Tuesday, March 29, 2011

Psychiatric Intensive Care Unit (PICU)



From the March 28th edition of the Capital District Mental Health Program's Mental Health Happenings:
The Mental Health Program and the Department of Psychiatry are opening a Psychiatric Intensive Care Unit (PICU) at the East Coast Forensic Hospital (ECFH). This is for short-term stabilization of highly-agitated individuals, admitted to other mental health units with involuntary status, who are exhibiting aggressive and harmful behaviour towards others on their current unit. On April 1, 2011, the PICU will open for patients from inpatient psychiatry units in Capital Health. Referrals will be from the current attending psychiatrist to an ECFH psychiatrist.

The Psychiatric Intensive Care Unit is located in one of the Rehabilitation Units at the East Coast Forensic Hospital. The PICU has six single bedrooms, a spacious dayroom with lots of natural light, and a secure patio area. The whole of ECFH is specifically designed to create a calming atmosphere. The unit is staffed by clinicians who work effectively with a population whose specific needs include de-escalation of behaviours that pose a risk for harm to themselves and others.

The PICU will soon become a provincial resource - open to all the district health authorities across the province. Referrals will be made by a physician in the referring district, usually a psychiatrist, to a psychiatrist at the East Coast Forensic Hospital.

Please find attached the referral form and patient information handbook [actually a handbook for families]. [Links to these two documents are found below.]

If you have any questions, please contact James MacLean or Dr. Scott Theriault [460-7343; scott.theriault@cdha.nshealth.ca].

You are also welcome to call or email either of us.

Thank you.

Peter and Nick

Peter Croxall, Director
Capital Health Mental Health Program
464-4147
peter.croxall@cdha.nshealth.ca

Nick Delva, Professor and Head
Dalhousie University Department of Psychiatry
473-2464
Nicholas.Delva@cdha.nshealth.ca

PICU Handbook - March 2011

PICU Referral - March 2011


Photo credit

Understanding schizophrenia: researchers uncover new underlying mechanism


A March 28th media release from The Hospital for Sick Children:
TORONTO – A new way of thinking about the fundamental pathobiology of schizophrenia could one day lead to improved therapeutic approaches to treating this disorder. Researchers at The Hospital for Sick Children (SickKids), the University of Toronto and Tufts University School of Medicine have linked proteins and genes that are implicated in schizophrenia in a novel way. The study is published in the March 27 advance online edition of Nature Medicine.

Schizophrenia is a disorder that affects one per cent of Canadians and 24 million people worldwide. A team of researchers led by Dr. Michael Salter [pictured], SickKids Senior Scientist and Professor of Physiology at the University of Toronto, identified a biochemical pathway in the brain that may contribute to the neurobiological basis of schizophrenia.

“This is a paradigm shift in the way that we view the neural mechanisms of schizophrenia,” says Salter, Head of the Program in Neurosciences and Mental Health at SickKids Research Institute. “With our discovery we have brought together in a new way pieces of the schizophrenia puzzle. We hope that the understanding we have put together will lead to new forms of treatment that are more effective than the ones that are currently available.”

The scientists studied in mice two partner proteins, NRG1 and ErbB4, and the effect they have on a key brain receptor known as the N-methyl D-aspartate glutamate receptor (NMDAR). While NRG1 and ErbB4 have been genetically implicated in schizophrenia, the new study finds an unexpected link to NMDARs.

The NMDAR is a major component of synapses -- the highly specialized sites of communication between the brain’s billions of individual nerve cells -- that is critical for many brain functions including learning and memory. Suppressed functioning of NMDARs was suspected in schizophrenia because drugs that block NMDARs cause the hallucinations and disordered think, that occur in schizophrenia.

It had been suspected that NRG1 and ErbB4 might suppress generally NMDAR function but the present study found this was not the case. Rather, the researchers discovered that NRG1 and ErbB4 work together through inhibiting another protein, Src. The link to NMDARs is that Src normally increases NMDAR function under circumstances when this is needed such as in learning and memory. The researchers found that by blocking Src, NRG1 and ErbB4 selectively prevented that critical boost in NMDAR function.

The researchers also studied the responses of nerve cells during brain activity that mimicked normal brain oscillations known as theta rhythm. Theta rhythm activity, which is critical for learning and memory, is impaired in individuals with schizophrenia. The researchers determined that by acting through Src, NRG1 and ErbB4 greatly reduced the nerve cell responses to theta rhythm activity.

