Breakthrough in schizophrenia treatment?

[soaringheights]

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http://www.thestar.com/Health/article/174971

 

[gbv]

interesting article.

 

[Anasazi23]

I often wonder how I'll be treating psychotic spectrum disorders 20 years from now when I'm in practice.

This site is always reporting new news in schizophrenia research. It might be of interest also:
http://www.schizophrenia.com/sznews/archives/cat_schizophrenia_biology.html

 

[Chinnychin]

Hopefully I will not be treating any psychotic patients by the time I am practicing in 10-15 years-I am looking more for the cush depressed and anxiety ridden population which seems to be everyone these days. I really hate dealing with psychos (literally pscyhotic!). They are a great learning expierience and fun for awhile but are too draining for me. But yes I am sure things will change hugely in psych. I think psych is just on the verge of finally breaking through and developing some really cool treatments due to genetics of most of the major diseases and cool new drug research.

 

[slope]

the first article was probably a breakthrough in the late 80s when the dopamine receptors were described and analyzed; their distribution and involvement in schizophrenia was already being known back then.
The research at McLean seems to be very promising. I guess we'll have to wait quite a few years until other studies will be able to replicate (or not) their findings

 

[Anasazi23]

Hopefully I will not be treating any psychotic patients by the time I am practicing in 10-15 years-I am looking more for the cush depressed and anxiety ridden population which seems to be everyone these days. I really hate dealing with psychos (literally pscyhotic!). They are a great learning expierience and fun for awhile but are too draining for me. But yes I am sure things will change hugely in psych. I think psych is just on the verge of finally breaking through and developing some really cool treatments due to genetics of most of the major diseases and cool new drug research.

I, too, don't plan on working with floridly psychotic patients once I'm comfortable and established, but I do have an appreciation for the more subtle psychotic spectrum processes that can allow people to be functional or even highly successful, but disabled in other ways. One example could be so-called crippling 'psychotic anxiety,' or even pseudopsychopathic schizophrenics.

 

[toby jones]

Ah, another breakthrough.

I'm about as dubious that medications or psychosurgery will fix schizophrenia as I am dubious that one can teach a person to cook by giving them medication or psychosurgery.

Of course schizophrenia is brain based. But then so is learning and memory. I don't think that biological breakthroughs will ever result in psychological and sociological interventions being outmoded or made redundant.

But tell it to the insurance companies I guess...

So people want to work with wealthy neurotics? Giving them prozac and xanax and effexor and whatever is the drug of the year?

Are people into therapy or do people envisage pharmacological interventions mostly?

 

[soaringheights]

The reason I posted this in the psychiatry forum was because the nature of the 'breakthrough' was biologically based. Anyone has a list of all of the supposed biological breakthroughs in schizophrenia treatment?
And while we are on the topic of breakthroughs..can there ever be a psychological intervention for a mental disorder (schizophrenia in this case) that can truly be termed as a breakthrough? Would it be more apt to view them in terms of relative success/failure of the psychological intervention in question?
Guess the term breakthrough has different definitions in different niches....

 

[TheWowEffect]

I don't think that biological breakthroughs will ever result in psychological and sociological interventions being outmoded or made redundant.

Of course, psychological and sociological interventions will always be important but its the biological interventions which are and will be the mainstay. I think the psychosocial interventions are important even in "non-brain" diseases like diabetes, HTN, CHF etc etc. We just don't call them such. Talk about controlling cravings for salty, sweet and oily foods. Talk about spouse and family reminding a person that they need to excercise, eat properly and take their meds.

So people want to work with wealthy neurotics?

Less said the better about these people but then, to each his own....

 

[Anasazi23]

Ah, another breakthrough.

I'm about as dubious that medications or psychosurgery will fix schizophrenia as I am dubious that one can teach a person to cook by giving them medication or psychosurgery.

I feel much less pessimistic when I consider that there will be no biological breakthroughs that will drastically improve treatment of, or even cure, schizophrenia. We've seen stepwise improvements in medications and outcomes every decade. Why should I think that this will not continue?

This is even more clear when compared to the example of giving a pill to teach someone to cook.

Of course schizophrenia is brain based. But then so is learning and memory. I don't think that biological breakthroughs will ever result in psychological and sociological interventions being outmoded or made redundant.

But tell it to the insurance companies I guess...

Probably not to the first paragraph. But, there must come a time when we stop looking at the brain as this amorphic mysterious organ, and accept hard research facts with the hope that clinical betterment can come of it. The same was once said of the heart as an organ.
Just because the roots of 'biological schizophrenia' and behavior/learning occurs in the same organ, does not make them completely integrated. Think about treatment such as pineal tumor reduction or debulking, which is 'based in the brain.'

So people want to work with wealthy neurotics? Giving them prozac and xanax and effexor and whatever is the drug of the year?

To some degree, yes. Along with middle income obsessives, and a myriad of other disorders. You imply that this is unchivalric to do so.

Are people into therapy or do people envisage pharmacological interventions mostly?

Some are. Many are not. We all learn it, as it is required of any residency program. But, your tone insinuates that medications are seen as a quick fix, or an easier way out. The long hard road is not always better, either for you or the patient. Medications work, as does therapy.

 

[OldPsychDoc]

Here's a link to the primary article.

