Psychiatric Diagnosis and Genetics

An interesting piece by Vaughan Bell of Mind Hacks. He notes that recent studies in medical genetics tend to undermine the foundations of some psychiatric diagnoses. At Mind Hacks he summarizes as follows:

The “mental illness is a genetic brain disease” folks find that their evidence of choice – molecular genetics – has undermined the validity of individual diagnoses, while the “mental illness is socially constructed” folks find that the best evidence for their claims comes from neurobiology studies.

And here’s a snippet from the Observer piece he wrote, well worth a read:

This new realisation rests on evidence that genetic factors initially associated with, for example, schizophrenia have now been recognised as equally important in raising the risk for several other problems including epilepsy, attention deficit disorder, autism and learning disability.

If you speak the language of science, there’s also a link to a British Journal of Psychiatry review article on the topic:

There is accumulating evidence for shared genetic as well as environmental risk between intellectual disability and other conditions with a neurodevelopmental basis such as autism, attention-deficit hyperactivity disorder, epilepsy and schizophrenia. These can be conceived as lying along a continuum of genetically and environmentally induced neurodevelopmental causality.

As usual, not suggesting diseases such as schizophrenia don’t exist — but our understanding of their causes is far from complete. And of course, DSM-V (Diagnostic and Statistical Manual of Mental Disorders) is slated to come out this May 2013.




Is that Schizophrenia or a Schizophrenic?

The all powerful receptor. Harold Maio quotes one participant’s part of the New York Times Freakonomics piece on the progress of psychology and psychiatry:

“It works by binding to certain receptors in the brain, and if you give it to “schizophrenics,” many of them stop their otherwise full-blown hallucinations.” Until the practice of referencing people as diseases ends, psychiatry will continue to fail. “schizophrenics,” indeed!!

Schizophrenia or schizophrenic — what’s the difference?
The source of Maio’s indignation might be lost on some. What he is sorely rejecting to is the objectification of the patient. Rather than “schizophrenic,” I am quite sure he would prefer “the patient suffering from schizophrenia.” What’s the big difference? The former, schizophrenic, implies an outcome, foreclosure, even worse — an identity.

The latter implies a process, with a number of symptoms that come and go, it also implies that there’s a person in there! No doubt — schizophrenia is a lifelong condition that requires medication, management, and psychotherapy, but to be a “schizophrenic” sounds like a life sentence rather than a lifelong condition. Please take a look at Elyn Saks’ book on this topic. (She manages to graduate from Oxford and teaches law at USC, all while having a diagnosis of schizophrenia.)

The objectification reminds me of a New Yorker story about medical training. At a certain point in his training the writer recounted that he and his colleagues starting referring to the body parts of the people they were treating, rather than the people themselves. “You should see the liver in room 18!”

As clinicians we can never lose sight of the fact that we are treating human beings with human problems, and there is not so much separating them from ourselves.

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Kalea Chapman, Psy.D.

Antipsychotics as the New Antidepressants

In case you were skeptical of the April 2 post. Here’s Furious Seasons (April 4 entry) with a quote from the maker of Seroquel describing it as an antidepressant.

A bizarre incident in Mississippi: a middle school student gave the antipsychotic Seroquel to several friends, the friends took the drug, the students began acting oddly, the students were taken to a hospital, and the student who gave them the drug is in big trouble.

Then this from a press account:

“Seroquel is an antidepressant drug used to treat manic depression, schizophrenia and bipolar disorder, according to the Web site”Where the hell does AstraZeneca get off describing the drug, which is not approved for depression, as an anti-depressant? The drug is approved for bipolar depression, but it’s most common use is as an antipsychotic, shut-people-up drug. If it’s an anti-depressant, then I am Zeus.

Kalea Chapman, Psy.D.

Functioning with Schizophrenia

The Yale Daily News ran a February 29 story on Elyn Saks whose recent memoir The Center Cannot Hold: My Journey Through Madness. Time magazine voted it one of the top ten best non-fiction books of 2007. One of the interesting aspects of the story is Saks’ crediting of her psychoanalysis as being critical to her management of her schizophrenia. While schizophrenia is currently viewed as a brain disease (medical model), that does not mean that it is not amenable, in part, to psychotherapeutic intervention. Bertram Karon, for one, has written about this mode of treatment. Saks has spoken explicitly about the importance of her psychotherapy treatment. She has also spoken about her humiliating experiences on psychiatric wards.

Here’s an excerpt from the story:

Saks said the initial symptoms of her condition began appearing around age six or seven, when she started to experience phobias, obsessions and night terrors. Her teen years brought a bout with anorexia and drug use that landed her in a daytime rehabilitation program, she said. Then she began hearing thoughts in her head that were not her own.

“It was as if my mind were a sand castle and all the sand were sliding away,” she said.

After graduating first in her class from Vanderbilt University, Saks began studying philosophy at Oxford on a Marshall Scholarship. That is when she really broke down. Stricken by depression and paranoia, the five-foot-ten Saks shriveled to 95 pounds, and she fantasized about dousing herself with gasoline and lighting herself on fire. Continue reading Functioning with Schizophrenia