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1 NAMI PA ALLEKISKI A Family Support Group Affiliated with the National Alliance On Mental Illness. "Until There's A Cure, There's Nami" President Mary K. Slater, 603 Clyde St., New Kensington, Pa 15068, mkslater@gmail.com.,contact Person & Bulletin Editor Thad Kaminski 1802 Kimball Ave., Arnold, PA E mail: tkaminski1@verizon.net if you would like to subscribe to this letter free by . Meetings every second Tuesday of the month, Family Services Bldg, 310 Central City Plaza off Ninth St. New Kensington. Next meeting Tuesday December 8 at 6PM Thanks to the following members for promptly sending in their dues. It makes our job a little easier: Julie Kostenbader, Joe Piontkowski, Elaine Detman, Thad Kaminski, Greg Kaminski, Eileen Londino, Bill Reitler, Jo Turano, Patricia Helsley, Eileen Carvin. Bill Oplinger. LOCATION, LOCATION, LOCATION: GOLD STANDARD SCHIZOPHR RENIA TREATMENT VARIES BY STATE Dramatic differences exist in how widely clozapine widely regarded as the gold standard of schizophrenia treatment is prescribed from state to state, according to a new report published by the Treatment Advocacy Center. Clozapine for Treating Schizophrenia: A Comparison of the States found that, in South Dakota, nearly 16% of individuals with schizophrenia on Medicaid receive clozapine (trade name: Clozaril). In Nevada, Oregon and Louisiana, only 2% do. The use of clozapine can be regarded as a measure of the effort being made by a state to treat individuals with schizophrenia who are most in need of treatment, concluded the report authored by Treatmentt Advocacy Center founder E. Fuller Torrey, MD, and three distinguished co-authors. And based on Medicaid and pharmacy prescription data, not much effort is being made. Only six states were found to be reaching what a prominent psychopharmacologist calls the bare minimum of treating at least 10% of the candidate population with clozapine. At the other end of the spectrum, in nine states, fewer than 3% of candidates weree receiving it. This compares with Germany, where 20% of the candidate population receives clozapine; China, 30%; and Australia, 35% %. Nationwide in the US, fewer than 5% of individuals with schizophrenia are being treated with clozapine. Clozapine is the only antipsychotic medication ever approved by the FDA for the prevention of suicide and for treating the 20-30% of people with schizophrenia whose symptomss are treatment-resistant. It is considered the most effective medication in particular for individuals who are suicidal or violent, half of whom improve on the drug. At the same time,, clozapine must be discontinued in 1 out of every 6 individuals because of side effects, according to the report. The most serious side effect is a condition called neutropenia, in which white blood cells are significantly reduced. Neutropenia is extremely rare occurring in about 8 in every 1,000 individuals taking the medication but can result in death if unaddressed. Individuals taking clozapine undergo regular blood testing to monitorr their white blood cell counts. Readd the full report, Clozapine for Treating Schizophrenia: A Comparison of the States, to learn more. The study is based on an analysis of data collected by the Institute for Health, Health Care Policy and Aging Research at Rutgers University for the Stanley Medical Research Institute, a supporting organization of the Treatment Advocacy Center. It is co-authored by Michael B. Knable, DO and Cameron Quanbeck, MD, members of the Treatment Advocacy Center board of directors, and John M. Davis, MD, professor of psychiatry at the University of Illinois at Chicago and a member of the organization s Psychiatric Advisory Board. Medicaid Redesign and Expansion: Can We Have One Without the Other?? Monday, November 16th at 2:00 p.m. EST Withh the Supremee Court s ruling on Affordable Care Act came the option for states to expand their Medicaid programs. To date, 31 states, including the District of Columbia, have chosen to expand Medicaidd and receivee federal funding for the program at 100% for , and gradually decrease to 90% by Twenty remaining states have not chosen to expand Medicaid. In either case, it seems that our work is not done. Even among the 31 states/dc that have expanded Medicaid, the process for expansion and decisions to redesign theirr Medicaid delivery system vary. Moreover, among the 20 states thatt have not expanded, some state legislatures and governors have indicated that Medicaid first needs a redesign or reform before expansion can 1

2 take place. What, then, is the best prescription for Medicaid: Redesign and expansion, or one without the other? Does immune activity affect schizophrenia? Published: Friday 16 October 2015 at 12am PST Immune cells are more active in the brains of people at risk of schizophrenia, as well as those already diagnosed with the disease, according to a study published in the American Journal of Psychiatry. The new study suggests immune cells are more active in the brains of those at risk for schizophrenia. The discovery could offer a new approach to treating this chronic, severe and disabling brain disorder that has affected people throughout history. Schizophrenia occurs in 1% of the general population, but it occurs in 10% of people who have a first-degree relative with the disorder, such as a parent, brother or sister. Treatment for the disorder so far has focused on an imbalance in the complex, interrelated chemical reactions of the brain. By targeting the neurotransmitters dopamine and glutamate, antipsychotic medicines have been used to control it. However, the drugs often have side effects, and if patients