Chapter 16. Psychopathology: Biological Basis of Behavior Disorders

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Etelka Lehoczky Like any good story about a scientific discovery, Walter A. Brown's account of the history of lithium features plenty of improvisation, conjecture and straight-up kismet. Unlike many such stories, though, it also features a fair share of personal bias, senseless puttering and random speculation — on part of these scientific researchers. Brown, a practicing psychiatrist and university professor of more than 40 years, seems to have been drawn to write Lithium: A Doctor, A Drug and a Breakthrough as much because of lithium's fluky history and overlooked importance (for many years, he argues, it was "the Cinderella of psychiatric drugs") as by the profound impact it's had on countless sufferers of bipolar disorder and depression. Lithium is a homage, not just to a drug, but to the renegade side of science. Its heroes are researchers scattered around the globe, short on funding and frequently unaware of each other's work, without whom a commonly available substance would never have been recognized as a treatment for one of the most baffling psychiatric illnesses. By celebrating these men, Brown hopes to do a lot more than simply raise awareness about an underappreciated substance. He aims to demolish what remains of the myth that scientific progress is driven by rigorous dispassion. The story of lithium's use in medicine is certainly colorful, as is the history of the illness it's become known for. Brown doesn't stint on either tale. He goes all the way back to the first century to find a would-be description of manic depression by the Greek doctor Aretaeus of Cappadocia. These patients, Aretaeus wrote, "'laugh, play, dance night and day, and sometimes go openly to the market crowned, as if victors in some contest of skill,'" only to become "'torpid, dull and sorrowful.'" © 2019 npr

Keyword: Schizophrenia
Link ID: 26502 - Posted: 08.15.2019

By Tiffany Hsu Scientists at Virginia Commonwealth University in Richmond, Va., were concerned when a young man contacted their department last year complaining of a heart-pounding, hallucinogenic high he had neither expected nor wanted to have. The team, led by the forensic toxicologist Michelle R. Peace, had published a study about mysterious ingredients in vaping liquids. That’s how the man, a graduate student Dr. Peace declined to name, knew to tell it about his experience. He said he had vaped a liquid, from a company called Diamond CBD, that contained CBD, or cannabidiol. A compound reputed to have soothing properties, CBD has been marketed by the fast-growing cannabis industry as an ingredient in sleeping masks, kombucha, Carl’s Jr. burgers and Martha Stewart-backed dog treats. It is not supposed to cause a psychoactive experience. Dr. Peace decided to run some tests of Diamond CBD vaping liquids, some from the graduate student and some bought from the manufacturer. In four of nine samples, all marketed on the company’s website as 100 percent natural, her lab discovered a synthetic compound, 5F-ADB. That ingredient has been linked by the Drug Enforcement Administration to anxiety, convulsions, psychosis, hospitalization and death. Diamond CBD has often promoted its products as health aids meant to “help your body to heal and recover” and “to make you feel the best version of yourself.” The company’s parent, PotNetwork Holdings, said in a statement that independent tests did not show “any unnatural or improper derivative.” The company said it planned to run more tests on its products and materials and would issue a recall if it found any problems. The efforts of cannabis companies to go mainstream could be hampered by CBD advertising that depends on misleading or unproven claims, entrepreneurs and researchers said. Dr. Peace compared the marketing efforts of some companies to snake-oil scams in the 1800s, “when guys in wagons were selling sham tinctures in glass bottles.” © 2019 The New York Times Company

Keyword: Drug Abuse; Stress
Link ID: 26497 - Posted: 08.14.2019

By Simon Makin Can an Illusory World Help Treat Psychosis's Real-World Delusions? Scenes of everyday living within a virtual-reality simulation attempt to lessen social anxiety for people with psychosis. Credit: University of Oxford/Oxford VR Many people with psychosis suffer from persecutory delusions—beliefs that terrible things will happen to them in everyday situations, such as people trying to harm them. The disorder causes social anxiety, which can be exacerbated by other symptoms, such as hearing voices. All of this makes ordinary activities such as shopping or going to the doctor challenging. Often a person just withdraws entirely from social contact. In a vicious cycle, the ensuing isolation and rumination can exacerbate other symptoms, including those causing the withdrawal. The idea behind a virtual-reality system called gameChange is to help patients learn to feel safer, allaying social anxiety by putting them in simulations of situations they fear in which their worst dread does not materialize. Last month, clinical psychologist Daniel Freeman of the University of Oxford and his colleagues launched a clinical trial of gameChange, the biggest such trial to date of a VR treatment for schizophrenia. It will enroll 432 people with psychosis from five National Health Service (NHS) centers across the U.K. Researchers will assess participants’ avoidance and distress in real-world situations, using an established measure, before and after treatment and then do so again six months later. The hope is that the treatment will reduce participants’ anxiety, which will, in turn, improve other symptoms, particularly persecutory delusions. Freeman co-founded an Oxford spin-off company, Oxford VR, to develop and commercialize the technology. And if the trial is successful, gameChange could be rolled out by the NHS. © 2019 Scientific American

