Thursday, October 29, 2015

Advocacy: Economic Inequality, Stigma and Discrimination for Those with Mental Illness

Opinion: Public attitudes toward mental illness can be more damaging than the condition itself

October has been a busy month for mental health activists. Hundreds of people turned up to participate in Montreal Walks for Mental Health on Oct. 4, and other local events were held to celebrate World Mental Health Day on Oct. 10, including mental health awareness weeks at local universities.

Attempts to raise awareness are vitally important, as people with mental illness still suffer numerous social inequities. This is especially so for people with the most severe mental illnesses, such as schizophrenia.

Many of these inequities relate to the basic necessities of life. Around 80 per cent of people with a severe mental illness are unemployed, even though approximately 70 per cent express a desire to work. Likewise, roughly 35 per cent of the homeless population have a severe mental illness. Unemployment, underemployment, homelessness and poverty are frequent experiences for people with severe mental illness, contributing to a life on society’s margins.

Shockingly, life expectancy among people with a severe mental illness is considerably lower than the rest of the population, by around 15 years. This has been attributed to preventable factors including poor diet, obesity, heavy smoking, lack of exercise and high rates of diabetes. Some of these problems have been linked to the side-effects of psychiatric medication. Rates of suicide, injury and victimization are also much higher. Contrary to popular belief, people with severe mental illness are much more likely to be a victim of crime rather than a perpetrator.

Sadly, stigma and discrimination remain ever-present realities in their lives, with research indicating that public attitudes toward mental illness have not improved. This leads to thwarted opportunities and social exclusion. Indeed, many people with mental illness report that societal stigma is more damaging than the symptoms of the illness itself.

These are outrageous statistics that should not be tolerated by a humane society.

Fortunately, numerous national and local projects, many of these driven by the Mental Health Commission of Canada, are attempting to address these inequities.

One of these initiatives is an effort to reduce homelessness among people with severe mental illness: the “at home/ chez soi” project. This $110 million five-year national project tested the Housing First model in five different cities. This model quickly places homeless people with mental illness in ordinary private market rental housing, with supportive social services given as needed. Results suggest over 60 per cent of previously homeless people partaking in the program had become securely housed. These are very good rates compared to other models. Housing First is now considered a cost-effective evidence based practice that can reduce homelessness.

Another recent milestone is the release of Canada’s first ever mental health strategy, Changing Directions, Changing Lives. This states that a national priority must be to “increase awareness and reduce stigma.” The Opening Minds program of the Mental Health Commission of Canada has been tasked with leading such anti-stigma initiatives.

Impressively, they have supported dozens of targeted “contact-based education” programs reaching thousands of people. These programs consist of people with mental illness visiting workplaces, schools and various other settings to make powerful and evocative presentations about their recovery. Evaluations indicate that this is a highly effective way to reduce stigma and stereotypes among people including teachers, students, employers and health-care providers.

The federal government announced in 2015 that funding for the Mental Health Commission of Canada would be renewed for another 10 years. This will allow important activities to continue and new initiatives to commence. It is hoped that the incoming government will continue to take action to diminish stigma and promote recovery, supporting the full social integration of people with mental illness.

Rob Whitley is the principal investigator of the Social Psychiatry Research and Interest Group (SPRING) at the Douglas Hospital Research Centre. He is also an assistant professor in the Department of Psychiatry at McGill University.

Thursday, October 22, 2015

Research: Dementia, Cognitive Health and Well-being

Grow old along with me...

Detecting the earliest signs of dementia is the first step in finding ways to slow it down.
Kim Westad (Sept. 15). knowlEDGE, 15 (7). Retrieved from:

We spend plenty of time and money on gadgets and apps that track our steps, heart rate or how many calories we’ve burned in a day.

But what about our cognitive health and well-being?

How we think, reason, remember and process information varies from person to person. And importantly, it varies within ourselves, perhaps more and more so, as we age. Over time, these changes can signal neurocognitive problems such as dementia.

Yet, tracking individual cognitive changes in a person in real time, which we do with fitness gadgets for our physical health, is a relatively untested world.

Researchers and students at the University of Victoria’s Centre on Aging are working to change that. They’re teaming with community groups and institutions—including a key partner, Island Health—in groundbreaking research that could lead to earlier detection of dementia-related changes.

“We should be able to detect individual ‘change-points’ a number of years prior to when a person shows enough change that they become clinically identifiable as having dementia,” says Scott Hofer, director of the centre.

