Recognizing Suicide Risk Factors in Primary and Psychiatric Care

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In those with major depression, the risk for suicide is increased 20-fold compared with the general population.[1] A history of major depression is present in about 60% of those who complete suicides. An estimated 8% of those with major depression attempt suicide at some time during their lifetime. This rate is increased in those with comorbid anxiety disorders (eg, 25% with comorbid panic disorder and 38% in those with comorbid posttraumatic stress syndrome disorder).[2] About 31,000 people in the United States and 1 million worldwide die by suicide each year, and 650,000 people in the United States are treated emergently following a suicide attempt.[3]

Reported by Larry Culpepper, MD, MPH
Medscape Psychiatry & Mental Health
http://www.medscape.com/viewarticle/730857

Disclaimer: Neither SARDAA nor SA, assume any legal liability, responsibility nor does inclusion of articles or comments constitute or imply its endorsement, recommendation, or favoring for the accuracy, completeness, or usefulness of any information, product or process disclosed in the blog.

Family Therapy May Cut Relapse Rates in Schizophrenia

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Family interventions that curb negative emotions might help schizophrenic patients avoid relapse, primarily by promoting medication compliance, according to a new Cochrane systematic review.

Compared to standard care with medications, therapy that reduced negative emotions against the schizophrenic member of the family reduced relapses by 45% and hospitalizations by 22%, while increasing medication compliance by 40%, according to lead author Dr. Fiona Pharoah and associates.

“I see this as further validation of the potential impact family psychoeducation can have, beyond what medication can do to reduce relapse and hospitalizations,” said Dr. Lisa Dixon, professor of psychiatry at the University of Maryland School of Medicine, Baltimore, who was not involved in this research.

“The real question now is why it isn’t used more widely,” she added.

Relapses are more frequent in schizophrenia when families are critical, hostile, or overly involved, the authors explain. The goals of family psychosocial interventions are to reduce levels of expressed emotion, stress and family burden while improving problem-solving skills.

Reported by Karla Gale
Reuters Health
http://www.medbioworld.com/news.php?topic=0&article=20101110clin010.xml

Disclaimer: Neither SARDAA nor SA, assume any legal liability, responsibility nor does inclusion of articles or comments constitute or imply its endorsement, recommendation, or favoring for the accuracy, completeness, or usefulness of any information, product or process disclosed in the blog.

From Cognition to Genomics: Progress in Schizophrenia Research

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This week’s issue of Nature has a special section dedicated to research progress on schizophrenia.i There have been few such issues dedicated to any medical disorder, so this is a landmark for schizophrenia research, a follow-up perhaps to an editorial in Nature at the beginning of this year predicting a “decade for psychiatric disorders”.ii But beyond the mere fact that schizophrenia has been singled out for this distinction, the contents document remarkable progress on a disorder that has been such a conundrum for the past century.

For one thing, schizophrenia can now be described as a brain disorder or, more precisely, as a disorder of brain circuits. With neuroimaging, several of the major nodes in the circuit have been identified, especially within the prefrontal cortex. A major advance has been linking changes in circuit function to cognition and behavior. As a result, we are increasingly focusing on the cognitive deficits of schizophrenia as the core problem, preceding and perhaps leading to the more obvious positive symptoms of hallucinations and delusions.

Another area of unambiguous progress has been genomics. Five years ago the field was frustrated by the lack of replicated findings. With the creation of international consortia sharing data from thousands of patients, we can now see several of the major risk genes. They are not the usual suspects, such as genes involved in dopamine or serotonin neurotransmission. Common variants in genes from the MHC complex, which is important for immune self-recognition, a gene for a transcription factor called TCF4, and several genes that encode synaptic proteins have all been found to confer increased risk. The list is probably not complete as together these explain only a fraction of the genetic risk for the disorder. Many rare variants have also been described in the past year, adding to the known major structural lesions like DISC1 and the 22q11 deletion. These rare events may explain only a small fraction of cases, but as with hypertension and cancer, even rare mutations that cause disease can yield important clues to the pathophysiology underlying more common forms of disease.

