Impact News

Responding to Violence, Suicide, Psychosis and Trauma

New Imaging Research Reveals Dysfunction In The Brain’s “Hub” In The Earliest Stages Of Schizophrenia

Although the following article is not new, I’m putting it up in response to some enquiries relating to the thalamus and hallucinations. Happy reading! Iain Bourne

ScienceDaily (Jan. 1, 2001) — A new brain imaging study from the Institute of Psychiatry shows for the first time that the thalamus, the brain’s main sensory filter or ‘hub’, is smaller than normal from the earliest stages of schizophrenia. The findings, published in the American Journal of Psychiatry in January, may explain why people with schizophrenia experience confusion during their illness. The thalamus is the area where information is received and relayed to other areas of the brain. It is of particular interest in schizophrenia because of the role it plays in processing information. The thalamus receives information via the senses, which is then filtered and passed to the correct regions of the brain for processing. People with schizophrenia often have difficulties in processing information properly and as a result may end up with an information overload in some areas of the brain. This study, led by Dr Tonmoy Sharma, involved 67 participants: 38 were experiencing their first episode of psychosis and 29 were healthy volunteers. In contrast to other studies, thirteen of the people with schizophrenia had no or little experience of antipsychotic medication. Magnetic resonance imaging (MRI) scans identified differences in the thalamus between the two groups. Previous MRI studies have identified several brain regions affected by schizophrenia, but the results in the thalamus have been inconclusive. This study finds that even in the earliest stages of schizophrenia the thalamus is smaller than in healthy people. Dr Tonmoy Sharma said: “This study reveals that there is a fundamental problem in the hub of the brain. If you think of the brain in terms of networks, it is like making a phone call when the line is not connected properly, the call can’t be made, or you may get through to the wrong person. It is the same in the brain. If there are problems with the connections, information will not be passed to the correct regions. The ability to filter and process information is vital for leading a normal life.” These findings, along with a recent study from Dr Sharma’s team that showed people with schizophrenia have decreased grey matter at the earliest stages of the illness suggest a role for brain imaging in pinpointing warning signs of the illness and even preventing its development.

Filed under: Impact Training, Other Mental Health, psychosis, Violence

I talk back to the voices in my head

* Dean Smith * The Guardian, Saturday 4 April 2009

Dean Smith Dean Smith of Stockport who has suffered from schizophrenia.

I was working as a holiday rep in Brittany 15 years ago when I started hearing voices. I was in my mid-20s and thought it was my mates mucking about. I looked inside and outside the flat to see where they were. It felt really scary, because the voices were saying stuff like, “Right, you’re having it” and, “We’ll get you in the end.” Over the next four days, the voices taunted me more and more, and I became depressed and paranoid. I had a strong desire to be with my family – I had no money, but I got back to my mum and dad’s house in Stockport by hitchhiking and dodging fares. The train journey was particularly harrowing: the voices convinced me everyone was talking about me. My family were brilliant. My mum used to care for my auntie, who had mental health issues, so she had some insight, and my dad was very patient with me. My visits to the GP were less successful – I was put on antidepressants and, when they didn’t work, antipsychotics. They didn’t work either, and by now I was regularly hearing three, one laughing in a wicked kind of way, the other two using abusive and threatening language. The voices got me down so much that I started self-harming. I wound up getting sectioned several times. I was put on heavy medication and encouraged to spend my days playing games with the other patients – anything to distract the voices. Each time, I’d come out being a fantastic Scrabble or blackjack player, but none the wiser about the voices. Ten years ago, at 29, I was told I had paranoid schizophrenia. Friends – well, people I thought were friends – immediately associated the diagnosis with knife-wielding murderers. A lot of them stopped having anything to do with me. I realised I’d been given a label that comes with a huge stigma and a prescription of potent, but in my case useless, medication. I remained keen to find out about innovative treatments, and finally, at a mental health seminar, I heard a speaker talk about an approach advocated by growing numbers of mental health professionals that involves people engaging with the voices inside their head. He was from the Hearing Voices Network and I agreed to visit him. He said I should be frank and uncompromising with the voices. If they told me to self-harm, I should just say no. “If anyone else told you to put your finger in the fire, you wouldn’t, so why act on what they say?” he said. He added that if I wanted to know why they were there, I should ask them, and if I wanted them to go away, I should tell them. It was so simple, but it made so much sense. I took his advice, questioning them, challenging them and even cutting them off if I didn’t have time to talk to them. I’d say things like, “I’m watching TV now, I’ll talk to you later” or “Why exactly do you think I deserve it when bad things happen to me? You can’t answer that, can you?” Sometimes I’d do it in my head; other times out loud. I began to recognise the voices as representing the negative feelings I had about myself, and that alone helped me feel less frightened of them. It’s not that they aren’t real, but they ceased to have the power over me they did. I began to realise they couldn’t carry out their threats. Now they bother me a lot less and, when they do, I’m in control of the conversations. I’ll still talk out loud to them if I feel like it, even if I’m on the bus or in the street. I get some funny looks, but I don’t mind. Recently another voice appeared, but this one is positive and happy, sounding like me as a young teenager. He’s mischievous, but funny, and I quite enjoy chatting with him. I’m off medication now and have been discharged from mental health services. I’ve got my own place and have a girlfriend, and I train nurses and mental health staff in helping others to engage with their voices. The fact that I can speak with genuine understanding means I usually have a captive audience. I also work with people who hear voices, getting them to understand the benefits of talking back. I’ve learned that my voices themselves are not a problem. It’s my relationship with them that’s important. Facing them and working with them has changed my life and made me feel optimistic about it instead of scared. • Do you have an experience to share? Email

