Clinical Trials Test a Psychedelic Drug as a Cure for Depression

The largest-ever clinical trial of a psychedelic drug will soon begin in Europe and North America to find a cure for depression.

Psychedelic Drug Chemistry

The psychedelic drug is psilocybin – the active ingredient in magic mushrooms. The target is treatment-resistant depression. In the episode 27 of the After On Podcast, listeners are introduced to George Goldsmith and Katya Malievskaia. They are a married couple whose startup – Compass Pathways – will soon launch the largest triple-blind clinical trial ever of a psychedelic drug. The drug is psilocybin, an active ingredient derived from psychedelic mushrooms. And the condition is treatment-resistant depression. A condition that affects over a hundred million people worldwide. The term “treatment-resistant” implies, it lacks a cure.

While this may sound implausible, the individuals that have been drawn to this company’s work is quite remarkable. Their Board of Directors includes Thomas Lonngren, who spent ten years running Europe’s equivalent of the FDA (the European Medicines Agency). Also on their board is the former Chief Medical Officer of Bristol Meyers Squibb – one of the world’s largest pharmaceutical companies. In addition, they have raised roughly $20 million for their company from some extremely savvy investors.

This podcast showcases Katya and George’s their expansive knowledge in medical research. Their efforts are focused heavily on the drug approval process. Also, they have designed their trial in consultation with the top drug regulators of multiple countries.

Psychedelic drug as a potential cure for treatment-resistant depression

Katya and George express their strong sentiments against treatment-resistant depression. They describe how the illness has severely afflicted an individual very dear to them. Listeners will learn about Katya and George’s backgrounds, along with their motivations. As well as, the trial they are architecting and their company: Compass Pathways. The discussion the long clinical history certain psychedelics and other recreational drugs have had, and the major promise several of them are now showing against a diversity of afflictions.

Click here for some helpful resources on how to support individuals with depression or other mental health issues.

Research Study: Health Professional Mothers of Adult Children with Schizophrenia

Research Study

The University of New England School of Health is looking for health professionals to participate in a research study. The health professional must be a mother of an adult child who has been diagnosed with schizophrenia.

The purpose of the research study is to look at these mothers’ stories to see how they have negotiated care for adult children with schizophrenia.

Participation will involve:

  • Answering questions on the phone to see if you meet the inclusion criteria
  • Signing a consent form with your agreement to participate (with the proviso that you can withdraw at any time for any reason)
  • Participating in an interview in which the audio will be taped.

The research is conducted by PhD student Debra Klages from the School of Health at the University of New England.

For more information about participating in this study, please contact Debra Klages by email at dklages@myune.edu.au. The principal investigator Professor Kim Usher may also be contacted by kusher@une.edu.au.

 

Ms. Debra Klages RN, BScN, Cert Case Mgmt., M Adv Nurs Prac (Mental Health), MACN

Study Title: Health Professionals as Mothers of Adult Children with Schizophrenia

This project has been approved by the Human Research Ethics Committee of the University of New England (Approval No HE17-028, Valid to 23/03/2019)

Bringing Cognitive Remediation to British Columbia

Bringing Cognitive Remediation to British Columbia

Saturday, October 14, 2017 | 8:30 AM – 4:30 PM
Paetzhold Education Centre | Vancouver General Hospital

899 West 12 Avenue, Vancouver, B.C.

People living with schizophrenia and other psychotic disorders often develop profound and
disabling cognitive deficits. Even more than positive or negative symptoms, cognitive deficits can impair daily functioning and are a major factor in chronic disability and unemployment. (Hurford, 2011)

Come learn more about these cognitive difficulties and about evidence-based cognitive
remediation programs. Hear about an efficient strategy for training staff to deliver programs, and hear from people in B.C. working on related initiatives.

Keynote speakers:
Dr. Alice Medalia (Director, Lieber Recovery Clinic, Columbia University)
Dr. Christopher Bowie (Director, Cognitive & Psychotic Disorders Lab, Queen’s University)
Dr. Medalia and Dr. Bowie are co-editors of the recently published anthology, Cognitive
Remediation to Improve Functional Outcomes (Oxford University Press, 2016).

