'Normal procedures' can lead to death

To read this column by David Rodenhiser (pictured, right) in the November 28th edition of the Halifax Daily News, click here.

Dealing with people in crisis

From CBC Information Morning on November 26th:

A grieving sister, and the head of the Schizophrenia Society of Nova Scotia explain how police should respond when dealing a person in a mental health crisis. Click here to listen to RealAudio file (runs 12:04).

For an interactive map of taser-related deaths in Canada, click here.

Court for mentally ill on way — province

Director: N.S. has ‘great need for general mental health services’

An article published in the November 24th edition of The Chronicle Herald:

By Jennifer Stweart, Court Reporter, with Dan Arsenault, Crime Reporter, and The Canadian Press

The province has committed to establishing a mental health court in Nova Scotia that would deal with mentally ill offenders.

"It’s in development," Justice Department spokeswoman Cathy MacIsaac said Friday. "I can’t really give you any further details."

The announcement came Thursday as part of the Conservatives’ throne speech. But it received little attention because of the buzz surrounding the death earlier in the day of Howard Hyde.

Officers arrested the Dartmouth man early Wednesday. He died Thursday, 30 hours after Halifax Regional Police used a stun gun to subdue him.

Mr. Hyde [lived with schizophrenia] — a perfect candidate to be dealt with in mental health court.

Dr. Scott Theriault, clinical director of forensics and specialty services for mental health, said the news has him "cautiously excited."

"In Nova Scotia, we have a great need for general mental health services," he said. "There’s no doubt that with more robust general mental health services, you would have fewer people with mental illnesses finding themselves in conflict with the law."

Ms. MacIsaac said there’s no word on when the specialized court could be up and running, or how much it will cost.

She said the department is keeping an eye on the performance of mental health courts in other areas, including Toronto and Waterloo.

Staff Sgt. Rudy Smith of Waterloo Regional Police said the court in his area has been a great success.

In operation since September 2005, the specialized court — held every Tuesday — provides more services faster, he said.

"They weren’t getting the counselling or the help they needed," Staff Sgt. Smith said of mentally ill offenders. "The whole idea is to get them as much help as possible quicker than if they’d gone through the normal process."

Joanna Blair, Mr. Hyde’s sister, was unaware Friday that other provinces have mental health courts, but said she thinks there should be improvements to the way society handles people with psychiatric problems.

"I think that in the psychotic condition (my brother) was in, . . . (he) should have been dealt with by subduing him in some manner other than a Taser gun, possibly by an injection of medication," she said. "And I say that hesitantly because I have questions about that" as well.

Ms. Blair said she thinks her brother should have been kept at the East Coast Forensic Hospital, where he could have met with a psychiatrist and been medicated before his bail hearing Thursday.

Jean Hughes, a professor at Dalhousie University who specializes in psychiatric nursing, said officers need specific training on how to deal with the mentally ill to ensure such encounters don’t escalate into violence.

She said offenders who are paranoid can be easily spooked, especially if they have had violent encounters with police in the past.

Mr. Hyde, for example, was shocked with a stun gun by police during an arrest in 2005, and his sister said he had had other altercations with police before then.

"Once you’ve had encounters where people have used violent or corrosive or intrusive means of working with you, then you learn to expect that that’s probably going to happen again," said Ms. Hughes, a former vice-president of the Canadian Mental Health Association.

"For the large portion of our population, the only people you can call are police. So that puts tremendous onus on them.

"What we do know is with good training, people can learn alternative methods for de-escalating situations."

Justice system struggles to deal with mentally ill

Close co-operation urged between police and specialists in mental health

To read this November 24th article from the Ottawa Citizen, click here.

PACT model diverts mentally ill from courts

From the November 24th edition of the Halifax Daily News:

By Rachel Mendleson

If Nova Scotia is looking for a role model in psychiatric emergency response, perhaps it should consider Edmonton, Alta.

Since 2004, the city's mobile crisis teams have been equipped to respond to calls such as the one Karen Ellet placed when her common-law husband, who suffered from paranoid schizophrenia, assaulted her.

In addition to police and ambulance, one of four mobile teams, which consist of a uniformed officer and a mental-health professional, responds to psychiatric emergencies.

The Police And Crisis Team (PACT), keeps its own files on mental health patients, and has access to other databases, to ensure the history of the individual is known upon arriving on scene, says Tammy Dudas, regional manager of crisis and access services for Edmonton's mental health program. Being on scene allows the team to converse with the individual and help determine the appropriate course of action, she said.

She says so far, 100 per cent of the individuals PACT has brought to hospitals for acute care have been admitted.

The goal of the PACT program is to divert the mentally ill away from the criminal justice system, and toward health care, Dudas said.

But when charges are laid, PACT continues its relationship with the individual to present treatment options.

What We Know ... What We Don't Know About Schizophrenia

A very informative posting on the Schizophrenia Research Forum website. To view, click here.

Thanks go to the Nova Scotia Early Psychosis Program for pointing this website out to me.

The Missing Lint Cooperative Ltd.

is pleased to introduce

Mentality

A new, province wide magazine featuring the creative works of individuals living with mental illness.

We are seeking submissions for this exciting and unique project and would be pleased to consider for publication artistic works from individuals living with mental illness. Please contact us if you like to volunteer to have your work(s) published from any of the following categories:

Written

• poetry
• prose
• journalism
• essay
• short story
  

Visual

• painting
• photography
• digital
• drawing
• mixed media
  

For more information, contact us at:

The Missing Lint Cooperative Ltd.
648 George Street
PO Box 925
Sydney, Nova Scotia
B1P 6J1

Phone: (902) 539-6480
Fax: (902) 539-7062
e-mail: jmmissinglint@hotmail.com

Acceptance of submissions is ongoing.

Please submit written work in type, and visual art on CD (saved as TIFF format [640 x 480 and 300 dpi]) or high quality hard copy, by e-mail or regular mail. Please send a copy of original work as we are unable to return submissions.

For more information, click here and here (downloads PDF files).

Business, science groups unite to fight costly mental illness

$1B Brain Trust to fund research for prevention, treatment

From November 15th edition of The Ottawa Citizen:

By Don Butler

An alliance of North American business and science groups is proposing to create a $1-billion foundation to fund research into the cure and prevention of major mental illnesses and addictions.

Plans for the proposed non-profit corporation, known as the Brain Trust, were presented to delegates to a U.S.-Canada forum on mental health and productivity at the Canadian War Museum yesterday.

The Brain Trust will aim to raise $1 billion over 10 years from businesses and charitable foundations that don't currently support research into mental health, said Bill Wilkerson, president of the Global Business and Economic Roundtable on Addiction and Mental Health.

He said the Brain Trust will focus on funding research projects "with the greatest promise of finding a cure for mental illness."

One goal will be to find "the Holy Grail" of brain research -- why and how the brain responds to the social environment, producing the symptoms of mental illness.

