Schizophrenia Annual Evidence Update 2008

From the Mental Health Specialist Library:

The Schizophrenia Annual Evidence Update 2008 brings together evidence-based guidelines, systematic reviews, important primary research, service development literature and patient information.

2008 Building Bridges to the Future Bursary Program

The Schizophrenia Society of Canada (SSC) and Janssen-Ortho Inc. are pleased to partner again in offering the Building Bridges to the Future Bursary Program. Though administered by Janssen-Ortho Inc., the program is now coordinated through the SSC. The Building Bridges to the Future Bursary Program seeks to encourage and support individuals living with schizophrenia as they pursue educational opportunities. The money from the bursary program (the maximum amount awarded is $800) can be used for tuition/registration fees, books and other costs related to completing education and/or training program. Please fill out the forms found by clicking here and fax or mail to the SSC.

Applications must be submitted by May 31st, 2008.

Photograph by Jacob1207.

Task Force Proposes New Bipolar Guidelines

From the April 1st edition of Psychiatric Times:

By Arline Kaplan

An international team of experts recently proposed expanding the diagnostic criteria for several subtypes of bipolar disorder, adding a pediatric bipolar disorder category and eliminating the schizoaffective disorder category.

Bold emphasis is mine. To read the entire article, click here.

Reference
1. Ghaemi SN, Bauer M, Cassidy F, et al; ISBD Diagnostic Guidelines Task Force. Diagnostic guidelines for bipolar disorder: a summary of the International Society for Bipolar Disorders Diagnostic Guidelines Task Force Report. Bipolar Disord. 2008;10(1, pt 2): 117-128.

Addressing mental-health concerns fails in jails

From today's edition of The Chronicle Herald:

By Ainslie McDougall and Stanley Kutcher

The province of Nova Scotia has received some recent criticism regarding its detention facilities, such as accidental releases of inmates, an escaped inmate while transferred offsite, as well as the overcrowding of facilities. When considering the issue of overcrowding, it is important to highlight several issues. The answer is not to build more jails and employ more prison guards, but rather to take a closer look at the individuals who are overcrowding these jails and examine why they are there.

While the exact number is unknown, it has been estimated that as many as half of the incarcerated population suffers from mental illnesses, substance abuse problems, and/or learning disabilities. Because of a shortage of services and a lack of understanding by society, the mentally ill are not receiving the care they require and instead are being criminalized by being sent to prisons.

In a statement on March 8, 2007, Supreme Court Chief Justice Beverley McLachlin stated, "Such people are not true criminals, not real wrong-doers in the traditional sense of those words. They become involved with the law because they are mentally ill, addicted or both." Similarly, many police officers believe that mentally ill perpetrators represent a disproportionate number of individuals incarcerated for minor crimes. Some family members have noted that crimes may be committed or encouraged to be committed in order for the mentally ill person to be arrested. This may represent a "faint hope" that arrest will lead to treatment that for a variety of different reasons is not otherwise available.

There are alternatives to longer prison sentences (which studies show are not effective in decreasing repeat offences and stopping the "revolving door process"), such as drug treatment courts and mental health courts, which may meet the treatment needs of those with mental disorders. These courts attempt to identify and address the underlying causes of the criminal activity (such as behaviours associated with mental illness).

Mental health courts have been successfully implemented in many parts of Canada, as well as in the United States, and are specifically designed for those who have committed low level crimes (i.e. those who would be sentenced to incarceration in a provincial facility). These courts attempt to connect with community-based treatment through the interventions of mental health professionals. Studies in the United States show those who have gone through the mental health court received more access to mental health services and spent fewer days in jail than if they were sentenced in a criminal court.

These "problem-solving" courts are also more cost-effective for taxpayers. According to Juristat, Statistics Canada (2004-2005), the cost of incarcerating a federal prisoner was $93,000 per year, and $52,000 per year in a provincial institution. On the other hand, it costs approximately $8,000 for an individual to obtain addiction treatment through a drug treatment court. We are aware that the province of Nova Scotia is considering the development and implementation of similar courts and we encourage the Department of Health to move ahead quickly and thoughtfully in this matter.

