
{"id":22283,"date":"2011-12-08T10:58:26","date_gmt":"2011-12-08T15:58:26","guid":{"rendered":"http:\/\/www.carrborocitizen.com\/main\/?p=22283"},"modified":"2011-12-13T15:27:33","modified_gmt":"2011-12-13T20:27:33","slug":"charting-a-path-to-recovery","status":"publish","type":"post","link":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/2011\/12\/08\/charting-a-path-to-recovery\/","title":{"rendered":"Charting a path to recovery"},"content":{"rendered":"<p><strong>By Taylor Sisk<\/strong><br \/>\n<em>Staff Writer<\/em><br \/>\n<em>This is the second in a three-part series on the onset of psychosis in young adults, its treatment and UNC\u00e2\u20ac\u2122s Outreach and Support Intervention Services program. <\/em><br \/>\n<a href=\"http:\/\/www.carrborocitizen.com\/main\/oasis-\u00e2\u20ac\u201c-charting-a-path-to-recovery\/\">[OASIS series main page]<\/a><\/p>\n<p>When David Binanay was diagnosed with schizophrenia in 2006, a year out of college, he was very fortunate in a couple of fundamental ways.<\/p>\n<p>First, he had the support of his family.<\/p>\n<p>\u00e2\u20ac\u0153My family went through psychosis as much as I did, particularly my mom and dad,\u00e2\u20ac\u009d Binanay says. <\/p>\n<p>Obviously, the experience is a traumatic one, your loved one present, but from afar. <\/p>\n<p>\u00e2\u20ac\u0153Imagine your son coming from here,\u00e2\u20ac\u009d Binanay says, his hand reaching for the ceiling. \u00e2\u20ac\u0153And now where did he go? <\/p>\n<p>\u00e2\u20ac\u0153My family went through a lot,\u00e2\u20ac\u009d and stood by him each step of the way.<\/p>\n<p>Binanay was also lucky to be diagnosed soon after the onset of his illness, and to be referred to the Outreach and Support Intervention Services (OASIS) program \u00e2\u20ac\u201c administered by UNC\u00e2\u20ac\u2122s Center for Excellence in Community Mental Health \u00e2\u20ac\u201c in Carrboro\u00e2\u20ac\u2122s Carr Mill Mall.<\/p>\n<p>Binanay needed direction; he needed acknowledgement of his perception that what was going on was as much in his heart as his head. It was a profound spiritual experience.<\/p>\n<p>The staff at OASIS was willing to accept that. The importance of mapping an exit strategy of the client\u00e2\u20ac\u2122s own design is a cornerstone of the OASIS philosophy. The conviction that there\u00e2\u20ac\u2122s hope is another.<\/p>\n<p>Diana Perkins, OASIS\u00e2\u20ac\u2122 medical director, describes a recent meeting she had with the parents of an 18-year-old boy in rural North Carolina who had been diagnosed with schizophrenia. They had taken him to a local hospital, and were told by a psychiatrist that their son would never recover \u00e2\u20ac\u201c no hope; get used to it. <\/p>\n<p>\u00e2\u20ac\u0153And it was just devastating,\u00e2\u20ac\u009d Perkins says. \u00e2\u20ac\u0153Here they had this 18-year-old boy, off in college, and now they\u00e2\u20ac\u2122re being given this message. This was a psychiatric hospital; this was a trained psychiatrist.\u00e2\u20ac\u009d <\/p>\n<p>The problem, Perkins says, is that psychiatrists often don\u00e2\u20ac\u2122t see schizophrenia patients until their illness is advanced. <\/p>\n<p>\u00e2\u20ac\u0153Clinicians have this bias,\u00e2\u20ac\u009d Perkins says, \u00e2\u20ac\u0153and they really need to understand that this is not inevitably a chronic, disabling illness, that people can learn to manage it. <\/p>\n<p>\u00e2\u20ac\u0153They need to understand that there\u00e2\u20ac\u2122s tremendous hope.\u00e2\u20ac\u009d<\/p>\n<p><strong>Effective treatment<\/strong><br \/>\nUNC\u00e2\u20ac\u2122s OASIS program was launched in September 2005. Its objectives are to engage young people in treatment of the onset of psychosis and assist them in regaining social and occupational functioning, toward, ultimately, preventing disability from a psychotic disorder.<\/p>\n<p>From experience, Perkins and her colleagues have come to see that the needs of this young population are very different from those with chronic psychosis. They\u00e2\u20ac\u2122ve realized that early intervention can prevent the illness from becoming chronic. <\/p>\n<p>\u00e2\u20ac\u0153There is symptom recovery and functional recovery,\u00e2\u20ac\u009d OASIS program director Sylvia Saade explains. <\/p>\n<p>The strategy is to control symptoms with low doses of antipsychotic medication and then focus on functional recovery, which means the return to school or work, to lives in progress. Some patients, but not all, must adjust their expectations.