Community-based mental health services can improve outcomes in people with mental health diagnoses, several studies have found. Deinstitutionalization—the push to keep people out of long-term mental health institutions—increasingly means people with mental health conditions are living in their communities rather than treatment facilities. The Olmstead decision, a United States Supreme Court ruling on mental health treatment, enshrined the right to the least restrictive treatment available.

The number of available psychiatric beds dropped from 558,922 in 1995 to 37,679 in 2016. This is good news for those with mental health conditions, most of whom lead more fulfilling lives in their communities than in institutions. Inadequate funding for outpatient, community-based resources, however, has driven the number of homeless people with mental health diagnoses to more than 100,000.

When available and funded, court-ordered treatment programs—known as assisted outpatient treatment (AOT)—can help integrate people with mental health conditions back into their communities. The 21^st Century Cures Act, which former President Barack Obama signed into law in December 2016, includes additional funding for AOT. Research in several states points to the efficacy of these programs. In New York, for example, researchers looked at more than 3,000 people with access to AOT. AOT reduced mental health hospitalizations by 77% and homelessness by 74%.

Stop Smoking Services May Boost Mental Health of People With Depression

[fat_widget_right]Smoking cessation services may improve overall mental health, according to a study published in the journal Annals of Behavioural Medicine. Researchers found 66.3% of smokers who had moderate to severe depression when they used quit-smoking services experienced no symptoms a year later.

Good Outcomes With ‘Telepsychiatry’ in Medical Treatment of Opioid Use Disorder

Telepsychiatry, which offers remote therapeutic services via video conferencing, may be a good option for people with an addiction to opioids. According to a study published in the Journal of Addiction Medicine, for people using buprenorphine to treat their addiction, telepsychiatry offered similar results to in-person therapy. Participants in the telepsychiatry group were more likely to live in rural areas, making telepsychiatry a more accessible option.

Nicotine May Help Schizophrenia, Study Finds

According to a study published in Nature Medicine, nicotine may treat hypofrontality, one of the symptoms of schizophrenia. Hypofrontality denotes low activity in the prefrontal cortex during cognitive tasks. This leads to cognitive issues in people with schizophrenia. When exposed to nicotine, the prefrontal cortex of people with schizophrenia appears to work better. Smoking, which releases nicotine to the brain, is more prevalent among people with schizophrenia. One study estimated 88% of people with the diagnosis smoke.

Phyllis Harrison-Ross, Mental Health Pioneer, Dies at 80

Phyllis Harrison-Ross, who pioneered mental health treatments for children with disabilities, died of lung cancer January 16. Many public schools use Harrison-Ross’s programs, which were designed to keep children with disabilities out of institutional settings.

Trapped by the Game: Why Professional Footballers Don’t Talk About Their Mental Health

According to interviews with seven male football players, footballers do not feel safe discussing mental health issues. The interviews point to struggle as a common theme among players. They viewed the football field as a battlefield where they felt they had to struggle to “survive.” Shame and stigma often kept them from expressing any sense of vulnerability or emotional difficulties. Many also found it hard to integrate into the real world after careers in professional football.

Schizophrenia is a chronic, severe mental health condition thought to result from some combination of genetic and environmental factors. Imbalances in brain chemicals, such as dopamine and glutamate, also seem to play a role in schizophrenia.

Schizophrenia is diagnosed both by “positive” symptoms—among them hallucinations, delusions, and other disordered thinking—as well as “negative” symptoms such as reduced expression of emotion and speaking less. People who have this condition also may experience difficulties with cognitive functions such as decision making, planning, paying attention, and working memory.

There has been a great deal of talk about the role of gut flora, also known as the “microbiome,” and mental health. It may sound surprising, but severity of symptoms in depression, anxiety, autism, and now schizophrenia have been linked to imbalances in the gastrointestinal (GI) tract. More recent research has suggested a relationship between activity of the immune system, increased inflammation, the presence of food sensitivities, and imbalances in the GI tract in the presentation of schizophrenia.

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What’s the Gut Got to Do with It?

During the normal birth process, our GI tracts are populated with “good” bacteria (by moving down the mother’s vaginal canal). This, our diets, stress levels, and other factors subsequently affect our gut bacteria and our overall health, as well as our brain development.

Gut bacteria help regulate proteins and other substances that influence the brain’s development. One substance, “brain-derived neurotrophic factor” or BDNF, impacts the brain’s ability to develop new neurons and remain adaptable (referred to as neuroplasticity).