stop taking them, they relapse. The new findings raise the possibility that early testing of those most at risk could enable them to be treated early enough to avoid the most severe symptoms of the disease. Researchers at the Medical Research Council's (MRC) Clinical Sciences Centre, based at Imperial College London - in collaboration with colleagues at King's College London - used positron emission tomography (PET) scans to measure levels of activity of immune cells in the brain. Higher levels of microglia in people with schizophrenia The immune cells, known as microglia, respond to damage and infection in the brain. They are also responsible for "pruning," where connections between brain cells are rearranged to make them work as well as possible. The team tested a group of 56 people, of whom some were already diagnosed with schizophrenia, some were at risk of the disease and others had no symptoms or risk of the disorder. They found that activity levels of microglia in the brain increased according to the severity of symptoms in people with schizophrenia, and that people with diagnosed schizophrenia had high levels of activity of these immune cells in their brain. Peter Bloomfield, lead author of the study at the MRC Clinical Sciences Centre, says: "Our findings are particularly exciting because it was previously unknown whether these cells become active before or after onset of the disease. Now we have shown this early involvement, mechanisms of the disease and new medications can hopefully be uncovered." The effects of schizophrenia can be devastating for patients and families. Patients may experience delusions or hallucinations and believe that other people are reading their minds, controlling their thoughts or plotting to harm them. This can terrify people with the illness and make them withdrawn or extremely agitated. Prevalence in the US is around 1.1% of the population Of people with schizophrenia, 90% of men will show symptoms by age 30, but only 20% of women 10% of people with the disease will take their own lives. Learn more about schizophrenia Dangerous or inappropriate behavior can also result, as well as some risk of substance abuse and suicide. Many people with schizophrenia have difficulty holding a job or caring for themselves, so they rely on others for help. Dr. Oliver Howes, head of the psychiatric imaging group at the MRC Clinical Sciences Centre, describes schizophrenia as a "potentially devastating disorder," for which new treatments are desperately needed. He believes this study is promising, as it suggests that inflammation may lead to schizophrenia and other psychotic disorders, pointing the way for new developments. The next step will be to test whether anti-inflammatory treatments can target such disorders, to allow the disorders to be treated in a more effective way, or better still, prevented. Prof. Hugh Perry, chair of the Neuroscience and Mental Health Board at the MRC, says we know that genetic and behavioral factors play a part in schizophrenia, but to find that inflammation in the brain could be a factor brings hope for life-changing treatments. He adds that there could also be implications for other disorders, such as Alzheimer's disease and depression. Written by Yvette Brazier Copyright: Medical News Today Greater stress, depression risk for teens with lots of Facebook friends 2

3 Published: Wednesday 18 November 2015 at 7am PST The more friends a teenager has on Facebook, the more stressed they are likely to be, which may increase their future risk for depression. This is according to a new study published in the journal Psychoneuroendocrinology. [A teenager using a laptop] Researchers say the more Facebook friends a teenager has, the higher their stress levels are likely to be. Social media use among teenagers has grown rapidly in recent years. According to a 2012 study from Pew Research Center, around 81% of teenagers aged who are active online use some form of social media, and 71% of them use Facebook. While such sites can help people stay connected, numerous studies have suggested their use may have negative health implications, particularly for adolescents. In September, for example, Medical News Today reported on a study suggesting social media pressure in teenagers may lead to anxiety and depression. Now, study leader Prof. Sonia Lupien, of the Department of Psychiatry at the University of Montreal in Canada, and colleagues find that the number of friends teenagers have on Facebook may impact stress levels - potentially influencing their later-life depression risk. More than 300 Facebook friends increased stress levels To reach their findings, the team recruited 88 teenagers aged boys and 47 girls. Fast facts about social media As of this year, around 73% of Americans have a profile on at least one social media site Around 60% of teenage Facebook users set their Facebook profiles to private 1 in 4 teenage social media users say they post fake information on social media sites. Learn about how social media may impact health They asked them about their Facebook behavior, including how often they used the social media site, how many friends they had on the site, their self-promoting behavior and supporting behavior toward Facebook friends - such as "liking" the posts of others. In addition, participants were asked to provide four samples of cortisol - a hormone released in response to stress - four times a day for 2 consecutive days. Compared with teenagers who had fewer than 300 Facebook friends, those who had more than 300 friends on the social media site had higher cortisol levels. "We can therefore imagine that those who have 1,000 or 2,000 friends on Facebook