January 2020
Newsletter Editor: Denise Nelson
You're not Alone
Support is Here for You
Support Groups are Confidential
Visalia Family & Friends
Support Group
St. Paul’s Episcopal Church
120 N. Hall – Corner of Center and Hall 
Tuesday, January 7
First Tuesday of every month
Education Group at 5:45 p.m.
Support Group from 7:00-9:00 p.m.
Call for Information:  (559) 627-1306
Porterville Family & Friends Support Group
Wellness and Recovery Center
333 W. Henderson Ave.
Thursday, January 2
First Thursday of every month at 6:00 p.m.
Call for Information: (559) 280-5258 or (559) 539-5288

Spanish Speaking Family & Friends Support Group
Woodlake Family Resource Center
168 N. Valencia Blvd, Woodlake, CA
Monday, January 6
First Monday of every month
Call for Information: (559) 732-6264
Connections Support Group
My Voice Media near the Transit Center
300 E. Oak St. in Visalia
Every Tuesday from 2:00 to 3:00 p.m
Connections Support Group provides persons with mental health conditions a gathering of respect, understanding, encouragement, and hope. This group is led by trained individuals who are experienced at living well with a mental illness.  No registration is required for this confidential group, just drop by. We look forward to meeting you.
You can call to check if group will be held:  
Phone: (559) 685-2429 or (559) 300-5874
My Voice Media Center
300 E. Oak, Visalia
Near the Transit Center in downtown Visalia. Check the calendar in this newsletter for class schedule.

Visalia Wellness Center
1223 S. Lovers Lane
Visalia, CA 93292
Office: (559) 931-1001
Mon-Sat: 8:30 a.m. to 5:30 p.m.
Closed most major holidays

Porterville Wellness Center
333 W. Henderson Ave.
Porterville, CA 93257
Office: (559) 256-1183
Mon-Fri: 8:30 a.m. to 5:30 p.m.
Sat: 9:00 a.m. to 5:00 p.m.
Sunday: Closed
Places for adults to attend support groups and activities,
learn life skills, and practice socialization.
Your generosity can change people's lives for the better. When you donate, you help give NAMI Tulare County a voice in our community to make a difference for people living with mental illness and their families
You can also mail donations to:
NAMI Tulare County
P.O. Box 3655
Visalia, CA 93278
NAMI Tulare County is grateful for our members .
You help us provide support groups, education, and advocacy
for people within Tulare County who are living with mental illness.

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Articles of Interest
Maternal Infection During Pregnancy: Increased Risk of Psychosis in Offspring
Brian Miller, MD, PhD, MPH December 10, 2019

Maternal viral infection during pregnancy is a risk factor for schizophrenia. But there has been relatively less research on the association between maternal bacterial infection during pregnancy and psychosis risk. Maternal infections may include forms of sexually transmitted disease (STD), some viral respiratory and bacterial infections, toxoplasmosis. One study found that maternal bacterial infection was associated with a two-fold increase in schizophrenia risk.  Findings from another study suggest an association between pyelonephritis and risk of psychosis.  Moreover, gestational immune disruption may disproportionately affect males with regards to psychosis risk.

Lee and colleagues investigated the association between maternal bacterial infections during pregnancy and psychosis risk, including potential moderating effects of sex and parental history of psychiatric illness. They considered 16,188 live births enrolled between 1959 and 1966 at the Boston and Providence sites of the Collaborative Perinatal project, currently known as the New England Family Study. Parents and offspring (who are now in their 50s) with psychotic disorders were identified.

A total of 15,421 participants were included in the final analytic sample. Data on infectious disease exposures were collected at regular prenatal visits. The primary exposure variable was any bacterial infection during pregnancy. If women had multiple infections, they were counted only once. Infections affecting more than one major organ system were defined as multisystemic (eg, sepsis), and those affecting one system were defined as localized (eg, vaginitis).