"Now's the time for the public's imagination to be caught by another kind of climate change -- social climate change," Mr. Wilkerson said.

Business leaders are increasingly focusing on mental health issues, in part because depression is now the leading source of workplace disability.

According to figures presented at the forum, mental disorders cost Canada $35 billion a year in treatment and lost productivity -- $3 billion more than cancer.

Annual research spending on mental health in Canada is just $65 million, barely a quarter of research spending on cancer.

Health Minister Tony Clement assured delegates "there's a lot of focus on this issue" now within government. "I really want to keep the momentum going."

He said neurological disorders represent 14 per cent of the burden of disease worldwide and one in three disability claims in Canada.

Mr. Clement said the government has exclusive or predominant responsibility for mental health services to inmates, soldiers, First Nations and public servants. "As an employer, I believe we have the responsibility to lead by example," he said.

David Goldbloom, vice-chairman of the newly created Mental Health Commission of Canada, said mental disorders in the labour force have major strategic implications because the global economy is fast becoming brain-based. "We are increasingly valued for our above-the-neck capabilities."

The convergence of demand for brain skills and the rising incidence of brain disorders is "the greatest health-based threat to economic and industrial activity," he said.

Tom Insel, director of the National Institute of Mental Health in the U.S., said 16 per cent of people in Canada or the U.S. will suffer from mental disorders during their lifetimes, with about half of those disabled by the disease.

Unlike other chronic illnesses, mental disorders begin early in life, with onset by age 14 in half of all cases. "This is really one of the chronic diseases of young people," he said.

Depression, he said, "is a big one. This is a disease that kills." In the U.S., 30,000 depressed people commit suicide every year -- almost twice as many as are victims of homicide.

Yet depression is eminently treatable, he said, through medication or cognitive behaviour therapy. "The real crime here is we haven't been able to use them often enough and get them to the people who need them early enough."

Moya Greene, president and CEO of Canada Post, said the Crown corporation decided to champion mental health after employees selected it as their "cause of choice."

The corporation's 72,000 employees have the highest rate of absence in Canada, averaging 15 sick days a year, a third of which are due to stress or other mental conditions.

Depression and anxiety are responsible for nearly 37 per cent of Canada Post's disability claims, she said.

Ms. Greene said mental health problems cost the corporation $300 million a year, a figure she hopes to reduce to $30 million within five years by promoting a workplace culture of "tolerance, respect and support.

"This is a very, very big issue for us," she said.

Yesterday's forum was the second in a series of four. The final two will take place next year in New York and Toronto, after which Mr. Wilkerson hopes the Brain Trust will be ready for launch.

Click on the image to view an animated MRI sequence of sagittal transections through the human brain. The nose is to the left. Courtesy of Christian R. Linder.

My story dealing with schizophrenia.

Click the arrow to start the video.

"A future with hope … in a year of transition”

A Message from the Schizophrenia Society of Canada's president, Dr. Pam Forsythe

The Schizophrenia Society of Canada (SCC) Board of Directors realizes that the closure of the SSC office in Markham, Ontario and the ongoing changes in leadership and staff represent a significant transition for the Society. While we believe this transition period will better position the organization for optimal growth and success, we wish to recognize and address the questions that these changes may have generated among some of our stakeholders, including the members of the Schizophrenia Society of Canada.

It is understandable that our members, donors, sponsors and supporters would have questions about what these changes mean for the organization, for their donations, for the programs and projects they support, etc.

To that end, we have developed some key messages that we hope provide clear and consistent information that:

• Informs our members and stakeholders about the changes underway within the organization.
• Maintains the confidence and support of our stakeholders throughout this transitional period.
• Ensures representatives of the organization are speaking with the same voice.
• Reinforces our commitment to our mission statement and to individuals and families affected by schizophrenia and psychosis.
  

The questions to be addressed below are:

1. When will the SSC be hiring a permanent CEO?
2. Where and when will the SSC open a new office?
3. How can I reach the SSC?
4. There have been a lot of leadership and staff changes over the past few months. Why? What does it mean for the organization? Are there more changes to come?
5. Will you continue to fundraise and offer the same materials, programs and events?
6. What happens to the programs that are currently being run / funded?
7. With the virtual office in Winnipeg and the eventual move to Ottawa, does that mean you won’t be doing work in areas of research and education?
8. The SSC seems to focusing on individuals and not on families. Why?
9. There’s been more and more emphasis on recovery. What is recovery and does it take the place of treatment? What is the SSC’s stand?
   

Should you have any questions about the information below, please contact me at info@schizophrenia.ca.

Sincerely,

Dr. Pam Forsythe, President
Schizophrenia Society of Canada

For the entire text of this letter, click here.

Crewe (Re), 2007 NSSC 322

IN THE MATTER OF AN APPLICATION PURSUANT TO SECTION 58(2) OF THE HOSPITALS ACT, AS AMENDED PURSUANT TO SECTION 86(13) OF THE INVOLUNTARY PSYCHIATRIC TREATMENT ACT;

AND IN THE MATTER OF A DECLARATION OF CAPACITY WITH RESPECT TO BRANDON CREWE

To read the entire decision, click here (downloads a PDF).

A letter to the editor published in the November 15th edition of the Halifax Chronicle Herald:

Need a plan

How is it that Brandon Crewe is deemed to be well enough to be in prison, but incapable of deciding whether or not his remaining testicle should be removed (Nov. 12 story)? He didn’t even know he was in hospital to have his testicle removed until hospital staff told him (while he was chained to his bed) that they didn’t need his consent. Given this scenario and the entire context of this case, it is little wonder that Justice Mona Lynch noted he was in a "fragile state." Surgery may ultimately be warranted, but the process seems to be seriously flawed.

According to research, treatment and support of inmates who are mentally ill in Canadian prisons is sub-standard, and sometimes almost non-existent. Canadian prisons have become warehouses for a growing number of mentally ill due to funding cuts and closures in community facilities. Prisons are dangerous and destructive places for people with mental illness. This research is in the hands of people who are able to make decisions to change this tragedy. We hear of the need for more money for public safety and for health care, but the link between the two is seldom discussed.

The tiny window opened by The Chronicle Herald gives a glimpse into the worry and frustration experienced by Mr. Crewe, his family, medical staff, justice staff, etc. If you added up what it costs to try to deal with Mr. Crewe’s present situation, it would probably make more sense to put just a fraction of that toward a well-thought-out plan to deal with mental illness. Most importantly, people like Mr. Crewe would have the kind of care he truly needs.

Heather Johannesen, Halifax

Schizophrenia Sufferers Flock to Cheap Generic Zyprexa From Canada

To read a November 13th press release from GenericZyprexa.com, click here.

Image of NOVO-OLANZAPINE courtesy of Novopharm.

Pat MacLean - MICA Award Acceptance Speech

The following speech was delivered on October 2nd by Maxine McCuaig in Pat's absence:

Pat is unable to be here today because she is in Toronto attending an International Conference on Schizophrenia. She has given me the following message, which I will read to you now.

