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Schizophrenia Update - October 2nd, 2002

Table of Contents


New Family Oriented Book on Schizophrenia:

Diagnosis: Schizophrenia
A Comprehensive Resource

By Rachel Miller and Susan Mason

I've reviewed this book and think it is valuable for any family who has a family member or friend who suffers from schizophrenia. Its unique in that it is written in an easy-to-read personal style that almost anyone should be able to read and benefit from, and in that it covers the real stories of 35 different people who have experienced schizophrenia and incorporates their experiences and perspectives. With these stories the reader can get a good idea of what some people have gone through in their experience with schizophrenia. I highly recommend it.

Brian

  • "As a parent watching the process of this illness unfold, I felt confused, fearful, isolated and totally helpless. This book helped dispel those feelings and left in their place a better understanding of the illness and what my child was experiencing. For those whose lives are touched by schizophrenia, this book will bring understanding and more. It is like no other book I've read on the illness to date. Thank you to those in this book whose courage in telling their stories is almost unimaginable."
    –Connie Crespin,

    "These stories tell of experiences that all of us diagnosed with schizophrenia can relate to, so we don´t feel so alone. And the more people know about their illness, the easier it is to cope with the symptoms and the more willing they will be to accept treatment, including medication. I wish I had this book when I first got sick."
    –Tina, outpatient,

    "No fewer than 35 patients and their clinicians put a realistic face on schizophrenia. They provide easily understood answers to the universal questions about these disorders. The exchange is unique and the message is empowering. Schizophrenia becomes demystified and a template of hope and recovery is drawn for patients, families, and providers. For those seeking a patient education resource, this little gem gets my enthusiastic endorsement."
    –Gerard E. Hogarty, University of Pittsburgh Medical Center

    The disease is not fatal but few diagnoses have the capacity to instill as much fear in the hearts of patients and families. Here is a profoundly reassuring book that shows there can be life after a diagnosis of schizophrenia.

    The book includes thirty-five first-person accounts, along with chapters by professionals on a wide range of issues from hospitalization to rehabilitation. Jargon-free and technically accurate, the chapters are short and offer up-to-date information on medication, coping skills, social services, clinical research, and much more. Patients and their families can read the book from cover to cover or skip around and select topics as the need arises.

    For more information, or to purchase the book, go to:

    http://www.columbia.edu/cu/cup/catalog/data/023112/0231126247.HTM

    or Amazon.com - Diagnosis Schizophrenia


    STUDIES OF NEVER-TREATED PATIENTS CONFIRM SCHIZOPHRENIA IS A BRAIN DISEASE

    Abnormalities in brain structure and function not caused by medications

    A paper published in the October 2002 edition of the journal Schizophrenia Research (released September 20) confirms that schizophrenia is a brain disease, in exactly the same sense that Parkinson's disease, Alzheimer's disease, and multiple sclerosis are brain diseases.

    The paper reviewed 65 research projects carried out on individuals with schizophrenia who had never been treated with any antipsychotic medication. In many, the individual had only recently been diagnosed with the disease. In recent years, many critics of psychiatry have suggested that the brain abnormalities described in schizophrenia are caused by medications being taken by the patients. This review refutes that thesis.

    It is clear that schizophrenia, like many other brain diseases, produces abnormalities in brain structure and function. These abnormalities are inherent in the disease process and not caused by medications.

    ABOUT THE PAPER. The study reviewed 65 research projects carried out on individuals with schizophrenia who had never been treated with any antipsychotic medication. In many, the individual had only recently been diagnosed with the disease. The projects measured the structure and function of brains of individuals with schizophrenia and compared these with normal controls. Neurological and neuropsychological measures of brain function showed the most consistent and largest differences between patients and controls. Measures of brain structure, such as MRIs, and measures of brain metabolism, such as PET scans, were also significantly different but less impressive. The brain abnormalities were not localized to a single part of the brain but instead implicated a variety of interrelated regions at the base of the brain.