Filed under: Other Mental Health, psychosis, , , ,

Police With Higher Multitasking Abilities Less Likely To Shoot Unarmed Persons

ScienceDaily (Apr. 1, 2009) — In the midst of life-threatening situations requiring split-second decisions, police officers with a higher ability to multitask are less likely to shoot unarmed persons when feeling threatened during video simulations, a new Georgia State University study suggests.

Heather Kleider, Dominic Parrott and Tricia King, assistant professors of psychology at Georgia State, have taken a unique look at officer-involved shooting situations, signs of negative emotions and working memory capacity — the capacity to perform multiple mental tasks, such as reasoning, at the same time.

Other studies have examined factors such as ethnicity, stereotypes, neighborhood crime rates and other factors, but this study examines the effects of police officers’ characteristics on shooting decisions.

“In cognitive psychology, operation span, or working memory, is an overarching cognitive mechanism that indicates the ability to multitask, and the amount of available capacity to perform tasks varies by individual and situation,” Kleider said. “People with a higher capacity are able to keep more things ‘in play’ at one time.”

Urban police officers participated in the study, completing a test of working memory capacity, and then watched a video of an officer-involved shooting that resulted in the death of the officer, during which time negative affect and stress indicators were measured; including elevated heart rates and increased sweating.

Following the video, officers participated in a computer-based simulation where they were required to make split-second decisions whether to shoot or not to shoot someone, based on 80 slides that presented a person holding either a gun or a harmless object like a cell phone, for only a fraction of a second. Officers then pressed either a “shoot” or a “don’t shoot” button.

Analyzing the data, the researchers found that lower levels of working memory capacity increased the likelihood of shooting unarmed people among those officers who had higher levels of negative emotionality — a score determined by comparing readings of facial movement and heartbeat rates between a baseline reading and readings taken during the stressful situation.

Officers with a higher working memory capacity seemed to buffer officers against the negative effects of a threat when making shooting decisions.

“An important thing to consider is that some decision making requires controlled processing wherein balanced/accurate decisions require impulse control” Kleider explained. “For some people, this usurps a substantial amount of available working memory capacity to control impulses, and if you are someone with a lower capacity, it’s harder to do.”

Psychologists are not sure whether working memory capacity can be increased with training, but Kleider and her colleagues are planning to investigate this, and are also planning to work with several police departments on a broader study to see if training and years of experience influence shooting decisions.

Journal reference:

  1. . Shooting Behavior: How Working Memory and Negative Emotionality Influence Police Officer Shoot Decisions. Applied Cognitive Psychology, (in press)
Adapted from materials provided by Georgia State University.

Filed under: Violence, , ,

64% Of Medical Professionals Are Subject To Insults And Threats

Article Date: 01 Apr 2009 – 4:00 PDT

Researchers from the University of Zaragoza have studied violence suffered by medical professionals whilst carrying out their profession. The data show that 11% of doctors have been victims of physical aggression and 5% have been subject to this on more than one occasion, whereas 64% of medical professionals are subjected to threats, coercion and insults.

Until a few years ago the only knowledge regarding aggressive activities in hospitals concerned extreme cases. The study entitled “Analysis of Violence”, undertaken in 2005, provided the first results a year later. Now, this article deals with differences according to the type of centre, area and profession and informs us about the real incidence of this problem in Spain.

