Friday Factoid: Use of Antipsychotics When Not Psychotic: A Look at the Risks

Often children and youths are given antipsychotic medication despite not having symptoms of psychosis. These reasons include depression, ADHD, and other types of conditions other than what these drugs were designed for. Tennessee Medicaid enrollees aged 5 to 24 from 1999 to 2014 were included in a study by Ray, Stein, and Murray (2019). Excluded diagnoses were somatic illness, schizophrenia or related psychoses, or Tourette’s syndrome or chronic tic disorder. Three dosage groups were observed higher than 50 mg, lower than 50 mg, or controlled medications including antidepressants and mood stabilizers. Those prescribed the higher dosages of antipsychotics had a 3.5 greater risk of death compared with the other types of medications and dosages. These results show a need for closer management of prescription of antipsychotics and monitoring if they are given.

References:
Ray, W. A., Stein, C. M., Murray, K. T. (2019); Association of antipsychotic treatment with risk of unexpected death among children and youths. JAMA Psychiatry, 76 (2), 162-171.

Andrew Goebel, MS, LPA (Temp)
WKPIC Doctoral Intern 

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Friday Factoid: “So, You Don’t Want To Be My Neighbor”: Stigma in Action

Stigma can be expressed in various different ways, however, the current understanding of most psychiatric stigma is based on one’s beliefs about a particular condition rather than concrete behaviors. As a way to draw beliefs and feelings to real world settings, a study was conducted to determine how 114 undergraduate students would react to a particular man that they would meet.  Each of the participants completed several measures of self-reported stigma before stepping into an adjacent room and choosing where to sit in relation to a man. Prior to the meeting the man was introduced as a volunteer at a health agency and was told to either have Type 2 diabetes or schizophrenia. As a part of the experiment, the participants were asked to enter the room and select a chair to sit on as they wait for the volunteer with one of the pre-selected conditions to return. On average those who were told they were meeting an individual with schizophrenia chose to sit further than those expecting to meet someone with diabetes. Their self-reporting showed higher levels of fear and appraisals of dangerousness and unpredictability towards the man with schizophrenia compared to the more well-known medical condition.

References:
Thibodeau, R. & Principino, H. M. (2018). Keep your distance: People sit farther away from a man with schizophrenia versus diabetes. Stigma and Health DOI: 10.1037/sah0000156

Andrew Goebel, MS, LPA (Temp)
WKPIC Doctoral Intern

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Friday Factoid: Mouse Hugs over Hard Drugs: Implications of Neuroscience on Addiction Treatment

Neuroscience has only minimally contributed to addiction treatment. One of the factors that may advance research is this rodent model about social interaction and substance use. Researchers trained rats to make an operant level of choice between drugs or social interactions.  The two choices were either to press a lever for a drug (heroin or methamphetamine) or socialize with another rat. Across multiple conditions rats were consistently choosing social time over the drugs. These conditions were differing drugs, dosages, sex of the rat, and rat’s previous level of addictive responses to the drugs. The only time drugs were preferred was when researchers punished the rats for choosing social time with electric shocks or delaying access to other rats. These positive factors of social interaction are included in current treatment methods such as community reinforcement approach (CRA) which use social reinforcers such as support groups and positive work environments. The clinical implications are that they are hoping to use social-media approaches to expand use of social supports during or before drug-seeking episodes.

References:
Venniro, M., Zhang, M., Caprioli, D., Hoots, J. K., Golden, S. A., Conor, H., … Shaham, Y. (2018). Volitional social interaction prevents drug addiction in rat models. Nature Neuroscience, 21, 1520-1529.

Andrew Goebel, MS, LPA (Temp)
WKPIC Doctoral Intern

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Congratulations to the Leadership Class of 2019!

“Leadership is a choice, not a position.” -Stephen Covey

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Article Review: Park, Y. C. et al. (2018). To use the brief psychiatric rating scale to detect disorganized speech in schizophrenia: Findings from the REAP-AP study.

The Brief Psychiatric Rating Scale (BPRS) is one of the most commonly used measures for assessing psychopathy in patients diagnosed with schizophrenia, particularly disorganized speech (Leucht et al., 2005). Conceptually derived from classical ideas originating in German psychopathology, the term disorganized speech, has come to be defined as “switching from one topic to another” in terms of an individual’s manner of communicating, responding to questions in an “obliquely related or completely unrelated” way, or less frequently, speaking in a way that is so severely disorganized that one’s verbalizations are “nearly incomprehensible” and linguistically resembles receptive aphasia (American Psychiatric Association, 2013). Though, despite this definition, difficulties continue to arise with respect to precisely conceptualizing disorganized speech, and the inversely associated formal thought disorder, due to the variableness of its etiology (Park et al., 2018).

 

The BPRS has been proposed as an evaluative measure for assessing the aforementioned atypical patterns. Regarded as one of the most commonly used measures for assessing psychopathology, this instrument has been frequently used to evaluate disorganized speech in patients diagnosed with schizophrenia (Park et al., 2018). Specifically, the conceptual disorganization item on this rating scale has been used to assess this symptom; however, its ability to accurately detect disorganized speech remains highly controversial (Park et al., 2018). Though, despite this controversy, very few studies have investigated the capacity for the BPRS to accurately distinguish this core symptom.

