June 2020
Newsletter Editor: Denise Nelson
Update on NAMI Conferences
NAMI National Conference has been canceled.

California Annual Conference has been postponed. New Date: October 12-13, in Sacramento at the Hyatt Hotel. If you made previous reservations, your registration will be transferred to the new date. If you made hotel reservations you must contact the hotel.  
Support Groups
Family Support Group will not be held until further notice.

If you have a family member or friend with a mental illness, and you would like someone to talk to, you may call the following numbers:

Visalia Contact: Ralph (559-627-1306
Porterville Contact: Donna  (559-280-5258

NAMI Connection Recovery Support Group will not be held until further notice.
Porterville and Visalia Wellness Centers are closed until further notice. Visalia Wellness Center makes weekly phone calls to check on their members.
About AmazonSmile - Select NAMI Tulare County
Your shopping can help our cause. Amazon has just about everything under the sun that you can imagine! When you click the link below, and shop with Amazon Smile, Amazon will donate a portion of their earnings to
NAMI Tulare County. 

We appreciate your support!
How it Works
What is AmazonSmile?
AmazonSmile is a simple way for you to support your favorite charitable organization every time you shop, at no cost to you. When you shop at  smile.amazon.com , you’ll find the exact same low prices, vast selection and convenient shopping experience as Amazon.com, with the added benefit that Amazon will donate 0.5% of your eligible purchases to the charitable organization of your choice. You can choose from over one million organizations to support . Please select NAMI Tulare County.

How do I shop at AmazonSmile?
To shop at AmazonSmile simply go to  smile.amazon.com  from the web browser on your computer or mobile device. You may also want to add a bookmark to  smile.amazon.com  to make it even easier to return and start your shopping at AmazonSmile.

Which products on AmazonSmile are eligible for charitable donations?
Tens of millions of products on AmazonSmile are eligible for donations. You will see eligible products marked “Eligible for AmazonSmile donation” on their product detail pages. Recurring Subscribe-and-Save purchases and subscription renewals are not currently eligible.

Can I use my existing Amazon.com account on AmazonSmile?
Yes, you use the same account on Amazon.com and AmazonSmile. Your shopping cart, wish list, wedding or baby registry, and other account settings are also the same.

How do I select a charitable organization to support when shopping on AmazonSmile?
On your first visit to AmazonSmile  smile.amazon.com ,
you need to select a charitable organization to receive donations from eligible
purchases before you begin shopping. We will remember your selection, and then every eligible purchase you make at  smile.amazon.com  will result in a donation. AmazonSmile will occasionally contact you about donation amounts disbursed to your chosen charity or about the program.

Can I change my charity?
Yes, you can change your charity any time. Your AmazonSmile purchases after the change count towards your newly selected charity. To change your charity, sign in to  smile.amazon.com  on your desktop or mobile phone browser and simply select “Change your Charity” in “Your Account.”

What charities can I choose from?
You can choose from over one million eligible 501(c)(3) public charitable organizations Please choose NAMI Tulare County.

What if my selected charity does not register to participate in the AmazonSmile program or becomes ineligible?
If your selected charity does not register to participate, becomes ineligible, or requests to be removed from the program, you will have a chance to select a different charity to receive the accrued donations that have not yet been disbursed to your charity. If you do not select a different charity, the accrued donations will be distributed to other organizations receiving donations.

How much of my purchase does Amazon donate?
The AmazonSmile Foundation will donate 0.5% of the purchase price from your eligible AmazonSmile purchases. The purchase price is the amount paid for the item minus any rebates and excluding shipping & handling, gift-wrapping fees, taxes, or service charges. From time to time, we may offer special, limited time promotions that increase the donation amount on one or more products or services or provide for additional donations to charitable organizations. Special terms and restrictions may apply. Please see the relevant promotion for complete details.

