Serious Mental Illness Blog

An LIU Post Specialty Concentration

Posts tagged psychotic

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A Disease of Silence? Social Stigma and SchizophreniaBy Henry Lane, Jewish Journal
Schizophrenia is one of the most common health conditions yet it is also one of the most misunderstood, a knowledge gap that leads to a very stereotyped view of the disease. For example, many people believe that people with schizophrenia are violent and dangerous when in fact they are more at risk of attack or of hurting themselves than harming other people. Summing it up in his book, Surviving Schizophrenia, senior psychiatrist Dr E Fuller Torrey calls the condition “the modern-day equivalent of leprosy”.
Many people with schizophrenia recover fully or are able to manage the condition well enough to lead normal lives, especially if help is sought early on. However, in common with other mental health conditions, the disease brings a strong social stigma and discrimination.
In 2008, the National Alliance on Mental Illness (NAMI) conducted a survey to better understand the depths of the stigma surrounding schizophrenia. The survey found that:
85% of respondents understood that schizophrenia is a medical illness
Only 43% said they would tell their friends if they had schizophrenia.
27% admitted that they might be embarrassed if a family member had the illness.
Almost half of those living with schizophrenia said they felt that doctors did not take their physical health complaints seriously.
For many people, the stigma and discrimination they experience – from society in general but also from families, friends and employers – can make their problems far worse. Nearly nine out of ten people with mental health problems say that stigma and discrimination have a negative effect on their lives. Among those with a long-term health condition or disability, people with mental health problems are amongst the least likely to:
find work
be in a steady, long-term relationship
live in decent housing 
be socially included in mainstream society.
The NAMI survey highlighted the social and professional challenges that people with schizophrenia face, which can have huge impacts on their quality of life. The survey showed that:
Nearly one-quarter of respondents would not want to work with someone with schizophrenia, even if he or she was receiving treatment
34% would not want their boss to have schizophrenia
Nearly half would not want to date a person with schizophrenia, even if the person was in treatment. 
The stigma associated with schizophrenia also poses a dilemma for many doctors, says Ken Duckworth, MD, medical director at NAMI and assistant professor at Harvard Medical School. “Doctors are reluctant to make a diagnosis. They don’t want to give you what amounts to a social death sentence.” He called schizophrenia a “low-status illness”, meaning it doesn’t have the same acceptance as diseases such as breast cancer or inherited genetic problems.
Social stigma in Jewish communities?
Jewish communities have a long history with schizophrenia and many of those links are surprising. For example, there is a commonly held belief that those in the Ashkenazi community are at higher risk of developing the disease. This myth is explained by the fact that members of the Ashkenazi community have participated in a series of studies aimed at understanding the biological basis for both schizophrenia and bipolar disorder as part of the Epidemiology/Genetics Research Programme in Psychiatry at Johns Hopkins University.
Blogger and multi-faith chaplain, Diane Weber Bederman, quoted these studies in her blog article Mental Illness and the Jews. “Due to a long history of marriage within the faith, which extends back thousands of years, the Jewish community has emerged from a limited number of ancestors and has a similar genetic makeup. This allows researchers to more easily perform genetic studies and locate disease-causing genes.” She added: “Results of the studies: Scientists estimate the incidence of schizophrenia in the Ashkenazi Jewish population to be no higher than that of the general population (about one percent).”
Mental health problems may not be more common in Jewish populations, but what about social stigma? Betty Jampel, writing in the New Jersey Jewish News, has a clear message: “It is a sad fact of life that… we are still dealing with mental illness as a shameful malady. While there have been public awareness campaigns to stigmatize mental illness and a shift in the scientific community to understand the biochemical nature of psychiatric illnesses, the shame persists. Those with mental illnesses still tend to be viewed as flawed, as somehow not doing enough for themselves to get better.”
The focus should be on tackling social stigma, she added. “As a Jewish community of mental health professionals, clergy, and laypeople, it is incumbent on all of us to change our perceptions of mental illness and to stop perpetuating the myths that come with these disorders. We as a Jewish community need to embrace differences and practice inclusion in all the various settings that bring us together. We need to stop judging others and to lovingly accept that we are all here to fulfill different life goals. We may look different and our life’s goals may be different, but put all together, we are all here to lift each other as a collective community.” 
Artwork by Louis Wain



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

A Disease of Silence? Social Stigma and Schizophrenia
By Henry Lane, Jewish Journal

Schizophrenia is one of the most common health conditions yet it is also one of the most misunderstood, a knowledge gap that leads to a very stereotyped view of the disease. For example, many people believe that people with schizophrenia are violent and dangerous when in fact they are more at risk of attack or of hurting themselves than harming other people. Summing it up in his book, Surviving Schizophrenia, senior psychiatrist Dr E Fuller Torrey calls the condition “the modern-day equivalent of leprosy”.

Many people with schizophrenia recover fully or are able to manage the condition well enough to lead normal lives, especially if help is sought early on. However, in common with other mental health conditions, the disease brings a strong social stigma and discrimination.

In 2008, the National Alliance on Mental Illness (NAMI) conducted a survey to better understand the depths of the stigma surrounding schizophrenia. The survey found that:

  • 85% of respondents understood that schizophrenia is a medical illness
  • Only 43% said they would tell their friends if they had schizophrenia.
  • 27% admitted that they might be embarrassed if a family member had the illness.
  • Almost half of those living with schizophrenia said they felt that doctors did not take their physical health complaints seriously.

For many people, the stigma and discrimination they experience – from society in general but also from families, friends and employers – can make their problems far worse. Nearly nine out of ten people with mental health problems say that stigma and discrimination have a negative effect on their lives. Among those with a long-term health condition or disability, people with mental health problems are amongst the least likely to:

  • find work
  • be in a steady, long-term relationship
  • live in decent housing 
  • be socially included in mainstream society.

The NAMI survey highlighted the social and professional challenges that people with schizophrenia face, which can have huge impacts on their quality of life. The survey showed that:

  • Nearly one-quarter of respondents would not want to work with someone with schizophrenia, even if he or she was receiving treatment
  • 34% would not want their boss to have schizophrenia
  • Nearly half would not want to date a person with schizophrenia, even if the person was in treatment. 

The stigma associated with schizophrenia also poses a dilemma for many doctors, says Ken Duckworth, MD, medical director at NAMI and assistant professor at Harvard Medical School. “Doctors are reluctant to make a diagnosis. They don’t want to give you what amounts to a social death sentence.” He called schizophrenia a “low-status illness”, meaning it doesn’t have the same acceptance as diseases such as breast cancer or inherited genetic problems.

Social stigma in Jewish communities?

Jewish communities have a long history with schizophrenia and many of those links are surprising. For example, there is a commonly held belief that those in the Ashkenazi community are at higher risk of developing the disease. This myth is explained by the fact that members of the Ashkenazi community have participated in a series of studies aimed at understanding the biological basis for both schizophrenia and bipolar disorder as part of the Epidemiology/Genetics Research Programme in Psychiatry at Johns Hopkins University.

Blogger and multi-faith chaplain, Diane Weber Bederman, quoted these studies in her blog article Mental Illness and the Jews. “Due to a long history of marriage within the faith, which extends back thousands of years, the Jewish community has emerged from a limited number of ancestors and has a similar genetic makeup. This allows researchers to more easily perform genetic studies and locate disease-causing genes.” She added: “Results of the studies: Scientists estimate the incidence of schizophrenia in the Ashkenazi Jewish population to be no higher than that of the general population (about one percent).”

Mental health problems may not be more common in Jewish populations, but what about social stigma? Betty Jampel, writing in the New Jersey Jewish News, has a clear message: “It is a sad fact of life that… we are still dealing with mental illness as a shameful malady. While there have been public awareness campaigns to stigmatize mental illness and a shift in the scientific community to understand the biochemical nature of psychiatric illnesses, the shame persists. Those with mental illnesses still tend to be viewed as flawed, as somehow not doing enough for themselves to get better.”

The focus should be on tackling social stigma, she added. “As a Jewish community of mental health professionals, clergy, and laypeople, it is incumbent on all of us to change our perceptions of mental illness and to stop perpetuating the myths that come with these disorders. We as a Jewish community need to embrace differences and practice inclusion in all the various settings that bring us together. We need to stop judging others and to lovingly accept that we are all here to fulfill different life goals. We may look different and our life’s goals may be different, but put all together, we are all here to lift each other as a collective community.” 

Artwork by Louis Wain




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

Filed under schizophrenia psychosis psychotic Hallucinations hallucination delusion delusions delusional mad madness mental health mental illness health illness mental healthy wellness mind body brain treatment stigma jewish jew crazy hope recovery recover news meds

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The Play that Wants to Change the Way we Treat Mental IllnessBy Laura Barnett, The Guardian
The Eradication of Schizophrenia in Western Lapland is based on a new approach called ‘open dialogue’, and replicates the experience of having an auditory hallucination.
Can theatre offer a cure for psychosis? It’s unlikely – and it would be unwise for any theatre-maker even to try. What theatre can do, though, is convey the experience of psychosis: the hallucinations and delusions – often terrifying, sometimes comical – that define reality for those withschizophrenia and related conditions.
This, at least, is the belief shared by David Woods and Jon Haynes, co-founders of the theatre company Ridiculusmus. Their new show, The Eradication of Schizophrenia in Western Lapland, examines the effects of psychosis on several members of a fictional family, using an innovative conceit. The audience is split in two, with each half sitting on either side of a dividing wall. For the first act, each half of the audience watches one scene, while another scene is performed on the other side. Later, the audiences swap places; and in the final section, the wall becomes transparent, so that both halves of the audience are watching the same scene.
The effect, at least at first, is bewildering – and that is the point. “It’s as if you’re having auditory hallucinations,” Woods tells me when we meet during rehearsals at the Basement in Brighton, where the play is beginning a national tour. “Initially it’ll be overwhelming, chaotic. Then the audience will go out of the theatre, change sides. Slowly the voices will settle into place. In a way, it’s the same with schizophrenia. You don’t get cured, but you can recover.”
Woods and Haynes know more about schizophrenia and psychosis than most. Haynes was sectioned in the mid-80s, and spent six months as a patient in London’s Maudsley Hospital; Woods was a carer for several family members with mental health problems. It was this that first drew them towards making a show about mental illness: a series of early improvisations on the subject of family (the company devise all their work through improvisation and extensive research) threw up memories from their own pasts.
They contacted the Tavistock clinic in London, where they took part in a workshop on child carers for adults with mental health issues. It was there that they first learned about "open dialogue": a revolutionary approach to the treatment of psychosis that has, over the past few decades, virtually eradicated the condition in Western Lapland, the area of Finland where it originated.
Intrigued, Woods and Haynes travelled to the Keropudas hospital in Tornio, Finland, where Dr Jaakko Seikkula first evolved the method - and were so struck by what they found that they decided to make open dialogue the key subject of their show. “I thought: ‘Wow, this is wonderful,’” Haynes explains. “I can imagine that if we’d had this kind of approach [in the UK] years ago, things might have been very different for me. When I was ill, I remember feeling very much that I was the problem. With open dialogue, that’s not at all how the patient feels.”
Open dialogue is, as the name suggests, a treatment based on talking rather than medicating, and on intervening as early as possible in a psychotic episode. Families are directly involved in the patient’s therapy, with the aim of identifying the skewed dynamics, or other sources of emotional tension, that may have caused the patient’s crisis. “The idea,” Seikkula tells me over Skype, “is to organise the psychiatric system in a way that makes it possible to meet immediately in a crisis, and work very intensively together with the family.”
The statistics on open dialogue are startling: according to a 2003 study conducted at Keropudas hospital, 82% of patients who were given open-dialogue treatment had no, or mild, psychotic symptoms after five years, compared to 50% in a comparison group. The method has attracted international attention – in 2011, Seikkula helped found the Institute for Dialogic Practice in Massachusetts, to take open dialogue to the US. But it still remains far from the mainstream in many countries, including the UK.
The Eradication of Schizophrenia in Western Lapland has open dialogue as an underlying theme, inherent in the idea of an audience listening to a family’s experience of psychosis, much as a psychiatrist might do during an open-dialogue session. Each scene begins with a group of disembodied voices describing the principles of the method, and the psychiatrist character in the play mentions the fact that a colleague in the NHS has been struck off for using open dialogue in the place of anti-psychotic medication.
Haynes and Woods’ key aims are to raise awareness of open dialogue, and to dispel the wider stigma surrounding schizophrenia. “I would hope,” Woods says, “that people who see the show would start listening: talking to each other rather than just barging their way through life. And that they would realise that there is a lot more to schizophrenia than just the tiny minority who go out and stab somebody with a knife.”
Seikkula, too, believes that a piece of theatre such as this has a powerful role to play in expressing what he, and other practitioners of open dialogue, consider the fundamental definition of psychosis. “Psychosis belongs to life,” he says. “In my mind, we can all have hallucinations. If we are in a stressful enough situation, each of us can react in that way. This play gives people a very concrete experience of how that really is.”
The Eradication of Schizophrenia in Western Lapland is touring the UK. See ridiculusmus.com for full details.

