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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.

5 Ways To Overcome Dating Anxiety

Anxiety disorders are the most common psychological disorder in the US, affecting 18 percent of the adult population. Social anxiety disorder (SAD) is the third-most-common psychological disorder, affecting 15 million men and women in the US. The DSM-5 defines social anxiety as the “persistent fear of one or more situations in which the person is exposed to possible scrutiny by others and fears that he or she may do something or act in a way that will be humiliating or embarrassing.” Those who are shy, if not socially anxious, tend to experience social situations in a more reserved, tense and uncomfortable manner, especially when meeting new people. It may take longer to open up and share, which can affect one’s ability to form close relationships.

Dating is typically a situation where people feel scrutinized, have to meet new people, and may fear they’ll do something embarrassing. In this way, dating only adds fuel to the anxiety fire. Rife with opportunities for awkward conversations and infinite unknown factors — Will she show up? Will he like me? What do I say? What if I say too much? What if I spill my drink? Get rejected? — dating often is seen as overwhelmingly scary and decidedly unappealing. This type of anxiety and shyness leads to avoidance of meeting new people, as well as a sense of isolation and hopelessness about the prospect of finding a suitable partner.

Despite the high incidence of anxiety disorders, adults often don’t seek treatment until years of suffering with the disorder have passed, if they seek treatment at all. Because anxiety disorders typically start in early adolescents or pre-teen years, it can be hard to recognize anxiety disorders. And anxiety left untreated often leads to developing comorbid disorders, such as depression. People may assume it’s normal to feel the type of anxiety they experience, or believe the anxiety is something that can’t be treated.

Because social anxiety is such a widespread problem, psychologists have worked hard to develop treatments that work. Four separate meta-analyses have shown Cognitive-behavioral therapy (CBT) to be effective in treating SAD. In 2007, researchers Kristy Dalrymple from Brown Medical School and James Herbert at Drexel University conducted a small pilot study on an updated approach to social anxiety. Noting that CBT was effective for social anxiety in some clients but not others, or didn’t fully alleviate symptoms, they sought to explore further treatment options in the form of Acceptance and Commitment Therapy (ACT). The foundation of ACT is learning to accept that anxiety and internal struggle is a part of living fully, and that leading a life guided by personal values and willingness to experience life—as opposed to anxiety-based avoidance and decision making—is ultimately what frees one from the constraints of anxiety. The researchers found that upon follow up of a 12-week ACT and exposure program, the participants reported increased quality of life, decreased avoidance and reduced anxiety. Another study in 2009, focusing on acceptance and mindfulness-based group therapy, also showed similar gains for people with social anxiety.

In my work, and in my life in general, I so frequently saw amazing people who were deserving of love and companionship, but who were paralyzed by fear, struggling with loneliness and hopelessness rooted in anxiety. Knowing there were treatments that could (and did) help them gain confidence and a new perspective, I felt compelled to write a book about the skills that help people get past social anxiety. Single, Shy and Looking for Love: A Dating Guide For The Shy and Socially Anxious describes these evidence-based techniques. Combining ACT with traditional exposure and cognitive techniques rooted in CBT, here are some of the most effective ways to approach dating anxiety:

Practicing self-disclosures

Shy and anxious people are less likely to share about themselves and self-disclose. Dating advice books may prescribe pick-up lines or manipulative, gamey strategies to win over a date. But real relationships are based upon sharing who you are with your date. Self-disclosure is the gateway to intimacy—it lets you get closer to someone as you both reveal more and more. Yet the last thing a shy or anxious person may feel comfortable doing is letting their guard down, which is why practicing sharing is a vital element. Practicing self-disclosure might include letting your date know about a story or person that is special to you, sharing how you felt about a recent event, or letting your date know that you think they look great. Self-disclosure is simply telling people what you think, how you feel, and letting them see what matters to you.

