What Causes Schizophrenia?

Schizophrenia is a chronic, severe, and disabling psychiatric disorder that affects approximately two million Americans in any given year. Schizophrenia is a psychosis—that is to say, it is a severe mental disorder in which the person’s emotions, thinking, judgment, and grasp of reality are so disturbed that functioning is seriously impaired.

But what causes this condition? The answer to that question has eluded medical science for a long time. “Whether you love someone with the mental illness or have seen it depicted in movies and pop culture, you might find yourself wondering what causes schizophrenia,” wrote Kelly Burch in a recent article on Verywell Health. “Unfortunately, scientists don’t know exactly what causes this mental illness.”

Despite extensive research, the causes of schizophrenia remain unclear. “There is no single organic defect or infectious agent which causes schizophrenia, but a variety of factors increase the illness—among them genetics and obstetric complications,” wrote the late Colorado Recovery founder Richard Warner, MD, in his influential book The Environment of Schizophrenia. In the book, Dr. Warner drew upon the “knowledge of the environmental factors that affect schizophrenia” to suggest “changes which could decrease the rate of occurrence of the illness, improve its course, and enhance the quality of life of sufferers and their relatives.”

“Environmental factors, including some that occur while in the womb, can also contribute to developing schizophrenia,” confirmed Burch in her explainer. “Some research suggests that using drugs, particularly during the teen years, can increase risk for schizophrenia. However, people who are predisposed to schizophrenia may also be at a higher risk of developing substance use disorder. Drug use alone cannot trigger schizophrenia, and drug use during the teenage years cannot be blamed for causing the illness.”

There is however a strong genetic link to developing schizophrenia, which is why the disease often runs in families. According to Burch, about 80 percent of the chance of developing schizophrenia can be explained by genes. “Relatives of people with schizophrenia have a greater risk of developing the illness, the risk being progressively higher among those who are more genetically similar to the person with schizophrenia,” wrote Dr. Warner in The Environment of Schizophrenia.

Research into genetic factors continues. A team of researchers recently developed a new way to study how genes may cause schizophrenia and other neurodevelopmental disorders by growing tiny brain-like structures in the lab and tweaking their DNA.

While new diagnostic tools may play significant roles in the treatment of schizophrenia, meaningful recovery also requires that patients experience a sense of empowerment—a belief in their ability to take charge of their lives and manage the complex demands and consequences of such illnesses.

In any case, genetics seems to be only part of the story. “Since the identical twin of a person with schizophrenia only has a 50 percent risk of developing the illness, we know that genetics alone do not explain why someone gets the illness,” wrote Dr. Warner. “Other powerful factors have to play a part; one of these factors is problems of pregnancy and delivery. The risk for people born with obstetric complications, such as prolonged labor, is double the risk for those born with none.”

“Scientists don’t believe there’s one gene that is responsible for schizophrenia,” reported Burch on the genetic correlation. “Instead, they think there are many genes at play. However, they don’t have a full understanding of what genes impact the risk for schizophrenia.”

Dr. Warner considered schizophrenia primarily a bio-psycho-social disorder significantly affected by the environment surrounding the person with the mental health condition on multiple levels.

Colorado Recovery has been utilizing the Warner method to empower adults with mental illness for many years now. Our program approaches mental healthcare based on a path of self-reliance through developed practiced skills. We recognize the importance of empowerment for recovery, offering transitional living and outpatient levels of care, engaging patients in increasing community participation.

Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

 

Unveiling of Schizophrenia Brain Cells Shows New Treatment Targets

When you take a brain tissue sample, all that your analysis generally shows you is an average for all the cell types present. And since there are a whole lot of different cell types in our brain, you get a kind of cell soup, which makes it difficult if not impossible to tell the cells apart, let alone study them.

Now, researchers from the University of Copenhagen in Denmark applied a new method to analyze neurons one by one in order to reveal hitherto unobtainable information about them. The researchers specifically studied post-mortem brain tissue from adult patients with schizophrenia using control samples from non-schizophrenic brains.

