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New hope for schizophrenia

New hope in schizophrenia research

Research out of Johns Hopkins University may be the start of a promising development for the treatment of schizophrenia. 

While studying an anti-cancer drug in mice, researchers found it reversed behaviours associated with schizophrenia and even restored some lost brain cell function in mice affected by the rodent version of the disease. 

The medication is part of a class of drugs called PAK inhibitors, also shown to offer some protection in other brain conditions such as Fragile X syndrome and Alzheimer’s disease. 

In this study examining effects on adolescent mice whose condition mimics the progression of human schizophrenia, the experimental compound appeared to stop a biological ‘pruning’ process, which occurs in schizophrenia and needlessly destroys neural connections. Using the PAK inhibitor compound, researchers were able to partially restore disabled neurons in young mice. 

By stopping the out of control pruning, the researchers were also able to normalize the rodents’ behaviour. Achieving these results in such young mice was a particularly hopeful development since schizophrenia in humans typically begins to show up in late adolescence or early adulthood and tends to get worse over time. 

To date, we are not sure that PAK operates the same way in humans as it does in mice, so more work is definitely needed before we can be sure it will have a similar effect for humans. 

However, if we are able to replicate these findings in later stage clinical trials and in humans, it may improve the prognosis for those diagnosed with schizophrenia.

Schizophrenia affects roughly one percent of the population. It is a chronic disease characterized by disordered thinking and symptoms such as delusions and hallucinations. In addition, people with schizophrenia can have an altered sense of self, a lack of motivation, blunted emotions and confused communication and thinking. Depression and social withdrawal are also very common. 

Symptoms typically begin in adolescence or early adulthood and generally progress as a gradual deterioration in the brain’s ability to process information or communicate with itself. Because of its gradual onset, it can take quite a while for family or friends to realize there is a serious problem. 

Some early warning signs to be aware of include: bizarre or unusual behaviour; an inability to sleep or mixing up of day and night; social withdrawal or isolation; hyperactivity or inactivity; inability to concentrate; unusual preoccupation with religion or the occult; hostility, suspicion or fearfulness; over-reaction to peer or family disapproval; deterioration in personal hygiene; excessive writing or childlike printing with no clear meaning; flat, expressionless gaze; and peculiar use of language.

There is no cure for schizophrenia. For now, anti-psychotic medication can control symptoms such as delusions and hallucinations, but lack of motivation and blunted emotions may not respond as well to medication. 

Hopefully, in time we will come up with treatments that can stop disease progression or reverse damage caused and restore people to full functioning. Continued research is needed until we can reach this goal. 

In the meantime, if you are concerned for yourself or a loved one, speak with your doctor about options available now.

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Managing ADHD: Mistakes

Although a diagnosis of attention deficit disorder puts an end to questions about frustrating symptoms and experiences, it does not mean life instantly gets easier – this is really the beginning of the lifelong work of living well while managing this condition.

Whether the diagnosis is for yourself, your partner, or your child, there are things you can do to help, and some pitfalls to avoid as you move forward. Today I am going to focus on a few of the common mistakes people make when managing ADHD.

A first and major hurdle is accepting the diagnosis. Many people are not willing to accept they have ADHD. There are also a lot of misconceptions floating around about what the disorder is and what it isn’t. For this reason, it is important to receive your medical opinion from a professional trained in recognizing this condition. Educate yourself about the condition, and you can begin to create a plan for living with it. 

Another common mistake is to make too much or too little of medication use. Some people believe medication alone will solve all of their problems and make life easy to manage. Others think they should completely rule out the use of medication under any circumstance. Neither of these extremes represents a good plan when it comes to ADHD. In reality, medication is often a very useful tool in the management of ADHD. It needs to be monitored closely by a professional, and used in combination with other behavioural and organizational tools. 

Although it can be irksome to someone living with ADHD, planning out each day is a very helpful strategy. Without a concrete plan – usually in writing – it is easy for a person with ADHD to accomplish little during a day. Making a routine of writing out a plan for the following day doesn’t take too much work, and can have a big positive impact.

Another difficult area is time management. Not only is it more difficult to keep track of time, it is also more difficult to predict how long a task will take or move from one scheduled event to another without external cues. Setting timers can be a helpful tool, and thankfully this is easier than ever with smartphones.

One of the most important pitfalls to avoid is to listen too much to ignorant people. Well-meaning friends, relations, co-workers and even random people will often try to engage in a conversation about ADHD and how it should be handled. Unfortunately, many misconceptions exist about ADHD, and there are those who will share their ill-informed opinions and advice. Try to take your support and advice from those who know about the condition and professionals who are equipped to offer solutions and tips that will actually help. 

Finally, life is hard. With ADHD there are some specific challenges to cope with on top of the everyday struggles we all face. Don’t assume that having a good strategy will make everything perfect. So far, no one has cornered the market on making a perfect life. 

Create a plan using tools that work for your life. Keep the things that help, and tweak when necessary. Focus on the positive and just keep taking things one day at a time. Remember that life is a journey.