She says:

It is indeed an honour for me to be receiving this award. Thank you very much.

My involvement with mental illness and with the mental health system began in 1978, when my son was diagnosed with having schizophrenia, and was admitted to the Nova Scotia Hospital. He was 17. And in the 29 years that have passed since then, I have seen many changes.

One advantage in being around for so many years is that I have seen a number of positive changes and improvements in services that affect the ability of those with schizophrenia to reclaim their lives – and to realize that, for them, recovery is possible.

For example:

1. The arrival of new medications, with new ones yet to come, that control the positive and negative symptoms of the disorder, has brought individuals to the point where they can carry on with their lives.


2. We now understand clearly that the sooner a person begins treatment the more likely they are to move toward recovery.


3. I have seen the general attitude toward mental illness and to those whose lives are interrupted by mental illness improve tremendously. This has largely been brought about through discussion, interviews, and the education of the public by the media, and by groups such as the Schizophrenia Society and the Canadian Mental Health Association, as well as specific individuals, who have worked tirelessly to achieve positive results.
   
   Just recently, for example, CBC Radio, Toronto aired a series of programs over a period of a week that dealt with a variety of topics related to de-mystifying mental Illness. Also, our local CBC station has provided, during this year alone, many segments on local issues connected to living with a mental Illness.



4. And now, at last, after many years and much work on part of groups and individuals we now have a Mental Health Commission of Canada, chaired by Nova Scotia's own Michael Kirby.

There is so much happening that is positive. And yet, there is still much to be done - improvements in housing, access to treatment and therapy, and expenditures to increase and improve services to all Nova Scotians.

And, in spite of new and better medications for schizophrenia, there are still many, approximately 50 percent, of those with the disorder who do not understand that they are ill, and so refuse treatment. For these seriously ill individuals we need expert counselors and psychologists who can help them attain insight into their illness, and with help, be prepared to receive treatment.

We have all learned much over the past 29 years, and now we are well positioned to move forward into the future. There can be no going back.

Once again, thank you for this award today. It is very greatly appreciated.

I am very pleased to accept this award on behalf of Pat MacLean.

Photograph of Pat MacLean delivering a report at the SSNS's 2007 Annual General Meeting taken by Bill Gard.

Advocacy Toolkit

In September 2007, the Schizophrenia Society of Canada published an Advocacy Toolkit.

To download the Advocacy Toolkit document (PDF), click here.

From Innovations to Practice

A State of the Science Conference

Monday, April 14 & Tuesday, April 15, 2008
Hyatt Regency Hotel
Cambridge, Massachusetts, USA

A posting from the Center for Psychiatric Rehabilitation, Boston University:

This state of the science conference brings together participants from the USA, Canada and an estimated 25 nations into an exciting learning community, integrating research, practice and innovations.

Goal of Conference:

To highlight efforts and practices directed at making recovery a real possibility for the broadest group of individuals with psychiatric disabilities and to promote the mainstreaming of those practices into “everyday operations”.

Who is it for?

• Administrators, directors of rehabilitation, behavioral health etc.
• Individuals with mental illnesses, researchers, practitioners, families, and educators.
• Government agencies such as Veterans Administration, Employment/Rehabilitation agencies, Offices of Mental Health. Social Services etc.
  

Who is presenting?

Presenters from a wide diversity of cultural backgrounds, geographic locations, and experience with mental illnesses:

• systems leaders in transformation;
• program innovators;
• workforce developers;
• leading researchers.
  

What are some Presentation Examples?

• Eliminating Coercion
• Directing Innovations
• Global Perspectives on Rehabilitation & Recovery
• Embedding Rehabilitation in Organizations
• Functional Health as Foundation for Recovery
• Working as Peers
• Creating an Inclusive workplace
• Reaching marginalized Groups
• Honoring Differences
  

Be sure to look at the full list of presentations and registration before its too late.

All stakeholders are needed to design, reform, and rethink how we can make recovery oriented services a reality for all. We are proud to have the opportunity to host such an exciting event!

Early detection in psychosis

From the Care Improvement Partnership, National Institute for Mental Health in England. Click here to visit the website.

Schizophrenia could take Fred Frese far away, but it also gives him a niche in life

To read this article published in the November 10th edition of The Plain Dealer (Cleveland), click here.

Click here to visit the offical Fred Frese (pictured) website.

Recovering Mental Health in Scotland

From the Scottish Recovery Network:

After two years of investigation, interpretation and analysis, the eagerly awaited findings report of the Scottish Recovery Networks' narrative research project is available.

The research draws on the experience of 67 people across Scotland to highlight factors that helped and hindered their recovery from long-term mental health problems. It highlights several common elements which were found to be helpful for recovery. These included:

• Developing a positive view of yourself and having hope for the future.
• Having meaningful activities and purpose in your life, and having your contributions and choices in life validated and valued.
• Having supportive relationships.
• Having the right mix of treatments and support.
  

One of the things that is clear is that this is no different from what most people want in life.

The research is a major achievement for the Scottish Recovery Network (SRN) and is one of the largest qualitative narrative research studies on recovery in Scotland and worldwide.

To download the report Recovering Mental Health in Scotland, click here (large PDF).

To download individual sections the findings report Recovering Mental Health in Scotland click here.

Routes to Recovery
In addition to Recovering Mental Health in Scotland we have produced a companion resource entitled Routes to Recovery. This booklet does not aim to summarise the Narrative Research findings. It is intended to highlight some of the things that people said that they had been able to do to support their recovery. To download Routes to Recovery, click here (PDF).

Narrative Research Stories
Each participant in the narrative research project worked in conjunction with researchers to create their unique recovery story. Click here for more on how the stories were generated.

A selection of these stories have been published in a recovery booklet entitled: Journeys of Recovery, available by clicking here (large PDF).

To download the individual stories from the booklet click here.

To view other stories gathered in the narrative research project which did not feature in the Journeys of Recovery booklet then click here.

We’d like to take this opportunity to extend a heartfelt thank you to all the individuals that took the time to come and share with us their deeply personal and unique stories, without them this research would not have been possible.

Story disclaimer


Background for Narrative Research Project

One of the key tasks of the SRN is to gather and share people’s stories of recovery, looking at what helps and hinders on the road to living a satisfying and fulfilling life.

The majority of research around mental health problems focuses on treatments and interventions, for example comparing the effectiveness of psychiatric drugs. We aim to contribute to a new evidence base; one which is more concerned with the lived experience of recovery and things that help people stay well.

During the spring of 2005 the Scottish Recovery Network (SRN) conducted 67 interviews with individuals in towns and cities across Scotland about their recovery experience. Click here for more on the research project.

'Babble test' predicts onset of schizophrenia-spectrum disorders

Source: Reuters Health
Author: Karla Gale
Date: 5 November 2007

In patients with prodromal symptoms of psychosis, extracting spurious phrases from garbled, incomprehensible voices indicates that they are at risk of developing frank schizophrenia-spectrum disorders, according to results of a multicenter study.

