Chapter 12. Psychopathology: The Biology of Behavioral Disorders

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By Nicholas Bakalar Electroconvulsive therapy, or ECT, can be effective for the treatment of major depression and is just as safe as antidepressant drugs combined with psychotherapy, a large new study concludes. The procedure, once referred to as electroshock therapy, has a controversial and largely unfavorable history. This was partly due to inaccurate portrayals in popular books and films like “One Flew Over the Cuckoo’s Nest,” and partly the result of real problems with the earliest versions of the procedure, which used strong electrical currents and no anesthesia. Today, ECT is performed under general anesthesia, and the doctor, working with an anesthesiologist and a nurse, applies a weak electric current to the brain (usually about 0.8 amperes at 120 volts) for one to six seconds. This causes a seizure inside the brain, but because of the anesthesia, the patient does not experience muscular contractions. The seizure leads to brain changes that relieve symptoms of depression and certain other mental illnesses. Usually, doctors administer a series of ECT treatments over a period of days or weeks. The only painful part of the procedure is the insertion of an intravenous line before anesthesia. There can be side effects afterward, including temporary memory loss, confusion or transitory headaches and muscle aches. Doctors debate whether ECT can cause long-term memory problems distinct from the memory problems that can be caused by depression itself. For this new study, published in Lancet Psychiatry, Canadian researchers used the records of 10,016 adults whose depression was severe enough that they spent three or more days in the hospital. Half of them had received ECT, while the other half were treated with drugs and psychotherapy. Their average age was 57, and about two-thirds were women. The researchers tracked how each group fared in the 30 days after they were discharged from the hospital. © 2021 The New York Times Company

Keyword: Depression
Link ID: 27999 - Posted: 09.18.2021

By Husseini Manji, Joseph Hayes Depression affects more than 264 million people of all ages globally. The World Health Organization ranks depression as one of the most debilitating diseases to society. It is the leading cause of disability worldwide and the psychiatric diagnosis most commonly associated with suicide, which accounts for nearly 800,000 deaths globally each year. Individuals suffering from depression may face an inability to manage life’s demands and maintain social connections, affecting all aspects of their experiences, from school and employment to relationships and overall quality of life. When it comes to treatment, approximately one third of those suffering from depression do not respond to two or more antidepressants and are considered treatment-resistant. Treatment-resistant depression is a chronic condition that places an increased emotional, functional and economic burden on the individual, their loved ones and society. It is also associated with greater morbidity, higher health care costs and various comorbid conditions. While a number of antidepressants exist, they all work through changing the levels of brain-signaling molecules called monoaminergic neurotransmitters. New drug development for depression had stalled for a number of years, and many pharmaceutical companies have withdrawn from neuroscience entirely. But recent scientific advances have led to the development of novel antidepressants working via completely different mechanisms. The brain is the most advanced, adaptive information processing system in existence—in large part because of its tremendous plasticity. Scientists have been building upon these neuroscience advances to develop completely novel, rapid-acting antidepressants. In this regard, considerable evidence has demonstrated that the regulation of two receptors—AMPA and NMDA—on many neurons that respond to the neurotransmitter glutamate control changes in the tiny junctions, or synapses, between neurons. © 2021 Scientific American

Keyword: Depression
Link ID: 27991 - Posted: 09.15.2021

James M. Gaines Young macaques given the popular antidepressant fluoxetine for two years had lower levels of certain fatty acids and other lipids in their brains than ones not given the drug, finds a recent study (July 28) in International Journal of Molecular Sciences. The findings may help explain why younger people sometimes experience adverse side effects when taking the drug. Fluoxetine, often sold under the brand name Prozac, is a prescription medication that can be given to adults as well as children as young as 7 or 8 years old. But there’s not good literature on the long-term impact of fluoxetine and other psychoactive drugs that we use to treat adult symptoms in the young brain, says Bita Moghaddam, a behavioral neuroscientist at Oregon Health & Science University who was not involved in the study, “so [it] was really nice to see that there is this level of focus.” While genes and neurotransmitters may get the lion’s share of the attention in neuroscience research, brains are mostly made of up fats and other lipids. But lipids, it turns out, can be hard to study. So, when University of California Davis brain scientist Mari Golub and her colleagues wanted to know what was going on with the fats in the brains of the monkeys they were studying, they reached out to the brain lab at the Skoltech Institute of Science and Technology in Moscow where Anna Tkachev—the lead author on the new paper—works. “We happen to specialize in lipids in particular,” says Tkachev. For years, Golub and her colleagues had been using macaques to investigate the effects of fluoxetine. The antidepressant can be an effective treatment for maladies such as depression and obsessive-compulsive disorder. However, some studies suggest that the drug can occasionally cause serious, long-term side effects, and perhaps counter-intuitively for an antidepressant, it’s been linked to an increased risk of suicidal thinking and behavior, particularly in young people. © 1986–2021 The Scientist.

