The paper examines the often neglected, social factors implicated in recovery from severe mental distress, by presenting findings from a biographical study of individuals experiencing psychosis. Biographical interviews with 26 individuals with psychotic experiences and diagnosis of psychotic disorders were conducted and subjected to narrative biographical analysis. This paper focuses on a group of narrators who are engaged in a struggle to live a satisfactory life despite ongoing mental distress, and thus can be seen as being in recovery. In terms of therapeutic itineraries, the distinctive characteristics of this group are the early recognition and community management of psychotic experiences. Participants in this group also consistently employ various strategies for managing their psychotic experiences as well as for looking after their mental health. The two most central social parameters for recovery identified in this study are firstly, increased social participation through interpersonal and social networks, and secondly, access to empowering discourses and practices regarding mental distress, which are in turn related to developments in the mental health service system over the last two decades. We conclude that crucial parameters in building a life with psychosis involve the broader sociocultural context, the mental health service system, and familial and social networks.
Nigeria, like most African nations, has been taught and dictated to since its independence, largely seen by the rest of the world as a receptacle for ideas rather than a generator of them. But is there something the world could learn from us?Read More
A new study, published in JAMA Pediatrics, investigates the patterns of mental health diagnosis and medication treatment within a cohort of children from birth to 8 years old insured by Medicaid. The results confirm previous findings that children on Medicaid receive more psychiatric medication, and prolonged mental health treatment, when compared to their privately insured counterparts.
“In this cohort study of 35, 244 newborns, 19.7% received a psychiatric diagnosis and 10.2% received a psychotropic medication by 8 years; 20% of medication users received 2 or more medication classes concurrently for 60 days or more,” the researchers report. “At age 7 years, half or more of the medicated children had more than 200 days of drug exposure.”
The accelerating increase in the use of psychotropic medication among children in the United States has generated public concern. Particular attention has been given to the use of antipsychotics for behavioral management in children as, “most pediatric psychotropic medication use (67%) is not approved by the US Food and Drug Administration and is therefore prescribed off-label, whereby the evidence for the benefits is not available to balance the risk of potential harm.”Read More
Science 06 Jul 2018:
Vol. 361, Issue 6397, pp. 16-20
On a sweltering July day in 2010, seven medical researchers and one patient advocate gathered in a plush Marriott hotel in College Park, Maryland, to review a promising drug designed to prevent heart attacks and strokes by limiting blood clotting. The panel is one of dozens of advisory committees that vote each year on whether the Food and Drug Administration (FDA) should approve a therapy for the U.S. market. That day, panel members heard presentations on the drug’s preclinical and clinical data from agency staff and AstraZeneca in Cambridge, U.K., its maker and one of the world’s largest pharmaceutical companies. The occasion sparked little drama. In the cool refuge of the conference room, advisers politely questioned company scientists and complimented their work. By day’s end, the panel voted seven to one to approve. FDA, as usual, later signed off. The drug, ticagrelor, marketed under the name Brilinta, sold rapidly, emerging as a billion-dollar blockbuster. It cuts risk of death from vascular causes, heart attacks, and strokes modestly more than its chief competitor—and currently costs 25 times as much.
FDA, headquartered in Silver Spring, Maryland, uses a well-established system to identify possible conflicts of interest before such advisory panels meet. Before the Brilinta vote, the agency mentioned no financial conflicts among the voting panelists, who included four physicians. As Brilinta’s sales took off later, however, AstraZeneca and firms selling or developing similar cardiovascular therapies showered the four with money for travel and advice. For example, those companies paid or reimbursed cardiologist Jonathan Halperin of the Icahn School of Medicine at Mount Sinai in New York City more than $200,000 for accommodations, honoraria, and consulting from 2013 to 2016. During that period, Halperin got $7500 from AstraZeneca to study Brilinta, and the company separately declared nearly $2 million in “associated research” payments tied to him.
