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Mental Health News

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.

Missing Sleep May Hurt Your Memory

Lack of sleep, already considered a public health epidemic, can also lead to errors in memory, finds a new study by researchers at Michigan State University and the University of California, Irvine.

The study, published online in the journal Psychological Science, found participants deprived of a night’s sleep were more likely to flub the details of a simulated burglary they were shown in a series of images.

Distorted memory can have serious consequences in areas such as criminal justice, where eyewitness misidentifications are thought to be the leading cause of wrongful convictions in the United States.

“We found memory distortion is greater after sleep deprivation,” said Kimberly Fenn, MSU associate professor of psychology and co-investigator on the study. “And people are getting less sleep each night than they ever have.”

The Centers for Disease Control and Prevention calls insufficient sleep an epidemic and said it’s linked to vehicle crashes, industrial disasters and chronic diseases such as hypertension and diabetes.

The researchers conducted experiments at MSU and UC-Irvine to gauge the effect of insufficient sleep on memory. The results: Participants who were kept awake for 24 hours – and even those who got five or fewer hours of sleep – were more likely to mix up event details than participants who were well rested.

“People who repeatedly get low amounts of sleep every night could be more prone in the long run to develop these forms of memory distortion,” Fenn said. “It’s not just a full night of sleep deprivation that puts them at risk.”

Fenn’s co-investigators include Steven Frenda and Elizabeth Loftus from UC-Irvine.

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Study Links Enzyme To Autistic Behaviors

Fragile X syndrome (FXS) is a genetic disorder that causes obsessive compulsive and repetitive behaviors, and other behaviors on the autistic spectrum, as well as cognitive deficits. It’s the most common inherited cause of mental impairment and the most common cause of autism.

Now biomedical scientists at the Univ. of California, Riverside have published a study that sheds light on the cause of autistic behaviors in FXS. Appearing online in the Journal of Neuroscience, the study describes how MMP-9, an enzyme, plays a critical role in the development of autistic behaviors and synapse irregularities, with potential implications for other autistic spectrum disorders.

MMP-9 is produced by brain cells. Inactive, it is secreted into the spaces between cells of the brain, where it awaits activation. Normal brains have quite a bit of inactive MMP-9, and the activation of small amounts has significant effects on the connections between neurons, called synapses. Too much MMP-9 activity causes synapses in the brain to become unstable, leading to functional deficits.

“Our study targets MMP-9 as a potential therapeutic target in Fragile X and shows that genetic deletion of MMP-9 favorably impacts key aspects of FXS-associated anatomical alterations and behaviors in a mouse model of Fragile X,” said Iryna Ethell, a professor of biomedical sciences in the UC Riverside School of Medicine, who co-led the study. “We found that too much MMP-9 activity causes synapses to become unstable, which leads to functional deficits that depend on where in the brain that occurs.”

Ethell explained that mutations in FMR1, a gene, have been known for more than a decade to cause FXS, but until now it has been unclear how these mutations cause unstable synapses and characteristic physical features of this disorder. The new findings expand on earlier work by the research group that showed that an MMP-9 inhibitor, minocycline, can reduce behavioral aspects of FXS, which then led to its use to treat FXS.

To further establish a causative role for MMP-9 in the development of FXS-associated features, including autistic behaviors, the authors generated mice that were missing both FMR1 and MMP-9. They found that while mice with a single FMR1 mutation showed autistic behaviors and macroorchidism (abnormally large testes), mice that also lacked MMP-9 showed no autistic behaviors.

“Our work points directly to MMP-9 over-activation as a cause for synaptic irregularities in FXS, with potential implications for other autistic spectrum disorders and perhaps Alzheimer’s disease,” said Doug Ethell, the head of Molecular Neurobiology at the Western University of Health Sciences, Pomona, Calif., and a co-author on the study.

The research paper represents many years of bench work and effort by a dedicated team led by the Ethells. The work was primarily done in mice, but human tissue samples were also analyzed, with findings found to be consistent. Specifically, the work involved assessing behaviors, biochemistry, activity and anatomy of synaptic connections in the brain of a mouse model of FXS, as well as the creation of a new mouse line that lacked both the FXS gene and MMP-9.

FXS affects both males and females, with females often having milder symptoms than males. It is estimated that about 1 in 5,000 males are born with the disorder.

The Ethells were joined in the study by UCR’s Harpreet Sidhu (first author of the research paper), Lorraine E. Dansie, and Peter Hickmott. Sidhu and Dansie are neuroscience graduate students; Hickmott is an associate professor of psychology.

Next, the researchers plan to understand how MMP-9 regulates synapse stability inside the neurons. They also plan to find drugs that specifically target MMP-9 without side effects such as new tetracycline derivatives that are potent inhibitors of MMP-9 but lack antibiotic properties.

