Archive for the ‘schizophrenia’ Category

A pair of new studies links childhood cat ownership and infection with the parasite Toxoplasma gondii (T. gondii) with later onset schizophrenia and other mental illness. Researchers published their findings in the online Schizophrenia Research and Acta Psychiatrica Scandinavica.

In the Schizophrenia Research study, investigators compared two previous studies that suggested childhood cat ownership could be a possible risk factor for schizophrenia or another serious mental illness with a third, even earlier survey on mental health to see if the finding could be replicated.

“The results were the same,” researchers reported, “suggesting that cat ownership in childhood is significantly more common in families in which the child later becomes seriously mentally ill.”

If accurate, the researchers expect the culprit to be infection with T. gondii, a parasite commonly carried by cats. At this point, though, they are urging others to conduct further studies to clarify the apparent link between cat ownership and schizophrenia.

The Acta Psychiatrica Scandinavica study was a meta-analysis of 50 previously published studies to investigate the prevalence of t. gondii infection in people diagnosed with psychiatric disorders compared with healthy controls.

In cases of schizophrenia, researchers said evidence of an association with T. gondii was “overwhelming,” CBS News reported. Specifically, people infected with T. gondii were nearly twice as likely to be diagnosed with schizophrenia as people never infected with the parasite, according to the report.

The meta-analysis also suggested associations between T. gondii infection and bipolar disorder, obsessive-compulsive disorder, and addiction. No association, however, was found for major depression.

—Jolynn Tumolo

References

1. Fuller Torrey E, Simmons W, Yolken RH. Is childhood cat ownership a risk factor for schizophrenia later in life? Schizophrenia Research. 2015 April 18. [Epub ahead of print].

2. Sutterland AL, Fond G, Kuin A, et al. Beyond the association. Toxoplasma gondii in schizophrenia, bipolar disorder, and addiction: systematic review and meta-analysis. Acta Psychiatrica Scandinavica. 2015 April 15. [Epub ahead of print].

http://www.psychcongress.com/article/studies-link-cat-ownership-schizophrenia-other-mental-illness

katharine-thakkar

People with schizophrenia have different levels of the neurotransmitters glutamate and gamma-aminobutyric acidergic (GABA) than healthy people do, and their relatives also have lower glutamate levels, according to a study published online in Biological Psychiatry.

Using magnetic resonance spectroscopy, researchers discovered reduced levels of glutamate — which promotes the firing of brain cells — in both patients with schizophrenia and healthy relatives. Patients also showed reduced levels of GABA, which inhibits neural firing. Healthy relatives, however, did not.

Researchers are unsure why healthy relatives with altered glutamate do not show symptoms of schizophrenia or how they maintain normal GABA levels despite a predisposition to the illness.

“This finding is what’s most exciting about our study,” said lead investigator Katharine Thakkar, PhD, assistant professor of clinical psychology at Michigan State University, East Lansing. “It hints at what kinds of things have to go wrong for someone to express this vulnerability toward schizophrenia. The study gives us more specific clues into what kinds of systems we want to tackle when we’re developing new treatments for this very devastating illness.”

The study included 21 patients with chronic schizophrenia, 23 healthy relatives of other people with schizophrenia not involved in the study, and 24 healthy nonrelatives who served as controls.

Many experts believe there are multiple risk factors for schizophrenia, including dopamine and glutamate-GABA imbalance. Drugs that regulate dopamine do not work for all patients with schizophrenia. Dr. Thakkar believes magnetic resonance spectroscopy may help clinicians target effective treatments for specific patients.

“There are likely different causes of the different symptoms and possibly different mechanisms of the illness across individuals,” said Dr. Thakkar.

“In the future, as this imaging technique becomes more refined, it could conceivably be used to guide individual treatment recommendations. That is, this technique might indicate that one individual would benefit more from treatment A and another individual would benefit more from treatment B, when these different treatments have different mechanisms of action.”

—Jolynn Tumolo

References

Thakkar KN, Rösler L, Wijnen JP, et al. 7T proton magnetic resonance spectroscopy of GABA, glutamate, and glutamine reveals altered concentrations in schizophrenia patients and healthy siblings [publisehd online ahead of print April 19, 2016]. Biological Psychiatry.
Study uncovers clue to deciphering schizophrenia [press release]. Washington, DC: EurekAlert!; June 7, 2016.

An international team of researchers has linked specific symptoms of schizophrenia with various anatomical characteristics in the brain, according to research published in NeuroImage.

By analyzing the brain’s anatomy with magnetic resonance imaging (MRI), researchers from the University of Granada, Washington University in St. Louis, and the University of South Florida have demonstrated the existence of distinctive subgroups among patients with schizophrenia who suffer from different symptoms.

