A message from Senator Wilbert Keon

11 June 2007

Dear friends,

Just over one year ago, the Standing Senate Committee on Social Affairs, Science and Technology released its final report on mental health, mental illness and addictions, Out of the Shadows at Last.

One of the key recommendations in that report was to create a national mental health commission to help ensure that mental health issues were never again driven back into the shadows.

As you may already know, in its March 2007 budget the Government of Canada provided funding for the creation of the Mental Health Commission of Canada, as recommended in our report. The Government also named the former Chair of our Committee, the Honourable Michael Kirby, as the first Chair of the Commission.

I am writing you today to tell you about the launch of the temporary website of the Mental Health Commission of Canada. The website will provide information about the Commission as it begins its activities.

As one of its first tasks, the Commission must create a Board of Directors. Members of the Board will be responsible for the work of the Commission. As recommended in our report, around two thirds of the Directors will be selected from outside of government.

From today, June 11, until July 15, 2007, the Commission is accepting applications from anyone who is interested in serving as one of the eleven non-governmental members of its Board.

I invite you to click on the link below to visit the Commission’s website to find out how to apply.

www.mentalhealthcommission.ca

I would also like to ask you to share the link to the Commission’s website widely, so that as many people as possible can become involved in the work of the Commission. In particular, if you are able to place a link to the Commission’s website on your own webpage, or on that of your organization, it would be of great assistance.

On behalf of the Chair of our Committee, Senator Art Eggleton, and all the members of the Standing Senate Committee on Social Affairs, Science and Technology, I hope you join me in wishing the Mental Health Commission of Canada every success in its important mission to help improve the lives of the many thousands of Canadians living with a mental illness.

Best regards,

Senator Wilbert Keon

Deputy Chair
Standing Senate Committee on Social Affairs, Science and Technology

Warm and welcoming - Community Mental Health Bayers Road

From the Capital Health Website:

Gary Seymour and Wendy Miller both work at the reception desk at Community Mental Health Services, Bayers Road. Since the office’s opening on May 8, they’ve heard a lot of positive reviews about the bright and welcoming space, including “Wow. I feel like I’m at a spa.” And “This is really different.”

The warm, inviting and comfortable space was no accident. “A group of staff members took the lead on choosing colours and artwork for the walls and have done a tremendous job,” says Evelyn Pollard, service co-ordinator. “We still have work to do to make the space what we know it can be, but we are very happy with the response from clients.”

Community Mental Health Services, Bayers Road, will host an official open house in June, but in the meantime, please drop by to see the new location: Suite 109, Bayers Road Centre (entrance door between Lawtons and Fabricville).

To view photos of the new space, please click here.

Less talk, more action

From the June 1st edition of the Halifax Chronicle Herald:

My heart goes out to the families of Glen Race and his alleged victims. I echo the call for more treatment facilities and options for persons with mental illness.

Twenty years ago, my husband, John Legge, died by drowning himself at Point Pleasant Park while an inpatient at Camp Hill Hospital (Abbie Lane Building). A few months earlier, I had taken him to the then VG Hospital for behaving in a strange and uncharacteristic manner. The doctors in the emergency department told us he was depressed and could become suicidal, but they could not keep him against his will as he was not an "imminent" danger to himself or others.

Less than half an hour after leaving the hospital, he stabbed a family friend and was shot by a Halifax police constable who was called to the scene. After a stay at the East Coast forensic facility, he was transferred to the Abbie Lane for "treatment" and remained there until his ill-fated walk to the park on May 4, 1987.

In her report following the inquiry into John’s death, Judge Sandra Oxner stated that as a society, we have an obligation to offer viable treatment for persons with mental illness before they deteriorate to the point where they come in conflict with the law. It saddens me that 20 years later, we are still "discussing" the issue. I call on the government to put its money where its mouth is and adequately fund mental health treatment programs now, before its too late for yet another family.

Donna MacEachern, Halifax

The molecular wake-up call

Alison Abbott writes in the May 24, 2007 issue of Nature:

It is 50 years since Arvid Carlsson showed dopamine to be a neurotransmitter.

Catatonic rabbits were revived by dopamine in a 1957 experiment led by Arvid Carlsson (photographs, above). In the background is an image of Arvid Carlsson's 1957 publication in the prestigious journal Nature.

