June 25, 2010

Another Diagnosis Of Schizophrenia, This Time With Cats

Bastet_2.jpg
my boyfriend hates my cat but he loves my         

Part 1 here.

The patient's family asks, "what causes schizophrenia?"  And you give them the speech: "there are probably many causes: genetics, some say an in utero infection, or in the old days they said it was the schizophrenogenic mother."  And then chuckle like you possess any knowledge that allows you such dismissive confidence.  I'm not saying it's true, I'm saying you have no idea if it's true.

The problem is that those aren't all potential causes of schizophrenia, they are causes of different kinds of schizophrenia, none of which you are making any attempt to distinguish.


II.

Toxoplasmosis is an organism that lives part of it's life relatively benignly in the intestine of a cat, gets pooped out, and then taken up by rats where it lodges in the brain, not benignly.  That's the cycle, back and forth.  It also can be taken up by humans, especially little fetuses.

Going from cat to rat is easy.  But how is it supposed to get back to cat?  Rats run away from cats, not towards them.  Indeed, this is innate: even rats that have never seen a cat in hundreds of generations still freak out when confronted with cat odor.

There's been plenty of research observing that schizophrenics are more likely to have been exposed to toxoplasmosis in utero than normals.  So what?  So this.

Researchers took 60 rats, and infected 30 with brain munching toxoplasmosis (verified at the end by autopsy) and the other 30 with terrible, evil saline.  And then they gave them a choice of scented cages to explore.  The scents were either: their own, water, rabbit, or cat.

Comparing infected to non-infected rats, there was only one difference in their preference for cage exploration:


fatal feline attraction preference.png



i.e. the infected rats are insane.

Note that the toxoplasmosis didn't make them more exploratory in general, only dispatched them to their likely doom.  (No, it didn't interfere with their sense of smell.)

Taking the most active infected vs. non-infected mice, and watching them over multiple explorations, not only do they not avoid the cat cage, but they develop a preference for it over other cages:


fatal feline preference.jpg




One might say that toxoplasmosis is a chronic, worsening condition characterized by poor judgment...

The rats don't simply defy danger; they specifically want to die by cat.  Rats can also get killed by minks, but minks don't hunt them.  A similar study gave rats a choice of mink maze and cat maze, the infected rats chose cat-- they chose their specific predator.

It's a truly odd coincidence that while the cat is the mortal enemy of the rat,  the cat is the natural home of toxoplasmosis.  One might even be tempted to say that somehow the toxoplasmosis willed the rat to go against its nature.  "That's dangerous talk around here, lefty, better mind your tongue."   Apologies.

But the other way to look at it is

Studies investigating the neurological basis of anxiety, which often use the reaction of potential prey to cat stimuli as a model, have found that blocking the normally anxiogenic N-methyl-D-aspartic acid receptors in the amygdala, and/or provision of serotonin (5-HT) antagonists, causes rats to approach cat odors "fearlessly," in much the same way that T. gondii-infected rats do.
So the rats become less anxious, more daring?  Odd coincidence: the toxoplasmosis infection rate in 1974 was 22% for the Brits, 84% for the French.  Maybe it makes humans chase pussy as well? 

Lafferty, in 2006, found rates of 45% in the French and 6.6% in the Brits.  How have people changed since the 1970s?  Maybe the reason "there are no real men" is because all the antibiotics have "sterilized" them.


toxo vs masculinity.PNG

III.

Let's assume that these studies show causation and not simply staggeringly awful correlations.  The semantic problem posed here is that you could choose to label the toxoplasmosis as either "schizophrenogenic" or "anxiolytic."  Both are equally valid, by which I mean completely meaningless.  The only thing you know for sure is that it was caused by the toxoplasmosis. 

Toxoplamosis is not a cause of schizophrenia, it is a cause of toxoplasmosis infection.  The schizophrenia part never existed.

IV.

If all this wasn't troubling enough, there's this:

Following a similar model as above, a group of infected rats were also given the treatment for toxoplasmosis (pyrimethamine and Dapsone).  Predictably, this cured the rat and stopped their crazy cat seeking behavior.