“Although minocycline was successfully used in clinical trial in FXS, it has some side effects associated with its antibiotic properties, such gastrointestinal irritation,” Iryna Ethell said. “We, therefore, plan to test new non-antibiotic minocycline derivatives. These compounds lack antibiotic activity but still act as non-competitive inhibitors of MMP-9 similar to minocycline.”

The research was funded by grants from the FRAXA Research Foundation, the National Institutes of Health and the California Institute for Regenerative Medicine. 

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Drink Less For A Healthier Heart

These latest findings challenge the results of previous observational studies which found that the consumption of light-to-moderate amounts of alcohol (12-25 units per week) may have a protective effect on cardiovascular health.

The research, led by UCL, the London School of Hygiene & Tropical Medicine and the University of Pennsylvania, looked at evidence from over 50 studies into the drinking habits and cardiovascular health of over 260,000 people. They found that individuals who carry a genetic variant which tends to lower their alcohol consumption have, on average, a more favorable cardiovascular profile. The authors say this suggests that a reduction in alcohol consumption, even for light-to-moderate drinkers, is beneficial for cardiovascular health.

Specifically, the researchers found that these individuals had on average a 10% lower risk of having coronary heart disease, lower blood pressure and a lower Body Mass Index (BMI).

Senior author Professor Juan P. Casas of the UCL Institute of Cardiovascular Science and the London School of Hygiene & Tropical Medicine, said: “While the damaging effects of heavy alcohol consumption on the heart are well-established, for the last few decades we’ve often heard reports of the potential health benefits of light-to-moderate drinking. However, we now have evidence that some of these studies suffer from limitations that may affect the validity of their findings. In our study, we saw a link between a reduced consumption of alcohol and improved cardiovascular health, regardless of whether the individual was a light, moderate or heavy drinker. Assuming the association is causal, it appears that even if you’re a light drinker, reducing your alcohol consumption could be beneficial for your heart.”

In this study, the researchers used a gene that serves as an indicator of alcohol consumption. Individuals that carry a genetic variant of the ‘alcohol dehydrogenase 1B’ gene are known to breakdown alcohol at a different pace. This causes unpleasant symptoms including nausea and facial flushing, and has been found to lead to lower levels of alcohol consumption in the long term. By using this genetic variant as an indicator of lower alcohol consumption, they were able to find associations between these individuals and improved cardiovascular health.

Studies into the long-term health effects of alcohol can be challenging, due to the difficulty of setting up randomized control trials involving many individuals who will maintain the same alcohol consumption levels over an extended period of time. The authors say that their study’s genetic approach parallels the principles of a randomized control trial and therefore makes it less prone to some of the limitations of previous observational studies. These limitations are partly due to bias from the effects of other good health behaviors associated with a lifestyle of low-to-moderate alcohol consumption. This may explain why a protective effect has been observed in past studies, but does not mean that alcohol itself is protective.

Previous observational studies are also limited by the issue of distinguishing between self-reported non-drinkers, who may include those who have never consumed alcohol, and those who consumed alcohol in the past but have since stopped as a result of ill-health. Issues like these make it difficult for observational studies to assess the health effects of long-term alcohol consumption levels.

The current study’s results strongly suggest that reduction of alcohol consumption is beneficial for cardiovascular health, and is closer to establishing causality than observational studies, however further replication of similar genetic studies using large-scale prospective studies, such as the UK Biobank, will be needed.

The study was funded by the British Heart Foundation and the Medical Research Council.

Dr Shannon Amoils, Senior Research Advisor at the British Heart Foundation, said: “Studies into alcohol consumption are fraught with difficulty in part because they rely on people giving accurate accounts of their drinking habits. Here the researchers used a clever study design to get round this problem by including people who had a gene that predisposes them to drink less. The results reinforce the view that small to moderate amounts of alcohol may not be healthy for the heart although the study would need to be repeated in a larger group of people for definitive results. Whilst the heart health effects of light to moderate alcohol consumption are still unclear, what is clear is that drinking more than the recommended limits of alcohol can have a harmful effect on the heart.”

The study was an international collaboration that included 155 investigators from the UK, continental Europe, North America, and Australasia.

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New Schizophrenia Genes Identified

A multinational team of researchers has identified 83 new genes associated with schizophrenia and a variant in 1 gene that also increases the risk for bipolar disorder and alcoholism.

The findings are reported in 2 separate articles ― one published online July 22 in Nature, the other published online July 18 in Psychiatric Genetics.

In Nature, the Schizophrenia Working Group of the Psychiatric Genomics Consortium reports a genome-wide association study of 36,989 adults with schizophrenia and 113,075 healthy adults. They identified 108 different genetic locations associated with the disease, 83 of which have not been previously reported.

