Schizophrenia: A multi-system disorder?

To the Editor

The person with schizophrenia who presents either floridly psychotic or silent and reclusive may distract the examiner from other facets of this disorder. Recent observations have consistently shown spontaneous movement disorders and metabolic abnormalities that have preceded the use of antipsychotic medication (Pappa and Dazzan, 2009; Spelman et al., 2007). Medication, rather than causing side effects, may be bringing to the forefront those aspects of illness that have been previously obscured. That this may involve other organ systems is hinted at in a recent World Health Organization study involving 224,254 people (Moreno et al., 2013). While controlling for country of origin, gender, age and socioeconomic status, those people with at least one psychotic symptom in the last 12 months had a higher probability of also reporting angina, asthma, arthritis and tuberculosis than those reporting no psychotic symptoms.

That a single process may affect multiple organs is not new and includes the great mimics in medicine – alcohol, systemic lupus erythematosis and tuberculosis. The process that emphasises one facet whereby the person presents to one specialty and not another is intriguing as is the means by which anatomically separate areas are linked and affected. Analogies include the intersecting string lines on a building site or from nature, the threads of a spider’s web or the ripples from a thrown stone. Contact at one point creates an effect elsewhere. One difficulty in exploring potential mechanisms is the use of language which restricts understanding to existing paradigms. The word interconnecting suggesting neural pathways, endocrinology and autoimmunity suggesting alternative but equally limiting mechanisms.

If it is confirmed that schizophrenia is indeed a multi-system disorder, then, our relationship with our medical and surgical colleagues might shift from being a separate encounter for the treatment of an isolated problem to one that is integrated around the treatment of the person with schizophrenia in all of its manifestations.