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173 - Schizophrenia with Dr. Abigail Donovan · The Dr. Joe Show

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Join us now for the Dr. Joe Show.
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With Mark Stiles of Stiles Law, Thomas McCoy and your host, Dr.
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Joe Strand.
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Welcome to the Dr.
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Joe Show. Yay.
0:37
Thank you, John.
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Doing that with the four touchdowns in a single game.
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Yeah, that was really good.
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And you scored lots of points on.
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That was a real kick.
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That was the extra point.
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Oh, I just thought I'd make that.
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Just make that point.
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So how's the week been?
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Personally, not terrible.
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Okay.
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What about impersonally?
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Well, I'm pretty annoyed, to say the least.
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About what?
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Yeah, a few things.
1:09
So today, people, it might have slid on the radar, but
1:14
the Supreme Court overruled a court case that effectively guts the EPA.
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It gives them no power to enforce the Clean Air Act,
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which was signed by President Richard Nixon.
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Wow. Yeah.
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Not exactly the progressive hippie type, but understood the importance
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of having a safe planet.
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Yeah.
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And prior to that, overturning Roe versus Wade.
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Yeah.
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Which on its face, returns the rights to the states
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so that the people can decide people's reproductive rights.
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Here's the thing.
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State legislators aren't intrinsically democratic.
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There were laws in place in many states
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that sprang into law immediately, banning abortions without condition.
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It doesn't matter if you
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have an ectopic pregnancy which will kill you.
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Yeah, we I hope that we can get folks from Planned
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Parenthood and others on this show in a couple of weeks from now.
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We've got a guest scheduled for.
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No, actually, we're trying to get them for next week.
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Yeah, and I have one.
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I am.
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Good, good. Yeah, we have to talk about it.
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I mean, it's so silly.
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So the state gets a right to decide,
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but maybe not the woman.
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Yeah.
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So, I mean, we're talking about, like, individual, right?
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And I'm all about that.
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You know, let, let,
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let let the minority have their, you know, their own freedom to choose.
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So why don't we take that a step further?
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You know, we got the state deciding, well,
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how about let you know, the municipalities decide, the counties leave the towns.
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How about a little smaller?
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How about the person?
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Like each person with their own doctor?
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Oh, well, that's a good idea.
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Yeah, why not? Yeah.
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You know, Carol, my wife said in the Constitution,
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did they give you the right to get, like, a coronary bypass?
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Okay, so here's the thing.
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So people,
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I always assume that maybe like, hey, maybe the framers were against abortion.
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Not. No.
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They thought it was so trivial that it didn't even make it into the Constitution.
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You know?
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I know. You know.
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You know, I, I, I know it's a reality.
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I kind of wish it was not.
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And it was a hallucination and a delusion.
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And with that in mind, could you introduce our guest for tonight, please?
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Dr. Joe, we have a fantastic guest tonight.
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She is an associate psychiatrist at the Massachusetts General Hospital
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and an assistant professor of psychiatry at Harvard Medical School.
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She's the director of the first episode, an early psychosis program,
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the director of Clinical Services for the Psychosis Clinical and Research Program,
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and the Associate
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Director of the Acute Psychiatry Service at Massachusetts General Hospital.
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Welcome to the Dr. Joe Show. Dr.
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Abby Donovan.
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Oh, thank you so much.
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Thank you for that lovely introduction, and thank you for inviting me
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here tonight.
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We are so delighted to have you here, Dr.
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Abby Donovan. You want us to call you Abby?
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Yes. Abby, please.
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So I want people to know that we have permission to go back to Donovan.
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Abby? Yes.
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So let's.
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Let's get right into this first episode.
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Schizophrenia. Hmm.
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What?
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What it is that.
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So it is.
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It is the time in a person's life
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when they first start developing symptoms
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of what will eventually become schizophrenia.
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The typical course of illness is several months
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or even a year or two of symptoms
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that we call the prodromal.
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These are pretty vague, nonspecific
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symptoms, things like maybe feeling not quite like yourself,
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some changes in sleep, maybe feeling a little bit more anxious,
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withdrawing from friends a little bit, some trouble with concentration
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and memory.
