Friday, 7 December 2012

10 tips for mental illness


Top Ten Tips for Recovering From a Mental Illness

Posted: 24/11/2012 00:00

Here are my top ten tips for recovering from mental illness. Tell me any really good tips I've missed out in the comments. They're not commandments, just what worked for me - feel free to disagree.
1) Know your enemy
If you have a particular condition or group of conditions, research them and know them. Know your enemy: know the kind of negative thoughts and behaviour patterns you might fall into, and watch out for them. Don't let your condition lie to you or control you. Instead, learn how to manage it, and minimise its control over your life.
Go on to support sites and see how the condition affects different people. Go on to reputable health and psychology websites and research what sorts of therapy seem to work well with it, and where you might find those therapies. Learn to be your own doctor. Recognise the thoughts and attitudes that are messing you up and causing you suffering. You're probably all familiar with the CBT bingo list of cognitive distortions. Get to know your own particular biases, and watch out for them, guard against them.
2) Your thoughts are not 'you'
If you have a mental illness, the thoughts in your head will sometimes cause you pain. And then some of us will freak out at having those thoughts and being a rotten or weak person. Thoughts are just thoughts. We don't have to let them bully us or cause us pain. We can choose not to listen to them. We can say to ourselves: "I refuse to let those old negative thoughts cause me suffering any more". When we stop believing in negative thoughts, we take away their power over us. We can raise our negative thoughts and beliefs over us like a God, and hand them a whip to beat us. Or we can choose not to believe them, not to give them power over us. We can free ourselves from the prisons we have constructed for ourselves.
3) We are habitual creatures. Changing habits takes long-term effort
Human personalities are bundles of automatic habits, lit up by a small ray of conscious thought. We can shine that ray onto our habits, think if they're working for us, and if not, we can change our habits.
Our personalities are always changing, all the way through our life. That's the good news. Neuroscientists call it "plasticity" - our ability to re-wire ourselves. The habits we grew up with are not written in stone for eternity. We can change them. But you have to work hard, challenging the bad old habits of thought, challenging the bad old habits of behaviour, facing your fears, and going through some painful moments. It takes energy and effort to change yourself but we can, in fact, change ourselves much more than we typically think.
Change is slow - it happens over month and years. But then you look back and see how far you've come.
Part of Tip 3 is keeping track of our progress. Our intuitions about whether we're getting better or not are often wrong. So we need to keep track of our progress more objectively and accurately. Don't focus on the day-to-day fluctuations, focus on the long-term trend.
You win some battles, you lose some battles, but are you winning the war? Keep track of your progress in a journal or on smartphone apps, keep track of your depression levels, for example, or your binge-eating, or how often you get panic attacks, or how often you are getting out to see your friends. Be scientific in your approach to mental health recovery. Keep track of your success in reinforcing good habits while weakening bad ones.
4) Focus on what you can control, while accepting for the time being what you can't
Be efficient in your energy. Focus your energy on what you can control and change. With the things you can't immediately change, learn to shrug and say "f*ck it". Lots of things will happen to us in life, and we don't always have a choice over the people we meet or the situations we find ourselves in. But we do have a choice how we respond to them. Likewise, our childhoods are not our "fault". But our adult lives are now our responsibility.
Staying sane and mentally healthy in this world involves recognising the limits of our control. We're in a big, complex world and we only have limited control over it - over the economy, the weather, the government, other people, our friends, even our own bodies. If we fixate on things beyond our control, we'll make ourselves feel helpless, angry, paranoid, insecure and disempowered. Instead, we can focus on what we can control, even if it's only small things. Here's a nice quote from Albert Ellis, which my housemate just sent me:
The best years of your life are the ones in which you decide your problems are your own. You do not blame them on your mother, the ecology, or the president. You realize that you control your own destiny.
5) Get support
You can't do it all on your own. You need help and support. This is the fight of your life, and you need a team in your corner. Tell your family what you're going through. Tell some close friends. Be careful who you confide in though - not everyone you tell will be helpful. If they're not helpful or sympathetic, go easy on them - they're probably a bit frightened, or just ignorant. Find a local support group. Find a good therapist. Find a good support site and make contact with the more useful and positive voices on that site. Find stories of people who have come through the condition you are going through - then get in contact with them and ask for advice. And share your successes as well as your setbacks with other people. Celebrate your victories with your team.
6) Let go of the shame
Mental illness is as normal as physical illness. You wouldn't feel ashamed or mortified if you had flu, for example, or cancer. So why feel ashamed if you have a period of mental illness? A common statistic suggests that one in four suffer from a mental illness at some point in their lives. but in fact, just about everyone will have at least one period of mental instability in their lives at some point, even if it's not a diagnosable condition. There is nothing shameful about mental illness. In fact, facing mental illness with dignity and courage is morally laudable - it's an achievement - particularly if you then use your experience to help other people going through tough times.
7) Think of others, fight for others
Getting over mental illness isn't just about you - it's about all the other people struggling with poor mental health. As sufferers from it, we're in position to become experts, front-line correspondents from the trenches. So keep notes, get informed, share your experience, and if you get out of the labyrinth, go back and help other people get out. Remember how much it hurt, and don't forget there are people still hurting. Here's a quote from JD Salinger's Catcher in the Rye that I find inspiring:
Among other things, you'll find that you're not the first person who was ever confused and frightened and even sickened by human behavior. You're by no means alone on that score, you'll be excited and stimulated to know. Many, many men have been just as troubled morally and spiritually as you are right now. Happily, some of them kept records of their troubles. You'll learn from them--if you want to. Just as someday, if you have something to offer, someone will learn something from you. It's a beautiful reciprocal arrangement. And it isn't education. It's history. It's poetry.
And here's another, from Seneca, that I pinned up on my wall while I was writing Philosophy for Life:
There is no time for playing around. You have been retained as counsel for the unhappy. You have promised to bring help to the shipwrecked, the imprisoned the sick, the needy, to those whose heads are under the poised axe. Where are you deflecting your attention? What are you doing?


