Wednesday, February 28, 2007

Symptoms of Psychosis

Janssen-Ortho has produced an excellent one-page summary of the symptoms of psychosis. To access a copy, click here (opens a PDF file).

Sunday, February 25, 2007

An Rx to thin California prison population

From The Los Angeles Times by way of The Trouble With Spikol:

Tomorrow [February 24th], state Sen. Darrell Steinberg, a Democrat from Sacramento, will introduce a bill that calls for a complete overhaul of mental health care behind bars, with the goal of putting a big dent in both the overcrowding problem and the high recidivism rates.
For the entire article, written by Steve Lopez, click here.

Saturday, February 24, 2007

Schizophrenia: New Pathological Insights and Therapies

A recent article published by Annual Review of Medicine is available as a free download:

Abstract
The neuro- developmental hypothesis of schizophrenia posits an interaction between multiple susceptibility genes and one or more environmental insults in early life, resulting in altered brain development and the emergence of psychosis in early adulthood. Based on this framework, it has been argued that most neuropathological deficits observed in post mortem and neuroimaging studies of schizophrenia represent one or more lesions that originated in early life and remained static thereafter. However, recent longitudinal neuroimaging studies demonstrate a progressive component to the neuropathology of new-onset schizophrenia. This opens the possibility that the functional decline seen in many patients following the onset of illness may be halted or slowed. This review provides an update on developments in research on the neuropathology of schizophrenia and discusses recent advances in antipsychotic treatment and the potential impact on long-term outcomes.

Determining schizophrenia probability

From United Press International:

BINGHAMTON, N.Y., Feb. 22 (UPI) -- Abnormalities in eye movements and attention can be used to divide people into two groups in relation to schizophrenia-related risk, says a U.S. study.

The findings, presented in the Journal of Abnormal Psychology, suggest that the manner in which the eyes can follow a target and how well one can pay attention to a task together help to pinpoint risk factors related to schizophrenia.

"Schizophrenia affects one in every 100 people and has a strong genetic component; about 80 percent of what determines schizophrenia is related to genetic influences," said Mark F. Lenzenweger of Binghamton University, State University of New York.

"What was very exciting for us is that this method allows you to assign a probability to every person in the sample with respect to likelihood of risk for schizophrenia liability -- by doing this, one can generate very precise estimates of where individuals fall on the risk dimension."

Mind Your Mind - New Resource for Teens with Mental Health Questions




Posted January 24th on Schizophrenia Daily News Blog:

A new website has been launched in Canada to help teens with mental health problems.

MindYourMind.ca (MYM) is a non-profit award winning web site funded in part by the Government of Canada. MYM is dedicated to providing the necessary info, resources and skills to inspire youth to reach out, get help for themselves or give help to their friends who may be coping with stress, mental health issues, self-harming behaviours or suicide. MYM is committed to reducing the stigma often associated with reaching out for help.

The activity based coping tools and downloads appeal to youth who are looking for an interactive and non-intrusive way of receiving valuable mental health information.

Wednesday, February 21, 2007

Nobel Laureate John Nash to Give Convocation Lecture


From the February 16th edition of Psychiatric News:

During what is expected to be an unforgettable evening, Nash will present the William C. Menninger Memorial Lecture at American Psychiatric Association's Convocation of Fellows on Monday, May 21, at 5:30 p.m. in the San Diego Convention Center.

Sunday, February 18, 2007

Copies of Schizophrenia Digest available

A significant number of copies of the Winter 2007 edition of Schizophrenia Digest have been donated to the Schizophrenia Society of Nova Scotia. If you are interested in receiving a copy, please send an email, including your name and mailing address, to ssns@ns.sympatico.ca.

Mental health clinic moving outside hospital


From the February 17th edition of the Halifax Chronicle Herald:

BRIDGEWATER - The South Shore's outpatient mental health unit is being moved from the hospital to leased space in a call centre.

The clinic will move into the Resolve building on Dufferin Street in Bridgewater in April, along with addiction services. The in-patient unit will remain in South Shore Regional Hospital in Bridgewater.

Kevin McNamara, CEO of the South Shore district health authority, said the move will make services more accessible to client and open up much-needed space in the hospital. The emergency and ambulatory care areas are particularly cramped.

Phil Langford, vice-president of operations for South Shore Health, said he is working on a plan to make best use of the space that will become available in the hospital and expects to present that to the board at the end of March.
Photograph courtesy of the Town of Bridgewater.