Reducing the threat of judgment from others—and yourself

One of the reasons people may not disclose more about themselves is for fear of being judged. The threat of negative evaluation from others—such as being negatively perceived by your date—is the root of social anxiety, and is exacerbated in a dating setting. Most of the time, anxious daters highly overestimate how harshly their partner is judging them. If a social situation goes awry, they automatically blame themselves. If they make a comment that comes out wrong, they beat themselves up for hours or days afterwards. They assume the other person thinks the worst of them and is focusing on their flaws and mistakes. This is usually because people who are socially anxious tend to have lower self-esteem and make automatic negative assumptions about themselves. Because they judge themselves harshly, they assume others do, too. And it makes them not want to share, be open or be vulnerable.

Acceptance

There is an alternative to being guarded. By focusing on one’s sense of self-acceptance and self-worth, it feels less intimidating to share with others. When a person feels good about who they are, their values and what they have to offer, and sees their own experience in a compassionate way, it bolsters them against judgment. By calming their harshest critic, their own inner judge, it opens the door to experiencing closer connections with others.

Reframing catastrophic cognitions

The second way to approach the threat of judgment from others and from oneself is reframing catastrophic thinking. Because anxiety can cause catastrophic thoughts to take over, an effective strategy is to notice, point out and contradict catastrophic thoughts. Thoughts like, it’s the end of the world if I’m rejected, I’ll never find someone, or that was a complete disaster, are common in anxiety. Gently remind yourself that the anxiety is exaggerating these beliefs, and then list reasons that the thoughts are not fully accurate. This will help quell the predictions of disaster that can be so devastating to the process of finding love.

Mindfulness and emotional intelligence

Anxiety thrives by focusing on the future and the past, engendering worry about what will go wrong, how the future will play out or how past events have gone wrong. The alternative is mindfulness. Mindfulness is a conscious effort to focus on the present moment, the here-and-now. Connecting to the present moment with acceptance rather than judgment leads to greater emotional awareness within oneself. And emotional awareness is one important component of emotional intelligence (EI), or being able to discern one’s own and other people’s emotions and tailor behavior accordingly.

A recent research meta-analysis showed a strong association between EI and relationship satisfaction. This means that for both men and women, couples with high EI tended to be happier in their love life together. In order to glean the benefits of EI in dating and new relationships, the focus should be on learning to:

1) Monitor and understand one’s own emotions, rather than push emotions away or ignore them

2) Self-soothe and cope with emotions when they arise

3) Harness emotions to problem-solve or help a situation

4) Listen, tune into, and accurately perceive the feelings of your date

5) Show empathy and create a connection through shared experiences.

Summary

The message is one of hope. Social anxiety can be debilitating, isolating and lonely. But it doesn’t have to be that way. With treatment, practice and a willingness to try new behaviors, dating anxiety can be overcome.

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Yogic Breathing Shows Promise In Reducing Symptoms Of PTSD

One of the greatest casualties of war is its lasting effect on the minds of soldiers. This presents a daunting public health problem: More than 20 percent of veterans returning from the wars in Iraq and Afghanistan have post-traumatic stress disorder, according to a 2012 report by RAND Corp.

A new study from the Center for Investigating Healthy Minds at the Waisman Center of the University of Wisconsin-Madison offers hope for those suffering from the disorder. Researchers there have shown that a breathing-based meditation practice called Sudarshan Kriya Yoga can be an effective treatment for PTSD.

Individuals with PTSD suffer from intrusive memories, heightened anxiety, and personality changes. The hallmark of the disorder is hyperarousal, which can be defined as overreacting to innocuous stimuli, and is often described as feeling “jumpy,” or easily startled and constantly on guard.

Hyperarousal is one aspect of the autonomic nervous system, the system that controls the beating of the heart and other body functions, and governs one’s ability to respond to his or her environment. Scientists believe hyperarousal is at the core of PTSD and the driving force behind some of its symptoms.

Standard treatment interventions for PTSD offer mixed results. Some individuals are prescribed antidepressants and do well while others do not; others are treated with psychotherapy and still experience residual effects of the disorder.

