Serious Mental Illness Blog

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Study Ignites Debate Over Non-Drug Treatment For SchizophreniaBy Alexandra MorrisResearchers found that by the end of the study, the patients who received cognitive therapy had reduced psychiatric symptoms as compared to those who did not receive cognitive therapy.Antipsychotic drugs are typically the first-line treatment for the roughly one percent of people who have schizophrenia — often in conjunction with psychotherapy. But for patients who are not helped by the drugs or cannot tolerate their side effects, what’s left?Last month, the Lancet published a study looking at the effects of cognitive therapy on patients with schizophrenia who refused to take medication – and prompted a heated debate within the mental health community.Cognitive therapy involves one-on-one meetings between a patient and a therapist to discuss ways to change thinking and behavior in response to their symptoms.Patients in the study were randomly assigned to receive either treatment as usual — ranging from no treatment at all to psychosocial support and other methods — or treatment as usual plus cognitive therapy. The researchers found that by the end of the study, the patients who received cognitive therapy had reduced psychiatric symptoms as compared to those who did not receive cognitive therapy.Sounds reasonable, no? But initial media coverage included headlines claiming that cognitive therapy was an effective alternative to antipsychotic treatment. The Guardian posted “At last, a promising alternative to antipsychotics for schizophrenia,” and Science magazine wrote, “Schizophrenia: Time to flush the meds?” BBC News reportedly posted a headline “Schizophrenia: Talking therapies ‘effective as drugs.’”Shortly after the study hit the press, bloggers were off and running (from PLOS to The Mental Elf), highlighting the limitations in the study design, such as the small sample size of 74 patients and the fact that nearly a third of these patients dropped out of the study partway through. They urged readers not to generalize the effect of cognitive therapy on schizophrenia based on limited evidence.In fact, cognitive therapy was never compared to antipsychotics in the study. Some patients were even prescribed antipsychotics during the trial as part of their routine treatment. Several of the media reports also failed to mention an important caveat – that the trial was conducted in a specific patient population: those with mild to moderate psychiatric symptoms, as compared to those with severe illness who require hospitalization. The findings therefore cannot be extrapolated to all patients suffering from schizophrenia.Lead study author Dr. Tony Morrison of the University of Manchester attested to the high drop-out rate. He said in an email, “The relatively high rates of attrition (planned and unplanned) clearly limit the confidence we can have in our findings and suggest the need for a larger definitive trial.” The Lancet also published a commentary – Cognitive therapy: At last an alternative to antipsychotics? – that reiterated the study’s limitations.One of the major complaints about the study had to do with the abstract’s concluding statement: “Cognitive therapy significantly reduced psychiatric symptoms and seems to be a safe and acceptable alternative for people with schizophrenia spectrum disorders who have chosen not to take antipsychotic drugs.”Dr. David Henderson, psychiatrist and director of the Schizophrenia Clinical and Research Program at Massachusetts General Hospital, said that the abstract’s conclusion is “a bit of an overstatement, in that it’s suggestive that an effective treatment for patients who don’t want to take antipsychotic medication would be CT [cognitive therapy].”And while he felt the authors presented a good and promising study, he said, “a statement generalizing [the results] to the whole population is very misleading and actually could be quite dangerous. People will want to say ‘Well, let me use CT and not medication,’ and it will be a disaster,” he said.Dr. Henderson stressed the importance of adding qualifiers to explain that the patients studied do not represent the majority of patients with schizophrenia. The study patients who were “not very symptomatic” represented just 10 percent of his schizophrenia patient population, he said.Although the abstract includes no qualifiers, the authors of the Lancet study do mention several of the study’s limitations in their discussion section. Dr. Morrison confirmed that “the results cannot be generalized to hospitalized patients, those requiring community treatment orders and those presenting significant risk to self or others” – in other words, patients with more severe forms of schizophrenia.Could cognitive therapy have an impact on these patients with more severe symptoms? That was not tested in the trial. Henderson was skeptical that it would have the same level of effect, given the severity of illness and difficulty concentrating. “If you have somebody yelling in your head constantly, it’s difficult to focus and to pay attention and to work hard,” he said.Another issue with the study: its subjects reported quite a few negative outcomes during the trial, including hospitalizations and two attempted overdoses – one in each group. This suggests that for those patients, treatment as usual even with cognitive therapy may not have been enough.Antipsychotic drugs carry their own set of issues, including side effects such as drowsiness, weight gain, tremors, and reports that the drugs “mute” patients. Some researchers, such as Dr. Thomas Insel, the director of the National Institute of Mental Health, are also raising questions about the long-term impact of these treatments. In a blog entry published last year, Dr. Insel reports on a study in which antipsychotic medication proved beneficial in the early stages of psychosis, but over the long term, it appeared to worsen the prospects of recovery.For schizophrenic patients suffering from severe illness, it’s a question of tradeoffs, said Dr. Henderson: “In this population, the risks of not being treated are far greater than the risks of the long-term effects of the medication.”What does it mean to have schizophrenia? Imagine you are told that what you know to be real – the feel of someone’s fingers touching your skin, words you believe have meaning, or your internal voice that speaks to you, advises you, warns you of imminent danger – are just symptoms of a psychiatric disease. There are no fingers touching you, the words don’t exist, and the voice, or perhaps voices, guiding you each day are simply hallucinations. You’re trapped in your own version of reality.Schizophrenia is a spectrum disorder, meaning there are varying levels of symptoms. Some patients have such severe symptoms that they require hospitalization, while others are highly functional – they can live independently, hold a steady job, engage in relationships. Given the range of illness types, it would make sense that there is no universal treatment.For people with schizophrenia today, what is the answer? Antipsychotic treatment combined with psychotherapy? Drugs alone? Cognitive therapy alone? To help answer these questions, Tony Morrison and his colleagues are moving forward with a new trial that will conduct a head-to-head comparison of cognitive therapy versus antipsychotic treatment versus a combination of the two. The findings from that study could prove to be useful for patients trying to decide between treatment options. Stay tuned for results in the summer of 2017.For now, even with the new findings, the guidelines for schizophrenia remain the same: treatment with a combination of drugs and therapy.



For more mental health news, Click Here to access the Serious Mental Illness Blog

Study Ignites Debate Over Non-Drug Treatment For Schizophrenia
By Alexandra Morris

Researchers found that by the end of the study, the patients who received cognitive therapy had reduced psychiatric symptoms as compared to those who did not receive cognitive therapy.

Antipsychotic drugs are typically the first-line treatment for the roughly one percent of people who have schizophrenia — often in conjunction with psychotherapy. But for patients who are not helped by the drugs or cannot tolerate their side effects, what’s left?
Last month, the Lancet published a study looking at the effects of cognitive therapy on patients with schizophrenia who refused to take medication – and prompted a heated debate within the mental health community.
Cognitive therapy involves one-on-one meetings between a patient and a therapist to discuss ways to change thinking and behavior in response to their symptoms.
Patients in the study were randomly assigned to receive either treatment as usual — ranging from no treatment at all to psychosocial support and other methods — or treatment as usual plus cognitive therapy. The researchers found that by the end of the study, the patients who received cognitive therapy had reduced psychiatric symptoms as compared to those who did not receive cognitive therapy.
Sounds reasonable, no? But initial media coverage included headlines claiming that cognitive therapy was an effective alternative to antipsychotic treatment. The Guardian posted “At last, a promising alternative to antipsychotics for schizophrenia,” and Science magazine wrote, “Schizophrenia: Time to flush the meds?” BBC News reportedly posted a headline “Schizophrenia: Talking therapies ‘effective as drugs.’”
Shortly after the study hit the press, bloggers were off and running (from PLOS to The Mental Elf), highlighting the limitations in the study design, such as the small sample size of 74 patients and the fact that nearly a third of these patients dropped out of the study partway through. They urged readers not to generalize the effect of cognitive therapy on schizophrenia based on limited evidence.
In fact, cognitive therapy was never compared to antipsychotics in the study. Some patients were even prescribed antipsychotics during the trial as part of their routine treatment. Several of the media reports also failed to mention an important caveat – that the trial was conducted in a specific patient population: those with mild to moderate psychiatric symptoms, as compared to those with severe illness who require hospitalization. The findings therefore cannot be extrapolated to all patients suffering from schizophrenia.
Lead study author Dr. Tony Morrison of the University of Manchester attested to the high drop-out rate. He said in an email, “The relatively high rates of attrition (planned and unplanned) clearly limit the confidence we can have in our findings and suggest the need for a larger definitive trial.” The Lancet also published a commentary – Cognitive therapy: At last an alternative to antipsychotics? – that reiterated the study’s limitations.
One of the major complaints about the study had to do with the abstract’s concluding statement: “Cognitive therapy significantly reduced psychiatric symptoms and seems to be a safe and acceptable alternative for people with schizophrenia spectrum disorders who have chosen not to take antipsychotic drugs.”
Dr. David Henderson, psychiatrist and director of the Schizophrenia Clinical and Research Program at Massachusetts General Hospital, said that the abstract’s conclusion is “a bit of an overstatement, in that it’s suggestive that an effective treatment for patients who don’t want to take antipsychotic medication would be CT [cognitive therapy].”
And while he felt the authors presented a good and promising study, he said, “a statement generalizing [the results] to the whole population is very misleading and actually could be quite dangerous. People will want to say ‘Well, let me use CT and not medication,’ and it will be a disaster,” he said.
Dr. Henderson stressed the importance of adding qualifiers to explain that the patients studied do not represent the majority of patients with schizophrenia. The study patients who were “not very symptomatic” represented just 10 percent of his schizophrenia patient population, he said.
Although the abstract includes no qualifiers, the authors of the Lancet study do mention several of the study’s limitations in their discussion section. Dr. Morrison confirmed that “the results cannot be generalized to hospitalized patients, those requiring community treatment orders and those presenting significant risk to self or others” – in other words, patients with more severe forms of schizophrenia.
Could cognitive therapy have an impact on these patients with more severe symptoms? That was not tested in the trial. Henderson was skeptical that it would have the same level of effect, given the severity of illness and difficulty concentrating. “If you have somebody yelling in your head constantly, it’s difficult to focus and to pay attention and to work hard,” he said.
Another issue with the study: its subjects reported quite a few negative outcomes during the trial, including hospitalizations and two attempted overdoses – one in each group. This suggests that for those patients, treatment as usual even with cognitive therapy may not have been enough.
Antipsychotic drugs carry their own set of issues, including side effects such as drowsiness, weight gain, tremors, and reports that the drugs “mute” patients. Some researchers, such as Dr. Thomas Insel, the director of the National Institute of Mental Health, are also raising questions about the long-term impact of these treatments. In a blog entry published last year, Dr. Insel reports on a study in which antipsychotic medication proved beneficial in the early stages of psychosis, but over the long term, it appeared to worsen the prospects of recovery.
For schizophrenic patients suffering from severe illness, it’s a question of tradeoffs, said Dr. Henderson: “In this population, the risks of not being treated are far greater than the risks of the long-term effects of the medication.”
What does it mean to have schizophrenia? Imagine you are told that what you know to be real – the feel of someone’s fingers touching your skin, words you believe have meaning, or your internal voice that speaks to you, advises you, warns you of imminent danger – are just symptoms of a psychiatric disease. There are no fingers touching you, the words don’t exist, and the voice, or perhaps voices, guiding you each day are simply hallucinations. You’re trapped in your own version of reality.
Schizophrenia is a spectrum disorder, meaning there are varying levels of symptoms. Some patients have such severe symptoms that they require hospitalization, while others are highly functional – they can live independently, hold a steady job, engage in relationships. Given the range of illness types, it would make sense that there is no universal treatment.
For people with schizophrenia today, what is the answer? Antipsychotic treatment combined with psychotherapy? Drugs alone? Cognitive therapy alone? To help answer these questions, Tony Morrison and his colleagues are moving forward with a new trial that will conduct a head-to-head comparison of cognitive therapy versus antipsychotic treatment versus a combination of the two. The findings from that study could prove to be useful for patients trying to decide between treatment options. Stay tuned for results in the summer of 2017.
For now, even with the new findings, the guidelines for schizophrenia remain the same: treatment with a combination of drugs and therapy.





