Medications and Treatment

Long Term Management and Prevention of Schizophrenia

Biology and Current Research:

New Class of Psych Drugs on Horizon
 

The information in the following story was contained in an email sent to the administrative inbox as a "UBC Media Release". I was unable to find any sort of published research or other news releases, so I assume it is still in the preliminary stages of development.
-Julia

Scientists at the Brain Research Centre in Vancouver, Canada, are attempting to develop a new class of "smart" drugs for psychiatric disorders. These medications would target specific brain cells, rather than mimicking the generalized neurotransmitter and receptor actions of current psychiatric drugs.

Says neuroscientist and research team leader Yu Tian Wang, "the new drugs would be the first significant change in decades to medications used to treat psychiatric disorders."

The major difference is in the specificity of action. These newer drugs would hopefully be targeted specifically at brain cells that need repairs, reducing the potential for side effects in other areas of the brain. Current medications are capable of beneficially rebalancing neurotransmitter and cellular communication in some areas of the brain; however, because their effects are not regionally limited, they can cause unforeseen imbalances in other parts of the brain as well.

According to Dr. Wang's estimate, the drugs may go into early clinical trials within the next three years, and could be ready for consumer use within the next 5-10 years.

Information about the Brain Research Centre:

The Brain Research Centre, located at UBC Hospital, comprises more than 160 investigators with multidisciplinary expertise in neuroscience research ranging from the test tube, to the bedside, to industrial spin-offs.

NeuroScience Canada's Brain Repair Program is an $8-million program that has received major support from the Canadian Institutes of Health Research (CIHR) to support Canada's world-class neuroscience researchers. Further information about the NeuroScience Canada awards may be found at www.neurosciencecanada.ca.

NeuroScience Canada was founded in1988 and uses private, corporate and government funding to support research on mechanisms that protect and repair the brain and nervous system.

CIHR is the Government of Canada's agency for health research. VCHRI is a joint venture between UBC and Vancouver Coastal Health that promotes development of new researchers and research activity.

 

 

A Review of TMS Treatment in Schizophrenia

Transcranial Magnetic Stimulation in the investigation and treatment of schizophrenia: a review

H. Magnus Haraldsson, Fabio Ferrarelli, Ned H. Kalin and Giulio Tononi.

Schizophrenia Research
Volume 71, Issue 1, 1 November 2004, Pages 1-16

Transcranial magnetic stimulation is a technology that is increasingly being harnessed for use in psychiatry both therapeutically and as a tool for research. It works based on creating a targeted magnetic field that can interact with brain cells and cause them to be excited and fire more frequently. There are 2 main types of TMS and both have different uses. The most common side effect of TMS is headache.

There are 2 kinds of TMS. One offers a single pulse, while another technique utilizes more rapid, repeating pulses. In each, a coil is placed on the patients head and the magnetic field is applied. There are different shaped coils (circular or figure of eight) intended to reach either a more diffuse or more focused area of the brain. The circular coils tend to give a more diffuse area of stimulation. A number of variables influence how accurately a specific brain area can be stimulated with TMS. These variables include the intensity of stimulation, the shape and orientation of the stimulating coil and the excitability, type and orientation of the neurons in the area of stimulation. One can use one or two coils to acheive different electrical effects in the brain and to target different areas.

Is TMS effective in treating mental illness? Well, the research is just beginning...There is some evidence that it might help with depression when applied to either the Left or Right prefrontal cortex of the brain. Research has been limited until recently be difficulty in creating a "sham" condition. It is important to have a "sham" that seems like the patient is getting TMS, and appears/feels exactly the same, but does not have magnetic current that has any effect. This is needed to help eliminate placebo effect and more certainly attribute any benefits seen to the TMS than to the patient's psychological hope that the treatment is better. There is now a new sham technique so hopefully research into TMS will increase. It is still not known exactly what settings or locations to place the coils are best in schizophrenia.

Results with TMS have at best been mixed so far. Most studies have not shown a significant benefit, but not much is known about the most optimal way to utilize the technology. There is some hope that perhaps if the part of the brain that processes auditory hallucinations receives a signal from TMS it might decrease the hallucinations. This however, will be a long way off from being clinically useful.

