Posted by med_empowered on August 1, 2005, at 4:14:36
In reply to why the heavy caffiene use in schitsophrenia then?, posted by linkadge on July 31, 2005, at 20:33:46
high! Its long been known that those with schizophrenia have a tendency to consume MASSIVE amounts of caffeine (above 1,000mgs/day, or 10 or more cups, is pretty common) and they have a tendency to smoke...A LOT (I believe the average for someone with schizophrenia is a little over 2 packs daily, so 40 cigarettes or more a day). These tendencies are also found in those with bipolar disorder, but they aren't quite as common. Anyway, the best theory I've heard on this is that caffeine and nicotine are used to regulate the dopamine weirdness that accomapnies schizophrenia. Although the dopamine hypothesis of schizophrenia is pretty weak, this particular theory, I think, makes sense. Basically, since dopamine regulates so much related to drive and focus and well-being, caffeine and nicotine are consumed to kind of regulate dopamine weirdness...this may also be why those with schizophrenia have a tendency to abuse stimulants (cocaine, amphetamines) and pot rather than heroine, PCP, LSD, etc. Some people with schizophrenia may actually have less dopamine overall than a non-schizophrenic; that being the case, it makes sense to re-regulate the system by pumping it full of dopamine. It also (presumably) helps with the amotivation, flatness, apathy, and crushing depressive episodes seen in schizophrenia/schizoaffective disorders. When you factor in the heavy-handed use of neuroleptics, especially high-dose conventional antipsychotics, this behavior makes even more sense; caffeine and nicotine (and other stimulants) help to cushion the anti-dopamine effects of neuroleptics. Unfortunately, they also can screw with blood levels of the drugs--caffeine raises neuroleptic levels, nicotine lowers them-- but they offer some temporary relief. This kind of hints at a much more complicated, nuanced view of dopamine's role in schizophrenia than the oversimplified "schizophrenics make too much dopamine" view offered in the classic dopamine hypothesis. This more nuanced view is also behind some newer drugs for schizophrenia--particularly Abilify, which functions as a dual dopamine antagonist/agonist (and has similar effects on serotonin, as well). Apparently, the "next-generation" schizophrenia meds will probably be more Abilify-like than, say, Zyprexa-like in their dopamine actions. More meds will probably be used as well...Provigil, for instance, has been used in a couple of trials as an add-on for schizophrenia, with the hopes that it will help improve attention, motivation, and emotional expressiveness. It does help some people, but it can also make psychotic symptoms worse, so right now its a mixed bag.
poster:med_empowered
thread:535711
URL: http://www.dr-bob.org/babble/20050728/msgs/536290.html