Schizophrenia is the modern leprosy

From the February 5th edition of The Times:

A well-intentioned campaign risks creating a dangerous myth: that all mental illness is the same

By Sathnam Sanghera (pictured)

Three charities have teamed up to tackle what they call “the social justice issue of the 21st century” - mental illness. About time too.

Some might sneer at the multimillion-pound Time to Change campaign for using celebrities - such as Stephen Fry, who was diagnosed with bipolar disorder at 37, but in my view anything, up to and including the use of Alastair Campbell in advertising material (“I said to Tony Blair, you do know about my breakdown, don't you?”), is welcome if it encourages more open discussion of mental ill health.

However, as someone with a parent and sibling who suffer from schizophrenia, the most severe of all psychiatric illnesses, I am concerned about the campaign. In its glitzy efforts to show that mental illness need be no bar to becoming rich and famous, and in its enthusiasm to tackle some of the myths surrounding the subject, it glosses over the harrowing effects of more serious psychiatric conditions and creates a myth of its own - that all mental illness is the same.

At the heart of this problem lies the claim that “mental health problems affect one in four people”, a statistic that encompasses conditions ranging from anxiety to depression and schizophrenia. Each of these conditions can, of course, destroy lives. But what do anxiety or mild depression have in common with schizophrenia? Not much, I would argue. Three of the six generalisations in Time to Change's “myth-busting” Tube adverts don't apply to schizophrenia.

To read the entire article, click here.

Also see:

Schizophrenia is not a trivial issue

Drop-in centre to open in Kentville

From today's edition of The Chronicle Herald:

Former theatre building to offer support for those in need

KENTVILLE — A new drop-in centre for the homeless and people in crisis will soon open in downtown Kentville.

The Open Arms Drop-In Centre is expected to be ready early next week, offering needy people a warm place to go, a hot drink or bowl of soup.

"We have invited other groups, including local churches, to come in and try to keep the door open and keep the lights and coffee pot on so that people have a place to go," said John Andrew, pastor with the Open Arms ministry.

The drop-in centre, at the old Paramount theatre building on Main Street, will be open at least a couple of days a week, rotating with other programs like the local soup kitchen.

To read the entire article, click here.

The New York Times, worst quote of the year (so far):

“Boron is a truly schizophrenic element,” Dr. Oganov [pictured] said. “It’s an element of complete frustration. It doesn’t know what it wants to do. The outcome is something horribly complicated.”

Dr. Oganov, what exactly do you mean?

It you really care to read it, the full article can be accessed by clicking here.

Photograph of Dr. Oganov courtesy of The State University of New York.

New Chief Operating Officer named to Mental Health Commission

From the Mental Health Commission of Canada:

NEWS RELEASE
For immediate release

NEW CHIEF OPERATING OFFICER NAMED TO MENTAL HEALTH COMMISSION

Calgary, AB January 30, 2009 – Louise Bradley has been named Chief Operating Officer of the Mental Health Commission of Canada (MHCC). “Louise brings with her a wealth of experience in the mental health field and I am very pleased to welcome her to help lead our team,” says MHCC President and CEO Michael Howlett.

Ms. Bradley is currently Vice President and COO of Regional Mental Health for Capital Health in Edmonton. In that capacity she manages a broad continuum of services including both in-patient and community programs. She plays a lead role in policy development and in the design and implementation of mental health strategies in the region.

Prior to her appointment, Ms. Bradley was a member of the MHCC’s Service Systems advisory committee. During her career she has been actively involved in providing professional mental health advice and support, leading the integration of provincial health programs, and managing the needs of a wide variety of stakeholders in both Eastern and Western Canada.

“The Commission is the most important thing to happen to mental health in the country,” says Ms. Bradley. “I believe the work of the Commission can make a real difference in many lives and I am delighted and honored to become a formal part of this great initiative." Ms. Bradley is a registered nurse and also holds a Master of Science degree with a specialty in mental health. She will be based out of the Commission’s Calgary office and begins her new role on February 9th.

The MHCC is a non-profit organization created to focus national attention on mental health issues. It is funded by the federal government but operates at arm’s length from all levels of government. The Commission’s objective is to enhance the health and social outcomes for Canadians living with mental health problems and illnesses. www.mentalhealthcommission.ca

-30-

For further information and interview requests contact:
Micheal Pietrus, Director of Communications
403-385-4040

Can suicide be prevented?

Posted on February 1st by Amber Christian Osterhout on her weblog, Gaining Insight:

A mother once emailed me, after viewing my exhibit, and told me that her son had died from suicide. She refused to say he "commit[ted]" suicide. She viewed her son's death as a direct result of his mental illness. I agree with her because my own brother has attempted suicide, thankfully he has not succeeded. These attempts were made in order to escape psychosis, the pain and a lower quality of life. This is sad since life can improve with the help of medicine, therapy and family support. Another woman I know (who lost her sister to suicide), was not allowed to talk about her feelings with her family. Her mother called it an accident. Her father never mentioned his deceased daughter's name again. Very sad.

