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Understanding the Schizophrenia Brain

Schizophrenia is considered a disorder of the mind, influencing the way a person thinks, feels and behaves. It can cause a range of symptoms that may vary in type and severity over time. Some of the main symptoms are:

  • Hallucinations: seeing, hearing, smelling, or feeling things that are not real

  • Delusions: having false beliefs that are not based on reality

  • Disorganized thinking and speech: having trouble communicating clearly or logically

  • Abnormal motor behaviour: showing unusual or inappropriate movements or gestures

  • Negative symptoms: having reduced or lack of ability to function normally, such as neglecting personal hygiene, losing interest in activities, or showing no emotion.


Strange behaviour of schizophrenia


Behaviour isn't focused on a goal, so it's hard to do tasks. Behaviour can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement. Negative symptoms. This refers to a reduced or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion (doesn't make eye contact, doesn't change facial expressions or speaks in a monotone). Also, the person may lose interest in everyday activities, socially withdraw or lack the ability to experience pleasure. Symptoms can vary in type and severity over time, with periods of worsening and remission. Some symptoms may always be present. In men, schizophrenia symptoms typically start in the early to mid-20s. In women, symptoms usually begin in the late 20s.


Suicidal thoughts and behaviour

Suicidal thoughts and behaviour are common among people with schizophrenia. If you have a loved one who is in danger of attempting suicide or has made a suicide attempt, make sure someone stays with that person. Call local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.


Is schizophrenia self-aware?


Studies have found that patients with full-blown schizophrenia lack self-awareness of the illness. About 46% of First Episode Psychosis (FEP) patients showed poor insight, and insight impairment is associated with multiple cognitive deficits.


The subjective evaluation of self-awareness of illness can also be important in the early detection of schizophrenia because complaints precede prodromal symptoms and are therefore useful in predicting the onset and relapse of schizophrenia as well as long-term symptomatic deterioration. Subjective measures of cognitive function, such as self-report questionnaires or related scales, shed light on self-perceived cognitive difficulties that occur during daily activity and cannot be observed using behavioural tests. Although some self-reported scales measure clinical insight, such as the schedule of assessment of insight-expanded version (SAI-E) and the Beck cognitive insight scale (BCIS) , they are too broad to examine self-awareness of illness among patients with FEP. In particular, the SAI-E measures overall relabeling of symptoms, awareness of illness, and need for treatment, while the BCIS measures self-certainty and self-reflectiveness. Therefore, self-awareness of illness should be measured using other self-reporting scales that measure specific cognitive functions related to the pathological problems seen in patients with FEP.


What happens in the schizophrenic brain?


Schizophrenia episodes damage the brain. Each time the person experiences a psychotic episode or a flare-up, it damages their brain. It causes various changes in the brain that affect the structure and functioning of several key brain systems, including prefrontal and medial temporal lobe regions involved in working memory and declarative memory.


Some of the brain changes that may occur in schizophrenia are:

  • Reduced volume and thickness of the cortex, especially in the frontal and temporal lobes, which are involved in memory, judgment, emotions, and language12

  • Reduced volume and activity of the thalamus, which is responsible for relaying sensory information2

  • Reduced volume and integrity of white matter, which is important for connecting brain regions and allowing communication within the brain3

  • Increased brain aging, which means that the brains of people with schizophrenia may appear older than their chronological age

  • Imbalances and abnormalities in neurotransmitters, such as dopamine, glutamate, and serotonin, which are involved in regulating mood, motivation, learning, and reward1

These brain changes may begin before the onset of clinical symptoms and may contribute to the development and progression of schizophrenia. However, the exact causes and mechanisms of these brain changes are not fully understood and may vary from person to person.


What do brain imaging studies indicate?


Brain imaging shows that people with schizophrenia have less gray matter volume, especially in the temporal and frontal lobes. These areas of the brain are important for thinking and judgment. What's more, gray matter loss continues over time. There are also changes to white matter. White matter is made up of several different kinds of cells, including:

  • myelin, cells that wrap around nerves

  • glia, which protect neurons (nervous system cells)

  • perivascular cells, which help form a barrier that protects brain cells from blood

  • projection fibers that connect to different areas of the brain, allowing for communication between brain regions.

Changes in white matter are related to psychotic symptoms and a lower ability to think in people with schizophrenia. There’s also evidence that natural changes to white matter during puberty may be an underlying cause of schizophrenia.