Hofer is a psychologist who studies long-term changes in cognition and health that are related to dementia and other age-related conditions.

He’s been involved in coordinating the analysis of over 100 longitudinal studies from all over the world. These studies follow people, often for decades, measuring health behaviours, physical and cognitive functioning, social interactions and nutrition to find out why people change with age and why some age differently than others.

Longitudinal studies offer powerful windows into how and why we change as we age. But the measurements are often spaced years apart and rarely permit analysis of individual change-points.

Our personal levels of health, functioning and well-being fluctuate—often day to day and sometimes even hour to hour. To measure those minute changes, Hofer is taking the research to a far more precise level.

He and his students are working with local physicians and Island Health researchers on what are called “patient-reported outcome measures.” These take into account things like pain, fatigue and mobility limitations, but also include factors that influence a person’s day-to-day functioning, such as stress, physical activity and sleep quality. All are measured far more frequently than in longitudinal studies.

The patient would self-report the outcomes using a secure web-based portal or mobile app. In the future, this information could then be integrated into Island Health’s electronic health records system that allows a person’s health record to be viewed by approved health professionals—as well as the patient—to improve care.

“It’s through such long-term, personalized measurements that individual changes can be detected much earlier than currently possible—and potentially be reversed or stabilized through precision health care,” says Hofer.

There is no cure or ideal treatment for dementia and related neurocognitive disorders, yet. But earlier detection is a huge step forward and will lead to a better understanding of how the disease progresses, says Hofer. Such knowledge could also help reduce risk and improve prevention.

Until then, there are simple steps we all can take: stay active, both physically and mentally, and remain socially engaged. Research shows that these all help our day-to-day quality of life and decrease the risk of dementia in the long-term.

View as PDF (117K).

Dementia is the deterioration of mental function caused by the loss of cells in the brain and the breakdown of important nerve connections. Alzheimer’s disease is the most common form of dementia.

Up to 15 per cent of Canadians aged 65 years and older are living with some form of dementia. The number of Canadians with dementia is expected to double by 2031.

Symptoms of dementia worsen over time and include memory loss, changes in judgment and reasoning, difficulty performing familiar tasks, and changes in mood and communication abilities.

In 2011, family caregivers spent 444 million unpaid hours a year looking after someone with cognitive impairments, including dementia. This figure represents $11 billion in lost income and 227,760 full-time equivalent employees in the workforce.

The causes of dementia are not precisely known. Possible risk factors include physical inactivity, unhealthy diet, environmental influences, genetic factors, gender (women are at higher risk) and severe brain injury. For more information visit the Alzheimer Society of Canada at

UVic's Centre on Aging draws on the expertise and experiences of researchers across campus, governments, health organizations and practitioners to understand the social, psychological, environmental and cultural factors that affect us as we age, and apply that new knowledge to health care policy and practice.

Sunday, October 18, 2015

Breaking the Silence: Suicide, second leading cause of death for Canadians between the ages of 10 and 24

Video: An Alberta student died by suicide, and his family wants to talk about it

'It's not something to put under the carpet,' says Vanlee Robblee, whose brother died at the U of A

Marion Warnica (Oct 17, 2015).  CBC News. Retrieved from:

She listens to his voice and wonders how he got so lost.

His words reach out from April. Before he admitted to his older sisters he was struggling, before he made appointments with his doctor in a desperate move to try to figure out what was wrong.

Before he disappeared.

Mishma Mukith has played this old voicemail more than 100 times since she found out her friend was gone. To her, it's a reminder of what a wonderful person Evan Tran was.

To his family, it's more evidence of a double life they wish they'd known about sooner.

No shame

"Would everyone mind sharing this photo? My brother-in-law has been missing since yesterday," Colin Robblee wrote in a Facebook post on Thanksgiving Monday. His family had already called police.

"Just thought social media might help."

Word spread quickly online and across the University of Alberta.

Evan Tran 1
Evan Tran, 21, was known for snapping photos and volunteering on campus. Students are planning a memorial at the University of Alberta on Wednesday. (Supplied)

Tran, who volunteered with several student groups, was well-known on campus.

On Tuesday, they found him.

Administration says his was the third "non-criminal death" at the school in a year.

"I have no issue to say my brother committed suicide," said his sister, Vanlee Robblee.

