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Schizophrenia Update

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Series 2, Issue 9 - February 4, 2004

 

A Summary of Schizophrenia-related News and Events

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TABLE OF CONTENTS

Schizophrenia.com - Site Update

This is the first newsletter this year and I'd like to start it with a note of thanks to all of you that have supported the Schizophrenia.com web site in the past year; as donors and volunteers. I had wanted to send each of the donors a thank you note personally for your assistance this past year, unfortunately because we are a project under a larger nonprofit organization it was going to be very difficult for me to get the names.

So, I want to thank you today for your assistance during what I know has been a difficult year for many people economically. With donations and a little advertising revenue we managed to keep the web site up yet another year (just barely).

I think we're on our 8th year now! Late last year we managed to scrape together enough money for a new server for the discussion areas - so if you visit them now, you'll notice that its now very fast to post new messages as well as to search for old ones. We encourage you to join in the discussion areas (on-line support areas and chat) if you haven't been lately. We now have over 22,000 registered users of the on-line support areas.

During this past year we've been very busy upgrading the schizophrenia.com web site (please check out the new design and all the new information we've added - at www.schizophrenia.com).

Web Logs - Assistance Needed. This year one of my top priorities is to expand the Schizophrenia Web Logs (or Blogs for short) at the site, to allow you - the visitors to the site - a much more active hand in the development of the site. We've already got two great web logs up and running - including one by the noted writer (Pamela Wagner) and an India resident by the name of Puzli. Both Pam and Puzli suffer from schizophrenia. I encourage you to check out the writings of these two - and I hope you'll consider starting your own Blog to help educate the world about schizophrenia with your own insights and experiences. We'd love to get some assistance from Universities (students and professors working in the area of schizophrenia), as well as from professionals. For information on starting your own blog - please go to: http://www.schizophrenia.com/blogintro.htm

Internet Videos - Another high priority is to offer a lot more Internet-based videos related to schizophrenia, right on the schizophrenia.com web site. We are very actively seeking donations of high quality public-domain educational videos on schizophrenia that we will then convert to Internet format so that anyone can access them at our web site any time of the day , from anywhere in the world. We'd also like to get video and audio recordings of good conferences and the presentations associated with them (ie. the powerpoint files) so that we could convert these also to Internet-based formats. Examples of the types of video and audio files that we'd like to get include NIMH symposiums, University Presentations, NAMI or other schizophrenia organization annual meeting presentations, and similar such events. Please send us an email at news@schizophrenia.com if you can suggest anyone we might talk to about source materials such as this.

Related to the desire to add more videos to our web site - we've also begun linking to more Internet-based videos on other web sites. The recently updated "Advanced Information" part of the web site now has many new videos on the latest schizophrenia research symposiums. See : http://www.schizophrenia.com/research/

We at schizophrenia .com wish you the best for 2004, and look forward to conveying to you the latest progress in the battle against schizophrenia.

Sincerely,

Brian and the site volunteers and assistants.

Letters to the Editor

"Orthomolecular Psychiatry"/Vitamin Therapies for Schizophrenia?

Do you have more information on Orthomolecular psychaitry in treating schizophrenia? I am looking for critical information (I can get tons on positive glowing but typically very biased reports on Orthomolecular psychiatric on the net). I also have access to a local medical library and so I can go to the "source" if I need to.

You mentioned the American Psychiatric Association Task Force Report, July 1973 already. Are there other good evaluation materials also?

I am asking this because I keep on running into this "vitamin" therapy stuff (and many variations of it). This is very important for me because I am also a volunteer instructor for a local NAMI Family to Family class (for family who struggle with serious mental illness). What I need is some good material backing me up in terms of the ineffectiveness of Orthomolecular psychiatry, especially with regard to schizophrenia.
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Dear Don,

I have seen information on this "Orthomolecular Psychiatry" and have read about a number of recent and serious law suits in Canada against hucksters on the Internet who have marked vitamin C and others as "cures" to schizophrenia. Everything I've read on the subject has been very negative - and Dr. Irwin of Vancouver, Canada has stated that Orthomolecular Psychiatry is "an approach which Dr. Abram Hoffer and others developed in the 1950s, but which by the 1970s was proven to be fruitless. The work of Dr. Hoffer and others is discussed in detail in the American Psychiatric Association Task Force Report, July 1973, which points out methodological flaws in the early work and reviews later studies which failed to show any benefit for such treatments."

I thought that the issue was so old and dead that it wasn't worth addressing any further - but you are right, families with schizophrenia are frequently desperate and there doesn't seem to be much public literature on this. Also - and please if there are some researchers out there who are familiar with this, please let us know more - but it seems like there are two aspects to vitamins as they relate to schizophrenia. Recent research seems to suggest that EPA and Omega-3 fish oils do provide some (relatively minor, but statistically significant) relief from some schizophprenia symptoms but in my opinion in absolutely no sense do they (or any other vitamins) provide any type of "cure" or even significant relief from schizophrenia - and should not be used as the only treatment for schizophrenia. This is very different than the "cures" that Dr. Hoffer and others have been claiming for decades (as Dr. Irwin suggests above). If any scientists have any further information on this, please let us know.

If anyone out there knows about, or has access to, the report that is mentioned above or any other good reviews or information on the literature related to this subject - please email us at news@schizophrenia.com

Scholarships or grants for offspring of schizophrenics?

Perhaps you can help me, or direct me in the right direction. My mother is a paranoid schizophrenic who refuses treatment. As you probably know, treatment cannot be legally forced on her, but she has been hospitalized several times. She refuses to live with my father (who has custody of me), and so they are separated- but she also is unable to function well enough to have a job of any kind. The hospital bills, psychiatrist bills, and payments associated with fully supporting two separate residences have put great financial stress on my father's modest income.

My question is, do you know of any way I can get any sort of help in furthering my education?
Any sort of scholarship or grant dealing with my issue? Even if you could only direct me in the right direction, your help would be greatly appreciated. Although I have sought help, I am quite lost in the issue and refuse to believe that there is not some way to get aid in my very rare and very serious situation. Thank you very much for your time and concern.

Sincerely, B Parker

RESPONSE: I'm Sorry - I don't have any such information. If any of the readers of this newsletter do - please send it to me at news@schizophrenia.com and we'll forward it to the student.