Cohort members with psychosis were identified at ages 32 to 39 years through a systematic follow-up. Affected parents and offspring were identified via record linkage, direct interview, and subject self-report. After systematic follow-up and structured clinical interviews, 116 adult offspring were found to have a nonorganic psychotic disorder (n = 52 schizophrenia or schizoaffective disorder, depressed type; and n = 53 schizoaffective disorder, bipolar type, or mood disorder with psychotic features; n = 11 delusional disorder, brief psychotic disorder, or psychotic disorder not otherwise specified).

The researchers included maternal race, study site, maternal education, parental socioeconomic index, year and season of birth, parental psychiatric history, and maternal viral infection during pregnancy as covariates. Logistic regression was used to estimate the odds of psychosis for maternal exposure to bacterial infection during
pregnancy, adjusting for these covariates. The authors also examined effect modification by offspring sex and parental mental illness. They also performed sensitivity analyses considering only confirmed bacterial infection (by antibiotic treatment and/or physician diagnosis).

The researchers identified 399 (3%) multisystemic and 3191 (21%) localized infections during pregnancy. Localized infections included vaginitis, urinary tract infections, pneumonia, syphilis, gonorrhea, and tuberculosis. Maternal bacterial infection was associated with a significant increased odd of psychosis (adjusted OR = 1.8; 95% CI, 1.2-2.7), with stronger effects for multisystemic (OR = 2.9; 95% CI, 1.3-5.9) compared with localized (OR = 1.6; 95% CI, 1.1-2.3) infections. Furthermore, the association between maternal bacterial infection and psychosis risk was modified by offspring sex.

Psychotic disorders were 3-fold more likely to develop in males after maternal infection (OR = 2.6; 95% CI, 1.6-4.2), whereas there was no difference in females (OR = 1.0; 95% CI, 0.5-1.9). The pattern of findings was similar when considering localized bacterial infections. Additionally, in sensitivity analysis, the association remained significant and with slightly greater magnitude. By contrast, the association was not moderated by parental mental illness.

The authors concluded that maternal bacterial infection during pregnancy was significantly associated with the development of schizophrenia and related psychoses among offspring, with stronger effects for multisystemic than localized infections, and in males. Findings underscore the potential role of maternal bacterial infections during pregnancy in the etiology of psychosis.

The strength of the study is the systematically collected prospective data in this birth cohort. The authors noted potential misclassification of exposure and interactions between infection and other non-biological factors (eg, socioeconomic status) as study limitations.

The bottom line

Maternal bacterial infections during pregnancy are associated with risk of psychosis in the offspring, which is moderated by the severity of infection and gender. Future, larger samples are needed to address components of the potential etiologic pathway regarding this connection, including gestational timing of exposure and sex-specific transmission. Replicated findings would underscore the need for public health and clinical effects to reduce psychosis risk by preventing and managing bacterial infection in pregnant women.

Dr Miller is Associate Professor of Psychiatry, Department of Psychiatry and Health Behavior, Augusta University, Augusta, Georgia. He is the Schizophrenia Section Editor for Psychiatric Times. The author reports that he receives research support from Augusta University, the National Institute of Mental Health, the Brain and Behavior Research Foundation, and the Stanley Medical Research Institute

“Shoot for the moon and if you miss
you will still be among the stars.”

Les Brown
Large Study Implicates 10 Genes in Schizophrenia Development
December 02, 2019
In a study incorporating genetic data from more than 125,000 people, researchers have implicated 10 new genes in the development of schizophrenia.
One of the largest such studies ever, the project was part of the Schizophrenia Exome Sequencing Meta-Analysis Consortium and conducted by Tarjinder Singh, PhD, a postdoctoral fellow affiliated with the Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Massachusetts General Hospital, and Harvard Medical School, and colleagues. It was presented as a featured plenary presentation at the  American Society of Human Genetics 2019 Annual Meeting  in Houston, Texas.

Below, Dr. Singh explains how the research was conducted, the importance of the findings, and how they could inform future work in the field.

