“Most teenagers have their first alcoholic drink during puberty. However, most research on the risks of early-onset alcohol use up to now has not focused on the pubertal stage during which the first alcoholic drink is consumed,” said Miriam Schneider, Ph.D., a researcher at the Central Institute of Mental Health, University of Heidelberg, and one of the authors of the new study.

She noted that a common notion in alcohol research is that the earlier adolescents began to drink, the bigger problems they faced later in life.

“However, a closer look at the statistics revealed a peak risk of alcohol use disorders for those beginning at 12 to 14 years of age, while even earlier beginners seemed to have a slightly lower risk,” she said.

On average, girls begin puberty between the ages of 10 and 11, while boys typically start between the ages 11 of 12. Puberty lasts approximately 5 to 6 years for most teens.

For the study, Schneider and her colleagues determined the age at first drink in 283 young adults — 152 females, 131 males — who were part of a larger epidemiological study.

In addition, the participants’ drinking behavior — such as number of drinking days, amount of alcohol consumed, and hazardous drinking — was assessed at ages 19, 22, and 23 years via interviews and questionnaires.

The researchers also concurrently conducted a rodent study to examine the effects of mid-puberty or adult alcohol exposure on voluntary alcohol consumption in later life by 20 male Wistar rats.

“Both studies revealed that those individuals that initiated alcohol consumption during puberty tended to drink more and also more frequently than those starting after puberty,” said Schneider.

That means that puberty is a “risk window” for having that first drink, said Rainer Spanagel, Ph.D., head of the Institute of Psychopharmacology at the University of Heidelberg.

The study’s results also show a higher Alcohol Use Disorders Identification Test (AUDIT) score later in life in those individuals who had their first drink in puberty, he said.

“A higher AUDIT score is indicative of a high likelihood of hazardous or harmful alcohol consumption,” he explained. “This information is of great relevance for intervention programs. Even more interesting, neither pre-pubertal nor post-pubertal periods seem to serve as risk-time windows. Therefore, intervention programs should be directed selectively towards young people in puberty.”

Both Schneider and Spanagel noted the influence of a high degree of brain development that occurs during puberty.

“Numerous neurodevelopmental alterations are taking place during puberty, such as maturational processes in cortical and limbic regions, which are characterized by both progressive and regressive changes, such as myelination and synaptic pruning,” said Schneider.

“Typically, an overproduction of axons and synapses can be found during early puberty, followed by rapid pruning during later puberty, indicating that connections and communication between subcortical and cortical regions are in a highly transitional state during this period.”

“Puberty is a phase in which the brain reward system undergoes major functional changes,” added Spanagel. “For example, the endocannabinoid and dopamine systems are at their peak and these major neurobiological changes are reflected on the behavioral level; reward sensitivity is highest during puberty.

“Therefore, during puberty the brain is in a highly vulnerable state for any kind of reward, and drug rewards in particular. This high vulnerability might also affect reward seeking, or in this particular case, alcohol seeking and drinking behavior later in life.”

Said Schneider, “It is exactly during puberty that substances like drugs of abuse — alcohol, cannabis, etc. — may induce the most destructive and also persistent effects on the still developing brain, which may in some cases even result in neuropsychiatric disorders, such as schizophrenia or addictive disorders.

“Prevention work therefore needs to increase awareness of specific risks and vulnerability related to puberty.”

Source: Alcoholism: Clinical & Experimental Research

Adolescent drinking alcohol photo by shutterstock.

Schizophrenia is a rare but serious psychiatric disorder, usually beginning in late adolescence, and is characterized by hallucinations, delusions, paranoia, cognitive impairment, social withdrawal, self-neglect and loss of motivation and initiative.

The study, published in Biological Psychiatry, involved data from 937 individuals in Scotland who first completed IQ testing in 1947, at age 11.

At age 70, their IQ was tested again, and their DNA was analyzed to estimate their genetic risk for schizophrenia.

The findings show that those with a higher genetic risk for schizophrenia had a lower IQ at age 70 but not at age 11.

Having more schizophrenia risk-related gene variants was also linked to a greater decline in lifelong cognitive ability.

“If nature has loaded a person’s genes towards schizophrenia, then there is a slight but detectable worsening in cognitive function between childhood and old age.

