Chapter 12. Psychopathology: Biological Basis of Behavioral Disorders

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By NICHOLAS BAKALAR A large study has linked several common anti-anxiety drugs and sleeping pills to an increased risk of death, although it’s not certain the drugs were the cause. For more than seven years, researchers followed 34,727 people who filled prescriptions for anti-anxiety medications like Valium and Xanax, or sleep aids like Ambien, Sonata and Lunesta, comparing them with 69,418 controls who did not. After adjusting for a wide variety of factors, the researchers found that people who took the drugs had more than double the risk of death. The study appears online in BMJ. The researchers tried to account for the use of other prescribed drugs, age, smoking, alcohol use, socioeconomic status, and other health and behavioral characteristics. Most important, the investigators also controlled for sleep disorders, anxiety disorders and other psychiatric illnesses, all of which are risk factors for mortality. The lead author, Dr. Scott Weich, a professor of psychiatry at the University of Warwick, said that while he and his colleagues were careful to account for as many potential risks as possible, they were not able to control for the severity of the illnesses suffered by the study participants. Still, he said, the research “adds to an accumulating body of evidence that these drugs are dangerous.” He added: “I prescribe these drugs, and they are difficult to come off. The less time you spend on them the better.” © 2014 The New York Times Company

Keyword: Depression; Aggression
Link ID: 19419 - Posted: 03.29.2014

by Colin Barras What a nerve! Skin cells taken from people with bipolar disorder have been turned into brain cells. These in turn are offering up clues about the changes in the brain that drive the disorder, and may also provide a way to test new treatments. About three in every 100 people develop bipolar disorder – a mental illness characterised by episodes of depression and euphoria. But the condition remains poorly understood. That's because it would be too invasive to obtain and study viable nerve cells from the brains of people with the condition. There are also no good animal models, because bipolar disorder – although highly heritable – has, for the most part, not been linked to any specific genes that can be studied using animals. "People say the condition is probably the result of a lot of small contributions by multiple genes," says Sue O'Shea at the University of Michigan in Ann Arbor. Now O'Shea and her colleagues may have found an ethical way to make a genetic model of the condition. First, they took skin samples from 22 people with bipolar disorder and 10 healthy volunteers. They induced these adult skin cells to return to a stem-cell-like state, creating what are called induced pluripotent stem cells (iPSCs) and then encouraged these cells to mature into neurons. O'Shea was surprised to find that neurons derived from people with bipolar disorder grew differently from those from people without the condition. "I was expecting it would take decades of careful science before we would find any real differences," she says. © Copyright Reed Business Information Ltd.

Keyword: Schizophrenia; Aggression
Link ID: 19412 - Posted: 03.26.2014

By Gisela Telis, Jodi Corbitt had been battling depression for decades and by 2010 had resigned herself to taking antidepressant medication for the rest of her life. Then she decided to start a dietary experiment. To lose weight, the 47-year-old Catonsville, Md., mother stopped eating gluten, a protein found in wheat and related grains. Within a month she had shed several pounds — and her lifelong depression. “It was like a veil lifted and I could see life more clearly,” she recalled. “It changed everything.” Corbitt had stumbled into an area that scientists have recently begun to investigate: whether food can have as powerful an impact on the mind as it does on the body. Research exploring the link between diet and mental health “is a very new field; the first papers only came out a few years ago,” said Michael Berk, a professor of psychiatry at the Deakin University School of Medicine in Australia. “But the results are unusually consistent, and they show a link between diet quality and mental health.” “Diet quality” refers to the kinds of foods that people eat, how often they eat them and how much of them they eat. In several studies, including a 2011 analysis of more than 5,000 Norwegians, Berk and his collaborators have found lower rates of depression, anxiety and bipolar disorder among those who consumed a traditional diet of meat and vegetables than among people who followed a modern Western diet heavy with processed and fast foods or even a health-food diet of tofu and salads. © 1996-2014 The Washington Post