For more information on Open Dialogue, see opendialogueapproach.co.uk

 


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

The Play that Wants to Change the Way we Treat Mental Illness
By Laura Barnett, The Guardian

The Eradication of Schizophrenia in Western Lapland is based on a new approach called ‘open dialogue’, and replicates the experience of having an auditory hallucination.

Can theatre offer a cure for psychosis? It’s unlikely – and it would be unwise for any theatre-maker even to try. What theatre can do, though, is convey the experience of psychosis: the hallucinations and delusions – often terrifying, sometimes comical – that define reality for those withschizophrenia and related conditions.

This, at least, is the belief shared by David Woods and Jon Haynes, co-founders of the theatre company Ridiculusmus. Their new show, The Eradication of Schizophrenia in Western Lapland, examines the effects of psychosis on several members of a fictional family, using an innovative conceit. The audience is split in two, with each half sitting on either side of a dividing wall. For the first act, each half of the audience watches one scene, while another scene is performed on the other side. Later, the audiences swap places; and in the final section, the wall becomes transparent, so that both halves of the audience are watching the same scene.

The effect, at least at first, is bewildering – and that is the point. “It’s as if you’re having auditory hallucinations,” Woods tells me when we meet during rehearsals at the Basement in Brighton, where the play is beginning a national tour. “Initially it’ll be overwhelming, chaotic. Then the audience will go out of the theatre, change sides. Slowly the voices will settle into place. In a way, it’s the same with schizophrenia. You don’t get cured, but you can recover.”

Woods and Haynes know more about schizophrenia and psychosis than most. Haynes was sectioned in the mid-80s, and spent six months as a patient in London’s Maudsley Hospital; Woods was a carer for several family members with mental health problems. It was this that first drew them towards making a show about mental illness: a series of early improvisations on the subject of family (the company devise all their work through improvisation and extensive research) threw up memories from their own pasts.

They contacted the Tavistock clinic in London, where they took part in a workshop on child carers for adults with mental health issues. It was there that they first learned about "open dialogue": a revolutionary approach to the treatment of psychosis that has, over the past few decades, virtually eradicated the condition in Western Lapland, the area of Finland where it originated.

Intrigued, Woods and Haynes travelled to the Keropudas hospital in Tornio, Finland, where Dr Jaakko Seikkula first evolved the method - and were so struck by what they found that they decided to make open dialogue the key subject of their show. “I thought: ‘Wow, this is wonderful,’” Haynes explains. “I can imagine that if we’d had this kind of approach [in the UK] years ago, things might have been very different for me. When I was ill, I remember feeling very much that I was the problem. With open dialogue, that’s not at all how the patient feels.”

Open dialogue is, as the name suggests, a treatment based on talking rather than medicating, and on intervening as early as possible in a psychotic episode. Families are directly involved in the patient’s therapy, with the aim of identifying the skewed dynamics, or other sources of emotional tension, that may have caused the patient’s crisis. “The idea,” Seikkula tells me over Skype, “is to organise the psychiatric system in a way that makes it possible to meet immediately in a crisis, and work very intensively together with the family.”

The statistics on open dialogue are startling: according to a 2003 study conducted at Keropudas hospital, 82% of patients who were given open-dialogue treatment had no, or mild, psychotic symptoms after five years, compared to 50% in a comparison group. The method has attracted international attention – in 2011, Seikkula helped found the Institute for Dialogic Practice in Massachusetts, to take open dialogue to the US. But it still remains far from the mainstream in many countries, including the UK.

The Eradication of Schizophrenia in Western Lapland has open dialogue as an underlying theme, inherent in the idea of an audience listening to a family’s experience of psychosis, much as a psychiatrist might do during an open-dialogue session. Each scene begins with a group of disembodied voices describing the principles of the method, and the psychiatrist character in the play mentions the fact that a colleague in the NHS has been struck off for using open dialogue in the place of anti-psychotic medication.

Haynes and Woods’ key aims are to raise awareness of open dialogue, and to dispel the wider stigma surrounding schizophrenia. “I would hope,” Woods says, “that people who see the show would start listening: talking to each other rather than just barging their way through life. And that they would realise that there is a lot more to schizophrenia than just the tiny minority who go out and stab somebody with a knife.”

Seikkula, too, believes that a piece of theatre such as this has a powerful role to play in expressing what he, and other practitioners of open dialogue, consider the fundamental definition of psychosis. “Psychosis belongs to life,” he says. “In my mind, we can all have hallucinations. If we are in a stressful enough situation, each of us can react in that way. This play gives people a very concrete experience of how that really is.”

The Eradication of Schizophrenia in Western Lapland is touring the UK. See ridiculusmus.com for full details.

For more information on Open Dialogue, see opendialogueapproach.co.uk

 





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

Filed under mental illness mental health mental illness health healthy wellness schizophrenia psychosis psychotic mind body brain theater play art artist creative news diagnosis disorder hallucination hallucinations recovery mad madness playwright playwriting psychology psychiatry

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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?





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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.





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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.'


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

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


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

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

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

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

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

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

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



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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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At last, a promising alternative to antipsychotics for schizophreniaBy Daniel and Jason Freeman, the authors of Paranoia: The 21st Century FearFor many, the side-effects of antipsychotics are worse than the symptoms they’re meant to treat. No wonder some people with schizophrenia refuse to take them.Imagine that, after feeling unwell for a while, you visit your GP. “Ah,” says the doctor decisively, "what you need is medication X. It’s often pretty effective, though there can be side-effects. You may gain weight. Or feel drowsy. And you may develop tremors reminiscent of Parkinson’s disease." Warily, you glance at the prescription on the doctor’s desk, but she hasn’t finished. "Some patients find that sex becomes a problem. Diabetes and heart problems are a risk. And in the long term the drug may actually shrink your brain … "
This scenario may sound far-fetched, but it is precisely what faces people diagnosed with schizophrenia. Since the 1950s, the illness has generally been treated using antipsychotic drugs – which, as with so many medications, were discovered by chance. A French surgeon investigating treatments for surgical shock found that one of the drugs he tried – the antihistamine chlorpromazine – produced powerful psychological effects. This prompted the psychiatrist Pierre Deniker to give the drug to some of his most troubled patients. Their symptoms improved dramatically, and a major breakthrough in the treatment of psychosis seemed to have arrived.
Many other antipsychotic drugs have followed in chlorpromazine’s wake and today these medications comprise 10% of total NHS psychiatric prescriptions. They are costly items: the NHS spends more on these medications than it does for any other psychiatric drug, including antidepressants. Globally, around $14.5bn is estimated to be spent on antipsychotics each year.
Since the 1950s the strategy of all too many NHS mental health teams has been a simple one. Assuming that psychosis is primarily a biological brain problem, clinicians prescribe an antipsychotic medication and everyone does their level best to get the patient to take it, often for long periods. There can be little doubt that these drugs make a positive difference, reducing delusions and hallucinations and making relapse less likely – provided, that is, the patient takes their medication.
Unfortunately, dropout rates are high. This is partly because individuals sometimes don’t accept that they are ill. But a major reason is the side-effects. These vary from drug to drug, but they’re common and for many people are worse than the symptoms they are designed to treat.In addition, antipsychotics don’t work for everyone. It is estimated that six months after first being prescribed them, as many as 50% of patients are either taking the drugs haphazardly or not at all.
The conventional treatment for this most severe of psychiatric illnesses, then, is expensive, frequently unpleasant, and not always effective even for those who carry on taking the drugs. But it is what we have relied upon – which helps to explain why the results of a clinical trial, recently published in The Lancet, have generated so much interest and debate.
A team led by Professor Anthony Morrison at the University of Manchester randomly assigned a group of patients, all of whom had opted not to take antipsychotics, to treatment as usual (involving a range of non-pharmaceutical care) or to treatment as usual plus a course of cognitive therapy (CT). Drop-out rates for the cognitive therapy were low, while its efficacy in reducing the symptoms of psychosis was comparable to what medication can achieve.
So what exactly is CT for schizophrenia? At its core is the idea that the patient should be encouraged to talk about their experiences – just as they would for every other psychological condition. Psychosis isn’t viewed as a biological illness that one either has or does not have. Instead, just like every other mental disorder, psychotic experiences are seen as the severest instances of thoughts and feelings – notably delusions and hallucinations – that many of us experience from time to time.
Working together, the patient and therapist develop a model of what’s causing the experiences, and why they’re recurring. These factors will vary from person to person, so what is produced is a bespoke account of the individual’s experience, which is then used to guide treatment. For example, a person so worried by paranoid fears that they won’t set foot outside might be helped to trace the roots of their anxiety to past experiences; to gradually test out their fearful thoughts; and to learn to manage their anxiety while getting on with the activities they enjoy. An individual troubled by hearing voices will be helped to understand what’s triggering these voices, and to develop a more confident, empowering relationship with them.
These are early days. Nevertheless, most of the meta-analyses of CT’s efficacy for psychosis, when added to standard treatment, have indicated definite (albeit modest) benefits for patients, with the latest showing that CT is better than other psychological treatments for reducing delusions and hallucinations. The latest guidelines from the UK’s National Institute for Health and Care Excellence (Nice) recommend it for those at risk of psychosis and, when combined with medication, for people with an ongoing problem.
But not everyone is convinced, and although the research published in The Lancet is encouraging, it was small scale. CT for psychosis is still evolving, and we think that evolution should prioritise three key areas.First, we must focus on understanding and treating individual psychotic experiences. As we’ve reported in a previous post, there is increasing reason to doubt the usefulness of the diagnosis “schizophrenia”. The term has been used as a catch-all for an assortment of unusual thoughts and feelings that often have no intrinsic connections, and aren’t qualitatively different from those experienced by the general population. Each psychotic experience may therefore require a tailored treatment.Second, we must build on the recent transformation in understanding the causes of psychotic experiences, taking one factor at a time (insomnia, say, or worry), developing an intervention to change it, and then observing the effects of that intervention on an individual’s difficulties.And finally, we must listen to what patients want from their treatment – for example, by focusing on improving levels of wellbeing, which tend to be very low among people with schizophrenia.
What about costs compared with drug treatment? A course of CBT is typically just over £1,000, but if it leads to a reduction in the amount of time patients spend in hospital and their use of other services, or a return to work, then it easily pays for itself.
The Nice guidance on psychosis and schizophrenia, updated this year, is unequivocal:"The systematic review of economic evidence showed that provision of CBT to people with schizophrenia in the UK improved clinical outcomes at no additional cost. This finding was supported by economic modelling undertaken for this guideline, which suggested that provision of CBT might result in net cost savings to the NHS, associated with a reduction in future hospitalisation rates."
If the real promise of cognitive therapy can be fulfilled, we may at last have a genuinely effective, relatively cheap, and side-effect-free alternative to antipsychotics for those patients who don’t wish to take them.


