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Last week, Brookhaven consultant Dr Gainer was the guest speaker for a  national Webinar presented by the BIA – USA.    Attached is the file from the presentation to post

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A new study from researchers at the Norwegian Institute of Public Health suggests social anxiety disorder may directly contribute to an increased risk for alcohol use disorder.

Unlike other forms of anxiety disorders, social anxiety disorder could be causally linked to a greater risk of problematic drinking and alcohol use disorder according to the report recently published online in the journal Depression & Anxiety.

“Many individuals with social anxiety are not in treatment. This means that we have an underutilized potential, not only for reducing the burden of social anxiety, but also for preventing alcohol problems,” said lead author Fartein Ask Torvik, Ph.D. “Cognitive behavioral therapy with controlled exposure to the feared situations has shown good results.”

The findings come from a large scale study, in which Dr. Torvik and colleagues interviewed over 2,800 adult Norwegian twins. In the interviews, the researchers largely focused on assessing alcohol use, social anxiety, generalized anxiety, panic, agoraphobia, or other specific phobias.

While other types of anxiety and phobia have been linked to substance abuse, social anxiety was the only form which was clearly linked with the later development of alcohol use disorder.

“In clinical settings, it is important to assess if a patient with social anxiety disorder uses alcohol as a coping strategy and to discuss the dangers of self‐medication with alcohol,” researchers wrote. “Although alcohol use disorder does not seem to be a strong influence on the new onset of social anxiety disorder, alcohol use disorder could worsen the course of social anxiety disorder. This is particularly relevant when alcohol is naturally present in the feared situations.”

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As attention deficit-hyperactivity disorder (ADHD) diagnoses continue to rise, new questions are being asked about the safety of the most common medications used to treat the condition.

The findings of a new study published in the New England Journal of Medicine suggests that amphetamines, such as the frequently prescribed Adderall, may contribute to a significantly higher risk of developing psychosis compared to other drugs for ADHD such as methylphenidate stimulants like Ritalin.

The findings come from a large scale assessment of insurance claim data which included information from 221,486 individuals between the ages of 13 to 25 who were first prescribed a stimulant for ADHD between 2004 and 2015.

Approximately half of those included in the data were prescribed amphetamines like Adderall, while the other half were given methylphenidates like Ritalin.

Of those who were followed for the study, a total of 343 teens and young adults developed an episode of psychosis within a few months of being prescribed a stimulant.

While episodes of psychosis were rare for individuals on both types of medications, those given amphetamines were still more than twice as likely to experience psychosis compared to those on methylphenidates (0.21% vs. 0.1%).

“We’ve seen cases of people coming in without much of a psychiatric history who are developing this sort of first episode of psychosis in the setting of stimulant use, most commonly Adderall,” said Dr. Lauren Moran, assistant professor at Harvard Medical School, practicing psychiatrist at McLean Hospital, and lead author of the study.

In fact, it was her experiences and observations treating young individuals with psychosis which inspired the study.

Under the current guidelines, both classes of medicine are recommended for the treatment of ADHD. However, prescription rates for amphetamines had quadrupled among teens and young adults with ADHD between 2004 and 2015. In the same time span, prescription rates for methylphenidates were only 1.6 times higher.

While the public tends to view these medications as interchangeable, “there are subtle differences in the way Adderall and Ritalin affect dopamine systems in the brain,” says Moran.

Adderall tends to trigger the release of dopamine, while Ritalin blocks the reuptake of dopamine which allows it to linger in the system.

The release of dopamine from amphetamines closely resembles the flood of dopamine during a psychotic episode, which may explain some of the findings, according to Moran.

Although the findings raise concern about the risk for psychotic episodes when taking amphetamines for ADHD, it is important to understand how low the overall risk is. Additionally, Moran notes that the risk for those who have been on the medications for a sustained time and have been taking them as prescribed is likely even lower.

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A new website created by researchers at the University of New South Wales aims to help people better understand their hereditary or genetic risk of developing depression or bipolar disorder through an educational journey.

After creating a free account on the website at links.neura.edu, users start the process with a short anonymous questionnaire which explores a person and their family’s experiences with episodes of major depressive disorder (MDD) or bipolar disorder (BD) symptoms.

From there, the site walks users through educational information about the types of depression, how genetics and environmental factors contribute to mental illness, and the risk of developing MDD or BD if it runs in the family.

Importantly, the site also provides a number of prevention, coping, and support resources.