The following is a fund raising film festival that seems like something that schizophrenia groups around the world could do to raise awareness and money.

Toronto, Ontario, Canada film festival:

The schedule and list of films for the Rendezvous with Madness Film Festival (Nov 14-23) online at:
http://www.rendezvouswithmadness.com

Bird Brains, by E. Fuller Torrey

You might not know this, but the National Institute of Mental Health (NIMH), the federal agency responsible for research on mental illnesses, is the world's leading center for study on how pigeons think. In fact, the agency funded 92 research projects on pigeons from 1972 to 2002.

During the same period, by contrast, NIMH funded only one project on postpartum depression, a devastating mental illness that affects women like Andrea Yates, who killed her five children in Texas in 2001.

NIMH clearly has its priorities wrong. Serious mental illnesses like Yates's account for 58 percent of the total costs of mental illnesses in the U.S. Yet NIMH spends just 5.8% of its resources on real search that could lead to more effective treatment of schizophrenia, bipolar disorder, severe depression, and other serious mental afflictions. Worse still, a new study from the Treatment Advocacy Center (a group I am affiliated with) shows that the percentage of NIMH research resources devoted to serious mental illnesses actually fell over the past five years, even as the institute's budget doubled from $661 million to $1.3 billion. At the same time, federal costs for the care of seriously mentally ill individuals have gone through the roof; they now total $41 billion yearly and are rocketing upward at a rate of $2.6 billion a year. Expenditures on the mentally ill are a big factor in the surging costs of Medicaid and Medicare. Putting aside the fact that men and women with untreated serious mental illnesses make up a third of the homeless population and crowd our jails and prisons-transforming them into our de facto mental institutions-we should, on economic grounds alone, be investing heavily in research on the causes and treatment of these diseases. Breakthroughs could save billions of dollars a year.

But NIMH doesn't see it that way. During the past five years, it has funded research on how Papua New Guineans think but refused to pay for a treatment trial for schizophrenia; bankrolled research on self-esteem in college students but nixed funding for research on bipolar disorder in children; and paid for a study on how electric fish communicate but not for research on why some individuals with schizophrenia refuse to take their medication. If NIMH were an individual, a psychiatric assessment would be in order.

The diagnosis would be terminal grandiosity. According to long-standing NIMH culture, the institute's mission concerns mental health-and that means that all forms of human behavior and social problems are legitimate research topics. From NIMH's perspective, mental illness is only a small, and not very interesting, part of its lofty purpose.

Since we can't call a psychiatrist to examine NIMH, we should at least get Congress to take a closer look. Congressional hearings should assess NIMH's priorities and require that a minimum percentage of the institute's budget-50%, say-fund research on serious mental illnesses. Furthermore, the General Accounting Office, charged with evaluating federal programs, should also critically examine NIMH's work.

Among many dubious recent NIMH research projects are several on the idea of happiness, including "Cultural Differences in Self-Reports of Well-Being." If the money spent on researching happiness had gone instead toward developing better treatments for depression, the NIMH likely would have added a lot more to the sum of human felicity.

Dr. Torrey, president of the Treatment Advocacy Center in Arlington, Va., is author of Surviving Schizophrenia (Quill, 4th ed., 2001). This is adapted from the latest City Journal.

Full report on NIMH Spending on Serious Brain Disorders see:

A Federal Failure in Psychiatric Research, November, 2003 (click on link below)

http://www.psychlaws.org/nimhreport/federalfailure.htm

Editor: If you agree with Dr. Torrey - I recommend you contact both your local congressman and your local NAMI office to let them know your thoughts.

Excerpt from: In Mental Health Research, a Clash Over Funding Priorities

By Shankar Vedantam
Washington Post
Wednesday, December 24, 2003; Page A13

A recent report criticizing the funding priorities of the federal government's National Institute of Mental Health has reignited controversy over the organization's direction and destiny -- with the top official at the institute echoing some of the criticism himself.

The percentage of funds devoted to severe mental illnesses has shrunk even as the institute's budget has doubled, according to the report issued last month by psychiatrist E. Fuller Torrey's Treatment Advocacy Center, the Public Citizen Health Research Group and other mental health experts.

The report has created sharp divisions among the many mental health experts, advocacy groups and professional organizations that have stakes in the agency's mission and direction, and has illustrated the growing gap between scientific and popular visions of mental health research. Ultimately, the issue may be decided not within the NIMH but on Capitol Hill.

"If you are a psychologist out there studying people with schizophrenia and bipolar disorder, it's hard work," Torrey said in an interview. "It's infinitely easier and much more pleasant to study the romantic lives of your college students or how the students decorate their dorm rooms."

Like many of the disorders they treat, the difference between the positions of Torrey and other mental health experts lies in the details: What constitutes a serious mental disorder? What is the best way to measure the impact of a disorder? What basic neuroscience or behavioral research is relevant to a disorder?

Torrey's six disorders, for instance, are a small fraction of the total number described in the American Psychiatric Association's Diagnostic and Statistical Manual, which now runs to nearly 1,000 pages. The psychiatrist, whose sister suffers from severe schizophrenia, said the six serious disorders cost the United States at least $41.2 billion a year, more than half of the direct costs of all mental illnesses. The serious illnesses are relatively rare, but extremely disabling. Someone with persistent major depression, Torrey said, cannot hold a job and "stays in bed for 13 hours a day, and a trip to the store is all they can manage -- and they have to think for a couple of hours before they can do even that."

The serious disorders are also a major cause of deprivation and poverty: Of 400,000 homeless people in the United States, Torrey said about 130,000 have one of the six serious mental disorders. Implicit in the report is a criticism of the psychiatric establishment, which Torrey and his co-authors said is more interested in treating the milder disorders of richer people.

Kraut noted that, like Torrey, he has not hesitated to take his concerns to Congress, saying it is right that disagreements between Torrey and the other groups be resolved through scientific and political debate. "It's not Fuller's NIMH," he said.

Source: http://www.washingtonpost.com/wp-dyn/articles/A26270-2003Dec23.html

Schizophrenia and Sunlight

The chance of developing schizophrenia may be directly linked to how sunny it was in the months before a person's birth, research suggests.