From genomics have come clues to the importance of reconceptualizing schizophrenia as a neurodevelopmental disorder. Many of the genetic factors are involved with neurodevelopment; hardly surprising as thousands of genes must be expressed in a carefully choreographed sequence to develop a healthy brain. What is unexpected is that many of the genetic variations associated with schizophrenia appear to disrupt fragments of proteins expressed only in fetal development……

Dr. Thomas Insel
NIMH Director
NIMH’s Director Blog
http://www.nimh.nih.gov/about/director/index.shtml#p115270

Disclaimer: Neither SARDAA nor SA, assume any legal liability, responsibility nor does inclusion of articles or comments constitute or imply its endorsement, recommendation, or favoring for the accuracy, completeness, or usefulness of any information, product or process disclosed in the blog.

Is Recovery Attainable in Schizophrenia?

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Is recovery attainable once someone had a diagnosis of schizophrenia? The short answer is, “it depends.” The answer has a lot to do with how recovery is defined, as will be discussed in greater detail in this review. Currently there is no agreed-on definition of recovery pertaining to someone with schizophrenia or a related persistent psychotic disorder. Therefore, we will review the various meanings in how the word “recovery” is used in the context of someone with schizophrenia. It is my belief that a large part of the current difficulties arise from the lack of precision in some of the terminology, which then creates misunderstanding and unnecessary controversy.

This review will try to sort out what is — and is not — known about the recovery process. To make matters even more complicated, right now there is no consensus among researchers as to whether schizophrenia is best characterized as a progressive disorder whose natural history is to get worse with time, or is a neurodevelopmental problem that, while serious, is not progressive. If the field cannot come to agreement on this issue, this uncertainty creates many challenges in helping clinicians formulate appropriate long-term treatment plans.

Reported by Peter J. Weiden, MD
Medscape Psychiatry & Mental Health
http://www.medscape.com/viewarticle/729750

Disclaimer: Neither SARDAA nor SA, assume any legal liability, responsibility nor does inclusion of articles or comments constitute or imply its endorsement, recommendation, or favoring for the accuracy, completeness, or usefulness of any information, product or process disclosed in the blog.

Mental Illness in 2010: Putting the Recovery Model Into Practice

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The Refocus on Recovery 2010 conference, held in London, United Kingdom on September 20th to 22nd, provided a multitude of insights for clinicians interested in applying the recovery paradigm to clinical psychiatric practice. After a brief overview of the recovery model, which has been developed primarily in public-sector psychiatric settings caring for individuals with serious mental illnesses, I will summarize some ways that this approach can be put into practice.

Reported by Michael T. Compton, MD, MPH
Medscape Psychiatry & Mental Health
http://www.medscape.com/viewarticle/730233

Disclaimer: Neither SARDAA nor SA, assume any legal liability, responsibility nor does inclusion of articles or comments constitute or imply its endorsement, recommendation, or favoring for the accuracy, completeness, or usefulness of any information, product or process disclosed in the blog.

$379 MILLION FOR ACCESS TO RECOVERY GRANTS

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Just over 22 million people (8.9 percent of this population) had a diagnosable substance abuse problem last year. To help people access substance abuse treatment, the Substance Abuse and Mental Health Services Administration (SAMHSA) is awarding up to $379 million over the next four years for Access to Recovery (ATR) grants. The ATR program provides vouchers to people with drug and alcohol use problems to pay for needed treatment and recovery support services.

“Access to Recovery provides resources to people seeking help with conquering drug and alcohol addiction,” said Pamela S. Hyde, J.D., SAMHSA Administrator. “Vouchers provide people access to treatment options that fit their needs and give them the flexibility to find the best path to recovery. Investing in treatment and recovery support not only saves lives, but every dollar invested in treatment and recovery services returns $7 in cost savings from social benefits such as reduced health costs, crime, and lost productivity.”

Both clinical treatment services and recovery support services are supported by ATR. Clinical treatment services are provided by individuals who are licensed, certified, or otherwise credentialed. Examples of clinical treatment services include screening, individual counseling, group counseling, treatment services for co-occurring mental disorders, and medication-assisted therapy.