    ABOUT THE AUTHOR. The paper's author, Dr. E. Fuller Torrey, is executive director of The Stanley Medical Research Institute in Bethesda, Md., and president of the Treatment Advocacy Center in Arlington, Va. "Studies of Individuals with Schizophrenia Never Treated with Antipsychotic Medications: A Review," is the lead article in the October 2002 Schizophrenia Research. Dr. Torrey is a leading research psychiatrist specializing in schizophrenia and manic-depressive illness. He is the author of 20 books and more than 200 lay and professional papers.

    His full bio is available at http://www.psychlaws.org/PressRoom/Bio1.htm

    View the full paper online at:
    http://www.psychlaws.org/GeneralResources/report-nevertreated.htm


    The Sights and Sounds of Schizophrenia

    By Joanne Siebert, NPR

    Aug. 29, 2002 -- The textbook description of schizophrenia is a listing of symptoms: delusions, hallucinations, disorganized speech and behavior. But what does schizophrenia really feel like? NPR's Joanne Silberner reports on a virtual reality experience that simulates common symptoms of the mental illness.

    Janssen Pharmaceutica, a company that makes a drug treatment for schizophrenia, has created a multimedia simulation that it says lets a participant see the world through the eyes and ears of a person with schizophrenic illness. Janssen created the simulation as an education tool for doctors and others who want a more visceral understanding of the illness.

    Silberner, who experienced the simulation, says it works this way: "For five to 10 minutes, someone wanting to know what it feels like to have untreated schizophrenia puts on goggles and headphones, and sees and hears a range of hallucinations. You can choose your virtual reality -- what happens on a trip to the doctor's office, or on a ride on a city bus." In the program she experienced, a caseworker takes the schizophrenia patient to a grocery store with a pharmacy in the back, to refill a prescription.

    To create the virtual reality project, technical director Stephen Streibig consulted a group of people with schizophrenia, including Daniel Frey, 26. Frey describes what he and Silberner experienced in the program: “When you first walk into the pharmacy, you’re walking through the aisles and there are people staring at you, just staring at you from every aisle. And there’s one instance where there is a woman sort of protecting her children from you when you walk through the aisle.

    Dr. Sam Keith, medical advisor on the virtual reality project, is a veteran psychiatrist who’s heard thousands of patients describe schizophrenic episodes. Still, after trying the simulation, Keith said, “When it’s real, it’s different -- it’s very frightening, it’s very scary."

    Streibig said that’s precisely the effect he hoped to achieve: After years of the illness being misdiagnosed, mismanaged and stigmatized, he says, “People should understand what it’s like to go through this."

    Even though schizophrenia patient Frey consulted on the project, he found the simulation too disturbing to sit all the way through. When Silberner tells him she was terrified by the experience, Frey responds, “Yeah, you ought to be… Imagine not being able to take off the goggles, the helmet."

  • For the full story, with slides and more information on the new Janssen Pharmaceutica simulation of schizophrenia - see the following link:

    http://www.npr.org/programs/atc/features/2002/aug/schizophrenia/


  • August 27, 2002

    Pill-Splitting Can Yield Cost Savings on Common Prescription Drugs, Stanford Researchers Find

    STANFORD, Calif., Aug. 29 -- Squeezed by the rising cost of prescription drugs, health plans and other health-care organizations are pursuing cost-saving strategies such as encouraging the use of generics, using narrowly tailored drug formularies and implementing multi-tiered co-payment systems.

    Now, researchers at Stanford University Medical Center have confirmed that a less-common strategy - pill-splitting - could yield significant cost savings without compromising drug efficacy or safety. They emphasize that pill-splitting must be implemented with careful controls and begin with a doctor-patient conversation.

    "When properly implemented, pill-splitting can be a safe, viable cost-saving strategy," said Randall Stafford, MD, PhD, a researcher at the Stanford Center for Research in Disease Prevention and lead author of an article published in the August issue of the American Journal of Managed Care. "Physicians should consider using pill-splitting with selected medications and patients, and patients may want to bring it up with their doctors."

    The researchers emphasized that pill-splitting must be implemented with drug-specific and patient-specific criteria to ensure patient safety. Just as certain types of medications are unsuitable for pill-splitting - including extended-release medications and those with enteric coatings - certain patients may be unable to split tablets consistently and accurately. Such patients may include those with poor eyesight, loss of a limb, tremors, debilitating arthritis, dementia or psychosis. The researchers noted that results are best when the patient uses a pill-splitting device and is trained to use it.

