Chapter 16. Psychopathology: Biological Basis of Behavior Disorders

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Diana Kwon The effects of antidepressant exposure during early development can pass down through three generations of offspring—at least in zebrafish. A new study, published today (December 10) in PNAS, reveals that fluoxetine, a commonly used antidepressant that goes by the brand name Prozac, can alter hormone levels and blunt stress responses in an exposed embryo and its descendants. “The paper is very intriguing,” says Tim Oberlander, a developmental pediatrician at the British Columbia Children’s Hospital who was not involved in this work. The question of whether these medications have a transgenerational effect is “a really important one that requires further study in other animal models, and ultimately, when we have the data, we need to figure out whether it’s also true in humans.” Fluoxetine is a selective serotonin reuptake inhibitor (SSRI), a class of drugs widely used to treat depression as well as other conditions such as obsessive-compulsive disorder and anxiety disorders. Recent data from the US National Health and Nutrition Survey show increasing antidepressant use, from approximately 7.7 percent of the population in 1999–2002 to 12.7 percent from 2011–2014. SSRIs are often prescribed as the first-line treatment for pregnant women with depression, and prior studies in humans suggest infants exposed to SSRIs while in the womb may experience developmental disturbances such as delayed motor development and increased levels of anxiety later in childhood. Oberlander, whose research is focused on the influence of prenatal exposure to these medications, notes that it has been unclear whether those correlations represent a direct result of the drugs or if other factors, such as a genetic propensity for those outcomes or growing up with a parent with a mood disorder, may also play a part. © 1986 - 2018 The Scientist

Keyword: Epigenetics; Depression
Link ID: 25781 - Posted: 12.12.2018

Rhitu Chatterjee Researchers have traced a connection between some infections and mental illnesses like schizophrenia, depression and bipolar disorder. New research from Denmark bolsters that connection. The study, published Thursday in JAMA Psychiatry, shows that a wide variety of infections, even common ones like bronchitis, are linked to a higher risk of many mental illnesses in children and adolescents. The findings support the idea that infections affect mental health, possibly by influencing the immune system. "This idea that activation of the body's immune inflammatory system as a causative factor in ... select mental illnesses is one that has really caught on," says Dr. Roger McIntyre, a professor of psychology and pharmacology at the University of Toronto, who wasn't involved in the study. "This study adds to that generally, but builds the case further in a compelling way." In the new study, the researchers gathered data on hospitalizations and prescription medications for the 1.1 million children born in Denmark between Jan. 1, 1995, and June 30, 2012. "We could follow individuals from birth, so there was no missing information during the study period," says Dr. Ole Köhler-Forsberg of Aarhus University Hospital, a neuroscientist and one of the authors of the study. Köhler-Forsberg and his colleagues used two national registries — one to get data on hospitalizations because of severe infections like pneumonia and another for data on antimicrobial or antiparasitic medications prescribed to children for less severe infections. "Most of them are those infections that you and I and all others have experienced," says Köhler-Forsberg. © 2018 npr

Keyword: Development of the Brain; Schizophrenia
Link ID: 25756 - Posted: 12.06.2018

By Pam Belluck CHARLOTTE, N.C. — Steve Singer, who has bipolar and borderline personality disorders, knows when he’s on the verge of a mental health crisis. The female voice he hears incessantly in his head suddenly shuts up, and the hula hoop he gyrates while walking to the grocery store stops easing his anxieties. That’s when he gets to a hospital. Usually, talking briefly with a nurse or social worker calms him enough to return home. But this year a hospital placed him on a locked ward, took his phone, and had an armed guard watch him for 20 hours before a social worker spoke with him and released him. “I get the heebie-jeebies thinking about it,” said Mr. Singer, 60. “They didn’t help me, they hurt me.” Deeply upset, he turned to something he’d never known existed: He completed a psychiatric advance directive, a legal document declaring what treatment he does and doesn’t want. Increasingly, patients, advocates and doctors believe such directives (called PADs) could help transform the mental health system by allowing patients to shape their care even when they lose touch with reality. Hospitals must put them in patients’ medical records and doctors are expected to follow them unless they document that specific preferences aren’t in the patients’ best medical interest. As the pendulum has swung from institutionalization to outpatient care, psychiatric directives also offer a middle path by allowing patients to designate family members to speak for them when they’re too sick to do so themselves. But some doctors and hospitals are wary that the documents could tie their hands and discourage treatment they consider warranted. Some worry the directives won’t be updated to reflect medical advances. Others question whether people with serious psychiatric conditions are ever capable of lucidly completing such directives. “A decision based on erroneous information on a PAD, that can happen,” said Dr. Katayoun Tabrizi, a forensic psychiatrist at Duke. “This is not a cookbook.” © 2018 The New York Times Company

