Serious Mental Illness Blog

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Mentally Ill Patients Are More Likely to End Up in Jail Rather than a Hospital
By Justin Caba, Medical Daily
Left untreated, an individual with a serious mental illness is likely to suffer further as their symptoms worsen, and their perception of the world around them gets more and more out of touch. 
A recent survey conducted by the Treatment Advocacy Center (TAC) and the National Sheriffs’ Association has found that patients with a severe mental illness are ten times more likely to end up in a state prison rather than a state mental hospital.
“The lack of treatment for seriously ill inmates is inhumane and should not be allowed in a civilized society,” lead researcher and founder of the Treatment Advocacy Center, Dr. E. Fuller Torrey, said in a statement. “This is especially true for individuals who – because of their mental illness – are not aware they are sick and therefore refuse medication.” 
Torrey and his colleagues from both the TAC and the National Sheriff’s Association probed the records of state run prisons and mental hospitals in discovering where the majority of patients with a psychiatric illness end up. Unfortunately, jails and prisons are considered the largest institutions housing individuals with a serious mental illness. Findings revealed that only 35,000 patients with a mental illness are being kept in a hospital setting compared to 356,000 who currently reside in a prison or jail cell.
Researchers called the outcome of mistreatment experienced by some mentally ill inmates “usually harmful and sometimes tragic.” Due to their erratic or disruptive behavior, many inmates with a psychiatric disorder are at danger to being beaten, raped, self-mutilated, or suicidal. Mentally ill inmates also run the risk of being thrown into solitary confinement or having physical restraints placed on them for most of their day. Although moving inmates with a serious mental illness to a more suitable institution would be in their best interest, the research team said states and counties would also benefit from the funds that would be saved on corrections.
According to the National Alliance on Mental Illness, upward of 13.6 million adults in the United States are currently living with a serious mental illness. Many Americans may be surprised to find out what exactly is included as a serious mental illness. Major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD), and borderline personality disorder all fall under the category of serious mental illness. One in four Americans experiences a mental illness in a given year. 

 

 


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Mentally Ill Patients Are More Likely to End Up in Jail Rather than a Hospital

By Justin Caba, Medical Daily

Left untreated, an individual with a serious mental illness is likely to suffer further as their symptoms worsen, and their perception of the world around them gets more and more out of touch.

A recent survey conducted by the Treatment Advocacy Center (TAC) and the National Sheriffs’ Association has found that patients with a severe mental illness are ten times more likely to end up in a state prison rather than a state mental hospital.

“The lack of treatment for seriously ill inmates is inhumane and should not be allowed in a civilized society,” lead researcher and founder of the Treatment Advocacy Center, Dr. E. Fuller Torrey, said in a statement. “This is especially true for individuals who – because of their mental illness – are not aware they are sick and therefore refuse medication.” 

Torrey and his colleagues from both the TAC and the National Sheriff’s Association probed the records of state run prisons and mental hospitals in discovering where the majority of patients with a psychiatric illness end up. Unfortunately, jails and prisons are considered the largest institutions housing individuals with a serious mental illness. Findings revealed that only 35,000 patients with a mental illness are being kept in a hospital setting compared to 356,000 who currently reside in a prison or jail cell.

Researchers called the outcome of mistreatment experienced by some mentally ill inmates “usually harmful and sometimes tragic.” Due to their erratic or disruptive behavior, many inmates with a psychiatric disorder are at danger to being beaten, raped, self-mutilated, or suicidal. Mentally ill inmates also run the risk of being thrown into solitary confinement or having physical restraints placed on them for most of their day. Although moving inmates with a serious mental illness to a more suitable institution would be in their best interest, the research team said states and counties would also benefit from the funds that would be saved on corrections.

According to the National Alliance on Mental Illness, upward of 13.6 million adults in the United States are currently living with a serious mental illness. Many Americans may be surprised to find out what exactly is included as a serious mental illness. Major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD), and borderline personality disorder all fall under the category of serious mental illness. One in four Americans experiences a mental illness in a given year. 

 

 





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

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Panel discusses mental health care race gap
Karina Shedrofsky, The Diamondback
Even as mental health awareness and services increase, university officials said, mental health experiences vary for people of different races, a disparity they highlighted in a panel discussion last night. 
As part of Stress Less Week, an awareness campaign aimed at reducing stress and the stigma associated with mental illness, the university’s chapter of Active Minds, the Counseling Center and the Division of Student Affairs’ Diversity Advisory Council hosted a panel to address mental health resources and mental health in communities of color. A small crowd attended the event in the Benjamin Banneker room in Stamp Student Union.
Charmaine Wilson-Jones, the Diversity Advisory Council’s chairwoman, said the council wanted to host a mental health event focusing on unaddressed or underserved communities. 
“We feel like there’s a huge push for mental health right now, on campus and off,” said Wilson-Jones, a junior government and politics major. “But a lot of minority students — and people of color in general — are being left out of that discussion, and we wanted to find a way to sort of bring those two sides together.” 
Wilson-Jones connected with members of Active Minds and brought together Howard Lloyd, a doctoral intern at the Counseling Center; Na-Yeun Choi, a fifth-year psychology doctoral student; and James Houle, a Counseling Center staff psychologist. 
Wilson-Jones began the discussion by asking the speakers about their personal experiences with diversity and mental health. Each panelist identified as a different race and had different experiences but agreed that students of color face specific sources of stress and anxiety that must be combated.
“For students of color, there’s a real feeling or idea that, ‘If I go to talk to someone, they aren’t going to look like me or understand where I’m coming from. And how can someone who doesn’t look like me understand where I’m coming from?’” Lloyd said. 
Choi, a first-generation immigrant from Korea, discussed the stereotypes that can impact an individual’s mental health, such as the model minority myth surrounding Asian-American and Pacific Islander communities that creates pressure to live up to an ideal of perfectionism.
She said students of color can face numerous barriers when seeking help.   
“Maybe loss of faith and kind of bringing some shame to the families in their own community, especially in more communal and non-individual communities — they tend to look more into this concept of you really are supporting your whole community and family,” Choi said. 
Each speaker mentioned the extra emotional toll racism takes on students of color, and more specifically the idea of microaggressions — subtle and small acts of discrimination or prejudice that students who identify as white might not notice. 
“Somebody once described a million little paper cuts as a form of microaggression,” Houle said. “Over time one paper cut might not hurt, but a thousand or a million paper cuts will hurt.” 
Lloyd, who identifies as African-American, recognized that students might fear seeking help from people they don’t think they can relate to or who won’t understand their stresses and problems because of difference in race or ethnicity. 
To combat the stigma surrounding mental health issues in multiracial communities, the panelists said, talking about the issues and making students more aware of the realities of counseling — such as what psychologists and psychiatrists look like and how sessions are typically run — can go a long way.
Houle said the Counseling Center reaches out to explain the services they offer and meet people to show what psychologists look like outside of pop culture depictions, he said. The center offers Students of Color Walk-In Hour sessions during which students can see a counselor without making an appointment.
Mudit Verma, a senior psychology major and Active Minds’ fundraising director, appreciated the panelists’ advice on how to productively react when a friend or family member says something offensive that might discourage someone from seeking professional help. 
“Their responses really intrigued me,” he said. “Using objective information is really a powerful tool to sort of convince an audience.”
Josh Ratner, the Student Government Association’s student affairs vice president, said that identifying the different ways communities perceive mental health is important when trying to improve services.
“It’s really interesting to see how different communities value, stigmatize, prioritize mental health,” the junior government and politics major said. “And it’s great to see that the university has programs to try and reach out to different communities that might have more stigma associated with mental health.” 

 

 


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

Panel discusses mental health care race gap

Karina Shedrofsky, The Diamondback

Even as mental health awareness and services increase, university officials said, mental health experiences vary for people of different races, a disparity they highlighted in a panel discussion last night. 

As part of Stress Less Week, an awareness campaign aimed at reducing stress and the stigma associated with mental illness, the university’s chapter of Active Minds, the Counseling Center and the Division of Student Affairs’ Diversity Advisory Council hosted a panel to address mental health resources and mental health in communities of color. A small crowd attended the event in the Benjamin Banneker room in Stamp Student Union.

Charmaine Wilson-Jones, the Diversity Advisory Council’s chairwoman, said the council wanted to host a mental health event focusing on unaddressed or underserved communities. 

“We feel like there’s a huge push for mental health right now, on campus and off,” said Wilson-Jones, a junior government and politics major. “But a lot of minority students — and people of color in general — are being left out of that discussion, and we wanted to find a way to sort of bring those two sides together.” 

Wilson-Jones connected with members of Active Minds and brought together Howard Lloyd, a doctoral intern at the Counseling Center; Na-Yeun Choi, a fifth-year psychology doctoral student; and James Houle, a Counseling Center staff psychologist. 

Wilson-Jones began the discussion by asking the speakers about their personal experiences with diversity and mental health. Each panelist identified as a different race and had different experiences but agreed that students of color face specific sources of stress and anxiety that must be combated.

“For students of color, there’s a real feeling or idea that, ‘If I go to talk to someone, they aren’t going to look like me or understand where I’m coming from. And how can someone who doesn’t look like me understand where I’m coming from?’” Lloyd said. 

Choi, a first-generation immigrant from Korea, discussed the stereotypes that can impact an individual’s mental health, such as the model minority myth surrounding Asian-American and Pacific Islander communities that creates pressure to live up to an ideal of perfectionism.

She said students of color can face numerous barriers when seeking help.   

“Maybe loss of faith and kind of bringing some shame to the families in their own community, especially in more communal and non-individual communities — they tend to look more into this concept of you really are supporting your whole community and family,” Choi said. 

Each speaker mentioned the extra emotional toll racism takes on students of color, and more specifically the idea of microaggressions — subtle and small acts of discrimination or prejudice that students who identify as white might not notice. 

“Somebody once described a million little paper cuts as a form of microaggression,” Houle said. “Over time one paper cut might not hurt, but a thousand or a million paper cuts will hurt.” 

Lloyd, who identifies as African-American, recognized that students might fear seeking help from people they don’t think they can relate to or who won’t understand their stresses and problems because of difference in race or ethnicity. 

To combat the stigma surrounding mental health issues in multiracial communities, the panelists said, talking about the issues and making students more aware of the realities of counseling — such as what psychologists and psychiatrists look like and how sessions are typically run — can go a long way.

Houle said the Counseling Center reaches out to explain the services they offer and meet people to show what psychologists look like outside of pop culture depictions, he said. The center offers Students of Color Walk-In Hour sessions during which students can see a counselor without making an appointment.

Mudit Verma, a senior psychology major and Active Minds’ fundraising director, appreciated the panelists’ advice on how to productively react when a friend or family member says something offensive that might discourage someone from seeking professional help. 

“Their responses really intrigued me,” he said. “Using objective information is really a powerful tool to sort of convince an audience.”

Josh Ratner, the Student Government Association’s student affairs vice president, said that identifying the different ways communities perceive mental health is important when trying to improve services.

“It’s really interesting to see how different communities value, stigmatize, prioritize mental health,” the junior government and politics major said. “And it’s great to see that the university has programs to try and reach out to different communities that might have more stigma associated with mental health.” 

 

 





