Schizophrenia Update, January 15, 2003

Table of Contents

Schizophrenia 'may be many diseases'

Saturday, 26 October, 20

Schizophrenia may be an array of different disorders rather than one single disease, doctors believe. Research carried out in the United States suggests there could be at least three different types.

Doctors suggested the finding could help to dramatically improve their understanding of schizophrenia and help in the development of new drugs to fight the disease.

Dr Bruce Turetsky and colleagues at the University of Pennsylvania compared symptoms and brain patterns in 116 people with the disease and 129 healthy people. Both groups were assessed using the California Verbal Learning Test which examines learning and memory skills and their recall ability. They also underwent scans to examine the physical make-up and chemistry of their brain.

The tests revealed three distinct types of schizophrenia.

In the first group, parts of the brain called temporal lobes were smaller. They also transmitted fewer chemicals in these areas, which are linked to language and memory. They had problems paying attention, organising their thoughts and expressing ideas in a logical and coherent way.

They were mostly young males who had been diagnosed with schizophrenia at an early age. It affected almost one in five of those with the disease involved in the study.

In the second group, doctors discovered changes in the frontal-striatal region of the brain. They had less grey matter in the frontal lobes and had enlarged ventricles. This area affects cognition and motor function. Their temporal lobes were normal.

Almost one in three of those with the disease who were involved in the study fitted into this category.

More than half of the remaining patients had mild memory problems. Damage to their temporal lobes or frontal lobes was not as great as those included in the other two groups.

The doctors suggested that their findings may explain why a broad range of symptoms can be diagnosed as schizophrenia.

They added that their study may also indicate why scientists have found it difficult to identify the causes of the disease - particularly if they believe it is just one disease.

Dr Turetsky said: "One of the reasons we haven't been successful in identifying 'the cause' of schizophrenia may be because we are studying mixed groups of individuals who don't really have the same thing wrong with them."

He added: "Our results indicate that there are different neurobiological profiles associated with different presentations of schizophrenia. We may be dealing with more than one disease."

The researchers are now planning to expand their study to find out if differences in the brains of patients remain the same throughout their lives.

The study is published in the journal Neuropsychology which is published by the American Psychological Association.

For more information see:

A Hopeful Voice - A powerful, first-person account describes one man's three-decade struggle with and eventual recovery from schizophrenia; The Day the Voices Stopped; A Memoir of Madness and Hope; Review


Joseph Annibali, M.D., has a private practice of psychiatry and psychoanalysis in McLean, Virginia.

If you want to journey inside a mind tormented by schizophrenia, read The Day the Voices Stopped. As William Styron did for severe depression in Darkness Visible, and Kay Redfield Jamison did for manic depression in An Unquiet Mind, coauthors Ken Steele and Claire Berman have written a firsthand account of Steele's three-decade struggle with chronic schizophrenia and his remarkable recovery when a new medication stopped the hallucinatory voices. After his condition improved dramatically, Steele devoted himself to improving the plight of the severely mentally ill, becoming a nationally recognized advocate. He intended that this story of courage and recovery would give hope to those who suffer from similar illnesses. Although this is a remarkable book, I believe that it is overly optimistic about the current prospects for recovery from severe mental illnesses such as his.

Ken Steele, an apparently normal boy in a blue-collar family in Connecticut, was fourteen when his auditory hallucinations started, without warning. He began to hear insistent, taunting voices, commanding him to kill himself: "Hang yourself," they told him. "The world will be better off. You're no good, no good at all." Through nearly 250 pages Steele assaults the reader relentlessly with descriptions of the voices that commanded and taunted him. Together with other descriptions of his suffering, the impact is at times mind numbing. Not until near the end of the book (and his life), when new medication finally helped him, is Steele given more than a moment's respite.

The Day the Voices Stopped straightforwardly presents his deteriorating world and descent into psychosis. At first he began to have difficulty differentiating what was happening outside himself from what was happening within. For example, at times he perceived his voices as coming from the television. During his mother's pregnancy he believed that his unborn brother was speaking to him directly from her womb. He became isolated from friends and family.

