Schizoaffective Disorder - Jonny Benjamin challenges an expert

oh I used to be so I mean I've got schizoaffective disorder was diagnosed just over six years ago when I was 20 and I have I've struggled with the treatments that I've been put on and you know coming out cycle six that I went cold turkey on and I haven't responded to well right through treatment so I was very interested in kind of developments and oshino-san research that's being done so no there's not a great deal of research that's been done and I'm quite lucky in the sense that I've come to kind of accept condition and the way my mind works and I don't really kind of obviously up you know give me a chance to have another person's writing and you know without these symptoms and yeah sure I would but yeah there's level of acceptance and kind of not wanting to kind of question it too much because I can't change you know always have this conch Ange the way my mind works but yeah there is this kind of within society within that health kind of industry there's a resistance to maybe I don't know progress it feels like with with treatments or with research that's what I've always been talking to conditions and because I've gone into these like options and suggested oh will how about you know me taking this alternative medication yeah I'm really interested in say natural herbal therapies in I'm always dismissed and talking therapies as well and I just mmm I'm just really intrigued by the whole resistance - right yeah - kind of moving forwards to advancements in too much status quo I mean ya know it's um this research is really interesting so what was it that first drew you to this area of medicine well I was actually interested in psychiatry before I started med of school and it was but it was only in a kind of a kind of we it's a bit difficult to explain that kind of thought of psychiatry is kind of almost at that can ease at attic part of life and I know is who's sort of one of these kind of intellectual pursuits you know I was probably more interested at that time in things like Freud and so on and when I was thinking about psychiatry and hypnosis and all these other sorts of things and that I found that was kind of interesting but you know when I was a teenager and Vanetta stuff to do medicine it was kind of with that sort of thing in mind and then though medical school progress has learned about all the lack of physical diseases and about psychiatry and actually I found psychiatry to be the most interesting you know there's food there's other people are supposed rather then it was more about people in those days when you were doing diabetes or heart attacks which most important general medicine was have you seen changes in cognitive area psychiatry and changes you know this I don't know that there's been the Buddhist services organized has changed quite a lot in that time but whether or not there's phones differences in treatment so unfortunately no we know that in medication doesn't retain and it's like lots of summary changed and support the 1970s but you're right different brands have come along but in terms of treatment efficacy yeah and can you define what schizophrenia actually is so that's a really I mean it's important schizophrenia is a diagnostic term that really captures the soluble freeze to capture videos yeah it's groups together people with a very wide range of different symptoms and presentations and behaviors we and it's difficult to see what exactly if at its core what what do these people with Sweeney all have income actually the answers you don't all have anything in common everyone has a different cell symptoms but it's broadly speaking it's a way of classifying people who have a psychotic illness and this often it's symptoms that people are most familiar with the people with schizophrenia often do not always of hallucinations the earphones they feel things they smell things tasting things that see things the that there's no explanation for in the external world they often have very unusual beliefs they're not always and we should have called them delusions mm-hmm but then there's enough a lot more to schizophrenia than that I mean this increasing evidence that a substantial number of people yes bring you have what we call cognitive changes and that's basically change in the way the brain processes information more you know IQ zackrude town for that but you know it's clear for a lot of people does impact upon things like concentration attention and it does is associated with reduced IQ and then there's some behavioral things but some of the most problematic parts of this veneer people who have so-called negative symptoms and you know they may be doing the socially withdrawing they don't interact with other people often to take care of themselves could properly don't clean properly and when you put all that together a lot of people with schizophrenia have some of the most disadvantaged people in society and it's more like as a cloud of symptoms and presentations that me or may have something in common but me many of them mean have nothing in common in terms of what we call this pathology of the origins or the causes it's all I've been diagnosed with schizoaffective disorder can you explain the difference between schizoaffective disorder and schizophrenia yes so one of the problems with skips effect restores the multiple ways of defining schizoaffective disorder but really and when you're talking about the most common forms of psychosis at least those from Declassified one extreme you've got what I've described is schizophrenia and at the other extreme you've got what's called typical bipolar disorder and the of them in theory the mean changes out of mood energy sleep and but people with that disorder also often affiliations