may be subjected to even greater stress," notes Prof. Lupien. The researchers point out that participants' heightened stress levels were not purely down to Facebook; other external factors played a part. However, they estimated that Facebook was responsible for around 8% of increased cortisol levels. The researchers also identified a reduction in cortisol levels among teenagers who supported friends on the social media site by "liking" their posts or sending them encouraging words. Higher cortisol levels in teens may indicate future depression risk Prof. Lupien and her team say that, while they did not observe any symptoms of depression among participants, their findings suggest that teenagers with a higher number of Facebook friends may be at greater future depression risk. "[...] Adolescents who present high stress hormone levels do not become depressed immediately; it can occur later on," explains Prof. Lupien. "Some studies have shown that it may take 11 years before the onset of severe depression in children who consistently had high cortisol levels." The authors say further research is warranted to determine whether their findings can be replicated in children and adults who use Facebook. "Developmental analysis could also reveal whether virtual stress is indeed 'getting over the screen and under the skin' to modulate neurobiological processes related to adaptation," adds Prof. Lupien. Contrary to this new research, a study reported by MNT earlier this year suggested social media use is not directly associated with stress. Tougher disability benefit assessment may have taken "serious" toll on mental health Published: Tuesday 17 November 2015 at 12am PST Higher reassessment rate linked to more suicides, mental ill health, and antidepressant use. The introduction of a more stringent test to assess eligibility for disability benefit in England may have taken a "serious" toll on the nation's mental health, concludes research published online in the Journal of Epidemiology & Community Health. Since 2010 the test, known as the Work Capability Assessment (WCA), has been used to assess the eligibility of claimants of the main out of work disability 3

4 benefit, in a bid to get more people back into the workplace and help curb the government's rising welfare bill. But areas with the greatest use of the WCA to assess existing claimants have seen the sharpest rises in reported suicides, mental health issues, and antidepressant prescribing, the findings show, prompting the researchers to question the wisdom of introducing this policy. Doctors and disability rights organisations have voiced fears that use of the tough new criteria to measure incapacity to work is undermining the mental health of claimants. However, up till now, there has been no hard evidence to substantiate these concerns. To find out if there was any link between use of the WCA and a rise in the prevalence of mental health issues, the researchers analysed the numbers of disability assessments carried out in 149 local authorities in England between 2004 and They looked at local trends in suicide rates among 18 to 64 year olds; antidepressant prescribing patterns; and Labour Force Survey data on self-reported mental health issues among the working population in each local authority. Between 2010 and 2013, more than one million (1.03) people claiming disability benefit were reassessed using the WCA. A higher proportion of people living in areas of deprivation were reassessed. The analysis showed that in those areas with higher rates of reassessment, there was a corresponding increase in suicides, mental health issues, and antidepressant prescribing. After taking account of the impact of baseline deprivation, economic trends, and long term trends in mental health, the researchers calculated that, there were around six extra suicides, 2700 more cases of mental ill health, and an extra 7020 prescriptions for individual antidepressants for every 10,000 people reassessed during this period. This adds up to a total of 590 additional suicides, 279,000 extra cases of mental ill health and 725,000 more prescriptions for antidepressants across the country as a whole that were associated with the reassessment policy between 2010 and This is an observational study, so no firm conclusions can be drawn about cause and effect. None the less, the researchers point out that they were at pains to adjust for other potentially influential factors, and that the observed increases in mental ill health followed - rather than preceded - the reassessment process. The findings have important implications for policy, they say, particularly as this was introduced without any evidence of its potential impact or any plans to evaluate its effects, added to which a further 1 million people will have been reassessed in The policy also raises ethical issues for the doctors involved, given that they have professional and statutory duties to protect the health of patients and the public, they add. "Our study provides evidence that the policy in England of reassessing the eligibility of [disability] benefit recipients using the WCA may have unintended but serious consequences for population mental health, and there is a danger that these adverse effects outweigh any benefits that may or may not arise from moving people off disability benefits," they write. "Although the explicit aim of welfare reform in the UK is to reduce 'dependency,' it is likely that targeting the people living in the most vulnerable conditions with policies that are harmful to health, will further marginalise already excluded groups, reducing, rather than increasing, their independence," they conclude. Adapted