Host: Have you ever been tossing and turning in bed while your mind races trying to work out the solution to a tricky problem and then you wake up and the answer is just there? Like somehow while you were sleeping your brain figured it out, no conscious thought required. So how does that happen? We look at what science has to say about the stuff that dreams are made of. We still don't have all the answers. No surprise because the brain is incredibly complicated. And even now, much of it remains a mystery to scientists and philosophers alike. But researchers are putting together some pretty interesting pieces of the puzzle and raising new sets of questions. For example, a new Ontario-based study finds that rates of new diagnoses of psychotic disorders, including schizophrenia, increased by 60% in people aged 14 to 20 over the past few decades. We break down what the data shows and what it may mean. Welcome to the rundown.

Host: A new study published in the Canadian Medical Association Journal says that between 1997 and 2023, the annual incidence of psychotic disorders increased by 60% among people aged 14 to 20. I sat down with one of the co-authors to understand what the numbers are telling us and the questions they leave behind.

Host: Dr. Paul Kuriak is a psychiatrist and scientist at the Center for Addiction and Mental Health in Toronto and a senior scientist and lead of the mental health and addictions research program at ICE and he joins us in studio. How are you sir?

Dr. Paul Kuriak: Great. Thanks for having me.

Host: All right. Your study measured the incidence of psychotic disorders across different groups in Ontario. When you stepped back and looked at the findings, what surprised you the most?

Dr. Paul Kuriak: Well, I think the the first thing that surprised me uh and I should say at the beginning that I was a co-author on this study um it was led by a colleague of mine at a University of Ottawa, Dr. Daniel Myin did a great job on this project. When we looked at the findings, the there are a couple things that struck out. one is that um that that the incidence which means the the rate of new newly diagnosed individuals is increasing over time. Uh it is happening in younger individuals over time. And then the third piece is the the the way that the diagnosis are breaking out. Uh, so there are different types of diagnoses that that are part of of what we call psychotic disorders and and that's a bit of a nuanced aspect of the study, but that was a third piece that was kind of interesting to us.

Host: All right. Well, let's let's pick up on that. When you say psychotic disorders, what do we mean? We have schizophrenia in one room, an umbrella term perhaps, and then we have schizophrenia and we have psychosis. Help us understand uh sort of the terms there.

Dr. Paul Kuriak: Yeah. So, so there's schizophrenia and schizopeeffective disorders and for people to be diagnosed with those uh conditions they they need to meet certain criteria and and that uh the the incident rate for those diagnoses did have increased a little bit but not that much. The the one that's increased more so is called psychosis not otherwise specified. And this is a diagnosis that clinicians like myself use when somebody is clearly presenting with prominent psychotic symptoms like a deviation from reality.

Host: Sorry, hallucinations,

Dr. Paul Kuriak: delusions. Exactly. And uh but but they but there are other issues that prevent us from saying it is clearly schizophrenia and schizoeffective disorder. So, we know that the person's psychotic, but there could be other factors that that may ultimately be contributing to it. Um, like it could be related to substance use, it could be related to medical conditions, etc., etc. So, so it's kind of like a hedge diagnosis. It it is definitely a psychotic disorder and most individuals with this diagnosis do over time evolve to developing a diagnosis schizophrenia. just bel it it suggests a level of uncertainty that is truly schizophrenia at the time of first diagnosis. I don't want to simplify it but fair to say like you like you mentioned the specific set of symptoms one of them is it's chronic with schizophrenia that is long term that's about usually six months or more

Host: correct

Host: okay all right I want to look at a graph uh from this study this graph shows the incidence rate ratios for schizophrenia spectrum disorder which is in the dark blue color psychosis not otherwise specified in green and psychotic disorders which include both schizophrenia and psychosis in black. Now, for each cohort studied, this is comparing to the 1975 1979 cohort. For psychotic disorders, the black line, there is a gradual increase in the rate of diagnosis starting with those born in the 198589 cohort. When researchers separated the data, it showed that the rate of schizophrenia goes up slightly, but then starts to go down, but the rate of psychosis increases kind of like a ski hill. What is this telling us?