Keyword: Depression
Link ID: 19403 - Posted: 03.25.2014

By Ariana Eunjung Cha, Millions of ordinary Americans are now able to walk into a marijuana dispensary and purchase bags of pot on the spot for a variety of medical ailments. But if you’re a researcher like Sue Sisley, a psychiatrist who studies post- traumatic stress disorder, getting access to the drug isn’t nearly so easy. That’s because the federal government has a virtual monopoly on growing and cultivating marijuana for scientific research, and getting access to the drug requires three separate levels of approval. Marijuana offers hope for 6-year-old girl with rare condition: In marijuana, Lydia Schaeffer’s family members think they might have found a treatment that works. Now, they are trying to help legalize the drug. Sisley’s fight to get samples for her study — now in its fourth month — illuminates the complex politics of marijuana in the United States. While 20 states and the District have made medical marijuana legal — in Colorado and Washington state the drug is also legal for recreational use — it remains among the most tightly controlled substances under federal law. For scientists, that means extra steps to obtain, transport and secure the drug — delays they say can slow down their research by months or even years. © 1996-2014 The Washington Post

Keyword: Drug Abuse; Aggression
Link ID: 19396 - Posted: 03.22.2014

Sara Reardon Thomas Insel, the director of the US National Institute of Mental Health (NIMH), has had enough of shooting in the dark. He thinks that if a clinical trial of a psychiatric therapy fails, scientists should at least learn something about the brain along the way. Now Insel is translating that belief into action: the NIMH, based in Bethesda, Maryland, has decided to stop funding clinical trials that aim merely to ease patients’ symptoms. “Future trials will follow an experimental medicine approach in which interventions serve not only as potential treatments, but as probes to generate information about the mechanisms underlying a disorder”, he wrote in a 27 February blog post announcing the move. This funding switch, which will affect grants due to be made in a few months’ time, intensifies the NIMH’s apparent shift in emphasis from abstract psychiatry to the neurobiological roots of disease. “It’s a totally new departure for us,” says Bruce Cuthbert, a clinical psychologist and director of the institute’s adult translational-research division. Insel notes that the NIMH spent about US$100 million on clinical trials in 2013, and says that more than half of recipient projects received funding without any requirement to examine the biological processes involved in a disease. In many cases, “if you get a negative result you have no idea why, and you have to try something else at random”, Cuthbert says. “It’s an incredible waste of money.” The new rules, which will apply to the grant cycle that begins in June, also seek to increase transparency by requiring faster online registration of trials and stricter guidelines for reporting results. Insel acknowledges that researchers may have to rework their studies to satisfy the new guidelines. “I think this will be really unpopular,” he says. © 2014 Nature Publishing Group

Keyword: Schizophrenia; Aggression
Link ID: 19367 - Posted: 03.15.2014

by Clare Wilson ARE people with obsessive compulsive disorder addicted to their repetitive behaviours? In a test designed to measure decision-making, individuals with OCD performed much like gambling addicts, suggesting their underlying brain problems may be similar. OCD makes people worry obsessively, compelling them to carry out rituals like repeated hand washing. It affects about one in 50 people and can take over their lives. Because sufferers get anxious if they can't complete their rituals, OCD is usually treated as an anxiety disorder with talking therapies to relieve distress or anti-anxiety drugs. These approaches reduce symptoms but only a minority of people are cured. In the new study, 80 people – half of whom had OCD – had to choose cards from four decks, winning or losing money in the process. Two decks were rigged to produce big wins but even bigger losses. The people without OCD learned to choose from the two safer decks but those with the disorder were consistently less likely to make good judgements and finished with a significantly lower final score. Drug and gambling addicts also perform poorly on the test. That doesn't prove OCD is an addiction but a growing body of work, including brain scans and other cognitive tests, suggest it should be recast in this way, says Naomi Fineberg of the University of Hertfordshire in Welwyn Garden City. Both addiction and OCD "share a lack of control of behaviour", she says. © Copyright Reed Business Information Ltd.

