Etiopathogenesis of schizophrenia - the state of the art for 2021

In 2021, one-hundred and ten years passed since a Swiss psychiatrist, Eugen Bleuler, introduced a term ‛schizophrenia',denoting one of the most severe and stigmatizing psychiatric illnesses. Presently, it is known that the etiopathogenesis of schizophrenia is multifactorial, and a neurodevelopmental theory has been the most important pathogenic concept for more than 30 years. The theory postulates an interaction between genetic predisposition and environmental factors. In recent years, mainly thanks to employing the genome-wide association studies (GWASs), many molecular-genetic processes increasing a predisposition to schizophrenia have been identified. In the article, the role of pregnancy and perinatal period for risk of developing schizophrenia was considered. In patients with schizophrenia, as early as in childhood and adolescence, the disturbances of brain development occur, reflected, among others, by an impairment of cognitive functions. Childhood trauma makes a risk factor for developing schizophrenia and a less favorable course of the illness. The arising of the first psychotic episode is boosted by socio-environmental factors (e.g., migration, urbanicity) and psychoactive substance use, both increasing dopaminergic activity of the brain. In the paper, contemporary knowledge on the pathogenesis of psychotic and deficit symptoms and disturbances of cognitive functions was presented. This was done concerning the neurotransmitters' changes and genetic and neuroimaging studies, with emerging therapeutic implications. At the end of the article, acurrent position of schizophrenia in the context of dichotomic division of mental disturbances put forward by Emil Kraepelin in 1899 was discussed.