“With further research into how these genes affect the brain, it could become possible to understand how genes linked to schizophrenia affect people’s cognitive function,” said Andrew McIntosh, M.D., from the University of Edinburgh.

These findings suggest that common genetic variants may underlie both cognitive aging and the risk of schizophrenia.

“While this study does not show that these common gene variants produce schizophrenia per se, it elegantly suggests that these variants may contribute to declines in intelligence, a clinical feature associated with schizophrenia,” commented Dr. John Krystal, editor of Biological Psychiatry.

“However, we have yet to understand the development of cognitive impairments that produce disability in young adulthood, the period when schizophrenia develops for many affected people.”

More research is needed, but these new findings add to the growing and extensive effort to figure out how the gene variants that contribute to the development of schizophrenia give rise to the cognitive problems often associated with it.

Source: Biological Psychiatry

Abstract of human mind photo by shutterstock.

If the mother contracts the flu, the child has a nearly four-fold increased chance of developing bipolar disorder in adulthood, say researchers.

The findings add to mounting evidence of possible shared underlying causes and illness processes with schizophrenia, which some studies have also linked to prenatal exposure to influenza.

“Prospective mothers should take common sense preventive measures, such as getting flu shots prior to and in the early stages of pregnancy and avoiding contact with people who are symptomatic,” said Alan Brown, M.D., M.P.H, of Columbia University.

“In spite of public health recommendations, only a relatively small fraction of such women get immunized. The weight of evidence now suggests that benefits of the vaccine likely outweigh any possible risk to the mother or newborn.”

Brown and colleagues reported their findings online in the journal JAMA Psychiatry.

Although researchers have suspected a linkage between maternal influenza and bipolar disorder, the new study is the first to prospectively follow families using physician-based diagnoses and structured standardized psychiatric measures.

The research was made possible by use of comprehensive electronic medical records by Kaiser-Permanente, in association with county and Child Health and Development Study databases.

This shared health care data repository allowed the evaluation of more cases with detailed maternal flu exposure information than in previous studies.

Among nearly a third of all children born in a northern California county during 1959-1966, researchers followed, 92 who developed bipolar disorder, comparing rates of maternal flu diagnoses during pregnancy with 722 matched controls.

The nearly fourfold increased risk implicated influenza infection at any time during pregnancy, but there was evidence suggesting slightly higher risk if the flu occurred during the second or third trimesters.

Moreover, the researchers linked flu exposure to a nearly six-fold increase in a subtype of bipolar disorder with psychotic features.

Prior research suggested a threefold increased risk for schizophrenia associated with maternal influenza during the first half of pregnancy.

Autism has similarly been linked to first trimester maternal viral infections and to possibly related increases in inflammatory molecules.

“Future research might investigate whether this same environmental risk factor might give rise to different disorders, depending on how the timing of the prenatal insult affects the developing fetal brain,” suggested Brown.

Bipolar disorder shares with schizophrenia a number of other suspected causes and illness features, the researchers note.

For example, both share onset of symptoms in early adulthood, susceptibility genes, run in the same families, affect nearly one percent of the population, show psychotic behaviors and respond to antipsychotic medications.

Source: NIH/National Institute of Mental Health

For several decades now, “schizophrenia” has been the word used to describe a condition with a specific type of psychosis. However, many agree that the word tends to stir up a negative image with significant stigma — suggesting discrimination, labeling, isolation and social rejection.

Recently, discussions have emerged about whether or not to change the term “schizophrenia” to something that would be less stigmatizing.  Several suggestions have been made, but it seems that the most accepted term is salience syndrome.

The majority of experts in the scientific community agree that salience — which describes the internal process of reacting to and processing of stimuli — most accurately conveys the actual experience of individuals with schizophrenia.

However, the patients themselves had yet to weigh in on the name change, so Constantin Tranulis, M.D., of the Department of Psychiatry at the University of Montreal in Canada wanted to assess their opinions on the topic.

Tranulis asked 161 college students as well as 19 patients who were in the early stages of psychosis about the acceptability, validity, and impact of both diagnostic terms — schizophrenia and salience syndrome.

The college students did not seem to prefer one term over the other.

The findings showed that the college students already had preconceived beliefs about the stigmatizing characteristics of the illness, including social rejection and discrimination, no matter which name was assigned to it.

The only difference in opinion was found in the psychology students, who had a slight preference for salience syndrome when compared to biology students.