Her voice quavers when she talks about the shame Tran felt over his long battle with depression. And she's talking about it now to banish such embarrassment. For the sake of her family. And for others.

"It's not a shameful act. It's not something to put under the carpet."

2 years of happy

Tran, 21, loved playing video games, taking pictures and snowboarding. He ran his own Facebook page for photography and held a summer job organizing camp programs for children. He planned to run his own business someday, like his parents.

Tran's mother and father are Chinese refugees from Vietnam who moved to Edmonton in 1980.

They run a hair salon a few blocks from Whyte Avenue and the family lives in an apartment upstairs. They work hard, rarely say "I love you," but always felt close.

Doctors diagnosed Tran with depression and obsessive-compulsive disorder when he was 15 years old. He saw psychologists and sometimes took medication.

But over the last couple of years, as he started university, Tran seemed to find his balance. The change was noticeable to his family and friends.

Evan Tran 2

'Charmingly awkward' and 'quirky' is how sister Angela Tran describes her younger brother, seen here volunteering at a campus event. His funeral, planned for later this month, will be open to the public.

"He was always really positive and outgoing," said his friend Tyler Nguyen, who saved Tran a seat in organic chemistry class each day.

Nguyen and several other close pals volunteered with Tran in a student group that advocates for mental health. He remembers his friend's caring nature, bright smile and great laugh.

"It's something that expresses what I thought was how he enjoyed his life and how much positivity he had to share for others," Nguyen said.

"And I only wish he had some of that to keep for himself."

Double life

That's a wish his family shares, desperately.

The phone calls, messages and online memorials from students and staff at the university tell them about a world they didn't know existed. A world in which Tran was "the bubbly kid," cracking jokes, helping and making friends, popular.

In private, his family mainly saw his pain. They worried. And they supported him in every attempt he made to escape his shadows.

"It was not for lack of trying. He tried — so, so hard," Robblee said.

After he confided to her in July that he was sinking toward another low point, they made appointments with his doctor. Tran wanted to rule out any physical ailments. He was two days from an appointment for a brain scan when he died.

Now, hindsight is full of "if onlys" and "maybe thens."

If only they had known more about this other happy life of his, that was seemingly untouched by the doubts and worries he shared at home. Maybe then they could have helped remind him of how much people cared.
Maybe then he could have bridged the gap between his private struggle and public persona, to find a way to become the man he wanted to be.

"It's just unfortunate that his disease won."

Second biggest killer  

Numbers from the Centre for Addiction and Mental Health show suicide is the second leading cause of death for Canadians between the ages of 10 and 24.

The issue whipped into focus at the University of Alberta less than a year ago. In November 2014, administration announced it was working on a new suicide prevention program after two "non-criminal" deaths on campus in one month.

"If I'm in a really dark place, I'm probably not going to reach out to someone I don't know," said Kevin Friese, the executive director of the University Wellness Centre.

He said they're still working out the details of the new prevention plan. But the main goal is to be more strategic about bringing services to students, instead of students having to come to them.

"We need to help them so they don't get to that dark place."

And he says finding that help begins by talking — with anyone. Especially at this time of year.
CAMH's website says despite common beliefs that Christmas is most difficult, for Canadians the change of seasons from summer to winter is often toughest for those with mental health problems.

Holding on to light

Mishma Mukith was in a dark place when she got that call from Tran.

She went through a rough time in April. And she got through it, in part, with his help. The voicemail was one of many friendly calls to check in on her.

Listening to it now, she cries.

"It's just ironic that he offered so much support and help to his friends, but we couldn't be there for him."
Always thoughtful, he had slipped a little tea bag into her textbook the last time she saw him, a couple of weeks ago.

"For our next tea date," he said.

She's been sleeping with that tea bag under her pillow.

This link to the Canadian Association for Suicide Prevention can provide information, as well as contacts for crisis centres across Canada:

Saturday, October 17, 2015

Videos: Childhood and Adult Trauma: Impacts on the Brain and Development

Nadine Burke Harris: How childhood trauma affects health across a lifetime. Youtube. (15 min).


John Rigg: The effect of trauma on the brain and how it affects behaviors. TedX. (20 Mar 2015). (28 min.). Youtube. Retrieved from:

Friday, October 16, 2015

Research: CBT shown to be effective for depression prevention for at-risk youth even years later

Depression prevention therapy program effective for at-risk youth

Kathryn Doyle (Oct. 07, 2015). Reuters/Globe and Mail. Retrieved from: 

A cognitive-behavioural prevention program to prevent depressive symptoms among at-risk youth may still be effective years later, according to a new study.