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And then over time, people start to develop
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subtle symptoms of psychosis,
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which really means having a break from reality.
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So they start to hear things
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that aren't real or see things that aren't really there
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or believe things are happening when they really aren't.
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And those experiences and beliefs grow stronger over time
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and then take over much of the person's everyday life.
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And that that constellation of symptoms is what we
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what we call schizophrenia.
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It it comes actually at a very interesting point in development.
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I'm a child psychiatrist, so I think a lot about sort
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of the development of the child into adolescence and adulthood,
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and that really schizophrenia emerges at this time, which is critical.
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It's when adolescents are gradually moving into young adulthood
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and they're supposed to be becoming individuals and moving away
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from their families and going to college and getting jobs and individuated.
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And this is exactly when this illness strikes and it sort of turns
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that developmental period just on its head completely.
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So instead of becoming independent, these young adults
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or older adolescents are becoming dependent again.
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I'm curious about that.
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What do you think the evolutionary premium is on that?
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I mean, why then, as opposed to I mean,
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I think some kids get it much, much earlier, but it's very rare.
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Yeah.
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And then some people can get it much, much later.
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But that's very rare. Yes.
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Why do you think then?
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Yeah, it's a it's a great question.
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One of the hypotheses is that
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this is the time in in development
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when there is for everyone sort of normal development.
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There is prune of of
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of synapses, the connections between neurons.
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Some of them are becoming strengthened and others sort of die away.
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There's this pruning of of the neuronal relationships.
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And some people think that maybe what happens is schizophrenia
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is that pruning goes awry and too much gets pruned
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or the wrong, wrong pruning takes place in the wrong parts of the brain.
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And so that may be why it occurs
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at this particular period in development.
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And I want people to understand the pruning is like is not that
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it's like a fruit right prune where it's said,
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but it's like cutting branches and things to make a plant grow.
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Exactly. Exactly.
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Like if you have, you know, your bush in your backyard
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and you want to you need to write to have a healthy bush,
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you have to cut away some of those branches to let it flourish and flower.
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That's and that's normal.
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But if you prune off too much or if you prune
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in the wrong place, that's how you can get illness.
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Interesting.
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What an interesting hypothesis.
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What's what's the youngest that we can see this.
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So, as you mentioned, there are young kids
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who can develop schizophrenia.
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And, you know, I'm just trying to think back over my clinical practice.
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I've certainly seen a couple of kids that are like nine,
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ten years old with schizophrenia.
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It is incredibly rare.
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So these are less than 1% of all people who have schizophrenia
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will develop it before age 13.
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Very, very rare.
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Now, with this, make it more severe if it's being pruned at an earlier.
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Yeah, it it does make it more severe.
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So the younger you develop schizophrenia
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in general the worse outcome that you have over time.
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Mm hmm.
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Interesting.
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And does it look the same
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at eight or nine years old?
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It it does.
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It it can be challenging to diagnose
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because kids
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kids, especially younger kids,
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have all sorts of magical thinking
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and wild imaginations that you don't see in adolescents and young adults.
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So, you know, for a younger kid, it might be totally normal
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to have an imaginary friend that you talk to or to make up stories
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about things that happened during your day and to really believe those things.
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So it's it can be challenging to sort out.
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Well, are you talking to an imaginary friend or are you talking to
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the voices that you're hearing that no one else is hearing?
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Does it get frustrating to see pop culture portrayals of things like schizophrenia?
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Because one thing you might have heard
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brought up is this Marvel series, Moon Night, which was kind of
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it was a lower profile one, but I thought it was it was a fun,
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you know, if you like Oscar Isaac just gave it a watch. But
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it it touches into schizophrenia and I think
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multiple personality disorder, which I don't know how related it is.
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Yeah. Yeah.
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So it can't it can get a little frustrating.
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You know, multiple personality disorder and schizophrenia
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are totally different people with schizophrenia
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and don't have a split personality.
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They're not two or three or four different people.
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They are one person who is suffering with an illness
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that has a number of really impairing symptoms.
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I think one of the most common portrayals of schizophrenia
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in popular culture, which which probably bothers me the most, is,
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is that of being someone who's really violent or aggressive.
