Schizophrenia Update - December 1, 2003


Letters to the Editor

Doctors without Borders Needs Public Education Resources on Schizophrenia and Mental Illnesses (in general)


I'm working for Medecin Sans Frontiers, a Belgian NGO, in a mental
health project in Armenia where I'm responsible for the information,
education and communication of the project.

My main task is to "change the mentality" of the public towards mental health. Most family members of people with mental retardation or a mental illness are ashamed and hide their ill family members from the outside world. Some mentally ill people didn't see daylight for several years, some of them are living for more than ten years in stables before we see them.

Do you have any idea about other projects in 'developing countries' or former USSR-states, who have tried to work on the mentality of the general public towards mental illness?

Do you know about other organisations who could help me to get an idea about what I can do to 'promote' understanding of mental illness towards people who are not really interested in mental health? I'm looking forward to your answer.

Luk Van Baelen
Email: lukvanbaelen (at)

Medecin Sans Frantiers

Luk - I'm sorry I can't help you directly - but I'm sure my subscribers have experience with this. I encourage any of our readers who have information that might be of value to you to email you directly and get you the information. It sounds like a very valuable project!

Writer Seeks Personal Stories of Children of Parents with Schizophrenia
Virginia Holman, author of Rescuing Patty Hearst:: Memories From a Decade Gone Mad, who was honored with a Literary Award at NAMI's 2003 national convention, is seeking candidates to interview who are the children of parents with schizophrenia, Individuals selected will be profiled in an article about the experiences of children growing up with
a parent with schizophrenia. Candidates need to meet three requirements:

1. The parent must have a formal diagnosis of schizophrenia. Documentation is required.
2. As a child or adolescent, the interviewee must have resided with the parent at least five years following diagnosis. Documentation also may be required.
3. Candidates must not have told their story previously either through public-speaking or any other media venue.

Interested candidates should contact Holman directly at:

holmanedits (at)

NAMI Sees Cure for Schizophrenia as Possible in 10 Years
October 23, 2003

The NAMI Policy Research Institute (NPRI) today announced creation of a Task Force on Serious Mental Illness Research, co-chaired by Edward Scolnick, MD, president emeritus of Merck Research Laboratories and NAMI medical director Ken Duckworth, MD, former mental health commissioner for Massachusetts.

The Executive Committee of NAMI's Scientific Council, chaired by Jack Gorman, MD, Chair of the Department of Psychiatry at Mount Sinai School of Medicine, will help coordinate the effort.

"NAMI takes seriously the statement of Dr. Thomas Insel, director of the National Institute for Mental Health (NIMH), that with the right investments, scientists are within reach of finding a cure for schizophrenia in the next ten years," said NAMI national executive director Richard C. Birkel, PhD. "The critical challenge is to set the right priorities for research investments and to insist that the clinical research enterprise translates readily into real world practice. In the long run these investments will mean both lives and money saved."

"Recent advances in biomedicine, including the decoding of the human genome, make possible a revolution in the treatment of psychiatric illnesses, a revolution that is already underway for other serious diseases," Scolnick said. "The fact that we have the knowledge and tools to develop newer, better-targeted medication for illnesses like schizophrenia and bipolar disorder, with fewer side effects, demands that we make the appropriate research investments. The mission of the task force is to help provide a roadmap for that revolution."

"We also must invest in research that will make the effective interventions already achieved, along with those still to come, available to every individual with a serious mental illness as quickly as possible," said Duckworth.

NIMH, the main federal agency responsible for funding research on serious mental illnesses -- with a budget of more than $1.3 billion in fiscal year 2003 -- will be the focus of the task force's work.

"Given the unprecedented research opportunities that exist today, it is essential that NIMH use all of its resources wisely to expedite treatment advances in serious mental illness," said Gorman.

Source: National Alliance for the Mentally Ill

Study Finds Hundreds of Thousands of Inmates Mentally Ill

October 22, 2003, New York Times

As many as one in five (20%) of the 2.1 million Americans in jail and prison are seriously mentally ill, far outnumbering the number of mentally ill who are in mental hospitals, according to a comprehensive study released Tuesday.

The study, by Human Rights Watch, concludes that jails and prisons have become the nation's default mental health system, as more state hospitals have closed and as the country's prison system has quadrupled over the past 30 years. There are now fewer than 80,000 people in mental hospitals, and the number is continuing to fall.


