OCTOBER 2020 NEWSLETTER

EDITOR: DENISE NELSON

MONTHLY UPDATES
NAMI Tulare County is pleased to announce we are resuming our Porterville Family Support Group starting in October. Click the button for more information.
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FEATURED ARTICLES
Disorders Years Before
They Develop

September 4, 2020
Study Finds – Brain, Health & Medical; Psychological, Science & Technology
DUBLIN — Psychotic disorders, probably most synonymous with schizophrenia, are characterized by a disconnect from reality. Psychosis patients often see things that aren’t there, hear voices, or suffer from intense paranoia. Suffice to say, psychosis is an awful condition. Unfortunately, attempting to identify individuals at an elevated risk of developing psychosis later in life has proven elusive.

Now, however, researchers from RSCI University have developed a novel and potentially game changing new way to predict if a person is at risk of psychosis years down the line: a blood test.
Some people exhibit mild or brief psychotic symptoms throughout their lives, and are thus considered at a high risk of developing psychosis in the future. But, even in these cases, only 20-30% of such people actually end up developing an actual psychotic disorder.
  
How Your Blood Can Determine Your Risk For Psychosis
 
For their research, scientists analyzed a collection of blood samples taken from people already classified as being at high risk for psychosis. Then, they kept tabs on those individuals over the following
years to see who did and didn’t develop a psychotic disorder.

Using this process, along with some machine learning, researchers identified patterns of proteins within those blood samples that correlate with who had and hadn’t developed psychosis during the follow-up period.

A significant portion of those proteins are related to inflammation. This suggests, according to the study, that people who eventually suffer from psychosis undergo immune system changes fairly early in their life. All of this strongly indicates that a blood test measuring levels of these proteins can accurately predict psychosis outcomes years down the line.

Results Show Impressive Accuracy

The most accurate test, which focuses on the 10 most predictive proteins, is able to correctly estimate future psychosis patients in 93% of cases. It also correctly identifies individuals at little to no risk of the condition 80% of the time.
“Ideally, we would like to prevent psychotic disorders, but that requires being able to accurately identify who is most at risk,” says Professor David Cotter, the study’s senior and corresponding author and professor of molecular psychiatry at RCSI, in a release.

“Our research has shown that, with help from machine learning, analysis of protein levels in blood samples can predict who is at truly at risk and could possibly benefit from preventive treatments. We now need to study these markers in other people at high risk of psychosis to confirm these findings,” he adds.
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Reference(s):

The study is published in JAMA Psychiatry (August 26,2020)
RESEARCH WEEKLY: Methadone Maintenance Treatment for Co-Occurring Severe Mental Illness and Opioid Use Disorders 
 
By Molly Vencel
Methadone maintenance may be an effective treatment for people with co-occurring severe mental illness and opioid use disorder, according to a new study published in Schizophrenia Bulletin Open from researchers at McMaster University.  
 
While many with schizophrenia and other psychotic disorders lack access to mental health treatment, even fewer have access to treatment for co-occurring disorders. Opioid use disorder has reached crisis levels in recent years, but few studies have investigated the impacts on people with severe mental illness.  
 
Methods 

People with psychotic disorders such as schizophrenia are typically excluded from programs investigating the efficacy and safety of treatments for opioid use disorder, despite more than one in four individuals with a severe mental illness having a co-occurring substance use disorder during their lifetime.  
 
While treatments for people with both disorders exist, research has been scarce. The researchers of the study sought to fill this gap by analyzing data from 20 outpatient clinics currently providing methadone maintenance treatment, a common treatment for opioid use disorder.  
 
Methadone maintenance treatment works by providing a safe alternative to illegal opioids to reduce cravings and withdrawal symptoms. It is an evidence-based practice first used in the 1960s and is shown to effectively reduce a person’s misuse of opioids. Now, researchers are primarily interested in program retention rates because methadone maintenance requires daily contact and engagement with treatment to be effective.  
 A common myth is that those with psychotic disorders will not be able to engage with long-term treatment for drug use disorders. This is based on the general belief that people with co-occurring disorders have worse outcomes, and their psychotic symptoms will make drug use treatment nearly impossible. However, current data does not support this misconception.  
 
The researchers of the methadone maintenance study followed 415 individuals, 37 of whom had a psychotic disorder. Throughout the study, in addition to conducting interviews they tracked individual's clinical diagnosis, antipsychotic
prescriptions, demographic data and urine tests for methadone and other substances to determine treatment adherence. 

Findings 
 
The Canadian researchers found no significant difference in age, gender or time in treatment for those with versus without severe mental illness. Most important, there was no difference in methadone maintenance treatment retention rates between the two groups. About 80% of both people with psychosis and people without psychosis remained in methadone maintenance treatment after one year. The study authors highlight that this finding directly contradicts the commonly held belief that those with psychosis will not be able to participate in traditional methadone maintenance treatment programs. 


