What are the Principles for the Protection of Persons with Mental Illness?

Introduction

The Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care (MI Principles) were adopted by the United Nations General Assembly in 1991.

Background

The MI Principles provide agreed but non-legally-binding basic standards that mental health systems should meet and rights that people diagnosed with mental disorder should have.

Although the document underwent extensive drafting for 20 years and remains the international human rights agreement most specifically concerned with mental health, it has been criticised for not offering stronger protections in some areas.

It should now be read in the context of the United Nations Convention on the Rights of Persons with Disabilities.

The Principles

There are 25 principles:

  1. Fundamental freedoms and basic rights.
  2. Protection of minors.
  3. Life in the community.
  4. Determination of mental illness.
  5. Medical examination.
  6. Confidentiality.
  7. Role of community and culture.
  8. Standards of care.
  9. Treatment.
  10. Medication.
  11. Consent to treatment.
  12. Notice of rights.
  13. Rights and conditions in mental health facilities.
  14. Resources for mental health facilities.
  15. Admission principles.
  16. Involuntary admission.
  17. Review body.
  18. Procedural safeguards.
  19. Access to information.
  20. Criminal offenders.
  21. Complaints.
  22. Monitoring and remedies.
  23. Implementation.
  24. Scope of principles relating to mental health facilities.
  25. Saving of existing rights.

What is the National Institute of Mental Health?

Introduction

The National Institute of Mental Health (NIMH) is one of 27 institutes and centres that make up the National Institutes of Health (NIH). The NIH, in turn, is an agency of the United States Department of Health and Human Services and is the primary agency of the United States government responsible for biomedical and health-related research.

NIMH is the largest research organisation in the world specialising in mental illness. The institute was first authorised by the US government in 1946, when then President Harry Truman signed into law the National Mental Health Act, although the institute was not formally established until 1949.

NIMH is a $1.5 billion enterprise, supporting research on mental health through grants to investigators at institutions and organisations throughout the United States and through its own internal (intramural) research effort. The mission of NIMH is “to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery, and cure.”

In order to fulfil this mission, NIMH “must foster innovative thinking and ensure that a full array of novel scientific perspectives are used to further discovery in the evolving science of brain, behavior, and experience. In this way, breakthroughs in science can become breakthroughs for all people with mental illnesses.”

Research Priorities

NIMH has identified four overarching strategic objectives for itself:

  • Promote discovery in the brain and behavioural sciences to fuel research on the causes of mental disorders.
  • Chart mental illness trajectories to determine when, where and how to intervene.
  • Develop new and better interventions that incorporate the diverse needs and circumstances of people with mental illnesses.
  • Strengthen the public health impact of NIMH-supported research.

Brief History

Organisational History

Throughout its history the NIMH has witnessed a number of name and organisational changes, including:

  • PHS Narcotics Division (1929-1930).
  • PHS Division of Mental Hygiene (1930-1943).
  • Mental Hygiene Division, within the PHS Bureau of Medical Services (1943-1949).
  • National Institute of Mental Health (NIMH), one of the National Institutes of Health (NIH, 1949-1967).
  • NIMH as an independent division of the PHS (1967-1968).
  • NIMH, within the Health Services and Mental Health Administration (1968-1973).
  • NIMH, within NIH (1973).
  • NIMH, within the Alcohol, Drug Abuse, and Mental Health Administration (1973-1992).
  • NIMH, within NIH (1992-present).

In 1992, when the Alcohol, Drug Abuse, and Mental Health Administration was abolished, NIMH was transferred to NIH, retaining its research functions while its treatment services were transferred to the new Substance Abuse and Mental Health Services Administration.

Functions

Mental health has traditionally been a state responsibility, but after World War II there was increased lobbying for a federal (national) initiative. Attempts to create a National Neuropsychiatric Institute failed. Robert H. Felix, then head of the Division of Mental Hygiene, orchestrated a movement to include mental health policy as an integral part of federal biomedical policy. Congressional subcommittees hearings were held and the National Mental Health Act was signed into law in 1946. This aimed to support the research, prevention and treatment of psychiatric illness, and called for the establishment of a National Advisory Mental Health Council (NAMHC) and a National Institute of Mental Health. On 15 April 1949, the NIMH was formally established, with Felix as director. Funding for the NIMH grew slowly and then, from the mid-1950s, dramatically. The institute took on a highly influential role in shaping policy, research and communicating with the public, legitimising the importance of new advances in biomedical science, psychiatric and psychological services, and community-based mental health policies.