Can I receive a tax deduction for amounts donated from my purchases on AmazonSmile?
Donations are made by the AmazonSmile Foundation and are not tax deductible by you.
Featured Articles
Community Care VS Inpatient Care as Complements
(January 7, 2020) Often hospital and community-based care options are considered alternatives for each other, with advocates suggesting that an increase of one must be associated with a decrease with the other.
However, new international evidence suggests that this dichotomy between hospital and community care does not in fact exist. Published in the new year by Isabel Perara, PhD, data shows that countries that have high levels of community care also tend to have higher numbers of psychiatric hospital beds.
“Only by reducing hospital care and expanding community care, it is presumed, can societies optimize the treatment, empowerment, and ultimately, quality of life of people with mental disorders,” writes Dr. Perera. “If the desired expansion of community psychiatry rests on the reduction of hospital care, then societies with ample outpatient care should have very little inpatient care.”
However, Dr. Perera’s results calls these assumptions into question. As we know, hospital care is an essential component of the treatment continuum for people with serious mental illness. And in fact, outpatient and inpatient care are complements to one another.
Analyzing mental health system data from the World Health Organization across 15 developed countries, including the United States, Canada, and Australia, among others, Dr. Perara found that there is a positive correlation between the supply of psychiatric beds and community care facilities per population in a given country. This means that countries that have high-levels of psychiatric beds also tend to have high numbers of community care facilities. As well, countries that have low-levels of psychiatric beds also tend to provide the least amount of outpatient care. Interestingly, Dr. Perera found that countries that tend to have more inpatient beds were more likely to have them in specialty psychiatric hospitals, not in psychiatric wards in general hospitals.
“Achieving a top policy priority—a robust community care system—requires the destigmatization of the mental hospital,” concludes Dr. Perera. Rather than assuming there are trade-offs between inpatient and outpatient care, resources should be allocated to services throughout the continuum, she argues. Both outpatient and inpatient care serve important functions in the treatment continuum for people with mental illness.

Elizabeth Sinclair
Director of Research 
Treatment Advocacy Center
Research Weekly is a summary published as a public service of the Treatment Advocacy Center and does not necessarily reflect the findings or positions of the organization or its staff.
New Medications for Schizophrenia
Drug development for treating schizophrenia is entering a promising new era. This week’s research blog is about some of these new developments written by Michael B. Knable, DO, psychiatrist and Treatment Advocacy Center Board President.
The newest medication to reach the market for the treatment of Schizophrenia is lumateperone 1 (also known as Caplyta  and produced by Intra-Cellular Therapies). Lumateperone was approved by the FDA in December 2019. Several
different doses of lumateperone have been studied and it appears that an intermediate dose (42 mg) is most effective in reducing positive symptoms during an acute exacerbation of schizophrenia. There did not appear to be a significant effect of this medication on negative symptoms. Although studies that lead to FDA approval are usually short (4-6 weeks), and the true risk for side effects is often not known until patients have taken new medications for longer periods of time, it is encouraging that lumateperone did not appear to effect body weight, lipids, blood sugar, prolactin or to produce
involuntary movements.
Like most atypical antipsychotics lumateperone blocks dopamine D2
receptors and serotonin 2A receptors. The manufacturer claims that lumateperone is novel because it also
interacts with dopamine D1 receptors, glutamate and serotonin re-uptake. However, it is not possible to know how lumateperone compares to existing atypical antipsychotics since no direct studies of this question have been published. As of this writing, it appears that the monthly cost for lumateperone is approximately $1,300. Some Medicaid insurers may reimburse for this cost after prior authorization, but it is not yet clear whether private insurance companies will cover the cost of this medication. 

Drug development for schizophrenia may be entering an interesting new era, because a number of drugs currently under study are not new variations of dopamine receptor blockers. Recently, an interesting study was published on a new compound produced by Sunovion Pharmaceuticals (   SEP-363856   )   2   . This compound is thought to interact with the trace amine associated receptor (TAAR-1) and the serotonin 1A receptor, but not with dopamine receptors. In the four-week study, there was a significant improvement in symptoms of psychosis, but no apparent differences from placebo on metabolic measures or involuntary movements. I am looking forward to further studies and information about this interesting compound. 

