Sunday, November 30, 2008

Suicide risk in schizophrenia: learning from the past to change the future


The abstract of a review paper published in the March 16, 2007, edition of Annals of General Psychiatry:
By Maurizio Pompili, Xavier F. Amador, Paolo Girardi1, Jill Harkavy-Friedman, Martin Harrow, Kalman Kaplan, Michael Krausz, David Lester, Herbert Y Meltzer, Jiri Modestin, Lori P. Montross, Preben Bo Mortensen, Povl Munk-Jørgensen, Jimmi Nielsen, Merete Nordentoft, Pirjo Irmeli Saarinen, Sidney Zisook, Scott T Wilson and Roberto Tatarelli

Suicide is a major cause of death among patients with schizophrenia. Research indicates that at least 5–13% of [individuals living with schizophrenia] die by suicide, and it is likely that the higher end of range is the most accurate estimate. There is almost total agreement that [people living with schizophrenia] who [are] more likely to commit suicide [are] young, male, white and never married, with good premorbid function, post-psychotic depression and a history of substance abuse and suicide attempts. Hopelessness, social isolation, hospitalization, deteriorating health after a high level of premorbid functioning, recent loss or rejection, limited external support, and family stress or instability are risk factors for suicide in patients with schizophrenia. Suicidal [individuals with schizophrenia] usually fear further mental deterioration, and they experience either excessive treatment dependence or loss of faith in treatment. Awareness of illness has been reported as a major issue among suicidal patients with schizophrenia, yet some researchers argue that insight into the illness does not increase suicide risk.

Protective factors play also an important role in assessing suicide risk and should also be carefully evaluated. The neurobiological perspective offers a new approach for understanding self-destructive behavior among patients with schizophrenia and may improve the accuracy of screening [these individuals] for suicide. Although, there is general consensus on the risk factors, accurate knowledge as well as early recognition of patients at risk is still lacking in everyday clinical practice. Better knowledge may help clinicians and caretakers to implement preventive measures.

This review paper is the results of a joint effort between researchers in the field of suicide in schizophrenia. Each expert provided a brief essay on one specific aspect of the problem. This is the first attempt to present a consensus report as
well as the development of a set of guidelines for reducing suicide risk among schizophenia patients.
I have taken the liberty to edit the abstract to remove the word schizophrenic.

To read the entire paper, click here (PDF).

Thanks go to the Lancashire Care Library & Information Service for bringing this paper to my attention.

Friday, November 28, 2008

Freedom to be sick leaves families feeling chained

From today's edition of The Globe and Mail:
Caregivers who can't get mentally ill loved ones to seek help grapple with laws designed to protect civil rights

By André Picard

Mary Liz Greene [pictured] was in the midst of an animated conversation with her son when he suddenly lunged, grabbed her by the neck with two hands, then pushed his thumbs into the soft flesh of her throat, using the full force of his 6-foot, 200-pound frame.

Gasping for air, she felt the pressure let up for an instant, shoved him with all her might and fled to a neighbouring apartment to call 911.

“I'm lucky to be alive,” Ms. Greene said later, “although sometimes I doubt that.”

Her son, 24-year-old John Candow, suffers from severe bipolar disorder and, when untreated, is consumed by the delusion that he is Tony Soprano, the TV mobster. He has been living with his mother and, since he was diagnosed three years ago, has thrown knives at her, burned her with cigarettes, punched and kicked her repeatedly.

Last week's incident was the most violent yet. When police arrived, they were confronted with a psychotic young man holding a knife to his throat threatening suicide. They tasered, subdued and arrested him – and found 10 more knives in his knapsack.

When Ms. Greene, a Halifax social worker, visited her son at the East Coast Forensic Hospital a few days later, he reminded her, matter-of-factly, that he plans to kill her and chop her body to pieces.

“When John's not sick, when he's being treated, he's very loving. He's a sweet, beautiful boy,” Ms. Greene says tearfully.