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

At last, a promising alternative to antipsychotics for schizophrenia
By Daniel and Jason Freeman, the authors of Paranoia: The 21st Century Fear

For many, the side-effects of antipsychotics are worse than the symptoms they’re meant to treat. No wonder some people with schizophrenia refuse to take them.

Imagine that, after feeling unwell for a while, you visit your GP. “Ah,” says the doctor decisively, "what you need is medication X. It’s often pretty effective, though there can be side-effects. You may gain weight. Or feel drowsy. And you may develop tremors reminiscent of Parkinson’s disease." Warily, you glance at the prescription on the doctor’s desk, but she hasn’t finished. "Some patients find that sex becomes a problem. Diabetes and heart problems are a risk. And in the long term the drug may actually shrink your brain … "

This scenario may sound far-fetched, but it is precisely what faces people diagnosed with schizophrenia. Since the 1950s, the illness has generally been treated using antipsychotic drugs – which, as with so many medications, were discovered by chance. A French surgeon investigating treatments for surgical shock found that one of the drugs he tried – the antihistamine chlorpromazine – produced powerful psychological effects. This prompted the psychiatrist Pierre Deniker to give the drug to some of his most troubled patients. Their symptoms improved dramatically, and a major breakthrough in the treatment of psychosis seemed to have arrived.

Many other antipsychotic drugs have followed in chlorpromazine’s wake and today these medications comprise 10% of total NHS psychiatric prescriptions. They are costly items: the NHS spends more on these medications than it does for any other psychiatric drug, including antidepressants. Globally, around $14.5bn is estimated to be spent on antipsychotics each year.

Since the 1950s the strategy of all too many NHS mental health teams has been a simple one. Assuming that psychosis is primarily a biological brain problem, clinicians prescribe an antipsychotic medication and everyone does their level best to get the patient to take it, often for long periods. There can be little doubt that these drugs make a positive difference, reducing delusions and hallucinations and making relapse less likely – provided, that is, the patient takes their medication.

Unfortunately, dropout rates are high. This is partly because individuals sometimes don’t accept that they are ill. But a major reason is the side-effects. These vary from drug to drug, but they’re common and for many people are worse than the symptoms they are designed to treat.
In addition, antipsychotics don’t work for everyone. It is estimated that six months after first being prescribed them, as many as 50% of patients are either taking the drugs haphazardly or not at all.

The conventional treatment for this most severe of psychiatric illnesses, then, is expensive, frequently unpleasant, and not always effective even for those who carry on taking the drugs. But it is what we have relied upon – which helps to explain why the results of a clinical trial, recently published in The Lancet, have generated so much interest and debate.

A team led by Professor Anthony Morrison at the University of Manchester randomly assigned a group of patients, all of whom had opted not to take antipsychotics, to treatment as usual (involving a range of non-pharmaceutical care) or to treatment as usual plus a course of cognitive therapy (CT). Drop-out rates for the cognitive therapy were low, while its efficacy in reducing the symptoms of psychosis was comparable to what medication can achieve.

So what exactly is CT for schizophrenia? At its core is the idea that the patient should be encouraged to talk about their experiences – just as they would for every other psychological condition. Psychosis isn’t viewed as a biological illness that one either has or does not have. Instead, just like every other mental disorder, psychotic experiences are seen as the severest instances of thoughts and feelings – notably delusions and hallucinations – that many of us experience from time to time.

Working together, the patient and therapist develop a model of what’s causing the experiences, and why they’re recurring. These factors will vary from person to person, so what is produced is a bespoke account of the individual’s experience, which is then used to guide treatment. For example, a person so worried by paranoid fears that they won’t set foot outside might be helped to trace the roots of their anxiety to past experiences; to gradually test out their fearful thoughts; and to learn to manage their anxiety while getting on with the activities they enjoy. An individual troubled by hearing voices will be helped to understand what’s triggering these voices, and to develop a more confident, empowering relationship with them.

These are early days. Nevertheless, most of the meta-analyses of CT’s efficacy for psychosis, when added to standard treatment, have indicated definite (albeit modest) benefits for patients, with the latest showing that CT is better than other psychological treatments for reducing delusions and hallucinations. The latest guidelines from the UK’s National Institute for Health and Care Excellence (Nice) recommend it for those at risk of psychosis and, when combined with medication, for people with an ongoing problem.

But not everyone is convinced, and although the research published in The Lancet is encouraging, it was small scale. CT for psychosis is still evolving, and we think that evolution should prioritise three key areas.
First, we must focus on understanding and treating individual psychotic experiences. As we’ve reported in a previous post, there is increasing reason to doubt the usefulness of the diagnosis “schizophrenia”. The term has been used as a catch-all for an assortment of unusual thoughts and feelings that often have no intrinsic connections, and aren’t qualitatively different from those experienced by the general population. Each psychotic experience may therefore require a tailored treatment.
Second, we must build on the recent transformation in understanding the causes of psychotic experiences, taking one factor at a time (insomnia, say, or worry), developing an intervention to change it, and then observing the effects of that intervention on an individual’s difficulties.
And finally, we must listen to what patients want from their treatment – for example, by focusing on improving levels of wellbeing, which tend to be very low among people with schizophrenia.

What about costs compared with drug treatment? A course of CBT is typically just over £1,000, but if it leads to a reduction in the amount of time patients spend in hospital and their use of other services, or a return to work, then it easily pays for itself.

The Nice guidance on psychosis and schizophrenia, updated this year, is unequivocal:
"The systematic review of economic evidence showed that provision of CBT to people with schizophrenia in the UK improved clinical outcomes at no additional cost. This finding was supported by economic modelling undertaken for this guideline, which suggested that provision of CBT might result in net cost savings to the NHS, associated with a reduction in future hospitalisation rates."

If the real promise of cognitive therapy can be fulfilled, we may at last have a genuinely effective, relatively cheap, and side-effect-free alternative to antipsychotics for those patients who don’t wish to take them.



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

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Parkinsonism a Major Mortality Risk Factor in SchizophreniaBy Daniel M. Keller, PhD
There may be differences between different antipsychotic medications and their possible contribution. ”Specific treatments with clozapine or olanzapine could be related to more comorbidity and mortality,”
Compared with control individuals, patients with schizophrenia have significantly more physical comorbidity, including the novel finding that Parkinsonism is a major risk factor for inhospital mortality in this population, new research shows.A case-control study of general hospital admissions showed that the most common comorbidity among patients with schizophrenia was type 2 diabetes mellitus (T2DM). Twenty more physical diseases were also more prevalent, many of them associated with diabetic complications. Interestingly, Parkinsonism was a major risk factor for inhospital mortality in schizophrenia.The research was a collaboration between investigators in Germany and the United Kingdom. Speaking here at the 22nd European Congress of Psychiatry (EPA), Dieter Schoepf, MD, of the Department of Psychiatry at the University Hospital of Bonn, Germany, said that the study population comprised all admissions to 3 general hospitals in Manchester, United Kingdom (N = 369,488) between January 1, 2000, and June 30, 2012.It included 1418 patients who met diagnostic criteria for schizophrenia at initial admission according to the tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Control patients were 14,180 age- and gender-matched hospital patients at initial admission.Five Major FindingsThe study produced 5 major findings related to comorbidities affecting hospitalized patients with schizophrenia. First, they had a nearly 2-fold increased hospital-based mortality rate (18.0%) compared with control patients (9.7%) during the observation period. And the schizophrenic patients died at a younger mean age (64.4 ± 1.0 vs 66.2 ± 0.4 years, respectively).Second, "schizophrenics as compared to controls had a more severe course of illness and a shorter survival after their initial hospitalization," Dr. Schoepf reported. For the entire group of schizophrenic patients, survival averaged 1895 ± 35.1 days vs 2161 ± 11.6 days for all control patients. For deceased patients in each group, survival averaged 951.4 ± 62.9 vs 1030 ± 28.0 days, respectively.Third, patients with schizophrenia had substantially more physical diseases. Among 21 diseases with increased prevalence among the study population compared with control patients, odds ratios (ORs) ranged from 5.3 for fracture of the femur neck to 1.3 for asthma."T2DM was the most common disproportionally increased physical comorbidity," Dr. Schoepf said. Its prevalence among schizophrenic patients was double that of the control patients (17.4% vs 8.5%; OR = 2.3; 95% confidence interval [CI], 2.0 - 2.6).The fourth major finding was that among schizophrenic patients who died, T2DM was the most common physical comorbidity, contributing to about one third (31.4%) of those deaths, compared with 16.9% of deceased control patients.Parkinsonism affected 1.6% of the study group vs 0.4% of control patients (OR = 4.7; 95% CI, 2.8 - 7.7). It was present in 5.5% of deceased study group patients but in only 1.5% of control patients who died.Excluding Parkinsonism, a major risk factor for death among the schizophrenic group, the researchers developed a model that identified 9 other mortality risk factors that “had an equal impact on inhospital death in schizophrenics as compared to controls,” Dr. Schoepf reported.Although the prevalence of these risk factors differed between the 2 groups, their impact on inhospital mortality did not differ when these comorbidities were present in patients in either group. The comorbidities were as follows: T2DM, chronic obstructive pulmonary disease, pneumonia, bronchitis, iron-deficiency anemia, type 1 diabetes, ischemic stroke, nonspecific renal failure, and alcoholic liver disease.Novel ResultSpeaking with Medscape Medical News, session chair Guillermo Lahera Forteza, MD, PhD, professor of psychiatry at the University of Alcalá, Spain, who was not involved in the study, praised it as "impressive…especially the relationship between Parkinsonism and mortality in patients with schizophrenia. I was really shocked about this figure." He added that the relationship between T2DM and mortality has been well known, but the finding about Parkinsonism is something new.Dr. Lahera Forteza said he has questions about the causes of death in cases in which comorbidities exist. There may be differences between different antipsychotic medications and their possible contribution."Specific treatments with clozapine or olanzapine could be related to more comorbidity and mortality," he said, but Dr. Schoepf noted that there are not enough data from this study on this point.Dr. Lahera Forteza advises physicians “to restudy every treatment when the patient has this kind of comorbidity ― to re-evaluate and reassess the pharmacological treatment in every patient.” In addition, physicians should recognize the impact of lifestyle on these patients, who often smoke, drink alcohol, and do not get enough exercise. Negative symptoms, cognitive impairment, and social stigma can all affect lifestyle and contribute to or exacerbate physical comorbidities.Dr. Schoepf and Dr. Lahera Forteza report no relevant financial relationships. The study had no commercial funding.


