Psychology

The much-anticipated 5th edition of the reference manual mental health professionals use to classify and diagnose mental disorders — called the Diagnostic and Statistical Manual of Mental Disorders — was officially released today. The DSM-5, as it’s called, was published today after a 14 year revision process. The manual is published by the American Psychiatric Association (APA). The process included the analysis of hundreds of research studies published in the past two decades by multi-disciplinary, disorder-based workgroups. Then drafts of the proposed manual were published three times, resulting in over 13,000 comments, emails and letters from other researchers, clinicians and the public. James Scully, Jr., MD, CEO of the APA, suggested that the DSM-5 will be a “critical guidebook for clinicians.” “The manual is first and foremost a guidebook for clinicians,” reiterated David Kupfer, M.D., DSM-5 task force chair, who noted that the overall number of disorders remains largely the same as what appeared in the DSM-IV, the prior edition of the book. The number has stayed largely the same because new disorders have been offset by the combining or removing old, outdated disorders. Details of the biggest changes made in the DSM-5 were first reported by us earlier today in a blog entry. New disorders added since the publication of the DSM-IV nearly 19 years ago include Disruptive Mood Dysregulation Disorder (formerly known by clinicians as childhood bipolar disorder), mild neurocognitive disorder, binge eating disorder and premenstrual dysphoric disorder. The latter two were first suggested in the DSM-IV, and were formally recognized as disorders by the DSM-5. Childhood bipolar disorder has been recognized by some pediatric clinicians and researchers for over a decade. The DSM workgroup, however, decided that using a new term to describe this cluster of symptoms was more appropriate. Disruptive mood dysregulation is characterized by a child or teen under age 18 who exhibits persistent irritability and frequent episodes of extreme, out-of-control behaviors that cause significant distress in the child or teen. Mild neurocognitive disorder was added to recognize the neurodegenerative decline witnessed by many clinicians who wanted to help their patients, but had no diagnosis to give people who were beginning to experience out-of-the-ordinary memory problems associated with aging. Since normal aging is not associated with memory or cognition problems, the new diagnosis appears to fill the gap between such problems and full-blown dementia (now called Major Neurocognitive Disorder). Other changes include a difference in how attention deficit hyperactivity disorder (ADHD) is diagnosed in adults, and the merging of four disorders into the single label, Autism Spectrum Disorder. This last change was a significant re-labeling of well-known disorders such as Asperger’s syndrome, and lesser-known disorders: childhood disintegrative disorder and pervasive developmental disorder not otherwise specified. While some critics contend the new edition of the DSM will result in significant changes in how mental disorders are diagnosed in the U.S., they have failed to produce much research data to support their contentions. With little research producing reliable biomarkers or laboratory tests for mental disorders, the DSM-5 remains the most reliable diagnostic system that is empirically-based. Review all the major changes made in the DSM-5 here. Source: American Psychiatric Association

Below: Lottery Director Mike Jones is interviewed at a cafe that's giving away 600 cups of coffee paid for by the Illinois Lottery Office. The coffee giveaway is in celebration of the record-breaking $600 million dollar Powerball jackpot drawing tonight. Lots of people are accepting the free coffee and saying things like: Huh? But why free coffee? There were several satellite trucks parked nearby and more reporters were waiting to interview Jones. Lottery directors aren't usually all that visible, but...