In 1955 the Mental Health Study Act called for “an objective, thorough, nationwide analysis and re-evaluation of the human and economic problems of mental health.” The resulting Joint Commission on Mental Illness and Health prepared a report, “Action for Mental Health”, resulting in the establishment of a cabinet-level interagency committee to examine the recommendations and determine an appropriate federal response.

In 1963, Congress passed the Mental Retardation Facilities and Community Mental Health Centres Construction Act, beginning a new era in Federal support for mental health services. NIMH assumed responsibility for monitoring the Nation’s community mental health centres (CMHC) programmes.

During the mid-1960s, NIMH launched a campaign on special mental health problems. Part of this was a response to President Lyndon Johnson’s pledge to apply scientific research to social problems. The institute established centres for research on schizophrenia, child and family mental health, suicide, as well as crime and delinquency, minority group mental health problems, urban problems, and later, rape, aging, and technical assistance to victims of natural disasters.

Alcohol abuse and alcoholism did not receive full recognition as a major public health problem until the mid-1960s, when the National Centre for Prevention and Control of Alcoholism was established as part of NIMH; a research program on drug abuse was inaugurated within NIMH with the establishment of the Centre for Studies of Narcotic and Drug Abuse.

In 1967, NIMH separated from NIH and was given bureau status within PHS. However, NIMH’s intramural research program, which conducted studies in the NIH Clinical Centre and other NIH facilities, remained at NIH under an agreement for joint administration between NIH and NIMH. Secretary of Health, Education, and Welfare John W. Gardner transferred St. Elizabeth’s Hospital, the Federal Government’s only civilian psychiatric hospital, to NIMH.

In 1968, NIMH became a component of PHS’s Health Services and Mental Health Administration (HSMHA).

In 1970 the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act (P.L. 91-616) established the National Institute of Alcohol Abuse and Alcoholism within NIMH.

In 1972, the Drug Abuse Office and Treatment Act established a National Institute on Drug Abuse within NIMH.

In 1973, NIMH went through a series of organisational moves. The institute temporarily re-joined NIH on 01 July with the abolishment of HSMHA. Then, the DHEW secretary administratively established the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) – composed of the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, and NIMH – as the successor organisation to HSMHA. ADAMHA was officially established in 1974.

The President’s Commission on Mental Health in 1977 reviewed the mental health needs of the nation and to make recommendations to the president as to how best meet these needs in 1978.

In 1980 The Epidemiologic Catchment Area (ECA) study, an unprecedented research effort that entailed interviews with a nationally representative sample of 20,000 Americans was launched. The field interviews and first wave analyses were completed in 1985. Data from the ECA provided a picture of rates of mental and addictive disorders and services usage.

The Mental Health Systems Act of 1980 – based on recommendations of the President’s Commission on Mental Health and designed to provide improved services for persons with mental disorders – was passed. NIMH participated in development of the National Plan for the Chronically Mentally Ill, a sweeping effort to improve services and fine-tune various Federal entitlement programs for those with severe, persistent mental disorders.

In 1987, administrative control of St. Elizabeth’s Hospital was transferred from the NIMH to the District of Columbia. NIMH retained research facilities on the grounds of the hospital. The NIMH Neuroscience Centre and the NIMH Neuropsychiatric Research Hospital, located on the grounds of St. Elizabeth’s Hospital, were dedicated in 1989.

In 1992, Congress passed the ADAMHA Reorganisation Act, abolishing ADAMHA. The research components of NIAAA, NIDA and NIMH re-joined NIH, while the services components of each institute became part of a new PHS agency, the Substance Abuse and Mental Health Services Administration (SAMHSA). The return to NIH and the loss of services functions to SAMHSA necessitated a realignment of the NIMH extramural program administrative organisation. New offices were created for research on Prevention, Special Populations, Rural Mental Health and AIDS.

In 1994 The House Appropriations Committee mandated that the director of NIH conduct a review of the role, size, and cost of all NIH intramural research programmes (IRP). NIMH and the National Advisory Mental Health Council (NAMHC) initiated a major study of the NIMH Intramural Research Programme. The planning committee recommended continued investment in the IRP and recommended specific administrative changes; many of these were implemented upon release of the committee’s final report; other changes – for example, the establishment of a major new programme on Mood and Anxiety Disorders – have been introduced in the years since.

