Family Education Group for Mood Disorders - Halifax

A poster photographed today at the Mood Disorders Program locaton in Halifax:

Please click on the photograph to magnify it.

From the OurHealthyMinds.ca website:

Mood Disorders Program

Often collaborating with family physicians, the Mood Disorders Program provides consultation, assessment, group therapy and follow up for people living with mood disorders, especially bipolar disorder. The program also provides services for people at high risk of developing a mood disorder as a result of family history, and focuses on mood disorder research and education.

Telephone: (902) 473-2585

Location

Mood Disorders Program
QEII Health Sciences Centre
Abbie J. Lane Memorial Building, 3rd floor
5909 Veterans' Memorial Lane
Halifax, Nova Scotia
B3H 3E2

Also see:

Research: Mood Disorders (Dalhousie University)

Mood Disorders Research Group Contact Page

World Mental Health Day - A Revolution, Simple

An article posted today by the UK edition of the Huffington Post:

By Professor Richard Gray [pictured]

"If I'd asked my customers what they wanted, they'd have said a faster horse." Henry Ford

To enable people with mental health problems to lead full and productive lives, we need a revolution in care and treatment.

Today is world mental health day. Looking at mental health practice right now it feels sadly devoid of the revolutionary, imaginative and creative thinking that we take for granted in so many other areas of our lives. In a very real sense the outcomes for patients with long term mental illnesses like schizophrenia are getting worse, not better.

This is a tragedy; mental illness is painful and distressing. It is hard to imagine the torment that someone with schizophrenia experiences when they hear voices telling them that they are evil and deserve to die. To understand the pain of these symptoms we have to recognise that this is their reality and it is absolutely terrifying. These are symptoms of an illness, an illness where there is dysfunction in the patient's brain.

Medicines are essential to alleviate the distress and torment of psychotic symptoms. Reducing the intensity of the delusion or pushing the voices into the background antipsychotic drugs rarely completely eliminate symptoms and are certainly no cure.

In many respects, the medicines we have now are little different to those like chlorpromazine, that we used in the 1950s. The new generation of antipsychotic drugs are more refined and cause fewer side effects, but fundamentally they work in the same way. Metaphorically drug researchers have bred slightly faster horses, there has been no great jump forward.

Where will new treatment advances come from?

There is a sense that investment, both intellectually and financially, in the development of new drug treatments has faded and shifted; in part because of the negative public perception drugs for mental illness have, and an increase in demand for talking treatments as an alternative to pills.

Sensational media stories of antidepressants making patients suicidal are ill informed but attention grabbing and have contributed to our negative image. Even among mental health professionals there is widespread "anti medication" sentiment. A senior and influential Clinical Psychologist suggested to me recently that pharmaceutical industry research was "little more than propaganda".

Do psychological (talking) treatments represent the paradigm shift from horse to car that we need? I want to argue that our current obsession with improving access to psychological treatments reflects society's Freudian belief that mental illness is located in the mind and not the brain and can be sorted out by talking.

Cognitive behavioural therapy (CBT) is probably the most popular talking treatment.

Researchers have demonstrated that when delivered by a skilled therapist, CBT is as effective as antidepressant medication in the treatment of depression. Against schizophrenia and bipolar disorder, CBT also seems to be effective for example in helping patients cope with voices. But, and it is an important but, CBT only works (in schizophrenia and bipolar disorder), if patients are already on medication.

CBT, like all talking treatments, are complex interventions that need to be provided by skilled therapists. The problem; there simply aren't enough to meet demand and there never will be. A major initiative to improve access to psychological therapies (IAPT) consumed £170 million of new money.

Three and a half thousand new therapists have been trained and over 600,000 patients have entered the programme. Impressive; but rather than receiving the 20 sessions of CBT necessary for the treatment to work patients on average get just 3. Unless patients get 20 sessions the therapy can't work; this is what the research tells us. So whilst CBT is effective it is not the mental health equivalent of the Henry Ford's Model-T [pictured] providing effective psychological treatment for everyone.