FULL REPORT: Ill-Equipped: U.S. Prisons and Offenders with Mental Illness
HRW Report, November 5, 2003

Mentally Ill Offender Treatment and Crime Reduction Act (Note: Large PDF File - slow to download - see information below)
As introduced in U.S. Senate, June 5, 2003

----------------------- End ----------------------

Note: There is an initiative before the US senate right now to help address the problem of the mentally ill being excessively jailed rather than treated. See story below:

June 6, 2003
NAMI Applauds Visionary Bill to Reduce Criminalization of Mental Illness

Your Advocacy is Needed to Achieve Passage!

As public resources for treatment and services for individuals with
mental illnesses shrink, the use of adult jails and prisons and juvenile
justice facilities as de-facto "psychiatric treatment programs" grows.
On June 5, 2003, identical bills were introduced in the U.S. Senate and
House of Representatives to reverse this disturbing and shameful trend.

The "Mentally Ill Offender Treatment and Crime Reduction Act of 2003"
would authorize new federal funds for jail diversion programs for adults
with serious mental illnesses and juveniles with serious emotional
disturbances, treatment programs for individuals who are incarcerated, and
services to aid people transitioning back into the community.

The Senate bill (S. 1194) was introduced by Senator Mike DeWine
(R-Ohio) and co-sponsored by Senators Patrick Leahy (D-Vermont), Charles
Grassley (R-Iowa), Maria Cantwell (D-Washington) and Pete Domenici (R-New
Mexico). The House bill (HR 2387) was introduced by Representative Ted
Strickland (D-Ohio). The collaboration between Senator DeWine and
Representative Strickland is the continuation of a partnership that first
occurred when the two worked together to pass federal legislation
authorizing Mental Health Courts in 2000.

The "Mentally Ill Offender Treatment and Crime Reduction Act of 2003"
would authorize $100 million to establish a grant program at the U.S.
Department of Justice that can be used by states and communities to:

* Create jail diversion programs;

* Provide treatment to adults with serious mental illness and juveniles
with serious emotional disturbance who are incarcerated;

* Fund cross-training of criminal justice, law enforcement, court and
mental health personnel; and

* Provide mental health services to individuals with serious mental
illnesses upon reentry into the community.

In recognition that programs authorized by this bill will require
extensive cooperation among agencies, providers and stakeholders, S. 1194
and HR 2387 requires successful applicants for grants to demonstrate the
involvement of multiple stakeholders, including mental health, criminal
or juvenile justice agencies, consumers, family members, and others in
all planning and implementation activities.

At a press conference announcing introduction of this bill, Tom Lane,
Director of NAMI's Office of Consumer Affairs, spoke about how the
services available through this legislation could have helped him. "Five
years ago, I was in crisis, suicidal, and in desperate need of access to
mental health services," Lane explained. "I got a law enforcement
response, not a mental health response. What I needed was help from the
mental health system, not entanglement with the criminal justice system.
There simply were no alternatives available at that time. This bill will
create alternatives."

Additional sponsors are needed for both the Senate and House bills - as
many as possible. Therefore, please contact your U.S. Senators and your
Congressman or Congresswoman and urge them to co-sponsor S. 1194 or HR
2387. If you are a constituent of Senators DeWine, Leahy, Grassley,
Cantwell, or Domenici, please contact them and thank them for their
leadership. Please urge your friends to make these calls as well. All
Senators and House members can be reached by calling the Capitol Switchboard
toll free at 1-800-839-5276 or at 202-224-3121 or contact them online
now at at:

Talking Points:
When urging your Senator(s) and Representative to support S 1194/HR
2387, you may consider making the following points.

* More than 16% of adults incarcerated in U.S. jails and prisons have a
mental illness, and approximately 20 % of youth in juvenile justice
systems have serious mental illnesses. A significant number of these
individuals have co-occurring mental illnesses and substance abuse
disorders. Most of these individuals are not hardened or violent criminals but
rather have committed minor offenses that are a direct consequence of
lack of treatment and services.

* The provision of treatment, rehabilitation, and support services have
proven effectiveness in preventing additional criminal justice
involvement and reducing recidivism among low-level offenders with mental
illnesses or co-occurring mental illnesses and substance abuse disorders.

* Targeting resources for jail diversion, mental health/substance
treatment, and community reentry services ultimately frees up law
enforcement and criminal justice personnel to focus on preventing and fighting
crime rather than responding to adults or juveniles with mental illnesses
in crisis.

* Collaborations among mental health, substance abuse, law enforcement,
criminal justice, consumers, and family members are already in place in
many communities and have shown to be the most effective way to respond
to the needs of adults with serious mental illnesses and juveniles with
serious emotional disturbances in adult and juvenile corrections
facilities, while reducing criminal behaviors among these individuals.

