Intro To Schizophrenia Animation

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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. Its passing will not be mourned.

Today, having a diagnosis of schizophrenia is associated with a life-expectancy reduction of nearly two decades. By some criteria, only one in seven people recover. Despite heralded advances in treatments, staggeringly, the proportion of people who recover hasn’t increased over time. Something is profoundly wrong.

Part of the problem turns out to be the concept of schizophrenia itself.

Arguments that schizophrenia is a distinct disease have been “fatally undermined”. Just as we now have the concept of autism spectrum disorder, psychosis (typically characterised by distressing hallucinations, delusions, and confused thoughts) is also argued to exist along a continuum and in degrees. Schizophrenia is the severe end of a spectrum or continuum of experiences.

Jim van Os, a professor of psychiatry at Maastricht University, has argued that we cannot shift to this new way of thinking without changing our language. As such, he proposes the term schizophrenia “should be abolished”. In its place, he suggests the concept of a psychosis spectrum disorder.

Another problem is that schizophrenia is portrayed as a “hopeless chronic brain disease”. As a result, some people given this diagnosis, and some parents, have been told cancer would have been preferable, as it would be easier to cure. Yet this view of schizophrenia is only possible by excluding people who do have positive outcomes. For example, some who recover are effectively told that “it mustn’t have been schizophrenia after all”.

Schizophrenia, when understood as a discrete, hopeless and deteriorating brain disease, argues van Os, “does not exist”.
Breaking down breakdowns

Schizophrenia may instead turn out to be many different things. The eminent psychiatrist Sir Robin Murray describes how::


I expect to see the end of the concept of schizophrenia soon … the syndrome is already beginning to breakdown, for example, into those cases caused by copy number [genetic] variations, drug abuse, social adversity, etc. Presumably this process will accelerate, and the term schizophrenia will be confined to history, like “dropsy”.

Research is now exploring the different ways people may end up with many of the experiences deemed characteristic of schizophrenia: hallucinations, delusions, disorganised thinking and behaviour, apathy and flat emotion.

Indeed, one past error has been to mistake a path for the path or, more commonly, to mistake a back road for a motorway. For example, based on their work on the parasite Toxoplasma gondii, which is transmitted to humans via cats, researchers E. Fuller Torrey and Robert Yolken have argued that “the most important etiological agent [cause of schizophrenia] may turn out to be a contagious cat”. It will not.Toxoplasma gondii – likely a cause of ‘schizophrenia’, unlikely the most important. Kateryna Kon/Shutterstock

Evidence does suggest that exposure to Toxoplasma gondii when youngcan increase the odds of someone being diagnosed with schizophrenia. However, the size of this effect involves less than a twofold increase in the odds of someone being diagnosed with schizophrenia. This is, at best, comparable to other risk factors, and probably much lower.

For example, suffering childhood adversity, using cannabis, and having childhood viral infections of the central nervous system, all increase the odds of someone being diagnosed with a psychotic disorder (such as schizophrenia) by around two to threefold. More nuanced analyses reveal much higher numbers.

Compared with non-cannabis users, the daily use of high-potency, skunk-like cannabis is associated with a fivefold increase in the odds of someone developing psychosis. Compared with someone who has not suffered trauma, those who have suffered five different types of trauma (including sexual and physical abuse) see their odds of developing psychosis increase more than fiftyfold.Smoking skunk every day increases your odds of developing a psychotic disorder fivefold. Pe3k/Shutterstock

Other routes to “schizophrenia” are also being identified. Around 1% of cases appear to stem from the deletion of a small stretch of DNA on chromosome 22, referred to as 22q11.2 deletion syndrome. It is also possible that a low single digit percentage of people with a schizophrenia diagnosis may have their experiences grounded in inflammation of the brain caused by autoimmune disorders, such as anti-NMDA receptor encephalitis, although this remains controversial.