However, so did Depakote and Haldol, sometimes even better:

odds ratio cat cage.png
Look at this as the chance of being in the cat cage. a) is all behaviors, and b) teases them out.  You can see that untreated rats like cat cages, treated rats don't. 

What happened?  There's the obvious behavioral explanation (Haldol treated the psychosis); though Haldol does also block toxoplasmosis growth and infection.

Which means if you gave Haldol to a "schizophrenic," and saw "improvement," you would not really know if it was blocking D2 receptors or killing parasites.

And what would you have assumed had the Depakote worked?

V.

No one says syphilis is a cause of schizophrenia, but the same people would say toxoplasmosis is.  I hope you see there is no difference.

---

http://twitter.com/thelastpsych








Comments

i.e. the infected cats are ... (Below threshold)

June 25, 2010 12:26 PM | Posted by aaron: | Reply

i.e. the infected cats are insane.
???

cats or rats??

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Fascinating stuff, and beau... (Below threshold)

June 25, 2010 12:36 PM | Posted by DJMoore: | Reply

Fascinating stuff, and beautifully illustrates the problem of trying to interpret feelings from behavior.

===

My apologies, I don't usually bother to suggest correction of minor typos (I am controlling my Editors' Disease with exercise, meditation, avoidance of caffeine, and forced exposure to YouTube comments), except in cases where they radically change the meaning of what was written, as here:

In the sentence immediately following your first chart, "i.e. the infected cats are insane", I think you meant that the infected R-for-romeo Rats are insane.

Similarly here: "somehow the toxoplasmosis willed the cat to go against its nature."

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Causation is really complic... (Below threshold)

June 25, 2010 1:24 PM | Posted by Catalin: | Reply

Causation is really complicated. The subject you're circling is related more to the definition of therapeutic value(s). Causation is a very indirect route to go; was it intentional? Depends on how old you are.

Or: you are maybe implying that there may be no grounds for establishing something called psychiatry. Correct, but the real point is not if it works because it happens to work or if it works because it has to work. The question is are we kidding ourselves when we say it works? The way you answer that however, has more to do with what one has to lose professionally than to what one actually thinks.

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Your conception of psychiat... (Below threshold)

June 25, 2010 3:50 PM | Posted by Aaron Davies: | Reply

Your conception of psychiatry reminds me a bit of dermatology--while there are plenty of fully understood and treatable skin conditions, there are also a lot of things where you'll just get told "dermatitis" and given a cortisone scrip.

Perhaps a first step would be to stick "idiopathic" in front of all psychiatric conditions. (Well, except for those where "iatrogenic" is more appropriate....)

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So a giant chart with a per... (Below threshold)

June 25, 2010 3:52 PM | Posted by Shannon: | Reply

So a giant chart with a per-person viral and bacterial inventory from various sources (spinal fluid, gut, skin, etc.) and corresponding behavioral traits might tease out the differences between "[oblique idiopathic disorders or unexplainable mental defect]" and treatable or at lest understandable conditions which can be dealt with rationally, increasing the effectiveness of treatment and our understanding of how medications actually work???

You realize there is a movement comprised of people who are all for evaluating human "disease" in a way that acknowledges that what we know about how medicines and diseases work might not be right, and everyone thinks they're crazy. I bet you they don't even watch TV.

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Correct me if I'm wrong, bu... (Below threshold)

June 25, 2010 5:00 PM | Posted by RC: | Reply

Correct me if I'm wrong, but schizophrenics are typically oblivious to danger or they are paranoid, perceiving danger when it does not really exist. Correct?

The rats that were infected didn't become oblivious to danger, nor did they become paranoid. THEY ACTIVELY SOUGHT DANGER!! This could be the definition of insanity, or it could be (again, I'm not an expert) the risk-taking behavior of an adrenaline junkie with ADHD.

As a person with ADHD, I know all too well the allure of skydiving, driving fast, and sordid drunken affairs. I'm quite aware that they are dangerous, BUT THAT'S WHAT MAKES IT FUN!

I'm sure Depakote and Haldol would help fix this by making me numb to any and all forms of pleasure, but right now Ritalin is my drug of choice for that purpose. I'd be interested to know how the risk-taking behavior of these mice would change when treated with psychostimulants.

