Antidepressants rapidly alter brain architecture, study finds []



A single dose of a popular class of psychiatric drug used to treat depression can alter the brain’s architecture within hours, even though most patients usually don’t report improvement for weeks, a new study suggests.

More than 1 in 10 adults in the U.S. use these drugs, which adjust the availability of a chemical transmitter in the brain, serotonin, by blocking the way it is reabsorbed. The so-called Selective Serotonin Reuptake Inhibitors, or SSRIs, include Prozac, Lexapro, Celexa, Paxil and Zoloft.

The findings could be a first step toward figuring out whether a relatively simple brain scan might one day help psychiatrists distinguish between those who respond to such drugs and those who don’t, an area of mystery and controversy in depression treatment.

Researchers at the Max Planck Institute in Leipzig, Germany, used a magnetic resonance imaging machine to compare connections in the gray matter of those who took SSRIs and those who did not. They were particularly interested in what goes on when the brain is doing nothing in particular.

“We just tell them to let their minds wander and not think of anything particularly dramatic or upsetting,” said neuroscientist Dr. Julia Sacher, a co-author of the study published online Thursday in the journal Current Biology.

They created 3-D maps of connections that “matter” to gray matter: interdependence, not just anatomical connection. They relied on a discovery in the late 1990s that low-frequency brain signaling during relative inactivity, such as daydreaming, is a good indicator of functional connectivity.

When more serotonin was available, this resting state functional connectivity decreased on a broad scale, the study found. This finding was not particularly surprising — other studies have shown a similar effect in brain regions strongly associated with mood regulation.

But there was a two-fold shock: Some areas of the brain appeared to buck the trend and become more interdependent. And all the changes were evident only three hours after the single dosage.

“It was interesting to see two patterns that seemed to go in the opposite direction,” Sacher said. “What was really surprising was that the entire brain would light up after only three hours. We didn’t expect that.”

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Schizophrenia Is Actually Eight Distinct Genetic Disorders []

by George Dvorsky /

New research published in the American Journal of Psychiatry suggests that schizophrenia is not a single disease, but rather a group of eight genetically distinct disorders, each of them with its own set of symptoms. The finding could result in improved diagnosis and treatment, while also shedding light on how genes work together to cause complex disorders.

Schizophrenia is classified as a psychotic disorder, one characterized by an inability to discern what is real and not real, to think clearly, have normal emotional responses, and act normally in social situations. As Elyn Saks told us last year, “it’s a waking nightmare, where you have all the bizarre images, the terrible things happening, and the utter terror — only with a nightmare you open your eyes and it goes away. No such luck with a psychotic episode.”

Scientists aren’t entirely sure what causes it, nor does it manifest identically in all people who have it (leading to the broader diagnosis of being on the ‘schizophrenia spectrum’). But links have been made to genetics, social factors (including early development), and neurobiology. The heritability link looks to be particularly promising, however; about 80% of the risk for schizophrenia is genetic. Yet scientists have struggled to identify which genes are responsible for the condition.

But a novel approach to analyzing genetic influences on more than 4,000 people with schizophrenia has finally allowed researchers to identify distinct gene clusters that contribute to eight different classes of schizophrenia.

“Genes don’t operate by themselves,” noted C. Robert Cloninger, MD, PhD, one of the study’s senior investigators in a statement. “They function in concert, much like an orchestra, and to understand how they’re working, you have to know not just who the members of the orchestra are but how they interact.”

Indeed, complex diseases like schizophrenia may be influenced by hundreds or thousands of genetic variants that interact with one another in complicated and dynamic ways, leading to what scientists call “multifaceted genetic architectures.” Now, thanks to the work of investigators at the Washington University School of Medicine in St. Louis, the genetic architecture for schizophrenia is starting to take shape.

That’s a Match

For the study, Cloninger and his colleagues matched precise DNA variations in people with and without schizophrenia to symptoms in individual patients. In total, they looked at nearly 700,000 sites within the genome where a single unit of DNA is altered (i.e. a single nucleotide polymorphism, or SNP). Specifically, they analyzed the SNPs of 4,200 people with schizophrenia and 3,800 people without it. This allowed them to learn how individual genetic variations interact with each other to produce the illness.

So, for example, hallucinations and delusions were associated with one set of DNA variations, that carried a 95% risk of schizophrenia. Another symptom, disorganized speech and behavior, was found to carry a 100% risk with another set of DNA.

