Chapter 16. Psychopathology: Biological Basis of Behavior Disorders
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By James Gallagher Health and science reporter, BBC News Changing the way people think about and deal with schizophrenia could be as effective as drugs, say researchers. Cognitive behavioural therapy is an officially recommended treatment, but is available to less than 10% of patients in the UK with schizophrenia. A study published in the Lancet indicates CBT could help the many who refuse antipsychotic medication. Experts say larger trials are needed. About four-in-10 patients benefit from taking antipsychotic medication. But the drugs do not work for the majority and they cause side-effects such as type 2 diabetes and weight gain. Up to half of patients with schizophrenia end up not taking the drugs. The study looked at cognitive behaviour therapy in 74 people. The therapy works by identifying an individual patient's problem - such as hearing voices, paranoid thinking or no longer going out of the house - and developing techniques to deal with them. Prof Tony Morrison, director of the psychosis research unit at Greater Manchester West Mental Health Foundation Trust, said: "We found cognitive behavioural therapy did reduce symptoms and it also improved personal and social function and we demonstrated very comprehensively it is a safe and effective therapy." It worked in 46% of patients, approximately the same as for antipsychotics - although a head-to-head study directly comparing the two therapies has not been made. Douglas Turkington, professor of psychiatry at Newcastle University, said: "One of our most interesting findings was that when given the option, most patients were agreeable to trying cognitive therapy." BBC © 2014
Link ID: 19212 - Posted: 02.06.2014
By BENEDICT CAREY BETHESDA, Md. — The police arrived at the house just after breakfast, dressed in full riot gear, and set up a perimeter at the front and back. Not long after, animal rights marchers began filling the street: scores of people, young and old, yelling accusations of murder and abuse, invoking Hitler, as neighbors stepped out onto their porches and stared. It was 1997, in Decatur, Ga. The demonstrators had clashed with the police that week, at the Yerkes National Primate Research Center at nearby Emory University, but this time, they were paying a personal call — on the house of the center’s director, inside with his wife and two teenage children. “I think it affected the three of them more than it did me, honestly,” said Dr. Thomas R. Insel, shaking his head at the memory. “But the university insisted on moving all of us to a safe place for a few days, to an ‘undisclosed location.’ “I’ll say this. I learned that if you’re going to take a stand, you’re going to make some people really angry — so you’d better believe in what you’re doing, and believe it completely.” For the past 11 years, Dr. Insel, a 62-year-old brain scientist, has run an equally contentious but far more influential outfit: the National Institute of Mental Health, the world’s leading backer of behavioral health research. The job comes with risk as well as power. Patient groups and scientists continually question the agency’s priorities, and politicians occasionally snipe at its decisions. Two previous directors resigned in the wake of inflammatory statements (one on marijuana laws, one comparing urban neighborhoods to jungles), and another stepped down after repeatedly objecting to White House decisions. © 2014 The New York Times Company
Christie Nicholson reports. Advocates claim numerous health benefits for meditation, many of which are supported by studies on the practice. Still, meditation has not become part of mainstream medicine. So researchers at Johns Hopkins University analyzed 47 previously published clinical trials to narrow down the most effective use for meditation as medical therapy. The studies involved more than 3,500 patients suffering from various issues including stress, addiction, depression, anxiety, diabetes, heart disease, cancer and chronic pain. The meta-analysis is in the journal JAMA Internal Medicine. [Madhav Goyal et al, Meditation Programs for Psychological Stress and Well-being: A Systematic Review and Meta-analysis] Apparently practicing just 30 minutes of meditation per day significantly decreases the symptoms of anxiety and depression. An 8-week training program in mindfulness meditation – where participants have to focus on the current moment – led to optimal improvement in lowering anxiety, depression and pain. And the improvements continued over the six months following the training. For depression and anxiety, the effects of meditation were as strong as for those achieved by taking antidepressant medication. However, meditation failed to significantly affect any of the other conditions, such as heart disease or cancer. Nevertheless, while some might view meditation as sitting and doing nothing, doing nothing does something. © 2014 Scientific American
By Melissa Healy Adolescents treated with the antidepressant fluoxetine -- better known by its commercial name, Prozac -- appear to undergo changes in brain signaling that result in changed behavior well into adulthood, says a new study. Adult mice and rats who were administered Prozac for a stretch of mid-adolescence responded to daunting social and physical challenges with less despair than animals who passed their teen years unmedicated, a team of researchers found. But, even as adults long separated from their antidepressant days, the Prozac veterans reacted to stressful situations with greater anxiety than did the adult Prozac virgins. The latest research, published Wednesday in the Journal of Neuroscience, offers evidence that treatment with a selective serotonin reuptake inhibitor -- an SSRI antidepressant -- has long-lived effects on the developing brain. It also zeroes in on how and where fluoxetine effects those lasting changes: by modifying the cascade of chemical signals issued by the brain's ventral tegmentum -- a region active in mood regulation -- in stressful situations. Yet, the new research raises more questions than it answers, since the changes in adults who were treated with Prozac as adolescents seem contradictory. Sensitivity to stress appears to predispose one to developing depression. So how does a medication that treats depression in children and teens -- and that continues to protect them from depression as adults -- also heighten their sensitivity to stress?
