Helping Patients Get Over The Stigma Of Mental Illness

Stigma refers to the condition in which someone judges you depending on any particular personal trait. The sad part is that most of the people who suffer from mental illness face such a stigma quite commonly. Stigma of mental illness can be both direct and obvious, for instance, when someone comments negatively on your mental condition or treatment; or subtle, such as a person assuming that you might be violent or unstable due to an underlying health condition. Some patients may even judge themselves.

The most common detrimental effects of stigma include:

• Not being understood by friends, family, colleagues or other people around you.
• Discrimination at school or work or in the society.
• Problems in finding housing opportunities.
• Harassment, bullying, or physical violence.
• Health insurance which doesn't offer coverage for mental illnesses.
• Having a belief that you will never succeed in any challenge and that you are incapable of improving your condition.

Ways to Help a Patient Cope Up with Stigma

Read on to find out the ways in which you can help a patient of mental illness cope up with the stigma related to the condition.

1. Get the right treatment for them: Most of the mental patients are reluctant to admit that they suffer from any kind of medical condition for which they need treatment. Help them to overcome their fear of being 'labeled' as a mental patient, which often prevent them from getting help. Treatment of the condition can be extremely helpful as it can help in identifying the root of the problem and in reducing symptoms which often hinder one's personal life or work.

2. Don't allow the stigma to develop shame and self-doubt in the mental patient. It is not necessary that stigma will always come from someone else. Some people believe that their connection is being caused due to their own personal weakness. Taking the help of a psychologist, encouraging interaction with other and educating them about their mental condition will help them to overcome self-judgment and gain self-esteem.

3. Encourage them to joint a local support group. Few groups like National Alliance for Mental Illness offer programs to help decrease stigma by educating mental patients, their family members as well as general public about the same.

4. In case your child is a patient of mental illness which has a negative impact of his / her learning abilities, try to find help through him / her school by taking the help of teachers and administrators and try to develop the best possible approach to deal with the problem.

People's judgment of mental patients usually stems due to a lack of understanding on the subject. Helping the patient to accept their condition, finding out the best ways to treat the problem, getting support from others, as well as educating others about the same can go a long way in reducing the stigma faced by patients of mental illness.

Kaye Dennan is the author of an ebook 'Carer Coping Strategies.' Kaye has been a carer for 10 years and has been a Carers' Support group facilitator for 3 years. To read more about mental health carer's coping strategies or for more insight into mental health carer problems visit http://schizophrenia-carers.com/

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COPD patients with sense of humor feel better, but laughter may be bad for lungs

ScienceDaily (Aug. 2, 2011) — Having a sense of humor is associated with improved emotional functioning and an enhanced quality of life among patients with a chronic lung illness, but the actual act of laughing out loud can reduce lung function, at least in the short term, research suggests.

The study evaluated humor and laughter in patients with chronic obstructive pulmonary disease, or COPD. Participants who exhibited a greater sense of humor were more likely to report fewer symptoms of depression and anxiety and better quality of life, and tended to report that they had experienced fewer respiratory illnesses in the month before the study.

But patients who watched a 30-minute comedy video and laughed during the viewing had lower pulmonary function afterward than did patients who watched a home-repair video that did not prompt laughter.

COPD is a chronic, progressive disorder characterized by difficulty breathing, and especially in expelling air from the lungs. It is the fourth-leading cause of death in the United States, affecting more than 12 million people, according to the Centers for Disease Control and Prevention. COPD patients are at increased risk of experiencing depression, anxiety, a diminished quality of life and frequent respiratory illnesses.

The pattern of findings in this research suggests that appreciating and perceiving humor may have a different effect than laughing aloud for patients with moderate to severe COPD, researchers say.

"This study shows that humor is really more complex than people make it out to be," said Charles Emery, professor of psychology at Ohio State University and senior author of the study. "Yes, humor definitely has benefits, but the behaviors associated with humor in fact may not be good for all people all the time -- which is a useful thing to know.

"Because these patients are at risk for depression and anxiety, one implication of this study would be that encouraging or even teaching people to use humor as a way of coping may actually be a novel way of enhancing their well-being."

The research is published in the current issue of the journal Heart & Lung.

