Biological Psychology Links

by Timothy McDonald, Babies born with low vitamin D levels are twice as likely to develop schizophrenia later in life, researchers from the Queensland Brain Institute have found. But the researchers say the good news from the study is that it suggests it may be possible to prevent schizophrenia. John McGrath from the Queensland Brain Institute says there have been suggestions for some time that there may be a link between sunlight, vitamin D and brain development. He says it is increasingly clear children with low vitamin D levels are more likely to develop schizophrenia. "For the babies who had very low vitamin D, their risk was about twice as high as those babies who had optimal vitamin D," said McGrath. "But the amazing thing was that the study that was based in Denmark, where low vitamin D is quite common, we found that if vitamin D is linked to schizophrenia our statistics suggest that it could explain about 40 percent of all schizophrenias. That's a much bigger effect than we're used to seeing in schizophrenia research." While the simplest way to get enough vitamin D is to spend more time in the sun, it remains unclear whether there are fewer cases of schizophrenia in a country like Australia which sees a lot more sunlight. "We don't have high-quality data on that, but some statistics suggest we do have slightly lower incidences and prevalence of schizophrenia," said McGrath. © 2010 Discovery Communications, LLC.

People with a severe mental illness are no more likely to be violent than anyone else - unless they abuse drugs or alcohol, a study has suggested. The relationship between bipolar disorder and violence largely came down to substance abuse, researchers said.. The study compared the behaviour of people with the disorder with their siblings and the wider population. One of the authors said it was probably more dangerous to walk past a pub at night than a mental health hospital. The study, led by Oxford University's Department of Psychiatry, examined the lives and behaviour of 3,700 people in Sweden who had been diagnosed with bipolar disorder, commonly known as manic depression. The disorder leads to sudden and unpredictable mood swings which are more severe than the normal ups and downs of life. The team, led by consultant forensic psychiatrist Dr Seena Fazel, wanted to examine the public perception that there is a link between the disorder and violent crime. They did this by comparing the experiences of the patients with some 4,000 siblings of people with bipolar disorder - and a further group of 37,000 people selected from the general population. (C)BBC

By Emily Anthes Three weeks after beginning his freshman year of college, 18-year-old David started behaving strangely. He made an impromptu trip from his New Hampshire school to his home in Revere, arriving at 3 a.m. His mother immediately noticed that something was wrong. “David was acting weird,’’ says Norma, 51, who asked that she and her son be identified by first names only. “He was spacing out, he was very disheveled, saying things that weren’t making sense at all. He cried a lot. He was listening to one CD on repeat. I kept asking what went through his mind, but he wouldn’t answer.’’ Doctors determined that David could be in the early stages of a psychotic episode and referred him to Massachusetts General Hospital. There, the First-Episode and Early Psychosis Program is designed to prevent small psychotic episodes from turning into big problems, such as schizophrenia. It’s tricky to identify the warning signs of mental health problems — there’s no blood test, for instance, that can signal coming distress. But experts are increasingly watchful for children and teens who are displaying subtle signs that their brains might be in trouble. Traditionally, attention has focused on chronic disease. But “once people have had five hospitalizations the train has sort of left the station,’’ says Dr. Oliver Freudenreich, a psychiatrist who directs the MGH program. “Catching the illness as early as possible means that you probably have an illness that is not as severe, [for which] interventions work better.’’ © 2010 NY Times Co