and and these and other unusual ideas but quite a number of people have some of the symptoms of schizophrenia and quite marked symptoms of of mood disorder and we tend to see the people who could quite mark symptoms of these two disorders have God's affective disorder there's some people of the mood changes are predominately depressive and other people the mood changes are predominantly only excited expansive kind of manic side began it's unlikely this gets affective disorder is not a single condition and there's a lot of debate amongst researchers about whether my schizoaffective disorder means someone has actually got both disorders or that it's completely separate category or it's some kind of continuum where you know you've got this kind of spectrum of one end you've got bipolar saw the one any schizophrenia you just agreed and a mixture of symptoms and between and schizoaffective is a bit in the middle so it's an area of research and what it is a fundamental level just as what bipolar disorder is a fundamental level of what schizophrenia is a very fundamental level fear that's not clear okay I mean connect in the diagnosis change over time to say I said I was diagnosed with schizoaffective disorder we can then change to maybe a diagnosis of Just's schizophrenia if they say just the symptoms it's really not the moods mmm changes I mean in psychiatry we tend to operate on a lifetime I write Pat on that sentence so if someone's had prominent episodes that look like mood disorder as well as prom episode the look and more like schizophrenia and work oh we see the biscuits affective disorder usually a person we mean with that diagnosis however if you look at someone along with shooting you know sorry that was if you can over ten but if you're looking in the picture you know what we call cross sectionally so see over the last six months or even over the last year the symptoms could become more prominently one versus the other and then they would have a lifetime diagnosis is get affective disorder but at that point they would look more like disease gets really or more like they'd pull up sort of and and what's the rate of recovery from schizophrenia and schizoaffective disorder you know it's quite surprising how difficult that is to see someone so recent and very old work suggests that perhaps the response recovery from skits for years better than more psychiatrist imagined so according some recent estimates maybe about half people with schizophrenia well actually we've had one episode will actually do very well and then more of another chunk of with 50% wondering very well we'll have periods where the symptoms are more or less under control so I would say that the outlook for people worth right at the beginning of the illness is you know it's not necessarily a diagnosis that you'd be thrilled to receive but it's not all doom and gloom but maybe at once you've had multiple episodes and if you if you've been ill for a very long period of time then the chances of complete recovery or become increasingly small okay and why might people develop schizophrenia probably the hardest fact that we could see about is that a substantial amount of the differences in risk in the population are due to inherited of genetic facts and you know this argument about exactly how much but probably the majority of the risk comes from DNA okay but then there's also important environmental contributions we can do these studies that show that you know even if you YouTube you genetically identical one of them may develop the illness one of them we not in fact all about fifth half the time if one member of an identical twin will ask us from you the other one it doesn't and that shows you that is not because they've got identical genes is not just for genes so there are environmental contributions and by environment you know we're including the whole of the environment we're not only talking about the families the reason you're talking about there's a lot of infections but a lot of premature weather over the world of this book cannabis or take other drugs immigration is migration is a reason factor and presumably about the power related to the stresses of migration and you can be born in a city seems to be a reason factor now what we don't know about these types of environmental risk factors as how does see living in a city increase your risk is that an indication of what's going on in your family is that an indication of infections or perhaps will Whateley communicated in dense populations or pork or is it about the urban environment that there's a toxic okay I'm going to do people tend to develop a spring it well the the peak age is early twenties for men and maybe off a few years later or for grooming and that's when we see the develops history like it's that's when they kind of most obvious symptoms that can hallucinations and delusions may typically come on but actually and again by no means everyone but quite a large number of speakers get Sofia even when the children are a bit different from the average child and often maybe the it's been more difficult to make friends they meet her for some things we call soft neurological signs so that a bit clumsy and and we've developed walking talking a bit later and then the new bridge so and this type of business where people when their children have some kind of differences has led to the idea that a lot of history is new developmental sirs actually have the brain has developed perhaps and the interest or continually developed through childhood and then tantalizes mm-hmm I suppose you've kind of reluctant to diagnose people T Reilly oh absolutely I mean you wouldn't dream of diagnosis and this video and the pieces have been clumsy or having difficulty making friends yeah Harvey