Learning about Schizophrenia: Rays of Hope

A Reference Manual for Families & Caregivers

Revised Fourth Edition (2012)

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To download the 2012 fourth revised edition of Rays of Hope (PDF), please click here.

Printed copies of Rays of Hope are available from the Schizophrenia Society of Nova Scotia at a cost of $10.00 (including shipping).  To order a copy with payment by Visa, MasterCard, or American Express, please call (902) 465-2601 or 1-800-465-2601 (toll-free in Nova Scotia), or send a cheque or money order to:

Schizophrenia Society of Nova Scotia
Room B-23, Purdy Building
P.O. Box 1004
Dartmouth, Nova Scotia
B2Y 3Z9

Examining Schizophrenia (Video)

A video from PsyWeb.com:




Also see:

Elyn R. Saks

National Guidelines for a Comprehensive Service System to Support Family Caregivers of Adults with Mental Health Problems and Illnesses

A report released on June 27, 2013, by the Mental Health Commission of Canada:

From this webpage:

A loved one’s mental health problem or illness often impacts family, friends and supporters. Caring for a person living with a mental illness often creates emotional, physical, financial and social burdens for caregivers. The Mental Health Commission of Canada has created guidelines for policy makers and service providers that seek to recognize and support family caregivers’ needs, including recommendations on services and supports caregivers find useful.

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To download the entire document (PDF), please click here.

Also see:

National Family Caregiving Support Guidelines

Perceived need for mental health care in Canada: Results from the 2012 Canadian Community Health Survey–Mental Health (September 2013)

By Adam Sunderland and Leanne C. Findlay

From this webpage:

Background

Past research and national survey data on Canadians’ perceived need for mental health care (MHC) have focused on unmet needs overall, and have not considered specific types of MHC needs or the extent to which needs are met.

Data and methods

Using data from the 2012 Canadian Community Health Survey–Mental Health, this article describes the prevalence of perceived MHC needs for information, medication, counselling and other services. The degree to which each type of need was met is explored. Associations between risk factors for having MHC needs and the extent to which needs were met are investigated.

Results

In 2012, an estimated 17% of the population aged 15 or older reported having had an MHC need in the past 12 months. Two-thirds (67%) reported that their need was met; for another 21%, the need was partially met; and for 12%, the need was unmet. The most commonly reported need was for counselling, which was also the least likely to be met. Distress was identified as a predictor of perceived MHC need status.

Interpretation

Many Canadians are estimated to have MHC needs, particularly for counselling. People with elevated levels of distress are significantly more likely to have unmet and partially met MHC needs than to have fully met MHC needs, regardless of the presence of mental or substance disorders.

Keywords

Mental illness, mental disorder, distress

Findings

Many Canadians experience a need for mental health care (MHC), but not all of those needs are met. In fact, the presence of mental illness has repeatedly been associated with an MHC need, despite evidence-based practices suggesting that mental illness can be successfully treated. Rates of unmet needs were higher among people with the criteria for mental illness, especially those with depression. This is relevant considering that, in 2012, an estimated 10% of Canadians experienced a mental disorder (depression, bipolar disorder, generalized anxiety disorder, or alcohol, cannabis or substance abuse or dependence) in the past year. [Full Text]

Authors

Adam Sunderland and Leanne C. Findlay (1-613-951-4648; leanne.findlay@statcan.gc.ca) are with the Health Analysis Division at Statistics Canada, Ottawa, Ontario, K1A 0T6.

What is already known on this subject?

Many Canadians experience a need for mental health care (MHC), but not all of those needs are met.

Past research and national survey data on Canadians’ perceived need for MHC have focused on unmet need overall, and have not considered specific types of MHC needs or the extent to which needs are met.

What does this study add?

Based on data from the 2012 Canadian Community Health Survey–Mental Health, an estimated 17% of the population aged 15 or older reported having had an MHC need in the past 12 months.

Two-thirds (67%) of them reported that the needs were met; for another 21%, the needs were partially met; and for 12%, the needs were unmet.

The most commonly reported need was for counselling, which was also the least likely to be met.

Distress was associated with perceived MHC need status.

To download the entire article (PDF), please click here.

Also see:

Mental and substance use disorders in Canada (September 2013) (PDF)

Mental Health Profile, Canadian Community Health Survey - Mental Health (CCHS), by age group and sex, Canada and provinces (2013)

Response to the release of Canadian Community Health Survey: Mental Health 2012 by the Mental Health Commission of Canada

The Schizophrenia Society of Canada - VALUES

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To download a PDF version of the above document, please click here.