Having worked in this field, I am always amused by how someone's hard work in the basic sciences gets translated to the popular media.
Basically, these folks have shown that D1 and D2 receptors form complexes in the brain. That's new, and that's cool. They've also characterized the phamacology of this complex, using SKF83959, a well characterized research-grade dopamine agonist, hardly "discovering a new chemical" as the Star article implies, and show that there are changes in the intracellular 2nd messenger cascades. That's important. Yes, we know that D2 antagonists are effective anti-psychotics (though they do nothing for negative symptoms). However, there's never been a lot of strong evidence of a primary disruption in dopamine receptors in schizophrenia, and this article offers essentially no claim that we would see a change in D1-D2 complexing in schizophrenics. Nevertheless, the Star jumps right ahead to the whole "hope for a new drug" thing that you see just about every damn time a study like this gets reported. It's like the stock footage of someone in a white coat pipetting that the TV news shows everytime there's a "health care breakthrough story". 🙄
My opinion? The real breakthrough will be figuring out exactly what is the disruption in these folks' wiring, and figuring out how to prevent it before it happens. (So make sure your pregnant patients get their flu shots!)
BTW--I'll take a pleasantly psychotic patient ANY DAY rather than have to sit through another half hour of a droning, complaining chronically depressed middle-class neurotic, thank you very much!

 

[Chewbacca Jung]

..can there ever be a psychological intervention for a mental disorder (schizophrenia in this case) that can truly be termed as a breakthrough? ....

I think part of the problem is that we have piece-mealed mental disorders into lists of epidemiologic-best-fit models of phenomenology-- otherwise known as the DSM. And while it's been great for standardizing research and billing (kind of ) it's really taken the gestalt out of mental illness. So in grand aristotolean fasion, we have defined and catagorized MDD, BP, SAD, PTSD... and think that we understand them. But all we know about mental illness, from the standpont of the DSM, is what people with these mental disorders tend to do, along with some associated genetic abnormalities. But as OldPsychDoc says, real breakthroughs aren't likely until we COLOR="DarkOrange"]figuring out exactly what is the disruption in these folks' wiring...[/COLOR] I suppose that means a more functional view of psychopathology. One way to go about this, in the case of investigating into the bizarre thoughts and behaviors of schizophrenia spectrum and defining it not by a checklist of observable behaviors, but by what what abberations in language, symbolic reasoning centers, processing of information... the patient is experiencing. These can then be correlated to either neurophysiologic circuits or to psychological processes, and then to treatments. This is just one direction, but I think that at any rate, reconceptualization of mental illness is needed for breakthroughs to occur-- "breakthrough" being defined more by the reconceptualizing process than by the details of the discovery.

 

[toby jones]

I’m not sure about medication as the number one intervention. I suppose it all depends on exactly what it is that you are trying to intervene on and whether there is any such thing as the number one intervention will be an empirical matter. We have seen stepwise improvements in medications but then we have also seen stepwise improvements in psychological interventions and in social interventions as well. I don’t at all mean to imply that it is unchivalric to work with wealthy neurotics. Just because they are wealthy and neurotic doesn’t preclude their having genuine and serious distress. I suppose my concern was a combination of a biological focus and a wealthy neurotic focus. I understand why people who are focused on severe psychopathology focus on biological interventions. I understand why people who are focused on wealthy neurotics focus on psycho/social interventions. I don’t really understand the focus on treating wealthy neurotics with medications, however.

I mean, I understand that patients rate their satisfaction the highest when they are prescribed what they wanted to be prescribed. Or that they report satisfaction when they come away with a prescription. That they report least satisfaction when they are not given a prescription and when they are offered psychological / social interventions instead. But if it is about successful intervention then (according to Shorter) there were the prescriptions of visits to the spa and there was the strategic application of magnets and there was hypnotism and then the success of the sales of xanax and prozac. The buzz drug at the moment is Effexor which is marketed as a treatment for both anxiety and depression (bonus!). People report horrific side-effects when they attempt to wean themselves off Effexor, however. (Consumer boards are a good source of information for side-effects from medications. See, for example: http://www.dr-bob.org/babble/wdrawl/ where the longest thread in the history of the board is regarding Effexor withdrawal). I haven’t heard of people experiencing such horrific withdrawal symptoms from the removal of psychological or social types of intervention or such horrific side effects from having psychological or social types of interventions. Though I suppose some people do react badly to some therapists so maybe that is comparable ;-)

Medications have side-effects that are not always appreciated by the drug companies (who probably aren’t too bothered about systematically investigating the prevalence of side-effects from their drugs). There has been some concern expressed about how much neurological differences found in patients with schizophrenia existed prior to their being treated with anti-psychotics and how much the neurological differences that we know about are actually caused by being treated with anti-psychotics, for example. I guess I was wondering how many people who wanted to work with the wealthy neurotics were thinking of practicing therapy or if they were more envisaging writing prescriptions for designer drugs, was all. Anyone thinking of training as an analyst? (I’m not being derogatory here I too have sympathy for the wealthy neurotics and I’ve contemplated training as an analyst).


I'm wary of the conclusion that medication is the best way to alter neurology (back to the learning how to cook example). The WHO did a study (not often cited) and then a repeat study and what was found was that: The worst predictor for recovery from schizophrenia was living in a developed western nation. With (one supposes) better access to medication. People in the less developed countries (with less access to medications) tended to get better whereas people in more developed countries (with more access to medications) tended to remain ill. Perhaps the most effective way of altering neurology is by way of social interventions? Perhaps...

;-)

 

[kugel]

My interpretations of that study have been that
A) there are fewer jobs avail for the barely functional schizophrenic in dev'ped western countries; less family companies/farms where such a person can work 10 hrs today, 2 hrs tomorrow, not at all for 6 days.
B) western countries tend to ration care and public assistance, creating a situation in which it is advantageous to remain severely ill. If one of my pts gets a decent job, 1) he can't get into the clinic b/c it's only open 9-5 weekdays, and 2) he loses his insurance and his $ assistance and housing assistance. Not a good way to use what we know of behavior change (Skinnerian B-Mod) to help people get better.