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New schizophrenia drug could treat Alzheimer’s disease

By Diana Kwon Since a schizophrenia drug, the first in decades with an innovative mechanism of action, gained US regulatory approval in September, some researchers have proclaimed a new era for psychiatric medicine. About half a dozen similar drugs — for schizophrenia, Alzheimer’s disease and other conditions involving the brain — are in various stages of development, most in early-stage clinical trials. But the success of these medicines is not a given. Last week, a trial of a highly anticipated schizophrenia drug reported disappointing results. For decades, schizophrenia drugs worked in essentially the same way. They blunted the activity of dopamine, a chemical involved in the disorder’s hallmark symptoms, such as hallucinations and delusions. The new kid on the block is KarXT, sold as Cobenfy. It targets muscarinic receptors and leads to antipsychotic and cognitive benefits. “I don’t think I’ve ever seen this much buzz and excitement over a new approach in psychiatry in my career,” says Jeffrey Conn, a pharmacologist at Vanderbilt University in Nashville, Tennessee, who was one of the company’s scientific co-founders. KarXT’s success in winning US regulatory approval has revived interest in muscarinic drugs. “Drug discovery is coming back to psychiatry,” says Arthur Christopoulos, a molecular pharmacologist at Monash University in Melbourne, Australia, who was involved in the development of KarXT. But developing new medicines is a hard, long road. On 11 November, Abbvie, a pharmaceutical company in North Chicago, Illinois, announced that its muscarinic drug for schizophrenia, called emraclidine, had failed to outperform a placebo. What this means for other muscarinic drugs in development remains to be seen, Christopoulos says. “It is still early days.” © 2024 Springer Nature Limited

Related chapters from BN: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders
Link ID: 29574 - Posted: 11.23.2024

Using avatars in psychosis therapy can help those who hear voices

PA Media Digital characters – avatars – could help people with psychosis hear voices less often and reduce the distress caused, research suggests. The therapy involves a series of guided sessions during which patients are able to have a conversation with an animated digital representation of their distressing voice. Often in psychosis, as in other conditions, the voices people hear can be abusive or bullying and affect people’s day-to-day life. The voices can be experienced as powerful and almost omniscient, seeming to know what the person is thinking and feeling, and preventing them from taking the steps they want to every day. According to the research from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London, the avatar therapy using computer-generated animations is an effective way of helping people with psychosis who hear voices. Philippa Garety, professor emerita of clinical psychology at King’s IoPPN and the study’s lead author, said: “To our knowledge, this is the first therapeutic intervention that has a direct and sustained impact upon the frequency with which people hear voices. “This is an extremely important finding, as it is a clear priority for voice-hearers, and hearing fewer voices, less often, or voices going away altogether can have a hugely positive impact on their day-to-day lives. “People who hear voices rarely only hear one. In an interesting development, the extended version of the therapy proved effective at reducing voice frequency in total, despite participants only creating one avatar for one voice.” © 2024 Guardian News & Media Limited

Revolutionary drug for schizophrenia wins US approval

By Elie Dolgin The first schizophrenia medication in decades with a new mechanism of action won US regulatory approval today. The approval offers the hope of an antipsychotic that would be more effective and better tolerated than current therapies. The drug, known as KarXT, targets proteins in the brain known as muscarinic receptors, which relay neurotransmitter signals between neurons and other cells. Activating these receptors dampens the release of the chemical dopamine, a nervous-system messenger that is central to the hallmark symptoms of schizophrenia, such as hallucinations and delusions. But muscarinic signalling also modulates other brain circuits involved in cognition and emotional processing. This mode of action provides KarXT with a more comprehensive therapeutic effect than other schizophrenia treatments, which mainly blunt dopamine activity alone. In clinical trials, KarXT not only alleviated core symptoms of schizophrenia, but also showed signs of improving cognitive function, all while avoiding many of the burdensome side effects commonly associated with older antipsychotics. “This will be a revolution of the treatment of psychosis, and I’m not saying this lightly,” says Christoph Correll, a psychiatrist at the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York, who helped to analyse data from the trials. “Now we will now be able to treat people who haven’t been helped with traditional antipsychotics. That’s highly exciting.” KarXT is just the first of many next-generation drug candidates designed to engage muscarinic receptors in the brain. Several follow-on schizophrenia therapies are already in or nearing clinical trials, showing promise for improved tolerability and more convenient dosing schedules. This progress is leading clinicians and drug developers to imagine a future in which schizophrenia treatment becomes more tailored to individual needs — providing an alternative for the many people who don’t benefit from current therapies or abandon them owing to intolerable side effects. © 2024 Springer Nature Limited