To read the entire article, click here.

Image courtesy of Amber Christian Osterhout.

Book review in the Los Angeles Times

Published February 1st:

By Susan Salter Reynolds

I Never Promised You a Rose Garden
A Novel
By Joanne Greenberg
Holt: 304 pp., $15 paper

Since its initial publication in 1964, this classic story of a young girl's diagnosis and treatment for schizophrenia has sold millions of copies and inspired similar ventures like Susanna Kaysen's "Girl, Interrupted" and Augusten Burroughs' "Running With Scissors."

This paperback edition has a new afterword by the author, an essay that reveals just how painful the stigma of schizophrenia was in those days. Joanne Greenberg was institutionalized from age 15 to 19; she left the hospital in 1951 and has returned only once, in 1953. Many years were spent lying about her past; Greenberg was forced to show "sanity papers" before she could take classes at a local college -- there was no guarantee her privacy would be respected.

"I did not write 'Rose Garden' as therapy," Greenberg writes. "I wanted to show what being mentally ill felt like, how it felt to be so deeply estranged from the world." It's a pioneering, unforgettable and generous book.

Recovering from psychosis: Personal learning, strategies and experiences

The abstract of an article published in the February 2009 issue of Psychosis:

By Ian Sparrowhawk

This paper is about the experience of recovering from psychotic breakdown over a 10-year period. This period saw the author gradually rebuilding a functioning life and identity. This had led to him establishing a strong professional reputation and career in the field of economic regeneration. This paper emphasises the active recovery strategies, psychological techniques and conceptual understandings of mental illness which have been found helpful in rebuilding a functioning life and identity after psychosis. The author was sectioned and hospitalised in 1996, suffering from acute paranoid delusions. There then followed a long-term “recovery period”, which is the focus of this paper. It outlines an approach to recovery which emphasises:

• waiting;

• avoidance if necessary;

• cumulative desensitisation;

• gradual expansion of the comfort zone;

• the insufficiency of reason; and

• respecting the integrity of unusual ideas.

The paper is meant to be of value to those suffering mental distress (with practical strategies), whilst also advancing the general understanding of psychotic breakdown from the survivor's perspective.

Keywords: first-person account; interpersonal relationships; paranoia; philosophical issues; prognosis

Posting of this abstract is for the purposes of research into psychosis.

Saying goodbye to a therapist

Posted January 29th on the Mental Nurse weblog:

(Guest post from Torah)

Hi, I'm a long time lurker on this site. I really enjoy being able to see mental health issues from lots of different points of view. I am in therapy for CPTSD and I have had to say goodbye to my mental health case manager (who is an awesome nurse) when she changed roles. Over our time together she became my friend, my sister, my mother, my safe place, my information centre, my rock and it was all done in a way that never violated any boundaries, duty of care, job description. I had no idea how I would go without her and I really didn't want her to go. I had a couple of sessions where I told her this, where I cried and said it wasn't fair, where I asked questions like “If I wasn't coping so well, would you be allowed to go?”. She was always open and honest in her answers back to me, she told I would be o.k, she soothed me for a while and told me to stop dwelling on things I couldn't change. And then our time was up and now I have another very lovely nurse as my case manager. My old case manager called me today, in a professional role, just to check in on me. And you know what……I was completely fine. I didn't cry or demand her back. Everything was good. Anyway, what I wanted to say is, if you ever have to leave a mental health worker, for what ever reason, just allow your self to be human and grieve the loss. We are all human before we are mental health patients, we are allowed to 'like' or 'dislike' our treating team, and we are allowed to be sad or happy when that's over. It doesn't mean we have any 'pathology' or 'disorders', it just means we are human. Torah.

Graphic courtesy of Mental Nurse.

Select SZ Magazine articles are free to read online

From the SZ Magazine website:

Over the years, SZ Magazine has examined a number of important and relevant issues, including stigma, therapy alternatives, medication, legislation and career counseling. Our library of previous issues includes access to past cover stories [as well as select other articles], dating back to May/June 2001.

To view the free online SZ Magazine stories and articles, click here (use the double arrow on the page to move between publication years, and click on the magazine cover image to get access to the free online stories and articles).

Your Recovery Jouney: Meaning, Management, and Medication

Your Recovery Journey is based on the experiences of people who have a mental illness and who know there is hope, who are well and doing the things they want in their lives.

The program offers five free interactive weekly sessions, each ninety minutes long, and all facilitated by people in recovery who can give you valuable information that will help you on your recovery journey. You'll also learn to find peer support and build new life skills.

