New Hope for Patients with Treatment-Resistant Schizophrenia

That is the title of this article I am writing about. “Researchers at Northwestern University Feinberg School of Medicine have discovered a genetic biomarker that could help identify schizophrenia patients who are resistant to antipsychotic drugs (about 30 percent of all schizophrenia patients).  ‘Many treatment-resistant patients are not identified as such and are treated with mixtures of ineffective antipsychotic and other drugs, accruing little benefit and serious side effects, said Herbert Meltzer, M.D., professor in psychiatry and behavioral sciences, pharmacology, and physiology.  By definition, treatment-resistant schizophrenia patients are those who continue to have psychotic symptoms, such as delusions and hallucination, after they have completed at least two rounds of conventional antipsychotic medications.” This is hope I know a lot of people still have voices when they are taking antipsychotics medications and that is a hard pill to swallow.  If there is some way to help them it would be great.
The article goes on to say: “For the research, Meltzer, Jiang Li, Ph.D., a research assistant professor in Psychiatry and Behavioral Sciences, conducted a genome-wide association study on a group of Caucasian schizophrenia patients – a combination of both treatment-responsive and treatment-resistant patients. In the treatment-resistant group, the researchers found a mutation in the dopa decarboxylase gene, which is involved in the production of dopamine and serotonin. Certain variations of this gene have been linked to psychosis in previous studies.  Many patients who were once treatment-resistant do eventually respond to a drug called clozapine.  However, it’s usually not administered in early treatment stages due to potentially severe side effects and required weekly blood monitoring.”  They need something that works as soon as possible so they do not get discouraged with seeking treatment.  They need some kind of medication that manages their symptoms and gives them some kind of relief.
The article ends with: ‘“This biomarker can be used to easily identify patients who should be treated with clozapine, avoiding the use of drugs that are not able to help them.  This can be life-saving,’ said Meltzer, who has dedicated years to developing atypical antipsychotic drugs to help these patients.  He was the lead researcher in the landmark clinical trial that led to FDA’s approval of clozapine in 1989.  Not every patient who benefits from clozapine, however, has the specific dopa decarboxylase genetic mutation.  The researchers will work with a greater variety of schizophrenia patients in the future – particularly patients from other ethnic groups – to look for other biomarkers and treatment options for those who don’t get better with conventional treatments. ‘In a broader sense, this work defines treatment-resistant schizophrenia as a distinct subtype of the illness,’ said Meltzer.  Schizophrenia is one of the most severe and rarest of the mental health disorders, occurring in about one in 100 people. It is characterized by symptoms such as hallucinations, delusions, paranoia, cognitive impairment, social withdrawal, self-neglect, and loss of motivation and initiative.  The finding were published in the journal Schizophrenia Research.” It is finally defined as treatment-resistant.  Again we cannot lump all schizophrenics in the same category.  I just wish there were more options there just clozapine for treatment.  I do not know in my lifetime if I will ever find out everything about this disease.  I would like to also to find out why I have it and how.

Severe Mental Illness Ups Risk for Substance Abuse

That is the title of this article I am writing this blog about. “A new study finds substance abuse is higher among individuals with severe mental illness. Researchers discovered people with schizophrenia, bipolar disorder and similar conditions have a higher risk for substance use—especially cigarette smoking – and protective factors usually associated with lower rates of substance use do not exist in severe mental illness.  Studies exploring the link between substance use disorders and other mental illnesses have typically not included people with severe psychotic illnesses. Estimates based on past studies suggest that people diagnosed with mood or anxiety disorders are about twice as likely as the general population to also suffer from a substance use disorder.  Researchers used data from the 2012 National Survey on Drug Use and Health to show that close to 8.4 million adults in the United States have both a mental and substance use disorder.”  That is a lot of people that have mental illness and substance use disorder. It takes a person wanting to quit in being able too.  You have to see that not everyone always does substances and quitting only helps you to know yourself.

