![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 30. This is the beginning of the thread.
Posted by alexandra_k on September 26, 2006, at 20:45:15
> His plan was to make use of the extensive available genealogical and census data on the Icelandic population, the relative homogeneity of the Icelandic gene pool and the general willingness of the Icelandic population to participate in research projects. Having managed to raise venture capital to found the genomics company deCODE genetics, Inc., the deCODE CEO managed to establish an alliance in 1998 with the pharmaceutical company Hoffman-La Roche. Among key initial targets were genetic risk factors in 12 common complex disorders, including Schizophrenia and stroke.
> While deCODE's perhaps overzealous plans to establish a comprehensive national healthcare database linking encrypted demographic, clinical and genetic data of all Icelanders (29,000) has not materialised despite parlimentary support, the genomics company has been meeting its goals of identifying loci and genes for several complex brain disorders in the past 2 years. All participants in these studies have provided a signed informed consent form and all personal identifiers are encryped PIN codes provided by the Ieclandic Data Protection Authority. deCODE has also recently published a high-resolution map of the human genome. Over the past two years the company has been changing fast from a genomics company to a biotechnology company which aims to develop drugs faster than previously thought tenable through acquisitions and close collaboration with the pharmaceutical industry.
> Among the central elements of deCODE's successful approach has been the making of a new computerized genealogical database called Islendingabok - the Book of Icelanders. This database extends back to the settlers described in the Book of Settlements, but with greater reliability back to the complete census in 1703. The Book of Icelanders includes the names of about half of the Icelanders who have ever lived and of 95% of those born since the first complete census in 1703. No other biotechnology company has access to such a powerful tool to establish familiarity between participants, e.g., second and third cousins, in genetic research...
>'This core 7-marker haplotype was present in 7.6% of 394 controls and 14.4% of 402 independent affecteds, thereby conferring a relative risk of around 2.1 (p=0.000087)'
I'm not sure how they get from 7.6% of people without schizophrenia having the 7-marker haplotype and 14.4% of people with schizophrenia having the 7-marker haplotype to this:
>'On the basis of these frequencies and relative risks, the 7-marker haplotype has a population attributable risk of 16% under a multiplicative model, indicating that 16% of schizophrenia in Iceland could be eradicated if the haplotype were - in theory - eliminated from the Icelandic population (Stefansson et al., 2002)'
Do the findings generalise outside the Icelandic population (the Icelandic population is more homogenous than most)?
> 'Among Scots [who are historically similar to Icelanders] the 7-marker core haplotype was found in 10.2% of around 609 patients and 5.9% of 618 controls (p=0.00031) and conferred a relative risk of 1.8'
Findings have also been replicated in the UK, China, and Ireland (though the Scots result was the closest to the Icelandic result)
Journal of Mental Health, February 2004; 13(1): 21-27(There is also an appendix where the author provides his login information so you can login to the Book of Icelanders project online)
Posted by notfred on September 26, 2006, at 21:38:09
In reply to genetics of schizophrenia, posted by alexandra_k on September 26, 2006, at 20:45:15
>'This core 7-marker haplotype was present in 7.6% of 394 controls and 14.4% of 402 independent affecteds, thereby conferring a relative risk of around 2.1 (p=0.000087)'
I'm not sure how they get from 7.6% of people without schizophrenia having the 7-marker haplotype and 14.4% of people with schizophrenia having the 7-marker haplotype to this:
>'On the basis of these frequencies and relative risks, the 7-marker haplotype has a population attributable risk of 16% under a multiplicative model, indicating that 16% of schizophrenia in Iceland could be eradicated if the haplotype were - in theory - eliminated from the Icelandic population (Stefansson et al., 2002)'
Maths aside this part is very troubling:if the haplotype were - in theory - eliminated from the Icelandic population
Posted by alexandra_k on September 26, 2006, at 23:05:33
In reply to Re: genetics of schizophrenia, posted by notfred on September 26, 2006, at 21:38:09
> Maths aside this part is very troubling:
> if the haplotype were - in theory - eliminated from the Icelandic populationThere are different ways that they could go about eliminating the gene in practice.
