Chapter 16. Psychopathology: Biological Basis of Behavior Disorders

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By Catherine Caruso, More than half of all opioid prescriptions in the United States are written for people with anxiety, depression, and other mood disorders, according to a new study that questions how pain is treated in this vulnerable population. People with mood disorders are at increased risk of abusing opioids, and yet they received many more prescriptions than the general population, according to an analysis of data from 2011 and 2013. “We’re handing this stuff out like candy,” said Dr. Brian Sites, of Dartmouth-Hitchcock Medical Center, the senior author of the study. Opioid prescribing in the U.S. quadrupled between 1999 and 2015, and during that time over 183,000 people died from overdoses related to prescription opioids, according to the CDC. Sites said more research is needed to understand whether opioids are being overprescribed to adults with mood disorders. “If you want to come up with social policy to address the need to decrease our out-of-control opioid prescribing, this would be the population you want to study, because they’re getting the bulk of the opioids, and then they are known to be at higher risk for the bad stuff,” he said. The study, published Monday in the Journal of the American Board of Family Medicine, tapped a U.S. health survey that gathered data from providers and facilities on prescription medications, health status, and basic demographics for about 51,000 adults. It found that 19 percent of the 38.6 million Americans with mood disorders use prescription opioids, compared to 5 percent of the general population — a difference that remained even when the researchers controlled for factors such as physical health, level of pain, age, sex and race. © 2017 Scientific American

Keyword: Depression; Drug Abuse
Link ID: 23779 - Posted: 06.27.2017

By JANE E. BRODY It’s perfectly normal for someone to feel anxious or depressed after receiving a diagnosis of a serious illness. But what if the reverse occurs and symptoms of anxiety or depression masquerade as an as-yet undiagnosed physical disorder? Or what if someone’s physical symptoms stem from a psychological problem? How long might it take before the true cause of the symptoms is uncovered and proper treatment begun? Psychiatric Times, a medical publication seen by some 50,000 psychiatrists each month, recently published a “partial listing” of 47 medical illnesses, ranging from cardiac arrhythmias to pancreatic cancer, that may first present as anxiety. Added to that was another “partial listing” of 30 categories of medications that may cause anxiety, including, ironically, popular antidepressants like selective serotonin reuptake inhibitors, or S.S.R.I.s. These lists were included in an article called “Managing Anxiety in the Medically Ill” meant to alert mental health practitioners to the possibility that some patients seeking treatment for anxiety or depression may have an underlying medical condition that must be addressed before any emotional symptoms are likely to resolve. Doctors who treat ailments like cardiac, endocrine or intestinal disorders would do well to read this article as well lest they do patients a serious disservice by not recognizing an emotional cause of physical symptoms or addressing the emotional components of a physical disease. © 2017 The New York Times Company

Keyword: Depression; Stress
Link ID: 23773 - Posted: 06.26.2017

Researchers have identified structural changes in two genes that increase the risk of developing Tourette syndrome, a neurological disorder characterized by involuntary motor and vocal tics. The study, published in the journal Neuron, was supported by the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health. “Our study is the tip of the iceberg in understanding the complex biological mechanisms underlying this disorder. With recent advancements in genetic research, we are at the cusp of identifying many genes involved in Tourette syndrome,” said Jeremiah Scharf, M.D., Ph.D., assistant professor of neurology and psychiatry at Harvard Medical School and Massachusetts General Hospital, Boston, and co-corresponding author of the study. The research was part of an international collaboration co-led by Dr. Scharf; Giovanni Coppola, M.D., professor of psychiatry and neurology at the University of California, Los Angeles; Carol Mathews, M.D., professor of psychiatry at the University of Florida in Gainesville; and Peristera Paschou, Ph.D., associate professor in the department of biological sciences at Purdue University, West Lafayette, Indiana. The scientific team conducted genetic analyses on 2,434 individuals with Tourette syndrome and compared them to 4,093 controls, focusing on copy number variants, changes in the genetic code resulting in deletions or duplications in sections of genes. Their results determined that deletions in the NRXN1 gene or duplications in the CNTN6 gene were each associated with an increased risk of Tourette syndrome. In the study, approximately 1 in 100 people with Tourette syndrome carried one of those genetic variants.