Rabbit photographs by Tor Magnusson

To read about the dopamine hypothesis of schizophrenia, click here.

The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science

From Schizophrenia Daily News Blog, May 29, 2007:

There is a good review in the New York Times of the new book called "The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science" written by the Canadian psychiatrist Norman Doidge (who does work at Columbia University in NY). While this book is not specifically about schizophrenia - it provides hopeful stories and background information on the science of brain regeneration (called neuroplasticity) which provides hope for individuals and families that [live with] schizophrenia.

The Nova Scotia Early Psychosis Program is moving

The following is taken, verbatim, from a bulletin board posting found on May 31st, 2007, in the Purdy Building:

The Nova Scotia Early Psychosis Program is moving ......
(From The Nova Scotia Hospital site)

You have probably heard we are moving! Yes, it's true! Our offices are being relocated to:

The Abbie J. Lane Memorial Building
5909 Veterans' Memorial Lane
Halifax, Nova Scotia
B3H 2E2

There is no definite date yet.
(we expect it will likely occur by September 2007)
When more details are available we will pass them on to you.

We will make every effort to ensure your care is not interrupted, and we will continue to work hard to make sure convenient appointments are made available to you.

If you have any questions, please ask your clinician or call 464-5997

THE VILLAGE

By Jon David Welland

It is said that it takes a village to raise a child; it also takes a village to care for the ill and the disabled. The social footprint of any disability includes not only family and friends but also the professionals of all stripes who contribute to their care. Mental illness is a disability, in this and many other important ways. This social footprint causes a shift in the family dynamic of those who are affected. It is moving us away from the “nuclear family” whose family unit consists of a husband, wife and their children. When children reach a certain age they are expected to leave home in hopes of creating another similar unit on their own. This model had its start in the nineteen fifties, which had a high standard of living and a prosperous economy. During the depression however, people lived in “extended families”, where two or three generations lived under the same roof and the neighbours would often share in many of their duties.

The community has a powerful role in the treatment and recovery of anyone suffering from a mental illness, and they will never become well in a community that does accept and tolerate them. They cannot remain outcasts from the village; they are your friends, your family. You see them every day on the bus, in the malls and on the street, and you wouldn’t know most of them were mentally from looking at them. They used to be hidden away in hospitals, never to see the light of day, but things have changed.

Institutions first began closing their doors out of economic necessity; because housing people in hospitals was very expensive, but there were very few supports in place in the community for these individuals, causing some serious social problems. “Psychiatric Ghettos” sprung up around the hospitals, filled with patients from all over the district, who had been tossed out and who were forced to fend for themselves.

Supports were eventually created, like free clinics, drug plans and affordable housing. This was also out of economic necessity, since the cost of these services was still much less than the cost of warehousing people in institutions.

Hospitalization became even more unnecessary when effective medications were developed to treat the symptoms of mental illness with fewer side effects and less chance of a relapse. Their struggle is now to find acceptance and a place in the community. They now have a chance to contribute to the society that supports them. They have a chance to lead normal lives.

However, there is still a great deal of stigma associated with mental illness. Housing programs have been struggling against the attitude of “not in our backyard”. People accept the need for housing, but don’t want it in their neighbourhood. There have been protests, petitions and demonstrations; even city aldermen have gotten into the act. The best way to fight this stigma is through public education about the facts of mental illness.

We refuse to be driven out of our homes.

Photograph by Brendel.

How to Foster Continuity of Care

From Psychiatric News, May 18, 2007, Volume 42, Number 10, page 19:

The following are recommendations from the National Council for Community Behavioral Healthcare on helping people with serious mental illness continue to receive treatment after their discharge from inpatient care:

• Hospitals and community-based organizations should collaborate more closely with one another. This may include standardization of information and shared electronic health records.


• Providers and mental health organizations should use treatment-performance standards as part of a quality-improvement approach that can enhance treatment continuity.


• All mental health consumers should receive care management for transition from hospital to community; care-management services should be reimbursable by all payers, and the disincentives to providing them should be removed.


• Mental health agencies should focus on the "pull model" of transition from inpatient to outpatient care, which emphasizes involving community-based providers in the transition process.


