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 MCG Today - Fall 2006

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The first time he heard the voice, he was a child and it was a whisper.

“I thought it was just my imagination,” says Brian*, who first heard the unintelligible voice when he was 4 or 5. “It only happened a couple of times in my childhood that I can remember.”

Otherwise, life was mostly good. Brian had loving parents and good friends but struggled with school. He could do the work; he just didn’t want to. He quit when he was 16 and still in the seventh grade. “I didn’t find it challenging or interesting,” he says. So Brian moved on, working long and hard to make a living.

But the voices eventually  came back. Over the years, they got louder and began to sound like his. They would tell him he was going to go to hell, or direct him to move a glass or sit a certain way. Amazingly, he mostly didn’t listen.

Brian was listening to his parents, who kept urging him to take the General Educational Development exam. Even with some goofing off, he managed to prepare for the high school equivalency test and pass it within five months. He was 21 and working as a security officer, a job that was a solid fit for his natural curiosity.

In the next few years, the voices grew impossible to ignore. He could no longer focus on work, so he started losing jobs. “I don’t know how I got through it. I give a lot of credit to my God. I wanted to go into a closet, real dark, and just stay there. It’s like  I had a shove each and every time I felt like that to get out, do things, work.”

Bad got worse and Brian eventually became homeless. “It was scary. I didn’t know where I was going to get my next meal, where I was going to sleep.

It’s not something anybody should have to go through. I don’t see why it happens, but it does.”

He went to the Salvation Army, where once again he was able to put his life back together. The voices subsided and he went to work for the institution that gave him shelter. One day, a young woman in need came to the center. Four months later, they married. “It was one of those things, just love. That’s it,” he says.

Their lives were awesome for a time. “I was working. I was doing well, [no longer in] financial constraints.” They had cars, food in the refrigerator and money for vacation.

Then, in 2003, the couple had to move quickly. Brian thinks stress set off another episode. The voices started again... loud this time, and telling him to kill somebody.

“One morning, I was supposed to go to work. I told my wife I would be back that afternoon. I got in my truck and instead of making my usual right-hand turn to go to work, I took the left fork and went to the hospital.”

At the hospital, Brian, then in his late 20s, was finally diagnosed with schizophrenia.

A psychiatrist he had seen back when he was struggling with school had diagnosed depression. But Brian had stopped taking the antidepressants almost as soon as he started. A book about mental health his wife had given him made him suspect this second doctor was right.

“It was a relief,” he says of finally understanding why he heard voices ... why sometimes  he would feel a presence standing behind him, even feel a hand on his shoulder. “I finally found a weapon I could use to beat those episodes back and have      a clear mind.”

While many people with schizophrenia won’t take their medicine, Brian happily takes his. “I don’t want to go through what I have been through again. There are a lot of things I want to do. I want to work again. I want to take care of my family [without] my wife having the worry of all the bills on her shoulders.” While he’s grateful for a small disability check, he’d rather work.

Brian daily ponders how to make those dreams come true.

He steps into his own world sometimes, replete with Harry Potter books, when the realities of this one get to be a little too much.

In his world, the voices are not gone, but they are once again a whisper.

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* Last name withheld by request.

-Toni Baker

 
Pills vs. Injections - "We are comparing whether people who get the injectable medicine will do better in symptoms or functioning and have fewer relapses over 30 months of treatment." -Dr. Peter Buckley A new study will determine whether schizophrenics—more than half of whom don’t take their medication as directed—will fare  better with biweekly physician visits and injectable drugs.

“We are comparing whether people who get the injectable medicine will do better in symptoms or functioning and have fewer relapses over 30 months of treatment,” said Dr. Peter Buckley, chair of the Department of Psychiatry and Health Behavior and a principal investigator on the five-year, $11 million study funded by the National Institute of Mental Health.

The study will follow 304 outpatient adults whose disease relapsed within the last six months because they did not take their medicines properly or became resistant to them. MCG will enroll 38 patients, including those at two public mental health centers, Ogeechee Behavioral Health Services and Serenity Behavioral Health Systems.

Participants will take a commonly prescribed antipsychotic pill or injections of risperidone microspheres, an injectable version of a relatively new antipsychotic. Injectable antipsychotics have been around since the 1970s, but only about 5 percent of U.S. patients use them. “Some doctors believe injections violate patient autonomy. With a pill, you can always stop it the next day; here you have something that is going to stay in the system,” said Dr. Buckley, who chairs the National Institutes of Health’s Interventions Committee for Schizophrenia Spectrum Disorders, Personality Disorders and Disorders of Late Life.

“If this package of regular visits and injectable medicine reduces relapse rates, it will provide a tremendous quality-of-life benefit for patients and be economically advantageous as well,” said Dr. Buckley.

“Relapse is the nature   of the disease,” says Dr. Philip Horton, medical director at Serenity Behavioral Health System. “The same people come back over and over again; they stop their medications and relapse. Participating in this study will be good for us and our patients.”

“Conducting this study at public mental health facilities is a great boost to this research since it is in centers like these that the study’s results are likely to have the greatest impact,” said Dr. Thomas Bornemann, executive director of the Mental Health Program at the Carter Center in Atlanta. “This study provides an excellent opportunity to help transform the mental health system in Georgia.”

 

image: prescriptions

Study Sites

  • Medical College of Georgia

  • Ogeechee Behavioral Health Services, Waynesboro, GA.

  • Serenity Behavioral Health Systems, Augusta, GA.

  • Harvard Medical School-Freedom Trail Clinic and Corrigan Mental Health Center, Boston

  • The University of New Mexico, Alburquerque

  • The Zucker Hillside Hospital, New York City

  • The University of Iowa, Iowa City

  • Creigton University, Omaha, NE

  • The University of California at Los Angeles

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December 21, 2006