8) Take care of your body as well as your mind
We sometimes don't realise the extent to which our mental health is connected to our physical health. An important part of recovery from mental illness is learning to take care of our bodies too: taking exercise can be crucial to getting better. If nothing else, going for a run or a swim gets rid of some of our nervous mental energy. Exorcise the demons through exercise! Also be careful of what you eat and drink - too much coffee might make you anxious. You might drink a lot in the evening to overcome your inhibitions, but end up making a fool of yourself, and then feeling extra-anxious and paranoid when you're hungover in the morning. Take care of your body - you need as much energy as possible for the fight. Sleep is also hugely important - try to get to bed at a proper time and get at least seven hours. Try to live on a steady, even keel, however boring that sounds.
9) Don't romanticise or over-intellectualise your condition
I don't mean this in a harsh way, like 'pull up your socks and stop making a fuss'. What I mean is, let go of the drama. Let go of the romantic myth of yourself as a tragic martyr, singled out for suffering. Let go of the myth of yourself as a unique snowflake, whose problems are deliciously interesting and complex. Let that sh*t go! It's just another way to hold on suffering - to make love to your disease. I did that for years, then I realised the millions of people suffering from social anxiety had exactly the same thoughts and beliefs as me. Beneath all our drama and intellectual sophistication, our mental illness conditions are often pretty basic, even humiliatingly so (we long to be complex). This is why a lot of clever people would rather spend thousands of pounds on Freudian psychoanalysis - because, even if it doesn't make them better, it flatters their unique complexity. Instead, try to define the beliefs or attitudes that cause you suffering as simply, clearly, humbly and undramatically as possible.
I also think it can be useful to see the ridiculousness in your situation. Having a mental illness is, often, ridiculous. It puts us in ridiculous situations. If we laugh at that, it means we're not turning it into a big tragic drama. I like the Woody Allen scene at the end of Hannah and her Sisters about this. Woody's been trying to find the meaning of life, then he stumbles into a cinema and sees a Marx Brothers film and decides, even if he doesn't know if there's a God, he can still relax and try to enjoy the strange experience of being alive.
10) Enjoy the little moments
I have my reservations about the 'happiness movement' and its exclusive focus on happiness as the meaning of life. But they got something right: we can learn to cultivate moments of peace and happiness. That's not the meaning of life, but it helps, because experiencing mental illness means we're probably soaked in negative emotions. So we can try to cultivate little moments of positivity along the way. Learn what gives you pleasure - reading a particular author, maybe, or listening to music, or going for a walk, or seeing particular friends, or even tidying up your room. Drop by drop, we can get into the habit of happiness. We can choose not to beat ourselves up, but to let ourselves be happy, here in this moment. Eckhart Tolle may be a weirdo, but he got that right. All we have is this moment. We can take a breath, let go of our worries and regrets for just a second, and enjoy the moment, without putting any demands on it.
And finally, a last quote, from (I think) Winston Churchill: if you're going through hell, keep going. Don't give up. You're in this fight for all of us. And we're in it too, shoulder-to-shoulder with you.
 

