Dr. Herbert Meltzer, MD is known world-wide for his work in developing Clozapine for use in treatment resistant schizophrenia.  Dr. Meltzer has received many awards world-wide for his outstanding achievement in schizophrenia research.   He is a Professor of Psychiatry, Pharmacology and Physiology at Northwestern Feinberg University. 

 

Dr. Meltzer became a close friend of John Forbes Nash, Jr. and to his family - much of this  webcast is based on that personal relationship.  

 

JOHN FORBES NASH was b orn in West Virginia into a family with no known mental illnesses.  He graduated Princeton at age 19 and got his Ph.D. a mere 2 years later.   He received the Nobel memorial prize in 1994 for his work in Economic Sciences with Game Theorists.  He was regarded as an extraordinary mathematician and went on to publish 3 famous math papers.  He was highly respected in his field.    John Nash and his wife d ied in car accident in 2015.  The importance of his work is recognized in the field and depicted in the famous  Movie "A Beautiful Mind" which was based on his life.

 

He displayed clear signs of paranoid schizophrenia at age 31 in 1959 (unlike what the movie portrayed.)  He was a sensitive human being with an intense desire to achieve and be recognized professionally for his work. Dr. Meltzer finds abnormal brain chemistry as well as stress make it more difficult to treat those with brain issues.   First trimester events and stress in pregnant women (and stress in dad's to be) can be a risk factor in later developing schizophrenia.  John Nash had a relationship with a woman who became pregnant. This unplanned pregnancy stress weighed heavily on him.  She went on to give birth to their son prior to John Nash marrying Alicia.  Shortly after his son was born his first psychosis emerged.  

 

Once the positive symptoms emerged they proved extremely hard to treat.  John Forbes Nash is perceived to have had treatment resistant schizophrenia.  This is what drove Dr. Meltzer to begin his research and later development of Clozapine for those with treatment resistant cases of schizophrenia.   Dr. Meltzer was a resident at the time John Nash was first hospitalized.   Despite Insulin coma and ECT (Electro-Shock-Therapy,) Dr. Nash rejected medications as a way to deal with his illness likely because they were not working well.   He had a full range of psycho social treatments at the time.  His wife divorced him but became his caretaker outside of the hospital.  He became nearly a street-person but with his former wife helping him as much as she could.  In 1994 he got the Nobel prize.   Dr. Meltzer wrote to one of his colleagues and shared about the drug Clozapine.   Nash read his email and said yes he wanted to meet him.

 

John Nash was intermittently treated with anti-psychotic drugs w/partial response and several courses of insulin coma and ECT,

after 1970 his general level of self-care improved without medication.

 

Nash was never able to achieve anything approaching the achievement of his youth following his period of his florid psychosis. 

The belief that thoughts can be inserted into ones mind, or diffused, or broadcast from one mind to another is thought to be common in the prodromal phase of schizophrenia.

 

There are 2 main classes of anti-psychotic drugs: atypical and typical.   Atypical doesn't product the Parkinson's-like side affects.   The basis for clozapine may also improve cognition and reduce risk for active schizophrenia per Dr. Meltzer.   All schizophrenia is related to excessive dopamine in the brain.   Anti-psychotics work to block excess dopamine.

 

Different genes produce a picture of schizophrenia - they are risk genes - but there are other genes influencing chemistry in brain that affect response to medication.   This is the area of research Dr. Melzer continues to do.   They are working to come up with blood or saliva samples to be able to assess best medication for an individual.    Dr. Meltzer and his team tested a 49-yr old female with severe untreated schizophrenia. Within 6 months of treatment on an atypical anti-psychotic, with pre and post-MRI-brain-scans they saw vast improvement in cognition through neuroplasticity and neurogenesis.   This gives us all hope for the future!

 

Despite years of psychosis with no treatment - treatment is still possible.  Optimal preservation of cognition is to get early intervention and prompt treatment.   Most with schizophrenia will require life-long medication but some like John Nash (a brilliant man using self-cognitive therapy and highly educated learned in his older years of life to control his psychosis.)    Dr. Meltzer remains optimistic about the future of mental health.