By RICHARD A. FRIEDMAN, M.D. “How the Federal Government Destroyed the Mental Illness Treatment System”: That subtitle is the opening shot across the bow in this jeremiad of a book by the psychiatrist Dr. E. Fuller Torrey. It could just as well have read: “How a group of well-intentioned, starry-eyed idealists made a hash of mental health care.” You could hardly blame them for trying, though. The care of people with serious mental illness was long a national disgrace. By the 1950s, slightly more than half a million psychiatric patients resided in overcrowded and underfunded state mental hospitals, often under appalling conditions. Related Coverage Enter a group of high-minded psychiatrists with a vision to “create a brave new world, a mentally healthy America,” in Dr. Torrey’s words. Armed with little more than optimism, they helped start the National Institute of Mental Health and set in motion an ambitious agenda for the next half-century: closing the state mental hospitals, initiating a federal takeover of the mental health system, and creating a nationwide network of community mental health centers. Reform was well underway when President John F. Kennedy endorsed this new era in mental health in a 1963 speech, calling for a “bold new approach” in which “reliance on the cold mercy of custodial isolation will be supplanted by the open warmth of community concern and capability.” Those were heady days in American psychiatry, when psychoanalysis and the mental hygiene movement held sway and promised to cure all manner of ills by early intervention and improving the social environment. In hindsight, the therapeutic zeal of these professionals was impressively naïve: They were certain that severely mentally ill patients in state hospitals — many living there for decades — would magically adjust to the community and do well with outpatient treatment. How wrong they proved to be. © 2014 The New York Times Company
Link ID: 19127 - Posted: 01.14.2014
By Megan Wiegand and Slate, Tips for beating the seasonal blues are as numerous as the winter night is long. Light boxes, touted to “uplift people’s spirits” and “improve mood and energy,” offer a New-Agey-seeming solution to propel us into the cold as if it’s the first beautiful day of spring. But can sitting in front of a light for a few minutes a day actually counteract the dreariest months? Yes, in many cases. Light-box therapy has been shown to alleviate symptoms in people who suffer from seasonal affective disorder, or SAD. Symptoms of this form of depression — they can include lost interest in beloved activities, overeating, loss of energy, disrupted sleep cycles and feelings of hopelessness or guilt — typically appear in late fall or early winter and dissipate in spring. Women are twice as likely as men to seek treatment for SAD, and those farther away from the equator are more likely to be diagnosed: About 11 percent of Mainers have a clinical SAD diagnosis, but only 2 percent of Floridians report the illness, according to Kathryn Roecklein, an assistant professor of psychology at the University of Pittsburgh. One tool doctors use to treat SAD is light-box therapy. Light boxes use bright white fluorescent bulbs (or sometimes blue light) that reproduce some wavelengths of the sun’s light. They contain filters to block harmful UV rays and come in various shapes, sizes, light types and price points. © 1996-2014 The Washington Post
By Tia Ghose and LiveScience Neurons derived from schizophrenic patients. Image: Dr. Kristen Brennand, Salk Institute for Biological Studies. Some so-called jumping genes that copy and paste themselves throughout the genome may be linked to schizophrenia, new research suggests. The new study, published Jan. 2 in Neuron, suggests these jumping genes may alter how neurons (or nerve cells in the brain) form during development, thereby increasing the risk of schizophrenia, study co-author Dr. Tadafumi Kato, a neurobiologist at the RIKEN Brain Science Institute in Japan, wrote in an email. Jumping genes, or retrotransposons, are mobile genetic elements that copy and paste themselves at different places throughout the genome. About half of the human genome is made of these mysterious elements, compared with the 1 percent of genes that actually code for making proteins, Kato said. Earlier studies had found that a certain type of jumping gene, known as long interspersed nuclear element-1 (LINE-1), was active in human brain cells. Kato and his colleagues wondered whether they might play a role in mental illness. To find out, the team conducted a post-mortem analysis of 120 human brains, 13 from patients who had been diagnosed with schizophrenia. The team found a higher number of LINE-1 copies in the brains of schizophrenics compared with other groups. © 2014 Scientific American