Our gut environment also appears to affect receptors in our brains. Receptors may be thought of as the equivalent of a keyhole on the surface of a neuron. Brain chemicals are like the “keys” that are designed to fit in a specific type of receptor. Once such type of receptor, the NMDA, is a type of glutamate receptor involved in, among other things, plasticity (or adaptability) of neurons related to memory and other functions. An unbalanced microbiome (gut bacteria, or flora) can lead to under-functioning NMDA receptors and variations in BDNF that may contribute to the production of schizophrenia symptoms.

Structural damage to the GI tract in people with schizophrenia has been linked to developing antibodies to brain cells in the hippocampus, amygdala, and frontal cortex. These brain areas are involved in working memory, emotion, motivation, decision making, and logical thinking—all of which may be impaired in people with schizophrenia.

Dr. Kaitlyn Nemani and colleagues reviewed the literature on the role of the gut in schizophrenia. Their review found that imbalances in the microbiome may be linked to structural damage in the gut, inflammation, and the development of autoimmune disorders. People who have schizophrenia, as well as their relatives, have been found to have a greater incidence of autoimmune disorders than people who either do not have or are not related to someone with schizophrenia.

In addition, structural damage to the GI tract in people with schizophrenia has been linked to developing antibodies to brain cells in the hippocampus, amygdala, and prefrontal cortex. These brain areas are involved in working memory, emotion, motivation, decision making, and logical thinking—all of which may be impaired in people with schizophrenia.

Gut flora imbalances may also play a role in increased sensitivity to gluten (a protein found in grains) and casein, which is the main protein found in milk and milk products. A growing body of research has found a relationship between gluten sensitivity that is not due to celiac disease and symptoms of both schizophrenia and autism.

Finally, imbalances in gut flora are linked to obesity and insulin resistance, both of which are linked to diabetes. People who have schizophrenia have an increased risk for these types of metabolic imbalances, and antipsychotic medication can further induce weight gain that can lead to metabolic problems and diabetes.

Novel Therapies to Balance the Gut

Dr. Nemani and colleagues suggest some nontraditional therapies that may complement existing medication and psychotherapy approaches for treating schizophrenia. These include:

1. Dietary changes. Although the evidence has been mixed, there is some data and also anecdotal reports suggesting that a subset of people who have schizophrenia benefit from avoiding gluten-containing foods (i.e., wheat, rye, barley, and other grains). Data regarding the impact of a casein-free diet on schizophrenia symptoms are lacking, but if your current treatment regimen provides insufficient relief, or you have GI symptoms that appear to worsen after consuming dairy, it may be worth going dairy-free for a few weeks to see if this improves your symptoms.
2. Antimicrobials. Minocycline (a form of tetracycline) is under investigation as an adjunct treatment in people with schizophrenia. It is thought to reduce inflammation and enhance glutamate neurotransmission.
3. Probiotics. Probiotics, or supplements containing “good bacteria,” may help balance gut flora and have been shown to positively impact mood, digestion, immunity, and weight. There does not appear to be risk associated with taking probiotics.

The last type of novel therapy discussed by the authors is fecal transplantation, or transplanting the fecal bacteria from someone with a healthy microbiome to a person who has a gut imbalance. Although this is considered a cutting-edge GI treatment for those who have inflammatory bowel disease, the authors conclude that a better understanding of the microbiome in those with schizophrenia is needed to know if this therapy is warranted.

As always, consult with your medical team when considering new therapies, conventional or complementary, such as those described above.

References:

1. Celiac Disease Foundation. (n.d.). Sources of Gluten. Retrieved from https://celiac.org/live-gluten-free/glutenfreediet/sources-of-gluten/
2. National Institute of Mental Health. (2016). Schizophrenia. Retrieved from http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml
3. Nemani, K., Ghomi, R. H., McCormick, B., & Fan, X. (2015). Schizophrenia and the gut-brain axis. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 56, 155-160.

For those dwelling in climates prone to the dark, chilly days of fall and winter, it is widely understood that along with changes in the natural world, seasonal shifts in mood and temperament are also likely to occur. These shifts may be more drastic and debilitating for some than for others, and when seasonally induced woes weigh too heavily on a person, he or she may be diagnosed with conditions like depression or seasonal affective disorder (SAD). While such diagnoses have become quite common, people are just recognizing consensus among researchers that a person’s season of birth appears to increase the chances that a person will develop these or other mental health conditions.

