Following are the latest news and information resources for the various mental health topics that we cover. We hope you will find the news educational and the links in the resources section useful in helping you to get even more in-depth data.
Patients treated for schizophrenia or bipolar I disorder under the ACCESS model have low levels of service disengagement, high levels of medication adherence and improvements in clinical outcomes, researchers report.
Daniel Schöttle (University Medical Center Hamburg-Eppendorf, Germany) and colleagues explain that ACCESS “was created to offer assertive community treatment embedded in an integrated care program to patients with schizophrenia spectrum disorders.”
Following positive results in an initial 12-month comparative trial (ACCESS I), the ACCESS model was implemented into routine care and extended to patients with bipolar I disorder with psychotic features.
The current ACCESS II Study assessed the efficacy of the model in a new sample of patients over 24 months to test whether treatment effects can be sustained over longer periods under “real-life” conditions.
A total of 115 patients (mean age 41.8 years, 44.3% men) with schizophrenia spectrum disorders or bipolar I disorder with psychotic features were included in the study. They received an average of 1.6 treatment contacts per week, and over the 24-month treatment period 3.4% became service disengaged after a median of 36.9 weeks. A further 9.6% dropped out of the study because they moved away from the catchment area.
“The positive effect of assertive community treatment on sustained service engagement may be explained by the high team fidelity, lower and shared case load, higher contact frequency, no drop-out policy, 24-hour-per-day availability, and possibility of visiting patients in the community, especially if at risk for disengagement”, write Schöttle et al in TheJournal of Clinical Psychiatry.
Psychotherapeutic orientation, intensive involvement of family members, a good relationship with self-help groups and active involvement of patients towards recovery may also have played a part, the researchers say.
They add that these factors may also explain the much lower number of involuntary admissions compared with the 2 years prior to ACCESS treatment (7.8 vs 34.8%) the low mean number of inpatient days (11.6, compared with a benchmark of 63 days per 2 years in the study catchment area) and the higher rates of medication adherence compared with baseline (78.3 vs 25.2%).
Other benefits of ACCESS included medium to large improvements in satisfaction with care within the first 6 weeks, quality of life within the first 3 months, illness severity and global functioning within the first 6 months and psychopathology within the first 18 months. Furthermore, all of these improvements were sustained for the duration of the study.Read article >>
We live in a world that is very volatile, uncertain, complex and full of ambiguity. We live in an environment, particularly in the corporate world, where competition is increasing, where there is a 24/7 always-on mentality, and where people are expected to do more with less. This sort of environment is conducive to driving people to high levels of stress, which can evolve into depression and anxiety. And given that there's no indication that things are going to get any easier in the future, how can the corporate world better address depression and anxiety and break the stigma associated with those illnesses?
Here are four starting points:
1. Managers and leaders need to become better educated on the importance of a healthy mind. When we were in school, we were taught the importance of a healthy body through physical education and health classes, but we were never taught the importance of also keeping our minds healthy. There is a significant amount of work that needs to be done to educate managers and leaders on healthy minds. They should learn why a healthy mind is important; how to identify if someone might be moving from stress to distress to depression and anxiety; how stress and anxiety are illnesses, not weaknesses; and how to support someone who might be ill and reintegrate them back into the workplace.
2. We need corporate leaders to "come out of the closet" about their experiences with mental illness. When leaders rack up the courage to talk about personal experiences -- or those of a family member or close friend -- they help normalize mental illness and make it easier to talk about these issues.
3. Put in place opportunities for employees to address their emotional and mental health. It's commonplace for companies to have gyms where people can improve their physical health. Mindfulness and meditation courses, quiet rooms and other opportunities for employees to recover, recharge and reflect can help nurture employees' mental and emotional health. Oftentimes, the source of anxiety and depression can be factors in the workplace.
The simple act of not giving feedback to employees regarding their performance on a regular basis can be a real source of stress and distress, and can lead to depression and anxiety. When you combine already-existing stress and demands with technology and the need to cut costs, the pressures are even higher. In their New York Times article, "Why You Hate Work," Tony Schwartz and Christine Porath note that 87% of people today find their work disappointing, which leads to less productive work.
Therefore, the competitive edge in the future might be to ensure that employees are well in a holistic sense. In order to achieve this complete sense of well-being, corporations must focus more on enhancing the well-being of their people, and thus attend to not only their physical health, but also their mental well-being (i.e. ability to focus), emotional well-being (i.e. level of happiness), and spiritual well-being (i.e. sense of purpose).
