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PUBLIC HEALTH

* Severe Psychiatric Disorders May Be Increasing

* Anti-MMR Supporters Criticise Research

* Study of Possible Link Between Measles Vaccine And Autism Funded

RESEARCH

* Brain Cells May Treat Parkinson’s

* A Look at Hyperlexia, The Compulsion to Read

AWARENESS

* Come Back Jack 2002: Award Winning Documentary

Severe Psychiatric Disorders May Be Increasing

Evidence is accumulating that the occurrence of severe psychiatric disorders, especially schizophrenia and bipolar disorder, may be increasing.

The most visible manifestation of this is the increasing number of severely mentally ill individuals among the homeless population and in the nation's jails. Multiple studies have reported that at least one-third of the approximately 600,000 homeless individuals have a severe psychiatric disorder, and there are suggestions that the problem is getting worse.

Similarly, a 1999 U.S. Department of Justice study reported that 16% of inmates in local jails and state prisons -- 275,900 individuals -- had been treated psychiatrically (Ditton, 1999). There are, therefore, five times more psychiatric patients in jails and prisons than the 55,000 remaining patients in state psychiatric hospitals. Headlines are increasingly proclaiming statements such as: "Mental Illness Behind Bars: A Tragic Situation Getting Worse" (Kupers, 2000).

Another measure of the increasing number of individuals with severe psychiatric disorders is the number of these individuals on supplemental security income (SSI) and social security disability insurance (SSDI), the two federal programs for the support of disabled individuals. The number of individuals in the category "mental disorders other than mental retardation" increased from 1.1 million in 1985 to 2.9 million in 1998, a 164% increase during a time in which the U.S. population increased only 13%. The "mental disorders" category is both the largest and the fastest-growing diagnostic category for both the SSI and SSDI programs.

Increasing numbers of individuals with severe psychiatric disorders are also suggested by the experience of managed care companies assuming responsibility for state psychiatric programs. In state after state, managed care companies have underestimated the number of individuals with severe psychiatric disorders who require services, with dire fiscal consequences.

Typical is a statement from the press regarding the January report from the state of Maryland discussing the failed managed care program for Maryland's mentally ill Medicaid patients: "But the state greatly underestimated demand, and the system was soon overwhelmed" (Becker and Hedgpeth, 2002).

The strongest evidence that severe psychiatric disorders may be increasing comes from the Epidemiologic Catchment Area (ECA) study, carried out in the early 1980s, and the National Comorbidity Survey (NCS), carried out in the early 1990s. In a 1999 discussion, Darrel Regier, M.D., co-author of the ECA study, said the study found that, after accounting for duplicate diagnoses, 2.2% of adults (ages 18 years and over) met diagnostic criteria for schizophrenia or bipolar disorder over a one-year period. A recent reanalysis of this study revised this estimate to 1.7% (Narrow et al., 2002). This translates into a prevalence rate of 12 to 16 per 1,000 total population, not including any mentally ill adults with other severe psychiatric disorders such as major depression or severe obsessive-compulsive disorder. The NCS study reported that 2.6% of adults had a "severe and persistent mental illness [SPMI]," defined as including schizophrenia; bipolar disorder; severe forms of depression, panic disorder and obsessive-compulsive disorder; and autism (Kessler et al., 1996). This translates into 19 adult individuals with SPMI per 1,000 total population.

Although comparisons of rates over time are fraught with diagnostic and other methodological pitfalls, the 12 to 19 per 1,000 rate contrasts sharply with prevalence surveys done in earlier years. For example, the 1958 Hollingshead and Redlich study of New Haven, Conn., one of the ECA study sites, reported a rate of 4.2 individuals who were being treated for schizophrenia and affective psychoses per 1,000 total population. Similarly, a census study of Baltimore, another ECA study site, found a rate of 7.1 individuals with psychosis or with psychotic traits, both treated and untreated, per 1,000 total population (Lemkau et al., 1942).

The most complete enumeration of severe psychiatric disorders ever carried out by the U.S. Census Office was done in 1880. Because of widespread fears at the time that insanity was increasing, census enumerators were given special forms and extra pay to identify all severely mentally ill people, including querying neighbors of the person in question. In addition, all 100,000 physicians in the United States were asked to report "all idiots and lunatics within the sphere of their personal knowledge," and over 80% did so. Insanity was classified by seven subtypes using definitions supplied by the New England Psychological Association. All duplication between the enumerator and physician lists was eliminated.

A total of 91,997 insane people were identified. Of these, 38,047 were in asylums, an increase of 115% in hospitalized insane since the 1870 census.

