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Periodic Newsletter - Series 2, Issue 27 - May 9, 2005
Summary of Schizophrenia-related News and Events. Note: Please forward
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Member and Site News, Editorials
- A View of Dr. Dan Fisher of the National Empowerment Center - an editorial
by Marvin Ross
- Schizophrenia.com interviews Dr. Dan Javitt, schizophrenia and glycine
- Schizophrenia Awareness Week - May 22-28
and Prevention News
- Family dysfunction influences Psychosis & Schizophrenia risk
Medication and Treatment
In Community, Society, and
Biology and Current Research
View of Dr. Dan Fisher - editorial by Marvin Ross, schizophrenia.com
representative at Dr. Fisher's recovery workshop in Ontario
Dr. Daniel Fisher, a psychiatrist who suffers from schizophrenia
and who heads the National Empowerment Center, told the audience at
his recovery workshop in Hamilton, Ontario that when he first entered
psychiatry he found that his ideas ran counter to the newly emerging
physiological theories of mental illness. "They were all jumping
on the brain and I was jumping off" he said.
While science has made considerable progress in defining the changes
in the brain of people with serious mental illness, Fisher continues
to espouse controversial views to the point where a number of participants
at the Hamilton workshop that I talked to were angered. One family
member told me that she could hardly wait to get out she was so outraged
by his comments that serious mental illness is an emotional problem
and that people do not hear voices they just have loud thoughts.
Others expressed concern about his anti medication bias and one senior
psychiatric hospital administrator said that while not agreeing with
him it is important to hear other views. While defending the rights
of people to present their opinions, I am concerned that Dr. Fisher
gives the wrong message and that can be dangerous. Much of what he
talks about is "touchy feely" unscientific new age platitudes
combined with some common sense and a message that serious mental
illness is not physiological. His answers to questions that I posed
are at the end of this editorial and are very revealing. Dr. Fisher,
as you will see, considers me to be overly simplistic.
How often have we heard someone with severe depression being told
to "snap out of it"? Asking the question or expecting the
depressed individual to cure their own depression implies that it
is not a disease but a personal failure. You can't "snap out
of" a broken leg or an occluded blood vessel. But, Dr. Fisher
seems to think that you can overcome what he calls a severe emotional
distress (SED) that is precipitated by trauma or loss. When an individual
suffers this SED, they often are taken over by the mental health system
and labeled as severely mentally ill.
He further discounts the medical model by stating "the present
mental health care system is based on an illness model in which an
expert defines the problem as primarily a defective chemical mechanism
in the patient's brain that needs to be repaired by the expert. This
model reduces symptoms but interferes with the person's taking an
active role in recovery." In that same paper, he states "all
of us can achieve self control of symptoms to varying degrees
And "genuine healing comes from within by an activation of our
own healing powers".
This is from a paper he had published in 1994 in Hospital and Community
Psychiatry that he handed out at his workshop as if we have not made
numerous advances in the past 10 years. First, serious mental illness
is just that - an illness of the brain. One needs to look at the many
imaging studies of the brains of people having a first episode psychosis
compared to normal controls to realize that.
Dr. Fuller Torey has an excellent paper in which he reviews 65 studies
of individuals with schizophrenia who had never been treated with
medications that indicate significant abnormalities in brain structure.
How can you achieve self-control of symptoms when the symptoms are
caused by circumstances beyond your control like abnormalities of
the brain? You can't. That is like telling someone with epilepsy that
they can will away their seizures.
These notions are the same as those in cancer where it is suggested
that you can control your cancer and its spread through imaging, visualization,
laughter, prayer, biofeedback, and other similar modalities. I could
not find any studies in the medical literature that support this.
A few years ago, I did an article on group therapy and its ability
to help ameliorate the symptoms of advanced cancer and help to prolong
I did a group interview with women who were dying of advanced metastatic
breast cancer but who were part of a study to see if group support
might help their symptoms and prolong life. All of the women expressed
intense dislike for the proponents of the visualization treatment.
They all said that the implication is that their failure to control
their cancer and get better is their fault. It is not. They were very
ill and they were going to die and it was not because they did not
want to live or they were not visualizing hard enough. But, the consequence
of this New Age concept of will your way to better health is to demean
their suffering and their incredible strength.
The same goes for serious mental illnesses like schizophrenia. Dr.
Fisher may not need meds for whatever reason but most do. When I asked
him why people experience a return of symptoms when they go off meds,
he said that it might be because they were not far enough along in
their recovery process (see Q and A below). What balderdash! What
does that mean?
