Category Archives: schizoaffective disorder

Outlook for schizoaffective disorder and schizophrenia

Outlook for schizoaffective disorder and schizophrenia
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How Schizoaffective Disorder compares to other disorders

There is little information about schizoaffective disorder in children, which usually starts around puberty.  As a parent, you know how seriously it affects your child, but how does it compare to depression and bipolar (manic and depressive states) and schizophrenia?  What is the course of schizoaffective disorder, and how can you help your child’s future?

Schizoaffective disorder is not as serious as schizophrenia,
but more serious than bipolar/depression.

Research conducted in Britain* studied young people who received typical treatment for schizoaffective disorder, schizophrenia, and bipolar/depression who were between the ages of 17 and 30 (average age was 22).  Over a 10 year period, those with schizoaffective disorder improved slightly, better than those with schizophrenia.

Outlook for schizoaffective disorderBehavioral functioning over time for schizoaffective disorder, schizophrenia and affective disorders (depression, bipolar) at four consecutive follow-ups.  (This scale goes from 2 (good) to 6 (poor). A “1” would be the level of a person with no symptoms and who is considered normal.)
*M. Harrow, L. Grossman, Herbener, E. Davies; The British Journal of PsychiatryNov 2000, 177 (5) 421-426

Behavioral functioning is measured by how well a person does in five areas:Russian brain diagram

  1. Work and social functioning
  2. Adjustment to typical life situations
  3. Capacity for self-care
  4. Appearance of major symptoms
  5. Number of relapses and re-hospitalizations.

Your child will struggle with these, but there’s good news according to a recent landmark study:
Family support improves a patient’s outcome.

Life with a schizoaffective teen,” tells my story, and what steps I discovered which worked to improve my daughter’s functioning and behavior.  This article also provides insights into how children with schizoaffective disorder think.

A new treatment program was developed that altered some well-established practices.  A set of schizophrenia patients received the following support and were later compared with those who had the usual medication approach.

  1. Dosages of antipsychotic medication were kept as low as possible
  2. Help with work or school such as assistance in deciding which classes or opportunities are most appropriate, given a person’s symptoms;
  3. Education for family members to increase their understanding of the disorder;
    (“Efforts to engage and collaborate with family members are often successful during an acute psychotic episode, whether it is the first episode or a relapse, and are strongly recommended.
    Family Involvement Strongly Recommended by the American Psychiatric Association)
  4. One-on-one talk therapy in which the person with the diagnosis learns tools to build social relationships, reduce substance use and help manage the symptoms.”

Patients who went through this for of treatment made greater strides in recovery over the first two years of treatment than patients who got the usual drug-focused care.  More here.
New Approach Advised to Treat Schizophrenia, Benedict Carey, New York Times, Oct. 20, 2015

“..if you look at the people who did the best—those we caught earliest after their first break with reality—their improvement by the end was easily noticeable by friends and family.”

beautifulbrainThe longer psychotic symptoms stay in an extreme phase,” in which patients become afraid and deeply suspicious,” the more likely the person will be vulnerable to recurring psychosis, and the more difficulty they will have coming out of it and adjusting to normal life.

How to help your child

Be very realistic about what your child can handle in school.  They may be extremely intelligent–but maybe can’t handle too much homework; or class disruptions; or lack of empathy from the teacher.  A parent or school counselor should help your child find low-stress classes or activities, and consider limiting the number of classes per day.  They can only hold it together for so long!  I found it helped my schizoaffective child to take later classes, starting at 10 or 11 am.

Get the whole family on board to make his or her life easier.  Your child might be stressful and a source of irritation for everyone, but family members can help reduce this by taking on the chores your troubled child would ordinarily do; avoid pressuring them about something, or anything; and allow your child to say oddball things without confronting them about how irrational they are or arguing with them.

DIY talk therapy – Here are some ways to guide your child out of their troubled states.

Anxiety

  •  psychosisSchizoaffective kids may express anxiety in a tangled web of seemingly unrelated things, and spike them with paranoia about what they mean. Listen carefully, and conduct a gentle interview to explore what truly is bothering them.  It may be as simple as the room being too cold.
  • Give them plenty of time (if you can). A venting session is sometimes all they need.
  • Diplomatically redirect a negative monologue with a comment about something pleasant. This is where it’s useful to hand them a cat or call over a dog, offer tea or juice, or briefly check email.  The point is to break the spell.

Run-on obsessive thoughts

  • Voices and thoughts can be angry, mean, and relentless. Your child may not tell you this is happening, or may simply assume you already know what’s in their head.  Ask him or her if thoughts or voices are pestering them.  If so, show indignation at how wrong it is for them to mistreat your child, “that’s not right that this is happening to you; this is so unfair to you; you deserve better; I want to help if I can…”
  • Encourage your child to ignore the voices/thoughts and they may go away, or encourage them to tell the voices/thoughts to leave them alone. “I refuse to listen to you anymore!  Quit pestering me!  Obsessive thoughts and voices are just bullies.

Help your child stand up to thought/voice bullies the same as
as you would help any child dealing with a bully.  This works.

Life with a schizoaffective teen,” tells my story, and what I discovered that worked to improve my daughter’s functioning and behavior.  It also provides insight into how people with this disorder think.

Take care and have hope.  You can do this.

Margaret

 

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What to know about psychiatric residential treatment

What to know about psychiatric residential treatment
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residential centerHave you been searching for psychiatric residential treatment for your child?  Do all the programs sound wonderful?  Ads include quotes from happy parents, and lovely photos and fabulous-sounding activities.  But what’s behind the ads?  Residential treatment programs are diverse, but there are important elements they should all have.  Here’s how to avoid low quality residential treatment.

Psychiatric residential treatment is serious stuff–it’s difficult to do–especially when troubled children and teens are put together in one facility.

