Guest guest Posted March 15, 2002 Report Share Posted March 15, 2002 Adapted and modified from © 2002 Newsweek, Inc by Dr Abe Lieberman Yates, the Houston mother who drowned her 5 children, Todd Lincoln, and van Gogh all suffered from Schizophrenia. Are Schizophrenia and Parkinson Disease two ends of the same condition? Adapted from the Schizophrenic Mind in Newsweek, 11 March 2002 A popular movie, " A Beautiful Mind, " and a murder trial, Yates, bring schizophrenia to light. How can the voices sound so real? And what, if any is the relationship to Parkinson disease? WHAT IS REAL, WHAT IS IMAGINARY? The disease called schizophrenia was first described by the German psychiatrist Emil Kraepelin in the 1890s, and it remains one of the most tragic and mysterious of mental illnesses. Whether it brings the voices of heaven or of hell, it causes what must surely be the worst affliction a conscious person can suffer: the inability to tell what is real from what is imaginary. This occurs spontaneously among people who are schizophrenic. In also occurs among PD people who are on medication for their PD. To the person with schizophrenia the voices and visions sound and look as authentic as the announcer on the radio and the furniture in the room. And to the person with PD who suffers from visual not sound hallucinations, the visions are equally real. 2.5 million Americans have schizophrenia, and it is estimated that 300,000 of the 1,000,000 people with PD at one time have hallucinations related to medication. Neither doctors nor scientists can accurately predict who will become schizophrenic. The cause is unknown. Although the disease arises from neurons that take a wrong turn during development, it strikes people just as they become adults. The hallucinations of PD however, strike the elderly. Whatever the cause, it seems not to change in frequency: the incidence of schizophrenia has remained at about 1 percent of the population for all the decades doctors have surveyed it. There is a genetic predisposition, but not an omnipotent one: when one identical twin has schizophrenia, his or her twin has the disease in fewer than half the cases. Treatment is improving, but at present there is no cure. And the drugs which are helpful in schizophrenia: clozaril, geodon, risperidol, seroquel, and zyprexa are helpful in treating the hallucinations of PD. Diagnosing schizophrenia can take years. Soon after Yates confessed that she had drowned her five children, one by one, in a bathtub, the prison psychiatrist diagnosed her as having postpartum depression “with psychotic features.” So had the psychiatrist who treated Yates after her 1999 suicide attempt. Since psychosis—the inability to distinguish reality from imagination—lies at the core of schizophrenia, both psychiatrists recommended that Yates be evaluated for that disease. Dr. Resnick of Case Western Reserve University did so. Last week, taking the witness stand for the defense at Yates’s murder trial, he testified that she had a combination of schizophrenia and depression when she killed her children. In 1994, after her first child was born, she said she heard Satan’s voice telling her to “get a knife” and hurt baby Noah. If Yates’s is the face of schizophrenia—bedeviled by voices, gripped by evil forces—then Nash’s is the hidden one. As shown in the Academy Award-nominated picture “A Beautiful Mind,” the disease, at least in its early stages, can inspire leaps of creativity and insight. “That’s the paradox of schizophrenia,” says Dr. sen, professor of psychiatry at the University of Iowa. “People see things others don’t, most of which aren’t there. But because they perceive the world in a different way, they sometimes also notice things—real things—that normal people don’t.” STARING INTO SPACE Schizophrenia is marked by the persistent presence of at least two of these symptoms: delusions, hallucinations, frequently derailed or incoherent speech, hugely disorganized or catatonic behavior, or the absence of feeling or volition. If the delusions are especially bizarre, or the hallucinations consist of either a running commentary on what the person is doing or thinking, or multiple voices carrying on a conversation, then that alone qualifies the person as schizophrenic. This is similar to what many PD people experience when they develop side effects: hallucinations and delusions on PD drugs. In one subtype, catatonic schizophrenia, the patient often seems to be in a stupor, resisting all entreaties and instructions, or engages in purposeless movements, bizarre postures, exaggerated mannerisms or grimacing. A similar type of behavior may occur in some PD people who become apathetic, lethargic, and lack the energy or will to do anything. Sometimes a person with PD will sit and stare into space for hours and not think about anything. In paranoid schizophrenia, the patient becomes convinced of beliefs at odds with reality, hears voices that aren’t there or sees