We need to move away from the common misconception that locking someone up and throwing away the key is an appropriate manner by which to address mental health problems in our society. Mental illness and addiction are health issues and are not effectively dealt with by the criminal justice system.

The independent audit called for by Justice Minister Cecil Clarke is inadequate as it is not addressing the pressing issues facing provincial jails. Fundamental changes need to be made to the system.

Ainslie McDougall is with the IWK Health Centre. Dr. Stanley Kutcher is Sun Life Financial Chair in Adolescent Mental Health, IWK, and a professor in the department of psychiatry, Dalhousie University.

Photograph of Dorchester Penitentiary by Verne Equinox.

Another use for the diabetes drug metformin: Helping people taking antipsychotics lose weight

To read this April 21st article by Julie K. Silver, M.D., of Harvard Medical School (pictured), click here.

News from the Lunenburg County Chapter of the SSNS

The April 2008 meeting of the Lunenburg Chapter of the SSNS featured entertainment by the group Bale O' Hey (pictured below).


Ellen Balser (below left) and Carolyn Eisner (back to camera) Dosado to tunes by Bale O' Hey.


Click on the photographs to enlarge them.

Mentalization-Based Therapy Shows Promise With Borderline Personality Disorder (BPD)

I'm moving away from this weblog's usual focus on schizophrenia and psychosis for one important posting.

From the April 18th edition of Psychiatric News:

by Mark Moran

Mentalization-Based Therapy Shows Promise With Borderline Personality Disorder (BPD)

All of the structured psychotherapies—including dialectical-based therapy, transference-based therapy, and schema-focused therapy—are proving superior to treatment as usual in randomized control trials.

To read the entire article, click here.

Related links:

8-Year Follow-Up of Patients Treated for Borderline Personality Disorder: Mentalization-Based Treatment Versus Treatment as Usual

Effectiveness of Partial Hospitalization in the Treatment of Borderline Personality Disorder: A Randomized Controlled Trial

Longer initial hospital stays positive for individuals diagnosed with schizophrenia

From today's edition of The Chronicle Herald:

By John Gillis, Health Reporter

The longer a person’s initial stay in hospital for schizophrenia, the less likely they are to be readmitted, says a new report from the Canadian Institute for Health Information.

The report found 38 per cent of people hospitalized for schizophrenia are readmitted to hospital within a year.

That figure shows a majority of people with the illness actually fare well outside hospital, said Stephen Ayer, executive director of the Schizophrenia Society of Nova Scotia.

"The amazing part, quite frankly, for me is that 62 per cent are not (readmitted)," he said. "When you have a first episode of schizophrenia or psychosis, it’s very, very scary."

Mr. Ayer said the report does not examine what care patients are getting while in hospital and what supports are available to them in the community.

Those people who were in hospital between a week and two weeks were 21 per cent less likely to be readmitted unexpectedly within 30 days than those whose initial stay was a week or less, the report says.

It notes the average length of hospital stays has been declining.

A week in hospital would be considered quite a short stay for someone admitted with schizophrenia, said Dr. Ian Slayter, clinical director for general psychiatric services for the Capital district health authority.

He said an admitted person would often be psychotic and needs time to stabilize.

"Someone who is (in) three or four weeks, they can often be helped to settle down and one can arrange things in the community."

Dr. Slayer said the length of stay for people hospitalized for schizophrenia in the Capital district averaged 28 to 30 days.

A person returning to hospital shouldn’t be assumed to be a bad thing, he said.

"Obviously, if they’re having problems, readmission is a good and necessary thing."

The services available to people after discharge include community mental health clinics and clubhouses, an assertive community treatment team, private psychiatrists and general practitioners.

Dr. Slayter said Capital Health also offers supportive services to check in with people in their homes and do things like drop off medication.

"That’s an area that we’re actively growing."

He said people who are hospitalized for very long periods are also likely to be readmitted due to instability.

Capital Health has recently changed the way it compiles statistics, so local readmission rates are unavailable.