In previous research, "we noticed that more extended babble-induced speech illusions were elicited among patients whose illness was recent onset, compared to normal subjects and patients with established, long-standing schizophrenia," Dr. Ralph Hoffman told Reuters Health.

"We subsequently wondered if babble-induced speech illusions might also be a predictor of those high-risk patients who actually go on to develop schizophrenia," he added.

During the 'babble task,' participants listen with headphones to overlapping recordings of six speakers reading neutral texts, the investigators explain in the October issue of the British Journal of Psychiatry. Patients are instructed to repeat words or phrases they believe they hear while listening to the babble, and the number of words is recorded as the length of speech illusion (LSI) score.

Dr. Hoffman, at Yale University in New Haven, Connecticut, and associates tested their theory in a cohort of subjects with prodromal symptoms. Forty-three subjects were tested in the absence of antipsychotic medication, and a subset of the subjects were also tested during treatment with olanzapine for a year.

Twelve converted to a schizophrenia-spectrum disorder.

In the 'no medication state,' the LSI score was significantly associated with subsequent conversion (hazard ratio, 1.78, p = 0.0011). With an LSI cutoff of 4 or above, the positive predictive value was 0.80 and negative predictive value was 0.94 (p = 0.0001).

Dr. Hoffman was careful to preclude any possible clinical recommendations until after their findings are independently replicated. Still, he said, "a test that was established to be predictive at the high rate we found ... could be enormously beneficial."

Data from their preliminary study "suggest that high LSI scores in persons with prodromal symptoms would be an indication to start antipsychotic medication," Dr. Hoffman said. "In contrast, individuals with low LSI scores appear to be at much lower risk," and would not require medication.

Currently, research is dominated by expensive and complex procedures, such as brain scans and neuropsychological testing, he pointed out. "However, I believe that a very careful probing of the positive symptoms of schizophrenia could provide some simple methods for detecting underlying brain changes in their early phase, which could afford a great opportunity to shut down these (psychologically) malignant processes before they take hold."

Austin Mardon on Schizophrenia

From Schizophrenia Daily News Blog (November 9th):

Recently we covered the award (the Order of Canada) Austin Mardon, a schizophrenia advocate and sufferer, received for, among other things, his work on improving the treatment of people who have schizophrenia. [Read About Him Receiving the Honor Here.] But what we haven't yet covered is the personal perspective Austin Mardon has on his illness and what it is that motivated him to follow the path of advocacy. Below we quote Mardon and summarize his remarkable, bold perspective on living with schizophrenia:

Mardon is an academic, author, researcher and a man who suffers from the debilitating psychiatric disorder known as schizophrenia. Despite dealing with stigma for most of his life, his story is one of triumph, which his recent honor of being awarded the Order of Canada proves. Mardon has experiences with schizophrenia from even before his own development with the illness. At age five he witnessed the diagnosis of his mother with schizophrenia. He experienced then what he continues to experience now, his mother's sometimes denial of the illness she suffers from. Perhaps partially because of her denial, Mardon insists on the importance of acceptance, stating that a lack of acceptance and insight into the illness make his peer sufferers vulnerable to repeated hospitalizations.

Mardon says this of acceptance:

"Acceptance is a fundamental ideal of many of the world's ancient philosophies and religions and can be a powerful tool. When you accept your destiny, a peace can descend on your existence. I have had to accept the limitations of my reality and work within those limitations to, as my wife says, be as happy and as healthy as I am capable of being. It might not be the life that I dreamed of, or that society or my family expected, but it has become so very fulfilling."

Mardon states further the importance of compliance with medications, saying that he remains compliant because he understands the importance of medications and the stability they provide. Yet, he doesn't deny their often unpleasant side effects. He says that the last batch of medicines he was on made him sleep 12 to 14 hours a day, and even when awake, he was in an extremely drowsy state which he attempted to deal with by drinking a lot of coffee. But he's recently switched to new medicines that give him more awake time during which he's actually "awake".

Austin Mardon's Take on Stigma

Mardon says the stigma and prejudice he experiences because of his illness are severe and that too often, when as an academic he's co-authoring papers, his fellow co-authors cut-off communication with him because they discover he has schizophrenia. Such instances make it difficult for him to be so open about his illness. But he says he feels like he owes it to his fellow sufferers to spread knowledge of schizophrenia. He says that for every negative story he reads about schizophrenia or mental illness, he wants a positive story.

The assumption from most people that his wife must also have schizophrenia (because she's married to him) is just another form of stigma they both face. His wife sees symptoms of his illness as separate from his identity and this is the message she spreads on her talks about being the wife of a schizophrenic: Symptoms of the illness should be separated "from the core of the person," she says.

Austin Mardon on His Reasons for Becoming a Schizophrenia Advocate and Methods of Dealing With Symptoms of His Illness

"My attitude is that people think that if they don't have a nice house or nice things they're not well respected, they're not worthwhile, but I don't care about that stuff. What I really care about is trying to make a contribution in some small way to society. You don't get paid for that, but my attitude in life is not defined by money..." This approach, along with the aid of medication, are what enabled him to live a "somewhat normal" life, he says "I still have the symptoms, but they're well under control, and I try to live a stress-less life. I live a very simple life."...While he experiences periods of paranoia, anxiety and fear, Mardon says he's "learned some techniques to adapt to that." He has also learned how to ignore the voices in his head, and knows how to resist the "lure" of hallucination. "The voices are kind of random, they're sometimes male voices, sometimes female voices…sometimes they make sense. It's like a conversation inside your head, but I've learned to disregard the voices, it's like white noise now, I just ignore them completely."

United Nations Expert on Adequate Housing Calls for Immediate Attention to Tackle National Housing Crisis in Canada

United Nations Press Release

The Special Rapporteur on adequate housing as a component of the right to an adequate standard of living, Miloon Kothari, issued the following statement today:

Geneva, 1 November 2007

From 9 to 22 October 2007, the Special Rapporteur on adequate housing as a component of the right to an adequate standard of living, Mr. Miloon Kothari, conducted a mission to Canada to examine the status of realization of the right to adequate housing, particularly focusing on homelessness, women and their right to adequate housing, Aboriginal populations' adequate housing and affordability and speculation of land and property including the possible impact of the 2010 Olympic Games on the right to adequate housing in Vancouver.

During the course of the mission, the Special Rapporteur visited urban and rural areas, including Montréal, Kahnawake territories, Edmonton, Little Buffalo and Lubicon, Vancouver, Musqueam territories, Toronto and Ottawa. In these locations, the Special Rapporteur met with high-ranking officials, representatives of various Government agencies, community-based housing and homelessness service providers, housing agencies, representatives of Aboriginal peoples and civil society organizations. He also heard testimonies from many women, men, youth and children across the country that were homeless or living in adequate and insecure housing, and participated in large public forums and hearings. On the last day of his mission, the Special Rapporteur shared his preliminary observations with the Canadian authorities.