A lack of sunlight can lead to vitamin D deficiency, which scientists believe could alter the development of a child's brain in the womb. according to an article in the New Scientist in 2002, research suggests people who develop schizophrenia in Europe and North America are more likely to be born in the spring.

A psychiatrist at the Queensland Centre of Schizophrenia Research in Brisbane, Australia, made similar findings, suggesting a lack of UV light during pregnancy tips the balance towards schizophrenia in genetically susceptible people.

Note: The following is a short summary of a very good article from Scientific American Magazine that is freely available on the internet. To read the full article (which we highly recommend) please click on the link at the end of the summary.

December 15, 2003

Decoding Schizophrenia

A fuller understanding of signaling in the brain of people with this disorder offers new hope for improved therapy

By Daniel C. Javitt and Joseph T. Coyle

Today the word "schizophrenia" brings to mind such names as John Nash and Andrea Yates. Nash, the subject of the Oscar-winning film A Beautiful Mind, emerged as a mathematical prodigy and eventually won a Nobel Prize for his early work, but he became so profoundly disturbed by the brain disorder in young adulthood that he lost his academic career and floundered for years before recovering. Yates, a mother of five who suffers from both depression and schizophrenia, infamously drowned her young children in a bathtub to "save them from the devil" and is now in prison.

The experiences of Nash and Yates are typical in some ways but atypical in others. Of the roughly 1 percent of the world's population stricken with schizophrenia, most remain largely disabled throughout adulthood. Rather than being geniuses like Nash, many show below- average intelligence even before they become symptomatic and then undergo a further decline in IQ when the illness sets in, typically during young adulthood. Unfortunately, only a minority ever achieve gainful employment. In contrast to Yates, fewer than half marry or raise families. Some 15 percent reside for long periods in state or county mental health facilities, and another 15 percent end up incarcerated for petty crimes and vagrancy. Roughly 60 percent live in poverty, with one in 20 ending up homeless. Because of poor social support, more individuals with schizophrenia become victims than perpetrators of violent crime.

Medications exist but are problematic. The major options today, called antipsychotics, stop all symptoms in only about 20 percent of patients. (Those lucky enough to respond in this way tend to function well as long as they continue treatment; too many, however, abandon their medicines over time, usually because of side effects, a desire to be "normal" or a loss of access to mental health care). Two thirds gain some relief from antipsychotics yet remain symptomatic throughout life, and the remainder show no significant response.

An inadequate arsenal of medications is only one of the obstacles to treating this tragic disorder effectively. Another is the theories guiding drug therapy. Brain cells (neurons) communicate by releasing chemicals called neurotransmitters that either excite or inhibit other neurons. For decades, theories of schizophrenia have focused on a single neurotransmitter: dopamine. In the past few years, though, it has become clear that a disturbance in dopamine levels is just a part of the story and that, for many, the main abnormalities lie elsewhere. In particular, suspicion has fallen on deficiencies in the neurotransmitter glutamate. Scientists now realize that schizophrenia affects virtually all parts of the brain and that, unlike dopamine, which plays an important role only in isolated regions, glutamate is critical virtually everywhere. As a result, investigators are searching for treatments that can reverse the underlying glutamate deficit.

Multiple Symptoms
To develop better treatments, investigators need to understand how schizophrenia arises--which means they need to account for all its myriad symptoms. Most of these fall into categories termed "positive," "negative" and "cognitive." Positive symptoms generally imply occurrences beyond normal experience; negative symptoms generally connote diminished experience. Cognitive, or "disorganized," symptoms refer to difficulty maintaining a logical, coherent flow of conversation, maintaining attention, and thinking on an abstract level.

The public is most familiar with the positive symptoms, particularly agitation, paranoid delusions (in which people feel conspired against) and hallucinations, commonly in the form of spoken voices. Command hallucinations, where voices tell people to hurt themselves or others, are an especially ominous sign: they can be difficult to resist and may precipitate violent actions.

The negative and cognitive symptoms are less dramatic but more pernicious. These can include a cluster called the 4 A's: autism (loss of interest in other people or the surroundings), ambivalence (emotional withdrawal), blunted affect (manifested by a bland and unchanging facial expression), and the cognitive problem of loose association (in which people join thoughts without clear logic, frequently jumbling words together into a meaningless word salad). Other common symptoms include a lack of spontaneity, impoverished speech, difficulty establishing rapport and a slowing of movement. Apathy and disinterest especially can cause friction between patients and their families, who may view these attributes as signs of laziness rather than manifestations of the illness.

When individuals with schizophrenia are evaluated with pencil-and-paper tests designed to detect brain injury, they show a pattern suggestive of widespread dysfunction. Virtually all aspects of brain operation, from the most basic sensory processes to the most complex aspects of thought are affected to some extent. Certain functions, such as the ability to form new memories either temporarily or permanently or to solve complex problems, may be particularly impaired. Patients also display difficulty solving the types of problems encountered in daily living, such as describing what friends are for or what to do if all the lights in the house go out at once. The inability to handle these common problems, more than anything else, accounts for the difficulty such individuals have in living independently. Overall, then, schizophrenia conspires to rob people of the very qualities they need to thrive in society: personality, social skills and wit.

New Treatment Possibilities
...
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DANIEL C. JAVITT and JOSEPH T. COYLE have studied schizophrenia for many years. Javitt is director of the Program in Cognitive Neuroscience and Schizophrenia at the Nathan Kline Institute for Psychiatric Research in Orangeburg, N.Y., and professor of psychiatry at the New York University School of Medicine. His paper demonstrating that the glutamate-blocking drug PCP reproduces the symptoms of schizophrenia was the second-most cited schizophrenia publication of the 1990s. Coyle is Eben S. Draper Professor of Psychiatry and Neuroscience at Harvard Medical School and also editor in chief of the Archives of General Psychiatry. Both authors have won numerous awards for their research. Javitt and Coyle hold independent patents for use of NMDA modulators in the treatment of schizophrenia, and Javitt has significant financial interests in Medifoods and Glytech, companies attempting to develop glycine and D-serine as treatments for schizophrenia.