Also see:

Schizophrenia patients with short hospital stays soon readmitted: report

Statement: The Schizophrenia Society of Ontario Supports CIHI's Findings on the Relationship Between Hospital Length of Stay and Readmission for Individuals with Schizophrenia

Short hospital stays failing schizophrenic patients

Which drugs best for schizophrenia?

An article from The Gazette (Cedar Rapids - Iowa City - Eastern Iowa). To read the entire article, click here.

I’m Here, Mom

I understand the game we’re playing. It’s how we keep from talking about the present, trading stories about when I was 10 years old and she was still whole.

By Anish Majumdar

For the entire story from Little India, the largest Indian publication in the United States, click here.

schizophrenia. let's talk about it.

A new website from Schizophrenia Digest. To view the website, click here.

From the website:

The "Let's Talk About It" campaign is an initiative of Schizophrenia Digest, Canada's foremost magazine for people with schizophrenia. For 14 years, Schizophrenia Digest has been providing inspiration and information about the issues surrounding this mental illness. The campaign is financed through an unrestricted grant from Pfizer Canada. Pfizer is dedicated to improving the health and quality of life of Canadians.

"Let's Talk About It" is intended to motivate Ontarians to begin a dialogue about mental illness and take action to improve access to new drug therapies that effectively treat the symptoms of schizophrenia. With your help we can focus a provincial dialogue on helping those affected by this tragic disease.

Stroke of insight: Jill Bolte Taylor on TED.com

From TEDBlog:

Neuroanatomist Jill Bolte Taylor had an opportunity few brain scientists would wish for: One morning, she realized she was having a massive stroke. As it happened -- as she felt her brain functions slip away one by one, speech, movement, understanding -- she studied and remembered every moment. This is a powerful story of recovery and awareness -- of how our brains define us and connect us to the world and to one another. (Recorded February 2008 in Monterey, California. Duration: 18:44.)

She begins her talk by stating:

"I grew up to study the brain because I have a brother who has been diagnosed with a brain disorder, schizophrenia. And as a sister and as a scientist, I wanted to understand, why is it that I can take my dreams, I can connect them to my reality, and I can make my dreams come true - what is it about my brother’s brain and his schizophrenia that he cannot connect his dreams to a common, shared reality, so they instead become delusions?"




Click on the arrow to start the video.

Sainsbury Centre for Mental Health - Making Recovery a Reality

From the Sainsbury Centre for Mental Health:

March 2008

Abstract:

“Two or three years ago I realised that you really could recover…I thought that once you had it, that was it – but you can recover. I find that quite an amazing fact…”

‘Recovery’ is an idea whose time has come. At its heart is a set of values about a person’s right to build a meaningful life for themselves, with or without the continuing presence of mental health symptoms. Recovery is based on ideas of self-determination and self-management. It emphasises the importance of ‘hope’ in sustaining motivation and supporting expectations of an individually fulfilled life.

To download the entire publication, click here (PDF).

Restrictive drug policies often cause patients with schizophrenia to discontinue medication, study finds

NEWS ALERT
Harvard Medical School Office of Public Affairs

FINDINGS: {Patients with schizophrenia] in Maine’s Medicaid program experienced more frequent interruptions in treatment when the state began requiring physicians to seek prior authorization for medications not on the programs’ preferred drug list.

RELEVANCE: Schizophrenia is a devastating psychiatric illness that affects roughly three million Americans. Disruptions in medication compliance can be devastating for the patient. Despite this, prior authorization policies for antipsychotic drugs are used in about forty percent of state Medicaid programs and in one-third of the Medicaid Part D drug benefit in attempts to save costs.

BOSTON, Mass. (April 1, 2008)—Policies requiring authorization before physicians can prescribe newer medications to [patients with schizophrenia] may be counter-productive. According to a new study, patients in Maine’s Medicaid program who found themselves in this situation were 29% more likely to stop or disrupt medication use than patients not subject to the policy. In addition, although the policy was originally designed to cut costs, government savings were minimal at best.

These findings are reported online in Health Affairs [click here to download the entire article (PDF)].