According to new research, published in the journal BMC Psychiatry, the website may provide an important service which is currently being overlooked by other online support tools.

“There aren’t really any specialised genetic counsellors who cover psychiatric illnesses in Australia,” explained lead author of the study, professor Bettina Meiser.

“The vast majority of genetic counsellors do prenatal genetic counselling or cancer genetic counselling. So we identified a gap and for that reason we set up this website to cater for what we believe is a sizeable group of people.”

Notably, the site isn’t just a simple explainer of depression or bipolar disorder. It uses an analysis of how likely a person is to develop MDD or BD based on their family history to provide personalized information relevant for each user.

One positive result of the tool, according to Meiser, is that it helps to show people the risk of developing a mental illness when it is present in their family is likely lower than they perceive.

“The good news is that while there is certainly a genetic component to both MDD and BD, the chances of a child developing the same condition as their parents is considerably lower than fifty-fifty,” she says.

As an example, Meiser notes that a person with two or more close blood relatives living with bipolar disorder has an 18% chance of developing the condition in their lifetime or a 12% chance within the next year.

“Our study showed that many people with a family history of MDD or BD greatly overestimate the risk of passing on this condition to their children,” Professor Meiser says.

“We found that the Links website improved participants’ accuracy at estimating the future risk of bipolar disorder. So this is clearly a resource that can allay fears around this, and we believe it may also lead to decreased self-stigmatisation about having the condition.”

While the site shows that genetic risk for developing a mental health disorder is generally lower than people expect, it also reveals that environmental factors can play a big role in driving conditions like MDD or BD.

“All of us have a fixed predisposition to depressive disorders that our experience in the world adds to which can make us more vulnerable to depression – things like relationships, work, stress, socioeconomic backgrounds, our social networks and health,” Professor Meiser says.

At the end of the experience, the site then provides a number of tested prevention strategies, including therapy, mindfulness exercises, physical exercise, and getting an adequate amount of sleep.

“Our study showed that the Links website increased users’ intention to adopt psychological therapy as a preventative measure against depression,” Professor Meiser said.

“In fact, the increase in the proportion of individuals who intended to undergo or had undergone psychological therapy from before and after undertaking the online educational course was 22%.”

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The link between heart disease and depression has been well-known for years but has largely remained a mystery. All we have really known is that people with heart disease are more likely to live with depression, and those living with depression are more likely to develop heart disease.

Now, researchers at the University of Cambridge say they have uncovered the missing piece linking these two conditions – inflammation.

Inflammation is a natural response to a wide variety of negative factors, including stress, injury, and even physical inactivity. At normal levels, inflammation can be an essential step in healing injuries and fighting off dangerous bacteria or viruses.

At heightened levels, however, chronic inflammation can be harmful to the body.

Notably, inflammation is significantly related to both heart disease and depression.

“It is possible that heart disease and depression share common underlying biological mechanisms, which manifest as two different conditions in two different organs—the cardiovascular system and the brain,” says Dr. Golam Khandaker, a Wellcome Trust Intermediate Clinical Fellow at the University of Cambridge. “Our work suggests that inflammation could be a shared mechanism for these conditions.”

For the study, published recently in the journal Molecular Psychiatry, Dr. Khandaker and study co-author Dr. Stephen Burgess led a group of researchers in reviewing data from bearly 370,000 middle-age individuals who participated in the UK Biobank.

The first factor the team investigated was whether a person’s family history of coronary heart disease was closely linked with their risk of major depression. Through this, they discovered that people who reported having at least one parent die from heart disease were 20% more likely to develop depression in their lifetime.

From there, the researchers created a genetic risk score for coronary heart disease designed to take into account the wide variety of genetic risk factors which contribute to heart disease. This allowed them to compare the genetic risk of heart disease and developing depression.

Notably, the researchers say there was no strong link between a genetic predisposition for heart disease and the risk of developing depression.

Taken together, these two findings are illuminating. They show that there is no genetic link between depression and heart disease. Rather, the link between the two conditions is being triggered by something in an individual’s environment – such as behavioral risk factors like smoking, substance abuse, or physical inactivity.

With this in mind, the team went in search of biomarkers which are associated with increased risk for coronary heart disease. They found 15 such biomarkers.

Through a process called Mendelian randomization, the researchers were then able to narrow down these biomarkers to just three which could also be linked to depression – triglycerides (which are a type of fat found in blood), and the proteins IL-6 and CRP.

