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The Need for Early Intervention in Schizophrenia
 

Editorial by Marvin Ross

"Once the damage is done, it cannot be undone. Neither love nor money can ever undo the damage of delayed treatment for schizophrenia. The individual is disabled for the rest of his or her life and this is what early intervention can prevent."

These words were spoken by a man whose own diagnosis and treatment were delayed for over ten years and whose life today would have been considerably different if he had been treated early. In addition to the human cost, the cost to society would have been much less.

He went on to say that "it is only too self-evident to me that I have permanent damage that I must live with because I was not treated in the first six months. It is something that I think about everyday, something I have to reaccept every morning".

And it's not as if early intervention and prevention are foreign words in health care. We are continually being bombarded in the media with messages on the need to monitor our blood pressure and cholesterol in order to prevent heart attacks and stroke. We are continually being told about the value of early detection and the need to do breast self- exams and to have mammograms, or to have colonoscopies every five years for those over 50 or to get PSA levels checked.

But when it comes to schizophrenia and other serious mental disorders, that message is absent or only spoken by a few. Certainly, the funding for these initiatives is minimal.

Beside the horrendous cost to individuals and their families from this disease, there is an enormous cost of untreated or inadequately treated schizophrenia to society. A Canadian study found that the total cost of schizophrenia to Canadian society was $2.35 Billion in 1996. As the US is about ten times the population of Canada, we can estimate that the US cost is probably around $25 Billion a year.

Early identification is becoming more accurate for those at high risk. One study conducted in Melbourne and reported in Schizophrenia Research (April 2004), followed 104 young people with a family history of psychotic disorder combined with some functional decline or the presence of sub threshold or self-limiting psychotic symptoms. All were symptomatic but not psychotic.

A third of them developed psychotic symptoms within 12 months and this was predicted with very high accuracy based on the duration of their initial symptoms, poor functioning, high levels of depression and reduced attention. Also predictive of psychosis were a family history of psychosis, a recent significant decrease in functioning and a recent experience of sub threshold psychotic symptoms.

The British Journal of Psychiatry published a Scottish study in January 2005 on a simple test that can be given to those at high risk that can also help predict who will develop schizophrenia. The test, which measures IQ, memory, motor skills and verbal learning, was administered to 163 people aged 16-24 with a family history of schizophrenia. They also had brain scans.

45% of the group showed symptoms of schizophrenia but only 12% went on to become sick. The researchers were able to predict with high accuracy who would become ill up to three years before they actually did become sick.

Let us go back to the person in our quote at the start of this editorial. He, like so many others, has permanent damage because of the delayed identification and treatment for his schizophrenia. The Canadian consensus guidelines developed by psychiatric specialists from across Canada based on the best scientific evidence to date state "evidence indicates there may be long-term benefits when effective treatment of schizophrenia is started as early as possible in the illness".

In fact, the evidence implies that intervention early in the development of psychosis may lead to complete or almost complete recovery in a much larger proportion of patients than is currently the case and that there is evidence to demonstrate that untreated psychosis may have a negative impact on the functioning of the brain but that first episode patients may be much more responsive to drugs than they would be later in the illness and even require lower doses.

Early intervention for those at risk can help to predict who can be treated early so as to minimize the impact of the disease and to help them carry on as near normal lives as possible. Work is being done on other predictors but much more needs to be done and more funding is required from governments.

It is just as important to help identify early the potential onset of schizophrenia as it is to identify early hypertension, breast cancer, prostate cancer and colon cancer. Our young people deserve it and should expect it.
 

 

Input for Upcoming Schizophrenia Researcher Interviews - Assistance Interviewing Needed Too

Hi everyone,

We're starting work on a series of interviews with top researchers in all aspects of schizophrenia and I wanted to get your ideas on questions that you'd like answered in these interviews.

Our goal is to provide you (our site members) a look at the progress that is taking place in schizophrenia research - and get the latest views on schizophrenia treatments and therapies that are coming down the road. We'll primarily be talking to academic researchers - but we'll also be approaching some biotech and pharma and neurobiology researchers.

Please email your suggestions and/or comments to szwebmaster@yahoo.com, and we'll add them as we think appropriate for the given person.

Interviewers Needed

We're also looking for assistance from people who have strong telephone and English skills and also (ideally) some education in biology, psychology, etc. (i.e. a bachelors degree) to assist in interviewing the schizophrenia researchers. You can work from home - we'll pay for the phone calls and also some moderate hourly rate - if you're interested, send us some of your background information (education background, availability, etc.) and let us know what your hourly rate is.

This interviewing effort will be relatively simple. Working with our team here we'll be developing a list of customized questions relevant to the researcher and his or her research, and we'll provide you the necessary equipment for recording the conversation and software for doing conversion from speech to text. Each interview should take about 30 minutes or so.

