Lessons from schizophrenia

[hinterland]

The Concept of Schizophrenia Is Coming to an End – Here's Why

"The concept of schizophrenia is dying. Harried for decades by psychology, it now appears to have been fatally wounded by psychiatry, the very profession that once sustained it."

"Either way, it turns out that the two extreme camps in the schizophrenia wars – those who view it as a genetically-based neurodevelopmental disorder and those who view it as a response to psychosocial factors, such as adversity – both had parts of the puzzle."

I'm not saying the BPS crowd are holding a significant part of the puzzle for ME/CFS. But it's interesting to note that they have their oar in many other waters too, some of which seem unexpected at first glance. But, nowhere else does it -- the BPS ideology and 'behavioural activation' -- have such downside potential to do harm than in ME/CFS, in my opinion - something that proponents fail to acknowledge and are in denial about.

"Many medical conditions, such as diabetes and hypertension, can be reached by multiple routes that nevertheless impact the same biological pathways and respond to the same treatment."

I'm not sure if this will turn out to be the case for ME/CFS or not, for a major subgroup. If it did, then I think that would help legitimise the condition, and make it possible to explain in a few sentences. I don't agree that finding a final common pathway would make investigating different causes academic, though the powers that be controlling health budgets might favour that argument.

"It has also been suggested that if some cases of schizophrenia are actually a form of autoimmune encephalitis, then the most effective treatment could be immunotherapy (such as corticosteroids) and plasma exchange (washing of the blood)."

"The potential for different treatments to work for different people further explains the schizophrenia wars. The psychiatrist, patient or family who see dramatic beneficial effects of antipsychotic drugs naturally evangelically advocate for this approach.

The psychiatrist, patient or family who see drugs not working, but alternative approaches appearing to help, laud these. Each group sees the other as denying an approach that they have experienced to work."

"None of this is to say the concept of schizophrenia has no use. Many psychiatrists still see it as a useful clinical syndrome that helps define a group of people with clear health needs.

Here it is viewed as defining a biology that is not yet understood but which shares a common and substantial genetic basis across many patients.

Some people who receive a diagnosis of schizophrenia will find it helpful. It can help them access treatment. It can enhance support from family and friends.

It can give a name to the problems they have. It can indicate they are experiencing an illness and not a personal failing. Of course, many do not find this diagnosis helpful."

"However, historically, the classification of diseases in psychiatry has been argued to be the outcome of a struggle in which "the most famous and articulate professor won"."

Yes... sounds about right, I think we can all relate to that one!

 

[Hip]

the two extreme camps in the schizophrenia wars – those who view it as a genetically-based neurodevelopmental disorder and those who view it as a response to psychosocial factors, such as adversity – both had parts of the puzzle

There is also a third important causal factor involved with developing schizophrenia, and that is infectious etiologies:

One study found the risk of developing schizophrenia was increased by 4.8 times in people who suffered a central nervous system viral infection in childhood.

In this particular study, coxsackievirus B5 infection of the CNS was a prominent in schizophrenia patients. Now we know that coxsackievirus B can form chronic persistence intracellular infections of the brain and other tissues. So there is clearly a need to perform brain autopsies on schizophrenia patients, to see if a persistent coxsackievirus B brain infection might be present.

And one study found risk of developing schizophrenia was increased by 7 times for adults whose mothers suffered an influenzavirus infection in the first trimester of pregnancy.

 

[Luther Blissett]

https://www.psychologytoday.com/blo...became-black-disease-interview-jonathan-metzl

Is interesting about the ways in which schizophrenia diagnosis changes due to non-clinical signs.

 

[notmyself]

There is also a third important causal factor involved with developing schizophrenia, and that is infectious etiologies:

One study found the risk of developing schizophrenia was increased by 4.8 times in people who suffered a central nervous system viral infection in childhood.

In this particular study, coxsackievirus B5 infection of the CNS was a prominent in schizophrenia patients. Now we know that coxsackievirus B can form chronic persistence intracellular infections of the brain and other tissues. So there is clearly a need to perform brain autopsies on schizophrenia patients, to see if a persistent coxsackievirus B brain infection might be present.

And one study found risk of developing schizophrenia was increased by 7 times for adults whose mothers suffered an influenzavirus infection in the first trimester of pregnancy.

i trully belive that many cases if not most of people with mental disorder, are caused by infections..otherwise,everyone will get better with meds,if the serotonin brain chemistry imbalance bullshit will be true..

 

[Learner1]

As in ME/CFS, there are potentially many things going on in schizophrenia likely resulting in different patient subgroups:

https://www.sciencedaily.com/releases/2016/07/160719094230.htm

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028184/#__ffn_sectitle

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3641836/#__ffn_sectitle

http://www.schizophreniaforum.org/news/icosr-2017-getting-grasp-gaba

http://science.sciencemag.org/content/353/6301/772.long

 

[anciendaze]

I've watched this debate recur over decades, without much benefit to patients, who are still being treated for symptomatic relief. I'm suspecting the problem is not any single infectious agent, because I can point to infections that are uncommon now, but were once major factors in psychiatric populations, like syphilis. Some patients with untreated disease met all the clinical requirements for schizophrenia, except that doctors knew they had syphilis. There were cases in which curing the infectious disease reversed the psychiatric problem.

(This still happens in cases where some doctor recognizes that the patient has acute toxoplasmosis. More commonly this does not happen. There is a correlation between antibodies associated with such infections and this diagnosis. Nobody seems to know what to do with chronic toxoplasmosis without clear clinical signs.)

I've also watched research on etiology, especially genetics. There was a discovery of a gene thought to be the cause of schizophrenia and labeled DISC1 (for "disrupted in schizophrenia".) Every patient with that genetic anomaly in one family developed a major mental illness, and none of those without had disabling mental problems. Sounds pretty clear, right?

The problem was that some people with the genetic problem were not schizophrenic. Psychiatric diagnoses ranged across the spectrum: schizophrenia, schizo-affective disorder, major depression, bipolar illness. These cover most of the daily business of psychiatrists. The particular diagnosis did not seem related to the known etiology, though it was very clear that "something mental was wrong" with patients. That does not sound like a useful scientific analysis of the problem.

Turning the problem around, some studies of hundreds of carefully diagnosed schizophrenics failed to find a single example of this genetic cause. This causes me to doubt that this diagnostic category is useful in research aimed at etiology, prevention or cure.

Failure to connect the condition with an etiology is reflected in life-long dependence on medication for symptom relief, there don't seem to be any real cures, and a complete failure of prevention. Incidence rates keep rising.

 

[Learner1]

After taking my loved one to over 20 doctors who offered drug after drug, and diagnosis after diagnosis, and all kinds of talk therapies, but didn't even run a lab test, I became very disillusioned with psychiatrists, particularly when a cure from a very serious mental illness was effected by treating celiac, food allergies, hormones, and nutrieMr deficiencies.

How many patients are in the same situation...misdiagnosed as psychiatric when they were, in fact, seriously ill?

http://www.mercurynews.com/2014/04/...rd-doctors-make-bold-diagnosis-and-treatment/

https://www.cbsnews.com/news/newly-...ay-be-misdiagnosed-as-psychological-disorder/

It has always seemed to me that people don't just wake up one day with a serious mental illness, but that environmental factors, sometimes on top of underlying genetic predisposition, shift the brain's biochemistry so it misbehaves. The challenge, then, is figuring how to correct the system thsyd out of whack, and its likely different for each person....its unlikely anyone has a Haldol deficiency....