Only 41% of those with a psychotic disorder were prescribed antipsychotic medication during the study period, according to the results. The authors hypothesize that this may be due to the complex nature of psychosis, substance use and substance-induced psychosis, resulting in a failure to identify and treat psychosis according to clinical guidelines.  
 
Researchers did not explore the cause for the low antipsychotic use; however, it is likely that many participants could have benefited from an antipsychotic prescription. Even with access to methadone maintenance treatment, people with co-occurring disorders need other mental health services to make a full recovery. However, access to concurrent treatment is lacking in the current services available for this population, the results suggest. 
 
Limitations and Further Research
 
The study authors cautioned that this research only included people voluntarily seeking drug treatment, so results may not apply to people who lack insight or do not desire treatment. In addition, the study did not differentiate between active and controlled psychosis which could ultimately impact a person’s ability to engage in substance use treatment.  
 
Despite these limitations, this study provides support for including those with co-occurring psychosis and substance use disorders in opioid treatment programs. Future research should focus on how to incorporate substance use and mental health treatments into one program, so that people can have the best proven treatments that address their full needs. 
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Reference(s):
 
 
Molly Vencel is the research intern at the Treatment Advocacy Center.
Bipolar Depression
Media portrayals often equate “bipolar” with “manic.” In lived experience, however, it’s depression that predominates for most people. 

“We don’t fully understand the reason why this happens, but depression represents the majority of time that people with bipolar disorder tend to be ill,” says Dan Losifescu, MD, Director of Clinical Research for the Nathan Kline Institute for Psychiatric Research and an associate professor of psychiatry at the New York University School of Medicine.
 
Past research suggests that, on average, people with Bipolar I tend to experience depression three times as often as mania. In Bipolar II, that ratio is nearly 40 to 1.
 
Some individuals may stay on the elevated end of the spectrum with scarcely any time in depression or see their mood swings shift more heavily downward as they age.
 
The destructive force of mania can level relationships, careers, finances, and reputations. Severe depressive episodes can do the same.
 
Both recovery and prevention hinge heavily on self-care strategies, ideally, backed by a combination of psychotherapy and medication.
 
Medication and Psychotherapy; Hand- in-Hand Some proven talk therapy approaches for bipolar disorder:
 
  • Cognitive Behavioral Therapy (CBT) is a short-term, goal-oriented intervention focused on helping people shift negative thought patterns and habitual responses to make permanent behavior changes. A body of research affirms CBT to be effective in decreasing bipolar-related relapse rates and improving depressive symptoms, mania severity, and psychosocial functioning.

  • Mindfulness-Based Cognitive Therapy (MBCT) adds training in being present without judgment to the traditional roster of CBT skills.

  • Dialectical-Behavior Therapy (DBT) found effective for bipolar in several studies, also incorporates mindfulness skills, along with learning to tolerate distress. Other ‘modules” focus on regulating emotions and interacting with others in a way that’s assertive yet respectful.
  • Family-Focused Therapy, originally developed for schizophrenia but adapted for bipolar, combines psycho-education and family therapy. Treatment emphasizes communication and problem-solving skills.
 
  • Interpersonal and Social Rhythm was developed specifically for bipolar disorder. It aims to help people cultivate emotional stability through maintaining daily routines, developing less stressful relationships, and recognizing triggers for and early signs of manic or depressive episodes.

Research shows that exercise, yoga, meditation, and mindfulness practices ease depressive symptoms and improve mental wellness. Nourishing the brain with a healthful diet and avoiding junk food has a positive effect on mood. The role that good sleep plays in maintaining balance can’t be overstated.
 
Challenging the negative self-talk pessimistic attitudes, and other mindsets that are characteristic of and contribute to depression often requires working with a psychotherapist.  
 
The good news is there are psycho-therapies that seem to be working for bipolar depression, says, Dr. Dan Losifescu. They don’t work fast, unfortunately, but they do work.
 
“Finding the proper combination of medications for an individual with bipolar can be tricky. There’s no scientific shortcut no lab test, biopsy, genetic analysis to predict whether a particular prescription will work and at what dosage. That means giving something a try, waiting to see whether symptoms improve, then experimenting with changes to that medication, or starting over with a different one. Even when on the correct medication regime, it may take a few weeks for the depression to lift during an episode of bipolar depression," says Dr. Borenstein, president and CEO of the nonprofit Brain and Behavior Research Foundation, one of the top funders of mental health research in the U.S. outside of the federal government.
 
He states, “Progress in developing new treatments will remain slow until more resources are committed to dedicated research. Although figures vary year-to-year, research into major depressive disorder typically outpaces research into bipolar disorder by a 5 to 1 ratio, according to the National Institute of Health. An estimated $83 million will be spent in 2020 on examining what triggers and treats bipolar disorder.”





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Reference(s):

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Porterville Wellness Center is open. Visalia Wellness Center is temporarily closed for remodeling.

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Sandra Juarez, Vice President
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Donna Grigsby
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