Keyword: Depression; Development of the Brain
Link ID: 27988 - Posted: 09.13.2021

By Baland Jalal Obsessive-compulsive disorder (OCD) has puzzled artists and scientists for centuries. Afflicting one in 50 people, OCD can take several forms, such as compulsively putting things in just the right order or checking if the stove is turned off 10 times in a row. One type of OCD that affects nearly half of those with the condition entails irresistible washing urges. People with this type can spend hours scrubbing their hands in agitation after touching something as trivial as a doorknob even though they know this makes no sense. There is currently a shortage of effective therapies for OCD: 40 percent of patients do not benefit from existing treatments. A major issue is that today’s treatments are often too stressful. First-line “nonpharmacological therapies” involve telling patients to repeatedly touch things such as toilet seats and then refrain from washing their hands. But recent work by my colleagues and me has found something surprising: people diagnosed with OCD appear to have a more malleable “sense of self,” or brain-based “self-representation” or “body image”—the feeling of being anchored here and now in one’s body—than those without the disorder. This finding suggests new ways to treat OCD and perhaps unexpected insights into how our brain creates a distinction between “self” and “other.” In our recent experiments, for example, we showed that people with and without OCD responded differently to a well-known illusion. In our first study, a person without OCD watched as an experimenter used a paintbrush to stroke a rubber hand and the subject’s hidden real hand in precise synchrony. This induces the so-called rubber hand illusion: the feeling that a fake hand is your hand. When the experimenter stroked the rubber hand and the real one out of sync, the effect was not induced (or was greatly diminished). This compelling illusion illustrates how your brain creates your body image based on statistical correlations. It’s extremely unlikely for such stroking to be seen on a rubber hand and simultaneously felt on a hidden real one by chance. So your brain concludes, however illogically, that the rubber hand is part of your body. © 2021 Scientific American

Keyword: OCD - Obsessive Compulsive Disorder; Pain & Touch
Link ID: 27980 - Posted: 09.08.2021

by Peter Hess Children born to mothers who take antipsychotic medications during pregnancy do not have elevated odds of autism or attention deficit hyperactivity disorder (ADHD), nor are they more likely to be born preterm or underweight, according to a study released this past Monday in JAMA Internal Medicine. Some women with schizophrenia, Tourette syndrome or bipolar disorder take antipsychotic drugs, such as aripiprazole, haloperidol or risperidone. Clinicians have long debated whether women should discontinue these medications during pregnancy out of concern for the drugs’ effects on the developing fetus. But children born to mothers who take antipsychotics during pregnancy and to those who do not take them have similar outcomes, the new work shows. “Our findings do not support a recommendation for women to discontinue their regular antipsychotic treatment during pregnancy,” says senior investigator Kenneth Man, research fellow at the University College London School of Pharmacy in the United Kingdom. Prescribing antipsychotics during pregnancy can help prevent potentially dangerous psychotic episodes and ensure that an expectant mother can take care of herself, says Mady Hornig, associate professor of epidemiology at Columbia University, who was not involved in the study. “We certainly don’t want to be cavalier about the use of any medication during pregnancy, but one also wants to balance out the implications of not treating.” © 2021 Simons Foundation

Keyword: Schizophrenia; Development of the Brain
Link ID: 27954 - Posted: 08.21.2021