However, when Tranulis surveyed patients with the actual disorder, the results were quite different. The individuals with psychosis almost unanimously chose “salience syndrome” over “schizophrenia.”

The biggest reason for their choice was that the name change could help protect them from experiencing the stigmatization associated with the well-known term of schizophrenia.

But they also were concerned that eventually people would know that salience syndrome and schizophrenia were the same disorder, and that, overtime, patients with salience syndrome would be subjected to the same negative stigma.

Overall, the participants had varying views on choosing a name for the disorder, but people who actually lived with the pain of stigma seemed most sensitive to the options.   An interesting findings was that the patients felt less self-inflicted stigma with the term “salience syndrome.”

Tranulis added, “Future studies with larger samples are warranted in order to clarify the role of labels on self-stigmatizing attitudes.”

Source:  PLoS ONE

Schizophrenia word collage photo by shutterstock.

Sodium nitroprusside is used to treat severe hypertension. But there is also evidence that it also regulates the activity of N-methyl-D-aspartate (NMDA) glutamate receptors, said the researchers.

Since blocking those receptors in animals leads to psychosis-like behavior, the researchers wondered if the drug could benefit humans with schizophrenia.

In a small randomized trial, many patients experienced a diminishing of their symptoms within four hours, while those who got a matching placebo did not, according to Serdar Dursun, M.D., Ph.D., of the University of Alberta in Edmonton, and colleagues. 

The improvements lasted up to four weeks without any noticeable adverse effects.

Although the results should be considered preliminary because of the size of the study — only 20 patients — the authors said that the findings “are exciting in terms of effectiveness of the drug.”

The study involved 20 patients, in an acute phase of schizophrenia, all of whom required inpatient care. The participants were between the ages of 19 and 40 and were in the first five years since diagnosis. All were on stable antipsychotics at the time of the infusion.

Ten patients received sodium nitroprusside at 0.5 micrograms per kilogram of body weight per minute for four hours – the lowest recommended dose for humans. The remaining 10 patients got 5 percent glucose, also infused for four hours.

During the infusions and for four weeks afterward, psychiatrists monitored schizophrenia symptoms using the 18-item Brief Psychiatric Rating Scale and the negative subscale of the Positive and Negative Syndrome Scale. They also measured safety and tolerability of the drug, both physiologically and psychologically.

During the infusion, they found a positive effect on the brief rating scale that was apparent by the second hour. The effect was seen in all patients getting the drug, but not in any placebo patient.

A similar rapid effect was observed on the positive-negative symptom scale.  On both scales, the improvement continued for at least four weeks, the researchers reported.

The findings offer further support that NMDA receptors are underperforming in schizophrenia, commented Joseph Coyle, M.D., of Harvard Medical School.

Coyle noted that the results are consistent with other studies that involve those receptors. But, he said, the current study remains too small to justify changes in clinical practice.

“Caution must be exercised until sufficiently powered clinical trials of nitroprusside are performed in patients with schizophrenia,” said Coyle.

The researchers note that participants were fairly early in their disease course. Future research, they said, should test the drug in patients with long-term illness.

They also noted that the study allowed for changes to supplemental medications (such as benzodiazepines and analgesics) 48 hours after the infusion and to antipsychotics after seven days. Because of this, there is “uncertainty to the antipsychotic effects of sodium nitroprusside alone at later time points.”

Source: JAMA Psychiatry

schizophrenia word collage photo by shutterstock.

Bipolar disorder causes unusual shifts in mood, energy, activity levels and the ability to carry out basic tasks. Although some people have their first symptoms during childhood, the disorder often develops in the late teens or early adult years.

“We don’t fully understand this,” said study co-author Alan Brown, M.D. “The best guess is it’s an inflammatory response. It could also be a result of fever.”

Brown, a professor of clinical psychiatry and clinical epidemiology at the Columbia University College of Physicians and Surgeons in New York City, said, “Mothers should stay away from people who have the flu.”

Brown added that “women should not be greatly concerned, because a fourfold increase is pretty high from an epidemiological standpoint, but still the vast majority of the offspring did not get bipolar disorder.”

Brown further explained that “the risk of bipolar disorder in the population is about 1 percent, so if it’s increased fourfold that would make it a 4 percent risk.”

Furthermore, the study only looked at one risk factor for bipolar disorder, not all risk factors, which could skew these results, he noted.