“We have already shown that the intervention was more effective than usual care but it is surprising that we are still finding a difference between groups six years later,” said lead author Dr. David A. Brent of the University of Pittsburgh Medical Center.

Over time, youngsters in the therapy group were still at risk for depression but were functioning better at work and in their interpersonal lives as a result of having more depression free days, Brent told Reuters Health by email.

The researchers randomly divided 316 at-risk teens, with prior depressive episodes of their own and with at least one parent having current or prior depressive episodes, into two groups between 2003 and 2006.

Teens in the cognitive-behavioural prevention program attended eight weekly 90-minute group therapy sessions followed by six months of monthly sessions. The other group did not receive care other than what might have been initiated by their family members.

Some teens in each group did develop depression during the study period and over the six-year follow up period, but it was less common in the therapy group, the authors reported in JAMA Psychiatry.

Over the first nine months of the study, those in the therapy group were about 36 per cent less likely to develop depression than those in the comparison group.

“Even six years after the intervention,” the risk of depression was lower for adolescents who received cognitive-behavioural prevention therapy than for those who received usual care, the authors reported.

“This preventive effect largely was driven by the significant difference in new onsets of depression during the first nine months after enrollment,” they added, because after that point, the risk of new depressive episodes was similar in the two groups.

The therapy was most effective for kids whose parents were not depressed when the study began, the authors noted.

“Theoretically, cognitive behavioral therapy works by changing children’s thinking patterns - so that they can challenge negative thoughts and not engage in the kinds of interpretations of events in their lives that lead to depression,” said Irwin Sandler, director of the Prevention Research Center at Arizona State University in Tempe, who was not part of the new study.

The best time to begin this preventive therapy may be following a parent’s treatment for depression rather than during treatment, Sandler told Reuters Health by email.

Teens are actively learning new academic and social skills, and a person who is depressed most likely will fall behind his or her peers, he said.

“By relieving that depression, he or she will catch up to some degree and that could be reflected years later,” he said.

“Youth who have had a previous episode of depression should receive some ongoing help to keep them well, this is now standard care,” he said. “Youth who are at risk, and may have some symptoms but not full blown depression would probably benefit from getting (cognitive-behavioral therapy) earlier, prior to developing a full-blown episode.”

If a child appears to develop depressive symptoms, earlier intervention is better, he said.

Group therapy sessions cost considerably less than individual sessions, said Jeremy Pettit, professor of Psychology and Psychiatry at Florida International University in Miami, who was not part of the new study.

“Even adolescents who do not respond well to this kind of program in terms of depression prevention tend to report that they benefited in some ways from the program and that they are satisfied with the program,” Pettit told Reuters Health by email.

“Prevention services are not widely available because our health system does not reimburse for them, so it’s a real problem, Sandler said. Some programs are offered through schools or other community agencies, he said.

Not everything offered as prevention really is evidence based, so parents need to do their homework and insist on programs that have been demonstrated to work and where the leaders are certified to be competent providers of the program, Sandler said.

More Related to this Story

Research: Impacts of Childhood Abuse

2 types of child abuse have the same consequences

Monday, October 12, 2015

Raising awareness about mental health

Clara Hughes poses for a photo after the Bell Let's Talk special announcement held at the TIFF Bell Lightbox in Toronto, Tuesday, Sept, 22, 2015. MARTA IWANEK / THE CANADIAN PRESS

Editorial: Raising awareness about mental health

Mental Illness Awareness Week (Oct. 4 to 10) aims to help break the silence on mental-health issues, to bring them out of the shadows in which they so often dwell. It’s a hugely worthwhile goal.

Comedian and television show host Howie Mandel, who has obsessive-compulsive disorder, has said that if we could speak as openly about our mental health as we do about our dental health, we’d be in a good place.

We’re not there yet.

It helps when high-profile people associate themselves with mental health issues, like Mandel and like Canadian Olympian Clara Hughes, who has spoken publicly about her clinical depression. It helps, too, when ordinary Canadians speak out, as they do in the Faces of Mental Illness campaign, a key component of Mental Illness Awareness Week.

Through video profiles and in meetings with policymakers and at workplaces, five ordinary Canadians have chosen to share their experiences of living with mental illness and finding recovery. The campaign, in its 13th year, is organized by the Canadian Alliance on Mental Illness and Mental Health and days is underwritten mainly by Bell as part of a 10-year, $100 million commitment to its Bell Let’s Talk initiative.

