New approaches to mental illness

For world-leading mental health researcher Christos Pantelis, unravelling the mystery of how schizophrenia changes the brain is more than just an academic curiosity. It’s personal.

Professor Pantelis, a professor of medicine at the University of Melbourne, grew up watching his beloved aunt Paraskevi trying to cope with the delusional ideas and persecutory voices she heard as a result of schizophrenia.

“She had a very warm personality and people quite liked her,” he said.

Typical of the disorder’s onset in late adolescence and early adulthood, Paraskevi developed the illness in her early 20s. Remarkably, she lived for almost five decades without any treatment, somehow finding a way to cope with her symptoms.

Her experience with schizophrenia had a profound influence on Professor Pantelis, who has spent his career trying to better understand why the illness most commonly occurs during that critical period of development.

Schizophrenia remains one of the more elusive mental disorders, affecting up to 200,000 Australians. Experts are hoping to raise awareness of it and other mental health issues during Mental Health Week, which runs until Saturday.

During his first major research project in 1985, when he was assessing patients with schizophrenia in Camden, London, Professor Pantelis became intrigued by how the brain was affected by the disorder.

“At that time there wasn’t a great deal of brain research, it was all about looking at the social factors relevant to schizophrenia.

“I started to look at higher-level mental function and identifying where there were problems in the way the brain was functioning,” said Professor Pantelis, who was later part of a team that developed a technique for volumetric analysis of brain magnetic resonance imaging pictures.

He subsequently established the cognitive neuropsychiatry research unit in Melbourne, the first in the world to describe how the brain actively changes as schizophrenia develops.

“We want to look at how we might develop new treatments to prevent the changes and ultim­ately prevent the illness. That would be the ideal,” he said.

As with Professor Pantelis, Anthony Stratford’s work in mental health is uniquely informed by experience. Mr Stratford’s onset of bipolar disorder in 1981 led to two three-month stints in a psychiatric hospital that year. He was 25.

An honorary fellow in the University of Melbourne’s department of psychiatry, Mr Stratford believes it was his father’s suicide six months earlier that triggered the first episode of mania.

As was common at the time, many of the patients in the former Royal Park Psychiatric Hospital were heavily medicated, he said.

“The clinical model was about controlling and lessening symptoms,” he said.

“It may have controlled the symptoms, but it took away your life.”

Mr Stratford’s mother, who was a doctor, disagreed with her medical peers and set about developing a more holistic approach to help her son.

“What often happens with a diagnosis is it takes away all your hopes and dreams. What my mother did for almost a year was, she held my hope. Where I saw no hope for myself, she did, and she just quietly reinforced that.”

The approach worked. Mr Stratford gradually got better, and went on to work for various mental health agencies.

At Melbourne University, he has used his experience to shape the development of a module on recovery-oriented practice that is now a core unit in the masters of psychiatry.

The approach encourages budding psychiatrists to work in partnership with their patients, to focus on their hopes and aspirations. It also promotes self-determination and highlights the person’s resources and resilience.

“It’s a holistic approach. While medication can play an important role, it’s no more important than relationships, families, work and secure housing.”

Professor Pantelis, meanwhile, advocates to young people the importance of managing stress, which his research has shown can be a precipitant in people who have a vulnerability for schizophrenia.

In her later years, Professor Pantelis’s aunt required nursing home care, and small doses of antipsychotics kept the symptoms of her schizophrenia at bay. She died, aged 90, a few years ago.

Professor Pantelis said he felt an affinity for what people living with schizophrenia, and their families, were going through.

“I hope that understanding helps me in helping them.”

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Originally published by The Australian.