One option would be to screen pre-embryos and turn off the gene.
Another option (more controversial) would be to only implant embryos that didn't have the gene.
Another option (even more controversial) would be... Well I'm sure I don't need to say it... It is the latter option that I find most... Frightening.
The trouble is that it seems that a number of people with the gene don't get schizophrenia and also that a number of people without the gene do get schizophrenia. I'm not sure on the ethics of eliminating the gene because only around 14% of people with the gene develop schiozphrenia. Generally speaking... Genetic diversity is a good thing. It makes human beings (as a species) more resistent to mass extinction in the face of radical environmental change...In practice I'm sure the drug companies are more interested in discovering the developmental effects of the genes. So they can develop expensive medications that counter the developmental effects. More money in that over the long haul, I would imagine...
Posted by notfred on September 26, 2006, at 23:15:25
In reply to Re: genetics of schizophrenia » notfred, posted by alexandra_k on September 26, 2006, at 23:05:33
> There are different ways that they could go about eliminating the gene in practice.
>
> One option would be to screen pre-embryos and turn off the gene.
>
> Another option (more controversial) would be to only implant embryos that didn't have the gene.
>
> Another option (even more controversial) would be... Well I'm sure I don't need to say it... It is the latter option that I find most... Frightening.
Seems to me you cannot have hybrid vigor without
some mistakes but they are self limiting via natural selection.
Posted by alexandra_k on September 27, 2006, at 0:07:40
In reply to Re: genetics of schizophrenia, posted by notfred on September 26, 2006, at 23:15:25
> Seems to me you cannot have hybrid vigor without
> some mistakes but they are self limiting via natural selection.If the schizophrenia gene (which isn't even close to being perfectly correlated with schizophrenia) decreased the individuals fitness then it would be hard to see why it is still in the population.
The study didn't make it very clear who the control group consisted in. Whether the control group consisted in people with other psychiatric dx or whether the control group were lacking a psychiatric dx altogether or both. That is important... With respect to seeing whether the gene does decrease individual fitness. Were the people in the control group who had the gene suffering from another mental disorder? How were they functioning in general? How many kids did they have?
There was a study done that showed that people with schizophrenia didn't have kids that much less than people without schizophrenia (I think males tended to have less but females tended to have more). That challenged the assumption that people with schizophrenia were less fit than people without. I don't know how much number of offspring is related to presence of the schizophrenia gene. I'm even reluctant to call it 'the schizophrenia gene' since it isn't necessary or sufficient for the development of the disorder.
One notion might be that presence of the gene predisposes... And then there is something environmental (like a virus in the third trimester) so that together those two conditions are sufficient for the development of schizophrenia. Still seems that the gene (and the virus) isn't necessary, however...
There could be something advantageous about 'the schizophrenia gene' so that it increases individual fitness (so long as the virus, lets say, doesn't come along). One idea that comes up is creativity. I guess if you had an operational definition of creativity you could do a survey and figure whether that were true or not.
Another theory is that it could be similar to sickle cell anemia. With sickle cell anemia you want one... Can't remember what it is called... You want Bb to be resistent to malaria. If you are bb then you aren't resistent. If you are BB then you have sickle cell anemia. B (the sickle cell anemia gene or whatever) is maintained in the population because it benefits people in the form of providing resistence against maleria (that is what has maintained the presence of the gene in the population). But the nasty offshoot of that is the possiblity of BB or sickle cell anemia. Whatever genes are involved in schizophrenia could work like that too...
I guess my main worry is that we don't know enough about what the genes do to say whether knocking them out / turning them off (in the form of pre-embryos) would be helpful or harmful to the population as a whole. We don't even know enough to know whether it would be helpful or harmful to the individuals...
Stuffed if I know.
But given the gene (and the virus) don't seem to be necessary or sufficient for the development of the disorder maybe there are different kinds of schizophrenia or maybe we just need more genetic research or maybe... The environment (aka sociological conditions) play a bigger role than is commonly supposed...
