Kenneth Duckworth

Digital Technology Use Among Individuals with Schizophrenia: Results of an Online Survey

Background Despite growing interest in the use of digital technology by individuals with schizophrenia, little is known about how these individual relate to, own, and use technology in their daily life and in the context of their symptoms. Objective The goal of this study is to better characterize technology use in those with schizophrenia. Methods A Web-based survey of individuals’ use of and attitudes toward technology for those 18 years and older self-identifying as having schizophrenia, schizoaffective disorder, or schizophrenia spectrum disorders was conducted. Consumer input was sought in the design of the survey. Results In total, 457 individuals responded to this Web-based survey. Ninety percent owned more than one device (personal computer, landline telephone, tablet, public computer, mobile phone without applications or Internet, or smartphone), with many reporting high utilization of multiple devices, and 61% having 2 devices. The respondents reported that Web-based technology helped with support from family and friends, as well as in gathering information. Many respondents used Web-based technology to help identify coping strategies (24% very often or often) including music to help block or manage voices (42%), while others used technology to set alarms/reminders for medication management (28%). Younger respondents in particular anticipated the role of technology growing over time with respect to their recovery. Conclusions Survey respondents reported that technology access was common, with utilization involving coping, reminders for medications and appointments, and connection. Overall, attitudes were largely positive. Overuse was a concern for 30% of respondents. The study is limited in its generalizability as the population was highly engaged in mental health treatment (87%), self-identified as living with the disorder, and had awareness of their illness. This survey demonstrates high engagement for a subset of technology-oriented individuals living with schizophrenia. It is not known what percent of individuals with schizophrenia are represented by these technology-oriented survey respondents.

Perceived Impact of the Disclosure of a Schizophrenia Diagnosis

Stigma against those with schizophrenia has demonstrated deleterious effects. However, less is known about the experience of individuals who disclose this diagnosis and how such disclosures differ by social situations. This study examines diagnosis disclosure in different contexts. A convenience sample of 258 adults with schizophrenia recruited via the internet and e-mail lists completed an online survey. Subjects were more open about their diagnosis with doctors, parents and friends than with employers or police. Those who report very good current mental health or who had fewer types of relationships were more open overall. Although reactions to disclosure varied, many report worse treatment by police and better treatment by parents after disclosure. Many also experienced worse treatment for medical problems after disclosing their schizophrenia diagnosis. These results support targeted anti-stigma interventions. It also suggests that stigma must be understood through individual experience in specific contexts rather than as a unitary experience.

Peer support and peer-led family support for persons living with schizophrenia.

Purpose of review Peer support and peer-led family psychoeducation represent two distinct and complementary recovery-oriented models to support individuals who live with schizophrenia and their families, respectively. The goals of these models focus on improving knowledge, coping, self-care, social support, and self-management strategies. These models represent important capacity-building strategies for people who live with the illness and the people who love them. This brief article is intended to provide the practicing clinician, person living with schizophrenia, and policy maker with a working knowledge of the current state of the literature in these two related fields. Practitioners should consider these resources and integrate them into their care. A person living with schizophrenia could use this review to advocate for appropriate resources and to identify career opportunities. Policy makers could benefit from an understanding of the literature to mitigate financial and cultural barriers to adopting these practices. Recent findings The last 5 years have seen a dramatic expansion of the application of randomized controlled trials (RCTs) to give evidence to match the experience of people in these programs. The field has seen Wellness Recovery Action Plan (WRAP) named as evidence-based practice by the National Registry of Evidence-Based Practices. A RCT was also conducted for another peer-developed and led program called Building Recovery of Individual Dreams & Goals through Education & Support. Family to Family, the largest peer-led family psychoeducation course, was also found to have significant impact after the study and also 6 months later in RCT. Family to Family has also been named as an evidence-based practice. Summary The field of people who are living well with schizophrenia working as resources and supports to others living with the illness is an idea that is growing momentum. This momentum has been matched by the RCT evidence. Peer support as a professional role has an emerging literature that needs to be grown. WRAP and National Alliance on Mental Illnesss Family to Family program are evidence-based practices and widely available. Peer support and peer-led family support for persons living with schizophrenia is a nascent field with much potential.

Needing Treatment, Wanting Nothing: Ethical Dilemmas in the Treatment of the Homeless Mentally III

&NA; One of the most uncomfortable dilemmas faced by contemporary clinicians is that of balancing a sense of responsibility for a patient with a desire to respect the patients autonomy. A patient may “need” treatment but, unless incompetent or dangerous, freely decline it. The clinician may thus feel forced to sit by and watch the patient make seemingly ill‐advised choices.

Roles, Quandaries, and Remedies: Teaching Professional Boundaries to Medical Students

&NA; This article conceptualizes a predictable set of tensions that medical students experience in their new roles with patients on clinical clerkships: empathy versus overidentification, objectivity versus avoidance, collaboration versus coercion, and self‐confidence versus “specialness.” These tensions are framed in a developmental context for students and are used to highlight potential boundary difficulties. The role of supervision in teaching students and other beginning trainees about possible boundary issues is discussed.

NAMI Perspective on CATIE : Policy and Research Implications

The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) was designed to assess effectiveness of antipsychotic medication for people with schizophrenia. The authors, who are administrators of the National Alliance on Mental Illness (NAMI), discuss CATIE and related policy and research studies and their implications. CATIE has answered some important questions for consumers and their families and raises many more. The prevalence of medical risk factors in the population with schizophrenia is an important part of advancing prevention. Poor adherence to medications randomly prescribed by CATIE physicians in a blinded procedure is also a key finding and points to the need for individually tailoring medication regimens. Policy makers may be tempted to oversimplify the results of CATIE by restricting access to the costlier second-generation medications. However, doing so will hurt clinical care, and any savings to state and community mental health programs may be illusory. Policy can be constructed to focus on clinical outcomes and not merely restrict access to medications on the basis of cost. Research is urgently needed on a new generation of medications with benign side effects and greater efficacy than their predecessors for people with schizophrenia.

Should Google offer an online screening test for depression

It could raise awareness to improve identification and treatment of depression, says Ken Duckworth, but Simon Gilbody worries that screening for depression is not recommended because it could cause harm

Pseudo-ADHD in a Case of First-Episode Schizophrenia: Diagnostic and Treatment Challenges

TC is a 16-year-old male of Colombian descent with a prior history of attention-deficit/hyperactivity disorder (ADHD) and depression who initially presented to our outpatient treatment program following his first hospitalization in the context of suicidal gestures and increasing psychotic symptomatology. TC had been hospitalized at a local community adolescent inpatient unit after holding a knife to his throat while experiencing command auditory hallucinations to kill himself. During the patient’s hospitalization he was stabilized on a moderate dose of risperidone (4–6 mg daily). Two weeks later, he was experiencing less positive psychotic symptomatology (albeit with persistent commenting auditory hallucinations and ongoing thought insertion