Overall, TMS is a new technology that may eventually have clinical benefit and currently is helpful in researching isolated parts of the brain. It may prove more beneficial as an adjunct to other technologies or may ultimately be useful on its own in treating schizophrenia.

This work was supported by a grant from the families of Donald and Patricia Cheney and Jack and Patricia Lane

Click here to find the article on PubMed

A Comparison of Ziprasidone and Olanzipine
 

Randomized, Controlled, Double-Blind Multicenter Comparison of the Efficacy and Tolerability of Ziprasidone and Olanzapine in Acutely Ill Inpatients With Schizophrenia or Schizoaffective Disorder

George M. Simpson, M.D., Ira D. Glick, M.D., Peter J. Weiden, M.D., Steven J. Romano, M.D., and Cynthia O. Siu, Ph.D.

Am J Psychiatry 161:1837-1847, October 2004

This is a study that compares both the effectiveness and side effects of two second generation antipsychotics: Olanzapine (Zyprexa, by Eli Lilly) and Ziprasidone (Geodon, by Pfizer). The authors state that there have not been very many direct comparisons between the newer drugs but that each drug seems to have various side effects labeled on them.

The study was set up very well to help eliminate confounding variables (things that can alter a study other than what one is looking for.) It is a double-blind (neither the patient or the people working on the study know what drug the patient is on), randomized (anyone is equally likely to get one drug or the other), and it takes place throughout the US to help eliminate regional differences. The authors used a number of common rating scales to asses for changes in symptoms both positive symptoms and negative symptoms. They also looked at weight gain (body mass index), insulin levels (to see of increased risk of diabetes) and cholesterol levels. However, the authors only looked at 6 weeks worth of data so long-term implications of these data are hard to decipher and can only at best be inferred.

The results showed that both groups were the same with respect to the number of patients who dropped out of the study because the drug did not work. However, ultimately, a statistically significant number of patients dropped out from the ziprasidone group vs the olanzapine group, however the reasons are not made clear (lost to followup or withdrawn consent perhaps.) This may or may not be clinically meaningful. Having patients withdraw early from a study potentially can distort results and lead to statistical confusion and less accurate results depending on how the lost patients are tabulated.

The main results of the study showed that both drugs had approximately equal efficacy on treating the core symptoms of schizophrenia. Where thedifferences were seen was primarily in side effects. This is where the withdrawal of patients makes things difficult as well as the short duration of the study. The side effects looked at were weight gain, cholesterol changes and diabetes parameters. Many of these things take time to develop and while a change in six weeks is suggestive of future problem it does not necessarily speak to the long term significance. However, this study showed that olanzapine had a more serious side effect profile than ziprasidone which is something that many people have noted over recent years. They also showed that cardiac conduction defects often attributed to ziprasidone were not clinically seen here.

Overall, does this mean that olanzapine is a bad medication compared to ziprasidone? Well, this is one case where it is definitely helpful to see who sponsored this study: Pfizer, who makes ziprasidone (geodon) in the US. Ziprasidone has had a lower market share since coming onto the market several years ago. While there may be many reasons for this, perhaps this study was done to help bolster ziprasidone's position in the marketplace. Regardless of intention, data is data (statistical manipulation aside) and this is important information.

However, it cannot be denied that olanzapine does have severe metabolic side effects that should be considered when one starts on an antipsychotic. If someone you know is already on one of these or another, this study is not enough to warrant a change, especially if the medication is working. HOwever, it does point out again the importance of maintaining a close eye on the overall health of someone with schizophrenia and not settling for merely the reduction of symptoms to be enough when one is taking care of such a patient.

This study was supported by Pfizer Inc. (maker of Geodon which is the tradename for ziprasidone).

Click here for a link to this study on PubMed

 

A National Trend of "Health Family Trees"

When U.S. Surgeon General Richard Carmona spoke with his colleauge Francis Collins, Director of the National Human Genome Research Institute, both realized an emergent need for comprehensive family health histories created by patients themselves. As research identifies a prominent genetic role in more and more chronic conditions, ranging from heart disease to schizophrenia, it is becoming increasingly more important for both patients and doctors to have current family history information at hand.

