Many people with psychosis hear voices. Such voices are considered “auditory hallucinations”, and they constitute one of the so-called positive symptoms of schizophrenia. In fact, many people in general hear voices. While schizophrenia is estimated to affect 1% of all people, the percentage of people who hear voices has been estimated to be as high as 25 per cent.
Psychiatry’s traditional approach to voices has been to reduce or eliminate auditory hallucinations by the application of antipsychotic medications. Sometimes this succeeds, albeit with the potential high cost of significant and often iatrogenic side effects. Sometimes this doesn’t succeed, leaving an individual who hears such voices hearing them still.
Perhaps a more benign alternative approach is to accept, accommodate, manage, redirect, and try to understand such voices. In addition to (or instead of) the possibility of voices resulting from biochemical imbalances in the brain, voices may also result from painful or disturbing associations in the mind, more specifically deeply seated and unresolved psychological stress arising from physical or psychological trauma. Thus it may be worth considering an alternative to heavy antipsychotic medication as a treatment approach to the presence of auditory hallucinations.
To help families and their loved ones who may hear voices research the issue of hearing voices, PsychOdyssey is pleased to present a new page on Hearing Voices of in our “Research…” section, accessible here.
Yale Program of Recovery and Community Health in New Haven, CT does collaborative research, evaluation, education, training, policy development, and consultation. It works to transform behavioral health programs, agencies, and systems to be culturally responsive and re-oriented to facilitating the recovery and social inclusion of the individuals, families, and communities they serve.The Program promotes the recovery, self-determination, and inclusion of people experiencing psychiatric disability, addiction, and discrimination through focusing on their strengths and the valuable contributions they have to make to their communities.
To read more about the Yale Program, click here. To see all of PsychOdyssey’s state links, click here.
At the New Jersey Psychiatric Rehabilitation Association’s 2013 Annual Convention, PsychOdyssey’s Tom Pyle spoke about how to understand public financing for psychiatric rehabilitation in the State of New Jersey. His talk, entitled “Psychiatric Rehabilitation: Public Finance 101″, was an introduction to agency and governmental funding. Referring to an agency’s Form 990, the 2014-15 New Jersey Division of Mental Health and Addictions Services SAMHSA Block Grant application, and the NJ Governor’s 2014 Budget, Tom helped the participants differentiate among information sources and evaluate the line items in each.
Dr. Tom Insell, chief of the National Institute of Mental Health, has written an important post on his blog at the NIMH website. He has focused on two recent studies that call into question traditional medical model treatment assumptions for schizophrenia. The first study, by Wunderink et al. (2013), shows better recovery outcomes after sevens for those with schizophrenia no longer on their antipsychotic medications. The second study, by Harrow and Jobe (2007), indicates lower relapse rates over time of those with psychiatric disabilities who have discontinued medications. These studies call into question the efficacy of long-term antipsychotics usage. As Dr. Insell concludes from both articles, we need to broaden our understanding of schizophrenia–including a rethinking of additional modalities of psychiatric rehabilitation care:
It appears that what we currently call “schizophrenia” may comprise disorders with quite different trajectories. For some people, remaining on medication long-term might impede a full return to wellness. For others, discontinuing medication can be disastrous. For all, we need to realize that reducing the so-called “positive symptoms” (hallucinations and delusions) may be necessary, but is rarely sufficient for a return to normal functioning. Neither first nor second generation antipsychotic
medications do much to help with the so-called negative symptoms (lack of feeling, lack of motivation) or the problems with attention and judgment that may be major barriers to leading a productive, healthy life. Family education, supported employment, and cognitive behavioral therapy have all demonstrated efficacy in reducing the likelihood of relapse events, increasing the ability to function in daily life, and improving problem-solving and interpersonal skills.
To read Dr. Insell’s entire blog post, click here. To read the Wunderink study, click here. To read the Harrow study, click here.
Harrow, M., & Jobe, T. H. (2007). Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications: A 15-year multifollow-up study. The Journal of Nervous and Mental Disease, 195, 406-414.
Wunderink, L., Nieboer, R. M., Wiersma, D., Sytema, S., & Nienhuis, F. J. (2013). Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy: Long-term follow-up of a 2-year randomized clinical trial. JAMA Psychiatry, 70(9), 913-920. doi: 10.1001/jamapsychiatry.2013.19
After a while, some parents in the maelstrom begin to wonder. Are all the psychiatric medications prescribed to our loved one really helping? Or are they doing more harm than good?