I can give him all sorts of examples as most can of the return of
symptoms that are so bad that people have committed suicide as a consequence.
But, here is an example of someone who was recovered. A man with schizophrenia
who took his meds, worked full time at a career, was married and was
enjoying his retirement and his many hobbies. The doctors decreased
his anti-psychotics and his symptoms came back and he had to be hospitalized
until the increased dosage kicked in.
I'm not sure how Dr. Fisher would account for that but I think of
the comments made in a presentation by Dr. Robert Zipursky of the
Centre for Addiction and Mental Health in Toronto. Dr. Zipurski said
about 80% of patients will relapse within the first five years if
they stop taking their medications. But, even if they are in remission,
they should stay on indefinitely because of the cumulative damage
each psychotic episode inflicts. "Recovery from relapse may take
a long time and it is uncertain," he said. Scientists, he added,
still don't know if someone can remain well for five or 10 years without
medication, and the risk of not recovering from a relapse is too great.
"If you've spent a year or two getting someone well and watching
them rebuild their lives . . . to watch them get sick again is not
something you would wish on anyone,"
Questions Dr. Fisher:
Q. Some people define recovery as being off all medications. You
have said that you are not opposed to using medications as one tool
in a person's recovery journey. I have not been able to find your
7 steps to recovery on your website. Does your definition of recovery
include not being on medication?
A. We do not define recovery as being off all medication. After all
there are many people who take a variety of psychiatric medications
but were not labeled mentally ill because there (sic) life was not
interrupted by the experience. No, we say that when a person has recovered
medication is one tool among many freely chosen by the individual.
Q. One psychiatrist that I talked to stated that your pro recovery
position suggests that there are people who are anti recovery. He
found that offensive as his goal for his patients is to help them
recover. Could you comment on that?
A. I do not believe any psychiatrists are anti recovery, however
many do remove hope by saying the person will remain mentally ill
their entire life.
Q You say that taking medication should be informed and voluntary.
Where do you stand on committal and treatment for people who are so
psychotic that they cannot make an informed decision?
A. Except under emergency conditions of a very acute nature, for
a person in a hospital, where there is a risk of harm, I am opposed
to forced medication. Even under those conditions I think it should
be called chemical restraint as it is called for persons with developmental
Q. You have said that you are off medications and that you know many
people who are. One psychiatrist told me that 25 years ago, the diagnostic
criteria for schizophrenia was much broader in North America than
in Europe and that some people may have been diagnosed at that time
who would not have been today since the North American criteria and
now much tighter. It is not possible that some of the people who were
diagnosed when you were might have been misdiagnosed?
A. I am tired of hearing that I was misdiagnosed. I still would have
met the criteria of schizophrenia
Q. I have seen some very impressive imagings of the brain of people
who were having a first psychotic episode and were unmedicated. There
were significant differences between those images and normal controls.
When these psychotic patients were treated with medications, you could
see a significant change in the brain images that were now much closer
to the brain images of the normal controls. Does this not suggest
that schizophrenia is a neurobiological problem?
A. Our biology is not our destiny. Our brains change over time as
we learn new behaviors and patterns of thought. This has been shown
with all nervous systems.
Q. If it is then how can anyone go off medication? Is that not like
suggesting that someone with epilepsy can go off medication and remain
A. Therefore one can have a severe mental illness, and change over
time to the extent that medication is no longer necessary.
Q. Researchers are also finding genetic links to schizophrenia. Does
this not also imply a physiological cause?
A. It may imply a genetic factor but not the cause. These conditions
are very complex and involve a variety of factors. It is not helpful
to focus so exclusively on only one factor and say it is the cause.
Q. I know of a number of people who attempt to go off medication
and start to become psychotic again. How would you explain this in
your recovery model?
A. Perhaps they went off too quickly. There is a rebound effect.
Perhaps they were not far enough along in their recovery.
Q.. You told Medscape in an interview in January that you tell people
going through a psychotic episode that: "this is not a permanent
condition and that other people have recovered." Does that not
suggest that you do not believe schizophrenia to be a physiological
A. There is no contradiction between saying these are not permanent
conditions and my saying that there is a physiological factor. That
factor can be changed over time. As I said there is good evidence
that our brains change over time with new learning.
Here are Dr. Fisher's unsolicited comments about my questions:
Overall it appears you have misunderstood my position. The world
is not nearly as black and white as you make it seem. There is (sic)
mostly shades of grey, in fact mostly grey matter. It is true I emphasize
that people can recover and in many cases even completely recover.
