Sunday, February 24, 2008

Recognizing a common genetic syndrome: 22q11.2 deletion syndrome

An article in published in the February 12th edition of the Canadian Medical Association Journal. To download the entire article (PDF) click here.

Below is a quote from the article authored by Ronak K. Kapadia, BSc,* and Anne S. Bassett, MD.**

*Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia.
**Clinical Genetics Research Program, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario.
22q11.2 deletion syndrome, previously known as DiGeorge syndrome or velocardiofacial syndrome, is the most common microdeletion syndrome known (estimated prevalence of 1 in 4000 live births), yet it remains underrecognized, especially in adults (1,2). Clinical variability, multisystem disease, subtle features, lack of medical genetics services, the recent availability of molecular cytogenetic testing in 1994 and, most importantly, the unfamiliarity of clinicians with this syndrome all contribute to delayed and missed diagnoses. Clinic visits and admissions to hospital present opportunities to diagnose 22q11.2 deletion syndrome, but without knowledge of this syndrome and its features, patients will not receive the correct diagnosis.

The deletion is hemizygous (affecting only 1 chromosome) and involves the 22q11.2 region of the long arm of chromosome 22. In most newly diagnosed cases (> 90%), and in our case, the parents are unaffected because this is a de novo mutation. Both parents of patients with 22q11.2 deletion syndrome should be tested for the deletion because expression may be mild (1). Fertility is generally unaffected in individuals with 22q11.2 deletion syndrome. Patients with a confirmed diagnosis require genetic counselling about the 50% chance of transmitting the deletion with each pregnancy and about the wide range of congenital and later-onset conditions associated with this syndrome (1). Common later-onset conditions include endocrine disorders, such as hypothyroidism and hypoparathyroidism (1), and schizophrenia or schizoaffective disorder (about 25% of cases) (1,2).
Bold emphasis is mine.

References
  1. Bassett AS, Chow EWC, Husted J, et al. Clinical features of 78 adults with 22q11 deletion syndrome. Am J Med Genet A 2005;138:307-13. [Medline]
  2. Bassett AS, Chow EWC. 22q11 deletion syndrome: a genetic subtype of schizophrenia. Biol Psychiatry 1999;46:882-91. [Medline]

Daring to Think Differently About Schizophrenia

An interesting article in today's The New York Times. To read the article, click here.

Darryle D. Schoepp (right) has helped develop new drugs for treating schizophrenia, relying on a novel approach for combating some symptoms of the disorder.



Photograph by Aaron Houston for The New York Times.

What is WRAP?



From the Copeland Center for Wellness & Recovery:
WRAP stands for Wellness Recovery Action Plan™

WRAP is a self-management and recovery system developed by a group of people who had mental health difficulties and who were struggling to incorporate wellness tools and strategies into their lives. WRAP is designed to:
  • Decrease and prevent intrusive or troubling feelings and behaviors
  • Increase personal empowerment
  • Improve quality of life
  • Assist people in achieving their own life goals and dreams.
WRAP is a structured system to monitor uncomfortable and distressing symptoms that can help you reduce, modify or eliminate those symptoms by using planned responses. This includes plans for how you want others to respond when symptoms have made it impossible for you to continue to make decisions, take care of yourself or keep yourself safe.

People who are using WRAP say:

“It helps me feel prepared.”

“I feel better more often and I’m able to improve the overall quality of my life.”

The person who experiences symptoms is the one who develops their personal WRAP. The person may choose to have supporters and health care professionals help them create their WRAP.

The WRAP system was developed by people who have been dealing with a variety of psychiatric symptoms for many years and who are working hard to feel better and get on with their lives. Mary Ellen Copeland has shared it with people with other illnesses and they too believe that it can be easily adapted for use with other conditions.

What People are Saying About WRAP . . .

"Recovery & WRAP have changed my life."

"I've gone from being totally disabled to being able to live a full and rich life. I am so grateful."

"Everything has improved at our organization. People are recovering and moving forward with their lives. Our work is so much more fulfilling."

“Finally, something I can do to help myself.”

“I used to spend months, even years, in the hospital. Now I have a bad afternoon or a bad day. And it's all because I use WRAP.”

