SOS for Schizophrenia

May 19, 2003

A new program to increase the recognition and treatment of schizophrenia -- a frequently misunderstood mental illness -- was launched by the National Mental Health Association this week.

The program is called "SOS" or "Signs of Schizophrenia," and is funded by Janssen Pharmaceutica, a company that manufactures a drug used to treat the mental illness.

About 2.5 million people, or 1 out of every 100 in the U.S. has schizophrenia, a disease that most often strikes between the ages of 13 and 25. The warning signs can include a change in personality, withdrawal from social situations, deterioration in school or work performance, inability to sleep or concentrate, and irrational anger or fear towards family or friends.

People with schizophrenia may hear voices or see things that aren't there, feel as if they are being watched constantly, and may become extremely preoccupied with religion or the occult, according to the National Mental Health Association. A brochure on the signs and symptoms of schizophrenia can be obtained by calling the Association at 1-800-969-NMHA.

"Through SOS, we hope many people will learn what to look for and how to seek the treatment and services they need to recover from schizophrenia to the fullest extent possible," said Michael Faenza, president and CEO of the NMHA.

New studies suggest that the sooner a person gets treatment, the better. Treatments include antipsychotic medication and behavioral therapy to reduce stress -- which has a bigger impact on those with mental illness.

Clozapine is a highly effective drug for those who have not responded to other medication, according to the American Psychiatric Association, which recently released treatment guidelines for the mental illness according to a previous Reuters report. However, about 1% of people taking the drug have a potentially life-threatening drop in white blood cells count -- so patients need frequent blood tests to monitor for the condition.

Newer antipsychotic medications, such as olanzapine, sertindole, and quetiapine don't have that side effect or those associated with older drugs. Such side effects can include tremors, restlessness, and shuffling gait.

smoking has been shown to be a common "self medicating" drug for schizophrenics. Read the following article for details.

Smokers May Have Mental Health Problems

August 12,2003

Hard core smokers may be using nicotine to help manage psychiatric problems such as depression, anxiety, attention deficit-hyperactivity disorder (ADHD), and bulimia or binge-eating, says a researcher at the University of Michigan.

Her conclusion, based on a review of studies involving smokers, may help explain why it is so hard for some smokers to quit. The proposed solution: treat the psychiatric disorders first or along with smoking-cessation efforts.

"Many of those who have given up smoking in the past appear to have been the 'easy quits' or casual adult smokers," says Dr. Cynthia S. Pomerleau, a senior researcher with the Nicotine Research Laboratory at the University of Michigan's department of psychiatry, and Substance Abuse Research Center in Ann Arbor, Michigan.

Pomerleau says health professionals concerned with helping smokers with psychiatric "co-factors" quit nicotine "need to develop new kinds of smoking interventions tailored to the special needs of these difficult-to-treat, at-risk populations."

The researcher notes that smoking has declined among adults in the United States from about 40% in 1965 to less than 29% in 1990. Despite the decline, Pomerleau sees smoking rates leveling off at about 15% to 20% of the adult population.

"Nicotine produces temporary, small but reliable adjustments in a wide variety of cognitive and behavioral functions," she says. "Administered via smoking, nicotine quickly enters the brain where it affects neural regulators (neurotransmitters) such as norepinephrine, dopamine and serotonin, and can either sedate or stimulate depending on the timing, dosage, and other factors," the researcher explains.

Pomerleau points out that when smokers with co-factors such as depression or binge-eating try to quit, their psychiatric symptoms are worsened or "unmasked" by the absence of nicotine and can persist well beyond the usual two- to three-day nicotine withdrawal period. Consequently, they are more likely to relapse back to smoking than smokers with no psychiatric co-factors, she says.

