Tag Archives: Schizophrenia

Y – #AtoZChallenge on Mental Health

Welcoe to the letter Y post in the #AtoZChallenge on mental health. This was definitely the hardest letter of all. In fact, I cheated a little, because I have only one word and it’s practcally unrelated to mental health. I use it to talk about an important topic in mental health though. Here goes.

Ypsilon

Ypsilon is of course the Greek letter from which the Latin Y is derived. However, it is also the Dutch organization for family members of people with schizophrenia and other psychotic disorders. Like I said, it’s a little out of left field, but I want to use this word to discuss the importance family plays in severe mental illness and recovery from it.

A few years ago, there was some debate that revolved around the question whether organizations of families of patients should receive government funding, or whether it should only be organizations of patients themselves. Ypsilon spoke up, saying that people with severe mental illness cannot necessarily advocate for themselves. Never mind that there’s an organization for people with schizophrenia and related disorders too, called Anoiksis.

Some other organizations, like the Association of Manic-Depressives and Relatives (that’s the literal translation of the Dutch name), allow both patients and family to be active members in the organization. I don’t know how each group is represented on the board of directors. However, this organization makes it clear that patients and family should really work together towards a common goal. Note that bipolar disorder is often as severe a mental illness as schizophrenia, so Ypsilon’s argument that people with severe mental illness can’t advocate for themselves, holds no ground.

Family are, of course, important in people’s mental health recovery. However, it’s still the patients who have the first-hand experience of mental illness. As such, they should always be at the center of their recovery process. Ypsilon is an okay’ish organization in this sense, often cooperating with Anoiksis and having destigmatization as a goal. Other organizations, however, often do not value patients’ input.

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V – #AtoZChallenge on Mental Health

Welcome to the letter V post in the #AtoZChallenge on mental health. Pfew, we’ve arrived at the last week and I’m looking forward to writing regular posts once again. This letter wasn’t too hard though. Here goes.

Visiting Hours

Mental hospitals, like most hospitals, have visiting hours. The difference is that they are particularly meant for patients from other units. Family often can come when they want.

Vitamins

Many mental institution patients take one or more vitamins or minerals. The reason is that many don’t have the healthiest diets and hence run a risk of vitamin deficiency. However, it is also thought that vitamin deficiencies may contribute to people’s mental illness. For example, depression may be associated with vitamin D deficiency.

Voice-Hearing

Many people with severe mental illnesses hear voices. Many people without severe mental illness do too, but they can function in spite of their voice-hearing. As such, voice-hearing itself does not indicate severe mental illness, even though until recently, you could be diagnosed with schizophrenia by merely hearing voices.

There is an international movement of voice-hearers. The most well-known organization supporting this movement is Intervoice in the UK. Intervoice aims to support people who hear voices, whether they’ve been diagnosed with a mental illness such as schizophrenia or not.

Core values of the hearing voices movement are:


  • Hearing voices, seeing visions and related phenomena are meaningful experiences that can be understood in many ways.

  • Hearing voices is not, in itself, an indication of illness, though difficulty coping with voices can lead to great distress.

  • When people are overwhelmed by their experiences, support should be based on respect, empathy, informed choice and an understanding of the personal meaning of this person’s voice-hearing.

Volunteers

Many mental hospitals and support organizations for people with severe mental illness employ volunteers. Volunteers might be visiting buddies, visiting the patient every so often. They may also help paid staff during day activities. My institution isn’t keen on employing volunteers. There was this staff member who would be laid off due to budget cuts and she offered to come back as a volunteer. The management said “No”, because volunteers cost some money too.

N – #AtoZChallenge on Mental Health

Welcome to the #AtoZChallenge on mental health, day 14. Today’s letter is N. Another late post, because I slept through the day yesterday so wasn’t able to schedule it. Here goes.

Neuropsychiatry

Neuropsychiatry is the branch of psychiatry specializing in the effects recognized brain diseases have on people’s mental health and behavior. Of course, mental illnesses have a biological component too, but neuropsychiatry is particularly interested in conditions like epilepsy, Parkinson’s Disease and brain injury. Some psychiatric institutions have specialized neuropsychiatric units or outpatient clinics. Mine has both. The inpatient unit is mostly for people with brain injury. In my institution, a neurologist is in charge of directing the care on this unit.

Neurotransmitters

Neurotransmitters are chemicals that the brain cells use to communicate. They commonly have multiple functions, hence the side effects of psychiatric medications affecting neurotransmission. Well-known neurotransmitters are serotonin and dopamine.