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

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Mom sues psychiatric prison, alleges son isolated for 6,300 hours, shackled to bedBy ABC News
"They have criminalized his illness. That’s what they are doing," she said. "And it’s unconscionable and he’s not in a therapeutic environment. I know he is ill. I can live with that. But no one should be treated like an animal, locked in an isolation cage."
When Joanne Minich recently visited son Peter, 31, at Bridgewater State Hospital in Massachusetts, prison guards brought her to a locked cell that inmates call the “bird cage,” where he was shackled at the hands, waist and bare feet, she says.
For the past 14 months, Peter Minich has been legally committed to a legendary facility once called the state hospital “for the criminally insane” but, according to his Brookline, Mass., mother, he has never been convicted of a crime – only diagnosed with a mental illness.
Minich says her son has suffered from paranoid schizophrenia since his late teens and a court sent him to Bridgewater in January 2013, after staff members at another psychiatric hospital filed assault misdemeanor criminal charges against him. Her son had no previous criminal record or history of violent behavior, she says.
"People say it’s a hospital, but it’s not a hospital. It’s a prison," Minich, 66, said of the facility, which is administered by the state Department of Correction. "I don’t think they are helping him at all. It’s torture. It looks like a cage you put an animal in."
Minich has now filed a lawsuit in Norfolk County Superior Court against the state Department of Correction, the superintendent of Bridgewater State Hospital, the state of Massachusetts and MHM Services Inc., a national health care provider, for alleged abuses against her son.
The March 31 lawsuit, which was obtained by ABCNews.com, alleges that staff have isolated her son in a locked seclusion room at the intensive-treatment unit for at least 6,300 hours from January 14, 2013 to March 12, 2014, and restrained him to objects like his bed for 815 hours from January 14, 2013 to January 22, 2014.
She says her son’s caregivers have violated American Psychiatric Association guidelines, as well as the state’s Seclusion and Restraint law, which allows such techniques “in cases of emergency, such as the occurrence of, or serious threat of, extreme violence, personal injury or attempted suicide.”
Seclusion and restraints were ordered for incidents such as hearing voices, licking another inmate’s feet, having a seizure and being assaulted by another inmate, according to 5,000 pages of prison records cited in the lawsuit.
The lawsuit alleges that her son was offered no exercise program or outdoor activity, and his food was delivered through a “slot in the door.” His only contact with other human beings was when placed in restraints, medicated or given electro-shock treatment, according to the lawsuit.
Peter Minich’s parents have only been allowed to visit their son once a week, with a 10-minute phone call every two days. They say his condition has worsened, with more hallucinations and anxiety, and he has become more aggressive as a result of incarceration. They say their son has also lost 40 pounds.
"It’s horrible," Minich, who works in a special care nursery with premature babies, told ABCNews.com. "He’s living with this mental illness and you can’t let the system destroy him. It’s not humanitarian what they are doing to him. He is a difficult case. I am not denying that, but it doesn’t mean he should be in a prison."
Minich is demanding that her son be moved from Bridgewater. “All I want is him out of there and in a therapeutic environment,” she said. “I am afraid one day I will get the phone call saying he is dead. It’s a horrible way to live.”
The lawsuit is not seeking damages, but compliance with the seclusion and restraint statute; a treatment plan that includes individual and group therapy, and socialization and “activities of daily living” training; and a transfer to a place that is not a prison.
This is not the first time Bridgewater has come under fire for alleged abuse. In 2009, inmate Joshua K. Messier, 23, died while guards were placing him in restraints. A Boston Globe expose resulted in the discipline of six correction officials, and the state has agreed to pay the family $3 million as part of a settlement.
In 1967, Bridgewater State Hospital was the subject of a documentary, “Titicut Follies,” which showed graphic examples of physical abuse by staff and doctors. A Superior Court judge banned its public showing and ordered all copies of the film seized because of “crudities, nudities, and obscenities … eighty minutes of brutal sordidness and human degradation.”
"This is worse than anything I saw in ‘Titicut Follies,’" Minich’s lawyer, Roderick MacLeish Jr., told ABCNews.com. "At least they let them out in the yard and they had Christmas parties."
The lawsuit states that for 60 days at the end of 2013, Minich was held in seclusion for 24 hours a day, all but for eight and a half hours, including Thanksgiving and Christmas. In October of that year, he was allegedly held in mechanical restraint for more than 50 consecutive hours.
MacLeish alleges that Peter Minich, an intelligent man, has been given no reading materials when asked, nor stimulating activities while in solitary confinement, and, as a result, has deteriorated mentally.
"This is a slow death for Peter," he said. "It has evolved as part of our punitive culture." MacLeish said that Bridgewater was "cleaned up" in the 1980s. "But now we find out they are back to their old practices. … It’s a disgrace, particularly since our governor [Deval Patrick] used to be head of the Civil Rights Division at the Justice Department and has widely said that isolation should not be used."
Patrick has been outspoken on the issue, saying these measures should be used as a “last resort.”
The governor’s press secretary, Heather Nichols, responded to a request by ABCNews.com for comment by referring by citing part of a speech Patrick made last month:
"The evidence tells us that methods traditionally used to handle difficult prisoners may actually exacerbate the difficulties of those with mental illness. Solitary confinement can cause extreme disorientation that only worsens asocial behavior within a correctional institute — let alone after release. If it remains a feature of our correctional system, it should be reserved for the most exceptional situations, and only as a last resort.
"Fully restraining a mentally ill inmate carries similar risks. Unless it can be said with certainty that the inmate poses a serious and immediate physical danger to himself or his fellow inmates, he should not be tied down, limb-by-limb, in a 21st Century correctional institution. Most of our inmates — even the most difficult ones — will return to the streets of our Commonwealth. Our treatment of them must always keep that fact in mind, and preserve to the extent possible their own grip on their humanity."
Click here to read the rest of the article\

 


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Mom sues psychiatric prison, alleges son isolated for 6,300 hours, shackled to bed
By ABC News

"They have criminalized his illness. That’s what they are doing," she said. "And it’s unconscionable and he’s not in a therapeutic environment. I know he is ill. I can live with that. But no one should be treated like an animal, locked in an isolation cage."

When Joanne Minich recently visited son Peter, 31, at Bridgewater State Hospital in Massachusetts, prison guards brought her to a locked cell that inmates call the “bird cage,” where he was shackled at the hands, waist and bare feet, she says.

For the past 14 months, Peter Minich has been legally committed to a legendary facility once called the state hospital “for the criminally insane” but, according to his Brookline, Mass., mother, he has never been convicted of a crime – only diagnosed with a mental illness.

Minich says her son has suffered from paranoid schizophrenia since his late teens and a court sent him to Bridgewater in January 2013, after staff members at another psychiatric hospital filed assault misdemeanor criminal charges against him. Her son had no previous criminal record or history of violent behavior, she says.

"People say it’s a hospital, but it’s not a hospital. It’s a prison," Minich, 66, said of the facility, which is administered by the state Department of Correction. "I don’t think they are helping him at all. It’s torture. It looks like a cage you put an animal in."

Minich has now filed a lawsuit in Norfolk County Superior Court against the state Department of Correction, the superintendent of Bridgewater State Hospital, the state of Massachusetts and MHM Services Inc., a national health care provider, for alleged abuses against her son.

The March 31 lawsuit, which was obtained by ABCNews.com, alleges that staff have isolated her son in a locked seclusion room at the intensive-treatment unit for at least 6,300 hours from January 14, 2013 to March 12, 2014, and restrained him to objects like his bed for 815 hours from January 14, 2013 to January 22, 2014.

She says her son’s caregivers have violated American Psychiatric Association guidelines, as well as the state’s Seclusion and Restraint law, which allows such techniques “in cases of emergency, such as the occurrence of, or serious threat of, extreme violence, personal injury or attempted suicide.”

Seclusion and restraints were ordered for incidents such as hearing voices, licking another inmate’s feet, having a seizure and being assaulted by another inmate, according to 5,000 pages of prison records cited in the lawsuit.

The lawsuit alleges that her son was offered no exercise program or outdoor activity, and his food was delivered through a “slot in the door.” His only contact with other human beings was when placed in restraints, medicated or given electro-shock treatment, according to the lawsuit.

Peter Minich’s parents have only been allowed to visit their son once a week, with a 10-minute phone call every two days. They say his condition has worsened, with more hallucinations and anxiety, and he has become more aggressive as a result of incarceration. They say their son has also lost 40 pounds.

"It’s horrible," Minich, who works in a special care nursery with premature babies, told ABCNews.com. "He’s living with this mental illness and you can’t let the system destroy him. It’s not humanitarian what they are doing to him. He is a difficult case. I am not denying that, but it doesn’t mean he should be in a prison."

Minich is demanding that her son be moved from Bridgewater. “All I want is him out of there and in a therapeutic environment,” she said. “I am afraid one day I will get the phone call saying he is dead. It’s a horrible way to live.”

The lawsuit is not seeking damages, but compliance with the seclusion and restraint statute; a treatment plan that includes individual and group therapy, and socialization and “activities of daily living” training; and a transfer to a place that is not a prison.

This is not the first time Bridgewater has come under fire for alleged abuse. In 2009, inmate Joshua K. Messier, 23, died while guards were placing him in restraints. A Boston Globe expose resulted in the discipline of six correction officials, and the state has agreed to pay the family $3 million as part of a settlement.

In 1967, Bridgewater State Hospital was the subject of a documentary, “Titicut Follies,” which showed graphic examples of physical abuse by staff and doctors. A Superior Court judge banned its public showing and ordered all copies of the film seized because of “crudities, nudities, and obscenities … eighty minutes of brutal sordidness and human degradation.”

"This is worse than anything I saw in ‘Titicut Follies,’" Minich’s lawyer, Roderick MacLeish Jr., told ABCNews.com. "At least they let them out in the yard and they had Christmas parties."

The lawsuit states that for 60 days at the end of 2013, Minich was held in seclusion for 24 hours a day, all but for eight and a half hours, including Thanksgiving and Christmas. In October of that year, he was allegedly held in mechanical restraint for more than 50 consecutive hours.

MacLeish alleges that Peter Minich, an intelligent man, has been given no reading materials when asked, nor stimulating activities while in solitary confinement, and, as a result, has deteriorated mentally.

"This is a slow death for Peter," he said. "It has evolved as part of our punitive culture." MacLeish said that Bridgewater was "cleaned up" in the 1980s. "But now we find out they are back to their old practices. … It’s a disgrace, particularly since our governor [Deval Patrick] used to be head of the Civil Rights Division at the Justice Department and has widely said that isolation should not be used."

Patrick has been outspoken on the issue, saying these measures should be used as a “last resort.”

The governor’s press secretary, Heather Nichols, responded to a request by ABCNews.com for comment by referring by citing part of a speech Patrick made last month:

"The evidence tells us that methods traditionally used to handle difficult prisoners may actually exacerbate the difficulties of those with mental illness. Solitary confinement can cause extreme disorientation that only worsens asocial behavior within a correctional institute — let alone after release. If it remains a feature of our correctional system, it should be reserved for the most exceptional situations, and only as a last resort.

"Fully restraining a mentally ill inmate carries similar risks. Unless it can be said with certainty that the inmate poses a serious and immediate physical danger to himself or his fellow inmates, he should not be tied down, limb-by-limb, in a 21st Century correctional institution. Most of our inmates — even the most difficult ones — will return to the streets of our Commonwealth. Our treatment of them must always keep that fact in mind, and preserve to the extent possible their own grip on their humanity."

Click here to read the rest of the article\

 





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

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Doctors’ notes on mental health shared with patients: Policy shift at Beth Israel DeaconessBy Liz Kowalczyk, The Boston Globe
At the end of every workday, psychiatrists, social workers, and other mental health providers write notes describing their patients’ visits. It is where they chronicle paranoid behavior, excessive drinking, or relationship problems. These candid comments often are available to other doctors, but they are rarely shared with patients themselves.
Now, as part of an ongoing effort to make care more transparent, clinicians at Beth Israel Deaconess Medical Center have begun posting the mental health notes in patients’ electronic medical records, allowing the patients immediate access to the summaries at home.
On March 1, about 40 providers started sharing their notes with more than 650 patients. Some are eagerly reading every word, clinicians said, while others have no interest.
“We all had some reservations,’’ said Dr. Michael Kahn, a psychiatrist who has worked at Beth Israel Deaconess for 20 years. “What about if a patient misinterpreted a note? Would they be upset about it? Would it confuse them?’’
But ultimately, he and his colleagues decided that sharing the notes could improve care by encouraging patients to more actively participate in their treatment, while inspiring providers to describe patients nonjudgmentally.
Patients can correct mistakes, such as a wrong medication dose. And rather than write a word such as “paranoid,’’ which to many people “means crazy or bad,’’ Kahn said he now uses less-loaded terms such as “persecutory anxiety.’’
Primary care providers at the Boston hospital, along with those at a handful of medical centers and physicians groups nationally, have been posting notes from medical visits in patients’ secure online medical records for several years — with mostly positive results.
But except for the Veterans Health Administration, which gives veterans online access to mental health notes, providers have hesitated to share psychiatric notes out of a belief that this approach is a minefield for patients. They worry patients will be rattled upon learning that their firm convictions are seen as delusions, or angered by diagnoses that feel harsh and stigmatizing.
Patients have a right under federal law to request their medical records, including doctors’ notes. But most patients do not ask for them, in part because the process is cumbersome and can take days or even weeks. But as electronic medical records become more widespread, it is far easier to share sensitive health information.
Stephen O’Neill, social work manager for psychiatry and primary care at Beth Israel Deaconess, said he has offered to share notes with patients informally for years. Most, including Lori, a 53-year-0ld woman who suffers from depression, have not taken him up on it. But now that he has made the summaries available online, she said she plans to read them.
On Wednesday, he showed her how the system works in his office and she read the notes from their appointment that day. “It’s not what I thought it would be,’’ she said.
Lori, who did not want her last name used because she feels mental health problems still carry a stigma, said she was surprised at the detail in O’Neill’s notes about issues she did not see as important. For example, she had discussed turning down a friend’s request for a significant favor.
After reading the entry, she understood how it related to her overall therapy. “We again reinforced. . . that she should share how she feels with her friend so that she does not internalize this,’’ O’Neill wrote.
Reading the notes is “a good way to see if you are on the same level,’’ Lori said. “Sometimes when I am in session with [him], I wonder does he understand what I am trying to get across. I get to see if he does.’’
In an opinion piece published in the Journal of the American Medical Association, Kahn and three colleagues argued that sharing notes could be particularly beneficial for patients who abuse drugs or alcohol, who are “often so used to being lectured that they tune out real-time discussions of harmful consequences.’’ Allowing them to read a doctor’s assessment in private “may diminish the need for defensive maneuvers,’’ the authors said.
Still, not all mental health providers are ready for this level of openness with patients.
Nina Douglass, who works in obstetrics and gynecology at Beth Israel Deaconess, is one of five social workers who declined to participate — for now. Some of her patients are addicted to drugs, while others are in abusive relationships. Douglass tells them at the outset that she is required to report abuse or neglect of a child to state officials. If she writes about a specific concern in a note, and the patient reads it, Douglass is worried the patient might flee rather than risk losing custody of the child.
“I absolutely share the hospital ethic of transparency,’’ she said. “But I want more time to see how this works.’’
At Geisinger Health System in Pennsylvania, where more than 1,300 providers share medical visit notes with 200,000 patients, mental health providers and pain specialists do not participate yet. The organization is planning to share psychiatric notes in the next six months, but Dr. Jonathan Darer, chief innovation officer, said doctors can exclude patients whom they feel will be harmed by easy access to visit notes, such as those with anxiety disorders who see even minor symptoms as catastrophic.
At Beth Israel Deaconess, mental health providers have identified at least 10 percent of their patients to participate in the project initially, and most are starting with those who are functioning at a high level.
“We thought, how can we find a safe place to start?’’ said Pamela Peck, clinical director for the psychiatry department. “Are there patients who would feel” upset by reading “about aspects of their psychiatric illness? That is a question that is still up for discussion.’’
Beth Israel Deaconess began encouraging providers to share medical notes nearly five years ago. Now, almost 2,300 doctors and nurse practitioners post notes for almost 225,000 patients. According to surveys done by the hospital, the vast majority want access to continue, though patients and caregivers have suggested changes.
Some patients want to approve what doctors write or to write responses. Some doctors want the option to hide notes, or portions of them, from patients or families, and want ways to communicate with colleagues privately, according to an opinion piece published in the New England Journal of Medicine earlier this year.
Partners HealthCare, the largest health care system in Massachusetts, is moving toward putting medical notes online, but is still debating whether to post mental health notes in patients’ records. One unanswered question is whether a psychiatrist’s notes are still useful and precise for other doctors, including those in the emergency room, if they are written with the knowledge that the patient can read them, said Dr. Gregg Meyer, chief clinical officer.
“One of the key points that physicians need to think about is whether the way we document care is going to fundamentally change,’’ he said. “First and foremost we have to make sure patient care is not compromised. We are watching their experience closely.’’
At Beth Israel Deaconess, doctors still have the option of putting certain notes in a locked area of the record, which patients cannot see and other doctors can access only if they provide written justification.
The hospital said it is too early to know how many patients are reading the mental health notes. Kahn spoke to one patient, a highly educated, successful woman whom he thought would jump at the chance. Kahn was surprised by her response.
“She said, ‘No, no no, I don’t want to read anything. I prefer not to look.’”