The program is designed for any person with a mental illness who would like to find support and explore different aspects of recovery. Using a variety of formats, including presentation, interactive exercises, and structured activities, the program guides participants their goals of establishing and maintaining wellness.

Who are the leaders?

The program is designed to be facilitated or co-facilitated by people who themselves have experience with mental illness and have also experienced recovery in their own lives. This 'hope in action' approach is a fundamental principle of the program.

What is covered?

This program aims to increase your ability to meet your personal recovery goals by:

• exploring the many aspects of recovery

• sharing knowledge and tools that will that will help you take responsibility for your wellness and stability

• introducing a variety of self-help techniques so you can manage and reduce symptoms

• learning to use medication effectively

• planning your recovery journey

• finding effective ways to reach out for and use the support of family members, friends, and service providers
  

When is it offered?

The Schizophrenia Society of Nova Scotia (SSNS) will offer Your Recovery Journey in the Halifax Regional Municipality during the spring of 2009.

If you are interested in participating, please contact the SSNS at (902) 465-2601 or 1-800-4652601 (toll-free in Nova Scotia), or sent an email to ssns@ns.sympatico.ca.

Materials

To view the Your Recovery Journey brochure, click here (PDF). To examine the Your Recovery Journey Participant Workbook, click here (PDF).

Facing Psychosis Video

Posted by ReachOut on January 28th:

This short video, made by and for youth and persons with psychosis, gives an excellent summary of what to watch out for in this brain illness.

Also see:

Scientists Can Predict Psychotic Illness in up to 80 Percent of High-Risk Youth

Mentally ill family member? You don’t have to feel alone

For the first in a five-part series on life with a mentally ill family member, written by Fortune McLemore (pictured), click here.

Also see:

Strengthening Families Together

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

Early detection of psychosis – Establishing a service for persons at risk

An abstract published in the January 2009 edition of European Psychiatry:

By Frauke Schultze-Lutter, Stephan Ruhrmann, and Joachim Klosterkötter [pictured]

University of Cologne, Department of Psychiatry and Psychotherapy, Early Recognition and Intervention Centre for Mental Crises (FETZ), 50924 Cologne, Germany

Purpose

The establishment phase of an early detection centre for prodromal psychosis is introduced and characterised, along with its detaining and promoting factors within a universal multi-payer health care system.

Method

Across the first six years (1998–2003), users' characteristics are compared between different diagnostic groups and to the local population statistics; and, for an exemplary 12-months period (3-1-2002 to 2-28-2003), the characteristics of telephone contacts with the service are studied.

Results

Rising steadily in number across the first three years, 872 persons, predominately of German citizenship and higher education, consulted the service until 2003, 326 with first-episode psychosis and 144 not fulfilling criteria for a current or beginning psychosis. Of the 402 putatively prodromal patients, 94% reported predictive basic symptoms, 68.9% attenuated and 20.6% transient psychotic symptoms. Most contacts by persons meeting any prodromal criterion were initiated by mental health professionals (psychiatrists or psychologists) and counselling services.

Conclusion

Supported by public awareness campaigns, an early detection service is well received by its users and private practitioners as reflected by the large proportion of referrals from the latter. However, persons of non-German background as well as of lower education were underrepresented indicating that these sub-groups should be approached by tailored programmes.

Keywords: Psychosis; Early detection; Prodrome; Outpatient health services; Program evaluation

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

Posting of this abstract is for the purposes of research into early psychosis.

Also see:

Early Detection Fact Sheet (PDF)

Nova Scotia Early Psychosis Program

Photograph of Joachim Klosterkötter courtesy of the University of Cologne.

Suffers every day

A letter to the editor published in today's edition of The Chronicle Herald:

I have followed with great interest the story of Glen Race, who will be sentenced with life in prison for the murder of Darcy Manor of New York State. It most intrigued me that Jane Manor was able to make a statement to Mr. Race, hoping that he will "suffer just half the pain" that Mr. Manor’s family and friends had suffered.

I know how much people with schizophrenia suffer. My husband’s brother, Nigel, suffered from this mental illness for the better part of 25 years. He refused medication and treatment for most of his time with this illness, as he felt it "deadened" him. Even when he was ordered to take the medications, it was too easy for him to run.

I saw first-hand the tortured looks on Nigel’s face in times when he could somewhat manage his symptoms, and I had to fight with anger when he forced entry into our home and had to be forcibly removed by police at gun point.

In the end, Nigel took his own life, only a few months before Mr. Race murdered Darcy Manor. I realize Mr. Race’s crime is a punishable offence and he needs to serve his time, but I hope we can all spare one moment of compassion for Mr. Race, and all people afflicted with mental illness. Mrs. Manor need not hope that Mr. Race will "suffer just half the pain" her family suffers. I am sure Mr. Race suffers every day, from having to cope with this most terrible mental illness.

Mental illness needs a higher profile in our community; we need to spend more on this often marginalized sector of the health care population.