These findings could herald a significant step forward in diagnosing and treating schizophrenia.

To perform the study, the researchers conducted the MRI technique “diffusion tensor imaging” on 36 healthy participants and 47 schizophrenic participants.

The researchers found that tests on schizophrenic participants revealed various abnormalities in parts of the corpus callosum, a bundle of neural fibers that connects the left and right cerebral hemispheres and is essential for effective interhemispheric communication.

Different anomalies in the corpus callosum were associated with different symptoms in the schizophrenic participants. An anomaly in one part of the brain structure was associated with strange and disorganized behavior; another anomaly was associated with disorganized thought and speech, as well as negative symptoms such as a lack of emotion; and other anomalies were associated with hallucinations.

In 2014, this same research group proved that schizophrenia is not a single illness. The team demonstrated the existence of 8 genetically distinct disorders, each with its own symptoms. Igor Zwir, PhD, and Javier Arnedo from the University of Granada’s Department of Computer Technology and Artificial Intelligence found that different sets of genes were strongly linked with different clinical symptoms.

“The current study provides further evidence that schizophrenia is a heterogeneous group of disorders, as opposed to a single illness, as was previously thought to be case,” Dr Zwir said in a statement.

While current treatments for schizophrenia tend to be generic regardless of the symptoms exhibited by each patient, the researchers believe that in the future, analyzing how specific gene networks are linked to various brain features and specific symptoms will help develop treatments that are adapted to each patient’s individual disorder.

To conduct the analysis of the gene groups and brain scans, the researchers developed a new, complex analysis of the relationships between different types of data and recommendations regarding new data. The system is similar to that used by companies such as Netflix to determine what movies they want to broadcast.

“To conduct the research, we did not begin by studying individuals who had certain schizophrenic symptoms in order to determine whether they had the corresponding brain anomalies,” said Dr Zwir in a statement. “Instead, we first analyzed the data, and that’s how we discovered these patterns. This type of information, combined with data on the genetics of schizophrenia, will someday be of vital importance in helping doctors treat the disorders in a more precise and effective way.”

Reference
Arnedo J, Mamah D, Baranger DA, et al. Decomposition of brain diffusion imaging data uncovers latent schizophrenias with distinct patterns of white matter anisotropy. NeuroImage. 2015; doi:10.1016/j.neuroimage.2015.06.083.

http://www.psychiatryadvisor.com/schizophrenia-and-psychoses/types-subgroups-schizophrenia-linked-various-different-brain-anomalies-corpus-callosum/article/470226/?DCMP=EMC-PA_Update_rd&cpn=psych_md&hmSubId=&hmEmail=5JIkN8Id_eWz7RlW__D9F5p_RUD7HzdI0&NID=&dl=0&spMailingID=13630678&spUserID=MTQ4MTYyNjcyNzk2S0&spJobID=720090900&spReportId=NzIwMDkwOTAwS0

Excessive activity in complement component 4 (C4) genes linked to the development of schizophrenia may explain the excessive pruning and reduced number of synapses in the brains of patients with schizophrenia, according to a study published in Nature.

The study, co-funded by the Office of Genomics Research Coordination at the National Institute of Mental Health and the Stanley Center for Psychiatric Research at the Broad Institute in Cambridge, Massachusetts, analyzed various structurally diverse versions of the C4 gene.

Led by Steve McCarroll, PhD, of the Broad Institute of Harvard and MIT, researchers analyzed the genomes of 65 000 study participants and 700 postmortem brains, detecting a link between specific gene versions and the biological process that causes some cases of schizophrenia.

The team—including Beth Stevens, PhD; Michael Carroll, PhD; and Aswin Sekar, BBS— determined that C4 genes generate varying levels of C4A and C4B proteins; the more C4A found in a person, the higher his or her risk of developing schizophrenia. The researchers found that during critical periods of brain maturation, C4 identifies synapses for pruning. Overexpression of C4 results in higher amounts of C4A, which could cause excessive pruning during the late teens and early adulthood, “conspicuously corresponding to the age-of-onset of schizophrenia symptoms,” the researchers noted.

“It has been virtually impossible to model [schizophrenic] disorder in cells or animals,” said Dr McCarroll. “The human genome is providing a powerful new way into this disease. Understanding these genetic effects on risk is a way of prying open that black box, peering inside, and starting to see actual biological mechanisms.”

Research suggests that future schizophrenia treatments may be developed to target and suppress excessive levels of pruning, halting a process that has the potential to develop into psychotic illness.