Typically, a person’s birthdate is given astrological significance in the form of a zodiac sign, but not necessarily predictive powers when it comes to psychological well-being. There was a time not so long ago when the study of astrology was considered to be of scholarly and scientific value in treating physical maladies, but few modern-day doctors still refer to the celestial bodies when determining diagnoses and treatment conditions (Wolfson, 2013). However, a connection between season of birth and certain mental health conditions has been observed by a number of researchers in recent years. The primary finding of this vein of research is that being born in the fall, winter, and spring increases the chances of mental and emotional instability.

The most widely researched correlation is the heightened likelihood of developing schizophrenia if a person is born in the darker, colder months of the year—winter, primarily. Over 200 studies have confirmed this correlation since 1929 (Wolfson, 2013), including one study which revealed that being born in the Northern Hemisphere in either winter or spring may increase the tendency toward schizophrenic symptoms (Davies, Welham, Chant, Fuller Torrey, and McGrath, 2003).

In this particular study, researchers compared winter/spring versus summer/autumn births using data from eight preexisting studies of 126,196 people who had been diagnosed with schizophrenia and 86,605,807 “general population births.” The subjects were located in 27 sites across the Northern Hemisphere, and the positive correlation between schizophrenia and winter/springtime birth as well as latitude-based weather conditions was reported as “small but significant” (Davies et al., 2003).

Further studies reveal that a similar connection exists between season of birth and SAD. Pjrek et al. (2004) discovered a notable link with being born in the fall and winter and experiencing “melancholic depression” during those times of year as an adult. This finding inspired additional research that explored and confirmed the apparent correlation of SAD and season of birth (Pjrek et al., 2007).

Yet another study conducted in England examined the correlation between season of birth and schizophrenia, bipolar, and recurrent depression in “the largest cohort of English patients collected to date” (Disanto et al., 2012). Once again, they found that those born during darker days and colder temperatures were more likely to develop these conditions later in life. Specifically, cases of schizophrenia and bipolar were found to be at their peak in those born in January, and at their lowest rate of occurrence in July, August, and September births. A slight deviation from the fall-winter-early spring correlation was their discovery that those born in May appeared to be particularly susceptible to recurrent episodes of depression.

Overall, the message seems to be that a large portion of the population is primed to experience what are commonly known as mood disorders from birth; ultimately, the only ones who are not at a high inborn risk of developing these conditions are those whose birthdays are in the sunshine-rich summer months. This has led some researchers in England to theorize that vitamin D deficiency—whether in the biological mother or in the child after birth—factors in to these findings (Disanto et al., 2012). So the explanation for this phenomenon could be as simple as less exposure to sunlight depriving a person of sunnier brain chemistry from birth. These same researchers also posit that environmental exposure to viral or bacterial strains on the part of the mother during these times of year may play a part in their children’s psychological development.

Another widely held theory, shared by neuroscientist Chris Ciarleglio in a recent article published in The Atlantic, suggests that “developing in a certain season seems to imprint your circadian clock,” which is known to have a strong influence on mental and emotional well-being (Wolfson, 2013; Foster and Roenneberg, 2008).

Of course, it remains to be fully understood how much of our mood-related makeup and behavior is hardwired at birth, and how much of it is determined by outside factors like family, childhood experiences, education, and financial lack or privilege. Regardless, the findings of these studies spark intriguing inquiries regarding what, exactly, it means to experience depression, schizophrenic hallucinations, and swings in emotional state characteristic of bipolar—plus how much can or should be done to prevent these conditions if they are, in fact, imprinted at birth.

References:

