Schizophrenia Daily News Blog

Significant research has shown that there are psychological and social factors that are strongly linked to increased risk of schizophrenia.

A study completed last summer looked at the incidence of schizophrenia in the pacific islands of Micronesia and found significant variation in the rates of schizophrenia - in lands that have people with historically very similar biology and nutrition - suggesting that the variations that they find in these populations may be more likely due to societal (or psychological and social) factors.

As was reported in Science News:

"Although researchers routinely assume that this devastating fragmentation of thought and emotion occurs in 1 percent of people everywhere, it afflicts almost twice that level in Palau - or about 1.7% of the approximately 17,000 Palau residents at some time in their lives. Among Palauan men, schizophrenia's prevalence soars as high as 2.8 percent. Yet in other parts of Micronesia, the schizophrenia rate dips as low as 0.4 percent."

The researchers note "Research on Palau ... underscores how environmental and cultural challenges interact with the numerous genes that studies have linked to schizophrenia." The new Palau findings—published in the April Current Anthropology along with comments from six researchers—contribute to growing evidence that schizophrenia especially targets two groups: men and recent immigrants to various countries.

The researchers believe that schizophrenia impacts men much worse than women because the stress of the role changes for a male as he enters puberty is much higher than it is for women, and the outcomes are also much worse for men than women because if women begin having psychological problems their family will be supportive towards them, but men "typically receive scant family and clan support."

Moreover, the researchers note, a man in rural Palau "has few job options and little ability to fulfill customary obligations to repay family members for their prior assistance. As an undesirable marriage partner, he misses out on traditional transfers of family wealth to married men."

The researchers note that "The combination of stress and rejection twists their schizophrenia into a much knottier disorder than it would otherwise become, Sullivan asserts."

Professor Sullivan now plans an additional 1-year study of symptom progression, social support, and social activities among Palauans with schizophrenia.

Read the full story: Trouble in Paradise (Science News)

Related Reading:

Social Factors in the Development of Schizophrenia: A Review of Recent Findings

Causes of Schizophrenia

Prevention Tactics for Schizophrenia

Major mental disorders cost the nation at least $193 billion annually in lost earnings alone, according to a new study funded by the National Institutes of Health's National Institute of Mental Health (NIMH). The study was published in the May 2008 issue of the American Journal of Psychiatry.

"Lost earning potential, costs associated with treating coexisting conditions, Social Security payments, homelessness and incarceration are just some of the indirect costs associated with mental illnesses that have been difficult to quantify," said NIMH Director Thomas R. Insel, M.D. "This study shows us that just one source of these indirect costs is staggeringly high."

Direct costs associated with mental disorders like medication, clinic visits, and hospitalization are relatively easy to quantify, but they reveal only a small portion of the economic burden these illnesses place on society. Indirect costs like lost earnings likely account for enormous expenses, but they are very difficult to define and estimate.

In the new study, Ronald C. Kessler, Ph.D., of Harvard University, and colleagues analyzed data from the 2002 National Comorbidity Survey Replication (NCS-R) , a nationally representative study of Americans age 18 to 64.

Using data from 4,982 respondents, the researchers calculated the amount of earnings lost in the year prior to the survey among people with serious mental illness (SMI). SMI is a broad category of illnesses that includes mood and anxiety disorders that have seriously impaired a person’s ability to function for at least 30 days in the year prior to the survey. It also includes cases of any mental disorder associated with life-threatening suicidal behaviors or repeated acts of violence.

Eighty-six percent of respondents reported earning income in the previous year. But those with SMI reported earning significantly less—around $22,545—than respondents without SMI, who averaged $38,852. Although men with SMI took a greater hit in earnings than women with SMI, men still earned more overall than women with and without SMI.

By extrapolating these results to the general population, the researchers calculated that SMI costs society $193.2 billion annually in lost earnings. The researchers attributed about 75 percent of this total to the reduced income that people with SMI likely earn, while 25 percent is attributed to the increased likelihood that people with SMI would have no earnings.

“The results of this study confirm the belief that mental disorders contribute to enormous losses of human productivity,” said Kessler. “Yet this estimate is probably conservative because the NCS-R did not assess people in hospitals or prisons, and included very few participants with autism, schizophrenia or other chronic illnesses that are known to greatly affect a person’s ability to work. The actual costs are probably higher than what we have estimated.”

The researchers concluded by recommending that future studies on the effectiveness of treatments should consider measuring employment status and earnings over the long term to document the effects of mental disorders on a person’s functioning and ability to remain productive.

Additional reading: Tallying Mental Illness' Costs (Time Magazine)

Journal Reference: The individual-level and societal-level effects of mental disorders on earnings in the United States: Results from the National Comorbidity Survey Replication. American Journal of Psychiatry, 2008 May.

A growing body of economic research suggests that public investment in early childhood programs may be able to lower public costs for social services by improving children's long-term welfare, according to a new RAND Corporation report.