By Michael Pollan After a half century spent waging war on drugs, Americans seem ready to sue for peace. The 2020 elections brought plenty of proof that voters have leapt ahead of politicians in recognizing both the failures of the drug war and the potential of certain illicit drugs as powerful tools for healing. Ballot initiatives in five states — four of them traditionally red — legalized some form of cannabis use. By substantial margins, Oregon passed two landmark drug reform initiatives: Fifty-nine percent of voters supported Measure 110, which decriminalized the possession of small quantities of all drugs, even hard ones like heroin and cocaine. A second proposal, Measure 109, specifically legalized psilocybin therapy, directing the state’s health department to license growers of so-called magic mushrooms and train facilitators to administer them beginning in 2023. In the past two years, a new drug policy reform movement called Decriminalize Nature has persuaded local governments in a half dozen municipalities, including Washington, D.C., to decriminalize “plant medicines” such as psilocybin, ayahuasca, iboga and the cactuses that produce mescaline. Last month, the California State Senate passed a bill that would make legal the personal possession, use and “social sharing” of psychedelics, including LSD and MDMA, a.k.a. Ecstasy or Molly. Political opposition to all these measures has been notably thin. Neither party, it seems, has the stomach for persisting in a war that has achieved so little while doing so much damage, especially to communities of color and our civil liberties. But while we can now begin to glimpse an end to the drug war, it is much harder to envision what the drug peace will look like. How will we fold these powerful substances into our society and our lives so as to minimize their risks and use them most constructively? The blunt binaries of “Just say no” that have held sway for so long have kept us from having this conversation and from appreciating how different one illicit drug is from another. © 2021 The New York Times Company

Keyword: Drug Abuse; Depression
Link ID: 27907 - Posted: 07.14.2021

Michael Marshall Since the beginning of the pandemic, researchers have been trying to understand how the coronavirus SARS-CoV-2 affects the brain.Credit: Stanislav Krasilnikov/TASS/Getty How COVID-19 damages the brain is becoming clearer. New evidence suggests that the coronavirus’s assault on the brain could be multipronged: it might attack certain brain cells directly, reduce blood flow to brain tissue or trigger production of immune molecules that can harm brain cells. Infection with the coronavirus SARS-CoV-2 can cause memory loss, strokes and other effects on the brain. The question, says Serena Spudich, a neurologist at Yale University in New Haven, Connecticut, is: “Can we intervene early to address these abnormalities so that people don’t have long-term problems?” With so many people affected — neurological symptoms appeared in 80% of the people hospitalized with COVID-19 who were surveyed in one study1 — researchers hope that the growing evidence base will point the way to better treatments. Breaking into the brain SARS-CoV-2 can have severe effects: a preprint posted last month2 compared images of people’s brains from before and after they had COVID-19, and found loss of grey matter in several areas of the cerebral cortex. (Preprints are published without peer review.) Early in the pandemic, researchers speculated that the virus might cause damage by somehow entering the brain and infecting neurons, the cells responsible for transmitting and processing information. But studies have since indicated3 that the virus has difficulty getting past the brain’s defence system — the blood–brain barrier — and that it doesn’t necessarily attack neurons in any significant way.

Keyword: Chemical Senses (Smell & Taste); Learning & Memory
Link ID: 27899 - Posted: 07.08.2021

By Jane E. Brody I was doing research and interviews on bipolar disorder when notices appeared in my Brooklyn neighborhood about a 21-year-old man who had been missing for a week. He was described as “bipolar” and “may be experiencing a manic episode.” It took me back nearly seven decades when the state police in Texas called my father to say they had found his brother, my favorite uncle, wandering on a highway. How he got there from Brooklyn we never learned. He had apparently suffered a psychotic break and ended up in a New York State mental hospital that administered electric shock treatments but did little else to help him re-enter society effectively. Not until decades later did he receive a correct diagnosis of manic depression, now known as bipolar disorder. Characterized by extreme shifts in mood, “manic-depressive illness” was officially recognized by the American Psychiatric Association in 1952. But it would be many years before an effective treatment, the drug lithium, which acts on the brain to help stabilize debilitating episodes of severe mania and depression, was available to help my brilliant uncle resume a reasonably normal life. Bipolar disorder typically runs in families, with different members experiencing symptoms to a greater or lesser degree. If a parent has the disorder, a child’s risk can rise to 10 percent. My uncle’s only child displayed some minor behavioral characteristics of bipolar disorder, like very rapid speech and frenetic activity, but was able to complete two advanced degrees, marry, be a parent and succeed in an intellectually demanding career. Bipolar disorder is most often diagnosed in the later teen years or young adulthood, affecting some 4 percent of people at some point in their lives. But in recent decades, diagnosis of the disorder has soared in children and adolescents, although some experts believe the condition is overdiagnosed or overtreated with potent psychiatric drugs. © 2021 The New York Times Company