Please send us an email if you're interested (szwebmaster at yahoo.com )

Thanks,

Schizophrenia.com Team

Following is our first draft of the list of questions for your review.

Schizophrenia Researcher Interview - Generic Questions

How and when did you first become interested in schizophrenia? How did you get your start in schizophrenia (or neuroscience) research? Do you have any family or personal relationship with someone with schizophrenia?

What areas of schizophrenia does your research cover? (or perhaps we do background reading on every researcher and come up with more specific questions to ask them about their research).

Which line of your research has yielded the most significant results in terms of our understanding of schizophrenia?

What are you working on now and plan to explore in the future?

Do you get involved with any clinical applications of schizophrenia, or are you focused entirely on research?

What do you consider most exciting discovery and/or connection that you have made in your work on schizophrenia?

What, in your opinion, is the most exciting thing about about being in schizophrenia research (or neuroscience research) today?

What do you enjoy most about working in your field?

What abourabout your work do you find particularly challenging or frustrating?

How have you seen the public’s perception of schizophrenia change during your career – and what are some of the major misunderstandings that you believe still persist in the average citizen?

How has this field of research changed/progressed since you began your work? Is the rate of progress pretty consistent, or is it increasing or decresing?

What sorts of new practical innovations or applications can people with schizophrenia and/or other psychiatric disorders expect to see in the next 5 years, 10 years? In the next 20 years?

In what specific areas of schizophrenia research do you feel that is most in need of additional funding or greater investigation today?

What, in your view, could advocates for people with schizophrenia do to accelerate the development of prevention strategies and new therapies for people with schizophrenia – does the need to be greater political pressure to increase funding, do fund raising drives need to be increased to better fund groups like NARSAD, etc.?

What relatively new or unproven theories related to schizophrenia do you think are most intriguing and show most potential for being significant steps forward in terms of schizophrenia treatment or prevention?

What do you consider the most significant unanswered questions about schizophrenia today?

What would you like the public to know about the state of your schizophrenia (or neuroscience) research right now?

What is your prediction for the state of our knowledge about your field 10 years from now?

What other fields of research or medicine do you think are particularly relevant to schizophrenia (or neuroscience) research? Why?

Are there a few other scientists who you specifically admire, or who have seriously influenced your work?

What other endeavors (besides research) do you devote time to?

Biotech/Pharma Researcher Questions:

Can you describe the nature of your research, and the potential products that you hope to develop for schizophrenia?

What is the process and time frame for the development and sale of these products?

What other companies are there in the market that you think are doing interesting work that relates to schizophrenia?

Questions for Researchers focused on Schizophrenia Prevention

What do you think are the top 5 things that families should do to minimize risk of schizophrenia (in either their unborn children, or existing children) ?
 

 

 

Medscape.com recently ran an interview with Dr. Daniel B. Fisher, MD, PhD, Executive Director of the National Empowerment Center in Lawrence, Massachusetts. Dr. Fisher described his theory of Empowerment Model recovery, how it fits in with the medical model and medication treatment of mental illness, and how he believes it helps people with severe mental illness recover. Although this is just one person's opinion, some ideas could certainly be integrated into long-term care. Below is a paraphrase of some key points:

An integral part of the Empowerment Model is a distinct definition for mental illness. According to Dr. Fisher, mental illness "is a combination of severe emotional distress and an interruption of a person's place in the community and social role -- being a worker, parent, student, a participant in overall community life -- which is not dissimilar from what is considered a mental disorder in DSM-IV.[2]." This is a functional view of what mental illness is, although it doesn't rule out the possibility (a strong possibility, given scientific research findings) that such "severe emotional distress" and an "interrupted role in community and society" could stem from biological causes as well as environmental and social ones.

Another key part of the Empowerment Model is hope. Dr. Fisher states that in his research experience, the most important aspects of recovery from schizophrenia and bipolar disorder was a person's hope for their own future, a belief that their condition was not permanent, and a supportive environment that helped reestablish them to a role in the community. He also cites as evidence two studies from the World Health Organization, showing that the rate of recovery from severe mental illness is twice as high in developing countries than in industrialized countries. In these developing countries, Dr. Fisher says, the approach to healing is "...very socially oriented, and they instinctively recognize the importance of keeping people connected to the community."

When asked how his empowerment model contrasts to the medical model of mental illness, Dr. Fisher replied that an empowerment model emphasizes that severe mental illness is not permanent, and that people have recovered. He stresses the importance of reestablishing social connections, and having peers as guides and mentors in the recovery process. He tells people that medication is to be used as a tool in their recovery process, as a way to help them control their symptoms enough that they can begin re-establishing relationships and re-entering the community. With the help of medication, a person can begin the process of learning to be with others, make friends, find a job, go to school, and take care of themselves.