The findings suggest new approaches to schizophrenia treatment by reversing the effects of NRG1 and ErbB4 through enhancing the Src boost of NMDARs. “The tricky part is that all of these proteins are involved in other functions of the body; we can’t randomly enhance or inhibit them as this would lead to side effects,” says Salter. “The key will be to develop clever ways to target the proteins in the context of the synapse.”

This study is funded by supported by the Canadian Institutes of Health Research, the Deafness Research Foundation, Howard Hughes Medical Institute and SickKids Foundation.


About The Hospital for Sick Children

The Hospital for Sick Children (SickKids) is recognized as one of the world’s foremost paediatric health-care institutions and is Canada’s leading centre dedicated to advancing children’s health through the integration of patient care, research and education. Founded in 1875 and affiliated with the University of Toronto, SickKids is one of Canada’s most research-intensive hospitals and has generated discoveries that have helped children globally. Its mission is to provide the best in complex and specialized family-centred care; pioneer scientific and clinical advancements; share expertise; foster an academic environment that nurtures health-care professionals; and champion an accessible, comprehensive and sustainable child health system. SickKids is proud of its vision of Healthier Children. A Better World.™ For more information, please visit www.sickkids.ca.

About SickKids Research & Learning Tower

SickKids Research & Learning Tower will bring together researchers from different scientific disciplines and a variety of clinical perspectives, to accelerate discoveries, new knowledge and their application to child health — a different concept from traditional research building designs. The Tower will physically connect SickKids science, discovery and learning activities to its clinical operations. Designed by award-winning architects Diamond + Schmitt Inc. and HDR Inc. with a goal to achieve LEED® Gold Certification for sustainable design, the Tower will create an architectural landmark as the eastern gateway to Toronto’s Discovery District. SickKids Research & Learning Tower is funded by a grant from the Canada Foundation for Innovation and community support for the ongoing fundraising campaign. For more information, please visit www.buildsickkids.com.

For more information, please contact:

Matet Nebres
Manager, Media Relations
Communications and Public Affairs
The Hospital for Sick Children
Phone: 416-813-6380
Fax: 416-813-5328
email: matet.nebres@sickkids.ca

Suzanne Gold
Communications Specialist - Media Relations
Communications and Public Affairs
The Hospital for Sick Children
Phone: 416-813-7654 ext. 2059
Fax: 416-813-5328
email: suzanne.gold@sickkids.ca

Photo credit

Sunday, March 27, 2011

Schizophrenia, “Just the Facts” 6. Moving ahead with the schizophrenia concept: From the elephant to the mouse


The abstract of an article published in the April 2011 issue of Schizophrenia Research:
By Matcheri S. Keshavan, Henry A. Nasrallah, and Rajiv Tandon

Abstract

The current construct of schizophrenia as a unitary disease is far from satisfactory, and is in need of reconceptualization. The first five papers in our “facts” series reviewed what is known about schizophrenia to date, and a limited number of key facts appear to stand out. Schizophrenia is characterized by persistent cognitive deficits, positive and negative symptoms typically beginning in youth, substantive heritability, and brain structural, functional and neurochemical alterations including dopaminergic dysregulation. Several pathophysiological models have been proposed with differing interpretations of the illness, like the fabled six blind Indian men groping different parts of an elephant coming up with different conclusions. However, accumulating knowledge is integrating the several extant models of schizophrenia etiopathogenesis into unifying constructs; we discuss an example, involving a neurodevelopmental imbalance in excitatory/inhibitory neural systems leading to impaired neural plasticity. This imbalance, which may be proximal to clinical manifestations, could result from a variety of genetic, epigenetic and environmental causes, as well as pathophysiological processes such as inflammation and oxidative stress. Such efforts to “connect the dots” (and visualizing the elephant) are still limited by the substantial clinical, pathological, and etiological heterogeneity of schizophrenia and its blurred boundaries with several other psychiatric disorders leading to a “fuzzy cluster” of overlapping syndromes, thereby reducing the content, discriminant and predictive validity of a unitary construct of this illness. The way ahead involves several key directions: a) choosing valid phenotype definitions increasingly derived from translational neuroscience; b) addressing clinical heterogeneity by a cross-diagnostic dimensional and a staging approach to psychopathology; c) addressing pathophysiological heterogeneity by elucidating independent families of “extended” intermediate phenotypes and pathophysiological processes (e.g. altered excitatory/inhibitory, salience or executive circuitries, oxidative stress systems) that traverse structural, functional, neurochemical and molecular domains; d) resolving etiologic heterogeneity by mapping genomic and environmental factors and their interactions to syndromal and specific pathophysiological signatures; e) separating causal factors from consequences and compensatory phenomena; and f) formulating or reformulating hypotheses that can be refuted/tested, perhaps in the mouse or other experimental models. These steps will likely lead to the current entity of schizophrenia being usefully deconstructed and reconfigured into phenotypically overlapping, but etiopathologically unique and empirically testable component entities (similar to mental retardation, epilepsy or cancer syndromes). The mouse may be the way to rescue the trapped elephant!