“The human brain has very heterogenous tissue with hundreds of neuron types. We identified exactly those neurons that are most affected by schizophrenia, the position of these neurons in the human brain, and what is wrong with these neurons,” explained Konstantin Khodosevich, group leader and associate professor at the Biotech Research & Innovation Center (BRIC) at the University of Copenhagen.

What is Schizophrenia?

“Schizophrenia is a psychosis,” wrote the late Colorado Recovery founder Richard Warner in his book The Environment of Schizophrenia. “It is a severe mental disorder in which the person’s emotions, thinking, judgment, and grasp of reality are so disturbed that his or her functioning is seriously impaired.”

Symptoms can vary in type and severity over time, with periods of worsening and remission of symptoms. It’s frequently difficult to distinguish between symptoms of bipolar disorder from schizophrenia.

Approximately one percent of Americans are affected by schizophrenia. In most cases, schizophrenia first appears in men during their late teens or early 20s. In women, schizophrenia often first appears during their 20s or early 30s.

New Treatment Target

By finding the neurons most affected in schizophrenia as a whole, the research team points out that these neurons could become the next treatment target.

“Now that we know the most affected neurons, we can try to target them to alleviate some of the symptoms that come with the disease. We also now know the molecular changes in these neurons. This gives us the potential to not only alleviate the symptoms but also treat schizophrenia early in the therapeutic window, which is during the brain’s maturation until 20–25 years of age,” said Khodosevich.

The researchers discovered a network of neurons most affected by schizophrenia. In particular, they show that it is the upper layers of the prefrontal cortex, the region of the cortex which is involved in higher cognitive brain functions such as learning and memory, and general cognition.

“Our results suggest that for treatment of schizophrenia we should not target one type of neurons, but rather their overall network. Impacting this network or cell ensemble could help restore the impaired function of these neurons,” Khodosevich said.

Identifying neurons that are possibly involved in developing schizophrenia can only be one aspect of treating this serious condition. Treatment is frequently lifelong and usually involves a combination of medications, psychotherapy, and coordinated specialty care services.

Colorado Recovery founder Richard Warner considered schizophrenia a bio-psycho-social disorder significantly affected by the environment surrounding the person with the mental health condition on multiple levels.

Colorado Recovery approaches care for mental health based on a path of self-reliance through developed practiced skills. This non-institutionalized philosophy offers comprehensive levels of care supported by an expert medical and clinical team, engaging patients in increasing community participation.

Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

The Prodromal Stage of Schizophrenia

Schizophrenia is a mental health disorder characterized by continuous or relapsing episodes of psychosis. “When schizophrenia is active, symptoms can include delusions, hallucinations, disorganized speech, trouble with thinking, and lack of motivation,” according to the American Psychiatric Association. “With treatment, most symptoms of schizophrenia will greatly improve and the likelihood of a recurrence can be diminished.”

As the late Colorado Recovery founder Richard Warner made clear in The Environment of Schizophrenia, the popular view that “schizophrenia has a progressive and downhill course with universally poor outcome is a myth. Over the course of months or years, about 20 to 25 percent of people with schizophrenia recover completely from the illness—all their psychotic symptoms disappear and they return to their previous level of functioning.”

As Dr. Warner explained, there is wide variation in the course of schizophrenia. In some cases the onset is gradual, “extending over the course of months or years; in others it can begin suddenly, within hours or days. Some people have episodes of illness lasting weeks or months with full remission of symptoms between each episode; others have a fluctuating course in which symptoms are continuous; others again have very little variation in their symptoms of illness over the course of years.”

Schizophrenia symptoms often only emerge well into adulthood, typically from the late teens to early 40s. The actual onset of psychosis is frequently preceded by a prodromal stage, wrote Michelle Pugle in a recent article on Verywellhealth.com, “where people (often still in adolescence) begin experiencing pre-psychotic mild or moderate disturbances in everyday functioning, including speech and movement difficulties. These changes can be attributed to heredity, genetic, environmental, and other causes.” 

“Psychosis is preceded by a 3–4-year prodromal phase characterized by non-specific symptoms and deficits in approximately 75 percent of patients with a first episode of psychosis (FEP),” according to Michael First, Professor of Clinical Psychiatry at Columbia University in New York. 