    Pill-splitting should be embarked upon only after a discussion between physician and patient, Stafford explained. "We're not advocating this as a global solution. It needs to be conducted in the context of doctor-patient communication." He noted that the list of 11 medications he identified for pill-splitting isn't exhaustive and may differ depending on local practices and
    prices.

    The researchers acknowledged that some physicians are reluctant to suggest pill-splitting because of concerns that patients may be unwilling or unable to split pills accurately. Stafford's research suggests that pill-splitting is likely to be safe and effective with appropriate screening, but he said further research is needed o this question.

    He noted that pill-splitting would help those who pay for prescription drugs out-of-pocket, including the uninsured and some Medicare beneficiaries. For them, pill-splitting "may make newer, more expensive medications available to people who might not otherwise afford them."

    Potential cost savings from pill-splitting:

    Clonazepam [Klonopin]/Panic disorder; epilepsy/41 percent savings*

    Citalopram [Celexa]/Depression/46 percent savings

    Atorvastatin [Lipitor]/High cholesterol/33 percent savings

    Paroxetine [Paxil]/Depression; anxiety/46 percent savings

    Nefazodone [Serzone]/Depression/49 percent savings

    Sertraline [Zoloft]/Depression/46 percent savings

    Olanzapine [Zyprexa]/Schizophrenia; bipolar disorder/31 percent savings

    *average potential cost savings of pill-splitting, in percentage terms, over varying dosages of each medication


  • Medical Food for Tardive Dyskinesia
    Drug as food reduces involuntary body movements.

    Tarvil, formulated as a "medical food," was introduced at a medical meeting and is said to be the first product to effectively manage the symptoms of tardive dyskinesia (TD) in men. Tarvil decreases the symptoms that occur secondarily to the anti-psychotic medications used to treat severe mental illness, such as schizophrenia. TD affects as many as one million people in the U.S. Clinical research shows that a decreased ability to clear phenylalanine is associated with symptoms of TD in men. Tarvil is a powdered pineapple-flavored drink mix. The recommended usage, under guidance of a physician, is three times a day, dependent on the patient's body weight and condition.


    (Source: SHS North America, Rockville, MD; presentation at the 155th Annual American Psychiatric Association Meeting in Philadelphia.)


    August 9, 2002
    Risperdal Consta to be launched in United Kingdom

    UK Joins Germany next week in introducing first long-acting, injection form of atypical antipsychotic
    Saunderton, United Kingdom - The Medicines Control Agency in the United Kingdom has approved Janssen-Cilag's Risperdal Consta [risperidone], clearing the way for the launch next week of the only approved long-acting injection developed for a newer-generation, atypical antipsychotic. The UK action follows the recent approval of Risperdal Consta in Germany, where the product will be launched next week as well. In a number of other countries, Risperdal Consta is in late-stage regulatory review.

    Janssen Pharmaceutica Release: Germany Approves Risperdal Consta,
    First Atypical Antipsychotic To Be Available As Long-Acting Injection

    http://www.biospace.com/news_story.cfm?StoryID=9567920


  • 180 Years After Gregor Mendel, UC Irvine Researchers Unlocking Secrets of Genetics

    IRVINE, Calif., July 29, 2002

    " Gene Chips on the Brain Unlocking Cause of Mental Disorders"

    Schizophrenia and depression are two common and devastating mental diseases; their cause is still unknown. But some advanced computer technology is helping Dr. William Bunney, chairman of psychiatry, and his colleagues find genes that are most closely associated with the disorders. Using new "microarray chips" that contain information on tens of thousands of genes in the brain, the researchers are looking for differences in gene activation between normal brains and people who died with these disorders.
    "With microarrays we can identify genes that are significantly different in schizophrenia and depression, and discover brain pathways that may help us understand the dysfunctions in these illnesses," says Bunney.


    Montreal Gazette

    September 23, 2002 Monday Final Edition

    Speaker (Fred Frese) surmounted his own mental illness

    BYLINE: SUSAN SCHWARTZ

    Twelve years after he was declared insane and committed to an Ohio state hospital at 25, dazed and delusional with paranoid schizophrenia, Fred Frese was promoted to chief psychologist at the largest hospital in the system that had confined him.

