Archive for the ‘schizophrenia’ Category

Some people develop symptoms that could indicate future schizophrenia, but never actually develop it.  Other people with the same symptoms do. The better we get at telling who will and who won’t develop schizophrenia, the better we can treat it.

Anxiety, Addiction, Depression, and Depression Treatments reports on a study that exposed people with symptoms indicating possible future schizophrenia to a mix of six voices speaking simultaneously.  It was designed so that only four words were clearly audible in the noise.  When asked to describe any words they heard, most people reported words and phrases that were not spoken.  The interesting finding, though, was that 6% who reported phrases under three words developed schizophrenia within two years – but 80% who heard phrases of four or more words did.

This doesn’t tell us whether the under-three-words people will ever develop schizophrenia, but it suggests a time frame in which most of them won’t, and a time frame in which many of the four-words-or-more people will.

I hope this finding holds up!  An easy test that could help doctors know who best to medicate to help avert development of full-blown schizophrenia could mean a lot fewer people developing it.

I store interesting things up for when I have time to post, but I’m too jaded today to do anything but criticize them.

Finding a single gene causing schizophrenia? May be being misunderstood by the science writer – people have been looking for years and years for a (meaning one single) gene that causes bipolar disorder, schizophrenia, etc., and it’s much more likely that multiple genes are in play. And the body of the article doesn’t talk about a single gene, just the leader into the article.
ADD is not overdiagnosed. They define “overdiagnosed” as the number of people mistakenly diagnosed with ADD exceeding the number of people who have ADD but no diagnosis. While evidence does suggest it’s underdiagnosed much more often than overdiagnosed, by this definition you could misdiagnose the entire population of several countries with ADD, while failing to diagnose the population of substantially more (let’s say 10) countries with ADD (and failing to diagnose anyone properly at all). I think a lot of people would still be justifiably concerned with overdiagnosis, were that the case. (And I think that’s what a lot of people are thinking of when they mean “overdiagnosis” – how many people don’t have ADD and get diagnosed with it.)

Cardiovascular disease, not suicide, is the #1 killer of the mentally ill. That sounds pretty counterintuitive until you realize that cardiovascular disease is the #1 killer in the U.S. Although I don’t want to minimize the damage caused by cardiovascular disease, the appropriate comparison here is the ratio of mentally ill with cardiovascular disease to the general population with cardiovascular disease, versus the mentally ill/non-mentally ill ratio for suicide.

Losing 25 to 30 years of life (on average) compared to the general population is still pretty scary, though. I’m not jaded about that. I would think it might be better in countries that don’t require you to have a job with benefits to get good medical insurance, rather than the crappy jobs that many people with severe mental illness get, if they’re able to hold one down at all. But I don’t know that.

There’s this virtual reality device that simulates psychosis, called Virtual Hallucinations.  It’s been mentioned in some news stories as an empathy-inducing device for police officers, and it seems to be helpful.  I think that’s great (and I’m really pleased to keep seeing mention of more police forces being trained in handling mental illness issues).

But it’s weird to see it presented (not in that article but in some others I’ve seen) as letting people experience what it’s like to be schizophrenic.  That’s like saying that induced nausea and malaise and having your head shaved is like having cancer and going through chemotherapy.

Maybe someday they’ll be able to simulate delusions and lack of insight and thought disorders and other things like not having insurance and not having a job and having strained or absent friendships and family relationships and physical health problems and all the other things that often go along with actually having a mental illness, and then that will be like what it’s like to have schizophrenia.  (Or bipolar and schizoaffective disorders, since it’s simulating psychosis, not psychosis in schizophrenia.)

Environmental Connections: A Deeper Look into Mental Illness

I love when I see articles discuss environment/biology in ways that are cutting-edge, instead of “nature versus nurture” or even “nature and nurture are both important”. This one is a good one.

We had the manic mice; now, the schizophrenic mice! Or, more accurately, the mouse model of mania and the mouse model of schizophrenia, since they’re unlikely to be exactly the same thing as what humans gets, just things that involve some of the same systems. But even that will buy you a whole heck of a lot…

Coming soon: a mouse model of videogame addiction. You give them a mini-Nintendo controller, and they punch the “A” key to get a pellet. If you keep reinforcing them, they start punching it really fast. (Maybe we should refer to the human model of mouse pellet addiction instead?)

sz mouse link via confused.