For more mental health news, Click Here to access the Serious Mental Illness Blog

Filed under psychotic psychosis schizophrenia psycho mad madness crazy recovery health illness mental health mental illness mind brain body therapy cbt psychology psychiatry med meds drug drugs news science research study hallucination delusion diagnosis

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Residual depression has lasting impact on bipolar patientsBy Eleanor McDermid, Senior medwireNews ReporterIn bipolar disorder, depressive symptoms are not only negatively associated with the outcome, but also affect verbal memory performanceA prospective study confirms the detrimental effect of subthreshold depressive symptoms on the outcomes of patients with bipolar disorder.
The findings, published in the Journal of Affective Disorders, also suggest that the effect is partly mediated by cognitive impairment.Researcher Anabel Martínez-Arán (University of Barcelona, Spain) and colleagues say that most studies have been cross-sectional, whereas they followed up 111 patients for 1 year. The patients were aged an average of 40 years and 78.4% had bipolar I disorder; all were euthymic at inclusion.
The team assessed verbal memory (using the California Verbal Learning Test), because impairment in this neurocognitive function is thought to be a core feature of bipolar disorder. Along with subsyndromal depressive symptoms (≤8 on the Hamilton Depression Rating Scale), patients’ composite verbal memory score explained 19% of the variance in their baseline scores on the Functioning Assessment Short Test (FAST).
Subthreshold depressive symptoms and verbal memory were associated with each other, such that patients with more depressive symptoms had larger memory impairments. They were also individually associated with baseline functional status.
“Thus in bipolar disorder, depressive symptoms are not only negatively associated with the outcome, but also affect verbal memory performance,” say the researchers.
Verbal memory had a significant indirect effect on outcome, partly mediating the relationship between depressive symptoms and functional status.
During 1 year of follow-up, patients’ functional status remained fairly stable overall, with average FAST scores of 29 at baseline and 27 at follow-up. Baseline functional status explained 44% of the variance in 1-year functional outcomes.
As baseline functional status was, in turn, partly dependent on depressive symptoms and verbal memory, these variables therefore contribute to follow-up functional outcomes, explain Martínez-Arán et al.The researchers note, however, that the study only assessed verbal memory, and impairments in this domain could be partly caused by other neurocognitive deficits.
“The identification of mediators in the prediction of functional outcome may help to disentangle the complex network of variables that contribute to functional outcome, since many variables with direct and indirect effects might be involved,” they conclude.


For more mental health news, Click Here to access the Serious Mental Illness Blog

Residual depression has lasting impact on bipolar patients
By Eleanor McDermid, Senior medwireNews Reporter

In bipolar disorder, depressive symptoms are not only negatively associated with the outcome, but also affect verbal memory performance

A prospective study confirms the detrimental effect of subthreshold depressive symptoms on the outcomes of patients with bipolar disorder.

The findings, published in the Journal of Affective Disorders, also suggest that the effect is partly mediated by cognitive impairment.
Researcher Anabel Martínez-Arán (University of Barcelona, Spain) and colleagues say that most studies have been cross-sectional, whereas they followed up 111 patients for 1 year. The patients were aged an average of 40 years and 78.4% had bipolar I disorder; all were euthymic at inclusion.

The team assessed verbal memory (using the California Verbal Learning Test), because impairment in this neurocognitive function is thought to be a core feature of bipolar disorder. Along with subsyndromal depressive symptoms (≤8 on the Hamilton Depression Rating Scale), patients’ composite verbal memory score explained 19% of the variance in their baseline scores on the Functioning Assessment Short Test (FAST).

Subthreshold depressive symptoms and verbal memory were associated with each other, such that patients with more depressive symptoms had larger memory impairments. They were also individually associated with baseline functional status.

“Thus in bipolar disorder, depressive symptoms are not only negatively associated with the outcome, but also affect verbal memory performance,” say the researchers.

Verbal memory had a significant indirect effect on outcome, partly mediating the relationship between depressive symptoms and functional status.

During 1 year of follow-up, patients’ functional status remained fairly stable overall, with average FAST scores of 29 at baseline and 27 at follow-up. Baseline functional status explained 44% of the variance in 1-year functional outcomes.

As baseline functional status was, in turn, partly dependent on depressive symptoms and verbal memory, these variables therefore contribute to follow-up functional outcomes, explain Martínez-Arán et al.
The researchers note, however, that the study only assessed verbal memory, and impairments in this domain could be partly caused by other neurocognitive deficits.

“The identification of mediators in the prediction of functional outcome may help to disentangle the complex network of variables that contribute to functional outcome, since many variables with direct and indirect effects might be involved,” they conclude.





For more mental health news, Click Here to access the Serious Mental Illness Blog

Filed under mental illness mental health mental health illness bipolar depressed depression depressive research neuro neuroscience psychology psychiatry psych psy tumblr news mad madness recovery recover mind body brain sad sadness cognition science scientific

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After I Was Diagnosed With Bipolar Disorder, I Decided to Move ForwardBy Cooper Moll; Mental health advocate, psychology student
Arianna Huffington has invited her Facebook followers to share their wake-up calls — the moments they knew they had to make changes in their lives in order to truly thrive and not just succeed — as part of a series produced in conjunction with the release of her book Thrive: The Third Metric to Redefining Success and Creating a Life of Well-Being, Wisdom, Wonder and Giving. You can read all the posts in the series here.
When I was 17 years old, I was diagnosed with Bipolar Disorder, something that came as no surprise, as my life prior to my diagnosis was fraught with behavioral challenges. At 21 years old, after years of battling uncontrollable moods, fits of rage, a myriad of body image issues, addiction and frustration with finding adequate medication I found myself in my first psychotic episode. This was no way to live, I knew I was capable of so much more as an articulate young woman with big dreams. At 5 o’clock in the morning on July 7, 2011, after driving through the night with a head full of racing thoughts in a mind that possessed zero ability to cope, I found myself collapsed on the porch of my father’s home manic, enraged and inconsolable. I was surrendering, I could no longer fight the battle my life prior to that summer had felt so unrelenting and inhibiting. After a brief rest early that morning, the first few hours of sleep I had experienced in days, is when made my decision to thrive. For years prior to that hazy morning, I had been urged by loved ones to receive intensive clinical psychological treatment in a formal setting, but I believe part of me was always resisting in denial and arrogance. It was at the end of my rope where I found my desire to change the trajectory of my life. On July 11, 2011, I made the first imprints in the path toward my new way of being in the world. I spent 90 days in intensive psychological care and healing treatment where I acquired invaluable “tools” that allowed me to move forward in the world, the woman I was on my father’s porch that July morning became a shadow of my former self and an unwelcome stranger in my future. 
Almost three years later not a day goes by where I don’t draw on the lessons learned through my decision to thrive. I am currently finishing my Bachelor’s degree in clinical psychology and work as a peer counselor to youth experiencing their first onset of mental illness in Los Angeles, California. Everything I do comes from a place of gratitude for my demons and experiences that catalyzed my decision to forge the path I am on today. For I would be nothing without them just as I would be nothing without the boundless compassion, patience and support of the loved ones in my life who have championed all of my efforts.
I used to think the notion that people could change was a farce … until I did it myself. I am changing everyday, creating a more authentic self with every opportunity to do so, and within the beautiful chaos of it all — I am thriving.
(Image credits: Bipolar Disorder 1 by chi-of-ink)


For more mental health news, Click Here to access the Serious Mental Illness Blog

After I Was Diagnosed With Bipolar Disorder, I Decided to Move Forward
By Cooper Moll; Mental health advocate, psychology student

Arianna Huffington has invited her Facebook followers to share their wake-up calls — the moments they knew they had to make changes in their lives in order to truly thrive and not just succeed — as part of a series produced in conjunction with the release of her book Thrive: The Third Metric to Redefining Success and Creating a Life of Well-Being, Wisdom, Wonder and Giving. You can read all the posts in the series here.

When I was 17 years old, I was diagnosed with Bipolar Disorder, something that came as no surprise, as my life prior to my diagnosis was fraught with behavioral challenges. At 21 years old, after years of battling uncontrollable moods, fits of rage, a myriad of body image issues, addiction and frustration with finding adequate medication I found myself in my first psychotic episode. This was no way to live, I knew I was capable of so much more as an articulate young woman with big dreams. At 5 o’clock in the morning on July 7, 2011, after driving through the night with a head full of racing thoughts in a mind that possessed zero ability to cope, I found myself collapsed on the porch of my father’s home manic, enraged and inconsolable. I was surrendering, I could no longer fight the battle my life prior to that summer had felt so unrelenting and inhibiting. After a brief rest early that morning, the first few hours of sleep I had experienced in days, is when made my decision to thrive. For years prior to that hazy morning, I had been urged by loved ones to receive intensive clinical psychological treatment in a formal setting, but I believe part of me was always resisting in denial and arrogance. It was at the end of my rope where I found my desire to change the trajectory of my life. On July 11, 2011, I made the first imprints in the path toward my new way of being in the world. I spent 90 days in intensive psychological care and healing treatment where I acquired invaluable “tools” that allowed me to move forward in the world, the woman I was on my father’s porch that July morning became a shadow of my former self and an unwelcome stranger in my future. 

Almost three years later not a day goes by where I don’t draw on the lessons learned through my decision to thrive. I am currently finishing my Bachelor’s degree in clinical psychology and work as a peer counselor to youth experiencing their first onset of mental illness in Los Angeles, California. Everything I do comes from a place of gratitude for my demons and experiences that catalyzed my decision to forge the path I am on today. For I would be nothing without them just as I would be nothing without the boundless compassion, patience and support of the loved ones in my life who have championed all of my efforts.

I used to think the notion that people could change was a farce … until I did it myself. I am changing everyday, creating a more authentic self with every opportunity to do so, and within the beautiful chaos of it all — I am thriving.

(Image credits: Bipolar Disorder 1 by chi-of-ink)



For more mental health news, Click Here to access the Serious Mental Illness Blog

Filed under news story true story bipolar bipolar disorder disorder diagnosis hope recovery rethinking madness madness crazy manic psychosis psychotic recover mental health mental illness health illness psychology psychiatry med meds therapy mental mad mind body brain