Also visit:

Schizophrenia Society of Canada

Schizophrenia Society of Nova Scotia

Cannabis & Psychosis: Exploring the Link

Also visit:

Cannabis & Psychosis: Exploring the Link

Schizophrenia is not a progressive brain disease

A December 4, 2012, posting by the Nova Scotia Early Psychosis Program:

Young people who experience a first episode of psychosis often receive a diagnosis of schizophrenia.

Historically there has been the view that schizophrenia is a progressive, deteriorating condition and many clinicians were taught that point of view in their training.

When the field of Early Psychosis began to develop in the 1990s, a major theme was to discard the pessimistic attitude that clinicians held toward the possibility of significant recovery in psychotic disorders and replace it with a more balanced positive approach. The specialized Early Psychosis services that are now widely available are based on this attitude of realistic optimism.

As well, people with lived experience of psychosis, and their families, have increasingly insisted and demonstrated that recovery in schizophrenia is a realistic and attainable goal.

Yet studies of brain structure and function continue to produce data suggesting that there may be progressive changes associated with a diagnosis of schizophrenia.

In an article published in the Schizophrenia Bulletin journal in November 2012, Dr. Robert Zipursky (pictured) a leader in psychosis reseach in Canada, along with eminent colleagues in the UK, reviews the current evidence related to the question of whether or not a diagnosis of Schizophrenia indicates the person has a progress brain disease.

The article reviews all the recent evidence from brain scans, as well as other sources of data, and concludes that “schizophrenia is not a malignant disease that inevitably deteriorates over time, but one from which most people can achieve a significant degree of recovery”.

The authors strongly urge clinicians to provide young people and their families with this up-to-date information so that the old myths regarding negative outcomes for people receiving a diagnosis of schizophrenia can be laid to rest.

For a free copy of the full article click here.

Schizophrenia Infographic from Rethink Mental Illness

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Also see:

Rethink Mental Illness

First-Episode Psychosis - Academic Re-Entry Promotion Project -- Research Recruitment

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To download the a PDF of the poster, please click here.

OneInFive.ca - A Focus on Psychosis

To read more, please visit OneInFive.ca.

Also see:

Nova Scotia Early Psychosis Program

Experiences of psychosis - website

From healthtalkonline.org:

This module is about people’s experiences of psychosis. Many of the people we interviewed had, at some point in their lives, received a diagnosis of schizophrenia. However there were a number of people we spoke to who had never received this diagnosis but who had experienced psychosis i.e. hearing or seeing things or holding unusual beliefs which other people don’t see or share. We interviewed 34 people (31 people with direct experience and three carers) about their experiences.

To visit the website, please click here.


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Information about NICE clinical guideline 120

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To download the full document, please click here.

Also see:

Psychosis with coexisting substance misuse

New NICE Guidance To Help Manage Psychosis With Co-Existing Substance Misuse

Cannabis May Influence Onset of Psychosis

An article posted on February 7th by Scientific American:

Research to be published this summer finds that the use of cannabis is associated with the early onset of psychosis.

By Christie Nicholson

Pot is one of those drugs that appears to maintain a fairly good rep, despite its growing bad rep. Consider this research that will be published this June in the Archives of General Psychiatry.

This particular study found that marijuana use is associated with early development of psychosis. Scientists analyzed 83 studies involving over 8,000 subjects who used pot and over 14,000 subjects who did not. They compared the age of onset for psychosis between these groups. And they found that those who used cannabis developed psychosis nearly three years younger than those who did not use any pot.

The researchers proposed some theories behind the pattern. One that cannabis use is a causal factor for schizophrenia, or that it precipitates psychosis in vulnerable people. They also theorize that cannabis might simply exacerbate symptoms of schizophrenia. Or the link could come from the other direction of course, those suffering from schizophrenia may be more likely to use pot.

The evidence here suggests that limiting marijuana use could delay or even prevent some cases of psychosis. And timing is important, since earlier onset of schizophrenia is linked to a worse prognosis overall.


Please click here to listen to the podcast.

Also see:

Cannabis Use and Earlier Onset of Psychosis

Psychosis - Fact Sheets

From the Early Psychosis Prevention and Intervention Centre:

Fact Sheets

These fact sheets, in English, and 10 linguistically diverse languages, provide information specific to early psychosis. The information is most useful for young people, their family and friends. Anyone can print these fact sheets out and distribute them. The fact sheets provide information about the different types of psychotic disorders, and the phases of assessment, treatment, and recovery.

• What is psychosis?
• Getting help early
• Recovering from psychosis
• How can I help?
  

These information sheets are also available in other languages.