Such research could promote a reorientation of child and human services toward investment and prevention, moving away from the current system that seeks to “treat” problems (including mental illness) that develop later in life, according to the report.

But economic analysis of early childhood programs does not necessarily result in clear direction about what is the single best approach to any problem, according to researchers. Instead, economic research is more likely to highlight a spectrum of promising services and provide guidance about how to choose an optimal level of each program.

The RAND report is intended to provide policymakers with a primer about how economic analysis can help set agendas for early childhood policy and identify the economic benefits of targeting certain groups for help.

“Economic analysis increasingly plays a role in the debate on the merits of early childhood programs, but many people are unprepared to participate in the discussion,” said Rebecca Kilburn, the report’s lead author and an economist at RAND, a nonprofit research organization. “The report is intended to provide clarity and structure for making use of such research.”

Interest in using economics to help analyze early childhood policies has grown as business CEOs, Federal Reserve Bank analysts, and Nobel Prize-winning economists have called for increased public spending on early childhood programs.

Two overarching concepts from economic research have become important in discussions of early childhood policy -- human capital theory and monetary “payoffs” from investments in early childhood programs.

Human capital theory is an economic model that provides a framework that brings together current thinking about early childhood policy, including the concept that later skills build on skills developed earlier in life. The theory accounts for such concepts as nature and nurture, and the idea that capabilities involve multiple dimensions.

Probably the most widely recognized intersection between economics and early childhood policy is in the analysis of the costs and benefits of early childhood programs such as home visiting and preschool. Such analysis typically compares the costs and benefits of early childhood programs to determine the “rate of return” the public will receive for money spent on such efforts.

A growing body of program evaluations shows that investments in early childhood programs can generate government savings by, for example, reducing the need to provide social services later in life or by improving individuals’ earnings, which then generates more tax revenue.

Kilburn and co-author Lynn Karoly write that an increasing body of knowledge has demonstrated how poorly U.S. children fare compared to their counterparts in other developed countries. Research has shown that U.S. babies increasingly are born with low birth weights, elementary-age children are overweight and asthmatic at growing rates, and more than 700,000 children spend time in foster care each year.

In addition, research from the fields of neuroscience, developmental psychology and program evaluation has shown how early experiences help determine how a person’s brain develops and that effective early intervention strategies can improve a wide range of outcomes from childhood through early adulthood.

While many studies have found that the cost of early childhood programs can produce long-term benefits that offset their costs, not every early childhood program does so, according to the RAND report.

In addition, researchers caution that evidence suggests that the returns from early childhood programs may decline under certain conditions. While monetary benefits can remain positive for universal programs, the rate of return may be higher when programs are targeted toward the groups likely to benefit from them the most, according to the report.

There also is recognition that the benefits from early childhood interventions may be tied to the quality of those interventions, but higher quality often costs more. Unless funding grows, researchers say, shifting toward higher quality may mean that fewer children can be served.

###

The study, “The Economics of Early Childhood Policy: What the Dismal Science Has to Say About Investing in Children,” is available at www.rand.org. Support for study was provided by Casey Family Programs.

The RAND Labor and Population program examines issues involving U.S. labor markets, the demographics of families and children, social welfare policy, the social and economic functioning of the elderly, and economic and social change in developing countries.

We've covered in the past how high levels of stress that a child experiences when they are in the womb and in young childhood can amplify the stress response system of the child's brain so that high levels of stress hormones are frequently released in the brain. When this happens for a long time - researchers now believe that it can damage the brain and increase the risk of many problems - including memory problems, cognitive functioning, and increased risk of serious mental illness. (read more here). Research is suggesting that many children who develop mental illness and experience either very high stress hormone levels, or artificially low stress hormone levels, have experienced high levels of stress at an early age.

Now a new research study shows that the ongoing stress of having a mother who cannot respond to a child's needs due to serious depression - causes a great deal of stress for the child, and can damage the child's brain so that stress hormone levels are permanently set at very low levels. Postpartum depression is common around the world in women of all income brackets - in fact its estimated that postpartum depression is experienced by between 10% and 15% (or more) of women.

In this new study of young children living in extreme poverty it was found that those whose mothers showed symptoms of depression had low levels of cortisol, a hormone activated during times of stress, compared with children whose mothers did not exhibit depressive symptoms.

The researchers say the blunted cortisol levels they found in some children may indicate an adaptive response to chronic stress on the hypothalamic-pituitary-adrenal (HPA) system, which is responsible for producing hormones that help our bodies respond to stressful situations.

Cortisol is a corticosteroid hormone pumped out by the adrenal glands as part of a body's fight-or-flight response to stress. It raises blood pressure and blood sugar levels to help with quick bursts of energy, and is naturally found at higher levels in the early morning, declining to its lowest point at bedtime.

"Many people assume that the only way the body responds to constant stress is to produce too much cortisol, but repeated stress can also cause the HPA system to shut down so that you are not producing cortisol when you normally should," said Lia Fernald, assistant professor of community health and human development at the University of California, Berkeley, and lead author of the study.

