Family Crisis Therapy Helps Suicidal Teens

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A new UCLA study suggests a specialized mental health intervention for suicidal youth can help troubled teens. The new approach is welcomed as experts say that roughly 1 million people die by suicide each year.

In the U.S., where nearly 36,000 people take their own lives annually, more than 4,600 victims are between the ages of 10 and 24, making suicide the third leading cause of death in this age group.

In the new investigation, researchers discover a program that helps to link follow-up care after treatment in emergency rooms improves outcomes among the high risk youths.

This program has been developed in response to the U.S. Department of Health and Human Service’s National Strategy for Suicide Prevention call to increase rates of follow-up care after discharge for patients who come to the emergency department due to suicidal behavior.

Reporting in the November issue of the journal Psychiatric Services, Joan Asarnow, Ph.D., a professor of psychiatry at UCLA, and colleagues show that a family-based intervention conducted while troubled youths were still being treated in the emergency department led to dramatic improvements in linking these youths to outpatient treatment following their discharge.

“Youths who are treated for suicidal behavior in emergency departments are at very high risk for future attempts,” said Asarnow, the study’s first author.

“Because a large proportion of youths seen in the emergency department for suicide don’t receive outpatient treatment after discharge, the United States National Strategy for Suicide Prevention identifies the ED as an important suicide prevention site. So, a national objective is to increase the rates of mental health follow-up treatment for suicidal patients coming out of emergency departments.”

Researchers studied 181 suicidal youths at two emergency departments in Los Angeles County, with a mean age of 15. of the group, 69 percent were female, and 67 percent were from racial or ethnic minority groups.

For 53 percent of the participants, their emergency department visit was due to a suicide attempt. The remainder were seen because they had thoughts of suicide.

The youths were randomly assigned to either the usual emergency department treatment or an enhanced mental health intervention that involved a family-based crisis-therapy session designed to increase motivation for outpatient follow-up treatment and improve the youths’ safety, supplemented by telephone contacts aimed at supporting families in linking to further outpatient treatment.

Researchers discovered the enhanced mental health intervention was associated with higher rates of follow-up treatment.

Of the participants in the enhanced intervention, 92 percent received follow-up treatment after discharge, compared with 76 percent in the standard emergency department treatment arm — a clinically significant difference.

While the results are positive, the study is only a first step, according to Asarnow, who also directs UCLA’s Youth Stress and Mood Program.

“The results underscore the urgent need for improved community outpatient treatment for suicidal youths,” she said. “Unfortunately, the follow-up data collected at about two months after discharge did not indicate clinical or functioning differences among youths who received community outpatient treatment and those who did not.”

Still, Asarnow said, the data from the new study underscores the critical importance of this work.

Researchers say that follow-up treatment is needed for troubled youth. In accordance, current studies at UCLA are aimed at evaluating outpatient treatments for preventing suicide and suicide attempts.

By Rick Nauert PhD

Psych Central

Low Levels of Vitamin D Linked to Teen Delusions, Hallucinations

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Researchers have shown before that low vitamin D levels are linked with psychiatric disorders like major depression.

Now, a presentation at the annual meeting of the American Academy of Child and Adolescent Psychiatry signals the importance of testing those who suffer from psychotic symptoms—delusions (fixed and false beliefs) and hallucinations—for vitamin D deficiency.

A group of researchers led by Dr. Barbara L. Gracious, a psychiatrist at Nationwide Children’s Hospital in Columbus, Ohio, presented data at that meeting showing that adolescents who were vitamin D deficient showed a fourfold (400 percent) increased rate of psychotic symptoms, compared to other adolescents with normal vitamin D levels who sought psychiatric treatment at the University of Rochester, in New York.

In other words, in the group of adolescents asking for psychiatric help that Gracious studied, low vitamin D was very, very powerfully connected to the likelihood that they would report symptoms like delusions (like paranoia) or hearing voices or seeing visions.

Delusions and hallucinations are among the most serious symptoms we psychiatrists treat. And the idea that vitamin D deficiency could be so substantially linked to psychotic symptoms is a tantalizing prospect. It suggests that it is time to routinely measure the Vitamin D levels of those complaining of such symptoms.

When vitamin D levels are found to be low, they should, of course, be corrected. Whether or not this will lessen psychotic symptoms remains to be definitively proven.

The vitamin D-mental health connection is particularly interesting given the fact that millions of Americans report symptoms of seasonal affective disorder—depression that typically seems to recur each late fall, or early winter—when exposure to sunlight is limited. Vitamin D plummets, of course, when people are deprived of sunlight.

