Schizophrenia June 14th, 2005

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SchizophreniaJune 14th, 2005

• Prevalence
• Symptoms
• A major breakthrough
• The dopamine hypothesis
• Other defects?

Munch, 1893
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SchizophreniaA familys struggle
Peter Zartman was born on a beautiful morning in
May, 1962. He was welcomed with joy as our first
son. He and his sister Judy later had two younger
brothers.All parents hope for a good
environment -- the best environment -- for the
nurture of their children. We were supremely
confident that our situation provided that. Peter
lived among happy, busy, lively siblings and with
loving parents who spent time with their children
and enjoyed doing so.The Presbyterian seminary
campus where we lived was the equivalent of a
small village in the heart of the Lincoln Park
neighborhood in Chicago. The nearby private
school which the children attended provided a
well-rounded education with much emphasis on
creativity, the arts and independence. It was
here that Peter grew up, well liked by classmates
and teachers alike -- a gentle, intelligent,
athletic boy with a ready smile, a special touch
with animals and a wonderful sense of humor. He
looked a lot like his father who often proudly
proclaimed he was "a chip off the old
block."Peter was quite gifted academically. He
started to read (without prompting) at age four
and his verbal skills were unusual but his
particular aptitude was in mathematics. He was
dependable and honest -- I always thought he
lived up to the biblical meaning of his name
Peter, "the rock." It was a comfort to me to know
that I would never need to worry about the future
of the family. Peter could and would take care of
things if there were ever problems.As he grew
up, he enjoyed soccer, playing the trumpet,
creative writing and especially skateboarding for
which he won an impressive array of ribbons in
local competitions.But somewhere along the way,
things began to change. During his last two years
of high school, Peter began to be somewhat
withdrawn and less responsive. That is common to
adolescence and we assumed this phase would pass,
particularly since his academic work did not
decline. As the Illinois State Scholar in his
high school, he qualified for a four-year
all-tuition scholarship to the University of
Illinois School of Engineering, one of the
toughest in the country.
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SchizophreniaA familys struggle
It was there that his schizophrenia manifested
itself. The unthinkable became a reality. Though
he was on the Dean's List, he was now so
disconnected that he was unaware of that fact
until somebody congratulated him. During his
sophomore year, he could no longer conceal his
illness. We learned that he had been in bed for
two weeks unable to leave his room as he was
bombarded by voices. And so, finally, we brought
Peter home for psychiatric evaluation.The next
part of this story is a familiar one to most
families who have struggled with this illness
disbelief as you watch the disintegration of the
personhood of someone you love, horror as you
realize the power of the delusions and paranoia
which haunt him, dismay as you feel the stigma
and pity of others who perceive mental illness as
a failure of parenting, But the most painful part
is the gradual realization of your own
powerlessness to make things better. You can't
change the awful agony behind those staring
eyes.Peter suffered from treatment-resistant
schizophrenia with unremitting psychosis for the
next six years. He entered a long-term treatment
hospital in Rockville, MD in November of
1984.His care was excellent. We visited him
every two months and were in phone contact with
him several times a week. He was able to find
friends and to have acceptance and respect there
in spite of the terrible transformations which
this illness and medicinal side effects visit
upon its victims.In December of 1987 he began
clozapine which was at that time an experimental
drug awaiting FDA approval. Peter was one for
whom it produced dramatic improvement. In the
spring, we began discussions about a gradual
transition to outpatiency for him with hopes that
he could continue his return to the community and
be able to come home again.Jim and I were with
Peter the last weekend in July, 1988, and were
delighted with the progress he had made and his
decision to sign a lease for a room in an
outpatient house. Though his mind was now clear
and he was able to read again, he was having
frequent panic attacks which his doctors believed
were responding to increased anti-anxiety
medication. Peter was scheduled to begin sleeping
in his new room for several nights a week on
September 18.On the Saturday that he died, he
had lunch in the hospital cafeteria, gave his
cigarette lighter to a friend and walked
hurriedly to the metro train. He bought a one-way
ticket to White Flint -- 2 stops down -- and
crossed the platform there, jumping in front of
the next northbound train. His skateboarding
skills stood him in good stead. He timed it
perfectly and died instantly.
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SchizophreniaA familys struggle
famous
In 1971 Mark Vonnegut went crazy while living the
Good Hippie Life on a commune in British
Columbia. In many ways his bouts with
schizophrenia fulfilled his aspiration to live an
Eden-like existence where the Inner and Outer are
one. Schizophrenia brought him to Eden in record
time--hence the title. It also brought him
terrifying delusions, incapacity, anorexia, and
close to the brink of suicide many times. Mark
Vonnegut graduated from Swarthmore College in
1969. Ambivilant about the academy and suspicious
of his father's new literary fame, he travelled
to British Columbia to build an ideal community.
On Valentine's Day, 1971, he was committed to
Vancouver's Hollywood Psychiatric Hospital as a
schizophrenic. The Eden Express is his account of
his life with schizophrenia.
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SchizophreniaPrevalence

• Approximately 1 percent of the population
  develops schizophrenia during their lifetime.
• More than 2 million Americans suffer from the
  illness in a given year.
• Schizophrenia affects men and women with equal
  frequency. However, the disorder often appears
  earlier in men.

http//www.diseases-explained.com/Schizophrenia/sc
hizodiagnosis.html
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SchizophreniaFacts.