In 1996 NIMH, with the NAMHC, initiated systematic reviews of a number of areas of its research portfolio, including the genetics of mental disorders; epidemiology and services for child and adolescent populations; prevention research; clinical treatment and services research. At the request of the National Institute for Mental Health director, the NAMH Council established programmatic groups in each of these areas. NIMH (National Institute of Mental Health) continued to implement recommendations issued by these Workgroups.

In 1997, NIMH realigned its extramural organisational structure to capitalise on new technologies and approaches to both basic and clinical science, as well as changes that had occurred in health care delivery systems, while retaining the Institute’s focus on mental illness. The new extramural organisation resulted in three research divisions: Basic and Clinical Neuroscience Research; Services and Intervention Research; and Mental Disorders, Behavioural Research and AIDS.

Between 1997 and 1999 NIMH refocused career development resources on early careers and added new mechanisms for clinical research.

In 1999 The NIMH Neuroscience Centre/Neuropsychiatric Research Hospital was relocated from St. Elizabeth’s Hospital in Washington, D.C. to the NIH Campus in Bethesda, Maryland, in response to the recommendations of the 1996 review of the NIMH (National Institute of Mental Health) Intramural Research Programme by the IRP Planning Committee.

The first White House Conference on Mental Health, held 07 June, in Washington, D.C., brought together national leaders, mental health scientific and clinical personnel, patients, and consumers to discuss needs and opportunities. The National Institute on Mental Health developed materials and helped organise the conference.

US Surgeon General David Satcher released The Surgeon General’s Call To Action To Prevent Suicide, in July, and the first Surgeon General’s Report on Mental Health, in December. NIMH, along with other federal agencies, collaborated in the preparation of both of these landmark reports.

Since the appointment of Thomas R. Insel as Director of NIMH in 2002, the institute has undergone organisational changes to better target mental health research needs (the expansion from three extramural divisions to five divisions, with the two new divisions focusing on adult and child translational research). NIMH also weathered several years of controversy due to conflict of interest and ethics violations by some of its intramural investigators. This situation cast light on an area that affected all of NIH, and resulted in more stringent rules about conflict of interest for all of NIH. Recently, Congressional interest turned to ethics and conflict of interest concerns with external investigators who receive NIMH or other NIH support. Current federal law has responsibility for managing and monitoring conflict of interests for external investigators with their home institutions/organisations. NIH responded to these new concerns by initiating a formal process for seeking public input and advice that will likely result in a change to the rules for monitoring and managing conflict of interest concerns for externally supported investigators. Finally, the past decade has also been marked by exciting scientific breakthroughs and efforts in mental illness research, as new genetic advances and bioimaging methodologies have increased understanding of mental illnesses. Two notable consequences of these advances are the Institute’s collaboration with the Department of Army to launch the Study To Assess Risk and Resilience in Service Members (STARRS), a Framingham-like effort scheduled to last until 2014 and the Research Domain Criteria (RDoC) effort, which seeks to define basic dimensions of functioning (such as fear circuitry or working memory) to be studied across multiple levels of analysis, from genes to neural circuits to behaviours, cutting across disorders as traditionally defined.

A collection of interviews with directors and individuals significant in the foundation and early history of the institute conducted by Dr. Eli A. Rubenstein between 1975 and 1978 is held at the National Library of Medicine in Bethesda, Maryland.

Noted Researchers

In 1970, Julius Axelrod, a NIMH researcher, won the Nobel Prize in Physiology or Medicine for research into the chemistry of nerve transmission for “discoveries concerning the humoral transmitters in the nerve terminals and the mechanisms for their storage, release and inactivation.” He found an enzyme that terminated the action of the nerve transmitter, noradrenaline in the synapse and which also served as a critical target of many antidepressant drugs.

In 1960s-70s John B. Calhoun, ethologist and behavioural researcher studied the population density and its effects on behaviour in the NIMH facility in Maryland. Later his work become renowned after several publications, including article in Scientific American and a widely known “Universe 25” story predicting anti-utopian future based on rodent experiments in overpopulated environment.