Schizophrenia can a seriously disabling disorder. Antipsychotics, antidepressants, and mood stabilizers can be helpful in addressing specific problems associated with the disorder, such as hallucinations, delusions, anxiety, insomnia, and depression. But an increasing volume of evidence is showing that such medications also bring serious risks, especially over the long term. Often cited risks include obesity, diabetes, metabolic syndrome, brain shrinkage, psychosis, shorter lifespans (by 25 years on average), and even suicide.1-3 Other studies show that those with psychiatric disabilities have who eventually eschew medications may have better prospects for recovery over the long run.4
There are questions about certain marketing practices of pharmaceutical companies. Clinical trials for FDA approval are conducted mostly by companies whose primary purpose is profit maximization, not scientific advancement. Accordingly, it is not surprising, nor reassuring, that companies have often published findings selectively, manipulated publications in professional journals, sequestered the raw data generated in their studies, and even invented entire new diseases (i.e., bipolar) and to which to market their products and new classes of much more expensive drugs (i.e., second-generation atypicals like risperidal) that proved no better than existing drugs (i.e., haloperidol).5-9
No wonder that there is a movement in some quarters for loved ones to get off all psychiatric medications altogether. Will Hall is a Portland, OR therapist who knows about this matter. As one with schizophrenia who has been prescribed many medications during his ordeals, he have a vivid personal experience. He coaches loved ones who decide for themselves how best to reduce their medications. A believer in both medications when appropriate and personal freedom for those who decide to use—or reduce them, Hall takes a balanced, measured, objective, non-ideological approach. He has published a helpful free resource called Harm Reduction Guide to Coming Off Psychiatric Drugs. In this 30 minute video Hall offers counseling on “harm reduction” that few, including most psychiatrists, could fault and that family members in the maelstrom should bear in mind.
1. Ho B, Andreasen NC, Ziebell S, Pierson R, Magnotta V. Long-term antipsychotic treatment and brain volumes: A longitudinal study of first-episode schizophrenia. Archives of General Psychiatry. 2011;68(2):128-137.
2. Moncrieff J, Cohen D. Do antidepressants cure or create abnormal brain states? PLoS Med. 2006;3(7).
3. Whitaker R. Anatomy of an epidemic: Magic bullets, psychiatric drugs, and the astonishing rise of mental illness in America. New York: Crown Publishers; 2010.
4. Wunderink L, Nieboer RM, Wiersma D, Sytema S, Nienhuis FJ. Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy: Long-term follow-up of a 2-year randomized clinical trial. JAMA Psychiatry. 2013;70(9):913-920.
5. Healy D. Pharmageddon. Los Angeles, CA: University of California Press; 2012.
6. Tyrer P, Kendall T. The spurious advance of antipsychotic drug therapy. The Lancet. // 2009;373(9657):4-5.
7. Whitaker R. The case against antipsychotic drugs: A 50 year record of doing more hard than good. Medical Hypothesis. 2003;62:5-13.
8. Lieberman JA, Stroup TS, McEvoy JP, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine. 2005;353(12):1209-1223.
9. Turner EH, Matthews AM, Linardatos E, Tell RA, Rosenthal R. Selective publication of antidepressant trials and its influence on apparent efficacy. New England Journal of Medicine. 2008;358(3):252-260.
The International Society for Ethical Psychology and Psychiatry (ISEPP) is an organization of mental health professionals, researchers, parents, families, teachers and others who study and promote safe, humane, life-enhancing approaches to helping people who are diagnosed with mental disorders. When describing states of being which lead people to be diagnosed with mental disorders it prefers to use non-medical model language such as emotional distress, life crises, difficult dilemmas, spiritual emergencies and overwhelm. It regards all symptoms as being understandable, meaningful, somewhat functional and potentially useful to the process of learning how to live well. ISEPP uses the standards of scientific inquiry to critique biopsychiatry with its belief that mental disorders are caused by chemical imbalances, genetic dynamics and brain disorders, its medicalization of human experience and its use of drugs as a primary modality of treatment. It opposes the use of drugs and of forced treatment in all but the most dire of circumstances. It promotes approaches that help people use their thoughts, feelings, intentions, perceptions and behavior to learn how to live more the way they want to live.
To connect to ISEPP’s site, click here. To see PsychOdyssey’s other international links, click here.
Back in November 2010, Nature, the weekly science journal, printed a feature issue on schizophrenia. For families with loved ones having schizophrenia, the issue provides good additional information about this difficult, dreaded syndrome, including NIMH Director Tom Insel’svision piece called “Rethinking Schizophrenia”. Insel tries to posit a vision of schizophrenia for 2030, a difficult task as he admits. Here are some of Insel’s thoughts:
“The history of schizophrenia say more in many ways about the perspectives of the observer than the observed.”