Keyword: Tourettes; Genes & Behavior
Link ID: 23761 - Posted: 06.22.2017

/ By Joshua C. Kendall Dr. Joshua A. Gordon, the new director of the National Institute of Mental Health, took office in the final year of Barack Obama’s presidency. But he has this much in common with Obama’s successor: He has little patience for incremental reforms. As Gordon defines it, the job involves both advocating for the mental health needs of Americans and developing science to guide policymakers and clinicians. A 49-year-old psychiatrist who made his reputation as a brilliant researcher of mice with mutations that mimic human mental disorders, Gordon is convinced that radical changes are needed in the treatment of illnesses like schizophrenia. In an interview in his office at the NIMH campus in Bethesda, Maryland, he lamented that while modest improvements have been made in patient care over the last few decades, we don’t know enough about the brain to “even begin to imagine what the transformative treatments of tomorrow will be like.” Few psychiatrists would disagree that change is overdue. Take depression: Current approaches, which employ drugs like Prozac or cognitive-behavioral therapy, or a combination of the two, can relieve major symptoms in only some patients. The hope is that “precision medicine” — treatments targeted to the specific biological makeup of the patient — can do for psychiatry what scientists like Gordon’s Nobel Prize-winning mentors J. Michael Bishop and Harold E. Varmus did for cancer treatment a generation ago. Unfortunately, as Gordon is well aware, mental illness is particularly challenging in this regard. In contrast to many types of cancer, where one genetic mutation can cause unregulated cell growth, psychiatric diseases rarely stem from any single faulty gene; instead, they are typically rooted in a complex interplay of genetic, environmental, and cultural factors. Copyright 2017 Undark

Keyword: Depression; Schizophrenia
Link ID: 23751 - Posted: 06.17.2017

By Sam Wong Microdosing, the practice of regularly taking small amounts of psychedelic drugs to improve mood and performance, has been taking off over the past few years. But the fact that these drugs are illegal makes it difficult to research their effects and possible health consequences. There are no rigorous clinical trials to see whether microdosing works (see “Microdosers say tiny hits of LSD make your work and life better”). Instead, all we have are anecdotes from people like Janet Lai Chang, a digital marketer based in San Francisco. She will present her experience of microdosing at the Quantified Self conference in Amsterdam from 17 to 18 June. When did you start microdosing? I started in February 2016. I wanted to understand how my brain works and how it might work differently with the influence of psilocybin [the active ingredient in magic mushrooms]. What else did you hope to achieve? I had been struggling with a lot of social anxiety. It was really preventing me from advancing professionally. I was invited to give a talk at Harvard University and a TedX talk in California. I didn’t feel ready. I felt all this anxiety. I procrastinated until the last minute and then didn’t do it. It was one of my biggest regrets. What doses did you take? At first I was taking 0.2 grams of mushrooms every day, with a day or two off at the weekend. In August, I had a month off. From October to April, it was a few times a week. How did it affect you? I was less anxious, less depressed, more open, more extroverted. I was more present in the moment. It’s harder to get into the flow of the focused solo work that I’m normally really good at. But it’s good for the social aspect. © Copyright New Scientist Ltd.