In 1984, Norman E. Rosenthal, a psychiatrist and NIMH researcher, pioneered seasonal affective disorder, coined the term SAD, and began studying the use of light therapy as a treatment. He received the Anna Monika Foundation Award for his research on seasonal depression.

Louis Sokoloff, a NIMH researcher, received the Albert Łasker award in Clinical Medical Research for developing a new method of measuring brain function that contributed to basic understanding and diagnosis of brain diseases. Roger Sperry, a NIMH research grantee, received the Nobel Prize in Medicine or Physiology for discoveries regarding the functional specialisation of the cerebral hemispheres, or the “left” and “right” brain.

Eric Kandel and Paul Greengard, each of whom have received NIMH support for more than three decades, shared the Nobel Prize in Physiology or Medicine with Sweden’s Arvid Carlsson. Kandel received the prize for his elucidating research on the functional modification of synapses in the brain. Initially using the sea slug as an experimental model but later working with mice, he established that the formation of memories is a consequence of short and long-term changes in the biochemistry of nerve cells Greengard was recognised for his discovery that dopamine and a number of other transmitters can alter the functional state of neuronal proteins, and also that such changes could be reversed by subsequent environmental signals.

Nancy Andreasen, a psychiatrist and long-time NIMH grantee, won the National Medal of Science for her groundbreaking work in schizophrenia and for joining behavioural science with neuroscience and neuroimaging. The Presidential Award is one of the nation’s highest awards in science.

Aaron Beck, a psychiatrist, received the 2006 Albert Lasker Award for Clinical Medical Research. Often called “America’s Nobels”, the Laskers are the nation’s most distinguished honour for outstanding contributions to basic and clinical medical research. Beck developed cognitive therapy – a form of psychotherapy – which transformed the understanding and treatment of many psychiatric conditions, including depression, suicidal behaviour, generalised anxiety, panic attacks and eating disorders.

In 2010, Mortimer Mishkin was awarded the National Medal of Science. Mishkin is chief of the NIMH’s Section on Cognitive Neuroscience, and acting chief of its Laboratory of Neuropsychology. He is the first NIMH intramural scientist to receive the medal. Due in part to work spearheaded by Mishkin, science now understands much about the pathways for vision, hearing and touch, and about how those processing streams connect with brain structures important for memory.

What is Paranoid Personality Disorder?

Introduction

Paranoid personality disorder (PPD) is a mental illness characterised by paranoid delusions, and a pervasive, long-standing suspiciousness and generalised mistrust of others.

People with this personality disorder may be hypersensitive, easily insulted, and habitually relate to the world by vigilant scanning of the environment for clues or suggestions that may validate their fears or biases. They are eager observers. They think they are in danger and look for signs and threats of that danger, potentially not appreciating other interpretations or evidence.

They tend to be guarded and suspicious and have quite constricted emotional lives. Their reduced capacity for meaningful emotional involvement and the general pattern of isolated withdrawal often lend a quality of schizoid isolation to their life experience. People with PPD may have a tendency to bear grudges, suspiciousness, tendency to interpret others’ actions as hostile, persistent tendency to self-reference, or a tenacious sense of personal right. Patients with this disorder can also have significant comorbidity with other personality disorders (such as schizotypal, schizoid, narcissistic, avoidant and borderline).

Epidemiology

PPD occurs in about 0.5-2.5% of the general population. It is seen in 2-10% of psychiatric outpatients. It is more common in males.

Brief History

Paranoid personality disorder is listed in DSM-V and was included in all previous versions of the DSM. One of the earliest descriptions of the paranoid personality comes from the French psychiatrist Valentin Magnan who described a “fragile personality” that showed idiosyncratic thinking, hypochondriasis, undue sensitivity, referential thinking and suspiciousness.

Closely related to this description is Emil Kraepelin’s description from 1905 of a pseudo-querulous personality who is “always on the alert to find grievance, but without delusions”, vain, self-absorbed, sensitive, irritable, litigious, obstinate, and living at strife with the world. In 1921, he renamed the condition paranoid personality and described these people as distrustful, feeling unjustly treated and feeling subjected to hostility, interference and oppression. He also observed a contradiction in these personalities: on the one hand, they stubbornly hold on to their unusual ideas, on the other hand, they often accept every piece of gossip as the truth. Kraepelin also noted that paranoid personalities were often present in people who later developed paranoid psychosis. Subsequent writers also considered traits like suspiciousness and hostility to predispose people to developing delusional illnesses, particularly “late paraphrenias” of old age.

