smiliu:

[Article of Interest] National Institute of Mental Health Abandoning the DSM
by Vaughan Bell

In a potentially seismic move, the National Institute of Mental Health – the world’s biggest mental health research funder, has announced only two weeks before the launch of the DSM-5 diagnostic manual that it will be “re-orienting its research away from DSM categories”.
In the announcement, NIMH Director Thomas Insel says the DSM lacks validity and that “patients with mental disorders deserve better”.
This is something that will make very uncomfortable reading for the American Psychiatric Association as they trumpet what they claim is the ‘future of psychiatric diagnosis’ only two weeks before it hits the shelves.
As a result the NIMH will now be preferentially funding research that does not stick to DSM categories:
Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system. What does this mean for applicants? Clinical trials might study all patients in a mood clinic rather than those meeting strict major depressive disorder criteria. Studies of biomarkers for “depression” might begin by looking across many disorders with anhedonia or emotional appraisal bias or psychomotor retardation to understand the circuitry underlying these symptoms. What does this mean for patients? We are committed to new and better treatments, but we feel this will only happen by developing a more precise diagnostic system.
As an alternative approach, Insel suggests the Research Domain Criteria (RDoC) project, which aims to uncover what it sees as the ‘component parts’ of psychological dysregulation by understanding difficulties in terms of cognitive, neural and genetic differences.
For example, difficulties with regulating the arousal system might be equally as involved in generating anxiety in PTSD as generating manic states in bipolar disorder.
Of course, this ‘component part’ approach is already a large part of mental health research but the RDoC project aims to combine this into a system that allows these to be mapped out and integrated.
It’s worth saying that this won’t be changing how psychiatrists treat their patients any time soon. DSM-style disorders will still be the order of the day, not least because a great deal of the evidence for the effectiveness of medication is based on giving people standard diagnoses.
It is also true to say that RDoC is currently little more than a plan at the moment – a bit like the Mars mission: you can see how it would be feasible but actually getting there seems a long way off. In fact, until now, the RDoC project has largely been considered to be an experimental project in thinking up alternative approaches.
The project was partly thought to be radical because it has many similarities to the approach taken by scientific critics of mainstream psychiatry who have argued for a symptom-based approach to understanding mental health difficulties that has often been rejected by the ‘diagnoses represent distinct diseases’ camp.
The NIMH has often been one of the most staunch supporters of the latter view, so the fact that it has put the RDoC front and centre is not only a slap in the face for the American Psychiatric Association and the DSM, it also heralds a massive change in how we might think of mental disorders in decades to come.

neurosciencestuff:

Implanted device predicts oncoming seizures in those with epilepsy

A new device may offer hope to people with epilepsy as the technology could predict the onset of seizures in adults who have the condition and can’t be treated with medication, according to Australian scientists.

The small device is implanted in the brain. Researchers at the University of Melbourne said their proof-of-concept study found that it can successfully detect brain activity that would lead to episodes of seizures.

“Knowing when a seizure might happen could dramatically improve the quality of life and independence of people with epilepsy and potentially allow them to avoid dangerous situations, such as driving or swimming, or to take drugs to stop the seizures before they start,” Dr. Mark Cook said.

“The first thing of this was to give people back some independence. If they know when a seizure is going to happen, they can arrange their lives to be better, make themselves safer, go about work and so on in a much more comfortable and relaxed way.”

His complete findings were published Thursday night in the prestigious journal, Lancet Neurology.

Epilepsy is a physical condition marked by sudden, brief changes in the brain’s functioning.

The unusual activity in the brain causes patients to have recurring, unprovoked seizures.

There is a wide spectrum when identifying a seizure, from convulsions on one end to tuning out for just a few seconds before returning to regular activities.

Device monitors abnormal brain activity in patients

In the study, 15 people with focal epilepsy between the ages of 20 and 62 had the device implanted between the skull and brain surface.

The study participants typically experienced between two and 12 seizures per month. Although most cases of epilepsy can be treated with medication, theirs was not responsive to at least two drug therapies.

The device, developed by Seattle-based company NeuroVista, monitors electrical activity in the brain.

Once abnormal electrical activity is flagged, the device sends a message to a second device implanted under the skin of the chest similar to a pacemaker.

The information then makes its way to a wireless, hand-held device that calculates the likelihood of a seizure.

Three coloured lights – red, white or blue – warn users of the probability of encountering a seizure.

The researchers found that the system was right about “high warning” of seizures more than 65 per cent of the time and in about 11 of the 15 subjects.

Eight of the patients kept the device activated for about four months – the accuracy ranged from 56 to 100 per cent.

However, three patients had serious side effects, with two needing the device to be removed.

Cook said the findings are promising. If they’re replicated in larger, longer studies, the technology could even offer insight into how to prevent seizures using fast-acting drugs or brain stimulation to stifle a seizure.

ikenbot:

How Abuse Changes a Child’s Brain

Image: D. Sharon Pruitt/Flickr

The brains of children raised in violent families resemble the brains of soldiers exposed to combat, psychologists say.