Youth mental health: time to act

From the February 6th edition of the Halifax Chronicle Herald:

By STAN KUTCHER and NONI MACDONALD

Young people are this country’s most valuable resource. We are obliged, for moral, economic and political reasons, to do our best to optimize the growth and development of our youth in healthy and productive ways. The Nova Scotia government’s response to the Nunn inquiry illustrates an increased awareness of this responsibility.

Youth travel through a period of major physical, emotional, social and financial changes as they move from childhood into adulthood. The youth years are among the most physically healthy. However, emotional and behavioural problems arise from many factors, which can result in high-risk behaviours. Many of the most severe and persistent brain disorders that manifest themselves as mental illnesses, such as depression, manic-depression and schizophrenia, come on during these years. These disorders are due to alterations in brain development that create difficulties in thinking, mood and behaviour.

Suicide is highly related to mental disorders – especially those unrecognized and untreated. Mental disorders beginning in these years tend to be chronic and persistent illnesses. They are also related to the onset and premature death from other medical issues – including diabetes and heart disease. Some youth may exhibit a variety of high-risk behaviours which, even in the absence of mental illness, will lead to both short- and long-term negative outcomes, including injury and death. About 20 to 25 per cent of youth may suffer from problems that will interfere with their ability to mature and develop.

Many young offenders have significant mental disorders, substance abuse or emotional/behavioural problems; they need better access to helpful programs and interventions.

The province’s response to the Nunn report lists about 75 programs that are available to address the needs of young people. Making appropriate changes to the Youth Criminal Justice Act, increasing youth accountability, improving the delivery of offender services, increasing accountability for youth services, and enhancing the integration among the many players in the youth services arena are necessary; but these, in and of themselves, will not be sufficient to meet the needs of youth.

To achieve success, programs and policies need to be more than well-intentioned. First, all interventions must be based on validated data from scientifically sound research. Second, programs or other interventions need to meet the developmental needs of youth and the social-cultural realities of the communities in which they live. Third, programs need to be integrated across jurisdictions – Education, Health, Justice and Community Services at the government level – as well as in communities and schools. Fourth, interventions must be evaluated to ensure they are achieving the expected effects. Finally, there needs to be an increased investment in high-quality research designed to study which interventions are most helpful, unhelpful or even harmful.

We are pleased the province has decided to address the needs of young people and to acknowledge that the justice/corrections system areas highlighted by Nunn must be urgently considered. We are heartened that the government is looking to prevent youth crime through identifying and dealing with root causes. The interdepartmental steering group to develop a child and youth strategy is a major step forward. We urge the province to implement effective programs that address the wider mental-health needs of young people, not just the mental health needs of those within the justice system or those at risk of criminal activity.

Our province is blessed with expertise that could be harnessed to meet the mental-health needs of our youth. Practitioners and researchers, who are nationally and internationally recognized, are available. What is required is a small amount of resources, and an infrastructure that has the authority and responsibility to lead, utilize and direct our collective expertise in a manner that will change youth mental health outcomes. The Nunn inquiry and the government’s response have set the stage – now we need action.

Dr. Stan Kutcher is Sun Life Financial chair in adolescent mental health and Dr. Noni MacDonald is professor of pediatrics, IWK Health Centre, Dalhousie University.

Wednesday, February 14, 2007

Mental Health Services and Supports in Communities Across Nova Scotia

The Nova Scotia Department of Health has a useful one-page summary of telephone numbers for mental health services and supports in Nova Scotia. I am not sure how up-to-date this document is, and, unfortunately, the Schizophrenia Society of Nova Scotia is not listed (something we will work on changing).

Margaret Trudeau fighting to end stigmas attached to mental illness


By Elianna Lev

VANCOUVER (CP) - Margaret Trudeau (left, in red) says she has chosen sanity and that's the choice she wants other Canadians suffering with mental illness to make.

The former wife of the late Pierre Trudeau is using her profile to bring attention to mental illness, which has affected her for 35 years.

"Acceptance. . . is the biggest thing for people to do, just to accept that there is a problem, to accept that they need help," Trudeau told a news conference Monday.

"With mental health issues we're reluctant to accept it because of the stigma that has been played out in the media and the movies."

Trudeau, 58, first experienced depression after giving birth to her second son, Alexandre. That was the first of three times she was hospitalized for her illness. The second time came after the death of her son Michel in 1998 and then after her ex-husband died two years later.

She said she was in such dire straits at that time that she was forced to accept her bipolar disorder and get the help she needed.