• Accreditation standards should be aligned to address and improve continuity of therapy in treating mental illness.


• Consumers and their families should be educated about the benefits of maintaining their medical histories, whether through written logs or portable electronic devices.


• Consumer-driven recovery planning should include the appropriate use of hospitalization. More thoughtful use of inpatient services can lead to a reduction in emergency-room use and a decrease in number of hospitalizations.


• Payers who collect data about mental health services and performance should share the data with appropriate stakeholders to enhance the provision of care.


• Consumers and mental health advocates should be involved in all levels of system delivery and evaluation. Examples include using peer specialists as part of a treatment team and involving them in the development and implementation of performance-evaluation measures.

Americans' Attitudes Toward Mental Health Treatment Seeking: 1990–2003

Ramin Mojtabai, M.D., Ph.D. (pictured), writes in the May 2007 issue of Psychiatric Services:

Mental health treatment seeking has become more acceptable over the past decade, and perceived stigma associated with it has declined. These changes in public attitudes have likely contributed to the growing demand for mental health services in the United States and will continue to do so in the coming years.

Also visit this article in Psychiatric Times.

Seven recent newspaper articles

The first.

The second.

The third.

Photograph of Jon Welland by Andre Forget and courtesy of the Halifax Daily News (see the third article for story).

The fourth.

The fifth.

The sixth.

The seventh.

Speech by The Hon. Michael Kirby

The Hon. Michael Kirby is chair of the Mental Health Commission of Canada. For the full text of a speech he made to the Empire Club of Canada on May 17, 2007, click here.

It was awful

Click on the arrow to start the video.

Liz Spikol is managing editor of Philadelphia Weekly. She writes the award-winning column "The Trouble With Spikol," which began as a chronicle of her struggle with mental illness, and has since expanded into humorous musings on everything from graphic novels to how to use a mop.

Her blog is entitled The Trouble with Spikol.

To view more of Ms. Spikol's YouTube videos click here.

Health Canada Warning: Recall of Two Valproic Acid Drugs, Depakene 500 mg and Ratio-Valproic 500 mg

For individuals taking Epival:

OTTAWA (May 11, 2007) - Health Canada is warning patients taking the anti-epilepsy medications Depakene 500 mg and ratio-VALPROIC 500 mg that they may not be getting the full dose of the active drug, which could result in inadequate treatment of their seizures. These products are being recalled and patients using Depakene 500 mg and ratio-VALPROIC ECC 500 mg (valproic acid) are advised to contact their physician or pharmacist immediately to obtain another suitable product. Patients should not discontinue their medication before consulting their health care provider.

If seizures are not adequately treated, patients are at risk of increasing number and frequency of seizures and of related complications, including injury from falls, injury from a seizure while driving or operating machinery, or inhalation of fluid into the lungs and aspiration pneumonia.

ABBOTT Laboratories Limited is recalling Depakene 500 mg and ratiopharm Inc. is recalling ratio-VALPROIC 500 mg. The capsules may not disintegrate properly; as a result, a lesser amount of the active ingredient may be released. Consumers who have purchased either of these products should return their product to their pharmacist.

Consumers requiring more information about this advisory can contact Health Canada's public enquiries line at (613) 957-2991, or toll free at 1-866-225-0709.

To report a suspected adverse reaction to this or any other health product, please contact the Canadian Adverse Drug Reaction Monitoring Program (CADRMP) of Health Canada by one of the following methods:

Telephone: 1-866-234-2345
Facsimile: 1-866-678-6789

CADRMP
Marketed Health Products Directorate
Tunney's Pasture, AL 0701C
email: cadrmp@hc-sc.gc.ca

The CADRMP adverse reaction reporting form, including a version that can be completed and submitted online, is located on the MedEffect portal of the Health Canada Web site. (www.medeffect.gc.ca)

Distal support and community living among individuals diagnosed with schizophrenia and schizoaffective disorder

The following is the abstract of a paper published, by researchers at Yale University, in the March 1st issue of Psychiatry: Interpersonal & Biological Processes:

Community integration for individuals diagnosed with schizophrenia is essential to successful community tenure. Most of the research and clinical emphasis on the process of integration has been focused on the successes in normative goals (e.g., employment, support networks). Little research has focused on how individuals diagnosed with schizophrenia and schizoaffective disorder integrate in the realm of public life involving the casual routine interactions with other community members, termed "distal support" in this study. This was a cross-sectional study specifically designed to develop a measure of distal support and to identify clinical and sociodemographic factors associated with fostering distal supports.

