Images of psychiatry and psychiatrists

11 01 2015

By: Stuart H, Sartorius N, Liinamaa T, the Images Study Group. Acta Psychiatr Scand 2015: 131: 21–28

 

Objective: This study surveyed medical teaching faculty to determine
their attitudes toward psychiatry and psychiatrists.
 
Method: We conducted a multisite survey of a probability sample of
1057 teaching medical faculty members from 15 academic teaching
centers in the United Kingdom, Europe, and Asia stratified by early,
middle, and late career stage. The average response rate across
countries was 65%.
 
Results: The outstanding findings were that 90% of respondents
considered that psychiatrists were not good role models for medical
students, 84% thought psychiatric patients were unsuitable to be
treated outside of specialized facilities, and 73% thought psychiatric
patients were emotionally draining. We noted statistically significant
differences by country, gender, career stage, and specialty.
 
Conclusion: These results highlight why recruitment into psychiatry is
problematic in many countries and suggest that greater attention should
be given to improving the perception of psychiatrists as good role
models and the efficacy of psychiatric treatments
The full text of this interesting paper is available Here 




The Center Cannot Hold

14 10 2014

Yes, it is not a new book but in case you have not read it yet I want to recommend the book: The Center Cannot Hold: My Journey Through Madness by Elyn R. Saks. Saks is an esteemed professor, lawyer, and psychiatrist and is the Orrin B. Evans Professor of Law, Psychology, Psychiatry and the Behavioral Sciences at the University of Southern California Law School, yet she has suffered from schizophrenia for most of her life, and still has ongoing major episodes of the illness. THE CENTER CANNOT HOLD is the eloquent, moving story of Elyn’s life, from the first time that she heard voices speaking to her as a young teenager, to attempted suicides in college, through learning to live on her own as an adult in an often terrifying world. Saks discusses frankly the paranoia, the inability to tell imaginary fears from real ones, the voices in her head telling her to kill herself (and to harm others); as well the incredibly difficult obstacles she overcame to become a highly respected professional. This beautifully written memoir is destined to become a classic in its genre.

In addition to this book you can find her lecture at TED: http://www.ted.com/talks/elyn_saks_seeing_mental_illness

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Yom Kipur of the mental health community

12 10 2014

Atonement

by 

One of my first meetings when I arrived at NIMH 12 years ago was with board members of the National Alliance on Mental Illness (NAMI). I asked them how NIMH could be helpful. One board member’s request was especially memorable. “Declare a day of atonement,” she suggested. When I saw this same board member last month at the annual NAMI meeting, we both recalled that 2002 meeting with a touch of regret. I wished I had had a better response to her request. And, as she said to me last month, “I wished I had asked for a week.”

As it turns out, Mental Illness Awareness Week this year began with Yom Kippur, the Jewish Day of Atonement. Which begs the question: what do we (in the mental health community) need to atone for? There are so many answers. For some, it may be the culture of blame and shame perpetuated for years by clinicians who explained all mental illness as being caused by trauma and evil parents. For others, it may be the singular reliance on medication and modifying behavior rather than holistic care and the provision of skills. Others will name the paternalistic structure of mental health care, which can undermine rather than empower individuals and their families. The list goes on. Maybe it would take a week, not just a day, to capture the many complaints.

My own favorite atonement issue for Mental Illness Awareness Week this year is the lack of humility in our field. Mental disorders are among the most complex problems in medicine, with challenges at every level from neurons to neighborhoods. Yet, we know so little about mechanisms at each level. Too often, we have been guided more by religion than science. That is, so much of mental health care is based on faith and intuition, not science and evidence. On the plus side, we put a premium on listening and compassion. We help people to change through understanding. But not enough of our care has been standardized to a high level of quality, as expected in the rest of medicine.

On the research side, it’s easy to lose humility. The pace of discovery in genomics and neuroscience is ever more rapid—this week’s Nobel Prize in Physiology or Medicine  is a good example of how neuroscience is revealing the fundamentals of brain activity—in this case describing the brain’s “GPS” network. Advances in systems neuroscience, from dissecting circuits to human brain imaging, are unequivocally stunning. But, and this is a humbling caveat, we simply have not been able to translate this revolution in neuroscience to diagnostics or therapeutics for people with mental disorders.