Related chapters from BN: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders; Chapter 4: Development of the Brain
Link ID: 29498 - Posted: 09.28.2024

Balancing Act: Pregnancy and Bipolar Disorder

By Frieda Klotz For five years, Clare Dolman took lithium to manage her bipolar disorder. The medicine kept her happy and well with few side effects, and she described it as a wonder drug. But when she began to plan for a pregnancy, her psychiatrist advised her to go off the medication to protect the fetus. This was 1988, and it was the standard guidance at the time. While Dolman experienced some stresses during the pregnancy, her mood remained stable. But soon after giving birth, she began to experience mild hallucinations. “I thought, yes, there’s something wrong here,” she recalled. “But I had the insight still to see that I was getting ill, and my husband knew I was getting ill because he had seen me really bad.” She went on to spend five weeks in the hospital. Clare Dolman at the launch of the Bipolar Commission at the U.K. Parliament. Dolman, who has bipolar disorder, stopped taking lithium during her own pregnancies more than 30 years ago. She later became a mental health advocate and has studied the experiences of pregnant women with the illness. Visual: Courtesy of Clare Dolman Bipolar disorder involves extreme fluctuations in mood and is classified into different types according to symptoms and severity. For women with the condition, pregnancy can be a fraught endeavor as they balance the health of their growing fetus with their own mental state. Many, like Dolman, stop taking the medications that keep them well — which can lead to a recurrence of symptoms — and some avoid pregnancy altogether.

Related chapters from BN: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 12: Sex: Evolutionary, Hormonal, and Neural Bases
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders; Chapter 8: Hormones and Sex
Link ID: 29475 - Posted: 09.11.2024

How a Leading Chain of Psychiatric Hospitals Traps Patients

By Jessica Silver-Greenberg and Katie Thomas Acadia Healthcare is one of America’s largest chains of psychiatric hospitals. Since the pandemic exacerbated a national mental health crisis, the company’s revenue has soared. Its stock price has more than doubled. But a New York Times investigation found that some of that success was built on a disturbing practice: Acadia has lured patients into its facilities and held them against their will, even when detaining them was not medically necessary. In at least 12 of the 19 states where Acadia operates psychiatric hospitals, dozens of patients, employees and police officers have alerted the authorities that the company was detaining people in ways that violated the law, according to records reviewed by The Times. In some cases, judges have intervened to force Acadia to release patients. Some patients arrived at emergency rooms seeking routine mental health care, only to find themselves sent to Acadia facilities and locked in. A social worker spent six days inside an Acadia hospital in Florida after she tried to get her bipolar medications adjusted. A woman who works at a children’s hospital was held for seven days after she showed up at an Acadia facility in Indiana looking for therapy. And after police officers raided an Acadia hospital in Georgia, 16 patients told investigators that they had been kept there “with no excuses or valid reason,” according to a police report. Acadia held all of them under laws meant for people who pose an imminent threat to themselves or others. But none of the patients appeared to have met that legal standard, according to records and interviews. Most doctors agree that people in the throes of a psychological crisis must sometimes be detained against their will to stabilize them and prevent harm. These can be tough calls, balancing patients’ safety with their civil rights. But at Acadia, patients were often held for financial reasons rather than medical ones, according to more than 50 current and former executives and staff members. © 2024 The New York Times Company

