A revised and updated edition of I Am Not Sick, I Don't Need Help

From the NAMI website:

For seven years, many families have found renewed hope and practical guidance in Xavier Amador’s defining book, I Am Not Sick, I Don’t Need Help: How to Help Someone with Mental Illness Accept Treatment. The revised and updated edition has been long awaited. Now it is here.

In the foreword to the new edition, Pete Earley, author of Crazy: A Father’s Search Through America’s Mental Health Madness, recounts how one man stood in line at a book-signing simply to thank and shake hands with Amador for having “given me my son back.” Earley echoes the sentiment, describing how the book also helped him to overcome a wedge that bipolar disorder had driven between him and his own son.

Individuals with mental illnesses sometimes have difficulty coming to terms with the nature of their conditions, and their need for medication or other treatment. Amador explains the root of the problem: agnosognosia, a clinical condition in which a person’s lack of awareness, insight, and acceptance of their illness is caused by the illness itself.

The condition is intimately tied to a person’s “sense of self,” including a state of being “stranded” in a past self-concept, unable to address the needs of altered personal circumstances.

For family members who want to help loved ones stricken by mental illness, agnosognosia is a source of endless frustration and distress, not to mention conflict.

Amador prescribes an approach that helps to overcome conflict and recognizes the individual dignity of the family member with the illness, without paternalism.

Based on four principles, it’s called the LEAP method—learn, empathize, agree, and partner. He calls it a “communication style” rather than a “complicated therapeutic intervention.”

In other words, LEAP is family-friendly. “You don’t need an M.D., M.S.W., or Ph.D. to use the main elements of this therapy effectively,” Amador writes.

The point of the therapy is not to force individuals to admit that they are sick. Instead, the goal is to get them to find other reasons to accept help and treatment. Once that happens, and a relationship of respect and trust is maintained, insight into the illness will begin to develop.

Amador is a professor of clinical psychology at Teachers College of Columbia University in New York City and a former NAMI research director and member of NAMI’s national board. He also writes from the heart. The book provides numerous references to individuals with whom he has worked with in clinical practice, but even more, his perspective is influenced by his loving relationship with his brother, who lived with schizophrenia.

Tragically, Enrique Amador died in an accident this spring. In a sense, the book is a memorial to him. It will also help the save lives of many people like him, who are equally loved by their own families.

Joyce Cooling speaks out on mental illness

Joyce Cooling performs at the third Jarasum International Jazz Festival in September 2006 (below).

Look deeper

A letter to the editor published in today's Halifax Chronicle Herald:

The article, "Psychiatric nurses under assault," fails to address a number of possible causes of increased patient aggression. With the headline it used, and by neglecting to interview patients or ex-patients for balanced reporting, this newspaper is contributing to the stigma of living with a mental illness.

Individuals involuntarily admitted to a psychiatric facility may feel fearful and confused due to their loss of freedom. Additionally, the nature of some acute psychotic illnesses means that a few patients, while still deserving of dignity and respect, are at times incapable of distinguishing between appropriate and inappropriate behaviour.

For example, involuntary patients who smoke are no longer allowed to do so and alternative methods of nicotine delivery may not be satisfying to some people who are experiencing psychosis. As a result, these individuals may become aggressive. While smoking has significant negative heath effects, and the Schizophrenia Society of Nova Scotia encourages smoking cessation, the fact remains that the majority of individuals living with schizophrenia smoke.

Investigating the root causes of increased patient aggression at the Abbie Lane will contribute to public understanding of mental illness instead of reinforcing public prejudice.

Stephen W. Ayer, PhD, executive director, Schizophrenia Society of Nova Scotia

Focus Group: Mental Health Mobile Crisis Team (MHMCT) Services

Over the past year, have you used any of the crisis services of the Mental Health Mobile Crisis Team (MHMCT) for yourself or someone you know? If so, you may be interested in taking part in a focus group!

The MHMCT would like to know whether or not their new integrated service is meeting the needs of individuals living with mental illness and their family members. They will be bringing together groups of 8-10 people to talk about experiences with the Mental Health Mobile Crisis Team. If you participate, you will be given $25 as compensation for your time.