Liz Kowalczyk can be reached at kowalczyk@globe.com.

 


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Doctors’ notes on mental health shared with patients: Policy shift at Beth Israel Deaconess
By Liz Kowalczyk, The Boston Globe

At the end of every workday, psychiatrists, social workers, and other mental health providers write notes describing their patients’ visits. It is where they chronicle paranoid behavior, excessive drinking, or relationship problems. These candid comments often are available to other doctors, but they are rarely shared with patients themselves.

Now, as part of an ongoing effort to make care more transparent, clinicians at Beth Israel Deaconess Medical Center have begun posting the mental health notes in patients’ electronic medical records, allowing the patients immediate access to the summaries at home.

On March 1, about 40 providers started sharing their notes with more than 650 patients. Some are eagerly reading every word, clinicians said, while others have no interest.

“We all had some reservations,’’ said Dr. Michael Kahn, a psychiatrist who has worked at Beth Israel Deaconess for 20 years. “What about if a patient misinterpreted a note? Would they be upset about it? Would it confuse them?’’

But ultimately, he and his colleagues decided that sharing the notes could improve care by encouraging patients to more actively participate in their treatment, while inspiring providers to describe patients nonjudgmentally.

Patients can correct mistakes, such as a wrong medication dose. And rather than write a word such as “paranoid,’’ which to many people “means crazy or bad,’’ Kahn said he now uses less-loaded terms such as “persecutory anxiety.’’

Primary care providers at the Boston hospital, along with those at a handful of medical centers and physicians groups nationally, have been posting notes from medical visits in patients’ secure online medical records for several years — with mostly positive results.

But except for the Veterans Health Administration, which gives veterans online access to mental health notes, providers have hesitated to share psychiatric notes out of a belief that this approach is a minefield for patients. They worry patients will be rattled upon learning that their firm convictions are seen as delusions, or angered by diagnoses that feel harsh and stigmatizing.

Patients have a right under federal law to request their medical records, including doctors’ notes. But most patients do not ask for them, in part because the process is cumbersome and can take days or even weeks. But as electronic medical records become more widespread, it is far easier to share sensitive health information.

Stephen O’Neill, social work manager for psychiatry and primary care at Beth Israel Deaconess, said he has offered to share notes with patients informally for years. Most, including Lori, a 53-year-0ld woman who suffers from depression, have not taken him up on it. But now that he has made the summaries available online, she said she plans to read them.

On Wednesday, he showed her how the system works in his office and she read the notes from their appointment that day. “It’s not what I thought it would be,’’ she said.

Lori, who did not want her last name used because she feels mental health problems still carry a stigma, said she was surprised at the detail in O’Neill’s notes about issues she did not see as important. For example, she had discussed turning down a friend’s request for a significant favor.

After reading the entry, she understood how it related to her overall therapy. “We again reinforced. . . that she should share how she feels with her friend so that she does not internalize this,’’ O’Neill wrote.

Reading the notes is “a good way to see if you are on the same level,’’ Lori said. “Sometimes when I am in session with [him], I wonder does he understand what I am trying to get across. I get to see if he does.’’

In an opinion piece published in the Journal of the American Medical Association, Kahn and three colleagues argued that sharing notes could be particularly beneficial for patients who abuse drugs or alcohol, who are “often so used to being lectured that they tune out real-time discussions of harmful consequences.’’ Allowing them to read a doctor’s assessment in private “may diminish the need for defensive maneuvers,’’ the authors said.

Still, not all mental health providers are ready for this level of openness with patients.

Nina Douglass, who works in obstetrics and gynecology at Beth Israel Deaconess, is one of five social workers who declined to participate — for now. Some of her patients are addicted to drugs, while others are in abusive relationships. Douglass tells them at the outset that she is required to report abuse or neglect of a child to state officials. If she writes about a specific concern in a note, and the patient reads it, Douglass is worried the patient might flee rather than risk losing custody of the child.

“I absolutely share the hospital ethic of transparency,’’ she said. “But I want more time to see how this works.’’

At Geisinger Health System in Pennsylvania, where more than 1,300 providers share medical visit notes with 200,000 patients, mental health providers and pain specialists do not participate yet. The organization is planning to share psychiatric notes in the next six months, but Dr. Jonathan Darer, chief innovation officer, said doctors can exclude patients whom they feel will be harmed by easy access to visit notes, such as those with anxiety disorders who see even minor symptoms as catastrophic.

At Beth Israel Deaconess, mental health providers have identified at least 10 percent of their patients to participate in the project initially, and most are starting with those who are functioning at a high level.

“We thought, how can we find a safe place to start?’’ said Pamela Peck, clinical director for the psychiatry department. “Are there patients who would feel” upset by reading “about aspects of their psychiatric illness? That is a question that is still up for discussion.’’

Beth Israel Deaconess began encouraging providers to share medical notes nearly five years ago. Now, almost 2,300 doctors and nurse practitioners post notes for almost 225,000 patients. According to surveys done by the hospital, the vast majority want access to continue, though patients and caregivers have suggested changes.

Some patients want to approve what doctors write or to write responses. Some doctors want the option to hide notes, or portions of them, from patients or families, and want ways to communicate with colleagues privately, according to an opinion piece published in the New England Journal of Medicine earlier this year.

Partners HealthCare, the largest health care system in Massachusetts, is moving toward putting medical notes online, but is still debating whether to post mental health notes in patients’ records. One unanswered question is whether a psychiatrist’s notes are still useful and precise for other doctors, including those in the emergency room, if they are written with the knowledge that the patient can read them, said Dr. Gregg Meyer, chief clinical officer.

“One of the key points that physicians need to think about is whether the way we document care is going to fundamentally change,’’ he said. “First and foremost we have to make sure patient care is not compromised. We are watching their experience closely.’’

At Beth Israel Deaconess, doctors still have the option of putting certain notes in a locked area of the record, which patients cannot see and other doctors can access only if they provide written justification.

The hospital said it is too early to know how many patients are reading the mental health notes. Kahn spoke to one patient, a highly educated, successful woman whom he thought would jump at the chance. Kahn was surprised by her response.

“She said, ‘No, no no, I don’t want to read anything. I prefer not to look.’”

Liz Kowalczyk can be reached at kowalczyk@globe.com.

 





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Ideas of New Attention Disorder Spurs Research, and DebateBy Alan Schwarz, The New York Times
“Some powerful figures in mental health,” according to today’s New York Times, “are claiming to have identified a new disorder that could vastly expand the ranks of young children treated for attention problems.” Sluggish Cognitive Tempo (SCT) – characterized by lethargy, daydreaming, and slow mental processing – was the subject of 131 pages in the January issue of the Journal of Abnormal Child Psychology. The lead paper claims that the question of the disorder’s existence “seems to be laid to rest as of this issue,” with other papers claiming “exciting findings” of pharmaceutical treatment for the disorder. Eli Lilly promises to study the disorder as part of its mission to “help satisfy unmet medical needs around the world.”
Read more at http://www.nytimes.com/2014/04/12/health/idea-of-new-attention-disorder-spurs-research-and-debate.html?hp&_r=0

 


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Ideas of New Attention Disorder Spurs Research, and Debate
By Alan Schwarz, The New York Times

“Some powerful figures in mental health,” according to today’s New York Times, “are claiming to have identified a new disorder that could vastly expand the ranks of young children treated for attention problems.” Sluggish Cognitive Tempo (SCT) – characterized by lethargy, daydreaming, and slow mental processing – was the subject of 131 pages in the January issue of the Journal of Abnormal Child Psychology. The lead paper claims that the question of the disorder’s existence “seems to be laid to rest as of this issue,” with other papers claiming “exciting findings” of pharmaceutical treatment for the disorder. Eli Lilly promises to study the disorder as part of its mission to “help satisfy unmet medical needs around the world.”

Read more at http://www.nytimes.com/2014/04/12/health/idea-of-new-attention-disorder-spurs-research-and-debate.html?hp&_r=0

 





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126 notes

Shooting Unfairly Links Violence with Mental Illness — AgainBy Joseph Shapiro, Shots: Health News from NPR
Experts in mental health say (even as more facts about Lopez emerge) that it’s highly unlikely the violence could have been predicted. Just raising that question, psychologists and psychiatrists say, shows how much Americans misunderstand the link between mental illness and violence.
With the Army’s disclosure that Army Spc. Ivan Lopez was being evaluated for post-traumatic stress disorder before he went on a shooting rampage Wednesday, there were once again questions about whether the Army could have prevented the violence at Fort Hood.
Experts in mental health say (even as more facts about Lopez emerge) that it’s highly unlikely the violence could have been predicted. Just raising that question, psychologists and psychiatrists say, shows how much Americans misunderstand the link between mental illness and violence.
One national survey in 2006 found that most Americans — 60 percent — believed people with schizophrenia were likely to be violent. But the vast majority of people with psychiatric disorders are not violent. In fact, another study found they are far more likely to be the victims of violence, and that 1 in 4 experience violence every year.
Dr. Carl Bell, a psychiatrist at the University of Illinois at Chicago, says being able to predict who will be violent in advance “is impossible.”
"The reality," Bell says, "is that prediction of violence is only useful in an immediate clinical situation: Someone comes in and says, ‘I’m going to kill myself.’ Then you take their word for it, and can predict violence in the short term. But you cannot use that to predict violence in the long term."
Army officials said Thursday that Lopez had seen a psychiatrist in the past month, but there were no indications that he was suicidal.
Dr. Thomas Grieger, a clinical and forensic psychiatrist who worked in military hospitals for three decades, says that one reason violence is so hard to predict is because it is so rare. “Acts of extreme violence and acts against yourself — suicide attempts — are so infrequent that it really becomes almost impossible to predict when any individual or situation is going to escalate to that,” Grieger says. “So many factors come to play: interpersonal relationships, difficulty in the workplace, issues at home, career issues and true mental health issues like depression, bipolar disorder or psychosis.”
Medications are another complicating factor — which ones and whether a soldier was taking them. For many troops back from deployment, multiple medications are prescribed to deal with pain, mental health issues and other problems. Army officials say Lopez had been prescribed Ambien, a drug to help him sleep, and other medications to treat anxiety and depression.
Still, there are a few factors that are more likely than others to be present among people who do become violent. The best predictor of future violence is whether a person with a psychiatric illness has been arrested or acted violently in the past. And people with substance abuse problems, on top of mental illness, are also at a greater risk of committing violence.
Bell says there’s growing study of “mass murder preceding suicide.” In these cases, someone who goes on a shooting spree wants to die, but wants to do so in a way that gets a lot of attention.
"There’s a huge dynamic in suicide where people get angry because they’re hurt," Bell says. "They say, ‘I’ll fix you. I will kill myself and I’ll get even with you.’ What better way to get even (and make a big splash) than to kill a bunch of people before you kill yourself?" It’s been reported that Lopez shot himself, bringing his shooting spree to an end, after he was confronted by a police officer.
This was the second mass shooting at Fort Hood in less than five years. Last year, Maj. Nidal Hasan, an Army psychiatrist, was sentenced to death for killing 13 people and wounding 32 others in the November 2009 shooting that remains the worst mass murder at a military installation.
It’s more reasonable to question whether the Army could have prevented Hasan’s violence — but not because of mental illness. The FBI had seen email that Hasan had sent to the website of terrorist Anwar al-Awlaki, expressing his own sympathy toward suicide bombers.
And, as my NPR colleague Daniel Zwerdling reported, Hasan’s supervisor at Walter Reed Army Medical Center was so concerned about Hasan’s “pattern of poor judgment and a lack of professionalism” that he wrote a memo sharply criticizing the doctor. That kind of document could have ended a military career.
But instead, the Army — with a shortage of psychiatrists and a flood of soldiers returning from Iraq and Afghanistan with mental health problems — kept Hasan working.
After the 2009 shootings, the Pentagon commissioned a report on how to prevent a repeat of the shootings. The report made 47 recommendations for how to improve security. One was to improve training so that military personnel could better “identify contributing factors and behavioral indicators of potentially violent actors.” Another was simply to realize that its own soldiers could be a threat. Another was to find ways to restrict the carrying of personal firearms on military bases. Lopez, it’s been reported, died of a self-inflicted gunshot wound from a .45-caliber Smith & Wesson semiautomatic pistol. The gun, according to media reports, was purchased at the same Killeen, Texas, store where Hasan bought his pistol.