Since the prodromal phase is the earliest phase and schizophrenia symptoms are absent, it’s commonly diagnosed only after a person has entered the active phase of the disorder.

“Prodromal symptoms are generally seen as unspecific symptoms of schizophrenia (those involving an absence of normal interactions and functioning) that evolve over time,” wrote Pugle. “They can fluctuate in intensity, severity, and length of time. Such symptoms can begin in adolescence and the teenage years, although they aren’t likely to be seen as such unless a future diagnosis of schizophrenia is made later in life (a retrospective diagnosis).”

Early indicators are easy to miss. Small changes to personality and behavior or normal routine could be some of the first signs of prodromal phase schizophrenia. As we reported on this blog, researchers recently found new clues in young adults that could help predict the severity of symptoms later in life. According to their study published in the Journal of Abnormal Psychology, “Early detection of subtle, nonpsychotic forms of perceptual disturbance may aid in identifying individuals at increased risk for nonaffective psychosis outcomes in adulthood. Perceptual aberrations may constitute a useful endophenotype for genetic, neurobiological, and cognitive neuroscience investigations of schizophrenia liability.” 

Early signs and symptoms of schizophrenia may include:

  • Nervousness and/or restlessness
  • Depression
  • Anxiety
  • Thinking or concentration difficulties
  • Worrying
  • Lack of self-confidence
  • Lack of energy and/or slowness
  • A significant drop in grades or job performance
  • Social isolation or uneasiness around other people
  • Lack of attention to or care for personal hygiene 

“Some of the prodromal signs, such as a significant change in personal hygiene and a worrisome drop in grades or job performance, can also be early warning signs of other issues, including psychosis or detachment from reality,” explained Pugle in the article. 

If your child or teen starts showing the above signs and symptoms, talk to a pediatrician or mental health professional as soon as possible. Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. About half of our clients are under 35 years of age and we expect good outcomes regardless of the duration of the disorder. Clients of any age will feel comfortable in our program. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

Assessing Cognitive Symptoms in Schizophrenia

Cognitive dysfunction is a core feature of schizophrenia, wrote Christopher Bowie and Philip Harvey in their study “Cognitive deficits and functional outcome in schizophrenia.”

“Deficits are moderate to severe across several domains, including attention, working memory, verbal learning and memory, and executive functions. These deficits pre-date the onset of frank psychosis and are stable throughout the course of the illness in most patients.” 

It is now widely recognized that these deficits are among the best predictors of functional outcomes in schizophrenia. In a recent presentation for Psych Congress Network, Leslie Citrome, MD, MPH, clinical professor of psychiatry and behavioral sciences at New York Medical College, Valhalla, NY, discussed the significance of cognition in schizophrenia. 

“We’ve known for quite some time about the positive symptoms of schizophrenia, such as delusions and hallucinations, and the negative symptoms of schizophrenia, such as the lack of motivation, lack of interest, and difficulty in expressing emotion,” Dr. Citrome explained.

“We’ve also learned to acknowledge the existence of cognitive dysfunction. Problems, for example, with verbal fluency, with paying attention, with problem-solving. At the same time, we’ve also paid more attention to the affective symptoms of schizophrenia. These overlap somewhat with negative symptoms.”

Cognitive impairment is quite common in people with schizophrenia. This has been confirmed by a number of studies. For example, in a 2019 study published in the American Journal of Psychiatry, Zanelli, Mollon, et al. found that patients with schizophrenia and other psychoses had a cognitive decline in memory, verbal learning, and vocabulary over a 10-year period. 

“Cognitive impairment occurs in first-episode and chronic schizophrenia,” said Dr. Citrome. “We can observe that people with schizophrenia have a lower degree of cognitive abilities, relative to the general population, right from the beginning.” 

Cognitive dysfunction can serve as an early warning sign. “This can be apparent at the very first episode. In fact, can predate the first episode of psychosis,” said Citrome. “People who are in the prodrome, or even in their childhood or adolescence, can exhibit some degree of cognitive impairment.” 

