Recent quotes:

The narrative drive = human instinct

If a person goes from being a political martyr to a mental patient in just a few days—the sign of a successful hospital stay, by most standards—her life may begin to feel banal and useless. Insight is correlated with fewer hospital readmissions, better performance at work, and more social contacts, but it is also linked with lower self-esteem and depression. People recovering from psychotic episodes rarely receive extensive talk therapy, because insurance companies place strict limits on the number of sessions allowed and because for years psychiatrists have assumed that psychotic patients are unable to reflect meaningfully on their lives. (Eugen Bleuler, the psychiatrist who coined the term “schizophrenia,” said that after years of talking to his patients he found them stranger than the birds in his garden.)

Denying a Diagnosis

Today, insight is assessed every time a patient enters a psychiatric hospital, through the Mental Status Examination, but this form of awareness is still poorly understood. Patients are considered insightful when they can reinterpret unusual occurrences—growing angel’s wings, feeling as if their organs have been removed, decoding political messages in street signs—as psychiatric symptoms. In the absence of any clear neurological marker of psychosis, the field revolves around a paradox: an early sign of sanity is the ability to recognize that you’ve been insane. (A “correct attitude,” for most Western psychiatrists, would exclude interpretations featuring spirits, demons, or karmic disharmony.)

Participants' perceived benefits of family intervention following a first episode of psychosis: a qualitative study - Nilsen - 2014 - Early Intervention in Psychiatry - Wiley Online Library

Patients and family members reported benefits that could be classified in five categories: (i) developing insight and acceptance requires understanding of the fact that the patient has an illness, and recognizing the need for support; (ii) recognizing warning signs requires an understanding of early signs of deterioration in the patient; (iii) improving communication skills is linked to new understanding and better communication both within the family and in groups; (iv) Learning to plan and solve problems requires the ability to solve problems in new ways; (v) becoming more independent requires patients to take responsibility for their own life.

The effects and determinants of exercise participation in first-episode psychosis: a qualitative study | BMC Psychiatry | Full Text

Preliminary research has indicated that increasing physical activity and fitness during the first-episode of psychosis (FEP) can improve physical health and support functional recovery [14, 15, 16]. In a recent feasibility trial (the “iBeep” study) of an exercise intervention delivered through EIP services for patients with FEP, significant improvements were observed in cardio-metabolic health, positive and negative symptoms and cognitive functioning after just 10 weeks [17]. Additionally, adherence and retention rates were substantially higher than in previous exercise trials in schizophrenia [8, 17], perhaps due to the nature of the intervention applied, or certain characteristics of the first-episode sample. We conducted a qualitative study of patients who had participated in the iBeep trial. The aim of this investigation was to explore the perceived benefits of exercise as experienced by people with FEP, and to establish the barriers and facilitating factors for increasing physical activity in this patient group. These findings could inform the development of future studies, and the implementation of exercise interventions within EIP services.

The Human Connectome Project: 180 zones per hemisphere

The researchers report that they’ve found a total of 180 distinct areas per hemisphere, regions which are bounded by sharp changes in cortical architecture, function, connectivity, and/or topography.

Self-reported impact of exercise on psychosis: good quotes

Participants generally felt that exercise was capable of providing acute relief for psychiatric symptoms. These effects varied across participants. Some reported relief from positive symptoms (i.e. auditory hallucinations and paranoia) and others for negative symptoms (amotivation and anhedonia). This seemed to depend on which aspects of psychosis characterised the individual’s current condition.

Towards a study of exercise impact on schizophrenia

We aim to conduct a trial where these methodological considerations are addressed by comparing a 12-week aerobic high-intensity interval training (HIIT) program to skills training of the same duration, with regard to: 1) aspects of cognitive function, especially memory, attention and executive function, and 2) psychiatric symptom load (negative and positive symptoms) and wellbeing. Post-treatment improvement in cognition and psychotic symptoms are anticipated. We hypothesize that the individuals in the Exercise Group (EG) will perform better than individuals in the Computer Skills Group (CSG) on aspects of cognitive function, especially memory, attention and executive function. In addition, we expect ameliorated positive and negative symptoms in the EG.

The effects and determinants of exercise participation in first-episode psychosis: a qualitative study | BMC Psychiatry | Full Text

Exercise offers a possible adjunctive intervention which may improve both physical and mental health outcomes in schizophrenia. A recent systematic review and meta-analysis found that 90 min of moderate-to-vigorous activity per week can increase fitness, reduce positive and negative symptoms and improve cognition [5]. The qualitative literature has also shed light on how exercise may have these effects. Two separate reviews, each including between 11 and 13 qualitative studies, found that vigorous exercise can draw attention away from auditory hallucinations and/or adverse beliefs that people with long-term schizophrenia may have, and help them to ‘reconnect with reality’ by focusing on physical exertion [6, 7]. Furthermore, exercise may improve negative symptoms and real-world functioning through providing a valued, sociable activity with achievable and rewarding goals [6, 7].

