NIH has launched new site as the place for the broader community to discuss the new BRAIN (Brain Research through Advancing Innovative Neurotechnologies) Initiative and provide important feedback regarding the BRAIN Initiative’s scientific agenda. This Initiative, launched by President Obama on April 2, 2013 focuses on accelerating the development and application of innovative new technologies to enable scientists to create a dynamic picture of brain function.
The U.S. military has faced two epidemics over the last decade of war in Afghanistan and Iraq.
One is suicide. The annual rate of military personnel taking their own lives has doubled to about 20 per 100,000. That translated to a record 324 suicides in the Army last year.
The other is concussion, also known as mild traumatic brain injury, or TBI. The proliferation of roadside bombs has subjected thousands of troops to brain-rattling explosions.
Several studies have suggested a link between the two epidemics — that service members who suffered concussions are at greater risk for suicide.
by Alan Zarembo, Los Angeles Times
Importance: The human brain forms a large-scale structural network of regions and interregional pathways. Recent studies have reported the existence of a selective set of highly central and interconnected hub regions that may play a crucial role in the brain’s integrative processes, together forming a central backbone for global brain communication. Abnormal brain connectivity may have a key role in the pathophysiology of schizophrenia.
Objective To examine the structure of the rich club in schizophrenia and its role in global functional brain dynamics.
Design Structural diffusion tensor imaging and resting-state functional magnetic resonance imaging were performed in patients with schizophrenia and matched healthy controls.
Results Rich club organization between high-degree hub nodes was significantly affected in patients, together with a reduced density of rich club connections predominantly comprising the white matter pathways that link the midline frontal, parietal, and insular hub regions. This reduction in rich club density was found to be associated with lower levels of global communication capacity, a relationship that was absent for other white matter pathways. In addition, patients had an increase in the strength of structural connectivity–functional connectivity coupling.
Conclusions Our findings provide novel biological evidence that schizophrenia is characterized by a selective disruption of brain connectivity among central hub regions of the brain, potentially leading to reduced communication capacity and altered functional brain dynamics.
The human brain is a complex network of structurally and functionally interconnected regions. Studies examining the brain’s underlying network structure are motivated by the notion that brain function is not solely attributable to the properties of individual regions or individual connections but rather emerges from the network organization of the brain as a whole, the human connectome. Conversely, brain dysfunction may result from abnormal wiring of the brain’s network.
The notion that schizophrenia, a severe psychiatric disorder characterized by hallucinations, delusions, loss of initiative, and cognitive dysfunction, may relate to disconnectivity among brain regions has a long history. As cited by Stephan, Wernicke was among the first to suggest that schizophrenia may involve anatomical disruption of association pathways. Bleuler, who coined the term schizophrenia, hypothesized that decoupling of psychological processes might be the primary cause of the disease. Lately, studies using imaging techniques, such as diffusion tensor imaging (DTI) and functional magnetic resonance imaging (fMRI), have reported widespread disconnectivity in patients, in particular reduced integrity of frontal and temporal white matter connections and affected functional coupling of the default mode network.
A few highly connected and central regions, the so-called hub nodes, have a key role in the global topology of the brain’s network. Previous network studies report disruptions in the overall organization of structural connectivity (SC) and functional connectivity (FC) in patients with schizophrenia, together with a less centralized position of some of these hubs in the frontal, temporal, and parietal cortex. However, it remains unknown whether reduced connectivity of hubs constitutes a nonspecific generalized phenomenon involving white matter connectivity to and from all brain regions or whether this disruption disproportionally involves pathways that link highly connected regions. In the healthy brain, hubs have been found to be densely interconnected, together forming a central core or rich club, with rich club connections having a pivotal role in interregional brain communication. We test the hypothesis that disturbed wiring of this central rich club may contribute to the pathophysiology of schizophrenia.
Using neuroimaging data in a group of 48 patients and 45 healthy controls, we examined potentially abnormal connectivity of the brain’s rich club and the relationship of a disruption of this communication backbone to (reduced) levels of global communication capacity and changed functional dynamics in the brain networks of patients. An independently acquired data set of patients and controls (41 patients and 51 controls) was used to replicate possible findings.
Martijn P. van den Heuvel, PhD; Olaf Sporns, PhD; Guusje Collin, MD; Thomas Scheewe, PhD; René C. W. Mandl, PhD; Wiepke Cahn, MD, PhD; Joaquín Goñi, PhD; Hilleke E. Hulshoff Pol, PhD; René S. Kahn, MD, PhD
People With Behavioral Health Conditions Are More Likely to Smoke. Psychologists Are Among Those Working to Understand Why and Helping Them Quit
For people with mental illnesses, just staying alive can be challenging: People with serious mental illness treated in the public health system die a startling 25 years earlier than those without mental illness, according to a 2006 article in Preventing Chronic Disease. The problem hasn’t improved in the years since, Morris notes, and all too often, smoking is part of that mortal equation.