By DUFF WILSON OPELOUSAS, La. — At 18 months, Kyle Warren started taking a daily antipsychotic drug on the orders of a pediatrician trying to quell the boy’s severe temper tantrums. Thus began a troubled toddler’s journey from one doctor to another, from one diagnosis to another, involving even more drugs. Autism, bipolar disorder, hyperactivity, insomnia, oppositional defiant disorder. The boy’s daily pill regimen multiplied: the antipsychotic Risperdal, the antidepressant Prozac, two sleeping medicines and one for attention-deficit disorder. All by the time he was 3. He was sedated, drooling and overweight from the side effects of the antipsychotic medicine. Although his mother, Brandy Warren, had been at her “wit’s end” when she resorted to the drug treatment, she began to worry about Kyle’s altered personality. “All I had was a medicated little boy,” Ms. Warren said. “I didn’t have my son. It’s like, you’d look into his eyes and you would just see just blankness.” Today, 6-year-old Kyle is in his fourth week of first grade, scoring high marks on his first tests. He is rambunctious and much thinner. Weaned off the drugs through a program affiliated with Tulane University that is aimed at helping low-income families whose children have mental health problems, Kyle now laughs easily and teases his family. Ms. Warren and Kyle’s new doctors point to his remarkable progress — and a more common diagnosis for children of attention-deficit hyperactivity disorder — as proof that he should have never been prescribed such powerful drugs in the first place. Copyright 2010 The New York Times Company

By MATTHEW PERRONE WASHINGTON — Andrew White returned from a nine-month tour in Iraq beset with signs of post-traumatic stress disorder: insomnia, nightmares, constant restlessness. Doctors tried to ease his symptoms using three psychiatric drugs, including a potent anti-psychotic called Seroquel. Thousands of soldiers suffering from PTSD have received the same medication over the last nine years, helping to make Seroquel one of the Veteran Affairs Department's top drug expenditures and the No. 5 best-selling drug in the nation. Several soldiers and veterans have died while taking the pills, raising concerns among some military families that the government is not being up front about the drug's risks. They want Congress to investigate. In White's case, the nightmares persisted. So doctors recommended progressively larger doses of Seroquel. At one point, the 23-year-old Marine corporal was prescribed more than 1,600 milligrams per day — more than double the maximum dose recommended for schizophrenia patients. A short time later, White died in his sleep. "He was told if he had trouble sleeping he could take another (Seroquel) pill," said his father, Stan White, a retired high school principal. An investigation by the Veterans Affairs Department concluded that White died from a rare drug interaction. He was also taking an antidepressant and an anti-anxiety pill, as well as a painkiller for which he did not have a prescription. Inspectors concluded he received the "standard of care" for his condition. Copyright 2010 The Associated Press.

Neuroscientists have long used EEGs to try to understand the brain.Neuroscientists have long used EEGs to try to understand the brain. (Str Old/Reuters) Psychiatrists and engineers have teamed up to help predict how people with schizophrenia will respond to a medication that can produce serious side-effects. Psychiatrists say clozapine is an effective treatment for chronic medication-resistant schizophrenia, but it can produce side-effects such as seizures, cardiac arrhythmias or bone marrow suppression and blood problems that require weekly to monthly blood tests to monitor. Now researchers at McMaster University in Hamilton have used machine learning to "train" a computer to predict whether a patient will respond to the drug based on the brainwave patterns and responses recorded on an EEG device readily available at hospitals and laboratories. "Now what we can do is predict beforehand whether the person is going to respond, so we only expose the patient to the risk if there's a very good chance the treatment will be effective," said study author James Reilly, a professor of electrical and computer engineering at McMaster. Reilly and his psychiatrist and engineering colleagues at the university were able to correctly predict whether 23 middle-aged people diagnosed with schizophrenia would respond to the drug with an accuracy of about 89 per cent, according to the study published in the current online issue of the journal Clinical Neurophysiology. © CBC 2010

