Links for Keyword: Schizophrenia

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By PAULINE W. CHEN, M.D. One afternoon at a school not far from the hospital where I was working, a teacher opened a utility closet and found a staff member passed out on the floor. He was clutching a small bloody mass in one hand, a sharp knife in the other, she reported, a red stain spreading rapidly at his middle. He had amputated his genitals. Once he’d been brought to our emergency room and resuscitated, the man refused further treatment. Doctors and nurses, concerned that if they waited any longer to reattach the severed part the surgery might not work, took the necessary steps to deem him mentally incompetent to make such decisions. “The guy was seriously nuts,” I remember one of the doctors saying afterward. “He kept screaming that he didn’t want ‘it’ back.” For days after the successful operation, the gruesome story was all anyone at the hospital could discuss. Most of us chalked it up to his being “certifiable,” and several wondered if maybe they should have skipped the surgery. “After all,” said one clinician, “isn’t that what he wanted?” But in all the chatter none of us mentioned a key part of the patient’s story: the unbearable suffering that must have pushed him to commit so brutal an act. In fact, anyone overhearing our conversations might have been hard pressed to find any of the warmth and sensitivity we routinely displayed toward patients with cancer, AIDS or heart disease. I remembered the man and our reactions this past week while reading “Falling Into the Fire: A Psychiatrist’s Encounters With the Mind in Crisis,” a thought-provoking new book by Dr. Christine Montross. Of all the afflictions that fall upon us, few remain as misunderstood and stigmatized as those that affect the mind. Copyright 2013 The New York Times Company

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 12: Sex: Evolutionary, Hormonal, and Neural Bases
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders; Chapter 8: Hormones and Sex
Link ID: 18648 - Posted: 09.16.2013

By Brian Mossop A fine line separates creativity and madness. Bipolar disorder teeters along that line, with patients experiencing moments of impulsive thought, which can yield bold insights or quickly descend into confusion or rage. In her new book, Haldol and Hyacinths, Iranian-American author and activist Moezzi presents a captivating autobiographical account of her struggle with bipolar disorder. Using a series of vignettes, she reconstructs her downward spiral into psychosis, which eventually led to a suicide attempt and multiple stays in mental health facilities. From seemingly innocuous bouts of insomnia to full-blown hallucinations, Moezzi describes how she descended into madness. Moezzi's medical issues first emerged in her sophomore year of college, when she began to experience severe abdominal pain, later diagnosed as pancreatitis. Doctors decided to remove her pancreas to save her life and prevent a cyst from festering. Everyone she knew rallied alongside her during this time. Things were much different when Moezzi's bipolar disorder took hold in the years following her physical illness. She soon discovered that mental illness has no heroes, no celebrity spokesperson, no champions. Relying solely on the support of her immediate family and a devoted husband, Moezzi saw that the disorder carries a stigma, exacerbated by inaccurate media portrayals. Even worse is the plight of patients in places such as Moezzi's homeland of Iran, where mental illness is simply ignored. Despite bipolar disorder being the sixth leading cause of disability in the world, there is not even a word for the disease in Farsi. © 2013 Scientific American

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders
Link ID: 18559 - Posted: 08.26.2013

By Fred Guterl Myths can be more harmful than lies, Nobel laureate Harry Kroto has said, because they are more difficult to recognize and often go unexamined. For many years, a diagnosis of schizophrenia was like a prison sentence, because many people (some of them in the medical profession) held to the notion that a schizophrenic could not recover from the illness and was condemned to an inexorable decline into madness. Like any myth, this one had some truth to it. Many people with severe symptoms do not recover. But some can, as Eleanor Longden discovered for herself. Longden began hearing voices when she was an undergraduate. At first they were somewhat benign, making mostly neutral, factual comments, but they grew more troublesome as she struggled to adjust to college life. Longden was diagnosed as schizophrenic and underwent conventional treatment. By her own account, in “Listening to Voices” in the September/October 2013 issue of Scientific American MIND, the label of schizophrenic and the attitudes of those around her to that label exacerbated her own internal struggles. The voices grew more menacing. Longden began her own slide into madness. But then something odd happened: she began to recover. She did so in part, she says, by accepting the voices in her head as an aspect of her own personality. She listened to them, and tried to understand them. In this way she was able to tame them, and she got enough control over her life to attend school and pursue her graduate studies. © 2013 Scientific American