Keyword: Schizophrenia; Alzheimers
Link ID: 25749 - Posted: 12.04.2018

By Moises Velasquez-Manoff In May of 2017, Louise decided that her life was just too difficult, so she’d end it. In the previous four years, three siblings and a half-sibling had died, two from disease, one from fire and one from choking. Close friends had moved away. She felt painfully, unbearably alone. It would be the fourth time Louise (I’m using her middle name to protect her privacy), then 68, would attempt suicide, and she was determined to get it right. She wrote a letter with instructions on where to find important documents and who should inherit what. She packed up her jewelry and artwork, addressing each box to particular friends and family members. Then she checked into a motel — homes where people have committed suicide lose value and she didn’t want hers to sell below market — put a plastic sheet on the bed, lay down and swallowed what she figured was an overdose of prescription pills with champagne. A few days later, she woke up in a psychiatric ward in Albuquerque. The motel maid had found her. “I was very upset I had failed,” she told me recently. So she tried to cut her wrists with a bracelet she was wearing — unsuccessfully. The suicide rate has been rising in the United States since the beginning of the century, and is now the 10th leading cause of death, according to the Centers for Disease Control and Prevention. It’s often called a public health crisis. And yet no new classes of drugs have been developed to treat depression (and by extension suicidality) in about 30 years, since the advent of selective serotonin reuptake inhibitors like Prozac. The trend most likely has social causes — lack of access to mental health care, economic stress, loneliness and despair, the opioid epidemic, and the unique difficulties facing small-town America. These are serious problems that need long-term solutions. But in the meantime, the field of psychiatry desperately needs new treatment options for patients who show up with a stomach full of pills. Now, scientists think that they may have found one — an old anesthetic called ketamine that, at low doses, can halt suicidal thoughts almost immediately. © 2018 The New York Times Company

Keyword: Depression; Drug Abuse
Link ID: 25746 - Posted: 12.03.2018

By Diana Kwon For almost a decade, cleaning rituals ruled Kathrine’s life. The middle-aged resident of Bergen, a coastal town in the southern tip of Norway, was consumed by a fear of germs and contamination that led to endless cycles of tidying, vacuuming and washing. “I realized that I was facing a catastrophe,” Kathrine Mydland-aas, now 41, recalls. “I couldn’t help the kids with homework, couldn’t make dinner for them, couldn’t give them hugs. I didn’t do anything but cleaning. I tried to quit, but the rituals always won.” Last year, around nine years after Mydland-aas’s cleaning rituals began, a psychologist diagnosed her with obsessive-compulsive disorder (OCD) and referred her to a clinic at the Haukeland University Hospital in Bergen. There, a team was administering a behavioral therapy for the condition that, to Mydland-aas’s surprise, was only four days long. “I thought, what can they do in four days?” she says. “[But] it changed my life.” Mydland-aas is one of more than 1,200 people who have received the Bergen four-day treatment for OCD, a concentrated form of exposure therapy designed by two Norwegian psychologists, Gerd Kvale and Bjarne Hansen. The four-day protocol has recently gained international attention for its effectiveness and efficiency—last month Time magazine named the pair, who are both currently affiliated with the Haukeland University Hospital and the University of Bergen, as two of this year’s 50 most influential people in healthcare. © 2018 Scientific American