For the study, researchers at Columbia University and Kaiser Permanente identified cases of bipolar disorder by database linkages of a Northern California health plan and a county health care system, along with data from a mailed survey.

The study participants were mothers who gave birth between 1959 and 1966 and their offspring. Researchers found 92 cases of bipolar disorder and compared them with 722 people matched in terms of occurrence of maternal influenza during pregnancy.

Although the research found a link between pregnant women getting the flu and a higher risk of bipolar disorder in their offspring, it didn’t establish a cause-and-effect relationship.

“There is no understanding of the causal factors of this,” said Alan Manevitz, M.D., a clinical psychiatrist at Lenox Hill Hospital in New York City. He was not involved with the study.  “Pregnancy itself puts extra stress on women in general,” he pointed out. “Pregnancy also affects the immune system and increases the risk of getting the flu.”

Flu during pregnancy increases the risk of miscarriage, premature birth and low birth-weight infants, Manevitz said.

Other studies have shown a similar connection between flu during pregnancy and the child’s risk for autism and schizophrenia — now there is a link with bipolar disorder, Manevitz said.

Source:  JAMA Psychiatry

“This higher risk held if they were hospitalized for an infection at any given age before the onset of schizophrenia,” said lead investigator Philip R. Nielsen, a Ph.D. candidate at the National Centre for Register-based Research, Aarhus University, Denmark.

The findings also showed an increased risk for schizophrenia if the child’s father had been hospitalized for infection.

“These are serious infections requiring hospitalization, so it is only the more severe cases of infections that are implicated here, and the fact that we found raised risk if the father had a history of being hospitalized for infection indicates that there may be some familial susceptibility to infection and subsequent schizophrenia risk,” Nielsen said.

“We know that we are dealing with a multifactorial etiology in the case of schizophrenia, so infection is probably not a single causal factor. The association between childhood infection and schizophrenia may be due to inflammatory responses affecting the brain, or genetic and environmental risk factors in certain families,” Nielsen said.

The research was presented at the 14th International Congress on Schizophrenia Research (ICOSR).

Although several studies have reported links between maternal infections during pregnancy and schizophrenia, few studies have investigated infections in children, and their results have been inconclusive, Nielsen said.

In the new study, researchers pulled data from two population-based registers — the Danish Psychiatric Central Register and the Danish National Hospital Register — and selected all individuals born in Denmark between 1981 and 2000, which totaled 843,390 individuals.

They then identified 3,409 individuals who had entered a hospital for the first time with schizophrenia between the years 1991 and 2010. Of these, 1549 were exposed to an infection during their childhood that required hospitalization.

Those who were hospitalized for infection during childhood were almost 50 percent more likely to develop schizophrenia than individuals who were not.  Bacterial infection was associated with the highest risk. Viral infections increased the risk by 40 percent.

“There are several schools of thought in terms of the infection-based hypothesis of the link between infection and schizophrenia,” said Emily G. Severance, Ph.D., a schizophrenia expert at Johns Hopkins University School of Medicine in Baltimore, Md., who was not involved in the study.

“Perhaps it is something that occurs prenatally that affects the development of the neurons in the developing brain, or perhaps it happens postnatally, as in this study, when the brain is still developing. Infection could also disrupt synaptic connections,” Severance said. “There are a number of different risk factors associated with the immune system and schizophrenia.”

Source:  International Congress on Schizophrenia Research

Young boy in the hospital photo by shutterstock.

As part of her doctorate in clinical psychology, Rachel Morton of Queensland University of Technology’s School of Psychology and Counseling in Australia interviewed relatives of people with schizophrenia to gain a better understanding of the disorder’s impact on the family.

“Most relatives identified that having a relative with schizophrenia contributed to their own personal development, such as having greater compassion for those with mental health issues and having a greater appreciation for what is important in their life,” she said.

According to Morton, one participant reported that living with someone with schizophrenia had influenced her own career choice to become a health professional. In another example, a family member credited living with someone with schizophrenia to giving life new meaning.

As a result of the findings, Morton plans to conduct a worldwide survey to determine whether or not  personal growth and benefits are common across a wider cross-section of family members living with a loved one with schizophrenia.

Morton will be interviewing participants over the age of 16 who have a first-degree family member with schizophrenia and who have lived with that person at some point during their diagnosis.

