Psychology

Director of the National Institute for Mental Health Thomas Insel gives a TED Talk on the new domain criteria research direction, and how an important first step is to reframe mental illness as brain disorders. By doing so, diverse fields like psychology, cognitive science, molecular neuroscience, genetics, psychiatry, and more can work together toward a new understanding of the mind.

Any Pittsburgh Steeler fan over the age of 36 could tell you about Mike Webster.  He was our All-Pro center who, alongside Terry Bradshaw, Jack Lambert, Franco Harris, Mean Joe Greene and so many notorious others, carried the team to four Super Bowl wins in the 1970s.  Mike was bigger than Mean Joe but known for a heart of gold. Pittsburgh heard the news a little before it went national in 2002. Webster died at the young age of 50 after a few years of suddenly erratic behavior occasionally reported upon in local papers. His life had unraveled inexplicably, not due to drugs or alcohol but some strange other force. He seemed sidelined by debilitating depression, disjointed thinking in public, and bouts of anger previously foreign to his easy nature off the field. There were murmurings but nothing made fully public until after Webster’s death. The diagnosis was a first for the National Football League (NFL), but one that slowly made its way into the banner headlines of the game over the next decade: Chronic Traumatic Encephalopathy (CTE). Indeed, the diagnosis was becoming intrinsically connected to America’s most popular sport. Doctors surmised that what happened to Webster’s brain happened because of the hits he took to the head as a football player. Now such hits, even at the junior and high school level of playing all across our country, are being critically examined and debated, and the NFL is scrambling to defend itself against unprecedented legal action by former players and their families. Webster’s family felt like he had been disappearing before their eyes. And the city of Pittsburgh sighed and seemed to collectively look away upon hearing of his confused state and eventual death — saddened and ashamed that a sports hero and gentle man could be so reduced by ill mental health.   But no one forgot Mike Webster as a Steeler, a man who had to compete against mental illness or this brain disease. At the Brain Injury Research Institute in Pittsburgh, Webster’s son Garrett approaches families about brain donations. With in-depth study, more is being learned about just how debilitating continual hits to the head are to athletes and soldiers. Such work seems to have had an effect over the 10 years since Webster made an even bigger impact off the field. David Duerson and Ray Easterling were two NFL players also likely suffering from brain injury. They committed suicide in ensuing years after after Webster’s bout with brain disease, and both left notes to donate their brains for research. They and their families and, it seems, society had begun to see all the hits more clearly. The NFL currently is fighting a lawsuit led by former players or their families. It doesn’t matter if either the league or the players knew the dangers. Generous compensation for hits to the head resulting in disability or death is called for.

I spend a lot of time thinking about questions such as, “How do we change?” “Why is it so hard to make ourselves do things that we want to do?” For instance, Why is it so hard to make myself go to bed? and “How can we stick to our resolutions? I realize now that a big challenge for me is simply finding clarity. Often, if there’s something that I want to do, but somehow can’t get myself to do, it’s because I don’t have clarity. This lack of clarity often arises from a feeling of ambivalence — I want to do something, but I don’t want to do it; or I want one thing, but I also want something else that conflicts with it. Here’s a conflict: It’s nice when my older daughter is around while she does her homework; on the other hand, it’s good for her to be in her room without the distractions of family noise. So do I nudge her to go to her room, or do I let her stay in the kitchen? I can never decide. These days, when I’m trying to get myself to pursue some course of action, I work hard to make sure I know exactly what I expect from myself, and why, and what value I’m choosing to serve. I don’t think I’m the only one who struggles with this problem. Lack of clarity, and the paralysis that ensues, seems to be common. Here’s a list of aims in conflict that I’ve heard. Do any ring a bell for you? I want to eat healthfully. It’s wrong to waste any food. I want to give 110% to work. I want to give 110% to my family. I want to work on my novel. I want to exercise. I want to get more sleep. I want some time each day to talk to my sweetheart, watch TV, and goof around. I want to spend less time in the car. I want my children to participate in many after-school activities. Making money is not important. Making money is important. I want to be very accessible to other people. I want time alone to think and work. I want to be a polite guest. I want to avoid sugar. I want to be frugal. I want to join a gym. I want leisure time when I come home from work. I want to live in a house that’s clean and well-run. I want to meet new people and see my friends. I want more solitude. I want to stop nagging you. I want you to help me. Have you experienced this–a paralysis that comes from conflicting values? Check out this 1-minute video about 10 ways to be happier at home. One tip proved controversial; I almost tweaked it but then decided to leave it. Can you guess which one? Of course, the book Happier at Home is more thoughtful — but it was fun to come up with a list of ten.

