Tuesday, October 27, 2015

New Approach Advised to Treat Schizophrenia

That is the title of this article I am writing about. "More than two million people in the United States have a diagnosis of schizophrenia, and the treatment for most of them mainly involves strong doses of antipsychotic drugs that blunt hallucinations and delusions but can come with unbearable side effects, like severe weight gain or debilitating tremors.  Now, results of a landmark government-funded study call that approach into question. The findings, from by far the most rigorous trial to date conducted in the United States, concluded that schizophrenia patients who received a program intended to keep dosages of antipsychotic medication as low as possible and emphasize one-on-one talk therapy and family support made greater strides in recovery over the first two years of treatment than patients who got the usual drug-focused care.Its findings have already trickled out to government agencies: On Friday, the Centers for Medicare & Medicaid Services published in its influential guidelines a strong endorsement of the combined-therapy approach. Mental health reform bills now being circulated in Congress “mention the study by name,” said Dr. Robert K. Heinssen, the director of services and intervention research at the National Institute of Mental Health, who oversaw the research. In 2014, Congress awarded $25 million in block grants to the states to be set aside for early-intervention mental health programs. So far, 32 states have begun using those grants to fund combined-treatment services, Dr. Heinssen said. Experts said the findings could help set a new standard of care in an area of medicine that many consider woefully inadequate: the management of so-called first episode psychosis, that first break with reality in which patients (usually people in their late teens or early 20s) become afraid and deeply suspicious. The sooner people started the combined treatment after that first episode, the better they did, the study found. The average time between the first episode and receiving medical care — for those who do get it — is currently about a year and half." I wish they would have kept my medicine low dose maybe I would not be fighting all this weight.
The article goes on to say: "'As for medications, I have had every side effect out there, from chills and shakes to lockjaw and lactation,' said a participant in the trial, Maggie, 20, who asked that her last name be omitted. She did well in the trial and is now attending nursing school. Doctors praised the study results. 'I’m very favorably impressed they were able to pull this study off so successfully, and it clearly shows the importance of early intervention,' said Dr. William T. Carpenter, a professor of psychiatry at the University of Maryland School of Medicine, who was not involved in the study. Dr. Mary E. Olson, an assistant professor of psychiatry at the University of Massachusetts Medical School, who has worked to promote approaches to psychosis that are less reliant on drugs, said the combined treatment had a lot in common with Open Dialogue, a Finnish program developed in the 1980s. 'These are zeitgeist ideas, and I think it’s thrilling that this trial got such good results,' Dr. Olson said. In the new study, doctors used the medications as part of a package of treatments and worked to keep the doses as low as possible minimizing their bad effects. The sprawling research team, led by Dr. John M. Kane, chairman of the psychiatry department at Hofstra North Shore-LIJ School of Medicine, randomly assigned 34 community care clinics in 21 states to provide either treatment as usual, or the combined package. The team trained staff members at the selected clinics to deliver that package, and it included three elements in addition to the medication. First, help with work or school such as assistance in deciding which classes or opportunities are most appropriate, given a person’s symptoms. Second, education for family members to increase their understanding of the disorder. And finally, one-on-one talk therapy in which the person with the diagnosis learns tools to build social relationships, reduce substance use and help manage the symptoms, which include mood problems as well as hallucinations and delusions." If some one would have explained a mental illness to me when I first was ill it would have been a great help.
The article ends: "For example, some patients can learn to defuse the voices in their head — depending on the severity of the episode — by ignoring them or talking back. The team recruited 404 people with first-episode psychosis, mostly diagnosed in their late teens or 20s. About half got the combined approach and half received treatment as usual. Clinicians monitored both groups using standardized checklists that rate symptom severity and quality of life, like whether a person is working, and how well he or she is getting along with family members. The group that started on the combined treatment scored, on average, more poorly on both measures at the beginning of the trial. Over two years, both groups showed steady improvement. But by the end, those who had been in the combined program had more symptom relief, and were functioning better as well.The researchers expect to have lowered average doses in the combined program but had not yet finished analyzing that data. 'One way to think about it is, if you look at the people who did the best — those we caught earliest after their first episode — their improvement by the end was easily noticeable by friends and family,' Dr. Kane said. The gains for those in typical treatment were apparent to doctors, but much less obvious. Dr. Kenneth Duckworth, medical director for the National Alliance on Mental Illness, an advocacy group, called the findings “a game-changer for the field” in the way it combines multiple, individualized therapies, suited to the stage of the psychosis. The study, begun in 2009, almost collapsed under the weight of its ambition. The original proposal called for two parallel trials, each including hundreds of first-episode patients. But that plan was changed due in part to recruiting problems, said people familiar with the project. 'It’s been a long haul,” Dr. Heinssen added, “but it’s worth noting that it usually takes about 17 years for a new discovery to make it into clinical practice; or that’s the number people throw around. But this process only took seven years.'
 October 23, 2015 
An article on Tuesday about a study of the treatment of first-episode schizophrenia referred incorrectly to the conclusions of the study. Though it studied a program intended to reduce medication dosages, the researchers do not yet know for sure if dosages were lowered or by how much. Therefore, the study did not conclude “that schizophrenia patients who received smaller doses of antipsychotic medication and a bigger emphasis on one-on-one talk therapy and family support made greater strides in recovery.” (The study did conclude that the alternative treatment program as a whole led to better outcomes.) The article also erroneously attributed a statement to Dr. Robert K. Heinssen, who oversaw the research. It was scientists familiar with the project — not Dr. Heinssen — who said that the study’s original proposal, calling for two nearly identical trials, was changed in part because of recruiting problems. (Dr. Heinssen said that one trial was redirected, but did not say why.) And because of an editing error, the article misidentified the institution where Dr. Heinssen is director of services and intervention research. It the National Institute of Mental Health, not the Centers for Medicare & Medicaid." I just hope there is something new that can especially with the face cramping and other side effects from the medication.