Follow Jules Evans on Twitter: www.twitter.com/@julesevans77

Tuesday, 27 November 2012

B12 and depression


Lack of Nutrients and Metabolic Syndrome Linked to Different Subtypes of Depression

ScienceDaily (Nov. 26, 2012) — A low intake of folate and vitamin B12 increases the risk of melancholic depressive symptoms, according to a study among nearly 3,000 middle-aged and elderly Finnish subjects. On the other hand, non-melancholic depressive symptoms are associated with an increased risk for the metabolic syndrome. Based on these new observations, melancholic and non-melancholic depression may be separate depressive subtypes with different etiologies in terms of proinflammation and diet. The study was the first to look at these depressive sub-types separately.
"The findings have practical implications in the care of patients with depressive symptoms. For example, it may be wise to avoid medication causing weight gain among patients with non-melancholic depression, whereas melancholic depressive symptoms may call for a closer look at the quality of the patient's diet," says Mr Jussi Seppälä, MD, Chief of the Department of Psychiatry of the Hospital District of Southern Savo.
Melancholic depression involves typical depressive symptoms, such as a depressed mood. Non-melancholic depression is characterized by other types of symptoms, such as low self-esteem and feelings of worry and anxiety.
Among subjects with the highest folate intake, the risk for melancholic depressive symptoms was almost 50 per cent lower than among those with the lowest intake. In addition, among those with the highest vitamin B12 levels, the risk for melancholic depressive symptoms was almost three times lower than among those with the lowest levels. Both findings are new. A similar association with non-melancholic depressive symptoms was not observed.
Another novel observation is that the risk for the metabolic syndrome was twofold among those with non-melancholic depressive symptoms, as compared to those with melancholic symptoms or those with no depressive symptoms.
Mr Seppälä's doctoral thesis "Depressive symptoms, metabolic syndrome and diet" was published at the University of Eastern Finland. The study was conducted as part of the Finnish Type 2 Diabetes Prevention Programme. The findings were originally published in Journal of Affective Disorders.
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Tuesday, 18 September 2012


Simple tool may help evaluate risk for violence among patients with mental illnessopen original article
Sun Sep 16, 2012 23:21 from RSS 2.0 by University of California at San Francisco
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Mental health icon
Mental health professionals, who often are tasked with evaluating and managing the risk of violence by their patients, may benefit from a simple tool to more accurately make a risk assessment, according to a recent study conducted at the University of California, San Francisco.
The research, led by psychiatrist Alan Teo, MD, when he was a UCSF medical resident, examined how accurate psychiatrists were at evaluating risk of violence by acutely ill patients admitted to psychiatric units.
The first part of the study showed that inexperienced psychiatric residents performed no better than they would have by chance, whereas veteran psychiatrists were moderately successful in evaluating their patients’ risk of violence.
However, the second part of the study showed that when researchers applied the information from the “Historical, Clinical, Risk Management–Clinical” (HRC-20-C) scale – a brief, structured risk assessment tool – to the patients evaluated by residents, accuracy in identifying their potential for violence increased to a level nearly as high as the faculty psychiatrists’, who had an average of 15 years more experience.
“Similar to a checklist a pilot might use before takeoff, the HRC-20-C has just five items that any trained mental health professional can use to assess their patients,” Teo said. “To improve the safety for staff and patients in high-risk settings, it is critical to teach budding psychiatrists and other mental health professionals how to use a practical tool such as this one.”
The study was published Aug. 31 in the journal Psychiatric Services.
The HCR-20-C was developed several years ago by researchers in Canada, where it is used in a number of settings such as prisons and hospitals. However, in the United States, structured tools such as the HCR-20-C are only beginning to be used in hospitals.
“This is the first study to compare the accuracy of risk assessments by senior psychiatrists to those completed by psychiatric residents,” said senior author Dale McNiel, PhD, UCSF professor of clinical psychology. “It shows that clinicians with limited training and experience tend to be inaccurate in their risk assessments, and that structured methods such as HCR-20-C hold promise for improving training in risk assessment for violence.”
“The UCSF study was unusual,” Teo added, “in applying a shorter version of the tool that could be more easily incorporated into clinical practice.”
Teo and his team assessed the doctors’ accuracy by comparing the risk assessments that they made at the time patients were admitted to the hospital, to whether or not patients later became physically aggressive toward hospital staff members, such as by hitting, kicking or biting. The study included 151 patients who became violent and 150 patients who did not become violent.
The patients in the study had severe mental illnesses, often schizophrenia, and had been involuntarily admitted to the hospital.