Questions about S. 1194 or HR 2387 should be directed to Ron Honberg,
RonH (at), or Andrew Sperling, Andrew (at)

Study Shows Lilly's Zyprexa Works Only as Well as "Typical" Drug Costing Pennies per Dose

A study comparing a pennies-a-day schizophrenia drug with a far more expensive and widely prescribed Eli Lilly & Co. drug found no difference between the two in reducing schizophrenia symptoms and improving quality of life.

The results of the Lilly-sponsored study, published in this week's Journal of the American Medical Association, run counter to those of some earlier studies. In those earlier studies it was found that Lilly's Zyprexa -- the more expensive drug -- improved symptoms and quality of life and lowered health-care costs when compared with Haldol, largely by cutting down on hospitalization of schizophrenic patients.

Indeed, before they began enrolling patients, the authors of the JAMA study, a randomized trial that followed 309 military veterans for a year, believed the results would mirror the prior studies' findings and initially were surprised by their results. Upon further review, the principal author, Robert Rosenheck, said he found some problems in the design of some of the major prior studies.

"We need to rethink what we're getting for what we're paying," said Dr. Rosenheck, director of the U.S. Department of Veterans Affairs Northeast Program Evaluation Center in West Haven, Conn., and a professor of psychiatry and public health at Yale Medical School. "The profound issue in health care is do we pay anything -- regardless of the price -- for a statistically significant benefit?"

The participants in this study, which was conducted by doctors at 17 VA hospitals, don't mirror the general population: Nearly all were men -- with an average age of 46 -- who had been suffering from schizophrenia for about two decades. Still, in an era marked by sharply rising health-care costs, the study is likely to raise questions about what many doctors have seen as a costly but worthwhile first-line treatment for a debilitating disease. According to the study, about two million people in the U.S. suffer from schizophrenia, a psychotic disorder marked by delusions and hallucinations.

Zyprexa didn't reduce hospital stays, according to the study. Zyprexa was associated with substantially greater costs, ranging from $3,000 to $9,000 a patient annually. Zyprexa typically costs the Department of Veterans Affairs $8 a day per patient, while Haldol costs six cents a day, the agency said.

Alan Breier, Lilly's chief medical officer, said he didn't believe the study would prompt doctors to revert to prescribing Haldol or other older drugs before Zyprexa. Instead, he said, doctors need to look at the "totality of the literature" on Zyprexa. The drug had world-wide sales of $4.1 billion during the year ended Sept. 30 and makes up more than one-third of the Indianapolis drug maker's revenue. "I think it's important not to draw black-and-white conclusions from one study," Dr. Breier said.

Patients were randomly assigned to Zyprexa or Haldol and neither the doctor nor the patient knew which drug was being used. Patients taking Haldol also were given another drug to prevent tremors and other Parkinson's-like side effects of Haldol; that drug also costs pennies a day. (Zyprexa patients were given an inert companion pill to mimic the side-effect medication taken with Haldol.)

Patients taking Zyprexa were less likely to suffer from mild akathisia, a feeling of inner restless, and more likely to perform slightly better on tests that measure memory and fine movements. When adjustments were made to account for those who switched medications, the patients in the Zyprexa group also had fewer symptoms of tardive dyskinesia, a neurological problem that causes repetitive, involuntary movements, such as smacking lips, grimacing and rapidly moving arms and legs. But none of those benefits, when assessed by patients and trained raters, led to a greater quality of life for patients using widely accepted measures, the researchers concluded.

Still for some doctors, those benefits are enough to merit prescribing Zyprexa as a first-line treatment. "Even mild akathisia can be tormenting," said Stephen R. Marder, a professor at UCLA Neuropsychiatric Institute.

Zyprexa patients in the study also were more likely to report substantial weight gain than those on Haldol and the side-effect drug. That is a concern because the Food and Drug Administration recently required Lilly and other makers of drugs in that class to carry warning labels on the drugs about a possible risk of diabetes.

In the study, patients unhappy with their treatment could switch to another medication. The data were analyzed to make sure that medication switches didn't bias the results.

The study set out to recruit about 600 participants and ended up with about half that, although it had enough patients to draw statistically valid conclusions. Nonetheless, Dr. Breier, of Lilly, said the results could have been skewed by 28 patients for whom treatment costs exceeded $50,000. Of those "outliers," 17 were in the Zyprexa group, a Lilly spokeswoman said.

