Causes of schizophrenia in women

A severe form of mental disorder characterized by specific distortions of thinking and perception, inadequate mood and behavior, can manifest itself in people of any gender and at any age. This disease is currently not treated, but in most patients it is possible to slow down its development, and sometimes even completely relieve symptoms. However, the onset of the disease manifestation is important for the prognosis - an early onset usually indicates a malignant process. Gender differences also take place - schizophrenia in women in most cases manifests itself closer to 30 years (later than in men) and, accordingly, it is characterized by a less progressive course. In addition, women more often seek medical attention for mental disorders and respond well to treatment with antipsychotics. Due to these circumstances, the development of the process is long, and often never leads to gross personality changes and social isolation.

Women are great malingerers and actresses, they tend to invent non-existent illnesses. Women even attempt suicide more often, although they cannot boast of their effectiveness, unlike men, which suggests that most of them have a manipulative goal.

The weaker half of humanity experiences several serious hormonal changes throughout their lives, and the female psyche is very dependent on hormonal levels. A woman's mood sometimes changes dramatically during the month depending on the phase of the menstrual cycle, so it is not surprising that representatives of different age groups are susceptible to different types of mental disorders.

Girls aged ten to twelve are at risk for developing anxiety disorders combined with hyperactivity and absent-mindedness.

During puberty, there is a high probability of deviations from the norm of eating behavior, the most pronounced manifestations of which are anorexia, neurotic vomiting, and overt gluttony. The period of establishing the menstrual cycle is characterized in some girls by pronounced premenstrual syndrome in the form of dysphoric disorder. Later, the risk of developing depression increases.

The beginning of sexual life, the first negative experience can result in the development of vaginismus and sexual frigidity.

For some women, motherhood begins with postpartum depression, which can sometimes be long-lasting and severe.

Climacteric syndrome, which develops on average after 45 years, is also a risk factor – against its background, anxiety, sexual, somatoform and other mental disorders can develop.

In old age, the risk of dementia, drug-induced delirium, and depression increases due to the death of a spouse.

Schizophrenia in women is less common than other mental disorders, but is more severe and can lead to personality degradation. It manifests itself after stress, substance abuse, and in the postpartum period. Schizophrenia is rare in childhood and adolescent girls, but this option cannot be ruled out. In adult women, schizotypal personality disorder is more common, previously interpreted as low-progressive schizophrenia. Currently, these conditions are distinguished precisely because, despite the similarity of symptoms, personality disorder does not lead to such destructive consequences as true schizophrenia. The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, 2013) recognizes schizophrenia as only its most severe forms with a duration of schizophrenia-like symptoms of more than six months. Less than this period is a schizophreniform disorder, including less than a month is a short-term psychotic disorder. Similar changes are expected in the next, eleventh, edition of the ICD.

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Cause

Schizophrenia and schizophrenia spectrum disorders are far from the most common mental disorders among the fair half of humanity. Women are much more susceptible to affective spectrum disorders, eating disorders, phobias and panic states. Post-traumatic stress disorders develop in women much more often than in men, depression can even be associated with a change of season.

The origin of schizophrenia is not exactly known, even the term itself is debated as an independent disease, since positive and negative schizophrenia-like symptoms accompany psychoses of various genesis. The Japanese Society of Psychiatrists at the beginning of this century already abandoned the diagnosis of "schizophrenia", however, at the moment such authoritative organizations as the American Psychiatric Association and the World Health Organization have not yet come to the conclusion about the need for such changes.

Currently, scientists' conclusions about the causes of schizophrenia are at the hypothetical stage and are based on clinical observations of patients with this diagnosis.

Modern neuroimaging methods have made it possible to study the characteristics of the brain of schizophrenic patients during their lifetime and have somewhat lifted the curtain of mystery of the disease. Nevertheless, the structural features that occur in patients with schizophrenia lack specificity and most findings so far are a statement of the fact that changes in the total volume of the brain, as well as damage to individual structures (left temporal lobes, thalamus, prefrontal, occipital cortex and other areas) occur in schizophrenics. But the exact pathogenesis of the disease has not yet been proven.

The prerequisites for schizophrenia in women, as well as in representatives of the opposite sex, are due to the presence of a hereditary predisposition, but the manifestation of the disease occurs under the influence of external causes.

