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This is the second of an occasionally-appearing series on topics having to do with psychiatry.  Ever since Freud first wrote about young women sickened by their repressed sexual thoughts, America has been fascinated by the world of psychiatry.  And given that salacious introduction to the world of mental illness, who wouldn't be fascinated?  I too have been fascinated by the field of psychiatry, and I hope this series of articles will explain some of that fascination to readers in ways that are both enjoyable and enlightening.  For interested readers, the first installment of this series can be found here:

Schizophrenia is the Big Kahuna of psychiatric illness.  While not the most common of the psychiatric illnesses, schizophrenia is perhaps the disease that mostly captures the public imagination.  Literature and history are full of references to the bizarre behaviors and ramblings of mad kings and poets, prophets and criminals.  Today, we recognized many of these behaviors as the manifestations of schizophrenia.  The disease has been with us for a long time, has fascinated us for a long time, and today, despite our advances in medical science, schizophrenia still remains a burden and a mystery.

Science has been unable to identify a definitive cause of schizophrenia.  The current thinking among psychiatrists is that schizophrenia is a disorder of brain chemistry, and perhaps genetics plays a role in determining vulnerability to the disease.  But the detailed mechanisms for how chemistry or genetics actually causes schizophrenia remain hidden.  And the medications we give to people suffering from schizophrenia, medications used because of the idea that schizophrenia is caused by a disorder of brain chemistry, do not actually cure or resolve the illness, and can provide only partial symptomatic relief.  Schizophrenia remains a stubbornly chronic and mysterious illness.  However, there is now an accumulation of scientific evidence that suggests an infection might be the cause of schizophrenia.  An infectious cause of schizophrenia would mean not only a radical change in how we treat the illness, but how we think about psychiatric disease.

Bizarre and odd are the hallmarks of schizophrenia.  The disease is characterized by disordered and delusional thinking, seeing, hearing, and feeling things that aren't there, a strange blank quality to the individual's emotional response, and odd behaviors and social interactions.  Indeed, talking with a schizophrenic can be an exercise in strangeness: the topics of conversation can include the extraordinary – aliens, mind control, angels and demons – and the conversation often jumps from topic to topic with little logical coherence.  It is common to hear new words in these conversations, or old words used in new and idiosyncratic ways.  “I'm just spread on Bratteo's twist”, a person with schizophrenia once told me, an apparent reference to a recent stay in a psychiatric hospital in Brattleboro, Vt.

The inner experience of schizophrenia seems to be primarily that of fear.  Schizophrenics have bizarre, often paranoid thoughts in their heads – aliens are thinking my thoughts, the hospital wants to tie me up and give me experimental medications, the landlady is sneaking into my room to steal my belongings, the Devil wants to make me one of his angels.  The schizophrenic seems convinced these things are real, and it must be terrifying to see the world in this way.  Add auditory and/or tactile hallucinations – voices telling me that I am no good, or feeling bugs crawling on my skin – can only increase the level of inner apprehension.  To even the healthiest of us, the world often seems cruel and uncaring, and painfully beyond our control.  Couple that difficult reality with hallucinations and bizarre delusions, and the experience of schizophrenia must approximate a living nightmare.  

Yet for all the attention given to hallucinations and delusional thinking, perhaps the most damaging of the features of schizophrenia is the one that receives the least attention.  Schizophrenia is also characterized by what the psychiatrists call the “negative symptoms”: manifested by a lack of affect, a lack of motivation, a lack of decision-making, a lack of interest and enthusiasm for the world around them.  Hallucinations and bizarre behaviors are often what brings the patient to the attention of mental health workers, because they are dramatic.  Hallucinations and bizarre behaviors can be corrected with anti-psychotic medication, while the negative symptoms do not respond to any medication.  So commonly, the older treated schizophrenic patient will stop exhibiting the wild hallucinations and behaviors, and turns into a burnt-out shell of a person, seemingly without ambition or choice or resolution, speaking little, moved mostly by outside forces and with little evidence of any internal volition.  This passivity and seeming loss of self will is a common attribute of schizophrenia and the strongest and most long-lasting feature of the disorder.

Schizophrenia effects somewhere between 0.5 – 1.0% of the population.  It effects men and women equally, and it occurs at similar rates in all ethnic groups.  Schizophrenia is fairly evenly distributed around the world, in both western industrialized nations and in non-industrialized third-world countries.  It is a condition that appears to be as old as mankind itself, with references found back to the beginnings of written history.  Schizophrenia typically begins in adolescence or early adulthood: a common story is that of a young person going off to college but being unable to continue because of poor grades and increasingly erratic behaviors.  Once past age 40, a new diagnosis of schizophrenia is rare

Since the 1960's, the primary treatment for schizophrenia has been anti-psychotic medications.  Most of the anti-psychotic medications have some effect on the level of dopamine, a chemical in the brain.  The theory is that taking the medication corrects the changes in brain chemistry that is thought to cause schizophrenia.  A variety of these anti-psychotic medications are now available.  They all have some degree of effectiveness at reducing the severity of the hallucinations and delusional thinking that characterizes schizophrenia.  Sadly, these medications also have strong and disturbing side effects.  Worse yet, the anti-psychotic medications are only effective at reducing symptoms, they do not cure the disease.

 The search for better treatments for schizophrenia has led scientists to consider alternative explanations for the phenomenon of schizophrenia.  What if schizophrenia is not a metabolic disorder that alters brain chemistry?  A variety of evidence now points to an infectious organism as a possible cause of schizophrenia: Toxoplasma gondii, the cause of toxoplasmosis in humans.