Eventually, in response to the continued self-destructive demands of the voices, he attempted suicide for the first of many times. Denying the illness, Steele's father refused to allow his son to be hospitalized. Steele's condition continued to deteriorate. Though he was unusually bright and loved reading, he dropped out of school. Tension with his father increased. Needing to get away but still very ill, at age seventeen Steele left home for New York City, never having visited there before and without a job. It's rather obvious that he was trying to escape his family, who could neither understand nor help him.

New York City is no escape

Not surprisingly, soon after arriving in New York, he met a helpful stranger who turned out to be a homosexual predator and pimp. Steele was exploited sexually and began working as a hustler. When the voices commanded him to commit suicide by jumping off a tall building, he was apprehended by the police and sent to the first of many state hospitals. There are numerous heartrending reports of the well-intended but often horrendous treatment in these facilities. On page after page Steele describes months of seclusion, restraint, and horrible medication side effects. In one hospital, he was attacked by other patients, bound, gagged, and raped by several men. His injuries in this attack were so severe that he needed major surgery.

Many readers will react with sorrow and despair to the descriptions of Steele's illness, his apparent inability to get good, consistent, helpful mental health care, and the reports of frank neglect and even abuse at the hands of those who were supposed to be his caretakers. He often felt alone and abandoned, at times living as a street person. His parents never visited him in the hospital. He became more and more depressed, went in and out of various hospitals, suffered severe side effects from antipsychotic medications, and wandered from city to city, all across the United States. The pattern he reports in each location was similar: When his psychosis flared up, he would be hospitalized against his will. He would be forced to take medication that was ineffective, which would be followed by severe side effects, and he might be assaulted by staff, patients, or the police. Often he returned to the streets, living as a homeless person, working now and then as a prostitute. Depression and suicide were companions as dependable as his ever-present voices.

Steele states that living on the street often was preferable to being treated in deplorable state facilities. He comments that some staff members were dedicated to keeping patients hospitalized indefinitely as a means of retaining their jobs. He also reports that the hospital staff encouraged ethnic tension, often leading to violence.

Eventually, Steele found that alcohol muffled his voices, but he drank excessively and became addicted to alcohol. His overall health deteriorated. Heavy smoking took a toll on his lungs; he developed severe asthma and required treatment with steroids. While improving his breathing, the steroids caused his weight to balloon to more than four hundred pounds. The obesity precipitated severe sleep apnea. Eventually, Steele's psychiatric disability was joined by a physical incapacitation. He could hardly move around.

Recovery on Risperidone

Ultimately, Steele came under the care of a good therapist, who referred him for a psychiatric consultation. The psychiatrist placed Steele on Risperidone, one of a new generation of antipsychotic medications. His voices ceased for the first time, after more than three decades as unwanted residents of his psyche.

Steele's descriptions of the challenges he faced as he recovered are poignant. Initially, he was confused as he struggled to make sense of the voices' disappearance. He lamented their loss, wished for their return, even felt abandoned. At other times, he worried that the voices were tricking him, lying in wait to catch him off guard. He felt bombarded by the everyday noises that they previously had masked.

After the voices stopped, Steele was aware that people saw him as a grown man but that he felt like a child. Ordinary tasks, such as organizing his kitchen, were great challenges. Steele writes with authority about the pernicious effects of chronic dependency on the mentally ill: "Things that most people pick up through life experience have to be taught to those of us whose primary residence, for years, has been our inner world. When we reenter 'the real world,' it's like stepping into foreign territory." The freedom feels threatening: "During the first few months of being well, many people who have suffered from hallucinations quickly get unwell. System addiction is often the cause. It needs to be recognized so that it can be addressed and combated."

Work as an activist

An important part of Steele's life story is his long-standing interest in and involvement with community activities to benefit the mentally ill. Even before his recovery, he was appointed to and served on panels and advisory committees in Hawaii and San Francisco. In New York City he started a voter empowerment project for the mentally ill population. Once he recovered on the Risperidone, as Steele writes, "I vowed that I would use my own voice, in whatever ways I could, to make life better for myself and others who struggle, each day, to survive schizophrenia, and other devastating diseases of the mind. I would listen to, and learn from, the voices of other mentally ill people and their families. Working together, we could make a difference. And we would be heard."

