Chapter 7
As we wove our way through Meringen in the crowd of Swiss locals, I began to notice that we, the American tourists, were something that the Swiss were rather used to. We were, after all, the loudest, most rowdy and gaudy bunch on the streets that morning. Everyone else, however were more subdued, traveling in smaller groups, some couples at the local cafe drinking coffee. They, however, did not condemn our loud and often offensive demeanor. They must have realized that we were a necessary evil in their land, the American tourist who buy their watches and chocolate in great numbers in order to bring them home to our families. Yes, this much quieter French/German mixed culture in Meringen, Switzerland was a grateful group(for our money, but not for our customs).
Soon, Sean was chatting it up with Ginger and myself as if we were all old friends. It had been only two short days since we had met, although we all shared a common experience now, however short-lived it was. The cobblestone street felt uneven from years of wear as I briefly noticed a charming chocolatier shoppe and checked out the delicacy through the window from afar. Then, and just then, it occurred to me, that I wouldn't have an experience quite like this in my life for many years hence.
Short, and roughly paved sidewalks were tracing the outlines of the stony middle portion of road in between. When you looked up, you could only be in awe of the stunning view of snow capped mountains disappearing into the clouds high above where we stood. From a bird's eye view, the architecture stunned me, but now the trip down the ski-lift had revealed a much more rustic look with architectural intricacies imbedded in much of the buildings' weathered charm.
Surrounding the village were plenty of ruffage, shrubbery and neglected (by the rain and climate) blooming flowers. Since this region was so mountainous and the valleys were starved of rain during the summer, smokers like me where on notice that we were to dispose of our cigarette butts safely at all times to avoid the imminent risk of wild fire. Indeed, the wind played a factor in this too, as the gusts would spread and fan even a tiny smolder into something of a disaster in a hurry.
Hurrying wasn't something that we were doing while ambling through the streets of the Swiss Village. We wanted to enjoy every minute and photo opportunity in this picturesque place.
This was the most walking I had done in a while. Although I was in shape, the uneven footing on these village streets were taking it right out of me.
"This is my first time to the Alps," I managed, smiling through the pain.
"Mine too," Ginger replied in her southern drawl.
"You're dressed for this much walking in the summer," then to Shawn, "You and I look like we are hitting the ski slopes."
"Yeah," Shawn was panting, worse off than me with a noticeable spare tire around his mid-section. He was aged beyond his years, or so the eye would perceive. When he spoke, he sounded like a little boy, however, and his intelligent glasses angled and fit with his youthful smile. His hair, a mess of dark brown mish- mosh atop his head was gleaming with beads of sweat in the hot summer sun.
Ginger, on the other hand, was a charming mix of southern bell with all the fix ins and striking dimple-faced beauty. Her short stature was offset while we were walking by her long, generous stride. As if to say, look how smart I am, Ginger kept her Georgetown University tee shirt on with pride.
We strolled into many a shoppe and kiosk with American guile, while we pointed our fingers at the local fare and made off-colored comments. Shawn feigned expertise with the local customs and crafts while Ginger played off the southern inexperienced part well. Me, on the other hand, just gawked at the intricate glass-blown crafts and delectable chocolates at the same time enjoying the company of these two.
"Check this out," flew out of Ginger's mouth from somewhere behind me.
I whirled and set my vision on the Swiss-woven purse that she was already sporting on her shoulder stylishly.
"Very nice," Shawn replied before I could muster a response.
"Yeah, it looks cute on you," I added. "How much?"
"It's a steal at 15 Franks," said Ginger. "I was thinking about getting it for my sister, but I may have to keep it for myself," she added playfully.
Our time in the village was winding down as the sun had found its place behind one of the tall mountains that surrounded us. We boarded the ski lift for the ride back up to the hotel on the ridge.
There was more rehearsing to do tomorrow and for the rest of the two weeks that we were to spend with the sensational Swiss.
As the darkness fell over the rocky landscape, my eyes were heavy from the day and I drifted off to sleep. I could almost see the thick clouds rolling over the mountain range coming closer and closer as it swallowed me in dense immobility.
