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About half of all cases of adult mental illness, including schizophrenia, are first diagnosed at around age 14, when the body is undergoing the stress of puberty. The physical, biochemical, and emotional changes of puberty are not the only stresses that contribute to mental illness, Victoria Costello explains in an article for Scientific American Mind. Costello wrote A Lethal Inheritance: A Mother Uncovers the Science behind Three Generations of Mental Illness. Genetics has a role. About 1.1% of the general population is diagnosed with schizophrenia, but that risk increases to 10% to 12% for their offspring. Drawing on experience with her son, Costello urges parents to be proactive in recognizing early signs of schizophrenia and in addressing factors that add stress to genetically susceptible children, factors such as bullying, physical abuse, and cannabis use. In childhood, Costello's son had many potential indications of schizophrenia such as "impaired body sensations, reduced tolerance to stress, increased emotional reactivity, and, especially, social deficits." As a teen, he withdrew socially and emotionally, lost his motivation, and developed sleep difficulties and a disregard for hygiene.
Costello urges adult family members to be proactive in protecting their children's mental-emotional health, calling for transparency and responsibility. Family secrets shrouded in shame can pollute the emotional health of the family system; they need to be revealed. Parents who learn and use good communication skills can help strengthen their children's mental health. Parents can also find ways to mitigate stresses linked to schizophrenia. By being aware of early signs of schizophrenia, parents can seek help early on. "The earlier the symptoms are noticed, the less invasive or onerous the treatment tends to be," Costello writes.
Orthomolecular treatment is a viable alternative to pharmaceutical treatment, particularly in the early stage. In one of his last published articles for Journal of Orthomolecular Medicine, Abram Hoffer, MD, PhD, along with coauthor Frances Fuller, RNCP (Cand), wrote about a 20-year-old patient who came to Hoffer's clinic with his mother in 2007. The young man "had been diagnosed schizophrenic, or schizo-affective, and was on parenteral drugs." Unlike conventional medicine that views schizophrenia as an incurable illness, requiring lifelong pharmaceutical treatment, orthomolecular medicine uses high doses of vitamins and minerals to bring about recovery. Hoffer told this young man, "… schizophrenia genes are good genes if you feed them properly, which meant giving his genes the vitamins he needed, especially niacin." In treating over 5000 people with schizophrenia, Hoffer observed that they "aged gracefully, hardly ever got arthritis and rarely got cancer." Moreover, these people tend to be very intelligent, creative, and talented.
Suggested treatment for this young man included the avoidance of dairy products because of allergy signs that he displayed: dark rings under the eyes, white spots on fingernails, and drinking lots of milk. "Food allergies are trigger factors and have to be eliminated, as the constant inflammation of the gastrointestinal tract creates the 'leaky gut' syndrome and prevents the adsorption of nutrients, vitamins and minerals from the small intestine," Hoffer and Fuller explain. Hoffer also told the young man to take several supplements at the end of his meals: niacin (starting dose of 500 mg t.i.d.), vitamin C 1000 t.i.d.; B complex 100 mg o.d.; vitamin D 6000 IU o.d. in winter and 4000 IU in summer for Canadians; omega-3/salmon oil 1 g t.i.d.; zinc citrate 50 mg o.d. The young man reported improvement within a few weeks.
"Orthomolecular treatment is sophisticated, effective and safe and not time-consuming as many more patients can be seen," wrote Hoffer and Fuller. "Patients need not be seen as frequently because they recover, in contrast to those given only drugs. The saving in time and money is enormous; there is nothing more economical than recovery."
Costello V. A mind in danger. Sci Am Mind. March/April 2012: 31–37.
Hoffer A, Fuller, F. Orthomolecular treatment of schizophrenia. J Orthomolecular Med. 2009;24(1):9–13. Available at http://orthomolecular.org/library/jom/2009/toc1.shtml. Accessed July 5, 2013.
