Hacker News Reader

Schizophrenia like autism is not something to pin down to any one cause. The symptoms are like an equation and the defects are the values which cause the expression of the disease/satisfy the equation/describe the surface. There are many genes that are culprit to the disease as well a number of environmental factors, so it is possible that parasites may induce the symptoms for certain (possibly less robust) phenotypes. But it does not mean that the disease is caused by parasites any more than a plane can be a point.

One hypothesis I read recently is that schizophrenia is an emergent phenomenon of a brain trying to compensate for any number of gene induced deficiencies in wiring but instead over compensating due in part to the faulty wiring in the first place, thus creating a negative feedback loop as the brain develops and wires itself.

Again on connectivity errors, schizophrenia is also associated with a malfunction in how the default mode and task positive networks interact with each other, where in schizo, default is not properly attenuated leading to higher likelihood of dissociativity. I read recently on using ketamine to study this particular malfunction: see http://www.schizophreniaforum.org/new/detail.asp?id=1809

As for [4] it is worth reading: http://www.bmj.com/content/345/bmj.e6673. Aside from the separate dangers of overuse of antibiotics, the matter is way more subtle than being too clean. Yes we have lost contact with certain reinforcing environmental pathogens, but it is also true that the gain from cleanliness far outmatches the current risk of autoimmune disorders.

UK researchers say that they have dismantled the “myth” that allergic diseases have risen to epidemic levels because people now live in sterile homes and have become “too clean.” .... The report says that although deficiencies in microbial exposure could be important in the rise in allergies and chronic inflammatory diseases—driven also by genetic predisposition and modern lifestyle factors such as different diets, stress, inactivity, and pollution—it is not yet clear how the trend can be reversed.

Rook said, “There are lots of ideas being explored, but relaxing hygiene regimes won’t reunite us with our old friends—just expose us to new enemies like E coli 0104.”

Responding to your first comment about teachers not being psychiatrists, I agree with that observation but disagree that this means teachers should not be trained to recognize the signs of mental and other disabilities. The tendency today is often to ignore the problem, given there is little penalty for failing to intervene. But there are heavy costs to individuals and society.

As an example, when I was growing up I was extremely nearsighted but didn't get glasses until I was out of the home and in college. I was unable to read the chalkboard from K through 12. Yet no teacher intervened to suggest glasses to my parents, or to suggest I see an eye doctor. Only when a college prof noticed that I was squinting my eyes at the board and said "hey man, you need glasses!" did I get my eyes examined and discover what the world looked like in focus.

Along the way, everyone from the public school nurses who administered eye and hearing tests to a DMV examiner fudged my eye test results to "help" me pass those tests. And I was pretty good at doing things with limited vision. I know I'm not alone in this regard -- many children find a way to get by with a range of limitations because they don't know there is an alternative.

But we're living in the modern world, and many limitations can be controlled given early intervention. And teachers are well positioned to observe children over extended periods of time, while doctor visits are often 5 minutes ling and most children will never see a psychiatrist at all.

> teachers aren't psychiatrists or clinical psychologists and can't really be expected to be.

True.

Equally: Programmers aren't operations staff.

But we can damn well learn how to call them in when we need them.

Very good analogy.

You wrote "This kinda reminds me of how peptic ulcers were once thought to be caused by stress until they were found to caused by a virus [3].". First of all, if you read the article you reference, you'll note that Heliobacter Pylori is a bacterium, not a virus. Second, the presence of h. pylori in the gut is not conclusively proven to be a causal relationship for ulcers. That is, in some people h. pylori is just part of the normal gut flora. Further, it HAS been shown that stress is a strong cofactor in peptic ulcers.

I heavily doubt that there we'll find a single cause for what essentially can be described as faulty wiring in the brain. Drugs, genetic predisposition and a whole lot of other causes could be the trigger just as well.

Upvote for the first point though.

> This kinda reminds me of how peptic ulcers were once thought to be caused by stress until they were found to caused by a virus [3].

_H. pylori_ is a bacterium, as your source indicates.

> but teachers aren't psychiatrists or clinical psychologists and can't really be expected to be.

rather to the contrary, i think. Or you haven't had occasion to attempt teaching enough?

> There's been research to show that there is correlation between the incidence of schizophrenia and the domestication of cats.

As I recall, this was more recently debunked, largely on the basis of correlation/causation confusion. ... Unfortunately, I failed in googling the counterpoint. Don't take my word for it, obviously. But consider: the popularity of cat-themes, and of mental-health quackery, especially on the internet.

OTOH, my grandmother, who was paranoid schizophrenic, refused to spay/neuter her cats because she had, to her, important conversations with them. So maybe you/they are correct.

Also note, the fluoridation of the public water supply may be sapping our precious bodily fluids[1].

