Childhood Catatonia Commonly Missed, Badly Managed

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Catatonic syndrome is a common child and adolescent psychotic disorder that responds well to benzodiazepines, with the addition of electroconvulsive therapy (ECT) if there is insufficient response to benzodiazepines.

However, a retrospective study suggests the condition is frequently missed, that these specific interventions are underused, and that the inappropriate use of neuroleptic drugs can precipitate clinical worsening.

Catatonia symptoms are often overlooked or misinterpreted because of the misperception that these symptoms are rare in children.

by Daniel M. Keller, PhD

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Early Postdischarge Period Linked to Very High Suicide Risk

Psychiatric inpatients are at extreme risk for suicide in the period immediately following discharge, but high-quality aftercare may be protective, new research suggests.

A retrospective case-control study showed that 55% of 100 patients in England with psychiatric illness who died by suicide did so within the first week of being discharged — and nearly half of those died before their first follow-up treatment appointment.

Factors associated with increased suicide risk during this period included hospitalization of less than 1 week, recent adverse events, older age, and comorbid psychiatric disorders.

by Deborah Brauser, Medscape

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Antipsychotic Hiatus Prolongs Recovery, Ups Relapse Risk

Interrupting antipsychotic medication following a first episode of psychosis is associated with a 5-fold increased risk for relapse and a longer time to recovery, new research shows.

The results of a prospective study led by Thomas Elanjithara, MBBS, MRCPsych, of the Institute of Psychiatry at Maudsley Hospital and King’s College London in the United Kingdom, suggest that “antipsychotic treatment should be uninterrupted in the early stages of psychosis, and periods of even short breaks in treatment carry risk of adverse outcome, like longer time to recover, and high risk of immediate relapse.”

by Daniel M. Keller, PhD

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New 3-D Imaging Technology Promises Breakthroughs in Brain Research

Brain & Behavior Research Foundation Scientific Council Member and NARSAD Grantee, Karl Deisseroth, M.D., Ph.D., led a team at Stanford in developing a new experimental method they are calling “CLARITY,” that enables researchers for the first time to obtain high-resolution three-dimensional imagery of the brain. The new method, as reported today in Nature, renders the brain essentially transparent, making it possible to see in detail its complex fine wiring and essential features underpinning the functioning of the brain while also offering a global perspective of brain structure.

Prior to CLARITY, creating a 3-D image of the brain required carving its tissue into hundreds or thousands of hair-thin slices, scanning images of the slices in microscopic detail, and then painstakingly realigning the sections. Now a 3-D view of all the complex circuitry in the brain is possible while all of the important structures of the brain remain intact and in place (neurons, axons, dendrites, synapses, proteins, nucleic acids, etc.). By replacing the brain’s fat with a clear gel, CLARITY turns the opaque and impenetrable brain transparent and permeable. The hydrogel also importantly holds the brain’s anatomy intact and because it is permeable, the brain can be stained to localize proteins, neurotransmitters and genes at a high resolution (as in video below).

–Brain and Behavior Research Foundation

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Mental Health Awareness and Improvement Act of 2013

Senate adopted the Mental Health Awareness and Improvement amendment (S. 689) to the gun policy bill (S 649) that would reauthorize various Health and Human Services mental-health programs. Tom Harkin, D-IA, and Lamar Alexander, R-Tenn. , the chairman and ranking member, respectively, of the Health, Education, Labor and Pensions panel, offered the proposal. It was adopted 95-2 under a 60-vote threshold vote.

Cannabis Use Linked to More Severe Schizophrenia

Cannabis use not only increases the risk for schizophrenia but new research suggests it is associated with more severe schizophrenic psychosis.

A large, longitudinal cohort study shows that schizophrenia patients with a history of cannabis use had longer hospital stays, a higher rate of hospital readmission, and a type of schizophrenia “that may be more severe than schizophrenia cases in general,” according to study investigator Peter Allebeck, MD, PhD, professor of social medicine in the Department of Public Health Sciences at the Karolinska Institute in Stockholm, Sweden.

by Daniel M. Keller, PhD

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Oxytocin May Augment Social-Cognition Training in Schizophrenia Patients

Oxytocin, a hormone known to influence a variety of emotional responses including attachment and social engagement, appears to be helpful as an adjunct to social-cognition training for some patients with schizophrenia, said Stephen Marder, M.D., of the Semel Institute for Neuroscience at UCLA yesterday at the International Congress on Schizophrenia Research in Orlando, Fla.