Kim Lebowitz Feingold, lead author of the study, performed the research for her psychology Ph.D. dissertation at Ohio State. Now director of Cardiac Behavioral Medicine at the Bluhm Cardiovascular Institute of Northwestern Memorial Hospital, Lebowitz Feingold said the project grew from her interest in the field of positive psychology.

"We wanted to look at positive attributes or traits associated with improved physical or emotional health. I've long been fascinated with the idea that laughter and a sense of humor can be positive for well-being," she said.

Previous research had suggested that humor is beneficial to healthy adults because it can improve mood and strengthen immune function. Laughter also had been characterized as a behavior that may help expel stale air from the lungs. The researchers sought to determine whether the benefits of humor and laughter could extend to people who suffer from COPD.

"We know the negative emotional consequences of COPD. So I thought it was an ideal condition to serve as the focus of an examination of the potential benefits of humor and laughter," said Lebowitz Feingold, also an assistant professor of psychiatry and surgery at Northwestern University.

Forty-six COPD patients participated in the sense of humor portion of the study, and of those, 22 participated in the portion of the study that the researchers called "laughter induction."

All participating patients completed a number of questionnaires to assess their sense of humor, psychological functioning and health-related quality of life, as well as a brief interview about recent infectious illnesses. The assessments included the Coping Humor Scale, which measures the degree to which someone uses humor to cope with stress, and the Situational Humor Response Questionnaire, which counts the frequency of smiles, laughter and other so-called mirthful behaviors in a variety of situations. Measures of depression and anxiety symptoms were used to evaluate psychological functioning.

In the laughter induction, patients completed pulmonary function tests, and reported their mood and the severity of their shortness of breath symptoms immediately before and after watching a 30-minute video. After being randomly assigned to either a neutral or humor condition, participants watched either a neutral instructional video or their selection of one of three comedy options: Abbott and Costello, Bill Cosby or a segment of funny home videos.

As expected, the COPD patients reported more impaired psychological functioning, lower quality of life and above-average anxiety in their daily lives compared to national data on these symptoms in healthy adults. Patients also had reported an average of five sick days on which they experienced infectious illness symptoms in the previous four weeks.

But on average, the patients also reported that they used a sense of humor in their daily lives. Out of a possible score of 24 on the Coping Humor Scale, this patient sample's average score was 19.3. As a group, they were less likely to report use of mirthful behaviors to express humor, scoring 56.6 out of a possible 105 on the Situational Humor Response Questionnaire.

An analysis of association between the patients' sense of humor and well-being measures suggested that the higher their score on the sense of humor scales, the lower were their symptoms of depression and anxiety. A sense of humor was significantly associated with enhanced psychological functioning and better quality of life. And though the relationship was not as strong, a higher sense of humor score also was linked to fewer recent sick days.

Emery noted that because of the nature of the study, the researchers can't be certain which came first -- the sense of humor or the better well-being.

"Is it that people with a greater use of humor have better well-being or is it that better well-being is leading to a better sense of humor? There are limitations to the data," said Emery, also an investigator in Ohio State's Institute for Behavioral Medicine Research. "But we know that the humor and higher quality of life are associated in those people."

When it came to laughter, however, the results were a surprise. Patients watching comedy videos did laugh more than patients who watched instructional videos, as expected. But follow-up pulmonary tests showed that those participants who laughed also had more air trapped in their lungs afterwards, a sign of reduced lung function.

"During laughter, we're expiring more air than we're inhaling so it's a potential way of ridding our lungs of stale air. COPD is characterized by this increased air trapping, so our hypothesis was that laughter would reduce some of that trapped air," Lebowitz Feingold said. "But in hindsight, the findings make sense. With laughter, people also are introducing an increased amount of air into their lungs compared with a normal breath. These patients have trouble getting the air out, so they are taking in more air with laughter, but they cannot easily expire that air, leaving them with increased trapped air following laughter."

She noted, too, that the study measured only the acute response to laughter.

"We can't tell if this effect is cumulative, how long it might last, or whether it has any impact on physical health or pulmonary function long-term," she said.

Co-authors of the study include Sooyeon Suh of the Department of Psychology and Philip Diaz of the Department of Internal Medicine, both at Ohio State.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Ohio State University.