Sudarshan Kriya Yoga is a practice of controlled breathing that directly affects the autonomic nervous system. While the practice has proven effective in balancing the autonomic nervous system and reducing symptoms of PTSD in tsunami survivors, it has not been well studied until now.

The CIHM team was interested in Sudarshan Yoga because of its focus on manipulating the breath, and how that in turn may have consequences for the autonomic nervous system and specifically, hyperarousal. Theirs is the first randomized, controlled, longitudinal study to show that the practice of controlled breathing can benefit people with PTSD.

“This was a preliminary attempt to begin to gather some information on whether this practice of yogic breathing actually reduces symptoms of PTSD,” says Richard J. Davidson, founder of CIHM and one of the authors of the study. “Secondly, we wanted to find out whether the reduction in symptoms was associated with biological measures that may be important in hyperarousal.”

These tests included measuring eye-blink startle magnitude and respiration rates in response to stimuli such as a noise burst in the laboratory. Respiration is one of the functions controlled by the autonomic nervous system; the eye-blink startle rate is an involuntary response that can be used to measure one component of hyperarousal. These two measurements reflect aspects of mental health because they affect how an individual regulates emotion.

The CIHM study included 21 soldiers: an active group of 11 and a control group of 10. Those who received the one-week training in yogic breathing showed lower anxiety, reduced respiration rates and fewer PTSD symptoms.

Davidson would like to further the research by including more participants, with the end goal of enabling physicians to prescribe treatment based on the cognitive and emotional style of the individual patient.

“A clinician could use a ‘tool box’ of psychological assessments to determine the cognitive and emotional style of the patient, and thereby determine a treatment that would be most effective for that individual,” he says. “Right now, a large fraction of individuals who are given any one type of therapy are not improving on that therapy. The only way we can improve that is if we determine which kinds of people will benefit most from different types of treatments.”

That assessment is critical. At least 22 veterans take their own lives every day, according to the U.S. Department of Veterans Affairs. Because Sudarshan Kriya Yoga has already been shown to increase optimism in college students, and reduce stress and anxiety in people suffering from depression, it may be an effective way to decrease suffering and, quite possibly, the incidence of suicide among veterans.

The study, published in the Journal of Traumatic Stress, was funded by a grant from the Disabled Veterans of America Charitable Service Trust and individual donors.

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Going To Work During Depressive Episode May Help

Attending work while suffering a depressive illness could help employees better manage their depression more than taking a sickness absence from work, a new study has found.

The collaborative study between the University Of Melbourne and the Menzies Research Institute at the University of Tasmania is the first to estimate the long-term costs and health outcomes of depression-related absence as compared to individuals who continue to work among employees with depression in Australia.

Lead researcher Dr Fiona Cocker from the Melbourne School of Population and Global Health said a greater understanding of the costs and consequences of both absenteeism and presenteeism would allow for more informed recommendations to be made to the benefit of employees and their employers.

“We found that continuing to work while experiencing a depressive illness may offer employees certain health benefits, while depression-related absence from work offers no significant improvement in employee health outcomes or quality of life,” she said.

“Cost associated with depression-related absence and attending work while depressed were also found to be higher for white collar workers who also reported poorer quality of life than blue collar workers.”

Researchers calculated the costs based on lost productivity, expenses associated with medication and use of health services and the cost of replacing an employee who is absent from work and unwell.

“This is important information for employers, health care professionals (e.g. GPs) and employees faced with the decision whether to continue working or take a sickness absence. It suggests that future workplace mental health promotions strategies should include mental health policies that focus on promoting continued work attendance via offering flexible work-time and modification of tasks or working environment,” she said.

Workplace programs and modifications may also have positive, long-term effects on health and well-being via the maintenance of a daily routine and co-worker support.

Finally, the exploration of these outcomes in blue and white collar workers allows work attendance recommendations to be tailored to specific occupation types.

These methods also have the potential to be adapted to other health conditions where work attendance behavior is affected, such as diabetes or heart disease.