Q: What prompted you and your co-investigators to research the genetic underpinnings of schizophrenia?
There has been challenges in developing new medicines for schizophrenia, in part because we don't really understand how it develops. Past research has demonstrated that both genetics and the environment contribute to disease risk. While there are different approaches to studying schizophrenia and how it develops, we chose to look at genetic factors that predispose individuals to risk, and use that to learn more about the biology that underlies the condition. 
Q: Please briefly describe your study and its findings.
As part of the Schizophrenia Exome Sequencing Meta-Analysis Consortium, we analyzed the DNA sequence of 25,000 people with schizophrenia and 100,000 people without the condition to identify risk genes for schizophrenia. In particular, we focused on genetic differences that disrupt protein-coding genes, which are very rare in the general population given how strongly they are selected against in every generation.

Through this work, we implicated 10 genes in which disruptions in the protein-coding sequence dramatically increase schizophrenia risk. Two of the 10 genes are coded for glutamate receptors, known to be important in communication between brain cells. Our findings suggest that decreased function of these receptors increases the individual risk for schizophrenia, and that studying them further, along with the other associated genes, can teach us more about how the condition develops. 
Q: Were any of the outcomes particularly surprising to the study team?
We compared the genetic signal in schizophrenia to other neurodevelopmental and autism spectrum disorders, and found that some genes are more specific to schizophrenia and others are more shared across diagnoses. By comparing these data sets and conditions, we are learning how specific these risk genes are for schizophrenia, and about their wider clinical and biological consequences.
Q: What are the possible real-world applications of these findings in clinical practice?
I see these findings as an important but early step to learning more about the biology underlying schizophrenia. The end goal is to use these findings to design experiments which will help us better clarify the mechanisms of disease, and motivate the development of new and better therapies.
Q: Do you and your co-investigators intend to expand upon this research?
It is clear from this initial work that there are many more risk genes to be discovered, and that we are still in the early phases of gene discovery for schizophrenia. With a growing group of international collaborators, we hope to scale up this research and push towards a more complete genetic picture of schizophrenia. 
Q: Is there anything else pertaining to your research and findings that you would like to add?
This kind of work—where tens of thousands of individuals are part of a study—is only possible through global collaborations between universities and institutes from around the world. It is really exciting and motivating to be part of a large team that is passionate and dedicated to better understanding mental illnesses and working towards better therapies.

Tarjinder Singh, PhD, is a postdoctoral fellow in the Analytic and Translational Genetics Unit at Massachusetts General Hospital, Harvard Medical School, and the Stanley Center for Psychiatric Research at the Broad Institute of Harvard and MIT. He completed his PhD in 2017 at the Wellcome Sanger Institute and the University of Cambridge, United Kingdom, where he studied the role of rare variation in the genetic architecture of psychiatric and neurodevelopmental disorders with Dr. Jeffrey Barrett. Mentored by Dr. Mark Daly and in close collaboration with Dr. Benjamin Neale’s group, he currently works on the meta-analyses of sequencing data in psychiatric traits, with a primary focus on gene discovery in schizophrenia.
“If you want to go fast go alone;
if you want to go far go together.”

African Proverb
Monthly Activities at My Voice Media Center
The purpose of My Voice Media Center, located in the Art District of downtown Visalia, is to help peers in their wellness and recovery. They do so by providing a creative outlet for self-expression, striving to reduce stigma in surrounding communities, and promoting available wellness and recovery services.
Support & Resources
Your membership makes it possible for NAMI Tulare County to advocate for access to services, treatment, and research.
Please continue to join us!
Ralph Nelson (President)
Sandra Juarez (Vice President)
Kathy Farrell (Secretary)
Mary Mederos (Treasurer)

Board of Directors:
Donna Grigsby
Ivy Jones
Ray Lara
Karen Mabry
Bruce Nicotero
Elizabeth Vander Meer
Office Hours: Mon-Thu 9:30am-3:00pm / Friday 9:30-11:30am
Phone: (559) 732-6264
Email: namitc@att.net
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