MCG Today

32 Pages·1992·2.6 MB·English

by  Medical College of Georgia

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MEDICAL
COLLEGE
TheHealthSciencesUniversity
oftheStateofGeorgia
Volume 20, Number2 Winter 1992
Introduction Contents
^Schizophrenicshearvoices that 21 Silencingthe Voices
f|(u exist in noone'sreality buttheir
Medical CollegeofGeorgiaresearchers are uncovering vital information about
own. Anorexicsaresoafraidof
schizophrenia, adisease markedby delusions andparanoia.
gainingweightthat they literally
starvethemselvestodeath. Social phobics 61 FightingDepression
cloisterthemselves from the worldto An MCG psychiatrist is testing whichdrugs, and in whatdoses, aremost effective for
avoidothers' scrutiny. Alzheimer's thosewithdepression.
patientsdiea littleeachday, theirminds
slipping away into irretrievabledarkness. 7/ BlueprintoftheMind
Theonly commondenominatorofall Adiagnostictestguides psychiatriststhrough interviews designedtopickthe brain.
these groups is that their—illnesses are
classified as psychiatric diseasesofthe 91 AlumNews
mind whoseorganicroots are beingbetter
understoodeveryday. 221 A MatterofControl
MCG
Research atthe Medical College of hasestablishedaneating-disordersclinictohelppeople regain control oftheir
GeorgiaDepartment ofPsychiatry isdra- eating habits.
matically enhancing that understanding.
Wanediitnsvictleinyiocaultaopplleiacrantaibonosutinthtehirseesdeiatricohn 261 AMnapMCofGtrheeseBarracihnerisrefining a hi-tech way todiagnose mental illness.
ofMedicalCollegeofGeorgia Today.
271 Facingthe World
Drs. ManuelCasanovaand Sukdeb
Mukherjeeareeach pursuingdifferent New drugs may enablethose with social phobiatoovercome theirfearandfacethe
world.
meansofshedding light on schizophrenia,
adiseasecharacterizedbydelusions and 281 ReclaimingthePast
paranoia. Dr. Casanovais tryingtoisolate MCG istestingtwodrugsthat may help victimsofAlzheimer'sdiseasereclaim their
agene; Dr. Mukherjee is probingacellu- memories.
larbasis. Readabout theirresearchand
theconsiderable human toll involved in 291 Plan YourGiving
thedisease.
Dr. RichardBorison,chiefofthe MCGPresident: FrancisJ.Tedesco,M.D. MCGFoundationOfficers
department, is testing memory-enhancing ExecutiveEditor: JamesB.Osborne.Ed.D. President: H.GordonDavis,M.D.
drugs in the hope thattheycan salvage DirectorofMarketingandPublicRelations: FirstVicePresident: WilliamC.Collins,M.D
the memoriesofAlzheimer's patients. GeorgeH.Foster SecondVicePresident: VirgleMcEverJr.,M.D.
Dr. Jeffrey Rausch is tryingtopredict Editor: ChristineHurleyDeriso Secretary-Treasurer: HaroldS.Engler,M.D.
how those withdepression will react to ArtDirector: BrentD.Burch ExecutiveDirector: JamesB.Osborne.Ed.D.
antidepressantdrugs andat whatdoses Photographers: PhilJones AssistantSecretary-Treasurer: LarryTyler
thedrugs will be mosteffective. WillWillner
The departmentalsohasestablished TheMedicalCollegeofGeorgiaisthehealthsciencesuniversityoftheUniversitySystemofGeorgia.Focusingon
aneating-disordersclinic totreatthose health-careeducation,researchandpatientcare,theAugusta-basedinstitutionconsistsofMCGHospital,morethan
HOsupportclinics,statewideoutreachprogramsandtheSchoolsofAlliedHealthSciences,Dentistry,Graduate
tormentedby food. And readaboutbrain- Studies.MedicineandNursing.
mapping, adazzling technique todiagno- MedicalCollegeofGeorgiaToday(USPS867340)issponsoredbygrantsfromMCGFoundation.Inc.andthe
sispsychiatricdisorders. MCGSchoolofMedicineAlumniAssociation.ItisproducedbytheDivisionsofInstitutionalRelationsandHealth
Wehopetheseandotherarticles CGroampmhuincicAadtvierotniss;inMge,dPi.cOa.lBCoolxle3g97e.oAfuGgeuosrtgai,a;GeAourgguisata3,09G0e3o.rgPiuabl3i0s9h1e2d.qAudavrteerrtliys,inMgCiGnquTiorideasysihsofuulrdnibsehdeidretoctedto
included in thisedition ofthe magazine alumniandfriendsofMCGwithoutcharge.Second-classpostageispaidatAugusta.GA.Theappearanceofadvertise-
will intrigueandenlighten you aboutthe mentsinthispublicationdoesnotconstituteanendorsementbytheMedicalCollegeofGeorgiaoftheproductsorser-
vicesadvertised.Postmaster:SendaddresschangestoDataUpdateOffice,FI-100AlumniCenter,MedicalCollege
workingsofthe mind. ofGeorgia.Augusta.Georgia30912.
