Posts tagged Neuroscience
Posts tagged Neuroscience
Residual depression has lasting impact on bipolar patients
By Eleanor McDermid, Senior medwireNews Reporter
In bipolar disorder, depressive symptoms are not only negatively associated with the outcome, but also affect verbal memory performance
A prospective study confirms the detrimental effect of subthreshold depressive symptoms on the outcomes of patients with bipolar disorder.
The findings, published in the Journal of Affective Disorders, also suggest that the effect is partly mediated by cognitive impairment.
Researcher Anabel Martínez-Arán (University of Barcelona, Spain) and colleagues say that most studies have been cross-sectional, whereas they followed up 111 patients for 1 year. The patients were aged an average of 40 years and 78.4% had bipolar I disorder; all were euthymic at inclusion.
The team assessed verbal memory (using the California Verbal Learning Test), because impairment in this neurocognitive function is thought to be a core feature of bipolar disorder. Along with subsyndromal depressive symptoms (≤8 on the Hamilton Depression Rating Scale), patients’ composite verbal memory score explained 19% of the variance in their baseline scores on the Functioning Assessment Short Test (FAST).
Subthreshold depressive symptoms and verbal memory were associated with each other, such that patients with more depressive symptoms had larger memory impairments. They were also individually associated with baseline functional status.
“Thus in bipolar disorder, depressive symptoms are not only negatively associated with the outcome, but also affect verbal memory performance,” say the researchers.
Verbal memory had a significant indirect effect on outcome, partly mediating the relationship between depressive symptoms and functional status.
During 1 year of follow-up, patients’ functional status remained fairly stable overall, with average FAST scores of 29 at baseline and 27 at follow-up. Baseline functional status explained 44% of the variance in 1-year functional outcomes.
As baseline functional status was, in turn, partly dependent on depressive symptoms and verbal memory, these variables therefore contribute to follow-up functional outcomes, explain Martínez-Arán et al.
The researchers note, however, that the study only assessed verbal memory, and impairments in this domain could be partly caused by other neurocognitive deficits.
“The identification of mediators in the prediction of functional outcome may help to disentangle the complex network of variables that contribute to functional outcome, since many variables with direct and indirect effects might be involved,” they conclude.
For more mental health news, Click Here to access the Serious Mental Illness Blog
Factors predicting disengagement from psychosis early intervention identified
By Afsaneh Gray, medwireNews Reporter
A study of first-episode psychosis patients in Hong Kong has found that those with fewer negative symptoms at presentation and poor medication compliance were more likely than others to disengage from an early intervention program.
“We have confirmed reports in previous studies, which were mostly conducted in western populations, that diagnosis of a non-schizophrenia-spectrum psychotic disorder, lower baseline negative symptom severity, poor medication compliance and substance abuse history predicted service disengagement,” write study author Wing Chang (The University of Hong Kong) and colleagues.
The team identified 700 patients aged 15 to 25 years who were enrolled in the Early Assessment Service for Young People with Psychosis (EASY) program between 2001 and 2003.
Data on each patient were retrieved from clinical records, and the Clinical Global Impressions–Severity Scale was used to determine symptom severity. Information on medication compliance was derived from sources including case management notes, medical records and information from caregivers.
Disengagement was defined as missing all outpatient appointments until the end of the 2-year service despite therapeutic need and active follow-up from staff, and occurred in 94 patients.
The mean age of participants was 20.65 years and the median duration of untreated psychosis was 91 days. Most (69.14%) patients had a diagnosis of a schizophrenia spectrum disorder (ie, schizophrenia or schizoaffective disorder).
Multivariate analysis identified three factors that were independently associated with disengagement. Patients were 56% less likely to disengage if they had schizophrenia-spectrum disorders, rather than other types of psychosis. They were 63% less likely to disengage if they were adherent to their medication, and they were 24% less like to disengage if they had high baseline negative symptom scores (>3).
Substance abuse history within the initial 6 months of the program increased the chances of disengagement, but, due to the small number of patients affected, was not included in the final multivariate analysis.
The team also found that 63% of disengaged patients were in symptomatic remission during the month in which they left the EASY program.
“Early intervention teams should pay attention to factors associated with disengagement, and monitor at risk patients closely to detect signs of non-adherence,” Chang and colleagues conclude in Schizophrenia Research.
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Chronic marginalization and chronic exclusion could cause hallucinations and delusions
Changing schools can be a wrenching social and emotional experience for students, say researchers from Warwick Medical School in the U.K. And the legacy of that struggle may be psychosis-like symptoms of hallucinations and delusions.
Dr. Swaran Singh, a psychiatrist and head of the mental health division at Warwick, became curious about the connection between school moves and mental health issues after a study from Denmark found that children moving from rural to urban settings showed increased signs of psychoses. The authors also noted that the students had to deal with not just a change in their home environment, but in their social network of friends at school as well.
Singh was intrigued by whether school changes, and the social isolation that comes with it, might be an independent factor in contributing to the psychosis-like symptoms.
