Chronic trauma can inflict lasting damage to brain regions associated with fear and anxiety. Previous imaging studies of people with post-traumatic stress disorder, or PTSD, have shown that these brain regions can over-or under-react in response to stressful tasks, such as recalling a traumatic event or reacting to a photo of a threatening face. Now, researchers at NYU School of Medicine have explored for the first time what happens in the brains of combat veterans with PTSD in the absence of external triggers.
Their results, published in Neuroscience Letters, and presented today at the annual meeting of the American Psychiatry Association in San Francisco, show that the effects of trauma persist in certain brain regions even when combat veterans are not engaged in cognitive or emotional tasks, and face no immediate external threats. The findings shed light on which areas of the brain provoke traumatic symptoms and represent a critical step toward better diagnostics and treatments for PTSD.
A chronic condition that develops after trauma, PTSD can plague victims with disturbing memories, flashbacks, nightmares and emotional instability. Among the 1.7 million men and women who have served in the wars in Iraq and Afghanistan, an estimated 20% have PTSD. Research shows that suicide risk is higher in veterans with PTSD. Tragically, more soldiers committed suicide in 2012 than the number of soldiers who were killed in combat in Afghanistan that year.
“It is critical to have an objective test to confirm PTSD diagnosis as self reports can be unreliable,” says co-author Charles Marmar, MD, the Lucius N. Littauer Professor of Psychiatry and chair of NYU Langone’s Department of Psychiatry. Dr. Marmar, a nationally recognized expert on trauma and stress among veterans, heads The Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury at NYU Langone Medical Center.
The study, led by Xiaodan Yan, a research fellow at NYU School of Medicine, examined “spontaneous” or “resting” brain activity in 104 veterans of combat from the Iraq and Afghanistan wars using functional MRI, which measures blood-oxygen levels in the brain. The researchers found that spontaneous brain activity in the amygdala, a key structure in the brain’s “fear circuitry” that processes fearful and anxious emotions, was significantly higher in the 52 combat veterans with PTSD than in the 52 combat veterans without PTSD. The PTSD group also showed elevated brain activity in the anterior insula, a brain region that regulates sensitivity to pain and negative emotions.
Moreover, the PTSD group had lower activity in the precuneus, a structure tucked between the brain’s two hemispheres that helps integrate information from the past and future, especially when the mind is wandering or disengaged from active thought. Decreased activity in the precuneus correlates with more severe “re-experiencing” symptoms—that is, when victims re-experience trauma over and over again through flashbacks, nightmares and frightening thoughts.
One in five U.S. kids has a mental disorder; ADHD the most common: CDC
Up to 20 percent of children in the United States suffer from a mental disorder, and the number of kids diagnosed with one has been rising for more than a decade, according to a report released on Thursday by the U.S. Center for Disease Control and Prevention.
In the agency’s first-ever study of mental disorders among children aged 3 to 17, researchers found childhood mental illnesses affect up to one in five kids and cost $247 billion per year in medical bills, special education and juvenile justice.
Children with mental disorders - defined as “serious deviations from expected cognitive, social, and emotional development” - often have trouble learning in school, making friends, and building relationships later in life, the report said.
They are more likely to have other chronic health problems, such as asthma and diabetes, and are at risk for developing mental illnesses as adults.
“This is a deliberate effort by CDC to show mental health is a health issue. As with any health concern, the more attention we give to it, the better. It’s parents becoming aware of the facts and talking to a healthcare provider about how their child is learning, behaving, and playing with other kids,” Dr. Ruth Perou, the lead author of the study, told Reuters in an interview.
“What’s concerning is the number of families affected by these issues. But we can do something about this. Mental health problems are diagnosable, treatable and people can recover and lead full healthy lives,” Perou added.
The study cited data collected between 1994 and 2011 that showed the number of kids with mental disorders is growing. The study stopped short of concluding why, but suggested improvements in diagnoses as one possible explanation
“Changes in estimated prevalence over time might be associated with an actual change in prevalence, changes in case definition, changes in the public perception of mental disorders, or improvements in diagnosis, which might be associated with changes in policies and access to health care,” the study said.