Does exposure to a virus count as environmental?
How about adequate nutrition?Stuffed if I know
Posted by notfred on September 27, 2006, at 1:02:14
In reply to Re: genetics of schizophrenia, posted by alexandra_k on September 27, 2006, at 0:07:40
>
> If the schizophrenia gene (which isn't even close to being perfectly correlated with schizophrenia)agreed
decreased the individuals fitness then it would be hard to see why it is still in the population.
>The usual suspects, random mutation, background radiation, etc.
Posted by SLS on September 27, 2006, at 1:11:48
In reply to Re: genetics of schizophrenia, posted by alexandra_k on September 27, 2006, at 0:07:40
> If the schizophrenia gene (which isn't even close to being perfectly correlated with schizophrenia) decreased the individuals fitness then it would be hard to see why it is still in the population.
You know this isn't true. We still see Huntington's Chorea in the population.
One thing that we see emerge sociologically during evolution is care of the inferm. It is seen prehistorically as fossil remains have been discovered with clearly disabling skeletal injuries. I wonder to what degree schizophrenia and other mental illnesses were tolerated within the group? Did these people reach reproductive ages? Who cared for their offspring? Perhaps none of the above. Perhaps this is why we see major mental illnesses existing as multi-genetic. The only way these defective genes can exist in an intolerant population is if they do not express a dysfunctional phenotype without the simultaneous expression of other critical genes that themselves do not appear regularly and are not chromosomally linked (as a haplotype).
I think we do see that schizophrenia and bipolar disorder are multi-genetic disorders with several loci on different genes having been identified. I will, for the time being, exclude Major Depressive Disorder from the discussion, even though I believe it deserves a place as a biologically-driven mental illness with multi-genetic components.
> There could be something advantageous about 'the schizophrenia gene'
True.
- Scott
Posted by alexandra_k on September 27, 2006, at 2:00:19
In reply to Re: genetics of schizophrenia, posted by notfred on September 27, 2006, at 1:02:14
> The usual suspects, random mutation, background radiation, etc.I don't know enough about this...
I think the 'gene'...
(Now 'gene' is a tricky concept... They found 'fine mapping of the Icelandic 8p locus [that is a particular segment of chromosome i think) led to the identification of 4 haplotypes - i.e., series of alleles at a linked loci... Haplotype sharing between families narrowed the region down to a relatively small area covering the 5' end of a large and very complex gene, neurogulin 1, a gene never before implicated in schizophrenia. These four haplotypes proved to have a common 7 marker core described by two microsatellite markers and five single nucleotide polymorphisms markers, usually referred to as KNPs ("snips"). This core 7 marker haplotype was present in 7.6% of 394 controls (without schizophrenia, or without mental illness in general?) and 14.4% of 402 independent affecteds, therby conferring a relative risk of around 2.1')
I'm a little lost as to what this means...
Huntingtons is associated with a gene IT15 on the short arm of chromosome 4 characterised by a an abnormally long CAG repeat...
Does that mean if they could cut the repeat out... Then the person wouldn't develop Huntingtons?
I'm just wondering whether it is about cutting a bit out or reprogramming the code or what.
Sorry... My knowledge of this stuff is very basic indeed...
Regarding random mutation, background radiation etc I don't know that that would explain the heritability side of things...
Posted by alexandra_k on September 27, 2006, at 2:01:32
In reply to Re: genetics of schizophrenia » notfred, posted by alexandra_k on September 27, 2006, at 2:00:19
> Regarding random mutation, background radiation etc I don't know that that would explain the heritability side of things...Though of course those things are heritable.
I don't know.
I just mean that it can't affect your fitness too much or there wouldn't be so much of it around...
Posted by alexandra_k on September 27, 2006, at 2:08:31
In reply to Re: genetics of schizophrenia, posted by SLS on September 27, 2006, at 1:11:48
> I wonder to what degree schizophrenia and other mental illnesses were tolerated within the group?I've heard it is controversial whether there are records of schizophrenic symptoms (in terms of enough of them cooccuring to warrant what we would now regard to be a dx of schizophrenia) before... Around the time of... The industrial revolution.