Silencing the Voices
usan Ellis* was people were waitingforher still lying in bed, terrifiedto smothered. She frantically
hearing voices outside herdorm room with move. She'dgotten upfor clutchedherchest. Convinced
again. guns. Shewastoldto lie in bed foodonlyonce, andthen ate she washavingaheartattack,
Thistime, the and stay there; herlife only halfasandwich. she wenttoanemergency room
voicestoldherthat dependedon it, they said. She Thevoiceseventually Thathospital tripmarked
listened. became socacophonousthat the beginning andtheendfor
*Notherreal name. Fourdays later, shewas Susanfeltherheart wasbeing Susan: thebeginningofanew
2 MEDICALCOLLEGEOFGEORGIATODAY
MCG
life freeofvoices, theendofa wouldn't havegone forhelp." ofVeterans Affairs Medical fessorofpsychiatry at
uniquely cruel kindofhell. Shewasdiagnosedalmost Center. and the VA, is pinpointing
She learned in the hospital that immediately. "When I was told Andcertaincharacteristics exactly whatdistinguishes the
this kindofhell hada name: 'schizophrenia,' I didn'teven ofschizophreniabaffle brainofaschizophrenic.
Susan was schizophrenic. know whatthe word meant. I researchers. Thediseaseis While on thefaculty ofJohns
She hasn'talwaysheard thoughtschizophrenia meant much lesscommon in rural Hopkins University andthe
—
voices. Susa—n pretty, outgo- multiple-personality disorder." than urban areas, forinstance. National InstituteofMental
ing,artistic enteredcollege But shewashapp—yto learnthat And schizophrenics in Nigeria Health, heparticipated in a
afterhigh school topursueher amedica—l reason andatreat- and Indiahave much better study of20setsofidentical
loveofart. Butshortlythere- ableone explained hernight- outcomesthan thoseelse- twins. One twin ofeach set
after, herfatherdied. Theyear mare. "I was relievedwhen I where. "They don't showthe was schizophrenic. Each
was 1989. Shewasdeeply wasdiagnosed." progressivedeterioration," Dr. schizophrenic's brainwas
depressedthenextfew months. In the twoyears since her Mukherjee said. He is found to haveunusually large
Then she sankdeeperstill. diagnosis, Susan has learned researching such variationsto ventricles, fluid-filledcavities
"WhatI wentthrough wasa more about schizophreniathan determinethecauses. within thebrain.
seriesofdelusionsthatwent she likelyeverwantedto Researchers have found Since the schizophrenics'
through my head," shesaid. "I know. Thedisease, which that schizophrenics have an twins were not likewise
thought someonewastryingto affects about 1 percentofthe excess ofdopamine, an amine affected, theresearchersdeter-
control methrougha machine. I population, generally strikes in essential tonormal nerve minedthatthecharacteristic
thoughtthe machine...orthese youn—g adulthood. The symp- activity in the brain. Susan's resulted not genetically, but
people...weretryingtoget me toms delusio—ns, paranoia, schizophreniaiscontrolled from an injury. Noneofthe
todosomething. I thought it disorientation maybetrig- with drugs that inhibit the twins sustained abrain injury
involveddrugsandthatthey geredby atraumaorforno body's productionof afterbirth, soDr. Casanova
wereaftermoneyorsomething. apparentreason. Some dopamine. Thedrugscontrol concluded the brain was
I alsosawand felt thingsthat schizophrenics are sometimes hersymptomsandallow herto injuredin utero. "I believethat
weren'tthere. I wouldsee catatonic, acquiring and hold- lead afull life. any lesions tothebrain should
people'sfacesswell up.... ingoddpostures forhoursata Butas importantasthese haveoccurredduringthe first
"Itstruck measvery real. I time. That is becoming drugsare, theyonlytreatthe orsecond trimester,"hesaid.