Leslie Hill, Dartmouth

Also see:

'Unspeakable sorrow' haunts murder suspect's family

MIT discovers a brain process involved in schizophrenia

An article posted January 22nd on masshightech.com:

Some researchers at MIT believe that schizophrenia may be triggered by over-stimulating the brain system that handles self-reflection processes.

This past week, researchers at the MIT McGovern Institute for Brain Research made public their findings. Historically, they claimed, schizophrenia — characterized as a series of disturbed thoughts, perceptions and emotions — is believed to be caused by disconnections among the individual brain regions that control the various cognitive and other processes.

However, they found that schizophrenia is also associated with an excess of communication between the so-called default brain regions. These default regions handle self-reflection processes and activate when a person is either contemplating himself or herself or nothing in particular. This default network includes the medial prefrontal cortex and the posterior cingulate cortex — brain portions associated with self-reflection and autobiographical memory recall processes.

People usually suppress the brain default system when performing challenging tasks, stated John Gabrieli, an MIT professor and one of the study’s authors. The researchers found that patients with schizophrenia don’t have the typical brain default suppression capabilities, however. Ultimately, this realization may help to explain schizophrenia’s cognitive and psychological symptoms. The hyperactive default system may account for schizophrenic hallucinations and paranoia. For instance, point out the researchers, if a brain region, whose activity normally handles the self-focus process, is active while the patient is listening to a voice on television, the patient may perceive erroneously the voice is directed at them specifically.

To conduct its study, the team selected three carefully matched groups of 13 subjects each: schizophrenia patients; non-psychotic first-degree relatives of patients; and healthy controls. The subjects were scanned by functional magnetic resonance imaging during rest or while performing easy or hard memory tasks.

Gabrieli explained that future research may lead to ways of predicting or monitoring individual patients’ response to treatments for schizophrenia, which afflicts about one percent of the population.

Also see:

Altered brain activity in schizophrenia may cause exaggerated focus on self: MIT study links schizophrenia to key 'default mode' brain system

Hyperactivity and hyperconnectivity of the default network in schizophrenia and in first-degree relatives of persons with schizophrenia

Graphic courtesy Susan Whitfield-Gabrieli, McGovern Institute for Brain Research at MIT.

Families 'fail' on schizophrenia

An article posted today by BBC News:

People with schizophrenia are more likely to experience discrimination by those closest to them than by employers or officials, a global survey suggests.

Nearly half of the 730 respondents to the King's College, London, study reported negative treatment by relatives and friends after diagnosis.

About a third said they had encountered problems when seeking or keeping a job.

Writing in the Lancet, the authors said they saw a remarkable consistency in those surveyed in 27 countries.

To read the entire article, click here.

Also see:

Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey

People With Schizophrenia Say Bias Is Part of Their Lives

Strengthening Families Together

Princess Anne hands charity a royal reason to be cheerful

Posted on January 19th by NEWS.scotsman.com:

HER royal engagements will take her to the City Chambers and one of the city's premier cathedrals.

But to the astonishment of workers, a senior member of the Royal Family is also set to pay a visit to a small city charity who invited her on a whim of hope rather than expectation.

As part of an official trip this week, Princess Anne will unveil the new offices of a charity helping people with schizophrenia and their families on Wednesday.

To read the entire article, click here.

APA Helps Psychiatrists Improve Patient Safety

From the January 16th edition of Psychiatric News:

By Aaron Levin

A new APA [American Psychiatric Association] publication helps psychiatrists reduce errors and keep patients safer.

Patient safety rose in prominence in American medical thinking with the publication a decade ago of "To Err Is Human," the Institute of Medicine's (IOM) report estimating that tens of thousands of people die every year in American hospitals due to preventable medical errors.

Now APA has published a 33-page handbook that addresses ways to develop and integrate systems to reduce or prevent six critical events: suicide, aggression, falls, elopement, medical comorbidities, and drug or medication errors. Each chapter provides examples of unsafe care along with discussions of what went wrong and how to prevent mistakes.

To read the entire article, click here.

Click on the image to enlarge it.

To download SAFE MD, the 33-page handbook, click here (PDF).

SAFE MD: Practical Applications and Approaches to Safe Psychiatric Practice

Resource document, approved by the Joint Reference Committee in June 2008, that emphasizes applications and approaches to safe psychiatric practice in six categories: Suicide; Aggression; Falls; Elopement; Medical comorbidity; and Drug/medication errors.

Cross Country Checkup ... mental illness ... recorded January 11th

From CBC.ca:

Rex Murphy's introduction to the January 11, 2009, program:

"Our question today: "Are governments across Canada doing enough for the mentally ill?"

Today we want to talk about the state of mental illness in Canada.