Keyword: OCD - Obsessive Compulsive Disorder; Learning & Memory
Link ID: 25736 - Posted: 11.30.2018

Jon Hamilton There's new evidence that mild pulses of electricity can relieve depression — if they reach the right target in the brain. A study of 25 people with epilepsy found that those who had symptoms of depression felt better almost immediately when doctors electrically stimulated an area of the brain just above the eyes, a team reported Thursday in the journal Current Biology. These people were in the hospital awaiting surgery and had wires inserted into their brains to help doctors locate the source of their seizures. Several of the patients talked about the change they felt when the stimulation of the lateral orbitofrontal cortex began, says Kristin Sellers, an author of the paper and a postdoctoral researcher at the University of California, San Francisco. One person's response was: "Wow, I feel a lot better. ... What did you guys do?" The stimulation only lasted a few minutes. After it stopped, the effect on mood quickly faded. To be sure that the effect was real, the researchers also pretended to stimulate the lateral OFC in the same patients without actually running current through the tiny wires implanted in their brains. In those sham treatments, there was no discernible change. DBS is an approved treatment for tremors, including those associated with Parkinson's disease. But results with depression have been less consistent, and DBS isn't approved for this purpose by the Food and Drug Administration. © 2018 npr

Keyword: Depression
Link ID: 25735 - Posted: 11.30.2018

By Roni Caryn Rabin A. A deficiency of vitamin B12 can cause neurological and psychiatric problems that “can progress if left untreated, and can lead to irreversible damage,” said Dr. Donald Hensrud, director of the Mayo Clinic’s Healthy Living Program. Fortunately, it can be reversed fairly easily with vitamin pills or injections. Vitamin B12 is required for proper red blood cell formation, nerve function and DNA synthesis. It is naturally present in fish, meat, eggs and dairy products, as well as some fortified breakfast cereals and nutritional yeast products. Strict vegans who avoid animal products can develop a deficiency of B12 over time if they don’t take a supplement. But two-thirds of cases occur in the elderly, who are susceptible because they may not absorb adequate amounts of B12 from foods but who are not routinely tested, Dr. Hensrud said. Consequences of B12 deficiency can cause a range of symptoms that include fatigue, weakness, constipation, loss of appetite and weight loss. Other symptoms include difficulty maintaining balance, depression, confusion, dementia, poor memory and soreness in the mouth or tongue. B12 deficiency may also result in a form of anemia called megaloblastic anemia, which can also result from a deficiency of folic acid, another B vitamin. If anemia is detected on blood tests, levels of both vitamins should be checked. Neurological symptoms can, however, occur in the absence of anemia. Early treatment is critical to avoid potentially irreversible damage. Older adults are susceptible to B12 deficiency because they may have decreased secretion of hydrochloric acid in the stomach, which makes it difficult to absorb B12. Also vulnerable to B12 deficiency are those with gastrointestinal disorders like celiac disease or Crohn’s disease; those who have had weight loss or other gastrointestinal surgery; and those who use certain acid reflux drugs or the diabetes drug metformin. Individuals with pernicious anemia, which affects up to 2 percent of older adults, are also susceptible. © 2018 The New York Times Company