Our definition is on our website on the home page, right side. However,
you must recall that I am a psychiatrist and I prescribe medications.
I am not opposed to medication I just feel it is overemphasized
Interviews Dr. Dan Javitt
As a follow-up to our recent special
report on glycine supplementary treatment for schizophrenia,
we contacted Dr. Dan Javitt, one of the leading researchers/developers
in the field. Dr. Javitt generously agreed to answer some of
our questions about his work and about the future of glycine
treatment, and responded a wealth of detailed and thoughtful
information on the subject. This is only the first portion of
the interview - we are currently still corresponding on questions
about his company that develops glycine treatments, and the
future of glycine treatment marketing. More to come in later
newsletter editions. In the meantime, many thanks to Dr. Javitt
for his contributions!
Read the interview transcript
(available at http://www.schizophrenia.com/research/javitt.htm)
Awareness Week is this week!
The National Schizophrenia Foundation (http://www.nsf.org)
has declared May 22-28 to be Schizophrenia Awareness Week. This
year's theme is appropriately "Schizophrenia: It's Not
What You Think!" Please link to the full
newsblog story on schizophrenia.com (May 20, 2005 entry)
to read more comments about Awareness Week, and a list of what
we as advocates for people with schizophrenia can do now and
in the future.
Dysfunction Influences Psychosis and Schizophrenia Risk
York University - a top Canadian university - has announced
an extended certificate program in "Infant Mental Health"
working in concert with the "Sick Kids Hospital".
This seems like a good step forward in early identifcation of
brain disorders which should result in earlier treatment and
better outcomes. Too bad the course isn't available over the
Internet - I'm sure a lot of people would be interested in participating.
This Program is designed to provide front-line service providers
with essential knowledge and practical skills to encourage positive
parent-infant interactions and promote optimal developmental
progress in infants. The Program is directed to those interested
in working effectively in the field of infant development, prevention
and/or early intervention with infants with special needs, and
with infants living in high-risk environments.
The Ceritificate is offered by York University - Atkinson
College in collaboration with Infant Mental Health
Promotion Project, The Hospital for Sick Children & Ontario
Association for Infant Development
It is a 120-hour non-degree credit Certificate for a broad
front-line services providers and managers who wish to acquire
essential knowledge and practical skills to work effectively
with infants and their families.
Infant Mental Health Promotion Project (IMP)
The Hospital for Sick Children - CHSRG
555 University Avenue
Toronto, ON M5G 1X8
MORE INFORMATION: Infant
Mental Health Program (http://www.atkinson.yorku.ca/~dce/Programs/Certificates/IMH/IMH1.html)
for Sick Children - Infant Mental Health Program (http://www.sickkids.ca/imp/)
risk for children if mother has schizophrenia
This paper looks at a large population in Finland in which
the authors collected data on all children born to mothers with
a psychiatric diagnosis. They were interested in the chance
that those born to such mothers might develop a mental illness
in their lifetime. They looked at all mothers who were born
in Helsinki from 1916 to 1948 and had previously been treated
in a psychiatric hospital in Finland and received a diagnosis
of a schizophrenia spectrum disorder and gave birth from 1960-1964.
192 children were identified, and they were compared with the
children born in the same hospital immediately preceding their
birth. Since diagnostic criteria have changed over the years,
the charts were reviewed and patients assessed a diagnosis based
on current standards.
The authors found that there was a nearly 7 percent chance
of developing schizophrenia in an offspring if the mother had
schizophrenia versus about a 0.6% chance in the control group
in which the mother did not have schizophrenia. Other schizophrenia
spectrum disorders yielded similar figures. Mothers with a mood
disorder had no children develop schizophrenia though it was
a small sample. Overall, mothers with schizophrenia had a 13.5%
risk of their child developing a significant psychiatric disorder
in their lifetime compared with 1.2% in the control group. In
similar studies done previously in New York and Copenhagen the
results were similar though they were higher than in this study
(Copenhagen study had nearly 17% of offspring develop a psychiatric
diagnosis.) However, there are explanations for the difference
not the least of which is that diagnostic criteria became more
strict in this study. Also, only those diagnosed as inpatients
could become part of the study while there are some that will
present as outpatients and ever be hospitalized therefore lowering
the overall number of cases. There were also increased rates
of substance abuse in the high risk mothers but it was found
that in this study (different from the other similar studies)
that the paternal substance abuse had a greater correlation
to the offspring likelihood of similar problems though it was
noted that generally the fathers with substance abuse had more
significant problems than the mothers with substance use disorders.
