WHAT comes to mind when you hear ‘schizophrenia’? Hallucinations and delusions? Cognitive impairment? Feeling withdrawn from everyone around you? Apathy? With all the above being symptoms of this mental disorder, and with 1 in every 100 people affected, each individual’s life becomes a relentless battle, struggling with habitual activities, social interaction, and general wellbeing and self-care.
Current treatments help to reduce the severity of symptoms and allow patients to maintain a more functional daily life. However, antipsychotic medications, which are typically required lifelong, are not guaranteed to work for all schizophrenia patients, with only about 4 in 5 people benefitting usually.
Advances in scanning have allowed researchers for the first time to show lower levels of a protein found in the connections between neurons in the living brains of people with schizophrenia.
The researchers, who conducted the scans at the psychiatric imaging facility at the MRC London Institute of Medical Sciences, say these changes could underlie the cognitive difficulties seen in schizophrenia and provide targets for research into new treatments.
Synapses are the junctions between neurons. Neurons communicate across the synapse via neurotransmitters; chemicals that transmit the nerve signal.
Researchers investigated the relationship between synaptic density and schizophrenia, questioning whether a reduction in these brain connections is present in schizophrenia and whether they result from treatment with antipsychotic drugs.
The study was inspired by findings from previous post-mortem studies that demonstrated synaptic reductions in the brains of schizophrenia patients compared to healthy controls.
Measuring synaptic protein levels in living patients was not possible before the development of a new PET (Positron Emission Tomography) radioactive tracer that binds to a specific protein associated with synapses. Being “one of the first centres in the world” to have access to this, Professor Oliver Howes, Head of the Psychiatric Imaging Group at the MRC LMS, and his team grasped this opportunity to investigate synaptic loss in schizophrenic brains through the synaptic marker protein SV2A, which is found on the nerve terminal preceding the synapse and is involved in regulating neurotransmitter release.
The team found lower levels of SV2A in the brains of schizophrenia patients, indicating a reduction of synapses. Certain areas exhibited significantly lower levels, such as the frontal cortex which coordinates use, recall and processing of memory, planning complex cognitive behaviour and personality expression. These findings were supported by the understanding that these areas are associated with some of the major cognitive impairments seen in schizophrenia, thus providing a potential clue that synaptic loss may underlie these problems.
But to test whether the loss was a result of the illness or in fact due to treatment, a preclinical study was conducted in rat models investigating the effect of antipsychotic drugs on the levels of SV2A. They found that the antipsychotics did not contribute to the synaptic loss seen in schizophrenic patients, thereby reinforcing their overall findings.
So, what does this mean for the development of schizophrenia treatment?
If the synaptic loss is an underlying key contributor in the disease, further research into the mechanisms could lead to exploring ways to prevent this loss. Moreover, since microglia, known as the immune cells of the brain, play a role in mediating synaptic pruning, there is also potential to target microglia and see if it could introduce a way of preventing excess synaptic loss; an investigation that the team have already begun.
“The human brain, with its approximately 100 trillion synapses, is an extraordinarily complex organ,” says Dr Ellis Chika Onwordi of the Psychiatric Imaging Group and first author of this study. “Having the means to characterise the distribution of these synapses in the living brain, and to find differences in synaptic distribution between patients with schizophrenia and healthy controls, represents a significant advance in our ability to study the neurobiology of schizophrenia.”
Professor Oliver Howes, who led the study, said: “Our current treatments for schizophrenia only target one aspect of the disease – the psychotic symptoms – but the debilitating cognitive symptoms, such as loss of abilities to plan and remember, often cause much more long-term disability and there’s no treatment for them at the moment. Synaptic loss is thought to underlie these symptoms.
“Our lab at the MRC London Institute of Medical Sciences is one of the few places in the world with this new tracer, which means we’ve been able for the first time to show there are lower levels of a synaptic protein in people with schizophrenia. This suggests that loss of synapses could underlie the development of schizophrenia.
“We need to develop new treatments for schizophrenia. This protein SV2A could be a target for new treatments to restore synaptic function.”