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

Parkinsonism a Major Mortality Risk Factor in Schizophrenia
By Daniel M. Keller, PhD

There may be differences between different antipsychotic medications and their possible contribution. ”Specific treatments with clozapine or olanzapine could be related to more comorbidity and mortality,”

Compared with control individuals, patients with schizophrenia have significantly more physical comorbidity, including the novel finding that Parkinsonism is a major risk factor for inhospital mortality in this population, new research shows.
A case-control study of general hospital admissions showed that the most common comorbidity among patients with schizophrenia was type 2 diabetes mellitus (T2DM). Twenty more physical diseases were also more prevalent, many of them associated with diabetic complications. Interestingly, Parkinsonism was a major risk factor for inhospital mortality in schizophrenia.
The research was a collaboration between investigators in Germany and the United Kingdom. Speaking here at the 22nd European Congress of Psychiatry (EPA), Dieter Schoepf, MD, of the Department of Psychiatry at the University Hospital of Bonn, Germany, said that the study population comprised all admissions to 3 general hospitals in Manchester, United Kingdom (N = 369,488) between January 1, 2000, and June 30, 2012.
It included 1418 patients who met diagnostic criteria for schizophrenia at initial admission according to the tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Control patients were 14,180 age- and gender-matched hospital patients at initial admission.

Five Major Findings
The study produced 5 major findings related to comorbidities affecting hospitalized patients with schizophrenia. First, they had a nearly 2-fold increased hospital-based mortality rate (18.0%) compared with control patients (9.7%) during the observation period. And the schizophrenic patients died at a younger mean age (64.4 ± 1.0 vs 66.2 ± 0.4 years, respectively).
Second, "schizophrenics as compared to controls had a more severe course of illness and a shorter survival after their initial hospitalization," Dr. Schoepf reported. For the entire group of schizophrenic patients, survival averaged 1895 ± 35.1 days vs 2161 ± 11.6 days for all control patients. For deceased patients in each group, survival averaged 951.4 ± 62.9 vs 1030 ± 28.0 days, respectively.
Third, patients with schizophrenia had substantially more physical diseases. Among 21 diseases with increased prevalence among the study population compared with control patients, odds ratios (ORs) ranged from 5.3 for fracture of the femur neck to 1.3 for asthma.
"T2DM was the most common disproportionally increased physical comorbidity," Dr. Schoepf said. Its prevalence among schizophrenic patients was double that of the control patients (17.4% vs 8.5%; OR = 2.3; 95% confidence interval [CI], 2.0 - 2.6).
The fourth major finding was that among schizophrenic patients who died, T2DM was the most common physical comorbidity, contributing to about one third (31.4%) of those deaths, compared with 16.9% of deceased control patients.
Parkinsonism affected 1.6% of the study group vs 0.4% of control patients (OR = 4.7; 95% CI, 2.8 - 7.7). It was present in 5.5% of deceased study group patients but in only 1.5% of control patients who died.
Excluding Parkinsonism, a major risk factor for death among the schizophrenic group, the researchers developed a model that identified 9 other mortality risk factors that “had an equal impact on inhospital death in schizophrenics as compared to controls,” Dr. Schoepf reported.
Although the prevalence of these risk factors differed between the 2 groups, their impact on inhospital mortality did not differ when these comorbidities were present in patients in either group. The comorbidities were as follows: T2DM, chronic obstructive pulmonary disease, pneumonia, bronchitis, iron-deficiency anemia, type 1 diabetes, ischemic stroke, nonspecific renal failure, and alcoholic liver disease.

Novel Result
Speaking with Medscape Medical News, session chair Guillermo Lahera Forteza, MD, PhD, professor of psychiatry at the University of Alcalá, Spain, who was not involved in the study, praised it as "impressive…especially the relationship between Parkinsonism and mortality in patients with schizophrenia. I was really shocked about this figure." He added that the relationship between T2DM and mortality has been well known, but the finding about Parkinsonism is something new.
Dr. Lahera Forteza said he has questions about the causes of death in cases in which comorbidities exist. There may be differences between different antipsychotic medications and their possible contribution.
"Specific treatments with clozapine or olanzapine could be related to more comorbidity and mortality," he said, but Dr. Schoepf noted that there are not enough data from this study on this point.
Dr. Lahera Forteza advises physicians “to restudy every treatment when the patient has this kind of comorbidity ― to re-evaluate and reassess the pharmacological treatment in every patient.” In addition, physicians should recognize the impact of lifestyle on these patients, who often smoke, drink alcohol, and do not get enough exercise. Negative symptoms, cognitive impairment, and social stigma can all affect lifestyle and contribute to or exacerbate physical comorbidities.

Dr. Schoepf and Dr. Lahera Forteza report no relevant financial relationships. The study had no commercial funding.



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

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Stress & Schizophrenia: How to Help Your Loved One & YourselfBy Margarita Tartakovsky, M.S. Associate Editor, PsychCentralThe authors emphasize the idea people with schizophrenia are “more sensitive to the effects of stress because it can trigger symptom relapses and rehospitalizations.” Helping your loved one deal with stress in a healthy way helps them pursue their personal goals and improves their life.A common cause of relapse in schizophrenia is “difficulty managing high levels of stress,” according to Susan Gingerich, MSW, a psychotherapist who works with individuals with schizophrenia and their families.Learning to manage stress isn’t just important for preventing relapse; it’s also important because stress is an inevitable part of facing new challenges and working to accomplish personal goals — “what recovery is all about,” write Gingerich and clinical psychologist Kim T. Mueser, Ph.D, in their book The Complete Family Guide to Schizophrenia.Learning to navigate stress healthfully is key for family and friends, too. Having a loved one with schizophrenia can be stressful. Taking care of yourself enhances your well-being and daily functioning. And it means you’re in a better, healthier place to help your loved one.In their comprehensive book, Mueser and Gingerich share excellent tips for helping your loved one and yourself cope with stress (along with valuable information on schizophrenia and how you can support your loved one).Here are those suggestions and insights on managing and alleviating stress.Recognizing Stress SignsWhat one person finds enjoyable, another can find stressful. In the same way, how people respond to stress will differ. For instance, one person might exhibit changes in mood, such as becoming depressed and anxious, while another person will show physical signs, such as experiencing headaches and a heightened heart rate.So it’s important to talk to your loved about their individual signs of stress. Talk about your personal signs, as well. Create separate lists for each of your reactions to stress.Reducing Sources of StressThe authors suggest thinking about what situations were stressful for your loved one in the past. Then try to avoid that situation or modify it. If your loved one had a tough time at Thanksgiving last year, it might help to shorten their stay or not go next year.It’s also helpful to support your loved one in creating a stimulating environment with reasonable expectations. For instance, rather than attend a day program three times a week, one man preferred volunteering twice a week delivering meals to housebound seniors.Plus, it’s important that you take care of yourself. Eat nutrient-rich foods, get enough sleep, participate in physical activities and engage in fun hobbies. Help your loved one identify what kinds of activities they’d like to do, too.As the authors point out, because of the negative symptoms of schizophrenia, individuals can have a hard time thinking of enjoyable activities. Talk with them about the activities they’ve enjoyed in the past.Be sure to give yourself and your loved one credit. (Being self-critical just spikes your stress.)Mueser and Gingerich note how one father acknowledges the positive things that happen on a daily basis: “I’m proud of how persistent my daughter has been in pursuing her art career in spite of the many difficulties she’s encountered. We both have a lot to learn about coping with this illness, but we’ve also come a long way.”Learning to Cope with StressEmphasize the importance of your loved one communicating with others when they’re feeling stressed, since “these feelings can be an early warning sign of relapse,” according to the authors. Make sure you, too, are able to turn to individuals who understand your situation.Have family meetings to talk openly about the stressor and brainstorm potential solutions. Learn to use relaxation techniques, such as deep breathing, progressive muscle relaxation and visualization (such as imagining a serene beach scene).Self-defeating thoughts only bolster stress for both of you. Try to practice positive self-talk and teach your loved one to do the same.Mueser and Gingerich share the example of a father helping his daughter reframe her hospitalization, which made her feel like a failure: “I’m sorry you had to go through that, but I’m proud of you for getting help when you needed it and for being so strong in dealing with this illness. You’re a survivor.”Don’t underestimate the power of humor. Try to find the lighter side of a stressful situation, according to the authors. It’s not always – or usually – easy, but it helps with stress. Plus, you and your loved one can enjoy a funny film or sitcom to lessen stress.For some people, religious services and prayer can be very helpful. For others being in nature may feel like a spiritual experience and shrink stress.Again, regular exercise — around three times a week — that you enjoy is important for both of you. Journaling can provide a great source of stress relief. “Many people with schizophrenia say that writing down what they experience, think, and feel is an important outlet.”See if your loved one is interested in listening to music or making music themselves, such as singing or taking lessons; visiting art exhibits or creating their own art; playing games with family and friends; and pursuing other hobbies.As the authors emphasize, people with schizophrenia are “more sensitive to the effects of stress because it can trigger symptom relapses and rehospitalizations.” Helping your loved one deal with stress in a healthy way helps them pursue their personal goals and improves their life.Plus, working together to develop healthy coping strategies can strengthen your relationship and gives you plenty of opportunities for savoring quality time.


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

Stress & Schizophrenia: How to Help Your Loved One & Yourself
By Margarita Tartakovsky, M.S.
Associate Editor, PsychCentral

The authors emphasize the idea people with schizophrenia are “more sensitive to the effects of stress because it can trigger symptom relapses and rehospitalizations.” Helping your loved one deal with stress in a healthy way helps them pursue their personal goals and improves their life.

A common cause of relapse in schizophrenia is “difficulty managing high levels of stress,” according to Susan Gingerich, MSW, a psychotherapist who works with individuals with schizophrenia and their families.
Learning to manage stress isn’t just important for preventing relapse; it’s also important because stress is an inevitable part of facing new challenges and working to accomplish personal goals — “what recovery is all about,” write Gingerich and clinical psychologist Kim T. Mueser, Ph.D, in their book The Complete Family Guide to Schizophrenia.
Learning to navigate stress healthfully is key for family and friends, too. Having a loved one with schizophrenia can be stressful. Taking care of yourself enhances your well-being and daily functioning. And it means you’re in a better, healthier place to help your loved one.
In their comprehensive book, Mueser and Gingerich share excellent tips for helping your loved one and yourself cope with stress (along with valuable information on schizophrenia and how you can support your loved one).
Here are those suggestions and insights on managing and alleviating stress.

Recognizing Stress Signs
What one person finds enjoyable, another can find stressful. In the same way, how people respond to stress will differ. For instance, one person might exhibit changes in mood, such as becoming depressed and anxious, while another person will show physical signs, such as experiencing headaches and a heightened heart rate.
So it’s important to talk to your loved about their individual signs of stress. Talk about your personal signs, as well. Create separate lists for each of your reactions to stress.

