Category: Neuroscience

1 A blood test to diagnose depression-118138414119886042cd33f08a35cf742e1cc5c5

A Blood Test to Diagnose Depression?

00Addiction, Depression, Featured news, Neuroscience, Psychiatry, SSRIs March, 16

Source: Andrew Mason on Flickr

Researchers at the Feinberg School of Medicine at Northwestern believe it may be possible to diagnose depression using a blood test. According to Eva Redei, a professor of psychiatry at the university, previous studies with lab animals have identified 26 markers in the blood (called biomarkers) that are associated with depression.

With human subjects, Redei identified nine biomarkers that differed between depressed and non-depressed individuals. The biomarkers signify a difference in gene expression associated with depression and allowed Redei to identify all those suffering from Major Depressive Disorder (MDD) in a sample of 66 adults.

Further, Redei was able to use biomarkers to identify adults with MDD who benefited from Cognitive Behavioural Therapy (CBT).  When depression symptoms were improving, some of the original biomarkers that helped to identify depressed individuals disappeared in blood samples.

If replicable, these findings would have major implications for the future of mental health diagnosis. Patients sometimes seek the attention of a primary care physician when they have concerns about depression. Unfortunately, such physicians are not as equipped or experienced as psychiatrists and psychologists in diagnosing and treating depression. This increases the time between when individuals begin to experience symptoms and when they are able to receive treatment. On average, an official depression diagnosis can take between 2 to 40 months.

At the same time, untreated depression has severe risks. “The longer depression is not treated, the more difficult it is to treat,” says Redei. “There’s also a higher chance of suicide, and adverse effects in the person’s work environment, home environment, [and] social structure.”

Untreated depression usually worsens over time, and to cope, patients may succumb to addiction, self-injury, and reckless behaviors such as having unprotected sex and drunk driving. Risk of suicide also goes up the longer depression remains untreated.

Using a test such as this to identify depression could reduce some of the stigma tied to the disorder and bridge the gap between mental and physical health. Depression affects the whole person, body and mind. A test such as this underscores that connection.

Does it all sound too easy?

Perhaps.  New biological findings in mental illness have a way of promising a whole lot more than they deliver.

Nowhere is this seen more than in the area of depression (Anyone out there remember Peter Kramer’s 1993 classic, Listening to Prozac?)  Decades of research on SSRI’s, once hailed as revolutionary, are increasingly showing just how modest, indeed disappointing, the medication’s effects actually are.

So a healthy dose of skepticism is in order.

This study is one of the first in its category. Depression is an exceptionally complex disorder that can only be partially understood in terms of biology. For the above implications to be substantiated, many studies with larger sample sizes must replicate the findings.

In fact, a much larger study that looked for genetic associations with MDD in over 6,000 individuals (of whom 2,000 were diagnosed with MDD) found little to no genetic links.

Further, even if blood sampling were used to diagnose depression, it would not account for the social and environmental components of the disorder. It is possible that increased reliance on biological factors could lead to increased numbers of people being misdiagnosed and forced to suffer alone due to the narrow diagnostic scope that blood tests would provide.

Still, Redei’s research does show promise. She hopes that using blood tests to diagnose depression will help expedite the otherwise lengthy process. But she does not feel that current diagnostic practices should be replaced. Instead, the combination of blood tests and self-report evaluations of symptoms may be key to early diagnosis in the future.

Although further research is needed, the hope is that blood tests may eventually help clinicians with the question of which treatment may be most effective for which client. “I think this opens the possibility to begin to look at whether there are biomarkers that may be able to predict response to a behavioral treatment like cognitive behavioral therapy, pharmacotherapy and other forms of treatment,” says co-author David Mohr.

Redei’s research responds to the very real need for more efficient and effective methods of diagnosing depression.  And it opens doors to new ways of understanding the disorder and its identifying characteristics.

– Alessandro Perri, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Nasal Spray May Prevent PTSD, Study Finds

Nasal Spray May Prevent PTSD, Study Finds

00Ethics and Morality, Featured news, Law and Crime, Memory, Neuroscience, Post-Traumatic Stress Disorder, Therapy, Trauma January, 16

Source: Stan Dominguez on Flickr

The emotional connection between a memory and an event can be powerful. A child rescued from a house fire or a soldier returning from Afghanistan may be plagued by flashbacks that elicit guilt, fear, and anxiety. These associations may disrupt daily functioning, causing social isolation, difficulty sleeping, and paranoia—all symptoms of Post-Traumatic Stress Disorder (PTSD).

Traditionally, PTSD has been treated with counseling and cognitive behavioural therapy, as well as psychiatric medications. Now, new research by biochemistry professor Esther L. Sabban and colleagues at New York Medical College is exploring how to stop the negative emotional association from being formed in the first place. They developed a nasal spray that, when administered before, during, or after crises, may do just that.

The spray contains Neuropeptide Y (NPY) which, at low levels, is associated with reduced negative emotional processing of events. Increased NPY in the amygdala and hippocampus—structures of the brain involved in processing memory and emotional responses—is associated with decreased anxiety, fear, and depression resulting from stressful situations.

Sabban and colleagues found that, when inhaled, the peptide acts as a neurotransmitter that has an immediate effect on the brain and prevents the development of PTSD symptoms in rats. In their study, rats were first subjected to stress by being immobilized, forced to swim, and exposed to chemicals which made them lose consciousness. Thirty minutes before or after the stress, some rats were given NPY. After seven days, rats that received NPY had lower levels of anxiety, decreased avoidant behaviour, and fewer startle responses.