Perhaps toxoplasmosis and not organophosphates are to blame for the rising number of kids diagnosed with ADHD. Or, more likely, perhaps rats are not the best subjects to model human behavior.

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Sorry RC, but what was your... (Below threshold)

June 25, 2010 11:16 PM | Posted, in reply to RC's comment, by Anonymous: | Reply

Sorry RC, but what was your point again?

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Re-read my last paragraph S... (Below threshold)

June 26, 2010 3:47 AM | Posted, in reply to Anonymous's comment, by RC: | Reply

Re-read my last paragraph SLOWLY, preferably having taken the psychostimulant of your choice.

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Speaking of rats (and corn ... (Below threshold)

June 26, 2010 10:10 AM | Posted by Whatever: | Reply

Speaking of rats (and corn flakes)

http://www.westonaprice.org/modern-foods/567-dirty-secrets-of-the-food-processing-industry.html

ouch

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Excellent post as usual... (Below threshold)

June 26, 2010 5:07 PM | Posted by Vince: | Reply

Excellent post as usual

It's a very interesting topic; impressive how fine-grained some of the behavioral modification can be. There was a nice paper back from 2005 by Thomas on Parasitic manipulation, which could be found here:

http://tiny.cc/5h45a

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and if you reread the artic... (Below threshold)

June 26, 2010 11:33 PM | Posted, in reply to RC's comment, by Anonymous: | Reply

and if you reread the article SLOWLY then you might have remembered that the levels of toxoplasmosis infection seemed to be decreasing in the human population.

In short, it's probably not the cause of ADHD. The rise in ADHD is better explained by current diagnostic practice.

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A lot of you are being waaa... (Below threshold)

June 27, 2010 1:47 AM | Posted by Anonymous: | Reply

A lot of you are being waaay to literal.

If an organism can somehow affect the nervous system of rats resulting in what can only be called illogical and disorganized behavior of cat-seeking, it is not at all unreasonable to think this organism could destroy/alter the nervous system in a similar way in humans creating schizophrenic symptoms.


YOu are falsely reading into this that T. Gondii creates "fearlessness" or that it creates "fear seeking" in rats. There is absolutely zero evidence that T. Gondii is making rats fearless or fear seeking. The only evidence is that T. Gondii makes the rats behave in an illogical reckless, i.e. disorganized way.

Schizophrenics also behave in an illogical, reckless, disorganized way.

Humans are not rats. We do not have a rat nervous system. If we were, maybe these types of "schizophrenics" would simply seek out cats, as opposed to having complex crazy ideas about the government planting chips in their head.

Humans have a complex mind, with the ability to think extremely abstract intricate thoughts, emotions... the outcome of any nervous system disturbing agent (e.g. T. Gondii) is going to have a VERY different effect on a human nervous system than a rat nervous system.

The logical, orderly human mind says "I'm going to get up today, get dressed for the season appropriate way, go outside, go to work, beat rush hour traffic". The crazy brain says "there are people outside listening to my thoughts. I cannot leave the house, satan will get me. I need to plan for the end of the world. The government is inserting thoughts in my brain".

All in all, it's not that much different than a rat running toward cats. It's just a lot bigger, in a much more complex brain. Chaos and irrationality.

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First, I'm so flattered tha... (Below threshold)

June 27, 2010 3:38 AM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

First, I'm so flattered that you find my comment worthy of your time and scrutiny.

Second, I thought I had conveyed with the word "perhaps" that I don't know what causes ADHD. I hadn't expected somebody to take this suggestion so seriously. You do make a good point though.

Third, none of what you mention should overshadow my final point: "Or, more likely, perhaps rats are not the best subjects to model human behavior."

(Note the use of "perhaps" again, with all the uncertainty the word entails.)

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First, I'm so flattered tha... (Below threshold)

June 27, 2010 3:38 AM | Posted, in reply to Anonymous's comment, by RC: | Reply

First, I'm so flattered that you find my comment worthy of your time and scrutiny.

Second, I thought I had conveyed with the word "perhaps" that I don't know what causes ADHD. I hadn't expected somebody to take this suggestion so seriously. You do make a good point though.

Third, none of what you mention should overshadow my final point: "Or, more likely, perhaps rats are not the best subjects to model human behavior."

(Note the use of "perhaps" again, with all the uncertainty the word entails.)

