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Researchers Test a New Approach to Treating Schizophrenia



By Mary Elizabeth Hopkins

A glimmer of hope shines in the eyes of researchers trying a new treatment for schizophrenia–in most cases a baffling, chronic and incurable brain disease that separates its sufferers from reality.

The news might not affect schizophrenics or caregivers for the next few years because even larger studies will be necessary. But caregivers are desperate, said Rajiv Tandon, MD, professor of psychiatry and director of the University of Michigan Health System Schizophrenia Program, so participating in the studies may be worth any risks and concerns.

Tandon is leading a study at the university that examines the idea that schizophrenia may be linked to disturbances in the body’s ability to regulate acetylcholine, rather than dopamine alone. Two other studies in the United States and one in Germany focus on a similar hypothesis.

Although conservative among psychiatrists who treat schizophrenia, Tandon is optimistic that cholinergic medications may point to a new way to treat this disease.

Acetylcholine–which is difficult to study because it affects several systems in the body, including the circulatory and digestive system–has intrigued researchers for a century as a possible link to schizophrenia. But only since the emergence of two tolerable cholinergic drugs for Alzheimer’s patients have researchers been able to try one of them, Aricept (donepezil hydrochloride), on schizophrenics who also take anti-psychotic medications.

"It is quite interesting, [Tandon’s] approach," said Constance Lieber, president of the board of directors of the National Alliance for Research on Schizophrenia and Depression, which partially funded the study at Michigan. "I think we need this, because I don’t think there will be one course of treatment for schizophrenia." The National Institutes of Health and Scottish Rite also funded the study.

It is well-documented that treating schizophrenia with medication within the first three to five years after diagnosis can keep the disease from progressing, Tandon said. If more caregivers and patients knew about it, he said, it could prevent the devastating and irreversible brain damage that schizophrenia usually causes.

"The sooner one is diagnosed, the better," said Nancy Mann, RN, a Clinical 2 nurse at the University of Michigan, who has worked with Tandon. "There’s absolutely nothing good about the diagnosis for patients, but the study could have real promise for schizophrenics."

In the past, clinicians tended to either undermedicate schizophrenics because of a nihilistic attitude toward the disease, Tandon said, or to prescribe as many as six medications to control the symptoms.

Although four newer medications ��?clozapine, risperidone, olanzapine and quetiapine ��?have improved symptoms for schizophrenics in the United States during the past decade, they still focus on dopamine regulation in the brain.

While dopamine is clearly part of the problem, Tandon said that anti-psychotic medications are ineffective 30 percent to 40 percent of the time. Even when they are effective, they leave significant deficits and can cause severe side effects, such as tardive dyskinesia and weight gain.

Older and newer medications for schizophrenia, if they work at all, most often address symptoms such as delusions and hallucinations. The existing medications hardly touch the second and third set of symptoms, Tandon said. Those, unfortunately, are the ones caregivers most often grapple with, he said.

Many schizophrenics in the United States live in institutions and are dependent on others. Fewer than 10 percent are employed. Symptoms such as lack of motivation and poor hygiene result in a poor level of functioning, which leads to a marginal life at best.

Cognitive deterioration, possibly the most devastating symptom, means that many schizophrenics, no matter what their native intelligence level before onset, deteriorate to about an 80 to 84 IQ, Tandon said.

Mann’s work revolves around teaching schizophrenics to function as well as they can.

"A lot of things go into the total package," she said. "The meds are of primary importance, but everyone has been looking at life skills, too."

A grant from the Flinn Foundation allows Mann to visit schizophrenics at clubhouses, drop-in centers and Rose Hill Center, a structured farm where she teaches patients how to problem-solve, set goals and live with others.

"The ones that are having a hard time participating in the life skills training are the ones on the older medications," Mann said.

Her article in the Archives of Psychiatric Nursing ("Psychosocial Rehabilitation in Schizophrenia: Beginnings in Acute Hospitalization" Vol. 7, No. 3, June 1993) describes her work with inpatients.

"As a strategy, I’m interested in all aspects of treatment," Tandon said. "It’s a hypothesis, but the treatment we’re trying certainly has benefits for the delusions and hallucinations, and it probably alleviates tardive dyskinesia and cognitive deterioration. It may also have a secondary effect on lack of motivation and poor hygiene.

"Despite all our significant advances, in all honesty, we still don’t precisely understand schizophrenia, and it’s not for lack of looking. But we are likely to achieve major improvements in our treatment approaches over the next decade."

(From Yahoo)

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