In the House of Psychiatry, a Jarring Tale of Violence

By Ellen Barry The annual gathering of the American Psychiatric Association is a dignified and collegial affair, full of scholarly exchanges, polite laughter and polite applause. So it was a shock, for those who took their seats in Room 1E08 of the Jacob K. Javits Convention Center in Manhattan, to watch a powerfully built 32-year-old man choke back tears as he described being slammed to the floor and cuffed to a stretcher in a psychiatric unit. Because the man, Matthew Tuleja, had been a Division I football player, he had a certain way of describing the circle of bodies that closed around him, the grabbing and grappling and the sensation of being dominated, pinned and helpless. He was on the ground in a small room filled with pepper spray. Then his wrists and ankles were cuffed to the sides of a stretcher, and his pants were yanked down. They gave him injections of Haldol, an antipsychotic medication he had repeatedly tried to refuse, as he howled in protest. Forcible restraints are routine events in American hospitals. One recent study, using 2017 data from the Centers for Medicare and Medicaid Services, estimated the number of restraints per year at more than 44,000. But it is rare to hear a first-person account of the experience, because it tends to happen to people who do not have a platform. Researchers who surveyed patients about restraint and seclusion have found that a large portion, 25 to 47 percent , met criteria for post-traumatic stress disorder. Listening, rapt, to Mr. Tuleja was a roomful of psychiatrists. It was a younger crowd — people who had entered the field at the time of the Black Lives Matter protests. Many of them lined up to speak to him afterward. “I still can’t forget the first time I saw someone restrained,” one doctor told him. “You don’t forget that.” © 2024 The New York Times Company

Related chapters from BN: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 15: Emotions, Aggression, and Stress
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders; Chapter 11: Emotions, Aggression, and Stress
Link ID: 29317 - Posted: 05.21.2024

Medical Mysteries: A daughter’s pregnancy and a life-or-death decision

By Sandra G. Boodman On the day after Christmas 2021, Abigail Aguilar, 18, and nearly three months pregnant, walked into her mother’s bedroom and in a flat, emotionless voice announced, “Mom, I’m going to slit my throat.” For weeks Quintina Sims had grappled with her daughter’s increasingly bizarre and frightening behavior. Aguilar had also been plagued by unremitting nausea, splitting headaches and weakness so severe her stepfather sometimes had to carry her to the bathroom. Doctors had largely brushed off her symptoms as the normal manifestations of early pregnancy. Aguilar’s threat triggered a cascade of events that would end in a hospital 130 miles south of her Kern County, Calif., home where doctors mobilized in an effort to discover what was making the previously healthy teenager so sick. After treatment after treatment failed, Sims, now 42, would be called upon to make what she called “the hardest decision of my life” — one that appears to have saved her daughter. Aguilar, who will turn 21 in a few weeks, is now working full time as a preschool teacher’s assistant and studying child development at a community college. She remembers very little of her harrowing six-week stay at Loma Linda University Medical Center, but says the months she spent recovering proved to be clarifying. “It made me realize that I had to value my life a lot more,” Aguilar said. “And I learned that my family was always going to be there for me.” An unexpected surprise In the fall of 2021, Aguilar, a recent high school graduate, was living with her grandparents in Los Angeles, working in a movie theater and going to college part time. In October, she discovered she was pregnant; the baby was due in July 2022. “It was a surprise,” she recalled. Aguilar, who was unmarried, struggled with what to do. She decided to have the baby, a decision her mother supported. “At first everything was fine,” Aguilar said.

Can Cats Increase the Odds of Developing Schizophrenia in Owners?

By Bill Sullivan Schizophrenia can produce persistent delusions, hallucinations, and disorganized thinking. The precise cause is unknown but seems to involve a combination of genetics and environmental risk factors. One environmental factor may be an infectious agent, such as the common parasite Toxoplasma gondii, which causes toxoplasmosis. Since cats can transmit Toxoplasma to humans, scientists have been investigating whether there is a link between cat ownership and schizophrenia. Many studies have tried to answer this question over the past 50 years; some studies show an association, but others do not. Researchers at the University of Queensland in Australia recently reanalyzed all these studies to determine the current consensus. What Is Toxoplasma? Toxoplasma is a single-celled parasite that infects all warm-blooded animals, including up to one-third of the human population. Cats are the only animals that support the sexual stage of the parasite’s life cycle, which culminates in the expulsion of infectious parasites in the feces. These fecal parasites are housed in sturdy containers called oocysts, which are stable in the environment for years and can spread the infection to a new individual if inhaled or ingested. In addition to litter boxes, people can pick up oocysts wherever a cat may have defecated, for example in the yard, sandbox, or garden (including unwashed fruits and vegetables). Oocysts have also made their way into streams and seawater, where they can infect people though shellfish. Up to 40 million people in the U.S. are infected with Toxoplasma. While a healthy immune system can control the parasite’s growth, it cannot get rid of the infection entirely. Toxoplasma parasites remain in the brain and other tissues as latent cysts, which can resume growth if the immune system is weakened.

