watchLAB: Looking for Caregiver Perspectives Regarding Schizophrenia Treatment

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watchLAB health is trying to find caregivers of schizophrenia patients for a paid non-clinical market research study we are conducting.

Caregivers can receive $150 for as little as 105 minutes of their time and feedback regarding developments in the care of schizophrenic patients. We are currently scheduling group discussions in Chicago’s River North neighborhood for Wednesday, July 24th and Thursday, July 25th.

Interested caregivers can contact us at 312-428-2585 and refer to project #115 to see if they qualify. Also, they have the option of filling out some of our pre-questions through our secure online portal at https://www.research.net/s/caregiverresearch

Please note that:

- The conversation is for research only.

- All identifying information for participants is protected and kept confidential.

- No attempt will be made to sell anything during or as a result of participation.

 

You can visit www.watchlab.com to learn more about us. watchLAB professional associations include MRA, EphMRA & ESOMAR, PBIRG, and PMRG. watchLAB Health is the growing health branch of a progressive company bringing convenience and practicality to the forefront of market research. Please let us know if you have a preferred method of contact or any suggestions on how we can make participating more feasible for you.

‘My Son played Russian Roulette With Cannabis – and Lost’: Patrick and Henry Cockburn Tell Their Story

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Award-winning journalist Patrick Cockburn has spent many years working as a foreign correspondent, reporting from the world’s trouble spots from Belfast to Baghdad. Here, however, he tells an intensely personal story – how his son succumbed to schizophrenia

On February 8, 2002, I called my wife Jan from Kabul where I was working as a foreign correspondent. Jan sounded more anxious than I had ever heard her, and I felt a sense of dread as I realised there had been some disaster.

Henry, our 20-year-old son, had nearly died when he swam across the River Ouse estuary at Newhaven, East Sussex, fully clothed and was rescued by fishermen as he left the near-freezing water. The police had been called and decided Henry was a danger to himself. He was now in a psychiatric hospital.

This was the beginning of eight years of mental illness for Henry. During much of that period Jan and I lived with an almost constant sense of dread and disaster.

As Henry started to recover – and this recovery is by no means complete – about three years ago, I began to think we should write about our experiences. Henry is well enough to write but not so distant from his psychosis that it has become ancient history in his mind. I believed we could serve a broader purpose by making mental illness less of a mystery. I ran the idea past Henry and he liked it.

by Patrick and Henry Cockburn, DailyMail

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Neuroprotective Effects of Antidepressant and Mood Stabilizing Drugs

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Recent animal studies have led us to reconsider the mechanism of action of antidepressant and mood stabilizing drugs. Whereas effects on neurotransmitter systems and intracellular signalling pathways continue to amass, studies now suggest that these drugs may act to prevent neuronal damage and cell loss that may occur in the brain of patients with mood disorders. Animal studies suggest that antidepressant and mood stabilizing drugs are neuroprotective and may also lead to neurogenesis in selected brain regions. Although the mechanisms through which neuroprotection occurs and the experimental conditions differ for these 2 classes of drugs, the net effects are clearly relevant to the pathophysiology of mood disorders.

L. Trevor Young, Journal of Psychiatry and Neuroscience

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Psychiatry Gets More Scientific

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Hello. This is Dr. Jeffrey Lieberman of Columbia University, speaking to you for Medscape. Today I am going to talk about a study that recently appeared in Neuron [1] and was published by a research group at Columbia, of which I am a member.

The article is titled, “Imaging Patients With Psychosis and a Mouse Model Establishes a Spreading Pattern of Hippocampal Dysfunction and Implicates Glutamate as a Driver.” The first author is my colleague and former student, Scott Schobel, a talented young psychiatric researcher, and the senior author is Dr. Scott Small, a colleague of mine in the Department of Neurology, with whom we collaborate closely.

The reason I wanted to talk about this paper today is that it illustrates 2 things that are fundamentally important to where psychiatry is going. First, the study illustrates the potential power of early identification and intervention in mental disorders and, in this case, in the area of psychotic disorders and schizophrenia in particular. Second, the research reported in this paper illustrates what is called translational research — the ability to take a clinical problem and to study it preclinically in animals using basic science techniques or to take studies that come from basic science in the laboratory and move them into human studies.

by Jeffrey A. Lieberman, M.D., Medscape

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Lithium Demonstrates Neuroprotective Effects

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Treatment with lithium is associated with increased hippocampal volume in patients with bipolar disorder, even if those patients have severe, highly recurrent illness.

The finding provides more evidence that lithium has neuroprotective effects and may be more widely useful in patients with neurodegenerative disorders, researchers said here in an oral session at the 10th International Conference on Bipolar Disorders (ICBD).

