Healthinmind/News

Notes on Schizophrenia

A recent issue of Discover magazine reports a startling new finding on one risk factor for schizophrenia. Dr. Dolores Malaspina studied records kept in Israel since 1950 and discovered that children born of fathers who were 50 to 54 years old were 2 1/2 times as likely to become schizophrenic as children born of fathers in their late twenties. The reason probably is that the precursors to sperm cells divide about 23 times per year, for a total of 663 times by the time a man is 40 years old. Every division offers a chance that a copying error will be made. One possible effect of such genetic errors is an increased possibility of becoming schizophrenic in environmental circumstances that act as triggers. In the Israeli data the probability of becoming schizophrenic by the age of 34 was 1 in 47 for children of the older fathers, but only 1 in 121 for children born to men in their late twenties. 

Two recent reports comparing the effectiveness of typical drugs for treating schizophrenia (chlorpromazine is the classic example) with atypical drugs (clozapine is the best-known) reached different conclusions. A November report in the British Medical Journal covered 52 clinical trials, and concluded that the typical antipsychotics should be tried first because the atypical antipsychotics neither controlled symptoms better nor were better tolerated. However, the authors did say that the atypicals produced fewer side effects. The second study was a direct comparison of clozapine with chlorpromazine for the treatment of people who were diagnosed for the first time with schizophrenia. Clozapine acted faster and produced fewer side effects. The authors clearly prefer clozapine for treating people with their initial diagnosis of schizophrenia. However, clozapine is over 10 times more expensive than chlorpromazine, and is restricted to 2nd- or 3rd-line treatment in the United States because it suppresses the immune system's white cells in about 1% of patients. For that reason, the study was conducted in China, where this restriction does not apply. Further research on five atypical antipsychotics is under way. These findings were presented December 11, 2000, at the Annual Meeting of the American College of Neuropsychopharmacology. An interesting additional finding of the study was that patients whose blood showed indications of the presence of the parasite, toxoplasmosis, did not respond well to treatment. The authors suggest that treatment in these cases might include both antipsychotic and antiparasitic medication.

A study of the brains of 37 patients with schizophrenia and 31 healthy volunteers was led by Dr. Tonmoy Sharma at Maudsley Hospital in London. The researchers used magnetic resonance imaging (MRI) to detect significant differences in the brains of the two groups. Such differences have been found in previous studies, but this study was unique because the patients were undergoing their first episode, so the differences could not have been caused by taking antipsychotic medication or as a consequence, rather than the cause, of the schizophrenia. Although there is as yet no clue as to what causes the observed differences in the brain, the study opens up the possibility that MRI could be used to predict and perhaps even prevent schizophrenia. The study was reported in the November issue of the American Journal of Psychiatry. 

Three Kinds of Schizophrenia?

An article published in the October, 2002, issue of Neuropsychology contains evidence that schizophrenic patients fall into one of three classes. The first type has problems maintaining attention, and organizing and expressing thoughts coherently. Most people in this group are male with an early disease onset. Brain scans indicate that they have problems in the temporal lobes in the cerebral cortex, areas particularly important for language.

The second group appears to have problems in subcortical areas in the frontal-striatal region, which affects both thought and action. They had scattered deficits in gray matter in these regions, and the fluid-filled central areas of the brain were enlarged.

Help for Tardive Dyskinesia

A small study led by Dr. Eyal Shamir, reported in the Archives of General Psychiatry, gives some hope that the seriousness of tardive dyskinesia can be decreased by taking melatonin. Although tardive dyskinesia is less likely to be a side effect of the newer antipsychotics than it was of the traditional antipsychotics, it continues to be a concern. Unfortunately, the observed improvements were relatively small, but it is possible that a longer course of treatment or larger doses of melatonin would produce better results. Melatonin is an antioxidant, and these tentative results suggest that other antioxidants might also be worth examination in future research.