The latest research approach of an Israeli doctor and his team in the treatment of schizophrenia might simply be summed up as “the earlier, the better.”
Treating schizophrenia in young people before they have their first episode is a controversial method, but during the last decade, ongoing studies by Dr. Uriel Heresco-Levy show that an intervention targeted to glutamates, one of two major neurotransmitters in the brain, won’t prevent the occurrence of the disease, but may improve a patient’s outcome over a lifetime. Neurotransmitters allow brain cells to communicate with each other.
Heresco-Levy is the director of the Schizophrenia Research Program and the Department of Psychiatry at Herzog Memorial Hospital, an associate professor at Hadassah Medical School, and a leader in this prevention work. He was part of a 2012 study on this research recently published in Schizophrenia Bulletin.
“One aspect of this increased emphasis is to highlight the potential damage associated with delays in treatment of early phases of psychotic illness,” wrote Heresco-Levy. “Recent data indicate that the duration of untreated psychosis in schizophrenia’s first episodes consistently predicts outcome independently of other variables.”
There is a growing body of evidence suggesting that changes in the neurotransmitter system, possibly caused by defects in the early development of the neurotransmitter processes, may be a root cause for the onset of this disease. The glutamate system, which may be altered in schizophrenia, could be functioning below optimum levels.
This type of neurotransmitter therapy is not the only approach researchers are taking in the quest to manage this disease, for which there is no cure. Drug therapies, however, have several negative side effects.
“Their use implies patient exposure to a variety of side effects, including motor, Parkinson’s disease-like symptoms, and metabolic side effects, e.g. obesity, blood sugar level elevation that characterize second-generation antipsychotic drugs,” said Heresco-Levy.
“During the last decade, our group has contributed extensively to the development and establishment of a novel class of medications to be used in psychotic disorders such as schizophrenia, and in illnesses such as autism, Post-Traumatic Stress Disorder, and Parkinson’s disease,” he added.
These medications typically contain glycine, D-serine, and sarcosine, natural amino acids present in the human body that “have the advantage of being practically devoid of significant side effects,” Heresco-Levy said. “By now, studies performed by our and other research groups have demonstrated that these compounds have the capacity to significantly alleviate negative symptoms and cognitive deficits in schizophrenia subjects.”
Scientists in the field believe that several genes may contribute to the risk of developing the disease. Additionally, they suspect that those with schizophrenia have a greater occurrence of rare genetic mutations and that these mutations, with hundreds of different genes, may “disrupt” brain development.
At an early age, typically between 16 and 30, according to the National Institute of Mental Health, an individual at risk for schizophrenia will manifest his or her first fully blown episode of the disease. Schizophrenia is a broad term for a disease that includes many kinds of symptoms such as psychotic hallucinations and delusions, or more subtle ones, such as impairments to cognition, learning, socializing, apathy, and a general “blunted affect,” which can also impact attention and memory.
Schizophrenia often limits the lifelong potential of those who suffer from it and it can change the trajectory of their lives, stunting the success of one’s education and preventing successful and ongoing employment.
Although schizophrenia manifests itself in only 1 percent of population in general, that risk rises to 10 percent for those who have a “first-degree” relative with the disease, such as a parent or sibling. A second-degree relative with the disease also has an elevated risk; a person with an identical twin has between a 40 and 65 percent chance of succumbing to schizophrenia.
Using behavioral, neurophysiological, and functional brain imaging approaches, Heresco-Levy said that his studies during the last 20 years clearly show there is “severe sensory dysfunction in schizophrenia.”
He believes that limiting the onset and the severity of symptoms is, at this time, one of the only ways doctors can affect the progression of schizophrenia, but noted that this approach may set the stage for further treatment options for other conditions.
“We recently performed clinical trials that found evidence that glutamatergic drugs can help not only schizophrenia but also depression, Post-Traumatic Stress Disorder, and Parkinson’s disease,” added Heresco-Levy. “Yet these possible treatments are not established and certainly not in the health fund basket. It is research for the future.”