Should you ask other parents for their opinion of a program?  In my experience with a child in psychiatric residential care, and as a former employee of one, word-of-mouth is not the best way to assess quality or success rate.  There are too many variables: children’s disorders are different; acuity is different; parents’ attitudes and expectations are different; length of time in the facility is different; what happens once a child returns home is different…  It’s most helpful to ask questions of intake staff and doctors or psychologists on staff.  Quality psychiatric residential care facilities have important things in common.

What to ask about the staff:

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  • What is the training and licensure of staff?  Are there therapists with MSW degrees, registered nurses, psychiatrists and psychiatric nurse practitioners, and is a medical professional available on site 24/7?
  • There should be a high staff to patient ratio, and a physically comfortable environment with lots of emotional support.
  • Do the staff seem mature to you?  Do they support each other, are they a team?  There is often heavy staff turnover at residential treatment centers because the work is emotionally draining, so staff cohesion is as important as the qualities of each individual.
  • Safety is paramount.  Staff must be able to safely manage the things that can go wrong with troubled kids.  They should be trained in NCI (Nonviolent Crisis Intervention), “training that focuses on prevention and offers proven strategies for safely defusing anxious, hostile, or violent behavior at the earliest possible stage.”

What to ask about programs:

  • Does the program specifically identify parent/family involvement as part of treatment?  Does it emphasize parent partnership with staff?  Ask.  Whether you live close or far from the center, even out-of-state, you should be regularly included in conversations with staff about your child’s treatment.  You should also be included in a therapy session with your child periodically; some facilities can connect with you over Skype.  Your child’s success in psychiatric care depends on their family’s direct involvement.
  • The program should coach you in specific parenting approaches that work for child’s behavioral needs.  While your child is learning new things and working on their own changes, you must also.
  • You should be informed why your child is getting the treatment or behavioral modifications he/she is receiving.

Body health is mind health, and vice versa.

  • residential programsMental health treatment will include medication and therapy, but must also include positive activities and an educational program.  The whole body needs care:  exercise, social activities, therapeutic activities (art, music, gardening), healthy food, restful sleep, etc.

Is your child emotionally safe as well as physically safe?

  • You should be able to visit the unit or cottage where your child will live, see their bedroom, and see how the other children interact with staff and how staff interact with each other.

What to ask about the business itself:

  • Can you take a tour ahead of time?  Can your child or teen visit too if appropriate?
  • Are emergency services nearby (hospital, law enforcement) that can arrive quickly?
  • Does the facility have a business license in their state?  Do they have grievance procedures?  Is the center accredited as a treatment facility, and by whom?  In the U.S., the main accreditation authority is called JCAHO (Joint Commission on Accreditation of Healthcare Organizations).

Psychiatric residential treatment works miracles, but it doesn’t work for all children.  Some need to go into treatment more than once to benefit. Some fall apart a few weeks or months after discharge.  These are common.  What’s important is that you and your child are taught skills for managing his or her unique symptoms, communicating well, and committing to staying well together.

Good luck.

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Life with a schizoaffective teen

Life with a schizoaffective teen
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I have first-hand experience raising a child with schizoaffective disorder.  Up until my child’s onset of the disorder in the ‘tweens’, I never thought I had much patience or backbone.   But one’s character strengthens with trials, and I learned I was patient and stronger inside than I thought.  Parenting my child entirely changed my life’s direction.

Farther down this post are practical tips and advice for raising your child.

My Story:  Schizoaffective teens have both schizophrenic symptoms (thoughts disconnected from reality) and affective symptoms (unstable emotions and moods).  What an unfair combination of experiences to sabotage one’s brain.   My child had to persevere through intense feelings, excruciating anxiety, and thoughts that rarely touched on facts.  How could anyone maintain any semblance of normalcy during this?   The mental effort of holding oneself together was exhausting.

My child was often exasperated with me, as other teens are with their parents:  “Mom, you don’t understand me, it’s like the TV’s on, the radio’s on, the stereo’s on, you’re talking to me, and I’m trying to read a book, and I can’t not think about every single thing.”  Right, I couldn’t relate.  I could not imagine processing 10,000 inputs at once without going crazy.

Hallucinations feel normal when you’re in them

My child had a slow early onset of hallucinatory experiences beginning about 11 or 12, and was able to hide it until 14.  She considered the hallucinations and voices normal, and became accustomed to them.  Eventually, she noticed that others didn’t see or hear the same things:  the rhinoceros walking by; the sky turning green; words writing themselves on a blackboard.  To my child, here was proof of being special, magical, a traveler on the metaphysical plane.  Because there was proof, she felt superior to others and that she had special powers.

I have never had hallucinations, but imagine they are like dreaming wide awake.  My child’s audio hallucinations included something out of Monty Python:  two loudly arguing British ladies, with thick Cockney accents, relentlessly criticizing each other’s cooking and husbands.  She complained it was impossible to hear what the teacher said in class.  (Even today, during summers when she is happy, the stand-up comic voice visits and tells jokes throughout the day.  Our family witnessed many outbursts of laughter and giggling for no apparent reason, then started laughing contagiously.

My child’s visual hallucinations took fascinating forms:  stairs looked like a cascading waterfall; a living room chair continually rotated in space instead of standing still; moving objects left trails in space, like a series of images seen with a strobe light.

She awoke one morning with stories of her life as a queen for 1000 years, and talked about it in extraordinary detail.

My child is the bipolar type of schizoaffective person.  While depressive types don’t have the highs or excessive agitation,  they still suffer with anxiety and paranoia.  When she was in a down cycle, she darkened her room and slept in a pile of bed-clothes on the floor.  She avoided things with negative symbolic meaning, such as certain people, certain streets, or certain names.   For some reason, sunflowers and Christmas were upsetting.  During depressive phases, she talked about suicide, or “caught” other disorders such as anorexia and PTSD.  I was often accused of abuse and endured many hurtful words.

