Tag: depression

Does smoking increase your risk for dementia and cognitive decline?

Photo by Abhishek Koli on Unsplash

Scientists from the Uniformed Services University (USU), Emory University and the University of Vermont have found that cigarette smoking is linked to increased lesions in the brain’s white matter, called white matter hyperintensities.  White matter hyperintensities, detected by MRI scan, are associated with cognitive decline and Alzheimer’s disease. These findings may help explain the link between smoking and increased rates of dementia and other forms of cognitive decline.

The study, “Associations of cigarette smoking with gray and white matter in the UK Biobank” was published online in the journal, Neuropsychopharmacology, https://rdcu.be/b1jPS

In June 2019, the Surgeons General of the Army, Navy, Air Force, and United States, released an open letter stating that tobacco use is a threat to the health and fitness of U.S. military forces and compromises readiness. This burden also extends to care provided by the Veterans Health Administration, which spends more than $2.5 billion annually on smoking-related care.  In response, Dr. Joshua Gray, assistant professor of Medical and Clinical Psychology and Neuroscience at USU, and colleagues, examined the association between cigarette smoking and brain structure. Cigarette smoking is associated with increased risk for myriad health consequences including increased risk for neuropsychiatric conditions, but research on the link between smoking and brain structure is limited.

Their study was the largest of its kind, including MRI brain scans from more than 17,000 individuals from the UK Biobank, a large cohort of volunteers from across the United Kingdom. They found that smoking was associated with smaller total gray and white matter volume, increased white matter lesions, and variation in specific gray matter regions and white matter tracts. By controlling for important variables that often co-occur with smoking, such as alcohol use, this study identified distinct associations between smoking and brain structure, highlighting potential mechanisms of risk for common neuropsychiatric consequences of smoking such as depression and dementia.

“Cigarette smoking is known to elevate risk for neuropsychiatric conditions such as depression and dementia. We found that smoking is associated with multiple aspects of brain structure, in particular with increased white matter lesions. White matter lesions are linked to many of the same neuropsychiatric diseases as smoking,” said Gray.  “Although further research is needed to understand to what extent smoking is a cause or consequence of these aspects of brain structure, our findings suggest a mechanism that links smoking to increased risk for dementia, depression, and other brain diseases.”

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When chronic pain leads to depression in children

When chronic pain keeps children from being active and social, it’s no surprise that anxiety and depression can become unwelcome playmates.

Unfortunately, this scenario can become a vicious cycle—not only can pain lead to depression and anxiety, but worsening depression and anxiety can worsen pain perception.

Overall, about 5 to 20 percent of children live with chronic pain, usually in the form of musculoskeletal pain, headaches or abdominal pain associated with medical conditions such as juvenile fibromyalgia, juvenile arthritis, sickle cell anemia, migraines, Crohn’s disease, irritable bowel syndrome or chronic cancer.

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“Parents may feel helpless and frightened as they watch their children try to cope—which can make them feel anxious and depressed, just when they need to be their child’s biggest cheerleader,” said Dr. Taranjeet Jolly, an adult and pediatric psychiatrist at Penn State Health Milton S. Hershey Medical Center.

Sound familiar? If so, don’t despair. There is help, and it starts with recognizing that a problem exists, Jolly said.

“Look for red flags that depression may be overwhelming your child. Often your first clue is a change in their everyday routine,” Jolly said. “Is their sleep time way up or down? Is there a marked change in their social interaction? Maybe they are more irritable, angry or emotional.”

Jolly suggests starting by talking with your child to get an idea of what might be going on; however, sometimes children might not be able to directly explain or describe depression. The next step would be to follow up with a pediatrician who can rule out other causes of low energy, poor sleep etc. Once it’s established that the child is suffering from depression, a referral to a child psychiatrist is recommended, depending on the complexity of the case.

“The treatment varies according to the level of severity, but something called cognitive behavioral therapy can almost always help,” Jolly said. This approach to pain management is designed to teach children and adolescents coping skills for controlling behavioral, cognitive and physiological responses to pain.

Cognitive behavioral therapy involves educating children and parents about mechanisms by which pain messages are transmitted and perceived as well as the role of the individual in these processes.

Children can be taught various pain-coping skills with guidance in applying the skills in difficult situations. Such skills might include decreasing cognitive responses to pain and relaxation strategies such as distraction, guided imagery and progressive muscle relaxation—because nerve fibers can actually open or close the gate for pain channels.

Medication is another option—typically nonsteroidal anti-inflammatory drugs such as ibuprofen and sometimes an anti-depressant. Opioids are not found to be very helpful when dealing with chronic pain issues and can also lead to addiction.