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Early Life Stress Can Leave Lasting Impacts On The Brain

For children, stress can go a long way. A little bit provides a platform for learning, adapting and coping. But a lot of it — chronic, toxic stress like poverty, neglect and physical abuse — can have lasting negative impacts.

A team of University of Wisconsin-Madison researchers recently showed these kinds of stressors, experienced in early life, might be changing the parts of developing children's brains responsible for learning, memory and the processing of stress and emotion. These changes may be tied to negative impacts on behavior, health, employment and even the choice of romantic partners later in life.

The study, published in the journal Biological Psychiatry, could be important for public policy leaders, economists and epidemiologists, among others, says study lead author and recent UW Ph.D. graduate Jamie Hanson.

"We haven't really understood why things that happen when you're 2, 3, 4 years old stay with you and have a lasting impact," says Seth Pollak, co-leader of the study and UW-Madison professor of psychology.

Yet, early life stress has been tied before to depression, anxiety, heart disease, cancer, and a lack of educational and employment success, says Pollak, who is also director of the UW Waisman Center's Child Emotion Research Laboratory.

"Given how costly these early stressful experiences are for society ... unless we understand what part of the brain is affected, we won't be able to tailor something to do about it," he says.

For the study, the team recruited 128 children around age 12 who had experienced either physical abuse, neglect early in life or came from low socioeconomic status households.

Researchers conducted extensive interviews with the children and their caregivers, documenting behavioral problems and their cumulative life stress. They also took images of the children's brains, focusing on the hippocampus and amygdala, which are involved in emotion and stress processing. They were compared to similar children from middle-class households who had not been maltreated.

Hanson and the team outlined by hand each child's hippocampus and amygdala and calculated their volumes. Both structures are very small, especially in children (the word amygdala is Greek for almond, reflecting its size and shape in adults), and Hanson and Pollak say the automated software measurements from other studies may be prone to error.

Indeed, their hand measurements found that children who experienced any of the three types of early life stress had smaller amygdalas than children who had not. Children from low socioeconomic status households and children who had been physically abused also had smaller hippocampal volumes. Putting the same images through automated software showed no effects.

Behavioral problems and increased cumulative life stress were also linked to smaller hippocampus and amygdala volumes.

Why early life stress may lead to smaller brain structures is unknown, says Hanson, now a postdoctoral researcher at Duke University's Laboratory for NeuroGenetics, but a smaller hippocampus is a demonstrated risk factor for negative outcomes. The amygdala is much less understood and future work will focus on the significance of these volume changes.

"For me, it's an important reminder that as a society we need to attend to the types of experiences children are having," Pollak says. "We are shaping the people these individuals will become."

But the findings, Hanson and Pollak say, are just markers for neurobiological change; a display of the robustness of the human brain, the flexibility of human biology. They aren't a crystal ball to be used to see the future.

"Just because it's in the brain doesn't mean it's destiny," says Hanson.

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Experimental UC Davis Therapy Treats Depression With Magnets To Head

Scientists are working on a way to essentially rewire a brain to treat a number of disorders.

Deep transcranial magnetic stimulation sends magnetic waves through your brain, targeting areas that cause problems such as obesity, obsessive-compulsive disorder and bipolar disorder.

UC Davis psychiatrist Dr. Guohua Xia is a researcher on the forefront of the research. It works sort of like an MRI, where patients wear a helmet that delivers magnetic pulses to targeted portions of the brain.

“The patient feels like a tapping kind of feeling, the muscle contract,” he said.

The technique is supposed to regulate brain activity, and Xia has already received FDA approval to treat patients for depressions.

“The result is better than what I expected before the trial started,” he said.

Small trials have even shown the therapy might help people lose weight. Xia was not a part of that research, but he can see how it would work.

“Theoretically it can suppress for example, the eating center, or suppress the rewarding system to suppress some urge to eat more,” he said.

Patients got the treatment for up to 40 minutes on work days, and he says it takes about a month to treat a major depressive attitude.

The technology has actually been around since the 1980s, but Xia’s new machine penetrates deeper into the brain, giving him more consistent results than past research.

