Open Dialogue: Does the Current Research Data Support Further Investment?
Psychiatric Services, a leading US journal, has published two important papers on Open Dialogue. Freeman and colleagues did an extensive literature review and analysis of currently available research. Their paper is accompanied by a commentary by Kim Mueser, PhD, Director of the Boston University Center for Psychiatric Rehabilitation and one of the world’s experts in his field.
Freeman and colleagues begin their paper with a detailed explanation of the criteria for inclusion into their investigation. They identified 23 studies for review. Papers selected were published in English and evaluated Open Dialogue effectiveness using either case study, qualitative, quantitative, or mixed methods. Studies were conducted in Finland, Norway, Sweden, and the US.
As the authors point out, most of the available research comes from the Western Lapland group that developed Open Dialogue (OD). This poses a fundamental source of weakness in the evidence base. Their studies had small sample sizes, there was no control group, and the ratings were not blinded. In addition, there were not consistent methods for either defining or evaluating OD.
Many of us learned of Open Dialogue because of their reported excellent outcomes for individuals who experienced a first episode of psychosis. We are eager to see if these results can be replicated elsewhere. But there are other important questions.
What Would Real Informed Consent on Psychiatric Drugs Look Like? New Webinar Series Begins January 22
I’m excited to announce a new series of Mad in America Continuing Education webinars for 2019. They focus on what I believe is a central issue—what does a true informed consent process look like for the prescription of psychiatric drugs? This is a leverage point for changing the paradigm of care by starting with how people are informed about what psychiatric drugs do.
I believe that righting this ship is largely going to be up to non-medical mental health professionals and persons with experience in having been through a system that fails miserably to provide real informed consent. Since we are a continuing education program, our courses are designed primarily for the first group: psychologists, social workers, nurses, licensed professional counselors, and marriage/family therapists. We will continue to apply for continuing education credits (CEs) and at some point recruit more interest from physicians so it would be worthwhile to apply for the more expensive continuing medical education credits (CMEs).
October 28, 2018 by Sandra Steingard, MD | Community Mental Health Journal
Five Year Outcomes of Tapering Antipsychotic Drug Doses in a Community Mental Health Center
There is evidence that many individuals are on higher doses of antipsychotic drug than is required for optimal functioning yet there are limited guidelines on how to reduce them. This paper reports on 5 year outcomes for sixty-seven individuals who received treatment at a community mental health center and were offered the opportunity to gradually reduce their doses of antipsychotic drug in collaboration with the treating psychiatrist. Over a period of 6 months, the author invited patients who were clinically stable and able to participate in discussions of potential risks and benefits to begin gradual dose reductions. Initially, 40 expressed interest in tapering and 27 declined. The groups did not differ in age, sex, race, or diagnosis. The group who chose to taper began on significantly lower doses. Most patients succeeded at making modest dose reductions. At 5 years, there were no significant differences in the two outcomes measures, rate of hospitalization and employment status. Many patients were able to engage in these discussions which did not result in widespread discontinuation of drug. This is a naturalistic, small study of a topic that warrants further research.
When Rain Comes, Words Are Unnecessary: Our Search for a Better Way
Living in New Mexico means hoping for rain. The state is in drought, with most areas officially in either “extreme” or “exceptional” drought. The soil is full of life waiting for a chance to express itself, but the rare rain forecasts usually promise only “scattered showers nearby,” with the outcome being either clear blue skies or the sight of rain falling elsewhere. New Mexico is also one of the poorest states in the U.S., with more than one in five New Mexicans, and one in four children, living in poverty. We are second in the nation for the prevalence of youth living without connection to work, school, or family. New Mexico ranks high (#7) for people living with serious mental and emotional challenges.
Fort Collins Research Collaborative Recruiting for Second Test Group of Novel Program
The Fort Collins-based Learning and Self-development Collaborative grant project is midway through supporting its first group of young adults experiencing mood-related distress. It is also actively recruiting for the second group, scheduled to start in late August.
