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Responding to Violence, Suicide, Psychosis and Trauma

Hearing Healthy Voices

At a time when DSM-V would have us classify just about anything vaguely different as a disorder it is good to be reminded that auditory hallucinations can be healthy. The study below offers further confirmation of Romme’s assertion that health/ill health lies not in the hallucinations themselves, but our relationship with them:

J Psychiatr Ment Health Nurs. 2012 Oct 15;
Auditory hallucinations as a personal experience: analysis of non-psychiatric voice hearers’ narrations.
Faccio E, Romaioli D, Dagani J, Cipolletta S
ACCESSIBLE SUMMARY: Auditory hallucinations are voices heard speaking with the hearer or discussing his or her thoughts or behaviours. They are common also among non-psychiatric population and may be a positive experience. These hallucinations cannot be considered merely as symptoms because they may have an adaptive function. We should avoid trying to helping voice hearers to eliminate or deny voices, and rather we should help them to feel allowed to preserve their voices. ABSTRACT: This exploratory research investigates the phenomenon of non-psychiatric auditory hallucinations from the perspective of the voice hearer, evaluating the possibility that this experience can contribute the maintenance and adaptation of the hearer’s personal identity system. A semi-structured interview was administered to 10 Italian voice hearers, six men and four women, aged 18-65 years, who had never been in contact with any mental health services because of the voices, even though some of them had been hearing voices for decades. Participants were not distressed or worried about the voices; on the contrary they developed their own understanding, personal coping resources and beliefs in relation to the positive functions of the voices. These results indicate that voices cannot be considered merely as symptoms, but may be seen also as adaptation systems. Consequently, we should avoid trying to helping voice hearers to eliminate or deny voices, and rather we should help them to feel allowed to preserve them.
© 2012 Blackwell Publishing.
Affiliation: Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padua, Padova, Italy.

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

Reduced thalamic volume in men with antisocial personality disorder or schizophrenia and a history of serious violence and childhood abuse

This is interesting because it lends further support to the idea that the thalamus is implicated, through faulty sensory filtering, both in the development of psychotic symptoms – particularly hallucinations – and also it’s relationship with violent behaviour.

http://www.ncbi.nlm.nih.gov/pubmed/22944337?dopt=Citation

Filed under: Impact Training, psychosis, Violence, , , ,

Trust ‘sorry’ for murders by patients in its care

• Reports criticise Humber mental health trust for failure of care
• Mother of five and elderly woman died in separate incidents

* Sam Jones
* guardian.co.uk, Wednesday 6 May 2009 00.30 BST

A mental health trust has apologised to the family of a pregnant woman who was killed by a paranoid schizophrenic man, and to the relatives of an 82-year-old woman who died at the hands of her mentally ill son.

New reports into both cases have criticised Humber mental health teaching NHS trust for failing to provide better care for the two men.

Tina Stevenson, a 31-year-old mother of five, was on her way home from an ante-natal class in Hull on 5 January 2005 when she passed Benjamin Holiday. The 25-year-old man, who had missed his medication the day before, stabbed Stevenson in the back. Neither she nor her unborn twin boys could be saved.

Holiday admitted manslaughter during his trial in May 2006 and was ordered to be detained indefinitely at a secure mental hospital.

An independent report into his care and treatment published by NHS Yorkshire and Humber concluded he had been “under-treated” by the trust.

Holiday, who had been suffering mental health problems since 2001, spent a fortnight in a secure unit in 2004 but was later discharged and treated in the community. The report admitted that Holiday, whom it referred to as “B”, was a difficult patient to engage with and was skilled at masking his symptoms.

It concluded: “The root cause contributing to B’s continuing severe mental disorder was that of ‘under treatment’. B’s situation and condition could and should have been more assertively managed.”

The chief executive of the Humber trust, David Snowden, apologised to those affected by the case and promised lessons would be learnt. He said his trust “fully accepted the recommendations, which we are taking very seriously”.

