!!! Need help on schizophrenia please !!!

[Michalchik]

First let me say that I am not a doctor just 
a scientist that has been following the 
liturature and attending some conferences. I 
have a few brief things to say about the 
issues that concerned you.

It is unusual to get a dual diagnosis of 
schizophrenia and manic depression. If I were 
you I would be concerned that the doctors who 
diagnosed your sister are confusing the 
psychotic symptoms that frequently accompany 
the severe phases of depresion and mania with 
schizophrenia. Delusions and hallucinations 
are not too unusual when a person is severely 
manic or depressed. If your sister is only 
bipolar and not schizophrenic the 
anti-psychotic medications are unlikely to do 
her much good, but she may still have many of 
the more dangerous side effects. There are 
many incompetant doctors out there try to 
find someone doing research in the field. I 
have generally been favorably impressed with 
the people I have met from NIH. Hope that she 
is just bipolar, though this is an extremely 
serious disease that can kill people and ruin 
lives, it is more treatable than 
schizophrenia. 

As far as short term medical treatment for 
these diseases, I have to say that though I 
perfectly understand your desire for this and 
have voiced the same desire myself when I 
have talked to people in the field, this 
desire is a VERY dangerous one. There have 
been several studies where patients that 
responded well to medication and seemed to 
loose their symptomatology were weened off 
their medication either on doctors advice or 
by the patients own doing. The results were 
often disasterous; so bad in fcat that there 
are several law suits pending based on the 
claim that the patients were never told how 
dangerous going off medication was. Usually 
there were severe relapses that happened 
after a short but unpredictable time after 
the medication was discontinued. These 
relapses often were the worst that the 
patient ever experienced. Much more 
frightening was the fact that medication 
often seems to loose its effectiveness if the 
relapse occurs; High functioning medicated 
patients were turned into severely mentally 
ill people that had to be institutionalized 
and will likely spend the rest of their lives 
in their own private hell. NEVER, NEVER, 
NEVER allow a bipolar or schizophrenic to go 
off their medication because they feel well. 
It is the medication that is allowing them to 
feel well and if they stop they may never 
feel well again!

	Should they take medication in the first 
place? Both Schizophrenia and Bipolar 
disorder almost always get worse with time. 
The longer they go untreated the harder they 
generally are to treat. Think of it like 
this. The brain is a learning device and I 
learns to be sick as well as learning useful 
things. Diseases such as post-traumatic 
stress disorder are examples of the brain 
overlearning an emotional response. Brains 
can also learn to think disorganizedly or can 
learn severe mood swings. Give a brain time 
off medication for bipolar disorder, 
schizophrenia, epilepsy, etc... and you allow 
it to learn more amd more profound ways to be 
sick. Treat-early and treat consistantly 
seems to be the way for these three 
disorders. I wish I could tell you otherwise. 
I would like it to be so.

You are probably wondering why these diseases 
are incurable and require life long 
treatment. We can't say for sure because we 
don't know for sure why these diseases occur. 
There is mounting evidence that schizophrenia 
is the result of congenital brain damage. 
Schizophrenic brains often seem to ahve 
shrinkage in critical areas related to memory 
and cognition. One theory that I favor but 
thatis not widely accepted in the field is 
that ceratin peopl have a genetic 
susceptability to damage to these areas from 
either flu viruses or environemtal toxin 
while the brain is developing in utero. This 
damage is subtle and does not result in a 
severe problem until the brain fully matures 
in early adulthood. In early adulthood long 
association pathyways are completed that 
allow a person to weigh the full emotional 
impact of major life events and decisions. 
Basically in adulthood the brain learns to 
cooperate on a large scale to deal with 
complex life decisions. If part of the system 
is damaged and a major life stress comes 
along the damaged area can get overloaded and 
fail to organize critical information. (it is 
just pushed beyond its limits). The rest of 
the brain is disrupted by the torrent of 
faulty information and you get an ugly 
situation of garbage in garbage out in a 
feedback loop. The antipsychotic drugs may 
cool down the information flow enough for the 
damaged areas to keep pace. Since the brain 
is constantly learning the disease will 
progress if untreated because the brain 
learns the faulty patterns of information 
flow perhaps also there is additional growth 
of long association pathways. I have some 
problems with this theory, but I think it is 
adequate for now as a working hypothesis.

	Bipolar disorder is even more mysterious but 
seems to involve something to do with the 
regulation of calcium and magnesium in the 
body, the brains response to stress hormones, 
and the regulation of neurotransmitters over 
long time scales. There is probably some 
genetic disorder in metabolism that causes 
the persons body to respons abberently to 
stress and causes a series of uncontrolled 
mood swings. Since the underlying disorder is 
a biochemical one there is no permanent way 
to fix it currently and if there was it may 
not be worth the trouble. Similarly in 
schizophrenia the trouble is probably 
underlying brain damage in a very 
sophisticated part of the brain. we may never 
know how to fix such damage.