In a previous post, I mentioned there was a rumor of redundancy for some friends of mine. Some people were in fact let go, though none of my friends were among the unfortunate ones. Redundancy — losing your job in a layoff — is difficult for most people. I’ve worked with many people who have been made redundant and struggled with the aftermath. On the whole, these individuals have been hard workers, intelligent, and loyal to their companies; when the hammer finally fell, they often went into an emotional tailspin. After the initial shock, and even though many had been compensated well for losing their job, it’s interesting to note money became the least important factor. What really mattered was suddenly losing direction and meaning in their lives. Without work, they became unsure and lost. One executive I worked with received a very healthy financial package when he’d been made redundant. With money and time on his side, he could have used this opportunity to take his family away for a long-needed vacation, something he hadn’t done in many years. But instead, all he started to focus on was, “I should have done better at my job. I’ve failed.” This became his daily mantra and within a week he started to become very depressed. His sense of self had been totally shattered by this turn of events. He’d worked with the same company for twenty years, he was the VP of a large multinational company, and his identity was wrapped up with what that meant: the power, the prestige, and the financial trappings that came with the title. In his eyes, he’d absolutely failed, therefore he was a total failure. Period. There was no rational thinking going on here — he wasn’t able to step back and rationally examine the work situation, and what might have lead to him being let go. He couldn’t see that after his company had been taken over, the new management structure meant there were two people in his position. Too many chiefs and his position was superfluous. Nothing personal. To add to his depressive emotional state and irrational thinking about being a failure, he began to create anxiety by asking his wife over and over, “I will be all right, I will get another job won’t I?” At the beginning she would reassure him, but as is the way with anxious thinking, his incessant need for reassurance meant she lost patience with him, causing a rift in their relationship, which he then used to reinforce his belief that he was a ‘failure.’ Down, down, down he went. Long story short, he tried to hang himself — and fortunately failed. This is when I met him and started to help him on a long road back to being a confident, capable man. Redundancy can be a shock to the system, and that’s completely natural. It threatens our sense of safety. But when our sense of safety is threatened, our emotions can take over. It’s important to keep calm because anxiety and depression are not good bedfellows. The last thing you need to do is have your cognitive abilities impaired because you’re thinking irrationally about yourself and the situation you’re in. Don’t let your thoughts overwhelm you. If you catch yourself constantly thinking things like, “I can’t stand this, I must get another job” or “I’m going to lose everything, I’m such a failure,” then there’s a good chance you’re going to become anxious and depressed – and that’s not going to help. If you are in this situation, I always think it’s a good idea to talk to somebody else, quickly. Often people feel shame for being made redundant and will hide away, but don’t ruminate on your plight, talk. Friends and family are helpful, but they may not be objective enough. Also, family members tend to have their own anxieties about you not working and this might influence your thinking and mood. On

Jon Lieff YouTube Channelhttp://jonlieffmd.com/blog/jon-lieff-youtube-channelSent via Flipboard

The DSM-5 was officially released today. We will be covering it in the weeks to come here on the blog and over at Psych Central Professional in a series of upcoming articles detailing the major changes. In the meantime, here is an overview of the big changes. We sat in on a conference call that the American Psychiatric Association (APA) had in order to introduce the new version of the diagnostic reference manual used primarily by clinicians in the U.S. to diagnose mental disorders. It is called the Diagnostic and Statistical Manual of Mental Disorders and is now in its fifth major revision (DSM-5). James Scully, Jr., MD, CEO of the APA, kicked off the call by remarking that the DSM-5 will be a “critical guidebook for clinicians” — a theme echoed by the other speakers on the call. Why has it taken on such a large “role [both] in society as well as medicine?” he asked. Dr. Scully believes it’s because of the prevalence of mental disorders in general, touching most people’s lives (or someone we know). The APA has published three separate drafts of the manual on their website, and in doing so received over 13,000 comments from 2010 – 2012, as well as thousands of emails and letters. Every single comment was read and evaluated. This was an unprecedented scale of openness and transparency never before seen in the revision of a diagnostic manual. “The manual is first and foremost a guidebook for clinicians,” reiterated David Kupfer, M.D., DSM-5 task force chair, who walked us through the major changes detailed below. 1. Three major sections of the DSM-5 I. Introduction and clear information on how to use the DSM. II. Provides information and categorical diagnoses. III. Section III provides self-assessment tools, as well as categories that require more research. 2. Section II – Disorders Organization of chapters is designed to demonstrate how disorders are related to one another. Throughout the entire manual, disorders are framed in age, gender, developmental characteristics. Multi-axial system has been eliminated. “Removes artificial distinctions” between medical and mental disorders. DSM-5 has approximately the same number of conditions as DSM-IV. 3. The Big Changes in Specific Disorders Autism There is now a single condition called autism spectrum disorder, which incorporates 4 previous separate disorders. As the APA states: ASD now encompasses the previous DSM-IV autistic disorder (autism), Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified. ASD is characterized by 1) deficits in social communication and social interaction and 2) restricted repetitive behaviors, interests, and activities (RRBs). Because both components are required for diagnosis of ASD, social communication disorder is diagnosed if no RRBs are present. Disruptive Mood Dysregulation Disorder Childhood bipolar disorder has a new name — “intended to address issues of over-diagnosis and over-treatment of bipolar disorder in children.” This can be diagnosed in children up to age 18 years who exhibit persistent irritability and frequent episodes of extreme behavioral dyscontrol (e.g., they are out of control). ADHD Attention deficit hyperactivity disorder (ADHD) has been modified somewhat, especially to emphasize that this disorder can continue into adulthood. The one “big” change (if you can call it that) is that you can be diagnosed with ADHD as an adult if you meet one less symptom than if you are a child. While that weakens the criteria marginally for adults, the criteria are also strengthened at the same time. For instance, the cross-situational requirement has been strengthened to “several” symptoms in each setting (you can’t be diagnosed with ADHD if it only happens in one setting, such as at work). The criteria were also relaxed a bit as the symptoms now have to had appeared