The prevalence of insane people, both hospitalized and living in the community, was 1.83 per 1,000 total population. In 1880, asylum superintendent Foster Pratt called that increase an "important and alarming fact...a great question of public health that demands careful study" (as cited in Grob, 1980). And yet the ECA study from 1980 reported a prevalence rate for schizophrenia and bipolar disorder that was almost 10 times higher than the 1880 prevalence rate.

Concern about increasing rates of severe psychiatric disorders in the United States dates back to the early 19th century. In 1817, for example, an unknown writer in the September issue of North American Review facetiously suggested that "instead of a hospital for the insane, this [proposed] establishment be exclusively appropriated to the use of the sane," since the sane would soon be a small minority. By 1833, one observer noted, "Insanity was once a rare occurrence" but "is no longer rare" (Fuller, 1833, as cited in Jimenez, 1987). State hospitals were built, despite substantial resistance from the taxpayers, at an increasing rate to accommodate the increasing numbers, but the hospitals were filled as quickly as they opened.

Dorothea Dix urged state legislatures to build more hospitals, and in 1840 the federal government added an enumeration of insane people to the decennial census.

Edward Jarvis, a prominent psychiatrist of the 1800s, presented a paper to his fellow asylum superintendents in which he asserted, "Insanity is an increasing disease" and that this "corroborates the opinion of nearly all writers" (Jarvis, 1852). In the January 1845 issue of North American Review, a review of I. Ray, M.D.'s, book A Treatise of Medical Jurisprudence of Insanity also noted the "great prevalence of the disease of insanity, and especially its remarkable apparent increase of late years." Between 1880 and 1887, an additional 15 state asylums opened. Most of the existing asylums had been enlarged, some multiple times. In 1870, there had been just two asylums with more than 1,000 patients each; by 1890, there were 17 such asylums, and by 1910 there were 75. Asylum superintendent William Godding, in an 1890 address to his colleagues, reflected on "the rising tide of indiscriminate lunacy pouring through the wards, filling every crevice, rising higher and higher until gradually most distinctions and landmarks have been blotted out." The increasing prevalence of severe psychiatric disorders, as measured by hospitalization rates, continued steadily until the mid-20th century. The increase was unaffected by World War I, Prohibition, the Great Depression or World War II. Much discussion took place, both among psychiatrists and among the lay public, regarding what might be causing the increase in insanity.

Proposed causes included genetics, increasing alcohol use, urbanization, industrialization, increased immigration and various concomitants of civilization that might have caused an overload on the brain. In 1916, North American Review called rising insanity "the Apocalyptic Beast" but reassured readers, "Let us be tranquil. The human race is not all going mad" (Harvey, 1916).

A century ago, rising insanity was a major public issue. Yet today, despite the fact that studies suggest the prevalence of severe psychiatric disorders is much higher than a century ago, the issue is never raised. Historians such as David Rothman (1971) assured us, "The rate of insanity in this country has remained constant from before the Civil War to the present," and this assumption, implicit or explicit, is included in every psychiatric textbook. Why did this important issue disappear? There are several reasons.

In the first half of the 20th century, the issue of increasing insanity was rendered irrelevant by beliefs in eugenics and mental hygiene. Insofar as insanity was caused by genetics, restricting reproduction and sterilizing psychiatric patients would solve the problem. Insofar as insanity was caused by bad parenting and early childhood experiences, education for parents and psychotherapy for those afflicted would solve the problem. Despite eugenics and mental hygiene, however, insanity continued to relentlessly increase. In 1953, Herbert Goldhamer and Andrew Marshall published Psychosis and Civilization, which claimed, "There has been no long-term increase during the last century in the incidence of psychoses of early and middle life." They further noted that their conclusion that no increase had taken place was consistent with psychoanalytic theories "that view the functional psychoses as resulting from repression of basic human drives." The conclusion of Psychosis and Civilization was subsequently widely quoted by textbooks of psychiatry despite the fact that its data appear to contradict the authors' interpretation of it. In an incisive analysis, William Eaton (1980) showed that the authors had used highly selective figures "to support the hypothesis that the rates have not changed." From the 1960s on, the question of increasing insanity was explained in sociological and Marxist terms. Michel Foucault's influential 1961 Madness and Civilization was followed by books by Andrew Scull, Rothman and a host of other writers who claimed that insanity had not increased. Instead, they said that the 19th-century insane asylums had been built to rid society of "the non-able-bodied poor" (Scull's phrase) or "the deviant and the dependent" (Rothman's phrase). Despite having no factual basis, these views have been remarkably influential. When one examines the historical records, it is clear that the asylums were built in response to the rising tide of insanity, that there was considerable resistance by taxpayers to building them, and that the individuals being hospitalized as insane were, in fact, severely mentally ill and not merely "the non-able-bodied poor." As Edward Shorter noted when discussing the Foucault-Scull-Rothman thesis in his book A History of Psychiatry (1997): "It is astonishing that this interpretation could have achieved such currency as there is virtually no evidence on its behalf." The final reason why there is no current discussion of the increasing incidence of severe psychiatric disorders is that reports from Scotland, England and Denmark in the 1980s indicated that the incidence of schizophrenia was in fact decreasing. Subsequent studies in Scotland found that the apparent decrease was due to diagnostic changes (Allardyce et al., 2000). Recent reports from Denmark (Tsuchiya and Munk Jørgensen, in press) and England (Brewin et al.,

