Revisiting Schizophrenia – A Synopsis




shutterstock_168957980

On Brain Blogger there is clearly an avid interest in this particular disorder. This article provides a synopsis of a recent Medscape review, regarding our current state of knowledge. I encourage all who are interested to peruse the original resource.

The following are consensual clinical guidelines regarding the use of neuroleptics – otherwise known as antipsychotics.

  1. They are prescribed only for persons who are clearly psychotic, i.e., delusional, hallucinating or manic.
  2. When prescribed they are to be monitored very closely.
  3. There are very few indications for using two or more of them at the same time.
  4. They are not a first-line intervention for persisting insomnia.
  5. They are not to be used solely for “behavioral dyscontrol” in kids of the elderly.
  6. Finally, there is some clinical evidence for use in those with autism. However, this conflicts with other best practices which I have reviewed, and conflicts with my own clinical judgment.

Given the gradual and wider acceptance of the medical/clinical use of marijuana, it is clearly contraindicated for those who already posses a vulnerability to psychotic states. In fact, so-called “Spiceophrenia” accelerates pre-psychotic conditions and renders clinical care to be more challenging. This evidence is firmly established.

In regards to etiology or pathogenesis, this disorder is deemed to be multi-factorial in causation and expression. Much of what we think we know about it remains largely theoretical with little clinical substantiation.

And finally, regarding bio-medical interventions such as electroconvulsive therapy (ECT), transmagnetic stimulation (TMS), psychosurgery, and gene therapy, there is little or no support of their efficacy. Most behavioral health disorders are thought to be poly-genetic and quite heterogeneous in their expression and treatment.

In summary, we still have a very long way to go in clinically managing schizophrenia in a safe and effective manner.

Reference
Stetka, B. (Jan 6 2014). 7 Advances in Schizophrenia. Medscape.

Image via patrice6000 / Shutterstock.

  • http://jochesh00.wordpress.com herb wiggins

    IN terms of understanding schizophrenia, there appears to be a connection to it in many cases with a dominantly inherited gene, with variable penetrance. Surprisingly, this gene also seems to be the same, or nearly so for what has in some, lead to a bipolar disorder. Now we have two braind disorders within the specific genetically influenced disorder to compare to each other.

    It’s very simple. Mania may be a short term psychotic break of a milder, less sustained nature than schizophrenia. & it makes sense, because of the delusional states we see in mania, as well as the partial signs of psychosis, too.

    Similarly, we find a great deal of depression in schizophrenia. It’s not just situational, but might well be a cycling depressive disorder like its near twin, the bipolar disorder. Most have considered that the depression of schizoprenia to be situational, because the dreadful social consequences of psychosis. But is it all that? There are many, many suicides among the psychotic. We may need to rethink bipolar disorders and schizophrenias.

    There is more to understand, as you so cogently state, but we still have much to learn about the major emotional disorders.
    & how long term memory and stable behaviors within thoes two parameters may make many of them more resistant to treatment.

    Consider looking at Ibogaine, for some new insights into treating personality disorders.
    Herb

  • Gabby

    And I quote:

    In the first half of the 20th century schizophrenia was considered to be a hereditary defect, and sufferers were subject to eugenics in many countries. Hundreds of thousands were sterilized, with or without consent—the majority in Nazi Germany, the United States, and Scandinavian countries. Along with other people labeled “mentally unfit”, many diagnosed with schizophrenia were murdered in the Nazi “Action T4″ program.

    In the Soviet Union the diagnosis of schizophrenia has also been used for political purposes. The prominent Soviet psychiatrist Andrei Snezhnevsky created and promoted an additional sub-classification of sluggishly progressing schizophrenia. This diagnosis was used to discredit and expeditiously imprison political dissidents while dispensing with a potentially embarrassing trial.[39] The practice was exposed to Westerners by a number of Soviet dissidents, and in 1977 the World Psychiatric Association condemned the Soviet practice at the Sixth World Congress of Psychiatry.[40] Rather than defending his claim that a latent form of schizophrenia caused dissidents to oppose the regime, Snezhnevsky broke all contact with the West in 1980 by resigning his honorary positions abroad.