Almost three years ago we did a similar program after the Senate Committee on Social Affairs, Science and Technology released a report three years in the making called "Out of the Shadows at Last." It was an in-depth look at what it was like to be mentally ill in Canada and what kind of support could be expected. It was not an optimistic picture. The chair of that Senate committee and the co-author of the report was Michael Kirby. One of the recommendations was to set up a mental health commission to, among other things, act as a co-ordinating body in Canada's approach to mental illness.

In 2007 the federal government created the Commission and named Michael Kirby the chair. It has been almost two years since the Commission was created and this week we want to take a look at how things are going in the battle against mental illness.

Those who deal with mental illness are very familiar with the 'trap' this illness falls in. It is the one illness that still has something of a 'taboo' about it. People are 'shy' when talking about mental illness. It is also among the most intractable problems a person, family, or society can face. It is twinned with other more immediately visible problems. How much of homelessness, for example, is wound up - tied to - persons suffering mental disability.

We'd like to have your thoughts today on this sometimes difficult subject. What can be done to advance the treatment of mental illness? What are the difficulties faced by people who have mental illness - or have to deal with or care for someone in their family with that problem.

The Honourable Michael Kirby has joined us from a studio in Florida ...and he'll be staying with us throughout the program.

We want to hear from Canadians across the country ....how do you think Canada is doing in its handling of people with mental illness? Is there enough support ...for individuals and for families? Is there still a tendency to hide the problem? Are there too many people falling through the cracks in the system? How can the system be made better? If there are problems could they be solved by more money ...or is it a problem of organization?

Our question today: "Are governments across Canada doing enough for mental illness?"

To download the entire broadcast, click here (mp3).

Photograph of Rex Murphy courtesy of CBC.ca.

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

Clozaril® (clozapine)

For Nova Scotia Residents Only

To the very best of my knowledge and effective today, many individuals currently taking Clozaril® (clozapine) produced by Novartis Canada Inc. will be switched to a generic version of Clozaril® called Gen-Clozapine produced by Genpharm. Again, to the very best of my knowledge, this only applies to all individuals receiving income assistance form the Nova Scotia Department of Community Services or enrolled in the Nova Scotia Family Pharmacare Program and currently taking Clozaril®. Blood monitoring will now be conducted by a program called GenCAN instead of Novartis’ CSAN® program. A patient’s prior blood work information will be transferred, and from what I understand without the individual’s permission, from the CSAN® program (Novartis) to the GenCAN program (Genpharm).

If you have any questions or concerns about the above, please feel free to contact the Schizophrenia Society of Nova Scotia.

Also see:

Evaluation of an interchangeability switch in patients treated with clozapine: A retrospective review.

Generic clozapine: a cost-saving alternative to brand name clozapine?

Branded versus generic clozapine: bioavailability comparison and interchangeability issues.

Clinical equivalence of generic and brand-name drugs used in cardiovascular disease: a systematic review and meta-analysis.


Clozaril® graphic courtesy of Novartis.

Schizophrenia 101

From MySanAntonio.com:

This is a primer for parents, educators, police officers, coaches, band parents and other “influencers” who really do need to have a very basic knowledge of schizophrenia and mental illness. This is part one of five columns on schizophrenia — and these are just the basics.

All columns by Dr. María Félix-Ortiz (pictured).

Column #1
Myths linked to schizophrenia lead to discrimination, abuse (December 17th)

Column #2
In the active phase of schizophrenia, patient obviously ill (December 24th)

Column #3
Hospitalization figure in schizophrenia myths (December 30th)

Column #4
Various factors determine treatment plans for schizophrenia (January 6th)

Column #5
Don't know of anyone with schizophrenia? Think again (January 14th)

Lunenburg County Chapter Christmas Party

Two photographs from the Lunenburg County Chapter of the Schizophrenia Society of Nova Scotia's 2008 Christmas Party!

Santa (Linda Dagley, right) and her elf (Kaye Joudrey)

Kenny Joudrey (right) and Rachael Robar try to figure out Kenny's gift from Santa - Doesn't look like a lump of coal!

Click on the images to enlarge them. Photographs by Jan House.

Canadian Human Rights Commission’s Policy and Procedures on the Accommodation of Mental Illness

From the Canadian Human Rights Commission:

October 2008

The Canadian Mental Health Association has urged employers to do more to address mental health issues in the workplace.

At the Canadian Human Rights Commission, we are committed to achieving the highest standards of human rights practice within our own workplace, and to act as both catalyst and leader in areas within our specific mandate. In support of this, we recently created an internal Policy and Procedural guideline on the Accommodation of Mental Illness.

Because we recognize that many other organizations face the same challenges, we are happy to share it with any organization interested in this subject matter.

The policy below outlines the accommodation process and provides guidance to help managers and supervisors take the initiative to ensure employees with a mental illness are offered appropriate accommodation when necessary.

