19 ms·

Psychiatrist here; glad to see this near the top of HN.Schizophrenia is a serious illness, and often misunderstood as "split personality." It is a constellation

Psychiatrist here; glad to see this near the top of HN.Schizophrenia is a serious illness, and often misunderstood as "split personality." It is a constellation of delusions, hallucinations, and scrambled thoughts that is often (though not always) pretty devastating to work, school, relationships, etc. For some reason, because we have no blood test or genetic test for it, the diagnosis is still met with skepticism from many in the public, even though everyone seems to accept the diagnosis of migraine headaches which similarly has no clear-cut lab or imaging findings. What most people don't consider is the change in life span: http://www.ncbi.nlm.nih.gov/pubmed/21741216 http://www.ncbi.nlm.nih.gov/pubmed/21741216 Life expectancy as about 17 years less for those with the diagnosis, which is worse than most cancers. It's mentioned in the article, but worth repeating.

andyjdavis 13y ago
>Life expectancy as about 17 years less for those with the diagnosis That's interesting. Is that due to some sort of biological action of the illness itself or is it due to behaviors that are associated with the illness? To put it another way, is it due to illness itself shortening their life span or due to behaviors like self medicating with alcohol or a higher suicide rate?
- michaelochurch 13y ago
  Mix of factors. Drugs play a role (especially alcohol and cigarettes) but a surprising percentage of the deaths are non-drug cardiovascular deaths, related to poor diet (many mentally ill people are obese and diabetic by middle age) and high levels of chronic stress. Being low on the socioeconomic totem pole, even for a short time, is pretty dangerous to the heart, brain, and immune system.
  - cypherpunks01 13y ago
    An also shocking percentage: One in ten people who suffer from schizophrenia dies by suicide.
sillysaurus3 13y ago
I've heard schizophrenia can be triggered by prolonged stress, e.g. a stressful work environment. (This presupposes you have susceptible genes.) There seems to be a lot of anecdotal evidence supporting this. Do you know whether it's backed up by any research? Or more generally, does anyone know of any (successful) research about whether schizophrenia can be avoided by avoiding whatever triggers it? Or are you doomed if you have the wrong genes?
- phren0logy 13y ago
  What you are describing is the "Stress-Diathesis Model." The rough explanation is that many people have vulnerabilities for mental illness (including schizophrenia, bipolar disorder, major depressive disorder, and others), and that the vulnerability is triggered by environmental stressors. It is in some ways similar to the "two-hit hypothesis" for cancer. A search for "Stress-Diathesis Model" will yield a lot of hits in the academic literature. It's well accepted as at least part of the explanation for why some people with a genetic vulnerability develop symptoms and others do not.
  - sillysaurus3 13y ago
    Thank you for your insight, and for referring me to the proper literature on the subject. It's very much appreciated.
  - wisty 13y ago
    Amateur here ... don't a lot of people have schizophrenic symptoms (voices), but as long as they are positive or the person can ignore them it's usually just ignored? Like, some people might have "imaginary friends" who they chat to about the weather, quietly. Other people have "imaginary friends" who they have screaming arguments with. In some cases, could stress either make the delusions / voices less benevolent, or send people into a cycle in which they are no longer able to manage them?
    - sillysaurus3 13y ago
      some people might have "imaginary friends" who they chat to about the weather, quietly. Other people have "imaginary friends" who they have screaming arguments with. That's very interesting. I hadn't heard of that before. I wonder if it'd be possible to conduct an anonymous survey as to whether people have imaginary friends that they routinely chat with or get into screaming arguments with? I wish such a survey could be trusted, but it'd probably attract troll results.
vacri 13y ago
In the mid-90s, I remember hearing that in my state, cancer research received $150/hospital bed, heart disease received $100/bed, and schizophrenia received $7/bed. My amateur theory on that was that the first two affect old, wealthy people, whereas the third affects young people with no power.
- protomyth 13y ago
  Well, if you look at cause of death, the first two are the big hitters in the US so that is part of the basis for more money. The history of funding treatment is pretty bad though. It's not so much no power, it has been the lack of advocates because of the shame associated with all mental illnesses. A person with cancer can do the noble stand. A person with schizophrenia is much less capable of doing the needed advocacy. Things are changing as more people are pushing and not keeping quiet. From a advocacy view, we better start putting this and brain problems in general front and center since we are living long enough that we need the understanding of treating the brain to use our longer lives well.