Keyword: Schizophrenia; Depression
Link ID: 27893 - Posted: 07.06.2021

Linda Geddes Science correspondent Fibromyalgia – a poorly understood condition that causes widespread pain throughout the body and extreme tiredness – may be caused by be an autoimmune response that increases the activity of pain-sensing nerves throughout the body. The findings, published in the Journal of Clinical Investigation, challenge the widely held view that the condition originates in the brain, and could pave the way for more effective treatments for the millions of people affected. They could also have implications for patients suffering from myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and “long Covid”. “These different syndromes are symptomatically very similar, so I think it could be very relevant to both of these conditions,” said Dr David Andersson from the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, who led the new study. Fibromyalgia affects at least 1 in 40 people worldwide, although some estimates suggest nearly 1 in 20 people may be affected to some degree. It is characterised by widespread pain and crippling fatigue – often referred to as “fibro fog” – and usually develops between the ages of 25 and 55, although children can also get it. Similar to many autoimmune conditions, the vast majority of those affected (80% are women). Current treatment tends to focus on gentle aerobic exercise, as well as drug and psychological therapies designed to manage pain. However, these have proven ineffective in most patients and have left behind an enormous unmet clinical need, said Andersson. “The widespread paradigm at the moment is that this is a disease that emanates from the brain, and I think our findings suggest that that’s not the case,” he said. © 2021 Guardian News & Media Limited

Keyword: Neuroimmunology; Depression
Link ID: 27888 - Posted: 07.03.2021

As I lean back in the leather recliner, my limbs feel heavy. The strong dose of ketamine I've just taken is making it harder to move, so I struggle to put on my headphones and eyeshades. Soothing music lulls me into deep relaxation, as my consciousness starts to float away from my body and into a world of swirling lights, colours and images. I'm not at a new-age music festival, or in a seedy underground drug den. This fully-legal experience is taking place under medical supervision at Field Trip Health in Toronto, a clinic that offers psychedelic-assisted therapy for those suffering treatment-resistant mental illnesses like depression and PTSD. The clinic, which was the first of its kind in Canada, opened last year. Since then, similar clinics have opened in Quebec, Alberta, Saskatchewan, B.C., and Nova Scotia. Ketamine was first approved for use in Canada and the U.S. as a general anesthetic more than 50 years ago. Since then it has gained a reputation as a party drug, with names like Special K or Vitamin K. Today, it's increasingly being used as a fast-acting and effective treatment for depression. But it isn't without controversy. I've dealt with bouts of depression and suicidal thoughts for about as long as I can remember. By the fall of 2020, after months of isolation due to the COVID-19 pandemic had taken their toll, my depression was as bad as it had ever been. ©2021 CBC/Radio-Canada.

Keyword: Depression; Drug Abuse
Link ID: 27873 - Posted: 06.26.2021

By Nicholas Bakalar If you are a morning person, you may be at reduced risk for major depression, a new study suggests. Several studies of the body’s circadian sleep-wake cycle have shown that being an early bird is associated with a lower risk for depression. But those studies were observational so could not prove cause and effect. For example, people who are early birds may have other health or lifestyle behaviors that reduce their risk for depression — they may have a healthier diet, for example, exercise more, or have fewer health conditions, such as chronic pain, that are associated with depression. All these factors, and many others, could explain the decreased risk for depression, and not the fact of being an early bird. Moreover, depression itself causes sleep disturbances, so it could be that depression is a cause of being a night owl, rather than the other way around. The new study, however, offers more compelling evidence that going to bed early and waking early may, in itself, provide protection against depression, independent of other factors. The study, published in JAMA Psychiatry, uses a research method called Mendelian randomization that helps pinpoint the cause of what may be a cause-and-effect relationship. With Mendelian randomization, researchers can compare large groups of people based on genetic variants that are independent of other health or behavioral characteristics — in this case, the tendency to being a night owl or a morning person, inherited traits that are randomly allocated during our development in the womb. More than 340 genetic variants associated with circadian sleep rhythm have been identified, and the researchers can compare large groups of people with the genetic variants for being a morning person with groups that lack them. Nature has, in essence, set up the randomized experiment for them. © 2021 The New York Times Company