Mental health practice is littered with countless examples of effective but complex interventions that work in theory but not in practice. The reason that they don't work is that they are too complex. Perhaps rather than focusing on ever more complex intervention we should consider simple intervention that can be reliably provided to all patients with mental illness. In a time of austerity making sure that everything we do really counts makes a lot of sense.

Back to medication. Mental illnesses such as schizophrenia , bipolar disorder and quite often depression, are long term conditions that require patients to stick with their medication, often indefinitely.

Whilst we need new treatments we could get much more out of the medicines we already have. Virtually every patient with schizophrenia or bipolar disorder misses doses of medication; this increases the risk of relapse and the return of painful and distressing psychotic symptoms. In fact the single biggest cause of relapse is that patients stop taking medication. There are many simple things that we can do to enhance adherence to treatment. I passionately believe we should be more positive about promoting the benefits of medication to our patients and their families.

For many patients, those with schizophrenia and bipolar disorder particularly, medication is a foundation to effective treatment and we should do everything to make sure that they stick with treatment. This is perhaps one of the most important things we do as mental health professionals.

There are other things we can do to help patients manage their medication; help them make choices about which drug will suit them best; closely monitor the effects and side effects of medicines, offer long acting injections rather than daily pills, use mobile phone text prompts to remind patients to take pills, prescribing a tablet that can be taken once once rather than four times a day. Simple things that work and help patients stick with treatment.

Ever more complex treatments that can never be scaled up to meet the need within the population seems to me like flogging, if it's not extending a metaphor to far, dead horse.

Our customers (patients) want greater access to talking treatments. I am far from convinced that the investment in psychological therapies has reaped the rewards that were promised when the IAPT programme was launched.

We need new medications and this requires intellectual as well as financial investment. When Henry Ford launched the Model-T, when Apple launched the iPad, these were leaps of imagination.

I want to argue for a simple revolution; we stop doing the complex badly and focus of doing simple things exceptionally well. But my real plea on world mental health day is to stop listening quite so much and start imagining.

Now more than ever we need real invention in mental health care and treatment.

Image credit

Model-T image credit

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

Gene-Environment Interactions Could Influence Several Psychiatric Disorders; 'Schizophrenia Gene' May Also Trigger Anxiety, Depression

A December 3rd media release from Johns Hopkins University:

BALTIMORE, Dec. 3 (AScribe Newswire) -- Male mice born with a genetic mutation that's believed to make humans more susceptible to schizophrenia develop behaviors that mimic other major psychiatric illnesses when their mothers are exposed to an assault to the immune system while pregnant, according to new Johns Hopkins research.

What was most surprising to researchers was that the mental illnesses the mice developed didn't look like schizophrenia, which they were genetically predisposed to, but more like mood and anxiety disorders, suggesting that one gene mutation can lead to different mental illnesses when influenced by the same environmental factor.

"Psychiatric diseases have genetic roots, but genes alone do not explain the entire disease," says Mikhail V. Pletnikov, M.D., Ph.D. [pictured], an associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and the study's leader. "When we study genes in conjunction with environmental challenges, we can better understand how diseases develop."

Pletnikov hopes his research, which appears in the December issue of the journal Biological Psychiatry, may be a small step toward eventually finding ways to prevent mental illnesses in humans. "The main goal here is to understand how gene-environment interactions take place on the molecular level so that you can find suitable drug targets, ultimately stopping these diseases before they happen," he says. "It all can start before birth."

Pletnikov and his team studied a mutant human form of the Disrupted-in-Schizophrenia 1 gene (mhDISC1), breeding mice in the laboratory with this mutation. This genetic variation is believed to be associated with vulnerability to major mental illnesses in humans. The mhDISC1 mice were impregnated, and at the ninth day of gestation (the equivalent to the middle or end of the first trimester in a human pregnancy), one group was given a drug to stimulate the immune system, forcing it to react as if it had been exposed to a virus like influenza or a parasite like toxoplasma. The rest of the pregnant mice - whose fetuses also had the mutated gene- were kept as a control group and their immune systems were left unchallenged.