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders
Link ID: 18481 - Posted: 08.10.2013

By CHRISTINE MONTROSS PROVIDENCE, R.I. — M is a 33-year old woman who swallowed silverware. She wasn’t psychotic, or out of touch with reality. She knew it was not a good idea to swallow forks and knives and she wasn’t trying to kill herself. In fact, each time she ingested utensils, she went to the emergency room so that doctors could remove them from her esophagus and stomach. Then the hospital transferred M to the psychiatric unit, where she was assigned to my care. Enlarge This Image Robert Frank Hunter When I met M she had already been hospitalized 72 times. She’d swallowed silverware — and batteries — before. Sometimes she inserted sharp objects or large doses of medication into her vagina. There are psychiatric patients who cut or burn themselves in an attempt to relieve mental anguish; M did both of these things, too, periodically, but she had primarily developed a maladaptive habit of ingesting or inserting dangerous objects into her body as a means of coping with stress. Each time, she said, she felt better afterward. Then she brought herself to the emergency room for treatment. M’s case is dramatic. But she is one of countless psychiatric patients who have nowhere to turn for care, other than the E.R. It is well known that millions of uninsured Americans, who can’t afford regular medical care, use the country’s emergency rooms for primary health care. The costs — to patients’ health, to their wallets, and to the health care system — are well documented. Less visible is the grievous effect this shift is having on psychiatric care and on the mentally ill. © 2013 The New York Times Company

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders
Link ID: 18457 - Posted: 08.05.2013

Steve Connor A gene thought to be involved in nerve development can double the risk of schizophrenia when it is damaged, according to a pioneering study into one of most costly mental illnesses. The findings are further evidence of a genetic basis for schizophrenia – which affects about one in every 100 people at some time of their lives – and could lead to a greater understanding of the physical faults that might lead to the psychiatric disorder in some susceptible people. The chronic, long-term illness, which results in persistent delusions and hallucinations, is estimated to cost the NHS about £2bn a year in care and treatment alone. But the extra burden on patients, their families and the criminal justice system is thought to be at least twice as high. Scientists said the genetic fault they have discovered is also associated with a separate inherited disorder that results in learning difficulties and autism. This link, they said, is probably the result of them sharing a common biological pathway at the genetic level. The gene linked to schizophrenia, called TOP3B, is normally involved in unwinding the DNA double helix to allow other genes to function, especially when the nerve cells of the brain are developing, both in the womb and during the crucial first years of life. © independent.co.uk

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders
Link ID: 18456 - Posted: 08.05.2013

Researchers have reverse-engineered the outlines of a disrupted prenatal gene network in schizophrenia, by tracing spontaneous mutations to where and when they likely cause damage in the brain. Some people with the brain disorder may suffer from impaired birth of new neurons, or neurogenesis, in the front of their brain during prenatal development, suggests the study, which was funded by the National Institutes of Health. “Processes critical for the brain’s development can be revealed by the mutations that disrupt them,” explained Mary-Claire King, Ph.D. External Web Site Policy, University of Washington (UW), Seattle, a grantee of NIH’s National Institute of Mental Health (NIMH). “Mutations can lead to loss of integrity of a whole pathway, not just of a single gene. Our results implicate networked genes underlying a pathway responsible for orchestrating neurogenesis in the prefrontal cortex in schizophrenia.” King, and collaborators at UW and seven other research centers participating in the NIMH genetics repository, report on their discovery Aug. 1, 2013 in the journal Cell. “By linking genomic findings to functional measures, this approach gives us additional insight into how early development differs in the brain of someone who will eventually manifest the symptoms of psychosis,” said NIMH Director Thomas R. Insel, M.D. Earlier studies had linked spontaneous mutations to non-familial schizophrenia and traced them broadly to genes involved in brain development, but little was known about convergent effects on pathways.