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And the reality is that people with schizophrenia are actually much
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more likely to be a victim of violence
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than they are to perpetrate violence.
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So picturing them in movies or TV shows, as, you know,
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violent serial killers is just it's just wrong.
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These yeah.
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We're we're programed to just go.
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Oh, when someone says their voices in my head.
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Right.
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Right.
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Yeah.
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So most, most people with schizophrenia are not violent.
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They're they're suffering. They're victims.
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They deserve our compassion rather than our fear.
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Yeah, very, very true. And
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how do we get that message out to people?
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I mean, that's what we're hoping to do here tonight.
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How do we educate people about that?
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Have a
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you know, I think it is doing things exactly like this.
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It is talking about it whenever
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and wherever we can.
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I think also
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doing what we can to
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combat the stigma of mental illness.
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You know, people talk about having high
12:58
blood pressure or diabetes all, all the time.
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And it's so normalized.
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But it's not as normal for someone to say, oh, I'm diagnosed with schizophrenia
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or I have depression or I have anxiety.
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These are these are like well-kept secrets.
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And so
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you don't we we don't have
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a personal relationship or a face
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that we can put on these illnesses to say, you know what, I actually know a number
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of different people with schizophrenia and they're not violent.
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It you know, these keeping these secrets
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and the ongoing stigma of mental illness is is enormously problematic.
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Yeah.
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And this this really is part of what the IAM is also trying to address
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that that there is no illness or disease.
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We're doing the best we can.
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If it's schizophrenia, then it's schizophrenia.
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We can make some changes in the domains.
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There's something called theory of mind, right?
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But we can't see someone's mind.
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We have to guess and think what they think or feel, especially about us.
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So secrets aren't secrets because of what we've done.
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Secrets are secrets because we worry.
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How will someone judge me if they know my secret?
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And just imagine this, folks.
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There you are already struggling and challenge and feeling
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more and more isolated.
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And you can't tell anyone about it
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because you're going to be even more isolated.
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This is just not right. We are.
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We are better than that as a species.
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We are now.
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Now, schizophrenia is it's must have been around evolution really for a long time.
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I mean,
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what percentage in general,
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what's the prevalence of schizophrenia now?
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So we think about 1% of the population is affected.
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So so let's just think about that.
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That means there's some genetic component to a biological component.
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Is there also an environmental component, schizophrenia?
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There is. There is.
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It's it's both genetic and environmental.
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We know of a number of environmental risk factors
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that increase the risk of developing schizophrenia.
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So things like infection during gestation.
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So babies that were exposed to viruses
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like influenza when they were gestating
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or starvation in the prenatal period.
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So babies that were gestating
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during the Dutch Hunger Winter and the Chinese famine,
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they have double the risk of developing schizophrenia later in life.
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Even things like bullying
15:51
increase your risk of developing schizophrenia, other traumas,
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sexual trauma, immigration is another risk factor.
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So to
16:02
think we're going to be tracking this during COVID postcode.
16:07
Yeah, I mean, I think it's an absolutely fascinating question.
16:12
We absolutely should to be, you know, for for all of the babies
16:17
that were exposed to coronavirus during gestation and,
16:21
you know, 15 to 25 years
16:23
from now, we have to wonder what what rates of schizophrenia
16:28
are going to be like.
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So how do you how did you become interested in this?
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You know, I, I fell into it.
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I, I knew from medical school that I was very interested in child psychiatry.
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I knew I was going to be a child psychiatrist.
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And when I was doing my training,
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you have to rotate through a number of different areas to be exposed
16:57
to all different forms of treatment and and different illnesses.
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And when I was working in the Freedom Trail Clinic
17:05
with people who had chronic schizophrenia, I just
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I just fell in love with the community
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and with the treatment
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and with thinking about this this illness.
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It for me, it combines everything I love about psychiatry
17:26
because we get to think about the biology, what's happening
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on a cellular level in the brain, what's happening with dopamine mean.
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But we also get to think about development,
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which is what I love as a child psychiatrist
17:44
and we get to think about family systems.
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What happens to the family when one individual develops
17:53
schizophrenia and we have to think about psycho dynamics.
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Why does someone have the delusion that they have?
