Schizophrenia Linked to Malnutrition

Here is some very exciting news on a possible cause of schizophrenia reported by the Associated Press via CTV from a study comparing starvation of Holland's citizens in the second world war, which found increased incidences of schizophrenia and also it's increase as result of famine in China 40 years ago.

Once again, I’m going to refer to the American Psychiatric Association's ‘A Research Agenda for DSM-V’. (It's available in book format here)

The paper was written as a challenge to the current Diagnostic Statistical Manual of Mental Illnesses (the DSM-IV) to encourage the American psychiatric community and researchers in mental health to develop tests that discover the causes (etiologies) of mental illness.

It wasn’t written to undermine serious and qualified mental illnesses. It was written to encourage research on tests that can scientifically determine if an individual has a qualified mental illness that is long term and ongoing. Its written to discourage diagnosis of mental illness based on short-term symptoms or normal behavior that mimic a mental illness and would otherwise be diagnosed as such according to the current DSM’s anal retentive (pun intended) use of its definitions.

Those definitions are based on catchwords and semantics that was originally meant to improve communications among clinicians and researchers, not because those definitions are valid to make a diagnosis.

Instead, the mental health system has relied on the current DSM IV that kept out-dated data at the time of publication due to deadline issues. As the report states: “[the] DSM IV process was almost completely dependent on already collected data once the short deadline was imposed”.

These out-dated statistics have been used since then in determining mental illness in both the U.S and Canada.

The Research Agenda goes on to say that the “DSM IV favours descriptive approach (to mental illnesses) where disorders are characterized in terms of “symptoms” by patient reports, direct observation and measurement as opposed to hypothetical and unproven theories about etiology”.

In order to develop these unproven theories, this report is attempting to encourage informative research in “fruitful areas to be further investigated well in advance of DSM-V”

It goes on to say that the “descriptive approach [of the DSM IV] was its ability to improve communication among clinicians and researchers, not its established validity.” (My emphasis).

In many cases of diagnosis of mental illness, it is commonplace to diagnose more than one ‘disorder’. The Agenda states that “symptom co variation could be explained by a common underlying etiology. Epidemiological and clinical studies have shown extremely high rates of comorbidities (more than one mental disorder) among the disorders, undermining the hypothesis that the syndromes represent distinct etiologies (my emphasis).

For example: “Twin studies have shown that generalized anxiety disorder and major depressive disorders may share genetic risk factors. Epidemiological studies have shown a high degree of short-term diagnostic instability for many disorders. With regard to treatment, specificity is the rule rather than the exception.”

The Agenda’s reasoning to encourage more research on the causes of mental illness is this: “ Researcher’s slavish adoption of DSM-IV definitions may have hindered research in the etiology of mental disorders. Reification (to make concrete or ‘set in stone’) of DSM-IV entities (realities of conventional thought) to the point that they are considered to be equivalent of diseases, is more likely to obscure than to elucidate research findings. The current diagnostic paradigm on refining DSM defined syndromes may never be successful in uncovering underlying etiologies.

Criteria listed in DSM’s have been uncritically used by legal professionals and health care administrators as representing lapidary (received wisdom) about the nature of mental disorders. Potential misinterpretation of DSM is the degree to which many, if not most, conditions and symptoms represent a somewhat arbitrarily defined pathological excess of normal behaviors and cognitive processes.

This problem has led to criticisms that the system pathologizes ordinary experiences of the human condition, such as normal bereavement or the rebelliousness of adolescents.

If the diagnostic system included criteria or decision rules that explicitly acknowledged symptoms and disorders, this would place the pathological nature of more extreme symptomatic behavior into context. In particular, it may be helpful to find ways to denote a distinction between mild or borderline cases and clear-cut or severe cases.”

This Research Agenda gives a good argument to reign in pharmaceutical companies who have used the current DSM-IV’s “slavish adoption of DSM-IV definitions” that misinterpret the DSM to the degree that have arbitrarily defined “pathological excess of normal behaviors and cognitive processes” into qualified diagnosis of mental illness in order to sell more drugs.

In many cases on-line psychological testing is sponsored by pharmaceutical companies with the caveat upon a pseudo diagnosis to ‘check with your doctor’. Diagnosing serious mental illness requires historical evidence of consistent severe symptoms, not some snake oil salesman’s misuse of the DSM.

The Agenda is also a good argument to re-examine the mental health system here in Ontario (I don’t know what it’s like in other provinces). In particular, with respect to Ontario’s Mental Health Act under clause 15, where thorough historical evidence has to be requested with consent and signed by the assessing psychiatrist in order to make a qualified diagnosis.

A diagnosis can’t be based on some haphazard and arbitrary use of DSM definitions to explain symptoms that are not necessarily consistent over time and become dubious without an assessing psychiatrist to confirm it.

Unfortunately, this irresponsible medicine has occurred in Ontario and I’m afraid any attempts on making changes to a broken system will be shrugged off because the Ontario government chooses to ignore the voices of the people they have affected.

What’s more nefarious is that taking an action to question the established medical community in this area brings on slanderous and discriminating accusations towards any individual who tries.