Based on their analysis, says Singh, switching schools three or more times in early childhood seemed to be linked to an up to two-fold greater risk of developing psychosis-like symptoms such as hallucinations and interrupting thoughts. “Even when we controlled for all things that school moves lead to, there was something left behind that that was independently affecting children’s mental health,” he says.
Factors such as a difficult home environment – whether caused by financial or social tension, or both – living in an urban environment, and bullying contributed to the mental health issues, but switching schools contributed independently to the psychosis-like symptoms.
Singh suspects that repeatedly being an outsider by having to re-integrate into new schools may lead to feelings of exclusion and low self-esteem. That may change a developing child’s sense of self and prime him to always feel like an outlier and never an integrated part of a social network; such repeated experiences of exclusion are known to contribute to paranoia and psychotic symptoms.
Bullying created a secondary way in which repeated school moves could lead to mental health issues — bullying is known to be associated with psychotic symptoms, and mobile students are more vulnerable to bullying,
The negative emotional experiences students go through in trying to adjust to new schools can have physiological consequences as well. “Repeated experiences of being defeated in social situations leads to changes in the brain and in the dopaminergic system,” says Singh. That makes the brain more sensitive to stress, and stress, with its surges of cortisol, can lead to unhealthy neural responses that can contribute to mental health problems. “Something about chronic marginalization, and chronic exclusion, is neurophysiologically damaging,” he says.
Singh and his team plan to continue to follow the students for several more years, to determine how frequently the psychosis-like symptoms manifest into true psychotic disorders like schizophrenia. So far, the findings don’t suggest that kids who move schools three or more times are priming themselves for future mental health problems – what the data suggest instead is that children who are more mobile early in development may need more attention and help to settle into their new environments and make strong social connections. “If we start thinking of mobile students as a potentially vulnerable group, then we can shift how we view school moves,” he says. Psychiatrists and psychologists, for example, often ask young children about their family and friends, but rarely inquire about how often they have moved schools. In his continuing investigation, Singh also hopes to dissect the reasons why students moved, to see if that can be another factor explaining the intriguing connection – if children move frequently because they are bullying others or being bullied, for example, that may suggest that the association to psychosis-like symptoms may have more to do with the students’ pre-existing behavioral state than the experience of uprooting themselves so frequently.
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A first step in addressing the mental health aspect of mass shootings
By Rep. Ron Barber (D-Ariz.)
Barber has represented Arizona’s 2nd Congressional District since 2012. He sits on the Armed Services; the Homeland Security; and the Small Business committees. Follow him on Facebook or Twitter at RepRonBarber or contact him through his website at barber.house.gov.
When the omnibus spending bill was signed into law by the president, most of the attention was – quite understandably – on the big-ticket items: defense, border security, health care and the like.
But included in that budget was a $15 million gem that is an important positive step for those of us working to reduce the incidence of gun-related violence.
The legislation included $15 million for Mental Health First Aid training – a program I have been calling for since I took office more than 1½ years ago.
Let me explain why this funding is so important:
In the wake of the mass shootings in Tucson, in Newtown and elsewhere, I and many of my colleagues in Congress – both Republicans and Democrats – understood that we must work together to prevent such tragedies.
While there is no single answer to preventing mass shootings, we know that untreated or undiagnosed serious mental illness has been a factor in a number of the recent tragedies.
It was a factor in the January 2011 shooting in Tucson.
The young man who killed six people and wounded 13 of us in Tucson had displayed symptoms of serious mental illness for at least two years prior to the shooting. And yet he never received a mental illness diagnosis or treatment – until he was sent to prison.
People who knew the shooter did not understand what he was going through or how to get him help. So we are left to ask, “Could this tragedy have been prevented if he and others had been provided mental health services?” I believe several of the recent mass shootings could have been averted if the public was more aware of the indications of mental illness and how to get help.
We must do more to reduce the stigma surrounding mental illness. And we must invest in the early identification of mental illness and in treatment programs.
Nationally, 60 percent of people living with a mental illness are not receiving the services that they need. We must do better. Mental illness, like so many other illnesses, can be recognized and will respond to treatment.
It is important to note that more than 95 percent of individuals living with a mental illness are not violent. They are far more likely to be the victims of violence than the perpetrators.
It is clear, however, that we must expand mental health awareness of and treatment services for 100 percent of individuals living with mental illness. That is why I worked with Republicans and Democrats last year to introduce the Mental Health First Aid Act.
This legislation will provide training to first responders, educators, students, parents and the general public on how to identify and respond to signs of mental illness.
The $15 million in the budget bill begins nationwide implementation of this crucial program.
As mental illness impacts the lives of millions of Americans and their families and too many mental health disorders continue to go unaddressed and untreated, we must make prudent investments to support mental health awareness in our communities.
We should have acted after six people were killed in Tucson two years ago. We should have acted after seven people were killed in Oakland. Or 12 people killed in Aurora. Or six people killed in Oak Creek. Or 26 children and adults killed in Newtown. Or 12 people killed at the Washington Navy Yard.
We had so many opportunities to act.
Now we have begun to act by funding Mental Health First Aid training. When the president signed the bill, an important first step was taken.
This single act won’t solve everything. But if it prevents just one death, it will be money very well spent.