Keyword: OCD - Obsessive Compulsive Disorder; Aggression
Link ID: 19356 - Posted: 03.13.2014

Imagine that, after feeling unwell for a while, you visit your GP. "Ah," says the doctor decisively, "what you need is medication X. It's often pretty effective, though there can be side-effects. You may gain weight. Or feel drowsy. And you may develop tremors reminiscent of Parkinson's disease." Warily, you glance at the prescription on the doctor's desk, but she hasn't finished. "Some patients find that sex becomes a problem. Diabetes and heart problems are a risk. And in the long term the drug may actually shrink your brain … " This scenario may sound far-fetched, but it is precisely what faces people diagnosed with schizophrenia. Since the 1950s, the illness has generally been treated using antipsychotic drugs – which, as with so many medications, were discovered by chance. A French surgeon investigating treatments for surgical shock found that one of the drugs he tried – the antihistamine chlorpromazine – produced powerful psychological effects. This prompted the psychiatrist Pierre Deniker to give the drug to some of his most troubled patients. Their symptoms improved dramatically, and a major breakthrough in the treatment of psychosis seemed to have arrived. Many other antipsychotic drugs have followed in chlorpromazine's wake and today these medications comprise 10% of total NHS psychiatric prescriptions. They are costly items: the NHS spends more on these medications than it does for any other psychiatric drug, including antidepressants. Globally, around $14.5bn is estimated to be spent on antipsychotics each year. Since the 1950s the strategy of all too many NHS mental health teams has been a simple one. Assuming that psychosis is primarily a biological brain problem, clinicians prescribe an antipsychotic medication and everyone does their level best to get the patient to take it, often for long periods. There can be little doubt that these drugs make a positive difference, reducing delusions and hallucinations and making relapse less likely – provided, that is, the patient takes their medication. © 2014 Guardian News and Media Limited

Keyword: Schizophrenia
Link ID: 19336 - Posted: 03.08.2014

By BENEDICT CAREY He heard about the drug trial from a friend in Switzerland and decided it was worth volunteering, even if it meant long, painful train journeys from his native Austria and the real possibility of a mental meltdown. He didn’t have much time, after all, and traditional medicine had done nothing to relieve his degenerative spine condition. “I’d never taken the drug before, so I was feeling — well, I think the proper word for it, in English, is dread,” said Peter, 50, an Austrian social worker, in a telephone interview; he asked that his last name be omitted to protect his identity. “There was this fear that it could all go wrong, that it could turn into a bad trip.” On Tuesday, The Journal of Nervous and Mental Disease is posting online results from the first controlled trial of LSD in more than 40 years. The study, conducted in the office of a Swiss psychiatrist near Bern, tested the effects of the drug as a complement to talk therapy for 12 people nearing the end of life, including Peter. Most of the subjects had terminal cancer, and several died within a year after the trial — but not before having a mental adventure that appeared to have eased the existential gloom of their last days. “Their anxiety went down and stayed down,” said Dr. Peter Gasser, who conducted the therapy and followed up with his patients a year after the trial concluded. The new publication marks the latest in a series of baby steps by a loose coalition of researchers and fund-raisers who are working to bring hallucinogens back into the fold of mainstream psychiatry. Before research was banned in 1966 in the United States, doctors tested LSD’s effect for a variety of conditions, including end-of-life anxiety. But in the past few years, psychiatrists in the United States and abroad — working with state regulators as well as ethics boards — have tested Ecstasy-assisted therapy for post-traumatic stress; and other trials with hallucinogens are in the works. © 2014 The New York Times Company

