Mystery of schizophrenia

Schizophrenia is one of the most frightening psychiatric diagnoses.

It is a chronic condition affecting about one per cent of the population and is associated with some of the most notorious symptoms of mental illness – hallucinations and delusions.

Schizophrenia is troubling because it often begins when a person is in the prime of his or her life and can distort one’s ability to tell what is real and what is not

Schizophrenia can be difficult to treat and its causes and triggers are still a mystery.

A large-scale study published in 2014 in Nature has brought us a little bit closer to understanding this complex disease.  

A collaborative group of researchers examined the genetic codes of more than 150,000 people. Roughly 37,000 were diagnosed with schizophrenia and results found 108 genetic markers for the risk of getting the disease.

This is a big finding because the majority of these markers had not previously been reported.

Most people will have some of these genetic markers and still not develop schizophrenia, but this study did find that those with the most markers were 15 times more likely to develop the disease than those with fewer of them.

This is very interesting and provides some insight into genetic vs. environmental triggers for the condition.

We have long known there seems to be a link between the immune system and schizophrenia.

Families with autoimmune disorders appear to be at increased risk and there is a link between viral infections during pregnancy and higher rates of schizophrenia in offspring.

The markers identified in this study confirm this immune system link. Researchers associated with the study say it is now very clear the immune system is involved with the condition.

Although it will still be many years before this information can lead to new treatments for schizophrenia, it is a piece in the ongoing puzzle.

There is still much to learn, but when scientists from around the world work together and pool data from many thousands of people, it certainly allows our understanding to move forward much more quickly than when we work in isolation.

I look forward to seeing more results from this group and others as we continue to unlock the mystery of schizophrenia.

In the meantime, there are treatments available that help many with this frightening condition. If you are concerned for yourself or a loved one, contact your doctor now for help.

Mania can be depressing

Caution is a good prescription when using anti-depressants to treat bipolar disorder.

Although depression is one of the hallmark stages of this chronic mental illness, treating it with anti-depressants alone brings a risk of the patient switching from depression to mania.

A Swedish study published in 2014 in the American Journal of Psychiatry confirms this long-held observation.

Researchers from the Karolinska Institute in Stockholm performed a population-based study of more than 3,000 bipolar patients.

Results confirmed that those using just an anti-depressant were at increased risk for a manic switch compared to those using combined therapy of antidepressant and mood-stabilizing medication.

In this study, 34 per cent of people were treated with an anti-depressant alone and they had a two-fold increased risk for developing treatment-emergent mania.

Among those treated with both an anti-depressant and a mood stabilizer, no acute change in risk for mania occurred during the three months after starting the anti-depressant treatment and the risk actually decreased between three and nine months later.

This finding is reassuring because it confirms a treatment guideline we have been using for some time.

Most mental health professionals are careful not to prescribe an anti-depressant alone when dealing with bipolar disorder, however it does happen sometimes when a diagnosis is not yet made.

In the early days of bipolar disorder treatment, the individual may be thought to have unipolar major depression and be treated accordingly.

Bipolar disorder can be a difficult condition to treat even under ideal circumstances and it is best managed by a mental health professional with experience in its diagnosis and treatment.

Roughly three per cent of the population will experience bipolar disorder. It is a chronic, life-long mental illness that usually manifests itself in late adolescence or young adulthood.

People experiencing this condition will cycle between episodes of major depression as well as episodes of mania, which is an excessively heightened mood.

Although it may sound nice to be extra happy, mania is no picnic. People experiencing mania tend to be impulsive, reckless and irritable.

They lack insight into their behaviour and often say and do things they would never normally consider and which have a lasting harmful impact on their lives.

If a loved one’s behaviour is causing you to worry, encourage them to seek help as soon as possible.

As noted above, we do have treatment options available and this is a condition that can be managed effectively.

Addicted to exercise

With all of the attention being placed on North America’s obesity epidemic and sedentary lifestyles, it is easy not to notice the flip side of that problem – when fitness becomes an unhealthy obsession.

We hear a lot about exercising for good health to achieve a goal weight or to boost strength and endurance. Engaging in regular exercise is healthy and an important part of a balanced life.

But we have all met people — or seen their posts on social media sites — who take exercise and fitness into the realm of compulsion.

Excessive exercise has long been observed as a co-existing problem with eating or body dysmorphic (deformity or abnormality in the shape or size of a specified part of the body) disorders.

