JAN OLAV JOHANNESSEN
University of Stavanger/Stavanger University Hospital, Division of Psychiatry, Stavanger, Norway
The word “schizophrenia” still signals, to some, that we are dealing with a brain disease, a disease that should be challenged and treated by biological measures. There is however a change in the way we perceive these disorders that we name by the term “psychosis; there is now a shift towards a more reflective, integrative psychosocial and psychobiological perspective, with important new findings on the neurobiological basis in psychosis.
There seems to be a kind of dysregulation of the dopamine signal system in the brain during a psychotic episode. Most antipsychotic medication targets this dysregulation. In biological psychiatric circles one have thought that this is a kind of inborn “error” in some people, I e that psychosis has a biological genetic “cause”.
This dysregulation in the dopamine/glutamate system is somehow connected to the HPS-axis (stresshormon axis), the disturbances in the brains signal substances can be (are?) a result of external stress. And if this dysregulation in the brain’s signal system persists over time, it will be “attacked” by the body’s own defense system, an autoimmune reaction. These changes seems to be reversible in “at risk mental states, ARMS”, and in first episode psychosis (FEP), but at some point seem to become more irreversible.
The new research presented above underlines the importance of psychosocial interventions, stress reduction strategies and psychotherapies aiming at finding the meaning behind the psychotic expressions in each individual case. As demonstrated by research on trauma and adverse life events, psychosis is connected to serious things happening in young persons’ lives, in their past and present.
This research also contributes to the understanding of serious mental disorders as dimensions, not cathegories.