Similar results were obtained when the spray was administered a week after the stressful event.

If effective for people, the spray might benefit those with high-risk jobs or those who help others during emergencies. By reducing negative emotional processing of a traumatic event, victims and responders might have a weaker emotional reaction to the memory, limiting the subsequent development of PTSD symptoms.

But there are many questions as well as practical impediments.

Professor Evelyn Tenanbaum of Albany Law School outlines a number of legal and ethical issues that using this spray might have. She argues that blunting the emotional impact of such an event could hinder a victim’s ability to impact a judge or jury in criminal trials. Social change may also be more difficult as the emotional stories of trauma victims often act as catalysts.

Informed consent before administration must also be considered. Victims need to know they may no longer be a reliable witness to a crime and that their memory of the incident may become unclear. Informed decisions may be hard to make during crisis situations.

It is also important to remember that the spray has only been tested on animal populations. NPY purportedly severs ties between emotion and memory; it is unclear what this would mean for humans. Would individuals be left feeling neutral regarding the traumatic event?

A lack of emotion may leave some victims confused or depressed in an entirely different way. Philosophical counselor Elliot Cohen writes how some individuals may become depressed over not feeling guilt, even if they were not personally responsible for the event’s occurrence. And, some victims find their traumatic histories become vital parts of their identities. Personal experiences, memories, and feelings about painful events inform how we see ourselves. What does blunting memory do to a person’s sense of who they are?

NPY’s unpredictable effects on human emotion require much research. If effective, the spray might be a powerful tool for preventing PTSD in some.

Still for others, a painful memory may be preferable to none at all.

– Anjali Wisnarama, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Patients with Misophonia require help and understanding

Patients with Misophonia require help and understanding

10Empathy, Featured news, Happiness, Loneliness, Neuroscience, Relationships, Social Life November, 15

Source: Rick&Brenda Beerhorst on Flickr

Some people find the sound of nails on a chalkboard or the rumbling of a snoring spouse irritating, but what if the sound of someone breathing sent you into a fit of rage?  This is a reality for many sufferers of misophonia.

Only recently garnering attention from researchers, misophonia is a condition where individuals have a decreased tolerance for certain sounds.  Chewing, coughing, scratching, or pen clicking can provoke an immediate aggressive response.  Verbal tantrums are common and in severe cases, sufferers may even physically attack the object or person causing the noise.

“I turn my eyes to face the source of the noise and feel myself glaring at that person in rage,” misophonia sufferer Shannon Morell explains to The Daily Record.  “The only thing I can think about is removing myself from the situation as quickly as possible.”

Many sufferers begin to structure their lives around their struggle with the disorder and avoid triggers by socially isolating themselves.  Public spaces like restaurants or parks are readily avoided and in extreme cases, eating or sleeping in the same room as a loved one can feel impossible.  Even establishing or maintaining relationships is very challenging.

Misophonia can interfere with academic and work performance.  In a study by PhD candidate Miren Edelstein at the University of California in San Diego, patients reported trouble concentrating in class or at work due to distraction from trigger noises.  In some cases, students may resort to isolating themselves, taking their courses online.

David Holmes tells The Daily Record that he finds refuge in using headphones (whenever possible) to block out external noises while at work.

The cause of misophonia is currently believed to be neurological, where the patient’s limbic (emotional) and autonomic nervous systems are more closely connected with the auditory system.  This may be why hearing a disliked sound elicits an emotional response.  Aage Moller, a neuroscientist at the University of Texas, describes it as a complication in how the brain processes auditory stimuli.

Research shows that misophonia usually develops at puberty and tends to worsen into adulthood.

But misophonia is still greatly misunderstood.  There is a lack of research examining its causes or possible treatments.  There is no cure, and some critics even wonder if misophonia should be considered a disorder at all, arguing instead that it’s just a personality quirk.

While it seems there is little help available for people with the disorder, Misophonia UK, an organization dedicated to providing information and support to misophonia sufferers, outlines a number of interventions.

Tinnitus Retraining Therapy (TRT) involves teaching patients how to slowly build sound tolerance, while Cognitive Behavioural Therapy (CBT) focuses on changing negative attitudes that can contribute to the severity of the disorder.  In some cases, hypnosis can be used to relax individuals.  Breathing techniques are also taught so patients can learn to sooth themselves when hearing their trigger noises.

Keeping a diary to record feelings and providing education to loved ones are also strategies recommended by Misophonia UK.  Support groups and online forums like UK Misophonia, Selective Sound Sensitivity, and Misophonia Support also provide a way for sufferers to share their experiences and interact with others.

Researchers in the Department of Psychiatry at the University of Amsterdam say that DSM classification may be necessary to pave the way for more recognition and research on the disorder, and that if misophonia is not regarded as a distinct psychiatric condition, it should at least be viewed as part of Obsessive Compulsive Spectrum Disorder (OCSD).

The prevalence of misophonia is currently not documented, and it seems few seek help.  Suffers of misophonia can only do so much on their own before the disorder starts intruding on their lives.

– Anjali Wisnarama, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

empathy sand sculpture_1

I Feel Your Pain: The Neuroscience of Empathy

00Empathy, Featured news, Neuroscience, Relationships, Stress April, 15

Source: Empathy Sand Sculpture/photopin

“I saw you doubling over and it felt like a shot right through me. I didn’t see any blood and there was nothing that scared me. Just you, in your misery, and a horrible sensation…I could feel your pain.”

This was my mother’s explanation for fainting while watching the doctor treating me in the operation room.