For the Full Article - go to:

http://www.sciam.com/article.cfm?articleID=000EE239-6805-1FD5-A23683414B7F0000&pageNumber=1

Out of the Asylum, into the Cell

By Sally Satel, M.D.
New York Times November 1, 2003

A new report by Human Rights Watch has found that American prisons and jails contain three times more mentally ill people than do our psychiatric hospitals. The study confirmed what mental health and corrections experts have long known: incarceration has become the nation's default mental health treatment. And while the report offers good suggestions on how to help those who are incarcerated, a bigger question is what we can do to keep them from ending up behind bars at all.

The Los Angeles County jail, with 3,400 mentally ill prisoners, functions as the largest psychiatric inpatient institution in the United States. New York's Rikers Island, with 3,000 mentally ill inmates, is second. According to the Justice Department, roughly 16 percent of American inmates have serious psychiatric illnesses like schizophrenia, manic-depressive illness and disabling depression.

Life on the inside is a special nightmare for these inmates. They are targets of cruel manipulation and of physical and sexual abuse. Bizarre behavior, like responding to imaginary voices or self-mutilation, can get them punished--and the usual penalty, solitary confinement, only worsens hallucinations and delusions.

How did we get here? Actually, with the best of intentions.

Forty years ago yesterday, President John F. Kennedy signed the Community Mental Health Centers Act, under which large state hospitals for the mentally ill would give way to small community clinics. He said of the law that the "reliance on the cold mercy of custodial isolation will be supplanted by the open warmth of community concern and capability."

Kennedy was acting in response to a genuine shift in attitudes toward the mentally ill during the postwar years. The public and lawmakers had become aware of the dreadful conditions in the state hospitals, largely though exposes like Albert Deutsch's book The Shame of the States and popular entertainment like the movie The Snake Pit, both of which appeared in 1948. In addition, Thorazine, an anti-psychotic medication, became available in the mid-50's and rendered many patients calm enough for discharge.

Between Kennedy's signing of the mental health law in 1963 and its expiration in 1980, the number of patients in state mental hospitals dropped by about 70 percent. But asylum reform had a series of unintended consequences. The nation's 700 or so community mental health centers could not handle the huge numbers of fragile patients who had been released after spending months or years in the large institutions.

There were not enough psychiatrists and health workers willing to roll up their sleeves and take on these tough cases. Closely supervised treatment, community-supported housing and rehabilitation were given short shrift. In addition, civil liberties law gained momentum in the 70's and made it unreasonably hard for judges to commit patients who relapsed but refused care. Those discharged from state hospitals were often caught in a revolving door, quickly failing in the community and going back to the institution. And they were the lucky ones--many others ended up living in flop-houses, on the streets or, as Human Rights Watch has reminded us, in prison.

Reforms like segregating mentally ill prisoners in treatment units would help. Of course, the ultimate solution is keeping psychotic people whose criminal infractions are a product of their sickness out of jails in the first place. This requires a two-part approach. The first entails repairing a terribly fragmented mental health care system. The most important change would be liberating states from the straitjacket of federal regulations surrounding the use of money from Medicaid and Medicare--programs that account for two-thirds of every public dollar spent on the mentally ill.

These regulations force many states to make rigid rules dictating what services will and won't be reimbursed, which forces practitioners and administrators to perform bureaucratic gymnastics to circumvent them. For example, Medicaid will not pay for clinicians who provide "assertive community treatment"--a system in which professionals work as a team, making home visits, checking on medication and helping patients with practical day-to-day demands. Yet such teams have been proved to reduce re-hospitalization rates by up to 80 percent.

Relaxing regulations would be great progress in helping those mentally ill people who seek treatment. Unfortunately, about half of all untreated people with psychotic illness do not recognize that there is anything wrong with them. Thus the second part of any sensible reform would be finding ways to help patients who have a consistent pattern of rejecting voluntary care, going off medication, spiraling into self-destruction or becoming a danger to others.

One approach is encouraging their cooperation with "treatment through leverage." This process, not new but underused, involves making social welfare benefits, like subsidized housing and Social Security disability benefits, conditional to participation in treatment.

A more formal approach is to have civil courts order people to enter community treatment. New York State's Kendra's Law, named in memory of a woman killed in 1999 after being pushed into the path of a subway train by a man with schizophrenia, is a good model. From 1999 to 2002, about 2,400 people spent at least six months in mandatory community treatment under the law.

And for those who end up committing crimes, some states have developed special mental-health courts that can use the threat of jail to keep minor offenders with psychosis in treatment and on medication at least long enough for the offenders to make informed decisions about treatment. Such efforts may get help from Washington: last Monday the Senate approved a bill authorizing $200 million for states to develop more mental-health courts and other services for nonviolent, mentally ill offenders; it awaits action in the House.

For many thousands of mentally ill people, America has failed to make good on John F. Kennedy's promise of 40 years ago. Releasing them from the large state institutions was only a first step. Now we must do what we can to free them from the "cold mercy" that comes with criminalizing mental illness.

Sally Satel, a psychiatrist and resident scholar at the American Enterprise Institute, is coauthor of the forthcoming One Nation Under Therapy.

American Enterprise Institute
http://www.aei.org/news/newsID.19406/news_detail.asp

U.S. Senate Passes Mentally Ill Offender Treatment and Crime Reduction Act

(New York, November 5, 2003) Human Rights Watch welcomes the U.S. Senate’s passage on October 29, 2003 of the Mentally Ill Offender Treatment and Crime Reduction Act. Introduced in the Senate by Senator Mike Dewine (R-Ohio), the bipartisan bill was cosponsored by Senators Patrick Leahy (D-VT), Maria Cantwell (D-WA), Pete Domenici (R-NM), Charles Grassley (R-IA), and Orrin Hatch (R-UT). The legislation authorizes federal grants to support collaborations between mental health, criminal justice, juvenile justice, and corrections systems to reduce the number of mentally ill offenders in the criminal justice system, to improve the mental health care received by those who are incarcerated, and to increase the number of transitional and discharge programs to help reduce the rate of recidivism of mentally ill offenders discharged from prison and jail.

Human Rights Watch urges enactment of the Mentally Ill Offender Treatment and Crime Reduction Act. The legislation reflects a realization that a criminal justice approach, and particularly incarceration, may be both unnecessary and counterproductive in many cases of nonviolent misconduct by persons with mental illness. In addition, the legislation moves beyond a purely punitive approach to conditions in prisons and jails, recognizing that individuals as well as society are best served when those mentally ill offenders who are behind bars are provided necessary mental health services and programs while incarcerated and post-release support upon release.

