Targeting Nicotine Receptors to Treat Cognitive Impairments in Schizophrenia

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Smoking is a common problem for patients with schizophrenia. The increased tendency of patients diagnosed with this disorder is to not only smoke, but to do so more heavily than the general public. This raises the possibility that nicotine may be acting as a treatment for some symptoms of schizophrenia.

Nicotine acts through two general classes of brain receptors, those with high and low affinity for nicotine. The low affinity class of nicotinic receptors contains the alpha-7 subunit, which is present in reduced numbers in people with schizophrenia.

Two papers published in the January 1st issue of Biological Psychiatry suggest that drugs that stimulate these alpha-7 subunit-containing nicotinic receptors might enhance cortical function and treat cognitive impairments associated with schizophrenia.

In their study of healthy monkeys, Graham Williams and colleagues at Yale University and AstraZeneca found that very low doses of AZD0328, a novel drug that acts as an alpha-7 agonist, produced both acute and persistent improvements in their performance on a spatial working memory task……

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Elsevier, via AlphaGalileo.

Journal References:
1. Jason R. Tregellas, Jody Tanabe, Donald C. Rojas, Shireen Shatti, Ann Olincy, Lynn Johnson, Laura F. Martin, Ferenc Soti, William R. Kem, Sherry Leonard. Effects of an Alpha 7-Nicotinic Agonist on Default Network Activity in Schizophrenia. Biological Psychiatry, 2011; 69 (1): 7 DOI: 10.1016/j.biopsych.2010.07.004
2. Stacy A. Castner et al. Immediate and Sustained Improvements in Working Memory After Selective Stimulation of α7 Nicotinic Acetylcholine Receptors. Biological Psychiatry, (in press)

http://www.sciencedaily.com/releases/2011/01/110111084220.htm

NIMH OUTREACH PARTNERSHIP PROGRAM UPDATE for February 1, 2011

The Outreach Partnership Program a nationwide outreach initiative of the National Institute of Mental Health (NIMH) that enlists state and national organizations in a partnership to help close the gap between mental health research and clinical practice, inform the public about mental illnesses, and reduce the stigma and discrimination associated with mental illness. For more information about the program please visit: http://www.nimh.nih.gov/outreach/partners. To subscribe to receive the Update every two weeks, go to: http://www.nimh.nih.gov/outreach/partnership-program/subscribe-to-the-update.shtml

The information provided in the Update is intended for use by NIMH Outreach Partners, National Partners and their associates for the express purpose of exchanging information that may be useful in the development of state and local mental health outreach, information, education and partnership programs.

NIMH_Update_2-1-11

SARDAA is a supporter and sponsor of the Independence At Home Act

On February 3, HHS Secretary Sebelius sent a letter to the Governors suggesting ways states might reduce their spending on Medicaid. http://www.hhs.gov/news/press/2011pres/01/20110203c.html The letter and its attachment notes that “five percent of [Medicaid] beneficiaries accounted for more than half of all Medicaid spending and one percent of beneficiaries accounted for 25 percent of all expenditures” and that 15% of “dual eligibles” account for 40% of all Medicaid spending. The letter further notes that most of these high cost beneficiaries suffer from chronic and disabling conditions. The letter further show that reducing the cost of this beneficiary population by just 10% “could save $15.7 billion in total Medicaid spending and produce a significant positive impact on longer term spending trends.”

The Independence at Home program was designed expressly to address the needs of the highest cost beneficiaries suffering from multiple chronic diseases and disabilities. The IAH home-based primary care model has been proven at hundreds of locations across the country for decades and has produced savings of 23% to 60% for this high cost patient population. This experience shows that the Independence at Home program could reduce Medicaid costs by more than $30 billion a year, based on HHS’ numbers.

The letter from Secretary Sebelius states that new service delivery models that focus on the high cost chronically ill population can be implemented without a waiver under the “Health Home” provision at section 2703 of PPACA that became effective January 1, 2011 and that the new Federal Coordinated Care Office is assisting the states to develop new models for serving the “dual eligibles”. Representatives of the American Academy of Home Care Physicians and staff from the offices of Congressman Ed Markey and Ron Wyden met on January 6 with personnel from the Federal Coordinated Care Office and showed how the Independence at Home program can be implemented by states under the “Health Home” provisions in section 2703. The Independence at Home program is the only program under the health reform legislation that (A) expressly targets the highest cost patient population, (B) provides primary care tailored to the patient’s individual needs in the home, (C) coordinates care across all treatment settings, (D) requires a minimum level of savings, outcomes and patient/caregiver satisfaction and (E) significantly reduces costs—not by cutting reimbursement or coverage—but by adding a new chronic care coordination benefit that better addresses the patient’s needs.