 

Thus, in an attempt to assess the psychometric validity of this measure and/or its conceptual disorganization item, Park et al. (2018) recruited a total of 3,744 patients diagnosed with schizophrenia via the REAP-AP study to participate in their investigation. A final total of 1,494 subjects from survey centers spanning across 5 different Asian countries participated. Those who were recruited, were selected based on the following inclusion criteria: diagnosis of schizophrenia, use of neuroleptics and/or psychotropic medications, and availability of a completed 18-item BPRS (Park et al., 2018). However, given differences in their languages, the English version of the BPRS was used to assess for disorganized speech and other psychopathy in each participant (Park et al., 2018). After adjusting for differences noted between patients who displayed this core symptom versus those without, results of their investigation showed that subjects with disorganized speech had significantly higher scores for emotional withdrawal, conceptual disorganization, mannerism and posturing, hostility, suspiciousness, hallucinations, uncooperativeness, unusual thought content, blunted affect, and excitement (Park et al., 2018). Similarly, when accounting for any degree of variability, conceptual disorganization, uncooperativeness, and excitement were shown to be independently associated (Park et al., 2018). Furthermore, results that were yielded from ROC curve analyses showed that scores from each of these scale (four) items, with their “defined optimum cut-off values,” accurately differentiated patients diagnosed with schizophrenia who exhibited disorganized speech from those who did not (Park et al., 2018, p. 118).

 

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders   (5th ed.). Arlington VA: American Psychiatric Publishing.

 

Leucht, S., Kane, J. M., Kissling, W., Hamann, J., Etschel, E., & Engel, R. (2005). Clinical implications of Brief Psychiatric Rating Scale scores. British Journal of Psychiatry,             187(4), 366-371. doi: 10.1192/bjp.187.4.366

 

Park, Y. C., Kanba, S., Chong, M. Y., Tripathi, A., Kallivayalil, R. A., Avasthi, A., Grover, S., Chee, K. Y., Tanra, A. J., Maramis, M. M., Yang, S. Y., Sartorius, N., Tan, C. H.,           Shinfuku, N., Park, S. C. (2018). To use the brief psychiatric rating scale to detect                  disorganized speech in schizophrenia: Findings from the REAP-AP study. Kaohsiung Journal of Medical Sciences, (34), 113-119. doi: 10.1016/j.kjms.2017.09.009

 

Shirreka Mackay, LPC
Practicum Student, Western State Hospital

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Friday Factoids: Mental Health and the Courts

  • In 1980, President Jimmy Carter signed the Mental Health Systems Act of 1980, which provided grants directly to community mental health centers. Though, it was short- lived.
  • Between 2009 and 2012, the US legislatures cut a total of nearly $4.5 billion in services for the mentally ill, even though patient intakes increased by nearly 10%.
  • 6 out of 10 states with the least access to mental health care also have the highest rates of incarceration.
  • 73% of women and 55% of men have at least one mental health problem in state prisons.
  • 61% of women and 44% of men have at least one mental health problem in federal prisons.

 

If you would like to read more about the mental health system in relation to the courts, here are some additional resources:

http://www.mentalhealthamerica.net/issues/access-mental-health-care-and-incarceration

https://www.pbs.org/newshour/health/numbers-mental-illness-behind-bars

https://www.theatlantic.com/politics/archive/2015/06/americas-largest-mental-hospital-is-a-jail/395012/

 

Hannah Sutherland, MA, LPA (Temp)
WKPIC Doctoral Intern

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Congratulations!!!

BREAKING NEWS: Dr. Danielle Smith has just been awarded her MS in Clinical Psychopharmacology!!!

Congratulations, Dr. Smith!!!

 

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Article Review: Mullen, P. E., Mackenzie, R., Ogloff, J. R.P., Pathé, M., McEwan, T., & Purcell, R. (2006). Assessing and managing the risks in the stalking situation.

February has become a time for romance and displays of love as many partners begin to look forward to Valentine’s Day to celebrate their feelings towards each other. However, there are certain groups of people who do not always take conventional routes in declaring their feelings for others. Instead, they undergo stalking which is a social problem that can have lasting consequences and psychological damage for both perpetrator and victim.

 

The level of distress is typically burdened by the individual who is stalked. Assessment and management of risk associated with stalking falls into three categories. First is determining if the stalking behavior continues or reoccurs if stopped. Second is to determine if the victim will suffer psychological or social damage such as suicidal behavior. Third is whether the stalking behavior will escalate to actual physical contact such as physical or sexual assault. Stalkers themselves shoulder their own risks in carrying out these behaviors. These risks include whether their preoccupation becomes socially and psychologically damaging, potential legal proceedings, and disapproval from peers.

 

Most stalking behavior lasts no more than two weeks. However, the longer it lasts the higher chance it will persist. Typical stalkers include ex-patients or clients, co-workers, ex-partners who are unable to accept a separation, or those with erotomanic delusions, in which one party believes the other is in love with them. Generally, those who do have erotomanic delusions are typically less likely to re-offend which is likely due to hospitalization and receiving of treatment.

