Wednesday, November 19, 2014

Hearing Voices at 20? A New Look at How and When Schizophrenia Starts

That is the title of this article I am writing about. “PHILADELPHIA The traditional view was that schizophrenia, the most devastating of mental illnesses, struck young people on the cusp of adulthood, often without much warning.  In their late teens or early 20s, previously healthy men and women would suddenly begin hearing voices no one else could hear and withdrawing from a world teeming with delusional threats. They faced a lifetime of disability even with strong medication and —in a country without adequate care —of increased risk of homelessness, suicide and prison.  Raquel Gur, a University of Pennsylvania neuropsychiatrist and nationally known expert on schizophrenia, is at the forefront of the new way of thinking about the disorder, which affects 1 percent of the population.  Scientists now view it as a neurodevelopmental condition that begins years before its most disturbing symptoms appear, in much the same way that heart disease begins long before the first heart attack.  Gur's painstaking work, done with the help of 9,500 Philadelphia children and their families, finds that those at risk for psychosis diverge from their peers in important ways as early as age 8. The differences in brain functioning —these are thinking skills, not psychosis —widen in the mid-teens.” I believe it starts at a younger age before you develop full blown psychosis.  Even though mine did not come on until I was twenty seven something was wrong when I was nineteen.
The article goes on to say: “The tantalizing question is whether early identification and treatment can delay or prevent the onset of psychosis, allowing young sufferers time to build a firmer foundation for life.  It's early, but there is some evidence that the answer is yes.  Schizophrenia experts are excited by promising results for cognitive behavioral therapy and, surprisingly, fish oil.  Work on the first stages of schizophrenia —what is often called the prodrome —is unfolding at a time when scientists are learning the brain is a far more dynamic organ than was once thought. True, the brains of people with schizophrenia do not look or function normally, but all of our brains are changing more than we realize. ‘Most people have gotten far more hopeful that we will be able to use experience or training or something else to help the brain rewire," said Thomas Insel, director of the National Institute of Mental Health (NIMH).  He sees hope in teaching people with schizophrenia how to focus and control their thoughts. Lack of cognitive control, he said, "is the on-ramp to psychosis.’  Gur's work, undertaken with $26 million in NIMH funding since 2009 and help from Children's Hospital of Philadelphia, is an ambitious effort that is following children over time to see how psychotic illnesses unfold. Four percent of the teenagers had symptoms of psychosis. The rates were higher for 8- to 10-year-olds, but Gur chalks some of that up to "vivid imagination." Because of funding constraints, Gur's team is closely following only 250 at-risk children and 250 who are normal. The researchers are analyzing genes and brain images, family history, neighborhood environment, and early life experiences as well as measures of perceptual and cognitive abilities and emotion processing. While much previous research has focused on positive symptoms —hallucinations and delusions —in schizophrenia, there is growing recognition that negative symptoms —problems with working memory, advanced decision-making and social skills —are equally disabling.”  I’ve read that they are using fish oil with some good results before you develop mental illness. I take it although for my eyes.  I really do not notice anything different mentally.  Although my Geodon works so well I would not know the difference. 
The article ends: “Gur's husband, Ruben, a brain/behavior expert at Penn who collaborates with her, will soon start testing the theory that acting may help at-risk youths recognize and express emotions better. Raquel Gur will test cognitive retraining as a therapy. That program will focus on improving attention, working memory (the ability to hold thoughts in your head while working with them) and problem-solving. Gur hopes for results within a year. Like other experts, she thinks early intervention will be better for schizophrenia, as it is for so many other diseases. ‘If you want somebody to continue on a fairly normal trajectory of development,’ she said, ‘you need to capture them before they fall off the track so much that it's difficult to bring them back.’  If schizophrenia strikes before victims have grown up, it's hard for them to catch up later. ‘They're not equipped to become adults,’ she said.  William Carpenter, a well-known schizophrenia researcher at the University of Maryland, says that, even if early treatment only delays the worst symptoms, it has to be better to have more time to develop life skills and relationships. Those make it easier to cope.  ‘If you have to become psychotic,’ he said, ‘it's a whole lot better to do it after you've finished school and got a job and got married.’  Carpenter chaired the American Psychiatric Association committee that decided not to list ‘attenuated psychosis syndrome,’ a term for people with psychotic like symptoms that are not strong enough to meet the definition of schizophrenia, in the official list of psychiatric disorders last year. The group questioned whether most therapists could identify the condition properly. There were also worries about stigmatizing young people and exposing them to antipsychotic medications, which don't work in this group.  And, there was the problem of false positives. Only about 30 percent of people who get what Carpenter called the "placeholder diagnosis" progress to having psychosis within two years. In Gur's sample, about half the children who had psychotic symptoms at intake still had persistent or worsening symptoms two years later. Among those who at first seemed normal, 17 percent later developed sub-psychotic or psychotic symptoms. One of the things she's learning is that a surprising number of children have perceptual problems that go away or don't become severe.  Her study could help define who is most likely to become schizophrenic as well as factors common in those who are most resilient. ‘It will become a national resource,’ she said. What she knows already is that the children most likely to have serious problems are different from an early age. If you look back at family pictures taken at 7 or 8, these are kids who are always at the corner, looking down. They often start to experience more serious interpersonal problems, perception changes and heightened anxiety two to three years before they have a ‘break’ or become actively psychotic. ‘It's not overnight,’ she said. ‘It's insidious.’ The Philadelphia Inquirer” I believe early intervention would be good if a person could just help these young people live the best lives’ that they can.  I have always been quiet person I do not know how that fits into my mental illness although I believe it does.  My only problem now is that my concentration is not the best.  If I could fix that I would be ok.