Studies so far show the therapy is safe, but the long term effects are unknown.

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UC Davis Autism Study: Early Intervention Helped 86% Of Toddlers

Kristin Hinson noticed something wasn’t quite right with her baby Noah when he was 6 months old.

He was her fourth child, and he seemed behind developmentally.

“He started showing signs, questionable things. Nothing terrible, but not following me around the room with his eyes,” Hinson said. With two older children who have autism, she worried little Noah was headed in that same direction. “No one was super concerned, but at 9 months he was showing significant delays.”

A child isn’t typically diagnosed with autism until age 3 or later. While the signs for autism spectrum disorder, or ASD, may be hard to detect in infants, researchers suggest there may be some early indications if you know what to watch for.

Children with autism often don’t produce many sounds or use their voices to communicate. They may engage in frequent repetitive behavior. They stare at their hands or at objects for long periods of time.

Sally Rogers, a professor of psychiatry and behavioral studies at UC Davis MIND Institute, wondered what would happen if a parent could intervene before a child is officially diagnosed with autism. Other research on early intervention has shown some promise.

Rogers asked Hinson if she would be interested in becoming part of a study. Since the study involved behavioral modification therapy, if Noah wasn’t diagnosed with autism there would be no harm. Hinson said yes, as did six other parents with children between the ages of 7 months and 15 months who showed some signs of autism.

“As a parent, I’ll take anything that can help my child,” Hinson said.

For the study, she and the other parents visited Rogers’ clinic once a week for 12 weeks. There the researchers taught the parents behavioral modification techniques they could use on their children.

The techniques were simple exercises: Hinson would play “piggies” with Noah, reciting the classic poem about pigs going to market and touching Noah’s feet. Often children with autism become distressed when they are touched. Other times she would play “airplane” with Noah’s food as she fed him. Or they’d focus on songs and rhymes.

“Basic things you do as a mom, but really are cuing into the responses he is making and really reinforcing the responses to get him to engage with me,” Hinson said. “The wonderful thing about it was that most of what they taught me, they taught me how to use in my general day-to-day routines with Noah.”

Scientists thought parents would be more apt to do exercises that could be woven into daily life.

At about 15 months in, there were still concerns, but Hinson had noticed improvement in Noah’s interactions with her. At 18 months, he seemed to be back on track developmentally.

“It was like this beautiful thing happened.”

Noah didn’t just catch up to the developmental goals of other children his age, he surpassed them. He remained talkative and engaged.

“This completely helped him,” she said. “I don’t know what would have happened (otherwise).”

She was not alone. At 36 months, the group that had used the behavioral intervention techniques with their children had much lower rates for autism spectrum disorder. Five children no longer showed symptoms of autism, one had mild autism but no developmental delays, and one had severe autism.

Today Noah is a 4-year-old boy with extensive language skills.

The scientists behind the study caution that this is only a pilot study; the findings cannot be applied to a larger population yet.

“With seven (children) you can’t draw a conclusion,” Rogers said.

But other researchers in the field see real promise in the results.

“It is exciting to think about an intervention that could change the developmental outcome for babies at risk of autism spectrum disorder,” said Dr. Jeremy Veenstra-VanderWeele, an associate of psychiatry at Columbia University. “This pilot study … suggests that parents can be trained to interact with their at-risk infants using many of the same principles that are used for toddlers and preschoolers with ASD.”

“It begins to set the scene for future randomized, controlled studies to evaluate whether this type of intervention could actually prevent babies from developing full symptoms of autism spectrum disorder,” Veenstra-VanderWeele said. If it proves to work on a larger group, this “would be a truly transformative finding.”

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Autoimmune Diseases Implicated In Eating Disorders

Several autoimmune diseases have been linked to, and may even play a role in the development of, eating disorders (EDs), new research suggests.

In a large cohort study, investigators found that patients with EDs were significantly more likely to have an autoimmune disease diagnosis compared with healthy control individuals.

