each month ...
sleep and dreams
A UK website, principally for carers about and carers for schizophrenia; family, community, and professional service caring, who should - must ! - give voice for the best interests of those cared for they can't, they won't, they don't, voice for themselves.
The site is edited by a retired psychiatrist who has looked after someone with the schizophrenia condition, at home, affected by the negative form of schizophrenia, for the last twenty years. [The blue highlit links take you to another page.. ] You return via the back arrow at the top of your screen or from a link at the bottom of a page
contact me if you want to help me out with my views, email about some issue of caring service that is promising, or unsettled and unsettling or text to (44) (0)7547153244
There is a limited general psychiatry section .... links
..... Page 2. helping with the illness ]
The Cause for continuing Schizophrenia.
Family carers, and professional carers, must get to know all about the hippocampus area of the brain. My apologies for the many repetitions in what follows but overread is better than otherwise
Because at illness onset, the volume of the hippocampus in schizophrenia is reduced - the change in the schizophrenic brain most likely happens at the start of the illness
The hippocampus area of the brain in continuing schizophrenia is producing only half the number of new cells that the normal hippocampus proliferates.
The hippocampus in schizophrenia is proliferating half only of the amount of new cells that their normal peers require to cope with the problems of daily living [prospective memory ] Reif et al 2006 Allen et al 2015
In humans as in rodent studies those people with reduced new hippocampal new cell proliferation, have poor memories. Those with good memories have the full proliferation. [Coras]
Studies in catchment area samples of all those with continuing schizophrenia, 80%show poor memory management [Al-usri et al 2006 ]
The hippocampus uses new cells to see to it that, of the multitude of information coming in from outside perception, only that which is new and of value for the person's usefully stored experience, are moved into consolidation with longterm memory.
Continual new cells in the hippocampus hold information for a required contextual time, after which they are replaced by other continual new cells, ready to take in changes from incoming environment stimuli and update those changes into working experience.
The hippocampus is part of the working memory process that makes available what it is from stored experience that gives the context, for dealing with whatever is going on.
Hippocampal memory management fails in schizophrenia
The hippocampus plays an important role in learning and memory processes.
It is the region where incoming sensory information converges with stored memories. Interaction of these two currents is an essential principle of organised thinking.
Encoding allows the perceived item of interest or usefulness to be formulated in a way that can subsequently be placed with experience previously stored whilst available to be called upon to give context in completing the sequence of any intended action now or in the future All sensory information passes through a trisynaptic pathway formed by the entorhinal cortex, dentate gyrus (DG), CA3 and CA1 regions. CA1 region provides a comparison of patterns or predictions formed in CA3 region with "sensory reality" i.e. with the inputs from the entorhinal cortex . Working memory stores information for immediate use or manipulation which is aided through hooking onto previously archived items already present in the long-term memory of an individual. Memories are a combination of old and new information, so the nature of any particular memory depends as much on the old information already in our memories as it does on the new information coming in through our senses. In other words, how we remember something depends on how we think about it at the time.
CA1 region provides a comparison of patterns or predictions formed in CA3 region with "sensory reality" i.e. with the inputs from the entorhinal cortex
now a fact- because of the replication by Allen et al, in 2015 of the finding by Reif et al in 2006( vide infra ), ,
- that those with continuing schizophrenia have to try to manage normal day to day living , to complete the the sequence of their intentions,
with HALF only, of the hippocampal new cell proliferation that their normal peer groups require, to be able so to do.
The brain loses the ability to tune out information that isn't useful or relevant.
' They are walking down the street trying to have a conversation and their brain is being flooded with the sound of the door slamming, the airplane going overhead,â€ﾝ says Vinogradov, of the San Francisco VA hospital
. The brain is starting to process all of that information as if it has meaning, and is something the brain needs to pay attention to and needs to do something about.ﾝ
Maybe, the theory goes, thats what gives rise to hallucinations and delusions. The mind seeks explanations for the extra data coming in.
If you pay attention to everything,says UCSF Sohal, you might start paying attention to coincidences, and you might get paranoid. Or you might pay even more attention to your own thoughts and start thinking, These are other peoples thoughts.
In schizophrenia, the selection of what to attend to, and to organise it into retrievable useable experience , has to be done with half only ofthe new cells that are ordinarily made available. - the continual updating and storing of useful experience does not happen
They cannot move on in their lives as they should, with only the experience stored before the illness arrives. .
When schizophrenia arrives during adolescence and early adulthood, they have not the level of stored experience to cope with a daily world that brings new matters to be dealt with in daily living.
Those with their illness arriving in later life, are already better equipped in matured experience to cope better.
Q. What has happened to bring about schizophrenia? A. The crucial failure
The disabling brain change is a failure to sustain new cell formation [ neurogenesis ] in the hippocampus area of the brain.
[ In 2006 a study, found in continuing schizophrenia reduced new cell activity in the hippocampus
- !! After 9 years now confirmed by Allken et al in a different group of people with continuing schizophrenia.Now it must be accepted
NINE YEARS, having to wait !!!!
