Elevated rate of autism symptoms found in children with Tourette syndrome

Around one in five children with Tourette syndrome, a neurological disorder characterized by involuntary movements and vocalizations, met criteria for autism in a study headed by UC San Francisco. But this prevalence may be more a reflection of similarity in symptoms than actual autism, according to the study’s researchers.

Researchers tested 535 children and adults with Tourette’s for autism, using a self-reporting test called the Social Responsiveness Scale. Among the 294 children tested, 22.8 percent reached the cutoff for autism, versus 8.7 percent of the 241 adults. In contrast, autism is estimated to affect between 0.3 and 2.9 percent of the general population, according to studies cited in the paper.

The Social Responsiveness Scale Second Edition is a 65-item quantitative measure of autism symptoms that assesses the ability to engage in “emotionally appropriate reciprocal social interactions.” It evaluates levels of social awareness, social cognition, social communication, social motivation, and restrictive interests and repetitive behavior. Its threshold for autism compares favorably with the diagnostic gold standard, the Autism Diagnostic Interview, the researchers noted.

The study is publishing on June 22, 2017, in the Journal of the American Academy of Child and Adolescent Psychiatry.

OCD, ADHD Frequent Co-Occurrences

The researchers wanted to examine autism symptoms in patients with Tourette’s, including those whose diagnosis was coupled with obsessive-compulsive disorder (OCD) or attention deficit hyperactivity disorder (ADHD), conditions that frequently co-occur. Tourette’s, OCD and ADHD have been shown to share common symptoms and genetic relationships in a recent study by the same researchers.

“Assessing autism symptom patterns in a large Tourette’s sample may be helpful in determining whether some of this overlap is due to symptoms found in both disorders, rather than an overlapping etiology,” said first author Sabrina Darrow, PhD, assistant professor in the department of psychiatry at UCSF.

“Our results suggest that although autism diagnoses were higher in individuals with Tourette’s, some of the increase may be due to autism-like symptoms, especially repetitive behaviors that are more strongly related to obsessive-compulsive disorder.”

The researchers found that the highest scores on the Social Responsiveness Scale, which met autism criteria, were found in participants with Tourette’s and either OCD or ADHD. Among those with Tourette’s who met the cutoff for autism, 83 percent also met criteria for OCD, the researchers found, noting that high scores were especially evident in the part of the autism test that measures restrictive interests and repetitive behavior.

Wide Gulf Between Adults, Kids with Autism Diagnosis.

A potentially compelling argument against the surprisingly high rates of autism found in this sample was the wide discrepancy between children and adults who met the diagnostic criteria. Tourette’s is usually diagnosed between the ages of 3 and 9; symptoms most often peak in the early teens and start to abate in the early twenties, with continued improvement in early adulthood.

“Children were more than twice as likely to meet the cutoff than adults, indicating that as tics recede, so do symptoms of autism. In contrast, autism is usually lifelong,” said Darrow.

“Previous studies have shown that children with mood and anxiety disorders also have higher rates of autism symptoms, based on the Social Responsiveness Scale,” said senior author Carol Mathews, MD, who did the research while a professor of psychiatry at UCSF. She currently is adjunct professor of psychiatry at UCSF and professor of psychiatry at the University of Florida in Gainesville.

Psychiatric Impairment Possible Factor in Diagnosis

“This suggests that some of the increase may reflect underlying psychiatric impairment rather than being specific for autism. Some of the children in the study probably have autism, others have symptoms that mimic autism, but are not really due to autism. These symptoms are called phenocopies.”

Tourette’s affects between one and 10 in 1,000 children according to the National Institutes of Health. Like autism, it is significantly more prevalent in males. Common tics include repetitive throat clearing, blinking or grimacing. Most people do not require medication to suppress their symptoms, but treatment may be recommended for co-occurring ADHD and OCD.