The study, led by investigators from Harvard Medical School’s Department of Ambulatory Care and Prevention, looked at Maine Medicaid beneficiaries with schizophrenia on antipsychotic drugs before, during, and after a policy that required patients to use an authorized medication (step treatment) before they were allowed to use drugs not on the preferred list. They were compared to similar beneficiaries in New Hampshire, where there was no prior authorization regulation. The Maine policy was replaced by a provider education program after less than a year.

Study data indicated that the original Maine policy disrupted essential antipsychotic treatment for vulnerable patients with schizophrenia, with minimal or no cost savings.

“This study calls into question the effectiveness of many similar policies throughout the country,” says Stephen Soumerai (pictured), Harvard Medical School professor and senior author on the study. “Getting prior authorization requires paperwork and is time-consuming, so physicians may tend to switch to prescribing preferred medications even if they have concerns about the appropriateness of the medication for a specific patient.” However, as medication choice is restricted, more patients discontinue treatment.

Previous studies have shown that gaps in antipsychotic medication use are likely to result in recurrence of psychotic episodes and higher hospitalization rates and costs for these patients.

Schizophrenia is a disabling and costly illness that afflicts approximately one percent of the US population, or three million people. Without antipsychotic treatment, about 80% of patients will have a serious recurrence of their illness within a year. The study investigators believe that while there is a legitimate place for prior authorization and step treatment policies for some medications, patients with chronic mental illness are put at particular risk of receiving inadequate treatment.

“Given the tremendous variation in individual responses to these drugs as well as the devastating impact of treatment disruptions on schizophrenic patients, a policy that pushes all patients toward a limited number of preferred drugs may do more harm than good,” says Dr. Soumerai. “It would be much better to focus on ensuring that antipsychotic drugs are prescribed for evidence-based reasons and that preferred drugs are prescribed only to patients who can benefit from them.”

This study was supported by the Agency for Healthcare Research and Quality (AHRQ), Centers for Education and Research in Therapeutics (CERT) Public/Private Partnership Program and the HMO Research Network CERT, Eli Lilly and Company, and the Harvard Pilgrim Health Care Foundation.

Written by Ann Plasso

CITATION:
Health Affairs, April 1, 2008
“Use of atypical antipsychotic drugs for schizophrenia in Maine Medicaid following a policy change”
Stephen Soumerai(1), Fang Zhang(1), Dennis Ross-Degnan(1), Daniel Erik Ball(2), Robert LeCates(1), Michael Robert Law(1), Tom Hughes(2), Daniel Chapman(3), and Alyce Adams(1)

1-Harvard Medical School, Department of Ambulatory Care and Prevention, Boston MA
2-Eli Lilly and Company, Indianapolis, IN
3-Centers for Disease Control and Prevention, Atlanta GA

CONTACT:
David Cameron
public_affairs@hms.harvard.edu
617.432.0442

Harvard Medical School has more than 7,500 full-time faculty working in 11 academic departments located at the School's Boston campus or in one of 47 hospital-based clinical departments at 18 Harvard-affiliated teaching hospitals and research institutes. Those affiliates include Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, Cambridge Health Alliance, Children's Hospital Boston, Dana-Farber Cancer Institute, Forsyth Institute, Harvard Pilgrim Health Care, Joslin Diabetes Center, Judge Baker Children's Center, Immune Disease Institute, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, McLean Hospital, Mount Auburn Hospital, Schepens Eye Research Institute, Spaulding Rehabilitation Hospital, and VA Boston Healthcare System.

Living Healthy in Atlantic Canada

A new magazine published by the QEII Foundation contains an article on the Nova Scotia Early Psychosis Program. The article, entitled Mending Minds, appears on pages 28 to 31 and can be accessed by clicking here (downloads a large PDF).

For a hard copy of Living Healthy in Atlantic Canada, send an email to fndnew@qe2-hsc.ns.ca with your mailing address. (Note: The QEII Foundation provided an incorrect email address. The correct email address was posted here on April 5th. Thanks to Valarie R. for pointing this error out to me.)

Scientists probe meditation secrets

Scientists are beginning to uncover evidence that meditation has a tangible effect on the brain.

For the complete article from BBC News, click here.

Photograph courtesy of BBC News.

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