It keeps people with schizophrenia in school and on the job. Why won't insurance pay?

By April Dembosky Every year, an estimated 100,000 young adults or adolescents in the U.S. experience a psychotic episode. Only 10-20% of them gain access to the holistic treatment approach recommended by the National Institute of Mental Health as the gold standard of care for early psychosis, due to lack of space or because insurance won't cover it. Illustration by Anna Vignet/KQED After M graduated from high school in California, she got a job at a fast food restaurant making burgers. Her coworkers were chatting over the fryer one day when M got a weird feeling, like somehow they knew what she was thinking. It was like her coworkers could read her mind and were discussing her thoughts with each other. "I was like, are they talking about burgers or are they talking about me?" says M, now 21. NPR has agreed to identify M by her middle initial because she fears the stigma around her mental illness could disrupt her career path. There was one coworker in particular, a guy she had a crush on, and she was pretty sure he was watching her. She suspected he hacked into her phone so he could listen to her conversations, find out where she was and follow her around. If she was walking down the street, or hanging out in the park, she saw him. Her mom remembers M wanted to sleep with the lights on, repeatedly asking her through the night, "Mom, is someone here?" One day, her mom said M got so paranoid, so scared, she locked herself in the bathroom and just screamed and screamed and screamed. Her mom wanted to call for help. But she didn't have a job at the time. This was about a year into the pandemic, and the hotel where M's mom worked had been closed since the first lockdown. When she lost her job, she lost her family's health benefits, too. "My husband was like, 'What is that going to cost?'" her mom remembers. © 2024 npr

Major Problem With Compulsory Mental Health Care Is the Medication

By Daniel Bergner If severe mental illness, untreated, underlies the feeling of encroaching anarchy and menace around the homeless encampments of San Francisco or in the subways of New York City, then the remedy appears obvious. Let’s rescue those who, as New York’s mayor, Eric Adams, says, “slip through the cracks” of our mental health care systems; let’s give people “the treatment and care they need.” It sounds so straightforward. It sounds like a clear way to lower the odds of tragic incidents occurring, like the chokehold killing of Jordan Neely, a homeless, psychiatrically troubled man, or the death of Michelle Alyssa Go, who was pushed off a Times Square subway platform to her death by a homeless man with schizophrenia. Improving order and safety in public spaces and offering compassionate care seem to be convergent missions. But unless we confront some rarely spoken truths, that convergence will prove illusory. The problems with the common-sense approach, as it’s currently envisioned, run beyond the proposed solutions we usually read about: funding more beds on hospital psychiatric wards, establishing community-based programs to oversee treatment when people are released from the hospital and providing housing for those whose mental health is made increasingly fragile by the constant struggle for shelter. The most difficult problems aren’t budgetary or logistical. They are fundamental. They involve the involuntary nature of the care being called for and the flawed antipsychotic medications that are the mainstay of treatment for people dealing with the symptoms of psychosis, like hallucinatory voices or paranoid delusions, which can come with a range of severe psychiatric conditions. © 2023 The New York Times Company

