Investigating schizophrenia research is like watching a piece of marble being chipped away, small flake by small flake, slowly revealing the sculptural form underneath. Little about schizophrenia, from the diagnosis to the prognosis, is firmly established. Recently, researchers have come closer to a “Eureka” moment with the discovery of malfunctioning genes in the brain cells of some schizophrenic patients.
In the past, schizophrenia was blamed primarily on nurture rather than nature. Popular books such as Joanne Greenburg’s autobiographical 1964 novel, “I Never Promised You a Rose Garden” (published under the pen-name Hannah Green) focused on social dynamics, such as anti-Semitism and sibling rivalry. Today it is estimated that schizophrenia is strongly influenced by hereditary factors, with thousands of genes possibly affected.
The Schizophrenia Research Forum posted “The Shifting Diagnostic Sands of Psychosis” where a discussion of recent longitudinal data is underway. The study, conducted over a ten year period and published in June, 2011 in the American Journal of Psychiatry, suggests that psychiatric diagnoses shift over time. Of individuals with an initial diagnosis of a psychotic disorder, the diagnosis of schizophrenia was made only after diagnoses of bi-polar illness; substance-induced psychosis, major depression, etc. were first assigned.
By the second year of treatment, thirty percent of the study participants were diagnosed as schizophrenic, a percentage that increased to 50% by the tenth year. This suggests either that the diagnostic categories are not clearly differentiated, and that misclassification frequently occurs, or that the path of psychosis runs through several stages, terminating with schizophrenia.
If diagnosis is a problem for schizophrenic patients, so is the question of treatment. A substantial number of individuals in the United States diagnosed with schizophrenia receive little or no treatment. More than half were found to have no treatment or treatment that was “suboptimal” according to research published in the Schizophrenia Journal in 2009.
Treatment for schizophrenia has been problematic due to the inability of most patients to tolerate the side effects of commonly prescribed anti-psychotic medications. According to a 2006 article in Psych Central, three-quarters of people diagnosed with the disorder stop taking medications. Only one drug, clozapine, which is not heavily marketed, was tolerated for more than a few months on average.
Genes Research and the Promise of Targeted Medications
Stem cell research has allowed the postmortem examination of neurons from those diagnosed with schizophrenia. This research, originally published in Nature Outlook, and reported in the Irish Times in April 2011, revealed that 600 genes appeared to malfunction in people with schizophrenia. Individual neurons can be examined for their response to anti-psychotic drugs, raising hopes for more effective treatment options.
In February, 2011, Jonathan Sebat, Ph.D., assistant professor of psychiatry and cellular and molecular medicine at the University of California, San Diego School of Medicine, and his colleagues, published research identifying a gene which holds particular promise in the treatment of schizophrenia. According to Dr. Sebat’s research, Vasoactive Intestinal Peptide Receptor 2 or VIPR2 is much more likely to be found in those with schizophrenia. Because VIPR2 responds to synthetic peptides, already available, targeting this gene is a promising treatment strategy.
Schizophrenia is a complex condition, with a variety of challenges from diagnosis to treatment and continuing care. Although options are currently limited, recent advances illustrate the progress science is making toward understanding and conquering schizophrenia for tomorrow’s patients.
Alstrom, D. Schizophrenia Research Breakthrough. The Irish Times. (April 2011). Accessed July 23, 2011.
Bromet, E., et al. Diagnostic Shifts During the First Decade Following First Admission for Psychosis. American Journal of Psychiatry. (June 2011).
Green, H. I Never Promised You a Rose Garden. Signet. (1964).
Grohol, J. Schizophrenia Treatment. Psych Central. (April 2006). Accessed July 22, 2011.
The International Schizophrenia Consortium. Common Polygenic Variation Contributes to Risk of Schizophrenia and Bipolar Disorder. Nature. (August 6, 2009) Accessed July 22, 2011.
LaFee, S. Schizophrenia Gene Mutation Found; Target for New Drugs. UC San Diego. (February, 2011). Accessed July 22, 2011.
Mojtabai, R., Fochtmann, L., Chang, S., Kotov, R., Craig, T., Bromet, E. Unmet Need for Mental Health Care in Schizophrenia: An Overview of Literature and New Data from a First-Admission Study. Oxford Journals, Schizophrenia Bulletin. (June, 2009. Accessed July 22, 2011.
Schizophrenia Research Forum. The Shifting Sands of Psychosis. (June 2011). Accessed July 22, 2011.
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