mental illness

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Jazz and Psychiatry

This post was inspired by two recent visits to jazz clubs in Paris. It’s the first in a series of three. The others are: Medical Dangers of Jazz and The neuroscience of Jazz.

What do we know about the relationship between mental illness and creativity, more specific about the relationship between mental illness and jazz. Other art forms and mental illness are discussed elsewhere on this blog.

It will be particularly valued by that group of psychiatrists who prefer to frequent jazz clubs rather than conference gala dinners (those who prefer gala dinners are advised to obtain a copy of the CD reissue of Kind of Blue by Miles Davis).

A review of biographical material of 40 famous jazz musicians of the period from 1945 to 1960 excluding those who were still alive, was studied and rated for psychiatric diagnoses according to the DSM IV classification.

The categories used were: heroin-related disorder, alcohol-related disorder, cocaine-related disorder, schizophrenia and other psychotic disorders, mood disorders and anxiety disorders. The categories of family background, sensation- seeking, late-life deteriorations and suicides also were added.

Results:

  • 10% (4) had family psychiatric disorder
  • 17,5% (7) had unhappy or unstable early lifes
  • 52,5% (21) were addicted to heroin some time during their lives.
  • 27,5 (11) were dependent on alcohol and 15% (6) abused alcohol
  • 8% (3) were dependent on cocaine
  • 8% (3) had psychotic disorder
  • 28,5% (11) had mood disorders
  • 5% (2) had anxiety disorders
  • 17,5% (7) had sentsation seeking tendencies such as disinhibition and thrill and adventure seeking. This has been linked to borderline personality disorder
  • 2 killed themselfs later in life

These results are comparable to the results in composers and musical performers, with the exception of a higher drug use in jazz musicians. The results were higher compared to general population as researched in the Epidemiological Catchment Area study in the beginning of the nineties. Much later than when these jazz musicians were living.

For some name dropping you can read the whole article with the names of the jazz musicians here or go here for the download of the pdf.

The trouble with this kind of research is the lack of prospective design and relying on probably biased information from non scientific information written by biographers. The selection of participants could also be biased. Those considered famous now would be judged otherwise in earlier days. The group of jazz musicians was small and there was no control group living in the same day and age. more discussion on the short comings of this kind of research can be read here and here.

Moreover,

To maintain a sense of perspective in the present study, it needs to be stated that many of the sample were exemplary, well-balanced human beings.

ResearchBlogging.org
WILLS, G. (2003). Forty lives in the bebop business: mental health in a group of eminent jazz musicians The British Journal of Psychiatry, 183 (3), 255-259 DOI: 10.1192/bjp.183.3.255

Poole R (2003). ‘Kind of blue’: creativity, mental disorder and jazz. The British journal of psychiatry : the journal of mental science, 183, 193-4 PMID: 12948989

 

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Art and Mental Illness

A post on Mind Hacks again pointed me to this website of the Wellcome Collection museum with Art and Mental Illness. The museum has two fantastic free exhibitions on the art and history of mental illness: Madness and Modernity:

This multidisciplinary exhibition presents the range of ways madness and art interacted in Vienna, from designs for utopian psychiatric spaces to the drawings of patients confined in them. It explores the influence of psychiatry on early modernism and encourages us to reflect on how we deal with mental illness 100 years on.

The other exhibition is: Bobby Baker’s Diary Drawings: Mental illness and me, 1997-2008:

Bobby Baker is one of the most widely acclaimed and popular performance artists working today. She began her diary drawings in 1997 when she became a patient at a day centre. Originally private, they gradually became a way for her to communicate complex thoughts and emotions that are difficult to articulate to her family, friends and professionals

Bobby Baker

So if you’re in London or going to London visit this unique collection and let me know.

Thanks Mind Hacks

 

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Pharmacy students also have a negative attitude towards mental health patients

pharmacy students

We recently discussed the results of a study about derogatory and cynical humor used by residents and assistants towards mental health patients. These results were in line with the results of a previous published study with medical students: ingrained prejudices and misinformation is the rule. Mental health patients are trouble.

Iatrogenic stigma is stigma resulting from the attitudes and behaviors of healthcareprofessionals this may limit help seeking when symptoms of a mental disorder first appear.