Both IL-6 and CRP are inflammation-related proteins triggered by damage to the body, such as infection, stress or smoking. They have also been found in heightened levels in people with clinical depression – particularly in those with treatment-resistant depression.

This leads Dr. Khandaker to believe anti-inflammatory drugs – which have shown promise in clinical trials for treating depression – could be essential in directly addressing these inflammation-related factors.

Meanwhile, the link between triglycerides, coronary heart disease, and depression is less clear. It has been well-documented that high levels of triglycerides can contribute to heart disease, it is not known how this could also trigger depression. The researchers say the connection is not likely to be related to obesity, though, as they were unable to find evidence for a connection between body mass index (BMI) and depression.

“Although we don’t know what the shared mechanisms between these diseases are, we now have clues to work with that point towards the involvement of the immune system,” says Dr. Burgess. “Identifying genetic variants that regulate modifiable risk factors helps to find what is actually driving disease risk.”

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Deaths from substance abuse and suicide reached an all-time high in America in 2017 according to a troubling new report from the U.S. Centers for Disease Control and Prevention (DCD) and the Trust for America’s Health and Well Being Trust.

Throughout the year, more than 150,000 Americans died from drug use, alcohol, or suicide – more than double the number in 1999.

Compared to the previous year, the national death rate from drugs, alcohol, and suicide rose 6% from almost 44 to 46.6 deaths per 100,000.

While the yearly increase was actually less than in the two previous years, it was still higher than the 4% average annual increase since 1999.

“It is important to see hope in the slowing of rates — but it’s not nearly enough,” Benjamin Miller, chief strategy officer of Well Being Trust, said in a news release from the two groups. “We should not be satisfied at all. Too many of us are dying from preventable causes.”

The study indicates the ongoing opioid epidemic is driving the surge of deaths. Synthetic opioid-related deaths increase 10-fold over the last 5 years, jumping 45% between 2016 and 2017 alone.

According to the CDC, the total number of deaths related to synthetic opioid use last year was greater than the total deaths from drug use in 1999.

To put into context just how serious the opioid epidemic has become, the report notes that fewer than 1,000 individuals died from fentanyl and synthetic opioids in 1999. In 2017, more than 1,000 people were dying every two weeks from synthetic opioids.

The groups most at risk from deaths from synthetic opioids were 18- to 54-year-old men, African-Americans, Caucasians, and people living within cities. The Northeastern and Midwestern states were also particularly vulnerable to the ongoing opioid epidemic.

The report’s’ findings on suicide were also troubling, with a 4% rise in suicide deaths occurring between 2016 to 2017 – increasing from 13.9 per 100,000 to 14.5. This is the largest yearly increase since the CDC began collecting suicide death data in 1999.

Since 2008, suicide rates have risen an average of 2% every year, or 22% overall.

White males and people living in rural areas were most at risk of committing suicide according to the report.

“As a nation, we need to better understand and to systematically address the factors that drive these devastating deaths of despair,” said CEO of Trust for America’s Health, John Auerbach in the press release.

While 43 states and Washington D.C. all saw their overall death rates from drugs, alcohol, and suicide increase between 2016 to 2017, five states actually saw declines – Massachusetts, Rhode Island, Utah, Wyoming, and Oklahoma.

Both Miller and Auerbach say the current strategy of responding to specific issues as they appear isn’t doing the job.

“Each time we make progress – like with prescription opioids – new problems – like synthetic opioids – appear,” said Miller.

“We need a comprehensive approach with attention to the upstream root causes – like childhood trauma, poverty, and discrimination – and the downstream lifesaving efforts – like overdose reversal and access to treatment – and everything in between,” concluded Auerbach.

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While growing evidence suggests that maintaining a healthy diet can help prevent depression, a new study published in the Journal of the American Medical Association indicates simply taking vitamin pills or other supplements won’t cut it.

The study of more than 1,000 overweight or obese individuals from the United Kingdom, the Netherlands, Germany, and Spain, found that taking vitamin pills or supplements does not ward off depression in the same ways as a healthy diet.

The participants were all identified as being at risk for depression at the outset of the study but were not currently exhibiting symptoms of depression.

For the study, the participants were split into two groups. One group was given daily supplements containing folic acid, vitamin D, omega-3 fish oils, zinc, and selenium. The other half of the participants took a placebo pill.

At the same time, half of the participants were randomly selected to receive counseling and were encouraged to change their eating habits, such as limiting snacking and following a Mediterranean-style diet.

After one year, the researchers say they could find no evidence the supplements performed any better at preventing depression than the placebo.