After Writing About Mental Illness, Kay Redfield Jamison Turns to Healers

By Casey Schwartz Kay Redfield Jamison arrives punctually at a towering marble statue of Jesus Christ in the entrance of the old hospital building on Johns Hopkins Medical Campus. Next to it, two guest books are left open to receive the wishes and prayers of those who pass through these halls. “Dear God please help our daughter feel better. …” “Dear Lord, please heal my grandpa and let him live happily. …” This building, decorated with rows of oil paintings of Hopkins doctors and nurses through the ages, is redolent of the history of healing. The desperate, uncertain, even heroic attempt to heal is at the center of Jamison’s new book, “Fires in the Dark: Healing the Unquiet Mind,” out on May 23 from Knopf. “If I could have subtitled it ‘A Love Song to Psychotherapy,’ I would have,” she said. Jamison, 76, her blond hair cut into a bob, wears a colorful floral dress as she makes her way through hallways filled with people in scrubs to a quiet corridor reserved for psychiatry. She is the co-director of the Center for Mood Disorders and a professor of psychiatry. Her bookcase displays her many publications: her psychobiography of the poet Robert Lowell, which was nominated for the Pulitzer Prize, and her books on suicide, on exuberance and on the connection between mania and artistic genius. And, of course, her best-known work, “An Unquiet Mind,” a memoir she published in 1995 in which she went public with her own manic depression, at considerable personal cost. Jamison had been a thriving, sporty high school senior in the Pacific Palisades neighborhood of Los Angeles until suddenly, falling into a deep depression after a mild mania, “I couldn’t count on my mind being on my side,” she said. She was bewildered by what she was going through. Her high school English teacher handed her a book of poems by Robert Lowell, who had struggled all his life with manic-depression, and with whom she felt an instant connection. That same teacher also gave her “Sherston’s Progress,” by the English poet Siegfried Sassoon. More than fifty years later, Sassoon’s book would become one of the central inspirations of “Fires in the Dark.” © 2023 The New York Times Company

Unraveling the Enigma of Schizophrenia

By Joshua C. Kendall Schizophrenia has long been understood to be among the most serious and intractable of all mental disorders. The condition typically begins in early adulthood and lasts a lifetime. Its hallmark features include hallucinations, withdrawal from social situations, and serious problems in cognition, such as a highly irrational belief system and a limited attention span. In “Malady of the Mind: Schizophrenia and the Path to Prevention,” a comprehensive history of this perplexing mental disorder from the Ancient World to the present, Jeffrey A. Lieberman argues that psychiatry has finally turned a corner in determining both what causes schizophrenia and how to treat it. “Due to the progress and success of science,” he concludes, schizophrenia is “a malady of the mind no more.” BOOK REVIEW — “Malady of the Mind: Schizophrenia and the Path to Prevention,” by Jeffrey A. Lieberman (Simon & Schuster, 528 pages). It’s a bold pronouncement to make, given that Lieberman himself admits that the history of psychiatry is filled with declarations of victory over a disorder that nonetheless continues to defy efforts to pin it down. Several once-heralded treatments — say, insulin coma therapy and ice-pick lobotomies, which were both popular in the 1940s — are now dismissed as barbaric. Likewise, while antipsychotic medications, which were introduced with great fanfare in the mid-1950s and remain today’s treatment of choice, can reduce the intensity of the most troubling symptoms for some patients, they are far from a cure. The chapters on past approaches are elegantly written and are helpful in giving context to current debates about how best to address this devastating illness.

A Link Between Hearing Voices and Hearing Your Own Voice

By Veronique Greenwood It is the rare person who likes hearing their own voice on a recording. It sounds fake, somehow — like it belongs to someone else. For neuroscientists, that quality of otherness is more than a curiosity. Many mysteries remain about the origins of hallucinations, but one hypothesis suggests that when people hear voices, they are hearing their own thoughts disguised as another person’s by a quirk of the brain. Scientists would like to understand what parts of the brain allow us to recognize ourselves speaking, but studying this using recordings of people’s own voices has proved tricky. When we talk, we not only hear our voice with our ears, but on some level we feel it as the sound vibrations travel through the bones of the skull. A study published Wednesday in the journal Royal Society Open Science attempted a workaround. A team of researchers investigated whether people could more accurately recognize their voices if they wore bone-conduction headphones, which transmit sound via vibration. They found that sending a recording through the facial bones made it easier for people to tell their voices apart from those of strangers, suggesting that this technology provides a better way to study how we can tell when we are speaking. That is a potentially important step in understanding the origins of hallucinated voices. Recordings of our voices tend to sound higher than we expect, said Pavo Orepic, a postdoctoral researcher at the Swiss Federal Institute of Technology who led the study. The vibration of the skull makes your voice sound deeper to yourself than to a listener. But even adjusting recordings so they sound lower doesn’t recreate the experience of hearing your own voice. As an alternative, the team tried using bone-conduction headphones, which are commercially available and often rest on a listener’s cheekbones just in front of the ear. © 2023 The New York Times Company