• French
• Arabic
• Croatian
• Greek
• Italian
• Serbian
• Spanish
• Turkish
• Vietnamese
• Simplified Chinese
• Traditional Chinese

Click here to go to the Free Downloads page

York study finds schizophrenia and superior verbal intelligence can co-exist

An October 15th media release from York University:

A study released yesterday by York University researchers has found that schizophrenia patients with superior verbal abilities are like similarly-gifted healthy people in many ways, but still have trouble functioning in the community.

The study is the first to confirm the existence of small numbers of schizophrenia patients with superior levels of verbal ability, defined as a vocabulary score in the upper five-to-ten per cent of the general population.

Researchers investigated the cognitive performance, life skills and community independence of verbally gifted schizophrenia patients, comparing their abilities in these areas to those of verbally gifted healthy people. They found no significant differences between the two groups except in the ability to function independently in the community.

“Impaired cognitive performance is widely regarded as a core feature of schizophrenia and a major cause of disability in daily life,” says the study’s lead author, Walter Heinrichs (right), a psychology professor in York’s Faculty of Health. “We’re seeing that this is not necessarily the case with these exceptional patients. They resemble similarly-gifted healthy people in most aspects of cognition as well as in daily living skills, but they still can’t function normally in the community.”

Researchers tested 151 patients, ranging in age from 21 to 65, alongside healthy people with no history of medical or mental illness. Twenty-five of these patients scored in the superior range. Heinrichs notes that the large number of patients tested meant it was possible to compare the gifted group with more typical schizophrenia patients, and with verbally gifted and average healthy people.

The gifted and more typical patient groups differed on virtually every comparison except the severity of their psychotic symptoms. The gifted group was significantly more independent than typical patients, but experienced equivalent levels of symptoms like delusions, hallucinations, apathy and lack of motivation.

It was also noted that neither verbally-superior patients nor verbally-superior healthy subjects performed at superior levels on all cognitive tasks. Instead, oral reading, visual abstract reasoning, working memory, word fluency, learning and attention scores for both groups ranged between average and high-average levels.

“The discovery of verbally gifted patients is important because they offer a window on the schizophrenic brain when it is relatively free of the abnormalities underlying cognitive impairment,” Heinrichs says. “These patients also demonstrate that cognitive ability cannot be the only determinant of community adjustment in this severe form of mental illness.”

Heinrichs worked alongside York graduate students Ashley Miles and Narmeen Ammari, and psychologists Stephanie McDermid Vaz and Joel Goldberg, a York psychology professor.

The study, “Cognitive, Clinical, and Functional Characteristics of Verbally Superior Schizophrenia Patients,” is published in the journal Neuropsychology.

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

Laura Burke named a 2010 Champion of Mental Health

From the 2010 Mental Illness Awareness Week website:

Champion - Youth

Laura Burke
Concordia University, Master's in Drama Therapy student



Ms. Burke [pictured above] has made outstanding contributions to the field of mental health in Canada, working to raise awareness, fight biases and stigma, and contribute to community organizations. She has given talks on recovery for the Nova Scotia Early Psychosis Program and acted as a peer support worker at Laing House, a drop-in centre for youth living with mental illness. When at Laing, she also ran a drama group and a writer’s circle, and was constantly inspired by the courage, resilience and determination of the youth she worked with.

In 2008 she recorded an album of her spoken word poetry about her journey through schizophrenia and recovery, and in 2009, she began her role at the Schizophrenia Society of Nova Scotia as a peer support facilitator. Ms. Burke has showed continued dedication to the field of mental health, and has bravely drawn on her own experience with schizophrenia to positively impact her community.

Ms. Burke strongly believes that social inclusion, unconditional acceptance, and the opportunity to use creativity as a force of healing are invaluable, too often overlooked components of recovery. After graduation, Ms. Burke hopes to research and practice drama therapy to improve negative and cognitive symptoms in youth experiencing first episode psychosis.

Also see:

2010 Mental Illness Awareness Week (October 3rd to 9th)

2010 Champions of Mental Health

About the Champions of Mental Health Awards

Superhero - A Visual Poem

The Continuum of Psychotic Symptoms in the General Population: A Cross-National Study

The abstract of an article published online on September 13th by Schizophrenia Bulletin:

By Roberto Nuevo (1,2), Somnath Chatterji* (3), Emese Verdes (3), Nirmala Naidoo (3), Celso Arango1 (4), and José Luis Ayuso-Mateos (1,2)

Author Affiliations

1. Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain
2. Department of Psychiatry, Universidad Autonoma de Madrid, Hospital Universitario de la Princesa, Madrid, Spain
3. Department of Health Statistics and Informatics, World Health Organization, Avebue Appia 20, Geneva 27, CH 1211, Switzerland
4. Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
   

* To whom correspondence should be addressed; tel: +41-227913609/3202, fax: +41-227914328, e-mail: chatterjis@who.int.