They’re primed to perceive threat and anticipate pain, adaptations that may be helpful in abusive environments but produce long-term problems with stress and anxiety.

“For them to detect early cues that might signal danger is adaptive. It allows them to react, to try and avoid the danger,” said psychologist Eamon McCrory of University College London. However, “a very similar neural signature characterizes quite a few anxiety disorders.”

In a study published Dec. 5 in Current Biology, McCrory’s team used functional magnetic resonance imaging, or fMRI, to measure blood flows in the brains of 43 children exposed to violence at home as they looked at pictures of sad or angry faces.

Previous studies have shown that abuse affects kids’ brains; as they grow up, abused children become adults with high levels of aggression, anxiety, depression and other behavioral problems. But according to McCrory, the new study is the first to use fMRI to study the form of those changes.

“Understanding the neural mechanisms might give us clues as to how someone’s future might be shaped by their experience,” McCrory said.

His team compared fMRIs from abused children to those of 23 non-abused but demographically similar children from a control group. In the abused children, angry faces provoked distinct activation patterns in their anterior insula and right amygdala, parts of the brain involved in processing threat and pain. Similar patterns have been measured in soldiers who’ve seen combat.

Another recent study found that depression in people who were abused as children is especially difficult to treat. McCrory hopes future work will give a more complete picture of abuse’s neurological effects — and, perhaps, the effects of interventions that help children heal.

“Can children change in response to an act of intervention? To a better home environment? We’re quite optimistic that’s the case, that this is reversible. But that’s something we need to test,” McCrory said.

stayspectacular:

mildlyamused:

An artist with Alzheimer’s drawing self-portraits.

Terrible, frightening disease.

this is one of the saddest things ever.

neurosciencestuff:

Single gene might explain dramatic differences among people with schizophrenia

Some of the dramatic differences seen among patients with schizophrenia may be explained by a single gene that regulates a group of other schizophrenia risk genes. These findings appear in a new imaging-genetics study from the Centre for Addiction and Mental Health (CAMH).

The study revealed that people with schizophrenia who had a particular version of the microRNA-137 gene (or MIR137), tended to develop the illness at a younger age and had distinct brain features – both associated with poorer outcomes – compared to patients who did not have this version. This work, led by Drs. Aristotle Voineskos and James Kennedy, appears in the latest issue of Molecular Psychiatry.

Treating schizophrenia is particularly challenging as the illness can vary from patient to patient. Some individuals stay hospitalized for years, while others respond well to treatment.

“What’s exciting about this study is that we could have a legitimate answer as to why some of these differences occur,” explained Dr. Voineskos, a clinician-scientist in CAMH’s Campbell Family Mental Health Research Institute. “In the future, we might have the capability of using this gene to tell us about prognosis and how a person might respond to treatment.”

“Drs. Voineskos and Kennedy’s findings are very important as they provide new insights into the genetic bases of this condition that affects thousands of Canadians and their families,” said Dr. Anthony Phillips, Scientific Director at the Canadian Institutes of Health Research Institute of Neurosciences, Mental Health and Addiction.

Also, until now, sex has been the strongest predictor of the age at which schizophrenia develops in individuals. Typically, women tend to develop the illness a few years later than men, and experience a milder form of the disease.

“We showed that this gene has a bigger effect on age-at-onset than one’s gender has,” said Dr. Voineskos, who heads the Kimel Family Translational Imaging-Genetics Research Laboratory at CAMH. “This may be a paradigm shift for the field.”

The researchers studied MIR137 — a gene involved in turning on and off other schizophrenia-related genes — in 510 individuals living with schizophrenia. The scientists found that patients with a specific version of the gene tended to develop the illness at a younger age, around 20.8 years of age, compared to 23.4 years of age among those without this version.

“Although three years of difference in age-at-onset may not seem large, those years are important in the final development of brain circuits in the young adult,” said Dr. Kennedy, Director of CAMH’s Neuroscience Research Department. “This can have major impact on disease outcome.”

In a separate part of the study involving 213 people, the researchers used MRI and diffusion tensor-magnetic resonance brain imaging (DT-MRI). They found that individuals who had the particular gene version tended to have unique brain features. These features included a smaller hippocampus, which is a brain structure involved in memory, and larger lateral ventricles, which are fluid-filled structures associated with disease outcome. As well, these patients tended to have more impairment in white matter tracts, which are structures connecting brain regions, and serving as the information highways of the brain.

Developing tests that screen for versions of this gene could be helpful in treating patients earlier and more effectively.

“We’re hoping that in the near future we can use this combination of genetics and brain imaging to predict how severe a version of illness someone might have,” said Dr. Voineskos. “This would allow us to plan earlier for specific treatments and clinical service delivery and pursue more personalized treatment options right from the start.”

(Image: Akelei van Dam)

smiliu:

[Article of Interest] I’m Elyn Saks and this Is What It’s Like to Live with Schizophrenia

By George Dvosky

Elyn Saks first started noticing that something was wrong when she was 16. One day, and without reason, she suddenly left her classroom and started walking home. It turned into an agonizing journey in which she believed all the houses in her neighborhood were transmitting hostile and insulting messages directly into her brain. Five years later, while attending law school at Oxford, she experienced her first complete schizophrenic break. Saks struggled over the course of the next decade, but she came through thanks to medication, therapy, and the support of friends and family.

