Over the past several years, numerous advances in medicine and treatment of mental illness have occurred. What sort of research and developments are taking place in St. Louis?

St. Louis University is currently conducting studies in the treatment of manic-depressive illness (bipolar disorder). Bipolar disorder is a highly debilitating illness characterized by the presence of severe, sustained fluctuations in mood (alternating between depression and a sustained, hyperexcitable state called mania).

Historically, the disease has been treated with lithium, valproic acid and carbamazepine. The best studied and most proven of these agents is lithium. Though considered the "gold standard" in treating bipolar disorder, lithium is associated with several disagreeable side effects, including weight gain, tremor, and cognitive dulling, among others. Also, recent studies suggest that as many as 60% of bipolar patients will experience a severe mood episode in a five-year period, even while taking lithium. Valproic acid and carbamazepine are less well studied, but these also carry significant side effects. This often leads to poor medication compliance and poorly controlled disease.

We are currently exploring the use of a new agent, oxcarbazepine (Trileptal) in the treatment of bipolar disorder. Oxcarbazepine is an FDA-approved antiseizure medication. It is related to carbamazepine (Tegretol), but has a much better side effect profile.

We are currently enrolling manic-depressive subjects between the ages of 18 to 65 who experience incomplete or partial remission of their illness. Subjects are reimbursed for travel and time. If you know someone whom you believe meets this criteria, please contact Katherine at 314-577-8000 extension 3417.

Schizophrenia

One area of research at St. Louis University involves the treatment of schizophrenia. Schizophrenia is a severe, disabling mental illness characterized by hallucinations, delusions, disorganized thoughts and behavior, and "negative symptoms" (social withdrawal, minimal verbal communication). In the past 20 years, the advent of new or "atypical" antipsychotic medications has drastically improved the lives of individuals with schizophrenia. These medications are superior to the older medications because they have fewer side effects and treat the "negative symptoms" of the disease. Studies suggest that the newer medications improve the ability of individuals with schizophrenia to think more clearly.

Recent studies looking at functional outcomes in schizophrenia suggest schizophrenia should be reconceptualized as a disease of thinking (cognition). These studies suggest that cognition is the best predictor of how well individuals with schizophrenia do living in the community. Individuals with schizophrenia have specific and "global" cognitive deficits. Particular areas of deficit include memory, attention, and the ability to execute plans. These deficits are similar to the cognitive deficits of Alzheimer's disease.

We are currently studying the possibility of directly enhancing thinking in schizophrenia by the use of a medication which is currently FDA-approved for the treatment of Alzheimer's disease.

We are currently seeking individuals with schizophrenia who are not abusing substances. Subjects are reimbursed for travel and time. If you know someone who meets these criteria, contact Jessica at 314-577-8000 extension 3371.

Charles R. Conway, M.D.
Director, Adult Inpatient Psychiatry Unit
St. Louis University School of Medicine

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