If you have any questions, or if you wish to participate, please contact the Dalhousie University Research Coordinator at (902) 473-7458. Space is limited.

YWCA HERizons supports single moms at University

Posted August 13th on the Eastern Views blog:

HALIFAX - Are you or do you know a single mom who is attending University full time?

YWCA HERizons has a goal is to support women to achieve economic independence and long term housing security. the program provides a limited number of affordable, 2 bedroom supported apartments to mothers whose current housing is unstable or unaffordable. All applicants must meet entry criteria.

YWCA HERizons is currently accepting applications for fall occupancy. For more information or to obtain an application please contact Wanda Hill, HERizons Program Manager - by telephone 423-6162 ext 222 or by email at w.hill@ywcahalifax.com

“Canvas” to hit theatres on October 12, 2007

From the British Columbia Schizophrenia Society (BCSS) website:

In his debut feature film, writer/director Joseph Greco explores mental illness through the eyes of a child (Devon Gearhart) as he learns to cope with his mother (Academy Award winner Marcia Gay Harden) and the fact that she has schizophrenia.

The subject matter is addressed with an uplifting and sometimes even humourous tone that illustrates how from tragedy springs hope, growth, and understanding.

BCSS has been in touch with the production company to find out the Canadian release dates for this movie.

Keep your eyes on www.bcss.org for further updates!

For more information on this film, please visit www.canvasthefilm.com.

Image courtesy of Schizophrenia Digest.

Novel targets for drugs in schizophrenia

The abstract of a paper by J.M. Stone and L.S. Pilowsky published in the August 1st issue of CNS & Neurological Disorders - Drug Targets:

Since the discovery of the first antipsychotic drug, chlorpromazine, in the early 1950s, all effective antipsychotic drugs have been found to share the common property of dopamine D2 receptor antagonism. There has been some suggestion that simple D2 receptor antagonism may not confer optimal antipsychotic efficacy. Currently available antipsychotic drugs leave many symptoms of the illness untreated and cause unacceptable side effects. Recent research in schizophrenia suggests a number of potential new non-D2 targets for pharmacotherapy including glutamate, acetylcholine and serotonin neurotransmitter systems. This review summarises the main neurochemical theories of schizophrenia, and, in the light of these, examines possible therapeutic targets for new antipsychotic drugs.

D2 receptor binding of typical and atypical antipsychotic drugs. (Source: ABPI via drugdevelopment-technology.com.) Click on the figure to magnify it.

Two new books in the SSNS Library

Thanks go to the Schizophrenia Society of Canada for donating these two books to the SSNS.

To view the entire SSNS Library Catalogue, click here.

The [U.K.] Mental Health Act 2007: the final report

Produced by the Mental Health Alliance. Click here to read (downloads a PDF).

To view The Mental Health Act 2007, which was given Royal Assent on July 19th, 2007, click here (also downloads a PDF).

Insight into a Schizophrenia-related Mutation

A paper of the week in The Journal of Biological Chemistry. Click here to read the editorial (downloads a PDF).

Schizophrenia Daily News Blog also has a summary of this research. To view, click here.

Factors affecting outcome in schizophrenia and their relevance for psychopharmacological treatment

In line with the Schizophrenia Society of Nova Scotia's mission to improve the quality of life for those affected by pschizophrenia and psychosis, below is the abstract of a paper written by A. Carlo Altamura, William V. Bobo, and Herbert Y Meltzer which was published in the September 2007 issue of International Clinical Psychopharmacology, pages 249-267:

A major focus of current treatment research in schizophrenia is the determinants of long-term outcome, including functional outcome and general medical well being, rather than just specific domains of psychopathology such as positive and negative symptoms, mood symptoms, and cognitive impairment. This focus does not negate the importance of the latter issues but sees them as factors contributing to long-term outcome to variable extents. A long-term treatment focus facilitates a more clinically relevant assessment of benefits versus risks of available treatments. For instance, atypical antipsychotic drugs as a group have clear advantages for several important domains of efficacy that may influence long-term outcome, but are also more expensive over the long term. Use of some agents may also result in deleterious physical health consequences as well as large additional costs over the long term owing to metabolic adverse effects.