Toxoplasma gondii (T. gondii) is a protozoan parasite, a motile, single-celled organism that requires a host animal in which to reproduce.  T. gondii has two phases to its life cycle.  The sexual phases of the life cycle takes place only in cats, which makes domestic and wild cats the primary host for T. gondii.  The asexual part of the life cycle can take place in other mammals including cats, mice, birds, and humans.  Rodents are the typical intermediate host for T. gondii.  In rodents, the T. gondii bradyziotes form cysts within the muscles and brain.  When a cat eats an infected rodent, the parasite enters the cat through the GI tract and undergoes sexual reproduction: the bradyzoites differentiate into gametocytes, which fuse to form a zygote, which then matures into an oocyst.  Oocysts are shed in cat feces.  The life cycle of T. gondii is completed when an intermediary host comes into contact with cat feces and the oocysts are ingested, and bradyzoites are form in the host tissues.

Humans become infected with T. gondii in a couple of different ways.  Humans can ingest toxoplasma bradyzoites by eating improperly cooked meat.  Farm livestock can be intermediary hosts for T.gondii, and have toxoplasma cysts in their muscles.  If a human eats improperly prepared meat from an infected animal, the person can become infected.  Humans can also acquire toxoplasma through accidental contact with cat feces, while handling a cat, while cleaning the cat litter box, or when the neighborhood cat deposits oocysts in your garden.  Toxoplasma can also be transmitted during pregnancy from an infected mother to her unborn child.

It is estimated that over 20% of Americans (more than 60 million people) carry the toxoplasma organism inside them.  For most adults with a fully-functioning immune system, getting infected with toxoplasma is entirely asymptomatic or it might result in a mild flu-like illness that lasts a couple of weeks and then goes away.  However, the toxoplasma organisms remains in the body in an inactive state.  For people with a compromised immune system (i.e. has AIDS or is receiving immunosuppressant medications for a medical condition), a new infection with toxoplasma may cause a severe illness consisting of fever, nausea, headache, confusion, loss of coordination, and seizures.  Persons who were previously infected with toxoplasma and then later become immunosuppressed can have a reactivation of their infection, with symptoms varying from mild to severe.

Women who acquire a new infection with toxoplasma during pregnancy can pass the infection to their child in utero.  Such congenital infections may cause a miscarriage, or a stillborn birth.  Children infected in utero may show few or no signs of infection at birth, but may develop neurological problems later on in life, including eye and vision problems, seizure disorders, mental retardation, and/or other mental disabilities.  

So infection with toxoplasma results in a variety of disorders of the nervous system, in both rodents and humans.  We know that infection with toxoplasma causes behavioral changes in mice.  Mice infected with toxoplasma show evidence of impairments of learning and memory.  Rodents infected with T. gondii show problems with motor coordination.  Rodents infected with T. gondii show increased movements, and show reduced fear around cats and cat smells.  Indeed, infected mice seem to be drawn to the cat, a possible evolutionary strategy that furthers the reproduction, transmission, and spread of toxoplasma.

In addition to the neurological symptoms described above following new infections in adults and congenital infections in children, infection with toxoplasma has been linked to changes in psychological function in humans.  Humans with evidence of previous toxoplasma infections have been show to perform worse on tests of immediate and delayed memory, and on tests of attention, and have delayed reaction times.  Toxoplasmosis has also been linked to psychiatric illness in humans.  In a study of 114 people with known toxoplasmosis, 24 were found to have symptoms of psychiatric illness (psychosis, paranoia, or “psychic alteration”).  Psychiatric symptoms were also noted in two people who got toxoplasmosis while working in a toxoplasma lab, including difficulty concentrating, having difficulty holding a conversation, feeling disembodied, delusions, and hallucinations.  

People with a fully-functioning immune system will make antibodies in response to infection with toxoplasma.  So if toxoplasma is the cause of schizophrenia, it should be possible to find antibodies to toxoplasma in the blood of schizophrenics.  Many studies have found toxoplasma antibodies in patients with schizophrenia.  Since the 1950's, there have been over 70 studies looking for toxoplasma antibodies in patients with schizophrenia.  When the data from some of these studies was lumped together, it showed that a person with toxoplasma antibodies was over 2.7 times more likely to have a diagnosis of schizophrenia than a person without toxoplasma antibodies.  In an intriguing study of military personnel in whom blood specimens were available in the previous eleven years, people diagnosed with schizophrenia were compared to “normal” control subjects.  Among the subjects with schizophrenia, marked increases in toxoplasma antibodies were found prior to the onset of the illness.

And then there are the intriguing results of studies using different drugs.  There was a study of rats recently  infected with toxoplasma and then treated with haloperidol (Haldol, a powerful anti-psychotic medication).  The treatment with haloperidol reversed the behavioral effects of recent toxoplasma infection in these rats.  Anti-psychotic medications used in the treatment of schizophrenia have also been shown to inhibit the growth of toxoplasma in petri dishes.  In some cases, the anti-psychotic medications were more effective at inhibiting the growth of toxoplasma than trimethoprim, the standard treatment for toxoplasmosis.  And there have been studies in which schizophrenics have been given the anti-microbial agents used in the treatment of toxoplasmosis.  One study showed improvement in both positive and negative symptoms in patients receiving trimethoprim along with an anti-psychotic medication: previously, negative symptoms have not been shown to respond to any anti-psychotic treatments.  Other studies of the effectiveness of anti-microbial agents used in toxoplasmosis as a treatment for schizophrenia are currently underway.

So a variety of evidence suggests that toxoplasma might be the cause of schizophrenia: 1) infection with toxoplasma is known to cause neurological problems and strange behaviors in both rodents and humans; b) recent infection with toxoplasma has been documented to cause psychiatric symptoms in humans; c) people who have documented toxoplasma infections are more likely have a diagnosis of schizophrenia than those without toxoplasma infection; d) medications used in the treatment of schizophrenia show some effective at inhibiting the growth of toxoplasma; and e) anti-toxoplasma drugs show some effectiveness in treating the symptoms of schizophrenia.  At this time, the evidence suggesting toxoplasma is the cause of schizophrenia is stronger than the evidence that a disorder of dopamine metabolism is the cause of schizophrenia.  