“Although both conventional and atypical antipsychotics reliably reduce delusions and hallucinations, they have not enhanced functional recovery…“
“Research focusing on the drugs instead of the illness has thus far yielded too little progress…“
“One of the most egregious aspects of schizophrenia treatment in 2010 is the fragmentation of care, with medical care separated from psychiatric care and both isolated from psychosocial interventions, such as supportive employment and family education, which has a strong evidence base for effectiveness.”
“Schizophrenia today too often defines a person rather than describing the illness.”
“We need a personalized and preemptive approach, based on understanding and detecting individual risk and facilitated by safe and effective interventions for those in [the early stages] of this disorder. In the meantime, we can create policies for social inclusion, family support, and continuity of care to ensure that those in the later stages of the syndrome have the best chance of recovery.”
Families of loved ones with schizophrenia will benefit from a careful reading of Insel’s article, as well as all the related articles in this feature issue. Connect to this issue of Nature by clicking here.
Implementation of the Patient Protection and Affordable Care Act is bringing a new era in American health care. For those with psychiatric disabilities, the outlook is uncertain. While access will increase as the Medicaid rolls expand by 25%, the availability, quality, cost, and innovation of care could likely decrease, as described in PsychOdyssey’s recent white paper about Medicaid expansion in New Jersey (Will Medicaid’s 3 Big Changes Improve Recoveries of Adults with Schizophrenia in New Jersey?)
Healthcare observers from all corners of the country have made predictions on everything from the ultimate cost of health reform to the percentage of the uninsured. There’s a mix of both optimism and pessimism. 2014 will provide us an opportunity to compare their predictions to the ultimate reality. Managed Healthcare Executive, a trade publication of the managed care industry, polled readers on their forecast for 2014 and beyond. Nearly 350 readers responded and their feedback is summarized here in its 2014 State of the Industry slideshow. See the slide show and its related articles here.
When the call comes and police arrive, what will they do? If the case involves someone with a mental illness, the outcome is often uncertain. Often the consequences can be tragic, even fatal. Police encounters with those with mental illness doesn’t have be end this way.
The social challenge is to train police better in the management of cases involving mental illness. The means to this end is a program called Crisis Intervention Training, or CIT. All police forces should engage this program. Alas, too few have. The recent Capitol Hill shooting of an alarmed and frightened mother possibly troubled by a psychiatric disability has brought this issue again to light, as described in a prominent article by The Alantic, one of the nation’s major magazines.
From the article:
The recent Capitol Hill shooting of an unarmed woman by police officers, and the uncertainty surrounding her mental state at the time she drove her car into a White House barricade, is a stark reminder of the uncomfortable interplay between mental illness and law enforcement in times of crisis.
Without the appropriate amount of mental health training for police, experts say, rash stigmatization and misinterpretation of the intentions of the mentally ill can cause vital errors and ultimately make the difference between life and death… [Read the full article].
ECT (Electroconvulsive Therapy), formerly known as “shock treatment”, has a fearsome reputation. Many recall the dramatic scene from the movie One Flew Over The Cuckoo’s Nest where patient McMurphy winds up stupefied and dull after being forcibly administered ECT.
While in earlier decades ECT may have had its dramatic–and perhaps overdramatized–effects, today ECT is much more safe and effective. For patients with treatment-resistant depression, ECT is a viable treatment option—one that should no longer be relegated to the option of last resort. As reported in Psychiatric Times, Modern ECT is a “remarkably safe, effective, and well-tolerated treatment”, according to Charles Kellner, MD, who discusses the state-of-the-art of this mode of therapy in the video below.
ECT can be particularly effective for geriatric depressed patients, many of whom do not tolerate or respond well to antidepressants. Dr. Kellner is Professor of Psychiatry and Chief of the Division of Geriatric Psychiatry at the Mount Sinai School of Medicine and Director of the ECT Service of the Mount Sinai Medical Center in New York.
ECT may not be for everyone, but it is a therapy that is worthy of a family’s consideration for loved ones who have found other therapies ineffective.
...is paramount. PsychOdyssey intends to be a resource, refuge, and support--a safe harbor--for family members navigating the maelstrom of mental illness. Mindful of every individual's right to share personal information as each may wish, PsychOdyssey for its part will not share with or sell to any third party any of its community participants' personal information, since to do so would violate our intended virtual sanctuary of trust.