Healthcast: Spotting Schizophrenia

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Roughly three-million Americans suffer from schizophrenia, a mental disorder that can cause people to hear voices or have hallucinations. Currently, doctors diagnose the disorder in a very subjective way. But that could soon change.

Isaac has schizophrenia. Isaac told Ivanhoe, “I didn’t know if I could talk to any of my friends about it.”

Isaac has frequent hallucinations and hears voices and laughing in his head.
“It was this low, warm female voice’s laugh, and it was definitely laughing at me and everything that i cared about” he explained.

He’s now being treated with medications and therapy but getting a diagnosis for patients like Isaac is often difficult and requires a doctor’s subjective opinion after a simple interview.

“Unfortunately, diagnosis really relies on a clinician’s ability to make inferences about a person’s inner experience.”

But Gregory Light, Ph.D. Professor of Psychiatry at UCSD says that may change. His studies show this test known as an EEG can help us understand schizophrenia. It uses sensors to measure the brain’s responses to sounds. Researchers found people who can’t detect changes in auditory tones are more likely to have schizophrenia.
Professor Light told Ivanhoe, “The patients with schizophrenia have abnormalities in how their brains process simple information.”

Researchers at Neuroverse are now working on an app so people can test themselves at home. The hope is the objective test will help diagnose and improve treatment for people like Isaac sooner.

Professor Light says in high-risk kids, the EEG test can improve prediction of whether the child will develop schizophrenia perhaps as much as 65 to 75-percent. The test takes about 15 t0 20 minutes to perform and it’s painless.




BACKGROUND: Schizophrenia is a chronic, severe, and disabling brain disorder that occurs in one percent of the general population. Those who suffer from schizophrenia will often hear voices others do not hear, they may believe other people are reading their minds, controlling their thoughts, or wanting to harm them. Because of this constant paranoia, people who suffer from schizophrenia may sit for hours without talking or moving, they may have difficulty keeping a job, caring for themselves, and seem withdrawn or agitated the majority of the time. Schizophrenia is speculated to have many causes but the direct causes of schizophrenia are still unknown. Ten percent of people who have a first-degree relative with the disorder develop schizophrenia. Researchers believe that genes passed down from our parents are associated with an increased risk of the illness. Scientists also believe that people with schizophrenia tend to have higher rates of rare genetic mutations and that the development of the illness may be a result of a malfunction of a certain gene that is key in making brain chemicals. Scientists think that interactions between genes and the environment aid in the development of schizophrenia as well. (Source: http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml)

SIGNS AND SYMPTOMS: Schizophrenia equally affects both men and women and all ethnic groups around the world. Men tend to experience symptoms earlier than women do. Symptoms of the illness usually begin between the ages of 16 and 30 years old and there can be many signs. The illness rarely occurs in children but cases of early onset schizophrenia are increasing. Because schizophrenia symptoms usually occur in teenagers, it can be difficult to diagnose. Some first signs may include a change of friends, a drop in grades, sleep problems, and irritability. These are all common behaviors that a typical teenager exudes. But, if these behaviors are in combination with factors such as isolating oneself, withdrawing from others, an increase in unusual thoughts and suspicions, and a family history of psychosis; a diagnosis of schizophrenia can be predicted in up to 80 percent of those youth. Other symptoms include losing touch with reality, hallucinations, delusions, thought and movement disorders, and trouble focusing or paying attention.
(Source: http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml)

NEW TECHNOLOGY: Because the causes of schizophrenia are still unknown, treatments for the disease focus on eliminating the symptoms and not the disorder altogether. The EEG test allows doctors to diagnose patients with schizophrenia easier as well as predict its severity. The test is based on recording patterns of electrical brain activity as a person listens to an auditory cue. It could also be useful for assigning patients to cognitive training interventions for which they are likely to benefit.
(Source: Gregory Light, Ph.D.)

FOR MORE INFORMATION ON THIS REPORT, PLEASE CONTACT:
Gregory Light, Ph.D.
619-543-2496
glight@ucsd.edu

If this story or any other Ivanhoe story has impacted your life or prompted you or someone you know to seek or change treatments, please let us know by contacting Marjorie Bekaert Thomas at mthomas@ivanhoe.com

Gregory Light, Ph.D., Associate Professor of Psychiatry, at the University of California, San Diego (UCSD), explains how an EEG test can measure the functioning of the brain in order to identify response to treatments for schizophrenia.
Interview conducted by Ivanhoe Broadcast News in November 2014.