(The Lancet) – The great Aneurin Bevan founded the UK National Health Service (NHS) not as a charity, but as an institution that belonged to everyone, so that sudden poverty was not added to the pain of illness. Nowadays, there is (rightly) an expectation that the NHS should provide more than just relief from poverty caused by sudden illness, but also, increasingly, that it should provide everything we can imagine that we need to maintain good health, whether our livelihoods are in jeopardy or not. Is this expectation realistic in the 21st century, with an ever more aged population with complex multimorbidities? One driver (although not the only one) of spiralling costs and expectations is the price of novel biological therapies. In this regard, the current situation is wholly unsatisfactory, particularly in relation to the current mode of price-setting by pharmaceutical companies.Read More
In self-direction, participants control individual budgets, allocating service dollars according to needs and preferences within program parameters to meet self-defined recovery goals. Mental health self-direction is associated with enhanced wellness and recovery outcomes at lower or similar cost than traditional service arrangements. This study compared outcomes of housing independence and employment between individuals who participated in self-direction and those who did not.
This quasi-experimental study involved administrative data from 271 self-directing participants. Using coarsened exact matching with observed demographic, diagnostic, and other characteristics, the authors constructed a comparison group of non-self-directing individuals (N=1,099). The likelihood of achieving positive outcomes between first and last assessments during the approximately four-year study period was compared for self-directing and non-self-directing individuals.
The purpose of this review was to describe key attributes and outcome measures reported in controlled trials of peer work, identify outcome measures likely to report significant change as a result of peer work, assess the quality of reporting, and formulate guidelines for the design and reporting of future trials.
A systematic review was undertaken of randomized and nonrandomized controlled trials of peer work published since 1995. A content analysis identified reported program attributes in seven areas. Outcome measures were compared with results to identify measures most likely to report a significant difference as a result of peer work. Descriptions of program attributes were rated with respect to how clearly they were specified by authors.
(Irish Times) – It takes a village to raise a child, so they say, but what if that village no longer exists?
Parenthood has a funny way of keeping you overly occupied as the kids rally around you and ensure you are never truly alone. The sad juxtaposition of being lonely and isolated as a parent is that, while you may physically never have a moment to yourself, the desperate isolation you feel from friends, family and life in general can hang on your shoulders.
With partners at work, friends and family leading their own lives, nap-times and school-runs dictating your free-time, it can be overwhelmingly isolating.
While this isn’t a new phenomenon, it is only lightly spoken about and parents-to-be are often not forewarned about the isolating factor of babies. Lately, it is striking a cord with more and more parents who openly admit: “I’m lonely and feel lost.”
The question is, how much can this isolation and loneliness affect our mental health? And how can we step out from the loneliness?Read More
A higher fitness level in middle age is associated with a lower risk of depression and cardiovascular disease (CVD) mortality some 20 years later, new research shows.
“What’s surprising about this study is the time interval between the measurement of fitness and the outcomes of depression and CVD mortality,” author Benjamin L. Willis, MD, MPH, Director of Epidemiology, Cooper Institute, Dallas, Texas, told Medscape Medical News.
“Something that you’re doing right now can actually provide some benefits many years later, even when you might have a problem, say, of depression that occurs because of some other life event. It’s never too late to get off the couch, but sooner is better,” he added.
The study was published online June 27 in JAMA Psychiatry.Read More
(NBC News) – It hit 101 degrees Thursday in Wichita, and special education teacher Sherry White knows to stay inside.
That’s because this kind of heat — currently making much of the country sweat — can be especially dangerous for people like her, who take certain psychiatric drugs.
White has fibromyalgia, which her doctor treats with Cymbalta, an antidepressant that helps treat the symptoms. But because of the drug, White’s ankles swell, she sweats profusely, feels faint, and is short of breath when it gets too hot.
“I’ve seen people who say they are feeling feverish, they don’t realize it’s the medication.”