Findings suggest that personality factors, specifically extroversion and openness, play a role in the process of fostering community distal supports. It was also found that a greater number of distal supports were associated with higher quality of life satisfaction ratings and sense of belonging scores with the participants who were diagnosed with schizophrenia. A greater number of distal supports were associated with higher hospitalization rates and emergency contacts among the participants diagnosed with schizoaffective disorder, but not among those diagnosed with schizophrenia.

Independent Living Support Program to Undergo Expansion

The following was posted on the Eastern Views blog on March 26, 2007:

Nova Scotians living with disabilities, including intellectual disabilities and long-term mental illness, will soon benefit from an expanded government program.

Initiated in Cape Breton last January, the Independent Living Support Program will begin to serve clients in the northern counties of Guysborough, Antigonish, Pictou, Colchester and Cumberland at the end of the month and will expand to the rest of the province over the next year.

"This program will help people maintain their independence, while ensuring they have enough support to meet their daily needs," said Judy Streatch (pictured), Minister of Community Services. "We've targeted our programs to meet the needs of individuals with disabilities by offering varying levels of support."

The Independent Living Support program serves people who are semi-independent and need a minimum level of assistance to live on their own in the community. It provides up to 21 hours of weekly support, including help maintaining health and wellness, household chores, and accessing services in the community.

The Independent Living Support Program expansion and other new services were announced in December 2004, following extensive community consultation. The services include: Direct Family Support, providing financial assistance to people who care for a family member with a disability at home; the Alternative Family Support Program, which offers a family-like setting in the community. These new programs complement existing residential services already in place for people who need a higher level of care in the community.

For the related Nova Scotia Department of Community Services press release click here.

Several Trends Shaping Future of Mental Health Care in U.S.

Rich Daly writes in the May 5th issue of Psychiatric News:

[A] report, "Mental Health, United States, 2004," was released by the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Mental Health Services (CMHS) in March [2007]. It aims to provide a snapshot of the federal government's understanding of current mental health services, trends, and statistics that affect the nearly 44 million Americans who suffer from a mental illness in any given year.

Information Matters: Spring 2007

The latest issue of Information Matters, the quarterly newsletter of the Schizophrenia Society of Nova Scotia, is now available. Click here to view and/or download.

Walk Nova Scotia Challenge Reception

To walk the last 5K of the Walk Nova Scotia Challenge, members of the Lunenburg County Chapter participated in Park View Education Centre's Field of Dreams 5K Walk in Bridgewater.

Below are some photographs from the Walk Nova Scotia Challenge reception, held Sunday, May 6th, 2007, at the Girl Guide's Cabin in Bridgewater.

Just a Smile and a Hello on the Golden Gate Bridge

An article by Robert I. Simon, M.D., published in the May 2007 issue of the American Journal of Psychiatry.

Photograph by Rich Niewiroski Jr.

Medical News TODAY

Click here for international coverage of the annonuncement of a new mission statement for all eleven schizophrenia societies in Canada.

Son with schizophrenia inspires genetic discovery

For the full story, visit CBC News and Biology News Net.

For more information on Dr. John Roder's schizophrenia research, click here.

Involuntary Psychiatric Treatment Act: July 3, 2007

The new Involuntary Psychiatric Treatment Act will be proclaimed in effect in Nova Scotia on July 3, 2007. The regulations that accompany this Act can be found here (downloads a PDF file; note: parts of some pages are missing).

International Caregiver Survey Results

From the Mood Disorders Society of Canada website:

Results from the first International Caregiver Survey provide significant insight into the experiences and concerns of families caring for individuals with mental illness.

Key among the findings were the harsh physical, emotional and financial consequences that occur within families when an individual’s treatment is disrupted.

