Saturday, January 29, 2011

RG1678 looks promising for the treatment of schizophrenia

A January 28th posting by Gerson Lehrman Group:

This article will explore RG1678, a new schizophrenia drug from Roche.


RG1678 (molecular structure pictured) is a new compound under investigation by Roche for the treatment of schizophrenia. It is a unique drug in that it targets the negative symptoms of schizophrenia such as apathy and social withdrawal. The currently available medications for schizophrenia usually target the positive symptoms such as delusions and hallucinations. Another very interesting thing about RG1678 is its mechanism of action. It acts as a glycine reuptake inhibitor which normalizes glutamate neurotransmission by increasing synaptic levels of glycine. Elevation of extracellular synaptic glycine concentration by blockade of GlyT1 has been hypothesized to potentiate NMDA receptor function and may represent a new approach for the treatment of schizophrenia and cognitive disorders. Namenda is another drug which also works at the NMDA receptor to affect cognitive function.

RG1678 is currently in Phase 3 studies at Roche and the early results look very promising. Side effects to date have been mild and include anxiety and dose dependent mild elevation of hemoglobin. RG1678 may represent a fresh approach to the treatment of a difficult and debilitating illness.

By Gregg L. Friedman MD, Hallandale Beach, FL

Wednesday, January 12, 2011

Understanding Severe Mental Illness

A January 11th posting by the National Institute of Mental Health:
By Thomas Insel (pictured)

When a tragedy occurs like the shooting in Tucson this past weekend, all of us seek an explanation. While there remain many questions, a leading hypothesis is that the suspect has a serious mental illness (SMI), such as schizophrenia. The topic of violence and mental illness is never an easy discussion: with issues such as stigma, incarceration, public safety, and involuntary treatment in the mix. There is a legitimate concern that talking about violence and mental illness in the same sentence increases the likelihood that people with serious illness will be further marginalized and less likely to receive appropriate care. But tragic events, whether at a Safeway in Tucson or a classroom at Virginia Tech, require us to address this uncomfortable subject with the science available.

Is violence more common in people with SMI? Yes, during an episode of psychosis, especially psychosis associated with paranoia and so-called “command hallucinations”, the risk of violence is increased. People with SMI are up to three times more likely to be violent and when associated with substance abuse disorders, the risk may increase much further (1). But, mental illness contributes very little to the overall rate of violence in the community. Most people with SMI are not violent, and most violent acts are not committed by people with SMI. In fact, people with SMI are actually at higher risk of being victims of violence than perpetrators. Teplin et al found that those with SMI are 11 times more likely to be victims of violent crime than the general population (2).

The most common form of violence associated with mental illness is not against others, but rather, against oneself. In 2007, the most recent year for which we have statistics, there were almost 35,000 suicides, nearly twice the rate of homicides. Suicide is the 10th leading cause of death in the United States (3). Although it is not possible to know what prompted every suicide, it is safe to say that unrecognized, untreated mental illness is a leading culprit.

Treatment may be the key to reducing the risk of violence, whether that violence is self-directed or directed at others. Research has suggested that those with schizophrenia whose psychotic symptoms are controlled are no more violent than those without SMI (4). It’s likely that treatment not only helps ease the symptoms of mental illness, but also curbs the potential for violence as well.

As we learn more about the circumstances surrounding the tragedy in Tucson, we should be working harder to ensure people with SMI receive the care they need. Early intervention offers the best hope to prevent more tragedies in the future.

For more information on SMI and other mental health statistics, please visit NIMH’s Statistics page.

  1. Swanson JW. Mental disorder, substance abuse, and community violence: an epidemiological approach. In: Monahan J, Steadman HJ, eds. Violence and mental disorder: developments in risk assessment. Chicago: University of Chicago Press, 1994:101-36.

  2. Teplin et al. Crime victimization in adults with severe mental illness. Archives of General Psychiatry. 2005 Aug. 62. 911-921.

  3. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS).

  4. Steadman HJ, Mulvey EP, Monahan J, et al. Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Arch Gen Psychiatry 1998;55:393-401.

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Sunday, January 9, 2011

Tragic cases show how much we misunderstand mental illness

An opinion piece published in the January 8th edition of The Chronicle Herald:
By Lezlie Lowe (pictured)

How many times have I heard this?

"She had everything."

Last time was New Year’s Day, when a family member and I were chatting about the November suicide of Daron Richardson, the 14-year-old daughter of Ottawa Senators assistant coach Luke Richardson.

Daron was a top student and hockey ace. She had, as it goes, everything.

Well, sure she did. She had pools, private school and iPods, but not her health — not her mental health.

It’s not uncommon to hear this logic tossed around: the better off a person is, the less likely he or she will suffer from psychiatric disorders.

And it’s true; mental distress is more prevalent in lower income households in Canada. But wealth, by no means, acts as a prophylactic against depression or psychosis. Just ask the family of Ali Reza Pahlavi, the son of the former Shah of Iran, who suffered from depression and shot himself Tuesday.