18:01
What is it about their psychology that that created that delusion in their mind?
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So it's it's like all of the richness of psychiatry
18:11
is coming together in this one area.
18:15
So it felt felt like the perfect fit for me.
18:20
It's so interesting.
18:22
So is there a psychodynamic component to the
18:26
to hallucinations, delusions the person has?
18:29
I mean, I think that that the at times there is. Wow
18:36
that's so interesting.
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I've never considered that that's fascinating. Hmm.
18:42
So can we can we use psychotherapy at all as an intervention?
18:48
So it's a great question.
18:51
And there are people who believe
18:55
that you can
18:58
I'm not actually one of them,
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but there are people who believe that you can.
19:05
I with schizophrenia, I fall
19:08
more into the CBT camp.
19:12
I think CBT is. Just a CBT move.
19:15
Some of my viewers may not know what that acronym means.
19:18
Absolutely.
19:19
So CBT is cognitive behavioral therapy.
19:23
It's different than psychotherapy, where we might talk about
19:27
sort of our thoughts
19:29
and our feelings and our upbringings and our relationships with people.
19:33
CBT is more about thinking
19:37
in a concrete way about thoughts, feelings and behaviors
19:42
and changing one of those to impact the other too.
19:47
And with with schizophrenia,
19:50
we do CBT for psychosis.
19:53
So we, we do a lot of testing.
19:58
Are the voices real or not testing?
20:02
Am I actually being followed by someone or not
20:07
and using a variety of strategies
20:10
and it's it's highly effective for both positive symptoms.
20:15
Hearing voices, feeling paranoid and negative symptoms.
20:19
Trouble with a motivation
20:21
and, you know,
20:26
impaired energy and cognition and those sorts of things.
20:30
Can can you just clarify promises, positive and negative?
20:34
Because, you know,
20:35
positive symptoms in this case doesn't mean this is a really good thing.
20:38
Right? Exactly. Exactly.
20:40
So it is positive in the sense
20:44
that it is an addition
20:47
to everyday experience.
20:49
So you're hearing extra you're hearing more or then what is there?
20:55
You're seeing more than what is there?
20:59
So that's it's positive because it's an addition neg it.
21:03
If symptoms are a subtraction,
21:08
you have less motivation than before.
21:12
You get less pleasure from activities than before.
21:17
You talk less or use fewer words
21:21
and have fewer facial expressions.
21:24
So it's a subtraction.
21:27
Yeah. Yeah.
21:28
I think that's really important for for our viewers to hear, especially
21:31
in this day of COVID, where words in reverse
21:35
for positive is negative and negative is positive.
21:40
I had a positive test.
21:41
Well, that's negative. Yes.
21:44
Okay, that's crazy. So
21:47
with with these
21:49
populations, are you
21:52
I mean, do you see more of one
21:54
than the other people with more positive than negative?
21:59
It it's very dependent on the individual.
22:03
Some people will have a positive
22:06
symptom, predominant form of the illness.
22:09
Some people will have very,
22:11
very few positive symptoms and have more negative symptom.
22:15
Predominant illness
22:17
varies from person to person.
22:20
But in general, statistically or schizophrenia,
22:24
four or more people going to present with
22:28
positive hallucinations or more people
22:31
with sort of negative, almost catatonic component.
22:35
Yeah, statistically, most people with schizophrenia have both.
22:40
Really?
22:41
Yeah.
22:42
Well, Tom, you wanted to say what we were talking about off line a little bit.
22:46
Let's bring it in.
22:47
Yeah.
22:47
So, Dr. Joe, I think you've done this before.
22:50
You really did a perfect elevator pitch of drug story theater to Abby,
22:55
prompted by a conversation about how apparently
22:58
we can really complicate things with schizophrenia.
23:03
Yeah, Abby, let's hear about this.
23:05
Absolutely. So
23:08
people ask me sometimes,
23:10
you know, schizophrenia runs in my family, how can I prevent it?
23:14
Or how can I make sure that my child doesn't get schizophrenia
23:20
and and we are researching a number of different interventions at this moment.
23:25
We don't have a surefire way to prevent schizophrenia,
23:30
but we can do things
23:33
to decrease the risk for developing schizophrenia.