Exercise mediates against psychotic symptoms

Exercise offers a possible adjunctive intervention which may improve both physical and mental health outcomes in schizophrenia. A recent systematic review and meta-analysis found that 90 min of moderate-to-vigorous activity per week can increase fitness, reduce positive and negative symptoms and improve cognition [5]. The qualitative literature has also shed light on how exercise may have these effects. Two separate reviews, each including between 11 and 13 qualitative studies, found that vigorous exercise can draw attention away from auditory hallucinations and/or adverse beliefs that people with long-term schizophrenia may have, and help them to ‘reconnect with reality’ by focusing on physical exertion [6, 7]. Furthermore, exercise may improve negative symptoms and real-world functioning through providing a valued, sociable activity with achievable and rewarding goals [6, 7].

FDA study -- stimulant triggered psychosis, violence sometimes doesn't resolve

FDA Review ADHD Drugs Induce-Psychosis, Mania, Homicide, Suicide http://www.fda.gov/ohrms/dockets/ac/06/briefing/2006-4210B-Index.htm DATE: March 3, 2006 TO: Thomas Laughren, M.D., Director Division of Psychiatric Products (DPP), FDAOffice of Counter-Terrorism and Pediatric Drug Development (OCTAP) Memorandum. FROM: Kate Gelperin, M.D., M.P.H., Medical Epidemiologist Kate Phelan, R.Ph., Safety Evaluator The DDRE ADHD Psychiatric Review Team Office of Drug Safety (ODS) 1 EXECUTIVE SUMMARY / INTRODUCTION A BPCA (Best Pharmaceuticals for Children Act) review of methylphenidate products, prompted by Concerta pediatric exclusivity requirements, identified psychiatric adverse events as a possible concern. The review found some psychiatric adverse events mentioned in labeling, but a need for improved clarity was identified. The Pediatric Advisory Committee1 agreed at the June 2005 meeting at which the methylphenidate reviews were discussed, that the issue of psychiatric adverse events with all drugs indicated to treat ADHD should be examined with the goal of better characterizing these events so that drug labeling could be updated and made consistent between products. Thus, DDRE embarked on reviews of postmarketing and clinical trial reports of psychiatric adverse events associated with drugs used to treat ADHD. This document presents the results of the review of postmarketing reports. A companion document2, from Dr. Andrew Mosholder, presents the results of the review of clinical trial reports.  Information pertaining to selected psychiatric adverse event reports received since January 1, 2000 was requested from the manufacturers of products approved or with pending applications for the treatment of ADHD. Sponsors were asked to provide information regarding four broad categories of psychiatric adverse events: 1) signs and/or symptoms of psychosis or mania; 2) suicidal ideation and behavior; 3) aggression and violent behavior; and, 4) miscellaneous serious adverse psychiatric events. In addition, searches of the FDA AERS safety database were conducted covering the same time period, and the identified cases were assessed by a DDRE Review Team. Duplicates, and reports which were considered to be of poor quality or highly unlikely to be related to the drug of interest were excluded from this analysis.  Cases received from Sponsors, as well as those identified from the FDA AERS safety database, were systematically reviewed and analyzed to assess the probability of adverse drug reactions and to describe characteristics or risk factors observed in these reports. This review focuses on postmarketing safety data from the first three search categories. The miscellaneous category was considered to be beyond the scope of this current analysis due to the large volume of data for review. The most important finding of this review is that signs and symptoms of psychosis or mania, particularly hallucinations, can occur in some patients with no identifiable risk factors, at usual doses of any of the drugs currently used to treat ADHD. Current approved labeling for drug treatments of ADHD does not clearly address the risk of drug induced signs or symptoms of psychosis or mania (such as hallucinations) in patients without identifiable risk factors, and occurring at usual dosages. In addition, current labeling does not clearly state the importance of stopping drug therapy in any patient who develops hallucinations, or other signs or symptoms of psychosis or mania, during drug treatment of ADHD. We recommend that these issues be addressed.  A substantial proportion of psychosis-related cases were reported to occur in children age ten years or less, a population in which hallucinations are not common. The occurrence of such symptoms in young children may be particularly traumatic and undesirable, both to the child and the parents. The predominance in young children of hallucinations, both visual and tactile, involving insects, snakes and worms is striking, and deserves further evaluation. Positive rechallenge (i.e., recurrence of symptoms when drug is re-introduced) is considered a hallmark for causality assessment of adverse events. Cases of psychosisrelated events which included a positive rechallenge were identified in this review for each of the drugs included in this analysis.  In many patients, the events resolved after stopping the drug. In the FDA AERS review, resolution of the events after stopping the drug was reported in 58% of amphetamine /dextroamphetamine cases, 60% of modafinil cases, 33% of atomoxetine cases, and 48% of methylphenidate cases. (Note: Outcome of the psychiatric adverse events was not reported in 21% of amphetamine / dextroamphetamine cases, 9% of modafinil cases, 41% of atomoxetine cases, and 30% of methylphenidate cases.) For drugs currently approved for ADHD treatment, no risk factors were identified which could account for the majority of reports of psychosis-related events. For instance, drug abuse was reported in fewer than 3% of overall cases from the FDA AERS analysis of psychosis-related events. Also of note, in the overwhelming majority of cases (roughly 90% overall), the patient had no prior history of a similar condition. Numerous postmarketing reports of aggression or violent behavior during drug therapy of ADHD have been received, most of which were classified as non-serious, although approximately 20% of cases overall were considered life-threatening or required hospital admission.