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This reminds me of Richard ... (Below threshold)

June 28, 2010 1:16 AM | Posted by Basil: | Reply

This reminds me of Richard Feynman's talk on "Cargo Cult Science", so called because it has the outward appearance of good science while tending to generate mixed to bad results.

In this case "we think a certain type of disordered thinking is caused by mechanism X and so is treatable by something that we think uses mechanism Y" becomes "schizophrenia is caused by dopamine in the mesolimbic pathway and so we'll treat it with an antipsychotic"-- like wildly searching for a destination and, when you miraculously find the way, saying you knew the route the whole time.

Feynman's talk: http://www.lhup.edu/~DSIMANEK/cargocul.htm

BTW, it's extremely lazy (and also somewhat ironic) to just pepper your statements with "perhaps" and similar caveats when commenting (I say "commenting" as opposed to "debating" because you're not making a point, or at least, not one that wasn't implicit). If you think TLP's wrong, or off-base, or whatever, then find or conduct a study/experiment to prove it.

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Lazy? Are you serious? An... (Below threshold)

June 28, 2010 3:00 AM | Posted, in reply to Basil's comment, by RC: | Reply

Lazy? Are you serious? And "somewhat ironic"? Would you care to explain that one?

When somebody, as I did, says "perhaps," "correct me if I'm wrong," and "I'm not an expert," he is not being lazy or even remotely ironic, he is recognizing his own limitations. I'm not a psychiatrist! Although, I'd like to think that even if I were an expert I would still approach a discussion topic with humility.

Also, citing studies is one way of supporting an argument (or if you want to waste time splitting hairs, a "comment lacking a point that was not implicit"). Another is sharing personal experience. Having lived with ADHD my whole life, I do think I know quite a bit about the nature of this disease, not necessarily from a scientific standpoint but FROM ACTUAL EXPERIENCE.

[In the same way, cancer patients often know more about their disease than their oncologists do. Doctors make a huge blunder when they don't realize this.]

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thanks for a great post! i ... (Below threshold)

June 28, 2010 10:30 AM | Posted by medsvstherapy: | Reply

thanks for a great post! i believe the main flaw is the confidence man approach: when teh head-shrinkers act and feel confident. the sad thing is that the head-shrinkers act quite knowledgeably, but how often do they satisfactorily resolve a problem? especially in someone with schizophrenia symptoms?

maybe a meteorologist is a good analogy: with all of those charts and such, but fail to predict rain tomorrow. should a head-shrinker give a forecast with a margin of error?

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i am right now in a researc... (Below threshold)

June 28, 2010 10:57 AM | Posted by medsvstherapy: | Reply

i am right now in a research conference paper session, and in a parallel universe: increase of prescribing of psych meds for kids of families in distress, pre/post acute stressor administrative data study design, must mean the kids have a biologically based brain disorder. we all calmly accept the data presentation unblinkingly. after all, the powerpoint slides are so well developed, and the analyses included a handful of covariates. god help us.

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"Lazy? Are you serious? And... (Below threshold)

June 28, 2010 1:25 PM | Posted by Basil: | Reply

"Lazy? Are you serious? And "somewhat ironic"? Would you care to explain that one?"

Sure. Saying "perhaps" or "I'm not an expert" and then continuing on regardless contributes noise absent signal to the conversation. If you're not willing to actually become an expert or at least informed enough so you don't have to hedge with "perhaps", then you're not helping someone reach understanding, you are just playing linguistic games. "Of that which we cannot speak..." and all that.

It's lazy because it allows you to talk without having anything worth saying, and it's ironic because this very propagation of ignorance is what allows a supposedly rational, scientific field like medicine to devolve into word manipulation and pseudo-science.

http://en.wikipedia.org/wiki/Weasel_word

I hope that clarifies.

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I still don’t understand ho... (Below threshold)

June 28, 2010 2:29 PM | Posted, in reply to Basil's comment, by Anonymous: | Reply

I still don’t understand how I was being “somewhat ironic” – your explanation is not logical – but it’s VERY IRONIC when somebody prefaces criticism with the weasel word “somewhat,” then subsequently denounces the use of weasel words for how it “contributes noise absent signal to the conversation [sic].”