you know because there's a lot of people who are one of the challenges in all the types of psychiatric research is that we see things that are associated with illness but actually not necessarily tremendously uncommon in the general population so one fact of this emerged is probably important although again you don't know that the causal links between the two childhood adversity probably enemies adversity rather than maltreatment but having a really really rough childhood is associated with increased risk of schizophrenia but you know loads of kids over a rough childhood don't develop schizophrenia so but you know a lot of the links are quite weak and that may be because we don't know fish there may be specific bits in that maltreatment that would have a stronger and thinking that we haven't yet measured okay what other treatments are available people diagnosed with schizophrenia well there's a range of treatments with the what the one that is probably most widely received is a treatment with medicines called antipsychotic drugs and in a lot of people they're pretty effective they're most when they are affected the most effective in for the what we call the positive symptoms the hallucinations in the delusions the less effective to the point of not being effective at all in the while referred to the cognitive symptoms in the a lot of the concentration and the ability to process information so there's the kind of drug treatment and sometimes we argument or we add to the antipsychotics we made other medicines that are used in the treatment of mood disorder to take the viewable schizoaffective so in fact but a lot of people with schizophrenia from the relatively friendless orphanhood poor living arrangements are very dependent on appearance are very unlikely to find a job so they need a fair bit of social support and for some people psychological specific psychological treatments can also be helpful as well and tell me about the research that you're doing the brain is a very difficult thing to study seldom are people willing to give brain biopsies so we reserved people studying cancer or kidney diseases often take biopsies and if it's approved directly the tissue and measure and all sorts of things that's not really a viable thing in the brain and the fund at the core of genetics is if if you can find some genes we can usually figure out them or proteins new genes make and if we know what kind of proteins seem to be altered and people will see a string and we can hopefully piece those together to get a grasp on what the fundamental biology of the disorder is and then I mean this this is all based upon the premise that if you understand your enemy the biology of this sorta then it's easier to develop it's easier to think about how you may develop treatments are different to those that already exist because the treatments that and here at all about the physical treatments physical treatments life psychotics we really just found out by chance and wasn't there was no great theory behind their development okay so that's really why I focused on for the last many years and this it requires the participation from huge numbers of people with the various diagnosis I mean because schizophrenia schizoaffective disorder and bipolar disorder probably increase a range of conditions and their risk factor no one risk factor can show a huge amount you really need very large samples of participants in order to get poor because statistically to make a link between one risk factor and the disorder so we don't studies we are doing these days often for twenty thirty thousand people and and good image to get bigger there's a big hard to have bet to find participants to take off the short answer is yes and partly is this is a kind of often a culture not necessarily amongst people with the disorder but often in most the people who look after them or the or the health service in in not having a strong research culture in snake actually the we literacy for example of cancer so as you can you talk me through the process so as a participant comes to you and then what's up the tests so yeah I mean see for example you want to participate in a genetic studies so you come along and someone explains what we're trying to do offers you the opportunity to take part of ourselves emphasizes that if you see you don't want to take a nice known effective clinical care and then for the simplest of studies we take that of a lengthy history to try captures our symptoms you may experience the difficulties you've had the longitudinal development all the sort of thing a bit like a more structured form of a psychiatric interviewed that most participants would be familiar with and then we take a small sample of blood much like when often people get admitted to hospital lot of regulars Ted cup of tea spoonfuls of blood and we then if they're not talking to the lab and we extract DNA and then we see try to find genetic changes that are more common in people with the disorder than people who don't have the disorder and would be pretty successful at doing that recently and those genetic changes then we can see that so that bit of your genome we have tiny little bit of your genome it contains something that's influencing your risk of schizophrenia right and then we try to figure out how it's doing that the genetic difference between people with kids feeling the genetic difference between people without it is a numbers game in general people in this case we have more of these things but we've all wrong so it's not you are very different in terms of if you see a figure it's not necessarily that you're very different in terms of your DNA it's just that you've bit more of something that's very common in population and then what's next for the research well so it's