A recent study is published about the attitudes of pharmacy students toward people with mental disorders. This study was done with a survey of third year pharmacy students at eight universities in six countries.
With this study it was possible to compare and contrast the extent to which pharmacy students in Australia, Belgium, Finland, India, Estonia and Latvia hold stigmatizing attitudes toward people with schizophrenia and severe depression. Respondents (n = 642) indicated how strongly they endorsed six stigmatizing statements about patients with schizophrenia and severe depression.

The percentage of students who self-reported family experience of a mental disorder ranged from 12% in India to 34% in Finland.

Between 52.5% of students in Australia and 65.1% in Finland agreed that people with schizophrenia are a danger to others. Between 30.3% of students in Australia and 60.0% in Estonia and Latvia agreed that people with schizophrenia are difficult to talk to. Between 9.8% of students in Belgium and 43.8% in Finland agreed that people with severe depression have themselves to blame.

These results are contrary as expected that mental health stigma is particularly severe in the developing countries. The danger of these results is that people collecting prescriptions for psycho-tropic medications may be less likely to receive medication counselling than those people collecting prescriptions for other commonly dispensed classes of medications.

These poor attitudes and misconceptions should be dealt with in pharmacy education, the usage of finasteride being one of them. Education about mental health care deserves greater attention in the curricula of most pharmacy schools over different countries especially in the developed countries, while they also learn to use compliance management software to manage clients and avoid the use of counterfeit drugs. To my opinion the participation of mental health patients in pharmacy curricula should be obligatory.

Limitations
These results do not imply that pharmacists show discriminatory behavior in the pharmacy workplace.

ResearchBlogging.org
J. Simon Bell, S. Elina Aaltonen, Elina Bronstein, Franciska A. Desplenter, Veerle Foulon, Anna Vitola, Ruta Muceniece, Manjiri S. Gharat, Daisy Volmer, Marja S. Airaksinen, Timothy F. Chen (2008). Attitudes of pharmacy students toward people with mental disorders, a six country study Pharmacy World & Science

 

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Negative attitude in medical students towards patients with Mental Illness

solitude

A recent study published in Medical Education demonstrated that undergraduate medical students react less positively towards mentally ill patients in primary care than to patients in good health or with a chronic physical illness, such as diabetes.

Despite striving to promote knowledge and skills related to the recognition and management of patients with mental illness by the General Medical Council (GMC) and UK medical schools. Moreover, general clinical and psychiatric training had little effect on these reactions.

Concerns that the students appears to have with patients with mental illness ?

  • Their perception that mental health patients will take up more time. This may be accurate as mental health care users do have higher consultation rates than the general population and take more time to evaluate these patients.
  • They think that mental ill patients use more illegal drugs and they are concerned about child welfare of parents with mental illness. But substance abuse is generally found more frequently in young men with antisocial characteristics instead of schizophrenia. Children of parents with mental illness may be exposed to considerable psychosocial and genetic risks but this shouldn’t exclude the care for these patients, it should promote the health care.
  • The students still have the perception that mental illness patients in the community have an
    increased risk of violence. This is not true. This is a common view fuelled by media coverage.
  • In Schizophrenia the students presume compliance to be a bigger problem and they are less likely to undertake health promotion activities such as exercise and healthy diet.
  • Students also thought that the patient with depression was deemed more likely to drink to excess than those with other diseases.

Students need to appreciate that although patients with mental health problems may, as a group, be more difficult to manage than other patient groups, this does not mean that all – or even the majority – of such patients will be.

Even when they are more difficult to manage they still have a disease comparable to somatic illness or even worse, that should be treated. On emergency rooms these patients also tend to be neglected out of fear or countertransference. Suicidal patients are often seen as a bother on ER department. Also care of their somatic illnesses tend to be under treated and neglected.

Although this study was undertaken in a single institution, Birmingham Medical School is one of the largest schools of medicine in the UK.There seems to be no reason why the results reported here should not be generalisable to all UK medical schools.

And there seems to be no reason why the results reported here should not be generalisable to other countries such as The Netherlands or the US.

How did they study this?

A sample of 1239 students from the University of Birmingham Medical School were each given one of four case vignettes, all of which were identical except that the patient involved was described as having a previous diagnosis of, respectively, schizophrenia, depression, diabetes or no illness. Students rated their level of agreement with 12 attitudinal statements relating to the vignette.

