Schizophrenia as a brain disease: Implications for psychologists and families.

Explains why families of persons with mental illness and members of the National Alliance for the Mentally Ill (NAMI) believe that schizophrenia is a brain disease, and presents evidence for the brain disease model. Etiological models of schizophrenia are discussed and the biopsychosocial model of G. W. Engel (see record 1978-01423-001) was found to be most comprehensive. The merits of different treatments for schizophrenia and rehabilitative models are considered. The concern of NAMI members is to obtain the best treatment possible for mentally ill individuals and that goal can only be achieved with the help of mental health professionals, including psychologists. It is therefore important that psychologists and NAMI members communicate and understand each other. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Building bridges: Psychologists and families of the mentally ill.

Describes problems faced by families of the mentally ill, particularly since the caregiving system in the US provides only incomplete solutions. Psychologists have provided important support to family members coping with seriously mentally ill relatives; however, psychology's response has been incomplete. Families have helped themselves in the initiation in 1979 of the National Alliance for the Mentally Ill (NAMI), an advocacy and education organization that originated as a network of mutual support groups. The history of communication between NAMI and the American Psychological Association (APA) is outlined. The need for "building bridges" between psychologists and families of the mentally ill resulted in 2 conferences between APA and NAMI. Other steps to enhance communication between psychologists and these families are listed, including communication with legislatures and the general public about public policy agendas on mental health services and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The mental health system: Experiences from both sides of the locked doors.

Although people who have been diagnosed and treated for serious mental illness are visible as advocates and for some new paying jobs within public mental health systems, there are few psychologists actively engaged in the emerging models of consumer-provider collaboration. The key values and concepts of the consumer, and even more so the psychiatric survivor, have received too little attention. The lack of information, dialogue, and trust sustains an adversarial relationship that prevents the respectful sharing of expertise attained from different learning experiences. The knowledge gleaned from consumer/survivors' personal experiences can provide a rich resource for everyone who attempts to aid individuals engaged in the struggle to deal with these painful life circumstances. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Families, culture, and mental illness: constructing new realities

In Modern Western cultures, conceptual models of mental illness are interwoven with value systems of individualism, agency, internal locus of control, and fear of dependency. These values have translated into psychological theory and practice, affected families' relationships with the professional, legal, and consumer communities and have often exacerbated family burden. Culturally patterned attributions of individual accountability also affect family-patient interactions and may have an effect on relapse and prognosis. The family and consumer movements are discussed in terms of their orientations, services, social impact, and influence on epistemology, particularly with reference to the different effects of protective paternalism and individualistic autonomy. Questions are raised regarding cultural values and differential prognoses in modern and developing countries and whether the process of recovery may be shaped by different cultural introjects. It is suggested that the era of family and consumer empowerment may be heuristic in discovering parameters of mental illness and potential for recovery, and ideas are offered for future cross-cultural research.     

How are psychotic symptoms perceived? A comparison between patients, relatives and the general public

OBJECTIVE: The aim of this study is to compare patients with schizophrenia with their relatives and the general public in their attitudes towards schizophrenic psychotic symptoms. METHOD: We used a case vignette depicting a person with typical schizophrenic psychotic symptoms and compared the attitudes of 44 inpatients and 47 outpatients with schizophrenia, 48 of their relatives and 43 members of the general public. We also compared the attitudes of patients with schizophrenia to their own symptoms and the symptoms described in the vignette. RESULTS: Subjects from the general public tended not to recognise psychotic symptoms as features of mental illness and tended not to consider drug treatment and hospitalisation as required. Sex, education level as well as previous contact with the mentally ill were found to be significant determinants of attitude. The levels of symptom awareness in patients with schizophrenia and their relatives are higher but still relatively low. In addition, we found that patients with schizophrenia who correctly appraised psychotic symptoms in another person were also aware of their own mental symptoms and need of treatment. CONCLUSIONS: The level of recognition of psychotic symptoms and awareness of a need for treatment are low in the general public, as well as in patients with schizophrenia and their relatives. These findings are discussed in relation to the assessment of insight in patients and a need for psychoeducational programs for each group.     