4. Corporations need to become more purposeful in what they do so employees feel a sense of purpose. Giving people a sense of purpose at work is strongly linked to overall well-being. We need a more conscious form of capitalism, where organizations are driven by purpose, by addressing the social and environmental challenges the world faces and in doing so, grow and be profitable. This gives individuals in organizations a greater sense of purpose in what they do and thus contributes to their overall well-being.
Overall, in wealthy countries, mental illness accounts for 40% of all ill health for people under 65. And as Richard Layard and David Clark write, " [I]t is terrible for those who experience it. But it is also bad for business, since it gives rise to nearly half of all days off sick. And it is bad for taxpayers, since mental illness accounts for nearly half of all the people who live on disability benefits."
The last 50 years have seen enormous progress in advanced societies: less absolute poverty, better physical health, more education, among many other developments. Yet there is almost as much misery as there was 50 years ago. And the ever-increasing volatility, uncertainty, complexity and ambiguity is contributing to this. Businesses must now do their part to reduce this burden, and the four starting points above provide some guidance as to how to begin tackling these issues, to the benefit of their performance, their employees and society as a whole.Read article >>
Healthy children who have a parent with bipolar disorder show altered brain activation during reward processing, research shows.
Compared with children with no Axis I psychiatric disorders among their first- or second-degree relatives, children of bipolar patients had altered function in the pregenual cingulate when anticipating a reward and in the orbitofrontal cortex (OFC) when gaining or failing to gain a reward.
These findings in children of bipolar disorder patients suggest mechanisms that may “underlie early vulnerabilities for developing dysfunctional regulation of goal pursuit and motivation in children at high risk for mania”, say lead researcher Manpreet Singh (Stanford University School of Medicine, California, USA) and co-workers.
The 20 children of bipolar patients had significantly lower Children’s Global Assessment Scale scores than a demographically matched group of 25 low-risk children, as well as higher levels of novelty seeking. However, the two groups did not differ in terms of mania, depression or anxiety.
On functional magnetic resonance imaging, the low-risk children had more pregenual cingulate activation when anticipating a loss than when anticipating a reward. But the reverse was true among children of bipolar patients, who had the greatest activation when anticipating a reward.
“The pregenual cingulate typically functions in the regulation of emotion and to weigh cost against benefit in situations that require approach-avoidance decision-making”, the researchers write in JAMA Psychiatry.
“Thus, reduced pregenual cingulate activation in high-risk youth may represent a neurobiological vulnerability that predisposes high-risk children to impaired hedonic function.”
In connectivity studies of the pregenual cingulate, children of bipolar patients had weaker connectivity with the right ventrolateral prefrontal cortex during anticipation of reward than of loss. The reverse was true for the low-risk children, implying that the children of bipolar patients had “impaired regulation of affect while anticipating rewards, but excessive regulation while anticipating losses.”
During reward feedback (when the children successfully gained a reward or avoided a loss), children of bipolar patients had greater left lateral OFC activation when they successfully gained rewards than when they avoided losses. Again, low-risk children had the reverse pattern, consistent with the OFC having a regulatory function in monitoring reward values in mentally healthy people.
The team did not find altered connectivity between the OFC and other, predetermined cerebral areas of interest, however.
Singh et al suggest that future research into their findings “may facilitate the development of intervention strategies that use adaptive reward responses that could prevent the onset of mania.”Read article >>
Our gadgets are so interwoven with our lives, it’s fair to argue that they’ve become an extension of who we are. Phones are no longer just phones, they are Life Interface Devices (let’s just go ahead and coin it – they’re LIDs), and losing your LID is no small matter. Back in the day if someone stole your cellphone or you left it in a public bathroom, the loss stung for sure, but was remedied easily enough. Not so with LIDs, which carry as much of you in them as anything else you own.
It stands to reason, then, that losing your LID is likely to bring on anxiety. Researchers are calling this “Smartphone-Loss Anxiety Disorder” – the “disorder” part conveying not a clinical diagnosis, but just how grave a blow losing or having stolen our LID is, and just how difficult it is to get over.
A recently published paper by researchers from McMaster University in Hamilton, Ontario discusses the core of this anxiety, and a few coping mechanisms to overcome it. The problem they describe comes down to the depth of data “assets” we entrust to these little boxes in our pockets.
“These assets may include personal and business contacts, private pictures and videos, meeting and lecture notes and the like, banking details, utility statements, company spreadsheets and much more. All such assets are potentially sensitive to abuse by third parties,” they write.
On top of that, many companies now have a BYOD policy (bring your own device) for employees to use their own smartphones as work phones, rather than issuing company phones. So along with the ocean of personal data on your phone, you may also be safeguarding proprietary company data. Losing your phone in that case catalyzes anxiety about the security of your job along with the personal loss you’re already feeling.
