Most days, Sam wanders the streets. He has no home or job, and doesn’t attend school. He owns only one set of clothes, which are tattered and torn. Without work he has little money; but what he gets, he squanders. He has difficulty retracing his steps, and is unable to discern one day from the next. But in Sam’s mind, he leads a normal life.
In his mind, he’s studying to become a detective. He thinks he has a close group of friends, but actually they’re illusory voices with whom he interacts. To Sam, the life he lives inside his head is much more real than the one he lives outside of it. Anyone who tells him otherwise is out to sabotage his plans.
Sam’s name has been changed, but his story has not. Sam is schizophrenic – a condition characteristic of intense paranoia, compromised cognition, auditory delusion and reduced social functioning. It afflicts one in every 100 people in all communities the world over. The causality of this neurological disorder is not well recognized, but its name very much is.
The complexity and prevalence of this condition has sparked the interest of Michael Minzenberg, MD, a UC Davis assistant professor of clinical psychiatry. He has devoted much of the last 10 years of his professional career to understanding its pathology.
For his work as a physician scientist, he is now the recent recipient of a 2009 Doris Duke Charitable Foundation Clinical Scientist Development Award, which will help further fund his progressive research that seeks to evaluate treatment for schizophrenia, and more specifically, understand the neurochemical mechanisms that regulate the negative cognitive, emotional and social functioning processes associated with it.
“It’s a fascinating condition that can lead to great insight about the brain and how it works,” he said. “Ultimately we want to understand which brain system is modulating schizophrenia for both an understanding of the disorder and the efficacy of medication.“
Minzenberg was nominated by UC Davis officials after an application process, and then selected as one of only 14 physician-scientist recipients nationwide. As a member of the laboratory for Translational Cognitive and Affective Neuroscience (TCAN), he will earn $135,000 per year for three years for his research.
“The workings of psychiatry and brain function has traditionally been a black box,” said Jong Yoon, M.D., Assistant Professor of Clinical Psychiatry and member of the TCAN laboratory. “Our research is trying to unpack that black box.“
There are many symptoms associated with schizophrenia which may be present or absent to varying degrees in those who suffer from the disorder, explained Peter Yellowlees, M.D., UC Davis Professor of Psychiatry and Behavioral Sciences.
These include “positive” symptoms – hallucinations and illusions – most associated with schizophrenia that are thought to be a product of “cell malfunction,” he said. Then, there are “negative” symptoms, which are thought to be associated with “cell loss and decay.” These are much more difficult to assess and treat.
Minzenberg is most interested in the “negative” cognitive symptoms associated with the disorder – disorganized thinking, difficulty understanding and expressing thoughts, poor concentration and memory.
“Medication is the mainstay of treatment for schizophrenia,” Minzenberg said. “But these drugs do not effectively treat the cognitive problems. They are the single most unmet symptom.”
Minzenberg’s award will help fund his efforts to assess the effects of acute and sustained doses of modafinil on the cognitive symptoms in schizophrenics. Modafinil is a mild stimulant thought to induce the neurotransmitters dopamine and norepinephrine, which are crucial components to attention and memory function.
The drug is relatively new, and not traditionally used to treat schizophrenia, but by performing functional magnetic resonance imaging (fMRI), which, simply, looks at the brain while it works, his research will assess the drug’s impact on the prefrontal cortex, the area of the brain that moderates actions associated with correct social behavior.
“This type of study between sustained versus acute treatment using fMRI technology has not been seen in psychiatry,” he said. “It may lead to an eventual understanding of the underlying pathology of the condition, which hopefully will have bearing on how to optimize treatment for schizophrenia.“
DAVID LAVINE can be reached at firstname.lastname@example.org.