There were two patterns emerging:

1. Children who later developed schizophrenia had early deficits in verbal and visual learning, reasoning and conceptualization and these remained as they grew older

2. They also developed more slowly than their peers in processing speed, attention, visual-spatial problem solving and working memory

How all this ends up as schizophrenia is still unknown but another co-author in the study, Avshalom Caspi, who is the Edward M. Arnett Professor of Psychiatry at Duke, speculates that a child who struggles to make sense of the world becomes more socially isolated or more delusional.

Keefe said that eventually he hoped that they might be able to intervene, perhaps with anti-psychotic medication, in childhood and head off the adult psychosis. The study suggests that adult psychosis doesn’t just emerge fully formed but has early roots in the developmental process.

I have thought for a long time that schizophrenia is one of the saddest disorders as it seems as if one’s mind turns against oneself but there is another disorder that it is even sadder where one’s mind does something quite similar. That disorder is Obsessive Compulsive Disorder (OCD). One of the required symptoms for a diagnosis of OCD is that the person must be conscious of their obsessive or compulsive behavior but be helpless to do anything about it. I know at least one person who has OCD and my heart goes out to her. Many times when she is exhibiting symptoms, she is in tears. I have, for a brief time in the past, had OCD symptoms and so have some understanding of how this plays out. In my case the behavior was checking and it was like I had forgotten whether I had locked a door again and again and again. I had, as a child, seen my father do this (so maybe it’s a family trait) and at the time a part of me marveled at the fact that I was repeating this simple action so many times. In my case it passed and has not returned. It happened at a time of great stress so I do have a worry that it could, at some point, return but the person that I was describing earlier has it most of the time and spends much of that time locked in her apartment because it is so painful for her to go outside. Her behavior is also checking but it involves looking at every scrap of paper she comes across to see if one of her friends or family has left her a personal message. A mutual friend who was trying to help her by walking with her one time asked her, “Do you really think that a friend would leave a note for you on the street in the gutter.” The friend with OCD just looked down and cried.

I am so glad that my own symptoms were so short lived but I also hope that this new study will lead to the possibility of earlier intervention and perhaps head of the disorder–at least for schizophrenia.

The study looked at patients with temporal lobe epilepsy which causes problems in the hippocampus leading to short-term memory problems.  The researchers said, “The patients could not distinguish the studied images from new images after 60 minutes but performed normally after five seconds.”  Professor Emrah Duzel of University College London went on to say  that a striking deficit emerged even at five seconds when the subjects were asked to recall the detailed arrangements of objects within scenes in photographs.

The study concluded that there are two distinct short-term memory networks within the brain.  The other one that is separate from the hippocampus remains intact in patients with hippocampus-related disorders.

Nathan Cashdollar, also from University College London said, “This is the fist functional and anatomical evidence showing which mechanisms are shared between short-term and long-term memory and which are independent.”

The findings of this study, I think, are interesting in showing that there are distinct elements to short-term memory and that they are located in different areas of the brain.  When I was in Dr. Attila Turgay’s (one of the leading experts on ADHD in Canada) office last year he did three separate tests for short-term memory: verbal, numerical and spatial.  It was only spatial short-term memory with which I had trouble.  If indeed this function is located in a different part of the brain than either verbal or numeric working memory it does make sense that one aspect of working memory would by dysfunctional while the other two are intact.

According to the study’s lead researcher Dr. Nuno Sousa in an article in Science magazine, “Behaviors become habitual faster in stressed animals than in the controls, and worse, the stressed animals can’t shift back to goal-directed behaviors when that would be a better approach.”

Take heart though, even though your brain may have rewired itself for the worse, it still has the potential to unlearn these habits and learn new more advantageous ones.

Dr. Sousa said, “The brain is a very resilient and plastic organ. Dendrites and synapses retract and reform and reversible remodeling can occur throughout life.”