Overall, you are assuming WAY too much about my intentions. When somebody is “playing linguistic games,” he/she is INTENTIONALLY trying to deceive and manipulate others. How the hell do you know what I’m doing? You don’t and you can’t.

As your wikipedia article states, “for a statement to be a weasel expression, it needs other indications of disingenuousness.” As I said before, I AM NOT A PSYCHIATRIST!! I am not trying to pass myself off as an expert, and I am not trying to deceive anybody.

I follow and participate in this blog, not because I’m interested in “helping someone reach understanding,” not because I am a member of a “supposedly rational, scientific field like medicine,” but for one reason only: BECAUSE IT IS FUN!! Don’t assume everybody who follows this blog does so with the same reasons as you.

Instead of calmly and rationally explaining why my points (excuse me, COMMENTS) were wrong, you’ve resorted to mudslinging and insults. Now, instead of talking about psychiatry, I’m here trying to defend my integrity, to show I’m not an ignorant/lazy/ironic weasel, or something like that. Alone calls this “the cognitive kill switch,” but less educated, low-brow folks like me describe it more bluntly with four letter words.

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zombie snails, what?... (Below threshold)

June 28, 2010 4:54 PM | Posted by Anonymous: | Reply

zombie snails, what?
http://www.i-am-bored.com/bored_link.cfm?link_id=21122

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Going from cat to rat is... (Below threshold)

June 29, 2010 9:35 AM | Posted by Jack Coupal: | Reply

Going from cat to rat is easy. But how is it supposed to get back to cat?

Because cats eat rats they catch??

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Good post, however there ac... (Below threshold)

June 29, 2010 2:23 PM | Posted, in reply to Basil's comment, by Anonymous: | Reply

Good post, however there actually is quite a lot of evidence for the relationship between dopamine, catecholamines, and hallucinations.

It is shown that using dopaminergic drugs such as bromocriptine and carbidopa will induce hallucinations in people. Note, this doesn't turn into frank psychosis and schizophrenia, but it DOES create "positive symptoms" particularly visual hallucinations... particularly in people with noted brain problems (e.g. elderly with parkinsons are more vulnerable to hallucinating on dopaminergics than healthy young with in tact non-messed up brains).

Speaking personally, I experienced carbidopa-like hallucinations from an OTC tyrosine supplement. While taking lots of tyrosine, I began to have simple visual hallucinations such as bugs and small animals and occasionally crazy thoughts in my head (which I knew weren't true but none the less was prone to having crazy thoughts). Tyrosine converts to carbidopa and dopamine fyi.
I am young, although I have a strong family history of insanity and psychosis and I myself am a bit mental so perhaps I am more vulnerable than the average person to the crazy making effects of slightly elevated catecholamines/precursors.

Either way, it really is a fact that positive sypmtoms are a function of dopamine and junk.

This doesn't mean the illness of psychosis and schizophrenia is CAUSED by dopamine, but it does mean that medications which block the stuff will reduce crazy thoughts - no matter what class they are (i.e. antiemetics like reglan / metocloprimide are also effective antipsychotics).

Psychiatry is mostly palliative care for the mind.

The problem is psychiatry is they pretend to be in the business of understanding disease and curing it. That's more neurology's bag.

Psychiatry is equipped, fundamentally, to only really offer medications that reduce symptoms of distress and functional impairment. As a BEST case scenario. It is palliative care for the mind.

If psychiatry stopped pretending and posing like their palliative treatments were cures, we would all be much less upset, I think.

If morphine sulfate as part of hospice care reduces the subjective and objective behavior of chronic pain, no one says "morphine sulfate is curing the disease of pain". Unfortunately, psychiatrists make this statement when they say haldol treats schizophrenia.

Dopamine blockers do not have any ability to treat disease with mental symptoms. All they can due is reduce the most significant symptoms of it, and so allow people to function a bit better, until one day science (neurologists, immunology, whoever) discovers what actually CAUSES these problems and how to fix it, if it is possible to fix it.

Dopamine blockers for psycohsis isn't any different than morphine sulfate for stage 4 cancer w. mets, the only difference is that the doctors who prescribe the dopamine blockers lie to patients and tell them the medication treats the disease.