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Good sleep habits, aerobic exercise, good social support, positive self-statements—such as “I am stronger than this disease”—and keeping busy are also key to restoring normal function.

Parents should take an active role in promoting their child’s re-entry into school and other social environments. The goals of therapy should focus on promoting function rather than simply alleviating pain. The more functional the patient is, the less pain they feel.

Jolly also encourages parents to work closely with their child’s multidisciplinary medical team—which may include a behavioral specialist/pain psychologist, pain physician, child psychiatrist and physical therapist—to design a plan for physical activity. “It’s a team game where the goal is to help your child stop thinking about the pain and gain as much functionality as possible.”

“As with all challenges in life, some days are better than others, but always trying is the key,” Jolly said.

Borderline Personality Disorder—as Scientific Understanding Increases, Improved Clinical Management Needed

Even as researchers gain new insights into the neurobiology of borderline personality disorder (BPD), there’s a pressing need to improve diagnosis and management of this devastating psychiatric condition.

The special issue comprises seven papers, contributed by experts in the field, providing an integrated overview of research and clinical management of BPD. “We hope these articles will help clinicians understand their BPD patients, encourage more optimism about their treatability, and help set a stage from which the next generation of mental health professionals will be more willing to address the clinical and public health challenges they present,” according to a guest editorial by Drs. Lois Choi-Kain and John Gunderson of the Adult Borderline Center and Training Institute at McLean Hospital, Belmont, Mass.

Borderline Personality Disorder—Research Advances, Emerging Clinical ApproachesAlthough the diagnostic criteria for BPD are well-accepted, it continues to be a misunderstood and sometimes neglected condition; many psychiatrists actively avoid making the diagnosis. Borderline personality disorder accounts for nearly 20 percent of psychiatric hospitalizations and outpatient clinic admissions, but only three percent of the research budget of the National Institute of Mental Health. (The NIMH provides information about BPD online at www.nimh.nih.gov/health/topics/borderline-personality-disorder)

The Guest Editors hope their special issue will contribute to overcoming the disparity between BPD’s public health importance and the attention received by psychiatry. Highlights include:• A research update on the neurobiology of BPD. Evidence suggests that chronic stress exposure may lead to changes in brain metabolism and structure, thus affecting the processing and integration of emotion and thought. This line of research might inform new approaches managing BPD—possibly including early intervention to curb the neurobiological responses to chronic stress.• The urgent need for earlier intervention. A review highlights the risk factors, precursors, and early symptoms of BPD and mood disorders in adolescence and young adulthood. While the diagnosis of BPD may be difficult to make during this critical period, evaluation and services are urgently needed.• The emergence of evidence-based approaches for BPD. While these approaches have raised hopes for providing better patient outcomes, they require a high degree of specialization and treatment resources. A stepped-care approach to treatment is proposed, using generalist approaches to milder and initial cases of BPD symptoms, progressing to more intensive, specialized care based on clinical needs.• The critical issue of BPD in the psychiatric emergency department. This is a common and challenging situation in which care may be inconsistent or even harmful. A clinical vignette provides mental health professionals with knowledge and insights they can use as part of a “caring, informed, and practical” approach to helping BPD patients in crisis.

The special issue also addresses the critical issue of resident training—preparing the next generation of mental health professionals to integrate research evidence into more effective management for patients and families affected by BPD. Drs. Choi-Kain and Gunderson add, “For clinicians, educators, and researchers, we hope this issue clarifies an emerging basis for earlier intervention, generalist approaches to care for the widest population, and a more organized approach to allocating care for individuals with BPD.”

About the Harvard Review of PsychiatryThe Harvard Review of Psychiatry is the authoritative source for scholarly reviews and perspectives on a diverse range of important topics in psychiatry. Founded by the Harvard Medical School Department of Psychiatry, the journal is peer-reviewed and not industry sponsored. It is the property of Harvard University and is affiliated with all of the Departments of Psychiatry at the Harvard teaching hospitals. Articles encompass all major issues in contemporary psychiatry, including (but not limited to) neuroscience, psychopharmacology, psychotherapy, history of psychiatry, and ethics.

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Higher rates of post-natal depression among autistic mothers

Autistic mothers are more likely to report post-natal depression compared to non-autistic mothers, according to a new study of mothers of autistic children carried out by researchers at the University of Cambridge

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A better understanding of the experiences of autistic mothers during pregnancy and the post-natal period is critical to improving wellbeing. The results are published in Molecular Autism.

The team recruited an advisory panel of autistic mothers with whom they co-developed an anonymous, online survey. After matching, this was completed by 355 autistic and 132 non-autistic mothers, each of whom had at least one autistic child.

