London, 10th January (pm)

The first Schizophrenia Commission event was held at The Imperial War Museum on 10 January 2012. Below you will find material from the afternoon session including presentations from our speakers.
You can also see material from the morning session, which includes videos of our lived experience speakers.

Afternoon speakers:

Professor Mike Owen – Rethinking causes and concepts.

Professor Owen talked about the latest research on the genetics and serious mental illness. He covered the problem of traditional psychiatric classification, the role of genes in schizophrenia alongside other factors, critique of the neuro-developmental hypothesis, need a much better understanding of mechanisms when looking at causation.

The fundamental causes (Genetic and Environmental) and mechanisms remain unknown. Brain develops in response to the environment and connections between neurons are established by experience.

Professor Mike Owen presentation

Dr Craig Morgan – The social origins of psychosis.

Dr Morgan presented data exploring social factors that are involved in the development of psychosis experiences. He covered variations in incidence rates by urbanicity and ethnicity. Presented data on increased risk through cannabis use as well as isolation, disadvantage, threatening events such as witnessing violence or victim of crime, childhood poverty and disadvantage and childhood trauma.

Evidence is starting suggest that for some people, social experiences and adversity over the life course is key to understanding the development of psychosis. Yet there is still need for a better understanding of the mechanisms that lead to the experiences of psychosis. Adversities tend to cluster, we need to begin to disentangle these factors.

 

Dr Craig Morgan presentation

Professor Richard Bentall – From social causation to symptoms: What we know about mechanisms

Professor Bentall began by highlighting the convergence of understanding psychosis in recent years;

There has been considerable dispute about the concept of schizophrenia over the years and arguments about whether the concept is useful. But the important point is that this is not to dispute that there are people that have severe psychiatric difficulties. The argument is about classification, not about whether people have difficulties.

He has written widely about social adversity and mental illness talked about some of the mechanisms that lead to symptoms of psychosis and how these risk factors help explain the social risk factors for psychosis. Their research group looked at early trauma and psychosis:

We found a significant association between trauma and psychosis across all different research designs (patient-control studies). Averaged across the studies, the population attributable risk (proportion of people who would not have become psychotic, had the risk factor not been present) was 33% (range 15% -48%). How big is the effect? In the UK, this is about 160,000 people who either have been or will be diagnosed as suffering from schizophrenia or a related condition during their lifetime.

Focusing upon mechanisms – the role of emotion and cognition was explored. In conclusion Professor Bentall emphasised:

It is possible to construct convincing scientific accounts of symptoms which apply across diagnostic boundaries. (Adding diagnoses to the models does not improve them!)

For more information please look at the accompanying slides:

Professor Richard Bentall presentation

Professor Jim Van Oz – The Schizophrenia industry: Industrious for sure – but has it helped?

Professor Van Oz talked about fuzzy typologies and how there is psychosis in the general population outside of psychotic disorders. He introduced the network concept to understanding psychosis – as well as directing treatment.

The experience of psychosis is embedded in daily life and social context.

The genes – environment question was addressed with a call for the natural sciences and the social sciences to join forces to understand complex aetiology of psychosis. Conclusions included how psychotic disorders are fuzzy sets requiring dimensional representations and a need for care network following a network model of symptoms should be progressed to informFor mental health, we know that social experiences shape the expression and course of symptoms treatment decision making.

Professor Jim Van Oz presentation

Dr Diana Rose – Psychosis; Inside out? Outside in?

Dr Rose spoke from a personal perspective of experiences of psychosis – but not schizophrenia- and as a service user researcher.  The presentation looked at the problems of a reductionist diagnosis;

The concept of schizophrenia is not only conceptually flawed, it is ethically flawed…research reveals that the diagnosis of schizophrenia is seen as particularly excluding and totalising[by people living with the diagnosis]

Dr Rose also gave examples of why complexity of genes x environment is so central in mental health;

There are various ways in which a persons’ genomic constitution interacts with the environment (plasticity, psychological level) and the environment can impact on the expression of genes throughout [a persons life]. Genes and the environment collide… Social experience shapes the expression of genes and the course of symptoms.

And how the issue of medication has come up in every focus group Dr Rose has ever conducted – regardless of the topic guide and research focus.

Why do we call them side effects – they are all effects?  Medication used for symptoms of mental illness have many effects – some help, some do not. We need to think about how people are using medication…research shows that psychiatrists are not as good at prescribing medications as they need to be.

Dr Rose asked that some research resource which currently goes into translational research should be diverted to helping society be more tolerant of differences. The barriers people face with schizophrenia and psychosis far exceed their symptoms of illness but rest also in peoples’ reactions to it.

There needs to be a commitment to changing the lack of caring in our society and the intolerance to experiences of people diagnosed with schizophrenia. We are being told that more care is going into the community, but actually we are seeing more and more cuts. We need to be more vocal.

 

Dr Diana Rose presentation