One of the harder problems we face in medicine and Biblical counseling is deciding which diagnostic labels represent disease and which are simply descriptions of inconvenient behavior. The one thing that has helped us sort out the difference has been pathology. Pathology is the study of disease. It looks at how changes at the cell level in our bodies result in abnormal function.
Understanding the pathology or change at the cell level is very important if we hope to help those who suffer from disease. When we know the process that causes the change in our body function, we have the opportunity to look for a cure or better care. This is particularly true in the arena of mental illness.
This week new research published in Nature[i] offered a new insight into the cause of schizophrenia that may open the door to better treatment. While the lifetime risk of schizophrenia is around 1%, those affected account for as much as 25% of costs for inpatient hospitalizations. Those who struggle with the delusions, hallucinations and personality changes are often unable to work or relate in a normal way to their families. It is likely that they make up from one third to one half of the homeless. It is an enormous burden for those affected and those who love them.
The last major advance in treatment for schizophrenia came 60 years ago with the introduction of Thorazine. This drug literally emptied the mental hospitals of the day, but since then most of the new drugs used have been variations of the original. Currently there is no new novel medical treatment on the horizon.
The reason why we are struggling to find new and better medicine is that we do not have a good understanding of the underlying pathology in schizophrenia. Pathology is the change at the cell level in the brain that causes the problem. Without that understanding it is nearly impossible to find new treatment. This may be changing.
New research in the genetics of schizophrenia has shown that there may be a connection between genes that govern brain tissue and tissue that play “important roles in immunity.”[ii] This connection may support the speculation that schizophrenia is a disorder of the brain in which our immune system attacks brain tissue resulting in symptoms.
This is important research because it is looking for the underlying cause and not another palliative treatment for symptoms. If we find the underlying cause and the change at the cell level in the brain that results in the damage, it offers the possibility of a real cure.
Along the same line a case report that was presented at the American Psychiatric Associations May 2014 meeting also offered another insight into schizophrenia.[iii] Patients in a long term warfarin clinic for blood thinning who were also diagnosed with schizophrenia were found to be in remission and no longer required anti-psychotic medication. The report included five patients and by no means does it suggest that all schizophrenics should be treated with anti-coagulants. But, it if it proves out in further research it may give an insight into the process that damages the brain and causes the hallucinations.
This is the kind of research that is desperately needed in the area of mental illness. Instead of trying to using surveys to count symptoms, this research is trying to find the cause. Medical research is at its best when starts with the change that a disease causes in the structure and function of human tissue at the cell level. If offers the hope of really understanding the patients problem and finding a cure.
[i] Biological Insights from 108 Schizophrenia-associated Genetic Loci. Nature 511, 421-427 (24July 2014)
[iii][iii] Warfarin for Long-Term Psychosis Remission? Medscape.com, Deborah Brauser, May 15, 2014.