Perou told Reuters more research was needed to determine the specific causes of mental disorders, and that greater awareness could lead to an uptick in diagnoses. A host of environmental factors, including chemical exposure and poverty, can also affect a child’s mental health, she said.
Lead, for example, is known to be “one of the biggest toxins to impact behavior and learning,” Perou said. Poor children are at a higher risk for developing certain conditions, according to the study.
The most prevalent mental health diagnosis, as reported by parents, was Attention Deficit/Hyperactivity Disorder (ADHD), which affects 6.8 percent of children. Also common were behavioral conduct problems (3.5 percent), anxiety, which consists mostly of fears and phobias (3 percent), depression (2.1 percent) and autism spectrum disorders (1.1 percent). Many of these disorders occur together, the report said.
Boys were found more likely to have most of the listed disorders except for depression and alcohol abuse, which affect more girls.
The study also noted that suicide, which can be precipitated by an untreated mental illness, was the second leading cause of death (after accidents) among children 12 to 17 years old.
The CDC report was based on multiple other studies that collected data and interviewed children and their guardians about their diagnoses, habits, behaviors and other factors.
Meditation for panic attacks.
*High five* Buddhism.
(He describes meditation amidst a panic attack where he “makes friends” with the panic - not avoiding it or telling it to leave - and this results in the panic going away. That is, mindful awareness of the panic with the intention of “befriending” it!)
Those of us who have been part of any eating disorder communities online know the power of technology in aiding treatment. I know for me, Livejournal’s ed_recovery community was pretty important when I was in my mid-teens. I’m friends with several people from that community even now (some have written for the blog, some I’ve met, some I meet every 1.5 years or so—which is impressive given that they live across the ocean).
I know many of you feel the same way. Support is crucial and sometimes online is the only place you can get it.
So, I’m pretty hopeful for the use of technology in treatment. Do I think it is going to replace face-to-face interventions? No. It shouldn’t. But given how many people are stuck waiting for beds, or waiting for a therapist, or waiting for whatever, this is a good alternative. Moreover, it might be helpful for groups of individuals who face increased stigma in seeking help (minorities, males, individuals in particular geographic regions).
Being held accountable for my actions was pretty important throughout treatment, and I think this is one thing that this kind of treatment can offer. We’ll see what happens in a few years.
|Epidemiological, cross-cultural, and longitudinal studies underscore the importance of the idealization of thinness and resulting weight concerns as psychosocial risk factors for eating disorders. Personality factors such as negative emotionality and perfectionism contribute to the development of eating disorders but may do so indirectly by increasing susceptibility to internalize the thin ideal or by influencing selection of peer environment. During adolescence, peers represent self-selected environments that influence risk. |
Keel PK, Forney KJ. Psychosocial risk factors for eating disorders. Int J Eat Disord. 2013 Jul;46(5):433-9
There are at least two responses to this article in the same issue of the International Journal of Eating Disorders. Must find a moment to read this.
People in the military who suffer more than one mild traumatic brain injury face a significantly higher risk of suicide, according to research by the National Center for Veterans Studies at the University of Utah.
A survey of 161 military personnel who were stationed in Iraq and evaluated for a possible traumatic brain injury – also known as TBI – showed that the risk for suicidal thoughts or behaviors increased not only in the short term, as measured during the past 12 months, but during the individual’s lifetime.
The risk of suicidal thoughts increased significantly with the number of TBIs, even when controlling for other psychological factors, the researchers say in a paper published online Wednesday, May 15 in JAMA Psychiatry, a specialty journal of the American Medical Association.
“Up to now, no one has been able to say if multiple TBIs, which are common among combat veterans, are associated with higher suicide risk or not,” says the study’s lead author, Craig J. Bryan, assistant professor of psychology at the University of Utah and associate director of the National Center for Veterans Studies. “This study suggests they are, and it provides valuable information for professionals treating wounded combat servicemen and women to help manage the risk of suicide.”