Is 'cloning' appropriate terminology for somatic cell nuclear transfer derivation of human embryonic stem cells?... Tachibana, M., Amato, P., Sparman, M., Gutierrez, N., Tippner-Hedges, R., Ma, H., Kang, E., Fulati, A., Lee, H., Sritanaudomchai, H.... (2013) Human Embryonic Stem Cells Derived by Somatic Cell Nuclear Transfer. Cell. DOI: 10.1016/j.cell.2013.05.006 Human Embryonic Stem Cells Derived by Somatic Cell Nuclear Transfer

. In honor of 100 years of psychiatry at Johns Hopkins, Baltimore cinematographer Richard Chisolm, along with Kindall Rende, created this movie of members of the department talking about psychiatry at Hopkins. Many of the people shown in the film have been guest bloggers on Shrink Rap, and they include our mentors, colleagues, and friends. Both ClinkShrink and I are proud to be members of the department and we are both grateful for the education we've received, so we hope you'll spend a few minutes watching Richard's tribute.----- Listen to our latest podcast at mythreeshrinks.com or subscribe to our rss feed. Email us at mythreeshrinks at gmail dot com Our book is out now.

New research shows that youths who first drink during puberty are at greater risk for developing later alcohol problems. “Most teenagers have their first alcoholic drink during puberty. However, most research on the risks of early-onset alcohol use up to now has not focused on the pubertal stage during which the first alcoholic drink is consumed,” said Miriam Schneider, Ph.D., a researcher at the Central Institute of Mental Health, University of Heidelberg, and one of the authors of the new study. She noted that a common notion in alcohol research is that the earlier adolescents began to drink, the bigger problems they faced later in life. “However, a closer look at the statistics revealed a peak risk of alcohol use disorders for those beginning at 12 to 14 years of age, while even earlier beginners seemed to have a slightly lower risk,” she said. On average, girls begin puberty between the ages of 10 and 11, while boys typically start between the ages 11 of 12. Puberty lasts approximately 5 to 6 years for most teens. For the study, Schneider and her colleagues determined the age at first drink in 283 young adults — 152 females, 131 males — who were part of a larger epidemiological study. In addition, the participants’ drinking behavior — such as number of drinking days, amount of alcohol consumed, and hazardous drinking — was assessed at ages 19, 22, and 23 years via interviews and questionnaires. The researchers also concurrently conducted a rodent study to examine the effects of mid-puberty or adult alcohol exposure on voluntary alcohol consumption in later life by 20 male Wistar rats. “Both studies revealed that those individuals that initiated alcohol consumption during puberty tended to drink more and also more frequently than those starting after puberty,” said Schneider. That means that puberty is a “risk window” for having that first drink, said Rainer Spanagel, Ph.D., head of the Institute of Psychopharmacology at the University of Heidelberg. The study’s results also show a higher Alcohol Use Disorders Identification Test (AUDIT) score later in life in those individuals who had their first drink in puberty, he said. “A higher AUDIT score is indicative of a high likelihood of hazardous or harmful alcohol consumption,” he explained. “This information is of great relevance for intervention programs. Even more interesting, neither pre-pubertal nor post-pubertal periods seem to serve as risk-time windows. Therefore, intervention programs should be directed selectively towards young people in puberty.” Both Schneider and Spanagel noted the influence of a high degree of brain development that occurs during puberty. “Numerous neurodevelopmental alterations are taking place during puberty, such as maturational processes in cortical and limbic regions, which are characterized by both progressive and regressive changes, such as myelination and synaptic pruning,” said Schneider. “Typically, an overproduction of axons and synapses can be found during early puberty, followed by rapid pruning during later puberty, indicating that connections and communication between subcortical and cortical regions are in a highly transitional state during this period.” “Puberty is a phase in which the brain reward system undergoes major functional changes,” added Spanagel. “For example, the endocannabinoid and dopamine systems are at their peak and these major neurobiological changes are reflected on the behavioral level; reward sensitivity is highest during puberty. “Therefore, during puberty the brain is in a highly vulnerable state for any kind of reward, and drug rewards in particular. This high vulnerability might also affect reward seeking, or in this particular case, alcohol seeking and drinking behavior later in life.” Said Schneider, “It is exactly during puberty that substances like drugs of abuse — alcohol, cannabis, etc. — may

