Research Participants Needed: Tardive Dyskinesia and Bipolar

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Kinect 2 Study

Kinect2Study logoWe invite those 18 to 85 years old who are experiencing involuntary movements in their face or other parts of their body – and suffer from bipolar disorder – to see if they may qualify for the Kinect 2 Study. The purpose of this clinical research study is to determine the safety and effectiveness of an investigational oral medication for tardive dyskinesia.

Each individual will be evaluated to determine his or her eligibility. Those who qualify will receive study medication, study-related medical exams, and lab tests at no charge. Compensation for time and travel may also be available.

Upon enrollment in the study, participants will be required to complete a screening period prior to receiving their first dose of study medication and a study treatment period of up to 6 weeks (which includes three in-office visits and a follow-up appointment two weeks after completing treatment). Throughout the study, participants will continue to receive regular general health check-ups and monitoring of TD symptoms.

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Ending Your Life Is Not The Answer To Your Situation

You are at the end of your rope and you can’t take it any much longer. You are in pain and you are suffering and you feel there is no hope. The first thing that you need to do is to seek the services of a professional counselor. As a published author of a managing fear book and as a layman, here are five reasons why suicide is not a solution to your problems.

1. Things Change Over Time
Regardless of your situation, things do not stay the same. You may feel very bad today, but it won’t last forever. Remember this fact:  Regardless of your current situation, everything changes over time. This includes your current situation. Nothing remains the same forever.

2. There Are Always Other Options…..Always
You may feel lost and confused but the answers to your specific problems are out there. The key is that you have to find the answers. The answers to your problem will not come to you. As mentioned before, the first step in finding the solution to your problem is to seek help from a qualified professional.

3. You Can’t Predict The Future
You are fearful, confused and do not know where to turn. You think that there is no hope for you. When you are in this situation, remember the 99% rule. The 99% rule states that that no one can predict the future with one hundred percent certainty. Even if the thing that you are afraid of does happen, there are circumstances and factors that you can’t predict which can be used to your advantage. For instance, you miss the deadline for a project you have been working on for the last few months.

Everything you feared is coming true. Suddenly, your boss comes to your office and tells you that the deadline is extended and that he forgot to tell you the day before. This unknown factor changes everything. We may be ninety-nine percent correct in predicting the future, but all it takes is for that one percent to make a world of difference.

4. Focus On The Facts of Your Situation and Not Your Thoughts
When people are depressed they rely on their fearful, depressing, and negative thoughts.  That is a huge mistake. Your fearful thoughts are exaggerated and are not based on reality. When you are depressed, focus on the facts of your current situation and not on what you think. Do not assume anything regarding your current situation. Seek help from a professional immediately.

5. Go To The Hospital Immediately When It’s That Bad
If things are so bad that you are unable to function, drop everything and go to your local hospital or crisis center immediately. The people there will take care of your situation right away.

No situation is hopeless. Your loved ones, friends, relatives, God, mental health counselors, priests, ministers, etc. are all good sources of help. They are all willing to help you and they can make a difference, but you must be willing to take advantage of this help. Regardless of your situation, take advantage of the help that is around you.

Remember: Every problem has a solution. You just have to find it.

BIOGRAPHY:
Stan Popovich is the author of “A Layman’s Guide to Managing Fear Using Psychology, Christianity and Non Resistant Methods” – an easy to read book that presents a general overview of techniques that are effective in managing persistent fears and anxieties. For additional information go to: http://www.managingfear.com/

Jane Pearson Talks About Suicide Prevention Research on NPR’s Science Friday

Suicide does not discriminate. People of all genders, ages, and ethnicities are at risk for suicide. This prevalent health problem is also one of the most preventable. Yet the numbers tell a different story: Each year twice as many Americans die from suicide than murder.

On Friday, August 30, Jane Pearson, Ph.D., chair of the Suicide Research Consortium at the National Institute of Mental Health, appeared on NPR’s Science Friday to discuss ways research is trying to prevent this pressing issue.