by MNT from original media release Eat vanilla yogurt, be happy, says research Published: Saturday 14 November 2015 at 12am PST Being pleasantly or unpleasantly surprised by the taste of something can change a person's mood, according to research published in Food Research International. [vanilla yogurt] Vanilla yogurt elicited a positive emotional reaction in tests, researchers say. There is a growing conviction that emotional reactions to the consumption of foods or the perception of fragrances play an important role in the acceptance of products in the market. However, it is not clear how to measure this reliably. Previous tests have had the disadvantage of being heavily language-based, of tending to suggest feelings that people might have but perhaps never did, and of fixating the respondent's explicit attention on the food or the odor under consideration, rather than on implicitly expressing their feelings. In the search for a simple method to measure implicit and unconscious emotional effects of food consumption, a team of researchers from the Netherlands, Austria and Finland, used four different techniques to measure people's emotional responses, and to find out what emotional effects, if any, eating different yogurt had on people. 4

5 Testing for emotional reactions to food Three groups of at least 24 participants were each given a pair of yogurts to taste, and the four tests were carried out around this activity. The pairs of yogurts were of the same brand and were marketed in the same way, but they had different flavors or fat content. The four methods used to measure emotional response were: Face reading during consumption A new emotive projection test (EPT) An autobiographical reaction time test based on mood congruency Eye tracking to measure the impact of the packaging. EPT was used to determine the effect of different yogurts on people's moods. It involved showing participants photographs of other people and asking them to rate the people in the photographs on six positive and six negative traits before and after eating the yogurt. The idea is that people project their emotions onto others, thus giving an indication of their own mood. The eye-tracking test aims to characterize gazing behavior and visual attraction of stimuli, and was used to evaluate the food packaging. Gazing behavior can be influenced by emotional reactions, but the results of the eye-tracking measurements are not able to describe emotion states. Results from the face-reading test were hindered due to technical difficulties, and the autobiographical test results were not significant, but the other tests yielded interesting results. Comparing eye-tracking measurements before and after eating the yogurt showed the effects of familiarity but not necessarily emotion. The team found that that liking or being familiar with a product had no effect on a person's emotion. What did affect the emotions was changes in attitude to the food after tasting it. Being pleasantly surprised or disappointed about the food appears to influence people's moods. Positive response to low-fat yogurts The team also looked at the sensory effect of the yogurts. There was no difference in the emotional responses to strawberry versus pineapple yogurts, but low-fat versions led to more positive emotional responses. Most strikingly, vanilla yogurt elicited a strong positive emotional response, supporting previous evidence that a subtle vanilla scent in places like hospital waiting rooms can reduce aggression and encourage relationships among patients and between patients and staff. The team found that eating vanilla yogurts made people feel happy and that yogurts with lower fat content gave people a stronger positive emotional response. They also found that even if people reported differences in liking them, yogurts with different fruits did not show much difference in their emotional effect. Lead author of the study, Dr. Jozina Mojet from the Netherlands, says: "This kind of information could be very valuable to product manufacturers, giving them a glimpse into how we subconsciously respond to a product. We were surprised to find that by measuring emotions, we could get information about products independent from whether people like them." Traditionally, products have been trialled using explicit methods, such as directly asking people how they feel. In contrast, the new method is implicit and therefore not controlled by people's conscious thought. Dr. Mojet believes that sensory and consumer research should be conducted in an ecologically valid way and suggests this sort of implicit method can reveal the complex interactions between the different factors involved, which may be affected by the individual's memory and expectations. Medical News Today reported on research suggesting that fat should be added to the basic senses of taste: salt, sweet, sour, bitter and umami. Written by Yvette Brazier Depressed? Look For Help From A Human, Not A Computer By Lynne Shallcross November 12, 2015 Almost 8 percent of Americans 12 and older dealt with depression at some point between 2009 and With that many of us feeling blue, wouldn t it be nice if we could simply hop on the computer in our pajamas, without any of the stigma of asking for help, and find real relief? Online programs to fight depression are already commercially available, and while they sound efficient and cost-saving, a study out of the U.K. reports that they re not effective, primarily because depressed patients aren t likely to engage with them or stick with them. depressed businessman with laptop The study, which was published in The BMJ on Wednesday, looked at computer-assisted cognitive behavioral therapy and found that it was no more 5