1. Davies, G., Welham, J., Chant, D., Fuller Torrey, E., and McGrath, J. (2003). A systematic review and meta-analysis of Northern Hemisphere season of birth studies in schizophrenia. Schizophrenia Bulletin, 29(3), 587-593. Retrieved from  http://schizophreniabulletin.oxfordjournals.org/content/29/3/587.full.pdf
2. Disanto, G., Morahan, J. M., Lacey, M. V., DeLuca, G. C., Giovannoni, G., Ebers, G. C., Ramagopalan, S. V. (2012, April 4). Seasonal distribution of psychiatric births in England. PLOS One. doi: 10.1371/journal.pone.0034866. Retrieved from http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0034866
3. Foster, R. G., and Roenneberg, T. (2008, September 9). Human responses to the geophysical daily, annual, and lunar cycles. Current Biology, 18(17), R784-R794. doi: 10.1016/j.cub.2008.07.003. Abstract retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18786384
4. Pjrek, E., Winkler, D., Praschak-Rieder, N., Willeit, M., Stastny, J., Konstantinidis, A., and Kasper, S. (2004, October). Seasonality of birth in seasonal affective disorder. Journal of Clinical Psychiatry, 65(10), 1389-1393. Abstract retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15491243
5. Pjrek, E., Winkler, D., Praschak-Rieder, N., Willeit, M., Stastny, J., Konstantinidis, A., and Kasper, S. (2007, October). Season of birth in siblings of patients with seasonal affective disorder. A test of the parental conception habits hypothesis. European Archives of Psychiatry and Clinical Neuroscience, 257(7), 358-382. Abstract retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17902009
6. Wolfson, E. (2013, November 15). Your zodiac sign, your health. The Atlantic. Retrieved from http://www.theatlantic.com/health/archive/2013/11/your-zodiac-sign-your-health/281358/

Schizophrenia is often found in families with high rates of psychological illness. When one member of a family has schizophrenia, the chances of other members developing psychological problems, including schizophrenia and psychosis, increase. Some of the factors that are considered when analyzing risk for illness are family history, life stressors, trauma, and IQ. Each of these had a unique relationship with risk and schizophrenia.

In a recent study, Kim W. Verweij of the Department of Psychiatry at the University Medical Centre Utrecht in the Netherlands sought to explore the influence and evidence of IQ in families with schizophrenia. Using a sample 696 individuals with schizophrenia and their siblings (766), Verweij compared IQ scores to those of 517 individuals with no history of schizophrenia or psychiatric issues. Researchers collected data from all participants without schizophrenia and scored them separately. Those with schizophrenia also completed IQ tests and their results were analyzed independently.

The results showed that siblings of those with schizophrenia only had elevated IQs if they themselves had any history of mental health issues, or if other members of their family did. Those siblings who did not have a family history, excluding the member with schizophrenia, had average IQs compared to siblings with a robust family history. Verweij also found that the individuals with schizophrenia, who also had a family member with mental health issues, had higher IQ scores than the individuals with schizophrenia and no family history.

Verweij believes that this suggests a high familial influence on psychiatric impairment in the participants with family illness, while those without may be more influenced by external and variable factors, such as trauma, premature birth, or other stressors. Not only do these factors create a ripe environment for psychological impairment, but they also increase vulnerability for intellectual and cognitive disability.

This study provides much needed insight into the unique association between IQ and genetic predisposition for schizophrenia. Verweij added, “Since the association between IQ scores and family history of psychiatric disorder in siblings is not extensively investigated, more research is needed to further address this question.”

Reference:
Verweij, K.H.W., Derks, E.M., Genetic Risk and Outcome in Psychosis (GROUP) investigators (2013). The association between intelligence scores and family history of psychiatric disorder in schizophrenia patients, their siblings and healthy controls. PLoS ONE 8(10): e77215. doi:10.1371/journal.pone.0077215

What does it mean to hear voices? Is someone who hears voices and sees visions necessarily schizophrenic, or could these hallucinations, as they are commonly called, simply be another of the myriad ways the human psyche responds to traumatic life experiences?

Groups like Intervoice, which is also known as The International Network for Training, Education, and Research into Hearing Voices, are devoted to raising awareness of what it means to hear voices–an experience that is far more common than most people believe.

And yet, despite increased global consciousness regarding voices and visions, the fact remains that the majority of individuals who show up in psychiatrists’ offices saying they hear and see things that no one else sees or hears are likely to receive a diagnosis of schizophrenia. Unfortunately, this often leads to long periods of psychiatric care that may cause further damage to these individuals’ psyches.

A Personal Account: Eleanor Longden’s Story

In a TED TalentSearch video published on July 5, 2012, Eleanor Longden, a woman who was diagnosed with schizophrenia at 17 years old, shares her lifelong struggle to understand and make peace with the voices in her head. Longden, who is now a published academic author with a master’s degree in psychology, says her experience of hearing a “disembodied voice” as a teenager quickly led to hospital admittance and receiving the diagnoses of schizophrenia.