People with severe mental illness such as schizophrenia or bipolar disorder have a higher risk for substance use, especially cigarette smoking, and protective factors usually associated with lower rates of substance use do not exist in severe mental illness, according to a new study funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health. Estimates based on past studies suggest that people diagnosed with mood or anxiety disorders are about twice as likely as the general population to also suffer from a substance use disorder. Statistics from the 2012 National Survey on Drug Use and Health indicate close to 8.4 million External Web Site Policy adults in the United States have both a mental and substance use disorder. However, only 7.9 percent of people receive treatment for both conditions, and 53.7 percent receive no treatment at all, the statistics External Web Site Policy indicate. “Drug use impacts many of the same brain circuits that are disrupted in severe mental disorders such as schizophrenia,” said NIDA Director Dr. Nora D. Volkow. “While we cannot always prove a connection or causality, we do know that certain mental disorders are risk factors for subsequent substance use disorders, and vice versa.” In the current study, 9,142 people diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder with psychotic features, and 10,195 controls matched to participants according to geographic region, were selected using the Genomic Psychiatry Cohort program. Mental disorder diagnoses were confirmed using the Diagnostic Interview for Psychosis and Affective Disorder (DI-PAD), and controls were screened to verify the absence of schizophrenia or bipolar disorder in themselves or close family members. The DI-PAD was also used for all participants to determine substance use rates.
By MICHAEL M. PHILLIPS Roman Tritz’s memories of the past six decades are blurred by age and delusion. But one thing he remembers clearly is the fight he put up the day the orderlies came for him. “They got the notion they were going to come to give me a lobotomy,” says Mr. Tritz, a World War II bomber pilot. “To hell with them.” The orderlies at the veterans hospital pinned Mr. Tritz to the floor, he recalls. He fought so hard that eventually they gave up. But the orderlies came for him again on Wednesday, July 1, 1953, a few weeks before his 30th birthday. This time, the doctors got their way. The U.S. government lobotomized roughly 2,000 mentally ill veterans—and likely hundreds more—during and after World War II, according to a cache of forgotten memos, letters and government reports unearthed by The Wall Street Journal. Besieged by psychologically damaged troops returning from the battlefields of North Africa, Europe and the Pacific, the Veterans Administration performed the brain-altering operation on former servicemen it diagnosed as depressives, psychotics and schizophrenics, and occasionally on people identified as homosexuals. The VA doctors considered themselves conservative in using lobotomy. Nevertheless, desperate for effective psychiatric treatments, they carried out the surgery at VA hospitals spanning the country, from Oregon to Massachusetts, Alabama to South Dakota. The VA’s practice, described in depth here for the first time, sometimes brought veterans relief from their inner demons. Often, however, the surgery left them little more than overgrown children, unable to care for themselves. Many suffered seizures, amnesia and loss of motor skills. Some died from the operation itself. Mr. Tritz, 90 years old, is one of the few still alive to describe the experience. “It isn’t so good up here,” he says, rubbing the two shallow divots on the sides of his forehead, bracketing wisps of white hair.
