Morning Zen

E. Fuller Torrey Is Right About a Cause of Schizophrenia, but Missed How to Prevent Schizophrenia

May 24, 2017

Morning Zen Guest Blog Post ~ Dennis Embry ~ 

Yep, it’s true that cat poop can cause schizophrenia.  To be more correct, studies by Dr. E. Fuller Torrey promote the idea that the actual cause is bacteria found in cat poop, toxoplasma gondii [1-8].  The data Dr. Torrey cites are almost certainly, true. However as a cat lover, I do not propose killing cats to prevent schizophrenia—even though Dr. Torrey’s research might imply that.

Dr. Torrey is widely known for his advocacy for assisted outpatient treatment or AOT­—after people have been diagnosed with serious mental illnesses such as schizophrenia. Treatment is a good idea, yet why not prevention in the first instance. Could we prevent toxoplasma gondii infection carried by cats associated with schizophrenia without killing cats?  Yes, and it doesn’t involve psychiatric medication or treatments. The prevention mechanism is a behavioral vaccine, like hand washing that prevents many infectious diseases [9-11].

The prevention of schizophrenia caused by toxoplasma gondii has to be viewed in context. First, rates of schizophrenia increase among humans who are increasingly North or South of the equator [12-25]. Second, darker skin increases the risk of schizophrenia [14, 21, 26], while eating oily fish reduces the prevalence of schizophrenia [21, 27, 28].  All of this implicates vitamin D [26, 29, 30].

As a prevention scientist and a child psychologist, it troubles me that exquisite data exists on a preventable cause of schizophrenia—thanks to Dr. Torrey and others— are not receiving enough attention.  We have good data to show that Americans are increasingly deficient in the protective power of vitamin D, because of cultural practices such as diets low in oily fish and low levels of outdoor play.  That, in turn, increases our risk of infections that increase the risk of schizophrenia.

The time is now to stop writing off psychiatric disorders as caused by some unknown genetic defect or chemical imbalance in the brain. The 2009 Institute of Medicine Report on the Prevention of Mental, Emotional, and Behavioral Disorders Among Young People [31] makes it clear that psychiatric disorders are increasingly preventable.  Let’s give a round of applause to E. Fuller Torrey for identifying one way to prevent serious mental illness. 