Being labeled mentally ill in the eyes of healthcare professionals took its toll on her self-image; additionally, she says, “[H]aving been encouraged to see the voice not as an experience, but as a symptom, my fear and resistance towards it intensified.”

This, in turn, propelled her to take an “aggressive stance” against her mind, which she believes contributed to an increased cacophony of voices resounding in her head. The voices eventually morphed into visual hallucinations of a “bizarre” and “grotesque” nature. At one point, she says she felt “so tormented by my voices that I attempted to drill a hole in my head in order to get them out.”

Ultimately, Longden said that when her perspective began to shift regarding her chances of recovery thanks to the help of the “good and generous people” who believed in her, she discovered what she had always suspected: “My voices were a meaningful response to painful life events, particularly childhood events, and as such, were not my enemies, but . . . insights into solvable emotional problems.” This realization gave her the strength to gather the fractured pieces of her “splintered self” and eventually, to apply her personal experience to her studies in advanced psychology. She now believes, “An important question in psychiatry shouldn’t be, ‘What’s wrong with you?’ but rather, ‘What happened to you?’”

Aside from being a survivor of a harrowing battle with what was diagnosed as schizophrenia, Longden is now part of Intervoice, which she describes as seeking to establish “voice hearing as a creative and ingenious survival strategy; a sane reaction to insane circumstances—not as an abstract symptom of illness to be endured, but as a complex, significant, and meaningful experience to be explored.”

Stories to Tell: The Significance of Hearing Voices

In 1997, a meeting of mental health professionals and voice hearers in Maastricht, one of the oldest cities in the Netherlands, led to the creation of Intervoice. The earlier hearing voices groups that paved the way for Intervoice to become what it is today were inspired in the late 1980s by the work of Marius Romme, MD, PhD, and Sandra Escher, PhD, at the University of Maastricht.

Originally, according to the Intervoice website (www.intervoiceonline.org), Dr. Romme did not believe that his clients who reported hearing voices were actually hearing them. Like many psychiatrists, “[H]e had always dismissed voices as being part of the delusional and hallucinatory world of the psychiatrically ill.”

Now, however, Romme states in his personal message to those who visit the Intervoice site, “There are many fears and misunderstandings in society and within psychiatry about hearing voices. They are generally regarded as a symptom of illness, something that is negative, to be got rid of and consequently the content and meaning of the voice experience is rarely discussed.”

This is an important point to consider, seeing as the most common mode of treatment for people diagnosed with schizophrenia is psychotropic medication. In fact, a recent GfK study revealed that 45%, nearly half, of those handed prescriptions to cope with their voices and visions do not follow their doctors’ drug orders. For the past 17 years, GfK researchers in the field of psychiatry have conducted this study, and the rate of noncompliance has ranged from 41% to 46% since 2009.

The most common reasons for noncompliance cited by prescribing psychiatrists are “dislike of medication, concern about side effects, and denial of illness.” The unpleasant side effects reported by 71% of psychiatrists in the 2013 study were drowsiness, weight gain, and extra-pyramidal symptoms (EPS) such as tremors, stiffness, and severe restlessness (Stanton 2013). The primary assumption on the part of researchers and psychiatrists is that there must be something wrong with the medications. But it’s possible that the people who refuse to take these pills or who do not take them as directed are onto something with their “denial of illness.”

In light of the movement to raise awareness about voices, visions, and extra sensory perceptions as a globally shared aspect of the human experience, one has to wonder whether the core issue is more likely to be overdiagnosis or misdiagnosis—potentialities that have stirred much discourse and debate, particularly with regard to African-Americans (De Coux Hampton 2007; Helwick 2012; Vedantam 2005).

In Eleanor Longden’s experience, psychiatric care left her feeling hopelessly flawed and ultimately defeated. True healing came when she realized, with the help of professional counselors and loved ones, that each of the voices she was hearing represented a piece of her fractured psyche, and each fragment had a story to tell. Acknowledging these stories, she says, was essential to her recovery—and she is not alone in this conclusion.

According to research conducted by Romme and Escher with over 300 voice hearers, “70% of people who hear voices can point to a traumatic life event that triggered their voices,” and “talking about voices and what they mean is a very effective way to reduce anxiety and isolation; even when the voices are overwhelming and seemingly destructive, they often have an important message for the hearer.” Of course, it is important to go through the process of listening to voices under the guidance of a licensed professional. Especially in the early stages, it may be difficult to decipher their true meaning without help.

