Reply to Gaughran and Kapur:- an editorial in 'The Psychiatrist' - the online house Journal of the Royal College of Psychiatrists:- " How change comes: translating biological research into care"
Lost in Translation
Not much has come to psychiatry from biological research but it is down to clinical disregard rather than irrelevance in research.
Two clinical studies Bruce and Mackntosh (5.) Kelly et al (6) agree memory fails in continuing schizophrenia. Cognitive weakness is linked to that, is a trait in the illness.Memory management requires intact neurogenesis and correlates with the level of neurogenesis in the hippocampus.Siebzehnrubl and Blumcke (4 )
Reif et al (1.) looking for some connection between neurogenesis and mood illness found no connection there but instead serendipitously demonstrated depletion in the hippocampus of the control sample from continuing schizophrenia.sufferers. There has been no attempt to replicate this crucial finding.
But subsequent studies Gold (2) Elvevaag (8) Raalten (3) in the area of working memory lend some confirmation of the finding. They show poor working memory in continuing schizophrenia, sufficient to explain how and why they fail to cope with outside engagement.
With that difficulty they are unable to move on and rehabilitate themselves. If neurogenesis fails at the onset of the illness, Shobel et al (7), they are unable to acquire, to build on new experience, to add in enough store inside to enable to advance personal domestic and social supporting skills.
If it is accepted that depleted neurogenesis is there at the beginning of the illness, consequences follow that should receive clinical attention.
1.
Those developing schizophrenia later have more built in capability than when the illness starts at the early age
2.
Working memory is required for insight. Choice will not be from full awareness. If there is evidence of both illness and neglect it is not 'their choice'
3.
Although the studies on working memory point to failure in coping with ordinary living choices and decisions, the studies confirm the ability to 'automate' that is to build up primed internal stores of experience by mentored rehearsal, together with the presentation of, and engagement with, material to be remembered, bit by bit until a whole process can be done.
4.
In this way rehabilitation into outside activities can be established and something like a 'normalising' routine achieved.
5.
Family carers have long known that 'routine is what help care most, promoting contact and preventing relapse by relieving uncertainty and high emotional differences.Service provision, divided as it is between Local Authority and NHS provision., may be neglecting to provide the sheltering resource that will allow those with continuing schizophrenia to go into recovery.
How many OT staff are there in aftercare teams ?References : -
1.
stem cell proliferation is decreased in schizophrenia, but not in depression
A Reif,, S Fritzen,, M Finger, A Strobel, M Lauer, A SchmittK-P Lesch Molecular Psychiatry (2006) 11, 514522
2.
Reduced capacity but spared precision and maintenance of working memory representations in schizophrenia
JM Gold, Ph.D., Hahn, Ph.D., Zhang, Ph.D. Robinson, , Kappenman, , Beck, , and Luck, Ph.D. Arch Gen Psychiatry. 2010 June ; 67(6): 570577.
3.
Automatization and working memory capacity in schizophrenia
Tamar R. van Raalten , Nick F. Ramsey , J. Martijn Jansma , Gerry Jager a, Ren้ S. Kahn /
Schizophrenia Research 100 (2008) 161171
4.
Neurogenesis in the human hippocampus and its relevance to temporal lobe epilepsies
Florian A. Siebzehnrubl and Ingmar Blumcke
Epilepsia, 49(Suppl. 5):5565, 2008 5.
Measuring memory impairment in community-based patients with schizophrenia
J. Bruce, MBChB, MRCPsych, S. Frost, MBBS, MRCPsych and D. Mackintosh, MBChB, MRCPsych
B J PSYCHIATRY 2006 189 132-13
6.
Cognitive function in a catchment - area - based population of patients with schizophrenia
CIARA KELLY, VAL SHARKEY, GARY MORRISON, JUDITH ALLARDYCE, and ROBIN G. McCREADIE
The British Journal of Psychiatry 2000 v. 177, p. 348-353.
Nithsdale Schizophrenia Surveys 20
7.
targeting of the CA1 sub- field of the hippocampus by schizophrenia and related psychotic disorders.
Scott A. Schobel; Nicole M. Lewandowski; Cheryl M. Corcoran; Holly Moore;
September Archives of General Psychiatry, 2009
8.
Brita Elvevaag, Elizabeth A Maylor, Abigail L Gilbert Habitual prospective memory in schizophrenia
BMC Psychiatry 2003.3.9 [ research article open access ] is available from:D H Yates FRC Psych. Retired psychiatrist