Reducing Sources of Stress
The authors suggest thinking about what situations were stressful for your loved one in the past. Then try to avoid that situation or modify it. If your loved one had a tough time at Thanksgiving last year, it might help to shorten their stay or not go next year.
It’s also helpful to support your loved one in creating a stimulating environment with reasonable expectations. For instance, rather than attend a day program three times a week, one man preferred volunteering twice a week delivering meals to housebound seniors.
Plus, it’s important that you take care of yourself. Eat nutrient-rich foods, get enough sleep, participate in physical activities and engage in fun hobbies. Help your loved one identify what kinds of activities they’d like to do, too.
As the authors point out, because of the negative symptoms of schizophrenia, individuals can have a hard time thinking of enjoyable activities. Talk with them about the activities they’ve enjoyed in the past.
Be sure to give yourself and your loved one credit. (Being self-critical just spikes your stress.)
Mueser and Gingerich note how one father acknowledges the positive things that happen on a daily basis: “I’m proud of how persistent my daughter has been in pursuing her art career in spite of the many difficulties she’s encountered. We both have a lot to learn about coping with this illness, but we’ve also come a long way.”

Learning to Cope with Stress
Emphasize the importance of your loved one communicating with others when they’re feeling stressed, since “these feelings can be an early warning sign of relapse,” according to the authors. Make sure you, too, are able to turn to individuals who understand your situation.
Have family meetings to talk openly about the stressor and brainstorm potential solutions. Learn to use relaxation techniques, such as deep breathing, progressive muscle relaxation and visualization (such as imagining a serene beach scene).
Self-defeating thoughts only bolster stress for both of you. Try to practice positive self-talk and teach your loved one to do the same.
Mueser and Gingerich share the example of a father helping his daughter reframe her hospitalization, which made her feel like a failure: “I’m sorry you had to go through that, but I’m proud of you for getting help when you needed it and for being so strong in dealing with this illness. You’re a survivor.”
Don’t underestimate the power of humor. Try to find the lighter side of a stressful situation, according to the authors. It’s not always – or usually – easy, but it helps with stress. Plus, you and your loved one can enjoy a funny film or sitcom to lessen stress.
For some people, religious services and prayer can be very helpful. For others being in nature may feel like a spiritual experience and shrink stress.
Again, regular exercise — around three times a week — that you enjoy is important for both of you. Journaling can provide a great source of stress relief. “Many people with schizophrenia say that writing down what they experience, think, and feel is an important outlet.”
See if your loved one is interested in listening to music or making music themselves, such as singing or taking lessons; visiting art exhibits or creating their own art; playing games with family and friends; and pursuing other hobbies.
As the authors emphasize, people with schizophrenia are “more sensitive to the effects of stress because it can trigger symptom relapses and rehospitalizations.” Helping your loved one deal with stress in a healthy way helps them pursue their personal goals and improves their life.
Plus, working together to develop healthy coping strategies can strengthen your relationship and gives you plenty of opportunities for savoring quality time.



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Substance abuse worsens course of first-episode psychosisBy Afsaneh GrayThe identification of potentially modifiable environmental predictors, such as substance use […] allows us to envisage a preventive approach to chronicity in psychotic disordersPatients with first-episode psychosis (FEP) who also present with substance abuse have a higher rate of hospitalisation after 12 months than their peers who do not, an Italian study reports.The difference remained significant even in patients who stop using substances after psychosis onset, the study researchers note.“The identification of a ‘potentially modifiable’ environmental predictor of the course of the illness such as substance use at sychosis onset allows us to envisage the possibility of ameliorating the course of the illness by managing this factor,” say lead author Ilaria Tarricone (Bologna University) and colleagues.They carried out a 12-month follow-up study of an incidence cohort of 163 patients who presented with FEP at one of three community mental health centres in Bologna between January 2002 and December 2009. Patients fell into four diagnostic groups: affective psychoses, non-affective psychoses, schizophrenia (including schizoaffective disorder) and substance-induced psychoses.The frequency of use of cannabis and other drugs was recorded using the Cannabis Experience Questionnaire.Tarricone and co-workers found that the 50 patients who used substances were significantly more likely to be hospitalised during follow-up than non-users, with 32 (64%) requiring hospitalisation compared with 27 (24%).The odds of hospitalisation were 5.8 times greater for substance users, after adjusting for age, gender, being single and duration of untreated psychosis., factors which also significantly influenced the chance of compulsory hospitalisation.And even if patients stopped using substances after the onset of FEP, they still had a significantly higher rate of hospitalisation compared with non-users, at 61% versus 24%.Substance use was not only associated with an increased likelihood of hospitalisation, but also of compulsory hospitalisation, with rates of 35% versus 12% for non-users.Male gender and being single were found to be associated with a higher rate of hospitalisations, and substance abuse seemed to affect particularly male, native Italian patients.Writing in Schizophrenia Research, the researchers conclude: “The identification of potentially modifiable environmental predictors, such as substance use, on the course of the illness and of a specific group of patients who more frequently present this factor, such as native young men in Bologna, allows us to envisage a preventive approach to chronicity in psychotic disorders.”


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Substance abuse worsens course of first-episode psychosis
By Afsaneh Gray

The identification of potentially modifiable environmental predictors, such as substance use […] allows us to envisage a preventive approach to chronicity in psychotic disorders

Patients with first-episode psychosis (FEP) who also present with substance abuse have a higher rate of hospitalisation after 12 months than their peers who do not, an Italian study reports.
The difference remained significant even in patients who stop using substances after psychosis onset, the study researchers note.
“The identification of a ‘potentially modifiable’ environmental predictor of the course of the illness such as substance use at sychosis onset allows us to envisage the possibility of ameliorating the course of the illness by managing this factor,” say lead author Ilaria Tarricone (Bologna University) and colleagues.
They carried out a 12-month follow-up study of an incidence cohort of 163 patients who presented with FEP at one of three community mental health centres in Bologna between January 2002 and December 2009. Patients fell into four diagnostic groups: affective psychoses, non-affective psychoses, schizophrenia (including schizoaffective disorder) and substance-induced psychoses.
The frequency of use of cannabis and other drugs was recorded using the Cannabis Experience Questionnaire.
Tarricone and co-workers found that the 50 patients who used substances were significantly more likely to be hospitalised during follow-up than non-users, with 32 (64%) requiring hospitalisation compared with 27 (24%).
The odds of hospitalisation were 5.8 times greater for substance users, after adjusting for age, gender, being single and duration of untreated psychosis., factors which also significantly influenced the chance of compulsory hospitalisation.
And even if patients stopped using substances after the onset of FEP, they still had a significantly higher rate of hospitalisation compared with non-users, at 61% versus 24%.
Substance use was not only associated with an increased likelihood of hospitalisation, but also of compulsory hospitalisation, with rates of 35% versus 12% for non-users.
Male gender and being single were found to be associated with a higher rate of hospitalisations, and substance abuse seemed to affect particularly male, native Italian patients.
Writing in Schizophrenia Research, the researchers conclude: “The identification of potentially modifiable environmental predictors, such as substance use, on the course of the illness and of a specific group of patients who more frequently present this factor, such as native young men in Bologna, allows us to envisage a preventive approach to chronicity in psychotic disorders.”





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You Can Change Schizophrenia’s Name, But the Stigma Will Be the SameBy Marvin RossBill MacPhee, the publisher of SZ Magazine (formerly known as Schizophrenia Digest), has just launched a campaign to change the name of schizophrenia in order to, as he says, “stop stigma.” The name change suggestion is not new, but what is different is his proposal to change the name to MacPhee Syndrome.
Mr. MacPhee argues, “When people hear the word ‘schizophrenia’ they think the worst. They research the word and find the media reference people like James Holmes the Colorado movie shooter or John Hinckley who shot president Reagan.” He goes on to say that when people think of schizophrenia, they never think of someone like him. Mr. MacPhee does have schizophrenia, but he is also the publisher of Magpie Media in Fort Erie, Ont., and a man with a wife and three kids.
His campaign is using crowd source funding to try to raise $75,000 towards a North American tour kicking off April 2 in his home town of Fort Erie, petitioning The Diagnostic and Statistical Manual of Mental Disorders (DSM) and launching a letter writing campaign to encourage them to change the name in their next revision.
The name for schizophrenia was already changed in Japan in 2002. According to a description of that name change process in World Psychiatry, the old name Seishin Bunretsu Byo (“mind-split-disease”) was replaced with Togo Shitcho Sho (“integration disorder”). Before that change, only 7% of doctors always told their patients diagnosed with schizophrenia that they had the disorder, while 37% only told the families and not the patients. Japan had a long history of negative attitudes towards schizophrenia and inhumane treatment to those suffering from it. Prior to 1950, schizophrenia patients in Japan were incarcerated with restraints, so it was understandable that doctors were reluctant to provide that diagnosis. After the change of name in 2004, almost 70% of patients were told their diagnosis.
I haven’t been able to find any data on how well those with schizophrenia are doing in Japan as a result, although the treatment guidelines developed for the new name now recommend community-based care instead of hospitalization; a treatment plan including medication and psychosocial intervention; and therapeutic alliances with other professionals.
It would be interesting to know if as many Japanese with schizophrenia wind up untreated, homeless and in prison as is the case in North America. Our system, as a Toronto Star article on the mentally ill in jail noted, is considered medieval by experts. Criminal defence lawyer Frank Addario is quoted as saying, “It’s like putting you in jail for having cancer.”
In the Western Hemisphere, the term salience syndrome has been suggested as an alternative to the term schizophrenia. “Salience refers to how internal and external stimuli are consciously experienced and how, unwilled or overinclusive attention to some stimuli can become perplexing and foster a search for explanations which are later recognized as delusional” according to a 2013 published research study that attempted to see if changing schizophrenia to salience syndrome would in fact make any difference.
The study found that it would not!
One part of this study involved 161 undergraduate students at the University of Montreal. Students were told of another student called Nathan who had become withdrawn, was missing classes, looked dishevelled and was becoming paranoid. Half were told that he was diagnosed with schizophrenia and half that he was diagnosed with salience syndrome.They were then asked to respond to the following five questions using a five-point scale, ranging from very unlikely to very likely:1. Do you think that this would damage Nathan’s career?2. I would be comfortable if Nathan was my colleague at work?3. I would be comfortable about inviting Nathan to a dinner party?4. How likely do you think it would be for Nathan’s girlfriend to leave him?5. How likely do you think it would be for Nathan to get in trouble with the law?Students showed no significant differences in their response to these questions regardless of being told the diagnosis was schizophrenia or salience syndrome.
A second study was done with 19 patients in a first episode psychosis clinic and the researchers found that “the majority of participants preferred a diagnosis of salience syndrome, considering it less stigmatizing mostly because of its novelty and the concealing potential of the new diagnostic entity, though many found it hard to relate to and somewhat difficult to understand.”
As Gertrude Stein said, “a rose is a rose is a rose.” Changing the name will not reduce what is.
Mr. MacPhee is to be commended for his efforts to bring awareness to these issues, but stigma exists because we are focusing on the wrong things; that is why I wondered above if many in Japan are still untreated.
That, in my opinion, is the main reason for stigma. The image that the public has of those with schizophrenia is of violent, potential killers and dishevelled homeless people wandering the streets. That is who they see in public and in the news, so it is no wonder that the response is to shun all. Those who are treated are invisible because they are mostly just like us.
Mr. MacPhee and I have both been on the board of the Schizophrenia Society of Ontario, I sometimes contribute freelance articles for his magazine, and I’ve sat and had coffee with him. Most people would not give him a second glance if they passed him on the street, nor would they fear having a coffee with him. He would not be capable of all that he has achieved if he was not getting treatment. And that goes for many people with schizophrenia.
Elyn Saks is a Professor of Law, Psychology, and Psychiatry and the Behavioral Sciences at the University of Southern California Gould Law School and she has schizophrenia. Dr. Fred Frese is associate professor of psychiatry at Northeast Ohio Medical University; clinical assistant professor at Case Western Reserve University; and coordinator of the Summit County Recovery Project. He also has schizophrenia. Dr. Carolyn Dobbins has been a practising psychotherapist for over 25 years and suffers with schizoaffective disorder.
The key to the success of these people and all who are doing well is proper treatment and that is what we fail to provide as well as we should as a society. Dr. Julio Arboleda-Florez of Queen’s University in Kingston, Ontario wrote in an editorial in the Canadian Journal of Psychiatry in November 2003 that “helping persons with mental illness to limit the possibilities that they may become violent, via proper and timely treatment and management of their symptoms and preventing social situations that might lead to contextual violence, could be the single most important way to combat the stigma that affects all those with mental illness.”
It is truly mind boggling that we, as a society, care so little for the suffering of those with serious mental illnesses like schizophrenia that we continue to fail to provide them with proper treatment. We ourselves stigmatize and shun those who we refuse to provide with the treatment that would relieve them of their suffering. And so, if Mr. MacPhee can help emphasize that in his campaign, then I wish him well.