Chapter 8
As dawn broke, I rolled over to see my room mate, named Leatus, still deep in slumber. Leatus Reed was from Tennessee and had long dark hair, which was currently drowning his face and pillow in it's thick guise. He was fairly slender, with a few ill-placed tattoos and both ears pierced. His face was round with striking blue eyes and a nose that constituted the rest of his persona, which was currently lost in a mess of dark, straight mane.
"Get up, lazybones." I mumbled, too softly to wake Leatus Reed in his current state of REM sleep. I wanted to yank on his past-his-shoulders brunette hair, but it was just a thought that never made it to an action.
"Yo, Leat-man!" I hollered, this time too loudly. My voice carried too well, I had been told, and probably pierced through the walls and doors all the way down to Steven Kimbrough's room.
"Ugh, what's the hurry?" he mumbled in reply.
"Breakfast is in 10 minutes and then we got rehearsal for an hour and a half."
"So what's your hurry? We've got another ten minutes to catch a few winks," he added.
As the native from Tennessee spoke and made his half-awake protest, I knew that this was more than a comment, it was a lifestyle. Harking to the rest of our trip, when we rode the mighty roller coaster of life, love, sex and rock and roll-- Thats what life was all about to us in this time and place. Oh, and there was religion and the gift of song, but we knew that came naturally to us and that rehearsal was just a formality.
Saturday, August 28, 2010
Monday, August 16, 2010
Excerpt from book
Excerpt from what I have been working on tonight:
That night is so vivid in my mind, even though it happened some twenty nine years ago. Tonight I can remember it like it happened yesterday.
My mom and dad traveled a whole lot with me—so much so that I hardly knew when it was time to sleep or time to be up, since I was so young. After all, it was told to me that I was around the world twice before I was eighteen months old.
All alone in that crib, like a jail cell in the pitch black, there I was. Well, it wasn’t exactly pitch black, because there was a tiny red LED light on, but pretty darn close to inky blackness. For some reason, I was scared, by what, I don’t to this day know. But I started crying, the young two-year old that I was, and kept crying—as if summoning the devil himself. My parents probably wanted like the dickens for me to “self-sooth,” you know, just cry myself to sleep and put myself out. For they, too must have been exhausted.
As I wailed in the darkness of my room, the demons edged yet closer. There they were, just at the other side of the room in the closet, which I knew was there, but could not make out in the deep darkness that surrounded me.
I will never forget that, what seems like an eternity of never-ending torture was probably only a few minutes, yet like a scene from a horror movie, all the makings of the suspense and cliff hangers were there, in my mind.
Although one of my earliest memories, we are all a sum of our experiences that mar our perceptions, jading us for the rest of our victories and downfalls later.
That night is so vivid in my mind, even though it happened some twenty nine years ago. Tonight I can remember it like it happened yesterday.
My mom and dad traveled a whole lot with me—so much so that I hardly knew when it was time to sleep or time to be up, since I was so young. After all, it was told to me that I was around the world twice before I was eighteen months old.
All alone in that crib, like a jail cell in the pitch black, there I was. Well, it wasn’t exactly pitch black, because there was a tiny red LED light on, but pretty darn close to inky blackness. For some reason, I was scared, by what, I don’t to this day know. But I started crying, the young two-year old that I was, and kept crying—as if summoning the devil himself. My parents probably wanted like the dickens for me to “self-sooth,” you know, just cry myself to sleep and put myself out. For they, too must have been exhausted.
As I wailed in the darkness of my room, the demons edged yet closer. There they were, just at the other side of the room in the closet, which I knew was there, but could not make out in the deep darkness that surrounded me.
I will never forget that, what seems like an eternity of never-ending torture was probably only a few minutes, yet like a scene from a horror movie, all the makings of the suspense and cliff hangers were there, in my mind.
Although one of my earliest memories, we are all a sum of our experiences that mar our perceptions, jading us for the rest of our victories and downfalls later.
