876 Nancy C. Andreasen describes the function of hospitals as communities on page 32 of The Family Face of Schizophrenia (1994).
877 The quotation from the frustrated father (“The authorities say it is their choice and their right to live like stray animals . . .”) occurs on page 11 of Rael Jean Isaac and Virginia C. Armat, Madness in the Streets (1990).
878 This passage is based on my interview with Madeline Grammont in 2008. All names in this passage are pseudonyms.
879 For a large-scale study of schizophrenia risk in twins, see Alastair G. Cardno et al., “Heritability estimates for psychotic disorders: The Maudsley twin psychosis series,” Archives of General Psychiatry 56, no. 2 (February 1999): 162–68.
880 For a review of enlarged lateral ventricles in schizophrenia, see Danilo Arnone et al., “Magnetic resonance imaging studies in bipolar disorder and schizophrenia,” British Journal of Psychiatry 195, no. 3 (September 2009).
881 The function of dendritic spines is described in detail in Anissa Abi-Dargham and Holly Moore, “Prefrontal DA transmission at D1 receptors and the pathology of schizophrenia,” Neuroscientist 9, no. 5 (2003).
882 Temporal lobe function in schizophrenia is discussed in Christos Pantelis et al., “Structural brain imaging evidence for multiple pathological processes at different stages of brain development in schizophrenia,” Schizophrenia Bulletin 31, no. 3 (July 2005).
883 For more information on synaptic connectivity and frontal lobe function in schizophrenia, see Gábor Faludi and Károly Mirnics, “Synaptic changes in the brain of subjects with schizophrenia,” International Journal of Developmental Neuroscience 29, no. 3 (May 2011); and Francine M. Benes, “Amygdalocortical circuitry in schizophrenia: From circuits to molecules,” Neuropsychopharmacology 35, no. 1 (January 2010). Synaptic connectivity in autism is discussed in Carlos A. Pardo and Charles G. Eberhart, “The neurobiology of autism,”Brain Pathology 17, no. 4 (October 2007).
884 For discussion of the contribution of maternal infection to schizophrenia, see Douglas Fox, “The insanity virus,” Discover, June 2010; and Alan S. Brown and Ezra S. Susser, “In utero infection and adult schizophrenia,” Mental Retardation & Developmental Disabilities Research Reviews 8, no. 1 (February 2002).
885 Studies documenting an increase in schizophrenia in offspring of women who experienced the death or life-threatening illness of a close relative during pregnancy include Ali S. Khashan et al., “Higher risk of offspring schizophrenia following antenatal maternal exposure to severe adverse life events,” Archives of General Psychiatry 65, no. 2 (2008); and Matti O. Huttunen and Pekka Niskanen, “Prenatal loss of father and psychiatric disorders,” Archives of General Psychiatry 35, no. 4 (1978). Unforeseen mental health consequences of war are documented in Jim van Os and Jean-Paul Selten, “Prenatal exposure to maternal stress and subsequent schizophrenia: The May 1940 invasion of the Netherlands,” British Journal of Psychiatry 172, no. 4 (April 1998); and Dolores Malaspina et al., “Acute maternal stress in pregnancy and schizophrenia in offspring: A cohort prospective study,” BMC Psychiatry 8 (2008). Schizophrenia following famine is discussed in Hans W. Hoek, Alan S. Brown, and Ezra S. Susser, “The Dutch famine and schizophrenia spectrum disorders,”Social Psychiatry & Psychiatric Epidemiology 33, no. 8 (July 1998); and David St. Clair et al., “Rates of adult schizophrenia following prenatal exposure to the Chinese famine of 1959–1961,” Journal of the American Medical Association 294, no. 5 (2005).
886 Prenatal stress hormones and dopamine activation in schizophrenia are explored in Alan S. Brown, “The environment and susceptibility to schizophrenia,” Progress in Neurobiology 93, no. 1 (January 2011); and Dennis K. Kinney et al., “Prenatal stress and risk for autism,” Neuroscience & Biobehavioral Reviews 32, no. 8 (October 2008).
887 For a recent study finding an increased risk of schizophrenia following traumatic brain injury, see Charlene Molloy et al., “Is traumatic brain injury a risk factor for schizophrenia?: A meta-analysis of case-controlled population-based studies,” Schizophrenia Bulletin (August 2011).
888 Meta-analyses of studies on increased risk of schizophrenia in immigrant populations include Elizabeth Cantor-Graae and Jean-Paul Selten, “Schizophrenia and migration: A meta-analysis and review,” American Journal of Psychiatry 162, no. 1 (January 2005); and Jean-Paul Selten, Elizabeth Cantor-Graae, and Rene S. Kahn, “Migration and schizophrenia,” Current Opinion in Psychiatry 20, no. 2 (March 2007).