Dr. Paul Kuriak: Yes. So, so if we return to the difference between psychosis not otherwise specified and and uh the something that is like truly a schizophrenia spectrum disorder. Uh it is the the the market increase in in the sort of the slightly uncertain category. the psychosis not otherwise specified which means that uh at the time of first diagnosis there is is less certainty that this is truly schizophrenia which means that there are there's complexities in in in the diagnosis over time that is increasing the most

Host: a lot of headlines in terms of what is causing it this study was not looking at what was causing this uh but help us understand what what are what are some links that have been sort of made

Dr. Paul Kuriak: yeah so I think the the The first important point is that this study was very well designed to characterize changes in rates over time. There's nothing about this particular study that helps us understand why we're observing what we're observing. So when I think about the links, it's really like extrapolating to evidence beyond this study. Um but I would say uh what we are observing generally amongst young people and these are 16 to 35 year old individuals typically uh what we're observing amongst young people is they are far less stigmatized than previous generations and much more inclined to seek help. So that may partly explain why we're seeing more and younger. Um the other factor is that uh over time there has been more robust um implementation of early psychosis intervention programs proincially.

Host: Okay.

Dr. Paul Kuriak: So anytime you put more services into a province it that there's a tendency to pull in more more cases. And then the third piece that that actually is the cause for concern is is the um is the fact that the rise in the less certain diagnosis than not otherwise specified is is occurring dramatically at a time of uh cannabis legalization. And and what comes with cannabis legalization is the young people are exposed with high potency uh cannabis which uh evidence outside of this study suggests does pose a serious risk for the onset of psychosis.

Host: What does cannabis high high potency or not? Uh these are young brains that we're talking about. We're talking um you know when they're still developing up until about the age of 25. But what what does it do to the brain?

Dr. Paul Kuriak: Yeah. So, so there's lot So, it's not entirely clear, but that does seem to uh like there's a there's a aggregation of evidence that suggests that there's something about uh the THC chemical in cannabis that binds with certain receptors in the brain that causes a biological inclination to become psychotic. So the way I think about it and there are there are people who are more better experts than me on this is I think like if you are vulnerable to developing a psychotic disorder, exposure to high potency cannabis may increase your likelihood to develop a psychotic disorder.

Host: Okay. Um is there a difference between uh men and women?

Dr. Paul Kuriak: There's there's been a a baseline difference in men and women in the onset of of schizophrenia. So men develop it uh psychosis at a younger age. They tend to be more disabled as a result of the condition. Uh the ratio of men to women is a little higher in men. And of course uh as it relates to the cannabis risk factor uh and actually to the service utilization. Men, young men are notoriously difficult to engage in healthcare. Uh and they are much more likely to consume substances than women. uh we talked about legalization of course 2018 um looking at this data and of course this is just just the beginning here was that the right call

Host: yeah so so uh it's it's an important question um the policy is inherently a compromise and I think that the the legalization issue in 2018 responded to a couple of important issues one is that that I mean, if you walk around Toronto, there's clearly a a public interest in having ready access to marijuana recreationally. I mean, that that is just what what people want and so policy follows what what people want typically. I also think, and this is a really important piece, is that um when cannabis was illegal, uh the the consequences of it being illegal, incarceration for possession did not happen equitably. and that we know we knew and that more marginalized individuals were more likely to be incarcerated and have all the negative consequences of having a criminal record etc.

Dr. Paul Kuriak: Tobacco is a legal substance, but it's pretty highly regulated and highly taxed. So, you know, I think there are policy solutions to to find that compromise or balance between, you know, maintaining the benefits for which the policy was first enacted at the same time address some of the risks that we're learning about.

Host: All right. receiving this kind of diagnosis uh can be frightening for many. Um could you explain how this diagnosis is challenging for the indivi dual or for those who are in their lives as well?

Dr. Paul Kuriak: Oh, this is you know my my clinical work is in the CAMH emergency department and this is this is one of those ones where you uh you really feel for the individual. Uh so how it manifests um it typically it is a it often a slowly evolving sort of uh deviation from reality and also often uh a slowly evolving uh social withdrawal that that uh so a young man uh in high school like totally social engaged in everything starts to withdraw from stuff then starts like like avoiding school, reluctant to avoid school, family starts noticing that that he might be sort of talking to himself, laughing inappropriately at times. Um, so that's kind of how it it it manifests. Um, and and it's incredibly important that individuals uh have access to care early because we know that the longer an individual goes untreated, the worse the prognosis uh is. like like if we can get people into care early the we can really change the trajectory of a young person's life.