Haunted by anxiety and paranoia

Anxiety and panic are torturous, and I wished I could have spared her from the pain.  She would obsess on a past emotional hurt and become horribly upset for hours, days, weeks at a time. (In my stress and ignorance back then, I yelled at my child unaware of how hard this impacted emotional memory.)  I had to apologize a zillion times.

My child continues to obsess on ancient hurts, now well into adulthood.  Any traumatizing experience can become a theme in the life story of a schizoaffective person.   They will refer to it and make connections to it for the rest of their lives.   Big issues with my child are about money (having money, people stealing money, having no control over money).   It’s common for her to interpret any event as the turning point when everything started to go downhill, “That’s when you took all my money, “That’s when you ruined my life.”

It may not be preventable.  It’s the very nature of schizophrenia spectrum disorders to find something to be paranoid about.  The point is for a parent to learn to avoid triggering the traumatic memories, and avoid reasoning or explaining what really happened.  Our children cannot reason once upset.  I had to learn to “de-escalate” my child, don a quiet and patient demeanor, affirm feelings, show empathy, and change the subject (“redirect”) etc.

Stalkers of famous people often have schizoaffective disorder

She did some reading and told me that people with schizoaffective disorder often believe they are connected to a celebrity’s life as lovers or confidantes, and some will stalk that person.  John Hinkley is a famous case.  He believed he was the boyfriend of actress Jodie Foster.  In her film, “Taxi Driver,” her would-be boyfriend attempted to assassinate the president to impress her.  Hinckley did the same, and attempted to assassinate then-President Ronald Reagan.  In prison, Hinkley was diagnosed with schizoaffective disorder.  The Beatles musician, John Lennon, was killed by Mark David Chapman, who believed he was the rock star and John Lennon was impersonating him–Chapman is another person with schizoaffective disorder.  I was amused that she realized, only then, that her ever-present (invisible) boyfriend was a famous rock star.

Partial complex seizures can simulate symptoms of schizoaffective disorder

Partial complex seizures of the left temporal lobe (temporal lobe epilepsy) cause, enhance, or simulate symptoms of schizoaffective disorder.  If your child has not had an EEG, request one.  If there is seizure activity, it can be treated by anticonvulsants such as Tegretol (carbamazepine).  This helped to reduce many of my child’s symptoms, such as intermittent bouts of terror, seeing auras around people, and color changes in the sky.  (See an abbreviated article with an explanation at the end of this post.)

Lessons I learned

  • Don’t challenge your child’s beliefs about their experiences, even if you think they are strange, focus instead on keeping your child functional: taking meds, attending school, engaging in safe activities, and managing personal care.  You will be better able to correct/redirect their thinking once they feel comfortable speaking openly with you.
  • Believe and act on any references to suicide or destructive ideas—this may be manipulation, but don’t take the chance.   If you believe your child is being manipulative or overly dramatic, ask them respectfully to stop.  Yes, just ask.
  • Allow your child to talk comfortably about their hallucinatory experiences.  You want to know what they are witnessing or monitoring in their head.  You want to know if a voice is verbally abusing your child, or telling them to hurt themselves or others.
  • “Inoculate” your child from cruel voices or messages–teach them to deny the power of the voice or not take it seriously.  Example:  “I know you can’t stop [this voice] from pestering you, but it’s OK to resist [him] or ignore [him].  [He] has no power over you.”  She was very upset once because her rock star boyfriend/ghost yelled at her.  I told her to tell him, “Stop it and leave me alone! Don’t talk to me that way!”  She did (somehow), and it worked!  The rock star guy stopped talking to her for a couple of days (as if he was sulking), and returned and was nice to her again.

Things you can do

  • Low stress is a priority. Create a low-key environment in the home, limit sensory input, use quiet or soft voices as much as possible.
  • Allow your child to avoid over-stimulation–crowds or energized spaces with too many things happening (parties, malls, sports events or activities, slumber parties, or whatever they say it is).
  • Don’t argue with them if something they say doesn’t make sense to you.  Listen attentively and avoid offering your opinions.  Let me repeat, don’t reason with someone who is inherently irrational.  Ensure they are safe, comfortable, and appropriate, and spend quality time listening like you would any other child.
  • Help them avoid anxiety-causing things or places.  Go out of your way.  Make a point of driving down a different road, or bringing them home from an event early, even if it’s inconvenient.  This is respectful and humane because they are  agonizing about something that you don’t experience.  You need their trust in you to protect them from their own mind.
  • Ask your child what they need to calm down or settle.  If they want to be in a dark room with the windows covered with foil, fine.  If they want to listen to loud ghastly music through headphones, fine.  Just watch.  It will be obvious if it settles them, or helps them focus and relax.
  • Allow your child to be weird at home as long as they adhere to basic rules.  “I respect your freedom to be who you want to be, but you must take showers and wear clean clothes.  Hygiene is the family policy.  This rule won’t change, but I am happy to help you with this if you want.”  No reasoning or justification, just a simple statement of the rules everyone follows.

You can ask for, and expect, respectful behavior

It is possible to ask your schizoaffective teen to stop disrespectful or harmful, inappropriate behavior, and it is possible to set a boundary if done in a respectful straightforward manner without justifying yourself.

Example of something I said to my daughter during a particularly dark period:  “I’m leaving the house and I’ll be gone about 2 hours.  Do not try to commit suicide, stay right here in your room and be calm.  I’ll bring you a snack when I get home.”  Note that this gave her a reason to wait until I came home.

