Monday 3 November 2014
Cannabis: A precursor of psychosis.
Cannabis is often the precursor of psychosis, especially paranoia. Anecdotally it seems to exacerbate psychotic moods and symptoms. My own view is that it cannot possibly benefit sufferers and it seems risky to prescribe it (if I have correctly understood the summary) at all. I remember Professor Robin Murray saying some years ago that cannabis was implicated in the causation of mental illness. Well, he should know and I don't suppose his views have become obsolete.
Acupuncture: Used more widely.
Larger scale trials are needed with or without medication, unless the latter option is too risky. I would vouch for the benefits of acupuncture to support well-being and would like to see it used more widely.
Tuesday 28 October 2014
Cannabis for schizophrenia: the need for people's views.
The cannabis summary raised many questions for me as it has, I believe, been indicated that the drug can bring on psychosis rather than treat it. Surely there is some good, well-based research around that can do good to the people who have psychosis, and can suggest steps to improve treatments and care.
It seems to me that what is missing is the views of parents and partners of patients who can give their take on what the patients are reporting. Only then will the true picture of the situation of people with psychosis be available, as patient views would be ratified - or contradicted - by those involved in their care long-term.
It seems to me that what is missing is the views of parents and partners of patients who can give their take on what the patients are reporting. Only then will the true picture of the situation of people with psychosis be available, as patient views would be ratified - or contradicted - by those involved in their care long-term.
Cannabis and psychosis: A carer's view.
There does not seem to be much rigorous research on this subject. I feel the effect of cannabis on the developing brain of teenagers cannot be overstated, articles always allude to "an increased risk of psychosis" but what this means in reality, the devastation of mental health problems and schizophrenia particularly is never explained or demonstrated.
Our son started experimenting with cannabis when he was fourteen and we feel strongly that this contributed to his developing schizophrenia from about the age of seventeen. It became apparent during his prolonged stay in a psychiatric unit under a section that he was also treatment resistant. Only when he was treated with clozapine which had to be augmented did he begin to stabilise.
The doctor treating him felt that he, in his practice, was seeing more young men like this and he felt that the brain being bathed in these illicit drugs during adolescence was a contributory factor.
Our son managed to procure cannabis whilst in hospital under section and was cautioned and fined for this despite at the time not being deemed fit to make decisions. Fortunately he now no longer smokes cannabis but has to take medication and lives in supported accommodation. He is now 23 years old and is just beginning to have a life again.
Our son started experimenting with cannabis when he was fourteen and we feel strongly that this contributed to his developing schizophrenia from about the age of seventeen. It became apparent during his prolonged stay in a psychiatric unit under a section that he was also treatment resistant. Only when he was treated with clozapine which had to be augmented did he begin to stabilise.
The doctor treating him felt that he, in his practice, was seeing more young men like this and he felt that the brain being bathed in these illicit drugs during adolescence was a contributory factor.
Our son managed to procure cannabis whilst in hospital under section and was cautioned and fined for this despite at the time not being deemed fit to make decisions. Fortunately he now no longer smokes cannabis but has to take medication and lives in supported accommodation. He is now 23 years old and is just beginning to have a life again.
Cannabis for schizophrenia: Unpredictable and disastrous.
Cannabis - No! That is something I gave up because one day I started feeling alarmingly weird, dizzy and disorientated. This is complete madness, not just because of the drug and its effects, but because of the disorganised, chaotic lifestyle of drug users. I know a few people who continued using cannabis well into old age. In every case, they are less than they could have been.
I believe that all mind altering drugs are harmful. The ideal psychiatric system would be Open Dialogue, a non-invasive method with a very minimal use of drugs. ANY mind altering drug is just a short cut, panic measure, which might work for a short time, but with unpredictable and often very disastrous long-term effects.
I believe that all mind altering drugs are harmful. The ideal psychiatric system would be Open Dialogue, a non-invasive method with a very minimal use of drugs. ANY mind altering drug is just a short cut, panic measure, which might work for a short time, but with unpredictable and often very disastrous long-term effects.
Acupuncture: Placebo and 'snake oil'?
Concerning acupuncture, I really don't know, I had it once for back pain and it didn't do anything. It may be harmless and could have a placebo effect. A bit of a worry that desperate people might pour money into something akin to 'snake oil'.
Acupuncture, culture and fear of needles: A carer's perspective.
I have to say that for the Acupuncture summary, whereas in China putting needles into people's skin may be normal, in the UK it is not a cultural norm. My daughter would not tolerate acupuncture, I believe, as she hates injections and blood tests - and most other medical interventions. She would benefit more from the social side of any treatment - the care shown and the attention paid her. The confusion of these factors would have to be dealt with if any really valid research was undertaken into the effectiveness of the treatment.
Acupuncture for schizophrenia: A service user's view
I have experienced the effectiveness of acupuncture for physical pain (lower neck has had some pretty strong peer-reviewed evidence of effectiveness, I believe). I don’t know about mental state other than the many reports I’ve had about acupuncture being successful with stopping tobacco smoking. This has always been auricular acupuncture, though, which is quite specialised.
Comment on the latest two summaries.
I have no experience of these two summaries (Cannabis for schizophrenia and Acupuncture for schizophrenia), but from the short summaries you sent, I get the impression that they do not work?
Friday 24 October 2014
Acupuncture for schizophrenia.
Although acupuncture or Traditional Chinese Medicine has been practised for over 2000 years in China and the Far East, especially in Korea and Japan, it is a relatively new form of treament for physical and psychological conditions in the West. Acupuncture inserts needles into the skin to stimulate specific points of the body (acupoints). The aim is to achieve balance and harmony of the body.
