NS dirty secret = produce many crazies in our population

Schizophrenia and Stress

A Diverse Illness
Given similar treatments, some patients with schizophrenia recover completely; some are able to work and have families. However, more than half experience some degree of disability throughout their lives, while an additional 25% require lifelong care. It is not clear what accounts for these differences. One answer may be stress. Researchers suspect that stress worsens the course of illness by increasing the body's production of a substance called cortisol, which can damage an area of the brain called the hippocampus.

There is a growing body of evidence supporting the idea that stress and schizophrenia are closely linked.(16) One groundbreaking study found that 46% of patients who experienced their first bout of schizophrenia underwent some stressful life event in the preceding three months.(17)(18)

The Effects of Stress on the Body and on the Brain
Medical scientists have demonstrated that stress can cause physical damage to the brain. Although schizophrenia is not the only illness that is connected to stress, the so-called "stress cascade" appears to play an important role in schizophrenia.

The stress cascade begins with the release of certain hormones in the brain. This release, in turn, triggers physiological effects that make your heart work more, shunt blood away from the digestive system and set up the "fight or flight" reaction, a state of high arousal, increased vigilance and excessive levels of cortisol.(19)

Combat veterans with PTSD suffer a loss of hippocampal volume. In fact, there is a direct link between how these veterans perform on standard memory tests and the size of their hippocampus.

Stress and cortisol have been shown to damage -- and even destroy -- nerve cells in the hippocampus, which plays an important role in memory. These elements of the stress cascade -- excessive cortisol production, damage to the hippocampus and impairment in certain types of memory related to the hippocampus, all occur commonly in patients with schizophrenia.(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)

Research has shown that patients with schizophrenia have smaller hippocampal volumes than people without the disease.(31)(32)(33)(34)(35)(36)

This is backed up by studies that have found that individuals with schizophrenia suffer from problems in areas of brain functions that are associated with the hippocampus, such as memory and the ability to coordinate and carry out tasks.(37)

Stress, Cortisol, Memory and the Hippocampus
A number of studies in the last several years have confirmed a strong connection between stress, high cortisol levels, damage to the hippocampus and memory. This connection shows up across a wide range of human medical conditions, including post-traumatic stress disorder (PTSD), Cushing's disease, overexposure to steroid drugs, aging and depression.

For example, combat veterans with PTSD suffer a loss of hippocampal volume. In fact, there is a direct link between how these veterans perform on standard memory tests and the size of their hippocampus. Adult survivors of childhood abuse also have both smaller hippocampi and impaired memory. Problems regulating cortisol production ("cortisol dysregulation") and small hippocampal size are also common in depression.(38)

Chronic stress by itself seems to cause wear and tear on the brain. Cortisol levels increase with age and studies have shown shrinkage of the hippocampus and memory impairment even in healthy older people.

Cushing's disease is an illness that causes the body to make too much cortisol. Patients with Cushing's have memory problems that can actually be reversed when the disease is successfully treated.

Finally, both healthy research subjects who take medications that resemble cortisol, such as prednisone, and patients who take these medications for medical reasons, demonstrate these same reversible memory problems.

New Possibilities for the Treatment of Schizophrenia
Cognitive deficits such as problems with memory are a major component of schizophrenia.(39)(40) If these problems are related to the stress cascade, as they seem to be, then the exciting possibility exists that reducing stress may be an effective way of treating the disease.(41)

Not only may stress management techniques prevent the onset or lessen the severity of schizophrenia, delay relapse in those already ill and reduce overall anxiety, (42)(43)(44)(45) but studies indicate that cells within a damaged hippocampus can regenerate when stress or cortisol is reduced.

There are also several drugs with good safety records that seem to prevent stress-induced damage to the hippocampus. These include tianeptine, 46 an anti-depressant, and phenytoin (sold under the brand name Dilantin®) which is used to treat seizures (epilepsy).

Conclusion
Stress has long been suspected as a player in the onset and course of schizophrenia. And, although the precise details of the relationship between the two remains poorly understood, there is extensive and consistent research linking stress, cortisol regulation, the area of the brain called the hippocampus, as well as memory and other brain functions in schizophrenia.

Because schizophrenia is a group of varied disorders, not one disease, and because there is unquestionably a genetic component to the disease, stress may well be a more important factor in some cases of schizophrenia than in others.

Nevertheless, a better understanding of how stress may affect the onset and course of schizophrenia is likely to lead to the development of newer and better treatments, including more effective drugs, for the devastating and, up to now, relatively untreatable cognitive problems that are one of the chief effects of this terr