Coping with this anxiety, the researchers say, starts well before we lose our LID. We need to punch up our awareness of our options. The research team says they found few people in their study who were aware of “countermeasures” like remote device locks or “time bomb” data deletion settings that effectively nuke everything on the phone before someone manages to break into it. People generally don’t investigate these countermeasures, according to the researchers, because they’re simply “in denial of the risk of losing their phone.”
Even with those coping mechanisms, there’s still a sharp uneasiness that comes with feeling like you’re cut off from the world. Losing a LID even for just a few days feels like drifting into a black hole where every voice, text and social media need is sucked into oblivion. And since so many of us have jettisoned our land lines and gone fully mobile, the anxiety of disconnection is all the more intense.
So what can we do? First we can take the researchers’ advice and get acquainted with the security measures available to us in case our LID goes AWOL. Then we can take our phone in hand, give it a good long look, and make peace with the possibility that this beloved device can quite easily go missing, either by mistake or by the misdeeds of others. It happens. Life will go on. And who knows, you might even enjoy the break.Read article >>
A study is shining new light on a sleep disorder called "sleep drunkenness." The disorder may be as prevalent as affecting one in every seven people. The research is published in the August 26, 2014, print issue of Neurology®, the medical journal of the American Academy of Neurology.
Sleep drunkenness disorder involves confusion or inappropriate behavior, such as answering the phone instead of turning off the alarm, during or following arousals from sleep, either during the first part of the night or in the morning. An episode, often triggered by a forced awakening, may even cause violent behavior during sleep or amnesia of the episode.
"These episodes of waking up confused have received considerably less attention than sleepwalking even though the consequences can be just as serious," said study author Maurice M. Ohayon, MD, DSc, PhD, with Stanford University School of Medicine in Palo Alto, CA.
For the study, 19,136 people age 18 and older from the general US population were interviewed about their sleep habits and whether they had experienced any symptoms of the disorder. Participants were also asked about mental illness diagnoses and any medications they took.
The study found that 15 percent of the group had experienced an episode in the last year, with more than half reporting more than one episode per week. In the majority of cases—84 percent—people with sleep drunkenness also had a sleep disorder, a mental health disorder or were taking psychotropic drugs such as antidepressants. Less than 1 percent of the people with sleep drunkenness had no known cause or related condition.
Among those who had an episode, 37.4 percent also had a mental disorder. People with depression, bipolar disorder, alcoholism, panic or post-traumatic stress disorder and anxiety were more likely to experience sleep drunkenness.
The research also found that about 31 percent of people with sleep drunkenness were taking psychotropic medications such as antidepressants. Both long and short sleep times were associated with the sleep disorder. About 20 percent of those getting less than six hours of sleep per night and 15 percent of those getting at least nine hours experienced sleep drunkenness. People with sleep apnea also were more likely to have the disorder.
"These episodes of confused awakening have not gotten much attention, but given that they occur at a high rate in the general population, more research should be done on when they occur and whether they can be treated," said Ohayon. "People with sleep disorders or mental health issues should also be aware that they may be at greater risk of these episodes."Read article >>
40 million Americans suffer from general anxiety disorder, but just a third of them receive treatment. How do those with anxiety deal with panic attacks, social uneasiness and other issues that stem from the mental health disorder?
In a HuffPost Live conversation Maria Senise, who suffers from general anxiety disorder, described how she learned to deal with her own anxiety. Senise uses everything from mindfulness to meditation to medication -- all of which help her control her condition.
“I have to do it all and I’m willing to do anything,” she said. “I’m on meds... and the Xanax for me is like a safety blanket. Just knowing that it’s available to me, sometimes helps me calm down in general. But I do use essential oils, aromatherapy, working out -- if I don’t work out, my mind goes haywire.”
Clinical Director for The Anxiety Treatment Center Karen Lynn Cassiday focused on the importance of seeking out a holistic practice to compliment medical treatment.
“A lot of the time, people just have a pill thrown at them,” she told host Alyona Minkovski. “If we look at what really helps, we see that on their own, if people exercise regularly, have good nutrition, learn to do things like tolerate stress, that can have an effect."
Cassiday advised those suffering from anxiety to deconstruct the reasons behind their feelings with exposure practice and acceptance.
“We know that the best treatments are ones that teach people to face their fear,” she said. “And whether you’re using mindfulness to help you face the fear…the trick of it is, you don’t have to fear the uncertainty in life.”Read article >>
The risk of eating disorders has been shown to be increased in some somatic illnesses. Many of these illnesses, such as type 1 diabetes and inflammatory bowel diseases, present autoimmune etiology. In addition, a prior autoimmune disease has recently been shown to increase the risk of mood disorders and schizophrenia.