“Family members frequently reported that the nature of schizophrenia meant their relative required a range of support, including financial, social, and assistance in getting treatment, all of which were reported to take a large emotional toll on the family members themselves,” said Morton. 

“It was common for people to report frustration with some mental health professionals and systems.

“I want to investigate this issue more widely and further explore the stress they feel and how family members cope with this stress,” she said.

“This survey is important because family members often get forgotten when health professionals are dealing with people with schizophrenia.”

Source:  Queensland University of Technology

Man holding a heart of light photo by shutterstock.

As with all mental disorders and many other diseases, mental health professionals rely on a set of diagnostic criteria in which to diagnose schizophrenia. The criteria list symptoms and is usually based upon self-report or the report of family members. Sometimes when further information is needed, additional psychological testing may aid in an accurate diagnosis.

Provocative new pilot research suggests collecting tissue from the nose through a biopsy — a surgical incision that removes physical material for analysis — may provide another set of diagnostic capabilities.

Researchers from Tel Aviv University and Johns Hopkins Hospital believe this method to collect and sequence neurons from the nose may permit earlier detection of the disease, giving rise to helping people who are at risk for developing schizophrenia earlier access to treatment.

The finding is reported in the journal Neurobiology of Disease.

Investigators say that until now, biomarkers for schizophrenia had only been found in the neuron cells of the brain, which can’t be collected before death.

By that point it’s obviously too late to do the patient any good, said researcher Noam Shomron, Ph.D. Instead, psychiatrists depend on psychological evaluations for diagnosis, including interviews with the patient and reports by family and friends.

To help improve earlier diagnosis, the researchers turned to the olfactory system, which includes neurons located on the upper part of the inner nose.

Investigators at Johns Hopkins University collected samples of olfactory neurons from patients diagnosed with schizophrenia and a control group of non-affected individuals, then sent them to Shomron’s TAU lab. Shomron and his fellow researchers applied a high-throughput technology to these samples, studying the microRNA of the olfactory neurons.

Within these molecules, which help to regulate our genetic code, they were able to identify a microRNA which is highly elevated in those with schizophrenia, compared to individuals who do not have the disease.

However, the study could not say whether the microRNA changes were a result of the schizophrenia, or a possible precursor biomarker. Further research is needed to determine whether such findings actually could predict schizophrenia or not, or whether it’s simply an expression of fully developed schizophrenia.

If this change comes near the beginning of the timeline, it could be invaluable for early diagnostics. This would mean early intervention, better treatment, and possibly even the postponement of symptoms. If, for example, a person has a family history of schizophrenia, this test could reveal whether they too suffer from the disease.

“We were able to narrow down the microRNA to a differentially expressed set, and from there down to a specific microRNA which is elevated in individuals with the disease compared to healthy individuals,” Shomron said.

Afterwards, additional research revealed that this particular microRNA controls genes associated with the generation of neurons.

In practice, material for biopsy could be collected through an outpatient procedure, using a local anesthetic, said Shomron. Getting microRNA results would likely take most offices a few additional days, since most doctors’ offices do not have the necessary equipment to perform such testing.

Source: American Friends of Tel Aviv University

Abstract of a person’s nose photo by shutterstock.

BDD sufferers feel they are disfigured and ugly, even when they look normal to others. The discovery that abnormal connections between regions of the brain lead to problems in visual and emotional processing builds upon earlier research.

The findings, published in the May edition of the journal Neuropsychopharmacology, suggest that these patterns in the brain may relate to impaired information processing.

“We found a strong correlation between low efficiency of connections across the whole brain and the severity of BDD,” Feusner said. “The less efficient patients’ brain connections, the worse the symptoms, particularly for compulsive behaviors, such as checking mirrors.”

People suffering from BDD tend to fixate on minute details, such as a single blemish on their face or body, rather than viewing themselves in their entirety.

They become so distressed with their appearance that they often can’t lead normal lives, are fearful of leaving their homes and occasionally even commit suicide.

Patients frequently have to be hospitalized. BDD affects approximately 2 percent of the population and is more prevalent than schizophrenia or bipolar disorder. Despite its prevalence and severity, scientists know relatively little about the neurobiology of BDD.