But the central fact of the sordid tale is this: Mr. Candow refuses to get treatment, as is his right under Canadian law.

That right presents a dilemma for countless caregivers across the country whose loved ones have such severe mental illnesses as schizophrenia, bipolar disorder and addictions, especially when they also suffer from anosognosia – an inability to recognize they are sick.
To read the entire article, click here.

Photograph by Sandor Fizli for The Globe and Mail.

Thursday, November 27, 2008

The loneliness of the psych ward

From today's edition of The Globe and Mail:
By Erin Anderssen

Ben Robinson [pictured] spent long months during his hospital stays pacing the halls alone, hoping someone would visit.

Hardly anyone did, except for his mother, even though he phoned friends specifically to ask for company. The people who eventually braved the locked ward at the Clarke Institute never stayed long. “Where are the white padded rooms?” they joked.

“It was a bit of freak show kind of thing,” says Mr. Robinson, a 24-year-old part-time student in Toronto who has been diagnosed with schizo-affective disorder – a condition defined by symptoms of both a mood disorder, such as depression, and schizophrenia. “Like, ‘Whoo, let's go see my friend in the mental hospital.' ”

Even so, those visits made all the difference, he remembers – a few moments to feel “semi-normal,” to talk to someone from the outside and forget that he wasn't free to leave. The nurses, he says, were too busy to spend much time on chit-chat; the patients didn't mix much except to watch TV in silence. Other than a daily 30-minute appointment with his psychiatrist and taking a few workshops, he spent most of his time drinking tea and walking. “It's incredibly lonely and boring in the hospital,” he says. “I needed people to be there as much as possible.”

Mr. Robinson was lucky to get any visitors: Studies suggest that as many as 40 per cent of psychiatric patients never see a family member or friend at their bedside. According to a recent survey conducted at Toronto's Centre for Addiction and Mental Health, one-third of hospitalized patients in the mood and anxiety program received no family visits – and 20 per cent were visited only once or twice. Friends were even less in evidence: More than 70 per cent of the people surveyed said they received no more than two visits, and the majority didn't see a single friend.

There's a reason why psychiatric hospitals don't usually have gift shops: Nobody buys gifts for their patients. “You go into any ward in any hospital, and you will see cards, a balloon or two, flowers, teddy bears,” says Karen Liberman, executive director of the Mood Disorders Association of Ontario. “The psych ward is virtually the only place where you see nothing and nobody.”
To read the entire article, click here.

Photograph by Deborah Baic of The Globe and Mail.

Tuesday, November 25, 2008

Psychiatry: A specialty relegated to the basement


An article published in the today's edition of The Globe and Mail:
By Carolyn Abraham

Jai Shah [pictured] could have been any sort of doctor he wished. Even before he graduated with honours from the University of Toronto's medical school, the 30-year-old Edmonton native had earned a master's degree in international health policy from the London School of Economics, published papers and worked for the Canadian Institutes of Health Research.

Praise follows him wherever he goes. Except for last fall – when he decided to specialize in psychiatry.

“A psychiatrist?” some of his supervisors said, “But you're smart! … You're taking the easy way out … Your patients will make your life hell … Your patients will make you depressed … What a waste of talent!”

Dr. Shah knew mentally ill people battle both their disorders and the social stigma their conditions carry. But it surprised him that psychiatrists confront a certain stigma, too.

“I'm sure the feedback has discouraged some young doctors from choosing this as their career,” said Dr. Shah, now at the Harvard Longwood Psychiatry Residency Training Program in Boston.

In fact, Susan Abbey, who heads the U of T first-year residency program in psychiatry, said the disparaging comments are “ubiquitous.”

“I don't think there's one of our incoming residents who hasn't been exposed to negative comments from family or friends or academic supervisors,” Dr. Abbey said.