2002) even suggest that first-admission rates for schizophrenia have increased in recent years. What, then, are we left with? We are left with an epidemic of schizophrenia and bipolar disorder that presently affects 4 million Americans, four times more than are infected with HIV. An epidemic that slowly kills by suicide 15% of those afflicted (Goodwin and Jamison,

1990) and that costs the nation over $110 billion each year in direct and indirect costs (Wyatt and Henter, 1995; Wyatt et al., 1995). An epidemic that is so insidious and ingratiating that it is barely noticed, an invisible plague. An epidemic that increased as much as 10-fold over the last century and that appears to still be increasing. Dr. Torrey is executive director of the Stanley Medical Research Institute and co-author of The Invisible Plague: The Rise of Mental Illness from 1750 to the Present, on which this article is based.

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* * *

Anti-MMR Supporters Criticise Research

An expert on autism has been criticised by campaigners for saying new research has been unable to find a link between the condition and the MMR jab.

In a wide-ranging discussion at the International Science Festival in Edinburgh last night, consultant in paediatric neuro-disability, Dr Paul Gringas, said about 30% of children with autism would develop normally for a period and then show signs of a condition known as regressive autism.

He said: "It is extremely understandable that we are going to look at whatever was being used by the child at the time and the MMR jab is normally given at 13 months.

"But autistic regression has been well described for at least 20 years before MMR was ever used."

During the wide ranging discussion, Dr Gringas said there had been a steady global rise of autism over the past 30 years, with one in every 175 children now affected.

But the expert from Harper House Children's Services in Hertfordshire said he believed the rise was down to more efficient diagnosis and a broader definition of autism.

Science in detecting the condition had improved, he said.

He cited research which showed abnormal head or brain growth early after birth was detected in 90% of autism cases, while further studies had picked up early signs of the condition in children as young as one year old.

Although dubious about the MMR link, Dr Gringas, addressing an audience of about 100 parents, experts and other interested parties, said there appeared to be a connection between bowel problems and the condition.

He said: "Bowel problems are more common in children with autism but the rate of these problems are no higher between children who received the vaccine and those that didn't."

But protesters who argue that there is a link between the vaccine for measles, mumps and rubella and autism, said his presentation had been "one-sided".

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Study of Possible Link Between Measles Vaccine And Autism Funded

The M.I.N.D. Institute at U.C. Davis in California has awarded Glenn F. Rall, PhD, a member and noted scientist at Fox Chase Cancer Center $189,000 to study whether a link exists between the measles vaccine and the development of autism.

“Few believe that the vaccine directly causes a child to develop autism,” Rall says. “However, we have an obligation as scientists to investigate this disease and any of its possible causes.”

Recent reports have fueled a debate within both medical and parent communities concerning the safety of childhood vaccines and their possible link to autistic spectrum disorders (ASD).

“However,” says Rall, “if such a link exists, it is not well defined. It is imperative that this issue be resolved, either leading to the development of safer vaccine alternatives, or reassuring parents of the safety of childhood vaccines.”

Rall and his colleagues at Fox Chase Cancer Center will be using transgenic mouse models, that is, mice that are genetically engineered to be susceptible to measles virus infected in the brain. They will explore the hypothesis that the immune response of a newborn mouse is directly influenced by the exposure history of its mother. “Neonatal mice that nursed on unexposed mothers cannot resolve the infection,” he says. “In contrast, we’ve found in our preliminary research that newborn mice nursed on mothers who were previously exposed to measles were protected from central nervous disease, suggesting that the maternal exposure history afforded protection to her offspring,” Rall says. In some mice however, previous maternal exposure to measles leads to an absence of an appreciable immune response, which Rall and his colleagues believe may indicate a novel form of tolerance.