Cognitive Therapy is also part of Dr. Fisher's 10 Principles of Recovery, to help people manage and control their thoughts during the stresses of everyday life.

To read the whole interview, see "An Empowerment Model of Recovery From Severe Mental Illness: An Expert Interview With Daniel B. Fisher, MD, PhD" (Jan 20, 2005) on www.medscape.com. Requires free registration for viewing.

 

The science magazine "New Scientist" reported on February 5, 2005 on a new blood test being tested for schizophrenia, as reported in a genetics journal (American Journal of Medical Genetics B , vol 133, p 1). It is still early, and this still needs to be validated in larger studies and by other groups, but the initial small sample was positive.

The early results suggest a 95% to 97% accuracy level - which should help a great deal in early diagnosis and potential prevention of serious psychotic episodes.

The story mentioned that:

"A blood test that measures the activity of genes can accurately detect mental illnesses such as schizophrenia, a small trial suggests.

RNA molecules are produced whenever a gene is active and, by measuring levels of these molecules in the blood, a team led by Ming Tsuang, at the University of California in San Diego has distinguished healthy individuals from patients with either schizophrenia or bipolar disorder (manic depression).

These conditions are currently diagnosed by assessing patients' behaviour. "A laboratory test would enable earlier diagnosis and more timely treatment," Tsuang says."

The study examined the blood gene _expression of 74 patients - 30 with schizophrenia, 16 with bipolar disorder and 28 controls. Eight gene blood biomarkers were identified and used to discriminate amongst the 3 groups, with an overall accuracy of 95% to 97%. The paper was co-authored by Dr. Ming T. Tsuang, Distinguished Professor of Psychiatry, and Director, Institute of Behavioral Genomics, Department of Psychiatry at the University of California, San Diego, and Director, Harvard Institute of Psychiatric Epidemiology and Genetics, Harvard Department of Epidemiology and Psychiatry, Harvard University and Dr. C.C. Liew, ChondroGene's Chief Scientist, Visiting Professor and Founder of The Cardiovascular Genome Unit at The Brigham and Women's Hospital, Harvard Medical School, and Professor Emeritus at The University of Toronto, and was responsible for conceiving the Sentinel Principle.

The data presented in the paper is a result of an initial collaborative research project between ChondroGene and Dr. Tsuang in which the Sentinel Principle was applied to these two psychiatric disorders. Additional studies to further validate disease-specific biomarkers in larger psychiatric populations are ongoing.

"At present there are no tests that can effectively diagnose psychiatric disorders early in their evolution. Using current methods, it can take months or even years to make a definitive diagnosis", stated Dr. K. Wayne Marshall, President and CEO of ChondroGene Limited. "Application of ChondroGene's Sentinel Principle to schizophrenia and bipolar disorder has generated unique blood-based molecular signatures for each disease. These molecular signatures can be used to develop disease-specific biomarkers that will enable earlier diagnosis and more timely treatment of these devastating disorders."

Rory Riggs, ChondroGene's Chairman and Managing Director of Balfour LLC, stated that "the Sentinel Principle is an extremely powerful tool that can provide a snapshot of what is happening throughout the body from a simple blood sample. So far ChondroGene has applied the Sentinel Principle to over 50 different diseases with very promising results."

The Sentinel Principle is used to identify unique molecular signatures in blood associated with a specific disease. These molecular signatures are then used to identify blood-based biomarkers that can be used for disease- specific diagnostic tests. ChondroGene is applying the Sentinel Principle in four main disease areas; cancer, central nervous system disorders, cardiovascular disease and arthritis. The Company currently works with research collaborators and organizations around the world in these various disease areas.

New Scientist magazine mentioned that "Peter Liddle, co-director of the Nottingham Institute of Neuroscience in the UK, warns that the similarities in gene _expression in patients could be a coincidence or the result of their medication. Tsuang is already carrying out a second, larger study and hopes to start a third with patients not on medication, to rule out possible effects of prescription drugs on gene _expression."