Gracious’ findings are yet another reason why psychiatry would be wise to drop all resistance to considering the impact of vitamin and nutritional deficiencies of one kind or another on mental well-being.

We know, after all, that Deplin, an altered form of folic acid that can reach the nervous system without being metabolized, shows powerful promise in the treatment of mood disorders. Indeed, Deplin, which I have written about on FoxNews.com before, is already approved by the FDA as a “medical food” that can be used to treat depression. We also know that taking high doses of fish oil can impact mood and may significantly decrease aggression.

These findings on vitamins and other nutrients come at a time when psychiatry’s traditional medications—like serotonin reuptake inhibitors and antipsychotic medications—are under siege. Recent studies have questioned whether many of these agents are any better than placebos. A large study of the very common use of the antipsychotic Risperdal in veterans with post-traumatic stress disorder (PTSD) showed it had essentially no value at all. Yet, such medications can be very, very expensive and can have very serious side effects, including movement disorders, suicidal thinking, cardiac abnormalities and significant weight gain.

I am not saying that traditional psychoactive medications are not important. Used judiciously, with expertise, in the right patients, they can be lifesaving. I’m certain of that. But it is time to open our minds to treatments based on vitamins and other nutrients, as well as other alternative ways of affecting the brain, like repetitive transcranial magnetic stimulation (rTMS, about which I have also written at FoxNews.com).

It is possible that a large percentage of those who now suffer from major depression, for example—even when that depression is severe enough to spark psychotic symptoms—could soon be most effectively treated with psychotherapy, magnetic therapy and nutritional/vitamin therapy. That’s would represent a massive shift in the way psychiatry treats that illness. And other illnesses may be no different.

By

Fox News

Mental Health Risk Originates in the Womb, Researchers Conclude

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In essence, we come into the world pre-programmed with ailments that appear later in life, such as depression, anxiety and  chemical dependence, scientists concluded.

The researchers, headed by biologist Nenad Sestan of Yale University, initiated the study to track the nearly 15,000 genes that flicker on and off during brain development to create nearly 100 billion brain cells and the incalculable number of connections between them.

The study found that men and women’s brains develop differently before birth, what might help explain why men and women suffer from mental illnesses at different rates. For example, about six percent of men and 12 percent of women have depression in the U.S., according to the Centers for Disease Control and Prevention. Other illnesses like schizophrenia and autism disproportionately affect men.

“We knew many of the genes involved in the development of the brain, but now we know where and when they are functioning in the human brain,” said Sestan in a statement from Yale. “The complexity of the system shows why the human brain may be so susceptible to psychiatric disorders.”

The study appeared online in the journal Nature on Wednesday.

The researchers tested post-mortem brain tissue samples from 57 people of all ages, including unborn babies. They found that over 90 percent of the genes associated with mental illness were turned on before birth, meaning the parts of the brain responsible for symptoms of mental illness had developed.

The findings are a departure from the idea that genes for mental illness turn on later in life.

“It is clear that these disease-associated genes are developmentally regulated,” Sestan said.

Even with the insight, how genes regulate brain development remains a mystery. Another group found that despite genetic differences across gender and ethnicities, the prefrontal cortex – the part of the brain where the most complicated cognitive functioning takes place – is structurally similar all the way down to the cell level.

Despite the vast genetic differences between people, the aggregate of all our genes makes our brains virtually indistinguishable from each other. A scientist could look at a brain tissue sample under a microscope and would not be able to tell the ethnicity or gender of the person from whom it was taken, so it is not our race or gender that accounts for our personality, intelligence, and likelihood of becoming mentally ill; it is how our genes expressed themselves while our brains were developing in the womb. Unlike what those who touted the Eugenics movement of the early 20th century thought, it is impossible to “breed out” all so-called imperfect human traits.

Carlo Colantuoni of the Lieber Institute for Brain Development was a co-author of the paper. He said these findings further illustrate the vast complexity of human genes and how they affect brain development.

“The whole thing is kind of surprising when you put all the pieces together,” Colantuoni said.

The research will appear in Thursday’s edition of Nature.

By Kirk Klocke

International Business Times

Undiagnosed Bipolar Disorder — Common and Concerning

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Study Summary

Many patients with major depressive episodes (MDEs) who have an underlying but unrecognized bipolar disorder receive pharmacologic treatment with ineffective regimens that do not include mood stabilizers. The objective of this multicenter, multinational, transcultural, cross-sectional, diagnostic study was to quantify how often bipolar disorder symptoms are encountered in patients seeking treatment for an MDE. Included were 5635 adults seen for an MDE at community and hospital psychiatry departments. A total of 903 patients fulfilled DSM-IV-TR criteria for bipolar disorder (16.0%; 95% confidence interval, 15.1%-17.0%), whereas 2647 (47.0%; 95% confidence interval, 45.7%-48.3%) met an alternate set of criteria for bipolarity called the “bipolarity specifier” criteria.