Schizophrenia is a serious mental illness and is usually treated using antipsychotic medication. However, although effective, antipsychotic medication can cause side-effects (such as sleepiness, weight gain and even dribbling). Acupuncture has been shown to have very few negative effects on the individual and could be more socially acceptable and tolerable for people with mental health problems. Acupuncture may also be less expensive than drugs made by pharmaceutical companies, so reducing costs to individuals and health services.
This reviews looks at the effectiveness of various types of acupuncture as treatment for people with schizophrenia. An update search for studies was carried out in 2012 and found 30 studies that randomised participants who were receiving antipsychotic medication to receive additional acupuncture or standard care.
Although some of the studies did favour acupuncture when combined with antipsychotics, the information available was small scale and rated to be very low or low quality by the review authors, so not completely provable and valid. Depression was reduced when combining acupuncture with antipsychotic medication, but again this finding came from small-scale research, so cannot be clearly shown to be true. The review concludes that people with mental health problems, policy makers and health professionals need much better evidence in order to establish if there are any potential benefits to acupuncture.
This means that the question of whether acupuncture is of benefit to people, and whether it is of greater benefit than antipsychotic medication, remains unanswered. There is not enough information to establish that acupuncture is of benefit or harm to people with mental health problems.
See more at: http://summaries.cochrane.org/CD005475/SCHIZ_acupuncture-for-schizophrenia
and
https://twitter.com/BenGray40
Schizophrenia is a serious mental illness and is usually treated using antipsychotic medication. However, although effective, antipsychotic medication can cause side-effects (such as sleepiness, weight gain and even dribbling). Acupuncture has been shown to have very few negative effects on the individual and could be more socially acceptable and tolerable for people with mental health problems. Acupuncture may also be less expensive than drugs made by pharmaceutical companies, so reducing costs to individuals and health services.
This reviews looks at the effectiveness of various types of acupuncture as treatment for people with schizophrenia. An update search for studies was carried out in 2012 and found 30 studies that randomised participants who were receiving antipsychotic medication to receive additional acupuncture or standard care.
Although some of the studies did favour acupuncture when combined with antipsychotics, the information available was small scale and rated to be very low or low quality by the review authors, so not completely provable and valid. Depression was reduced when combining acupuncture with antipsychotic medication, but again this finding came from small-scale research, so cannot be clearly shown to be true. The review concludes that people with mental health problems, policy makers and health professionals need much better evidence in order to establish if there are any potential benefits to acupuncture.
This means that the question of whether acupuncture is of benefit to people, and whether it is of greater benefit than antipsychotic medication, remains unanswered. There is not enough information to establish that acupuncture is of benefit or harm to people with mental health problems.
See more at: http://summaries.cochrane.org/CD005475/SCHIZ_acupuncture-for-schizophrenia
and
https://twitter.com/BenGray40
Cannabis for schizophrenia.
Many people with the serious mental illness and schizophrenia smoke cannabis but it is not known why people do so or the effects of smoking cannabis. It is unclear what the best methods are that help people to reduce or stop smoking cannabis. Cannabis is the most consumed illicit drug in the world – amounting to 120 to 224 million users. Cannabis, which is usually smoked or eaten, gives a feeling of well-being, but in high doses it may also cause mental illness or psychosis. Clinical evidence suggests people who have schizophrenia have a worse overall outcome from using cannabis, however, there are some people with schizophrenia who claim that using cannabis helps their symptoms and reduces the side effects of antipsychotic medication. This review aims to look at the effects of cannabis, both its use and withdrawal, in people who have schizophrenia. A search for trials was conducted in 2013, eight randomised trials, involving 530 participants were included. Five trials investigated the effects of using a specific psychotherapy aimed at reducing cannabis intake, two investigated the effects of antipsychotic medication for cannabis reduction and one investigated the use of cannbidiol (a compound found in cannabis) as a treatment for the symptoms of schizophrenia.
The results of the review are limited as trial sizes were small and data were poorly reported.
Overall, there is currently no evidence for any intervention, whether it is psychological therapy or medication, being better than standard treatment or each other in reducing or stopping the use of cannabis. More research is needed to explore the benefits of medication or psychological therapy for those with schizophrenia who use cannabis. It is unclear if cannabidiol has an antipsychotic effect.
See more at: http://summaries.cochrane.org/CD004837/SCHIZ_cannabis-for-schizophrenia
and
https://twitter.com/BenGray40
The results of the review are limited as trial sizes were small and data were poorly reported.
Overall, there is currently no evidence for any intervention, whether it is psychological therapy or medication, being better than standard treatment or each other in reducing or stopping the use of cannabis. More research is needed to explore the benefits of medication or psychological therapy for those with schizophrenia who use cannabis. It is unclear if cannabidiol has an antipsychotic effect.
See more at: http://summaries.cochrane.org/CD004837/SCHIZ_cannabis-for-schizophrenia
and
https://twitter.com/BenGray40
Monday 29 September 2014
Experts by Experience
The Experts by Experience group was invited to comment and share their lived experiences on two summaries (1. Post natal psychosis and 2. Sedatives for aggression or agitation).
See what they said below.
See what they said below.
Further research is needed on sedatives
Further research on sedatives would be useful and on the side effects. Disagreeable side effects can mean that patients stop their medication, leading to the need for emergency measures.
An expert by experience shares her story about sedatives and use of restraint.
RESTRAINTS USE IN MENTAL HEALTH.
I can only answer this from a carers point of view. I understand that in some cases when a person is so distressed that they are on the verge of harming themselves or someone else, they need to be stopped. At the moment restraint as a last resort may need to be used. But some research should be happening to find a better way. Restraining someone is barbaric.
