Distinguishing between the reality and imaginary is something most healthy humans can do without much of an issue. However, schizophrenia is a harmful mental disorder where an individual often has trouble with this distinction. As an example, one schizophrenic was asked to draw a self portrait, and this is what he drew:
Unless this individual was a purple man hooked up to a machine with math equations written on his body, it’s apparent that this individual has a warped perception of reality. Schizophrenia is a harmful, chronic, socially detrimental disease. Often, individuals experience hallucinations, can hear imaginary voices inside their head, or believe in illogical delusions. Schizophrenics often lose touch with reality; examples of symptoms include believing they are someone else, attempting to smell or touch something that isn’t there, or difficulty in communicating what they are thinking. While only 1% of Americans have this illness, the risk of having it jumps much higher if there is a family history of schizophrenia. However, more de novo mutations are being discovered where a genetic change occurs without any family history of schizophrenia. Understanding the origins of the disease can lead to future developments in medicine and treatment to help those with the disease.
Pink Floyd rock n’ roll drummer Syd Barrett was famously thought to have the illness
No one gene mutation by itself can cause schizophrenia. People with the disease generally have copy-number variations (CNVs), where the DNA has an abnormal number of copies. This means thousands of base pairs of DNA can be deleted, duplicated, or somehow altered. Clearly, this leads to detrimental results where a human can have drastically altered neural functions. In fact, schizophrenics likely have other mental illnesses, issues with brain development, or malfunctions in production of chemicals in the brain. De novo mutations especially link schizophrenia with autism and other intellectual disabilities.
Notable CNVs, including deletion and duplication of alleles in a strand of DNA
The authors Fromer et. al of the paper De Novo Mutations in Schizophrenia Implicate Synaptic Networks, used a large DNA sequencing study of de novo mutations in schizophrenics to determine if these mutations caused changes in biological processes, what genes they changed, and how it affected development of other neurological illnesses. They found several synaptic protein-protein interactions in both the pre- and post-synaptic (although the study focused on the post-synaptic proteins) affected by numerous de novo schizophrenic mutations.
Image a on the left shows the localization of post-synaptic proteins affected by several de novo mutations. Notably, the NMDA, AMPA and kainite receptors receptors are affected (shown with a upside down purple triangle or an orange circle), which are necessary for healthy nervous system function and are involved in breathing, learning, and memory. They bind to glutamine and allow positively charged ions such as calcium to pass through the cell membrane. These receptors are excitatory, meaning when glutamines bind they will activate subsequent signaling cascades by producing second messengers. In this example, the protein DLG2 is a member of this receptor family, and the de novo mutation associated it is a loss of function mutation. Many signals associated with proper learning and memory will thus be disrupted in an individual with this de novo mutation.
Alternatively, another notable de novo mutation affects the actin dynamic and stability signaling cascade. These proteins play an important role in muscle contraction, cell motility and cell shape and polarity. In schizophrenics, actin filament mutations affect proteins that can change the shape and polarity of synaptic receptors and can pass on the signaling cascade of the aforementioned NMDA receptors. These mutations further affect cognitive ability and neurological stability, leading to several mental illnesses and intellectual disabilities, most notably autism.
Image b shows how the overlap in genes and proteins due to de novo mutations can lead to further mental illnesses that coexist with schizophrenia. The study focused on how these CNVs changing large sections of DNA can also lead to autism, ADHD, and other intellectual disabilities. Autism is a spectrum disorder involved with difficulty in social interaction while individuals with ADHD generally have difficulties focusing and paying attention. These are common symptoms seen in schizophrenics, so it’s possible these illnesses are linked somehow. To see how, we should examine them on the molecular level and the de novo mutations common in each disease.
Studies have shown that these NMDA receptors also exhibit loss of function mutations in autism and ADHD. In addition, genes such as SCN2A and POGZ also exhibited de novo loss of function mutations in studies concerning all three diseases. SCN2A is a gene involved in proper action potential propagation in voltage gated sodium channels, while POGZ is necessary for mitosis and regulating neuron proliferation. The overlaps in de novo mutations suggest that schizophrenia, ADHD, and autism not only often occur simultaneously, but also share similar disease mechanisms.
What does this mean for the future of the disease? While future treatments cannot be formed from these studies alone, they do provide a basis for thinking about mental illnesses as a complex system in the body that cannot be thought of in a vacuum. The similarities between the three illnesses in genetic mutations suggest basing treatments around how these diseases interconnect with one another, not each one as a separate entity.
1.) Fromer M., Pocklington A.J., Kavanagh D.H., Williams J.H., Dwyer S., Gromley P., Georgieva L., Rees E., Palta P., Ruderfer D.M., Carrera N., Humphreys I., Johnson J.S., Roussos P., Barker D.D., Banks E., Milanova V., Grant S.G., Hannon E., Rose S. S., Cahmbert K., Mahajan M., Scholnick E.M., Moran J.L., Kirov G., De novo mutations in schizophrenia implicate synaptic networks. 2014. Nature. 506: 179-184
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3.) Blanke, Marie L., VanDongen A. M. J. "Activation Mechanisms of the NMDA Receptor." NCBI: Biology of the NMDA Receptor. U.S. National Library of Medicine, 2009. Web. 12 Mar. 2015.
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