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Researchers report the patients showed better medication adherence and better control of their diabetes.
“Our results were especially pronounced for Latinos, who are twice as likely as non-Latinos to develop diabetes,” said lead study author Sanjay Arora, M.D., of the Keck School of Medicine at the University of Southern California in Los Angeles.
“These patients, when followed up by text messages for 6 months, improved enough to reduce their dependence on the emergency department for care of their diabetes. Text messaging is effective, low-cost and widely available for our patients who often have no other source of medical care.”
In the study, adult patients with poorly controlled diabetes who visited an urban, public emergency department for care received two daily text messages for 6 months.
For patients who received the text messages, blood glucose levels decreased by 1.05 percent and self-reported medication adherence improved from 4.5 to 5.4 (on an eight-point scale).
Effects were even larger among Spanish speakers for both medication adherence and blood glucose levels.
The proportion of patients who visited the emergency department was lower in the text messaging group (35.9 percent) than in the control group (51.6 percent).
Almost all (93.6 percent) patients enrolled in the program reported enjoying it and 100 percent reported that they would recommend it to family and friends.
The text messaging program, called TExT-MED, included daily motivational messages such as “Having diabetes can lead to a heart attack or stroke – but it doesn’t have to” and “Eat more fruits, vegetables, beans and whole grains and less salt and fat.”
In addition, it provided three medication reminders per week, two healthy living challenges per week and two trivia questions per week, designed to build diabetes awareness (“Trivia” sample: Eating too much sugar and other sweet foods is a cause of diabetes. A. True. B. False.”).
“Diabetes is emerging as a public health epidemic, particularly in low-income, underserved inner city and minority populations who depend on safety-net systems for medical care,” said Arora.
“Our goal is to transition our patients from crisis management to long-term diabetes management. In the absence of other health care options, reaching our patients by text message makes us partners in handling their disease and improves their quality of life.”
Study findings are published online in the Annals of Emergency Medicine.
Sadly, the stigma associated with mental illness plus limited access to quality treatment prevents many women from receiving care.
A new study shows that screening for the disorder and providing short-term, relationship-focused therapy through weekly home visits can relieve depression among minority mothers, even in the face of poverty and personal histories of abuse or violence.
Such help can have far-reaching benefits not only for mothers, but also for their children, say the authors.
“It’s amazing, really,” said lead researcher psychologist Dr. Sheree Toth.
“This research tracked a 14-week intervention for mothers who are terribly overwhelmed, surrounded by high-crime neighborhoods, lacking social support, and often traumatized — my fear was, ‘this is never going to work.’”
But to the surprise of Toth and her team, the series of convenient, one-hour therapy sessions relieved depression in participants much better than standard clinic-based care.
The study participants also continued to improve eight months after the treatment ended, regaining a sense of hope and control over their lives and reporting feeling more connected to and supported by others.
For example, on the Beck Depression Inventory (BDI), a widely used questionnaire in which a score of 19 or above indicates major depression, women in the study group saw their depressive symptoms decline from an average of 27 at the beginning of therapy to 9.6 eight months after the program concluded.
By contrast, women who received community care remained clinically depressed, with an average BDI score of 21 at the follow-up.
The results, said Toth, point to the need for screening high-risk populations.
None of these women were seeking treatment, but were identified instead through a questionnaire and an interview at physicians’ offices and clinics for the Women, Infants, and Children (WIC) subsidized nutrition program.
Said Toth: “When I go to the doctor, they ask me if I use my seatbelt. Why would we not be asking questions about depression when we know the chances of being hit by a car are way less than the chances of being hit by depression? People are suffering needlessly.”
The study is published in online in the journal Development and Psychopathology.
Experts say the findings are good news for mothers and their children alike.
“Extensive research has shown that young children whose primary caregivers are depressed often begin life on the wrong foot,” said Toth.
“They may fail to develop secure attachments, setting them up for a cascade of difficulties, from behavior problems during childhood and failure in school to involvement in the juvenile justice system and major psychiatric problems down the road.”
Despite the widespread prevalence of depression among minority mothers, researchers have largely overlooked this vulnerable population.
“In fact, studies that formed the empirical base for the American Psychiatric Association guidelines for depression treatment included 3,860 participants, with only 27 identified as African-American and none as being of Latina descent,” the authors write.
To address the imbalance, the researchers tracked 128 low-income mothers of one-year-olds, 60 percent of whom were Black, 20 percent Hispanic, and 20 percent Caucasian.
In addition to poverty, the vast majority of these mothers faced extensive life challenges. All but 6 percent had been depressed for more than a year, 87 percent reported histories of child abuse, 30 percent had been raped or sexually assaulted by a relative, and 27 percent suffered from posttraumatic stress disorder.
The study tested the effectiveness of interpersonal psychotherapy, a short-term depression treatment that has worked with more advantaged populations.
“A big part of this approach is instilling hope,” said Robin Sturm, Ed.D., a co-author and one of the family therapists who worked on the study.
She and other therapists first help clients recognize that feelings, such as a lack of energy or motivation, are symptoms of depression not signs of laziness or other character flaws. “If they can separate themselves from the symptoms, it helps them see that they can get better,” says Sturm.
The bulk of the intervention then focuses on identifying and easing one or two key relationship problems in clients’ lives.
This could be overcoming the loss of a loved one, reconnecting with a family member, or learning how to resolve conflicts with a partner. Using a variety of tools, from role-playing to analyzing arguments, participants practice more effective ways to interact.
“The aha moment is when these women realize, ‘I have a sense of control,’” said Sturm. “Perhaps there is domestic violence. They can’t control what the other person does, but they can control what they do. That stuck feeling is the hallmark of depression.”