A paper entitled "Assessing the Validity of Blood- Based Gene _Expression Profiles for the Classification of Schizophrenia and Bipolar Disorder: A preliminary Report" is available online on the American Journal of Medical Genetics Part B: Neuropsychiatric Genetics' website at http://www3.interscience.wiley.com/cgi-bin/abstract/109865056/ABSTRACT

The work is in part sponsored by a company called "ChrondroGene". ChondroGene is focussed on the application of functional genomics to enable early diagnosis and personalized therapeutic intervention based on disease-specific biomarkers. The Company has developed a novel approach, based on the Sentinel Principle, to detect and stage virtually any disease or medical condition from a simple blood sample. ChondroGene is currently applying the Sentinel Principle in major areas with unmet clinical needs such as cancer, arthritis, cardiovascular disease and neurological disorders. For more information on ChondroGene, visit http://www.chondrogene.com

 

 

 

 

 

 

 

 

 

Ephedra Worsens Schizophrenia Symptoms

A new study in this month's American Journal of Psychiatry indicates that the herbal supplement ephedra may cause or exacerbate psychiatric symptoms, including mania, hallucinations, and severe depression.

Although Ephedra (also called ma huang) has already been removed from popular use by the FDA due to other serious health concerns (including heart attack and stroke), an exemption from the ban exists for practitioners of Chinese medicine, who use the herb for a wide variety of remedies.

Before the ban, Ephedra was a popular supplement to enhance weight-loss and athletic performance.

The study reviewed 1,820 cases of reported Ephedra-related side effects (since Sept 2001), and concluded that 57 of these included severe psychiatric symptoms. However, this is probably an underestimation, as it is impossible to know how many ephedra-related events may have gone unreported. Most of the incidents involved people who had previously diagnosed conditions such as depression or bipolar disorder, or were involved in substance abuse.

No one knows why Ephedra may be causing these effects, although it is well known that psychoactive natural substances (often in herbal or nutritional remedies) can interact in unexpected ways with brain neurochemistry or with psychiatric prescription drugs.

Study author Margaret Maglione cautions people to be careful. "If your friend starts acting a bit strangely, it might be the ephedra supplements he's taking," she told Reuters Health.

Source: "Psychiatric Problems Another Ephedra Side Effect", Jan 26 2005. Yahoo Health (http://health.yahoo.com)

View the FDA whitepaper on the Safety and Effectiveness of ephedra (http://www.fda.gov/bbs/topics/NEWS/ephedra/whitepaper.html)

 

 

 

 

 

 

 

 

 

Predicting the Course of Schizophrenia

A new study in Schizophrenia Research suggests that certain gender- and disease- related markers identified prior to diagnosis can help predict the future prognosis of those who develop schizophrenia.

The study obtained behavioral and intellectual functioning data from 996 adolescents with schizophrenia and 335 with affective disorders at least 1 year prior to a first hospitalization. Resesarchers continued to monitor the hospitalizations of these individuals.

Data revealed that males who had poor social functioning and organization skills before their diagnosis of schizophrenia spent more days in the hospital per year than other males with schizophrenia. Among the female subjects, those with higher intellectual measure before their first hospital admission spent fewer days in the hospital. Moreover, those women with higher intellectual functioning prior to diagnosis tended to have only one (as opposed to more than one) hospital admission.

Intellectual measures did not seem to be a predictive indicator for males, however.

The study concludes that: "overall...gender-specific and disease-specific premorbid deficits appear to have differential prognostic value for outcomes in schizophrenia and affective disorders."

Source: "Premorbid Deficits Predict Schizophrenia Prognosis" (Jan 20 2005). Available at http://www.psychiatrysource.com.

Click here to see the study abstract, or do a search at http://www.pubmed.com with the title "Association between functioning in adolescence prior to first admission for schizophrenia and affective disorders and patterns of hospitalizations thereafter."

 

 

 

 

 

 

 

 

Antipsychotic Mellaril Removed from Market

Novartis has announced a worldwide discontinuation of the drug Melleril (Mellaril in the US and Canada, and also known under the generic name thioridazine), due to concerns that the drug causes increased risk of cardiac arrhythmias and sudden death.

Doctors have been alerted of the situation, and are advised by Novartis to switch patients on Melleril to an alternate medication. The drug will be officially discontinued in all forms by June 2005.

Source: "Schizophrenia Drug Withdrawal", Jan 28 2005. Irish Health (http://www.irishhealth.com/?level=4&id=6897).

More information:
http://www.mentalhealth.com/drug/p30-m01.html

 

 

 

 

 

 

Poor Results from Phase II Secretin Trial

Phase II clinical trials with secretin show that the treatment had no more effect than placebo, despite hopeful results from phase I studies.

Repligen, the biotechnology company that develops the treatment, reported that "moods and behavior of patients treated with the secretin during [phase II trial] was about the same as those who received a placebo."

Phase I trials, carried out at the University of North Carolina, had initially reported transient symptom improvements in patients who recieved secretin treatment vs. those that did not.