AstraZeneca settles Seroquel claims for $198 mln - MarketWatch
AstraZeneca settles Seroquel claims for $198 mln - MarketWatch
This article particularly hits home, since I am a long time user of this medication for my symptoms of psychosis due to schizoaffective disorder. Be warned, drugs aren't always the answer.
This article particularly hits home, since I am a long time user of this medication for my symptoms of psychosis due to schizoaffective disorder. Be warned, drugs aren't always the answer.
Sunday, August 1, 2010
Diagnosis Change
I think that my previous PDoc had this part correct from the start, schizoaffective disorder was my diagnosis then, and still is, according to Doctor Malhotra. Since this summer, I have felt extreme highs and lows with no symptoms of Paranoia, psychosis, delusions or hallucinations this summer. The summer is always the worst time for me and maybe it's time to do something about it.
It has been suggested by my mom that I may have a seasonal affective portion of the disorder in which there is a lag time of not having enough light, and my disorder, therefore, manifests itself later in the summer. Then, having stored up all the extra sunlight, I have a great winter, and then, being so deprived of the sun again during the winter months, I then go back to having my negative AND positive symptoms again in the Spring and Summer.
Who knows?
It has been suggested by my mom that I may have a seasonal affective portion of the disorder in which there is a lag time of not having enough light, and my disorder, therefore, manifests itself later in the summer. Then, having stored up all the extra sunlight, I have a great winter, and then, being so deprived of the sun again during the winter months, I then go back to having my negative AND positive symptoms again in the Spring and Summer.
Who knows?
An interesting review of one of my favorite manuals on Schizophrenia
Review - Surviving Schizophrenia
A Manual for Families Consumers and Providers, Third Edition
by E. Fuller Torrey
Harperperennial, 1995
Review by Matt Lee
Dec 19th 2001 (Volume 5, Issue 51)
The manual Torrey has written is a toolbox of information and contacts, written for the everyday lay reader with an interest in the practical side of schizophrenia. It presents as part of that genre of writing that we might call 'medical empowerment', where users or providers outline the background to their concerns, in this case schizophrenia, as well as describing practical methods for negotiating the varieties of treatments and social implications. It focuses on North America alone and so the details Torrey gives of practical issues and possible solutions is limited in scope and means the book is of little use outside of North America. It is also inevitably going to have a relatively short shelf life. The edition I reviewed was from 1995 and is already 6 years out of date and I would suspect that in order for such a manual to fulfill its function adequately it would need updating and reviewing every two to three years. The book then is limited in its remit, useful mainly for North Americans and then only after noting that some of the details will be redundant. One questions remains then. Is it a good manual; can it do what it intends to, which is enable people to 'survive' schizophrenia.
The first thing to note when reading Torrey's manual is his apocalyptic tone with regard to schizophrenia, a tone which is part of an overall polemical attitude that is quite aggressive and often questionable. The first chapter of the work is entitled 'dimensions of the disaster' and traces a history of schizophrenia in the last century in North America. This 'disaster' is not, however, simply schizophrenia itself, although Torrey is clear that being 'afflicted' by schizophrenia is itself a disaster for both the schizophrenic and everyone around them. The real 'disaster' with which Torrey opens his work, however, is the closure of the asylums in North America. Hospitalisation has been reduced too much, according to Torrey, and there is now a crisis in the treatment of schizophrenics for which the main solution seems to be a radical increase in hospitalization. This advocacy of the hospital is a central point in his polemic but that is not the focus of Torreys polemic. The main focus is any suggestion that schizophrenia is anything other than a massively debilitating brain disease treatable with drugs. Torrey is a primary advocate of this medical model and does so in such a way that any discussion or challenge to such a model is seen as not only ludicrous but often as dangerous to the schizophrenic. This is particularly the case with 'insight-oriented psychotherapy'. Such treatment is "not only negligent, it is malpractice" (p.169).