When people are already badly distressed and in fear, this method just adds to it. It should only be used as a last resort, and not just because someone has come into hospital under section three of the mental health act in an agitated and distressed state.
My son was never a threat to other people, only to himself, he was always respectful to the police and doctors even when in the midst of psychosis, and terrified of everyone. Yet when taken in hospital by the police he was restrained and given an injection, and if they had taken time to talk to him I know he would have complied.
When he really needed help because he was a threat to himself, and already tried by cutting his own throat and told the doctor "he was really scared and didn't want to die", they took no notice. I asked if they could give him something to calm the voices and help him get some sleep, they said not until bed time and they did nothing.
After I left him he walked out and found a building where he jumped to his death. They didn't restrain him, in fact they didn't do anything, not even keep him safe.
Restraining someone is not the answer,
There has to be a better way, where are the crisis action plans? Where are the Recovery Centres? A place both carers and service users can learn about the best way to approach and deal with a crisis before it escalates.
I can only answer this from a carers point of view. I understand that in some cases when a person is so distressed that they are on the verge of harming themselves or someone else, they need to be stopped. At the moment restraint as a last resort may need to be used. But some research should be happening to find a better way. Restraining someone is barbaric.
When people are already badly distressed and in fear, this method just adds to it. It should only be used as a last resort, and not just because someone has come into hospital under section three of the mental health act in an agitated and distressed state.
My son was never a threat to other people, only to himself, he was always respectful to the police and doctors even when in the midst of psychosis, and terrified of everyone. Yet when taken in hospital by the police he was restrained and given an injection, and if they had taken time to talk to him I know he would have complied.
When he really needed help because he was a threat to himself, and already tried by cutting his own throat and told the doctor "he was really scared and didn't want to die", they took no notice. I asked if they could give him something to calm the voices and help him get some sleep, they said not until bed time and they did nothing.
After I left him he walked out and found a building where he jumped to his death. They didn't restrain him, in fact they didn't do anything, not even keep him safe.
Restraining someone is not the answer,
There has to be a better way, where are the crisis action plans? Where are the Recovery Centres? A place both carers and service users can learn about the best way to approach and deal with a crisis before it escalates.
Worries about post natal psychosis
With post natal psychosis there is the problem that a mother may well hide the fact that she is unwell, because of fears that the baby may be taken away and she herself locked up.
An expert by experience shares their view on post natal psychosis
I'm afraid (or should that be glad!) that I have no personal experience of post natal psychosis but I am shocked that the review couldn't find any research into the treatments available to mothers and their families in need of intervention, despite recent high profile cases.
As with so many areas of treatment for mental illness, outcomes are determined by the luck of the draw .... by the chance of being spotted by the right person at the right time. Training midwives and GPs to become that right person must surely be a good start. Giving them the time and knowledge to provide appropriate interventions (drugs, family support and talking therapies) is the obvious follow-up.
As with so many areas of treatment for mental illness, outcomes are determined by the luck of the draw .... by the chance of being spotted by the right person at the right time. Training midwives and GPs to become that right person must surely be a good start. Giving them the time and knowledge to provide appropriate interventions (drugs, family support and talking therapies) is the obvious follow-up.
Women's mental health after giving birth: an expert by experience shares her story.
About a month after my first child was born I had post natal depression. Didn't know anything about it or reconsider what was happening. I just found it difficult to bond with my daughter, I was able to care for her needs, but I was sad and troubled, very tearful, and had difficulty in cuddling and nursing her, which added to my misery. I felt ill physically as well as mentally.
I was lucky to have had a good health visitor, who saw I was different from the first couple of times she had visited and took me to my GP where I found support through the coming months.
When my second child was born I was very aware of the symptoms and sought help as soon as I recognised the signs so did not suffer so badly, the second time. There are such high expectations on a pregnant woman from family friends and medical staff, it is a shock after the birth when all this expected wonderment and fulfilment is not there, then to feel depressed as well is hard enough.
Psychosis may be rare and only affect a few, but during the pregnancy it's not mentioned, post natal depression can be dismissed if you ask about it, yet forwarded would be better, for the woman and their partners.
There should be more research, has there ever been any?
I was lucky to have had a good health visitor, who saw I was different from the first couple of times she had visited and took me to my GP where I found support through the coming months.
When my second child was born I was very aware of the symptoms and sought help as soon as I recognised the signs so did not suffer so badly, the second time. There are such high expectations on a pregnant woman from family friends and medical staff, it is a shock after the birth when all this expected wonderment and fulfilment is not there, then to feel depressed as well is hard enough.
Psychosis may be rare and only affect a few, but during the pregnancy it's not mentioned, post natal depression can be dismissed if you ask about it, yet forwarded would be better, for the woman and their partners.
There should be more research, has there ever been any?
Friday 26 September 2014
Experts by Experience
The experts by experience group has been asked to comment on two summaries.
The group is comprised of 20 people (service users and carers).
They have been asked to add their lived experience to summaries on:(1) postnatal psychosis; and (2) sedatives for aggression and agitation.
These will be posted in the near future.
The group is comprised of 20 people (service users and carers).
They have been asked to add their lived experience to summaries on:(1) postnatal psychosis; and (2) sedatives for aggression and agitation.
These will be posted in the near future.
Friday 27 June 2014
A Service User Shares Their Experiences
I read in the Schizophrenia Commission about them including pharmacists in the treatment of patients, which I think is long overdue.
We have everybody else in a Ward round- surely the pharmacist should be included!
My own hospitalisation experience dates back to, initially, 1983 and most recent in 2001.
I think I am a recovered schizophrenic!