That lent some credibility to the virus in the second (I know I said third before but I should have said SECOND) trimester notion. The notion is that the virus occured around the time of the industrial revolution.
> The only way these defective genes...
I don't know that it has been established that they are 'defective'.
The majority of people with a dx of schizophrenia don't have the gene though.It MIGHT be the case that the people with the gene who don't have schizophrenia would have got schizophrenia if they had certain other genes... or it MIGHT be the case that the people whith the gene who don't have schizophrenia would have got schizophrenia if they had a virus in the second trimester..
But how about the people who have schizophrenia who don't have the gene?
Posted by SLS on September 27, 2006, at 2:32:04
In reply to Re: genetics of schizophrenia, posted by alexandra_k on September 27, 2006, at 2:08:31
The other thing I forgot is that if schizophrenia doesn't develop until after the age of successful breeding, it will remain in the population. It is unusual for it to appear before age 18. It occurs most often in the mid 20s. Therefore, an individual will breed successfully before developing the disorder and will transmit the genes.
For right now, the majority of scientists regard schizophrenia to be a complex, multigene disease that is highly heritable. To talk about a single gene or haplotype and use it as a point to try to make or break an argument regarding the genetic nature of schizophrenia might be difficult. It could make the argument, but it couldn't break it.
- Scott
Posted by alexandra_k on September 27, 2006, at 5:23:36
In reply to Re: genetics of schizophrenia, posted by SLS on September 27, 2006, at 2:32:04
> The other thing I forgot is that if schizophrenia doesn't develop until after the age of successful breeding, it will remain in the population. It is unusual for it to appear before age 18. It occurs most often in the mid 20s. Therefore, an individual will breed successfully before developing the disorder and will transmit the genes.
Yeah.
> For right now, the majority of scientists regard schizophrenia to be a complex, multigene disease that is highly heritable.Depends on what kinda scientists... The geneticists certainly think the disorder is genetic :-)
> To talk about a single gene or haplotype and use it as a point to try to make or break an argument regarding the genetic nature of schizophrenia might be difficult. It could make the argument, but it couldn't break it.
Well...
It is an empirical matter...The term 'gene' is ambiguous. I think it tends to be used in two ways. In one sense a gene is a combination of allels. (Is that right?). But in one sense the notion of a gene is a localised part of a chromosome. In the other sense the notion of a gene is more abstract... Something along the lines of a placeholder for whatever allels.
If you talk about the 'schizophrenia gene' you might mean that there are a bunch of allels somewhere on the chromosome and however those allels are is necessary and sufficient for schizophrenia.
Or you might mean that surely people must develop schizophrenia because of the way their allels are... And the 'schizophrenia gene' can be multiply realised by all kinds of allels at all kinds of locations.
Griffiths talks about 4 (I think) different meanings of innate (in the sense of genetic versus environmental). He doesn't think we should talk about things being genetically determined / innate because the way genes express is dependent on the environment. He distinguishes 4 things we might mean (of varying strengths).
I can't remember what they are...
I'm tired.
I'm sorry.I don't really know anything about genetics / biology
But I guess I'm gonna have to learn...
Posted by SLS on September 27, 2006, at 7:19:21
In reply to Re: genetics of schizophrenia, posted by alexandra_k on September 27, 2006, at 5:23:36
> The term 'gene' is ambiguous.
I think it tends to be used in two ways. In one sense a gene is a combination of allels. (Is that right?). But in one sense the notion of a gene is a localised part of a chromosome. In the other sense the notion of a gene is more abstract... Something along the lines of a placeholder for whatever allels.
Yes. I guess the word "gene" should basically be defined as a coding unit. It is also often used interchangeabley with the term "allele".
> If you talk about the 'schizophrenia gene' you might mean that there are a bunch of allels somewhere on the chromosome and however those allels are is necessary and sufficient for schizophrenia.No, not me personally.