The polemical tone of Torrey's work comes throughout the work and the text is littered with side swipes at psychoanalysis, Thomas Szasz, R.D.Laing, anti-psychiatry and the National Institute for Mental Health (NIMH). It is also littered with the phrase 'schizophrenia is a brain disease' and at no point tolerates any deviation from this basic model, even though the manual itself deals in large part with the medical social situation of the schizophrenic. Despite schizophrenia being a 'brain disease' the chapter on neurology (Chapter 6) is a cursory overview of the competing theories. Torrey presents 4 main theories, 5 minor theories and 6 'obsolete theories', none of which inspires much confidence in the rather blunt and absolutist way in which he reduces schizophrenia to brain disease. Moreover the history of psychiatric theories of schizophrenia is not one of increasing clarity of theory but, as anyone who begins to examine the area will find, rather one of ongoing waves of 'fashionable' theories, each of which seems to last a generation or two before being moved onto the shelf of minor or obsolete theories.
Torrey clearly revels in the argument but his polemic is too strident to be convincing. He attempts to offer a route through the maze of treatments and practices on offer in North America and through so doing highlights the crisis in social and medical policy that exists in that country. He does not inspire any confidence, however, in his own approach. The crucial issue of the social implications of schizophrenia is reduced, in essence, to a practice of finding the 'right' doctor or the 'right' treatment. Torrey's own role within the debate appears to blind him to the fact that schizophrenia is a major site of social struggle, possibly the most urgent site of such struggle in our attempt to grapple with 'biotechnologies' and our ability to affect ourselves through medicine.
Torrey himself has taken charge of one of the largest 'brain banks' in the world, as a result of private funding, and now controls a large part of the budget for research into schizophrenia in North America. His preferred organisation, the National Alliance for Mentally Ill, is a particular group within the debate, largely family orientated and inevitably partisan in its approach. The final chapter in his book, 'How to be an advocate' reads as a form of recruitment manifesto for NAMI but does so not through putting the policy differences clearly but rather through writing a history in which, in some sort of inevitable evolution, the only real advocacy organization is now the NAMI. At this point Torrey's clearly political - with a small 'p' - agenda comes to the fore and yet at no point does he step back from the controversy and attempt a more objective account of the issues. In the end the manual is marred fundamentally by this partisanship. A manual should aim to be an objective tool. It should not be a way to garner support for a particular policy with regard to schizophrenia. Torrey uses his position within the medical profession - even down to the 'M.D.' after his name on the cover - to give a veneer of authority and objectivity to his manual but this is an objectivity that he singularly fails to deliver.
©
2001 Matt Lee
A Manual for Families Consumers and Providers, Third Edition
by E. Fuller Torrey
Harperperennial, 1995
Review by Matt Lee
Dec 19th 2001 (Volume 5, Issue 51)
The manual Torrey has written is a toolbox of information and contacts, written for the everyday lay reader with an interest in the practical side of schizophrenia. It presents as part of that genre of writing that we might call 'medical empowerment', where users or providers outline the background to their concerns, in this case schizophrenia, as well as describing practical methods for negotiating the varieties of treatments and social implications. It focuses on North America alone and so the details Torrey gives of practical issues and possible solutions is limited in scope and means the book is of little use outside of North America. It is also inevitably going to have a relatively short shelf life. The edition I reviewed was from 1995 and is already 6 years out of date and I would suspect that in order for such a manual to fulfill its function adequately it would need updating and reviewing every two to three years. The book then is limited in its remit, useful mainly for North Americans and then only after noting that some of the details will be redundant. One questions remains then. Is it a good manual; can it do what it intends to, which is enable people to 'survive' schizophrenia.
The first thing to note when reading Torrey's manual is his apocalyptic tone with regard to schizophrenia, a tone which is part of an overall polemical attitude that is quite aggressive and often questionable. The first chapter of the work is entitled 'dimensions of the disaster' and traces a history of schizophrenia in the last century in North America. This 'disaster' is not, however, simply schizophrenia itself, although Torrey is clear that being 'afflicted' by schizophrenia is itself a disaster for both the schizophrenic and everyone around them. The real 'disaster' with which Torrey opens his work, however, is the closure of the asylums in North America. Hospitalisation has been reduced too much, according to Torrey, and there is now a crisis in the treatment of schizophrenics for which the main solution seems to be a radical increase in hospitalization. This advocacy of the hospital is a central point in his polemic but that is not the focus of Torreys polemic. The main focus is any suggestion that schizophrenia is anything other than a massively debilitating brain disease treatable with drugs. Torrey is a primary advocate of this medical model and does so in such a way that any discussion or challenge to such a model is seen as not only ludicrous but often as dangerous to the schizophrenic. This is particularly the case with 'insight-oriented psychotherapy'. Such treatment is "not only negligent, it is malpractice" (p.169).
