Nidotherapy for schizophrenia.

Nidotherapy (from the Latin ‘nidus’ or ‘nest’) aims at identifying the need for and making changes to a person’s environment and surroundings. It works alongside other treatments to make improvements to a person’s well being, housing, money management, personal relationships, work and other factors. The aim of nidotherapy is not to change the person (whereas other psychological therapies often aim to make changes in an individual’s behaviour, emotions and thinking) but to create a better ‘fit’ between the environment and the individual.

Read the full summary here: http://summaries.cochrane.org/CD009929/nidotherapy-for-schizophrenia

From a service user perspective (SUPER), nidotherapy seems an intriguing, exciting but experimental approach to helping people with mental health problems.  Unlike other psychological therapies which focus on changing an individual’s behaviour, emotions and thinking, nidotherapy seeks to make changes in a person’s environment and surroundings.  Nidotherapy works alongside other treatments to make improvements to a person’s well being, housing, money management, personal relationships, work and other factors.  By focusing on the individual’s environment, rather than the individual themselves, this new therapy might be less stigmatising and more holistic than other psychological approaches that centre around the problems with an individual’s behaviour, emotions and thinking.  Nidotherapy seeks to make people’s social networks and relationships stronger, more harmonious and with a better ‘fit’.  Nidotherapy is new and at an experimental stage, so further information on its benefits and possible hazards is much needed before it can become more mainstream and accepted in health services.

Training to recognise the early signs of recurrence in schizophrenia.

Training in early warning signs techniques encourages people to learn, detect and recognise the early warning signs of future illness. Studies indicate that noticing even small changes in signs and symptoms of schizophrenia can often predict future illness and relapse two to 10 weeks later.

Read the full summary here: http://summaries.cochrane.org/CD005147/training-to-recognise-the-early-signs-of-recurrence-in-schizophrenia

From a service user perspective (SUPER), training in recognising early warning signs of illness and relapse seems like a good idea.  Training helps people with mental health problems, health professionals, families and carers to anticipate future illness.  This is preventative, helping people to avoid relapse and admission to hospital.  But it is also a collaborative endeavour, leading to personal insight about illness and self- understanding, so giving people with mental health problems more ownership, a greater say and more power to build their own recovery.

At the opposite end of the spectrum, the authors of the review note that it is possible that training in recognising early warning signs might have difficulties and negatives.  For example, there might be increased depression due to an increased self-focus.  Awareness of illness has also been linked to suicidal thoughts.  Another negative effect might be increased medication due to the increased reporting of people’s symptoms, without reducing relapse.

However, on balance, training and keeping a personal logbook, reflective diary or folder would seem to offer people more insight, control and say in their care.

Aripiprazole versus other atypical antipsychotics for schizophrenia.

This review includes 12 research trials with 6389 people. It evaluates whether aripiprazole is better than other drugs.

Read the full summary here: http://summaries.cochrane.org/CD006569/aripiprazole-versus-other-atypical-antipsychotics-for-schizophrenia

From a service user perspective (SUPER), it is perhaps surprising that there is so little information on the different medications that are available to service users (atypical antipsychotics such as aripiprazole, olanzapine, risperidone and ziprasidone).  The wholesale use of these drugs is widespread, but the benefits as well as the negative side- effects for service users are not fully understood or adequately researched.  Although these medications are thought to help service users, people with mental health issues may have little understanding of the medications that they are taking and little say in which ones they would prefer in their treatment. 

The first line of defence should certainly include medication, but service users should also have a greater say in what medications they would prefer.  Research should not just focus on the effectiveness of these medications, but should look at subjective and personal factors, which is just another way of saying that service users should have more say in the tablets or drugs they take in their treatment.  Taking into account the views of service users and carers, patient preference and impact on quality of life are mentioned by this review as needing further research.  This would encourage people to take their medication, so making it better understood, fair and acceptable for people.