“We see pronounced structural brain changes in patients with bipolar disorder who have been ill for a long time, unless they have been treated with lithium,” lead author Tomas Hajek, MD, from Dalhousie University, Halifax, Nova Scotia, Canada, told Medscape Medical News.

“Patients who are not treated with lithium have smaller hippocampal volumes compared with those who are treated with lithium. Even if the patients have been ill for years, have had many episodes, and have spent months or years in those episodes, if they are treated with lithium, their brains are comparable to those of healthy controls,” Dr. Hajek said.

by Fran Lowry, Medscape

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DSM-5′s Validity: Non Sumus Angeli!

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Whenever some reporter makes the fatuous claim, “The DSM is psychiatry’s bible!” I am reminded of a story concerning the Vatican, during the years of Pope John XXIII. It seems that a new building had to be constructed on Vatican grounds, and the architect submitted his plans directly to the Pope. Soon the plans were returned to the architect with the words “Non sumus angeli” written in the margin: “We are not angels.” The architect and his staff were baffled as to what the Pope meant, until finally someone noticed the plans did not include bathrooms.

No, psychiatrists are not gods or angels, and the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)[1] is not our “bible.” It is a useful but incomplete text; an informative but fallible guide. Many of us respect the time and effort that went into developing the DSM-5, while also hoping that DSM-5.1 or -5.2 will provide substantially more. Of course, we would all like more neuroscience, and many of us would like to see more psychodynamic explication of the major disorders. Although symptom checklists lend themselves to the goals of research — for example, establishing cut-offs and inclusion criteria for a particular study — they rarely answer the needs of clinicians for a comprehensive understanding of the patient.[2] I believe that the framers of the DSMs have always acknowledged this limitation.

That said, I bristle when I hear some in the mental health field — and many in the mass media — argue that the DSM- 5 is “not valid” because it lacks definitive biological tests or biomarkers. This sort of claim reflects a profound misunderstanding on the part of both the general public and, alas, many clinicians: namely, the identification of ”scientific” with “laboratory test” or “radiologic image.” This amounts to a kind of scientism, not science, and the public has been sold a bill of goods on this subject.

by Ronald W. Pies, M.D., Medscape

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Phone Calls May Help Keep Suicide at Bay in Bipolar Disorder

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A novel telephone-based intervention to help ease the transition from inpatient to outpatient after a suicide attempt is showing definite promise as an effective suicide prevention strategy for people with bipolar disorder.

Dubbed the Coping Long-Term with Active Suicide Program for Bipolar Disorder, or CLASP-BD, the intervention was found to be feasible and acceptable to patients to reduce their risk for suicide in the 12 months following hospitalization for bipolar depression.

“Suicide risk in bipolar disorder is extremely high, arguably the highest amongst all the psychiatric disorders,” Lauren Weinstock, PhD, from Brown University, Providence, Rhode Island, told Medscape Medical News.

“We feel, from a clinical perspective, that we really need to develop interventions that target suicide specifically if we are going to reduce this risk,” Dr. Weinstock said here at the 10th International Conference on Bipolar Disorders (ICBD).

Suicide Risk Forgotten After Hospital Discharge

As she was developing CLASP, Dr. Weinstock said she discovered that once patients were discharged from the hospital, the fact that they remained at risk for suicide was forgotten.

“We found this anecdotally, and it is actually quite alarming. After a suicide crisis, patients often go back to their community providers, and the providers may pay some attention to the suicide attempt immediately after the hospitalization, but in the months that follow, it doesn’t come up again in treatment. But the fact is, we need to continue to pay close attention to suicide risk, which remains very high in the first 12 months after hospitalization.”

by Fran Lowry, Medscape

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The Doctor Won’t See You Now

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Even psychiatrists and psychiatric nurses are biased against individuals with schizophrenia who are seeking general medical care, according to a new study.

The study found that people with severe psychiatric diseases often receive poor care for their physical health problems even though they are at high risk for chronic medical conditions (“Bias against schizophrenia patients seeking medical care,” Psychiatric Times, June 13).

To investigate possible bias, the researchers presented two hypothetical vignettes to primary care physicians and nurses and to psychiatrists and psychiatric nurses. In one, the patient had stable schizophrenia and was taking risperidone. In the other, the patient did not have the disorder and did not take risperidone.

They found that all providers expected patients with schizophrenia to be less likely to adhere to medications for chronic medical conditions or to participate in prescribed weight management programs. The providers also expected these patients to have lower social functioning and be less competent to make treatment decisions.

The biases and misperceptions were found across the board – in both nurses and doctors, mental health and primary care physicians.

When we ponder how to prevent people with severe mental illnesses from dying approximately 25 years younger than people without them, eliminating biases against providing medical care to this population would be a good place to start.