Both mothers and fathers of the higher risk children were more
likely than the control group to have substance abuse in their
Editorial note: even if schizophrenia runs in your family,
there are lots of controllable measures you can take to help
reduce your own and your child's risk of developing the disease,
both during pregnancy and throughout life. See http://www.schizophrenia.com/hypo.html
for more details.
Study Title: Cumulative incidence of mental disorders among
offspring of mothers with psychotic disorder Results from the
Helsinki High-Risk Study
Laura T. Niemi, Jaana M. Suvisaari, Jari K. Haukka, Gunnel
Wrede and Jouko K. Lonnqvist
British Journal of Psychiatry (2004), 185:11-17.
here to access the article on PubMed, or do a search at
Cuts Hurt Those with Mental Illness
We learned from testimony by Dr. Insel (head of the US National
Institute of Mental Health - see "Comments from NIH Head
Dr. Insel on Substance Abuse and Mental Illness", also
in this newsletter issue) that:
--People with serious mental illness represent
the single largest group -- diagnostic group -- of those receiving
SSI, (social security).
--Unlike the rest of medicine, most of the costs for both direct
and indirect mental illness care are in the public sector. That
means that more than 50 percent of all mental health expenditures
are paid for by Medicaid / Medicare and state and local governments.
Again, quite different from the rest of medicine, where we're
often dealing with questions about third-party reimbursements
and private insurance coverage.
Medicaid is the single largest payer of mental health services
in the country. And just as one example, last year Medicaid
wrote for more than half of the prescriptions for atypical antipsychotics,
a group of medications that cost the nation over $12 billion.
So this is a very large outlay of funds.
Read the recent
press release from NAMI (http://tinyurl.com/7o4dw) on how
anticipated cuts in Medicaid will have a very significant impact
on the mentally ill - likely resulting in more of the mentally
ill being poorly treated and ending up in jail. See also "Treating
Mental Illness Cuts Costs" - another article in this
newsletter issue - to learn how such a vast proportion of mentally
ill people turned away from public sector care will ultimately
increase the burden of cost for everyone.
Mental Illness Cuts Costs for Everyone
An editorial in the Virginia Roanoke Times acknowledged the
efforts of those who participated in a weekend fundraiser for
community mental health programs, and made the important but
oft-overlooked point that the best way to economize mental health
is to treat it.
For example, the article notes that emergency room use by uninsured
people with mental health crises is costing the region about
$1million per year. This is not even considering the indirect
costs accrued from loss in productivity, increased burden on
public health and criminal services, increased unemployment
rolls, and crowding of jails by people with untreated mental
However, as funding for community treatment services is usually
below officially-mandated levels (according to the article),
it is becoming even more important for citizens to not only
advocate for greater funding, but to also contribute their time
and energy to fundraisers for mental health services.
A great way to do this during the next two months is to get
involved with a NAMI Walk. They are taking place in 38 U.S.
States. Visit the NAMI website (http://www.nami.com) for
location and registration information.
to economize on mental illness: Treat it." The Roanoke
Times, May 1 2005. (www.roanoke.com)
Drugs to Target Negative Symptoms
Prestwick Pharmaceuticals Inc. a Washington, DC company that
is developing a new drug for treatment of tardive dyskinesia,
another drug called "D-Serine" for the treatment of
the negative symptoms of schizophrenia - has announced that
they have filed for an initial public offering to raise an estimated
$ 74.8 million in preparation for the potential launch of its
dopamine depletor, tetrabenazine.
Prestwick said it received fast-track designation for tetrabenazine,
and if the New Drug Application (NDA) is filed this quarter,
the company would be eligible for FDA approval as early as the
first quarter of 2006. The company licensed rights to develop
and commercialize tetrabenazine, a selective and reversible
dopamine depletor, from UK-based Cambridge Laboratories Ltd.
The product is marketed by Prestwick in Canada under the brand
name Nitoman and by Cambridge Laboratories in Europe under the
The company also received what is termed by the FDA "orphan
drug status" (which means that it addresses a relatively
small market or number of people) for tetrabenazine in a second
movement disorder, tardive dyskinesia, and is planning a Phase
III trial in that indication.
The company also plans to file with the FDA an Investigation
for New Drug (IND) this year for its schizophrenia drug, D-Serine,
a selective amino acid co-agonist (NMDA enhancer). A Phase IIb
trial is anticipated to begin next year.