Identification, characterization, and functional role of phosphodiesterase type IV in cerebral vessels: effects of selective phosphodiesterase inhibitors

Research on families of people with severe mental illness has identified significant caregiving burden. Although professional interventions generally assume that families have a major role in the client's progress, the focus of the consumer movement on recovery through empowerment, peer supports, and consumer-run services may have important, as yet unquantified, effects. Keeping in mind the functional heterogeneity of individuals with mental illness, it is suggested that consumer emphasis on autonomy may provide the major relief for family burden.     

The consumer–survivor movement, recovery, and consumer professionals.

This article presents a brief history of the consumer-survivor movement in the United States, including the basis for various viewpoints within that movement. The authors also describe the concept of recovery that has arisen primarily from within the consumer movement and how it offers an important perspective for mental health providers. Also described is the impact of stigma and discrimination, which are especially destructive when they come from mental health providers. Finally, the authors explore the importance and utility for consumers to have mental health providers who themselves have experienced a serious mental illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Blame, shame, and contamination: The impact of mental illness and drug dependence stigma on family members.

Family members of relatives with mental illness or drug dependence or both report that they are frequently harmed by public stigma. No population-based survey, however, has assessed how members of the general public actually view family members. Hence, the authors examined ways that family role and psychiatric disorder influence family stigma. A national sample (N = 968) was recruited for this study. A vignette design describing a person with a health condition and a family member was used. Family stigma related to mental illnesses, such as schizophrenia, is not highly endorsed. Family stigma related to drug dependence, however, is worse than for other health conditions, with family members being blamed for both the onset and offset of a relative's disorder and likely to be socially shunned. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Rejoinder to Robert F. Morgan's review of psychobattery.

The present author applauds Robert F. Morgan's stated efforts in his review (see record 2007-04428-001) of the author's book, Psychobattery, (1981) to form "an ombudsman group to improve professional practice and protect the consumer." However, the present author does not approve of Morgan's inability to interpret straightforward statements in Psychobattery. He first seems to have completely missed the point that the book is about serious mental illness; essentially schizophrenia and bipolar and unipolar affective diseases. If Morgan were more interested in reviewing Psychobattery, instead of ventilating his prejudices in favour of unproved treatments by unqualified personnel, perhaps he would have mentioned the chapter of "The Biological Basis of Mental Illness." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Demographic, clinical, and neurocognitive correlates of everyday functional impairment in severe mental illness.

Although cognitive deficits often accompany severe mental illness, their implications for everyday functioning remain poorly understood. In this study, an occupational therapist (OT) rated the everyday functioning of 105 adult psychiatric patients. Using demographic, clinical, and cognitive variables, the authors tested alternative models to account for the observed variability in OT ratings. Although age, education, and the presence of schizophrenia each contributed to a model that accounted for 27% of the variation in functional independence, adding terms for auditory divided attention and verbal learning increased the proportion of explained variance to 45% and decreased the beta weights for age and education—but not schizophrenia—to nonsignificant levels. These findings demonstrate the relevance of cognitive performance to everyday functioning in severe mental illness. They are discussed with respect to hypothesized determinants of psychiatric disability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emerging trends in mental health policy and practice

The continuing deinstitutionalization of patients in public mental hospitals and the growth of managed care are fundamentally altering mental health practice. Managed care provides opportunities for achieving parity of insurance coverage between mental and physical illness, but serious problems persist in integrating mental health, substance abuse, and general medical care and assuring an appropriate range of services and programs for persons with serious mental illness residing in community settings. Hospital and community care are poorly coordinated, and hospital care needs to be integrated into a more balanced system of services. Important new roles are emerging for purchasers, patient advocates, and mental health authorities.     