"I've chosen sanity, I've chosen to be well," Trudeau said.

She has also distanced herself from marijuana, one aspect of her life that was well-documented when she was thrust into the Canadian spotlight as a 22-year-old flower child and bride of the former prime minister.

She said she's since found the enlightenment she felt from drugs in the form of spirituality. Trudeau is interested in Buddhism and follows the works of the Dalai Lama.

Trudeau said people should treat mental health as they would their physical health, taking days off when they feel unwell.

If Canadians start to talk openly about mental wellness, the stigma will diminish and people help will get the help they need, she said.

"It should be a conversation at the kitchen table, it should be a conversation on the way to work," Trudeau said. "Because recognizing depression in the early stages, you can change the course of the disease."

Thanks go to John Devlin for bringing this article to my attention.

Friday, February 9, 2007

Book Review


Cognitive Therapy of Schizophrenia

by David G. Kingdon and Douglas Turkington; New York, Guilford Press, 2004, 219 pages, $37

A book review published in the February 2007 edition of Psychiatric Services and written by Timothy B. Sullivan, M.D.:

It's hard to say how bad ideas, misinformed or misguided clinical saws, originate. One of the most enduring in psychiatry is the notion that talking to patients with schizophrenia about their symptoms or about their subjective experiences is potentially harmful. It is little wonder that so few medical students or psychiatric residents wish to specialize in work with patients who have seriously mental illness.

There have been studies and reviews, most famously the Patient Outcomes Research Team recommendations (1), which have directed our attention to the lack of efficacy (2), obvious paucity of controlled observation, and insufficiently documented putative harm associated with "uncovering therapies," by which is meant psychoanalytic therapy and its congeners. Kingdon and Turkington lament the effect these proscriptions have unintentionally had on creative engagement of persons suffering from disorders such as schizophrenia. They note that "many practitioners continue to believe that the content of psychotic symptoms should be ignored and that any psychological work ... is liable to lead to increased distress and exacerbation of symptoms, as a result of having opened up disturbing areas."

Of course the problem with past, well-intentioned, and compassionate efforts by a legion of gifted therapists is that the therapeutic model, and the theory of mind supporting it, did not accurately reflect the nature of the disorder. It was not the effort to be empathic that was flawed but the various notions about how symptoms were produced or could be ameliorated. If you don't understand what you're treating, you will misdirect, misinform, and inevitably disappoint.

Kingdon and Turkington set out to provide clinicians with a treatment model that will make the uncertain knowable and that which is alienating comfortable. They successfully present a cogent, approachable, and flexible model for psychotherapeutic engagement of persons suffering from serious psychotic illness. This is not a "manualized" treatment, and the authors explain why that approach is not appropriate. A careful exposition of the nature of the illness processes, and the theory of cognitive-behavioral therapy and its particular adaptation to this setting, is explicated. There are many clinical examples, guidelines, forms to use, and even patient handouts that can be copied and distributed are included. The succinct review of the psychology of schizophrenia is particularly useful, such as the discussion of "externalizing bias" and the central role of stigmatization in symptom development.

The fourth chapter, on therapeutic engagement, and later chapters on work with delusions and hallucinations, are not only brilliantly executed but come as close as one can, in print, to detailed individual case supervision. Even experienced practitioners will find these presentations extremely helpful, because they reflect the careful thought of talented clinicians who have immersed themselves in their subject and achieved valuable insights.

I do have one brief quibble. As a heuristic device, Kingdon and Turkington use four clinical subgroups to differentiate "types" of schizophrenia. In the context of the book, these subgroups are useful and unify their presentation. I am not sure I can agree that the subgroups encompass the range of patients I see.

Reviewers will often say that the book they are reviewing belongs on everyone's shelf. I urge you to please buy and read this book. Our patients deserve our attention to these issues. Those of you who are talented clinicians but who avoid this population out of confusion or lack of confidence in your ability to help will, I assure you, find this book crucial. You will find yourself able to approach a person with schizophrenia with confidence, and it will change how you think about your work.

Footnotes

Dr. Sullivan is chief of services for the seriously mentally ill at Saint Vincent's Catholic Medical Center, Westchester, New York, and assistant professor of psychiatry at New York Medical College, Valhalla.