Related chapters from BN: Chapter 9: Hearing, Balance, Taste, and Smell; Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 6: Hearing, Balance, Taste, and Smell; Chapter 12: Psychopathology: The Biology of Behavioral Disorders
Link ID: 28669 - Posted: 02.15.2023

Behind New York City’s Shift on Mental Health, a Solitary Quest

By Ellen Barry BETHESDA, Md. — The psychiatrist E. Fuller Torrey is 85 years old and has Parkinson’s disease, the tremors at times so strong that his hand beats like a drum on the table. Still, every morning when he reads the newspapers, he looks for accounts of violent behavior by people with severe mental illness, to add to an archive he has maintained since the 1980s. His records include reports of people who, in the grip of psychosis, assaulted political figures or pushed strangers into the path of subway trains; parents who, while delusional, killed their children by smothering, drowning or beating them; adult children who, while off medication, killed their parents with swords, axes or hammers. Dr. Torrey, who has done pioneering research into the biological basis of schizophrenia, has used these stories in service of an argument: that it was a mistake for the United States to shut down its public psychiatric hospitals without adequate follow-up care. And that to remedy this, the government should create systems to compel seriously mentally ill people in the community to get treatment. For much of his career, Dr. Torrey was a lonely voice on this issue, disavowed by patient advocacy groups and by organized psychiatry. But his ideas are now animating major policy shifts, including the announcement by Mayor Eric Adams of New York last month that city officials would send people with untreated mental illnesses to hospitals, even if they posed no threat to others. Dr. Torrey’s influence on New York City’s policy is profound. The mayor’s adviser on this matter is Brian Stettin, who was thrust into mental health policy in 1999 when, as a lawyer in the office of Attorney General Eliot Spitzer of New York, he was asked to draft Kendra’s Law, named for a woman who was pushed in front of a subway train by a man with schizophrenia. The law allows a court to order a person with mental illness to comply with an outpatient treatment plan, risking involuntary commitment if the person refuses. © 2022 The New York Times Company

Many People with Bipolar Disorder Use Cannabis.

By Gary Stix Many people with bipolar disorder have a strong attraction to marijuana. A 2019 review of 53 studies found that almost a quarter of a combined sample of 51,756 individuals with the condition used cannabis or had a problematic pattern of consumption (cannabis use disorder), compared with 2 to 7 percent in the general population—and an earlier study placed usage estimates still higher. Cannabis and bipolar disorder do not go particularly well together. Consumption may increase manic and psychotic symptoms, and there may be a greater risk of suicide. But can the allure of cannabis be explained as a mere form of substance misuse? Why are people with bipolar disorder so attracted to marijuana? Could they be getting any possible benefit from it? Alannah Miranda of the University of California, San Diego, is a postdoctoral scholar working with U.C.S.D. psychiatry professors William Perry and Arpi Minassian to explore these questions. Miranda presented her and her colleagues’ unpublished work at this year’s giant Society for Neuroscience conference, which attracted more than 24,000 people earlier this month. She talked to Scientific American about what she discovered in this continuing study, which has been funded by the National Institute on Drug Abuse. [An edited transcript of the interview follows.] Tell me about what you’re studying. I’m researching the effects of cannabis on cognition in people with bipolar disorder. People with bipolar disorder report that it’s helping alleviate some of their symptoms in terms of issues related to memory, attention, focus and anxiety. © 2022 Scientific American,

Why Do Mental Illnesses—From Depression to Schizophrenia—Raise the Risk of Dementia?

