There is certainly a wealth of historical evidence supporting a non-medical approach to madness ranging from Geel, the city in Belgium where the ‘mad’ lived with local families, receiving support and care that allowed them to function in the ‘normal’ social world despite the emotional distress some experienced (Goldstein, 2003), to the so-called Moral Treatment developed at the York Retreat by William Tuke towards the end of the eighteenth century (Digby, 1985), which advocated peace, respect, and dignity in all relationships, and emphasised the importance of maintaining usual social activities, work and exercise. These approaches, predicated as they were on a gentle and humane engagement with the vagaries of human experience at the limits, and invoking respect, dignity, collective responsibility, and an emphasis on interpersonal relationships as guiding principles, have much to tell contemporary biomedical psychiatry. In the modern era, non-medical attempts to understand and tend to ‘psychosis’ have coalesced into a tradition counterposed to the biomedical orthodoxy. The richest seam of evidence within this tradition is that relating to Soteria House , the project developed by Loren Mosher and colleagues in San Francisco during the early 1970s (www.moshersoteria.com). Here, people diagnosed with schizophrenia could live in a suburban house staffed with non-professionals who would spend time ‘being’ with them in an attempt to try and secure shared meanings and understandings of their subjective experience. Comment: PsychMinded, by Tim Carlton, April 24, 2009 Read More Here: Continue Reading…
ShareAntipsychotic medication, mortality and neurodegeneration: The need for more selective use and lower doses – Weinmann & Aderhold
Abstract Introduction: Although a range of adverse effects of antipsychotic medication are well documented, less attention has been paid to the issue of reduced life expectancy. Method: The medical literature was searched to identify studies assessing severe somatic side-effects of long-term antipsychotic treatment with a possible impact on mortality, and studies evaluating antipsychotic-associated brain structure changes. Conclusion: Antipsychotics should be used more selectively, for shorter durations and with lowest possible effective dose. Greater use of psychosocial interventions that have been proven effective should be an integral part of facilitating reductions in frequency, dosage and duration of antipsychotics. Psychosis, Volume 2, Issue 1 February 2010 , pages 50 – 69 Read More Here: Continue Reading…
ShareReversal of Schizophrenia Without Neuroleptics – Irwin
It is commonly believed tha t reversal of schizophrenia is accomplished primarily through neuroleptic drug treatment, but this belief can only be maintained by ignoring a great deal of material published in the scientific literature. Randomized studies comparing psvchosocial treatment programs without neuroleptics to drug-based programs were sought out for review, and six were found. Long-term out comes were statistically equivalent or superior in the nondrug group in all six studies, even those where the quality of the psvchosocial treattment was questionable. In studies with psychosocial interventions that appeared to have higher quality, both short- and long-term results were equivalent or superior without neuroleptics. These findings suggest that neuroleptics interfere with long- term recovery and, if appropriate psychosocial interventions are available, are not even necessary for short-term behavior control. Matt Irwin, Ethical Human Psychology and Psychiatry, Vol. 6, No. 2, Summer 2004 Read More Here: Continue Reading…
SharePsychosocial treatment, antipsychotic postponement, and low-dose medication strategies in first-episode psychosis: A review of the literature – Bola, Lehtinen, Cullberg and Ciompi
Reconsidering medication-free research in early-episode schizophrenia prompts a review of acute psychosocial treatments using medication postponement protocols. We describe and compare the different psychosocial treatment approaches. Studies were included in the review if initial psychosocial treatment combined with a time-limited postponement of antipsychotics was compared to initial antipsychotic treatment using a quasi-experimental or better research design and reportcd outcomes of at least one year. Five studies were included (N=261). each reporting modestly better long-term outcomes than initial medication treatment. resulting in a composite sma l l – medium effect-size advantage ( r .= 0.17). In addition, 27-43% of experimental patients were not receiving anti psychotics at the two- or three-year follow-up. These projects demonstrate the feasibility of a carefully supervised approach to medication-free research and also suggest a strategy for integrating biological, psychological and social treatment components in early-episode psychoses. Initial psychosocial treatment combined with a time-limited postponement of antipsychotic medications for eligible, non-dangerous. early-episode patient- may facilitate a reduction in long-term medication dependence and the discrimination of similar but pathophysiologically different diagnostic entities. Rigorous evaluation in a randomized controlled trial designed to identify medication and psychosocial treatment-responsive subgroups of patients may contribute to diagnostic specificity and improved patient outcomes. Psychosis Vol. I, No. I, February 2009, 4 18 Read More Here: Continue Reading…
Share“The Open Dialogue Approach to Psychosis: Its Poetics and Micropolitics” – Seikkula & Olson
In Finland, a network-based, language approach to psychiatric care has emerged, called “Open Dialogue.” It draws on Bakhtin’s dialogical principles (Bakhtin, 1984) and is rooted in a Batesonian tradition. Two levels of analysis, the poetics and the micropolitics, are presented. The poetics include three principles: “tolerance of uncertainty,” “dialogism,” and “polyphony in social networks.” A treatment meeting shows how these poetics operate to generate a therapeutic dialogue. The micropolitics are the larger institutional practices that support this way of working and are part of Finnish Need-Adapted Treatment. Recent research suggests that Open Dialogue has improved outcomes for young people in a variety of acute, severe psychiatric crises, such as psychosis, as compared to treatment-as-usual settings. In a nonrandomized, 2-year follow up of first-episode schizophrenia, hospitalization decreased to approximately 19 days; neuroleptic medication was needed in 35% of cases; 82% had no, or only mild, psychotic symptoms remaining; and only 23% were on disability allowance. Read more here: The Open Dialogue Approach to Psychosis: Its Poetics and Continue Reading…
Share‘Family and Network Therapy Training for a System of Care: ‘A Pedagogy of Hope’” – Olson
In the past decade, the field of family therapy has witnessed the emergence of a new template for practice based on reflection and narrative, instead of strategy and intervention. There also are broader social and cultural frameworks, especially regarding gender and issues of social justice. The style of practice has evolved from a hierarchical one to therapeutic conversation based on collaboration. The intellectual movements of postmodernism and feminism challenged traditional cybernetic and systems models and provided the seeds for new forms of therapy. This evolving tradition as a whole can be traced back to the communication research of Gregory Bateson and his colleagues in Palo Alto. One of the distinguishing features of postmodern therapy is the stance of treating the patient and family as members of a partnership within a network that includes the professionals and anyone else connected to the situation (Seikkula et al., 1995). Read more: Family and Network Therapy Training for a System of Care: “A Pedagogy of Continue Reading…
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