Source: "Repligen reports poor results for schizophrenia treatment", Feb 4 2005. The Boston Herald (http://www.bostonherald.com)

 

 

 

 

 

 

 

 

Web Guide for Pediatric Antidepressants

Several medical and consumer organizations, among them the American Psychiatric Association and Suicide Prevention Action Network, have collaborated to advance a new website. ParentsMedGuide.org is meant to help parents of children with depression make informed and educated decisions about medications in the wake of numerous warnings about SSRI safety.

The site is designed in an easy-to-follow question and answer format, addressing concerns about antidepressants, the meaning of the FDA blackbox warning, and questions about treatment with and without medication.

This is an excellent advance over what parents previously had to do - that is, search through a jumble of FDA online literature and translate statements written in some form of legal-ese. Hopefully it will prove helfpul to those looking for information during difficult times.

View the site at http://parentsmedguide.org/

 

 

 

 

 

 

 

 

A True Story of Cannabis-Induced Schizophrenia

The following is a true story, appearing in the Nationwide News Pty Limited Sunday Mail (Queensland, Australia).

It is written by a mother who lost her son to drug-induced schizophrenia. Her story is a frightening and sad reminder of what scientific studies are still telling us - that recreational drug use significantly increases the risk of developing schizophrenia and suffering dire health consequences. (For more information on these risks, please see http://www.schizophrenia.com/hypo.html#street).

The most relevant portions of the story are excerpted below.

Source: Nationwide News Pty Limited Sunday Mail (Queensland, Australia). Jan 22, 2005.

HEADLINE: My son Liam was a brilliant student, but his first puff of cannabis was the start of a terrifying descent into depression and paranoia that cost his life

BYLINE: Clare Campbell

...

As a child, Liam had been bright, gifted and extremely energetic. Looking back I would say that he always found it difficult to communicate his feelings, and even when obviously distressed would tell me he was "fine". At the time I just thought this was a typical male reluctance to reveal his emotions.

...

As his mother, my instinct tells me he would eventually have worked these through by himself if only he had never touched drugs. From the moment he smoked his first joint of cannabis to try to make himself feel better, Liam had started on a road that would lead him to severe mental disturbance.

...

Although by nature a shy boy, Liam made several lasting friendships at the local school he attended. He did brilliantly academically. Graham and I knew Liam found his first year at university difficult, although he rarely confided in anyone. He told me he hated his first lodgings.

I phoned a student counsellor, who went to see Liam, but our son simply told him he was fine. Liam later said that he had some of the best, and the worst, times of his life at university. But it was during the beginning of his second year that I discovered, to my horror, how he was using cannabis to try to solve his confidence problems.

I was appalled when he told me. Liam had always seemed sensible and I had trusted him not to do anything stupid. How could he behave like this? I know that thousands of students go out every weekend and use drugs, but knowing how highly-strung Liam was, I was terrified of the effect cannabis might have on him.

I had read about use of the drug being linked to psychosis and felt desperately afraid for him. What would these drugs do to his health and his future? I only hoped these feelings of low self-worth would pass, but I don't believe Liam ever really got over his lack of self-esteem, even though he was tall, good-looking, and very clever. He had everything to live for if only he'd known it.

...

His father and I were out of our minds with worry. If he had been defiant or arrogant about his drug-taking, we could have shouted and threatened him. But Liam wasn't like that at all. All we saw was an unhappy, disturbed boy who needed our help as he had never done before.

...

We realised he was in danger both of becoming dependent and psychiatrically disturbed by the drugs.

Yet all the time Liam claimed that he was only doing it to "make himself feel better". I tried my best to persuade him to see the counsellor -- but he was deeply suspicious of any attempts to help him and hated talking about himself or his feelings to anyone.

...

In 2000, he finally admitted to us that his use of cannabis and ecstasy had triggered a deep depression -- ironically the very thing he had been battling all along. I said I'd do all I could to help him. At my request, Liam went to see our family GP and was prescribed an antidepressant. For a few months I hoped Liam might be getting better, but then in early 2001 I made a horrifying discovery. Liam had been ordering prescription-only medications over the Internet and using them in combination with cannabis and ecstasy.

...

Later I found out from the local pharmacist that hundreds, if not thousands, of unsolicited e-mails offering on-line drugs are sent to Internet users all over the world every day.

...

He didn't even attempt to deny what he had been doing, but broke down, telling me over and over how sorry he was, and repeating: "I'm evil, you don't really know me, Mum." When I asked about the prescription drugs, he told me Valium was used to soften the come-down after taking ecstasy. I was appalled and, as any parent would be, dreadfully frightened that my son's life was out of control. I kept thinking: "If only he had never started smoking cannabis, none of this would be happening."

It seemed so obvious that it had led him on to more serious drugs. From then on, I was constantly trying to prevent Liam's access to drugs. Sometimes I would go through his room and get rid of them. On one occasion I threw away as many as 200 Valium tablets. After confiding in both my local pharmacist and our GP, I started handing any drugs I found to them. I couldn't understand how it could be possible young, vulnerable people could obtain prescription-only drugs online. Surely it was illegal?

