[throw18376]

i'm getting very argumentative on the internet today (under a pseudonymous account because as you might guess from my incessant posting, this issue is personal for me)

trauma (at any time), drug use, other experiences -- all can make schizophrenia more likely in those susceptible. absolutely true.

but it is a biological disease, and healing trauma won't stop its progression. as your source notes, the trauma causes differences in brain development, and once that's done its done.

i don't think coming up with a new drug, the main advantage of which is it doesn't numb you the horrible way existing antipychotics do, is a bad thing.

this is basically a drug that was only created to improve the QoL of people with schizophrenia. if society just wanted to numb them, we already have drugs for that and could just be much more aggressive in violently coercing treatment.

investing in these drugs isn't "looking away", it's putting in a huge investment of many billions of dollars to help the victims live better lives.

[rendx]

> once that's done its done

"As such, the hippocampus and hippocampal neuroplasticity may also play a key role in resilience and recovery from stress. This is supported by the current finding that hippocampal volume increased following psychological therapy."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5943737/

"we found a significant [hippocampal] volume expansion during a 12-week treatment period, which correlated with clinical improvement"

https://www.biologicalpsychiatryjournal.com/article/S0006-32...

Increased hippocampal volume and gene expression following cognitive behavioral therapy in PTSD

https://www.frontiersin.org/journals/human-neuroscience/arti...

[sterlind]

All those articles are for PTSD. PTSD is not the same as schizophrenia. Just because psychotherapy helps with PTSD doesn't mean it'll help with schizophrenia. Mental illnesses, and their treatments, are not fungible!

[rendx]

1. See my other reply in this thread about the potential link between and high comorbidity of PTSD and schizophrenia.

2. The argument brought up was that brain 'damage' "just is", and cannot be reversed; which is where any neuroplasticity research can be used to show that it is not that simple, and that even brain structures can and do continue to change over the course of a lifetime, not only on the level of transmitters.

3. The positive effects of psychotherapy for schizophrenia are well researched.

[rendx]

Hardy, A., Keen, N., van den Berg, D., Varese, F., Longden, E., Ward, T., & Brand, R. M. (2023). Trauma therapies for psychosis: A state‐of‐the‐art review. Psychology and Psychotherapy: Theory, Research and Practice. https://doi.org/10.1111/papt.12499

Schäfer, I., & Fisher, H. L. (2022). Childhood trauma and psychosis-what is the evidence? Dialogues in clinical neuroscience. P. 360 – 365. https://doi.org/10.31887/DCNS.2011.13.2/ischaefer

[asveikau]

Psychotherapy does in fact help with schizophrenia. It's been a while since I was steeped in reading sources that backs this up, but one thing I came across was the notion that therapy alone is actually more effective than antipsychotics alone for certain symptoms. (If memory serves, therapy is better than drugs for persistent delusions.)

However, I think the best treatment involves both.

[none4methx]

I’d like to call you both right on the basis that a working brain at age 40 retired with less than a working brain from age 27 or whenever schizophrenia tends to present.

Outcomes are what we’re hoping to improve. Your data looks like we get brain recovery, which is an improvement to outcomes. Necessary, maybe not sufficient.

[creatonez]

No one mentioned PTSD?

[rendx]

I did!

When you look at the studies I posted initially, one theory is that schizophrenia is a result of posttraumatic stress caused by childhood trauma, and a coping strategy (flashbacks, intrusions, dissociation). It may not be in all cases, but in the cases where that is, PTSD treatment seems to work to fundamentally heal schizophrenia.

Remission of schizophrenia after an EMDR session https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8820797/

Applications of Trauma Treatment for Schizophrenia https://www.tandfonline.com/doi/full/10.1080/109267710037051...

Making meaning of trauma in psychosis https://www.frontiersin.org/journals/psychiatry/articles/10....

Even if you believe schizophrenia to be first and then lead to traumatic experiences (which it certainly will), it makes total sense to do a trauma assessment and heal the maladaptive strategies and broken beliefs related to these traumatic experiences, which is where again PTSD treatment comes in.