Host: I think I know the answer to this but are there enough supports uh in place for those seeking treatment?

Dr. Paul Kuriak: So uh I would say that um throughout our province we know that we don't have enough services uh for individuals struggling with mental illnesses generally. In this case, we do have a in comparison to other areas of our mental health system, we do have a robust system of early psychosis intervention programs that currently exist. Um, but evidence that has come out of uh my research team suggests that even though this provincial network exists, um not not everybody with the disorder can can can or does access them. And and some of that has to do with inadequacy of resources. Some of it has to do with awareness. And so, for example, if you're diagnosed by a psychiatrist or diagnosed in a hospital setting, you're much more likely to be referred to one of these programs, excuse me, than if you were managed in primary care. And that's probably just an awareness situation. Um and and the the that's a big problem because uh what we know about the consequences in addition to like you know longer periods of no treatment uh this is a deadly illness that that um you know people who are diagnosed in a hospital these are 16 to 35 year olds uh one in 25 die within 5 years. If you're diagnosed in outpatient setting one in 40 nobody should be dying between the ages of 16 and 35. And

Host: how do they how do they die? The most common cause is suicide.

Dr. Paul Kuriak: Yeah. The suicide rate is is incredibly high and and it just makes sense because these are young people who have a sense of who they are and what they're going to be doing in their life and their whole identity gets rocked by this diagnosis.

Host: All right. Uh doctor, we're going to have to leave it there, but really appreciate your insights. Uh thank you for this and of course um with this there will be more things to come out of this in terms of uh research and studies and policy. So, we look forward to that and uh thank you so much.

Dr. Paul Kuriak: Thanks very much for having me.

Host: When Karen Ben Campin was a child, she hung out at her father's lab, one of the first independent sleep labs in North America. Now, the health and science journalist has turned her lifelong interest in sleep, dreams, and everything in between into a new book called The Brain Never Sleeps: Why We Dream, and What It Means for Our Health. Karen Vancampen is a health and science journalist. How are you doing Karen?

Karen Vancampen: I'm well. How are you?

Host: I am doing well. Let's talk. Dreams are quite complex. There's emotions. There's visual components to help us understand what parts of the brain are affiliated with dreaming.

Karen Vancampen: So, different parts of the brain are active at different times in the sleep cycle. Um, one part of the brain that's active during dreaming is the emotional center of your brain. So, um the parts of the brain that help process emotions that um are involved in our feelings, uh the preffrontal cortex, uh during REM sleep, it's less active than when we're awake. And that's the part of the brain that really deals with making decisions, thinking rationally, and that's less active during REM.

Host: All right. You mentioned REM and you mentioned cycle. So, REM to simplify rapid eye movement, and then there is non-rapid eye movement. Um you mentioned which cycles we dream in. How do we know what you know there there's eye movement that's very clear in when we talk about but how do we know that's where we dream?

Karen Vancampen: So we dream um through nonrem and REM. So nonREM sleep is stages one through three. Stages 1, two, and three is nonrem sleep. And REM sleep is stage four. So we actually dream all through the sleep cycle all through the night. Um so that's

Host: where are the best most vivid dreams?

Karen Vancampen: REM sleep. So, it's typically our most intense, vivid, emotional dreams happen during REM and we get to our first REM. We go through four or five stages of the sleep cycle a night, right? And um so we get it's about 90 minutes into the sleep cycle that we have our first period of REM.

Host: Okay. Uh reading your book, you have I would say quite an unusual childhood in terms of what you were what you experienced. what drew you to understand more about sleep and dreams and I know your father had a lot to do with that.