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Shooting Unfairly Links Violence with Mental Illness — Again
By Joseph Shapiro, Shots: Health News from NPR

Experts in mental health say (even as more facts about Lopez emerge) that it’s highly unlikely the violence could have been predicted. Just raising that question, psychologists and psychiatrists say, shows how much Americans misunderstand the link between mental illness and violence.

With the Army’s disclosure that Army Spc. Ivan Lopez was being evaluated for post-traumatic stress disorder before he went on a shooting rampage Wednesday, there were once again questions about whether the Army could have prevented the violence at Fort Hood.

Experts in mental health say (even as more facts about Lopez emerge) that it’s highly unlikely the violence could have been predicted. Just raising that question, psychologists and psychiatrists say, shows how much Americans misunderstand the link between mental illness and violence.

One national survey in 2006 found that most Americans — 60 percent — believed people with schizophrenia were likely to be violent. But the vast majority of people with psychiatric disorders are not violent. In fact, another study found they are far more likely to be the victims of violence, and that 1 in 4 experience violence every year.

Dr. Carl Bell, a psychiatrist at the University of Illinois at Chicago, says being able to predict who will be violent in advance “is impossible.”

"The reality," Bell says, "is that prediction of violence is only useful in an immediate clinical situation: Someone comes in and says, ‘I’m going to kill myself.’ Then you take their word for it, and can predict violence in the short term. But you cannot use that to predict violence in the long term."

Army officials said Thursday that Lopez had seen a psychiatrist in the past month, but there were no indications that he was suicidal.

Dr. Thomas Grieger, a clinical and forensic psychiatrist who worked in military hospitals for three decades, says that one reason violence is so hard to predict is because it is so rare. “Acts of extreme violence and acts against yourself — suicide attempts — are so infrequent that it really becomes almost impossible to predict when any individual or situation is going to escalate to that,” Grieger says. “So many factors come to play: interpersonal relationships, difficulty in the workplace, issues at home, career issues and true mental health issues like depression, bipolar disorder or psychosis.”

Medications are another complicating factor — which ones and whether a soldier was taking them. For many troops back from deployment, multiple medications are prescribed to deal with pain, mental health issues and other problems. Army officials say Lopez had been prescribed Ambien, a drug to help him sleep, and other medications to treat anxiety and depression.

Still, there are a few factors that are more likely than others to be present among people who do become violent. The best predictor of future violence is whether a person with a psychiatric illness has been arrested or acted violently in the past. And people with substance abuse problems, on top of mental illness, are also at a greater risk of committing violence.

Bell says there’s growing study of “mass murder preceding suicide.” In these cases, someone who goes on a shooting spree wants to die, but wants to do so in a way that gets a lot of attention.

"There’s a huge dynamic in suicide where people get angry because they’re hurt," Bell says. "They say, ‘I’ll fix you. I will kill myself and I’ll get even with you.’ What better way to get even (and make a big splash) than to kill a bunch of people before you kill yourself?" It’s been reported that Lopez shot himself, bringing his shooting spree to an end, after he was confronted by a police officer.

This was the second mass shooting at Fort Hood in less than five years. Last year, Maj. Nidal Hasan, an Army psychiatrist, was sentenced to death for killing 13 people and wounding 32 others in the November 2009 shooting that remains the worst mass murder at a military installation.

It’s more reasonable to question whether the Army could have prevented Hasan’s violence — but not because of mental illness. The FBI had seen email that Hasan had sent to the website of terrorist Anwar al-Awlaki, expressing his own sympathy toward suicide bombers.

And, as my NPR colleague Daniel Zwerdling reported, Hasan’s supervisor at Walter Reed Army Medical Center was so concerned about Hasan’s “pattern of poor judgment and a lack of professionalism” that he wrote a memo sharply criticizing the doctor. That kind of document could have ended a military career.

But instead, the Army — with a shortage of psychiatrists and a flood of soldiers returning from Iraq and Afghanistan with mental health problems — kept Hasan working.

After the 2009 shootings, the Pentagon commissioned a report on how to prevent a repeat of the shootings. The report made 47 recommendations for how to improve security. One was to improve training so that military personnel could better “identify contributing factors and behavioral indicators of potentially violent actors.” Another was simply to realize that its own soldiers could be a threat. Another was to find ways to restrict the carrying of personal firearms on military bases. Lopez, it’s been reported, died of a self-inflicted gunshot wound from a .45-caliber Smith & Wesson semiautomatic pistol. The gun, according to media reports, was purchased at the same Killeen, Texas, store where Hasan bought his pistol.





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Psychiatry a Key Player in Effective Health Reform, APA SaysBy Megan Brooks, Medscape
An American Psychiatric Association (APA) work group on healthcare reform outlines key issues facing the field of psychiatry and offers recommendations for action in a report released today.
"Throughout this recent period of change, the focus on behavioral health, which includes mental illnesses and substance use disorders, has begun to shift from a compartmentalized provider approach to an integrated delivery system linking behavioral health and primary care services. This has led to a renewed awareness that mental health is critical to overall health and wellbeing," the report notes.
The work group was established by the APA board of trustees and chaired by Paul Summergrad, MD, chair of the Department of Psychiatry at Tufts University School of Medicine, Boston, Massachusetts, and president-elect of the APA. The group met numerous times during an 18-month period with input from the board of trustees, the assembly, and relevant councils and components.
Critical Role for Psychiatrists
According to the report, as healthcare reform expands insurance coverage and extends parity of benefits for behavioral health needs, it will be “critical to monitor new developments, models of care, and payment methodologies, and to enforce compliance to ensure patients and families receive the best quality of care.”
"Psychiatry must play a central role in the new patient care and delivery and payment models. These models must include an expanded emphasis on behavioral health," the report says.
The report also notes that integrated care models “hold promise” in addressing many of the challenges facing the healthcare system, but “more research is needed to build their evidence base, explore their financial impact and define the role of psychiatrists, primary care providers and other behavioral health providers.”
"Psychiatrists, alongside primary care providers, must play a major role in formulating integrated care solutions by defining their role and benefit to patients," the report recommends. It encourages the National Institutes of Health, the Centers for Medicare and Medicaid Services, and other federal agencies to continue their ongoing research and evaluation of these models.
The work group also tackled issues of financing of psychiatric care, concluding that fundamental payment issues, including implementation of parity laws, “must be addressed” to achieve the coverage, access, and new care delivery goals of the Affordable Care Act. This includes the economic impact of integration, Medicaid reimbursement policies, Medicare fee schedule distortions, fee for service payment methodologies, and the structure and management of payment.
IT Challenges Ahead
They conclude that payer and systems’ budgeting mechanisms must include management of psychiatric care within the broader medical healthcare budgets, while protecting core services for those with mental illnesses.
On the subject of quality performance and measurement, the group notes that healthcare reform has accelerated the development and use of performance indicators and recommends that the behavioral health field “become more fully engaged in the development of performance measures.”
"The field must lead on quality metrics for psychiatric care and their consistent adoption across payers and other regulatory entities. This can be accomplished by identifying a few priority areas for improvement, as well as establishing a series of goals covering various areas of practice," the group advises.
On health information technology (HIT), the group says several “challenges” lie ahead in the behavioral health field. The success of integrated care models is particularly dependent upon the deployment of electronic health records and patient registries, the report says.
The report concludes that HIT “should be a priority focus of communication and education for the psychiatric field, healthcare providers in general, patients, policy makers and the public.”
The report also addresses workforce, work environment, and medical education and training. Its key finding: “Without changes in the workforce, the field will have difficulty meeting the increased demand for specialty psychiatric physician services. Curriculum, accreditation standards, new Continuing Medical Education (CME) trainings and collaboration with primary care practitioners are needed to meet newly insured patient needs as well as provide for new care delivery models.”
The recommendations of the work group “serve as a springboard for discussion and action within the field of psychiatry,” the authors say.
APA. Integrated Care. Full article



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Psychiatry a Key Player in Effective Health Reform, APA Says
By Megan Brooks, Medscape

An American Psychiatric Association (APA) work group on healthcare reform outlines key issues facing the field of psychiatry and offers recommendations for action in a report released today.

"Throughout this recent period of change, the focus on behavioral health, which includes mental illnesses and substance use disorders, has begun to shift from a compartmentalized provider approach to an integrated delivery system linking behavioral health and primary care services. This has led to a renewed awareness that mental health is critical to overall health and wellbeing," the report notes.

The work group was established by the APA board of trustees and chaired by Paul Summergrad, MD, chair of the Department of Psychiatry at Tufts University School of Medicine, Boston, Massachusetts, and president-elect of the APA. The group met numerous times during an 18-month period with input from the board of trustees, the assembly, and relevant councils and components.

Critical Role for Psychiatrists

According to the report, as healthcare reform expands insurance coverage and extends parity of benefits for behavioral health needs, it will be “critical to monitor new developments, models of care, and payment methodologies, and to enforce compliance to ensure patients and families receive the best quality of care.”

"Psychiatry must play a central role in the new patient care and delivery and payment models. These models must include an expanded emphasis on behavioral health," the report says.

The report also notes that integrated care models “hold promise” in addressing many of the challenges facing the healthcare system, but “more research is needed to build their evidence base, explore their financial impact and define the role of psychiatrists, primary care providers and other behavioral health providers.”

"Psychiatrists, alongside primary care providers, must play a major role in formulating integrated care solutions by defining their role and benefit to patients," the report recommends. It encourages the National Institutes of Health, the Centers for Medicare and Medicaid Services, and other federal agencies to continue their ongoing research and evaluation of these models.

The work group also tackled issues of financing of psychiatric care, concluding that fundamental payment issues, including implementation of parity laws, “must be addressed” to achieve the coverage, access, and new care delivery goals of the Affordable Care Act. This includes the economic impact of integration, Medicaid reimbursement policies, Medicare fee schedule distortions, fee for service payment methodologies, and the structure and management of payment.

IT Challenges Ahead

They conclude that payer and systems’ budgeting mechanisms must include management of psychiatric care within the broader medical healthcare budgets, while protecting core services for those with mental illnesses.

On the subject of quality performance and measurement, the group notes that healthcare reform has accelerated the development and use of performance indicators and recommends that the behavioral health field “become more fully engaged in the development of performance measures.”

"The field must lead on quality metrics for psychiatric care and their consistent adoption across payers and other regulatory entities. This can be accomplished by identifying a few priority areas for improvement, as well as establishing a series of goals covering various areas of practice," the group advises.

On health information technology (HIT), the group says several “challenges” lie ahead in the behavioral health field. The success of integrated care models is particularly dependent upon the deployment of electronic health records and patient registries, the report says.

The report concludes that HIT “should be a priority focus of communication and education for the psychiatric field, healthcare providers in general, patients, policy makers and the public.”

The report also addresses workforce, work environment, and medical education and training. Its key finding: “Without changes in the workforce, the field will have difficulty meeting the increased demand for specialty psychiatric physician services. Curriculum, accreditation standards, new Continuing Medical Education (CME) trainings and collaboration with primary care practitioners are needed to meet newly insured patient needs as well as provide for new care delivery models.”

The recommendations of the work group “serve as a springboard for discussion and action within the field of psychiatry,” the authors say.