I can really sympathise with the carer who feels her son was nearly killed by Clozapine,
and also with all the side effects of drugs- the dribbling, tardive dyskinesia, etc.
I get restless feet all the time. I get too much spit in my mouth. I move my jaw, sort of clicking it, an involuntary movement.
We have everybody else in a Ward round- surely the pharmacist should be included!
My own hospitalisation experience dates back to, initially, 1983 and most recent in 2001.
I think I am a recovered schizophrenic!
I can really sympathise with the carer who feels her son was nearly killed by Clozapine,
and also with all the side effects of drugs- the dribbling, tardive dyskinesia, etc.
I get restless feet all the time. I get too much spit in my mouth. I move my jaw, sort of clicking it, an involuntary movement.
Monday 23 June 2014
A Carer Speaks Out.
I do think, when one is a patient, or by extension, a relative, it is hard to speak out.
1. When one is in an angry or disturbed state of mind, one cannot, physically, think straight.
2. Very often one is not believed.
3. Going back over things, actually causes MORE pain.
My son doesn't seem to want to complain, although I feel he has been quite unfairly treated, I guess the above, or something like that, is the reason.
1. When one is in an angry or disturbed state of mind, one cannot, physically, think straight.
2. Very often one is not believed.
3. Going back over things, actually causes MORE pain.
My son doesn't seem to want to complain, although I feel he has been quite unfairly treated, I guess the above, or something like that, is the reason.
Friday 6 June 2014
According to an Expert by Experience and Carer:
The discussion about transferring research into evidence-based practice is a very valid one, especially with regard to the Schizophrenia Commission and NICE guidelines recommendation that psychological therapies should be offered as a matter of course, alongside pharmaceutical interventions, from the very start of the treatment..... not left until the drugs, with all their acknowledged side effects, have 'stabilised' the poor patient into a state of readiness to 'receive' talking therapy. In our area, the waiting lists for psychological therapies for people with severe and enduring mental illness are running at around 2 years.
An Expert by Experience writes about side effects of her son.
Dribbling, tardive dyskinesia (which I have witnessed in my son) slurred voice (I was once traumatised by phoning a helpline and somebody had a horribly slurred voice) are in my opinion, appalling. I do not think a drug should be licensed, if it produces these effects.
Several years ago, my son was forced to take Clozapine, on the orders of a desperate, burnt- out and frankly very incompetent psychiatrist. My son, ended up on a medical ward, on intravenous drip, immobilised, vomiting, vomiting, vomiting, non-stop for a whole week. I was going mental, phoning psychiatrist who tried to fob me off with "it's a virus". I asked if anyone else on the psychiatric ward, where my son was imprisoned at the time had come down with a virus. He said no. As viruses are normally very catching, this alarmed me. I protested, but was completely ignored.
At the end of the week, thank God, the psychiatric nurses, placed around my son's hospital bed, to stop him escaping (he had run off to France, was okay for three months, ran out of money, come back, readmitted to hospital), alerted the psychiatrist that the vomiting might be due to the Clozapine. Clozapine withdrawn, torture ended temporarily.
A few years later, I came across an article, some unfortunate had died, obstructed bowel, directly caused by Clozapine. The coroner had ruled, as mental patients, object to taking care of their physical health, the doctors could not be blamed, so my panic had been justified. My son could have died, the psychiatrist could have got away with killing him.
At a tribunal regarding my son, I voiced my horror at the terrible side-effects, I was completely discounted, ignored, brushed aside as if I was stupid and unreasonable.
Several years ago, my son was forced to take Clozapine, on the orders of a desperate, burnt- out and frankly very incompetent psychiatrist. My son, ended up on a medical ward, on intravenous drip, immobilised, vomiting, vomiting, vomiting, non-stop for a whole week. I was going mental, phoning psychiatrist who tried to fob me off with "it's a virus". I asked if anyone else on the psychiatric ward, where my son was imprisoned at the time had come down with a virus. He said no. As viruses are normally very catching, this alarmed me. I protested, but was completely ignored.
At the end of the week, thank God, the psychiatric nurses, placed around my son's hospital bed, to stop him escaping (he had run off to France, was okay for three months, ran out of money, come back, readmitted to hospital), alerted the psychiatrist that the vomiting might be due to the Clozapine. Clozapine withdrawn, torture ended temporarily.
A few years later, I came across an article, some unfortunate had died, obstructed bowel, directly caused by Clozapine. The coroner had ruled, as mental patients, object to taking care of their physical health, the doctors could not be blamed, so my panic had been justified. My son could have died, the psychiatrist could have got away with killing him.
At a tribunal regarding my son, I voiced my horror at the terrible side-effects, I was completely discounted, ignored, brushed aside as if I was stupid and unreasonable.
Monday 2 June 2014
An expert by experience writes about side effects.
It is difficult for us to make definitive comment on the efficacy of various forms of medication, we can however offer some observations and experiences:
1. The side effects of weight gain and dribbling are apparent on a wide scale with many mental health patients. Our son is affected by both. We understand that Clozapine can affect the part of the brain that measures hunger and appetite. The patient then continues to overeat and consequently gain weight. I wonder if there is any evidence of medication affecting an individual’s metabolism? Dribbling is a particularly unfortunate side effect, causing embarrassment and loss of self-esteem. Medication is often prescribed as an antidote but, with relative poor outcomes.
1. The side effects of weight gain and dribbling are apparent on a wide scale with many mental health patients. Our son is affected by both. We understand that Clozapine can affect the part of the brain that measures hunger and appetite. The patient then continues to overeat and consequently gain weight. I wonder if there is any evidence of medication affecting an individual’s metabolism? Dribbling is a particularly unfortunate side effect, causing embarrassment and loss of self-esteem. Medication is often prescribed as an antidote but, with relative poor outcomes.