U.S. Representative Ted Strickland (D-OH) introduced the bill in the House. With passage by the Senate, Human Rights Watch hopes the House of Representatives will move swiftly to pass it. We urge people to write their representatives to urge them to support the Mentally Ill Offenders Treatment and Crime Reduction Act.

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Related Material

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)
As introduced in U.S. Senate, June 5, 2003

Faulty wiring in the brain may cause early-onset schizophrenia

CHICAGO – Using diffusion tensor imaging (DTI) to look into the brains of children with schizophrenia, researchers have discovered abnormalities in the white matter of the frontal lobe that disrupt the transmission of signals regulating behavior, according to a study presented today at the 89th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA).
"Until now there's been no sophisticated method of finding abnormalities in the white matter of the brain," said the study's lead author Manzar Ashtari, Ph.D., associate professor of radiology and psychiatry at North Shore-Long Island Jewish Health System and Albert Einstein College of Medicine in New York. "Conventional magnetic resonance (MR) imaging is limited in its ability to reveal brain myelination, but DTI enables us to measure the myelination process."

Myelin is the covering of nerve bundles that protects neurons and increases their transmission efficiency. The accumulation of myelin around these neurons is called myelination. In the human developmental process, myelination correlates with maturing patterns of behavior. In patients with schizophrenia, the cells that carry out the process of myelination are defective.

Myelination activity is at its strongest during the teen years. "This is a critical time for adolescents who are still maturing emotionally," Dr. Ashtari said. "During the myelination process, microstructural damage to developing white matter fiber tracts may lead to developmental abnormalities. These are the types of abnormalities we observed in the frontal white matter regions in the children with schizophrenia."

Dr. Ashtari and her team used DTI to study 12 adolescents with early-onset schizophrenia and nine healthy, age-matched adolescents. They found distinct differences in the white brain matter of the frontal lobe, which controls numerous emotional, cognitive and linguistic behaviors. When signals are disrupted, abnormal behaviors result. "It's a problem with connectivity," Dr. Ashtari said. "It's like the wiring in a house, only we are looking at the network of the brain--how the brain is wired."

Schizophrenia is a chronic and extremely disabling brain disease that affects one out of every 100 people in the United States. There is no cure.

According to Sanjiv Kumra, M.D., co-author of the study and research scientist at Zucker Hillside Hospital in New York, adolescents are diagnosed with schizophrenia if they meet two of the five criteria – hallucinations, delusions, thought disorder, bizarre behavior and negative symptoms (lack of motivation, loss of enjoyment in activities) – for at least six months and display deterioration of functioning. Children with schizophrenia are likely to exhibit developmental delay and language and emotional problems before the onset of psychotic symptoms.

DTI can identify white matter abnormalities before major symptoms are apparent. "Our goal is to detect and treat this disease early, so we can stop the progression before full-fledged symptoms develop," Dr. Ashtari said.

"Early-onset schizophrenia is especially disheartening because so many of these teens aren't diagnosed until they're adults," Dr. Kumra said. "Because these patients develop the disease at an early age when they have not yet built their lives, they tend to have a worse prognosis than those who have adult-onset schizophrenia."

Dr. Ashtari hopes that further DTI studies will yield more insight into the inner workings of schizophrenia. "If the malformation in the myelination process is the cause of schizophrenia, future special efforts can be focused in production of therapeutic agents that speed up or restart the myelination process," she said.

Co-authoring the study with Drs. Ashtari and Kumra are Marjorie McMeniman, Ph. D., Joshua Vogel, Alan Sloan Diamond, M.D., and Philip Szeszko, Ph.D.

Drug Implant Offers New Hope for People with Schizophrenia

By Ellen Barry, Globe Staff, 9/26/2003

PHILADELPHIA -- Researchers said yesterday that they are prepared to seek FDA approval of a surgically implanted tablet that could deliver daily doses of psychiatric medication for as long as a year.

The implants might revolutionize treatment of chronic mental illnesses like schizophrenia, which now require patients to take daily cocktails of powerful medications.

For some, the implant of haloperidol, a powerful antipsychotic drug, promises to stop the destructive spirals of psychosis that occur when patients stop taking medication because of side effects, logistical barriers, or lapses in memory. But patients' rights advocates say that implants of psychiatric medication would give the state coercive power unmatched since the age of the lobotomy.

Dr. Steven Siegel, the University of Pennsylvania researcher who is leading the development of the implant, gathered with advocates yesterday to debate its impact on the rights of people with mental illness.

"This is very doable technology," said Siegel, director of the Stanley Center for Experimental Therapeutics in Psychiatry. "It's not the science that is limiting. If there really is interest, then I think drug companies and other groups" would be happy to move forward with implants.

The implant consists of a biodegradable polymer disk about 1 centimeter in diameter and 1 millimeter thick, which would be inserted during a 15-minute outpatient surgical procedure, he said.

The disk, which could also contain antidepressants or other medications, gradually disappears over the course of a year, slowly releasing the drug as it dissolves.

If the patient needed to be taken off the drug, its effects would immediately cease when the tablet was removed, Siegel added. Currently, the nearest alternative is an antipsychotic injection, which is not reversible and lasts for only a month.

Siegel said he envisions that the implant would be used only on a voluntary basis, by people who have made the decision to accept medication for a year.

But Jonathon Stanley, a lawyer and activist whose parents founded the Stanley Foundation after he became severely psychotic as a young man, said he sees the implant as useful only for people who refuse medication.

"I would not get [an implant] right now, because I sometimes change the [dosage] a little" to adjust to mood, said Stanley, who has pushed for tougher laws compelling people to take psychiatric medication.

But he said he could have used an implant as a young man, when "the only reason I was able to take my pills was because my parents were there watching me like a 2-year-old."

The first human trials of the device are at least two years away, Siegel said. But with testing completed on rats and rabbits, Siegel's laboratory and the three other laboratories affiliated with the project approached the Food and Drug Administration two weeks ago and requested a meeting to discuss beginning trials to test the device's safety in humans, he said. The device will not be on the market for at least five years.