In the journal Psychiatric Genetics, researchers from the United Kingdom report a genetic analysis of 4971 people with schizophrenia, bipolar disorder, or alcoholism and 1309 healthy control individuals.

They found that people with a variant in the metabotropic glutamate receptor 3 (GRM3) gene have a 2- to 3-fold increased risk of developing schizophrenia or alcohol dependence and about a 3-fold increased risk of developing bipolar disorder.

Next Big Drug Target?

The GRM3 gene is thought to be important in brain signaling, and the implicated variant is found in roughly 1 in 200 people.

"It may be that this variant could represent a very nonspecific risk factor for mental disorder in general," David Curtis, MD, PhD, FRCPsych, from University College London in the United Kingdom, and coauthor on both articles, told Medscape Medical News.

"We could be looking at the next big drug target for treating mental illness," he added in a statement.

"Immediately," said Dr. Curtis, "we could test for this GRM3 variant alongside testing for CNVs [copy number variants] and could give some people with schizophrenia some kind of explanation of why they had the illness ― that they had an abnormality of their genetic code which stopped this receptor working properly."

"Longer term," Dr. Curtis said, "it should help us understand what goes wrong in schizophrenia and assist us in developing new and better treatments. An obvious place to start would be to seek to develop pharmacologically active compounds which target this receptor (ie, mGluR2/3 agonists)."

This latest research implicates both glutamate transmission and calcium channels in schizophrenia development, the researchers note.

"Drug treatments for schizophrenia have barely changed over the past few decades, as they still target dopamine receptors," coauthor Andrew McQuillin, PhD, head of the UCL Molecular Psychiatry team that first discovered GRM3, notes in a statement.

"Schizophrenia treatments targeting glutamate receptors have been tested in the past without success. However, they might be more effective at treating patient groups with mutations in glutamate receptors such as GRM3," Dr. McQuillin said. "Overall, I expect we will see increased interest in drugs against both glutamate receptors and calcium channels as a result of the research," he added.

Wonders of Genomics

"By studying the genome, we are getting a better handle on the genetic variations that are making people vulnerable to psychiatric disease," Thomas Insel, MD, director of the National Institute of Mental Health (NIMH), noted in a statement from the Broad Institute at Massachusetts General Hospital, which is involved in the consortium. "Through the wonders of genomic technology, we are in a period in which, for the first time, we are beginning to understand many of the players at the molecular and cellular level," he added.

"In just a few short years, by analyzing tens of thousands of samples, our consortium has moved from identifying only a handful of loci associated with schizophrenia to finding so many that we can see patterns among them. We can group them into identifiable pathways ― which genes are known to work together to perform specific functions in the brain. This is helping us to understand the biology of schizophrenia," said Stephan Ripke, MD, of the Broad Institute's Stanley Center for Psychiatric Research.

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Sleep Problems A Growing Health Hazard

There has been much talk about obesity as a global health problem in recent years. But another health hazard causing problems for a growing number of people is sleep.

An estimated one third of people in Europe suffer from sleep problems, especially insomnia.

But only 20 percent get medical treatment.

And it gets worse with age. Half the population aged over 65 has trouble finding sleep or sleeping through the night.

To better understand this phenomenon, euronews went to the psychiatric hospital Le Vinatier in Lyon to speak to a sleep specialist. We met doctor Alain Nicolas, a psychiatrist specialising in sleep problems.

Claudio Rocco, euronews:

“Has there been an increase in sleep problems in recent decades, or have we simply become more aware of them?”

Doctor Alain Nicolas:

“Progress in sleep medicine over the past 30 to 40 years has made us more aware of these problems, especially in Europe. But on top of that, a growing number of people are complaining about sleep problems in general, and about insomnia in particular, because there is much more social pressure about the issue of sleep.”

euronews:

“What is the impact of new technologies on this problem?”

Doctor Alain Nicolas:

“When it comes to new technologies, the most important is the advent of LED screens, which give off blue light, that has a major impact on the biological clock. This will delay the time you go to bed and therefore the time you get up. This has an impact on the population as a whole, but especially on young people, on teenagers who go to bed later and later.”

euronews:

“In rural societies, people used to follow the rhythm of the sun. Today all this has changed. What impact does this have on sleep patterns?”

Doctor Alain Nicolas:

“Humans have adapted to alternating between day and night, and to the difference between seasons. That was the least detrimental to their health. We often say that it was Edison who really messed up sleep patterns, because by inventing electric light, he suppressed night time, which means you can work or even enjoy leisure activities 24 hours a day. And that is detrimental to your sleep.”