The people with schizophrenia who were scanned had all received antipsychotic medication, so the researchers wanted to exclude this as a factor in the synaptic dysfunction. They gave antipsychotic drugs, haloperidol and olanzapine, to rats for 28 days and found it did not affect the levels of the protein SV2A.
Professor Howes said: “This is reassuring as it’s suggesting that our antipsychotic treatments aren’t leading to loss of brain connections.
“Next we hope to scan younger people in the very early stages to see how synaptic levels change during the development of the illness and whether these changes are established early on or develop over time.”
People urged to remain vigilant as COVID-19 cases continue to rise in Ceredigion
A SIGNIFICANT increase of COVID-19 cases has been seen across Ceredigion lately.
Between 3 and 9 September 2021, Ceredigion saw the third largest increase of all Welsh Authorities, where the incidence increased by 132.1 cases per 100,000 compared to the previous 7 days.
There is a real concern regarding the number of cases amongst people under 25 years old who continue to be the age group with the highest number of cases – in the last 7 days, this accounted for 859.8 cases per 100,000 in Ceredigion.
We are also seeing a slow increase in the number of cases amongst people aged 60 and over.
There is also evidence of household transmission, so if someone is self-isolating in your household, make sure that you can keep as much social distance as possible, maintain good hygiene and keep your home well ventilated.
It is never too late to get your vaccine, this will give you the best protection against the virus as we look ahead to winter.
Following a Welsh Government announcement this week, the vaccine will now be offered to 12-15 year olds in Wales. More information can be found here: https://gov.wales/written-statement-covid-19-vaccination-jcvi-chief-medical-officers-advice-vaccinating-12-15-year. Further information will be available shortly regarding the rollout in Ceredigion.
An autumn booster vaccine will also be offered to certain groups over the next few weeks. The booster vaccine aims to reduce the incidence of COVID-19 and maximise protection in those who are most vulnerable to serious infection. The booster vaccine will be offered initially to people living and working in care homes and frontline health and social care staff. Those who are eligible for the booster vaccine will be invited to attend a vaccination centre shortly. More information can be found here: https://gov.wales/written-statement-covid-19-vaccination-jcvi-announcement-autumn-booster-programme
If you develop any symptoms, self-isolate immediately and book a test via https://gov.wales/get-tested-coronavirus-covid-19 or by calling 119.
The main symptoms include a high temperature, a new continuous cough and a loss or change to smell or taste. You should also be mindful of symptoms including a sore throat, runny nose, headache, tiredness, shortness of breath, vomiting, diarrhoea and generally feeling unwell.
The COVID-19 vaccine offers you protection but also offers greater protection for your loved ones and our communities. Getting vaccinated saves lives.
Even if you’ve been double-vaccinated, please be respectful of others by washing your hands regularly, wearing a face mask where needed and keeping a social distance from other people.
By following these good practices we can all do our bit to keep Ceredigion safe.
Almost 22,000 Virtual Consultations carried out with patients over past 12 months
A STAGGERING 21,685 consultations have been carried out virtually between medical staff and patients during the past 12 months in Carmarthenshire, Ceredigion and Pembrokeshire.
As part of the Welsh Government’s response to COVID-19, TEC Cymru and partners established the NHS Wales Video Consulting (VC) Service that provides safe access to healthcare online. The service is utilised across all health settings in Wales, including pharmacies, prisons, opticians, and dental practices.
Clinicians and patients in the Hywel Dda University Health Board area agreed that the greatest benefit of having a virtual consultation was the lowered risk of catching infection, with 93 percent saying they would be happy to use the VC Service again in the future.
Across Wales almost a quarter of a million video consultations have been held, with the highest number of users in physiotherapy as well as speech and language therapy.
The findings reinforce the Welsh Government’s Help Us, Help You campaign, which encourages people to get to know the breadth of NHS services and options available to them through the NHS 111 Wales website.