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A psychiatrist thinks some patients are better off without antipsychotic drugs
By Matt McClain
What does it mean that the man who killed 12 people at the Washington Naval Yard had told people that he was “hearing voices”?
I have spent 30 years as a psychiatrist treating people who are psychotic. Almost every day I meet with individuals who hear voices that no one else hears, are sure the TV or radio is talking to them or have such confused thinking that it is hard to understand what they are trying to tell me.
Sometimes these patients lead quiet lives. But not uncommonly these voices get them into trouble. I’ve had patients who call the police repeatedly, demanding that they stop bugging their phone. And others who stay up all night talking back at the voices. Some accuse family members of being involved in the torment.
In many cases, this is a frightening experience — for the people I see and those who love them. And the labels we use — “schizophrenia,” “bipolar disorder,” “psychosis” — only crudely capture these experiences.
About 60 years ago, a group of drugs was discovered that appeared to quiet the voices, improve the clarity of thought and lessen the preoccupation with delusion beliefs. Originally called major tranquilizers and later renamed antipsychotic drugs, these have been considered essential for the treatment of people with schizophrenia.
Once it was clear that these drugs were helpful in the short term, questions arose over how long people should remain on them. Studies done in the 1970s and 1980s looked at people who were stabilized after being treated with antipsychotic drugs for several months and then followed them for up to two years. Some continued on the drugs, while others stopped taking them. The relapse rate was much higher in the group that stopped the medications. Based on these studies, treatment guidelines now state that people should stay on anti-psychotics indefinitely.
The problem with “indefinitely” is that antipsychotic drugs have many troubling side effects. They can cause muscle stiffness, tremor and something called tardive dyskinesia, where muscles in the face or limbs move uncontrollably. But the belief — my belief — was that this was the unfortunate price paid to help people who were suffering.
Many people do not want to take these drugs because of the side effects or because they do not think of themselves as ill. After all, if the government is using telemetry to transmit messages into your brain, the solution is to turn off the source of the transmission, not to take a pill. I considered myself a successful psychiatrist when I was able to use my powers of persuasion to convince a reluctant patient to stay on the drugs.
Yet, over the past 15 years, my attitude has shifted. I have become deeply disturbed by the marketing practices that many pharmaceutical companies began to use in the 1990s to push their new medications.
Like many of my colleagues, I awaited the new drugs with enthusiasm, hoping that they would have fewer terrible side effects. Leading psychiatrists who had worked on the development of the drugs also said that they not only were less likely to cause neurological problems but also were more effective.
Quickly, though, I started to think that their benefits were being inflated and their side effects minimized. With one drug in particular, it was clear after a year that my patients were gaining weight at alarming rates: 20, 30, even 100 pounds in a matter of months, a real threat to their health.
Researchers test such new drugs on people for years before they reached the market, but little attention was focused on this issue and only then in the context of a product war — i.e., whether one drug caused more weight gain than others. Only a decade after they were released to the market was it widely acknowledged that severe weight gain was common with many of the newer anti-psychotics, increasing the risk of diabetes. Given that people may take these drugs for decades, the health consequences are serious.
Yet until 21 / 2 years ago, I still thought that prescribing antipsychotic drugs was necessary. After all, a good number of my patients ended up in the hospital or, worse, the police station, when they stopped taking their medications. I did not think I had any other option than to continue to employ my now well-honed powers of persuasion to convince them to stay on their drugs.
And then I read Robert Whitaker’s “Anatomy of an Epidemic,” in which he wondered why, if these new drugs were so great, we were seeing increasing numbers of people on disability for psychiatric conditions. He looked at the studies of long-term outcomes, and what he found surprised me and many of my colleagues: Although it is very hard to do a definitive study that follows people for many years, the research suggested that, over time, the people who remain on these drugs do worse than those who stop using them.
Those who remained on the drug were less likely to return to work or develop meaningful relationships. Of equal concern, it appeared that brain shrinkage — thought initially to be due to the illness itself — was in fact caused by the drugs. Even when monkeys took these drugs for a period of months, their brains shrank.
If Whitaker was right, everything I had been doing for 20 years was wrong. Many psychiatrists have accused him of cherry-picking the data or distorting the findings of the studies. I have spent much of my time rereading the articles and studies he cites, looking for others, talking to colleagues and reading as much criticism of his work as I can find.
And what I concluded is that Whitaker is probably right.
This created a dilemma for me: If the drugs that are helpful in the short run may be harmful over time, what do I do for the person who is unable to have a conversation because the voices in his head are so loud?
If the medications stop the voices, do I suggest he come off the drugs and risk relapse? Or do I suggest he stay on them and reduce his chances for a full recovery? If I suggest that he stop the drugs and then something bad happens, I may be blamed for his relapse, while I am unlikely to be blamed 30 years from now when he has diabetes.
Doctors are held to a standard of “accepted community practice.” What if my own research has led me to a conclusion that is at odds with accepted community practice? What if accepted community practice is so distorted by pharmaceutical advertising in favor of these drugs that it is suspect and unreliable?
Two years ago, I decided to invite my patients into this conversation. I explain to them what I have read and what conclusions I have drawn, as well as the conflicting views of other psychiatrists.