important to stress that although we've been pretty successful this is really only the real big successes have only happened in the last two or three years but we've still only captured a small fraction of the genetics of schizophrenia we don't really believe that everyone gets free has I disagree true they all have the same illness and what we're interested in doing is seeing whether or not people different people definitely will definitely have different combinations of the genetic risk factors I'd like I said there's a hundred we've already identified 100 or so them so no one no one person screen has got all 105 no one person is Trina that we've seen really even involved in any no two people would be exactly the same in terms of the ones of the good a discovered so we're trying to figure out whether or not different combinations of different genetic risk factors can be used to divide people into more biologically similar groupings and because the hope in doing that is that if it's guess if Renia contains a whole cluster of people with different biological DeSoto's then it's hardly a surprise that one treatment is going to cover everyone say in the same way that you're some people with I take my cancer will respond to treatment but other half of them won't and more success has been achieved recently in other areas of Medicine by 19 groupings of people are more biologically similar so we're interested in doing that and imagine you've come up against lots of obstacles along the way let me take up some of the biggest well I mean I suppose the biggest obstacle is the nature of the illness itself is there's a weak link between genetic variation or risk factor and under and the disorder itself or the complicated and mixed nature of the sort of pressure as I said require these huge sample sizes so simply getting the participation is is is difficult second point is engaging people with the research and as there's also an obstacle there is a significant power of psychiatry within the profession and also in society that doesn't like to think of psychiatric disorders as having any biological basis think attitudes are changing then in their field you know I would like to think so Perth or in my heart I'm not so sure that they've changed dramatically I think maybe people a bit more sympathetic to depression than perhaps they used to be I'm not sure that society really has embraced people with psychosis the way that it needs to do you think a lot of that's got to do with say media what's reasoning well yeah I mean you probably want to speak to a sociologist about you know that but we I'm sure that cycle whacko nutjobs etc the media doesn't help too much and you know you're a young guy B probably don't remember the people with cancer and things used to be very stigmatized the case is well I mean people would have you know but I was but I was training to be a doctor my little book on talking and talking to patients said don't mention about cancer and gives a whole load of euphemisms who is that come along quick partly because there's better treatment is partly because champions of information I would talk that that will happen then institution yet but cultures and aptitudes I think do take very long takes change mhm do you think they'll never be a cure it's Afeni another wouldn't be one sure I have no doubt that's at some point if cures for some types of the disorder will emerge but I don't think is five years and I don't think is ten years I think that's a bit longer yeah visit but that could be improvements any medication perhaps many people myself included are beginning to really view for we fall schizophrenia no as to a bit far down the line and that actually that's the manifestation of a disease process that's taking place earlier and that it's a bit like saying one has a heart attack or you use plentiful to cure the heart and a heart attack but whilst of developing warning signs of this one may be able to prevent the heart attack in the first place I suspect that's more how it's going to be that people will increasingly be able to recognize the process an earlier stage through perhaps diagnosis based ultimately on improved brain imaging or better ways of measuring psychology perhaps combining that with some genetic risk factors when do you think treatment should be given to particularly location think we should be given some honors showing signs because they're the brains and development zone yeah not saying Hudson yeah so there's a lot of interest in reception what's called high-risk groups ultra high risk groups people who are beginning to often tell mood instability and changes in behavior maybe in mid teens what we don't yet know is whether or not the source of treatments that we've got know if we apply them are they likely to change the course but if you know perhaps treating someone at this critical point o'clock a year or two and then stopping the treatment might prevent this moving into the full scale symptoms described before so that's nearly of active study but my bet is that for a lot of people we need to be treating them in their teens and we simply don't know who to be treating and then with the research thing now would that help maybe in a few tests so yeah one can perhaps see that as we get better at identifying the inherited factors we made people to quantify a bit more about a few years and more is not more likely to develop the illness but I think it's always going to be who is more likely rather than who is but one can easily see that if you've got a grouping that's a particularly high risk some of the things they talked about about measuring psychology or brain imaging may be able to say okay well I've got a child I've got schizophrenia if my child is showing something in a combination