 

‘Little brain’ plays a major role in schizophrenia

In a new study, Norwegian researchers have documented that the cerebellum is among the most affected brain regions in schizophrenia. Compared to healthy individuals, cerebellar volume was smaller in patients with schizophrenia. The study, published in Molecular Psychiatry, is the largest brain imaging study to date on the cerebellum in schizophrenia, with important implications for our understanding of the disorder.

Although the cerebellum (latin for “little brain”) occupies only about 20% of the human brain, it actually contains about 70% of all its neurons. This brain structure has traditionally been thought of as responsible for body movement and coordination, and has therefore often been ignored in research on the biological basis of psychological functions and mental disorders.

The current study included brain scans from 2300 participants from 14 international sites. The researchers used sophisticated tools that allowed them to analyze both the volume and shape of the brain.

Surprisingly, the results showed that the cerebellum is among the brain regions with the strongest and most consistent differences in schizophrenia. On a group level, patients had smaller cerebellar volumes compared with healthy individuals. “These findings clearly show that the cerebellum plays a major role in schizophrenia,” says lead author Torgeir Moberget.

Most mental disorders emerge during childhood and adolescence, and a better understanding of the causes may give better patient care. “To develop treatments that could reverse or even prevent the disease we need to understand why some people are at risk of developing these serious illnesses in the first place,” says senior author Lars T. Westlye.

The large sets of data allowed the researchers to identify very nuanced differences in brain volume in patients when compared with healthy controls. “It is important to emphasize that the brain differences we see in schizophrenia are generally very subtle. This is one reason why large collaborative studies are so important,” Moberget says. “When we saw the same pattern repeated across many groups of patients and controls from different countries, the findings became much more convincing.”

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Materials provided by University of Oslo, Faculty of Medicine. Note: Content may be edited for style and length.

 

One in 6 women with learning disabilities has attempted suicide

A new study by the University of Toronto found that the lifetime prevalence of suicide attempts was much higher for women who had been diagnosed with learning disabilities (16.6%) compared to women who had not (3.3%). Men with learning disabilities also were more likely to have attempted suicide compared to men without learning disorders (7.7% vs 2.1%).

“Learning disabilities such as dyslexia cast a very long shadow. Adults with learning disabilities still had 46% higher odds of having attempted suicide than their peers without learning problems, even when we took into account a wide range of other risk factors including lifetime history of depression and substance abuse, ADHD, early adversities, age, race, sex, income and education” reported lead author Professor Esme Fuller-Thomson, Sandra Rotman Endowed Chair at University of Toronto’s Factor-Inwentash Faculty of Social Work and Director of Institute for Life Course and Aging.

“When we focused only on individuals in the survey with learning disorders, we found that people who had been exposed to chronic parental domestic violence had double the odds of suicide attempts” said co-author Samara Z. Carroll, a recent University of Toronto social work graduate.

Parental domestic violence was defined as “chronic” if it had occurred more than 10 times before the respondent was age 16. “The cross-sectional nature of this study prohibits our ability to determine causality. The relationship between chronic parental domestic violence and suicide attempts could flow in either direction. We speculate that parental violent conflict could be an indicator of poor childhood circumstances (disorganized household, lack of social supports, low socioeconomic status, lack of reading in the home, etc.) which may increase the likelihood of learning disabilities. The higher stress levels in these homes may undermine children’s ability to focus or ask for help, thereby impairing learning. Alternatively, a child’s scholastic underperformance may cause parental conflict, which may escalate into domestic violence” stated Carroll.

Adults with learning disabilities who had been sexually abused in childhood also had twice the odds of having ever attempted suicide and those with a history of major depression had seven times the risk. Both childhood sexual abuse and depression are well-established risk factor for suicidal behaviors in the general population.

The study examined a nationally representative sample of 21,744 community-dwelling Canadians, of whom 745 reported they had been diagnosed with learning disabilities. Data were drawn from the 2012 Canadian Community Health Survey-Mental Health.

“The disturbingly high prevalence of suicide attempts among people with learning disabilities underline the importance of health professionals screening patients with learning disabilities for mental illness and suicidal thoughts.” said Wook Yang, a co-author and doctoral student in the Dalla Lana School of Public Health at the University of Toronto.