• Schizophrenia is observed in all races and
  cultures
• Its onset is sudden and intense. It often
  begins with an acute psychotic phase.
• Schizophrenia can be brought on by drug use or by
  a life stressor.
• Schizophrenia can be successfully treated with
  drugs, but the long-term prognosis is poor.

http//www.nimh.nih.gov/publicat/schizoph.cfmschi
z1 http//www.diseases-explained.com/Schizophrenia
/schizodiagnosis.html
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SchizophreniaFacts.

• The World of People With Schizophrenia.
• Distorted Perceptions of Reality
• Hallucinations
• Delusions
• Incoherent thought
• Inappropriate affect
• Odd Behavior i.e., catatonia, echolalia

http//www.nimh.nih.gov/publicat/schizoph.cfmschi
z1
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SchizophreniaCauses

• Is Schizophrenia Inherited?
• There is a 10 likelihood of developing
  schizophrenia if a biological relative has
  schizophrenia (even if the relative was adopted
  by a healthy family).
• The concordance rate in identical twins is 45.
• The concordance rate is 10 in fraternal twins.
• Genetic regions on chromosomes 6 and 13 have been
  associated with schizophrenia.

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SchizophreniaCauses

• A major breakthrough..
• Chlorpromazine - First developed as an
  antihistamine, it was shown to have calming
  effects and was later shown to alleviate some of
  the symptoms of schizophrenia.
• Chlorpromazine is a DA antagonist.
• Reserpine was later used to treat schizophrenia
  and was shown to deplete dopamine in the brain.
• Prolonged use of these drugs produced Parkinsons
  like symptoms.

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SchizophreniaCauses
The dopamine hypothesis of schizophrenia
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SchizophreniaCauses
The dopamine hypothesis of schizophrenia

• Evidence FOR the Dopamine Theory of
  Schizophrenia
•     
• Drugs that block dopamine reduce schizophrenic
  symptoms.
• The most effective antipsychotic drugs block D2
  receptors

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SchizophreniaCauses
The dopamine hypothesis of schizophrenia

• Evidence FOR the Dopamine Theory of
  Schizophrenia
•     
• Drugs that block dopamine reduce schizophrenic
  symptoms.
• The most effective antipsychotic drugs block D2
  receptors
• Drugs that block dopamine have side effects
  similar to Parkinson's disease. Parkinson's
  disease is caused by a lack of dopamine in a
  parts of the brain called the basal ganglia.
• The best drugs to treat schizophrenia resemble
  dopamine and completely block dopamine receptors.
  
• High doses of amphetamines cause
  schizophrenic-like symptoms in a disorder called
  "amphetamine psychosis." Amphetamine psychosis is
  a model for schizophrenia because drugs that
  block amphetamine psychosis also reduce
  schizophrenic symptoms. Amphetamines also make
  the symptoms of schizophrenia worse.

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Schizophrenia
The dopamine hypothesis of schizophrenia
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SchizophreniaCauses
The dopamine hypothesis of schizophrenia

• Questioning the Dopamine Theory of Schizophrenia
  
• Amphetamines do more than increase dopamine
  levels. They also alter other neurotransmitter
  levels.
• Drugs that block dopamine receptors act on
  receptors quickly. However, these drugs sometimes
  take many days to change the behavior of people
  with schizophrenia.

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SchizophreniaCauses
The dopamine hypothesis of schizophrenia

• Questioning the Dopamine Theory of Schizophrenia
  
• Amphetamines do more than increase dopamine
  levels. They also alter other neurotransmitter
  levels.
• Drugs that block dopamine receptors act on
  receptors quickly. However, these drugs sometimes
  take many days to change the behavior of people
  with schizophrenia.
• The effects of dopamine blockers may be indirect.
  These drugs may influence other systems that have
  more impact on the schizophrenic symptoms.
• New drugs for schizophrenia, for example,
  clozapine, block receptors for both serotonin and
  dopamine.
• There are structural abnormalities in the brain
  of schizophrenics outside of the dopamine
  systems

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SchizophreniaCauses
Enlargement of the ventricles..
Normal
Schizophrenic
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SchizophreniaCauses
Decreased cortical volume..