Toxoplasma Infection Linked to Schizophrenia

August 19, 2011 — Toxoplasma gondii infection is associated with subsequent development of schizophrenia spectrum disorders, new research suggests.

In a prospective cohort study of more than 45,000 women in Denmark who had recently given birth, those with the highest levels of T gondii–specific IgG antibodies were almost twice as likely to develop this psychiatric disorder as women with low levels.

“Based on the findings, it seems advisable to take natural precautions to avoid T gondii infection,” lead author Marianne Giørtz Pederson, MSc, from the National Center for Register-Based Research at Aarhus University, Denmark, told Medscape Medical News.

In an accompanying editorial, Alan S. Brown, MD, MPH, from the New York State Psychiatric Institute in New York City, Columbia University College of Physicians and Surgeons, and Department of Epidemiology at the Mailman School of Public Health, writes that the study suggests that “environmental exposures may play a more important role in the etiopathogenesis of schizophrenia” than previously assumed.

“The promise of this work is underscored by the fact that many infectious exposures and other environmental insults are treatable and preventable,” he added.

The study is published in the August issue of the American Journal of Psychiatry.

Reported by Deborah Brauser
Medscape Medical News

Mentally ill man’s death in fight with Calif. police focuses attention on training

FULLERTON, Calif. — Police should have been intimately familiar with Kelly Thomas and his history of mental illness.

Thomas had symptoms of schizophrenia and a 16-year string of arrests for everything from assault with a deadly weapon to public urination to jaywalking. But somehow, things ended differently this time.

Six officers who were trying to search Thomas’ backpack after reports of break-ins at a Fullerton, Calif., transit hub got into a violent fight with the 37-year-old. He later died of severe head and neck injuries.

His death has provoked outrage in the college town southeast of Los Angeles and raised questions about how well police in Fullerton and elsewhere are trained to deal with the mentally ill….


Learning to Cope With a Mind’s Taunting Voices

LEE’S SUMMIT, Mo. — The job was gone, the gun was loaded, and a voice was saying, “You’re a waste, give up now, do it now.”

It was a command, not a suggestion, and what mattered at that moment — a winter evening in 2000 — was not where the voice was coming from, but how assured it was, how persuasive.

Losing his first decent job ever seemed like too much for Joe Holt to live with. It was time.

“All I remember then is a knock on the bedroom door and my wife, Patsy, she sits down on the bed and hugs me, and I’m holding the gun in my left hand, down here, out of sight,” said Mr. Holt, 50, a computer consultant and entrepreneur who has a diagnosis of schizophrenia.

She says, ‘Joe, I know you feel like quitting, but what if tomorrow is the day you get what you want?’ And walks out. I sat there staring at that gun for an hour at least, and finally decided — never again. It can never be an option. Patsy deserves for me to be trying.”

In recent years, researchers have begun talking about mental health care in the same way addiction specialists speak of recovery — the lifelong journey of self-treatment and discipline that guides substance abuse programs. The idea remains controversial: managing a severe mental illness is more complicated than simply avoiding certain behaviors. The journey has more mazes, fewer road signs….

New York Times

Groups want to voice views on forced medication in case against Ariz. shooting spree suspect

PHOENIX — Two national psychiatric groups on Wednesday asked an appeals court to let them weigh in on the issue of forced medication in the criminal case against the man accused of wounding Rep. Gabrielle Giffords in a deadly shooting rampage in Tucson.

The American Psychiatric Association and the American Academy of Psychiatry and The Law made a request to become a party in the case as the 9th U.S. Circuit Court of Appeals considers whether the decision to forcibly medicate Jared Lee Loughner with psychotropic drugs can be made by prison officials or a judge.

Loughner has been at a Missouri prison facility since May 27 after a judge concluded he was mentally unfit to help in his legal defense.

He was forcibly medicated between June 21 and July 1 after prison officials concluded his outbursts at the prison posed a danger to others.

The appeals court temporarily halted the medication. But prison officials resumed medicating him July 19 after they concluded his psychological condition was deteriorating and put him on round-the-clock suicide watch.

The court later lifted its ban on medicating Loughner.

The psychiatric groups say in their friend-of-the-court brief that the decision to treat dangerous patients should be made by those who have custody of them, not by a judge who lacks the background to make appropriate treatment decisions.

They also say requiring a prison to seek court approval for such medications is likely to delay treatment and prolong patients’ risks to themselves or others.

The groups have voiced their views in other cases involving forced medication.

Loughner has pleaded not guilty to 49 charges in the Jan. 8 shooting that killed six people and wounded 13, including Giffords.

His lawyers haven’t said whether they intend to present an insanity defense, but they have noted in court filings that his mental condition likely will be a central issue at trial.

Mental health experts have determined Loughner suffers from schizophrenia.


Court Won’t Bar Forced Medication Of Tucson Suspect

TUCSON (AP) — A federal appeals court has refused to bar prison officials from forcibly administering a psychotropic drug to Jared L. Loughner, the suspect in a shooting rampage here that left six people dead.
Judges from the United States Court of Appeals for the Ninth Circuit on Friday night denied an emergency motion on the medication from defense lawyers. They also rejected the lawyers’ request for daily reports about Mr. Loughner’s condition at a federal prison facility in Springfield, Mo.

Federal prosecutors said in a filing earlier Friday that Mr. Loughner should remain medicated because he may be a danger to himself and because his mental and physical conditions were rapidly deteriorating.

Mr. Loughner, 22, has pleaded not guilty to 49 charges in the Jan. 8 shooting that left six people dead and 13 wounded, including Representative Gabrielle Giffords of Arizona. He has been at the Springfield facility since May 27 after a federal judge concluded that he was mentally unfit to help in his legal defense. Mental health experts have determined that Mr. Loughner suffers from schizophrenia and will try to make him psychologically fit to stand trial.