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Mental Illness Parity Needs to Be the New Gay RightsOpinion By Marilee Newell
While sexuality is an aspect of human nature to embrace whereas moodiness, depression, and paranoia may be harder to stomach, these are aspects of human nature too, and nobody — especially if they have no choice over their behavior — deserves to be the target of discriminatory laws and assumptions that make their lives even more difficult.Mental illness and homosexuality are considered separate issues in 2014, but one important thing they have in common is a long history of cultural perception revolving around the individual’s “choice” to be gay or “choice” to be mentally ill. Retired psychologist Dr. Philip Hickey says that until 1974, homosexuality was even considered a mental illness by the American Psychiatric Association. Hickey calls homosexuality “the mental illness that went away” and says that mainstream vilification and persecution of homosexuals was done away with because “gay people gained a voice and began to make themselves heard.” Society has proved itself capable of deeper understanding and a broader concept of human rights in terms of gay parity and anti-discrimination laws over the past decade: now mental illness parity needs to follow suit in the cultural consciousness.
There was no scientific breakthrough justifying the removal of homosexuality from the DSM-II, according to Hickey — just a gradual shift in understanding. Hickey says that there are no mental illnesses, only complicated people — and yet, many people in the United States living with diagnoses recognized as mental illnesses are subject to the kinds of persecution and sensationalizing of their conditions that, were it directed at a different people-group, would be seen as outright bigoted.
There is much conflicting information about mental illness and so many unknowns. This complicates understanding. Some studies indicate that mental illness is caused by a person’s environment: rates of mental illness have shown to be higher in soldiers than civilians, for example. Other studies point toward a genetic cause, such as a father aged upwards of 45.
Many people living with mental illness feel afraid to come out of the closet and tell their friends and co-workers of their condition for fear of stigma. In the US, health insurance companies have denied coverage to the mentally ill. What will it take for people with mental illnesses to feel that they can make their voices heard in society? In the Gay Rights Movement, many prominent public figures and celebrities came out as either gay or in support of gay rights, speaking up for those who did not have a voice. In his 2006 documentary The Secret Life of the Manic Depressive, British actor and writer Stephen Fry explores his own journey living with a mental illness, as well as the story of Princess Leia actress Carrie Fischer.
The behavior of a person with a mental illness is often assumed to be the person’s fault: poor impulse control, bad choices, and drug use — without much insight on the part of the person making the assumption that many people with such illnesses use drugs and alcohol to slf-medicate. Additionally, many people may not have access to effective, legal treatments such as psychiatric evaluation and therapy. Even when people have access to therapeutic medications, many of the generic versions of these drugs are manufactured in China and India without adequate FDA regulation, in order to save US drug companies money. Some generics are essentially placebos with no active ingredients, and yet for many people insurance will not cover the more closely regulated name-brand drugs, which can cost as much as $250 per medication, per month. Seeing as 1 in 5 Americans is estimated to have a mental illness, what if society became as outraged over this lack of parity for America’s mentally ill as, during the recent Sochi Olympics, Americans became outraged by Vladimir Putin’s law against promoting homosexuality to minors? Americans were also shocked at Russia imprisoning people for being homosexual, yet unmedicated people with mental illnesses often end up in America’s for-profit prison system.
Perhaps this is because there is a strain running through American society that seems to be telling people mental illness is just an excuse for bad behavior. Fox News recently ran the headline “Kidnapping dad caught faking mental illness,” emphasizing a plea of mental insanity as a way of getting away with crimes. In literature, too, there is the notion that the mad woman in the attic is not really mad.When former child star Amanda Bynes famously went through a psychotic break in 2013, many people, ignorant of what a bipolar or schizophrenic episode might look like, assumed from Bynes’s behavior that she was a simply spoiled star who had let fame and fortune ruin her judgment instead of a person in desperate need of compassion and help. When Bynes finally set fire to herself and her dog in a woman’s driveway, was placed under a psychiatric hold, and diagnosed with schizophrenia, the press finally had the decency to stop jeering at her downfall (although perhaps then only because in hospital she was away from the public eye).
A society that can move away from prejudices against homosexuality and towards an acceptance of gay parity laws should be capable of the move towards treating those who live with mental illness with acceptance, as human beings, with understanding of their reality. While sexuality is an aspect of human nature to embrace whereas moodiness, depression, and paranoia may be harder to stomach, these are aspects of human nature too, and nobody — especially if they have no choice over their behavior — deserves to be the target of discriminatory laws and assumptions that make their lives even more difficult.


For more mental health news, Click Here to access the Serious Mental Illness Blog

Mental Illness Parity Needs to Be the New Gay Rights
Opinion By Marilee Newell

While sexuality is an aspect of human nature to embrace whereas moodiness, depression, and paranoia may be harder to stomach, these are aspects of human nature too, and nobody — especially if they have no choice over their behavior — deserves to be the target of discriminatory laws and assumptions that make their lives even more difficult.

Mental illness and homosexuality are considered separate issues in 2014, but one important thing they have in common is a long history of cultural perception revolving around the individual’s “choice” to be gay or “choice” to be mentally ill. Retired psychologist Dr. Philip Hickey says that until 1974, homosexuality was even considered a mental illness by the American Psychiatric Association. Hickey calls homosexuality “the mental illness that went away” and says that mainstream vilification and persecution of homosexuals was done away with because “gay people gained a voice and began to make themselves heard.” Society has proved itself capable of deeper understanding and a broader concept of human rights in terms of gay parity and anti-discrimination laws over the past decade: now mental illness parity needs to follow suit in the cultural consciousness.

There was no scientific breakthrough justifying the removal of homosexuality from the DSM-II, according to Hickey — just a gradual shift in understanding. Hickey says that there are no mental illnesses, only complicated people — and yet, many people in the United States living with diagnoses recognized as mental illnesses are subject to the kinds of persecution and sensationalizing of their conditions that, were it directed at a different people-group, would be seen as outright bigoted.

There is much conflicting information about mental illness and so many unknowns. This complicates understanding. Some studies indicate that mental illness is caused by a person’s environment: rates of mental illness have shown to be higher in soldiers than civilians, for example. Other studies point toward a genetic cause, such as a father aged upwards of 45.

Many people living with mental illness feel afraid to come out of the closet and tell their friends and co-workers of their condition for fear of stigma. In the US, health insurance companies have denied coverage to the mentally ill. What will it take for people with mental illnesses to feel that they can make their voices heard in society? In the Gay Rights Movement, many prominent public figures and celebrities came out as either gay or in support of gay rights, speaking up for those who did not have a voice. In his 2006 documentary The Secret Life of the Manic Depressive, British actor and writer Stephen Fry explores his own journey living with a mental illness, as well as the story of Princess Leia actress Carrie Fischer.

The behavior of a person with a mental illness is often assumed to be the person’s fault: poor impulse control, bad choices, and drug use — without much insight on the part of the person making the assumption that many people with such illnesses use drugs and alcohol to slf-medicate. Additionally, many people may not have access to effective, legal treatments such as psychiatric evaluation and therapy. Even when people have access to therapeutic medications, many of the generic versions of these drugs are manufactured in China and India without adequate FDA regulation, in order to save US drug companies money. Some generics are essentially placebos with no active ingredients, and yet for many people insurance will not cover the more closely regulated name-brand drugs, which can cost as much as $250 per medication, per month. Seeing as 1 in 5 Americans is estimated to have a mental illness, what if society became as outraged over this lack of parity for America’s mentally ill as, during the recent Sochi Olympics, Americans became outraged by Vladimir Putin’s law against promoting homosexuality to minors? Americans were also shocked at Russia imprisoning people for being homosexual, yet unmedicated people with mental illnesses often end up in America’s for-profit prison system.

Perhaps this is because there is a strain running through American society that seems to be telling people mental illness is just an excuse for bad behavior. Fox News recently ran the headline “Kidnapping dad caught faking mental illness,” emphasizing a plea of mental insanity as a way of getting away with crimes. In literature, too, there is the notion that the mad woman in the attic is not really mad.
When former child star Amanda Bynes famously went through a psychotic break in 2013, many people, ignorant of what a bipolar or schizophrenic episode might look like, assumed from Bynes’s behavior that she was a simply spoiled star who had let fame and fortune ruin her judgment instead of a person in desperate need of compassion and help. When Bynes finally set fire to herself and her dog in a woman’s driveway, was placed under a psychiatric hold, and diagnosed with schizophrenia, the press finally had the decency to stop jeering at her downfall (although perhaps then only because in hospital she was away from the public eye).

A society that can move away from prejudices against homosexuality and towards an acceptance of gay parity laws should be capable of the move towards treating those who live with mental illness with acceptance, as human beings, with understanding of their reality. While sexuality is an aspect of human nature to embrace whereas moodiness, depression, and paranoia may be harder to stomach, these are aspects of human nature too, and nobody — especially if they have no choice over their behavior — deserves to be the target of discriminatory laws and assumptions that make their lives even more difficult.



For more mental health news, Click Here to access the Serious Mental Illness Blog

Filed under mental health illness psy psych psychologyy mental health mental illness psychology psychiatry stigma gay rights gay rights stigmatizing mad madness rethinking madness human rights diagnosis dsm homosexuality mentally ill apa sexuality sex gender equality

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Op-ed: Mental illness: Another point of viewBy: Richard Shulman
Richard Shulman, Ph.D., is a licensed psychologist and director of West Hartford-based Volunteers In Psychotherapy, which provides strictly private therapy to people in exchange for community volunteer work they provide, privately and independently, to the charity of their choice.
The Connecticut Forum will soon host a panel of celebrities and professionals to take “An Honest Look at Mental Illness.”  The selected panelists’ consensus is that science has demonstrated that ‘mental illnesses’ are illnesses – biological diseases of bodily tissue… (and that pharmaceuticals are indispensable).
The problem: Prominent psychiatrists – the same people who promulgated this view – now admit that this isn’t demonstrated fact. Never has been.
The psychiatrist heading the National Institute of Mental Health criticized psychiatric “diagnoses” as lacking in both “validity” and any “objective laboratory measure.” His NIMH predecessor agreed: “psychiatric diagnoses seem arbitrary and lack objective tests; and there are no validated biomarkers…”.
Physician Marcia Angell, M.D., former editor-in-chief of the “New England Journal of Medicine,” concurs:  “Unlike the conditions treated in most other branches of medicine, there are no objective signs or tests for mental illness – no lab data or MRI findings…”  “I have spent most of my professional life evaluating the quality of clinical research, and I believe it is especially poor in psychiatry.”
A prominent psychiatrist admitted in the “Psychiatric Times” that the truism repeated to the public, about people’s problems being rooted in “chemical imbalances,” is an “urban legend” – “never a theory seriously propounded by well informed psychiatrists.”
But, isn’t this the very explanation most psychiatric professionals promote to the public? Based on past statements, there’s little evidence that this viewpoint, or the centrality of psychotropic medications, will be questioned by Forum panelists.
People who are upset, confused, overwhelmed are presumed “ill” – not emotionally distressed but medically sick.
For 20 years I served on the Institutional Review Board (IRB) of Hartford Hospital–Institute of Living, an ethics-in-research committee. IRBs ensure that potential research participants are told the truth about their medical or psychiatric conditions. “Informed Consent” is the medical ethics doctrine requiring that people be given accurate, understandable information; to make their own decisions based on honest assessments of their conditions, and the known risks/benefits of their options.
Researchers (whether funded by drug companies, government or others) are required to submit to IRBs their research designs, including comprehensive summaries of previous research. Buried in pages of background, these scientists repeatedly admit that the conditions we mislabel “psychiatric illnesses” are simply not documented to be diseases of the body – despite decades of attempts to verify biomarkers, specific lesions or physical/chemical malfunctions that might cause these “conditions.”
No reliable, reproducible research has ever demonstrated people’s sadness (“depression”) or a child’s rambunctiousness (“ADHD”) to be physically rooted in tissue abnormality; nor is there an identifiable brain disease called “schizophrenia.” Physical confirmation of “mental illness” is unavailable in research, hence absent in clinical practice.
Check any library. Medical pathology textbooks codify disease — verifiable physical/chemical abnormalities. “Psychopathology” lists theories – not established physical evidence. Markedly different rules of science, logic and culture apply in psychiatry compared to medical science. The proponents of biological theories, ascendant in psychiatry and pharmaceutical companies, downplay this illogicality.
Will Forum panelists tell you that the National Alliance on Mental Illness, the most media-quoted nonprofit source of “lay” information, was secretly majority-funded by the pharmaceutical industry, until a congressional inquiry forced NAMI to divulge their commercial backing?
Will panelists admit the non-specificity of psychoactive medications, their documented sedative, stimulant or placebo effects, and their often downplayed but expectable side-effects?
Will there be any mention of “Anatomy of an Epidemic,” which won the prestigious Investigative Reporters and Editors Prize for best book of 2010 (with judges’ comments, “an in-depth exploration of medical studies and science … [that] punches holes in the conventional wisdom of treatment of mental illness with drugs.”)?
Neglected, in the tunnel-vision search for the biological cause and nature of “mental illness” (and its misleading promotion as established fact) is human experience.
News outlets regularly publish stories of murder, sexual abuse, genocide, family conflict. We human beings, affected by overwhelming events, sometimes show our distress in complex, confusing ways. We may cope with painful, troubling personal difficulties and secrets, and usually work hard to keep those secrets — sometimes even deceiving ourselves.
We can and do help people with their private confusions, trauma, upset and conflict – without a “medical” paradigm that may interfere with their self-examination and improvement. A growing number of resources, including Greater Hartford’s Volunteers In Psychotherapy, help people by exploring and discussing people’s private lives under truly private conditions (with no reports to insurers).
You deserve a second opinion. An “Honest Look” must include the previously mentioned empirical findings… and must consider people’s troubling secrets, which often explain their initially inscrutable personal problems.