Ethical concerns about the device -- and psychiatry's long history of adopting treatments that are later seen as civil-rights violations -- prompted scientists to gather partisans on both sides of the argument for yesterday's discussion.

"This is very, very early to begin this conversation," said Paul Root Wolpe, a professor of psychiatry and senior fellow at the University of Pennsylvania's Center for Bioethics. "Very often, when there is this kind of conversation, it's right before a pharma company is about to introduce the product."

At the heart of yesterday's debate were the antipsychotic medications themselves, which have become the primary treatment for serious mental illness over the last 50 years.

The newer generation of antipsychotics were greeted as miracle drugs when they were introduced about 15 years ago, and their sales have climbed to become the fourth highest-selling class of drugs in the nation, according to IMS Health, which tracks industry sales.

But once outside hospital walls, patients frequently stray from the drug regimens. One study showed that over a two-year period, 80 percent of people with schizophrenia stopped taking their medication at least temporarily, Siegel said.

But one clinician interviewed said that if a long-term medication implant is administered ethically, it could be an enormous boon to patients struggling to build an independent life.

"I see so many people who so often go off medication because they lost their prescription, their doctor was on vacation, they ran out of medication, the pharmacy was closed," said Laurie Goldman, a clinical psychologist who sees severely mentally ill patients at the South End Community Health Center. "They ended up homeless. They ended up burning down houses."

Audience members raised concerns yesterday about possible widespread use of implants, most pointedly, the danger that they would be used in the criminal justice system as an alternative to imprisonment.

Others worried that the managed-care industry would promote implants because they would offer the cost savings of reduced psychiatric visits.

Unrepresented in the gathering of patients' advocates yesterday were the most seriously ill people, those so disorganized and isolated that they are unable to manage their medications at all.

Excerpted from: The Boston Globe, 9.26.3003

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Your Opinion on Schizophrenia Drug Delivery Implant

Note: If you believe - as we do - that this new medication delivery system would be a valuable addition to the options available to people with schizophrenia -please send an email message of support to:

Mary Dankert, Email: mdankert@bbl.med.upenn.edu

This drug delivery system may not be developed if people don't let the University of Pennsylvania know that this is a valuable addition to the options available for treatment of schizophrenia.

Note: I see this as good news for helping the many people who have schizophrenia and who - because of the damage to the brain caused by schizophrenia - find it very difficult to remember to take medications on a regular basis. This effort is supported by the Stanley Research Foundation - a leading Non-profit that supports a great deal of schizophrenia research to improve treatment for people with schizophrenia. - Editor.

For More information on this new drug delivery system - see:

http://stanley.med.upenn.edu/

For more information on the Stanley Foundation Schizophrenia Research programs, see:

http://www.stanleyresearch.org/programs/stanley_research.asp

State Lawmakers Preview Award-Winning Documentary of Artist's Struggle With Schizophrenia at NCSL Annual Health Policy Forum

12/10/03 6:02:00 PM

WASHINGTON, Dec. 10 /U.S. Newswire/ -- Artist John Cadigan today shared his story of his struggle with schizophrenia with more than 400 members of the National Council of State Legislatures, comprised of state legislators and staff from across the country at their annual Fall Forum to discuss health policy. In an effort to challenge existing negative stereotypes about those who struggle with severe mental illnesses, Cadigan filmed his life for over 10 years.

Cadigan's story came to life at the NCSL's annual Fall Forum through a preview of excerpts from the artist's documentary, People Say I'm Crazy. The documentary has been sweeping film festivals throughout North America, winning major awards such as the Humanitarian Award at the Vancouver International Film Festival and the Best Documentary award at the Chicago International Film Festival. The documentary has recently been purchased by HBO/Cinemax for airing in summer 2004.

In addition to the preview, Cadigan's unique art depicting his vision was also displayed at the NCSL meeting. A relief printmaker, Cadigan has exhibited his woodcuts in galleries and museums nationwide.

"Society turns away from those who suffer from mental illnesses such as schizophrenia," Cadigan said. "Fifty-five million Americans suffer from some form of mental illness. It is important that we foster understanding within society that these are brain disorders and these disorders can be successfully treated, so there is hope for people to return to productive lives."

As states confront the worst budget shortfalls since World War II, investment in mental health services is in great jeopardy. According to the National Mental Health Association (NMHA), nearly two-thirds of states cut funding for mental health services in 2002.

"States can choose to invest in effective, community-based services or pay a greater price through increased emergency room visits, homelessness and an overburdened criminal justice system," said Senator Peter Knudson, assistant majority whip for the Utah State Senate and emcee of the event. "John Cadigan's story shows us how important it is to provide timely and appropriate treatment for those who suffer from mental health disorders."

"The search for appropriate treatment was extremely difficult for my family and me," Cadigan said. "My story is not unique, but sharing it puts a face on the thousands of other sufferers out there who need timely and effective care. We must encourage decision makers to dramatically improve the quality and availability of mental health services which saves society an enormous amount of taxpayer resources in the long term."

Cadigan, now 33, was diagnosed with schizophrenia in 1991 while he was a senior at Carnegie Mellon University. From the beginning of his illness, he decided to document his experiences on film. His sister, Katie Cadigan, a professional documentary film producer and director who has taught film at Stanford University, used her knowledge to teach John how to film himself so that he could explore what was happening to him.

The film follows Cadigan and his family as he battles schizophrenia, and captures his setbacks and milestones on his journey to build a stable life. Cadigan's blunt honesty helps audiences to understand the overwhelming challenges facing those with severe mental illnesses.

The film was made possible in part through a grant from the National Endowment for the Arts, and through an unrestricted educational grant from AstraZeneca as part of its commitment to foster greater understanding and compassion about mental illness.

People Say I'm Crazy was co-produced by Academy Award winning producer Ira Wohl. The film is scheduled for theatrical release in New York in April 2004. It is currently in educational distribution.

For more information about People Say I'm Crazy, log onto http://www.peoplesayimcrazy.org

Excerpt: Drug-induced discovery sheds light on mental illness.
21 November 2003
HELEN R PILCHER

Schizophrenia affects the brain's chemistry and structure

A single molecule may underpin the psychotic symptoms of schizophrenia, a mouse study suggests. A better understanding of the roots of the disease and new antipsychotic medications may follow.