“The reality is that there is a less serious, insidious and continued violence of physical aggression, threatening behaviour and verbal abuse that is not reported as this is considered less important, but this type of violence can damage the health of the professionals and the quality of healthcare”, explains Santiago Gascón to SINC, who is the principal author of the study. The study has been undertaken together with Begoña Martínez-Jarreta and other researchers from the University of Zaragoza (UNIZAR).

The results, which are published in the latest number of the International Journal of Occupational and Environmental Health, shown that 11% of the professionals have been the victim of physical aggression and 5% have been subjected to this on more than one occasion, whereas 64% have been subjected to threatening behaviour, coercion and insults. 34,4% have suffered threats and coercion on at least one occasion and 23.8% on numerous occasions. Similarly, 36.6% have been subjected to insults on one occasion, at least.

The work, which was undertaken during 2005 in three hospitals and 22 primary care centres in rural and urban areas in Aragón and Castilla-La Mancha, analyses the experiences and identifies the variables implicated, their distribution according to service, profession, age and gender, as well as the possible association between the number and severity of incidents and psychological health problems.

Among 1,845 participants in the research, 64,2% were women and 35,8% were men, and the mean age was 42.8 years. According to profession the proportion was as follows: 33.5% were doctors, 47.5% were nursing professionals, 7.9% were administrative personnel, 1.7% were from management, 2.8% were porters and 6.6.% were technical personnel and other professionals.

The figures are higher in the large hospitals compared to the small centres and reach very high values in services such as Accident and Emergency and Psychiatry. According to Gascón, “the data show the true dimension of under-reported violence”.

Violence due to waiting time

The study shows, moreover, that 85% of cases of aggression are perpetrated by the patients themselves (this percentage is lower in the Accident and Emergency Service where 27.3% of the aggressors turn out to be the people accompanying the patient). 21% of the aggressors are affected by a psychiatric disorder and cognitive deterioration and 5.7% are under the influence of alcohol or drugs.

The most frequent reason for aggression is related to waiting time (58%), followed by disagreements over the issuing of a doctor’s certificate (15%) or the prescription of medication (10%).

But the data contrast with the fact that only eight professionals in this study actually reported the aggression (all were serious physical injuries) whereas there were no reports for episodes of threats of insults.

“Taking into account that the proportion of women in the healthcare environment usually exceeds 60%, no relationship was observed between physical aggression and the fact that the victim was a man or a woman; but this did occur in the threats variable, with a clear prevalence of male victims and who were higher up in the hierarchy”, the researcher from Zaragoza points out to SINC.

Both physical and psychological violence show an identical negative impact in terms of burnout (work dissatisfaction). The perceived support is a variable which protects against the psychological effect of aggression, in such a way that those who do not feel supported by the administration show a worse prognosis following a violent episode.

“Professionals complain about the fact that the legislation in the different communities does not give the same attention to the rights of the professional as they do to the rights of the patient and that, among the responsibilities and duties of the patient, it states that they must show respect to the equipment and property in the centres, but not one single line mentions observing respect for the dignity of the person who is caring for them”, concludes Gascón.

Plataforma SINC

Filed under: Violence

Northern Ireland Doctors Raise Concerns Over Domestic Abuse

Article Date: 01 Apr 2009 – 4:00 PDT

The BMA(NI) highlighted its concerns about domestic violence to local Assembly members in advance of the motion put forward by Sinn Fein MLAs Sue Ramsey and Jennifer McCann.

Commenting on recent Policing Board figures which indicated that police officers in Northern Ireland respond to a domestic incident every 23 minutes, Dr Brian Patterson, Chairman of the BMA’s Northern Ireland Council said,

“The BMA supports the range of efforts being made by the police, the DHSSPS and by individual MLAs in both raising awareness and tackling the unacceptable levels of domestic violence in Northern Ireland.

“As doctors, we are well placed to help victims and their families and it is important that we support our patients when they come forward to discuss this.”

1 The BMA(NI) briefing note on Domestic Abuse (March 2009) suggests that the Northern Ireland Executive should:

a. Raise general awareness of domestic abuse, including its prevalence, manifestation and available support for victims.

b. Ensure strategies to address domestic abuse, such as ‘Tackling violence at home – a strategy for addressing domestic violence and abuse in Northern Ireland’, are highlighted.

c. Develop a structured and statutory basis for addressing domestic abuse at a local level.

d. Recognise that men are also victims of domestic abuse and this needs to be taken into consideration when developing policy.

e. Work to identify and combat the barriers to reporting incidents of domestic abuse.

f. Promote a ‘zero-tolerance’ attitude to domestic abuse.

g. Ensure that information about support services is readily available in healthcare settings such as GP surgeries, A&E units and maternity departments.

h. Raise awareness of the scale of domestic abuse among Section 75 groups, and break down the barriers for such individuals to access the services and protection they need.

i. empower victims to report the abuse to the police.