The responses in comments and emails to my ‘scratching my head about mindblog’ post are telling me that my small contributions are valued, with some making it part of the ritual that structures their lives. So, I guess I should listen to that rather than fretting about adding to the digital stream that threatens to overwhelm us all. We all want to understand how our show is run, what is going on with the little grey cells between our ears (and of course, we would like it run it better). We want to ‘see’ in addition to just ‘being.’ Indeed, this distinction is one of the most central ones I have been making through the course of over three thousand posts. It can be recast in numerous guises, such as being a moral agent in addition a moral patient or between third and first person self construals. I feel like the recent disjunctive break in generating Deric’s MindBlog - occasioned by a two week return to my former world of vision research - has been a useful one for me. (I will mention, by the way, that I was gratified a the recent vision meeting I attended when several doctoral and postdoctoral students told me that they look back on their time in my laboratory as one of the best in their lives - a time when they were given structure and support, and also given freedom to grow the beginnings of their future independent professional selves.) I’ve kept a journal since 1974, when I was into gestalt therapy, transactional analysis, and trips to Esalen to learn massage, attend workshops, and commune with the Monarch butterflies and whales of the Big Sur. That journal started to mark entries on psychology and mind with a tag (*mind), that I could search for. My reading on mind and brain grew out of the cellular neurobiology course I started with Julius Adler and then Tony Stretton in 1970, and it formed a parallel track alongside my vision research laboratory work that finally resulted in a new course, The Biology of Mind, in 1994, and the book “Biology of Mind” of 1999 that grew out of its lecture notes. A number of lectures and web essays in the early 2000’s led to the startup of this MindBlog in February of 2006. Thinking about this stuff is how I have structured my life for over 40 years, and I realize that giving that up would be the same as giving up my self. So..... I guess MindBlog, in some form, isn’t going away.

When the brain’s primary learning center is damaged, new neural circuits arise to compensate for the lost function, a new study has found. Researchers from the University of California-Los Angeles and Garvan Institute of Medical Research in Australia found that parts of the prefrontal cortex take over when the hippocampus — the brain’s key center of learning and memory formation — is disabled. For the study, researchers Michael Fanselow, Ph.D. and Moriel Zelikowsky conducted laboratory experiments showing that rats were able to learn new tasks even after damage to the hippocampus. While the rats needed more training than they would have normally, they nonetheless learned from their experiences, said the researchers. “I expect that the brain probably has to be trained through experience,” said Fanselow, who was the study’s senior author. “In this case, we gave animals a problem to solve.” After discovering the rats could learn to solve problems, Zelikowsky, traveled to Australia to work with Dr. Bryce Vissel at the Garvan Institute. There, they analyzed the anatomy of the changes that had taken place in the rats’ brains. Their analysis identified significant functional changes in two specific regions of the prefrontal cortex. “Interestingly, previous studies had shown that these prefrontal cortex regions also light up in the brains of Alzheimer’s patients, suggesting that similar compensatory circuits develop in people,” Vissel said. “While it’s probable that the brains of Alzheimer’s sufferers are already compensating for damage, this discovery has significant potential for extending that compensation and improving the lives of many.” The hippocampus plays critical roles in processing, storing and recalling information, the researchers said. It is highly susceptible to damage through stroke or lack of oxygen and is “critically involved” in Alzheimer’s disease, according to Fanselow. “Until now, we’ve been trying to figure out how to stimulate repair within the hippocampus,” he said. “Now we can see other structures stepping in and whole new brain circuits coming into being.” Sub-regions in the prefrontal cortex compensated in different ways, with one sub-region — the infralimbic cortex — silencing its activity and another sub-region — the prelimbic cortex — increasing its activity, Zelikowsky said. Complex behavior always involves multiple parts of the brain communicating with one another, with one region’s message affecting how another region will respond, Fanselow noted. These molecular changes produce our memories, feelings and actions. “The brain is heavily interconnected — you can get from any neuron in the brain to any other neuron via about six synaptic connections,” he said. “So there are many alternate pathways the brain can use, but it normally doesn’t use them unless it’s forced to. “Once we understand how the brain makes these decisions, then we’re in a position to encourage pathways to take over when they need to, especially in the case of brain damage.” Behavior creates molecular changes in the brain, Fanselow said. “If we know the molecular changes we want to bring about, then we can try to facilitate those changes to occur through behavior and drug therapy. I think that’s the best alternative we have. Future treatments are not going to be all behavioral or all pharmacological, but a combination of both.” The study was published in the journal Proceedings of the National Academy of Sciences. Source: University of California-Los Angeles