Journal Reference:

Kim R. Lebowitz, Sooyeon Suh, Philip T. Diaz and Charles F. Emery. Effects of humor and laughter on psychological functioning, quality of life, health status, and pulmonary functioning among patients with chronic obstructive pulmonary disease: A preliminary investigation. Heart & Lung: The Journal of Acute and Critical Care, Volume 40, Issue 4, July-August 2011, Pages 310-319 DOI: 10.1016/j.hrtlng.2010.07.010

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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Spiritual retreat can lower depression, raise hope in heart patients

ScienceDaily (Aug. 1, 2011) — Attending a non-denominational spiritual retreat can help patients with severe heart trouble feel less depressed and more hopeful about the future, a University of Michigan Health System study has found.

Heart patients who participated in a four-day retreat that included techniques such as meditation, guided imagery, drumming, journal writing and outdoor activities saw immediate improvement in tests measuring depression and hopefulness. Those improvements persisted at three- and six-month follow-up measurements.

The study was the first randomized clinical trial to demonstrate an intervention that raises hope in patients with acute coronary syndrome, a condition that includes chest pain and heart attack. Previous research has shown that hope and its opposite, hopelessness, have an impact on how patients face uncertain futures.

"The study shows that a spiritual retreat like the Medicine for the Earth program can jumpstart and help to maintain a return to psycho-spiritual well-being," says study lead author Sara Warber, M.D., associate professor of family medicine at the U-M Medical School and director of U-M's Integrative Medicine program. "These types of interventions may be of particular interest to patients who do not want to take antidepressants for the depression symptoms that often accompany coronary heart disease and heart attack."

The findings were published in the July issue of Explore: the Journal of Science and Healing.

The retreat group was compared to two other groups: one received standard cardiac care and the other participated in a lifestyle change retreat run by the U-M Cardiovascular Center that focused on nutrition, physical exercise and stress management.

The spiritual retreat portion of the study was conducted at the Windrise Retreat Center in Metamora, Michigan, about 50 miles north of Detroit. In the Medicine for the Earth program, participants are encouraged to see themselves as part of an interconnected web of life. The approach is founded on the work of co-author Sandra Ingerman, M.A., who wrote the book Medicine for the Earth: How to Transform Personal and Environmental Toxins, which emphasizes principles of love, harmony, beauty, unity and peace.

The study used a number of standard mental and physical benchmarks to assess the success of the program.

The spiritual retreat group went from a baseline score of 12 on the Beck Depression Inventory, indicating mild to moderate depression, to an improved score of 6 immediately afterward, a 50-percent reduction. Their scores remained that low half a year later. The lifestyle group saw their scores drop from 11 to 7 and remain there. The control group's score started at 8 and went down to 6.

Participants also showed marked improvement in their scores on a test measuring hope. Scores on the State Hope Scale can range from 6 to 48, with higher scores indicating greater hope. All three study groups started with average scores between 34 and 36. After the spiritual retreat, participants' average scores rose and stayed at 40 or above, while the other two groups' averages remained significantly lower, ranging from 35 to 38, three and six months later.

"Our work adds an important spiritual voice to the current discussion of the importance of psychological well-being for patients facing serious medical issues, such as acute coronary artery disease," Warber says.

Citation: "Healing the Heart: A Randomized Pilot Study of a Spiritual Retreat for Depression in Acute Coronary Syndrome Patients," Explore: The Journal of Science and Healing, July 2011.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Michigan Health System, via EurekAlert!, a service of AAAS.

Journal Reference:

Sara Warber et al. Healing the Heart: A Randomized Pilot Study of a Spiritual Retreat for Depression in Acute Coronary Syndrome Patients. Explore: the Journal of Science and Healing, 2011

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Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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To help doctors and patients, researchers are developing a 'vocabulary of pain'

ScienceDaily (July 27, 2011) — All over the world, patients with chronic pain struggle to express how they feel to the doctors and health-care providers who are trying to understand and treat them.

Now, a University at Buffalo psychiatrist is attempting to help patients suffering from chronic pain and their doctors by drawing on ontology, the branch of philosophy concerned with the nature of being or existence.

The research will be discussed during a tutorial he will give at the International Conference on Biomedical Ontology, sponsored by UB, that will be held in Buffalo July 26-30.

"Pain research is very difficult because nothing allows the physician to see the patient's pain directly," says Werner Ceusters, MD, professor of psychiatry in UB's School of Medicine and Biomedical Sciences, and principal investigator on a new National Institutes of Health grant, An Ontology for Pain and Related Disability, Mental Health and Quality of Life.