Editor's Note: Incidentally, D-serine is a naturally-made body
molecule that occupies a cofactor binding site (called the glycine
modulatory site) in the NMDA receptors in the brain, allowing
them to fire when they are stimulated by glutamate neurotransmitters.
D-serine is one of the compounds showing promise in a new angle
of treatment for schizophrenia - enhancing NMDA receptor function
through the glycine modulatory site (using glycine, d-serine,
or d-cycloserine). Read more about the role of NMDA receptors
and glycine in schizophrenia pathophysiology, and how supplementary
treatments of glycine or d-serine may help improve negative
and cognitive symptoms, in this new
schizophrenia.com special report on glycine therapy.
More information on new
schizophrenia drugs in development (http://www.schizophrenia.com/newmeds2004.htm)
Weight-Loss Medications - may help counter extra weight-gain from
On April 28 2005, it was announced that Corcept Therapeutics
Inc., of Menlo Park, Calif. has results from two preclinical
studies. These results show that their new drug in development
(called "Corlux") can induce weight loss following
olanzapine-induced weight gain, and prevent the weight gain
induced by olanzapine (brand name Zyprexa), one of several atypical
antipsychotics that carry a warning of weight gain as a side
This drug is still just in early stage trials - we'll report
more as it gets closer to larger scale human trials, and potential
More Information: Corcept
Therapeutics Inc. (http://www.corcept.com/)
on Stigma - prevalence, prevention, what works and what doesn't
Several news sources this week had something to say about mental
illness stigma. The first two summaries deal with the prevalence
of stigma (diminishing or otherwise) among Americans according
to a Gallup poll, and suggested ways to diminish stigma based
on an analysis of techniques (called "social marketing"
to target audiences) used by the World Psychiatric Association
(WPA) Programme to Reduce Stigma and Discrimination Because
of Schizophrenia. The third news story is a response to the
first two, citing information from the Treatment Advocacy Center
(and other sources) claiming that public anti-stigma campaigns
(such as the ones described by WPA) have not worked in the past,
and that a better way to manage stigma is to focus efforts on
treating people so that there are fewer high-profile criminal
incidents involving the mentally ill. Unfortunately, with Medicaid
being slashed the way it is (see Medicaid cuts hurt mentally
ill - earlier in this edition), it does not appear that such
treatment will be available to the majority anytime soon unless
something else is done.
The three stories are summarized below:
press release (http://en.wikipedia.org/wiki/Press_release)
entitled "Mental Illness Stigmas Are Receding, But Misconceptions
Remain", reported that 90% of Americans surveyed feel that
people with mental illness can lead healthy lives, and the vast
majority also felt that current psychiatric treatment works,
and that visitng a psychiatrist is a sign of strength. However,
despite these encouraging statistics, 1 in 5 adults still stated
that they personally would never see a psychiatrist "under
any circumstances." Additionally, although 75% believed
(correctly) that mental illness is caused by a chemical imbalance
in the brain, twice as many respondants from that group said
they would seek help from a primary care physician, who is not
specially trained to diagnose and treat mental illness.
Other statistics from the survey:
Additional significant findings:
* More women than men think that seeing a psychiatrist is a
sign of strength (78 percent vs. 61 percent)
* 75 percent of adults surveyed correctly understand that psychiatrists
are medical doctors with medical degrees, while 38 percent mistakenly
think that psychologists are medical doctors
* Younger adults are significantly more positive than older
adults (65+) about mental illness issues, highlighting progress
made in younger generations embracing the realities of mental
The survey included 1,020 randomly-selected adults (50% men
and 50% women) living in private households in the continental
Source: "Mental Illness Stigmas Are Receding, But Misconceptions
Remain", PRNewswire press release (http://www.prnewswire.com)
While this survey reports on the prevalence of mental illness
stigma, another research study examines the effectiveness of
methods used to reduce such stigma. The study specifically investigates
the effectiveness of "social marketing", a tool used
by World Psychiatric Association (WPA) Programme to Reduce Stigma
and Discrimination Because of Schizophrenia. Social marketing,
which has been used for successful AIDS prevention and smoking
cessation campaigns, relies on segmenting the overall general
audience into several more homogenous, demographically-similar
sub-groups (for example: school-age youth, police and criminal
justice personnel, employers, etc). The article suggests that
such sub-groups can be identified using surveys and other analysis
tools to identify among which groups of people stigma appears
to be most prevalent.