	The good news is that treatment of these 
disorders is improving. there are a variety 
of medications available for both disorders 
that in skilled hands are effective and have 
aminimum of side-effects. For Bipolar 
disorder in addition to lithium there are 
other drugs such as verapamil and valproic 
acid that have been shown to be effective in 
most cases where lithium is not. The 
depressive phase of the disease can be 
treated with anti-depressents like prozac. 
For schizophrenia the current treatments are 
more limited and less effective, but we are 
literally on the brink of some major 
breakthroughs with drugs that are specific 
antagonists to D4 and D3 receptors. These 
drugs will be able to treat the hallucination 
and delusions without causing the movement 
side-effects that traditional drugs like 
halperidol do, and also the D3 antagonists 
should be able to treat the apathy and 
disorganization that many schizphrenics seem 
to experience. we do not really know how 
these drugs work but they will be a big 
improvemnet over the previous generations 
because of their specificity and strength.

I would also make sure that the doctors have 
ruled out any possibility od a metabolic 
disorder, liver disease, vitamine deficiency, 
throid problems , and blood sugar 
abnormalities can all cause some symptoms 
that look like these disorders.

You might also check out the Huxley institute 
in Florida (boca raton I think). They are 
alternative medicin people who claim that 
these disorders are caused by vitamine 
deficiencies. I think that that is a crock of 
shit but they may have found some vitamines 
that may help to correct some of the 
metabolic components of these disorders. 
Vitamines in high doses act like drugs. If 
you get the right ones they may help some 
without hurting. Don't be sucked into the 
idea that they have all the answers though 
modern medecin does alright with these 
disorders and you'll be taking a foolish 
gamble with your sisters life if you abandon 
it. If the doctors that you are seeing don't 
get good result or don't seem to be listening 
to your concerns they are probably bad 
doctors and I would find somebody else. Don't 
put much weight in reccomendations. Doctors 
who are at the top of their field are often 
there because they kissed ass correctly not 
because they are brilliant. Also nobody 
dislikes the doctor they go to because 
everybody wants to believe they are getting 
the best care. Go to a doctor who seems to be 
actively up on the liturature, is not 
threatened by tough questions, and seems to 
care about what happens to your sister. Don't 
get second opinions by having your doctor 
reccomend some one. Ask your insurance 
company for reccomendations or better yet go 
to your local library and have the librarian 
help find you a list of specialists in your 
area.

	Finally, especially if your sister is 
schizophrenic, talk therapy (conversations 
with a psychiatrist where you talk about your 
life and tried to figure out what went wrong) 
is BAD. There have been several clinical 
studies that show that talk therapy makes 
schizophrenia worse!. I do not know about its 
effectiveness is bipolar disorder but I 
suspect it is a waste of money that will just 
piss your insurance company off. Any 
psychiatrist that tries to drag your sister 
into a series of long therapy sessions is 
proabaly ignorant or dishonest. for 
schizophrenics the best thing seem to be 
properly tailored medication and leading as 
normal and low stress life as possible. this 
is probably also a good perscription for 
bipolar disorder though I have not seen 
studies on this. Keeping levels of stress low 
is almost certainly helpful for both these 
mental disorders, but don't start 
condescending to her or you'll damage your 
relationship. I also suggest that you try to 
take care of yourself contact support groups 
in your area. You can find them through your 
local library and they may be able to help 
you in many ways.


Jeremy Winterson <J.Winterson at rhbnc.ac.uk> 
wrote:
>Hi
>
>My sister has been diagnosed as a schizophrenic and manic depressive.
>She hasn't always been this way... at least not the schizophrenia... and
>it just seemed to happen over a period of a few terrible weeks or so. 
>In the end she was diagnosed with both schizophrenia and manic depression
>and is recieving medication. Problem is that apparantly she will be on
>medication for the rest of her life. Is this really the case? Is there
>nothing she can take as some sort of therapudic drug? Will she be in a
>danger of remission? I realise it is inthe interests of medical companies to 
>develop drugs that the patient will rely on for the rest of his or her life 
>and therefore was wondering if there was some sort of other drug that she 
>could be taking. 
>Could you please e-mail me if you have any info.
>Thanks in advance,
>                  Jeremy


-------------- next part --------------
From: Jeremy Winterson <J.Winterson at rhbnc.ac.uk>
Newsgroups: bionet.neuroscience
Subject: !!! Need help on schizophrenia please !!!
Date: 12 May 1995 17:03:35 GMT
Organization: Royal Holloway, Univ of London
Message-ID: <3p04d7$7qr at sun.rhbnc.ac.uk>

Hi

My sister has been diagnosed as a schizophrenic and manic depressive.
She hasn't always been this way... at least not the schizophrenia... and
it just seemed to happen over a period of a few terrible weeks or so. 
In the end she was diagnosed with both schizophrenia and manic depression
and is recieving medication. Problem is that apparantly she will be on
medication for the rest of her life. Is this really the case? Is there
nothing she can take as some sort of therapudic drug? Will she be in a
danger of remission? I realise it is inthe interests of medical companies to 
develop drugs that the patient will rely on for the rest of his or her life 
and therefore was wondering if there was some sort of other drug that she 
could be taking. 
Could you please e-mail me if you have any info.
Thanks in advance,
                  Jeremy