An International Movement to Manifest Change

To spark further conversation and exploration, Intervoice, Voices Vic, and Hearing Voices Network Australia are organizing this year’s World Hearing Voices Congress (www.hearingvoices2013.org), an annual gathering of voice hearers, mental health professionals, students, researchers, and anyone else who wishes to deepen their understanding of what it means to hear voices. The 2013 event, “Hearing Voices: Journeys to Understanding,” is being held from November 20 to 22 in Melbourne, Australia.

Additionally, on their “National Networks” page, Intervoice provides listings of hearing voices communities in 22 countries across the globe. The few options listed in the United States are in Denver, Colorado; Holyoke, Massachusetts; and Portland, Oregon. However, the Hearing Voices Network USA (www.hearingvoicesusa.org), based in Madison, Wisconsin, also provides a search tool for U.S. groups, and reveals additional hearing voices support groups in Arizona, Colorado, Idaho, Illinois, Massachusetts, Michigan, New Jersey, New York, Oregon, Pennsylvania, and Vermont.

Thanks to groups such as these, those who do not wish to accept the widely held notion that they are “disordered” or “mentally ill” because of their voices, visions, and extra sensory perceptions can find kinship with people all over the world. And the more individuals like Eleanor Longden who stand up and share their stories, the more likely the possibility is for real change in the mental health field regarding this fascinating facet of the human experience.

References:

1. DeCoux Hampton, M. (2007, December). The role of treatment setting and high acuity in the overdiagnosis of schizophrenia in African Americans. Archives of Psychiatric Nursing, Vol. 21, Issue 6. 327-335.
2. Helwick, C. (2012, July 31). Schizophrenia may be overdiagnosed in black patients. Medscape Medical News. Retrieved from http://www.medscape.com/viewarticle/768391
3. Longden, Eleanor. (2012, July 5). Learning from the voices in my head. TED TalentSearch . Retrieved from https://www.youtube.com/watch?v=AgZHOSxN5cE
4. Romme, M. Welcome message from Prof Marius Romme. Intervoice: The International Hearing Voices Network. Retrieved from http://www.intervoiceonline.org/about-intervoice/welcome-message-from-prof-marius-romme
5. Stanton, D. (2013, October 14). New GFK study finds 45% of schizophrenia patients do not comply with doctors’ prescribing instructions [GfK Press Release]. Retrieved from http://www.gfk.com/us/news-and-events/press-room/press-releases/pages/new-gfk-study-finds-45-of-schizophrenia-patients-do-not-comply-with-doctors-prescribing-instructions-.aspx
6. Vedantam, S. (2005, June 28). Racial disparities found in pinpointing mental illness. The Washington Post. Retrieved from http://www.washingtonpost.com/wp-dyn/content/article/2005/06/27/AR2005062701496.html

Schizophrenia is often diagnosed after someone has a psychotic episode. When someone who has had a psychotic episode initially seeks treatment, however, he or she may have had a prolonged duration of untreated psychosis (DUP). This period of time has been theorized to significantly impact later symptom severity and even progression, prognosis, and outcome.

Surprisingly, even though this theory has been introduced and explored, few studies have looked at the relationship between DUP and symptoms via a long-term follow-up. Therefore, Dr. Wing Chung Chang of the Department of Psychiatry at the University of Hong Kong in China recently led a study examining the long-term effects of DUP on executive function in a sample of 93 adults with schizophrenia.

The participants ranged in age between 18 and 55, and were evaluated extensively when they first presented for treatment for psychosis. They were followed up with several other assessments over the course of the next three years. Chang measured executive functions and looked at various aspects of cognitive function and memory.

The results revealed that when compared to nonpsychotic control participants, the participants with psychosis had large deficits in areas of memory. Chang found that visual memory was especially impaired in the participants with psychosis and that verbal memory continued to experience deficits over the three-year period. Additionally, the length of DUP was directly predictive of symptom severity and outcome at three years.

Chang believes this study supports other research that demonstrates a link between DUP and illness outcome. The longer an individual experiences psychosis, the more likely they are to have a worse illness trajectory, more severe symptoms, and more impairment to cognitive capacities. Chang said, “Our findings provided further supportive evidence that delayed treatment to first-episode psychosis is associated with poorer cognitive and clinical outcomes.”