Outcomes are poor with schizoaffective people, but statistics say they have a better long-term prognosis than those experiencing schizophrenia (see “Outlook for schizoaffective disorder and schizophrenia”).  Perhaps it’s because their emotional awareness gives them the ability to form friendships and relationships, and talk about feelings (unlike those suffering with ‘pure’ schizophrenia).  See article at the end of this post, “Social Interaction Increases Survival by 50%.”

You are in this for the long haul.  You will experience a roller coaster ride of emotions.  Pace yourself as if in a marathon.  There may be multiple crises  and hospitalizations, but these may space farther apart over time with treatment and family support, and you’ll have respite.  Your child will settle into stable, repeated patterns unique to them, and you’ll learn which triggers to avoid, and to ignore what isn’t important.  You’ll also learn how to bring them back into positive states of mind, and set up a healthy environment where they choose to stay.  Have hope.  I lived this, and can attest to it.

 

–Margaret

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Please add a comment about your experiences.  Your observations help others. 

– – – – – – – 

Complex Partial Seizures Present Diagnostic Challenge  (summary)
Richard Restak, M.D. | Psychiatric Times, September 1, 1995

Temporal lobe epilepsy (TLE), is now more commonly called complex partial seizure disorder. It may involve gross disorders of thought and emotion, and patients with temporal lobe epilepsy frequently come to the attention of psychiatrists.

A Dr. Jackson observed in the late 1800’s that seizures originating in the medial temporal lobe often result in a “dreamy state” involving vivid memory-like hallucinations sometimes accompanied by déjà vu or jamais vu (interpreting frequently encountered people, places or events as unfamiliar). Jackson wrote of “highly elaborated mental states, sometimes called intellectual aura,” involving “dreams mixing up with present thoughts,” a “double consciousness” and a “feeling of being somewhere else.” While the “dreamy state” can occur in isolation, it is often accompanied by fear and a peculiar form of abdominal discomfort associated with loss of contact with surroundings, and automatisms involving the mouth and GI tract (licking, lip-smacking, grunting and other sounds).

– – – – – – –

Social Interaction Increases Survival by 50%

Psychiatric Times. July 30, 2010

Theoretical models have suggested that social relationships influence health through stress reduction and by more direct protective effects that promote healthy behavior. A recent study confirms this concept.  Findings from a meta-analysis published in PLoS Medicine indicate that social interaction is a key to living longer. Julianne Holt-Lunstadt, PhD of Brigham Young University and colleagues analyzed data from 148 published studies (1979 through 2006) that comprised more than 300,000 individuals who had been followed for an average of 7.5 years. Not all the interactions in the reports were positive, yet the researchers found that the benefits of social contact are comparable to quitting smoking, and exceed those of losing weight or increasing physical activity.

Results of studies that showed increased rates of mortality in infants in custodial care who lacked human contact were the impetus for changes in social and medical practice and policy. Once the changes were in place, there was a significant decrease in mortality rates. Holt-Lundstadt and colleagues conclude that similar benefits would be seen in the health outcomes of adults: “Social relationship-based interventions represent a major opportunity to enhance not only the quality of life but also of survival.”

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Filed under bipolar disorder, depression, mental illness, mental illness, parenting, schizoaffective disorder, schizoaffective disorder, schizophrenia, schizophrenia

Marijuana and psychosis in teens

Marijuana and psychosis in teens
5 votes

Underside of a normal brain. Filled-in volume identifies areas where there is blood flow.

Underside of 16 year old’s brain after 2 years’ marijuana use, with voids where there is no blood flow.

It’s a myth that marijuana is safe.  While it has proven benefits for certain physical ailments, the drug’s effect on adolescents, especially those with psychiatric vulnerabilities, can lead to psychosis and debilitating long-term cognitive impairment. Research on the effects of marijuana on the human brain has been taking place internationally for a couple of decades.  Studies show marijuana has a more negative effect on the brain than is generally understood.  Even though it is from a plant source, it is a psychoactive drug with dangerous side-effects the same as any synthetic psychoactive drug.

Just because marijuana is plant-based does not mean it is safe.  Its use and dosage should be guided by a doctor.

One researcher discovered that both mentally ill and normal adult test subjects experienced negative mental health side-effects.  He wrote, “When THC (tetrahydrocannabinol) was administered in one trial, it caused both patients and controls to experience transient increases in cognitive impairments and schizophrenia-like… symptoms.”

Marijuana legalization has deeply concerned pediatric psychiatrists and other providers specializing in child, adolescent, and young adult mental health treatment.  Up until the their early 20’s, young brains undergo radical changes as part of normal development.  Neurons are “pruned” to reduce their number (yes indeed, one can have too much gray matter to function as an adult). Pruning occurs more rapidly in teenagers–think about it, a lot of nonsensical teenage behavior can be explained by this.  The THC in marijuana, the part responsible for the high, interferes with the normal pruning process.

Numerous research summaries are appended below, and the dangers to adolescents are shown time and again.  I find this statement extraordinarily sad:

“Increasing levels of cannabis use at ages 14-21 resulted in lower levels of degree attainment by age 25, lower income at age 25, higher levels of welfare dependence, higher unemployment, lower levels of relationship satisfaction, and lower levels of life satisfaction.” 

I worked with adolescents in residential care and in the juvenile justice system who regularly used marijuana when they could.  A young man on my caseload grew noticeably depressed after he started smoking regularly, and his anxiety and paranoia increased.  He said that smoking helped him feel better, but he couldn’t observe what I and other social workers observed over time. Smoking marijuana, ironically, was briefly relieving him of its own side-effects.

When marijuana is ‘medical,’ a medical professional determines a safe adequate dose.
And when it is ‘recreational,’ there is no such limit… no one even realizes there should be.