Keyword: Depression; Drug Abuse
Link ID: 23743 - Posted: 06.15.2017

By ALEX WILLIAMS This past winter, Sarah Fader, a 37-year-old social media consultant in Brooklyn who has generalized anxiety disorder, texted a friend in Oregon about an impending visit, and when a quick response failed to materialize, she posted on Twitter to her 16,000-plus followers. “I don’t hear from my friend for a day — my thought, they don’t want to be my friend anymore,” she wrote, appending the hashtag #ThisIsWhatAnxietyFeelsLike. Thousands of people were soon offering up their own examples under the hashtag; some were retweeted more than 1,000 times. You might say Ms. Fader struck a nerve. “If you’re a human being living in 2017 and you’re not anxious,” she said on the telephone, “there’s something wrong with you.” It was 70 years ago that the poet W.H. Auden published “The Age of Anxiety,” a six-part verse framing modern humankind’s condition over the course of more than 100 pages, and now it seems we are too rattled to even sit down and read something that long (or as the internet would say, tl;dr). Anxiety has become our everyday argot, our thrumming lifeblood: not just on Twitter (the ur-anxious medium, with its constant updates), but also in blogger diaries, celebrity confessionals (Et tu, Beyoncé?), a hit Broadway show (“Dear Evan Hansen”), a magazine start-up (Anxy, a mental-health publication based in Berkeley, Calif.), buzzed-about television series (like “Maniac,” a coming Netflix series by Cary Fukunaga, the lauded “True Detective” director) and, defying our abbreviated attention spans, on bookshelves. With two new volumes analyzing the condition (“On Edge: A Journey Through Anxiety,” by Andrea Petersen, and “Hi, Anxiety,” by Kat Kinsman) following recent best-sellers by Scott Stossel (“My Age of Anxiety”) and Daniel Smith (“Monkey Mind”), the anxiety memoir has become a literary subgenre to rival the depression memoir, firmly established since William Styron’s “Darkness Visible” and Elizabeth Wurtzel’s “Prozac Nation” in the 1990s and continuing today with Daphne Merkin’s “This Close to Happy.” © 2017 The New York Times Company

Keyword: Depression; Stress
Link ID: 23732 - Posted: 06.12.2017

By JULIA FIERRO A few months ago, I gave a reading at a local bookstore. A small but enthusiastic crowd attended, and I confessed to the audience filled with emerging writers that I had, in my 20s and early 30s, stopped writing for eight years, and that I had accepted I’d never write again. Then someone asked, “How did you return to writing?” I decided to tell the truth: Zoloft. I began flipping light switches on and off (always in fives) in third grade. My frugal parents were aghast at the waste of electricity. I tried to explain. I had to flip the switches. Or else something bad would happen, to me, to them. We were all in danger — my younger brother, my school friends, even my pets. I assumed that my fears were rational and that my school friends were like me, worrying all the time. As my obsessions accumulated, the dread throbbed more insistently, and my rituals became more complex. I counted in fives all day at school, my teeth clicking in time so much my teacher grew annoyed by the sound, and when the last school bell rang, my jaw was sore. My nightly prayers became a chant I had to recite 20, then 50 and, later, 100 times. Now that I am a mother, it astounds me that I was able to hide my rituals from my family — but I felt I had no choice. As the daughter of an Italian immigrant who survived unimaginable horrors — poverty, plague, war, domestic violence, the death of his baby sister because of a lack of basic health care — I heard one word over and over again. “Forte.” Strength. Weakness or, to be more specific, showing or admitting to weakness, seemed both un-Italian and un-American. I was raised in a historic whaling village on Long Island. Every year our grade school class field-tripped to the town museum, where we heard stories about courageous Dutch and English settlers who harpooned and lanced whales before towing them ashore and using their flensing knives to cut blubber into long strips. The stories taught us that America was bedrocked with self-reliance and fortitude.

Keyword: Depression
Link ID: 23716 - Posted: 06.07.2017

By Helen Thomson Life is full of decisions, and sometimes it’s difficult to know if you’re making the right one. But a drug that blocks the rush of noradrenaline through your body can boost your confidence, and may also lead to new treatments for schizophrenia and obsessive compulsive disorder. How much we trust our decisions is governed by the process we use to assess our own behaviour and abilities, known as metacognition. Our judgements shape how we’ll behave in future. For example, if you play Frisbee and you think you played badly, you might be less likely to do it again, says Tobias Hauser at University College London. Having low confidence in our actions can play a part in mental health conditions. “We see many symptoms associated with poor metacognitive judgement in schizophrenia and OCD,” says Hauser. “In OCD, for instance, people may constantly go and check whether they’ve closed a door. They are poor at judging whether they have done something correctly or not.” Little is known about the neural underpinnings of metacognition, but it is likely to involve the prefrontal cortex and the hippocampus, two brain areas modulated by the chemicals dopamine and noradrenaline. To investigate, Hauser and his colleagues asked 40 people to take a drug that blocks dopamine or noradrenaline either before or after a placebo. Another 20 people received two doses of the placebo drug. Eighty minutes after receiving the second drug, the subjects performed a task in which they had to decide whether the overall motion of a burst of randomly moving dots was directed to the left or right. © Copyright New Scientist Ltd.