A study of more than 2000 Finnish patients with EDs showed that these individuals had significantly more diagnoses of autoimmune disease than a matched group of healthy control persons in the general population.

ED patients were more than twice as likely to have endocrinologic diseases, especially type 1 diabetes, and gastroenterologic disorders, especially Crohn's disease.

However, when these 2 categories of disorders were excluded, patients with EDs were still significantly more likely to have autoimmune disease even before receiving ED treatment.

"I was surprised about the robust link that we found between autoimmune diseases and eating disorders," lead author Anu Raevuori, MD, PhD, from the Department of Public Health at the University of Helsinki, Finland, told Medscape Medical News.

"On the other hand, my clinical impression is that in many patients with eating disorders, particularly those with long-lasting and persistent symptoms, the disorder appears to have a biological background," said Dr. Raevuori.

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Long-Term Use Of Pills For Anxiety Linked To Alzheimer’s Risk

In the global effort to understand the causes of Alzheimer’s disease, another culprit emerges: Benzodiazepines. This class of drugs includes the widely prescribed anti-anxiety medications Ativan (lorazepam), Xanax (Alprazolam), Valium (diazepam), and Klonopin (Clonazepam). Researchers from France and Canada report in The BMJ that prolonged use of the drugs – for three months or more – may significantly increase the risk of Alzheimer’s disease years later. The drugs have been associated with short-term cognitive impairment, but the connection to Alzheimer’s has been less clear. Now, the new study finds a convincing, and apparently strong, link between benzodiazepines and Alzheimer’s disease.

At present, 5 million people in the U.S. suffer from Alzheimer’s disease alone, according to the Alzheimer’s Association, and the number is expected to more than triple by 2025. Worldwide, the numbers are even more startling: 36 million are affected globally, and by 2050, it’s projected to rise to 115 million.

In the current study, the researchers looked at the health insurance records of almost 1,800 elderly Quebec residents who had recently been diagnosed with Alzheimer’s disease. They looked at whether the participants had taken benzodiazepines in the past – specifically in the 5 to 10 year window preceding the diagnosis – and ran statistics to determine whether there was any link between having taken the meds and having developed Alzheimer’s. The data were compared to over 7,100 healthy people without Alzheimer’s disease.

People who had taken the drugs for at least three months had a 50% higher risk of having been diagnosed with Alzheimer’s. Those who took benzodiazepines for six months had an almost double risk of an Alzheimer’s diagnosis. The relationship worked in a dose-dependent manner, meaning that the longer a person took the medications or the higher the dose, the higher the risk of developing Alzheimer’s. Longer-acting forms of the drugs were also linked to a greater Alzheimer’s risk than shorter-acting forms. The results held true even when the authors adjusted for symptoms like anxiety, depression, and sleep problems, which are often symptoms of dementia.

It’s not totally clear why the connection exists biologically, but researchers do know that the short-term cognitive effects of benzodiazepines may be due to changes in the signaling of a neurotransmitter called GABA. “The short-term deleterious effects of benzodiazepine on memory are well documented,” study author Sophie Billioti de Gage said in an email. “They are mediated though an agonist action on receptors of gamma-aminobutyric acid [GABA], a major inhibitory neurotransmitter in the brain.”

She adds that another clue to what’s going on is that researchers have found reductions in the density of benzodiazepine receptors in people who died of Alzheimer’s. “The reduction in the number of benzodiazepine receptors has been observed comparing brains obtained at autopsy from individuals with Alzheimer’s disease and healthy individuals. Whether or not this observation can explain a biological mechanism linking benzodiazepine and Alzheimer disease is unclear.”

The cognitive reserve theory may also play in: People who use benzodiazepines over the long term may have neurological changes that deplete their cognitive reserve, reducing the brain’s ability to cope with and compensate for early Alzheimer’s symptoms.