I have been monitoring those who have chosen to wean themselves from the antipsychotic drugs they have been taking, in some cases for 20 years or more. What has been most striking is that my patients make careful and deliberate decisions. Many psychiatrists fear that having this conversation will lead to massive dropping of the drugs, but this has not been my experience. Some do — most often, the ones who have stopped them multiple times in the past — but most are cautious. Of the 64 people I have tracked, 40 decided to try a dose reduction, 22 chose to remain in their current dose and only four abruptly stopped taking their medications.
Some might think my approach cavalier. When we read about Aaron Alexis, who heard voices and shot 12 people before being killed at the Washington Navy Yard, it raises our fears. However, it is important to keep in mind that the problems I describe are common and that the vast majority of people who experience psychosis are not likely to be violent toward others. One study found an increased risk of violence only among those with mental illness who also abuse drugs or are young men. Such risk factors and an individual’s history would, of course, be a part of any decision about whether to wean someone off medication.
In this context, a blog post by Thomas Insel, the director of the National Institute of Mental Health, received much attention this year. Insel described a Dutch study involving 103 people treated for schizophrenia and related disorders. The participants were randomly assigned to one of two groups: Half remained on drugs continuously; the others stopped taking drugs when they became well but restarted them if symptoms emerged. After seven years, the researchers found that those who were not continuously on drugs had a much greater likelihood of getting a job and resuming their regular life activities than those who remained on medications. Remember that people who stop drugs have a higher rate of relapse? It turns out that over the seven years, those who remained on the drugs relapsed as often as the others.
“For some people, remaining on medication long-term might impede a full return to wellness,” Insel wrote. “For others, discontinuing medication can be disastrous.”
The problem is that we do not know who is in which group.
A slow reduction
A man I have known for many years has had some serious bouts with psychosis. He has been hospitalized multiple times, and his thoughts have put him — though not others — at personal risk. However, the medications have also put him at risk. He is now overweight and has diabetes and his kidneys are not working well. He spends a good part of his day sleeping and the rest watching TV.
We have tried in the past to reduce his dose, but these efforts have never gone well. Within days he would be hallucinating and delusional. However, recently we found that with a very slight reduction in dose, he would relapse for about a month but then improve. Perhaps it was his age or greater experience, but he was able to get through the bad days without getting into trouble, and once things quieted down in his mind he felt better. We have agreed to slowly proceed.
His family supports his choice. We all understand the risk of dose reduction, but we see it in the context of all of the risks. Maintaining his current dose is not without consequence. I have known him for a long time, but the problems of schizophrenia tend to start early and he is still a young man. Even if it takes five years to get him on a significantly lower dose, we have the opportunity to improve the long-term quality of his life.
The Dutch study shifted the focus away from the belief that we need to eradicate all symptoms of schizophrenia to a focus on improving the quality of patients’ lives and health, the relationships they have, the work they do. Some people can learn to live with voices. Some people find that the voices have a significant meaning for them and that communicating with them is what is most important. Some people can learn to talk themselves down from delusional thoughts. And some people might choose hearing voices over being 30 pounds overweight and tired all of the time. The point is that this is not a choice I should be making for my patients; it is a choice I need to make with them.
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[Article of Interest] Unmasking the agony: Combat troops turn to art therapy
By Bill Briggs, NBC News contributor
The skull’s left corner is gone, leaving a jagged, diagonal edge drenched in red. The eyes are black and frantic. All of it resembles the Iraqi man who, in his final minute alive, stared up at Maj. Jeff Hall.
For five years, that face tortured Hall, once a sharp Army leader later shoved to his own ragged edge. Not long ago, a woman handed Hall a blank mask, brushes and paints. She asked him to see what may emerge on the surface.
“That image, seared into my mind, began leaking out of me,” said Hall, one of hundreds of active-duty troops who have created masks as part of an art therapy program at Walter Reed National Military Medical Center. “I almost needed to regurgitate it. To be honest, it helped me let it go.”
Many more masks, some resembling Hall’s violent creation, some depicting abstract demons, adorn walls at the National Intrepid Center of Excellence (NICOE) on the Walter Reed campus.
They reveal scars once carried and cloaked inside the minds of men and women back from war — troops diagnosed with mild brain injuries and secondary psychological issues, including post-combat stress.
Hall, 43, who titled his mask “The Shock of Death,” served a pair of year-long tours in Iraq spanning 2003 to 2005. Ultimately haunted by violent events he saw and survived in Iraq, including the loss of friends, Hall eventually contemplated suicide and became more isolated. His commander noticed Hall’s behavioral changes and guided him into counseling in 2008. Two years later, Hall was invited to seek treatment for a traumatic brain injury at then-new NICOE, a Department of Defense facility offering research, education and treatment focused on TBIs and psychological health.
When service members initially enter the art-therapy studio, their faces often are blank and unyielding, hiding unwelcome war souvenirs within — the mental cargo they’ve lugged home but can’t shake. On their masks, they expose that secret turmoil: vulnerabilities, anger, grief or, often, fragmented identities.