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Dopamine Anonymous: to add ... (Below threshold)

June 29, 2010 6:27 PM | Posted by medsvstherapy: | Reply

Dopamine Anonymous: to add to the discussion abt causes, labels, and symptoms around the concept "schizophrenia:" I have worked with and gotten to know, across time, maybe a hundred people who reasonably were dx with schizophrenia. we did not regard visual hallucinations as indicating likely schizophrenia. the ppl with vis hallucination almost always had a readily identifiable organic cause - head injury, someone who played around with LSD, someone with head injury, and so on.

we weren't the first to figure this out. schneider gets the credit.

at least we did not get faked out to easily.

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Hi, dopamine anonymous here... (Below threshold)

June 29, 2010 8:28 PM | Posted by Anonymous: | Reply

Hi, dopamine anonymous here (I like that name, I might use it from now on. DOPAMINE ANONYMOUS, cuz I'm off kilter and ramble anyway, pretty fitting).

MedsVTherapy, I believe we spoke before. We spoke regarding a response you made where in which you said something about how you had a client in therapy who's mother made her attempt to commit arson/murder by throwing a flaming object at a rival neighbor's house. You believed this was evidence a single event, not dealt with, can affect a person's development... you, believing that she grew feeling like a terrible person for doing this and it affected her forever.

I then pointed out it was highly unlikely this event is the reason your client was so fucked up and venting in massive purging crying, but was probably much more likely a long pattern of abuse at the hands of her parents.

You then agreed and said the client did have terrible abuse by her parents and this was not an isolated event.

Well, I would argue again you seem to be committing the same error of short sightedness.

Just because "schizophrenic" clients who have primarily or exclusively visual hallucinations have an organic cause that is readily identifiable, does not mean that "schizophrenic" clients who have no visual hallucies, OR visual + auditory/delusions/tactile hallucies are NOT suffering from an organic condition that can be identified with enough investigation.

I would also at this junction point out this is exactly what TLP is saying - schizophrenia does NOT really exist. It is a description of a description. Every "schizophrenic" has a pathophysiological, biological cause for their fucked up thinking if only we could identify it, and they are NOT going to be the same from one client to the other.


You are correct, patients who present with primary or exclusively visual symptoms are almost always suffering from an easily identifiable condition. Brain tumors, LSD, etc.

The reason this is so is because people with visual hallucinations only do not really meet the criteria for schizophrenia. No negative symptoms, only one type of hallucination...they are misdiagnosed. This means to say their 'psychotic symptoms" are nowhere near extreme enough to warrant a mental health diagnosis. That doesn't stop malicious psychiatrists who want that insurance money, though.

http://en.wikipedia.org/wiki/Schizophrenia

Read the diagnostic criteria. The criteria is there specifically to prevent people from being diagnosed with mild thought disorder symptoms as schizophrenic.

IF a dude presents with only visual hallucinations, NO delusions or auditory or tactile or negative symptoms... he's misdiagnosed.


so you have two issues going on here.

One, psychiatrists just randomly label patients with whatever diagnosis they want. Misogynistic psychiatrist? All female patients are borderline or suffering from some other PD. Greedy psychiatrist? Then you're bipolar. Or schizophrenic. Anything that requires lots of meds chronically. Lazy psychiatrist (often found with greed too)? Something NOS, and then SSRIs and PRN benzos/seroquel to medicate away any poor coping or distress and placate the patient.

As a result of this, a lot of people who end up in a psychiatrists office are going to be diagnosed with shit that is out and out ridiculous... like a man who is totally normal and functional with visual hallucinations being labeled schizophrenic.


The second issue is that schizophrenia itself is not a real disease. Every schizophrenic in existence has a real physiological reason for those symptoms... it just so happens that when doctors don't know why, when it occurs younger than 65, they just end up calling it schizophrenia. If it happened later they would probably call it dementia, and if it were obvious/less extreme (e.g. simple visual hallucinations) there is probably an isolated, specific reason for it like a tumor pressing on the visual optic nerve region of the brain.

But when you have the extreme thought disorder found in schizophrenia (multiple types of hallucinations, with delusions and negative symptoms too) there is not going to be a "readily identifiable organic cause". Schizophrenia is a generalized thought disorder, not one type of positive/negative symptom, MULTIPLE types.