  - thaumasiotes 13y ago
    But we're not living long enough that we're all getting schizophrenia. We're living long enough that we're all getting cancer and heart disease. Even in the realm of mental illness, if the problem is "we're living long enough to develop new problems", wouldn't we want to focus on age-related problems?
    - Retric 13y ago
      You can still get schizophrenia in your old age. "23.5% of patients with schizophrenia developed the illness after the age of 40" Beyond that in the elderly it often get's lumped in with other form of Dementia and ignored. IMO, finding real treatments for mental illness is probably the most important part of longevity research as a healthy body and a decayed mind is in some ways little different than a dead body. http://www.medscape.com/viewarticle/564899_6 http://www.medscape.com/viewarticle/564899_6
wlesieutre 13y ago
Some people are similarly skeptical that migraines without auras are "real migraines," but once you explain that it's otherwise the same symptoms (headache, sensitivity to light/sound, nausea, vomiting) and treated by the same specialized painkillers, they'll generally take your diagnosis at face value. According to Wikipedia, a pretty sizable majority of migraine sufferers don't have auras. But it's a distinctive symptom, so it's well known. I wonder if the reaction to schizophrenia is partly due to not having as strong an understanding of how to treat it, in addition to not knowing what it's exact causes are. Having a well proven solution to a problem seems to make it easier for people to accept that the problem really existed.
- virtualwhys 13y ago
  What on earth is a migraine with an "aura"? I used to get what I would very much consider "real migraines" as a child. Would lay in bed shivering with this crippling jack hammer bashing into the (always) lower left side of my skull. Eventually the pain would get to the point where I'd get up, go to the bathroom and vomit; then within minutes the migraine would subside. As an adult I rarely get them, but when I feel one coming I know to take a couple of Advil to head it off at the pass so to speak. Anyway, what is a migraine with an aura? The only aura about me that I recall was my sisters telling me to shut the hell up from their bedrooms o_O
  - thomasz 13y ago
    http://en.wikipedia.org/wiki/Aura_(symptom) http://en.wikipedia.org/wiki/Aura_(symptom)
    - virtualwhys 13y ago
      Thanks, interesting. I've never had that experience pre-migraine, although subtle scotoma is always there; i.e. transparent squiggly lines in the vision (assume everyone has this).
michaelochurch 13y ago
Schizophrenia is a serious illness, and often misunderstood as "split personality." It is a constellation of delusions, hallucinations, and scrambled thoughts that is often (though not always) pretty devastating to work, school, relationships, etc. For some reason, because we have no blood test or genetic test for it, the diagnosis is still met with skepticism from many in the public I'm glad you posted this. These diseases (schizophrenia, bipolar disorder, depression, PTSD) are challenging and can be horrible but I feel like the stigma makes them a lot worse. It's like many natural disasters in which the human malfeasance after the event causes more harm than the thing itself. The way people treat people who are afflicted by these diseases is, in many cases, an aggravating factor. Instead of helping them, plenty of people (especially in the corporate world, and in society at large after 1980 or so) kick them when they're down. It's pretty disheartening.
- swalkergibson 13y ago
  The stigma is absolutely the biggest problem with the treatment of mental illness. It would be as if you went to someone with cancer and said, "Well, if you really wanted to, you could just shrink that tumor right now. You just don't want to commit to changing your life. It is your fault." I never believed this until my sister died. Now I realize just how broken the system is.
  - erichurkman 13y ago
    And worse yet, the cause is wildly misunderstood. One person's debilitating depressing might be resolved spectacularly via light therapy, another via a single medication, another yet only moderated by a constellation of medications, and others who have undergone a variety of treatments for a decade with little improvement. Compare that to, say, a broken leg, which is much easier to understand. There's a huge stigma attached to certain cancers, too, like lung cancer not caused by smoking.
  - serf 13y ago