<\/p>\n<p>Though there\u00e2\u20ac\u2122s no cure for schizophrenia, Perkins says, \u00e2\u20ac\u0153We have treatments that can effectively control symptoms and prevent disability in most patients.\u00e2\u20ac\u009d<\/p>\n<p>While it\u00e2\u20ac\u2122s known that the frontal cortical and temporal lobe regions of the brain are affected by schizophrenia, the disease\u00e2\u20ac\u2122s causes are unknown. There are many theories about causation. One theory relates to mitochondrial function, the energy producers in our cells. There\u00e2\u20ac\u2122s also evidence that the way the brain responds to stress may contribute to schizophrenia risk.<\/p>\n<p>\u00e2\u20ac\u0153At different levels, we have lots of different theories that are driving our understanding of what might be contributing to risk,\u00e2\u20ac\u009d Perkins says. \u00e2\u20ac\u0153But it\u00e2\u20ac\u2122s probably not the same thing for every person.\u00e2\u20ac\u009d<\/p>\n<p>Schizophrenia is diagnosed on the basis of psychosis. One of the senses will start making mistakes. For example, you may start having hallucinations. <\/p>\n<p>Or you may have delusions, believing that people are talking about or laughing at you. You may think people on TV are making special reference to you. You observe connections between things that most people don\u00e2\u20ac\u2122t see, or you may think, \u00e2\u20ac\u0153That person just said exactly what I was thinking.\u00e2\u20ac\u009d<\/p>\n<p>\u00e2\u20ac\u0153When your brain\u00e2\u20ac\u2122s not working right,\u00e2\u20ac\u009d Perkins says, \u00e2\u20ac\u0153all these things you depend on your brain to do \u00e2\u20ac\u201c to interpret visual stimuli, what you see and what you hear to make sense of the world \u00e2\u20ac\u201c start to break down.\u00e2\u20ac\u009d <\/p>\n<p>It\u00e2\u20ac\u2122s not necessarily the first sign, but it\u00e2\u20ac\u2122s the defining sign of the illness.<\/p>\n<p>\u00e2\u20ac\u0153The whole point is that there is a disorder in perception and interpretation. Those are the main things our cortex does; it perceives and interprets the world, and that breaks down.\u00e2\u20ac\u009d <\/p>\n<p>It\u00e2\u20ac\u2122s a bit like what happens in dreams, Perkins says. \u00e2\u20ac\u0153You know how while you\u00e2\u20ac\u2122re dreaming, it all kind of makes sense to you? And then you wake up and try to tell someone your dream, and you realize you can\u00e2\u20ac\u2122t tell it.\u00e2\u20ac\u009d<\/p>\n<p><strong>A \u00e2\u20ac\u02dcsevere course\u00e2\u20ac\u2122 <\/strong><br \/>\nDavid Binanay believed he had a special purpose. He had known great success in his life: singing with the Raleigh Boychoir in Carnegie Hall, school president, top of his class, a talented violinist.<\/p>\n<p>He\u00e2\u20ac\u2122d also survived four open-heart surgeries. \u00e2\u20ac\u0153My mission was to survive,\u00e2\u20ac\u009d he says.<\/p>\n<p>As schizophrenia set in, Binanay began to perceive synchronicities and coincidences: \u00e2\u20ac\u0153I would walk outside expecting to see my mom, and my mom would drive up,\u00e2\u20ac\u009d he says. \u00e2\u20ac\u0153That\u00e2\u20ac\u2122s really cool, when that gets firing on all cylinders.<\/p>\n<p>\u00e2\u20ac\u0153For me, it was like purpose. I\u00e2\u20ac\u2122ve always been about purpose.\u00e2\u20ac\u009d <\/p>\n<p>He can still feel the passion that imbued him, the passion to figure out what it was all about. <\/p>\n<p>\u00e2\u20ac\u0153I started reading a lot of religious texts, the Bible. I would drive, searching for places just to hear the word, to hear people speak. I would meet interesting people. I was living the dream.\u00e2\u20ac\u009d <\/p>\n<p>He talked with his priest, but it was at the height of his psychosis, and, \u00e2\u20ac\u0153It didn\u00e2\u20ac\u2122t go well. It did not go well.\u00e2\u20ac\u009d <\/p>\n<p>OASIS was his refuge: \u00e2\u20ac\u0153They knew everything I was going through.\u00e2\u20ac\u009d<\/p>\n<p>But a commitment to the meds was part of the plan, and that involved a tradeoff \u00e2\u20ac\u201c the euphoria for a shot at stability \u00e2\u20ac\u201c he wasn\u00e2\u20ac\u2122t quite ready to make. <\/p>\n<p>\u00e2\u20ac\u0153His illness took a severe course,\u00e2\u20ac\u009d Saade says of Binanay\u00e2\u20ac\u2122s struggle with recovery.