Schizoaffective disorder is a less well-known diagnosis than schizophrenia, depression, or bipolar disorder, and it tends to confuse people. It was categorized under schizophrenia in earlier versions of the DSM, but in the current version you have to have a mood episode for a “substantial portion” of the time, as well as having psychotic symptoms outside of a mood episode.

That last bit is important because some people with bipolar disorder have psychotic symptoms during manic periods, and some people with bipolar disorder and some people with major depressive disorder have psychotic symptoms during depression. But (according to the DSM-IV) they don’t have psychotic symptoms outside of mood episodes.

But we don’t know from this what schizoaffective disorder actually is. Is it having both a mood disorder and schizophrenia at the same time? Is it a separate disorder from either? (And what about if your depression isn’t long enough or severe enough to be schizoaffective disorder and you get diagnosed with schizophrenia with comorbid depression? Is that a totally different thing?)

Goodwin and Jamison do a quick review, which I will summarize:

The five major schools of thought are:

  • a separate disorder (but it doesn’t run in families, so this seems less likely)
  • “an intermediate form on the continuum of psychosis” (I think this means that if you think of disorders as lying along a continuum of psychosis, like you could think of bipolar symptoms as lying along a continuum of severity, schizoaffective is inbetween schizophrenia and bipolar with psychotic symptoms)
  • comorbid schizophrenia and depression/bipolar
  • more severe bipolar
  • less severe variant of schizophrenia

Another school of thought might be that schizoaffective disorder is actually several different things, which is what they tentatively suggest (we’re a little short on actual research to draw strong conclusions):

  • People who are primarily manic and less pronouncedly psychotic may have an especially severe form of bipolar disorder (suggested by studies showing that it is more associated with bipolar disorder and has a worse course: Gershon et al, 1982; Coryell et al., 1990).
  • People who are predominantly psychotic and have less prominent, exclusively depressive symptoms may have a less severe variant of schizophrenia (suggested by studies showing outcomes or neuropsych profiles similar to schizophrenics: Brockington et al, 1980; Tsuang and Coryell, 1993; Evans et al, 1999).
  • People who have about an equal mix are the unlucky bastards who just happened to get both a mood disorder and schizophrenia. (suggested by the epidemiological prevalence of the disorder being a fraction of a percent, about what you’d expect for those two just happening to co-occur: Kendler et al, 1993, 1996).

Again, this is still speculative and we don’t have enough research to confirm (or deny) it. But it’s pretty interesting, no? Maybe we’ll get a bipolar 0.5 to complement I and II? Since all the love’s been going in the other direction, maybe it’s time the crazier among us got a little more attention. And what kind of “less severe” schizophrenia manages to hit you with something akin to major depressive disorder, yet still be less disabling than regular schizophrenia?

Columbia University researchers have created a visualization of disease comorbidity using health records from 1.5 million people (article and full-text paper). There’s a lot they’ll be able to do with this – look for genetic links, look to see if some conditions protect from other conditions, look for potential environmental triggers like bacterial or viral infections.

This sounds awesome in general – people can process complex information about associations much faster when represented visually than when they see a bunch of numeric correlations. (Way to go, information usability!)
They find that bipolar, autism, and schizophrenia are associated (quotes from the paper):

We estimate that {approx}20–60% of autism-predisposing variations also predispose the bearer to bipolar disorder, and 20–75% of autism-predisposing variations also predispose the bearer to schizophrenia. It is therefore extremely likely that there is a three-way positive correlation among autism, bipolar disorder, and schizophrenia, a correlation that probably arises from a genetic variation that predisposes to all three disorders.

If so that’s extremely interesting, although I wonder how much of a link between autism and schizophrenia is due to the two being mistaken for each other (or perhaps the overlap in predisposing genes is why the two are mistaken for each other – our diagnostic categories are attempting to clearly delineate fuzzy categories).

