Have Researchers Found a New Risk Factor for Schizophrenia?

Scientists have located an intriguing link between schizophrenia and the Epstein-Barr virus, a type of herpes virus. Now, they need to determine which way the risk lies.

A new study may have found another environmental risk factor linked to schizophrenia. Schizophrenia, a condition characterized by a confused perception of reality, delusions, and altered behavior, affects more than 21 million people globally.

In a new study, specialists from Johns Hopkins Medicine in Baltimore, MD, and the Sheppard Pratt Health System in Townson, MD, found evidence that links schizophrenia with the Epstein-Barr virus.

This is a herpes virus that causes infectious mononucleosis, or glandular fever.

As the scientists report in a paper published in the Schizophrenia Bulletin, they saw higher levels of antibodies against the Epstein-Barr virus in the bodies of those with schizophrenia than in those of people without any mental health conditions.

The higher level of antibodies suggests exposure to the virus, but it is unclear which way the risk runs - that is, whether infection with the Epstein-Barr virus renders people more vulnerable to schizophrenia, or whether schizophrenia impacts the immune system and exposes people to infections.

"We are interested in the role of infectious agents such as Epstein-Barr virus in schizophrenia and other serious psychiatric disorders, so we did this study to look at the associations," says senior study author Dr. Robert Yolken.

A link between schizophrenia and infection?

Research has identified certain genetic risk factors for schizophrenia, but it has also recognized the possibility that some environmental factors - including exposure to infections - can raise schizophrenia risk.

In the new study, the scientists worked with 743 participants, of whom 432 had schizophrenia and 311 had no mental health problems (the control group). Around 55 percent of the cohort was male.

Dr. Yolken and colleagues compared the levels of antibodies against the Epstein-Barr virus in the participants with schizophrenia with those of participants in the control group.

They saw that people with schizophrenia were 1.7–2.3 times more likely than controls to have higher antibody levels against this herpes virus.

These participants did not have higher antibody levels against other types of infections, such as varicella (or chickenpox) or the herpes simplex type 1 virus, which is mainly transmitted orally (through kissing, for example).

'Unusal response to Epstein-Barr virus'

However, the researchers found that people with high genetic risk of schizophrenia and who also presented high levels of Epstein-Barr virus antibodies had an increased probability to pertain to the schizophrenia group - more than eight times higher, to be precise.

Also, among participants with schizophrenia, around 10 percent had both high levels of antibodies against this type of herpes virus and a higher genetic risk for schizophrenia, compared with only a little over 1 percent of the participants in the control group.

"We found that individuals with schizophrenia had an unusual response to Epstein-Barr virus. This indicated that the prevention and treatment of Epstein-Barr virus might represent an approach for the prevention and treatment of serious psychiatric disorders such as schizophrenia." - Dr. Robert Yolken

The study did not seek to establish cause and effect relationships, but the researchers suggest that preventing infection with the Epstein-Barr virus may be helpful in the context of schizophrenia risk.

However, the United States Food and Drug Administration (FDA) have not yet approved any drugs for the treatment of this type of herpes virus. That said, researchers are currently studying some drugs with therapeutic potential.

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Mental Health: Tougher Checks Before Superdrug Botox

High street retailer Superdrug is to introduce tougher mental health checks before performing cosmetic procedures, following criticism by the NHS.

Prof Stephen Powis, the medical director of NHS England, said the injections risked fuelling mental health disorders - and the health service was left to pick up the pieces.

Superdrug started offering Botox and dermal fillers last year.

The retailer said it was "fully committed" to the issue.

High Street procedures

Botox is an injection of Botulinum toxin that relaxes muscles to temporarily hide lines and wrinkles.

Dermal fillers are injections under the skin that can fill skin creases or lead to bigger lips

NHS Choices: Botox and Dermal fillers

Superdrug's Skin Renew Service offers the cosmetic procedures to people over the age of 25, surgeons have criticised the company for treating Botox and fillers as "casual beauty treatments" on a par with having a wax.

The NHS is concerned about the impact on people who are mentally ill, including with Body Dysmorphic Disorder (BDD), in which people are fixated on what they think are flaws in their appearance.

The BDD Foundation says body dysmorphia can be a crippling illness and severely impair someone's life.

Woman's Botox party warning after lip filler swelling

Prof Powis wrote to Superdrug's chief executive, saying the company could do more to protect people who were seeking treatment because they were mentally unwell, or might have a mental health disorder triggered by treatment.

Prof Powis said: "Pressures on young people's mental health are greater than they ever have been, with families and the health service too often left to pick up the pieces.

"The lack of tough checks on cosmetic surgery means that the public is dependent on businesses taking voluntary steps to get their house in order, leaving people avoidably exposed to dangerous practices."

Superdrug said it already performs an hour-long consultation before cosmetic procedures take place and these include a mental health assessment.

The company said it would now ask specific questions about Body Dysmorphic Disorder:

"We remain fully committed to including recommended protections for mental health. We met with the NHS to ensure we have the highest safety standards and quality of patient care."

People fixate

Alana, who has BDD, told Radio 4's Today programme that prior to being treated for the condition she would "beg and plead" with her parents to access plastic surgery and cosmetic procedures.

The 22-year-old believes that it would have been a "real issue" for her if these procedures had been available on the high street at the time.

Kitty Wallace, a trustee with the BDD Foundation, said fewer than 10% of patients with BDD were satisfied with the results of their cosmetic procedures.

She said: "It is important that these measures are in place to protect such individuals from potentially damaging and unnecessary procedures.

"Although their anxiety might reduce temporarily, they will often find themselves fixating on another part of their body that they want to change.

"We commend that Superdrug will be screening for the disorder, and referring people who are positive to their GP and Mind."

The foundation has its own questionnaire, which asks questions about how much people fixate on their appearance and how much it affects their day-to-day life.

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