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Psychiatry in the news: 10 February 2009


Schizophrenia is the modern leprosy – Times 5 Feb
A man with a father and sister who suffer from schizophrenia criticizes the Time for change campaign as it considers all mental health disorders equally – commented on in letters Feb 7

What makes an arsonist? – Times Feb 10
There is a rising death toll from bush fires in Australia.  Some of the fires appear to have been started deliberately…

If we had turned away Churchill – BBC 9 February
On Newsnight last night, former spin supremo Alastair Campbell talked about his mental health problems and his contribution to the Time to Change Campaign

Woman in Mind, Vaudeville Theatre, London – FT 9 February
The FT has a review of this play by Alan Ayckbourn about a vicar’s wife and the aftermath of her head injury.  Apparently the main protagonist’s difficultly in understanding her peers once injured is illustrated to the audience by the play being in gibberish itself.  Sounds like an interesting device!

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  1. I read both Sathnam Sanghera’s piece in the Times and the comments and I have to say I disagree with him. Mr. Sanghera confidently calls Schizophrenia “the most serious mental illness” – I wonder if he has investigated the mortality rates, and suicide rate in all of them. Traditionally the suicide rate for Schizophrenia is 10%, Sanghera quotes it as 10-15%. However, Palmer BA, Pankratz VS, Bostwick JM. (2005) “The lifetime risk of suicide in schizophrenia: a re-examination.” (Archives of General Psychiatry) estimated it is more like 5%.

    According to a study in Current Psychiatry (can’t find it anymore, alas.) estimates the suicide risk for Bipolar Disorder at 15.5%, Major Depressive Disorder at 14.6%. And then we have Eating Disorders. Anorexia Nervosa is thought to be the psychiatric disorder with the highest mortality rate – some studies have put it as high as 25%, some as low as 5%, so clearly there’s a lot of variation but the estimate is usually given as 20%.

    According to the Institute of Psychiatry, London, a study on hospital admissions for adult psychiatric illness in England found that out of all diagnoses considered, eating disorders had the highest proportion of admissions with a length of stay over 90 days, and the longest median length of stay (36 days). I find it hard to believe that Schizophrenia was not included in that study, but I can’t find the study itself so I concede that might be the case.

    But the point I’m trying to make is that Mr. Sanghera is obviously completely speaking out of his own personal experience, not clinical evidence. Schizophrenia is a potentially devastating illness, but generally speaking it can be successfully controlled with medication and therapy. Or, if you believe John Nash, it can even be treated successfully without medication. His idea of “recovery” is just very skewed. It’s true there’s no cure for Schizophrenia, but there’s not one for Bipolar Disorder, Major Depressive Disorder, Anorexia Nervosa, Bulimia Nervosa… etc. People with Schizophrenia can and do achieve remission of their symptoms.

    I think it’s wonderfully ironic that Sanghera criticises the Time To Change campaign for lumping all mentally ill people into one category when he himself are lumping all “Schizophrenic” people into one category and all “People With A Mental Illness That’s Not Schizophrenia” into another. He’s just creating more prejudice, misunderstanding and stigma than there already is and for that I think he’s incredibly irresponsible.

  2. I’d also like to add this.

    Sanghera says, and I quote… “[My father] had to live through decades of violent breakdowns, suicidal episodes, a period of imprisonment, endless firings from jobs due to erratic behaviour, and unexplained domestic violence before he got there.”

    Yeah? Well my grandfather who was Bipolar suffered the same things – erratic behaviour, imprisonment, suicidal episodes, etc. He eventually killed his wife, was imprisoned, and then later killed himself. Schizophrenia is not the only mental illness which affects people that way. Jesus.

    Sorry I’m just really REALLY pissed off at the stupidity of that article. I could rant about it all day but I will save that for my own blog/a letter to the editor of the Times.

  3. Sarah, the article really pissed me off as well and I’m tempted to put a letter together. We’ve noticed in our service that when these sort of stories and articles are published or broadcast they can cause some people we work with to get so anxious they end up becoming psychotic.

    I certainly respect the authors personal experience, but it is regrettable he chose to base his assertions almost entirely upon it. Furthermore, saying that people with a diagnosis of schizophrenia are as much of a risk to themselves as they are to others is also misreporting the data I think. The risk of people with a schizophrenia-spectrum diagnosis harming themselves is, as far as I know, far far greater than the risk they present to others. Keith Hawton’s recent review of suicide in this population found the ‘fear of mental catastrophe’ was strongly related to suicide attempts, while experiences such as hearing voices were thought to be protective. It’s a good review, and I recommend a read.

    Anyway, imagine a young person has just received this shaky diagnosis from their psychiatrist. Depending on the psychiatrist, they may have been told they need to take medication for the rest of their life, but there is no cure. They have an illness that follows a chronic, deteriorating course. Most of us in that situation would probably develop a ‘fear of mental catastrophe’. Given the link between that and suicide, I personally wouldn’t be surprised if then reading that Times article could be a final straw.

  4. Paul, I hope you do write to the editor of the Times in response, the more people who do the better the chance one of them will be published. I enjoyed the BJP article, it was a great read. I did think to myself when I read the Times article “god I would feel really shit reading this if I had just been diagnosed with schizophrenia” – he doesn’t paint a very hopeful picture, does he? And that kind of negative attitude is just what campaigns like Time To Change need to, um, change.

  5. Here’s a paragraph from the Shorter Oxford Book of Psychiatry which you may find interesting:

    In a 3-13 year follow up study of patients with schizophrenia discharged between 1975 and 1985 Johnson et al (1991) found that almost half had a good social outcome. In a 15-year follow up of 330 patients with schizophrenia almost one third recovered but 17 per cent remained unable to function outside hospital (Tsoi and Wong, 1991) Finally a recent 15 and 25 year follow-up study of patient cohorts in 15 countries found that one-sixth of patients had achieved full recovery: importantly late recovery was seen in a significant minority challenging therapeutic pessimism that such improvements are very rate (Harrison et al 2001)

    I’ll add the links tomorrow.

  6. It’s also crucial that we specify what we mean by ‘recovery’. This is a multi-dimensional concept rather than simply improved PANSS scores or reduced hospital admissions. People can experience recovery in relation to employment, or social functioning or in their ability to form meaningful relationships, or a whole host of other things.

    Furthermore, how many people who are initially diagnosed with schizophrenia have their diagnosis changed to schizoaffective disorder, bipolar disorder, psychosis NOS or something else if they improve? Given chronicity is built into the definition of schizophrenia, it becomes almost impossible to get better. That is, if you do get better you don’t have schizophrenia!

  7. True, there are mental illnesses which are chronic in nature and complete, enduring remission of symptoms is extremely rare, but that doesn’t mean that some kind of meaningful “recovery” is possible. That’s the problem with the article. For example, I suffer from Major Depressive Disorder. Severe affective disorders run in my family and I did not respond to SSRI treatment, so I’m not that likely to achieve complete remission and although I’m a million times better than I was in June last year when I was admitted to hospital, I still get depressed. The difference is that when I do feel down, it isn’t that really really severe, soul-crushing, suffocating depression where all you can do is crawl into bed and stay there, it’s more moderate. And instead of lasting months at a time, it lasts a few hours, a few days, maybe a week at most.

    When I’m well, apart from some problems with low self-esteem I haven’t overcome yet, I’m pretty much normal. I laugh, smile, look forward to things… things I hadn’t done in years. Things I thought I would never do again. Is it “recovery”? No, but I feel like I have my life back and my psychiatrist and I are the ones in control, not the depression. And people with Schizophrenia, from what I’ve read, can certainly aim for that too.