Results showed that one in five patients (21.7 percent) who had ever sustained more than one TBI reported suicidal ideation – thoughts about or preoccupation with suicide – at any time in the past. For patients who had received one TBI, 6.9 percent reported having suicidal thoughts, and zero percent for those with no TBIs. In evaluating the lifetime risk, patients were asked if they had ever experienced suicidal thoughts and behaviors up to the point they were assessed.
The increases were similar for suicidal thoughts during the previous year rather than at any time: 12 percent of those with multiple TBIs had entertained suicidal ideas during the past year, compared with 3.4 percent with one TBI and zero percent for no TBIs.
In this study, suicidal ideation was used as the indicator of suicide risk because too few patients reported a history of suicide plan or had made a suicide attempt for statistically valid conclusions to be made.
Researchers found that multiple TBIs also were associated with a significant increase in other psychological symptoms already tied to single traumatic head injuries, including depression, post-traumatic stress disorder or PTSD, and the severity of the concussive symptoms. However, only the increase in depression severity predicted an increased suicide risk.
“That head injury and resulting psychological effects increase the risk of suicide is not new,” says Bryan. “But knowing that repetitive TBIs may make patients even more vulnerable provides new insight for attending to military personnel over the long-term, particularly when they are experiencing added emotional distress in their lives.”
How the Study was Conducted
During a six-month period in 2009, 161 patients who received a suspected brain injury while on duty in Iraq were referred to an outpatient TBI clinic at a combat support hospital there. Patients were predominantly male, average age of 27, with 6.5 years of military service.
Diagnosis of traumatic brain injury was made by a clinical psychologist specifically trained in the assessment, diagnosis and management of the condition. Only patients with mild or no TBI completed all assessments; patients with moderate to severe TBI were immediately evacuated from Iraq.
TBI was confirmed if at least one clinical event was newly presented or worsened following the injury: loss of consciousness or memory, alteration of mental state, some neurological decline or brain damage.
Patients were divided into three groups based the total number of TBIs during their entire lives – zero, single TBI and two or more – the most recent of which was typically within the days immediately preceding their evaluation and inclusion in the study.
Each individual was also given surveys as part of his or her evaluation and treatment. Using standard evaluation tools, patients were surveyed about their symptoms of depression, PTSD and concussions, and their suicidal thoughts and behaviors.
“An important feature of the study is that by being on the ground in Iraq, we were able to compile a unique data set on active military personnel and head injury,” Bryan says. “We collected data on a large number of service members within two days of impact.”
At the same time, because the results of this study are based on a single clinical sample –active military in a war zone within days of the injury – the researchers note that caution is advised before assuming that the results from this particular group will apply to every other group. Studies with larger sample sizes and conducted over longer periods of time will be needed.
Why TBI is of Concern for Military Personnel
As defined by the Centers for Disease Control and Prevention, a traumatic brain injury is caused by a bump, blow or jolt to the head, or a penetrating head injury that disrupts the normal function of the brain. Effects can be mild to severe. The majority of TBIs that occur each year are concussions or other mild forms.
TBI is considered a “signature injury” of the Iraq and Afghanistan conflicts and is of particular concern because of the frequency of concussive injuries from explosions and other combat-related incidents. Estimated prevalence of TBI for those deployed in these two countries ranges from 8 percent to 20 percent, according to a 2008 study.
In addition, according to studies by the RAND Corp., suicide is the second-leading cause of death among U.S. military personnel, and the rate has risen steadily since the conflicts began in Iraq and Afghanistan. Prevalence of PTSD, depression and substance abuse have risen as well, especially among those in combat, and each has been shown to increase risk for suicidal behaviors.
“Being aware of the number of a patient’s head injuries and the interrelation with depression and other psychological symptoms may help us better understand, and thus moderate, the risk of suicide over time,” Bryan says. “Ultimately, we would like to know why people do not kill themselves. Despite facing similar issues and circumstances, some people recover. Understanding that is the real goal.”
Why Is Psychiatry’s New Manual So Much Like The Old One?