23:38
And the number one thing
23:42
is to avoid marijuana.
23:45
No marijuana in any form, no pot,
23:48
no edibles, no vaping, no marijuana.
23:52
We know that adolescents who are
23:55
heavy users of marijuana
23:58
are increasing their risk for developing schizophrenia
24:01
on the order of like two or three times greater
24:06
just by using marijuana.
24:09
It is it is awful for the developing brain.
24:12
It is a toxic toxin.
24:15
So if there's anything that kids out there can be doing or families out
24:19
there can be doing, it is to avoid marijuana.
24:24
So how do we
24:26
how do we combat the mythology that that, you know, that
24:31
the marijuana
24:32
companies have insidiously, insidiously,
24:36
you know, said it's okay.
24:37
I mean, we started with medicalized, we then decriminalized and now it's
24:41
legalized.
24:44
How we get the message across because people don't believe it.
24:47
It just is just weed. Yeah.
24:50
I mean, I in my family,
24:54
we make this every day
24:58
regular our conversations this is like dinner table conversation
25:03
starting from incredibly young ages about how
25:09
advertising companies lie to us
25:12
and the commercials and then TV lie to us.
25:17
And we can only trust the facts.
25:20
And and so we know from science that marijuana is dangerous.
25:26
We know that other drugs are dangerous.
25:28
And we'll use other examples. Right.
25:30
We know how gross smoking is.
25:33
We know how smoking kills you.
25:36
Well, 30 years ago, everyone smoked.
25:38
No one thought it was bad.
25:41
This is just the same thing.
25:43
Marijuana is gross.
25:45
Marijuana is bad for your body.
25:48
So we
25:49
we make these things ongoing conversations.
25:52
I do it in my family, and I think everyone should be doing it
25:55
in their family now.
25:59
It's such a challenge with
26:02
with our kids these days because,
26:04
you know, it's illegal here in Massachusetts.
26:07
Yeah.
26:08
And the way I see it is, you know, guns are legal, doesn't make them safe.
26:12
Cars are legal.
26:14
Doesn't make it safe.
26:15
Prescription pain medicine is legal.
26:19
It doesn't make it safe.
26:20
So I don't know why people just think weed, you know, it's just weed.
26:25
No, I don't have a problem.
26:26
I suppose if you're over 21.
26:30
But even then, what you're saying is that it's still with people at risk.
26:35
Absolutely.
26:35
Your brain is still developing 21.
26:38
Your brain is still developing.
26:42
Do we have any any insight into why weed
26:46
may be contributing like this?
26:50
We don't have really conclusive evidence.
26:54
I mean, I think in part because we don't have a fabulous
26:59
understanding right now of how or why schizophrenia actually develops.
27:05
We have a number of hypotheses, but we don't have an enormously clear
27:09
understanding of what is happening on a on a cellular level in the brain.
27:15
So I'm just I'm just curious and I'm just sort of thinking off the top
27:18
of my head here.
27:18
But I know that when we use medications
27:22
to address schizophrenia, is it true
27:25
that we're doing mostly dopamine blockade?
27:29
Yeah, that's the major target of our medications is dopamine
27:34
blockade of various different dopamine receptors.
27:38
So so maybe we can like let's let's sort of take that down
27:43
so people can understand what does that really mean?
27:47
What what is a receptor? What is dopamine?
27:51
I'm listening.
27:52
And Abby sorry.
27:53
So, so in our brain,
27:58
there are cell cells that need to be able to talk to each other.
28:04
There are a number of different types of cells.
28:06
Some of the most important ones are the neurons,
28:09
and they're transmitting signals from from one neuron to another.
28:15
The way that they transmit the signals is by releasing
28:19
chemicals into the space in between them.
28:23
There's lots of different chemicals they can release,
28:26
and each one has a different meaning
28:29
in this conversation between the two cells so they can release serotonin.
28:34
And that means one thing
28:35
they can release Nora Norepinephrine, that means something else.
28:38
And they can release dopamine.
28:40
And that sends a particular signal through cells to different parts of the brain.
28:47
One of the things that
28:48
happens in schizophrenia is that dopamine
28:51
conversation goes awry.