I was beside myself with worry and stress, and made sure I had the chance to intercept the mail before Liam got it.

Looking back, I wonder how I managed to stay sane.

...

Partly as a result of my increasing stress about Liam, as well as the fact that I was also caring for my elderly mother, my husband Graham and I separated in May 2001. We remained loving friends, but simply had no reserves of energy left to put into our own relationship.

Liam continued to live with his father while Ros came with me. I noticed that Liam did not show any emotion at this time, either over our separation, or my mother's death shortly afterwards. During the following year, Liam continued to be very unstable. I knew he was still experimenting with drugs obtained over the Internet, and he admitted that he was still using cannabis "occasionally".

Yet all the time he claimed not to be doing this for thrills, but simply to feel better about himself. I asked him what we could do to help. He decided he wanted to live on his own and rented a unit close to his father and me. But he continued to act in a very frightening way.

In June 2002, he came to my house in a highly disturbed and paranoid state. Terrified, I took him to the local hospital, where he was eventually seen by the duty psychiatrist. An out-patient appointment was made for a few weeks later.

But Liam's behaviour was deteriorating too rapidly for this to be of use. He barricaded himself into his room so that communication became impossible. It was agonising to see my brilliant child's mind unravelling before my eyes.

Two weeks later, I had a phone call from Graham to say Liam had been taken to hospital after running in front of a bus. I felt almost faint with relief when he said Liam had not been hurt.

...

I went straight to the hospital, where the doctor on duty administered an anti-psychotic drug. Liam suddenly showed a dramatic improvement, proving the doctor's diagnosis of a drug-induced psychosis to be correct. Yet a urine test showed he had taken only six codeine tablets.

When I talked to a drugs helpline, I discovered that psychosis does not have to be the result of drugs present in the body, but may be the result of drug abuse from years earlier. This is particularly linked with the long-term use of cannabis.

Recent medical research has established a strong link between the use of cannabis and the development of psychosis and schizophrenia in vulnerable young people. Scientists say that by disrupting the delicate chemical balance of the brain, the drug causes changes leading to long-term mental illness.

I kept Liam with me as much as possible for six weeks after that.

He seemed to be improving steadily, and appeared brighter and more optimistic about the future. I even persuaded him to see a counsellor. But a diary he kept shows his mood swings: "Still getting delusional thoughts -- worst fears -- dying painfully, having to relive my life again and again, voices encouraging me to kill myself."

In the autumn he got a permanent job. He had moved back to his father's, but frequently came around to me for dinner.

HE saw his psychiatrist regularly and was prescribed various anti-psychotic drugs.

Liam had complained of hearing voices and had been diagnosed as suffering from schizophrenia from all the drugs he had taken.

By June last year, Liam was more active: swimming, cooking and playing the piano at home. I began to have hope. When I said he could live with me, he said he loved my house but felt there was something missing inside him.

He complained of an emotional numbness, described by psychiatrists as the "negative symptoms" of schizophrenia. He asked how he could go on for another 50 years feeling like this. On the day he died, he was due to come for lunch but he didn't turn up and we were all worried. If he was not at his father's house, where was he?

Even as I took that first call from Graham, I knew the answer. But it was not until about 20 agonising minutes later that Graham rang again: "Sue, come straight away. The police are here . . . Liam has thrown himself under a train."

I didn't ask whether our son was dead as I could not bear to be told over the telephone. Instead, after driving to the house in minutes, I ran up the path crying: "But he is all right, isn't he?" Of course, in my heart I knew he wasn 't. Later the police told us that Liam had thrown himself under a train at 11 that morning.

Like any distraught mother, I blamed myself. Whatever I had done had not been enough. All I can do is hope to prevent other vulnerable people from being harmed by drugs in the way Liam was. I only wish with all my heart that I had been able to save my own son.

 

 

 

 

 

 

 

 

 

 

 

Med Bills Cause 1/2 Bankruptcy

Half of Bankruptcies Due to Medical Bills, Harvard Study Says

A report on Feb. 2 by Bloomburg on a new study by Harvard University indicates that Half of U.S. bankruptcy filers say that out-of-pocket medical expenses led to their financial hardship -- and most of the people had health insurance, according to a Harvard University study.

The news story states that:

"For the study, researchers surveyed 1,771 filers in five states, and as many as 54.5 percent cited medical expenses as a reason for filing. In addition, the study showed about a 30-fold increase in medical expense-related bankruptcies since 1981.
 