“WRAP for me is about personal responsibility. I can just let my "symptoms" take over my life. Or I can take personal responsibility, use my WRAP, and do what I need to do to take care of myself and feel better.”

“In the years that I have been using WRAP, everything has changed in my life. I used to spend all my time just sitting around, watching TV and smoking. Now I hardly ever watch TV, I've given up smoking, I've gone back to school and I have a real job. And I have a wonderful partner. I never thought life could be this good.”

“This has changed my life completely. I used to think of myself as this "mentally ill" person. Now I am a person who knows how to take care of myself and help myself in difficult time. If I am feeling badly or having a hard time, I take action. And there are so many simple, safe things I can do.”

“When I was feeling badly I used to call the doctor or call the hotline. Now I check my list of Wellness Tools and do something I really enjoy. Usually its call a friend to go for a walk, go to a movie, watch a video or just talk.”

“The word crisis has a different meaning for me now. I used to think it was a crisis when I felt really anxious and upset. I thought I needed to go into the hospital or get my medications increased. Now a crisis is when everything is so bad I need others to take over for me. And I don't have them anymore, because now I know how to take care of myself.”
For other websites on WRAP visit:
  1. WRAP Personal Workbook (PDF)
  2. PsychCentral
  3. HealthyPlace.com
  4. MentalHealthRecovery.com
Thanks go to Dachia Joudrey for bringing these websites to my attention.

Sunday, February 17, 2008

Mental Health Commission of Canada Appoints President & CEO

A February 15th news release from the Mental Health Commission of Canada:
CALGARY, AB February 15, 2008 - The Honourable Michael Kirby, Chair of the Mental Health Commission of Canada (MHCC), today announced the appointment of Michael Howlett (right, standing) as the President and Chief Executive Officer of the newly formed Commission. His appointment will take effect February 18, 2008.

“Michael Howlett brings the vision, proven leadership and experience essential to help the Commission achieve its ultimate goal of keeping mental illness out of the shadows forever,” said Michael Kirby, Chair of the MHCC`s Board of Directors. “Michael Howlett has distinguished himself as a results-oriented business and non-profit sector leader who is respected for his work nationally and internationally. He understands the important balance of fiscal and philanthropic responsibility.”

Mr. Howlett is currently the President and CEO of the Canadian Diabetes Association (CDA). For the last five years, he has been a champion for those affected by diabetes, working with government, the medical and research community and business. Under his direction, the CDA experienced a dramatic turnaround. It has become a financially sound and effective national organization, internationally recognized as the authority in diabetes research, education and advocacy.

Mr. Howlett’s professional career spans three decades. Prior to joining CDA, he established himself both as a successful business leader and champion of causes that defended those who could not defend themselves.

“This is a great opportunity to make a difference. I have seen firsthand the effect poor mental health can have on a family, and I look forward to working on behalf of the Mental Health Commission to improve the lives of Canadians impacted by mental illness. We look to build strong partnerships with government and business to make mental health the foundation of total health,” said Mr. Howlett.

The MHCC is a non-profit organization created to focus national attention on mental health issues. It is funded by the federal government but operates at arm’s length from all levels of government. The Commission’s objective is to enhance the health and social outcomes for Canadians living with mental health problems and illnesses.

To achieve this goal the Commission is pursuing three key initiatives: leading the development of a national mental health strategy; creating a ten-year campaign to reduce the widespread stigma associated with mental health problems and illnesses; and establishing a Knowledge Exchange Centre to improve cross-sector communication about mental health and mental illness for all Canadians.

The Commission was announced by Prime Minister Stephen Harper in response to one of the recommendations in the report by the Standing Senate Committee on Social Affairs, Science and Technology, titled “Out of the Shadows at Last – Transforming Mental Health, Mental Illness and Addiction Services in Canada.” Former Senator Michael Kirby was Chair of the Senate Committee and Senator Wilbert Keon served as Deputy Chair during the drafting of the report.

Funding for the Mental Health Commission of Canada was provided by the Government of Canada in its March 2007 budget, and the Mental Health Commission’s Board of Directors held its first meeting on September 10, 2007.