The present paper focuses on several key issues in schizophrenia which are important determinants of long-term outcome in schizophrenia, or influence choice of antipsychotic drugs, or both, including: (i) duration of untreated psychosis; (ii) impact of relapse on long-term outcome; (iii) limited efficacy for specific domains of psychopathology of current treatments; (iv) mortality owing to suicide; and (v) mortality owing to other causes (e.g. cardiovascular disease).

New Bifeprunox Medication Not Approved by FDA

To read the full story, visit Schizophrenia Daily News Blog.

Molecular structure of bifeprunox.

Elyn Saks: A Scholar's Memoir of Schizophrenia

Fresh Air from WHYY, August 7, 2007

From National Public Radio:

Click here to listen to this story.

In The Center Cannot Hold, lawyer and psychiatry professor Elyn R. Saks chronicles her own struggle with schizophrenia. The battle began with early symptoms at age 8 and has continued throughout her life; she had her first full-blown episodes during her terms at Oxford and Yale.

Saks, who has for years controlled her condition with daily medication and therapy, is an expert in the field of mental-health law, and teaches at the University of Southern California.

For information on the book, click here and here.

For an October 6th newspaper article, click here.

Trends in U.S. Mental Health Spending, 1986–2003

From the August 2007 issue of Psychiatric Services:

According to data in this month's lead article, total spending on mental health treatment in the United States grew from $33 billion in 1986 to $100 billion in 2003. Per capita spending increased from $205 to $345. However, as a percentage of total health care, spending on mental health treatment fell from 8% in 1986 to 6% in 2003. The research team, which was led by Tami L. Mark, Ph.D., found a large shift away from spending on inpatient mental health care—41% of total mental health expenditures in 1986 and 24% in 2003—to spending on psychoactive prescription drugs—7% in 1986 and 23% in 2003. Medicaid has assumed a more prominent payer role, accounting for 26% of mental health expenditures in 2003, up from 16% in 1986. One conclusion from these findings is that more people are receiving treatment for mental illness—an increase partly driven by the growing use of pharmacotherapy. In addition, the authors call for greater monitoring of the quality of care to ensure that Americans are getting an adequate return on their investment.

To read the abstract for the lead article referred to above, click here.

Professor develops snapshot of mental health economic burden

From the University of Alberta website:

By Donna Richardson - (January 30, 2007)

We don’t like to talk much about mental illness, but that doesn't mean it doesn't exist. In fact, it is estimated that one in three Canadians will experience it during their life. The effect of mental illness on an individual's well being and the associated social and economic burden in Canada are significant.

One person who understands this burden is Dr. Philip Jacobs (left), a professor in the Department of Public Health Sciences (School of Public Health) who directed the development of a booklet called Mental Health Economic Statistics.

The booklet, jointly published by the Alberta Mental Health Board (AMHB) and the Institute of Health Economics (IHE), is small enough to fit into your pocket, yet it is chock full of information about the social and economic burden of mental health, the resources that have been committed to addressing the burden, and an assessment of how well the Canadian system performs – relative to some other countries – in effectively allocating these resources.

Egon Jonsson, Executive Director and CEO of IHE, says, "In order to improve the overall mental health system and address its needs, we must understand the prevalence of mental health problems and where mental health resources are currently being utilized."

This is the first time that comprehensive economic statistics about mental health in Canada have been compiled. According to Jacobs, "No one has presented a bird's eye view of the economic aspects of the system." Along with his team, he used numerous sources to create a snapshot of information that was scattered and some times difficult to locate.

When asked about the status of the Canadian mental health system from an economic viewpoint, Jacobs points out that, "There is no single bottom-line indicator of mental health. We can't easily summarize the state of the system as it is very complex with multiple indicators." He does note, however, that prior to compiling the Mental Health Economic Statistics, we had very little idea how much money was spent in Canada on treatment of mental illness.

"The statistics also show that our system is not very generous towards people with mental illness in terms of social supports such as the Canada Pension Plan and Workers' Compensation," states Jacobs. He also draws attention to the gaps in information on private insurance.