In response to this need, Carmona, Collins, and colleagues at the Department of Health and Human Services launched a free web-based program to assist patients in tracking and documenting their family medical histories. They hope that patients will become better informed through the creation of their own family trees (which often involves discussions with extended family), and that doctors will be better able to determine what kind of specific tests and care are needed for which patients.

Carmona has announced that the program is part of the first annual National Family History Day, which will now share a date with Thanksgiving.

Although it can be difficult to amass all the information necessary to generate a complete family tree - it may involve being overly-persistant with less familiar relatives, dredging up subjects that some would rather let alone - the benefits of knowing a comprehensive family health history are indisputable.

"Knowing your family medical history can help the health professionals you see to determine if you should be offered medical screening that would not normally be conducted," said Robin Bennett, a genetics counselor and manager of the Medical Genetics Clinics at the University of Washington in Seattle.

The new software tool, entitled "My Family Health Portrait", is available for free downloading at http://www.hhs.gov/familyhistory/. The program incorporates information (entered by the user) about the occurence of several genetically-based conditions in grandparents, parents, siblings, children, aunts, uncles, and cousins. The outcome is a family tree that shows kin relationships as well as the existence of medical conditions such as heart disease, diabetes, and cancer (indicated by shaded symbols). In addition to these diseases, the user can choose to enter additional information about general patterns of health, psychiatric problems (such as depression or schizophrenia), birth defects, allergies, dental problems, health-related habits such as smoking or substance abuse, and vision/hearing problems. All this information is incorporated into the final family tree.

Dr. Richard Imirowicz, a child and adolescenet psychiatrist, indicates that it is helpful when patients share comprehensive knowledge about their family medical history with him. "It's rare for families to bring in a medical history, but it would be welcomed," he said. "The more information we get, the better."

For a full news report about the software program, see "Tracing Your Health Roots" (Nov 16 2004) in the Washington Post (http://www.washingtonpost.com). Viewing this article may require free user registration.

 

 

 

 

 

 

How Stress Can Worsen SZ Symptoms

Researchers have recently suggested how an overactive protein (protein kinase C, or PKC) in the brain can cuase disturbed thinking, impaired judgement, impulsivity, and distractibility when a person is under stress.

As explained by Dr. Arnsten, one of the researchers on the project, activation of PKC can cause a reduction in memory-related cell firing, particularly in the prefrontal cortex. This, in turn, makes it harder for a person to hold on to information and memories from moment to moment. Protein kinase C can be activated by even mild stress.

The tendency for kinase overactivity seems to be mediated by an abnormal gene found in some patients with bipolar disorder. Overactivity of PKC may also be present in schizophrenia patients as well.

Scientists are looking at the possibility of a fast-acting protein kinase C inhibitor drug as a future treatment for such cognitive symptoms. Antipsychotics, currently used to treat both schizophrenia and bipolar disorder, block certain receptors in the brain that activate PKC.

Until such a treatment is found, people with schizophrenia and bipolar disorder can take steps in their own lives to reduce their exposure to stress. Family and friends can also help to create a low-key, low-stress environment. Read about the importance of avoiding excessive emotion and stress (http://www.schizophrenia.com/family/expressed.htm).

For the full news story, see "Stress Impairs Thinking Via Mania-Linked Enzyme" (Nov 3 2004). Available at http://www.sciencedaily.com.

 

 

 

 

 

 

 

Art Helps Woman Cope w/ SZ

Tiffani Ross Parker, diagnosed with schizophrenia since high school, says that painting helps her to positively deal with her troubling symptoms and difficult life.

Ms. Parker's past has been as tumultuous as anyone's. Besides her schizophrenia diagnosis, she has struggled with drug addiction, a teenage pregnancy and abortion, poverty, and homelessness. However, she can proudly claim a free and sober history for the last four years. She credits part of this success to the assistance of the Brooklyn Bureau of Community Service's Transitional Living Community (located in New York), which helped her find a permanent apartment, enroll in high school equivalency classes, and put her in touch with creative arts therapist Rita Jendrzejewski.

Ms. Jedrzejewski says that art therapy "helps people to bring out what's inside that they may not be able to talk about." Ms. Parker agrees: "All that had been bottled up inside me, I would be able to put it on paper, and I would be able to express myself. I didn't smoke it up. I didn't use my body negatively. It was something that I created and that I could keep; that I like; that I loved. And it was really beautiful. It was something from my heart. It was like prayer."