Just as lawyers can face a barrage of bottom-feeder jokes, psychiatrists, both in film and real life, have long been seen as doctors of a lesser science. Even their own physician colleagues can view their patients as difficult and time-consuming. The negativity, experts say, is contributing to a national shortage of psychiatrists and shoddy care for mentally ill people.
To read the entire article, click here.

Photograph by Jodi Hilton for The Globe and Mail.

Membership Involvement is Required to Bring About Change



Click on the image to enlarge it.

Saturday, November 22, 2008

Schizophrenia study puts patients in charge



Posted November 21st on StoneyCreekNews.com:
Hearing [Our] Voices sheds light on control, medication challenges

By Richard Leitner, News Staff

Barbara Schneider [pictured] recalls her shock at her eldest son’s reaction to his being diagnosed with schizophrenia at 23. They had stopped for a breather during a bike ride and she had expected him to agree with her observation that he’d had a tough year.

“He said, ‘Oh, no. No, since my diagnosis I think that it’s so much better,’ ” Ms. Schneider recounted at a recent forum hosted by St. Joseph’s Healthcare Hamilton.

“He was referring to the fact that he’d received a diagnosis that helped him make sense of his very frightening experiences and that he was taking medication to help him cope better with life in general.

“It’s not too strong to say that I was completely stunned by the difference in our perspectives.”

The revelation prompted the University of Calgary communications professor to spearhead a groundbreaking study that took a unique look at the struggles faced by people diagnosed with schizophrenia: it put the patients in charge.
To read the entire article, click here.

Also see:
callhome.ucalgary.ca

Photograph of Dr. Barbara Schneider courtesy of the University of Calgary.


$9.8 Million Grant to Map “Epigenome” of Schizophrenia



A November 21st press release from Johns Hopkins Medicine:
Researchers at the Johns Hopkins University School of Medicine and four other academic medical centers have been awarded a $9.8 million grant from the National Institutes of Mental Health to pin down inherited changes that occur outside a cell’s DNA sequence in people with schizophrenia. Unlike changes or mutations in the DNA sequence itself, epigenetic marks or alterations can be affected by a lifetime of exposure to the environment in which cells operate.

“A comprehensive understanding of a disease’s epigenome can provide hidden and valuable clues to the role of diet, chemicals, infections and behaviors in genetic predisposition to diseases,” says Andrew Feinberg [pictured], M.D., professor of medicine and director of Hopkins’ Center for Epigenetics in its Institute of Basic Biomedical Sciences. Because a significant indicator of epigenetic change is our body chemistry’s addition of so-called methyl groups to DNA at specific sites, the research will focus on identifying changes in “methylated” sites in the epigenome that are associated with schizophrenia.

The research team is comprised of scientists at Hopkins, University of Pennsylvania, University of Alabama at Birmingham, University of Pittsburgh, and University of California San Diego. "The NIMH is very excited about funding this team of world-class scientists to look into epigenetic factors as possible causes for schizophrenia," says Thomas Lehner Ph.D., M.P.H., chief of the genomics research branch and the associate director of the division of neuroscience and basic behavioral science at the National Institute of Mental Health.

“Many researchers have identified genetic alterations associated with schizophrenia, but so far they do not account for a large proportion of schizophrenia patients,” says Feinberg, who is leading the multi-institutional effort. “Our work can identify differences in methylation patterns seen in blood samples or brain tissue samples from patients with and without schizophrenia to fill out the whole picture of both epigenetic and genetic contributions to this disabling disorder.”

The scientists will take advantage of DNA samples from the National Institutes of Mental Health genetics repository. They will analyze the methylation patterns at nearly ten thousand sites throughout the genomes of several thousand samples and controls, choose the 50 most prominent sites, and map the locations of the methylation marks to identify and analyze the activity of nearby genes.

“These studies will provide the first comprehensive evaluation of the epigenetics of schizophrenia and allow for unprecedented integration of genetic and environmental information about schizophrenia,” says Feinberg.