The study found that prenatal immune stimulation in mhDISC1 mice produced behavioral abnormalities that were not present in the unchallenged mice: elevated anxiety, depression-like responses, an altered pattern of sociability and a weakened response to stress. The unchallenged mice did not show those behaviors, even though they also had the mutant gene. Pletnikov says the findings suggest that the same mutation, in this case mhDISC1, can lead to different illnesses, depending on interactions with environmental factors.

This may provide an explanation, he says, for why the extended Scottish family in which scientists first discovered this genetic mutation had members who suffered not solely from schizophrenia but also from major depression and bipolar disorder. "This one gene mutation can lead to very different clinical manifestations," Pletnikov says.

Along with the behavior differences, Pletnikov and his team also found that parts of the brain, including the amygdala and the hypothalamus, were smaller in the mice that had been prenatally challenged. A similar abnormality can be found in those same areas of the brain in humans with major depression and bipolar disorder.

Previous studies have suggested that the prenatal immune response to a microbe - be it a major illness or just transient flu-like symptoms barely noticed by the pregnant woman - may be responsible for the increased incidence of adult psychopathology in humans. But this hypothesis, Pletnikov says, has been difficult to prove. Using this mouse model, he suggests, is a valuable way to study the relationship between gene-environment interactions and mental illness, and should be replicated to find more of these interactions to gain a better understanding of these relationships.

Future studies, he says, will try to sort out whether different timing or stimulating different parts of the immune system might lead to specific types of mental illness, as well as explore the consequences of other environmental adverse events such as stress or drug abuse.

Other Johns Hopkins researchers on the study include Bagrat Abazyan, M.D.; Jun Nomura, Ph.D.; Geetha Kannan; Koko Ishizuka, Ph.D.; Kellie L. Tamashiro, Ph.D.; Frederick Nucifora, Ph.D.; Vladimir Pogorelov, Ph.D.; Chunxia Yang; Carlos Pardo, M.D.; Susumu Mori, Ph.D.; Atsushi Kamiya, M.D., Ph.D.; Akira Sawa, M.D., Ph.D.; and Christopher A. Ross, M.D., Ph.D.

The study was supported by the National Institute of Mental Health, Autism Speaks, the National Alliance for Research on Schizophrenia and Depression, the Mortimer W. Sackler Foundation, the Cell Science Research Foundation and the National Institutes of Health/National Institute on Drug Abuse-Intramural Research Program.

For more information: http://www.hopkinsmedicine.org/psychiatry/research/neurobiology/research_labs/behavioral_pletnikov.html

- - - -

CONTACT: Stephanie Desmon, Johns Hopkins Medicine Media Relations and Public Affairs, 410-955-8665, sdesmon1@jhmi.edu

Image credit

Address the real barriers

A letter to the editor published in today's edition of The Globe and Mail:

Untreated mental illness is a major risk for suicide: The rate of suicide for people with schizophrenia is 50 times higher than the general population, and 15 to 30 times higher for people with bipolar disorder (Suicide Barriers Fail To Address Root Of Problem – July 7). Suicide is the leading cause of death for 15- to 24-year-olds.

In Canada, only three in 10 adults access mental health care; the situation is worse for children and youth. While stigma may be a factor, the biggest problem is the lack of accessible mental health services and a lack of focus on early intervention. It is ironic that the share of health spending on mental health continues to decline, even though we know recessions lead to increased demands for mental-health services.

Provincial governments have an opportunity to use the increase in federal health transfers between now and 2014 to reverse this trend and focus on early intervention.

Steve Lurie [pictured], executive director, CMHA Toronto Branch

Also see:

Effect of a barrier at Bloor Street Viaduct on suicide rates in Toronto: natural experiment

Suicide barrier on Bloor Viaduct worked, but jumpers went elsewhere: study


Photo credit

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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The Hidden Business Cost of Mental Illness

An article posted December 3rd on blogs.harvardbusiness.org:

By Stew Friedman (pictured)

It's hard to focus on your work when your child is hallucinating.

One of the least discussed yet quite salient issues for American business in this year of health care reform is an important yet hidden cost associated with mental illness: the drain on productive work endured by family members struggling to support loved ones who suffer from such diseases. The good news for business leaders is that it's not hard to do something to help and thus feel good while improving company culture and morale, as well as your bottom line.