Keyword: Schizophrenia
Link ID: 26478 - Posted: 08.02.2019

By Aimee Berg Virginia Fuchs announced herself to the boxing world at the 2016 United States Olympic Trials, where she twice upset Marlen Esparza, a world champion. In 2017, Fuchs went 18-0. In 2018, she claimed a bronze medal at the world championships by attacking her flyweight opponents, on average, every four seconds during nine minutes of boxing. “That’s an engine!” said Billy Walsh, the head coach for the American team. “She’s a supreme athlete. We joke and call her Seabiscuit because she’s like a racehorse.” Fuchs, known as Ginny, is now the most established fighter from the United States at the Pan American Games this week. The same will most likely be true at the 2020 Tokyo Olympics. “Pretty much everybody’s looking at me to win gold,” said Fuchs, a 31-year-old Texan. Boxing, though, is the least of her battles. About 20 years ago, she learned she had severe obsessive-compulsive disorder. In January, Fuchs had a breakdown that sent her to inpatient treatment for the second time in her life. She spent a month at an O.C.D. clinic in Houston. “I was like: I can’t function like this anymore,” she said. She grew so stuck in her cleaning rituals that she was training daily on three hours of sleep. One night, she said, she couldn’t stop at all and thought: “I’m out of control. I’m scared. I need serious help.” Elite athletes usually know how to solve their opponents. If they are taller and stronger, be quicker. If they are faster, be smarter. If they are tactically superior, be relentless. But what do you do when the most powerful opponent lies permanently within? By definition, O.C.D. involves unwanted, recurring and distressing thoughts. In response, people often perform repetitive behaviors, or rituals, to alleviate the anxiety caused by the obsessions. “But the ritual only works very temporarily,” said Dr. Joyce Davidson, a psychiatrist and medical director at the Menninger Clinic in Houston. “The obsessions keep coming back so people get stuck in this vicious circle of obsessions and rituals. In many cases, it really snowballs.” © 2019 The New York Times Company

Keyword: OCD - Obsessive Compulsive Disorder
Link ID: 26469 - Posted: 07.31.2019

By Zheala Qayyum A nurse showed me the newspaper just as I was walking in. I saw the smiling face of the young man I had taken care of since he was a teenager. Several times after hurting himself or threatening suicide he had been admitted to the Connecticut hospital where I work as a child and adolescent psychiatrist. I wished I had seen that smile during our interactions. It looked genuine. But this was an obituary. I was devastated. I didn’t know what to do with how I felt, and too ashamed to let people know. Suicide assessments were a fundamental part of my psychiatric training, but what to do when suicide occurs was not. This is true for many psychiatry training programs across the country. The emphasis lies on suicide prevention but there is not enough focus on preparing psychiatry trainees for the loss of a patient due to suicide or how to deal with the aftermath. This young man’s death was particularly painful because he was not a complete stranger. His last hospitalization, a couple of months before his death had been the first time I didn’t care for him. Just before that hospitalization, the lovely lady who altered my clothes mentioned that her grandson had been hospitalized several times. She knew I was a psychiatrist and started telling me about the arduous journey her family had faced because of her grandson’s mental health struggles. Then she mentioned his name. © 2019 Scientific American,