Because epigenetic changes — unlike nuclear DNA changes — are potentially reversible, “these studies may also lead to exciting new avenues for schizophrenia therapy,” Feinberg notes.

Stephen Desiderio, M.D., Ph.D., director of the Institute for Basic Biomedical Sciences at Hopkins, says the collaborative nature of the epigenome investigation “promises to add quickly and richly to the growing body of knowledge about schizophrenia,” which affects an estimated 2 million adults in the United States alone.

On the Web:
www.hopkinsmedicine.org/ibbs/research/epigenetics

Media Contacts:
Audrey Huang; 410-614-5105; audrey@jhmi.edu
Maryalice Yakutchik; 443-287-2251; myakutc1@jhmi.edu
Photograph of Dr. Feinberg courtesy of Johns Hopkins Medicine.

Friday, November 21, 2008

Costas Halavrezos interviews the executive director of the SSNS


From the November 19th edition of CBC Radio's Maritime Noon:
Donnie Harvey is from Bridgewater, Nova Scotia. His family tried to get him help for what they believed were his psychotic episodes, but couldn't - until he threatened his mother with a knife, and she involved the police.

Since 2007, psychiatrists in Nova Scotia have had a tool that could prevent such attacks. It's called the Involuntary Psychiatric Treatment Act. It allows mental health professionals to force someone into treatment if they determine the person is a danger to others or themselves.

Stephen Ayer [pictured] is the executive director of the Schizophrenia Society of Nova Scotia and he says it's a powerful tool that isn't being consistently used, and that endangers many families.
To listen to Costas Halavrezos interview Stephen Ayer, click here (RealPlayer).

Photograph by Denton Conrad.

Monday, November 17, 2008

Laing House is all about healing

From the November 13th edition of the Community Herald Halifax:
Unique facility helps teens, young adults deal with mental health issues

By Pat Lee, Staff Reporter


Early November is a sad time of year for Hans [pictured] and Dani Himmelman. It’s the time of year when their 23-year-old daughter Genna took her own life.

But the couple have found a way to channel some of their grief by becoming avid supporters of Laing House, the only centre of its kind in Canada offering critical support to teens and young adults dealing with serious mental health issues.

"It’s very rewarding for us to be involved with Laing House," Hans said recently.

"It’s a way for us to deal with our own grief and to help other kids."

Along with being active volunteers at the house — Dani works with parents, and Hans is the incoming chairman of the board — they were involved with the home’s annual fundraiser UnMasked Mental Health Masquerade, held just a few weeks ago.

Last year, the event raised $150,000 for Laing House.

Hans, a 30-year employee at CIBC Wood Gundy, got people in his workplace involved and secured $16,000 for the cause, half from the investment firm and the other half from seven colleagues.

"Our Halifax office has been a major supporter," he said.

Hans said that although his daughter lost her struggle with mental illness four years ago, it’s been healing to see the success stories that happen at Laing House every day.

"She was one of the few who didn’t make it through," he said of his daughter’s struggle with schizophrenia and depression from about the age of 12.

"But Laing House was instrumental in getting her back on her feet."

Located in a Victorian house on Barrington Street, the centre was established in 2001 by his friends Keith and Rosemary Hamilton in honour of Rosemary’s mentally ill mother and a child of their own with mental illness. The centre offers a wide range of programs and supports for teens, young adults and their families.

Hans said that through Laing House, Genna was able to find jobs and activities she enjoyed.

"There’s a real void in our mental health system that doesn’t provide for peer support or the support that Laing House provides," he said.

"When kids are recovering from, or living with, a mental illness, they need to know that they’re not in isolation."

Next fall, the Himmelmans and four other couples will climb Mount Kilimanjaro to raise money for the house.
Photograph by Christian Laforce of the Community Herald Halifax.