A critical element of the study model was to offer therapy in clients’ homes, an option chosen by 85 percent of participants.
“It sends a powerful message that I am willing to come to you,” said Sturm, who, if needed, also met with clients in her car or drove them to the clinic for their appointment.
“When people are depressed, it may be too hard to have the energy to make it to appointments,” she said. The program’s flexibility also reduced the need for child care and transportation, resulting in a compliance rate of 100 percent, the authors report.
Therapists were also sensitive to the stigma of mental illness in minority communities. If clients appeared uncomfortable with a diagnosis like depression, therapists used terms like overwhelmed or moody instead and stressed that such feelings were common for parents faced with the demands of child-rearing.
Instead of therapy, they sometimes describe their appointments as “spending some time talking about how you are feeling.” The program involved no antidepressants or other medication, further distancing the intervention from psychiatric care, said Sturm.
To assess the effectiveness of this flexible, problem-solving approach, the study randomly assigned a second group of mothers to standard community care, matched by race, education, age, and other factors.
The control group received clinic-based counseling or cognitive-behavioral therapy, a common short-term treatment for depression, along with a variety of other interventions, including medication, support groups, and marital and family counseling.
The comparison was clear: Home-based, interpersonal psychotherapy lifted depression much more effectively than standard care.
The findings underscore the importance of actively screening and offering culturally sensitive, convenient care for our most vulnerable populations, said co-author Fred Rogosch, Ph.D.
In one clinical trial, 83 percent of low-income young minority women referred for treatment for depression did not attend even one session.
“Most of these women don’t even like to talk about depression. Most of these women would never have asked for treatment,” said Rogosch.
“We also are concerned about the children of mothers who feel isolated, helpless, and angry. That is not the ideal emotional environment for infants and toddlers to grow up in. Reaching out to these mothers is critical for their children,” he said.
Even with the creative accommodations offered in this study, Rogosch noted that 40 percent of mothers identified as depressed declined all care. The authors suggest that future research should explore ways to make the interview process even more welcoming.
Source: University of Rochester
And, as humans live longer, these choices also affect aging and quality of life.
During the conference, experts presented evidence showing that lifestyle changes in diet and exercise should be viewed as analogous to drug therapies, yet without the side-effects.
Findings presented at the conference include:
- As few as 12 consecutive days of exercise in aging rats helps preserve and improve movement function, an effect possibly caused by changes in dopamine. The results suggest that exercise could stave off or reverse the slowed movements that are hallmarks of age;
- Practices like yoga or meditation that increase mind/body awareness help people learn a brain-computer interface quicker. This finding may have implications for those who need brain-computer interfaces to function, such as people with paralysis;
- Long-term exercise in aging rats improves memory function, as well as increases the number of blood vessels in the white matter of their brains — the tracts that carry information between different areas of the brain. Increased blood flow may explain why exercise can help preserve memory;
- Regular, supervised exercise helped young adults with depression overcome their symptoms in a pilot study. The results suggest that exercise could be an important treatment for depression in adolescents;
- A low calorie diet starting in middle-age onward protected rats against the effects of aging on movement. The results suggest that dietary interventions can help preserve movement function in a manner similar to exercise.
“We all know that keeping fit is critically important to a healthy lifestyle, from combating the effects of aging to boosting our mood,” said Teresa Liu-Ambrose, Ph.D., of the University of British Columbia, an expert on exercise and its role in healthy aging.
“Today’s results begin to show us not only how different types of exercise interventions can improve our lives, but how other types of lifestyle behaviors, from diet to meditative practice, can help us achieve wellness in our body and our brain as we age.”
Source: Society for Neuroscience
New research confirms recent contentions that social media platforms are turning people into “slacktivists” — making it easy for them to associate with a cause without committing resources to support it.
Researchers from the University of British Columbia’s Sauder School of Business discovered would-be donors skip giving when offered the chance to show public support for charities in social media.
“Charities incorrectly assume that connecting with people through social media always leads to more meaningful support,” said Kirk Kristofferson, who co-authored the forthcoming Journal of Consumer Research article.
“Our research shows that if people are able to declare support for a charity publicly in social media it can actually make them less likely to donate to the cause later on.”
In a series of studies, researchers invited participants to engage in an initial act of free support for a cause — joining a Facebook group, accepting a poppy, pin or magnet or signing a petition. Participants were then asked to donate money or volunteer.
Investigators found that the more public the token show of endorsement, the less likely participants are to provide meaningful support later.
However, if participants were provided with the chance to express token support more privately, such as confidentially signing a petition, they were more likely to give later.
The researchers suggest this occurs because giving public endorsement satisfies the desire to look good to others, reducing the urgency to give later. Providing token support in private leads people to perceive their values are aligned with the cause without the payoff of having people witness it.
With the holiday season being the biggest fundraising period of the year, the researchers say it is vital that charities take another look at their strategies and plan appropriately.
Source: University of British Columbia
The findings emerge from a new study which discovered many Boston-area military veterans diagnosed with post-traumatic stress disorder (PTSD) experienced flashbacks, unwanted memories and other psychological effects as a result of the Boston Marathon bombing on April 15, 2013.
The study raises awareness of the effects that horrific events such as terror attacks and mass shootings have not only on those directly affected but also on those with PTSD and other preexisting psychological conditions.
The researchers urge health care systems to be prepared in the future to treat individuals who were either directly or indirectly affected by such tragedies.
Researchers from Boston University School of Medicine (BUSM) and the U.S. Department of Veteran’s Affairs National Center for PTSD have published their findings online in the Journal of Traumatic Stress.
