[Schizophrenia as a brain disorder and its development].
Schizophrenia is a psychiatric disease associated with functional und structural brain abnormalities. Beside global deficits, like a reduction of the whole brain volume and an enlargement of the ventricular system, there are circumscribed changes especially in the gray matter of the frontal lobe. Regarding possible causes for these changes some are related to the vulnerability of the disease, some to the manifestation of the disorder and some are very likely related to the course of the illness and the associated treatment options. It is hypothesised that the neurobiological changes of schizophrenia are different in each stage of the illness ranging from the prodromal state, over the first manifestation of the illness up to the relapsing course. It is assumed, that the hypofunction of the gabaergic system is essential to the vulnerability of the disorder, while a destabilisation of the glutamatergic system especially of the NMDA-receptor-system forms the next step to first break schizophrenia. When the illness develops into a relapsing course these mechanisms are destabilised, which inhibits the recovery from functional und structural changes. The outlined pathophysiological hypotheses are used to discuss possible causal pharmacological treatment options.
Falkai
P
P
Abteilung für Psychiatrie und Psychotherapie, Georg-August-Universität Göttingen, Germany. pfalkai@gwdg.de
Wobrock
T
T
Schneider-Axmann
T
T
Gruber
O
O
D001921:Brain / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D012559:Schizophrenia / Q000473:pathology* / Q000503:physiopathology