Keyword: OCD - Obsessive Compulsive Disorder
Link ID: 23705 - Posted: 06.03.2017

Sarah Marsh When depression takes hold of Helen it feels like she is drowning in a pool of water, unable to swim up to the world above. The 36-year-old former nurse has had mental health problems most of her life. No drugs, hospital stays or therapies have been able to help. Then one day, during yet another spell in hospital, her consultant told her about a psychiatrist treating patients with ketamine. The psychiatrist in question visited her to discuss using the drug. He warned there were no guarantees, but it had helped some patients. Since then Helen’s life has transformed. Sitting on a bench in the grounds of the hospital where her treatment began a year and a half ago, she lists everything she can do now that she could not before: take her kids to school, give them hugs, go on coffee dates. “I am managing my thoughts and that is what ketamine helps to do. It slows down my thought process so instead of being completely overwhelmed by all these immense negative thoughts and feelings … I can think, stop and breathe,” she says, nervously pulling her sleeves over her hands as she talks. She adds: “It’s still really hard but now there is a tiny fraction of a second where my thoughts are slow enough to think: ‘I can deal with this. I cannot give up.’”

Keyword: Depression; Drug Abuse
Link ID: 23697 - Posted: 06.02.2017

By Ariana Eunjung Cha Depression is usually considered an issue parents have to watch out for starting in the turbulent teenage years. The CW channel, full of characters with existential angst about school, friends and young love, tells us so, as do the countless parenting books about the adolescent years in every guidance counselor's office. But what if by that time it's already too late? A large new study out this week contains some alarming data about the state of children's mental health in the United States, finding that depression in many children appears to start as early as age 11. By the time they hit age 17, the analysis found, 13.6 percent of boys and a staggering 36.1 percent of girls have been or are depressed. These numbers are significantly higher than previous estimates. Understanding the risk of depression is critically important because of the close link between depressive episodes and serious issues with school, relationships and suicide. While researchers have long known about the gender gap in depression, with more adult women than men suffering from the condition, the new numbers show that whatever divergent paths boys and girls take happens even earlier than expected. Published in the journal Translational Psychiatry, the study was based on data compiled from in-person interviews with more than 100,000 children who participated in the National Survey of Drug Use and Health from 2009 to 2014. The NSDUH is an annual survey on a representative sample of the U.S. population. Among the standard questions asked are ones about insomnia, irritability, and feelings of guilt or worthlessness that researchers used to “diagnose” survey participants with depression using diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders. Through the survey, they were able to capture a broader group of children than those who have a formal diagnosis and who may be in treatment. © 1996-2017 The Washington Post

Keyword: Depression; Development of the Brain
Link ID: 23687 - Posted: 06.01.2017

By Sharon Begley, STAT Living in a city makes people develop schizophrenia. Tell me more: The claim is not quite that stark, but it’s close. For a study published last week, researchers interviewed 2,063 British twins (some identical, some not) at age 18 about “psychotic experiences” they’d had since age 12—such as feeling paranoid, hearing voices, worrying their food might be poisoned, and having “unusual or frightening” thoughts. Among those who lived in the most densely populated large cities, 34 percent reported such experiences; 24 percent of adolescents in rural areas did. The twins are part of a long-running study that has followed them from birth in 1994-95, so the researchers— led by Helen Fisher of King’s College London and Candice Odgers of Duke University—also knew the teens’ family income, parents’ education, where they lived, and more. Conclusion: 18-year-olds raised in big cities were 67 percent more likely to have had psychotic experiences, the researchers reported in Schizophrenia Bulletin. They then used standard statistics tools to account for possible psychosis-related factors other than cities per se. Cities have more people who are poor and uneducated, which are risk factors for schizophrenia and other forms of psychosis, so they controlled for socioeconomic status. Family psychiatric history raises the risk of an individual’s developing psychosis, and since there is some evidence that people with mental illness move to cities, which have more treatment facilities, the researchers controlled for this, too. They also controlled for drug use, some forms of which are more common in urban than rural areas. These calculations brought the extra risk of psychosis among urban teens down to 43 percent. © 2017 Scientific American,