PTSD is a psychiatric disorder defined by serious changes in cognitive, emotional, behavioral and psychological functioning that can occur in response to a psychologically traumatic event.
Previous studies have estimated that approximately eight percent of the U.S. population will develop PTSD in their lifetime. That number is significantly greater among combat veterans where as many as one out of five suffer symptoms of the disorder.
Using data from an ongoing study of Boston area veterans diagnosed with PTSD, the researchers conducted 71 telephone interviews within one week of the bombing.
Because the researchers had symptom data from participants approximately two months before the bombing, they were able to compare those levels with results from the interview one-week after the bombing.
Of those interviewed, 38 percent reported that they were emotionally distressed by the bombing and the subsequent lockdown of Boston and other communities. A majority of those participants said that the bombing caused them to experience flashbacks and the re-emergence of unwanted memories relating to their own past traumas.
“The effects felt by the veterans were likely due to thematic similarities between the Marathon explosions and the veterans’ own traumatic combat experiences, especially for those deployed to recent conflicts characterized by attacks involving improvised explosive devices,” said Mark Miller, Ph.D,, the study’s principal investigator.
There was not a significant change of symptoms between the pre- and post-event data across the sample as a whole.
However, for those who reported being personally affected, there was a strong correlation between distress at the time of the bombing and change in the severity of PTSD symptoms. According to the researchers, this change was primarily attributable to increases in intrusion and avoidance symptoms.
“This study highlights the fact that tragic local and national events of this type can have a significant impact on the health and well-being of individuals already suffering with PTSD,” said Miller.
“It is crucial that relevant healthcare organizations understand this phenomenon and be prepared in the wake of tragedy to care not only for those who are directly impacted, but also for those with preexisting psychological conditions, including our nation’s veterans with PTSD.”
Source: Boston University Medical Center
Investigators believe that during sleep the brain uses neural oscillations — brain waves — of particular frequencies to consolidate learning in specific brain regions.
As reported in the Journal of Neuroscience, Brown University scientists discovered that two specific frequencies of brain waves — fast-sigma and delta — are directly associated with learning a finger-tapping task similar to typing or playing the piano.
A recent study discovers a similar pattern on a visual task in which 15 volunteers were trained to spot a hidden texture amid an obscuring pattern of lines.
It’s a bit like an abstracted game of “Where’s Waldo” but such training is not merely an academic exercise, said Takeo Watanabe, Ph.D., professor of cognitive, linguistic, and psychological sciences at Brown.
“Perceptual learning in general has been found to improve the visual ability of patients who have some decline of function due to aging,” Watanabe said.
In this case the researchers devised an experiment to see how sleep may help such training take hold.
They measured the brainwaves of the participants during sleep before and the training, and they measured the volunteers’ performance on the task before and after.
Investigators saw significant increases in sigma brainwave power after sleep compared to before in the visual cortical area in the occipital lobe of the volunteers’ brains.
To ensure they were measuring activity related to learning the task, the researchers purposely put the stimulus of the discrimination task in a particular quadrant of the subjects’ field of view.
That position corresponds to an anatomically distinct part of the visual cortical area. The team saw that the measured gain in sigma wave power was greater specifically in that trained part of the visual cortical area rather than in the untrained parts.
They also saw that the difference of power increase between trained and untrained regions of the visual cortical area was correlated with each individual’s performance improvement on the task.
Researchers used novel technology in the study including magnetic and electronic encephalography, magnetic resonance imaging and polysomnography to measure the brainwaves in specific brain regions during distinct phases of sleep.
The repeated significance of sigma oscillations, known as sleep spindles, in both the visual task and the motor task may be important in figuring out a broader picture of how the brain consolidates learning during sleep, the researchers said.
They did not, however, see the same uptick of delta frequency power that they saw in their study of the motor task.
Neuroscientists believe the two frequency bands play different roles. The sigma frequency is associated with internal workings of a brain region, while delta is associated more with inter-region communication.
“So far we are thinking that the sigma band is used commonly during learning-related jobs, but not necessarily the delta bands,” said Yuka Sasaki, Ph.D., associate professor (research) of cognitive, linguistic, and psychological sciences.
Source: Brown University
Researchers at the University of Montreal note this head start could have an impact on the child’s entire life.
“We hope these results will guide public health interventions and research on brain plasticity,” said Dave Ellemberg, Ph.D., who led the study.
“Most of all, we are optimistic that this will encourage women to change their health habits, given that the simple act of exercising during pregnancy could make a difference for their child’s future.”
While in the past obstetricians would tell women to rest during their pregnancy, it is now commonly accepted that inactivity actually increases the risk of complications during pregnancy, noted Daniel Curnier, Ph.D.
“Being active can ease postpartum recovery, make pregnancy more comfortable and reduce the risk of obesity in the children,” he said.
“Given that exercise has been demonstrated to be beneficial for the adult’s brain, we hypothesized that it could also be beneficial for the unborn child through the mother’s actions.”
To verify this, the researchers randomly assigned pregnant women who were entering their second trimester to either an exercise group or a sedentary group.
Women in the exercise group were asked to perform at least 20 minutes of cardiovascular exercise three times a week at a moderate intensity, which should lead to at least a slight shortness of breath, the researchers explained. Women in the sedentary group did not exercise.
The researchers then assessed the brain activity of the newborns between the ages of 8 to 12 days, by means of electroencephalography, which enables the recording of the brain’s electrical activity.
“We used 124 soft electrodes placed on the infant’s head and waited for the child to fall asleep on his or her mother’s lap,” said Ph.D. candidate Élise Labonté-LeMoyne. “We then measured auditory memory by means of the brain’s unconscious response to repeated and novel sounds.”