889 For studies establishing an association between severity of schizophrenic symptoms and recreational use of cocaine, methamphetamine, and cannabis, see, e.g., Killian A. Welch et al., “The impact of substance use on brain structure in people at high risk of developing schizophrenia,” Schizophrenia Bulletin 37, no. 5 (September 2011); and P. A. Ringen et al., “The level of illicit drug use is related to symptoms and premorbid functioning in severe mental illness,” Acta Psychiatrica Scandinavica 118, no. 4 (October 2008).
890 Methamphetamine use and psychosis in postwar Japan are discussed in Hiroshi Suwaki, Susumi Fukui, and Kyohei Konuma, “Methamphetamine abuse in Japan,” in Methamphetamine Abuse: Epidemiologic Issues and Implications, edited by Marissa J. Miller and Nicholas J. Kozel (1991); and Mitsumoto Sato, Yohtaro Numachi, and Takashi Hamamura, “Relapse of paranoid psychotic state in methamphetamine model of schizophrenia,” Schizophrenia Bulletin 18, no. 1 (1992).
891 For the Swedish cannabis/schizophrenia study, see Stanley Zammit et al., “Self reported cannabis use as a risk factor for schizophrenia in Swedish conscripts of 1969: Historical cohort study,” British Medical Journal 325, no. 7374 (November 23, 2002).
892 The quotation from Cyril D’Souza comes from my interview with him in 2007. One of his recent articles that addresses this topic is R. Andrew Sewell, Mohini Ranganathan, and Deepak Cyril D’Souza, “Cannabinoids and psychosis,” International Review of Psychosis 21, no. 2 (April 2009).
893 Dysregulation of neural transmitters is described in Paul J. Harrison and D. R. Weinberger, “Schizophrenia genes, gene expression, and neuropathology: On the matter of their convergence,” Molecular Psychiatry 10, no. 1 (January 2005).
894 Studies and review articles by Anissa Abi-Dargham and her colleagues include Anissa Abi-Dargham et al., “Increased baseline occupancy of D2 receptors by dopamine in schizophrenia,” Proceedings of the National Academy of Sciences 97, no. 14 (July 2000); Anissa Abi-Dargham and Holly Moore, “Prefrontal DA transmission at D1 receptors and the pathology of schizophrenia,” Neuroscientist 9, no. 5 (October 2003); Bernard Masri et al., “Antagonism of dopamine D2 receptor/beta-arrestin 2 interaction is a common property of clinically effective antipsychotics,” Proceedings of the National Academy of Sciences 105, no. 36 (September 9, 2008); Nobumi Miyake et al., “Presynaptic dopamine in schizophrenia,” CNS Neuroscience & Therapeutics 17, no. 2 (April 2011); and Robert W. Buchanan et al., “Recent advances in the development of novel pharmacological agents for the treatment of cognitive impairments in schizophrenia,”Schizophrenia Bulletin 33, no. 5 (2007).
895 Elyn Saks credits talk therapy with saving her life in The Center Cannot Hold: My Journey Through Madness (2007). Cognitive behavioral therapy for schizophrenia is discussed in Xavier Amador, I Am Not Sick, I Don’t Need Help (2007); Jennifer Gottlieb and Corinne Cather, “Cognitive behavioral therapy (CBT) for schizophrenia: An in-depth interview with experts,” Schizophrenia.com (February 3, 2007); Debbie M. Warman and Aaron T. Beck, “Cognitive behavioral therapy,” National Alliance on Mental Illness (2003); Susan R. McGurk et al., “A meta-analysis of cognitive remediation in schizophrenia,” American Journal of Psychiatry 164, no. 12 (2007); and Sara Tai and Douglas Turkington, “The evolution of cognitive behavior therapy for schizophrenia: Current practice and recent developments,” Schizophrenia Bulletin 35, no. 5 (2009).
896 The quotation from Jeffrey Lieberman (“There is no better time in the history of mankind to have a mental illness than now . . .”) comes from my interview with him in 2008.
897 I
nternational Early Psychosis Association website: http://www.iepa.org.au.
898 Thomas McGlashan discusses the potential benefits of early treatment in an article written with Scott Woods, “Early antecedents and detection of schizophrenia: Understanding the clinical implications,” Psychiatric Times 28, no. 3 (March 2011).
899 Jeffrey Lieberman’s comment about the “Humpty-Dumpty situation” comes from the article “A beacon of hope: Prospects for preventing and recovering from mental illness,” NARSAD Research Quarterly 2, no. 1 (Winter 2009).