Program:

8:00 Registration Opens

9:00 Opening Comments – Dr. John Gray Welcome – Dr. Bill Honer Why and How This Conference Came to Be – Susan Inman

9:30 Keynote Speaker: Dr. Christopher Bowie “Cognition in Mental Disorders: Impairments, Implications and Opportunities for Treatment”

10:45 Coffee/Nutrition Break

11:00 Keynote Speaker: Dr. Alice Medalia “How to Make Cognitive Health Services a Part of Mental Health Care”

12:30 Lunch (Not included)

1:30 Panel 1: “Cognition: A Brief Scan of B.C. Initiatives”

Moderator: Dr. Ashok Krishnamoorthy

Panelists:

Dr. Tom Ehmann “Guided Self-care for Cognitive Problems Associated with Psychotic Disorders”
Dr. Mahesh Menon and Dr. Ivan Torres “Adapting Cognitive Remediation for the Refractory Psychosis Population”
Dr. Amy Burns “Isn’t it Ironic? Social Cognition in Schizophrenia”
Dr. Todd Woodward “Treatment of Symptoms vs. Cognitive Remediation in Psychotic Disorders”
Dr. Randall White “The (limited) Role of Medications in Improving Cognition in Schizophrenia”

2:45 Coffee/Nutrition Break

3:00 Panel 2: “Next Steps in Implementing Cognitive Remediation in B.C.”

Moderator: Monica McAlduff

Panelists:

Dr. John Higenbottam
Dr. Regina Casey
Dr. Tom Ehmann
Dr. Chris Bowie
Dr. Alice Medalia

4:15 Closing Remarks: Susan Inman and Gerrit van der Leer

4:45 Conference Ends

This conference will be of great interest to clinicians, families, consumers, mental health
administrators and educators.

Conference Fees:
Professional, Clinician, Researcher, etc. $100 + GST
Family Member $50 + GST
For a full schedule, speaker bios and to register, visit www.bcss.org
Bringing Cognitive

Remediation to
British Columbia
Saturday, October 14, 2017 | 8:30 AM – 4:30 PM
Paetzhold Education Centre | Vancouver General Hospital

899 West 12 Avenue, Vancouver, B.C.

www.bcss.org

 

Coping With a Loved One’s Opioid Addiction: What Science Says To Do

Coping With a Loved One’s Opioid Addiction: What Science Says To Do

While many factors are blamed as contributing factors in North America’s opioid crisis and overdose, Canadian hospitals and clinics are handing out naloxone kits as a stop-gap measure for at-risk opioid users. But it can be a tricky time at any point to deal with a loved one’s addiction, whether it be to Vicodin or heroin.

What does existing science say you can do to help someone you care about? For over three decades, Maia Szalavitz, author of “Unbroken Brain: A Revolutionary New Way of Understanding Addiction,” has presented the evidence that should play a vital role when weeding through conflicting advice in a field that she states is largely unregulated. Searching out care based on scientific fact as opposed to personal and clinical experience can improve recovery chances.

Her article “What Science Says To Do If Your Loved One Has An Opioid Addiction” is an excellent, evidence-based guide derived from the best research available on addictions, including systematic reviews and clinical medication trials. Szalavitz lays out how to accurately assess the problem, delves into the psychology of addictive behavior, and suggests how to intervene gently. Then, most importantly, she explains how to choose a treatment that is research-based.

Studies suggest that most people with addiction eventually recover, a far cry from the bleak picture portrayed in the media. Recovery from an opioid addiction can look different for different people, but no doubt is rooted in two key aspects: medical assessment and a long-term maintenance program. At least, so says the World Health Organization and the Institute of Medicine, for starters. Read on for more on the science to help you help your loved one on the road to recovery.

Evidence for accelerated aging in severe mental illness

A panel of five investigators discussed an emerging concept in psychiatry which integrates findings in epidemiology, pathophysiology  and cell biology. Dilip V. Jeste, Distinguished Professor of Psychiatry and Neurosciences at the University of California at San Diego, described “inflammaging” as the low-level inflammatory tissue derangement that accompanies aging and which seems to be accelerated in people with chronic mental illness, whether major mood disorders or schizophrenia. Inflammaging can be measured by biomarkers such as C-reactive protein (CRP), tumor necrosis factor-alpha, F2-isoprostanes, chemokines, and leukocyte telomere length. The latter, which refers to the tips of chromosomes which slowly shorten over the lifespan, is a well-recognized measure of cellular senescence.

Although psychiatrists seldom examine these biomarkers in their patients, they know that on a population basis, people with schizophrenia have a high prevalence of metabolic disorder, diabetes, and atherosclerotic vascular disease. Compared to age-matched controls, people with schizophrenia and bipolar disorder have a high rate of morbidity and mortality from these disorders, which are partially inflammatory in nature and age-related.