Keyword: Depression; Aggression
Link ID: 19322 - Posted: 03.04.2014

|By Roni Jacobson Modern antipsychotic drugs are increasingly prescribed to children and adolescents diagnosed with a broad variety of ailments. The drugs help to alleviate symptoms in some disorders, such as schizophrenia and bipolar disorder, but in others their effectiveness is questionable. Yet off-label prescribing is on the rise, especially in children receiving public assistance and Medicaid. Psychotic disorders typically arise in adulthood and affect only a small proportion of children and adolescents. Off-label prescriptions, however, most often target aggressive and disruptive behaviors associated with attention-deficit hyperactivity disorder (ADHD). “What's really concerning now is that a lot of this prescription is occurring in the face of emerging evidence that there are significant adverse effects that may be worse in youth than in adults,” says David Rubin, a general pediatrician and co-director of PolicyLab at Children's Hospital of Philadelphia. Here we review the evidence for the effectiveness of antipsychotic medications commonly prescribed for five childhood conditions. But do the benefits outweigh the risks? Schizophrenia Evidence from several randomized controlled trials conducted in the past 10 years strongly suggests that antipsychotics are an effective treatment for youths with schizophrenia. Indeed, the FDA has approved five medications—risperidone, aripiprazole, olanzapine, quetiapine and paliperidone—for use in adolescents aged 13 to 17. Bipolar Disorder Recent research indicates that antipsychotics may hasten the resolution of manic and mixed episodes in children with bipolar disorder and increase the likelihood that the illness will go into remission. The FDA has approved the same set of drugs for 10- to 17-year-olds with bipolar disorder as it has for youths with schizophrenia, with the exception of paliperidone. © 2014 Scientific American

Keyword: Development of the Brain; Aggression
Link ID: 19321 - Posted: 03.04.2014

Ian Sample, science correspondent Children born to fathers over the age of 45 are at greater risk of developing psychiatric problems and more likely to struggle at school, according to the findings of a large-scale study. The research found that children with older fathers were more often diagnosed with disorders such as autism, psychosis, attention deficit hyperactivity disorder (ADHD), schizophrenia and bipolar disorder. They also reported more drug abuse and suicide attempts, researchers said. The children's difficulties seemed to affect school performance, leading to worse grades at the age of 15 and fewer years in education overall. "We were shocked when we saw the comparisons," said Brian D'Onofrio, the first author of the study at Indiana University in the US. But he added that it was impossible to be sure that older age was to blame for the problems. Scientists have reported links between fathers' age and children's cognitive performance and health before but this study suggests the risks may be more serious than previously thought. The increased risks might be caused by genetic mutations that build up in sperm as men age. Researchers at Indiana University and the Karolinska Institute in Stockholm studied medical and educational records of more than 2.6 million babies born to 1.4 million men. The group amounted to nearly 90% of births in Sweden from 1973 and 2001. Using the records, the scientists added up diagnoses for psychiatric disorders and educational achievements and compared the figures for children born to fathers of different ages. © 2014 Guardian News and Media Limited

Keyword: Schizophrenia; Aggression
Link ID: 19303 - Posted: 02.27.2014

By MICHAEL HEDRICK I still remember the first group therapy session I went to after I got out of the hospital. I was 20 and had been diagnosed as schizophrenic after a road trip that took me from Colorado to the United Nations building in New York City, my mind riddled with notions of good and evil, demons and angels, and a determination to save the world. Now I was in something of a state of shock, having come to understand that amid the delusions and paranoia that swarmed through my head I was, in reality, insane. A constant need to move felt like ants crawling over my skin, a side effect of the antipsychotic medications I had been prescribed. Every second of every day, I felt like clawing out my eyes and tearing out my hair because I just couldn’t sit still. I held up my front, though. I smiled when I thought I had to and tried to be nice to people. Laughter, however, was not something that was possible, and wouldn’t be for a long time. The group was a dual-functioning therapy technique to address both mental health issues and drug abuse. I had been assigned to it after disclosing that I had a marijuana habit. The doctors had told me that therapy groups were an integral part of my getting better. I agreed to go only to get out of the hospital prison and back home to my warm bed. I sat in a circle with a melting pot of people. There was the construction worker still wearing dusty boots and clothes splattered with mud, and the depressed sorority girl, makeup and hair still impeccable. The two had formed a friendship over their history with methamphetamine. There was the quiet bipolar Hispanic man who spoke only in short staccato sentences, and the rotund marketing guy who introduced himself by saying his drugs of choice were food, cocaine and marijuana. © 2014 The New York Times Company

