Biochem460

1. CASE STUDY:
SCHIZOPHRENIA
By: Kelly Tran

2. CONSIDER THE FOLLOWING INDIVIDUAL
Jeremy, a 21-year-old male, works part-time delivering pizza. Upon arriving at a
customer’s house, he has extreme difficulty deciding whether to ring the doorbell or
knock on the door. After a couple minutes, he rings the doorbell. A woman opens the
door, pulls out her wallet, and asks Jeremy the cost of the order. He doesn’t hear her
because he is focused on a eerie silhouette in a brightly lit corner of her house. A voice
repeatedly tells him to grab her wallet and run. The woman hands him a $50 bill and
tells him to keep the change. Jeremy is able to focus on his job again and quickly
departs. This is the fourth time Jeremy has experienced this since beginning his job
three months ago.

3. YOUR TURN
What is your initial diagnosis for
Jeremy?
Which tests would you perform
to confirm your diagnosis?

4. DIAGNOSIS
• A physical exam was performed and ruled out conditions harboring similar
symptoms, such as seizure disorders, metabolic disorders, thyroid dysfunction, and
brain tumors.
• Various tests and screenings were done to pinpoint causes that may have been
induced by drug and alcohol use. Results were negative.
• Diagnosis of schizophrenia was made by a psychiatrist. Jeremy’s mental status was
checked through questions about his thoughts, moods, delusions, hallucinations, and
violent/suicidal urges.

5. QUICK OVERVIEW

6. MECHANISM
• Although an exact mechanism is not known, there are multiple hypotheses that
attempt to explain the causes behind schizophrenia.

7. DOPAMINE HYPOTHESIS
• Argues that a patient’s unorthodox behavior is
caused by an excess amount of dopamine receptors
at the post-synaptic membrane of their neurons.
• Evidence comes from studies of numerous
schizophrenic patients compared to healthy
patients
• Schizophrenics are more sensitive to dopamine
uptake, have different volumes of grey matter in
their brains (which are linked to dopamine
sensitivity), and experience less symptoms when
dopamine receptors are blocked

8. PRUNING HYPOTHESIS
• Based on the observation that schizophrenia tends to run in families
• A group at Harvard Medical School examined the C4 gene, which codes for
complement component 4, because it has the strongest ties to schizophrenia. (C4 is
part of the immune system pathway that eliminates pathogens and cell debris.)
• Found that C4 was expressed at much higher levels in schizophrenic patients, especially
at synapses
• Concluded that C4 is likely involved with promotion of synaptic pruning
• Recurrent synaptic pruning can largely impair mental function, which may explain
schizophrenic behavior

9. TREATMENT
• Schizophrenia requires a lifetime of treatment, even when symptoms lessen
• Usually administered and guided by a psychiatrist, possibly along with a
psychologist, social worker, or case manager
• Antipsychotic medications that regulate dopamine are usually prescribed
• Antidepressants and anti-anxiety medication may also be prescribed
• Various therapy sessions may also be conducted to help focus on learning how to
cope with stress, identifying signs of relapse, and improving communication among
friends and family

10. REFERENCES
• A biological mechanism for schizophrenia. (2016, February 2). Retrieved December
19, 2016, from https://www.nih.gov/news-events/nih-research-matters/biological-
mechanism-schizophrenia
• Schizophrenia. (2016, October 11). Retrieved December 19, 2016, from
http://www.mayoclinic.org/diseases-conditions/schizophrenia/home/ovc-20253194
• Schizophrenia explanations. (2016). Retrieved December 19, 2016, from
http://flipped.gardenpsychology.co.uk/a2-psychology/a2-class-
resources/clinical/clinical-content/schizophrenia-explanations/