Dr. Jeste and his research team have studied 140 patients with schizophrenia, ages 26-65 with a mean age of 49, half women, and they confirmed the higher prevalence of metabolic and vascular disorders in this cohort. Moreover, in comparison to a group of 120 non-mentally-ill age-matched subjects, they found elevations in six inflammation-related biomarkers including CRP and the chemokine eotaxin-1. In patients and control subjects, telomere length inversely correlated with age, but only in women with schizophrenia was telomere length significantly reduced compared to controls. According to Dr. Jeste, younger women seemed most at risk for metabolic disturbances: they had the highest rates of obesity, insulin resistance, and elevated inflammatory markers. The researchers will follow the cohort longitudinally to observe what they hypothesize is an accelerated aging process.

References

Jeste DV, Wolkowitz O, Harvey P, Eyler L, Nasrallah H. Accelerated biological aging in serious mental illness: are these disorders of the whole body and not of the brain only? American Psychiatric Association Annual Meeting, San Diego, California, May 20-24, 2017.

Hong S, Lee EE, Martin AS, et al. Abnormalities in chemokine levels in schizophrenia and their clinical correlates. Schizophr Res. 2017;181:63-69. Abstract

Partnership: People with schizophrenia, family members and clinicians talk about schizophrenia

Schizophrenia is a long-term but treatable brain condition. 1 in 100 people worldwide live with schizophrenia.

Dr. Diane Fredrickson is a psychiatrist who treats psychosis-related conditions including schizophrenia.

Gerhart Pahl is the father of four sons—three of whom it turns out suffer from schizophrenia.

Bryn Ditmars has a form of schizophrenia known as schizoaffective disorder.

Schizophrenia occurs most commonly between people between the ages of 15-25. It is the result of physical and biochemical changes in the brain. Symptoms may include:

  • Disordered thinking
  • Changes in emotion
  • Bizarre behaviour
  • Catatonia
  • Paranoia
  • Hallucinations
  • Delusions

60% of people with schizophrenia live with their families. Recovery takes time, a team, medication, and a healthy lifestyle.

Research has improved with brain imagery, but a cause and cure are still unknown.

Statistics about schizophrenia and suicide:

  • 50% attempt suicide.
  • 10-15% of people commit suicide.
  • Self-harm is more common than harm to others.

50% of people with schizophrenia have anosognosis, a condition in which they don’t know they’re ill. Early psychosis intervention (EPI), early diagnosis and treatment improve outcomes.

Stigma contributes to discrimination, which limits access to education, housing and employment. The media contribute to perpetuating myths that create skewed perceptions and unfounded fears.

The B.C. Schizophrenia Society (BCSS) Partnership Program provides mental health literacy. To increase your knowledge, book a presentation.
Call 604-270-7841
Toll Free: 1-888-888-0029
Email: community@bcss.org

Dr. Xavier Amador Talk on Helping People with Mental Illness at Cambridge, MA

Dr. Xavier Amador
President and Founder
The LEAP Instititute
(Listen, Empathize, Agree, Partner)

Dr. Amador lays out pathways to build trust, heal relationships and partner with someone who is suffering from mental illness but is resisting help.

“I’m going to tell you a little bit about something that is very important to me from a professional perspective… but is also very personal. I have a brother with schizophrenia who really is the one who gave me the title for this talk and book by the same name: I’m not sick. I don’t need help.

“This is a very very common problem. I will talk about just how common it is”


Dr. Xavier Amador, founder of The LEAP Institute giving a public talk on how to help people with mental illness who don’t realize they are sick. Sponsored by the NAMI (National Alliance on Mental Illness) Cambridge Chapter. The lecture was given on the evening of October 2, 2012 at the Cambridge Public Library in Cambridge, Massachusetts.

For more information, visit leapinstitute.org.

Anosognosia

Anosognosia

“I think that’s exactly what he had. I believe that my son Chris, over the course of repeated breakdowns, lost his capacity to understand his illness so he went off his meds. That’s when we lost him for good. He never took meds again. He ultimately chose to take his life rather than take medication.” — Cathy Weaver, Austin, Texas

People with anosognosia have a real neurological condition caused by damage to the brain, most likely in the frontal and parietal lobes.

Because of this condition, they can’t recognize that they are sick.

Anosognosia is associated with many diseases.

Some people with strokes, brain tumours, Alzheimer’s disease, and Huntington’s disease suffer from this same lack of insight.

It’s very clear that about half the people with schizophrenia and roughly 40% of people with bipolar disorder have some degree of anosognosia. In other words, they don’t recognize their own illness. We recognize this for Alzheimer’s disease but we seem to have trouble recognizing that this is also common for people with schizophrenia and bipolar disorder.