    Despite repeated hospitalizations over a 10-year period, he was able to hold jobs, he married, had children and earned a master's and doctoral degree.

    Among his accomplishments, Frese, now 61, holds university faculty appointments, has published extensively and is a longtime activist on behalf of people with serious mental illnesses. Since retiring from the hospital in 1995, he has traveled extensively, sharing his experience of living successfully with an often-devastating mental illness. He'll be in Montreal on Wednesday.

    Schizophrenia, believed to result from a combination of biological and environmental factors, typically develops between the ages of 17 and 25. Classic symptoms include an inability to separate fantasy from reality and the hearing of inner voices.

    Historically, schizophrenia was viewed as a degenerative disorder from which no one recovered. In recent years, however, the notion that recovery is possible has gained momentum.

    "With mental illness, we can't talk about cure," said Ella Amir, executive director of AMI-Quebec, a support group for families living with mental illness.

    "I think recovering is a process which is ongoing, which may involve some relapses along the way. It is not something you do and finish doing. Recovery means putting an accent on what these people can do."

    Frese considers himself recovering, not recovered. "My experience is that mental illness is much more analogous to diabetes," he said. "With proper care you can function in a normal mode, but you always have vulnerabilities."

    In A Beautiful Mind, Russell Crowe portrayed mathematician John Nash who, like Frese, emerged from the stranglehold of paranoid schizophrenia. Frese liked that the film showed that "a person with the disorder can make significant contributions." Just as he has.


  • Friday, 23 August, 2002, 15:50 GMT 16:50 UK, BBC News Service

    Mystery particle' in schizophrenics

    Tests will continue on the particles A tiny particle found in the spinal fluid of schizophrenia patients is baffling doctors who cannot work out what it is. The Swedish researcher involved has even suggested it might be "a new form of life", although other experts say this is unlikely

    However, it could mean that doctors have a reliable test for schizophrenia. The study, led by experts at the Karolinska Institute in Stockholm, involved giving 22 schizophrenics, and 38 apparently healthy "control" patients lumbar punctures to get a sample of their cerebrospinal fluid.

    Tiny spherical particles were found in the fluid from 20 of the 22 schizophrenic patients, but only two out of the 38 controls. The study then focused on trying to work out what the particles actually were. First a simple method of scanning for the presence of DNA - basic genetic code - failed to reveal anything.

    He suggested that the next step might be to use more detailed tests to analyse the particles further. He added that it was unlikely that similar experiments could be carried out here or in the US, as ethical approval for lumbar punctures on schizophrenic patients for this reason would be difficult to obtain.

    The research was published in the journal Neuroscience Letters.

    For Full BBC News Article on this: http://news.bbc.co.uk/1/hi/health/2212766.stm


     


    EPA (Omega 3 Fatty Acid) Useful Add-on Therapy in Schizophrenia
    By: Laurie Barclay, MD

    Sept. 9, 2002 — Ethyl-eicosapentaenoic acid (EPA) may be a useful add-on therapy for schizophrenia, according to results of a randomized, placebo-controlled trial published in the September issue of the American Journal of Psychiatry. Patients who were still symptomatic after six months of standard therapy had a significant reduction in both positive and negative symptoms after 12 weeks of treatment.

    "Extrapyramidal symptoms and limited efficacy are serious limitations of conventional antipsychotics, while high acquisition costs have put the novel antipsychotics beyond the reach of patients in lower-income countries," write Robin Emsley, MD, from the University of Stellenbosch, Cape Town, South Africa, and colleagues. "Omega-3 polyunsaturated fatty acids may offer an affordable treatment alternative."

    "EPA may be an effective, safe, and well-tolerated add-on treatment in chronic schizophrenia," the authors write. "If efficacy in psychosis and tardive dyskinesia is confirmed, it is likely to lead to revision of our understanding of the pathophysiology and treatment of these disorders."

    Am J Psychiatry. 2002;286(6):159(9):1596-1598

    Relevant Links:

    Health and Age Web Site News


  • 30 September 2002

    Aripiprazole looks promising for treating schizophrenia

    Researchers in the US have found aripiprazole effective for the treatment of positive and negative symptoms of schizophrenia and schizoaffective disorder.

