Don't lose sleep over this...

Having recently shared a twin room with a heavy snorer, I can tell you a thing or two about sleep deprivation. I lasted a total of three nights and, had I sustained the remaining four for which we were booked, I'm convinced I would have gone mad (I paid the extra for a single room).

A new study suggests I'm not far wrong on this -  researchers from the University of Bonn and King's College London have shown that just 24 hours of sleep deprivation can lead to symptoms of schizophrenia (I would have upgraded sooner, had I known).

Twenty-four healthy volunteers aged between 18 and 40 were trialled in the sleep laboratory, in an initial run being allowed to sleep, normally, overnight. A week later, they were kept awake all night, with conversation, games, movies and walks. They were also exposed to a measurement known as 'pre-pulse inhibition' in which a startle response was elicited through headphones as part of the protocol. The following morning, on both occasions, they were asked to record their thoughts and feelings, using a questionnaire format.

After sleep deprivation, there were pronounced attention deficits, as can occur in the case of schizophrenia. The subjects were found to be more sensitive to light, colour and brightness and their sense of smell was altered. They also reported distortions in their perception of time and many had the impression of being able to read others' minds. Professor Ettinger, a psychologist from the University of Bonn, said the team had not expected that symptoms could be so pronounced after one night spent awake.

I can. And I'm relieved to know that sleep deprivation, though apparently inducing schizophrenia-like symptoms is not harmful; the symptoms rapidly disappear after a solid night's sleep. The researchers wonder whether the symptoms might become gradually weaker as one acclimatises to sleep deprivation. Bags not participating in any of their follow-up work!

Written by Jacqui Hogan

Schizophrenia proven genetic, claims new US study

A new study published in Nature and widely reported in the mainstream media claims to have 'removed any doubt' about a biological cause for schizophrenia.

The study claims that more than one hundred genes associated with dopamine, the immune system and heavy smoking are implicated in causing the condition.

The researchers, from across many different countries, but led by the Stanley Centre for Psychiatric Research at the Broad Institute of MIT and Harvard, looked for genes that were common across of 150,000 participants, 25% of whom were diagnosed with schizophrenia. The over-representation of those with the condition (i.e. 1%, not 25%, of the American population are diagnosed with schizophrenia) was apparently necessary to identify the contributions of multiple genes to the schizophrenia picture.

Commenting on the diffuse and seemingly unrelated collection of genes identified, Steven Hyman, director of the Stanley Centre said:

"Some are very familiar genes expressed in nerve cells, and some are results where you scratch your head and you know you have more work to do."

Fortunately for Hyman, there will be no shortage of funding for continuing research on this theme - thanks to a $650 million donation by Ted Stanley (the largest ever to date in biomedical research), who obviously has more than a passing interest in both schizophrenia and the Stanley Centre.

Hyman made clear the end-game of the research is to wind up not with a list of genes but, rather, novel treatments. His colleague at the institute, former Merck executive, Ed Scolnick, has already developed a pioneering drug development programme which is ready and waiting to get those drugs into the public domain.

Smaller genetic studies have hinted at a link between the immune system and schizophrenia - people with schizophrenia often carry inflammatory blood markers. But equally, studies have implicated stress as a cause of schizophrenia, in which case you would expect to find immune compromise. Twin and adoption studies also clearly demonstrate the role of nurture in the development of the condition, even where there is thought to be a genetic predisposition.

The tone of the publicity being given to this research is authoritative and, combined with what is clearly a very large media spend, it runs the risk of being perceived by the public as ultimate truth - this is certainly the way it is being pitched.

On the very first day of my science degree, the lecturer penned onto the white-board in large capital letters THE SCIENTIFIC PRINCIPLE and, from there, went onto explain, at depth for several lectures, that in science, nothing is ever proven. We formulate hypotheses, yes, and the hypothesis is then either supported or refuted. We never, ever arrive at a conclusive position, simply a working model - that is, we have the humility to understand that life and science are bigger than we are and that our understanding is only valid until such time as further evidence illuminates the proposition.

We would be well advised to scrutinise this research and its context - it is not independent (a thing of the past, as far as anyone can tell) and therefore is bound to be influenced by the commercial aspirations of its funders. Perhaps schizophrenia can be attributed to a specific set of genes, but even if it can, there is too much evidence for the effectiveness of non-genetic interventions in the treatment of the condition to be certain either way.

We need to keep our eyes and ears open as the old order, rooted in morality, gives way to the new. Otherwise we risk falling prey to the obfuscation of reality. Ironically, we'll all be schizophrenic.

Written by Jacqui Hogan

Schizophrenia Awareness Week, November 11-17, 2013

R.D. Laing

And so it is upon us - Schizophrenia Awareness Week 2013, now with just two days to go until the closing gong. So here I am doing my bit, in the hope that my small action here will help to de-stigmatise what must be an incredibly difficult condition to live with.

I have not had much personal exposure to schizophrenia, though I do hold the view that diagnostic labels can often be more dangerous than the conditions which they describe. In that sense, I have some sympathy with the thoughts of R.D Laing (1927 -1981), a Scottish Psychiatrist and a controversial figure, who believed that schizophrenia was "a theory not a fact". He rejected that schizophrenia was genetically inherited - a prominent model of the time - which was also rejected by leading contemporary medical geneticists.

Laing's views were greatly informed by existential philosophy and he believed that the feelings and experiences expressed by the person with schizophrenia were valid descriptions of the lived experience, from which there was much of therapeutic value to be gleaned. In fact, he rejected the notion of an underlying biological model of mental illness more generally - according to Laing, diagnosis of mental illness did not follow a traditional medical model and this led him to question the use of medication, such as anti-psychotics, for those diagnosed with schizophrenia.

Rather, he saw 'schizophrenics' as somehow luminary, people who were expressing fundamental truths about their lives and the world around us, and whose difficulties were merely a reflection and expression of unresolved aspects of their lives. A passage from one of his books, The Politics of Experience, reads:

"If our human race survives, future men will, I suspect, look back on our enlightened epoch as a veritable age of Darkness. They will presumably be able to savour the irony of the situation with more amusement than we can extract from it. The laugh's on us. They will see that what we call 'schizophrenia' was one of the forms in which, often through quite ordinary people, the light began to break through the cracks in our all-too-closed minds."  

From this, we observe the respect he has for those who suffer from schizophrenia, whom he sees as shining beacons in the darkness of our 'enlightened epoch'. Frankly, I'm with Laing, who was effectively blowing wide open preconceptions and misconceptions about the condition.

A year ago, in November 2012, the independent Schizophrenia Commission published its report The Abandoned Illness which found that significant change is urgently required in the NHS (and beyond) to ensure that people affected by schizophrenia, and their families, get the support they need. Following its publication, Rethink Mental Illness Innovation Network has been working with the NHS and independent providers to turn the report's recommendations into nationwide change. The focus has been on providing therapeutic inpatient care, supporting people into employment and improving physical health outcomes.

Whether you hold with Laing's views or a more biological basis for the condition, it's clear that people with schizophrenia need understanding and they need help. Let's hope that awareness-raising, along with government-sponsored and private action, will deliver positive change.

Written by Jacqui Hogan