The findings, appearing in the Spring 2008 issue of the journal Development and Psychopathology, highlight a biological effect in children who are facing not only economic deprivation, but also an added risk of possible depression in a key caregiver, the researchers said.

"The unexpectedly low levels of cortisol we found are most likely an expression of chronic, intense, long-term stress on the HPA system," said Megan Gunnar, professor of child development at the University of Minnesota and co-author of the study. "Really high increases over a period of time end up driving the system to the ground."

Awareness of hypo-cortisol levels has grown in the past five to 10 years, said Gunnar, a developmental psychobiologist. The researchers said that depressed levels of cortisol have been seen a few times before in young children, including in studies of neglected children in Romanian orphanages and preschoolers who experienced repeated bouts of foster care beginning in infancy.

The few studies that have been done suggest a link between low cortisol levels in children and disruptive behavior disorders, including aggression.

This new study is part of a larger project studying social welfare interventions for low-income families in Mexico. Researchers focused on children in some of Mexico's poorest regions, areas identified through a baseline census of families across the country. The study's sample of 639 children, ages 2.5 to 5, live in a region where the median per capita income is $730 per year, more than 14 times lower than the national figure in Mexico of approximately $10,000 per year. Approximately 40 percent of the children come from homes without electricity or running water, and many are from isolated indigenous communities.

In 2003, a research team of health professionals paid unannounced visits to homes in the low-income regions, providing verbal explanations of the goals and risks of research to participants and obtaining informed consent from the mothers. The researchers conducted one-hour interviews with each mother that included a standard screening test used to assess symptoms of depression. Although the screening tool has not been extensively used in Mexico, it has been used in the United States, where a score of 16 or higher indicates that the respondent is at risk for clinical depression.

More than 60 percent of the mothers in the study scored above 16, with 10 percent scoring above 35.

At the same time the mother was being interviewed, the researchers selected one child, usually the eldest, to undergo cognitive tests. They also took three samples of saliva from the child throughout the hour to determine whether any significant changes in levels occurred during the visit, and they controlled for the time of day the sample was taken.

The initial saliva sample, collected approximately five minutes after arrival in the home, represented baseline cortisol levels, since it takes more than five minutes for stress activations of the HPA system to raise cortisol concentrations in saliva. It takes about 20 to 25 minutes for the hormone's secretion to reach peak levels.

The unexpected presence of strangers was used by researchers as a mild stressor for young children. The administration of standardized cognitive tasks to assess language and cognitive competence was a second mild stressor for the children.

These are situations in which it would be normal for cortisol levels to increase moderately, said Fernald.

The researchers found that for all children, higher maternal scores on the depression screening tool were linked to the youngsters' lower overall cortisol levels. The baseline values for salivary cortisol in the children averaged 2.78 nanomoles per liter; about two to 2.5 times lower than what a typical middle class child in the United States would be showing at the same time of day.

"This study speaks to the fact that maternal depression, particularly when it goes along with poverty, really needs to be addressed," said Fernald. "Public health interventions typically focus on physical health, such as promoting immunizations and preventing malnutrition. However, we are seeing that a mother's mental health could be a critical factor influencing the physiology of their kids."

Moreover, the researchers found a greater impact of maternal depression symptoms on girls than on boys. Girls whose mothers had a greater number of depressive symptoms had the lowest baseline levels of cortisol.

"It is unclear why a larger effect was seen among girls, but I would suspect that it would be necessary to go beyond biology for an explanation," said Gunnar. "It may be related to the unique relationship between mothers and daughters, and the possibility that daughters often spend more time in the home."

"Maternal depression is very tough on little kids because it interferes with the mother's capacity to be responsive and supportive," added Gunnar. "On the flip side of that is that a mother who can provide supportive care can buffer her children from a lot of adversity. Other studies have shown that. But of course, it's hard to be sensitive and supportive to the demands of young children when you are struggling emotionally and physically with trying to live in extremely impoverished conditions."

The study was also co-authored by Heather Burke, assistant adjunct professor of psychiatry at UC San Francisco.

Source Journal Article: Salivary cortisol levels in children of low-income women with high depressive symptomatology

Related Reading:

New Moms at Increased Risk for Mental Illness, Should be Screened After Childbirth

Pregnancy and Schizophrenia - The Importance of Low Stress During Pregnancy for Healthy Brain Development

How To Lower the Stress Your Baby Experiences, and Lower the Risk of Mental Illness

Treat depression during pregnancy, researchers urge

Schizophrenia Prevention - Risk Reduction Approaches

The following is a marketing release from a developer of a new medication that they hope will eventually prove successful in treating schizophrenia. It is, however, still very early in the testing - and is only entering Phase 1 of a 3-phase process that will likely take another 4 to 6 years. Its positive to see these new medications in development - but only time will tell if it passes the required FDA tests that would allow it to be offered to the public, and if it is ever ultimately effective in helping people with schizophrenia, and whether it has a positive side-effect profile.