“What we’ve done here, after a decade of frustration in the field of psychiatric genetics, is identify the way genes interact with each other, how the ‘orchestra’ is either harmonious and leads to health, or disorganized in ways that lead to distinct classes of schizophrenia,” Cloninger said.

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Why Solitary Confinement Is The Worst Kind Of Psychological Torture []

by George Dvorsky /

There may be as many as 80,000 American prisoners currently locked-up in a SHU, or segregated housing unit. Solitary confinement in a SHU can cause irreversible psychological effects in as little as 15 days. Here’s what social isolation does to your brain, and why it should be considered torture.

There’s no universal definition for solitary confinement, but the United Nations describes it as any regime where an inmate is held in isolation from others, except guards, for at least 22 hours a day. Some jurisdictions allow prisoners out of their cells for one hour of solitary exercise each day. But meaningful contact with others is typically reduced to a bare minimum. Prisoners are also intentionally deprived of stimulus; available stimuli and the fleetingly rare social contacts are rarely chosen by the prisoners, and are are typically monotonous and inconsiderate of their needs.

As for the jail cell itself, it typically measures 6′ x 10′. Nearly all scenarios for human contact, such as a guard, or medical and family visits, are done through a metal mesh, behind glass partitions, or in hand- and leg-cuffs.

Writing in Wired, Brandon Keim describes the conditions in the cells:

What’s emerged from the reports and testimonies reads like a mix of medieval cruelty and sci-fi dystopia. For 23 hours or more per day, in what’s euphemistically called “administrative segregation” or “special housing,” prisoners are kept in bathroom-sized cells, under fluorescent lights that never shut off. Video surveillance is constant. Social contact is restricted to rare glimpses of other prisoners, encounters with guards, and brief video conferences with friends or family.

For stimulation, prisoners might have a few books; often they don’t have television, or even a radio. In 2011, another hunger strike among California’s prisoners secured such amenities as wool hats in cold weather and wall calendars. The enforced solitude can last for years, even decades.

These horrors are best understood by listening to people who’ve endured them. As one Florida teenager described in a report on solitary confinement in juvenile prisoners, “The only thing left to do is go crazy.”

Prisoners in low and medium security jails are often thrown in the SHU for “just” a few days. But in maximum security prisons, individuals in solitary are held on average for five years, and there are thousands of cases of prisoners who have been held in solitary confinement for decades. Some countries, including the United States, employ the use of Super Maximum Security Prisons, or “Supermax Prisons,” in which solitary confinement is framed as a normal, rather than exceptional, practice for inmates.

Exact statistics are not known, but a 2011 study suggested that 20,000 to 25,000 prisoners in the United States are held in this way. Keim claims that that California holds some 4,500 inmates in solitary confinement, and that there are as many as 80,000 prisoners held in solitary across the United States — more than any other democratic nation.

Lasting Effects

Human beings are social creatures. Without the benefit of another person to “bounce off of,” the mind decays; without anything to do, the brain atrophies; and without the ability to see off in the distance, vision fades. Isolation and loss of control breeds anger, anxiety, and hopelessness.

Indeed, psychologist Terry Kupers says that solitary confinement “destroys people as human beings.” A quick glance at literature review studies done by Sharon Shalev (2008) and Peter Scharff Smith (2006) affirms this assertion; here are some typical symptoms:

  • Anxiety: Persistent low level of stress, irritability or anxiousness, fear of impending death, panic attacks
  • Depression: Emotional flatness/blunting and the loss of ability to have any “feelings”, mood swings, hopelessness, social withdrawal, loss of initiation of activity or ideas, apathy, lethargy, major depression
  • Anger: Irritability and hostility, poor impulse control, outbursts of physical and verbal violence against others, self, and objects, unprovoked angers, sometimes manifested as rage
  • Cognitive disturbances: Short attention span, poor concentration and memory, confused thought processes, disorientation
  • Perceptual distortions: Hypersensitivity to noises and smells, distortions of sensation (e.g. walls closing in), disorientation in time and space, depersonalization/derealization, hallucinations affecting all five senses (e.g. hallucinations of objects or people appearing in the cell, or hearing voices when no one is speaking
  • Paranoia and psychosis: Recurrent and persistent thoughts, often of a violent and vengeful character (e.g. directed against prison staff), paranoid ideas (often persecutory), psychotic episodes or states, psychotic depression, schizophrenia
  • Self-harm: self-mutilation and cutting, suicide attempts

In California, it has been shown that inmates are 33 times more likely to commit suicide than other prisoners incarcerated elsewhere in the state. Disturbingly, solitary confinement beyond 15 days leads directly to severe and irreversible psychological harm. But for some, it can manifest in even less time. What’s more, a significant number of individuals will experience serious health problems regardless of specific conditions of time, place, and pre-existing personal factors.