Mr. Kirby expressed his appreciation to Glenn Thompson for his leadership as Interim President and CEO of the MHCC over the past 7 months.

About the Mental Health Commission of Canada
The Mental Health Commission of Canada is a non-profit organization created to focus attention on mental health issues and to work to improve the health and social outcomes of people living with mental illness. The Mental Health Commission of Canada is governed by a Board of Directors, consisting of 11 non-governmental directors, and seven who are appointed by Federal, Provincial and Territorial governments as well as the Chair – the Honourable Michael Kirby – who was appointed by the Government of Canada. The Board is assisted in its work by eight Advisory Committees.

- 30-

For more information contact:
Micheal Pietrus, Director Information Services
(403) 620-6154


Friday, February 15, 2008

Looking Beyond


An article by Sean Flinn in the February 14th edition of The Coast:

Connections Clubhouse brings together people with mental illness, creating a community within the community. The recent publication of Looking Beyond, for example, collects poetry, short stories, essays and art (drawings primarily---check out Jon Welland's stuff) by Connections members, and creates not only a document reflecting the daily life and vibe of the place, it also offers some damn fine writing to enjoy.

Though there was an editorial committee in place that selected the contributions, "everyone was given a chance to contribute---no one was turned away," explains Teresa Brown, editor of Looking Beyond.

Still, that didn't mean they published whatever was sent to them. According to Brown, the committee looked for honesty and a unique voice in submissions.

Adam Jack Pelley's short story "Sidewalk Sam (The Bum)" demonstrates the calibre of writing reached in these pages. Though it should've been called "Happy Thursday"---a line silently repeated by the narrator as he asks for spare change on Spring Garden---the story starts the collection off on a confident, strong note, giving insight into the interior experience of a life spent on the street. (The 1999 indie film Heater, starring Gary Farmer, does the same.) Pelley is in talks with a publisher, Brown says. Brown herself contributes two imaginative modern fables and a poem to Looking Beyond. "Writing for me is just about the release---letting it all hang out." As an editor, she says, "I simply did a lot in terms of encouraging people to be involved."

Clearly, the weekly creative writing class held at Connections Clubhouse is paying off.

The book is $15. Call 473-8692 or drop by 1221 Barrington for a copy.

Looking Beyond is available for loan from the SSNS library. Email ssns@ns.sympatico.ca or call 1-800-465-2601 for more information on borrowing this book.

Thanks go to John Devlin for bringing The Coast article on Looking Beyond to my attention.


Wednesday, February 13, 2008

The SSNS makes a presentation at Trenton Middle School

Staff and a volunteer from the Schizophrenia Society of Nova Scotia discussing schizophrenia and psychosis with Grade 9 students at Trenton Middle School on Monday, February 4th.

Click on the photographs to enlarge them.






All photographs by Jill Fraser, Trenton Middle School.

Saturday, February 9, 2008

Peer-Professional First-Person Account: Schizophrenia From the Inside—Phenomenology and the Integration of Causes and Meanings

Click here for a free PDF of Peter K. Chadwick's 2007 article in Schizophrenia Bulletin.

Suicide: scientific overview and relevance for trauma care providers

An abstract from the journal Trauma, Vol. 9, No. 3, 213-220 (2007):
By Marie Crandall

Department of Surgery, Northwestern University, Chicago, IL 60611, USA, mcrandall@northwestern.edu

The World Health Organization estimates that in the year 2000, approximately one million people died from suicide worldwide. Over the last 45 years, suicide rates have increased by 60%, with a particularly precipitous rise among young people. The underlying psychology of suicide is complex and individual. However, certain themes emerge from studying individuals who have attempted or completed suicides. This paper will provide an overview of suicide and suicidal behaviour as it relates to trauma practitioners, detailing risk factors, biologic and genetic interactions, and opportunities for prevention and treatment.