When people tell their stories, it encourages dialogue with friends, the broader community and government. And it helps those who are struggling realize they’re not alone.

Grief and Grieving

A dirty secret called grief

After her mother’s death, Kiran Sidhu found she was expected to ‘move on’ with such bewildering haste that her only option was to conceal her sorrow 
Kiran Aldridge (15 October, 2015). The Guardian. Retrieved from:

At around midnight tonight, there will be a clandestine group of people logging on to their computers. They are not interested in Tinder, making stealthy purchases or Facebook. No, these people are grievers and I’m one of them.

Nine months after my mother died at the age of 62, I have found myself concealing what feels like a dirty secret – I’m still grieving. Most people would agree that after such a momentous loss, grief cannot be measured in months. It takes its time and so should we. So, why do we grievers feel the need to go underground with our feelings?

After living with grief for nine months, the world has never felt so divided to me as it does now; there are the grievers and then there are those oblivious to the black hole left in one’s life when someone significant dies. It is because of this division that so many of us visit forums for the bereaved in search for solace.

An anonymous contributor to the bereaved community section on Macmillan Cancer Support’s website posted the following: “Grief, I’ve realised, is like a dirty little secret. People who haven’t been through pain like ours don’t really want to know but want to be seen to care.”

It is true, I believe, that people have a finite amount of sympathy to dispense before they expect the bereaved person to move on. As a griever, I have come to realise this and so my grief, to some, has become a secret.

When someone asks you how you are for the 100th time after, say, seven months, you begin to reply “OK” – there’s only so much about your grief you can tell another person. I am not saying people are intentionally callous, but, generally, they do not know how to deal with another person’s grief. It’s not convenient for them to know the truth. What if you were to tell the truth – “I’m not OK”? You have just handed the person a hot potato. I think the natural reaction, especially for family members, is to “fix the problem”. But it’s important to point out that we grievers do not expect you to fix anything. You cannot fix it.

There’s a miscalculated expectation on both sides; the griever thinks that people expect them to have moved on and the questioner thinks the griever wants to to be saved. This produces unnecessary anxiety for both parties.

Like the embarrassed griever and the well-meaning friend, our society dances politely around death. We’re inundated with information about the latest super-foods and their health benefits. No one just says, “We’re going to die.” Full stop.

Death is the uninvited dinner guest at the banquet of life. Our inability to talk about death has left us ill-equipped to talk about grief.
Bereavement forums are a lifeline for people like me. They provide a safe haven for the things we dare not share with the rest of the world. In hushed tones we disclose regrets about not spending enough time with our deceased loved ones. This, I have come to realise, is a universal regret. Even if we had spent all our waking hours with the deceased, we would still wish for more.

This is a revelation when we all seem to live as if we have all the time in the world, one that would benefit us all.

I’ve been reading about addiction to grief. It’s an impulse I can understand. When you feel the gut-wrenching pain of loss, that’s when you feel closest to them. To feel their presence is to feel the loss. It’s a double-edged sword. The pain is exquisite. There’s also a desire to be back at the funeral when you were surrounded by family and friends who understood your pain. Months on, the understanding has gone but you still need the comfort.

With passing time, my grief looks different to the outside world. Earlier on, externally I looked the same as I felt internally: a mess. Now my appearance tells a different a story, but inside I haven’t changed.

It is no secret that we live in a throwaway society and that goes for bereavement too. People don’t want to hear too much about your grief when they are too busy living. It forces them to look in the mirror and confront their own mortality. Thinking too much about grief is maudlin and thinking too much about death seems macabre and wasteful.

I have chosen to examine the open wound of my grief and almost befriend it. It has visited and cast its shadow over my life. I can only live with it. I am open to what it has to teach me, that when those we love die, they leave holes in our lives that can never be filled. Grief is the fate of us all. Maybe it’s about time we all had an honest conversation about it.

Saturday, October 3, 2015

Training: Mental health 'first aid'

 Workshop shows how to help

Advocacy: Solutions to Homelessness for those with mental health issues

There's A Solution For Mental Health Homelessness In Canada -- But It Needs Help

Excerpt below. Read the whole article at the link above.

"I don't think they understand what I’m dealing with. I just don't want people to feel sorry for me. Right now, I have a lot of shame, shame and pain. And this is what no mother wants."