Why the disconnect? Translation takes time. Translation requires replication, regulation, and ultimately reimbursement. Fundamentally, translation is really difficult. For instance, we have thousands of neuroimaging studies but none that has delivered a clinically useful biomarker. For NIMH this is a humbling realization—we still lack biomarkers to identify who should get which treatment. We still lack effective treatments for many aspects of mental illness.

So this year on Mental Illness Awareness Week, my call is for humility. We need to be aware that mental disorders are immensely complex—too complex for scientists, clinicians, patients, or families to solve alone. Prevention, recovery, and cure—the NIMH vision—need a collective effort. Beyond the day—or week—of atonement, we need a massive campaign to transform diagnosis and treatment.





“seeking treatment is a sign of strength”

6 06 2013

Following President Obama calls for end to mental illness stigma, here is an interesting post by Dr. Insel, NIMH director.

June 3 marked the first White House Conference on Mental Health in 14 years. President Obama opened the event by describing how many people “suffer in silence” rather than seeking help:

We see it in the veterans who come home from the battlefield with invisible wounds of war, but who feel like seeking treatment is somehow a sign of weakness – when, in fact, it’s a sign of strength.

We see it in the parents who would do anything for their kids, but who often fight their mental health battle alone – afraid that reaching out would invite judgment or reflect badly on them.

And we see it in tragedies that we have the power to prevent.

With these remarks, the President launched the National Dialogue on Mental Health, bringing together 200 mental health experts, a dozen members of Congress, and celebrities like Glenn Close and Bradley Cooper to start a national conversation about youth and mental health. The White House has also launched a website, mentalhealth.gov, with its tag line “Let’s talk about it.”

Noting that less than 40 percent of people with mental disorders seek treatment, the President stressed the need to do a better job recognizing mental health issues, especially in children. Acknowledging that we must ensure that treatment is available, the President described how the Affordable Care Act will expand mental health care to 60 million more Americans, and he detailed new investments to increase the mental health workforce. He also noted how new investments in science, including the BRAIN initiative, should bring better treatments for those who need them.

It’s hard not to draw a parallel to the June 1999 White House conference, which was precipitated by the school shootings in Littleton, Colorado six weeks earlier. Hosted by Tipper Gore and President Clinton, the focus was on youth mental health and reducing stigma. Fourteen years later, the conversation leaders are different, but the issues are much the same. Again we are in the wake of a school shooting; again we turn our attention to mental health in youth; and again we are discussing how to overcome negative attitudes toward those with mental disorders. But this begs the question: why are we still having the same conversation about the same issues in mental health? How do we refocus this discussion?

First of all, much has changed in the past 14 years that should be enriching our dialogue: the era of genomics has transformed biomedical science; the revolution in mobile technology reaches countless adolescents and holds potential as an avenue to change behaviors; and the advent of health care reform will help more people get the treatment they need. All of these have the promise to transform mental health care and mental health research.

Second, we need not only a national dialogue but a national action plan. “Let’s talk about it” is a good place to start, but for a 19-year-old in the grip of a psychotic episode or a 16-year-old on the path to serious mental illness, we urgently need an action plan to alter the course of their illness. This year, the 100,000 young Americans who will have a first episode of psychosis will join over two million adults with schizophrenia. The majority of people with mental illness delay seeking care, which is especially serious for people with psychotic disorders. In the United States, individuals with psychosis go untreated for, on average, 110 weeks.1 Among other serious consequences, untreated psychosis poses an increased risk for substance use and suicide, both of which contribute to the elevated mortality associated with these disorders. Our best hope of reducing mortality from serious mental disorders will come from realizing that just like other medical illnesses, we need to diagnose and preempt the illness before the symptoms become manifest. At the White House conference, Vice President Biden spoke to this point directly, stressing that we must intervene earlier, as we do today for cancer and heart disease.