Reference

Sekar A, Bialas AR, de Rivera H, et al. Schizophrenia risk from complex variation of complement component 4. Nature. 2016; doi: 10.1038/nature16549.

An automated speech analysis program correctly differentiated between at-risk young people who developed psychosis over a two-and-a-half year period and those who did not. In a proof-of-principle study, researchers at Columbia University Medical Center, New York State Psychiatric Institute, and the IBM T. J. Watson Research Center found that the computerized analysis provided a more accurate classification than clinical ratings. The study, “Automated Analysis of Free Speech Predicts Psychosis Onset in High-Risk Youths,” was recently published in NPJ-Schizophrenia.

About one percent of the population between the age of 14 and 27 is considered to be at clinical high risk (CHR) for psychosis. CHR individuals have symptoms such as unusual or tangential thinking, perceptual changes, and suspiciousness. About 20% will go on to experience a full-blown psychotic episode. Identifying who falls in that 20% category before psychosis occurs has been an elusive goal. Early identification could lead to intervention and support that could delay, mitigate or even prevent the onset of serious mental illness.
Speech provides a unique window into the mind, giving important clues about what people are thinking and feeling. Participants in the study took part in an open-ended, narrative interview in which they described their subjective experiences. These interviews were transcribed and then analyzed by computer for patterns of speech, including semantics (meaning) and syntax (structure).

The analysis established each patient’s semantic coherence (how well he or she stayed on topic), and syntactic structure, such as phrase length and use of determiner words that link the phrases. A clinical psychiatrist may intuitively recognize these signs of disorganized thoughts in a traditional interview, but a machine can augment what is heard by precisely measuring the variables. The participants were then followed for two and a half years.
The speech features that predicted psychosis onset included breaks in the flow of meaning from one sentence to the next, and speech that was characterized by shorter phrases with less elaboration. The speech classifier tool developed in this study to mechanically sort these specific, symptom-related features is striking for achieving 100% accuracy. The computer analysis correctly differentiated between the five individuals who later experienced a psychotic episode and the 29 who did not. These results suggest that this method may be able to identify thought disorder in its earliest, most subtle form, years before the onset of psychosis. Thought disorder is a key component of schizophrenia, but quantifying it has proved difficult.

For the field of schizophrenia research, and for psychiatry more broadly, this opens the possibility that new technology can aid in prognosis and diagnosis of severe mental disorders, and track treatment response. Automated speech analysis is inexpensive, portable, fast, and non-invasive. It has the potential to be a powerful tool that can complement clinical interviews and ratings.

Further research with a second, larger group of at-risk individuals is needed to see if this automated capacity to predict psychosis onset is both robust and reliable. Automated speech analysis used in conjunction with neuroimaging may also be useful in reaching a better understanding of early thought disorder, and the paths to develop treatments for it.

http://medicalxpress.com/news/2015-08-psychosis-automated-speech-analysis.html

Schizophrenia is associated with structural and functional alterations of the visual system, including specific structural changes in the eye. Tracking such changes may provide new measures of risk for, and progression of the disease, according to a literature review published online in the journal Schizophrenia Research: Cognition, authored by researchers at New York Eye and Ear Infirmary of Mount Sinai and Rutgers University.

Individuals with schizophrenia have trouble with social interactions and in recognizing what is real. Past research has suggested that, in schizophrenia, abnormalities in the way the brain processes visual information contribute to these problems by making it harder to track moving objects, perceive depth, draw contrast between light and dark or different colors, organize visual elements into shapes, and recognize facial expressions. Surprisingly though, there has been very little prior work investigating whether differences in the retina or other eye structures contribute to these disturbances.

“Our analysis of many studies suggests that measuring retinal changes may help doctors in the future to adjust schizophrenia treatment for each patient,” said study co-author Richard B. Rosen, MD, Director of Ophthalmology Research, New York Eye and Ear Infirmary of Mount Sinai, and Professor of Ophthalmology, Icahn School of Medicine at Mount Sinai. “More studies are needed to drive the understanding of the contribution of retinal and other ocular pathology to disturbances seen in these patients, and our results will help guide future research.”

The link between vision problems and schizophrenia is well established, with as many as 62 percent of adult patients with schizophrenia experience visual distortions involving form, motion, or color. One past study found that poorer visual acuity at four years of age predicted a diagnosis of schizophrenia in adulthood, and another that children who later develop schizophrenia have elevated rates of strabismus, or misalignment of the eyes, compared to the general population.

Dr. Rosen and Steven M. Silverstein, PhD, Director of the Division of Schizophrenia Research at Rutgers University Behavioral Health Care, were the lead authors of the analysis, which examined the results of approximately 170 existing studies and grouped the findings into multiple categories, including changes in the retina vs. other parts of the eye, and changes related to dopamine vs. other neurotransmitters, key brain chemicals associated with the disease.