Have you seen a rise in schizophrenia?
Dr. Light: Schizophrenia affects between one and two percent of the population. We rarely hear about this devastating illness unless a tragic event is in the news involving people who are suffering from psychotic illnesses that shoot people or have other problems. The prevalence has stayed pretty well fixed though at one to two percent.
A lot of the diagnoses have been subjective, right?
Dr. Light: While we have made spectacular advances in neuroscience over the past century, current diagnostic methods do not yet capitalize on the accumulated wealth of information about brain functioning. Instead, diagnosis relies on a clinician’s ability to make inferences about a person’s inner experience. That’s done through careful observation and interviewing techniques. Our work is focused on taking robust measures of brain function out of our academic laboratories and bringing them into real-world mental health centers to inform and monitor response to treatments.
Does someone with schizophrenia have different brain functions?
Dr. Light: After testing thousands of people, we’ve learned that the patients with schizophrenia have abnormalities in how they process sensory information and how that information is transmitted across brain networks. These abnormalities can be indirectly inferred from interviews about symptoms and clinicians are quite skilled at making fine distinctions among clinical symptoms. Even the best clinicians, however, will acknowledge that some symptoms can be difficult to assess and our interviews vary in precision. By using these EEG tests, we hope we can better understand how the brain is processing information and develop more precise treatment algorithms.

How do they differ?

Dr. Light: They have impairments in the efficiency of basic information processing. Our tests measure the functioning of auditory processing networks using simple sounds as probes. Objective tests of these networks are tightly linked to a person’s cognitive abilities, their ability to live independently and function in the community. We’re trying to take these tests now and use them to predict and measure response to treatments.
Can you give me an example of how someone with schizophrenia would comprehend something to someone without schizophrenia?

Dr. Light: One of the most dramatic symptoms that affect most patients with schizophrenia at some point over the course of their illness is auditory hallucinations. They hear things that other people do not hear. So, we use tests that are designed to measure the functioning of that brain network that processes sounds. This network also supports many important cognitive functions. We depend on it for making decisions on how we respond to stimuli in our environment. We need to be able to adaptively, efficiently and quickly process perceptual information in our environment. Even as we speak, we’re automatically acting on subtle sensory information. For example, changes in the pitch of my voice might indicate humor, sarcasm, anger or fear. If this subtle cues are misinterpreted, problems in social interactions are an obvious consequence. Such sensory processing abnormalities can be objectively and reliably measured with EEG tests.

When someone with schizophrenia hears voices, are you saying that it’s going through their auditory process like they’re hearing it?
Dr. Light: One of the big challenges with the reliance on clinical interviews is that ultimately we’re unable to tell what’s going on inside a person’s mind. Even the best clinicians sometimes struggle to disentangle complex experiences like hallucinations versus a defeatist attitudes versus automatic thoughts. These are the kinds of things that get in the way with how we think, how we act and how we feel. When a person with schizophrenia who hears voices, we don’t know if that voice is perceived as outside of their head or an automatic thought. The voice might be someone saying to them, “Youre no good, you’re a failure.” These could be defeatist attitudes or hallucinations, but the problem is it’s tough to sort it out and is often filtered through the clinical interview process and doesn’t always go well. So, we’re trying to bring in more objective laboratory-based tests that can help us better characterize the functioning of critical cognitively linked brain networks.
What can you see on an EEG?

Dr. Light: Our EEG tests are extremely reliable read outs of the functioning of an auditory network. For example, if you were to take the gold standard clinical interview and study kids who are at highest imminent risk for developing psychosis, only twenty to twenty five percent of them will ultimately go on to develop psychosis within two to three years. One EEG test, called mismatch negativity, can substantially improve the prediction of which kids go on to develop psychosis over two to three years. In fact, the degree of abnormality in this brain measure actually forecasts the length of time until those kids go on to develop psychosis. Those with greater abnormalities develop psychosis sooner than those who are more in the normal range or only have mild levels of impairment.

Is anyone at risk or is it hereditary?