2 Please contact the BMA(NI) Press Office for a copy of the briefing note

3 Further information is contained in the BMA report ‘Domestic Abuse’ (published 2007).

4 The Policing Board’s Human Rights and Professional Standards Committee published its first Human Rights Thematic Inquiry on 24 March 2009 examining how effectively the PSNI are tackling domestic abuse in Northern Ireland

Sara Morrow
Public Affairs Officer
British Medical Association Northern Ireland
16 Cromac Place
Cromac Wood, Ormeau Road,
Belfast BT7 2JB

Filed under: Violence, , ,

Study Links Increased Risk Of Suicidal Behaviour In Adults To Sleep Problems

Article Date: 01 Apr 2009 – 6:00 PDT

Adults who suffer chronic sleep problems may face an increased risk of suicidal behaviour, new research indicates.

In a study to be presented on April 1, 2009 at the World Psychiatric Association international congress “Treatments in Psychiatry,” scientists found that the more types of sleep disturbances people had, the more likely they were to have thoughts of killing themselves, engage in planning a suicidal act or make a suicide attempt.

“People with two or more sleep symptoms were 2.6 times more likely to report a suicide attempt than those without any insomnia complaints,” said the study’s leader, Dr. Marcin Wojnar, a research fellow at the Department of Psychiatry at the University of Michigan in the United States and Associate Professor of Psychiatry at the Department of Psychiatry at the Medical University of Warsaw in Poland.

The World Health Organization estimates that about 877,000 people worldwide die by suicide every year. The UN health agency says surveys indicate that for every death by suicide, anywhere from 10-40 suicide attempts are made.

“Identifying those at high risk of suicide is important for preventing it and these findings indicate that insomnia may be a modifiable risk factor for suicide in the general population,” Wojnar said. “This has implications for public health as the presence of sleep problems should alert doctors to assess such patients for a heightened risk of suicide even if they don’t have a psychiatric condition. Our findings also raise the possibility that addressing sleep problems could reduce the risk of suicidal behaviours.”

Scientists have consistently linked sleep disturbances to an increased risk of suicidal behaviour in people with psychiatric disorders and in adolescents, but it has been unclear whether the association also exists in the general adult population.

In the study, the broadest and most rigorously conducted of its kind, scientists examined the relationship over one year between three characteristics of insomnia (difficulty falling asleep, difficulty staying asleep and waking at least two hours earlier than desired) and three suicidal behaviours (suicidal thoughts, planning and attempts) in 5,692 Americans. About 35 percent of those studied reported experiencing at least one type of sleep disturbance in the preceding 12 months.

The most consistent link was seen for early morning awakening, which was related to all suicidal behaviours. People with this problem were twice as likely as those with no sleep problems to have had suicidal thoughts in the preceding 12 months, 2.1 times more likely to have planned suicide and 2.7 times more likely to have tried to kill themselves.

Difficulty falling asleep was a significant predictor of suicidal thoughts and planning. Compared with people who reported no sleep problems, those who had trouble initiating sleep had 1.9 times the risk of suicidal ideas and 2.2 times the risk of planning suicide.

People who had trouble sleeping through the night – waking up nearly every night and taking an hour or more to get back to sleep were twice as likely to have thought of suicide in the last year and were three times more likely to have attempted it than those who had no sleep problems.

The results were adjusted for several factors known to influence suicide, including substance abuse, depression, anxiety disorder and other mood disorders, as well as chronic medical conditions such as stroke, heart disease, lung disease and cancer. They were also adjusted for the influence of sociodemographic factors such as age, gender, and marital and financial status.

How sleep disturbance might increase the risk of suicide is still poorly understood, Wojnar said. Scientists have proposed that insufficient sleep may affect cognitive function and lead to poorer judgement, less impulse control and increased hopelessness. A dysfunction involving serotonin a brain chemical involved in mood regulation that plays an important role in sleep, psychiatric disorders and suicide is also suspected.

Further research is needed to determine whether other sleep problems, such as sleep apnoea (interrupted breathing during sleep) and non-restorative sleep, where people feel unrefreshed after an adequate amount of sleep, are also associated with suicidal behaviour, Wojnar added.

The study was funded by the US Department of Veterans Affairs, the US National Institute on Drug Abuse, the US National Institute on Alcohol Abuse and Alcoholism and the US National Institute of Mental Health.

World Psychiatric Association

Filed under: Suicide, , , ,