Keyword: Depression
Link ID: 25732 - Posted: 11.30.2018

By Lisa Sanders, M.D. “Something’s wrong,” the 27-year-old woman said to her new husband. “I think you need to take me to the hospital.” It was the day after their wedding. The woman’s husband and her best friend were car fanatics, and so the newlyweds had wanted to commemorate their union with pictures at a drift track in rural Toutle, Wash. The best friend would “drift cookies,” circling the couple in a tight, controlled skid. As another friend took pictures, the two embraced, wreathed by smoke and dust and barely contained chaos as the red Mustang fishtailed around them. In the photos, the couple look happy. But as they loaded up the car to go home, the young woman started to feel strange. She’d been a little jittery all day. She noticed she couldn’t stop talking. She figured it was just the excitement of the wedding’s aftermath. But suddenly her excitement felt out of control. Her heart, which was racing since she got up that morning, went into overdrive. It pounded so hard that it hurt her throat and chest. She couldn’t think. Her hands took on a life of their own — they opened and closed incessantly. Her new husband was confused and worried. They drove to a hospital a couple of towns over. It was a panic attack, they were told. Since the birth of the couple’s daughter a year before, the young woman had struggled with postpartum depression and anxiety. She’d just married and had these crazy pictures taken; it was no wonder she was panicking. The young woman accepted the diagnosis, but she couldn’t help feeling that this was different from the anxiety she sometimes experienced. She was given a medication to take if she had more symptoms and sent home. The pills didn’t seem to help. The next day she felt her heart pounding in her throat and the same spacy-headed jitters from the day before. She tried the medicine again but after that, her memory is just fragments. © 2018 The New York Times Company

Keyword: Schizophrenia; Neuroimmunology
Link ID: 25719 - Posted: 11.26.2018

At 35, Sharon Jakab knew something was wrong when she started hallucinating. "I saw my grandmother on the wall in the room. She was talking to me. I wasn't sleeping, and I was a mess," she says from her home in Burlington, Ont. Jakab had been suffering from postpartum depression following the birth of her daughter. About a year and a half later, Jakab had another episode of postpartum depression following an ectopic pregnancy. It became so bad, she was suicidal. "There was a gun in the house and there were cartridges. I was all set to kill myself." She had to suicide-proof her home by taking away all dangerous objects, even skates, which have sharp blades. Now 61, Jakab has been in and out of hospitals, dealing with what she calls "waves of depression" that have lasted most of her adult life. She's tried about a dozen medications, including the antipsychotic drug clozapine. "Clozapine really helped me a lot, but I still suffered from depression, psychosis and mania." Because standard treatment like medication and therapy weren't effective, Jakab was diagnosed with treatment-resistant depression, a severe form of depression that close to a million Canadians experience. Electroconvulsive therapy or ECT, better known as shock treatment, is still considered the go-to treatment but comes with the common side effect of memory loss. So doctors are now exploring less invasive experimental approaches like brain stimulation that rewires the brain's circuits. ©2018 CBC/Radio-Canada

Keyword: Depression
Link ID: 25718 - Posted: 11.26.2018

By Benedict Carey Nothing humbles history’s great thinkers more quickly than reading their declarations on the causes of madness. Over the centuries, mental illness has been attributed to everything from a “badness of spirit” (Aristotle) and a “humoral imbalance” (Galen) to autoerotic fixation (Freud) and the weakness of the hierarchical state of the ego (Jung). The arrival of biological psychiatry, in the past few decades, was expected to clarify matters, by detailing how abnormalities in the brain gave rise to all variety of mental distress. But that goal hasn’t been achieved — nor is it likely to be, in this lifetime. Still, the futility of the effort promises to inspire a change in the culture of behavioral science in the coming decades. The way forward will require a closer collaboration between scientists and the individuals they’re trying to understand, a mutual endeavor based on a shared appreciation of where the science stands, and why it hasn’t progressed further. “There has to be far more give and take between researchers and the people suffering with these disorders,” said Dr. Steven Hyman, director of the Stanley Center for Psychiatric Research at the Broad Institute of M.I.T. and Harvard. “The research cannot happen without them, and they need to be convinced it’s promising.” The course of Science Times coincides almost exactly with the tear-down and rebuilding of psychiatry. Over the past 40 years, the field remade itself from the inside out, radically altering how researchers and the public talked about the root causes of persistent mental distress. The blueprint for reassembly was the revision in 1980 of psychiatry’s field guide, the Diagnostic and Statistical Manual of Mental Disorders, which effectively excluded psychological explanations. Gone was the rich Freudian language about hidden conflicts, along with the empty theories about incorrect or insufficient “mothering.” Depression became a cluster of symptoms and behaviors; so did obsessive-compulsive disorder, bipolar disorder, schizophrenia, autism and the rest. © 2018 The New York Times Company