"The patient has to describe what he or she is feeling."

That is a serious shortcoming, Ceusters says, because each patient's subjective experience of pain is different. Descriptions of pain therefore lack the precision and specificity that is taken for granted with other disorders, where biomarkers or physiological indicators reveal what health-care providers need in order to assess the severity of a particular disorder.

"If we want to more effectively help people suffering from chronic pain, we need to study a population that is consistent, patients who have features in common," Ceusters says. "The problem with pain is, it's very hard to build up a group with the same sort of pain. People don't have the same vocabulary or linguistic capabilities or even the same cultural backgrounds. It's something pain researchers have struggled with for decades," Ceusters says. "We need to develop a vocabulary of pain."

That's where ontology comes in.

"The philosophical definition of ontology is the study of things that exist and how they relate to each other," says Ceusters, who also is director of the Ontology Research Group of UB's New York State Center of Excellence in Bioinformatics and Life Sciences. "I am a person and you are a person so we share something. Suppose I drop dead. What lies on the floor? Is that still a person? If it is no longer a person, is it still the very same thing that was sitting here as a person but now is a corpse?"

Ceusters says that in much the same way, definitions of pain and especially of chronic pain need to be much more precise; ontology provides methods of distinguishing among categories and describing data in uniform and formal ways.

While the philosophical approach to ontology naturally has its roots in ancient Greece, a computational approach to ontology began in the latter part of the 20th century, when computer scientists interested in artificial intelligence wanted to create software programs that perform reasoning they way humans do. To do so, they began to draw on ontology.

"Here at the University at Buffalo, we excel at combining the two approaches; we have a very strong foundation in the philosophical approach to ontology with Barry Smith, who is a pioneer in contemporary ontology, especially related to biomedical applications," says Ceusters, "while we also have a very strong presence in computational approaches, especially to biomedical ontology. These computational approaches allow us to devise systems of communication in which there is a consistent meaning for terms used in different language systems and conceptual frameworks."

With the $793,571 NIH grant, Ceusters and colleagues will study data gathered from thousands of patients in the U.S., the United Kingdom, Sweden, Israel and Germany who suffer from oral and facial pain, including temporomandibular disorder (TMD).

Ceusters will work with his colleagues, including Richard Ohrbach, DDS, PhD, associate professor of oral diagnostic sciences in the UB School of Dental Medicine, to develop an ontology that allows the data to be described in a much more uniform way.

"The goal is to integrate the data together so that we have a large pool of data that will allow us to obtain better insight into the complexity of pain disorders, specifically the assessment of pain disorders and how they impact mental health and a patients' quality of life," Ceusters says.

The grant will build on past work that Ceusters conducted with a grant from the Oishei Foundation related to improving the classification, diagnosis and treatment of psychiatric conditions.

Ceusters, who has degrees in knowledge engineering and information science as well as in neuropsychiatry, says that the current effort grew out of his work on that grant and also from a meeting with pain researchers that he attended in 2009.

"At that meeting, we discussed how we might build an ontology so that it could represent what pain is and how it relates to body parts and their activities and functions," he says. "Our goal is to create a software program that will allow all pain specialists to express themselves in crystal clear terms," he says, "We will create a symptom checklist that can be understood by computers. We have to define the terminology of pain. This can only be solved by the kind of ontology we are doing here at the University at Buffalo."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University at Buffalo.

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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Brain connectivity disrupted in patients with post-concussive syndrome

ScienceDaily (July 26, 2011) — A new study has found that patients with mild traumatic brain injury (MTBI) exhibit abnormal functional connectivity in the thalamus, a centrally located relay station for transmitting information throughout the brain. The results of the study appear online in the journal Radiology.

"Using resting-state functional MRI, we found increased functional connectivity of thalamocortical networks in patients following MTBI, due to the subtle injury of the thalamus," said study co-author Yulin Ge, M.D., associate professor in the Department of Radiology at NYU Langone Medical Center. "These findings hold promise for better elucidating the underlying cause of a variety of post-traumatic symptoms that are difficult to spot and characterize using conventional imaging methods."