900 The quotation from Jack Barchas comes from a personal communication in 2010.
901 Early symptoms of schizophrenia are described in Nancy C. Andreasen, “Schizophrenia: The characteristic symptoms,” Schizophrenia Bulletin 17, no. 1 (1991); and Tandy J. Miller et al., “The PRIME North America randomized double-blind clinical trial of olanzapine versus placebo in patients at risk of being prodromally symptomatic for psychosis II: Baseline characteristics of the ‘prodromal’ sample,” Schizophrenia Research 61, no. 1 (March 2003).
902 Thomas McGlashan and his colleagues reported their findings in Thomas H. McGlashan et al., “Randomized, double-blind trial of olanzapine versus placebo in patients prodromally symptomatic for psychosis,” American Journal of Psychiatry 163, no. 5 (May 2006); and Keith A. Hawkins et al., “Neuropsychological course in the prodrome and first episode of psychosis: Findings from the PRIME North America double blind treatment study,” Schizophrenia Research 105, nos. 1–3 (October 2008). McGlashan’s assessment of the results as only “marginally significant” comes from Benedict Carey, “Mixed result in drug trial on pretreating schizophrenia,” New York Times, May 1, 2006.
903 Studies from the UK and Australia finding benefit in cognitive-behavioral therapy include Patrick D. McGorry et al., “Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms,” Archives of General Psychiatry 59, no. 10 (October 2002); Mike Startup, M. C. Jackson, and S. Bendix, “North Wales randomized controlled trial of cognitive behaviour therapy for acute schizophrenia spectrum disorders: Outcomes at 6 and 12 months,” Psychological Medicine 34, no. 3 (April 2004); Mike Startup et al., “North Wales randomized controlled trial of cognitive behaviour therapy for acute schizophrenia spectrum disorders: Two-year follow-up and economic evaluation,” Psychological Medicine 35, no. 9 (2005); P. Kingsep et al., “Cognitive behavioural group treatment for social anxiety in schizophrenia,” Schizophrenia Research 63, nos. 1–2 (September 2003); and Andrew Gumley et al., “Early intervention for relapse in schizophrenia: Results of a 12-month randomized controlled trial of cognitive behavioural therapy,” Psychological Medicine 33, no. 3 (April 2003).
904 For more information on prevention of psychosis by omega-3 fatty acids, see K. Akter et al., “A review of the possible role of the essential fatty acids and fish oils in the aetiology, prevention or pharmacotherapy of schizophrenia,” Journal of Clinical Pharmacy & Therapeutics (April 19, 2011); Claire B. Irving et al., “Polyunsaturated fatty acid supplementation for schizophrenia: Intervention review,” Cochrane Library 9 (January 20, 2010); and Max Marshall and John Rathbone, “Early intervention in psychosis,” Cochrane Library 15, no. 6 (June 2011).
905 The quotation from Thomas McGlashan comes from my interview with him in 2007.
906 The concept of a “psychosis risk syndrome” was first developed by Thomas McGlashan and incorporated into the design of the PRIME study: Keith A. Hawkins et al., “Neuropsychological course in the prodrome and first episode of psychosis: Findings from the PRIME North America double blind treatment study,” Schizophrenia Research 105, nos. 1–3 (October 2008). McGlashan and his colleagues argue for the establishment of the syndrome as a diagnostic category in Scott W. Woods et al., “The case for including Attenuated Psychotic Symptoms Syndrome in DSM-5 as a psychosis risk syndrome,” Schizophrenia Research 123, nos. 2–3 (November 2010). Their proposals attracted considerable opposition; see, e.g., Cheryl M. Corcoran, Michael B. First, and Barbara Cornblat, “The psychosis risk syndrome and its proposed inclusion in the DSM-V: A risk-benefit analysis,” Schizophrenia Research 120 (July 2010); and Allen Frances, “Psychosis risk syndrome: Far too risky,” Australian & New Zealand Journal of Psychiatry 45, no. 10 (October 2011). For a scholarly review of the controversy, see Barnaby Nelson and Alison R. Yung, “Should a risk syndrome for first episode psychosis be included in the DSM-5?,” Current Opinion in Psychiatry 24, no. 2 (March 2011); for a journalistic discussion, see Sally Satel, “Prescriptions for psychiatric trouble and the DSM-V,” Wall Street Journal, February 19, 2010. A report of the decision of the DSM working committee finally to drop the diagnosis is presented in Benedict Carey, “Psychiatry manual drafters back down on diagnoses,” New York Times, May 8, 2012.
907 The quotation from John Krystal (“What they do in the DSM is a fashion question . . .”) comes from a personal communication in 2012.
908 The anecdote from Jeffrey Lieberman about an anonymous patient comes from my interview with him in 2007.
909 This passage is based on my interviews with George Clark, Charlotte Clark, Electa Reischer, and Jackie Clark in 2008 and subsequent communications.