It’s not always easy to detect cognitive impairment associated with schizophrenia. In his presentation, Citrome explained some of the diagnostic tools. “Cognition in clinical trials with schizophrenia can be formally assessed using neuropsychological testing. The standard today is to use a battery of tests called the MATRICS Consensus Cognitive Battery or MCCB.”

The MCCB consists of 10 tests that include testing the speed of processing, attention or vigilance, working memory, verbal learning, visual learning, reasoning and problem-solving, and social cognition.

Measuring cognition has an important purpose. “Cognitive deficits do predict functional outcomes,” explained Dr. Citrome. Testing cognition “helps us predict how well someone will function.” 

Current research appears to indicate that the existence of positive schizophrenia symptoms may not necessarily impair functioning, but impairment of cognition can lead to impairment in functioning, and negative symptoms may impair functioning.

That means that “hallucinations and delusions by themselves aren’t going to be the determinants whether someone can work or have social relationships,” said Citrome. “It’s going to be negative symptoms and cognitive impairment.” 

The Colorado Recovery treatment model emphasizes the experience of empowerment, the strengthening of social relationships, and overall support for people with schizophrenia to improve all aspects of their lives. “Recovery from mental illness is about more than just getting rid of the symptoms and staying out of hospital. It is about regaining a sense of identity, belonging, and meaning in life,” said the late Richard Warner, M.D. and founder of Colorado Recovery. 

Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

Treehouse Planning Session at IOP Level


Colorado Recovery is now expanding services outside our signature continuum of care. We are admitting directly into our intensive outpatient program (IOP) clients who may be ready to begin their recovery at the IOP level of care, or for those in the process of stepping down from another program. Community integration and social engagement continue to be at the heart of the approach, setting the course for a life of engagement, purpose, and connection.

This non-institutional approach created by Colorado Recovery founder Richard Warner is key to outcomes associated with independence and self-respect. One of the offerings now available at the IOP level is our Treehouse Planning Session.

This group gives clients the opportunity to participate in their recovery plan and voice what they seek from the psychosocial program. We review any needs that they have toward connecting and contributing to the community or improving the space. It’s also a time for people to meaningfully get to know each other and develop friendships outside of a strictly therapeutic setting.

Dr. Warner considered schizophrenia and similar conditions bio-psycho-social disorders significantly affected by the environment surrounding the client on multiple levels. The Warner method harnesses the benefits of client empowerment to increase skills and work preparedness and assist them with social integration. 

The Treehouse planning group is an important element of that. On the one hand, it’s “a safe space to take a break and just hang out,” says Treehouse community organizer Elise Alvarez. “At the same time, it’s a great opportunity to build more comfortable relationships.” The Treehouse group highlights the value of social integration, “many people have found roommates and best friends here,” says Alvarez. “Treehouse gives a population that doesn’t have too much opportunity to socialize the chance to do just that.”

People are able to reach a deeper level of knowing one another while engaging in fun activities. “Hiking is always the most popular group,” reveals Alvarez. “Especially people who are not from Boulder appreciate the nature side Colorado Recovery has to offer.”

In Treehouse planning, people work out their budget, another aspect of empowerment. “It’s an important skill to come to a decision yourself and not just defer to the judgment of the coordinator. Often, I keep pushing it back to them, telling them ‘this is your space,’ so they get to make the call.”

It’s important to give clients some measure of control, to let them work out the budget and create the space the way they want it to be. “We typically start with me making announcements, and then open the floor to things they want to talk about,” explains Alvarez. “We’ve had discussions about terminology: should it be mental illness or biopsychosocial disease? Other times, we plan out dinners or days at the beach.”

For more information about direct admission to our intensive outpatient program or our other services, connect with a specialist who can answer your questions at (720) 218-4068.

 

People With Schizophrenia Have A Higher Risk of Suicide Study Confirms

The suicide risk for people with schizophrenia between the ages of 18 to 34 years is ten times higher than that for the general US population, according to a new study published in May.

The study from the Columbia University Department of Psychiatry looked at a large population of adults diagnosed with schizophrenia and found that the youngest group (18-34) had the highest suicide risk and those aged 65 and older the lowest. By comparison, in the general US population, the reverse is true: younger adults have a smaller risk and older age groups have a greater risk.