The researcher points to a substantial accumulation of research to support her conclusions, including:

1. a 1986 comparison study of psychiatric patients and non-psychiatric outpatients in which 47% of patients with anxiety disorder and 49% of those with a major depressive disorder smoked, compared with 30% of non-psychiatric outpatients.
2. a 1994 study conducted by Pomerleau and her colleagues found that 42% of men and 38% of women diagnosed with ADHD were current smokers -- nearly twice the rate in the general population. Also the "quit ratio" was 29% for ADHD patients who had ever smoked compared with 48% in the general population.
3. a 1991 study of young adults in which the rate of nicotine dependence was twice as high in adults with any anxiety disorder, three times as high in individuals with major depression, and more than four times as high among those with the two disorders combined.
4. a 1992 study of women entering college in which less than 10% of non-dieters and casual dieters smoked, compared with almost 20% who reported eating behaviors typical of bulimia. Similarly, a 1986 study of 10th grade females found 28% of bulimics and 32% of food "purgers" smoked regularly, compared with 18% of girls without eating disorders.

Pomerleau concludes that health professionals helping smokers with co-factors quit smoking may have to treat the depression, anxiety, ADHD, or binge-eating behaviors first or simultaneously.

"A 1995 study found that Prozac helped smokers with depression to quit, but it had no effect on smokers who were not depressed," she says.

"It is possible that some of these patients (with co-factors) wouldn't need nicotine replacement treatment once they received appropriate medications or psychotherapy for their underlying conditions," she adds.

Nicotine replacement products -- such as nicotine patches, inhalers, nasal sprays, or gum -- may in fact be useful in the treatment of ADHD and other diseases such as Parkinson's and Alzheimer's disease, says Pomerleau, but more research is needed. "We need more data on the possible toxic effects of nicotine to weigh against its possible therapeutic effects."

And recent studies in twins suggest that there may be a genetic component to smoking, perhaps influencing the age at which people start smoking, the amount smoked, and the likelihood of quitting.

"It may be that some families are predisposed to both smoking and depression," says Pomerleau. "There also is good evidence of assortative mating in smokers -- the tendency to find each other, marry and have children, with the nature and severity of problems experienced by smokers with co-factors being magnified in succeeding generations. Prevention efforts and early identification and treatment of the co-factor itself may be needed in these children."

Caring for mentally ill impacts health

August 19, 2003

NEW YORK, Aug 19 (Reuters) -- Caring for a family member with schizophrenia can take a serious toll on the mental health of caregivers, according to a survey conducted by the market research company, Consumer Health Sciences (CHS), and the National Mental Health Association (NMHA).

More than half of the 1,328 caregivers surveyed said that fears that their schizophrenic charges might engage in drug abuse, violent behavior, or make suicide threats, caused them constant anxiety. And nearly one-third said that caring for a loved one with schizophrenia caused them "extreme hardship."

According to Consumer Health Services, the survey showed that "the mental health of many family caregivers borders dangerously close to clinical depression due to the stressful demands of treating and living with a person suffering from schizophrenia."

"Primary caregivers need a lot of support, education, and care themselves in order to cope with the impact of the disease on the loved one they are providing care to," said Dr. Laura Young, the NMHA's Senior Director of Adult Mental Health, in an interview with Reuters Health.

The shift toward deinstitutionalization in recent years makes this need especially urgent, said Young. "People have been discharged from institutions without there being enough community-based services to provide the kind of support they need. The real burden of providing care falls on family members."

Nearly 80% of the caregivers surveyed said they play "an extremely important role in the treatment of the person for whom they care." And an equal number say "healthcare professionals do not understand the problems they face in caring for a person with mental illness," according to the CHS and NMHA press statement.

Characterized by confused thinking, social isolation and hallucinations, schizophrenia affects nearly 2.7 million Americans. Symptoms tend to appear in late-teens and early 20s and are often misdiagnosed.

The new generation of antipsychotic drugs used to treat schizophrenia -- including clozapine, olanzapine, and risperidone -- have fewer debilitating side effects than older drugs, but while medications help symptoms, they cannot completely normalize the life of a person with schizophrenia.

"The reality is there are a lot of wonderful new medications that can help people with schizophrenia live productive and independent lives in the community," said Young. "But they still need support to keep them on target, to help them remember to take their medication, and to get them involved in rehabilitation programs. That responsibility still falls on family members or primary care providers."

"I think as a culture we need to provide support for those people who are doing that primary care giving," Young added.

The promotion of the survey findings was sponsored by Novartis Pharmaceuticals Corporation.