Keywords: Schizophrenia, Models, Heterogeneity, Etiology, Pathophysiology, Phenotype, Treatment, Biology

Posting of the abstract is for the purposes of research into schizophrenia.

No health without mental health: a cross-government mental health outcomes strategy for people of all ages (UK)



Please click on the image to magnify it.


Published February 2nd, 2011. To download the entire document (PDF), please click here.

For related documents, please click here.

Friday, March 25, 2011

Metabolome in schizophrenia and other psychotic disorders: a general population-based study

A provisional abstract posted on March 23 by Genome Medicine:
By Matej Oresic, Jing Tang, Tuulikki Seppanen-Laakso, Ismo Mattila, Suoma E Saarni, Samuli I Saarni, Jouko Lonnqvist, Marko Sysi-Aho, Tuulia Hyotylainen, Jonna Perala and Jaana Suvisaari

Abstract (provisional)

Background

Persons with schizophrenia and other psychotic disorders have a high prevalence of obesity, impaired glucose tolerance, and lipid abnormalities, particularly hypertriglyceridemia and low HDL. More detailed molecular information on the metabolic abnormalities may reveal clues about the pathophysiology of these changes, as well as about disease specificity.

Methods

We applied comprehensive metabolomics in serum samples from a general population-based study in Finland. The study included all persons with DSM-IV primary psychotic disorder (schizophrenia n=45, other nonaffective psychosis (ONAP) n=57, affective psychosis n=37) and controls matched by age, sex, and region of residence. Two analytical platforms for metabolomics were applied to all serum samples: (1) global lipidomics platform based on Ultra Performance Liquid Chromatography coupled to mass spectrometry, which covers molecular lipids such as phospholipids and neutral lipids and (2) platform for small polar metabolites based on two-dimensional gas chromatography coupled to time-of-flight mass spectrometry (GCxGC-TOFMS).

Results

Compared with their matched controls, persons with schizophrenia had significantly higher metabolite levels in six lipid clusters containing mainly saturated triglycerides and in two small-molecule clusters containing, among other metabolites, (1) branched chain amino acids phenylalanine and tyrosine and (2) proline, glutamic, lactic and pyruvic acids. Among these, serum glutamic acid was elevated in all psychoses (P=0.0020) as compared to controls, while proline [moleculecular structure illustrated] upregulation (P=0.000023) was specific to schizophrenia. After adjusting for medication and metabolic comorbidity in linear mixed models, schizophrenia remained independently associated with higher levels in seven of these eight clusters (P<0.05 in each cluster). The metabolic abnormalities were less pronounced in persons with ONAP or affective psychosis. Conclusions

Our findings suggest that specific metabolic abnormalities related to glucoregulatory processes and proline metabolism are specifically associated with schizophrenia and reflect two different disease-related pathways. Metabolomics may become a powerful tool in psychiatric research to investigate disease susceptibility, clinical course, and treatment response, sensitive to both genetic and environmental variation.


The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Posting of this abstract is for the purposes of research into schizophrenia and psychosis.

Wednesday, March 23, 2011

Mental health care for the few


An article posted on March 22nd by MacLeans.ca:
Each year, seven million of us experience mental illness. Many can’t get help.

By Ken Macqueen and Julia Belluz

On March 29, Maclean’s hosts “Health Care in Canada: Time to Rebuild Medicare,” a town hall discussion at the Winspear Centre in Edmonton. The conversation on health care, held in conjunction with the Canadian Medical Association and broadcast by CPAC, continues in coming months in Maclean’s and at town halls in Vancouver and Ottawa.