In sum, this study extends existing research into this topic by demonstrating the long-term negative effects of psychosis on cognitive function, especially verbal memory. Future work could fortify this area of research by extending the study duration even further and by examining particular shifts in cognitive deficits and how they relate to DUP.

Reference:
Chang, W. C., et al. (2013). Impacts of duration of untreated psychosis on cognition and negative symptoms in first-episode schizophrenia: A 3-year prospective follow-up study. Psychological Medicine 43.9 (2013): 1883-93. ProQuest. Web.

The number of incarcerated individuals with mental health issues is disproportionately high. Not all people who commit an offense have psychological problems, but those that do often go without care prior to being introduced to the criminal justice system. Having a better understanding of the relationship between offending and mental health issues could help in the development of interventions and identification measures aimed at those most at risk for mental health issues and criminal offense behaviors.

To capture a more accurate picture of the prevalence of psychological problems among offenders, Vera A. Morgan of the School of Psychiatry and Clinical Neurosciences at the University of Western Australia recently led a study that analyzed data from a birth cohort spanning 15 years.

Morgan found that of those who were born during that time, over 116,000 had been arrested and over 40,000 had been registered as receiving psychiatric care. Of those who received psychiatric care, 32.1% were in the criminal justice system. The most common psychological issues in this group were substance abuse and schizophrenia. A combination of these two significantly increased the likelihood of being arrested.

When Morgan looked solely at arrest records, she found that over 11% had a psychological issue, 6.5% had substance abuse issues, and almost 2% had a diagnosis of schizophrenia. When she looked at other mental health issues, Morgan found that personality issues accounted for 35.9% of arrests, and 29.2% of all arrests were among people with psychological conditions other than substance misuse, schizophrenia, or personality issues. For many, being arrested led to their first contact with mental health services.

“Given a growing proportion of schizophrenia offenders being arrested prior to their first contact with psychiatric services, there are important implications for mental health and criminal justice policy and practice,” said Morgan. The development of programs designed to identify mental health issues prior to entering or at the threshold of the doorway into the criminal justice system should be explored in future work. Doing so has the potential to reach individuals most in need of mental health care and also to decrease the risk of offending by those with mental health issues, and in particular, substance abuse and schizophrenia.

Reference:
Morgan, V. A., et al. (2013). A whole-of-population study of the prevalence and patterns of criminal offending in people with schizophrenia and other mental illness. Psychological Medicine 43.9 (2013): 1869-80. ProQuest. Web.

How an individual perceives time affects how they plan for a particular action and what behaviors and steps they will take to complete that action. Research on time deficits and impairments in time perception has suggested that people with mental illness and psychosis may have a disrupted and distorted sense of time.

In particular, the research on schizophrenia has proposed that time processing deficits can lead to confusion, hallucinations, and delusions. The existing data on time processing and schizophrenia points to a disrupted internal clock which causes individuals to overestimate and underestimate time in certain tasks. However, to date there is little evidence linking symptom severity and time alteration in people with schizophrenia.

To add to the existing literature on time processing impairments and to further explore how symptoms severity may impact any time deficits, Jutta Peterburs of the Institute of Medical Psychology Systems Neuroscience at the University of Muenster in Germany recently led a study involving 22 individuals with schizophrenia and 22 without. The participants were instructed to estimate the time it would take for certain stimuli to reach targets. The tasks were designed to be of varying levels of cognitive demand so that Peterburs could determine if cognitive load was a factor in time processing impairment.

The results revealed that the participants with schizophrenia underestimated the time it would take for the stimuli to reach the targets. Those with more severe symptoms had the highest level of time processing impairment, especially on the most cognitively demanding tests. Peterburs believes that these findings clearly demonstrate a link between symptom severity and both predictive and anticipatory time perception in schizophrenia. This deficit is further exacerbated by symptom severity and difficulty of task.

Other factors may influence these findings, such as medication, age, gender, and length of illness. However, Peterburs did not isolate any of those factors. Future studies will have to investigate to what extent temporal processing in schizophrenia is modulated by antipsychotic medication,” added Peterburs. More specifically, future work should look at how antipsychotic medication influences the internal clock and dopaminergic dysregulation, a process that influences time perception. Until then, the findings presented here offer more support for impairment in time processing that could have a cause and effect influence on symptoms of schizophrenia.