The polemical tone of Torrey's work comes throughout the work and the text is littered with side swipes at psychoanalysis, Thomas Szasz, R.D.Laing, anti-psychiatry and the National Institute for Mental Health (NIMH). It is also littered with the phrase 'schizophrenia is a brain disease' and at no point tolerates any deviation from this basic model, even though the manual itself deals in large part with the medical social situation of the schizophrenic. Despite schizophrenia being a 'brain disease' the chapter on neurology (Chapter 6) is a cursory overview of the competing theories. Torrey presents 4 main theories, 5 minor theories and 6 'obsolete theories', none of which inspires much confidence in the rather blunt and absolutist way in which he reduces schizophrenia to brain disease. Moreover the history of psychiatric theories of schizophrenia is not one of increasing clarity of theory but, as anyone who begins to examine the area will find, rather one of ongoing waves of 'fashionable' theories, each of which seems to last a generation or two before being moved onto the shelf of minor or obsolete theories.
Torrey clearly revels in the argument but his polemic is too strident to be convincing. He attempts to offer a route through the maze of treatments and practices on offer in North America and through so doing highlights the crisis in social and medical policy that exists in that country. He does not inspire any confidence, however, in his own approach. The crucial issue of the social implications of schizophrenia is reduced, in essence, to a practice of finding the 'right' doctor or the 'right' treatment. Torrey's own role within the debate appears to blind him to the fact that schizophrenia is a major site of social struggle, possibly the most urgent site of such struggle in our attempt to grapple with 'biotechnologies' and our ability to affect ourselves through medicine.
Torrey himself has taken charge of one of the largest 'brain banks' in the world, as a result of private funding, and now controls a large part of the budget for research into schizophrenia in North America. His preferred organisation, the National Alliance for Mentally Ill, is a particular group within the debate, largely family orientated and inevitably partisan in its approach. The final chapter in his book, 'How to be an advocate' reads as a form of recruitment manifesto for NAMI but does so not through putting the policy differences clearly but rather through writing a history in which, in some sort of inevitable evolution, the only real advocacy organization is now the NAMI. At this point Torrey's clearly political - with a small 'p' - agenda comes to the fore and yet at no point does he step back from the controversy and attempt a more objective account of the issues. In the end the manual is marred fundamentally by this partisanship. A manual should aim to be an objective tool. It should not be a way to garner support for a particular policy with regard to schizophrenia. Torrey uses his position within the medical profession - even down to the 'M.D.' after his name on the cover - to give a veneer of authority and objectivity to his manual but this is an objectivity that he singularly fails to deliver.
©
2001 Matt Lee
Friday, July 23, 2010
An interesting life expectancy in Mental Illness article I came across
Home » News » Suicide News » Life Expectancy in Mental Illness
Life Expectancy in Mental Illness
By JESSICA WARD JONES, MD, MPH Associate News Editor
Reviewed by John M. Grohol, Psy.D. on July 13, 2010
Mental illness can take years off a person’s life, but perhaps not as many as previously thought.
Recent research shows that serious and persistent mental illness can result in patients losing up to four years of life compared to individuals without mental illness.
Dr. Elizabeth E. Piatt from the Department of Behaviors and Community Health Services at Northeastern Ohio Universities Colleges of Medicine and Pharmacy in Rootstown, and her colleagues, examined death records of patients from a community mental health center, and from the general population. The researchers found an increase in premature mortality in the mentally ill patients, not only from suicide, but also cancer, accidents, liver disease and septicemia.
“We found that a community-based sample of adults with severe and persistent mental illness lost 14.5 years of potential life, a difference of 4.2 years from the (control) sample,” said Piatt.