Many times, people experiencing one of these conditions will exercise compulsively as part of their quest to control their bodies.

Exercise is a problem in this context. Compulsive exercisers require longer hospital stays, they have more relapses and their long-term outcome is worse than those who do not exercise compulsively.

Also, the compulsive exercise usually begins before an eating disorder and is often the last symptom to subside when the eating disorder is treated.

We now also know that excessive or compulsive exercise can occur independently of eating disorder. So-called exercise addiction has been difficult to define and measure because what may seem excessive to some, could be perfectly healthy for others.

We know that those who exercise compulsively do not want to exercise as much as they do. They often realize it is too much, they know they will hurt themselves or even die if they continue and yet they are unable to stop.

The focus has now shifted from defining this addiction in quantitative terms to more qualitative ones  — examining what is motivating the exercise.

Some new studies out of the U.K. have set out to determine whether compulsive exercise can be measured.

In order to understand compulsive exercise better, researchers undertook a large review and then used the data to create a Compulsive Exercise Test, which they have been using in several studies in young women, athletes and patients with eating disorders.

These studies found avoidance, weight-control exercise, lack of enjoyment and exercise rigidity were pronounced among those with eating disorders.

Using this information they have also created an intervention called the LEAP program, which takes a cognitive behaviour therapy approach to compulsive exercise.

The goal is to help patients determine what exercise is healthy and help them regain control of their behaviour. A four-year study using this program is wrapping up and preliminary results are promising.

It will be interesting to see more results from this group and others as to how we can promote healthy lifestyle while preventing the development of compulsive exercise as well as how we can help those experiencing this compulsion both within the context of an eating disorder and on its own.

Depressing consequences

A few years ago there was a great deal of media frenzy surrounding a finding that antidepressant use in adolescents and young adults could cause an increase in suicidal thoughts.

As a result, the FDA put black-box warnings on antidepressants and there was major media coverage of the whole thing.

Now that a decade has passed, there has been time to monitor the consequences of this move.

A large U.S. study examining claims data from healthcare claims of 11 major health plans between 2000 and 2010 has shown these black-box warnings may have backfired.

Results showed antidepressant use among adolescents dropped by 31 per cent following the warnings. It dropped by 24 per cent among young adults and 14.5 per cent among adults during the same period.

At the same time, there was also a significant increase in psychotropic drug poisonings in adolescents during that time – a measure of suicide attempts.

Completed suicides did not change in any age group at that time.

Researchers believe it is possible the extensive media coverage and FDA warnings at the time led to unexpected and unintended results.

People became fearful of receiving some of the most commonly used treatments and so opted for no treatment at all. Unfortunately, untreated depression may have led to an increase in suicide attempts.

Of course, it is important to communicate about potential risks and adverse events associated with any medical treatment.

We all need to be able to make informed decisions when it comes to our health. However, the authors of this study say that the FDA should be careful in its communication of information.

Black-box warnings likely do not convey the level of complexity necessary for someone to gain an accurate picture of the risks and benefits of a treatment option.

We do know there was a small increase in suicidal ideation linked to antidepressant use among adolescents and young adults.

We also know that untreated depression is the leading cause of completed suicide.

Before making a decision about what treatment to pursue when dealing with depression or any other mental health issue, it is important to get complete information from a qualified professional.

Meet with your doctor and discuss your situation and all options at length. Get educated on the risks and benefits of treatments as well as the risk of doing nothing.

There are effective treatment options for depression. These include both pharmaceutical and talk therapy methods.

Speak with your doctor or a mental-health care professional to learn more.

More States of Mind articles

About the Author

Paul Latimer has over 25 years experience in clinical practice, research, and administration.

After obtaining his medical degree from Queen's University in Kingston, Ontario, he did psychiatric training at Queen's, Oxford and Temple Universities. After his residency he did a doctorate in medical science at McMaster University where he was also a Medical Research Council of Canada Scholar.

Since 1983 he has been practicing psychiatry in Kelowna, BC, where he has held many administrative positions and conducted numerous clinical trials.

He has published many scientific papers and one book on the psychophysiology of the functional bowel disorders.

He is an avid photographer, skier and outdoorsman.

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The views expressed are strictly those of the author and not necessarily those of Castanet. Castanet does not warrant the contents.

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