Key Words: trauma • injury • suicide • prevention • review • epidemiology

New schizophrenia treatment now available in Canada: Zeldox

A recent news release:
LEGER MARKETING RESEARCH SHOWS STRONG STIGMA ASSOCIATED TO DISEASE AFFECTING MORE THAN 300,000 CANADIANS

MONTREAL, Feb. 6 /CNW/ - Canadians with schizophrenia now have a new treatment option to manage their disease. Health Canada has approved ZELDOX(TM) (ziprasidone hydrochloride) for the treatment of schizophrenia and related psychotic disorders, bringing an important additional option to manage this chronic complex mental illness, which is highly stigmatized and misunderstood.

New research from Léger Marketing reveals the extent of the stigma associated with the disease. Seventy per cent of Canadians feel that those who suffer from schizophrenia are not always treated the same way as people who are not afflicted with the disease. Even more surprising is the fact that among those Canadians who have been personally diagnosed or know someone who has schizophrenia, 44 per cent say they would be uncomfortable having a person with schizophrenia spend the weekend in their home.

"ZELDOX(TM) is a welcome new treatment option because it controls the symptoms of schizophrenia and appears to cause less weight gain than other antipsychotic medications. Weight gain can increase the risk of developing diabetes and heart disease. These side effects are often distressing and stigmatizing and are a major reason that patients go off their medication," said Dr. Ashok Malla, Director of the Prevention and Early Intervention Program for Psychoses at the Douglas Mental Health University Institute in Montreal, Quebec. "ZELDOX(TM) has demonstrated an excellent safety and efficacy profile as demonstrated through over a decade of research and patient experience."

The Léger survey revealed the low level of awareness among Canadians about the impact of the side effects associated with many medications that are used to treat schizophrenia. Only one in ten Canadians (10 per cent) believes that those with schizophrenia stop their treatment due to weight gain and other side effects. Surprisingly, 57 per cent of Canadians who have been or know someone that has been diagnosed with schizophrenia believe that people with the illness stop their treatment because they are well enough.

In Canada, one in every hundred persons lives with schizophrenia - over 300,000 Canadians in all. It is characterized by symptoms such as delusions, hallucinations, unusual suspiciousness, becoming withdrawn, and becoming depressed or anxious. People who suffer from schizophrenia have difficulty performing tasks that require abstract memory and sustained attention.

Mary K. was diagnosed with schizophrenia in 2001. Frustrated by the fact that the first treatment she took caused her to gain upwards of 20 pounds, she found herself feeling exhausted and hungry all the time and she was unable to hold down a job. When her psychiatrist suggested that she participate in a clinical trial evaluating the efficacy of ziprasidone, she was enthusiastic at the prospect of trying a new treatment. Almost immediately after taking ZELDOX(TM), Mary was able to lose the weight she had gained and feel more energized. She was able to go back to school, earn a diploma and obtain a steady job. She has now been taking ZELDOX(TM) for the treatment and management of her schizophrenia for the past five years through a clinical trial.

"Since I began taking ZELDOX(TM), I can not only manage my symptoms, but I don't experience any of the side effects such as weight gain that were typical of other medications I had taken. ZELDOX(TM) has enabled me not only to regain control of my life but it has allowed me to enjoy my life."

The precise cause of schizophrenia remains unknown and there is no definitive cure. In 2006, the total cost of schizophrenia (both direct and indirect) in Canada was estimated to be $4.35 billion. It also places a substantial financial burden on sufferers themselves and their caregivers.

"The approval of ZELDOX(TM) represents a significant step forward for Canadians living with schizophrenia. It provides them with another option with which to treat this chronic mental condition, a condition that has a significant impact not only on individuals living with schizophrenia, but also on their families and on society," said Dr. Bernard Prigent, Vice-President, Medical Affairs, Pfizer Canada.

About ZELDOX(TM)
Discovered and developed by Pfizer, ZELDOX(TM) is a serotonin and dopamine antagonist which treats the symptoms characterized as both positive (e.g. visual and auditory hallucinations) and negative (lack of motivation and social withdrawal) as well as the overall psychopathology of the disease.