This policy, plus education initiatives, and counselling and support, will contribute to the Commission's continuous engagement in creating a work environment that supports the health and well-being of all employees.

For any questions about the policy, please contact us by email at policy-politiques@chrc-ccdp.ca.

To download the policy, click here (PDF).

A Letter of Invitation

to make a donation, to become a member, or to renew your membership with the Schizophrenia Society of Nova Scotia (SSNS)

The SSNS Needs Your Support!

On behalf of the Board of Directors of the Schizophrenia Society of Nova Scotia (SSNS), the Dr. Paul Janssen Chair in Psychotic Disorders at Dalhousie University and I would like to take this opportunity to invite you to become a member of the SSNS, or, if you have been a member in the past, to thank you for supporting the important work the SSNS has performed over the years. The SSNS depends on the membership and financial support of people like you to accomplish our mission of improving the quality of life for those affected by schizophrenia and psychosis through education, support programs, public policy, and research.

Please see the list of accomplishments of the SSNS over the past two years by clicking here.

We know we have much more work to do, including:

• advocacy for those living with schizophrenia and other psychotic disorders;

• promotion of better living conditions for these individuals;

• improving access to dental care and medical treatment (including early detection of psychosis);

• better support for families;

• monitoring of the new Mental Health Court system;

• education of professionals, the public, families, and those living with schizophrenia / psychosis about the Involuntary Psychiatric Treatment Act; and

• further development of our provincial network of Chapters.
  

One way you can be of much needed and immediate assistance is to make a donation. Every donor of $15 or more is automatically entitled to be a member of the SSNS. When approaching the Nova Scotia Government and other decision makers, we are empowered by our grassroots membership.

Please take a moment to complete the SSNS Membership Form now and mail it to us along with a cheque for at least $15.00. Memberships can also be renewed over the telephone, using Visa or MasterCard, by calling (902) 465-2601 or 1-800-465-2601 (toll-free in Nova Scotia).

In order to sustain our work towards improving the quality of life for those affected by schizophrenia and psychosis, we need your continued financial support.

Yours sincerely,

Stephen W. Ayer, Ph.D.
Executive Director
Schizophrenia Society of Nova Scotia








Philip Tibbo, MD, FRCPC
Medical Advisor to the SSNS
Dr. Paul Janssen Chair in Psychotic Disorders
Department of Psychiatry, Dalhousie University

More on Canadian System

A letter to the editor published in the January 2nd edition of Psychiatric News:

By Nancy Porter-Steele, Ph.D.
Halifax, Nova Scotia

I write from two perspectives: as a colleague and the wife of a psychiatrist, Curtis Steele, M.D., formerly living and working in the United States and now in Canada; and as a member of an extended family living mostly in the United States.

In the November 7, 2008, issue, Dr. Steven Sharfstein accurately presented the situation for psychiatrists in Canada. Curtis and I practiced in the United States for several decades before moving to Canada. For our professional situation, the move has been excellent. In the United States, we had to have a full-time, well-trained, highly competent employee whose time was almost entirely spent collecting our fees from insurance companies. In Canada, as Dr. Sharfstein said, billing for the psychiatric practice takes about 10 minutes a week and requires no office staff—which means less office space, less equipment, and so on, saving money for everyone including the provincial health insurance fund.

Furthermore, provincial insurance pays enough for group therapy that Curtis can afford to pay me to serve as cotherapist with him. We are able to see in our groups not only fully employed people, but also people whose incomes are very tiny, people who are between jobs, people whose jobs carry no insurance benefits—many people we would never have been able to see in the United States.

As I am not a medical doctor, the services that I provide on my own are not covered by provincial health insurance; therefore, for that part of my practice, I continue to see only people who can pay out of pocket or who have private insurance with one of the companies that recognize my registrations. (They pay as they go; no office staff for me either.)

As for our family members: there are at least two of our relatives living in the United States who have suffered permanent impairment as a result of being unable to afford the medical care they needed when they needed it. This kind of tragedy seems to be underrecognized.

Photograph of Nancy Porter-Steele courtesy of CFQ Healing Qigong Society of Atlantic Canada.

Eric Kandel on the Year in Neuroscience

An article posted by The Dana Foundation on December 29th:

What were the most significant neuroscience discoveries of 2008? Eric Kandel, a professor of biochemistry and biophysics at Columbia University, weighed in on the topic at an event at the Dana Center in Washington, D.C., in November. Kandel was a co-recipient of the 2000 Nobel Prize in Physiology or Medicine for his work on the physiological basis of memory. Here is an edited transcript of his remarks during a reception for members and guests of the Dana Alliance for Brain Initiatives.

To read the entire article, click here.

I thank David Whitehorn for bringing this article to my attention.