Samantha Bowens is a 37-year-old single mother. She moved to Toronto from the island of St. Vincent when she was 17, and other than a sojourn to Saskatoon with her husband before their marriage broke down, this city has been her home. She lives with her daughters, Daniella, 15, and Sarah, 2, in an apartment building downtown near Trinity Bellwoods Park.

But it's not just any apartment. It is run by Houselink Community Homes, a non-profit supportive housing organization that goes beyond affordable accommodation. Houselink also provides a range of other services, from problem-solving to community-building for their tenants, all of whom are struggling with mental health issues.

Supportive housing is not a particularly well-known concept in Canada. It’s like affordable housing in some ways — there is rental assistance, and there are not enough units — but it’s geared toward people struggling with mental illness, so support services are also provided.

Toronto has 5,063 mental health supportive housing units and 9,885 people on the waiting list, up from about 900 in 2009. The Access Point, which co-ordinates the city’s mental health and addictions support services, estimates that 400 supportive housing vacancies come up annually. (An additional 9,000 people with mental illness are in traditional social housing without supports.)

The Canadian Mental Health Association told HuffPost Canada it would cost about $150 million to house those waitlisted people with rental and social support services.

A Mental Health Commission of Canada report found there were about 25,000 supportive housing units across the country. These range from Supportive Housing of Waterloo, which runs a 30-unit apartment as well as a hoarder outreach program, and Homeward Trust Edmonton, which recently opened the 21-unit Iris Court for people with schizophrenia, to Nova Scotia’s Tawaak Housing, which owns and operates two six-unit apartments for homeless aboriginal people, to Vancouver’s McLaren Housing, which cut the ribbon in July on a 12-storey complex that adds another 110 units to the mix.

That report also found that Canada needs a minimum of 100,000 units — or four times what we have now — to handle the 120,000 homeless and 520,000 "inadequately housed" people living with mental illness.

Friday, October 2, 2015

Peer support: Peer mentoring project tackles teen anxiety

Age of Anxiety: Peer mentoring project tackles teen anxiety

North Vancouver teen mentoring programs gives youth chance to give back

Young people who struggle with anxiety and depression on the North Shore have a new resources to turn for help — two teenage mentors who have faced the same reality, and figured out a way to cope.

The peer-mentor program is being piloted by the North Vancouver branch of the Canadian Mental Health Association as part of its STEPS program, which brings together young people struggling with mental health to participate in a range of recreational activities.

"It gives youth the opportunity to take what might have been a really negative dark time in their life and actually do something positive with it," says outreach worker Jennifer Gibson.

Gibson facilitates the STEPS program, which for the past two years has focussed on dealing with three issues associated with anxiety: social isolation, physical inactivity and stigma.

Building resiliency

But the development of the peer mentor program, Gibson notes, will hopefully address a fourth issue — resiliency within the teenagers.

"I've seen a lot of growth in people who have come here" says 17-year-old Yvana Avram, who says the program itself is "a safe place that's free of stigma."

Avram participated in STEPS for the past two years after she was diagnosed with depression in Grade 9, but now in her Grade 12-year Avram says she is recovering and she felt mentoring other youth was a way to help.

"When I got the opportunity to be a peer mentor, of course I said yes, because I thought it would be really cool, and it's a chance to give back" says Avram.

Gibson says the two peer mentors were chosen because they are open about their lived experiences, and have been trained in active listening and boundary setting.

The teen mentors will not be involved in any crisis intervention and will regularly debrief with Gibson about their roles.

With files from Manusha Janakiram.

Research: Eye problems may signal onset of schizophrenia

Eye problems may signal onset of schizophrenia

Carl Blesch (2015). Rutgers University. Retrieved from:

A link between vision problems and schizophrenia is well known, with as many as 62 percent of adult patients with the disorder experiencing some kind of visual distortions involving form, motion, or color.
Now researchers say tracking changes in the eye’s retina may help doctors provide more effective treatment for people with the disorder.

Researchers reported on and summarized multiple, replicated indicators of eye abnormalities in schizophrenia in a literature review published in the journal Schizophrenia Research: Cognition.

They describe a widening of small blood vessels in the eyes of schizophrenia patients, and in young people at high risk for the disorder, perhaps caused by chronic low oxygen supply to the brain—which they said could explain vision changes and signal disease risk and progression.