    Aripiprazole has a unique pharmacological profile in that it acts as a potent partial agonist at dopamine D2 receptors, a partial agonist at serotonin 5-HT1A receptors, and an antagonist at 5-HT2A receptors.

    J Clin Psychiatry 2002; 63: 763–771


    CyDex, Inc. Announces Second U.S. Approval of a Captisol-Enabled Prescription Anti-psychotic Drug
    OVERLAND PARK, Kan.,

    CyDex announced the second U.S. approval of a Captisol-Enabled product --
    Geodon for Injection (ziprasidone mesylate), the first atypical antipsychotic intramuscular
    therapy for rapid control of acute agitation in schizophrenia from Pfizer Inc.
    CAPTISOL is an advanced formulation system that improves the solubility of drug compounds.
    Pfizer received clearance from the Food and Drug Administration for use of Geodon for Injection to rapidly control agitated behavior in patients with
    schizophrenia. Geodon for Injection , an intramuscular formulation for acute therapy, complements Geodon (ziprasidone HCl) capsules that have been available in the United States since the first quarter of 2001. Pfizer first launched both the oral and intramuscular forms in 2000 in Sweden (under the trade names Zeldox and Zeldox IM). Zeldox IM is currently approved in seventeen other countries including Germany, Spain and Brazil .


  • Edmonton Journal September 11, 2002
    LENGTH: 690 words

    A personal look at schizophrenia

    By Mike Sadava

    Alex Viszmeg's film about schizophrenia doesn't have the Hollywood lustre of A Beautiful Mind, but his first-hand knowledge of the illness could take the viewer further into understanding the nature of the beast.

    Viszmeg's 42-minute video Invisible Odyssey, which premieres Thursday night at the Metro Cinema, might be the first movie on the subject made by someone who suffers from schizophrenia.

    At a preview he gave me Tuesday in the offices of FAVA, the Film and Video Arts Society of Alberta, I found the film to be enlightening, disturbing like a bad drug trip, at times overwhelming, yet striking a note of hope.

    Interviews, electronic music, surrealistic poetry, clips from the classic Lon Chaney movie The Wolf Man and clips from an old National Film Board series about schizophrenia are interwoven with footage from Viszmeg's experimental films and random images.

    It's not exactly pleasant viewing, hearing about the voices in people's heads, paranoia and the strange hallucinations, but it starts to give an inkling of what it's like to suffer from this illness.

    In an interview in the FAVA smoking room (like most schizophrenics, Viszmeg is a chain smoker), he says he was concerned about turning people off when he made the movie, but he was also determined not to softpedal the reality of the disease. "It's sort of a sketch of what it's like. But everyone is individual, and everyone has his own story."

    The upbeat ending comes from sufferers and medical professionals alike talking about the improvements in drug therapies, and how people with schizophrenia can improve their lives by doing activities they are passionate about. For example, an artist who describes how he takes refuge in sketching during the dark moments asserts that people with schizophrenia can be
    productive, that they are not "discards" from society.

    "I wanted the ending to be up -- it's a dark journey, but to come out of it with some hope."

    This film has been the product of Viszmeg's journey through schizophrenia and more than 25 years' worth of involvement in film.

    Now 48, he graduated from Ryerson in film arts in 1978. Acetate seems to run in the blood of the Viszmeg family -- his brother was the late Joe Viszmeg, a well-known Edmonton filmmaker who received national exposure for his moving films about his battle with cancer, which killed him three years ago.

    A native of Cobourg, Ont., Alex moved to Edmonton in the 1980s after Joe was established here and was working at post-production and film processing, and making his own experimental films.

    He was diagnosed with schizophrenia in 1989, after what he calls a long period of denial.

    Ironically, film, which has been his salvation, also may have contributed to the onset of schizophrenia. He was working in total darkness processing film, and his mind started playing tricks on him.

    He has been living on a disability pension and is on medication, but thankfully on a dosage that's low enough that he doesn't suffer from the bloating that's a common side-effect of the drug therapy.

    He got the idea for the video about five years ago, after noticing a dearth of information in the media about schizophrenia.