Following Kraepelin, Eugen Bleuler described “contentious psychopathy” or “paranoid constitution” as displaying the characteristic triad of suspiciousness, grandiosity and feelings of persecution. He also emphasized that these people’s false assumptions do not attain the form of real delusion.

Ernst Kretschmer emphasized the sensitive inner core of the paranoia-prone personality: they feel shy and inadequate but at the same time they have an attitude of entitlement. They attribute their failures to the machinations of others but secretly to their own inadequacy. They experience constant tension between feelings of self-importance and experiencing the environment as unappreciative and humiliating.

Karl Jaspers, a German phenomenologist, described “self-insecure” personalities who resemble the paranoid personality. According to Jaspers, such people experience inner humiliation, brought about by outside experiences and their interpretations of them. They have an urge to get external confirmation to their self-deprecation and that makes them see insults in the behaviour of other people. They suffer from every slight because they seek the real reason for them in themselves. This kind of insecurity leads to overcompensation: compulsive formality, strict social observances and exaggerated displays of assurance.

In 1950, Kurt Schneider described the “fanatic psychopaths” and divided them into two categories: the combative type that is very insistent about his false notions and actively quarrelsome, and the eccentric type that is passive, secretive, vulnerable to esoteric sects but nonetheless suspicious about others.

The descriptions of Leonhard and Sheperd from the sixties describe paranoid people as overvaluing their abilities and attributing their failure to the ill-will of others; they also mention that their interpersonal relations are disturbed and they are in constant conflict with others.

In 1975, Polatin described the paranoid personality as rigid, suspicious, watchful, self-centred and selfish, inwardly hypersensitive but emotionally undemonstrative. However, when there is a difference of opinion, the underlying mistrust, authoritarianism and rage burst through.

In the 1980s, paranoid personality disorder received little attention, and when it did receive it, the focus was on its potential relationship to paranoid schizophrenia. The most significant contribution of this decade comes from Theodore Millon who divided the features of paranoid personality disorder to four categories:

  1. Behavioural characteristics of vigilance, abrasive irritability and counterattack.
  2. Complaints indicating oversensitivity, social isolation and mistrust.
  3. The dynamics of denying personal insecurities, attributing these to others and self-inflation through grandiose fantasies.
  4. Coping style of detesting dependence and hostile distancing of oneself from others.

Causes

A genetic contribution to paranoid traits and a possible genetic link between this personality disorder and schizophrenia exist. A large long-term Norwegian twin study found paranoid personality disorder to be modestly heritable and to share a portion of its genetic and environmental risk factors with the other cluster A personality disorders, schizoid and schizotypal.

Psychosocial theories implicate projection of negative internal feelings and parental modelling. Cognitive theorists believe the disorder to be a result of an underlying belief that other people are unfriendly in combination with a lack of self-awareness.

Diagnosis

ICD-10

The World Health Organisation’s ICD-10 lists paranoid personality disorder under (F60.0). It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria. It is also pointed out that for different cultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and other obligations.

PPD is characterised by at least three of the following symptoms:

  1. Excessive sensitivity to setbacks and rebuffs;
  2. Tendency to bear grudges persistently (i.e. refusal to forgive insults and injuries or slights);
  3. Suspiciousness and a pervasive tendency to distort experience by misconstruing the neutral or friendly actions of others as hostile or contemptuous;
  4. A combative and tenacious sense of self-righteousness out of keeping with the actual situation;
  5. Recurrent suspicions, without justification, regarding sexual fidelity of spouse or sexual partner;
  6. Tendency to experience excessive self-aggrandising, manifest in a persistent self-referential attitude;
  7. Preoccupation with unsubstantiated “conspiratorial” explanations of events both immediate to the patient and in the world at large.

Includes: expansive paranoid, fanatic, querulant and sensitive paranoid personality disorder.

Excludes: delusional disorder and schizophrenia.