Marder made his remarks during a symposium on “Pharmacological Approaches for Facilitating Non-Pharmacologic Treatments.” He outlined evidence for impairment in social cognition in schizophrenia and its relationship to poorer outcome, as well as studies indicating that training can improve social cognition and evidence for the efficacy of oxytocin in enhancing empathic accuracy and recognition of positive and negative social cues. Marder explained that social cognition consists of “lower level” cognitive skills—such as recognition of facial cues—and “higher order” skills such as the ability to make emotional inferences and recognize sarcasm, for instance. He then described studies at UCLA in which schizophrenia patients were administered oxytocin prior to receiving social-cognition training. The findings were intriguing: while the skills training was primarily useful for lower-level social skills, the oxytocin appeared to enhance the higher-level skills of drawing accurate inferences from social cues and empathic accuracy.

APA, Psychiatric News Alert

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TED Talk: Thomas Insel talks about Mental Disorders as Brain Disorders

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A rethink is needed in terms of how we view mental illness, stated National Institute of Mental Health Director Thomas Insel, M.D., in a recent TED talk at the California Institute of Technology (Caltech) in Pasadena.

Deaths from medical causes such as leukemia and heart disease have decreased over the past 30 years. The same cannot be said of the suicide rate, which has remained the same. A vast majority of suicides—90 percent—are related to mental illnesses such as depression and schizophrenia.

Insel believes part of the problem is that mental illness is referred to either as a mental or behavioral disorder. “We need to think of these as brain disorders,” he said, adding that for these brain disorders, behavior is the last thing to change.

Insel walked the audience through recent advances in neuroscience, including the Human Connectome, which indicates that mental illness may be more of a neuronal connection or circuit disorder. The earlier these circuits are identified, he said, the earlier preventive treatments could be used to save the lives of people with mental illnesses.

“If we waited for the ‘heart attack,’ we would be sacrificing 1.1 million lives every year in this country,” he said. “That is precisely what we do today when we decide that everyone with one of these brain disorders, brain circuit disorders, has a behavior disorder. We wait until the behavior emerges. That’s not early detection, that’s not early prevention.”

NIMH Director, Dr. Thomas Insel:  Brain Disorders as Brain Disorders

Research Points to Early Warning Signs For Schizophrenia

Changes in brain function may foreshadow schizophrenia as early as puberty, nearly a decade before most patients begin showing obvious symptoms, new research from the University of North Carolina shows.

Researchers in Chapel Hill looked at brain scans of 42 children, some as young as 9, who had close relatives with schizophrenia. They saw that many of the children already had areas of the brain that were “hyperactivated” in response to emotional stimulation and tasks that required decision-making, said Aysenil Belger, associate professor of psychiatry at the UNC School of Medicine and lead author of the study.

“These children are trying extra hard to do something that other children are able to do without so much effort,” Belger said.

Belger said her team’s findings could help establish an earlier diagnosis of the brain disease and ultimately point to techniques for offsetting or minimizing disease progression.

“We are interested in seeing if we can find some way to intervene,” Belger added.

Among the possibilities for treatment are hormone therapies, cognitive skills training and new medicines to improve brain function.

People who have a parent or sibling with schizophrenia are about 10 times more likely to develop the disease than those who do not. Signs of the illness typically begin in the late teens to mid-20s. These include declines in memory, intelligence and other brain functions that indicate a weakening in the brain’s processing abilities. More advanced symptoms may include paranoid beliefs and hallucinations.

Belger and her research team have been involved in previous studies that identified at-risk teens beginning at age 16.

The latest study, published in the March 6 issue of the online journal Psychiatry Research: Neuroimaging, intentionally drew its subjects from a younger age group.