APA. Integrated Care. Full article





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192 notes

People with psych labels suffer discrimination: Mental health professionals are often guilty of such prejudiceBy Monica Cassani, Beyond Meds
People with psychiatric labels suffer discrimination that is not only demeaning but can also be dangerous.
A 2007 UK study by the Royal College of Psychiatrists revealed that prejudicial treatment of mentally ill patients extends to physical medical care; they receive poorer quality of care and doctors spend less time with them possibly leading to higher rates of death and preventable disease. Though tragic, the more scandalous aspect of the phenomena is the fact that mental health professionals apply the same prejudices to those whom they attempt to treat. The worst thing someone in mental distress can experience is dehumanizing treatment from other human beings who are supposed to be caring for them. I suppose as long as we continue to label people as ill and abnormal due to mental distress this will continue. We create a class of people who aren’t quite like everyone else.
I’ve written about my experience, as a mental health professional and as a person labeled with a serious mental illness quite often on Beyond Meds. I can attest to the fact that depending on how I choose to identify myself with other professionals, I am treated radically different. Generally speaking, when I identify as a social worker, rather than the author of Beyond Meds, – which is identified commonly as a “patient” blog, – I am received with respect by mainstream and alternative professionals both. I am also engaged more deeply and with more interest. On the other hand, when I identify primarily as the author of the blog but also a mental health professional, I am more likely to be treated dismissively. Because those professionals who profess to share my interest in radically changing the system or using alternatives to psychiatry exhibit this bigotry as well, it only reinforces how deeply entrenched these prejudices are across all sectors of society. Clearly what professionals across the board remember once it’s disclosed is that I was a user of psychiatry: a mentally ill person. I don’t consider myself as such — not anymore, but that doesn’t seem to matter even, quite often, among those professionals who profess not to believe in mental illness!
My online experience of identifying as patient vs. social worker, therefore, offers me a unique perspective. The sad fact is that the majority of those in mental distress are subject to the care of mental health professionals who consider them inherently less than equal. This is not generally recognized because on a conscious level people believe they really care. But well-meaning and acting with prejudice are unfortunately not mutually exclusive. I don’t know how one extracts this insidious form of bigotry. People don’t see it in themselves. How do we help them see? One way, of course, is to begin to courageously find and root out our own bigotries. All human beings have them.
Peer counseling, too, is a concept that may help bridge the divide between clinician and patient. When we meet those we are helping from a place of vulnerability and equality, we can bring about healing. I’ve noted that once I publicly acknowledged my frailty, my humanity, the healing relationship often became much stronger. Some of the connections and healing relationships I’ve made via my work at Beyond Meds have been astonishingly deeper and more honest than any work I ever did as a social worker when I relegated parts of myself as off limits to my clients. I was taught to separate myself this way as a professional.
Authenticity is trained right out of mental health professionals and instead a vague and subtle superiority replaces it. How do I know this? Because I too was tainted and saw it in myself, as a professional, even as I saw it in my colleagues around me. I also experienced it as a patient/client, I was actively made ‘other’ by the people I saw professionally. These parts – that of the knowing superior vs the ignorant inferior – are in all of us too, regardless of training! I suggest those in mental health circles who have taken up the mantle of helper become acutely conscious of this so that they might minimize the harm it can cause in relationship with others.
Also, I think that the concept of being a peer can be embraced by professionals. As human beings we are all peers. We are all, every one of us, in this wonderful and mysterious thing called life. And all of us are struggling in various ways to make sense of it. Is there really such a difference between someone trained as a clinician and a client? I think not!  If those trained to help were also trained to remember that their role as helper was because they have much more in common with their patients/clients than not, then we will start to see a flattening of hierarchy.
The fact is, we all have incredible capacities and learn very particular things in our own individual idiosyncratic ways. Most of it is not learned in school or training regardless of level of education.
This begs the question: Is it possible that identifying with a client might actually be a good thing? This is surely exactly why ”peer counselors” are effective.
Clinicians are trained to never, ever identify with the client. Why? What is wrong with recognizing shared humanity, even a weakness or flaw, and bonding in that? In providing a safe container from that understanding? The mere instruction to avoid such intimacy at all costs seems like a violent denial of oneself and clients both. It seems indicative of a deep fear of ones own dark parts. How do we help others find their way out of the dark if we hide from our own darkness? Such identification may not always be appropriate to share, no doubt, it may also not be present with many clients. But when it is present and appropriate to share from such a place, with adequate boundaries in place, it can be an incredibly healing experience for both parties. I believe that all our psyches contain a full spectrum of the content of the human psyche within it… Some people experience more or less of this or that, but we’ve all got it in there. Healing ourselves and others both require deep familiarity with all its parts. This is not understood particularly well among most mental health professionals, in my opinion.
Most mental health professionals not only know next to nothing about the deepest part of the psyche, they are terrified of it, adding another layer of obfuscation to the problem. When people in mental distress are terrified the last thing they need is to be met by a “healer” who is equally terrified of the clients thoughts and behavior.
Changing our system of care for those in mental distress requires deactivating the knee-jerk response of professionals and non-professionals alike towards those in psychic pain. Where we start with this is not always clear. I suppose I’m doing my bit here and all those conscious of these issues do what makes sense in their lives. There are schools of psychology that are very adept at thinking about these issues, but most training dwells on “abnormal psychology” thus the sense of “other” becomes a conditioned process as students learn about what is not normal in the human psyche. There are other ways of understanding unusual behaviors without considering it grossly pathological. For example in cases of trauma and abuse unusual behaviors may be highly adaptive. Then healing involves coming to understand how these behaviors or thinking patterns might have once served someone and how one might let them go now that they do not.
Needless to say, I’ve made some sweeping generalizations here and thus must add that there are indeed many wonderful healing people in the world. Ultimately what is at stake here is becoming conscious of the nature of our humanity. I am blessed to know many such people, lay and professional both, who are conscious of these issues. Still, it’s very hard for people lost in mental distress to find resources that include deeply healing professionals and so the people who need healing the most often do not find them. How do we change that? I suppose it starts with us going ever deeper into ourselves and lovingly, with compassion, helping others do the same.
Right now our system of psychiatric care is very toxic. Educating people by example is where we must start.



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

People with psych labels suffer discrimination: Mental health professionals are often guilty of such prejudice
By Monica Cassani, Beyond Meds

People with psychiatric labels suffer discrimination that is not only demeaning but can also be dangerous.

A 2007 UK study by the Royal College of Psychiatrists revealed that prejudicial treatment of mentally ill patients extends to physical medical care; they receive poorer quality of care and doctors spend less time with them possibly leading to higher rates of death and preventable disease. Though tragic, the more scandalous aspect of the phenomena is the fact that mental health professionals apply the same prejudices to those whom they attempt to treat. The worst thing someone in mental distress can experience is dehumanizing treatment from other human beings who are supposed to be caring for them. I suppose as long as we continue to label people as ill and abnormal due to mental distress this will continue. We create a class of people who aren’t quite like everyone else.

I’ve written about my experience, as a mental health professional and as a person labeled with a serious mental illness quite often on Beyond Meds. I can attest to the fact that depending on how I choose to identify myself with other professionals, I am treated radically different. Generally speaking, when I identify as a social worker, rather than the author of Beyond Meds, – which is identified commonly as a “patient” blog, – I am received with respect by mainstream and alternative professionals both. I am also engaged more deeply and with more interest. On the other hand, when I identify primarily as the author of the blog but also a mental health professional, I am more likely to be treated dismissively. Because those professionals who profess to share my interest in radically changing the system or using alternatives to psychiatry exhibit this bigotry as well, it only reinforces how deeply entrenched these prejudices are across all sectors of society. Clearly what professionals across the board remember once it’s disclosed is that I was a user of psychiatry: a mentally ill person. I don’t consider myself as such — not anymore, but that doesn’t seem to matter even, quite often, among those professionals who profess not to believe in mental illness!

My online experience of identifying as patient vs. social worker, therefore, offers me a unique perspective. The sad fact is that the majority of those in mental distress are subject to the care of mental health professionals who consider them inherently less than equal. This is not generally recognized because on a conscious level people believe they really care. But well-meaning and acting with prejudice are unfortunately not mutually exclusive. I don’t know how one extracts this insidious form of bigotry. People don’t see it in themselves. How do we help them see? One way, of course, is to begin to courageously find and root out our own bigotries. All human beings have them.

Peer counseling, too, is a concept that may help bridge the divide between clinician and patient. When we meet those we are helping from a place of vulnerability and equality, we can bring about healing. I’ve noted that once I publicly acknowledged my frailty, my humanity, the healing relationship often became much stronger. Some of the connections and healing relationships I’ve made via my work at Beyond Meds have been astonishingly deeper and more honest than any work I ever did as a social worker when I relegated parts of myself as off limits to my clients. I was taught to separate myself this way as a professional.

Authenticity is trained right out of mental health professionals and instead a vague and subtle superiority replaces it. How do I know this? Because I too was tainted and saw it in myself, as a professional, even as I saw it in my colleagues around me. I also experienced it as a patient/client, I was actively made ‘other’ by the people I saw professionally. These parts – that of the knowing superior vs the ignorant inferior – are in all of us too, regardless of training! I suggest those in mental health circles who have taken up the mantle of helper become acutely conscious of this so that they might minimize the harm it can cause in relationship with others.

Also, I think that the concept of being a peer can be embraced by professionals. As human beings we are all peers. We are all, every one of us, in this wonderful and mysterious thing called life. And all of us are struggling in various ways to make sense of it. Is there really such a difference between someone trained as a clinician and a client? I think not!  If those trained to help were also trained to remember that their role as helper was because they have much more in common with their patients/clients than not, then we will start to see a flattening of hierarchy.

The fact is, we all have incredible capacities and learn very particular things in our own individual idiosyncratic ways. Most of it is not learned in school or training regardless of level of education.

This begs the question: Is it possible that identifying with a client might actually be a good thing? This is surely exactly why ”peer counselors” are effective.

Clinicians are trained to never, ever identify with the client. Why? What is wrong with recognizing shared humanity, even a weakness or flaw, and bonding in that? In providing a safe container from that understanding? The mere instruction to avoid such intimacy at all costs seems like a violent denial of oneself and clients both. It seems indicative of a deep fear of ones own dark parts. How do we help others find their way out of the dark if we hide from our own darkness? Such identification may not always be appropriate to share, no doubt, it may also not be present with many clients. But when it is present and appropriate to share from such a place, with adequate boundaries in place, it can be an incredibly healing experience for both parties. I believe that all our psyches contain a full spectrum of the content of the human psyche within it… Some people experience more or less of this or that, but we’ve all got it in there. Healing ourselves and others both require deep familiarity with all its parts. This is not understood particularly well among most mental health professionals, in my opinion.

Most mental health professionals not only know next to nothing about the deepest part of the psyche, they are terrified of it, adding another layer of obfuscation to the problem. When people in mental distress are terrified the last thing they need is to be met by a “healer” who is equally terrified of the clients thoughts and behavior.

Changing our system of care for those in mental distress requires deactivating the knee-jerk response of professionals and non-professionals alike towards those in psychic pain. Where we start with this is not always clear. I suppose I’m doing my bit here and all those conscious of these issues do what makes sense in their lives. There are schools of psychology that are very adept at thinking about these issues, but most training dwells on “abnormal psychology” thus the sense of “other” becomes a conditioned process as students learn about what is not normal in the human psyche. There are other ways of understanding unusual behaviors without considering it grossly pathological. For example in cases of trauma and abuse unusual behaviors may be highly adaptive. Then healing involves coming to understand how these behaviors or thinking patterns might have once served someone and how one might let them go now that they do not.

Needless to say, I’ve made some sweeping generalizations here and thus must add that there are indeed many wonderful healing people in the world. Ultimately what is at stake here is becoming conscious of the nature of our humanity. I am blessed to know many such people, lay and professional both, who are conscious of these issues. Still, it’s very hard for people lost in mental distress to find resources that include deeply healing professionals and so the people who need healing the most often do not find them. How do we change that? I suppose it starts with us going ever deeper into ourselves and lovingly, with compassion, helping others do the same.

Right now our system of psychiatric care is very toxic. Educating people by example is where we must start.





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

Filed under stigma mental health mental illness mental health healthy fitness mind brain body label labels psychology psychiatry prejudice med meds medication medications blog tumblr patient recovery recover respect justice equality heal healing therapy