DSM-5

The American Psychiatric Association’s DSM-5 has similar criteria for paranoid personality disorder. They require in general the presence of lasting distrust and suspicion of others, interpreting their motives as malevolent, from an early adult age, occurring in a range of situations. Four of seven specific issues must be present, which include different types of suspicions or doubt (such as of being exploited, or that remarks have a subtle threatening meaning), in some cases regarding others in general or specifically friends or partners, and in some cases referring to a response of holding grudges or reacting angrily.

PPD is characterised by a pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts. To qualify for a diagnosis, the patient must meet at least four out of the following criteria:

  1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving them.
  2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
  3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against them.
  4. Reads hidden demeaning or threatening meanings into benign remarks or events.
  5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
  6. Perceives attacks on their character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
  7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.

The DSM-5 lists paranoid personality disorder essentially unchanged from the DSM-IV-TR version and lists associated features that describe it in a more quotidian way. These features include suspiciousness, intimacy avoidance, hostility and unusual beliefs/experiences.

Other

Various researchers and clinicians may propose varieties and subsets or dimensions of personality related to the official diagnoses. Psychologist Theodore Millon has proposed five subtypes of paranoid personality (table below).

SubtypeFeatures
Obdurate paranoid (including compulsive features)Self-assertive, unyielding, stubborn, steely, implacable, unrelenting, dyspeptic, peevish, and cranky stance; legalistic and self-righteous; discharges previously restrained hostility; renounces self-other conflict.
Fanatic paranoid (including narcissistic features)Grandiose delusions are irrational and flimsy; pretentious, expensive supercilious contempt and arrogance toward others; lost pride re-established with extravagant claims and fantasies.
Querulous paranoid (including negativistic features)Contentious, cavilling, fractious, argumentative, fault-finding, unaccommodating, resentful, choleric, jealous, peevish, sullen, endless wrangles, whiny, waspish, snappish.
Insular paranoid (including avoidant features)Reclusive, self-sequestered, hermitical; self-protectively secluded from omnipresent threats and destructive forces; hypervigilant and defensive against imagined dangers.
Malignant paranoid (including sadistic features)Belligerent, cantankerous, intimidating, vengeful, callous, and tyrannical; hostility vented primarily in fantasy; projects own venomous outlook onto others; persecutory delusions.

Differential Diagnosis

Paranoid personality disorder can involve, in response to stress, very brief psychotic episodes (lasting minutes to hours). The paranoid may also be at greater than average risk of experiencing major depressive disorder, agoraphobia, social anxiety disorder, obsessive-compulsive disorder or alcohol and substance-related disorders. Criteria for other personality disorder diagnoses are commonly also met, such as:

Treatment

Because of reduced levels of trust, there can be challenges in treating PPD. However, psychotherapy, antidepressants, antipsychotics and anti-anxiety medications can play a role when a person is receptive to intervention.

Book: Insane Medicine: How the Mental Health Industry Creates Damaging Treatment Traps and How you can Escape Them

Book Title:

Insane Medicine: How the Mental Health Industry Creates Damaging Treatment Traps and How you can Escape Them.

Author(s): Sami Timimi.

Year: 2021.

Edition: First (1st).

Publisher: Independently Published.

Type(s): Paperback and Kindle.

Synopsis:

This book digs through the rotten undergrowth which fertilises the mental health industry. The level of failure and deceit is hard to believe. The diagnoses we use are more akin to astrological than medical constructs. We have no medical tests and despite apparent innovations in drugs and therapy, five decades of research has shown no improvement in outcomes from treatment and instead an increase in the numbers categorised as severely mentally ill. Worse, we have convinced the population that they are experiencing pandemics of mental disorders, leading us to fear our ordinary emotions and to scythe away at our natural resilience. There can be no doubt that the mental health industry has caused more harm than good. In this hard hitting book, Dr Timimi, a child psychiatrist with over 30-years-experience as a practicing clinician and researcher, reveals the shocking truth about the unintended harms this industry has caused, both to those in distress and our culture more broadly. He explains how our institutional ideology traps people into becoming long-term patients and proposes a simple theory that explains why more people become long term patients than get better as well as sharing tips on how those caught in this trap can find safe ways back to health and contentment. A revolution in mental health care is inevitable. The current systems have failed and are un-reformable. They will be overthrown. This book will tell you why.

Long-Term Depression & Latent Inhibition

Research Paper Title

Disruption of long-term depression potentiates latent inhibition: Key role for central nucleus of the amygdala.

