DOES AMERICA OVERDRUG ITS
CRAZIES? (PBS FM Radio show )
Schizophrenia: Second Chances:
Dramatic advances in schizophrenia research 
are providing new
hope for people suffering from the disease Host Dr. Fred Goodwin begins with an
essay about how schizophrenia is the most devastating and mysterious of all
mental illnesses. It causes not only hallucinations and delusions, but also a
disconnection from normal life. Most people cannot relate to schizophrenia, the
way they can to clinical depression or anxiety. But new advances in brain
imaging are helping us understand what goes on in the brain of people with the
disease. And new medications are allowing many people with schizophrenia to
return to a functional life in society. These people can now report back to us
about what it’s like to live with this devastating thought disorder.
Next Edith Shuttleworth, an office manager in New York, tells
her personal story of living with schizophrenia. She has been hearing voices
since she was nine (an unusually early age). She became homeless in her
twenties. Now, she takes a medication called Zyprexa, one of the new atypical
anti-psychotics. She still hears voices sometimes, but now she can distinguish
the voices from her true self. Through the help of Fountain House, a
rehabilitation program for the mentally ill, she has found friends, housing,
and work. For more information on Fountain House, visit www.fountainhouse.org.
While genes are not the only answer to the question, “what
causes schizophrenia,” researches agree genetic predisposition is a key
factor.Our next guest, Dr. Linda Brzustowicz is Associate Professor of Genetics
at Rutgers, the State University of New Jersey. Her lab has been involved
cutting-edge research in the genetics of schizophrenia.
She begins by defining schizophrenia. It’s a chronic mental
illness that’s not rare—it affects 1% of the population. It’s marked by what
are called positive and negative symptoms. The positive symptoms include
hallucinations (for example, hearing voices that are not there) and delusions
(firmly held beliefs that do not coincide with reality). The negative symptoms
are deficits - the person may not have much interest in certain activities of
life, social relationships, and so on.
Dr. Brzustowicz goes on to explain that the disease is not
purely genetic - in identical twins, if one has it, there’s only a 50% chance
that the other will. So, the environment does play a role. One theory is that
something like a viral infection in utero or birth trauma could affect the
onset of the disease.
Her lab is trying to isolate genes that would confer
susceptibility to schizophrenia. Researchers agree it is likely there is not
just one gene, but rather five to seven, that would make a person vulnerable to
the disease.
To contact Dr. Brzustowicz,
write to: Dr. Linda Brzustowicz; Department of Genetics; Rutgers University;
604 Allison Road; Piscataway, NJ 08854.Or visit www.rutgers.edu.
Next, Dr. Nancy Andreasen discusses advances in brain imaging - the cluster of
technologies that allow researchers to study the brains of living people. Dr.
Andreasen is one of the world’s leading researchers on the diagnosis and
treatment of schizophrenia and other serious mental illnesses. She is the
Andrew H. Woods Chair of Psychiatry at The University of Iowa College of
Medicine and the Editor-in-Chief of The American Journal of Psychiatry. In the
year 2000, she received the National Medal of Science and The Lieber Prize for
Outstanding Research in Schizophrenia. Her most recent book, Brave New Brain:
Conquering Mental Illness in the Era of the Genome, which is published by
Oxford University Press, can be ordered by clicking here.
Dr. Andreasen has used brain imaging to look at structure, blood
flow and metabolism in the brain. Building on a previous discovery that
schizophrenia is, in fact, a brain disease, she has determined that it is not
one particular area of the brain that is abnormal in people with the disorder.
Rather, it is a disease of communication within the brain - it affects how
different parts of the brain talk to each other.
Schizophrenia affects almost all human mental activity, and the
symptoms are extremely diverse. Her theory explains this diversity of symptoms.
If the disease affects the communication of networks within the brain, then
proper connections cannot made, which can lead to hallucinations or delusions.
That is, people with schizophrenia misinterpret the outer world - they cannot
distinguish between what’s inside the mind and what’s outside.
Dr. Andreasen offers hope for the future. She says this is one
of the most exciting times in psychiatry because researchers are combining
knowledge at the systems level (that is, at the level of symptoms and how the
mind thinks) with knowledge at the genetic level. People are now thinking about
how to make these enormous domains of science meet in the middle and illuminate
what happens in mental illness.
To contact Dr. Andreasen, please
write: Dr. Nancy Andreasen; Director;
Next, Dr. Xavier Amador talks about helping someone with
schizophrenia who doesn’t believe he or she is ill. Dr. Amador is the
Director of Psychology at the New York State Psychiatric Institute and a
Professor of Psychology in the Department of Psychiatry at Columbia University
College of Physicians & Surgeons. He is the author of I Am Not Sick, I
Don’t Need Help, which is published by VidaPress.
Dr. Amador’s brother was diagnosed with schizophrenia in his
twenties.Dr. Amador says he couldn’t understand why his brother didn’t believe
he was ill. He thought his brother was in denial. Like many revolving-door
patients, his brother would end up back in the hospital because he didn’t think
he was sick, so he wouldn’t take his medication.
Dr. Amador says it’s natural for a family member or clinician to
feel frustrated and angry in this situation, but confronting the person with
reality doesn’t work. Research now shows that it’s not denial, but rather a
symptom of the brain disorder. It’s called anosognosia - a lack of insight into
the illness. About 50% of people with schizophrenia and bipolar disorder have
it. The person has concept of themselves that’s stranded in time - they don’t
comprehend whom the illness has made them into.
His suggestion for family members and clinicians is to fight
those battles you can win. He uses his brother as an example. Don’t fight over
whether the person has an illness; gain his trust and respect. Work with the
person to get the things he wants—look for common ground with the patient,
finding any reason he might want to take the medication. For example, taking
medication would keep him out of the hospital, so he can get a job.
To contact Dr. Xavier Amador
or to order “ I Am Not Sick, I Don’t Need Help”, visit www.vidapress.com or call 877-990-2369.
In the past decade, a new class of drugs called atypical
anti-psychotics has proven extremely beneficial for people with
schizophrenia - allowing many to work or go back to school, and thus function
normally in society. But these drugs still have serious side effects, and much
research into medications remains to be done. Our next guest, Dr.Herbert
Meltzer is a Professor in the Departments of Psychology and Pharmacology and a
member of the Center for Molecular Neuroscience at Vanderbilt Medical Center in
Tennessee.
The older ant-psychotics had major motor side effects, including
Parkinson’s syndrome and tardive dyskenesia. Symptoms include involuntary
movements most often affecting the mouth, lips, and tongue.
The new atypical antipsychotics do not produce these motor side
effects, and they are extremely effective in reducing psychosis. Still, they
have other side effects. For example, in one out of one hundred people, the
drug Clozapine has a toxic effect on bone marrow (people using it must
regularly test their blood). There are also even newer medications without the
bone marrow side effect, though these can cause weight gain and metabolic
disturbances, and some can lead to heart trouble.
Dr. Meltzer says that one possibility for the future is that if
people can be identified (through brain imaging and genetic testing, for
example) before they become psychotic, doctors might be able to give them the
medications as prevention.
To contact Dr. Meltzer,
write to Dr. Herbert Meltzer; Departments of Psychiatry and Pharmacology;
Vanderbilt University; 2201 West End Avenue; Nashville, TN 37235.
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