Copies of the booklet, available through AMHB and IHE, have been provided to policy makers across Canada, including some in the Canadian Mental Health Association, the Canadian Psychiatric Association, and relevant provincial and federal departments.

Reflecting on the value of the publication, Ray Block, President and CEO of AMHB says, "With an estimated one in three Canadians experiencing a mental health problem at some point in their life, understanding its impact on families, communities, health systems, and the economy is critical."

Jacobs hopes the information contained in the booklet will assist policy makers and planners by providing a clear picture of the current mental health system. "I'm optimistic that this tool will be helpful for developing policies and allocating resources that will reduce the impact of mental illness on Canadians," he says.

Please refer to the links below to upload an electronic copy of Mental Health Economic Statistics. For hard copies, please contact the Alberta Mental Health Board or the Institute of Health Economics.

Links:

* Alberta Mental Health Board
* Institute of Health Economics
* Mental Health Economic Statistics: In Your Pocket (PDF 973 KB)

Cannabis Use Linked With Risk for Psychosis in Later Life

From Medscape Medical News
News Author: Marlene Busko
CME Author: Désirée Lie, MD, MSEd

August 1, 2007 — A systematic review of longitudinal studies suggests there is sufficient new evidence that the use of cannabis (marijuana) increases the risk for later psychotic illness by roughly 40%. The study showed a trend towards an increased risk for depression in people who had used cannabis, but the evidence was not as strong.

The article by Theresa H.M. Moore, MSc, from the University of Bristol in the United Kingdom, and colleagues is published in the July 28 issue of The Lancet.

Study author Stanley Zammit, PhD, from Cardiff University in Wales, told Medscape that individuals who used cannabis on a weekly or daily basis had about a 2- to 3-fold increase in risk for psychotic outcomes, independent of transient intoxication or other confounding factors. He added, "We looked at the quality of the studies quite rigorously and feel the evidence is strong enough to warrant advising everyone, particularly young people, that the use of cannabis does potentially have some health risks, especially if they are using it on a regular basis."

Cannabis is the most commonly used illegal substance in most countries, the authors write, adding that in the United Kingdom and New Zealand, about 1 in 5 young people report using cannabis weekly or having used it more than 100 times. Previous studies have suggested that cannabis use can produce transient, usually mild, psychotic and affective experiences, but whether it increases the incidence of mental health outcomes such as schizophrenia or depression is unclear.

The group searched for population-based longitudinal studies that looked at the relationship between cannabis use and subsequent psychotic and affective outcomes. They found 11 studies from 7 cohorts that looked at psychotic outcomes and 24 studies from 15 cohorts that looked at affective outcomes.

Increased Risk, Dose-Response Effect
The researchers found a consistent increased risk for psychotic outcomes in the people who had ever used cannabis (adjusted odds ratio [OR], 1.41; 95% confidence interval [CI], 1.20 - 1.65), with a greater risk in individuals who had used it most frequently (OR, 2.09; 95% CI, 1.54 - 2.84).

Most studies excluded people with psychosis at baseline, so this association between cannabis use and psychosis is unlikely to result from reverse causation, the group writes. The studies also adjusted for about 60 confounding factors. "People who use cannabis might be different from other people in a number of factors and some of those might increase their risk of mental health disease, but even once we had adjusted for these factors, there was still an association," Dr. Zammit said.

The evidence that cannabis use leads to depression, suicidal thoughts, and anxiety outcomes was less consistent. "Overall, the quality of the studies wasn't as robust as the studies for psychosis," said Dr. Zammit, adding that for example, many of the studies did not try to adjust for confounding factors.

Although an individual's lifetime risk of developing a serious psychotic illness is only about 2% or 3%, he added, cannabis can be expected to have a large impact at a population level because exposure to this drug is so common.

"The overall message is that people who use cannabis on a regular basis need to be aware of this risk, so they can make an informed judgement about whether they want to continue using it, or perhaps try to cut down their use," or seek treatment of dependency, he concluded.