Truman syndrome and the Internet

“Think back a few hundred years,” Joel Gold says. “The idea of walking into Times Square would have been crazy-making to absolutely anyone. For most of human history, there weren’t strangers bumping into you. You lived in a place where there were fifty people, and you knew all of them intimately.” Now such collisions are constant: a smartphone is a Times Square that we carry around in our pocket. “If living in New York City is a risk factor of psychosis, then why not the Internet?” Gold continues. “We’re not saying, ‘Don’t let your children surf the Web—they will be psychotic.’ We are saying, ‘This is something we should think about.’ ” Just as Times Square is a diversion for some people and a stressful place for others, the cyclopic camera above a laptop’s screen might, for a certain type of person, become a source of corrosive unease.

So-called 'synthetic marijuana' linked to serious health problems

SCBs are often sold as safe alternatives to marijuana that, because of their chemical structures, will not be discovered through standard drug screenings. This feature makes them popular among groups who want to elude detection, such as adolescents and military personnel. SCBs are also more potent than ?9-THC; "these are highly efficacious drugs; they tend to activate the CB1 receptor to a greater degree than we can ever get to with THC from marijuana," says William E. Fantegrossi, a behavioral pharmacologist at UAMS. As a result, some users turn to them to achieve a more intense high. A range of both acute and long-term adverse effects of SCB use are reported in clinical case studies, including seizures and convulsions, kidney injury, cardiotoxicity, strokes, anxiety, and psychosis in susceptible individuals, as well as tolerance, withdrawal, and dependence. Twenty deaths have also been linked to SCB use.

CBT creates lasting changes in connectivity, drugs do not

In the original study, participants underwent fMRI imaging to assess the brain’s response to images of faces expressing different emotions, before and after six months of CBT. Participants were already taking medication when they took part in the study, and so were compared to a group receiving medication only. The group receiving medication only did not show any increases in connectivity, suggesting that the effects on brain connections could be attributed to the CBT. For the new study, the health of 15 of the 22 participants who received CBT was tracked for eight years through their medical records. They were also sent a questionnaire at the end of this period to assess their level of recovery and wellbeing. The results show that increases in connectivity between several brain regions – most importantly the amygdala (the brain’s threat centre) and the frontal lobes (which are involved in thinking and reasoning) – are associated with long-term recovery from psychosis. This is the first time that changes in the brain associated with CBT have been shown to be associated with long-term recovery in people with psychosis.

Oxytocin, diabetes and mental health

OT system dysfunction may be one common mechanism underlying MetS and psychotic disorders.

Talking therapy changes the brain's wiring, study reveals for first time -- ScienceDaily

CBT -- a specific type of talking therapy -- involves people changing the way they think about and respond to their thoughts and experiences. For individuals experiencing psychotic symptoms, common in schizophrenia and a number of other psychiatric disorders, the therapy involves learning to think differently about unusual experiences, such as distressing beliefs that others are out to get them. CBT also involves developing strategies to reduce distress and improve wellbeing. The findings, published in the journal Translational Psychiatry, follow the same researchers' previous work which showed that people with psychosis who received CBT displayed strengthened connections between key regions of the brain involved in processing social threat accurately. The new results show for the first time that these changes continue to have an impact years later on people's long-term recovery.

Sleep Deprivation Mimics Psychosis

"A single night of sleep deprivation may not at first seem like a particularly drastic intervention, and can for instance occur with students out partying or people working through the night; therefore, we were surprised to see such statistically significant increases in self-ratings of all 3 dimensions of schizophrenia ― thought disorder, perceptual aberrations, and negative symptoms."