Beyond the critical period: longitudinal study of 8-year outcome in first-episode non-affective psychosis

An abstract published in the January 1st edition of the British Journal of Psychiatry by Crumlish et al.:

Background

The critical period hypothesis proposes that deterioration occurs aggressively during the early years of psychosis, with relative stability subsequently. Thus, interventions that shorten the duration of untreated psychosis (DUP) and arrest early deterioration may have long-term benefits.

Aims

To test the critical period hypothesis by determining whether outcome in non-affective psychosis stabilises beyond the critical period and whether DUP correlates with 8-year outcome; to determine whether duration of untreated illness (DUI) has any independent effect on outcome.

Method

We recruited 118 people consecutively referred with first-episode psychosis to a prospective, naturalistic cohort study.

Results

Negative and disorganised symptoms improved between 4 and 8 years. Duration of untreated psychosis predicted remission, positive symptoms and social functioning at 8 years. Continuing functional recovery between 4 and 8 years was predicted by DUI.

Conclusions

These results provide qualified support for the critical period hypothesis. The critical period could be extended to include the prodrome as well as early psychosis.

Healthy Living Series - Cole Harbour Library

Wednesday, April 22nd, 6:30 pm!

Click on the image to enlarge it.

The Cole Harbour Public Library is located at Cole Harbour Place, 51 Forest Hills Parkway, Dartmouth, Nova Scotia.

Kiwis more accepting of mental health sufferers

From the December 31st edition of The New Zealand Herald:

More New Zealanders feel they could be supportive of someone with a mental illness, according to research issued yesterday.

The research, conducted periodically on behalf of the Ministry of Health's Like Minds, Like Mine programme by Phoenix Research, has tracked changes in New Zealanders' attitudes to mental illness since 1997.

Significant improvements had been made over the past decade, but the Mental Health Foundation was particularly pleased that 71 per cent of people in the latest survey reported that they knew how they could be supportive of someone experiencing mental illness, an increase of 10 per cent over the last survey in 2007.

To read the entire article, click here.

Photograph courtesy of Like Minds, Like Mine.

Schizophrenia: Medicine's Mystery - Society's Shame (Paperback, 2008)

From Amazon.com:

Written by a medical writer and family member of someone suffering from schizophrenia, this book outlines all of the issues involved with schizophrenia and its treatment including stigma, history, causes, physiological changes in the brain, and best treatments. It is an ideal reference and support for family members and others interested in this disease. It is also suitable as supplementary reading for students in health care fields (including medicine and nursing), psychology, social work and any occupation that needs solid information about schizophrenia. The book is recommended by the World Fellowship for Schizophrenia and Allied Disorders on its website.

Click on the image to enlarge it.

Nation Builder 2008: The Finalists - Casting a light on mental illness

From the December 26th edition of The Globe and Mail:

Michael Kirby wants a revolution in the way we regard diseases of the mind, and has established a unique charity to bring it about

By Erin Anderssen

OTTAWA -- As a math student at Dalhousie University, Michael Kirby [pictured] would spend long afternoons sitting in the "Roost," the top floor of his fraternity house, working through differential equations.

On occasion, he would know the answer after a quick glance at the problem.

"I realize it's going to take two hours to figure it out," he would say. "But I can just tell by looking that the answer is x=2."

And usually, recalls his fraternity brother George Cooper, now a prominent Halifax lawyer, he was right.

"He could just pierce through the central core," says Mr. Cooper, "and tell you the answer before he had actually done the heavy lifting to actually be able to prove it."

The ability to know the answer before others have even framed the question has marked Mr. Kirby's tenure as the first chair of the Mental Health Commission of Canada.

To read the entire article, click here.

Also see:

Mental Health Commission Chair Michael Kirby named to Order of Canada (December 30th, 2008).

Photograph by Ashley Fraser.

150 years of healing, serving

An article published in today's edition of The Chronicle Herald:

The Nova Scotia Hospital marks a century and a half of helping patients with mental illness

By John Gillis, Health Reporter

WHEN IT WAS OPENED, the vast Mount Hope Hospital stood on the Dartmouth waterfront off Asylum Road.

Today that route is called Pleasant Street and the Nova Scotia Hospital is a collection of smaller but still imposing buildings. The site will remain a centre of psychiatric care, but years from now a passerby might be hard-pressed to imagine its institutional past.

The first patient was admitted to what was then known as a lunatic asylum 150 years ago today, A.H. MacDonald notes in his Mount Hope Then and Now: A History of the Nova Scotia Hospital.

The evolution of the facility reflects the history of modern psychiatry, Dr. Nick Delva, chief of psychiatry for the Capital district health authority, said in the hospital’s health sciences library recently.

The original hospital, the first of its kind in Nova Scotia, was founded by former Halifax mayor Hugh Bell [pictured], whose push for such a facility was backed by American advocate Dorothea Dix.