Editorial: "Need to Warn the Public... Establish Treatment"
In an accompanying editorial, Merete Nordentoft, MD, and Carsten Hjorthøj, from Copenhagen University Hospital in Denmark, write that the study is the most comprehensive meta-analysis to date of this possible causal relationship and the adjustment for confounding factors and transient effects "is done more thoroughly than in previous reviews." They report, "We therefore agree with the authors' conclusion that there is sufficient evidence to warn young people that cannabis use will increase the risk of psychosis later in life."

The general public has considered cannabis to be relatively harmless in comparison with alcohol and opioids, they note, cautioning that, "however, the potential long-term hazardous effects of cannabis with regard to psychosis seem to have been overlooked, and there is a need to warn the public of these dangers, as well as to establish treatment to help young frequent cannabis users."

To view the entire article, click here.

References
Anonymous, Rehashing the evidence on psychosis and cannabis. The Lancet - Vol. 370, Issue 9584, 28 July 2007, Page 292.

Merete Nordentoft and Carsten Hjorthøj, Cannabis use and risk of psychosis in later life. The Lancet - Vol. 370, Issue 9584, 28 July 2007, Pages 293-294.

Theresa H.M. Moore, Stanley Zammit, Anne Lingford-Hughes, Thomas R.E. Barnes, Peter B. Jones, Margaret Burke, and Glyn Lewis, Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. The Lancet - Vol. 370, Issue 9584, 28 July 2007, Pages 319-328.

Photograph courtesy of the United States Fish and Wildlife Service.

For another interpretation of the results of this study, click here.

Time to End Mind-Brain Split

To read an interesting viewpoint on the above subject click here. The article was written by Ronald Pies, M.D., and published in the August 3rd edition of Psychiatric News.

Mouse model of schizophrenia is developed

From United Press International:

BALTIMORE, July 31 (UPI) -- U.S. scientists have genetically engineered the first mouse model of both the anatomical and behavioral defects involved in schizophrenia.

Johns Hopkins University researchers said their new mouse model is based on a genetic change relevant to the disease.

Dr. Akira Sawa, an associate professor of psychiatry and neuroscience, and his colleagues said they took advantage of the recent discovery of a major risk factor for the disease -- the DISC1 gene -- that makes a protein that helps nerve cells assume their proper positions in the brain.

The researchers generated mice that make an incomplete, shortened form of the DISC1 protein in addition to the regular type. That short form of the protein attaches to the full-length one, disrupting its normal duties.

As the mice mature, they display behaviors that parallel those observed in schizophrenic patients.

Sawa said the new mouse model will help in exploring how external factors, such as stress or viruses, might worsen symptoms.

"The animals can also be bred with other strains of genetically engineered mice to try to pinpoint additional schizophrenia genes," he said.

The study is reported online in the Proceedings of the National Academy of Sciences.

Photograph by Rasbak.

24/7 help with mental health crisis

From the June 22nd issue of Capital Health Update:

Beginning June 24, immediate mental health crisis support will be available 24 hours a day, every day.

Hundreds of people have called the Mental Health Mobile Crisis Team each month since the integrated service opened in June 2006. The number of people seeking help from the team is higher than expected and growing.

This is what prompted the IWK Health Centre to increase its funding to the service, which will enable the team to support people 24 hours a day by telephone. Until now, telephone crisis support was available from 9 a.m. to 5 a.m. daily, leaving a four-hour gap in service. (Mobile support continues to be available in areas of Halifax, Dartmouth and Bedford from 1 p.m. to 1 a.m. daily.)

“The early morning hours can be an essential time to offer follow-up services for people who have called us the night before,” says Mary Pyche, service co-ordinator. “Operating 24/7 provides the opportunity for us to continue to support a person in crisis regardless of the time of day.”

At the heart of the team of mental health professionals and dedicated police officers who are the crisis service is the ability to support people in the moment – where and when they are experiencing a crisis. The team also provides follow-up support, which often includes connecting a person to other resources, and education.

The Mental Health Mobile Crisis Team began as part of the Healthy Minds Initiative and is a partnership of Capital Health, the IWK Health Centre, the Halifax Regional Police and the Nova Scotia Department of Health.