Russell Weston is one tragic example. Mr. Weston came to Washington D.C. to “save the world from cannibals” and killed two Capitol Police officers while in this delusional state.

Weston was not taking medication because he did not believe he was sick.

County judge, Polly Jackson Spencer developed the first-of-its-kind outpatient commitment program in Texas. She saw the devastation caused when the severely mentally ill are too sick to seek treatment and end up trapped in a revolving door of incarceration, homelessness, hospitalization and victimization.

“You can’t simply tell someone who has a mental illness and is disorganized in their thinking, ‘Hey, you’ve got a doctor’s appointment in three weeks and it’s ten miles from here, these are the different buses you need to take to get there, and don’t forget to go’ and assume that they’re going to make that. That’s just not going to happen.” —Polly Jackson Spencer, County Judge

Judge Oscar Kazen supervises the day-to-day operations of Bexar County’s court-ordered outpatient treatment program. He meets regularly with patients, psychiatrists, and staff.

“When I sit in that little courtroom, down in the basement of that abandoned hospital, the guy who sits at the end of the chair—that mentally ill patient—didn’t have a choice. He didn’t wake up one morning and say ‘I want to lose my life, I want to lose my sanity.’ These people had no choice in the matter and it’s our responsibility to bring them back to sanity.” — Oscar Kazen, Judge

Anosognosia is the number one reason why people fail to seek treatment.

It’s up to the rest of us to make sure that they are able to get treatment.

Learn more about anosognosia at treatmentadvocacycenter.org

Video by the Treatment Advocacy Center.

Is treatment-resistant schizophrenia fundamentally different?

The Danish have comprehensive data bases that have allowed wide-ranging epidemiologic findings. A group from Denmark and the UK interrogated Danish national registries to create a cohort of 8624 people with schizophrenia born after 1955 and who were at least 18 years old as of 1996.  The registries allow for determination of ICD diagnosis and inpatient treatment for schizophrenia, but not treatment-resistant schizophrenia (TRS), which is not a diagnosis recognized in ICD or DSM. To determine which patients were treatment resistant, they applied 3 criteria:

  • Treatment with clozapine
  • An 18-month period during which a patient was treated non-concurrently for 6 weeks with 2 distinct nonclozapine antipsychotics and subsequently required admission to hospital (clozapine eligible)
  • 90 days of polypharmacy, i.e. treatment with two or more antipsychotics

Although the use of clozapine may be the best proxy criterion for treatment resistance, the investigators estimate that only a third of Danish patients with TRS receive clozapine, hence the need for other proxy criteria.

The total number of treatment-resistant patients as fulfilled by any of the 3 criteria was 5900. The largest group was those who received 90 days of polypharmacy (n = 3773), which is the least specific criterion. The researchers used a Cox proportional hazards regression to compare the patients who met any of the TRS criteria to those who met none and found the following characteristics more prevalent in the TRS group:

  • Younger age at onset
  • Residence in less urban area
  • Hospital admission at time of diagnosis
  • Comorbid mental disorders
  • Paranoid subtype
  • Early parental loss
  • History of substance use disorder
  • Receiving disability benefit
  • Any psychotropic medication prescribed during the year preceding diagnosis
  • At least one suicide attempt

Sensitivity analyses examined the subcohorts of clozapine-treated plus clozapine-eligible patients (n = 1703). This combined group was more likely to have educational attainment beyond primary level but had the same likelihood of receiving a long-term disability benefit as the non-TRS group.

Characteristics that did not differ in the broad TRS cohort (n = 5900) compared with the non-TRS cohort included:

  • Sex
  • Season of birth
  • Paternal age
  • Living with a partner
  • History of a violent offense
  • Employment

The recognized risk factors for schizophrenia such as sex and season of birth did not distinguish TRS in this Danish cohort, but urban residence is a well-known risk factor which surprisingly was less common in the TRS subcohort. Other known risk factors that could not be explored in the registry-based design include birth complications, prenatal infections, and duration of untreated psychosis. The data presented however point to a more severe illness from the outset as reflected by medication use prior to, younger age, and hospital admission at the time of diagnosis.

The strength of the study is its size, which the population-based method permits, but this is also a basis for its weakness, namely the inability to precisely define a cohort of people with TRS. Unfortunately, none of the factors identified here would allow a prospective determination of TRS, i.e. who should receive clozapine. For that we require patient-specific biological markers.

Wimberley T, Støvring H, Sørensen HJ, Horsdal HT, MacCabe JH, Gasse C. Predictors of treatment resistance in patients with schizophrenia: a population-based cohort study. Lancet Psychiatry. Published online Feb 24, 2016. Abstract