In the current study, Feusner and his colleagues performed brain scans of 14 adults diagnosed with BDD and 16 healthy controls. The goal of the study was to map the brain’s connections to examine how the white-matter networks are organized.

White matter is made up of nerve cells that carry impulses from one part of the brain to another.

Researchers used a sensitive form of brain imaging called diffusion tensor imaging, or DTI to perform the study. DTI is a variant of magnetic resonance imaging that can measure the structural integrity of the brain’s white matter.

From these scans, they were able to create whole brain “maps” of reconstructed white-matter tracks. Next, they used a form of advanced analysis called graph theory to characterize the patterns of connections throughout the brains of people with BDD and then compared them with those of healthy controls.

The researchers found people with BDD had a pattern of abnormally high network “clustering” across the entire brain. This suggests that these individuals may have imbalances in how they process “local” or detailed information.

During the research, investigators discovered specific abnormal connections between areas involved in processing visual input and in brain regions involved in recognizing emotions.

“How their brain regions are connected in order to communicate about what they see and how they feel is disturbed,” said Feusner.

“Their brains seem to be fine-tuned to be very sensitive to process minute details, but this pattern may not allow their brains to be well-synchronized across regions with different functions,” he said. “This could affect how they perceive their physical appearance and may also result in them getting caught up in the details of other thoughts and cognitive processes.”

Feusner says the study advances the understanding of BDD by providing evidence that the “hard wiring” of patients’ brain networks is abnormal.

“These abnormal brain networks could relate to how they perceive, feel and behave,” he said. “This is significant because it could possibly lead to us being able to identify early on if someone is predisposed to developing this problem.”

Source: UCLA

Abstract of brain networking photo by shutterstock.

The problem appears to be specific to emotion recognition, say the researchers, because schizophrenia patients performed as well as bipolar disorder patients and mentally healthy controls when asked to figure out the age of people with angry facial expressions.

The study included 27 patients with schizophrenia, 16 with bipolar I disorder, and 30 mentally healthy controls.

“A better understanding of facial emotional recognition deficits in the two severe mental disorders might assist with diagnostic clarification, as well as inform treatment development and selection,” according to the researchers, psychologists Drs. Vina Goghari of the University of Calgary and Scott Sponheim of the University of Minnesota.

During the study, schizophrenia patients correctly identified angry facial expressions just 60 percent of the time, most often mistaking these faces as frightened, followed by happy, sad, and then neutral.

Similarly, the patients with bipolar disorder tended to mistake anger as fear, significantly more so than the controls.

However, they were more accurate overall than schizophrenia patients, correctly labeling 75 percent of the angry faces, which was not very different from the controls, who got 78 percent correct.

“Greater facial emotion recognition deficits in schizophrenia patients compared to bipolar patients found in this study may be a reflection of greater degree of brain abnormalities in regions associated with facial emotion recognition, such as in the amygdala and hippocampus, in schizophrenia patients,” said the researchers.

While trying to identify the other facial expressions — fear, sad, happy, and neutral — both the schizophrenia and bipolar groups were as accurate as the controls. The three groups also had similar ability in identifying the age of the faces.

The only other difference found was that bipolar disorder patients took much longer to figure out emotional expressions than they did to determine age.  Schizophrenia patients and controls took a similar length of time to complete both tasks.

“This finding may have clinical implications for treatment development in schizophrenia as it suggests that schizophrenia patients may have a different strategy when viewing faces compared to bipolar patients, which may result in lower accuracy,” said the researchers.

Source:  Comprehensive Psychiatry

Man with angry expression photo by shutterstock.

Columbia University Medical Center (CUMC) scientists believe the discovery may help to identify those at risk for schizophrenia.

Furthermore, experts believe a possible glutamate-limiting treatment strategy cold prevent or slow progression of schizophrenia and related psychotic disorders.

Study findings are published in the current issue of the journal Neuron.

“Previous studies of schizophrenia have shown that hypermetabolism and atrophy of the hippocampus are among the most prominent changes in the patient’s brain,” said senior author Scott Small, M.D.

“The most recent findings had suggested that these changes occur very early in the disease, which may point to a brain process that could be detected even before the disease begins.”

Columbia researchers used neuroimaging tools in both patients and a mouse model to discover the process. Researchers first followed a group of 25 young people at risk for schizophrenia to determine what happens to the brain as patients develop the disorder.

