WHAT EVERYONE SHOULD KNOW
ABOUT MENTAL ILLNESS.
The voices of schizophrenia, the highs and lows of bipolar disorders
and the paralyzing sadness of severe depressions: science tells
us now that they are no more than malfunctions in brain electrochemistry.
Severe mental illnesses are due to a genetic predisposition;
they don't discriminate; they occur all over the world and must
be treated as early as possible in a seamless, uninterrupted
way and for a lifetime, because they are chronic and recurrent.
These complex illnesses are not caused by the environment or
the families; they don't kill the victims except by suicide;
no one is at fault and the main victims are those who lose everything
after experiencing psychotic crisis and/or abuse substances.
Half of the persons affected by these illnesses
also suffer from "lack
of insight," meaning they don't realize that they are mentally
ill, and consequently refuse or stop taking psychotropic medicines.
Without the authoritative and persistent intervention of others,
they remain sick and their irrational behaviors perpetuate stigma
and discrimination, with some becoming homeless and others incarcerated.
The same care we extend to persons suffering
from cancer or Alzheimer's should be given to those affected
by mental illness. The distressing
emotional pain and the unsettling thoughts that they cannot control
nor change are as distressing as the physical pain of other biological
illnesses. It is also in the best economic interest of everyone
to provide medical and social help to people with mental illnesses,
especially to the ones without "insight" and unable to
speak on their own behalf. Furthermore, we know that supervised
treatment does work.
Miami, May 6, 2005.
ASK THE DOCTOR
Lewis A. Opler, M.D. Ph.D.
Q: Are there any medications to treat lack
of insight?
A: No. And this can be very frustrating in
treating persons with schizophrenia, since even patients who have
responded well to antipsychotics may lack insight, question the
need to be on medication, become noncompliant, and relapse. In bipolar
disorder, during a manic phase, persons often lose insight, although
they usually retain insight during the depressive phase and during
the phase of good interepisode functioning. At present, the best
treatment for lack of insight in schizophrenia and bipolar disorder
is education.
Some of us have been able to use “advance directives”
with patients who lack insight: At a time when the patient’s
symptoms are minimal or in remission and they have at least some
understanding of the need to remain on medication, I sometimes have
them sign a “contract” agreeing that if certain warning
signs start to emerge, they will be given medication or even taken
to an emergency room for evaluation, even if they object at the
time. These “contracts” are not legally binding. But
sometimes they provide the leverage that a patient who has become
noncompliant needs to be restarted on medication.
I am an optimist: it is now 50 years since chlorpromazine was shown
by Delay and Deniker in 1952 to treat psychosis. It is now 12 years
since clozapine was introduced in the United States as a treatment
for patients with schizophrenia who responded poorly to standard
neuroleptics. I believe we will do even better. Over the next 50
years I believe we will develop better medications, including medications
that treat lack of insight.
Even more important, as we increase our understanding regarding
what causes schizophrenia, bipolar disorder, and other mental disorders,
we will be able to develop interventions that decrease the likelihood
of severe mental disorders emerging, even in vulnerable individuals.
But such breakthroughs will only occur if our society is willing
to invest the necessary resources in supporting research. Supporting
research must remain among the top priorities on the NAMI-NYS’
agenda!
Extracted from NAMI-NYS News * May 2002 * Issue No. 77 * Pg. 21
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