Serotonin is thought to play an important role in mood. A deficiency in it can cause mood disorders, such as depression or bipolar disorder. Unfortunately, an excess of serotonin caused by antidepressant use can cause serotonin syndrome, which is a potentially life-threatening condition. Serotonin syndrome is particularly associated with a type of old-school antidepressants called MAOIs.

Dopamine plays a role in different physical and mental functions. Dopamine is necessary for movement. Parkinson’s Disease is caused by a degeneration in the dopamine-producing cells in the brain. On the other hand, an excess of dopamine is linked to psychotic symptoms. First-generation antipsychotics (such as Haldol) block the brain receptors for dopamine. Like I said however, dopamine is necessary in movement. Hence, peoople on first-generation antipsychotics commonly experience tremors and muscle stiffness similar to Parkinson’s patients. This movement disorder associated with antipsychotic use is called Parkinsonism.

Nicotine

Many people with mental illness smoke. Among people with schizophrenia, as many as 90% do. It is well-known among smokers that cigarette-smoking relieves stress. This coul be psychological dependence though. However, research shows that nicotine actually helps decrease psychotic symptoms specifically. It is not just a matter of psychological dependence on nicotine that causes people with schizophrenia to experience fewer symptoms after smoking. As such, schizophrenics might unknowingly use nicotine as self-medication.

Nurse

Obviously, mental hospitals employ nurses as support staff. Their primary tasks are to observe and facilitate the patients’ day-to-day functioning. Obviously, administering medications is a common task. However, nurses also use psychosocial interventions.

Community psychiatric nurses (CPNs) are employed by outpatient clinics to help support patients in the community. They often do some form of psychosocial counseling and are also often employed as case managers. As such, they do some tasks formerly done by social workers.

Schizophrenia and Psychosis #Write31Days

31 Days of Mental Health

Welcome to day 24 in the #Write31Days challenge on mental health. As I said about a week ago, I’d write a post on schizophrenia and psychosis someday in this series. Today the day has come to write about this category of mental disorders. Most people admitted to psychiatric hospitals, and certainly most who are there long-term, have some form of a psychotic disorder. I do not and personally I find psychosis one of the most bewildering mental health symptoms.

Psychotic disorders are characterized by symptoms in one or more of the following five domains:


  • Delusions: fixed beliefs that do not change when the sufferer is presented with conflicting evidence. An example is the unfounded belief that one is being persecuted. Delusions are classified as bizarre when they are not understood by people from the sufferer’s culture and do not derive from ordinary life experience. In other words, a non-bizarre delusion is about something that could technically happen to the sufferer; a bizarre delusion is about something that is truly impossible. An example of a bizarre delusion is the belief that an outside force has removed one’s internal organs and replaced them by someone else’s.

  • Hallucinations: sensory perceptions (eg. smelling, hearing or seeing something) that occur without an external stimulus. Hallucinations are as clear and vivid as ordinary sensory perceptions. Hallucinations may occur in any sensory modality, but auditory hallucinations are most common in schizophrenia and related disorders. (Visual hallucinations are more common in neurological conditions.)

  • Disorganized thinking (speech). Formal thought disorder (disorganized thinking) is generally apparent through a person’s speech. For example, a person may switch from one topic to another (derailment or loose association). Rarely, a person’s speech may be so severely disorganized that it is barely comprehensible. These people’s speech is referred to as “word salad” (thhat’s the actual term used in DSM-5).

  • Grossly disorganized or abnormal motor behavior. An example of this is catatonia, a marked decrease in reactivity to the environment. People may “freeze” in a (usually odd) position. Other examples are complete lack of speech (mutism), repetitive, purposeless movements or repeating someone else’s words (echolalia) or actions (echopraxia).

  • Negative symptoms. These include reduced emotional expression and avolition. Avolition is a decrease in motivated, self-directed, purposeful activity. People may sit for hours and not be motivated for occupational, social or even simple household activities. They may therefore appear lazy.

Psychotic disorders may affect only one domain of symptoms. For example, delusional disorder is characterized by delusions only and no other psychotic symptoms. Sometimes, a person experiences more severe psychotic symptoms but the symptoms disappear within a month. This is called a brief psychotic disorder.