Keyword: Schizophrenia; Stress
Link ID: 23683 - Posted: 05.31.2017

Nicola Davis People from ethnic minorities have up to a five times greater risk of psychotic disorders than the white British population, researchers say. A new study reveals that the trend holds in both urban and rural settings, with first-generation migrants who arrive in the UK in childhood among those at increased risk. The team behind the study say a number of factors could be at play, including stresses related to the migration process, discrimination and issues related to isolation and integration. James Kirkbride, a psychiatric epidemiologist from University College London and co-author of the research, described the figures as shocking. It’s time to tackle mental health inequality among black people “If this was any other disorder we would be horrified and up in arms and we would be campaigning from a public health perspective on how we could reduce this level of suffering,” he said. “There is a massive health inequality and it hasn’t got much attention.” While psychosis is rare – rates in England stand at about 30 cases per 100,000 people per year – Kirkbride says more should be done to offer services to those in need and to unpick drivers behind raised risks. “In the present climate when issues about migration are at the forefront of the public’s mind, people from ethnic minority backgrounds may face additional stresses that could potentially contribute to mental health problems,” he added. Writing in the journal Schizophrenia Bulletin, Kirkbride and colleagues from the University of Cambridge and a collection of NHS foundation trusts describe how they looked at trends among 687 people in the east of England.

Keyword: Schizophrenia
Link ID: 23678 - Posted: 05.30.2017

By Sandra Lamb Each night before “Greg” goes to bed he brushes and flosses his teeth. Then he double-checks the instructions on the dark brown bottle his nurse gave him before he unscrews the cap and tips five drops of a light-amber, oily liquid onto a spoon. The brew, glistening from the light of the bathroom fixture, is tasteless and has no odor he can detect. But it’s chock-full of bacteria. He sloshes the substance around in his mouth and swallows. Greg hopes that while he sleeps the foreign microbes will wage war with other organisms in his gut, changing that environment to ultimately help him manage some of the post-traumatic stress disorder (PTSD) symptoms that cloud his mind and riddle his days and nights with nightmares, flashbacks, thoughts of suicide and irrational responses to stressful events. The bacteria he is swallowing, his doctors tell him, “may help reduce symptoms of stress.” Each drop of Greg's brew is filled with millions of Lactobacillus reuteri, a bacterium isolated and derived from human breast milk. The Denver VA Hospital orders the substance and prescribes it as part of a PTSD clinical trial involving 40 veterans who either receive the bacteria or a placebo mix of sunflower oil and other inactive substances. (The bacterium is also currently used to treat a dental condition called chronic periodontitis because it has been shown to help fight inflammation.) © 2017 Scientific American

Keyword: Stress; Obesity
Link ID: 23600 - Posted: 05.10.2017

Sara Reardon Tom Insel, former director of the US National Institute of Mental Health, is searching for new ways of addressing mental illness. Sixteen months after leaving the US National Institute of Mental Health (NIMH) for Google’s health sciences division, psychiatrist Tom Insel is on the move again. The former NIMH director, who left Google on 5 May, is starting his own company. Insel’s group, called Mindstrong, will try to infer a person’s mental-health status by analysing the way they use smartphones. Insel stepped down as NIMH director in December 2015 in order to start a mental-health program called Verily within Google’s Life Sciences group. One of the division’s goals overlaps with that of Mindstrong's: Verily intends to build tools, which could include smartphone apps or computer programs, that can recognize characteristics of mental illness using a method known as “digital phenotyping”. The method analyses factors such as a user’s word choice in communication, voice patterns when talking to digital assistants, their physical movements and location data to determine their state of mind. If a smartphone could recognize when its owner was feeling suicidal, for instance, it could potentially intervene by providing resources or alerting others. © 2017 Macmillan Publishers Limited