28:54
We don't know exactly why or how, but it does.
28:59
And so we give medications to block
29:04
the impact of dopamine on the cells
29:08
that are that that it would be activating.
29:11
So we're, you know, sort of, I guess like putting sort of ear plugs into that cell
29:16
that would have been receiving that dopamine message.
29:20
That's what these medications are doing.
29:23
Yeah.
29:24
And so if and this is just theoretical, but we know
29:28
that all drugs and alcohol force the brain to make more dopamine. Mm.
29:33
Could that then be a contributing factor.
29:36
Because when you smoke weed, you are increasing dopamine
29:40
secretion in your brain.
29:41
Yeah, it's an interesting idea.
29:44
The challenge is that not all drugs and alcohol
29:50
increase the risk of schizophrenia to the same degree that cannabis does.
29:56
It being the anxiety.
29:58
I know a lot of people will have terrible anxiety with weed.
30:01
So almost a chronic anxiety, if you will.
30:04
Yeah, yeah, yeah.
30:06
Especially with like edibles like.
30:10
Yeah.
30:11
And anxiety is on the spectrum
30:14
I suppose the paranoia, is that fair to say.
30:17
Yeah.
30:18
I mean you can think of paranoia as a
30:21
as a high anxiety state, right.
30:24
Where you're perceiving threat all around you.
30:30
And then yeah, the mechanism
30:32
is, is probably pretty complex
30:36
and not yet well elucidated, but
30:39
the effect is clear.
30:43
We know that that cannabis is increasing the risk of schizophrenia.
30:48
Yeah.
30:51
So I just wonder how our audience is going to,
30:54
you know, be able to take this information.
30:57
Remember the I Am approach.
31:00
We have a biological domain.
31:01
We are influencing that biological domain by taking cannabis in
31:06
and that thing can have an effect.
31:08
And so many other things.
31:10
And yet we are stuck with it.
31:13
You know, you know,
31:15
the the tobacco analogy is really important
31:20
because there was I think it was starting in 2000,
31:23
12 more kids were smoking weed
31:28
in the last 30 days in tobacco
31:30
because they knew tobacco hurt.
31:33
Yeah, yeah, yeah.
31:34
So, you know, the tobacco is going to hurt you.
31:37
We're not going to do it.
31:39
So against it.
31:41
Sorry.
31:43
You know, we're not we're not trying to get you to like say,
31:45
oh, you know, we don't want you to have fun.
31:47
There are many other ways to have fun exactly.
31:50
In smoking weed right now.
31:52
But we got pot shops everywhere.
31:55
Mm hmm. Everywhere.
31:57
So have you found
32:00
certain medications seem to be working better these days?
32:04
Correct.
32:04
My understanding is that there
32:06
you know, there's an old maybe.
32:08
Can you talk about maybe about that between that first generation
32:12
antipsychotic and the more second generation ones?
32:16
Yeah, absolutely.
32:17
So our older medications are the first generation antipsychotics.
32:24
Our newer medications are the second generation antipsychotics.
32:29
And the the biggest difference, actually, between
32:33
the two groups of medications is in the side effect profile.
32:38
So our first generation antipsychotics
32:43
tend to
32:44
have more muscular side effects
32:48
as well as something called extra parameters, symptoms or EPS.
32:54
So these are medicines that can cause
32:58
an uncomfortable, restless feeling in people.
33:02
They can cause people to develop Parkinsonian like symptoms,
33:07
which is not Parkinson's disease, but it can have some of the same symptoms
33:12
as Parkinson's, where you have a hard time walking, a shuffling gait,
33:17
a master expressionless face,
33:22
trouble having your voice at full volume.
33:25
And those muscle side effects I mentioned, if if they become severe,
33:30
they can cause something called tardive dyskinesia,
33:34
which can be a permanent muscle twitch
33:38
and it often actually affects facial muscles,
33:41
which can be pretty debilitating for people.
33:44
Yeah.
33:45
Now our second generation antipsychotics
33:48
have a whole host of different side effects.
33:51
They cause things like weight gain,
33:54
which then can trigger high cholesterol
33:58
and diabetes and the health problems that that go along there.