Schizophrenia is the most severe form of psychotic disorder. Individuals with schizophrenia experience symptoms in at least two of the domains listed above most of the time over a period of at least a month (or less if successfully treated). At least one of these symptoms must be delusions, hallucinations or disorganized speech. Since the onset of their symptoms, their functioning has declined significantly relative to their pre-illness level of functioning (in children or adolescents, consider failure to meet expected achievements in functioning). Even if the active phase of psychosis has subsided after a month, signs of disturbance remain for at least six months. If a person has residual symptoms for less than six months, they should be diagnosed with schizophreniform disorder.

The course of schizophrenia includes an active phase (at least one month during which at least two psychotic symptoms are present). This active phase may be preceded by a prodromal phase and followed by a residual phase. During the prodromal and/or residual phase, a person may experience only symptoms in one domain (usually negative symptoms), or they may experience two ore more psychotic symptoms but in a less severe (attenuated) form. Attenuated psychotic symptoms are symptoms that are similar to hallucinations, delusions etc. but are not full-fledged. Examples include odd beliefs or unusual perceptual experiences. Almost everyone experiences these at times. They become significant when they appear regularly and interfere with a person’s daily functioning. Some research shows that having attenuated psychosis symptoms is a risk factor for actual psychosis. However, there is no evidence so far that antipsychotics can prevent full-fledged psychosis in people who have only experienced attenuated symptoms.

What Are Personality Disorders? #Write31Days

31 Days of Mental Health

Welcome to day 10 in the #Write31Days challenge on mental health. Today, I will discuss the broad category of disorders I’ve been diagnosed with: personality disorders. Though there is some debate as to whether borderline personality disorder should be conceptualized as a personality disorder, it currently is.

A personality disorder is a pervasive pattern of dysfunctional thought, behavior and emotion that is stable across time and across situations. It is out of line with cultural expectations and causes distress or impairment. It usually emerges in early adulthood, though adolescents may be diagnosed as being at risk for developing a personality disorder. In fact. when I attended a conference on BPD in 2013, a psychiatrist specializing in this said that BPD can be reliably diagnosed from age sixteen on. In other disorders, such as antisocial personality disorder, there is a specific age requirement of being over eighteen.

The Diagnostic and Statisticla Manual of Mental Disorders, both DSM-IV and DSM-5, divides specific personality disorders into three subcategories, called clusters. These are:


  • Cluster A includes paranoid, schizoid and schizotypal personality disorders. Individuals exhibiting these disorders often appear odd or eccentric. The disorders in this cluster can precede schizophrenia. I tend to think of cluster A personality disorders as “psychosis light”.

  • Cluster B includes antisocial, narcissistic, borderline and histrionic personality disorders. Individuals with disorders in this cluster are often seen as dramatic, emotional or erratic. People with cluster B personality disorders are often perceived as among the most difficult people to get along with. When peope think of personality disorders in general, they mostly mean cluster B disorders. The same goes for treatment programs focused on personality disorders.

  • Cluster C includes avoidant, dependent and obsessive-compulsive personality disorders. Individuals with cluster C personality disorders tend to be anxious or fearful.


In DSM-5, it is stated clearly that the clustering of personality disorders, while it has some merit, may not be very useful in clinical practice. After all, many people exhibit traits of personality disorders across clusters. When a person has features of more than one personality disorder but doesn’t teet the full criteria of any, they may be diagnosed with an unspecified personality disorder. People with other specified personality disorder display behavior that is seen as a personality disorder but isn’t listed specifically in DSM-5. Examples include passive-aggressive and self-defeating personality disorder.

There are some clear gender differences in how commonly personality disorders occur. Antisocial personality disorder occurs far more often in males than females. Borderline, histrionic and dependent personality disorder occur more in females. Though this may reflect real gender differences, it is also likely that stereotypical views shape clinicians’ diagnoses. For example, I once read that BPD is really about as common in males as in females but is overdiagnosed in women and underdiagnosed in men. Women misdiagnosed with BPD are often later found to have ADHD, which interestingly used to be seen as a typical male disorder.

diagnosticians always need to be aware of a patient’s cultural background and life history. After all, in some cultures, behavior that is seen as disordered in the western world may be normal. People who experienced extreme stress or trauma may also exhibit long-lasting dysfunctional behavior patterns and be misdiagnosed with personality disorders when they really have PTSD. Veterans are disproportionately often diagnosed with personality disorders, for example.

Mental Illness: Nature or Nurture? #Write31Days

31 Days of Mental Health

Welcome to the seventh installment of the 31 Days of Mental health series. Today, I picked another of the 30 questions from the 30-day awareness challenge: do you believe nature (biology, physiology, etc.) or nurture (your psychosocial environment) causes mental illness? I am very tired, too tired to find the scientific evidence to back my post up with. will share what I do know off the top of my head, but please don’t ask me to cite my sources.