Imagine this: Every day, you can feel people looking at you warily. They want to hurt you. Even the police are out to get you. You try to rid your mind of all the ill-intentioned people, but you can't ignore the other thing that is gnawing at you. Those bugs on your arm won't leave you alone, no matter how often you gouge at them. Such are the hallucinations and paranoia felt by those with a stimulant drug addiction. Sometimes the substance abuse is so severe it causes neurological damage and psychosis becomes a chronic condition. Combine untreated addiction with homelessness and physical health problems, and you get a health emergency. Vancouver police and the region's health authorities are desperately trying to figure out how to help the most vulnerable of mentally ill drug addicts. The province estimates that roughly 130,000 people in British Columbia suffer from a severe addiction and/or mental health illness. But police and emergency workers are increasingly dealing with a much smaller group of people whose brains have been damaged by their stimulant addiction and who appear to be responsible for random violent acts on Vancouver's streets. Dr. Nader Sharifi, addiction medicine lead with the Fraser Health Authority, said there are few good treatment options for those people. "It's a bit of a challenging question, because what we have available isn't necessarily structured for this patient sub-type. It's either structured for addiction, or structured for mental health illness, but not necessarily the two together." © CBC 2013
By JULIE CRESWELL RALEIGH, N.C. — As darkness fell on a Friday evening over downtown Raleigh, N.C., Michael Lyons, a paramedic supervisor for Wake County Emergency Medical Services, slowly approached the tall, lanky man who was swaying back and forth in a gentle rhythm. In answer to Mr. Lyons’s questions, the man, wearing a red shirt that dwarfed his thin frame, said he was bipolar, schizophrenic and homeless. He was looking for help because he did not think his prescribed medication was working. In the past, paramedics would have taken the man to the closest hospital emergency room — most likely the nearby WakeMed Health and Hospitals, one of the largest centers in the region. But instead, under a pilot program, paramedics ushered him through the doors of Holly Hill Hospital, a commercial psychiatric facility. “He doesn’t have a medical complaint, he’s just a mental health patient living on the street who is looking for some help,” said Mr. Lyons, pulling his van back into traffic. “The good news is that he’s not going to an E.R. That’s saving the hospital money and getting the patient to the most appropriate place for him,” he added. The experiment in Raleigh is being closely watched by other cities desperate to find a way to help mentally ill patients without admitting them to emergency rooms, where the cost of treatment is high — and unnecessary. While there is evidence that other types of health care costs might be declining slightly, the cost of emergency room care for the mentally ill shows no sign of ebbing. Nationally, more than 6.4 million visits to emergency rooms in 2010, or about 5 percent of total visits, involved patients whose primary diagnosis was a mental health condition or substance abuse. That is up 28 percent from just four years earlier, according to the latest figures available from the Agency for Healthcare Research and Quality in Rockville, Md. By one federal estimate, spending by general hospitals to care for these patients is expected to nearly double to $38.5 billion in 2014, from $20.3 billion in 2003. © 2013 The New York Times Company
Link ID: 19071 - Posted: 12.27.2013
By Sandra G. Boodman, Bebe Bahnsen remembers the night, alone in her small cottage on the Alabama coast, that she felt a strong urge to drink a can of drain cleaner. For years, antidepressants combined with talk therapy had enabled Bahnsen, whose first name is Beatrice, to function well, establishing a thriving public relations business in Washington followed by a career as a newspaper reporter. But those days had been supplanted by a prolonged suicidal depression that had proved impervious to electroshock treatments, periodic hospitalizations and a raft of psychiatric drugs. The phone call in which Bahnsen confided her desire to drink poison seemed to confirm the worst fears of one of her closest friends. “I figured, well, she was one of those people who just was not ever going to get better,” said Paddy Bowman, a folklore specialist who lives in Alexandria. Bahnsen, now 73, traces the beginning of her psychological slide to the mid-1990s, when she decided that, after two decades, she’d had enough of Washington. She moved back to her home state of Georgia and her life slowly began to unravel. She felt estranged from her large and devoted circle of friends, began having problems at work, and grew restless and increasingly depressed. “I felt as though I was on a large island and everyone was slowly moving away and I was there by myself,” Bahnsen recalled. For the first time in her life, she said, she was intermittently psychotic. Periodic suicide attempts, some involving overdoses of prescribed sleeping pills, landed her in a series of mental hospitals. In November 2006 she was hospitalized in Las Vegas, where she was then living with one of her sons. Doctors, baffled by her longstanding failure to improve, decided to take a closer look at her case. What they found resulted in an entirely different treatment, one that had a rapid and dramatic effect on her mental state. © 1996-2013 The Washington Post