Tuesday, October 20, 2015

Brain inflammation linked to schizophrenia

That is the title of this article I am writing about today. "A direct link has been found between brain inflammation and schizophrenia that could mark a turning point in the prevention and treatment of serious mental illness.  Scientists have shown that immune cells in the brain called microglia appear to play a key role in psychotic disorders.  Brain scans of people with schizophrenia revealed that microglia activity increased in parallel with the severity of their symptoms.  The cells, which respond to damage and infection in the brain, were hyperactive compared with those of non-psychotic individuals.  Neuroscientist Peter Bloomfield, from the Medical Research Council (MRC) Clinical Sciences Centre based at Imperial College, London, said: 'Our findings are particularly exciting because it was previously unknown whether these cells become active before or after onset of the disease.  'Now we have shown this early involvement, mechanisms of the disease and new medications can hopefully be uncovered.'  Microglia have the important job of engulfing and disposing of dead and damaged cells, infectious agents, and potentially dangerous protein fragments in the brain.  In addition, microglia act as 'gardeners', stripping away unwanted neural connections through a process known as "pruning" that alters brain wiring"  It is very interesting I would like to learn more about what they do when they are hyperactive. If it can lead to new medication that would be great.
The article continues: "One theory about the origins of schizophrenia is that it is linked to pruning, which may explain why the disease normally strikes in late adolescence when major brain re-modelling is taking place.  For the new study, 56 people underwent positron emission tomography (PET) scans which produce 3D images of brain activity by tracking a radioactive tracer.  Some of the participants were diagnosed with schizophrenia while others were either at risk of the disease or symptom-free.  The results, published in the American Journal of Psychiatry, indicate that looking for signs of inflammation in the brain could provide an early warning of schizophrenia.  They also raise the possibility of new treatments that involve calming down microglia activity.  Dr Oliver Howes, head of the psychiatric imaging group at the MRC Clinical Sciences Centre, said: "Schizophrenia is a potentially devastating disorder and we desperately need new treatments to help sufferers, and ultimately to prevent it."It is alright for people who get schizophrenia when they are young.  For me I did not get it to age twenty seven. Even though I feel I had symptoms at nineteen it did not fully develop until I was twenty seven.
The article ends: "'This is a promising study as it suggests that inflammation may lead to schizophrenia and other psychotic disorders. We now aim to test whether anti-inflammatory treatments can target these. This could lead to new treatments or even prevention of the disorders altogether.'  Professor Hugh Perry, chair of the MRC's Neuroscience and Mental Health Board, added: 'This study adds to a growing body of research that inflammation in the brain could be one of the factors contributing to a range of disorders, including Alzheimer's, schizophrenia and depression. With this new knowledge comes the hope of life-changing treatments.'  Around one in 100 people in the UK will experience symptoms of schizophrenia in their lifetime.  The condition, most often diagnosed in the late teens and early 20s, is marked by hallucinations, delusions and disordered thoughts.  Suicide is closely linked to schizophrenia, with between 5% and 10% of sufferers ending their lives." I learned that suicide is a form of mental illness. I believe it would go along with depression.  I guess I will never know how and why I developed paranoid schizophrenia it does not run in my family.  I would like to know if alcohol and drugs caused it.

