The Pharmaceutical Journal
Vol 278 No 7442 p290
10 March 2007

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Rethinking schizophrenia more
Breaking the tobacco habit is complicated more
More on the mystery of the Flores hobbit more
Going over the top more

Rethinking schizophrenia

At the end of the 19th century the German psychiatrist Emil Kraepelin (1856–1926) took the then unitary concept of psychosis and divided it into two distinct forms, which he called manic-depressive psychosis and dementia praecox. The first of these conditions was a progressive illness that might exhibit itself in episodes spread over the years but eventually ended in recovery and restoration of the previous personality. The second was a mental disorder characterised by dissociation, intellectual and affective in particular, which later became known as schizophrenia.

Recently, more than a century after Kraepelin first recognised the condition, it has been suggested that the concept of schizophrenia may be scientifically meaningless, since its precise pathophysiology and cause are unknown. However, an editorial in the 20 January 2007 issue of the BMJ argues that, although the condition may defy strict diagnosis, the term “schizophrenia” is still a useful one.

Among the symptoms of schizophrenia are delusions, hallucinations, disorganised speech and behaviour, along with negative symptoms such as lack of motivation. The evidence is that these symptoms are all manifestations of brain pathology. Comparisons with normal controls show detectable abnormalities in brain structure and function. It seems clear also that there is a genetic basis to vulnerability to schizophrenia.

A mistaken diagnosis can lead to the wrong treatment and brand the patient as having a mental illness without justification. For example, a toxic psychosis induced by a drug such as phencycyclidine may lead to lengthy and unnecessary treatment with antipsychotic drugs. Only if the symptoms continue for a substantial period after the patient has ceased to take the suspected drug is a diagnosis of schizophrenia now allowed.

In order to minimise the stigma associated with schizophrenia, it has been suggested that it be renamed “integration disorder” or “dopamine dysregulation disorder”. This might help to relieve the concern of relatives that the disorder might cause undue fear in people who associate with the sufferer, with the result that the individual rather than the illness is blamed for the condition.

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Breaking the tobacco habit is complicated

With the approach of No Smoking Day on 14 March, it is revealing to look back at an interesting aspect of cigarette addiction in a report from California published in the 26 January 2007 issue of Science.

It is accepted that the smoking of cigarettes is the most common preventable cause of morbidity and mortality in the developed world today. It ranks as an addictive behaviour and it is notorious that many, if not most, smokers experience difficulty in limiting or discontinuing the habit ,despite ample warnings of the possible consequences of continuing it. Those who believe they have overcome the habit find it is easy to relapse.

Subcortical brain systems such as the amygdala, the nucleus accumbens and mecoencephalic dopamine system play a part in promoting the self-administration of drugs of abuse. Certain cortical systems call for closer attention, particularly the insula, which seems to be particularly active during relapsing episodes. A high level of activity in the right insula when a person has to make a decision is found to be associated with a relapse to a drug habit.

The question has been raised whether the insula is really necessary for maintaining the smoking habit. A study was carried out in 19 cigarette smokers with brain damage involving the insula, right or left, and a further 50 who had damage not involving this area. Patients with insula lesions were likely to show damage in adjacent areas. Smokers who acquired insula damage were more likely to quit smoking easily and immediately and remain abstinent. They often lacked the urge to resume the habit thereafter. There is evidence that the insula plays a role in conscious feelings by anticipating the effect on the body of emotional events.

None of the insula-damaged subjects who lost their taste for tobacco admitted to any reduction in the pleasure they derived from eating. However, impairment of taste perception has not been ruled out.

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More on the mystery of the Flores hobbit

The 2 February 2007 issue of Science calls attention once again to the mysterious hominid discovered on the Indonesian island of Flores. A research team has presented data indicating that the small-bodied and small-brained individual represents an entirely new species. It contradicts the claim that we are dealing with a modern human suffering from the severe deformity of microcephaly. The conclusion is not accepted by all the investigators and there are claims that another skull needs to be found before the argument can be settled.

Three-dimensional reconstructions of nine microcephalic and 10 normal human brains scanned by computed tomography revealed differences in the width of the frontal lobes compared with that of the cerebellum and the extent to which the cerebellum protrudes from the back of the brain. A reasonable conclusion was that the hominid brain represented that of a distinct species of Homo rather than a microcephalic specimen of H sapiens. Yet a pronounced flattening of the brain and abnormalities in the frontal lobes have given rise to some anxiety in those making a judgement.

There is no doubt that the shape of the hobbit brain differs from that of an adult microcephalic human. Further research in Flores is hoped to set some of the doubters at ease.

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Going over the top

I was amused to read in Chemistry World of a chemist who wonders if he has earned an entry in the record books for the largest batch of fireworks launched simultaneously.

The chemist, from the University of Plymouth, was taking part in a UK fireworks championship held in Plymouth in August last year. He adopted a scientific approach to the challenge. There were 55,000 rockets launched at a density of two rockets per square inch from a rig made from 15 wooden frames. A cotton string match, coated and cored with explosive black powder, was fired by a capacitor sparking a flame that travelled under the rockets at 25 metres per second. The batch of rockets was launched in five seconds. The atmospheric conditions were carefully assessed to determine the flight path and the fallout from detonations.

The previous greatest number of rockets launched simultaneously is 39,240.

The chemist commented that the experiment was designed to demonstrate that “science is fun”. So it may be, but many critics consider that such striving after record performances has its dark side and that perhaps there might be better ways of destroying the earth’s atmosphere than pointless and dangerous experiments.