While fainting from another person’s pain may be uncommon, it brings into view an interesting aspect of human experience: the ability to relate to and feel the sensations of others.

Empathy is understanding and experiencing emotions from the perspective of another, a partial blurring of lines between self and other. We put ourselves in the shoes of others with the intention of understanding what they are going through, we employ empathy to make sense of their experiences.

Pain empathy takes the concept of empathy to the next level, describing physical sensations occurring to others. The concept has been portrayed in the form of sympathetic pregnancy, men reporting symptoms similar to those of their pregnant partners.

A subset of motor command neurons, mirror neurons are thought to be responsible for these sensations, firing in our brain when we perform an action, or when we observe someone else perform an action. These neurons can make you feel like you know what the other person is feeling. Witnessing someone getting hit by a ball, you feel a twinge of pain too.

Originally discovered in primates, mirror neurons have been used to explain how humans relate, interact, and even become attached.

Mirror neurons connect us to others. Neuroscientist Vilayanur Ramachandran, at the University of California, has described mirror neurons as dissolvers of physical barriers between people (he even nicknamed them Gandhi neurons), explaining that it is our skin receptors that prevent us from getting confused and thinking we are actually experiencing the action.

Though not entirely responsible for empathy, mirror neurons do help us detect when another person is angry, sad or happy, and allow us to feel what the person is feeling as if we were in their place.

Ramachandran suspects that mirror neuron research will lead to understanding purported mind reading abilities, which may in fact have an organic explanation, such as a strong empathic occurrence in which one’s emotional/physical sensations are experienced by the other.

Mirror neurons are important in learning and language acquisition. Through imitation, vicarious learning allows for the construction of culture and tradition.

When malfunctioning, mirror neurons may have a big impact. Individuals diagnosed with autism have difficulty with empathy. And as Ramachandran suggests, it is indeed mirror neuron dysfunction that is involved in autism.

The discovery of mirror neurons also helps us rethink other concepts, such as human evolution. Ramachandran says that mirror neurons are what make culture and civilization possible because they are involved in imitation and emulation. In other words, historically, to learn to do something, we have adopted another person’s point of view, and for that we’ve used mirror neurons.

Empathy allows for intimacy and closeness, and mirror neurons provide evidence that humans are biologically inclined to feel empathy for others. More than just an abstract concept, empathy seems rooted in our neurological makeup.

My mother fainted because she couldn’t endure my pain. Perhaps my suffering triggered great anxiety that her body was unable to manage. Or maybe she physically felt my pain.

Mirror neurons are the interface that joins science and humanities. The connection allows us to reconsider concepts like consciousness, the self, even the emergence of culture and civilization.

Indeed, it’s not surprising that Ramachandran compares the discovery of mirror neurons in psychology, to the discovery of DNA in biology.

– Contributing Writer: Noam Bin Noon, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Forgetting PTSD: How Genes Affect Memory

00Fear, Featured news, Genetics, Memory, Neuroscience, Post-Traumatic Stress Disorder, Therapy, Trauma April, 15

Source: Jared Rodriguez // Flickr

Memory can be a double edged sword. It holds our identities, our relationships, our histories. But when memory holds our most unspeakable stories, it can become a painful burden.

Sufferers of PTSD live with this reality. Many cannot forget. Recent studies have found that a gene, called tet1, plays a central role in forgetting such traumatic experiences.

Massachusetts Institute of Technology researcher, Andrii Rudenko, found that when people with normal levels of this gene experience a traumatic event, the triggers to traumatic responses become extinct over time. For example, if you were bitten by a dog after walking past a neighbour’s house, you may be reluctant to walk by that same house again. And if you continued to walk past the house and nothing happened, eventually the association with being bitten and walking past that house would become extinct –you would no longer fear walking past the house. However, people with PTSD do not form these new associations, and would continue to fear walking past the neighbour’s house.

Currently, one of the most effective treatments for PTSD is exposure therapy, where patients learn new associations by being exposed to the triggers of PTSD in safe environments. This can include practicing driving on a driving simulator for someone who is afraid to drive due to a motor vehicle accident. Over time, patients begin to learn that driving is not as dangerous as they came to believe.

The tet1 gene aids in the expression of genes in the brain that help people form new memories and cover up old ones. However, when a person has low levels of this gene, old and traumatic memories are not masked.

In Rudenko’s study, mice were conditioned to fear a particular cage using electric shocks. When the electric shock was taken away and the mice were placed in the cage, the mice with normal levels of the tet1 gene lost their fear of the cage, while the mice with low levels of the tet1 gene continued to fear as before.

A process called DNA methylation blocks the expression of the promoter genes that are responsible for forming new memories. The methylation process is lowered by tet1 and other tet proteins in areas of the brain that are important for forming memories, including the hippocampus and the cortex.

Simply put, the more tet proteins, the more expression of promoter genes and memories formed. Conversely, even though low levels of the tet1 gene make learning new things difficult, it has been hypothesized that fear responses are so strong that tet2 and tet3 proteins can compensate for the demethylation processes of tet1 proteins. Therefore, memories are formed during strong responses to fear or traumatic events, but with a lack of tet1 proteins, new memories are not formed to replace the old memories, and chronic PTSD is the result.

Li-Huei Tsai, director of MIT’s Picower Institute for Learning and Memory, told MIT news that “if there is a way to significantly boost the expression of these genes, then extinction learning is going to be much more active.” That is, if we can find a way to boost the expression of the tet1 gene, then people’s traumatic memories will be covered up by new memories quicker.