In our highly structured, industrial culture, seven to eight hours of uninterrupted sleep is considered the ideal. People who habitually awaken for a couple hours during the night often worry about insomnia or not getting enough rest, and turn to sleep aids in some form. In reality, biphasic, or segmented, sleep – being awake for a couple hours in the middle of the night – is a normal pattern for humans. The existence of segmented sleep gained attention during the early 1990s with observations from two separate researchers: history professor A. Roger Ekirch and National Institute of Mental Health researcher Thomas A. Wehr.
While studying the history of night activity, Ekirch found numerous references in literary works, such as Homer's Odyssey and Chaucer's Canterbury Tales to "first sleep" and "second sleep." He also found nonliterary writings by doctors in the 15th and 16th centuries. "A doctor in England wrote that the time between the 'first sleep' and the 'second sleep' was the best time for study and reflection," according to journalist David K. Randall, author of Dreamland: Adventures in the Strange Science of Sleep. "And one 16th-century French physician concluded that laborers were able to conceive more children because they waited until after their 'first sleep' to make love." This segmented sleep cycle was considered normal.
In a 1992 experiment, Wehr reported that segmented sleeping patterns developed in 15 normal working people when their exposure to daylight and artificial light was decreased. For four weeks, the 15 adults stayed at a sleep lab instead of returning to their homes after work. Instead of having access to artificial lighting and daylight for 16 hours per day, the subjects had only 10 hours of light. Lights at the sleep lab were turned off at 6 p.m. and turned back on at 8 a.m. – simulating the longer nights of winter. In the study abstract, Wehr wrote "When normal individuals were transferred from a conventional 16-h photoperiod to an experimental 10-h photoperiod their sleep episodes expanded and usually divided into two symmetrical bouts, several hours in duration, with a 1-3 h waking interval between them." "The subjects reported feeling energized and more productive throughout the day because of this," according to journalist Isha Bagga. During those waking hours before second sleep, prolactin levels, secreted by the pituitary gland, rise. Prolactin produces feelings of calm and well-being. Worrying about insomnia may negate the positive effects.
"'This demand for a consolidated eight-hour bout of sleep is certainly cultural and not biological,'" anthropologist Kay Orzech, PhD, told Bagga. "'I think this cultural demand contributes to high rates of insomnia, because it's seen as pathological to wake in the night, instead of normal, like in segmented sleep."
Bagga I. The science of segmented sleep. Nexus. November 16, 2012. Available at http://wvnexus.org/2012/11/science-segmented-sl. Accessed July 20, 2013.
Randall DK. Rethinking Sleep. New York Times Sunday Review. September 23, 2012;1,3.
Wehr TA. In short photoperiods, human sleep is biphasic [abstract]. J Sleep Res. June 1992;1(2):103–107. Available at http://www.ncbi.nlm.nih.gov/pubmed/10607034. Accessed July 20, 2013.
Why do otherwise normal young people intentionally hurt themselves by cutting their skin? Several theories have been proposed to explain intentional self-injury, a practice that usually arises between ages 14 and 24. Most studies support the idea that people use the pain to alleviate negative or painful feelings and to release tension or stress and relax, according to a 2007 review conducted by E. David Klonsky. "Self-injurers reported feeling more tense, anxious, angry, sad, and uptight before self-injury, and more relaxed, calm, happy, and relieved afterwards," writes Klonsky. Physiological measurements in laboratory studies corroborate this pattern of increased tension and substantial relaxation when patients imagine the process of self-injury.
Self-injury is not found in humans alone. Otherwise healthy birds pull out feathers. Turtles bite their legs. Cats and dogs lick and chew themselves raw. Veterinarians are well acquainted with self-injury in their physically healthy animal patients. Vets call it "overgrooming," according to cardiologist Barbara Natterson-Horowitz, MD, and science journalist Kathryn Bowers. Natterson-Horowitz and Bowers wrote Zoobiquity: What Animals Can Teach Us About Health and the Science of Healing. (The book has chapters on fainting, cancer, sexuality, addiction, heart attacks, obesity, eating disorders, infection, and the challenges of adolescence.) Grooming activities have a powerful calming effect on animals and on humans. "Studies looking at hair pulling, scab picking, and nail biting all point to a calm, trancelike state that typically accompanies these small, automatic, self-soothing activities," the authors write.