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

You Can Change Schizophrenia’s Name, But the Stigma Will Be the Same
By Marvin Ross

Bill MacPhee, the publisher of SZ Magazine (formerly known as Schizophrenia Digest), has just launched a campaign to change the name of schizophrenia in order to, as he says, “stop stigma.” The name change suggestion is not new, but what is different is his proposal to change the name to MacPhee Syndrome.

Mr. MacPhee argues, “When people hear the word ‘schizophrenia’ they think the worst. They research the word and find the media reference people like James Holmes the Colorado movie shooter or John Hinckley who shot president Reagan.” He goes on to say that when people think of schizophrenia, they never think of someone like him. Mr. MacPhee does have schizophrenia, but he is also the publisher of Magpie Media in Fort Erie, Ont., and a man with a wife and three kids.

His campaign is using crowd source funding to try to raise $75,000 towards a North American tour kicking off April 2 in his home town of Fort Erie, petitioning The Diagnostic and Statistical Manual of Mental Disorders (DSM) and launching a letter writing campaign to encourage them to change the name in their next revision.

The name for schizophrenia was already changed in Japan in 2002. According to a description of that name change process in World Psychiatry, the old name Seishin Bunretsu Byo (“mind-split-disease”) was replaced with Togo Shitcho Sho (“integration disorder”). Before that change, only 7% of doctors always told their patients diagnosed with schizophrenia that they had the disorder, while 37% only told the families and not the patients. Japan had a long history of negative attitudes towards schizophrenia and inhumane treatment to those suffering from it. Prior to 1950, schizophrenia patients in Japan were incarcerated with restraints, so it was understandable that doctors were reluctant to provide that diagnosis. After the change of name in 2004, almost 70% of patients were told their diagnosis.

I haven’t been able to find any data on how well those with schizophrenia are doing in Japan as a result, although the treatment guidelines developed for the new name now recommend community-based care instead of hospitalization; a treatment plan including medication and psychosocial intervention; and therapeutic alliances with other professionals.

It would be interesting to know if as many Japanese with schizophrenia wind up untreated, homeless and in prison as is the case in North America. Our system, as a Toronto Star article on the mentally ill in jail noted, is considered medieval by experts. Criminal defence lawyer Frank Addario is quoted as saying, “It’s like putting you in jail for having cancer.”

In the Western Hemisphere, the term salience syndrome has been suggested as an alternative to the term schizophrenia. “Salience refers to how internal and external stimuli are consciously experienced and how, unwilled or overinclusive attention to some stimuli can become perplexing and foster a search for explanations which are later recognized as delusional” according to a 2013 published research study that attempted to see if changing schizophrenia to salience syndrome would in fact make any difference.

The study found that it would not!

One part of this study involved 161 undergraduate students at the University of Montreal. Students were told of another student called Nathan who had become withdrawn, was missing classes, looked dishevelled and was becoming paranoid. Half were told that he was diagnosed with schizophrenia and half that he was diagnosed with salience syndrome.

They were then asked to respond to the following five questions using a five-point scale, ranging from very unlikely to very likely:

1. Do you think that this would damage Nathan’s career?
2. I would be comfortable if Nathan was my colleague at work?
3. I would be comfortable about inviting Nathan to a dinner party?
4. How likely do you think it would be for Nathan’s girlfriend to leave him?
5. How likely do you think it would be for Nathan to get in trouble with the law?

Students showed no significant differences in their response to these questions regardless of being told the diagnosis was schizophrenia or salience syndrome.

A second study was done with 19 patients in a first episode psychosis clinic and the researchers found that “the majority of participants preferred a diagnosis of salience syndrome, considering it less stigmatizing mostly because of its novelty and the concealing potential of the new diagnostic entity, though many found it hard to relate to and somewhat difficult to understand.”

As Gertrude Stein said, “a rose is a rose is a rose.” Changing the name will not reduce what is.

Mr. MacPhee is to be commended for his efforts to bring awareness to these issues, but stigma exists because we are focusing on the wrong things; that is why I wondered above if many in Japan are still untreated.

That, in my opinion, is the main reason for stigma. The image that the public has of those with schizophrenia is of violent, potential killers and dishevelled homeless people wandering the streets. That is who they see in public and in the news, so it is no wonder that the response is to shun all. Those who are treated are invisible because they are mostly just like us.

Mr. MacPhee and I have both been on the board of the Schizophrenia Society of Ontario, I sometimes contribute freelance articles for his magazine, and I’ve sat and had coffee with him. Most people would not give him a second glance if they passed him on the street, nor would they fear having a coffee with him. He would not be capable of all that he has achieved if he was not getting treatment. And that goes for many people with schizophrenia.

Elyn Saks is a Professor of Law, Psychology, and Psychiatry and the Behavioral Sciences at the University of Southern California Gould Law School and she has schizophrenia. Dr. Fred Frese is associate professor of psychiatry at Northeast Ohio Medical University; clinical assistant professor at Case Western Reserve University; and coordinator of the Summit County Recovery Project. He also has schizophrenia. Dr. Carolyn Dobbins has been a practising psychotherapist for over 25 years and suffers with schizoaffective disorder.

The key to the success of these people and all who are doing well is proper treatment and that is what we fail to provide as well as we should as a society. Dr. Julio Arboleda-Florez of Queen’s University in Kingston, Ontario wrote in an editorial in the Canadian Journal of Psychiatry in November 2003 that “helping persons with mental illness to limit the possibilities that they may become violent, via proper and timely treatment and management of their symptoms and preventing social situations that might lead to contextual violence, could be the single most important way to combat the stigma that affects all those with mental illness.”

It is truly mind boggling that we, as a society, care so little for the suffering of those with serious mental illnesses like schizophrenia that we continue to fail to provide them with proper treatment. We ourselves stigmatize and shun those who we refuse to provide with the treatment that would relieve them of their suffering. And so, if Mr. MacPhee can help emphasize that in his campaign, then I wish him well.





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Living with SchizophreniaBy Mike Hedrick Living with SchizophreniaI’m sitting in a coffee shop at 7:53 a.m. and I’m minding my own business but I hear barely audible chatter and laughter from the baristas behind the bar and I can only think that there’s something about the way I’m sitting here on my computer writing that’s making them laugh at me.I wonder if I look OK, if the way my hoodie sits on my shoulders looks funny or if I said something and sounded weird or if the way I’m typing with only the middle fingers on both of my hands warrants some kind of ridicule.The truth is, I know they’re not laughing at me but every waking hour of every day I’m plagued by the notion that I’m an object of ostracism.This is a little thing called paranoia and it’s become my bittersweet companion in the last eight years since I was diagnosed with schizophrenia.It started when I was 20, first with paranoia in college and developing from there until I was getting secret messages from the TV and radio, afraid even to leave my house and consumed by conspiracy theories.It all came to a head when I somehow became convinced that I was a prophet and undertook a spur-of-the-moment trip across the country to the U.N., convinced that I would be ushered in as the next president or king or something like that.The trip took me from New York to Boston as I followed meaningful colors and secret messages in street signs and nonverbal communication from random people on the street.From Boston I took a Greyhound bus to a small town called Woods Hole, where I was convinced there was a hole through the woods to Canada where I could live and work on a farm and grow pot for the remainder of my life.Unfortunately, there was no hole to Canada. After a few days with a well-meaning stranger I took a train back to Colorado, where my parents picked me up and dropped me off at the psych ward of the Boulder Community Hospital. I spent the next week there.I’ve made strides in the last eight years to a place where I’m comfortable. I’ve also gained 60 pounds because of the side effects of powerful antipsychotic medications coursing through my bloodstream. I’ve become a hermit because I know the only place I’m really, truly free from ridicule or the very possibility of ridicule is alone in my second-floor apartment on the edge of town.I’m also still afraid. I’m afraid to make eye contact because I know if I do you’ll see something weird about the way I do it and laugh about it the rest of the day with your friends. I’m afraid to even consider a relationship because I know that if I broach even the subject of vulnerability with someone, they’ll inevitably use it against me and make fun of me and destroy whatever reputation I think I may have.I know the truth is simpler. I know people are generally pretty good and pretty nice but there’s a devil on my shoulder that will always whisper otherwise whenever things start to go well.There are countless times I’ve sacrificed any notable improvement as a human being because it took away somehow from my sense of ease, from the quiet, simple, albeit lonely life I need to stay centered.Among the things I’ve sacrificed are meaningful career opportunities where I’m fully capable of doing whatever job they ask of me — but I know that if I continue to do it I’ll have another nervous breakdown.Most recently I adopted a dog named Bella. I took her back a week and a half later because I couldn’t handle constantly considering the needs of another living creature. She was a great dog and didn’t have any considerable problems. But because I’m an insecure, paranoid shell of a man who needed personal space to stay sane, she had to go back to the pound.I’m nowhere near as crazy as I was but I still hear voices and sounds sometimes and they scare the hell out of me.I’m still delusional that things mean more than they actually do — body language, smiles, voice inflections, behavior intonations. I’m always worried about these things but the worry has become so second nature to me that I don’t think about it.I’ve gotten to the point where I’m no longer worried about worrying so much and that’s about the best I can ask for.The point I’m trying to make is that schizophrenia is a hell of drug. It’ll throw a wrench in any notion of a normal life you’ve ever had but it will also make you thank Christ, the universe or Satan for the simple things like a warm cup of coffee in the morning as the sun rises, the strength of a family that’s seen pain, and the joy of a good cigarette.Some days are good and some days are bad but that’s life, right?