Steele took over as editor of a mental health newsletter and renamed it New York City Voices: A Consumer Journal for Mental Health. "My hope was that voices could now become a positive noun--one that clarifies distortion instead of the other way around," he writes. The newsletter has informed readers about political and legislative issues, such as parity legislation. Additionally, it has printed individual stories about recovery and empowerment. Writes Steele: "I strongly believe that recovery and empowerment are possible for everyone with a mental illness, which is why it is important for us to reach out to one another with information and strategies for coping in the world of the 'normals.' "

In response to many requests for assistance that were pouring into New York City Voices, Steele started an information and referral service. He began to speak about mental illness and recovery before lay and professional groups and started a recovery support group that met in his home, noting that the group filled his own need for support as well as the needs of others. He spoke around the country, spreading the message that "recovery from mental illness is possible and that people suffering from mental illness need to be understood and assisted, not feared and avoided." The New York Times ran a front-page story about him in early 1999. With his therapist, he appeared in a Voice of America broadcast that brought in requests for information from all around the world.

Steele fought stigmatization and injustice in the treatment of the mentally ill. He writes: "There are now far more mentally ill people in the nation's jails than in state hospitals--people arrested for shoplifting, intoxication, fare-beating, living on the streets. More than 300,000 mentally ill people are in our jails and prisons, five times as many as are being treated in our state hospitals. Many would never have been incarcerated if there had been adequate community caring ... and care."

A vision of the future

He ends the book with this quote: "I have a vision that goes like this: In a new century, mentally ill people will have the science, the organized voting strength, and the means to leave our ghettos of isolation behind us. We will finally join with the mainstream community, where we'll be able to live as independent individuals and not as a group of people who are known and feared by the names of our illness."

Unfortunately, Steele's vision will be difficult to attain. He is correct in claiming that society views those who are mentally ill and homeless as a "throwaway population." Society seems unwilling to devote adequate financial resources toward caring for the severely mentally ill. Fairfax County, Virginia, where I live and practice, tops many lists as being the wealthiest county in the United States. Yet, I know firsthand from my work in mental health centers here that funding is inadequate, waiting lists can be long, and patients are often forced into group treatment because groups are cheaper than individual care.

Also, not every patient responds as positively as Steele did to the newer antipsychotic medications. Just recently, we have been learning that these medications may have serious side effects that previously were not well known. Many of these newer drugs are quite expensive and may not be covered by managed care. The patients who need them the most--those chronically disabled by psychiatric illness--are the very ones who are not working and lack the resources to pay for these drugs. Our society cannot legally force treatment on most severely ill people unless they are imminent dangers to themselves or others. Sadly, their illnesses often distort their thinking, making them run away from treatment. Many "street people" are severe mentally ill and refuse treatment for their illnesses.

As a practicing psychiatrist, I believe that the book's description of Steele's illness is one-dimensional. By the authors' report he was diagnosed with schizophrenia, and I accept this diagnosis. Schizophrenia is not just about auditory hallucinations, however. There typically are accompanying signs of psychotic illness, such as difficulties with thinking, delusions, and so-called negative symptoms. Although these other symptoms are alluded to, an unsophisticated reader might be left with the impression that the essence of schizophrenia is auditory hallucinations. This is not necessarily true. And if I may be permitted a quibble, the title of the book, The Day the Voices Stopped, while catchy and evocative, is misleading. Most of the book is about the periods before and after the cessation of voices, not the "day" referred to in the title.

Also, for the sake of balance, I need to mention that Steele and Berman present a one-sided view of treatment in state hospitals. The authors may give the uninitiated reader the impression that all state mental- health institutions are snake pits, run by venal individuals who are unconcerned about the welfare of their patients. I will acknowledge that there are some less-than-stellar facilities in this country, but most are not as bad as the book may imply. Furthermore, Steele does not emphasize enough that severe psychotic states often lead to perceptual distortions and resulting behaviors that predispose these individuals to the kinds of bad experiences he reports. When an individual with such predispositions enters an overworked and understaffed legal or mental health system, the results can sometimes be tragic. If accurate, there is no justification for the abuse and neglect that he describes. Still, it is not just a bad mental health system but these illnesses themselves that contribute to unpleasant and unfortunate treatment experiences like Steele reports.