Memory extinction, prefrontal lobotomies, and other psychosurgeries have been a topic of popular film and literature. It’s not surprising that questions on how these findings may be applied to PTSD treatment have raised eyebrows.

According to Tsai, “What happens during memory extinction is not erasure of the original memory.” Instead, new memories and associations can be formed and old ones forgotten. In the case of the mice, the mice with the higher levels of the tet1 gene begin to learn that the cage is safe, and forget that it was once dangerous. In Rudneko’s view, “association with safety is rebuilt.”

Manipulating tet1 proteins in the brain and combining exposure therapy may bring new PTSD treatment possibilities. This method might even be used to assess a person’s genetic predisposition to PTSD. One imagines a possible screening tool for applicants to jobs with exposure to highly stressful events, like police officers.

This research is still in its infancy. Yet it shows promise for those who, despite their best efforts, can’t find a way to forget.

– Contributing Writer: Andrew McColl, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

Photo Credit:Jared Rodriguez // Flickr

This article was originally published on Psychology Today

Brain Trauma, feature2

Coping With Traumatic Brain Injury

10Anxiety, Child Development, Cognition, Depression, Empathy, Environment, Featured news, Health, Memory, Neuroscience, Productivity, Sleep, Sport and Competition, Trauma February, 15

Source: Shine In Your Crazy Diamond//Flicker

Traumatic brain injuries (TBI) contribute to many deaths each year, and can lead to the development of secondary mental health problems.  The Centre for Disease Control has reported that approximately 1.7 million TBIs occur every year, and individuals with a TBI commonly suffer cognitive impairments and developmental delays.

The Trauma & Mental Health Report recently spoke with Tricia Williams, a clinical neuropsychologist at Holland Bloorview Kids Rehabilitation Hospital, who works with children who have different forms of TBI.  Williams explained how to improve child development and mental health for individuals coping with a TBI.

Q:  What are the most common injuries that lead to the development of a TBI?

A:  A TBI is caused when an external mechanical force, such as a blow to the head or a concussive force causes harm to the head or body.  Motor vehicle accidents are the leading cause of TBIs.

Other common injuries include falls (which are common in young children and infants), sport injuries, concussions, horseback riding, interpersonal violence (fighting, gun shots, physical hits to the head by person/object,) and war related injuries.

Q:  How is a TBI diagnosed?

A:  Professionals in emergency services diagnose a TBI in the acute state at the time of injury.  They assess the severity of the injury by checking eye responses, verbal responses, motor responses, and mobile ability.  CT scans are initially performed to rule out bleeding and swelling, and then an MRI may be performed as follow up.  Amnesia is another way to diagnose a TBI. The degree of memory loss prior to the event, and difficulty forming new memory can provide more information about the injury. The duration of loss of consciousness can also affect the severity of the injury, which may be ranked as either mild, moderate, or severe.

Q:  What is involved in rehabilitation following a TBI?

A:  In the acute state, the TBI is managed medically, including neurosurgical intervention.  Once stabilized at the hospital, children move on to rehabilitation.  An assessment of physical, functional, and speech abilities are conducted, and occupational therapists and speech and language pathologists then work with the children. Neuropsychological assessments are conducted after the acute state to help children transition back to school.  The children continue with follow-up visits to monitor the impact of the injury on developing cognitive skills.

Q:  As a clinical neuropsychologist, what is your role with patients who have a TBI?

A:  Children are seen as inpatients at the hospital after the injury, and are also seen as outpatients after they have transitioned home.  They can be followed for many years after the injury.  Typically, they are seen during transitional periods such as the transition from primary school to high school.  A thorough assessment of the child’s skills (IQ, memory and learning, language, processing speed, executive functioning, academic skills, visual and motor skills, socio-emotional status) are conducted and compared to previous testing to assess the child’s progress and developing difficulties.

Q:  What daily activities can become difficult for an individual with a TBI?

A:  Activities that can be difficult depend on the nature and severity of the injury, the stage of recovery, and how well they have been supported.  Common complaints across all injuries include:  keeping up with class, forgetfulness, difficulty paying attention, and becoming easily fatigued, overwhelmed, and frustrated.  Because these activities can be challenging, continued support from their physicians and neuropsychologists as well as family support is very important during the recovery process.

Q:  How can secondary mental health symptoms develop from a TBI?

A:  Depression is a common outcome, and can develop as a reaction to the injury or to neurochemical changes in the brain.  Anxiety is also a common reaction to the injury, because if the child is old enough to understand what has happened, they might expect it to happen again.  This is common for children who developed a TBI as a result of a sports injury.  Children can also be anxious about their academic achievement and about performing well in school.  It is important to make patients aware of potential secondary mental health symptoms. But, individuals with a TBI can also have a greater appreciation of life, as they see themselves as survivors.

Q:  What advice can you offer someone with TBI?

A:  Be patient with yourself and try to normalize your emotional variability.  It’s important to ask for and accept help, and to find the balance between accepting what has happened and moving on.  Individuals should keep in mind that while there are variable outcomes, full recovery is possible.  Finding a “new normal” for oneself without becoming centered on the injury is extremely important.

Q:  Do you have any further suggestions for coping with a TBI?