    With support from the Canada Council, the Alberta Foundation for the Arts and FAVA, he started production in 1999. He hopes it will get play in festivals and be used for educational purposes, and possibly be broadcast.

    He says it's neither a narrative nor a documentary, but an effort to fit a bunch of pieces together. The clips from The Wolf Man, for instance, draw out a parallel between a mental illness and the mythical stigma of being a werewolf.

    "The Wolf Man, he's torn inside about what's happening to him and he doesn't know what's going on."


    03 September 2002

    Use of schizophrenia medications not a case of new replacing old

    Researchers from the US find that the dynamic nature of pharmacotherapy for schizophrenia makes it important for both conventional and atypical antipsychotics to be included in drug formularies.

    Douglas Leslie (Yale School of Medicine, New Haven, Connecticut) and Robert Rosenheck (Veteran's Affairs Connecticut Mental Illness Research, Education, and Clinical Center, West Haven, Connecticut) looked at how the newer atypical antipsychotics, clozapine, risperidone, olanzapine, and quetiapine, have been "diffused" in a national healthcare system.

    Of 27,323 patients, 12,440 received conventional antipsychotics, 7649 received risperidone, 6613 were prescribed clozapine, and the remaining 621 took quetiapine.

    Patients who had stable prescriptions of clozapine were the least likely to be switched (18%), while patients receiving quetiapine were the most likely to be switched (37%).

    Interestingly, those with regular prescriptions of conventional antipsychotics stayed on their medication the longest before switching.

    Furthermore, olanzapine was the most common drug for patients to be switched to (1907), followed by risperidone (1581), conventional antipsychotics (1140), quetiapine (758), and clozapine (40).

    The team notes that only 31% of patients who switched maintained a stable regimen on their new medication.

    Based on the findings, the team concludes "that the growth in the use of atypical medications does not result from a simple replacement of the older drugs with the newer agents but from a more dynamic process of iterative decision making."

    The study is published in the American Journal of Psychiatry.

    Am J Psychiatry 2002; 159: 1534–1540


  • From: www.psychiatrymatters.md

    21 August 2002 Amisulpride improves depressive symptoms in schizophrenia


    Researchers have found amisulpride to be superior to haloperidol and risperidone for the treatment of depression in patients with schizophrenia.

    Noting that the treatment of affective symptoms in patients with schizophrenia remains a challenge, Jozef Peuskens (Universitair Centrum Sint Jozef, Kortenberg, Belgium) and colleagues pooled data from three separate studies involving 612 patients with schizophrenia who were treated with amisulpride, risperidone, or haloperidol.

    Eur Neuropsychopharm 2002; 12: 305––310


    September 27, 2002

    NEUROLOGY: deCODE publishes landmark study linking the Neuregulin 1 gene to schizophrenia

    deCODE genetics (DCGN) announced the publication of a paper describing the company's work on the genetics of schizophrenia.

    The paper presents data from deCODE's population genetics research linking Neuregulin 1 to schizophrenia, as well as the results of subsequent functional studies underscoring the role of this gene in the pathology of the disease. The Neuregulin pathway has yielded druggable targets, which deCODE is employing in its collaboration with Roche to discover new and more effective treatments for schizophrenia. The paper, entitled "Neuregulin 1 and susceptibility to schizophrenia," has been published in the online edition of the American Journal of Human Genetics.

    deCODE scientists succeeded in establishing the link between schizophrenia and the Neuregulin 1 gene, located on the short arm of chromosome 8, by leveraging the company's resources for pinpointing key genes involved in common diseases. These include a genealogical database covering the entire Icelandic population; unrivalled genotyping capacity and know-how; and the company's high-density genetic map of the human genome. deCODE's research brought together genome-wide and detailed genotypic data from more than 800 volunteer patients and unaffected relatives from across Iceland.

    The findings reported are further supported by at least five previous studies that offered suggestive linkage between schizophrenia and a region on the short arm of chromosome 8 containing the Neuregulin 1 gene.


    September 27, 2002

    HEADLINE: SCHIZOPHRENIA: Cause may be interaction of genes and viruses in glia cells

    A report in the open-access journal BMC Psychiatry presents a new hypothesis that may explain the causes of schizophrenia.