> Or you might mean that surely people must develop schizophrenia because of the way their allels are... And the 'schizophrenia gene' can be multiply realised by all kinds of allels at all kinds of locations.
I really am not on top of the research regarding which chromosomes and which loci are currently suspect as being associated with schizophrenia.
> Griffiths talks about 4 (I think) different meanings of innate (in the sense of genetic versus environmental). He doesn't think we should talk about things being genetically determined / innate because the way genes express is dependent on the environment. He distinguishes 4 things we might mean (of varying strengths).
>
> I can't remember what they are...Shame on you.
> I'm tired.
> I'm sorry.I know. You have to work in all that heavy air there down under.
> I don't really know anything about genetics / biology
> But I guess I'm gonna have to learn...No, actually, I think you know enough. I wish I were as well educated as you.
I think it might be more instructive to follow some pedigrees and twin studies. The twin studies will help support the types of ideas regarding the possible necessity for environmental contributors in the induction of schizophrenia, although I would not rule out congenital factors during gestation. Psychosocial stress is undoubtedly at work. Damn it.
Similar studies are available for bipolar disorder. Elliot Gershon has done much work on this. I believe he was one of the contributors on the work with the Amish community.
Depression is another matter. The word is just too big. Even the diagnosis of Major Depressive Disorder as defined in the DSM is too broad to sequester genetically based biological phenomena. That is not to say that other types of depression, both biologically-driven and psychologically-driven, could not benefit from biological treatment. However, it would be nice to be able to separate out people who would be best suited for biological versus psychological therapies, so as not to frustrate the sufferer with treatments that are not likely to work, and thus sabotage their spirit. Of course, there is a large area of overlap, as the brain and mind are inextricably linked. It is reasonable to conclude, and it has been demonstrated through clinical investigation, that concomitant biological and psychological treatments can act synergistically to enhance one's chances of recovering from depression. Depression is often not an either-or situation.
- Scott
Posted by alexandra_k on September 27, 2006, at 8:34:49
In reply to Re: genetics of schizophrenia » alexandra_k, posted by SLS on September 27, 2006, at 7:19:21
> I really am not on top of the research regarding which chromosomes and which loci are currently suspect as being associated with schizophrenia.
Neither am I.
I guess what it comes down to is whether there will be certain combinations of allels that on some abstract level are necessary and sufficient for the disorder or whether environment plays a more substantial role in the way the allels express.
I mean...
I can't remember what the 4 different meanings of innate / genetic were...It comes down to stuff like...
You would think that sexual behaviour in monkeys (in terms of mating) would be genetic if anything was.
But if you raise a monkey in isolation from its peers for a time and then place it in with some peers then it never does develop normal mating behaviour.
That is an extreme example of how the environment can play a substantial role in allel expression.If the environment does indeed play a substantial role (so that more subtle features of the environment have a significant impact) then it might well be the case that we won't be able to find a certain combination of allels that are necessary and sufficient for the disorder no matter how abstractly we define the relevant combinations.
I think the trouble with twin studies is that...
There aren't very many identical twins where one (or both) are affected with schizophrenia. But that being said I'm fairly sure there are some cases where only one developed schizophrenia. Identical twins have the same genes / allels so that would mean that the genes / allels aren't sufficient to determine whether one develops schizophrenia or not. One would also expect that if one was exposed to a virus in utero that the other one would have been too...
Actually... Thanks for that :-) It shows that no matter how abstractly we define combinations of allels... Genetic inheritence isn't enough to determine whether one has schizophrenia or not. Environment must play a role.:-)
> Similar studies are available for bipolar disorder. Elliot Gershon has done much work on this. I believe he was one of the contributors on the work with the Amish community.
Thanks. I'll look that up.
A fair few theorists have argued that schizophrenia isn't a natural kind. Instead they think that there are importantly different types of schizophrenia. If that is right... Then if we divide 'schizophrenia' up into the relevent types then we might have better luck with figuring out what is going on...