All the factors above could lead to similar experiences, which we in our infancy have put into a bucket called schizophrenia. One person’s experiences may result from a brain disorder with a strong genetic basis, potentially driven by an exaggeration of the normal process of pruning connections between brain cells that happens during adolescence. Another person’s experiences may be due to a complex post-traumatic reaction. Such internal and external factors could also work in combination.

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. The idea that schizophrenia was a single thing, reached by a single route, contributed to this conflict.
Implications for treatment

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. Schizophrenia could be like this. Indeed, it has been argued that the many different causes of schizophrenia discussed above may all have a common final effect: increased levels of dopamine.

If so, the debate about breaking schizophrenia down by factors that lead to it would be somewhat academic, as it would not guide treatment. However, there is emerging evidence that different routes to experiences currently deemed indicative of schizophrenia may need different treatments.

Preliminary evidence suggests that people with a history of childhood trauma who are diagnosed with schizophrenia are less likely to be helped by antipsychotic drugs. However, more research into this is needed and, of course, anyone taking antipsychotics should not stop taking them without medical advice. 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).Not everyone diagnosed with schizophrenia is helped by antipsychotic drugs. sylv1rob1/Shutterstock

Yet the emerging picture here is unclear. Some new interventions, such as the family-therapy based Open Dialogue approach, show promise for a wide range of people with schizophrenia diagnoses. Both general interventions and specific ones, tailored to someone’s personal route to the experiences associated with schizophrenia, may be needed. This makes it critical to test for and ask people about all potentially relevant causes. This includes childhood abuse, which is still not being routinely asked about and identified.

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 drugsnaturally 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. Such passionate advocacy is to be applauded, up to the point where people are denied an approach that may work for them.
What comes next?

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. We need to retain the benefits and discard the negatives of the term schizophrenia, as we move into a post-schizophrenia era.

What this will look like is unclear. Japan recently renamed schizophrenia as “integration disorder”. We have seen the idea of a new “psychosis spectrum disorder”. 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”. The future must be based on evidence and a conversation which includes the perspectives of people who suffer – and cope well with – these experiences.

Whatever emerges from the ashes of schizophrenia, it must provide better ways to help those struggling with very real experiences.

SOURCE:

https://theconversation.com/the-concept-of-schizophrenia-is-coming-to-an-end-heres-why-82775(accessed 27.8.17)

A lot of “Voice Hearing” isn’t an auditory experience at all

The message from recent surveys is that it’s not just people with a diagnosis of schizophrenia who hear voices in their heads, many people considered mentally well do to. This revelation may have a welcome de-stigmatising effect in terms of how people think about some of the symptoms associated with a diagnosis of schizophrenia, but a new study published in Psychosis asks us to hang on a minute – to say that one “hears voices” can mean different things to different people. You might assume that “hears voices” means that a person has an hallucinated auditory experience just like someone is talking to them. But what about hearing an inner voice that is experienced like an out-of-control thought rather than an external voice? Or a heard voice that’s not like either a thought or an external voice?

Our knowledge of the experience of voice hearing among patients has been limited by the fact that a lot of psychiatric research in this area (though not all) has been categorical in nature. For instance, a typical psychiatric scale used in research or the clinic includes a vague item like “[Patient] Reports voices than no one else hears” and a tick here can conceal a huge range of different experiences.

For the new research, Nev Jones and Tanya Luhrmann conducted in-depth interviews with 80 people diagnosed with schizophrenia in the US, India and Ghana about their first-hand experiences of hearing voices. There was great variety between participants in their descriptions of voice hearing and also within each individual participant’s own descriptions. Perhaps most importantly, while 79 per cent of the participants reported at least some limited experience of the hallucinated sound of external voices – as if someone was audibly speaking to them – a much smaller proportion (17.5 per cent) said this was their dominant experience of “voice hearing”.

The most common dominant experience for the participants was to say they had a mixture of auditory and thought-like voices – 29 per cent reported having this. Another 15 per cent said their dominant experience was to hear thought-like voices that seemed “foreign and alien” but clearly “non-auditory”. Other categories were “in-between”, being neither auditory or thought-like; “limited auditory” (an auditory experience but just simple words or sounds); “transformed”, which is when real voices or sounds were misheard as saying something different; and “multi-sensory”, involving visual experiences as much as or more than auditory – for example, one participant described how “the voice will show me all my enemies”.