Fuller-Thomson also noted “our findings of the strong link between learning disabilities and suicide attempts provide an additional reason to prioritize the early detection and timely provision of effective educational interventions for children with dyslexia and other learning problems. In addition to the benefits of these treatment for improving learning skills and academic success, it is possible that they may also decrease long-term suicide risk. It is unacceptable that many children with learning disabilities languish for years on waiting-lists for needed educational interventions.”

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Depressed patients more likely to be prescribed opioids

A new study shows that patients with low back pain who were depressed were more likely to be prescribed opioids and receive higher doses. Understanding these prescribing patterns sheds new light on the current opioid epidemic and may help determine whether efforts to control prescription opioid abuse are effective.

“Our findings show that these drugs are more often prescribed to low back pain patients who also have symptoms of depression and there is strong evidence that depressed patients are at greater risk for misuse and overdose of opioids,” said John Markman, M.D., director of the Department of Neurosurgery’s Translational Pain Research Program at the University of Rochester Medical Center (URMC) and senior author of the study which appears in PAIN Reports, a journal of the International Association for the Study of Pain.

Low back pain is a leading cause of disability in the U.S., the most common condition for which opioids are a prescribed treatment.

Using data from the Medical Expenditure Panel Survey, a federally-compiled set of large-scale surveys of families and individuals, their medical providers, and employers across the U.S., the researchers compiled opioid prescription data from 2004-2009. This period is important because it coincides with a steep rise the prescription rates of opioids to treat lower back pain. The timeframe of the study also immediately preceded the introduction on a new generation of drugs designed to deter abuse and the implementation of a wide range of policies to address the opioid epidemic and will serve as an important benchmark to evaluate the impact of these efforts.

The researchers found that individuals with low back pain who were positively screened for depression were more than twice as likely to be prescribed an opioid and received more than twice the typical dose of the drug over the course of a year.

The study also points out the need for researchers to more fully understand the risks and benefits associated with prescribing opioids and other forms of pain medications to individuals with low back pain and depression. Low back pain is also the condition most often studied to approve new pain medications.

“Excluding depressed patients may lead clinicians who rely on these studies to underestimate the risks of opioids when they are prescribed for low back pain in routine practice,” said Markman.

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Broken heart: Physical stress is a risk factor

The loss of a loved one, a dispute with your neighbour, infections or a fall — mental and physical stress can be triggers of a broken heart (broken heart syndrome). What is more, physical stress seems to be more dangerous than emotional stress, a study of the German Centre for Cardiovascular Research (DZHK) shows.

A disease that causes similar conditions to, but is not, a heart attack lies behind a broken heart. Unlike in a heart attack, the coronary vessels are not occluded. Nevertheless, a part of the heart beats poorly, patients become breathless and experience chest pains. Why and exactly how this disease, also known as Takotsubo cardiomyopathy, occurs has not yet been explained. It is known, however, that it most commonly occurs in women in their post-menopause years and can be triggered by both emotionally demanding events and acute physical stress. Even good news and happy incidents cause heartbreak.

Physical stresses worsen prognosis

As a result of the DZHK study, the trigger “physical stress” is gaining focus. The study was able to confirm that infections, accidents or similar, i.e., everything that puts the body under stress, are often the triggers of a Takotsubo cardiomyopathy in men. By contrast, in women, it is emotional stress. Now, new findings show that physical stress as a trigger considerably worsens the prognosis in both women and men.

For this purpose, DZHK researchers analysed the data of 84 patients who were monitored for over four years and examined how the different triggers affected the long-term progress of the disease. “For a long time, it was thought that the disease was harmless, since the heart function usually recovered again after three months at the latest,” explains Dr. Ibrahim El-Battrawy, who works at the University Medical Centre Mannheim and is the principle investigator of the study and a DZHK young scientist at the Medical Faculty Mannheim of the University of Heidelberg. “Yet serious secondary diseases can indeed still occur months later and up to four percent of patients even die following a Takotsubo cardiomyopathy.”