34:04
So side effect profiles are very different
34:07
efficacy, interestingly enough, between
34:10
the two groups is basically the same.
34:14
They are they're roughly as effective as each other.
34:18
It's just the side effect profiles which are very different.
34:22
So with the first generation, you're I said
34:25
I'm going to get so technical about this, but is a difference in the dopamine
34:30
blockade, is that what we're trying to do with antipsychotics is dopamine blockade?
34:35
Yes. Yes, we are.
34:37
We're trying to we're trying to to block dopamine. Yes.
34:42
Yeah, yeah.
34:45
Now I will say
34:48
the vast majority of the antipsychotics, first generation
34:51
and second generation, have equal efficacy to each other.
34:54
There is one stand out.
34:58
It is technically a second generation antipsychotic,
35:01
although it's a little bit different than all of those.
35:03
And it's Clozapine.
35:06
So Clozapine
35:08
is the single most effective antipsychotic that we have.
35:13
Interesting.
35:14
These are the sort of things
35:16
that is personal, real stories that people need to hear because it says
35:20
a lot about what is really happening also with schizophrenia.
35:23
And Abby and I know that something that is a really important topic to talk about.
35:28
Let's talk about that part.
35:30
Absolutely.
35:33
I I think that it is critical
35:40
to understand that this illness is is a spectrum
35:45
and that there are people who have
35:48
a severe form of the illness,
35:52
who are who suffer and require
35:55
intensive treatment and there are people
35:59
who, with treatment
36:02
can get their lives back
36:05
in a way that is meaningful for them.
36:09
They can go on to function and graduate from college
36:14
and have jobs and get married and have kids.
36:18
I, I, I worry sometimes when I talk about people
36:22
and I say, you know, I believe that you have schizophrenia.
36:25
I believe that your child has schizophrenia, that it feels like
36:29
a death sentence, that there is never going to be anything
36:33
that they can accomplish in their life.
36:35
And that's not that's not the case
36:38
with treatment, with early intervention.
36:42
People can
36:43
can have functioning and worthwhile lives and that's that is something we need
36:49
to hold on to that that there can be hope within this illness.
36:55
But you have to I identified early.
36:58
Yeah, that's that's critical.
37:00
It's critical that's why we focus in on that first episode.
37:04
It's the whole point of my work.
37:07
It is identifying schizophrenia
37:10
as early as possible and intervening with a coordinated,
37:16
needed, complex care, not just the medication,
37:20
but also the individual therapy and the family therapy.
37:25
So how do people find Abby Donovan?
37:30
So you can find me probably on the Internet, but I'll tell you,
37:36
if you are in Massachusetts, there is a website
37:40
called Map Net Map, and
37:44
on that website there is a list
37:46
of every first episode psychosis program in the state
37:52
and how to get in touch with each and every one of them.
37:56
So that if you're living in, you know, Northern Massachusetts,
38:01
you can find the three programs that are closest to you.
38:04
Or if you're in western Massachusetts, you can find the program out there
38:08
that's closest to you and get in touch with them.
38:12
Folks, it's so important you are not alone in this can.
38:15
Duckworth is writing a book right now.
38:17
You are not alone.
38:19
You must recognize that we are here to help.
38:24
There is no judgment here.
38:27
There's nothing like that. There's this is.
38:30
We can help, you know,
38:33
if you get seen right
38:35
away, there's suspicion
38:39
kind of get some treatment because then
38:41
we can maybe make a huge effect.
38:45
That can be life changing for you.
38:47
It's scary.
38:49
It's a scary, scary condition, there's no question.
38:53
But it's manageable.
38:55
May not be able to cure it, but you know what?
38:58
You may not be able to cure type one diabetes either.
39:01
We can manage a lifetime of it.
39:05
Really, really important.
39:08
So do you think
39:10
speaking of it as a spectrum,
39:14
do we all sometimes have distortions?
39:20
Sure. You know, just a human being.
39:22
You know, I think that person say something about me or.
39:25
Right.
39:25
I mean, isn't that just part of who we are also as human beings?
39:29
Yeah, yeah, absolutely.
39:31
I'm sure all of us have had the experience of did someone just call my name?
