Molecular genetics and schizophrenia

[Gooner007]

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Been doing some searching online, looking up latest research on this subject. I suppose most people are interested in schizophrenia, since its probably the most devastating of mental illnesses.

It seems like a double edged sword though. To me, its like a continuum. On one end, we have the potential biological markers, lab tests, and definitive diagnoses. And on the other end, we have behavioral therapies to manage overall well being of patients.

If we focus more on current molecular interest in research, is there a fear that less attention will be given to behavioral therapies? That would be like moving one step forward, and two steps backward!

Also, it still amazes me how much we don't know about biological bases of mental illness. We have so much advances in other specialties, but psychiatry seems to lag. Is it because of lack of funding? Maybe the medical technology to detect changes is not advanced enough for psychiatry? I wonder what psychiatrists think of these questions, and questions like them.

 

[Suedehead]

Also, it still amazes me how much we don't know about biological bases of mental illness. We have so much advances in other specialties, but psychiatry seems to lag. Is it because of lack of funding? Maybe the medical technology to detect changes is not advanced enough for psychiatry? I wonder what psychiatrists think of these questions, and questions like them.

It's because trying to understand the brain and humanity and the mind, etc, is like trying to untangle that Christmas tree light knot from Christmas Vacation (....I don't know, the image just came to me).

There's no genotype for humaness. Never will be.

 

[Sust]

I can't tell if you're being serious or not, but here's my 2 cents:
I dont think anyone denies the necessity for a biopsychosocial approach to mental illness given our current understanding of mental illness. Many flavors of psychotherapy are still very active areas of research as they have been since the early 20th century. I think it's only been in the last ~20 years that we've had the technological capacity to even begin non-traumatically figuring out how the brain works so it's not surprising to me that science would try to explore that final frontier a little more vigorously at the moment.
It is pretty amazing how little progress we've made in understanding the pathophysiological mechanisms of mental illness, but I just mentioned our recent technological advances plus I think the previous poster hit the nail on the head when he planted blame on the brain's sheer complexity. Nothing against the other organs in the body, but I dont think anything even approaches the complexity of this huge ball of neurons that are all connected to each other in one form or another and whose disparate/synchronous sequence of firing patterns everywhere gives rise to every single thing you consciously/unconsciously observe, think, and feel. Right now the brain is unique in that there's no amount of X-ray, ultrasound, or MRI that can explain how a flower is encoded in which neurons of our brain and where it's retrieved from when we want it. With the "simple" normal functioning of the brain still lingering un-answered, it shouldnt be surprising that psych has been going at what may seem like a slow pace. There are other reasons why psych has been behind in research, but that's a sociopolitical discussion for another time and place.
Psych. genetics is an interesting place to start the search in which you theoretically know the beginning(gene of interest) and you know the end(intermediate phenotypes of whatever mental illness). Thats a highly over-simplified view of genetic studies, but that's one way to skin a cat. I'm kinda curious to see where it all takes us.
As a future psych hopeful, I find these same unknowns are what make psych so interesting. It keeps me watching, waiting, and wanting more as we make each incremental step closer towards figuring out the brain. There are probably very few fields of medicine that are going to change as much as psych will over the next 50 years and for some reason i'm okay with that.

 

[Gooner007]

I can't tell if you're being serious or not, but here's my 2 cents:
I dont think anyone denies the necessity for a biopsychosocial approach to mental illness given our current understanding of mental illness. Many flavors of psychotherapy are still very active areas of research as they have been since the early 20th century. I think it's only been in the last ~20 years that we've had the technological capacity to even begin non-traumatically figuring out how the brain works so it's not surprising to me that science would try to explore that final frontier a little more vigorously at the moment.
It is pretty amazing how little progress we've made in understanding the pathophysiological mechanisms of mental illness, but I just mentioned our recent technological advances plus I think the previous poster hit the nail on the head when he planted blame on the brain's sheer complexity. Nothing against the other organs in the body, but I dont think anything even approaches the complexity of this huge ball of neurons that are all connected to each other in one form or another and whose disparate/synchronous sequence of firing patterns everywhere gives rise to every single thing you consciously/unconsciously observe, think, and feel. Right now the brain is unique in that there's no amount of X-ray, ultrasound, or MRI that can explain how a flower is encoded in which neurons of our brain and where it's retrieved from when we want it. With the "simple" normal functioning of the brain still lingering un-answered, it shouldnt be surprising that psych has been going at what may seem like a slow pace. There are other reasons why psych has been behind in research, but that's a sociopolitical discussion for another time and place.
Psych. genetics is an interesting place to start the search in which you theoretically know the beginning(gene of interest) and you know the end(intermediate phenotypes of whatever mental illness). Thats a highly over-simplified view of genetic studies, but that's one way to skin a cat. I'm kinda curious to see where it all takes us.
As a future psych hopeful, I find these same unknowns are what make psych so interesting. It keeps me watching, waiting, and wanting more as we make each incremental step closer towards figuring out the brain. There are probably very few fields of medicine that are going to change as much as psych will over the next 50 years and for some reason i'm okay with that.

thanks for your post! i'm curious as to know why you thought i wasn't serious...lol

i'm very much interested in psych, but i do find it sometimes frustrating compared to other specialties.

but i suppose there is a gray area between the frustration and willingness to explore the human mind further!

