A therapy for cognitive decline in schizophrenia
Neuroplasticity is the answer to cognitive decline in chronic schizophrenia
Its been many years of research into neurophysiology of memory. Many receptors like GABA, dopamine, acetylecholine, NMDA, epinephrine and glutamate affect memory in some way or the other. Long term potentiation of nerves is desirable to use our brains (in a layman’s language). It has long been known that the ‘kainate’ receptors potentiate glutamate expression in the brain to form new connections that stay. An excited neuron that keeps firing and rewiring electrical connections is a neuroplastic neuron. Glutamate plays a key role in neuroplasticity. It triggers the hyperpolarization of neurons.
In people suffering from schizophrenia, a higher functioning of NMDA receptor and reduction in glutamate in prefrontal cortex, also increased dopamine has been found to have an etiological consequence. Those who have depression or disuse atrophy of brain succumb to schizophrenia with firing of neurons in the primitive brain that cause urges and chaotic thinking that may not compromise memory but it will be a memory of hallucinations, delusions. We are doomed without learning, and thinking. Many compensate by simply doing something deliberately to not lose their mind. I would like to call it a flaccid and non mindful brain that predisposes to schizophrenia.
Too much of glutamate is also toxic because it results in excitatory chaos in the brain and the thinking in such situations becomes erratic. Like what too much caffeine does to the brain. Glutamate surge is found in acute onset schizophrenia but in long established disease, glutamate transmission is reduced.
There exist several neuroplasticity enhancing models of guided thinking that have helped many schizophrenics actually recover, supplementing the potent drugs that have been discovered for the cause. Sometimes a therapist listens to your jargon and makes you question things to think straight. It is very hard for the schizophrenic who keeps returning to the same type of thinking. Many years of sustained therapy is the answer towards recovery. For example, the paranoid schizophrenic might think that she is some Hollywood’s actress and people are her fans. Wherever she goes, she creates a sensation, (I saw such a patient during my psychiatric posting in my medical college). The therapist may want to bring her out of this delusion in the following manner: She may first console the patient by acknowledging that she is beautiful and tell her that Brad Pitt just discovered the beauty in her. Then bring her to places where she feels people are watching in awe. Then after such a delusion, everyday start involving her into spirituality and teach her in a graded manner about what it means to find God more than the beauty maintenance of a Hollywood sensation. Teach her that if you want to maintain your position and fanfare, you need to follow a routine, abide by it, like bathing and cleansing. Teach her self actualisation and help her to become really selfless and concentrate on other people. See how they look, eat, drink, dance and more. Train her to become thought conscious, start writing her thoughts for her fans. With years of such interventions, the schizophrenic lady starts to question her belief pattern and starts to look at her reality and is really cured.
But its not easy without the glutamate!! To bring her back, drugs, counseling and diet, all work together. Glutamine rich diet is the need. Glycine crosses the blood-brain barrier easily. It makes her learn a lot, read and reflect a lot to recover from this devastating illness. Thus, glutamine supplements help glutamate transmission in prefrontal cortex and reduce cognitive decline.
A balance between glutamine rich and poor diet must be obtained. Experiments in mice have shown promising results with glutamine supplements. But a diet containing eggs, poultry, dairy products, tofu and white rice, fish is glutamine rich and if prescribed in moderation can help schizophrenics especially in terms of their cognition.
Overall cutting down on sugars, high fibre diet, fruits and vegetables should be consumed by everyone but for schizophrenics, it is important to intake some glutamine also.
As therapists, holistic health proponents can really help people recover from schizophrenia with precise tailor-made interventions. It is no longer devastating to live with this disease especially for the grieving families of schizophrenics.