Nearly three-quarters of the young adults in the first group have prior mood disorder diagnoses and have tried psychiatric medications like antidepressants. However, the ineffectiveness and intolerable side effects of the drugs had left them searching for an alternative way forward when they decided to enroll in the Learning and Self-development Collaborative. These young adults are currently medication-free and their outcomes on mood distress, social connectedness, empowerment, and quality of life at six months will be compared to other young adults receiving usual care and daily psychiatric medications in the community.
An initial focus group with participants revealed a number of themes related to young adults’ past experiences with seeking help. Participants discussed feeling frustrated by one-size-fits-all solutions, such as drugs and mindfulness techniques, and invalidated by counselors who failed to connect with their experiences. Lack of information about prescribed drugs was frequently brought up by participants who also shared various stories of “chemical imbalance” and drugs “re-training the brain to relax” told to them by doctors and therapists.
Findings from pre-program focus groups are being used to help inform the content and delivery of educational material in the Learning and Self-development Collaborative.
There have been almost 900,000 views of Julia Rucklidge’s 2015 TEDx talk on nutrition and mental health, with many complimentary viewer comments.
Last week, however, the TED organization has inexplicably “flagged” the video with the following comment:
“NOTE FROM TED: We’ve flagged this talk, which was filmed at a TEDx event, because it appears to fall outside TEDx’s curatorial guidelines. There is limited evidence to support the claims made by this speaker.”
Julia has attempted to educate TED staff regarding the fact that over 35 peer-reviewed publications could hardly be described as “limited evidence,” and that her interpretations do not go beyond the data. But so far they are not interested in her evidence.
The whole thing seems so strange: isn’t TED supposed to be all about innovation? But clearly, some lobbyist has convinced them that a non-pharmaceutical treatment should not be respected.
I am asking you to help make this video go viral. That seems to be the only response we can make to such an inappropriate move on TED’s part.
Share it with others, through Facebook or email or Twitter
Ask your friends and colleagues to do the same
Let’s see if we can quadruple the views to 5 million or so.
Dr. Bonnie Kaplan, PhD is the fund advisor of the Nutrition & Mental Health Research Fund and a member of the new International Society for Nutritional Psychiatry Research (ISNPR). For many years, she studied developmental disorders in children, especially ADHD and reading disabilities (dyslexia). Dr. Kaplan was part of a team from University of Calgary and University of British Columbia which helped in the search for genes that predispose children to dyslexia. Also, with her students, she investigated the characteristics of adults with ADHD. Such work led her to further investigations of the role of nutrition. Another interest has been the mood symptoms that accompany ADHD and learning difficulties, and the role of micronutrient treatment of mood, aggression and explosive rage. This progression of topics has resulted in a research program focused on the role of nutrition in brain development and in brain function, especially the use of broad spectrum micronutrient treatment for mental disorders.
Kaplan, B. J., Simpson, J. S. A., Ferre, R. C., Gorman, C. P., McMullen, D. M., & Crawford, S. G. (2001). Effective mood stabilization with a chelated mineral supplement: An open-label trial in bipolar disorder. Journal of Clinical Psychiatry, 62(12), 936-944.
Popper, C. W. (2001). Do vitamins or minerals (apart from lithium) have mood-stabilising effects? Journal of Clinical Psychiatry, 62(12), 933-935.
Kaplan, B. J., Crawford, S. G., Gardner, B., & Farrelly, G. (2002). Treatment of mood lability and explosive rage with minerals and vitamins: two case studies in children. Journal of Child and Adolescent Psychopharmacology, 12(3), 205-219.
Kaplan, B. J., Fisher, J. E., Crawford, S. G., Field, C. J., & Kolb, B. (2004). Improved mood and behavior during treatment with a mineral-vitamin supplement: an open-label case series of children. Journal of Child and Adolescent Psychopharmacology, 14(1), 115-122.
Simmons, M. (2003). Nutritional approach to bipolar disorder. Journal of Clinical Psychiatry, 64(3), 338.
Frazier, E.A., Fristad, M., Arnold, L.E. (2009). Multinutrient Supplement as Treatment: Literature Review and Case Report of a 12-year-old Boy with Bipolar Disorder. Journal of Child and Adolescent Psychopharmacology.19:453-460.