I'm not sure how much schizophrenia is an either / or syndrome either. I have heard a number of cases where people were dx'd with schizophrenia and when they got better they were told they must have been misdiagnosed. That is one way to make a disorder chronic by definition.Then there are related conditions like brief psychotic episode and schizotypal personality etc etc...
I'm just learning... But I guess I've been reading a lot. I feel like it goes in one ear and out the other sometimes... Trying to retain more of it...
Posted by Phillipa on September 27, 2006, at 15:15:16
In reply to Re: genetics of schizophrenia, posted by SLS on September 27, 2006, at 1:11:48
Can I join the thread as I know a few schizophenics? Love Phillipa
Posted by SLS on September 27, 2006, at 17:29:50
In reply to Re: genetics of schizophrenia, posted by Phillipa on September 27, 2006, at 15:15:16
> Can I join the thread as I know a few schizophenics? Love Phillipa
What is it about these people that makes them schizophrenic?
Just trying to find out what this word means to people.
- Scott
Posted by SLS on September 27, 2006, at 18:07:50
In reply to Re: genetics of schizophrenia » SLS, posted by alexandra_k on September 27, 2006, at 8:34:49
Hi Alexandra.
> Actually... Thanks for that :-) It shows that no matter how abstractly we define combinations of allels... Genetic inheritence isn't enough to determine whether one has schizophrenia or not. Environment must play a role.
Not necessarily. There are still epigenetic processes that occur within the organism that are not programmed by the genes, but affect the expression of genes. In other words, a pair of identical twins do not have to be identical phenotypes due to the epigenetic differences in gene activity. The expression of schizophrenia can therefore be 100% biological, and not at all dependent on the environment. Instead it is dependant upon specific epigenetic events during development that lead to the turning on or turning off of specific genes.
> A fair few theorists have argued that schizophrenia isn't a natural kind.
I have a feeling that we need to better define what we mean by schizophrenia. Once we do, I think we will see that there is a phenotype that does represent a natural kind, and that one of its interesting generalizations will be the presence of specific genes of vulnerability; the expression of which will depend upon epigenetic events, including psychosocial stress.
> Instead they think that there are importantly different types of schizophrenia. If that is right... Then if we divide 'schizophrenia' up into the relevent types then we might have better luck with figuring out what is going on...
Yes.
- Scott
Posted by alexandra_k on September 27, 2006, at 21:16:49
In reply to Re: genetics of schizophrenia » alexandra_k, posted by SLS on September 27, 2006, at 18:07:50
hellos :-)
> a pair of identical twins do not have to be identical phenotypes due to the epigenetic differences in gene activity.
what is an 'epigenetic difference' if it is not the differential effect of the environment on how allels express in phenotype?
> I have a feeling that we need to better define what we mean by schizophrenia.
Current definition is:
A. Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time [I wonder how much a 'significant portion' is?] during a 1-month period (or less if successfully treated):
(1) delusions
(2) hallucinations
[it is interesting that the way DSM defines hallucination makes hallucinations a subset of delusions, hence if you have (2) you will meet (1) for free]
(3) disorganized speech (e.g., frequent [whatever that means] derailment or incoherence)
(4) grossly disorganised or catatonic behaviour
(5) negative symptoms, e.g., affective flattening, alogia, or avolitionNOTE: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behaviour or thoughts, or two or more voices conversing with each other.
B. SOCIAL / OCCUPATIONAL DYSFUNCTION: For a significant portion of the time [?] since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly [?] below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).
C. DURATION: Continuous signs of the disturbance persist for at least 6 months. This 6 month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).
D. SCHIZOAFFECTIVE AND MOOD DISORDER EXCLUSION: Schizoaffective Disorder and Mood Disorder With Psychotic Features have been ruled out because either (1) no Major Depressive, Manic, or Mixed Episodes have occured concurrently with the active-phase symptoms; or (2) if mood episodes have occured during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.
E. SUBSTANCE / GENERAL MEDICAL CONDITION EXCLUSION: The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
F. RELATIONSHIP TO A PERVASIVE DEVELOPMENTAL DISORDER: If there is a history of Autistic Disorder or another Pervasive Developmental Disorder, the additional diagnosis of Schizophrenia is made only if prominent delusions of hallucinations are present for at least a month (or less if successfully treated).