Dr. Rosenheck says Lilly suggested excluding those higher-cost patients from the analysis, which he refused to do. He crunched the data using four different methods to address the skewed distribution, each time coming up with the same results. "They began to suggest things that I did not feel comfortable publishing under my name," he said. "When we do research, we generally don't throw out data." A Lilly spokeswoman declined to comment.

Dr. Rosenheck knows of no prior studies comparing Zyprexa and Haldol that used a companion drug to prevent Haldol's side effects. Instead, he found some studies used a companion drug once the symptoms emerged. That is a problem, he said, because telltale symptoms let patients and doctors know that Haldol was used, prompting some patients to drop out. In addition, he said, some side effects may be mistaken for symptoms of schizophrenia. All of those factors could bias the results, he said.

In the yearlong study, Rosenheck and his coauthors enlisted 309 patients with schizophrenia at 17 Veterans Affairs medical centers. Half were given olanzapine and the other half were given haloperidol and a drug called benztropine to control side effects. Neither doctors nor patients knew which drugs were administered.

The scientists found that haloperidol patients had mildly diminished scores on cognitive tasks and a slightly increased rate of tardive dyskinesia, along with the slightly increased rates of akathisia. Patients on olanzapine experienced more weight gain.

The scientists detected no statistically significant difference between the two groups in overall quality of life or symptoms of schizophrenia.

Dr. John M. Kane, executive director of the Zucker Hillside Hospital in New York City, cautioned that the population of patients in the study was not completely representative: They were older and had been ill for about 20 years.

A longer, National Institutes of Health-funded study comparing an older, haloperidol-like drug to four of the newer medications in 1,500 people is currently underway.

Sources: Information compiled from the following news sources, and related stories:
Older, cheaper schizophrenia drug as effective as newer one: ..., Canada - Nov 26, 2003

Study Questions New Schizophrenia Drug

Newsday - Nov 25, 2003

Benefits of Newer Schizophrenia Drug in Doubt

MSNBC - Nov 25, 2003

Weighing the Costs of Schizophrenia Drugs - HealthCentral

Wall Street Journal

Smell test 'spots schizophrenia'
Source: BBC News

Simple smell tests could help doctors identify people at risk of developing schizophrenia, a study suggests.

It has long been known that people with schizophrenia or psychosis are unable to correctly identify smells.

But until now scientists were unsure whether this occurred before or after symptoms developed.

This latest study, published in the American Journal of Psychiatry, suggests it happens before the first symptoms appear.

Story from BBC NEWS:

For more information see:

Could You Suffer From Psychosis? The Nose Knows (Science Daily)

Schizophrenia: early detection study

Study: Schizophrenia Risk of Children, Increases with Father's Age
October 30, 2003

Children fathered by older men have an increased risk of schizophrenia in later life, possibly because of mutations in their father's DNA, according to a new study from Sweden published Friday.

A link between paternal age and schizophrenia has been reported before but scientists were not sure whether this was due to increasing mutations with advancing age or the result of inherited personality traits.

To find out, researchers at the University of Wales College of Medicine in Cardiff and Gothenburg University in Sweden examined the medical records of 50,087 Swedish army conscripts recruited between 1969 and 1970.

The study found that the odds of developing schizophrenia increased by 30 percent for each 10-year increase in paternal age.

"This supports the hypothesis that accumulating germ cell mutations may lead to an increase in genetic liability to schizophrenia in the offspring," Dr Stanley Zammit, from the University of Wales, said.

Source: British Journal of Psychiatry

Scientists identify more genes linked to schizophrenia

Scientists have identified three genes that could play a role in causing schizophrenia, a German researcher said.

"After 10 years without any real success, we have now determined three candidate genes," Germany's Saarland University Professor Peter Falkai said.

Professor Falkai said the genes Dysbindin, Neuregulin and G72 had been identified but that anywhere from 50 to 100 genes could be involved in causing schizophrenia.

Speaking at a conference of the German Research Network on Schizophrenia, a government healthcare research program, Professor Falkai said the findings were made by several working groups, with German scientists playing a significant role.

He said about half the cases of schizophrenia, which usually manifests itself during late adolescence or early adulthood, were probably caused by the genes with the other half due to environmental triggers.

Those could include complications at birth or during pregnancy, viral illnesses, hashish consumption and high stress levels in cities.

University of Bonn professor Wolfgang Maier described the progress made on the disease, which hits about one in 50 people, as a "crucial breakthrough".

While findings suggested that medicine currently used to treat schizophrenia was relatively effective, the gene findings could lead to new treatments.

"Instead of symptomatic therapy, we now have the chance to develop a selective causal therapy," Professor Falkai said.

Source of Excerpt:




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