Researchers at the University of Helsinki, Helsinki University Central Hospital and National Institute for Health and Welfare, Finland, aimed to address the prevalence and incidence of autoimmune diseases in a large Finnish patient cohort with anorexia nervosa, bulimia nervosa and binge eating disorder.
Patients (N=2342) treated at the Eating Disorder Unit of Helsinki University Central Hospital between 1995 and 2010 were compared with general population controls (N=9368) matched for the age, sex and place of residence. Data of 30 autoimmune diseases were from the Hospital Discharge Register from 1969 to 2010.
"We found that of patients with eating disorders, 8.9% had been diagnosed with one or more autoimmune diseases. Of the control individuals, the number was 5.4%", Dr. Anu Raevuori, from the University of Helsinki noted.
The increase in endocrinological diseases was explained by type 1 diabetes, whereas Crohn's disease contributed most to the risk of gastroenterological diseases.
The higher prevalence of autoimmune diseases among patients with eating disorders was not exclusively due to endocrinological and gastroenterological diseases; when these two categories were excluded, the increase in prevalence was seen in the patients both before the onset of the eating disorder treatment and at the end of the follow-up.
"Our findings support the link between immune-mediated mechanisms and development of eating disorders. Future studies are needed to explore the risk of autoimmune diseases and immunological mechanisms in individuals with eating disorders and their family members" Dr. Raevuori stated.Read article >>
One class of people want to recover from depression, and channel all their energy into doing so. They're the ones who work with their doctors and commit themselves to therapy - and if they can't afford therapy, they bury themselves in more cost-friendly alternatives like self-help books and free online therapy. They make sure they eat well, do their best to sleep well, and even though it may be the last thing in the world that they feel like doing, they force themselves to exercise.
And because all their energy is dedicated to recovering, they usually do so, and they go on to live happy, healthy lives.
The second group of people, on the other hand, do not want to recover - rather, they've convinced themselves that they're always going to suffer from depression, and as a result, their goal is just to be as comfortable while suffering from their affliction as they can.
And because they don't believe that they can get on top of their illness, they tend to do few of the things that would actually help them get on top of it.
After all, going to therapy isn't exactly the most fun thing in the world to do, so if you're goal isn't to recover from depression, then why would you do it?
Same with reading self-help books and doing free online therapy - in the short run, you'd feel more "comfortable" watching TV or playing with your dog - so if your goal isn't to recover from depression, then why would you bother?
Same story with healthy eating - it's easier (and it tastes better!) to let yourself go then stick to a healthy diet, so if your goal was just to be as comfortable while suffering from your illness as possible as opposed to recovering from it for good, then you're going to eat that hamburger with a large chips and Coke on the side instead of eating grilled chicken, a salad and a bottle of water.
Exercise, too - anyone who's suffered from depression will tell you that there are days when you feel so tired that going for a run or playing some sport is the last thing in the world that you want to do - but people whose goal it is to recover from depression pull themselves out of bed and force themselves to do it, because they know that doing so will help them recover. However, people whose goal isn't to recover from depression tend not to, because it's more comfortable to stay in bed.
Like I said, people whose goal it is to recover from depression usually do, because they throw themselves into doing so and gobble up the fruits of their labor.
On the other hand, people who don't have the goal of recovering from depression - people who just aim to be as comfortable while suffering from their depression as they can - tend not to recover, because their goal of "comfort" as opposed to "recovery" does not lead them to do the things that they need to do to in order to recover. As a result, depression rarely leaves them.Read article >>
Sleep becomes more difficult as people age. Until now, it’s been unclear why older individuals experience insomnia and sleep disruption.
Now, a new study finds that the loss of neurons in a particular region of the brain may be partially to blame. The finding could one day lead to specific treatments to treat sleep problems in older people.
In an article in Brain, researchers at the University of Toronto in Canada report that inhibitory neurons are significantly diminished in Alzheimer’s patients and some elderly people.
Researchers analyzed data from a community-based study involving about 1,000 subjects. Investigators followed the participants as healthy 65 years olds from 1997 when the study began until their deaths, when their brains were donated for research.
Every two years, the subjects wore a small water-proof wristwatch device 24 hours a day for seven to 10 days that monitored all their movements.
Toronto neurologist Andrew Lim says the absence of movement for five minutes or longer indicated the subjects were sleeping.
The authors studied the brains of 45 deceased participants. They counted the number of neurons in the brain area associated with regulating sleep patterns, and correlated that with data from the monitoring device.