Mental illness, and what passes for Canadian mental health policy, has been called the “orphan of health care,” and perhaps that’s true. It’s also been called an invisible disease, but that’s not really the case. The mentally ill have many faces. They are in our schools, our homes, our emergency wards. They are in our jails, in our graveyards; they are on our Olympic team.

They are people with names. Jack Windeler, a Queen’s University student of great promise, began to miss classes, skip assignments, withdraw from friends. A year ago on March 27, he killed himself in his residence room. He was 18. BobbyLee Worm [pictured], a deeply troubled 24-year-old Aboriginal woman from Saskatchewan, has spent some three years locked in solitary confinement in a B.C. prison, counting the bricks of her cell. Speed skater and cyclist Clara Hughes overcame a troubled adolescence to compete for Canada at the 1996 Olympics. Afterwards, she fell into a profound depression, slogging “through quicksand and hopelessness.” She sought help. She fought back to become one of Canada’s greatest athletes, and the kind of role model who can shatter stereotypes and stigmas surrounding mental illness.

This, then, is the state of mental health policy in Canada: scattered flashes of brilliance amid quicksand, hopelessness and waste. Canada is the only G7 country without a national mental health strategy, says Louise Bradley, president of the Calgary-based Mental Health Commission of Canada, a four-year-old agency mandated to finally draft a coherent approach to the issue. She blames the shame surrounding mental health issues for the lesser priority and lower funding accorded treatment of psychiatric disorders. Bradley, a nurse and former front-line mental health worker, sees the stigma in the public, but even among health care workers and those with mental illnesses. It’s tragic, she says, since hardly anyone is untouched by the problem. When people discover her job, they always have stories. “Every time it starts out in hushed tones,” she says. “And yet here we are in 2011 still with it shrouded with embarrassment and fear.”

The need is obvious. The annual cost to the economy in lost productivity was pegged at $51 billion in a report last year by researchers at the Centre for Addiction and Mental Health (CAMH). Some seven million Canadians will experience a mental illness this year, including depression, substance abuse and psychotic episodes. Many go undiagnosed, some suffer silently, others self-medicate with drugs or alcohol. They overwhelm family doctors or jam emergency wards ill-suited to their needs. They face long waits for counselling.

“Access to mental health services overall is pretty poor,” says Steve Lurie, executive director of the Canadian Mental Health Association. “In Ontario, basically one in three adults get access. If you’re a child, it’s worse. It’s one in six,” he says. “We wouldn’t accept that for cancer. We wouldn’t accept that for heart [disease] or if you have a broken leg.” Psychiatric care is far more likely to be provided to wealthy adults, says Dr. Michael Rachlis, a Toronto-based health policy consultant. “Children and youth is much harder work,” he says, “and it tends not to pay as well as sitting in your office and seeing people who have less serious problems.”

Many of the needed public services are delivered piecemeal or they fall outside of medicare. Sarah Cannon of St. Catharines, Ont., executive director of Parents for Children’s Mental Health, lost her husband to suicide eight years ago. He suffered from bipolar disorder. Their daughter Emily received a similar diagnosis at age five. Finding quality treatment was a struggle. Emily’s teachers used different treatment strategies from those offered by her community mental health workers. “[There's] a lack of consistency,” she says, “lack of them speaking with each other.” At times, Cannon was spending as much as $800 a month on drugs not covered by Ontario’s health plan. Emily, now 14, is being effectively treated with mood stabilizers, in combination with counselling and occupational therapy. “I want a system that is integrated, that communicates and coordinates,” Cannon says, “that is funded the same way they would fund a system that treats a child with physical health problems.”

Most psychological care, for example, is paid privately, putting it beyond the reach of many. About seven per cent of government health expenditures go to mental health, well below most developed countries.

Suicide is the second leading cause of death for young Canadians. Some, like Jack Windeler, never even seek help. His heartbroken family has launched a youth public awareness campaign, honouring his final wish that others benefit from his story. Bill MacPhee, 48, of Fort Erie, Ont., is alive because he got help, eventually. He was diagnosed with schizophrenia at 24. “After that, I was hospitalized six times, lived in three group homes, had a suicide attempt,” he says.