Keyword: Schizophrenia; Depression
Link ID: 25703 - Posted: 11.20.2018

A countrywide shortage of a common antidepressant medication has caused alarm among doctors, pharmacists and patients with mental illnesses. Nearly a dozen pharmacies in Saskatoon and Regina have told CBC News that they have run out of bupropion— both the brand-name product Wellbutrin and its generic counterparts — and can't get more from their suppliers. More than 12,000 patients in Saskatchewan take bupropion, according to the Ministry of Health. National figures are not readily available. The prescription antidepressant is used to treat major depressive disorder and seasonal affective disorder. "This might have been the drug that gave you the energy to live your life, do the things you needed to do, get on with your job, do your studies," said Dr. Sara Dungavell, a Saskatoon psychiatrist. She said she fielded anxious phone calls from patients about the shortage. Two pharmaceutical companies that produce generic bupropion are reporting a shortage or anticipated shortage on the Health Canada website. The company that manufactures Wellbutrin, Bausch Health, reported its shortage to Health Canada six weeks ago. On Thursday, it told CBC News it had resolved its shortage, and Canadian pharmacies would receive the drug "imminently," depending on delivery schedules. By Saturday afternoon, pharmacies in Calgary, Saskatoon, Regina and Winnipeg said they had yet to receive a shipment, and their pharmacists said it was still listed as unavailable in their system. ©2018 CBC/Radio-Canada

Keyword: Depression
Link ID: 25702 - Posted: 11.20.2018

By Donald G. McNeil Jr. The first treatment for sleeping sickness that relies on pills alone was approved on Friday by Europe’s drug regulatory agency, paving the way for use in Africa, the last bastion of the horrific disease. With treatment radically simplified, sleeping sickness could become a candidate for elimination, experts said, because there are usually fewer than 2,000 cases in the world each year. The disease, also called human African trypanosomiasis, is transmitted by tsetse flies. The protozoan parasites, injected as the flies suck blood, burrow into the brain. Before they kill, drive their victims mad in ways that resemble the last stages of rabies. The personalities of the infected change. They have terrifying hallucinations and fly into rages; they have been known to beat their children and even attack family members with machetes. They may become ravenous and scream with pain if water touches their skin. Only in the end, do they lapse into a long coma and die. The new drug, fexinidazole, cures all stages of the disease within 10 days. Previously, everyone with the parasites found in a blood test also had to undergo a spinal tap to see if the parasites had reached their brains. If so, patients had to suffer through a complex and sometimes dangerous intravenous regimen requiring hospitalization. An oral treatment that can safely be taken at home “is a completely new paradigm — it could let us bring treatment down to the village level,” said Dr. Bernard Pecoul, founder and executive director of the Drugs for Neglected Diseases Initiative, which was started in 2005 by the medical charity Doctors Without Borders to find new cures for tropical diseases. © 2018 The New York Times Company

Keyword: Neurotoxins
Link ID: 25695 - Posted: 11.17.2018

David DiSalvo Research findings suggesting that sleep loss and anxiety are closely linked were among those presented at Neuroscience 2018, the annual conference of the Society for Neuroscience held in San Diego, California. The news isn’t all dire, however – this year’s event offered some science-based encouragement along with causes for concern. Neuroscience continues focusing on the mysteries of sleep (and yes, it’s still plenty mysterious despite its media ubiquity)—not only the perils of failing to get enough, but the list of vital roles it plays in our brains. Research discussed at this year’s event touched on a range of findings, from sleep's roles in memory consolidation to garbage removal in brain tissue. We’re learning via more studies each year that sleep, including well-placed naps, facilitates the brain’s consolidation of information—moving memory freight from short-term to long-term storage, and sharpening its accessibility for when we need it. Without sleep, memory simply doesn’t happen. We’ve also learned that sleep provides the brain with an invaluable period of transporting toxins out of neural tissue through a complex garbage-removal system. Operating separately from the body's lymphatic system, the brain’s trash-disposal apparatus seems dependent on sleep to function properly. Links between neurodegenerative diseases like Alzheimer’s and the accumulation of toxins in brain tissue are exceptionally strong, and sleep loss is a likely culprit. A panel session at this year’s event called “Threats of Sleep Deprivation” highlighted new findings on the connection between sleep loss and anxiety. “Sleep deprivation isn’t what we usually think it is,” said session moderator Clifford Saper, MD, PhD of Harvard Medical School. It’s usually not “staying up 40 hours all at once,” but rather gradually losing sleep over time. ©2018 Forbes Media LLC.