The trust also apologised to the family of Ivy Torrie, 82, who was killed by her mentally ill son, Michael, in Pocklington, East Yorkshire, in 2003.

A separate report attributed Michael Torrie’s actions to the “rapid reduction of medication and the way this was managed in the absence of a risk assessment”.

Marjorie Wallace, chief executive of the mental health charity Sane, said that although such events were rare, they did not “come out of the blue”.

“It is not an expensive revolution in care we need but common sense,” she said. “You do not leave an 82-year-old mother alone to care for her mentally ill son whose medication has been radically changed, with no support.

“Nor do you allow someone who may be becoming severely disturbed to dictate their own care and treatment without rigorous assessment of the risk they may pose to themselves or others.

“We have had 15 years of independent inquiries all exposing the same fault lines in the care and treatment of people with serious mental illness.”

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

Hollow Mask Illusion Fails To Fool Schizophrenia Patients

ScienceDaily (Apr. 17, 2009) — Patients with schizophrenia are able to correctly see through an illusion known as the ‘hollow mask’ illusion, probably because their brain disconnects ‘what the eyes see’ from what ‘the brain thinks it is seeing’, according to a joint UK and German study published in the journal NeuroImage. The findings shed light on why cannabis users may also be less deceived by the illusion whilst on the drug.
People with schizophrenia, a mental illness affecting about one per cent of the population, are known to be immune to certain vision illusions. The latest study confirms that patients with schizophrenia are not fooled by the ‘hollow mask’ illusion, and that this may relate to a difference in the way two parts of their brains communicate with each other – the ‘bottom-up’ process of collecting incoming visual information from the eyes, and the ‘top-down’ process of interpreting this information.

Illusions occur when the brain interprets incoming sensory information on the basis of its context and a person’s previous experience, so called top-down processing. Sometimes this process can mean that people’s perception of an object is quite different to reality – a phenomenon often exploited by magicians. The new study, by scientists at the Hannover Medical School in Germany and UCL Institute of Cognitive Neuroscience in the UK, suggests that patients with schizophrenia rely considerably less on top-down processing during perception.

The study used a variation on the three-dimensional ‘hollow mask’ illusion. In this illusion, a hollow mask of a face (pointing inwards, or concave) appears as a normal face (pointing outwards, or convex). During the experiment, 3D normal faces and hollow faces were shown to patients with schizophrenia and control volunteers while they lay inside an fMRI brain scanner, which monitored their brain responses.

As expected, all 16 control volunteers perceived the hollow mask as a normal face – mis-categorising the illusion faces 99 percent of the time. By contrast, all 13 patients with schizophrenia could routinely distinguish between hollow and normal faces, with an average of only six percent mis-categorisation errors for illusion faces.

The results of the brain imaging analysis suggested that in the healthy volunteers, connectivity between two parts of the brain, the parietal cortex involved in top-down control, particularly spatial attention, and the lateral occipital cortex involved in bottom-up processing of visual information, increased when the hollow faces were presented. In the patients with schizophrenia, this connectivity change did not occur. These results suggest that patients with schizophrenia have difficulty coordinating responses between different brain areas, also known as ‘dysconnectivity’, and that this may contribute to their immunity to visual illusions. The research group is now investigating dysconnectivity in schizophrenia further, which will hopefully advance our understanding of this disorder.

Danai Dima, Hannover Medical School, says: “The term ‘schizophrenia’ was coined almost a century ago to mean the splitting of different mental domains, but the idea has now shifted more towards connectivity between brain areas. The prevailing theory is that perception principally comprises three components: firstly, sensory input (bottom-up); secondly, the internal production of concepts (top-down); and thirdly, a control (a ‘censor’ component), which covers interaction between the two first components. Our study provides further evidence of ‘dysconnectivity’ between these components in the brains of people with schizophrenia.”