For more mental health news, Click Here to access the Serious Mental Illness Blog

Op-ed: Mental illness: Another point of view
By: Richard Shulman

Richard Shulman, Ph.D., is a licensed psychologist and director of West Hartford-based Volunteers In Psychotherapy, which provides strictly private therapy to people in exchange for community volunteer work they provide, privately and independently, to the charity of their choice.

The Connecticut Forum will soon host a panel of celebrities and professionals to take “An Honest Look at Mental Illness.”  The selected panelists’ consensus is that science has demonstrated that ‘mental illnesses’ are illnesses – biological diseases of bodily tissue… (and that pharmaceuticals are indispensable).

The problem: Prominent psychiatrists – the same people who promulgated this view – now admit that this isn’t demonstrated fact. Never has been.

The psychiatrist heading the National Institute of Mental Health criticized psychiatric “diagnoses” as lacking in both “validity” and any “objective laboratory measure.” His NIMH predecessor agreed: “psychiatric diagnoses seem arbitrary and lack objective tests; and there are no validated biomarkers…”.

Physician Marcia Angell, M.D., former editor-in-chief of the “New England Journal of Medicine,” concurs:  “Unlike the conditions treated in most other branches of medicine, there are no objective signs or tests for mental illness – no lab data or MRI findings…”  “I have spent most of my professional life evaluating the quality of clinical research, and I believe it is especially poor in psychiatry.”

A prominent psychiatrist admitted in the “Psychiatric Times” that the truism repeated to the public, about people’s problems being rooted in “chemical imbalances,” is an “urban legend” – “never a theory seriously propounded by well informed psychiatrists.”

But, isn’t this the very explanation most psychiatric professionals promote to the public? Based on past statements, there’s little evidence that this viewpoint, or the centrality of psychotropic medications, will be questioned by Forum panelists.

People who are upset, confused, overwhelmed are presumed “ill” – not emotionally distressed but medically sick.

For 20 years I served on the Institutional Review Board (IRB) of Hartford Hospital–Institute of Living, an ethics-in-research committee. IRBs ensure that potential research participants are told the truth about their medical or psychiatric conditions. “Informed Consent” is the medical ethics doctrine requiring that people be given accurate, understandable information; to make their own decisions based on honest assessments of their conditions, and the known risks/benefits of their options.

Researchers (whether funded by drug companies, government or others) are required to submit to IRBs their research designs, including comprehensive summaries of previous research. Buried in pages of background, these scientists repeatedly admit that the conditions we mislabel “psychiatric illnesses” are simply not documented to be diseases of the body – despite decades of attempts to verify biomarkers, specific lesions or physical/chemical malfunctions that might cause these “conditions.”

No reliable, reproducible research has ever demonstrated people’s sadness (“depression”) or a child’s rambunctiousness (“ADHD”) to be physically rooted in tissue abnormality; nor is there an identifiable brain disease called “schizophrenia.” Physical confirmation of “mental illness” is unavailable in research, hence absent in clinical practice.

Check any library. Medical pathology textbooks codify disease — verifiable physical/chemical abnormalities. “Psychopathology” lists theories – not established physical evidence. Markedly different rules of science, logic and culture apply in psychiatry compared to medical science. The proponents of biological theories, ascendant in psychiatry and pharmaceutical companies, downplay this illogicality.

Will Forum panelists tell you that the National Alliance on Mental Illness, the most media-quoted nonprofit source of “lay” information, was secretly majority-funded by the pharmaceutical industry, until a congressional inquiry forced NAMI to divulge their commercial backing?

Will panelists admit the non-specificity of psychoactive medications, their documented sedative, stimulant or placebo effects, and their often downplayed but expectable side-effects?

Will there be any mention of “Anatomy of an Epidemic,” which won the prestigious Investigative Reporters and Editors Prize for best book of 2010 (with judges’ comments, “an in-depth exploration of medical studies and science … [that] punches holes in the conventional wisdom of treatment of mental illness with drugs.”)?

Neglected, in the tunnel-vision search for the biological cause and nature of “mental illness” (and its misleading promotion as established fact) is human experience.

News outlets regularly publish stories of murder, sexual abuse, genocide, family conflict. We human beings, affected by overwhelming events, sometimes show our distress in complex, confusing ways. We may cope with painful, troubling personal difficulties and secrets, and usually work hard to keep those secrets — sometimes even deceiving ourselves.

We can and do help people with their private confusions, trauma, upset and conflict – without a “medical” paradigm that may interfere with their self-examination and improvement. A growing number of resources, including Greater Hartford’s Volunteers In Psychotherapy, help people by exploring and discussing people’s private lives under truly private conditions (with no reports to insurers).

You deserve a second opinion. An “Honest Look” must include the previously mentioned empirical findings… and must consider people’s troubling secrets, which often explain their initially inscrutable personal problems.



For more mental health news, Click Here to access the Serious Mental Illness Blog

Filed under psy psych psychology psychiatry psychological research psychiatrist crazy mad madness rethinking madness diagnosis mental illness mental health mental illness health therapy hope recovery recover mind body brain neuro neuroscience new news science scientific

24 notes

Schizophrenic and wanting to connectBy Michael Hedrick
It takes work, a lot of work, to get better, but it can be done. It has been a long road from that first group therapy session. But life is nothing if it’s not a road. 
I still remember the first group therapy session I went to after I got out of the hospital. I was 20 and had been diagnosed as schizophrenic after a road trip that took me from Colorado to the United Nations building in New York City, my mind riddled with notions of good and evil, demons and angels, and a determination to save the world. Now I was in something of a state of shock, having come to understand that amid the delusions and paranoia that swarmed through my head I was, in reality, insane.
A constant need to move felt like ants crawling over my skin, a side effect of the antipsychotic medications I had been prescribed. Every second of every day, I felt like clawing out my eyes and tearing out my hair because I just couldn’t sit still.
I held up my front, though. I smiled when I thought I had to and tried to be nice to people. Laughter, however, was not something that was possible, and wouldn’t be for a long time.
The group was a dual-functioning therapy technique to address both mental health issues and drug abuse. I had been assigned to it after disclosing that I had a marijuana habit. The doctors had told me that therapy groups were an integral part of my getting better. I agreed to go only to get out of the hospital prison and back home to my warm bed.
I sat in a circle with a melting pot of people. There was the construction worker still wearing dusty boots and clothes splattered with mud, and the depressed sorority girl, makeup and hair still impeccable. The two had formed a friendship over their history with methamphetamine. There was the quiet bipolar Hispanic man who spoke only in short staccato sentences, and the rotund marketing guy who introduced himself by saying his drugs of choice were food, cocaine and marijuana.
I sat there looking at them, hands nervously trying to find a natural position. I could tell they were thinking things about me, adjudicating me on my appearance and facial expressions. While they nodded in a sort of feigned acceptance, I knew they were going to go back to their friends and joke about me, the schizophrenic kid who looked weird.
When it was my turn to speak, I stood and told them in a quiet voice, almost so quiet you couldn’t hear the nervous wavering, that my name was Mike. “Hey Mike, welcome” rang the chorus in a strange unison. It seemed welcoming, but I knew they were waiting for their opportunity to strike. Summoning everything to get any words out, I told them that I had been an inpatient the previous week, where the doctors said I was schizophrenic, and that my drugs of choice were marijuana, cigarettes and, taking a cue from the marketing guy, food.
Having their eyes on me was a special kind of hell, as I stood there fidgeting and averting my gaze. They were all drilling holes into me, isolating my weaknesses and then laughing about them to themselves. They were wolves, chewing at and snapping my bones. I just wanted to get out, but I continued, and when I was done, I sat back down in the chair and lowered my head, refusing to say a thing or acknowledge anyone for the rest of the session.
How had it come to this? I had been happy in high school, popular even, unafraid of my own insecurities, unconcerned with what people thought of me. I can remember having friends from every different clique, every group and every grade. The ability to connect with people seemed so effortless then.
It’s a goal I’ve been striving to reattain for the last eight years.
When you have schizophrenia, the overarching plot of the experience is the inability to tell whether the things you are thinking are actually taking place in reality. Was that inflection in your voice a signal that I should be more friendly — or more reserved? Was that laughter I heard over my shoulder about me or something totally innocuous? These are the kinds of things I ask myself daily.
Recovering from mental illness is a process. It takes diligence in therapy, a strong support system and habitually taking your meds. With different drugs, the paranoia has calmed down, though it is still there, a reminder I’m still sick. Learning to accept what that paranoia was telling me and being all right with it, that I would still be the same person whether or not people thought negative things about me, has been a big part of my recovery.
Since that first group therapy session, I’ve worked harder than you can imagine trying to perfect a state of normal. Regaining the ability to relate to others has been a driving force. I’ve studied books on body language, manners, neuroscience and behavior just to get any small grasp on being a normal person. I know that if I do it right, and successfully connect with another human being, I feel giddy. But more often the interactions are a bit off, or a lot off, though not the end of the world.
Needless to say, it should be obvious that dating is hard for me. But I have friends, and they all know that I have schizophrenia and don’t seem to mind. They seem to accept that mental illness is a disease and not some defect of self. I can see the stigma lessening day by day, although a lot of people are still afraid of it. It’s nothing that a few little jokes and a sense of humor often can’t fix. Still, I know many others with schizophrenia who don’t have it as easy, who suffer every day, and I feel for them because I’ve sure been there.
It takes work, a lot of work, to get better, but it can be done. It has been a long road from that first group therapy session. But life is nothing if it’s not a road.


For more mental health news, Click Here to access the Serious Mental Illness Blog

Schizophrenic and wanting to connect
By Michael Hedrick

It takes work, a lot of work, to get better, but it can be done. It has been a long road from that first group therapy session. But life is nothing if it’s not a road. 

I still remember the first group therapy session I went to after I got out of the hospital. I was 20 and had been diagnosed as schizophrenic after a road trip that took me from Colorado to the United Nations building in New York City, my mind riddled with notions of good and evil, demons and angels, and a determination to save the world. Now I was in something of a state of shock, having come to understand that amid the delusions and paranoia that swarmed through my head I was, in reality, insane.

A constant need to move felt like ants crawling over my skin, a side effect of the antipsychotic medications I had been prescribed. Every second of every day, I felt like clawing out my eyes and tearing out my hair because I just couldn’t sit still.

I held up my front, though. I smiled when I thought I had to and tried to be nice to people. Laughter, however, was not something that was possible, and wouldn’t be for a long time.

The group was a dual-functioning therapy technique to address both mental health issues and drug abuse. I had been assigned to it after disclosing that I had a marijuana habit. The doctors had told me that therapy groups were an integral part of my getting better. I agreed to go only to get out of the hospital prison and back home to my warm bed.

I sat in a circle with a melting pot of people. There was the construction worker still wearing dusty boots and clothes splattered with mud, and the depressed sorority girl, makeup and hair still impeccable. The two had formed a friendship over their history with methamphetamine. There was the quiet bipolar Hispanic man who spoke only in short staccato sentences, and the rotund marketing guy who introduced himself by saying his drugs of choice were food, cocaine and marijuana.

I sat there looking at them, hands nervously trying to find a natural position. I could tell they were thinking things about me, adjudicating me on my appearance and facial expressions. While they nodded in a sort of feigned acceptance, I knew they were going to go back to their friends and joke about me, the schizophrenic kid who looked weird.