Other differences compared to a neurotypical brain include: enlarged ventricles (the fluid-filled spaces) in the interior of the temporal lobes and diminished temporal lobe tissue. The greater the observed changes the greater the severity of the person's thought disorder and his or her auditory hallucinations.



Is schizophrenia a chemical imbalance?


A chemical imbalance does not simply cause schizophrenia, but it may involve changes in the levels and activity of certain neurotransmitters in the brain. Neurotransmitters are chemical messengers that help nerve cells communicate with each other. Some neurotransmitters that may be affected by schizophrenia are dopamine, serotonin, glutamate, and GABA12. These neurotransmitters regulate mood, motivation, cognition, reward, and stress response. Imbalances or abnormalities in these neurotransmitters may contribute to some of the symptoms of schizophrenia, such as hallucinations, delusions, and disorganized thinking1. However, chemical changes in the brain are not the only factor that influences schizophrenia. Other factors such as genetics, environment, brain structure, and brain ageing may also play a role in the development and progression of this complex disorder.

Different views, different perspectives


From a medical perspective, schizophrenia is a mental disorder that affects how a person thinks, feels, and behaves. It is caused by a combination of genetic, biological, environmental, and psychological factors. It is not a result of personal weakness or lack of faith. It can be treated with medications and psychotherapy that help manage the symptoms and improve the quality of life of people with schizophrenia.


From a psychological perspective, schizophrenia may be seen as a form of existential crisis, which is a period of inner conflict and anxiety about one’s identity, meaning, and purpose in life. People with schizophrenia may question their existence and reality, feel isolated and hopeless, and struggle to find a sense of direction and coherence. An existential crisis may be triggered by various life events or transitions, such as trauma, loss, illness, or aging. It may also be related to spirituality, as some people may seek meaning and connection through religious or spiritual practices.


From a transpersonal perspective, schizophrenia may be seen as a form of spiritual emergency, which is an intense and chaotic process of spiritual awakening or emergence. People with schizophrenia may experience altered states of consciousness, such as visions, voices, or mystical insights. They may also feel a connection with a higher power or a greater reality. A spiritual emergency may be seen as an opportunity for growth and transformation, rather than a pathology or illness. However, it may also require support and guidance from professionals or peers who understand the spiritual dimension of this experience.


These perspectives are not mutually exclusive or contradictory. They may offer different ways of understanding and coping with schizophrenia. Ultimately, the meaning and value of schizophrenia may depend on the individual’s personal experience and worldview.


Schizophrenia treatment at 360 Wellness Hub


Schizophrenia is a serious, long-term mental health condition that requires lifelong treatment. The main types of treatment for schizophrenia are:

  • Medications: Antipsychotic drugs are the cornerstone of schizophrenia treatment. They help reduce the symptoms of psychosis, such as hallucinations and delusions, by affecting the brain chemical dopamine. They may also help with negative symptoms, such as lack of motivation and emotion. Antipsychotic drugs may be taken as pills, liquids, injections, or patches. There are two classes of antipsychotic drugs: typical (first-generation) and atypical (second-generation). Both types can be effective, but they have different side effects and benefits. The choice of medication depends on the individual’s symptoms, preferences, and response to treatment.

  • Psychotherapy: Talking therapies can help people with schizophrenia cope with their condition, improve their self-esteem, manage stress, and enhance their social and work skills. Some common types of psychotherapy for schizophrenia are cognitive behavioural therapy (CBT), acceptance and commitment therapy (ACT), family therapy, and social skills training. Psychotherapy can be done individually or in groups.

  • Psychosocial interventions: These are non-medical treatments that aim to improve the quality of life and functioning of people with schizophrenia. They include case management, vocational rehabilitation, supported employment, cognitive remediation, peer support groups, and psychoeducation. Psychosocial interventions can help people with schizophrenia access services, find and keep jobs, improve their thinking and memory skills, learn from others with similar experiences, and gain knowledge and skills to manage their condition.

Treatment for schizophrenia is usually a team effort that involves the person with schizophrenia, their family and friends, their doctor, their therapist, and other mental health professionals. The goal of treatment is to help the person with schizophrenia achieve their personal recovery goals and live a fulfilling life.



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About the Author

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Dr. Lennie Soo

Founder and Clinical Director of 360 Wellness Hub.

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