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September 11th Webinar: Six Steps to Improve Your Drug Court Outcomes for Adults with Co-Occurring Disorders

Webinar date and time: Wednesday, September 11, 12:00 – 1:15 pm EDT 

Treatment court professionals know that people with co-occurring disorders (COD) are among the most challenging groups of participants in their programs, and many are both “high risk and high need” offenders. NADCP and SAMHSA’s GAINS Center recently collaborated on the Fact Sheet “Six Steps to Improve Your Drug Court Outcomes for Adults with Co-Occurring Disorders” to assist drug courts and other treatment courts in effectively working with persons with co-occurring substance use and mental health disorders. This webinar features a nationally-recognized expert on persons with COD in the justice system, Dr. Roger Peters, of the University of South Florida, Louis de la Parte Florida Mental Health Institute. Dr. Peters has written numerous clinical and research articles on this topic and is a regular consultant to both NADCP and the GAINS Center. Dr. Peters will discuss the newly-released Fact Sheet document from NADCP and the GAINS Center, on which he is a co-author. This webinar addresses common concerns across all types of adult treatment courts including drug courts, mental health courts, veterans’ treatment courts, and DWI courts. In addition to his presentation, Dr. Peters will answer questions from webinar participants.

Participants will need to call the number AND log-in to the link to join the webinar:
Call-in #: 888-677-3788
Participant passcode: COD

Log-in For Participants:
URL: https://www.mymeetings.com/nc/join/
Conference number: PW6269804
Audience passcode: COD

 

SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation

Schizophrenia Relapse: Real Life and On “Perception”, Season 2

This month we are living with fingers crossed.

Ben has had a close call, once again, with his symptoms of schizophrenia. We don’t know how it happened, but somehow in late May Ben’s med levels began to drop.  We saw the usual warning signs (agitation, self-talk, lack of focus, too-forced interactions, loud and constant music in his iPod, lack of desire to engage, etc.) and yet he kept insisting he was “fine” and “nothing is wrong.”

But we knew. And we ordered tests. The test result? Med levels near to zero.

….On the TV series Perception, neuroscience professor Daniel Pierce (played by Eric McCormack) lives with paranoid schizophrenia, which often conveniently manifests as helpful voices which help him solve crime. In between cases, he manages to lecture to his college students quite coherently and entertainingly.

When not in “focus mode”, though, Pierce is bothered by hallucinations and often relies on his assistant , Max Lewicki, to help him keep his realities straight. FBI Agent Kate Moretti, his partner-in-solving-crime, also keeps an eye out and sometimes asks, “Daniel, are you having an episode?”. And now, the character Natalie Vincent(voice)/Dr. Caroline Newsome (real) observes Dr. Pierce having symptoms of relapse.

Of course, Pierce always answers, “I’m fine.”

That’s the problem – and so it is in our family.

by Randye Kaye, Healthy Place

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Nursing Homes Are Reducing Use of Antipsychotics For Dementia and Behavioral Problems

Nursing homes are using antipsychotics less and instead pursuing more patient-centered treatment for dementia and other behavioral health care, according to new data released on Nursing Home Compare in July by the Centers for Medicare & Medicaid Services (CMS).

Unnecessary antipsychotic drug use is a significant challenge in dementia care. CMS data show that in 2010 more than 17 percent of nursing home patients had daily doses exceeding recommended levels. In response to these trends, CMS launched the National Partnership to Improve Dementia Care in 2012.

“This important partnership to improve dementia care in nursing homes is yielding results,” said Dr. Patrick Conway, CMS chief medical officer and director of the Center for Clinical Standards and Quality. “We will continue to work with clinicians, caregivers, and communities to improve care and eliminate harm for people living with dementia.”

The Partnership’s goal is to reduce antipsychotic drug usage by 15 percent by the end of 2013.  These new data show that the Partnership’s work is making a difference:

  • The national prevalence of antipsychotic use in long stay nursing home residents has been reduced by 9.1 percent by the first quarter of 2013, compared to the last quarter of 2011.
  • There are approximately 30,000 fewer nursing home residents on these medications now than if the prevalence had remained at the pre-National Partnership level.
  • At least 11 states have hit or exceeded a 15 percent target and others are quickly approaching that goal. The states that have met or exceeded the target are: Alabama, Delaware, Georgia, Kentucky, Maine, North Carolina, Oklahoma, Rhode Island, South Carolina, Tennessee and Vermont.

The Partnership aims to reduce inappropriate use of antipsychotics in several ways – including enhanced training for nursing home providers and state surveyors; increased transparency by making antipsychotic use data available online at Nursing Home Compare; and highlighting alternate strategies to improve dementia care.