Researchers also found a thinning of the retinal nerve fiber layer, known to be related to the onset of hallucinations and visual acuity problems in patients with Parkinson’s disease.

“Our analysis of many studies suggests that measuring retinal changes may help doctors in the future to adjust schizophrenia treatment for each patient,” says study coauthor Richard B. Rosen, an ophthalmology professor at the Icahn School of Medicine at Mount Sinai’s New York Eye and Ear Infirmary.

“More studies are needed to drive the understanding of the contribution of retinal and other ocular pathology to disturbances seen in these patients, and our results will help guide future research.”

Blindness and schizophrenia

Abnormalities in the way the brain processes visual information contribute to the difficulties people with schizophrenia have with social interactions and in recognizing what is real. That makes it harder for them to track moving objects, perceive depth, draw contrast between light and dark or different colors, organize visual elements into shapes, and recognize facial expressions, according to previous research.
[Why schizophrenia makes it hard to remember]
One past study also found that poorer visual acuity at age 4 predicted a diagnosis of schizophrenia in adulthood, and another that children who later develop schizophrenia have elevated rates of strabismus, or misalignment of the eyes, compared to the general population.

For the new paper, researchers examined the results of approximately 170 existing studies and grouped the findings into multiple categories, including changes in the retina compared with those in other parts of the eye, and changes related to dopamine compared with those related to other neurotransmitters, key brain chemicals associated with the disease.

Interestingly, the analysis uncovered no reports of people with schizophrenia who were born blind, suggesting that congenital blindness may completely or partially protect against the development of schizophrenia.

Because congenitally blind people tend to have cognitive abilities in certain domains (such as attention) that are superior to those of sighted individuals, understanding brain re-organization after blindness may have implications for designing cognitive remediation interventions for people with schizophrenia.
[ebola virus discovered in survivor’s eye]
“The retina develops from the same tissue as the brain,” Rosen says. “Thus retinal changes may parallel or mirror the integrity of brain structure and function. When present in children, these changes may suggest an increased risk for schizophrenia in later life.

Additional research is needed to clarify these relationships, with the goals of better predicting emergence of schizophrenia, and of predicting relapse and treatment response and people diagnosed with the condition.”
The findings also showed abnormal electrical responses by retinal cells exposed to light (as measured by electroretinography), suggesting possible cellular-level differences in the eyes of schizophrenia patients.

Vision has been understudied in schizophrenia, and studies of the retina and other ocular structures in the disorder are in their infancy, says coauthor Steven M. Silverstein, director of the division of schizophrenia research at Rutgers University Behavioral Health Care and Robert Wood Johnson Medical School Department of Psychiatry.

“Because it is much faster and less expensive to obtain data on retinal structure and function, compared to brain structure and function, measures of retinal and ocular structure and function may have an important role in both future research studies and the routine clinical care of people with schizophrenia.”

Source: Rutgers

Original study: 

Silverstein, S.M. & Rosen, R. (2015). Schizophrenia and the eye. Rutgers University. Retrieved from:


Although visual processing impairments are common in schizophrenia, it is not clear to what extent these originate in the eye vs. the brain. This review highlights potential contributions, from the retina and other structures of the eye, to visual processing impairments in schizophrenia and high-risk states. A second goal is to evaluate the status of retinal abnormalities as biomarkers for schizophrenia. The review was motivated by known retinal changes in other disorders (e.g., Parkinson’s disease, multiple sclerosis), and their relationships to perceptual and cognitive impairments, and disease progression therein. The evidence reviewed suggests two major conclusions. One is that there are multiple structural and functional disturbances of the eye in schizophrenia, all of which could be factors in the visual disturbances of patients. These include retinal venule widening, retinal nerve fiber layer thinning, dopaminergic abnormalities, abnormal ouput of retinal cells as measured by electroretinography (ERG), maculopathies and retinopathies, cataracts, poor acuity, and strabismus. Some of these are likely to be illness-related, whereas others may be due to medication or comorbid conditions. The second conclusion is that certain retinal findings can serve as biomarkers of neural pathology, and disease progression, in schizophrenia. The strongest evidence for this to date involves findings of widened retinal venules, thinning of the retinal nerve fiber layer, and abnormal ERG amplitudes. These data suggest that a greater understanding of the contribution of retinal and other ocular pathology to the visual and cognitive disturbances of schizophrenia is warranted, and that retinal changes have untapped clinical utility.