In terms of prevalence, somewhere between 8% and 19% of American prisoners will experience significant psychiatric or functional disabilities, while another 15% to 20% will require some form of psychiatric intervention during their incarceration. Figures in Europe are comparable. The American Psychiatric Association says that up to 20% of all prisoners are “seriously mentally ill” whereas up to 5% are “actively psychotic at any given moment.” About 4% of inmates have schizophrenia or some other psychotic disorder, nearly 19% suffer from depression, and around 4% have bipolar disorder (Abramsky and Fellner 2003).

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Lawmakers Aim To Restrict Guns for Mentally Ill After Shooting []

California lawmakers are calling for increased restrictions on gun purchases for individuals who are suspected of having mental health issues and could pose a threat to themselves or others, theAP/Sacramento Bee reports. The legislation comes after six people were killed last week by an individual with suspected mental health issues.

Background on Killings

On May 23, 22-year-old Elliot Rodger killed six individuals by stabbing or shooting them and wounded 13 others in Isla Vista, Calif. Rodger had legally purchased three semi-automatic guns and ammunition used in the attack (Dillon/Thompson, AP/Sacramento Bee, 5/28).

The incident occurred after Rodger’s family members had contacted the Santa Barbara County Sheriff’s Department on April 30 with concerns about his mental health. Police conducted a welfare visit and concluded that Rodger did not pose a risk (Pickert, Time, 5/27).

Details of Legislation

Following the killings, California lawmakers proposed changes to the state’s rules for purchasing guns.

Assembly members Nancy Skinner (D-Berkeley) and Das Williams (D-Santa Barbara) and state Sen. Hannah-Beth Jackson (D-Santa Barbara) have introduced a bill that would allow temporary restraining orders to prevent individuals who are potentially violent from purchasing guns. Under the bill, family members and friends could contact law enforcement if they believe an individual could be a threat to themselves or others, and officers then could ask a judge for the temporary restraining order (Mason, “PolitiCal,” Los Angeles Times, 5/27).

Under current state law, individuals can be banned from buying firearms only if they are involuntarily committed to a mental health facility.

Skinner said, “When someone is in crisis, the people closest to them are often the first to spot the warning signs, but almost nothing can now be done to get back their guns or prevent them from buying more.”

In addition, Senate President Pro Tempore Darrell Steinberg (D-Sacramento) said the state should require law enforcement officers to check for weapons when conducting welfare visits, such as the one that took place at Rodger’s residence on April 30. In addition, Steinberg suggested that officers should search the area when called on such visits and speak with roommates and neighbors (AP/Sacramento Bee, 5/28).


Sam Paredes, executive director of Gun Owners of California, said the new legislation limiting gun purchases is unnecessary. Parades said, “We don’t need another bill to solve this problem. The tools are there — the Legislature and the professionals involved need to be willing to understand and take advantage of the system that is there in place” (“PolitiCal,” Los Angeles Times, 5/27).

Meanwhile, a spokesperson with the California chapter of the National Alliance on Mental Illness noted that only 30 law enforcement employees in Santa Barbara County undergo crisis-intervention training each year. However, the official said increasing such training still might “not be enough to respond” to such violent incidents.

NAMI California Executive Director Jessica Cruz added that there often is a lack of funding for mental health prevention and treatment, noting that the state has fewer than 50% of the number of psychiatric in-patient hospital beds as recommended by an expert panel (Time, 5/27).–for-mentally-ill-after-shooting

Mental Health Problems Plague Transgender Kids []

by Stephanie Pappas /

Kids who are distressed because they feel their physical body doesn’t match their gender suffer from high rates of psychiatric symptoms, such as depression and suicide attempts, a new study finds.

In a sample of children and adolescents treated at the Endocrine Division at Children’s Hospital Boston, young people who experienced distress about the “mismatch” between their body’s sex and their mental gender had high rates of psychiatric complications (before any gender treatment). Kids who don’t get treatment, whether for financial reasons or because their parents aren’t supportive, likely have higher rates of psychiatric problems, said study researcher Scott Leibowitz, a psychiatrist at Children’s Hospital Boston.