After the target audiences are established, the campaign message
and tools for delivery can be specifically designed for the
needs and benefit of each different group. The article specifically
cited police training and classroom presentations as two examples
of interventions that are more cost-effective than attempting
to reach a massive general audience, and that also have the
potential to cause specific changes in attitudes, actions, or
behavior that could improve the quality of life for people with
The specific steps used by the WPA programme (now initiated
in 20 countries) are as follows:
1. establish a local action committee (the action committee
plans and implements the subsequent steps).
2. conduct a survey of sources of stigma
3. select target groups
4. choose messages and media
5. evaluate the impact of interventions, while continuously
For more detailed information on the anti-stigma program used
by WPA, and for tips on how to successfully launch a campaign,
The website is viewable in eight different languages.
Projects of the World Psychiatric Association Programme to Reduce
Stigma and Discrimination." Psychiatr Serv 56:570-575,
May 2005 (click on the link, or do a search for the abstract
Related to the earlier news story on stigma (above), a news
story from a few years back reported that research suggested
that anti-stigma campaigns for schizophrenia targeted at the
public don't work (echoing the statements of E. Fuller Torrey,
DJ Jaffe, and others, who contend that the real anti-stigma
effort should be focused on getting all people who have schizophrenia
successfully treated so that there are fewer incidences of violence
that are so widely covered in the news, to the detriment of
the approximately 99% of people with schizophrenia who aren't
See Excerpt below:
"Schizophrenia anti-stigma campaigns aimed at the general
public are usually a waste of money, says a mental health researcher
who questioned more than 1,600 people.
A better target would be health professionals and mental-health
providers, maintains Dr.
Heather Stuart (PhD), an epidemiologist at Queens University,
Canada and lead investigator in a study into public attitudes
and knowledge about psychiatric disorders.
The research by Dr. Stuart and Dr. Julio Arboleda-Florez, head
of psychiatry at Queens, was part of the World Psychiatric Association's
global program to fight the stigma of schizophrenia. It was
conducted with the co-operation of the Schizophrenia Society
While 52% of the respondents who did not work with the mentally
ill were rated as high on social distance, 57% of those who
worked with psychiatric patients scored high on the social distance
That, Dr. Stuart said, has profound implicationsnamely
that anti-stigma campaigns aimed at the lay public would be
a waste of money. She also noted Australia spent $8 million
on such a campaign and that it had little impact.
The bottom line is that health-care professionals "have
the same attitudes as the guy on the street when we should be
expecting more from them," Dr. Stuart said.
She said she feels anti-stigma efforts should be geared toward
health-care professionals to raise their awareness."
from NIH Head Dr. Insel on Substance Abuse and Mental Illness
Dr. Insel, head of the National Institute of Health, recently spoke
at a US Representative Meeting on Substance Abuse and Mental Health
Services (April 27, Washington DC). The following is a very brief
set of quotes from Dr. Insel highlighting the extreme importance of
providing early and adequate care to those with substance abuse and/or
What Dr. Insel does not address in much detail is the two-way cause
and effect relationship between substance abuse and mental illness.
Although it is true that people with mental illness are more susceptible
to developing substance abuse disorders (due to self-medicating and/or
sensitivity of certain reward-center brain circuits in the limbic
system), strong scientific evidence is showing that using street drugs
can significantly increase a person's risk for developing a mental
disorder. A particularly strong link has been identified between cannabis
use and schizophrenia/psychosis onset - see http://www.schizophrenia.com/hypo.html#street
for more details and links to scientific studies.
A link at the bottom of the article will lead to more lengthy relevant
excerpts in the schizophrenia.com newsblog; from there, you have the
option of navigating to the entire (very long) transcript of the meeting.
Comments from Dr. Insel:
We often don't recognize that many of the costs of these disorders
are different than the cost of other medical illnesses in the sense
that here, the indirect cost, that is the cost for social services
may be greater than the direct cost -- the cost for treatment.
That's not true for hypertension, diabetes and cancer, but it's
true across the board for these kinds of illnesses. And it's one of
the facts here that we need to keep in mind when we think about how
the nation supports people with these illnesses and what the actual
public health burden would be in an economic sense.
People with serious mental illness represent the single largest
group -- diagnostic group -- of those receiving SSI, the kind of disability
that you asked about before.