This is terribly exciting for a number of reasons.  If toxoplasma is indeed the true cause of schizophrenia, this finding would point the way to new treatments for schizophrenia.  It is possible that such treatments could for the first time actually cure the disease, rather than simply reduce the severity of the symptoms.  This would be a God-send to the millions of schizophrenics around the world.  And a cure for schizophrenia would completely change how we view the disease.  No longer would we regard people with schizophrenia as hopeless oddballs to be avoided, but as normal people who had the misfortune to catch an infection, and perhaps be made whole again.  The stigma of mental illness would change forever.  

This is a future we can all eagerly look forward to.  

Originally posted to Hugh Jim Bissell on Wed Jul 11, 2012 at 03:24 PM PDT.

Also republished by Mental Health Awareness.

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Comment Preferences

  •  Thank you for the excellent diary. Hopefully the (8+ / 0-)

    stigma of mental illness will change, regardless, but I hope the leads pan out.

    You can't make this stuff up.

    by David54 on Wed Jul 11, 2012 at 03:34:44 PM PDT

  •  Thank you for this diary. (5+ / 0-)

    Worked with schizophrenics for many years & have loved one with the illness.

    Heard E Fuller Torrey talk about this research a few years back. He seemed to believe that genes were also involved, that genetics, perhaps, made an individual more susceptible to the toxoplasma.

    Is there any new info on genetic research?

    A cure would be great for young people newly affected.

    Sadly, for those who have suffered for many years, brain damage has been done (enlarged venticles, etc). I doubt that much could be done about that. But if their illness could be cured, once and for all, that would be a wonderful thing.

    WE NEVER FORGET Our Labor Martyrs: a project to honor the men, women and children who lost their lives in Freedom's Cause. For May: Martyrs of the San Diego Free Speech Fight, Spring 1912.

    by JayRaye on Wed Jul 11, 2012 at 03:48:52 PM PDT

    •  Genes and Schizophrenia (10+ / 0-)

      Research on genetic changes in schizophrenia continues, and advances continue to be made.  Research shows many gene abnormalities can be found in people with schizophrenia.  But so far, no single gene, or single change in a gene, has been identified as responsible for schizophrenia.  

      Of course, genes interact with each other and the biologic environment in which they function, so teasing out cause and effect is very difficult.

      Interestingly, the genes that receive the most scrutiny in studies of schizophrenia are those that impact neurotransmitter (i.e. dopamine) synthesis and catabolism, or impact transmitter interactions neurotramsitter receptors (the molecules that transmitters bind to to effect changes in cellular function).  This theory grounding this kind of research is that schizophrenia is caused by a change in brain chemistry.  And as I tried to describe in the article, this theory has some flaws.

      The current thinking is that genetics probably influences a person's vulnerability to schizophrenia

      "The fool doth think he is wise: the wise man knows himself to be a fool" - W. Shakespeare

      by Hugh Jim Bissell on Wed Jul 11, 2012 at 04:23:16 PM PDT

      [ Parent ]

      •  Haven't followed the research lately, (2+ / 0-)
        Recommended by:
        joe wobblie, nother lurker

        so do appreciate this update.

        Very good to hear that advances in research are being made.

        WE NEVER FORGET Our Labor Martyrs: a project to honor the men, women and children who lost their lives in Freedom's Cause. For May: Martyrs of the San Diego Free Speech Fight, Spring 1912.

        by JayRaye on Wed Jul 11, 2012 at 05:14:03 PM PDT

        [ Parent ]

      •  So many advances (3+ / 0-)
        Recommended by:
        blueoasis, JayRaye, nother lurker

            by modern day neuroscientists...
          In the early sixties I was always a staunch advocate of the  Soviet materialistic approach.
          Perhaps if a change in brain chemistry is truly responsible, researchers
        are then seeking such a cure?

        ! The swinistic greed and racial hatred of the American ruling elite is abysmal ! - joe wobblie

        by joe wobblie on Wed Jul 11, 2012 at 05:30:29 PM PDT

        [ Parent ]

      •  About 20 or 25 years ago (2+ / 0-)
        Recommended by:
        JayRaye, nother lurker

        I heard a researcher at UCSF lecture on the subject. He was working on viral infection in the second trimester as a trigger. Did this line of inquiry pan out?

        We decided to move the center farther to the right by starting the whole debate from a far-right position to begin with. - Former House Majority Leader Tom DeLay

        by denise b on Wed Jul 11, 2012 at 08:17:46 PM PDT

        [ Parent ]

      •  a public health angle you may not have expected: (4+ / 0-)

        With the de-institutionalization of psychiatric patients in many cities, has come the widespread presence of schizophrenics among the homeless population.

        Humans need to poop.  In the absence of civilized facilities (public toilets), homeless people will make do with any private places, typically alleys.  

        Alleys are usually used for storage of refuse bins, and so are usually infested with mice and rats.  This gives rise to the urban ecosystem of mice, rats, raccoons, feral cats, and domestic cats.  The stereotype of domestic cats hooking up with feral alley cats is true.  

        Homeless people with psychiatric problems often have trouble maintaining personal hygiene.  Toilet paper is a luxury and any available item is used for cleaning their bottoms after pooping.   Hand-washing after pooping is virtually nonexistent among the homeless.

        And there you have all the necessary ingredients for a wide range of public health nightmares.

        Among them, a set of direct routes of transmission of toxo from humans to cats and thence to other humans, and from humans directly to other humans.

        The solutions are obvious:

        One, restore inpatient and custodial care for homeless psychiatric patients.  

