New studies illuminate roots of schizophrenia

February 5, 7:18 AM
by Meg Marquardt, Science News Examiner
Schizophrenia appears to be February's hot topic. Two important stories about the disease have surfaced in the past few days, and both offer hope for better treatment.

Schizophrenia is a notoriously difficult disease to diagnosis and treat. It can manifest in any number of ways, from severe mental decline to extreme paranoid hallucinations. There is also a struggle to find a universally effective medication. As of now, treatments work in a rough law of thirds: drugs are completely effective for a third of schizophrenic patients, are mildly effective for another third, and are completely ineffective for the last third.

The worst aspect of schizophrenia is that it strikes with little to no warning. But scientists are working to change that. By finding genetic and behavioral precursors to the onset of the disease, researchers hope to find a more effective and timely treatment.
The first study comes from Johns Hopkins University. Drawing from an extensive participant pool that included those afflicted by schizophrenia, family members of the patients, and unrelated non-affected volunteers, scientists studied genetic factors that may be associated with the disease. Focusing on chromosome 10, which has been shown previously to contain genes related to schizophrenia, the team investigated more than 1,400 single nucleotide polymorphisms (SNP) to see if there were common genetic mutations in those affected by Schizophrenia that didn't appear in those who were not.

"They found three SNPs strongly associated with delusions, and all three SNPs are located in the neuregulin 3 gene. In fact, of the team's top 20 most significant SNPs, 13 of them are located at or near this gene, but rather than being associated with delusion, the other SNPs are associated with scholastic, disorganization and hallucination factors." [EurekAlert] While much work still needs to be done on this front, isolating particular genetic mutations that may cause schizophrenia can eventually lead to an earlier diagnosis of the mental illness as well as better drugs to treat it.

The second study was conducted at Tel Aviv University in Israel. Instead of working on the genetic level, this experiment took a holistic view of the brain via brain mapping. Professor Talma Hendler of Tel Aviv's Department of Psychology used photographs of so-called "funny faces," images of faces which have been distorted, to indentify differences in the normal brain and the schizophrenic one. The basic principle behind that study is that "healthy minds respond with selective activity within the brain, sounding the alarm that there is something disturbing about the image" while schizophrenic brains will not. [American Friends of Tel Aviv University (AFTAU)]

By monitoring brain reactions to the photographs with imaging equipment, the research has shown that in a normal person "the visual areas of the brain are highly connected to other areas…but in schizophrenic patients, there is a diminished connection between the various parts, leading to disturbed integration of information — and thus to distorted experiences." [AFTAU] If a detailed map of a schizophrenic brain could be created, early diagnosis would be possible. While it is not feasible to apply this technology to the world at large, it could be used to screen those who are at high risk, such as children of people afflicted by the disease.

While both studies are still a long way off from being put to therapeutic use, they are steps in the right direction. As Hendler states, “Current drugs treat the abnormal behavior, not the brain disorder that is causing the behavior. We want to be able to develop more specific treatments based on objective brain markers, which are the actual characteristics of the disease.” [AFTAU]
Making Mental Health a Global Priority

WORLD MENTAL HEALTH DAY • 10 OCTOBER 2009

CANADIAN COLLABORATIVE MENTAL HEALTH INITIATIVE 

Collabortive Mental Health Care Framework

Collaborative mental health care describes a range of models of practice in which consumers, their families and caregivers, together with health care providers from a variety of primary health care and mental health settings—each with different experience, training, knowledge and expertise—work together to promote mental health and provide more coordinated and effective services for individuals with mental health needs. A conceptual Framework was developed based on previous research and an analysis of existing collaborative mental health care initiatives to:
• introduce key components of collaborative mental health care
• guide the discussion in the CCMHI
• research papers
• identify the need for future research

FUNDAMENTAL

Policies, Legislation, Funding Regulations and Funds
Policies, legislation and funding regulations need to be congruent with the principles of collaborative mental health care, and sufficient funds need to be made available to facilitate the implementation of collaborative initiatives. Support for the concept of collaborative mental health care, as it is reflected in policies, legislation and funding allocations, has increased since 2000. However, there are policy—related barriers to collaborative mental health care. These barriers can be grouped into two broad categories. The first category involves current efforts to reform the primary health and mental health care systems; challenges emerge when reform strategies are not coordinated. The second category encompasses legislation and policies as they relate to health human resources; in particular, issues related to remuneration, scope of practice and liability schemes.
Research and Community
Collaborative mental health care initiatives should also emerge from evidence-based research through the identification and implementation of best practices and should be based on the needs and resources of individual communities.

KEY ELEMENTS

There are four key elements that help define collaborative mental health care: accessibility, collaborative structures, and richness of collaboration and consumer centeredness.
Accessibility
The goals of collaborative mental health care are met by increasing accessibility to mental health services. This includes mental health promotion, illness prevention, detection, and treatment in primary health care settings, or “bringing the services closer to home”. Collaborative mental health care takes place in a range of settings including community health centres, the offices of health care providers, an individual’s home, schools, correctional facilities, or community locations such as shelters. Settings vary according to the needs and references of the individual, and the knowledge, training and skills of the providers. Collaboration may involve joint assessment or care delivery with several providers present with the consumer, families and caregivers, when appropriate, or it may take place through telephone or written communication. In other words, effective collaboration does not require that the health care providers be situated in the same physical location.
Providing mental health services in primary health care settings can be accomplished through various means, for example:

• providing direct mental health care in primary health care settings, or
• providing indirect mental health support to primary health care providers in primary health care settings

In the first instance, mental health care is provided by a mental health specialist; 1 in the second, mental health care is delivered by a primary health care provider who is supported by or consults with a mental health specialist. Strategies developed by various collaborative mental health care initiatives to provide mental health services in primary health care settings include the following:

• mental health specialist offers direct mental health care in primary health care setting:
• scheduled visits in primary health care settings
• co-location of mental health and primary health care services
• mental health specialist offers indirect mental health care in primary health care setting by supporting primary
• health care provider either formally or informally

Collaborative Structures

Successful collaborative mental health care initiatives recognize the need for systems and structures to support collaboration.

