1999 NAMI NC Awards

Lifetime Achievement Award:  Dan and Betty Lane, NAMI Western Carolina

Professional of the Year:  Breon Allen, Moore County

Media Awards:  Catherine Clabby, News & Observer
                            Jena Heath, News & Observer
                            Corey Lowenstein, News & Observer

NAMI North Carolina held its 16th annual spring conference on April 9-10 at the Holiday Inn, Research Triangle Park. More than 225 family members, consumers, and mental health professionals from across the state attended the two-day event which was hosted by NAMI Orange County.

If you missed this wonderful event, mark your calendars now for next year’s NAMI NC Spring Conference which will be held at the Adams-Mark Hotel in Winston-Salem, May 11-12, 2000.

 Capital Ideas

Determined to complete the session by early July, the legislature is dealing with bills at breakneck speed. Below are bills we are watching that are moving through the legislative process.

Inpatient Commitment/Conditional Release (H298/S303)

 Board Members Elected

All of the proposed Bylaws changes were approved by the membership.

With Term Expirations

 From the President...

The public mental health system, as we have known it, is vulnerable and at the crossroads. It faces changes as far reaching and ominous as those brought about by deinstitutionalization. The pressure brought to bear on the system is unrelenting and part of the larger managed care phenomenon. It is an effort not merely to operate more efficiently and effectively, but to reduce the amount being spent. Our task is to speak for a coherent and complete system of care for those with disabling brain disorders. All people do not need all services, but should be able to access what is necessary for their appropriate care, no more and certainly no less.

The bitter irony is that professionals and families know what treatments work. That’s the easy part. The hard part is finding the will and the dollars. All of us must spread the word that this is a disease like any other; that this is a public health issue; that people who are ill must be treated and that society can no longer turn its head away.

There are a variety of participants involved in the effort to redesign the system for the next century. We, as NAMI NC, are part of the advocacy group and our purpose is to speak for the needs of those with these debilitating diseases and their families. The Department of Human Services and under that umbrella the Division of Mental Health, Developmental Disabilities and Substance Abuse represents state government and state dollars. Because Medicaid dollars (both federal and state share) pay for some services for those on Medicaid rolls, the Division of Medical Assistance has an interest in curtailing those costs. Area programs, area directors and area boards are represented by the NC Council of Community Programs and the Administrative Services Organization. The membership is the same for both organizations and their purpose is to represent and speak for the needs of their members.

What appears lost in this welter of sometime conflicting goals is that the entire enterprise is supposed to be serving those who suffer with brain diseases and the discussion should be about treatment and moving toward recovery and how to accomplish this. It should never be dominated by who controls the purse strings and what is the lowest funding level possible and who will be in charge with fingers pointing in all directions.

It is time to refocus on the heart of the system— the people who should be served. For most families, the public system is all we have and it is absolutely imperative that all the participants, representing diverse interests, work within that framework to maintain and strengthen it. I ask for your help as we face this awesome challenge and pledge that NAMI NC will continue to work collaboratively to achieve this goal.

- Eileen Silber

Borderline Personality Disorder Examined

Borderline Personality Disorder (BPD) was not included in the DSM until 1980. It is an Axis II diagnosis, putting it in the category of maladaptive or developmental disorders, which coincidentally include mental retardation and autism. Even the better books, with the clearest descriptions of the syndrome, assume BPD is rooted in sociological and developmental causes, including the decline of Western Civilization. From a parent’s point of view, this can be a reminder of the "schizophrenogenic mother" theories that led to the founding of NAMI when schizophrenia was believed to be caused by the "schizophrenogenic mother." Likewise, autism was once believed to be caused by the "refrigerator mother."

In 1993, Dr. Rex William Cowdry of the National Institute of Mental Health wrote, "The term ‘borderline’ is likely to be somewhat puzzling or misleading to the average reader. This disorder was originally thought to be closely related to (‘border on’) schizophrenia. More recent research suggests that this is not true of most BPD. In fact, BPD is more likely to be related to classical depression, or in some cases, to neurological disorders or residual attention deficit disorder." Dr. Cowdry’s research focuses on drug trials "to identify possible abnormalities in neurotransmitter or endogenous opiate systems and using brain imaging techniques to identify possible structural or functional abnormalities in the brain."

Dr. Kenneth R. Silk, in a 1997 article in the Journal of the California Alliance for the Mentally Ill, talks about BPD first being taking seriously in the 1980s. Until that time BPD was considered to belong to the realm of the psychotherapist, not the psychiatrist. A "consensus formed that all our thoughts, reactions, and emotions are at least mediated through biological mechanisms even if they are not necessarily caused by those mechanisms." Psychiatrists began to compare this disorder with depression, anxiety, and schizophrenia, to look for similarities and differences. Doctors Siever, Davis and Cloninger suggested that instead of comparing and contrasting BPD patients with those with other disorders, "we would want to examine and think about how a person with BPD may have deficits or difficulties along a number of dimensions such as thinking." Since each patient presents with different aspects of the illness, or more pronounced problems in one of the above areas, it might become necessary to divide BPD into subgroups, suggests Dr. Silk.

