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March 5, 2014 by Russell Stence, MA

From Adversity to Advocacy


Negotiating with terrorists.  That’s the feeling I came to have in trying to communicate and work with staff in a local acute psychiatric ward who had total control of my adult daughter, and I do mean TOTAL control.  This may sound like hyperbole, and perhaps it is, in a way.  Because I believe these people were, for the most part, well-intentioned.  I don’t doubt that some of them were even kind and caring. It brings to mind the following quote of C.S. Lewis:

“Of all tyrannies, a tyranny exercised for the good of its victims may be the most oppressive.”

If they actually were terrorists, I think it would have been easier.  In that case, I could have gone to authorities who would have readily collaborated to get her out.  As it was, there was literally “no exit” (believe me, I checked ALL possibilities) and I had to constantly be “walking on eggshells” in the effort to stay in the good graces of those who held the pills, the needles, the restraints and the electrodes.  I had to suppress the urge to scream at these nice people, although I did plenty of screaming (even bawling like a baby) on my own time.

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July 11, 2013 by Christine Braehler, et al | Psychiatry Research

Childhood trauma and dissociation in first-episode psychosis, chronic schizophrenia and community controls


Increasing evidence supports the role of childhood trauma in the etiology of psychosis but underlying mechanisms are poorly understood. Early maltreatment has been linked to dissociative symptoms in psychosis patients. We explored associations between childhood trauma (Childhood Trauma Questionnaire) and dissociation (Dissociative Experiences Scale) in first-episode psychotic patients (n=62), chronic psychotic patients (n=43), and non-psychotic community controls (n=66). Multivariate analyses of covariance were used to test associations between childhood trauma and dissociation by group while controlling for sex. Chronic patients reported the highest level of dissociation. More severe childhood trauma was associated with greater dissociative symptoms in all groups although most strongly in chronic patients. Emotional abuse showed the strongest associations with dissociation, with these being strongest for chronic patients, followed by first-episode patients — and least for controls. Men showed a stronger association between physical neglect and dissociation than women, irrespective of group. There were no significant group by sex interactions. Our findings replicate the strong association between childhood trauma and dissociative symptoms in chronic and first-episode psychotic patients relative to non-psychotic control subjects. We also demonstrate the salience of emotional abuse in explaining variance in dissociation, especially in chronic patients.



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July 2, 2013 by JAMA | Lex Wunderink, MD, PhD, et al

First-Episode Psychosis Not a Life Sentence of Psychotropic Medication Use

Jama journalRecovery 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


Importance Short-term outcome studies of antipsychotic dose-reduction/discontinuation strategies in patients with remitted first-episode psychosis (FEP) showed higher relapse rates but no other disadvantages compared with maintenance treatment; however, long-term effects on recovery have not been studied before.

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April 14, 2013 by Sandra Steingard, MD

Optimal Use of Neuroleptics, Part 3: Duration of Untreated Psychosis

For the past 20 years, there has been a prevailing concern in psychiatry that psychosis is bad for the brain. The notion is that the psychotic process is in and of itself damaging and therefore every effort should be made to curtail this process in order to forestall further damage. This idea heightened the urgency to initiate drug treatment. When I read Anatomy of an Epidemic, this was one of my most pressing concerns; If I suggested to my patients that they pursue other treatments before starting drug treatment, was I helping or harming them?

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