The results show that the babies born from the mothers who were physically active had a more mature cerebral activation, “suggesting that their brains developed more rapidly,” she said.
The researchers said they are now in the process of evaluating the children’s cognitive, motor and language development at age 1 to see if these differences are maintained.
Ellemberg, Curnier and Labonté-LeMoyne presented their findings at Neuroscience 2013, the annual meeting of the Society for Neuroscience.
Source: University of Montreal
“It is very difficult now to assess the extent of dopamine loss — a hallmark of Parkinson’s disease — in people with the disease,” said lead author Katherine R. Gamble, a psychology Ph.D. student at Georgetown University, who is working with two Georgetown psychologists, a psychiatrist and a neurologist.
“Use of this test, called the Triplets Learning Task (TLT), may provide some help for physicians who treat people with Parkinson’s disease, but we still have much work to do to better understand its utility.”
The TLT tests implicit learning, a type of learning that occurs without awareness or intent. Implicit learning relies on the caudate nucleus, an area of the brain affected by loss of dopamine, the researcher explains.
The test is a sequential learning task that does not require complex motor skills, which tend to decline in people with Parkinson’s disease (PD), she added.
During the test, participants see four open circles, then see two red dots appear. They are then asked to respond when they see a green dot appear.
Unknown to them is that the location of the first red dot predicts the location of the green dot. Participants learn implicitly where the green dot will appear, making them faster and more accurate in their responses, the researcher explains.
Previous studies have shown that the caudate region in the brain underlies implicit learning.
In the latest study, 27 participants with Parkinson’s implicitly learned the dot pattern with training, but a loss of dopamine appeared to negatively impact that learning compared to healthy older adults, the researcher noted.
“Their performance began to decline toward the end of training, suggesting that people with Parkinson’s disease lack the neural resources in the caudate, such as dopamine, to complete the learning task,” she said.
The research team is now testing how implicit learning may differ in different stages of the disease and with different drug doses.
“This work is important in that it may be a non-invasive way to evaluate the level of dopamine deficiency in PD patients, and which may lead to future ways to improve clinical treatment of PD patients,” said Steven E. Lo, M.D., associate professor of neurology at Georgetown University Medical Center, and a co-author of the study.
The study is being presented at Neuroscience 2013, the annual meeting of the Society for Neuroscience.
Researchers at Georgetown University Medical Center say their observations of animals addicted to morphine suggest that managing withdrawal could promote a healthier mental state in people.
“Over time, drug-abusing individuals often develop mental disorders,” said Italo Mocchetti, Ph.D., a professor of neuroscience. “It’s been thought that drug abuse itself contributes to mental decline, but our findings suggest that quitting cold turkey can also lead to damage.”
In the study published in Brain, Behavior and Immunity, Mocchetti and his research team treated the animals with morphine, or allowed them to undergo withdrawal by stopping the treatment.
They then measured pro-inflammatory cytokines, which can promote damage and cell death, and the protein CCL5, which has various protective effects in the brain.
“Interestingly, we found that treating the addicted animals with morphine both increased the protective CCL5 protein while decreasing pro-inflammatory cytokines, suggesting a beneficial effect,” Mocchetti said.
He noted that the animals that weren’t treated during withdrawal had the opposite results — decreased CCL5 and increased levels of the damaging cytokines.
“From these findings, it appears that morphine withdrawal may be a causative factor that leads to mental decline, presenting an important avenue for research in how we can better help people who are trying to quit using drugs,” he concluded.
Women who suffer from depression before pregnancy should be monitored for manic symptoms—traits of bipolar disorder—during the postpartum period, according to new research published in the journal Bipolar Disorders.
Although women’s reproductive events (pregnancy, the postpartum period and menopause) are often linked to mood disorders, childbirth is more dramatic, explained Dr. Verinder Sharma, a psychiatrist from the Schulich School of Medicine & Dentistry at Western University in Canada.
“We know childbirth is a potent and specific trigger for mania and hypomania. What I wanted to do was to see, if you have a group of women with just depression, how many of them would convert to bipolar disorder after giving birth,” Sharma said. “A large number of women do convert.”
The study found that the occurrence of conversion from depression to bipolar disorder in postpartum women was 11-18 times higher than reported in non-postpartum women.
“If you look at the literature on postpartum mental illness, there’s lots of emphasis on postpartum depression; not much attention is paid to bipolar disorder,” Sharma said.
He also said that bipolar disorder in postpartum women tends to go unnoticed after a woman gives birth.
“When physicians and other caregivers are assessing women with postpartum depression, they have to screen them for bipolar disorder. This has important treatment implications and there are some safety issues as well. Bipolar disorder is more likely associated with suicide, and, perhaps, infanticide,” Sharma said.
He noted the importance of getting a diagnosis as soon as possible to ensure prompt and proper treatment, before symptoms escalate. Prescribing antidepressants to a woman whose diagnosis has converted to bipolar disorder wouldn’t be effective and could increase symptoms of mania, Sharma explained.
“If you look at women who get hospitalized for psychiatric reasons within the first couple of weeks after childbirth, a large number of them have bipolar disorder,” he said.
“We know childbirth is perhaps the most important and most potent trigger of bipolar disorder. We need to understand why that is the case, what is so unique about childbirth that it’s associated with such high risk,” he continued.
It is possible that genes, a family history of bipolar disorder, hormonal changes and sleep loss following pregnancy, contribute to the high risk. The researchers will continue to look into these factors to gain a better understanding of the underlying cause of the increased conversion of depression to bipolar disorder in postpartum women.
