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Schizophrenia environmental causes


[Environmental risk factors for schizophrenia: a review]

Review

. 2013 Feb;39(1):19-28.

doi: 10.1016/j.encep.2011.12.007. Epub 2012 Nov 21.

[Article in French]

J Vilain  1 , A-M Galliot, J Durand-Roger, M Leboyer, P-M Llorca, F Schürhoff, A Szöke

Affiliations

Affiliation

  • 1 Inserm U 955, équipe de psychiatrie génétique, département de génomique médicale, institut Mondor de recherches biomédicales (IMRB), 94000 Créteil, France. [email protected]
  • PMID: 23177330
  • DOI: 10. 1016/j.encep.2011.12.007

Review

[Article in French]

J Vilain et al. Encephale. 2013 Feb.

. 2013 Feb;39(1):19-28.

doi: 10.1016/j.encep.2011.12.007. Epub 2012 Nov 21.

Authors

J Vilain  1 , A-M Galliot, J Durand-Roger, M Leboyer, P-M Llorca, F Schürhoff, A Szöke

Affiliation

  • 1 Inserm U 955, équipe de psychiatrie génétique, département de génomique médicale, institut Mondor de recherches biomédicales (IMRB), 94000 Créteil, France. [email protected]
  • PMID: 23177330
  • DOI: 10. 1016/j.encep.2011.12.007

Abstract

Background: Evidence of variations in schizophrenia incidence rates has been found in genetically homogenous populations, depending on changes within time or space of certain environmental characteristics. The consideration of the impact of environmental risk factors in etiopathogenic studies has put the environment in the forefront of research regarding psychotic illnesses. Various environmental factors such as urbanicity, migration, cannabis, childhood traumas, infectious agents, obstetrical complications and psychosocial factors have been associated with the risk of developing schizophrenia. These risk factors can be biological, physical, psychological as well as social and may operate at different times in an individual's life (fetal period, childhood, adolescence and early adulthood). Whilst some of these factors act on an individual level, others act on a populational level, modulating the individual risk. These factors can have a direct action on the development of schizophrenia, or on the other hand act as markers for directly implicated factors that have not yet been identified.

Literature findings: This article summarizes the current knowledge on this subject. An extensive literature search was conducted via the search engine Pubmed. Eight risk factors were selected and developed in the following paper: urbanicity (or living in an urban area), cannabis, migration (and ethnic density), obstetrical complications, seasonality of birth, infectious agents (and inflammatory responses), socio-demographic factors and childhood traumas. For each of these factors, we provide information on the importance of the risk, the vulnerability period, hypotheses made on the possible mechanisms behind the factors and the level of proof the current research offers (good, medium, or insufficient) according to the amount, type, quality and concordance of the studies at hand. Some factors, such as cannabis, are "unique" in their influence on the development of schizophrenia since it labels only one risk factor. Others, such as obstetrical complications, are grouped (or "composed") in that they include various sub-factors that can influence the development of schizophrenia.

Discussion: The data reviewed clearly demonstrates that environmental factors have an influence on the risk of developing schizophrenia. For certain factors - cannabis, migration, urbanicity, obstetrical complications, seasonality - there is enough evidence to establish an association with the risk of schizophrenia. This association, however, remains weak (especially for seasonality). With the exception of cannabis, no direct link can yet be established. Concerning the three remaining factors - childhood traumas, infectious agents, socio-demographic factors - the available proof is insufficient. One main limitation concerning all environmental factors is the generalization of results due to the fact that the studies were conducted on geographically limited populations. The current state of knowledge does not allow us to determine the mechanisms by which these factors may act.

Conclusion: Further research is needed to fill the gaps in our understanding of the subject. In response to this need, a collaborative European project (European Study of Gene-Environment Interactions [EU GEI]) was set-up. This study proposes the analysis of those environmental factors that influence the incidence of schizophrenia in various European countries, in both rural and urban settings, migrant and native populations, as well as their interaction with genetic factors.

Copyright © 2011 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

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Environmental risk factors for psychosis

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causes, forms, symptoms, signs, stages, diagnosis, treatment

Causes

Classification

Symptoms

Complications

Diagnosis

Treatment

Prevention

Schizophrenia is a chronic mental disorder characterized by a disturbance in the process of thinking, emotional reactions, and a distorted perception of the outside world.

Without treatment, the disease progresses, the patient's social maladjustment increases, followed by disability. nine0003

In order to relieve symptoms and establish a long-term remission, drugs are used, psychotherapeutic and physiotherapeutic methods are used.

Causes

Most scientists adhere to the version that schizophrenia is caused by a whole range of factors, including hereditary burden, adverse social and environmental living conditions.

Predispose to the development of the disease:

  • the presence of mental disorders in close relatives; nine0032
  • complicated childbirth in the mother;
  • past infection or poor nutrition during pregnancy;
  • psychological trauma experienced in childhood;
  • violation of the laying of a number of brain structures even before birth;
  • age from 18 to 30 years.

Schizophrenia in men appears earlier than in women. It is also worth noting that it is more common among urban residents than rural ones. nine0003

The neurotransmitter theory of the onset of the disease states that, in essence, schizophrenia is a consequence of impaired activity of neurotransmitters in the dopaminergic and glutamatergic synapses of the brain. The debut of the disease is often preceded by a long pathological process in the central nervous system, which lasts for several months or years.

The first psychosis can be provoked by the use of narcotic substances, psycho-emotional shock, prolonged experiences and nervous overload. In women, schizophrenia often manifests during pregnancy or after childbirth. nine0021

Classification

According to the international classification of diseases, there are seven forms of schizophrenia with different manifestations and prognosis.