Reference:
Peterburs, J., Nitsch, A.M., Miltner, W.H.R., Straube, T. (2013). Impaired representation of time in schizophrenia is linked to positive symptoms and cognitive demand. PLoS ONE 8(6): e67615. doi:10.1371/journal.pone.0067615

One of the first signs of schizophrenia is a psychotic episode. Symptoms of psychosis can appear weeks, months, or even years before a psychotic episode requiring medical attention. Because psychotic symptoms can appear suddenly or more subtly, the duration of untreated psychosis (DUP) varies from individual to individual. Likewise, the acute onset or subtle onset of symptoms can also impact whether symptoms become severe (SC) or persist as less severe (NonSC). Schizophrenia can be difficult to treat, but many people who receive care for symptoms are able to achieve remission within the first few months. However, relapse is not uncommon and estimates point to a nearly 75% relapse rate within the first five years of treatment.

Nobuhiso Kanahara of the Department of Psychiatry at the Graduate School of Medicine at Chiba University in Japan wanted to explore how symptom severity, DUP, and mode of onset (MoO) of symptoms, either subtle or acute, affect long-term illness prognosis. To do this, Kanahara conducted a 10-year study involving several hundred participants treated for psychosis at a psychiatric hospital. The participants were assessed at initial intake for symptom severity, MoO and DUP. These factors were evaluated and measured against treatment outcomes and future diagnoses of schizophrenia.

The results revealed that although the DUP did not differ significantly between participants with SC and NonSC participants, those with acute onset had much shorter DUPs than those with more subtle MoOs. Further, those with subtle MoO, although they did not have more severe symptoms than acute MoO participants, did have poorer overall global functioning in the long-term. In other words, the subtle MoO participants had both longer DUPs and poorer illness prognoses than those with acute MoO.

Kanahara believes that acute and sudden psychosis can lead to more prompt medical attention and therefore, better treatment outcome. Individuals with more insidious MoO, on the other hand, may have symptoms that go unnoticed for a long period of time. In fact, in this study, the DUP for MoO was over three years at its longest, suggesting a chronic psychotic state than can lead to poorer overall outcomes.

Kanahara said, “Taken together, these results indicate that the initial positive symptoms do not act definitively as a prognosis predictor.” However, DUP and MoO appear to be strong indicators of overall illness outcome and therefore, should be examined more closely in clinical assessments and trials.

Reference:
Kanahara, N., Yoshida, T., Oda, Y., Yamanaka, H., Moriyama, T., et al. (2013). Onset pattern and long-term prognosis in schizophrenia: 10-year longitudinal follow-up study. PLoS ONE 8(6): e67273. doi:10.1371/journal.pone.0067273

There are several unique symptoms that occur in psychosis and schizophrenia. People with these psychological problems often report being hypersensitive to sounds and scenes. Their cognitive resources become distracted and aroused by seemingly mundane background noise and they have difficulty focusing on visual cues and performing relatively easy cognitive tasks as a result. This aspect of schizophrenia has just now begun to be explored in depth. In an effort to extend the existing research, Jason Smucny of the Neuroscience Program at the University of Colorado recently conducted a study measuring the neurological processes that occur during an easy and difficult task among 21 participants with schizophrenia and 23 with no history of psychosis.

All of the participants underwent magnetic resonance imaging (MRIs) while they performed both easy and difficult tasks that required varying degrees of visual and cognitive attention. While they were completing their tasks, the participants were also exposed to what would be considered normal urban sounds, such as the sound of a train or cars on the streets. The results revealed that the participants with schizophrenia had increased neural activation in specific brain regions that impaired their ability to focus on even the easy tasks. They performed far worse on both sets of tasks than the participants without psychosis. Additionally, the schizophrenic group had slower reaction times as a direct result of the auditory distraction.

Sensory overload, such as the kind evidenced in this study, can have a significant impact on the global functioning and quality of life for people with schizophrenia. They may be unable to perform normal activities, especially in social environments, such as reading street signs, following directions, or communicating with others. These deficits can encroach on other domains required to function at optimal levels, further impairing quality of life. Smucny said, “This work is the first to demonstrate that previously reported auditory processing abnormalities may be associated with neural response changes during cross-modal, visual attention tasks in schizophrenia.” Future work should examine ways to minimize auditory distractions that occur in psychosis and schizophrenia.

Reference:
Smucny J, Rojas DC, Eichman LC, Tregellas JR (2013). Neural effects of auditory distraction on visual attention in schizophrenia. PLoS ONE 8(4): e60606. doi:10.1371/journal.pone.0060606