Mental illness comes in a staggering array of forms, and affects a broad swath of our general population. According to the National Institute of Mental Health, an "estimated 26.2 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year."

Awareness and understanding of mental illness has grown in recent years; still, it's often not taken seriously or treated as a legitimate medical disease either by businesses, by the health care system, or by our society. Indeed, too many people remain reluctant to get the help they need because of the stigma associated with mental illness. The website bringchange2mind.org (with a powerful new public service video by film director Ron Howard) asserts that "for many, the stigma associated with the illness can be as great a challenge as the disease itself."

This stigma extends beyond those directly stricken to family members. Parents of children with mental illness are often viewed as guilty by association, unfairly perceived as the cause of the illness — the source of harmful child-rearing practices — when the origin is mainly biological. Parents and other family members feel shame and a sense of failure. I know because one of my adult children suffers from a toxic combination of schizophrenia (a thought disorder) and bipolar illness (a mood disorder).

There are real costs associated with employees having to carry this heavy weight of worry and responsibility, especially if they feel they must do so without the understanding and support of their organization. There is stress, unwanted social isolation in the workplace, and the feeling that they must find clandestine ways of responding to urgent demands for their attention. All of this undermines productivity by causing burn-out, unplanned absences, distractions from focused effort on tasks, and poor confidence in being able to contribute to the team.

As a leader in your organization, you can reduce these costs and inspire greater performance from valued employees. You can enable them to feel freer to ask for the help they need in supporting their families by changing how you think , how you talk, and how you act. In turn, they are bound to repay you with extraordinary effort and commitment to your goals and to your company.

Mind your attitude. Changing your attitude toward one of greater understanding and acceptance requires education (see, for example, this recent Harris survey on schizophrenia). If an employee with dependent care responsibilities born of a physical abnormality or illness needs to bring a loved one to a doctor's visit, no one judges him harshly. Indeed, this is likely to evoke sympathy. On the other hand, if he has to disrupt his work schedule to care for a family member, who — for reasons difficult to grasp and explain — cannot be left alone for fear of hearing voices or of some other dread psychological symptom, then he might well be reluctant to risk letting others know why he needs the time because they might look askance or even question his own mental stability. Your attitude can make all the difference. By taking mental illness as seriously as any physical illness, you convey emotional support and encourage employees to get the help they need to cope with the strains of caring for their sick loved one.

Watch your words. The words you use, and the way you use them, convey your attitude. Here's a tip from bringchange2mind.org: "Refrain from using terms like 'crazy,' 'nuts,' 'psycho' and 'lunatic.' While there may be times when it is too challenging or simply not possible to politely correct someone else's insensitive use of language, you can always try to watch your own." To combat harmful stereotypes and demonstrate understanding, it's better to say, for example, that someone "has schizophrenia" than to call that person a "schizophrenic" — the illness is not the person.

Model behavior. The kinds of actions that show genuine support are the same ones you'd want to show all your employees in treating them as whole people, with important aspects of life playing out beyond the bounds of work: Initiate and encourage dialogue with an open mind, address the individual needs of each employee, respect confidentiality, and be flexible and willing to engage in joint problem-solving while focusing on results that matter to you and to them.

Change the culture. As a business leader you are in a position to have a positive influence on the culture of your organization which, in turn affects all your employees as well as other stakeholders — clients and customers, suppliers, community members, and so on. Your supportive attitude about those who are forced to live with mental illness — with the words and deeds to reinforce it — can shape your company's values and the behavior in it that determine whether or not all your people get the help they need to both contribute fully to your business and lead productive lives.

What else can be done to make it easier for parents and other loved ones of those who live with mental illness to perform well at work? Please comment and share your stories, advice, and resources.


Stewart D. Friedman is Practice Professor of Management at the University of Pennsylvania’s Wharton School in Philadelphia. He is the founding director of Wharton’s Leadership Program and of its Work/Life Integration Project, and the former head of Ford Motor’s Leadership Development Center. He is the author of numerous books and articles on leadership development, work/life integration, and the dynamics of change, including the bestselling Total Leadership: Be a Better Leader, Have a Richer Life, from Harvard Business Press. For more, please visit www.totalleadership.org.