It has been known for years that people with severe psychiatric illness have shorter lifespans, thought to be from 13.5 to 32 years shorter. More than 90 percent of suicides are as a result of a mental illness, and persons with bipolar disorder, for example, have a 10 to 20 percent lifetime risk of suicide. However, recent research has made clear that there is an increased mortality in patients with mental illness that is not directly explained by mental health issues, and is related to general medical problems.
However, most studies have tended to focus on inpatients. In addition, previous research has not directly compared years of potential life lost between mental health patients and individuals without mental illness. Thus the number of potential years of life lost may be lower than previously suggested.
“By not examining differences in premature mortality, the results of these studies may have overestimated (this outcome) in the population with serious mental illness,” note the authors.
To accurately assess the true impact of serious and persistent mental illness on years of potential life lost, Piatt and her colleagues retrospectively matched 647 case management files from patients who had been treated at a community health center prior to their deaths to 15,517 state death records from the general population.
The authors defined serious mental illness as schizophrenia and schizoaffective disorder, bipolar disorder, dysthymia, major depression, anxiety disorder and personality disorders. Individuals with dementia and substance abuse disorders were not included in the study.
They found that the mean number of years of potential life lost for decedents with serious and persistent mental illness was 14.5 (standard deviation ± 10.6) compared to 10.5 (± 6.7) for the general population. The mean age of death for the psychiatric patients was 73.4 (± 15.4) years compared to 79.6 (± 10.9) years.
Heart disease was the leading cause of death for each group. After statistical adjustments were made for gender, race, education and marital status, the greatest differences in cause of death between the two groups were seen in suicide, cancer, accidents, liver disease, and septicemia.
Differences were also seen in every leading cause of death. However, even after adjusting for all the differences in cause of death, there was still a increased number of years of potential life lost that was not explained.
“Differences in cause of death did not explain the difference in years of potential life lost,” said Piatt.
These results are important in giving a more accurate picture of the true impact of serious and persistent mental illness on life expectency, and the nature of that impact. Patients with psychiatric disorders are not only at risk for psychiatric complications, but are also at greater risk for medical illness, and at an increased risk for more complicated medical disease and worse outcomes.
Patients with psychiatric illness may be more likely to engage in risky behaviors that result in accidents, or to smoke, or be less compliant with medications. Another recent study showed that patients with bipolar disorder are at an increased risk for heart disease. Other research has shown that patients admitted to psychiatric hospitals are at risk for increased mortality from general medical problems. In addition, some psychiatric medications, notably antipsychotics, can increase the risk of diabetes, or heart disease.
Mental health practitioners have an opportunity to intervene not just in preventing suicides, but also in discouraging risky behavior, encouraging a healthy lifestyle, and general primary medical care.
“Integrating mental health care, primary health care, and wellness-promoting activities….may ensure access to the interventions needed to reverse the causes of preventable early death,” say Piatt and her team. “Morbidity and mortality from the most common causes of death in this sample…may be reduced by effective medical care that attempts prevention, early detection, and chronic disease management.”
The authors conclude: “Our work adds to the growing body of literature that highlights the need for better preventative health care for persons with mental illness. Along with ongoing suicide prevention programs, efforts to integrate primary and psychiatric care should focus on these preventable causes of death.”
Dr. Piatt’s results are published in the July issue of Psychiatric Services.
Source: Psychiatric Services
Life Expectancy in Mental Illness
By JESSICA WARD JONES, MD, MPH Associate News Editor
Reviewed by John M. Grohol, Psy.D. on July 13, 2010
Mental illness can take years off a person’s life, but perhaps not as many as previously thought.
Recent research shows that serious and persistent mental illness can result in patients losing up to four years of life compared to individuals without mental illness.
Dr. Elizabeth E. Piatt from the Department of Behaviors and Community Health Services at Northeastern Ohio Universities Colleges of Medicine and Pharmacy in Rootstown, and her colleagues, examined death records of patients from a community mental health center, and from the general population. The researchers found an increase in premature mortality in the mentally ill patients, not only from suicide, but also cancer, accidents, liver disease and septicemia.