“For us to understand bipolar disorder in women, we have really neglected the role of hormonal changes,” he said.
“We now want to look at women who have just postpartum depression, to see whether the presence of manic symptoms (changes) in response to treatment.”
Source: University of Western Ontario
Children with autism are six to eight times more likely to suffer gastrointestinal problems than typically developing children, according to new research from the University of California-Davis’ MIND Institute.
“After years of parents raising concerns about such symptoms, the huge differences we see between parental reports on children with autism spectrum disorder versus those on children with typical development puts to rest the idea that gastrointestinal problems among children with autism spectrum disorder are just an accumulation of case reports,” said Irva Hertz-Picciotto, principal investigator for the CHARGE Study and a researcher affiliated with the MIND Institute.
“Our data clearly show that gastrointestinal problems are very common in children with autism.”
The study is the largest and most ethnically diverse research to compare digestive problems in autistic children with developmental delay and typical development. It is also the first to investigate the link between stomach upsets and behavior problems.
“Parents of children with autism have long said that their kids endure more GI problems, but little has been known about the true prevalence of these complications or their underlying causes,” said lead author Virginia Chaldez, Ph.D.
Researchers, however, are still unsure which problem comes first.
“The GI problems they experience may be bidirectional. GI problems may create behavior problems, and those behavior problems may create or exacerbate GI problems. One way to try to tease this out would be to begin investigating the effects of various treatments and their effects on both GI symptoms and problem behaviors,” said Chaldez.
For the study, the parents of nearly 1,000 children (between the ages of 24 and 60 months)who were enrolled in the Childhood Autism Risks from Genetics and the Environment (CHARGE) study in North Carolina filled out two questionnaires.
The first questionnaire detailed GI health history (GIH) and covered stomach pain, diarrhea, constipation and problems with swallowing. The next questionnaire was a behavior checklist (ABC). It detailed occurrences of irritability, social withdrawal/lethargy, repetitive behavior, hyperactivity and inappropriate speech.
Approximately half of the study population was white, with one-third Hispanic and the remainder from other ethnic or racial backgrounds.
The findings showed that children with autism were six to eight times more likely to have food sensitivities, bloating, constipation and diarrhea than typically developing children. It was also found that children with developmental delays suffered five times as much constipation and were much more likely to have problems with swallowing.
The researchers also point out that hyperactivity and repetitive behavior may be coping mechanisms for physical discomfort. They believe that autistic children may benefit from a full GI evaluation, especially if they lack verbal skills. It is possible that treatments that improve digestion may lead to an improvement in problem behaviors.
Source: UC Davis MIND Institute
Many schizophrenia patients who attempt suicide after leaving a hospital did not receive a suicide risk assessment before discharge, according to a new study from Denmark. These mostly include high-risk groups, such as men and patients with a new schizophrenia diagnosis.
Three-quarters of the completed suicides were done by men, and they were 22 percent less likely than women to have received a risk assessment, after adjusting for a variety of patient and treatment-related factors.
“Additional efforts appear warranted in order to ensure that all patients receive systematic suicide risk assessment before being discharged and that appropriate measures are taken to lower the risk of suicidal behavior,” said lead researcher Charlotte Gjørup Pedersen, Ph.D., of the Aalborg Psychiatric Hospital, Denmark and colleagues.
The findings showed that the practice of suicide risk assessments had increased significantly during the study period, with 72 percent of patients being evaluated by a psychiatrist in 2005, rising to 89 percent in 2009.
Overall, 1 percent of the 7107 study patients committed suicide within 1 year of discharge and 8 percent attempted it. Furthermore, 66 percent of patients who committed suicide had a documented risk assessment, as had 73 percent of those who attempted suicide.
Schizophrenia patients who abused alcohol or drugs were less likely to receive a suicide risk assessment, as were those with a score below 30 on the Global Assessment of Functioning — a numeric scale (1-100) designed to measure the functioning level of adults with mental health disorders.
Patients with new schizophrenia diagnoses accounted for 19 percent of all participants. Overall, 64 percent received a risk assessment, 23 percent had missing information on suicide risk assessment, and the others were not assessed at all. Among these patients, undergoing an interview test as well as a cognitive test greatly increased the likelihood that they would be given a pre-discharge suicide risk assessment.
“Despite the recommendations for the use of systematic suicide risk assessment, the predictive value of the risk assessment is modest due to the high prevalence of the assessment of risk factors and the low rate of suicidal behavior,” the researchers wrote in Psychiatric Services.
“Systematic suicide risk assessment should therefore be used with caution to guide clinicians and patients but should not stand alone.
“Attention to overall improvements in the care provided both before and after discharge is therefore warranted.”
Source: Psychiatric Services
Globally, depression is the second-leading cause of disability, and the Middle East and North Africa have the highest concentration of people with the disorder, according to a new study published in the journal PLOS Medicine.
Researchers at Australia’s University of Queensland used pre-existing data on the prevalence, incidence and duration of depression to figure out the social and public health burden of the condition throughout the world. They found that slightly more than 4 percent of the world’s population are diagnosed with the disorder.
The study found that more than 5 percent of the population suffers from depression in the Middle East, North Africa, Sub-Saharan Africa, Eastern Europe and the Caribbean.
The most depressed country is Afghanistan, where more than 20 percent suffer from the disorder, while the least depressed is Japan, with less than 2.5 percent.
Depression often shows up in regions with conflict and in the presence of other serious epidemics. Not surprisingly, Afghanistan, Honduras and the Palestinian territories are the three most depressed regions.
