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mental health mondays :: rethinking schizophrenia

schizophrenia is one of those things that people tend to assume they understand, because they've heard the word so often. but the fact is that none of us know very much about schizophrenia, because even the people who've studied it the most admit that they don't know very much about it. so the rest of us are clearly fumbling around in the dark.

a couple of things that everyone should know are what schizophrenia isn't: it isn't the same as schizoaffective disorder or schizoid disorder. and when you hear the term "schizo" applied to behaviour, more often than not it's referring to a layman's interpretation of bipolar disorder, meaning behaviour that seems to be diametrically opposed to itself over a short period of time. [that's not an accurate portrayal of bipolar disorder either, but that's an issue for another day.] also, schizophrenia is often conflated with dissociative personality disorder or "multiple personality disorder" as it used to be known. it isn't. schizophrenics do not have fugue states where they "turn into someone else".

the problem with schizophrenia is that it's essentially a catch-all term for serious mental disorders that aren't clearly something else. so we know that it's not bipolar disorder, because it isn't characterized by wild swings in emotion, energy and disposition. it's not a dissociative disorder, because the person doesn't perceive themselves as having "broken" from their body and because there seem to be physical, chemical symptoms that aren't present with "straight-up" dissociative disorders. but virtually anything else can be considered schizophrenia. it's a disease of positive symptoms- the common view where one is paranoid and incapable of discerning real from imaginary, and hallucinates or imagines various objects/ people/ beings that are not there- and of negative symptoms- absence of emotion or reaction, inability to experience emotion in the way that others normally do. it can be long-term or short term. it can change how it presents. it can co-exist with other disorders. it's defined by its symptoms, rather than a physical test, but its symptoms are almost impossibly vast and medicine holds that there is a physical component to it [errant brain chemistry], which is what separates it from mood disorders.

so: we know a few things it isn't, we know how it's diagnosed, but we very clearly don't know what it is. and we never have. psychiatrists have been howling for decades about how ridiculously broad the definition of schizophrenia is, but when it comes time to parse terms, everything sort of falls apart, because discussions are predicated on the idea that schizophrenia is one thing, and the discussion can't really begin without the acknowledgment that it may be a lot of things that have just generally been grouped together. [canadians may find this sort of problem familiar, because it's exactly like the problems we encounter when trying to deal with our constitution.]

luckily, we have very smart people trying to figure out the things that can go wrong in the brain and produce the grab-bag of symptoms we define loosely as "schizophrenia". for those of us who are curious but aren't quite smart enough to figure it out for ourselves [like me], i thought i'd offer a quick look at what recent research has uncovered about schizophrenia, its causes and the potential for a cure.

mean gene :: scientists at duke university published research earlier this year that helps narrow the range of suspect genes. specifically, it narrows the field to one, which explains three major physical traits associated with schizophrenia: a reduced number of "branches" to receive signals from other cells in the neurons at the front of the brain, hyperactive neurons and an excess of dopamine in the brain. all of those things are associated with schizophrenia and all of them were observed in mice when researchers selectively deleted a gene in the prefrontal cortex known as arp2/3. [i don't want to know how researchers selectively delete genes in mice either.]

your brain on drugs :: this isn't as new a hypothesis as the arp2/3 gene, but it's still a lot newer than any of the ones that inform the way that schizophrenia is currently treated. basically, it stems from the observation that certain drugs [particularly ketamine and pcp] mimic the symptoms of schizophrenia, and so maybe the key to understanding the mental disorder is by examining the mechanism of action of those drugs. ketamine and, to some extent, pcp, cause you to freak the fuck out because it interferes with the signalling patterns of the neurotransmitter glutamate. glutamate is the most plentiful neurotransmitter in the entire body and it has receptors in every part of the brain. most interestingly, it controls both the excitatory and inhibitory brain functions, so its culpability could explain why schizophrenia has both positive and negative symptoms. like the hypothesis that schizophrenia is caused by an imbalance of dopamine [which was also developed through observing the effects of certain drugs], it gives a direction for possible drug therapy. in fact, problems with glutamate would explain the dopamine imbalance itself. while promising, it's worth noting that testing of drugs that work on glutamate receptors has not been especially successful. yet.

the cat did it :: i'm always a little wary of fads, which are as prominent in science as they are anywhere else and it does seem like toxoplasmosis gondii, the cat poop parasite, is getting implicated in everything these days. nevertheless, there's some research that indicates that some cases of schizophrenia may be related. it's important to note that no one's claiming this is what causes schizophrenia. it may increase the chances of schizophrenia in people who are genetically predisposed to it anyway and even as far as that's concerned, the jury is still out. am i the only one thinking that this parasite is secretly ruling the world?

the hateful eight? :: in a study that got a lot of publicity last year, scientists broke down the schizophrenia model even further. unlike the researchers trying to isolate a particular gene responsible for schizophrenia, a scientific team at the washington university school of medicine in st. louis took a broad look at all of the genes that had been implicated and studied in the occurrence of the disorder and came to a conclusion: none of them is a reliable indicator of future schizophrenia. there is no single identified gene that is consistent through all types of schizophrenia. however, there are clusters of genes that, when they occur together, confer a pretty much a 100% chance of developing schizophrenia. furthermore, there are eight different clusters, each linked to a different variation of what we call schizophrenia. so schizophrenia is actually eight different conditions that we've been calling by the same name. that's not unheard of, by any means. i guarantee you've indulged in it yourself, telling people you have "a cold". "a cold" is any one of several hundred viruses [that mutate constantly to make hundreds of new viruses] that produce similar symptoms. you take medication that treats the symptoms, so that you can remain somewhat functional while the virus works its way through your system. so the proper answer to the tired old joke about why medicine can't find a cure for the common cold is "because there is no such thing".

finding treatments for eight different conditions, however, is very manageable, as long as your definition of "manageable" includes being prepared to dismiss any preconceived notions you might have about what it is you're treating. you also have to be willing to get serious about it very quickly, because the work that's lead to this breakthrough is basically telling us that the people who have these genetic clusters are destined to develop a particular form of schizophrenia no matter what they do.

clearly, there's a lot of work to be done in order to get real help for people with schizophrenia. the treatments we have now are based on research that was conducted decades before any of the above theories was advanced. doesn't mean that the treatments we have now can't work, but it does mean that we need to do a lot better.

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