believed itforalongtime." increasingly lesscommon, an symptoms. "Schizophreniaisa Researchersdobelieve,
She didn't confideher indication that schizophrenia is progressivedisease, notjust however, thatschizophrenia
experiencestoanyone. "I anevolvingdisease. acutesymptoms,"Dr. hasagenetic predisposition.
didn'tgotoanybody becauseI These symptoms, unfortu- Mukherjee said. "Wetreat the This tendency may makethe
thought these people would nately, provide the only basis acutesymptoms,butthebasic brain lesstolerantofinjury or
harmmeormy familyifI fordiagnosis. "Thetrouble disease is still progressing more susceptibletoit. Another
did," she said. with thisdisease isthatthere is underneath." Andthedisease study found that schizophren-
She hadaprivatedorm noclearbiological measure itselfis maddeninglyenigmatic. icsaremore likely than the
room, soshe wasrelatively thatdetermines whetheryou Researchers atMCG are general population tohave had
free from scrutiny. But Susan haveit," said Dr. Sukdeb doggedly tryingto shed light compli—cationsduring their
couldn't maskhersymptoms Mukherjee, professorofpsy- on it, and with often startling births anotherindication that
forlong. Herfearandparanoia chiatry at MCG with ajoint results.
made heredgy, withdrawn and appointment atthe Department Dr. Manuel Casanova,pro- Dr. ManuelCasanova
moredepressedthanever.
"That's—the firstthingmy mom
noticed boutsofdepression,"
she said. Herboyfriend
noticed, too; she seemedto
constantly pick fights with
him. And hergradesdropped
dramatically.
"Thequarter(before I was
hospitalized), I was failing in
one ofmy favorite artclasses.
My teacherknew something
waswrong. Shecalled me in
heroffice andaskedifthere
wasanythingshe coulddo."
But Susandidn't divulge
hersecret. Thosevoiceswere
asrealtoherasevery other
aspectofherlife, andshe
fearedforhersafety. "WhenI
finally wenttothehospital, it
wasbecause I thoughtmy
hearthad stoppedbeating. Ifit
hadn't been forthat, I
VOLUME 20, NUMBER 3/SPRING 1992
brain injury is relatedto,
although not theonlyreason
for, schizophrenia.
MCG
has establisheda
brain bank sothattissue of
schizophrenics andhealthy
individualscanbe furtherstud-
iedandcompared. Dr.
Casanovais seeking50
donors, whocanbeany age
and musthavedied from an
injury orillness that lefttheir
brains intact. Thebrains will
be storedat super-cool temper-
aturesatwhich icecrystals
don't form andtissuecan be
safely kept foryears. Dr.
Casanovaalso is interestedin
the brainsofthose withother
typesofneuropsychiatric
illnesses such asParkinson's
disease, epilepsy, manic
depression and mental retarda-
tion. (Braindonation coststhe
donornothinganddoes not
interfere with an open-casket
funeral. Those interested in
donating may contactthe
MCG Organ andTissue Donor
Serviceat404-721-341 1.)
In the meantime. Dr.
Casanovais fashioningother,
less literal meansofpeering
intothe brain. Magneticreso-
nance imaginggives him a
startingpoint, providingtwo-
dimensional imagesofthe
brain. But the brain is multi-
layered, sotheimagesprovide
limited information. One
method he usesto supplement
the information isquantitative
shape analysis.
"Ifyouhaveasphereanda
general forceactingonit,you
getasmallerspherebutreally
nochange in shape,"hesaid. He specifically studiedthe magazinetoanalyze braintex- Dr. SukdebMukherjee
"Ifyoutakethe same sphere temporal lobe, theonly areaof ture usingthe same principles
andapply afocal forceon it. schizophrenics' brainswith enabling fishermen topredict Mechanicsormagazinesof
youhave a—change in shape, abnormally low volume. "I thebest spotsto fishby study- this sort,"he said.
notvolume liketakingaslice foundthatthe injuries are ingthe numberoftheocean's Andthe more heunder-
outofapie."He wondered focal, as ifaportionofthe waves andthe heightsoftheir standsaboutaschizophrenic's
whichtypeofforceoccurredto brain has literally been sliced peaks. "I foundoutthrough brain and its injury, thecloser
thebrainofaschizophrenic, out,"he said. textureanalysisthat theante- he thinks heistosinglingouta
causingthe injury. "We'retrying torebuildthe riorand medial partsofthe generesponsibleforthedis-
Dr. Casanovaappliedthe pictureofwhatthe schizo- temporal lobeare wherethe ease. "We're working back-
mathematical principlesof phrenic brain looks like. By shapes are mostabnormal. The ward, fromthe lesiontothe
shape analysistomagneticres- plugging numbers intoan tissueisnotaslargeasnormal gene,"he said. "We may be
onance imagesofthetwins' equation, you build ashape. and is moredysplastic." verycloseto findingthegene."