    The hypothesis hinges on glia, a special type of cell that is important for the maintenance of the connections between brain cells. By re-examining previously published research, the authors suggested that schizophrenia may be caused by a combination of defective genes, which result in deficiencies of a variety of growth factors in glia, and infection by viruses, which may further weaken the glia. They concluded that this "weakening" of glia may result in the breakdown of connections between brain cells leading to the development of schizophrenia.

    It is clear that schizophrenia has a strong genetic component; however analysis of individual genes alone will not give us a full understanding the causes of schizophrenia.

    Irving Gottesman, one of the authors of this paper and originator of the now widely accepted polygenic model of schizophrenia explained, "The investigation of individual genes in isolation has its limitations since virtually all important biological phenomena, from normal brain functioning to schizophrenia, are the result of complex systems. What is needed is a systems approach for understanding the development of schizophrenia."

    This insight motivated Gottesman, and his colleagues Hans Moises and Tomas Zoega, to apply such an approach to previously published results of schizophrenia research.

    Human brains are made up of two main types of cells, nerve cells, which carry electrical impulses around the brain and glia, which are important for the normal development of the brain in the young and the maintenance of nerve connections in adults. The authors argued that many of the genes implicated in the development of schizophrenia code for factors involved in the development of glia cells.

    In addition they hypothesized that some viral infections may cause additional weakening of glial cells, which in turn may lead to the disruption of brain cell connections and the development of schizophrenia.

    "Epidemiological data indicate that all humans must harbor viruses in the glial cells of their brains, and since reproduction is a necessity for these viruses to survive, it seems reasonable to presume that they are reproducing at low levels in glial cells and that this results in an additional weakening of glial functioning", explained Moises.

    This new provocative hypothesis bridges the gap between several previously unrelated schizophrenia hypotheses, most notably the genetic, the neurodevelopmental and the virus hypotheses, thereby providing a unifying explanation for the development of schizophrenia. It is hoped that by testing this hypothesis in the laboratory, researchers will come up with new ways of treating this debilitating brain disease.

    Folks,

    I just got this link (below) from one of the top schizophrenia researchers (Dr. Irv. Gottesman). If you're more scientifically inclined - this may be of interest:

    http://www.biomedcentral.com/1471-244X/2/8

    Brian


    The Guardian (London)

    September 17, 2002

    No smoke without fear: Is there really a link between cannabis and psychosis? Robin Murray is in no doubt

    BYLINE: Robin Murray

    As a consultant psychiatrist working in the Maudsley Hospital, which serves the Brixton area, I have been surprised that in all the recent discussions about cannabis, there has been virtually no mention of the drug's relationship to psychosis.

    Psychiatrists have known for 150 years that heavy consumption of cannabis can produce hallucinations. This was thought to be rare and transient until the 1980s when, as cannabis consumption rose across Europe and the USA, it became apparent that people with chronic psychotic illnesses were more likely to be daily consumers of cannabis. Here in Britain, for example, people with schizophrenia do not take more alcohol, heroin, or ecstasy than the rest of us - but they are twice as likely to smoke cannabis regularly. Since people with schizophrenia have a miserable life, most psychiatrists initially thought that if the odd spliff brought them some pleasure, what was the harm? Then, in the mid-90s, a Dutch psychiatrist named Don Lintzen from the University Clinic in Amsterdam noted that people with schizophrenia who used a lot of cannabis had a much worse outcome than those who didn't. This was confirmed by other studies, including a four-year follow-up at the Maudsley Hospital. Those who continued to smoke cannabis were three times more likely to develop a chronic illness than those who didn't.

    Why does cannabis exacerbate psychosis? In schizophrenia, the hallucinations result from an excess of a brain chemical called dopamine. All the drugs that cause psychosis - amphetamines, cocaine and cannabis - increase the release of dopamine in the brain. In this way, they are distinct from illicit drugs such as heroin or morphine, which do not make psychosis worse.

    The distraught parents of a young man diagnosed with schizophrenia tell me that their son was a very bright child with no obvious psychological problems. Then, in his mid-teens, his school grades deteriorated and he seemed to have trouble thinking clearly. He complained that people were talking about him behind his back.

