People with schizophrenia struggle to turn goals into actions because brain structures governing desire and emotion are less active and fail to pass goal-directed messages to cortical regions affecting human decision-making, new research reveals.
Published in Biological…
The “negative” symptoms of schizophrenia - such as the lowered cognitive functioning, loss of motivation, and decreased affect - are often more problematic to individuals experiencing psychosis than the “positive” (delusions, hallucinations). It’s important to note that antipsychotics do not address the negative symptoms. Thus, it becomes essential that the individual and the family maintain structure and easy-to-follow system that helps people adjust and meet their goals.
Expressed emotion, or EE, refers to how family members spontaneously and negatively talk about the person in the family experiencing psychosis (or any other mental or physical condition). Family members with high expressed emotion are frequently hostile, critical, and intolerant of the person experiencing illness. Often, they believe that they are helping or giving advice. This can be the result of emotional over-involvement with the person experiencing illness and a lack of healthy boundaries. Usually, the person him or herself is blamed for their symptoms, rather than the disorder.
High EE can trigger symptoms or make them worse and more frequent. Research has demonstrated that individuals from families with high “expressed emotion” are 3.7 times more likely to relapse than in families from low expressed emotion families (where emotions are expressed calmly and without hostility/criticism). It’s important for family members to remember:
1) Remaining calm will help both the person experiencing illness and the family environment.
2) Don’t get angry over what can’t be controlled. Setting limits and boundaries are important, but prepare yourself to be in unexpected situations that are beyond your power to change.
3) Understand that the person’s actions can be a result of the illness, rather than behavioral problems.
4) Give the person space when they need it.
4) Have patience and compassion for yourself. Take time for your needs and seek out support. It can be tempting to focus exclusively on “fixing” the person experiencing illness. However, focusing too much can be overwhelming for that person, and unsustainable for family members
Low EE is vital to recovery - both for the person experiencing illness and the family itself. Take the time to consider your family’s communication patterns and assess if they are helping recovery to be successful.
"My good fortune is not that I’ve recovered from mental illness. I have not, nor will I ever. My good fortune lies in having found my life."
EDIPPP Intervention Reduces Conversion to Full-Blown Psychosis Among At-Risk Young People, Says RWJF-Funded Study Early Intervention Model Is Effective, Warrants Expansion,…
Directly educating community members and actively involving families in treatment can avoid the onset of full psychosis among at-risk young people and keep them in school and working, according to a new Robert Wood Johnson Foundation-funded study. The national Early Detection and Intervention for the Prevention of Psychosis Program (EDIPPP) demonstration shows how a package of pre-emptive services can prevent young people exhibiting the earliest signs and symptoms of a psychotic disorder from converting to full blown psychosis – enabling them to continue working and attending school.
There's a guy who stops me in the street every day on my lunch break from work. He is part of the Krishna movement and makes me smile with his bubbly-ness. Recently he has upset me, though. We got on to the subject of depression and I said that I am on anti-depressants. He looked alarmed. He explained that I was in danger. That they are designed to kill you and I needed to try things like vitamins and john's wart. I don't understand. Are they dangerous?
Religious/spiritual people are always going to have their own strong opinions on subjects like these, which I’m happy to respect if they want to apply those values to their own lives, but I think it’s wrong of people like this guy to spread information that isn’t supported by any legitimate research or evidence. A lot of the time they are only trying to help but they end up doing more harm than good honestly.
Antidepressants, as with any substance (including vitamins, St John’s wort & other ‘natural’ remedies) do have some potential side effects, but medical research has proven that they are generally considered safe & in fact that the effects of an untreated mental illness are far more dangerous. If you’ve been prescribed them by a doctor, he or she would have assessed your situation and determined that the benefits of medication outweigh the potential risks.
As for vitamins, although many people believe that they’re doing themselves good by taking very high doses of multivitamins & such, they are really only helpful in certain situations where a person isn’t able to maintain adequate levels of these vitamins or minerals from their regular diet. If you don’t have a deficiency of a vitamin there is little point in taking one, and the excess levels of the vitamin you consume will actually just end up being excreted from your body as it can only store so much. Your doctor will be able to test you for vitamin or mineral deficiencies & recommend a supplement if you do need one.
St John’s wort is thought to be helpful in treating some cases of depression, but the evidence is limited & as mentioned above it has potential negative side effects as well (natural doesn’t always equal safe!). Whatever you do please don’t start taking St John’s wort while you’re still on antidepressants or if you’ve taken antidepressants recently as there is a high risk of interaction between the two substances, & don’t stop taking your meds without consulting a doctor as stopping suddenly can have harmful effects on you.
My advice would be to carry on taking your antidepressants as prescribed, discuss any concerns you have with your doctor, & if the subject comes up with people other than medical professionals (such as this guy), tell them you’d rather not talk about it with them.
Hope this helps
This is great advice, but I just wanted to point out that the research on antidepressants has generally indicated them to be helpful only in the case of very severe depression. This, in combination with their side effects, makes prescribing them a risk. For those under 25, for example, they are correlated with increased suicidality.
Generally speaking, doctors and primary care physicians do not adequately screen for depressive symptom severity. Administering a valid reliable assessment requires a time commitment that most simply can’t afford, given tremendous patient loads. Antidepressants tend to be over-prescribed as a result. This is why the national shift towards integrated healthcare is so important.
Maintaining a medication schedule is a lot safer than switching off or switching to naturopathic remedies out of the blue. But it may be useful to get a second opinion from a psychiatrist, psychiatric nurse practitioner, psychologist, or another professionally licensed mental health professional who is trained in differential diagnosis and severity indicators for depression.
Although I haven’t been able to do anything about it research wise—nor do I expect to any time soon—the findings for epigenetics continue to intrigue. For example: Could the effects of certain types of psychological stressors persist in a family through genes being turned on or off? It’s at least possible.
The theory is certainly supported by monozygotic twin studies analyzing the potential inheritance of schizophrenia. Even when one identical twin has a confirmed diagnosis, the chances of the other receiving the same is only at 50%.
That speaks a lot to the importance of environmental factors and the relevance of the diathesis-stress model, which states that mental health disorders are often products of complex interactions between inherited vulnerability and psychosocial stressors.
The clinical implications of this research are that we need to understand the importance of nurture. If someone has a genetic vulnerability, we need to help them develop a safety plan and social support. Finally, the best thing we can do for serious mental health issues is help people have better less stressful lives.