According to the Centers for Disease Control and Prevention, each year in the U.S. 1.5 million people sustain traumatic brain injuries, resulting from sudden trauma to the brain. MTBI, or concussion, accounts for at least 75 percent of all traumatic brain injuries. Following a concussion, some patients experience a brief loss of consciousness. Other symptoms include headache, dizziness, memory loss, attention deficit, depression and anxiety. Some of these conditions may persist for months or even years. Typically in patients with MTBI, there are no structural abnormalities visible on the brain, so researchers have begun using specialized imaging exams to detect abnormalities in how the brain functions.

Comparing levels of activity among different groups of brain cells helps identify which brain networks are communicating with one another. Some brain networks, known as resting state networks (RSNs) and baseline brain activities can be detected when the brain is at rest. These networks include the parts of the brain associated with working memory.

"The RSNs have great potential for studying thalamic dysfunction in several clinical disorders including traumatic brain injury," Dr. Ge said.

Resting-state functional MRI (RS-fMRI) has rapidly emerged as a novel informative tool for investigating brain connectivity between regions that are functionally linked. RS-fMRI provides insight into functional activity and communication between brain regions, which play key roles in cognitive performance.

"The disruption of such functional properties is better characterized by RS-fMRI than by conventional diagnostic tools," Dr. Ge said.

Dr. Ge and colleagues used RS-fMRI to study the brain activity of 24 patients with MTBI and 17 healthy control patients. A normal pattern of thalamic RSNs with relatively symmetric and restrictive connectivity was demonstrated in the healthy control group. In the patients with MTBI, this pattern was disrupted, with significantly increased thalamic RSNs and decreased symmetry. These findings correlated with clinical symptoms and diminished neurocognitive functions in the patients with MTBI.

"The thalamic functional networks have multiple functions, including sensory information process and relay, consciousness, cognition, and sleep and wakefulness regulation," Dr. Ge said. "The disruption of thalamic RSNs may result in a burning or aching sensation, accompanied by mood swings and sleep disorders, and can contribute to certain psychotic, affective, obsessive-compulsive, anxiety and impulse control disorders. These symptoms are commonly seen in MTBI patients with post-concussive syndrome."

Because the causes of post-concussive syndrome are poorly understood, there is currently no treatment. But, according to Dr. Ge, the results of this study have implications for a new therapeutic strategy, based on sound understanding of the underlying mechanisms of thalamocortical disruption and post-concussive syndrome.

"Thalamic Resting-State Functional Networks: Disruption in Patients with Mild Traumatic Brain Injury." Collaborating with Dr. Ge on this paper were Lin Tang, Ph.D., Daniel K. Sodickson, M.D., Ph.D., Laura Miles, Ph.D., Yongxia Zhou, Ph.D., Joseph Reaume, B.S.R.T., and Robert I. Grossman, M.D.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Radiological Society of North America, via EurekAlert!, a service of AAAS.

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Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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New imaging technique captures brain activity in patients with chronic low back pain

ScienceDaily (July 27, 2011) — Research from Brigham and Women's Hospital (BWH) uses a new imaging technique, arterial spin labeling, to show the areas of the brain that are activated when patients with low back pain have a worsening of their usual, chronic pain.

This research is published in the August issue of the journal Anesthesiology.

"This study is a first step towards providing tools to objectively describe someone's chronic pain which is a subjective experience. We've found that when a patient has worsening of their usual pain, there are changes in the activity of the brain," said Ajay Wasan, MD, MSc, lead author of the paper and a researcher in the Pain Management Center at BWH. "These changes occur in the network of areas in the brain that process pain and mood."

Researchers compared 16 patients with chronic low back pain (CLBP) to 16 healthy subjects. Participants underwent three imaging sessions. The first was for a characterization and training session. During the second session, researchers used clinical maneuvers, such as pelvic tilting or straight leg raising , to temporarily exacerbate back pain. In the third session, heat was applied to the skin at an intensity that matched the pain levels during the second session. Patients rated their pain levels before and after the sessions and after each stimulation during the sessions.

During the last two sessions, researchers used the arterial spin labeling technique, which allows them to quantify the blood flow to specific regions of the brain over time. The amount of blood flow is indicative of neuron activity in that region of the brain. They found that there was increased activity in the brain of CLBP patients only when they experienced a worsening of their chronic pain and not during the heat pain session or in the healthy participants. Researchers also note that some of the areas of the brain that were activated when participants experienced a worsening of chronic pain have been shown to be associated with other types of pain found in other studies. However, researchers also observed activation of some areas, including the superior parietal lobule, which have been less frequently associated with pain in previous research.