When it was my turn to speak, I stood and told them in a quiet voice, almost so quiet you couldn’t hear the nervous wavering, that my name was Mike. “Hey Mike, welcome” rang the chorus in a strange unison. It seemed welcoming, but I knew they were waiting for their opportunity to strike. Summoning everything to get any words out, I told them that I had been an inpatient the previous week, where the doctors said I was schizophrenic, and that my drugs of choice were marijuana, cigarettes and, taking a cue from the marketing guy, food.

Having their eyes on me was a special kind of hell, as I stood there fidgeting and averting my gaze. They were all drilling holes into me, isolating my weaknesses and then laughing about them to themselves. They were wolves, chewing at and snapping my bones. I just wanted to get out, but I continued, and when I was done, I sat back down in the chair and lowered my head, refusing to say a thing or acknowledge anyone for the rest of the session.

How had it come to this? I had been happy in high school, popular even, unafraid of my own insecurities, unconcerned with what people thought of me. I can remember having friends from every different clique, every group and every grade. The ability to connect with people seemed so effortless then.

It’s a goal I’ve been striving to reattain for the last eight years.

When you have schizophrenia, the overarching plot of the experience is the inability to tell whether the things you are thinking are actually taking place in reality. Was that inflection in your voice a signal that I should be more friendly — or more reserved? Was that laughter I heard over my shoulder about me or something totally innocuous? These are the kinds of things I ask myself daily.

Recovering from mental illness is a process. It takes diligence in therapy, a strong support system and habitually taking your meds. With different drugs, the paranoia has calmed down, though it is still there, a reminder I’m still sick. Learning to accept what that paranoia was telling me and being all right with it, that I would still be the same person whether or not people thought negative things about me, has been a big part of my recovery.

Since that first group therapy session, I’ve worked harder than you can imagine trying to perfect a state of normal. Regaining the ability to relate to others has been a driving force. I’ve studied books on body language, manners, neuroscience and behavior just to get any small grasp on being a normal person. I know that if I do it right, and successfully connect with another human being, I feel giddy. But more often the interactions are a bit off, or a lot off, though not the end of the world.

Needless to say, it should be obvious that dating is hard for me. But I have friends, and they all know that I have schizophrenia and don’t seem to mind. They seem to accept that mental illness is a disease and not some defect of self. I can see the stigma lessening day by day, although a lot of people are still afraid of it. It’s nothing that a few little jokes and a sense of humor often can’t fix. Still, I know many others with schizophrenia who don’t have it as easy, who suffer every day, and I feel for them because I’ve sure been there.

It takes work, a lot of work, to get better, but it can be done. It has been a long road from that first group therapy session. But life is nothing if it’s not a road.



For more mental health news, Click Here to access the Serious Mental Illness Blog

Filed under mental illness mental health mental illness health body mind brain research survivor rethinking madness madness mad crazy schizophrenia schizophrenic schizo psy psych psychology bipolar psychosis psychotic hallucination delusion hallucinate catatonic mania manic depressed

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Factors predicting disengagement from psychosis early intervention identifiedBy Afsaneh Gray, medwireNews ReporterA study of first-episode psychosis patients in Hong Kong has found that those with fewer negative symptoms at presentation and poor medication compliance were more likely than others to disengage from an early intervention program.“We have confirmed reports in previous studies, which were mostly conducted in western populations, that diagnosis of a non-schizophrenia-spectrum psychotic disorder, lower baseline negative symptom severity, poor medication compliance and substance abuse history predicted service disengagement,” write study author Wing Chang (The University of Hong Kong) and colleagues.The team identified 700 patients aged 15 to 25 years who were enrolled in the Early Assessment Service for Young People with Psychosis (EASY) program between 2001 and 2003.Data on each patient were retrieved from clinical records, and the Clinical Global Impressions–Severity Scale was used to determine symptom severity. Information on medication compliance was derived from sources including case management notes, medical records and information from caregivers.Disengagement was defined as missing all outpatient appointments until the end of the 2-year service despite therapeutic need and active follow-up from staff, and occurred in 94 patients.The mean age of participants was 20.65 years and the median duration of untreated psychosis was 91 days. Most (69.14%) patients had a diagnosis of a schizophrenia spectrum disorder (ie, schizophrenia or schizoaffective disorder).Multivariate analysis identified three factors that were independently associated with disengagement. Patients were 56% less likely to disengage if they had schizophrenia-spectrum disorders, rather than other types of psychosis. They were 63% less likely to disengage if they were adherent to their medication, and they were 24% less like to disengage if they had high baseline negative symptom scores (>3).Substance abuse history within the initial 6 months of the program increased the chances of disengagement, but, due to the small number of patients affected, was not included in the final multivariate analysis.The team also found that 63% of disengaged patients were in symptomatic remission during the month in which they left the EASY program.“Early intervention teams should pay attention to factors associated with disengagement, and monitor at risk patients closely to detect signs of non-adherence,” Chang and colleagues conclude in Schizophrenia Research.


For more mental health news, Click Here to access the Serious Mental Illness Blog

Factors predicting disengagement from psychosis early intervention identified
By Afsaneh Gray, medwireNews Reporter

A study of first-episode psychosis patients in Hong Kong has found that those with fewer negative symptoms at presentation and poor medication compliance were more likely than others to disengage from an early intervention program.
“We have confirmed reports in previous studies, which were mostly conducted in western populations, that diagnosis of a non-schizophrenia-spectrum psychotic disorder, lower baseline negative symptom severity, poor medication compliance and substance abuse history predicted service disengagement,” write study author Wing Chang (The University of Hong Kong) and colleagues.
The team identified 700 patients aged 15 to 25 years who were enrolled in the Early Assessment Service for Young People with Psychosis (EASY) program between 2001 and 2003.
Data on each patient were retrieved from clinical records, and the Clinical Global Impressions–Severity Scale was used to determine symptom severity. Information on medication compliance was derived from sources including case management notes, medical records and information from caregivers.
Disengagement was defined as missing all outpatient appointments until the end of the 2-year service despite therapeutic need and active follow-up from staff, and occurred in 94 patients.
The mean age of participants was 20.65 years and the median duration of untreated psychosis was 91 days. Most (69.14%) patients had a diagnosis of a schizophrenia spectrum disorder (ie, schizophrenia or schizoaffective disorder).
Multivariate analysis identified three factors that were independently associated with disengagement. Patients were 56% less likely to disengage if they had schizophrenia-spectrum disorders, rather than other types of psychosis. They were 63% less likely to disengage if they were adherent to their medication, and they were 24% less like to disengage if they had high baseline negative symptom scores (>3).
Substance abuse history within the initial 6 months of the program increased the chances of disengagement, but, due to the small number of patients affected, was not included in the final multivariate analysis.
The team also found that 63% of disengaged patients were in symptomatic remission during the month in which they left the EASY program.
“Early intervention teams should pay attention to factors associated with disengagement, and monitor at risk patients closely to detect signs of non-adherence,” Chang and colleagues conclude in Schizophrenia Research.



For more mental health news, Click Here to access the Serious Mental Illness Blog

Filed under psy psychosis psychology psychiatry med meds drug drugs research science neuro neuroscience schizo schizophrenia schizophrenic mad madness crazy mind brain body patient therapy psycho psychotherapy bipolar depressed depression manic delusion

29 notes

Confessing DepressionBy Megan Davies Mennes; English teacher, writer, motherSometimes life is hard. I think I’m luckier than most in this world, and yet I still struggle with my own demons. I suppose that’s true of all of us, but not everyone faces the crushing weight of depression when things go wrong. I recently discovered that my dear friend is struggling to stay afloat and I want so desperately for him to know — for everyone experiencing the pain of depression to know — I’ve been there.Depression isn’t something we like to talk about in our society. Mental health in general is a rather taboo topic, perhaps because for those with no history of mental illness, it seems as simple as a change in mindset. But depression is very real, and often very difficult to control.I’ve struggled with depression, anxiety, and mood swings my whole life. I learned in early adulthood that I suffer from some pretty serious chemical imbalances that peak in the winter and ebb in the warmer months. I also know that stress can put me in a funk regardless of the weather. The past few years have been hard on me given the many changes we’ve experienced in our family. In fact, I suffered from late-onset post-partum depression when my first son, Atticus, was around 6 months old. The medicine my doctor prescribed made my skin crawl, so I lived with the sadness until things leveled out. And then when we moved to a new city, turned our entire lives upside-down, and received our unborn son Quinn’s Down syndrome diagnosis, the depression returned, this time with a severity I had never experienced. But the only drugs that we knew to fight the funk without the desire to pull my hair out or walk around like a zombie all day weren’t recommended for pregnant women (especially those with a high-risk pregnancy like mine), so I was forced to power through.It’s difficult to cope with something that many people feel is easy to fix. Over the years, I’ve had friends insist that I need learn to count my blessings, as if I hadn’t tried that before. Or they expect to snap me out of it with a quick hug, a phone call, or even chocolate cake. But depression doesn’t work that way. Depression is an all-encompassing reality that no amount of silver linings can overturn. Moreover, sometimes it feels normal to be sad. I know that’s not something that most of you can understand, but for those with chemical imbalances, they know how right it can feel to give in and allow the wave of hopelessness to take over. To fight it is to sink lower when you lose.The bright side is that there is a bright side. I’ve learned over the years to ride the waves of depression that come my way and seek help when they get too serious. I’m lucky in that my family keeps me close and ensures that recovery is swift. My husband is my rock in this. He knows what works and what doesn’t. And he never tries to fix me. He just listens. I’m also lucky that my depression has never affected my work, as walking into my classroom is like a refuge, as if I’ve suddenly found a life raft after treading water for days. But others aren’t so lucky. Others struggle to recover, regardless of their support system. If that’s you, then please seek help. It’s amazing how quickly depression can lead someone down a dead-end path. And once you start that road toward drug abuse, alcoholism, or even suicide, it’s hard to come back.Many of you will read this confession and feel embarrassed for me, or even sad. Don’t. I’m not ashamed. In fact, I’m actually pretty damn proud of my ability to overcome it and live a successful life. I’m proud of my coping mechanisms, my bursts of happiness in which I can appreciate the sun on my shoulders in late February, or the sound of my children’s giggles on Sunday mornings. Those are the moments I live for. Those are the moments that keep the depression at bay for longer stretches of time. In order for more people to find their moments, we need to talk about mental illness without shame or fear. We need to help more people become aware of the struggles so that we can be more aware of ways to help each other cope.
If you’re struggling with depression, anxiety, or any other mental illness, seek a strong support system. Here are some good places to start:
Depression and Bipolar Support Alliance.Helpguide.org.Mental Health America




For more mental health news, Click Here to access the Serious Mental Illness Blog

