Two years ago, Howard LeWine, MD, Chief Medical Editor, International Publishing, Harvard University Health Publications posted a blog in which he described that five seemingly different mental health disorders—major depression, bipolar disorder, schizophrenia, autism, and attention-deficit hyperactivity disorder—were discovered to be more alike than previously thought.
The research began in 2007 by a group of researchers from 19 countries, who created the Psychiatric Genomics ConsortiumA ground-breaking study has identified a handful of genes that are shared by people with these disorders. This work could help find new and better ways to diagnose and treat mental illness.
Back in 2007, researchers from 19 countries formed the Psychiatric Genomics Consortium. Since forming, the PGC analyzed DNA from 33,000 people with major depression, bipolar disorder, schizophrenia, autism, or attention-deficit hyperactivity disorder as well as the DNA from another 28,000 people without one of these disorders.
It was found that in the group with mental illness, four regions of the genetic code carried the same variations. Dr. Jordan Smoller, is the director of psychiatric genetics at Massachusetts General Hospital and a professor of psychiatry at Harvard Medical School explained these findings in basic terms. According to Dr. Smoller, “Two of the affected genes help control the movement of calcium in and out of brain cells. That might not sound like much, but this movement provides a key way that brain cells communicate. Subtle differences in calcium flow could cause problems that, depending on other genes or environmental factors, could eventually lead to a full-blown mental illness.”
It’s been known for many years that certain major mental health conditions run in families. For example, bi-polar disorder, major depressive disorder, and schizophrenia have been shown repeatedly to run within families.
Unfortunately for us mental health practitioners, there’s a long way to go before the work the PGC is doing can help diagnose such disorders. In fact, while I don’t have an issue keeping my clients educated, I personally would not yet inform a patient of these newly discovered genetic variation relationships as even the PGC reports these genetic variants are “weak risk factors” for the above five mentioned disorders.
When a client of mine suffers from a mental health disorder, I believe psych-education is an important part of treatment as they should understand their condition. A well educated client regarding their disorder, tend to participate very strongly in treatment, are often able to identify symptomology on their own, and thus provide therapists like me, better information as to their status between sessions. Some such clients become highly active not only in the treatment sessions, but the treatment planning which becomes a collaborative effort between therapist and client (which I believe it should be irrespective of the cause for requiring treatment).
What is really ground-breaking about this study is not what’s been formally reported, but rather what has been hinted at by the PGC, reading between the lines of their report which suggests bipolar disorder, major depression, and schizophrenia—and possibly autism and attention-deficit hyperactivity disorder—could possibly be different manifestations of the same underlying disorder.
If that were the case, first I’d have to wrestle with the millions of questions I would have especially as the symptoms and presentations of these illnesses can be radically different. That said, it certainly appears such a finding carries a great deal of potential benefit in term of new treatment modalities including preventative treatments.
While I find the science fascinating, I’ve treated many individuals who have one of these five disorders (in some case more than one). There is a very strong correlation between trauma and mental illness, but there are also many paths to mental illness, so I would tend to think the genetics are but a piece of of the puzzle which is sometimes present, and frequently not.
That’s why dealing with mental illness requires such a detailed history especially along with a current evaluation of mental status.
Lastly, I wonder how schizophrenia fits in to these genetic findings. There are already 4 groups of genes shown to cause an increased risk of schizophrenia with another dozen or thought to participate, but as of now, are unconfirmed. Keep in mind too, that the onset of schizophrenia is age 18 in men and 25 in women. So, not only is it extremely rare for a 10 year old or younger individual to have schizophrenia (I’ve only encountered and treated one), it is equally rare for the onset of schizophrenia to occur after age 40.
Schizophrenia, worldwide is in the top 10 causes of disability in developed countries worldwide (World Health Organization & Harvard University, 2003).
As you’ll see in an upcoming post, schizophrenia is an extremely tough condition that not only has no cure, but creates huge costs for the governments and tax payers, while funding for research is poor to to say the least.
Point being, is that hopefully the additional genetic relationships to mental illness can aid in yielding treatment measures, especially of the preventative type. The research funding for psychiatry is particular poor, and in my next post you’ll read the very sad outcomes for a great percentage of schizophrenics who wind up homeless, in jail, or committing suicide. 10 years ago, on October 23, 2003, The National Alliance of Mental Illness’s Policy Research Institute (NPRI) announced the creation of a Task Force on Serious Mental Illness Research, co-chaired by Edward Scolnick, MD, president emeritus of Merck Research Laboratories and NAMI medical director Ken Duckworth, MD, former mental health commissioner for Massachusetts.
A portion of the announcement stated that, “NAMI takes seriously the statement of Dr. Thomas Insel, director of the National Institute for Mental Health (NIMH), that with the right investments, scientists are within reach of finding a cure for schizophrenia in the next ten years,” said NAMI national executive director Richard C. Birkel, PhD. “The critical challenge is to set the right priorities for research investments and to insist that the clinical research enterprise translates readily into real world practice. In the long run these investments will mean both lives and money saved.”
