Dr. A Prabhu Dessai Consultant Psychiatrist
Panaji , Goa 403001
India
ph: 9096660920
What is Schizophrenia and How Should It Be Managed ?
http://dev.ranzcp.org/images/stories/ranzcp-attachments/pdfs/cpgs/AUS_CPGs/Schizophrenia (Aus).pdf
http://www.nimh.nih.gov/health/publications/schizophrenia/schizophrenia-booket---2006.pdf
Schizophrenia: The Journey to Recovery
A Consumer and Family Guide to Assessment and Treatment
http://ww1.cpa-apc.org/8080/Publications/Clinical_Guidelines/schizophrenia/november2005/index.asp
Is Psychological Therapy Effective for Schizophrenia?
http://www.schizophrenia.com/sznews/archives/005571.html
American Practice Guidelines
http://www.psychiatryonline.com/pracGuide/pracGuideTopic_6.aspx
Canadian Practice Guidelines
http://ww1.cpa-apc.org:8080/Publications/Clinical_Guidelines/schizophrenia/november2005/contents.asp
http://www.sciencedaily.com/releases/2006/06/060614120625.htm
ScienceDaily (June 14, 2006)— University of Manchester researcher Paul Hammersley is to tell two international conferences, in London and Madrid on 14 June 2006, that child abuse can cause schizophrenia.
The groundbreaking and highly contentious theory, co-presented by New Zealand clinical psychologist Dr John Read, has been described as "an earthquake" that will radically change the psychiatric profession.
Clinical psychologist and writer Dr Oliver James commented: "The psychiatric establishment is about to experience an earthquake that will shake its intellectual foundations [and] may trigger a landslide."
Mr Hammersley, Programme Director for the COPE (Collaboration of Psychosocial Education) Initiative at the
School of Nursing Midwiferyand Social Work, said: "We are not returning to the 1960s and making the mistake of blaming families, but professionals have to realize that child abuse was a reality for large numbers of adult sufferers of psychosis."
He added: "We work very closely in collaboration with the Hearing Voices Network, that is with the people who hear voices in their head. The experience of hearing voices is consistently associated with childhood trauma regardless of diagnosis or genetic pedigree."
Dr Read said: "I hope we soon see a more balanced and evidence-based approach to schizophrenia and people using mental health services being asked what has happened to them and being given help instead of stigmatizing labels and mood-altering drugs."
Hammersley and Read argue that two-thirds of people diagnosed as schizophrenic have suffered physical or sexual abuse and thus it is shown to be a major, if not the major, cause of the illness. With a proven connection between the symptoms of post-traumatic stress disorder and schizophrenia, they say, many schizophrenic symptoms are actually caused by trauma.
Their evidence includes 40 studies, which revealed childhood or adulthood sexual or physical abuse in the history of the majority of psychiatric patients and a review of 13 studies of schizophrenics found abuse rates from a low of 51% to a high of 97%. Psychiatric patients who report abuse are much more likely to experience hallucinations – flashbacks which have become part of the schizophrenic experience and hallucinations or voices that bully them as their abuser did thus causing paranoia and a mistrust of people close to them.
They admit not all schizophrenics suffered trauma and not all abused people develop the illness, but believe less traumatic childhood maltreatment, rather than actual abuse, may be an important difference. In their review of the 33,648 studies conducted into the causes of schizophrenia between 1961 and 2000, they found that less than 1% was spent on examining the impact of parental care. Still, they say, there have been enough studies to suggest negative or confusing early care may be an important addition to abuse as a cause.
Genes may still have a role to play but other evidence Hammersley and Read cite shows that genes alone do not cause the illness. A recent study compared 56 adoptees born to schizophrenic mothers with 96 adoptees whose biological parents did not have the illness. The families were observed extensively when the children were small and all the adoptees were assessed for psychiatric illness in adulthood. It was found that if there was a high genetic risk and it was combined with mystifying care during upbringing, the likelihood of developing schizophrenia was greater - genes alone did not cause the illness.
In addition a recent review revealed that, apart from for Alzheimer's, not a single gene has been shown to play a critical role in any mental illness, while sociological studies show that schizophrenia poor people are several times more likely than the rich to suffer schizophrenia and urban life increases the risk.
Finally, they argue, if patients believe their illness is an unchangeable genetic destiny and that it is a physical problem requiring a physical solution, they will readily accept a drug prescribed to them when in fact they require other therapy. Worse, those who buy the genetic fairytale are less likely to recover, and that parents who do so are less supportive of their offspring. They recommend that all patients be asked in detail about whether they have been abused, anti-psychotic drugs no longer be doled out automatically and psychological therapies offered more often.
Hammersley and Read will propose the motion 'Tears on my pillow, voices in my head: This house believes child abuse is a cause of schizophrenia' at a public debate at the
Instituteof Psychiatry in London on 14 June 2006. They will also be speaking at 15th ISPS Symposium for the Psychotherapy of Schizophrenia and other Psychoses in Madrid on the same day.
Teen Tries to Quiet the Voices Caused by Schizophrenia
http://edition.cnn.com/2009/HEALTH/04/24/schizophrenia.soloist.brain/index.html
By Madison Park (CNN) -- The intrusive voices popped into William "Bill" Garrett's head. "They're coming for you," the voices told the 18-year-old. "Find somewhere to hide; they're going to get you."
On left is William "Bill" Garrett in high school, and on the right is a 2007 photo of the Maryland teenager.
As schizophrenia took hold, the Maryland teenager became lost within his own mind and had to leave college after winning a full, four-year scholarship.
Garrett's experience echoes the teenage years of Nathaniel Ayers, a promising string bass player whose musical training at the Juilliard School was cut short by schizophrenia, a brain disorder that blurs a person's ability to distinguish between reality and delusions.
