3×5: Culture, Neuroscience, and Psychiatry Schizophrenia Roundup

Many thanks (seriously) to Nev Jones for sending so many great suggestions my way.

Culture/Environment
1. Variation – among individuals, geographically,  and across cultures – in the incidence, precedence, and course of schizophrenia is more complex than previously suggested by three WHO studies (on a putatively better outcome in “developing” vs. “developed” countries). For example, regional data from the Worldwide-Schizophrenia Outpatient Health Outcomes or W-SOHO study suggest a better clinical outcome but a worse functional outcome in regions other than “North Europe” (See, e.g., Haro et al’s “Cross-national clinical and functional remission rates.”)

Studies also continue to support variation within geographical region, e.g., Kirkbride et al’s PLOS One systematic review, “Incidence of schizophrenia and other psychoses in England, 1950–2009,” which describes, in particular, higher rates among “migrants and their descendants of black Caribbean and black African origin” and among those of “mixed ethnicity,” which the authors suggest may be a possible marker of “third-generation descendants.” Urban birth/upbringing also remains a significant risk factor, “independent of differences in the age, sex and ethnic population structure of different geographical areas, and correlated to a number of socio-environmental factors including ethnic density, social cohesion, social fragmentation, deprivation, and inequality.”

2. Early Adversity: A 3/29/12 meta-analysis published online by Jim van Os et al. supports the link between childhood adversity and risk of psychosis.  “Childhood adversities increase the risk of psychosis: A meta-analysis of patient-control, prospective- and cross-sectional cohort studies.” The addition of cannabis use appears to increase risk even further (Konings et al., 2012). But see also Susser and Widom’s July 2012 critique of such studies, “Still searching for lost truths about the bitter sorrows of childhood.

3. Diagnosis and Social Abandonment: In “Psychosis and the fog of reality,” Vaughan Bell of Mind Hacks has provided pdfs of two articles by journalist Rachel Aviv: “God knows where I am: What should happen when patients reject their diagnosis?” in the 5/30/11 New Yorker and “Which way madness lies: Can psychosis be prevented?” in the 12/10 issue of Harper’s. See also David Dobbs’s post, “What’s it like to be schizophrenic” and Jocelyn Marrow and Tanya Luhrmann’s recent paper for Culture, Medicine, and Psychiatry (CMP) on social abandonment in India and the US. And finally, Schomerus et al’s (2012) bleak conclusion of their meta-analysis that “Increasing public understanding of the biological correlates of mental illness seems not to result in better social acceptance of persons with mental illness.”

4. Cognition/Anthropology of Neuroscience: Elizabeth Bromley, Gail Fox Adams, and John Brekke’s “A video ethnography approach for linking naturalistic behaviors to research constructs of neurocognition in schizophrenia” in The Journal of Neuropsychiatry and Clinical Neuroscience (3/1/12). See also Bromley’s exploration of researchers’ understanding of the concept of “cognition” as it applies to schizophrenia in “The Texture of the Real” (CMP, 2012).

5. First-person Experience: The blog Ruminations on Madness, provides, as always, some much-need insight on philosophy, psychiatry, and first-person experience. In “Excerpts from the journals of E” the author provides us with the fragments of a brilliant philosophy student’s trajectory following his first episode of  psychosis.

The blog itself testifies to the more complex view that “schizophrenia” covers a range of conditions, capacities, and behaviors, that outcomes are as diverse as the people to whom the label is attached, and that living with the disorder offers in itself an important research perspective. The blog is an opportunity for significant advocacy, in regard to which, addressing anthropologists, psychiatrists, psychologists, and others in the mental health field in Berlin last year, Arthur Kleinman said,

We have all failed in a way that our brothers and sisters and cousins in the AIDS community have not failed. If you went back twenty years, you would see that everything I’ve said about the chronically mentally ill you could say about AIDS patients. And in twenty years the situation for AIDS patients has radically changed. There has been enormous efficacy from advocacy in the AIDS field. We have failed in the area of advocacy. And what I want to suggest is that in the future those of who who build your careers here: Advocacy will be part of your careers. Rather than seeing advocacy as a threat to academic life, you’re going to come to see advocacy as central to the new academy in the future.”