        Two, install public toilets in cities.  These benefit everyone in the most obvious ways.  Modern public toilets are private and fully self-cleaning after each person's visit.  Workers can be hired to inspect and provide supplementary cleaning and graffiti removal where needed.

        Three, enable the public toilets to operate with tokens as well as coins, and dispense the tokens freely among local shopkeepers and the general public to give to street people.  In conjunction with that, enact and strictly enforce municipal ordinances to forbid using alleys as latrines, particularly where a public toilet is available nearby.

        Four, maintain high standards of sanitation in alleys: collect refuse twice a week to daily, clean up spilled refuse at least on each visit (or hire workers to sweep it up daily), and set out electric rodent traps that are emptied daily (electric traps are more sanitary than snap traps and do not spread poison into the local environment).

        Five, conduct "trap and spay/neuter" programs for feral cat and raccoon populations.  This is a more effective means of reducing their populations than killing them, because the sterile ones will compete with fertile ones for mates and thus undermine the breeding cycle.  

        In general, sanitation & vaccinations are the most important methods of preventing disease and increasing life-expectancy.  Until there's a vaccine for toxo, sanitation has to carry the entire burden of prevention.  But the same steps that will prevent toxo, will also prevent a wide range of other diseases that are spread through human and animal feces, accumulated refuse, flies, mice, rats, and feral cats.  It's a win-win solution, and will reduce acute and chronic health care costs more than sufficiently to pay for it.  

        "Minus two votes for the Democrat" equals "plus one vote for the Republican." Arithmetic doesn't care about your feelings.

        by G2geek on Thu Jul 12, 2012 at 03:29:31 AM PDT

        [ Parent ]

        •  Thanks for your input (1+ / 0-)
          Recommended by:
          bluebird of happiness

          I agree: proper sanitation cures many infectious disease in ways medications cannot, and public washrooms would be a big help for public health.

          But I advocate for the whole enchilada: let us provide better care for the mentally ill and stop making them into homeless people.

          "The fool doth think he is wise: the wise man knows himself to be a fool" - W. Shakespeare

          by Hugh Jim Bissell on Thu Jul 12, 2012 at 09:11:55 AM PDT

          [ Parent ]

  •  Hmm I Recall Reading Some Years Ago That (6+ / 0-)

    brain ventricles were larger in (some?) brains of schizophrenics. Is that still regarded as true? If so it would seem to support a more structural cause or contribution than brain chemistry.

    I had a diagnosed schizophrenic in my apartment building some years ago. Observing him when I was a programmer at the time, I had the impression of process control systems that weren't functioning right.

    At any given instant I myself might notice a germ of a sensory impression or micro-memory but they never go anywhere. Some process(es) very quickly sort them out as extraneous or invalid. It seemed to me that similar events in his brain would get past some kind of sorting or error checking processes and go on developing as valid realworld activity and then go on to become memories as if real.

    It all gives me the impression that there is an astronomical amount of data and processing and competing activities going on to make up mental and emotional activity, healthy or otherwise.

    Thanks for this interesting diary.

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Wed Jul 11, 2012 at 03:49:24 PM PDT

    •  Yes, structural abnormalities are seen (6+ / 0-)

      Yes, there have been studies documenting brain sturctuaral abnormalities in people with schizophrenia.  Enlarged brain ventricles (fluid-filled spaces within the brain) are one finding.  However, enlarged brain ventricles are seen in a variety of neurological disorders, and so are not specific to schizophrenia.  And then no one knows if the enlarged ventricles seen in schizophrenic are a cause of a consequence.

      The other documented structural brain abnormalities documented in people with schizophrenia is a decrease in the size of the brain's grey matter- the region of the brain that contains nerve cell bodies.  Again, this is a non-specific finding: it is also seen in a variety of dementias.

      While interesting, neither of these findings can be show to be causative of schizophrenia.

      "The fool doth think he is wise: the wise man knows himself to be a fool" - W. Shakespeare

      by Hugh Jim Bissell on Wed Jul 11, 2012 at 04:08:23 PM PDT

      [ Parent ]

      •  A=B; larger ventricles are seen because... (2+ / 0-)

        the brain itself has shrunk.

        Elderly people routinely have generous sized ventricles in the brain easily seen on CT or MRI scan. That's not because the ventricles are 'swollen' or the fluid can't get out; it's because the brain itself is shrinking with the age-related loss of nerve cells, and the ventricles expand to fill the missing volume.

        Anything causing loss of brain cells will eventually lead to expansion of the ventricles.

  •  Republished to Mental Health Awareness Group (3+ / 0-)

    √-1 2³ Σ π and it was delicious.

    by second gen on Wed Jul 11, 2012 at 03:56:15 PM PDT

  •  interesting (6+ / 0-)

    My father had schizophrenia and a miserable life. There is still a huge stigma around it.

    It would be amazing if it could be prevented or cured.

  •  only had time to read about a third. (2+ / 0-)
    Recommended by:
    marina, nother lurker

    But i"m wondering--are there many cases in which schizophrenia has responded to various types of talk-therapy--psychoanalysis, etc?

    There was a theory proposed in the 60s or earlier, I think, the 'double-bind' theory--that suggested that in some cases schizophrenia may result from deep and conflicting signals from the earliest moments of childhood--that couldn't be reconciled because the infant hadn't developed an independent frame of reference.  that theory was since 'debunked' (to the extent a social-scientific theory really can be debunked--often there is a resurgence)

    But I saw some recent literature that suggested there may be something to it--and much of what I read--although the theories have changed somewhat--really do seem to resonate.

    •  I don't think so (5+ / 0-)

      At the time my father was losing his marbles, his mother had gone to family therapy and for a while psychiatrists were blaming parents and saying schizophrenia was caused by crappy parenting or whatnot...but later it became 'common knowledge' that it was a disorder of the brain and couldn't be cured or even managed with therapy, only with drugs. No therapy or drugs ever helped my father. Much of that occurred in the 1960s when they were still doing shock treatments and his options for anti-psychotics in the 1970s may not be what they are now...but none of that stuff ever helped.