Ayers became homeless and played Beethoven pieces on a broken violin in the streets of Los Angeles, California. His struggles with schizophrenia and his friendship with a Los Angeles Times columnist inspired the movie "The Soloist," which releases Friday.
His sister, Jennifer Ayers-Moore, hopes the movie will raise awareness about schizophrenia and has established the Nathaniel Anthony Ayers Foundation for the artistically gifted mentally ill.
"I know there are thousands of Nathaniels, and they deserve a chance, too," said Ayers-Moore, an Atlanta-based social worker.
Teen Interrupted
Schizophrenia is the result of disrupted brain development. Males typically get symptoms during their teens or early 20s, as Ayers and Garrett did.
"It's a critical time for the brain," said Dr. Jon McClellan, the medical director of the Child Study and Treatment Center at Seattle Children's Hospital. "It's the CEO part of the brain that pays attention, makes decisions and filters. The prefrontal cortex, that's the last area of the brain to develop. As that area comes online, that's when the illness presents."
In high school, Garrett won elected offices in student government and headed the lacrosse and cross country teams. A gifted student, he wanted to study political science and biology at Hopkins .
At home, he cooked family dinners, helped his little sister with homework, and surprised his mother with pancakes on her birthday.
"People likened him to the perfect child before he got sick," said his mother, Kristan Kanyuch.
In 2007, the unusual behaviors started. He slept a lot. He emptied an entire can of bug spray in his bedroom. When he came home for a weekend from college, he pointed to a blister on his hand that had formed from playing lacrosse.
"Look, I have gangrene," he said. "My hand is going to rot." Then he tried to cut off his hand with a paring knife.
His family stopped him and took him to an emergency room for a psych evaluation, but Garrett refused to wait and left.
A week later, Kanyuch got a call from the university. Her son was failing every class. When confronted, Garrett looked at the F's and calmly replied, "I'm not failing anything."
In the 1970s, Ayers-Moore saw the symptoms when her family picked her brother up from Juilliard to head home to Cleveland, Ohio, for summer.
"The look in his eye was so different," she said. "It was like you could see into his soul, he could look into yours. It sort of startled me a little bit. I didn't know what to say to him. On the way from New York, I pretended I was asleep. I didn't know what to say."
Paranoid Schizophrenia
About three decades later, Nickole Kanyuch, 15, watched a similar scenario unfold as her brother, Garrett, struggled with paranoid schizophrenia and obsessive compulsive disorder.
"I watched the big brother who I had looked up to all my life fall apart and become someone entirely new," she said. "The boy who was destined for greatness, who worked long and hard for 12 years to lead a successful life, was destroyed in a mere six months."
Garrett, whohad once organized his 600 books by the Dewey Decimal system, could hardly read two sentences. The voices in his head drowned out the words on the page, he told his mother.
Garrett, who color coordinated the clothes inside his closet, could no longer groom himself or shower. The voices told him the shampoo and soap were poisoned.
Kristan Kanyuch quit her financial planning job to take care of him. Despite taking medicine, Garrett's health fluctuated. One day he was fine; the next, he threatened to kill the neighbors. Frustrated and facing mounting debt, Kanyuch sought help.
She joined a mental health support group. At one session, she was told to follow simple instructions from a counselor. Meanwhile, 10 people who stood around her talked at once. While the chorus of voices drowned out the instructions, she realized this was how her son lived every day.
That night, Kanyuch hugged her son. "You have to be the most courageous person. You wake up every day," she told him.
"That's when he explained to me the reason he sleeps," Kanyuch said. "He doesn't hear the voices. He doesn't hear them telling him he's fat, stupid, there's a conspiracy. It's a break for him to sleep."
Although no one knows where these voices originated, they could be triggered by wiring problems in the brain, said McClellan, who researches adolescent psychiatry. One theory is schizophrenia causes difficulty distinguishing thoughts from their outside experiences, "so they experience internal thoughts and perceptions as voices," he said.
Recovery
Garrett has been a subject in two research programs searching for better schizophrenia treatments. His condition fluctuated, and, for months, he was on suicide watch.
Schizophrenia is a difficult disorder to treat, because one medication that soothes one patient can make another psychotic.
"Medication or dosages can't be matched absolutely with the individual, so there is some of that trial and error," said Dr. Thomas Bornemann, director of the Carter Center 's Mental Health Program.
Garrett tried many drugs. Some made him drowsy, others volatile and one drug made him gain 75 pounds. Severe side effects often cause patients to stop taking medication.
For now, doctors seem to have found one that helps Garrett. Since March, Garrett has been at a Maryland research center that looks into the relationship between metabolism, tobacco and schizophrenia.
After a violent visit in August, Garrett, 21, had not been home until Easter. During the recent visit, he played basketball, Yahtzee and Wii bowling with his family.
"He was able to carry on a conversation and play card games," Kanyuch said. "He was interacting."
At home, surrounded by reminders all his past achievements, Garrett said: "Mom, I was on the top of the world. Now I'm in the gutter."
His mother disagreed: "Look at it as an opportunity."
"What?" he said.
"It's not an opportunity everyone would jump at," she told Garrett. "But as you rehabilitate, as you grow an insight into your illness, there may be things you deal with forever. But you've had significant experiences that you may be able to use to help other people. There's no place where insight and advocacy [for mental health] is needed more than in politics, which is what you wanted to do."
A life with schizophrenia won't be easy, but some with the disorder have graduated from college, earned doctorates and lead enriched lives, she told Garrett.
"He doesn't understand the courage he has."
No part of ths site may be copied or reproduced without permission of the site owner.
All rights reserved.
Dr. A Prabhu Dessai Consultant Psychiatrist
Panaji , Goa 403001
India
ph: 9096660920