by Andy Coghlan NASAL sprays containing the hormone oxytocin, nicknamed the "cuddle chemical" because it helps mothers bond with their babies, have helped people with schizophrenia. Although the 15 participants used the sprays for three weeks only, most reported measurable improvements in their symptoms in this the first trial to test oxytocin in schizophrenia. "It's proof of concept that there's therapeutic potential here," says David Feifel at the University of California in San Diego, head of the team running the trial. Each participant received oxytocin or a placebo for three weeks, then the opposite treatment for three weeks with a week break in between. On the basis of two standard tests for schizophrenia, taken before and after each block of treatment, participants averaged improvements of around 8 per cent when taking the oxytocin compared with the placebo (Biological Psychiatry, DOI: 10.1016/j.biopsych.2010.04.039). The effects didn't kick in until the final week, suggesting that it takes a while for the hormone to begin acting. "Standard antipsychotic drugs increase their efficacy several weeks later too, so oxytocin fits that profile," says Feifel. Feifel thinks that oxytocin is dampening down the excessive production of the neurotransmitter dopamine, which can trigger schizophrenic symptoms such as hallucinations. © Copyright Reed Business Information Ltd.

COLUMBUS, Ohio – A drug used to help control psychotic behavior in people with schizophrenia holds promise for controlling similar symptoms in the early stages of Alzheimer’s disease, a new study suggests. What sets this drug – called quetiapine – apart from its contemporary counterparts is its apparent lack of serious side effects, such as confusion, muscle stiffness and imbalance in the joints, said Douglas Scharre, a study co-author and an associate professor of clinical neurology at Ohio State University. None of the 10 subjects in the study reported any of these symptoms during a 12-week trial.

Despite the considerable effort that leaders in the field of clinical psychology have taken to make the diagnosis of mental disorders an "objective" process, the theoretical beliefs of clinicians still appear to play a major role in the process. That is the conclusion of a study published in this month's issue of the Journal of Experimental Psychology, General conducted by Woo-kyoung Ahn, associate professor of psychology at Vanderbilt, and Nancy Kim, visiting faculty at Wesleyan University. "For the last 22 years, clinical psychologists have been told that they should make diagnoses based solely on a checklist of symptoms. But our results indicate that individual theories still play a surprisingly strong role. Clinicians are significantly more likely to diagnose patients with a mental disorder when the person exhibits symptoms that are central in the clinician's own theories of the disorder. Similarly, they are far less likely to make the same diagnosis for a patient with symptoms that they consider to be peripheral," says Ahn.

The unfolding story of how a common version of a gene shapes the efficiency of the brain’s prefrontal cortex — hub of “executive” functions like reasoning, planning and impulse control — and increases risk for mental illness will be told by Daniel R. Weinberger, M.D., at this year’s G. Burroughs Mider Lecture, “Complex Genetics in the Human Brain: Lessons from COMT.” Weinberger will explain why such psychiatric genetics has proven to be a daunting challenge, using as an example the gene that codes for catecho-O-methyltransferase (COMT), the enzyme that breaks down the chemical messenger dopamine. A tiny variation in its sequence results in different versions of the gene. One leads to more efficient functioning of the prefrontal cortex, the other to less efficient prefrontal functioning and slightly increased risk for schizophrenia. New studies are revealing complex interactions between the tiny glitch and other variations within the gene, and with environmental events, such as teenage marijuana use, that may bias the brain toward psychosis. Weinberger is Director of the Genes, Cognition and Psychosis Program at the NIH’s National Institute of Mental Health. The program uses brain imaging, post-mortem analysis and molecular approaches to understand how genes work in the brain to produce schizophrenia. See: http://calendar.nih.gov/app/MCalInfoView.aspx?EvtID=11488