The American Psychiatric Association is about to release an updated version of its Diagnostic and Statistical Manual of Mental Disorders. The DSM helps mental health professionals decide who has problems such as depression, anxiety and schizophrenia.
Psychiatry’s new manual, DSM-5, has been nearly 20 years in the making. During that time, scientists have learned a lot about the brain. Yet despite some tweaks to categories such as autism and mood disorders, DSM-5 is remarkably similar to the version issued in 1994.
“There are lots of changes throughout the manual that reflect the research in the last 20 years,” says Michael First, a clinical psychiatrist at Columbia University who was involved in creating both DSM-IV and DSM-5. (The APA abandoned Roman numerals for the new manual.) “But because that kind of research hasn’t allowed for a paradigm shift, the DSM is not a paradigm shift either,” First says.
Specifically, DSM-5 will continue to use symptoms as the primary way to decide whether a person has a particular disorder. That may not sound odd until you consider what’s happened in other fields of medicine, like cardiology.
If you go to a hospital with chest pain these days, chances are you’ll get a diagnosis based on tests of the electrical activity in your heart, the enzymes in your blood, and the blood flow through your arteries. But if your problem is emotional pain, your diagnosis will probably be based on a conversation.
So why is psychiatry still so last-century? Scientists say it has to do with the nature of the brain itself.
The Hippo Problem
When psychiatrists began work on DSM-5, they expected to come up with a document that would signal a new era in mental health care, First says.
“We were hoping and imagining that research would advance at a pace that laboratory tests would have come out,” he says. “And here we are 20 years later and we still unfortunately rely primarily on symptoms to make our diagnoses.”
That’s not ideal, First says. Not for doctors. Not for patients. Not for scientists.
The problem is that the new DSM is still classifying mental disorders based on their surface appearance, not their underlying biology. And the history of science shows that appearances can be deceiving.
Take hippos, for example. Early naturalists thought hippos must be related to pigs. After all they look somewhat alike and have similar teeth. But fossils and genetic studies showed that hippos’ closest living relatives are actually dolphins and whales.
So to avoid the hippo problem, many areas of medicine have begun to look beneath the superficial appearance of an illness.
A New Kind Of Medicine
“For literally centuries, doctors have looked at diseases using signs and symptoms,” says Susan Desmond-Hellman, an oncologist who is chancellor of the University of California, San Francisco. So, she says, doctors would ask questions like, “Do you have a lump somewhere?”
But now, many scientists are concerned that this emphasis on the signs and symptoms of a disease “could be seen as holding us back,” Desmond-Hellman says. Instead, she’s been advocating something called “precision medicine,” which tries to classify diseases in a way that indicates what’s truly causing the problem.
A good example of this new approach is breast cancer, Desmond-Hellman says. “I’m a cancer doctor and had the incredible opportunity to work on revolutionizing how we treat breast cancer based on what’s in your DNA that’s signaling the breast cancer to grow,” she says. “And it’s a wonderful opportunity because if a patient has a breast cancer that’s driven by something in the genome, we can turn it off.”
This revolution happened in part because cancer researchers looked beyond the old way of classifying tumors according to simply what body part they appeared in, Desmond-Hellman says. And something similar needs to happen in mental health because, she says, “everything from autism to Alzheimer’s is classified in ways that clearly don’t work today.”
Desmond-Hellman adds that she’s not criticizing psychiatrists or psychologists for using the DSM. It’s still the best option because there still aren’t genetic tests or brain scans that offer a better way to classify patients with mental disorders.
Brain Research Looks Ahead
So why haven’t researchers developed simple lab tests for mental disorders?
“We’ve tried,” says Thomas Insel, director of the National Institute of Mental Health. “You know we’ve actually looked — using brain imaging, using various endocrine tests, looking at a range of other kinds of biomarkers. So far that has been found wanting.”
For example, researchers tried for many years to find a genetic test or a brain-scanning technique that could identify people with depression. That approach would make sense if scientists knew that all depression can be linked to the same underlying problem. But what if it can’t, Insel says. What if depression is like a fever?