It's going to be either multiple causes (prenatal insult, PLUS postnatal stress, PLUS genetic vulnerability...) or it is going to be a single thing that is so obscure that it would take a fucking television doctor to figure it out... like patient misses an enzyme to process x nutrients resulting in some sort of deficiency or excess resulting in brain deterioration and thought disorder. No one will ever figure it out, you'll just keep sucking back haldol trying to control the insanity.

And, I would also say that you are simply wrong that every patient with visual symptoms is NOT schizophrenic. Research shows that people who do meet the full criteria for schizophrenia often have visual symptoms too... it's just that doctors generally don't recognize it since auditory hallucinations ("hearing voices") and delusions are so much more severe and impairing.


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Dopanonymous: these are tri... (Below threshold)

July 1, 2010 9:24 AM | Posted by medsvstherapy: | Reply

Dopanonymous: these are tricky issues. Long before the physiologiy of diabetes was recognized, clinicians recognized that there were a couple problems they encountered. In these clinical presentations, people were thirsty and had to urinate a lot. In the long run, they got sicker and died. To discriminate the two conditions, you would sip the urine. If the urine was sweet, the person had diabetes mellitus - which means urine is passing through this person and it has a sweet taste.

We still use this term, a descriptive term. It was hundreds of years before the physiology of insulin management and dysregulation was reasonably understood.

But the clinicians took this huge leap of inductive reasoning. They made the assumption that people with a similar pattern of symptoms had some similiar condition with similar etiology and similar pathophysiology.

This is why al-Razi is so well-recognized today: for noting patterns of symptoms, then figuring out how to determine if and when these were indicators of an underlying problem.

Psychiatry is filled with these types of stories. Sure, you can take any condition and declare that it does not really exist; that it is a label thrown at people in order for our society to oppress them, or for whatever malevolent reason it is that we throw labels on people. I am aware that happpens.

At the same time, I believe that there is a pathophysiological condition recognized, by Schneider and others, as schizophrenia. Sure, it can be confused with other conditions. And yes, it is probably heterogeneous, with a few causes that lead to similar presentations, and a range of presentations emerging from any of these causes, whether induced by a cat or a hebephrenegenic mother.

That is my belief. when I see a similar presentation, but it does not fit close enough to my prototype, I begin to suspect that I am barking up the wrong tree if I suspect "schizophrenia," and I consider other diagnoses.

Myself, I prefer to conduct pretty thorough histories. So, I usually stumble across the brain-injuring factor by my systematic style. I ask abt problems in pregnancy or in delivery, such as a time of anoxia at birth, early delivery, and so on. I ask this of anyone I am diagnosing.

I ask about head injuries, and also about any loss of consciousness with that. So, the hallucinating guy whose probelms started after he was hit with a forklift arm thingie was not too difficult to figure out.

I ask about education and work history. So, the guy with a workplace exposure to arsenic, in a workplace accident where they were removing the arsenic that naturally occurs in natural gas, was not too hard to figure out.

Sure, I could be totally wrong. But to me, there is a set of people who fit the profile I have in my head of "schizophrenia," and some people who sound like they do, but don't fit the pattern well. This is reasonable to pay attn to, since treatment will break along these lines. One way that ppl vary from the prototype is when their predominant probolem is VH, and as you note a lack of other pos symptoms and a lack of neg symptoms.

We were unsure of a young man was having crazy ideas because of drug use or "schizophrenia." So, in a state hosp setting, we took him off his antipsychotic drugs that he had been put on at admission a couple days before. I tested this guy in two sessions, a couple days apart. I and others had a great chance to observe his "decompensation," including his changed response to "touch your left elbow with your left hand." He was put back on meds and I got to see his thinking clearing up acouple days later.

That is my submission for "This I Believe." I believe that there is a condition called schizophrenia. I believe other things may look like it. I believe that the presence of visual hallucinations without other notable sx should make anyone be wary of sticking a schizophrenia label on a person, including your own experimentation with mushrooms, jimsonweed, or whatever.

You can pick apart my couple of brief case presentations. But I am only throwing them out there to illustrate a point. I have been through plenty of case presentations, staffings, and so on. Those are lots longer and more in depth. This is just a comment on a blog.