Tobacco-related illnesses including cancer, heart disease and lung disease are among the most common causes of death in this population. And Americans with mental illnesses have a 70 percent greater likelihood of smoking than the general population, according to new findings from researchers at the Centers for Disease Control and Prevention (Morbidity and Mortality Weekly Report, Feb. 8). People with mental illnesses also smoke more often than smokers without mental illness, says Tim McAfee, MD, director of the CDC’s Office on Smoking and Health and a co-author of the report. “We can’t just ignore this population.”
In some cases, people with mental illness may be using tobacco to mask symptoms or medication side effects, McAfee says. Some might also be more affected by nicotine withdrawal. “People with panic attacks, for instance, may have a harder time quitting because the symptoms of withdrawal — such as increased heart rate — can trigger an attack,” he says.
Quitting smoking does not impair mental health recovery. On the contrary, tobacco use is associated with greater depressive symptoms, a greater likelihood of psychiatric hospitalization and an increase in suicidal behavior. Abstaining from cigarettes, on the other hand, can help people with other addictions maintain sobriety, as Prochaska reported in 2010 in Drug and Alcohol Dependence. And despite some misconceptions, mental health patients can stop smoking; studies have shown that people with depression, schizophrenia and post-traumatic stress disorder can quit without impairing their mental health recovery, Prochaska says. She works with smokers with a full range of psychiatric disorders, recruited from acute inpatient settings. Using a combination of motivational approaches, cognitive-behavioral therapy and nicotine-replacement medications, she says, “we’re seeing quit rates comparable to those you see in the general population.”
Not only can mental health patients quit, says Morris, many of them would very much like to. “If you ask them, people with behavioral health conditions want to quit at the same rate as the general population, but we were not giving them the same resources and affording them the same opportunities to change,” he says. “At the bottom line, this is a patients’ rights issue.”
By Kirsten Weir, American Psychological Association (APA)
Use of an avatar can help treat patients with schizophrenia who hear voices, a UK study suggests.
The trial, published in the British Journal of Psychiatry, focused on patients who had not responded to medication.
Using customised computer software, the patients created avatars to match the voices they had been hearing.
After up to six therapy sessions most patients said their voice had improved. Three said it had stopped entirely.
The study was led by psychiatrist emeritus professor Julian Leff, who spoke to patients through their on-screen avatars in therapy sessions. Gradually he coached patients to stand up to their voices.
The avatar gradually changes to saying, ‘all right I’ll leave you alone’”
“I encourage the patient saying, ‘you mustn’t put up with this, you must tell the avatar that what he or she is saying is nonsense, you don’t believe these things, he or she must go away, leave you alone, you don’t need this kind of torment’,” said Prof Leff.
“The avatar gradually changes to saying, ‘all right I’ll leave you alone, I can see I’ve made your life a misery, how can I help you?’ And then begins to encourage them to do things that would actually improve their life.”
By the end of their treatment, patients reported that they heard the voices less often and that they were less distressed by them. Levels of depression and suicidal thoughts also decreased, a particularly relevant outcome-measure in a patient group where one in 10 will attempt suicide.
by Lorna Stewart, BBC
Elderly Health/Long-Term Care
Antipsychotic medications are commonly used in nursing homes to help patients with dementia, schizophrenia, and other behavior problems. Older drugs, called typical antipsychotics, can cause a variety of central nervous system side effects. The newer, atypical agents are preferred by many due to their better side effect profiles. Typical antipsychotics can increase the risk for mortality in the elderly, concludes a new study.
–Agency for Healthcare Research and Policy
In the United States, there are more than 400,000 children and teens in foster care. Research reveals that children and teens in the foster care system have disproportionately high rates of psychiatric disability.
One study by the National Institute of Mental Health found that nearly half (47.9 percent) of youth in foster care were found to have clinically significant emotional or behavioral problems. Likewise, researchers at the Casey Family Programs estimate that between one-half and three-fourths of children entering foster care exhibit behavioral or social competency problems that warrant mental health services.
Youth who have “aged out” of foster care also show high rates of psychiatric disability. According to a study by the Casey Family Programs and Harvard Medical School, a high number of former foster children have psychiatric disabilities as adults. Over half of foster care alumni had mental health diagnoses, compared to 22 percent of the comparison group.
The disproportionate level of mental health diagnoses is perhaps most evident with post-traumatic stress disorder (PTSD). Thirty percent of foster alumni are diagnosed with PTSD, which is about twice the rate of U.S. combat veterans.
by Stephanie Orlando, Disability Blog
Distinct patterns of brain activity are linked to greater rates of relapse among alcohol dependent patients in early recovery, a study has found. The research, supported by the National Institutes of Health, may give clues about which people in recovery from alcoholism are most likely to return to drinking.
