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Information about psychosis

What are the causes and background?

bildA large number of theories and hypotheses on the evolution of psychoses have been formulated. However, neither the biological nor the psychosocial research to date has been able to find a real cause applicable to all people. For this reason, today one assumes a so-called “multifunctional” cause, which means that various factors (biological and psychosocial) interact in the individual persons afflicted.

The currently best model on the evolution of psychosis is referred to as “vulnerability-stress-model”. This states that people with a possibly genetically induced predisposition to psychoses or rather other risk factors are particularly sensitive to stress situations such as puberty, school leaving examinations, falling in love, separation, overwork, holidays, moving house, marriage, loss or death of a closely associated person, pregnancy or other difficult life situation. Often, it is sensitive and creative people who are taken ill with a psychosis.

As a biological cause, metabolic disorders of so-called neurotransmitters (messenger substances) are associated with psychoses. Messenger substances are responsible for the flow of information between nerve cells. In the case of psychoses, it is assumed that among other things dopamine, serotonin and glutamate play a main role.

For the individual persons afflicted, these factors may be more or less significant. It is important therefore to record the development of the psychosis as completely as possible in the personal context and try to understand it in its circumstances. This is the basis of an individually integrated therapy of psychoses.

Causes – the vulnerability stress model

The “vulnerability stress model (vulnerability = the susceptibility to a disorder) means the susceptibility to react with psychotic symptoms in stressful stages of life. The susceptibility exists in all people; however, it is increased if various vulnerability factors come together. Stressful stages of life are for example puberty, school leaving examinations, marriage, loss or death of a closely associated person, pregnancy or other critical life situations. If these stresses coincide with vulnerability and insufficient coping mechanisms, in the event of a corresponding predisposition they can lead to psychotic symptoms. Despite this, through the protective effect of other factors (e.g. good social integration, good level of functioning, good coping skills), the onset of the psychosis can fail to materialize, so that a disorder is not inevitable.

Vulnerabilitäts-Stress-Modell

a) Person with low vulnerability becomes ill in the event of high stress intensity.
b) Person with high vulnerability becomes ill already at a low stress level.
c) In the case of the same vulnerability the person can tolerate higher stress intensity at a higher protective level without falling ill.

Causes – disorders of neurotransmitters

As a biological cause, metabolic disorders of so-called neurotransmitters (messenger substances) are associated with psychoses. Messenger substances are responsible for the flow of information between nerve cells. In the case of psychoses, it is assumed that among other things dopamine, serotonin and glutamate play a main role. In this, various symptoms are put down to various disorders of dopamine at different places in the brain.

  • For positive symptoms such as delusion and hallucination an overactivity of dopamine appears to exist in the part of the brain in which stimuli from outside are processed and feelings (e.g. anxiety, emotion) are regulated (so-called mesolimbic system).
  • For negative and cognitive symptoms such as listlessness, lack of energy, concentration disorders and social withdrawal, an underactivity of dopamine in the part of the brain that is responsible for cognitive abilities and motivation appears to exist (so-called mesocortical system).

Causes – vulnerability factors

Vulnerability for the onset of a psychosis and accordingly schizophrenia can be favoured by various factors. In this, mostly a vulnerability factor alone is not sufficient to cause the psychosis. Rather, it is an interaction of various vulnerability and protective factors which cooperate in a certain manner. Risk factors for the onset of schizophrenia are for example:

Type Vulnerability factors
Clinical
  • Personality disorder Cluster A
  • Schizotype of the person afflicted or in the family (e.g. introversion, self-centeredness, problems in the relationship with other persons)
  • Family stress with a schizophrenia spectrum disorder
  • Diagnosis of psychic disorder in childhood and adolescence
  • Asperger’s syndrome
Behaviour-related
  • Early development disorders with deficits in running and speaking at the right time, in temperament
  • Prominent symptoms before the prodromal phase (premorbid) including cognitive deficits with corresponding behavioural symptoms, neuromotor dysfunctions, reduced emotional expressiveness, deficits in social competence, lack of drive, academic and functional deficits.
Environment-related
  • Psychosocial stress including negative emotional climate, low socioeconomic status, instable parenting environment
  • Pregnancy, birth and lactation factors including measles infection of the mother during pregnancy, infection of the mother in the sixth month of pregnancy, poor nutrition of the mother during pregnancy, drug or alcohol abuse of the mother during pregnancy, premature birth, oxygen deficit of the infant at the time of birth, low birth weight
  • Cannabis consumption before the 15th to 18th year of life
Anatomically / neuro-anatomically
  • Slight prominent physical symptoms
  • Variations in the brain structure including expansions of the lateral ventricle and the basal ganglion cores, changes in the limbic system, volume reduction of various brain regions.
  • Injury or infection of the brain in the anamnesis
Chemical
  • Dopaminergic hypoactivity in the mesocortical and hyperactivity in the mesolimbic system
  • Changes in other neurotransmitters including glutamate, serotonin etc.
  • Changes in the availability of various neurotransmitter receptors
Genetic
  • Genetic loading (see pdf), however no reliable details of the number and type of genes affected
Motor
  • Deficits in slow eye movements
  • Neurological soft signs such as e.g. tremors (shaking hands) or EEG changes
Perceptive-cognitive
  • Deficits in various neuropsychological areas such as e.g. vigilance, ability to respond in the event of simple reaction tests, selective attention, early information processing, visual-spatial and sensory-motor information deficits, associative loosening, deficits in discriminating between equivocal stimuli
Neuropsychological
  • Lower IQ
  • Dyslexia (reading weakness)

Genetische Belastung

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