    Shock therapy has been in use in asylums since the early 1930s. The earliest form shock therapy, insulin therapy was invented by Manfred Sakel in 1933 as one of the first treatments that involved inducing comas or seizures. Sakel first tested his treatment on “addicts” and “neurotics,” and seeing some improvement in their condition reasoned that it might be a viable treatment option for patients with schizophrenia. Sakel recorded that “the convulsions and comas of the deep shock brought about dramatic psychological changes in the patient. . .the indications were rather that the physiological shock restored the homeostasis in the nerve cell by forcing it to mobilizing its defence reactions, thus causing a restoration of the balance in the automatic nervous system. . .In this, [he] thought, lay the curative efficacy of the Insulin Shock Treatment.”

    In 1939, the former London Asylum opened its Metrazol clinic. Metrazol replaced insulin therapy in most of the Ontario asylums as it was easier to administer than insulin shock. Metrazol was first used in clinical experiments by Hungarian physician, Ladislaus von Meduna in 1933. Meduna reasoned that artificially induced epileptic convulsions might “cure” schizophrenia due to his observations of patients who had both epilepsy and schizophrenia. Meduna noticed that those patients who had epileptic seizures would experience a remission of their symptoms of schizophrenia. Metrazol was one of many convulsant drugs used to induce seizures. The Asylum began to phase out its use in 1943, turning instead to electroconvulsive therapy. —–

    Schizophrenia is not a personality disorder, epilepsy, ptsd, associated with Alzheimer’s or Dementia, a nutrition deficiency, mercury or led poisoning, due to vaccinations, and still unproven to be genetic in nature.

    It is a terrible “sickness”, and it tends to ebb and flow with the evolution or de-evolution of our population, whether or not u believe in unity or think humanity is a group of individuals who don’t need to fit into a square someone else drew before them.

    • http://jochesh00,wordpress.com herb wiggins

      http://www.ncbi.nlm.nih.gov/pubmed/7034192
      This documents, among many other scientific/medical references within, some of the genetics of some paranoid schizophrenias. It can be traced back in some families for as long as there are records, even into the 17 & 18th C. I have seen 3 instances of this, for example. It’s often genetically loaded, which is why a good many persons will not marry individuals with paranoid schizophrenia in their families.

      When persons can reference clear cut scientific references, let them do so. When they cannot, res ipsae loquitur.

      It’s also highly variable. For instance when one of a pair ID twins have a single case of it, the odds are only 50% the other twin will get it. That’s still 100 times the ~1/2% incidence in many populations. It’s very likely a dominantly inherited trait with incomplete, highly variable penetrance. IE., many may carry the gene, yet have no signs or symptoms of it at all. This can create the illusion of no genetic loading. This, too, is commonly seen in AODM Type II. That’s largely confirming evidence of its genetic loading. Alzheimer’s and Parkinson’s conditions my also be genetically loaded, but not always.

      In these days with much schizophreniform illnesses being created by amphetamines, cocaine, androgenic steroids, PCP, among others, it’s been harder to see this genetic loading.

      Professionally writing,
      Herb W. (Diplomat, American Board of Psychiatry/Neuro.

Richard Kensinger, MSW

Richard Kensinger, MSW, has over forty years of clinical experience in behavioral healthcare as a psychotherapist, trainer, consultant, and faculty member in the Psychology Department, Mount Aloysius College. He has also taught at Penn State, University of Pittsburgh, and Temple University. He is also a lover of "football", known in the USA as soccer. He is currently associated for over 30 years with youth "football", 26 as a referee.
See All Posts By The Author

Do not miss out ever again. Subscribe to get our newsletter delivered to your inbox a few times a month.