In order to study sleep problems, doctors apply electrodes onto patients’ heads to analyse their brain activity during sleep. The electrodes also record eye movement and muscle activity in the face. Some insomniacs wake up several times a night, and suffer from light, fragmented sleep. The tests also highlight problems of sleep apnea, which is when the patient stops breathing for a short while.

But, according to Doctor Nicolas, there are a few simple tricks to improve your sleep:

Doctor Alain Nicolas:

“You have to find a quiet place where you feel safe, where you can relax and focus on sleeping. Secondly, you have to forget about the alarm clock, and concentrate on your need to sleep, be confident that sleep will come.”

euronews:

“If someone wakes up in the middle of the night, what should they do?”

Doctor Alain Nicolas:

“The best thing is to get up, but few people do that. They are afraid of “reactivating” their system. But in fact, it’s a good idea to get up, go to a quiet place with soft lighting, and read to take your mind off sleep. You read five pages, you finish your article, and then you go back to bed and go back to sleep.”

euronews:

“Is it advisable to have a TV in your bedroom?”

Doctor Alain Nicolas:

“It’s important not to have a TV in your bedroom and think, ‘OK, it’s eight o’clock, I am going to go to bed and watch TV for three hours and at eleven I will turn out the light and go to sleep.’ That never works. You have been lying down for three hours, your body simply doesn’t understand why you have prevented it from sleeping for three hours and why now, you are saying ‘Go to sleep’ after seriously reducing the drive to sleep. Also, by lying there, you’ll have made the temperature rise in your bed, and the higher the temperature, the longer it takes to go to sleep. So: no TV in bed.”

According to Doctor Nicolas, there are five basic rules to improve sleep: darkness, silence, a stable and pleasant temperature, a comfortable room dedicated exclusively to sleep, and trying to get to bed and to get up at regular hours – advice that can be hard to follow considering one person in five in Europe works irregular hours or at night.

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How To Overcome Depression After A Sports Injury

If you've ever experienced a sports injury, you’re probably familiar with that sinking feeling after hearing a pop followed by a sharp pain. Your mind races as you consider recovery time and the impact it will have on your game. But if the stress and frustration turns into long-term feelings of hopelessness, being upset about your injury could escalate to depression.

Whether you’re a professional hockey player, a college gymnast or a recreational basketball player, an injury certainly has the potential to impact your psychological well-being. It’s important to recognize why you’re feeling down and pay attention to your emotional health, experts say.

John Murray, a clinical sports psychologist based in Palm Beach, Florida, focused his doctoral dissertation on how an injury – and subsequent social support – affects an athlete's identity.

Murray’s patients range from junior to professional athletes, and he's seen patients from all levels on the athletic spectrum experience depressive symptoms. Anyone can be affected psychologically, but the more success an athlete has achieved, the more likely he or she might experience depression or feel a lack of self-worth. In other words, an Olympian would be more affected psychologically by an injury than someone who plays pick-up basketball on Saturdays.

“The more elite the athlete is, the more identity is ... wrapped up in the athlete role,” Murray says. “When they get injured, it’s a more devastating blow to them because they're losing something more valuable than a recreational athlete, who might just be doing it for weekend fun.”

Professional athletes also might be forced to face issues such as financial stress or the realization that the career they had planned on could be over.

Rebecca Symes​, a sports psychologist ​​who runs the sports consultancy Sporting Success in Britain​, says the more time and effort the athlete spends on a sport, the greater the psychological impact. “Athletes with a strong athletic identity will define themselves on the basis of their sport – that is, their sense of worth and self-esteem is wrapped up in their sport, and being successful and associated with being an athlete,” she says.

Depressive symptoms may also stem from the loss of a physical outlet and a change in exercise schedule. Especially for professional athletes, who spent hours every day focused on training and preparation, living with an injury that changes their daily routine is an adjustment.

William Wiener​, a sports psychologist in New York City, says athletes who participate in sports with an individual focus, such as tennis or gymnastics, are more at risk psychologically. “Injured athletes on teams can at times be very much a part of the team​and remain integrated socially, and feel engaged and invested in their team’s success,” he says. Meanwhile, athletes in individual sports often have to cope with their injury alone and may be cut from their sport completely while they're recuperating.

Olympic skier Hannah Kearney, who won a gold medal in 2010 and a bronze medal in 2014, has been seriously injured twice during her athletic career. After tearing her ACL in 2007, and suffering internal injuries after a crash while training in Switzerland in 2012, Kearney was able to rebound from her injuries.

“Every single athlete has some sort of physical obstacle in their career, so it’s really just a part of the identity. In fact, it sort of solidifies it,” she says.

While injuries can be difficult psychologically, Kearney says, there are some benefits to being taken out of the game or off the slopes.