The newly published review found multiple, replicated, indicators of eye abnormalities in schizophrenia. One of these involves widening of small blood vessels in the eyes of schizophrenia patients, and in young people at high risk for the disorder, perhaps caused by chronic low oxygen supply to the brain. This could explain several key vision changes and serve as a marker of disease risk and worsening. Also important in this regard was thinning of the retinal nerve fiber layer in schizophrenia, which is known to be related to the onset of hallucinations and visual acuity problems in patients with Parkinson’s disease. In addition, abnormal electrical responses by retinal cells exposed to light (as measured by electroretinography) suggest cellular-level differences in the eyes of schizophrenia patients, and may represents a third useful measure of disease progression, according to the authors.

In addition, the review highlighted the potentially detrimental effects of dopamine receptor-blocking medications on visual function in schizophrenia (secondary to their retinal effects), and the need for further research on effects of excessive retinal glutamate on visual disturbances in the disorder.

Interestingly, the analysis found that there are no reports of people with schizophrenia who were born blind, suggesting that congenital blindness may completely or partially protect against the development of schizophrenia. Because congenitally blind people tend to have cognitive abilities in certain domains (e.g., attention) that are superior to those of healthy individuals, understanding brain re-organization after blindness may have implications for designing cognitive remediation interventions for people with schizophrenia.

“The retina develops from the same tissue as the brain,” said Dr. Rosen. “Thus retinal changes may parallel or mirror the integrity of brain structure and function. When present in children, these changes may suggest an increased risk for schizophrenia in later life. Additional research is needed to clarify these relationships, with the goals of better predicting emergence of schizophrenia, and of predicting relapse and treatment response and people diagnosed with the condition.”

Dr. Silverstein points out that, to date, vision has been understudied in schizophrenia, and studies of the retina and other ocular structures in the disorder are in their infancy. However, he added, “because it is much faster and less expensive to obtain data on retinal structure and function, compared to brain structure and function, measures of retinal and ocular structure and function may have an important role in both future research studies and the routine clinical care of people with schizophrenia.”

http://www.eurekalert.org/pub_releases/2015-08/tmsh-rcm081715.php

Forum Pharmaceuticals announced that the FDA has granted Fast Track designation to encenicline for the treatment of cognitive impairment in schizophrenia.

Forum recently completed patient enrollment for the COGNITIV SZ phase 3 clinical trial program which includes two randomized, double-blind, placebo-controlled studies. The program is evaluating the safety and efficacy of two oral doses of once-daily treatment with encenicline as a pro-cognitive treatment compared to placebo when added to chronic, stable, atypical antipsychotic therapy in people with schizophrenia.

Primary endpoints of the trials include effect on cognitive function and effect on clinical function. The two global 26-week trials enrolled a total of more than 1,500 patients at approximately 200 clinical sites.

Encenicline is an orally administered, selective, and potent agonist of the alpha 7 receptor found in hippocampal and cortical neurons involved in cognition.

In a phase 2 trial, which was sponsored by Forum and results of which were released in March, 319 schizophrenia patients were randomized to receive either encenicline in one of two doses daily, or a placebo, for 12 weeks.

Patients in both encenicline dose groups showed significant cognitive improvement based on various measures, according to a presentation made at the 15th International Congress on Schizophrenia Research. In a subset of 154 patients, the improvement was greater in the higher-dose group (0.9 mg) than the lower-dose cohort (0.27 mg).


The Princeton mathematician, who along with his wife died in a car crash last month, claimed that aging as opposed to medicine helped improve his condition

Mathematician John Nash, who died May 23 in a car accident, was known for his decades-long battle with schizophrenia—a struggle famously depicted in the 2001 Oscar-winning film “A Beautiful Mind.” Nash had apparently recovered from the disease later in life, which he said was done without medication.

But how often do people recover from schizophrenia, and how does such a destructive disease disappear?

Nash developed symptoms of schizophrenia in the late 1950s, when he was around age 30, after he made groundbreaking contributions to the field of mathematics, including the extension of game theory, or the math of decision making. He began to exhibit bizarre behavior and experience paranoia and delusions. Over the next several decades, he was hospitalized several times, and was on and off anti-psychotic medications.

But in the 1980s, when Nash was in his 50s, his condition began to improve. In an email to a colleague in the mid-1990s, Nash said, “I emerged from irrational thinking, ultimately, without medicine other than the natural hormonal changes of aging,” according to The New York Times. Nash and his wife Alicia died, at ages 86 and 82, respectively, in a crash on the New Jersey Turnpike while en route home from a trip on which Nash had received a prestigious award for his work.

