Data from a PET study25 suggests the less the frontal lobes activated (red) during a working memory task, the greater the increase in abnormal dopamine activity in the striatum (green), thought to be related to the neurocognitive deficits in schizophrenia.Actress Clara Bow was diagnosed with schizophrenia in 1949.
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Schizophrenia

Schizophrenia is a severe mental illness characterized by persistent defects in the perception or expression of reality. A person experiencing untreated schizophrenia typically demonstrates grossly disorganized thinking, and may also experience delusions or auditory hallucinations. more...

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Although the illness primarily affects cognition, it can also contribute to chronic problems with behavior or emotions. Due to the many possible combinations of symptoms, it is difficult to say whether it is in fact a single psychiatric disorder; and Eugen Bleuler deliberately called the disease "the schizophrenias" (plural) when he coined the present name.

Diagnosis is based on the self-reported experiences of the patient, in combination with secondary signs observed by a psychiatrist or other competent clinician such as a doctor of psychology. There is no objective biological test for schizophrenia, though studies suggest that genetics and biochemistry are important contributing factors. Current research into the development of the disorder often focuses on the role of neurobiology, although a reliable and identifiable organic cause has not been found. In the absence of objective laboratory tests to confirm the diagnosis, some question the legitimacy of schizophrenia's status as a disease.

The term "schizophrenia" translates roughly as "shattered mind," and comes from the Greek σχίζω (schizo, "to split" or "to divide") and φρήν (phrēn, "mind"). Despite its etymology, schizophrenia is not synonymous with dissociative identity disorder, also known as multiple personality disorder or "split personality"; in popular culture the two are often confused. Although schizophrenia often leads to social or occupational dysfunction, there is little association of the illness with a predisposition toward aggressive behavior.

Overview

Schizophrenia is often described in terms of "positive" and "negative" symptoms. Positive symptoms include delusions, auditory hallucinations and thought disorder and are typically regarded as manifestations of psychosis. Negative symptoms are so named because they are considered to be the loss or absence of normal traits or abilities, and include features such as flat, blunted or constricted affect and emotion, poverty of speech and lack of motivation. Some models of schizophrenia include formal thought disorder and planning difficulties in a third group, a "disorganization syndrome."

Additionally, neurocognitive deficits may be present. These may take the form of reduced or impaired psychological functions such as memory, attention, problem-solving, executive function or social cognition.

Onset of schizophrenia typically occurs in late adolescence or early adulthood, with males tending to show symptoms earlier than females.

Psychiatrist Emil Kraepelin was the first to draw a distinction between what he termed dementia praecox ("premature dementia") and other psychotic illnesses. In 1911, "dementia praecox" was renamed "schizophrenia" by psychiatrist Eugen Bleuler, who found Kraepelin's term to be misleading, as the disorder is not a form of dementia, premature or otherwise.

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Dopamine gene ups schizophrenia risk
From Science News, 11/5/05

The chances of developing schizophrenia rise substantially for the small number of children who possess only one copy of a gene variant that regulates a crucial chemical messenger in the brain, according to a new finding of a long-term investigation.

A team led by psychiatrist Allan L. Reiss of Stanford University School of Medicine studied 24 children missing a small piece of DNA on chromosome 22. About 30 percent of youngsters with this deletion, which occurs in 1 in 4,000 births, eventually develop the severe mental disorder schizophrenia or related psychotic conditions. These children are also prone to other problems, including heart defects, cleft palate, and learning disorders.

Prior studies showed that people with this deletion lack one copy of the usual two copies of the COMT gene, which triggers production of a protein that breaks down the neurotransmitter dopamine. The protein comes mainly in two variants with contrasting dopamine-busting power, one weak and the other strong.

By young adulthood, seven of the study participants with the deletion had developed schizophrenia or another psychotic disorder, Reiss and his coworkers report in the November Nature Neuroscience. Of that number, the four individuals with the weak COMT variant--who presumably grew up with excessive amounts of dopamine in their brains--displayed larger drops in verbal intelligence and language skills, and harsher psychotic symptoms, than their three peers with the strong variant did. Also, the prefrontal brain area of the four participants with the weak variant shrank more than did that area in three participants with the strong variant. This brain region is linked to schizophrenia.

COMT-associated dopamine drenching of children's growing brains creates a strong susceptibility to schizophrenia, Reiss proposes. He also hypothesizes that a dopamine drought in children who inherit a single copy of the strong COMT variant can also foster psychotic symptoms.--B.B.

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