Michale Knable, MD
Treatment Advocacy Center
President, Board of Directors

  1. Correll CU, et al.: Efficacy and Safety of Lumateperone for Treatment of Schizophrenia. A Randomized Clinical Trial. JAMA Psychiatry 77:349-358, 2020.  
  2. Koblan KS et al.: A Non-D2-Receptor-Binding Drug for the Treatment of Schizophrenia. N Eng J Med 382:1497-506, 2020
Don’t let Exercise Myths Keep You on the Couch
Everyone gets health benefits from physical activity. If you are also facing mood issues, exercise can become part of your treatment toolkit. Many studies have described positive
benefits and reduction of depression and anxiety symptoms associated with exercise, both aerobic (like running) and anaerobic (like weight lifting).

The following are myths that fitness experts have debunked:
Exercise takes a lot of time
You don’t have to take a 45-minute class or a 3-mile run. Exercise medicine researcher, Greg Well, PhD. Author of The Ripple Effect: Sleep Better, Eat Better, Move Better, Think Better, says that as little as 15 minutes a day of any kind can have a dramatic impact of your overall health. The key is consistently, making it a daily habit.
Working out means going to the gym
The best workout for you depends on how motivated you are. Finding some large-scale muscle activities, you can do at home or on your own removes one more obstacle for exercising. For some the social environment of group exercise is more enjoyable, if so, join a gym. (Call several and check if they have a discount for people with a disability.)
If you’re not sweating, you’re not really exercising
Gentle movement, like tai chi practice still provides health benefits. (Recently offered at the wellness center in Visalia.)
You need to stretch before exercise
Recent research suggests that stretching doesn’t prevent injuries, and it may even cause some. Stretching can bring you flexibility benefits.  If you need to become more limber there are pluses to a yoga routine or stretching exercises guided by someone who knows proper form. You can find classes online.
After a workout, you’re set for the day
Taking even one minute every hour to move around can combat the effects of a
sedentary lifestyle. The more people engage their large muscles the healthier they are.

Women who lift weights can bulk up
 It is now recommended that adults perform weight bearing activities a couple times a week. There are many benefits—bone-density, muscle rebuilding, improved mood and decreased risk of diabetes and heart disease Wells says. Strength training helps develop more strength but also muscle tome, which helps decrease body fat and burn calories more efficiently.

The bathroom scale is the best measure of fitness
Just because you don’t lose a lot of weight right away, or ever, doesn’t mean that exercise isn’t helping you overall. Heart health and mental health benefits come with every kind of physical activity.
If you’re feeling frustrated because your pant size hasn’t budged, focus on other improvements. Is your mood better? Do you have more energy? Are you getting stronger? Keeping holistic benefits of exercise in mind is always better than staying focused on just that number on the scale.
Research has shown that paying attention to how your mood improves after exercising keeps you more motivated for the next time.

Exercise is a chore that you push yourself to do
As Newton’s first law of motion states, a body at rest stays at rest unless an external force is applied. That’s why fitness experts recommend tricks such as scheduling exercise as an appointment with yourself, making dates with a workout buddy, putting together a pick-me-up soundtrack, and finding activities you find fun in and of themselves. Viewing exercise as a privilege can give you added inspiration.
To have the ability and freedom to move and sweat every day is something that not everyone gets to do. With every workout, you become better than you were yesterday.
Editors thoughts: If you are outside in the California sun, don’t forget to apply some sunscreen and wear a hat. .
Esperanza , Fall, 2019, By Jessica Hart a journalist in San Francisco who covers sustainability and positive lifestyle change
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!
Board Officers:
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: Tue-Fri 9:30am-3:30pm
Phone: (559) 732-6264