Keyword: Sleep; Emotions
Link ID: 25680 - Posted: 11.14.2018

Nicola Davis Being overweight can cause depression, researchers say, with the effects thought to be largely psychological. While previous studies have found that people who are obese are more likely to have depression, it has been unclear whether that is down to depression driving weight changes or the reverse. Now, in the largest study of its kind, experts say having genetic variants linked to a high body mass index (BMI) can lead to depression, with a stronger effect in women than men. What’s more, they say the research suggests the effect could be down to factors such as body image. “People who are more overweight in a population are more depressed, and that is likely to be at least partly [a] causal effect of BMI [on] depression,” said Prof Tim Frayling, a co-author of the study, from the University of Exeter medical school. Get Society Weekly: our newsletter for public service professionals Read more Writing in the International Journal of Epidemiology, the researchers from the UK and Australia describe how they used data from the UK Biobank, a research endeavour involving 500,000 participants aged between 37 and 73 who were recruited in 2006-10. The researchers looked at 73 genetic variants linked to a high BMI that are also associated with a higher risk of diseases such diabetes and heart disease. They also looked at 14 genetic variants linked to a high percentage of body fat but which were associated with a lower risk of such health problems. While the former group could be linked to depression through biological or psychological mechanisms, the latter would only be expected to have a psychological effect. © 2018 Guardian News and Media Limited

Keyword: Obesity; Depression
Link ID: 25677 - Posted: 11.13.2018

By Alex Williams It’s hard to say the precise moment when CBD, the voguish cannabis derivative, went from being a fidget spinner alternative for stoners to a mainstream panacea. Maybe it was in January, when Mandy Moore, hours before the Golden Globes, told Coveteur that she was experimenting with CBD oil to relieve the pain from wearing high heels. “It could be a really exciting evening,” she said. “I could be floating this year.” Maybe it was in July, when Willie Nelson introduced a line of CBD-infused coffee beans called Willie’s Remedy. “It’s two of my favorites, together in the perfect combination,” he said in a statement. Or maybe it was earlier this month, when Dr. Sanjay Gupta gave a qualified endorsement of CBD on “The Dr. Oz Show.” “I think there is a legitimate medicine here,” he said. “We’re talking about something that could really help people.” So the question now becomes: Is this the dawning of a new miracle elixir, or does all the hype mean we have already reached Peak CBD? Either way, it would be hard to script a more of-the-moment salve for a nation on edge. With its proponents claiming that CBD treats ailments as diverse as inflammation, pain, acne, anxiety, insomnia, depression, post-traumatic stress and even cancer, it’s easy to wonder if this all natural, non-psychotropic and widely available cousin of marijuana represents a cure for the 21st century itself. The ice caps are melting, the Dow teeters, and a divided country seems headed for divorce court. Is it any wonder, then, that everyone seems to be reaching for the tincture? “Right now, CBD is the chemical equivalent to Bitcoin in 2016,” said Jason DeLand, a New York advertising executive and a board member of Dosist, a cannabis company in Santa Monica, Calif., that makes disposable vape pens with CBD. “It’s hot, everywhere and yet almost nobody understands it.” With CBD popping up in nearly everything — bath bombs, ice cream, dog treats — it is hard to understate the speed at which CBD has moved from the Burning Man margins to the cultural center. © 2018 The New York Times Company