Autism is a neurological disorder that strikes one in 500 children, according to the National Institute of Child Health and Human Development. Autism ranges significantly in its severity, and is characterized by dysfunction in areas of language, social interaction and behavior. The condition is four times more likely to occur in boys than in girls, and is often diagnosed between the ages of 18 to 30 months, during the same age that children in the United States receive the typical battery of 21 vaccinations.

“Not enough definitive research exists to prove or refute a link between the measles vaccine and the subsequent development of autism in a child. However, the powerful anecdotal evidence from parents demands an answer that can only be ascertained through credible research,” says Rall.

Rall points out the remarkable benefits of vaccines for most children and he remains a strong advocate for their use. When children are not vaccinated, they are left vulnerable to potentially fatal diseases. According to the National Coalition for Adult Immunization, measles virus continues to be a significant cause of mortality worldwide, resulting in over a million deaths annually, many of which could be prevented by vaccination.

Rall, an expert in viruses of the central nervous system, has been working in the virology and immunobiology laboratories at Fox Chase Cancer Center since 1995 where he investigates the causes and mechanisms of central nervous system diseases. In addition to his current work with the M.I.N.D Institute, he has also worked with The F.M. Kirby Foundation, investigating Lou Gehrig’s Disease. He received his Ph.D. in 1990 from Vanderbilt University in Nashville and has authored many scientific publications as well as being the recipient of numerous awards and grants.

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Brain Cells May Treat Parkinson’s

Transplant of patient’s own cells cleared up symptoms

The Researchers believe they isolated and nurtured adult stem cells from the patient’s brain, cells that they re-injected to restore normal function.

“We definitely need to do more studies,” said Dr. Michel Levesque of the Cedars-Sinai Medical Center in Los Angeles, who led the study. “This is the first case that shows a promising technique may work. It is an experimental procedure and has to be investigated further before it becomes accepted procedure.”

More than two years after the experimental treatment, the man has no symptoms of Parkinson’s, an incurable and fatal brain disease that starts with tremors and ends up incapacitating its victims.

Parkinson’s is caused when brain cells that produce dopamine die off. Dopamine is a key neurotransmitter or message-carrying chemical that is involved in movement.

Stem Cell Research

Many different groups of researchers are experimenting to see if these brain cells can be regenerated using stem cells, the so-called master cells that give rise to the various different tissues in the body.

Some stem cells come from very early embryos, some from aborted or miscarried fetuses and some can be found in a person’s own tissues, but they are elusive.

The study is sure to be used in the debate over the use of embryonic stem cells. Some groups say adult stem cells can be as useful as those taken from embryos. Many scientists disagree and say both adult and embryonic stem cells should be studied.

Cells Removed From Patient’s Brain

Levesque said the patient, a nuclear engineer and jet pilot, developed Parkinson’s in his 40s. He had tremors and stiffness in his muscles and the drugs used to treat the disease had, as they always do, stopped working.

His team drilled into the patient’s skull and removed a piece of his brain. “We took a tiny piece of cortex measuring probably less than the size of a pea,” Levesque said in a telephone interview. “What we extracted were neural stem cells or progenitor cells.”

It is hard to tell whether a cell is a stem cell, but they grew the cells in special media, a kind of nurturing soup.

They checked to make sure at least some of the cells were producing dopamine, and then injected them back into the patient’s brain, researchers told a meeting in Chicago of the American Association of Neurological Surgeons.

Increase In Dopamine

PET scans of the man’s brain, which show brain function, showed that dopamine was being produced and used. “At three months there was a 58 percent increase,” Levesque said.

But now the man’s dopamine production, as measured by PET scans, is back to where it was when he was first treated, which puzzles Levesque, as the symptoms of Parkinson’s have not returned.

He said it is possible that it takes a while for the symptoms to show after dopamine production dies down. Or perhaps PET scans do not show everything that is going on.

Other cells may also be involved in the processes that underlie Parkinson’s, Levesque said.

It is also possible that the animals used to study Parkinson’s do not accurately mimic the human disease, so that humans may react differently to treatment, he said.

Although the Phase I safety study was done using only the single patient, Levesque said the U.S. Food and Drug Administration had given his team the go-ahead to start a Phase II trial, which will include more patients and test for safety and whether the treatment works.

Levesque and colleagues formed a company to develop the technique, called Neurogeneration. It has been bought out by California-based CelMed Bioscience, a subsidiary of Canada-based Theratechnologies. © 2002 Reuters Limited.

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* * *

A Look at Hyperlexia, The Compulsion to Read

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"We have these flashcards," explained his mom Janine, and "he just out of the blue pulled them out, and he started saying some of the words … It was amazing."