General observations

During his mission, the Special Rapporteur heard testimonies and received voluminous reports from independent bodies, about the persistence of homelessness, substandard and inadequate housing and living conditions, an aging housing stock in both the public and private sectors, grossly inadequate housing and civic services, including potable water, conditions for Aboriginal people's on and off reserves, health concerns, inadequate heating systems, and high energy costs.

In its most recent periodic review of Canada's compliance with the International Covenant on Economic, Social and Cultural Rights, the United Nations Committee on Economic, Social and Cultural Rights characterized the state of homelessness and inadequate housing as a "national emergency." (1)

The Special Rapporteur confirms the deep and devastating impact of this national crisis on the lives of women, youth, children and men, including a large number of deaths (2). The Special Rapporteur also noted as a cause of this national crisis the lack of a properly funded national poverty reduction strategy.

Homelessness

Homelessness is one of the most visible and most severe signs of the lack of respect for the right to adequate housing, which is even more shocking to see in a developed and wealthy country as Canada. The Special Rapporteur was disappointed that the Government of Canada could not provide reliable statistics on the number of homeless in the country. While the National Homelessness Secretariat has suggested that there might be 150,000 homeless people, experts and academic institutions have suggested that the actual number of homeless people may be at least double that amount.

The large number of people in Canada living in poverty, the growing number of food banks, and studies show that the number of people that cannot afford housing or sustain their rent is increasing, resulting in an increase number of homeless. One major cause of growing homelessness is the high cost of rents and the overall decline in renter household incomes in recent years. In addition to the high number of people who are homeless the Canada Mortgage and Housing Corporation also notes that 1.5 million Canadian households are officially classified as being in 'housing core need' which outs them at great risk of homelessness.

Affordability

The increase of housing prices and the lack of affordability is growing in all sectors of the population. The Special Rapporteur observed how due to the shortage of social housing stock, the original target population has changed and programmes are distorted, needing to meet the necessities of a growing and more diverse population than originally assessed.

Canada lacks a national poverty reduction strategy, and only a handful of provinces have implemented provincial poverty reduction plans.

Grossly inadequate social assistance rates are trapping many of the lowest-income Canadian households into chronic poverty and inadequate housing. The Federal Government made major cuts to social spending, and cancelled the Canada Assistance Plan in 1995 (CAP provided a framework of national standards for income assistance) and virtually every province has allowed income assistance levels to drop to extremely low levels since then.

Women's right to adequate housing

The lack of adequate and secure housing particularly impacts women who are disproportionally affected by the homelessness, the issue of affordability, violence and discrimination in the private housing rental market. During the visit, the Special Rapporteur heard dozens of testimonies of women including on the insufficiency of social assistance entitlements that do not match the cost of housing and other living expenses or about children being taken away from their mothers because they were living in inadequate housing, an issue that particularly affects Aboriginal women (3).

Amongst the many forms of violence that aboriginal women suffer, studies show that they endure three times higher rate of spousal violence than non-Aboriginal. In this context, the lack of protection law for women living on a reserve, or the impossibility to file complaints to the Canadian Human Rights Commission constitutes one of the greatest barriers to the enjoyment the right to housing and a life free of violence. Another major barrier that needs to be overcome at the earliest is the family and matrimonial real property laws on reserves. Overcrowding houses, accommodating up to 3 generations in some regions, is one of the major causes for abuse, violence and homelessness. Women and young girls off reserve are experiencing violence in a daily basis.

Aboriginal peoples right to adequate housing

Throughout his mission, the Special Rapporteur was disturbed to see the devastating impact of the paternalism that marks federal and provincial government, legislations, policies and budgetary allocation for Aboriginal people on and off reserve. These policies have seriously compromised the right to self determination that Aboriginal people enjoy under the original treaties and the International human rights instruments and deeply affected their housing and living conditions (4).

Overcrowded and inadequate housing conditions, as well as difficulties to access basic services, including water and sanitation, are major problems for Aboriginal peoples (5). For instance, during his visit to the Lubicon Lake Nation, the Special Rapporteur could witness how families still live without access to potable water and sanitation and appalling living conditions. He also noted the destructive impact of oil extraction activities that continues to lead to the loss of lands and the asphyxiation of livelihoods and traditional practices.

Preparation of the Olympics in Vancouver

In his mandate, the Special Rapporteur has looked at the negative impact on housing in cities that host mega-events, such as the Olympics, the FIFA World Cup, and the Commonwealth Games. These impacts include forced evictions for construction of infrastructures, city beautification and speculation of land and property and measures to remove homeless people from cities prior to and during the event. In Vancouver, the Special Rapporteur also looked into the potential impact of 2010 Olympic Games on the right to housing of low income people.

Vancouver has been an innovative city, incorporating in their bid the Inner-City Inclusive Commitment Statement, developed by a representatives from a variety of inner-city community organizations and government agencies, which seek amongst its main objectives to address issues related to housing, civil liberties and public safety, health and social services, environment, transportation, accessible and affordable Games. The bid also included a sustainability plan aiming at guaranteeing that the social, economic and environmental impacts and opportunities of the event produce lasting benefits, locally and globally.

The Special Rapporteur is of the view that the resources generated by such an event should be used to improve adverse housing situation in Vancouver. The Special Rapporteur met with the CEO of VANOC who expressed his commitment to ensure that the games would contribute to improve housing conditions of the poor in Vancouver as a positive legacy.

Good practices

Canada has a long and proud history of housing successes, and has been known around the world for its innovative housing solutions especially for its non-aboriginal population. During this mission, the Special Rapporteur visited and received information about a number of programmes, laws and policies addressed at housing that are good practices, including Centers and shelters accommodating homeless people, women fleeing from violence, aboriginal women, HIV-AIDS positive people, children with disabilities, and people suffering from drug addictions. All of these Centers were fully or partially funded by the various programmes of the State.

But the funding support is irregular, groups are often required to rely on voluntary contributions and voluntary labour, and the process of sustaining non-government organizations is occupying a greater amount of time and resources.

Preliminary recommendations

At the end of his mission, the Special Rapporteur made a number of preliminary recommendations to the Canadian authorities including the following:

The Federal Government needs to commit stable and long-term funding and programmes to realize a comprehensive national housing strategy, and to co-ordinate actions among the provinces and territories, to meet Canada's housing rights obligations. The Special Rapporteur also noted that Canada needs to once again embark on a large scale building of social housing units across the country.

As part of a comprehensive national housing strategy, particular funding should be directed to groups that have been forced to the margins, including women, Aboriginal people, elders, youth, members of racialized communities, immigrants and groups with special needs. There should be a national adoption of the housing continuum concept including a plan to make available various forms of housing including transitional and supportive housing.