Sunday, November 16, 2008

Activists demand action against poverty


From the November 16th edition of The Chronicle Herald:
Province not giving enough support, rally told

By Tom Peters, Staff Reporter


Anti-poverty activists and support organizations took their cause to the streets of downtown Halifax on Saturday, demanding that the provincial government take action to assist poor people.

About 100 people, including young and old representing a variety of community groups, organizations and service agencies, chanted slogans, beat on drums and carried signs that bore messages such as Economic crisis not new to us, Stop the war on the poor, Child in poverty and Daycare for kids not bailouts for banks.

Their demands focused on increased social assistance, a raise in the minimum wage, increased access to employment insurance, affordable housing, universal childcare and affordable post-secondary education.

After a brief rally in Victoria Park, the activists marched to Province House, where speakers called for government action. There were no politicians at the House on Saturday.

Wayne MacNaughton, an advocate for the homeless, told the gathering in the park that politicians need to be held accountable for the things they are not doing. He said politicians demand report after report on poverty issues "yet they have known for years what needs to be done because every report always says the same thing," he said.

Mr. MacNaughton was critical of the lack of funds for Pendleton Place, a Halifax shelter for the homeless that won’t reopen this winter.

He said that was "appalling since government has done absolutely nothing to address the underlying issue, which is more affordable housing and more community supports for people suffering from mental illness and addictions. They have done nothing on either of those things."
To read the entire article, click here.

Also see:

Protestors call for end to the 'war on the poor'


Photograph by Ingrid Bulmer, The Chronicle Herald.

Saturday, November 15, 2008

In a Novel Theory of Mental Disorders, Parents’ Genes Are in Competition


An article published in the November 10th edition of The New York Times:
By Benedict Carey

Two scientists, drawing on their own powers of observation and a creative reading of recent genetic findings, have published a sweeping theory of brain development that would change the way mental disorders like autism and schizophrenia are understood.

The theory emerged in part from thinking about events other than mutations that can change gene behavior. And it suggests entirely new avenues of research, which, even if they prove the theory to be flawed, are likely to provide new insights into the biology of mental disease.

At a time when the search for the genetic glitches behind brain disorders has become mired in uncertain and complex findings, the new idea provides psychiatry with perhaps its grandest working theory since Freud, and one that is grounded in work at the forefront of science. The two researchers — Bernard Crespi [pictured], a biologist at Simon Fraser University in Canada, and Christopher Badcock, a sociologist at the London School of Economics, who are both outsiders to the field of behavior genetics — have spelled out their theory in a series of recent journal articles.

“The reality, and I think both of the authors would agree, is that many of the details of their theory are going to be wrong; and it is, at this point, just a theory,” said Dr. Matthew Belmonte, a neuroscientist at Cornell University. “But the idea is plausible. And it gives researchers a great opportunity for hypothesis generation, which I think can shake up the field in good ways.”

Their idea is, in broad outline, straightforward. Dr. Crespi and Dr. Badcock propose that an evolutionary tug of war between genes from the father’s sperm and the mother’s egg can, in effect, tip brain development in one of two ways. A strong bias toward the father pushes a developing brain along the autistic spectrum, toward a fascination with objects, patterns, mechanical systems, at the expense of social development. A bias toward the mother moves the growing brain along what the researchers call the psychotic spectrum, toward hypersensitivity to mood, their own and others’. This, according to the theory, increases a child’s risk of developing schizophrenia later on, as well as mood problems like bipolar disorder and depression.

In short: autism and schizophrenia represent opposite ends of a spectrum that includes most, if not all, psychiatric and developmental brain disorders. The theory has no use for psychiatry’s many separate categories for disorders, and it would give genetic findings an entirely new dimension.
To read the entire article, click here.

Also see:

Psychosis and autism as diametrical disorders of the social brain

Photograph by Annie Marie Musselman for The New York Times.

Families helping families


An October 9th news release from SANE Australia:
SANE Australia today launches a new DVD that offers first-hand insight on dealing with mental illness in your family.