Food-contact epoxy resin: co-variation between migration and degree of cross-linking

The last decade has witnessed the increasing importance of consumers as providers of mental health services. Assertive Community Treatment (ACT) teams and ACT variants, with their emphasis on rehabilitation and support in the client's natural environment, have hosted consumer-professional collaborations. The authors discuss one such program in which an ACT program for homeless mentally ill adults employed consumer advocates (CAs). Consumer advocates were found to have a service profile similar to other staff. Further, there is suggestive evidence that the employment of CAs created a more positive attitude toward persons with mental illness. Issues of role definition, boundaries, support with supervision and the importance of CAs' experiences with mental illness are discussed.     

Families of psychiatric patients: a critical review and future research directions

It is generally acknowledged that mental illness creates burdens for family caregivers. Since the 1950s, medical literature has identified the type and extent of those burdens, especially for families of patients with schizophrenia. Whereas the imperative to identify interventions for these families is clear, there has been a lack of systematic research of families' responses to and management of mental illness, resulting in significant gaps in knowledge. The rapidly changing health-care environment suggests that our understanding of families' responses to mental illness need to be reexamined for current relevance and new insights. This article critically examines the research to date and identifies gaps in knowledge related to family experience of mental illness. It argues the need to continue studies of caregiver burden and the stress resulting from that burden. Future directions for research are suggested.     

Detection of serum transforming growth factor-alpha in patients of primary epithelial ovarian cancers by enzyme immunoassay

OBJECTIVE: To survey the social outcome of patients with schizophrenia attending State mental health facilities in southern Tasmania. METHOD: Using the Statewide Mental Health Register, patients using inpatient and outpatient facilities who received a diagnosis of schizophrenia between 1981 and 1988 were identified (n = 771), and demographic and illness measures, and admissions and length of inpatient stay were compiled. The Life Skills Profile (LSP) was completed by mental health personnel for the 247 who were regular attenders or inpatients in 1991. RESULTS: Social morbidity as indexed by the LSP was highest in psychiatric hospital inpatients and patients in long-term rehabilitation programs, and lower in patients attending community centres. The majority of patients in suburban settings and attending community centres lived with their families, whereas patients in the inner city or in the rehabilitation service were mainly in hostel accommodation or living alone. Patients with schizophrenia attending State services were of a similar age range but had a longer duration of illness and more admissions, and had spent more days in hospital than patients who were not in regular contact with the service. CONCLUSIONS: The distribution of social morbidity in schizophrenia confirms that the public health system is supporting a group with high social morbidity. Patients with the highest morbidity are receiving the highest levels of care and intervention.     

Psychiatric care and health insurance reform

Concerns about cost, access, and quality of health care in the United States have led to a variety of legislative proposals that would reform our health care system and its financing. Health insurance benefits for mental illness, including substance abuse, are treated differently from medical/surgical benefits, with stricter limits on outpatient visits and hospital days. Medicare, Medicaid, and most private health insurance plans contain this historic disparity of coverage for mental illness compared to general medical illness. Psychiatric services are also distinguishable because of the large public sector reimbursement for mental illness treatment and support. Principles for a more equitable design of mental health benefits include a non-discriminatory approach; payment on the basis of service rather than diagnosis; application of cost containment for care of mental illness on the same basis as care of general medical illness; retention of the public sector as a backup system for high-cost, long-term care; encouragement of lower-cost alternatives to the hospital through the development of a continuum of care; and a recognition of the distinction between psychotherapy and medical management. All current approaches to universal health care fall short of these principles. A research agenda is needed now more than ever in order to articulate the case for complete coverage of mental illness and substance abuse.     

Illness, Responsibility, and Intervention.