A:  Here is a list of helpful tips:

  • Take additional time on activities as needed
  • Manage fatigue (with exercise/relaxation, sleep)
  • Ask for repetition of key information and written outlines of key terminology
  • Repeat back what people tell you to ensure you are understanding
  • Use your phone or equivalent to make dictated notes and reminders with regularly scheduled playback times
  • Break down (or ask someone to help you break down) larger tasks into smaller manageable parts
  • Choose the time of day when you are most able to accomplish tasks that require more obvious mental effort and sustained attention
  • Recognize the signs that you are losing attention/productivity or becoming overwhelmed and take a break
  • Exercise can help relieve tension, improve sleep and attention
  • Seek out a quiet room to complete work or practice techniques as needed
  • Social support is extremely helpful

Traumatic brain injuries (TBI) contribute to many deaths each year, and can lead to the development of secondary mental health problems.  The Centre for Disease Controlhas reported that approximately 1.7 million TBIs occur every year, and individuals with a TBI commonly suffer cognitive impairments and developmental delays.

The Trauma & Mental Health Report recently spoke with Tricia Williams, a clinical neuropsychologist at Holland Bloorview Kids Rehabilitation Hospital, who works with children who have different forms of TBI.  Williams explained how to improve child development and mental health for individuals coping with a TBI.

Q:  What are the most common injuries that lead to the development of a TBI?

A:  A TBI is caused when an external mechanical force, such as a blow to the head or a concussive force causes harm to the head or body.  Motor vehicle accidents are the leading cause of TBIs.

Other common injuries include falls (which are common in young children and infants), sport injuries, concussions, horseback riding, interpersonal violence (fighting, gun shots, physical hits to the head by person/object), and war related injuries.

Q:  How is a TBI diagnosed?

A:  Professionals in emergency services diagnose a TBI in the acute state at the time of injury.  They assess the severity of the injury by checking eye responses, verbal responses, motor responses, and mobile ability.  CT scans are initially performed to rule out bleeding and swelling, and then an MRI may be performed as follow up.  Amnesia is another way to diagnose a TBI. The degree of memory loss prior to the event, and difficulty forming new memory can provide more information about the injury. The duration of loss of consciousness can also affect the severity of the injury, which may be ranked as either mild, moderate, or severe.

Q:  What is involved in rehabilitation following a TBI?

A:  In the acute state, the TBI is managed medically, including neurosurgical intervention.  Once stabilized at the hospital, children move on to rehabilitation.  An assessment of physical, functional, and speech abilities are conducted, and occupational therapists and speech and language pathologists then work with the children. Neuropsychological assessments are conducted after the acute state to help children transition back to school.  The children continue with follow-up visits to monitor the impact of the injury on developing cognitive skills.

Q:  As a clinical neuropsychologist, what is your role with patients who have a TBI?

A:  Children are seen as inpatients at the hospital after the injury, and are also seen as outpatients after they have transitioned home.  They can be followed for many years after the injury.  Typically, they are seen during transitional periods such as the transition from primary school to high school.  A thorough assessment of the child’s skills (IQ, memory and learning, language, processing speed, executive functioning, academic skills, visual and motor skills, socio-emotional status) are conducted and compared to previous testing to assess the child’s progress and developing difficulties.

Q:  What daily activities can become difficult for an individual with a TBI?

A:  Activities that can be difficult depend on the nature and severity of the injury, the stage of recovery, and how well they have been supported.  Common complaints across all injuries include:  keeping up with class, forgetfulness, difficulty paying attention, and becoming easily fatigued, overwhelmed, and frustrated.  Because these activities can be challenging, continued support from their physicians and neuropsychologists as well as family support is very important during the recovery process.

Q:  How can secondary mental health symptoms develop from a TBI?

A:  Depression is a common outcome, and can develop as a reaction to the injury or to neurochemical changes in the brain.  Anxiety is also a common reaction to the injury, because if the child is old enough to understand what has happened, they might expect it to happen again.  This is common for children who developed a TBI as a result of a sports injury.  Children can also be anxious about their academic achievement and about performing well in school.  It is important to make patients aware of potential secondary mental health symptoms. But, individuals with a TBI can also have a greater appreciation of life, as they see themselves as survivors.

Q:  What advice can you offer someone with TBI?

A:  Be patient with yourself and try to normalize your emotional variability.  It’s important to ask for and accept help, and to find the balance between accepting what has happened and moving on.  Individuals should keep in mind that while there are variable outcomes, full recovery is possible.  Finding a “new normal” for oneself without becoming centered on the injury is extremely important.

Q:  Do you have any further suggestions for coping with a TBI?

A:  Here is a list of helpful tips:

Take additional time on activities as needed
Manage fatigue (with exercise/relaxation, sleep)
Ask for repetition of key information and written outlines of key terminology
Repeat back what people tell you to ensure you are understanding
Use your phone or equivalent to make dictated notes and reminders with regularly scheduled playback times
Break down (or ask someone to help you break down) larger tasks into smaller manageable parts
Choose the time of day when you are most able to accomplish tasks that require more obvious mental effort and sustained attention
Recognize the signs that you are losing attention/productivity or becoming overwhelmed and take a break
Exercise can help relieve tension, improve sleep and attention
Seek out a quiet room to complete work or practice techniques as needed
Social support is extremely helpful

– Contributing Writer: Janany Jayanthikumar, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

Photo Credit: Shine In Your Crazy Diamond//Flickr 

This article was originally published on Psychology Today

169037-174419

The Heart is a Drum Machine: Drumming as Therapy

00Anxiety, Creativity, Depression, Featured news, Neuroscience, Resilience, Therapy January, 15

We moderns are the last people on the planet to uncover what older cultures have known for thousands of years: The act of drumming contains a therapeutic potential to relax the tense, energize the tired, and soothe the emotionally wounded.