Sixty percent of autistic mothers in the study reported they had experienced post-natal depression. By comparison, only 12% of women in the general population experience post-natal depression. In addition, autistic mothers had more difficulties in multi-tasking, coping with domestic responsibilities, and creating social opportunities for their child.

The study also found that when autistic mothers disclosed their autism diagnosis to a professional, they were not believed the majority of the time. Autistic women felt misunderstood by professionals more frequently during pre- and post-natal appointments and found motherhood an isolating experience. Despite these challenges, autistic mothers reported they were able to act in the best interest of their child, putting their child’s needs first and seeking opportunities to boost their child’s self-confidence.

Dr Alexa Pohl, who led the study, said: “Autistic mothers face unique challenges during the perinatal period and parenthood. Despite these challenges, an overwhelming majority of autistic mothers reported that parenting overall was a rewarding experience. This research highlights the need for increased awareness of the experiences of motherhood for autistic women and the need for more tailored support.”

Professor Simon Baron-Cohen, Director of the Autism Research Centre at Cambridge, and part of the team, said: “This worryingly high number of autistic mothers who experience post-natal depression means we are failing them and their infants at a critical point in their lives. We now need more research into why the rates are so much higher, whether they are seeking help and not getting it, or if they are not seeking help and for what reasons. A new research priority is to develop autism-relevant screening tools and interventions for post-natal depression in these mothers.”

Monique Blakemore, an autistic advocate and member of the team, said: “This vital study was initiated by the autistic community, who collaborated as equal partners with researchers in the design, dissemination and interpretation of the survey. This is an excellent example of what can be achieved through such partnership.”

The study was supported by the National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC), East of England, at Cambridgeshire and Peterborough NHS Foundation Trust, the Autism Research Trust, the MRC, the NIHR Cambridge Biomedical Research Centre, and Autistica.

Reference

A comparative study of autistic and nonautistic women’s experience of motherhood by Alexa Pohl, Sarah Crockford, Monique Blakemore, Carrie Allison and Simon Baron-Cohen. Molecular Autism. DOI: 10.1186/s13229-019-0304-2

Taking Antidepressants During Pregnancy Increases Risk of Autism by 87%

Ground breaking study published in JAMA Pediatrics looks at outcomes of 145,456 pregnancies after antidepressant use

Credit: Hepingting, CC BY SA 2.0, https://flic.kr/p/95h8gu

Using antidepressants during pregnancy greatly increases the risk of autism, Professor Anick Bérard of the University of Montreal and its affiliated CHU Sainte-Justine children’s hospital revealed today. Prof. Bérard, an internationally renowned expert in the fields of pharmaceutical safety during pregnancy, came to her conclusions after reviewing data covering 145,456 pregnancies. “The variety of causes of autism remain unclear, but studies have shown that both genetics and environment can play a role,” she explained. “Our study has established that taking antidepressants during the second or third trimester of pregnancy almost doubles the risk that the child will be diagnosed with autism by age 7, especially if the mother takes selective serotonin reuptake inhibitors, often known by its acronym SSRIs.” Her findings were published today in JAMA Pediatrics.

Using antidepressants during pregnancy greatly increases the risk of autism, Professor Anick Bérard of the University of Montreal and its affiliated CHU Sainte-Justine children’s hospital revealed today. Prof. Bérard, an internationally renowned expert in the fields of pharmaceutical safety during pregnancy, came to her conclusions after reviewing data covering 145,456 pregnancies. “The variety of causes of autism remain unclear, but studies have shown that both genetics and environment can play a role,” she explained. “Our study has established that taking antidepressants during the second or third trimester of pregnancy almost doubles the risk that the child will be diagnosed with autism by age 7, especially if the mother takes selective serotonin reuptake inhibitors, often known by its acronym SSRIs.” Her findings were published today in JAMA Pediatrics.

Bérard and her colleagues worked with data from the Quebec Pregnancy Cohort and studied 145,456 children between the time of their conception up to age ten. In addition to information about the mother’s use of antidepressants and the child’s eventual diagnosis of autism, the data included a wealth of details that enabled the team to tease out the specific impact of the antidepressant drugs. For example, some people are genetically predisposed to autism (i.e., a family history of it.) Maternal age, and depression are known to be associated with the development of autism, as are certain socio-economic factors such as being exposed to poverty, and the team was able to take all of these into consideration. “We defined exposure to antidepressants as the mother having had one or more prescription for antidepressants filled during the second or third trimester of the pregnancy. This period was chosen as the infant’s critical brain development occurs during this time,” Prof. Bérard said. “Amongst all the children in the study, we then identified which children had been diagnosed with a form of autism by looking at hospital records indicating diagnosed childhood autism, atypical autism, Asperger’s syndrome, or a pervasive developmental disorder. Finally, we looked for a statistical association between the two groups, and found a very significant one: an 87% increased risk.” The results remained unchanged when only considering children who had been diagnosed by specialists such as psychiatrists and neurologists.

