At the Ram Manohar Lohia Hospital in Delhi, Smita Deshpande, who heads the psychiatry department, is hard at work to investigate how genes associated with schizophrenia — a mental condition which has perplexed the medical community for decades — play out in north Indians. Thousands of miles away, her brother, Vishwajit Nimgaonkar, who heads the programme in genetics and psychoses at the University of Pittsburgh, is also studying how the same predisposing genes for schizophrenia manifest themselves in the Caucasian population. Elsewhere, new research at the University of Buffalo, published by the university’s news centre, has found that problems with a particular pathway that includes 160 different genes lead to changes in the brain which cause schizophrenia later in life.
Around the world doctors and scientists are working hard to find out what causes schizophrenia and how different genetic mutations and environmental factors affect a person predisposed to this mental state of being. Deshpande and Nimgaonkar, for example, have found that even in people with similar predisposing genes which could have a role in developing schizophrenia, the mental disorder — characterised by a range of unusual behaviours like delusions and hallucinations, hostility and suspiciousness — manifests in different forms and to different degrees in north Indians and Caucasians. One study by them found that while 42 per cent of the patients in the US had a serious desire to die while attempting suicide; in Indians, 18 per cent of the cases showed this desire.
S K Chaturvedi, head of the psychiatry rehabilitation department at the National Institute of Mental Health and Neuro Sciences in Bangalore, has been tracking these studies closely. His is a difficult job — to help people with schizophrenia gradually integrate back into society and get into jobs. Studies such as these can help him identify the cause better and work out more effective ways of assisting people with schizophrenia to start interacting socially once again and keeping their minds focused elsewhere. Scientists and doctors, he says, are also trying to understand the genesis of schizophrenia through functional imaging — a study of the human brain’s functions based on the data acquired through brain imaging. The idea is to understand how the brain works, through its physiology and dynamics. The good thing, he says, is that in India the outcome of schizophrenia is better. “There is greater and better recovery because of the strong support system we have. Nobody, you see, is alone in our country.”
Even so, the prevalence of schizophrenia is around 1 per cent across populations, says Chaturvedi. According to the World health Organization, schizophrenia affects about 7 per thousand of the adult population (mostly in the age group of 15 to 35 years) worldwide.
* * * * *
That children do not suffer from schizophrenia is a myth. Arti Anand, consultant clinical psychologist at Sir Ganga Ram Hospital, Delhi, is working on a family where the mother and two children have schizophrenia. “In this case, genetics has played a key role in the children,” she says. Young children usually do not show signs of schizophrenia, adds Chaturvedi. “But, by the time they are 15 to 25, the symptoms appear.” These are in the form of changes in the individual’s personality, suspiciousness, fearfulness, incoherent speech, social withdrawal, decline in academics, blank gaze, smiling without reason, careless appearance, sharp fall in hygiene etc. Initially, this is often mistaken as changes or mood swings a young adult goes through. But the sooner the problem is identified and treated, the better it is,.
“Schizophrenia,” says Anand, “is a multi-factored disorder; genetics is often just one part of it.” Life stresses in the environment and early childhood experiences, which can lead to brain changes, are others. “There are people who have no threshold for stress and a small trigger may also lead to a psychotic disorder,” says Anand. Or, it could be a combination of genetic predisposition, stress and poor family support, she adds. “We see this condition in sensitive children if the family is not well knit, there are frequent fights and marital discord or alcoholic parents.”
For film maker Aparna Sen, it was an experience in the family which led her to make 15 Park Avenue (2005) on this disturbing and emotionally draining mental condition. The film, which won a National Film Award and stars Konkana Sen, Rahul Bose and Shabana Azmi, revolves around this issue. Here, Konkana lives in two realities — one of which is in her mind, where she is married to Bose, has five children and has a house at a non-existent address, 15 Park Avenue. “For us, she is delusional. But for her, that is her reality. Now how do you tell such a person what he or she believes is real does not exist?” says Sen who has observed her relative’s condition very closely. “It’s traumatic for both the person and the family,” she adds. “It badly affects the care-givers and siblings. The family too needs therapy to deal with something as sensitive and draining as this.” There is a scene in which Meethi (Konkana’s character in the film) is being forcibly taken away by her family from people she imagines are her husband
and children. “She screams and shouts that she is being abducted. For her (the patient) it is all so real. All of us, Shabana and I included, were in tears,” says Sen, adding, “It’s a heart-wrenching condition. And yet, there are long periods of lucidity too, when everything seems to fall in place and the person suffering from schizophrenia appears absolutely normal.”
The hallucinations, say Sen and the doctors, need not be visual. They are often auditory hallucinations, where you hear voices in your head. Research has shown that more men than women suffer from schizophrenia and its magnitude is worse in men. “In women, more emotional symptoms come up, so the problem is identified sooner. That is one speculation,” says Chaturvedi. Single men, without children, are the worst affected, he says.
* * * * *
According to the Chennai-based Schizophrenia Research Foundation, if the condition is detected early, it is possible to completely rehabilitate the person with medication and psycho-social therapy. But regular check-ups are advised. The foundation says that 30-40 per cent patients get cured completely; 30-40 per cent show partial recovery and will need continuous medication; and 20-30 per cent remain chronic patients, who may improve but never fully recover.
“The prognosis is quite encouraging in paranoid schizophrenia,” says Anand. This form of schizophrenia — there are five types — is characterised by auditory hallucinations, delusional thoughts about conspiracy and suspicion. People suffering from paranoid schizophrenia are, however, able to work, be constructively engaged and maintain relationships much better than those suffering from other type of schizophrenia. A remarkable example of this is John Nash, the mathematical genius and Nobel laureate in economics who is the subject of the movie, A Beautiful Mind. The reason people with paranoid schizophrenia remain constructive is most likely because the symptoms often manifest later in life and the patient might himself recognise the need for help.
This is unlike the case of disorganised schizophrenia where the person’s ability to communicate properly becomes impaired and the speech incomprehensible. He has trouble getting through even mundane tasks, like dressing or bathing. Then there is catatonic schizophrenia, in which the activity level drops considerably and the person chooses to remain immobile — sitting still for hours at a stretch in a seemingly uncomfortable position.
The recent research at the University of Buffalo shows that scientists might just have found the first model that could explain how defects in an important neurological pathway — Integrative Nuclear FGFR 1 Signaling (INFS) pathway — may lead to schizophrenia. The lead author of the study, Michal Stachowiak, a professor at the UB School of Medicine and Biomedical Sciences, has said: “INFS functions like the conductor of an orchestra. It doesn’t matter which musician is playing the wrong note, it brings down the conductor and the whole orchestra. With INFS, we propose that when there is an alteration or mutation in a single schizophrenia-linked gene, the INFS system that controls development of the whole brain becomes untuned. That’s how schizophrenia develops.”
This is a critical keg in the research on schizophrenia. Science, however, is still struggling to find others links — environmental, psychological and bio-psychosocial — that can explain what causes schizophrenia. But, as of now, the mind is holding its secrets close to its heart.