Then there are some subtypes...
PARANOID TYPE:
A. Preoccupation with one or more deluisons or frequent auditory hallucinations.
B. None of the following is prominent: disorganized speech, disorrganized or catatonic behaviour, or flat or inappropriate affect.DISORGANISED TYPE:
A. All of the following are prominent:
(1) disorganised speech
(2) disorganised behaviour
(3) flat or inappropriate affect
B. The criteria are not met for Catatonic Type.CATATONIC TYPE:
clinical picture dominated by at least two of the following:
(1) motoric immobility as evidenced by catalepsy (including waxy inflexibility) or stupor
(2) excessive motor activity (that is apparantly purposeless and not influenced by external stimuli)
(3) extreme negativism (an apparantly motiveless resistence to all instructions or maintenence of a rigid posture against attempts to be moved) or mutism
(4) peculiarities of volountary movement as evidenced by posturing (volountary assumption of inappropriate or bizzare postures), stereotyped movements, prominent mannerisms, or prominent grimacing.
(5) echolalia or echopraxiaand there is residual type and there are different courses (episodic, continuous, partial remission etc etc)
What a mess...
I wonder if the subtypes are natural kinds? I think (though I could be wrong) that disorganised and catatonic subtypes tend to be more associated with structural abnormalities. I wonder if these are the types that tend to have the relevant gene too?
Dunno...
Different clinicians probably have a different threshold for how willing they are to dx Schizophrenia. Because of terms like 'usually' 'significant portion' and 'markedly' there could be variation between clinicians. I think that is what 'inter-rater reliability' is supposed to measure (how much clinicians judgements agree). But then there are problems with clinicians making dx's for insurance purposes and / or in order to authorise a certain medication...
Posted by Phillipa on September 27, 2006, at 21:58:03
In reply to Re: genetics of schizophrenia » Phillipa, posted by SLS on September 27, 2006, at 17:29:50
Delusions, hallucinations, seeing things that are not there, hearing the TV talk to you, eating road kill, out of touch with reality. Not violent but could be hasn't been my experience. Wanting the voices or things they see to go away. Love Phillipa ps usually stopped their meds due to either selling on the street for money or bad really bad side effects.
Posted by Phillipa on September 27, 2006, at 22:05:32
In reply to Re: genetics of schizophrenia » SLS, posted by alexandra_k on September 27, 2006, at 21:16:49
Alex I think the dx is made depending on what meds work or don't work which takes time lots of time. And I've never seen a catatonic one posturing. Love Phillipa ps most of the ones I know hallucinate see aliens or such or voices that talk to them . One I correspond with has a boy in his head who tells him to hurt himself. That's usually a trip to the hospital for either getting back on meds or trying a different one. Most make you very very tired. Hygiene is nonexistant for some. No bathing or changing clothes. Very sad indeed.
Posted by alexandra_k on September 27, 2006, at 22:45:16
In reply to Re: genetics of schizophrenia » SLS, posted by Phillipa on September 27, 2006, at 21:58:03
> ...eating road kill
there isn't anything wrong with that - is there?
i mean i know it is illegal in some states but i know some moral vegans who aren't opposed to eating (accidental) road kill...
Posted by alexandra_k on September 27, 2006, at 22:54:40
In reply to Re: genetics of schizophrenia » alexandra_k, posted by Phillipa on September 27, 2006, at 22:05:32
> Alex I think the dx is made depending on what meds work or don't work...
the meds don't tend to be dx specific. anti psychotics, for example, are prescribed for a number of conditions...
paranoid type is by far the most common.
i think there tend to be different hospital wards... i know at the hospital i was in there were... 2 general psych wards. 1 secure ward. 1 seclusion ward. 2 open wards (people waiting for supported accomodation). 2 forensic wards. or something like that anyways...
but the secure and seclusion ward weren't really long term...