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

Living with Schizophrenia
By Mike Hedrick 

Living with SchizophreniaI’m sitting in a coffee shop at 7:53 a.m. and I’m minding my own business but I hear barely audible chatter and laughter from the baristas behind the bar and I can only think that there’s something about the way I’m sitting here on my computer writing that’s making them laugh at me.
I wonder if I look OK, if the way my hoodie sits on my shoulders looks funny or if I said something and sounded weird or if the way I’m typing with only the middle fingers on both of my hands warrants some kind of ridicule.
The truth is, I know they’re not laughing at me but every waking hour of every day I’m plagued by the notion that I’m an object of ostracism.
This is a little thing called paranoia and it’s become my bittersweet companion in the last eight years since I was diagnosed with schizophrenia.
It started when I was 20, first with paranoia in college and developing from there until I was getting secret messages from the TV and radio, afraid even to leave my house and consumed by conspiracy theories.
It all came to a head when I somehow became convinced that I was a prophet and undertook a spur-of-the-moment trip across the country to the U.N., convinced that I would be ushered in as the next president or king or something like that.
The trip took me from New York to Boston as I followed meaningful colors and secret messages in street signs and nonverbal communication from random people on the street.
From Boston I took a Greyhound bus to a small town called Woods Hole, where I was convinced there was a hole through the woods to Canada where I could live and work on a farm and grow pot for the remainder of my life.
Unfortunately, there was no hole to Canada. After a few days with a well-meaning stranger I took a train back to Colorado, where my parents picked me up and dropped me off at the psych ward of the Boulder Community Hospital. I spent the next week there.
I’ve made strides in the last eight years to a place where I’m comfortable. I’ve also gained 60 pounds because of the side effects of powerful antipsychotic medications coursing through my bloodstream. I’ve become a hermit because I know the only place I’m really, truly free from ridicule or the very possibility of ridicule is alone in my second-floor apartment on the edge of town.
I’m also still afraid. I’m afraid to make eye contact because I know if I do you’ll see something weird about the way I do it and laugh about it the rest of the day with your friends. I’m afraid to even consider a relationship because I know that if I broach even the subject of vulnerability with someone, they’ll inevitably use it against me and make fun of me and destroy whatever reputation I think I may have.
I know the truth is simpler. I know people are generally pretty good and pretty nice but there’s a devil on my shoulder that will always whisper otherwise whenever things start to go well.
There are countless times I’ve sacrificed any notable improvement as a human being because it took away somehow from my sense of ease, from the quiet, simple, albeit lonely life I need to stay centered.
Among the things I’ve sacrificed are meaningful career opportunities where I’m fully capable of doing whatever job they ask of me — but I know that if I continue to do it I’ll have another nervous breakdown.
Most recently I adopted a dog named Bella. I took her back a week and a half later because I couldn’t handle constantly considering the needs of another living creature. She was a great dog and didn’t have any considerable problems. But because I’m an insecure, paranoid shell of a man who needed personal space to stay sane, she had to go back to the pound.
I’m nowhere near as crazy as I was but I still hear voices and sounds sometimes and they scare the hell out of me.
I’m still delusional that things mean more than they actually do — body language, smiles, voice inflections, behavior intonations. I’m always worried about these things but the worry has become so second nature to me that I don’t think about it.
I’ve gotten to the point where I’m no longer worried about worrying so much and that’s about the best I can ask for.
The point I’m trying to make is that schizophrenia is a hell of drug. It’ll throw a wrench in any notion of a normal life you’ve ever had but it will also make you thank Christ, the universe or Satan for the simple things like a warm cup of coffee in the morning as the sun rises, the strength of a family that’s seen pain, and the joy of a good cigarette.
Some days are good and some days are bad but that’s life, right?





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[In the News] Study Says Comedians Have Psychotic Personality Traits—Here’s What Some Comedians Have To Say About ThatBy Asawin SuebsaengThe popular belief that creativity is associated with madness has increasingly become the focus of research for many psychologists and psychiatrists. However, despite being prime examples of creative thinking, comedy and humor have been largely neglected. To test the hypothesis that comedians would resemble other creative individuals in showing a higher level of psychotic characteristics related to both schizophrenia and manic depression. A group of comedians (n = 500+) and a control sample of actors (n = 350+) completed an online questionnaire containing the short version of the Oxford–Liverpool Inventory of Feelings and Experiences (O-LIFE), with scales measuring four dimensions of psychotic traits. Scores were compared with general population norms. Comedians scored significantly above O-LIFE norms on all four scales. Actors also differed from the norms but on only three of the scales. Most striking was the comedians’ high score on both introverted anhedonia and extraverted impulsiveness. This unusual personality structure may help to explain the facility for comedic performance.If you’ve ever seen footage of comedian Bill Hicks taking on a heckler, you might have thought to yourself, “Wow, that was pretty psychotic.”Well, according to a recent study published in the British Journal of Psychiatry, you weren’t that far off. For the study, which is titled, “Psychotic traits in comedians,” researchers recruited 523 comedians (404 male and 119 female, most of whom were amateurs) from the United States, Australia, and the United Kingdom. The researchers determined that comedians scored significantly higher on four types of psychotic personality traits compared to a control group of individuals who had non-artistic jobs. The study focuses on two major categories of psychosis—bipolar disorder and schizophrenia—and examines impulsive non-conformity."The results of this study substantially confirmed our expectation that comedians would behave like other creative groups in showing a high level of psychotic personality traits," the authors wrote. “They did so across all the domains sampled by the questionnaire we used, from schizoid and schizophrenic-like characteristics through to manic-depressive features.”The 6-page report also highlights English comedian and actor Stephen Fry, who has been diagnosed with bipolar disorder and attempted suicide in 2012.However, it’s important to point out that the authors of the study aren’t saying all famous or successful comedians are automatically pathologically bipolar or pathologically schizophrenic, or even that they necessarily require treatment. In other words, labeling someone’s personality traits as in the realm of “psychotic” may sound a bit scary—but it doesn’t mean that person is a psychopath or a menace to society.Still, some professional comedians aren’t big fans of this. According to Steve Hofstetter, a former Sports Illustrated columnist and one of most booked comic acts on the American college circuit, a large number of comedians have been taking to social media to share and mock the study in the past couple of days. "The new study claiming comedians have psychotic personality traits was written by a troll who talks to me from inside my butthole," Adam Newman wrote, for instance. Hofstetter has a much harsher take."The idea that it’s a news story that comedians are rebels is the equivalent of saying it’s a news story that people who spend their lives conducting studies never get laid," the Los Angeles-based comedian says. “And if you look at the actual results of the study, it shows that actors were not that far off from comedians at all. So this was clearly a study conducted on the hypothesis that comedians have mental problems.”Rob Delaney, the author and stand-up comedian who was named Mitt Romney’s “Twitter nemesis” during the 2012 election, was similarly critical of the comedians-are-psychotic study—but he was significantly less pissed about it."My honest opinion is that piece really has no effect on me," Delaney wrote in an email. "Plus, [the study] defangs itself when it says, ‘we’re not saying they’re the dangerous kind of psychopath,’ so really I just think it’s an attention-grabber and not actually a substantive piece of information. Do you need a psychological kink of some kind to function as a comedian, particularly one that makes a living at it? Yes. Is that kink psychosis or close to psychosis? I don’t know and I don’t really care. But perhaps that means I’m a psychopath? Maybe. I know I brutally pursue my goals regardless of whatever the hell else is happening in the world and anticipate success in all my endeavors, even when that feeling is unfounded. So that’s what I think.”(Lewis Black, Joan Rivers, and Gallagher did not respond to requests for comment.)So whatever the researchers’ intentions, perhaps their new report hasn’t won them any new friends in the community of stand-up comics. Hell, at least they didn’t author a study telling comedians that they were going to drop dead at a young age.


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

[In the News] Study Says Comedians Have Psychotic Personality Traits—Here’s What Some Comedians Have To Say About That
By Asawin Suebsaeng

The popular belief that creativity is associated with madness has increasingly become the focus of research for many psychologists and psychiatrists. However, despite being prime examples of creative thinking, comedy and humor have been largely neglected. To test the hypothesis that comedians would resemble other creative individuals in showing a higher level of psychotic characteristics related to both schizophrenia and manic depression. A group of comedians (n = 500+) and a control sample of actors (n = 350+) completed an online questionnaire containing the short version of the Oxford–Liverpool Inventory of Feelings and Experiences (O-LIFE), with scales measuring four dimensions of psychotic traits. Scores were compared with general population norms. Comedians scored significantly above O-LIFE norms on all four scales. Actors also differed from the norms but on only three of the scales. Most striking was the comedians’ high score on both introverted anhedonia and extraverted impulsiveness. This unusual personality structure may help to explain the facility for comedic performance.

If you’ve ever seen footage of comedian Bill Hicks taking on a heckler, you might have thought to yourself, “Wow, that was pretty psychotic.”
Well, according to a recent study published in the British Journal of Psychiatry, you weren’t that far off. For the study, which is titled, “Psychotic traits in comedians,” researchers recruited 523 comedians (404 male and 119 female, most of whom were amateurs) from the United States, Australia, and the United Kingdom. The researchers determined that comedians scored significantly higher on four types of psychotic personality traits compared to a control group of individuals who had non-artistic jobs. The study focuses on two major categories of psychosis—bipolar disorder and schizophrenia—and examines impulsive non-conformity.
"The results of this study substantially confirmed our expectation that comedians would behave like other creative groups in showing a high level of psychotic personality traits," the authors wrote. “They did so across all the domains sampled by the questionnaire we used, from schizoid and schizophrenic-like characteristics through to manic-depressive features.”
The 6-page report also highlights English comedian and actor Stephen Fry, who has been diagnosed with bipolar disorder and attempted suicide in 2012.
However, it’s important to point out that the authors of the study aren’t saying all famous or successful comedians are automatically pathologically bipolar or pathologically schizophrenic, or even that they necessarily require treatment. In other words, labeling someone’s personality traits as in the realm of “psychotic” may sound a bit scary—but it doesn’t mean that person is a psychopath or a menace to society.
Still, some professional comedians aren’t big fans of this. According to Steve Hofstetter, a former Sports Illustrated columnist and one of most booked comic acts on the American college circuit, a large number of comedians have been taking to social media to share and mock the study in the past couple of days. "The new study claiming comedians have psychotic personality traits was written by a troll who talks to me from inside my butthole," Adam Newman wrote, for instance. Hofstetter has a much harsher take.
"The idea that it’s a news story that comedians are rebels is the equivalent of saying it’s a news story that people who spend their lives conducting studies never get laid," the Los Angeles-based comedian says. “And if you look at the actual results of the study, it shows that actors were not that far off from comedians at all. So this was clearly a study conducted on the hypothesis that comedians have mental problems.”
Rob Delaney, the author and stand-up comedian who was named Mitt Romney’s “Twitter nemesis” during the 2012 election, was similarly critical of the comedians-are-psychotic study—but he was significantly less pissed about it.
"My honest opinion is that piece really has no effect on me," Delaney wrote in an email. "Plus, [the study] defangs itself when it says, ‘we’re not saying they’re the dangerous kind of psychopath,’ so really I just think it’s an attention-grabber and not actually a substantive piece of information. Do you need a psychological kink of some kind to function as a comedian, particularly one that makes a living at it? Yes. Is that kink psychosis or close to psychosis? I don’t know and I don’t really care. But perhaps that means I’m a psychopath? Maybe. I know I brutally pursue my goals regardless of whatever the hell else is happening in the world and anticipate success in all my endeavors, even when that feeling is unfounded. So that’s what I think.”
(Lewis Black, Joan Rivers, and Gallagher did not respond to requests for comment.)
So whatever the researchers’ intentions, perhaps their new report hasn’t won them any new friends in the community of stand-up comics. Hell, at least they didn’t author a study telling comedians that they were going to drop dead at a young age.