Keyword: Biological Rhythms; Depression
Link ID: 27868 - Posted: 06.23.2021

By Katie Free, Joel Goldberg When it comes to our senses, we frequently focus on the external—the crack of thunder, the glare of sunlight, the fragrance of flowers—that captured our attention in the first place. But our bodies also have a whole host of internal senses that tell our brains whether our hearts are beating at the right speed, for example, or whether our blood pressure is too high. These signals travel constantly via hormones and nerves, including a mysterious 100,000-fiber network called the vagus nerve. Now, new techniques are helping scientists map the thin, twisting branches of the vagus nerve—which connects the brain to the heart, intestines, and other internal organs—and make surprising discoveries about its role in memory and emotion. These findings have spawned investigations into treatments for everything from Alzheimer’s disease to post-traumatic stress disorder and have led to the approval of medical implants to help treat epilepsy and depression. When it comes to understanding the brain-mind connection, a gut check might not hurt. © 2021 American Association for the Advancement of Science.

Keyword: Epilepsy; Depression
Link ID: 27867 - Posted: 06.23.2021

An analysis of survey data from more than 280,000 young adults ages 18-35 showed that cannabis (marijuana) use was associated with increased risks of thoughts of suicide (suicidal ideation), suicide plan, and suicide attempt. These associations remained regardless of whether someone was also experiencing depression, and the risks were greater for women than for men. The study published online today in JAMA Network Open and was conducted by researchers at the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health. “While we cannot establish that cannabis use caused the increased suicidality we observed in this study, these associations warrant further research, especially given the great burden of suicide on young adults,” said NIDA Director Nora Volkow, M.D., senior author of this study. “As we better understand the relationship between cannabis use, depression, and suicidality, clinicians will be able to provide better guidance and care to patients.” The number of adults in the United States who use cannabis more than doubled from 22.6 million in 2008 to 45.0 million in 2019, and the number of daily or near-daily users almost tripled from 3.6 million to 9.8 million in 2019. Over the same time span, the number of adults with depression also increased, as did the number of people who reported suicidal ideation or plan or who died by suicide. To date, however, the relationship between trends in cannabis use and suicidality is not well understood. The current study sought to fill this gap.

Keyword: Depression; Drug Abuse
Link ID: 27866 - Posted: 06.23.2021

By Diana Kwon Long before the earliest animals swam through the water-covered surface of Earth’s ancient past, one of the most important encounters in the history of life took place. A primitive bacterium was engulfed by our oldest ancestor — a solo, free-floating cell. The two fused to form a mutually beneficial relationship that has lasted more than a billion years, with the latter providing a safe, comfortable home and the former becoming a powerhouse, fueling the processes necessary to maintain life. That’s the best hypothesis to date for how the cellular components, or organelles, known as mitochondria came to be. Today, trillions of these bacterial descendants live within our bodies, churning out ATP, the molecular energy source that sustains our cells. Despite being inextricably integrated into the machinery of the human body, mitochondria also carry remnants of their bacterial past, such as their own set of DNA. The DNA that constitutes the human genome is contained within the nucleus of our cells. But mitochondria possess their own set of circular DNA, which is likely a remnant of their ancient bacterial past. These features make mitochondria both a critical element of our cells and a potential source of problems. Like the DNA inside the nuclei of our cells that makes up the human genome, mitochondrial DNA can harbor mutations. Age, stress and other factors may disrupt mitochondria’s many functions. On top of that, mitochondrial injury can release molecules that, due to their similarities to those made by bacteria, can be mistaken by our immune system as foreign invaders, triggering a harmful inflammatory response against our own cells. © 2021 Annual Reviews, Inc