    Unfortunately, that stigma exists elsewhere in medicine, too. I'm a quadriplegic. My father has the overwhelming opinion that since my condition is 'incomplete' (meaning that I have some movement in affected regions), that it's up to me to recover, and that I can't walk because I don't put my mind to the task at hand. A shocking thing to say to someone, but his opinion has been echoed to me by various healthcare professionals and therapists throughout the course of my care, that the mind simply will not allow the body to recover without ample hope and work towards such a recovery. I have encountered a set of people in life that , while seemingly uninfluenced by religion or mysticism, believe that certain parts of the body (the brain, especially) work on principles and ideas that we're completely uninformed about. Consequently, those people suggest and use themselves methods derived from mysticism, without a solid scientific backing(not to say that hope and patient mental well-being aren't important for recovery, they are, but you can't 'hope' a spinal cord back together as some seem to think). Hopefully as we document more and more quantifiable physical changes associated to disorders which we know little about this trend will slow. It's important to consider the mental aspects behind a problem, but it's a waste of time and potentially destructive to put the recovery solely in the hands of the inflicted and their mental state.
towski 13y ago
People in general seem unsympathetic to difficult mental states, especially people who can't imagine what it would be like
Goopplesoft 13y ago
> because we have no blood test or genetic test for it I was reading about this: http://ge.tt/3nXdgiQ/v/0 http://ge.tt/3nXdgiQ/v/0, its from Reddit where the article stated: "However, when we examined the whole data set of 298 assessments, a cross-validated probabilistic neural network model was superior and could discriminate all cases from controls with near perfect accuracy at 98.3%." Is this not the case? (article here: http://www.scotsman.com/news/health/schizophrenia-diagnosed-by-simple-eye-test-1-2608469 http://www.scotsman.com/news/health/schizophrenia-diagnosed-...)
- caycep 13y ago
  Hm, that's interesting. A lot of parkinson's related disease (different than schizophrenia, but still involving dopamine a lot) have eye movement findings that are pretty recognizable. Culturally, not sure if psychiatrists are in the habit of examining eye movements as closely as, say, a neurologist or neuro-opthalmologist, but it'd be interesting if this is replicable by other groups.
  - sitkack 13y ago
    There was another test involving anomalous speech patterns, http://www.idt.mdh.se/kurser/ct3340/ht11/MINICONFERENCE/FinalPapers/ircse11_submission_1.pdf http://www.idt.mdh.se/kurser/ct3340/ht11/MINICONFERENCE/Fina... it might not be the canonical work. In the near future most laptops will have the ability to do realtime eye tracking so these kinds of tests could be administered broadly, probably even through a web page.
    - caycep 13y ago
      how close are consumer eye tracking devices? It'd be interesting to see. My group works w/ the PD side of things, and doing a desktop-based eye test might be something we'd be interested in...
      - sitkack 13y ago
        I have used an eye tracker in about 5 years but I think the cost back then was on the order of 4k+-1k. http://www.tobii.com/en/eye-experience/ http://www.tobii.com/en/eye-experience/ this is probably better than what we were using. So I'd say all the pieces are in place to do this. The architectural design of the tobii and the leapmotion is almost identical. High frame rate cameras over USB3 illuminated with IR. ---- Throw in an http://emotiv.com/ http://emotiv.com/ EEG and one could do all sorts correlations.
caycep 13y ago
Aren't there structural brain findings reported in some imaging research studies? I'd be interesting to see some of the work in MRI volumetric studies (i.e. voxel-based morphometry) or dopamine transmitter imaging, especially comparing longitudinal progression of schizophrenia patients or in cross sectional comparisons against healthy controls
zacinbusiness 13y ago
You see similar skepticism with autoimmune disorders. Invisible pain is something coworkers and families get bored with quickly.
- alan_cx 13y ago
  My 10 year old daughter has autoimmune liver disease. It also affects her kidneys and bladder. She is being lined up for transplants. Its devastating to her, and the family. Yet, despite numerous letters and meetings with her consultants, therapists, and social services, the moronic arrogant staff at her school refuse to take it seriously and cause her and us unbelievable problems and stress. It borders abuse.
  - zacinbusiness 13y ago
    I'm very sorry to hear that. My wife has an as yet in diagnosed autoimmune issue. It's looking like either lupus or MS, but we have to wait until she's churned through the system to get a proper diagnosis. Luckily, her work place has been extremely understanding and supportive. But we've heard stories of people who see initial understanding that quickly turns sour. I hope all goes well with your daughter and that she can have a happy and healthy life. Do you think home schooling could be an option? I've never looked in to it as we don't have children ourselves. I hated school because most of my teachers and the staff weren't qualified to teach tricks to a dog, much less teach life lessons and knowledge to children.
Fasebook 13y ago
Let this be a warning to all those who suspect. WE WILL GET YOU, EVEN IF IT TAKES 17 YEARS.
threatofrain 13y ago
Hey there, do you have any place to direct me to look for mediators or malleable predictors of life outcomes for young men with schizophrenia?