Stress, isolation, and boredom trigger overgrooming and self-injury in physically healthy animals. Veterinarians employ physical distractions and social-environmental changes to resolve the problem. Natterson-Horowitz and Bowers say that stress, isolation, and boredom may be the underlying triggers for self-injury in young people too: "The typical middle-class teen is a little like the horse alone in its stall, with most of its needs – especially food but even entertainment and physical activity – provided in easy-to-digest chunks. He's left with lots of extra time and few activities as invigorating as a daily struggle for survival." Therapists may convince a teen to substitute another action (e.g., snapping a rubber band against a wrist or drawing on skin with henna or a colored marker) as a short-term strategy to prevent self-injury, but long-term solutions may require changes in the social environment and participation in activities that reduce isolation and boredom, such as sports, theater, dance, or chorus.
Klonsky ED. The functions of deliberate self-injury: A review of the evidence. Clin Psychol Rev. 2007;27:226–239. Available at www.sciencedirect.com. Accessed July 9, 2013.
Natterson-Horowitz B, Bowers K. Grooming gone wild. Chapter 8 in: Zoobiquity. New York: Alfred A. Knopf; 2012:159–175.
Vitamin B12 and Cognitive Impairment
Numerous studies have found an association between low serum B12 levels and cognitive impairment, according to a 2012 Australian review led by E. Moore. Vitamin B12 is needed to transform homocysteine back into methionine, an essential amino acid needed for methylation and DNA synthesis. Vitamin B12 deficiency is a known cause of high homocysteine levels. The most common effects of B12 deficiency are megaloblastic anemia and spinal cord degeneration. Meat and eggs are the primary B12 dietary sources. Vegetarianism, poor nutrient absorption, and/or a genetic tendency for inefficient B12 transport and cellular uptake can produce B12 deficiency.
Numerous studies have found an association between low serum B12 and cognitive impairment. At this point, evidence that B12 supplementation improves cognitive function and delays dementia is sparse. Patients with signs of dementia/cognitive impairment for less than one year are more likely to benefit from supplementation than those with symptoms for over 12 months. As in other nutritional studies, people with vitamin B12 deficiency are the ones most likely to respond.
A two-year, randomized, double-blind controlled trial, conducted in the UK, used magnetic resonance imaging to show that supplementation with homocysteine-lowering B vitamins (folate, B6, and B12) slowed brain atrophy. The study involved 168 patients over age 70 with mild cognitive impairment. A subset received MRI cranial scans. Eighty-five patients took folic acid (0.8 mg/d), vitamin B12 (0.5 mg/d), and vitamin B6 (20 mg/d); and 83 received a placebo. Patients with the highest baseline levels of homocysteine showed the greatest benefit from supplementation. Overall, the supplement group showed a significantly slower mean rate of brain atrophy than the controls (p = 0.001): 0.76% (95% CI, 0.63–0.90) vs. 1.08% (0.94–1.22). Higher atrophy rates correlated with lower final cognitive function testing scores. The authors say that future tests should identify the vitamin or vitamin combination that has the most beneficial cognitive effect. Folate may not be necessary.
In their 2012 review, Australian researchers E. Moore and colleagues voiced concern about a rise in folate levels due to mandatory fortification of wheat products in Australia, the US, and Canada. They say, "… a high intake of folate may drive the distribution of vitamin B12 toward overutilization in the cytosol/methionine regeneration pathway, possibly disrupting the supply of vitamin B12 and its neuroprotective effect." High folate intake levels can also "mask" vitamin B12 deficiency in some people. The Australian researchers hypothesize that high folate intake with low serum levels of B12 may increase the risk of cognitive impairment.
Moore E, Mander A, Ames D, Carne R, Sanders K, Watters D. Cognitive impairment and vitamin B12: a review. Int Psychogeriatr. 2012:24(4):541–556. Available at http://www.researchgate.net. Accessed July 29, 2013.
Smith AD, Smith SM, deJager CA, et al. Homocysteine-lowering by B vitamins slows the rate of accelerated brain atrophy in mild cognitive impairment: a randomized controlled trial. Available at www.plosone.org. Accessed July 5, 2013.
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