    After years of increasingly bizarre behaviour, he dropped out of school, job and university, and was finally admitted to a psychiatric unit, overwhelmed by paranoid fears and persecution by voices. The parents tell me that, at some point during this downward spiral, they realised their son was dependent on cannabis. The National Schizophrenia Fellowship (Rethink) is full of parents who see cannabis as the cause of their son's or, less commonly, daughter's madness.

    Psychiatrists began to wonder if cannabis could actually cause psychosis as well as make established psychosis worse. A famous study interviewed 50,000 conscripts into the Swedish Army about their drug consumption and followed them up. Those who were heavy consumers of cannabis at 18 were six times more likely to be diagnosed with schizophrenia over the next 15 years than those did not take it.

    This year, Dutch epidemiologist Jim Van Os published the results of his study, in which 7,500 people were interviewed about their drug consumption and followed up for three years. Once again, regular consumers of cannabis were more likely to develop psychosis than those who didn't. Two other studies with similar findings are in progress.

    It is perhaps surprising that it took the professionals so long to reach this conclusion. For example, it is widely accepted in Jamaica that too much ganja can cause paranoia. Several famous Rastafarians spent their last years incarcerated in Bellevue, the squalid mental hospital in Kingston, among them the legendary ska trombonist, Don Drummond.

    Cannabis is now one of the biggest problems on in-patient psychiatric wards in England's major cities. It is common at Maudsley for those making progress to relapse suddenly. The explanation comes when a urine sample tests positive for cannabis. The same effect has been shown at Yale Medical School, where volunteers were given THC - the major active ingredient of cannabis - by injection. Psychotic symptoms could be produced in normal subjects, and people with schizophrenia had a brief exacerbation of their psychosis.

    So will reclassifying cannabis cause more people to become psychotic? The incidence of schizophrenia in south London has doubled since the 1960s; the use of cannabis and cocaine could be a factor. The increase in the prevalence and the deteriorating outcomes of schizophrenia due to cannabis use is the main reason why psychiatric services in London are in such a mess.

    Any public debate on cannabis needs to take account of the risks as well as the pleasure. Pro-marijuana campaigners claim, extrapolating from their Saturday-night joint, that cannabis is totally safe. Yet they would be unlikely to claim that a bottle of vodka a day is healthy on the basis of sharing a bottle of Chablis over dinner.

    No drugs that alter brain chemistry are totally safe. Just as some who drink heavily become alcoholic, so a minority of those who smoke cannabis daily go psychotic. Society has to balance the enjoyment that the majority get from cannabis with the harm it causes to a vulnerable few.

    Robin Murray is professor of psychiatry at the Institute of Psychiatry, and consultant psychiatrist at the Maudsley Hospital.


    10 September 2002

    Multiple genes behind schizophrenia in isolated population

    US scientists have found that even in the most remote populations, schizophrenia is associated with multiple genes.

    William Byerley (University of California, Irvine) and colleagues investigated the genetic basis of schizophrenia in the geographically and culturally isolated population of Palau in Micronesia.

    Using markers every 10 centimorgans (cM), the researchers genotyped five, large multigenerational schizophrenia pedigrees, and found the number of affected/unaffected individuals in each family varied from 11/21 to 5/5.

    Fitting a simple dominant and recessive model to the data, the team were able to calculate a substantial logarithm of odds (LOD) score for each family. A LOD score of above 3 indicates that two loci are close together on a chromosome and are likely to be inherited together.

    "Predictably, the most informative pedigrees produced the best linkage results," the scientists comment. They reveal that one pedigree produced a LOD of 3.4 for the dominant model, with seven of nine individuals with schizophrenia, mainly third or fourth degree relatives, sharing a 15 cM haplotype on chromosome distal 5q.

    A second pedigree showed a promising LOD of 2.6 for the recessive model on chromosome distal 3q, while two other pedigrees showed modest LODs (>2) for 5q and 9p. The fifth pedigree produced no evidence of linkage, the researchers report.

    Writing in the journal Molecular Psychiatry, Byerley et al conclude: "Similar to the results for other populations, our results suggest that there are multiple genes conferring liability to schizophrenia even in the small population of Palau (roughly 21,000 individuals) in remote Oceania."

    Mol Psychiatry 2002; 7: 689–694

 

 

 


 

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