An expert by experience shares their view about physical and mental health.
Physical health care monitoring for people with serious mental illness.
“People with mental health problems often have complex and long-term difficulties with their physical health such as weight gain, smoking and heart problems. They sometimes do not take care of themselves, have inactive lifestyles and may not be able to cope with daily life or work. People with mental health problems have higher rates of diabetes, lung disease, cancer, heart problems, HIV/Aids and other infectious diseases.”
Mental Health of a patient can only be viewed at different stages. I prefer to give them a colour spectrum. Green when they are well. Amber when they are moving into a transitional stage towards psychosis or depression. Red when they are in psychosis or deep depression.
Green = Amber = Red
1. At the Green stage, the patient has a good sense of well being. They are happy. Makes plans for future. Take on projects. Socialise with family and friends. Get involved in social and extra curricular activities. Note: this can only happen to this level if the psychiatric medication is not interfering with the natural progress of their wellness. By this I mean, the side effects of unnaturally lowered metabolism. Side effects of Cognitive functions being inhibited or switched off in some cases depending on dosage. Side effect of intellect being suppressed. Side effect of Perception eroded. And many more. But these are just basic criteria for the patient to be happy and fully compos to be in the Green zone.
2. At the Amber stage some patients are so well acquainted with their illness, that they will know the change has or is coming over. They may not always be clued enough to seek advice/ help at this stage. Something I have always done. I knew when I hit the Amber. But have waited many times for it to subside which has eventually taken me to Red. This is a mis- calculation. Amber stage should never happen if you are fully recovered. If you hit Amber, the chances are you are really going on to progress into Red stage. And that’s where a small increase in dosage of the medication nips in the bud the progression of illness to Red.
3. Red stage . It is advisable to be hospitalised at this stage. Only if it is for a brief spell to monitor the diminishing cycle of psychosis or acute depression.
Therefore given the 3 stages of the cycle of mental wellness/illness, I refer to the paragraph above that people with mental illness cannot cope with daily life or take care of themselves and smoking does become their only source of pleasure. Consequently comfort eating is also a big issue.
“People with mental health problems often have complex and long-term difficulties with their physical health such as weight gain, smoking and heart problems. They sometimes do not take care of themselves, have inactive lifestyles and may not be able to cope with daily life or work. People with mental health problems have higher rates of diabetes, lung disease, cancer, heart problems, HIV/Aids and other infectious diseases.”
Mental Health of a patient can only be viewed at different stages. I prefer to give them a colour spectrum. Green when they are well. Amber when they are moving into a transitional stage towards psychosis or depression. Red when they are in psychosis or deep depression.
Green = Amber = Red
1. At the Green stage, the patient has a good sense of well being. They are happy. Makes plans for future. Take on projects. Socialise with family and friends. Get involved in social and extra curricular activities. Note: this can only happen to this level if the psychiatric medication is not interfering with the natural progress of their wellness. By this I mean, the side effects of unnaturally lowered metabolism. Side effects of Cognitive functions being inhibited or switched off in some cases depending on dosage. Side effect of intellect being suppressed. Side effect of Perception eroded. And many more. But these are just basic criteria for the patient to be happy and fully compos to be in the Green zone.
2. At the Amber stage some patients are so well acquainted with their illness, that they will know the change has or is coming over. They may not always be clued enough to seek advice/ help at this stage. Something I have always done. I knew when I hit the Amber. But have waited many times for it to subside which has eventually taken me to Red. This is a mis- calculation. Amber stage should never happen if you are fully recovered. If you hit Amber, the chances are you are really going on to progress into Red stage. And that’s where a small increase in dosage of the medication nips in the bud the progression of illness to Red.
3. Red stage . It is advisable to be hospitalised at this stage. Only if it is for a brief spell to monitor the diminishing cycle of psychosis or acute depression.
Therefore given the 3 stages of the cycle of mental wellness/illness, I refer to the paragraph above that people with mental illness cannot cope with daily life or take care of themselves and smoking does become their only source of pleasure. Consequently comfort eating is also a big issue.
Thursday 29 May 2014
Experts by Experience
According to another expert by experience:
Neuroscience/Psychiatry/Mental Health is like many other research domains in that most of what we want to know we either don't know or are not sure of. There are many barriers to implementing clinical research trials; funding, regulatory red tape, cultural inertia within medical organisations, etc. One of the principal barriers is the lack of awareness of the importance of research amongst the clinical care work force. Ben Gray's blog highlights the need for research and the need for both clinicians and the public as well as academics and associated financial and regulatory bodies to support it.
Neuroscience/Psychiatry/Mental Health is like many other research domains in that most of what we want to know we either don't know or are not sure of. There are many barriers to implementing clinical research trials; funding, regulatory red tape, cultural inertia within medical organisations, etc. One of the principal barriers is the lack of awareness of the importance of research amongst the clinical care work force. Ben Gray's blog highlights the need for research and the need for both clinicians and the public as well as academics and associated financial and regulatory bodies to support it.
Wednesday 28 May 2014
People's Involvement: Experts by Experience
We are just about to start a group of 'Experts by Experience'. In other words, people who have lived experience of mental illness (as service users and carers).
Here is what one person said as initial feedback:
I would say that the research articles are well written, flow well and are robust. I personally would like references to the research literature and researcher names and a little more methodology i.e. qualitative or quantitative and aim of project. I think these summaries are excellent learning and I would look for research which can be read by the professionals and therefore have a hope of having learning embedded into practice, and sustained over time. I think all the summaries improve professional and user/carer understanding and are very relevant to the issues of today in mental health and in parity of esteem.