Rucklidge, J. J., & Harrison, R. (2010). Successful treatment of Bipolar Disorder II and ADHD with a micronutrient formula: A case study. CNS Spectrums, 15(5):289-295.
Rucklidge, J. J., Gately, D., & Kaplan, B. J. (2010). Database Analysis of Children and Adolescents with Bipolar Disorder Consuming a Micronutrient Formula. BMC Psychiatry, 10, 17.http://www.biomedcentral.com/1471-244X/10/74
Frazier, E.A., Fristad, M.A. & Arnold, L.E. (2012). Feasibility of a nutritional supplement as treatment for pediatric bipolar spectrum disorders. Journal of Complementary and Alternative Medicine, 18:678-85.
Frazier EA, Gracious B, Arnold LE, Failla M, Chitchumroonchokchai C, Habash D, et al. Nutritional and safety outcomes from an open-label micronutrient intervention for pediatric bipolar spectrum disorders. J Child Adolesc Psychopharmacol2013; 23(8): 558-67.
Retallick-Brown, H., Rucklidge, J. J., & Blampied, N. (2016). Study protocol for a randomised double blind, treatment control trial comparing the efficacy of a micronutrient formula to a single vitamin supplement in the treatment of premenstrual syndrome. Medicines, 3, 32. http://www.mdpi.com/2305-6320/3/4/32
Kimball, S., Mirhosseini, N., & Rucklidge, J. J. (2018). Database Analysis of Depression and Anxiety in a Community Sample—Response to a Micronutrient Intervention. Nutrients, 10(2):152. http://www.mdpi.com/2072-6643/10/2/152
Rucklidge, J. J. (2009). Successful treatment of OCD with a micronutrient formula following partial response to CBT: A case study. Journal of Anxiety Disorders, 23: 836–840.
Rucklidge, J. J., Johnstone, J., Harrison, R., & Boggis, A. (2011). Micronutrients reduce stress and anxiety following a 7.1 earthquake in adults with Attention-Deficit/Hyperactivity Disorder. Psychiatry Research, 189, 281-287. doi:10.1016/j.psychres.2011.06.016
Rucklidge, J. J., Andridge, R., Gorman, B., Blampied, N., Gordon, H. & Boggis, A. (2012). Shaken but unstirred? Effects of micronutrients on stress and trauma after an earthquake: RCT evidence comparing formulas and doses. Human Psychopharmacology: Clinical and Experimental, 27(5), 440-454. https://www.ncbi.nlm.nih.gov/pubmed/22782571
Rucklidge, J. J., Blampied, N., Gorman, B., Gordon, H., & Sole, E. (2014). Psychological functioning one year after a brief intervention using micronutrients to treat stress and anxiety related to the 2011 Christchurch earthquakes: A naturalistic follow-up. Human Psychopharmacology: Clinical and Experimental, 29(3), 230-243. https://www.ncbi.nlm.nih.gov/pubmed/24554519
Sole, E. J., Rucklidge, J. J., & Blampied, N. M. (2017). Anxiety and Stress in Children Following an Earthquake: Clinically Beneficial Effects of Treatment with Micronutrients. Journal of Child and Family Studies, 1-10. doi: 10.1007/s10826-016-0607-2 https://link.springer.com/article/10.1007%2Fs10826-016-0607-2
Kaplan, B. J., Rucklidge, J. J., Romijn, A. R., & Dolph, M. (2015). A randomized trial of nutrient supplements to minimize psychological stress after a natural disaster. Psychiatry Research, 228, 373-379. http://www.ncbi.nlm.nih.gov/pubmed/26154816
Mehl-Madrona, L., Leung, B., Kennedy, C., Paul, S. & Kaplan, B. J. (2010). A naturalistic case-control study of micronutrients versus standard medication management in autism. Journal of Child and Adolescent Psychopharmacology, 20(2):95-103. https://www.ncbi.nlm.nih.gov/pubmed/20415604
Rucklidge, J. J., & Harrison, R. (2010). Successful treatment of Bipolar Disorder II and ADHD with a micronutrient formula: A case study. CNS Spectrums, 15(5):289-295.