More heart attacks and life-threatening cardiac arrhythmias

During admission to hospital, all patients were asked whether they were suffering from high emotional or acute physical stress in the last one to two weeks. “We also determined that the group with emotional stress complained more about chest pains, whereas the group with acute diseases predominantly suffered from dyspnoea,” reports El-Battrawy. The crucial finding, however, was what was revealed over the long term: serious complications such as life-threatening cardiac arrhythmias, repeat heart failure, stroke, heart attack and recurrent Takotsubo cardiomyopathy occurred more frequently if physical stress was the trigger of the broken heart syndrome. Moreover, this patient group had a higher risk of death.

Monitor patients closely

“Our study shows that physical stress is a risk factor for a poor disease progress and it contributes to further limiting the high-risk patient group,” concludes El-Battrawy. “The study also emphasizes how important it is to monitor patients over the short and long term. No matter what the trigger, patients should be monitored just as closely as heart attack patients and should have regular check-ups following discharge from the hospital.”

In other studies, the scientist already demonstrated that the cardiac disease progressed better in patients with diabetes than in patients who do not suffer from this metabolic disease; whereas cancer worsened the prognosis. According to El-Battrawy, a systematic review using a questionnaire on the triggers of a broken heart and existing primary diseases would thus be useful to better assess the progress of the disease and adjust the treatment to the patient.

 

Early stress confers lifelong vulnerability causing alterations in a specific brain region

Early life stress encodes lifelong susceptibility to stress through long-lasting transcriptional programming in a brain reward region implicated in mood and depression, according to a study conducted at the Icahn School of Medicine at Mount Sinai and published June 15 in the journal Science.

The Mount Sinai study focuses on epigenetics, the study of changes in the action of genes caused not by changes in DNA code we inherit from our parents, but instead by molecules that regulate when, where, and to what degree our genetic material is activated. Such regulation derives, in part, from the function of transcription factors — specialized proteins that bind to specific DNA sequences in our genes and either encourage or shut down the expression of a given gene.

Previous studies in humans and animals have suggested that early life stress increases the risk for depression and other psychiatric syndromes, but the neurobiology linking the two has remained elusive until now.

“Our work identifies a molecular basis for stress during a sensitive developmental window that programs a mouse’s response to stress in adulthood,” says Catherine Peña, PhD, lead investigator of the study. “We discovered that disrupting maternal care of mice produces changes in levels of hundreds of genes in the VTA that primes this brain region to be in a depression-like state, even before we detect behavioral changes. Essentially, this brain region encodes a lifelong, latent susceptibility to depression that is revealed only after encountering additional stress.”

Specifically, Mount Sinai investigators identified a role for the developmental transcription factor orthodenticle homeobox 2 (Otx2) as a master regulator of these enduring gene changes. The research team showed that baby mice that were stressed in a sensitive period (from postnatal day 10-20) had suppressed Otx2 in the VTA. While Otx2 levels ultimately recovered by adulthood, the suppression had already set in motion gene alterations that lasted into adulthood, indicating that early life stress disrupts age-specific developmental programming orchestrated by Otx2.

Furthermore, the mice stressed during the early-life sensitive time period were more likely to succumb to depression-like behavior in adulthood, but only after additional adult stress. All mice acted normally before additional adult social stress, but a “second hit” of stress was more likely to trigger depression-like behavior for mice stressed during the sensitive time period.

To test the prediction that Otx2 was actually responsible for the stress sensitivity, the research team developed viral tools that were used to either increase or decrease Otx2 levels. They found that suppression of Otx2 early in life was both necessary and sufficient for increased susceptibility to adult stress.

“We anticipated that we would only be able to ameliorate or mimic the effects of early life stress by changing Otx2 levels during the early sensitive period.” says Dr. Peña. “This was true for long-lasting effects on depression-like behavior, but somewhat to our surprise we could also change stress sensitivity for short amounts of time by manipulating Otx2 in adulthood.”