Studies done in the 1930s, before medications for schizophrenia were available, found that about 20 percent of patients recovered on their own, while 80 percent did not, said Dr. Gilda Moreno, a clinical psychologist at Nicklaus Children’s Hospital in Miami. More recent studies have found that, with treatment, up to 60 percent of schizophrenia patients can achieve remission, which researchers define as having minimal symptoms for at least six months, according to a 2010 review study in the journal Advances in Psychiatric Treatment.

It’s not clear why only some schizophrenia patients get better, but researchers do know that a number of factors are linked with better outcomes. Nash appeared to have had many of these factors in his favor, Moreno said.

People who have a later onset of the disease tend to do better than those who experience their first episode of psychosis in their teens, Moreno said. (“Psychosis” refers to losing touch with reality, exhibited by symptoms like delusions.) Nash was 30 years old when he started to experience symptoms of schizophrenia, which include hallucinations and delusions.

In addition, social factors—such as having a job, a supportive community and a family that is able to help with everyday tasks—are also linked with better outcomes for schizophrenia patients, Moreno said.

Nash had supportive colleagues who helped him find jobs where people were protective of him, and a wife who cared for him and took him into her house even after the couple divorced, which may have prevented him from becoming homeless, according to an episode of the PBS show “American Experience” that focused on Nash. “He had all those protective factors,” Moreno said.

Some researchers have noted that patients with schizophrenia tend to get better as they age.

“We know, as a general rule, with exceptions, that as people with schizophrenia age, they have fewer symptoms, such as delusions and hallucinations,” Dr. E. Fuller Torrey, a psychiatrist who specializes in schizophrenia, said in an interview with “American Experience.”

However, Moreno said that many patients will get worse over time if they don’t have access to proper medical care and are not in a supportive environment.

“When you have a schizophrenic who has had the multiple psychotic breaks, there is a downward path,” Moreno said. Patients suffer financially because they can’t work, physically because they can’t take care of themselves, and socially because their bizarre behaviors distance them from others, Moreno said.

It may be that the people who have supportive environments are the ones who are able to live to an older age, and have a better outcome, Moreno said.

Still, there is no guarantee that someone will recover from schizophrenia—a patient may have all the protective factors but not recover, Moreno said. Most patients cope with their symptoms for their entire lives, but many are also able to live rewarding lives, according to the National Institute of Mental Health.

http://www.scientificamerican.com/article/beautiful-mind-john-nash-s-schizophrenia-disappeared-as-he-aged/


Results imply creative people are 25% more likely to carry genes that raise risk of bipolar disorder and schizophrenia. But others argue the evidence is flimsy.

The ancient Greeks were first to make the point. Shakespeare raised the prospect too. But Lord Byron was, perhaps, the most direct of them all: “We of the craft are all crazy,” he told the Countess of Blessington, casting a wary eye over his fellow poets.

The notion of the tortured artist is a stubborn meme. Creativity, it states, is fuelled by the demons that artists wrestle in their darkest hours. The idea is fanciful to many scientists. But a new study claims the link may be well-founded after all, and written into the twisted molecules of our DNA.

In a large study published on Monday, scientists in Iceland report that genetic factors that raise the risk of bipolar disorder and schizophrenia are found more often in people in creative professions. Painters, musicians, writers and dancers were, on average, 25% more likely to carry the gene variants than professions the scientists judged to be less creative, among which were farmers, manual labourers and salespeople.

Kari Stefansson, founder and CEO of deCODE, a genetics company based in Reykjavik, said the findings, described in the journal Nature Neuroscience, point to a common biology for some mental disorders and creativity. “To be creative, you have to think differently,” he told the Guardian. “And when we are different, we have a tendency to be labelled strange, crazy and even insane.”

The scientists drew on genetic and medical information from 86,000 Icelanders to find genetic variants that doubled the average risk of schizophrenia, and raised the risk of bipolar disorder by more than a third. When they looked at how common these variants were in members of national arts societies, they found a 17% increase compared with non-members.

The researchers went on to check their findings in large medical databases held in the Netherlands and Sweden. Among these 35,000 people, those deemed to be creative (by profession or through answers to a questionnaire) were nearly 25% more likely to carry the mental disorder variants.

Stefansson believes that scores of genes increase the risk of schizophrenia and bipolar disorder. These may alter the ways in which many people think, but in most people do nothing very harmful. But for 1% of the population, genetic factors, life experiences and other influences can culminate in problems, and a diagnosis of mental illness.