SAMHSA Press Office
http://www.samhsa.gov/newsroom/advisories/1010081330.aspx

Disclaimer: Neither SARDAA nor SA, assume any legal liability, responsibility nor does inclusion of articles or comments constitute or imply its endorsement, recommendation, or favoring for the accuracy, completeness, or usefulness of any information, product or process disclosed in the blog.

S.A. Step Two – I CHOOSE.

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I choose to be well. I take full responsibility for my choices and
realize the choices I make directly influence the quality of my days.
Many people with schizophrenia don’t realize that they have choices
bearing on their illness. Senior members of SA try to encourage new
members to fully grasp their choices. The primary alternative is a
conscious decision to get better.

To choose to be well may involve cooperating with a psychiatrist or a
psychotherapist, listening to what they say and adhering to their
advice. Another choice maybe to recognize the need to take the
medication that helps so many people with schizophrenia. To choose to
be well may also require the patient to acknowledge that, at some
point during his or her recovery, there may be setbacks and
re-hospitalization may be necessary.

The decision to be well may mean different things to different people.
A person with schizophrenia in the “back wards” of a state psychiatric
hospital is no more responsible for his or her illness than others and
he or she may be so overwhelmed with symptoms (such as voices) that
personal choice is limited.

Yet, SA encourages such a patient to make the best of his or her
circumstances, to make choices that would influence the quality of his
or her days. This might involve avoiding behaviors that would lead to
the patient being placed in seclusion in a locked room or to being
placed in restraints. We encourage behaviors that would lead to
granting of special passes to the patient, such as a grounds card,
enabling the patient to get out of the ward and into the sunlight.

One of the principles of Schizophrenics Anonymous is that, although we
may not be responsible for symptoms, we are responsible for our
responses. For those ready to accept the responsibility, comes the
satisfaction of having increased control on one’s own life and future.

SOURCE S.A. Blue Booklet (program text, first published in 1989)

Disclaimer: Neither SARDAA nor SA, assume any legal liability, responsibility nor does inclusion of articles or comments constitute or imply its endorsement, recommendation, or favoring for the accuracy, completeness, or usefulness of any information, product or process disclosed in the blog.

BRAIN SCANS – NOT QUITE READY FOR PRIME TIME

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http://www.nimh.nih.gov/about/director/2010/brain-scans-not-quite-ready-for-prime-time.shtml

Dr. Thomas Insel
Director’s Blog
NIMH Director

Submitted by Anna

Disclaimer: Neither SARDAA nor SA, assume any legal liability, responsibility nor does inclusion of articles or comments constitute or imply its endorsement, recommendation, or favoring for the accuracy, completeness, or usefulness of any information, product or process disclosed in the blog.

NIH LAUNCHES GENOTYPE-TISSUE EXPRESSION PROJECT—PROJECT TO CHART INFLUENCE OF DNA CHANGES ON GENE FUNCTION IN HUMAN TISSUES AND ORGANS

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The National Institutes of Health announced awards to support an initiative to understand how genetic variation may control gene activity and its relationship to disease. Launched as a pilot phase, the Genotype-Tissue Expression (GTEx) project will create a resource researchers can use to study inherited susceptibility to illness and will establish a tissue bank for future biological studies.

http://www.nimh.nih.gov/science-news/2010/nih-launches-genotype-tissue-expression-project.shtml

Submitted by Anna

Disclaimer: Neither SARDAA nor SA, assume any legal liability, responsibility nor does inclusion of articles or comments constitute or imply its endorsement, recommendation, or favoring for the accuracy, completeness, or usefulness of any information, product or process disclosed in the blog.

NIH RESEARCH MATTERS: STRESS HORMONE CAUSES EPIGENETIC CHANGES

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Researchers found that chronic exposure to a stress hormone causes modifications to DNA in the brains of mice, prompting changes in gene expression. The new finding provides clues into how chronic stress might affect human behavior.

Reported by Harrison Wein, Ph.D.

http://www.nih.gov/researchmatters/september2010/09272010stress.htm

Submitted by Anna

Disclaimer: Neither SARDAA nor SA, assume any legal liability, responsibility nor does inclusion of articles or comments constitute or imply its endorsement, recommendation, or favoring for the accuracy, completeness, or usefulness of any information, product or process disclosed in the blog.