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders
Link ID: 18446 - Posted: 08.03.2013

By PAM BELLUCK For some people with severe mental illness, life is a cycle of hospitalization, skipped medication, decline and then rehospitalization. They may deny they have psychiatric disorders, refuse treatment and cascade into out-of-control behavior that can be threatening to themselves or others. Now, a study has found that a controversial program that orders these patients to receive treatment when they are not hospitalized has had positive results. Patients were much less likely to end up back in psychiatric hospitals and were arrested less often. Use of outpatient treatment significantly increased, as did refills of medication. Costs to the mental health system and Medicaid of caring for these patients dropped by half or more. The study evaluated the program run by New York State, known as Kendra’s Law because it was enacted after Kendra Webdale was pushed to her death on the New York City subway tracks by a man with untreated schizophrenia in 1999. Forty-four other states have some form of Kendra’s Law, but New York’s is by far the most developed because the state has invested significant resources into paying for it, experts say. From the start, Kendra’s Law has had staunch defenders and detractors. But the new analysis, led by researchers at Duke University and published in The American Journal of Psychiatry, joins a series of studies that suggest the program can be helpful for patients who, while they constitute only a small number of the people with mental illness, are some of the most difficult and expensive to care for. © 2013 The New York Times Company

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 15: Emotions, Aggression, and Stress
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders; Chapter 11: Emotions, Aggression, and Stress
Link ID: 18436 - Posted: 07.31.2013

by Douglas Heaven Putting a digital face to the abusive voices in their head could help people with schizophrenia. Results of a preliminary trial, announced today at the Wellcome Trust in London, demonstrated how people with schizophrenia could overcome their auditory hallucinations by conversing with an avatar representation of the voice in their head. At the start of the trial, 16 people with schizophrenia created an on-screen avatar that best matched what they imagined the voice in their head to look like – much like a police photo-fit. They then chose a male or female voice closely resembling the one they hear. By conversing with a therapist via the avatar, the volunteers reported reduced levels of distress and higher self-esteem. Three people stopped hearing the hallucinatory voice altogether – including one who had lived with it for 16 years. Hearing voices is a common symptom of schizophrenia, which affects about 1 per cent of the population worldwide. The hallucinations can stop people from thinking clearly and prevent them from working and sustaining social relationships. The voices are also typically abusive, telling the person to harm themselves or others. "It's hard to imagine what it's like to hear a disembodied voice," says Julian Leff at University College London, who led the trial. People often say that the helplessness is the worst thing, he says. They cannot control the voices and they feel dominated. © Copyright Reed Business Information Ltd.

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders
Link ID: 18203 - Posted: 05.30.2013

Scientists have reversed behavioral and brain abnormalities in adult mice that resemble some features of schizophrenia by restoring normal expression to a suspect gene that is over-expressed in humans with the illness. Targeting expression of the gene Neuregulin1, which makes a protein important for brain development, may hold promise for treating at least some patients with the brain disorder, say researchers funded by the National Institutes of Health. Like patients with schizophrenia, adult mice biogenetically-engineered to have higher Neuregulin 1 levels showed reduced activity of the brain messenger chemicals glutamate and GABA. The mice also showed behaviors related to aspects of the human illness. For example, they interacted less with other animals and faltered on thinking tasks. “The deficits reversed when we normalized Neuregulin 1 expression in animals that had been symptomatic, suggesting that damage which occurred during development is recoverable in adulthood,” explained Lin Mei, M.D., Ph.D.External Web Site Policy , of the Medical College of Georgia at Georgia Regents University, a grantee of NIH’s National Institute of Mental Health (NIMH). “While mouse models can’t really do full justice to a complex brain disorder that impairs our most uniquely human characteristics, this study demonstrates the potential of dissecting the workings of intermediate components of disorders in animals to discover underlying mechanisms and new treatment targets,” said NIMH Director Thomas R. Insel, M.D. “Hopeful news about how an illness process that originates early in development might be reversible in adulthood illustrates the promise of such translational research.” Schizophrenia is thought to stem from early damage to the developing fetal brain, traceable to a complex mix of genetic and environmental causes. Although genes identified to date account for only a small fraction of cases, evidence has implicated variation in the Neuregulin 1 gene. For example, postmortem studies have found that it is overexpressed in the brain's thinking hub, or prefrontal cortex, of some people who had schizophrenia. It codes for a chemical messenger that plays a pivotal role in communication between brain cells, as well as in brain development.