In patients who progressed to schizophrenia, they found the following pattern: First, glutamate activity increased in the hippocampus, then hippocampus metabolism increased, and then the hippocampus began to atrophy.

To see if the increase in glutamate led to the other hippocampus changes, the researchers turned to a mouse model of schizophrenia.

When the researchers increased glutamate activity in the mouse, they saw the same pattern as in the patients: The hippocampus became hypermetabolic and, if glutamate was raised repeatedly, the hippocampus began to atrophy.

Conceptually, this dysregulation of glutamate and hypermetabolism could be identified through imaging individuals who are either at risk for or in the early stage of disease. For these patients, treatment to control glutamate release might protect the hippocampus and prevent or slow the progression of psychosis.

Experts say that strategies to treat schizophrenia by reducing glutamate have been tried before, but with patients in whom the disease is more advanced.

“Targeting glutamate may be more useful in high-risk people or in those with early signs of the disorder,” said Jeffrey A. Lieberman, M.D., a renowned expert in the field of schizophrenia.

“Early intervention may prevent the debilitating effects of schizophrenia, increasing recovery in one of humankind’s most costly mental disorders.”

In an accompanying commentary, experts suggest that if excess glutamate is driving schizophrenia in high-risk individuals, it may also explain why a patient’s first psychotic episodes are often caused by periods of stress, since stress increases glutamate levels in the brain.

Source: Columbia University Medical Center

Brain image available from Shutterstock

They may also have a type of schizophrenia “that may be more severe than schizophrenia cases in general,” according to Peter Allebeck, M.D., Ph.D., professor of social medicine in the Department of Public Health Sciences at the Karolinska Institute in Stockholm, Sweden.

For the study, 50,087 male Swedish army recruits (ages 18 to 19 years) underwent medical assessments as well as structured interviews by psychologists, including questions on family and socioeconomic background, work, leisure activities, and use of alcohol, drugs, and tobacco.

At baseline, there were no statistically significant differences between cannabis users and nonusers in terms of psychiatric diagnoses.

Of the 50,087 participants, 5391 used cannabis. During follow-up, 350 patients were identified as having schizophrenia, and of these, 58 used cannabis.

At first admission for schizophrenia, the only schizophrenia subtype showing a difference was paranoid schizophrenia, for which cannabis users had a lower rate compared with nonusers.

The length of stay during the first hospital admission was almost twice as long for users as for nonusers (59 days vs 30 days). One third of users (34 percent) required more than 90 days, whereas only 20 percent of nonusers were hospitalized that long on first admission.

Similarly, cannabis users had a median of 10 readmissions compared to 4 readmissions for nonusers. Nearly a third of the cannabis users had more than 20 readmissions — 29 percent of users vs 10 percent of nonusers.

“Those who had schizophrenia after cannabis use had many more hospital days…more than a third [38 percent] of those who had cannabis use had more than 2 years in total in hospital stay” compared with 21 percent of nonusers, said Allebeck. The median number of hospital days was 547 for cannabis users and 184 for nonusers.

After controlling for socioeconomic factors, personality disorders, IQ, and other factors associated with cannabis use, “there was more than three-fold increased risk of such long hospital days among cannabis users,” said Allebeck.

“The number of readmissions is also about three-fold increased of those with many readmissions after the first admission for schizophrenia,” he said.

“Schizophrenia caused by or contributed by cannabis may be more severe than schizophrenia in general,” he concluded.

“Patients with cannabis history seem to have more severe and more persistent history of schizophrenia, as indicated by duration of first admission, total duration of hospital days, number of readmissions. And these of course are true measures of severity and prognosis.”

The findings were reported at EPA 2013: 21st European Congress of Psychiatry.

Source:  21st European Congress of Psychiatry

Monitoring population mental illness trends has been an historic challenge for scientists and clinicians alike. Telephone surveys have been the primary method to determine the prevalence of mental issues, but this approach is limited because respondents may be reluctant to honestly discuss their mental health.

This approach also has high material costs and a low return rate. As a result, investigators have not had the data they need.

In the study to be published in the May issue of the American Journal of Preventive Medicine, researchers now believe the Internet, and specifically Google, can provide an accurate barometer of mental health trends.

“The Internet is a game changer,” said lead investigator John W. Ayers, Ph.D. “By passively monitoring how individuals search online we can figuratively look inside the heads of searchers to understand population mental health patterns.”