andyjdavis 13y ago

>Life expectancy as about 17 years less for those with the diagnosis That's interesting. Is that due to some sort of biological action of the illness itself or is it due to behaviors that are associated with the illness? To put it another way, is it due to illness itself shortening their life span or due to behaviors like self medicating with alcohol or a higher suicide rate?

michaelochurch 13y ago
Mix of factors. Drugs play a role (especially alcohol and cigarettes) but a surprising percentage of the deaths are non-drug cardiovascular deaths, related to poor diet (many mentally ill people are obese and diabetic by middle age) and high levels of chronic stress. Being low on the socioeconomic totem pole, even for a short time, is pretty dangerous to the heart, brain, and immune system.
- cypherpunks01 13y ago
  An also shocking percentage: One in ten people who suffer from schizophrenia dies by suicide.

sillysaurus3 13y ago

I've heard schizophrenia can be triggered by prolonged stress, e.g. a stressful work environment. (This presupposes you have susceptible genes.) There seems to be a lot of anecdotal evidence supporting this. Do you know whether it's backed up by any research? Or more generally, does anyone know of any (successful) research about whether schizophrenia can be avoided by avoiding whatever triggers it? Or are you doomed if you have the wrong genes?

phren0logy 13y ago
What you are describing is the "Stress-Diathesis Model." The rough explanation is that many people have vulnerabilities for mental illness (including schizophrenia, bipolar disorder, major depressive disorder, and others), and that the vulnerability is triggered by environmental stressors. It is in some ways similar to the "two-hit hypothesis" for cancer. A search for "Stress-Diathesis Model" will yield a lot of hits in the academic literature. It's well accepted as at least part of the explanation for why some people with a genetic vulnerability develop symptoms and others do not.
- sillysaurus3 13y ago
  Thank you for your insight, and for referring me to the proper literature on the subject. It's very much appreciated.
- wisty 13y ago
  Amateur here ... don't a lot of people have schizophrenic symptoms (voices), but as long as they are positive or the person can ignore them it's usually just ignored? Like, some people might have "imaginary friends" who they chat to about the weather, quietly. Other people have "imaginary friends" who they have screaming arguments with. In some cases, could stress either make the delusions / voices less benevolent, or send people into a cycle in which they are no longer able to manage them?
  - sillysaurus3 13y ago
    some people might have "imaginary friends" who they chat to about the weather, quietly. Other people have "imaginary friends" who they have screaming arguments with. That's very interesting. I hadn't heard of that before. I wonder if it'd be possible to conduct an anonymous survey as to whether people have imaginary friends that they routinely chat with or get into screaming arguments with? I wish such a survey could be trusted, but it'd probably attract troll results.

vacri 13y ago

In the mid-90s, I remember hearing that in my state, cancer research received $150/hospital bed, heart disease received $100/bed, and schizophrenia received $7/bed. My amateur theory on that was that the first two affect old, wealthy people, whereas the third affects young people with no power.

protomyth 13y ago
Well, if you look at cause of death, the first two are the big hitters in the US so that is part of the basis for more money. The history of funding treatment is pretty bad though. It's not so much no power, it has been the lack of advocates because of the shame associated with all mental illnesses. A person with cancer can do the noble stand. A person with schizophrenia is much less capable of doing the needed advocacy. Things are changing as more people are pushing and not keeping quiet. From a advocacy view, we better start putting this and brain problems in general front and center since we are living long enough that we need the understanding of treating the brain to use our longer lives well.
- thaumasiotes 13y ago
  But we're not living long enough that we're all getting schizophrenia. We're living long enough that we're all getting cancer and heart disease. Even in the realm of mental illness, if the problem is "we're living long enough to develop new problems", wouldn't we want to focus on age-related problems?
  - Retric 13y ago
    You can still get schizophrenia in your old age. "23.5% of patients with schizophrenia developed the illness after the age of 40" Beyond that in the elderly it often get's lumped in with other form of Dementia and ignored. IMO, finding real treatments for mental illness is probably the most important part of longevity research as a healthy body and a decayed mind is in some ways little different than a dead body. http://www.medscape.com/viewarticle/564899_6 http://www.medscape.com/viewarticle/564899_6