–Treatment Advocacy Center

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NIH BRAIN Initiative Webinar to Engage the Patient Advocacy Community

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Monday, July 22, 2013
1:00 PM – 2:00 PM EDT

Sponsored by the American Brain Coalition
Speaker: Kathy Hudson, PhD, NIH Deputy Director for Science, Outreach, and Policy
Moderator: Robin Elliott, American Brain Coalition Chair

Reserve your Webinar seat now at:
https://www1.gotomeeting.com/register/738258137

The National Institutes of Health agree that engaging the brain-related
patient advocacy community is integral to the success of this initiative.
It is the hope of NIH that every American Brain Coalition (ABC) member will
have at least one member from their organization participate (if not
more) in what we hope is the first of a series of ways the ABC can help keep
the patient advocacy community informed and engaged around this exciting
initiative.

For those of you who are not familiar, the NIH Brain Research through
Advancing Innovative Neurotechnologies (BRAIN) Initiative is part of a new
Presidential focus aimed at revolutionizing our understanding of the human
brain. By accelerating the development and application of innovative
technologies, researchers will be able to produce a revolutionary new
dynamic picture of the brain that, for the first time, shows how individual
cells and complex neural circuits interact in both time and space. Long
desired by researchers seeking new ways to treat, cure, and even prevent
brain disorders, this picture will fill major gaps in our current knowledge
and provide unprecedented opportunities for exploring exactly how the brain
enables the human body to record, process, utilize, store, and retrieve vast
quantities of information, all at the speed of thought.

Switching Antipsychotics May Reduce Metabolic Risks

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NIMH-funded study examines whether switching to a different antipsychotic can reduce side effects while maintaining effectiveness

Patients experiencing cardiovascular or metabolic side effects while taking an antipsychotic medication may fare better if they switch to a different medication provided they are closely monitored, according to an NIMH-funded study. The study was published online ahead of print July 18, 2011, in the American Journal of Psychiatry.

Antipsychotic medications can effectively treat psychotic symptoms among people with schizophrenia or related disorders. However, the medications, especially some of those that are most commonly used, are associated with serious metabolic side effects that can lead to heart disease or diabetes. Even when patients do experience these side effects, doctors are often reluctant to change a patient’s medication regimen if the patient’s psychotic symptoms are controlled by the existing medication.

“Treating the symptoms of schizophrenia is a delicate balancing act between risks and benefits,” said National Institute of Mental Health Director Thomas R. Insel, M.D. “The possible benefits of switching medications to reduce metabolic risks must be carefully weighed against the potential risk of symptom relapse or medication failure.”

Scott Stroup, M.D., of Columbia University and colleagues aimed to determine if a medication switch could be made safely and without sacrificing clinical stability. For the Comparison of Antipsychotics for Metabolic Problems (CAMP) study, they enrolled 215 patients from 27 clinical sites whose psychotic symptoms were stabilized on one of three frequently used antipsychotics (olanzapine, quetiapine or risperidone) but were experiencing serious metabolic side effects such as weight gain and high cholesterol levels. Half of the patients were assigned to stay on their current medication, while the other half were switched to aripiprazole, another antipsychotic that is generally associated with fewer metabolic risks. All of the participants received a behavioral intervention that included a diet and exercise program designed to reduce the risk of cardiovascular disease.

After 24 weeks, the researchers found that those who switched to aripiprazole had improved cholesterol levels and other metabolic factors, and lost more weight (average of 8 lbs) than those who stayed on their original medication (average of 1.5 lbs). Those who switched also did not experience any more illness relapses or worsening of psychotic symptoms compared to those who stayed on their original medication. However, those who switched to aripiprazole were more likely to discontinue the new medication compared to those who stayed on their original medication. Almost 44 percent of those who switched discontinued the aripiprazole compared to 24.5 percent of those who were assigned to stay on their current medication.

The authors suggest that the high discontinuation rate for switchers may have been related to the fact that the study was open label, meaning both the patient and the clinician knew what drug the patient was taking. Some patients who were switched may have felt uncomfortable changing from a medication they knew worked for them, and therefore stopped the new medication. In addition, because clinicians were encouraged to closely monitor and intervene before a patient experienced severe problems, many may have discontinued aripiprazole when the clinician first determined that the patient was having difficulties, but before full-blown treatment failure occurred.

“For patients whose symptoms are stabilized but who are overweight or experiencing other metabolic problems, clinicians may want to consider switching to a medication that is less likely to cause metabolic problems. However, because switching is not always successful, clinicians must monitor patients carefully to avoid illness exacerbation,” said Dr. Stroup. “If switching medications is not an option, then adding a medication like metformin or a statin could help reduce cardiovascular risks while maintaining symptom stability,” he concluded. He also noted that the study’s behavioral intervention that focused on improved diet and exercise habits benefited even those who did not switch medications.

 –National Institute of Mental Health (NIMH)