“The fact that I had been doing this sport for the majority of my life, and this was the first time I had had it taken away from me, it made me realize how much I loved the sport, and that was valuable in making me a better athlete, too," Kearney says. "If you’re more grateful then you’re more likely to enjoy it and appreciate it and work harder.”

She advises athletes to focus on other aspects of their life while they are healing.

“I had never put up a Christmas tree, I had not gone to see my brother play hockey very often, so I did both of those things during that time period when I was stuck at home not able to ski. It’s up to you how you view the injury and what you make of it,” she says. “If you can’t get better at your sport at a certain time, then try to get better at other parts of your life.”

Strategies for Coping

If you feel like you might be spiraling into a depressed state following an injury, it's crucial to recognize and address the problem. Coping mechanisms should be tailored to the athlete, but experts says there are ways for all athletes to maintain good mental health during the recovery process.

First, both recreational and professional athletes need to follow a regular sleep schedule, eat healthy and adhere to all medical instructions. Murray says a lot of post-injury anxiety stems from fear of re-injury. A medical professional can help ease that anxiety by ensuring the healing process is progressing on schedule.

To overcome depressive symptoms, it's important for professional athletes to establish a sense of greater self-worth and purpose. If the injury was career-ending, recognize that you have other favorable qualities besides being good at your sport. “That's why it's important for athletes to give consideration to post-playing career planning and to have other things in their life aside from their sport,” Symes says.

Picking up another sport after the injury might also be an option. Murray says participating in another athletic activity can be a great idea, and trying a different sport has offered some of his patients a competitive and physical outlet. “Golf is a lot less taxing on the body, so if you’re playing football and you get a serious knee injury, you might be able to play golf,” Murray suggests.

Wiener also says golf can be a great outlet for recreational athletes to cope with losing a sport, though professionals may find it challenging. If someone is accustomed to being the best, starting from scratch can be frustrating – especially in a less-than-perfect physical state. “That can be very hard for people who are always used to pushing the limit,” Wiener says. “Sometimes channeling athletic energy in another direction can be really helpful, and other times, athletes will be too ambitious and sort of force the process.”

Psychologists agree that seeking help from athletic peers who have had similar experiences, especially if they've overcome the psychological effects, can be helpful for athletes at all skill levels. And communicating your anxieties to other athletes – who can assure you that "life goes on" – can be encouraging.

Like with any kind of emotional distress, it's essential to see a professional who can address your psychological needs with a coping plan. As a sports psychologist, Murray says because he understands the athletic mentality, he can better address his client's needs.

“It’s really important, I think that [psychologists] understand the athlete and understand what they're experiencing,” Murray says. “That’s one of the biggest things that helps being a sports psychologist, as a person who has played sports, who has coached sports, who knows sports, as opposed to somebody else who might not be as sensitive to the potential impact of an injury.”

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Anxiety Disorders Become More Common With Age

Anxiety disorders are more prevalent among the elderly, statistics show, with the majority of patients visiting the doctor for such ailments being in their 70s and older.

The finding was announced by the National Health Insurance Service, which released an analysis on July 20 of health insurance treatment statistics for anxiety disorders from 2008 to 2013. According to the figures, the age group with the most patients was 70 and above, with 3,051 people per 100,000 seeing a doctor about the condition. The numbers were 2,147 for people in their 60s, 1,490 for people in their 50s, and 1,016 for people in their 40s.

The figures show that the number of patients suffering from anxiety disorders increases with age. The number of patients per 100,000 was three times higher in the 70 and older age group than the overall average of 1,101.

By gender, there were 1,401 female patients per 100,000 people, which was about 70% higher than the figure for male patients, 807 per 100,000. The total number of patients with anxiety disorders increased by 30% from 398,000 in 2008 to 522,000 in 2013.

Anxiety disorder, referring to pathological anxiety and fear, is a panic response that makes it difficult to breathe and go about one’s daily life. Common symptoms include pounding of the heart, increased pulse and blood pressure, with some patients complaining of other physical symptoms including dizziness and headaches.

“In South Korean society today, individuals are supposed to take care of themselves in their old age. It is pretty common for old people who were too busy looking after their children to prepare for their own retirement to deal with anxiety disorders when they start suffering from illnesses and other health problems,” said Yun Ji-ho, professor of mental health at National Health Insurance Service Ilsan Hospital.

“Since anxiety also causes various physical symptoms, it is common for patients with anxiety disorder to visit other doctors instead of the psychiatrist. If an individual continues to experience symptoms such as dizziness, difficulty breathing, and pounding of the heart even after other tests come back negative, they should have a consultation with a mental health professional,” Yun said.