References
  1. Lehman AF, Steinwachs DM: Translating research into practice: the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. Schizophrenia Bulletin 24:1-10,1998 [Medline]


  2. Gunderson JG: Effects of psychotherapy in schizophrenia: II. comparative outcome of two forms of treatment. Schizophrenia Bulletin 10:564-598,1984 [Medline]

Wednesday, February 7, 2007

Schizophrenia Risk Factor Found in Maternal Blood

Summarizing work published by Alan S. Brown, MD, et al., Joan Arehart-Treichel writes in the February 2nd issue of Psychiatric News:

An elevated prenatal blood level of homocysteine may double the risk of having a child who will develop schizophrenia. But rubella and flu infections during pregnancy seem to be even larger risks.

Sunday, February 4, 2007

Update on the Healthy Minds Initiative


From the January 2007 edition of the Healthy Minds Cooperative's The Blue Horse Chronicles.

By Amanda Crabtree

Since my last column, the Mental Health Program and the Department of Psychiatry, have distributed two “Healthy Minds Initiative Update to the Community” letters. The most recent letter was distributed on January 12th. I hope you have received the letter and have taken the time to read through it. It gives you a sense of the work we are doing on the Initiative.


Recently, Community Mental Health began offering evening hours. All five community teams are each open one evening per week. We appreciate that offering evening hours is more convenient for people who have commitments through the day. We are trying to spread the word that evening appointments are available so, please pass the message on as much as possible.

Community Mental Health:

  • Cole Harbour / Eastern HRM ~ 434-3263

  • Dartmouth City Team ~ 464-3116

  • Abbie Lane ~ 473-2531

  • Bedford / Sackville ~ 865-3663

  • Hants ~ 792-2042

In each of my columns, I touch on the Abbie Lane Mental Health Outpatient Department move to Bayers’ Village. In fact, in my last column, I mentioned that our goal was to relocate 55 per cent of the outpatient department to Bayers’ Village in January, 2007. Though the Mental Health Program and the Department of Psychiatry are committed to offering outpatient services at Bayers’ Village, we have adjusted our timeline. Once we have a new target date, I will be sure to include that in my column.


Moving both the Abbie Lane Mental Health Outpatient Department and the Dartmouth City Team to community locations is part of helping to create networks of mental health and related supports and services (Community Resource Networks).


A couple of closing notes:

  1. We are making progress on developing a web site that will provide mental health information, education materials and referral resources (Citizen Support Web). We hope to announce a developer for the site in February and then to begin building the site soon after that, with the aim of launching it this summer.

  2. The [Capital District] Mental Health Program will soon have a new director; Peter Croxall will begin with the Program on February 5th.
For additional information on the Healthy Minds Initiative, contact Amanda Crabtree by phoning (902) 460-7401, by email, or visit here.

A Creative Member of the SSNS


Idle Speculations on the Architecture of King’s College, Cambridge

John Devlin, a member of the Schizophrenia Society of Nova Scotia, has had an online article published by GRAND TRADITION: Classical Arts and Architecture on the Web.

Saturday, February 3, 2007

Friday, February 2, 2007

Time Magazine Advertisement

The Schizophrenia Society of Canada has a full-page advertisement in Time Magazine next week – completely pro bono. This ad (click here to view the PDF) is worth thousands in real dollars. It is self-explanatory – 100 faces to represent the 1 in 100 statistic for the prevalence of schizophrenia. The ad is simple, but powerful and compelling.

We are thrilled. There will be future opportunities as well, but this is one giant step in creating national awareness.

It will be on the newsstands across Canada next week … be sure to have a look!

Reminder: Tuesday, February 6th, come see Eternal Sunshine of the Spotless Mind

Film Series: The Ethics of Mental Health

This is to remind you that Novel Tech Ethics (Dalhousie University) is hosting a free public screening of the film Eternal Sunshine of the Spotless Mind followed by a panel discussion led by Dr. Lynette Reid (Dept. of Bioethics), Dr. Cheryl Murphy (Dept. of Psychiatry), and and Tana Woodward (Clinical Social Worker, Mood Disorder Clinic, QEII Hospital) on Tuesday, February 6th (7:00 pm) at the QE II 's Royal Bank Theatre located on the main floor of the Halifax Infirmary (1796 Summer Street).

Come early! Seating is limited. (Room capacity: 168)

Click here for more information about upcoming public education initiatives in the field of Neuroethics, including a public forum on “Smart Drugs” (19:30, February 28 at the Discovery Centre), a public lecture on “Building Better Brains” by Paul Root Wolpe (19:00, March 8 at the QEII’s Royal Bank Theatre), and another public lecture on “Wiring Brains to Machines” by Jason Scott Robert (19:30, May 9, Discovery Centre).