Psychiatrist Prof. Dr. Nevzat Tarhan noted that schizophrenia, one of the diseases that is challenging to treat in psychiatry, is encountered with similar frequency worldwide, and stated that new information about the disease has emerged thanks to innovations in the field of medicine. Emphasizing the importance of early treatment in schizophrenia, Tarhan warned, “Timely and strong treatment is important. If treatment is weak, it is suppressed, but because it is not fully controlled, the disease becomes chronic.” Prof. Dr. Nevzat Tarhan pointed out the importance of environmental support and the rehabilitation process during treatment. Tarhan stated that addictive substances and some medications used in the treatment of attention deficit can trigger schizophrenia if a person has a genetic predisposition, and said, “Especially dopamine-increasing drugs should be used under doctor’s supervision.”
“Dopamine-increasing drugs should be used under doctor’s supervision”
Üsküdar Üniversitesi Founding Rector, Psychiatrist Prof. Dr. Nevzat Tarhan, made evaluations about schizophrenia.
Prevalence is similar across all cultures and the world…
Prof. Dr. Nevzat Tarhan noted that schizophrenia is one of the most challenging diseases to treat in psychiatry and is encountered with similar frequency across all cultures and the world, stating, “In a city of 100,000 people, 80 new cases of schizophrenia emerge every year. On average, this figure corresponds to approximately 1 percent. The similar rate across all cultures and the world provides important insight into the genetics of the disease.”
Very serious genetic research is being conducted
Prof. Dr. Nevzat Tarhan stated that very serious genetic research has been conducted on this disease in recent centuries, adding, “Currently, there are target genes identified in schizophrenia. We are currently researching these target genes in patients for scientific purposes. To determine prevalence, if a person has a target gene, that gene is investigated. Target genes can also be present in diseases such as autism and bipolar disorder. If those target genes are present, there is a different outcome related to the disease and treatment. If there are no target genes, it is different.”
Genetic treatments are being researched
Prof. Dr. Nevzat Tarhan stated that genetic treatments have emerged in the fight against many diseases, saying, “You identify the target gene, and harmless viruses called adenoviruses are loaded onto a virus. A gene carrier is created to change that gene. We administer this protein or the virus that corrects that gene into the body. The virus goes and binds to that gene. It prevents that gene from working. That technology (mRNA). There is a separate laboratory for these treatments, a stem cell laboratory. As Üsküdar Üniversitesi, we have established transgenic cell laboratories within our structure.”
Prof. Dr. Nevzat Tarhan stated that mRNA technology, which came to the fore in the fight against the pandemic, is now on the agenda for the treatment of psychiatric diseases, adding, “Using that technology, we will first perform gene screening in individuals. It is a system that scans disease-specific genes in humans. The goal is to scan only the genes that are outside of the common genes in all humans, meaning genes that produce faulty proteins. In such cases, it gives us genetic clues related to schizophrenia.”
Schizophrenia means 'split mind'
Prof. Dr. Nevzat Tarhan, referring to the meaning of the word schizophrenia, said, “Schizo is a word meaning splitting, division, fragmentation. Phren means mind. It is a beautiful term, like the splitting of the mind. It expresses it well. Its origin is Greek. This definition was accepted at the beginning of the 20th century and that diagnosis has not been changed and continues.”
There are three realities: Dream, imagination, and the real world
Prof. Dr. Nevzat Tarhan stated that humans normally have three realities: “One is dream reality. In a dream, we are in a separate world. A person flies there, travels worlds, fights, does things, returns. When we wake up, we say it was a dream. We have an imaginary reality. They call it daydreaming. During the day, a person gets lost in imagination. It is very common in children and adolescents. They get lost in imagination, think about things. They always have a purpose and try to do things accordingly. Then, when something happens, they say this is imagination and return to the real world.”
Schizophrenia patients struggle to differentiate
Prof. Dr. Nevzat Tarhan noted that the real world is the one we live in, stating, “There are things a person will do and will not do. There is a familiar world created by reasoning. This is real reality. The other is imaginary reality. It is physical, imaginary, and dream reality. Schizophrenic individuals have a disorder in distinguishing between these three. A healthy brain has a network that performs reality testing. It distinguishes between what is real and not real. What is a dream and what is not.”
John Nash, an important example
Prof. Dr. Nevzat Tarhan, stating that there are globally recognized individuals with schizophrenia, said: “It is not very easy to diagnose schizophrenia. A very famous case known as schizophrenia is depicted in the film A Beautiful Mind. The American mathematician John Nash, a Nobel Memorial Prize in Economic Sciences laureate and Abel Prize recipient, is an intelligent mathematics professor, but somehow, due to a faulty genetic structure in his brain, he produces faulty protein. When faulty protein is produced, the brain generates images, imaginations, and sounds. That person produces things, and first believes them. He tries to chase away those voices. While doing this, he talks to himself. People say, ‘This man is hallucinating, he has schizophrenia,’ and he is hospitalized, but because he is intelligent, after a period and a few treatments, when he is well, he engages in mathematics. Later, he realizes that these are hallucinations. While working on mathematics, those hallucinations come. There are three people. A man, a woman, and a child are telling him things. He doesn't pay any attention to them. He continues his work. That's when schizophrenia ends. This person is said to have conquered schizophrenia. In fact, this is what our current new treatment approach involves. Whether the person performs reality testing or not. Hallucinations appear when the brain produces faulty protein. It produces faulty delusions. The person needs to decide that these are not real. When you teach this, schizophrenia ends. In intelligent people, the disease is easily overcome.” Prof. Dr. Nevzat Tarhan stated that better psychosocial psychoeducation can be provided to individuals with high IQs in coping with the disease, adding, “These individuals learn to perform reality testing more easily. When they learn it, they enter a period of recovery from the disease.”