Keyword: Depression
Link ID: 26468 - Posted: 07.31.2019

Tickling the ear with a small electric current could rebalance the nervous system in over-55s and help them age more healthily, research suggests. Stimulation of the vagus nerve, which connects to the heart, lungs and gut, led to improvements in body, sleep and mood, a small study found. The University of Leeds team said the procedure could make a big difference to people's lives. But more research is needed to work out the long-term health effects. Why the ear? The ear acts as a gateway to the body's nervous system. One small branch of the vagus nerve can be stimulated via the skin in specific bits of the outer ear. To some people, the therapy feels ticklish. To others, it's painless. What's the vagus nerve? Also called the "wandering nerve", because it's long and well-connected, the vagus nerve transmits information from the brain to organs around the body, such as the heart and lungs. It is also fundamental to the body's autonomic nervous system. This system, which has branches known as sympathetic and parasympathetic, controls many of the body's functions, such as breathing, digestion, heart rate and blood pressure. Does the nervous system change as we age? Yes. As we get older, the balance of the body's nervous system goes awry. The sympathetic branch, which helps the body prepare for high intensity "fight or flight" activity, begins to dominate. And the parasympathetic branch, which is important for "rest and digest" activity, becomes less active. This makes people more prone to diseases, such as heart problems and hypertension, as well as depression and anxiety. © 2019 BBC

Keyword: Sleep; Depression
Link ID: 26464 - Posted: 07.30.2019

By Kent Babb MINNEAPOLIS — On the day he’d bury his daughter, Mark Catlin stepped out of a chapel and into the fresh air. “Nice day for a walk,” he said, looking up, and on this morning in late March, the weather was flawless: cloudless, crisp, a bright blue sky. He took a breath and set off, heading down the cemetery’s path and falling behind the procession of cars ahead, talking as gravel crunched beneath his shoes. He asked if the memorial service, laboriously planned near the lakefront cycling trails Kelly Catlin had explored before becoming a silver medalist in the 2016 Olympics, had been good enough. He apologized if it had been too sad. The afternoon reception, he assured friends and visitors, should be more lively. A few paces up the winding path, a longtime friend shook his head. Mark, the friend whispered, would do anything to distract himself — he always had — in this case to avoid facing “the darkness”: Kelly’s suicide two weeks earlier, her thoughts during those final days and weeks, the way she’d planned her death in the same meticulous, results-oriented way she’d lived her life. Back on the walkway, Mark wore a blank expression as he accepted condolences and told people about his plans for the coming weeks. Eventually he reached a gravesite surrounded by mourners, and he stopped at the rear of the group as if happening upon a stranger’s funeral. Gradually the faces turned, and after a moment Mark noticed his wife and two other children waiting near a charcoal-colored casket. “I guess we’ll go lay her to rest now,” he said, stepping forward.

Keyword: Depression
Link ID: 26462 - Posted: 07.30.2019

By Kelli María Korducki The antidepressant Prozac came on the market in 1986; coincidentally, it was the year I was born. By the time I saw my first psychiatrist, as an early-2000s teenager, another half-dozen antidepressants belonging to the same class of drugs, selective serotonin reuptake inhibitors, or S.S.R.I.s, had joined it on the market — and in the public consciousness. The despondent cartoon blob from a memorable series of TV ads for the S.S.R.I. drug Zoloft became a near-instant piece of pop culture iconography after its May 2001 debut. It was commonplace through much of my childhood to find ads for other S.S.R.I.s tucked into the pages of the women’s magazines I’d leaf through at the salon where my mother had her hair cut, outlining criteria for determining whether Paxil “may be right for you.” In my depressed, anxious, eating disordered adolescence, I knew by name the pills that promised to help me. The mainstreaming of S.S.R.I.s and other psychopharmaceuticals didn’t eradicate stigmas against mental illness, but it certainly normalized a sense of their prevalence. (A 2003 study concluded that child and adolescent psychotropic prescription rates alone had nearly tripled since the late 1980s.) It also shaped the tone of conversation. No longer were mental illnesses necessarily discussed as a shameful aberration, but rather as chemically preordained sicknesses: functions of what became known as a “chemical imbalance.” As a teenager entering the psychiatric care system, I found this logic tremendously reassuring. I came from an extended family of medical providers and had been raised to trust in the hard, scientific grounding of modern medicine. © 2019 The New York Times Company