“In the case of North Africa/Middle East, conflict in the region increased the prevalence of [depression], leading to a higher burden ranking,” wrote the researchers. In sub-Saharan Africa, however, diseases such as malaria and AIDS have crowded out depression as the top public health problem.
Social scientists have found that people between the ages of 16 and 65 tend to suffer depression at much higher rates. That age factor, along with explosive population growth, explains why the burden of depression has increased by nearly a third since 1990, researchers say.
The investigators caution that reliable depression surveys don’t even exist for some low-income countries, driving the researchers to create their own estimates based on statistical regression models.
For example, people who live in countries with greater awareness of and easier access to mental health services are naturally going to have a higher rate of diagnosis. This may help explain the unusually low rate of depression in Iraq, for example, where public health services are poor.
Also, populations that often hold taboos against mental health problems—for example in East Asia— also drive down diagnosis rates, giving a false lower measure of clinical depression in that area.
Source: PLOS Medicine
Using functional magnetic resonance imaging (fMRI), researchers at the University of Liverpool scanned the brains of people in major depressive episodes and those who weren’t. The task subjects were given while in the fMRI machine was to choose adjectives to describe themselves or the British Queen — a figure significantly removed from their daily lives that all but one of the participants were familiar with.
“We found that participants who were experiencing depressed mood chose significantly fewer positive words and more negative and neutral words to describe themselves, in comparison to participants who were not depressed,” said Professor Peter Kinderman, head of the university’s Institute of Psychology, Health and Society.
“That’s not too surprising, but the brain scans also revealed significantly greater blood oxygen levels in the medial superior frontal cortex — the area associated with processing self-related information — when the depressed participants were making judgments about themselves.”
The research leads the way for further studies into the psychological and neural processes that accompany depressed mood, he continued.
“Understanding more about how people evaluate themselves when they are depressed and how neural processes are involved could lead to improved understanding and care,” he said.
“This study explored ways to consolidate some of the differences between medical and psychological models of depression,” added Dr. May Sarsam, from the Mersey Care NHS Trust.
“It showed that brain activity only differed when depressed people thought about themselves, not when they thought about the Queen or when they made other types of judgments, which fits very well with the current psychological theory.”
“Thought and neurochemistry should be considered as equally important in our understanding of mental health difficulties such as depression,” she added.
The research, in collaboration with the Mersey Care NHS Trust and the Universities of Manchester, Edinburgh and Lancaster, was published in PLOS One.
Source: University of Liverpool
In the largest study on the topic to date, researchers found that people who spoke two languages developed dementia four and a half years later than people who only spoke one language.
The findings are published in the online issue of Neurology.
“Our study is the first to report an advantage of speaking two languages in people who are unable to read, suggesting that a person’s level of education is not a sufficient explanation for this difference,” said study author Suvarna Alladi, M.D.
“Speaking more than one language is thought to lead to better development of the areas of the brain that handle executive functions and attention tasks, which may help protect from the onset of dementia.”
For the study, 648 people from India with an average age of 66 who were diagnosed with dementia were evaluated. Of those, 391 spoke two or more languages.
A total of 240 had Alzheimer’s disease, 189 had vascular dementia and 116 had frontotemporal dementia, with the remainder having dementia with Lewy bodies and mixed dementia. Fourteen percent were illiterate.
People who spoke two languages had a later onset of Alzheimer’s disease, frontotemporal dementia and vascular dementia than people who spoke only one language.
The difference was also found in those who could not read. There was no additional benefit in speaking more than two languages.
The two-language effect on age of dementia onset was shown separately of other factors such as education, gender, occupation and whether participants lived in the city or country.
“These results offer strong evidence for the protective effect of bilingualism against dementia in a population very different from those studied so far in terms of its ethnicity, culture and patterns of language use,” Alladi said.
Source: American Academy of Neurology
Emory University psychologists discovered that grandiose narcissism in U.S. presidents is associated with ratings by historians of overall greatness of presidencies.
Grandiose narcissism is characterized by an extroverted, self-aggrandizing, domineering and flamboyant personality.
Presidents with narcissist traits also scored high on public persuasiveness, crisis management, risk-taking, winning the popular vote and initiating legislation.
However, some negative aspects of grandiose narcissism include presidential impeachment resolutions, cheating and bending rules.
The new study is published in the journal Psychological Science.
“Most people think of narcissism as predominantly maladaptive,” said Ashley Watts, study leader, “but our data support the theory that there are bright and dark sides to grandiose narcissism.”
Researchers found that Lyndon B. Johnson scored highest on markers of grandiose narcissism, followed by Theodore Roosevelt, Andrew Jackson, Franklin D. Roosevelt and John F. Kennedy.
President Johnson was known both for getting tough legislation passed, and for being “a bit of a bully,” said Scott Lilienfeld, Ph.D., a so-investigator.
“It’s interesting to me that these are memorable presidents, ones that we tend to talk about and learn about in history classes,” Watts said.
“Only rarely, however, do we talk about most of those who had low ratings for grandiose narcissism, like Zachary Taylor and Millard Fillmore.”
The researchers also found that presidents exhibit elevated levels of grandiose narcissism compared with the general population, and that presidents’ grandiose narcissism appears to be rising over time.
“As the importance of television and other media has grown in presidential elections, this could be giving an edge to those with the attention-seeking, outgoing personalities associated with grandiose narcissism,” Lilienfeld said.
In psychology terms, narcissism comprises at least two largely distinct patterns of behavior associated with different traits. Vulnerable narcissism is marked by excessive self-absorption, introversion and oversensitivity.