By BENEDICT CAREY The drugs most commonly used to soothe agitation and aggression in people with Alzheimer’s disease are no more effective than placebos for most patients, and put them at risk of serious side effects, including confusion, sleepiness and Parkinson’s disease-like symptoms, researchers are reporting today. The report, based on a large government comparison of the drugs’ effectiveness, challenges current practice so sharply that it could quickly alter prescribing habits, some experts said. About 4.5 million Americans suffer from the progressive dementia of Alzheimer’s disease, and most patients with the advanced disease exhibit agitation or delusions at some point. The drugs tested in the study — Zyprexa from Eli Lilly; Seroquel from AstraZeneca; and Risperdal from Janssen Pharmaceutical — belong to a class of medications known as atypical antipsychotics. The drugs are used to treat schizophrenia and other psychoses, and are commonly prescribed for elderly patients in long-term care facilities. About a third of the estimated 2.5 million Medicare beneficiaries in nursing homes in the United States have taken the medications, researchers found. And the use of atypical antipsychotics in the elderly accounts for an estimated $2 billion in the annual sales of the drugs, much of the cost paid by Medicare and Medicaid. Copyright 2006 The New York Times Company

By BENEDICT CAREY Paul Williams, 13, has had almost as many psychiatric diagnoses as birthdays. The first psychiatrist he saw, at age 7, decided after a 20-minute visit that the boy was suffering from depression. A grave looking child, quiet and instinctively suspicious of others, he looked depressed, said his mother, Kasan Williams. Yet it soon became clear that the boy was too restless, too explosive, to be suffering from chronic depression. Paul was a gifted reader, curious, independent. But in fourth grade, after a screaming match with a school counselor, he walked out of the building and disappeared, riding the F train for most of the night through Brooklyn, alone, while his family searched frantically. It was the second time in two years that he had disappeared for the night, and his mother was determined to find some answers, some guidance. What followed was a string of office visits with psychologists, social workers and psychiatrists. Each had an idea about what was wrong, and a specific diagnosis: “Compulsive tendencies,” one said. “Oppositional defiant disorder,” another concluded. Others said “pervasive developmental disorder,” or some combination. Each diagnosis was accompanied by a different regimen of drug treatments. Copyright 2006 The New York Times Company

By GARDINER HARRIS, BENEDICT CAREY and JANET ROBERTS When Anya Bailey developed an eating disorder after her 12th birthday, her mother took her to a psychiatrist at the University of Minnesota who prescribed a powerful antipsychotic drug called Risperdal. Created for schizophrenia, Risperdal is not approved to treat eating disorders, but increased appetite is a common side effect and doctors may prescribe drugs as they see fit. Anya gained weight but within two years developed a crippling knot in her back. She now receives regular injections of Botox to unclench her back muscles. She often awakens crying in pain. Isabella Bailey, Anya’s mother, said she had no idea that children might be especially susceptible to Risperdal’s side effects. Nor did she know that Risperdal and similar medicines were not approved at the time to treat children, or that medical trials often cited to justify the use of such drugs had as few as eight children taking the drug by the end. Just as surprising, Ms. Bailey said, was learning that the university psychiatrist who supervised Anya’s care received more than $7,000 from 2003 to 2004 from Johnson & Johnson, Risperdal’s maker, in return for lectures about one of the company’s drugs. Doctors, including Anya Bailey’s, maintain that payments from drug companies do not influence what they prescribe for patients. Copyright 2007 The New York Times Company

By GABRIELLE GLASER IN the YouTube video, Liz Spikol is smiling and animated, the light glinting off her large hoop earrings. Deadpan, she holds up a diaper. It is not, she explains, a hygienic item for a giantess, but rather a prop to illustrate how much control people lose when they undergo electroconvulsive therapy, or ECT, as she did 12 years ago. In other videos and blog postings, Ms. Spikol, a 39-year-old writer in Philadelphia who has bipolar disorder, describes a period of psychosis so severe she jumped out of her mother’s car and ran away like a scared dog. In lectures across the country, Elyn Saks, a law professor and associate dean at the University of Southern California, recounts the florid visions she has experienced during her lifelong battle with schizophrenia — dancing ashtrays, houses that spoke to her — and hospitalizations where she was strapped down with leather restraints and force-fed medications. Like many Americans who have severe forms of mental illness such as schizophrenia and bipolar disorder, Ms. Saks and Ms. Spikol are speaking candidly and publicly about their demons. Their frank talk is part of a conversation about mental illness (or as some prefer to put it, “extreme mental states”) that stretches from college campuses to community health centers, from YouTube to online forums. Copyright 2008 The New York Times Company