39:36
Right. Right.
39:37
Oh, are they are they looking at me?
39:39
Where did I say something wrong or do something wrong?
39:43
Yeah,
39:44
that's that's the very mild end, right?
39:48
Yes. That's what I want people to hear.
39:51
That's what we mean when we say it's a spectrum.
39:53
All these conditions are a spectrum.
39:56
You know, schizophrenia, bipolar, major depression.
39:59
And sadly, everybody gets a little nervous,
40:01
but not everyone has a panic attack. Right.
40:04
Everyone can get sad, but not everyone necessarily has major depression.
40:10
Everyone could think somebody said something about they
40:16
knew everyone who had schizophrenia.
40:19
But it's part of who we are as human beings.
40:22
And I think that we can have these psychiatric conditions
40:25
if we didn't have some basis for it, which is part of our human condition?
40:30
Yes, absolutely.
40:33
Yeah.
40:34
So we're
40:37
coming to the end of the show the I am approach is remember,
40:41
I believe we're all at a current maximum potential
40:43
being the best we can influenced by the four domains of your home domain,
40:48
your social domain, the biological domain and the I see how I see myself,
40:52
how I think other people see me.
40:54
We've been talking a lot about that,
40:55
that there may be interactions between your biological domain
40:59
and your external domain the way you see yourself.
41:01
So because the domains interconnect, too small change can have a big effect.
41:07
Abby What small change can you recommend to our listeners
41:10
when it comes to schizophrenia?
41:14
I think that
41:20
I, you know, I think that there there are actually two things that come to mind.
41:24
I don't know is that cheating by giving to our clients. Via.
41:26
The biggest one is, one that we've already mentioned, it's
41:30
actually avoiding cannabis
41:34
and making it a part of our family discussions
41:39
for for our kids, no
41:40
matter how young or old they are, that it's important to avoid cannabis.
41:45
But I think the second thing
41:48
is to focus on just being present
41:54
with people
41:57
that, you know,
41:59
I find myself often seeing people at their worst,
42:03
whether it be in my office when I tell them that I believe
42:07
they have schizophrenia or in the emergency department when I
42:11
am hospitalizing them or talking with them after a suicide attempt
42:14
and just the act of being present
42:19
with someone in these critical moments
42:23
is so powerful.
42:27
Put aside what you're thinking, what I'm thinking,
42:32
or what I what I want to say next.
42:35
Do it when I change your mind do I want to offer a different perspective?
42:40
Take a few minutes each day to just be
42:43
present with someone.
42:46
Yeah,
42:48
yeah.
42:49
It's.
42:50
It's such important advice and small change.
42:54
It can have such a big effect because you
42:56
we all want the same thing, which is just to feel valued by someone.
42:59
And when you're in your present with someone,
43:02
you reminding them of their value.
43:04
You really have.
43:06
So that's a small change, both of them.
43:10
And it's not cheating. It's fine.
43:13
The second truth of the I am is everyone's got one.
43:17
Everyone is interested in what you think or feel about them.
43:20
To the I see their name and you know, it has an effect on the biological domain
43:24
because feels different when you feel respected or disrespected
43:28
and you're part of someone's home or social domain.
43:30
So the second truth you control
43:33
the one you influence everyone you get to choose,
43:37
the kind of influence you want to be the doctor.
43:41
Abby Donovan What kind of influence
43:44
do you want to be?
43:47
I want to be in an influence
43:52
of complete acceptance.
43:55
No, I.
43:57
I think about that with my kids a lot
44:00
and I think about it with my students a lot.
44:03
I teach.
44:03
I teach residence, and I teach fellows and
44:07
I want to accept
44:10
all of them wherever they are at,
44:15
and let them know that they are accepted by me
44:20
and whatever it is they are struggling with,
44:23
whatever it is they feel like they still need to learn and work on.
44:27
I accept that.
44:29
Yeah, it's great.
44:31
Folks, get in touch with Dr. Donovan.
44:34
Get in touch with us.
44:35
If you need some help, we'll have some sites on the website.
44:38
Thank you so much for being here, Abby.
44:40
Really a. Pleasure.
44:41
Thank you. Thank you for having me.