Dr Jonathan Roiser, UCL Institute of Cognitive Neuroscience, says: “Our findings also shed light on studies of visual illusions which have used psychomimetics – drugs that mimic the symptoms of psychosis. Studies using natural or synthetic tetrahydrocannabinol (THC), the ingredient of cannabis resin responsible for its psychotic-like effects, have found that people under the influence of cannabis are also less deceived by the hollow mask illusion. It may be that THC causes a temporary “disconnection” between brain areas, similar to that seen in patients with schizophrenia, though this hypothesis needs to be tested in further research.”

Journal reference:

1. Dima et al. Understanding why patients with schizophrenia do not perceive the hollow-mask illusion using dynamic causal modelling. NeuroImage, 2009; DOI: 10.1016/j.neuroimage.2009.03.033

Adapted from materials provided by University College London.

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

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 experience@guardian.co.uk

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

Smoking and Schizophrenia: Self-medication?

Recently on a Difficult, Disturbing and Dangerous Behaviour course I was asked about a comment I made regarding the self-medicating aspects of smoking among patients suffering from schizophrenia. I thought that the following from:

http://www.mentalhealthcare.org.uk/research/expanded/index.php?id=21

may be of interest.

Happy reading

Iain Bourne (impact@dangerousbehaviour.com)

www.dangerousbehaiour.com

Smoking in schizophrenia – an attempt to self medicate?

3rd November 2005 | schizophrenia and psychosis

Just over one quarter of the UK population are smokers. In people with schizophrenia the rate of smoking is thought to be between two and four times higher. In addition, smokers with schizophrenia smoke more cigarettes per day and smoke stronger brands than other smokers.

Various theories have been put forward as to why so many people with schizophrenia smoke. It is thought that nicotine acts as a form of ‘self-medication’ for people with schizophrenia, producing a number of beneficial effects despite the negative impact of smoking on long term health.

Dr Veena Kumari and colleagues from the Institute of Psychiatry investigated the self-medication theory, examining evidence from previous research studies. Their findings are described below.

Symptom reduction

Many smokers with schizophrenia report that smoking helps to reduce their symptoms. This has been confirmed by studies showing that smoking is related to a reduction in the negative symptoms of schizophrenia, such as lack of motivation and social withdrawal. It is thought that this effect is caused by nicotine’s ability to raise dopamine levels in areas of the brain involved in attention and engaging with one’s surroundings. Atypical antipsychotic drugs that produce a reduction in negative symptoms, including Clozapine, are thought to act in a similar way.

However, there is no evidence that nicotine has any effect on the positive symptoms of schizophrenia such as hallucinations and delusions and if nicotine is withdrawn from smokers with schizophrenia there is no increase in these symptoms.

Reduction of medication side effects

There is also evidence that smoking may reduce the unpleasant side effects of antipsychotic medication including stiffness and rigidity of movement. Again, this effect is though to be produced by the action of nicotine stimulating dopamine release in the brain.

Nicotine has also been found to counteract the adverse side-effects of certain antipsychotics on some kinds of mental function. A study of patients taking the drug haloperidol who were given nicotine skin patches found them to be less affected by side effects such as the slowing of thought and reduction of attention span.

Improvements in attention and working memory

The areas of the brain thought to be involved in working memory, attention span and motivation have large numbers of receptors for the nicotine molecule. Experiments have shown that nicotine improves these functions both in smokers with schizophrenia and non smoking people with no mental illness. However, in general, people with schizophrenia show greater improvements than the general population. This suggests that there may be genetic differences that determine the extent to which a person will be affected by the effects of nicotine.

Given the negative effects of smoking on health, including greatly increased risk of heart disease and cancer, Dr Kumari believes there is an urgent need for treatments that provide the benefits of nicotine without the risks to long term health. Drugs are being developed that have a similar action to nicotine but these have not yet been tested on people with schizophrenia. Dr Kumari predicts that when these new treatments are available they will not only provide a valuable new way of treating the illness but also offer an alternative for the many people with schizophrenia who put their health at risk by smoking.

Filed under: Impact Training, psychosis, , ,