The news is less good on the treatment front. Standard antipsychotic or neuroleptic drugs, which change the balance of chemicals in the brain and help control symptoms, can lead to sleepiness, weight gain, movement problems, and muscle contractions. While newer drugs called atypical antipsychotics come with fewer side effects, they aren't significantly more effective, Glatt says.
Meanwhile, other ways of managing schizophrenia are growing in popularity. Psycho-education teaches patients and their families about the illness and how to best avoid a relapse. Another approach, problem-oriented personalized psychotherapy, provides guidance on tackling everyday problems. Patients can learn to change their problematic thoughts with cognitive behavior therapy, and cognitive remediation uses computer-assisted training exercises to work on memory, attention, and problem-solving. Combined with medication, these options can make a big difference, experts say.
But with mental health and hospital resources scarce, it doesn't always happen, notes Jeffrey Lieberman, director of the New York State Psychiatric Institute in New York City. "There's a lot more that could be done in this field simply by applying what we already know."
STROKE: Widening the window for treatment
Time is brain, as the saying goes, and the push continues to make the most of those critical first hours after a stroke. The standard treatment for dissolving clots in ischemic strokes is intravenous tPA, or tissue plasminogen activator; administered within three hours, it can greatly increase the odds of recovery. But only one third of candidates make it to the hospital that quickly, and since the treatment isn't appropriate for a hemorrhagic, or bleeding, stroke (it would raise the risk of bleeding), it can't be started in the ambulance.
One promising technique now under study in California is to have emergency medical technicians administer magnesium sulfate (which dilates blood vessels and blocks the calcium buildup responsible for cell death) while en route to the hospital. "The hope is that more brain will be saved with this therapy," says Walter Koroshetz, deputy director of the National Institute of Neurological Disorders and Stroke. Meanwhile, evidence from Europe indicates that tPA can be administered effectively in some people up to four and a half hours after a stroke, and injecting tPA by catheter directly to the clot through an artery in the groin opens the window up to six hours. In some cases, it's possible to remove the clot using tools threaded through blood vessels in the brain; the Merci Retriever System, a coil-shaped device that pulls out clots, and the vacuum-like Penumbra System, which sucks them out, can be used up to eight hours after the first symptoms.
Once the damage is done, how to bring function back? Though many physicians still doubt motor skills can be regained much beyond six months out, the latest research indicates otherwise. One avenue of study suggests that high-intensity repetitive exercise, aided by robots or people, can significantly improve arm functioning even several years later. Transcranial magnetic stimulation also appears to help partially paralyzed patients as much as three years later. And researchers at the Toronto Rehabilitation Institute have reported that just eight sessions of Wii Tennis and Wii Cooking Mama—in which a player simulates peeling, cutting, and slicing—gave motor function a measurable boost.
By using stem cells to stimulate neuron and blood-vessel growth, researchers hope to someday repair stroke-injured areas. Last November, Scottish researchers injected fetal stem cells into the brain of a man in his 60s who had suffered a debilitating stroke 18 months earlier. The man will be monitored over two years to see if he gets better; 12 additional patients will get the therapy this year.