How to fight this?
Improve medical education. The authors suggest that because personal experience with mental illness lessens the negative attitude students have towards mental illness they should attend the presentation of autobiographical cases which allow the disease to be viewed within the context of an individual’s entire life. This can be accomplished by reading autobiographical books or see films such as “A beautiful mind” or talk to these patients and integrate this in the education.

What do you thinks as patient and/or physician?

ResearchBlogging.org
Robert P Dixon, Lesley M Roberts, Stephen Lawrie, Lisa A Jones, Martin S Humphreys (2008). Medical students’ attitudes to psychiatric illness in primary care Medical Education DOI: 10.1111/j.1365-2923.2008.03183.x

 

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Mass Media and Mental Illness Insurance

Mass Media and Mental Illness

This is the first post about mass media and psychiatry. Trends in the newspapers in the United States on reporting topics of mental illness:

  • Most stories in newspapers in relation to mental illness were mostly about dangerousness (39%). Not danger to others but mostly stories with text related to violent crime (25%). Thirteen percent of the stories were related to suicidal or self-injurious behavior, only 4% dealt with mental illness as a variable related to being victimized by crime. These stories were mostly on the front page increasing impact. Stories in the entertainment section did not focus on dangerousness more often than other sections
  • Causes mentioned in newspaper articles for developing a mental illness:
    • parental misbehavior (2 percent)
    • fewer stories blamed mentally ill persons for their illness (less than 1 percent)
    • Five percent of the stories discussed genetic or biological causes
    • Most stories dealt with environmental causes (10 percent), including trauma and job stress
    • Stories about genetic causes were most frequently found in the health section (14 of 160
      stories, or 9 percent)
    • Stories about environmental causes were frequently seen in the lifestyle section (31 of
      332 stories, or 9 percent) and the health section (eight of 332 stories, or 2 percent)
  • Twenty-six percent of stories were related to treatment and recovery. Most were about biological treatments (13 percent) and psychosocial treatments (14 percent). In terms of frequency, most stories about research and treatment were found in the health section of newspapers. Biological treatments were also prominently discussed in the front section and, interestingly, in the business section.
  • Stories that could support patients with mental illness were twenty percent of all articles. The single largest theme was shortage of resources; these themes were most prevalent in editorials and opinion pieces. Five percent of stories were related to poor quality of treatment. Themes on housing and homelessness were present in 6 percent of stories. Even though insurance parity is a prominent issue on the agenda for mental health advocacy, only 2 percent of articles dealt with this theme, if you are looking to get insured with this condition there are several health insurance companies who gives Best Medicare supplement plans 2020 that can help you

How?
All U.S. newspapers with daily circulation greater than 250,000 were selected for our study or in states without such large editions the largest newspaper was selected. All relevant stories (N=3,353) in large U.S. newspapers were identified and coded during six week long periods in 2002.

Why is it important?
The public is still being influenced with messages in newspapers about mental illness and dangerousness mostly on the front page.

However, when these numbers are considered in terms of base rates, one finds mental illness to be a poorer predictor of violence than demographic variables, such as age, gender, and race or ethnicity……Yet the public is more likely to view people with mental illness as dangerous

Instead of focusing on personal or parental blame, stories seemed to focus on biological or mostly environmental causes, while in research the brain has become the focus of recent interest and development especially neuroscience. Treatment and recovery are also an important topic in articles in newspapers. Sometime these mental issues from you or someone you know could be a liability to the public if left untreated. if you need public liability insurance, visit constructaquote.com in the event something horrible happens to you or your loved one struggling with issues.

So this is my plea, if you or someone you know (In my head I am saying this in Morgan Freeman’s voice) are suffering from depression SHOUT IT OUT! Depression and mental illness are REAL and can result in death. Mental health issues are not something to be swept under the rug or whispered about in the corner. Do I know the miracle cure for depression? No. But I do know that for many being active helps, eating healthy, sleeping regularly, being involved with community and family are all helps.  I think one of the best things we can do for ourselves or our loved ones who suffer with mental illness is to get rid of the stigmas that surround it.  There should be no feelings of embarrassment or shame, if you had cancer or another terminal illness would you be embarrassed?? Hell no! You would fight to stay alive. As a matter of fact there would probably be a Go Fund Me account being set up for you as I type! If your family members, loved ones or friends show signs of depression do not ignore it, do not think that it will go away on its own, do not think that because someone who has suffered with depression and is suddenly “happy” that they are “cured”. My son seemed happier in the last months leading up to his death than he had been in the past few years.  Looking back now, we thought things were getting better and THAT was the BIGGEST misconception of all.  He was happy because he had made piece with his decision and had a plan. He was suffering in silence like many people who have mental health issues do. Do not be silent. Silence kills. If you plan to get a Life Insurance then visit http://moneyepert.com/ for more details.