http://www.camh.ca/en/hospital/Pages/home.aspx


Researchers illuminate roles of novel epigenetic chemical in the brainopen original article
Mon Sep 17, 2012 18:03 from RSS 2.0 by Centre for Addiction and Mental Health
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DSI Image of a Whole Human Brain by Van WedeenResearchers from the Centre for Addiction and Mental Health (CAMH) have identified a new role of a chemical involved in controlling the genes underlying memory and learning.
“The brain is a plastic tissue, and we know that learning and memory require various genes to be expressed,” says CAMH Senior Scientist Dr. Art Petronis, who is a senior author on the new study. “Our research has identified how the chemical 5-hmC may be involved in the epigenetic processes allowing this plasticity.” Dr. Petronis is head of the Krembil Family Epigenetics Laboratory in CAMH’s Campbell Family Mental Health Research Institute.
5-hmC is an epigenetic modification of DNA, and was discovered in humans and mice in 2009. DNA modifications are chemical changes to DNA. They flag genes to be turned “on” – signalling the genome to make a protein – or turned “off.” As the overwhelming majority of cells in an individual contain the same genetic code, this pattern of flags is what allows a neuron to use the same genome as a blood or liver cell, but create a completely different and specialized cellular environment.
The research, published online in Nature Structural & Molecular Biology, sheds light on the role of 5-hmC. Intriguingly, it is more abundant in the brain than in other tissues in the body, for reasons not clear to date.
The CAMH team of scientists examined DNA from a variety of tissues, including the mouse and human brain, and looked at where 5-hmC was found in the genome. They detected that 5-hmC had a unique distribution in the brain: it was highly enriched in genes related to the synapse, the dynamic tips of brain cells. Growth and change in the synapse allow different brain cells to “wire” together, which enables learning and memory.
“This enrichment of 5-hmC in synapse-related genes suggests a role for this epigenetic modification in learning and memory,” says Dr. Petronis.
The team further showed that 5-hmC had a special distribution even within the gene. The code for one gene can be edited and “spliced” to create several different proteins. Dr. Petronis found that 5-hmC is located at “splice junctions,” the points where the gene is cut before splicing.
“5-hmC may signal the cell’s splicing machinery to generate the diverse proteins that, in turn, give rise to the unprecedented complexity of the brain,” he says.
The research team is continuing to investigate the role of 5-hmC in more detail, and to determine whether 5-hmC function is different in people with bipolar disorder and schizophrenia compared to people without these diagnoses.

Thursday, 13 September 2012

Self Control


Self-control may not be a limited resource after allopen original article
Wed Sep 12, 2012 19:05 from RSS 2.0 by Association for Psychological Science
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Students taking testSo many acts in our daily lives – refusing that second slice of cake, walking past the store with the latest gadgets, working on your tax forms when you’d rather watch TV – seem to boil down to one essential ingredient: self-control. Self-control is what enables us to maintain healthy habits, save for a rainy day, and get important things done.
But what is self-control, really? And how does it work?
In a new article in the September 2012 issue of Perspectives on Psychological Science, a journal of the Association for Psychological Science, researchers Michael Inzlicht of the University of Toronto and Brandon Schmeichel of Texas A&M University argue that the prevailing model of self-control may not be as precise as researchers once thought. Rather than being a limited resource, self-control may actually be more like a motivation- and attention-driven process.
Research on self-control has surged in the last decade and much of it has centered on the resource model of self-control. According to this model, originally proposed by Roy Baumeister and colleagues, self-control is a limited resource – if we exercise a lot of self-control by refusing a second slice of cake, we may not have enough self-control later in the day to resist the urge to shop or watch TV.
Over 100 papers have produced findings that support this model. Research has found, for example, that people who are required to manage their emotions show impaired performance on later tasks, such as solving a difficult puzzle, squeezing a handgrip exerciser, and keeping items in working memory.
But Inzlicht and Schmeichel point out that a newer crop of studies are yielding results that don’t fit with this idea of self-control as a depletable resource. Recent studies have shown that incentives, individual perceptions of task difficulty, personal beliefs about willpower, feedback on task performance, and changes in mood all seem to influence our ability to exercise self-control. These results suggest that self-control may not rely on a limited resource after all.
To accommodate these new findings and get at the mechanisms that underlie self-control, Inzlicht and Schmeichel propose an alternative model that describes self-control as a process involving motivation and attention.
“Engaging in self-control by definition, is hard work; it involves deliberation, attention, and vigilance,” the authors write. If we resist that second slice of cake, we may experience a shift in motivation so that we feel justified in indulging ourselves later on. It’s not necessarily the case that we can’t control ourselves because we’re “out” of self-control but rather that we choose not to control ourselves any longer.
At the same time, our attention shifts so that we’re less likely to notice cues that signal the need for self-control (cake = empty calories) and we pay more attention to cues that signal some kind of reward (cake = delicious treat).
In laying out the basic components of this process model, Inzlicht and Schmeichel want to motivate researchers to ask critical questions about how self-control really works. “The idea that self-control is a resource is one possibility, but there are alternative possibilities that can accommodate more of the accumulated data,” Inzlicht says.
Identifying the mechanisms that underlie self-control can help us to understand behaviors related to a wide range of important problems, including obesity, impulsive spending, gambling, and drug abuse. Inzlicht and Schmeichel hope that researchers will ultimately be able to use this knowledge to design effective methods for improving self-control.