wlesieutre 13y ago

Some people are similarly skeptical that migraines without auras are "real migraines," but once you explain that it's otherwise the same symptoms (headache, sensitivity to light/sound, nausea, vomiting) and treated by the same specialized painkillers, they'll generally take your diagnosis at face value. According to Wikipedia, a pretty sizable majority of migraine sufferers don't have auras. But it's a distinctive symptom, so it's well known. I wonder if the reaction to schizophrenia is partly due to not having as strong an understanding of how to treat it, in addition to not knowing what it's exact causes are. Having a well proven solution to a problem seems to make it easier for people to accept that the problem really existed.

virtualwhys 13y ago
What on earth is a migraine with an "aura"? I used to get what I would very much consider "real migraines" as a child. Would lay in bed shivering with this crippling jack hammer bashing into the (always) lower left side of my skull. Eventually the pain would get to the point where I'd get up, go to the bathroom and vomit; then within minutes the migraine would subside. As an adult I rarely get them, but when I feel one coming I know to take a couple of Advil to head it off at the pass so to speak. Anyway, what is a migraine with an aura? The only aura about me that I recall was my sisters telling me to shut the hell up from their bedrooms o_O
- thomasz 13y ago
  http://en.wikipedia.org/wiki/Aura_(symptom) http://en.wikipedia.org/wiki/Aura_(symptom)
  - virtualwhys 13y ago
    Thanks, interesting. I've never had that experience pre-migraine, although subtle scotoma is always there; i.e. transparent squiggly lines in the vision (assume everyone has this).

michaelochurch 13y ago

Schizophrenia is a serious illness, and often misunderstood as "split personality." It is a constellation of delusions, hallucinations, and scrambled thoughts that is often (though not always) pretty devastating to work, school, relationships, etc. For some reason, because we have no blood test or genetic test for it, the diagnosis is still met with skepticism from many in the public I'm glad you posted this. These diseases (schizophrenia, bipolar disorder, depression, PTSD) are challenging and can be horrible but I feel like the stigma makes them a lot worse. It's like many natural disasters in which the human malfeasance after the event causes more harm than the thing itself. The way people treat people who are afflicted by these diseases is, in many cases, an aggravating factor. Instead of helping them, plenty of people (especially in the corporate world, and in society at large after 1980 or so) kick them when they're down. It's pretty disheartening.

swalkergibson 13y ago
The stigma is absolutely the biggest problem with the treatment of mental illness. It would be as if you went to someone with cancer and said, "Well, if you really wanted to, you could just shrink that tumor right now. You just don't want to commit to changing your life. It is your fault." I never believed this until my sister died. Now I realize just how broken the system is.
- erichurkman 13y ago
  And worse yet, the cause is wildly misunderstood. One person's debilitating depressing might be resolved spectacularly via light therapy, another via a single medication, another yet only moderated by a constellation of medications, and others who have undergone a variety of treatments for a decade with little improvement. Compare that to, say, a broken leg, which is much easier to understand. There's a huge stigma attached to certain cancers, too, like lung cancer not caused by smoking.
- serf 13y ago
  Unfortunately, that stigma exists elsewhere in medicine, too. I'm a quadriplegic. My father has the overwhelming opinion that since my condition is 'incomplete' (meaning that I have some movement in affected regions), that it's up to me to recover, and that I can't walk because I don't put my mind to the task at hand. A shocking thing to say to someone, but his opinion has been echoed to me by various healthcare professionals and therapists throughout the course of my care, that the mind simply will not allow the body to recover without ample hope and work towards such a recovery. I have encountered a set of people in life that , while seemingly uninfluenced by religion or mysticism, believe that certain parts of the body (the brain, especially) work on principles and ideas that we're completely uninformed about. Consequently, those people suggest and use themselves methods derived from mysticism, without a solid scientific backing(not to say that hope and patient mental well-being aren't important for recovery, they are, but you can't 'hope' a spinal cord back together as some seem to think). Hopefully as we document more and more quantifiable physical changes associated to disorders which we know little about this trend will slow. It's important to consider the mental aspects behind a problem, but it's a waste of time and potentially destructive to put the recovery solely in the hands of the inflicted and their mental state.