Photo credit

Also see:

Work, Recovery and Inclusion: Employment support for people in contact with secondary mental health services (U.K.)

Canadian hospital pioneers mental-health treatment

An article published is yesterday's edition of The Globe and Mail:

By Anne McIlroy

A Canadian psychiatric hospital will be the first in the world to use a combination of genetic testing and brain imaging to help determine the best course of treatment for patients with schizophrenia, depression, bipolar disorder and other mental illnesses.

A few dozen patients will take part starting in the fall, and the experimental program will slowly ramp up to include 100 people, says James Kennedy, director of the neuroscience research department at the Centre for Addiction and Mental Health in Toronto. If it proves successful, the program will be a step toward giving psychiatrists more precise tools to assess patients with common psychiatric conditions.

“It is a small revolution, a great opportunity to change, in a fundamental way, how we treat patients,” says Dr. Kennedy, who along with his colleague, Sylvain Houle, is leading the new research initiative.

To read the entire article, please click here.

Also see:

CAMH combines genetics with brain imaging to personalize treatment for mental illness and addictions

I thank John Devlin for bringing this article to my attention.

Gene clues to schizophrenia risk

An article posted July 1st by BBC News:

Scientists have identified thousands of tiny genetic variations which together could account for more than a third of the inherited risk of schizophrenia.

They also showed the condition is genetically similar to bipolar disorder also known as manic depression.

The findings came from work by three separate teams, who analysed DNA from thousands of people.

The studies - the biggest ever into the genetics of schizophrenia - appear in the journal Nature.

The findings suggest that schizophrenia is much more complex than previously thought, and can arise not only from rare genetic variants, but common ones as well.

It is hoped the work could lead to new diagnostic tests and treatments for the condition.

To read the entire article, please click here.

Also see:

Common polygenic variation contributes to risk of schizophrenia and bipolar disorder

Hoopla, and Disappointment, in Schizophrenia Research

Audio recordings: Taser victim was shot twice

An article posted June 18th by thespectrum.com:

ST. GEORGE - Audio recordings of a Tasering incident that resulted in the death of Brian Cardall [pictured], age 32, released Wednesday by his family, indicate that the man was shot twice with the weapon and apparently stopped breathing at the scene.

The incident began when Cardall's wife, Anna, called police dispatch and said her husband was having a "serious psychosis."

The couple was stopped on state Route 59 on their way home to Flagstaff, Ariz., when the incident occurred.

Cardall's wife can be heard telling the dispatcher her husband was running in the road, had taken his clothes off and was trying to direct traffic.

"I'm really scared he's going to jump in front of a moving car," she is heard saying.

The recordings captured officers ordering Cardall to "get down on the ground ... police officers, get down on the ground, now."

Cardall is heard responding: "This is a standoff - don't shoot me."

A clear pop sound is heard followed by an unidentified officer saying, "Taser deployed."

The recording continues as an officer commands Cardall to stay on the ground. Then, the Taser is deployed again.

Officers go on to tell Cardall's wife to get back in the car and take care of her baby. She is heard saying, "Thank you so much. ... please let him be OK."

Officers are heard talking about how Cardall wasn't breathing.

An officer in the recording says, "He (Cardall) went down, now he's not breathing, no pulse." It continues with officers talking about the Taser deployment.

To read the entire article, please click here:

Also see:

Cardall Family Releases 911 Recordings

Family mourns 'remarkable soul'

Walsh: Police search for a defense in death

A four-part series on young people with mental illness ...

... written by John Gillis and published in the Chronicle Herald.