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The Fat Lady Has SungBy Robert Whitaker, Mad in AmericaCan the field as a whole hear the fat lady sing? Or will it turn a deaf ear to her, and continue with care — the regular long-term use of antipsychotics for all — that clearly does harm?When a medical specialty develops its clinical care guidelines, the “experts” in that specialty will review the research literature, and often that evidence base may present a very confusing picture. The results from the studies may be inconsistent, or contradictory. The experts are also faced with the challenge of weighing the benefits of a treatment against its risks. However, there are also instances when the “evidence base” tells a consistent story, across decades and in studies of various types, and when that happens, the experts developing clinical care guidelines can rejoice: science has provided them with a clear picture of what is helpful and what is not.
This provides the clinical context for assessing the importance of Martin Harrow’s latest paper: It adds a new data point to a long list of research findings that all lead to the same conclusion: antipsychotics, over the long term, do not reduce psychotic symptoms, and, in fact, increase the likelihood that such symptoms will persist.
Harrow has now published a number of papers detailing the outcomes of the schizophrenia patients he has followed for more than 20 years. In previous articles, he has reported that those who stopped taking antipsychotic medications did better over the long-term than the medicated patients in every domain: recovery rates, anxiety symptoms, psychotic symptoms, cognitive function, and employment. In his newest paper, Harrow focuses more closely on medication use and psychotic symptoms, and by doing so, he is narrowing psychiatry’s focus to one critical issue: do these drugs provide any long-term benefit?Antipsychotics, of course, cause many adverse effects, and thus, in any risk-benefit assessment, these drugs need to be effective in reducing psychotic symptoms in order for there to be something on the benefit side of the ledger. If the drugs don’t do that, then there are only risks – i.e. negatives – to be tallied up. And this is why I think we can now say that, with this latest publication of Harrow’s that the fat lady has sung. The case is closed: psychiatry needs to rethink its use of antipsychotics.The Evidence Cited for Long-term Use of Antipsychotics
Psychiatry, of course, does have evidence that it can cite supporting long-term use of antipsychotics. Its evidence consists of findings from relapse studies, but, as can be easily shown, those studies do not, in fact, tell of whether the drugs reduce psychotic symptoms over the long-term.
Once Thorazine and other antipsychotics were introduced, researchers ran studies designed like this: They would take a group of patients who had stabilized well on an antipsychotic, and then half of the patients would be withdrawn from the medication, and half would be maintained on it. With great regularity, those abruptly withdrawn from the antipsychotic relapsed at a higher rate. Thus, researchers concluded that staying on an antipsychotic lowers the risk of relapse.But there are evident flaws in that relapse literature. First, most of the relapse studies involved abrupt withdrawal of the medication, which is known to increase the risk that psychotic symptoms will return. Second, the studies only tell of the return of psychotic symptoms in patients who have been on an antipsychotic; they don’t tell of the risk of relapse in patients who haven’t been exposed to the drugs. Third, they don’t tell of the risk of relapse over longer periods (two years, five years, and so forth.)
Indeed, what the relapse studies prove is this: if a person is stable on an antipsychotic, then it is a very bad idea to withdraw that drug abruptly. They don’t tell of how such treatment affects people over the longer course of their lives.The Rest of the EvidenceAlthough it is well-recognized that the relapse studies don’t provide evidence that antipsychotics are effective over the long-term, most in the field assume that that is still true. However, there is a body of evidence, stretching back 50 years, that bears on this question, and when all of it is put together, it tells a consistent story. In brief:
a) In the 1960s, the NIMH conducted a nine-hospital study that compared placebo to drug treatment, and at the end of one year, those initially treated with an antipsychotic had a higher rehospitalization rate. Thus, at this very first moment of the research literature for antipsychotics, there is the hint of a paradox: treatment that is effective over the short term may increase the risk of relapse over the long term.b) In a retrospective study that compared five-year outcomes for patients treated in 1967 with antipsychotics compared to a similar group of patients treated in 1947 without drugs (as antipsychotics had yet to be introduced), Sanbourne Bockoven found that the 1967 cohort had a higher relapse rate.c) In three studies funded by the NIMH in the 1970s, which followed patients for one to three years, relapse rates were higher each time for the medicated patients. These findings led the NIMH’s William Carpenter to ask whether antipsychotics induced a biological change that made schizophrenic patients “more vulnerable to future relapse than would be the case in the natural course of the illness.”d) At that point, two researchers from McGill University, Guy Chouinard and Barry Jones, offered a biological explanation for why the drugs would have this paradoxical long-term effect. Antipsychotics blocked dopamine receptors in the brain, and in compensatory response, the brain increased the density of such receptors. The person’s brain was now supersensitive to dopamine, and this, they wrote, could lead to “psychotic symptoms.”e) In two cross-cultural studies conducted by the World Health Organization, which compared outcomes in India, Nigeria and Colombia with outcomes in the United States and five other developed countries, the patients in India and Nigeria fared the best. In those two countries, few patients were maintained long-term on antipsychotics, and patients there were much less likely to be psychotic at the end of two and five years.e) In the 1990s, researchers conducting MRI studies of schizophrenia patients reported that neuroleptic use, at the end of 18 months, was associated with hypertrophy of the thalamus and basal ganglion structures in the brain, and that this enlargement—as University of Pennsylvania investigators reported in 1998 —was in turn “associated with greater severity of both negative and positive symptoms.” Thus, the MRI studies told of antipsychotic-induced changes in the brain that made patients more psychotic over time.f) In animal studies, researchers at the University of Toronto have reported that the reason antipsychotics “fail” over time, as a treatment for psychotic symptoms, is that they cause an increase in dopamine receptors.f) A recent randomized study by Lex Wunderink, of the Netherlands, when carefully parsed, tells a similar story. In his study, patients who had stabilized on an antipsychotic were then either maintained on the drug or withdrawn from it (or tapered to a very low dose.) After two years, the relapse rate was higher in the withdrawn/low dose group (43% versus 21%.) However, at the end of seven years, the relapse rate for the withdrawn/low dose group was slightly lower (62% versus 69%), and the key point is this: during those five years (year two to seven in the study), the group that received drug treatment as usual relapsed more frequently than the withdrawn/low-dose group. This is a result consistent with the notion that antipsychotics increase the risk of relapse over the long-term.Why the Fat Lady Has SungWe can see that this body of evidence stretches over 50 years and that it tells a consistent story. The worry that antipsychotics might increase the risk of relapse showed up in the NIMH’s very first one-year study. It showed up in Bockoven’s retrospective study. Next, it showed up in three long-term studies funded by the NIMH in the 1970s. Researchers then offered a biological explanation for why these outcomes were occurring.
The WHO’s cross-cultural studies found better outcomes in poor countries where few patients were maintained long-term on antipsychotics. MRI studies identified a drug-induced change in brain morphology that was associated with a worsening of psychotic symptoms. Researchers who developed an animal model of psychosis concluded that drug-induced dopamine supersensitivity leads to treatment failure over time. Wunderink’s randomized study revealed a higher relapse rates between years two and seven for the medicated patients. Finally, Harrow’s long-term study, which is the best such study that has ever been conducted, found that the medicated patients were much more likely to be experiencing psychotic symptoms over the long term.
Harrow’s data does not stand alone. Instead, studies of multiple types are all leading to the same conclusion. Antipsychotics do not reduce psychotic symptoms over the long term and, in fact, increase the likelihood that such symptoms will persist. And imagine if the opposite were true and all these studies showed that medicated patients had fewer psychotic symptoms over the long term. Would anyone then question the long-term efficacy of antipsychotics? Psychiatry would then proclaim that the evidence was overwhelming that the drugs had such positive effect.
In her post on this site, Sandy Steingard presents a very compelling argument for a different use of these drugs: try to avoid initial use if possible, and then, if an antipsychotic is used, see if the person can be subsequently tapered from the medication. And if a person can’t be successfully tapered, prescribe as low a dose as possible. That is a protocol that provides for selective use of the drugs, and there is clearly an “evidence base” supporting a protocol of that type. Indeed, such use could be described as a “best-use” model.
But the obvious question for psychiatry is now this: Can the field as a whole hear the fat lady sing? Or will it turn a deaf ear to her, and continue with care — the regular long-term use of antipsychotics for all — that clearly does harm?



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

The Fat Lady Has Sung
By Robert Whitaker, Mad in America

Can the field as a whole hear the fat lady sing? Or will it turn a deaf ear to her, and continue with care — the regular long-term use of antipsychotics for all — that clearly does harm?

When a medical specialty develops its clinical care guidelines, the “experts” in that specialty will review the research literature, and often that evidence base may present a very confusing picture. The results from the studies may be inconsistent, or contradictory. The experts are also faced with the challenge of weighing the benefits of a treatment against its risks. However, there are also instances when the “evidence base” tells a consistent story, across decades and in studies of various types, and when that happens, the experts developing clinical care guidelines can rejoice: science has provided them with a clear picture of what is helpful and what is not.

This provides the clinical context for assessing the importance of Martin Harrow’s latest paper: It adds a new data point to a long list of research findings that all lead to the same conclusion: antipsychotics, over the long term, do not reduce psychotic symptoms, and, in fact, increase the likelihood that such symptoms will persist.

Harrow has now published a number of papers detailing the outcomes of the schizophrenia patients he has followed for more than 20 years. In previous articles, he has reported that those who stopped taking antipsychotic medications did better over the long-term than the medicated patients in every domain: recovery rates, anxiety symptoms, psychotic symptoms, cognitive function, and employment. In his newest paper, Harrow focuses more closely on medication use and psychotic symptoms, and by doing so, he is narrowing psychiatry’s focus to one critical issue: do these drugs provide any long-term benefit?
Antipsychotics, of course, cause many adverse effects, and thus, in any risk-benefit assessment, these drugs need to be effective in reducing psychotic symptoms in order for there to be something on the benefit side of the ledger. If the drugs don’t do that, then there are only risks – i.e. negatives – to be tallied up. And this is why I think we can now say that, with this latest publication of Harrow’s that the fat lady has sung. The case is closed: psychiatry needs to rethink its use of antipsychotics.
The Evidence Cited for Long-term Use of Antipsychotics

Psychiatry, of course, does have evidence that it can cite supporting long-term use of antipsychotics. Its evidence consists of findings from relapse studies, but, as can be easily shown, those studies do not, in fact, tell of whether the drugs reduce psychotic symptoms over the long-term.

Once Thorazine and other antipsychotics were introduced, researchers ran studies designed like this: They would take a group of patients who had stabilized well on an antipsychotic, and then half of the patients would be withdrawn from the medication, and half would be maintained on it. With great regularity, those abruptly withdrawn from the antipsychotic relapsed at a higher rate. Thus, researchers concluded that staying on an antipsychotic lowers the risk of relapse.
But there are evident flaws in that relapse literature. First, most of the relapse studies involved abrupt withdrawal of the medication, which is known to increase the risk that psychotic symptoms will return. Second, the studies only tell of the return of psychotic symptoms in patients who have been on an antipsychotic; they don’t tell of the risk of relapse in patients who haven’t been exposed to the drugs. Third, they don’t tell of the risk of relapse over longer periods (two years, five years, and so forth.)

Indeed, what the relapse studies prove is this: if a person is stable on an antipsychotic, then it is a very bad idea to withdraw that drug abruptly. They don’t tell of how such treatment affects people over the longer course of their lives.

The Rest of the Evidence
Although it is well-recognized that the relapse studies don’t provide evidence that antipsychotics are effective over the long-term, most in the field assume that that is still true. However, there is a body of evidence, stretching back 50 years, that bears on this question, and when all of it is put together, it tells a consistent story. In brief:

a) In the 1960s, the NIMH conducted a nine-hospital study that compared placebo to drug treatment, and at the end of one year, those initially treated with an antipsychotic had a higher rehospitalization rate. Thus, at this very first moment of the research literature for antipsychotics, there is the hint of a paradox: treatment that is effective over the short term may increase the risk of relapse over the long term.
b) In a retrospective study that compared five-year outcomes for patients treated in 1967 with antipsychotics compared to a similar group of patients treated in 1947 without drugs (as antipsychotics had yet to be introduced), Sanbourne Bockoven found that the 1967 cohort had a higher relapse rate.
c) In three studies funded by the NIMH in the 1970s, which followed patients for one to three years, relapse rates were higher each time for the medicated patients. These findings led the NIMH’s William Carpenter to ask whether antipsychotics induced a biological change that made schizophrenic patients “more vulnerable to future relapse than would be the case in the natural course of the illness.”
d) At that point, two researchers from McGill University, Guy Chouinard and Barry Jones, offered a biological explanation for why the drugs would have this paradoxical long-term effect. Antipsychotics blocked dopamine receptors in the brain, and in compensatory response, the brain increased the density of such receptors. The person’s brain was now supersensitive to dopamine, and this, they wrote, could lead to “psychotic symptoms.”
e) In two cross-cultural studies conducted by the World Health Organization, which compared outcomes in India, Nigeria and Colombia with outcomes in the United States and five other developed countries, the patients in India and Nigeria fared the best. In those two countries, few patients were maintained long-term on antipsychotics, and patients there were much less likely to be psychotic at the end of two and five years.
e) In the 1990s, researchers conducting MRI studies of schizophrenia patients reported that neuroleptic use, at the end of 18 months, was associated with hypertrophy of the thalamus and basal ganglion structures in the brain, and that this enlargement—as University of Pennsylvania investigators reported in 1998 —was in turn “associated with greater severity of both negative and positive symptoms.” Thus, the MRI studies told of antipsychotic-induced changes in the brain that made patients more psychotic over time.
f) In animal studies, researchers at the University of Toronto have reported that the reason antipsychotics “fail” over time, as a treatment for psychotic symptoms, is that they cause an increase in dopamine receptors.
f) A recent randomized study by Lex Wunderink, of the Netherlands, when carefully parsed, tells a similar story. In his study, patients who had stabilized on an antipsychotic were then either maintained on the drug or withdrawn from it (or tapered to a very low dose.) After two years, the relapse rate was higher in the withdrawn/low dose group (43% versus 21%.) However, at the end of seven years, the relapse rate for the withdrawn/low dose group was slightly lower (62% versus 69%), and the key point is this: during those five years (year two to seven in the study), the group that received drug treatment as usual relapsed more frequently than the withdrawn/low-dose group. This is a result consistent with the notion that antipsychotics increase the risk of relapse over the long-term.

Why the Fat Lady Has Sung
We can see that this body of evidence stretches over 50 years and that it tells a consistent story. The worry that antipsychotics might increase the risk of relapse showed up in the NIMH’s very first one-year study. It showed up in Bockoven’s retrospective study. Next, it showed up in three long-term studies funded by the NIMH in the 1970s. Researchers then offered a biological explanation for why these outcomes were occurring.

The WHO’s cross-cultural studies found better outcomes in poor countries where few patients were maintained long-term on antipsychotics. MRI studies identified a drug-induced change in brain morphology that was associated with a worsening of psychotic symptoms. Researchers who developed an animal model of psychosis concluded that drug-induced dopamine supersensitivity leads to treatment failure over time. Wunderink’s randomized study revealed a higher relapse rates between years two and seven for the medicated patients. Finally, Harrow’s long-term study, which is the best such study that has ever been conducted, found that the medicated patients were much more likely to be experiencing psychotic symptoms over the long term.

Harrow’s data does not stand alone. Instead, studies of multiple types are all leading to the same conclusion. Antipsychotics do not reduce psychotic symptoms over the long term and, in fact, increase the likelihood that such symptoms will persist. And imagine if the opposite were true and all these studies showed that medicated patients had fewer psychotic symptoms over the long term. Would anyone then question the long-term efficacy of antipsychotics? Psychiatry would then proclaim that the evidence was overwhelming that the drugs had such positive effect.

In her post on this site, Sandy Steingard presents a very compelling argument for a different use of these drugs: try to avoid initial use if possible, and then, if an antipsychotic is used, see if the person can be subsequently tapered from the medication. And if a person can’t be successfully tapered, prescribe as low a dose as possible. That is a protocol that provides for selective use of the drugs, and there is clearly an “evidence base” supporting a protocol of that type. Indeed, such use could be described as a “best-use” model.