Additionally, the point of view presented lacks a sense of the emotional complexity and nuance that exists in human life. If we lack a complex view of the psychic functioning of humans--individually and in groups--we cannot understand why human conflict is so universal. It is typical of individuals, when they come together as groups and even societies, to regress, to view the world in simple black-and-white terms, as all good or bad. This is a primary cause of racism, religious intolerance, and discrimination in general. Those groups discriminated against, whom we exclude and extrude, typically are those "different" from the rest of us. To put it simply, we want to get rid of those who are different from us. We even need groups who are different from us, and the mentally ill easily fall into that category. This universal human tendency, which the book does not acknowledge, will be a fundamental impediment to attaining Steele's vision.

The need for care and support

Despite these drawbacks, I know of no other book that so intimately portrays the day-to-day, moment-to-moment, reality of someone who has been hallucinating for so many years. For this description we should be grateful to the authors. Also, Steele and Berman provide an equally compelling account of the nature of treatment in the state hospital system, where many patients like Steele end up. While my own professional experience suggests that their descriptions of deplorable institutional treatment are not universally applicable, the pictures they paint are ugly, and we need to look at the situation with our eyes wide open.

Further, Steele writes thoughtfully about the problems of dependency that eventually trap these chronically ill, severely disturbed, patients in a web of poor functional capacity from which there is no escape. Finally, he writes movingly about the role of social support in recovery. I recall during my own psychiatric training that an eminent senior psychiatrist said that the best thing we could do for many of our most severely disturbed patients was to send them to an Alcoholics Anonymous meeting, whether or not they were alcoholics. He thought that the social support people get in AA was more helpful and powerful than the drugs and other treatments we then had available.

Steele did accomplish much, but he died of cardiac failure on October 7, 2000, just prior to his fifty-second birthday. Sadly, his new voice, of determination, dedication, and self-possession, was silenced when he had much left to say. Steele was a man on a mission, a man with a prophecy of hope and recovery. We need prophets: they show us where to aim as individuals and as a society. I hope that he will not have been a lone voice crying in the wilderness. His book will give hope to those who suffer from serious mental illness.

Some individuals and their families who read this book will be disappointed because they cannot and will not recover to the extent that Steele did. The problems they (and we) face in combating these serious conditions are complex. In my professional experience, there are no easy answers. In the future, Steele's belief--that all who suffer from severe mental illness can recover as he did--may be borne out. In the meantime, the severely mentally ill will benefit through the social and political empowerment that he advocated. Moreover, we all will benefit from his reminder that when patients are under the care of professionals, the professionals really ought to care. In our fast-paced world of managed care and managed everything, caring is often lost.


Brain images from hundreds of people with schizophrenia at 10 research sites nationwide will be shared in a first-of-its-kind research project funded with $10.9 million from the National Center for Research Resources (NCRR), a branch of the National Institutes of Health.

The project will create an extensive and unique database of brain information that is expected to expand our understanding of disabling brain illnesses such as schizophrenia and speed the development of new treatments.

The federal grant was awarded to the joint General Clinical Research Center (GCRC) of University of California, San Diego (UCSD) and the University of California, Irvine (UC Irvine). The GCRC will coordinate the nationwide effort to link and share vast amounts of computerized data from brain images of people who have schizophrenia. In addition, researchers participating in the project will create standardized, powerful discovery tools for future brain studies in large populations.

Although brain imaging technology has generated remarkable progress in understanding how mental and neurological diseases develop, it has been nearly impossible for one laboratory to share and compare findings with other labs. A lack of coordinated networks for sharing data, plus limitations in compatible computer hardware, software and imaging equipment, have isolated scientists, barring them from collaborative efforts that could provide the large database of brain images needed for a comprehensive look at brain dysfunction.

