Selected risk factors for schizophrenia: Between the diversity of aetiological models and personalised psychiatry

Abstract

Schizophrenia is a very serious and growing medical and social problem. Despite advances in pharmacotherapy and other forms of psychosis therapy, schizophrenia remains a chronic and degrading disorder. Several decades of research on the determinants of schizophrenia brought no insight into its aetiology. Hypotheses confirmed in the studies and verified in clinical practice either fail to account for the causes of schizophrenia or explain only some of its manifestations. The well-known and widely described models of impaired dopaminergic (the dopamine hypothesis) or serotonergic neurotransmission, which provide foundations for the contemporary pharmacotherapy, may serve as an example. However, such an intervention does not interfere with the mechanisms underlying the disease, but only eliminates some of the symptoms, with no effects on cognitive deficits. Studies on risk factors for schizophrenia, its first episode in particular, increasingly emphasise the importance of interactions between immunological dysregulation, oxidant-antioxidant imbalance, disturbances of the intestinal barrier and epigenetic phenomena. This fact points to the need to modify the classical metaconcept of the development of schizophrenia by adding the aspect of interaction between a range of diverse biological and psychosocial phenomena. There are many individual observations in the subject literature, however, studies exploring the relationships between immunological and inflammatory phenomena, gene expression and the dynamics of changes in the clinical condition in the course of treatment are lacking. The presented etiopathogenetic mechanisms of the disease are a potential goal of future research strategies, which may additionally reinforce both the more personalised approach and the potential of combined therapies.