  A note on medical marijuana – The plant Cannabis sativa has two substances of interest:

  1. cannabidiol (CBD) – the molecule considered safe for a variety of treatments and approved by the American Medical Association;
  2. tetrahydrocannabinol (THC) – the molecule responsible for the high and the one that can produce psychotic symptoms.

Please share this information with other parents and peruse the research below.   Everyone needs to know that the same warnings parents teach their kids about alcohol and illegal street drugs also apply to marijuana.  It may not be possible to totally prevent your troubled child from using, especially in states where it is legal, but you can do what you can.  We can’t ignore this anymore.

–Margaret

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Proof cannabis DOES lead teenagers to harder drugs
Daily Mail, London U.K., June 7, 2017

“The study of the lives of more than 5,000 teenagers produced the first resounding evidence that cannabis is a gateway to cocaine, amphetamines, hallucinogens and heroin.” Read the full story  “Teenagers who regularly smoke cannabis are 26 times more likely to turn to other drugs by the age of 21.  It also discovered that teenage cannabis smokers are 37 times more likely to be hooked on nicotine and three times more likely to be problem drinkers than non-users of the drug.”


Legal cannabis laws impact teen use
The Geisel School of Medicine at Dartmouth, NH, June 27, 2017

‘A new study has found that adolescents living in medical marijuana states with a plethora of dispensaries are more likely to have tried new methods of cannabis use, such as edibles and vaping, at a younger age than those living in states with fewer dispensaries. ” …As cannabis legalization rapidly evolves, in both medical and recreational usage, understanding the laws’ effect on young people is crucial because this group is particularly vulnerable to the adverse effects of marijuana and possesses an inherent elevated risk of developing a cannabis disorder.


Marijuana Can Permanently Lower IQ in Teens
Duke University and King College (London), August 2012

Teens who regularly smoke marijuana are putting themselves at risk of permanently damaging their intelligence as adults, and are also significantly more likely to have attention and memory problems later in life, than their peers who abstained, according to a new study conducted by Duke University and London’s King’s College. This study is among the first to distinguish between cognitive problems the person might have had before using marijuana, and those that were caused by the drug..

The research found that adults who started smoking pot as teenagers and used it heavily, but quit as adults, did not regain their full mental powers. In fact, “persistent users” who started as teenagers suffered a drop of eight IQ points at the age of 38, compared to when they were 13.  Researchers noted that many young people see marijuana as a safer alternative to tobacco. A recent “Monitoring the Future” study found that, for the first time, more American high school students are using marijuana than tobacco. Lead researcher Madeline Meier, a post-doctoral researcher at Duke University, said, “Marijuana is not harmless, particularly for adolescents.”


Risks of increasingly potent Cannabis: The joint effects of potency and frequency
Joseph M. Pierre, MD; Current Psychiatry. 2017 February;16(2):14-20

Cannabis at a young age (age <15 to 18) increases the risk of developing a psychotic disorder.  The accumulated evidence to date is strong enough to view the psychotic potential of Cannabis as a significant public health concern, especially a high-potency Cannabis (HPC) form of hash oil known as Cannabis “wax” or “dabs” that contains as much as 90% THC. Preliminary anecdotal evidence supports the plausibility of hyper-concentrated forms being more psycho-toxic than less potent forms.  Of great concern when it comes to teens, HPC comes in very appealing forms (baked goods, candy, and drinks).  Full article here.


“Woody Harrelson quit; What happens to your body after a stoner quits smoking weed.”
Expect the following if you child attempts to quit or quits marijuana, and give them lots of love and support!  Dr. Stuart Gitlow and Dr. Joseph Garbely explain what happens to them.  Read the full article here.

  • They miss and crave it at first
  • They get anxious
  • They feel feelings again
  • It’s going to be uncomfortable for months, even a year

Marijuana Use Linked with Poor Depression Recovery
Journal of Affective Disorders; ePub 2017 Feb 13; Bahorik, et al

Marijuana use is common and associated with poor recovery among psychiatry outpatients with depression a recent study found. Researchers evaluated 307 psychiatry outpatients with depression, and past-month marijuana use for a substance use intervention trial. They found:

  • Marijuana use worsened depression and anxiety symptoms; it also led to poorer mental health functioning.
  • Medical marijuana (26.8%; n=33) was associated with poorer physical health functioning.

Keeping Teenagers Safe In Vehicles:  Alcohol use is down but marijuana use is up
O’Malley, P. & Johnson, American Journal of Public Health. Nov. 2013, Vol 103, No. 11.

Driving accidents remain the number one cause of mortality among American teenagers. Alcohol use is often involved, and more recently, distracted driving as a result of cell phones is a contributor. A recent analysis has found that drinking and driving has decreased among teenagers, but using marijuana and driving has increased.”  In this longitudinal study, a sample of 22,000 12th grade students from high schools across the country were questioned over a ten-year period, from 2001-2011. They showed an increase over the 10-year period in either being the driver or passenger of a driver who had just used marijuana. Specifically, 28% reported doing so within the past two weeks.  Marijuana use can impact drivers as much as alcohol.


Early Marijuana Use Heightens Psychosis Risk in Young Adults (summary)
John McGrath MD, Rosa Alati MD Archives of General Psychiatry, published online March 1, 2010,
MedscapeCME: Psychiatry and Mental Health

“Early cannabis use increases the risk of psychosis in young adults,” reports lead investigator John McGrath, MD, of Queensland Centre for Mental Health Research in Brisbane, Australia.  “Apart from having an increased risk of having a disorder like schizophrenia, the longer the young adults reported since their first cannabis use, the more likely they were to report isolated symptoms of psychosis.”

Investigators assessed 3801 study participants at ages 18-23 years, identifying first marijuana use and three psychosis-related outcomes:  non-affective disease, hallucinations, and the Peters et al Delusions Inventory Score.  “Psychotic disorders are common and typically affect 1 or 2 people of every 100” Dr. McGrath said, “…(I) was surprised that the results were so strong and so consistent…  We need to think about prevention.”