images that exist nowhere but in his mind. One PD person who became overmedicated was so scared that someone would place him in a nursing home, as scared as a paranoid schizophrenic, that he would barricade the door. He would eat only canned food, so paranoid was he that his care-giver was trying to poison him. He soon lost his grip on reality altogether. Yates may have had paranoid as well as catatonic schizophrenia. At the trial, ’s mother-in-law, Dora Yates, recalled the time stood transfixed in front of the television, neither moving nor speaking, for more than half an hour, as her children watched cartoons. Later, Yates told a prison psychiatrist that the cartoon characters were speaking to her, calling her a bad mother and scolding her for allowing her children to consume too much sugar. Yet even after her two suicide attempts, and even after she became nearly mute, her husband, Rusty, testified, he never suspected how severely ill she was. Neuroscientists have now traced such hallucinations to malfunctions of the brain. In a 1995 study, researchers led by Drs. Silbersweig and Stern of Cornell Medical School teamed with colleagues in London to scan the brains of schizophrenics who were having hallucinations. As soon as an imagined voice spoke, or a vision appeared, a patient pressed a button. That told the scientists when to scrutinize the scans for abnormal activity. They found plenty. When one patient reported seeing dripping colors and severed heads, for instance, the parts of the sensory cortex that process movement, color and objects became active. It is possible similar parts of the brain are activated in over medicated PD people who have hallucinations. When patients hear voices, this does NOT happen in PD people, the auditory cortex as well as the language-processing areas became active. “These regions process complex auditory, linguistic information, not just beeps or buzzes,” says Silbersweig. The voices the patients heard were therefore as real to them as the conversations in the hallways they passed through en route to the lab. Deep within the brain during auditory hallucinations, structures involved in memory (the little sea-horse-shaped hippocampus), in emotions (the amygdala) and in consciousness (the thalamus) all flick on like streetlights at dusk. That suggests why hallucinations are packed with great emotional power. Sensory signals are conveyed deep into the brain, where they link up with memories and emotions. The neuronal traffic might go the other way, too, with activity in the emotional and memory regions triggering voices and visions. Why one person sees whales and another sees severed heads remains poorly understood. But the content of hallucinations probably reflects personal experience: in one patient the neuronal pathways activated during a hallucination run through the memories of seashore visits, while in another they intersect memories of pain and terror. Yates, who has a deeply religious background, had satanic hallucinations. Thus one person heard voices telling her that she would be killed and was so convinced that “I thought I was being followed and my phone was being tapped,” she says. “There was a hole in the ceiling of my closet, and I thought there was a wire up there. I thought they had installed microphones in my eyeglasses and a dental filling.” “What’s so cruel about voices is that they come from your very own brain,” says Carol North, now a respected psychiatrist and researcher at Washington University, who first heard voices when she was 16. “They know all your innermost secrets and the things that bother you most.” North’s voices tormented her about failing a neurophysiology exam. “That was a horrible thing for me. The voices said, ‘Carol North got an F.’ They’d say things like, ‘She can’t do it [get into medical school],’ ‘She’s just not smart enough’.” At least one-third of the nation’s estimated 450,000 homeless population suffers from schizophrenia or manic-depressive illness, and 28 percent of these people forage for some of their food in garbage cans. One out of 10 prison inmates, that’s about 170,000 people, suffer from these illnesses and the majority - were not taking their medication when they broke the law. Another key brain area involved in schizophrenia is nearly silent. The Cornell/London brain-imaging study showed that schizophrenia is marked by abnormally low activity in the frontal lobes (just behind the forehead). These regions rein in the emotional system, provide insight and evaluate sensory information. They provide, in other words, a reality check. Dopamine containing nerve cells from the midbrain project to this region. “You may need a double hit to suffer the psychotic symptoms of schizophrenia,” says Silbersweig. “You need the aberrant sensory and emotional functioning, but you also need aberrant frontal-lobe function, which leaves you with no inhibition of these hallucinations and no reality check. That makes the