“The schizophrenic patient tied himself up so as not to harm the children”

Psychologies: Is this disease inherited?

Margarita Alfimova: The likelihood of getting schizophrenia is affected by both the set of human genes and other factors that are in no way related to genes. These include changes in the functioning of the body – and the brain in particular, which could occur as a result of birth trauma, infection or malnutrition of the mother during pregnancy, abuse in childhood. Apparently, there are many other reasons that science has not yet established.

Can drug use cause disease?

Drugs slightly increase the likelihood of developing the disease. As shown by a recent study by an international team of scientists led by Dr. Julien Waucher from the University Hospital of Lausanne, marijuana use, even intermittent – from 5 doses, increases the risk of schizophrenia by about 40%. However, the mechanisms of this influence are still being studied.

One well-established hypothesis is that drug use disrupts the maturation of the cerebral cortex in adolescents. It is important to note that in some people, drugs can cause psychosis, a relatively long-term state of delusions and hallucinations that is very similar to that seen in schizophrenia, but is not schizophrenia.

Are people with schizophrenia prone to violence?

No more than other people. At the same time, the violent crimes they commit are often devoid of any motivation in the eyes of a healthy person and are so absurdly cruel that they attract a lot of public attention. This is due to the very essence of the disease. After all, one of the criteria for making a diagnosis is crazy ideas that do not have an adequate explanation and are incompatible with generally accepted ideas about the order of things.

Are people with schizophrenia capable of taking responsibility for their actions?

In general, yes. When we talk about incapacity or insanity, we do not mean the diagnosis in general, but the specific features of the state in which the crime was committed. In particular, a person may commit a crime under the influence of delusional ideas or hallucinations. The patient either cannot resist these symptoms emotionally, or because of them loses touch with reality.

However, even these manifestations of the disease can be resisted. For example, one patient tied himself up at night with ropes, as the voices “forced” him to harm his own children. Of course, this is a special case, and the only sure way to avoid tragic consequences is timely treatment.

Can a person who has been living next to a schizophrenic for many years “be imbued” with this state himself?

In general, no. However, there is a rather rare phenomenon – induced delusional disorder, it is also Lasegue-Falre syndrome or “insanity together.” Delusional or hallucinatory images and ideas of the patient begin to be shared by a person close to him.

This happens when the patient is significant and authoritative for the one to whom he induces these ideas – for example, the delirium of a sick father can be shared by his son or daughter. But authority is still not enough. In order for a person to be imbued with strange, and often quite unusual, ideas, special conditions are also needed – increased suggestibility, insufficiently developed intelligence, or even physically poor health.

Psychiatrists note that a person who shares a delusion with a patient can slightly transform these ideas, adapting them to reality. But I repeat, this is a very rare occurrence, several conditions must converge at once. Usually, relatives of the sick person at least understand that “something is not right” with him. You can’t get schizophrenia!

How should a person living with a schizophrenic behave? How to respond to his strange actions and statements?

Brad cannot be dispelled by arguments. This is his nature. So arguing with the patient is rather harmful, and it is pointless to agree. But relatives can still reduce the likelihood of a new attack if they refrain from direct criticism and irritable attitude towards the actions of the patient, they will try to maintain a calm and friendly atmosphere in the family.

Schizophrenia cannot be cured?

So far, unfortunately, we are not talking about a complete cure, but psychiatrists have learned quite successfully to cope with the acute manifestations of the disease, which cause the greatest suffering to the patient and his relatives – agitation, delirium, hallucinations. Over time, the patient may develop negative symptoms – this happens in most cases: the patient becomes inactive, disinterested, he loses his strength and desire to strive for something. They have not yet learned how to deal with this with the help of drugs. Some in these cases are helped by participation in various psychotherapeutic groups.

Is it true that there is no single gene for schizophrenia, but that there are eight different combinations of genes that contribute to the development of eight types of schizophrenia?

The story of the eight variants of schizophrenia is a consequence of an inaccurate interpretation of the very important and interesting work of Robert Cloninger and his colleagues. Its main result is not the selection of a certain number of sets of genes and their corresponding forms of disease. Scientists have shown that different people can have different genetic causes (sets of genes) at the heart of schizophrenia, and therefore the symptoms will be different.

Some sets were associated with persistent delusions and hallucinations and a gradual deterioration in the patient’s mental state, while others were associated with certain disorders, such as auditory hallucinations. Moreover, the same form of a gene can increase the risk of developing the disease in some cases and reduce it in others. It’s not about each specific gene, but about their combination, which may or may not lead to disorders in the brain systems, the breakdown of which we call schizophrenia.

What research in this area will help to understand the nature of the disease?

From the pursuit of the mythical “schizophrenia gene,” scientists are moving on to studying how genes work, interacting with each other and responding to external influences. In particular, processes called epigenetic are attracting attention. They regulate the work of genes, make some genes in the cell “silent”, while others “speak”.

These studies should explain why schizophrenia can manifest itself differently in people with the same set of genes. In addition, we hope that epigenetics will help us understand how events that occur in early childhood, or even before birth, contribute to the onset of disease many years later, in adolescence and adulthood.

For example, at the Mental Health Research Center, we are studying the epigenetics of cognitive deficits in schizophrenia: memory, attention, and thinking disorders. These disorders greatly affect the ability of patients to work and their relationships with others. To understand how they form is to find a way to return patients to normal life.

For many, though not all, patients with schizophrenia, symptoms such as hallucinations and delusions improve with age. What is it connected with?

Currently, the main reason for this is maintenance drug therapy. The probability of the onset – or rather, non-onset – of a new acute condition with delusions and hallucinations depends on how well the patient fulfills the doctor’s prescriptions outside the attack.

Of course, other mechanisms also contribute to the change in the manifestations of the disease – biological, including those associated with age-related changes, and psychological compensatory ones. So I would not argue that schizophrenia is a life collapse.

Currently, more than 40% of patients, many years after the onset of the disease, live, often work, without the need for constant medication. This number also includes those 20-25% of patients whose condition many doctors are ready to call recovery.