Monday, November 17, 2014

New Hope for Patients with Treatment-Resistant Schizophrenia

That is the title of this article I am writing about. “Researchers at Northwestern University Feinberg School of Medicine have discovered a genetic biomarker that could help identify schizophrenia patients who are resistant to antipsychotic drugs (about 30 percent of all schizophrenia patients).  ‘Many treatment-resistant patients are not identified as such and are treated with mixtures of ineffective antipsychotic and other drugs, accruing little benefit and serious side effects, said Herbert Meltzer, M.D., professor in psychiatry and behavioral sciences, pharmacology, and physiology.  By definition, treatment-resistant schizophrenia patients are those who continue to have psychotic symptoms, such as delusions and hallucination, after they have completed at least two rounds of conventional antipsychotic medications.” This is hope I know a lot of people still have voices when they are taking antipsychotics medications and that is a hard pill to swallow.  If there is some way to help them it would be great.
The article goes on to say: “For the research, Meltzer, Jiang Li, Ph.D., a research assistant professor in Psychiatry and Behavioral Sciences, conducted a genome-wide association study on a group of Caucasian schizophrenia patients – a combination of both treatment-responsive and treatment-resistant patients. In the treatment-resistant group, the researchers found a mutation in the dopa decarboxylase gene, which is involved in the production of dopamine and serotonin. Certain variations of this gene have been linked to psychosis in previous studies.  Many patients who were once treatment-resistant do eventually respond to a drug called clozapine.  However, it’s usually not administered in early treatment stages due to potentially severe side effects and required weekly blood monitoring.”  They need something that works as soon as possible so they do not get discouraged with seeking treatment.  They need some kind of medication that manages their symptoms and gives them some kind of relief.
The article ends with: ‘“This biomarker can be used to easily identify patients who should be treated with clozapine, avoiding the use of drugs that are not able to help them.  This can be life-saving,’ said Meltzer, who has dedicated years to developing atypical antipsychotic drugs to help these patients.  He was the lead researcher in the landmark clinical trial that led to FDA’s approval of clozapine in 1989.  Not every patient who benefits from clozapine, however, has the specific dopa decarboxylase genetic mutation.  The researchers will work with a greater variety of schizophrenia patients in the future – particularly patients from other ethnic groups – to look for other biomarkers and treatment options for those who don’t get better with conventional treatments. ‘In a broader sense, this work defines treatment-resistant schizophrenia as a distinct subtype of the illness,’ said Meltzer.  Schizophrenia is one of the most severe and rarest of the mental health disorders, occurring in about one in 100 people. It is characterized by symptoms such as hallucinations, delusions, paranoia, cognitive impairment, social withdrawal, self-neglect, and loss of motivation and initiative.  The finding were published in the journal Schizophrenia Research.” It is finally defined as treatment-resistant.  Again we cannot lump all schizophrenics in the same category.  I just wish there were more options there just clozapine for treatment.  I do not know in my lifetime if I will ever find out everything about this disease.  I would like to also to find out why I have it and how.