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 7: Life-Span Development of the Brain and Behavior
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders; Chapter 13: Memory, Learning, and Development
Link ID: 18186 - Posted: 05.23.2013

By Jeffrey A. Lieberman Like many psychiatrists, I have been amazed by the debates surrounding the DSM-5, the first major revision of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders in nearly twenty years, which was just released. Never before has a thick medical text of diagnostic nomenclature been the subject of so much attention. Although I was heartened to see more and more people discussing the real-world issues and challenges—for patients, families, clinicians and caregivers–within mental health care, for which the book offers an up-to-the-minute diagnostic GPS, I was also alarmed at the harsh criticism of the field of psychiatry and the APA. Consequently, I believe that as you read and watch this increased coverage, it’s important to understand the difference between thoughtful, legitimate debate, and the inevitable outcry from a small group of critics –made louder by social media and support from dubious sources —who have relentlessly sought to undermine the credibility of psychiatric medicine and question the validity of mental illness.. DSM-5 has ignited a broad dialogue on mental illness and opened up a conversation about the state of psychiatry and mental healthcare in this country. Critiques have ranged in focus from the inclusion of specific disorders in DSM-5, to the concern over a lack of biological measures which define them. Some have even questioned the entire diagnostic system, urging us to look with an eye focused on the impact to patients. These are the kinds of debate that I hope will continue long after DSM-5’s shiny cover becomes warn and wrinkled. Such meaningful discourse only fuels our ability to produce a manual that best serves those touched by mental illness. But there’s another type of critique that does not contribute to this goal. These are the groups who are actually proud to identify themselves as “anti-psychiatry.” © 2013 Scientific American

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders
Link ID: 18175 - Posted: 05.21.2013

Pregnant mothers’ exposure to the flu was associated with a nearly fourfold increased risk that their child would develop bipolar disorder in adulthood, in a study funded by the National Institutes of Health. The findings add to mounting evidence of possible shared underlying causes and illness processes with schizophrenia, which some studies have also linked to prenatal exposure to influenza. “Prospective mothers should take common sense preventive measures, such as getting flu shots prior to and in the early stages of pregnancy and avoiding contact with people who are symptomatic,” said Alan Brown, M.D., M.P.H, of Columbia University and New York State Psychiatric Institute, a grantee of the NIH’s National Institute of Mental Health (NIMH). “In spite of public health recommendations, only a relatively small fraction of such women get immunized. The weight of evidence now suggests that benefits of the vaccine likely outweigh any possible risk to the mother or newborn.” Brown and colleagues reported their findings online May 8, 2013 in JAMA Psychiatry. Although there have been hints of a maternal influenza/bipolar disorder connection, the new study is the first to prospectively follow families in the same HMO, using physician-based diagnoses and structured standardized psychiatric measures. Access to unique Kaiser-Permanente, county and Child Health and Development Study External Web Site Policy databases made it possible to include more cases with detailed maternal flu exposure information than in previous studies.