On Thursday, defense lawyers questioned whether the forced medication violated an earlier order by the court that forbade officials from involuntarily medicating Mr. Loughner as judges consider an appeal on his behalf.

The United States attorney for Arizona, Dennis K. Burke, wrote in his filing on Friday that “despite being under suicide watch, Loughner’s unmedicated behavior is endangering him.”

Mr. Loughner was forcibly medicated between June 21 and July 1 after prison officials determined that his outbursts posed a danger to others. He was given twice-daily doses of Risperidone, which is used to treat schizophrenia, bipolar disorder and severe behavior problems.


Low Dose vs Standard Dose of Antipsychotics for Relapse Prevention in Schizophrenia


Background: It remains unknown as to whether the antipsychotic dose needed for the acute-phase treatment of schizophrenia is also necessary for relapse prevention.
Aim: To compare the efficacy between standard dose [(World Health Organization daily defined dose (DDD)] vs low dose (≥50% to <1 DDD) or very low dose (<50% DDD) for relapse prevention in schizophrenia.
Data source: Double-blind, randomized, controlled trials with a follow-up duration of ≥24 weeks, including ≥2 dosage groups of the same antipsychotic drug for relapse prevention in schizophrenia, were searched using MEDLINE, the Cochrane Central Register of Controlled Trials, and EMBASE (last search: August 2009).
Data extraction: Data on overall treatment failure, hospitalization, relapse, and dropouts due to side effects were extracted and combined in a meta-analysis.
Data synthesis: Thirteen studies with 1395 subjects were included in this meta-analysis. Compared with the standard-dose treatment, the low-dose therapy did not show any statistically significant difference in overall treatment failure or hospitalization, while the standard dose showed a trend-level (P = .05) superiority in risk of relapse. The very low–dose group was inferior to the standard-dose group in all efficacy parameters. No significant difference was found in the rate of dropouts due to side effects between either standard dose vs low dose or very low dose.
Conclusions: Although antipsychotic treatment with ≥50% to <1 DDD may be as effective as standard-dose therapy, there are insufficient clinical trial data to draw firm conclusions on standard- vs low-dose maintenance antipsychotic therapy for schizophrenia.

Hiroyuki Uchida; Takefumi Suzuki; Hiroyoshi Takeuchi; Tamara Arenovich; David C. Mamo
Schizophr Bull. 2011;37(4):788-799.

Higher-Dose Quetiapine Won’t Improve Schizophrenia

NEW YORK (Reuters Health) Jul 29 – Increasing the dose of quetiapine won’t improve symptoms of schizophrenia or schizoaffective disorder, new trial results show.

And while parkinsonian symptoms didn’t increase at the higher dose, patients did gain more weight, said Dr. William G. Honer of the British Columbia Mental Health and Addictions Research Institute in Vancouver and his colleagues.

Higher-than-approved doses of quetiapine are prescribed frequently, without much data to support the practice, Dr. Honer and his team wrote in a June 14th online paper in the Journal of Clinical Psychiatry.

They designed their study to see whether patients who improved less than 30% on the Positive and Negative Syndrome Scale (PANSS) score after four weeks on the maximum approved quetiapine dose (800 mg/day) would do better on 1,200 mg/day for an additional eight weeks.

The primary outcome was emergent or worsening extrapyramidal symptoms, given that “this side effect of antipsychotics has shown the clearest dose-response relationship,” the authors said.

They randomized 43 patients to a placebo group that continued to take 800 mg/day; the other 88 received an average dose of 1,144 mg/ day.

Emerging or worsening parkinsonism was 3.1% more frequent in the higher dose group, which was within the 16% preset limit for non-inferiority.

On average, patients in the higher-dose group gained 1.7 kg, while 12.5% gained 7% or more of their baseline weight, compared to 1.1 kg and 9.3% for the lower-dose group.

Symptom severity declined in both groups over time, but without any significant differences between the two groups.

The researchers conclude, “The results of this study did not demonstrate any advantage for use of quetiapine at doses outside of the approved dose range.”


J Clin Psychiatry 2011.

Mutations Not Inherited from Parents Cause More Than Half the Cases of Schizophrenia

Columbia University Medical Center researchers have shown that new, or “de novo,” protein-altering mutations — genetic errors that are present in patients but not in their parents — play a role in more than 50 percent of “sporadic” — i.e., not hereditary — cases of schizophrenia.

The findings will be published online on August 7, 2011, in Nature Genetics….

Adapted by ScienceDaily Staff
Reference: Bin Xu, J Louw Roos, Phillip Dexheimer, Braden Boone, Brooks Plummer, Shawn Levy, Joseph A Gogos, Maria Karayiorgou. Exome sequencing supports a de novo mutational paradigm for schizophrenia. Nature Genetics, 2011; DOI: 10.1038/ng.902

Cancer Drugs May Help Treatment of Schizophrenia

Researchers have revealed the molecular pathway that is affected during the onset of schizophrenia and successfully alleviated symptoms of the illness in mice, using a commonly used cancer drug.

The research, published online in the journal Brain, is from a group led by Professor Peter Giese at King’s College London, and offers new avenues for drug discovery….

Adapted by ScienceDaily Staff
Reference: O. Engmann, T. Hortobagyi, R. Pidsley, C. Troakes, H.-G. Bernstein, M. R. Kreutz, J. Mill, M. Nikolic, K. P. Giese. Schizophrenia is associated with dysregulation of a Cdk5 activator that regulates synaptic protein expression and cognition. Brain, 2011; DOI: 10.1093/brain/awr155