It was medication and the help of a mentor that got him on track. In 1994, he founded SZ Magazine, for those affected by schizophrenia. As an advocate for those with mental illness, he sees many flaws in the system. Newer, more effective drugs aren’t covered by Ontario’s assistance plan for the disabled, and support systems are uncoordinated, he says. The Ministry of Health operates in one “silo,” the welfare system in another, community housing in another still. Misplaced ideas about patient confidentiality isolate parents. “Many people are being discharged out of hospital without a place to stay, without letting parents know,” he says. “They are trying to help sons and daughters—they’re not able to do that.”

Far too many who need treatment instead end up in jail, often with addictions compounding their mental illness. The number of male federal prisoners receiving drugs for mental illnesses has more than doubled in a decade, to 21 per cent. For women prisoners, the medication rate is an astonishing 46 per cent. The estimate of prisoners with psychiatric disorders ranges from 64 per cent to 81 per cent in one study by the Correctional Service of Canada. Among them is BobbyLee Worm, serving more than six years for robbery and other offences. She arrived at B.C.’s Fraser Valley Institution addicted to drugs and with a history of physical, emotional and sexual abuse. She’s spent years in segregation after repeated fights with prisoners. The isolation has caused “significant signs of psychological deterioration,” claims the British Columbia Civil Liberties Association in a lawsuit filed this month against the federal government.

The news isn’t all grim. There are good strategies in place, though they are often “well-kept secrets,” says Bradley of the mental heath commission. The commission itself is in the midst of an ambitious campaign to reduce the public stigma of mental illness, and aims to release its national mental health strategy by this time next year.

It is likely to build on the success of programs scattered across the country. Saskatchewan has been changing its delivery of services for children and youth, where mental health issues often begin. It includes parent mentoring and “preventive intervention programs” at 16 sites across the province for vulnerable children under five years old, and outreach programs in Aboriginal communities. In Saskatoon, psychologists and counsellors work from inner-city schools. Mental health is part of a larger “school wellness initiative” where speech pathologists, occupational therapists, nurses and counsellors work together. In addition, addiction workers operate in the inner city, says Rob Strom, coordinator for community and youth addiction teams in Saskatoon. “Our workers are out helping our clients get to appointments, get hooked up to the right services, taking them out for lunch or coffee, building relationships.”

Hamilton, meantime, has become a model for breaking barriers between family doctors and mental health services. Counsellors and psychiatrists are integrated into the offices of 150 family doctors in the area, in a program started in 1994, under the guidance of Nick Kates, a psychiatrist and professor at McMaster University. The program is as effective as it should have been obvious. Doctors are usually the first point of contact for those with mental issues, diagnosed or otherwise. Rather than a referral and a long wait, there’s immediate mental health counselling available, says Kates, “in an environment that people find is less stigmatizing and more comfortable.” Doctors in the program refer 11 times as many people for mental health assessments as they did before. Hospitalizations for mental health have dropped 10 per cent for patients of participating doctors, says Kates. The good news is patient-focused care saves money. “The key to successful change is not just throwing more and more resources into the system,” he says. “It’s redesigning the system and using existing resources differently.”

The same optimistic note is sounded by Dr. David Goldbloom, medical adviser for CAMH, and vice-chairman of the mental health commission. While there is a desperate need to improve services, especially for children, he says the issue is finally on the political radar. The cost of mental illness, to individuals and families, and its impact on society and the economy is too massive to ignore, he says. “Both a humanitarian and business argument can be made for doing a better job in this country around the provision of understanding, of help and of hope.”

Also see:

Sask. woman sues over solitary confinement


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Tuesday, March 22, 2011

More than a quarter of a million votes by Canadians choose 2011 Mental Health Stamp design

The 2011 Mental Health Stamp!




A March 22nd media release from the Canada Post Foundation for Mental Health:
More than a quarter of a million votes by Canadians choose 2011 Mental Health Stamp design

For the first time in history, public makes final selection on Canadian stamp

OTTAWA (ON) – THE PUZZLE, an original design by Terrebonne resident Miriane Majeau, has been chosen as Canada Post’s 2011 Mental Health Stamp, the first time in the post office’s history a stamp design was chosen by public vote. Ms. Majeau’s design received the most points, to win the stamp design competition. Overall, more than 286,000 votes were recorded.