Three main chemical messengers, called neurotransmitters, are implicated. Different researchers tend to favour one molecule the others as the disease's root cause.

"This study shows that all three schools of thought could be correct," says Paul Greengard of Rockefeller University, New York, who led the work.

Greengard's team treated mice with the mind-altering drugs amphetamine, LSD or PCP - also known as angel dust. Each drug specifically targets one of the suspect neurotransmitter systems, but has similar effects on brain and behaviour.

Each hallucinogen altered the same mystery brain protein, DARPP-32, the team found1. Animals developed schizophrenic symptoms - in mice, this involves repetitive grooming and nervousness.

The cause of the neurotransmitter imbalance is still a mystery. But the finding suggests that all three chemicals might influence DARPP-32, in turn causing schizophrenia.

Schizophrenia a complex disease that affects the brain's chemistry and structure, says Carol Tamminga from the University of Texas, Dallas, who studies the disorder. "The next step is to work out how a molecular change like this translates into hallucinations and delusions," she says.

Drug lead

The finding may aid the production of new schizophrenia therapies. Mice lacking DARPP-32 were immune to the drugs' psychotic effects, the team found.

Current therapies damp down one neurotransmitter called dopamine. Delusions subside but attention and memory problems often persist, and serious adverse effects are common.

The finding may also lead to improved animal models of schizophrenia. Mice with abnormal DARPP-32 might better mimic the brain chemistry and behaviour of human patients than drug-treated animals, says Tamminga.

References
Svenningsson, P. et al. Diverse psychotomimetics act through a common signalling pathway. Science, 302, 1412 - 1415, (2003). |Link|

http://www.nature.com/nsu/031117/031117-7.html

Omega 3 and EFA Fatty Acids and Antioxidants Useful for Schizophrenia

Essential fatty acid deficiency and resulting lipid membrane abnormalities have been hypothesized to play a role in schizophrenia onset. Moreover, epidemiologic data suggest an association between high fish consumption and positive outcomes in patients with schizophrenia.

These theories were supported in a recent study that showed Supplementation with omega-3 fatty acids and specific antioxidants may relieve symptoms associated with schizophrenia and improve quality of life. Schizophrenia Research (2003;62:195-204).

In the new study, 28 chronically medicated schizophrenic adults and 45 healthy adults received a combination of omega-3 fatty acids (360 mg per day of EPA and 240 mg per day of DHA) plus two antioxidants (800 IU of vitamin E per day and 1,000 mg of vitamin C per day) for four months. Those with schizophrenia continued to take their prescription medications, including haloperidol (Haldol), risperidone (Risperdal), olanzapine (Zyprexa), and clozapine (Clozaril). Several psychological tests were performed monthly to evaluate whether symptoms had improved or worsened. Twenty-one of the 28 people with schizophrenia were additionally evaluated four months after discontinuing treatment to determine if the effects of treatment were sustained. Blood measurements of fatty acids were taken initially, at the conclusion of the study, and four months after stopping treatment.

Schizophrenics taking the fatty acids and antioxidants had significant improvements on most of the psychological tests and also showed improvement in quality of life after four months of treatment. These benefits were sustained for an additional four months after the supplements were discontinued. Those with schizophrenia were found to have lower levels of EPA and DHA prior to treatment compared with the healthy people, but these levels increased while taking the supplements.

Studies using omega-3 fatty acids or antioxidants alone have showed inconsistent results. Some studies suggest that oxidative damage to nerve cells decreases fatty acid levels in the brain. Supplementing with fatty acids helps replenish the diminished stores in cells, while vitamins E and C help protect the cell wall from oxidative damage. .

Source: http://www.currentpsychiatry.com/2004_01/0104_omega-3_fatty_acids.asp

And other Internet news sources

Scientists find link for smoking, schizophrenia
Source:Canadian Press

TORONTO - A team of Toronto researchers has made a startling discovery about why people with schizophrenia are so much more likely than other people to be smokers.

Medications that block dopamine - commonly used by people with this debilitating condition - make smoking a more rewarding experience, they reported Friday in the journal Molecular Psychiatry.

The findings, which challenge long-held views about the role of dopamine in nicotine addiction, may provide science with clues on how to help schizophrenics and others give up cigarettes and kick other habit-forming drugs.

"It's a first step in identifying systems in the brain that can mediate vulnerability to addiction," said lead author Steve Laviolette, who is currently doing post-doctoral research at the University of Pittsburgh.

He admitted, however, that the findings are likely to spark controversy.

"It's basically overturning 30 years of previous research. So you might come across people who are hostile to - if not shocked by - the results."

Yavin Shaham, an addiction researcher at the U.S. National Institute on Drug Abuse in Baltimore, Md., agreed that the findings defy some of the dogma around nicotine addiction. But he said the science is sound and the findings will spark debate in the addiction research community.

"I think that it's very interesting research that points in new directions to understanding nicotine reward," said Shaham, who was not involved in the research.

"It's not necessarily the way we thought about it in the past. And it's certainly relevant for the understanding of why schizophrenics are smoking so much."

Laviolette wrote the paper with co-author Derek van der Kooy while working on his doctorate in neuropharmacology at the University of Toronto. The pair was trying to identify areas in the brain that are involved in nicotine addiction.

"The schizophrenic angle came up almost accidentally, really," Laviolette said from Pittsburgh.

The work, done on rats, involved injecting nicotine or a placebo - in this case saline - directly into a portion of the brain known as the ventral tegmental area, or VTA. The VTA is thought to be the pleasure centre of the brain and is known to be involved in nicotine, alcohol and drug addiction.

To the team's surprise, they discovered the VTA also is involved in aversion. Low doses of nicotine administered to that area of the brain actually induced a negative reaction from the rats. It was only when the dosage crossed a certain threshold that the animals began to perceive it as pleasurable and to seek it out.

"That was surprising, that a single brain area was responsible for both the aversive and the rewarding effects," Laviolette admitted.

More surprising still was what happened when they gave the rats drugs that blocked the dopamine receptors in the VTA.

For decades, research has shown that dopamine, a neurotransmitter, is responsible for the rewarding effects of nicotine. But researchers could never explain why people with schizophrenia on dopamine-blocking drugs tend to smoke like chimneys.