The survey was developed by the World Federation of Mental Health and Eli Lilly and Company, and conducted by Ipsos-Insight and All Global Ltd. It included 200 Canadian families, as well as families in Australia, France, Germany, Italy Spain, the United Kingdom and the United States.

Keeping Care Complete: International caregiver survey

View PDF File

Psychiatrists Join Wait Time Alliance to Advocate for Benchmarks for Psychiatric Care

Ottawa, Ontario (April 19, 2007)

For immediate release – Today the Canadian Psychiatric Association (CPA) joined the expanded Wait Time Alliance to step up its advocacy for wait time benchmarks in psychiatry.

“Benchmarks establish what is adequate care and this makes it easier to hold the system accountable to patients and their families,” says Dr. Manon Charbonneau, President of the Canadian Psychiatric Association. “We want the federal government and health ministers to include serious psychiatric illnesses on their priority lists.”

More people die by suicide than from motor vehicle accidents. Most people who die by suicide have some history of psychiatric illness—and those who die by suicide are disproportionately young. We also know untreated depression is the greatest cause of disability in women of working age. “The tragedy is that too often such illnesses do not get treatment in time to prevent these horrible consequences,” says Dr. Charbonneau.

CPA published wait time benchmarks for patients with serious psychiatric illnesses last March. Timely access to psychiatric health services is critical for the 20 per cent of Canadians who will need mental health services in their lifetime.

The Wait Time Alliance of Canada (WTA) is a partnership of specialty associations and the Canadian Medical Association.

The Canadian Psychiatric Association (CPA) is the national voice for Canada’s 4,100 psychiatrists and more than 600 psychiatric residents. Founded in 1951, the CPA is dedicated to promoting an environment that fosters excellence in the provision of clinical care, education and research.

View the CPA policy paper on wait time benchmarks by clicking here.

Information: Hélène Côté, Canadian Psychiatric Association
Cell: (613) 797-5488

A Wake Up Call

By John David Welland

Earlier this month, American society imploded. In a cultural environment teeming with intense violence and in a country rife with lethal firearms available to just about anyone, another young man has lashed out at a society he believed had destroyed and rejected him. There was a wide range of reactions to this tragedy. Some are calling for stricter gun laws, others are pointing to violent computer games. There are many people who are calling for armed guards in their schools, and a policy of zero tolerance against young people with emotional problems.

The problems with the later approach are many. The main ones are the implications of punishing people or restricting their freedoms because of something that they might do. There is also the danger that, seizing on the fact that the individual was being treated for a mental illness, many people will come to believe a that all people with a mental illness are capable of such an act, when in fact that they are generally less prone to violence than ordinary individuals, if they are being properly treated.

The stigma attached to mental illness is only going to be reinforced by these events, especially in our schools, and make young people even more reluctant to get help if they have a problem, for fear of being seen as a psycho and a killer. This sort of attitude will only serve to make things worse by making other such tragedies even more likely.

This is no time for the mental health community to shrink from the task of educating the public about mental illness; rather it is a wake up call. People need to know the facts about mental illness now more than ever. This tragedy needs to be placed within a larger context, so that people do not respond to it in a way that will increase stigma. This is a wake up call.

The opinions expressed here are those of the author and do not necessarily represent those of the Schizophrenia Society of Nova Scotia.

For another opinion click here.

Orange Broadband Award for New Writers: Poppy Shakespeare shortlisted

From Bloomsbury.com:

'Poppy Shakespeare could never have been written had I not spent nigh on a third of my life as a patient in the psychiatric system...'

Author Clare Allan tells us about the unusual background which was the inspiration for her debut novel, Poppy Shakespeare. Read on for more...click here.

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

Kings County Chapter: March 2007 Newsletter

To view the Newsletter, click here (downloads a PDF - please be patient, it is a rather large file at approximately 5 MB).

News Release – Schizophrenia Societies adopt joint mission statement

Schizophrenia Societies join forces on new mission statement to promote improved quality of life

The Schizophrenia Society of Canada and the Provincial Schizophrenia Societies across the country are proud to announce the launch of a new, joint mission statement that promotes improved quality of life for individuals and families affected by schizophrenia.

The new mission inspires the societies to improve the quality of life for those affected by schizophrenia and psychosis through education, support programs, public policy and research.