It was mainly a place to hold people with mental illnesses, rather than treat them, Dr. Delva said. A stay of two years would have been considered a short one.

He said the approach to the care of patients would likely have been centred on the idea of healthy living.

The hospital was deliberately located away from busy Halifax. Patients would be given good food and treated humanely. The hospital operated a farm across the road, partly so that it would be self-sustaining and also to give able patients an occupation.

A minority of patients would fare well enough to be discharged.

"Through just the natural courses of the illnesses, people would recover," Dr. Delva said, noting people with depression and even acute psychoses may go through cycles or "burn themselves out."

An 1876 hospital record book notes reasons for admission, including intemperance, "change of life" for a 47-year-old woman, sunstroke and measles.

Other people who would clearly be recognized as having mental illnesses today might never have seen the hospital in those days, said Dr. Alistair Munro, who worked at the Nova Scotia Hospital from 1983 to 1999 and is a former chief of psychiatry.

"Insanity was a disgrace," he said. Many people would have been kept at home, despite their illnesses, to avoid shaming their families.

There would have been some drugs available to treat mental illnesses at that time, but the fact the brain is a collection of separate cells — fundamental to current therapies — was not known until the turn of the 20th century.

The hospital grew in size, eventually holding more than 700 people. In 1918, 270 people were admitted, bringing the number under care to 746.

A letter from that year describes a patient of Dr. Lewis Thomas:

"This is to certify that Miss Mary O went insane in 1918 and died at the Nova Scotia Hospital Nov. 18, 1918. I first began to treat her on Feb. 6 for nervousness. This nervousness gradually developed into insanity. I consider that the explosion of Dec. 6, 1917 [pictured], had a good deal to do in causing this mental condition to develop."

There were major advances in the 20th century in the drugs available to treat mental illnesses, helping to drive a major shift in the approach to care.

"The expectation is that most people will live in a non-institutional setting," Dr. Delva said.

Several smaller buildings were constructed on the hospital grounds and the large original Mount Hope building eventually came down.

Those newer buildings are also destined to come down. Simpson Hall, built in 1964 as a residence for students of the hospital’s long-running nurse training program, will be demolished in the coming year to make way for four 10-bedroom houses for people getting ready to live in the community.

Plans are for the 50-year-old red-brick Purdy building, itself a waterfront icon, to fall in time.

In mid-December, there were a total of 116 in-patients at Nova Scotia Hospital buildings.

Among the artifacts on display in the library is a 1950s-era electro-convulsive therapy machine. So-called "shock treatments" may be thought of as outmoded, thanks in part to our "cultural memory" of the therapy gleaned from sources like the Oscar-winning film One Flew Over the Cuckoo’s Nest, Dr. Munro said.

He called the 1975 film, based on a 1962 novel, "dishonest," depicting conditions and approaches that were already very dated by that time.

Electro-convulsive therapy is still a treatment given at the Nova Scotia Hospital, but it’s a far cry from the punitive and traumatic treatment many might imagine. Dr. Delva said all kinds of medical evidence supports its effectiveness in treating persistent depression. It’s given under anesthetic and patients receive muscle relaxants that eliminate violent seizures. Dr. Delva said a person can’t drive home afterward because of the anesthetic but otherwise should have no physical effects.

A majority of mental issues are now handled by family doctors in co-operation with a variety of other health practitioners.

Some psychiatric patients still spend long periods in hospital. Some are seniors with dementia, some have intellectual disabilities as well as psychiatric illnesses and there are rehabilitation services for people who need significant help getting ready to live in the community.

Between those people whose illnesses can be managed by family doctors and those who require long hospitalization are a group of patients who need a complex system of care, Dr. Delva said.

Many can still live in the community with supports and medications, though for people whose illnesses impair their understanding of how well or sick they are, contact from mental health care providers sometimes needs to be assertive.

"That means you’ve got to get out there, be their memory, be their support," Dr. Delva said. "Those are people that would have been in institutional settings for sure their whole life in the olden days."

Today, mental illness may not always be viewed as the social disgrace it once was, but a real stigma remains.

Dr. Munro attributes much of that to the terrible conditions and failure to help patients in underfunded and overcrowded psychiatric hospitals of the middle part of the 20th century.

Dr. Munro and Dr. Delva agreed funding for mental health care is still not where it needs to be. But Dr. Delva said he’s optimistic Nova Scotia is moving in the right direction.

"Good care, good facilities will remove the stigma," he said.

Photograph of the Halifax Explosion from Wikipedia.

Photograph of the Nova Scotia Hospital by rwkphotos (used under Creative Commons License).

Playing For Change: Song Around the World - "Stand By Me"

Text with the video:

From the award-winning documentary, "Playing For Change: Peace Through Music", comes the first of many "songs around the world" being released independently. Featured is a cover of the Ben E. King classic by musicians around the world adding their part to the song as it travelled the globe.