Here is what one person said as initial feedback:
I would say that the research articles are well written, flow well and are robust. I personally would like references to the research literature and researcher names and a little more methodology i.e. qualitative or quantitative and aim of project. I think these summaries are excellent learning and I would look for research which can be read by the professionals and therefore have a hope of having learning embedded into practice, and sustained over time. I think all the summaries improve professional and user/carer understanding and are very relevant to the issues of today in mental health and in parity of esteem.
Monday 10 February 2014
Perazine for schizophrenia
Schizophrenia is often a severe and disabling illness that affects approximately one per cent of the worldwide population. Schizophrenia has 'positive' symptoms, such as strange and fixed beliefs (delusions), as well as hearing voices and seeing things (hallucinations). Schizophrenia also has 'negative' symptoms such as apathy, loss of emotion, lack of drive and disorganisation of behaviour and thought. The degree of disability is considerable with 80% - 90% not working and up to 10% dying.
Antipsychotic drugs are the main treatment for schizophrenia, and are grouped into older drugs (first generation or ‘typical’) and newer drugs (second generation or ‘atypical’). However, antipsychotic drugs also have serious side effects, particularly movement disorders such as uncontrollable shaking, tremors, muscle stiffness, tiredness, weight gain and the inability to sit still.
Perazine is an older antipsychotic drug first introduced in the 1950s. It is suggested to have a low level of side effects (especially for movement disorders). Its use is regional and restricted to countries like Germany, Poland, the Netherlands and the former Yugoslavia.
A search for trials was carried out in July 2012. The review now includes seven studies with a total of 479 participants and assesses the effects of perazine for people with schizophrenia. Comparisons of perazine versus placebo (‘dummy’ treatment) and versus other antipsychotic drugs revealed no clear differences or superiority of perazine. However, only a handful of studies have been undertaken and the number of participants in each study was small. In addition the studies avialable were of limited quality with data for the main outcomes of interest rated as low or very low quality. As perazine is a cheap drug and there is some limited evidence that it may cause less side effects than other older antipsychotic drugs, further large scale, well designed and well-reported studies are much needed.
Antipsychotic drugs are the main treatment for schizophrenia, and are grouped into older drugs (first generation or ‘typical’) and newer drugs (second generation or ‘atypical’). However, antipsychotic drugs also have serious side effects, particularly movement disorders such as uncontrollable shaking, tremors, muscle stiffness, tiredness, weight gain and the inability to sit still.
Perazine is an older antipsychotic drug first introduced in the 1950s. It is suggested to have a low level of side effects (especially for movement disorders). Its use is regional and restricted to countries like Germany, Poland, the Netherlands and the former Yugoslavia.
A search for trials was carried out in July 2012. The review now includes seven studies with a total of 479 participants and assesses the effects of perazine for people with schizophrenia. Comparisons of perazine versus placebo (‘dummy’ treatment) and versus other antipsychotic drugs revealed no clear differences or superiority of perazine. However, only a handful of studies have been undertaken and the number of participants in each study was small. In addition the studies avialable were of limited quality with data for the main outcomes of interest rated as low or very low quality. As perazine is a cheap drug and there is some limited evidence that it may cause less side effects than other older antipsychotic drugs, further large scale, well designed and well-reported studies are much needed.
Physical health care monitoring for people with serious mental illness.
People with mental health problems often have complex and long-term difficulties with their physical health such as weight gain, smoking and heart problems. They sometimes do not take care of themselves, have inactive lifestyles and may not be able to cope with daily life or work. People with mental health problems have higher rates of diabetes, lung disease, cancer, heart problems, HIV/Aids and other infectious diseases.
Physical health care monitoring can take a variety of forms from simple checks carried out by the person themselves to complex specific health checks carried out by health professionals. Monitoring helps identify current health problems and also anticipate future health problems.
In August 2006 the United Kingdom’s Department of Health issued guidance on how to provide better care for the physical health needs of people with serious mental illness. Spearhead Trusts, the Royal College of Psychiatrists, the National Institute for Clinical Excellence and other organisations all promoted the use of physical health care monitoring for people with mental health problems.
This review intended to find evidence to support this guidance. The authors’ conclude that current guidance and practice on physical health monitoring lacks a firm basis in research and there is little evidence to support this growing trend. They based their conclusions on results from a search carried out for trials in 2012 which found no relevant randomised studies. Current monitoring is mainly based on the agreement of experts, medical experience and good intentions. This does not mean that physical health monitoring is invalid, wrong or not of benefit to the physical health of people with severe mental illness, only that there is as yet no definite proof. Physical health care monitoring has the potential and promise to improve quality of life and help people with mental health problems live longer, but at this stage the information is uncertain and the research evidence unclear.
Physical health care monitoring can take a variety of forms from simple checks carried out by the person themselves to complex specific health checks carried out by health professionals. Monitoring helps identify current health problems and also anticipate future health problems.
In August 2006 the United Kingdom’s Department of Health issued guidance on how to provide better care for the physical health needs of people with serious mental illness. Spearhead Trusts, the Royal College of Psychiatrists, the National Institute for Clinical Excellence and other organisations all promoted the use of physical health care monitoring for people with mental health problems.
This review intended to find evidence to support this guidance. The authors’ conclude that current guidance and practice on physical health monitoring lacks a firm basis in research and there is little evidence to support this growing trend. They based their conclusions on results from a search carried out for trials in 2012 which found no relevant randomised studies. Current monitoring is mainly based on the agreement of experts, medical experience and good intentions. This does not mean that physical health monitoring is invalid, wrong or not of benefit to the physical health of people with severe mental illness, only that there is as yet no definite proof. Physical health care monitoring has the potential and promise to improve quality of life and help people with mental health problems live longer, but at this stage the information is uncertain and the research evidence unclear.
