Psychology

Still Charting Memory's DepthsThe New York Times20 May 2013 Read here

Why is it that families are kept so far out of the loop when it comes to a loved one’s health? The quick, easy answer, of course, is the nation’s health insurance portability and accountability act (HIPAA). Physicians are able to share only certain information with the family unless the patient agrees to more. The problem is that the patient might be too elderly, addicted or mentally ill to cooperate or even understand what they are agreeing to (or simply stubborn). Certainly individual civil liberties must be taken into consideration. This writer, in fact, is more than moderately liberal. But there is a blurry but significant line that puts human wisdom to the test, as we evaluate true need for family assistance. Beyond HIPAA’s ramifications, there are doctors who frankly don’t care to communicate with anyone other than the patient, no matter who they are allowed to talk to.  As well, many estranged families may not be interested in the health of their kin. But for those families of the mentally ill, alcoholic or addicted who want to help their loved one, they need to be able to communicate with clinicians, doctors, and therapists.  Rather than just informing the treatment team of a loved one’s behaviors at home and not receiving a treatment team response, the family must be brought into the fold of treatment teams. In the wake of the school shooting in Newtown, Conn. in December 2012, nothing less is required. HIPAA needs to be reworked. There needs to be an out clause granted to family members who obviously 1) are intelligently trying to work on their own coping strategies in a troubled family dynamic; 2) care about their ill family member; and 3) can offer the most significant information about the patient because of a shared living situation or close interaction. Lloyd Sederer, MD, medical director of the New York State Office of Mental Health and adjunct professor at Columbia University Mailman School of Public Health, wrote a few weeks after the Newtown tragedy of families being the true first responders of psychiatric illness.  How very true.  And yet how shabbily they have been treated. Anyone who has been around the block with a relative suffering from mental illness or related concerns — even those empowered with the great help of the National Alliance on Mental Illness and other advocacy organizations — knows how hard it still is dealing with treatment providers. Who, after all, knows a patient’s symptoms better than the family who lives with someone exhibiting psychosis, neurosis, manipulative behaviors, or obsessive-compulsive mannerisms?  Who directly witnesses what the patient may cleverly hide in a therapeutic session? Should not symptoms drive treatment more than diagnosis? Symptoms, after all, are what delineate an individual as being functional, or not, in various scenarios.  And should not families be given information on how to respond in ways that may actually help the patient? Though there are so many more, these alone are perhaps the two most critical, simple means of understanding that families must demand to be brought into the fold, respected as harbingers of the most significant information about mentally ill and addicted loved ones who are suffering, for the most part, needlessly.

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U.S. workers get less time off than those in other developed countries. The result? Unhappy employees who have more physical health problems to go along with family, relationship, and mental health issues....

Researchers have discovered that men diagnosed as children with attention-deficit/hyperactivity disorder (ADHD) were twice as likely to be obese adults. Investigators from the Child Study Center at New York University’s Langone Medical Center report the results of the 33-year follow-up study online in the journal Pediatrics. “Few studies have focused on long-term outcomes for patients diagnosed with ADHD in childhood. In this study, we wanted to assess the health outcomes of children diagnosed with ADHD, focusing on obesity rates and body mass index,” said lead author Francisco Xavier Castellanos, M.D. “Our results found that even when you control for other factors often associated with increased obesity rates such as socioeconomic status, men diagnosed with ADHD were at a significantly higher risk to suffer from high BMI and obesity as adults.” According to the Centers for Disease Control and Prevention, ADHD is one of the most common neurobehavioral disorders, often diagnosed in childhood and lasting into adulthood. People with ADHD typically have trouble paying attention, controlling impulsive behaviors and tend to be overly active. ADHD has an estimated worldwide prevalence of five percent, with men more likely to be diagnosed than women. The longitudinal prospective study included 207 white men diagnosed with ADHD at an average age of 8 and a comparison group of 178 men not diagnosed with childhood ADHD. Participants were matched for race, age, residence and social class. The average age at follow up was 41 years old. The study was designed to compare body mass index (BMI) and obesity rates in grown men with and without childhood ADHD. Results showed that, on average, men with childhood ADHD had significantly higher BMI (30.1 vs. 27.6) and obesity rates (41.1 percent vs. 21.6 percent) than men without childhood ADHD. “The results of the study are concerning but not surprising to those who treat patients with ADHD. Lack of impulse control and poor planning skills are symptoms often associated with the condition and can lead to poor food choices and irregular eating habits,” noted Castellanos. “This study emphasizes that children diagnosed with ADHD need to be monitored for long-term risk of obesity and taught healthy eating habits as they become teenagers and adults.” Source: NYU Langone Medical Center