The Columbia study, published online in the journal JAMA Psychiatry also showed that people with schizophrenia, overall, have a 4.5-fold increased risk of dying from suicide, the 10th leading cause of death in the United States.

“When a person with schizophrenia is becoming suicidal, an attempt can happen with little warning,” said Mark Olfson, Elizabeth K. Dollard professor of psychiatry at Columbia and lead author of the study. “Often, suicidal behavior in schizophrenia is driven by psychotic processes. This aspect can make it difficult to anticipate and prevent.”

The study, which provides a significant amount of data on age and suicide risk, could help suicide prevention efforts for people with schizophrenia. “Knowing more about which age groups and what personal characteristics are linked to higher risk could increase attention and support for the most vulnerable patients,” Olfson said.

Colorado Recovery founder Richard Warner believed that recovery rates for schizophrenia and suicidal thoughts are also linked to the social and economic environment. 

In his classic Recovery from Schizophrenia, Dr. Warner pointed out a strong statistical correlation between lack of employment and suicidal ideation. “Work problems, economic stress, and unemployment appear to be important in precipitating suicide.” (2nd edition, 1994)

Unfortunately, discrimination and stigma prevent many people with a mental illness such as schizophrenia and bipolar disorder from finding purposeful employment. Too many of their fellow citizens believe people with such mental disorders are unable to work.

In a more recent book, The Environment of Schizophrenia, Warner wrote that “the mentally ill are among the most alienated people in our society, daily confronting the key elements of alienation—meaninglessness, powerlessness, normlessness, and estrangement from society and from work.” This induces an “existential neurosis” which in turn drives a significantly higher risk of suicide. “Many people with mental illness face lives of aimlessness and boredom,” wrote Warner.

Work can help overcome that sense of aimlessness and provide a better chance of recovery. “Productive activity is basic to a person’s sense of identity and worth. Given training and support, most people with schizophrenia can work,” Warner wrote. A productive life in recovery can also shield from suicidal ideation. 

Colorado Recovery approaches care for mental health based on a path of self-reliance through developed practiced skills. This non-institutionalized philosophy offers comprehensive levels of care supported by an expert medical and clinical team, engaging patients in increasing community participation.

Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

Is It Schizophrenia? Is It Substance Use?

Around ten million adults in the United States currently experience both mental illness and a substance use disorder (SUD). It’s a well-established correlation, often complicating the treatment of both conditions. One such co-occurring disorder is schizophrenia

In a recent webinar for Harmony Foundation, Colorado Recovery’s medical director Alan Fine, M.D., talked about the symptoms of schizophrenia and substance use disorder and why it is frequently difficult to tell the two conditions apart.

 

 

First off, Dr. Fine presented a diagnostic flowchart to illustrate where SUD and schizophrenia can be found in the mental healthcare realm. If the symptoms are acute and were caused by taking drugs or drinking alcohol then we’re looking at substance misuse and a possible addiction scenario. If the diagnosis is psychosis without a physical cause, the condition is often diagnosed as schizophrenia or bipolar disorder. 

The diagnosis of schizophrenia itself is complicated and based on the work of three trailblazers in the field whose impact can still be felt today: Emil Kraepelin (1856–1926), Eugen Bleuler (1857–1939), and Kurt Schneider (1887–1967). 

Kraepelin is considered one of the founders of modern scientific psychiatry. His views dominated the field at the start of the 20th century. Bleuler renamed Kraepelin’s “dementia praecox” schizophrenia and established the classic four As of the condition: ambivalence, affect, alogia, and autism (preoccupation with self). Schneider in turn formulated the first-rank symptoms of schizophrenia: auditory hallucinations, feelings of external control, thoughts connected to others, and other delusions.  

In his book, The Environment of Schizophrenia, Colorado Recovery founder Richard Warner wrote that “schizophrenia is a psychosis. That is to say, it is a severe mental disorder in which the person’s emotions, thinking, judgment, and grasp of reality are so disturbed that his or her functioning is seriously impaired.”