      Flash forward about 30 years, to when I made friends with a woman who was fairly high-functioning on medication, who could either distinguish between her delusions and reality with the help or coaching of a therapist, or simply learned not to talk about the crazy stuff, and I don't know - but I was truly amazed that she could come across as normal (albeit somewhat quirky) for an extended period of time. She had hallucinations (auditory and visual) but she seemed to understand that's what they were.

      People are capable of being severely screwed up by awful life experiences...but of those people, how many become schizophrenic?

      •  thanks for the reply-- (3+ / 0-)

        I wasn't thinking so much about life experiences or bad-parenting---more along the lines of neo-natal 'crossed wires', for whatever reason.  Things like infant trauma, major surgery,  things like that, that may have caused some psychiatric damage even before the mind has the ability to process things.

        But all these are just thoughts...

        •  so little is known (1+ / 0-)
          Recommended by:

          about how our brains work. I worry about the genetic factor because I have children. Often I wonder how much "free will" we have, because there is a limited repertoire of human behavior - we don't have infinite options to choose from. For example, ADHD - attention deficit hyperactivity disorder. People used to think it was just laziness and irresponsibility, but now they know it's a manifestation of a sluggish prefrontal cortex. Some have suggested that attention deficit disorder is caused by a genetic predisposition but also stress during gestation or infancy.

          But anyway, I was sort of free-associating in response to your comment, based on my personal experience and observations. Schizophrenia sucks.

          It's frustrating and sad that we just have no idea. I was thinking, well, at least we don't still think it's caused by demons, like they did in the Middle Ages, so progress is being made, albeit slowly.

    •  Sadly no (3+ / 0-)
      Recommended by:
      bevenro, JayRaye, nother lurker

      Sadly, so-called talking therapies have not been shown to provide lasting improvements in schizophrenia symptoms.

      Often, the schizophrenic is too disorganized to be able to sit and attend to talking therapies.  And because schizophrenics are often destitue, doctors do not want to spend the time to engage in talking therapies unless they are fully paid.

      "The fool doth think he is wise: the wise man knows himself to be a fool" - W. Shakespeare

      by Hugh Jim Bissell on Wed Jul 11, 2012 at 04:27:47 PM PDT

      [ Parent ]

    •  I've read that talk therapy (3+ / 0-)
      Recommended by:
      bevenro, JayRaye, nother lurker

      is counterproductive for schizophrenics (maybe not all) because to be schizophrenic is "like having five different conversations going on in your head at the same time". I know it was not helpful for my brother, but only seemed to aggravate him until other thoughts replaced it in his mind.

    •  Freudian theory (2+ / 0-)
      Recommended by:
      llywrch, nother lurker

      has a bunch to say about possible causes of schizophrenia. The specific theory you are referring to was promulgated by Gregory Bateson, an anthropologist with interests in psychoanalysis, in the 1950s. But this is mostly considered a dead end now: its heyday predated the development of effective anti-psychotic drugs.

      •  that does sound familiar. But as I recall, the (1+ / 0-)
        Recommended by:
        nother lurker

        theory as initially posed was pretty specific--dealing with positive/negative signals regarding the infant's relationship with the mother, both physically and emotionally.

        I guess I was referring more to double-bind in the sense of strongly competing and irreconcilable signals which get effectively 'locked up' in the mind--but a mind that, as it develops normally in other ways, is either not directly aware of the deeper conflict or never developed the means to move forward.

        Some of these ideas come from personal experience and self-analysis, which I won't go into now but may write a diary on one day.

  •  Wow, thank you for this! (4+ / 0-)
    Recommended by:
    Vetwife, marina, DamselleFly, MKSinSA

    Can you recommend any references on the response of T. gondii to haloperidol?  Again, thanks!

  •  Really fascinating stuff (2+ / 0-)
    Recommended by:
    marina, nother lurker

    A couple of questions: I recall reading that schizophrenics often have more receptors in their brain for receiving stimuli, thus are often overwhelmed because they are feeling overstimulated a lot of the time. Did I get that right? And if so, is this finding also true for those who are infected with the toxoplasma?

    Also, I remember reading about Kurt Vonnegut's son, who is now a psychiatrist and claimed to have been a "cured" case of schizophrenia. Do you think he was truly schizophrenic and an anomaly? Or misdiagnosed in the first place?

    •  Thank you! I think so too. (3+ / 0-)
      Recommended by:
      JayRaye, gzodik, nother lurker

      I also think this is fascinating stuff.  I'm glad I am able to make some of my fascination come across.

      It seems obvious to me and other doctors that schizophrenics are "over-stimulated".  But for the most part, there is little understanding of how the brain deals with "normal" stimulation, to say nothing of figuring out how that process goes wrong.

      I also read Mark Vonnegut's autobiography about his mental illness.  I understand that he was once diagnosed as schizophrenic during a hospitalization in the 70's.  He has written that he used LSD and other hallucinagens as a young man.

      I think today, Mr. Vonnegut says he suffers from Bipolar Disorder.  Both schizophrenics and bipolar patients can have severe psychosis which commonly confuses the two diagnoses.

      "The fool doth think he is wise: the wise man knows himself to be a fool" - W. Shakespeare

      by Hugh Jim Bissell on Wed Jul 11, 2012 at 04:36:09 PM PDT

      [ Parent ]

  •  Very interesting diary and thank you (5+ / 0-)

    I have always seen it as a disconnect somewhat like demential or alzheimers.  some of the same symptoms.
    A misfiring in the chemical balance.  
    I do so wish people could understand not all severe illnesses are visible.