ARYx Therapeutics, Inc. announced that it has received clearance from the Food and Drug Administration (FDA) to initiate clinical testing of ATI-9242, a new antipsychotic for the treatment of schizophrenia and other psychiatric disorders. The company has begun dosing healthy volunteers with ATI-9242 in a Phase 1 safety study being conducted under an Investigational New Drug application (IND).

ATI-9242 is designed as a next-generation atypical antipsychotic agent. Its receptor profile is targeted at the treatment of both the positive and the negative symptoms of schizophrenia as well as the improvement of cognitive function. To date, preclinical work has supported this profile. ATI-9242 was also designed to avoid certain drug-drug interactions as well as reduce certain metabolic problems associated with this class of therapy, including weight gain and type 2 diabetes.

"ATI-9242 is a new compound with potential for significant utility in the treatment of psychiatric disorders," said Dr. Paul Goddard, Chairman and Chief Executive Officer of ARYx. "I am excited to have initiated human studies ahead of schedule, and I am appreciative of the pioneering work done by ARYx's research team, led by our Chief Scientific Officer, Dr. Pascal Druzgala, to enable rapid advancement of this compound into the clinic."

ARYx expects to complete the Phase 1 study by the end of 2008.

Trial Design

The current study, CLN-901, is a Phase 1, single center, randomized, double-blind, placebo controlled, single ascending dose, safety, tolerability, and pharmacokinetics (PK) study. Healthy subjects will be studied in groups of five and will receive ATI-9242 at one dose level or matching placebo. Four of the five subjects in each cohort will be randomly assigned to receive active study medication, and one of the five subjects will be randomly assigned to receive placebo. Each successive group will receive an increased dose of the drug and the dose will continue to be increased until a clear pharmacological effect is observed.

Time down on the farm with animals could provide some therapeutic benefit for people with mental illness, according to researchers writing in the open access journal Clinical Practice and Epidemiology in Mental Health. The results come from the first randomized controlled study of the benefits of farm animals, as opposed to domestic pets.

Bente Berget and Bjarne Braastad of the Norwegian University of Life Sciences in Ås, working with Øivind Ekeberg of the University of Oslo, Norway, note that the benefits of animal-assisted therapy (AAT) for mental disorders using cats and dogs has been well studied. However, until now, there have been no controlled trials of farm animals in treating psychiatric disorders.

The use of farms in promoting human mental and physical health in cooperation with health authorities is increasing in Europe and the USA, particularly under the Green care banner. Historically, the approach was associated with hospitals, psychiatric departments and other health institutions but today, most Green care projects involve community gardens, city farms, allotment gardens and farms.

To assess the benefits of Green care, the researchers asked ninety patients (59 women and 31 men) with schizophrenia, affective disorders, anxiety, and personality disorders to complete self-assessment questionnaires on quality of life, coping ability and self-efficacy, before a 12-week period spending three hours twice a week working with the farm animals.

The before and after results showed that AAT with farm animals had some positive effect on self-efficacy, the ability to cope, of patients with long-lasting psychiatric symptoms, their quality of life. "During the six months follow-up period self-efficacy was significantly better in the treatment group, but not in the control group," the researchers say.

They add that, "Further controlled studies are needed for confirmation and to more accurately define the psychiatric population with the greatest potential to benefit."

Read the related article: Better Mental Health, Down on the Farm (Free registration may be required, New York Times)

Source Journal Article:

1. Animal-assisted therapy with farm animals for persons with psychiatric disorders, effects on self-efficacy, coping ability and quality of life: a randomized controlled trial
Bente Berget, Øivind Ekeberg and Bjarne O Braastad
Clinical Practice and Epidemiology in Mental Health (in press)
Abstract available here.

Related Reading:

Psychiatric Service Dogs - A Source of Comfort

Caring For Cat Helps Woman With Schizophrenia

Pets Can Help Schizophrenia Patients

New research covered in the New Scientist magazine has identified now early childhood neglect can contribute to, or initiate, mental health problems that contribute to anger and aggressive behavior, and dopamine disruption that can increase risk of mental illness later in life. These findings confirm what a great deal of other research has shown - how important it is for parents to provide attentive, nurturing and responsive care giving to children early in life because it shapes a child's brain for the rest of their lives.

One study found that "Failing to care properly for a young child can be as damaging as physically or sexually abusing them, when it comes triggering aggression in later childhood."

See the science journal: Importance of Early Neglect for Childhood Aggression. The study indicated that "child neglect in the first 2 years of life may be a more-important precursor of childhood aggression than later neglect or physical abuse at any age."

An earlier study has also pointed out that "Early maternal neglect changes the expression of genes involved in the development of the dopamine system, research on mice has revealed. Dopamine disregulation has also been identified as a key factor in the development of schizophrenia.

Abnormal regulation of dopamine in the brain has been linked to drug abuse, depression and personality disorders - conditions that are also associated with childhood neglect in humans.