But the obvious question for psychiatry is now this: Can the field as a whole hear the fat lady sing? Or will it turn a deaf ear to her, and continue with care — the regular long-term use of antipsychotics for all — that clearly does harm?





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

Filed under psychosis psychotic psycho schizophrenia schizophrenic bipolar psychology psychiatry mental health mental illness mental health illness mind body brain healthy recover recovery med meds drug drugs therapy hallucination delusion mad madness rethinking madness symptom

126 notes

Interview: Borderline Personality Disorder, Fear Of Abandonment, And RelationshipsBy Richard Zwolinski, LMHC, Casac & C.R. ZwolinskiToday we’re talking with therapist Lisa Bahar about Borderline Personality Disorder and how it can affect relationships.Welcome, Lisa. BPD makes it difficult to be involved in a stable, healthy relationship. What are some kinds of behaviors that people with BPD have that are a challenge to a relationship?A person with BPD desires and responds to structure, predictability and communication. When there is lack of predictability, anxiety or fear of abandonment can potentially set in, and disruptive and unstable behavior can escalate into controlling and aggressive reactions.These reactions can occur when their partner’s behavior even slightly differs from what is expected. For example, if a partner, who is “always” on time is 15 minutes late, breaking a pattern of predictability, feeling of anxiousness increase. These feelings trigger feelings of abandonment, which can then lead to disproportionate reactions. These feelings are all rooted in fear.For example, when the partner shows up, the person with BPD might accuse them of cheating, leaving or have a plan to leave them. Or the person with BPD might act out with behaviors used as a way to give the message that the other is being “punished”. These might include not speaking, slamming doors, pouting, and so on. They all communicate I am angry.Tell us more about what this type of manipulative behavior looks like?Manipulation is a way to create control. If it is unconsciously motivated through a conscious act, such as an outward behavior like tantrums, crying, threatening, and attacking, it is what I call sloppy manipulation.Or, it can be sophisticated manipulation. When manipulative behavior takes the form of crafty questions which are intended to trap the other person into saying something that they really did not know mean to say, or give an answer that they really didn’t realize they were giving.The individual with BPD does not always use direct and healthy communication skills and instead acts out behaviorally and/or communicates indirectly.Are people with BPD consciously manipulating others? Sometimes, it seems like these manipulative behaviors are habits or knee jerk reactions rather than conscious emotional manipulation. Can you explain what is really going on?Exactly, these behaviors can be habits. Generally until awareness sets in, the individual may not know that they are unconsciously motivated. Once awareness sets in, and insight is gained, usually through various mindfulness practices, then there can be an opportunity for behavior change.Behavioral change is the real test of insight. Of course, the individual with BPD needs to actually know how to change and that is where the Dialectical Behavior Therapy skills become helpful.What are the underlying reasons and/or mechanisms driving manipulative behavior in someone with BPD?Fear of abandonment. Also, a feeling of disconnect particularly with a sense of self. This happens when an individual feels they don’t have an identity without the other there to define them. When the partner demonstrates behaviors that are interpreted as “leaving” by an individual with BPD it can feel like a loss of identity.Fear of abandonment can feel almost like death to the individual with BPD since it is a kind of “death of self.” That is why some people with BPD have a pattern of jumping from relationship to relationship—they do this in order to sustain sense of self.How does Dialectical Behavior Therapy help those with BPD resolve these issues?Dialectical Behavior Therapy is a set of skills that are very concrete and clear. They allow the individual to decrease emotionally intense reactions by providing a way to decrease the symptoms.DBT teaches a set of skills including:Core Mindfulness skills which help to calm the mind.Interpersonal Effectiveness skills which are designed to help you effectively communicate what you want, express feelings and say no clearly.Emotional Regulation skills which help you manage and deal with emotions rather than emotions controlling you.Distress Tolerance skills which help you be able to handle crisis situations more effectively and deal with reality and it’s terms, as opposed to resisting what reality is.What are some suggestions for people who want to overcome manipulative behaviors that drive people away?The first part is that the person has to want the change—they have to be the one to do the work! Of course, someone else such as the person the client is in a relationship might also want the change, and that is fine—but it can’t be the primary motivation.Next, there must be a willingness and dedication to learning skills that can help. For example the client must be willing to practice the skills he or she learns from DBT. They have to understand: This is a not a quick fix, but the development of a pattern of life skills.What advice do you have for family, friends and colleagues who are trying to cope with these behaviors and who, understandably, don’t want to feel attacked or manipulated?Education is key.Significant others must be aware of their part in interactions and reactions and must learn how best to respond. DBT is most effective if all family members are involved. Each person involved should practice a self care plan. It is so important for clients and family members to not point the finger at any one person.Thanks for speaking to this topic.


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

Interview: Borderline Personality Disorder, Fear Of Abandonment, And Relationships
By Richard Zwolinski, LMHC, Casac & C.R. Zwolinski

Today we’re talking with therapist Lisa Bahar about Borderline Personality Disorder and how it can affect relationships.

Welcome, Lisa. BPD makes it difficult to be involved in a stable, healthy relationship. What are some kinds of behaviors that people with BPD have that are a challenge to a relationship?
A person with BPD desires and responds to structure, predictability and communication. When there is lack of predictability, anxiety or fear of abandonment can potentially set in, and disruptive and unstable behavior can escalate into controlling and aggressive reactions.
These reactions can occur when their partner’s behavior even slightly differs from what is expected. For example, if a partner, who is “always” on time is 15 minutes late, breaking a pattern of predictability, feeling of anxiousness increase. These feelings trigger feelings of abandonment, which can then lead to disproportionate reactions. These feelings are all rooted in fear.
For example, when the partner shows up, the person with BPD might accuse them of cheating, leaving or have a plan to leave them. Or the person with BPD might act out with behaviors used as a way to give the message that the other is being “punished”. These might include not speaking, slamming doors, pouting, and so on. They all communicate I am angry.

Tell us more about what this type of manipulative behavior looks like?
Manipulation is a way to create control. If it is unconsciously motivated through a conscious act, such as an outward behavior like tantrums, crying, threatening, and attacking, it is what I call sloppy manipulation.
Or, it can be sophisticated manipulation. When manipulative behavior takes the form of crafty questions which are intended to trap the other person into saying something that they really did not know mean to say, or give an answer that they really didn’t realize they were giving.
The individual with BPD does not always use direct and healthy communication skills and instead acts out behaviorally and/or communicates indirectly.

Are people with BPD consciously manipulating others? Sometimes, it seems like these manipulative behaviors are habits or knee jerk reactions rather than conscious emotional manipulation. Can you explain what is really going on?
Exactly, these behaviors can be habits. Generally until awareness sets in, the individual may not know that they are unconsciously motivated. Once awareness sets in, and insight is gained, usually through various mindfulness practices, then there can be an opportunity for behavior change.
Behavioral change is the real test of insight. Of course, the individual with BPD needs to actually know how to change and that is where the Dialectical Behavior Therapy skills become helpful.

What are the underlying reasons and/or mechanisms driving manipulative behavior in someone with BPD?
Fear of abandonment. Also, a feeling of disconnect particularly with a sense of self. This happens when an individual feels they don’t have an identity without the other there to define them. When the partner demonstrates behaviors that are interpreted as “leaving” by an individual with BPD it can feel like a loss of identity.
Fear of abandonment can feel almost like death to the individual with BPD since it is a kind of “death of self.” That is why some people with BPD have a pattern of jumping from relationship to relationship—they do this in order to sustain sense of self.

How does Dialectical Behavior Therapy help those with BPD resolve these issues?
Dialectical Behavior Therapy is a set of skills that are very concrete and clear. They allow the individual to decrease emotionally intense reactions by providing a way to decrease the symptoms.
DBT teaches a set of skills including:
Core Mindfulness skills which help to calm the mind.
Interpersonal Effectiveness skills which are designed to help you effectively communicate what you want, express feelings and say no clearly.
Emotional Regulation skills which help you manage and deal with emotions rather than emotions controlling you.
Distress Tolerance skills which help you be able to handle crisis situations more effectively and deal with reality and it’s terms, as opposed to resisting what reality is.

What are some suggestions for people who want to overcome manipulative behaviors that drive people away?
The first part is that the person has to want the change—they have to be the one to do the work! Of course, someone else such as the person the client is in a relationship might also want the change, and that is fine—but it can’t be the primary motivation.
Next, there must be a willingness and dedication to learning skills that can help. For example the client must be willing to practice the skills he or she learns from DBT. They have to understand: This is a not a quick fix, but the development of a pattern of life skills.

What advice do you have for family, friends and colleagues who are trying to cope with these behaviors and who, understandably, don’t want to feel attacked or manipulated?
Education is key.
Significant others must be aware of their part in interactions and reactions and must learn how best to respond. DBT is most effective if all family members are involved. Each person involved should practice a self care plan. It is so important for clients and family members to not point the finger at any one person.

Thanks for speaking to this topic.





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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

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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.





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Depression, anxiety: What worked for meBy Gayathri Ramprasad; founder and president of ASHA International, a nonprofit organization promoting personal, organizational and community wellness. She is the author of “Shadows in the Sun: Healing from Depression and Finding the Light Within.Depression is no longer a demon I fear, it is a teacher whose wisdom I seek.For more than a decade of my life, I struggled with debilitating anxiety, panic attacks and depression. And, like millions of people around the world, I longed to discover a magic pill to cure my ills and promise me nirvana.But, despite taking many medications, ongoing psychotherapy, electroconvulsive therapy (ECTs), hospitalizations and failed suicide attempts, wellness remained a distant dream.The anti-anxiety medications and antidepressants worsened my symptoms, and made me more agitated, depressed and suicidal. And I was utterly confused why the medications that were supposed to alleviate my symptoms exacerbated them instead.Staring out of the fifth-floor hospital window one day after yet another failed suicide attempt, I promised to take charge of my life and create a life of wellness. I was sick and tired of being a chronically mentally ill patient. I just wanted to be well.Most of all, I wanted to be able to take my little girl to school, play with her in the park, and tuck her to bed at night with her favorite story.Somewhere deep in my soul, I was convinced that the medications were making me sicker instead of helping me heal. So, despite my fears and those of my family, I decided to listen to my inner wisdom and wean myself off all medications under the supervision of my psychiatrist and explore holistic pathways to health and wellness.Transcendental meditationWhen a medical resident at the hospital suggested I try transcendental meditation to manage my anxiety and depression, I did.Ironically, it was an American teacher, Pat, who taught me this life-affirming practice that had originated in India, my country of birth. I still remember sitting cross-legged on a Persian carpet across from Pat, in the dining-room-turned-shrine in her home.While Pat sat still, Buddha-like, eyes closed, breath steady, body relaxed, face serene, my breath was erratic, my eyelids fluttered like the wings of a hummingbird, and my “monkey mind” ran amok.But, one day, one breath at a time, I learned how to sit still. Despite my mind’s tendency to wander, like a mother lovingly guiding her wayward child back to its task I learned to gently guide my mind back to its still center. There, I discovered an oasis of energy, creativity, and restful calm.In time, meditation offered me a sacred space to reflect on my life, and taught me to become an observer of my thoughts and emotions instead of getting entangled in them. Eventually, the daily practice of meditation helped me regulate my emotions and live each moment with mindfulness. Ultimately, meditation set me free from the limitations of my suffering, and awakened me to a life filled with eternal possibilities.ExerciseDuring a visit, my psychiatrist recommended I start exercising, and educated me about the benefits of exercise in managing my anxiety and depression and promoting overall well-being.I joined a health club and started working out three times a week, attended aerobics and yoga classes and trained with free weights.I fell in love with my yoga classes. They relaxed and rejuvenated my mind, body, and spirit. Having never been athletic, I was surprised to find that exercise energized me and elevated my mood. It also provided a much-needed reprieve from my duties as a mother and homemaker, and helped me create a social network outside of my family.Cognitive behavioral therapyAlthough I was highly skeptical about how talking with a therapist could help me heal, it transformed my life.For the first time in my life, Dr. Lin, my therapist, explained how our thoughts, feelings, moods and behavior were interwoven, and taught me how to identify negative, self-defeating thoughts and replace them with positive, life-affirming thoughts.She also taught me how to regulate my breathing to manage my anxiety, and self-talk to break through the vicious cycle of depressive ruminations and suicidal ideation. She recommended I read “Feeling Good” by Dr. David Burns, which further reinforced the skills she taught, and served as a workbook for my life.Difficult at first, with practice the cognitive behavioral skills gradually became autonomous as breathing. Albert Einstein once said, “The world we have created is a product of our thinking; it cannot be changed without changing our thinking.” The tools of cognitive behavioral therapy, in essence, helped change my thinking, and, therefore, my world.Over the past 24 years, I have learned that wellness does not come encapsulated in a pill; rather, it encompasses the way I live. The consistent practice of transcendental meditation, exercise, and cognitive behavioral therapy have helped me thrive in life despite recurrent bouts of anxiety and depression.Depression is no longer a demon I fear, it is a teacher whose wisdom I seek.

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

Depression, anxiety: What worked for me
By Gayathri Ramprasad; founder and president of ASHA International, a nonprofit organization promoting personal, organizational and community wellness. She is the author of “Shadows in the Sun: Healing from Depression and Finding the Light Within.

Depression is no longer a demon I fear, it is a teacher whose wisdom I seek.