In a recent article (Amer. Psychologist, 1961, 16, 69-74; see record 1962-03334-001), Ausubel has questioned Szasz' position that mental illness is a disease process only by virtue of its having been so labeled. While Szasz' position seems to imply that the mentally ill patient is responsible for his behavior rather than being a passive participant in an ego-alien disease process, Ausubel contends that most mentally ill patients should be considered to be victims of a disease process and accorded the same exemption from ethical considerations as is enjoyed by people with any illness. While both positions seem to be well argued, it appears that the authors have neglected a possible alternative to the two extremes of responsibility versus no responsibility in the so-called mental illness (or any other illness, for that matter). The current author suggests that at different points in the longitudinal process we call mental illness, patients' responsibility for their behavior will vary. An analogy we might use in discussing responsibility in mental illness is peptic ulcer. During the preulcer phase when anxiety is the dominant symptom, we can and should hold the individual responsible for learning more effective methods for meeting the stresses of life than he now employs. Similarly, during the postulcer phase, we can and should hold the individual responsible for not utilizing his ulcer for secondary gain. However, during the ulcer phase when the gastric hyperacidity actually erodes the gastric mucosa, the ulcer per se follows physiological laws more closely than it does psychosocial laws. Perhaps this alternate view of patient responsibility during any pathological process will help the helping professions to clarify their responsibilities in the treatment of the "sick" individual. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The prevalence of allergic rhinitis and nasal symptoms in Nottingham

An overview of the most important older and newer results regarding the relationship between violent and criminal behavior on the one hand and schizophrenic illness on the other hand is presented. Four different methods are available to study this relationship: (i) study of the prevalence of mental illness in criminal/violent populations; (ii) study of criminality/violence rate in samples of psychiatric patients; (iii) study of criminality/violence in community samples comparing mental patients with non-patient community residents; and (iv) study of criminality/violence in birth cohorts prospectively. All these methods have been used; but samples composed of schizophrenic patients exclusively were only exceptionally studied. The results indicate that there is a modest but significant relationship between schizophrenia and violence and crime which persists even after controlling for demographic and socio-economic variables. The probability of schizophrenic patients to be criminal or violent depends on the acuity of their illness and is increased by their use of psychoactive substances. Generally, however, violent and criminal acts directly attributable to mental illness account only for a very small proportion of such acts in the society.     

The social course of schizophrenia: local and societal factors

In this paper, we propose a model of social course of schizophrenia based on cross-cultural research on the influence of family, wider social network, work, political economy, and legal and mental health care institutions on the experience of illness. We posit the way these ordinary arrangements of daily living organize the course of schizophrenia in part through cultural processes that affect the body-self in suffering and in part through social processes that establish an intersubjective matrix for the experience of illness. We believe this model can be generalized to other chronic illness such as depression, diabetes, asthma, osteoarthritis, chronic pain syndrome, chronic fatigue syndrome, and even heart disease and cancer. We develop the implications of this anthropological approach for research and practice.     

Schizophrenia--an illness and its treatment reflected in public attitude

Stigmatization with regard to mental illness and especially schizophrenia has been known from time immemorial. Meanwhile the negative attitudes have become metaphorical for unpredictability, violence, and bizarrely (grotesquely) contradictory behaviour. Persons concerned with these prejudices are excluded from the society and there is little willingness for contact. Particularly afflicted are also the relatives of schizophrenic persons. Media and motion pictures play an essential role in the maintenance of these negative attitudes. There will be suggestions (stimuli), especially by opinion leaders, to reach a change of the attitudes towards diseases and their methods of treatment.     

Failure of a moral enterprise: Attitude of the public toward mental illness.

Presents a critical analysis of published reports on the public's attitudes toward mental illness and toward deviant conduct. The mental health movement fits the defining criteria for a moral crusade, motivated and supported by moral entrepreneurs. The reported data indicate that the mental illness paradigm, as a formula for understanding and controlling deviant conduct, has not been widely accepted by the public. The central objective of the mental health movement has been to influence the general public to regard mental illness with the same nonrejecting valuations as somatic illness. Social survey reports and other data point to the conclusion that the public tends to declare negative (rejecting) valuations on persons diagnosed as mentally ill. However, the public tends to be more tolerant of deviant conduct when it is not described with mental illness labels. (37 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)