The Transitional Living Community continues to support Ms. Parker's art as an important part of her therapy - it provides money for classes, material, and transportation to the Art Students League in Manhattan.

Research has also identified a possible role for creative and art therapy in the comprehensive treatment of schizophrenia. See the following research abstract:

Art Therapy for Schizophrenia or Schizophrenia-like Illnesses (2003). Available at http://www.pubmed.com.

Please note: although many people find supplemental therapies such as art helpful in alleviating their symptoms and/or general stress levels, they are NOT meant to be primary treatment options. Medication and ongoing care under a psychiatrist are the current standard of treatment for schizophrenia and other major psychiatric disorders, and have proven to be the best tools for controlling debilitating symptoms and managing the illness over the long run.

The following are organizations in New York that assist "the neediest cases" such as Ms. Parker:

BROOKLYN BUREAU OF COMMUNITY SERVICE
285 Schermerhorn Street, Brooklyn, N.Y. 11217.

CATHOLIC CHARITIES OF THE ARCHDIOCESE OF NEW YORK
1011 First Avenue, New York, N.Y. 10022.

CATHOLIC CHARITIES, DIOCESE OF BROOKLYN AND QUEENS
191 Joralemon Street, Brooklyn, N.Y. 11201.

CHILDREN'S AID SOCIETY
105 East 22d Street, New York, N.Y. 10010.

COMMUNITY SERVICE SOCIETY OF NEW YORK
105 East 22d Street, New York, N.Y. 10010.

FEDERATION OF PROTESTANT WELFARE AGENCIES
281 Park Avenue South, New York, N.Y. 10010.

UJA-FEDERATION OF NEW YORK
Church Street Station P.O. Box 4100 New York, N.Y. 10261-4100

For the full article, see "When Art Helps to Deal With Harsh Realities" in the New York Times (http://www.nytimes.com), Nov 12 2004.
 

 

 

 

 

 

 

 

 

Early Intervention Program in Canada

For "Patricia" (not her real name), The Early Psychosis Program in Alberta, Canada was a godsend.

Patricia's parents became concerned when they began recieving odd, nonsensical emails from their daughter, who was doing research in Pakistan. They arranged her referral to the Early Psychosis Program at Foothills Hospital, an internationally-recognized program that treats about 700 outpatients a year.

EPP is equipped to deal with three phases of psychosis: the prodome (psychotic episode), the schizophreniform disorder (lasting up to six months), and full-blown schizophrenia. Patients are enrolled in a three-year treatment program under the supervision of a doctor and a case manager. The essential role of the case manager, an element missing from many medical treatment plans, is to help integrate the patient back into work, school, and home environments. A caseworker also helps patients find partner programs and services in their own communities.

EPP is looking to expand its message and its mission, through a public information campaign that will include media public service announcements, television/radio ads, and an educational website (http://www.thesoonerthebetter.ca).

Numerous research studies (see The Importance of Early Detection and Treatment for Schizophrenia on the schizophrenia.com Symptoms/Diagnosis page) have shown that early diagnosis and correct intervention for psychiatric disorders greatly improves an individual's prognosis.

That certainly seems to be the case among patients treated under EPP's model: duration of untreated psychosis in the Calgary region is among the lowest in the world, and the area also has reduced attempted suicides and suicide rates, lower relapses, improved quality of life, and excellent continuity of care.

The Early Psychosis Program seems to be an excellent coordinated-care model for people with schizophrenia or at-risk for schizophrenia. Hopefully similar programs will be initiated in other ares in the near future.

To learn more about the Early Psychosis Program in Alberta, see http://www.earlypsychosis.ca, or call 944-4836 (for local calls inside Canada region).

Original Source: "Early intervention key to psychosis treatment" (Oct 14, 2004). The Calgary Herald (Alberta).

 

 

 

 

 

Risk of SZ Possibly Linked to Prenatal Aspirin Use

A new study out of the University of Copenhagen suggests that moms-to-be who take painkillers such as aspirin or paracetamol while pregnant may be putting their babies at risk.