Keyword: Schizophrenia
Link ID: 19302 - Posted: 02.27.2014

|By Beth Skwarecki Prions, the protein family notorious for causing "mad cow" and neurodegenerative diseases like Parkinson's, can play an important role in healthy cells. "Do you think God created prions just to kill?" mused Nobel laureate Eric Kandel. "These things must have evolved initially to have a physiological function." His work on memory helped reveal that animals make and use prions in their nervous systems as part of an essential function: stabilizing the synapses that constitute long-term memories. These natural prions aren't infectious but on a molecular level they chain up exactly the same way as their disease-causing brethren. (Some researchers call them "prionlike" to avoid confusion.) This week, work from neuroscientist Kausik Si of the Stowers Institute for Medical Research, one of Kandel's former students, shows that the prion's action is tightly controlled by the cell, and can be turned on when a new long-term memory needs to be formed. Prions are proteins with two unusual properties: First, they can switch between two possible shapes, one that is stable on its own and an alternate conformation that can form chains. Second, the chain-forming version has to be able to trigger others to change shape and join the chain. Say that in the normal version the protein is folded so that one portion of the protein structure—call it "tab A"—fits into its own "slot B." In the alternate form, though, tab A is available to fit into its neighbor's slot B. That means the neighbor can do the same thing to the next protein to come along, forming a chain or clump that can grow indefinitely. © 2014 Scientific American,

Keyword: Learning & Memory; Aggression
Link ID: 19290 - Posted: 02.25.2014

Sara Reardon Freddie Lee Hall loved to gamble, although he usually lost. Winning was better: then he gladly gave the money back to the friends he'd won it from, along with all the wages he earned picking fruit in rural Florida. His friends praised him for this. It made him feel good. And Hall needed to feel good — as court documents make abundantly clear. As a child growing up in the impoverished town of Webster, Florida, he had struggled to keep up with 16 brothers and sisters, who were much smarter than he was. If he failed to understand something, his mother beat him, once while he was tied up in a bag strung over a fire. He stuttered, never learned to read and feared the dark. He was unable to live alone. “Even though he was full grown, mentally he was a child,” his sister Diana told the court. “I had hoped to protect Freddie Lee from the outside world.” But the outside world found him. In 1978, Hall and his friend Mack Ruffin decided to rob a convenience store. They needed a car, so they forced 21-year-old Karol Hurst, who was pregnant, to drive into the woods, where they raped and killed her. Later, one of the pair also shot and killed a sheriff's deputy. When the two men were caught, tried and convicted of murder, the court decided that Hall was the likely ringleader. Ruffin was eventually sentenced to life in prison; Hall was sentenced to death. Next month, after 35 years of failed appeals to have that death sentence commuted to life imprisonment, Hall will have his case heard before the US Supreme Court. His guilt is not in question: the issue is Florida's use of IQ test scores in sentencing him to death. © 2014 Nature Publishing Group,