``Cancer was the most expensive diagnosis, with average out- of-pocket expenses of $35,000,'' said Steffie Woolhandler, a professor at Harvard Medical School and an author of the study. Death caused by any disease totaled $17,283 on average, followed by neurological diseases at $15,560 and mental disorders at $15,478. Insurance premium payments were not included in out-of- pocket expenses. "

[Note: we have seen some commentary to the effect that the criteria for medical conditions was too broad in this study - (one criticism I saw was that the study includes such conditions as "gambling compulsion" may have been included). We have done no research into validating either the claims made in the report, or the counter arguments against the report.

More information:

Health Woes Lead to Bankruptcy
http://www.thecrimson.com/today/article505491.html

For information on resources to help handle medical and prescription drug costs, see http://www.schizophrenia.com/family/FAQgen.htm#medexpense

 

Little Justice for the Mentally Ill

Tragedies and violent crimes involving people who suffer with mental illness often get high-profile media attention, but for many, action from the legal system is the first real action that is ever taken in their cases. Due to publicity of violent cases, people with mental illness are seen as somehow more inherently violent or dangerous than the average person. However, examples such as the homicide committed by a mentally ill man in Alabama three weeks ago show that the danger is from the failure of legal and medical systems to intervene with treatment prior to a tragic breaking point.

Such is certainly the case in this most recent tragedy in Alabama. Prior to the incident, Calhoun County Sheriff Larry Amerson concluded that "The warning signs had been there for a long time." However, lack of proper funding and a dirth of specially trained personnel are just two of the barriers to more helpful interventions. Although state law in Alabama allows the appointment of a special community health official with broad legal powers, there is no money in Calhoun County to actually hire such a person, or to pay for any medical treatment ordered by the hypothetical official.

This situation persists in many counties across America, despite statistics from a 1998 U.S. Dept of Justice study stating that ten percent of state prisoners and jail inmates reported a mental or emotional condition. Moreover, 52 percent of state prisoners with some mental illness in the study had committed violent crimes, and 25 percent of those offenses were against family members or intimates. With numbers such as these, it is hard to see why no one places a higher priority on equipping our law enforcement personnel with the tools and training they need to intervene before the crimes happen.

Presently in Calhoun County, even if someone appeals to the legal system to have a mentally ill and potentially dangerous loved one involuntarily committed, the case may sit in the courts for weeks before any action is taken. If and when the involuntary committment is approved, the person will most likely sit in jail instead of receiving the care they need.

Sherriff Amerson concludes: "The process is time-consuming and offers little relief for law enforcement officers seeking to protect a person from themselves or others."

There are some hopeful steps being taken. For example, mental health courts (see http://www.schizophrenia.com/sznews/archives/000116.html) are springing up in certain areas specifically for the trials of defendants with mental illnesses. The sentences include treatment for their conditions as well as appropriate reparations for crimes. Organizations such as NAMI also promote special training for law enforcement personnel (see http://www.schizophrenia.com/sznews/archives/001091.html). These programs teach officers how to effectively deal with someone suffering from a mental illness without resorting to early or unnecessary force.

Help support and advocate for these sorts of vital programs by visiting NAMI's Criminalization site (see http://tinyurl.com/663ff)

Original Source: "Mental illness, justice system often meet", Feb 4 2005. From EverythingAlabama (http://www.al.com)
 

 

Many Gene Mutations May Affect Schizophrenia Development

University of Toronoto (Canada) Researchers links Schizophrenia and Gene Mutations

The supersensitivity to dopamine that is characteristic of schizophrenia can be caused by mutations to a wide variety of genes, rather than alterations to just two or three specific genes, says a University of Toronto researcher.

In research published in the Feb. 15 edition of the Proceedings of the National Academy of Sciences, University of Toronto pharmacology professor Philip Seeman and his 16 colleagues in eight universities show that mutations to genes that have no relation to the brain's dopamine receptors can still cause those receptors to become highly sensitive to their own dopamine, a condition that leads to psychosis.

By examining brain tissue from mice with various gene mutations, the researchers determined that the brain appears to compensate for the altered gene by becoming supersensitive to dopamine. Dopamine is a neurotransmitter that allows people to move, think and feel.

"The altered genes may provoke the brain to respond and compensate, and compensation often involves the dopamine system going into high gear," says Seeman. "The brain knows about mistakes, and to protect itself, it makes sense for the compensation to re-adjust the dopamine system to preserve the functions - such as movement and thought - that the body and brain needs."

An excessively active dopamine system can trigger the hallucinations and delusions experienced in schizophrenia, amphetamine drug abuse or Alzheimer's disease. In drug abuse, the reaction is temporary; in schizophrenia, it recurs.