People do not believe by smoking it does not harm them it will only happen to someone else they will develop lung problems not me. “However, only 7.9 percent of people receive treatment for both conditions, and 53.7 percent receive no treatment at all, the statistics indicate.  Drug use impacts many of the same brain circuits that are disrupted in severe mental disorders such as schizophrenia, said, National Institute on Drug Abuse (NIDA) Director, Dr. Nora D. Volkow.  While we cannot always prove a connection or causality, we do know that certain mental disorders are risk factors for subsequent substance use disorders, and vice versa. In the current study, 9,142 people diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder with psychotic features, and 10,195 controls matched to participants according to geographic region, were selected suing Genomic Psychiatry Cohort program. Mental disorders diagnoses were confirmed using the Diagnostic Interview for Psychosis and Affective Disorder (DI-PAD) and controls were screened to verify the absence of schizophrenia or bipolar disorder in themselves or close family members. The Di-PAD was also used for all participants to determine substance use rates.”  It must be hell to live with both substance use and a mental illness.  When I was in my mental illness the farthest thing in my mind was getting high.  It was hard enough trying to figure what was going wrong with me.
The article goes on to say: “Compared to controls, people with severe mental illness were about 4 times more likely to be heavy alcohol users (four or more drinks per day); 3.5 times more likely to use marijuana regularly (21 times per year); and 4.6 times more likely to use other drugs at least 10 times in their lives. The greatest increases were seen with tobacco, with patients with severe mental illness 5.1 times more likely to be daily smokers.  The association is a concern because smoking is the leading cause preventable death in the United States.  In addition, certain protective factors often associated with belonging to certain racial or ethnic groups – or being female – did not exist in participants with severe mental illness.  In the general population, women have lower substance use rates than men, and Asian-Americans have lower substance use rates than white Americans, but we do not see these differences among people with severe mental illness, said Dr. Sarah Hartz, first author on the study.  We also saw that among young people with severe mental illness, the smoking rates were as high as smoking rates in middle-aged adults, despite success in lowering smoking rates for young people in the general population.  Previous research has shown that people with schizophrenia have a shorter life expectancy than the general population.  Chronic cigarette smoking has been suggested as a major contributing factor to higher morbidity and mortality from malignancy as well as cardiovascular and respiratory diseases.  These findings indicate that the rates of substance use in people with severe psychosis may be underestimated.  Researchers call for additional investigation to improve understanding of the association between substance use and psychotic disorders, so that both conditions can be treated effectively.   Lower life expectancy that would make me think about changing my life if I had something to live for.  I am glad that I do.  I told this story of how I was coughing pretty much when I was smoking and it did not stop until I quit.  I did it for my granddaughter not because it was killing me already.

Cognitive Therapy

What they are trying to find out in this study is whether or not cognitive therapy reduces the severity of psychotic experiences in adults who may develop schizophrenia. “…set out to determine whether cognitive therapy, combined with monitoring, is effective in preventing the development and worsening of psychotic symptoms which can lead to schizophrenia, in young adults who were actively seeking help and were considered a high risk of developing schizophrenia and similar serious mental disorders.” It would be great if it will work to lessen the severity of a psychosis. Also get help sooner the way they say you have even a greater chance for recovery.
The article says: “The 288 young people in the trial were between the ages of 14 and 35 and came from across the UK:… 114 were assigned at random to cognitive therapy and 144 to monitoring of mental state alone and were followed up for two years. Those in the cognitive therapy group had up to 26 weekly sessions over six months and all patients had access to a GP throughout the trial if they required.” That seems like a good break down of a study. They gave them access to a doctor if they needed.
It also may help people not develop psychosis. “Overall, fewer of the young people developed psychosis than expected over the next year (23/288, 8%), with no statistically significant difference between the two groups. Results show that although cognitive therapy is not effective in preventing the development of first episode psychosis for those few that transition, it does significantly reduce the severity, frequency and intensity of psychotic symptoms in this help-seeking population.” Well it does not help stop you from getting a mental illness. Although it does help the severity of the mental illness and that is also good news.

Common Destruction, Depression or Manic Depression

When suffering from bi-polar or depression alone, you tend to have episodes or mood swings, some of these moods people have are over excitation, this is with the manic phase in manic depression. The other is of hopelessness or the depressive mood and combined becomes a mixed state which can lead to outrage or irritation during a mood swing. With depression a person might feel tired, cannot concentrate, remember or make decisions. They may be restless, irritable, lack an appetite, sleep restlessly even contemplate death or attempt suicide. When looking at depression or manic depression, sadness or hopelessness reflects the person’s mood. Depression in manic depress has psychotic symptoms as well which tend to reflect a person’s mood.
In the one extreme you may think you have great wealth, or that you may be some famous individual in the crowd of friends you associate with. In another way you may think you have some special powers, either physical or magical. There is an opposite extreme, that of being depressed with a psychotic episode of which you may believe your life is going nowhere, that you are destined to ruination, that you are poor or that you have become a criminal. People with this state of mind can be wrongly diagnosed with schizophrenia which may be a cause of medicinal problems when being diagnosed for medication.
Having friends on the one hand might be easy when you’re overspending or comical or mysterious, and living with depression on the other hand leads to often extreme abuse. There is in these matters use and abuse of one’s self and depression is a trap when things don’t go your way or you can go no further. During my struggle with being bi-polar I was also diagnosed as schizophrenic, through my use of drugs and alcohol, which lifted me from a slow sleepy gait to climbing mountains. This is not literal yet I thought I was enjoying life and I had no shame with the kinds of “friends” I had, with whom I used with, how long I partied or where I slept. Yet my life, both physically and mentally were not of good health. I used more drugs as time went by drank more, slept later and later, and ignored those good people who thought they would help me as I made believe my life was to wonderful and cool. I believed I could cause the rain to fall, all of this because I felt lowly and that I would never achieve anything in life.
After many years of Rehabilitation and fighting with the medications that were used, I finally braved reality. To begin a new life meant new friends not grave diggers and it meant understanding those who knew what was right. I knew I didn’t want to end my life with drug addicts standing above me, and I knew I had a reason to keep living and believing with the faith that grew inside yet I also knew, it was not the end of the world.

Written by Donald Sammons