Van Raalten, using an fMRI scanner, asked subjects to perform tasks in which they had to remember a series of letters, something that would be accompished in working memory, and discovered that the more the tasks were repeated, the lower the brain activity became in the areas of the brain associated with working memory. But this activity was not compensated for by other areas of the brain involved in long term memory. By automating the letter series the subjects were releasing working memory capacity allowing it to process new information. Van Raaltlen concluded that this restructuring of incoming information was another function of working memory, a process known as chunking. For example to remember 1232673445 you would clump numbers together as you might a phone number, 113 276 3445 . This allowed working memory to be freed up to process new information. Her initial conclusion, in observing schizophrenic patients performing the same tasks, was that their working memory was less efficient and automation did not proceed as well as with healthy subjects. Van Raalten went on to observe that schizophrenic patients process less information than healthy subjects. However, the testing revealed automation proceeded as well as with healthy subjects but subsequently, working memory was not released to deal with new tasks. Further testing revealed that the working memory in schizophrenic subjects struggled with the processing of information that continually changed, leading to the conclusion that Schizophrenics may have more of a tendency to adopt automatic strategies in circumstances that demand flexible behavior.

I understand their discomfort as I believe everyone wants to think of themselves as normal, functional and worthy of their own self esteem. But just thinking of yourself as normal doesn’t make it so. Besides that, it really seems like sweeping the problem under the carpet. Decades ago a friend of mine began seeing a psychiatrist who told him in the first visit to pretend he was normal until he was normal. Of course the psychiatrist would analyze his actions and thoughts over a period of time and offer advice and direction that would lead him to being normal. Another friend, only a year ago, when I raised the issue of my ADHD, asked me, “Why can’t you just think of yourself as normal?” My reply astonished even me at the time when I said, “I don’t want to think of myself as normal. I want to be normal.” I went on to explain that I thought that my journey began with finding out what wasn’t working for me, such as focus and attention, and then I could do something about it. This is what I have tried to do with medication. I would go about it differently now that I know about neuroplasticity and that problems with working memory seem to be at the heart of ADHD and that you can improve working memory. In other words I would be looking for a more permanent kind of change than what medication provides. To me this represents the hope provided by the new research in neuroscience–that the brain can change and we can change it.

In addition, multiple disorders do not necessarily equate to multiple causes or underlying problems. In fact one job of the diagnostician, as I undertand it, is to find the primary disorder. In many cases treatment of this disorder will have a beneficial effect across the board. A few years ago I read a book entitled Shadow Syndromes written by John Ratey, who co-wrote Driven to Distraction with Edward Hollowell. Ratey’s thesis is that there are a number of disorders that seem to have a common underlying cause which he calls ‘noisy brain’. This spectrum of noisy brain disorders would include Bi-Polar, Tourettes Syndrome, Obsessive Compulsive Disorder, Anxiety Disorders, Mood Disorders. I know that ADHD, which would be included in the noisy brain spectrum, almost always occurs with co-morbidities as they are known, that would be in the ‘noisy brain’ spectrum. It seems a forgone conclusion that if you could alleviate the ‘noisy brain’ problem you would also alleviate symptoms of the co-occurring conditions or co-morbidities.

The idea of multiple diagnoses would then not really matter if you could just treat ‘noisy brain’. I don’t know that ‘noisy brain’ is related to problems with working memory but I would be willing to bet on it. If this is the case, improving working memory could have a positive effect on all of these ‘noisy brain’ disorders and that I find that encouraging and hopeful…

I was also tested in these three key areas by Dr. Atilla Turgay during a consultation in his office last summer. He does this test in just a few minutes asking you to remember and repeat back seven digit numbers, sentences forward and backward and then, the one I did terribly at, the positioning of his fingers, hands and legs which I had to replicate.

Lately I have come across references to working memory as fluid intelligence and the I started to get confused. This confusion increased just a few weeks ago when I was reading a blog that referred to a relationship between schizophrenia and problems in working memory. It would seem this is getting pretty far from remembering someone’s phone number or a street address. I accept that my knowledge in this area is limited. In addition, new knowledge in the area of neuroscience seems to be increasing daily.

I will come back to this subject when my own understanding has grown enough to explore it further…