As students prepare for final exams, some will turn to a prescription amphetamine or other stimulant to gain an academic edge. Yet a new University of Michigan poll shows only one in 100 parents of teens 13 to 17 years old believes that their teen has used a study drug. Study drugs often include stimulant medications prescribed for the treatment of attention deficit hyperactivity disorder (ADHD). Common drugs abused for this purpose include Adderall, Concerta, Ritalin, and Vyvanse. Researchers discovered that among parents of teens who have not been prescribed a stimulant medication for ADHD, only 1 percent believes their teen has used a study drug to help study or improve grades. The finding stems from the latest University of Michigan Mott Children’s Hospital National Poll on Children’s Health. However, recent national data from the Monitoring the Future survey indicates that 10 percent of high school sophomores and 12 percent of high school seniors say they have used an amphetamine or other stimulant medication not prescribed by their doctor. Experts say that students without ADHD will take someone else’s medication, to try to stay awake and alert and try to improve their scores on exams or assignments. However, taking study drugs has not been proven to improve students’ grades, and it can be very dangerous to their health, says Matthew M. Davis, M.D., M.A.P.P., director of the Children’s Hospital National Poll on Children’s Health. “Taking these medications when they are not prescribed for you can lead to acute exhaustion, abnormal heart rhythms and even confusion and psychosis if the teens get addicted and go into withdrawal,” said Davis. “What we found in this poll is a clear mismatch between what parents believe and what their kids are reporting. But even though parents may not be recognizing these behaviors in their own kids, this poll also showed that one-half of the parents say they are very concerned about this abuse in their communities,” he said. White parents were most likely to say they are “very concerned” (54 percent), compared with black (38 percent) and Hispanic/Latino (37 percent) parents. Despite this concern, only 27 percent of parents polled said they have talked to their teens about using study drugs. Black parents were more likely to have discussed this issue with their teens (41 percent), compared with white (27 percent) or Hispanic (17 percent) parents. “If we are going to make a dent in this problem, and truly reduce the abuse of these drugs, we need parents, educators, health care professionals and all who interact with teens to be more proactive about discussing the issue,” Davis said. More than three-quarters of parents polled said they support school policies aimed at stopping abuse of study drugs in middle schools and high schools. Overall, 76 percent of parents said they believe schools should be required to discuss the dangers of ADHD medication abuse. Moreover, 79 percent of parents support a policy to require students with a prescription for ADHD medications to keep their pills in a secure location such as the school nurse’s office. This requirement could prohibit students from carrying such drugs which could potentially be shared with, or sold to, other students. “We know teens may be sharing drugs or spreading the word that these medications can give their grades a boost,” Davis said. “But the bottom line is that these prescription medications are drugs, and teens who use them without a prescription are taking a serious risk with their health.” Sourc: University of Michigan Teenager holding pills in his hand photo by shutterstock.

The new Diagnostics and Statistical Manual, DSM-V, is out. Not surprisingly, it has sparked some controversy. Psychiatry deniers are proclaiming that this is the collapse of the mental-illness fraud (I believe reports of the death of psychiatry are exaggerated). What the DSM-V does represent, to some degree, is an attempt to advance psychiatry to the next stage of our understanding of illness. It seems that we are not quite ready for this step in psychiatry, but the effort is sincere and interesting. For background, the DSM (now in the fifth edition) is essentially a list of official psychiatric diagnoses, based upon clinical criteria. For mental illness and disorders we mostly lack clear biological markers or pathology, and so we have had to make due with clinical descriptions – lists of signs and symptoms. This is very much a descriptive phase of scientific understanding. What almost every popular article I read on the subject gets terribly wrong, however, is in characterizing this as a unique feature of psychiatry, unlike the rest of medicine. A recent Wired article, for example, writes: In most areas of medicine, diagnoses are based on the cause of illness. Heartburn and heart attacks both cause chest pain, but they’re different diagnoses because they have different underlying causes. At least they added the qualifier “most”, but even that is misleading. In fact most disorders and medical illnesses begin their life as a description of signs and symptoms – a purely clinically defined entity. Scientists then investigate possible causes, with the full spectrum of success. Some illnesses we have very little idea, nothing but guesses, about the cause and pathology. In others we have a completely fleshed out model of what is happening, down to the most reductionist level. The Wired article also notes: What doctors now diagnose as schizophrenia may in fact be several disorders with different causes that happen to produce an overlapping set of symptoms. True, but his is also true of many medical illnesses. ALS (Lou Gehrig’s disease, which causes progressive weakness), for example, is a clinical syndrome. We don’t know the ultimate cause, so it is entirely defined clinically. It is very likely to be multiple pathophysiological diseases with a common manifestation. Migraine headaches are another favorite example. They are diagnosed by a list of symptoms, just like DSM diagnoses. Migraine is likely many different underlying biological entities that all manifest in a similar fashion. It is also possible that underlying biological traits manifest in some people as classic migraines, in others as a different type of headache, and in still others with no symptoms. Medical diagnoses span the entire spectrum from a pure description of clinical features, to some knowledge of mechanism, to fairly complete pathophysiologal description.  Mental illness is not unique for being at the clinical description end of the spectrum. What neuroscientists focusing on mental illness are seriously trying to do is advance pyshicatric diagnoses to the next step, from pure clinical description to at least classification by underlying mechanism. No one thinks this is going to be easy. The brain is very complex, and the higher cognitive manifestations of the brain are subject to a host of influences. Teasing apart those influences to determine their relative contribution to a mental disorder is a herculean task, but not impossible. Possible influence include genes, epigenetic factors, developmental factors, biological factors such as nutrition, and all possible environmental factors. Scientists understand this complexity, but you would not know that from reading many popular treatments of the current DSM and efforts to advance our understanding of mental illness. For example, a recent Slate article, Double Inanity, claims right in the subtitle that “twin studies are pretty much useless.” It opens with this howler