“This exciting new mission statement recognizes the significant changes in our understanding of and approaches to mental illness over the last 20 years,” said Chris Summerville, Interim Chief Executive Officer of the SSC.

“Today, the emphasis is rightly upon the possibility of recovery, not the mere reduction of suffering. Thus a shared mission statement more accurately reflects the purpose of the work of the schizophrenia societies across Canada,” Mr. Summerville said. “It represents our shared passion to advocate for mental health services that are recovery oriented and enhance quality of life, that advance the needs, rights and abilities of people living with and affected by schizophrenia and psychosis.”

The new statement expands beyond symptom reduction alone to promote the fact that there is hope for individuals and families to improve their quality of life. It integrates the importance of medical and psychiatric treatment to achieve maximum symptom relief and control with the myriad of other health, social and economic factors that can also add to a person’s quality of life, including but not limited to: community-based psychiatric rehabilitation with access to psychological support services; peer support; family education; safe and affordable housing; adequate income security; meaningful work; court diversion programs and mental health courts.

Quality of life and recovery are very individual, noted SSC President Michael Thomson. “The new mission statement incorporates that individuality and it promotes the idea of working towards a quality of life and recovery level that is possible and appropriate for each individual.”

The focus on the individuals and their quality of life is particularly meaningful for many impacted by the illness.

“I think the new mission statement is more proactive,” said 24-year-old Tammy Lambert of Winnipeg, Manitoba, who was diagnosed 10 years ago. “It doesn’t focus on symptoms alone; it focuses on the future and it gives people hope that they may be able to achieve a better quality of life.”

“As parents of a son who is living with schizophrenia, we welcome this new mission statement and its broader emphasis on the person rather than the illness,” said Dennis and Amy Butcher. “It conveys the hope and the opportunities that exist for many individuals – with the right supports and services – to return to a quality of life that is meaningful and fulfilling.”

The adoption of a shared mission also enhances the societies’ ability to speak with one united voice on behalf of those affected by the illness.

“As we promote the work of our societies, both individually and together, the shared mission statement enables us to promote the same message across the country and this will be a significant advantage in our ongoing efforts to educate, raise awareness and reduce the stigma and misperceptions that abound about schizophrenia,” said Mr. Summerville.

Schizophrenia is a serious biochemical brain disorder characterized by delusions, hallucinations, disturbances in thinking and emotional and social withdrawal. Statistics show that one person in
100, or about 300,000 Canadians, will experience an episode of schizophrenia in their lifetime.

The Schizophrenia Society of Canada and the 10 Schizophrenia Societies across the country work independently and together to improve the quality of life of those affected by the illness through education, public policy, support and research.

NIMH Perspective on Antipsychotic Reimbursement: Using Results from the CATIE Cost Effectiveness Study

A recent press release from the National Institute of Mental Health:

The recent publication (December 1, 2006, American Journal of Psychiatry) of the cost-effectiveness results from the National Institute of Mental Health (NIMH)-funded Clinical Antipsychotic Trials in Intervention Effectiveness (CATIE) has raised questions among advocates, families, and clinicians about reimbursement policies for antipsychotic medications.

Antipsychotics have now become the fourth largest group of medications prescribed in the United States, with a collective cost expected to surge past $10 billion this year. About 80 percent of the prescriptions for antipsychotics are paid via the public sector. The new atypical medications, representing 90 percent of the current market, are approximately 10 times the cost of the older conventional antipsychotics.

In a report in the September 22, 2005, New England Journal of Medicine, the CATIE research team compared discontinuation rates with four atypical antipsychotics (olanzapine, quetiapine, risperidone, ziprasidone) and one older conventional antipsychotic (perphenazine). The results demonstrated few differences overall among the various medications. The older medication, perphenazine, was as well tolerated as the newer compounds and as effective as three of the four newer drugs. The fourth compound, olanzapine, was slightly better than all the others in terms of discontinuation and hospitalization rates but was also associated with higher rates of weight gain and metabolic side effects.