Viewpoint

The authors provide supporting evidence that the bipolar-specifier criteria in comparison with DSM-IV-TR criteria were valid and identified an additional 31% of patients with MDEs who are better characterized as having bipolar rather than unipolar depression. This has substantial implications in terms of appropriate treatment selection because antidepressant monotherapy would be suboptimal for patients with bipolar depression. If we depend on DSM-IV-TR, this would come up in 1 of 6 patients presenting with an MDE. If we consider the “bipolarity-specifier” criteria, this diagnostic-therapeutic issue would be relevant in almost 1 of every 2 patients presenting for treatment with an MDE.

By Leslie Citrome, MD, MPH

Medscape

http://www.medscape.com/viewarticle/751178

Bipolar Disorder Risk Factors Found in Families

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Children who grow up in families where other mental disorders are present — such as attention deficit hyperactivity disorder (ADHD) or anxiety — appear to be at greater risk for developing bipolardisorder later in life, according to new research.

Researchers still do not know what causes bipolar disorder, although it is argued that family history is presently the strongest predictive factor for being diagnosed with bipolar. If an older relative has bipolar disorder, you are at greater risk for developing it.

In the present longitudinal study, led by John Nurnberger from the Indiana University School of Medicine, examined the lifetime prevalence and early clinical predictors for psychiatric disorders in 141 high-risk children and adolescents from families with a history of bipolar disorder.

The researchers found a significant difference between the high-risk families and a group of healthy control families. By age 17, the lifetime prevalence of a major affective disorder (such as depression or bipolar disorder) was more than 23 percent in the high-risk cases, but only just about 4 percent in children of mentally healthy controls.

Overall, the prevalence of bipolar disorder was 8.5 percent in the high-risk cohort, while no bipolar disorder was reported in the control group. The risk for developing bipolar disorder was more than 5 times greater in the children of families with bipolar disorder than in those from the families in the control group.

In high-risk children a childhood diagnosis of an anxiety disorder or a childhood disorder like attention deficit hyperactivity disorder (ADHD) significantly predicted the onset of major affective disorders later in life.

Children who were in families where others were diagnosed with anxiety or similar kinds of childhood disorders such as attention deficit hyperactivity disorder (ADHD) appear to be at significantly greater risk for developing bipolar disorder than children who lived in families without these disorders present.

“[Our results] reinforce the importance of family history in evaluating the meaning of diagnoses in children and adolescents,” wrote the researchers, “and they support a different monitoring and management strategy for children and adolescents with a positive family history of bipolar disorder.”

The article appears in the Archives of General Psychiatry.

By Psych Central News Editor

Psych Central

Experts Design ‘Toolkit’ to Help Spot Teens With Mental Health Issues

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Because many adolescents with mental health problems are never diagnosed and treated, an expert team has come up with a “toolkit” aimed at identifying those kids and getting them the right help.

“One in 10 youths have a mental health condition that is severe enough to impair functioning, either at home, school or in the community,” said Gary Blau, chief of the child, adolescent and family branch of the Substance Abuse and Mental Health Services Administration (SAMHSA), part of the U.S. Department of Health and Human Services.

Blau spoke at a Friday news conference to unveil the toolkit, which appeared online simultaneously in Pediatrics. Although the journal is published by the American Academy of Pediatrics, that organization has not endorsed the toolkit. SAMHSA provided partial funding for the project.

“This toolkit will allow pediatricians, teachers and others that could help get the word out to families we can close the gap so the three out of four children with mental health disorders who aren’t identified do get identified,” said Dr. Peter Jensen, who was the lead investigator on the project.

About half of mental health disorders manifest themselves by the time a child has turned 14, and 75 percent manifest by age 24, Blau said.

Yet treatment is often years away for that child, added Lisa Hunter Romanelli, an assistant professor of clinical psychology in psychiatry at Columbia University College of Physicians & Surgeons in New York City.

“That is too long in the life of a child,” said Romanelli, who is also executive director of the nonprofit REACH Institute, whose mission is to shorten the length of time it takes for effective interventions to reach teens. Jensen is president and CEO of the institute.

Researchers convened over a period of several years to analyze data collected from more than 6,000 children and parents to identify the most common symptoms of mental health disorders and to see if children with these troubling signs were receiving appropriate care.