Max Blake was 7 the first time he tried to kill himself. He wrote a four-page will bequeathing his toys to his friends and jumped out his ground-floor bedroom window, falling six feet into his backyard, bruised but in one piece. Children don't really know what death is, as the last page of Max's will made clear: "If I'm still alive when I have grandchildren," it began. But they know what unhappiness is and what it means to suffer. On a recent Monday afternoon, Max, now 10, was supposed to come home on the schoolbus, but a counselor summoned his mother at 2:15. When Amy Blake arrived at school, her son gave her the note that had prompted the call. "Dear Mommy & Daddy," it read, "I am really feeling sad and depressed and lousy about myself. I love you but I still feel like I want to kill myself. I am really sad but I just want help to feel happy again. The reason I feel so bad is because I can't sleep at night. And dad yells at me to just sleep at night. But, I can't control it. It is not me that does control it. I don't know what controls it, but it is not me. I really really need some help, love Max!!!!! I Love you Mommy I Love you Daddy." This is the story of a family: a mother, a father and a son. It is, in many ways, a horror story. Terrible things happen. People scream and cry and hurt each other; they say and do things that they later wish they hadn't. The source of their pain is bipolar disorder, a mental illness that results in recurring bouts of mania and depression. It is an elusive disease that no parent fully understands, that some doctors do not believe exists in children, that almost everyone stigmatizes. But this is also a love story. Good things happen. A couple sticks together, a child tries to do better, teachers and doctors and friends help out. Max Blake and his parents may not have much in common with other families. They are a family nonetheless. That is what has mattered most to Amy and Richie Blake since Oct. 31, 1997, the day their son took his first ragged breath. © 2008 Newsweek, Inc

By DUFF WILSON AstraZeneca “buried” unfavorable studies of its $4.4 billion blockbuster psychiatric drug Seroquel, according to internal documents released Friday in a legal dispute between the company and lawyers for thousands of people who sued the company because they said the drug caused diabetes and weight gain. In one of the documents, a 1997 e-mail message, Richard Lawrence, an AstraZeneca official, praised Lisa Arventis, the company’s Seroquel project physician at the time, for minimizing adverse findings in a “cursed” study. He wrote: “Lisa has done a great ‘smoke-and-mirrors job!’ ” Lawyers suing AstraZeneca, a British drug maker whose United States headquarters are in Delaware, said the documents show it tried to hide the diabetes link for nearly a decade. “AstraZeneca knew about the risk of weight gain and diabetes in 2000 and not only failed to warn physicians and patients but marketed in a way that represented there was no risk,” Edward F. Blizzard, a Houston-based lead lawyer on the cases, said in a conference call with reporters. Tony Jewell, an AstraZeneca spokesman, said the plaintiffs’ lawyers were trying the case in public because they recently lost their first two cases in court. Judge Anne C. Conway of Federal District Court in Orlando, Fla., dismissed them on summary judgment on Jan. 28 for lack of evidence that the drug caused diabetes in those two cases. Copyright 2009 The New York Times Company