The efficacy of ZELDOX(TM) in the treatment of schizophrenia was established in the largest ever clinical trials program conducted for a novel antipsychotic medication prior to launch. The program involved four short-term and one long-term placebo-controlled clinical trials of psychotic inpatients who met the DSM-III-R criteria for schizophrenia. Each study included 2-3 fixed doses of ZELDOX(TM) as well as placebo. In clinical trials, ZELDOX(TM) demonstrated excellent positive, negative, and affective symptom efficacy as well as improvement in social impairment and cognitive symptoms in switch studies at 6 weeks versus olanzapine and risperidone. Several instruments were used to assess psychiatric signs and symptoms in these studies, among them the Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale (PANSS), both multi-item inventories of psychopathology traditionally used to evaluate the effects of drug treatment in psychosis.

As with many other atypical antipsychotics, the exact mechanism of action of ZELDOX(TM) is unknown. However, it has been proposed that the efficacy of this drug in schizophrenia is mediated through a combination of dopamine type 2 (D2) and serotonin type 2 (5HT2) antagonism. ZELDOX(TM) is the only atypical antipsychotic with data showing long-term improvement in metabolic parameters including weight, cholesterol and triglycerides. The most common side effects of ZELDOX(TM) include fatigue, nausea or upset stomach, constipation, dizziness, restlessness, abnormal movements, diarrhea, rash or increased cough/runny nose. One potential side effect of ZELDOX(TM) is that it may induce an abnormal heart rhythm, a risk that can be increased in patients who already have certain abnormal heart conditions or in those who are taking certain medications. ZELDOX(TM) is not recommended in patients who have Long QT Syndrome (LQTS), those who have had a recent heart attack, severe heart failure or certain irregularities of heart rhythm.

ZELDOX(TM) has been approved in 89 other countries worldwide and is marketed under the brand name GEODON in some countries, including the United States.

About Pfizer Canada Inc.
Pfizer Canada Inc. is the Canadian operation of Pfizer Inc, the world's leading pharmaceutical company. Pfizer discovers, develops, manufactures and markets prescription medicines for humans and animals. Pfizer's ongoing research and development activities focus on a wide range of therapeutic areas following our guiding aspiration ... Working for a healthier world. For more information, visit www.pfizer.ca.

ZELDOX, Pfizer Products Inc.
For further information: Christina Antoniou, Pfizer Canada, (514)693-4766 or (514) 208-5960, christina.antoniou@pfizer.ca; Sandra Cruickshanks, Thornley Fallis Communications, (416) 515-7517 x248, cruickshanks@thornleyfallis.com; Farah Meghji, Thornley Fallis Communications, (416) 515-7517 x249, meghji@thornleyfallis.com

Monday, February 4, 2008

Tasers - Update

From the January 30th broadcast of CBC Radio's The Current:
Back in 1993, as the story goes, two high school athletes had been shot to death in a road rage incident in Scottsdale, Arizona. One of their team-mates -- a man named Rick Smith -- decided there ought to be something other than a gun that people could use to defend themselves. So he and his brother Tom developed a stun gun that would send a jolt of electricity through the target. It was called the Air Taser 34,000. And it was the beginning of what would become the Taser Corporation.

Today, 25,000 American police officers use a Taser stun gun. Canadian police began using them in 2000; there are nearly 7,000 Tasers in use in Canada. And the company says it has sold Tasers to more than 60 countries.

But despite all that, there are still questions about the safety of Tasers, leading the House of Commons Public Safety Committee to undertake a review of Taser use in Canada.

CBC Reporter Sandra Bartlett looked into some of the questions surrounding Tasers as part of a CBC News and Radio Canada investigation, Sandra Bartlett joined us in Toronto to talk about what she found.
To listen to the program (21 minutes, 57 seconds), click here (RealPlayer).

Photograph of Anna Maria Tremonti courtesy of CBC.ca.

Thanks go to Dachia Joudrey for bring this program to my attention.

Friday, February 1, 2008

Scientists Can Predict Psychotic Illness In Up To 80 Percent Of High-risk Youth


For the full story, click here.

For the abstract of the paper published in the Archives of General Psychiatry, click here.

For a related story published in the February 1st issue of Psychiatric News, click here.



Major Problem Often Overlooked When Linking Violence, Illness

To read this article written by Mark Moran and published in the February 1st issue of Psychiatric News, click here.