The newly funded project will utilize a nationally linked, high-speed computer network established by the Biomedical Informatics Research Network (BIRN), a consortium of U.S. universities that received their initial funding from the NCRR in 2001. During the past year, BIRN has utilized the new Internet 2 network and broad-band networking technologies to link several sites in the United States. With this new technology, scientists will distribute and share brain imaging data, including high-resolution digital magnetic resonance images (MRI) of brain structure and function, advanced 3-D microscope images, and related genomic, structural and gene expression data.

Steven G. Potkin, M.D., UCI professor of psychiatry, will lead the new three-year investigation.

"This grant allows a diverse group of researchers across the country to develop new methods to combine unique brain imaging data obtained at different centers," Potkin said. "This grant will find new ways to conduct very large imaging experiments and ease the exchange of data among researchers, not just in schizophrenia but eventually in a whole range of brain disorders and other diseases."

Sites and investigators participating in the new study are UCI (led by Potkin), UCSD (led by Gregory Brown) UCLA (led by Arthur Toga), Stanford University (led by Gary Glover), University of New Mexico (led by John Lauriello), University of Minnesota (led by Kelvin Lim), Massachusetts General Hospital (led by Bruce Rosen) with Brigham and Women's Hospital (led by Ron Kikinis), Duke University (led by Gregory McCarthy), University of North Carolina (led by Jeffrey Lieberman) and University of Iowa (led by Daniel O'Leary).

More information on BIRN is available at, and FIRST BIRN at

October 29, 2002
Media Contacts:
Andrew Porterfield, UCI (949) 824-3969
Sue Pondrom, UCSD (619) 534-6163

Misshaped 'spines' suggest new schizophrenia theory

18:25 05 November 02, Excerpt from New Scientist magazine
Helen Phillips, Orlando

Schizophrenia could be the result of differences in the structures that connect neurons together, according to new research.

The findings suggest a very different cause than other theories of schizophrenia, which focus on abnormal brain chemistry, particularly of dopamine signalling, or defects in the development of specific brain pathways.

The differences discovered are in the spiny structures found at synapses - the pathways through which nerve cells communicate. The spines in the brains of people with schizophrenia were smaller and abnormally shaped, losing their characteristic head and tail morphology in favour of a simpler tail or cylindrical structure, researchers from the University of Illinois, US, found.

Previous work had already revealed some general structural differences in the brains of people with schizophrenia. They seem to have a reduction in the volume of the cortex, particularly the prefrontal cortex, and enlargement of the ventricles.

"But this is really the first study to suggest large-scale differences in the structure of synapses," says one of the team, William Greenough. "It's a maladaptive change that would alter the way neurons communicate."
Brain plasticity

The research was presented at the Society for Neuroscience meeting in Orlando, Florida, US.

Saturday, 26 October, 2002, 00:54 GMT 01:54 UK
Medical research 'often flawed'

Medical research is expected to be independent

Clinical trials of many new drugs and treatments are flawed and possibly unethical, a study suggests.
Experts in the United States have found that many researchers fail to follow international guidelines when they are carrying out studies funded by the pharmaceutical industry.

They also fail to protect their independence and ensure that their findings are published, particularly if the results are unfavourable.

It is a worry if a drug company is able to find some way of stopping publication of the results of a study

Dr Michael Wilks, BMA
Doctors said the discovery raised serious questions about the integrity of some studies.

They added that it could also stop patients from volunteering to take part in future trials.

Countrywide survey

Doctors at the Duke Clinical Research Institute surveyed 108 medical colleges across the US.

Researchers were asked if they followed guidelines issued by the International Committee of Medical Journal Editors last year.

These guidelines were drawn up by the editors of more than 500 medical journals across the world and are aimed at ensuring studies are robust and of a high standard.

However, the study, which was funded by the institute, revealed that researchers rarely followed the guidelines when they were carrying out research funded by industry.

Just 1% said they had full access to all of the data from the clinical trial. The same proportion said they were able to decide when and where the results of their studies were published.

The survey also showed that many of the contracts between medical colleges and industry were inadequate.

Dr Kevin Schulman, professor of medicine at Duke University Medical Center, said the results were surprising.

