Schizoaffective Disorder: The Journey Back from Crazy...

Biology 202
2006 First Web Paper
On Serendip

Schizoaffective Disorder: The Journey Back from Crazy...

Christin Mulligan

I had always been a drama queen. My grandmother even nicknamed me Sarah Bernhardt, after the queen of Vaudeville melodrama. My high school superlative was "Most Stressed Out". Type A overachiever is the tip of the iceberg.

The problems began during my sophomore year here at Bryn Mawr. My moods swung like a pendulum. I would work productively for days and then suddenly find myself unable to get out of bed in the morning. At the end of fall semester, I decided to apply for the prestigious Hanna Hollborn Gray Fellowship, so I could spend my summer immersed in Irish Women's Literature and take a Gaelic course at Penn before my semester abroad at Trinity College in Dublin. I spent Winter Break up to my elbows in theory and criticism. I had 24-hour reading binges. My sleep cycle was in chaos. I did not even consider seeing a doctor.

My insomnia continued well into second semester. Flash forward to May, week of the Gray announcement: I wrote papers. I went to work. I ate meals with my friends. I did everything but sleep for five consecutive days. I was awarded the Gray. Rapture. I did not sleep that night either. I sobbed uncontrollably on the way to my first class. Someone had to escort me back to my dorm where I still did not sleep. My room was a shambles. I could not ignore the incessant "noise" in my head. I called my mother in a white-knuckled panic and begged her to come from New Jersey and pick me up. By the time she arrived, I was hysterical. I believed that everyone was angry with me and "no one loves me." I insisted that I was a failure and that everything that has ever gone wrong in my life was entirely my fault beginning with the end of my parents' relationship before I was even born. I contended that my life was a lie and demand to be told "the truth" -whatever that meant. At home, even my grandparents could not console me. I started apologizing for God only knows what. My mother called my stepmother and then my father arrived. I begged him to tell me "the truth." No one understood me. At this point, my parents convinced me to go lie down. Both my mother and father stayed with me through the night, and I only slept for two hours. In the morning, my mother called my aunt, her twin, a doctor in Boston. Aunt Katie contacted a mental hospital in Delaware. I committed myself in my pajamas. I remember the questions very clearly, "Who was the President of the United States?" George W. Bush-duh. "Who was the first President?" George Washington-duh. "What was today's date?" May 8-I'm not an idiot. "What were the three things I asked you to remember?" My mind was blank. I began to cry again. I became agitated when they wanted me to sign the forms. I became more agitated and curled into a ball when the nurse came to photograph me. My thoughts were racing. I could not form coherent sentences. The words were slipping away from me, vanishing like snow on a hot pavement, evaporating into the ether. There was only noise. The walls vibrated, colors shifting. I felt as if I was trapped in a Salvador Dalí painting. I began to pace back and forth and wandered the halls. I could not seem to calm down. Eventually, I was sedated.

The next fifteen days were a blur. I ate plain spaghetti and drank only water because I was certain there was something wrong with the food. I wrote compulsively, lists and lists of words, just so I would not forget any. I memorized the faces of the other patients. (I would see them for months afterward: at the movies, at the mall, on the beach.) I had many "visitors" in the hospital: my best friends, their parents, two of my favorite professors, my ex-boyfriend, his parents (whom I had never met), my hairdresser. I talked to even more people on the phone. In reality, my only visitors were my parents, my stepmother, and my grandparents. I have no idea who I spoke to on the phone. Eventually, I told the doctor I would die if I were not sent home.

For some inexplicable reason, he released me. I suppose crazy people are eerily persuasive. I was on ten medications and still hallucinating. I had horrible, violent nightmares. I insisted that someone was trying to kill me in my sleep. The doctor at the hospital was unable to take me on as a regular patient. It took me a month to get an appointment elsewhere. The nightmares continued. I cried for hours on end. I stopped eating. I could not stand to be alone. The TV upset me. There was still "too much noise" in my head.

After four appointments with the Head of Neuropsychiatry at the University of Pennsylvania, who listened patiently as I discuss my insomnia, my paranoid rationalizations, my delusions and hallucinations, I was formally diagnosed with schizoaffective disorder, a mix of schizophrenia and manic-depression. Positive symptoms of schizophrenia, those that should be absent but are present, include: hallucinations, delusions, and disturbed thinking. Negative symptoms, those that should be absent but are present, include: blunted affect, apathy, anhedonia, alogia or aphasia, and inattention (1). Symptoms of mania include: agitation, sleeplessness, paranoia, excessive cheerfulness resulting in extreme irritability, susceptibility to spending sprees and sexual indiscretions, and compulsive talkativeness. Symptoms of depression include: flat affect, constant sadness and fatigue, loss of interest in normal activities, indecisiveness, sleep and appetite deprivation or in excess, and morbid or suicidal ideations (2). The disorder is more common in women, and usually begins between the ages of sixteen and twenty-five. Twins of schizoaffectives have a 50% chance of developing the disease, while first-degree relatives have a 10% chance (1).