Keyword: Schizophrenia; Alzheimers
Link ID: 27863 - Posted: 06.19.2021

By Bill Hathaway A massive genome-wide association study (GWAS) of genetic and health records of 1.2 million people from four separate data banks has identified 178 gene variants linked to major depression, a disorder that will affect one of every five people during their lifetimes. The results of the study, led by the U.S. Department of Veterans Affairs (V.A.) researchers at Yale University School of Medicine and University of California-San Diego (UCSD), may one day help identify people most at risk of depression and related psychiatric disorders and help doctors prescribe drugs best suited to treat the disorder. The study was published May 27 in the journal Nature Neuroscience. For the study, the research team analyzed medical records and genomes collected from more than 300,000 participants in the V.A.’s Million Veteran Program (MVP), one of the largest and most diverse databanks of genetic and medical information in the world. These new data were combined in a meta-analysis with genetic and health records from the UK Biobank, FinnGen (a Finland-based biobank), and results from the consumer genetics company 23andMe. This part of the study included 1.2 million participants. The researchers crosschecked their findings from that analysis with an entirely separate sample of 1.3 million volunteers from 23andMe customers. When the two sets of data from the different sources were compared, genetic variants linked to depression replicated with statistical significance for most of the markers tested. Copyright © 2021 Yale University

Keyword: Depression; Genes & Behavior
Link ID: 27833 - Posted: 05.29.2021

By Laura Sanders The key ingredient in the illicit drug known as Ecstasy or Molly may offer profound relief from post-traumatic stress disorder. When paired with intense talk therapy, MDMA drastically eased symptoms in people who had struggled with severe PTSD for years, a new study reports. “This is a big deal,” says Steven Gold, a clinical psychologist in Fort Lauderdale and professor emeritus at Nova Southeastern University in Plantation, Fla. “All other things being equal, the use of psychedelic medication can significantly improve the outcome.” The results, published May 10 in Nature Medicine, are preliminary. But the findings offer hope to the millions of people worldwide who have PTSD, for whom new treatments are desperately needed. Antidepressants such as Zoloft and Paxil are often prescribed, but the drugs don’t work for an estimated 40 to 60 percent of people with PTSD. Ninety people participated in the new study, which took place at 15 clinical sites in the United States, Canada and Israel. All the participants received 15 therapy sessions with therapists trained to guide people as they experienced the drug. Half of the participants received MDMA in three eight-hour therapy sessions; the other half received placebos during three eight-hour therapy sessions. True to its nickname Ecstasy, MDMA evokes feelings of bliss and social connectedness. The participants took the drug (or the placebo) while wearing eye covers and listening to music, and occasionally talking with their therapist about their experience. © Society for Science & the Public 2000–2021.

Keyword: Stress; Drug Abuse
Link ID: 27826 - Posted: 05.19.2021

By Andrew Jacobs It’s been a long, strange trip in the four decades since Rick Doblin, a pioneering psychedelics researcher, dropped his first hit of acid in college and decided to dedicate his life to the healing powers of mind-altering compounds. Even as antidrug campaigns led to the criminalization of Ecstasy, LSD and magic mushrooms, and drove most researchers from the field, Dr. Doblin continued his quixotic crusade with financial help from his parents. Dr. Doblin’s quest to win mainstream acceptance of psychedelics took a significant leap forward on Monday when the journal Nature Medicine published the results of his lab’s study on MDMA, the club drug popularly known as Ecstasy and Molly. The study, the first Phase 3 clinical trial conducted with psychedelic-assisted therapy, found that MDMA paired with counseling brought marked relief to patients with severe post-traumatic stress disorder. The results, coming weeks after a New England Journal of Medicine study that highlighted the benefits of treating depression with psilocybin, the psychoactive ingredient in magic mushrooms, have excited scientists, psychotherapists and entrepreneurs in the rapidly expanding field of psychedelic medicine. They say it is only a matter of time before the Food and Drug Administration grants approval for psychoactive compounds to be used therapeutically — for MDMA as soon as 2023, followed by psilocybin a year or two later. After decades of demonization and criminalization, psychedelic drugs are on the cusp of entering mainstream psychiatry, with profound implications for a field that in recent decades has seen few pharmacological advancements for the treatment of mental disorders and addiction. The need for new therapeutics has gained greater urgency amid a national epidemic of opioid abuse and suicides. © 2021 The New York Times Company