Keyword: Depression; Schizophrenia
Link ID: 23597 - Posted: 05.10.2017

By CASEY SCHWARTZ OAKLAND, Calif. — In a packed, cavernous space one weekend late in April, a crowd of thousands was becoming increasingly amped up. Rainbow hair was commonplace, purple silk pants were sighted, and the smell of marijuana drifted in from a designated smoking area nearby. Audience members watched the stage with avid interest, leaping to occasionally shoeless feet to applaud and cheer. This wasn’t Coachella, taking place the same weekend some 500 miles south, or any other music festival, but a five-day convention of the Multidisciplinary Association for Psychedelic Studies (MAPS), its first in four years. Rather than rock stars, scientists from schools like Johns Hopkins and N.Y.U. were the main attraction, bringing evidence to the medical case for psychedelics like psilocybin (the active ingredient in magic mushrooms) to assuage end-of-life anxiety, to help deepen meditation practices, to search for the shared underpinnings of spiritual life, and — in a new study — to explore a possible treatment for severe depression. Paul Austin, 26, of Grand Rapids, Mich., a so-called social entrepreneur who runs a website called The Third Wave devoted to getting out information on psychedelic substances, had come to meet other members of the pro-psychedelic community and share with them his vision for how the next generation must proceed. “A lot of the people who are leading the movement now are 60 or 70 years old, based in academia or research,” Mr. Austin said. “But to catalyze change, you have to speak to people, get to them on an emotional level.” The conference was taking place just over the Bay Bridge from the city that introduced psychedelics to the American imagination in the early 1960s, when LSD was relatively new, legal and regarded by those who used it as a portal to expanded consciousness, a deeper life and an enlightened, humane society. (Cary Grant and other Hollywood stars were among those who experimented with it as part of their psychotherapeutic process.) © 2017 The New York Times Company

Keyword: Drug Abuse; Depression
Link ID: 23589 - Posted: 05.08.2017

A U.S.-based drug researcher who led a team that hunted through a massive database of patient records says the anesthetic ketamine shows potential as an antidepressant and should be further studied for its potential as a psychiatric drug. Doctors currently use ketamine to relieve pain during surgery and it is approved for that purpose. The drug's potential to relieve suicidal depression is also well known, but that information is based on anecdotes and small studies rather than a large clinical trial. Ruben Abagyan, a professor in the school of pharmaceutical sciences at the University of California San Diego, said ketamine is a "possible alternative treatment and definitely in particularly difficult cases." Those cases could include suicidal depression, where the weeks of treatment that traditional antidepressants require to take effect might be too long, Abagyan said. Search for beneficial signal Abagyan is the senior author of a study published in Wednesday's issue of the journal Scientific Reports, based on an analysis of a large U.S. database of adverse effect reports that were made for any reason. The U.S. Food and Drug Administration's adverse effects database, which contains over 8 million patient records of reports made for a wide range of reasons, is normally used to look for potentially harmful side-effects. But in a twist, the researchers turned this on its head, looking for reduction in depression symptoms among patients who took ketamine. "If we can look at the reduction of their complaints about depression that can be a signal for the beneficial effect of ketamine," Abagyan said. ©2017 CBC/Radio-Canada.

Keyword: Depression; Drug Abuse
Link ID: 23569 - Posted: 05.04.2017

Miriam E. Tucker In July 2012, a science reporter for The Washington Post, Brian Vastag, was in Wisconsin visiting his family when a high fever hit. He became instantly bedridden with flu-like symptoms that never went away. "It didn't feel like anything I'd ever had before. ... The things that distinguished it were the dizziness and the feeling of unreality in the head," Vastag says. Now, nearly five years later, the 45-year-old can no longer concentrate or read even a few sentences without becoming exhausted. A short walk to the mailbox means lying down for the rest of the day. In September, he'll qualify for Medicare due to his disability. That level of severity isn't the picture most people — including physicians — think of when they hear the term "chronic fatigue syndrome." But that was the diagnosis Vastag finally received after 18 months of visiting numerous doctors, submitting countless vials of blood and initially being misdiagnosed with West Nile virus. Actually, Vastag's condition is now termed "myalgic encephalomyelitis/chronic fatigue syndrome," or ME/CFS for short, and is estimated to affect at least 1 million people in the U.S. alone. Many with the condition dislike the name "chronic fatigue syndrome" because they feel it's trivializing and misleading, giving the impression that they're simply tired or depressed when in fact many are quite ill. Nailing down the cause — or, more likely, causes — of the illness has proven exceptionally difficult, since patients' symptoms vary tremendously. © 2017 npr