“Often, when people are creating something new, they end up straddling between sanity and insanity,” said Stefansson. “I think these results support the old concept of the mad genius. Creativity is a quality that has given us Mozart, Bach, Van Gogh. It’s a quality that is very important for our society. But it comes at a risk to the individual, and 1% of the population pays the price for it.”

Stefansson concedes that his study found only a weak link between the genetic variants for mental illness and creativity. And it is this that other scientists pick up on. The genetic factors that raise the risk of mental problems explained only about 0.25% of the variation in peoples’ artistic ability, the study found. David Cutler, a geneticist at Emory University in Atlanta, puts that number in perspective: “If the distance between me, the least artistic person you are going to meet, and an actual artist is one mile, these variants appear to collectively explain 13 feet of the distance,” he said.

Most of the artist’s creative flair, then, is down to different genetic factors, or to other influences altogether, such as life experiences, that set them on their creative journey.

For Stefansson, even a small overlap between the biology of mental illness and creativity is fascinating. “It means that a lot of the good things we get in life, through creativity, come at a price. It tells me that when it comes to our biology, we have to understand that everything is in some way good and in some way bad,” he said.

But Albert Rothenberg, professor of psychiatry at Harvard University is not convinced. He believes that there is no good evidence for a link between mental illness and creativity. “It’s the romantic notion of the 19th century, that the artist is the struggler, aberrant from society, and wrestling with inner demons,” he said. “But take Van Gogh. He just happened to be mentally ill as well as creative. For me, the reverse is more interesting: creative people are generally not mentally ill, but they use thought processes that are of course creative and different.”

If Van Gogh’s illness was a blessing, the artist certainly failed to see it that way. In one of his last letters, he voiced his dismay at the disorder he fought for so much of his life: “Oh, if I could have worked without this accursed disease – what things I might have done.”

In 2014, Rothernberg published a book, “Flight of Wonder: an investigation of scientific creativity”, in which he interviewed 45 science Nobel laureates about their creative strategies. He found no evidence of mental illness in any of them. He suspects that studies which find links between creativity and mental illness might be picking up on something rather different.

“The problem is that the criteria for being creative is never anything very creative. Belonging to an artistic society, or working in art or literature, does not prove a person is creative. But the fact is that many people who have mental illness do try to work in jobs that have to do with art and literature, not because they are good at it, but because they’re attracted to it. And that can skew the data,” he said. “Nearly all mental hospitals use art therapy, and so when patients come out, many are attracted to artistic positions and artistic pursuits.”

http://www.theguardian.com/science/2015/jun/08/new-study-claims-to-find-genetic-link-between-creativity-and-mental-illness

Academia is calling for the abolishment of the term “schizophrenia” in hopes of finding a label that’s less stigmatized. Why people with the medical condition have mixed opinions.
In an article recently published in the academic journal Schizophrenia Research, researchers called for the abolition of the term “schizophrenia.” Renaming the disorder, they argue, could destigmatize the disorder, create greater willingness of people with schizophrenia to pursue treatments, make it easier for doctors to give a diagnosis, and communicate that the prognosis is much less bleak than most people believe.

“Over the last years the term ‘schizophrenia’ has been increasingly contested by patients, families, researchers, and clinicians,” wrote Antonio Lasalvia in an email to The Daily Beast. Lasalvia is one of the study authors and a professor of psychiatry at University of Verona.

“The literature, from both Eastern and Western countries, consistently shows that the term schizophrenia holds a negative stigmatizing connotation. This negative connotation is a barrier for the recognition of the problem itself, for seeking specialized care, for taking full advantage of specialized care. It is therefore useless and sometimes damaging.”

The word “schizophrenia” was coined in the early 20th century, deriving from the Greek word for “split mind.” The term conveyed the idea that people with schizophrenia experienced a splitting of their personality—that they no longer had unified identities.

Considering all the words for mental illness, both those used by medical doctors and those that are cruel slurs used by the general public, it is striking how many of them have connotations of being broken or disorganized: deranged, crazy (which means cracked— itself a derogatory term), unglued, having a screw loose, unhinged, off the wall.

It seems there is some stigma attached to “schizophrenia.” One study showed that most people with schizophrenia (the preferred term is no longer “patients” but “users” or “consumers”) worry that they are viewed unfavorably by others, while some avoid telling people their diagnosis.

Another study examined the use of “schizophrenia” in the news media. Frequently, it is used not to describe a mental disorder, but as a metaphor for inconsistency, or being of a split mind. For example, The Washington Post included an opinion piece that mentioned, “the schizophrenia of a public that wants less government spending, more government services and lower taxes.” It is still socially acceptable—even among many card-carrying progressives—to say that something or someone is “insane,” “crazy,” or “unhinged.”