For Jo Buchanan, her family have been her greatest teachers. From helping her sister following a diagnosis of schizophrenia to becoming a carer for her son Miles when he discovered he had bipolar disorder, Jo has discovered many things.

One of the main things she learnt and is keen to pass on to others is the importance of learning how to cope.

‘When my sister first showed signs of schizophrenia, I had no idea what was happening as I had to deal with it alone. When Miles became unwell, I was able to recognise the symptoms, which meant I could find help from the right people immediately,’ Jo said.

‘Education and information about mental illness are so helpful when it comes to working out how to cope with the many changes it brings in a family’s life.’

Jo and Miles have joined others in sharing their experiences on a 30-minute DVD produced by SANE Australia in partnership with highly regarded production company RealTime Health.

The DVD is part of a kit, which includes the SANE Guide to Families ¬– offering practical advice on how to cope with the impact mental illness can have on a family. On the DVD, Jo talks about the challenges she’s faced as a carer and the many ways they have helped her to grow.

‘Through my experience as a carer, I have accessed strengths I didn’t know existed; strengths developed through surviving circumstances for which I was totally unprepared and untrained. I have learned about courage, hope, faith and humility,’ she said.

SANE Australia’s Paul Morgan says the Families DVD and guide are invaluable tools in helping families learn more about mental illness from people with first-hand experience.

‘Around one in five Australians will experience a mental illness at some time, and for every one of those there will be a ‘ripple effect’ on family and friends. Hearing from people who deal with mental illness on a daily basis can help those in similar situations,’ Dr Morgan said.

Tips from the DVD kit include:
  • Coming to terms with caring for someone with a mental illness
  • Finding support options for the whole family
  • Learning skills
  • Planning for the future
The Families and Mental Illness DVD Kit is available from SANE Australia, as well as many other resources on mental illness. Visit www.sane.org or phone the SANE Helpline on 1800 18 SANE (7263).

To arrange an interview with Paul Morgan or Jo Buchanan, contact Cathy Heycock on 03) 9682 5933 or 0414 427 291.
Thanks go to Chris Summerville for bringing this news release to my attention.

Friday, November 14, 2008

Predictors of general quality of life and the mediating role of health related quality of life in patients with schizophrenia


An abstract published online on October 30th in Social Psychiatry and Psychiatric Epidemiology:
Carin J. Meijer (1), Maarten W. J. Koeter (1), Mirjam A. G. Sprangers (2) and Aart H. Schene (1)

(1) Dept. of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

(2) Dept. of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

INTRODUCTION: The concept 'quality of life' (QoL) has become increasingly important as an outcome measure in the evaluation of services and in clinical trials of people with schizophrenia. This study examines the mediating role of health related quality of life (HRQoL) in the prediction of general quality of life (GQoL).

METHOD: QoL and other patient- and illness characteristics (psychopathology, overall functioning, illness history, self-esteem and social integration) were measured in a group of 143 outpatients with schizophrenia. GQoL was measured by the Lancashire Quality of Life Profile and HRQoL was measured by the MOS SF-36. To test the temporal stability of our findings, assessments were performed twice with an 18-month interval.

RESULTS: We found that patient's GQoL is predicted mainly by anxiety and depression and self-esteem and to a lesser extent by global functioning and social integration. At both time intervals HRQoL appeared to be a significant mediator of the relationship between anxiety and depression and self esteem versus patient's GQoL.

CONCLUSIONS: The results of this study are important for mental health professionals, as these provide more insight in the mechanisms by which they could improve the GQoL of their patients with schizophrenia. The results confirm that diagnosis and treatment of anxiety and depression in outpatients with schizophrenia deserves careful attention of clinicians. Also strategies and specific interventions to improve self-esteem of patients with schizophrenia are very important to maximise patient's QoL.

Families of mentally ill face daunting challenges


An article published in the November 12th edition of The Oregonian:
By Don Colburn

Imagine your brother had a severe chronic illness. Imagine it messed with his ability to realize how sick he was and made him act a little crazy.