“It’s intense. They get really invested in this. It becomes very meaningful for them,” said Melissa Walker, an art therapist who coordinates the masks program at NICOE.
Participants at NICOE must be active-duty troops who are dealing with a combination of TBI and psychological health concerns. Typically, they are referred by their primary health care provider or their commander. A designated team at NICOE determines which service members are most appropriate to receive treatment there. Attendees participate for four weeks. Art therapy is just one of the tools offered and the service members usually make one mask — done during their first week at the center.
“I tell them: ‘Don’t worry about the finished product; worry about what you are symbolizing in the mask.’ That makes it more powerful to them. It gives them a way to express to us, visually, what they’re going through,” Walker said. “It’s a little less intimidating then handing them a blank piece of paper.”
Art therapy has become a staple in the treatment of a wide array of traumas, from child abuse to PTSD. Making art can help people unlock dark emotions or memories that they can’t yet vocalize, pulling those buried anxieties from their subconscious and placing them onto a canvass or into a lump of clay, said Donna Betts, a professor in the art therapy program at George Washington University.
As a patients’ pieces are taking shape, art therapists help them talk about what they believe they are trying to express in their creations, Betts said.
“It’s especially effective in the treatment of trauma in service members. When trauma is experienced, it tends to be stored in the nonverbal part of the brain,” Betts said. “This is why so many of them can’t even put into words what they’ve been through. Art therapy helps them retell their story through art. It translate that trauma from the nonverbal part of the brain to the verbal part so they can start dealing with it.
“They then become more aware of the trauma. This is where that healing starts to take place.”
After the paint is dabbed and stroked at NICOE, many of those papier-mache masks offer chilling accounts of what it is like to live inside the minds of combat veterans.
One brown face with the mouth agape and with bloodshot eyes upturned is squeezed by a metal clamp that reads “TBI” on the left and “PTSD” on the right.
Another mask is coated by small chunks of amber bark — two tiny holes remain for eyes — symbolizing the outer camouflage the maker felt is necessary to blend back into the civilian world.
Some masks show mouths locked or sewn closed, whispering of an inability to speak of what they’ve witnessed. Many are divided down the middle — for example, one displays part of an American flag on the left and a skull on the right.
“There is a split sense of self. They feel like they’re one person when they’re deployed and one person when they return home,” Walker said. “Or, they do a really strong, warrior exterior with a vulnerable inside but they don’t feel like they can express that.”
The troops who come to NICOE for therapy can take their masks home. But many purposely leave them to hang from the walls to speak to — and perhaps even soothe — incoming troops trying to cope with the same thoughts and impulses.
The creations give service members a format “to say what they can’t say out loud — because it’s too painful or because we just don’t feel like anybody really wants to hear it,” said Hall, who remains on active duty, stationed at Rock Island Arsenal in northwestern Illinois.
“I absolutely believe it is a method to calm your mind.”
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[Article of Interest] Invitation to a Dialogue: Benefits of Talk Therapy
By Larry S. Sandberg
To the Editor [of the New York Times]:
We tend to divide treatments for mental illness into “psychological” approaches and “biological” ones; the former typically involve “talk therapy” and the latter medication. But this either-or way of thinking obscures the fact that talk therapy affects the brain and is no less biological than pills.
Numerous findings over the last two decades demonstrate how talk therapy alters the brain. Disabling conditions like clinical depression and anxiety can be treated effectively by understanding distorted patterns of thought, becoming aware of emotional conflicts that have not been conscious, or practicing new behaviors. Talk therapy is a potent treatment for serious mental disorders and not simply for the “worried well,” as it is sometimes characterized.
These conditions can also be treated with medication, either alone or in combination with talk therapy. Whereas the effects of medication tend to go away once the medication is stopped, the benefits of talk therapy can be enduring because of the significant changes that take place not only in the “mind” but in the “brain,” too. This is a real-life example of what the Nobel laureate Eric Kandel has discovered: learning affects the ways in which the brain forms new connections.
Why does this matter? It is important that the public know that talk therapy is an important tool in the healing process precisely because of its powerful effects on the brain. Medication, which is lifesaving for many, tends to be overprescribed. Rather than being introduced as part of a comprehensive treatment that includes psychotherapy, it is often used in its place. We should be aware of the cultural trends that devalue psychotherapy and the listening healer and the unintended consequences that may ensue.
[Article of Interest] Childhood Depression May Be Tied to Later Heart Risk
For these kids, obesity, smoking and inactivity more likely in adolescence, preliminary research shows
Teens who were depressed as children are more likely to be obese, to smoke and to be sedentary, a new study finds.
The findings suggest that depression during childhood can increase the risk of heart problems later in life, according to the researchers.
The study included more than 500 children who were followed from ages 9 to 16. There were three groups: those diagnosed with depression as children, their depression-free siblings and a control group of unrelated youngsters with no history of depression.
Twenty-two percent of the kids who were depressed at age 9 were obese at age 16, the study found. “Only 17 percent of their siblings were obese, and the obesity rate was 11 percent in the unrelated children who never had been depressed,” study first author Robert Carney, a professor of psychiatry at Washington University School of Medicine in St. Louis, said in a university news release.