brains. Usingacomputer, he Now you have morethan num- Dr. Casanova'suseofmath Assuming, ofcourse, that
pluggedin mathematical equa- bers; you havea figure, and andcomputerstoobtainclues onegene holds thekey. Dr.
tionscorresponding tothepor- youcancompareone figure toschizophreniaisdecidedly Mukherjee isn'tsosure. "All
tionofthebrain hecouldsee with another." unconventional. "Curiously disease is the net resultofthe
andwasabletoconstructa Healsowas inspiredby an enough, I've gotten mostof interaction between a
pictureoftheunseenportion. article inFieldandStream my ideas from Popular pathogenic insultandthe
4 MEDICALCOLLEGEOFGEORGIATODAY
——
body'sdefense mechanisms." He is focusingspecifically
he said. "Is itapathogenic on catalase, anenzyme which
geneorisita varietyofthings appearsto show markedly + FIPPS SURGICAL
affecting thedefense mecha- reducedactivity in schizo-
nismsofthe body thatcauses phrenic patients. Thisreduced SUPPLY CO., INC.
schizophrenia?" activity can deregulatecell
Ifthe latteristhecase activity and alterDNA, an
that the body'sdefense system individual'sgeneticblueprint.
The IndependentDealer
isatfault, ashe suspects "Thiscan lead togenetic faults
then theentire body is and virtually any kindof
affected, notjust the brain. He damage," Dr. Mukherjee said.
istestingthe theory by study- "Ourgeneral hypothesis is that
ingcell culturesofschizo- the fundamental defect in Fipps has been carefully serving the
phrenics, comparingthem to schizophrenics is ageneralized
cell culturesofhealthy indi- metabolicdefectofa nature needs of hospitals and physicians for
viduals. "Acell culturepro- that may not affect anypartof more than 20 years.
vides amodel ofapatient ina the body but thebrain."
If you're looking for quality health
littledish."he said. "But Thisyear, he will begin
unlikeblood, thisisagrowing, studyingcell culturesofchil- care products and personalized service,
dynamic system. To my under- dren ofschizophrenics to see if call us today:
standing, wehavethe world's theircells show the samedis-
biggestcell bankofschizo- organized pattern. Ifso,the 241-3296
phrenic patients." diseasemaybediagnosable (800)
or
He andhiscolleagues have before symptomsdevelop.
foundthat two-thirdsofthe Such findingsalsowould lead [phone]
cellsofschizophrenics are toamuchclearerunderstand-
grossly disorganizedand mis- ingofthedisease. "I would
shaped. "Atthispoint, we're liketointervene beforethe FIPPS SURGICAL SUPPLY CO., INC.
tryingtotrackdown thebasis psychosisdevelops," Dr. NE
733 Lambert Drive,
ofitandsee what itmeans," Muk—herjee said.
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VOLUME20, NUMBER 3/SPRING 1992 5
Making
psychia-
try a
more
exactsci-
ence is thegoal ofDr.
Jeffrey Rausch, professor
andvice chairman ofthe
DepartmentofPsychiatry
andHealth Behaviorat
the Medical College of
Georgia.
Dr. Rausch isobserv-
ingthecomplex molecular
reactionstoantidepressant
drugstobetterpredict
whichdrugswill be most
effective inagiven patient
andinwhatdoses.
"Sofar, we haveonly
testedone drug and were
abletopredict with 70
percentaccuracy how
patients wouldreact," Dr.
Rausch said.
The study hascen-
teredaround serotonin, a
chemical in thecentral
nervous system thatacts
asamessengerbetween
brain cells. Even though
theexactcorrelation
between serotonin and
the antidepressants is not
known, areaction
between thetwohas been
observed.
"In the studies we
havedonetodate, we
have usedthedrug
Nortriptyline," Dr.
Rausch said. "It is avery
common antidepressant."
Nortriptyline attaches itselftothe
same recognition site on thebraincells as
serotonin. Therefore, thedrug inhibits the
amountofserotonintransported bythe Fighting
cells which are involvedin theantide-
pressanteffect.
"Fortunately, forthe purposes ofour
research, the platelets in theblood havea
similartransport site as the braincells," Depression
Dr. Rausch said. "This allows ustocon-
ductourtrials usingtheplatelets, which
wecanobtain forstudy, when wecannot
directly examine the brain cells."