Confessing Depression
By Megan Davies Mennes; English teacher, writer, mother

Sometimes life is hard. I think I’m luckier than most in this world, and yet I still struggle with my own demons. I suppose that’s true of all of us, but not everyone faces the crushing weight of depression when things go wrong. I recently discovered that my dear friend is struggling to stay afloat and I want so desperately for him to know — for everyone experiencing the pain of depression to know — I’ve been there.
Depression isn’t something we like to talk about in our society. Mental health in general is a rather taboo topic, perhaps because for those with no history of mental illness, it seems as simple as a change in mindset. But depression is very real, and often very difficult to control.
I’ve struggled with depression, anxiety, and mood swings my whole life. I learned in early adulthood that I suffer from some pretty serious chemical imbalances that peak in the winter and ebb in the warmer months. I also know that stress can put me in a funk regardless of the weather. The past few years have been hard on me given the many changes we’ve experienced in our family. In fact, I suffered from late-onset post-partum depression when my first son, Atticus, was around 6 months old. The medicine my doctor prescribed made my skin crawl, so I lived with the sadness until things leveled out. And then when we moved to a new city, turned our entire lives upside-down, and received our unborn son Quinn’s Down syndrome diagnosis, the depression returned, this time with a severity I had never experienced. But the only drugs that we knew to fight the funk without the desire to pull my hair out or walk around like a zombie all day weren’t recommended for pregnant women (especially those with a high-risk pregnancy like mine), so I was forced to power through.
It’s difficult to cope with something that many people feel is easy to fix. Over the years, I’ve had friends insist that I need learn to count my blessings, as if I hadn’t tried that before. Or they expect to snap me out of it with a quick hug, a phone call, or even chocolate cake. But depression doesn’t work that way. Depression is an all-encompassing reality that no amount of silver linings can overturn. Moreover, sometimes it feels normal to be sad. I know that’s not something that most of you can understand, but for those with chemical imbalances, they know how right it can feel to give in and allow the wave of hopelessness to take over. To fight it is to sink lower when you lose.
The bright side is that there is a bright side. I’ve learned over the years to ride the waves of depression that come my way and seek help when they get too serious. I’m lucky in that my family keeps me close and ensures that recovery is swift. My husband is my rock in this. He knows what works and what doesn’t. And he never tries to fix me. He just listens. I’m also lucky that my depression has never affected my work, as walking into my classroom is like a refuge, as if I’ve suddenly found a life raft after treading water for days. But others aren’t so lucky. Others struggle to recover, regardless of their support system. If that’s you, then please seek help. It’s amazing how quickly depression can lead someone down a dead-end path. And once you start that road toward drug abuse, alcoholism, or even suicide, it’s hard to come back.
Many of you will read this confession and feel embarrassed for me, or even sad. Don’t. I’m not ashamed. In fact, I’m actually pretty damn proud of my ability to overcome it and live a successful life. I’m proud of my coping mechanisms, my bursts of happiness in which I can appreciate the sun on my shoulders in late February, or the sound of my children’s giggles on Sunday mornings. Those are the moments I live for. Those are the moments that keep the depression at bay for longer stretches of time. In order for more people to find their moments, we need to talk about mental illness without shame or fear. We need to help more people become aware of the struggles so that we can be more aware of ways to help each other cope.

If you’re struggling with depression, anxiety, or any other mental illness, seek a strong support system. Here are some good places to start:

Depression and Bipolar Support Alliance.
Helpguide.org.
Mental Health America



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Bullying has long-lasting effects on children’s mental healthBy Cari Nierenberg, LiveScienceBullied children don’t feel as good about themselves and experience more negative emotions as time passes.Being bullied at school leaves a lasting mark on young victims’ bodies and minds years after the bullying ends, a new study shows. Researchers found that bullying had its greatest influence on the health of kids who were repeatedly targeted, and it was linked with poorer mental and physical health, increased symptoms of depression and lower self-esteem.The study also revealed that victims of recent bullying fared worse than students who had been picked on by their peers further in the past."The effects of bullying can snowball over time," said study researcher Laura Bogart, a social psychologist at Boston Children’s Hospital.Children who experience continued bullying, such as in more than one grade, had more severe effects, she said."The results are a strong argument for an immediate, early intervention of bullying," Bogart said. [10 Scientific Tips for Raising Happy Kids]The findings were published online on Feb. 17 and will appear in the March issue of the journal Pediatrics.Early interventionIn the study, the researchers surveyed nearly 4,300 students attending public schools in Los Angeles, Houston and Birmingham, Ala. They collected data from students when they were in fifth, seventh and 10th grades, and also from their parents.To determine whether students were frequently or repeatedly bullied in elementary, middle and high school, they were asked how often another kid had kicked or pushed them in a mean way during the last year. Children also completed questionnaires describing their physical and mental well-being.By 10th grade, about 30 percent of the students in the study had been bullied.At all three grade levels, students who had never been bullied reported being the most psychologically healthy.But even the kids who had been bullied in the distant past had lasting psychological wounds, although not to the same extent as those being bullied currently or who were repeatedly bullied. For those children, mental health scores declined over time, suggesting they didn’t feel as good about themselves and experienced more negative emotions.The study did not look at bullying’s full range of physical effects, but the questionnaire asked children about basic physical activity, such as whether being bullied caused them to have trouble walking around the block, doing their chores or playing sports.It did not consider physical complaints and injuries, such as stomachaches, pain, cuts and broken bones, Bogart told Live Science.She also said the study only measured in-person bullying and didn’t include cyberbullying."Cyberbullying would be a good future direction for this research," Bogart said.Warning signsThe findings show that bullying’s emotional scars may remain long after the teasing and taunting stop. So what can a parent do to help their child?"The first step for parents is to strengthen communication with your child, so that bullying comes up in conversation, especially at younger ages," Bogart said. It can come up as part of a broader discussion about respecting other people and accepting differences among them, she suggested.Bogart also recommended that parents notice and recognize the signs of bullying, which may not be obvious physical clues like a black eye, but could take the form of unexplained scratches or bruises.Parents can also tune in to subtle changes in a child’s behavior, such as not wanting to go to school or seeming more anxious, sad or depressed.Bogart also suggested that parents should be even more vigilant to these warning signs if their child falls into one of the high-risk groups more likely to be bullied. These include kids who are obese or have disabilities, as well as young people who are lesbian, gay, bisexual or transgender. Although not all children are victims of bullying, many kids are affected by it and see it happening at school, and are aware that it’s going on, Bogart said.She advised parents to help teach kids that it’s OK to speak up if they witness someone being bullied.



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Bullying has long-lasting effects on children’s mental health
By Cari Nierenberg, LiveScience

Bullied children don’t feel as good about themselves and experience more negative emotions as time passes.

Being bullied at school leaves a lasting mark on young victims’ bodies and minds years after the bullying ends, a new study shows.
Researchers found that bullying had its greatest influence on the health of kids who were repeatedly targeted, and it was linked with poorer mental and physical health, increased symptoms of depression and lower self-esteem.
The study also revealed that victims of recent bullying fared worse than students who had been picked on by their peers further in the past.
"The effects of bullying can snowball over time," said study researcher Laura Bogart, a social psychologist at Boston Children’s Hospital.
Children who experience continued bullying, such as in more than one grade, had more severe effects, she said.
"The results are a strong argument for an immediate, early intervention of bullying," Bogart said. [10 Scientific Tips for Raising Happy Kids]
The findings were published online on Feb. 17 and will appear in the March issue of the journal Pediatrics.

Early intervention
In the study, the researchers surveyed nearly 4,300 students attending public schools in Los Angeles, Houston and Birmingham, Ala. They collected data from students when they were in fifth, seventh and 10th grades, and also from their parents.
To determine whether students were frequently or repeatedly bullied in elementary, middle and high school, they were asked how often another kid had kicked or pushed them in a mean way during the last year. Children also completed questionnaires describing their physical and mental well-being.
By 10th grade, about 30 percent of the students in the study had been bullied.
At all three grade levels, students who had never been bullied reported being the most psychologically healthy.
But even the kids who had been bullied in the distant past had lasting psychological wounds, although not to the same extent as those being bullied currently or who were repeatedly bullied. For those children, mental health scores declined over time, suggesting they didn’t feel as good about themselves and experienced more negative emotions.
The study did not look at bullying’s full range of physical effects, but the questionnaire asked children about basic physical activity, such as whether being bullied caused them to have trouble walking around the block, doing their chores or playing sports.
It did not consider physical complaints and injuries, such as stomachaches, pain, cuts and broken bones, Bogart told Live Science.
She also said the study only measured in-person bullying and didn’t include cyberbullying.
"Cyberbullying would be a good future direction for this research," Bogart said.

Warning signs
The findings show that bullying’s emotional scars may remain long after the teasing and taunting stop. So what can a parent do to help their child?
"The first step for parents is to strengthen communication with your child, so that bullying comes up in conversation, especially at younger ages," Bogart said. It can come up as part of a broader discussion about respecting other people and accepting differences among them, she suggested.
Bogart also recommended that parents notice and recognize the signs of bullying, which may not be obvious physical clues like a black eye, but could take the form of unexplained scratches or bruises.
Parents can also tune in to subtle changes in a child’s behavior, such as not wanting to go to school or seeming more anxious, sad or depressed.
Bogart also suggested that parents should be even more vigilant to these warning signs if their child falls into one of the high-risk groups more likely to be bullied. These include kids who are obese or have disabilities, as well as young people who are lesbian, gay, bisexual or transgender.
Although not all children are victims of bullying, many kids are affected by it and see it happening at school, and are aware that it’s going on, Bogart said.
She advised parents to help teach kids that it’s OK to speak up if they witness someone being bullied.





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[Article of Interest] Effect of Diagnostic Labeling
New study by Lorenza Magliano, John Read et al, in Psychiatry Research, (in press, 2013)
This study examines whether medical students’ views of treatments for ‘schizophrenia’ and of patients’ rights to be informed about their condition and their medication were influenced by diagnostic labeling and causal explanations and whether they differed over medical training.
Three hundred and eighty one Italian students attending their first or fifth/sixth year of medical studies read a vignette portraying someone who met diagnostic criteria for ‘schizophrenia’ and completed a self-report questionnaire.
The study found that labeling the case as ‘schizophrenia’ and naming heredity among its causes were associated with confidence in psychiatrists and psychiatric drugs. Naming psychological traumas among the causes was associated with confidence in psychologists and greater acknowledgment of users’ right to be informed about drugs.
Compared to first year students, those at their fifth/sixth-year of studies more strongly endorsed drugs, had less confidence in psychologists and family support, and were less keen to share information on drugs with patients.
These findings highlight that students’ beliefs vary during training and are significantly related to diagnostic labeling and belief in a biogenetic causal model.
Psychiatric curricula for medical students should include greater integration of psychological and medical aspects in clinical management of ‘schizophrenia’; more information on the psychosocial causes of mental health problems.

For more mental health news, Click Here to access the Serious Mental Illness Blog

[Article of Interest] Effect of Diagnostic Labeling

New study by Lorenza Magliano, John Read et al, in Psychiatry Research, (in press, 2013)

This study examines whether medical students’ views of treatments for ‘schizophrenia’ and of patients’ rights to be informed about their condition and their medication were influenced by diagnostic labeling and causal explanations and whether they differed over medical training.

Three hundred and eighty one Italian students attending their first or fifth/sixth year of medical studies read a vignette portraying someone who met diagnostic criteria for ‘schizophrenia’ and completed a self-report questionnaire.

The study found that labeling the case as ‘schizophrenia’ and naming heredity among its causes were associated with confidence in psychiatrists and psychiatric drugs. Naming psychological traumas among the causes was associated with confidence in psychologists and greater acknowledgment of users’ right to be informed about drugs.

Compared to first year students, those at their fifth/sixth-year of studies more strongly endorsed drugs, had less confidence in psychologists and family support, and were less keen to share information on drugs with patients.

These findings highlight that students’ beliefs vary during training and are significantly related to diagnostic labeling and belief in a biogenetic causal model.

Psychiatric curricula for medical students should include greater integration of psychological and medical aspects in clinical management of ‘schizophrenia’; more information on the psychosocial causes of mental health problems.