Tuesday, 24 April 2012

Meditation and Stress

via derek bownds Davidson and McEwen offer a nice review of stress induced changes in the amygdala and hippocampus, and also describe experiments showing that mindfulness meditation can decrease both stress behavior and amygdala size. Here is their abstract, followed by two figures from the paper: Experiential factors shape the neural circuits underlying social and emotional behavior from the prenatal period to the end of life. These factors include both incidental influences, such as early adversity, and intentional influences that can be produced in humans through specific interventions designed to promote prosocial behavior and well-being. Here we review important extant evidence in animal models and humans. Although the precise mechanisms of plasticity are still not fully understood, moderate to severe stress appears to increase the growth of several sectors of the amygdala, whereas the effects in the hippocampus and prefrontal cortex tend to be opposite. Structural and functional changes in the brain have been observed with cognitive therapy and certain forms of meditation and lead to the suggestion that well-being and other prosocial characteristics might be enhanced through training. Figure - Chronic stress causes neurons to shrink or grow, but not necessarily to die. Representation of the chronic stress effects detected in animal models on growth or retraction of dendrites in the basolateral amygdala and orbitofrontal cortex (growth) and in the CA3 hippocampus, dentate gyrus and medial prefrontal cortex (shrinkage). These effects are largely reversible in young adult animals, although aging appears to compromise resilience and medial prefrontal cortex recovery. Figure - Change in gray matter volume in the right basolateral amygdala from pre to post 8 weeks of mindfulness based stress reduction was associated with decreases in perceived stress over this same time period (see Hölzel et al.). Individuals undergoing MBSR who showed the largest decreases in perceived stress also showed the largest decreases in basolateral amygdala gray matter volume.

Thursday, 19 April 2012

Changing Brains

Changing brains for the better: Article documents benefits of multiple practices University of Wisconsin at Madison | April 18, 2012 | Cognition / 1 share digg redditstumblefark Practices like physical exercise, certain forms of psychological counseling and meditation can all change brains for the better, and these changes can be measured with the tools of modern neuroscience, according to a review article now online at Nature Neuroscience. The study reflects a major transition in the focus of neuroscience from disease to well being, says first author Richard Davidson, professor of psychology at University of Wisconsin-Madison. The brain is constantly changing in response to environmental factors, he says, and the article “reflects one of the first efforts to apply this conceptual framework to techniques to enhance qualities that we have not thought of as skills, like well-being. Modern neuroscience research leads to the inevitable conclusion that we can actually enhance well-being by training that induces neuroplastic changes in the brain.” “Neuroplastic” changes affect the number, function and interconnections of cells in the brain, usually due to external factors. Although the positive practices reviewed in the article were not designed using the tools and theories of modern neuroscience, “these are practices which cultivate new connections in the brain and enhance the function of neural networks that support aspects of pro-social behavior, including empathy, altruism, kindness,” says Davidson, who directs the Center for Investigating Healthy Minds at UW-Madison. The review, co-written with Bruce McEwen of Rockefeller University, begins by considering how social stressors can harm the brain. The massive neglect of children in orphanages in Romania did not just have psychological impacts; it created measurable changes in their brains, Davidson says. “Such studies provide an important foundation for understanding the opposite effects of interventions designed to promote wellbeing.” Davidson says his work has been shaped by his association with the Dalai Lama, who asked him in the 1990s, “Why can’t we use the same rigorous tools of neuroscience to investigate kindness, compassion and wellbeing?” Davidson, who has explored the neurological benefits of meditation, says, “meditation is one of many different techniques, and not necessarily the best for all people. Cognitive therapy, developed in modern psychology, is one of most empirically validated treatments for depression and counteracting the effects of stress.” Overall, Davidson says, the goal is “to use what we know about the brain to fine-tune interventions that will improve well-being, kindness, altruism. Perhaps we can develop more targeted, focused interventions that take advantage of the mechanisms of neuroplasticity to induce specific changes in specific brain circuits.” Brains change all the time, Davidson emphasizes. “You cannot learn or retain information without a change in the brain. We all know implicitly that in order to develop expertise in any complex domain, to become an accomplished musician or athlete, requires practice, and that causes new connections to form in the brain. In extreme cases, specific parts of the brain enlarge or contract in response to our experience.” Scientific documentation for the benefits of brain training may have broader social impacts, says Davidson. “If you go back to the 1950s, the majority of middle-class citizens in Western countries did not regularly engage in physical exercise. It was because of scientific research that established the importance of physical exercise in promoting health and well-being that more people now engage in regular physical exercise. I think mental exercise will be regarded in a similar way 20 years from now. “Rather than think of the brain as a static organ, or one that just degenerates with age, it’s better understood as an organ that is constantly reshaping itself, is being continuously influenced, wittingly or not, by the forces around us,” says Davidson, author of the new book “The Emotional Life of Your Brain.” “We can take responsibility for our own brains. They are not pawns to external influences; we can be more pro-active in shaping the positive