Studies of both classic schizophrenia and manic-depression (bipolar disorder) are relevant to studying schizoaffective disorder. In fact, bipolar and schizophrenic patients show susceptibility to both diseases through a distinct linkage pattern along chromosome 18 (3). Previous research on schizophrenia suggests negative symptoms are related to decreased activity in the pre-frontal cortex, which controls executive functioning, while positive symptoms are related to abnormal blood flow in various regions of the brain. There are both over-perfused (too much blood flow) and under-perfused (too little blood flow) regions (4). For example, during delusions, blood flow increases to the Broca's area, which controls language articulation. Furthermore, "schizophrenic brains tend to have larger lateral ventricles and a smaller volume of tissue in the left temporal lobe in comparison to healthy brains" (5).

Another significant factor in the development of the positive symptoms of schizophrenia is overproduction of the neurotransmitter dopamine in the limbic system, which regulates emotion, motivation, and memory. "Dopamine is secreted by cells in the midbrain that send their axons to the basal ganglia and frontal lobe. There are five dopamine receptors in the brain. Each of the receptors contains about 400 amino acids, and they have seven regions spanning the neural membrane. Their function is to bind to dopamine secreted by presynaptic nerve cells. This binding triggers changes in the metabolic activity of the postsynaptic nerve cells" (5). Additionally, there is an increase in the levels of serotonin, the "feel-good" neurotransmitter. Traditional neuroleptic drugs block the dopamine receptors thereby treating schizophrenia. Atypical neuroleptic drugs also block serotonin (5-HT) receptors. Negative symptoms, on the other hand, may be caused by decreased levels of dopamine in the frontal lobes. For both positive and negative symptoms, there is a decrease in the glutamate receptor NDMA, which is involved in the development of learning, memory, and neural processing in general (6).

Like schizophrenia, previous research on bipolar disorder suggests elevated levels of dopamine during manias. There are also elevated levels of the stress hormones norepinephrine and cortisol, and calcium (7). While environmental stressors that cause the brain to produce norepinephrine and cortisol can result in bipolar cycles, after multiple episodes, there is less and less need for a trigger. Eventually, the brain begins to respond automatically and requires no trigger at all. This phenomenon is called "kindling". If untreated, "kindling" worsens over time (9). Depending on whether the patient is manic or depressed, the level of serotonin and norepinephrine varies accordingly (7). Logically, there is an excess in manias and a paucity during depressions. Circadian rhythms, the body's natural cycles that control everything from appetite to sleep and sex drive, are believed to have an effect on bipolar disorder. The center of Circadian rhythms is the suprachiasmatic nucleus in the hypothalamus. The sleep cycle is particularly pivotal in mood shifts and triggers the pineal gland's secretion of melatonin. Patients experience insomnia during mania and hypersomnia during depression. Melatonin responds to light, so patients have been successfully treated with phototherapy to regulate melatonin secretion (8).

Neural structure and functioning also vary in the bipolar brain. There are fewer neurons in the hippocampus, which controls memory and navigation, and fewer glial cells, which provide nutrients to neurons, in the prefrontal cortex. Like schizophrenia, there is also a decrease in the protein myelin, which prevents electrical impulses from leaving the axons and causing a short-circuit in the brain (10).

So what do all these surpluses and deficiencies mean in terms of dealing with schizoaffective disorder in the real world? Remember the three C's. Commitment to taking the neuroleptics and/or mood stabilizers is essential. Coping with side effects can be difficult, but nonetheless, communicate these problems to your psychiatrist and work out an individual regimen of therapy in addition to simply medicating. If the meds are not working, do not be afraid to say so.

As for me, after agonizing tinkering with my medications, where I became depressed and lost the ability to sleep, read, and concentrate in general, I have not had a paranoid or hallucinatory episode in nine months. As the number of my medications was gradually reduced to one, my moods began to stabilize and I was again able to sleep, read, and focus. The journey back from crazy was long and hard, but ultimately worthwhile.

WWW Sources

1)Positive and Negative Symptoms, a rich text resource

2)The Symptoms of Schizoaffective Disorder, a rich text resource

3)Evidence of Genetic Overlap between Schizophrenia and Bipolar Disorder, a news article from Schizophrenia.com

4)Research on Schizophrenia, a news article on schizophrenia

5)The Role of Dopamine Receptors in Schizophrenia, an article on the role of dopamine in schizophrenia

6)Decoding Schizophrenia, a Scientific American article

7)What Causes Bipolar Disorder?, a rich text resource

8)Circadian Rhythms, a rich text resource

9)Kindling, a rich text resource