“Recent advances in biomedicine, including the decoding of the human genome, make possible a revolution in the treatment of psychiatric illnesses, a revolution that is already underway for other serious diseases,” Scolnick said. “The fact that we have the knowledge and tools to develop newer, better-targeted medication for illnesses like schizophrenia and bipolar disorder, with fewer side effects, demands that we make the appropriate research investments. The mission of the task force is to help provide a roadmap for that revolution.”
Well, it’s 10 years later, and there’s no cure. There are, however a wide variety of at least 15 newer and frequently prescribed anti-psychotic medications utilized in various courses of treatment of schizophrenia. These are expensive medicines, and would cost our society a lot less to fund the research for a cure than than endure the tremendous strain on society. Oh, but that could be a problem in and of itself, as it should be noted cardiovascular causes are now most common in accounting for the majority of the 5% of sudden and unexpected deaths. Prospective studies regarding these deaths and the lack of any signs of the cause of these deaths are now showing that people with prolongation of the QT interval (time from electrocardiogram Q wave to the end of the T wave corresponding to electrical systole) beyond a certain range are at increased risk of serious arrhythmias such as ventricular tachycardia and torsade de pointes. In about 1 in 10 cases, the torsade is fatal.
Most antipsychotics prolong the QTc interval in overdose but some prolong it even at therapeutic doses. Droperidol (Inaspine), sertindole (same class as Risperdone and Seroquel) and ziprasidone (Abilify, Zyprexa, Seroquel, Risperdal, Lamictal) extend the QT interval by an average of 15–35 ms; quetiapine (Seroquel), haloperidol (Haldol) and olanzapine (Zyprexa) by 5 ms, to 15 ms. There is only an approximate relationship between QT prolongation and risk of sudden death, and the risk related to antipsychotics is thought to increase in people with pre-existing cardiac disease, those taking multiple QT-acting drugs and those taking antipsychotics at high dose for long periods.and it should be mentioned that while suicide used to account for many of the deaths in schizophrenic patients, only 3 years after that 2003 announcement, the article by Abdelmawla & Mitchell (2006) published in Advances In Psychiatric Treatment illustrating the correlation between these “new and improved” anti-psychoticcs may in fact be directly responsible.
Something tells me the privatized research that occurs at pharmaceutical companies is not quite focused on a cure, but rather a management of symptoms. I’m only speculating. I wasn’t allowed in to the labs. Or maybe, there are efforts to assure these drugs stay on the market. Mandatory electrocardiograms might be a good idea, but is there an admission of guilt in instituting such a policy or is it just cheaper to roll the dice rather than buck up and pay for the electrocardiograms?
So, once again, let’s root for the good people in the PGC and other biomedical researchers to go further with their studies and take the genetic relationships and apply them to cure based oriented research, that hopefully moves away from the ant-psychotics that when given in doses for schizophrenia and/or psychotic symptoms, tend to leave the patient extremely sedate. I was once given 25mg of Seroquel to help with insomnia. That is 16 to 32 times less than the recommended dose for Bi-Polar Disorder’s Manic Episodes and for Schizophrenia in Adolescents and Adults. Needless to say, I slept 16 hours straight and the following 12 hours were needed to shake off the cobwebs so I could think and perceive things normally. I would highly recommend discussing with your Dr. an alternative if he/she suggests “a low dose of Seroquel” to help with sleep.
Until then, we’re looking at a global epidemic. No exaggeration. I’ll demonstrate this in my next post.
Although you might first see a post of the Financial Cost of Mental Illness in the USA. The numbers are too astonishing not to share.
Until then, I’ve said it before, and will no doubt say it again; There’s no shame in having a problem, but assuming you have the faculties to understand you have a problem, there’s a good chance the shame lies in not doing anything about it.
While I’m happy to answer questions about diagnoses and treatment, as always, all information on DashPsychotherapy© especially as it relates to medicine, is for educational and news purposes only. For specific medical advice and pharmacological treatment, consult your medical doctor. Do not alter your treatment based on the above information. Treatment is specifically established by individual by licensed physicians. If you think you may have a medical emergency, call your healthcare provider or 911 immediately.
Abdelmawla, N., & Mitchell, A. J. (2006). Sudden cardiac death and antipsychotics. Part 1: Risk factors and mechanisms. Advances in Psychiatric Treatment, 12(1), 35-44.
Allebeck, P. & Wistedt, B. (1986) Mortality in schizophrenia. A ten year follow-up based on the Stockholm County inpatient register. Archives of General Psychiatry, 43, 650–653.
Straus, S. M. J. M., Bleumink, G. S., Dieleman, J. P., et al (2004). Antipsychotics and the risk of sudden cardiac death. Archives of Internal Medicine, 164, 1293–1297.
World Health Organization, World Bank, & Harvard University Medical School (2003). The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Harvard University Press, Cambridge, MA
(source: http://www.who.int/msa/mnh/ems/dalys/intro.htm ) For additional information See the World Health Organization’s mental health publications.