It didn't seem to make sense: if dopamine allowed the brain to enjoy smoking and dopamine was blocked, smoking should no longer be a pleasurable experience.

"And what was the surprising thing was the rewarding effects were not blocked at all," Laviolette said of the rat experiments.

In fact, the contrary was true, he said. Blocking dopamine blocked the adverse effects of nicotine, but ramped up the rewarding sensations induced by the drug. Dramatically.

The findings suggest that schizophrenia medications that block dopamine are fixing one problem but causing another, he said.

"What's really happening is that you're blocking dopamine in the schizophrenics, you're increasing nicotine's rewarding effects. And that's why you see 95 per cent of schizophrenics are heavily addicted to nicotine."

Further, the same effect is probably happening with alcohol and possibly other drugs, Laviolette said.

"It's a two-edged sword. The drug is removing the psychosis but at the same time making them addicted to these extremely dangerous drugs."

Not all medications used to treat schizophrenia work by blocking dopamine, however. The newer generation of medications, known as atypical anti-psychotic drugs, work by a different mechanism.

Laviolette said the research suggests that the reactions to a drug induced in the VTA fall on a spectrum from aversion to pleasure. Whether one finds a cigarette satisfying or disgusting may depend on one's baseline dopamine levels, he said.

"So depending on how those two systems in the VTA are balanced in terms of dopamine, that could be a clue as to which person may be more vulnerable to become addicted to certain drugs."

Review shows that cannabis use is a risk factor for schizophrenia

Utrecht Tony Sheldon

Public health researchers in the Netherlands now believe that there is "converging evidence" to show that using cannabis is a risk factor for schizophrenia.

Researchers from the Netherlands Institute of Mental Health and Addiction warn that cannabis approximately doubles the risk of schizophrenia and that the risk increases in proportion to the amount of the drug used.

The researchers draw their conclusions from a review of five longitudinal studies recently published in four medical journals, including the British Medical Journal (Nederlands Tijdschrift voor Geneeskunde 2003;44:2178-83).

Data from these studies, which were carried out in the Netherlands, Sweden, New Zealand, and Israel, made it possible to clarify the sequence of events over a long period of time. They discounted the possibility that schizophrenia increases subsequent use of cannabis, the "self medication" hypothesis.

The researchers excluded people with a previous history of psychotic problems from the analysis, and they controlled for the effects of other confounders, such as the use of other drugs. Thus they were able to show the specific influence of cannabis.

The Swedish and Dutch studies also showed that the amount of cannabis used was associated with the risk of schizophrenia, supporting the causal hypothesis.

In the Netherlands five in 10 000 adults a year develop schizophrenia. The researchers say that a conservative estimate based on consistent results is that using cannabis doubles the risk of developing the disease.

They conclude that although the risk may be numerically small it is "serious in clinical terms" and that ignoring the message of the recent research "is not an option."

According to the 2003 national drugs monitor, a systematic collection and analysis of data carried out by the institute, the number of cannabis users in the Netherlands increased from 326 000 in 1997 to 408 000 in 2001.

By the age of 18 years half of Dutch men and a third of Dutch women have used cannabis at least once. Of the people who say that have used it in the past month, half say they have smoked more than five joints.

The researchers accept that epidemiological cohort studies do not offer complete proof, as there may be other underlying social or biological factors.

But a co-author, public health researcher Filip Smit, said that public health officials don’t require the same degree of certainty that scientists do. He said, "From a public health perspective we do not want to take the risk, especially with something as serious as schizophrenia." The institute says its conclusions have implications for health education, and it wants more preventive health projects, especially ones that are geared towards teenagers at school.

The paper has initiated a debate in the Dutch media, where a spokesman for the institute said, "Soft drugs have lost their innocence."

http://bmj.bmjjournals.com/cgi/content/full/327/7423/1070-c

EPO Might Help People with Schizophrenia
Source: Reuters Health

The anemia drug erythropoietin, commonly known as EPO, may be helpful for patients with schizophrenia, German researchers report.

New research in mice and in humans suggests EPO could improve the mental function of schizophrenics, and perhaps slow the deterioration that continues even when patients are treated with existing drugs.

Dr. Hannelore Ehrenreich, at Georg-August-University, Goettingen, and her associates note in the medical journal Molecular Psychiatry that their article is intended to "prepare the ground" for using EPO as add-on therapy for schizophrenia.

The editor of the journal, Dr. Julio Licinio, told Reuters Health that experts who reviewed the paper "all said the science was very good." Licinio, who is professor of medicine and psychiatry at the David Geffen School of Medicine, UCLA, said the German team's discoveries are particularly exciting at this time. "We are desperate to find a new drug," he added.

Ehrenreich's team injected five patients with schizophrenia and five healthy subjects with EPO tagged with a radioisotope. Brain scans showed that EPO entered the brain four hours after administration and lasted for at least 2 days. Levels were higher in the schizophrenic subjects.

They also showed in lab experiments that EPO blunted the toxic effects of the drug haloperidol on brain cells.

Ehrenreich and her colleagues conclude that EPO is "an interesting compound" that may protect brain cells in schizophrenia as well as other similar human disease. Based on their results, a multicenter "proof-of-concept" trial has been started.

SOURCE: Molecular Psychiatry, December 2003.

U of Calgary Early Psychosis Treatment Program Saves Lives

New schizophrenia research is saving lives and money by cutting down on attempted suicides among those suffering from the disease.

University of Calgary psychiatry professor Dr. Donald Addington announced yesterday his work with treating schizophrenia patients early -- through the Calgary Early Psychosis Treatment program -- has shown a significant reduction in suicide attempts.

"Compared to the results of other similar programs, we seem to have a low rate of attempted suicides -- which is very encouraging," Addington said, adding, without the program, about 10% of people with schizophrenia end their lives and one-third attempt to.

Reducing suicide attempts also saves the health region money on hospital stays, he said.

Addington's research into schizophrenia is funded by the Alberta Heritage Foundation for Medical Research.

The results are expected to be published in early 2004. For more on the Early Psychosis Treatment Program, visit www.calgaryhealthregion.ca/hecomm/epp/about.htm


Schizophrenia.com