So says Gary Diggins, an Ontario sound therapist.

When I met him, I entered his studio with some trepidation, overwhelmed by the hundreds of instruments I did not know how to play. Drums from around the world. Didgeridoos, rain sticks, and other indigenous instruments decorated the walls. I had come with the intention of exploring the sound therapy community to find out why so many people are choosing music as a form of healing as opposed to other, more traditional approaches to mental health treatment.

Since that first drumming experience, I began attending monthly sound therapy sessions: People coming together to create sound with the intention of restoring physical and mental well-being.

Diggins’ particular practice of sound therapy has been shaped by his studies with a Columbian Shaman, a Jungian therapist, an African Griot, an Australian Aborigine, and a few professors from the University of Toronto. The challenge, Diggins says, is to frame this ancient practice in a way that makes it accessible to wider cultural circles.

In Diggins’ group settings, clients connect with other drummers and create a supportive and collaborative musical community. For some, the positive impact comes from the feeling of belonging to a community. For others, it comes from the physical act of drumming and simultaneously connecting with one’s own emotional experience.

Neurologist Barry Bittman, who co-developed a program for REMO called Health Rhythms with music therapist Christine Stevens, found that group drumming and recreational music making increases the body’s production of cancer killing t-cells, decreases stress, and can change the genomic stress marker. Bittman says drumming “tunes our biology, orchestrates our immunity, and enables healing to begin.”

Psychologist Shari Geller, who teaches at York University, says her own early experiences with drumming sparked her interest in the practice’s healing benefits.

After working with Bittman at his Living Beyond Cancer Retreat at his Mind-Body Wellness Center in Pennsylvania, Geller combined her work as a clinical psychologist, her training in emotion focused therapy, and mindfulness with group drumming in a program called Therapeutic Rhythm and Mindfulness (TRMTM).

In studying the technique and combining it with her clinical knowledge, she discovered that healing can occur when emotions are enhanced through music making. She says it allows people to process trauma with greater ease and that through the facilitation of mindful drumming, people can express difficult emotions.

For individuals coping with depression, anxiety, or trauma, there is something more intuitive and liberating about communicating through music. Some find the combination of group therapy and drumming effective as it brings more contemporary approaches to mental health together with creative and non-judgemental expression of emotions.

Alongside the plethora of research on the effects of music on the brain, studies have found that drumming offers numerous health benefits. For women dealing with eating disorders, children with autism, cancer patients, war veterans living with PTSD, individuals with anger management issues, people with addictions, and even Alzheimer’s patients, drumming offers physical and emotional benefits.

Music therapies are now available in many hospitals and in a variety of counselling settings. More informal drumming circles are becoming increasingly popular within corporate team building and stress management workshops.

In Diggins’ view, our modern and secular world needs meaningful rituals and ceremonial practices to support major transitions and to challenge individuals.

For many seeking the benefits of therapy, an hour spent creating music and an hour spent in therapeutic drumming is an hour well spent.

– Contributing Writer: Jana Vigor, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

Photo Credit: <a href=”https://www.flickr.com/photos/hundreds/2831410776/“>max_thinks_sees</a>

This article was originally published on Psychology Today

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Video Games Rated A for Addictive

00Addiction, Depression, Diet, Featured news, Health, Neuroscience, Optimism, Psychopharmacology, Self-Control, Sex, Sleep, Stress, Treatment December, 14

Picture if you will, flashing screens, loud noises, focused faces and a crowd gathered to watch high stakes games; games that end only when you run out of money.

This is not a casino. Those faces are staring at flashing computer screens in an arcade and the high stakes match is actually a video game.

Scenes like this make it possible to view video gaming as an addiction. Like a gambler endlessly playing slots, the video gamer can spend hours on the vice of choice.

Those who consider gaming as addictive highlight similarities between models of addiction and the behaviour of those who can’t seem to stop playing video games, despite the consequences 

What does it mean to be addicted to a video game? Addiction used to be a term reserved for drug use defined by physical dependency, uncontrollable craving, and increased consumption due to tolerance. Advances in neuroscience show that these drugs tap into the reward system of the brain resulting in a large release of the neurotransmitter dopamine. This is a system normally activated when basic reinforcers are applied, like food or sex. Drugs just do it better.

Gaetano Di Chiara and Assunta Imperato, researchers at the Institute of Experimental Pharmacology and Toxicology at the University of Cagliani, Italy, found that drugs can cause a release of up to ten times the amount of dopamine normally found in the brain’s reward system. This has led to a shift in how addictions are viewed. Any physical substance or behaviour that can “hijack” this dopamine reward system may be viewed as addictive.

When can you be sure that the system has been hijacked? Steve Grant, chief clinical neuroscientist at the National Institute of Drug Abuse, says it happens when there “is continued engagement in self-destructive behaviour despite adverse consequences.”

Video games seem to hijack this reward system very efficiently. Certainly Nick Yee, author of the Daedelus Project, thinks so. He explains, “[Video Games] employ well-known behavioral conditioning principles from psychology that reinforce repetitive actions through an elaborate system of scheduled rewards. In effect, the game rewards players to perform increasingly tedious tasks and seduces the player to ‘play’ industriously.” Researchers in the UK found biological evidence that playing video games and achieving these rewards results in the release of dopamine.

This same release of the neurotransmitter occurs during activities considered healthy, such as exercise or work. Since dopamine release is not bad per se, it is not necessarily a problem that video games do the same thing.