 

A component of stalking is risk of threats and the potential for violence towards the victim. Those who are most at risk are individuals stalked by ex-partners. They hold the greatest likelihood of being physically assaulted. Although, the fear of violence is especially distressing and doubly true for individuals stalked by prior partners due to mixture of fears and prior intimacy. Previous convictions and substance use history, increase the risk of violence; whereas, psychotic illness diminishes risk of violence towards victims.

 

Risk management for stalking stems from a Stalking Risk Profile which has five domains. The first is the relationship between the stalker and the victim. There are various possibilities of arrangements of including prior partners, patients and health professionals, or just strangers encountered during day to day interactions. Motivation is the second domain which includes seeking reconciliation, revenge, a relationship, sexual relationship, or unknown. The third domain is consideration of the psychological, psychopathological, and social status of the stalker. Some of these factors include history of prior stalking, methods of stalking, and attitude towards the victim. Domain four is victim’s vulnerabilities such as nature of the relationship to the stalker and preexisting potential for depression or anxiety. Domain five is the legal and mental health context in that there is legal protection varying across jurisdictions, and clinicians need to be familiar with local laws to support victims and be aware of strategies available to the stalker.

 

The integration process involves first a needs analysis of known risks. Second is determining if imminent danger is present and if legal means should be used such as civil or criminal commitment of the stalker. Sharing the formulation of these factors is also important to aid in the treatment of the stalker or to improve the well-being of the victim to explain what drives the stalker. Stalking is a multifaceted issue which involves the determination of the physical and psychological damage that a stalker can inflict and what precautions can be taken to minimize this risk and support the victim through this time.

 

References:

Mullen, P. E., Mackenzie, R., Ogloff, J. R.P., Pathé, M., McEwan, T., & Purcell, R. (2006). Assessing and managing the risks in the stalking situation, Journal of American Academy of Psychiatry and the Law, 34, 439-450

 

Andrew Goebel, MS, LPA (Temp)
WKPIC Doctoral Intern

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Friday Factoids: Mental Health and the Court System

  1. In 1976, the Supreme Court ruled that prisons are Constitutionally required to provide adequate medical care to inmates in their custody, meaning that prisoners are the only group of Americans with a Constitutional right to health care.
  2. The first mental health law in the country was the National Mental Health Act of 1946, which established the National Institutes for Mental Health and provided research funding to the states.
    1. Prior to this act, 1854 was the last attempt for a federal mental health law, with a bill setting aside 10 million acres of public lands for mental health facilities being vetoed by President Franklin Pierce, who viewed it as an overreach of federal power.
  3. In 1963, reform efforts began to take place to decentralize American Mental Health Care, and attempt to reform the system of institutions in place.
    1. At the time, there were 800,000 patients in Mental Health Institutions across the country.
  4. The response was the Community Mental Health Act, which provided for $329 million dollars for Community Mental Health programs.
    1. However, this funding was only for brick and mortar facilities and did not include funding for personnel.
    2. In 1965, Congress created Medicaid, which barred federal insurance payments to people in “institutions of mental health.”
  5. As a result of the Community Mental Health Act and other federal legislation, by 1998, the number of people in state and county mental hospitals dropped to fewer than 60,000.

If you would like to read more about the mental health system in relation to the courts, here are some additional resources.

https://www.theatlantic.com/politics/archive/2015/06/americas-largest-mental-hospital-is-a-jail/395012/

 

Hannah Sutherland, MA, LPA (Temp)
WKPIC Doctoral Intern

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Friday Factoids: Did You Know . . . (Facts About Schizophrenia)

 

  • No one born blind has ever developed Schizophrenia.
  • Auditory hallucinations seem to be culturally shaped. In the U.S., AH of voices are often described as harsh and threatening, while those heard by individuals with the same diagnosis in Africa and India report the voices are more benign and playful.
  • The Soviet Union created a fake mental disorder called “Sluggish Schizophrenia” in the 1970s. It allowed anyone who criticized the leadership to be arrested.
  • Schizophrenia come from the Greek language and roughly translated means “split mind.” This does not imply an individual has a split personality, but rather a split from reality.
  • Schizophrenia is mentioned in literature dating as far back as the second millennium BC in the Egyptian text called The Book of Hearts.
  • Addiction to nicotine is the most common form of substance abuse in people diagnosed with Schizophrenia.
  • The cause of Schizophrenia is unknown. It is thought to be a combination of genetics, brain biology (including chemistry and structure) and environment.
  • Many individuals diagnosed with Schizophrenia experience anosognosia. This means “without knowledge” and refers to the fact that the person is unable to identify that they have a mental disorder. They often do not realize they have developed symptoms and may deny experiencing the symptoms.
  • Auditory hallucinations are more common than visual hallucinations.
  • When experiencing active psychosis, individuals diagnosed with Schizophrenia are often mistaken as being under the influence of a substance.

 

 

Crystal Henson, Psy.D.
WKPIC Instructor

 

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