The researchers found similar patterns when they looked at smoking and physical activity.
”A third of those who were depressed as children had become daily smokers, compared to 13 percent of their nondepressed siblings and only 2.5 percent of the control group,” Carney said.
Teens who had been depressed as children were the least physically active, their siblings were a bit more active and those in the control group were the most active, according to the study, which is scheduled for presentation Friday at the annual meeting of the American Psychosomatic Society in Miami. Although the study showed an association between childhood depression and obesity, smoking habits and inactivity later in life, it did not prove a cause-and-effect relationship.
These findings are cause for concern because “a number of recent studies have shown that when adolescents have these cardiac risk factors, they’re much more likely to develop heart disease as adults and even to have a shorter lifespan,” Carney said.
”Active smokers as adolescents are twice as likely to die by the age of 55 than nonsmokers, and we see similar risks with obesity, so finding this link between childhood depression and these risk factors suggests that we need to very closely monitor young people who have been depressed,” he said.
Note: Data and conclusions presented at meetings are typically considered preliminary until published in a peer-reviewed medical journal.
[Article of Interest] People with Mental Illness at Highly Increased Risk of Being Murder Victims
Risk highest among those with substance use disorders
People with mental disorders have a highly increased risk of being victims of homicide, a large study published today on bmj.com suggests. The perpetration of homicide by people with mental disorders has received much attention, but their risk of being victims of homicide has rarely been examined. Yet such information may help develop more effective strategies for improving the safety and health of people with mental illness.
So a team of researchers from Sweden and the USA assessed mental disorders and homicides across the entire population of Swedish adults between 2001 and 2008. Mental disorders were grouped into the following categories: substance use disorder; schizophrenia; mood disorders including bipolar disorder and depression; anxiety disorders and personality disorders. Results were adjusted for several factors such as sex, age, marital status, educational level, employment status and income. Of 7,253,516 adults in the study, 141 (22%) out of 615 homicidal deaths were among people with mental disorders.
After adjusting for several factors, the results show that people with any mental disorder were at a fivefold increased risk of homicidal death, relative to people without mental disorders. The risk was highest among those with substance use disorders (approximately ninefold), but was also increased among those with personality disorders ((3.2fold), depression (2.6fold), anxiety disorders (2.2fold), or schizophrenia (1.8fold) and did not seem to be explained by substance use.
One explanation for the findings may be that those with mental disorders are more likely to live in high deprivation neighbourhoods, which have higher homicide rates, say the authors. They may also be in closer contact with other mentally ill people and be less aware of their safety risks owing to symptoms of the underlying illness. They suggest that interventions to reduce these risks “should include collaborations between mental health clinics and the criminal justice system to develop personal safety and conflict management skills among people with mental illness.” Improved housing, financial stability, and substance abuse treatment may also reduce vulnerability to violent crime, they add. A key implication of these new findings is that clinicians should assess risk for the full array of adverse outcomes that may befall people with mental health problems, say Roger Webb and colleagues at the University of Manchester, in an accompanying editorial. This would include being a victim of violence as well as committing it, abuse and bullying, suicidal behaviour, accidental drug overdoses, and other major adverse events linked with intoxication or impulsivity.
These risks go together, and people with mental illness, as well as their families, should receive advice on avoiding various types of harm, they suggest. They acknowledge that some important questions remain unanswered, but suggest that national mental health strategies “should reflect the broad nature of safety concerns in mental healthcare, while antistigma campaigns among the public should aim to counter fear of mentally ill people with sympathy for the risks they face.”
“Mental disorders and vulnerability to homicidal death: Swedish nationwide cohort study”, Casey Crump et al. BMJ. 2013;346:f557 doi:10.1136/bmj.f557
Editorial: “Risk of people with mental illnesses dying by homicide”, Roger Webb et al. BMJ. 2013;345:f1336 doi: 10.1136/bmj.f1336
[Article of Interest] Edward Deeds, Outsider Artist, Leaves Behind Hauntingly Innocent Drawings From Mental Institution
By Priscilla Frank
”The artist really should be lost to history, and certainly these drawings should,” said curator Tom Parker of his upcoming exhibition. The works in question are by Edward Deeds, a mental patient at Missouri State Hospital for almost 40 years. The show, entitled, “Talisman of the Ward: The Album of Drawings by Edward Deeds,” presents 30 works by the outsider artist.
Deeds, who was diagnosed with dementia praecox and schizophrenia, was committed to a mental institution in 1936. Beyond this fact we know little about his condition, personality or life, although the curator sees all he needs to in Deeds’ artwork. “The images have one fabulous clue on every page,” Parker explained to the Huffington Post. “State Lunatic Asylum, written on the paper by the hospital. One poetic detail which encapsulates everything you need to know about the artist and his circumstance.”
The artist’s drawings, crafted on the official hospital stationary, radiate a remarkable innocence given the circumstances of their creation. Whimsical lions, wide-eyed characters and vintage vehicles comprise a pictorial land far beyond the mental facility walls. The only reminder of Deeds’ dark reality is recurrence of the letters “ECT,” a likely acronym for the controversial shock treatment known as electroconvulsive therapy.