Keyword: Drug Abuse; Depression
Link ID: 25623 - Posted: 10.27.2018

By JoAnna Klein Lavender bath bombs; lavender candles; deodorizing lavender sachets for your shoes, car or underwear drawer; lavender diffusers; lavender essential oils; even lavender chill pills for humans and dogs. And from Pinterest: 370 recipes for lavender desserts. Take a deep breath. Release. People like lavender. We’ve been using this violet-capped herb since at least medieval times. It smells nice. But Google “lavender” and results hint at perhaps the real fuel for our obsession: “tranquillity,” “calm,” “relaxation,” “soothing,” and “serenity.” Lavender has purported healing powers for reducing stress and anxiety. But are these effects more than just folk medicine? Yes, said Hideki Kashiwadani, a physiologist and neuroscientist at Kagoshima University in Japan — at least in mice. “Many people take the effects of ‘odor’ with a grain of salt,” he said in an email. “But among the stories, some are true based on science.” In a study published Tuesday in the journal Frontiers in Behavioral Neuroscience, he and his colleagues found that sniffing linalool, an alcohol component of lavender odor, was kind of like popping a Valium. It worked on the same parts of a mouse’s brain, but without all the dizzying side effects. And it didn’t target parts of the brain directly from the bloodstream, as was thought. Relief from anxiety could be triggered just by inhaling through a healthy nose. Their findings add to a growing body of research demonstrating anxiety-reducing qualities of lavender odors and suggest a new mechanism for how they work in the body. Dr. Kashiwadani believes this new insight is a key step in developing lavender-derived compounds like linalool for clinical use in humans. Dr. Kashiwadani and his colleagues became interested in learning how linalool might work for anti-anxiety while testing its effects on pain relief in mice. In this earlier study, they noticed that the presence of linalool seemed to calm mice. © 2018 The New York Times Company

Keyword: Emotions; Chemical Senses (Smell & Taste)
Link ID: 25610 - Posted: 10.24.2018

By Benedict Carey A generation ago, depression was viewed as an unwanted guest: a gloomy presence that might appear in the wake of a loss or a grave disappointment and was slow to find the door. The people it haunted could acknowledge the poor company — I’ve been a little depressed since my father died — without worrying that they had become chronically ill. Today, the condition has been recast in the medical literature as a darker, more permanent figure, a monster in the basement poised to overtake the psyche. For decades, researchers have debated the various types of depression, from mild to severe to “endogenous,” a rare, near-paralyzing despair. Hundreds of studies have been conducted, looking for markers that might predict the course of depression and identify the best paths to recovery. But treatment largely remains a process of trial and error. A drug that helps one person can make another worse. The same goes for talk therapies: some patients do very well, others don’t respond at all. “If you got a depression diagnosis, one of the most basic things you want to know is, what are the chances of my life returning to normal or becoming optimal afterward?” said Jonathan Rottenberg, a professor of psychology at the University of South Florida. “You’d assume we’d have an answer to that question. I think it’s embarrassing that we don’t.” In a paper in the current issue of Perspectives on Psychological Science, Dr. Rottenberg and his colleagues argue that, in effect, the field has been looking for answers in the wrong place. In trying to understand how people with depression might escape their condition, scientists have focused almost entirely on the afflicted, overlooking a potentially informative group: people who once suffered from some form of depression but have more or less recovered. Indeed, while this cohort almost certainly exists — every psychiatrist and psychologist knows someone in it — it is so neglected that virtually nothing is known about its demographics, how well its members are faring and, fundamentally, how many individuals it contains. © 2018 The New York Times Company