<\/p>\n<p>\u00e2\u20ac\u0153I think David had a hard time coming to terms with the role that medication would play in his life,\u00e2\u20ac\u009d Perkins says, \u00e2\u20ac\u0153what he needed to do to maintain a sustained recovery, how he was going to manage.\u00e2\u20ac\u009d<\/p>\n<p>It\u00e2\u20ac\u2122s a two-way commitment. <\/p>\n<p>\u00e2\u20ac\u0153Every person who comes in is unique, and we have to work with them to find the strategies that work best for them,\u00e2\u20ac\u009d Perkins says.<\/p>\n<p>\u00e2\u20ac\u0153People have to figure out how to believe that they\u00e2\u20ac\u2122re effective in the world, that they\u00e2\u20ac\u2122re a good person, that they can contribute, that they\u00e2\u20ac\u2122re valuable,\u00e2\u20ac\u009d and, yes, that they\u00e2\u20ac\u2122re living with schizophrenia.<\/p>\n<p><strong>Inevitable?<\/strong><br \/>\nSome three in four people with schizophrenia will have ongoing disability with relapses. OASIS is aiming to reduce that number. <\/p>\n<p>When a person experiences his or her first psychotic episode, often it\u00e2\u20ac\u2122s gone within a few weeks, and the person is back to normal. <\/p>\n<p>\u00e2\u20ac\u0153It feels to the patient, and sometimes to the physician treating them, that the patient is cured,\u00e2\u20ac\u009d Perkins says, \u00e2\u20ac\u0153or that it could be just a one-off thing that happened.\u00e2\u20ac\u009d <\/p>\n<p>Unfortunately, that\u00e2\u20ac\u2122s not usually the case.<\/p>\n<p>Seventy to 80 percent of those who recover from a first episode of psychosis will experience a relapse within a year, Perkins says, and virtually all will relapse within three years. <\/p>\n<p>With each relapse, it generally takes longer to respond to medication and the response is less complete. There is often a loss of cortical gray and cortical white matter: The brain, with each recurrent episode, shrinks.<\/p>\n<p>But is it inevitable that people with schizophrenia will experience that downward spiral? Is it inevitable that at least three in four will live with chronic illness and disability? <\/p>\n<p>\u00e2\u20ac\u0153The answer is no,\u00e2\u20ac\u009d Perkins says, \u00e2\u20ac\u0153it\u00e2\u20ac\u2122s not inevitable\u00e2\u20ac\u009d \u00e2\u20ac\u201c and that\u00e2\u20ac\u2122s the premise upon which OASIS is founded. <\/p>\n<p>OASIS strives to maintain long-term recovery through low-dose antipsychotic medication and psychotherapeutic intervention, with the help, if possible, of a client\u00e2\u20ac\u2122s family. The most crucial element is the client\u00e2\u20ac\u2122s own commitment to recovery.<\/p>\n<p>And: \u00e2\u20ac\u0153It\u00e2\u20ac\u2122s critical that it\u00e2\u20ac\u2122s caught early,\u00e2\u20ac\u009d Perkins emphasizes. \u00e2\u20ac\u0153The earlier it\u00e2\u20ac\u2122s caught, the greater the likelihood of a good outcome, the greater the response to medication, the greater likelihood of functional recovery, the greater resilience against relapse if it occurs.\u00e2\u20ac\u009d<\/p>\n<p><em>Next week: The road to recovery<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>When David Binanay was diagnosed with schizophrenia in 2006, a year out of college, he was very fortunate in a couple of fundamental ways.<\/p>\n","protected":false},"author":12,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[],"class_list":["post-22283","post","type-post","status-publish","format-standard","hentry","category-news"],"_links":{"self":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/22283","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/users\/12"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/comments?post=22283"}],"version-history":[{"count":3,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/22283\/revisions"}],"predecessor-version":[{"id":22356,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/22283\/revisions\/22356"}],"wp:attachment":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/media?parent=22283"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/categories?post=22283"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/tags?post=22283"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}