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

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Finding the Inner Wildby Ron Unger, recoveryfromschizophrenia.org
Modern “civilized” cultures do not have a good relationship with the wild.  It seems we are always doing everything possible to shut it out of our lives, or to kill or tame it to the point where it is unrecognizable.  Yet that which is wild is always still lurking, somewhere over the edge of our boundaries and frontiers, and also inside people, both inside the “others” we might approach warily on the street, and even inside our family members and ourselves.
Another name for the Wild is Mystery, or the Unknown.  We like to pretend that the Unknown is just a small affair of no great importance, but we are shadowed by a sense that the Unknown or Mystery totally dwarfs and makes a mockery of everything we think we know.  So we commonly act as quickly as we can to suppress that sense, to find whatever allows us to go back to thinking we know what we are doing.
And yet, as much as we try to suppress the Wild, we totally need it.  Sometimes we need it just as a location where we might find some missing ingredient that our tame world needs to function, and sometimes we need it when the contradictions in our “normal” world become too oppressive and we need to immerse ourselves, at least for a while, in something much vaster.
I am intrigued by the relationship between the experiences we call psychosis and wildness in general.  That’s why I especially enjoyed recently reading a book titled “Into the Thicket” by William Brundage, which tells his story of getting lost simultaneously in the wilder areas that existed near his home in Eugene Oregon, and getting lost in the wilds of his own mind.
“Madness” is often associated with one’s mind falling apart, but Will’s story is unique in that he recalls a specific time and place where he had an experience of his mind shattering.  It might be best to let him tell the story himself:
“At this point, gasping, I realized that something was going horribly wrong.  Futilely I attempted to rein in my mind, but I had no way of doing so.  How does one grasp a thought and force it to return, especially when it is flying high and away?  Then, there was a moment that I would never wish on anyone – I felt the cracks appear.  First one, then hundreds, of small shards broke free from my consciousness.  Within a minute, life had spun out of control.  Alone with the beating of my heart, I was fighting for survival.  The finale came only a minute later.  With a thunderous crack, my mind blew into dust and spread over the city like snow.  I could feel the reverberations in my ears, but the world was silent.
“As the cataclysm subsided, I looked around myself as if for the first time.  Every tree sparkled with dew.  The grass shown green like the hills of heaven.  The wood smoke smelled like myrrh.  Reaching out, I touched the trees around me, and felt my hand touch bark for the first time.  There was no thought or feeling, just a realization that I was watching myself be born again.  When I looked onto the city, I saw with new eyes the world that I thought I had known.  I was no longer myself:  my mind was scattered to the wind like chaff.  It was sunset when I set my feet along the downward path to Eugene.  I had been transfixed for an entire day, staring in mindless rapture at the city I had grown up in.”
For Will, this “wild” experience was just a beginning, a sense that if he could only turn himself over fully to something that waited for him in the wild areas near his home, everything would become right or better in some very important way.  This journey required courage, and he found himself increasingly able to face the dangers he encountered without regard to his personal welfare.  (Unfortunately, he lacked an adviser such as the friend I had in my late teens who was fond of repeating the quote “discretion is the better part of valor.”)  His adventures became increasingly chaotic, till he found himself facing a frosty evening, naked, alone, and deeply cut up by brambles.  He had made such a point of not giving in to any fears, but now he found himself abandoning his quest to humbly seek help at the home of a family that ever so symbolically happened to be named “Craven.”
Will speculates in the book on how different the rest of his experience may have been had a mental health system existed that understood the relationship between his personal quest and things like shamanic traditions, a health system that knew how to assist him in continuing his explorations using more sustainable methods.  Instead he ended up in a hospital, labeled and drugged.
The rest of the story is about his battle to regain control of his life from that point on, trying to find a balance between the excesses of the mystical wild “Faerie” world that still called to him and the sometimes helpful but often overly repressive world of “modern” mental health treatment.     He worked on his own to draw from diverse spiritual traditions to assist his recovery, and from them became inspired to try speaking in a friendly way with his voices, which he describes at first as being like “talking to a drunken man with a gun.”
Eventually though the practice of being friendly toward disturbing parts of his mind paid off, and Will was able to find enough mental calm that he was able to substantially reduce his medication, and to do things like attend school, go to work, including doing some peer support work, and start a family.  While he has at least not yet fully left behind the mental health system definition of his experience as “schizophrenia” and he still takes some medication, he has definitely found a valued and enjoyable life for himself at this point.
In a way, such success itself leads to a dilemma for people like Will.  Should he try getting off medication completely, even though that might lead to some “wild” mental states that could possibly threaten everything he has managed to achieve in his life?  And, to what extent should he allow himself to follow the wild impulses that got him into trouble in the first place?
Toward the end of his book he tells a story about doing some exploring in Scotland, accompanied by his wife, and encountering a wild area that seemed to be seducing him into once again wandering away from the world, from other people including his wife, and from anything coherent in his mind.  He reported that his wife sensed something was amiss, and called him back, and he left the area happy he had resisted its call.  I found myself wishing he had been able to heed its call, but in a limited way, that he had been able to perhaps draw his wife into wandering into that strange wild realm but without total abandon, instead bringing just enough discretion, just enough wariness, that he and his wife would likely not have come to harm, but might have had an amazing experience beyond the limits of the “normal.”
In the end, the wild is essential to us, but remains threatening as well.  I think we do best when we can acknowledge both sides of this complex truth, and see what emerges from that.  This means not denying any role for fear (as Will did in his early explorations) but also not giving fear too prominent a role, not letting it be stifling.  With work on finding the right balance and dialogue, I hope our society can come into a much healthier relationship with madness, with mystery, and with all forms of wild things.


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

Finding the Inner Wild
by Ron Unger, recoveryfromschizophrenia.org

Modern “civilized” cultures do not have a good relationship with the wild.  It seems we are always doing everything possible to shut it out of our lives, or to kill or tame it to the point where it is unrecognizable.  Yet that which is wild is always still lurking, somewhere over the edge of our boundaries and frontiers, and also inside people, both inside the “others” we might approach warily on the street, and even inside our family members and ourselves.

Another name for the Wild is Mystery, or the Unknown.  We like to pretend that the Unknown is just a small affair of no great importance, but we are shadowed by a sense that the Unknown or Mystery totally dwarfs and makes a mockery of everything we think we know.  So we commonly act as quickly as we can to suppress that sense, to find whatever allows us to go back to thinking we know what we are doing.

And yet, as much as we try to suppress the Wild, we totally need it.  Sometimes we need it just as a location where we might find some missing ingredient that our tame world needs to function, and sometimes we need it when the contradictions in our “normal” world become too oppressive and we need to immerse ourselves, at least for a while, in something much vaster.

I am intrigued by the relationship between the experiences we call psychosis and wildness in general.  That’s why I especially enjoyed recently reading a book titled “Into the Thicket” by William Brundage, which tells his story of getting lost simultaneously in the wilder areas that existed near his home in Eugene Oregon, and getting lost in the wilds of his own mind.

“Madness” is often associated with one’s mind falling apart, but Will’s story is unique in that he recalls a specific time and place where he had an experience of his mind shattering.  It might be best to let him tell the story himself:

At this point, gasping, I realized that something was going horribly wrong.  Futilely I attempted to rein in my mind, but I had no way of doing so.  How does one grasp a thought and force it to return, especially when it is flying high and away?  Then, there was a moment that I would never wish on anyone – I felt the cracks appear.  First one, then hundreds, of small shards broke free from my consciousness.  Within a minute, life had spun out of control.  Alone with the beating of my heart, I was fighting for survival.  The finale came only a minute later.  With a thunderous crack, my mind blew into dust and spread over the city like snow.  I could feel the reverberations in my ears, but the world was silent.

“As the cataclysm subsided, I looked around myself as if for the first time.  Every tree sparkled with dew.  The grass shown green like the hills of heaven.  The wood smoke smelled like myrrh.  Reaching out, I touched the trees around me, and felt my hand touch bark for the first time.  There was no thought or feeling, just a realization that I was watching myself be born again.  When I looked onto the city, I saw with new eyes the world that I thought I had known.  I was no longer myself:  my mind was scattered to the wind like chaff.  It was sunset when I set my feet along the downward path to Eugene.  I had been transfixed for an entire day, staring in mindless rapture at the city I had grown up in.”

For Will, this “wild” experience was just a beginning, a sense that if he could only turn himself over fully to something that waited for him in the wild areas near his home, everything would become right or better in some very important way.  This journey required courage, and he found himself increasingly able to face the dangers he encountered without regard to his personal welfare.  (Unfortunately, he lacked an adviser such as the friend I had in my late teens who was fond of repeating the quote “discretion is the better part of valor.”)  His adventures became increasingly chaotic, till he found himself facing a frosty evening, naked, alone, and deeply cut up by brambles.  He had made such a point of not giving in to any fears, but now he found himself abandoning his quest to humbly seek help at the home of a family that ever so symbolically happened to be named “Craven.”

Will speculates in the book on how different the rest of his experience may have been had a mental health system existed that understood the relationship between his personal quest and things like shamanic traditions, a health system that knew how to assist him in continuing his explorations using more sustainable methods.  Instead he ended up in a hospital, labeled and drugged.

The rest of the story is about his battle to regain control of his life from that point on, trying to find a balance between the excesses of the mystical wild “Faerie” world that still called to him and the sometimes helpful but often overly repressive world of “modern” mental health treatment.     He worked on his own to draw from diverse spiritual traditions to assist his recovery, and from them became inspired to try speaking in a friendly way with his voices, which he describes at first as being like “talking to a drunken man with a gun.”

Eventually though the practice of being friendly toward disturbing parts of his mind paid off, and Will was able to find enough mental calm that he was able to substantially reduce his medication, and to do things like attend school, go to work, including doing some peer support work, and start a family.  While he has at least not yet fully left behind the mental health system definition of his experience as “schizophrenia” and he still takes some medication, he has definitely found a valued and enjoyable life for himself at this point.

In a way, such success itself leads to a dilemma for people like Will.  Should he try getting off medication completely, even though that might lead to some “wild” mental states that could possibly threaten everything he has managed to achieve in his life?  And, to what extent should he allow himself to follow the wild impulses that got him into trouble in the first place?

Toward the end of his book he tells a story about doing some exploring in Scotland, accompanied by his wife, and encountering a wild area that seemed to be seducing him into once again wandering away from the world, from other people including his wife, and from anything coherent in his mind.  He reported that his wife sensed something was amiss, and called him back, and he left the area happy he had resisted its call.  I found myself wishing he had been able to heed its call, but in a limited way, that he had been able to perhaps draw his wife into wandering into that strange wild realm but without total abandon, instead bringing just enough discretion, just enough wariness, that he and his wife would likely not have come to harm, but might have had an amazing experience beyond the limits of the “normal.”

In the end, the wild is essential to us, but remains threatening as well.  I think we do best when we can acknowledge both sides of this complex truth, and see what emerges from that.  This means not denying any role for fear (as Will did in his early explorations) but also not giving fear too prominent a role, not letting it be stifling.  With work on finding the right balance and dialogue, I hope our society can come into a much healthier relationship with madness, with mystery, and with all forms of wild things.



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

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