The change in the brain that leads into continuing schizophrenia Reif et al 2006 - Reif et al 2006
the most important finding
NOW Replicated and Confirmed !!! - by Allen et al
... [ Allen et al :- - if linking is difficult - this is the Quote
We find a decrease in cell proliferation in the anterior hippocampus of people with schizophrenia, confirming the results of previous studies that have suggested a deficit in hippocampal cell proliferation and of neurogenesis in schizophrenia [ Reif et al ] in an independent cohort. Our results are consistent with those of Reif; however, we found a slightly larger decrease in Ki67 expression, 60% in the current study vs. 50% in Reif et al. ]
In those with schizophrenia, there is a stem cell failure of new cell proliferation in the hippocampus of the brain .
Normally the hippocampus new cells function as ' a gatekeeper' to take from incoming environment observations - whats new, whats going on outside around me - only what is a useful addition to stored away skill and experience. The new cells hold on to it temporarilyuntil it is consolidated with what is already stored longterm. The new material may be advantageous, or 'seen' a possible 'threat' that will need future attention and so has to be stored as experience
What is taken in from 'outside' comes with its useful context.
Once consolidated in the brain long term memory the temporary new information fades away leaving succeeding new cells to continue the updating.
Once the information is updated, the hippocampus will later take part in retrieving from store whatever context information is to be carried 'in mind' so as to deal with what ever crops up in daily living , putting together in sequence the relevant contexts to whatever is happening.
Sufferers from schizophrenia have to try to manage daily life problems, and these life coping decisions with half onlyof the amount of new hippocampal cells that those without illness NEED to have available so as to be able deal and move on in their lives.
Schizophrenia fails because of this working memory failure.
People suffering to any extent from continuing schizophrenia because of the reduced hippocampal new cell provision cannot disentangle all the incoming environmental stimuli. They will experience incoming stimulus information overload from their environment.
Foerde et al
describes information overload: what happens 'normally'
" [ Here, we present results from functional neuroimaging showing that the presence of a demanding secondary task during learning modulates the degree to which subjects solve a problem using either declarative memory or habit learning. Dual-task conditions did not reduce accuracy but reduced the amount of declarative learning about the task. Medial temporal lobe activity was correlated with task performance and declarative knowledge after learning under single-task conditions, whereas performance was correlated with striatal activity after dual-task learning conditions. ]
People with schizophrenia are less able 'to see to it' that the 'useful' goes to the flexible hippocampal consolidation stream, from which the chaff 'noise' is excluded.
The brain is starting to process all of that information as if it has meaning, and is something the brain needs to pay attention to and needs to do something about.
Maybe, the theory goes, thats what gives rise to hallucinations and delusions. The mind seeks explanations for the extra data coming in.
If you pay attention to everything,says UCSFSohal, you might start paying attention to coincidences, and you might get paranoid. Or you might pay even more attention to your own thoughts and start thinking, These are other peoples thoughts.
With half only of the new cells in the normal hippocampus, some non salient incoming sensory material will bypass the hippocampal stream, instead getting into the striatal procedural stream , to be wrongly consolidated as salient material , which will not make sense, will carry anxiety. So it is likely go to consolidation in REM sleep, to be made 'sense' of, as a delusional system, relatively inflexible, taking over under circumstances of any future stress or unresolved anxiety.
Information gets into the wrong memory stream, and is less flexibly available. Calling up from memory store what is required to be able to react to things that need attention, can only give insufficient context to any intention that is to be executed.
They do not move on in their lives, stuck at the level of ability and useful experience that they have at the age the illness arrived.
Information that passes the hippocampal new cell sorting 'office', will be consolidated in another memory stream tthrought the different route which deals with automated network storage , into an autonomous delusional explanation.
Those who go on to continuing schizophrenia do so because the hippocampus region in their brain - the gate-keeper of convergence between the inside and the outside world - has to manage this with half only of the new cell provision to the hippocampal functioning that heathy people need to be available to be able to cope with all the changes in day to day living - sorting out the wheat - necessary, from the chaff - ignore
People with continuing schizophrenia suffer from incoming information overload [ as in normal overload
Fuerte et al 2006 ] with poor background context
That is why reducing the information load in a daily life, providing a routine, in a reduced setting helps, where regularity and repetition, with plenty of uninterrupted time and less going on, is a relieving care situation.
The hippocampal gate-keeping function - keeping out irrelevant information whilst allowing in useful experience - can't cope with only half the usual hippocampal new cell provision - its anxiously unsettling - letting some incoming stimuli to go directly, 'uncensored ' ,
to the striatal memory net work - normally used for procedural learning - habits - grammar bicycle riding: relative to the hippocampal stream where stored material can be consciouly sought, the striatal route is less flexible, less conscious, less accessible, uses a different net work to consolidate what it has taken in, and where dopamine imprints value on what is passing through.
Stand out material that gets into storage this way is abnormal, carries anxiety with it, yet has to be dealt with , given an account in some way - so becomes consolidated as an explanatory delusional system, normally segregated , but returned to when stress/anxiety returns .
Less intact 'working memory' means at the age the illness arrives they do not , cannot, move on in their lives.
The earlier the illness arrives the less accumulated store of experienced information is there to cope with what crops up during the day .
Schizophrenia arriving later will have already acquired a store of living experience, will cope better., even though retaining delusional influence.
An active working memory is what keeps you up to date: keeps you going. Without new cell proliferation in the hippocampus workimg memory is not sustained.
Finally. When and how does the brain change happen. perinatal damage