Part One
‘It’s not him, it’s the illness’
Mom stands by son who choked her; she hopes his court-ordered stay at forensic hospital will finally help him

Part Two
Mom pleads for timely help

Part Three
‘It seemed so real’
Imaginery noises led to bipolar disorder diagnosis for bright young teenage girl

Part Four
Treat mental health problems early, avoid trouble later
The last in a four-part series on young people and mental illness

Common genetic determinants of schizophrenia and bipolar disorder in Swedish families: a population-based study

The summary of an article published in the January 17th edition of The Lancet:

By Paul Lichtenstein (a), Benjamin H. Yip (a), Camilla Björk (a), Yudi Pawitan (a), Tyrone D. Cannon (d), Patrick F. Sullivan (a,c), and Christina M. Hultman.

Background

Whether schizophrenia and bipolar disorder are the clinical outcomes of discrete or shared causative processes is much debated in psychiatry. We aimed to assess genetic and environmental contributions to liability for schizophrenia, bipolar disorder, and their comorbidity.

Methods

We linked the multi-generation register, which contains information about all children and their parents in Sweden, and the hospital discharge register, which includes all public psychiatric inpatient admissions in Sweden. We identified 9,009,202 unique individuals in more than 2 million nuclear families between 1973 and 2004. Risks for schizophrenia, bipolar disorder, and their comorbidity were assessed for biological and adoptive parents, offspring, full-siblings and half-siblings of probands with one of the diseases. We used a multivariate generalised linear mixed model for analysis of genetic and environmental contributions to liability for schizophrenia, bipolar disorder, and the comorbidity.

Findings

First-degree relatives of probands with either schizophrenia (n=35,985) or bipolar disorder (n=40,487) were at increased risk of these disorders. Half-siblings had a significantly increased risk (schizophrenia: relative risk [RR] 3·6, 95% CI 2·3—5·5 for maternal half-siblings, and 2·7, 1·9—3·8 for paternal half-siblings; bipolar disorder: 4·5, 2·7—7·4 for maternal half-siblings, and 2·4, 1·4—4·1 for paternal half-siblings), but substantially lower than that of the full-siblings (schizophrenia: 9·0, 8·5—11·6; bipolar disorder: 7·9, 7·1—8·8). When relatives of probands with bipolar disorder were analysed, increased risks for schizophrenia existed for all relationships, including adopted children to biological parents with bipolar disorder. Heritability for schizophrenia and bipolar disorder was 64% and 59%, respectively. Shared environmental effects were small but substantial (schizophrenia: 4·5%, 4·4%—7·4%; bipolar disorder: 3·4%, 2·3%—6·2%) for both disorders. The comorbidity between disorders was mainly (63%) due to additive genetic effects common to both disorders.

Interpretation

Similar to molecular genetic studies, we showed evidence that schizophrenia and bipolar disorder partly share a common genetic cause. These results challenge the current nosological dichotomy between schizophrenia and bipolar disorder, and are consistent with a reappraisal of these disorders as distinct diagnostic entities.

Funding

Swedish Council for Working Life and Social Research, and the Swedish Research Council.

Footnotes

(a) Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

(b) Department of Neuroscience, Psychiatry, Ulleråker, Uppsala University, Sweden

(c) Department of Genetics, University of North Carolina, Chapel Hill, NC, USA

(d) Departments of Psychology and Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA

Correspondence to: Prof. Paul Lichtenstein, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, 17177 Stockholm, Sweden

Posting of this summary on this weblog is for the purposes of research into schizophrenia and bipolar disorder.

Photograph of Prof. Paul Lichtenstein courtesy of Karolinska Institutet.

Also see:

The Observed Psychosocial & Psychopharmacological Commonalities Between Schizophrenia & Bipolar Disorder Seem More Than Just A Coincidence: Can We Now Add A Common Genetic Basis?

Large Family Study Links Genetics of Schizophrenia, Bipolar Disorder

Common Causes Of Schizophrenia And Bipolar Disorder

Quote for Today

"According to reports published in the Journal of the American Medical Association, roughly 50% of individuals with personality disorders are affected by substance abuse, and 37% of alcohol abusers suffer from some form of mental illness. Individuals with schizophrenia or bipolar disorder are four or five times more likely, respectively, to suffer from substance abuse than the general population."

