Schizophrenia: A Handbook For Families

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Research: The Hope For Tomorrow

Less research is done on schizophrenia than on any other major disease, given both the human and the financial burden that this illness imposes.

Most research conducted until the end of the Second World War was biological, after which there was an interlude of 10 to 15 years when psychiatry based its attempts to understand and to treat mental illness on the study of human behaviour. This approach led to the development of psychoanalytic techniques. This treatment, as noted earlier, is not effective for patients with schizophrenia.

Modern research into the biological causes of the disease began with the introduction of the neuroleptic drugs in the 1950s. This brought about a change in the direction of research on schizophrenia and its possible causes from the behavioural to the neurochemical. It is now largely accepted that the symptoms of the disease arise from a failure of the chemical processes in the brain to function properly. Today, the primary thrust in research on schizophrenia is to discover the reasons for this.

Research expenditures on schizophrenia still lag far behind those on other serious illnesses. Research interest in this mental disorder has, however, increased greatly throughout the world in recent years. Scientists now perceive a much wider range of opportunity in the search for answers about schizophrenia and other neurological illnesses (diseases affecting the nervous systems) than before. Torrey has noted that "we are in the midst of an explosion of knowledge in the neurosciences and its effects are spilling over to schizophrenia." (Surviving Schizophrenia, p. 129).

New Resources

Brain Tissue Banks
Brain tissue banks have been established to provide researchers with brain tissue for the study of neurological diseases, including schizophrenia. The Canadian Brain Tissue Bank is located in Toronto and is managed by the Canadian Neurological Coalition. (See Appendix II for a description of the work of the Brain Tissue Bank and how brains may be donated for research.)

Imaging Facilities
Research in the fields of neurology and biochemistry is greatly benefiting from the development of new brain imaging techniques that allow researchers to observe brains in living human beings directly. Brain investigations are no longer limited to the use of brain tissue from the deceased. (Appendix III gives a brief description of the different types of imaging.)

Basic Science Laboratories
The way in which neuroleptic medication affects dopamine receptors in the brain and reduces their ability to receive messages from the neurotransmitter dopamine, as explained earlier in the handbook, has led to a growing body of research on the dopamine system. Dr. Philip Seeman of the University of Toronto has been in the forefront of research in this area. Through his efforts and those of others, a picture of how neuroreceptors interact is gradually being clarified.

Among other benefits, this work promises significant improvement in the kinds of medication available for the treatment of schizophrenia in the near future.

One such medication, known as Clozaril (Clozapine), was introduced in 1989 in the United States, and is currently awaiting approval for its widespread use in Canada by the Health Protection Branch of the Department of National Health and Welfare. Known to be effective in treating cases that are resistant to other types of anti-psychotic medications, Clozaril also appears useful in the treatment of the negative symptoms of schizophrenia and the lowering of many side effects commonly caused by neuroleptics, such as stiffness and strong spasms of the eyes, neck and back. Because Clozaril has been linked with the reduction of white blood cells necessary to combat disease, careful consideration is required before the drug is accepted as a standard neuroleptic.

Genetic Laboratories
In the field of genetics it has long been known that members of families who have a history of schizophrenia have a greater likelihood of becoming ill with this disease. The closer the family relationship to someone with schizophrenia the higher the degree of risk. A great deal of attention is now being given to the role that our genes play in neurological illnesses. In many diseases, scientists have undertaken major work to find the faulty gene or genes responsible for such illnesses. Success has been achieved in a number of diseases. A recent example is the discovery of the defective gene responsible for cystic fibrosis at The Hospital for Sick Children in Toronto.

Well-publicized observations by Drs. Bassett and Jones at the University of British Columbia led to the identification of a chromosome 5 abnormality in an uncle and his nephew. Both suffer from schizophrenia and both have several identical physical abnormalities. Based on the Bassett and Jones findings, research has been conducted on a number of British and Icelandic families with a history of schizophrenia in several generations. Drs. Gurling and Sherrington of the University of London found that the chromosome 5 segment identified by Bassett and Jones seemed to be crucial to inheritance of schizophrenia in these families. Other groups, studying other families with a history of schizophrenia, have not found this linkage.

Social Science Programs
Research in the social sciences is also offering some encouraging results. Commenting on recent work in the United States and in Canada at Laval and McMaster Universities, Dr. Heather Munroe-Blum, Dean of Social Work at the University of Toronto noted that "of the few studies of psychosocial interventions (combined with drug therapy) most have demonstrated a significant reduction in relapse rates when compared with the drug therapy alone." (The Medical Post, March 13. 1990).

Co-ordination Effort
Starting a few years ago, the National Institute of Mental Health in the United States began a determined research attack on schizophrenia. This resulted in the development of "A National Plan for Schizophrenia Research." The plan covers all forms of research activity and is being supported by rapidly increasing annual amounts of public funds.

In Canada, a workshop on "Multicentre Study of Schizophrenia" sponsored by Health and Welfare Canada, was held in Ottawa in October 1989. This brought together leading researchers from across the country, and representatives from patient groups, voluntary family organizations, service agencies and the federal government.

The need for a national research strategy was clearly recognized in the proceedings. As a first step toward this objective, an interim group has been formed, with Dr. Barry Jones as Chairman. According to the report from the workshop, this group now has the task of telling the public and its political representatives about current schizophrenia research needs and their importance. The report also notes that a record of resources and people who could be usefully involved in research initiatives is needed. It concluded that a co-ordinating body is required to assist in moving ahead toward these goals.

Better Outlook for Research

Schizophrenia research opportunities now promise better understanding of the illness and eventually full knowledge of its cause or causes. Better treatment for patients and more effective support services in the community are now within reach. In the longer term, there is the hope of a cure. The challenge to both private and public sectors is to provide sufficient funding to make these possibilities a reality.

Research Findings of Interest

A higher percentage of people born in winter and early spring develop schizophrenia than during the remainder of the year. This may suggest viral infection.

More people with schizophrenia suffer birth complications than do the general population. This implies that early brain damage may play a role.

As mentioned earlier, schizophrenia runs in families. This suggests genetic inheritance.

Schizophrenia and manic-depressive psychosis may run in the same families. What is inherited may be a vulnerability to psychosis.

More people with schizophrenia have enlarged cisterns or ventricles in the brain than do the general population.

This enlargement could be produced by infection or trauma in early life, perhaps prenatal life.

A large percentage of those with schizophrenia have discontinuous eye movements. This eye-tracking disorder seems to he inherited.

The course of schizophrenia is different for males and females, for example, the age of onset is typically earlier for males. This may be a clue to a hormonal connection.

Some schizophrenics have a greater density of dopamine type 2 receptors than the regular population. This may be inherited.

Some with schizophrenia seem to have a deficiency of frontal lobe (front of the brain) functioning. This may help to explain "negative" symptoms in particular.

Some schizophrenics have abnormalities of left or right brain functioning. The left brain seems to be most affected.

Some with schizophrenia have memory system, arousal system and attention system abnormalities. A common neurotransmitter system may be implicated.

The outcome in schizophrenia is better in the long term than in the short term. Aging seems to reduce the symptoms. This may be an effect of brain cell loss.

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