Abstract

Objective:

To identify the cross-national prevalence of psychotic symptoms in the general population and to analyze their impact on health status.

Method:

The sample was composed of 256,445 subjects (55.9% women), from nationally representative samples of 52 countries worldwide participating in the World Health Organization's World Health Survey. Standardized and weighted prevalence of psychotic symptoms were calculated in addition to the impact on health status as assessed by functioning in multiple domains.

Results:

Overall prevalences for specific symptoms ranged from 4.80% (SE = 0.14) for delusions of control to 8.37% (SE = 0.20) for delusions of reference and persecution. Prevalence figures varied greatly across countries. All symptoms of psychosis produced a significant decline in health status after controlling for potential confounders. There was a clear change in health impact between subjects not reporting any symptom and those reporting at least one symptom (effect size of 0.55).

Conclusions:

The prevalence of the presence of at least one psychotic symptom has a wide range worldwide varying as much as from 0.8% to 31.4%. Psychotic symptoms signal a problem of potential public health concern, independent of the presence of a full diagnosis of psychosis, as they are common and are related to a significant decrement in health status. The presence of at least one psychotic symptom is related to a significant poorer health status, with a regular linear decrement in health depending on the number of symptoms.

Keywords: World Health Survey, extended phenotype, schizophrenia

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

The Voices of Schizophrenia

An article posted yesterday by The New York Times:

By Tara Parker-Pope

Few mental illnesses are as complex and confusing as schizophrenia, a mental disorder in which people may experience hallucinations or delusions, hear voices or have confused thinking and behavior.

Although the word “schizophrenia” means “split mind,” the disorder does not cause a split personality, as is commonly believed.

The latest Patient Voices segment by Karen Barrow, a Web producer, offers rare insights into schizophrenia and schizoaffective disorder, a related condition that combines thinking and mood problems, as seven men and women share their experiences.

“It disrupted my education, my relationships, it disrupted friendships,” explains Alita Van Hee, 32, of Santa Cruz, Calif. “I was so bombarded by voices. They would tell me things like ‘Don’t trust these people,’ ‘Don’t talk to your friends,’ ‘They’re not real friends,’ things like that. It’s kind of like having a TV or radio on blasting inside your head just all the time that you can’t turn off no matter what you do.”

You’ll also meet Michael Runningwolf, 40, of Tempe, Ariz., who wants to change people’s perceptions and fears about schizophrenia.

“I wish I could get a T-shirt that says, ‘We’re more afraid of you than you are of us,’ ” he says. “There are people with schizophrenia every day that are doing things to break down the stigma. They hold down jobs, and they’re out there every day giving it everything they’ve got. Even though schizophrenia is a disabling illness, it’s not the end. There is recovery.”

Susan Weinreich, 54, of Mount Kisco, N.Y., says that although her illness has made life difficult, it also has become part of her art. “I believe my art was a vehicle for me to be able to express some things that were very deep, deep down inside and that were trapped and difficult to get out and communicate,” she says.

Another artist, John Cadigan, 40, who is Ms. Van Hee’s partner, says the challenges of his illness have also played a role in his art. “The difficulty is I’m not always cognizant of what reality is,” he says. “I can’t trust my own brain…. When you have a brain disorder it unlocks parts of the brain I think normal people don’t have any knowledge of. I think I translate that into my woodcuts.”

To hear these and other stories of schizophrenia, click on the Patient Voices audio link. And then please join the discussion below.

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Serum S100B: A Potential Biomarker for Suicidality in Adolescents?

Structure of the S100B protein. Based on PyMOL rendering of PDB 1b4c.

The abstract of a paper published online by PLoS One:

By Tatiana Falcone, Vincent Fazio, Catherine Lee, Barry Simon, Kathleen Franco, Nicola Marchi, and Damir Janigro*

Cleveland Clinic-Lerner College of Medicine, Cleveland, Ohio, United States of America

Abstract

Studies have shown that patients suffering from depression or schizophrenia often have immunological alterations that can be detected in the blood. Others reported a possible link between inflammation, a microgliosis and the blood-brain barrier (BBB) in suicidal patients. Serum S100B is a marker of BBB function commonly used to study cerebrovascular wall function.

Methods

We measured levels of S100B in serum of 40 adolescents with acute psychosis, 24 adolescents with mood disorders and 20 healthy controls. Patients were diagnosed according to DSM-IV TR criteria. We evaluated suicidal ideation using the suicidality subscale of the Brief Psychiatric Rating Scale for Children (BPRS-C).