The Government and Parliament of Canada, along with the provinces and municipalities, are urged to take immediate steps to comply with concluding observations from United Nations treaty bodies including the Committee on Economic Social and Cultural Rights. Economic, social and cultural rights should be fully recognized in all relevant government legislation and should be fully justifiable including monitoring, implementing, investigative and accountability mechanisms.

The Federal Government needs a comprehensive and properly-funded poverty reduction strategy based on its human rights obligation. Complementary plans should be implemented in the provinces and territories that are linked to a comprehensive national housing strategy.

The Federal Government should commit the funding and resources to ensure all households have access to potable water and proper sanitation consistent with the recognition of water as a human rights and recommendations for State policies as detailed in General Comment Number 15 of the CESCR.

Canada should implement measures to address urgent, short term and long term needs of women in the country. Immediate implementation at all levels of the government of the recommendations from the United Nations treaty bodies on these specific measures, would eliminate the various barriers that women face both in urban and rural context in their daily life.

The Federal Government needs to commit funding and resources for a targeted national Aboriginal housing strategy – both on- and off-reserve – that ensures that Aboriginal housing and services are under Aboriginal control.

In line with treaty body recommendations, the Special Rapporteur calls for a moratorium on all oil and extractive activities in the Lubicon region until a settlement is reached with Lubicon Lake Nation. The Federal Government should resume negotiation with the Lubicon Lake consistent to the Human Rights Law instruments including the Declaration on the rights of indigenous peoples.

Vancouver Olympic officials, and the relevant city authorities, need to continue to implement specific targets and strategies on housing and homelessness, and to commit funding and other resources to support these targets, including the construction of 3,200 units of affordable housing (6). The social development plan of the Vancouver Games should be developed and implemented in public, so that the progress of Vancouver officials can be effectively monitored. The Special Rapporteur would recommend the formation of an independent monitoring body to assist VANOC in complying with its commitments to improve the housing rights situation in the region where the Olympics will take place.

Notes

1. Concluding observations of the Committee on Economic, Social and Cultural Rights, Canada (E/C.12/CAN/CO/4, E/C.12/CAN/CO/5), para. 62.
2. As far back as 1999, the United Nations Human Rights Committee after reviewing Canada's State report expressed concern that "... homelessness has led to serious health problems and even to death. The Committee recommends that the State Party takes positives measures to address this serious problem ...."
3. These testimonies matched other testimonies received by the Special Rapporteur in other occasions. See for instance the Women and Housing reports of the Special Rapporteur available by clicking here.
4. The United Nations Human Rights Committee review in 2006 referred to this phenomenon of having the potential to lead to "… extinguishment of inherent aboriginal rights …."
5. Report on the Mission to Canada of the Special Rapporteur on the situation of human rights and fundamental freedoms of indigenous peoples. E/CN.4/2005/88/Add.3.
6. Click here.
   

For a related post on this blog, click here.

Science, serotonin, and sadness: the biology of antidepressants

A series for the public

By Sylvia Wrobel

An interesting overview, written in layperson terms, of the discovery of psychiatric medications, including early drugs for the treatment of schizophrenia.

For the complete article, click here (downloads a PDF).

Housing and Disability

Disability Rights Coalition – Nova Scotia

On October 19, 2007, the Disability Rights Coalition - Nova Scotia made a submission to Miloon Kothari (pictured), United Nations Special Rapporteur on Adequate Housing, .

To read the submission click here.

For more information on the Disability Rights Coalition - Nova Scotia, click here.

Actress Victoria Maxwell Speaks with DBSA

Actress and playwright, Victoria Maxwell, speaks with the Depression and Bipolar Disorder Alliance's Maria Heim about her role as a mental health educator. Maxwell talks about her diagnosis and how she has learned to use humor as a wellness tool.

Click here to access the audio.



And here is Victoria in action:



Click on the arrow to start the video.

Trudeau discusses living with a mental illness

An article published in the November 2nd edition of the Halifax Chronicle Herald. To read the article, click here.

The article notes that "about 3,496 mental health assessments were done in the Cape Breton district health authority’s jurisdiction between April 2006 and March 2007. About 677 people were hospitalized for treatment of mental illness."

Mental Health Literacy in Canada

Phase One Report

Mental Health Literacy Project

May 2007

For a PDF of this report, click here.

Executive Summary:

Canadian Alliance on Mental Illness and Mental Health (CAMIMH)

CAMIMH was established in 1998 and serves as the only national coalition representing the mental health sector across the continuum of non-governmental stakeholders. The core purpose of CAMIMH is to put mental illness and mental health on the national health and social policy agendas. CAMIMH has been highly effective in forging collaborative national leadership on mental illness and mental health policy through four pillars of public education, research, data collection and reporting, and policy frameworks.

[Note: The Schizophrenia Society of Canada is a member of CAMIMH]

Mental Health Literacy Project
Mental health literacy has been defined as the knowledge, beliefs and abilities that enable the recognition, management or prevention of mental health problems. Enhanced mental health literacy appears to confer a range of benefits: prevention, early recognition and intervention, and reduction of stigma associated with mental illness. The Mental Health Literacy (MHL) project is the first of its kind in Canada, funded by Health Canada under the Population Health Fund (PHFN) as a response to the Chronic Disease - Integrated Approaches to Chronic Disease funding priority. It is a three-year project, which commenced in the fall of 2005. The report represents the conclusion of the first phase of the MHL project, which included a review of existing data, a national survey on MHL and follow-up focus group discussions. The next steps in the project involve sharing project findings and engaging with prospective partners across sectors and developing an Integrated National Strategy for Canada on Mental Health Literacy.

Data Sources and Areas of Investigation
Data sources for the MHL project included an extensive review of the research literature pertaining to mental health literacy, preliminary focus group discussions with Canadian seniors and youth, a national survey of Canadians and an Aboriginal survey, and followup focus group discussions across Canada. The sample sizes were not large and the focus groups may not have been representative of all Canadians however, in the opinion of the authors, triangulation of results lends credibility to the project findings. For the most part, the results from the surveys and focus groups are mutually confirming and consistent with research findings from the literature review.

Section two of the report includes summaries of the results of each of these investigations and implications for enhancing mental health literacy. The knowledge domains reviewed include prevalence, recognition, perceived causes, attitudes about interventions and recovery, conceptions of mental illness, stigmatizing attitudes and perceptions of dangerousness, beliefs about protecting and promoting mental health, and perceived linkages between mental and physical health.

Section three of the report provides an overview of an integrated model for enhancing mental health literacy, possible strategies and next steps.

KEY FINDINGS

Perceived Prevalence and Recognition of Mental Disorders
Canadians appear to have reasonably good MHL regarding prevalence, awareness of warning signs, and ability to identify a mental disorder as such. These capacities would likely enhance the ability to identify a mental health problem and to intervene early. There is room for some improvement of general knowledge of mental health problems: many people underestimate the prevalence of mental disorders and many, especially youth, confuse other types of disorders with mental disorders.

