I am not sick, I don't need help!

Dr. Xavier Amador is an internationally sought-after speaker, clinical psychologist, professor at Columbia University Teachers College in New York City, the Founder and Director of the LEAP™ Institute and author of eight books including the national best seller I’m Not Sick, I Don’t Need Help!™

In this video he talks about dealing with anosognosia, the lack of insight regarding a mental illness. The video was recorded during the Schizophrenia Society of Nova Scotia's Annual Conference in 2005.

For a PowerPoint presentation on Dr. Amador's Listen-Empathize-Agree-Partner (LEAP) approach, click here.

Part 1 of 2 (57 minutes)

Part 2 of 2 (53 minutes)

This video was reviewed by Schizophrenia.com on December 27, 2006. To read the review, please click here.


Other videos featuring Dr. Amador:

Cambridge Talk on Helping People with Mental Illness - October 2, 2012 (NAMI Cambridge Chapter)

Keynote speech to the annual convention of the National Council for Community Behavioral Healthcare (May 2011)

2011 Nordic Psychiatry Academy Interview with Dr. Amador

"I am not Sick, I don't need help!" presentation at the 2011 Nordic Psychiatry Academy

Anosognosia Workshop — July 3, 2010 (NAMI Conference)

Also see:

I am Not Sick, I Don't Need Help! How to help someone with mental illness accept treatment. 10th Anniversary Edition

New videos featuring Dr. Xavier Amador

Dr. Xavier Amador has links to two new videos posted on his website:

2011 Nordic Psychiatry Academy Interview with Dr. Amador

"I am not Sick, I don't need help!" presentation at the 2011 Nordic Psychiatry Academy

To view Dr. Amador's presentation at the Schizophrenia Society of Nova Scotia's 2005 Annual Conference, please click here.

To order the book, I Am Not Sick, I Don't Need Help, please click here or here.

Also see the following videos:

Anosognosia 1 of 2 (Recorded July 3, 2010)

Anosognosia 2 of 2 (Recorded July 3, 2010)

A New Blood-Based Diagnostic Aid for Schizophrenia

An letter to the editor published in the September 2011 edition of Psychiatric Services:

To the Editor: Many people with schizophrenia exhibit poor insight into and lack of acceptance of their illness (1,2). The absence of objective proof of this disease contributes to this problem. Investigators have been interested in developing a blood-based biomarker test to help identify a biological signature to aid in diagnosis of schizophrenia, particularly in the prodrome of the illness (3,4).

Such a test has recently been developed, validated, and marketed in the United States. This test, VeriPsych, uses a multiplex immunoassay technology that profiles a proprietary disease signature comprising 51 analytes. The test has been found to be 83% sensitive and specific in distinguishing persons with schizophrenia from those without the disorder; the study in which the test's validity was established included more than 500 patients in the development phase and more than 800 patients in the validation phase (5). However, little has been subsequently published about this test, and its clinical utility remains unclear.

Our treatment team administered the test to a 30-year-old woman with a five-year history of schizophrenia who did not accept the fact that she had schizophrenia and who had problems remaining adherent to antipsychotic medications. The test yielded a positive result for the diagnosis of schizophrenia (score of –9199), with a conditional probability score that indicated a 95% chance of having the illness. After being informed of these results, our patient began to accept that her symptoms could be attributed to schizophrenia. For the first time, she expressed interest in learning about schizophrenia, acknowledged a personal connection to her family history of the disorder, and accepted her need of antipsychotic medications. Her therapeutic alliance with her psychiatrist and treatment team has improved, she has enrolled in a college-level class, and her attitude toward antipsychotic treatment remains positive. Her psychiatrist notes that this remarkable change was the result of her confidence in the blood test results—for the first time she had objective data about her illness.

Improving insight and illness acceptance among patients with schizophrenia has proven to be no small task. Psychoeducation, meta-cognitive training, cognitive therapy, and family intervention aimed at developing an understanding and acceptance of schizophrenia have shown only some success (1). Our interest in the test was not to confirm a clinical diagnosis of schizophrenia but to help a patient with schizophrenia accept her illness. We feel that if this test or future serum tests are more widely utilized, then their use as an aid in helping people who have no illness insight or who lack acceptance of their illness may be an important application. We hope that our letter will bring attention to this new test and encourage further research to replicate and validate our results. We also need to develop a better understanding of the clinical and research uses of this blood-based diagnostic aid and of its potential role and place in the treatment of patients with schizophrenia.

Deanna L. Kelly, Pharm.D., B.C.P.P., Sheryl Thedford, Pharm.D. and Gopal Vyas, D.O.

Dr. Kelly is affiliated with the Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore.

When the test was administered, Dr. Thedford was with the Department of Pharmacy Practice, School of Pharmacy, University of Maryland. She is now with the Bernard J. Dunn School of Pharmacy, Shenandoah University, and the Pharmacy Department, Winchester Medical Center, Winchester, Virginia.

Dr. Vyas is with Spring Grove Hospital Center, Baltimore.