Mental illness isn’t a plague of the underprivileged or the fate of those who aren’t smart enough or committed enough or canny enough to seek out help, take their medication and stay in treatment.

Mental illness can be tweaked by our actions, sure. But it isn’t a choice. Ask yourself: if your best friend developed pancreatic cancer, would you ever say, "I just can’t understand it. He had everything."

And what of convicted killer Glen Douglas Race?

Race was a normal Dartmouth kid. Did he have everything? Perhaps not yachts, ponies and private jets, but by all accounts he had all the things most of us need to get by. And more than many have. Nevertheless, Race faced steady psychotic episodes. He was diagnosed with paranoid schizophrenia in 2001 in his second year at Dalhousie University.

To say Race’s illness was debilitating is an understatement. Race has been sentenced to life in prison for the upstate New York killing of Darcy Manor, a husband and father of two. He also stands accused of the first-degree murder of two Halifax men, Michael Paul Knott and Trevor Charles Brewster. Race’s parents and brother spoke publicly Wednesday, offering condolences to the families of the victims and raising this issue: Race needed more help than his family could give. And, more importantly, Race needed more help than the Nova Scotia mental health care system could offer.

Several families are in mourning now, Glen’s mother Donna Race said, because her son didn’t get the care his illness required.

The Involuntary Psychiatric Treatment Act, which could have forced Race into care and kept him from harming others, didn’t become law until July 2007, two months after the then 26-year-old was arrested trying to cross the U.S.-Mexico border with a rifle.

That policy is in place now. And it’s something. But it’s not enough. Our financial commitment to mental health still demonstrates a grave misunderstanding of its pervasiveness and seriousness.

As the Race family pointed out this week, in a painful and oft-repeated reminder, the system needs cash.

One in five Nova Scotians suffers from mental illness and Nova Scotia spends less than five percent of its health care budget on mental health.

In June, auditor general Jacques Lapointe released a report saying the province was failing to meet mental health treatment standards. Moreover, those failures were inadequately unmonitored, with no plan for a fix.

In short? We treat mental health like a joke; like it’ll clear up on its own.

Especially, we imagine, when those suffering from it have everything.


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Thursday, January 6, 2011

Mental health beds full up

An article published in the January 5th edition of The Chronicle Herald:
Capital Health faced with ‘unrelenting demand’ for admissions since September

By John McPhee, Health Reporter

Capital Health’s psychiatric care system has been under "almost unrelenting" pressure this fall, the head of psychiatric services said Tuesday.

Every one of the district’s 69 mental health acute care beds has been filled since September.

Ian Slayter [pictured] doesn’t know why there has been such a continuous need for admission.

"Our length of stay has decreased a little bit but we still have a lot of people coming for care," he said. "Any particular week, it’s not more than usual, but we’ve had week after week of almost unrelenting demand for beds."

Those who are waiting for acute care beds are either kept in the emergency department where they were admitted or, more preferably, sent to a psychiatric bed in a nearby health district, Slayter said.

Compounding the problem, patients often stay in psychiatric beds after they’re ready to be discharged. That’s because there’s often nowhere in the community — such as supported apartments or nursing home beds — for them to go, Slayter said.

"It’s like filling up a bathtub. Sooner or later you’re gong to overflow."

A woman who contacted The Chronicle Herald said she was turned away from the Cobequid Community Health Centre’s emergency department this week, even though she was told she needed treatment.

The elderly Beaver Bank woman, who didn’t want to be identified, said she was previously treated and hospitalized for acute anxiety.

"One doctor tried to get me in the hospital (but) another doctor told me that the beds were filled," she said. "We have a desperate problem here."

Slayter couldn’t comment on the woman’s specific case, but said hospitals don’t send anyone home who needs to be admitted.

"If the people assessing the patient feel they need to be in hospital . . . then we will keep them in emergency until we have a bed to send them to," he said.

Psychiatric services has been trying to deal with the shortage of psychiatric beds with several programs, Slayter said.

"We’ve been taking some of the more complex cases and building residential placements for people," he said. "It costs quite a bit of money — it’s a 24-hour support service — but when no one else has been willing to take them, we’ve done that in several cases over the past couple of years."

In another program, 35 to 40 people have been placed in supported apartments, where people live alone but they can call for help any time of the day, he said.

And plans are in the works for a psychiatric intensive care unit at the East Coast Forensics Hospital in Dartmouth. Five to 10 beds will be established in early spring for people at a high risk of harming themselves or others.


Tuesday, January 4, 2011

Laura Burke on CBC Radio's The Current

From the CBC Radio 1 program, The Current:
From the Heart

The story of a poet who was diagnosed with schizophrenia and her struggle to separate her medical condition from her muse.
To listen to the segment, please click here.