Soldiers who suffer more than one mild traumatic brain injury (TBI) face a significantly higher risk of suicide, according to a new study. Researchers from the National Center for Veterans Studies at the University of Utah also found that the risk for suicidal behaviors and thoughts increased not only in the short term, but during the soldier’s entire life. “Up to now, no one has been able to say if multiple TBIs, which are common among combat veterans, are associated with higher suicide risk or not,” said the study’s lead author, Craig J. Bryan, Ph.D., assistant professor of psychology at the University of Utah and associate director of the National Center for Veterans Studies. “This study suggests they are, and it provides valuable information for professionals treating wounded combat servicemen and women to help manage the risk of suicide.” During a six-month period in 2009, 161 patients who received a suspected brain injury while on duty in Iraq were referred to an outpatient TBI clinic at a combat support hospital. The researchers found that one in five (21.7 percent) who had sustained more than one TBI reported suicidal ideation, described as thoughts about or preoccupation with suicide. For those who had received one TBI, 6.9 percent reported having suicidal thoughts. Zero percent of those with no TBIs reported suicidal thoughts. In evaluating the lifetime risk, researchers asked patients if they had ever experienced suicidal thoughts and behaviors up to the point they were assessed. The increases were similar for suicidal thoughts during the previous year rather than at any time, according to the researchers. They found that 12 percent of those with multiple TBIs had entertained suicidal ideas during the past year, compared with 3.4 percent with one TBI, and 0 percent for no TBIs. The researchers explained that they used suicidal ideation as the indicator of suicide risk because too few patients reported a history of making a suicide plan or had made a suicide attempt for statistically valid conclusions to be made. Researchers also found that multiple TBIs were associated with a significant increase in other psychological symptoms, including depression and post-traumatic stress disorder (PTSD). However, only the increase in depression severity predicted an increased suicide risk, they noted. “That head injury and resulting psychological effects increase the risk of suicide is not new,” Bryan said. “But knowing that repetitive TBIs may make patients even more vulnerable provides new insight for attending to military personnel over the long-term, particularly when they are experiencing added emotional distress in their lives.” Because researchers were in Iraq, they were able to compile “a unique data set on active military personnel and head injury,” Bryan said. “We collected data on a large number of service members within two days of impact.” He noted that researchers assessed only patients with mild or no TBI at the combat hospital. Those with moderate to severe TBI were immediately evacuated from Iraq. The patients remaining in the study were divided into three groups based the total number of TBIs during their entire lives — zero, one, and two or more. The most recent TBI was typically within the days immediately preceding their evaluation and inclusion in the study. Each soldier was also surveyed about their symptoms of depression, PTSD and concussions, and their suicidal thoughts and behaviors. TBI is considered a “signature injury” of the Iraq and Afghanistan conflicts, according to the researchers. They note it is of particular concern because of the frequency of concussive injuries from explosions and other combat-related incidents. Estimated prevalence of TBI for those deployed in these two countries ranges from 8 percent to 20 percent, according to a 2008 study. Additionally, past studies have found that suicide is the