Keyword: Depression
Link ID: 26459 - Posted: 07.29.2019

Susie Neilson Living with anxiety can be tough — your thoughts might race, you might dread tasks others find simple (like driving to work) and your worries might feel inescapable. But loving someone with anxiety can be hard too. You might feel powerless to help or overwhelmed by how your partner's feelings affect your daily life. If so, you're not alone: Multiple studies have shown that anxiety disorders may contribute to marital dissatisfaction. "We often find that our patients' ... partners are somehow intertwined in their anxiety," says Sandy Capaldi, associate director at the Center for the Treatment and Study of Anxiety at the University of Pennsylvania. Anxiety is experienced at many different levels and in different forms — from moderate to debilitating, from generalized anxiety to phobias — and its impacts can vary. But psychiatrists and therapists say there are ways to help your partner navigate challenges while you also take care of yourself. Start by addressing symptoms. Because an anxiety disorder can be consuming, it can be best to start by talking with your partner about the ways anxiety affects daily life, like sleeplessness, says Jeffrey Borenstein, president and CEO of the Brain & Behavior Research Foundation in New York. Something as simple as using the word "stress" instead of clinical labels can help too. "Often people may feel a little more comfortable talking about stress as opposed to ... anxiety [disorders]," Borenstein says. Don't minimize feelings. "Even if the perspective of the other person absolutely makes no sense to you logically, you should validate it," says Carolyn Daitch, a licensed psychologist and director of the Center for the Treatment of Anxiety Disorders in Farmington Hills, Mich. Try to understand your partner's fears and worries, or at least acknowledge that those fears and worries are real to your partner, before addressing why such things might be irrational. © 2019 npr

Keyword: Stress
Link ID: 26456 - Posted: 07.27.2019

Mariam Alexander It might come as quite a surprise to learn that, as a psychiatrist, if I ever had the misfortune to develop severe depression, my treatment of choice would be electroconvulsive therapy (ECT). Why? Well, to put it simply, ECT is the most rapid treatment for severe depression that we currently have to offer – with a recent study in the BMJ highlighting its effectiveness. For the uninitiated, ECT is a medical procedure in which an anaesthetised patient has a small electrical current applied to their scalp in order to induce a seizure for the purposes of treating severe mental illnesses and occasionally neurological disorders too. Each treatment takes just a few minutes and is usually administered two or three times a week. ECT course length varies depending on the needs of the patient, but on average eight to 12 treatments are given. It’s almost impossible to discuss ECT without the word “barbaric” being used. For anyone who is familiar with the psychiatric era of One Flew Over the Cuckoo’s Nest, this is understandable. But things have moved on a great deal since then. Indeed, if you’re looking for a “b” word to describe the process of contemporary ECT, top of my list would be “boring” – the use of a general anaesthetic and muscle relaxant means there’s probably more drama involved in having a filling than ECT. That’s not to say ECT isn’t a significant intervention, but treatments should always be considered in relation to the condition that needs to be managed. Most people would be totally opposed to the idea of a surgeon amputating their leg. However, if there was an infection rapidly rising from their foot and an amputation was the best option to save their life, I suspect most people would then see it as a necessity. Context is key. © 2019 Guardian News & Media Limited

Keyword: Depression
Link ID: 26438 - Posted: 07.23.2019

Sara Reardon Nearly every scientist who has used mice or rats to study depression is familiar with the forced-swim test. The animal is dropped into a tank of water while researchers watch to see how long it tries to stay afloat. In theory, a depressed rodent will give up more quickly than a happy one — an assumption that has guided decades of research on antidepressants and genetic modifications intended to induce depression in lab mice. But mental-health researchers have become increasingly sceptical in recent years about whether the forced-swim test is a good model for depression in people. It is not clear whether mice stop swimming because they are despondent or because they have learnt that a lab technician will scoop them out of the tank when they stop moving. Factors such as water temperature also seem to affect the results. “We don’t know what depression looks like in a mouse,” says Eric Nestler, a neuroscientist at the Icahn School of Medicine at Mount Sinai in New York City. Now, the animal-rights group People for the Ethical Treatment of Animals (PETA) is jumping into the fray. The group wants the US National Institute of Mental Health (NIMH) in Bethesda, Maryland, to stop supporting the use of the forced-swim test and similar behavioural assessments by its employees and grant recipients. The tests “create intense fear, anxiety, terror, and depression in small animals” without providing useful data, PETA said in a letter to the agency on 12 July. © 2019 Springer Nature Publishing AG