Crisis Support: 429-8167 or 1-800-429-8167

Involuntary Commitment

From the PBS program, Religion & Ethics Newsweekly. To view, including a video, click here.

Search for Schizophrenia's Roots Started at Home

Mark Moran writes in the July 6th issue of Psychiatric News:

A brother's concern for a sister with schizophrenia drew him into a research career whose fruits may eventually prevent many individuals from experiencing the ravages of this disease.

To read the full story about the life of E. Fuller Torrey, M.D., click here.

Photograph by Breton Littlehales.

A parent's question ...

From the July 19th issue of The Times:

How one can distinguish between the slightly aberrant behaviour of many adolescents and the first signs of schizophrenia or allied conditions?

For the full story, click here.

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

Photograph courtesy of The Times.

Parade of Sails - Halifax, Nova Scotia

The tall ship Prince William parades in front of the Nova Scotia Hospital today. Click the photographs to make them larger.

Pride of Baltimore II

I'm fairly certain that this is the Gorch Fock II.

All photographs by Steve A.

Researchers may have schizophrenia breakthrough

From CTV.ca (May 3, 2007):

A team of Canadian and Scottish scientists has pinpointed one of the genes that causes schizophrenia -- a breakthrough that sheds new light on how the disease can develop.

The work is to be published Thursday [May 3rd] in the journal Neuron [to view the abstract, click here].

It demonstrates for the first time that schizophrenia can be caused by a malfunctioning gene, suggesting schizophrenia is linked to depression and bipolar disorder and may have the same underlying cause.

The discovery may someday help doctors identify which patients will respond to different types of treatments.

Click on the arrow to start the video.

Many thanks to Charlie G. for help with this posting.

the Self-Help Connection

From the Health Promotion Clearinghouse website:

Profile of the Month

July's Profile is the Self-Help Connection - It is a non-profit registered organization established in 1987 to assist Nova Scotians to take control of their health by increasing their knowledge, skills, and resources for individual and collective action. The Self-Help Connection has received national recognition as a 'Mental Health Best Practice Program' from the Federal, Provincial, and Territorial Advisory Network on Mental Health for self-help and consumer initiatives.

The Consumer Initiative Centre is a program of the Self-Help Connection launched in 2002 and is funded by the Nova Scotia Department of Health and Department of Community Services.

To visit the Self-Help Connection Clearinghouse Association's website, click here.

Note:
The purpose of the Consumer Initiative Centre is to increase the capacity of persons living with, through, and beyond mental illness to help themselves and each other move forward.

It is a provincial program that provides peer support, computer training, entrepreneurship / employability enhancement, and assistance with personal development.

Phone 404-7800 or 1-866-765-6639 (toll-free) for more information.

Schizophrenia: Looking at the Future

A guide about staying well and getting the most out of life, for a brighter tomorrow.

To view the guide, click here (downloads a PDF).

Photo by Infrogmation.

Homelessness 'chronic' in Canada: study

From CBC.ca, June 26, 2007:

Canada's homeless population is somewhere between 200,000 and 300,000 people, while another 1.7 million residents struggle with "housing affordability issues," says an analysis of the latest research on shelter.

In a report released Tuesday from the Calgary-based Sheldon Chumir Foundation for Ethics in Leadership, journalist and author Gordon Laird argues homelessness is now chronic and is quickly becoming one of the country's defining social issues. He makes a case for a national housing strategy and a more robust income security program.

Citing statistics from a wide range of organizations, Laird says poverty is the leading cause of homelessness in Canada, not substance abuse or mental illness. "Roughly half of all Canadians live in fear of poverty, and 49 per cent polled believe they might be poverty stricken if they missed one or two paycheques," he writes.

Laird is a media fellow with the foundation, which works to influence ethical actions in politics, business, government and the community.

In his report, Laird writes that street counts of homeless people have increased dramatically — "Calgary's homeless population grew 740 per cent between 1994 and 2006."

He cites government numbers showing a cost of up to $6 billion a year to service a "core" homeless population of 150,000. That cost includes health care, criminal justice, social services and emergency shelter costs.