Perceived Causes
Like people in other countries, Canadians are inclined to prefer psychosocial explanations for mental health problems, although they are more apt to identify biomedical causes for serious mental illness. It is debatable to what extent these tendencies represent an area for intervention. There is strong evidence for psychosocial causal influences especially prolonged stress, for common mental disorders. In addition, biomedical, particularly genetic, explanations can increase stigma and reduce optimism about recovery.

Attitudes about Treatment and Recovery
Compared to those studied in other research, Canadians are more inclined to recommend medical help for symptoms of mental disorders. However, they are still somewhat ambivalent about medical care, especially for common mental health problems and with regard to psychiatric medications, as found in other studies. Focus group results show that many people would like access to a range of treatment options, but many have a poor understanding of the different options available.

Canadians are generally optimistic about the prospect of recovery from mental disorders, but more so for common mental health problems compared to serious disorders.

Conceptions of Mental Illness, Stigma and Perceptions of Dangerousness
Stigma and discrimination toward persons with mental disorders remain somewhat problematic in Canada, although more so for serious mental illness. Canadians know that stigma and discrimination towards mental disorders exist, and they exhibit some reluctance about disclosing mental health problems especially in the workplace, for fear of stigma and discrimination.

Public education about mental disorders may help to reduce stigma. Because Canadians prefer to maintain a distinction between common mental health problems and serious disorders, targeted anti-stigma campaigns may be most effective. For less serious mental disorders, initiatives that emphasize the commonness of mental health problems appear to be helpful. As fear of stigma can deter treatment seeking, access to self-help interventions represents a promising practice. Workplace initiatives are needed to manage people’s concerns about disclosing mental health problems at work. Community development and self-help initiatives including training in communication and advocacy, would support mutual empowerment for social action to reduce stigma, end discriminatory practices, and improve services.

Beliefs about Protecting/Promoting Mental Health
Canadians appear to have good knowledge of prevention strategies and many of the strategies they recommended such as social support, physical exercise and stress reduction, are indeed protective factors. The focus group participants who attributed mental illness to genetic causes expressed more pessimism about prevention; this finding calls for careful construction of key messages for educational initiatives.

Perceived Linkages between Mental and Physical Health
Canadians show a good intuitive understanding of the mind/body connection. A significant body of research investigating how the relationship works has emerged in recent years, and people could benefit from this information, to protect their mental and physical health. Raising public awareness about the connections between stress, depression and chronic disease represents a good opportunity for intersectoral collaboration, which is itself integral to effective health promotion.

TOWARDS A NATIONAL STRATEGY FOR MENTAL HEALTH LITERACY

Assessing the degree of mental health literacy in a population depends on how mental health literacy is defined. The existing definition of mental health literacy, knowledge and beliefs about mental disorders that aid their recognition, management or prevention, does not specify which knowledge and beliefs represent good mental health literacy. There is a tendency among professionals to assume the mental health literacy of the public will increase as it comes into alignment with professional thinking and an expectation that this will result in stigma reduction, improvements in help seeking and better treatment outcomes. However, there are limitations and risks to this approach.

Mental health literacy could be more broadly defined as the range of cognitive and social skills and capacities that support mental heath promotion. This includes the capacity to act on social as well as individual determinants of mental health and mental illness. An expanded definition could serve as the basis for a comprehensive, population health model for enhancing mental health literacy, at all levels.

The next stage of this project will be to share project findings with prospective partners across sectors, including existing health prevention/promotion coalitions and alliances, the media, youth, seniors, health care providers, the private sector, other NGOs. Consultations will focus what the findings mean to prospective partners, the potential benefits of an integrated approach, identification of barriers, solutions and proposed contributions to a integrated plan to enhance mental health literacy in Canada.

Click on the image to enlarge it.

Cartoon courtesy of Merinda Epstein.

Canvas: New York Times Movie Review

Illness Rends One Mind, Three Hearts

To read the movie review, click here.

Devon Gearhart in Joseph Greco’s drama “Canvas.”

Photograph courtesy of SCREEN MEDIA FILMS.

For other news stories related to the movie, click here, here, and here.

Involuntary Psychiatric Treatment Act

The Involuntary Psychiatric Treatment Act came into effect on Tuesday, July 3rd, 2007.

Fact sheets and links to other important information on the Involuntary Psychiatric Treatment Act are available from the Nova Scotia Department of Health. To view, click here.


I have serious concerns about the accuracy of some of the Nova Scotia Department of Health Fact Sheets, as well as the accuracy of the webpage itself.

For example, the criteria for involuntary admission are, in fact:

Section 17
Where a psychiatrist has conducted an involuntary psychiatric assessment and is of the opinion that

(a) the person has a mental disorder;

(b) the person is in need of the psychiatric treatment provided in a psychiatric facility;

(c) the person, as a result of the mental disorder,

(i) is threatening or attempting to cause serious harm to himself or herself or has recently done so, has recently caused serious harm to himself or herself, is seriously harming or is threatening serious harm towards another person or has recently done so, or

(ii) is likely to suffer serious physical impairment or serious mental deterioration, or both;

(d) the person requires psychiatric treatment in a psychiatric facility and is not suitable for inpatient admission as a voluntary patient; and

(e) as a result of the mental disorder, the person does not have the capacity to make admission and treatment decisions,

the psychiatrist may admit the person as an involuntary patient by completing and filing with the chief executive officer a declaration of involuntary admission in the form prescribed by the regulations.

Maternal Effects on Schizophrenia Risk: Placental Status

Local environmental factors impinging on the fetal brain can tip the balance toward mental illness.

From the October 26th, 2007 edition of Science (Vol. 318. no. 5850, pp. 576-577:

By Paul H. Patterson, Division of Biology, California Institute of Technology, Pasadena, CA 91125, USA. E-mail: php@caltech.edu

Understandably, there is great enthusiasm surrounding the search for candidate genes that increase the risk for devastating mental disorders such as schizophrenia. Progress is being made on several fronts, such as identifying genes that regulate potential molecular pathways underlying brain development. Genetic variants are also being associated with brain functions during particular cognitive tasks. What is equally important, though, and at risk of being lost in this gene fervor, is a balanced view of the variety of risk factors for mental illness. Many mental disorders are now referred to as "genetic diseases" as if they were autosomal dominant, like Huntington's disease, in which inheriting a genetic mutation causes the disorder in every person. In the case of schizophrenia, recent epidemiological and animal studies are taking understanding of environmental influences to the molecular level.

Much of the emphasis on the genetics of schizophrenia comes from twin studies, where the incidence of the disorder in genetically identical (monozygotic) twins is 50%. This 50% concordance leaves considerable room for nongenetic influences. However, even that figure may be an overestimate of the role of genetic influence (1). Several lines of evidence point to a key role for maternal environment.