In her book, Reality is Broken: Why Games Make Us Better and How They Can Change the World, Jane McGonigal writes, “A game is an opportunity to focus our energy, with relentless optimism, at something we’re good at (or getting better at) and enjoy. In other words, game-play is the direct emotional opposite of depression.” Playing games can be an easy way to relieve stress and get that satisfaction that comes with dopamine release.

But it is concerning when this search for the dopamine kick becomes preferable to real life, when playing video games replaces activities like socializing with friends and family, exercising, or sleep. Nutrition may begin to suffer as the gamer picks fast-food over proper meals. School-work and job performance suffer as gaming turns into an escape from life. It becomes troubling when video games are used as the main way of coping.

Psychologist Richard Wood says just that in his article Problems with the Concept of Video Game “Addiction”: Some Case Study Examples. “It seems that video games can be used as a means of escape…If people cannot deal with their problems, and choose instead to immerse themselves in a game, then surely their gaming behaviour is actually a symptom rather than the specific cause of their problem.”

Regardless, there are some unable to stop despite the consequences. In rare cases it has actually caused death, through neglect of a child or physical exhaustion. Excessive video game playing may represent a way of coping with underlying issues. But it becomes its own problem when the impulse to play just can’t be denied.

Psychiatrist Kimberly Young, Director of the Center for Internet Addiction Recovery argues that “[gaming addiction is] a clinical impulse control disorder, an addiction in the same sense as compulsive gambling.” Her centre is one of many that are now found in the United States, Canada, the United Kingdom, and China.

These clinics treat those with gaming problems using an addiction model. They use detox, 12-step programs, abstinence training, and other methods common to addiction centres.

Notably, many people play well within healthy limits, and engage in the activity for diverse reasons. Stress relief, a way to spend time online with friends, or the enjoyment of an interactive storyline are all common reasons for playing. Whatever the reason for starting, when you can’t stop you have a problem. 

We are often critical of labels in mental health, for good reason; they can be misused. On the other hand, a label can sometimes be helpful. If we call it an addiction, then we recognize it as a problem worth solving.

– Contributing Writer: Bradley Kushner, The Trauma and Mental Health Report 

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report 

Copyright Robert T. Muller

Photo Credit: Ben Andreas Harding

This article was originally published on Psychology Today

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Womb Wounds: Fetal Alcohol Spectrum Disorder

00ADHD, Alcohol, Child Development, Education, Empathy, Featured news, Guilt, Health, Neuroscience, Parenting, Pregnancy, Psychiatry, Stress, Trauma November, 14

“Fifteen years ago there were very few people who knew about FASD. If you were to go to court and say, ‘My son or daughter has FASD,’ a judge wouldn’t even know if it was a real thing.” – Jonathan Rudin, Justice Committee Co-Chair at the FASD Ontario Network of Expertise

Recently referred to as an “invisible condition” by the popular Canadian newspaper, The Globe And Mail, Fetal Alcohol Syndrome Disorder (FASD) often goes undiagnosed.

A supervisor at the Toronto Children’s Aid Society described to the Trauma & Mental Health Report the stream of FASD cases that have recently found their way into youth care and justice systems.

“You often don’t know a child has FASD because the mother is not around to confirm alcohol exposure during pregnancy. With one case, we suspected it, and did some digging. The grandparents of the child confirmed that the mother did consume alcohol during pregnancy. It was the grandparent’s report that changed everything. Nobody would have known.”

Characterized by growth deficiencies and central nervous system damage, FASD is an incurable condition. According to Ernest Abel, Professor of Obstetrics and Gynaecology at Wayne State University and Ronald Sokol, Professor of Paediatrics at the University of Colorado, FASD is the leading cause of mental retardation.

The Canadian Academy of Child and Adolescent Psychiatry explains that mothers often feel intense guilt and are typically blamed for damage to the child. For this reason, they are not always forthright about drinking habits. Stigma also plays a powerful role in motivating mothers to withhold information. And often, mothers consumed alcohol before they knew they were pregnant and are therefore unable to recall precise quantities and timing of drinks.

Adelaide Muswagon, a single mom, was featured in the Winnipeg Free Press in an article on FASD. “It took a lot of courage for me to get help. I know behind my back I was called an alcoholic and druggie. I can’t change what I have done; I already harmed my child. But I want expecting mothers to know my story, realize the consequences, and not make the same mistakes I did.”

The diagnosis of FASD is only given at birth for the most extreme cases. More often than not, symptoms are mild and fall within the normal range of development. For a firm diagnosis, confirmation of alcohol use during pregnancy is required. Because FASD can look like other medical, psychosocial and psychiatric conditions, children can be mistakenly labelled with Attention Deficit Hyperactivity Disorder (ADHD) or a behavioural disorder.

Fortunately, the behavioural symptoms associated with FASD are becoming better known. As we learn more about the hardships associated with the condition, mothers may question their decision to be vague or dishonest about drinking.

Liz Kulp, award winning author, advocate, and person living with FASD speaks candidly about her experiences in her book, The Best I Can Be: Living with Fetal Alcohol Syndrome-Effects.

“Finding out [why life was so hard for me] didn’t change how hard life is, but it did make me believe I was not a bad person. When I ask a question, it is because I don’t understand, not because I have not been listening, sometimes there is a blank space and I can’t get across it. I may look really normal and I work really hard to maintain. That is really stressful and sometimes I get frustrated. Sometimes the stress just builds up, especially when different people put different expectations on me all at the same time.”