"The high cost of homelessness in Canada results from the role of homelessness as a proven multiplier of societal ills: malnutrition, unemployment, addiction, mental illness, family strife and lack of income security are all intensified when an individual or household becomes homeless," he writes.

The report criticizes Canada for trying to contain the growth of homelessness with temporary measures such as shelters and other crisis-based services. It cites studies that show the cost of emergency shelters is much greater than the cost of creating affordable housing and implementing rent supplements.

Laird says the former national affordable housing strategy, discontinued in 1993, created 650,000 units providing housing for more than two million Canadians. While new investments in affordable housing were made in 2005, there is no national strategy and so no guarantee the money will be well-spent, he says.

"And without a national strategy on housing and homelessness, there is much risk for repeating past mistakes and spending blindly on short-term fixes and emergency responses," writes Laird.

To view Gordon Laird's report, entitled SHELTER, click here (downloads a PDF).

Also see The True Cost of Homelessness, Gordon Laird's June 26th article in the Toronto Star.

Genetic polymorphism of the adenosine A2A receptor is associated with habitual caffeine consumption

Sound interesting? Grab a second cup of coffee and click here to find out more.

Photograph by Julius Schorzman.

Falling through the Cracks --

-- Virginia Tech and the Restructuring of College Mental Health Services

An article from the July 12th issue of The New England Journal of Medicine. Click here to view (downloads a PDF).

Tall Ships Nova Scotia Festival 2007, July 12-25

For complete information on this event, click here.

Bounty II

From Wikipedia:

MGM commissioned a replica of Bounty, named Bounty II, for their 1962 film Mutiny on the Bounty. This vessel was built to the original plans and in the traditional manner in a shipyard in Lunenburg, Nova Scotia. However, all the dimensions were increased by approximately one third to accommodate the large 70 mm cameras used. MGM kept this vessel in service. When Ted Turner bought MGM he used this vessel for entertaining. Eventually MGM donated the vessel to a charity.

Although expensive maintenance caused the vessel to lose her United States Coast Guard license for a time, Tall Ship Bounty was restored, initially at the Boothbay Harbor Shipyard in 2002, with restoration of the vessel's bottom planking. Moored in its winter home in St. Petersburg, Florida, it again became available for charter, excursions, sail-training, and movies (most recently in Pirates of the Caribbean: Dead Man's Chest and Pirates of the Caribbean: At World's End). In April 2006, the Bounty again arrived in Boothbay Harbor for further renovation, a refurbishing of the ship's front end, and topside decking. Following this renovation, the Bounty was scheduled to repeat the famous voyage of the original Bounty.

Psychoeducation in schizophrenia

The authors of a recent paper published in the Journal of Clinical Psychiatry conclude that "the integration of psychoeducation into standard therapy for schizophrenia should become obligatory."

To read the abstract of this paper, click here.

Sympathy Through Technology

Virtual Reality Experience Mimics Schizophrenia to Teach Health Professionals About Their Patients

The virtual reality simulator Mindstorm lets viewers experience the world through the mind of an individual living with untreated schizophrenia.

For the full story from ABC News, click here.

Drug coverage policies a prescription for disaster

From the July 4th edition of the Halifax Chronicle Herald:

WHO WRITES your prescriptions?

By Charles Cirtwill

I always thought it was my doctor who diagnosed my problem, decided on the appropriate drug and wrote a prescription. Boy, was I wrong.

Apparently, there are a great many people telling our doctors what they can and cannot prescribe and when. The latest group to be added to the mix is the Common Drug Review. The CDR is an inter-provincial panel that reviews drugs for purchase and use in situations where the provinces pay for drugs – i.e., for the most vulnerable among us, the elderly, those in hospital, and those unable to afford private drug plans of their own.

The CDR was intended to streamline the process of approval of drugs for purchase by governments in Canada by creating a single window for review. Unfortunately, once Health Canada certifies a drug as safe for use, it is then reviewed not only by the CDR but by the old provincial approval systems (they never went away), and in many cases by further approval committees at the health district and hospital levels, and by independent agencies that oversee drug plans for veterans, public servants and the military (among others).