Since its launch in early 2012, the goal of the Partnership has been to improve quality of care and quality of life for the country’s 1.5 million nursing home residents. This broad-based coalition includes long-term care providers, caregivers and advocates, medical and quality improvement experts, government agencies, and consumers.

For more information on the Partnership’s efforts to reduce use of antipsychotic drugs in nursing homes, please visit the Advancing Excellence in America’s Nursing Homes website: http://www.nhqualitycampaign.org/star_index.aspx?controls=MedicationsExploreGoal.

–Centers for Medicare and Medicaid Services

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Antipsychotics: Taking the Long View

One of the first lessons I received as a psychiatrist-in-training 35 years ago was the value of antipsychotic medications. These medicines have been available for the treatment of psychosis for over half a century, beginning with the prototype first generation drug chlorpromazine (Thorazine) and now extending to some 20 different compounds, including several second-generation medications, often called “atypical antipsychotics.” Symptoms such as hallucinations, delusions, and paranoia are reduced reliably by these drugs. Although these symptoms can be frightening and dangerous for patients, family members, and providers, antipsychotics safely and effectively help people through the crisis of acute psychosis.

However, the long-term management of chronic mental illness is another matter. Recently, results from several studies have suggested that these medications may be less effective for the outcomes that matter most to people with serious mental illness: a full return to well-being and a productive place in society.

That is not to say that people are not remitting or recovering from serious mental illness. An article recently posted online in JAMA-Psychiatry tells an interesting story about medications and recovery. Wunderink and colleagues from the Netherlands report on a seven-year follow-up of 103 people with schizophrenia and related disorders who had experienced a first episode of psychosis between 2001 and 2002. After six months of symptomatic remission following antipsychotic treatment, patients were randomly assigned to either maintenance antipsychotic treatment or a tapering-off and discontinuation of the drug. As expected, the group that stopped taking their medications experienced twice the relapse rates in the early phase of the follow-up. But these rates evened out after a few years, as some patients in the maintenance group also stopped taking their medication. Most important, by seven years, the discontinuation group had achieved twice the functional recovery rate: 40.4 percent vs. only 17.6 percent among the medication maintenance group. To be clear, this study started with patients in remission and only 17 of the 103 patients—21 percent of the discontinuation group and 11 percent of the maintenance group—were off medication entirely during the last two years of follow-up. An equal number were taking very low doses of medication—meaning that roughly one-third of all study patients were eventually taking little or no medication.

For me, there were three remarkable results in this study. First, the groups did not ultimately differ in their experience of symptoms: about two-thirds of each group reported significant improvement in symptoms at seven years. Second, 29 percent of the discontinuation group reported that they had also achieved a healthy outcome in work and family life—a number that should give hope to those struggling with serious mental illness. And finally, antipsychotic medication, which seemed so important in the early phase of psychosis, appeared to worsen prospects for recovery over the long-term. Or, as Patrick McGorry said in an accompanying editorial, “less is more.” At least for these patients, tapering off medication early seemed to be associated with better long-term outcomes.

What does this say about the long-term use of antipsychotics? Are they potentially harmful? Are they necessary for an individual’s entire lifetime? Earlier this year, Martin Harrow and Thomas Jobe reported an analysis of several long-term follow-up studies of people with schizophrenia to determine if antipsychotics, given long-term, facilitate a return to functional well-being. They describe the following pattern across these studies: (a) within the first 6-10 months after discontinuation, 25-55 percent of patients relapse; (b) for those who do not relapse during this period, subsequent relapses are much less frequent even after prolonged periods off medication.

It appears that what we currently call “schizophrenia” may comprise disorders with quite different trajectories. For some people, remaining on medication long-term might impede a full return to wellness. For others, discontinuing medication can be disastrous. For all, we need to realize that reducing the so-called “positive symptoms” (hallucinations and delusions) may be necessary, but is rarely sufficient for a return to normal functioning. Neither first nor second generation antipsychotic medications do much to help with the so-called negative symptoms (lack of feeling, lack of motivation) or the problems with attention and judgment that may be major barriers to leading a productive, healthy life. Family education, supported employment, and cognitive behavioral therapy have all demonstrated efficacy in reducing the likelihood of relapse events, increasing the ability to function in daily life, and improving problem-solving and interpersonal skills.