At the time of Deeds’ death he gave his collection of drawings to his mother, who then passed them to her other son, who stored them in his attic. Years later, the drawings were tossed out to a curbside junk pile and were discovered by a 14-year-old boy who became fascinated with them. He kept the works safe for 36 years.
The precious drawings, both unpretentious and cryptic, present an idyllic vision from a mysterious perspective. The story of their creation and survival is as magnetic as the raw emotion in his innocent crayon strokes.
“Talisman of the Ward: The Album of Drawings by Edward Deeds” will show from January 10 until February 9, 2013 at Hirschl & Adler Modern.
[Article of Interest] Side Effects of Mental Illness Drugs Cause Sudden Death
by Kerri Knox, RN
Schizophrenia is a scary and difficult chronic mental illness- both for the person and for their family who all have to live with the diagnosis. In most cases, antipsychotic medications need to be taken forever to control the disturbing symptoms. But rarely is anyone told that these medications not only double the risk of sudden cardiac death, but also put the sufferer at risk for several other chronic illnesses as well.
The severe mental condition that has been termed schizophrenia is NOT the ‘multiple personality disorder’ that many think of when they hear the term, but is a different mental illness characterized by bizarre behaviors like paranoia, hearing voices, and having hallucinations. It is often acquired after a stressful life event and occurs swiftly and unpredictably in what is known as a ‘psychotic break’. This is devastating for the patient and their family who suddenly have to live with a diagnosis of mental illness. And that is just the first step in a life filled with doctors, hospitals, medications and psychiatrists- with little hope to ever really have a normal life again.
Schizophrenia and a handful of medications forever
There is no ‘cure’, in traditional medicine, for Psychosis; and a prescription for one or more ‘antipsychotics’ with names like Haldol and Risperdal, along with a cocktail of other drugs often prescribed for anxiety, depression and sleep are frequently on the menu. But what these people are rarely, if ever, told about are the long term side effects of these drugs. While doctors are ever prescribing anticholesterol ‘statins’, aspirin and blood pressure medications in order to achieve a 1 - 2% reduction in heart disease, they are knowingly giving schizophrenic individuals, who generally get their first psychotic break as a teenager or young adult, a shortened lifespan from the medications that they are prescribing.
In the research available on these drugs, it is well known that Sudden Cardiac Death is a ‘side effect’ of antipsychotic medications. In fact, these medications DOUBLE the risk of sudden cardiac death. In the beginning, however, it does not give them the “heart disease” of clogged arteries that we associate with heart attacks. The immediate risk of antipsychotics is that they give sufferers a high risk for a very specific disorder called ‘Prolonged Q-T interval’.
Prolonged Q-T Interval gets its name from the prolonged time that it takes for the electrical activity of the heart to return to normal after each heartbeat. But this extra time isn’t measured in minutes or seconds, but in hundredths of a second- making it difficult to diagnose. But this extra millisecond can have the devastating consequence of putting the taker of these medications into an abnormal cardiac rhythm called Ventricular Fibrillation- which will quickly lead to death without immediate emergency care. And this will come on without pain, shortness of breath or any of the other ‘warning signs’ of a heart attack because it is not clogged arteries that are the problem, but the electrical system that is the primary problem.
Even worse, antipychotics don’t just put people into your vanilla, standard everyday Ventricular Fibrillation that generally responds well to the dramatic ‘paddles on the chest, everybody get away from the patient and shock them’ type of defibrillation that you see on television. It actually puts them into a very specific TYPE of Ventricular Fibrillation called Torsades de Pointes, that doesn’t change to a normal rhythm with the shocks and heart starting medications that are the ‘standard protocol’ for restarting the heart. Instead, ‘Torsades’ requires an immediate infusion of intravenous magnesium. As hospitals and emergency rooms have magnesium at hand, this shouldn’t be such a hard thing to do; but unfortunately, Torsades de Pointes is fairly rare and is difficult to recognize, so in many cases it is not even considered until the shocks and CPR are not working- and by then it is often too late for the magnesium to be effective.
But wait, there’s more…
Not only do antipsychotics double the risk of deadly heart rhythms, but they ALSO increase the risk of getting diabetes, high blood pressure, high cholesterol and obesity- which are risk factors for ‘regular’ heart disease complete with clogged arteries, angioplasty and open heart surgery. Fortunately, true psychosis is rare- so doctors don’t prescribe these dangerous medications unless they are absolutely necessary… right?
Unfortunately, this is not the case at all. In fact, over 200,000 people in the US are newly diagnosed each year and hundreds of thousands of prescriptions for antipsychotics are written every year. They are being given to adolescents, children and even preschoolers as young as two years old. Most of these are prescribed by primary physicians without the child having even had an evaluation by a psychiatrist. And almost half were written, not for schizophrenia as they are intended, but for ADD and ADHD for which the drugs have never even been tested!
"Rates of (doctor’s office) visits that resulted in a psychotropic prescription increased from 3.4 percent in 1994-1995 to 8.3 percent in 2000-2001. By 2001, one out of ten office visits by adolescent males resulted in a prescription for a psychotropic medication." Trends in the use of psychotropic medications among adolescents, 1994 to 2001.