In medicine in general, there used to be a strictly nature-based model of illness and health. This determined that biological and physiological processes in the body caused illness and there was no contribution of psychological or social influences. This model is called the biomedical model and my health psychology book used it to describe the history of views on physical illness.

In mental illness, there have been many schools of thought that laid blame on the environment, in fact. For example, Freud blamed fixations in one’s psychosexual development for mental illnesses. The school of behaviorism also blamed the environment. Watson, the founding father of behaviorism, at one point said that, if given a handful of babies at birth to raise, he’d be sure he could make whatever you wanted the babies to become from them purely by processes of conditioning (behavioral learning).

It is interesting that there is such a distinction between the biomedical views on physical illness and the psychosocial views on mental illness. After all, though religion may say otherwise, scientists usually see the mind as part of the body. At least the brain is and dysfunction in the brain can cause mental disorders.

I currently study healht psychology at university. Health psychology feels illness as resulting from an interplay of biological, psychological and social factors. Again, they usually study physical illness, but I must say I believe the same goes for mental illness.

I remember when I was still diagnosed with dissociative identity disorder reading a scientific article that said in part that the role of psychological trauma in the cause of what is often diagnosed as DID may be less significant than people think. They used the analogy of borderline personality disorder, which they said most people diagnosed with DID truly have. BPD is commonly thought of as a developmental trauma disorder, but research shows that there may be genetic and other biological factors predisposing to its development. Then again, trauma researchers have made it very clear that trauma and other strong environmental factors alter the brain.

I personally tend to believe there is not a single mental illness that is solely caused by nature or nurture. There are illnesses where biology is the main causative factor, such as schizophrenia, and illnesses where psychosocial factors are the main cause, such as post-traumatic stress disorder. However, stress can trigger psychosis in vulnerable people and trauma only causes PTSD in some of its victims, presumably those biologically predisposed to PTSD.

As for my own mental illness, there are biological factors predisposing me to developing mental disorders. Though I don’t have any family members diagnosed with a mental illness, autistic traits run in my family. NOw again I don’t see autism as a mental illness, but autistic people are more vulnerable to mental illnesses than neurotypicals. I also was a preemie, which may’ve caused brain dysfunction. Lastly, though none of my famly members are mentally ill, a difficult temperament tends to run in my family.

As for psychosocial factors, I am a childhood trauma survivor. I also have had high levels of stress in my life, possibly due to the incongruence between my autistic self and the neurotypical environment. It was a stressful event that sent me over the edge, but it was probably biology that predisposed me to vulnerability to stress.

Autism Speaks: Why We Need Autistic Representation

Through the week-end blog hop over at Single Mother Ahoy!, I came across a post supporting Autism Speaks and debunking the argumetns people have against it. The first of these is that Autism Speaks has no autistic people on the committee. That doesn’t bother Melissa Hopper, the post author, presumably because she’s a parent. It does, however, bother me. Since every autism blog (and though I don’t really write an autism blog, I sometimes write about autism, so…) should have a post for or against Autism Speaks, here’s mine. It isn’t, by the way, directed just at Autism Speaks, but at every parent-run organization aimed to represent the entire community of people with a particular disability.

Suppose, I wrote to Melissa, that your son were gay. Would you raise money for an organization that had only parents and families of gays on its committee? I realize that there are organizations like PFLAG (Parents and Friends of Lesbians and Gays), and Melissa might in this hypothetical scenairo want to join them. I mean, there’s nothign wrong with parents of children or teens or for that matter adults who are different wanting a place to be represented too.

The thing with Autism Speaks and possibly other organizations is that 1. they pretty explicitly exclude autistics from the committee, and 2. they don’t support the inclusion or equality of autistics, choosing instead to support their eradication.

Now I do realize that autism is a disability whereas homosexuality is not. People may disagree here, but I do see autism as a disability. However, that still doesn’t mean that social inclusion and equality shouldn’t b primary goals of an organization claiming to speak for that disability population, particularly since the majority of adults with this disability advocate this.