By Claudia Wallis Age is the single biggest risk factor for dementia, with the odds doubling about every five years after age 65. But many things influence those odds for a given individual. Genetic vulnerability is a contributor, as are so-called modifiable risk factors such as smoking, cardiovascular disease, social isolation, and impaired hearing and vision. Certain mental conditions, particularly depression and schizophrenia, have also been linked to dementia. But because depression can itself be a sign of cognitive decline, the causality has been a bit muddy. Earlier this year an analysis of data from New Zealand provided the most convincing evidence to date linking many kinds of mental illness with dementia. That study raises important questions about the reasons for this increased risk and what could be done to reduce it. The study looked at the health records of 1.7 million New Zealanders born between 1928 and 1967 covering a 30-year period ending in mid-2018. It found that those with a diagnosed mental disorder—such as anxiety disorders, depression or bipolar disorder—had four times the rate of ultimately developing dementia compared with people without such a diagnosis. For those with a psychosis such as schizophrenia, it was six times the rate. Among people who developed dementia, those with a psychiatric disorder were affected 5.6 years earlier, on average. The study did not examine biological, social or other reasons for the increased risk, but research on dementia points to several possible explanations. “There might be shared genetic risk factors,” suggests psychologist Leah Richmond-Rakerd of the University of Michigan, lead author of the study. Recent studies have found some overlap in genetic markers associated with Alzheimer's disease and those linked to bipolar disorder and to major depression. Long-term use of psychiatric medications could also be playing a role in dementia, but Richmond-Rakerd and her co-authors do not think it is a major contributor. © 2022 Scientific American,

Related chapters from BN: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 7: Life-Span Development of the Brain and Behavior
Related chapters from MM:Chapter 12: Psychopathology: The Biology of Behavioral Disorders; Chapter 13: Memory and Learning
Link ID: 28391 - Posted: 07.12.2022

The Limits of Drug-Based Psychiatry

By Joshua C. Kendall About 40 years ago, Daniel Bergner’s younger brother, Bob, then 21 and a college dropout, had a psychotic break. He became delusional; he was convinced that he might be the messiah and that he could cure their grandfather’s Alzheimer’s disease. Worn down by insomnia, Bob was also neglecting his personal hygiene. Out of desperation, the brothers’ parents arranged to have Bob committed to a locked psychiatric unit, where he was soon pumped up on a heavy dose of Haldol, an antipsychotic medication. Shortly after Bob was hospitalized, their father handed Daniel a popular book by the late Ronald Fieve — first published in 1975— on mood disorders. According to this prominent psychopharmacologist, psychiatry was undergoing “a third revolution,” which was leading to new and highly effective drug cures for major mental disorders, including schizophrenia, bipolar disorder, and major depression. This book, notes Daniel Bergner in “The Mind and the Moon: My Brother’s Story, The Science of Our Brains, and the Search for Our Psyches,” gave his parents hope that his brother’s condition could be treated. “It was as if they had ingested the book’s sentences and elevated its paragraphs to articles of faith,” he writes. “They were immediate converts.” As Bergner, a contributing writer for The New York Times Magazine, emphasizes in his moving narrative, the chief claim contained in that bestseller of yesteryear — that mental illnesses are diseases for which there exist chemical cures — ended up gaining a lot of traction. But Bergner himself has long harbored reservations about such biological reductionism.

Doctors Gave Her Antipsychotics. She Decided to Live With Her Voices.

By Daniel Bergner Caroline Mazel-Carlton began hearing voices when she was in day care. Mornings, by the time she was in middle school, a bowl of oatmeal awaited her for breakfast next to a white saucer of colorful pills. Her voices remained vibrant. They weren’t within her head; they spoke and screamed from outside her skull. They belonged to beings she could not see. The voice who had been with her longest warned of catastrophes coming for her family in Zionsville, a town north of Indianapolis, calamities tied in some unspecified way to TV images from the gulf war: fighter planes, flashes in the sky, explosions on the ground, luminous and all-consuming. A woman’s voice castigated her at school, telling her that her clothes smelled and that she had better keep her hand down, no matter that she knew the answers to the teacher’s questions. Another voice tracked her every move, its tone faintly mocking. “She’s getting out of bed now; oh, she’s walking down the hall now.” Her mix of psychotropic pills shifted, expanded: antipsychotics, mood stabilizers, an antidepressant, a benzodiazepine for anxiety, a stimulant for attention deficit. The pileup of drugs was typical; people hearing voices or having other hallucinations rarely wind up on just one medication. Multiple chemicals are prescribed, often more than one similar antipsychotic simultaneously, in an attempt to quell the psyche. This article is adapted from “The Mind and the Moon: My Brother’s Story, the Science of Our Brains, and the Search for Our Psyches,” published this month by Ecco. At most, for Mazel-Carlton, the antipsychotics sometimes succeeded in reducing her voices to a wall of sound. This could feel more assaultive than hearing them separately. The antipsychotics caused obesity — 50 pounds of new weight — and the feeling that she was losing control of her forearms and her neck. Her hands quivered and seemed to want to flap-paddle the air. To the isolation caused by the difference of her mind, the drugs added isolation from severe side effects. Her agitation and self-disgust, her terror of being barely human, drove her to twist clusters of her hair around her fingers, to yank hard. Patches of bare scalp crept into view. Classmates taunted, asking why she shook and was going bald, calling her “fat-ass” and “crackhead.” © 2022 The New York Times Company

Is the Immune System to Blame for Schizophrenia?

