Ophtho and Psych crossing paths - Cool article

[Blitz2006]

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http://www.futurity.org/retina-schizophrenia-999892/

Once again showing that Psych is becoming more and more integrated with other fields...

 

[smalltownpsych]

Good article and points to something I have been thinking about recently. Ever since my patient brought her one year old in to the opthamologist. How vision problems can affect neurodevelopment? I am not as confident that assessing the retina will improve treatment. There are just way too many variables and this is just one of them. Movement is another area we should probably be looking at more.

 

[clausewitz2]

If you have a screening test with a 62% sensitivity rate for a condition whose base incidence is probably no more than 1% in gen pop, you have a useless screening test (unless you believe that the specificity is actually perfect, which is almost certainly not the case). I think this stuff is interesting and might help differentiate discrete subtypes some day, but I can't help but feel this is a bit like the personality traits associated with epilepsy - interesting clinical trivia but not that useful diagnostically.

 

[whopper]

A problem with this is that with any field of medicine an awesome advance can occur (and the stuff in the article is awesome) but unless it can be exploited on a clinical level there is almost no point on the battlefield.

E.g. Charles Nemeroff alleges to have discovered the gene for PTSD. He speculated that perhaps the military could do gene testing on people to see if some people without the gene may be a better fit for going into battle or if a woman was raped and in the ER a gene test could be part of the rape-kit workup.

But unless someone actually mass produces such a gene test it has almost no clinical use. You can tell a PTSD pt about the gene all you want it likely won't do anything to make them better.

It's been known for years that the eyes are involved with schizophrenia. The saccades for example are abnormal in schizophrenic patients but no one developed a way this could be exploited on the field.

I'm not trying to downplay the important of articles like this because it' stuff like this that does eventually lead to something real and it is cool stuff. Just throwing a little bit of cynical reality to it.

 

[clausewitz2]

On closer reading the paper itself involves a lot of measurements that require specialized ophtho equipment or dilated eye exams and not a lot of numbers that describe the ROCs or anything even about the strengths of these correlations. No reason a psychiatrist couldn't use dilating eye drops - the ophthos are always puzzled as to why nobody else does this - but this is preliminary sketches of utility, not utility an sich.

 

[smalltownpsych]

A problem with this is that with any field of medicine an awesome advance can occur (and the stuff in the article is awesome) but unless it can be exploited on a clinical level there is almost no point on the battlefield.

E.g. Charles Nemeroff alleges to have discovered the gene for PTSD. He speculated that perhaps the military could do gene testing on people to see if some people without the gene may be a better fit for going into battle or if a woman was raped and in the ER a gene test could be part of the rape-kit workup.

But unless someone actually mass produces such a gene test it has almost no clinical use. You can tell a PTSD pt about the gene all you want it likely won't do anything to make them better.

It's been known for years that the eyes are involved with schizophrenia. The saccades for example are abnormal in schizophrenic patients but no one developed a way this could be exploited on the field.

I'm not trying to downplay the important of articles like this because it' stuff like this that does eventually lead to something real and it is cool stuff. Just throwing a little bit of cynical reality to it.

I didn't know about the eyes being implicated in schizophrenia till today and it sounds like this is taking it a step further, isn't it? Also, abnormal movements which is what the saccades are, is something that I have known about for years. You are right on the money about how far we are from actually being able to use these bits and pieces of information.

 

[clausewitz2]

The article is a review of the more specific ophthomalogical measurements that have been found to correlate with schizophrenia, so actual structural findings above and beyond eye movements. So definitely beyond saccades.

 

[whopper]

I didn't know about the eyes being implicated in schizophrenia till today and it sounds like this is taking it a step further, isn't it?

Quite a lot of stuff about schizophrenia isn't taught because somewhere along the line someone forgot we psychiatrists are physicians. E.g. there is a global wide dysfunction on the neuro-level with the brain. Another example is schizophrenics often times have problems filtering out unwanted noise.

Another example: schizophrenics have been documented to show different creases in their hands.
https://books.google.com/books?id=v...lw6M#v=onepage&q=schizophrenia simian&f=false

But the problem is psychiatrists somewhere along the line as a whole started to limit their diagnosis and understanding on a more behavioral/observational level. Another problem is some of these methods aren't reliable methods for use in the field. The hand study in particular has very limited data as far as I know so I wouldn't go as far as to state this is more than past the speculation level.

 

[hamstergang]

I'm doing some work now with someone who has done a lot of research on schizophrenia and eye stuff, so the below information is just based on what he's told me (I haven't independently verified it myself).

There certainly seem to be retinal changes associated with schizophrenia, but no retinal test is as of yet sensitive or specific enough to be of any clinical use. However, it's important to remember that the retina is an extension of the CNS, and as such it is the easiest and least-invasively visualizable piece of the CNS. If you are doing research in schizophrenia and want to look at the CNS to assess it's health (we know schizophrenia involves problems with the CNS), the retina becomes a good target. Also, seeing retinal changes in those at high genetic risk for schizophrenia would give us some information about the pathophysiology of schizophrenia as it would suggest CNS dysfunction before the onset of symptoms.

One problem in trying to assess brain functioning in schizophrenia is that many aspects of the disorder lead those afflicted to perform worse on most tests. So if you give some sort of test to a control subject and a person with schizophrenia, and the control does better, you won't know if that's because of some specific aspect of the schizophrenia or if it's due to medications or if it's due to active hallucinations distracting the individual or if it's an issue with motivation etc. If you could design a test where the dysfunction in a schizophrenic brain caused the person to perform better than a control, you could really pin down what you're looking for. Optical illusions present just such a test as they rely on our brains to do some extra work to tell us we're seeing something we're really not seeing. And so, if you show certain optical illusions to people with schizophrenia, they're more likely to see what's actually on the page -- they don't get fooled as normal controls do -- and therefore perform better on the test.