!!! 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.