6 effective in treating depression than the usual care patients receive from a primary care doctor. Traditional cognitive behavioral therapy (CBT) is considered an effective form of talk therapy for depression, helping people challenge negative thoughts and change the way they think in order to change their mood and behaviors. Online CBT programs have been gaining popularity, with the allure of providing low-cost help wherever someone has access to a computer. This KHN story also ran on NPR. It can be republished for free (details). logo npr A team of researchers from the University of York conducted a randomized controlled trial with 691 depressed patients from 83 physician practices across England. The patients were split into three groups: one group received only usual care from a physician while the other two groups received usual care from a physician plus one of two computerized CBT programs, either Beating the Blues or MoodGYM. Participants were balanced across the three groups for age, sex, educational background, severity and duration of depression, and use of antidepressants. After four months, the patients using the computerized CBT programs, or ccbt, had no improvement in depression levels over the patients who were only getting usual care from their doctors. Uptake and use of ccbt was low, despite regular telephone support, the study authors wrote. Almost a quarter of participants dropped out within four months, and patients noted the difficulty in repeatedly logging on to computer systems when they are clinically depressed. It s an important, cautionary note that we shouldn t get too carried away with the idea that a computer system can replace doctors and therapists, says Christopher Dowrick, a professor of primary medical care at the University of Liverpool, who wrote an accompanying editorial. We do still need the human touch or the human interaction, particularly when people are depressed. The lack of patient engagement in this study means these programs aren t the panacea that busy doctors and cost-conscious health care officials might be hoping for, Dowrick wrote in the editorial. Yet it s important to note that the study was conducted in a primary care setting, he says, because many other studies on ccbt that show some benefit have been conducted in psychological settings, where patients might be more motivated to engage with these kinds of online programs. Despite the unenthusiastic findings of the study, Dowrick says that do-it-yourself treatments like ccbt can still be effective. But they re more likely to succeed when people have relatively mild symptoms of depression or are in a recovery stage the participants in this study were mostly in the category of moderate to severe depression, he says. Computerized CBT is also more likely to succeed, he adds, if the patients are open to seeking help on a computer and when they have a reasonable amount of guidance as they go through the program, preferably from a therapist. In this study, he says, participants each totaled roughly six minutes of telephone support and guidance. Being depressed can mean feeling lost in your own little small, negative, dark world, Dowrick says. Having a person, instead of a computer, reach out to you is particularly important in combating that sense of isolation. When you re emotionally vulnerable, you re even more in need of a caring human being, he says. Call for help numbers Achieva.com Support for Disabled Alanon Allegheny Valley Hospital Allegheny County Family Services Treatment Team Legal Services Public Welfare Director s Action Line E mail: dal@alleghenycounty.us Resolve Crisis Intervention Ombudsman Apprise Free Health Insurance Counseling Best Health Borderline Personality Support Group Children With Challenging Behaviors Community Care Member Services Depression & Anxiety Eating Disorder Web www. something fishy.org or http.//trfn.clpgh.org/ Family Services of W.PA Crisis Line New Ken office All other calls Community treatment Westmoreland Cty Warm Line Gateway Health Choices Ombudsman Mental Health America Allegheny County Med Plus Nami Help Web Sites up. Nami of S.W. PA Toll free nami swpa( ) info@namiswpa.org National Nami Help Line Nami(6264) National Suicide Prevention Lifeline at TALK 6

7 Obsessive Compulsive Support Group x 15 PA Health Law Project Janice Meinert E mail: staff@phlp.org PA Educational Network for Eating Disorders Physical Health Plans Member Services: Prescription cost help Needy Meds Apply on line Recovery Inc., Coping Skills for Consumers Research Causes of Schizophrenia Research Brain Tissue Donation Survivors of Suicide WPIC Contact Sue Wesner SAMHSA TALK (8255) Trichotillomania Support x 15 Value Behavioral Health Westmoreland County Mental Health America Westmoreland County Toll free Westmoreland Case Management Westmoreland Mental Health Westmoreland Cty Crisis Westmoreland Public Welfare Laurel Legal Services Laurel Legal Services Kathleen Nagy Kemp Area Agency Aging Share the Ride Program County Court House In this issue.remember to get your dues payment in early, thank you!! Gold standard SZ treatment, Medicaid redesign, Does immune activity offset schizophrenia, Stress and depression for teenagers with Facebook, Tougher disability rules take toll on mental health, Be happy eat vanilla yogurt, Depressed? See humans not a computer. Call for help numbers. All Senate offices can be reached by calling Advocates can reach their House member by calling Rep. Eli Evankovich NK Office US Congress..toll free Nami PA Alle Kiski Affiliate Thad Kaminski, Editor 1802 Kimball Ave., Arnold, PA

8 Next Meeting Tuesday December 8 at 6 PM 8