Intriguingly, some participants described how a voice could begin as thought-like, but if they ignored it, then it became more auditory: “If I try ignoring them inside my brain, like they come out. They start telling me things.”

The researchers said the interviews showed there is huge variety in the ways that people diagnosed with schizophrenia hear voices, and that it is very difficult for both patients and clinicians to find ways to accurately describe these experiences. Another thing – many of the participants said that what they found most difficult about “hearing voices” was the disruption to their thoughts, rather than the sensory aspect of the experience. Indeed, by emphasising the normality of the auditory aspect of hearing voices, the researchers said there was a risk of mental health professionals presenting a “misleading view of what at least some patients are in fact struggling with”.

SOURCE:

https://digest.bps.org.uk/2016/08/04/a-lot-of-voice-hearing-isnt-an-auditory-experience-at-all/(accessed 29.8.16)

The voices heard by people with schizophrenia are friendlier in India and Africa, than in the US

When a patient with schizophrenia hears voices in their head, is the experience shaped by the culture they live in? Tanya Luhrmann and her colleagues investigated by interviewing twenty people diagnosed with schizophrenia living in San Mateo, California; twenty in Accra, Ghana; and twenty others in Chennai India. There were similarities across cultures, including descriptions of good and bad voices, but also striking differences.

In San Mateo the interviewees talked about their condition as a brain disease, they used psychiatric diagnostic terms to describe themselves, and their experiences were almost overwhelmingly negative. Fourteen described hearing voices that told them to hurt others or themselves. Eight people didn't know the identity of their voices and few described having a personal relationship with their voices.

By contrast, in Chennai, the interviewees frequently spoke of their relationships with their voices - that is, they heard the voices of relatives or friends, giving them advice or scolding them. These patients rarely used diagnostic terms, and rarely talked of voices instructing them to commit violence. Instead, distress, when it occurred, usually arose from their voices talking about sex. Nine interviewees described voices that were significantly good - in terms of being playful or entertaining.

In Accra, yet another picture emerged. Most of the interviewees here mentioned hearing God. This isn't simply a case of this sample being more religious - the interview groups in all three locations were predominantly religious. Half the interviewees in Accra reported that their voice hearing was mostly or entirely positive. Others frequently emphasised the positive. Use of diagnostic labels was rare, as were incitements to violence by voices.

Luhrmann and her team said their most striking finding was that the experiences of voice hearing in the two non-Western samples were less harsh and more "relational" - that is, patients perceived their voices as other people, who could not be controlled. The researchers believe this difference is likely due to Western cultures emphasising independence and individuality - in which case heard voices are experienced as a violation - whereas African and Asian cultures emphasise how each person's mind is interwoven with others. "We believe that these social expectations about minds and persons may shape the voice-hearing experience of those with serious psychotic disorder," the researchers said.

These results need to be replicated with larger samples matched more precisely for illness severity, and with more tightly controlled measures (the current study was deliberately qualitative and exploratory). If replicated, the findings would imply the experience of hearing voices in schizophrenia is to some extent malleable, which could have exciting therapeutic implications. Indeed, it's notable that the outcomes for patients with schizophrenia outside the West, especially in India, are known to be more positive - perhaps because of the way patients relate to their voices. "The harsh violent voices so common in the West may not be an inevitable feature of schizophrenia," the researchers said.
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Luhrmann, T., Padmavati, R., Tharoor, H., & Osei, A. (2014). Differences in voice-hearing experiences of people with psychosis in the USA, India and Ghana: interview-based study The British Journal of Psychiatry DOI: 10.1192/bjp.bp.113.139048

 

SOURCE:

http://digest.bps.org.uk/2014/07/the-voices-heard-by-people-with.html?utm_source=BPS_Lyris_email&utm_medium=email&utm_campaign=Newsletter(accessed 19.8.14)