In the same issue of the Journal, Dr. Larry J. Siever describes the two hallmarks of Borderline Personality Disorder: "affective instability" and "impulsive aggression." Using a medication that inhibits the breakdown of acetylcholine produced marked feelings of negative mood and dysphoria in the BPD patient. "This response was not observed in patients with other personality disorders or a normal volunteer comparison group." As for impulsive aggression, studies show that "an alteration in serotonergic system may at times be expressed in a propensity to impulsive aggression." The explanation Dr. Siever gives for the prevalence of BPD patients who have suffered childhood abuse is that the abuse itself "may sensitize or alter the activity of the stress system...and may have long term effects on the monoamine systems..."

Dr. Paul H. Soloff, in the same Journal issue, describes studies that show diminished serotonergic neurotransmitter function in patients with histories of suicidal behavior, especially when the attempt is by violent means.... "Diminished central serotonergic neurotransmitter function has also been demonstrated in suicidal patients with BPD, and in BPD patients with histories of impulsive aggression, independent of suicidal behavior or co-morbid depression." Dr. Soloff refers to studies conducted on glucose metabolism in the frontal cortex of psychiatric patients with personality disorders, especially patients with BPD. Similar results were found for convicted murderers compared to normal controls, and in impulsive adults with histories of childhood hyperactivity. Fenfluramine trials decreased "serotonergic responsiveness in depressed patients compared to healthy controls, especially in the frontal cortex" and of the prefrontal cortex, i.e. areas important to the regulation of impulse and affect. "Response to fenfluramine is greater in non-depressed patients with BPD than those with depression, but less robust than in healthy controls." Soloff concludes that, "impulsivity in the borderline patient is a serotonergically mediated personality dimension which predisposes the patient to aggressive and suicidal behaviors under duress. Diminished serotonergic regulation of impulse and affect may constitute a biologic" predisposition "to suicidal behavior in BPD." -Beth Greb

Talk up NAMI North Carolina’s Helpline

Do you know that from April 1998 to April 1999...

...more than 1701 calls have been received.

...calls have come to the Helpline from persons in 77 of North Carolina’s 100 counties.

...our number one Helpline referral is to NAMI affiliates.

...2870 pieces of literature have been sent to callers.

...39% of callers were family members, 31% were consumers and 9% were professionals*

These numbers are good, but we can do so much more! Talk up Helpline to people and places in your county! Also, remember to respond swiftly and warmly to family members referred to you by the Helpline.

The 1999 Food Lion Community Way Days to benefit NAMI North Carolina were April 26 through 28. This year, more than $1,088 were raised during the grocery shopping extravaganza.

To each affiliate and its volunteers who participated—THANK YOU. Final results will be announced when we receive the official breakdown from Food Lion.

Doctorate in Medicine (M.D.) — Physicians who have full medical training with specialized residencies in psychiatry. Psychiatrists are the only therapists who can prescribe drugs.

Doctorate in Philosophy (Ph.D.) — Psychologists who have completed 6-7 years of graduate work, including training in research methods and statistics, as well as psychotherapy internships. Generally perform psychological testing when needed.

Doctorate in Psychology (Psy.D.) — Psychologists who also have 6-7 years of training with a focus on practical clinical course work rather than on research.

Doctorate in Education (Ed.D) — Psychologists who have training similar to that of Ph.D.s, but whose degrees are issued through graduate schools of education.

Master of Science (M.S.) — Therapists who have completed a two-year graduate degree program in clinical psychology. They may have training in psychotherapy techniques, but usually not in psychological assessment or research.

Masters of Social Work (M.S.W.) — Therapists who have completed a 2-3 year graduate program that emphasizes training in psychotherapy and social work.

L.C.S.W., L.M.F.C.C., L.P.C., L.M.F.T. — These designations-Licensed Clinical Social Worker, Licensed Marriage and Family Child Counselor, Licensed Professional Counselor, and Licensed Marriage and Family Therapist-don’t refer to degrees, but to licensure by state professional boards. These initials usually follow others that indicate an academic degree. If they don’t, inquire about the therapist’s training.

Schizophrenia Research Opportunity

The Laboratory of Human Neurogenetics at Rockefeller University in New York is currently investigating the genetics of schizophrenia. The cause of schizophrenia is complex and may involve different genetic and environmental factors.

This study requires a small amount of blood from individuals with a diagnosis of schizophrenia or schizoaffective disorder. This is a genetic/family study and it involves participation of the diagnosed individual as well as both biological parents. If parents are not available, a sibling who also has schizophrenia or schizoaffective disorder can be included.

Each individual study participant (the person with schizophrenia as well as the biological parents) must agree to give a blood sample and complete a telephone interview with a study clinician. There is no cost to participants and the university will cover the costs of the blood draw and shipping charges. Blood samples can be obtained by a lab or physician convenient to the participant. Participants with schizophrenia will receive a payment of $50.

For more information, call Annamae Conry, RN, CNS, NP, at (888) 920-9100 toll-free, then press #5, or e-mail conrya@rockvax.rockefeller.edu. The website address is www.rockefeller.ed.

Substantial Gainful Activity Increase

The Social Security Administration will begin implementing an increase in Substantial Gainful Activity (SGA). Allowable earned income will increase from $500 to $700. This will affect persons who are on SSI or SSDI.

Substantial Gainful Activity is used to determine an individual with disabilities’ ability to earn wages and work, and acts as an incentive to seek employment and become independent. The SGA increase should help many people with brain disorders begin the process of entering the work force.

For more information, contact the Social Security Administration at 1 (800) 772-1213.

Outpatient Commitment Standard...