The Voices of Schizophrenia

An article posted yesterday by The New York Times:

By Tara Parker-Pope

Few mental illnesses are as complex and confusing as schizophrenia, a mental disorder in which people may experience hallucinations or delusions, hear voices or have confused thinking and behavior.

Although the word “schizophrenia” means “split mind,” the disorder does not cause a split personality, as is commonly believed.

The latest Patient Voices segment by Karen Barrow, a Web producer, offers rare insights into schizophrenia and schizoaffective disorder, a related condition that combines thinking and mood problems, as seven men and women share their experiences.

“It disrupted my education, my relationships, it disrupted friendships,” explains Alita Van Hee, 32, of Santa Cruz, Calif. “I was so bombarded by voices. They would tell me things like ‘Don’t trust these people,’ ‘Don’t talk to your friends,’ ‘They’re not real friends,’ things like that. It’s kind of like having a TV or radio on blasting inside your head just all the time that you can’t turn off no matter what you do.”

You’ll also meet Michael Runningwolf, 40, of Tempe, Ariz., who wants to change people’s perceptions and fears about schizophrenia.

“I wish I could get a T-shirt that says, ‘We’re more afraid of you than you are of us,’ ” he says. “There are people with schizophrenia every day that are doing things to break down the stigma. They hold down jobs, and they’re out there every day giving it everything they’ve got. Even though schizophrenia is a disabling illness, it’s not the end. There is recovery.”

Susan Weinreich, 54, of Mount Kisco, N.Y., says that although her illness has made life difficult, it also has become part of her art. “I believe my art was a vehicle for me to be able to express some things that were very deep, deep down inside and that were trapped and difficult to get out and communicate,” she says.

Another artist, John Cadigan, 40, who is Ms. Van Hee’s partner, says the challenges of his illness have also played a role in his art. “The difficulty is I’m not always cognizant of what reality is,” he says. “I can’t trust my own brain…. When you have a brain disorder it unlocks parts of the brain I think normal people don’t have any knowledge of. I think I translate that into my woodcuts.”

To hear these and other stories of schizophrenia, click on the Patient Voices audio link. And then please join the discussion below.

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A four-part series on young people with mental illness ...

... written by John Gillis and published in the Chronicle Herald.




Part One
‘It’s not him, it’s the illness’
Mom stands by son who choked her; she hopes his court-ordered stay at forensic hospital will finally help him

Part Two
Mom pleads for timely help

Part Three
‘It seemed so real’
Imaginery noises led to bipolar disorder diagnosis for bright young teenage girl

Part Four
Treat mental health problems early, avoid trouble later
The last in a four-part series on young people and mental illness

Task Force Proposes New Bipolar Guidelines

From the April 1st edition of Psychiatric Times:

By Arline Kaplan

An international team of experts recently proposed expanding the diagnostic criteria for several subtypes of bipolar disorder, adding a pediatric bipolar disorder category and eliminating the schizoaffective disorder category.

Bold emphasis is mine. To read the entire article, click here.

Reference
1. Ghaemi SN, Bauer M, Cassidy F, et al; ISBD Diagnostic Guidelines Task Force. Diagnostic guidelines for bipolar disorder: a summary of the International Society for Bipolar Disorders Diagnostic Guidelines Task Force Report. Bipolar Disord. 2008;10(1, pt 2): 117-128.

Recognizing a common genetic syndrome: 22q11.2 deletion syndrome

An article in published in the February 12th edition of the Canadian Medical Association Journal. To download the entire article (PDF) click here.

Below is a quote from the article authored by Ronak K. Kapadia, BSc,* and Anne S. Bassett, MD.**

*Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia.
**Clinical Genetics Research Program, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario.

22q11.2 deletion syndrome, previously known as DiGeorge syndrome or velocardiofacial syndrome, is the most common microdeletion syndrome known (estimated prevalence of 1 in 4000 live births), yet it remains underrecognized, especially in adults (1,2). Clinical variability, multisystem disease, subtle features, lack of medical genetics services, the recent availability of molecular cytogenetic testing in 1994 and, most importantly, the unfamiliarity of clinicians with this syndrome all contribute to delayed and missed diagnoses. Clinic visits and admissions to hospital present opportunities to diagnose 22q11.2 deletion syndrome, but without knowledge of this syndrome and its features, patients will not receive the correct diagnosis.

The deletion is hemizygous (affecting only 1 chromosome) and involves the 22q11.2 region of the long arm of chromosome 22. In most newly diagnosed cases (> 90%), and in our case, the parents are unaffected because this is a de novo mutation. Both parents of patients with 22q11.2 deletion syndrome should be tested for the deletion because expression may be mild (1). Fertility is generally unaffected in individuals with 22q11.2 deletion syndrome. Patients with a confirmed diagnosis require genetic counselling about the 50% chance of transmitting the deletion with each pregnancy and about the wide range of congenital and later-onset conditions associated with this syndrome (1). Common later-onset conditions include endocrine disorders, such as hypothyroidism and hypoparathyroidism (1), and schizophrenia or schizoaffective disorder (about 25% of cases) (1,2).

Bold emphasis is mine.

References

1. Bassett AS, Chow EWC, Husted J, et al. Clinical features of 78 adults with 22q11 deletion syndrome. Am J Med Genet A 2005;138:307-13. [Medline]
2. Bassett AS, Chow EWC. 22q11 deletion syndrome: a genetic subtype of schizophrenia. Biol Psychiatry 1999;46:882-91. [Medline]
   

Physiology of Schizophrenia, Bipolar Disorder, and Schizoaffective Disorder

An abstract from the December 2007 issue of the American Journal of Psychiatry:

Laura F. Martin, M.D., Mei-Hua Hall, M.S., Randal G. Ross, M.D., Gary Zerbe, Ph.D., Robert Freedman, M.D., and Ann Olincy, M.D.

OBJECTIVE: Endophenotypes have been proposed to identify the genetic and biological substrates of complex disorders. Three physiological inhibitory endophenotypes of large effect size in schizophrenia include suppression of P50 auditory evoked responses, inhibition of leading (small anticipatory) saccades during smooth pursuit eye movements, and cancellation of reflexive saccades in the antisaccade eye movement task. The aim of this study was to determine if the pattern of endophenotype abnormalities within individuals with schizophrenia differed from that within individuals with bipolar disorder. A second aim was to determine whether subjects with schizoaffective disorder, bipolar type, were neurophysiologically more similar to subjects with schizophrenia or subjects with bipolar disorder.

METHOD: Endophenotypes were recorded for subjects diagnosed with schizophrenia (N=29), bipolar disorder (DSM-IV-TR) (N=40), and schizoaffective disorder, bipolar type (N=18). Data from normal comparison subjects were used to establish normal performance.

RESULTS: Logistic regression determined that P50 ratio and frequency of leading saccades identified subjects with schizophrenia and bipolar disorder with a sensitivity of 95%* and a specificity of 83%*. The schizoaffective disorder group was split, with six subjects physiologically classified as schizophrenia-like and 12 subjects as bipolar-like. Those classified as schizophrenia-like were significantly younger at illness onset and had higher symptom ratings.

CONCLUSION: A composite endophenotype of P50 ratio and frequency of leading saccades is consistent with the current clinical nosology of schizophrenia and bipolar disorder and parses patients with schizoaffective disorder, bipolar type, into two subgroups.

* Emphasis is mine.