"In the last 2 decades, it has become obvious that child abuse, urbanization, migration, and adverse life events contribute to the etiology of schizophrenia and other psychoses. […] I expect to see the end of the concept of schizophrenia soon." (Murray, R. M. (2016). Mistakes I Have Made in My Research Career. Schizophrenia Bulletin, sbw165. doi:10.1093/schbul/sbw165)

[froh]

yes, there are indications for this to be true, however, it's _extremely_ hard to find clinicians willing to and courageous enough to work with patients with psychotic experiences on trauma.

basically admitting psychotic episodes kicks you out of most programs before you can even start, because the anticipated overreaction to slight triggers can only be handled by the most experienced counselors, or so they believe.

In that sense I appreciate you sharing these papers while pointing out that it's still a looong way to have this currently "esoteric" knowledge mainstream.

[47282847]

Trauma therapy has three components: safety from continued abuse, stabilization/resource building/(co)regulation, and confrontation. It would be ill-advised indeed to start confrontation when the other two are not in place, however it is perfectly possible to use trauma therapeutic methods for stabilizing, also for patients with psychoses.

Build a stable base camp. No need to go in deeper yet. But if you are preparing to go in and face the truth, you cannot do it with meds that blind you.

[maybelsyrup]

> but it is a biological disease

I want to be charitable because I think I know the point you're trying to make in your comment, and what I want to say is mostly to the side of that. But I think that this statement at best glosses over what's been a long, expensive, and heated (though sincere) scientific conversation about schizophrenia over the past century and change. It's one that not only includes a substantively fruitless search for any underlying pathophysiology, but a spirited conversation about the validity, reliability, and plain-English usefulness of the concept itself! Further, this conversation is far from the stomping grounds of cranks and scammers; it has taken place inside what you might call the most orthodox psychiatric and psychological institutions: the APA, the major high-impact journals, fancy universities etc etc.

So when an eminence like Robin Murray, knighthood and all, can go into Schizophrenia Bulletin (2017) and write something like ...

"I expect to see the end of the concept of schizophrenia soon. Already the evidence that it is a discrete entity rather than just the severe end of psychosis has been fatally undermined. Furthermore, the syndrome is already beginning to breakdown, for example, into those cases caused by copy number variations, drug abuse, social adversity, etc. Presumably this process will accelerate, and the term schizophrenia will be confined to history, like 'dropsy.'" [1]

... saying that we know it's a biological disease as part of broader claims about treatment effectiveness doesn't tell the whole story. (I encourage everyone to read Murray's reflections in the linked article, as it's a fascinating retrospective on an illustrious career in psychosis research and psychiatry.)

[1] https://academic.oup.com/schizophreniabulletin/article-abstr...

[sudoshred]

Excellent comment. A “symptom” of schizophrenia is thinking that one does not have schizophrenia. A “heads I win tails you lose” situation where the single doctor is solely and individually responsible for diagnostics and treatment, but not liable. Criminals are given more rights and protection from abuse, and the legal systems has known and documented failures. For those who are labeled mentally ill there have not been established effective safeguards to protect and support those who might speak out, and by definition of competency their perspectives are not valid. Those who are economically incentivized to argue in favor of a biological explanation can be expected to do so, despite no personal expertise in the matter, and regardless of reproducible evidence.

[throw18376]

i think we would agree a lot about the brutality and incompetence of the current system of psychiatric institutions.

however, the reality is, psychosis frequently prevents people from recognizing their own impairment. it's just true that this is very common, and maybe shouldn't be so surprising, since in many other cases (alcohol, drugs, dementia, brain injury) people also are prone to underestimate how impaired they are.

[slibhb]

As I read it, the parent comment is making a point about the classification of schizophrenia. It is not disputing that the condition (psychosis) is real, or claiming that people are frequently misdiagnosed with some form of psychosis.

[throw18376]

well, okay, then we can say that a lot of people diagnosed with schizophrenia now, even if the concept of schizophrenia is not viable, do have biological disease(s) that cause psychosis alongside what we now call the negative symptoms of schizophrenia. I'm fine with that claim.

it's very different than the common anti-psychiatry claim that the schizophrenia diagnosis is a social construction that gets applied to healthy people who violate social norms.

[throw23478]

Are there any consistent biomarkers for people with schizophrenia?