Several states are considering the Independence at Home program because it does not require any additional expenditures and is funded entirely from savings. Please let me know if you need more information about IAH as a Medicaid health home.

Jim Pyles
on behalf of the American Academy of Home Care Physicians and
The Independence at Home Coalition
POWERS PYLES SUTTER & VERVILLE PC
1501 M Street NW, Seventh Floor | Washington, DC 20005-1700
tel 202.466.6550 | fax 202.785.1756
jim.pyles@ppsv.com | www.ppsv.com

A Predictable Tragedy in Arizona: We emptied state mental hospitals starting in the 1960s without providing adequate treatment alternatives.

The killing of six people in Tucson is one more sad episode in an ongoing series of tragedies that should not be happening. The alleged shooter, Jared Lee Loughner, is reported to have had symptoms associated with schizophrenia—incoherent thought processes, delusional ideas, erratic behavior—and almost certainly was seriously mentally ill and untreated. The fact that he was barred from his college until he was evaluated by a psychiatrist would appear to confirm the nature of the problem.

The truth is that these tragedies are happening every day throughout the United States. The only reason this episode has received widespread publicity is because there were multiple victims and one victim was a member of Congress. Such senseless killings have become increasingly common over the past 30 years, starting in about 1980, when Allard Lowenstein, coincidentally a former congressman, was killed by Dennis Sweeney. Sweeney was a young man with untreated schizophrenia who had been Lowenstein’s protégé in the civil rights movement. Congress was also prominently involved in 1998, when Russell Weston, who also had untreated schizophrenia, killed two policemen while trying to shoot his way into the Capitol Building in Washington, D.C.

These tragedies are the inevitable outcome of five decades of failed mental-health policies. During the 1960s, we began to empty the state mental hospitals but failed to put in place programs to ensure that the released patients received treatment after they left. By the 1980s, the results were evident—increasing numbers of seriously mentally ill persons among the homeless population and in the nation’s jails and prisons.

Over the past three decades, things have only gotten worse. A 2007 study by the U.S. Justice Department found that 56% of state prisoners, 45% of federal prisoners, and 64% of local jail inmates suffer from mental illnesses.

A 2008 study out of the University of Pennsylvania that examined murders committed in Indiana between 1990 and 2002 found that approximately 10% of the murders were committed by individuals with serious mental illnesses. There are about 16,000 homicides a year in this country. Using the Indiana study as a guide, roughly 1,600 of them are likely committed by people with serious mental illnesses.

In Arizona, public mental-health services are among the worst in the nation. In a 2008 survey by the Treatment Advocacy Center, Arizona ranked next to last among all states in the number of psychiatric hospital beds per capita. If you don’t have hospital beds and outpatient clinics to treat mentally ill people, those people don’t get treated. Thus the tragedy was somewhat more likely to happen in Arizona because mentally ill individuals are less likely to receive treatment there. Although Arizona is the worst state, except for Nevada, in psychiatric-bed availability, there is no state that currently has enough beds for its mentally ill population, according to the Treatment Advocacy Center study. This tragedy occurred in Arizona, but it could easily have happened in any state….Read on!

Reported by E. Fuller Torrey
The Wall Street Journal
http://online.wsj.com/article/SB10001424052748703779704576073973345594508.html

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.

SA Member Letter to Pres. Obama

January 16th, 2011

To: President Barack Obama
c/o The White House
1600 Pennsylvania Avenue, NW
Washington, DC 20500

To: President Obama

From: Margery Wakefield

Re: Jared Loughner and the problem of untreated severe mental illness in the U.S.

“Individuals with severe mental illnesses are no more violent than the general population – so long as they are being treated.”
Dr. E. Fuller Torrey

Dear President Obama,

My name is Margery Wakefield, and I live in Denver, Colorado. I have the illness of schizophrenia. I was diagnosed at age seventeen after a severe psychotic break. I have been on medication since that age, and have actively sought treatment for my condition.

I will also say that I have a master’s degree in social work, and I belong to MENSA (I am intelligent). I work part time, have my own apartment, drive a car, teach piano, write books, travel, have many friends, and have a very quality life!!!