 

[AcronymAllergy]

One of the reasons it seems that such little headway has been made with respect to schizophrenia is that the category itself is such a messy one. There are clinicians and researchers who argue about which symptom clusters (e.g., positive vs. negative) are the most devastating and/or important for diagnosis, whether "other" schizo-like diagnoses are even true conditions (schizoaffective in particular), if paranoid-type should be broken out as its own category given the marked social functioning differences between these individuals and those with other subtypes of schizophrenia, etc.

Also, much of the current research is potentially confounded by the widespread use of antipsychotic medications. It's relatively rare nowadays that you'll come across an individual with schizophrenia who has no significant history of psychopharm treatment, and this has potentially changed the "face" of schizophrenia as a whole.

In terms of behavioral therapies, I do know that psychologists--along with psychiatrists and other mental health professionals, of course--are working to develop effective treatments, given that medication doesn't generally address negative symptoms. However, as you've pointed out, because the theory behind key deficits in schizophrenia is still so fragmented, it's difficult to apply that theory to the development of appropriate interventions. The only one I know of which actually works is social skills training, although there have been adaptations of existing treatments (e.g., CBT, substance abuse) for the treatment of these comorbid conditions in individuals with severe mental illness.

Oh, and sorry to invade your forum. Just got temporarily tired of reading all the admissions-based threads over in psychology and was looking for an appropriate distraction =)

 

[OldPsychDoc]

..
Oh, and sorry to invade your forum. Just got temporarily tired of reading all the admissions-based threads over in psychology and was looking for an appropriate distraction =)

Welcome--just be aware that there will plenty of Match angst over here this week.

 

[Sust]

Sorry, it's always hard for me to figure out interest in a serious answer over the internet. Maybe this is a skill they'll fill in for me after med school.

Also to add to what the other poster said about diagnostic categories, maybe what we all learn about in the DSM might not be as neatly defined as we had previously hoped, but this is the best we can do with the crude measurement tools we have at the moment. As previously stated, it's going to be interesting for psychiatry during this time of hopeful change and discovery. Im no doctor yet, but if your choice is psych(or any profession for that matter), I think it's important to keep the uncertainty and turbulence in mind when deciding and maintain some sense of flexibility when some things you thought you knew are entirely wrong. Frustration is everywhere, but manageable along with your expectations.

 

[homeobox_genes]

Gooner:

You're asking the right questions. You're curious. That's good.

I think you're off in ascribing any tension between research and behavioral therapies. Molecular genetic researchers don't think about behavioral therapies when going about their work in the lab. They sit down, strap on their gloves, and make things happen. Tension ain't coming from them.

One aspect of your question is that you should note that progress in neuroscience, as a whole, hasn't been particularly great relative to other systems. Its a similar story with cancer. Here's Rolf Kotter on the subject:

"This marks the difference that it makes whether one investigates the brain or, for example, the kidney: both are highly complex organs whose functions are incompletely understood. A fundamental difference is that with regard to the kidney one thinks that, in principle, it is clear how it works and that only the details still have to be worked out. With the brain remains the impression that in order to understand it at all we are still missing some fundamental insights and that this principal problem blocks significant progress despite a huge amount of detailed research being carried out. Thus, in order to make a significant contribution to brain research it seems important to focus on the most interesting problems which concern the mechanisms that explain structure/function relationships in the brain. "

Basically, we know a lot about cancer; we know a lot about the brain; but this knowledge all seems peripheral, interesting but not fundamental, not core, not decisive to intervention. Its the same with cancer; its the same with neurology (ask stroke victims, cerebral palsy patients, RSD patients, etc) and its the same with psychiatry. Where neurology overlaps with psychiatry closely: for instance, in post-stroke cognitive, intellectual or mood dysregulation: neurologists have as much luck with their interventions as do psychiatrists and developmental pediatricians. All three groups have no greater luck in treating, say, Tourette's, autism, ADHD.

But that's what's so interesting about our trying to understand behavior and cognition; its the holy grail of neuroscience. Stroke isn't; headache isn't; MS isn't; understanding human cognitive functions is, period. Because it's so hard, its going to take the longest to solve,. and we're probably going to need to have enough information about the brain to practically cure every other neurological illness, and build a brain ourselves, before we get there. All right, maybe I'm exaggerating. You should read Rolf Kotter's list of the twenty most important problems in neuroscience. That list hasn't altered one bit in the past 12 years.

http://www.hirn.uni-duesseldorf.de/rk/hilbert.htm