Dr. Erik Mortensen of the Psychology Dept and his team analyzed the birth records of 7,999 babies born between Oct 1959 and Dec 1961. Out of all, 116 were later diagnosed with schizophrenia as adults, and about 140 were exposed to painkillers during the second trimester of pregnancy.

The team concluded that pre-natal painkiller exposure can raise the risk of mental illness by a factor of four. Exposure during the first and third trimesters, however, appear to have no effect.

"In light of these findings, if a pregnant woman can go without using painkillers, it would be a good idea to do so," said Dr. Erik Mortensen.
One possible reason for the increased risk may be chemical-induced damage to the cortical suplate during fetal development.

The results of this study are particularly interesting, given the recent links identified between schizophrenia risk and influenza in pregnant women. Part of the risk may be due to the increased tendency of women to take painkillers and other medications when they are sick.

For the news story, see "Mothers-to-be warned to stay off painkillers", Oct 31 2004. Available online from News.telegraph (http://www.telegraph.co.uk).

To see the research study online, go to "Association between prenatal exposure to analgesics and risk of schizophrenia" (Nov 2004). Available at http://www.pubmed.com.

Read about the possible link between prenatal flu exposure and schizophrenia risk, in the Aug 9 2004 newsblog entry on schizophrenia.com.

Read about other ways to protect you and your children from developing schizophrenia (http://www.schizophrenia.com/prevent3.htm)

 

 

 

 

 

 

 

Brain Waves in SZ Patients May Suggest Disease Cause

The brain waves that people with schizophrenia generate when asked to perform a certain task appear to be different than those produced by healthy individuals. Researchers think that this may indicate a communication deficit between brain cells of people with schizophrenia.

A new study published in Proceedings of the National Academy of Sciences looked at the brain waves of 20 subjects with schizophrenia and 20 healthy volunteers while they performed and communicated about a simple visual perception task.

Results showed a distinct difference in that wave patterns of the two groups. Healthy subjects emitted gamma-wave activity (waves generated during higher brain functioning) on the EEG brain scan, while this particular wave was notably absent from people with schizophrenia. Lead researcher Dr. Robert McCarley says this might mean that brain cells are communicating inefficiently, which might in turn partially explain why people with schizophrenia perceive the world so differently.

The research findings may lead to further investigation of treatments to promote normal gamma responses in the brain.

For the full story, see "Schizophrenia brain fault 'found' " (Nov 9 2004), online at http://news.bbc.co.uk/1/hi/health/3991925.stm.

 

 

 

 

 

 

Can Auditory Hallucinations Be Pleasurable?

Pleasurable auditory hallucinations.

Sanjuan J, Gonzalez JC, Aguilar EJ, Leal C, Os J.
Acta Psychiatr Scand. 2004 Oct;110(4):273-8.

Auditory hallucinations (AH) or voices are one of the most frequent symptoms of schizophrenia. Some studies have suggested that hallucinatory voices can also be heard by members of the non-psychiatric general population. The authors suggest that these AH?s may range from a spectrum of those who are at ease with their AH and who are not identified as a patient, to individuals with a severe psychotic disorder who are tormented by intrusive voices. The emotional value of these voices may determine the extent of the distress that they cause. Some researchers have made the point that not many people have investigated voices that are perceived as being pleasurable. As a result, this study aimed to assess the frequency of voices as a pleasurable experience in a patient group and also cross-validate the pleasurable aspect of the experience using established scales.

This study was conducted in Spain. The authors used a standard rating scale (PSYRATS) to ask patients with AHs (89 schizophrenia and 17 other psychoses) who were taking anti-psychotic medications, about their experiences with voices. They added extra items to the questionnaire to inquire if the experience was pleasurable.

They found that 26% of the patients reported the voices as pleasurable at least occasionally, and for 10 individuals the experience of pleasurable voices was the norm and not the exception. Those who said they had pleasurable voices felt like the negative component of the voices was much lower and resulted in better scores on the rating scale. Those who had pleasurable hallucinations had less distress, less negative content, quieter voices and more control over their voices. The authors suggest that these results have implications for therapy. They suggest that since coping training and taking medications can be affected by the presence of pleasurable hallucinations, clinicians need to modify their technique depending on the patient?s response to his/her voices. Some individuals might need more psychoeducation, family therapy, cognitive-behavioral interventions that focus on adjustment to daily life, perhaps with conservation of pleasurable hallucinatory experiences.