For more mental health news, 
Click Here to access the Serious Mental Illness Blog

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[Article of Interest] Psychiatrists under fire in mental health battle
By Jamie Doward
British Psychological Society to launch attack on rival profession, casting doubt on biomedical model of mental illness
There is no scientific evidence that psychiatric diagnoses such as schizophrenia and bipolar disorder are valid or useful, according to the leading body representing Britain’s clinical psychologists.
In a groundbreaking move that has already prompted a fierce backlash from psychiatrists, the British Psychological Society’s division of clinical psychology (DCP) will on Monday issue a statement declaring that, given the lack of evidence, it is time for a “paradigm shift” in how the issues of mental health are understood. The statement effectively casts doubt on psychiatry’s predominantly biomedical model of mental distress – the idea that people are suffering from illnesses that are treatable by doctors using drugs. The DCP said its decision to speak out “reflects fundamental concerns about the development, personal impact and core assumptions of the (diagnosis) systems”, used by psychiatry.
Dr Lucy Johnstone, a consultant clinical psychologist who helped draw up the DCP’s statement, said it was unhelpful to see mental health issues as illnesses with biological causes.
“On the contrary, there is now overwhelming evidence that people break down as a result of a complex mix of social and psychological circumstances – bereavement and loss, poverty and discrimination, trauma and abuse,” Johnstone said. The provocative statement by the DCP has been timed to come out shortly before the release of DSM-5, the fifth edition of the American Psychiatry Association’s Diagnostic and Statistical Manual of Mental Disorders.
The manual has been attacked for expanding the range of mental health issues that are classified as disorders. For example, the fifth edition of the book, the first for two decades, will classify manifestations of grief, temper tantrums and worrying about physical ill-health as the mental illnesses of major depressive disorder, disruptive mood dysregulation disorder and somatic symptom disorder, respectively.
Some of the manual’s omissions are just as controversial as the manual’s inclusions. The term “Asperger’s disorder” will not appear in the new manual, and instead its symptoms will come under the newly added “autism spectrum disorder”.
The DSM is used in a number of countries to varying degrees. Britain uses an alternative manual, the International Classification of Diseases (ICD) published by the World Health Organisation, but the DSM is still hugely influential – and controversial.
The writer Oliver James, who trained as a clinical psychologist, welcomed the DCP’s decision to speak out against psychiatric diagnosis and stressed the need to move away from a biomedical model of mental distress to one that examined societal and personal factors.
Writing in today’s Observer, James declares: “We need fundamental changes in how our society is organised to give parents the best chance of meeting the needs of children and to prevent the amount of adult adversity.”
But Professor Sir Simon Wessely, a member of the Royal College of Psychiatrists and chair of psychological medicine at King’s College London, said it was wrong to suggest psychiatry was focused only on the biological causes of mental distress. And in an accompanying Observer article he defends the need to create classification systems for mental disorder.
“A classification system is like a map,” Wessely explains. “And just as any map is only provisional, ready to be changed as the landscape changes, so does classification.”


[Article of Interest] Psychiatrists under fire in mental health battle

By Jamie Doward

British Psychological Society to launch attack on rival profession, casting doubt on biomedical model of mental illness

There is no scientific evidence that psychiatric diagnoses such as schizophrenia and bipolar disorder are valid or useful, according to the leading body representing Britain’s clinical psychologists.

In a groundbreaking move that has already prompted a fierce backlash from psychiatrists, the British Psychological Society’s division of clinical psychology (DCP) will on Monday issue a statement declaring that, given the lack of evidence, it is time for a “paradigm shift” in how the issues of mental health are understood. The statement effectively casts doubt on psychiatry’s predominantly biomedical model of mental distress – the idea that people are suffering from illnesses that are treatable by doctors using drugs. The DCP said its decision to speak out “reflects fundamental concerns about the development, personal impact and core assumptions of the (diagnosis) systems”, used by psychiatry.

Dr Lucy Johnstone, a consultant clinical psychologist who helped draw up the DCP’s statement, said it was unhelpful to see mental health issues as illnesses with biological causes.

“On the contrary, there is now overwhelming evidence that people break down as a result of a complex mix of social and psychological circumstances – bereavement and loss, poverty and discrimination, trauma and abuse,” Johnstone said. The provocative statement by the DCP has been timed to come out shortly before the release of DSM-5, the fifth edition of the American Psychiatry Association’s Diagnostic and Statistical Manual of Mental Disorders.

The manual has been attacked for expanding the range of mental health issues that are classified as disorders. For example, the fifth edition of the book, the first for two decades, will classify manifestations of grief, temper tantrums and worrying about physical ill-health as the mental illnesses of major depressive disorder, disruptive mood dysregulation disorder and somatic symptom disorder, respectively.

Some of the manual’s omissions are just as controversial as the manual’s inclusions. The term “Asperger’s disorder” will not appear in the new manual, and instead its symptoms will come under the newly added “autism spectrum disorder”.

The DSM is used in a number of countries to varying degrees. Britain uses an alternative manual, the International Classification of Diseases (ICD) published by the World Health Organisation, but the DSM is still hugely influential – and controversial.

The writer Oliver James, who trained as a clinical psychologist, welcomed the DCP’s decision to speak out against psychiatric diagnosis and stressed the need to move away from a biomedical model of mental distress to one that examined societal and personal factors.

Writing in today’s Observer, James declares: “We need fundamental changes in how our society is organised to give parents the best chance of meeting the needs of children and to prevent the amount of adult adversity.”

But Professor Sir Simon Wessely, a member of the Royal College of Psychiatrists and chair of psychological medicine at King’s College London, said it was wrong to suggest psychiatry was focused only on the biological causes of mental distress. And in an accompanying Observer article he defends the need to create classification systems for mental disorder.

A classification system is like a map,” Wessely explains. “And just as any map is only provisional, ready to be changed as the landscape changes, so does classification.”

(via artfromtheedge)

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[Article of Interest] National Institute of Mental Health Abandoning the DSMby Vaughan BellIn a potentially seismic move, the National Institute of Mental Health – the world’s biggest mental health research funder, has announced only two weeks before the launch of the DSM-5 diagnostic manual that it will be “re-orienting its research away from DSM categories”.In the announcement, NIMH Director Thomas Insel says the DSM lacks validity and that “patients with mental disorders deserve better”.This is something that will make very uncomfortable reading for the American Psychiatric Association as they trumpet what they claim is the ‘future of psychiatric diagnosis’ only two weeks before it hits the shelves.As a result the NIMH will now be preferentially funding research that does not stick to DSM categories:Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system. What does this mean for applicants? Clinical trials might study all patients in a mood clinic rather than those meeting strict major depressive disorder criteria. Studies of biomarkers for “depression” might begin by looking across many disorders with anhedonia or emotional appraisal bias or psychomotor retardation to understand the circuitry underlying these symptoms. What does this mean for patients? We are committed to new and better treatments, but we feel this will only happen by developing a more precise diagnostic system.As an alternative approach, Insel suggests the Research Domain Criteria (RDoC) project, which aims to uncover what it sees as the ‘component parts’ of psychological dysregulation by understanding difficulties in terms of cognitive, neural and genetic differences.For example, difficulties with regulating the arousal system might be equally as involved in generating anxiety in PTSD as generating manic states in bipolar disorder.Of course, this ‘component part’ approach is already a large part of mental health research but the RDoC project aims to combine this into a system that allows these to be mapped out and integrated.It’s worth saying that this won’t be changing how psychiatrists treat their patients any time soon. DSM-style disorders will still be the order of the day, not least because a great deal of the evidence for the effectiveness of medication is based on giving people standard diagnoses.It is also true to say that RDoC is currently little more than a plan at the moment – a bit like the Mars mission: you can see how it would be feasible but actually getting there seems a long way off. In fact, until now, the RDoC project has largely been considered to be an experimental project in thinking up alternative approaches.The project was partly thought to be radical because it has many similarities to the approach taken by scientific critics of mainstream psychiatry who have argued for a symptom-based approach to understanding mental health difficulties that has often been rejected by the ‘diagnoses represent distinct diseases’ camp.The NIMH has often been one of the most staunch supporters of the latter view, so the fact that it has put the RDoC front and centre is not only a slap in the face for the American Psychiatric Association and the DSM, it also heralds a massive change in how we might think of mental disorders in decades to come.

[Article of Interest] National Institute of Mental Health Abandoning the DSM
by Vaughan Bell

In a potentially seismic move, the National Institute of Mental Health – the world’s biggest mental health research funder, has announced only two weeks before the launch of the DSM-5 diagnostic manual that it will be “re-orienting its research away from DSM categories”.
In the announcement, NIMH Director Thomas Insel says the DSM lacks validity and that “patients with mental disorders deserve better”.
This is something that will make very uncomfortable reading for the American Psychiatric Association as they trumpet what they claim is the ‘future of psychiatric diagnosis’ only two weeks before it hits the shelves.
As a result the NIMH will now be preferentially funding research that does not stick to DSM categories:
Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system. What does this mean for applicants? Clinical trials might study all patients in a mood clinic rather than those meeting strict major depressive disorder criteria. Studies of biomarkers for “depression” might begin by looking across many disorders with anhedonia or emotional appraisal bias or psychomotor retardation to understand the circuitry underlying these symptoms. What does this mean for patients? We are committed to new and better treatments, but we feel this will only happen by developing a more precise diagnostic system.
As an alternative approach, Insel suggests the Research Domain Criteria (RDoC) project, which aims to uncover what it sees as the ‘component parts’ of psychological dysregulation by understanding difficulties in terms of cognitive, neural and genetic differences.
For example, difficulties with regulating the arousal system might be equally as involved in generating anxiety in PTSD as generating manic states in bipolar disorder.
Of course, this ‘component part’ approach is already a large part of mental health research but the RDoC project aims to combine this into a system that allows these to be mapped out and integrated.
It’s worth saying that this won’t be changing how psychiatrists treat their patients any time soon. DSM-style disorders will still be the order of the day, not least because a great deal of the evidence for the effectiveness of medication is based on giving people standard diagnoses.
It is also true to say that RDoC is currently little more than a plan at the moment – a bit like the Mars mission: you can see how it would be feasible but actually getting there seems a long way off. In fact, until now, the RDoC project has largely been considered to be an experimental project in thinking up alternative approaches.
The project was partly thought to be radical because it has many similarities to the approach taken by scientific critics of mainstream psychiatry who have argued for a symptom-based approach to understanding mental health difficulties that has often been rejected by the ‘diagnoses represent distinct diseases’ camp.
The NIMH has often been one of the most staunch supporters of the latter view, so the fact that it has put the RDoC front and centre is not only a slap in the face for the American Psychiatric Association and the DSM, it also heralds a massive change in how we might think of mental disorders in decades to come.

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[Video of Interest] Simon Kyaga - Genius and Madness

Simon Kyaga, MD, of the Karolinska Institute in Stockholm, and colleagues conducted a nested case-control study that included 1,173,763 participants enrolled in the Swedish total population registries. The researchers compared patients diagnosed with psychiatric disorders and their healthy relatives to the general population. Scientific and artistic occupations were defined as creative professions. These included dancers, photographers, researchers and authors, for example. Diagnoses of psychiatric disorders were based on the International Classification of Diseases.

In this study, those in overall creative professions were not more likely to have psychiatric disorders, with the exception of bipolar disorder. However, authors were more than twice as likely as controls to have schizophrenia (OR=2.09; 95% CI, 1.35-3.23) and bipolar disorder (OR=2.21; 95% CI, 1.50-3.26). This population was also more likely to be diagnosed with unipolar depression (OR=1.54; 95% CI, 1.30-1.81), anxiety disorders (OR=1.38; 95%CI, 1.03-1.86), alcohol abuse (OR=1.47; 95% CI, 1.25-1.74), drug abuse (OR=1.53; 95% CI, 1.09-2.16) and to commit suicide (OR=1.49; 95% CI, 1.08-2.05).

Consistent with their earlier research, Kyaga and colleagues found that first-degree relatives of patients with schizophrenia, bipolar disorder, anorexia nervosa and, to a lesser degree, autism were significantly overrepresented in creative professions.

According to the researchers, the results have important clinical implications: If one takes the view that certain phenomena associated with the patient’s illness are beneficial, it opens the way for a new approach to treatment,” Kyaga said in a press release. “In that case, the doctor and patient must come to an agreement on what is to be treated, and at what cost. In psychiatry and medicine generally there has been a tradition to see the disease in black-and-white terms and to endeavor to treat the patient by removing everything regarded as morbid.”

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Successful and Schizophrenic
By Elyn R. Saks, law professor at the University of Southern California and the author of the memoir “The Center Cannot Hold: My Journey Through Madness.”