For students, FASD manifests with attention problems and difficulties understanding instructions and rules. Common sense can be lacking, along with a tendency to take things literally. Learning issues lead to high drop-out rates. Youth with FASD often become involved in criminal justice systems, and many such individuals are overrepresented in prison populations. Jonathan Rudin, an Ontario lawyer and chair of the FASD Justice Committee says people with FASD are “usually not the mastermind behind the crime” but they are “easily convinced to take the rap.”

Catching the condition early in life and understanding its effects can help with education, parenting strategies, and legal provisions.

Moving through life without knowing why things are harder for you and why everyone else seems to be able to function with ease can be devastating. Sadly, people with undiagnosed FASD often grow up using alcohol to cope, possibly giving birth to a child with FASD.

Alleviating stigma around FASD by providing mothers with a non-judgemental space to speak about their drinking may help with diagnosis and treatment.

– Contributing Writer: Anjani Kapoor, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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New EEG Technology Makes for Better Brain Reading

00Cognition, Featured news, Health, Intelligence, Mind Reading, Neuroscience, Optimism, Personality, Post-Traumatic Stress Disorder, Sleep, Sport and Competition, Therapy, Trauma September, 14

Clinical psychologists have a long tradition of attempting to understand what is “on the mind” of their clients by use of psychological tests. The Wechsler Adult Intelligence Scales, for example, have been used for decades to assess intelligence levels. And other empirically valid psychometric measures are commonly used to understand patient mood or personality functioning.

To this point, direct examination of brain activity as a window into the client’s mind has remained elusive. But advances in the field of brain examination using electroencephalographs (EEGs) may be changing all that.

The first EEG was developed in the 1920’s by the German psychiatrist Hans Berger. He developed it to test the biological electricity produced in the brain, and first used it during brain surgery performed in 1924 on a 17-year-old boy.

If the EEG has been around for almost a century, why is it so important now? Recent technological advancements may soon have a profound impact on how mental health practitioners diagnose mental illness.

Currently, we know that the EEG records activity in the brain through electrodes attached to the scalp. When neurons (electrical pulses the brain uses to send messages) fire, they produce a small current. The EEG reads and records this current between 250 and 2000 times a second. The graphs it makes of these readings are what we know as ‘brain waves.’

The EEG is primarily used to diagnose epilepsy. As of 2005, 70% of EEG referrals were for epilepsy. During an epileptic seizure there is a large spike in brain activity that the EEG has little difficulty detecting. Even then, it is used in conjunction with a clinical examination by a physician, not as the sole means of diagnosis.

The second most common use is to diagnose sleep disorders such as narcolepsy and sleep apnea. The EEG is effective at reading the brain waves produced during sleep, which show special patterns in those with sleep disorders.

Biomedical engineering professor Hans Hallez of Flanders’ University writes, “during the last two decades, increasing computational power has given researchers the tools to go a step further and try to find the underlying sources which generate [brain waves]. This activity is called EEG source localization.”

Source localization is the technique that tells us which part of the brain is communicating. With advances in neuroscience and imaging techniques, we know what activities are represented by different parts of the brain. For example, activity in the primary visual cortex in the occipital lobe is related to vision and activity in special areas of the temporal lobe is associated with speech.

If you know what part of the brain is communicating and what it is responsible for, then you can start to build a picture of what brain waves from different parts of the brain mean. In theory, this is what some experts consider akin to mindreading

But the game-changer is this: recent developments in the field have led to a portable EEG that is relatively cheap, effective, and requires no human scoring.

Philip Low, who is the founder, CEO, and chief scientific officer of NeuroVigil Inc., developed a complex algorithm in 2007 that allows one electrode to do the work of many. His company has developed what they have named the iBrain. It uses one wireless electrode sensor the size of a quarter to record brain activity with an app that works on a smartphone.

Low says, “our vision is that one day people will have access to their brain as routinely and as easily as they currently have to their blood pressure.” He hopes to code brain wave profiles of those suffering from mental illnesses into a database at NeuroVigil that receives information from iBrain users’ cell phones. The iBrain 3 is expected to cost around $100 and be available to the public in the next few years.

Low isn’t the only one pushing the boundaries of EEG technology using single electrode devices. Hashem Ashrafiuon, a mechanical engineering professor at Villanova University’s College of Engineering has developed similar technology. His work is being used in sports helmets that can instantly diagnose concussions by detecting large changes in brain waves that occur immediately after impact.

Ashrafiuon sees many applications for his work. “It can basically be used to diagnose any health problem that affects brain activity. We hope to monitor brain health in patients with mild traumatic brain injury, post-traumatic stress disorder, Alzheimer’s disease, mild cognitive impairment, and sleep and circadian disorders.”

It is the belief of technology developers Low and Ashrafiuon that we will one day have brainwave profiles of all mental illnesses stored. Diagnosing a mental illness would be assisted by comparing brain wave profiles of a patient to a database of stored sample profiles, allowing for rapid diagnosis.

Does it sound too simple? Perhaps. Diagnosis of mental illness involves a substantial behavioral component. What the brain looks like may be a far cry from the choices a given individual makes, and how those choices affect later functioning. 

Still, there is reason for guarded optimism about the developments in EEG technology. The portability and improved accuracy will help with the diagnosis of epilepsy and sleep disorders, allowing patients to be comfortable at home and still be monitored. The more physically and economically accessible it is the better.

In a few years you may be the proud owner of Low’s iBrain 3. But in all likelihood, it won’t replace mental health practitioners any more than a good toothbrush replaces a dentist.

– Contributing Writer: Bradley Kushnier, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today