One concern with studies like this is that reverse causation is at play: It could be that people who are already showing early symptoms of Alzheimer’s – like anxiety, depression, insomnia – are taking benzodiazepines to treat those symptoms. So it’s more that early effects of Alzheimer’s disease “caused” the use of the benzodiazepines, instead of the other way round. But the authors intentionally omitted the five years directly before the Alzheimer’s diagnosis. Instead, they looked at an earlier time period – five to 10 years preceding it. For this reason, and the dosing reasons mentioned above, they say it’s more likely that there is, in fact, a causal relationship going on, where long-term benzodiazepine use may actually trigger Alzheimer’s pathology.

How big a role benzodiazepines play is unclear. But the authors conclude that while benzodiazepines are “indisputably valuable tools for managing anxiety disorders and transient insomnia,” they shouldn’t be used for longer than three months.

At present, upwards of 50% of older people use the medication for some kind of mental health problem. The American Geriatrics Society has included benzodiazepines on its list of inappropriate drugs for seniors. It may be time for doctors to listen to this recommendation.

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New Research May Explain Why More Males Have Autism

The same sex hormone that helps protect females from stroke may also reduce their risk of autism, scientists say.

In the first look at a potential role of the female sex hormone in autism, researchers at the Medical College of Georgia at Georgia Regents University have found expression of estrogen receptor beta – which enables estrogen’s potent brain protection – is significantly decreased in autistic brains. The receptor also plays a role in locomotion as well as behavior, including anxiety, depression, memory, and learning.

“If you ask any psychiatrist seeing patients with autistic behavior their most striking observation from the clinic, they will say there are more males compared to females,” said Dr. Anilkumar Pillai, MCG neuroscientist and corresponding author of the study in Molecular Autism.

Estrogen is known to help protect premenopausal women from maladies such as stroke and impaired cognition. Exposure to high levels of the male hormone testosterone during early development has been linked to autism, which is five times more common in males than females.

The new findings of reduced expression of estrogen receptor beta as well as that of an enzyme that converts testosterone to estrogen could help explain the high testosterone levels in autistic individuals and higher autism rates in males, Pillai said.

It was the 5-to-1 male-to-female ratio along with the testosterone hypothesis that led Pillai and his colleagues to pursue whether estrogen might help explain the significant gender disparity and possibly point toward a new treatment.

“The testosterone hypothesis is already there, but nobody had investigated whether it had anything to do with the female hormone in the brain,” Pillai said. “Estrogen is known to be neuroprotective, but nobody has looked at whether its function is impaired in the brain of individuals with autism. We found that the children with autism didn’t have sufficient estrogen receptor beta expression to mediate the protective benefits of estrogen.”

Comparing the brains of children with and without autism spectrum disorder, the researchers found a 35 percent decrease in estrogen receptor beta expression as well as a 38 percent reduction in the amount of aromatase, the enzyme that converts testosterone to estrogen.

Levels of estrogen receptor beta proteins, the active molecules that result from gene expression and enable functions like brain protection, were similarly low. There was no discernable change in expression levels of estrogen receptor alpha, which mediates sexual behavior.

The study focused on the brain’s prefrontal cortex, which is involved in social behavior and cognition. Brain tissue from both autistic and healthy subjects was obtained from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Brain and Tissue Bank for Developmental Disorders at the University of Maryland. The children died at an average age of 11 from drowning, other accidents, or suicide. All the brain tissue was from male children except for one control.

While much work remains, estrogen receptor beta agonists, which are already known to improve brain plasticity and memory in animals, might one day help reverse autism’s behavioral deficits, such as reclusiveness and repetitive behavior, Pillai said.

The scientists already are moving to animal studies to see what happens when they reduce estrogen receptor beta expression in mice. They also plan to give an estrogen receptor beta agonist – which should increase receptor function – to a mouse with generalized inflammation and signs of autism to see if it mitigates those signs. Inflammation is a factor in many diseases of the brain and body, and estrogen receptor beta agonists already are in clinical trials for schizophrenia.

Larger, follow-up studies should also include comparing expression of testosterone receptor levels in healthy and autistic children, Pillai said.  MCG scientists also want to know more about why the reduced beta receptor expression occurs.