The hebephrenic variant of the disease often debuts in adolescence or youth, is characterized by foolishness, pretentious, mannered behavior, disorganized thinking and speech disorders.

Paranoid schizophrenia is the most common. Positive symptoms come to the fore with its exacerbation. In most cases, paranoid delusions and auditory hallucinations predominate. nine0003

The catatonic form is characterized by the predominance of movement disorders. Among the latter there may be stupor, lack of speech, episodes of freezing, sometimes with complete submission and the possibility of giving the sick person any posture (wax flexibility), periodically interrupted by short-term psychomotor agitation.

Simple schizophrenia proceeds slowly, without acute psychosis, with progressive negative symptoms. Apathy, emotional coldness, loss of initiative, drives and interests are growing. The patient becomes passive, uncommunicative, "withdraws into himself." nine0003

In cases where the scarcity or, conversely, the abundance of symptoms does not allow attributing schizophrenia to one of the known forms, it is diagnosed as undifferentiated.

Residual schizophrenia can be observed in patients who previously had episodes of acute psychosis with hallucinations and delusions, followed by a chronic mental disorder with the progression of negative symptoms. Post-schizophrenic depression appears immediately after psychosis and is characterized by a persistent decrease in mood along with mild residual manifestations of the disease. nine0003

Forms of childhood schizophrenia depend on the time of manifestation of the disease. At preschool age, negative symptoms predominate, autism increases, lack of interest in gaming activities, communication. Schizophrenia in children of primary school age is also manifested by isolation and emotional coldness, alienation from others. Patients can immerse themselves in their fantasies, live in a fantasy world. As they grow older, productive symptoms may appear, such as delusions, hallucinations, obsessions. Adolescents often have a hebephrenic variant, not only behavior changes dramatically, but also the social circle. nine0003

Conditions corresponding to various types of indolent schizophrenia (neurosis-like, psychopathic, "poor symptoms") are considered in the ICD-10 under the heading "Schizotypal disorder". They have manifestations similar to classical schizophrenia, but are more favorable in terms of prognosis, and are not accompanied by such profound personality changes.

Symptoms

Schizophrenia proceeds in several stages. Before the manifestation of the disease, the patient may have a prodromal period for months or years. At this time, the patient gradually loses interest in work, social life, and his own appearance. There may be non-specific disturbances in memory, thinking, speech, absent-mindedness, unexplained anxiety, mild depression. Characterized by introversion, perhaps a passion for philosophy, religion, the appearance of addiction to alcohol or drugs. nine0003

Symptoms of an exacerbation of schizophrenia or its manifestation depend on the form of the disease. During psychosis, the following phenomena may be present:

  • delusional thoughts and obsessions, more often delusions of persecution;
  • hallucinations, mostly auditory, often with a complete separation from reality;
  • disorganization of speech and thinking;
  • the appearance of suicidal tendencies;
  • unreasonable fear, increased anxiety; nine0032
  • behavior inappropriate to the situation;
  • psychomotor agitation or limitation of mobility.

The residual stage in the interictal period is characterized by complete or partial remission of the disease. In the first case, there are no obvious signs of schizophrenia, the patient's critical attitude towards the psychosis he has suffered is usually restored, and personality changes are minimally pronounced. With incomplete relief, less obvious symptoms of a mental disorder persist. The patient is able to maintain orderly, socially acceptable behavior. nine0021 the moment of falling asleep.

Complications

The disease can progress with aggravation of negative symptoms, a growing personality defect. People with this course of schizophrenia are emotionally empty, not interested in the feelings of others, absorbed in their own experiences, being in a bad mood most of the time.

At the same time, the social isolation of such patients increases, they stop going to work or study, prefer a solitary pastime. nine0003

Ultimately, there may be loss of self-care skills and ability to function. During acute psychosis, a person can be dangerous to himself and others, commit suicide or murder.

Diagnosis

A psychotherapist or psychiatrist is engaged in the identification and treatment of the disease. Diagnosis of schizophrenia includes a conversation with the patient, and, if possible, his relatives and close associates. The patient's behavior, hereditary anamnesis, social status, existing complaints are analyzed. Symptoms of a mental disorder must be present for a month or more. nine0003

Specially designed questionnaires, tests, scales are used to correctly assess the emotional and psychological status, determine suicidal tendencies, depressive disorders and clarify other parameters. For the purpose of differential diagnosis of schizophrenia with other diseases and the exclusion of an organic cause of psychotic disorders, a consultation with a neurologist can be prescribed, laboratory and instrumental studies have been carried out.

Treatment

When a diagnosis of schizophrenia is established, drug therapy is recommended to relieve acute psychotic symptoms and achieve long-term remission. Antipsychotics are the first choice drugs. Additionally, tranquilizers and mood stabilizers can be used. nine0003

Physiotherapeutic methods are used when medicines are ineffective. They involve the effect of an electric current or magnetic field on the brain.

Psychotherapy sessions are carried out outside the exacerbation of the disease. An important place in the treatment of schizophrenia is occupied by the social rehabilitation of such patients, education, psychological support by the patient's relatives and friends.

It is necessary to exclude factors that can cause a relapse of the disease and aggravate negative symptoms:

  • alcohol and drug use;
  • lack of family and social support;
  • condemnation from others;
  • stress;
  • insufficient sleep;
  • nicotine addiction.

Prophylaxis

Since the cause of schizophrenia has not been established, specific prevention measures have not been developed. Patients should be informed about the increased risk of developing mental disorders in their children. Early detection and treatment of the disease increases the patient's chances of establishing a long-term remission. nine0003

The author of the article:

Novikov Vladimir Sergeevich

psychotherapist, clinical psychologist, kmn, member of the Professional Psychotherapeutic League

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