of brain imaging in psychology and slow development maybe that child needs to be targeted for the sorts of interventions that don't necessarily exist yet but what I can see could possibly exist in the future we talked about antipsychotics and may not be not known psychotics and anyone who speaks it that's been on that psychotics place says about the side effects why why they're such dramatic side effects with antipsychotics every single one of them is for coffee elite dirty drug so as well and then tired of the drug that means they don't just affect the chemical what imagines targeting witches is dopamine they also you know depending upon which one is often Frank you know four five six seven other of the brain chemicals hence some people that appetite change is the movement coordination changes we sedative effects etc etc so I think it's is a function in the fact that the medicines are dirty in that sense but some of the darkness may actually be necessary for the treatment of things so what's the highlight of your craving it's not a person necessarily like to treat the impression there's a wealth of riches to chew that well and I suppose the thing I myself from my colleague may Cohen and other people here a few years ago published a paper where we first began to find that some of the genetic variation had big other we found about thirty-five genetic variants a lot of them are likely to increase history and we began to seek latins of commonality and how they a lot of them converging on a particular aspect of biology and for me beginning to beginning to see not just identifying a risk factor but beginning to see not only something of pattern that proves forward the biological model mmm I think that's probably the highlight actually it began to I think it's sure to us that actually all the sefirot that we were doing wasn't in vain and that would probably be successful and it's not just us but it would probably be successful in identifying aspects of biology that are relevant so it's really I think that's probably and what about was even awarded being recognized for your work you would it be is the Liebherr yeah yeah that must have been a highlight of yeah I mean that was nice but I recall that highlight that was a side effect of the highlight the highlight was the actual result and so so hey I would say that the dress was a highlight and it was nice to get ya recognition but it was the fundamental research behind it that I would call the highlight so yeah that give me the deception self made me look happier than get the price so I was nice getting prizes okay so we've been speaking far I don't know possibly about an hour what do you think of what do you think what I've been telling you is there anything that strangers be particularly nor times do you think it's because have given you any cause for optimism the research agenda yeah no it's exciting it's really exciting I haven't really come across any sort of research like this before and does give me hope of kind of for the future for future generations you know in terms of treating schizophrenia I'm lucky in the sense that hope in diagnosis space what lucky other no but you know if I was diagnosed what 30 40 50 years ago the outcome would have been much worse but the fact is that you know I've had one serious if so then I've recovered I'm you know trying to manage my symptoms but it's exciting in terms of the future you know I do feel that they were necessary big here but you know there will be improvements in treatment so it's been it's really encouraging you know an encouraging but I'm glad to see I mean it and I think in many ways that your perception is more important that than mine but it to underscore something you said well at the beginning if there is no research then it will always be the signature exactly yeah it doesn't and to some sending some matter for research is going on there were lots of different views about the causes the origins or the treatments of schizophrenia and in the fullness of time some of those views will be seen to be right some will be wrong but which ones are right which one's wrong with only gonna be found of people embrace research I think otherwise it's just the same as it is now it's just opinion and no one will be able to answer your questions about me and I take this alternative treatment should I have this talking therapy should I try haribol remedies because if you don't do that ourselves a clinician has to say to you hopefully not dismissively I don't know yeah but what does sort of concern me which I didn't realize so much is that there's such I knew there was resistance but so much resistance to and not just from saved conditions but from other sort of areas of society there's so much resistance to you know you're surely you'd want to put participants forward and kind of develop this research but there's there's this I think it the important message is that without ourselves you don't get change or you're gonna get any inform of change and so you're just left with the Theory after Theory after Theory and when there's no knowledge you have a vacuum yeah and you're wide open to all sorts of extremist views I know so but things have moved forward so much quicker in you you know the research can move forward so much quicker if that has kind of a more embracing yeah attitude will they agree hmm okay thank you thank you thanks very much

Channel: Cardiff University

Views: 41,627

Rating: 4.7613168 out of 5

Keywords: Cardiff University (College/University), Jonny Benjamin, Schizophrenia (Disease Or Medical Condition), Schizoaffective Disorder (Disease Or Medical Condition), Neuroscience (Field Of Study), Psychiatry (Medical Specialty)

Id: XYEloXi6z9k

Length: 33min 57sec (2037 seconds)

Published: Thu Dec 11 2014