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Big Rewards In Caring For Dementia Caregivers

A brief psychological support program for family members who care for individuals with dementia dramatically reduces caregiver depression and anxiety, improves quality of life, and is cost-effective, new research shows.

Two-year results from a randomized clinical trial conducted by investigators at University College London in the United Kingdom showed that caregivers who received treatment as usual were 7 times more likely to experience depression and anxiety compared with those who received the Strategies for Relatives (START) program, a brief, 8-session, manual-based coping strategy intervention.

Twenty months after the study ended, individuals in the intervention group were "much, much less likely to be depressed than those in the nonintervention group. This was a massive, massive difference," said principal investigator Gill Livingston, MBChB, MD, FRCPsych. In fact, she noted that the results are so encouraging that the program is now being rolled out across England.

Dr. Livingston presented the findings here at a press briefing held at the Alzheimer's Association International Conference (AAIC) 2014.

High Rates of Depression

Approximately 70% to 80% of dementia patients are cared for at home by a friend or family member. Perhaps not surprisingly, caregiver rates of depression and anxiety are high. About 40% of these individuals become clinically depressed or anxious, said Dr. Livingston, and many others, who may not meet the threshold for depression or anxiety, nonetheless take a significant hit to their mental health and well-being.

Importantly, said Dr. Livingston, caregiver depression predicts a breakdown in patient care.

She also noted that in the United Kingdom, friends and family members of dementia patients contribute an estimated £6 billion ($10 billion USD) to annual care costs.

"We are well aware of the everyday struggle of family caregivers. Our intervention aimed to provide them with the tools to keep themselves from becoming depressed and anxious ― immediately and in the long term," Dr. Livingston told Medscape Medical News.

Previous research examining the impact of the START program at 4- and 8-month follow-up and published in the BMJ in 2013 showed that the intervention was clinically effective. To determine whether it had a durable effect, the investigators examined caregiver outcomes at 2 years.

The pragmatic, multicenter, randomized trial included 260 caregivers recruited from 4 UK centers who were randomly assigned in a 2-to-1 ratio to receive the START program (n = 173) or treatment as usual (n = 87).

"We offered this program to everyone with a relative who presented with dementia at 4 different centers ― 3 of them were psychiatry, and 1 of them was a neurology center ― because we wanted it to be something that could be used in everyday practice, so we didn't want to exclude anyone at all," said Dr. Livingston.

Study outcomes included Hospital Anxiety and Depression Scale–Total (HADS-T) scores at 2 years as well as a comparison of cost-effectiveness between START and treatment as usual.

Individuals with a degree in psychology but who were without clinical training were taught to deliver the therapy and were supervised by a clinical psychologist.

Cost-effective

Participants underwent 8 sessions during a period of 2 to 4 months, depending on their availability. They were required to fill in and keep their own manual. The program comprised several components, including the following:

Education about dementia, caregiver stress, and understanding patient behaviors

Behaviors the caregiver finds difficult and generating solutions

Communication skills

Challenging negative thoughts

Skills to take better care of themselves, including relaxation CDs

Getting emotional and practical support

Planning for the future

Increasing pleasant activities

Maintaining learned skills

Two years after completing the START program, the investigators found that individuals in the treatment-as-usual group were 7 times more likely to be anxious or depressed compared with those who received the intervention.

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IC Professor Uses Zebrafish To Understand Anxiety In Humans

When Professor Ian Woods is not playing organ at a church downtown, he is working in his lab at Ithaca College, studying zebrafish and their relationship to human anxiety.

Woods says that anxiety disorders affect one in every five people, with treatment options that are often, unfortunately, “one-size-fits-all.”

“We treat it with these drugs that interact with serotonin signaling in the brain,” said Woods. “The problem with messing with serotonin is that serotonin has so many other functions than just the functions in anxiety and depression.”

“If you mess with serotonin, you get a lot of side effects because it has so many other activities,” said Woods.

But Woods hopes that his research with zebrafish will contribute to anxiety treatment becoming more personalized.

Woods, along with his team of student researchers, studies how fish with tweaked genes respond to different stimuli compared to fish with unmodified genes.

“By observing the ensuing behavioral changes in the fish, we know how that replaced gene changed the message in the brain,” Woods said in a statement.

“Genes typically don’t cause the anxiety,” Woods said. “But they can make organisms more susceptible to environmental triggers that might elicit what we’d call an anxious behavior.”

Zebrafish, a member of the minnow family, were chosen as the subject of the study due to their brains’ similarities to the human brain.

“We share a very large percentage of genes in common with the fish, so if you can figure out what’s happening within the fish brain in terms of anxiety, you can use that knowledge and translate it to humans,” said Woods.