> ...as parasties, viruses and bacteria (or even the lack thereof) may be far more immportant than currently realized, possibly even causal in many cases.

Agreed. Eg: http://www.npr.org/templates/story/story.php?storyId=1298621...

[1] http://www.youtube.com/watch?v=N1KvgtEnABY

It is not that hard to recognize symptoms of mental illness. You certainly don't need to be a psychiatrist or a clinical psychologist. You don't even need to be a LCSW or a LPC.

It would be, at most, a single course in an undergraduate or a graduate program. It could probably be rolled in to existing curricula just as a chapter or an exam as a component of a related class.

We're not talking about diagnosis, just recognition of symptoms to the point where a referral can be made.

An interesting study highlighting some of the problems with diagnosis of schizophrenia was the Rosenhan experiment (http://en.wikipedia.org/wiki/Rosenhan_experiment) essentially it showed that doctors working in mental hospitals were unable to reliably tell the difference between those with schizophrenia, and those without it who reported a single hallucination. Albeit, the study is now close to 40 years old, and the diagnosis techniques have been improved, with for example, further editions of the DSM, major problems still exist.

In my Master's thesis I created an algorithm to diagnose schizophrenia from EEG recordings. It's obviously very preliminary research, but it would be amazing to see computers revolutionizing the way that we do neurological diagnoses.

My thesis is here for those interested: http://www.adriangreen.ca/Green_Adrian_CA_201211_MASc_thesis..., and hopefully soon to be condensed and published as a paper.

Thanks for your article - a couple of questions. My background is that in the dim dark past I studied neuropsych and then worked as an EEG tech (mostly epilepsy screening with infrequent psych patients) for 4 years (2000-04) before going to work for the company that makes Synamps 2 :)

Now, I've only skimmed your method and results as I'm a bit flu-ridden and hence vague, but a couple of things popped out. The first is that you stated there was no control for medication. In our experience doing EEGs on folks on certain psych drugs, there was usually an increase in higher band activity (more beta, much less slow wave) - these drugs would create an unusual but not clinically abnormal EEG. It was rare to see such an EEG in someone not on those drugs.

The second is that for doing mathematical analysis on the EEG, I've had it trained out of me that resting EEG is okay to use. Some task, any task, no matter how easy, gives a more reliable baseline - since the EEG is quite dependent on arousal state, without a basic task, you don't have much control over whether the person is sitting there thinking about having a nap or highly alert and fretting over some unrelated item. For epilepsy you want them drowsy and nearly asleep as that lowers the bar for spike-and-wave activity, but unless a similar thing happens in schizophrenia and slowing, I'd think that doing a task would be superior to resting EEG.

I wonder if accounting for these issues might increase your hit rate? Like I said, I only skimmed the method and results, so I may have missed something that makes these points less relevant.

As an aside, the epileptic EEG sample looks really quaint and old-fashioned, since it has the curved needle-on-paper distortion. It doesn't need to be updated, it just looks like Ye Olde EEG to my eyes... :)

The no control for medication is primarily based on the conclusions of Boutros 2008, a summary of spectral abnormality studies of schizophrenia. I reproduced a table from the paper in the appendix. What type of psych drugs were you working with?

As an aside drugs used to treat schizophrenia have especially nasty side-effects, such as weight-gain, reduction of white blood cells, and--ironically--some of the "negative" symptoms of schizophrenia when given to healthy people. In fact the Soviets used to use antipsychotics to torture political prisoners.

I concur that active EEG could lead to a much more accurate diagnosis, however we had access to quite a bit more resting data, and it does make the math easier (stationarity for one). Standardization of other factors would also probably increase accuracy, but once again, I was limited by my data. Since I'm no longer in academia, I won't be continuing the research, but hopefully further studies address these questions in more detail.

Sorry, it's so long ago that I can't recall the drugs, only that as techs we had to report what was on the referral. We'd do our tech reports and the official report done by the neurologist would refer to the flat, beta-filled EEG as being 'normal for -foo-'. Part of me wants to say benzos, but I'm not sure if that's confabulation on my part.

I understand the limitation of the data - it's particularly hard to get access to inpatients as subjects for new studies. Thanks again for sharing your thesis - sorry I can't converse a bit more intelligently about it at the moment.

EDIT: looks like it is benzos: Some agents, particularly benzodiazepines and barbiturates, induce fast or beta (β) rhythms, and the EEG may be a useful pointer to drug intoxication when this is clinically unsuspected. from http://jnnp.bmj.com/content/76/suppl_2/ii8.full

To be clear, I was talking about recognition of symptoms and referral to experts, not diagnosis. Diagnosis is a much trickier issue. Thanks for sharing your thesis and for the interesting read about schizophrenia diagnosis.

It may well be that parasites contribute but there is also a genetic component to schizophrenia.