Christina Bruni, author of Left of the Dial: A Memoir of Schizophrenia, Recovery, and Hope, told me that her experience of stigma has changed over the years. “I used to not want to have ‘schizophrenia’ because I didn’t want people to think I was crazy. After a failed drug holiday, and a failed career in the gray flannel insurance field, I now have a creative job as a librarian,” she wrote in an email. “Ever since I started work as a librarian, I haven’t experienced any stigma in my ordinary life. It’s the people who fall through the cracks, who don’t get help, that the media chronicles, thus reinforcing stereotypes.”

Several people I spoke to noted that the general public confuses schizophrenia with dissociative identity disorder (which used to be known as multiple personality disorder), perhaps because they associate the word schizophrenia with “splitting.” The name change might make the distinction clearer.

There has been precedence for such a move. In addition to dissociative identity disorder, other mental and learning disorders have switched names. For example, “manic-depression” is now widely known as “bipolar disorder,” “mental retardation” is now known as “intellectual and developmental disability.”

“Changing the name can be very successful. What you call something is very important, which is why there is a PR industry,” David Kingdon, professor of psychiatry at the University of Southampton, told The Daily Beast. He has long advocated a change of name for schizophrenia.

Ken Duckworth is the medical director for the National Alliance on Mental Illness. He agrees that a name change has the potential to be powerful, but thinks we need more evidence that it will be effective. “Schizophrenia involves thought, mood, cognition,” he said in an interview. “This is powerful in terms of your identity. It’s not the same as saying you have diabetes. It comes across as something that’s wrong, something that’s negative.”

Kingdon prefers using terms that refer to different forms of psychosis, such as “traumatic psychosis” and “drug-induced psychosis.” “Clients don’t get so excited about it. It gives insight into treatment,” he says. “You can say, ‘Something can be done about this and what can be done is this.’”

Kingdon emphasized that many people feel hopeless upon receiving a diagnosis of schizophrenia when in fact treatments have improved prognoses dramatically in the last 20 years. “Cognitive behavioral therapy, complementary to medical treatment, has been pretty well-demonstrated to be effective,” he pointed out.

In cognitive behavioral therapy, users learn to recognize when they are having disruptive thoughts and are taught techniques for managing them. A recent study which Kingdon co-authored showed that cognitive behavioral therapy reduced both worry and persecutory delusions. “We don’t hear a lot of media stories of people getting better, but they do all the time,” added Duckworth.

Japan has changed the name of schizophrenia. In 2002, it was recommended that seishin-bunretsu-byo (“mind-split-disease”) become togo-shitcho-sho (“integration dysregulation syndrome”). The change was officially adopted by the Japanese Ministry of Health and Welfare by 2005.

Following the change, doctors in Japan became far more likely to disclose to patients that they had schizophrenia. While this shift occurred during a time in which Japanese doctors in general were becoming more willing to deliver difficult diagnoses to patients, it happened at a much more rapid pace with schizophrenia. This suggests that the name change itself increased doctors’ willingness to talk to their patients.

A large majority of Japanese psychiatrists felt, after the name change, better able to communicate information to patients about the disorder, and also that patients were more likely to adhere to treatment plans.

“The first lesson from the Japanese experience is that a change is possible and that the change may be beneficial for mental health users and their careers, for professionals and researchers alike,” said Lasalvia. “An early effect of renaming schizophrenia, as proven by the Japanese findings, would increase the percentage of patients informed about their diagnosis, prognosis, and available interventions. A name change would facilitate help seeking and service uptake by patients, and would be most beneficial for the provision of psychosocial interventions, since better informed patients generally display a more positive attitude towards care and a more active involvement in their own care programs.”

“It’s an empirical question whether it reduces stigma, and we don’t really know the answer yet,” said John Kane, chairman of psychiatry at the Zucker Hillside Hospital in New York. “The data from Japan certainly support the value of doing it. Given that, it is something that should be considered.”

The U.S. and other Western countries, however, are different from Japan in significant ways. In 1999, only 7 percent of clinicians informed patients of their diagnosis (about a third told families but not the patients).

Doctors in the West do tend to be more open with diagnoses in general. In the case of schizophrenia, however, fewer are. One study of Australian clinicians found that while more than half thought one should deliver a diagnosis of schizophrenia, doctors find reasons in practice to delay or avoid doing so. Some wanted to make absolutely sure the diagnosis was 100 percent correct since it was so potentially devastating. Others were concerned about the patient losing hope—many had a patient commit suicide.