“I’m very proud that my design connected with people. Dealing with mental health issues can be like putting a puzzle together,” Ms. Majeau noted. “But as the puzzle comes together, as you find the right pieces and connect them in the right way, something beautiful and whole is revealed.” Ms. Majeau will receive a framed commemorative enlargement of the final stamp featuring her design, and a $500 honorarium will be donated to La Fondation les petits trésors de l'Hôpital Rivière-des-Prairies, a mental health charity chosen by Ms. Majeau.

Of the more than 300 stamp designs submitted last fall, 75 were chosen as semi-finalists by a panel of mental health consumers, advocates, philatelists and designers. The Stamp Advisory Committee (a national committee that guides Canada Post in selecting stamp subjects and designs) narrowed that selection down to the five designs that were voted on by the public.

Concepts and design elements from the four remaining designs will be used on the Official First Day Cover envelope, and the souvenir sheet, for the 2011 Mental Health Stamp issue. “Each of these designs does an excellent job of raising awareness of the mental health issue and breaking down the stigma attached to it,” said Honourable Rob Merrifield, Minister of State (Transportation) and Minister responsible for Canada Post.

The other finalist designs are: BEAUTIFUL HOPE (designed by Richard Green of Toronto (ON)), FORECAST HOPE (designed by Marie Tomeoki of Toronto (ON)), NO NEED TO HIDE (designed by Brian Blatnicki of London (ON)) and THE FACE OF MENTAL ILLNESS (designed by Norbert Lisinski of Courtice (ON)).

The 2011 Mental Health stamp will be issued on September 6, as part of the kick-off for the company’s annual fundraising campaign, which last year raised $2.2 million dollars. More than 4 million of the stamps will be printed with a dollar from every booklet of 10 stamps sold donated to the Canada Post Foundation for Mental Health.

Canada Post made mental health its cause of choice in 2008. Since then, customers, employees, suppliers and the public have raised more than $4.8 million for the Canada Post Foundation for Mental Health. Almost $1 million of that was from sales of the 2008, 2009 and 2010 mental health stamps.

Wednesday, March 16, 2011

The Lunenburg County Chapter of the SSNS has a new weblog



Please click on the image to magnify it.

To visit the Lunenburg County Chapter's new weblog, please click here.

Sunday, March 13, 2011

Eleanor Owen's tireless battle for mental-health care


An article published in the March 12th edition of The Seattle Times:
Having a son with schizophrenia, Seattle's Eleanor Owen knows firsthand the heartache and worry families face. She joined others to found the National Alliance on Mental Illness.

By Maureen O'Hagan

HE IS your child.

You watch him go from artist to hermit, from scholar to stranger. He starts sleeping in the basement, in a box. You tell yourself it's an adolescent phase.

He walks the streets, barefoot and disheveled, a blanket around his shoulders and letters shaved into his head. Could it be drugs?

Then one day you find a noose he'd hung from a pipe.

Another day, he gets arrested after creating a disturbance at the train station, trying to get from Seattle to San Francisco on a movie-ticket stub.

Eleanor Owen [pictured] was teaching and staging children's plays. Her husband, John, was an engineer. They were well-educated and comfortable and endlessly resourceful. Yet they felt helpless.

Their son's life, Eleanor says, "became more and more tragic."

At some point, she realized two things.

Her son had schizophrenia.

And she would fight for him with all her might.

To read the entire story, please click here.


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Tuesday, March 8, 2011

Mental health system 'fragmented'


An article published in today's edition of The Chronicle Herald:
Canada lacks strategy, public forum told

By John McPhee, Health Reporter

Canada is the only G8 country that doesn’t have a national mental health strategy, a public forum was told Monday.

In fact, it would be a stretch to say we have a mental health system at all, said Louise Bradley (pictured), president and chief executive officer of the Mental Health Commission of Canada.

"It’s too fragmented to be called a system," Bradley told more than 250 people who packed two large rooms in the Halifax Forum complex for the forum.

The commission, made up of 50 staff members and 120 volunteers, was created three years ago as a result of the Kirby report on mental health and addiction in 2006. It was given a 10-year mandate to address such issues as homelessness, stigma and mental health "first aid," which seeks to identify and address problems as early as possible.

But it is up to grassroots organizations and the provinces to make the commission’s plan a reality, said Bradley, the former head of mental health services at the Capital district health authority.

"If we have no ability to implement anything, it’s going to be a waste of time and a waste of money."