"Clearly, if the dopamine system of the brain is compromised, and if this can be extrapolated to humans, it could lead to greater susceptibility for drug dependence and perhaps greater vulnerability to develop certain psychiatric illnesses," says researcher Wayne Brake of the University of California, Santa Barbara."

This research is part of the rapidly growing body of evidence that reveals how the psychological and social environment of pregnant women, infants and young children can have a lasting biological impact on the development of the child. The areas of scientific research that are covering this important progress includes "social neuroscience", and epigenetics.

Read more:

Early neglect can trigger childhood aggression

Mothers' neglect changes infants' brain development, Causes Abnormal Regulation of Dopamine (a key brain chemical involved in schizophrenia)

Early verbal abuse may reduce language ability

How to Prevent Schizophrenia in Children - Risk Reduction Tactics

Is Schizophrenia Psychological Or Biological?

Epigenetics and Mental Illness - Child Care Has an Impact

Childcare, Genetics, Epigenetics and Schizophrenia

Childhood Emotional Abuse, Emotional Neglect and Schizophrenia

In-depth Information about Voices and Hallucinations

Psychosis is a term that is often misunderstood. It is a real medical condition and there are effective treatments available to improve the symptoms. Having psychotic symptoms is usually a puzzling and distressing experience. Common psychotic symptoms are hallucinations (hearing, seeing, sensing, and/or smelling things that others do not hear, see, sense and/or smell) and/or delusions (having an unusual belief that other people do not share).

What are some examples of hallucinations?

You may have experienced any of the following symptoms:

Symptom: Hearing things that other people don’t hear
Examples: Doors slamming, people talking or singing, whistling noises

Symptom: Seeing things that other people don't see
Examples: Objects in the street, people at one’s bedside

Symptom: Hearing a voice that tells you what to do, or criticizes you
Examples: “You are a loser;” “Everybody hates you;” “Don’t go to the party;” “Don’t get on the bus;” “Shove that pedestrian”

Symptom: Hearing a voice that tracks your actions during the day
Examples: “Now go to the store;” “You are stepping off the train;” “You are cooking some soup”

Symptom: Hearing more than one voice talking
Examples: Two distinct voices having a conversation

Symptom: Feeling things inside your body or on your skin that aren't there
Examples: Sensation of others doing something to your body; feeling people touch you

Symptom: Smelling things that aren't really there
Examples: Smoke, peppermint, feces

Symptom: Tasting things that you aren't eating at the time
Examples: Cigarettes, alcohol, metal

Additional Characteristics of Voices:

Most often hallucinations are the auditory type (hearing things or voices), although some people do experience tactile hallucinations (feeling sensations on your body) and/or visual hallucinations (seeing things). Olfactory hallucinations (tasting things you aren’t eating at the time) are less common.

Everyone’s experience with hallucinations can be a little different. Some people hear the voices outside of their head (e.g., it seems like the voice is coming from inside the bus, or in the doctor’s waiting room) and some people hear the voices inside their head. Some people believe voices are really people speaking to them. Others believe that the voices are “loud thoughts.”

For some, the voices might say negative or critical things to them. Some people with auditory hallucinations describe that their voices are not critical, but can be friendly or even complimentary. Some have even said that they have gotten so used to the voices, that they would miss them if they were gone. Other people with voices have the experience that a particular person is speaking to them in their head, like an ex-girlfriend, a teacher, or a deceased relative. Most of the time, hearing voices is a very annoying, distracting, and/or distressful experience for people.

Hearing Voices is More Common than People May Think:

It is important to remember that the human brain has a vulnerability to have psychotic symptoms like hearing voices or sensing things that aren’t really there. This means that under certain conditions or in certain situations, almost everyone (whether they have a psychiatric condition or not) could hear voices.

For example, studies have found that when people are deprived of sleep for periods of time or when they are in “sensory deprivation” chambers, they often hear voices. Individuals who are subjected to high-stress situations, like when people are taken as hostages or are in solitary confinement, also tend to hear voices or have physical sensations (e.g., someone touching you) that aren’t there. Severe medical infections like pneumonia might bring on hallucinations or other psychotic symptoms. There are also some medical conditions which can cause hallucinations, like some types of epilepsy (Temporal Lobe Epilepsy) and certain vision problems (called Charles Bonnet Syndrome). Finally, certain types of drugs, like methamphetamines or hallucinogenics (e.g., acid), could produce the experience of hearing voices.

Summary
Hallucinations are common, often disturbing symptoms.

Certain medical conditions and/or drug use can also cause hallucinations.

What causes hallucinations?

The exact cause of hallucinations is still fairly unknown. However, researchers think that it has to do with a combination of problems with the way the brain is functioning. Some specific information about the cause of hallucinations is as follows:

1. Too much dopamine:

• Dopamine is a chemical in the brain called a neurotransmitter that influences our emotions, thoughts, and behavior. Many studies have found that medications that increase dopamine levels in the brain tend to cause hallucinations. Medications that decrease dopamine levels tend to cause a decrease in hallucinations.
• As a result, hallucinations are thought to be related to dopamine in some way; however it is likely that other brain chemicals are also involved.

