July 31 - august
Kraepelin wasn't so far out with calling it 'dementia praecox'
Many studies with patients indicate uncertain memory storage systems Old stores and interests are better kept, but are not always so relevant to current issues in living.
It's a common ordinary observation. They are not always'there'. Sometimes having to be 'led'
, to be tuned in and held along in conversation.
There is no evidence that people with schizophrenia have more fleeting or off-the-mark memories than healthy subjects. Rather, they are unable to simultaneously hold as many items at once in working memory
Working memory, the ability to briefly store and manipulate information, is the essential guide to completing purposeful behaviour
The results suggest that schizophrenia reduces working memory capacity, causing subjects with schizophrenia to store fewer items.
The length of delay made no difference in either the number of items recalled or the precision of recall for either control or patient group, contrary to expectations of less stable memories in schizophenia.
' Memory difficulty in schizophrenia is characterized primarily by reductions in storage capacity and not by an instability of the working memory representations '
There is not always enough memory available to deal with what is happening.
[ this is why conversation with sufferers is difficult and limited - there is little 'small talk' - it is literal ...concrete .... it follows leading, rather than leading - the pool of associations is not enough for making talk interesting and fresh, is not held in the background, there to be used for recall to initiative and association. ]
The information held in the memory store inside the brain, that has accumulated from experience is brought to bear on what is perceived to be happening 'outside'. It is to make sure it fits in with what is going on now and what is relevant for the personal background of the one perceiving,
Any significant consequence is tested against a memory hinterland. Do I have tohold this in mind, as I attend to what is going on?
Conscious perceiving is not just locally giving attention. It needs the application of a wave of gamma activity that is making the connected network in the brain that gives it meaning and value.
In order for neuron 1 to communicate to neuron 2 it does so best and clearest if the two are in a synchronised wave
Perceiving anything requires the synchronising of all the bits of it that are being dealt with separately in different parts of the brain:size, colour, shape, historical association. The synchronising of the wave means the information can be bound together at the same time to give theboth the image and what it means in context.
The pattern of synchronising in the brains of schizophrenia are less extensive or not so well formed..
This might lead to one area losing out – maybe the one that decides
whether some thing is coming from outside perception or from inside a thinking memory construction,
leading to misperceived 'voices' ; or perception might get linked to the wrong group of synchronised cells – a delusion
A reduced 'information pool' may not be doing such a good examining job.
Things immaterial may be allowed in and become fitted in somewhere, unchecked.
An established routine gives a stable outside framework. As it becomes predictable it builds up a new habitual memory store. It does not require so much working memory.
With the routine regularly in place there is less call on an active working memory pool than if there was no such order in place.
Internal order is be helped by external order.
A reduced working memory pool makes it impossible for the sufferer on their own to bring an outside routine into order themselves.
Too many mistakes follow from the reduced working memory pool.
Mentoring, finding, promoting establishing, supporting the routine needs the help of someone else with prior access to the appropriate resource.
That is why Mental Health Trust Services which do not have a Rehabilitation and Recovery service have a Service Deficiency.
Where staff see such a deficency they have a Service Deficiency Form to make out. That it is a clinical need - for aftercare - means this should go to the local NHS Managers and Commissioners so that they register the Deficiency, accept it or deny it, and plan to deal with the Unmet Need.
When the Form does not go in, managers, and NHS specialist secondary mental health services nationally can continue to be in denial - how were we to know this - no clinician told us that this was a basic clinical need
Nor did any family carer !
What is it
that carers must do.
Request, in writing to the local Team clinical lead, copied to the local Mental Health Trust Chief Executive, that there is an unmet need in the local Service for continued aftercare and treatment for those with schizophrenia, and that a Service deficiency Form is made out officially.
.. July 11-17
neurogenesis - the capacity to make new brain cells.
2. The area adjacent to the lateral ventricles in the brain called the 'Sub-Ventricular Zone [ SVZ ] ventricles are the fluid cisterns within the brain, [ probably there to buffer against brain movement from external skull collisions - boxers, centreback footballers ? ]
There is now known to be a third area of activity in this area, only in primates and humans - the Outer sub-ventricular zone [OSVZ ] which similarly provides and sends on new cells to the frontal cortex - what are they doing ? if not to back up on living experience as it goes on ? *** N !!! Somebody who knows more, explain more please - by e-mail
comment please to davidwatch@btinternet.com?