NIMH is supporting research on interventions that focus on a combination of approaches—symptom remission, family engagement, and functional recovery. The Recovery After Initial Schizophrenia Episode (RAISE) project combines low-dose medication with family psycho-education, supported education/employment, individual resilience training, and other interventions to focus on more than just the psychotic symptoms. Combining current treatments, as done in RAISE, looks like a promising approach.

We realize that for too many people, today’s treatments are not good enough. New, better treatments are essential if we are to improve outcomes for all – that is the promise of research. But in the meantime, we need to be thoughtful about the treatments we have. Clearly, some individuals need to be on medication continually to avoid relapse. At the same time, we need to ask whether in the long-term, some individuals with a history of psychosis may do better off medication. This is a tough call, where known risks need to be balanced against potential benefits. As the RAISE project has emphasized, shared decision-making between patients, families, and providers is essential for long-term management of psychotic disorders.

These new data on the long-term outcomes for people with “schizophrenia” remind us that 100 years after defining this disorder and 50 years after “breakthrough” medications, we still have much to learn.

by Thomas Insel, Director of NIMH

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College Mental Health Initiatives — Outreach to At-Risk Students

“Make the most of the next four years, they will be the best of your life,” say many parents as their children head off to college. And while choosing partying over studying used to be the primary concern of students and parents, now coping with a mental illness is one of the new norms for many college students.

According to epidemiological research, most mental health disorders emerge between the ages of 14 and 24 (Kessler, Berglund, Demler, Jin, Merikangas, & Walters, 2005). So, in addition to adjusting to college life, many freshmen also must manage the onset of anxiety, depression, bipolar disorder, and/or schizophrenia. And mental disorders in college-age students also are increasing in severity.

In a 2012 survey of 765 college students from 48 states and Washington, D.C., the National Alliance on Mental Illness (NAMI), the largest grassroots mental health advocacy organization in the United States, documented the following diagnoses: depression (27%); bipolar disorder and dysthymia (24%); other, including borderline personality disorder, eating disorders, obsessive compulsive disorder, schizoaffective disorder, and autism spectrum disorder (12%); anxiety (11%); schizophrenia (6%); PTSD (6%); ADHD (5%); and substance abuse disorder (1%).

….Added to the typical college stressors is the stigma that students with mental health issues face from peers, faculty, and other college staff. “From our survey respondents, we learned that stigma remains the No.1 barrier to students accessing mental health services and supports,” Gruttadaro notes. Fear of this stigma prevents students from disclosing their mental health diagnosis, according to the NAMI survey. Since disclosure is legally required to receive mental health assistance and accommodations, students who hide their mental health issues may be less successful, or even drop out. The NAMI survey revealed that 45% of students who dropped out of college for mental health reasons did not receive accommodations, and 50% did not access mental health services and supports.

By Jennifer Van Pelt, MA, Social Work Today

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Stray Prenatal Gene Network Suspected in Schizophrenia

May Disrupt Birth of New Neurons in Prefrontal Cortex

Researchers have reverse-engineered the outlines of a disrupted prenatal gene network in schizophrenia, by tracing spontaneous mutations to where and when they likely cause damage in the brain. Some people with the brain disorder may suffer from impaired birth of new neurons, or neurogenesis, in the front of their brain during prenatal development, suggests the study, which was funded by the National Institutes of Health.

Schizophrenia networks in prefrontal cortex - Source: Mary-Claire King, Ph.D., University of Washington“Processes critical for the brain’s development can be revealed by the mutations that disrupt them,” explained Mary-Claire King, Ph.D., University of Washington (UW), Seattle, a grantee of the NIH’s National Institute of Mental Health (NIMH). “Mutations can lead to loss of integrity of a whole pathway, not just of a single gene. Our results implicate networked genes underlying a pathway responsible for orchestrating neurogenesis in the prefrontal cortex in schizophrenia.”

King, and collaborators at UW and seven other research centers participating in the NIMH genetics repository, report on their discovery August 1, 2013 in the journal Cell.

“By linking genomic findings to functional measures, this approach gives us additional insight into how early development differs in the brain of someone who will eventually manifest the symptoms of psychosis,” said NIMH Director Thomas R. Insel, M.D.

Earlier studies had linked spontaneous mutations to non-familial schizophrenia and traced them broadly to genes involved in brain development, but little was known about convergent effects on pathways. King and colleagues set out to explore causes of schizophrenia by integrating genomic data with newly available online transcriptome resources that show where in the brain and when in development genes turn on. They compared spontaneous mutations in 105 people with schizophrenia with those in 84 unaffected siblings, in families without previous histories of the illness.