“We were interested in seeing if being a first-degree family member of someone with schizophrenia meant their brains were already different,” Belger said.

By Renee Elder, NewsObserver.com

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Become a Red Cross Disaster Mental Health Volunteer–Train and Prepare for the Next Disaster

MENTAL HEALTH PROFESSIONALS RECRUITMENT INFORMATION

What is the Red Cross doing and what does it need? 

The Red Cross helps those affected by natural and man-made disasters, which we have had plenty of during the last year!

Opportunities for Mental Health Professionals to Become Red Cross Disaster Mental Health Volunteers

Are you eligible?

Red Cross DMH Volunteers must be:

  • Independently-licensed, master’s level (or higher) mental health professionals (psychiatrists, psychologists, social workers, professional counselors),
  • State-licensed or state-certified school counselors and school psychologists, or
  • RNs with a certification for psychiatric and mental health nursing to include RN-BC, PMHNP-BC or PMHCNS-BC.
  • Licensed in the state in which you live

If you are not eligible, don’t worry. There are many volunteer opportunities within Red Cross that are equally important and rewarding.  Please contact your chapter to explore activities such as Client Casework or Mass Care. You chapter may recommend a good volunteer fit for you.

Steps to Become a Red Cross Disaster Mental Health Volunteer:

  • All volunteer work with the American Red Cross begins at the local chapter
  • Enter your zip code under “Find your local Red Cross” at www.redcross.org to find the chapter closest to you.
  • Register as a volunteer with the chapter.
    • Fill out a health status record
    • Complete a background check
    • Take Foundations of Disaster Mental Health training* and Disaster Services: An Overview
    • Fulfill any other training or paperwork that your chapter may require
    • While you are waiting for a course or to be approved to deploy, any support you can provide to your local community and Red Cross chapter will be of great value.
  • Psychological First Aid is also a required course for DMH volunteers. You may be able to take it after you have registered as a volunteer. Discuss this possibility with your chapter.

Why does it take so long to get deployed?  Why is there so much paperwork?

  • Essential information and background checks are needed to ensure the safety and welfare of Red Cross clients, volunteers and partners.  Preparing disaster relief workers to respond in the aftermath of disaster can be extremely challenging. Chapter staff is often overworked and are often volunteers themselves.
  • The Red Cross places high value in getting the right people, to the right place, doing the right thing, at the right time.  Sometimes that means taking more time before deployment in order to save time moving people later.
  • Local Red Cross chapters are managing large amounts of requests from the community and from prospective volunteers.

What is different about volunteering with the Red Cross?

  • Be patient and flexible.  Situations in disaster change rapidly and service delivery needs are fluid.  You may be asked to work at one site providing one type of service and then be switched to another site within a short period of time.
  • Our co-workers are also our clients.  90% of Red Cross staff are volunteers just like you.  They need your support.
  • You won’t have an office.  Most mental health work done in disaster is done in non-traditional settings, like shelters and service centers.  You may be providing support as you’re going for a walk or sitting under a tree.
  • Provide non-traditional mental health services.
    • Psychological first aid, triage, crisis intervention, assessment and basic support
    • Early intervention is primarily focused on assisting disaster survivors and response workers in meeting their most basic needs.
      • Helping people feel safe and secure
      • Obtaining food and water
      • Addressing physical health needs (e.g., first aid, medications)
      • Connecting to family, friends, and other social support networks.
    • Psychotherapy is not appropriate.
  • The work is very rewarding …. And very frustrating.  You’re working with people who have immediate needs for emotional support, food, shelter and other basics.  The most crucial need is information, which often you don’t have because the situation is constantly changing.  We do the best we can with the limited resources we have.

What if I’m already a trauma specialist – why do I need special training?

  • The Red Cross has a specific role in disaster response which is different from the regular work of most mental health professionals.  Training is needed to understand that role.
  • In order to minimize frustration, you need to understand the disaster response system and organization of the Red Cross.
  • Most trauma interventions are not appropriate in the early aftermath of disaster, but your specialized training can be helpful in identifying those who are at risk for longer-term complications.

www.redcross.org