Keyword: Intelligence; Aggression
Link ID: 19285 - Posted: 02.24.2014

By James Gallagher Health and science reporter, BBC News A tool for predicting the risk of clinical depression in teenage boys has been developed by researchers. Looking for high levels of the stress hormone cortisol and reports of feeling miserable, lonely or unloved could find those at greatest risk. Researchers at the University of Cambridge want to develop a way of screening for depression in the same way as heart problems can be predicted. However, their method was far less useful in girls. Teenage years and early adulthood are a critical time for mental health - 75% of disorders develop before the age of 24. But there is no way to accurately say who will or will not develop depression. Risky combination Now researchers say they have taken the "first step" towards a screening tool. Tests on 1,858 teenagers, reported in Proceedings of the National Academy of Sciences, combined hormone levels and mood questionnaires to assess risk. They showed that having both high cortisol levels and depressive mood symptoms posed a higher risk of depression than either factor alone and presented a risk of clinical depression 14 times that of those with low cortisol and no depressive symptoms. Around one in six boys was in the high-risk category and half of them were diagnosed with clinical depression during the three years of study. One of the researchers, Prof Ian Goodyer, said: "Depression is a terrible illness that will affect as many as 10 million people in the UK at some point in their lives. "Through our research, we now have a very real way of identifying those teenage boys most likely to develop clinical depression. BBC © 2014

Keyword: Depression; Aggression
Link ID: 19261 - Posted: 02.18.2014

by Ashley Yeager Humans aren’t the only ones to suffer from obsessive-compulsive disorder. Dogs can suffer from the disorder as well, with particular breeds compulsively chewing their feet, chasing their tails or sucking blankets. Now scientists say they have identified several of the genes that trigger the behavior in Doberman pinschers, bullterriers, sheepdogs and German shepherds. Four genes, CDH2, CTNNA2, ATXN1 and PGCP, involved in the communication between brain cells appear to play a role in dog OCD, researchers report February 16 in Genome Biology. The results could be used to better understand the disorder in people. © Society for Science & the Public 2000 - 2013.

Keyword: OCD - Obsessive Compulsive Disorder; Aggression
Link ID: 19255 - Posted: 02.17.2014

by Clare Wilson AS MANY as 1 in 10 cases of schizophrenia may be triggered by an autoimmune reaction against brain cells, according to early trial results shared with New Scientist. The finding offers the possibility of gentler treatments for this devastating mental illness. Last month, doctors at a conference at the Royal Society of Medicine in London were told to consider an autoimmune cause when people first show symptoms of schizophrenia. People with schizophrenia experience symptoms of psychosis, such as hallucinations, delusions and paranoia. It affects 1 per cent of people in the West and is thought to be caused by overactive dopamine signalling pathways in the brain. Anti-psychotic drugs don't always work wellMovie Camera and have serious side effects. Previous studies had found that antibodies that target the NMDA receptor on neurons trigger brain inflammation, leading to seizures, comas – and sometimes psychosis (Annals of Neurology, doi.org/fdgnpc). In the past few years, these antibodies have also been found in the blood of people whose only symptom is psychosis. In 2010, Belinda Lennox at the University of Oxford tested 46 people with recent onset of psychosis for antibodies known to target neurons. Three people – about 6 per cent – tested positive (Neurology, doi.org/chs532). "The question is whether a larger percentage of cases might have other antibodies which we cannot yet detect," says Robin Murray at the Institute of Psychiatry in London, who wasn't involved in the research. Now Lennox is conducting a larger trial. Early results suggest other antibodies could well be involved. © Copyright Reed Business Information Ltd.

Keyword: Schizophrenia; Aggression
Link ID: 19251 - Posted: 02.15.2014

Eighteen neurological patients in North Carolina may have been exposed to an incurable and fatal disorder similar to "mad cow" disease while undergoing surgery at the Novant Health Forsyth Medical Center because surgical instruments were insufficiently sterilized, the hospital said on Monday. Surgeons operated on the 18 patients on January 18 using tools that had not been sufficiently sanitized after they were used on a man suspected of having Creutzfeldt-Jakob Disease (CJD), the hospital in Winston-Salem said in a press statement. "On behalf of the entire team at Novant Health, I apologize to the patients and their families for having caused this anxiety," Jeff Lindsay, president of the medical center, said at a news conference. CJD causes failing memory, blindness, involuntary movement and coma, and kills 90 percent of patients within one year, according to the National Institute of Neurological Disorders and Stroke. The condition is similar to mad cow disease, but is not linked to beef consumption. The incubation period — before initial symptoms surface — can last years, the statement said. After the first sign of symptoms, most patients die within four months, it said The possibility of contracting the disease through surgical exposure is very remote, the hospital said.