Also, everything under the sun is associated with autism, apparently (I wonder whether there’s a causal relationship, and if so which way, or whether it’s third variables, or all of the above):

[A]utism, which typically manifests before the affected child is 3 years old, has a strong positive correlation with a number of neurological disorders, some of which have a late-age onset…: attention deficit, epilepsy, cerebral palsy, depression, schizophrenia, bipolar disorder, neurofibromatosis, Parkinson’s disease, and migraine. Our estimated significant overlap between autism and tuberculosis may indicate that both diseases are associated with genetic changes weakening the immune system.

They also mention associations between allergies/autoimmune disorders and autism, schizophrenia, and bipolar disorder. And here’s something totally new: female breast cancer is negatively associated with schizophrenia and bipolar disorder. They proposed an explanation involving schizophrenia and bipolar being associated with increased probability of abnormal cell death in some tissues, and breast cancer being associated with an increased probability of abnormal cell proliferation. And they mention that tamoxifen (a breast cancer treatment drug) can help treat bipolar disorder – I’ll try to follow up on that in a future post.

And the credits go to: Andrew Rzhetsky, David Wajngurt, Naeun Park, and Tian Zheng of the University of Columbia. And any unnamed undergraduate or graduate assistants.

(For anyone who’s requested an entry on a specific topic: I haven’t forgotten you, I’ve just been too busy to do background research because of moving this weekend, and have been doing stuff I could sit down and type out instead. Entries on schizoaffective disorder, kindling, worries about personality change on meds, and lots of stuff on culture coming up, among other things.)

I’m updating early because I’m moving apartments this weekend, but my general plan is to post every evening by nine-o-clock meds time (EST).

Nash Suggests Schizophrenia May Serve Adaptive Function

On the mental illness side: schizophrenia is not associated with genius or creativity. None of our evidence says it’s anything but severely impairing. Bipolar is associated with creativity despite fucking everyone over, but schizophrenia mostly just fucks people over, although there are people who do well at times. John Nash is a genius, but that’s not necesarily due to schizophrenia. People who are geniuses can also be crazy without a causal link. People who have bipolar are more likely to be creative, and not necessarily actually more creative. Inability to think clearly or concentrate, or being depressed or manic, can really do a number on your creativity.

On the evolutionary side: the detrimental effects of adaptations sometimes get undermentioned. An “successful” adaptation can severely impair most of the people who have it if, on average, there’s enough benefit for at least some people to “balance that out”. It doesn’t have to benefit an individual person. It doesn’t even have to benefit any of the people who actually have it! It might benefit copies of their genes that reside in their kin, instead. This is where schizophrenia may come into play – family members of people with schizophrenia display increased creativity (can provide cite later, seriously supposed to be packing my remaining crap right now).

Take-home point: If serious mental illnesses are adaptations (I’m not convinced they are, but I’m open to the possibility), they’re not beneficial for most affected people. If they were, we wouldn’t call them mental illnesses – a major requirement in the DSM is that a mental disorder cause marked impairment in functioning. It’s nice to think we’re all geniuses, but that stereotype covers up the crappy reality of just trying to make it day to day, let alone hold down a job or have good relationships.

UCSD researchers have come up with a shirt that takes various physiological measurements from people, and have found distinct patterns between people with schizophrenia and people with bipolar disorder. This is of note particularly because it can be very hard for clinicians to distinguish someone having a manic episode from someone who is schizophrenic. But it’s also interesting because anything that tells us more about what’s going on can lead to better treatment…

Here’s the link with the somewhat misleading headline (it’s not really about monitoring in the treatment sense, it’s not even in the pipeline, but it is an extremely interesting study):

Wearable Technology Helps Monitor Mental Illness

I also like that they mention difficulty filtering information. It can be a pretty big issue but because it’s not psychosis, nor mood, it’s not so well-known. One of my own problems, whenever I feel off in whatever way, is getting overwhelmed by sensory input and having to leave social situations because I can’t take it anymore. (Medication has definitely helped with that.)

Anyway. I wonder if something like this will eventually come into play in childhood bipolar diagnosis? That’s contentious in part because it’s very hard to diagnose in kids who don’t have clearcut manic periods.

Personally, I think they should make it Hypercolor and just have it turn different colors.