By RICHARD A. FRIEDMAN, M.D. When will we ever get depression under control? Of all the major illnesses, mental or physical, depression has been one of the toughest to subdue. Despite the ubiquity of antidepressant drugs — there are now 26 to choose from — only a third of patients with major depression will experience a full remission after the first round of treatment, and successive treatments with different drugs will give some relief to just 20 to 25 percent more. About 30 percent of people with depression have some degree of treatment resistance. And the greater the degree of resistance, the more likely a future relapse, even if the patient continues taking the drug. Although we have learned much about depression — for example, the recent research showing that the successful treatment of insomnia in depressed patients essentially doubles their response to a drug like Prozac — we still don’t understand its fundamental cause. The old idea that the disease results from a deficiency of a single neurotransmitter like serotonin or dopamine is clearly simplistic and wrong. Maybe psychiatrists and neuroscientists have something to learn from the successful hunt for the Higgs boson. Of course a debilitating disease has nothing in common with a subatomic particle, except that both are mysterious and elusive. But it was those very qualities that inspired international teams of physicists to work together for years until they finally identified the boson last year. Among biomedical scientists, who compete for the same research dollars and want to be first across the finish line with an important finding, such cooperation is hardly the norm. But there are signs that this is changing. Not long ago, I sat in at a meeting of the Hope for Depression Research Foundation. Audrey Gruss, the knowledgeable and energetic philanthropist who started the foundation, has corralled a group of senior basic and clinical neuroscientists to look for solutions. (It is not the first to try a collaborative approach; others are being sponsored by the MacArthur Foundation and the Pritzker Consortium.) Copyright 2013 The New York Times Company
Link ID: 19068 - Posted: 12.24.2013
By MICHAEL LUO and MIKE McINTIRE Last April, workers at Middlesex Hospital in Connecticut called the police to report that a psychiatric patient named Mark Russo had threatened to shoot his mother if officers tried to take the 18 rifles and shotguns he kept at her house. Mr. Russo, who was off his medication for paranoid schizophrenia, also talked about the recent elementary school massacre in Newtown and told a nurse that he “could take a chair and kill you or bash your head in between the eyes,” court records show. The police seized the firearms, as well as seven high-capacity magazines, but Mr. Russo, 55, was eventually allowed to return to the trailer in Middletown where he lives alone. In an interview there recently, he denied that he had schizophrenia but said he was taking his medication now — though only “the smallest dose,” because he is forced to. His hospitalization, he explained, stemmed from a misunderstanding: Seeking a message from God on whether to dissociate himself from his family, he had stabbed a basketball and waited for it to reinflate itself. When it did, he told relatives they would not be seeing him again, prompting them to call the police. As for his guns, Mr. Russo is scheduled to get them back in the spring, as mandated by Connecticut law. “I don’t think they ever should have been taken out of my house,” he said. “I plan to get all my guns and ammo and knives back in April.” The Russo case highlights a central, unresolved issue in the debate over balancing public safety and the Second Amendment right to bear arms: just how powerless law enforcement can be when it comes to keeping firearms out of the hands of people who are mentally ill. Connecticut’s law giving the police broad leeway to seize and hold guns for up to a year is actually relatively strict. Most states simply adhere to the federal standard, banning gun possession only after someone is involuntarily committed to a psychiatric facility or designated as mentally ill or incompetent after a court proceeding or other formal legal process. Relatively few with mental health issues, even serious ones, reach this point. © 2013 The New York Times Company