While early-life critical periods have been understood for processes such as language learning, little is known about whether there are sensitive periods in childhood when stress and adversity most impacts brain development and particularly emotion-regulation systems. This study is the first to use genome-wide tools to understand how early life stress alters development of the VTA, providing new evidence for sensitive windows in emotion development.

“This mouse paradigm will be useful for understanding the molecular correlates of increased risk of depression resulting from early life stress and could pave the way to look for such sensitive windows in human studies,” says Eric J. Nestler, MD, PhD, Nash Family Professor of Neuroscience and Director of the Friedman Brain Institute at Mount Sinai and senior investigator of the study. “The ultimate translational goal of this research is to aid treatment discoveries relevant to individuals who experienced childhood stress and trauma.”

Reckless behavior fuels ongoing stress for some with PTSD

Researchers with the National Center for PTSD at the VA Boston Healthcare System found that engaging in risky behavior — itself a symptom of posttraumatic stress disorder — could in turn lead to worse PTSD symptoms. This sets up a pattern of repeated stressful experiences, they say, that could have harmful consequences for those with PTSD.

As Dr. Naomi Sadeh, corresponding author on the article, explains: “For individuals with PTSD, exposure to new stressful events will often prolong their symptoms and can even make them worse. So these findings suggest that treatment providers should ask trauma-exposed veterans about reckless behavior to make sure they are not engaging in harmful behaviors that could make their PTSD symptoms worse.”

The results appeared in a May 2017 issue of the Journal of Traumatic Stress.

Recent research has found evidence of a link between risky behavior and PTSD. Because of this relationship, “reckless and self-destructive behavior” has been added as a symptom of PTSD in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, the handbook used to diagnose psychiatric conditions.

The new study assessed more than 200 veterans with PTSD diagnoses for both PTSD severity and reckless behavior at the beginning of the study, starting in 2006, and again four years later. Nearly three-quarters had engaged in reckless or self-destructive behavior at least once in the five years before the study.

The most common behaviors identified in this study were dangerous alcohol or drug use, drunken driving, gambling, and aggression. The researchers found a correlation between risky behavior and higher PTSD severity at both time points. The results lend further evidence that risky behavior is common among trauma-exposed veterans.

“These types of high-risk behaviors appear to be common among veterans who have experienced trauma, and put veterans in harm’s way by making it more likely that they will experience stress and adversity in the future,” says Sadeh.

But the study revealed more about the relationship between PTSD and risky behavior. In the time between the two tests, 82 percent of participants experienced at least one potentially traumatic event. These events included experiencing the sudden death of a friend or loved one; being threatened with or being the victim of a physical assault; being involved in a motor vehicle accident, or witnessing any severe accident; experiencing a life-threatening or disabling event affecting a loved one, or coping with a life-threatening illness.

Not only did the presence of risky behavior at baseline correlate with future PTSD symptoms, but it was also tied to the likelihood of experiencing new traumatic events. This led the researchers to suggest that risky behavior may lead to worse PTSD symptoms in the future by leading to a greater number of stressful life events. The findings suggest that many veterans with PTSD continue to experience stressful events that may prolong or worsen their PTSD symptoms, even years after the initial trauma.

The study authors write, “Driving while intoxicated, for example, increases the likelihood of experiencing a traumatic motor vehicle accident, overt aggression can elicit assaultive behavior from others, and drug use can increase exposure to drug-related crime and physical injury.” In other words, risky and harmful behaviors could lead to more trauma and, in turn, worse PSTD over time.

The results are of particular interest to VA. In addition to having much higher rates of PTSD, veterans are also more likely to engage in risky behavior. Veterans are at around 50 percent higher risk of suicide than civilians. They are also more frequently incarcerated for violent offenses and more likely to drive recklessly. Veterans also have higher rates of binge drinking and pathological gambling than their non-veteran counterparts.