Likewise, at 3 1/2 years old, Kyler can read just about anything his mother Alma puts in front of him. He taught himself the letters, numbers and shapes without any help. While lots of children are fascinated by cars, Kyler focused on the lettering, pointing out car names and license plate details.

Most parents would have been proud of their child's incredible intellectual gift. And at first, Jimmy's and Kyler's parents were. But they soon discovered that their boys' astounding fluency for shapes and numbers was shadowed by problems.

Their dazzling ability to read is in fact a rare syndrome called hyperlexia, which means excessive reading. The illness, which affects mostly boys, is so unusual no one is sure how many kids it affects. It is accompanied by significant delays in language, and an inability to interact normally with others. Some who are affected with hyperlexia also suffer from autism.

A Physical Need

When Kyler turned 2, his mother realized that his desire to read voraciously was not a choice he made.

"It seemed like an obsession for him," said Alma. "Basically he ignored his environment and he would just look at signs and letters … He was not interested in associating with other people."

For Jimmy, too, his reading ability had serious drawbacks. "He wouldn't do anything that didn't have to do with letters and numbers," said his mother.

Margie, another mother of a hyperlexic child named Alex, remembers when her pride turned to concern. One Thanksgiving, Alex was so absorbed in a book that he refused to join the family.

"It wasn't just something that he wanted to do. He had to do it," said Margie. "It was like a physical need for Alex, that he had to decode things in order to be calm and happy."

Alex, now 10, can read from a college textbook with ease — even if it's turned upside-down. But he doesn't understand what he's reading.

Typical children, explains Phyllis Kupperman, director of the Center for Speech and Language Disorders in Elmhurst, Ill., learn the meaning of language before they can read words. "Children with hyperlexia do it the opposite way. They learn to read the language first, and then later on they learn what those sounds and words mean."

Using Words For Treatment

Kupperman has found that the reading skill in itself can be an essential pathway into the minds of hyperlexic kids.

"It's all that they can do at that time," she says, "and it's our job then to use that reading skill to get them to do the things that other kids learn to do at two, and three and four."

To help Kyler learn how to communicate with another child, for example, Kupperman writes out sentences for him to read and use. At first, Kyler pays attention to the written words — and not to the other boy. But ultimately Kyler grasps the give and take of the conversation, and learns to communicate directly without reading.

As hyperlexic children get older, other kids catch up to them in reading, but the confusing emotional swirl intensifies. The social gap between them and other children grows.

"For instance, if we go swimming at a public pool, Alex very much wants to play with the other kids," says his mother Margie. But Alex's inability to express himself leaves him feeling isolated. "All of a sudden, the kids move away from him, and he doesn't know what to do about that."

Far more fluent in writing than in speaking, Alex uses the computer in therapy to try to express himself. But for the time being, Alex's best friends are the cookbooks he devours wherever he is. Margie remembers going to a parent support group, where parents said what their goals for their children were. When it was her turn to speak, she says, "I said, 'I just want Alex to be able to talk to me. That's all.'"

* * *

Come Back Jack 2002: Award Winning Documentary

An update of the award-winning, nationally broadcast documentary 'Come Back Jack', which is currently airing on PBS stations around the United States (through American Public Television), the Knowledge Network in Canada, Discovery Europe, and Israeli Television will be broadcast on more than 100 PBS stations this spring and summer.

Narrated by Jack's father (Robert Parish), this hour-long sequel chronicles the therapeutic journey (from 1999-2001) of young Jack Parish, who was diagnosed with Autism in 1996.

'Come Back Jack 2002' features interviews with three experienced interventionists (Dr. Arnold Miller, Eileen Eller-Miller and Dr. Paul

Callahan) at the Language and Cognitive Development Center in Boston, where Jack and has received treatment and guidance during the last several years. Also included in the program are interviews with Jack's siblings (Graham, Ryan and Courtney), his mother, Diane, and Bobbi Thies, Jack's instructor at a therapeutic riding program in Cincinnati. The documentary also explores the sometimes-devastating effect of divorce on special children.

For broadcast dates and times in your area, please check your local listings.

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APRIL 21, 2002 - 12 Noon to 5pm

THIRD NATIONAL AUTISM AWARENESS RALLY:

"The Power of ONE! I.D.E.A."

FREE and OPEN TO THE PUBLIC

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FEAT'S "Night of Caring" April 27

Sacramento FEAT is holding its' 9th Annual "Night of Caring" Dinner and Auction fundraiser on April 27, 2002. If you have been helped by the FEAT and the Daily Newsletter and would like to show your appreciation you can by supporting our fundraiser. Make an auction contribution or sponsorship donation. Please call 916-843-1536 for more information. Thank you.

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