910 The quotation from Deborah Levy comes from my interview with her in 2008.
911 The quotation from Larry Davidson and David Stayner (“While perhaps appearing wooden and vacant to others . . .”) comes from their paper “Loss, loneliness, and the desire for love: Perspectives on the social lives of people with schizophrenia,” Psychiatric Rehabilitation Journal 20, no. 3 (Winter 1997).
912 The quotation from Jean Frazier comes from my interview with her in 2008.
913 The quotation from the unnamed mother whose son’s therapist proposed a motto is from a personal communication, 2008.
914 This passage is based on my interviews with George, Giuseppe, and Bridget Marcolo in 2008 and subsequent communications. All names in this passage are pseudonyms.
915 For more information on recovery and the recovery movement, see Robert Paul Liberman et al., “Operational criteria and factors related to recovery from schizophrenia,” International Review of Psychiatry 14, no. 4 (November 2002); Jeffrey A. Lieberman et al., “Science and recovery in schizophrenia,” Psychiatric Services 59 (May 2008); and Kate Mulligan, “Recovery movement gains influence in mental health programs,” Psychiatric News 38, no. 1 (January 2003).
916 The quotation from the unnamed mother (“Two years ago, I would have thought he was living a sad, wasted, pointless life . . .”) comes from a personal interview in 2009.
917 This passage is based on my interview with Marnie Callahan in 2008. All names in this passage are pseudonyms.
918 The quotation from Jeffrey Lieberman (“The problem is . . .”) comes from my interview with him in 2011.
919 Statistics on homelessness among people with schizophrenia occur on page 3 of E. Fuller Torrey, Out of the Shadows: Confronting America’s Mental Illness Crisis (1997).
920 See the US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Results from the 2008 National Survey on Drug Use and Health: National Findings (2008).
921 The quotation from Jean Frazier (“The thing that makes me emotionally drained . . .”) comes from my interview with her in 2008.
922 Estimates of costs associated with schizophrenia come from Eric Q. Wu et al., “The economic burden of schizophrenia in the United States in 2002,” Journal of Clinical Psychiatry 66, no. 9 (September 2005).
923 Elevated rates of suicide in schizophrenia are reported in Kahyee Hor and Mark Taylor, “Suicide and schizophrenia: A systematic review of rates and risk factors,” Journal of Psychopharmacology 24, no. 4 suppl. (November 2010); and Alec Roy and Maurizio Pompili, “Management of schizophrenia with suicide risk,” Psychiatric Clinics of North America 32, no. 4 (December 2009). See also Maurizio Pompili et al., “Suicide risk in schizophrenia: Learning from
the past to change the future,” Annals of General Psychiatry 6 (March 16, 2007). From page 863: “Attempts at suicide are also common among schizophrenics. For example, the National Institute of Mental Health (NIMH) Longitudinal Study of Chronic Schizophrenia found that, over a mean of 6 years, 38% of the patients made at least one suicide attempt and 57% admitted to substantial suicidal ideation.” See also Maurizio Pompili et al., “Suicide risk in schizophrenia: Learning from the past to change the future,” Annals of General Psychiatry 6, no. 10 (2007). From page 2: “Suicide attempts, which often result in death from suicide at a later time, are common among patients with schizophrenia; about 20–40% of these patients do make suicide attempts.”
924 The anecdote about the feces-eating prisoner who remained uncommitted following a petition to the court occurs on page 142 of E. Fuller Torrey, Out of the Shadows (1997).
925 The quotation from Kenneth Duckworth (“It’s harder to get into a state hospital than into Harvard Medical School”) comes from Deborah Sontag, “A schizophrenic, a slain worker, troubling questions,” New York Times, June 17, 2011.
926 Figures for the percentage of individuals with schizophrenia who live with their families rely on Richard S. E. Keefe and Philip D. Harvey, Understanding Schizophrenia: A Guide to New Research on Causes and Treatment (1994) (estimating 65 percent, page 173); Agnes B. Hatfield, Family Education in Mental Illness (1990) (estimating 65 percent, page 15; the family survey finding that only 3 percent of responders thought their schizophrenic relatives should live in the family home is discussed on pages 16–17); and Ellen Lukens, “Schizophrenia,” in Handbook of Social Work Practice with Vulnerable and Resilient Populations, 2nd ed., edited by Alex Gitterman (2001) (estimating 50–70 percent, page 288). For more information on living arrangements and parent satisfaction, see Benedicte Lowyck et al., “Can we identify the factors influencing the burden family-members of schizophrenic patients experience?,” International Journal of Psychiatry in Clinical Practice 5, no. 2 (January 2001).
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