Source

For help, visit:

Schizophrenia & Substance Use

Addiction Services (Nova Scotia)

Alcoholics Anonymous (Nova Scotia)

Narcotics Anonymous (Nova Scotia)

Can childbirth make you lose touch with reality?

To read this article written by Jo Ciavaglia and published in the October 12th edition of the Bucks County Courier Times, click here.

What is postpartum psychosis?

Postpartum psychosis is a rare mental condition that typically develops within the first two weeks after delivery, but can appear within the first three months. Women with a personal or family history of psychosis, bipolar disorder or schizophrenia are at an increased risk of developing postpartum psychosis.

Signs and symptoms of postpartum psychosis may include:

• Confusion and disorientation

• Hallucinations and delusions

• Paranoia

• Attempts to harm yourself or the baby

• Rapidly shifting moods

• Restlessness and insomnia

What is postpartum depression?

A serious mental condition whose symptoms can include mood swings, uncontrollable crying, fatigue or exhaustion, feelings of guilt, thoughts of harming yourself or the baby, inadequacy or worthlessness, lack of interest in the baby and other common signs. Women with postpartum depression rarely harm their baby.

Other environmental factors can aggravate symptoms such as the temperament of the baby, an unsupportive or absent partner or extreme stress. The symptoms can last for months and often require professional treatment.

Source: Mayoclinic.com

Did you know?

• Experts say fewer than 20 percent of postpartum psychosis sufferers will speak to their health care provider about their symptoms.

• Women who have already experienced postpartum depression or psychosis have a 20-50 percent chance of it recurring after future births, according to research.

Jane Pauley to accept award

From the National Alliance on Mental Illness (NAMI):

TV Journalist Jane Pauley (pictured) will be honored at NAMI's National Convention in Orlando for her significant national contributions in the fight against stigma and discrimination. She is the author of Skywriting: A Life out of the Blue, in which she shared her personal experience with bipolar disorder. This month she will moderate a PBS panel discussion in conjunction with the premiere of the documentary, Depression: Out of the Shadows (May 21 at 9:00 p.m.).

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.

Schizophrenia takes a daughter away

Even a loving family with ample financial resources is powerless against the disease.

An well-written article in the December 29th issue of the Los Angeles Times describes the heart-wrenching story of a family dealing with a daughter living with schizophrenia, bipolar disorder, and drug addiction.

Accompanying the article are are numerous photographs and a Flash audio presentation.

To read the entire article, click here.

To access a series of articles entitled Breakdown: A Times Special Report, click here.

Photograph by Robert Gauthier / Los Angeles Times

Kurt Entsminger named executive director of the Treatment Advocacy Center

National nonprofit working to secure right to treatment for the mentally ill will benefit from Entsminger's extensive legal, nonprofit expertise, consumer perspective

November 19, 2007

ARLINGTON, VA –The Board of Directors of the Treatment Advocacy Center (TAC) selected attorney and consumer Kurt Entsminger (pictured, right) to be the organization's next executive director, only the second since the organization was formed nine years ago.

Entsminger was unanimously approved at TAC’s board meeting on November 10, 2007. He will start work January 2, 2008.

“Kurt Entsminger will be a strong leader,” said TAC president E. Fuller Torrey. “TAC has firmly established itself as the only organization willing to stand up and fight for treatment for the most seriously ill and neglected patients. Entsminger’s expertise in the nonprofit world, combined with his personal experiences with bipolar disorder, give him an unique understanding of how to position TAC for future success.”

“I believe it is time to restore common sense to a society that has literally sacrificed human sanity in the name of personal privacy,” said Entsminger, who was most recently president of the national nonprofit Care Net. “I consider it a great honor and privilege to join this effort.”

Entsminger was at Care Net for nine years, where he doubled the organization’s income and greatly expanded its impact. He is a former Assistant United States Attorney for the Southern District of West Virginia, and spent 18 years as a trial lawyer, including serving as a partner in two law firms. He was also an Administrative Law Judge for Huntington Human Relations Commission. He has a bachelor’s in economics from West Virginia University and a law degree from West Virginia University College of Law, where he graduated first in his class.