By Gary Stix Is sleep good for everything? Scientists hate giving unqualified answers. But the more sleep researchers look, the more the answer seems to be tending toward a resounding affirmative. The slumbering brain plays an essential role in learning and memory, one of the findings that sleep researchers have reinforced repeatedly in recent years. But that’s not all. There’s a growing recognition that sleep appears to be involved in regulating basic metabolic processes and even in mental health. Robert Stickgold, a leading sleep researcher based at Harvard Medical School, gives a précis here of the current state of sommeil as it relates to memory, schizophrenia, depression, diabetes—and he even explains what naps are good for. How far have we come in understanding sleep? Although we understood the function of every other basic drive 2,000 years ago, we are still struggling to figure out what the biological functions of sleep are. One of the clearest messages now is that for every two hours humans spend awake during the day, the brain needs an hour offline to process the information it takes in and figure out what to save and what to dump and how to file and what it all means. So what is sleep for? Memories are processed during sleep. But sleep doesn’t have just one function. It’s a little bit like listening to tongue researchers arguing about whether the function of the tongue has to do with taste or speech. And you want to say: ‘Guys, c’mon, it’s both.’ There’s very good evidence now that sleep, besides helping memory, has a role in immune and endocrine functions. There’s a lot of talk about to what extent the obesity epidemic is actually a consequence of too little sleep. © 2013 Scientific American
Amanda Mascarelli In children with certain gene variants, symptoms similar to common learning disabilities could be omens of serious psychiatric conditions. People who carry high-risk genetic variants for schizophrenia and autism have impairments reminiscent of disorders such as dyslexia, even when they do not yet have a mental illness, a new study has found. The findings offer a window into the brain changes that precede severe mental illness and hold promise for early intervention and even prevention, researchers say. Rare genetic alterations called copy number variants (CNVs), in which certain segments of the genome have an abnormal number of copies, play an important part in psychiatric disorders: Individuals who carry certain CNVs have a several-fold increased risk of developing schizophrenia or autism1. But previous studies were based on individuals who already have a psychiatric disorder, and until now, no one had looked at what effects these CNVs have in the general population. In a study published today in Nature2, researchers report that people with these variants but no diagnosis of autism or a mental illness still show subtle brain changes and impairments in cognitive function. “In psychiatry we always have the problem that disorders are defined by symptoms that patients experience or tell us about, or that we observe,” says study co-author Andreas Meyer-Lindenberg, a psychiatrist and the director the Central Institute of Mental Health in Mannheim, Germany, affiliated with the University of Heidelberg. This work, on the other hand, provides a glimpse into the biological underpinnings of people who are at risk of psychiatric disorders, he says. The team searched a genealogical database of more than 100,000 Icelanders, focusing on 26 genetic variants that have been shown to increase the risk of schizophrenia or autism. They found that 1,178 people in the database, or 1.16% of the sample, carried one or more of these CNVs. © 2013 Nature Publishing Group
By John Chipman, CBC News Andrew Solomon is not your typical depressive, if such a thing exists. Most people struggling with clinical depression do not like to talk about it. Depression is usually suffered in silence, because of the stigma that still clings to it. Many people still see depression as a sign of weakness, or believe that if you just cheered up or had a better attitude you'd feel so much better. Solomon has heard the wrong-headed chatter most of his life. But rather than shy away, the journalist and best-selling author wrote a book about it, detailing his own struggles with depression. It’s called The Noonday Demon: An Atlas of Depression. And he has become a vocal advocate, calling for more progressive attitudes about the disease so that people suffering from it can step out of the shadows and feel comfortable getting the help they need to survive, and to thrive. So it was with some shock and dismay that Solomon learned about Ellen Richardson, a Canadian woman turned back at the U.S. border last month because she was hospitalized last year for her depression. Richardson was told she could only enter the U.S. if a doctor — not her own, but one from a shortlist of others whom she had never met — signed a document vouching for her. She would also have to pay a fee of $500. U.S. border guards are allowed to bar anyone they deem a threat to themselves, to other Americans, or their property. They have access to police records — including even uneventful encounters with officers — but medical records are supposed to be held in the strictest confidence. © CBC 2013