This study is limited in several ways. First, the relative proportion of those with pleasurable voices was small and hence statistically, the study may have lacked power. Second, the questions that were attached to the standard questionnaire were not standardized (i.e. gone through statistical tests) and as such may have presented a response bias. Also, clinical information was collected based on patient's recollection without corroboration on all occasions. Nevertheless, this study highlights the need for family, doctors and therapists to discuss the possibility of pleasurable AH with all patients before starting any form of treatment.

This study was supported by Spanish grants from Generalitat Valenciana (GV01-93), Red de Genotipaci?? Psiquiatr?Gen?ca (ISCIII 2003- G03/184), FISS P.I. 02/0018, and Eli Lilly Company Spain.

Click here to find this article on PubMed
 

 

 

 

 

 

Study Shows Inactivity Affects Mentally Ill

A new study from the Indiana University, Bloomington highlights suprising inactivity among some populations of mentally ill people.

 

The study examined participants with severe and persistant mental illness (or SPMI, encompassing such disorders as schizophrenia and bipolar) for daily physical activity. Data was collected through motion sensors (which recorded physical activity over seven consecutive days), and patient recall (notations in booklets about what they were doing, who they were with, their mood, and other aspects of activity).

 

Out of the four groups studied (SPMI participants, a sedentary control population, a population with severe mental detriments, and a group who exercised regularly), those with mental illness averaged the lowest in "counts per minute", or the unit of measurement used by the motion sensors to record activity during waking hours. The SPMI population averaged 305 counts per minute, as compared to 312 averated by the sedentary control group, 330 averaged by the group with mental detriment, and 550 counts averaged by the active exercising group.

 

Those with SPMI also reported being alone more often.

 

Given that people with schizophrenia often suffer from related conditions ranging from depression and anxiety to diabetes, obesity, and cardiovascular disease, the findings of this study are particularly relevant. Exercise has been proven to elevate mood, relieve depression and anxiety, lower cholesterol, blood pressure, and weight, and reduce risk for cardiovascular diseases. Moreover, many people who live with chronic psychiatric disorders indicate that a daily exercise routine (even as little as ten minutes of walking a day) is an important part of their particular therapy. A daily exercise plan can help overcome apathy and give a satisfying order to the day, as well as provide the physical and psychological benefits already noted.

 

Source: "Indiana University Professors Focus on Daily Lives of People
With Serious Mental Health Conditions; Study Participants Surprisingly
Inactive" (Oct 13 2004). AScribe Newswire (http://www.ascribe.org/).

 

 

 

 

 

 

 

 

 

Higher Risk of Cancer with Mental Illness

Men and women with mental disorders have higher odds of being diagnosed with brain tumors and lung cancer and they develop these cancers at younger ages than individuals without mental illness according to a study published in the current issue of Psychosomatic Medicine.

"This work is a piece in the larger puzzle of understanding the relationships between mental and physical health," said Caroline Carney, M.D., M.Sc., associate professor of psychiatry and medicine at the Indiana University School of Medicine and a research scientist at the Regenstrief Institute, Inc. Dr. Carney is the first author of the study which looked at insurance claims data from over seven hundred thousand adults between the ages of 18 and 64 living in Iowa and South Dakota.

"It is known that people with mental illness smoke more than the general population, so the higher incidence of lung cancer was not surprising. The association between mental health problems and brain tumors, was less expected but is explained by the likelihood that brain tumors cause mental symptoms prior to other symptoms like neurological symptoms. Our data showed the new diagnosis of mental symptoms up to one year prior to brain tumor diagnosis," said Dr. Carney who is both a psychiatrist and an internist.

The researchers also found the incidence of lymphoma and leukemia higher in women with mental health problems than those in the control group, however odds of developing breast cancer was the same in both groups.

"These findings underscore the need for smoking cessation counseling and physical work-ups for new psychiatric symptoms occurring with physical symptoms, for psychiatric symptoms presenting in an unusual pattern, or for new psychiatric symptoms occurring at ages atypical in the mentally ill," said Dr. Carney.

This study was supported by the American Cancer Society and the National Institute of Mental Health.

 

Source: Indiana University