"We didn't expect to find full compliance with the guidelines but we were surprised by the extent to which the agreements entered into by medical schools did not protect the independence of investigators in clinical studies and the integrity of their research."

But he added: "This is the first study to look at compliance with the new ICMJE guidelines so we hope it will offer medical schools a road map for how they might improve their agreements with industry sponsors."


However, Dr Jeremy Sugarman, director of the Center for the Study of Medical Ethics and Humanities at the university, warned that patients could stop volunteering to take part in clinical trials if researchers failed to strengthen their procedures.

"Patients often participate in clinical trials not only for personal benefit, but also because they believe they are contributing to scientific knowledge as a whole.

"If trial data are not made available to others, this may break an implicit promise to research participants that their contributions will be used in such a way."

Dr Michael Wilks, chairman of the British Medical Association's medical ethics committee, said the findings were worrying.

"It is a worry if a drug company is able to find some way of stopping publication of the results of a study which is not favourable to its product."

But he added: "It is different in the UK. Studies are approved by research ethic committees before they can go ahead and I don't think there would ever be a case where they would allow a study to proceed if there was a chance that the drug company could prevent publication of the findings."

The study is published in the New England Journal of Medicine.

Australia Scientists Identify Schizophrenia Genes
Tue Nov 26, 2002

An Australian research team said on Tuesday it had identified 153 genes affected by schizophrenia in a step toward discovering the causes of the illness.

The 153 affected genes were identified after completing high-throughput screening of 12,000 genes in post-mortem studies of brain tissue from schizophrenia sufferers.

The research team at the institute's Rebecca Cooper Laboratories outlined its plans to identify the core genes to the Australian Health and Medical Research Congress.

Dean said general current thinking is that genetics plays a major role in the development of schizophrenia, but studies with the identical twins of sufferers suggest there must also be another factor that brings on the disease.

Israeli Biotech: Schizophrenia Associated With the COMT Gene
IDgene Pharmaceuticals (Jerusalem) says it has discovered an association between the COMT (catechol-O-methyltransferase) gene and schizophrenia. The details of this finding will be published in next month's issue of The American Journal of Human Genetics and are now available online at "The genetic basis of schizophrenia is poorly understood and the data presented to date has been mostly inconclusive. IDgene has successfully produced the most statistically significant results ever reported in schizophrenia or in any other common polygenic disease. The study shows that the COMT gene may account for more than 20% of all schizophrenia patients. In the near future, we expect several additional discoveries of novel disease susceptibility genes, as well as genes responsible for variation in drug response," notes IDgene's CEO, Ariel Darvasi.

University Of Toronto , 11/13/2002

Gene Increases Schizophrenia Risk, Says Study
Scientists at U of T have discovered the first "risk gene" for schizophrenia found in the general population.

An uncommon variation of a gene called Nogo, when inherited from both parents, increases the risk of developing schizophrenia, says a study to be published in Molecular Brain Research Nov. 15. Previous findings about other risk genes for the disease were restricted to specific ethnic groups.

"Finding a risk gene in the general population - the first finding of this type internationally - opens the door to discovering new and related risk genes. Now scientists will know where to look for related genes," says pharmacology and psychiatry professor Philip Seeman. "This will help in diagnosis and potentially in the design of new medications for treatment of this terrible disease," adds Seeman who worked on the study with psychiatry professor Teresa Tallerico, lead author and pharmacology graduate student Gabriela Novak and undergraduate student David Kim.

The study shows that one in five people with schizophrenia has this risk gene. Researchers found that 17 of 81 individuals with schizophrenia - 21 per cent - had inherited the uncommon Nogo variant gene from both parents. In a control group of individuals without schizophrenia, only three per cent had inherited the gene from both parents. People can inherit the variant Nogo gene from just one parent but there's a schizophrenia risk only when this gene is inherited from both parents. The gene does not suggest a diagnosis for schizophrenia but rather an increased predisposition to the illness.

