Nature, nurture cause disorder

Topeka Capital-Journal, The, Jul 5, 2008 by James Carlson

By James Carlson

THE CAPITAL-JOURNAL

Bob Owen was as normal a teenager as any other.

He played baseball and basketball, quarterbacked the football team and led the hockey team at his high school in a Minneapolis suburb in the early 1950s. He talked girls and sports and jokingly jabbed at his friends like any other boy.

But inside his mind, chemicals churned. Schizophrenia laid in wait.

Psychologists couldn't say exactly what led Owen to break down with the disorder in 1963 because they still don't fully understand the illness. The disorder is often confused with bipolar disorder, marked by spikes and lows in mood. Doug Denney, clinical psychology professor at The University of Kansas, said bipolar patients have episodic problems, whereas schizophrenia has to be dealt with for life.

Here is what is known about the murky beginnings of the illness.

Schizophrenia affects approximately 1 percent of the world's population every year, according to the U.S. Department of Health and Human Services. Men usually develop the disorder earlier, in their late teens and early 20s. Women are generally affected in their 20s and early 30s.

Denney said both nature and nurture play a part in the disorder. Schizophrenia doesn't follow a direct blood line but does run in some families. Owen always told friends about a "paranoid" uncle.

The other half of the disorder is attributed to environment, usually a difficult home life, though it can come from other areas as well.

"The stress of the environment can set in motion the emergence of the disorder," Denney said.

He said a vast majority of schizophrenics have oversensitive receptors for the brain chemical dopamine, which is normally associated with good moods. But an overabundance of dopamine also is associated with delusions and even hallucinations.

Researchers see the same result in those who use high amounts of cocaine, which releases large quantities of dopamine and can lead to what is known as "cocaine psychosis."

The disorder manifests as positive and negative symptoms. The positive symptoms - an addition to a normal personality - can include delusions, auditory hallucinations and disordered thinking. Owen never had hallucinations, but he had delusions . One day he looked out his window to his gardener and swore the man was poisoning him.

But there are also negative symptoms or a deficit of normal personality. That usually comes out as a loss of motivation and blunted emotional expression. Many schizophrenics withdraw from normal interactions, isolating themselves.

For Owen, the answer was antipsychotic medications, first introduced in the early 1950s. The first generation of medications was effective at dampening delusions and hallucinations by inhibiting the uptake of dopamine. But they also carried harsh side effects.

"They suppressed everything, tranquilized people kind of," Denney said. "Things would be fuzzy. Nothing was in sharp view."

New families of antipsychotic drugs work without so many of the negative side effects, he said.

James Carlson can be reached

at (785) 295-1186

or james.carlson@cjonline.com.