Health Minister, Eluned Morgan, said, “This useful evaluation shows promising results on the use of video consultation in healthcare settings. It’s encouraging to see that this service has been highly rated by both patients and clinicians and I hope that it will continue to be used and developed beyond the pandemic to allow wider access to healthcare services.”
The evaluation of the service showed it is well accepted across a wide range of care sectors and specialities and is clinically suitable for a wide range of patient demographic groups regardless of health status, age, gender, ethnicity, household income, and place (urban/rural).
Gemma Johns, TEC Cymru Research & Evaluation Lead said, “TEC Cymru follow a robust phased approach to its Research and Evaluation. We learn more as we move through each phase and utilise each dataset to support local Health Boards to make better informed decisions for their staff and patients.
“In the new Phase 2a evaluation VC report, we have been able to deep dive into patient and clinician experiences and identify how the benefits clearly outweigh the challenges. We have been able to demonstrate how well VC is working for our Welsh patients and clinicians and also the opportunity to challenge many assumptions on digital exclusion in Wales. The findings in this report seek to support Health Boards and the Welsh Government on future decisions and ways of working in NHS Wales and the sustainable use of VC moving forward.”
Jill Paterson, Director of Primary Care, Community and Long Term Care at Hywel Dda University Health Board, said, “If you are offered a video consultation appointment this is because your Health Care Professional has indicated that is it safe and appropriate to do so. Your video appointment will be confidential and will not be recorded.
“By putting off small problems or regular appointments you could potentially be putting more strain on NHS emergency services so please, help us, help you, do not put anything off. Local GP surgeries are open and are there to offer medical advice and consult patients.”
Have you used the VC service? A series of focus groups is being held online throughout August for anyone who has used the VC service to share their experience. Find more information on how to get involved here: www.eventbrite.co.uk/e/phase-2-data-follow-up-groups-tickets-159459861739
A reminder to residents and visitors as the number of Delta cases increase
CEREDIGION is starting to see an increase in the number of COVID-19 cases in Ceredigion and across Wales over recent days. The Delta variant has been detected in Ceredigion; a different variant which causes a wider range symptoms than previously, the Council has said.
We are becoming increasingly concerned about this increase; the current rate per 100 thousand of the population is 33 and this is likely to increase further over the coming days. This is a significant rise, considering at the beginning of June the rate per 100 thousand of the population was as low as 2.8 per 100 thousand.
The new variant of COVID-19 is in all parts of Wales. It spreads faster and we need to be more vigilant and ensure that we follow the most recent guidelines which are as follows:
· Only members of your extended household can enter your home.
· Face coverings continue to be mandatory in the indoor public spaces that are open (subject to certain exemptions and exceptions), and on public transport and in taxis.
· People should try and work from home if they can.
· People should maintain social distancing, including outdoors, and don’t mix with too many different groups of people.
· People should wash their hands regularly and follow other advice on hygiene.
· People must self-isolate when told to do so by NHS Wales Test, Trace, Protect or as soon as you develop symptoms
· Book a test if you experience any of the symptoms.
Symptoms of the Delta variant of coronavirus include a headache, followed by sore throat, runny nose and fever. We are urging people who feel unwell with ANY of these symptoms to book a test, be extra cautious, social distance, and maintain good hand hygiene.
As everybody is making the most of a summer with more relaxed restrictions than at the start of the year, it’s still vital for everyone to remember we’re still battling this virus and trying to prevent the threat of a third wave. Limiting your contacts is essential for keeping the infection rate down and it’s how we will ultimately protect each and every one of us.
In Ceredigion, over 68% have received the first vaccine and over 44% have now received the second vaccine. A first dose of the vaccine is now available to everyone over 18. The second vaccine significantly improves your immunity, so it is important that you get your second dose to complete your course of vaccinations.
Getting both vaccine doses and following COVID-19 guidelines will protect us all against the new variant. Hywel Dda University Health Board (HDdUHB) are now running walk-in clinics for first and second dose vaccination from Monday 21 to Sunday 27 June. More information on the HDdUHB website.
Together, we can keep Ceredigion safe.
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