a page for Those in the early days of caring

*** New !!! Another personal setback !! My last attempt at a letter to a house Journal of the College of Psychiatrists denied an airing !! Have a look .... The first go !!

Cognitive Therapy - the latest thing coming your way - maybe not all that it seems. It is a way of getting some to join in a friendly social setting where interest is shown , on a regular basis, bringing a routine into otherwise unorganised lives.
But what folows ?
It does bring hope and funding to the lost - what's to argue against it

Schizophrenia is an illness that comes out of a structural change in an area of the brain that deals with information, stored and new: there is reduced new cell formation in the hippocampus.
Because those cells deal with whatever new information is to be accepted, to be built into that already experienced and stored, because the hippocampus is necessary to bring stuff up, to make it available at the right time in a sequence, hippocampal neurogenesis being reduced means the brain networks needed to call up experience, immediate and already ' in store ' , to deal with outside matters, is in difficulty.
[ There are a lot of brain imagery studies trying to decide whether the hippocampus is smaller in schizophrenia - opinion for and against - irrelevant really, [ because clinical studies and academic research confirm that memory is poor in schizophrenia. If memory is poor the hippocampus is involved. ]
In any case, there is something wrong in hippocampus memory functioning that has to be addressed in any system of 'recovery'. ( A glimmer of hope ? too hard going ?)

Hippocampal failure on it's own seems too little to be a sufficient explanation for the 'craziness' in the inner life of schizophrenia.
But there is a whole lot of odd inner past 'experience' in 'day dreaming'' [ the so-called 'default state' when there is nothing else to do or to attend to ] for a malfunctioning information service to pick up on, drawing on from whatever fictive has been read or imagined, or part of the fancy which is there in 'mindwandering ', in presleep and wakeful drowsiness , that can come to make up the inner life of the illness, if the 'scrutiny for acceptability ' is weakened by inadequate new cell formation in the hippocampus.

Clinical services , particularly the consultant psychiatrists - the lead advisors for commissioning [ they don't commission themselves but if they said that memory failure is not being addressed as an unmet NEED that would help. If clinical leaders do not bother , why should commissioners care ? ] , as something a service has to take into account to provide for. Instead they 'cover' them selves with high talk about 'their choice' , neither expressing nor using 'authority'; neither that which comes from their qualification and experience, nor that given them under the Mental Health Act. If the lead clinical figures give the memory fault no regard, it diminishes the chance of lay people - the Primary Care Trusts - commissioning and paying for a rehabilitation service to residual schizophrenia.

The adverse publicity goes on, no one wanting to be identified with the illness.

The split between LA Social Services and Health delivery, means neither delivers. LA Services are now the lead in aftercare, but they are lay people and shrug off from the range of occupational activities that they should be providing to those with residual schizophrenia.

Carers despair.

The evidence

*** New !!!

There you are - the Guardian has a supplement on memory. The neuroscience page singles out the importance of a functioning hippocampus in updating the past - applying it to what is relevant in the present - and in preparing for whatever will be neededto come from memory for dealing with the future, near and far .

No mention - we don't talk about it - about the likelihood that the failure in hippocampal new cell formation at the time of the onset of schizophrenia, continues, making entry into recovery impossible for many - having to cope with the contemporary world, without a helpful professional service ready to acknowledge and take account of, the limitations that come with a reduced functioning memory capacity

Human Rights Convention on Disability rights. quoted against 'Leverage' [ = coercion ] on Schizoprenia

To inform carers about this illness, and what is not being done for it - and why.

The evidence

Reaction from family carers are necessary for me and welcome.

Carers are not listened too by those who provide standards of care, unless they have numbers behind them, and they have an issue that is clear, true, presented as a common issue, where publicity to the neglect of it is shaming. it.

Otherwise it's only the tragedies of homicide that expose the shortcomings.

Recent tragedies find carers unable to press their observations so as to get actions, and become the victims. In homicides by mentally ill people there are two victims - the family of the perpetrator not goven sufficient care, and the family of the victims, often the same people.

What to do in such situations . Go to Tragedy strikes - continuing care for what could have been done

Psychiatric Journal: January: Mordoe: Weatherby
Since 1995, there have been a total of 1213 litigation claims against the NHS where the specialty recorded was psychiatry, at a total cost of £47.2 million.
Of the total claims, 980 have been closed (81%), with 662 attracting compensation (68%).
The mean compensation payment was £71 299.

It is worth noting that five individual claims exceeded £1 million, accounting for a total of £10.7 million (25%). The remaining 233 open claims (19%) are relatively recent additions to the database and might be expected to inflate the number of compensated claims as they reach a conclusion

*** New !!!
new weekly pages, keeping the old one for a while to refer to recent matters affecting mental health service delivery, especially when relevant to continuing schizophrenia
I'll worry over how to get people with influence - know any ? - to give attention to the evidence I have brought together about hippocampal failure. I had written to the newly formed Schizophrenia Commission lead figure [ by coincidence at it's launch not knowing about it ] with neither acknowledgement nor reply

contact me at davidwatch@btinternet.com or tel no 01208 81 6035

!! New this week !!