Diana Kwon Susannah Cahalan was 24 years old when her world turned upside down. Cahalan was living a busy life as a news reporter at the New York Post when she suddenly began experiencing sensitivity to light, numbness in her limbs, and an unsettling feeling that something was not quite right in her body and her brain. One day at work, she found herself inexplicably going from crying hysterically to skipping giddily down a hall. After a seizure landed her in the hospital, her condition rapidly worsened. She started having delusions and hallucinations, believing that her father was a murderer, that she was being secretly recorded, and that she could age people using her mind. In a matter of weeks, walking, speaking, and swallowing became difficult. She eventually became immobile and unresponsive, lying in her hospital bed in a catatonic state. Despite her worsening condition, dozens of specialists from various fields—psychiatry, neurology, internal medicine—couldn’t figure out what was wrong. Numerous blood tests and brain scans failed to generate answers. To many who saw her, Cahalan’s condition looked indistinguishable from mental illnesses such as bipolar disorder or schizophrenia, in which people can experience delusions and hallucinations that make it difficult for them to distinguish what’s real and what’s not. It wasn’t until a neurologist asked Cahalan to draw a clock that the problem became clear. Cahalan had drawn all the numbers on just one side of the clock face, indicating that there was a problem in the functioning of one half of her brain. A brain biopsy confirmed what the doctor had suspected. Cahalan had anti-NMDAR encephalitis, a rare autoimmune disease in which the body produces antibodies that attack the NMDA receptor, a protein found throughout the brain. The condition had only been discovered in the early 2000s, just a few years prior to Cahalan’s diagnosis, by neurologist Josep Dalmau, then at the University of Pennsylvania. This diagnosis was much-needed good news for sufferers of the mysterious condition—their disease was treatable. After receiving immunotherapy, Cahalan was able to fully recover. © 1986–2022 The Scientist.

Researchers identify new genetic link to schizophrenia

By Lenny Bernstein Researchers have found variations in a small number of genes that appear to dramatically increase the likelihood of developing schizophrenia in some people. The interplay of a wide array of other genes is implicated for most people with schizophrenia, a severe brain disorder characterized by hallucinations, delusions and inability to function. But for some who possess mutations in the 10 genes identified in the new study, published Wednesday in the journal Nature, the likelihood of developing the disease can be 10, 20 and even 50 times greater. The discovery could one day lead to advances in diagnosis of, and therapy for, the disease, according to the lead author of the study, Tarjinder Singh, of the Broad Institute at MIT and Harvard, which led an effort that involved years of work by dozens of research institutions worldwide. “This is the biological clue that leads to better therapies,” Singh said in an interview. “But the key thing is, we haven’t had any meaningful clues for the longest time.” Ken Duckworth, chief medical officer for the National Alliance on Mental Illness, a nationwide advocacy group, said the study is an important development in the neuroscience that underlies schizophrenia. But he said it is difficult to predict how soon such basic research would pay off for people living with the disease. “This is a big step forward for science that may pay a long-term return for people with schizophrenia and the people who live with them,” Duckworth said. But, he said, “if this is a 17-inning game and they’ve gotten us from the first to the second inning, how does this help someone today?” Less than 1 percent of the U.S. population is believed to have schizophrenia, which is generally treated with an array of powerful antipsychotic medications. The disease reduces life expectancy by about 15 years, according to the new research. Scientists have long recognized a hereditary component to the disease, along with other factors such as environment. The work of isolating these genes could not have been accomplished even 10 or 15 years ago, Singh said, before the sequencing of the human genome and the spread of technology that allows such genetic detective work to be conducted in laboratories around the world. © 1996-2022 The Washington Post

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