Not widely appreciated in deducing the importance of genes from twin studies is the fact that two-thirds of monozygotic twins share a placenta, which is a key environmental factor. Individual placentas vary with respect to the transport of various nutrients and hormones (2), which affects normal development. Interestingly, X-chromosome inactivation is affected by placental status (3) and, in the largest study of its kind, so is IQ (4). It is therefore possible that the placental environment can influence the expression of genes that are linked to neurodevelopment and schizophrenia. Moreover, indirect evidence suggests that monozygotic twins sharing a placenta have a higher concordance for schizophrenia than monozygotic twins with separate placentas (5, 6). It would be extremely informative to directly assess placental status in twin studies of schizophrenia, and there are twin registries where this could be done (7).

Placental status could also influence fetal responses to infectious agents in the mother. For instance, twins sharing a placenta are bathed in the identical blood supply of cytokines that are induced by maternal infection. Moreover, sharing a placenta increases the risk for infection in twins (8). Birth in winter or spring months, when respiratory infections are frequent, is a well-established risk factor for schizophrenia, and most ecological studies of influenza report an increased incidence among offspring born to mothers who were in the second trimester of pregnancy during an epidemic (9). Most importantly, a recent prospective study found that maternal respiratory infection increases the risk for schizophrenia in the offspring three-to sevenfold. Because of the high prevalence of influenza infection, Brown et al. estimate that 14 to 21% of schizophrenia cases would have been prevented if maternal infection had not occurred (9). Moreover, there is an association between elevated concentrations of cytokines or antibodies to influenza antigens in maternal serum and the incidence of schizophrenia in offspring (9). Maternal infection may also play a role in the pathogenesis of autism (10), although more epidemiology is needed here. Such links are remarkable, considering that elevated risk may only be in genetically susceptible individuals. If so, the risk associated with maternal infection in that subgroup would be considerably greater than three-to sevenfold.

The maternal environment. Alterations in fetal brain development, and their associated behavioral changes, have been linked to the placental environment in human and animal studies.

Although epidemiological studies cannot establish causality, recent work with animals provides experimental evidence that maternal respiratory infection can influence the physiology, behavior, and neuropathology of adult offspring. For instance, maternal influenza infection in rodents causes abnormal behaviors in adult offspring that are consistent with those seen in schizophrenia and autism. These include deficits in social interaction, working memory, prepulse inhibition, and latent inhibition. The latter deficits display postpubertal onset and are normalized by antipsychotic drug treatment. Maternal infection in rodents is also associated with elevated anxiety and neuropathology in offspring that is consistent with that observed in schizophrenia (11, 12).

Changes in the behavior and neuropathology of the rodent offspring are also elicited by injection of synthetic double-stranded RNA into the mother, which evokes an antiviral-like inflammatory response (12-14). Molecular manipulation in this model shows that behavior of the adult offspring results from the balance of pro-versus anti-inflammatory cytokines produced by the mother. That is, blocking pro-inflammatory interleukin-6 or increasing the concentration of anti-inflammatory interleukin-10 strongly attenuates the effects of maternal immune activation on fetal brain development (15, 16). Similar findings have been reported for a model in which maternal bacterial infection is mimicked in rodents by injection of lipopolysaccharide, an immunogenic bacterial component (17).

Although a genetic element clearly contributes to schizophrenia and other mental disorders, the maternal-fetal environment must also be taken into account. Environment can alter genetic outcomes and vice versa, and future research must both tease the two influences apart and consider them together to better understand the onset, progression, and treatment of mental disorders.

References

1. E.F. Torrey, Schizophr. Bull. 18, 159 (1992).
2. B.C. Ryan, J.G. Vandenbergh, Neurosci. Biobehav. Rev. 26, 665 (2002).
3. J. Monteiro et al., Am. J. Hum. Genet. 63, 339 (1998).
4. N. Jacobs et al., Behav. Genet. 31, 209 (2001).
5. J.O. Davis, J.A. Phelps, H.S. Bracha, Schizophr. Bull. 21, 357 (1995).
6. A. Rosa et al., Schizophr. Bull. 28, 697 (2006).
7. C.A. Derom et al., Twin Res. Hum. Gen. 9, 733 (2006).
8. D. T. Phung et al., Am. J. Obstet. Gynecol. 186, 1041 (2002).
9. A.S. Brown, Schizophr. Bull. 32, 200 (2006).
10. S.L. Hyman, T.L. Arndt, P.M. Rodier, Int. Rev. Res. Ment. Retard. 30, 171 (2006).
11. S.H. Fatemi et al., Cell. Mol. Neurobiol. 22, 25 (2002).
12. L. Shi, S.H. Fatemi, R.W. Sidwell, P.H. Patterson, J. Neurosci. 23, 297 (2003).
13. L. Zuckerman, M. Rehavi, R. Nachman, I. Weiner, Neuropsychopharmacology 28, 1778 (2003).
14. U. Meyer, B.K. Yee, J. Feldon, Neuroscientist 13, 241 (2007).
15. S. E. P. Smith, J. Li, K. Garbett, K. Mirnics, P. H. Patterson, J. Neurosci. 27, 10695 (2007).
16. U. Meyer et al., Mol. Psychiatry, 10.1038/sj.mp.4002042 (2007).
17. S.A. Robertson, R.J. Skinner, A.S. Care, J. Immunol. 177, 4888 (2006).

Correlates and Long-Term Consequences of Poor Insight in Patients With Schizophrenia. A Systematic Review

The abstract of an article published by Tania M. Lincoln, Eva Lüllmann and Winfried Rief in the November 2007 edition of Schizophrenia Digest:

Between 50 and 80% of the patients diagnosed with schizophrenia have been shown to be partially or totally lacking insight into the presence of their mental disorder. Although a causal chain connecting poor insight with poor treatment adherence and thus with poorer outcome and functioning is straight forward, numerous studies investigating correlates and long-term impact of insight have provided differing results. In addition, higher levels of insight in schizophrenia have been associated with depression and hopelessness, but the causal direction of the relationship is unclear and the data are inconclusive.

The current study provides a critical review of 88 studies on the assessment of insight and its impact on symptoms and functioning. Studies published by June 2006 were selected using a keyword search for English peer-reviewed articles in the databases PsycINFO and MEDLINE.

The majority of studies support the assumption that insight is associated with adherence during treatment phase, but the association with long-term adherence remains unclear. Insight correlates with better long-term functioning, but this might be explained by its association with symptoms. There is a positive cross-sectional and longitudinal relationship between insight and depression, but the underlying processes need further clarification.

In the concluding discussion, the problems relating to definition and study designs are considered responsible for many of the inconclusive findings. Suggestions for further research are derived.

Reference:
Schizophrenia Bulletin 2007 33(6):1324-1342; doi:10.1093/schbul/sbm002

The cover art (above, right) on the November 2007 issue of Schizophrenia Digest is entitled Another Face by an anonymous author. “Many times, I draw faces as a way to tell of my feelings about being so separated from myself and others. I am confused how to find my way back.”