Keyword: Depression; Drug Abuse
Link ID: 27817 - Posted: 05.12.2021

by Laura Dattaro Many genes linked to autism, schizophrenia and developmental delay share the same functions: They regulate the expression of other genes and support communication between neurons, according to an unpublished study. Researchers presented the findings virtually today at the 2021 International Society for Autism Research annual meeting. (Links to abstracts may work only for registered conference attendees.) Hundreds of genes with diverse functions are linked to autism, but how each contributes to the condition is unclear. In the new work, researchers analyzed the functions of 102 autism-linked genes that previous studies identified by comparing the genetic sequences of thousands of people with autism and those with other conditions, along with their family members and controls. “The genes identified give us an unprecedented opportunity to follow the biology, follow the genetics, to ask the question, where does this converge on function?” said lead investigator Stephan Sanders while presenting the work. Sanders is associate professor of psychiatry at the University of California, San Francisco. Other researchers are studying convergence in 3D brain models called organoids and looking for neuroanatomical similarities and differences across different animal models of autism, including mice and frogs. “Distinguishing causal functions from non-causal functions of these genes is a massive challenge,” Sanders says, and finding points of convergence could help. “The ultimate goal is to identify why disrupting these genes leads to autism.” © 2021 Simons Foundation

Keyword: Autism; Genes & Behavior
Link ID: 27808 - Posted: 05.08.2021

By Paul E. Greenberg Since the early 1990s, I, together with my colleagues, have been studying the economic burden of adults with major depressive disorders (MDD). Over that time, we have tracked shifts in the prevalence of this disease; in the makeup of those suffering from it; and in the nature of treatment both for the disease itself and for the host of comorbidities, such as pain and anxiety disorders, that accompany it. We have then used these data as the basis for calculating the incremental economic burden of adults with MDD—that is, the additional costs traceable to those suffering from the disease in terms of both medical treatment and workplace productivity impacts. Our most recent study was just published in a special issue of PharmacoEconomics (which I also co-edited) that presents new research on the economics of MDD. By focusing on one year during the Great Recession (2010) and another after a long macroeconomic expansion (2018), our analysis provides a helpful profile of the changing economic effects of this widespread and pernicious illness. We report our latest estimates showing that the incremental economic burden of adults with MDD was $326 billion in 2018, 38 percent higher than in 2010. But our work goes deeper than simply providing an economic calculator. This research offers a multifaceted lens through which we can gain a better understanding of how the myriad effects of the illness manifest themselves. Importantly, we find that only 11 percent of the overall burden of illness was attributable to the direct medical costs of treating MDD itself, while the costs of treating comorbid medical conditions made up 24 percent. Another 4 percent was due to suicide-related costs, while fully 61 percent of the total burden in 2018 resulted from a combination of elevated workplace absenteeism and presenteeism (that is, reduced productivity as a result of working while sick). This striking imbalance between medical expenditures to treat either MDD or its comorbidities on the one hand and workplace-related costs on the other is one aspect of the story that has changed dramatically since 2010, when medical costs were equivalent to workplace costs. © 2021 Scientific American,

Keyword: Depression
Link ID: 27806 - Posted: 05.08.2021

By Christina Caron Finding a therapist can be a tough and time-consuming process involving multiple phone calls, waiting lists and insurance hurdles. But what if you were able to walk into your corner drugstore for a bottle of shampoo and also had the option of scheduling a walk-in session for mental health treatment? That’s the future that CVS, the largest retail pharmacy in the United States, is envisioning. Since January the company has added licensed clinical social workers trained in cognitive behavioral therapy to 13 locations in the Houston, Philadelphia and Tampa metro areas. The providers will offer mental health assessments, referrals and counseling either in person or via telehealth, a CVS spokeswoman said, and this spring the company plans to expand to 34 locations in those same regions. The social workers are available during the day, and also on evenings and weekends in the company’s MinuteClinics, which provide a variety of nonemergency health care services either via walk-in or by appointment. The hours are more flexible than what therapists might normally offer, and the social workers partner with the clinic’s nurse practitioners and pharmacists to give prescriptions when needed, said Dr. Daniel Knecht, the vice president of clinical product at CVS Health. CVS is just one of a growing number of retailers who are recognizing the unmet need for mental health providers and hoping to fill the gap. On Thursday, Walmart announced it is acquiring MeMD, which offers online medical and mental health care. Walmart currently provides counseling via Walmart Health, a health center located in a separate building alongside Walmart Supercenters. In Georgia, Walmart Health offers in-person mental health counseling and in Arkansas customers can receive online counseling. Later this year, counseling services will become available at Walmart Health locations in Illinois and Florida, a spokeswoman said. © 2021 The New York Times Company

Keyword: Depression
Link ID: 27805 - Posted: 05.08.2021