By ROBERT PEAR WASHINGTON — Psychiatrists are significantly less likely than doctors in other specialties to accept insurance, researchers say in a new study, complicating the push to increase access to mental health care. The study, published Wednesday in the journal JAMA Psychiatry, found that 55 percent of psychiatrists accepted private insurance, compared with 89 percent of other doctors. Likewise, the study said, 55 percent of psychiatrists accept patients covered by Medicare, against 86 percent of other doctors. And 43 percent of psychiatrists accept Medicaid, which provides coverage for low-income people, while 73 percent of other doctors do. The lead author of the study, Dr. Tara F. Bishop of Weill Cornell Medical College in New York, said: “In the wake of the school killings in Newtown, Conn., and other recent mass shootings, the need for increased mental health services is now recognized. But unless patients have deep pockets, they may have a hard time finding a psychiatrist who will treat them.” Mental health care is one of 10 types of “essential health benefits” that must be provided by insurers under the new health care law. A federal rule issued last month requires insurers to cover care for mental health and addiction on the same terms as treatments for physical illnesses, without charging higher co-payments or deductibles or imposing stricter limits on services. Starting next year, Medicare will end a discriminatory policy that for decades has required people to pay a larger share of the bill for mental health care than for other outpatient services. However, the study suggests that expanding coverage may not by itself guarantee access to psychiatrists. “Even if you have good insurance that covers mental health care, you may still have a problem if there’s no doctor who accepts your insurance,” Dr. Bishop said. © 2013 The New York Times Company
By Jeanene Swanson Depression strikes some 35 million people worldwide, according to the World Health Organization, contributing to lowered quality of life as well as an increased risk of heart disease and suicide. Treatments typically include psychotherapy, support groups and education as well as psychiatric medications. SSRIs, or selective serotonin reuptake inhibitors, currently are the most commonly prescribed category of antidepressant drugs in the U.S., and have become a household name in treating depression. The action of these compounds is fairly familiar. SSRIs increase available levels of serotonin, sometimes referred to as the feel-good neurotransmitter, in our brains. Neurons communicate via neurotransmitters, chemicals which pass from one nerve cell to another. A transporter molecule recycles unused transmitter and carries it back to the pre-synaptic cell. For serotonin, that shuttle is called SERT (short for “serotonin transporter”). An SSRI binds to SERT and blocks its activity, allowing more serotonin to remain in the spaces between neurons. Yet, exactly how this biochemistry then works against depression remains a scientific mystery. In fact, SSRIs fail to work for mild cases of depression, suggesting that regulating serotonin might be an indirect treatment only. “There’s really no evidence that depression is a serotonin-deficiency syndrome,” says Alan Gelenberg, a depression and psychiatric researcher at The Pennsylvania State University. “It’s like saying that a headache is an aspirin-deficiency syndrome.” SSRIs work insofar as they reduce the symptoms of depression, but “they’re pretty nonspecific,” he adds. © 2013 Scientific American
Link ID: 19020 - Posted: 12.11.2013
Someday, a smart phone app that asks what you’re feeling 10 times a day may be able to tell you if you’re edging closer to depression—and recommend that you seek preventive therapy or drugs. Scientists have discovered that how quickly someone bounces back from negative feelings, over hours or days, can predict whether that person is at risk of an episode of major depressive disorder. “The holy grail of depression epidemiology is that we want to intervene early to prevent people from having depressive episodes,” says social scientist Stephen Gilman of Harvard University, who was not involved in the study. “Where this work is headed is making an advance in that direction, toward early detection and therefore early intervention.” Researchers asked more than 600 people—some healthy and some with a diagnosis of depression—to track their emotions for 5 or 6 days. Ten times a day, at random intervals, a watch would beep and the subjects would record how strongly they identified with each of four emotions: cheerful, content, sad, and anxious. Six to 8 weeks later, participants filled out a more detailed questionnaire that rated their levels of clinical depression. By the end of the follow-up period, about 13% of the subjects had experienced a shift toward being more depressed, a number consistent with what would be expected in the general population. Trends in the daily mood records, the team discovered, could predict whether a previously healthy person would make that shift toward depression. © 2013 American Association for the Advancement of Science
Link ID: 19015 - Posted: 12.10.2013