Excerpt:

• Often Misunderstood

Schizophrenia as a health condition is as neglected as it’s misunderstood. People tend to get squeamish when it comes to mental illness, convincing themselves that it’s not a wide scale problem, or that people who suffer from it are lost causes. At the same time, many people cling to outdated notions about the disorder.

Indeed, schizophrenia is not as rare as some people think. It has been estimated that anywhere from 0.3 to 0.7 percent of the population is afflicted with it. For a country like the United States, that’s anywhere from 940,000 to 2,200,000 people. And the costs are enormous, estimated at $62.7 billion per year in the U.S. alone. Yet, schizophrenia receives only a small fraction of the amount of medical research dollars that go into other serious diseases and disorders.

It’s also commonly mistaken for multiple personality disorder, what’s now referred to as dissociative identity disorder (DID). These two conditions are distinct, though some crossover exists; DID patients sometimes exhibit psychotic symptoms. Also, both DID and schizophrenia can be triggered by traumatic experiences. But that’s where the similarities end.

Another common misconception about schizophrenia is that people who suffer from it are extremely violent.

“And that’s just not true,” says Saks. “Most people with schizophrenia are less violent, but are more likely to be victimized.” The big, violent folks, added Saks, tend to be teenage males and substance abusers.

There’s also a misconception that all people with schizophrenia can’t hold down a job, and that they lose the ability to work in any kind of meaningful way. Or that they can’t live independently, that they need some kind of supervised living arrangement.

Like many other psychological disorders, schizophrenia follows along a spectrum in terms of its severity. While many people can become incapacitated by their symptoms, Saks argues that most of them could benefit from drugs and therapy.

And indeed, Saks is convinced that there are more “high functioning” people with schizophrenia than is typically assumed. To that end, she, along with her colleagues at UCLA and USC, designed a study to recruit high functioning people with schizophrenia in the LA area. Specifically, they were looking to study professionals, a group that included MDs, PhD candidates, teachers, CEOs, and full-time students.

“I mean, we got 20 subjects fairly quickly,” she told me, “I started to suspect that I wasn’t unique, that there were many other people like me. It would interesting to know what the stats are on how many people with schizophrenia are so-called “high functioning” professionals.”

• More than Meds

Moreover, Saks is convinced that, with proper resources, nearly everyone can live up to their potential — regardless of their situation or status.

“There are going to be some people who you do everything for and they still won’t be able to thrive,” she says, “But I think many more people can do better than we give them credit for — but instead, we prematurely tell people to lower their expectations.”

Indeed, antipsychotic medications have revolutionized the treatment of schizophrenia — and they work startling well. “A lot of people get on medication and they completely recover and never require therapy,” says Saks. But there are some people who don’t respond to medication — and that, she argues, is where therapy and social support could potentially help.

“The best evidence with major mental illness shows that the most effective strategy is to use a combination of meds and a therapy for choice,” says Saks. “For me, I know I need the therapy and the medication. I need both of them. If one of them were to go away I would probably be really compensated.”

Saks is currently in psychoanalytic treatment, where she attends sessions five days a week. And by doing so, she’s going against the grain; conventional wisdom says psychoanalytic treatment shouldn’t work for people with psychosis. But she’s convinced it’s helping.

Saks told me about several aspects of psychoanalytic treatment that have been tremendously beneficial for her — and they’re not typical things that psychoanalysts do.

For example, because stress is particularly bad for psychiatric illnesses, Saks has been taught to identify her stressors and avoid them. Or cope with them at the very least. She has also learned to bolster her “observing ego” — that part of her brain which allows her to step back and observe her mind, feelings, and thoughts in order to understand them and not get swept up.

“It’s also a place where you can bring your thoughts,” she says. “A lot of therapists have a rule where their patients cannot articulate their delusions or hallucinations — but to me you need to have a place where you can do that, where it’s safe. It’s sort of like a steam valve. I don’t have to do it in my outside world, I have a place where I can do it in therapy.”

Another important thing, says Saks is insight.

“People have different theories about psychotic symptoms,” she says. “Some people think they’re just the random firing of neurons that don’t have any meaning. But I think they have meaning and that they tell you some truth about your psychological reality. So, when I say I’ve killed hundreds of thousands of people, it’s really an archaic way of saying I feel like a very bad person. But even though it’s meaningful in this sense, it doesn’t help patients in the moment of the psychotic symptoms that they interpret.”

Saks believes that extreme and exaggerated ideations are a defense mechanism — which in some circumstances can make a person feel better or safe.

Saks closed our conversation by noting that, outside of medications and drugs, it’s people who can make the greatest impact.

“It’s so important to have a benign, smart, caring, non-judgmental person that accepts you — not only for the good — but for also the bad and the ugly,” she said, “That is incredibly empowering.”