Monday 27 January 2014
Implementation of treatment guidelines in mental health care
During the past few decades, a wide range of therapies and interventions for mental health have been developed that have been supported by research and randomised evidence. This includes research evidence on the effectiveness of pharmacological treatments (such as antipsychotic drugs) and psychological therapies (such as cognitive behavioural therapy, family therapy and psychoeducation). However, research evidence is not easily translated into practice and the everyday working of healthcare services. A huge gap exists between the production of research evidence (what is known) and its uptake in healthcare settings (what is done). Better uptake of research evidence can be achieved by increasing awareness that such evidence exists.
One method of encouraging better uptake is the use of treatment guidelines based on assessments of research evidence. Treatment guidelines are now commonly employed in healthcare settings, including those providing treatment for schizophrenia. It remains unclear, however, whether treatment guidelines have any positive impact on the performance of mental health services or whether they improve outcomes for patients (such as better quality of life, improved mental state, employment and fewer admissions to hospital).
This review is based on a search carried out in March 2012 and includes five studies. The review examines the effectiveness of guideline implementation strategies in improving healthcare services and outcomes for people with mental illness. However, with such a small number of studies, and with all main results graded by review authors as providing very low quality evidence, it is not possible to arrive at concrete and definite conclusions. Although single studies provided initial evidence that implementation of treatment guidelines may achieve small changes in mental health practice, a gap in knowledge still exists about how this might improve patient outcomes and health services. This leaves scant information for people with mental health problems, health professionals and policy makers. More large-scale, well-designed and well-conducted studies are necessary to fill this gap in knowledge.
One method of encouraging better uptake is the use of treatment guidelines based on assessments of research evidence. Treatment guidelines are now commonly employed in healthcare settings, including those providing treatment for schizophrenia. It remains unclear, however, whether treatment guidelines have any positive impact on the performance of mental health services or whether they improve outcomes for patients (such as better quality of life, improved mental state, employment and fewer admissions to hospital).
This review is based on a search carried out in March 2012 and includes five studies. The review examines the effectiveness of guideline implementation strategies in improving healthcare services and outcomes for people with mental illness. However, with such a small number of studies, and with all main results graded by review authors as providing very low quality evidence, it is not possible to arrive at concrete and definite conclusions. Although single studies provided initial evidence that implementation of treatment guidelines may achieve small changes in mental health practice, a gap in knowledge still exists about how this might improve patient outcomes and health services. This leaves scant information for people with mental health problems, health professionals and policy makers. More large-scale, well-designed and well-conducted studies are necessary to fill this gap in knowledge.
Trifluoperazine versus placebo for schizophrenia
Trifluoperazine (trade name Stelazine) is a long‐established antipsychotic drug that has been used since the 1950s to treat schizophrenia. It is one of the first generation (typical) drugs that have proven very effective for treating the ‘positive symptoms’ of schizophrenia, such as hearing voices, seeing things and having strange beliefs. These drugs may cause side effects such as involuntary shaking, restlessness and movement disorders such as having a strange posture.
There are also more modern drugs (second generation and atypical antipsychotic drugs). These are effective with the ‘positive symptoms’ of mental illness but also help treat ‘negative symptoms’ such as apathy, weight gain and loss of emotion in people with schizophrenia. These more modern drugs are much more expensive.
This review is based on a search for trials carried out in July 2012, and includes 10 studies with 686 participants. The aim was to determine the effects of trifluoperazine for schizophrenia when compared with placebo (a ‘dummy’ treatment). As expected, people given trifluoperazine showed a significant improvement compared to placebo in both the short and medium term, reinforcing the use of this well‐established typical antipsychotic for people with schizophrenia. However, trifluoperazine can cause side effects such as confusion, agitation, having a dry mouth and blurred vision, but causes less sedation and dizzy spells, so is generally well tolerated by people with schizophrenia.
The authors of the review conclude that trifluoperazine has similar effectiveness to other common antipsychotic drugs, although it may cause more side effects. Evidence used in the review was also graded as low or very low quality. In the light of this, use of other antipsychotic drugs should be considered before starting on trifluoperazine. Most of the included studies were conducted roughly 40 years ago so new, large, comprehensive and independent research trials are needed.
There are also more modern drugs (second generation and atypical antipsychotic drugs). These are effective with the ‘positive symptoms’ of mental illness but also help treat ‘negative symptoms’ such as apathy, weight gain and loss of emotion in people with schizophrenia. These more modern drugs are much more expensive.
This review is based on a search for trials carried out in July 2012, and includes 10 studies with 686 participants. The aim was to determine the effects of trifluoperazine for schizophrenia when compared with placebo (a ‘dummy’ treatment). As expected, people given trifluoperazine showed a significant improvement compared to placebo in both the short and medium term, reinforcing the use of this well‐established typical antipsychotic for people with schizophrenia. However, trifluoperazine can cause side effects such as confusion, agitation, having a dry mouth and blurred vision, but causes less sedation and dizzy spells, so is generally well tolerated by people with schizophrenia.
The authors of the review conclude that trifluoperazine has similar effectiveness to other common antipsychotic drugs, although it may cause more side effects. Evidence used in the review was also graded as low or very low quality. In the light of this, use of other antipsychotic drugs should be considered before starting on trifluoperazine. Most of the included studies were conducted roughly 40 years ago so new, large, comprehensive and independent research trials are needed.
Supported employment for adults with severe mental illness.
