Researchers at Johns Hopkins Medicine have found new evidence that schizophrenia in some patients can be marked by the buildup of abnormal proteins similar to those found in the brains of people with such neurodegenerative disorders as Alzheimer’s or Huntington’s diseases. The findings could lead to the development of new treatments for the disorder.
Currently, there is no cure for schizophrenia. A combination of medication and therapy is most often used to help a patient manage their condition.
Schizophrenia, which affects an estimated 200,000 people in the United States each year, is a chronic disabling mental disorder characterized by delusions, hallucinations and disordered thinking that impairs daily life.
Patients with schizophrenia suffer from psychotic episodes in which they cannot tell what is real from what is imagined. Schizophrenia can interfere with a person’s ability to manage emotions, make decisions and relate to others.
“We have been so focused on the genetic aspects of schizophrenia that less attention has been paid to what is happening at the protein level, and especially the possibility of protein aggregation,” says Frederick Nucifora Jr., DO, Ph.D., the leader of the study and a psychiatrist with The Johns Hopkins Schizophrenia Center. “This may be a whole new way to look at the disorder and develop more effective therapies that give patients more independence.”
Most patients are prescribed antipsychotics drugs as the first line of treatment. These can help relieve many of the troubling symptoms, but they don’t work for everyone.
For those who don’t respond well to antipsychotics, Dr. Nucifora recommends clozapine, an FDA-approved medication for treatment-resistant schizophrenia. Clozapine is underutilized, likely due to the risk of serious side effects, the challenges related to blood work monitoring and a registry requirement. His clinic at Johns Hopkins has instituted a holistic program that helps patients manage the challenges of sticking to a strict regimen.
Many patients are able to successfully work and live on their own but others require the support of family or a group home.
Development of the mental illness
While schizophrenia occurs in about 1% of the population, a history of family psychosis greatly increases the risk. Roughly 10% of people who have a parent or sibling with the disorder develop the illness.
Scientists also believe certain environmental factors can trigger schizophrenia. These may include exposure to certain viruses or toxins, malnutrition during pregnancy, older paternal age or substance use during teen and young adult years.
Evidence shows that smoking marijuana increases the risk of psychotic incidents and development of the disease and Dr. Nucifora is concerned by the loosening regulation of cannabis. More frequent use and how young a person is when they start correlates with additional risk.
Diagnosis and a test for schizophrenia
In men, schizophrenia symptoms typically start in their early- to mid-20s. In women, symptoms typically begin in their late 20s or early 30s. Some of the symptoms—withdrawal, poor grooming habits, trouble focusing—are common during teenage years, which can make diagnosis difficult.
While there is no specific test for the illness, a physician can conduct a psychological evaluation and medical exam to rule out other conditions like bipolar disorder or multiple personality disorder.
One challenge, Dr. Nucifora says, is that people with schizophrenia often lack awareness that their difficulties stem from a mental disorder. It often falls to family or friends to get them help. Early diagnosis and treatment can help improve the long-term outlook of the patient.
Understanding that the disease is long-term and that the symptoms will vary is helpful to both the family and patient.
“Patients who undergo treatment that includes both medication and counseling support have gone from being unable to care for themselves to returning to university,” says Dr. Nucifora. “A whole-person approach to care can successfully control a condition often characterized by distrust and paranoia,” he notes.