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But that is what I am sayin... (Below threshold)

July 1, 2010 1:04 PM | Posted by Anonymous: | Reply

But that is what I am saying...

People labeled schizophrenia who only have 1 type of positive symptom, visual hallucinations, without meeting the other criteria, are misdiagnosed. They do not even come close to fitting the criteria. You need to have the following to be properly schizophrenic:

1) TWO characteristic symptoms (hallucinations, grossly disorganized speech (to the point where communication is impossible), disorganized behavior, delusions, negative symptoms)

2) Duration > 6mos

3) Symptoms make you stand out as abnormal (i.e. "impaired functioning")

If you read that criteria it becomes VERY obvious that a lot of people are being diagnosed with schizophrenia who don't have it. Like a man who has visual hallucinations and no other symptoms, who gets along pretty well w/o disorganized speech, behavior, negative symptoms or delusions.

The hallucination part is only a small aspect of schizophrenia, as you see the other criteria focuses on disordered thinking, being unable to really function due to craziness and such.

So, okay, even if we agree that "schizophrenia" does exist, that there is a collection of symptoms which defines this thing and it isn't a random bunch of sick people with nothing in common pathophysiologically speaking (the way diabetes mellitus IS diagnostically useful since it describes a common condition of being unable to use glucose resulting in hyperglycemia)... okay lets assume that all schizophrenics who are validly schizophrenic (i.e. meet the criteria) have something pathophysiologically common and useful enough to maintain the diagnosis.

Still, you really didn't "discover" visual hallucinations aren't schizophrenia. This is already known, it is part of the diagnostic criteria. Visual hallucinations do occur in schizophrenia, but when a relatively normal person comes in and says "I see things sometimes" and there aren't any symptoms of thought disorder and impaired functioning, this person does NOT meet the criteria for schizophrenia so any schizo diagnosis is inappropriate.

If they see things, hear the voice of god, think the government is putting thoughts in their brain, plus don't make sense when they talk, plus can't work or get along in society, plus have had the symptoms for 7 months, then that person is probably "schizophrenic".

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Do other "antipsycho... (Below threshold)

July 3, 2010 1:28 AM | Posted by David: | Reply


Do other "antipsychotics" work against toxoplasmosis or just Haldol? Or is it just that Haldol's the only one that's been tested against it? And does Haldol really kill the parasites or just disable the chemical crap they cause?

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As someone diagnosed with s... (Below threshold)

July 4, 2010 3:13 PM | Posted by kurt: | Reply

As someone diagnosed with schizophrenia I immediately started to wonder, how am I like the mice that is attracted to the cat's scent? How do I seek out behaviors that hurt me? The funny answer is we all do to an extent. We smoke and drink. Don't wear seat belts. Construct high rise buildings without safety nets. There's a lot of risky behavior that we willingly engage in. Then I thought of my dad, almost the complete opposite of me. He's never been depressed, hardly ever gets angry, certainly never been manic. I think our main difference is I beat myself up a lot more. He can live with imperfection whereas I berate myself over the smallest details. In short he loves himself and I hate myself. My cat scent is self-loathing.

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All I got out of this is th... (Below threshold)

July 18, 2011 3:53 PM | Posted by Phil A.: | Reply

All I got out of this is that T. Gondii is responsible for Caturday-type memes.

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So T. gondii is a really a ... (Below threshold)

November 1, 2011 2:20 PM | Posted by Nepeta: | Reply

So T. gondii is a really a food delivery system for cats?

TIL

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Turizmtrend.com ile en günc... (Below threshold)

June 4, 2012 6:39 AM | Posted by Turizm: | Reply

Turizmtrend.com ile en güncel turizm bilgilerine, en trend tatil bilgilerine ulaşabilirsiniz. Türkiye`nin en profesyonel turizm ekibinin hazırladığı içeriklerimiz ile turizm sektörüne yeni bir soluk katacağız. Turizm Trend - Turizmin Yeni Trendi - Erken Rezervasyon Tatil


Turizm

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I think maybe this is the s... (Below threshold)

November 19, 2012 4:50 PM | Posted by baba: | Reply

I think maybe this is the same person talking to themselves.

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