Neuroscience

See also Ford & Mathalon’s (2012) review, “Neurobiology of schizophrenia: Search for the elusive correlation with symptoms” in Frontiers.

1. Epigenetics: Steven Hyman, “Target practice: HDAC inhibitors for schizophrenia,” in News and Views / Nature Neuroscience published online 8/28/12 re Kurita et al. on targeting epigenetic changes that occur with the use of antipsychotics.

2. Vulnerability: Jim van Os and Richard Linscott’s introduction to a special issue of Schizophrenia Bulletin,The extended psychosis phenotype – Relationship with schizophrenia and with ultrahigh risk status for psychosis.

3. More Gene x Environment: Book review of The Origins of Schizophrenia, edited by Alan Brown and Paul Patterson. (Reviewed by Michael Owen, MRC Centre for Neuropsychiatric Genetics and Genomics, and Neuroscience and Mental Health Research Institute, Cardiff University.)

4. Schizophrenia and Autism: Kong et al’s 8/23/11 Nature paper, “Rate of de novo mutations and the importance of father’s age to disease risk.

5. Auditory Hallucinations: A series of related papers featured in July 2012 Schizophrenia Bulletin prepared by members of the International Consortium on Hallucination Research [InCoHR] working groups.

Psychiatry/DSM-5

1. DSM-5: Randy Tanon and William Carpenter’s, DSM-5 Status of Psychotic Disorders: 1 Year Prepublication” dd. 4/13/12 in Schizophrenia Bulletin provides a “snapshot of current status of potential changes” in DSM-5 regarding psychotic disorders. The proposed revisions include a “schizophrenia spectrum concept (which would include the attenuated psychosis syndrome listed in Section III – see [4] below). Also, the subtypes of SZ will be dropped in favor of eight or nine possible “dimensional ratings of different psychopathology domains,” including hallucinations, delusions, disorganized speech, abnormal psychomotor behavior, negative symptoms, impaired cognition, depression, and mana. (NB: “Catatonia, formerly a subtype, will now be listed as a “specifier for psychotic disorders, mood disorders, and general medical disorders.”) The authors note that “the issue of how many dimensions are useful, reliably assessed, necessary, and practical remains an open question.”

2. Diagnostic labels: Ruminations on Madness (“In defense of the schizophrenia construct (?)” ) argues that labels can obscure differences between persons and kinds of experiences, but is

less sure … that the advantages of more dimensional or non-label-based approaches outweigh the potential benefits—benefits, specifically, in the domain of identity. Like most sociopolitical minority group labels (Latino or Autistic, for example), “schizophrenic” cuts an arguably over-wide swathe and yet clearly marks something that, for cultural, historical and individual reasons, is shared between individuals and provides a (potentially vital) sense of collective ‘being’ and cohesion. [To make this a little more personal, and to repeat something that I believe I’ve said many times in earlier posts,  I do not think I would be alive today were it not for the deep and sustaining sense of recognition and belonging I found early on in Louis Sass’ brilliant work on schizophrenia.]

3.  Attenuated Psychosis Syndrome (Proposed for Section III of the DSM-5) (Revised April 27, 2012): Because of reliability issues (according to Tanon and Carpenter validity is “fairly established), “this condition is being recommended for further study in Section III, which is the section of the DSM-5 text in which conditions that require further research will be included.”

4. A good prior discussion/debate by Carpenter and Jim van Os, “Should attenuated psychosis syndrome be a DSM-5 diagnosis?” in  Am J Psychiatry 2011, and also a recent review, “A Rose is a Rose is a Rose,” But At-Risk Criteria Differ” by Schultze-Lutter et al. of University Hospital of Child and Adolescence Psychiatry (Bern) and Department of Psychiatry and Psychotherapy (Cologne).

5. William Carpenter’s “The future of schizophrenia pharmacotherapeutics: Not so bleak” in response to Chattaranjan Andrade, Rajiv Radhakrishnan, and Praveen Fernandes, “Psychopharmacology of schizophrenia: The future looks bleak,” in Mens Sana (2012). One question he raises is how reconceptualization of schizophrenia as a multi-dimensional construct will affect drug development?

See also the following (non-psychosis specific):

Advertisements

Leave a Reply

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s