of the theories mentioned working as contributing factors. When combined with diagnosis of Depression, low serotonin levels have been found in those individual’s brains. Exercise is known to increase endorphins, which increase serotonin. So exercise can be used to aid as part of treatment programs. Scientists also know that families with Schizophrenia are more likely to produce children with Schizophrenia than those with no other prior history. Studies have revealed that as the disease progresses, brains of Schizophrenics do actually tend to lose mass. Spaces in the ventricles tend to become enlarged making normal daily functioning more difficult. Cognitive techniques have been proven to slow down this process, but cannot reverse the process once begun.


Common medication categories for treatment of Schizophrenia include anxiolytics, sedative-hypnotics, antidepressants, and antipsychotics. Some common medications include Haldol, Risperidane, Seroquel, Zyprexa, and Clozaril. These medications target specific symptoms. Olanzapine, Clozapine, and Quetiapine are used to target a wider range of symptoms. Antipsychotic drugs are used in general to help lower dopamine levels in the brain. Neurontin and Welbutrin are used to alleviate symptoms of Depression. Ativan is used to ease anxieties. Dosages for drug therapies start low then build-up gradually under supervision until symptoms are relieved at the lowest possible dosage. Side effects of these medications may include parkinsonism or akathisia such as a restlessness of the legs and body; acute dystonia or tardive dyskinesia such as involuntary movements of tongue, face, fingers, hands, legs, and trunk. Cogentin, for example, would be taken to prevent side effects from Haldol. Only as little as five percent of all Schizophrenics ever get cured in that they never experience another episode of symptoms.

PET Scans and MRIs can be used to review damage to the actual brain and monitor physiologic progression of the disease. Polypharmacology in combination with psychotherapy is the preferred treatment over psychotherapy alone. Drug treatment is not considered a cure, but more of an aid for Schizophrenics to cope better. These medicines help to relieve the symptoms. Psychotherapy helps to teach individuals about their disease and how to best handle specific episodes.

Random controlled studies have determined that social skills training can improve social competence. Supported employment programs result in higher competitive employment rates. Cognitive behavior therapy may reduce delusions and hallucinations in medication resistant patients and compliment pharmacotherapy in acute psychosis. Family therapy works for frequent relapsers in family settings. Assertrive community treatment programs help for patients with high rates of service.


Burling, S. (2002). Schizophrenia may be many ailments. Philadelphia Inquirer, October 24. Retrieved 11/02/02 from Bustillo, J.R., Lauriello, J., Horan, W.P., & Keith, S.J. (2001). The psychosocial treatment of schizophrenia: An update. The American Journal of Psychiatry, 158; 163-175. Retrieved 10/25/02 from . Bustillo, J.R., Lauriello, J., Horan, W.P., & Landeen, J. (2001). Review: Social skills training, supported employment programs, and cognitive behavior therapy improves some outcomes in schizophrenia. EBN Online. Retrieved 10/25/02 from . Hochman, G. (2002). When your mother is crazy. Philadelphia Inquirer, September 11. Retrieved 11/02/02 from  HYPERLINK Maltin, L.J. (2001). Genital Herpes in mom linked to schizophrenia in baby. WebMD Health. Retrieved 09/28/02 from Maltin, L.J. (2001). Schizophrenia linked to childhood poverty. WebMD Health. Retrieved 09/28/02 from McCuistion, L.E. & Gutierrez, K.J. (2002). Psychotherapeutic Agents. In Pharmacology (2, pp.107-111). Philadelphia: W.B. Saunders Company. McGrath, J. (1999). Treatment of schizophrenia. British Medical Journal, October 16. Retrieved 10/25/02 from . N. A. (2002). Schizophrenia. Retrieved 10/25/02 from . N. A. (2002). Schizophrenia and Bipolar disorder. Brighter Beginnings In Mental Health. Retrieved 09/25/02 from NewsEdge Staff. (2002). Schizophrenia – cause may be interaction of genes and viruses in glia cells. Psychiatry 24X7.Com. Retrieved 09/28/02 from Smith, M. (2001). Study fingers schizophrenia genes. WebMD Health. Retrieved 09/28/02 from The Schizophrenia Fellowship of South Australia, Inc. Staff. (2002). The Schizophrenia Fellowship of South Australia, Inc. is here to help people with schizophrenia and their families. Retrieved 10/25/02 from WebMD Staff. (2002). WebMD chat transcript: Talking about Schizophrenia with Judy Kendall, RN, PhD. WebMD Health. Retrieved 09/28/02 from

© By Bob Singer 11/2002, BS, NHA, PCHA, Author.

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