Unlike most other genes, expression levels of many of the 50 mutation-containing genes that form the suspected network were highest early in fetal development, tapered off by childhood, but conspicuously increased again in early adulthood – just when schizophrenia symptoms typically first develop. This adds to evidence supporting the prevailing neurodevelopmental model of schizophrenia. The implicated genes play important roles in migration of cells in the developing brain, communication between brain cells, regulation of gene expression, and related intracellular workings.

Having an older father increased the likelihood of spontaneous mutations for both affected and unaffected siblings. Yet affected siblings were modestly more likely to have mutations predicted to damage protein function. Such damaging mutations were estimated to account for 21 percent of schizophrenia cases in the study sample. The mutations tend to be individually rare; only one gene harboring damaging mutations turned up in more than one of the cases, and several patients had damaging mutations in more than one gene.

The networks formed by genes harboring these damaging mutations were found to vary in connectivity, based on the extent to which their proteins are co-expressed and interact. The network formed by genes harboring damaging mutations in schizophrenia had significantly more nodes, or points of connection, than networks modeled from unaffected siblings. By contrast, the network of genes harboring non-damaging mutations in affected siblings had no more nodes than similar networks in unaffected siblings.

When the researchers compared such network connectivity across different brain tissues and different periods of development, they discovered a notable difference between affected and unaffected siblings: Genes harboring damaging mutations that are expressed together in the fetal prefrontal cortex of people with schizophrenia formed a network with significantly greater connectivity than networks modeled from genes harboring similar mutations in their unaffected siblings at that time in development.

The study results are consistent with several lines of evidence implicating the prefrontal cortex in schizophrenia. The prefrontal cortex organizes information from other brain regions to coordinate executive functions like thinking, planning, attention span, working memory, problem-solving, and self-regulation. The findings suggest that impairments in such functions — often beginning before the onset of symptoms in early adulthood, when the prefrontal cortex fully matures – appear to be early signs of the illness.

The study demonstrates how integrating genomic data and transcriptome analysis can help to pinpoint disease mechanisms and identify potential treatment targets. For example, the mutant genes in the patients studied suggest the possible efficacy of medications targeting glutamate and calcium channel pathways, say the researchers.

“These results are striking, as they show that the genetic architecture of schizophrenia cannot be understood without an appreciation of how genes work in temporal and spatial networks during neurodevelopment,” said Thomas Lehner, Ph.D., chief of the NIMH Genomics Research Branch.

De Novo damaging genetic mutations
Seemingly disparate and scattered throughout the genome, spontaneous, or de novo, damaging mutations found in people with schizophrenia (red) clustered within genes forming a suspected disrupted network in the prefrontal cortex, thought to impair formation of new neurons during prenatal development.
Source: Mary-Claire King, Ph.D., University of Washington

Reference

Gulsuner S, Walsh T, Watts AC, Lee MK, Thornton AM, Casadei S, Rippey C, Shahin H, Consortium on the Genetics of Schizophrenia (COGS), PAARTNERS Study Group, Nimgaonkar VL, Go RCP, Savage RM, Swerdlow NR, Gur RE, Braff DL, King M-C, McClellan JM. Spatial and Temporal Mapping of De novo Mutations in Schizophrenia To a Fetal Prefrontal Cortical Network. Cell, Aug. 1, 2013.

The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit the NIMH website.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit the NIH website.

 

Five-Point Action Plan for President Obama to Reduce Violence by the Mentally Ill

President Obama said the federal government has to do something meaningful to prevent future shootings, like the recent massacre of 26 children and adults at a school in Newtown, Connecticut.  Here is what the federal government can do to prevent violence related to mental illness:

1. Start demonstration projects of Assisted Outpatient Treatment (e.g.Kendra’s Law in New York, Laura’s Law in California) throughout the country.

2. Write exceptions into the Health Insurance Portability and Accountability Act (HIPAA) so parents of mentally ill children can get access to medical records and receive information from their children’s doctors on what is wrong and what the children need.

3. End the Institutes for Mental Disease (IMD) exclusion in Medicaid law.

4. Create a federal definition of serious mental illness, and require that the vast majority of mental-health funding go to it.

5. Eliminate the Substance Abuse and Mental Health Services Agency (SAMHSA).

by D. J. Jaffe, National Review

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