Keyword: Depression; Animal Rights
Link ID: 26431 - Posted: 07.19.2019

By Emily Anthes In 2002, Marin Sardy and her younger brother Tom traveled to a small Costa Rican town for what they hoped would be a low-key beach vacation. The siblings, both in their 20s, planned to spend a few weeks relaxing, learning to surf, and just generally enjoying each other’s company. Sardy reveals what it means to love someone who is mentally ill and how hard it is to truly understand another person’s mind. And then, one day, Tom began to complain about his face. His bones, he said, had detached from each other, and his jaw had separated from his head. He couldn’t get his face back into alignment, he told Sardy. He began to talk — excitedly and cryptically — about “building matrices” and his plans to swim from Alaska to Japan. His facial expressions turned blank. Sardy observed these developments with growing alarm. She and Tom had grown up with a mother whose life had been derailed by schizophrenia, and she was well acquainted with its signs and symptoms. “Memories unfurl inside as I watch Tom,” Sardy writes in her intimate, multigenerational memoir, “The Edge of Every Day: Sketches of Schizophrenia.” “It is as if I already know that doctors and medications and hospitals and our efforts will all fail him.” “The Edge of Every Day” is Sardy’s attempt to come to terms with a fundamentally mysterious disease and how its effects ripple throughout her family. It’s a deeply compassionate book about what it means to love someone who is mentally ill — about how hard it is to truly understand another person’s mind and the importance of continuing to try. Copyright 2019 Undark

Keyword: Schizophrenia
Link ID: 26415 - Posted: 07.13.2019

By Meghana Keshavan, Christian Angermayer is an unlikely proselyte of psychedelia: The German financier didn’t drink so much as a sip of beer for the first three decades of his life. But five years ago, after careful consideration (and the encouragement of a personal physician), Angermayer boarded a yacht with a handful of his closest friends. They sailed into the crystalline, tropical waters of a jurisdiction in which such substances are legal (he is very emphatic on this point), and had his very first psychedelic trip. His entire worldview was changed. “It was the single most meaningful thing I’ve ever done or experienced in my life,” said Angermayer, 40. “Nothing has ever come close to it.” The first thing Angermayer did after the experience was call his parents and tell them, with a newfound conviction, that he loved them. Then, being a consummate entrepreneur, he quickly identified a business opportunity: He would commercialize psychedelics. Today, with a net worth of roughly $400 million accrued through various enterprises, Angermayer is one of the driving forces behind the movement to turn long-shunned psychoactive substances, like the psilocybin derived from so-called magic mushrooms, into approved medications for depression and other mental illnesses. Though he still resolutely won’t touch even a drop of alcohol, he has banded together a team of like-minded entrepreneurs—including Silicon Valley billionaire Peter Thiel—to invest in a handful of startups focused on developing psychedelics. © 2019 Scientific American,

Keyword: Drug Abuse; Depression
Link ID: 26403 - Posted: 07.10.2019

By Bassey Ikpi This bipolar II. This many-sided creature. This life of mine. This brain constantly in conference with the racing heart, reminding me to slow down, stay calm. Remember the first time you were ever on a Ferris wheel? Remember when you got to the very top and just sat there, the entire world at your feet? You felt like you could reach up and grab the sky. Your entire body tingled with the intersection of joy and indestructibility and fearlessness and that good anxious recklessness. So damn excited to be alive at that moment. You could do anything. Now imagine feeling that every day for a week, or a month, or a few months. Twenty-four hours a day, seven days a week, without a break. So that everything you do feels like THE BIGGEST MOST AMAZING THING YOU HAVE EVER DONE IN YOUR LIFE! The first week or so, it’s great. Until it’s not. Because then the insomnia sets in. And you’re stacking days on top of one another, adding a new one before the last one ends. And you have to write the entire book tonight before you can sleep or eat or leave the house or do anything. But first you have to call your friends and your sister and the guy you just met and tell them all how much you love them. Tell each one that you’ve never felt this way about any other human being in the entire world and you’re so lucky and so glad and so grateful to have such an amazing, magical person in your life. And you believe it because it’s true. Until it isn’t. Until everything about them — the way their voices trail, the way their mouths move when they chew, the fact that he crosses his legs at the knee, the way she speaks about movies she’s never seen, the way they refer to celebrities by their first names — starts to make you feel like your blood is filled with snakes and you want to scream awful things at them about how the sounds of their voices feel like teeth on your skin and how much you hate their mother or their apartment or yourself. You want to bury your hatred in them, but you’re never quite sure who you hate the most. You, it’s always you. © 2019 The New York Times Company