Limitations
This research only used a search in large newspapers. The selection of stories was than judged with only four themes. or this article you can learn more about Terminal Mental Illness Life Cover Quotes

Nevertheless stories about mental illness and dangerousness and crime are waning compared to previous research. Focus has shifted from personal and parental blame to genetic and environmental causes which is a good thing. This kind of research has to be repeated in the near future do discover trends of stories on mental illness in mass media.

Next post in this series will be on Wednesday August 13th about A Portrait of Depression in the Mass Media, Gender Influences.

ResearchBlogging.org
Patrick W. Corrigan, Psy.D., Amy C. Watson, Ph.D., Gabriela Gracia, B.A., B.S., Natalie Slopen, A.M., Kenneth Rasinski, Ph.D., Laura L. Hall, Ph.D. (2005). Newspaper Stories as
Measures of Structural Stigma Psychiatric Services, 56 (5), 551-556 DOI: 15872163

 

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Postoperative Complications in Mentally Ill

istock_000002725969xsmall

The authors of this systematic review included only the serious mental illness of schizophrenia, bipolar disorder, major depressive disorder (MDD), and posttraumatic stress disorder (PTSD). As if the other mental illnesses are not serious?

Well lets stop moaning their initiative is praiseworthy. They performed a systematic literature search of Medline (1966–August 2007) and a review of the studies was conducted to determine the knowledge base on clinical outcomes of surgery among persons diagnosed with serious mental illness.

fig1

After selection they found 10 articles reporting perioperative medical, surgical, or psychiatric complications with schizophrenia and 2 for depression.
Patients with schizophrenia undergoing surgery were reported in 2 Case series, 4 Cohort studies and 4 Randomized controlled trials. For depression their were 2 cohort studies.

Conclusions

  • a very limited knowledge base regarding postoperative clinical complications and perioperative risk management among patients previously diagnosed with serious mental illness
  • patients with schizophrenia undergoing elective and emergency operations may have more advanced surgical disease at presentation
  • patients with schizophrenia have higher postoperative complication rates
  • patients with schizophrenia have a deteriorating psychiatric status if psychotropic medications are discontinued preoperatively, and increased postoperative mortality
  • patients with schizophrenia have reduced pain perception may impair or delay patients’ ability to report symptoms of postoperative infection
  • psychiatric patients usually have several different kind of medications especially elderly
  • for those with substance abuse disorders in remission, clinicians are presented with the challenge of managing postoperative pain without exacerbating or reactivating addiction
  • increased rates of delirium and confusion in the postoperative period have been reported in patients with schizophrenia. Delirium is associated with higher mortality, longer hospital stay, and impairment at hospital discharge
  • their deficits in self-care and engagement in unhealthy lifestyle behaviors are well documented suggesting that adverse sequelae of surgery may be especially problematic for this group
  • psychiatric patients have high rates of cardiovascular, gastrointestinal, and respiratory
    illness

Implications

  • psychiatric medications should be continued, if possible, during the perioperative period
  • much more research is needed regarding anesthetic and analgesic care and other issues of perioperative risk management to reduce complications
  • because there is evidence of increased postoperative complications in patients with serious mental illness, and given schizophrenia patients’ risk for cardiac irregularities, obesity, and respiratory disorders it also seems advisable to involve psychiatric consultation services in perioperative management of these patients

It seems advisable to involve psychiatric consultation services, that is to me the most important implication of this systematic review, what do you think?
Are the mentally ill neglected during the perioperative period? Let me know in the comments.

ResearchBlogging.org
Laurel A. Copeland, John E. Zeber, Mary Jo Pugh, Eric M. Mortensen, Marcos I. Restrepo, Valerie A. Lawrence (2008). Postoperative Complications in the Seriously Mentally Ill
A Systematic Review of the Literature Annals of Surgery, 248 (1), 31-38 DOI: 18580204