Wednesday, 18 April 2012

Blood tests and depression

First blood test to diagnose major depression in teens Tue Apr 17, 2012 17:41 from RSS 2.0 by Northwestern University A Northwestern Medicine scientist has developed the first blood test to diagnose major depression in teens, a breakthrough approach that allows an objective diagnosis by measuring a specific set of genetic markers found in a patient’s blood. The current method of diagnosing depression is subjective. It relies on the patient’s ability to recount his symptoms and the physician’s ability and training to interpret them. Diagnosing teens is an urgent concern because they are highly vulnerable to depression and difficult to accurately diagnose due to normal mood changes during this age period. The test also is the first to identify subtypes of depression. It distinguished between teens with major depression and those with major depression combined with anxiety disorder. This is the first evidence that it’s possible to diagnose subtypes of depression from blood, raising the hope for tailoring care to the different types. “Right now depression is treated with a blunt instrument,” said Eva Redei, a professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine and lead investigator of the study, published in Translational Psychiatry. “It’s like treating type 1 diabetes and type 2 diabetes exactly the same way. We need to do better for these kids.” “This is the first significant step for us to understand which treatment will be most effective for an individual patient,” added Redei, also the David Lawrence Stein Professor of Psychiatric Diseases Affecting Children and Adolescents. “Without an objective diagnosis, it’s very difficult to make that assessment. The early diagnosis and specific classification of early major depression could lead to a larger repertoire of more effective treatments and enhanced individualized care.” The estimated rates of major depressive disorder jump from 2 to 4 percent in pre-adolescent children to 10 to 20 percent by late adolescence. Early onset of major depression in teens has a poorer prognosis than when it starts in adulthood. Untreated teens with this disease experience increases in substance abuse, social maladjustment, physical illness and suicide. Their normal development is derailed, and the disease persists into adulthood. The depressed teens in the study were patients of Kathleen Pajer, M.D., a co-first author of the study, and her colleagues from the Research Institute of Nationwide Children’s Hospital in Columbus, Ohio. Pajer is now head of Dalhousie University’s division of child and adolescent psychiatry in Nova Scotia, Canada. The study subjects included 14 adolescents with major depression who had not been clinically treated and 14 non-depressed adolescents, all between 15 to 19 years old. The depressed and control subjects were matched by sex and race. Redei’s lab tested the adolescents’ blood for 26 genetic blood markers she had identified in previous research. She discovered 11 of the markers were able to differentiate between depressed and non-depressed adolescents. In addition, 18 of the 26 markers distinguished between patients that had only major depression and those who had major depression combined with anxiety disorder. The blood analysis was done by Brian Andrus from Redei’s lab, the other co-first author of the study, who was blind to the diagnoses of the subjects. “These 11 genes are probably the tip of the iceberg because depression is a complex illness,” Redei said. “But it’s an entree into a much bigger phenomenon that has to be explored. It clearly indicates we can diagnose from blood and create a blood diagnosis test for depression.” Redei first isolated and identified the genetic blood markers for depression and anxiety based on decades of research with severely depressed and anxious rats. The rats mirror many behavioral and physiological abnormalities found in patients with major depression and anxiety. Further indicating the challenge in working with depressed adolescents, none of the teens who were diagnosed with depression opted for treatment. “Everybody, including parents, are wary of treatment, and there remains a social stigma around depression, which in the peer-pressured world of teenagers is even more devastating,” Redei said. “Once you can objectively diagnose depression as you would hypertension or diabetes, the stigma will likely disappear.”

Monday, 16 April 2012

Monkey Fairness Video

De Waal on Fairness with Monkey Video http://www.ted.com/talks/frans_de_waal_do_animals_have_morals.html