Karen Vancampen: So my dad's a sleep doctor, so I was always immersed in this world of sleep. And I sort of look at it as sleep was kind of like this gateway to the world of dreams. And so I was always, you know, always thinking about sleep and trying to get enough sleep. And sleep was a really big part of growing up um my childhood. And then a few years ago, I read this uh scientific study that said we're as dreamd as we are sleepd deprived. And it's it made me think, you know, why do dreams matter on their own in, you know, not just sleep? Sleep is its own industry and we're very focused on sleep, but what about dreams? And then it got me it turned me on to uh the science of dreaming

Host: as you mentioned and what we've talked about in terms of the brain. We have come a long way in terms of understanding the brain. Yes. Uh do we better understand dreams? I know this is a question of why do we dream has been asked for decades. uh but do we have a better understanding of that?

Karen Vancampen: So there's many possibilities of why we dream. So one idea is that we dream to help uh dream sleep and dreams help consolidate memories. Okay. So let's say we've learned something uh new during the day or we've had a new experience. It's thought that uh during sleep and during dreams it helps to strengthen these memories. So that's one thing is memory consolidation. Um,

Host: so a cabinet of of dreams that you can put in and

Karen Vancampen: Exactly. So, and then uh it's really neat. Um, so one idea is it's called this ne it's called the next up model of dreaming. Okay. And I found this fascinating because I've always wondered, you know, why do I suddenly dream of something from my childhood or years ago? Why do I do I choose to say dream of it tonight? What what is it? And this idea is that in order to strengthen memories, say recent experiences, recent memories, you associate it with with memories from your catalog of memories that are already stored in your brain. So that's it's finding possibilities through these connections, these unique and um yeah, unique connections through these associations.

Host: Uh another theory is sort of viewing dreams as sort of a night therapy.

Karen Vancampen: Walk me through that. That's interesting.

Karen Vancampen: It's so interesting. So um Yep. So Matthew Walker he uh so it's dreams as overnight therapy and the whole idea um about dreams as overnight therapy and other uh dream researchers have have also studied this is that it helps to process our emotions. So um it helps come to terms with say difficult emotions. Um Roslin Cartwright, she was known as the queen of dreams and she did these studies on people who were going through divorce and she found out if you dream you have these unsettling dreams about your divorce you actually they the subjects tended to cope better a year later.

Host: So that is also so it's it helps to um process the emotions but keep the details of the memory. There's also this thinking of our dreams. Some people may look look at them as two separate compartments when we're awake and we're falling asleep. But when we wake up sometimes we might have solved some of the issues that we dealt with. Help us understand perhaps how dreams kind of help us when we wake up in our real world.

Karen Vancampen: So it's thought that when we're falling asleep, we sort of tag certain ideas to revisit later in the night. So let's say you're you're trying to, you know, you're noodling around. When you're thinking about a problem you're trying to solve, you might be thinking about it as you're falling asleep. So during sleep onset, it's this really unique time. It's almost like a dreamy brainstorming session.

Host: I was going to say it's like a to-do list for it's another to-do list. All right.

Karen Vancampen: Exactly. So you can like if you you can even guide your dream thoughts. That's about dream engineering. Okay. And so let's say you want to work on a problem, you want to solve a problem or you want to think about a new creative idea. when you're falling asleep, you can think about this idea, think about this problem that you want to work on and then often times it will help guide your dreams. So those thoughts that you're thinking about and dream engineering um uses technology to um help you guide and shape your dreams. So I did this dream experiment and it was really fun. And so basically I um Adam Har he's a dream researcher and he helped me set it up this sort of ad hoc dream experiment at home

Host: and so as I was just falling asleep in sleep onset the first few minutes of sleep

Karen Vancampen: um a recording I did a recording before and then it would the recording played and it said it was my voice and it said remember to think of a tree.

Host: Ah

Karen Vancampen: and then so then that was help guide my my dreams.

Host: And what did you dream then?

Karen Vancampen: I dreamt about all these different trees. First it was very concrete. Okay. And I was dreaming of there was this willow tree um in front of this cabin where um our family used to have this cabin. And then it started to get the farther I went into sleep onset, it started getting more creative and um not as concrete and not as logical. Okay. And then I thought of uh this time that my husband and I got lost in these woods and then the the trees became waves and so it got very abstract almost.

Host: Yeah. Um speaking of abstract, let's talk about lucid dreams there. I'm sure there are many listeners who have probably had a dream where they're running and then all of a sudden they're like, "Hold on, I am dreaming. I know I'm dreaming and probably stop." Um explain to us about lucid dreams. What can you tell us about them? Why do we have control?