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Assisted dying legislation

In February 2015, the Supreme Court of Canada, in a unanimous decision (Carter v Canada), confirmed that in certain defined circumstances, Canadians have the constitutional right to choose physician assistance in dying. 

The BC Civil Liberties Association and a number of individuals filed this lawsuit in 2011 to challenge the laws that criminalize doctors for helping competent individuals with serious and irremediable medical conditions who wish to hasten death.  

After four years and hundreds of hours of pro bono work by lawyers, experts from all over the world, very ill people and their families, and many others who volunteered their time and resources, this was a decision of monumental significance, about which I was very pleased. 

Full disclosure - my daughter, Alison Latimer, was one of the lawyers on the team that took this case to the Supreme Court, and I am very proud of her and her work. 

Since then, Canadians have been discussing, debating, and predicting how our government would craft new legislation surrounding physician-assisted suicide. The Conservative government did nothing, and the Liberals sought an extension from the Supreme Court.

Finally the federal government has tabled bill C-14 in response to the Supreme Court of Canada’s ruling on the subject. To those who fought so valiantly to get the Carter v Canada decision, this bill is a disappointment. It is much more restrictive than the Supreme Court decision and, if passed, will almost certainly be challenged again on constitutional grounds.

Bill C-14 gives too narrow a set of circumstances under which an individual may request assistance in dying. They must be mentally competent adults with a serious, incurable illness, disease or disability, they must be in “an advanced state of irreversible decline in capability”, and their “natural death” must be “reasonably foreseeable”. 

There are people with serious, chronic illness including mental illness, who suffer horribly but who may not meet the stringent criteria set out in this proposed legislation. Many of these people, having exhausted all available treatment options, commit suicide, alone and unsupported, as their only means of escape. Those who cannot do it on their own are left to simply suffer unbearably - some for decades.

Psychiatric disorders are not always treatable. There are people who, despite their own courage and best efforts, remain very ill, miserably unhappy, isolated, and often abandoned by their families and communities. 

I hear quite frequently from such people that they want to die, wish they were dead, and are constantly thinking about suicide as an option. I think that when all reasonable, conventional treatments have been tried and failed, and assuming they are competent to make the decision, these people should have physician assisted dying as an option. 

Of course many psychiatric patients have thoughts about suicide before they have had reasonable attempts at treatment and we would continue to do what we can to help these people as we do now.

My position on this is simple. Competent individuals suffering from any illness, terminal or otherwise, should be able to choose for themselves the amount of suffering that is tolerable for them, and have doctor assisted dying as an option. 

When they have a condition such as dementia, in which their competency will be gradually deteriorating, they should be able to provide an advance directive while they are still competent.

The autonomy of the individual is paramount. It is not up to society to determine who has to live or die, for how long, and under what circumstances.

Many polls have documented that Canadians support this position, the Supreme Court has already supported it, and the government should draft legislation that is consistent with these wishes. Failure to do so will result in much more unnecessary suffering and many more years of unnecessary legal wrangling.

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Stem cell research: Bipolar

Stem cell research in bipolar disorder

When most of us think of stem cells, we think of ethical controversy, umbilical cord blood banks, growing new tissues and other commonly discussed topics in medical research. 

I would venture that not many think of stem cell research in relation to psychiatric conditions and what we might learn about them. 

Researchers at the University of Michigan are using stem cells from skin fibroblasts of people with bipolar disorder to gain more understanding of this difficult mental illness. 

By observing how the stem cells behave and change, researchers have already discovered a few ways in which cells from individuals with bipolar disorder are different from those with no bipolar disorder. Differences lie in how often certain genes are expressed, how they differentiate, how they communicate, and also how they respond to lithium.

Gene expression

Examining gene expression in cells from those with and without bipolar disorder as they differentiated into neurons, researchers found the cells from bipolar patients express more genes involved with sending and receiving calcium signals between cells. This is particularly interesting because calcium signals are known to be important to neuron development and function, and other studies have already linked bipolar disorder to problems with neuronal calcium balance. 

Signalling patterns changed in the presence of lithium among the cells from bipolar patients – the lithium didn’t completely normalize the calcium signalling, but did made a noticeable difference and showed that lithium (a mainstay in treatment for bipolar disorder) affects the metabolism of calcium.

Researchers also noticed differences in what is called microRNA expression in the cells from bipolar patients, and this suggests bipolar disorder likely occurs as a result of a combination of genetic susceptibilities.

Preliminary findings, but exciting

These are preliminary findings, but exciting. The more we learn about the way cells act and react in bipolar disorder and other psychiatric conditions, the better we’ll understand about causes and possible interventions to help people living with these illnesses. 

I anticipate much more to come from this and other groups examining stem cells in hope of discovering more about mental illness. I look forward to the day when this kind of research enables more personalized treatment and prevention tools. 

Help is available now

In the meantime, bipolar disorder and other mental illnesses can be effectively managed. Speak with your doctor and get a referral to a mental health professional if you think you or a loved one are experiencing mental health symptoms. Help is available now.

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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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