What about substance use then?

By definition, schizophrenia is not caused by the effects of a substance or another medical condition. That, however, is not quite all. 

Mental health conditions and SUDs frequently co-occur because many people with addiction are primarily misusing addictive substances to self-medicate emotional pain caused by serious mental health disorders. 

“The proportion of schizophrenic patients of comorbidity of substance abuse varies in published studies from 10–70 percent, depending on how patients are diagnosed with schizophrenia, the types of populations studied, and the different ways of defining drug and alcohol disorders,” said Dr. Fine. “There’s a remarkable overlap in both directions.”

People with schizophrenia are at a higher risk of engaging in substance misuse because many of them will be tempted to self-medicate the severe symptoms of their mental illness as well as some of the side effects of their antipsychotic medications. At the same time, substance misuse may cause syndromes that are similar or even identical to schizophrenia.

In the short term (acute intoxication), schizophrenia-like symptoms may include delusions (stimulants and inhalants), loose associations (stimulants, alcohol, sedatives, and inhalants), and hallucinations (stimulants, alcohol, and inhalants). Both alcohol and sedative withdrawal symptoms include hallucinations and paranoia. 

In the long term (prolonged misuse), “amphetamine use is associated with long-term psychosis—thirty percent of all amphetamine-induced psychoses become chronic,” Dr. Fine explained. Chronic alcohol misuse may cause persistent dementias such as Korsakoff syndrome and delirium tremens. 

People with schizophrenia also engage in substance misuse to cope with the deterioration of their social environment, an area that Dr. Warner explored extensively

So, the answer to the question “Is It schizophrenia or is it substance misuse?” is often: both! That means, should both conditions be present, both need to be treated because they may reinforce each other. An important element in this regard is empowerment

Empowering people with schizophrenia reduces the need to self-medicate and often improves symptoms. Believing in their ability to take charge of their lives and manage the complex challenges of their illness is crucial for people with schizophrenia.

Over the course of his long professional career, the late Dr. Warner realized that social inclusion empowers people with mental illnesses and improves outcomes. “Work helps people recover from schizophrenia,” Warner concluded. “Productive activity is basic to a person’s sense of identity and worth.”

Colorado Recovery has been utilizing the Warner method to empower adults with mental illness for many years now. Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

 

The Role of Work and Community in the Treatment of Schizophrenia

Empowering People with Mental Illness at Colorado Recovery

Upcoming Training with Expert in Communicating with Someone Experiencing a Mental Health Challenge

Do you ever struggle to connect and communicate with a loved one who is experiencing a mental health challenge? Dr. Xavier Amador is an internationally renowned clinical psychologist, expert, and author specializing in communication tools to help support people with mental health disorders like schizophrenia or bipolar disorder. Dr. Amador developed his evidence-based techniques to help him develop a better relationship with his brother, who was diagnosed with schizophrenia. He founded the  LEAP® (Listen-Empathize-Agree-Partner) method. Many family members and caregivers have found his techniques very helpful. 

 

Colorado Recovery encourages families and caregivers to read his book, I Am Not Sick and I Don’t Need Help, or attend an upcoming training listed below. 

Dr. Xavier Amador will be presenting an online training sessionlive with Q&A! 

Wednesday, January 13, 2021, @12:00pm-3:00 pm Eastern Time (the US and Canada)

This session is for Family Caregivers and Professionals who want to help someone with serious mental Illness and anosognosia—the neurological symptom that leaves a person unable to understand s/he is ill, resulting in conflict, isolation, and treatment refusal.

Participants will be introduced to LEAP® (Listen-Empathize-Agree-Partner), an evidence-based approach that teaches you how to create relationships that lead to treatment and recovery. Learning objectives include:

  • Identify Anosognosia vs. “Denial”
  • Lower Anger, Resistance & Defensiveness
  • Re-establish Trust & Broken Relationships

Cost

$130 Early Bird (ends Dec 11), $150 Regular

LEAP Foundation is a small nonprofit and 100% of proceeds from this session are used to fulfill the organization’s mission.

More info: https://lfrp.org/online-trainings