In the laboratory, the platelets areiso-
latedandthe serotonin is added. itmaybeone indication ofthe effective- variables also figure intotheequation.
Researchersthen measuretheamountof ness aspecific medication will haveona Even thoughthis research is promis-
serotonintaken upby theplatelets. given patient." ing, itis still in its infancy. Dr. Rausch is
"When the amountproducingthe Limiting the amount ofserotonin now studyinganotherserotonin receptor
maximum absorbancy level isdetermined absorbedby the braincells is anecessary site on thecells which he hopes willoffer
inthepatient, wecutitinhalf,"Dr. partoftheaction ofan antidepressant, but even more insight intotheeffectsof
Rausch said. "This numberis knownas this action alone will notproduce the antidepressantson individ—ual cells.
the affinity constant, andwebelievethat antidepressanteffect. Otherunknown DAVIDWALLER
6 MEDICALCOLLEGEOFGEORGIATODAY
Blueprint
Mind
of the
Georgia. "A structured format such as thinkingorconcentrating?" and "Didyou
thisis more accurate, and it has been everfeel thatyou wereespecially impor-
shown togreatly improve the inter-rater tant in some way, orthat you had powers
reliability ofadiagnosis, meaningthat todothingsthatotherpeoplecouldn't
twopsychiatrists are more likely to do?" Questions areaccompanied by crite-
concuronthecorrectdiagnosis." riatohelpthe psychiatristrate how
SCIDis most useful in research stud- normal these responses are andthe sever-
ies,toassurethatpatientsare identified ityofthe difficulty, as well asa variety of
anddiagnosedconsistently, totrainresi- follow-upquestions.
dents howtoconductathorough interview "It'sespecially helpful incomplex
andforclinicalqualitycontrol, according cases, where several thingsaregoingon
toDr. Rausch. It is notcommonly used in atonce, tohelpyoudecidethe impor-
general psychiatricpractice. tance and meaningofeach," Dr. Rausch
"A problem with alotofpsychiatric said. "Italsotends tobe really useful in
literature in the past wasthat you were makingadiagnosis in apatient whotends
neversure ifthe studies werediagnosing togiveadisorderedhistory.
the patients inthe same way," he said. "This is particularly helpful in training
"Thisreducesthe variability, and means residents how toconductathoroughpsy-
thatyou can morereadily comparediffer- chiatric interview. Whilethere's not
entstudies." really anythingcompletely new inthe
Forexample, MCGisconductinga SCID interview, it'sagreat stepforward
study onpredictingtheeffect ofthe indiagnosisby making sure that all the
antidepressantdrugNortriptylineon questionsare asked in a logical sequence
people with depression. (See Fighting and in a standardizedway. Ithelps train a
Depression, opposite) Inordertostan- psychiatristtoaskthe rightquestions, go
dardize the research, patients involved in through the interviewin astructured way
the study arediagnosed using SCID. andcategorizetheproblem clearly."
—
A SCID interview isconducted much INGRID HEGGOY
likeanyotherpsychiatricinter-
/t's
oneofthe mostdifficult aspects view: thephysician asksthe
ofpsychiatry: determiningexactly patientanumberofquestions,
whatone's mental illness is. takesnotesanddeterminesthe
Anexample ofatried, reliable probablenature ofthedisorder
method isthe StructuredClinical basedonthepatient's
InterviewsforDSM-III-R. SCIDisan responses. The psychiatrist first
organized, structured interview designed asksgeneral background infor-
tocoverawide variety oftopics in athor- mation, suchasage, marital
ough, organized manner. status,educational level and
There arethree variationsofthe inter- employment history. Hegoeson
view: ageneral psychiatric screening,one toaskabout why they came for
forpersonality disorders andathird for treatment,current symptoms,
psychoses. possibledrug useand feelings
"Oneofthe problemstraditionally in andreactionsto situations.
psychiatry has been thatthere is apoten- Questionscoverawide
tial foragreaterdegreeofsubjectivity in variety oftopics, such as. "In
makingthecorrectdiagnosis thanyou the last month, hastherebeen a
may find in many otherfields of periodoftime when you were
medicine," said Dr. Jeffrey Rausch, pro- feelingdepressedordown most
fessorand vicechairmanofthe oftheday nearly everyday?
Department ofPsychiatry and Health During this time, how wereyou
Behavioratthe Medical Collegeof sleeping?Did you have trouble
VOLUME20, NUMBER3/SPRING 1992 7
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