Results mirror those of another study conducted by Michael Compton MD, published in the American Journal of Psychiatry (November 2009), where investigators looked at 109 patients in a psychiatric unit and found that daily marijuana and tobacco use was common.  Of those who abused cannabis, almost 88% were classified as weekly or daily users before the onset of psychosis.

Emma Barkus, PhD, from the University of Wollongong in New South Wales, Australia, says other studies suggest that those who are engaging in risk behaviors about the age of 14 years are more likely to persist as they get older, adding further support to the role of cannabis use in predicting earlier psychoses.


Evidence Accumulates for Links Between Marijuana and Psychosis (summary)
Michael T. Compton, MD, MPH – Assistant Professor, Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, Georgia, 2008

Cannabis is the most abused illicit substance in the general US population, and the most abused illegal drug among individuals with schizophrenia.This literature reviewed studies that examined (1) associations between cannabis use and clinical manifestations of psychosis, and (2) the biologic plausibility of the observed links.

The initiation of cannabis use among those with psychotic disorders often precedes the onset of psychosis by several years.Cannabis use in adolescence is increasingly recognized as an independent risk factor for psychosis and schizophrenia.  Progression to daily cannabis use was associated with age at onset.

Study evidence also supported biological links between cannabis use and psychosis.  In the brains of heavy users, interactions with specific cannabinoid receptors are distributed in brain regions implicated in schizophrenia.  Other studies report elevated levels of endogenous cannabinoids in the blood and cerebrospinal fluid of patients with schizophrenia.  When THC (tetrahydrocannabinol) was administered in one trial, it caused both patients and controls to experience transient increases in cognitive impairments and schizophrenia-like positive and negative symptoms.


Chronic toxicology of cannabis.  (summary)
Reece, Albert Stuart; Clinical Toxicology (Philadelphia, PA.)   vol. 47  issue 6, Jul  2009 . Medical School, University of Queensland, Highgate Hill, Brisbane, QLD, Australia.

 Findings: There is evidence of psychiatric, respiratory, cardiovascular, and bone toxicity associated with chronic cannabis use.  Cannabis is implicated:

  • In major long-term psychiatric conditions including depression, anxiety, psychosis, bipolar disorder;
  • Respiratory conditions include reduced lung density, lung cysts, and chronic bronchitis;
  • elevated rates of myocardial infarction and cardiac arrythmias;
  • linked to cancers at eight sites, including children after in utero maternal exposure.

Marijuana Use, Withdrawal, and Craving in Adolescents (summary)
Kevin M. Gray, MD, Assistant Professor in the youth division of the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina in Charleston.

Findings in the literature survey:  Initiation of marijuana use typically occurs during adolescence.  Recent data indicate that in the United States, 42% of high school seniors have tried marijuana; 18% have used it in the past 30 days; and 5% use it daily.  Among adolescents aged 12 to 17, 3.6% met criteria for cannabis use disorder (abuse or dependence) and 2% met criteria for cannabis dependence.

More than half (51%) of adolescents reported that marijuana is fairly or very easy to obtain.  Ironically, this ready availability may be a “reverse gateway” from marijuana use to cigarette use to nicotine dependence.  Earlier initiation is associated with problem-related marijuana use: “hard” drug use, poly-drug use, and academic failure.  Using marijuana once per week or more during adolescence is associated with a 7-fold increase in the rate of daily marijuana use in young adulthood.  Cannabis dependence increases the risk factors for impaired driving and delinquent behavior.  Chronic use is associated with impaired immune function, respiratory illnesses, cognitive problems, and motivational impairment. 

There is a debate whether marijuana use begins as “self-medication” for psychiatric disorders, or whether habitual marijuana use can predispose some individuals to psychiatric symptoms.

Social anxiety disorder in adolescence is associated with 6.5-times greater odds of subsequent cannabis dependence, and vice versa, frequent marijuana use during adolescence appears to increase the risk of subsequent development of anxiety and depressive disorders.  The prevalence of cannabis abuse is 2 to 3 times greater among adolescents who have major depression.  Also linked in both directions: conduct disorder predicts marijuana and other substance use, while early-onset marijuana use predicts conduct disorder.

Five treatment regimes were studied: motivational enhancement/cognitive-behavioral therapy (MET/CBT), family education and therapy intervention, a community reinforcement approach, and multidimensional family therapy.  All resulted in positive but modest outcomes, with MET/CBT and community reinforcement treatments being most cost-effective.

Emerging evidence indicates rewards for marijuana abstinence may be positive.  Multi-systemic therapy, an intensive approach that incorporates individual, family, and community components, has demonstrated effectiveness among delinquent adolescents.

Withdrawal: Marijuana withdrawal symptoms are a constellation of emotional, behavioral, and physical symptoms that include anger and aggression, anxiety, decreased appetite and weight loss, irritability, restlessness, and sleep difficulty, which result specifically from withdrawal of marijuana’s psychoactive ingredient, THC.  Less frequent but sometimes present symptoms are depressed mood, stomach pain and physical discomfort, shakiness, and sweating.  Onset of withdrawal symptoms typically occurs within 24 hours of cessation of THC, and symptoms may last days to approximately 1 to 2 weeks.

Craving: Patients’ craving of marijuana is evidenced after presenting them with cues associated with marijuana (e.g. sight or smell of the substance, films of drug-taking locations, and drug-related paraphernalia).   Exposure to cues leads to robust increases in craving, along with modest increases in perspiration and heart rate.  Cue reactivity can predict drug relapse.