First, providers will either create or be part of an organizational structure that will define the ways in which people have agreed to work together. This structure can be:
• formal (e.g., service agreements, coordinating centres, collaborative networks)
• informal (e.g., verbal agreements between providers).

Second, providers will organize or create systems that will define how they agree to accomplish certain key functions of collaborative mental health care, for example:
• referral strategies (e.g., forms, referral networks)
• information technology (e.g., electronic client records, Web-based information exchange, teleconferencing,
• videoconferencing, e-mail, list serve)
• evaluations (e.g., developing evaluation instruments and agreeing to adopt certain evaluation instruments,
• methodologies and software in common)

Richness of Collaboration

A central feature of effective collaborative mental health care is the richness of collaboration among health care partners, including: primary and mental health care providers, consumers and caregivers. Characteristics of richness of collaboration include:
• knowledge transfer among health care partners through various educational initiatives, for example:
• courses, lectures, tutorials, seminars, rounds, rotations, case discussions, internships, workshops, symposia;
• educational materials, such as: research papers, studies, books, guides, manuals
• the involvement of health care partners from a wider range of disciplines (e.g., nurses, social workers, dietitians, family physicians, psychologists, psychiatrists, pharmacists, occupational therapists, peer support workers)
• communication among all health care partners.

Consumer Centeredness

The needs of consumers are at the core of collaborative mental health care. Consumer centeredness calls for consumers to be involved in all aspects of their care, from treatment choices to program evaluation, and for initiatives to be designed to address the needs of specific groups; in particular, those that are often underserved or has a great need for both primary and mental health care. A growing number of collaborative mental health care initiatives emphasize the role of the consumer by allocating time and resources to consumer and/or caregiver:
• education (e.g., educational materials, sessions or information centres)
• peer support
• participation in the development of collaborative mental health care initiatives (e.g., focus groups, committees) and in the development and implementation of program evaluations (e.g., instrument design, roles as interviewers or respondents)
• participation in adapting mental health promotion and treatment interventions to individual

CONCLUSION

Collaborative mental health care is ultimately influenced by these fundamentals: policies, legislation, funding, research, and community needs and resources. There are four key elements that define collaborative mental health care: accessibility, collaborative structures, richness of collaboration and consumer centeredness. In our upcoming series of papers on the current state of collaborative mental health care, the discussion will be framed according to these key elements and fundamentals. The series of forthcoming implementation
Toolkits and the collaborative mental health care Charter will also be based on this Framework.

For Further Information:
Canadian Collaborative MH Initiative
C/O Cheryl D’Souza
The College of Family Physicians of Canada (Project Sponsor)
2630 Skymark Avenue, Mississauga, Ontario
Canada L4W 5A4
Tel.: (905) 629-0900
E-mail: info@ccmhi.ca
http://www.ccmhi.ca/

Sandy Jeff “Flying With Paper Wings”
Flying With Paper Wings is about my fall into schizophrenia and how I became a poet. It examines my childhood which was disrupted by the violence of my father and the alcoholism of my mother.
My diagnosis of schizophrenia at 23 set in train a life in which I would struggle with this monster of madness for the next 33 years.

Poetry was my saviour. It gave me an identity which I could live with. It also gave me a means by which to process my experience of madness in poems that shaped my life and which were published in my first book Poems from the Madhouse. Since Poems from the Madhouse's first publication in 1993 there have been four other volumes of poetry published. It is a story of survival and resilience.

Sandy Jeffs is author (and co-author) of a number of volumes of poetry. Jeffs was diagnosed with schizophrenia at the age of twenty three, soon after completing university. Her writing is concerned with diverse subjects, including madness, domestic violence and midweek ladies tennis. Jeffs is an original member of the award-winning Melbourne-based poetry performance “mob”, Loose Kangaroos.

Artist’s statement
“Nothing I am going to say is new. You have all heard it before. I have no wisdom, no new knowledge. All I can offer you is a world viewed through the eyes of a poet—a mad poet, but a poet nonetheless. I hope you, too, see the world through the eyes of a poet—after all, there is a poem in everyone’s heart.”
Sandy Jeffs, op. cit. (2004), p. 1

Copies of Flying With Paper Wings can be ordered by emailing Sandy on sandyjeffs@ozemail.com.au or phoning on 0418 523 644.

Depression

Sandy Jeff “Flying With Paper Wings”
Flying With Paper Wings is about my fall into schizophrenia and how I became a poet. It examines my childhood which was disrupted by the violence of my father and the alcoholism of my mother.
My diagnosis of schizophrenia at 23 set in train a life in which I would struggle with this monster of madness for the next 33 years.