New Understanding of Schizophrenia

Fascinating new information came out of a study at Washington University in St. Louis yesterday that may lead to a better understanding of schizophrenia--perhaps the most debilitating of all psychiatric illnesses.  We have always known there is a genetic link to schizophrenia; only about 1% of the population is diagnosed with the disease, but if you have relatives with the disease, your risk increases, with the risk being 50% if your identical twin has been diagnosed with it.  In the past, studies tended to look for one genetic marker, but as we learn more and more about how our DNA works, we are learning more and more about many illnesses, including mental illnesses, and realizing that they are often too complicated to be caused by one broken gene. 

The Washington University study suggests that schizophrenia may actually be more like eight different diseases, not one, and that many genes are acting in concert to cause the symptoms of schizophrenia, typically hallucinations, disorganization, and flat affect.  The researchers found that certain gene clusters were risk factors, not simply one specific gene, and that there were different clusters or causes, not just one. 

These results may change how we diagnose and treat schizophrenia and other illnesses.  Medications have improved over time, but real breakthroughs haven't happened in awhile, and anti-psychotic medications still have side effects that some people can't tolerate.  Having a better sense of genetic makeup and the causes of the disease can help us choose better medications from those available and also help with the development of new medications that may be better able to target symptoms without the unpleasant side effects, some of which are debilitating, and at least with some older medications, irreversible. 

CNN's Anderson Cooper did a fantastic job of showing what it's like to experience the auditory hallucinations that are typically experienced by someone with schizophrenia.  The video, as well as the article about the Washington U study can be seen here Exercise In Empathy. 

Most of us don't see people with chronic psychotic illnesses in private practice, as many are unable to work (therefore unable to get good health insurance to pay private practitioners), and most need more support than weekly, or even twice weekly, psychotherapy.  And since only about 1% of the population has been diagnosed with schizophrenia, it is obviously not as common as many other illnesses.  However, most psychologists did at least some training in hospitals and day programs, and have seen how difficult it is to manage the symptoms of this disease as well as the medications that need constant monitoring.  If you watch Anderson Cooper's video, you can see how a presumably intelligent, capable person is reduced to incompetence, isolation, and frustration due to the cacophony of sounds in his head.  Imagine now dealing with that every minute of every day, and you may start to understand how some of these patients live and why they are not typically in the population at large, but are instead in intensive treatment programs, group homes, and the like.  When the newer medications hit the scene a couple of decades ago, with fewer side effects, more people with psychotic illnesses were able to work, go to school, and function better in society.  Here's hoping that this new information aids in the development of even better treatment so that the vast majority of patients can find fulfillment in their lives rather than living with the torment that they do now.