Anxiety disorders are the most common mental disorders in the United States, according to the Anxiety and Depression Association of America. Anxiety disorders cost the U.S. approximately $42 billion per year.  (According to the Anxiety and Depression Association of America, only one-third of people suffering with anxiety receive treatment.)

Woods has been working with fish since 2000, when he was pursuing medical school. To get into medical school, Woods said, he needed to have research lab experience.

“I found a lab to work in, and it just so happened that this lab worked in fish, and it turned out that I like that a lot better,” he said. “It seemed a more attractive option than medical school.”

Woods found a passion for studying fish, and if all goes according to plan, he said, he’ll be doing it until the day he retires.

“That’s the great thing about biology — it’s a blessing and a curse — there’s never an end.

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California Study: Youth Depression Thrives On Silence

When Amber Cavarlez was in high school and her mother died of colon cancer, she and her Filipino Catholic family went to church and lit candles every day. But, she says, “After she passed, nothing was said about it. No one talked about it.”

In her home, she says, sadness was an “invisible subject.” And when she cried at school and sought help, she received an anonymous message through Facebook that said, “Don’t cry at school because no one cares.”

She learned to keep her feelings to herself, but her family’s struggles weren’t over – her brother was diagnosed with bipolar disorder and attempted suicide several times in the following years. By then attending college in San Francisco, she often found herself emotionally unable to go to class, and was told by the administration that she’d have to improve academically or drop out.

She sought the help of a therapist on campus and eventually graduated. Now 23, she is a mentor with the Peer Wellness Program at Edgewood Center for Children and Families in San Francisco. Though doing well herself, she wishes her brother had had someone to talk to when he was in school. Young people “need someone there to ask about [their feelings], to make it valid,” she says.

Cavarlez spoke with other young people at a media forum organized by New America Media in San Francisco last week on challenging stigmas around youth depression. Alongside the youth storytellers, a panel of experts in the mental health field weighed in on the views of depression across different cultures and a fractured system for delivering mental health services. They agreed that youth depression is more widespread than many people realize, and that it thrives on silence.

But both advocates and practitioners were above all optimistic about the future of mental health in children and youth, and expressed a growing excitement over treatment options – in the words of Patrick Gardner, founder of the Young Minds Advocacy Project, “We have a moment of opportunity to change some things.”

“The public is engaged in a way that I have never seen before around children’s mental health,” he said.

A fractured system, but new opportunities for treatment

Gardner says that access to mental health coverage has increased dramatically because of the Affordable Care Act, and that “we can expect these resources to continue to grow.” But, he says, “We aren’t especially effective at systems in delivering services to children.”

He points to long waiting lists for services – “Because we delay access to the system, [people] drop out,” he says – as well as the need to improve the quality of care.

And the need is high, especially in California. Gardner says that mental health problems account for 85 percent of the disease burden for people between the ages of 15 and 25.

Dr. Regan Foust, the data manager at the Lucile Packard Foundation for Children’s Health, agrees. In 2012, she said, mental diseases and disorders accounted for the largest share of hospital admissions among children under 18 in California – some 12 percent of all hospitalizations. Statistics from kidsdata.org (the program that Foust manages) show that mental health problems are the most common primary diagnosis for a hospital stay for kids under 18, more common than bronchitis or fevers.

Depression in the very young

Dr. Manpreet K. Singh, an assistant professor at Stanford School of Medicine who works in the university’s Pediatric Mood Disorders Program, stressed the importance of parents and educators being able to recognize early warning signs. “These signs can be evident even as early as infancy and early childhood, especially if the child has been exposed to family stress, chaos, conflict, or trauma,” she said.

Young children who are depressed, she says, might withdraw from activities that are normally fun for them, easily anger or become irritable, have difficulty with relationships, or be extremely sensitive to rejection or failure as compared to other kids. They also might decline academically, have headaches or stomachaches that don’t respond to treatment, or change their eating or sleeping patterns. She cautions that depression tends to run in families and can transmit from parent to child.

Like Gardner, Singh is optimistic about the future of treatment. “We now know for a fact that [depression] is treatable in children,” she said.

A 19-year-old woman who spoke on the panel was one such person who was depressed from a young age. Lena’s parents are immigrants from China. Her biological father had another family in China; he brought them to the United States when she was 6 years old and kicked Lena and her mother out of the house.

“No one would acknowledge me as family. That was very hard for me to deal with,” she said. “I really had nobody growing up … I asked, ‘Why didn’t I have a father? Why was everybody else so lucky?’ I realized I didn’t like doing things anymore. I had no interest in things.”

She went to a teacher when she was in 6th grade and asked to talk to a therapist. “I would cry through the entire session,” she said. She would often think about “What [she] was taught, how [she’s] not supposed to share anything.”