“We found that a community-based sample of adults with severe and persistent mental illness lost 14.5 years of potential life, a difference of 4.2 years from the (control) sample,” said Piatt.
It has been known for years that people with severe psychiatric illness have shorter lifespans, thought to be from 13.5 to 32 years shorter. More than 90 percent of suicides are as a result of a mental illness, and persons with bipolar disorder, for example, have a 10 to 20 percent lifetime risk of suicide. However, recent research has made clear that there is an increased mortality in patients with mental illness that is not directly explained by mental health issues, and is related to general medical problems.
However, most studies have tended to focus on inpatients. In addition, previous research has not directly compared years of potential life lost between mental health patients and individuals without mental illness. Thus the number of potential years of life lost may be lower than previously suggested.
“By not examining differences in premature mortality, the results of these studies may have overestimated (this outcome) in the population with serious mental illness,” note the authors.
To accurately assess the true impact of serious and persistent mental illness on years of potential life lost, Piatt and her colleagues retrospectively matched 647 case management files from patients who had been treated at a community health center prior to their deaths to 15,517 state death records from the general population.
The authors defined serious mental illness as schizophrenia and schizoaffective disorder, bipolar disorder, dysthymia, major depression, anxiety disorder and personality disorders. Individuals with dementia and substance abuse disorders were not included in the study.
They found that the mean number of years of potential life lost for decedents with serious and persistent mental illness was 14.5 (standard deviation ± 10.6) compared to 10.5 (± 6.7) for the general population. The mean age of death for the psychiatric patients was 73.4 (± 15.4) years compared to 79.6 (± 10.9) years.
Heart disease was the leading cause of death for each group. After statistical adjustments were made for gender, race, education and marital status, the greatest differences in cause of death between the two groups were seen in suicide, cancer, accidents, liver disease, and septicemia.
Differences were also seen in every leading cause of death. However, even after adjusting for all the differences in cause of death, there was still a increased number of years of potential life lost that was not explained.
“Differences in cause of death did not explain the difference in years of potential life lost,” said Piatt.
These results are important in giving a more accurate picture of the true impact of serious and persistent mental illness on life expectency, and the nature of that impact. Patients with psychiatric disorders are not only at risk for psychiatric complications, but are also at greater risk for medical illness, and at an increased risk for more complicated medical disease and worse outcomes.
Patients with psychiatric illness may be more likely to engage in risky behaviors that result in accidents, or to smoke, or be less compliant with medications. Another recent study showed that patients with bipolar disorder are at an increased risk for heart disease. Other research has shown that patients admitted to psychiatric hospitals are at risk for increased mortality from general medical problems. In addition, some psychiatric medications, notably antipsychotics, can increase the risk of diabetes, or heart disease.
Mental health practitioners have an opportunity to intervene not just in preventing suicides, but also in discouraging risky behavior, encouraging a healthy lifestyle, and general primary medical care.
“Integrating mental health care, primary health care, and wellness-promoting activities….may ensure access to the interventions needed to reverse the causes of preventable early death,” say Piatt and her team. “Morbidity and mortality from the most common causes of death in this sample…may be reduced by effective medical care that attempts prevention, early detection, and chronic disease management.”
The authors conclude: “Our work adds to the growing body of literature that highlights the need for better preventative health care for persons with mental illness. Along with ongoing suicide prevention programs, efforts to integrate primary and psychiatric care should focus on these preventable causes of death.”
Dr. Piatt’s results are published in the July issue of Psychiatric Services.
Source: Psychiatric Services
Saturday, July 17, 2010
Cognitive functioning certainly protected in some patients, including me
A gene has been found in some people with schizophrenia that can help protect cognitive ability.
While it may put individuals at risk for schizophrenia in the first place, schizophrenic patients with the at-risk gene performed better on certain tests of cognitive function than patients with a less risky variant of the same gene.
Dr. James T.R. Walters of the Medical Research Council for Neuropsychiatric Genetics and Genomics at Cardifff University in Wales, and his colleagues found preserved memory with a variation in the gene known as the Zinc Finger Protein 804A.