Please sign up to this petition - led by carerwatch.com to get a parliamentary review of the 'welfare to work ' changes to benefit. Benefit changes leading to interrogatory face to face challenges will unsettle those with schizophrenia, for some enough to lead to distress, to breakdown.
If your family member gets such a summons, obtain a letter from the consultant psychiatrist, with the diagnosis, take it to the interview to be read, but to be kept in confidence and not shown to the interviewee

*** R !!! marks 'Revised' ....... *** New !!! marks new ... Risk ... Cognitive remediation ? " does it do what it says

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*** New !!! marks new Cognitive Remediation *** New !!! marks new Risk management direct DOH Mental Health 'Basic' Psychiatry; anxiety alcoholism, ADHD etc Carers know a thing or two Carer user and professional Carer and confidentiality

10

A happy accident from a guardian angel? New cell - neurogenesis - in the brain hippocampus - examined as likely to be connected to mood depression illness - luckily included continuing schizophrenia as a control sample as well as a normal control group. Lo and behold , unexpectedly, hippocampal neurogenesis - responsible for letting present memory update stored experience, essential to uploading what you need from stored experience - is reduced in residual schizophrenia. What that means is that you are stuck with what capability you have at the age the illness strikes, that mow you cannot command from mind at the right time, all the relevant material that allows you to measure up to the quite complicated activities needed to cope in modern personal life, social life, or work life. By yourself - but you could, with help !!!!! Reif et al 2006 ... Neural stem cell proliferation is decreased in schizophrenia, but not in depression And then - maybe - this ..... the abstract: ..... *** New !!! Adult hippocampal neurogenesis buffers stress responses and depressive behaviour. Nature August 2011 Volume: 476, Pages: 458–461 Jason S. Snyder et al Snyder Never mind the puff for depressive ilness - the mice equivalent doesn't stand up. ........ ' The hippocampus, a brain region densely populated with receptors for stress hormones, stress and glucocorticoids strongly inhibit adult neurogenesis' ..... 'Here we show that adult-born hippocampal neurons are required for normal expression of the endocrine and behavioural components of the stress response.' ...... Stress - what is that if not High Expressed Emotion - one of the most robust associations with breakdown in schizophrenia !!! ??? The factual bit is the effect on dental cell neurogenesis Add that effect on to reduced dental neurogenesis in schizophrenia, then you get a further down turn onto the already reduced neurogenesis in the hippocampus in schizophrenia . If Reif et al is right schizophrenia will be worse. If you don't have enough hippocampal neurogenesis you don't have enough capacity in memory mangement to organise yourself to cope with everyday matters, particularly if the illness arrives early before maturing experience has been stored away. To get from experience and recent memory what is required to prepare and complete the sequence required for a task ahead. The necessary information has to pass through the faulty hippocampus. You just can't move on from what you already have. You can't rehabilitate yourself. You can't take the first steps. You don't get better unless you are helped into a simplified life routine. You can, when the outside world is simplified enough and welcoming - if you are mentored in engagement, if you are given time, if there is a service, if there are activities and a place for them, with an introductory 'pace' that allows a step by step participation. Once in place stabilising expectation, settles the inside associations onto normal matters. They are there to come back to. Most with continuing schizophrenia unfortunately, are in settings whose grant aid often depends upon doing a whole day, or half day involvement from the start , sometimes a five day week commitment, which is too much of a facer for many with continuing residual schizophrenia. [ It may be that this hippocampal shortage is not a fault in all people with the illness. It is critical that the finding be confirmed more generally, and over the age range. ] If the professional service has access to such facilities, and stays until a supportable routine is in place; such a routine acts against relapse I am going to leave this here until somebody pays heed, and either confirms the finding of reduced hippocampal neurogenesis in schizophrenia, or repudiates it. The lack of interest in verifying the finding is a disgrace and neglect of service to those with continuing schizophrenia It certainly reflects the relatively unchallenged assertion 'schizophrenia no longer at the heartland of psychiatry' that appeared in the Psychiatric house Journal some time ago. The deficiency inj neurogenesis is a visible adverse structural change in schizophrenia, that explains, in particularity, how and why those with continuing schizophrenia have difficulty in being unable to rehabilitate themselves to cope with the outside world, because less able to organise their thoughts, to capture, plan for, to deal with what lies ahead,; subsequent studies point to the need for, and the ability of, the kind of service provision that will give a helping hand. Build up a daily and weekly routine for them, to it 'bit by bit' , taking enough care and time over it, mentoring all the way. Family carers know about routine for their family sufferers - it is from these certainties that they get by. Neural stem cell proliferation is needed for enough capacity in working memory Without enough working memory capacity, carrying the ability to deal with day to day difficulties becomes too much, more so if unsupported, on their own. Reif et al 2006 ... Neural stem cell proliferation is decreased in schizophrenia, but not in depression ... the penultimate two paragraphs in Discussion ... quote This study is on post-mortem material held ' in stock ' much earlier. The hippocampal area in tissue from schizophrenia is compared with that from mood disordered people and from normal controls. " Does the finding of decreased Adult Neurogenesis [ AN ] in Schizophrenia make sense? Sz is known to go along with several cognitive deficits, which is stable over time, that is, trait rather than state dependent. The prime role of hippocampus is rather memory formation than affect regulation. Thus, diminished Adult neurogenesis, which has been suggested to result in impaired memory formation, will contribute to the cognitive impairment seen in Sz; improvement of cognitive functioning in Sz by clozapine might be due to the increase of AN seen in animal studies. As learning, exercise, and enriched environment all increase AN as well, this directly points toward non-pharmacological treatment of schizophrenics. The preliminary finding of reduced AN in Sz provided in the present study is thus worth being pursued further." In post-mortem examination of the hippocampal area in schizophrenia [ - a surprise finding as the authors were looking for change in affective llnesses - ] the area now known to continue producing new cells, neurogenesis was depleted. Depleted hippocampal neurogenesis means reduced working memory capacity. all the links to subsequent studies ... fresh page 2

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The Royal College of Psychiatrists starts a National Audit of Schizophrenia - now and for next three months. Important ! carers who are approached should request regular breaks on three days in the week