“It’s a funny thing,” Jane Jacobs told an interviewer in an interview I cannot find, “you can’t change something unless you love it.” (By “change” she meant improve.) She had seen that people who disliked cities gave poor advice about improving them and understood that it wasn’t just cities. To improve something, it isn’t enough to have a good idea. You also need to (a) pay close attention and (b) overcome obstacles. (a) and (b) aren’t easy. You are unlikely to do them without strong motivation, such as love. Jacobs’s point is at the heart of the success of my personal science. My personal science is hugely different from professional science, but different may or may not be better. It has succeeded, I’m sure, because of what Jacobs says. How did I manage to find new ways to sleep better, lose weight, and so on? I had good ideas, yes, but so do many people, including professional scientists. One reason for my success: I observed myself closely. Now and then I noticed outliers (e.g., nights when I slept unusually well, days when I lost my appetite). These gave me ideas to test. In professional science, this rarely happens. For one thing, they can’t wait for outliers. They are under pressure to get results soon. Another reason for my success: I persisted. For many years, I measured my weight, sleep, mood, and so on. Unlike a professional scientist, I had no required output. I could spend as much time as necessary. I keep coming back to this because Jacobs’s point is absent from conventional American thinking, such as New York Times op-eds. But it is illustrated again and again. A recent episode of This American Life, titled “Dr. Gilmer and Mr. Hyde“, is about two doctors named Gilmer: Dr. Benjamin Gilmer and Dr. Vince Gilmer (who are unrelated). VG kills his father and goes to jail. BG replaces him at a rural clinic. His patients tell him what a nice man VG was. This puzzles BG: Why would such a nice man kill his father? The legal system had ignored this question or at least not provided a convincing answer. BG, on the other hand, actually cares. (Spoiler alert.) He gathers information about the case and visits VG in prison. With the help of a psychiatrist friend, he comes up with a new idea: VG has Huntington’s disease, whose symptoms include aggression (such as murder). In prison, VG has been far too aggressive. His hands shake some of the time; this had been called “malingering” (faking) by a psychologist. When tested, it turns out VG does have Huntington’s disease, in the sense that he has the gene for it. When VG was given medication appropriate for Huntington’s disease, he got much better. BG, who cared about VG, managed to improve his condition. The legal system, which did not care about him, did not. The implication for all health care, including research, is straightforward: Empower those who care.

Patients with treatment-resistant major depression saw dramatic improvement after treatment with ketamine, according to results from a clinical trial. According to researchers from the Icahn School of Medicine at Mount Sinai Hospital in New York City, the antidepressant benefits of ketamine, normally used as an anesthetic, were seen within 24 hours. Traditional antidepressants can take days or even weeks to demonstrate a reduction in depression, researchers noted. Led by psychiatrists Drs. Dan Iosifescu, of Mount Sinai, Sanjay Mathew of Houston’s Baylor College of Medicine; and James Murrough, at Mount Sinai, the research team evaluated 72 people with treatment-resistant depression, which means their depression failed to respond to two or more medications. These patients were administered a single intravenous infusion of ketamine for 40 minutes or an active placebo of midazolam, another type of anesthetic without antidepressant properties. Patients were interviewed after 24 hours and again after seven days. According to the researchers, after 24 hours, the response rate was 63.8 percent in the ketamine group compared to 28 percent in the placebo group. The response to ketamine, however, did not last for most, with only 45.7 percent reporting benefits seven days after treatment. Only 18 percent of people in the placebo group reported such benefit after a week. “Using midazolam as an active placebo allowed us to independently assess the antidepressant benefit of ketamine, excluding any anesthetic effects,” said Murrough, who is first author on the new study. “Ketamine continues to show significant promise as a new treatment option for patients with severe and refractory forms of depression.” Major depression is caused by a breakdown in communication between nerve cells in the brain, a process involving chemicals called neurotransmitters, the researchers explained. Traditional antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), influence the activity of the neurotransmitters serotonin and noreprenephrine to reduce depression, though the exact mechanism is not known. But these medications can take a long time to make a difference — and up to 60 percent of people do not respond to treatment, according to the U.S Department of Health and Human Services. Ketamine works differently than traditional antidepressants in that it influences the activity of the glutamine neurotransmitter to help restore the dysfunctional communication between nerve cells in the depressed brain, the researchers said. It also works much more quickly than traditional antidepressants. Further studies are needed to investigate the longer term safety and efficacy of ketamine in depression, according to Murrough. He recently published a preliminary report in the journal Biological Psychiatry on the safety and efficacy of ketamine given three times weekly for two weeks in patients with treatment-resistant depression. Because ketamine is a short-acting drug, it must be injected multiple times a week in order for a person to continue to receive its antidepressant effects. Longitudinal studies on its long-term use over the course of months or even years have not yet been done, so its long-term effects on a person’s health remain unknown. “We found that ketamine was safe and well-tolerated and that patients who demonstrated a rapid antidepressant effect after starting ketamine were able to maintain the response throughout the course of the study,” he said. “Larger placebo-controlled studies will be required to more fully determine the safety and efficacy profile of ketamine in depression.” “Major depression is one of the most prevalent and costly illnesses in the world, and yet currently available treatments fall far short of alleviating this burden,” said Dr. Dennis Charney, Anne and Joel Ehrenkranz Dean of the Icahn School of Medicine at Mount Sinai. Charney was amo