Background

Latent inhibition (LI) reflects an adaptive form of learning, which is impaired in certain forms of mental illness. Glutamate receptor activity is linked to LI, but the potential role of synaptic plasticity remains unspecified.

Methods

Accordingly, the present study examined the possible role of long-term depression (LTD) in LI induced by prior exposure of rats to an auditory stimulus used subsequently as a conditional stimulus (CS) to signal a pending footshock. The researchers employed two mechanistically distinct LTD inhibitors, the Tat-GluA23Y peptide that blocks endocytosis of the GluA2-containing glutamate α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR), or the selective glutamate n-methyl-d-aspartate receptor (NMDAR) 2B antagonist, Ro25-6981, administered prior to the acquisition of two-way conditioned avoidance with or without tone pre-exposure.

Results

Systemic LTD blockade with the Tat-GluA23Y peptide strengthened the LI effect by further impairing acquisition of conditioned avoidance in CS-pre-exposed rats compared to normal conditioning in non-pre-exposed controls. Systemic Ro25-6981 had no significant effects. Brain-region specific microinjections of the Tat-GluA23Y peptide into the nucleus accumbens, medial prefrontal cortex, central or basolateral amygdala demonstrated that disruption of AMPAR endocytosis in the central amygdala also potentiated the LI effect.

Conclusions

These data revealed a previously unknown role for central amygdala LTD in LI as a key mediator of cognitive flexibility required to respond to previously irrelevant stimuli that acquire significance through reinforcement. The findings may have relevance both for our mechanistic understanding of LI and its alteration in disease states such as schizophrenia, while further elucidating the role of LTD in learning and memory.

Reference

Ashby, D.M., Dias, C., Aleksandrova, L.R., Lapish, C.C., Wang, Y.T. & Phillips, A.G. (2021) Disruption of long-term depression potentiates latent inhibition: Key role for central nucleus of the amygdala. The International Journal of Neuropsychopharmacology. doi: 10.1093/ijnp/pyab011. Online ahead of print.

Are Those With Serious Mental Illness More or Less Likely to Receive Cancer Screening?

Research Paper Title

Cancer Screening Among Adults With and Without Serious Mental Illness: A Mixed Methods Study.

Background

Persons with serious mental illness (SMI) die 10-20 years earlier than the general population; cancer is the second leading cause of death. Differences in cancer screening between SMI and the general population are not well understood.

Therefore the aim of this study was to describe receipt of cancer screening among individuals with versus without SMI and to explore clinicians’ perceptions around cancer screening for people with SMI.

Methods

Mixed-methods study using 2010-2017 MarketScan commercial insurance administrative claims data and semi-structured clinician interviews. In the quantitative analyses, we used multivariate logistic regression analyses to calculate the likelihood of receiving cervical, breast, colorectal, or prostate cancer screening among people with versus without SMI, defined as schizophrenia or bipolar disorder. We conducted semi-structured interviews with 17 primary care physicians and 15 psychiatrists. Interview transcripts were coded using a hybrid deductive/inductive approach.

Results

Relative to those without SMI, individuals with SMI were less likely to receive screening for cervical cancer [adjusted odds ratio (aOR): 0.80; 95% confidence interval (CI): 0.80-0.81], breast cancer (aOR: 0.79; 95% CI: 0.78-0.80), colorectal cancer (aOR: 0.90; 95% CI: 0.89-0.91), and prostate cancer (aOR: 0.85; 95% CI: 0.84-0.87). Clinicians identified 5 themes that may help explain the lower rates of cancer screening in persons with SMI: access to care, available support, prioritization of other issues, communication, and patient concerns.

Conclusions

People with SMI were less likely to receive 4 common types of cancer screening. Improving cancer screening rates in the SMI population will likely require a multidisciplinary approach to overcome barriers to screening.

Reference

Murphy, K.A., Stone, E.M., Presskreischer, R., McGinty, E.E., Daumit, G.L. & Pollack, C.E. (2021) Cancer Screening Among Adults With and Without Serious Mental Illness: A Mixed Methods Study. Medical Care. 59(4), pp.327-333. doi: 10.1097/MLR.0000000000001499.

Book: A Sociology of Mental Health and Illness

Book Title:

A Sociology of Mental Health and Illness.

Author(s): Anne Rogers and David Pilgrim.

Year: 2020.

