Transforming Schizophrenia Treatment

Monday, April 25, 2016

Early diagnosis and comprehensive treatment can improve lives


By Ben Feldheim

One in every 100 people suffers from schizophrenia, facing serious challenges throughout their lives, even after they find treatment.

Too often, people are diagnosed with schizophrenia long after they have developed severe psychotic symptoms, such as hallucinations, delusions and disordered thinking. Anti-psychotic medications can treat those symptoms; however, the drugs aren’t designed to address the cognitive, social and emotional difficulties stemming from schizophrenia.

But with a combination of earlier diagnosis, cognitive and behavioral therapy, and a safe environment free of judgment and reproach, in addition to medication, people with schizophrenia have a chance at living with more comprehensive relief from the disease than they’ll experience if they’re treated with medicine alone.

A team at Rush University Medical Center is working to make this potentially life-changing help available. It’s the initiative of Christine Hooker, PhD, the Stanley G. Harris Sr. Professor of Psychiatry (above), who recently came to Rush University Medical Center from Harvard University.

She is collaborating with Mark Pollack, MD, the Grainger Professor of Psychiatry and chairperson of the Rush Department of Psychiatry, and Corey Goldstein, MD, assistant professor of psychiatry. Together, they’re creating a new clinic and research program at Rush to improve the lives of individuals and families affected by the risk and emerging symptoms of psychosis.

The program is called STEP-UP, standing for Services to Treat, Evaluate, Prevent and Understand Psychosis. It’s designed not only to reduce the symptoms and distress of schizophrenia in the short-term, but also to promote individual and cultural changes that enhance resilience and recovery for subsequent years and future generations.

Proceeds from the upcoming Rush Associates Board Casino Night on May 6, and fundraising efforts throughout the year by the Rush Associates Board, will benefit STEP-UP. Hooker explains why this unique program for adults, teens and children is needed to help the 3.5 million people in the United States with schizophrenia and the many others at risk for developing the disorder.

What is missing from schizophrenia treatment right now?

Many people don’t realize how prevalent schizophrenia is — about one in 100 people have this condition. That’s not all that far off from the prevalence of autism.The standard treatment for the last 50 years has been to prescribe anti-psychotic medication after psychosis has begun. Those medicines reduce what we call positive psychotic symptoms, such as hallucinations and delusions.

But most people with schizophrenia also struggle with functional problems, including cognitive and social deficits. They have trouble remembering things and have trouble understanding feelings and intentions. If I am misinterpreting other people’s behaviors, it will interfere with my ability to develop friendships and relationships, which can be especially problematic in a work environment. The anti-psychotic meds weren’t developed to treat these functional problems.

Your own research focuses on early diagnosis and treatment for schizophrenia. How can earlier diagnosis help?

The cognitive and emotional problems associated with schizophrenia start earlier than psychotic symptoms and reflect the functioning of brain systems that are affected by the disease. We can use neuropsychological tests and other tools to measure cognitive and emotional skills, such as memory, attention, and social cognition, and characterize specific areas in the brain that support these skills.

I’ve been looking at neural biomarkers having to do with social dysfunction and cognitive dysfunction. For example, we’ve found that adolescents and young adults with elevated genetic risk for the disease, such as those with an immediate family member with schizophrenia, have worse social and cognitive skills than people without genetic risk, as well as less grey matter and worse brain function in the neural systems supporting those skills.

Research also shows that among those with genetic risk, individuals with worse behavioral and neural function are more likely to develop a psychotic disorder in the future. Together, it suggests that eventually we should be able to assess an individual’s risk for schizophrenia well before psychotic symptoms fully emerge.

While there is a serious stigma attached to mental illness, which often prevents people from being identified or diagnosed earlier, my philosophy is that knowing your vulnerability is powerful. You can then manage your health better, and if we start earlier, we can help people so they never develop a mental illness that becomes crippling.

Once someone is diagnosed with schizophrenia, what can be done to help that person in addition to medication?

In my first research job, I worked for Michael Merzenich, PhD, a widely known neuroscientist whose work showed that you can recover brain function through behavior training, a concept known as neural plasticity. Fast forward 30 years to now, and we are using those principles to treat the areas of the brain responsible for cognitive, social and emotional functions.

Among several projects I worked on was a study in which adults who lived with schizophrenia for between 10 and 20 years participated in an hour a day of intensive cognitive training, five days a week for 10 weeks. Those neural systems impaired by the disease improved because of the training.

The project that I brought here from Harvard to Rush is to take these initial findings and see whether we can use neural plasticity-based cognitive training as a way to intervene before the symptoms of schizophrenia start and actually prevent the disease from progressing.

How will proceeds from Casino Night support this effort?

Casino night is providing seed funding for the creation of STEP-UP. This new clinic will include a comprehensive clinical research program with a whole range of services: cognitive behavior therapy, counseling, medication management, early consultations and the early interventions I am developing. The proceeds will fund the clinical care associated with the program.

We will approach schizophrenia treatment on multiple fronts by educating the public about what exactly the disease really is and how people experience it, as well as available treatments and how we can make the situation better. The initial support that casino night and other Associates Board fundraising provides will enable us to launch STEP-UP and operate it until it becomes sustainable through fees for service, grants and additional philanthropy.

With the clinic, we also want to provide a safe place for young people and their families to openly discuss what’s going on with them. We can treat the condition and also lessen the stigma that holds so many people back from seeking the treatment they need.

To learn more about the Ninth Annual Rush Associates Board Casino Night, purchase tickets or make a donation, visit our event page.