The forum was jointly sponsored by Dalhousie University’s psychiatry department and the Mental Health Coalition of Nova Scotia, made up of individuals and organizations focused on addressing mental health issues.

The province puts about 3.8 per cent of roughly $3.5 billion in health spending into mental health services.

"The system has to work, the capacity has to be built up," Nick Delva, the head of the Dalhousie psychiatry department and co-leader of Capital Health mental health services, said in an interview.

"I don’t think that’s occurring right now. Many people aren’t getting care."

Delva spoke at the forum along with other care providers and advocates from the province and Capital Health.

He singled out the need for housing and treatment in the community for people dealing with complex problems.

"Any particular day here (in Capital Health), we have 50 to 70 people in our in-patient beds who could be placed in the community if there were adequate support."

During question-and-answer sessions, Delva and other speakers heard criticism about access to mental health services, particularly in rural areas.

"There’s plenty of mental health services, but there’s no way people can access them," said Randy Carter of East Jeddore, Halifax County, who noted the lack of public transportation outside of urban centres.

"Something has seriously got to be done because I’ve been involved in this for 40 years and it’s still the same as it was back then."

Collaboration among all government levels are crucial to addressing these kinds of problems, said Susan Kilbride Roper, the co-chairwoman of the mental health coalition.

She particularly welcomed the national commission’s work and that of the Nova Scotia mental health strategy advisory committee.

"We’ve got a bunch of advocates, federal advocates, we’ve never had that before," Kilbride Roper said in an interview. "This is the good news. Getting back to the bad news, the issues are still there and they’re becoming increasingly (serious). Hospital wait times, services in the community, there’s not enough funding. Provincially, we have a lot more work to do."

(jmcphee@herald.ca)

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Wednesday, March 2, 2011

Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study



The abstract of an article published in the March 1st edition of the British Medical Journal:

By Rebecca Kuepper, research psychologist (1), Jim van Os, professor (1), visiting professor (2), Roselind Lieb, professor (3,4), Hans-Ulrich Wittchen, professor (4,5), Michael Höfler, research statistician (5), Cécile Henquet, lecturer (1)
  1. Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Center, Maastricht, Netherlands
  2. King’s College London, King’s Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, UK
  3. Department of Psychology, Division of Epidemiology and Health Psychology, University of Basel, Switzerland
  4. Max Planck Institute of Psychiatry, Munich, Germany
  5. Institute of Clinical Psychology and Psychotherapy, Technical University Dresden, Germany

Objective

To determine whether use of cannabis in adolescence increases the risk for psychotic outcomes by affecting the incidence and persistence of subclinical expression of psychosis in the general population (that is, expression of psychosis below the level required for a clinical diagnosis).


Design

Analysis of data from a prospective population based cohort study in Germany (early developmental stages of psychopathology study).


Setting

Population based cohort study in Germany.


Participants

1923 individuals from the general population, aged 14-24 at baseline.


Main outcome measure

Incidence and persistence of subthreshold psychotic symptoms after use of cannabis in adolescence. Cannabis use and psychotic symptoms were assessed at three time points (baseline, T2 (3.5 years), T3 (8.4 years)) over a 10 year follow-up period with the Munich version of the composite international diagnostic interview (M-CIDI).


Results

In individuals who had no reported lifetime psychotic symptoms and no reported lifetime cannabis use at baseline, incident cannabis use over the period from baseline to T2 increased the risk of later incident psychotic symptoms over the period from T2 to T3 (adjusted odds ratio 1.9, 95% confidence interval 1.1 to 3.1; P=0.021). Furthermore, continued use of cannabis increased the risk of persistent psychotic symptoms over the period from T2 to T3 (2.2, 1.2 to 4.2; P=0.016). The incidence rate of psychotic symptoms over the period from baseline to T2 was 31% (152) in exposed individuals versus 20% (284) in non-exposed individuals; over the period from T2 to T3 these rates were 14% (108) and 8% (49), respectively.


Conclusion

Cannabis use is a risk factor for the development of incident psychotic symptoms. Continued cannabis use might increase the risk for psychotic disorder by impacting on the persistence of symptoms.

Posting of this abstract is for the purposes of research into psychosis.

Also see:

Cannabis use 'raises psychosis risk' - study

Cannabis use 'doubles risk of psychosis for teenagers'

Marijuana Use Linked to Risk of Psychotic Symptoms

Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study


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