Continued from Part 1 In March 1926, the Soviet government granted Alexander Bogdanov a large building in downtown Moscow, not far from the Kremlin itself.  It was an impressive looking structure; a former mansion built by a prosperous merchant in the 1890s.  Despite assorted delays, Bogdanov used his generous budget to renovate the building and hire new staff.   Much as his appointment had been controversial, so was his choice of staff members since they were mostly his fellow blood-transfusion enthusiasts instead of any of the prominent members of the Moscow medical community already experienced  in blood transfusions.  The institute's special status meant that the health ministry could not oversee its operations.  Instead, Bogdanov and his institute only answered to the commissar directly. While the institute's reports were kept confidential, Bogdanov  published glowing reports on his progress in Isvestiia including ambitious plans for using blood transfusions to treat a range of diseases such as trauma, anemia, and  blood poisoning. He also stressed that the Soviet Union lagged far behind other countries in availability of blood transfusions (which was true enough) and that the new procedure would help combat the "Soviet exhaustion"  killing older Soviet workers.   By the time renovations were finished, Bogdanov's institute was expanded to a ten-bed clinic though many of his promises had yet to materialize.  His 1927 treatise, Struggle for Viability, was hardly the comprehensive manual for blood transfusion  medical doctors had been promised.  According to medical historian Douglas Huestis,  who provides one of the first English translations for Bogdanov's monograph,  The Struggle for Viability proposed a "physiological collectivism" with blood transfusions  not only extending life but effectively rejuvenating older people as well. A rehashed version of Bogdanov's earlier work on tectology , it did little to help the Soviet Union catch up to the West in blood medicine.  Alexander Bogdanov was hardly the only Russian doctor making bold claims about solving the problem of aging, though.   Elie Metchnikoff had done the same years before.   Though Metchnikoff's claims had been just as grandiose in linking aging to "toxicity" of intestinal bacteria, his scientific credentials were far greater than Bogdanov's (Metchnikoff won the 1908 Nobel prize in Medicine).    Many other researchers around the world were also pursuing the dream of rejuvenation, whether through gland injections or actual organ transplants.    Serge Voronoff's research into transplanting monkey testicles into elderly humans during the 1920s and 1930s appeared to be succeeding, at least according to the enthusiastic newspaper coverage he was receiving at the time.    Along with funding Bogdanov's clinic, the Soviet Health Ministry established a primate breeding station to supply monkey glands for transplants. For his part, Bogdanov argued that monkey gland transplants, Metchnikoff's yogurt remedies, and all the other rejuvenation treatments being offered could be replaced by regular blood transfusions which would be safer and more effective.  Blood was a "universal tissue" that could be "purified" through transfusions and he specifically viewed aging as being due to a "weakening" of the sex glands.   Since young people had "too much" sex hormone and older people "too little",  blood transfusions could be beneficial to both.   Bogdanov also maintained that blood transfusions could be used to "transfer" immunity with diseases such as cancer and tuberculosis being treated by blood exchanges between healthy and non-healthy su