The findings are hugely important as six to ten percent of pregnant women are currently being treated for depression with antidepressants. In the current study, 1,054 children were diagnosed with autism (0.72% of the children in the study), on average at 4.5 years of age. Moreover, the prevalence of autism amongst children has increased from 4 in 10,000 children in 1966 to 100 in 10,000 today. While that increase can be attributed to both better detection and widening criteria for diagnosis, researchers believe that environmental factors are also playing a part. “It is biologically plausible that anti-depressants are causing autism if used at the time of brain development in the womb, as serotonin is involved in numerous pre- and postnatal developmental processes, including cell division, the migration of neuros, cell differentiation and synaptogenesis – the creation of links between brain cells,” Prof. Bérard explained. “Some classes of anti-depressants work by inhibiting serotonin (SSRIs and some other antidepressant classes), which will have a negative impact on the ability of the brain to fully develop and adapt in-utero”

The World Health Organization indicates that depression will be the second leading cause of death by 2020, which leads the researchers to believe that antidepressants will likely to remain widely prescribed, including during pregnancy. “Our work contributes to a better understanding of the long-term neurodevelopmental effects of anti-depressants on children when they are used during gestation. Uncovering the outcomes of these drugs is a public health priority, given their widespread use,” Prof. Bérard said.

About this study:Takoua Boukhris, Odile Sheehy, Laurent Mottron, MD, PhD, and Anick Bérard, PhD, published “Antidepressant use during pregnancy and the risk of autism spectrum disorder in children” in JAMA Pediatrics on December 14, 2015.

Anick Bérard, PhD, is a professor at the University of Montreal’s Faculty of Pharmacy and a researcher at the CHU Sainte-Justine Research Centre.

This study was supported by the Canadian Institutes of Health Reseach (CIHR) “Quebec Training Network in Perinatal Research”, and the Fonds de la recherche du Québec – Santé (FRQ-S).,

Dr. Bérard is the recipient of a FRQ-S research Chair on Medications and Pregnancy. Dr Bérard is a consultant for plaintiffs in litigations involving antidepressants and birth defects.

The University of Montreal is officially known as Université de Montréal.

Black Teens Face Racial Discrimination Multiple Times Daily

Teens in study experience anti-black microaggressions most frequently online, according to Rutgers researcher

Black teenagers experience daily racial discrimination, most frequently online, which can lead to negative mental health effects, according to a Rutgers researcher.

The study, published in the Journal of Applied Developmental Psychology, examined how often black teens experience racial discrimination each day – either personally or vicariously and online or offline.

The researchers surveyed 101 black youth between ages 13 and 17 from predominantly black neighborhoods in Washington, D.C., each day for two weeks about their experiences with racial discrimination and measured changes in their depressive symptoms across that period. The teens reported more than 5,600 experiences of racial discrimination in total – an average of more than five experiences per day.

“This research reflects what researchers and activists have asserted for years: Black adolescents are forced to face antiblack microaggressions on a daily basis. Importantly, this study expands the research on the many ways that discrimination happens, whether it is being teased by peers, asked to speak for their racial group in class or seeing a racist post on social media,” said lead author Devin English, an assistant professor at Rutgers School of Public Health.

The experiences reported in the study, which ranged from teasing about physical appearance to overt discrimination, mainly occurred online and led to short-term increases in depressive symptoms. Examples of discrimination included teasing by peers about wearing their hair natural, seeing jokes about their race online and witnessing a family member or friend being treated poorly due to their race or ethnicity.

“Racial teasing is important because it is one of the most common ways adolescents communicate about race,” English noted. “Critically, young people and adults, such as teachers, often see this teasing as harmless and choose not to address it. Our results, however, show several types of racial teasing are harmful for black adolescents.”

“Although public discourse can indirectly or directly blame health inequities on black youth, our study provides evidence that racial discrimination in society is a fundamental cause of these health inequities,” he continued. “Knowing this, people in positions of power such as clinicians, school administrators and policy makers have a responsibility to consider discrimination as a critical aspect of the daily experience and health of black teens. Racial discrimination prevention should be a public health imperative.”

Borderline Mother and Autism (Part 1)

Credit Photo Velizar Ivanov

By Fabrizio Catalfamo

“I would like to point out that this is not an article to blame mothers but a simple (non-technical) analysis, the result of personal experiences, therefore to be read in a narrative and non-scientific way, on the other hand I would not have the necessary qualifications.”