Results

Serum S100B levels were significantly higher (p<0.05) and correlated to severity of suicidal ideation in patients with psychosis or mood disorders, independent of psychiatric diagnosis. Patients with a BPRS-C suicidality subscores of 1–4 (low suicidality) had mean serum S100B values +/− SEM of 0.152+/−0.020 ng/mL (n = 34) compared to those with BPRS-C suicidality subscores of 5–7 (high suicidality) with a mean of 0.354+/−0.044 ng/mL (n = 30). This difference was statistically significant (p<0.05).

Conclusion

Our data support the use of S100B as an adjunctive biomarker to assess suicidal risk in patients with mood disorders or schizophrenia.


Citation: Falcone T, Fazio V, Lee C, Simon B, Franco K, et al. (2010) Serum S100B: A Potential Biomarker for Suicidality in Adolescents? PLoS ONE 5(6): e11089. doi:10.1371/journal.pone.0011089

Copyright: © 2010 Falcone et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

*E-mail: janigrd@ccf.org

To download the entire paper, please click here (PDF).

Also see:

Serum Biomarker May Help Predict Suicidality in Adolescents

Identifying Suicide Risks in Adolescents


Image courtesy of Emw. This image is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license.

Rethinking Mental Disorders

An article posted May 20th on Care2.com:

By Kristina Chew

Psychiatric or mental disorders such as schizophrenia, bipolar disorder, depression and psychosis are better understood and treated as 'disorders of the brain' according to an article by Tom Insel, M.D., Director of the National Institute of Mental Health, and Philip Wang, M.D., Deputy Director of NIMH. The article, Rethinking Mental Illness, is published in the May 19th issue of the Journal of the American Medical Association. The authors note that, while there have been many 'insights gained from genetics and neuroscience'---such as twin studies that show high heritability for autism, schizophrenia, and bipolar disorder---such research explains only a 'fraction of the heritability' of mental disorders. (For instance, some182 genes have been identified as linked to eating disorders, and some 100 to autism.) These should rather be seen as 'disorders of brain circuits':

"The genetics of mental illness may really be the genetics of brain development, with different out comes possible, depending on the biological and environmental context."

Other advances in the field of genetics contribute to a reconceptualization of mental disorders. Epigenetics looks at the inherited changes in gene expression caused that are caused by something other than than changes in the underlying DNA sequence; Insel and Wang note that:

"The same twin studies that point to high heritability also demonstrate the limits of genetics: environmental factors must be important for mental disorders......The advent of epigenomics [the study of the factors that control genes], which can detect the molecular effects of experience, may provide a powerful approach for understanding the critical effects of early-life events and environment on adult patterns of behavior."

Further, the authors write that the behavioral and cognitive symptoms that indicate 'mental illness' may actually be the 'late stages' of neurological processes that, if detected at early stages, might be better and more fully treated:

"As a result, interventions, rather than being ameliorative or rehabilitative, could become preemptive or even preventive. But this transformation in diagnosis and treatment, which can be informed by recent progress in cardiovascular disease and cancer, will depend on an intense focus on the genetics and circuitry underlying mental illness to ensure new approaches to detecting risk, validating diagnosis, and developing novel interventions that may be based on alter ing plasticity or retuning circuitry rather than neurotransmitter pharmacology."

As an example, in the past several years, autism has gone from being seen as a psychiatric, and even psychogenic, disorder, to a neurological/neurodevelopmental one, with significant consequences in how autism is conceived of, treated and, too, perceived by the public. Autism was once thought to be caused by bad parenting, by 'refrigerator mothers' who were emotionally withdrawn and 'cold,' and therefore did not 'bond' with their children, who 'withdrew into autism'; the damage wrought to families and individuals by these misconceptions is unmeasurable. Seeing autism as a neurodevelopmental disorder---due, perhaps, to 'abnormalities' in synapses in the brain does change how autistic individuals are see by others.

Similarly, understanding that an eating disorder such as anorexia nervosa is biologically based rather than simply putting the blame on parents, on our society's and culture's equating being thin with success, has significant changes on treatment and, again, understanding, and this can make a huge difference in people's (parents, for sure) lives. Societal factors do play a role, but seeing anorexia as biologically based---a recent study of brain imaging has found neurocircuit dysregulation in anorexics---can have real changes for people's lives and, hopefully, for the ultimate outcomes of those diagnosed with these conditions.

Also see:

NIMH Builds New Framework for Understanding Mental Illness

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