Tuesday, October 13, 2015

Scans Show People Have a Brain 'Fingerprint,' Researchers Say

That is the title of this article I am writing about. "People appear to have their own individual fingerprint of brain activity, one that might be used to predict the risk of mental illness and see the effects of medical treatment, researchers reported on Monday.  The pattern of brain activity is consistent — and the research team at Yale University could turn it around and identify specific individuals based on the pattern.  "The patterns were different enough that we were able to pick people out of a crowd regardless of what people were doing," said Emily Finn, a graduate student who led work on the study.  They even used it to show differences in what's called fluid intelligence — quick thinking and problem solving.  'We demonstrate that it is possible, with near-perfect accuracy in many cases, to identify an individual from a large group of subjects solely on the basis of his or her connectivity matrix,' Finn's group, led by Todd Constable, director of MRI research at Yale, wrote in the journal Nature Neuroscience. The team used data from multiple functional magnetic resonance imaging (fMRI) brain scans of 126 volunteers. They're all taking part in a bigger study called the Human Connectome Project, which is looking to see just how different parts of the brain work together." This sounds promising.  If they can help people with mental illness that would be great.
The article goes on to say: "They found a distinct pattern of activity in each person, which held true when they were doing something and when they were just sitting there. It's not so much showing that one brain region is connecting to another as showing that two or more regions are functioning in synchrony at certain times, Finn said. 'It's definitely not easy to see,' she said. The effect wasn't visual, but could be seen in the streams of data coming from the scans. 'It was about the pattern,' she said. 'It wasn't necessarily that people had overall strong connection strength or overall weak connection strength.' It's step towards applying the benefits of fMRI to individuals. 'In the past, in an fMRI you would image a bunch of people doing the same thing and you would average together the data from many people and see how the brain lights up,' she said. 'The dogma has always been that it is hard to get any meaningful information from a single person's scan because this method is so noisy and crude.'  The Yale team's approach found that you could, in fact, find out quite a bit about an individual from his or her fMRI.  'Characteristic connectivity patterns were distributed throughout the brain, but the frontoparietal network emerged as most distinctive,' the team wrote.  These are regions associated with fluid intelligence, Finn said." They can tell from the brain how it is working. All I have seem of MRI's is brain lighting up when we are using certain parts.
The article ends with: "These two lobes, the prefrontal and parietal, are some of the most recently evolved parts of the brain,' she said. They're linked with attention and memory. Not that this means brain scans will replace IQ tests. 'It is a lot easier to give someone an IQ test than to put them in a scanner,' Finn said. 'The real potential in this is not predicting IQ per se, but thing that are harder to predict in a test like who is going to go on to develop mental illness,' she said. 'Maybe we could find a way to predict it so we can intervene and prevent mental illness,' Finn added.  There aren't drugs or treatments that can do that now but there may be in years to come, she said.  It might be useful in predicting or measuring someone's response to drug education programs, or to other therapies, she added."  It would be nice to see if they can predict when people are going to get mental illness.  If they can stop before people go through hell that would be great. I know this will take years before anything can be done.  They do not have medication that helps everyone right now.

Tuesday, October 6, 2015

How Those With Schizophrenia Misinterpret Social Cues

That is the title of this article I am writing about today. "People who suffer from schizophrenia often misinterpret social cues, which can lead to unpleasant and often paranoid or persecutory thoughts. A new study provides insight into this misperception. Researchers believe their findings, published in the journal Psychological Medicine, could foster psychological interventions to assist people with schizophrenia better interpret social cues and perhaps ease related symptoms.  Investigator Dr. Sukhi Shergill of King’s College London, said, 'Humans are social beings, often finding joy in interacting with others. While most attention is on talking with each other, non-verbal behavior such as gestures, body movement, and facial expression also play a very important role in conveying the message.'However, the message being conveyed is not always clear, or perceived as a positive one, and an extreme example is evident in patients suffering from schizophrenia who show a strong tendency to misinterpret the intentions of other people in a malevolent manner.'" It is true especially when I was a teenager and first married.  Even though I was not diagnosed yet and I feel paranoid schizophrenia was playing a large part in my behavior and thoughts. I always thought about my mariage that if me and me ex were born in a different time it would have worked.  Now I know if I would have been born without this disease it would have worked.
The article goes on to say: "In the study, investigators studied the behavior of 54 participants, including 29 people with schizophrenia, as they viewed the body position and gestures of an actor on a silent video clip. The video included gestures such as putting a finger to the lips to indicate ‘be quiet’ or incidental movements such as scratching an eye. Researchers found that patients with schizophrenia are able to interpret meaningful gestures and incidental movements as accurately as healthy subjects. However, when the direction of the gestures was ambiguous (i.e. not obviously directed at or away from them), they were much more likely to misinterpret the gestures as being directed towards them. Investigators believe this could indicate an increased tendency to self-infer these ambiguous social cues or to “hyper-mentalize,” falsely inferring intent in the actions of others.
Both of these misinterpretations could strengthen paranoid thoughts experienced by patients with schizophrenia, said the study authors. Moreover, the patients’ confidence in their interpretation was found to be strongly associated with their tendency to experience hallucinatory symptoms." I never had hallucinatory symptoms all thought I can relate to some of this. I just put it up to my lack of social awkwardness.
The article ends: "Our study offers a basis for psychological interventions aimed at improving gestural interpretation,” Shergill said. “It could also provide guidance for health professionals and care-givers on how to communicate with patients who have schizophrenia, in order to reduce misinterpretations of non-verbal behavior.' Emerging technology can help to improve communication as well as enhance quality of life among individuals with schizophrenia. 'The recent advent of adaptable virtual-reality technology provides a means of investigating the psychological effects of gestural communication with greater flexibility, which may prove a boon for our future understanding of social deficits in schizophrenia,' said Shergill." I am glad they have found something that may work to help people with schizophrenia.  If they can help them not to make the same mistakes in life that I did because I did not understand what was going on for real I think it would be a great help.