It's also true that unlike the rest of medicine, that most
of the costs here for both direct and indirect care are in the public
sector. That means that more than 50 percent of all mental health
expenditures are paid for by Medicaid/Medicare and state and local
governments. Again, quite different from the rest of medicine,
where we're often dealing with questions about third-party reimbursements
and private insurance coverage.
Medicaid is the single largest payer of mental health services
in the country. And just as one example, last year Medicaid wrote
for more than half of the prescriptions for atypical antipsychotics,
a group of medications that cost the nation over $12 billion. So this
is a very large outlay of funds.
The other point that we want you to take away from this hearing
is to -- and we say this every year, but it's one that I think we
don't say enough -- is to remind you and others that these disorders
are brain disorders. And our science has now taught us that without
What you see here on the screen is the evidence that we've had
for some time that those people who are incapacitated by depression,
whether it's bipolar depression or unipolar depression, have structural
changes that we can now see with brain imaging.
But perhaps even more exciting -- what we've begun to realize
in the last year with the advent of functional studies -- is that
we can now begin to identify those areas in the brain where function
has to change for someone to recover. And those are often areas that
we hadn't recognized before as having a very important role in depression,
whether we're talking about major depression, depressive disorder
or bipolar depression. So we now really think about these as brain
The big difference between how we think about depression and
schizophrenia and how we think about Parkinson's and perhaps Alzheimer's
is in these disorders we're not talking about a specific lesion, in
the sense that there are dead cells in one area, or there's a hole
in the brain in the sense that you might look for some stroke victims;
here what we're really interested in are changes in how the brain
functions as a system and where the system is no longer functioning
in a normal fashion. And we now have the tools to be able to identify
So for the first time, we can begin to think about these as brain
disorders in a way that allows for different kinds of diagnosis and
hopefully, different kinds of treatments.
COMMITTEE: LABOR, HEALTH AND HUMAN SERVICES, EDUCATION AND RELATED
SUBCOMMITTEE: HOUSE APPROPRIATIONS COMMITTEE
HEADLINE: U.S. REPRESENTATIVE RALPH REGULA (R-OH) HOLDS HEARING ON
SUBSTANCE ABUSE/MENTAL HEALTH SERVICES
LOCATION: WASHINGTON, D.C
See a longer version of relevant excerpts at http://www.schizophrenia.com/sznews/archives/001740.html,
or access the full transcript (Register or Pay to View) at http://tinyurl.com/bh9sf
More resources for those with dual-diagnosis (both substance abuse
and mental illness) are available at http://www.schizophrenia.com/family.htm#dualdiag
to Encourage Attitudes of Recovery in People with Schizophrenia
Study title: An empirical conceptualization of the recovery orientation.
Resnick SG, Fontana A, Lehman AF, Rosenheck RA
Northeast Program Evaluation Center, Yale University School of
Medicine, VA Maryland Healthcare System and University of Maryland
School of Medicine
In the scientific literature, recovery is described
as process representing the belief that all individuals,
even those with severe psychiatric disabilities, can develop hope
for the future, participate in meaningful activities, exercise
self-determination, and live in a society without stigma and discrimination.
Helping people with schizophrenia move towards this recovery orientation
is an important part of grass-roots movements and mental healthy
advocacy by groups including NAMI ( National Alliance for the
Mentally Ill), state mental health systems and the President's
New Freedom Commission on Mental Health (see http://www.mentalhealthcommission.gov/index.html
for more information)
In this article, the authors propose an empirical (research based)
way to think about peoples recovery orientation. They used
data from the Schizophrenia Patient Outcomes Research Team (PORT)
Client Survey which is the largest systematic survey of the treatment
of schizophrenia ever conducted. The PORT asked people with schizophrenia
in Ohio and Georgia questions about many different things including
measures of clinical status, community adjustment and attitudes
about different things. There was a total of 1076 participants.
Based on the analysis of the results, they suggest a way of encouraging
recovery attitudes by focusing on 4 areas: the capacity to feel
empowered in one's life; self-perceptions of knowledge about mental
illness and available treatments; satisfaction with quality of
life; and hope and optimism for the future.
For the goal of empowerment, it helps to promote self-esteem
and help individuals discover and reach their goals. This involves
helping the person to feel empowered to take responsibility to
make one's own decisions and take responsibility for treatment,
as well as encouraging the feeling that one's treatment and treatment
providers match your own treatment goals.
They also talk about the importance of fostering hope
- hope for the future, hope for achieving one's goals and the
importance of being surrounded by treaters, peers and family members
who share realistic optimism and hope.