Thursday, 12 April 2012

Status and Health

Misery index Low social status is bad for your health. Biologists are starting to understand why Apr 14th 2012 | from the Economist ONCE upon a time the overstressed executive bellowing orders into a telephone, cancelling meetings, staying late at the office and dying of a heart attack was a stereotype of modernity. That was before the Whitehall studies, a series of investigations of British civil servants begun in the 1960s. These studies found that the truth is precisely the opposite. Those at the top of the pecking order actually have the least stressful and most healthy lives. Cardiac arrest—and, indeed, early death from any cause—is the prerogative of underlings. Such results have since been confirmed many times, both in human societies and in other primate species with strong social hierarchies. But whereas the pattern is well-understood, the biological mechanisms underlying it are not. A study just published in the Proceedings of the National Academy of Sciences, however, sheds some light on the matter. In this section »Misery index Little and not often, please To dye for Fun run Reprints In it, a group of researchers led by Jenny Tung and Yoav Gilad at the University of Chicago looked at the effects of status on rhesus macaques. Experience has shown that these monkeys display the simian equivalent of the Whitehall studies’ findings. The high risk of disease among those at the bottom of the heap in both cases suggests that biochemical responses to low status affect a creature’s immune system. Those responses must, in turn, depend on changes in the way the creatures’ genes are expressed. To investigate this phenomenon means manipulating social hierarchies, but that would be hard (and probably unethical) if it were done to human beings. You can, however, do it to monkeys, and the researchers did. Unhappy minds in unhealthy bodies Dr Tung and Dr Gilad took 49 middle-ranking female macaques (females were chosen because a lot of previous work on animal hierarchies has been done on female macaques) and split them into groups of four or five. The researchers were able to control where in a group an individual ranked by the order in which it was introduced into its group (newly introduced monkeys almost always adopt a role subordinate to existing group members). The hierarchies thus established, the team conducted tests on cells in the monkeys’ blood, in an attempt to determine the effect of a macaque’s rank on her biochemistry and, in particular, on how rank influences the activity of various genes. The answer is, a lot. Dr Tung and Dr Gilad looked at the expression in each animal of 6,097 genes (30% of the total number in a monkey genome—or, for that matter, in a human one). They were searching for correlations between social rank and gene activity, and in 987 genes they found one. Some genes were more active in high-ranking individuals; others were more active in low-ranking ones. The relationship was robust enough to work the other way round, too. Given a blood sample and no other information, it was possible to predict an individual’s status within her group with an accuracy of 80%. The next question was what all these genes actually do. Sure enough the answer, for a substantial fraction of them, was that they regulate aspects of the immune system. In particular, low-status individuals showed high levels of activity in genes associated with the production of various immune-related cells and chemical signalling factors, as well as those to do with inflammation (a general immune response that involves tissue swelling and increased immune-cell activity in the affected area). Although the researchers did not explicitly examine the health of their simian charges, chronic, generalised inflammation is a risk factor, in people, for a long list of ailments ranging from heart trouble to Alzheimer’s disease. Finally, the team investigated the mechanisms behind these differences in gene expression. In keeping with previous work, they found that high- and low-rank individuals showed different levels of responsiveness to a class of hormones called glucocorticoids, which regulate immune-system activity and response to stress. They also found changes in the mix of cells within the animals’ immune system itself. But what is new, and intriguing, is that they discovered, for the first time, evidence that a phenomenon called epigenetic change is at work. Epigenetics—currently one of molecular biology’s hottest topics—is a process by which genes are activated or deactivated by the presence or absence of chemical structures called methyl and acetyl groups. Dr Tung and Dr Gilad found that methylation patterns were systematically different in high- and low-ranking animals. Crucially, these changes are generally passed on to the daughter cells produced when a cell divides, and are thus perpetuated throughout an animal’s life. To the extent that epigenetic marking is involved in creating social status, then, status may be being maintained by the animal’s cells as they replicate. Destiny’s child? Those who believe in progress will, however, be pleased to know that epigenetics is not necessarily destiny. Methyl groups may help maintain the status quo, but if that status quo is interrupted by outside events they can be wiped away and a new lot put in place. Dr Tung and Dr Gilad discovered this because a few of their monkeys did change status within their groups. When that happened, changes in gene expression appropriate to the new status quickly followed. Those who do break free from their lowly station, then, may begin to reap the health benefits almost immediately. As with any animal study, this one cannot simply be mapped straight onto humans. But it does provide pointers that researchers who work on people can use. In particular, the experiment ensured that social rank was the only factor being changed, providing strong evidence that the chain of causality runs from low social status, through a disrupted immune system to worse health, and not the other way around. The best medicine, then, is promotion. Prosper, and live long

Depressive Cognition Scale

Negative thinking is a red flag for clinical depression. Stopping such thoughts early on can save millions of people from mental illness, according research study from the Frances Payne Bolton School of Nursing at Case Western Reserve University. Jaclene Zauszniewski, the Kate Hanna Harvey Professor in Community Health Nursing and associate dean for doctoral education at the school, has developed a brief 8-item survey to help healthcare providers identify depressive thinking patterns that may lead to serious depression if not identified and addressed early. Zauszniewski’s Depression Cognition Scale (DCS) asks individuals to respond to questions about helplessness, hopelessness, purposelessness, worthlessness, powerlessness, loneliness, emptiness and meaninglessness using a scale that ranges from “strongly agree” to “strongly disagree.” “Clinicians need guidelines and measures to know when negative thinking has reached a tipping point and has begun to spiral into clinical depression,” she said. The DCS has been used effectively to screen for more serious depressive symptoms in persons in the U.S. and around the world, but the researchers wanted to take it further and determine the point at which negative thinking establishes a pattern for the onset of clinical depression—even without other emotional expressions or body symptoms associated with depression. In a study of 629 healthy adults from 42 states who responded to questions through the Internet survey, they found the answer. Participants ranged in age from 21 to 84 years, and 70 percent were women; women make up the majority depression sufferers. The majority of the participants were college educated and had incomes greater than $40,000. For this study, the researchers compared DCS scores to the Center for Epidemiologic Studies Depression Scale (CES-D), which is recognized as a “gold standard” measure for identifying clinically significant depressive symptoms. Their goal was to determine a cut score on the DCS that would represent the point at which individuals may benefit from learning ways to change negative thinking in order to prevent serious depression. They found that a score of 7 on the DCS would be that point at which individuals should begin initiating strategies to change negative thoughts into positive ones. The findings also showed that at this cut score, the DCS accurately differentiated between persons with and without clinical depressive symptoms as determined by the CES-D. Zauszniewski and Abir K. Bekhet, a researcher from Marquette University in Milwaukee, report their findings in Issue 34 of the Western Journal of Nursing Research article, “Screening Measure for Early Detection of Depressive Symptoms: The Depressive Cognition Scale.”

