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.
Kinds of Schizophrenia?
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.
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.
third group was less differentiated and had less serious symptoms.
Bruce Turetsky, who led the study, suggested that this group might
be comprised of a mixture of the other two. He believes that
recognizing that schizophrenia is not a single disease entity may
help in seeking its causes, which may be different for the different
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.