Among participants who did not have Alzheimer’s disease - those with the highest number of neurons slept the longest during periods of non-movement. Those with fewer brain cells had more fragmented sleep.
However, the greatest sleep impairment was found among Alzheimer’s patients, whose brains had the fewest number of neurons.Read article >>
Learning to live with a debilitating illness is a true test in and of itself, but scientists and mental health professionals have found an additional struggle that comes with the diagnosis of certain neurological and physical disorders: clinical depression.
It’s an area that is still being researched, but some experts suggest depression co-occurs with medical conditions such as Parkinson’s disease, multiple sclerosis and heart disease.
“There is some evidence that some medical conditions that have changes in brain chemistry and brain functioning because of the illness do contribute to the development of depression and mood problems,” said Dr. Alan Schwartz, director of psychology with Christiana Care Health System.
“The chemical changes in the brain can cause depression that is almost a direct medical or biological link. The other link, which is probably much more common, is the result of the condition.”
After the diagnosis of an illness, like heart disease or diabetes, the diminishing functions and lack of energy can lead to feelings of depression, Schwartz said.
“It’s common for people to have both mood-related and anxiety-related conditions,” he said.
However, it is difficult to pin down the root cause, since family history does play a role in a depression diagnosis.
“For most of the conditions, it’s unclear whether it’s a direct biological cause or if it’s co-occurring,” he continued.
Adjusting to a radically changing lifestyle can lead to depression.
“Just the idea of not being able to do the same thing,” Schwartz said. For example, he said, not being able to eat ice cream anymore.
Dr. William Weintraub, chair of cardiology at Christiana Care Health System, said there is a clear link between heart disease and depression. People with depression who have other ailments like hypertension, diabetes, tobacco use and high cholesterol, have a higher risk of developing cardiovascular disease. The reverse is true as well; people with heart disease have a higher chance of developing a reactive depression, he said.
“They react to the fact that something terrible has happened to them,” Weintraub said.
But, experts still need to figure out why.
“The question that is not fully understood is the path of physiology, how does this work,” he said.
Depression also has a strong likelihood of occurring with a Parkinson’s diagnosis, said James Beck, vice president of scientific affairs for the Parkinson’s Disease Foundation. The foundation estimates that of the 1 million people living with Parkinson’s, 600,000 also live with depression.
Parkinson’s causes certain chemicals in the brain that control functioning, like dopamine (movement), serotonin (mood balance) and norepinephrine (fight-or-flight response) to collapse, Beck said.
“Without dopamine in the brain, [people] have trouble with balance and walking. You can think of a rusty gate and the hinges prevent the gate from moving easily,” he said.
That chemical imbalance can lead to the development of depression, but no one fully understands why, Beck said.
Additionally, certain Parkinson’s treatments, like dopamine replacement therapy, can cause adverse effects related to mood.
A recent University of Pennsylvania study examined 423 newly diagnosed, untreated Parkinson’s patients, before they began dopamine replacement therapy. The therapy uses synthetic dopamine pills to stimulate dopamine cells, but in some cases, the pills can upset different brain functions involved with mood and compulsion.
“In general the understanding is that some symptoms, non-motor symptoms can worsen with the dopamine therapies,” said Dr. Daniel Weintraub, professor of psychiatry and neurology at the Perelman School of Medicine, lead author of the study.
He found that 88 patients had compulsive symptoms in the brain that would increase the frequency of impulse control disorders like compulsive gambling, sexual behavior or eating.
Beck said that 15 percent of Parkinson’s patients on that medication experience those symptoms.
The obsessive compulsions can go away, by eliminating the medication, but the symptoms can still cause depression.
“These compulsive behaviors can range the gamut, but they are also devastating personally,” Beck said.
There are also high incidences of depression in the neurological disease multiple sclerosis. MS attacks the central nervous system and disrupts nerves in the brain specifically related to behavior and thinking. The weakened brain functions can increase the risk of depression to surface, especially coupled with a newly diagnosed MS patient’s ability to cope with the disease.
“When you have neurological damage in parts of the brain that affect mood you can see a variety of mood changes, depression being the most common,” said Dr. Rosalind Kalb, vice president of clinical care at the National Multiple Sclerosis Society.
Over 50 percent of people with MS can expect to experience a major depressive episode after being diagnosed, she said. It’s estimated there are 2.3 million individuals worldwide living with the disease.
Kalb said it is important for all individuals living with a chronic disease to monitor depression symptoms; the stigma of seeking treatment needs to be erased.
“This isn’t about being wimp or weak or crazy, this is about having a symptom that deserves treatment,” she said.Read article >>