“Some people who have a fever have a bacterial infection, some a viral infection, some an endocrine problem,” Insel says, “a whole range of reasons why that would be your presenting symptom and a whole range of different treatments that you need for each of those causes.”
So a few years ago, the NIMH began moving away from research based on categories defined only by symptoms. Instead, it’s pushing an approach it calls Research Domain Criteria that emphasizes basic functions in the brain. Researchers might get money to study circuits involved in fear, or so-called working memory.
This sort of research has the potential to uncover problems in the brain that will change the way mental disorders are classified, Insel says. “A biological thing that presents with depression in some people might present with psychosis or anxiety in others,” he says. “And so maybe what you’ll find is a problem that cuts across the current diagnostic categories.”
Insel says findings like that are years off. Maybe they’ll get here in time for the next version of the DSM. Maybe.
A Better Future?
Michael First, the psychiatrist who spent much of his career working on the DSM, says he’s learned to be cautious about anticipating major advances in any problem that affects the brain.
Back in the 1990s, when he was writing a guidebook to DSM-IV, First says, he made an unfortunate prediction about Alzheimer’s. “I stuck my neck out,” he says. “We said that by the time DSM-5 comes out, Alzheimer’s will be the first diagnosis that has a laboratory test.”
That hasn’t happened. Even though scientists have learned a huge amount about the plaques and tangles associated with Alzheimer’s and even though high-tech scans can reveal ever more subtle changes in the brains of people with the disease, there’s still no lab test that’s good enough to diagnose Alzheimer’s.
First says migraine headaches are another brain problem still waiting for a lab test. “If you have a headache and you go to a neurologist, even though they might run some blood tests, the actual diagnosis of a migraine vs. a cluster headache depends on the description of the symptoms,” he says. “So psychiatry is not unique.”
In fact, almost every specialty that deals with the brain has run into the same roadblocks facing psychiatrists. “The brain is very, very complicated and it really hasn’t yielded its secrets yet,” First says.
And that, he says, is the primary reason mental health isn’t more like cardiology or oncology, why psychiatrists and psychologists still rely on symptoms, rather than lab tests. The human brain is the most complicated thing in the universe. It has nearly 100 billion neurons and many trillions of connections, and its complex wiring changes all the time.
But the daunting complexity of the brain is no reason to give up on the DSM or the ability of mental health professionals to treat mental disorders, First says. “When people walk into our offices they come for help, not some explanation of the neurobiology of what’s going on,” he says. “They want some relief of suffering and the DSM remains the most valuable tool for psychiatrists to be able to do that.”
I can’t imagine we will ever be able to diagnose mental health disorders based on any sort of brain imaging or blood testing or what have you… they’re just such multifaceted issues. It doesn’t seem right to me. But what do I know, I guess.
I personally think that a death is a death. If shed died from natural causes, it would be included. Why is suicide different?
I dont think people should judge him as weird because his mom committed suicide. Definitely perpetuates stigma.
^^ That, too!
This was posted on the Active Minds, Inc. page on Facebook:
Is there a law against or something so the media can’t post in articles that someone died by suicide? My friend’s ex wife took her life Monday, and the local news paper PUBLISHED ruled suicide. Now, her son is 12, goes to school, can read! people already have different views on suicide, so why, publish “suicide” in the paper? His friends could read it and think weird things about him, which won’t help his grieving process.
What are your thoughts? Does omitting suicide as the cause of death perpetuate the stigma or appropriately allow the family privacy as they grieve?
The breakthrough technique that allowed scientists to obtain one-of-a-kind, colorful images of the myriad connections in the brain and nervous system is about to get a significant upgrade.
A group of Harvard researchers, led by Joshua Sanes, the Jeff C. Tarr Professor of Molecular and Cellular Biology and Paul J. Finnegan Family Director, Center for Brain Science, and Jeff Lichtman, the Jeremy R. Knowles Professor of Molecular and Cellular Biology and Santíago Ramón y Cajal Professor of Arts and Sciences, has made a host of technical improvements in the “Brainbow” imaging technique. Their work is described in a May 5 paper in Nature Methods.