The relevance for schizophrenia - maybe none - but one hard fact - the lateral ventricles are larger in many of those with Schizophrenia - never given a satisfactory explanation - what area of the brain gives way to allow for that enlarging - the brain cannot enlarge, confined within the skull: could it be a reduction or loss of the the SVZ and the OSVZ , which are the source of new brain cells, so that what depends on these new cells [ needed to codify new experience ?] ? Might this loss be behind Schizophrenia.
Recently a study of the new born of mums with schizophrenia - a higher risk group for the illness later - have more of babies with lateral ventricles larger than the equivalents in babies of mums without schizophrenia
Hitherto in the brain it was until quite recently not able to distinguish new cells with a 'marker' . That is now possible.
Neurogenesis cells are 'stem cells ' already being tried in spinal cord injuriea and the brain disease 'Parkinson's' disease.
New research has taken fibroblast cells from the skin of patiients with Parkinson's, turned them into stem cells and on into Dopaminergic brain cells so as to be able examine why such cells fail in Parkinson's [ You can't take such cells from directly from the brain in someone in early Parkinson's ]
Maybe similar research into schizophrenia one day.
Schizophrenia wastes young lives for the rest of their life, fifty DALY years gone to blight, often for their families, communities, and friends as well .
Many too often drop out of NHS service. Too unable in the nature of a remainder of illness, willingly to co-operate for practical resource or maintain connection - if it was available locally.
Charities give very little expression to the lack of publicity accountability for the national failure. They want the illness to disappear. In fact they often won't use the name. That's ok to avoid stigma, but the name not used it becomes impossible to know what service those affected should be having in their area , as opposed to what they are getting in practice - for a whole catchment ares of service , not cherry picking.
Charities too uncomfortable to be seen in their failure in sticking up for this singular illness, as their own failure.
They use ' serious mental illness ' cherry picking for success in the publicity for themselves that makes sure they get the Government and Lottery funding, they depend on.
A consistent finding in studies of ACT [ Assertive Community Treatment = Asserive Outreach ] is that it is more acceptable to "difficult to engage" clients than standard care, but although UK ACT services are engaging clients,
As one Assertive Outreach [AO ] consultant [Shetty] rightly states, they are not building on this to deliver the evidence based interventions, such as occuptional routines, likely to improve clinical outcomes. In some cases this is due to inadequate specialist staffing.
A survey of 222 English ACT teams in 2003 found that only half had a psychiatrist, one fifth had a psychologist and very few could deal with substance misuse or had occupational therapists or vocational rehabilitation specialist.
... many did not operate outside office hours.
A comparison of ACT in London and Melbourne, Australia, found that London teams had around one quarter of the input from a psychiatrist, only half operated outside office hours (vs most Melbourne teams), only one third made the bulk of their contacts away from the office (vs. the majority of Melbourne teams) and they scored lower for caseload sharing .
Inadequate implementation of the ACT model, inadequate delivery of evidence based interventions, and the lack of much diffeence between key elements of ACT and standard care therefore appear to explain the variation in its effectiveness reported in the international literature.
In the UK, ACT teams need to be staffed appropriately and operate with the critical components likely to result in improved outcomes
. Otherwise, their lack of DALY cost-effectiveness will make them vulnerable to closure. [ or replaced by Home Treatment, burdensome and ineffective, and often used when there are no immediate admission beds.]
week three :-
How to discover and retake these into the help needed.
For those in a system of living which provides for the support of a regular domestic success,
plus a routine achieving connection to settled activities within the week - a programme for their living which is and reliable, with someone - often a family member - to be a monitor for early intervention when that seems necessary; here, the light touch is reasonable.
For the others, erratic and excluding themselves, it increasingly looks as though some kind of 'wardship' should be developed - Community Treatment Orders and depot regime [ CTO's]
but with clear reciprocal benefit in funding, for appropriate residential support and occupational activities; guardianship with extra powers?
There is a difference from those in some residual illness , but who have a directed life that they keep in contct with; that is one connected to some meaningful regular activity, a routine for themselves, with contiinuing help, maintained by them, observed by other people :
from those others who do not have this, and consequently are open to times when the illness is in charge, not open to observation; there is no such programme onto which to re-engage and restore the commitment.
It is the these latter who have to be kept in contact, sufficient to carry some form of surveillance and with the contact to a significant person in their lives, often a family member, able to do reporting in.
E-mail reaction is welcome