The result is a great deal of duplication and a continued lack of consistent drug coverage. Veterans, politicians and public servants, for instance, have quite broad formularies (a list of drugs the specific drug plan will pay for) compared to the rest of us. Similarly, the province of Quebec will cover many drugs not available under provincial plans elsewhere in Canada.

Of the 53 drugs that were reviewed by the CDR between 2003 and 2006, 53 per cent were rejected. Quebec, which does not participate in the CDR, rejected only 38 per cent. That translates into 11 new drugs paid for by the government of Quebec that are not paid for elsewhere in Canada because of the efforts of the CDR.

Now, remember, you can pay for ALL of these drugs privately if you wish because all of them have been approved for use by Health Canada.

Yes, that means they have gone through clinical trials and have been approved as safe for human consumption and as having positive and demonstrable effects in the treatment of specific diseases. But in 53 per cent of the cases, public servants decided that the most vulnerable among us should not have access to these drugs. That decision was made because the cost of those drugs to the provincial treasury outweighed the benefit they delivered to affected patients.

Or, at least, we think that was the reason. You see, you and I have no right to know what evidence was considered, what questions were asked, what experts were consulted, or what trade-offs were made when these decisions were reached. That lack of accountability arises because, while it provides this service for the federal and provincial governments, and our tax dollars pay for it, the CDR is technically a private, not-for-profit entity and does not report to you, or to anyone, and is not covered by freedom of information laws.

Let’s be clear. These are hard decisions, decisions that have to be made. But they must be based on the best available evidence and the most accurate definition of total system cost available. They must be made promptly and in a dependable, transparent manner. They cannot be made behind closed doors or in a manner that results in their veracity being in any way in doubt. We must demonstrably account not only for the short-term savings by refusing certain drugs, but the long-term potential costs of other treatments that will be necessary in the absence of those drugs.

Consider private drug plans. Private plans make use of generic replacement stipulations, for example, that allow them to reduce costs and cover more services – a good thing. But normally, if your doctor makes the case that only the brand name medication will work for you, then they allow for that. Simply put, it is better for the insurance company to pay a higher price now rather than risk that you will get sicker and need more – and more expensive – care later on.

This is something the CDR should be considering next time the news is full of stories about bed shortages and staffing challenges: Health is an interconnected system and the cash all comes from one source. Saving on drugs today generally means more spending on doctors, nurses and hospitals tomorrow.

Charles Cirtwill is the acting president of the Atlantic Institute for Market Studies, a non-partisan public policy think tank based in Halifax.

Also see: Pharmacist from Dal part of intensive drug study.

Listen to the Wind

A Journey in Schizophrenia

A portion of the proceeds from sales of this book are donated to the Schizophrenia Scoiety of Nova Scotia. To order Listen to the Wind, please click here.

From the Breton Books website:

A rare and fascinating book, this is Mary Ellen Tramble’s haunting, tender autobiography of her life with schizophrenia. With the power and detail of a novel, and laced with her small, strong poems, it is, as well, an extraordinary and moving work of art. “Listen to the Wind” displays the tense and terrifying sentences, the sudden self-mocking and degradation, the grand insights that take Tramble (and us) high on the ferris wheel of emotions—and then toss us overboard for the plunge [a person living with schizophrenia] knows only too well. In “Listen to the Wind,” Mary Ellen Tramble has made of her struggle a lasting piece of extraordinary writing. We can only be grateful for her determination to record, and her courage and generosity to share. “A monument to the tenacity of the human spirit in its struggle to face mysterious terrors, maintain hope and avoid despair.” — Sheldon Currie, author of “The Glace Bay Miners’ Museum” "For all of the pain and fear in ‘Listen to the Wind,’ there is also great love and beauty.” — Patrick F. Walsh, editor and author of “The History of Antigonish”

176pages . $14.95 . ISBN 1-895415-56-X . Breton Books

Invega introduced into the United Kingdom

Visit New Treatment for Schizophrenia Licensed in the UK.

Can you tell the difference between the molecular structures of

paliperidone [Invega(TM)]

and


risperidone?

For more information on paliperidone, click here.