Mass. Sweeps Awards for Restraint Reduction & Elimination

Massachusetts Department of Mental Health Press Release
Anna Chinappi
Anna.Chinappi@state.ma.us
617-626-8124
April 02, 2010 - For immediate release:

Massachusetts Sweeps First-Ever National Award for Reducing and Eliminating Restraint and Seclusion
BOSTON — Massachusetts swept the first-ever awards given by the U.S. Substance Abuse Mental Health Services Administration (SAMHSA), recognizing sustained restraint and seclusion reduction and prevention work. Five of the ten awards were given to Massachusetts' facilities, including Taunton State Hospital and the nine child/adolescent statewide programs operated by the Department of Mental Health (DMH).

Massachusetts has led the nation in the reduction and elimination of restraint and seclusion since DMH launched its Restraint and Seclusion Elimination Initiative in 2001. In that time, the use of seclusion and restraint has decreased more than 63 percent statewide with more robust reductions in several facilities like Taunton State Hospital which has reduced its use 88 percent and the DMH child/adolescent statewide programs which have reduced total episodes of restraint and seclusion by 93 percent. The DMH statewide programs were the only youth-serving programs in the country to be recognized by SAMHSA.

"I could not be more proud of the work we have done and will continue to do in Massachusetts facilities and I am fully committed to advancing our restraint and seclusion prevention work even further," said DMH Commissioner Barbara A. Leadholm, M.S., M.B.A. "Congratulations to all of our award winners — they are a shining example of the positive outcomes we strive for as our system continually transforms and promotes recovery-based practices."

In addition to Taunton State Hospital and the nine DMH child/adolescent programs, SAMHSA's "Alternatives to Seclusion and Restraint Recognition Program" also recognized

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Kindred Hospital Northeast Stoughton, Neurorehabilitation Units, Stoughton, MA
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Kindred Hospital Park View-Springfield, Psychiatric Rehabilitation Unit; Springfield, MA
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Noble Hospital, Fowler Unit; Westfield, MA
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Salem Hospital, Psychiatric Medicine Center; Salem, OR
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Andrew McFarland Mental Health Center; Springfield, IL
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Elgin Mental Health Center; Elgin, IL
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Cherokee Mental Health Institute; Cherokee, IA
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Northern Nevada Adult Mental Health Services; Sparks, NV

SAMHSA hosted a recognition ceremony at its headquarters in Rockville, MD this week to honor the efforts of these leaders among behavioral health facilities that have made remarkable strides towards preventing the use of seclusion and restraint practices.

As part of SAMHSA's mission to reduce the impact of substance abuse and mental illness on America's communities, the agency has set forth a vision to reduce and ultimately eliminate the use of seclusion and restraint practices in behavioral health care settings. The "Alternatives to Seclusion and Restraint Recognition Program" acknowledges the excellent work being done across the country and creates the opportunity for leaders to share experiences with other programs throughout the U.S.
About DMH

The Massachusetts Department of Mental Health (DMH) is one of the 17 state agencies that comprise the Executive Office of Health and Human Services. DMH provides services to adults, children and adolescents with long-term or serious mental illness and serious emotional disturbance; provides early and ongoing treatment for mental illness; and conducts research into the causes of and treatments for mental illness. Through state operated inpatient facilities and community mental health centers and through community services and programs provided by nearly 200 mental health providers, DMH directly serves 21,000 citizens, including about 3,500 children and adolescents, with severe and persistent mental illness and serious emotional disturbance.

Antipsychotic [Haldol] Deflates the Brain, Drug for schizophrenia causes side effects by shrinking part of the brain.

NATURE
6 June 2010
Amy Maxmen

A leading antipsychotic drug temporarily reduces the size of a brain region that controls movement and coordination, causing distressing side effects such as shaking, drooling and restless leg syndrome.

Just two hours after injection with haloperidol, an antipsychotic commonly prescribed to treat schizophrenia, healthy volunteers experienced impaired motor abilities that coincided with diminished grey-matter volume in the striatum1 — a brain region that mediates movement.

"We've seen changes in the brain before, but to see significant remodelling of the striatum within a couple of hours is staggering," says Clare Parish at the Howard Florey Institute for brain research in Melbourne, Australia, who was not involved in the study. "Our viewpoint was that only chemical changes would happen in such a short time."

In functional magnetic resonance imaging (fMRI) scans the authors observed the participants' striatal volume diminishing and changes to the structure of the motor circuitry in their brains. Further, their reaction times slowed in a computer test taken after the treatment, indicating the onset of lapses in motor control that affect many patients on antipsychotics.
Dopamine downsizing

Haloperidol has a number of side effects, although many of these are minor and recede within weeks of starting treatment. With few better alternatives, psychiatrists have prescribed the drug for more than 40 years to treat people suffering from hallucinations, delirium, delusions and hyperactivity.

Like most antipsychotics, haloperidol blocks the D2 receptor, which is sensitive to dopamine. The drug stifles the elevated dopamine activity that is thought to underlie psychosis. D2 receptors are abundant in the striatum, where their activity regulates gene expression. But, until now, no one knew that blocking the receptors would rapidly alter the brain's physical structure.

"This is the fastest change in brain volume ever seen," says Andreas Meyer-Lindenberg, professor of psychiatry and psychotherapy at the University of Heidelberg in Mannheim, Germany, and a lead author on the report in Nature Neuroscience1. "Studies have found that the volume of brain regions changes over a number of days, but this is in one to two hours, and in half that time it bounces back."

Within a day, volunteers' brains returned to almost their original size as the effects of the single haloperidol dose subsided. Meyer-Lindenberg says this result should alleviate fears that the drug destroys brain cells. "We know it's not killing neurons because the brain rebounds," he says.

Instead, the team suggests that haloperidol downsizes synapses, the junctions through which neurons communicate. Meyer-Lindenberg speculates that the change is mediated by the protein BDNF, which is involved in synapse growth and diminishes in response to antipsychotic treatments in mice.
The bigger picture

"I think this study will cause worry to some," says Shitij Kapur, dean of the Institute of Psychiatry at King's College London. To counteract those fears, he notes that the brain changes caused by the drug seem to be reversible and that the dose used in the study was a little higher than that usually given to patients who had not taken the drug before.

The findings may also hint at why people with bipolar disorder have reduced grey matter in parts of their brains after manic mood swings2. Andrew McIntosh at the University of Edinburgh, UK, says that the connection between the brain-shrinking effects of an antipsychotic reported in this study and the grey-matter reduction he and others have observed in schizophrenic and bipolar patients is "a bit uncertain but this paper definitely makes this worthy of further investigation".

Furthermore, D2 receptors in parts of the striatum have been associated with addiction. This has led Parish to ponder on whether structural changes underlie reward-seeking behaviours. "You wonder what sort of acute changes happen through those receptors in the addicted brain because you hear of cases where addiction happens after just one exposure," she says.

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References
1. Tost, H. et al. Nature Neurosci. doi:doi:10.1038/nn.2572 (2010).
2. Moorhead, T. et al. Biol. Psychiatry 62, 894-900 (2007). Article PubMed