Prior research has implicated the Zinc Finger Protein 804A gene (ZNF804A) as a risk factor for schizophrenia. Alleles are different variations of the same gene, and one allele of the ZNF804A gene seems to be more commonly present in patients with psychiatric diagnoses such as schizophrenia and bipolar disorder. While its exact function remains elusive, some researchers suspect that the ZNF804A gene affects communication in the brain.
Walters and his team studied 297 adults with schizophrenia and 165 healthy adults in Ireland. The same research was repeated in Germany on a population of 251 patients with schizophrenia and 1472 controls to confirm the results.
All participants were genetically tested to assess which allele of the ZNF804A gene was present. Study participants also underwent tests of cognitive function including IQ, episodic memory, working memory, and attention.
Variations of the ZNF804A gene did not have any effect on the results of the cognitive testing in the adults with no psychiatric disorder.
However, in the individuals with schizophrenia, the at-risk allele of ZNF804A appeared to have a protective effect on cognitive functions such as working memory and episodic memory.
Walters then limited the results to only patients with a relatively higher IQ and the association between the at-risk gene and the preserved memory functions became even stronger.
“Although the observed association with cognition seem counterintuitive, it is important to note that the risk allele at ZNF804A is not so much associated with better cognitive performance in the present study as with less impaired cognitive performance,” writes Walters.
The exact nature between the relationship of ZNF804A and the development of schizophrenia is not entirely understood. These results are important in suggesting that ZNF804A may be a risk factor for one subtype of schizophrenia, and the development of some subtypes of schizophrenia may also involve cognitive pathways.
Further research into the genetics and the molecular biology of the development of schizophrenia could provide important information to help in diagnosis, treatment and prevention of the disease.
Dr. Walter’s results can be found in the July issue of the Archives of General Psychiatry.
Source: Archives of General Psychiatry
While it may put individuals at risk for schizophrenia in the first place, schizophrenic patients with the at-risk gene performed better on certain tests of cognitive function than patients with a less risky variant of the same gene.
Dr. James T.R. Walters of the Medical Research Council for Neuropsychiatric Genetics and Genomics at Cardifff University in Wales, and his colleagues found preserved memory with a variation in the gene known as the Zinc Finger Protein 804A.
Prior research has implicated the Zinc Finger Protein 804A gene (ZNF804A) as a risk factor for schizophrenia. Alleles are different variations of the same gene, and one allele of the ZNF804A gene seems to be more commonly present in patients with psychiatric diagnoses such as schizophrenia and bipolar disorder. While its exact function remains elusive, some researchers suspect that the ZNF804A gene affects communication in the brain.
Walters and his team studied 297 adults with schizophrenia and 165 healthy adults in Ireland. The same research was repeated in Germany on a population of 251 patients with schizophrenia and 1472 controls to confirm the results.
All participants were genetically tested to assess which allele of the ZNF804A gene was present. Study participants also underwent tests of cognitive function including IQ, episodic memory, working memory, and attention.
Variations of the ZNF804A gene did not have any effect on the results of the cognitive testing in the adults with no psychiatric disorder.
However, in the individuals with schizophrenia, the at-risk allele of ZNF804A appeared to have a protective effect on cognitive functions such as working memory and episodic memory.
Walters then limited the results to only patients with a relatively higher IQ and the association between the at-risk gene and the preserved memory functions became even stronger.
“Although the observed association with cognition seem counterintuitive, it is important to note that the risk allele at ZNF804A is not so much associated with better cognitive performance in the present study as with less impaired cognitive performance,” writes Walters.
The exact nature between the relationship of ZNF804A and the development of schizophrenia is not entirely understood. These results are important in suggesting that ZNF804A may be a risk factor for one subtype of schizophrenia, and the development of some subtypes of schizophrenia may also involve cognitive pathways.
Further research into the genetics and the molecular biology of the development of schizophrenia could provide important information to help in diagnosis, treatment and prevention of the disease.
Dr. Walter’s results can be found in the July issue of the Archives of General Psychiatry.
Source: Archives of General Psychiatry
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