I am the father of three splendid boys, two of those born of a second marriage. One of the two youngest will turn twelve in four days, diagnosed in autism spectrum when he was 3 years old. The mother, never diagnosed (also because she refuses every test) in my opinion with deep teenage borderline wounds.

Borderline Personality Disorder (BPD)

Is a condition characterized by difficulties regulating emotion. This means that people who experience BPD feel emotions intensely and for extended periods of time, and it is harder for them to return to a stable baseline after an emotionally triggering event.

This difficulty can lead to impulsivity, poor self-image, stormy relationships and intense emotional responses to stressors. Struggling with self-regulation can also result in dangerous behaviors such as self-harm (e.g. cutting).

It’s estimated that 1.4% of the adult U.S. population experiences BPD. Nearly 75% of people diagnosed with BPD are women. Recent research suggests that men may be equally affected by BPD, but are commonly misdiagnosed with PTSD or depression. 

Autism is related to emotional disorder

I lived for more than 10 years with the mother of my 2 children and after the first apparently “normal” times, the borderline personality manifested itself.
This led me to try to understand the reasons and the causes of all this, reading and informing myself, about this type of disorder that destroyed the relations of this woman at the same speed as everyone could fall in love with her.

Over time, I learned to recognize this kind of personality and at the same time for obvious reasons, I met parents of other autistic children. The thing that struck me at the beginning was that, the most part of the parents were single parents and those that were not, presented with evidence the presence of the man, subordinate to the woman. Clearly in the rare cases of couples, the man appeared as a second-rate figure.
I wouldn’t want to bore you too much with this story, I promise you I’ll follow up on the next posts.
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Narcissism Reduce Chances of Depression

Photo by Amir Geshani

Queen’s University Belfast

People who have grandiose narcissistic traits are more likely to be ‘mentally tough’, feel less stressed and are less vulnerable to depression, research led by Queen’s University Belfast has found.

While narcissism may be viewed by many in society as a negative personality trait, Dr Kostas Papageorgiou, who is Director of the InteRRaCt Lab in the School of Psychology at Queen’s, has revealed that it could also have benefits. He has published two papers on narcissism and psychopathology in Personality and Individual Differences and European Psychiatry.

Dr Papageorgiou explains: “Narcissism is part of the ‘Dark Tetrad’ of personality that also includes Machiavellianism, Psychopathy and Sadism. There are two main dimensions to narcissism – grandiose and vulnerable. Vulnerable narcissists are likely to be more defensive and view the behaviour of others as hostile whereas grandiose narcissists usually have an over inflated sense of importance and a preoccupation with status and power.”

He adds: “Individuals high on the spectrum of dark traits, such as narcissism, engage in risky behaviour, hold an unrealistic superior view of themselves, are overconfident, show little empathy for others, and have little shame or guilt.

“However, what this research has questioned is – if narcissism, as an example of the dark tetrad, is indeed so socially toxic, why does it persist and why is it on the rise in modern societies?”

The papers include three independent studies each involving more than 700 adults in total and highlights some positive sides of narcissism, such as resilience against symptoms of psychopathology.

A key finding of the research was that grandiose narcissism can increase mental toughness and this can help to offset symptoms of depression. It also found that people who score high on grandiose narcissism have lower levels of perceived stress and are therefore less likely to view their life as stressful.

The research is a fresh approach to the study of personality and psychopathology, highlighting that there are some positives to be found in terms of potential societal impact.

Dr Papageorgiou comments: “The results from all the studies that we conducted show that grandiose narcissism correlates with very positive components of mental toughness, such as confidence and goal orientation, protecting against symptoms of depression and perceived stress.

“This research really helps to explain variation in symptoms of depression in society – if a person is more mentally tough they are likely to embrace challenges head on, rather than viewing them as a hurdle.

Dr Papageorgiou says: “While of course not all dimensions of narcissism are good, certain aspects can lead to positive outcomes.

“This work promotes diversity and inclusiveness of people and ideas by advocating that dark traits, such as narcissism, should not be seen as either good or bad, but as products of evolution and expressions of human nature that may be beneficial or harmful depending on the context.

“This move forward may help to reduce the marginalisation of individuals that score higher than average on the dark traits. It could also facilitate the development of research-informed suggestions on how best to cultivate some manifestations of these traits, while discouraging others, for the collective good.”

An event on Mental Toughness and Narcissism is being held at Queen’s on 15 November 2019, for more information visit https://aqrinternational.co.uk/event/mental-toughness-symposium.