A new study of elite male strength athletes finds a link between use of anabolic-androgenic steroids (AAS) and mental health problems later in life. This is the main conclusion of a new University of Gothenburg study recently published in the British Journal of Sports Medicine. The study included almost 700 former Swedish wrestlers, weightlifters, powerlifters and throwers who competed at the elite level sometime between 1960 and 1979. Twenty per cent of them admitted using steroids during their active careers. The purpose of the study was to look for links between AAS use and mental problems. “We found a clear link. AAS users were more likely to have been treated for depression, concentration problems and aggressive behavior,” said researcher and psychologist Dr. Claudia Fahlke. Investigators also found that AAS users were more likely to have abused other illicit drugs and alcohol. Still, it remains unclear whether the steroid use actually caused the mental health problems or the mental health problems rather caused the steroid use. ‘What we were able to show, though, is that psychiatric symptoms and use of steroids and other drugs tend to reinforce each other in a vicious cycle,” Fahlke said. “This suggests that the anti-doping efforts remain very important, both in and outside of sports.” Source: University of Gothenburg Hand holding a syringe photo by shutterstock.

Yesterday I commented about Give and Take by Adam Grant, a professor at Wharton who teaches organizational psychology. When Grant was a graduate student (at the University of Michigan), he was asked to help people at the university’s fund-raising call center raise more money. They call alumni, asking for money. The person who ran the center had tried the usual motivational tactics, such as offering bonuses. They hadn’t worked. Grant noticed that most of the money being raised went for scholarships. He tried various ways of making the call center employees aware that the money they raised helped students directly. The most effective way turned out to be a 5-minute meeting with a scholarship recipient. This had a staggering effect: The average caller doubled in calls per hour and minutes on the phone per week . . . Revenue quintipled: callers averaged $412 [per week] before meeting the scholarship recipient and more than $2000 afterward. A huge effect — and a useful huge effect. And one that is not even hinted at in countless introductory psychology books. Notice that physical conditions of the job and the “physical” payoff (the salary) didn’t change. All that changed was employees’s mental models of their job. I conclude that people are far more motivated by a desire to help others than you would ever guess from reading psychology textbooks — and, even more, from reading economics textbooks. Grant says nothing about this, at least in the book, but I’d guess that the employees were considerably happier at their jobs as well. You might think that there has been so much research on job design that there were no big effects left to be discovered. You’d be wrong.

Founder of SharpBrains talks about brain health (Saludify): “My passion is learning,” Fernandez told Saludify. “I love learning, and I love to see other people learn. I just realized that if we can improve the way our brains work, in not just me but millions of people, then we can help everyone learn better in every single decade of their lives.” …Fernandez’s work in the field led to the release of the book The SharpBrains Guide to Brain Fitness. The impetus behind the book came from Fernandez examining professional research related to the brain’s learning ability and functionality at various periods of life. “We thought the book would be perfect to educate people on this new understanding of the brain and equally important how to apply it to oneself, which is after all what people really want to do,” Fernandez said. “It’s what we call brain fitness. How people can maintain their brains and minds in top shape.” Keep reading article