Craving and withdrawal symptoms interfere with successful cessation of use and sustained abstinence.  In addition, medications are often used to target withdrawal from substances, such as benzodiazepines for alcohol dependence and clonidine and buprenorphine for opioid dependence. These medications could be combined with psychosocial interventions, or developed to complement concurrent psychosocial treatments.


Legalization of Marijuana: Potential Impact on Youth (summary)
Alain Joffe, MD, MPH, W. Samuel Yancy, MD the Committee on Substance Abuse and Committee on Adolescence – PEDIATRICS Vol. 113 No. 6 June 2004, pp. e632-e638

Scientists have demonstrated that the emotional stress caused by withdrawal from marijuana is linked to the same brain chemical that has been linked to anxiety and stress during opiate, alcohol, and cocaine withdrawal.  THC stimulates the same neurochemical process that reinforces dependence on other addictive drugs.  Current, well known, scientific information about marijuana shows the cognitive, behavioral,and somatic consequences of acute and long-term use, which include negative effects on short-term memory, concentration, attention span, motivation, and problem solving.  These clearly interfere with learning, and have adverse effects on coordination, judgment, reaction time, and tracking ability.  http://pediatrics.aappublications.org/cgi/content/full/113/6/e632


The Past, Present, and Future of Medical Marijuana in the United States (summary)
By John Thomas, JD, LLM, MPH, Professor of advanced law and medicine, civil procedure, and commercial law at the Quinnipiac University College of Law, Hamdon, Connecticut, January 6, 2010

Cannabidiol (CBD) is considered safe and has a variety of positive benefits, and this component should be legalized.  However, the other narcotic component in marijuana, tetrahydrocannabinol (THC), is responsible for the high, and too much may not be a good thing because it can produce psychotic symptoms in people.


 Medical Marijuana:  The Institute of Medicine Report (summary)
Ronald Pies, MD, Editor in Chief – Psychiatric Times. Vol. 27 No. 2 , January 6, 2010
Marijuana is not a completely benign substance. It is a powerful drug with a variety of effects.  However, except for the harms associated with smoking, the adverse effects of marijuana use are within the range of effects tolerated for other prescription medications. Cannabinoids can induce acute transient psychotic symptoms or an acute psychosis in some individuals… (but it is unclear) what makes some individuals vulnerable to cannabinoid-related psychosis.  There is a pressing need for more high-quality research in the area of medical marijuana and cannabinoid use.

 Link Between Cannabis Use and Psychosis Onset at a Younger Age (summary)
Ana Gonzales MD, Santiago Apostol Hospital in Vitoria, Spain, Journal of Clinical Psychiatry. August 2008

Researchers found a strong and independent link between cannabis use and the onset of psychosis at a younger age, regardless of gender or the use of other drugs.  The link is related to the amount of cannabis used.  “The clinical importance of this finding is potentially high,” Dr. Gonzalez-Pinto given that cannabis use is extremely prevalent among young people… estimates of the attributable risk suggest that the use of cannabis accounts for about 10 percent of cases of psychosis.”The findings showed a significant gradual reduction in the age at which psychosis began that correlated with an increased dependence on cannabis. Compared with nonusers, age at onset was reduced by 7, 8.5, and 12 years among users, abusers, and dependents, respectively, the researchers report.

Cannabis use and later life outcomes. (summary)
Fergusson DM, Boden JM, Addiction;  Pages: 969-76;  Volume(Issue): 103(6), June 2008

A longitudinal study of a New Zealand birth cohort tracked subjects to age 25 years.  Cannabis use at from ages 14-25 was measured by:  university degree attainment to age 25; income at age 25, welfare dependence during the period 21-25 years, unemployment 21-25 years, relationship quality, and life satisfaction.  Other indices were measured to adjust for confounding factors:  childhood socio-economic disadvantage, family adversity, childhood and early adolescent behavioral adjustment and cognitive ability, and adolescent and young adult mental health and substance use.The findings were statistically significant.  Increasing levels of cannabis use at ages 14-21 resulted in lower levels of degree attainment by age 25, lower income at age 25, higher levels of welfare dependence, higher unemployment, lower levels of relationship satisfaction, and lower levels of life satisfaction.


Doctors:  Pot Triggers Psychotic Symptoms (summary)
May 1, 2007
Aetna Intelihealth – Mental Health

 LONDON — New findings show physical evidence of the drug’s damaging influence on the human brain.  In some people, it triggers temporary psychotic symptoms including hallucinations and paranoid delusions. Two of the active ingredients of cannabis: cannabidiol (CBD) made people more relaxed.  But second ingredient: tetrahydrocannabinol (THC) in small doses produced temporary psychotic symptoms in people, including hallucinations and paranoid delusions. According to Dr. Philip McGuire, a professor of psychiatry at King’s College, London, THC interfered with activity in the inferior frontal cortex, a region of the brain associated with paranoia. “THC is switching off (a chemical) regulator,” McGuire said, “effectively unleashing the paranoia usually kept under control by the frontal cortex.”In another study, Dr. Deepak Cyril D’Souza, an associate professor at Yale University School of Medicine, and colleagues tested THC on 150 healthy volunteers and 13 people with stable schizophrenia. Nearly half of the healthy subjects experienced psychotic symptoms when given the drug.  Unfortunately, the results for the schizophrenic subjects was so much worse that researchers scrapped adding additional schizophrenic subjects to the study.  The negative impact was so pronounced that it would have been unethical to test it on more schizophrenic people.”One of the great puzzles is why people with schizophrenia keep taking the stuff when it makes the paranoia worse,” said Dr. Robin Murray, a professor of psychiatry at King’s College in UK.  She theorized that schizophrenics may mistakenly judge the drug’s pleasurable effects as outweighing any negatives. 