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 7: Life-Span Development of the Brain and Behavior
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders; Chapter 13: Memory, Learning, and Development
Link ID: 18154 - Posted: 05.14.2013

Heidi Ledford Nassir Ghaemi, director of the Mood Disorders Program at Tufts Medical Center in Boston, Massachusetts, has felt shackled by the Diagnostic and Statistical Manual of Mental Disorders (DSM), often called the bible of psychiatry. Some of his depressed patients occasionally show manic behaviour but do not fulfil the DSM’s criteria for a diagnosis of bipolar disorder. Ghaemi is interested in whether such patients might respond better to drugs for bipolar disorder than for depression. But his colleagues warned him against straying from the DSM when he applied for funding at the US National Institute of Mental Health (NIMH), because peer reviewers tended to insist on research that hewed to DSM categories. Ghaemi held off from applying. If NIMH director Thomas Insel has his way, Ghaemi and other mental-health researchers will no longer feel the weight of the DSM. “NIMH will be re-orienting its research away from DSM categories,” Insel wrote in a blog entry on 29 April. The latest edition, the DSM-5, will be unveiled on 22 May at the annual meeting of the American Psychiatric Association in San Francisco, California. Like many psychiatrists, Insel questions whether the DSM’s categories accurately reflect the way the brain works. He is pushing a project that aims to create a new framework that classifies mental-health disorders according to their biological roots. “Going forward, we will be supporting research projects that look across current categories — or sub-divide current categories — to begin to develop a better system,” Insel wrote. The blog post made waves in the media and rattled some psychiatric clinicians and researchers. But Insel says that he has been talking about the issue since 2008. “The word was just still not out there,” he says. Insel says that he has increasingly received complaints from grant applicants who have tried to follow his guidance, only to be shot down by peer reviewers for eschewing DSM scripture. © 2013 Nature Publishing Group

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders
Link ID: 18144 - Posted: 05.11.2013

by Claudia M Gold It seems that the National Institute of Mental Health (NIMH) may have dealt a death blow to the recently published Diagnostic and Statistical Manual of Mental Disorders (DSM 5) when the organization declared they would no longer fund research based on the DSM system of diagnosis. The views of NIMH director Thomas Insel were referenced in the recent New York Times article on the subject. His goal was to reshape the direction of psychiatric research to focus on biology, genetics and neuroscience so that scientists can define disorders by their causes, rather than their symptoms. I am no fan of the DSM system, which reduces complex experience to lists of symptoms; focusing on the "what" rather than the "why." However, the NIMH model has limits as well. There seems to be a wish to study mental illness in the same way we study cancer or diabetes. While I certainly have great respect for the complexity of the pancreas, or the process of malignant transformation of cells, trying to understand the brain/mind in an analogous way seems to be an unnecessary and even undesirable reduction of human experience. What is missing from both paradigms is recognition of the relational and historical context of being human. Fortunately there seems to be awareness that neither paradigm is complete. The Times article goes on to say: Dr. Insel is one of a growing number of scientists who think that the field needs an entirely new paradigm for understanding mental disorders, though neither he nor anyone else knows exactly what it will look like. © 2013 NY Times Co.

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders
Link ID: 18143 - Posted: 05.11.2013

By James Gallagher Health and science reporter, BBC News Flu during pregnancy may increase the risk of the unborn child developing bipolar disorder later in life, research suggests. A study of 814 expectant women, published in JAMA Psychiatry, showed that infection made bipolar four times more likely. The overall risk remained low, but it echoes similar findings linking flu and schizophrenia. Experts said the risks were small and women should not worry. Bipolar leads to intense mood swings, which can last months, ranging from depression and despair to manic feelings of joy, overactivity and loss of inhibitions. Researchers at the Columbia University Medical Center identified a link between the condition, often diagnosed during late teens and twenties, and experiences in the womb. In their study looking at people born in the early 1960s, bipolar disorder was nearly four times as common in people whose mothers caught flu during pregnancy. The condition affects about one in 100 people. The lead researcher, Prof Alan Brown, estimated that influenza infection during pregnancy could lead to a 3-4% chance of bipolar disorder in the resulting children. However, in the vast majority of cases of bipolar disorder there would no history of flu. BBC © 2013

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 7: Life-Span Development of the Brain and Behavior
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders; Chapter 13: Memory, Learning, and Development
Link ID: 18135 - Posted: 05.09.2013