"This research brings together two worlds: the psychosis of drug abuse and schizophrenia," says Seeman. "There's a common denominator based on the dopamine receptor."

It also offers a new direction for research into schizophrenia.

"Vast amounts of money are being spent to look for the magical two or three genes that cause psychosis but it could be many genes - and that includes genes that have nothing to do with dopamine," said Seeman. "It was a real eye-opener to have all these different pathways factored in."

The next step, says Seeman, is to identify and explain the mechanism that causes the brain to become supersensitive to dopamine, regardless of whether it's caused by a gene mutation or by drug use.

The research was funded by the Ontario Mental Health Foundation, the National Alliance for Research on Schizophrenia and Depression, the Canadian Institutes of Health Research, the National Institute on Drug Abuse, the Canadian Psychiatric Research Foundation, the National Institute of Mental Health and the Dr. Karolina Jus estate.

The other universities involved in the study were McGill University, McMaster University, Emory University, Oregon Health and Science University, Duke University, University of Kuopio (Finland) and University of Washington.

Source: University of Toronto

 

 

 

 

 

 

 

 

 

 

 

 

Lunch Time Behavior Predicts SZ?

Could youngsters' behaviour while eating lunch predict which ones will develop schizophrenia? According to the results of a study headed by Jason Schiffman, Ph.D., the answer is yes.

Some 9,000 children were born in a particular hospital in Copenhagen, Denmark, between 1959 and 1961. In 1972, when the children were between 11 and 13 years of age, some 250 were selected for an investigation into the early signs of schizophrenia. One aspect of the study consisted of videotaping the youngsters while eating lunch to record their social behaviour and neuromotor skills.

These adolescents were followed up in 1992, when they were between the ages of 31 and 33, to determine whether any of them had been diagnosed with schizophrenia or other psychiatric disorders.

The researchers found that the adolescents who later developed schizophrenia had, on average, a lower total score on a sociability scale including smiles, laughs, and vocalizations than did adolescents who developed other kinds of psychopathology or remained free of mental disorder.

Boys who later developed schizophrenia scored, on average, higher on a neuromotor scale consisting of involuntary facial movements, raised elbows, nystagmus-like eye movements, and other abnormal movements than did boys who developed other psychopathology or none.

Another study that shows that compared with non-schizophrenic patients with the first-episode of psychosis, avoidant personality is the most common premorbid personality dimensions in first-episode schizophrenia patients.

Source: American Journal of Psychiatry, November 2004

Personality Dimensions in First-Episode Psychoses, The American Journal of Psychiatry, January, 2005

Low Bone Density in Males with Schizophrenia

A new study in the American Journal of Psychiatry indicates that men with schizophrenia are at high-risk for low bone mineral density - surprisingly, males are at higher-risk than females.

The study tracked 75 in- and out-patients with schizophrenia who had been consistently taking antipsychotic medication for at least one year. The ages of the subjects (19-50) excluded those that might already be suffering from age-related osteoperosis. In males, lower than normal bone mineral density in the lumbar region of the back correlated with increased negative symptoms. In contrast, bone density increased as levels of vitamin D and/or body mass index increased. However, antipsychotic drugs (despite their tendency to increase prolactin levels) did not appear to significantly affect bone mineral density.

The investigators recommend physical activity, good exposure to sunlight (which increases vitamin D3 levels in the body), and adequate nutrition to counteract the potential for bone density loss.

To view the study abstract, see "Osteoporosis in Patients With Schizophrenia" (Hummer M, Malik P, et al) at http://www.pubmed.com. Published in the February edition of American Journal of Psychiatry.

 

 

Schizophrenia Impact on Pregnancy

Women with Schizophrenia Have Increased Risk of Obstetric Complications

A new journal article published in January's issue of "The American Journal of Psychiatry" suggests that women with schizophrenia or a major affective disorder have increased risks of pregnancy, birth and neonatal complications, according to a study in the American Journal of Psychiatry for January.

"Research aiming at a better understanding of both the genetic and environmental reproductive risks could pave the way for the development of preventive programs ensuring optimal antenatal and postnatal care for these vulnerable groups," Dr. Assen V. Jablensky and colleagues at the University of Western Australia in Perth note in their paper.

There is also some evidence that maternal obstetric complications are associated with offspring's risk of schizophrenia in adulthood, they add.

Their study included all births of women with schizophrenia (n = 618), bipolar disorder (n = 1301) or unipolar depression (n = 1255) in Western Australia between 1980 and 1992. These cases were matched with 3129 births drawn randomly from women without major mental illness.

Source: American Journal of Psychiatry, and Reuter's Health.

More information see:

Pregnancy, delivery, and neonatal complications in a population cohort of women with schizophrenia and major affective disorders (available at http://www.pubmed.com)