Acknowledgments and disclosures

Rules Based Medicine supplied the VeriPsych test but had no involvement in the use of the test, the results, or publication.

The authors report no competing interests.

References

1. Lysaker PH, Buck KD, Salvatore G, et al: Lack of awareness of illness in schizophrenia: conceptualizations, correlates and treatment approaches. Expert Review of Neurotherapeutics 9:1035–1043, 2009 [CrossRef][Medline]
2. Buckley PF, Wirshing DA, Bhushan P, et al: Lack of insight in schizophrenia: impact on treatment adherence. CNS Drugs 21:129–141, 2007 [Medline]
3. Schwarz E, Guest PC, Rahmoune H, et al: Identification of a biological signature for schizophrenia in serum. Molecular Psychiatry epub ahead of print PMID , 2011 [Medline]
4. Dudley E, Hassler F, Thome J: Profiling for novel protemonics biomarkers in neurodevelopmental disorders. Expert Review of Proteomics 8:127–136, 2011 [CrossRef][Medline]
5. Schwarz E, Izmailov R, Spain M, et al: Validation of a blood-based laboratory test to aid in the confirmation of a diagnosis of schizophrenia. Biomarker Insights 5:39–47, 2010 [Medline]

United front on mentally ill urged

An article published in the July 19th edition of the National Post:

By Joseph Brean

Canada needs a "dynamic, broadly based social movement" to improve its citizens' mental health, a "whole of government" approach that unites everyone from political leaders to "experts by experience," says a national strategy five years in the making.

The goal, says the Mental Health Commission of Canada (MHCC), should be a "cultural shift toward recovery," which favours real improvement over ideal cure, and is informed by "multiple sources of knowledge," including the traditions of restorative justice and the hard-won wisdom of people in recovery.

The 37-page draft strategy document, obtained by the National Post, also seeks to reduce the stigma of suicide; calls for an end to "seclusion and restraint" of psychiatric patients; and demands that, in criminal-record checks, police stop disclosing information about people they have driven to hospital in a mental health crisis.

"This practice inhibits people's ability to volunteer or get a job, and should be stopped," reads the report, Mental Health Strategy for Canada - Draft, Not For Circulation. A final version is expected to be presented to the MHCC's board in October, and released publicly next year.

The strategy acknowledges the federal government's arm's-length role in healthcare delivery, but argues that mental health is not purely a health issue, as it also involves criminal justice, housing, finance and child services. The MHCC's broad solution is to "shift upstream and across sectors" by taking a "whole of government" approach, in which actions are nationally co-ordinated, and "leadership [is] located at the highest level possible within government and the bureaucracy."

Clinically, the strategy calls for a "genuine partnership" between caregivers and people with mental illnesses, who should be offered "self-directed care-funding initiatives," so they can "directly manage part of their social service and health budgets."

"The expertise gained from lived experience should be complemented by professional expertise, not dominated by it," the report reads.

"Not only will this change in the distribution of power within the mental-health system benefit users of services, it will also create a more positive context in which mental health providers can deploy their skills, experience and knowledge."

Examples of self-directed care choices might include art or music therapy, or training in mindfulness techniques, said Howard Chodos [pictured], special advisor to the MHCC.

Finding the right balance, he said, "involves the skill and art of medicine as much as it does the science.

"Unfortunately, in mental health there are no blood tests and there are no medical tests which tell you what illness you have and what treatment to use," he said.

The strategy also calls for better training for so-called "gatekeepers" - teachers, doctors, clergy, police and prison staff - to help them recognize and react to warning signs of suicide, and to promote mental health.

This focus on prevention and health promotion is a target of early critics of the report, who say it offers little to people with serious mental illnesses, such as schizophrenia or bipolar disorder, which cannot be prevented by social policy, as they are organic diseases of the brain.

They cite New York State's Office of Mental Health as a cautionary tale of a system in which the "worried well" gained support at the expense of the truly sick.

Susan Inman, a Vancouver advocate for the families of people with serious mental illnesses, whose daughter recovered from schizophrenia, said the strategy's deference to lived experience will make things worse for people who are so mentally ill they are incapable of realizing it - a condition known as anosognosia. She fears the emphasis on personal empowerment will make involuntary treatment almost impossible.

"This plan is really about mental wellness," she said. "People with serious mental illnesses are ignored."

Mr. Chodos said research shows a range of factors can increase or decrease the risk of even the most serious mental illnesses.

"We do not yet know that there is anything more than a genetic predisposition," he said.

"Prevention [in the strategy] is not only prevention of onset, but also the debilitating consequences of it."

He gave the example of homelessness, often associated with schizophrenia and substance abuse, as an area where social policy can, in fact, prevent the worst of a mental illness.

He said another is cannabis use among youth, a known risk factor for schizophrenia.

The MHCC, which was established in 2007 by Prime Minister Stephen Harper on the recommendations of former Senator Michael Kirby, has a twin mission. Erasing stigma has always been the long-term goal, but this formalized national strategy is the immediate plan.