Keyword: Depression
Link ID: 23561 - Posted: 05.02.2017

By Dave A. Chokshi, In medicine, we speak of “seeing patients” when we are rounding in the hospital or caring for those who come to our clinics. But what about those people who may be sick but do not seek care? What is our responsibility to the patients we do not see? This question takes on greater urgency in the current political climate, as patients face the threat of losing health insurance. Renewed efforts to repeal and replace the Affordable Care Act leave millions wondering whether they will be covered. For me, as a physician practicing in the safety net, abstract numbers evoke the very real stories of my uninsured patients. One of my patients, whom I’ll call Elsa, had not seen a doctor since immigrating to the United States 15 years ago. That abruptly changed one morning: She awoke to find the room spinning around her and, terrifyingly, she could not articulate the words to explain to her husband what was going on. She was having a stroke. There are many reasons that patients like Elsa may not seek care – until they have no choice. Although she felt no symptoms before her stroke, Elsa was one of about 13 million U.S. adults with undiagnosed high blood pressure. I wondered if making her aware of her blood pressure would have been enough to avoid her suffering. But even if high blood pressure may sit atop the list of problems I write out, from his or her perspective it may not crack the top five. Food security, job stability, child care and affordable housing understandably feel more urgent. Time and again, I have learned that taking care of my patients starts by trying to walk a mile in their shoes. © 2017 Scientific American

Keyword: Stroke; Schizophrenia
Link ID: 23555 - Posted: 05.01.2017

Amy Maxmen Psychedelic drugs could soon help people, including soldiers, who suffer from post-traumatic stress disorder with the pain of recalling traumatic memories. Psychologists have occasionally given people psychedelic drugs such as LSD or magic mushrooms to induce altered states, in an attempt to treat mental illness. Today, many of those drugs are illegal, but if clinical trials testing their efficacy yield positive results, a handful could become prescription medicines in the next decade. The furthest along in this process is MDMA — a drug sold illegally as ecstasy or Molly — which is showing promise in the treatment of post-traumatic stress disorder (PTSD). Last week, at the Psychedelic Science 2017 conference in Oakland, California, researchers presented unpublished results from phase II trials involving a total of 107 people diagnosed with PTSD. The trial treatment involved a combination of psychotherapy and MDMA (3,4-methylenedioxymethamphetamine). The US Food and Drug Administration (FDA) reviewed these data in November, which were not released to the public at the time. The agency recommended that the researchers move forward with phase III trials, the final stage before potential approval of the drug. At the conference, researchers affiliated with the non-profit organization that is sponsoring the trials, the Multidisciplinary Association for Psychedelic Studies (MAPS) in Santa Cruz, California, presented some of their latest resutls. They used a cinically validated scale that assesses PTSD symptoms such as frequency of nightmares and anxiety levels. More than one year after two or three sessions of MDMA-assisted therapy, about 67% of participants no longer had the illness, according to that scale. About 23% of the control group — who received psychotherapy and a placebo drug — experienced the same benefit. © 2017 Macmillan Publishers Limited,

Keyword: Drug Abuse; Stress
Link ID: 23554 - Posted: 04.29.2017

Elizabeth Eaton Researchers have pinpointed a gene that keeps important brain cells in mice from crossing their wires, providing a possible link between brain wiring and mood disorders like depression. Without the gene, called Pcdhαc2, mice acted more depressed, researchers report April 28 in Science. Nerve cells, or neurons, that produce the chemical messenger molecule serotonin extend long projections called axons to various parts of the brain. Serotonin released from the tips of the axons signal other neurons in these target areas to influence mood and other aspects of behavior. For efficient signaling, the axon tips must be properly spaced. In the new work, scientists from New York City, St. Louis and China found that such spacing is disrupted in mice lacking the Pcdhαc2 gene. As a result, serotonin-signaling circuits are not properly assembled and the mice exhibited behaviors indicating depression. Pcdhαc2 is found in a cluster of genes that contain the blueprints for proteins that protrude from the surface of cells. These proteins work like ID cards, says study coauthor Joseph Dougherty, a neurogeneticist at Washington University School of Medicine in St. Louis. As serotonin neuron axons branch out through the brain, they can recognize other axons carrying identical IDs and spread out to keep out of each other’s paths. This process, called tiling, evenly spaces the axons in their target areas within the brain. |© Society for Science & the Public 2000 - 2017

Keyword: Depression; Brain imaging
Link ID: 23553 - Posted: 04.29.2017