For more than a decade of my life, I struggled with debilitating anxiety, panic attacks and depression. And, like millions of people around the world, I longed to discover a magic pill to cure my ills and promise me nirvana.
But, despite taking many medications, ongoing psychotherapy, electroconvulsive therapy (ECTs), hospitalizations and failed suicide attempts, wellness remained a distant dream.
The anti-anxiety medications and antidepressants worsened my symptoms, and made me more agitated, depressed and suicidal. And I was utterly confused why the medications that were supposed to alleviate my symptoms exacerbated them instead.
Staring out of the fifth-floor hospital window one day after yet another failed suicide attempt, I promised to take charge of my life and create a life of wellness. I was sick and tired of being a chronically mentally ill patient. I just wanted to be well.
Most of all, I wanted to be able to take my little girl to school, play with her in the park, and tuck her to bed at night with her favorite story.
Somewhere deep in my soul, I was convinced that the medications were making me sicker instead of helping me heal. So, despite my fears and those of my family, I decided to listen to my inner wisdom and wean myself off all medications under the supervision of my psychiatrist and explore holistic pathways to health and wellness.

Transcendental meditation
When a medical resident at the hospital suggested I try transcendental meditation to manage my anxiety and depression, I did.
Ironically, it was an American teacher, Pat, who taught me this life-affirming practice that had originated in India, my country of birth. I still remember sitting cross-legged on a Persian carpet across from Pat, in the dining-room-turned-shrine in her home.
While Pat sat still, Buddha-like, eyes closed, breath steady, body relaxed, face serene, my breath was erratic, my eyelids fluttered like the wings of a hummingbird, and my “monkey mind” ran amok.
But, one day, one breath at a time, I learned how to sit still. Despite my mind’s tendency to wander, like a mother lovingly guiding her wayward child back to its task I learned to gently guide my mind back to its still center. There, I discovered an oasis of energy, creativity, and restful calm.
In time, meditation offered me a sacred space to reflect on my life, and taught me to become an observer of my thoughts and emotions instead of getting entangled in them. Eventually, the daily practice of meditation helped me regulate my emotions and live each moment with mindfulness. Ultimately, meditation set me free from the limitations of my suffering, and awakened me to a life filled with eternal possibilities.

Exercise
During a visit, my psychiatrist recommended I start exercising, and educated me about the benefits of exercise in managing my anxiety and depression and promoting overall well-being.
I joined a health club and started working out three times a week, attended aerobics and yoga classes and trained with free weights.
I fell in love with my yoga classes. They relaxed and rejuvenated my mind, body, and spirit. Having never been athletic, I was surprised to find that exercise energized me and elevated my mood. It also provided a much-needed reprieve from my duties as a mother and homemaker, and helped me create a social network outside of my family.

Cognitive behavioral therapy
Although I was highly skeptical about how talking with a therapist could help me heal, it transformed my life.
For the first time in my life, Dr. Lin, my therapist, explained how our thoughts, feelings, moods and behavior were interwoven, and taught me how to identify negative, self-defeating thoughts and replace them with positive, life-affirming thoughts.
She also taught me how to regulate my breathing to manage my anxiety, and self-talk to break through the vicious cycle of depressive ruminations and suicidal ideation. She recommended I read “Feeling Good” by Dr. David Burns, which further reinforced the skills she taught, and served as a workbook for my life.
Difficult at first, with practice the cognitive behavioral skills gradually became autonomous as breathing. Albert Einstein once said, “The world we have created is a product of our thinking; it cannot be changed without changing our thinking.” The tools of cognitive behavioral therapy, in essence, helped change my thinking, and, therefore, my world.
Over the past 24 years, I have learned that wellness does not come encapsulated in a pill; rather, it encompasses the way I live. The consistent practice of transcendental meditation, exercise, and cognitive behavioral therapy have helped me thrive in life despite recurrent bouts of anxiety and depression.
Depression is no longer a demon I fear, it is a teacher whose wisdom I seek.




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

(Source: CNN)

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Children who have lots of nightmares at risk of suffering hallucinations and psychosis as teenagersBy Daily Mail Reporter
At 12, nightmares tripled occurrence of psychotic symptoms later in life
For those between two and nine, psychosis was 56 per cent more likely
If they persist ‘they can be a sign of something more significant later in life’
Children who have lots of bad dreams and nightmares are at a greater risk of suffering psychosis, a study has shown.Research showed that for 12-year-olds, nightmares more than tripled the occurrence of psychotic symptoms such as hallucinations and delusions.And children aged between two and nine who were most plagued by bad dreams were 56 per cent more likely to experience later episodes of psychosis than those whose sleep was undisturbed.However, scientists have moved to reassure parents that nightmares are common in young children, and that they usually grow out of them.Lead researcher Professor Dieter Wolke, from the University of Warwick, said: ‘We certainly don’t want to worry parents with this news; three in every four children experience nightmares at this young age.'However, nightmares over a prolonged period or bouts of night terrors that persist into adolescence can be an early indicator of something more significant in later life.'The study, part of a wide-ranging health investigation called the Avon Longitudinal Study of Parents and Children (Alspac), recruited more than 6,700 children.By the age of 12, around a quarter of the group reported having nightmares in the previous six months.Fewer than one in 10 experienced night terrors, which are often signified by a loud scream and the individual sitting upright in a panicked state, though unaware of any of the involuntary action. Nightmares and night terrors are often confused but very different forms of sleep disturbance.The former tend to occur during the shallower REM (rapid eye movement) part of the sleep cycle, when most dreaming takes place.Night terrors happen during deep sleep, causing the unaware sleeper to sit bolt upright in a panicked state, thrash about or scream.The children were assessed six times between the ages of two and nine. Higher rates of nightmares during this period were found to increase the likelihood of psychosis.Children who reported persistent nightmares at only one of the assessment time points were 16 per cent more likely to experience adolescent psychotic episodes than those who had no nightmares.Three or more nightmare periods were associated with a 56 per cent increased risk.At 12 years of age the risk of psychosis was more than tripled by having nightmares and almost doubled by night terrors.Lucie Russell, from the charity YoungMinds, which campaigns to improve the mental health of children and young people, said: ‘This is a very important study because anything that we can do to promote early identification of signs of mental illness is vital to help the thousands of children that suffer.'Early intervention is crucial to help avoid children suffering entrenched mental illness when they reach adulthood.'


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Children who have lots of nightmares at risk of suffering hallucinations and psychosis as teenagers
By Daily Mail Reporter

  • At 12, nightmares tripled occurrence of psychotic symptoms later in life
  • For those between two and nine, psychosis was 56 per cent more likely
  • If they persist ‘they can be a sign of something more significant later in life’


Children who have lots of bad dreams and nightmares are at a greater risk of suffering psychosis, a study has shown.
Research showed that for 12-year-olds, nightmares more than tripled the occurrence of psychotic symptoms such as hallucinations and delusions.
And children aged between two and nine who were most plagued by bad dreams were 56 per cent more likely to experience later episodes of psychosis than those whose sleep was undisturbed.
However, scientists have moved to reassure parents that nightmares are common in young children, and that they usually grow out of them.
Lead researcher Professor Dieter Wolke, from the University of Warwick, said: ‘We certainly don’t want to worry parents with this news; three in every four children experience nightmares at this young age.
'However, nightmares over a prolonged period or bouts of night terrors that persist into adolescence can be an early indicator of something more significant in later life.'
The study, part of a wide-ranging health investigation called the Avon Longitudinal Study of Parents and Children (Alspac), recruited more than 6,700 children.
By the age of 12, around a quarter of the group reported having nightmares in the previous six months.
Fewer than one in 10 experienced night terrors, which are often signified by a loud scream and the individual sitting upright in a panicked state, though unaware of any of the involuntary action.
Nightmares and night terrors are often confused but very different forms of sleep disturbance.
The former tend to occur during the shallower REM (rapid eye movement) part of the sleep cycle, when most dreaming takes place.
Night terrors happen during deep sleep, causing the unaware sleeper to sit bolt upright in a panicked state, thrash about or scream.
The children were assessed six times between the ages of two and nine. Higher rates of nightmares during this period were found to increase the likelihood of psychosis.
Children who reported persistent nightmares at only one of the assessment time points were 16 per cent more likely to experience adolescent psychotic episodes than those who had no nightmares.
Three or more nightmare periods were associated with a 56 per cent increased risk.
At 12 years of age the risk of psychosis was more than tripled by having nightmares and almost doubled by night terrors.
Lucie Russell, from the charity YoungMinds, which campaigns to improve the mental health of children and young people, said: ‘This is a very important study because anything that we can do to promote early identification of signs of mental illness is vital to help the thousands of children that suffer.
'Early intervention is crucial to help avoid children suffering entrenched mental illness when they reach adulthood.'



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Tom Rob Smith describes his mother’s psychosis – which inspired new book The Farmhttp://metro.co.uk/
Best-selling thriller writer Tom Rob Smith’s world was turned upside down three years ago, when his mother arrived on his doorstep informing him she was being spied on and that his dad and their neighbours were conspiring against her.
Smith’s parents had retired from their careers as antique dealers in London to live on a farm in Sweden. As far as Smith knew, all was going well until the day his father phoned to tell him he suspected his mum was mentally ill. Hours later, she arrived in Britain.
‘She was slightly more animated than usual,’ recalls Smith, ‘but she would have been if she really had gone through a terrible conspiracy as she claimed. Otherwise she seemed normal. I was bewildered.’
This real-life event is the inspiration behind his latest thriller, The Farm, in which his protagonist faces a similar crisis. His mother turns up claiming to have uncovered a sinister conspiracy in Sweden and, from there, the reader is invited to speculate as to whether these events are a figment of her imagination.
As The Farm is fictional, it turns out the neighbours might not be up to much good after all, whereas the mystery Smith’s mother claimed to have unearthed was resolved much more quickly. ‘I took her to the hospital for tests,’ says Smith. ‘She was diagnosed with psychosis.’
Hearing his mother was psychotic must have come as a shock? ‘Yes, because that word is used in all sorts of ways,’ he says. ‘I thought it meant someone was dangerous. The word’s bandied about so much we’ve lost what it really means. It describes a situation where someone has created a world they are inhabiting that is both connected to and disconnected from the real world. Her world was utterly plausible – she wasn’t describing seeing flying elephants – and everything she described seemed real.’
Smith’s mother recovered within weeks and his parents have moved back to Britain. Now, his mother gives talks to women who are going through similar problems. ‘The worst part was thinking: “Is she ever going to get better?”’ says Smith, whose first novel, Child 44, has been turned into a movie starring Tom Hardy and Noomi Rapace.
‘I remember phoning NHS Direct and looking all the terms up online. But when I started asking people about it I was amazed by how many had similar experiences in their families. It’s swept under the carpet.’
Smith says the experience made his family closer. ‘Complacency can slip into relationships,’ he says. ‘Parents are always there for you but this was the first time I’d been there for my mother. I started to relate to my parents as people who have their own problems.’

 
 

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Tom Rob Smith describes his mother’s psychosis – which inspired new book The Farm
http://metro.co.uk/

Best-selling thriller writer Tom Rob Smith’s world was turned upside down three years ago, when his mother arrived on his doorstep informing him she was being spied on and that his dad and their neighbours were conspiring against her.

Smith’s parents had retired from their careers as antique dealers in London to live on a farm in Sweden. As far as Smith knew, all was going well until the day his father phoned to tell him he suspected his mum was mentally ill. Hours later, she arrived in Britain.

‘She was slightly more animated than usual,’ recalls Smith, ‘but she would have been if she really had gone through a terrible conspiracy as she claimed. Otherwise she seemed normal. I was bewildered.’

This real-life event is the inspiration behind his latest thriller, The Farm, in which his protagonist faces a similar crisis. His mother turns up claiming to have uncovered a sinister conspiracy in Sweden and, from there, the reader is invited to speculate as to whether these events are a figment of her imagination.

As The Farm is fictional, it turns out the neighbours might not be up to much good after all, whereas the mystery Smith’s mother claimed to have unearthed was resolved much more quickly. ‘I took her to the hospital for tests,’ says Smith. ‘She was diagnosed with psychosis.’

Hearing his mother was psychotic must have come as a shock? ‘Yes, because that word is used in all sorts of ways,’ he says. ‘I thought it meant someone was dangerous. The word’s bandied about so much we’ve lost what it really means. It describes a situation where someone has created a world they are inhabiting that is both connected to and disconnected from the real world. Her world was utterly plausible – she wasn’t describing seeing flying elephants – and everything she described seemed real.’

Smith’s mother recovered within weeks and his parents have moved back to Britain. Now, his mother gives talks to women who are going through similar problems. ‘The worst part was thinking: “Is she ever going to get better?”’ says Smith, whose first novel, Child 44, has been turned into a movie starring Tom Hardy and Noomi Rapace.

‘I remember phoning NHS Direct and looking all the terms up online. But when I started asking people about it I was amazed by how many had similar experiences in their families. It’s swept under the carpet.’

Smith says the experience made his family closer. ‘Complacency can slip into relationships,’ he says. ‘Parents are always there for you but this was the first time I’d been there for my mother. I started to relate to my parents as people who have their own problems.’

 

 



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Filed under tom rob smith child 44 child44 the farm the secret speech agent 6 author writer book books novel artist psychology psychiatry diagnosis psychosis psychotic schizophrenia schizophrenic story true story mental health mental illness mental health illness tumblr blog serious mental illness knafo