Recognizing this call to action, NIMH is preparing for a surge of research focused on predicting and preventing serious mental illness. New initiatives will seek to change the treatment paradigm from one of treating chronic illness to one of preempting the illness long before symptoms emerge. We have two landmark NIMH studies to build upon: The North American Prodrome Longitudinal Study (NAPLS) is a consortium of clinical research centers studying ways to identify individuals earlier who are at risk for an initial psychotic episode. Through NAPLS, we have the opportunity to create a toolkit to improve prediction of psychosis using biosignatures and neurocognitive testing. The Recovery After an Initial Schizophrenia Episode (RAISE) project is a large-scale research effort to explore whether using early and aggressive treatment will reduce the symptoms for individuals who have already had a psychotic episode and prevent the subsequent gradual deterioration of functioning. RAISE will be expanded with the aim to reduce the duration of untreated psychosis by linking community mental health care to primary care and school mental health resources.

We must make sure that the next White House conference on mental health is a celebration of progress. Science is the path on which progress is made. Investing in programs focused on early diagnosis are the best hope for creating more precise diagnostics and more effective preventive interventions to ensure better outcomes. Let’s start writing a new chapter in the chronicle on mental health. Our nation’s youth deserve to be part of a better story.

References

 1 Marshall M, Lewis S, Lockwood A, Drake R, Jones P, Croudace T. Association between duration of untreated psychosis and outcome in cohorts of first-episode patientsArch Gen Psychiatry. 2005 Sep 62:975-983.





A New State of Mind: Ending the Stigma of Mental Illness by Glenn Close

30 05 2013

Award-winning actress and mental health advocate Glenn Close will narrate “A New State of Mind: Ending the Stigma of Mental Illness” an inspiring documentary that tells the stories of everyday people to shatter myths about mental illness, highlighting the struggles faced by those with mental health challenges, and their hope, resilience and recovery.

Ms. Close is a dedicated mental health advocate, having founded a national anti-stigma campaign, Bring Change 2 Mind in partnership with The Balanced Mind Foundation, Fountain House, and Garen & Shari Staglin of the International Mental Health Research Organization (IMHRO). The idea for Bring Change 2 Mind was born when Ms. Close volunteered at Fountain House in order to learn more about mental illness, which both her sister, Jessie Close, and nephew, Calen Pick, live with.

“The toxic stigma around mental illness can be as painful as the illness itself,” said Ms. Close. “It’s crucial that these diverse and powerful stories are told and shared so that everyone realizes that mental illness touches us all. No one need struggle in isolation, silence and shame. Listening and having the courage to join the conversation will save lives.”

“A New State of Mind: Ending the Stigma of Mental Illness” is produced by KVIE, Sacramento’s PBS station, as part of a comprehensive statewide effort to increase the number of people who seek early help for mental challenges by reducing stigma and discrimination around mental illness. It is a Prevention and Early Intervention program of California Mental Health Services Authority (CalMHSA), an organization of county governments working together to improve mental health outcomes for individuals, families, and communities, and funded by the voter-approved CaliforniaMental Health Services Act (Prop. 63).

SOURCE California Mental Health Services Authority (CalMHSA)
glenn-close





A New Paper Concerning Depression-related Stigma and Discrimination

20 10 2012

The results of the paper below which was written by some of the leading figures in the field, will probably not strike you: stigma and discrimination toward people with major depression still exist, and is still, indeed, one of the main barriers to recovery and social inclusion of people with psychiatric illnesses. While not surprising, the results of this comprehensive research require us to think harder of effective ways to tackle this negative phenomenon. Any ideas?  

Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey

Background: Depression is the third leading contributor to the worldwide burden of disease. We assessed the nature and severity of experienced and anticipated discrimination reported by adults with major depressive disorder worldwide. Moreover, we investigated whether experienced discrimination is related to clinical history, provision of health care, and disclosure of diagnosis and whether anticipated discrimination is associated with disclosure and previous experiences of discrimination.
Methods: In a cross-sectional survey, people with a diagnosis of major depressive disorder were interviewed in 39 sites (35 countries) worldwide with the discrimination and stigma scale (version 12; DISC-12). Other inclusion criteria were ability to understand and speak the main local language and age 18 years or older. The DISC-12 subscores assessed were reported discrimination and anticipated discrimination. Multivariable regression was used to analyse the data.
Findings: 1082 people with depression completed the DISC-12. Of these, 855 (79%) reported experiencing discrimination in at least one life domain. 405 (37%) participants had stopped themselves from initiating a close personal relationship, 271 (25%) from applying for work, and 218 (20%) from applying for education or training. We noted that higher levels of experienced discrimination were associated with several lifetime depressive episodes (negative binomial regression coeffi cient 0·20 [95% CI 0·09–0·32], p=0·001); at least one lifetime psychiatric hospital admission (0·29 [0·15–0·42], p=0·001); poorer levels of social functioning (widowed, separated, or divorced 0·10 [0·01–0·19], p=0·032; unpaid employed 0·34 [0·09–0·60], p=0·007; looking for a job 0·26 [0·09–0·43], p=0·002; and unemployed 0·22 [0·03–0·41], p=0·022). Experienced discrimination was also associated with lower willingness to disclose a diagnosis of depression (mean discrimination score 4·18 [SD 3·68] for concealing depression vs 2·25 [2·65] for disclosing depression; p<0·0001). Anticipated discrimination is not necessarily associated with experienced discrimination because 147 (47%) of 316 participants who anticipated discrimination in fi nding or keeping a job and 160 (45%) of 353 in their intimate relationships had not experienced discrimination.
Interpretation: Discrimination related to depression acts as a barrier to social participation and successful vocational integration. Non-disclosure of depression is itself a further barrier to seeking help and to receiving eff ective treatment. This finding suggests that new and sustained approaches are needed to prevent stigmatisation of people with depression and reduce the eff ects of stigma when it is already established.

For the full paper click HERE





“Understanding of mental illness as a neurodevelopmental disorder is key”

3 10 2012

“[Mental illnesses] are brain disorders and by that I don’t mean you have a tumor or a lesion but that they are disorders of circuits. These are brain circuit problems. It’s is not a question of behavior but of the genetics of the organ, the brain in this case”.

“The brain is incredibly resilient… behavior is the last thing to go,” says Dr. Insel. Trying to treat a mental disorder by addressing behavior is difficult and not the most effective method. By that time, the illness is already in Stage IV of its development and symptoms have begun to show, the brain has already been deeply impacted. The warning signs of an impending illness (stage II) have already passed and the first episodes have already occurred (stage III). As with heart disease, if you wait until the last thing happens—a heart attack in the case of heart disease—outcomes aren’t good.

“….Studies are being made and research is being conducted that allows for more accurate images of the brain that in turn have allowed us to examine the different levels of an illness. Instead of addressing merely the behavioral manifestations of the brain disorder, we can hopefully begin to address the illness in the prodromal, or beginning, stages. Looking at the behavioral symptoms is still important but we need to find out what’s going on at the level of physiology, at the level of cells and genes and molecules, to get a much more comprehensive picture”.

New techniques such as diffusion spectrum imaging have allowed scientists to begin to map the neural fiber pathways of the brain. While these methods are still in their infancy they show promise. They allow us to decode the “bowl of spaghetti”. With the new technologies we can now begin to see into that mass in the middle. We hope that by the end of this year we will be able to tell what the actual connectivity is between two parts of the brain. Ultimately being able to discover what is exactly different between individuals with depression and individuals with schizophrenia, what part of the brain changes with treatment.

“For the first time we can begin to say, ‘So this is what depression looks like… these are the parts of the brain that are involved in PTSD or the parts that are involved in OCD  or schizophrenia.’”

“The understanding of mental illness as a neurodevelopmental disorder is key. Continued research on the early stages of the development of mental illness will result in treatments that can truly begin to address the core of the problem rather than focusing on mitigating the visible expressions of the illness”.

“Research into the circuits of the brain is not the only thing to be done. It’s not just a matter of getting clearer pictures of the brain, identifying the neurons, cells and structures in the brain. Evidence has continued to show one thing, over and over: “If you look at those things that help to build resilience… one of the best is simply by getting families involved.” It’s not just all the brain talk that’s important, it’s the human talk too”.

These very important and exciting things were said by Dr. Thomas Insel, Head of the National Institute of Mental Health (USA). Now I hope to hear the same thing from policy makers in Israel…

To read the full article enter:

http://www.nami.org/Template.cfm?Section=About_Research&template=/ContentManagement/ContentDisplay.cfm&ContentID=142938

And a related article by Insel:

http://www.nimh.nih.gov/about/director/2012/words-matter.shtml?utm_source=govdelivery&utm_medium=email&utm_campaign=govdelivery