This information was then translated into warning signs that are written in “crisp, easy-to-understand language,” said Jensen, who is vice chair of research in the department of psychiatry and psychology at the Mayo Clinic in Rochester, Minn. “They don’t sound like mental health jargon. It was deliberate, to make them as parent-friendly as possible.”

Because differentiating a true mental health disorder from the inevitable ups and downs of adolescence is difficult, the authors chose to focus on the more severe end of the mental health spectrum.

“We realized there was a potential for harm for parents to worry when they didn’t need to be worried,” said Jensen. “So we decided to target not the 15 percent or so who have these problems, but the 8 percent who are at the more severe end.”

If your child has any of these 11 warning signs, he or she may have a mental health disorder and should be referred to treatment as soon as possible:

  • Feeling very sad or withdrawn for two or more weeks
  • Seriously trying to harm or kill themselves, or making plans to do so
  • Sudden overwhelming fear for no reason, sometimes with a racing heart or fast breathing
  • Involved in multiple fights, using a weapon, or wanting badly to hurt others
  • Severe out-of-control behavior that can hurt the teenager or others
  • Not eating, throwing up, or using laxatives to lose weight
  • Intense worries or fears that get in the way of daily activities
  • Extreme difficulty in concentrating or staying still that puts a teenager in physical danger or causes school failure
  • Repeated use of drugs or alcohol
  • Severe mood swings that cause problems in relationships
  • Drastic changes in behavior or personality

“This data substantiates what we already knew, that there are warning signs of significant mental illness, but children and adolescents aren’t getting help because health care providers don’t share the same language,” said Dr. Abigail Schlesinger, medical director of outpatient behavioral health services at Children’s Hospital Pittsburgh.

“This toolkit will help mental health providers and others on the front lines, such as teachers, people in the juvenile justice system [and] parents speak the same language,” added Schlesinger, who was not part of the research team.

More information

The U.S. National Institute of Mental Health has more on child and adolescent mental health issues.

By Amanda Gardner

HealthDay News

A High-Profile Executive Job as Defense Against Mental Ills

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PASADENA, Calif. — The feeling of danger was so close and overwhelming that there was no time to find its source, no choice but to get out of the apartment, fast.

Keris Myrick headed for her car, checked the time — just past midnight, last March — and texted her therapist.

“You’re going to the Langham? The hotel?” the doctor responded. “No — you need to be in the hospital. I need you consulting with a doctor.”

“What do you think I’m doing right now?”

“Oh. Right,” he said. “Well, O.K., then we need to check in regularly.”

“And that’s what we did,” said Ms. Myrick, 50, the chief executive of a nonprofit organization, who has a diagnosis of schizoaffective disorder, a close cousin of schizophrenia, and obsessive-compulsive disorder. “I needed to hide out, to be away for a while. I wanted to pamper myself — room service, great food, fluffy pillows, all that — and I was lucky to have a therapist who understood what was going on and went with it.”

Researchers have conducted more than 100,000 studies on schizophrenia since its symptoms were first characterized. They have tested patients’ blood. They have analyzed their genes. They have measured perceptual skills, I.Q. and memory, and have tried perhaps thousands of drug treatments.

Now, a group of people with the diagnosis is showing researchers a previously hidden dimension of the story: how the disorder can be managed while people build full, successful lives. The continuing study — a joint project of the University of California, Los Angeles; the University of Southern California; and the Department of Veterans Affairs — follows a group of 20 people with the diagnosis, including two doctors, a lawyer and a chief executive, Ms. Myrick….

By

New York Times

http://www.nytimes.com/2011/10/23/health/23lives.html?pagewanted=all

Human Factor: There is no face of schizophrenia

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In the Human Factor, we profile survivors who have overcome the odds. Confronting a life obstacle injury, illness or other hardship they tapped their inner strength and found resilience they didn’t know they possessed. This week  Ashley Smith shares the shock and struggle of learning she had schizophrenia.

In the summer of 2007, my life changed drastically when I was diagnosed with paranoid schizophrenia at the age of 20.

I was made aware of my illness when I stole a military truck from an airport and went on a high-speed chase with the police. I was jailed and later hospitalized for that crime.

I am now on my journey to recovery with the support of family, treatment team, peers and my faith. I share my recovery story as often as I can because I want to help reduce stigma, change perceptions, and encourage an open conversation about mental illness.

My hope is that that the public will have a better understanding of schizophrenia, be supportive of people living with it, be open to discuss one’s need for treatment, and help them seek treatment. Support and treatment are the keys to successfully managing schizophrenia and there are resources available to help consumers, caregivers, family, co-workers and friends understand it and that recovery is very possible.