By BENEDICT CAREY Decades ago modern medicine all but stamped out the nervous breakdown, hitting it with a combination of new diagnoses, new psychiatric drugs and a strong dose of professional scorn. The phrase was overused and near meaningless, a self-serving term from an era unwilling to talk about mental distress openly. But like a stubborn virus, the phrase has mutated. In recent years, psychiatrists in Europe have been diagnosing what they call “burnout syndrome,” the signs of which include “vital exhaustion.” A paper published last year defined three types: “frenetic,” “underchallenged,” and “worn out” (“exasperated” and “bitter” did not make the cut). This is the latest umbrella term for the kind of emotional collapses that have plagued humanity for ages, stemming at times from severe mental difficulties and more often from mild ones. There have been plenty of others. In the early decades of the 20th century, many people simply referred to a crackup, including “The Crack-Up,” F. Scott Fitzgerald’s 1936 collection of essays describing his own. And before that there was neurasthenia, a widely diagnosed and undefined nerve affliction causing just about any symptom people cared to add. Yet medical historians say that, for versatility and descriptive power, it may be hard to improve upon the “nervous breakdown.” Coined around 1900, the phrase peaked in usage during the middle of the 20th century and echoes still. One recent study found that 26 percent of respondents to a national survey in 1996 reported that they had experienced an “impending nervous breakdown,” compared with 19 percent from the same survey in 1957. Copyright 2010 The New York Times Company

When it comes to schizophrenia, Albertans have proven to be among the most accepting & supportive in the world, says a University of Alberta researcher. Dr. Gus Thompson, from the Departments of Psychiatry and Public Health Sciences at the U of A, compared medical students, advocates of a local schizophrenic society and the general public. Participants answered questions about symptoms of schizophrenia, perceived dangerousness of schizophrenics, increasing taxes for better services and more. He found that Canadians--Albertans in particular--think schizophrenia is caused mainly by genetic factors and biochemical imbalances in the brain. No other country of those studied was like that--the others attributed schizophrenia to social factors and stress.

Richard A. Friedman, M.D. On Sunday afternoon, September 3, 2006, Wayne Fenton, a prominent schizophrenia expert and an associate director at the National Institute of Mental Health (NIMH), was found dead in his office. He had just seen a 19-year-old patient with schizophrenia who later admitted to the police that he had beaten Fenton with his fists. This tragic incident was widely publicized and raises, once again, the controversial question about the potential danger posed by people with mental illness. The killing also left many in the mental health and medical communities concerned about their own safety in dealing with psychotic patients. After all, if an expert like Fenton, who understood the risks better than most, could not protect himself, who could? It is not an idle question. According to the National Crime Victimization Survey for 1993 to 1999, conducted by the Department of Justice, the annual rate of nonfatal, job-related, violent crime was 12.6 per 1000 workers in all occupations. Among physicians, the rate was 16.2 per 1000, and among nurses, 21.9 per 1000. But for psychiatrists and mental health professionals, the rate was 68.2 per 1000, and for mental health custodial workers, 69.0 per 1000. For Tim Exworthy, a forensic psychiatrist at Redford Lodge Hospital in London who was recently assaulted by a patient, the risk of job-related violence is no longer a dry statistic. © 2006 Massachusetts Medical Society.

Most people inherit a version of a gene that optimizes their brain’s thinking circuitry, yet also appears to increase risk for schizophrenia*, a severe mental illness marked by impaired thinking, scientists at the National Institutes of Health’s (NIH) National Institute of Mental Health (NIMH) have discovered. The seeming paradox emerged from the first study to explore the effects of variation in the human gene for a brain master switch, DARPP-32. The researchers identified a common version of the gene and showed how it impacts the way two key brain regions exchange information, affecting a range of functions from general intelligence to attention. Three fourths of subjects studied had at least one copy of the version that results in more efficient filtering of information processed by the brain’s executive hub, the prefrontal cortex. However, the same version was also more prevalent among people who developed schizophrenia, a severe mental illness marked by delusions, hallucinations and impaired emotion that affects one percent of the population. “We have found that DARPP-32 shapes and controls a circuit coursing between the human striatum and prefrontal cortex that affects key brain functions implicated in schizophrenia, such as motivation, working memory and reward related learning,” explained Andreas Meyer-Lindenberg, M.D. “Our results raise the question of whether a gene variant favored by evolution, that would normally confer advantage, may translate into a disadvantage if the prefrontal cortex is impaired, as in schizophrenia,” added Daniel Weinberger, M.D.

Links for keyword: Schizophrenia