  1. Torrey, E.F., et al., Antibodies to Toxoplasma gondii in patients with schizophrenia: a meta-analysis. Schizophr Bull, 2007. 33(3): p. 729-36.
  2. Torrey, E.F. and R.H. Yolken, Schizophrenia and toxoplasmosis. Schizophr Bull, 2007. 33(3): p. 727-8.
  3. Xiao, J., et al., Serological pattern consistent with infection with type I Toxoplasma gondii in mothers and risk of psychosis among adult offspring. Microbes Infect, 2009. 11(13): p. 1011-8.
  4. Yolken, R.H., et al., Serological evidence of exposure to Herpes Simplex Virus type 1 is associated with cognitive deficits in the CATIE schizophrenia sample. Schizophr Res, 2011. 128(1-3): p. 61-5.
  5. Torrey, E.F., J.J. Bartko, and R.H. Yolken, Toxoplasma gondii and other risk factors for schizophrenia: an update. Schizophr Bull, 2012. 38(3): p. 642-7.
  6. Torrey, E.F. and R.H. Yolken, Toxoplasma oocysts as a public health problem. Trends Parasitol, 2013. 29(8): p. 380-4.
  7. Torrey, E.F. and R.H. Yolken, The urban risk and migration risk factors for schizophrenia: are cats the answer? Schizophr Res, 2014. 159(2-3): p. 299-302.
  8. Yuksel, P., et al., Stability of Toxoplasma gondii: Antibody levels in schizophrenia. Schizophr Res, 2017.
  9. Embry, D.D., Community-Based Prevention Using Simple, Low-Cost, Evidence-Based Kernels and Behavior Vaccines. Journal of Community Psychology, 2004. 32(5): p. 575.
  10. Embry, D.D., Behavioral Vaccines and Evidence-Based Kernels: Nonpharmaceutical Approaches for the Prevention of Mental, Emotional, and Behavioral Disorders. Psychiatric Clinics of North America, 2011. 34(March): p. 1-34.
  11. Embry, D.D., The Good Behavior Game: A Best Practice Candidate as a Universal Behavioral Vaccine. Clinical Child & Family Psychology Review, 2002. 5(4): p. 273-297.
  12. Almeras, L., et al., Developmental vitamin D deficiency alters brain protein expression in the adult rat: implications for neuropsychiatric disorders. Proteomics, 2007. 7(5): p. 769-80.
  13. Amato, R., et al., Schizophrenia and vitamin D related genes could have been subject to latitude-driven adaptation. BMC Evol Biol, 2010. 10: p. 351.
  14. Dealberto, M.J., Why are immigrants at increased risk for psychosis? Vitamin D insufficiency, epigenetic mechanisms, or both? Med Hypotheses, 2007. 68(2): p. 259-67.
  15. Dealberto, M.J., Are the rates of schizophrenia unusually high in Canada? A comparison of Canadian and international data. Psychiatry Res, 2013. 209(3): p. 259-65.
  16. Eyles, D., et al., Developmental vitamin D deficiency alters the expression of genes encoding mitochondrial, cytoskeletal and synaptic proteins in the adult rat brain. J Steroid Biochem Mol Biol, 2007. 103(3-5): p. 538-45.
  17. Grant, W.B., R.C. Strange, and C.F. Garland, Sunshine is good medicine. The health benefits of ultraviolet-B induced vitamin D production. J Cosmet Dermatol, 2003. 2(2): p. 86-98.
  18. Humble, M.B., S. Gustafsson, and S. Bejerot, Low serum levels of 25-hydroxyvitamin D (25-OHD) among psychiatric out-patients in Sweden: relations with season, age, ethnic origin and psychiatric diagnosis. J Steroid Biochem Mol Biol, 2010. 121(1-2): p. 467-70.
  19. Huotari, A. and K.H. Herzig, Vitamin D and living in northern latitudes–an endemic risk area for vitamin D deficiency. Int J Circumpolar Health, 2008. 67(2-3): p. 164-78.
  20. Kimlin, M.G., W.J. Olds, and M.R. Moore, Location and vitamin D synthesis: is the hypothesis validated by geophysical data? J Photochem Photobiol B, 2007. 86(3): p. 234-9.
  21. Kinney, D.K., et al., Relation of schizophrenia prevalence to latitude, climate, fish consumption, infant mortality, and skin color: a role for prenatal vitamin d deficiency and infections? Schizophr Bull, 2009. 35(3): p. 582-95.
  22. McGrath, J.J., et al., Developmental vitamin D deficiency and risk of schizophrenia: a 10-year update. Schizophr Bull, 2010. 36(6): p. 1073-8.
  23. Menkes, D.B., et al., Vitamin D status of psychiatric inpatients in New Zealand’s Waikato region. BMC Psychiatry, 2012. 12: p. 68.
  24. Schwartz, P.J., Can the season of birth risk factor for schizophrenia be prevented by bright light treatment for the second trimester mother around the winter solstice? Med Hypotheses, 2014. 83(6): p. 809-15.
  25. Wacker, M. and M.F. Holick, Sunlight and Vitamin D: A global perspective for health. Dermatoendocrinol, 2013. 5(1): p. 51-108.
  26. Yuksel, R.N., et al., Correlation between total vitamin D levels and psychotic psychopathology in patients with schizophrenia: therapeutic implications for add-on vitamin D augmentation. Ther Adv Psychopharmacol, 2014. 4(6): p. 268-75.
  27. Hedelin, M., et al., Dietary intake of fish, omega-3, omega-6 polyunsaturated fatty acids and vitamin D and the prevalence of psychotic-like symptoms in a cohort of 33,000 women from the general population. BMC Psychiatry, 2010. 10: p. 38.
  28. Miller, B.J., et al., Dietary supplements for preventing postnatal depression. Cochrane Database Syst Rev, 2013. 10: p. Cd009104.
  29. Zhu, D.M., et al., High levels of vitamin D in relation to reduced risk of schizophrenia with elevated C-reactive protein. Psychiatry Res, 2015. 228(3): p. 565-70.
  30. Shivakumar, V., et al., Serum vitamin D and hippocampal gray matter volume in schizophrenia. Psychiatry Res, 2015. 233(2): p. 175-9.
  31. O’Connell, M.E., T. Boat, and K.E. Warner, eds. Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth and Young Adults: Research Advances and Promising Interventions. 2009, Institute of Medicine; National Research Council: Washington, DC. 576.

embryDennis D. Embry, Ph.D., is a prominent prevention scientist in the United States and Canada, trained as a clinician and developmental and child psychologist. He is president/senior scientist at PAXIS Institute in Tucson, AZ and co-investigator at Johns Hopkins University and the Manitoba Centre for Health Policy. Dr. Embry was recently appointed to the member of the SAMHSA Center for Mental Health Services National Advisory Council. His work and that of colleagues is cited in 2009 the Institute of Medicine Report on The Prevention of Mental, Emotional, and Behavioral Disorders Among Young People. Clinically his work has focused on children and adults with serious mental illnesses. Dennis Embry is a member of the Children’s Mental Health Network Advisory Council.

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