By PAM BELLUCK and BENEDICT CAREY Just weeks before the long-awaited publication of a new edition of the so-called bible of mental disorders, the federal government’s most prominent psychiatric expert has said the book suffers from a scientific “lack of validity.” The expert, Dr. Thomas R. Insel, director of the National Institute of Mental Health, said in an interview Monday that his goal was to reshape the direction of psychiatric research to focus on biology, genetics and neuroscience so that scientists can define disorders by their causes, rather than their symptoms. While the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., is the best tool now available for clinicians treating patients and should not be tossed out, he said, it does not reflect the complexity of many disorders, and its way of categorizing mental illnesses should not guide research. “As long as the research community takes the D.S.M. to be a bible, we’ll never make progress,” Dr. Insel said, adding, “People think that everything has to match D.S.M. criteria, but you know what? Biology never read that book.” The revision, known as the D.S.M.-5 and the first since 1994, has stirred unprecedented questioning from the public, patient groups and, most fundamentally, senior figures in psychiatry who have challenged not only decisions about specific diagnoses but the scientific basis of the entire enterprise. Basic research into the biology of mental disorders and treatment has stalled, they say, confounded by the labyrinth of the brain. © 2013 The New York Times Company

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders
Link ID: 18128 - Posted: 05.07.2013

by Emily Underwood The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—slated for release this month—has lost a major customer before even going to print. Thomas Insel, director of the National Institute of Mental Health (NIMH), declared last week on his blog that the institution will no longer use the manual to guide its research. Instead, NIMH is working on a long-term plan to develop new diagnostic criteria and treatments based on genetic, physiologic, and cognitive data rather than symptoms alone. Insel's pronouncement is the most recent hit in a long barrage of criticism that has rained down upon the latest DSM revision process since it began over a decade ago. "While DSM has been described as a 'Bible' for the field," he wrote, "it is, at best, a dictionary, creating a set of labels and defining each." Although the manual's strength has been to standardize these labels, he wrote, "[t]he weakness is its lack of validity," and "[p]atients with mental disorders deserve better." Although Insel's blog was reported as a "bombshell," and "potentially seismic," NIMH's decision to scrap the DSM criteria has been public for several years, says Bruce Cuthbert, director of NIMH's Division of Adult Translational Research and Treatment Development. In 2010, the agency began to steer researchers away from the traditional categories of DSM by posting new guidance for grant proposals in five broad areas. Rather than grouping disorders such as schizophrenia and depression by symptom, the new categories focus on basic neural circuits and cognitive functions, such as those for reward, arousal, and attachment. © 2010 American Association for the Advancement of Science.

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders
Link ID: 18127 - Posted: 05.07.2013

By John Horgan What is mental illness? Schizophrenia? Autism? Bipolar disorder? Depression? Since the 1950s, the profession of psychiatry has attempted to provide definitive answers to these questions in the Diagnostic and Statistical Manual of Mental Disorders. Often called The Bible of psychiatry, the DSM serves as the ultimate authority for diagnosis, treatment and insurance coverage of mental illness. Now, in a move sure to rock psychiatry, psychology and other fields that address mental illness, the director of the National Institutes of Mental Health has announced that the federal agency–which provides grants for research on mental illness–will be “re-orienting its research away from DSM categories.” Thomas Insel’s statement comes just weeks before the scheduled publication of the DSM-V, the fifth edition of the Diagnostic and Statistical Manual. Insel writes: “While DSM has been described as a ‘Bible’ for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been ‘reliability’–each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment. Patients with mental disorders deserve better.” © 2013 Scientific American

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 7: Life-Span Development of the Brain and Behavior
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders; Chapter 13: Memory, Learning, and Development
Link ID: 18120 - Posted: 05.06.2013