Studies published in the journal Molecular Psychiatry earlier this year by scientists at the University of Cambridge and Denmark’s Statens Serum Institute showed that male children who develop autism were exposed to higher levels of steroid hormones, including testosterone and progesterone, during development than their healthy peers.

The incidence of autism has increased about 30 percent in the past two years in the United States, to the current rate of about 1 in 68 children, according to the Centers for Disease Control and Prevention. Most children are diagnosed at about age 4, although the disorder can be diagnosed by about age 2, according to the CDC. Diagnosis is made through extensive behavioral and psychological testing.

GRU graduate student Amanda Crider is first author on the study.

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Brain Damage Caused By Severe Sleep Apnea Is Reversible

A neuroimaging study is the first to show that white matter damage caused by severe obstructive sleep apnea can be reversed by continuous positive airway pressure therapy. The results underscore the importance of the “Stop the Snore” campaign of the National Healthy Sleep Awareness Project, a collaboration between the Centers for Disease Control and Prevention, American Academy of Sleep Medicine, Sleep Research Society and other partners.

Results show that participants with severe, untreated sleep apnea had a significant reduction in white matter fiber integrity in multiple brain areas. This brain damage was accompanied by impairments to cognition, mood and daytime alertness. Although three months of CPAP therapy produced only limited improvements to damaged brain structures, 12 months of CPAP therapy led to an almost complete reversal of white matter abnormalities. Treatment also produced significant improvements in nearly all cognitive tests, mood, alertness and quality of life.

“Structural neural injury of the brain of obstructive sleep apnea patients is reversible with effective treatment,” said principal investigator and lead author Vincenza Castronovo, PhD, clinical psychologist at the Sleep Disorders Center at San Raffaele Hospital and Vita-Salute San Raffaele University in Milano, Italy. “Treatment with CPAP, if patients are adherent to therapy, is effective for normalizing the brain structure.”

The study results are published in the September issue of the journal Sleep.

“Obstructive sleep apnea is a destructive disease that can ruin your health and increase your risk of death,” said American Academy of Sleep Medicine President Dr. Timothy Morgenthaler, a national spokesperson for the Healthy Sleep Project. “Treatment of sleep apnea can be life-changing and potentially life-saving.”

The “Stop the Snore” campaign was launched recently to encourage people to talk to a doctor about the warning signs for sleep apnea, which afflicts at least 25 million adults in the U.S. Sleep apnea warning signs include snoring and choking, gasping or silent breathing pauses during sleep. Pledge to stop the snore at www.stopsnoringpledge.org.

The study involved 17 men with severe, untreated obstructive sleep apnea who had an average age of 43 years. They were evaluated at baseline and after both three months and 12 months of treatment with CPAP therapy. At each time point they underwent a neuropsychological evaluation and a diffusion tensor imaging examination. DTI is a form of magnetic resonance imaging that measures the flow of water through brain tissue. Participants were compared with 15 age-matched, healthy controls who were evaluated only at baseline.

A previous study by Castronovo’s research team found similar damage to gray matter volume in multiple brain regions of people with severe sleep apnea. Improvements in gray matter volume appeared after three months of CPAP therapy. According to the authors, the two studies suggest that the white matter of the brain takes longer to respond to treatment than the gray matter.

“We are seeing a consistent message that the brain can improve with treatment,” said co-principal investigator Mark Aloia, PhD, Associate Professor of Medicine at National Jewish Health in Denver, Colorado, and Senior Director of Global Clinical Research for Philips Respironics, Inc. “We know that PAP therapy keeps people breathing at night; but demonstrating effects on secondary outcomes is critical, and brain function and structure are strong secondary outcomes.”

The study was supported by the Respironics Foundation and performed in collaboration with the Center of Excellence in High-Field Magnetic Resonance Imaging at Vita-Salute San Raffaele University.

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Did You Know?

Globally, by 2020, the WHO expects depression to come second only to heart disease as a cause of lost years of health.

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