I encourage people to visit www.choicesinreovery.com to get that information. You can also view the documentary, “Living With Schizophrenia: A Call For Hope and Recovery,” which is about three people, including myself, who are living successful and productive lives.

Two additional things about schizophrenia that I want to share is that there is no face to schizophrenia; and that the myths that people with schizophrenia are violent, have split personalities and that it is caused by poor parenting are not true. As you can see from my story, I do not fit the stereotype of how people characterize the condition and the people who have it.

Coping with schizophrenia: Why you need a crisis plan

I did not know what schizophrenia was prior to being diagnosed. I did not know that I had a history of mental health in my family, and I did not recognize that the illness was gradually stealing my identity. But now that I am aware of my condition, I am fighting back by giving back and sharing information to spread awareness and hope through my nonprofit Embracing My Mind, Inc.

The hardest thing I’ve had to cope with was the fact that I have a lifelong diagnosis and I will be in treatment for the rest of my life. If there was something I could change it would be societal acceptance of mental health and schizophrenia to be viewed as a medical condition like any other.

I’m hopeful that through my story, people will become more aware of schizophrenia and change their perceptions about it. I’m hopeful that people who witness my story on Human Factor will provide comments to this blog on whether my story has helped them to better understand schizophrenia and put them on the road to changing their perceptions.

Post by:

CNN

http://thechart.blogs.cnn.com/2011/11/01/human-factor-there-is-no-face-of-schizophrenia/

Cannabis Disrupts Brain Waves Like Schizophrenia, Study-Finds

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Cannabis causes the same type of chaotic brain activity seen in people with schizophrenia, British scientists found.

Researchers from Bristol University, in western England, made the discovery after measuring the brain neurons of rats that were given the psychoactive ingredient of cannabis.

They found that the drug completely disrupted coordinated brain waves, which are essential for memory and decision-making, in the area across the hippocampus and prefrontal cortex.

The resulting brain activity was uncoordinated and inaccurate, leading to neurophysiological and behavioral impairments similar to those seen in schizophrenia.

The rats exposed to the cannabis-like drug were left unable to make accurate decisions when navigating a maze, according to findings published Tuesday in the Journal of Neuroscience.

Dr. Matt Jones, who led the study, said, “Marijuana abuse is common among sufferers of schizophrenia, and recent studies have shown that the psychoactive ingredient of marijuana can induce some symptoms of schizophrenia in healthy volunteers.”

He added that the effects of the drug on the brain were similar to parts of an orchestra playing out of synch and that the findings advanced our understanding of psychiatric diseases, which could be treated by “re-tuning brain activity.”

Generic Zyprexa OK’d by FDA for Schizophrenia, Bipolar Disorder

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Generic Zyprexa OKd by FDA for Schizophrenia, Bipolar DisorderThe U.S. Food and Drug Administration (FDA) on Monday approved the first generic versions of Zyprexa (olanzapine tablets) and Zyprexa Zydus (olanzapine orally disintegrating tablets) to treat schizophrenia and bipolar disorder.

Olanzapine is an atypical antipsychotic medication widely prescribed in the U.S. to control psychotic symptoms such as those frequently found in these illnesses.

Schizophrenia is a chronic, severe, and disabling brain disorder. About 1 percent of Americans have this illness. Symptoms of those with schizophrenia include hearing voices, believing other people are reading their minds or controlling thoughts, and being suspicious or withdrawn.

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. The symptoms of bipolar disorder include alternating periods of depression and high or irritable mood, increased activity and restlessness, racing thoughts, talking fast, impulsive behavior, and a decreased need for sleep.

“The approval of generic olanzapine offers greater access to a widely used treatment for mental illnesses,” said Keith Webber, Ph.D., deputy director of the Office of Pharmaceutical Science in the FDA’s Center for Drug Evaluation and Research. “Having affordable treatment options is good for patients with long-term illnesses that must be carefully managed.”

Olanzapine must be dispensed with a Medication Guide that describes the risks and adverse reactions people should be mindful of when using the product. Olanzapine has a boxed warning alerting that this type of drug can raise the risk of death in elderly people who have lost touch with reality (psychosis) due to confusion and memory loss (dementia). Olanzapine is not approved for treating psychosis in the elderly with dementia.

Other serious risks of olanzapine include high blood sugar (hyperglycemia), high-lipid levels in the blood (increased cholesterol and triglycerides), and weight gain. Clinicians should take these effects into account when deciding to use this type of medication.

Generic drugs approved by FDA have the same high quality, strength, purity, and stability as brand-name drugs. The generic manufacturing, packaging, and testing sites must pass the same quality standards as those of brand name drugs.

By David McCracken, MA, LPC

PsychCentral