Wednesday, November 5, 2014

Scientist spends nine months in max-security prison to learn how prisons manage mental illness in inmates

That is the title of this article I am writing about. “Case Western Reserve University mental health researcher Joseph Galanek spent a cumulative nine months in an Oregon maximum-security prison to learn first-hand how the prison manages inmates with mental illness. What he found, through 430 hours of prison observations and interviews, is that inmates were treated humanely and security was better managed when cell block officers were trained to identify symptoms of mental illness and how to respond to them. In the 150- year-old prison, he discovered officers used their authority with flexibility and discretion within the rigid prison structure to deal with mentally ill inmates.  Galenek’s observations and interviews with 23 staff members and 20 inmates with severe mental illness, are described in Medical Anthropology Quarterly article, ‘Correctional Officers and the Incarcerated Mentally Ill: Responses to Psychiatric Illness in Prison.’ The National Science Foundation and the National Institute of Mental Health supported his research. ‘With this research, I hope to establish that prisons, with appropriate policies and staff training, can address the mental health needs of prisoners with severe mental illness,’ said Galenek, PhD, MPH a medical anthropologist and research associate at the Jack, Joseph and Morton Mandel School of Applied Social Sciences’ Begun Center for Violence Education and Prevention Research at Case Western Reserve.” He looks like he has the skills necessary to find out how to best treat mentally ill prisoners.  I know that this is a prison and they are there to do time.  Although I was once one of them and there is nothing crueler than being mentally ill while you are locked up.
The article goes on to say: “ Additionally, he said, ‘I show that supporting the mental health needs of inmates with severe mental illness concurrently supports the safety and security of prisons, and that these two missions are not mutually exclusive.  With the number of prisoners with severe mental illness increasing, efforts need to be made by all prison staff to ensure that this segment of the prison population has appropriate mental health care and safety.’ Galanek saw how administrative policies and cultural values at the prison allowed positive relationships to develop between officers and prisoners diagnosed with severe mental illness, among the prison’s 2,000 inmates. In this maximum-security prison, left unidentified for the study to protect the confidentiality of officers and inmates officers received training to identify symptoms of mental illness, which, in turn, led to better security, safety and humane treatment of potentially volatile inmates.  But officers were also able to use their discretion in handling some situations. Galanek observed, for example, the following instances where an officer’s decision—rather than rigidly enforcing prison rules—helped mentally ill inmates and maintain order within the institution.” It is always better when you can work a situation for the better for both parties involved.  A person just wants to make life easier for themselves and all.  If no inmates get hurt in prison it would be all the better.
The article ends with: “Prisoners are required to work 40 hours at an assigned job.  But one inmate chose to remain in his cell instead of reporting to work—a prison offense.  The inmate told the officer he was experiencing auditory hallucinations.  Instead of sending the prisoner to a disciplinary unit, the officer allowed the prisoner to remain in his cell until the hallucinations passed.  A correctional officer confronted a violent prisoner, who was off his medication and began smashing a TV and mirror and threatened other prisoners.  Instead of disciplinary confinement, the officer conferred with mental health workers, who sent the prisoner to the inpatient psychiatric  unit to get him back on his medication.  Prisoners aren’t allowed to loiter or talk to other inmates outside their cells.  But a high-functioning inmate with a bipolar disorder worked a janitorial job that allowed him to talk to other mentally ill inmates.  Through those conversations, he was able to let officers know when inmates were exhibiting symptoms of their mental illness.  That information allowed officers to quickly address potential problems and decrease security risks.  Conversely, Galanek said, if these inmates were sent to the segregation unit (“the hole”) to sit isolated for hours their thoughts could lead to agitation and hallucinations that often bring on prison security problems.  Mentally ill prisoner’s work was important and meaningful because it acted as a coping mechanism to decrease the impact of psychiatric symptoms, he said.  To gain such access to prison culture is highly unusual.  In fact, such ethnographic studies have declined in past 30 years due to perceptions that researchers are seen as security risks within these highly controlled environments.  But as a mental health specialist in Oregon’s Department of Corrections from 1996-2003, Galanek was uniquely prepared to navigate the prison for his research. ‘They trusted me,’ he said. ‘I knew how to move, talk and interact with staff and inmates in the prison.