apparantly the chronic cases (where people don't respond so well to meds) are sent someplace else...
two hospitals in the country who take them... or something like that...
we used to joke about their being a secret ward underneath the general ward where people sometimes went to... we were just kidding around but were told to stop it because it really wasn't helping some people (oops).
i'm not sure on the disorganised / catatonic types whether those kinds of (positive?) symptoms respond fairly well to meds, or not. i don't know. i don't really know anything about this.
but when i was living in supported accomodation most of the people staying there had a dx of schizophrenia. personally... i think more social activities and group type stuff would have helped. there was one girl there who was really smart and wanted to study psychology. she was doing it by correspondence, though, and had trouble motivating herself to keep with it. i studied with her for a while... but then i got back into drugs and became a bad influence methinks :-( there was a guy who was really into drawing and playing the guitar. he used to draw while we were studying for a while... but then playstation is more fun when you are stoned and so... i don't know. little help. thats what struck me. little help...
Posted by Phillipa on September 27, 2006, at 23:18:30
In reply to Re: genetics of schizophrenia, posted by alexandra_k on September 27, 2006, at 22:54:40
Alex this road kill was a three day old dead racoon they are known to carry rabies here. And that is not normal where I live. Love Phillipa
Posted by SLS on September 28, 2006, at 5:33:56
In reply to Re: genetics of schizophrenia » SLS, posted by alexandra_k on September 27, 2006, at 21:16:49
Short and dirty explanation:
There is an environment within the organism. Of particular importance as it relates to schizophrenia would be the environment of the cell, both the cytoplasm and nucleoplasm, where chaotic events analogous to mutations can occur that lead to the differential turning on and turning off of key genes as the progenetor cells of the nervous system are dividing and activating during development.
- Scott
Posted by SLS on September 28, 2006, at 6:33:16
In reply to Re: genetics of schizophrenia » SLS, posted by alexandra_k on September 27, 2006, at 21:16:49
Oh yeah. I forgot.
<smiles> to you to. :-)
You are going to laugh at me,
> What a mess...
That description isn't too bad.
Is that from the DSM?
I am not a DSM critic. I think it needs a lot of work, but it works sometimes. :-)
Actually, when it comes to mood disorders, it really sucks. I don't know why. Perhaps it is because of the diversity of human behavior. It spends much more time on the other Axes. Still, I don't know if I could do any better.
> I wonder if the subtypes are natural kinds?
Hmm. Yes, I think so. At the place I go, there are both paranoid schizophrenics without thought disorder, and those with thought disorder and no paranoia. I converse with both. It is an interesting and human experience. Even though medicated, these people have residual symptoms. The DSM works for them.
> I think (though I could be wrong) that disorganised and catatonic subtypes tend to be more associated with structural abnormalities. I wonder if these are the types that tend to have the relevant gene too?
Sounds like an interesting field trip. I really don't know. This is my suspicion.
When a paranoid woman, Angela, had her medication changed, her paranoia became unmanageable. No amount of explanation helped. She fell apart and was not caring for herself as well. She lost weight and became gaunt. She was recluse and isolative. Poor thing. She is so sweet. I can usually get her to understand that there are no real witches with special powers and that no one means her harm. Recently this hasn't been a problem. She is logical, organized, and linear. Even at her best, though, she is still just a little off target with insight, usually in a cute way. Sometimes, though, she will hit a homerun that is truly humbling. The guy with the thought disorder, Frank, is just full of word salads and non-linear, but is pretty sharp when it comes to insights. He is exceptionally intelligent and reads a lot. When he sits alone, you swear that he is depressed, and are tempted to want to console him. He isn't. He is just disengaged. He is wonderfully friendly, willing to engage in sophisticated, yet dissociated conversations, and will loan you just about anything so you can share what he considers his wealth of experience. There are other schizophrenic people there who do follow almost identical patterns, but these are my two favorites who I interact with the most. They just happen to be of two subtypes. To me, I am sure both have brain disorders and are of two natural kinds. I do not say these things without much experience and reflection.
- Scott
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