By Ferris Jabr This month the American Psychiatric Association (APA) will publish the fifth edition of its guidebook for clinicians, the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5. Researchers around the world have eagerly anticipated the new manual, which, in typical fashion, took around 14 years to revise. The DSM describes the symptoms of more than 300 officially recognized mental illnesses—depression, bipolar disorder, schizophrenia and others—helping counselors, psychiatrists and general care practitioners diagnose their patients. Yet it has a fundamental flaw: it says nothing about the biological underpinnings of mental disorders. In the past, that shortcoming reflected the science. For most of the DSM's history, investigators have not had a detailed understanding of what causes mental illness. That excuse is no longer valid. Neuroscientists now understand some of the ways that brain circuits for memory, emotion and attention malfunction in various mental disorders. Since 2009 clinical psychologist Bruce Cuthbert and his team at the National Institute of Mental Health have been constructing a classification system based on recent research, which is revealing how the structure and activity of a mentally ill brain differs from that of a healthy one. The new framework will not replace the DSM, which is too important to discard, Cuthbert says. Rather he and his colleagues hope that future versions of the guide will incorporate information about the biology of mental illness to better distinguish one disorder from another. Cuthbert, whose project may receive additional funding from the Obama administration's planned Brain Activity Map initiative, is encouraging researchers to study basic cognitive and biological processes implicated in many types of mental illness. Some scientists might explore how and why the neural circuits that detect threats and store fearful memories sometimes behave in unusual ways after traumatic events—the kinds of changes that are partially responsible for post-traumatic stress disorder. Others may investigate the neurobiology of hallucinations, disruptions in circadian rhythms, or precisely how drug addiction rewires the brain. © 2013 Scientific American

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders
Link ID: 18101 - Posted: 05.01.2013

By LINDA LOGAN The last time I saw my old self, I was 27 years old and living in Boston. I was doing well in graduate school, had a tight circle of friends and was a prolific creative writer. Married to my high-school sweetheart, I had just had my first child. Back then, my best times were twirling my baby girl under the gloaming sky on a Florida beach and flopping on the bed with my husband — feet propped against the wall — and talking. The future seemed wide open. I don’t think there is a particular point at which I can say I became depressed. My illness was insidious, gradual and inexorable. I had a preview of depression in high school, when I spent a couple of years wearing all black, rimming my eyes in kohl and sliding against the walls in the hallways, hoping that no one would notice me. But back then I didn’t think it was a very serious problem. The hormonal chaos of having three children in five years, the pressure of working on a Ph.D. dissertation and a genetic predisposition for a mood disorder took me to a place of darkness I hadn’t experienced before. Of course, I didn’t recognize that right away. Denial is a gauze; willful denial, an opiate. Everyone seemed in league with my delusion. I was just overwhelmed, my family would say. I should get more help with the kids, put off my Ph.D. When I told other young mothers about my bone-wearying fatigue, they rolled their eyes knowingly and mumbled, “Right.” But what they didn’t realize was that I could scarcely push the stroller to the park, barely summon the breath to ask the store clerk, “Where are the Pampers?” I went from doctor to doctor, looking for the cause. Lab tests for anemia, low blood sugar and hypothyroidism were all negative. © 2013 The New York Times Company

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders
Link ID: 18085 - Posted: 04.28.2013

Sunanda Creagh, The Conversation Testosterone may trigger a brain chemical process linked to schizophrenia but the same sex hormone can also improve cognitive thinking skills in men with the disorder, two new studies show. Scientists have long suspected testosterone plays an important role in schizophrenia, which affects more men than women. Men are also more likely to develop psychosis in adolescence, previous research has shown. A new study on lab rodents by researchers from Neuroscience Research Australia analysed the impact increased testosterone had on levels of dopamine, a brain chemical linked to psychotic symptoms of schizophrenia. The researchers found that testosterone boosted dopamine sensitivity in adolescent male rodents. “From these rodent studies, we hypothesise that adolescent increases in circulating testosterone may be a driver of increased dopamine activity in the brains of individuals susceptible to psychosis and schizophrenia,” said senior Neuroscience Research Australia researcher and author of the study, Dr Tertia Purves-Tyson, who is presenting her work at the International Congress on Schizophrenia Research in Florida. Dr Philip Mitchell, Scientia Professor and Head of the School of Psychiatry at the University of NSW, said the research was very interesting. © 2013 ScienceAlert Pty Ltd.

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 12: Sex: Evolutionary, Hormonal, and Neural Bases
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders; Chapter 8: Hormones and Sex
Link ID: 18076 - Posted: 04.27.2013