Keyword: Prions
Link ID: 19234 - Posted: 02.11.2014

|By Simon Makin For decades two very different treatments of depression have existed side by side. Medications act on molecules, cells and synapses in the brain. Psychological therapies focus on cognition and behavior, trying to alter negatively biased thinking. Now a new theory suggests that these interventions may work in more similar ways than anyone realized, providing an opportunity to better integrate the two approaches. More important, it may help provide patients faster, more reliable relief from this crippling condition. Antidepressant drugs increase the levels of certain chemical messengers in the brain, such as serotonin and norepinephrine. Yet exactly how these neurotransmitters affect mood is unknown. “There was a missing link between the cellular, molecular and synaptic bases of these drugs, on the one hand, and what they affect in humans, which is their experiences, perceptions, memories and feelings,” says Catherine Harmer, a neuroscientist at the University of Oxford. The psychological explanation, meanwhile, describes depression in terms of distorted information processing. Depressed people are thought to process perceptions, experiences and memories with a negative bias. Many studies confirm that depressed individuals show increased sensitivity to sad faces, greater memory for negative material and reduced responsiveness to rewards as compared with healthy people. Successful therapies teach patients how to correct for this clouded vision. Harmer now believes that antidepressants may also work by altering this negative emotional processing. About a decade ago she and her colleagues tested the effects of commonly prescribed antidepressants on healthy volunteers and found that many of the drugs skewed emotional processing to the positive. Previous research had shown that antidepressants also change these measures in depressed people, but studies included only patients who had been on medication for six to eight weeks because the drugs were assumed to take that long to kick in. © 2014 Scientific American

Keyword: Depression; Aggression
Link ID: 19231 - Posted: 02.10.2014

Schizophrenia and related mental illnesses can have a devastating effect on people who suffer from them, often making it impossible for them to work or maintain normal social relationships. Antipsychotic drugs are usually the first line of defense, but they can have serious side effects. A new study concludes that psychological approaches could be an alternative for patients who either can’t or won’t take medication, although some critics continue to question the effectiveness of these interventions. Schizophrenia, which can involve hallucinations, delusions, paranoia, emotional problems, and severe difficulty focusing on daily tasks, affects about 1% of populations worldwide. More than 20 antipsychotic medications, such as risperidone, haloperidol, and clozapine, are now on the market, and they are often effective in temporarily relieving the worse symptoms. But when taken for extended periods, such drugs can cause uncontrollable muscle movements, serious weight gain, and higher risk of heart attacks. In recent years, a number of psychiatrists and psychologists have begun to advocate psychological approaches, including an approach called cognitive behavioral therapy (CBT), as an adjunct to antipsychotic drugs. With CBT, which has long been shown to be effective for depression and anxiety disorders, a therapist takes the subject through a series of guided steps designed to explore alternative interpretations and explanations of what he or she is experiencing, with the goal of changing both outlook and behavior. A schizophrenic patient who is having hallucinations might be encouraged to stop trying to fight them off or suppress them, for example, or to stop engaging with voices in his or her head, to test how strong such symptoms really are and how much control they exert over the subject’s life. The technique also involves what practitioners call “normalization”: The patient might be reassured that hearing voices and seeing things that are not there is an experience that many normal people have from time to time, thus reducing some of the anxiety that makes sufferers feel distressed and isolated. © 2014 American Association for the Advancement of Science

Keyword: Schizophrenia
Link ID: 19227 - Posted: 02.08.2014

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

Keyword: Schizophrenia
Link ID: 19212 - Posted: 02.06.2014