Ahead of our forthcoming international meeting exploring the neurobiology of psychosis and schizophrenia, Dr Musa Sami shares his reflections on 'the most enigmatic' of psychiatric disorders.
Around 20 million people across the world suffer from schizophrenia and a greater number suffer from psychotic disorders. The intellectual fervent at the turn of the century lead to a plethora of theories of still great relevance today. Although originally unified by Kraeplin over 120 years ago we still lack an understanding of the fundamental mechanisms with the disorder. Kraeplin brought together several diverse presentations including catatonic, hebephrenic (disorganised), and paranoid presentations to unify a single disorder characterised by as he termed it a breakdown in psychic function and progressive ‘mental enfeeblement’. A first-rate epidemiologist and careful clinical observer it is perhaps a sad state of affairs that the disorder he so carefully clinically characterised became associated with lack of responsiveness to treatment and poor outcome.
Bleuler coined the name schizophrenia and considered that what are often now regarded as sine qua non symptoms i.e. hallucinations and delusions were in fact accessory manifestations of the deteriorating clinical course. In his conception a loosening of associations was the fundamental symptom of the disorder. Wernicke advanced the sejunction hypothesis of brain dysconnectivity. Freud, although now discredited in the field, hoped schizophrenia research drew attention to the internal psychic conflict which underpins the disorder. Later on, Schneider would advance first rank symptoms which began to be known as the basis of the recognisable disorder we have today, and Jaspers would delineate the psychopathology of delusions to be ‘un-understandable’.
What have we achieved in the last century? We know that schizophrenia and psychotic disorders are no longer considered disabling – a large proportion of those presenting to Early Intervention services recover from disorder and do not relapse again. The discovery of dopamine receptor blockers has revolutionised the field in the last 70 years, leading to the closure of the psychiatric asylums and arguably precipitating remission and recovery in a large portion of individuals. We have understood a great deal about the risk factors for psychosis: trauma, substance abuse, familial and genetic predisposition play key roles. Once called the ‘pathologist’s graveyard’ neuroimaging abnormalities have moved the conception from psychosis and schizophrenia from being ‘functional disorders’ to having an organic basis. Yet we remain unresolved in the fundamental understandings of the disorder – is there a primary dopaminergic or glutamatergic abnormality, what are the neural mechanisms, does inflammation play a role and if so, what is it. Neuroimaging and genomics have provided crucial insights, but these have sometimes proved elusive, at times yielding conflicting findings.
This symposium will review the state-of-the-art neurobiological theories of schizophrenia and the psychotic disorders by world leading experts in the field. Join us on 16 November 2022 to discuss these latest findings in what has proven to be perhaps the most enigmatic amongst the psychiatric disorders.
https://www.institutemh.org.uk/events/event/189-neurobiology-of-schizophrenia-and-psychosis
Dr Musa Sami MRCP MRCPsych PgDip PhD
Clinical Associate Professor of Psychiatry, University of Nottingham & Honorary Consultant Psychiatrist