2. Attention difficulties:

• Due to irregularities in the brain, some people have trouble paying attention when there are many things going on at once (like when you are in crowded mall and there are lots of people talking and walking around, music playing, food smells, etc).
• Voices may occur when a person has “sensory overload” (e.g., when too many things are going on at once in the immediate environment).

3. Trouble separating internal events from external events:

• Some people, because of brain irregularities have trouble recognizing whether a thought they are having is coming from themselves or from another person or voice.
• For example, if you hear the sentence, “You are stupid” in your head, some people have trouble determining if they are saying that to themselves (as a thought they are having) or whether someone else is saying it to them in their head (like a voice).
• It is often the case that people will have a thought in their head but mistake it for the statement of another person. This is experienced as hearing voices.

4. Feeling judged or criticized by others:

• Some people feel like other people (people they know and also people in general) are judging them or criticize them, or intruding upon them. As a result, they may feel extra sensitive or vulnerable (like they can be easily upset, hurt, or put in danger). They may also feel helpless, like they can’t do anything about it.
• When people who have a biological vulnerability to psychosis AND they have these kinds of beliefs, voices can develop.

5. Stress:

• Just like other symptoms of schizophrenia, researchers have found that for people who have a vulnerability to psychosis, stress can be a cause to experiencing hallucinations in the first place.
• Stress can also play a role in how and when hallucinations get worse. In high stress times, voices may get louder, more frequent, or more hostile.

Common Reactions to Voices

Some people hear voices almost all of the time. Some people have experienced voices or visions only once or twice. Sometimes the voices or visions come and go. This can be related to stress Research studies have found that when new things or changes happen in a person’s life (good or bad), this may affect how severe the psychotic symptoms become.

Unfortunately, if the symptoms become bad enough, it can be a really distressing situation for the person and his/her family. This may mean that the person needs to go to the hospital to stay in a safe environment for a period of time.

How can hallucinations be treated?

It is important to understand that even with really good treatment, for some people, hallucinations will not completely be eliminated forever. For most people, one of the best treatments that can be received is learning some helpful coping skills so that the voices don’t interfere with their life and their goals.

*Remember also to avoid using drugs and alcohol because substances can increase the frequency and intensity of voices and other types of hallucinations.

Below are some common treatments for hallucinations:

Medications:
• Antipsychotic medications are used. Sometimes mood-stabilizing medications and/or antidepressant medications are used too. Medications are very important to control the frequency of hallucinations and the severity of the symptoms.

Cognitive Behavioral Therapy (CBT):

• Learning about hallucinations is an important part of treatment. People often feel scared and overwhelmed by voices. Becoming more educated can help you cope and learn that the voices are not as powerful as they may seem.

• Learning about your personal triggers for increases in voices (like not getting enough sleep, staying at home all day, using alcohol, feeling stressed out by finances, etc.) can help reduce or prevent them.

• Understanding the patterns of your voices (like when they tend to occur most often, what time of day, etc) and how you react to them (like yelling back, or crying, or doing whatever they say) can be helpful to plan ahead and develop more effective ways to cope. This can help these symptoms lessen over time. This can also lessen the distress you feel about voices in general.

We received notice today of the efforts of an advocacy group in India that is focused on changing portrayal of the mentally ill in a new movie in India.

Sadly, unlike the new generation of movies like "A Beautiful Mind" - there are many movies and TV programs being produced still that perpetuate ignorance about mental illness.

Advocacy groups like Torchbearers are leading the way by educating the public and media groups about the harm that these negative stereotypes cause.

"NEW DELHI: Long abused for creating slapstick and often distasteful humour in films, the portrayal of schizophrenics in an upcoming Rakesh Roshan film “Krazzy 4” has offended the sensibilities of several afflicted families who have demanded a change of the title and suitable censorship of its contents.

Historically eyed with dread and suspicion, schizophrenia (and other mental illnesses) is one such disease that raises paradoxical impressions of violence and mirth in the minds of the general public.

According to the spokesperson of Torchbearers (an Advocacy for Disabling Brain Illness) Rukmini Pillai, maligning and stigmatising people with mental afflictions by caricaturing them in movies was highly violative of their dignity and proved a deterrent to their inclinations of seeking timely medical advice. "

Read the entire story: Krazzy 4 kicks up a controversy

We encourage you to send letters of protest about this movie - and explain to the movie promoters that it represents a lack of knowledge about mental illness and perpetuates negative stereotypes.