Using Google’s public database of queries, the study team identified and monitored mental health queries in the United States and Australia for 2006 through 2010.

All queries relating to mental health were captured and then grouped by type of mental illness, including ADHD (attention deficit-hyperactivity disorder), anxiety, bipolar, depression, eating disorders (including anorexia or bulimia), OCD (obsessive-compulsive disorder), schizophrenia, and suicide.

Using advanced mathematical methods to identify trends, the authors found all mental health queries in both countries were consistently higher in winter than summer.

The research showed eating disorder searches were down 37 percent in summers versus winters in the U.S., and 42 percent in summers in Australia. Schizophrenia searches decreased 37 percent during U.S. summers and by 36 percent in Australia.

Bipolar searches were down 16 percent during U.S. summers and 17 percent during Australian summers; ADHD searches decreased by 28 percent in the U.S. and 31 percent in Australia during summertime. OCD searches were down 18 percent and 15 percent, and bipolar searches decreased by 18 percent and 16 percent, in the U.S. and Australia respectively.

Searches for suicide declined 24 and 29 percent during U.S. and Australian summers and anxiety searches had the smallest seasonal change – down 7 percent during U.S. summers and 15 percent during Australian summers.

Researchers said they were startled by the discovery of apparent seasonal trends for mental illness.

While some conditions, such as seasonal affective disorder, are known to be associated with seasonal weather patterns, the connections between seasons and a number of major disorders were surprising.

“We didn’t expect to find similar winter peaks and summer troughs for queries involving every specific mental illness or problem we studied,” said co-author James Niels Rosenquist, M.D., Ph.D. “However, the results consistently showed seasonal effects across all conditions – even after adjusting for media trends.”

“It is very exciting to ponder the potential for a universal mental health emollient, like Vitamin D (a metabolite of sun exposure). But it will be years before our findings are linked to serious mental illness and then linked to mechanisms that may be included in treatment and prevention programs,” said Ayers.

“Is it biologic, environmental, or social mechanisms explaining universal patterns in mental health information seeking? We don’t know.”

“Our findings can help researchers across the field of mental health generate additional new hypotheses while exploring other trends inexpensively in real-time,” said Benjamin Althouse, a doctoral candidate at Johns Hopkins Bloomberg School of Public Health and researcher on the study.

“For instance, moving forward, we can explore daily patterns in mental health information seeking … maybe even finding a ‘Monday effect.’ The potential is limitless.”

Source: Elsevier

Abstract of person and light photo by shutterstock.

Schizophrenia is a rare but serious psychiatric disorder, usually beginning in late adolescence, and is characterized by hallucinations, delusions, paranoia, cognitive impairment, social withdrawal, self-neglect and loss of motivation and initiative.

Urinary tract infections (UTI) are common but patients hospitalized for schizophrenia are far more likely to have a UTI than healthy individuals or even others whose illness is under control, said Dr. Brian J. Miller, psychiatrist and schizophrenia expert at the Medical College of Georgia at Georgia Regents University.

The researchers looked at UTI rates in 57 relapsed hospitalized patients, 40 stable outpatients and 39 healthy controls.  They found that 35 percent of the relapsed patients had UTIs versus 5 and 3 percent, respectively, of the other groups.

During a relapse, delusions and symptoms can hinder good hygiene and proper hydration, increasing the risk of UTIs. However, Miller said UTIs could be the trigger.

A link between infection and brain disorder relapse has also been found in dementia, in which a significant percentage of patients with increasingly aggressive behavior and psychotic symptoms have a UTI that, when treated, improves dementia-related problems.

It’s clear that the immune system plays a role in schizophrenia, which affects about 1 percent of the population, said the researchers. Babies born to mothers who develop a severe infection during pregnancy, such as influenza or pneumonia, have a significantly greater risk of developing schizophrenia.

Miller and others suspect that the mother’s infection somehow reprograms the baby’s immune system, making its reactions more extreme — more aggressive at times and more passive at other times.  This leaves the individual vulnerable to both infections and autoimmune diseases, such as lupus, in which the body’s immune system attacks itself.

On average, schizophrenia patients die 15-20 years earlier than the general population, have an eight-fold increased risk of death from pneumonia and nearly five percent greater risk of death from all infectious diseases.

Source:  Georgia Regents University

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