"While this study begins to uncover some of the basic physiology of the brain as it processes pain, more studies are needed to help us understand how the brain function may change over the course of treatment of pain and to examine the brain mechanisms by which pain improves," Wasan said. "We are getting closer to describing, on an objective level, how the body and brain are reacting when a patient reports having more pain. We are hopeful that this could lead to an understanding of an individual patient's neurocircuitry and that knowledge could lead to therapies that would be tailored to the individual."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Brigham and Women's Hospital.

Journal Reference:

Ajay D. Wasan, Marco L. Loggia, Li Q. Chen, Vitaly Napadow, Jian Kong, Randy L. Gollub. Neural Correlates of Chronic Low Back Pain Measured by Arterial Spin Labeling. Anesthesiology, 2011; 115 (2): 364 DOI: 10.1097/ALN.0b013e318220e880

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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Patients who use anti-depressants are more likely to suffer relapse, researcher finds

ScienceDaily (July 19, 2011) — Patients who use anti-depressants are much more likely to suffer relapses of major depression than those who use no medication at all, concludes a McMaster researcher.

In a paper that is likely to ignite new controversy in the hotly debated field of depression and medication, evolutionary psychologist Paul Andrews concludes that patients who have used anti-depressant medications can be nearly twice as susceptible to future episodes of major depression.

Andrews, an assistant professor in the Department of Psychology, Neuroscience & Behaviour, is the lead author of a new paper in the journal Frontiers of Psychology.

The meta-analysis suggests that people who have not been taking any medication are at a 25 per cent risk of relapse, compared to 42 per cent or higher for those who have taken and gone off an anti-depressant.

Andrews and his colleagues studied dozens of previously published studies to compare outcomes for patients who used anti-depressants compared to those who used placebos.

They analyzed research on subjects who started on medications and were switched to placebos, subjects who were administered placebos throughout their treatment, and subjects who continued to take medication throughout their course of treatment.

Andrews says anti-depressants interfere with the brain's natural self-regulation of serotonin and other neurotransmitters, and that the brain can overcorrect once medication is suspended, triggering new depression.

Though there are several forms of anti-depressants, all of them disturb the brain's natural regulatory mechanisms, which he compares to putting a weight on a spring. The brain, like the spring, pushes back against the weight. Going off antidepressant drugs is like removing the weight from the spring, leaving the person at increased risk of depression when the brain, like the compressed spring, shoots out before retracting to its resting state.

"We found that the more these drugs affect serotonin and other neurotransmitters in your brain -- and that's what they're supposed to do -- the greater your risk of relapse once you stop taking them," Andrews says. "All these drugs do reduce symptoms, probably to some degree, in the short-term. The trick is what happens in the long term. Our results suggest that when you try to go off the drugs, depression will bounce back. This can leave people stuck in a cycle where they need to keep taking anti-depressants to prevent a return of symptoms."

Andrews believes depression may actually be a natural and beneficial -- though painful -- state in which the brain is working to cope with stress.

"There's a lot of debate about whether or not depression is truly a disorder, as most clinicians and the majority of the psychiatric establishment believe, or whether it's an evolved adaptation that does something useful," he says.

Longitudinal studies cited in the paper show that more than 40 per cent of the population may experience major depression at some point in their lives.

Most depressive episodes are triggered by traumatic events such as the death of a loved one, the end of a relationship or the loss of a job. Andrews says the brain may blunt other functions such as appetite, sex drive, sleep and social connectivity, to focus its effort on coping with the traumatic event.

Just as the body uses fever to fight infection, he believes the brain may also be using depression to fight unusual stress.

Not every case is the same, and severe cases can reach the point where they are clearly not beneficial, he emphasizes.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by McMaster University.

Journal Reference:

Michael C. Neale, Charles O. Gardner, Lisa J. Halberstadt, Susan G. Kornstein, Paul W. Andrews. Blue Again: Perturbational Effects of Antidepressants Suggest Monoaminergic Homeostasis in Major Depression. Frontiers in Psychology, 2011; 2 DOI: 10.3389/fpsyg.2011.00159

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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To Be Successful, Health-Care Reform Must Involve Psychologists, Medical Providers, Educate Patients

Main Category: Psychology / Psychiatry
Also Included In: Public Health
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While some members of Congress and others are trying to repeal the healthcare reform law that was passed in 2010, known as the "Patient Protection and Affordable Care Act," medical providers have begun to implement requirements as the law slowly phases in over the next several years. For reform to be successful, one University of Missouri public health expert has determined that professional associations for psychologists and other medical providers need to be at the forefront of the planning stages, and that everyone, including providers and patients, will need to be educated on rights and responsibilities.