The movie is called "Krazzy4" (here is the web site) and its being released worldwide on April 11th. We recommend you send emails to all of these people:

Press Contacts
UK: vaishali.malhotra@erosintl.com
US: leena.pahuja@erosintl.com
India: amita.naidu@erosmultimedia.net

Torchbearers suggests:

"Yes it would be wonderful if you could get people to write to these people. It would really help. When there is a problem with a Hollywood movie a lot of people protest.Can that be done in US and UK - about Krazzy 4? Lots of letters and some press reporting? Probably that would catch our Government's attention."

The Torchbearers is a group of parent Advocates for the mentally ill in India - if you have any tips or suggestions on how they can further their cause - I recommend you drop them an email at:

torchbearers.r@gmail.com

Torchbearers reports:

"The Secretary ( the senior most civil servant in the Ministry ), Ministry of Information and Broadcasting had told me on Friday that the movie would be reviewed with a mental health expert. Today I rang up to find out the name of the mental health expert. The Secretary was unavailable. Her PS said that she had made notes in the petition and the file was with the Joint Secretary (Films). He was very evasive. He said that once the film was certified it could not be done again. When I told him that I was assured by the Secretary he said,' Why are you going on calling me Madam. Please let me do my work."

I plan to use the Right to Information Act to find out who is the mental health expert who certified the film. I will do that tomorrow.

Also have petitioned the Central Mental Health Authority of India who is supposed to oversee the National Mental Health Programme.

We have used 'stigmatisation' coming in the way of treatment etc...The link is given below.

India - National Mental Health Program Legislation

Also have requested meeting with the Health Minister and the Chairman of the National Commission of Human Rights(NCHR). The NCHR is sympathetic to homeless mentally ill women and the thousand patients abandoned in the 37 mental hospitals of the country.

Generally families are put in the dock for abandoning their family member although there are millions of families taking care of people with mental illness."

A virtual reality Underground (subway) ride has been used by UK researchers to reveal the extent that paranoia occurs in the general public. This research is interesting to us at schizophrenia.com because it highlights that many symptoms of schizophrenia are simply extreme versions of common thoughts and behaviors in society.

The research, funded by the Wellcome Trust in England, demonstrates that suspicious or paranoid thoughts are much more common in the general population than was previously thought and that they are almost as common as anxiety and depression.

Until now, researchers have been unable to study paranoia (exaggerated fears about threats from others) in laboratory settings, instead relying on questionnaires, which can be inaccurate. A collaboration led by Dr Daniel Freeman, a Wellcome Trust researcher at the Institute of Psychiatry, King's College London, has developed a computer simulation to study paranoid thoughts.

"Paranoid thoughts are often triggered by ambiguous events such as people looking in one's direction or hearing laughter in a room but it is very difficult to recreate such social interactions," says Dr Freeman. "Virtual reality allows us to do just that, to look at how different people interpret exactly the same social situation. It is a uniquely powerful method to detect those liable to misinterpret other people."

Wearing virtual reality headsets, 200 volunteers broadly representative of the general population walked around a virtual London Underground carriage in a four-minute journey between station stops. The carriage contained neutral computer people (avatars) that breathed, looked around and sometimes met the gaze of the participants. One avatar read a newspaper; another would occasionally smile if looked at. A soundtrack of a train carriage was played.

Dr Freeman and colleagues found that the participants interpreted the same computer characters very differently. The most common reaction was to find the virtual reality characters friendly or neutral, but almost 40 per cent of the participants experienced at least one paranoid thought. The participants were extensively assessed before entering the train ride, and it was found that those who were anxious, worried, focused on the worst-case scenarios and had low self-esteem were the most likely to have paranoid thoughts. The results of the study are published today in the 'British Journal of Psychiatry'.

Comments about the virtual reality characters by participants who experienced paranoid thoughts included:

* "There was a guy spooking me out - tried to get away from him. Didn't like his face. I'm sure he looked at me more than a couple of times though might be imagining it."
* "A girl kept moving her hand. Looked like she was a pickpocket and would pass it to the person standing opposite her."
* "Felt trapped between two men in the doorway. As a woman I'm a lot more suspicious of men. Didn't like the close proximity of the men. The guy opposite may have had sexual intent, manipulation or whatever."
* "There's something dodgy about one guy. Like he was about to do something - assault someone, plant a bomb, say something not nice to me, be aggressive."

"In the past, only those with a severe mental illness were thought to experience paranoid thoughts, but now we know that this is simply not the case," says Dr Freeman. "About one-third of the general population regularly experiences persecutory thoughts. This shouldn't be surprising. At the heart of all social interactions is a vital judgment whether to trust or mistrust, but it is a judgement that is error-prone. We are more likely to make paranoid errors if we are anxious, ruminate and have had bad experiences from others in the past."

Dr Freeman believes that paranoid thoughts are more likely to develop in settings such as on public transport, where people can feel trapped and observed, and can't hear what others are saying. People who feared terrorism on the Underground tended to report more paranoid thoughts in the virtual train, possibly reflecting the after-effects of the London bombings on 7 July 2005. However, the researchers also found that people who regularly used the Underground experienced less paranoid thoughts in the virtual train.