“Individuals who are not transgender take for granted what life must be like when our minds and bodies are incongruent with one another,” Leibowitz told LiveScience. “Personally, I’ve seen so many kids who experience such high levels of distress with their changing bodies that it impairs their emotional and social functioning,” he said.

Mind-body mismatch

Transgender people — people who feel that their biological sex does not reflect their true gender — have astonishingly high rates of mental health problems: A 2010 survey found that 41 percent of transgender people in the U.S. have attempted suicide.

Researchers attributed those rates to discrimination and stigma, as well as a lack of laws protecting transgender people from employment discrimination. Poor insurance coverage of hormones and other treatments to help a transgender person transition to their desired gender also account for the rates, the researchers found. [5 Myths About Gay People]

But the mismatch between mind and body alone can be a major source of psychological pain, Leibowitz said. Of 97 patients who came to the Endocrine Division for hormones and other treatments related to gender identity disorder between January 1998 and February 2010, 44.3 percent had significant mental health histories. Twenty percent had self-mutilated, and 9.3 percent had attempted suicide at least once. About 37 percent were taking psychiatric medication.

Treating gender identity

Growing up, many children experiment with cross-gender behaviors, but very few of them will grow up to experience distress about their biological sex. Persistent gender identity disorder is rare: In the Netherlands, where gender-treatment programs are well- established, only about 1 in every 10,000 to 30,000 people seeks treatment.

When young people start puberty and experience serious distress about their bodies developing into a gender they don’t identify with, there are solutions, Leibowitz said. The medical standard established by the Endocrine Society and the World Professional Organization for Transgender Health call for treatment with hormones that suppress puberty in teens who have not yet undergone major physical changes. These treatments “buy time,” Leibowitz said, preventing the development of secondary sex characteristics such as breasts or an Adam’s apple while kids mature mentally enough to make decisions about whether they’d like to transition to a new gender. These treatments are reversible.

Older teens, ages 16 or 17, can begin to make decisions about taking estrogen or testosterone to promote the sexual characteristics of the gender they feel they are. Puberty-suppressing treatments are also used at this stage to lessen the doses — and thus side effects — of these hormones. The effects of cross-sex hormone therapy are partially reversible.

At every step of the way, Leibowitz said, families and children are counseled and evaluated to be sure they’re ready for treatment. Doctors counsel young children and their families, but do not treat them with drugs or hormones unless their gender identity distress persists at puberty.

The cost of not treating can be high, as the new study, published today (Feb. 21) in the journal Pediatrics, highlights.

“Without treatment, a lot of these kids are prone to psychiatric disorders, including depression, suicide, self-mutilation, anxiety,” Leibowitz said.


Are Your Annoying Friends Making You Physically Ill? []

by Cassie Murdoch /

We all have those friends who are competitive or are constantly causing drama for one reason or another. It’s tempting to just put up with them, but a new study has found that conflicts with those kinds of people could actually be irritating you physically—as in causing your immune system to fire up. This leads to your body to become inflamed, a state which has been associated with things like cancer and diabetes.

The study investigated whether stress from personal conflicts or sports competitions would cause the body to release cytokines, which are molecules linked to inflammation. The researchers saw cytokine levels rise after negative interactions like arguments, but people’s cytokine levels did not rise when they were playing a competitive sport. Co-author psychology professor Shelley Taylor explains the consequences of her findings, “What this tells me is that people should be investing in socially supportive relationships, and they should not court relationships that lead to a great deal of conflict.”

It’s probably a lot more complicated than that, but let’s just take this for what it’s worth: a good excuse to break up with your obnoxious friends and suspend contact with irritating workmates. No one will be able to argue with your scientific reasoning.

As luck would have it, the New York Times has also just offered up a hideously detailed explanation of how to dump your friends when the need arises. It takes them a remarkable three pages to conclude what we all already know: The easiest way to put a friendship out of its misery is to just let it slowly fade away with a series of declined invitations, severed social network ties, and unreturned texts. But if you really need to do a direct, in-person execution, theTimes points you to the advice of psychologist Erika Holiday, who is totally legit because she’s been on Dr. Phil:

Schedule a time where you can sit down with them. It’s not about putting the other person down, but telling them, “You don’t fit into my life, you’re not on same path as me.”

But the great thing is that now you don’t even need to do the bit about fitting into your life, you can just say, “I’m sorry we can’t hang out anymore, but studies have shown you make me sick.” And with those magic words your toxic friendship will most certainly be dead, and you can live healthily ever after.

Study shows how stress triggers immune system [USA Today]
It’s Not Me, It’s You [New York Times]