It has also been found that antipsychotic drugs work better and are more acceptable to people when combined with psychological therapies: the ‘talking cures’ of psychotherapy; family therapy; counselling; and cognitive behavioural therapy.  Both objective factors (the effectiveness of medication) and subjective feelings (what treatment or therapy service users say they feel they would prefer) need to be taken into consideration, so as to strike a good balance in the treatment, care and possible recovery of people who use mental health services.

Flupenthixol versus placebo for schizophrenia.

Flupenthixol is an antipsychotic drug, first made available in the UK in 1965. Although this drug has been available for many years, few systematic reviews of its effectiveness are available and the effects of this drug in helping people cope with the symptoms of schizophrenia are not currently well measured, quantified and known.

Read the full summary here: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0049715/

From a service user perspective (SUPER), it may at first appear quite shocking that the use of flupenthixol is more rooted in the clinical experience and the everyday decision making of psychiatrists instead of being based on firm scientific knowledge.  This is often the case, though.  In my and other service users’ experience, we often progress through different medications until one is found that helps in coping with symptoms such as hearing voices and which lead to feelings of better stability. 

Side- effects from medication are nearly always a problem, with feelings of sleepiness, weight gain, restlessness, and shaking hands.  But the dosage of medication can always be reduced over time.  Newer drugs with less side- effects can be introduced by talking openly with a psychiatrist about your feelings and difficulties with side- effects.       

It has also been found that medication works better when combined with more person- centred care, such as psychotherapy, counselling, cognitive behavioural therapy, hearing voices and stress management groups, creative writing, music and art therapy. 

Benjamin Gray

Service User Expert

Rethink Mental Illness.  

Haloperidol as a means of calming people who are aggressive or agitated due to psychosis.

Haloperidol is a drug that can be taken as by mouth or injected. As well as being an antipsychotic (preventing psychosis), it calms people down or helps them to sleep.

Read the full summary here: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0049743/

From a service user perspective (SUPER), the experience of hearing voices, being agitated and seeing things can be confusing, frightening and sometimes terrifying.  If people’s voices are shouting at them, putting them down, being derogatory or abusive, then it is perhaps not surprising that people become aggressive and sometimes violent.  After all, if someone shouted at you in the street, many people would just shout back!  This is what it is like for people who hear voices or see things: it is like someone shouting straight into your ear and never going away. 

Many people choose to shout back at their goading voices and this can be taken as being aggressive and violent.  No one can hear the voice, the verbal abuse or what the voice is saying, so an aggressive response to hearing an internal voice can seem to come from nowhere.  A service user that I met some time ago would often walk along the hospital corridors, screaming back at her voices.  She would sometimes hit herself violently on the head, as if trying to physically knock the voices out of her mind.  This was seen as aggression and unexplained violence by onlookers, but left me with mixed feelings of pity, consternation and fear.  

Similarly, three other people who I met in hospital would often hear voices that seemed to come from the television.  This would make them frightened and aggressive.  On one occasion, this led to the television being smashed and the individual being forcibly injected with tranquillisers to calm him down.  

Unfortunately, some people may become very aggressive or violent towards others.  They may have panic attacks or be in emotional turmoil.  Sometimes sedatives and tranquillisers are necessary to help people calm down (and some people even ask for them to help them cope). 

The use of these sedatives is never ideal, and the use of forced injection can feel like a violation.  It can break the trust between the person with mental health problems and nurses.  Nurses want to foster and build therapeutic relationships with people.  But all the time it takes to build up feelings of trust and intimacy can be broken in an instant, when force is used to restrain or inject the person.

I was unfortunate enough to witness the injection of sedatives on two other occasions: the first time involving a young girl called ‘B’ who was trying to cut herself with the shards of a broken bottle; and the second time a man called ‘R’ who was violently kicking the door of the nurse station and shouting abuse at staff.  The use of sedatives in these two situations could perhaps be said to be necessary but never ideal or therapeutic in the long term.