Thirty years ago, I was given a diagnosis of schizophrenia. My prognosis was “grave”: I would never live independently, hold a job, find a loving partner, get married. My home would be a board-and-care facility, my days spent watching TV in a day room with other people debilitated by mental illness. I would work at menial jobs when my symptoms were quiet. Following my last psychiatric hospitalization at the age of 28, I was encouraged by a doctor to work as a cashier making change. If I could handle that, I was told, we would reassess my ability to hold a more demanding position, perhaps even something full-time.
Then I made a decision. I would write the narrative of my life. Today I am a chaired professor at the University of Southern California Gould School of Law. I have an adjunct appointment in the department of psychiatry at the medical school of the University of California, San Diego, and am on the faculty of the New Center for Psychoanalysis. The MacArthur Foundation gave me a genius grant.
Although I fought my diagnosis for many years, I came to accept that I have schizophrenia and will be in treatment the rest of my life. Indeed, excellent psychoanalytic treatment and medication have been critical to my success. What I refused to accept was my prognosis.
Conventional psychiatric thinking and its diagnostic categories say that people like me don’t exist. Either I don’t have schizophrenia (please tell that to the delusions crowding my mind), or I couldn’t have accomplished what I have (please tell that to U.S.C.’s committee on faculty affairs). But I do, and I have. And I have undertaken research with colleagues at U.S.C. and U.C.L.A. to show that I am not alone. There are others with schizophrenia and such active symptoms as delusions and hallucinations who have significant academic and professional achievements.
Over the last few years, my colleagues, including Stephen Marder, Alison Hamilton and Amy Cohen, and I have gathered 20 research subjects with high-functioning schizophrenia in Los Angeles. They suffered from symptoms like mild delusions or hallucinatory behavior. Their average age was 40. Half were male, half female, and more than half were minorities. All had high school diplomas, and a majority either had or were working toward college or graduate degrees. They were graduate students, managers, technicians and professionals, including a doctor, lawyer, psychologist and chief executive of a nonprofit group.
At the same time, most were unmarried and childless, which is consistent with their diagnoses. (My colleagues and I intend to do another study on people with schizophrenia who are high-functioning in terms of their relationships. Marrying in my mid-40s — the best thing that ever happened to me — was against all odds, following almost 18 years of not dating.) More than three-quarters had been hospitalized between two and five times because of their illness, while three had never been admitted.
How had these people with schizophrenia managed to succeed in their studies and at such high-level jobs? We learned that, in addition to medication and therapy, all the participants had developed techniques to keep their schizophrenia at bay. For some, these techniques were cognitive. An educator with a master’s degree said he had learned to face his hallucinations and ask, “What’s the evidence for that? Or is it just a perception problem?” Another participant said, “I hear derogatory voices all the time. … You just gotta blow them off.”
Part of vigilance about symptoms was “identifying triggers” to “prevent a fuller blown experience of symptoms,” said a participant who works as a coordinator at a nonprofit group. For instance, if being with people in close quarters for too long can set off symptoms, build in some alone time when you travel with friends.
Other techniques that our participants cited included controlling sensory inputs. For some, this meant keeping their living space simple (bare walls, no TV, only quiet music), while for others, it meant distracting music. “I’ll listen to loud music if I don’t want to hear things,” said a participant who is a certified nurse’s assistant. Still others mentioned exercise, a healthy diet, avoiding alcohol and getting enough sleep. A belief in God and prayer also played a role for some.
One of the most frequently mentioned techniques that helped our research participants manage their symptoms was work. “Work has been an important part of who I am,” said an educator in our group. “When you become useful to an organization and feel respected in that organization, there’s a certain value in belonging there.” This person works on the weekends too because of “the distraction factor.” In other words, by engaging in work, the crazy stuff often recedes to the sidelines.
Personally, I reach out to my doctors, friends and family whenever I start slipping, and I get great support from them. I eat comfort food (for me, cereal) and listen to quiet music. I minimize all stimulation. Usually these techniques, combined with more medication and therapy, will make the symptoms pass. But the work piece — using my mind — is my best defense. It keeps me focused, it keeps the demons at bay. My mind, I have come to say, is both my worst enemy and my best friend.
That is why it is so distressing when doctors tell their patients not to expect or pursue fulfilling careers. Far too often, the conventional psychiatric approach to mental illness is to see clusters of symptoms that characterize people. Accordingly, many psychiatrists hold the view that treating symptoms with medication is treating mental illness. But this fails to take into account individuals’ strengths and capabilities, leading mental health professionals to underestimate what their patients can hope to achieve in the world.
It’s not just schizophrenia: earlier this month, The Journal of Child Psychology and Psychiatry posted a study showing that a small group of people who were given diagnoses of autism, a developmental disorder, later stopped exhibiting symptoms. They seemed to have recovered — though after years of behavioral therapy and treatment. A recent New York Times Magazine article described a new company that hires high-functioning adults with autism, taking advantage of their unusual memory skills and attention to detail.
I don’t want to sound like a Pollyanna about schizophrenia; mental illness imposes real limitations, and it’s important not to romanticize it. We can’t all be Nobel laureates like John Nash of the movie “A Beautiful Mind.” But the seeds of creative thinking may sometimes be found in mental illness, and people underestimate the power of the human brain to adapt and to create.
An approach that looks for individual strengths, in addition to considering symptoms, could help dispel the pessimism surrounding mental illness. Finding “the wellness within the illness,” as one person with schizophrenia said, should be a therapeutic goal. Doctors should urge their patients to develop relationships and engage in meaningful work. They should encourage patients to find their own repertory of techniques to manage their symptoms and aim for a quality of life as they define it. And they should provide patients with the resources — therapy, medication and support — to make these things happen.
“Every person has a unique gift or unique self to bring to the world,” said one of our study’s participants. She expressed the reality that those of us who have schizophrenia and other mental illnemesses want what everyone wants: in the words of Sigmund Freud, to work and to love.

Successful and Schizophrenic

By Elyn R. Saks, law professor at the University of Southern California and the author of the memoir “The Center Cannot Hold: My Journey Through Madness.”

Thirty years ago, I was given a diagnosis of schizophrenia. My prognosis was “grave”: I would never live independently, hold a job, find a loving partner, get married. My home would be a board-and-care facility, my days spent watching TV in a day room with other people debilitated by mental illness. I would work at menial jobs when my symptoms were quiet. Following my last psychiatric hospitalization at the age of 28, I was encouraged by a doctor to work as a cashier making change. If I could handle that, I was told, we would reassess my ability to hold a more demanding position, perhaps even something full-time.

Then I made a decision. I would write the narrative of my life. Today I am a chaired professor at the University of Southern California Gould School of Law. I have an adjunct appointment in the department of psychiatry at the medical school of the University of California, San Diego, and am on the faculty of the New Center for Psychoanalysis. The MacArthur Foundation gave me a genius grant.

Although I fought my diagnosis for many years, I came to accept that I have schizophrenia and will be in treatment the rest of my life. Indeed, excellent psychoanalytic treatment and medication have been critical to my success. What I refused to accept was my prognosis.

Conventional psychiatric thinking and its diagnostic categories say that people like me don’t exist. Either I don’t have schizophrenia (please tell that to the delusions crowding my mind), or I couldn’t have accomplished what I have (please tell that to U.S.C.’s committee on faculty affairs). But I do, and I have. And I have undertaken research with colleagues at U.S.C. and U.C.L.A. to show that I am not alone. There are others with schizophrenia and such active symptoms as delusions and hallucinations who have significant academic and professional achievements.

Over the last few years, my colleagues, including Stephen Marder, Alison Hamilton and Amy Cohen, and I have gathered 20 research subjects with high-functioning schizophrenia in Los Angeles. They suffered from symptoms like mild delusions or hallucinatory behavior. Their average age was 40. Half were male, half female, and more than half were minorities. All had high school diplomas, and a majority either had or were working toward college or graduate degrees. They were graduate students, managers, technicians and professionals, including a doctor, lawyer, psychologist and chief executive of a nonprofit group.

At the same time, most were unmarried and childless, which is consistent with their diagnoses. (My colleagues and I intend to do another study on people with schizophrenia who are high-functioning in terms of their relationships. Marrying in my mid-40s — the best thing that ever happened to me — was against all odds, following almost 18 years of not dating.) More than three-quarters had been hospitalized between two and five times because of their illness, while three had never been admitted.

How had these people with schizophrenia managed to succeed in their studies and at such high-level jobs? We learned that, in addition to medication and therapy, all the participants had developed techniques to keep their schizophrenia at bay. For some, these techniques were cognitive. An educator with a master’s degree said he had learned to face his hallucinations and ask, “What’s the evidence for that? Or is it just a perception problem?” Another participant said, “I hear derogatory voices all the time. … You just gotta blow them off.”

Part of vigilance about symptoms was “identifying triggers” to “prevent a fuller blown experience of symptoms,” said a participant who works as a coordinator at a nonprofit group. For instance, if being with people in close quarters for too long can set off symptoms, build in some alone time when you travel with friends.

Other techniques that our participants cited included controlling sensory inputs. For some, this meant keeping their living space simple (bare walls, no TV, only quiet music), while for others, it meant distracting music. “I’ll listen to loud music if I don’t want to hear things,” said a participant who is a certified nurse’s assistant. Still others mentioned exercise, a healthy diet, avoiding alcohol and getting enough sleep. A belief in God and prayer also played a role for some.

One of the most frequently mentioned techniques that helped our research participants manage their symptoms was work. “Work has been an important part of who I am,” said an educator in our group. “When you become useful to an organization and feel respected in that organization, there’s a certain value in belonging there.” This person works on the weekends too because of “the distraction factor.” In other words, by engaging in work, the crazy stuff often recedes to the sidelines.

Personally, I reach out to my doctors, friends and family whenever I start slipping, and I get great support from them. I eat comfort food (for me, cereal) and listen to quiet music. I minimize all stimulation. Usually these techniques, combined with more medication and therapy, will make the symptoms pass. But the work piece — using my mind — is my best defense. It keeps me focused, it keeps the demons at bay. My mind, I have come to say, is both my worst enemy and my best friend.

That is why it is so distressing when doctors tell their patients not to expect or pursue fulfilling careers. Far too often, the conventional psychiatric approach to mental illness is to see clusters of symptoms that characterize people. Accordingly, many psychiatrists hold the view that treating symptoms with medication is treating mental illness. But this fails to take into account individuals’ strengths and capabilities, leading mental health professionals to underestimate what their patients can hope to achieve in the world.

It’s not just schizophrenia: earlier this month, The Journal of Child Psychology and Psychiatry posted a study showing that a small group of people who were given diagnoses of autism, a developmental disorder, later stopped exhibiting symptoms. They seemed to have recovered — though after years of behavioral therapy and treatment. A recent New York Times Magazine article described a new company that hires high-functioning adults with autism, taking advantage of their unusual memory skills and attention to detail.

I don’t want to sound like a Pollyanna about schizophrenia; mental illness imposes real limitations, and it’s important not to romanticize it. We can’t all be Nobel laureates like John Nash of the movie “A Beautiful Mind.” But the seeds of creative thinking may sometimes be found in mental illness, and people underestimate the power of the human brain to adapt and to create.

An approach that looks for individual strengths, in addition to considering symptoms, could help dispel the pessimism surrounding mental illness. Finding “the wellness within the illness,” as one person with schizophrenia said, should be a therapeutic goal. Doctors should urge their patients to develop relationships and engage in meaningful work. They should encourage patients to find their own repertory of techniques to manage their symptoms and aim for a quality of life as they define it. And they should provide patients with the resources — therapy, medication and support — to make these things happen.

Every person has a unique gift or unique self to bring to the world,” said one of our study’s participants. She expressed the reality that those of us who have schizophrenia and other mental illnemesses want what everyone wants: in the words of Sigmund Freud, to work and to love.

Filed under schizophrenia elyn saks psychiatry psychology antipsychotic psychoanalysis psychopathology psychopharmacology psychosis psychotherapy psychotic diagnostic dsm symptoms delusions delusional mad crazy madness mental illness success successful inspire inspiring ucsd macarthur genius new york