“Reducing the high rate of relapse among people treated for alcohol dependence is a fundamental research issue,” said Kenneth R. Warren, Ph.D., acting director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of NIH. “Improving our understanding of the neural mechanisms that underlie relapse will help us identify susceptible individuals and could inform the development of other prevention strategies.”
Using brain scans, researchers found that people in recovery from alcoholism who showed hyperactivity in areas of the prefrontal cortex during a relaxing scenario were eight times as likely to relapse as those showing normal brain patterns or healthy controls.
The prefrontal brain plays a role in regulating emotion, the ability to suppress urges, and decision-making. Chronic drinking may damage regions involved in self-control, affecting the ability to regulate cravings and resist relapse.
–National Institutes of Health (NIH)
Report reveals special challenges of pregnant teens in substance abuse treatment
A new report shows that among the approximately 57,000 teenage female (ages 12 to 19) substance abuse treatment admissions each year, about 2,000 (4 percent) involve pregnant teens. The Substance Abuse and Mental Health Services Administration’s (SAMHSA) report finds that these pregnant teen admissions tend to face greater challenges than other female teen admissions in a number of key areas such as financial and educational status.
For example, pregnant teen admissions were three times more likely than other female teen admissions to receive public assistance as a primary source of income (15 percent versus 5.3 percent). Similarly in education, while 74 percent of non-pregnant female teen admissions who were not in the workforce were students, only 44.2 percent of pregnant teen admissions not in the workforce were students.
The report also indicates that about half (51 percent) of pregnant teen admissions reported some use of drugs or alcohol in the month prior to their treatment entry. This rate is substantially lower than that of other female teenage admissions (70.9 percent). However, nearly one fifth (19.3 percent) of pregnant teen admissions had used a drug or alcohol on a daily basis in the month before entering treatment – comparable to the rate among other female teen admissions (24.5 percent).
Marijuana was the most commonly used substance among both pregnant teen and other female teen treatment admission groups (72.9 percent and 70.2 percent respectively). However there were some notable differences in the substance use patterns between the two groups, particularly with regard to the use of methamphetamines and amphetamines. Pregnant teen admissions were twice as likely as other female treatment admissions to abuse these substances (16.9 percent for pregnant teen admissions versus 8.4 percent for other female teen admissions).
“It is critical that pregnant women of all ages have access to prevention, support, and recovery services that meet their specialized needs,” said SAMHSA Administrator Pamela S. Hyde. “These specialized needs are even more acute for our pregnant teens. Community programs that can address the needs of pregnant teens by providing them both access to substance abuse support services and specialized pregnant and post partum services can help ensure that these future mothers and their children live healthier, happier and more productive lives.”
Zolpidem is the active ingredient in Ambien, Ambien CR, Edluar and Zolpimist
A new report shows that the number of emergency department visits involving adverse reactions to the sleep medication zolpidem rose nearly 220 percent from 6,111 visits in 2005 to 19,487 visits in 2010. The Substance Abuse and Mental Health Services Administration (SAMHSA) report also finds that in 2010 patients aged 45 or older represented about three-quarters (74 percent) of all emergency department visits involving adverse reactions to zolpidem.
In 2010 there were a total of 4,916,328 drug-related visits to emergency departments throughout the nation.
From 2005 to 2010 there was a 274 percent increase in the number of female visits to emergency department involving zolpidem (from 3,527 visits in 2005 to 13,130 in 2010) – in comparison to a 144 percent increase among males during the same period (2,584 visits in 2005 to 6,306 in 2010). In 2010 females accounted for more than two-thirds (68 percent) of all emergency department visits related to zolpidem.
Zolpidem is an FDA-approved medication used for the short-term treatment of insomnia and is the active ingredient in drugs such as Ambien, Ambien CR, Edluar and Zolpimist. These drugs have been used safely and effectively by millions of Americans, however, in January 2013, FDA responded to increasing numbers of reports of adverse reactions by requiring manufacturers of drugs containing Zolpidem to halve the recommended dose for females. FDA also suggested that manufacturers reduce the recommended dose for men as well.
Adverse reactions associated with the medication include daytime drowsiness, dizziness, hallucinations, agitation, sleep-walking and drowsiness while driving. When zolpidem is combined with other substances, the sedative effects of the drug can be dangerously enhanced. This is especially true when zolpidem is combined with certain anti-anxiety medications and narcotic pain relievers which depress the central nervous system. The report finds that in 2010 half of all emergency department visits related to zolpidem involved its use with other drugs. In 37 percent of all emergency department visits involving zolpidem it was used in combination with drugs that depress the central nervous system.
“Although short-term sleeping medications can help patients, it is exceedingly important that they be carefully used and monitored,” said SAMHSA Administrator Pamela S. Hyde. “Physicians and patients need to be aware of the potential adverse reactions associated with any medication, and work closely together to prevent or quickly address any problems that may arise.”