Imagine he resisted getting treatment and insisted he was fine. Imagine he threatened you when you tried to help. Imagine his caregiver nearly went bankrupt. Imagine you found out he was off his meds again and about to be evicted. Imagine you were scared, desperate and clueless what to do -- but decided to visit him one more time.

Imagine, in other words, you were Theresa Rockwood last month.

Her dilemma played out with horrific consequences: She was found stabbed to death in her brother's apartment. Her brother, Joseph F. Rockwood [pictured], 54, who has schizophrenia, is charged with murder.

"One of the things our system is not well prepared to do is engage families," said Chris Bouneff, director of marketing and development for DePaul Treatment Centers and president of the National Alliance on Mental Illness of Oregon.

With a physical illness, Bouneff said, caregivers are more insistent on bringing family members into discussions about treatment. "Typically, in mental health, that doesn't happen."

There are many reasons: fear, stigma, denial, ethical concerns about privacy protection.
To read the entire article, click here.

Also see:

Man to be arraigned in stabbing death of sister

Slain woman desperate to help her mentally ill brother

Stabbing death: Another victim of Oregon's broken mental health system

Need help?

Capital Health's Mental Health Mobile Crisis Team takes calls 24 hours a day. Trained staffers can refer callers to mental health services and, if necessary, dispatch a mobile crisis team (between the hours of 1:00 pm and 1:00 am). Call (902) 429-8167 or 1-888-429-8167 (toll free).

The Schizophrenia Society of Nova Scotia (SSNS) offers the Strengthening Families Together program. For more information click here or call the SSNS at (902) 465-2601 or 1-800-465-2601 (toll-free in Nova Scotia).

Saturday, November 8, 2008

Medical Monitoring Often Missing From Care of Patients on SGAs


From the November 7th edition of Psychiatric News:
By Mark Moran

Psychiatrists are told that they must assume responsibility for screening and monitoring severely mentally ill patients at high risk for diabetes, cardiovascular disease, and metabolic syndrome.

Studies of lab orders for patients receiving second-generation antipsychotic (SGA) medications reveal that few are getting screened or monitored for cardiovascular and metabolic risk factors, reported Elaine Morrato, Dr.P.H., [pictured] at a symposium at APA's Institute on Psychiatric Services last month in Chicago.

Both patient reports and lab order results suggest that the actual rate of screening and monitoring is lower than the self-reports of psychiatrists—a fact that may be explained by patient failure to follow up on referrals for lab screening.

Moreover, warnings by the Food and Drug Administration regarding cardiometabolic risk factors associated with use of SGAs and recommendations by APA and the American Diabetes Association (ADA) appear to have done little to change prescriber behavior regarding screening and monitoring. Rather, trends in screening and monitoring of patients on SGAs appear to follow those for the general population.
To read the entire article, click here.

Photo courtesy of Elaine Morrato, Dr.P.H., M.P.H.

Friday, November 7, 2008

Self-disclosure and Its Impact on Individuals Who Receive Mental Health Services



From an unknown source:
The stigma associated with mental illness is one of the most persistent problems people face. It is fundamental to discrimination in housing, employment, and health insurance. It prevents treatment, and it impedes recovery.

Self-disclosure and Its Impact on Individuals Who Receive Mental Health Services
, developed by the Center for Mental Health Services (CMHS), examines the role self-disclosure plays in reducing stigma and discrimination associated with mental illness. Research has shown that public attitudes about mental illness improve when people have contact, or interactions, with people with mental illnesses.

This monograph examines current literature related to self-disclosure and provides the findings from a series of key informant interviews to examine the factors that promote or hinder self-disclosure.

Download a free copy by clicking here.
Thanks go to Chris Summerville for bringing this publication to my attention.