While doctors are reluctant to give diagnoses, caregivers are eager to receive them. One study showed that caregivers unanimously preferred a full diagnosis as soon as possible, and their pain was greatly increased by the fact that their doctors—frequently—avoided talking to them about it. It also seems likely that a disorder’s stigmatization can only increase if even one’s doctor is secretive about it or avoids discussing it.

Tomer Levin is a psychiatrist at Memorial Sloan Kettering Cancer Center who studies doctor-patient communication. He first proposed a name change to schizophrenia almost 10 years ago. “Before the 1980s, ‘cancer’ was a stigmatizing term. The same thing was going on with ‘schizophrenia.’ A stigmatizing term doesn’t help the conversation,” he told The Daily Beast. “Our research is figuring out how to train doctors how to communicate. Say your son or daughter has psychotic break, you’re coping with that. Then you get a diagnosis. It should reflect its neurological roots and be a diagnosis that offers hope.”

Levin suggested Neuro-Emotional Integration Disorder to emphasize both its neural basis and its emotional one. He suggested that while clinicians are often focused on symptoms such as delusions, users are focused on how they feel emotionally: withdrawn, alienated, and isolated.

“We want a term that reflects that this is not just one disorder, but includes many different subtypes. A name should de-catastrophize the worst-case scenario so people don’t panic. We could improve people’s desire to access treatment and family support,” Levin continued. “Cognitive behavioral therapy can be very useful to come to terms with it. With a different name, we can link people into psychotherapy by discussing what illness is, hook them into medication by emphasizing its biological basis.”

A change is also already underway in the UK, with more doctors and patients referring to “psychosis” than “schizophrenia.” Kingdon noted that one competitive scholarship was more successful after its name was changed from National Schizophrenia Fellowship to Rethink. Proposed name changes include Kraepelin–Bleuler Disease (after two of the people who first described and delineated schizophrenia), Neuro-Emotional Integration Disorder, Youth onset CONative, COgnitive and Reality Distortion syndrome (CONCORD), or psychosis.

It is startling to read studies on proposed name changes and realize how few studies have canvassed what people with schizophrenia actually think. But the feelings experiences and feelings of users ought to be decisive. It is they who have actually experienced receiving a diagnosis, telling friends and family, informing other health care practitioners.

Elyn Saks is a law professor at the University of Southern California who specializes in mental health law and is a MacArthur Foundation Fellowship winner. She has written about her experience of schizophrenia in a memoir called The Center Cannot Hold. “We need to consult consumer/patients and see what’s least stigmatizing,” she pointed out. “We’re not a group with a big movement which can speak for us. Consumers should be surveyed.”

Duckworth was on the same page as Saks. “The name change should be driven by people with the illnesses saying, ‘We think we need this,’” he said.

“Schizophrenia is a medical condition. The term doesn’t need to be changed. If the term schizophrenia spooks a person living with the illness, they need to examine why they’re upset,” said Bruni. “The only power the diagnosis has over you is the power you give it. You need to have the balls or breasts to say, ‘OK, I have this condition and it’s something I have. That’s all it is.’ The term ‘schizophrenia’ is in my view a valid reference for what’s going on with the illness: Your thoughts and feelings are in a noisy brawl and there’s no calm unity or peace of mind.”

Kane, too, worries that changing the name might be a matter of semantics. “We might ignore underlying factors contribute to the stigmatization. What’s frightening about schizophrenia is our misperceptions and our lack of knowledge. Changing the name is only one dimension.”

Bruni prefers “schizophrenia” to “psychosis,” since “the word psychosis has been co-opted by people who are proud to be psychotic and not take medication. They think psychosis is a normal life experience.”

“The term psychosis to me conveys a terrifying hell. I doubt using the term psychotic to describe yourself is going to help you succeed in life,” she continued. “Employers don’t want to hire individuals who are actively psychotic.”

On the other hand, Lasalvia pointed out, “Any term might be problematic to someone for some reason. However, the most conservative option would be the use of an eponym, since eponyms are neutral and avoid connotations.”

Saks tended to agree with Lasalvia. “A more benign name can be good in terms of people accepting that they have it,” she said. “Kraepelin-Bleuler Disease might be the way to go, on the model of Down syndrome or Alzheimer’s disease. I’d also like to see it called a ‘spectrum disorder’ to emphasize differences in outcome.”

“With the right treatment, therapy, and support, a person living with schizophrenia can have a full and robust life,” said Bruni. “If you’re actively engaged in doing the things that give you joy, the diagnosis will become irrelevant. My take on this is: ‘Schizophrenia? Ha! I won’t let it defeat me.’ And it hasn’t.”

http://www.thedailybeast.com/articles/2015/03/26/stigmatized-schizophrenia-gets-a-rebrand.html