Often, all it takes is for a nurse or member of staff to ‘de-escalate’ the situation.  This involves nurses talking to the individual, to calm them down before they become agitated or aggressive.  Other techniques, such as seclusion, can often give people some space and time to calm down in their own room. 

Benjamin Gray

Service User and Service User Expert

Rethink Mental Illness

Management of sexual problems due to antipsychotic drug therapy.

Drugs commonly used to treat schizophrenia often cause sexual problems. This may affect erection, lubrication, orgasm, desire or libido, ejaculation, sexual arousal or overall sexual satisfaction. This may have serious negative consequences such as putting people off taking their medication or stopping taking drugs at an early stage. Sexual problems may limit a person’s quality of life, worsen self-esteem and cause relationship problems. Strategies to manage these sexual problems are taking additional drugs (Viagra TM), short drug holidays when people temporarily stop antipsychotic medication, reduction of dose and switching to another antipsychotic drug.

Read the full summary here: http://summaries.cochrane.org/CD003546/management-of-sexual-problems-due-to-antipsychotic-drug-therapy

From a service user perspective (SUPER), having a mental health problem can affect all aspects of life and limit people’s quality of life.  People with mental health problems face difficulties in education, employment, stigma and social exclusion.  Having a mental health problem, combined with side- effects from medication, can make you feel very tired and reduce being able to feel emotions such as pleasure, satisfaction and happiness.  People may also experience sexual and relationship problems.

Many partners of people with mental health problems who I have spoken with say that mental illness has changed the person they love, so that they are almost unrecognisable.  They feel that they have lost the person they love, causing problems of intimacy and trust in sexual relationships.

Having a mental health problem can make you feel like a non- person, whose views, life and sexuality feel like they are unimportant and eroded. 

Several strategies to manage sexual problems are mentioned (such as additional drugs like Viagra, short drug holidays when people temporarily stop antipsychotic medication, reduction of dose and switching to another antipsychotic drug).  Talking therapies, such as psychotherapy and sex therapy, may also help to improve people’s relationships and sex lives.

Benzodiazepines for Schizophrenia.

Benzodiazepines can be taken alone or in combination with more traditional antipsychotic drugs. They cause sedation, calmness and relax the muscles, so are helpful in calming down agitated people with anxiety, sleep problems, seizures, alcohol withdrawal and acute mental health problems.

Read the full summary here: http://summaries.cochrane.org/CD006391/benzodiazepines-for-schizophrenia

From a service user perspective (SUPER), benzodiazepines are frequently used as a drug of choice for schizophrenia.  It is sobering that this is the case even though there is little information or evidence to support their widespread use.  Furthermore, the range and complexity of drugs available to treat mental health issues is large and confusing.  Many drugs have triple barrelled and long names, which are hard to say and pronounce (Benzodiazepines, Risperidone; Antiglucocorticoid).

If people are taking one type of drug, then it can be quite daunting and scary to switch to a new drug or a combination of several new drugs.  New drugs do have the promise to work better for people who use mental health services, but there is always doubt at the back of the mind about possible relapse, not least because most drugs have side- effects (such as weight gain, sleepiness, shaking and dizziness).

This points out the fact that there needs to be better information sharing between psychiatrists and people who use mental health services.  The benefits of taking certain drugs need to be explained, as well as the potential side- effects, to promote better understanding and to encourage people to regularly take their medication. 

However, if there is little information and evidence to support a drug’s prescription, then psychiatrists might be basing their prescription of drugs on daily clinical judgement and experience, rather than strong and proven research evidence.  Although this means that better information and research evidence is needed to support the use of a drug, it also means that psychiatrists and service users hopefully know each other quite well.  They can talk to one another, collaborate and discuss which medication works best for them and come up with practical and real- life solutions to improve the lives of people who use mental health services.   

Benjamin Gray

Service User and Service User Expert

Rethink Mental Illness.