Edition: Sixth (6th).

Publisher: Open University Press.

Type(s): Paperback and Kindle.

Synopsis:

How do we understand mental health problems in their social context?

A former BMA Medical Book of the Year award winner, this book provides a sociological analysis of major areas of mental health and illness. The book considers contemporary and historical aspects of sociology, social psychiatry, policy and therapeutic law to help students develop an in-depth and critical approach to this complex subject. New developments for the sixth edition include:

  • Brand new chapter on ageing and older people.
  • Updated material on social class, ethnicity, user involvement, young people and adolescence.
  • New coverage on prisons legalism and the rise of digital mental health management and delivery.

A classic in its field, this well-established textbook offers a rich, contemporary and well-crafted overview of mental health and illness unrivalled by competitors and is essential reading for students and professionals studying a range of medical sociology and health-related courses. It is also highly suitable for trainee mental health workers in the fields of social work, nursing, clinical psychology and psychiatry.

Book: Anatomy of an Epidemic

Book Title:

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America.

Author(s): Robert Whitaker.

Year: 2010.

Edition: First (1ed).

Publisher: Crown Publishing Group.

Type(s): Hardcover and Kindle.

Synopsis:

The award-winning author of Mad in America presents a controversial assessment of the rise in mental illness-related disabilities that considers if drug-based care may be fuelling illness rates throughout the past half century.

Book: Wrestling With My Thoughts: A Doctor With Severe Mental Illness Discovers Strength

Book Title:

Wrestling With My Thoughts: A Doctor With Severe Mental Illness Discovers Strength.

Author(s): Sharon Hastings.

Year: 2020.

Edition: First (1st).

Publisher: IVP.

Type(s): Paperback and Kindle.

Synopsis:

She couldn’t believe it. There she was with her medical qualifications sitting on the floor of a mental hospital. She’d offered her life to God, wanted to serve him anywhere, but no, surely not this… Sharon Hastings is absolutely passionate about helping anyone who suffers from ‘severe and enduring mental illness’ (SEMI): schizophrenia, bipolar disorder and schizoaffective disorder. She wants the church to know all about these illnesses: how they devastate ordinary people and how they need to be treated. By telling her story, warts and all, showing her own tortuous, painful journey, she equips us to come alongside loved ones, fellow church members, friends and neighbours, understanding the social and spiritual ramifications of their illnesses, including them in our activities (where appropriate) and encouraging their spiritual growth. A natural storyteller, the author draws us in. We journey with her. With wisdom, kindness and the heart of a bruised survivor, she interweaves her exceptional story with vital teaching which simply cannot be ignored by anyone within the church today.

Book: The End of Mental Illness

Book Title:

The End of Mental Illness: How Neuroscience Is Transforming Psychiatry and Helping Prevent or Reverse Mood and Anxiety Disorders, ADHD, Addictions, PTSD, Psychosis, Personality Disorders, and More.

Author(s): Daniel G. Amen.

Year: 2020.

Edition: First (1st).

Publisher: Tyndale House Publishers.

Type(s): Hardcover, Paperback, Audiobook, and Kindle.

Synopsis:

Though incidence of these conditions is skyrocketing, for the past four decades standard treatment has not much changed, and success rates in treating them have barely improved, either. Meanwhile, the stigma of the “mental illness” label – damaging and devastating on its own – can often prevent sufferers from getting the help they need.

Brain specialist and bestselling author Dr. Daniel Amen is on the forefront of a new movement within medicine and related disciplines that aims to change all that. In The End of Mental Illness, Dr. Amen draws on the latest findings of neuroscience to challenge an outdated psychiatric paradigm and help readers take control and improve the health of their own brain, minimising or reversing conditions that may be preventing them from living a full and emotionally healthy life.

The End of Mental Illness will help you discover:

  • Why labelling someone as having a “mental illness” is not only inaccurate but harmful.
  • Why standard treatment may not have helped you or a loved one – and why diagnosing and treating you based on your symptoms alone so often misses the true cause of those symptoms and results in poor outcomes.
  • At least 100 simple things you can do yourself to heal your brain and prevent or reverse the problems that are making you feel sad, mad, or bad.
  • How to identify your “brain type” and what you can do to optimise your particular type.
  • Where to find the kind of health provider who understands and uses the new paradigm of brain health.