Rucklidge, J. J., Taylor, M. R., Whitehead, K. A. (2011). Effect of micronutrients on behaviour and mood in adults with ADHD: Evidence from an 8-week open label trial with natural extension. Journal of Attention Disorders, 15(1), 79-91.
Rucklidge, J. J., Johnstone, J., Harrison, R. (2011). Effect of micronutrients on neurocognitive functioning in adults with ADHD and Severe Mood Dysregulation: A pilot study. Journal of Complementary and Alternative Medicine, 17(12), 1-7. https://www.ncbi.nlm.nih.gov/pubmed/22112202
Rucklidge, J. J., & Blampied, N. M. (2011). Post earthquake functioning in adults with Attention-Deficit/Hyperactivity Disorder: Positive effects of micronutrients on resilience. New Zealand Journal of Psychology, 40(4), 51-57.
Rucklidge, J. J. (2013). Could yeast infections impair recovery from mental illness? A case study using micronutrients and olive leaf extract for the treatment of ADHD and depression. Advances in Mind-Body Medicine, 27(3), 14-18. https://www.ncbi.nlm.nih.gov/pubmed/23784606
Rucklidge, J. J., Johnstone, J., Gorman, B., & Boggis, A., & Frampton, C. (2014). Moderators of treatment response in adults with ADHD to micronutrients: demographics and biomarkers. Progress in Neuro-Psychopharmacology and Biological Psychiatry,50, 163–171. https://www.ncbi.nlm.nih.gov/pubmed/24374068
Gordon, H. A., Rucklidge, J. J., Blampied, N. M., & Johnstone, J. M. (2015). Clinically Significant Symptom Reduction in Children with Attention-Deficit/Hyperactivity Disorder Treated with Micronutrients: An Open-Label Reversal Design Study. Journal of Child and Adolescent Psychopharmacology, 25(10), 783-798. doi: 10.1089/cap.2015.0105 https://www.ncbi.nlm.nih.gov/pubmed/26682999
Rucklidge, J. J., Eggleston, M., Johnstone, J. M., Darling, K., & Frampton, C. M. (2017). Vitamin-mineral treatment improves aggression and emotional regulation in children with ADHD: A fully-blinded, randomized, placebo-controlled trial. Journal of Child Psychology and Psychiatry.http://onlinelibrary.wiley.com/doi/10.1111/jcpp.12817/full
Kaplan, B. J., Isaranuwatchai, W., & Hoch, J. S. (2017). Hospitalization cost of conventional psychiatric care compared to broad-spectrum micronutrient treatment: literature review and case study of adult psychosis. Int J Ment Health Syst, 11, 14. https://link.springer.com/article/10.1186/s13033-017-0122-x
Harrison, R., Rucklidge, J. J., & Blampied, N. (2013). Use of micronutrients attenuates cannabis and nicotine abuse as evidenced from a reversal design: A case study. Journal of Psychoactive Drugs, 45(2), 1-11. https://www.ncbi.nlm.nih.gov/pubmed/23909004
Popper, C. W. (2014). Single-Micronutrient and Broad-Spectrum Micronutrient Approaches for Treating Mood Disorders in Youth and Adults. Child and Adolescent Psychiatric Clinics of North America, 23(3), 591-672. doi: 10.1016/j.chc.2014.04.001
Sarris, J., Logan, A. C., Amminger, G. P., Balanzá-Martínez, V., Freeman, M. P., Hibbeln, J., Matsuoka, Y., Mischoulon, D., Mizoue, T., Nanri, A., Nishi, D., Ramsey, D. Rucklidge, J. J., Sanchez-Villegas, A., Scholey, A., Su, K. P., Jacka, F. N. (2015). Nutritional Medicine as Mainstream in Psychiatry: A Consensus Position Statement from The International Society for Nutritional Psychiatry Research (ISNPR). Lancet Psychiatry, 2, 271-274. http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)00051-0/abstract
Sarris. J., Logan, A. C., Akbaraly, T. N., Amminger, G. P., Balanzá-Martínez, V., Freeman, M. P., Hibbeln, J., Matsuoka, Y., Mischoulon, D., Mizoue, T., Nanri, A., Nishi, D., Parletta, N., Ramsey, D., Rucklidge, J. J., Sanchez-Villegas, A., Scholey, A., Su, C., Jacka, F. N. (2015). The International Society for Nutritional Psychiatry Research (ISNPR) Consensus Position Statement: Nutritional Medicine in Modern Psychiatry (letter to editor). World Psychiatry, 14(3), 370-371. http://onlinelibrary.wiley.com/doi/10.1002/wps.20223/abstract
A study investigating the safety and toxicity of this product shows that, as studied to date, it has not produced any serious adverse effects:
Simpson, J. S. A., Crawford, S. G., Goldstein, E. T., Field, C., Burgess, E., & Kaplan, B. J. (2011). Systematic review of safety and tolerability of a complex micronutrient formula used in mental health. BMC Psychiatry, 11(62). http://www.biomedcentral.com/1471-244X/11/62
So What’s This About Another Webinar Series on Psychiatric Drug Withdrawal?