hallucinations so believable.” The absence of a reality check makes “willing” yourself out of schizophrenia just about impossible. “It is very unlikely for somebody to will themselves to get better,” says NIMH’s Wyatt. Even among people who have had their illness for decades, and who have periods of clarity (thanks to medication), only some learn to discriminate between the voices everyone hears and the voices only they can hear. Identifying what happens in the brain during schizophrenic or dopamine caused hallucinations is one step short of understanding why they happen. The old theory that cold, rejecting mothers make their children schizophrenic has long been discredited. Although the actual cause remains elusive, scientists know a few things. The age of the father matters. A 25-year-old has a 1-in-198 chance of fathering a child who will develop schizophrenia by 21, finds Dr. Dolores Malaspina of Columbia University. That risk nearly doubles when the father is 40, and triples when he passes 50. Viruses or stresses that interfere with a fetus’s brain development also raise the risk; mothers who suffer rubella or malnutrition while pregnant have a greater chance of bearing children who develop the disease. And if there is schizophrenia in your family, you run a higher-than-average risk of developing it. Last year researchers led by NIMH’s Dr. Weinberger linked a gene on chromosome 22 to a near-doubled risk of schizophrenia. When the gene, called COMT, is abnormal, it effectively depletes the frontal lobes of the neurochemical dopamine. That can both unleash hallucinations and impair the brain’s reality check. The seeming authenticity of the voices means that people with schizophrenia can be barraged by commands that, they are convinced, come from God or Satan. That inference is not illogical: who else can speak to you, unseen, from inside your head? Some patients have heard commands to shoplift, some to commit suicide. Believing she was possessed by Satan, Yates thought that her children “were not righteous.” If she killed them while they were young, she told a psychiatrist, then “God would take them up” to heaven. Legally, “insanity” means the inability to tell right from wrong. There is no evidence that people with schizophrenia have impaired moral judgment. Then why do some obey commands to break the law, or worse? Perhaps one need look no further than Joan of Arc who obeyed the voices that asked her to overthrow the English. Or to look at Genesis 22. When Abraham heard God’s command to sacrifice his only son, Isaac, he did not hesitate to take the boy up the mountain to the place of sacrifice and raise the knife. There is, as yet, no cure for schizophrenia, for drugs cannot unscramble tangled neuronal circuits. But drugs can quiet them. Those that give rise to the delusions and hallucinations of schizophrenia are awash in the neurochemical dopamine. Thorazine, an early antipsychotic, blocked dopamine receptors, with the result that dopamine had no effect on neurons. But since dopamine is also involved in movement, Thorazine leaves patients slow and stiff, “doing the Thorazine shuffle,” says Suzanne Andriukaitis of NAMI. Dopamine also courses through circuits responsible for attention and pleasure, so Thorazine puts patients in a mental fog and deadens feelings. “The old drugs are a nuclear weapon against dopamine,” says Dr. Weiden of Downstate Medical Center in Brooklyn, N.Y. “They eliminate your sense of pleasure and reward. Patients lose their joy.” The new antipsychotics, called “atypicals,” are more like smart bombs. Drugs including Clozaril, Geodon, Risperdal, and Zyprexa, target mainly the dopamine-flooded regions, so patients no longer feel as if the voices of 40 radio stations are blaring in their ears. “The volume is softer, the speed is slower, it’s making more sense,” says Donna Willey. Although the voices and visions don’t always disappear, the new drugs can allow people with schizophrenia to hold jobs and have families. Still, they increase appetite, and may alter metabolism, resulting in what NIMH’s Wyatt calls “the enormous problem” of huge weight gain. Willey gains 20 pounds a year on one drug and has ballooned from 120 pounds to her current 280. That makes some reluctant to take the drugs. Another side effect is foggy thinking, the feeling that brain signals are trying to push through caramel. Patients may also lose their libido. For all the power of the new drugs, they are treatment and not cure. But as our understanding of the brain grows the visual and auditory hallucinations of schizophrenia and the visual hallucinations and delusions of dopamine drugs will be overcome. adapted and modified from © 2002 Newsweek, Inc by Dr Abe Lieberman ______________________________________________________________________ Find, Connect, Date! http://personals.yahoo.ca Quote Link to comment Share on other sites More sharing options...
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