    We the People have to make a difference and the Change.....Just do it ! Be part of helping us build a veteran community online. United Veterans of America

    by Vetwife on Wed Jul 11, 2012 at 04:21:23 PM PDT

    •  Psychiatry knows this (1+ / 0-)
      Recommended by:
      nother lurker

      You are prefectly correct: not all severe illness can be seen from the outside.

      For all its faults, the field of psychiatry is truly dedicated to understand and treating these kinds of severe illnesses.

      The burden of these "unseen illness" among our service veterans is enormous.

      I thank you for your advocacy for the health care needs of our veterans.

      "The fool doth think he is wise: the wise man knows himself to be a fool" - W. Shakespeare

      by Hugh Jim Bissell on Thu Jul 12, 2012 at 07:35:12 AM PDT

      [ Parent ]

  •  T. gondii and suicide (2+ / 0-)
    Recommended by:
    denise b, nother lurker

    Cat ladies and suicide:

    They found that women who were infected with T. gondii were one-and-a-half times more likely to attempt suicide than uninfected women. The higher the levels of T. gondii antibodies found, the higher the suicide risk. They were also more likely to try to commit suicide violently, with a gun, sharp object or by jumping. When the researchers took into account women’s previous mental illness, they found that those who had toxoplasmosis were more likely to attempt suicide than those who had been mentally ill.

    In Soviet Russia, you rob bank. In America, bank robs you.

    by badger on Wed Jul 11, 2012 at 05:11:00 PM PDT

  •  Excellent. (2+ / 0-)
    Recommended by:
    nother lurker, ebohlman

    And fascinating.

    I'm tempted to think diagnoses like schizophrenic, bipolar, depression, etc. are (possibly overlapping) "baskets" of different disorders.

    GOP: Bankers, billionaires, suckers, and dupes.

    by gzodik on Wed Jul 11, 2012 at 06:38:38 PM PDT

    •  Psychiatrists get 'em mixed up sometimes (1+ / 0-)
      Recommended by:
      nother lurker

      One of the difficulties of psychiatry is that there is a lot of overlap of the symptoms - psychosis shows up in schizophrenia and bipolar disorder, sadness occurs in depression and bipolar disorder, feelings of anxiety occur in depression, bipolar disorder and anxiety disorder.   And so on.  

      This problem is compounded by the lack of quantative tests for psychiatric disorders.  The diagnosis depends in large part to the judgement and experience of the psychiatrist.

      So doctors can and do get the diagnosis wrong.  some cases are obvious and clear-cut.  Other patients may have a variety of symptoms and the diagnosis is more ambiguous.

      "The fool doth think he is wise: the wise man knows himself to be a fool" - W. Shakespeare

      by Hugh Jim Bissell on Thu Jul 12, 2012 at 07:28:00 AM PDT

      [ Parent ]

      •  Proteomics? (1+ / 0-)
        Recommended by:
        bluebird of happiness

        I came across an article in PLoS that discussed the use of proteomics as a potential diagnostic tool for schizophrenia and depression (Domenici et al. 2010:  "Plasma Protein Biomarkers for Depression and Schizophrenia by Multi Analyte Profiling of Case-Control Collections").  Are these methods used more widely now or are they still in the research phase.  Interesting stuff.

        •  Not currently used (2+ / 0-)

          Currently there are no biomarkers available that definitively diagnose any psychiatric disease, the way antibodies indicate an infection or troponin indicates a heart attack.  

          There is a lot of research being done, but nothing definitive yet.  Good candidate biomarkers need to also be approved by the FDA, and this process can take years of careful clinical studies.

          "The fool doth think he is wise: the wise man knows himself to be a fool" - W. Shakespeare

          by Hugh Jim Bissell on Thu Jul 12, 2012 at 09:16:21 AM PDT

          [ Parent ]

      •  throw ADHD into that mix (0+ / 0-)

        Many people I know with ADHD have been misdiagnosed as bi-polar, depressed, or with anxiety disorders, etc.

        Having undiagnosed ADHD can certainly cause problems that lead one to become depressed.

        Sometimes people have more than one of these issues going on at the same time.

        It's particularly tricky because there is no good way of measuring or assessing for it. There is no test. Much of the evaluation is based on subjective reports and observation.

        •  Same thing with ADHD (0+ / 0-)

          While there are a variety of quantative test used to assess the function of attention, these are not used in making a diagnosis of ADHD.

          And yes, making a psychiatric diagnosis is complicated by the fact that two or more psychiatric illnesses can occur in the same person.

          "The fool doth think he is wise: the wise man knows himself to be a fool" - W. Shakespeare

          by Hugh Jim Bissell on Thu Jul 12, 2012 at 10:44:34 AM PDT

          [ Parent ]

  •  now this was a good read.... (2+ / 0-)

    accessible to the those not steeped in healthcare profession but reads such that the author comes across as well informed.

    Any idea of the next step in this area? Someone very close to me has been diagnosed as schizophrenic - I'd love to see it cured if toxoplasma is the cause (we've had cats all our lives and I know this is a possible source).

    One small typo - stands out because the diary prose is uncommonly well-written: "Schizophrenia effects somewhere between 0.5" - should be "affects"

    •  Next steps (2+ / 0-)

      The definitive proof that toxoplasma causes schizophrenia would be if scientist could isolate and culture (grow in the lab) toxoplasma from people with schizophrenia, and use the lab cultures to cause schziophrenia in anothe rhealthy human.  This experiment will never be done because of the questionable ethics of inducing schizophrenia in a healthy person.  So scientists continue to accumulate evidence of a causative role of toxoplasma in schizophrenia

      Scientists are also working on better treatments for ttoxoplasma infection, and testing such treatments in people with schizophrenia.  There a some studies currently underway of using existing toxoplasma treatments in patients with schizophrenia.  These studies are preliminary at this point as doctors work out best dosages, and side effect profiles and toxicities.

