Psychiatrist Prof. Dr. Nevzat Tarhan, Founding Rector of Üsküdar University, addressed the topic of “Schizophrenia” in his Hürriyet Aile column this week.
In addition to addictive substances, some medications used especially in the treatment of attention deficit disorder carry the risk of triggering schizophrenia if there is a genetic predisposition in the person. The use of such medications under medical supervision is of great importance. 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 can lead to schizophrenia. Dopamine is the reward chemical of the brain's reward/punishment system. The brain releases an excessive amount of dopamine in schizophrenics. Schizophrenia patients struggle to differentiate between fantasy, dream, and reality. They invest their love in themselves.
Schizophrenia, which is among the most challenging diseases in primary treatment in psychiatry, stands out as a disease encountered with similar frequency both in our society and worldwide. In a city of 100,000 people, 80 schizophrenia cases emerge every year, meaning, on average, this figure corresponds to approximately 1 percent.
MRNA technology is now on the agenda for the treatment of psychiatric disorders…
The similar prevalence of the disease across different cultures worldwide provides important insights into its genetics. In recent centuries, very serious genetic research has been conducted on schizophrenia. Current studies also identify target genes in schizophrenia. To determine prevalence, if a person has a target gene, that gene is investigated. Genetic therapies have emerged in the fight against many diseases. You identify the target gene, and harmless viruses called adenoviruses are loaded onto a virus. A gene carrier is created to modify that gene. We administer this protein or the gene-correcting virus to the body. The virus goes and binds to that gene. It prevents the gene from functioning. That technology is MRNA. The MRNA technology, which came to the forefront in the fight against the pandemic, is now on the agenda for the treatment of psychiatric diseases.
Schizophrenia: Splitting of the mind
Schizophrenia is a word of Greek origin. When looking at its meaning, “schizo” is a word meaning splitting, division, fragmentation. Phren means mind, so it can be expressed as “splitting of the mind.” This definition, accepted in the early 20th century, has not been changed and continues to be used.
Humans normally have three realities. The first is the real world, the world we live in. The second is dream reality. The third is fantasy reality. In a dream, we are in a separate world. One can fly there, travel worlds, fight. Upon waking, we realize we were in a dream. In fantasy reality, or daydreaming, a person gets carried away by imagination. This is very common in children and adolescents. The person gets lost in thought, contemplates things. Then returns to the real world.
Schizophrenia patients struggle to differentiate
There are things a person will and will not do. There is a familiar world created by reasoning. This is true reality. The other is imaginary reality. It is physical, imaginary, and dream reality. Schizophrenic individuals have a disorder in differentiating between these three. A healthy brain has a network that performs reality testing, called reality testing. It distinguishes between what is real and what is not real, what is a dream and what is not a dream.
Faulty protein disrupts brain chemistry
When there is a certain stress or environment in specific genes in the brain, the need for serotonin and dopamine increases. These two important chemicals activate the gene that is normally dormant in that person and begin to produce faulty protein. The faulty protein then disrupts brain chemistry. When brain chemistry is disrupted, a person's judgment is impaired. In treatments, we are currently aiming to correct this situation with medication. Medications suppress the faulty expression of the gene. The production of faulty protein is prevented.
Rehabilitation is very important in schizophrenia
Early diagnosis, timely and strong treatment are very important in schizophrenia. If the treatment is weak, the disease is suppressed but not fully controlled, leading to chronicity. Therefore, strong, comprehensive, and early treatment is crucial in schizophrenia. After the acute phase passes and the chemical storm in the brain subsides, social adaptation and rehabilitation efforts are carried out for the individual. While there are very important rehabilitation centers in this field in Europe, unfortunately, the inability to establish such centers in our country stands as a significant deficiency.
Medication refusal is common in schizophrenia patients
Rehabilitation centers make very significant contributions to patient recovery. Mental health centers established and serving in our country have been very beneficial but are not enough. Controlling many diseases has become very difficult. Especially in schizophrenia patients, medication refusal is common. Because of a lack of illness awareness, the person does not accept their own disease. Therefore, they see every treatment method as an enemy. Schizophrenia can be behind many incidents of violence against healthcare professionals. 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-enhancing drugs should be used carefully!
Addictive substances and some medications used in the treatment of attention deficit disorder carry the risk of triggering schizophrenia if there is a genetic predisposition in the person. Therefore, it is very important that medications are used under medical 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 can lead to schizophrenia. Dopamine is the reward chemical of the brain's reward/punishment system. The brain releases an excessive amount of dopamine in schizophrenics.
They only invest their love in themselves
One of the main symptoms of schizophrenia is dereistic thought patterns and an autistic lifestyle. Dereistic is used to mean a thought pattern that does not conform to reality. Freud states that when children are first born, they first love themselves and first admire themselves. Before learning about life, a child only says ‘me and my mother.’ They invest their love in their own ego. Later, as they grow, they invest their love in their father, family, friends, country, and as they grow and mature even further, they make mental and emotional investments in the universe, existence, and the creator. Schizophrenic individuals do not invest their love in others. They only direct it towards themselves,” he said.
Emotional, thought, and behavioral changes may occur
In schizophrenia patients, emotional, thought, behavioral, and lifestyle changes are observed from time to time. Emotional changes may occur. Some experience euphoria, some types of schizophrenia involve withdrawal, some types involve obsession, and some develop suspicion. Others are disconnected from everything. In cases we formerly referred to as disorganized schizophrenia, nonsensical speech may be observed. Various examples are seen around the world from time to time, and mass suicides can occur.
Schizophrenia should not be labeled as incurable!
Significant advancements have been made in the treatment of schizophrenia today. Medicine has made important progress in this regard. One-third of cases recover, one-third do not recover no matter what is done. The other one-third reaches what we call social healing, using medication for years. Therefore, time is needed to diagnose schizophrenia. A case cannot be called schizophrenic at first sight. A diagnosis of schizophrenia requires more than just a thought disorder. It must be accompanied by emotional, thought, and behavioral disorders. The person's social adaptation is impaired. Environmental support is also important in individual psychotherapy for the patient during treatment. For example, in many schizophrenia cases, the environment is constructive. Because it is constructive, schizophrenia can progress without relapse. Medicine in schizophrenia treatment is more advanced than before. Many secrets of the brain can now be understood, which is why no one should label schizophrenia as incurable.