On Wednesday nights (for the past five years), I run a support group for adult schizophrenics at the mental health center in Denver. We are a part of SARDAA (Schizophrenia and Related Disorders Alliance of America in Houston, Texas). The group is a social and educational support group in which we emphasize the importance of staying on medications, and using hospitalization when necessary. In addition to our regular meetings, we have parties, pizza nights, community outings, and an annual picnic for members and their families. We have fun!

I am very concerned about the problem in this country of the UNTREATED severely mentally ill population. When violent, they give the rest of us a bad name. I take that personally.

I would like to make a suggestion: please set up a task force to study this problem so that the tragedy in Arizona (and others) does not repeat itself. The purpose of the task force would be:

1. To study how this problem is handled in other countries.
2. To examine FEDERAL legislation re: involuntary procedures to restrain severely mentally ill persons who give evidence of being a danger to themselves and/or others until those persons can be properly evaluated and treated.
3. To make legislation that would require such individuals to have some sort of follow-up to make sure they are continuing in treatment.

The task force should include a consumer advocate as well as experts in the field such as Dr. Torrey.

As Dr. Torrey states in a recent article:
“The solution to this problem is obvious – make sure individuals with serious mental illnesses are receiving treatment. Many such patients will take medication voluntarily if it is made available to them. Others are unaware they are sick and should be required by law to receive assisted outpatient treatment, including medication and counseling… If they do not comply with the court-ordered treatment plan, they can and should be involuntarily admitted to a hospital.”
OPINION JOURNAL December 21, 2010

I am sick at heart that a nine-year-old child was a victim of this man’s (Loughner’s) sick rage.

Please see that this tragedy does not happen again!!!

Sincerely,

Margery Wakefield

Using Electricity, Magnets for Mental Illness

Physicians have known for 2,000 years that electricity could help troubled minds—even before they knew what electricity was. Roman Emperor Claudius pressed electric eels to his temples to quell headaches. Sixteenth-century doctors induced seizures with camphor to treat psychiatric illnesses.

Now, research is advancing rapidly on a host of far more precise techniques to stimulate or calm the brain with electricity, magnets or even ultrasound and infrared waves. Most of the therapies target severe, resistant depression—a problem for nearly seven million Americans. But some are also showing promise for treating obsessive-compulsive disorder, panic disorders, schizophrenia, addictions and memory problems.

Some battery-operated brain stimulators are even being marketed for home use, so patients can treat their own depression and insomnia, though some neurologists say the evidence for these devices is thin.

“There’s a stampede of these new technologies,” says Mark George, a psychiatrist and neurologist at the Medical University of South Carolina and editor-in-chief of the journal Brain Stimulation. “There are all these different ways to get into the brain and figure out how to change the circuits.”

Indeed, there’s a growing consensus among neuroscientists that many psychiatric illnesses stem from problems in the brain’s electrical circuits.

“In psychiatry, we have gone from ‘It’s all about your mother’ a la Freud to the concept of chemical imbalances in the brain to the current focus on dysfunctional brain circuits and genetics,” says Emory University neurologist Helen Mayberg, a pioneer in brain imaging and depression.

Reported by Melinda Beck
The Wall Sreet Journal
http://online.wsj.com/article/SB10001424052748703779704576073762463762744.html?KEYWORDS=schizophrenia

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.

Learn More Quickly by Transcranial Magnetic Brain Stimulation, Study in Rats Suggests

What sounds like science fiction is actually possible: thanks to magnetic stimulation, the activity of certain brain nerve cells can be deliberately influenced. What happens in the brain in this context has been unclear up to now. Medical experts from Bochum under the leadership of Prof. Dr. Klaus Funke (Department of Neurophysiology) have now shown that various stimulus patterns changed the activity of distinct neuronal cell types. In addition, certain stimulus patterns led to rats learning more easily. The knowledge obtained could contribute to cerebral stimulation being used more purposefully in future to treat functional disorders of the brain.

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Ruhr-University Bochum.
Science Daily
http://www.sciencedaily.com/releases/2011/01/110128121629.htm

Journal References:
1. Annika Mix, Alia Benali, Ulf T. Eysel, Klaus Funke. Continuous and intermittent transcranial magnetic theta burst stimulation modify tactile learning performance and cortical protein expression in the rat differently. European Journal of Neuroscience, 2010; 32 (9): 1575 DOI: 10.1111/j.1460-9568.2010.07425.x
2. Benali, A., Trippe, J., Weiler, E., Mix, A., Petrasch-Parwez, E., Girzalsky, W., Eysel, U.T., Erdmann, R. and Funke, K. Theta-burst transcranial magnetic stimulation alters cortical inhibition. J. Neurosci., (in press)

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.