The strategy comes at a crucial moment for psychiatry, not just in Canada but globally, as the discipline's diagnostic manual undergoes a thorough revision.

There is also a strong climate of suspicion about the role of drug manufacturers in the proliferation of psychiatric drugs, and about the spike in diagnoses of childhood behavioural disorders.

jbrean@nationalpost.com

Image credit

Also see:

An open letter to the Mental Health Commission of Canada - A response to their draft Mental Health Strategy for Canada

Identification of a biological signature for schizophrenia in [blood] serum

A 12-Step Program For Canada

Stopping the Revolving Door - A Civil Approach to Treating Severe Mental Illness

Stopping the Revolving Door - A Civil Approach to Treating Severe Mental Illness from Treatment Advocacy Center on Vimeo.

Serious Mental Illness, Care-Giver Stress and the Mental Health Commission of Canada

An article posted on June 24th by Huffpost Canada:

By Marvin Ross

Caring for a family member with a serious mental illness (mainly schizophrenia and bipolar disorder) is often extremely stressful for families; it impacts them financially, emotionally, socially and physically.

Hoping to improve the situations for the tens of thousands of families in this situation, a group of 45 B.C. families sent suggestions to the Mental Health Commission of Canada with the hope that the Commission would adopt them and help support families. Their suggestions were sent via e-mail and were widely distributed.

The Commission had previously stated they wanted to hear from stakeholders. But, Susan Inman [pictured], a Vancouver teacher, writer and parent said in an e-mail to me, "We didn't feel very reassured" that they are listening. "We are still hoping that Ms. Bradley will respond to our suggestions."

Ms. Inman is the unofficial group spokesperson and Louise Bradley is chair and CEO of the commission.

The commission defines itself as "a catalyst for transformative change" with the goal to, among other things, "improve services and support." The organization arose from the report Out of the Shadows at Last -- Transforming Mental Health, Mental Illness and Addiction Services in Canada in 2006. It received federal funding in 2007.

Ms. Inman further stated in her e-mail:

"I don't think that family caregivers for people with psychotic disorders are feeling hopeful when we see the limited agenda promoted by the Family Caregivers Advisory Committee (FCAC) on the Mental Health Commission of Canada's website. The group pointed out that the only research project the FCAC listed, a family mutual assistance strategy, has already been well researched in BC.

The group also pointed out that, by selecting this as their one project, the FCAC is communicating that "the message that what is most important is for caregivers to just learn how to take better care of each other. Meeting the needs of family caregivers involves much more careful examination of many systemic issues."

One suggestion is to research the quantity and nature of family care-giving for people with serious mental illnesses and to estimate the value of the unpaid family labour in terms of decreasing health care costs. The group also believes that the Commission should advocate to raise the standards of programs training mental health professionals to include science based approaches to understanding severe mental illnesses. Many professionals are not knowledgeable about advances in brain research and often still believe that families cause these mental illnesses. Inadequately trained mental health professionals aren't equipped to refer to early intervention programs -- a new best practice being implemented across the country. The group would like to see more collaboration between families and professionals.

One area of growing scientific understanding is of anosognosia -- the neurologically based inability of someone who is ill to understand that they are ill. Research shows that 40 to 50 per cent of people in the grip of a psychosis suffer this and it often results in treatment refusal.

Family caregivers wish to see the Commission recognize this problem and to recognize the need, at times, for involuntary treatment. Many have ill relatives who look to their families to ensure that they are not left untreated and allowed to deteriorate in case of a relapse. Families need help to gain access to legal means to be able to fulfil this responsibility.

Parents often still continue to experience the destructive impact of unjustified blame for these disorders -- a holdover from the non-research based and unscientific theories that dominated psychiatry and psychology in the past. These parents would like to see the Commission openly acknowledge and address this.

Finally, the language in Commission documents suggests that severe and persistent mental illnesses, like other mental health concerns, may be caused by adverse social circumstances. The Commission should openly support a science based understanding of these neurobiological disorders. As well, it should actively promote the brain based research that can lead to better treatments and, ultimately, cures. Currently, on the Commission's Science Advisory Committee site, there are no proposals for encouraging ongoing scientific investigation of any kind of mental illness.

The group has yet to hear from Ms. Bradley. They did receive a response from Ella Amir, Chair, Family Caregivers Advisory Committee (FCAC). She stated in her e-mail reply to the group, "One of the projects the FCAC has proposed focuses on the same concerns you describe... if approved, this proposed project will address yours (and our) concerns," Since Ms. Amir didn't describe any of the proposed projects, Ms. Inman didn't feel reassured that the FCAC is moving in the right direction.

Ms Amir did add that she was sure that Ms Bradley would also reply. When contacted, Kyle Marr, a spokesperson for the Commission, said he understood their concerns about not having any reply yet but "due to the depth of the email and the issues that it addressed, careful consideration is required".


Follow Marvin Ross on Twitter: www.twitter.com/dysdads

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Dr. Xavier Amador speaks about anosognosia