Keyword: Schizophrenia
Link ID: 26395 - Posted: 07.08.2019

By Courtenay Harris Bond Before I started ketamine infusions this spring, I was milling around my house, unhinged, ducking into my bedroom to weep behind the closed door whenever my three young children were occupied. I felt like an actor playing a wife and mother. I had been having trouble concentrating on anything for several months, including my work as a journalist. Unable to read a book or watch a crime thriller — diversions I usually love and use to unwind — and in a torturous limbo with no plan, I felt hopeless, full of self-loathing, even suicidal. The only thing keeping me from hurting myself was the thought of what that would do to my family. Globally, nearly 800,000 people die by suicide each year, according to the World Health Organization, which also reports that more than 300 million people worldwide suffer from depression. Approximately 10 to 30 percent of those with major depressive disorder have treatment-resistant depression, typically defined as a failure to respond to at least two different treatments. I have treatment-resistant depression, as well as generalized anxiety disorder. Throughout my life, I have been on a quest to conquer these formidable demons. I am 48 and have been in therapy off and on — mostly on — since the fourth grade. I have tried approximately 14 different antidepressants, but they either haven’t worked, or they’ve caused insufferable side effects. I have done a full course of transcranial magnetic stimulation, during which magnetic fields were applied to my scalp at specific points that affect depression and anxiety. And I recently tried Nardil, a first-generation antidepressant that requires a special diet. I was dizzy at times with blurred vision and felt overwhelming fatigue to the point where I feared I might fall asleep while driving. Copyright 2019 Undark

Keyword: Depression; Drug Abuse
Link ID: 26391 - Posted: 07.05.2019

By Dana Najjar Four days after the birth of our daughter, my husband and I brought her home from the hospital. We were exhausted but giddy, ready to start our new lives. For nine months I had imagined what those first weeks at home would be like: sleepless nights, bleary-eyed arguments, a few late-night tears, all bundled up in the soft happy glow of new motherhood. In short, an adventure. But none of that materialized. What I came up against instead was a sheer wall of blinding panic. We had left the hospital with instructions to wake our newborn up every three hours to feed, but by the time we got home and settled in, five hours had elapsed, and nothing would rouse her long enough to nurse. She lay limp in my arms, drifting in and out of sleep, howling uncontrollably just long enough to tire herself out. We took our cues from the internet and tickled her feet with ice cubes, placed wet towels on her head and blew onto her face, but only managed to upset her more. And somewhere between trying to persuade her to latch for what felt like the hundredth time and willing my body to stay awake, it struck me that I had made a terrible mistake, one that I could never unmake. My stomach lurched, my hands and feet went numb and my heart began to pound. © 2019 Scientific American

Keyword: Depression; Hormones & Behavior
Link ID: 26359 - Posted: 06.26.2019

New statistics suggest almost one-quarter of mothers experience either postpartum depression or an anxiety disorder in the months following birth, and that younger mothers are most at risk. The Statistics Canada survey analyzed the experiences of 7,085 respondents who gave birth in 2018 between January and the end of June. The women were surveyed online and by phone five to 13 months after delivery. The data found 23 per cent reported feelings consistent with either postpartum depression or an anxiety disorder — feelings that are more intense and longer-lasting than the so-called "baby blues" and may not resolve on their own. The rate ranged from 16 per cent in Saskatchewan to 31 per cent in Nova Scotia and was especially high among younger respondents. Among those under the age of 25 — numbering between 500 and 550 respondents — 30 per cent reported mental-health issues. That's compared to 23 per cent of mothers aged 25 and older. The survey also asked mothers about drug use and found 3 per cent used cannabis during pregnancy and 3 per cent used cannabis while breastfeeding. In addition, 1 per cent reported opioid use during pregnancy, including medical use and non-medical use. The survey was conducted in conjunction with the Public Health Agency of Canada and Health Canada and involved data collected from Nov. 29, 2018 to Feb. 5, 2019.