So, while researchers who study the cardiac death risk profile of antipsychotic drugs are advocating “sharp reductions” in the use of these agents- doctors are ignoring this advice and are steadily increasing the number of antipsychotic drugs prescribed each year. These patients, who are often children and teens without true schizophrenia, will somehow have to deal with several chronic health conditions that will not only shorten their lives, but decrease the quality of a life already made more difficult by mental illness.
The creators of the Serious Mental Illness blog invite you to submit your visual art, music, photography, crafts, video work, poetry, collage, or short fiction to Art from the Edge.
Art from the Edge, a virtual gallery and resource center, is dedicated to art created in and about extreme mental states. It is an open and public world wide forum for artists to share their visual and written works and their personal stories with all those interested in the connection between creativity and “edge” states.
Much like art, which exists in a multitude of mediums and forms of expression, there are a plurality of “edge” states that inspire the artists who harbor them. For this reason, we leave the term completely open to our community’s interpretation, knowing from research and experience that this state could be driven by psychosis or trauma, or an altered state induced by drugs. It could be the offshoot of extreme depression or grief, or the aftermath of a spiritual or mystical state of consciousness.
Ultimately, we are interested in the artist’s individual experience and in his or her sense of what it is that drove the creative act.
[Video of Interest] Simon Kyaga - Genius and Madness
Simon Kyaga, MD, of the Karolinska Institute in Stockholm, and colleagues conducted a nested case-control study that included 1,173,763 participants enrolled in the Swedish total population registries. The researchers compared patients diagnosed with psychiatric disorders and their healthy relatives to the general population. Scientific and artistic occupations were defined as creative professions. These included dancers, photographers, researchers and authors, for example. Diagnoses of psychiatric disorders were based on the International Classification of Diseases.
In this study, those in overall creative professions were not more likely to have psychiatric disorders, with the exception of bipolar disorder. However, authors were more than twice as likely as controls to have schizophrenia (OR=2.09; 95% CI, 1.35-3.23) and bipolar disorder (OR=2.21; 95% CI, 1.50-3.26). This population was also more likely to be diagnosed with unipolar depression (OR=1.54; 95% CI, 1.30-1.81), anxiety disorders (OR=1.38; 95%CI, 1.03-1.86), alcohol abuse (OR=1.47; 95% CI, 1.25-1.74), drug abuse (OR=1.53; 95% CI, 1.09-2.16) and to commit suicide (OR=1.49; 95% CI, 1.08-2.05).
Consistent with their earlier research, Kyaga and colleagues found that first-degree relatives of patients with schizophrenia, bipolar disorder, anorexia nervosa and, to a lesser degree, autism were significantly overrepresented in creative professions.
According to the researchers, the results have important clinical implications: “If one takes the view that certain phenomena associated with the patient’s illness are beneficial, it opens the way for a new approach to treatment,” Kyaga said in a press release. “In that case, the doctor and patient must come to an agreement on what is to be treated, and at what cost. In psychiatry and medicine generally there has been a tradition to see the disease in black-and-white terms and to endeavor to treat the patient by removing everything regarded as morbid.”
[Blog Post of Interest] The Big Chill: Psychiatric Medications Now Are on Trial For Murder
By Michael Cornwall, Ph.D. on Mad in America
Excerpt: The Canadian judge in the first North American criminal trial to find Prozac the sole cause of a murder ruled – “There is clear medical evidence that the Prozac affected his (defendant’s) behavior and judgment, thereby reducing his moral culpability.” Will those chilling words cause a small tremor in the writing hand of every prescriber of Prozac and other psychiatric medications from now on?
That Prozac verdict which is not going to be appealed by the District Attorney changes everything. The upcoming Utah Supreme Court trial where the court has already ruled that prescribers of psychiatric medications can be held responsible for the actions of their patients, adds to the huge shift in the landscape for anyone who prescribes.
Being an ex-drug-addict turned neuroscientist brings a unique insight into the physiological and phenomenological realities of addiction.
Excerpt: For 10 years I spun in and out of an addiction to opiates (and other drugs) that led to despair, crime, and the loss of everything I valued most—including my place in graduate school. After many failed attempts, I finally quit taking addictive drugs 30 years ago. I reentered grad school, got my PhD in developmental psychology, and became a professor at the University of Toronto, focusing on emotional and personality development. I studied these topics for 13 years, but I never quite understood my own personality development. I came to believe that my theories needed help from neuroscience, and that’s why I switched to research on the emotional brain—my focus for the past decade.
When I was in the throes of intense psychological addiction, my thoughts were continuously (and unpleasantly) drawn to drug imagery. It would be so great to have some now! How can I get some tonight?! But attraction to something you are just about to get feels marvelous. Dopamine-induced engagement turns into a headlong rush of triumph when the goal is finally accessible.
This perspective on the dual nature of attraction helps make sense of addiction. Unsated attraction can be a kind of torture, and addicts may seek drugs to put an end to that torture, more than for the modicum of pleasure drugs actually bestow.