towski 13y ago

People in general seem unsympathetic to difficult mental states, especially people who can't imagine what it would be like

Goopplesoft 13y ago

> because we have no blood test or genetic test for it I was reading about this: http://ge.tt/3nXdgiQ/v/0 http://ge.tt/3nXdgiQ/v/0, its from Reddit where the article stated: "However, when we examined the whole data set of 298 assessments, a cross-validated probabilistic neural network model was superior and could discriminate all cases from controls with near perfect accuracy at 98.3%." Is this not the case? (article here: http://www.scotsman.com/news/health/schizophrenia-diagnosed-by-simple-eye-test-1-2608469 http://www.scotsman.com/news/health/schizophrenia-diagnosed-...)

caycep 13y ago
Hm, that's interesting. A lot of parkinson's related disease (different than schizophrenia, but still involving dopamine a lot) have eye movement findings that are pretty recognizable. Culturally, not sure if psychiatrists are in the habit of examining eye movements as closely as, say, a neurologist or neuro-opthalmologist, but it'd be interesting if this is replicable by other groups.
- sitkack 13y ago
  There was another test involving anomalous speech patterns, http://www.idt.mdh.se/kurser/ct3340/ht11/MINICONFERENCE/FinalPapers/ircse11_submission_1.pdf http://www.idt.mdh.se/kurser/ct3340/ht11/MINICONFERENCE/Fina... it might not be the canonical work. In the near future most laptops will have the ability to do realtime eye tracking so these kinds of tests could be administered broadly, probably even through a web page.
  - caycep 13y ago
    how close are consumer eye tracking devices? It'd be interesting to see. My group works w/ the PD side of things, and doing a desktop-based eye test might be something we'd be interested in...
    - sitkack 13y ago
      I have used an eye tracker in about 5 years but I think the cost back then was on the order of 4k+-1k. http://www.tobii.com/en/eye-experience/ http://www.tobii.com/en/eye-experience/ this is probably better than what we were using. So I'd say all the pieces are in place to do this. The architectural design of the tobii and the leapmotion is almost identical. High frame rate cameras over USB3 illuminated with IR. ---- Throw in an http://emotiv.com/ http://emotiv.com/ EEG and one could do all sorts correlations.

caycep 13y ago

Aren't there structural brain findings reported in some imaging research studies? I'd be interesting to see some of the work in MRI volumetric studies (i.e. voxel-based morphometry) or dopamine transmitter imaging, especially comparing longitudinal progression of schizophrenia patients or in cross sectional comparisons against healthy controls

zacinbusiness 13y ago

You see similar skepticism with autoimmune disorders. Invisible pain is something coworkers and families get bored with quickly.

alan_cx 13y ago
My 10 year old daughter has autoimmune liver disease. It also affects her kidneys and bladder. She is being lined up for transplants. Its devastating to her, and the family. Yet, despite numerous letters and meetings with her consultants, therapists, and social services, the moronic arrogant staff at her school refuse to take it seriously and cause her and us unbelievable problems and stress. It borders abuse.
- zacinbusiness 13y ago
  I'm very sorry to hear that. My wife has an as yet in diagnosed autoimmune issue. It's looking like either lupus or MS, but we have to wait until she's churned through the system to get a proper diagnosis. Luckily, her work place has been extremely understanding and supportive. But we've heard stories of people who see initial understanding that quickly turns sour. I hope all goes well with your daughter and that she can have a happy and healthy life. Do you think home schooling could be an option? I've never looked in to it as we don't have children ourselves. I hated school because most of my teachers and the staff weren't qualified to teach tricks to a dog, much less teach life lessons and knowledge to children.

Fasebook 13y ago

Let this be a warning to all those who suspect. WE WILL GET YOU, EVEN IF IT TAKES 17 YEARS.

threatofrain 13y ago

Hey there, do you have any place to direct me to look for mediators or malleable predictors of life outcomes for young men with schizophrenia?