Karen Vancampen: So lucid dreaming is when it starts with to be aware that you're in a dream as the dream is happening. So it's to have that awareness and then once you gain the awareness, it's to develop that skill to actually learn that you your dream is a it's a creation of your imagination. So you actually can be in control. So then you start to control your dream characters or maybe the plot. You could choose, you know, what to do, what you've always wanted to do. Some people want to try and fly. Um I read about I talked to a dream researcher and he told me there's an artist and he imagines um an art gallery.

Host: Okay.

Karen Vancampen: And he opens the door and goes into this art gallery and there's all these beautiful paintings and they're a creation of his own his own imagination and mind. Okay. So then he wakes up and and sketches out what he was dreaming.

Host: All right. I I'm going to I feel like there's a lot of uh a lot of power to harness here if we can really sort of figure it out. On the flip side, there's something that you talk about in your book called dream advertising.

Karen Vancampen: Yes.

Host: Help us understand what that is.

Karen Vancampen: So it was brought up a few years ago and so basically we are more there we are vulnerable when we're sleeping and so the question was brought up let's say if we have um a speaker in our in our bedroom and it could you know if we're susceptible to ideas and thoughts could it then could we be um influenced say if a company wanted to um you know say push their product while we were sleeping.

Host: Yeah. So that's kind of what it is. So, you know, the is it is it probable? Is it possible? These are sort of, you know, things where technically if we're susceptible to suggestion at certain times of the sleep sleep cycle, but is it really probable that this will change our say buying and consumer habits?

Karen Vancampen: I think that dreams are so powerful. I mean it's it makes me think you know we spend a third of our lives asleep and a large portion of that time dreaming and there's this whole this mental life that we have there that we can tap into to try and you know guide our dreams for creativity to solve problems and then in the morning use our dreams to better understand say our preoccupations or our concerns what's sort of weighing on our minds.

Host: During the production of this book, uh you have delved into a number of studies. I am curious what's one that kind of left you sitting back and being like that is like amazing to think how our brain works when it comes to dreams.

Karen Vancampen: So the the work that I was so so dreaming for sure that I talked about and then also anesthesia dreams. So, it's a group of researchers at Stanford and they've discovered that if you keep a patient at a certain brain state just under the level of consciousness, they come to this calm, relaxed state. And it's wonderful because you can revisit potentially difficult and even traumatic experiences and events, but having this calm state. So, you're able to revisit them and then almost create new memories of them. And so, I spoke with people who had these experiences as well and they said they were lifealtering, transforming. So, um it's it's unbelievable actually.

Host: The potential is the potential. Yeah, there's so much there. Um, I can't imagine what's what your bedside table looks like, but I imagine there's probably a book and a pen there. Yes. Um, I will admit before this interview this weekend, I was trying to remember my dreams, right? Uh, because lots of people when they share dreams, they want some interpretation of the symbols. Um, what do you how do we take full advantage of our dreams?

Karen Vancampen: So, I always think we're the best interpreter of our own dreams. So we it's how we want to tap into them, delve into them, look at them differently. Um, you know, we know if let's say there's a certain theme or even a person keeps showing up. The way I look at it is it's like our dreams are saying, you know, pay more attention to this idea or maybe this person. That's something um that you can do. I did um a dream salon.

Host: I did read about this. Yes. Okay.

Karen Vancampen: So it was so interesting. I've never shared a dream before and so it was with a group of friends and dream researchers and um it was so interesting because I shared a dream and the perspectives that other people had on so you you share your dream and then different people say you know if it was my dream I would maybe think about this and it totally changed my perspective on my dreams and then you know you can you can look at it from other people's perspectives and and see what works for you

Host: very fascinating exciting stuff. This is a really exciting read. Lots of potential as as we talked about. Karen, thank you so much for this. Really appreciate it.

Karen Vancampen: Thank you. It was great chatting.

Host: I'm Jan. Thanks for watching the rundown. What do you like or not like about what we're doing so far? Send us your feedback at tvo.org/runddown feedback or leave us a comment on YouTube. Until then, see you tomorrow.