Once Melissa’s son grows up, I asked her, does she want to be his representative for the rest of her life, or does she want him to be able to speak for himself? I am hoping for the latter, as most parents want their children to grow up to be able to speak for themselves. Now I can totally see why at age three Melissa’s son can’t speak for himself and he needs his mother to do so. I totally also see that right now the number of autistic children (who need their parents to speak for them) is greater than the number of autistic adults. In twenty years or so, this will not be the case anymore. And while there will still be autistic children, and hence the need for a parent organization, an autistic-run organization should have far more to say. And just for your information: there are already a number of adults who grew up with parents supporting the likes of Cure Autism Now, who are now old enough to speak for themselves and vehemently disagree with the cure position. Christine Motokane, whose book I reviewed on Wednesday, is one of them.

In the Netherlands, there ae two organizations for the schizophrenia community. One, Anoiksis, is run by people with schizophrenia themselves, while the other, Ypsilon, is run by families. I can see why there’s a need for both, but they cooperate on some level. Same for the Dutch Autism Society and Persons on the Autistic Spectrum. (The Autism Society has autistic members, like myself, but I don’t know if they have anyone autistic on the committee.) Autism Speaks has never sought any form of cooperation with autistic-run organizations. It will never do so, because Autism Speaks advocates the eradication of autism rather than the equal rights of autistics.

Now I do know there are autistic people who support Autism Speaks, and John Elder Robison used to be a token a =utistic for them. I don’t even have strong opinions against all of Autism Speaks’ positions – I used to read their blog and it wasn’t too bad. I also wouldn’t mind Autism Speaks existing if a major organization representing autistic people themselves were getting as much support. Like with the Anoiksis/Ypsilon thing, I can see the need for a parent organization. But Autism Speaks aims to speak for autistic people without having a single autistic person on the committee, without cooperating with autistic people, and without advancing the inclusion of autistic people. If just one of these were the problem, oh well, but now that all of them are, I have major concerns.

Melissa’s son is just three. She doesn’t likely think of him representing himself. But he’ll eventually reach that point, and by that time, I can only hope he has his mother’s support rather than opposition.

Mass Murder and Autism: I’m Not Impressed

Today, I came across a post on why the new DSM-5 definition of autism may actually be good. In it, the author talked about an apparent mass murder and the associated speculation of the killer having Asperger’s Syndrome. I googled, hoping to find out which mass murder she was writing about, but instead came across a Washington Post article which claimed a “significant” link beteeen mass murder and autism. I read the original study (Allely et al., 2014) on which this article was based, and I’m not impressed.

First, the actual question the authors aim to answer, is inverted. They research whether a significant number of mass or serial killers have autism and/or head injury. They found that this is so: roughly ten percent of the mass or serial killers the researchers read about, had suspected or diagnosed ASD, and a similar percentage had a possible or definite head injury. This may be significantly more than the prevalence of autism or head injury in the general population, but so what? The really important question is whether autistics or those who sustained head trauma are more likely to become serial killers. One thing I learned from Ton Dekrsen, author of Lucia de B., a book on the Dutch nurse falsely accused of serial murder on her patients, is that a statistical link that runs in one direction, doesn’t necessarily run in the other as well. Since serial or mass murders are rare, this is especially important.

Also please note that Allely et al. state that, of none of the six murderers (out of 239 total!) with “definite” autism, diagnostic data was available. “Probable” ASD also included a psychiatrist or psychologist having said the murderer had ASD. This raises suspicion, as psychologists and psychiatrists are not immune to media hyping wanting to label every murderer with the mental illness du jour. Dutch readers might remember psychiatrist Menno Oosterhoff accusing Volkert van der Graaf, who murdered politician Pim Fortuyn, of having Asperger’s in 2003. With no diagnostic data on any of the murderers with suspected or “definite” ASD, it is really speculative to even say that there is a one-directional link between mass murder and ASD. And don’t get me talking on the “possible” ASD people, who were simply described as “odd” or “loners” by their family members.

Allely et al. do say in their discussion that speculation about a link between autism and mass murder may lead to negative steretoypes. This of course is not a reason not to document it. If autistics are in fact more likely to be serial or mass murderers, there’s no reason not to write that into a research paper. The thing is, due to the rarity of serial and mass murders, this is unlikely to ever become truly apparent. And even if a definite link could be found, so what? I recently read in another book that, while there is a link between schizophrenia and violence, locking away all schizophrenics in England and Wales for the rest of their lives would save the lives of four potential murder victims each year.

Reference

Allely CS, Minnis H, Thompson L, Wilson P, and Gillberg C (2014), Neurodevelopmental and Psychosocial Risk Factors in Serial Killers and Mass Murderers. Aggression and Violent Behavior, 19(3)288-301. DOI: 10.1016/j.avb.2014.04.004.