Wednesday, 11 April 2012

Social ranking and Stress

Social stress changes immune system gene expression in primatesopen original article Tue Apr 10, 2012 18:11 from RSS 2.0 by University of Chicago Medical Center The ranking of a monkey within her social environment and the stress accompanying that status dramatically alters the expression of nearly 1,000 genes, a new scientific study reports. The research is the first to demonstrate a link between social status and genetic regulation in primates on a genome-wide scale, revealing a strong, plastic link between social environment and biology. In a comparison of high-ranking rhesus macaque females with their low-ranking companions, researchers discovered significant differences in the expression of genes involved in the immune response and other functions. When a female’s rank improved, her gene expression also changed within a few weeks, suggesting that social forces can rapidly influence genetic regulation. “We were able to use gene expression to classify individuals based on their rank,” said Yoav Gilad, PhD, associate professor of human genetics at the University of Chicago Biological Sciences and senior author of the study in PNAS. “Demonstrating these very plastic and temporal changes was novel and quite interesting.” The research, led by University of Chicago postdoctoral researcher Jenny Tung, was conducted with rhesus macaques housed in groups of five at the Yerkes National Primate Research Center in Atlanta. As in the wild, each group self-organizes into a dominance hierarchy, defined by which individual yields first during competition over food, water and grooming partners. In captivity, dominance is determined by the order of introduction into the group, giving researchers an opportunity to study how changes in rank lead to biological effect. “In the wild, females would not ordinarily leave the social group they were born into,” said Tung, PhD, now an assistant professor of evolutionary anthropology at Duke University. “They inherit their social rank from their mothers. But in this unnatural situation, order of introduction determines rank – the newcomer is generally lower status.” Previous research on rhesus macaques discovered that social rank influenced components of the stress response, brain, and immune system. With gene chip technology for measuring the expression of over 6,000 different genes, Tung, Gilad and colleagues at Yerkes, Emory University, and Johns Hopkins looked for the first time in primates at the effects of social rank on genetic function. Comparing 49 different female monkeys of different rank revealed significant changes in the expression of 987 genes, including 112 genes associated with immune system function. The result fits with data in monkeys where low rank and chronic stress lead to compromised immune function, and, more loosely, with human studies linking low socioeconomic status and high social stress to elevated disease risk. The overall genetic “signature” of expression changes was robust enough that researchers could predict an individual monkey’s social rank with high accuracy from their gene expression profile alone. That predictive power also enabled an unanticipated second test of whether gene expression would reflect unplanned changes in dominance rank. “It was a fortunate event in the experiment,” Gilad said. “When a couple of animals were removed from cages for various reasons and new ones were introduced to the groups, it turned out to improve the rank of a few monkeys. We could take advantage of this switch and see if our classifier still works.” By analyzing blood samples from these monkeys before and after their move, the researchers were able to use gene expression signatures to correctly predict the change in rank for six of seven monkeys. The result demonstrates that socially-induced gene expression changes are not stable, but can change rapidly in response to changes in social environment. “There’s a spooky side to this kind of research, in that an individual’s social rank is partially determining health status,” Tung said. “But there’s also a hopeful side. For the seven females that changed ranks, their gene status changed with them. They’re not stuck in place, and I think that says something more broadly about the capacity for change.” The researchers also investigated the mechanisms by which social status could influence gene expression. Dominance rank affected signaling of the glucocorticoid “stress hormone” system and the cell composition of blood samples, both of which contributed to changes in gene expression. Experiments also demonstrated for the first time that social rank influenced the DNA methylation status of many genes, an epigenetic mechanism of transiently turning genes on and off. Genes that changed expression with rank status were more likely to be methylated than unaffected genes, suggesting that this mechanism also plays a role in the social influence on genetic regulation. “That’s a novel mechanism that people haven’t considered in primates,” Gilad said. “I know that some have been resistant to the possibility of methylation changes on this timescale, but this is a demonstration that this mechanism also matters.” The authors caution that the experiments used monkeys in captivity, and stressed that the relationship between stress and gene regulation in the wild might not look the same. The influence of social factors on human genetics also remains to be tested, and measuring status while controlling for confounding factors in people would be a difficult endeavor, Gilad said. But if social stress does in fact influence human health, the current research provides some optimism. “An encouraging message to humans is the fact that the effects are plastic, reversible and change on a really large scale when rank changes,” Gilad said. “Whatever it is that causes stress through social environment, you might be able to fix.”