Keyword: Depression; Hormones & Behavior
Link ID: 26354 - Posted: 06.25.2019

By Benedict Carey and Jennifer Steinhauer Confronted by a rising rate of suicides in some groups of veterans., the Department of Veterans Affairs on Friday decided to approve the use of a new and costly depression drug, despite concerns among doctors and other experts about the drug’s effectiveness. The decision to endorse the drug — called Spravato, and manufactured by Janssen, a unit of Johnson & Johnson — came days after President Trump offered to negotiate a deal between the drug maker and the agency. Johnson & Johnson reportedly was working with associates at Trump’s Mar-a-Lago club, and the company has been supporting V.A. suicide-prevention efforts. A spokesman for the V.A. said that the decision to approve the drug, which would cover its use by doctors in its nearly 1,000 clinics nationwide, was a medical one. In a statement, the agency said, “V.A. will closely monitor the use of esketamine” — the generic name for Spravato — “in veterans to more fully understand its relative safety and effectiveness as compared to other available treatments. Based on this information, V.A. may revise its clinical guidance” and the availability of the drug. The V.A. stopped short of putting Spavato on its formulary, the list of drugs it requires to be carried in its 260 or so pharmacies. The approval enables V.A. doctors to offer the drug to patients they believe could benefit. Some Congressional Democrats expressed concern at the fast approval process. “I am incredibly alarmed by reporting today that suggests Spravato, a controversial new drug, is being rushed through critical reviews and may be prescribed to veterans before fully vetting the potential risks and benefits,” said Mark Takano, Democrat of California and chairman of the House Committee on Veteran’s Affairs, in a prepared statement released Wednesday. © 2019 The New York Times Company

Keyword: Depression; Drug Abuse
Link ID: 26351 - Posted: 06.24.2019

By Benedict Carey Last winter, several dozen people who were struggling with suicidal urges and bouts of intense emotion opened their lives to a company called Mindstrong, in what has become a closely watched experiment in Silicon Valley. Mindstrong, a venture co-founded by a former director of the National Institute of Mental Health, promised something that no drug or talk therapy can provide: an early-warning system that would flag the user when an emotional crisis seemed imminent — a personal, digital “fire alarm.” For the past year, California state and county mental health officials, along with patient representatives, have met regularly with Mindstrong and another company, 7 Cups, to test smartphone apps for people receiving care through the state’s public mental health system. Officials from 13 counties and two cities are involved, and the apps are already available to the public. The new users, most of whom have a diagnosis of borderline personality disorder, receive treatment through the Los Angeles County mental health network, and were among the first test subjects in this collaboration. They allowed Mindstrong to digitally install an alternate keyboard on their smartphones, embedded in the app, and to monitor their moment-to-moment screen activity. “People with borderline personality disorder have a very difficult time identifying when distress is very high,” said Lynn McFarr, director of the cognitive and dialectical behavior therapy clinic at Harbor U.C.L.A. Medical Center, which provides care for people in the Los Angeles County system. “If we can show them, in this biofeedback fashion, that the signals went off the rails yesterday, say, after they got into a fight with a co-worker, then they’d be able to anticipate that emotion and target it with the skills they’ve learned.” The potential for digital technology to transform mental health care is enormous, and some 10,000 apps now crowd the market, each promising to soothe one psychological symptom or another. Smartphones allow near continuous monitoring of people with diagnoses such as depression, anxiety and schizophrenia, disorders for which few new treatments are available. But there has been little research to demonstrate whether such digital supports are effective. © 2019 The New York Times Company

Keyword: Schizophrenia; Depression
Link ID: 26336 - Posted: 06.18.2019

By Neuroskeptic If you delve into the wildest depths of the scientific literature, you will find a trilogy of papers so weird, that they have become legendary. In these articles, spanning a 12 year period, author Jarl Flensmark says that heeled shoes cause mental illness, while flat footwear promotes brain health: Is there an association between the use of heeled footwear and schizophrenia? (2004) Physical activity, eccentric contractions of plantar flexors, and neurogenesis: therapeutic potential of flat shoes in psychiatric and neurological disorders (2009) Flat shoes increase neurogenesis (2016) The abstract of the first paper gives a good sense of Flensmark’s ideas: A selective literature review and synthesis is used to present a hypothesis that finds support in all facts and is contradicted by none. Heeled footwear began to be used more than a 1000 years ago, and led to the occurrence of the first cases of schizophrenia. Industrialization of shoe production increased schizophrenia prevalence. The neurobiological mechanism for this shoe-induced psychosis is said to be that: During walking synchronised stimuli from mechanoreceptors in the lower extremities increase activity in cerebello-thalamo-cortico-cerebellar loops through their action on NMDA-receptors. Using heeled shoes leads to weaker stimulation of the loops. Reduced cortical activity changes dopaminergic function which involves the basal ganglia-thalamo-cortical-nigro-basal ganglia loops. And so it goes on.

Keyword: Schizophrenia
Link ID: 26305 - Posted: 06.06.2019