Grandiose narcissism, on the other hand, is characterized by an extroverted, self-aggrandizing, domineering and flamboyant interpersonal style.
“We don’t believe there is a specific dividing line between normal and clinical narcissism,” Lilienfeld said. “It’s probably inherently blurred in nature.”
A queen obsessed with being “the fairest of them all” illustrates a worst-case scenario of narcissism and leadership in the classic fairy tale “Snow White.”
Their analyses drew upon personality assessments of 42 presidents, up to and including George W. Bush, compiled by co-authors Steven Rubenzer and Thomas Faschingbauer for their book “Personality, Character and Leadership in the White House.”
More than 100 experts, including biographers, journalists and scholars who are established authorities on one or more U.S. presidents, evaluated their target presidents using standardized psychological measures of personality, intelligence and behavior.
For rankings on various aspects of job performance, the analysis relied primarily on data from two large surveys of presidential historians: One conducted by C-SPAN in 2009 and a second conducted by Siena College in 2010.
Lyndon Johnson’s mixed presidential legacy reflects both positive and negative outcomes tied to grandiose narcissism, Lilienfeld said. “Johnson was assertive, and good at managing crises and at getting legislation passed. He also had a reputation for being a bit of a bully and antagonistic.”
Franklin D. Roosevelt, he adds, was also a highly assertive, dominant personality, but not particularly antagonistic or impulsive.
“In U.S. history, there is an enormous variety in presidential leadership style and success,” Lilienfeld said. “One of the greatest mysteries in politics is what qualities make a great leader and which ones make a disastrous, failed leader. Grandiose narcissism may be one important part of the puzzle.”
The study of narcissism and the presidency follows an earlier analysis by Lilienfeld and colleagues that showed that the fearless dominance associated with psychopathy may be an important predictor of U.S. presidential performance.
Source: Emory Health Sciences
Unfortunately, teens often pick up on the negative elements in a relationship, such as conflict and antagonism, and then copy these attitudes into their own relationships.
The new study investigated a previously understudied association — how a parent’s friendships influence the emotional well-being of their adolescent children.
For the study, doctoral student Gary Glick and Amanda Rose, Ph.D., studied the development of friendships and other peer relationships during adolescence and their impact on psychological adjustment.
They found that adolescents may mimic the negative characteristics of their mothers’ relationships in their own peer-to-peer friendships suggesting that mothers can serve as role models for their adolescents during formative years.
“Mothers who display high levels of conflict with friends may signal to their children that such behavior is acceptable, or even normative in friendships,” Glick said.
“Additional findings suggest that adolescents internalize their reactions to their mothers’ conflict with adult friends which may lead to anxiety and depression.”
Previous research of this type focused on elementary-aged children, but MU researchers wanted to expand their study to focus on the formative adolescent years.
Youth ranging in age from 10 to 17 and their mothers were polled separately to measure perceived positive and negative friendship qualities in both groups.
Results showed that positive friendship qualities were not always imitated by adolescents; however, negative and antagonistic relationship characteristics exhibited by mothers were much more likely to be mimicked by the youth studied.
“We know that conflict is a normal part of any relationship — be it a relationship between a parent and a child, or a mother and her friends — and we’re not talking physical altercations but verbal conflicts,” Glick said.
“But being exposed to high levels of such conflict generally isn’t going to be good for children. Parents should consider whether they are good role models for their children especially where their friends are concerned. When things go awry, parents should talk with their children about how to act with their friends, but more specifically, how not to act.”
Researchers anticipate future studies on how conflict resolution may be incorporated into parental methods in the home.
Source: University of Missouri
Exposure therapy is an evidence-based psychotherapy for post-traumatic stress disorder (PTSD).
The intervention typically requires at least 10 sessions and, to reach its full potential, any misperceptions or ruptures in trust and communication between therapist and client must be resolved, say Case Western Reserve researchers.
The study is among the first to examine how ruptures in the relationship between the therapist and client can damage a patient’s treatment outcome.
As reported in the Journal of Consulting and Clinical Psychology, an alliance rupture may occur when there is a break in the therapist-client bond.
For example, ruptures in the therapeutic relationship may occur when therapeutic progress stalls, negative feelings arise between the therapist and client, or when the work in therapy becomes challenging.
“We want therapists to know that a rupture in the therapeutic relationship isn’t a bad thing, as long as the therapist tends to it,” said graduate student Stephanie Keller, one of the study’s researchers.
“However, if the rupture is not repaired, then your patient may not do as well in treatment.”
The research study included 116 people who experienced a traumatic event such as childhood sexual or physical abuse, physical assault, or combat exposure, and had a primary diagnosis of PTSD. Participants engaged in a 10-session treatment program called prolonged exposure (PE) therapy.
To help therapists chart progress and examine the therapeutic relationship, each client assessed his or her own PTSD symptoms and perception of their relationship with the therapist during treatment.
This helped researchers to identify those clients who experience no ruptures in the therapeutic relationship (a stable relationship), clients who experienced a rupture that was subsequently repaired, and those with ruptures that went unrepaired.
The first PE session outlined what would happen over the course of treatment to set specific goals. Exposure-based exercises began in the second session, which included exposure to anxiety-provoking situations that served as trauma-reminders and talking about their traumatic experiences.
In this sample, 28 percent of patients experiences a repaired rupture and 18 percent experienced a rupture, or dip in the therapeutic relationship, that was never repaired. An unresolved rupture in the therapist-client relationship became a predictor for a poorer outcome in treatment, Keller said.
She also said more research is needed to figure out why these alliance ruptures occur and how to best repair them.