Knowledge about one's illness, the range of available
treatments and ways to navigate the service system is another
way that can help people improve their confidence in coping with
mental illness. It can help people with schizophrenia attend to
their own personal experiences, manage symptoms, and achieve greater
independence and less dependence on the mental health system.
Satisfaction with family, social networks, living arrangements,
community and safety are also important. These can be encouraged
by family psychoeducation that can help with improving communication
with family members. Case management services such as assertive
community treatment may also help those with schizophrenia maximize
their housing opportunities and create housing stability.
Overall, the authors suggest that the evidence-based practice
(EBP) movement in science, which promotes treatments that are
supported by clinical trials, can help to identify interventions
that promote these recovery orientations in people with schizophrenia.
These EBPs can help by providing a mechanism for identifying treatments
that promote recovery orientations.
Overall, this article highlights the importance of people with
schizophrenia and caregivers to be well informed of current advances/treatments
that are continuously being introduced, so as to encourage recovery
in their loved ones.
Schizophr Res. 2005 Jun 1;75(1):119-28.
here to find this article on PubMed, or do a search for the
article at http://www.pubmed.com
Therapy for the Brain - could this Alzheimer's research someday
apply to schizophrenia treatment?
In a development that highlights the potential to mitigate brain
diseases (such as Schizophrenia) via gene therapy, The University
of California, San Diego (UCSD) announced today that Alzheimer's
Cognitive Decline Slowed In Gene Therapy Patients.
PET scans and cognitive tests have suggested that Alzheimer's
disease patients with genetically modified tissue inserted directly
into their brains show a reduction in the rate of cognitive decline
and increased metabolic activity in the brain, according to a
study published in the April 24, 2005 online issue of the journal
Nature Medicine by researchers at the University of California,
San Diego (UCSD) School of Medicine.
PET scans demonstrated an increase in the brain's use of glucose,
an indication of increased brain activity, while mental-status
tests showed a slowing of the patients' rate of cognitive decline
was reduced by 36 to 51 percent. In addition, researchers examined
the brain tissue of a study participant who had died and found
robust growth of extensions from the dying cholinergic cells near
the site of growth factor gene delivery. Cholinergic neuron loss
is a cardinal feature of Alzheimer's disease, a progressive brain
disorder affecting memory, learning, attention and other cognitive
"If validated in further clinical trials, this would represent
a substantially more effective therapy than current treatments
for Alzheimer's disease," said Mark Tuszynski, M.D., Ph.D.,
UCSD professor of neurosciences, neurologist with the VA San Diego
Healthcare System, and the study's principal investigator. "This
would also represent the first therapy for a human neurological
disease that acts by preventing cell death."
In this first-ever gene therapy for Alzheimer's disease, UCSD
physician-scientists took skin cells from eight patients diagnosed
with early Alzheimer's disease. The tissue was modified in the
lab to express nerve growth factor (NGF), a naturally occurring
protein that prevents cell death and stimulates cell function.
In surgeries that took place in 2001 and 2002 at UCSD's John M.
and Sally B. Thornton Hospital, the genetically modified tissue
was implanted deep within the brains of the eight patients who
had volunteered for the study.
The human clinical trial was undertaken following extensive studies
in primates conducted by Tuszynski and colleagues, which showed
that grafting NGF-producing tissue into the brains of aged monkeys
restored atrophied brain cells to near-normal size and quantity,
and also restored axons connecting the brain cells, essential
for communication between cells.
Cognitive outcomes were assessed in the six patients who completed
the NGF delivery procedure safely. The Mini Mental Status Examination
(MMSE), which evaluates cognitive function, was administered at
screening, the time of treatment and at several intervals after
treatment. Over an average post-treatment follow-up period of
22 months, the rate of decline on the MMSE among NGF-treated patients
was reduced by as much as 51 percent. An additional test, called
the Alzheimer's Disease Assessment Scale-Cognitive Subcomponent,
or ADAS-Cog, also showed improvements in rates of decline followed
the MMSE findings.
In addition to Tuszynski, authors of the paper in Nature Medicine,
were Leon Thal, M.D., UCSD chair of neurosciences, director of
the UCSD Shiley-Marcos Alzheimer's Disease Research Center (ADRC),
and a neurologist with the VA San Diego Healthcare System; Mary
Margaret Pay., and others.
The study was supported by the Institute for the Study of Aging
and the Shiley Family Foundation
Please see the online newsblog entry about this study for an
image of the PET scans referred to in the research - http://www.schizophrenia.com/sznews/archives/001735.html