"We looked at psychology departments here in the United States and in other countries to determine what worked best when implementing the policies outlined in healthcare reform," said Nancy Cheak-Zamora, assistant professor of health science in the MU School of Health Professions. "Many providers, especially psychologists, work independently, but the new healthcare law is encouraging providers to develop a medical team approach, one that can tackle many different aspects of a disease."

The new law encourages providers to bundle payment methods, study best practices, and develop accountable care organizations (ACO), which are formal groups or institutions that include teams of general practitioners and specialists taking a team approach to patient care. ACOs will have a financial stake in the outcomes of their patients. These changes could force a major shift in health care providers' practices, including those in psychology and rehabilitation. Physicians and psychologists, and specifically rehabilitation psychologists, need to move away from the traditional model of considering mental and behavioral health care services as separate from medical care, Cheak-Zamora said.

Cheak-Zamora said that large professional organizations, such as the American Psychological Association, should take the lead to help form expectations and policies for the team approach. Simultaneously, new psychologists should be trained to work in a team with other medical providers. Benefits of a medical team include reduced unnecessary procedures, less paperwork, better coordination with other providers and specialists, and better monitoring of prescriptions to discourage abuse or unintended drug interaction.

In her analysis, which is being published as a chapter in The Oxford Handbook of Rehabilitation Psychology by Oxford University Press, Cheak-Zamora also found that patients and providers need to be educated about the current system, how to access care, how to get questions addressed, and how to get the quality care patients deserve.

"With the implementation of healthcare reform, many patients might have been uninsured or underinsured for so long that they no longer know how the system is supposed to benefit them," Cheak-Zamora said. "They need to know how to access insurance information and utilize the system effectively."

Additionally, medical staff will need to be trained to handle requests through the new system, and how to work with individuals that do not have experience with insurance.

"Healthcare reform is an outline of what the government wants. Policymakers are working to develop policies, so now is the time to air any concerns and help shape a policy that works for everyone," she said.

Source:
Christian Basi
University of Missouri-Columbia

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Patients with eating disorders have an elevated rate of death

ScienceDaily (July 5, 2011) — Individuals who have eating disorders have an elevated mortality rate, especially those with anorexia nervosa (AN), according to a meta-analysis of previous studies, reported in the July issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

According to background information in the article, the majority of studies of eating disorder-related death rates focus on AN. Some research of bulimia nervosa (BN) implies that death rates are low for this condition. Moreover, there is limited information about the likelihood of death with eating disorders not otherwise specified (EDNOS), disordered eating that does not meet the criteria for AN or BN, say the authors: "Despite EDNOS being a common presentation in eating disorders services, few published data exist regarding mortality rates in patients given this diagnosis." In this study, the investigators sought to determine the death rates (and the factors thereof) for each of these types of eating disorders.

Jon Arcelus, L.M.S., M.Sc., M.R.C.Psych., Ph.D., from Leicester General Hospital in Leicester, England, and colleagues systematically searched, assessed and analyzed studies related to eating disorder death rates. They included English-language, peer reviewed articles published between January 1966 and September 2010 from a variety of scientific-literature databases and collections. The researchers examined 36 studies; almost all included AN, one-third included BN, and one-fifth included EDNOS. The studies included 17,272 different patients with eating disorders and reported a total of 755 deaths.

The total number of person-years represented by the studies was 166,642 for AN; 32,798 for BN; and 22,644 for EDNOS. For each 1,000 person-years, the AN group experienced 5.1 deaths (1.3 of which were from suicide), the BN group experienced 1.7 deaths, and the EDNOS group experienced 3.3 deaths. The standardized mortality ratio (the number of actual deaths compared with the number of expected deaths) was 5.86 for AN, 1.93 for BN and 1.92 for EDNOS. The age at which a patient presented for treatment was found to correlate with AN deaths, with patients in their late teens and 20s having a higher death rate than younger patients or those in their 30s.