The stigma across cultures

Katherine Kam, a journalist who has reported on depression and suicide in Asian American adolescents, added that “Among parents, especially in traditional immigrant households, there’s not a lot of understanding about mental illness and about depression … Parents often rejected the diagnosis because they felt that it was a very embarrassing diagnosis. It brought shame to their families.”

Counselors who work with Asian American families told her that depression is often seen as a personal weakness or a moral failing in Asian cultures, and that if a person works hard enough he or she can overcome it.

Jeneé Darden, the host of Mental Health and Wellness Radio at P.E.E.R.S. in Oakland (Peers Envisioning and Engaging in Recovery Services), spoke of a similar experience having depression in the African American community.

She would sometimes hear from family and friends, “Black women are supposed to be strong, or depression is a white thing, that going to a therapist is a white thing.”

“I would hear, ‘You’re not praying hard enough,’” she added. “Our first step to getting help is the pastor, is the church … [I would hear] ‘Don’t take your problems to the therapist, take them to Jesus.’”

Different ways of finding help

A 20-year-old Indian American woman going by “Leela” (she didn’t want her parents to know that she had spoken publicly about her experiences) recalled having been depressed for most of her life. Her depression worsened, though, after she was sexually assaulted in college.

“My tendency is to become immobile, and I barricaded myself inside my dorm room for the rest of the year,” she said. “I did not leave. I told my parents that I was going to school but I was not.”

“When I tell my parents, I sort of feel like I have to justify the way I’m feeling,” she said. “[I say] ‘I’m not doing well in school because I’m scared.’ ‘I’m not doing well in school because some days I cannot leave the house.’”

She says that what helped her was finding other people who feel the way she does.

Robert Cervantez, 19, said that talking about his depression doesn’t help. For him, it’s being a musician that helps him cope – it gives him “an outlet to express [his] depression and [his] anger.”

Sonya Mann, also 19, called herself “genetically unlucky” coming from a family with a strong history of mental illness. She feels lucky to have had professional medical support while she was growing up, but she continues to feel shame over her depression: “Even though I’ve been told so many times that it’s not my fault, that’s it’s not a personal weakness … I don’t believe that it’s not my fault.”

She’s had to come to terms with the fact that she will likely have to manage her depression all her life. She agrees that it’s treatable, she says, but “I don’t think it’s curable. It’s something you have that you learn how to deal with.”

New ways of thinking, and looking to the future

Rob Gitin, the co-founder and executive director of At The Crossroads, which reaches out to homeless youth, said that current trends around the way services are delivered need to change.

“Services are becoming more conditional, more outcome-focused, shorter-termed and more disciplined,” he said.

When kids act out in ways that are consistent with symptoms of youth depression, such as skipping school and getting into fights, “These are things that will get you kicked out programs,” he said. “You’re not doing what you’re told to, you’re being violent, you’re not engaging with services.” In their search for evidence-based results, programs end up shutting out the kids who need help the most, because those kids don’t live up to strict expectations.

And, he says, the outlook of many service providers needs to change.

“I think that a lot of the time the people doing the work make a mistake. They think that it is your job to make people feel better. It’s not your job to make people feel better, it’s your job to make people feel okay about however they’re feeling,” he says. “If you try to do that all you’re going to do is force them to deny their feelings and suppress whatever they’re going through.”

“There is no model on how you help people,” he adds. “How you help people is you listen to them, you get to know them as an individual. You learn what’s great about them and what’s awful about them, and you help them accept whoever they are and help them figure out who they want to be.”

Ziomara Ochoa, LMFT, is the supervisor of the South County Youth Team at Behavioral Health and Recovery Services in San Mateo. She primarily provides services to a Latino population, many of whom are immigrants or undocumented. Her work, she says, is moving from a focus on treatment into the realm of prevention, with programs like Mental Health First Aid, a public education program that educates participants about risk factors and warning signs of mental health problems and teaches them how to help a person in crisis.

The hope is that by educating the community through platforms like forums and group discussions, depression and mental illness in young people can be prevented through community awareness.

It’s part a movement, she says, to “integrate community-based practices that really work with our community and really validate [them] just as much as evidence-based practices.”

Kordnie Lee, a Youth Mental Health First Aid instructor with Lincoln Child Center in Alameda County, added “It’s really about giving a common language … if a young person is doing something that you don’t understand or exhibiting symptoms that you don’t understand, that you [don’t] just send them to someone else and that person’s going to figure it out. It is a community, it is a holistic responsibility that all of us have.”

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Did You Know?

Untreated young people at clinical high risk for psychosis have increased salivary cortisol levels compared with treated high-risk patients and mentally healthy individuals, study results show.

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