Posts Tagged ‘schizophrenia’

The Best Laid Plans

April 8th, 2011

During the decades I have spent in academic medicine and psychiatry, I have read countless inspired theories and hypotheses concerning diseases and their treatments. Unfortunately, few have panned out. Scientists were going to cure schizophrenia with renal dialysis. Personally, I was going to alleviate tardive dyskinesia and depression with the dietary neurotransmitter precursors lecithin and tyrosine.

Fortunately, medical science is not a religious faith. The nature of empiricism allows for hypotheses to be proved—or more commonly, disproved. That’s been the story of my career and, sadly, most psychiatric science of the last century. But in our healing arts, it’s better to face the truth.

Doesn’t it stand to reason that if we inhibit both the norepinephrine and serotonin reuptake pumps, we should heal more depressed people than if we block only the serotonin transporter? A study called PREVENT showed that not to be the case.

And if we administer long-acting injectable antipsychotic medicines to patients with schizophrenia, shouldn’t we lower the relapse rate more than if we depend on their taking oral tablets? Again, no. An upcoming article in Biological Therapies in Psychiatry—“Does LAIR Beat Oral Antipsychotics?”—bursts this very logical bubble.

Someday, we’ll reach “personalized medicine” in psychiatry. Someday, more good theories will prove true than not. We’re not there yet.

-Alan J. Gelenberg, M.D.
Editor, Biological Therapies in Psychiatry
Shively/Tan Professor and Chair, Psychiatry, Penn State University
Editor-in-Chief, Journal of Clinical Psychiatry


 

The Person Within

January 10th, 2011
Gerry Klerman, my mentor, referred to the Washington University approach to psychiatric diagnosis (and the DSM-III that it spawned) as a “Chinese-menu:” one from column A, 2 two from column B. We have lived with this descriptive focus for several decades, and truly, psychiatrists must be competent in reliable diagnosis. But there’s undoubtedly more to our art and science.
A few days ago I admitted a 50-something gentleman to our in-patient hospital. He came with a long-standing diagnosis of schizophrenia. I always bring a critical eye to psychiatric diagnoses of patients I am newly meeting. But in his case, the diagnosis fit well. The history was totally consistent, and with his blunted affect and ongoing paranoid and odd delusions, the diagnosis of schizophrenia was pretty well established.
I completed our interview, then explained to the patient that I was going to spend a few minutes entering his information into a computer terminal. (It was my first experience with our new electronic medical record.) While I was busily typing away, he leaned over to read my ID badge. “Alan,” he said. I was surprised to hear my first name and looked up. “You’re a snappy dresser.” My face broke into a broad, spontaneous grin. “Thanks,” I responded. “I really appreciate your saying that.”
I do my best to teach our students and residents what I struggle to remember myself. There’s the Axis-I diagnosis. Sometimes it’s a severe one, like schizophrenia—which robs people of much of their human ability to connect with others. But beyond the multiple axes of DSM-IV, there are human strengths, talents, likes and dislikes. And as this man showed me, the ability to reach out and relate at a person-to-person level often persists.

- Alan J. Gelenberg, M.D.
Editor,
Biological Therapies in Psychiatry
Professor and Chair, Psychiatry, Penn State University
Editor-in-Chief,
Journal of Clinical Psychiatry