"Paranoid thinking is a topic of national discussion given increasing public attention to threats such as terrorism," says Dr Freeman. "It sometimes seems as if the one thing that unites the diverse peoples of the world is our fear of one another. Worries about other people are so common that they seem to be an essential - if unwelcome - part of what it means to be human."

Paranoia is increasingly being treated using cognitive behavioral therapy (CBT). Dr Freeman believes that in the future virtual reality may be used as a tool in clinical assessment and be incorporated into CBT interventions for paranoia, allowing patients to test out their fears in virtual worlds.

Source: Welcome Trust

Research Paper Source: Virtual reality study of paranoid thinking in the general population

Related Reading:

New Book: "Overcoming Paranoid and Suspicious Thoughts"

CBT for Schizophrenia - Interview with Experts

Cognitive Behavioral Therapy for Schizophrenia - List of US Providers

Cognitive Behavioral Therapy and Schizophrenia

Research has shown that there are a few minor differences between the brains of men and women. New research by neuroscientist Adrianna Mendrek indicates a reversal of these differences in the brains of schizophrenics.

"In comparison to the general population, women's brains seem masculine and men's brains seem feminine," says Mendrek, a researcher from the Centre de recherche Fernand-Seguin that is affiliated with the Université de Montréal's Department of Psychiatry.

The main difference between a man’s brain and a woman's brain has to do with how certain structures and circuits treat emotion. These structures and circuits are usually more elaborate in a woman’s brain. Mendrek wanted to know how a schizophrenic’s brain would react to certain emotional stimuli.

Image: Differences in activation of brains, in white, of men (top row) and women (bottom row) schizophrenics. (Credit: Image courtesy of University of Montreal)

The researcher showed two film excerpts to her test subjects: the first was sad, and the second showed anger. Meanwhile, her subjects underwent an fMRI as they watched the films. The sad film activated certain parts of the male brain that remained unaffected in women. The angry excerpts activated more elaborate and more intense reactions in men.

“These results are surprising seeing as women are usually more emotionally expressive than men,” says Mendrek. “The differences aren’t the result of drugs or of subjective past experience seeing as the emotions were felt identically in all subjects.” But according to the researcher, the profiles of activation in women would indicate that they have more difficulty integrating cognition and emotion associated to stimuli related to empathy.

Dr. Mendrek notes on her web site:

"I have used fMRI to explore sex differences in the cerebral function associated with the emotion processing in schizophrenia. The existence of sex differences in various aspects of epidemiology and phenomenology of schizophrenia was already noted by Kraepelin at the beginning of the 20th century.

Today it is widely acknowledged that men have poorer premorbid functioning, earlier age at onset, worse response to treatment, and more severe course of the illness, than women. Men with the diagnosis of schizophrenia exhibit more pronounced negative symptoms such as social withdrawal, blunted affect and poverty of speech, whereas women display more affective symptoms such as dysphoria, impulsivity, inappropriate affect, as well as more atypical psychotic symptoms.

Recent neuroanatomical studies imply a reversal of normal sexual dimorphism in schizophrenia. Prompted by these reports we have analyzed data of fifteen men and ten women with the diagnosis of schizophrenia who underwent functional magnetic resonance imaging (fMRI) during exposure to two emotion processing tasks: sad vs. neutral film clips, and aversive vs. neutral pictures.

Overall both tests evoked much more extensive and intense cerebral activations in men than in women with schizophrenia. The pattern of obtained results differs significantly from what has been observed in the general population, thus giving support for the recent suggestion of “masculinization” of females and “feminization” of males with schizophrenia (at least at the neuroanatomical level)."

Source: University of Montreal (2008, April 1). Schizophrenic Brains Show Sex Pattern Reversal, Compared With General Population.

Second generation "Atypical" antipsychotic drugs are not much better than the older, less expensive Haldol treating a first episode of schizophrenia, according to a study done by Dutch researchers that was published in the British Medical journal "The Lancet". However, the researchers also said that more patients prefer the newer drugs and will likely continue using for longer than haloperidol (Haldol).

In comparing the medications the researchers did an open randomized trial involving 498 patients between the ages of 18 to 40 years. The study participants were given either the old drug haloperidol (Haldol) or one of four higher-dose new drugs -- Seroquel, Zyprexa, Pfizer Inc's Geodon or Sanofi-Aventis SA's Solian.

During the next 12 months 63 of the patients that were on haloperidol stopped treatment compared to 51 on Seroquel, 32 on Solian, 31 on Geodon and 30 on Zyprexa.

The reductions in symptoms that was experienced by the study participants were about the same for all groups and medications, at around 60 percent, and there were no significant differences between the drugs according to sex, tendencies towards suicide and substance abuse.

The Dutch study received funding from AstraZeneca, Pfizer and Sanofi.

Related Reading: Haloperidol Holds Its Own Against Second-Generation Antipsychotics for Schizophrenia

Research Paper Source: The Lancet, Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial March, 2008.