Faulty protein production is prevented with drug treatment
Prof. Dr. Nevzat Tarhan stated that when there is specific stress and a particular environment in the identified genes in the brain, the need for serotonin and dopamine increases, adding, “These two important chemicals activate that normally dormant gene in the person and start producing faulty protein. Faulty protein also disrupts brain chemistry. When brain chemistry is disrupted, a person's judgment is impaired. In current treatments, we aim to correct this situation with medication. Medications suppress the faulty expression of the gene. Faulty protein production is prevented.”
Early and strong treatment is important
Prof. Dr. Nevzat Tarhan, emphasizing the importance of early treatment in schizophrenia, said, “Timely and strong treatment is important. If treatment is weak, it is suppressed, but because it is not fully controlled, the disease becomes chronic. Therefore, strong, comprehensive, and early treatment is very important in schizophrenia. After the acute phase passes and the chemical storm in the brain normalizes, social adaptation and rehabilitation efforts are carried out for the individual.”
Prof. Dr. Nevzat Tarhan stated that there are very important rehabilitation centers in this field in Europe and unfortunately, such centers cannot be established in our country.
Medication refusal is common in schizophrenia patients
Prof. Dr. Nevzat Tarhan noted that rehabilitation centers make very important contributions to a patient's recovery, stating, “The mental health centers established and operating in our country have been very beneficial but are not sufficient. Controlling many diseases has become very difficult. Especially in schizophrenia patients, medication refusal is very common. Since there is no disease awareness, the person does not accept their own illness. Therefore, they view every treatment method as an enemy. Schizophrenia can be behind many incidents of violence against doctors. Thinking ‘They will hospitalize me, they will harm me, kill me, rape me,’ they attack anyone in a white coat. For this reason, the approach to these patients is very different and important.”
Dopamine-increasing drugs should be used carefully
Prof. Dr. Nevzat Tarhan noted that addictive substances and some medications used in the treatment of attention deficit can trigger schizophrenia if a person has a genetic predisposition, and warned, “It is very important that medications are used under doctor’s supervision. Especially dopamine-increasing drugs should be used very carefully. An excessive increase in dopamine in the brain means that if a person has a susceptibility gene, it triggers schizophrenia. Dopamine is the reward chemical of the brain's reward/punishment system. The brain in schizophrenics secretes excessive amounts of dopamine.”
Schizophrenic individuals invest their love only in themselves
Prof. Dr. Nevzat Tarhan also touched upon the main symptoms of schizophrenia, stating, “It is a dereistic thought pattern, an autistic lifestyle. Dereistic is used in the sense of a thought pattern that does not conform to reality. Freud states regarding autism that when children are first born, they first love themselves and admire themselves. Before learning about life, the child only says ‘me and my mother.’ They invest their love in their own ego. Then, as they grow, they invest their love in their father, family, friends, country, homeland, and as they grow further and mature, they make mental and emotional investments in the universe, existence, and the Creator. Schizophrenic individuals do not invest their love in others. They only turn it back to themselves.”
Prof. Dr. Nevzat Tarhan also stated that there are sometimes changes in emotion, thought, behavior, and lifestyle in schizophrenia patients, and said, “Emotional changes can occur. Some experience elation, some types of schizophrenia involve withdrawal, some types involve obsession, and some involve suspiciousness. Some are detached from everything. In cases we call disorganized schizophrenia, nonsensical speech can be observed. Various examples are seen around the world from time to time, and mass suicides can occur.”
Treatment methods for schizophrenia have advanced greatly
Üsküdar Üniversitesi Founding Rector, Psychiatrist Prof. Dr. Nevzat Tarhan, stated that the treatment of schizophrenia has advanced greatly today, saying, “Medicine has made significant progress in this regard. One-third of cases recover, one-third do not recover no matter what you do. The other one-third reaches what we call social recovery, using medication for years. Therefore, time is needed to diagnose schizophrenia. A case cannot be called schizophrenic at first glance. For a diagnosis of schizophrenia, merely having a thought disorder is not enough. Emotional, thought, and behavioral disorders must also accompany it. The person’s social adaptation is impaired. Environmental support is also important in individual psychotherapy for the individual during treatment. For example, in many schizophrenia cases, the environment is constructive. Because it is constructive, schizophrenia can progress without relapse. In the treatment of schizophrenia, medicine is more advanced than before. Many secrets of the brain can now be understood, so no one should label schizophrenia as untreatable.”