Some people are asking me, “Why another series of webinars on withdrawing from psychiatric drugs?” That’s a reasonable question given that our first series, Withdrawal from Psychiatric Drugs, covered a lot of territory. We presented general information as well as more specific subjects like wellness, personal experiences, research findings, and the evidence base for drug withdrawal.
But this subject is a complex one, and our first course was just our start in exploring this topic. With this second course we are focusing on the challenges that drug withdrawal presents to prescribers.
As many have noted, prescribers may have extensive experience getting patients on psychiatric medications and then managing their drug use, but little or no experience helping patients taper off the drugs. As some have quipped, prescribers have learned to fly the plane but not land it.
20-year Outcomes for First-episode Psychosis: Impact of Neuroleptic Drug Discontinuation
Standard treatment guidelines in psychiatry recommend that neuroleptic drugs are continued indefinitely after a person has experienced more than one psychotic episode. These recommendations are based on studies which have found a higher rate of recurrence of psychosis among those who stop as compared to those who remain on drug.
Anatomy of an Epidemic raised concerns about the long-term outcomes for those who remain on these drugs. Most psychiatrists, including me, assumed that by reducing risk of relapse one would be improving long-term outcome. However, there seems to be reasonable evidence that this assumption is not correct.
Not only does long-term use of drugs expose people to the risks of weight gain and tardive dyskinesia, the drugs may also impair functional outcome. My own view is that this is a discussion psychiatrists need to have with their patients. A person may choose to accept a higher (and not inevitable) risk of recurrence of psychosis as a way to minimize the long-term risks of negative outcomes associated with staying on drug.
Crisis Now: Transforming Services is Within Our Reach
The following is a report from the National Action Alliance for Suicide Prevention Crisis Services Task Force from 2016, which focuses on transforming crisis response services to include recognition and response to trauma, a robust role for peer support, and a reorientation to recovery. This report, which we currently are finding very valuable in our on-going system transformation efforts in Connecticut, is a testament to the fact that even acute services, and even those services addressing persons in extreme distress, can be made strength-based, person-centered, culturally responsive (in including natural and community supports), and recovery-oriented.
Soteria: Reflections on “Being With”, finding one’s way through psychosis
Soteria Housereflections from a former staff member: What is psychosis? Altered states? Extreme states? And why psychiatry is failing to support people during these challenging times.
After 40 years of working in the mental health field, I reflect on the beginning of my career in a National Institute of Mental Health–funded research project called “Soteria House.” I moved on to work in the public sector from crisis worker, to supervisor, to program manager, to Chief of Adult Outpatient services for the public mental health system in Santa Cruz County, California. I have come full circle, back to the lessons learned at Soteria House in the mid-1970s.
It is from this work experience that I learned about “extreme states”, aka persons labeled with psychosis and schizophrenia. As a 23-year-old undergraduate student working on my own major, art therapy, at University of California Santa Cruz, I was offered a field placement assignment at Soteria House.
My background was primarily art, but I was being encouraged to explore a new field called “art therapy.” This brought me to Soteria in San Jose, California. I arrived at Soteria, my first day on the job to find a Victorian-style large home in the heart of San Jose.