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Stigma is prejudice, and harmful to children

Stigma is prejudice, and harmful to children
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Stigma victimizes the victimes

Stigmatization, blame, judgment… It only takes a few individuals to harm a child or family with their words, but it takes a whole society to allow it.  In this article, I’m going to present recent research on the negative stereotyping of families and children with mental disorders, and share stories from families I know.  I hope readers will be empowered to speak out against this form of prejudice and mobilized into changing our society’s attitudes.

Have you ever heard of a bake sale to help a child get treatment for a mental disorder or addiction?
Have you ever heard of a bake sale to help a child get treatment for a mental disorder or addiction?

Puckette©2008

Stigma takes many forms.

The most common scenario of stigma is when you are seen as a bad parent, perhaps even an abusive one, or your child is seen as stupid, spoiled, attention-getting, or manipulative.  Another form of stigma is having others show disrespect to parents who seek help from the mental health profession.  Psychologists are “flakes,” and families  who see them are “wackos.”  “Where’s your faith?”, some say, or “why don’t you quit making excuses for your child and give them real consequences?”

One of the more destructive forms of stigma is the condemnation parents receive when they “drug their child to fix them.”  Too many believe drugs turn children into “zombies” (see research study below).  Because of the stigma of treatment, I’ve seen many parents try every alternative treatment possible to help their child, only to have their child struggle year after year in school, fall farther behind their peers, make no progress in therapy, and other setbacks that medicines can prevent.  These parents cling to the belief that they are doing the right thing, yet some children really need medicines, and the drugs don’t turn them into zombies.  [In today’s treatment approaches, drugs are always considered a piece of the treatment puzzle, never the complete answer.]

A mother’s story about her experience with stigmatization:

This mother lost her best friend of 20 years because the friend got tired of hearing the mom talk about her very troubled 10-year-old son.  In frustration, the friend wrote her a letter saying the mom was neurotic, and that she should quit trying to control her son, that her son’s behavior was a cry for help.  The friend said she needed to set her son free and get help for her emotional problems, and that she wasn’t going to “enable” this mom anymore by being her friend.  The mom was stunned and hurt by the letter.  She intellectualized that she didn’t need a friend like this, but her heart was nonetheless broken by the betrayal.  The son turned out to have brain damage from a genetic disorder and it was getting worse.

What you can do when someone makes thoughtless remarks, lectures you, or avoids you because of your child

From my blog post November 2008:

http://raisingtroubledkids.wordpress.com/2008/11/25/ideas-for-what-to-do-when-youre-blamed-and-judged/

First, resist defending yourself; it can attract more unwanted attention and disagreement.  You don’t have the time or emotional energy to explain or teach someone who will challenge everything you say.  Do everything you can to avoid people like this—many have had to cut off some family members and friends, and even their clergy or religious communities.

My story:  when my child was diagnosed with a serious mental disorder, I stood up in front of my church congregation, explained what was happening, and asked for prayers for my family.  At the end of that service, people started avoiding me.  There were no more hello’s.  There wasn’t even eye contact.  The abrupt isolation from people I knew was devastating and I stopped attending.  What did I say?  Why did this happen?  I thought if my child had a ‘socially-acceptable’ cancer others would know what to do or say to ease the isolation and grief.

Second, actively seek out supportive people who just listen.  You need as large as possible a network of compassionate people around you.  You may be surprised how many people have a loved one with a mental or emotional disorder, and how many are willing to help because they completely understand what you’re going through.

Third, politely and assertively say thanks but no thanks.  Try something like this:  “Thanks for showing interest, but we are getting the help we need from doctors we trust.” Or simply, “please don’t offer me advice I didn’t ask for.”  No apologies.

– – – – – – –

Public Perceptions Harsh of Kids, Mental Health (excerpt)

May 1, 2007   (USA TODAY)

Though the subject has been analyzed in adults, until now there has been limited research illuminating how the public perceives children with mental disorders such as depression and attention deficit disorders, according to experts from Indiana University, the University of Virginia and Columbia University.  The findings are published in the May 2007 issue of Psychiatric Services.

The study, based on in-person interviews with more than 1,300 adults, indicates that people are highly skeptical about the use of psychiatric medications in children.  Results also show that Americans believe children with depression are more prone to violence and that if a child receives help for a mental disorder, rejection at school is likely.

“The results show that people believe children will be affected negatively if they receive treatment for mental health problems,” says study author Bernice Pescosolido, director of the Indiana Consortium for Mental Health Services Research, in Bloomington.  “Nothing could be further from the truth.  These misconceptions are a serious impediment to the welfare of these children.

According to the study:

  • those interviewed believed that doctors overmedicate children with depression and ADHD and that drugs have long-term harm on a child’s development.  More than half believed that psychiatric medications “turn kids into zombies.”
  • respondents thought children with depression would be dangerous to others; 31% believed children with ADHD would pose a danger.
  • Respondents said rejection at school is likely if a child goes for treatment, and 43% believe that the stigma associated with seeking treatment would follow them into adulthood.

Pescosolido and her colleagues say such stigma surrounding mental illness — misconceptions based on perception rather than fact — have been shown to be devastating to children’s emotional and social well-being.

Population studies show that, at any point in time, 10% to 15% of children and adolescents have some symptoms of depression.  About 4 million children, or 6.5%, have been diagnosed with ADHD, only 2% less than the number of children with asthma.

“People really need to understand that these are not rare conditions,” says Patricia Quinn, a developmental pediatrician in Washington, D.C.

To banish the stigma linked to mental health problems in children, the public has to get past labels and misconceptions, Pescosolido says.   Normalizing these conditions would help too, Quinn says.  “We need to view depression and ADHD like we do allergies,” she says. “They are very treatable.”

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Filed under bipolar disorder, borderline personality disorder, depression, mental illness, oppositional defiant disorder, parenting, schizoaffective disorder, schizophrenia, teens