The December 1, 2006 study analyzed the economic implications of the CATIE results and found that, because perphenazine was as effective overall and less expensive, the older antipsychotic medications such as perphenazine still have a valuable role in treating schizophrenia. The results should encourage doctors to reconsider the use of these older medications as another choice for patients with schizophrenia. This study should help expand the current list of medications most commonly used for schizophrenia, rather than restrict or reduce access to any of the antipsychotic medications. NIMH believes that this is important for the following reasons:

• Although the CATIE results suggest little difference in the overall effectiveness for the entire cohort, individual patients respond differently to different medications. To say the medications are equivalent is not to say they are identical. There is substantial variability in the response of individuals to these treatments. Future studies will focus on predicting individual patterns of response.
  


• There are additional outcomes to consider. Upcoming reports will describe the effectiveness of these various medications on quality of life and cognitive deficits. Cognitive impairment is a central clinical feature of schizophrenia and is strongly associated with functional outcomes.


• CATIE was limited to people with chronic schizophrenia who were moderately treatment-resistant. People with acute, first onset schizophrenia and those with other psychotic disorders were not included in this study. These patients may respond differently to antipsychotic medications.


• CATIE was an 18-month study. While this is longer than most clinical trials it is not long enough to fully consider whether patients would develop serious long-term side effects such as tardive dyskinesia, diabetes, or other medical conditions that can develop even years after starting medication.

Taking all these points into consideration, NIMH holds that families and physicians need more, not fewer, choices for addressing schizophrenia. A one-size-fits-all approach for treating schizophrenia could be harmful, essentially turning the clock back 40 years to an era when conventional antipsychotics were the only medications available for patients with this chronic, disabling disorder affecting 3.2 million Americans.

For additional SSNS Blog posts on the CATIE results, click 1, 2, and 3.

Advanced Family Work for Schizophrenia: An Evidence-Based Approach

by Julian Leff; London, Gaskell Publications, 2005, 160 pages, $29.46 softcover

Harriet P. Lefley, Ph.D., reviews this book in the April 2007 issue of Psychiatric Services.

Update on the Healthy Minds Initiative

From the March 2007 edition of the Healthy Minds Cooperative's The Blue Horse Chronicles:

By Amanda Crabtree

In this month’s column, I have two exciting and long awaited announcements. In May, the Abbie Lane Mental Health Outpatient Department will move some of its services to Bayers Road Centre (the former Bayers Road Shopping Centre) in Halifax. The result will be the opening of Community Mental Health Services, Bayers Road on Tuesday, May 8th, 2007. We have also just confirmed that Dartmouth Community Mental Health will relocate to Belmont House [pictured above] on Alderney Drive in Dartmouth. We do not yet have a move date.

Information about Community Mental Health Services, Bayers Road is being provided to clients of the Abbie Lane Mental Health Outpatient Department and their families, community organizations, family physicians and others. All clients who will need to go to Bayers Road Centre to receive services will be contacted. We have set up a phone line where people can leave messages with questions about the move. The phone number is 473-4847. Messages left at this number will be returned within two business days.

We are in the early planning stages of moving Dartmouth Community Mental Health to Belmont House. This is why a move date is not yet confirmed. Once the move date is confirmed, clients will be notified.

We are very excited about both of these moves because through mental health strategic planning, we heard that clients wanted services located in their communities as much as possible. This is a first but significant step toward building relationships with residents, leaders and service providers in those communities. It will be these relationships that give us the knowledge we need to tailor our services to meet the needs of clients and their communities.

For more information on the Initiative, please e-mail or call me: amanda.crabtree@cdha.nshealth.ca or 460-7401.

A Mentally Healthy Workforce—It’s Good for Business

From the Partnership for Workplace Mental Health, A Program of the American Psychiatric Foundation:

Most employers know that a mentally healthy workforce is linked to lower medical costs, as well as less absenteeism and presenteeism. And most employers know that a mentally unhealthy workforce is associated with increased loss of productivity. What employers may not know, however, is how to get from A to B: How does a company change a mentally unhealthy workplace — or a marginally healthy one — to a healthy workplace? Where does it start?

The Partnership provides some insight into that question with its just-released publication, A Mentally Healthy Workforce—It’s Good for Business. The document is unique because it weaves together stories from the workplace world with research findings to build a coherent picture of workplace mental health.

Click here to download a PDF version of A Mentally Healthy Workforce— It’s Good for Business.