The Line Between Madness and Mayhem: What science tells us about the risk of violence, and why treatment in prisons could help

There has been a lot of speculation about whether Jared Lee Loughner, the man arrested for the Arizona shooting, has a severe mental illness. But is mental illness a sufficient explanation for his actions? Recent research has found that mental illness is, in fact, tied to an increased risk of violence—but it is not a simple relationship.

Most experts before the 1990s argued that violence perpetrated by the mentally ill was no more common than violence by the non-mentally ill, once socioeconomic factors were taken into account. This view was advocated by several generations of clinicians and mental health workers—perhaps in part to counter the stigma that psychiatric patients were dangerous—but it lacked any consistent evidence.

We now know that there is an increased risk of violence in individuals suffering from severe mental illness. This conclusion has been confirmed by large-scale historical studies drawing on routinely collected national data in Sweden, Denmark, Australia and Finland. These have consistently found an increased risk of violence in individuals with schizophrenia, bipolar disorder and some forms of severe brain injury.

With the advent of new research tools over the past 20 years, more sophisticated summaries of existing studies have also been possible. The most recent systematic review on this subject, published in the journal PLoS Medicine in 2009 and involving over 18,000 subjects in 11 countries, found that individuals with schizophrenia were more likely, as compared to the general public, to commit acts of violence, regardless of how violence was measured. This increase was typically two to five times higher in men with schizophrenia and over four-fold higher in women with schizophrenia. As one expert commented, clinicians have to face up to this “unpalatable” evidence “for the sake of our patients.” A similar review on bipolar disorder and violence from 2010 found similar increases in risk.

These investigations also found, however, that only 3% to 10% of all violence in society is committed by individuals with severe mental illness. In other words, at least 90% of all violent crime in Western countries is committed by people who are not suffering from such conditions. In Sweden, for example, from 1988 to 2000, there were 45 violent crimes per 1,000 persons, of which two to three were attributable to persons with severe mental illness.

Moreover, the vast majority of patients with severe mental illness are not violent during their lifetimes. The largest and longest study of schizophrenia and violence, conducted in Sweden over the course of 30 years, found that only 13% of patients had violent convictions after receiving their diagnoses. For most patients, the risk of becoming a victim of violence is higher than the risk that they will commit violence.

Nor should we make the mistake of assuming that a correlation between mental illness and violence somehow establishes a causal connection between them. It may be that schizophrenia is simply a marker for other factors that increase the risk of violence. Of these factors, one of the strongest is alcohol and drug abuse. Estimates from the U.S. indicate that around half of patients with schizophrenia also have problems with substance abuse. One study in American urban centers found that nearly a third of patients who were discharged from the hospital and also diagnosed with substance abuse were violent within one year…….

Reported by Seena Fazel
The Wall Street Journal
http://online.wsj.com/article/SB10001424052748703583404576080373538042898.html?KEYWORDS=schizophrenia

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.

FDA panel advises more testing of ‘shock-therapy’ devices

An expert panel advising the Food and Drug Administration decided Friday that electroconvulsive therapy (ECT) machines should undergo the same rigorous testing as new medical devices coming onto the market – a decision that could drastically affect the future of psychiatry’s most controversial treatment.

Reported by David Brown
The Washington Post
http://www.washingtonpost.com/wp-dyn/content/article/2011/01/28/AR2011012806328.html

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.

SUICIDAL THOUGHTS AND BEHAVIORS AMONG ADULTS

Annual averages of combined 2008 and 2009 data indicate that an estimated 8.4 million adults aged 18 or older had thought seriously about committing suicide in the past year; 2.3 million had made a suicide plan in the past year; and, 1.1 million had attempted suicide in the past year. The rates of thinking seriously about committing suicide, making plans for suicide, and attempting suicide were higher among young adults aged 18 to 25 than the rates among other age groups, and among the unemployed than among those in other employment categories. Of the 1.1 million adults who attempted suicide in the past year, 61.2 percent received medical attention for their suicide attempt, and 43.9 percent stayed overnight or longer in a hospital for their suicide attempt.

http://oas.samhsa.gov/2k10/212/SuicidalThoughts.cfm

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.