Source: Case Western Reserve University
Positive findings are that Brown University psychiatry researchers discovered seven in 10 primary care patients with anxiety disorders receive potentially adequate medication or psychotherapy.
The not-so-positive finding was that the successful anxiety reduction would often take years to accomplish and that it was considerably less likely for minorities.
As published in the journal, Depression and Anxiety, a study of 534 subjects revealed that 28 percent were receiving “potentially adequate” medication (19 percent) or psychotherapy (14 percent) or both when they began their course of care from one of 15 primary care sites in four New England states.
By year five of follow-up, 69 percent had received either or both appropriate medication (60 percent) or psychosocial treatment, such as cognitive-behavioral therapy (36 percent).
“The good news here was that eventually, most patients got some good treatment,” said study lead author Risa Weisberg, Ph.D.
“The bad news is that pharmacotherapy wasn’t sustained for long periods of time, that cognitive-behavioral therapy was rarely received even over the longer time period, and that ethno-racial minorities were less likely to get good care.”
Most studies of anxiety treatment adequacy have only looked at one time point and have therefore found very low levels of care.
But anxiety disorders are often chronic and primary care providers typically have an ongoing relationship with patients, Weisberg said. This study looked at a longer term.
Another key feature of the study was that it measured the provision of “potentially adequate” therapy.
In the case of medication, that meant a drug had to have known efficacy and be taken at an adequate dose for enough time.
For psychotherapy, the authors defined cognitive therapy or behavioral therapy as potentially adequate based on the method having empirical support. These methods also had to meet basic benchmarks such as identifying problematic patterns in thinking and recommending a course to change them or asking patients to conduct exposure exercises in which they attempt to engage in feared behaviors.
Although over the course of five years many patients eventually received care, some patients were less likely to receive it. Minorities, for example, were less than half as likely to receive “potentially adequate” treatment for anxiety either at the beginning of the five-year study period or by the end. People of any race or ethnicity with a college education, on the other hand, were almost twice as likely to receive care.
The patients were recruited through via the Primary Care Anxiety Project and were tracked through a follow-up period that ran from 2002 to 2007.
Weisberg said it is possible that rates of referral to potentially adequate care have categorically increased since then, but there was no evidence in the study data that the rates were systematically increasing during the study’s five-year period.
Instead, she said, patients may take a while to eventually get potentially adequate care because primary care physicians often employ a strategy of “watchful waiting” to see if symptoms will improve. Weisberg and her co-authors noted in the study that patients with more severe anxiety symptoms were more likely to get potentially adequate care.
In a future work, Weisberg said, she hopes to study explicitly what triggers the start of anxiety therapy for primary care patients.
The study was funded by Pfizer Inc.
Source: Brown University
“When young children lie or cheat or steal, parents naturally wonder if they’ll grow out of it,” said Dr. Luke Hyde, a University of Michigan psychologist who is studying the development and treatment of antisocial behavior.
Hyde and colleagues form several other universities have been exploring the role of the environment and biology as they interact over time to shape behavior.
This new field of study is called neurogenetics and combines genetics, neuroscience and psychology, to learn how genes and neural processes interact with harsh environments — including dangerous neighborhoods and harsh parents — and with a child’s own levels of empathy and personality traits, to increase the risk of antisocial behavior.
Hyde studies how genes, experience and the brain work together to heighten or reduce the risks that normal childhood transgressions will develop into full-blown conduct disorders in adolescence and early adulthood.
“The lifetime prevalence of conduct disorder is around 10 percent, and even higher in males and low-income populations,” says Hyde.
“The total cost to society is enormous, since these behaviors are often chronic, lasting through adulthood.”
In one recent study, for example, Hyde and colleagues studied subjects with overreactive amygdala responses. The amygdala is an almond-shaped part of the brain’s primitive limbic system involved in processing fear and other visceral emotions.
It has been associated with impulsive, aggressive behavior, as well as anxiety disorders and depression.
“Previous research suggests that the amygdala becomes overreactive probably as a result of both genetics and experience,” says Hyde.
“And once the amygdala is overreactive, people tend to behave in an anxious, over-reactive way to things they see as a potential threat.
“Our study found that this tendency is moderated by a person’s environment, including the social support they get. If they’re not getting support from family, friends, neighbors, or professionals, then the link between the amygdala and anxious behavior is much stronger.”
In another study, Hyde and colleagues showed that kids who are impulsive are only at higher risk of engaging in antisocial behavior if they live in dangerous neighborhoods.
He also identified specific items within childhood behavior checklists that can be used as early as the age of three to identify kids who will likely have worse trajectories for anti-social behavior compared to other children who have similar behavior problems, such as throwing tantrums.
These items assess observable behaviors that include whether the child is cruel to animals, doesn’t seem to feel guilty after misbehaving, is sneaky, lies, is selfish or won’t share, and won’t change his or her behavior as a result of punishment.
“The results of this test aren’t really meaningful until age three or three-and-a-half,” says Hyde. “Before that, many of these behaviors are fairly common, and don’t predict anything. But after age three, if children are still behaving in these ways, their behavior is more likely to escalate in the following years rather than improve.”
There is good news, though. Kids who scored high on this test benefitted just as much as other kids from interventions, according to Hyde.
These interventions, often called parent management training, focus on giving parents better skills to manage child behavior problems, including training parents to spend more positive time with their kids, use time-outs instead of physical punishments and reward good behavior by giving out stickers.
“Parents need to know that intervention works, especially if it’s done early,” says Hyde. “They need to go for help if they see signs of trouble.
“Clinical psychologists, among other professionals, have empirically supported treatments that are quite effective for children, especially in this age period.”
Source: University of Michigan