Dr. Light: Ultimately, we all carry some risk for brain disorders ranging from low to high. Children at high risk for psychosis are often referred by school counselors, parents or pediatricians. Some have a family history of psychosis and unusual ideas that others just don’t understand. They might also be experiencing abnormal perceptual experiences that aren’t quite hallucinations, but are getting in the way of their functioning. You can’t intervene with medications since the majority of these kids are not going to develop psychosis. They might have side effects from their treatment or they might have stigma from their treatments. We have to be very careful in these high risk groups.

What exactly are you looking for with an EEG?

Dr. Light: We measure the brain’s response to sounds. Our particular task looks at brain waves when a sound becomes a little bit different from a frequently presented stream of information. It’s the start of a cascade of information processing involved in detecting a change. It’s this temporal window, or tiny window of information processing, that appears to be critical for triggering higher order cognitive decision-making, action and modifying behavior. Your brain has to decide whether something is different, and if it is different, is it something that you need to act on.
How accurate are these studies?

Dr. Light: Some of the really exciting findings of these studies is that you can measure this brainwave potential and find that it accounts for substantial portions of variance in a person’s clinical symptoms. It accounts for about half the variance in some of their cognitive performance as well as their ability to function in the community. So, you give this EEG test, it takes fifteen to twenty minutes and from that you can get a pretty good characterization of their clinical symptoms, their cognitive functioning and their psychosocial abilities.

If you have someone that hasn’t had a real problem yet, but they show the signs and they get the EEG, how do you then go to treat them?
Dr. Light: Well, there are many different forms of treatment. One treatment is medications. You have to be really careful with these kids who are at high risk because we don’t know if they need the medications and the medications are not without side effects. One promising strategy is to identify these kids who are at highest risk and give them non-pharmacologic treatments. These treatments can include cognitive training interventions, psychosocial interventions or peer to peer support. You want to offer treatments that don’t have side effects or things that might otherwise be harmful to kids that are not on the path to developing a chronic psychotic condition.

Can that actually stop the occurrence of it?

Dr. Light: That’s our goal. We want to find out if we can actually alter the progression and course of these devastating illnesses through supportive interventions or restorative interventions that are guided by laboratory-based biomarkers.

Do you have a percentage of how accurate it is in what you’ve studied?

Dr. Light: No. I don’t do a lot of studies with high risk kids as these studies can take intensive efforts to just find the ultra high risk cohort. My studies are mostly trying to establish the relationships between the biomarker, brain function, cognition and response to treatments in patients with established psychosis. In the high risk kids, the EEG test can improve the prediction from about twenty to twenty five percent, and maybe up to as high as sixty five to seventy five percent. That’s an actionable number and something that you can act on and then use that to assign those high risk kids to receive supported interventions.
You’re trying to get this technology more mobile so they can do it in any office?

Dr. Light: Yes. This technology has existed for a very long time. There have been hundreds of studies validating different kinds of EEG tests. The ones that we use are the best of the best and have been extensively characterized in thousands of individuals studied at centers around the country and world. We have recently validated some tests for use in multi-site clinical studies. So, we’ve done studies to demonstrate short- and long-term reliability, relationship to important domains of cognitive and psychosocial functioning, and now we’re working to predict and monitor response to cognitive training interventions.
Talk about how we get it into real world.

Dr. Light: Our focus has been to try to make this technology simpler and easier to use. We can now demonstrate with confidence that what we see with the smaller devices is the same as what we see in our specialty labs. We’re working to make it even simpler and smaller where we can measure the same event through a mobile device that’s connected to wireless sensors attached to a person’s forehead. These devices are low cost and can be scaled to test thousands of people. They can be used by non-specialists in clinics or even homes. Data is uploaded into the cloud, gets scored and sent back either to the individual or to a care provider. Our idea is that by being able to directly measure the functioning of the brain, that we can identify response to treatments. We can predict which individuals are likely to benefit from a given treatment and then use that laboratory test to assign patients to receive interventions for which they are likely to benefit. Currently, we don’t have anything like that in psychiatry. We base a lot of our treatment decisions on our interview or our ability to make inferences about their inner experience. We think we can get better by getting the technology out into the real world centers and rationally pairing it with treatments that engage that same auditory system with treatments that are designed to improve the cognitive and psychosocial function in many of our patients.

This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.

If you would like more information, please contact:

Gregory Light, Ph.D.
619-543-2496
glight@ucsd.edu

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