One of the Nogo gene's functions is to produce proteins that inhibit the growth of nerve endings in the brain. Unlike the common form of Nogo, the variant gene has three extra chemical bases, known as CAA, in a region of the gene that regulates protein production. The researchers found that activity of the Nogo genes was higher in the post-mortem brain samples of individuals with schizophrenia. It is possible that these extra CAA bases lead the variant Nogo gene to produce more proteins, thereby reducing the number of nerve endings in regions of the brain associated with schizophrenia symptoms, Seeman says. However, more research is needed to confirm this.

"This study adds to the rapidly evolving theory that, in the brain of those who suffer from schizophrenia, the nervous system develops in a slightly altered fashion leading to the onset of symptoms such as hallucinations and delusions in young adulthood," says Seeman.

Although the cause of schizophrenia is not known, the treatment of the symptoms has been well-established since the 1970s. Antipsychotic medication is used to block the action of dopamine, an adrenaline-like chemical transmitter in the nervous system that becomes overactive in people with schizophrenia.

"This finding of a risk gene in the general population could lead to the development of medications outside the dopamine system, perhaps targeting the protein produced by the gene," suggests Seeman.

The study was supported by the National Alliance for Research on Schizophrenia and Depression, the Eli Lilly Research Fellowship in Women's Mental Health, the Stanley Foundation Scholars Mentors Program of the National Alliance for the Mentally Ill, the Canadian Institutes for Health Research, the Ontario Mental Health Foundation and the National Institute on Drug Abuse. Professor Tallerico is an Essel Investigator of the National Alliance for Research on Schizophrenia and Depression (NARSAD) and Professor Seeman is a Janice Lieber Investigator of NARSAD.

The University of Toronto, Canada's leading research university with 60,000 students, is celebrating its 175th anniversary in 2002.

Schizophrenia drugs linked to diabetes

HALIFAX - Some doctors are warning about a class of anti-psychotic drugs linked to life-threatening side effects.

Health Canada has received reports that Zyprexa is suspected as the cause of four diabetes-related deaths. The drug was approved for use in Canada in 1996 and is made by Eli Lilly.

Zyprexa is part of a new class of drugs called atypical anti-psychotics. A growing number of schizophrenics in the country are using the new drugs, such as Clozaril. There are 300,000 schizophrenics in Canada.

People with schizophrenia experience three major types of symptoms:

  • psychotic symptoms: delusions and hallucinations
  • deficit symptoms: diminished emotions, social withdrawal and low motivation
  • mood symptoms: depression to suicidal

"It helps me by calming me down because I'm also nervous, my legs shake and my hands tremble," says Richard Thompson of Edmonton who has gained more than 30 pounds (14 kg) and developed diabetes since taking the drugs. His doctors believe the drug is at least partly responsible for his weight gain.

The most common side effects associated with Zyprexa are:

  • drowsiness
  • insomnia
  • agitation
  • dizziness

Less common effects include skin rash, depression, fast heart rate and constipation
Other known, but less common, effects are listed as: skin rash, headache, depression, fast heart rate, constipation and weight gain.

Research published in the British Medical Journal and other journals suggest atypical anti-psychotics can cause diabetes.

"We suspect…those drugs interfere with some kind of chemical processes both in the brain and body and lead to the development of something called insulin resistance," says Dr. Pierre Chue, Thompson's doctor. "As that develops, the diabetes sets in."

Health Canada has received four reports of diabetes-related Zyprexa deaths over five years.

Two of those deaths involved teenage boys who fell into diabetic comas.

In the U.S., the government has collected reports of 140 people who developed diabetes after taking Clozaril.

The companies which make the drugs say people with schizophrenia tend to have unhealthy diets which put them at risk of getting diabetes.

Marie Josee-Poulin, a psychiatrist at Laval University in Quebec, says the evidence linking the drugs to diabetes isn't clear yet but she says the concerns are justified.

A Health Canada newsletter has warned doctors that atypical anti-psychotics may be associated with new cases of diabetes. Some doctors would like to see this as a clear warning on the label.

Both Poulin and Chue says too many doctors are unaware of the risks and side effects of the new class of anti-psychotics. They say patients should be closely monitored for signs of unstable blood sugars or weight gain.

Written by CBC News Online staff





   Copyright 1996-2004. All Rights Reserved.