At the same time, the counseling alone did little to curb depression from developing. However, those who had attended more sessions and made significant changes to their diet did appear to be less likely to show clinical signs of depression a year later.

“Because depression is such a common problem, finding effective and widely available ways to prevent depression at a population level is an important goal,” said study co-author Ed Watkins, a professor of experimental and applied clinical psychology at the University of Exeter in England.

“Diet and nutrition held promise as one means to reach large numbers of people. However, this trial convincingly demonstrates that nutritional supplements do not help to prevent depression,” concluded Watkins in a university press release.

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A large number of children growing up with attention-deficit hyperactivity disorder (ADHD) receive little to no assistance in school despite the widely recognized effect that ADHD can have on a child’s schooling and social ability.

Most troubling, a new study published in the Journal of Attention Disorders, indicates that children from non-English speaking or lower-income families were least likely to receive school services to assist with ADHD.

“We found that although the majority of students were currently receiving one or more school services, only a minority received support to manage their behavior, and at least one out of five students did not receive any school support despite experiencing significant educational impairment,” said lead author Dr. George DuPaul, professor of school psychology and associate dean for research in the College of Education at Lehigh University.

“The gap between impairment and service receipt was particularly evident for adolescents with ADHD and for youth with ADHD from non-English speaking and/or low-income families.”

The researchers evaluated a wide range of school services, including educational support such as tutoring or extra help from a teacher, as well as classroom management assistance such as rewards systems, behavioral modification strategies, or a daily reward card.

Parents of the 2,495 children included in the study were also asked if their children had an individualized education program (IEP) or specific educational accommodations under the federal disability civil rights code (504 plan).

Based on the findings, the researchers say that approximately one-in-three students living with ADHD were receiving no school-based interventions, and two-in-three receiving no forms of classroom management.

Most concerning, nearly one-in-five students with ADHD who reported significant academic and social difficulties were receiving no school services.

As a result, nearly one-in-four students with ADHD had repeated a grade while one-in-six had been expelled from school.

The study also found that the situation tends to worsen as students progress through school. While students with ADHD were more likely to receive some form of school services in elementary school, the availability of these services decreased in middle and high school – despite impairment rates remaining largely similar as individuals with ADHD age.

“We expected that most students with ADHD would be receiving some form of support, but were surprised that so few were receiving services to manage their behavior (the latter being the primary difficulty that students with this disorder experience),” DuPaul said.

“We expected that there would be disparities in service receipt based on age (ie. teens received less support) and race/ethnicity; however we were surprised with the extent to which these gaps were evident and the magnitude of the disparities.”

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One of the most difficult parts of living with any mental illness – whether it is depression, substance abuse, schizophrenia, or an eating disorder – is how isolating they can be. Between the fears of being shunned and the feeling that others won’t understand, it can be incredibly difficult to open up about your experiences with mental illness to even your closest friends and family.

Of course, the statistics on mental illness show that you are far from alone. Millions of people struggle with mental health issues every year. However, the stigma surrounding mental illness keeps people from talking openly about them.

Thankfully, a recent study suggests this is starting to change.

A Pew Research Center survey of 920 teens between the ages of 13 to 17 indicates younger Americans are becoming more empathetic about the dangers of mental illness and more aware of just how prevalent these conditions are.

The survey covered a wide range of issues among teens, including asking about their family life, goals for the future, and daily pressures. It also inquired about their experiences with mental health.

While the study supported the current belief that approximately 20% of teens experience some form of mental health issue – depression and anxiety being the most common – it also included a surprising finding.

According to the data, approximately 70% of teens say mental health is a major struggle for their peers.

The data could be interpreted in a number of ways. While some might say it reflects the growing issue of teenage mental illness, it is also possible to see it from another more optimistic perspective.

Specifically, the finding could suggest that teens are becoming more comfortable talking about their experiences with mental health issues with their friends. This would lead to a larger number of their peers to understand how common mental illness is and the more subtle ways it can affect a person’s life.

As clinical senior lecturer at King’s College London Institute of Psychiatry, Psychology, and Neuroscience told The Atlantic, “It’s both worrying and positive at the same time.”

“In terms of more people saying they know someone [with mental illness], it may be because the rates are going up, but it may also be because of a greater level of awareness.”

Henderson also noted that simply knowing someone with mental health issues can have a profound effect on a person’s understanding of mental illnesses as a whole.

“Those factors are much more strongly associated with having positive attitudes [about mental health] than any kind of demographic characteristics.”

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