New research has shown that kava, a medicinal South Pacific plant, reduces the symptoms of anxiety and may be used as a successful alternative treatment to pharmaceutical drugs for those who suffer from generalized anxiety disorder (GAD). Lead researcher Dr. Jerome Sarris, from the Department of Psychiatry at the University of Melbourne, said that GAD is a complex condition that significantly affects people’s day-to-day lives. Current medications have a modest clinical effect and new effective options are needed. “Based on previous work, we have recognized that plant-based medicines may be a viable treatment for patients with chronic anxiety,” Sarris said. “In this study we’ve been able to show that kava offers a potential natural alternative for the treatment of chronic clinical anxiety. Unlike some other options it has less risk of dependency and less potential for side effects.” The roots of the kava plant have long been used to make a drink that has sedative and anesthetic effects. It is consumed throughout the Pacific Ocean cultures of Polynesia, including Hawaii, Vanuatu, Melanesia and some parts of Micronesia. The study, published in the Journal of Clinical Psychopharmacology, also found that genetic differences in neurobiological mechanisms called GABA transporters may affect response to kava. “If this finding is replicated, it may pave the way for simple genetic tests to determine which people may be likely to have a beneficial anxiety-reducing effect from taking kava,” Sarris said. The eight-week study involved 75 patients who had been clinically diagnosed with generalized anxiety disorder.  The participants were given either kava or placebo, and anxiety levels were regularly assessed. Those in the kava group were given tablets twice per day consisting of water-soluble extracted kava (peeled rootstock) for a total dose of 120mg of kavalactones for the first three-week controlled phase. In cases of non-response, this was increased to a double-dose twice per day for the second three-week controlled phase. Participants in the placebo group took matching dummy tablets in the same manner. At the end of the study, the kava group showed a significant reduction in anxiety compared to the placebo group.  For those diagnosed with moderate to severe GAD, kava had an even greater effect in reducing anxiety. In the end, 26 percent of the kava group were in remission from their symptoms compared to six percent of the placebo group. Kava was also well-tolerated. The findings showed no significant difference among the two groups for liver function, which had previously been a concern for kava’s medicinal use. Furthermore, there were no significant adverse reactions that could be attributed to kava and no difference in withdrawal or addiction between the groups. Another novel finding of the study, recently published in Phytotherapy Research, was that kava increased women’s sex drive compared to those in the placebo group.  This is thought to be a result of the reduction in anxiety, rather than an aphrodisiac effect. Source: Journal of Clinical Psychopharmacology Kava plant photo by shutterstock.

I am fairly convinced that my wife has some degree of bi-polar disorder. She goes into fits of rage over any question about her, her parents or upbringing. She constantly belittles me and talks bad about my family to the children. It has escalated in recent years with her attempting to push me, going into 20 minute tirades where she brings up everything that I had done over the last 12 years and her drinking has increased. She drinks to the point that she is carried out of neighborhood parties with the children crying out of embarrassment then blames me. Those who dont tolerate it are ‘fake people’ but the others are ‘true friends’ and she has been going out and staying out all night this past month. What is of greatest concern is that her explosions have increasingly come in front of the children resulting in them crying hysterically and her threatening to ‘kick me out’. She yells at them and then goes into a dialog of how much she does for them and how lucky they are. It is very stressful but I need confirmation that this is what I am dealing with and how do I proceed? A. It’s unclear whether your wife has bipolar disorder. Emotionally she is unstable but it might be due to her drinking. The fact that she is drinking makes it difficult to determine if a mental health disorder is present or if her drinking is the main problem. It may be a combination of both but I cannot make that determination based on this short letter. What is clear is that your wife’s drinking is excessive and is causing a great deal of distress for your marriage and for your children. Both you and the children are subjected to her tirades. It’s abusive, unacceptable and something needs to change. Encourage her to seek psychological treatment or inpatient rehabilitation if necessary. If she is unwilling to seek treatment, then you must take action. This might include seeking psychological help for yourself so that you know how best to deal with your wife or temporarily moving out of the home. Your children should not be subjected to your wife’s tirades. It most certainly frightens them and it’s abusive. You may also want to consider an intervention. By this I mean you and members of your family come together as a group and ask your wife to seek help. During the intervention, members of the group describe how her behavior is affecting them and ask her to receive help. Perhaps she would be willing to seek help if she knew how her behavior was negatively affecting friends and family. I can confirm the fact that there is a problem but I cannot determine the precise problem that is causing your wife to behave in such an unstable manner. Utilize the help of mental health professionals to assist you in dealing with your wife and children. I firmly believe that trained mental health professionals can give you the best advice about how to proceed. I wish you the best of luck. Please take care. Dr. Kristina Randle Mental Health & Criminal Justice Blog