First described in 2007, the system combines three fluorescent proteins — one red, one blue, and one green — to label different cells with as many as 90 colors. By studying the resulting images, researchers were able to begin to understand how the millions of neurons in the brain are connected.
“‘Brainbow’ generated beautiful images of a kind we had never been able to obtain before, but it was difficult in some ways,” said Sanes, who also serves as director of the Center for Brain Science.
“These modifications aim to overcome some of the more problematic features of the original genetic constructs,” Lichtman said. “Lead author Dawen Cai, a research associate in our labs, worked hard and creatively to find ways to make the ‘Brainbow’ colors brighter, more variable, and useable in situations where the original gene constructs were hard to implement. Our first look at these animals suggests that these improvements are fantastic.”
Among the challenges faced by researchers using the original method, Sanes said, was the chance that certain colored proteins would bleach out faster than others.
“If one color bleaches faster than the others, you start with a ‘Brainbow,’ but by the time you’re done imaging, you might just have a ‘blue-bow,’ because the red and yellow bleach too fast,” he said.
Sanes said that some colors also were too dim, causing problems in the imaging process, while in other cases the protein didn’t fill the whole neuron evenly enough, or there was an overabundance of a certain color in an image.
“What we decided to do was to make the next generation of ‘Brainbow,’” Sanes said. “We systematically set out to look at these problems. We looked at a whole range of fluorescent proteins to find the ones that were brightest and wouldn’t bleach as much, and we developed new transgenic methods to avoid the predominance of a particular color.”
The researchers also explored new ways to create “Brainbow” images, including using viruses to introduce fluorescent proteins into cells.
The advantage of the new technique, Sanes said, is it offers researchers the chance to target certain parts of the brain and better understand how neurons radiate out to connect with other brain regions. Ultimately, he said, he hopes that other researchers are able to apply the techniques outlined in the paper in the same way that they expanded on the first “Brainbow” method.
“People adapted the method to study a number of interesting questions in other tissues to examine cellular relationships and cell lineages in kidney and skin cells,” he said. “It was also used to examine the nervous system in animals like zebrafish and C. elegans. With these new tools, I think we’ve taken the next step.”
In terms of medicated vs not, who is the “real” you? have you struggled with taking medication because you feel it alters who you are?
“Taking medication to calm down and be normal just assures me if I do change it would be an artificial me, and that I’ll always be this ugly thing deep down”,…
While I understand the idea behind it, I would like to suggest that the question is actually asking a different type of underlying question. When people ask this question, and after reading some of the comments, I think what this question is really asking about is whether being medicated is the type of person you want to be AND the type of person you need to be.
One important thing this calls into question is what constitutes the “real me” or a sense of self in the first place. Often, these questions imply that there is some baseline or “real” self, but beyond biological or developmental dispositions we are “stuck” with, I don’t really think there is a baseline. I think we construct “me” on a daily basis, from moment to moment. In forty years, I’ll still be me, but a different kind of me. Some things may change, some things may stay constant, but my point is that we define and construct “me” and our sense of self all the time. And that construction is often guided by who we want to be and who we need to be. Sometimes, we change our mind later and sometimes we realize it wasn’t the best choice, but it is still who we thought was the “real” me at the time. For people who have gone on and off their meds, they can probably tell you that their sense of a “real” self has changed over time.
So, in regards to this question, I feel that it can be answered differently at different times in your life. Today, medication is what I need. In forty years, it may not be. Also, why can’t it be both? I still experience some of the things on medication that I also experienced when not. I don’t think taking medication should or does wipe out everything else. Sometimes it may feel like it, but I think for most people you still possess some of the same qualities when not on meds.
So again, I understand why we want to ask these questions. But, I think that they aren’t asking the right question and don’t depict the constantly changing nuances of our everyday life. I feel a more concrete and non-philosophical question would be to ask, “Who do you want to be and who do you need to be?” Instead of soul searching, this propels us into action-oriented thinking, thus owning ourselves and the role our mental illness plays in or life (because it’s still only a part of us, regardless how small or large).
I think this is so well-stated.