Latest CATIE Analysis Shows Patient Response Suggests Pathway

As a continuation of two previous postings on this blog (1, 2), the latest issue of Psychiatric News has an article written by Jim Rosack on the latest "Clinical Antipsychotic Trials of Intervention Effectiveness" (CATIE) results.

SSNS Member Publishes Article

John Devlin writes in to the Schizophrenia Society of Nova Scotia:

A while ago I was asked by the editor of a Cambridge University publication - the NEWSLETTER - to do up a little blurb on my thoughts on King's College, Cambridge architecture. It appeared online yesterday in their April/May 2007 issue and is here [click the word here].

You scroll down to the very bottom to the last page and it is there [near the top left hand side of page 16]. This newsletter is not an alumni office publication but is an in-house magazine "for the staff of the University of Cambridge" as it says on the front cover.

I thought you might find it a bit interesting.

Indeed we do, John. Congratulations!

How common is psychosis?

According to a recent review article written by Peter Byrne (right), Early Intervention Team for Ealing, Southall, United Kingdom, and published in the British Medical Journal:

The one year prevalence of non-organic psychosis is 4.5 per 1000 community residents (Ref. 1). Most new cases arise in men under 30 and women under 35, but a second peak occurs in people over 60 years. Psychotic symptoms had a 10.1% prevalence in a non-demented community population over 85 years (Ref. 2). Schizophrenia has a one year prevalence of 3.3 per 1000 people, and a lifetime morbidity risk of 7.2 per 1000 people (Ref. w1). Independent of known associations with migration and ethnic origin, increased economic inequality in areas of high deprivation also predicts a higher incidence of schizophrenia (Ref. 3). Some people who become depressed (one in five of us over a lifetime) also develop hallucinations and delusions, related to and “congruent with” their low mood.

Bipolar affective disorder has a lifetime prevalence of 1.3-1.6% (Ref. 4), and it is characterised by episodes of psychosis during both high (“manic”) and low (depressive) relapses. The misuse of substances, notably cannabis (Ref. 5), raises the prevalence of psychotic symptoms further — substance misuse partly explains the 10 times higher prevalence of psychosis in prison populations (Ref. 1). Psychosis occurs frequently in all forms of dementia including Parkinson’s disease. Other causes of organic psychoses are neurological disorders (epilepsy, head injury, haemorrhage, infarction, infection, and tumours) and most causes of delirium.

Altogether, therefore, acute psychosis is one of the most common psychiatric emergencies. There are explanations of psychotic “symptoms” other than the biomedical model of this review; medicalising psychosis as “an illness like any other” increases both public pessimism about outcome and the stigma attached to people with psychosis (Ref. 6).

References:

1. Brugha T, Singleton N, Meltzer H, Bebbington P, Farrell M, Jenkins R, et al. Psychosis in the community and in prisons: a report from the British national survey of psychiatric morbidity. Am J Psychiatry 2005;162:774-80. (Download a free PDF of this paper by clicking here.)

2. Ostling S, Skoog I. Psychotic symptoms and paranoid ideation in a nondemented population-based sample of the very old. Arch Gen Psychiatry 2002;59:53-9. (Abstract available by clicking here.)

3. Boydell J, van Os J, McKenzie K, Murray RM. The association of inequality with the incidence of schizophrenia: an ecological study. Soc Psychiatry Psychiatr Epidemiol 2004;39:597-9. (Abstract available by clicking here.)

4. Müeller-Oerlinghausen B, Berghöfer A, Bauer M. Bipolar disorder. Lancet 2002;359:241-7. (Abstract available by clicking here.)

5. Henquet C, Krabbendam L, Spauwen J, Kaplan C, Lieb R, Wittchen HU, et al. Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people. BMJ 2005;330:11. (Abstract available by clicking here.)

6. Read J, Haslam N, Sayce L, Davies E. Prejudice and schizophrenia: a review of the “mental illness is an illness like any other” approach. Acta Psychiatr Scand 2006;114:303-18. (Abstract available by clicking here.)

w1. Saha S, Chant D, Welham J and McGrath J. A systematic review of the prevalence of schizophrenia. PLoS Med 2005; 2(5): e141. (Download a free PDF of this paper by clicking here.)