Thursday, November 6, 2008

Pitt Research Identifies New Target in Brain for Treating Schizophrenia


A November 3rd news release from the University of Pittsburgh:
Study published in Proceedings of National Academy of Sciences shows that orbitofrontal cortex responds to current and experimental antipsychotic drugs

PITTSBURGH- Research from the University of Pittsburgh could expand the options for controlling schizophrenia by identifying a brain region that responds to more than one type of antipsychotic drug. The findings illustrate for the first time that the orbitofrontal cortex could be a promising target for developing future antipsychotic drugs-even those that have very different mechanisms of action. The study will be published during the week of Nov. 3 in the online edition of the Journal Proceedings of National Academy of Sciences, with a print version to follow.

Bita Moghaddam [pictured], a professor in the Department of Neuroscience in Pitt's School of Arts and Sciences and the paper's lead author, found that schizophrenia-like activity in the orbitofrontal cortex - a brain region responsible for cognitive activity such as decision making - could be triggered by the two different neurotransmitters linked to schizophrenia: dopamine and glutamate. Brain activity was then normalized both by established antipsychotic medications that regulate only dopamine and by experimental treatments that specifically target glutamate.

“The orbitofrontal cortex is an area that's been somewhat neglected in schizophrenia research. This study should encourage researchers to focus on this brain region in imaging and other human studies, and also to use as a model for developing antipsychotic drugs,” Moghaddam said. “Schizophrenia appears to be caused by very diverse and sometimes rare genetic mutations. Diverse mutations can end up causing the same disease if they disrupt the function of a common group of neurons or networks of neurons. We think that the key to understanding the pathophysiology of schizophrenia and finding better treatments is to identify these networks. This data suggests that the orbitofrontal cortex may be a critical component in networks affected by schizophrenia.”

Working with UPMC neurology resident Houman Homayoun, Moghaddam first established that dopamine and glutamate could, separately, produce schizophrenia-like symptoms in the orbitofrontal cortex. They first simulated symptoms brought on by irregular neural receptors of glutamate. Studies within the last few years - including work by Moghaddam at Yale University - have shown that under-functioning glutamate receptors known as NMDA receptors can produce schizophrenia-like symptoms. Moghaddam and Homayoun found that stunting the NMDA receptors resulted in schizophrenia-like effects in the orbitofrontal cortex. The team also used a dose of amphetamine to simulate dopamine-related schizophrenia symptoms in the orbitofrontal cortex; schizophrenia is often linked to an excess of dopamine in the brain.

Moghaddam and Homayoun then tested the currently prescribed medication - a treatment developed more than 50 years ago that targets neural receptors of dopamine - and new experimental drugs that work on the glutamate system. They found that both medications normalized brain activity.

The paper can be found on the Proceedings of National Academy of Sciences' Website at www.pnas.org/content/early/recent or by contacting Morgan Kelly at 412-624-4356 (office); 412-897-1400 (cell); or by sending an email to mekelly@pitt.edu.

Saturday, November 1, 2008

Postnatal depression 'in the genes'


From the November 2nd edition of The Observer:
By Amelia Hill, social affairs correspondent

Fresh medical research suggests the serious mental illness which bedevils new mothers may be due to nature, not nurture

The most severe form of postnatal depression, which affects one in 500 new mothers and has been linked to suicide and infanticide, could be genetic, according to new research.

It is also claimed, in a separate piece of research, that thousands more women could suffer postnatal depression than currently thought, with up to 17,250 late-onset cases a year in the UK going undetected.

It was believed that the mood disorders affecting up to 75 per cent of new mothers were caused by the women's circumstances, personality and hormonal changes.

But according to a study by Cardiff University, Birmingham University and Trinity College, Dublin, funded by medical charity the Wellcome Trust, the most severe form of postnatal depression - postpartum psychosis - has a genetic cause. The study is now working to isolate the gene, which will enable doctors to identify and treat high-risk women before they fall ill.
To read the entire article, click here.