      If a good candidate drug is identifed, doctors will try a large-scale test comparing the candidate drug to existing treatments.

      I too look forward to the day your loved one can be cured of this illness.

      "The fool doth think he is wise: the wise man knows himself to be a fool" - W. Shakespeare

      by Hugh Jim Bissell on Thu Jul 12, 2012 at 07:15:10 AM PDT

      [ Parent ]

  •  My late wife had (1+ / 0-)
    Recommended by:
    nother lurker

    a slightly different diagnosis, schizoaffective disorder.
    In what ways does the T. gondii correlate with that disorder?

    -9.75, -7.49 "He that will not reason is a bigot - He that cannot reason is a fool - He that dares not reason is a slave." Sir William Drummond 1585-1649

    by zamrzla on Wed Jul 11, 2012 at 07:22:18 PM PDT

    •  I'm not aware of any research (2+ / 0-)

      Schizoaffective disorder is an illness that combines the disorganization of schizophrenia with the mood fluctuations similar to bipolar disorder.  This is a very difficult illness to experience, both for the patient and close family members.

      I'm not aware of any research connecting toxoplasma infection with schizoaffective disorder.  It may be that such work is being done, and I simply have not read any of the reports.

      My sympathies for your wife.  I'm sure there were moments that tested your strenght.

      "The fool doth think he is wise: the wise man knows himself to be a fool" - W. Shakespeare

      by Hugh Jim Bissell on Thu Jul 12, 2012 at 06:55:01 AM PDT

      [ Parent ]

      •  Nicki (0+ / 0-)

        did test my resolve on many occasions, but she remains the single best thing that happened to me over the course of my life. Our daughter, now 13 (the second best thing to have happened to me), is having a much rougher time of it. She is in therapy and will remain in therapy for the foreseeable future.

        Also, thank you for the reply.

        -9.75, -7.49 "He that will not reason is a bigot - He that cannot reason is a fool - He that dares not reason is a slave." Sir William Drummond 1585-1649

        by zamrzla on Thu Jul 12, 2012 at 12:16:00 PM PDT

        [ Parent ]

  •  Exciting, yes, but association is not causation. (1+ / 0-)
    Recommended by:
    nother lurker

    The association between toxoplasmosis and various behavioral and psychiatric issues is fascinating, but nowhere near definitive. It's a string to start pulling, and may lead to more definitive information about the cause of schizophrenia. It's far too early to ascribe schizophrenia to toxo. A 2.7x higher prevalence of toxo antibodies in schizophrenics versus the general populace is interesting but nowhere near definitive.

    I'm reminded of the initial reports of an intriguing association between genital herpes infections and cervical cancer, reported in the medical literature in the early 1980s. This sparked further research, but turned out to be a red herring. Cervical cancer is in fact caused by HPV, or human papilloma virus, interacting with host immune factors including patient's age & maturity of the immune system, tobacco use, and other factors. The association with herpes simplex was just that: a statistical association. Women infected with herpes simplex were also more likely to have a higher number of lifetime sexual partners and more likely to be infected with HPV, the true causative agent.

    I would bet $50 that this will also turn out to be the case with Toxo and schizophrenia: that both are associated with some other agent we haven't discovered yet.

    •  hmm (0+ / 0-)

      If a virus can cause cervical cancer, could a virus cause other forms of cancer?

      •  Yes. (0+ / 0-)

        There are a variety of cancers caused by viruses.

        Perhaps the best known and studied is a virus that infects cats.  Feline Leukemia Virus causes leukemia in cats.

        In humans, there is Human Papilloma Virus, which causes cervical cancer.  Herpesvirus causes Burkitt's Lymphoma in humans. Hepatitis B virus is a cause of soem forms of liver cancer.  A polyomavirus is thought to be the cause of Merkel Cell carcinoma.

        So yes, viruses can and do cause cancers.

        "The fool doth think he is wise: the wise man knows himself to be a fool" - W. Shakespeare

        by Hugh Jim Bissell on Thu Jul 12, 2012 at 12:00:17 PM PDT

        [ Parent ]

        •  as that is the case (0+ / 0-)

          (I had no idea)

          Why is treatment for cancer not focused on killing the virus? Or is killing a virus not possible? (I have heard a virus is not technically alive, but does have the ability to copy itself)....Or is it just that once someone has cancer, the virus becomes irrelevant?

          And why does a virus cause cancer? Is it because it disrupts the body's normal DNA replication process?

          I read somewhere that in treating HIV, neuraminidase inhibitors help to impede the replication of the virus...I think...but I also read that there might be some sort of laser treatment that would destroy a virus by breaking it apart, although that may have been a science idea bordering on futuristic fiction.

          My general impression is that anti-viral drugs have limited success. Do you know how they work?

          •  Viruses as causes for cancer largely a blind alley (1+ / 0-)
            Recommended by:
            bluebird of happiness

            This was a very hot topic back in the 1960s when the etiology of cancer was really terra incognita. After all, if you could blame cancer on viruses, then cigarettes were off the hook, right? The American Cancer Society and the Feds spent millions on research into this hypothesis in the 1960s and 1970s, only to come up almost completely empty.

            Cancers occur because at least two and probably three separate DNA errors or mutations get propagated in the same cell line. One removes constraints on the cell's capacity to divide. Another removes metabolic constraints on rapid growth and proliferation. The third disables the cell's 'suicide switch' that otherwise would command it to die due to its genetic fault. Some folks inherit one of these mutations, which helps explain families that have lots of cancer.