The role of genetic factors is very high, it is confirmed by studies of twin pairs, as well as other relatives of patients, in whom the same structural changes are detected on tomograms of the brain as in patients with schizophrenia, however, expressed to a lesser degree. The nature of inheritance is quite complex, it is assumed that several mutated genes interact, as a result of which the risk of developing the disease increases to a critical point. It is assumed that a failure occurs simultaneously in several metabolic processes occurring in the brain and causing mental changes that fit into the diagnosis of schizophrenia. At the same time, genetic changes specific to this disease have not been identified, and in some cases, the culprit of development was random gene mutations that were absent in the patient's parents.

Prenatal factors play a major role in the pathogenesis of the disease. Prenatal infections and other undesirable effects during pregnancy introduce pathological correction into the early stage of neuronal development. Neurobiological studies have suggested that the development of the disease is based on degeneration of neurons, especially gray matter, and/or neurochemical imbalance, which began at the stages of intrauterine development.

Some structural anomalies are present already at the onset of the disease and indicate brain damage that occurred during its formation. For example, the detected violation of the relationship of the grooves and convolutions indicates early deviations in development, since the folding of the brain is established soon after birth and practically does not change subsequently.

Exogenous risk factors are superimposed on the innate predisposition. These include both living conditions in early childhood, various infectious diseases, and later stressors – various psychological and social interactions. Even the seasonality of birth was studied, and it turned out that among schizophrenics in the northern hemisphere, the majority were born in the winter and autumn months.

Among social factors, it is noted that schizophrenia is a disease of urban residents, and a higher degree of urbanization increases the likelihood of developing the disease. Other factors - dysfunctional family, poverty, forced migration, loneliness, emotional and physical abuse in childhood and repeated similar episodes in later life increase the likelihood that genetically predisposed people will develop schizophrenia.

Substance abuse itself can trigger schizophrenia-like symptoms, and sick people often use psychedelics to overcome their characteristic dopamine hunger. Therefore, cause-and-effect relationships in such cases are difficult to trace, and if it is known for certain that the patient is an alcoholic or drug addict, then he is not diagnosed with schizophrenia, but this case is interpreted as a withdrawal syndrome or severe intoxication.

The risk period specific to the female sex is pregnancy and the postpartum period. In predisposed women, it is precisely at this time, associated with changes in hormonal and social status, that schizophrenia may manifest.

Psychological risk factors are also multiple. The reactions of female patients with schizophrenia show their hypersensitivity to negative stress stimuli, so various exciting situations are perceived very emotionally and can serve as an impetus for the development of the disease.

Neuronal mechanisms are disrupted by the disease, especially the frontal, temporal parietal lobes, hippocampal areas suffer, the connections between them are disrupted, the parallel orientation of the white matter fibers decreases. This leads to a disruption of executive functions and verbal memory, impulsive behavioral reactions. Other brain structures are also affected, however, mainly people who have been ill for a long time and are receiving antipsychotic therapy are being studied. In some cases, it leads to the normalization of individual structures, for example, the basal ganglia, however, it also causes side effects in the form of circulatory disorders and structural deformations. And it is still difficult to separate the contribution to the resulting disorders provoked by the drugs.

Against the background of new possibilities, many neurotransmitter theories of the origin of schizophrenia have emerged - kynurenic, dopamine, GABAergic and others. In essence, all processes of transmission of nerve impulses are affected, but so far none of the hypotheses can reliably explain the structural changes occurring in schizophrenia and the pathogenesis of the disease development.

Almost all risk factors are considered: smoking and a sedentary lifestyle, alcoholism and drug addiction, drug therapy leading to loss of brain volume, high physical activity in patients with schizophrenia, on the contrary, causing an increase in the volume of the hippocampus. Many changes in the structure are reversible under the influence of drug therapy, however, all this is still being studied and, perhaps, in the near future, schizophrenics will be able to really help overcome their disease.

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Epidemiology

Statistics show that the probability of developing schizophrenia over the entire period of life is 1%, however, studies conducted at the beginning of our century have reduced this figure by almost half (0.55%). Predisposition increases the probability of developing the disease to 10-15% in cases of illness of one of the closest first-line blood relatives (mother, father, siblings), and both parents - up to 40-50%. If more distant relatives are ill (uncles, aunts, grandparents, cousins, etc.), the probability is estimated at about 3%.

The peak incidence in the fair sex is in the age group from 26 to 32 years. In men, this period occurs earlier (20-28 years). At a young age, there are many more sick men, but by the age of 40, women begin to catch up with them and as a result, it turns out that the chances of getting sick do not have gender differences. In middle (late schizophrenia) and old (very late) age, the incidence is low, but its probability cannot be ruled out. Prevalence on a global scale is uneven, it is well established that the urban population gets sick much more often and the lifestyle associated with a high level of urbanization is considered one of the risk factors.

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