Entsminger said he was drawn to the empathy and compassion of the Treatment Advocacy Center. “It is my history that brought me to TAC. As a person who has lived with bipolar disorder for many years, I understand firsthand the importance of effective treatment. My hospitalization and subsequent and continuing treatment is the reason I’m well today. I come to the Treatment Advocacy Center with great respect and appreciation for its work, and a particularly strong passion for its mission. TAC is making a difference in the lives of hundreds of thousands of Americans who continue, without treatment, to struggle with severe brain disorders.”

“The search committee recommended Entsminger without reservation and feels he is extraordinarily qualified to be a champion for those with severe mental illnesses that other organizations ignore,” said search committee co-chair and board vice chair Stephen Segal. “His unique background and passion make him worthy of being Mary Zdanowicz’ successor and building on the continued outstanding work of the staff of the Treatment Advocacy Center.”

TAC’s founding executive director Mary Zdanowicz resigned July 2007. She remains active as a member of the honorary advisory board.

“The nationwide search brought in an impressive group of candidates,” said search committee co-chair Jonathan Stanley, TAC’s assistant director. “The caliber and reach of the almost 150 applicants is reflective of TAC’s status in the broader community.”

Since it opened its doors in 1998, TAC has been involved in reforming treatment laws in 18 states, including Kendra’s Law in New York. Kendra’s Law is hailed as a national model for assisted outpatient treatment, a way to court order someone with severe mental illness who is too ill to recognize they need help into community-based treatment. The American Psychiatric Association awarded TAC its Presidential Commendation for “sustained extraordinary advocacy on behalf of the most vulnerable mentally ill patients."

The Treatment Advocacy Center (www.treatmentadvocacycenter.org) is a national nonprofit organization dedicated to eliminating barriers to the timely and effective treatment of severe mental illnesses. TAC promotes laws, policies, and practices for the delivery of psychiatric care and supports the development of innovative treatments for and research into the causes of severe and persistent psychiatric illnesses, such as schizophrenia and bipolar disorder.

We take no money from pharmaceutical companies. The American Psychiatric Association awarded TAC its 2006 presidential commendation for "sustained extraordinary advocacy on behalf of the most vulnerable mentally ill patients.”

Physiology of Schizophrenia, Bipolar Disorder, and Schizoaffective Disorder

An abstract from the December 2007 issue of the American Journal of Psychiatry:

Laura F. Martin, M.D., Mei-Hua Hall, M.S., Randal G. Ross, M.D., Gary Zerbe, Ph.D., Robert Freedman, M.D., and Ann Olincy, M.D.

OBJECTIVE: Endophenotypes have been proposed to identify the genetic and biological substrates of complex disorders. Three physiological inhibitory endophenotypes of large effect size in schizophrenia include suppression of P50 auditory evoked responses, inhibition of leading (small anticipatory) saccades during smooth pursuit eye movements, and cancellation of reflexive saccades in the antisaccade eye movement task. The aim of this study was to determine if the pattern of endophenotype abnormalities within individuals with schizophrenia differed from that within individuals with bipolar disorder. A second aim was to determine whether subjects with schizoaffective disorder, bipolar type, were neurophysiologically more similar to subjects with schizophrenia or subjects with bipolar disorder.

METHOD: Endophenotypes were recorded for subjects diagnosed with schizophrenia (N=29), bipolar disorder (DSM-IV-TR) (N=40), and schizoaffective disorder, bipolar type (N=18). Data from normal comparison subjects were used to establish normal performance.

RESULTS: Logistic regression determined that P50 ratio and frequency of leading saccades identified subjects with schizophrenia and bipolar disorder with a sensitivity of 95%* and a specificity of 83%*. The schizoaffective disorder group was split, with six subjects physiologically classified as schizophrenia-like and 12 subjects as bipolar-like. Those classified as schizophrenia-like were significantly younger at illness onset and had higher symptom ratings.

CONCLUSION: A composite endophenotype of P50 ratio and frequency of leading saccades is consistent with the current clinical nosology of schizophrenia and bipolar disorder and parses patients with schizoaffective disorder, bipolar type, into two subgroups.

* Emphasis is mine.