Schizophrenia

Schizophrenia

In our clinic we use various neuromodulation techniques for individuals with schizophrenia.

Information about the disorder:

Schizophrenia is a complex brain disorder characterised by a breakdown of thought processes and by a deficit of typical emotional responses. There is fluctuating, gradually deteriorating or relatively stable disturbances in thinking, behaviour and perception. The typical onset is in late adolescence to early adulthood with a chance in lifetime of around 1%. For many people, the condition continues throughout their life.

Common symptoms of schizophrenia include auditory hallucinations, paranoid or bizarre delusions, or disorganised speech and thinking. These symptoms are accompanied by major social or occupational dysfunction.

Hallucinations are perceptions experienced without any external stimulation of the sense organs. They could involve auditory, visual, tactile, smell or taste modalities.

Delusions are beliefs contrary to the educational and cultural background of the individual. They may involve grandiose, nihilistic, persecutory, somatic, sexual and religious themes.

Disorganisation syndrome (thought disorder) involves struggling to think, speak or behave in a planned and logical manner, fragmentation of ideas, loosening of associations of ideas, hoping from topic to topic, and inappropriate emotional expression.

Schizophrenia is usually described in terms of positive and negative (or deficit) symptoms. Positive symptoms are those not normally experienced by other people but present in people with schizophrenia. These include delusions, disordered thoughts and hallucinations, and typically considered as manifestations of psychosis (loss of contact with reality). On the other hand, negative symptoms are deficits of normal emotional responses or of other thought processes; such as flatness of affect and emotion, poverty of speech (alogia), reduced spontaneous movements, inability to experience pleasure (anhedonia), lack of desire to form relationships (asociality), and lack of motivation (avolition).

There are a number of subtypes of schizophrenia; including paranoid, disorganised (hebephrenic), catatonic, undifferentiated and residual types.

The exact cause of schizophrenia is not yet known. However, genetics, early environment, neural function, and psychological and social processes appear to be important contributory factors. Studies using psychological tests and imaging to examine functional differences in brain activity have shown that differences seem to most commonly occur in the frontal lobes, hippocampus and temporal lobes. According to the recently favoured dopamine hypothesis, there are alterations in major dopaminergic pathways in the brain. According to this view, in the mesolimbic pathway from ventral tegmentum to temporal lobe structures there is hypersecretion of dopamine, which produces the positive symptoms, whereas there is hyposecretion of dopamine in the mesocortical pathway from ventral tegmentum to frontal cortex, which is the cause of negative symptoms.

Currently, treatment options in schizophrenia include antipsychotic medications and various psychosocial interventions, most commonly cognitive behaviour therapy (CBT). However, in recent years, increasingly non-invasive neuromodulation techniques are also used as a management option. Interventions, such as qEEG guided neurofeedback, transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) are producing promising outcomes and proving the effectiveness of non-invasive neuromodulation techniques.

Recently, the Foundation for Neurofeedback and Applied Neuroscience, USA, rewarded their Annual Award for the Best Neurofeedback Article for 2013 to a research study which demonstrated the effectiveness of neurofeedback in schizophrenia (T. Surmeli, A. Ertem, E. Eralp and I.H. Kos, “Schizophrenia and the Efficacy of qEEG-Guided Neurofeedback Treatment: A Clinical Case Series,” Clinical EEG and Neuroscience, 43 (2) 133-144, April 2012).