            HPV is the culprit for cervical cancer, though it's not the sole cause. Immune factors, tobacco, age of the patient and a bunch of other factors are involved. The same seems to be true for squamous cell cancer of the head and neck: this has been strongly associated with tobacco use since the late 1950s, but it is now known to be far more common in people who also are infected with some HPV strains. It will likely turn out to require both HPV and tobacco in most cases.

            Other than this, virtually all other human cancers appear likely to have environmental causes (tobacco, hormones, industrial toxins & solvents, alcohol, air pollution, radon etc.)

          •  Killing the virus doesn't kill the cancer (0+ / 0-)

            This is not my area of expertise, so I'm kind of coming off the top of my head.

            Caners are masses caused by uncontrolled cell multiplication.  If I remember correctly, viruses that cause cancers do so by invading cells, and reprogramming the cells' genetic material so that the cells continue to live and divide past the point where the cells' own internal mechanisms would otherwise command the cell to stop dividing and die.  Once the reprogramming part is done, it no longer matter if the virus is around or not.  The cells continue to live and divide, creating a mass of cells we call a cancer.

            So killing a cancer-causing virus will stop the virus from infecting other cells, but it won't stop the cells that have already been infected from doing the uncontrolled multiplication thing.

            And as Ralphdog has already said, viruses have been idenftified as the cause of only a minority of human cancers.  So even if killing a virus would stop a cancer, this would only work to cure a few specific types of cancer, not all cancers.

            Still, stopping even one kind of cancer is an worthy goal.  And targeting the responsible virus is exactly the strategy use in combating cervical cancer.  As you probably know, there is now a vaccine to prevent infection with Human Papilloma Virus (HPV), the causative agent of human cervical cancer.  Prevent infection with HPV, and you will prevent people from getting cervical cancer.  A most worthy goal.

            I am confident we will see other virus vaccines as a way of preventing other human cancers.  We may also see use of anti-viral agents to fight certain cancer in other ways.

            "The fool doth think he is wise: the wise man knows himself to be a fool" - W. Shakespeare

            by Hugh Jim Bissell on Fri Jul 13, 2012 at 08:26:37 AM PDT

            [ Parent ]

  •  We stumble when we talk about THE cause (0+ / 0-)

    of schizophrenia. This is a very reasonable diary but no sophisticated medical people think of single causes of complex diseases such as hypertension, autism, bipolar disease and schizophrenia.  Autism and schizophrenia have extremely high heritabilities- usually about 0.8, bipolar disease about 0.7, depressive disorder 0.3 or 0.4, in other words bipolar disease is more heritable than monophasic depressive disorder.  They run in families but hardly ever can be blamed on single genes. These disorders are defined by behavior (hypertension behavior is blood pressure). ASD (autism spectrum disorders- there are many), SSD  (schizophrenia spectrum disorders, again many although you don't see much mention of SSD- the phrase is used in the Pedersen study of toxoplasma antibodies) and bipolar disease are brain diseases, but environmental factors may precipitate illness in those with certain genotypes. We can identify physical brain abnormalities in close relatives of ASD & SSD patients but they don't need treatment if they are functioning normally.

    Toxoplasma antibodies might cause problems by cross-reacting with other antigens (the body response to some diseases introduces additional problems).  At least 50% of people in the US and Europe have/develop toxoplasma antibodies; the incidence of such antibodies is much lower in India. India may have lesser prevalence of schizophrenia than the developed countries, but probably doesn’t differ much from other developing countries. Schizophrenia is more common in urban than rural people around the world.

    Various factors that may increase the risk of developing schizophrenia  include nutritional deficiencies, infection, fetal hypoxia, maternal stress, cannabis use, and childhood trauma (see Brown, The environment and susceptibility to schizophrenia. Prog Neurobiol 2011; 93:23–58). Schizophrenia and autism seem to be made up of many small components, only some of which are understood. The high heritability implies that genetic factors are very important, but there may be others.  Identical twins are usually congruent  for presence/absence of autism or schizophrenia, but there are exceptions even though they have identical DNA at birth (after birth epigenetic changes such as DNA methylation may be induced in one twin only). For autism, we know that the risk of ASD is half if you have a half sibling with ASD (compared to SSD), the data is not as good for SSD but looks similar. One major difference between ASD and SSD is the tremendous male preponderance of ASD.

    Beware of the news media and their constant barrage of over simplified medical sound bites. They are often misleading, but rarely totally false.

    •  Very Possible (1+ / 0-)
      Recommended by:

      It is very possible that many things working together cause schizophrenia.  It is also possible that only one thing - an infection, or a disorder of metabolism - causes schizophrenia.

      My personal opinion is that we do not yet fully understand the workings and malfunctions of the brain.  And one day in the future we will understand that a number of disorders have been lumped together in what we today call schizophrenia.  And these different disorder will likely have different causes.  So, we might find that gene problems cause one slice of what we today call schizophrenia, and that toxoplasma causes another slice of what we today call schizophrenia.

      What we do not know about the brain, and especially the higher functions of the brain like emotional responses and cognition, is orders of magnitude greater than what we do know about the brain.  

      "The fool doth think he is wise: the wise man knows himself to be a fool" - W. Shakespeare

      by Hugh Jim Bissell on Thu Jul 12, 2012 at 12:17:01 PM PDT

      [ Parent ]

  •  a typo in my next to last paragraph (0+ / 0-)

    The sentence that begins "For autism, we know.." should read For autism, we know that the risk of ASD is half if you have a half sibling with ASD (compared to a full sibling), the data is not as good for SSD but looks similar.

    The importance of this is that half siblings are often raised in different households and therefore have greater difference in their environment than full siblings, yet their risk is half that of full siblings  who share twice as much DNA. It's just a way of saying that genetic factors (unspecified) are powerful. This data is almost exclusively from half siblings with the same mother. It's conceivable that this doesn't apply to half siblings with the same father, or people with an uncommon variant of either ASD or SSD.

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