Keyword: Depression
Link ID: 25603 - Posted: 10.23.2018

Richard Harris Powerful drugs that have been used for decades to treat delirium are ineffective for that purpose, according to a study published online Monday in the New England Journal of Medicine. Antipsychotic medications, such as haloperidol (brand name, Haldol), are widely used in intensive care units, emergency rooms, hospital wards and nursing homes. "In some surveys up to 70 percent of patients [in the ICU] get these antipsychotics," says Dr. E. Wesley "Wes" Ely, an intensive care specialist at Vanderbilt University Medical Center. They're prescribed by "very good doctors at extremely good medical centers," he says. "Millions of people worldwide are getting these drugs to treat their delirium." But the drugs can have serious side effects. And Ely says there is no solid research showing that they are effective at treating delirium. Patients with delirium are often confused and incoherent and sometimes can suffer hallucinations. This condition can lead to long-term cognitive problems, including a form of dementia. Ely and colleagues at 16 U.S. medical centers decided to put antipsychotic drugs to a rigorous test. They divided nearly 600 patients who were suffering from delirium into three groups. One group got the powerful antipsychotic haloperidol. A second group got ziprasidone, which is a related medication from a class of drugs called "atypical antipsychotics." A third group got a placebo. © 2018 npr

Keyword: Alzheimers; Schizophrenia
Link ID: 25602 - Posted: 10.23.2018

By Sandra G. Boodman Ever since he was a toddler, Michael had been beset by an array of medical problems that doctors couldn’t explain. Severe leg pain came first. That was followed a few years later by recurrent, sometimes severe, stomachaches. Later, the little boy developed a wracking cough, followed by trouble breathing. In fifth grade, after he fell and smacked his tailbone, he was in so much pain he wound up in a wheelchair. His worried parents took him to four emergency rooms and an array of Washington-area specialists, among them orthopedists, neurologists, pediatricians and a gastroenterologist. Yet virtually every test failed to uncover a problem. It would take a seasoned pediatrician to pull together the disparate elements of the 10-year-old’s medical history and make an unexpected diagnosis that would prove to be a turning point for the boy and his family. Three years later, Michael, now 14 and a freshman in high school, seems to have moved beyond the disorder that dominated his first decade. His father said he believes his son’s illness resulted from “a perfect storm” of factors. He would have preferred that the doctors who saw Michael had spoken “a little more freely about their guesses” and had provided more guidance. To protect Michael’s privacy, his parents requested that he and they be identified by their middle names. When he was nearly 2, Michael, who had been previously healthy, began limping and then stopped walking. His pediatrician found no obvious explanation and sent him to a pediatric neurologist, who ordered an extensive work-up, including scans and blood tests. © 1996-2018 The Washington Post

Keyword: Development of the Brain; Emotions
Link ID: 25598 - Posted: 10.22.2018

Sasa Woodruff Ryan "China" McCarney has played sports his entire life, but sometimes he has to force himself to show up on the field to play pick-up soccer with his friends. "I'm dreading and I'm anticipating the worst. But I do it anyway. And then, it's a euphoric sensation when you're done with it because you end up having a great time," says McCarney. McCarney was just 22 when he had his first panic attack. As a college and professional baseball player, he says getting help was stigmatized. It took him six years to get professional support. He still struggles with depression and social anxiety, but says exercising helps him — especially when it's with his teammates. Research shows exercise can ease things like panic attacks or mood and sleep disorders, and a recent study in the journal, Lancet Psychiatry, found that popular team sports may have a slight edge over the other forms of physical activity. The researchers analyzed CDC survey data from 1.2 million adults and found — across age, gender, education status and income — people who exercised reported fewer days of bad mental health than those who didn't. And those who played team sports reported the fewest. One of the study's authors, Adam Chekroud, an assistant adjunct professor at Yale's School of Medicine, thinks team activity could add another layer of relief for sufferers of mental illness. He says there are biological, cognitive and social aspects to mental illness. "Some sports might just be hitting on more of those elements than other sports," he says. "If you just run on a treadmill for example, it's clear that you're getting that biological stimulation. But perhaps there are other elements of depression that you're not going to be tapping into." © 2018 npr

Keyword: Depression
Link ID: 25597 - Posted: 10.22.2018