The authors acknowledge that some of the deaths included in the studies may be due to factors other than an eating disorder. However, they found that death rates for eating disorders -- especially AN -- are higher than for some other psychiatric disorders, such as schizophrenia and depression. The elevated death rate for BN and EDNOS as well "highlights the seriousness of those conditions," write the authors. They call for more research into what factors might predict death risk in those two conditions in particular.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by JAMA and Archives Journals.

Journal Reference:

Jon Arcelus; Alex J. Mitchell; Jackie Wales; Soren Nielsen. Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders: A Meta-analysis of 36 Studies. Archives of General Psychiatry, 2011; 68 (7): 724-731 DOI: 10.1001/archgenpsychiatry.2011.74

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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Parkinson's Patients Get No Benefit From Antidepressants Sertraline Or Mirtazapine, But Have More Side Effects

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Academic Journal
Main Category: Parkinson's Disease
Also Included In: Depression;  Psychology / Psychiatry
Article Date: 19 Jul 2011 - 15:00 PDT window.fbAsyncInit = function() { FB.init({ appId: 'aa16a4bf93f23f07eb33109d5f1134d3', status: true, cookie: true, xfbml: true, channelUrl: 'http://www.medicalnewstoday.com/scripts/facebooklike.html'}); }; (function() { var e = document.createElement('script'); e.async = true; e.src = document.location.protocol + '//connect.facebook.net/en_US/all.js'; document.getElementById('fb-root').appendChild(e); }()); email to a friend   printer friendly   opinions  

Two antidepressants prescribed often for individuals with Parkinson's disease - sertraline or mirtazapine - were found to have no benefits for such patients. In fact, they also experienced unpleasant side effects., according to the results of the HTA-SADD trial published in The Lancet. The article was written by Professor Sube Banerjee and team, Institute of Psychiatry, King's College London, UK.

The trial involved 325 patients from nine different centers in England. They all had either possible Alzheimer's disease, depression which had lasted at least 4 weeks, or a dementia-related depression above a certain score. Any patient who was a suicide risk, contraindicated for the drugs, was already on antidepressants, or was at the time already taking part in another trial, was ineligible for this study.

They were randomly selected into one of three groups: Sertraline group - 150mg per day - 107 patientsMirtazapine group - 45 mg per day - 107 patientsControl group - placebo - 111 patientsThe researchers were focusing (primary outcome) on how much depression might be reduced after 13 weeks of treatment. They all also received standard care.

At 13 weeks there were no differences in the depression scores among the three groups, not even at 39 weeks.

26% of those on the placebo group experienced adverse reactions, compared to 43% in the sertraline group and 41% in the mirtazapine group. By week 39 five participants had died in each group.

The researchers concluded:

"The two classes of antidepressants most likely to be prescribed for depression in Alzheimer's disease are no more effective than placebo. In our study, there were more adverse reactions in individuals treated with antidepressants than there were with placebo. Clinicians and investigators need to reframe the way they think about the treatment of people with Alzheimer's disease who are depressed, and reconsider routine prescription of antidepressants."

Dr Henry Brodaty, Brain and Ageing Research Program and Primary Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia, concluded in a Comment in the same journal:

"The HTA-SADD trial has underscored the need for clinicians to think about creative alternatives to drug treatment for management of depression in people with dementia, and to use evidence-based techniques and partnerships with family carers."

"Sertraline or mirtazapine for depression in dementia (HTA-SADD): a randomised, multicentre, double-blind, placebo-controlled trial"
Prof Sube Banerjee MD, Jennifer Hellier MSc, Michael Dewey PhD, Renee Romeo PhD, Clive Ballard MD, Robert Baldwin MD, Peter Bentham MRCPsych, Chris Fox MD, Clive Holmes PhD, Cornelius Katona MD, Martin Knapp PhD, Claire Lawton FRCPsych, James Lindesay DM, Gill Livingston MD, Niall McCrae PhD, Esme Moniz-Cook PhD, Joanna Murray MA, Shirley Nurock MSc, Martin Orrell PhD, John O'Brien DM, Michaela Poppe PhD, Alan Thomas PhD, Rebecca Walwyn PhD, Kenneth Wilson MD, Alistair Burns MD

The Lancet, Early Online Publication, 18 July 2011 doi:10.1016/S0140-6736(11)60830-1

Written by Christian Nordqvist
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