People with mental health problems experience high rates of unemployment. There are various schemes delivering support to people with mental health problems who are trying to find employment. Supported employment tries to place people into competitive jobs. People are placed quickly in normal work settings where they receive intensive support and training from ‘job coaches’.
Individual placement and support (IPS) is a more specified scheme that includes: finding local jobs; a rapid job search; customer choice in what they want from the employment service; close working between employment and mental health teams; attention to people’s preferred job, their strengths and work experience; ongoing and, if necessary, long-term individual support; and the benefits of counselling. Employment specialists act to identify people’s job interests, assist with job finding, give job support and engage other support services. IPS uses assertive outreach to deliver training, advice and vocational support in the community. Augmented supported employment is where employment support is given with other supplementary techniques, such as social skills training, motivational classes and various types of rehabilitation. Other approaches are many and varied, including: job workshops; job counselling; peer support; partnerships with business; and the Clubhouse model, which involves training, work experience, peer support and transitional employment and IPS because they do not search for immediate and competitive employment. However, all approaches involve periods of preparation, education and on-the-job training.
This review compares supported employment and IPS with other approaches for finding employment. Drawing from a total of 2259 people with mental health problems in 14 studies, the review has two main findings: 1) Supported employment increases the length and time of people’s employment; 2) People on supported employment find jobs quicker. Supported employment and IPS are better than other approaches in these two respects, but there is limited information or measurable differences on other important issues for service users.
For example, there is little information on issues such as improving quality of life, impact on people’s mental health, days in hospital and costs. Furthermore, the review built its main findings on limited statistical evidence drawn mainly from studies carried out in North America and Europe. Future studies should address a fuller range of information and outcomes. Longer studies are needed to see how long the effects of supported employment last.
Individual placement and support (IPS) is a more specified scheme that includes: finding local jobs; a rapid job search; customer choice in what they want from the employment service; close working between employment and mental health teams; attention to people’s preferred job, their strengths and work experience; ongoing and, if necessary, long-term individual support; and the benefits of counselling. Employment specialists act to identify people’s job interests, assist with job finding, give job support and engage other support services. IPS uses assertive outreach to deliver training, advice and vocational support in the community. Augmented supported employment is where employment support is given with other supplementary techniques, such as social skills training, motivational classes and various types of rehabilitation. Other approaches are many and varied, including: job workshops; job counselling; peer support; partnerships with business; and the Clubhouse model, which involves training, work experience, peer support and transitional employment and IPS because they do not search for immediate and competitive employment. However, all approaches involve periods of preparation, education and on-the-job training.
This review compares supported employment and IPS with other approaches for finding employment. Drawing from a total of 2259 people with mental health problems in 14 studies, the review has two main findings: 1) Supported employment increases the length and time of people’s employment; 2) People on supported employment find jobs quicker. Supported employment and IPS are better than other approaches in these two respects, but there is limited information or measurable differences on other important issues for service users.
For example, there is little information on issues such as improving quality of life, impact on people’s mental health, days in hospital and costs. Furthermore, the review built its main findings on limited statistical evidence drawn mainly from studies carried out in North America and Europe. Future studies should address a fuller range of information and outcomes. Longer studies are needed to see how long the effects of supported employment last.
Tuesday 7 January 2014
Anticholinergic medication for excessive salivation caused by use of antipsychotics other than clozapine
The first line of treatment of schizophrenia is usually antipsychotic drugs. These drugs help in the treatment of the ‘positive symptoms’ of schizophrenia, such as hearing voices, seeing things and having strange beliefs. However, these drugs often have serious side effects, such as weight gain, muscle stiffness, tiredness, apathy and lack of drive. Dribbling or drooling (hypersalivation) is another common side effect, which frequently occurs at night when asleep. This can be an embarrassing and stigmatising problem that can affect quality of life and cause people to stop their medication, which may result in relapse and going back into hospital. Dribbling and drooling can be difficult to treat; however, anticholinergic drugs can decrease production of saliva and dribbling. This review assessed the evidence for the benefit or harm of anticholinergic drugs used in treating hypersalivation caused by antipsychotic or neuroleptic medication. The review excluded the antipsychotic clozapine, as its role in causing hypersalivation has been the subject of another Cochrane review.
The search was carried out 15 November 2012 and resulted in identification of four potential studies, but none could be included. Three of these were excluded because they involved clozapine-related hypersalivation. The fourth study was excluded because it involved people with mood or other mental disorders and Chinese medicines. Dribbling or hypersalivation is an important problem that needs to be investigated via well-designed research and randomised trials. Until such time, psychiatrists and patients are likely to continue their treatment of hypersalivation on the basis of daily clinical judgement and personal experience rather than hard evidence. Treatment of hypersalivation caused by antipsychotics or neuroleptics other than clozapine does not seem to have received adequate research attention to help guide practice. The review authors conclude that using anticholinergics to treat dribbling or hypersalivation caused by antipsychotic drugs other than clozapine cannot be justified without further study.
The search was carried out 15 November 2012 and resulted in identification of four potential studies, but none could be included. Three of these were excluded because they involved clozapine-related hypersalivation. The fourth study was excluded because it involved people with mood or other mental disorders and Chinese medicines. Dribbling or hypersalivation is an important problem that needs to be investigated via well-designed research and randomised trials. Until such time, psychiatrists and patients are likely to continue their treatment of hypersalivation on the basis of daily clinical judgement and personal experience rather than hard evidence. Treatment of hypersalivation caused by antipsychotics or neuroleptics other than clozapine does not seem to have received adequate research attention to help guide practice. The review authors conclude that using anticholinergics to treat dribbling or hypersalivation caused by antipsychotic drugs other than clozapine cannot be justified without further study.
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