VA and other health care systems need to focus on more assessment and treatment of problematic behavior in trauma-exposed individuals, say the researchers. They write, “Considering the number of veterans who have been diagnosed with PTSD and are reintegrated into society, understanding how reckless behaviors relate to the maintenance of PTSD symptoms is an important area of study.”

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Materials provided by Veterans Affairs Research Communications. Original written by Tristan Horrom. Note: Content may be edited for style and length.

 

Clinical trial evaluating potential treatment for postpartum depression

Researchers at the University of North Carolina School of Medicine announced the publication of results from a multi-site phase 2 clinical trial with brexanolone, an investigational medication, in the treatment of severe postpartum depression (PPD).

Currently, there are no drugs specifically indicated to treat postpartum depression, which affects an estimated 10 to 20 percent of all mothers who give birth, according to Samantha Meltzer-Brody, M.D., M.P.H., director of the Perinatal Psychiatry Program at the UNC School of Medicine, and academic principal investigator and senior author of the study published in The Lancet. Steve Kanes, M.D. Ph.D., Chief Medical Officer of Sage Therapeutics, is the lead author of the paper.

Postpartum depression is a mood disorder in women that can be triggered in some women by fluctuations in reproductive hormones. Common symptoms in mothers that experience PPD include low mood, feeling overwhelmed, anxious and ruminating thoughts, potential withdrawal from the baby and her family, and, in the most severe cases, suicidal thoughts.

“The results of this trial are like nothing I’ve seen before in the treatment of postpartum depression,” Meltzer-Brody said. “It’s vital that we develop a promising treatment for postpartum depression, which is so common, yet so stigmatized.”

During the study, which was conducted at multiple sites across the country, including UNC’s Perinatal Psychiatry Unit, physician researchers administered the intravenous agent brexanolone, an allosteric modulator of both synaptic and extra-synaptic GABAA receptors. In postpartum depression, the GABA pathway may play a key role in regulating hormones that researchers believe play a critical role in triggering PPD, Meltzer-Brody said.

In the study of 21 women, 10 women were administered a 60-hour continuous intravenous dose of brexanolone. The other 11 women were given a placebo. To be eligible for the trial, women had to have severe postpartum depression, which was assessed using the Hamilton Depression Rating Scale (HAM-D). A HAM-D score of at least 26 was required for study enrollment.

Women treated with brexanolone had a mean reduction of 21 points in their HAM-D score, compared to an 8.8-point reduction in the placebo group. Brexanolone was generally well tolerated. There were no deaths, serious adverse events, or discontinuations. The most commonly reported adverse events in the brexanolone group were dizziness (two brexanolone-treated subjects; three placebo-treated subjects) and somnolence (two brexanolone-treated subjects; 0 placebo-treated subjects).

“In women with severe postpartum depression in the trial, infusion of brexanolone resulted in a rapid, sustained, statistically significant and clinically meaningful mean reduction in the HAM-D total score,” Meltzer-Brody said. “A 21-point reduction is not only meaningful in a clinical setting; it’s very promising in terms of potential drug development.”

Further, mean HAM-D scores for the women who received brexanolone remained significantly lower for a follow-up period of 30 days compared to the placebo group.

“As long as I’ve been in this field, I don’t believe I’ve ever seen results quite as dramatic as those from this study,” said David Rubinow, MD, chair of the Department of Psychiatry at the UNC School of Medicine, and coauthor of the paper.

Brexanolone is currently being evaluated in a phase 3 clinical program underway at UNC and various other sites across the country.

“To have an approved drug to treat postpartum depression, which affects so many women, their babies and their entire families, would be groundbreaking for our field and absolutely life-changing for the women who are suffering from PPD,” Meltzer-Brody said.

Sleep duration impacts treatment response for depressed patients with insomnia

Preliminary results from a new study show that depressed patients with insomnia who sleep seven or more hours per night are more likely to benefit from cognitive behavioral therapy for insomnia (CBTI) and achieve depression remission.

Results show that when insomnia and depression co-occur, longer pre-treatment objective sleep duration is predictive of remission of both disorders when patients are given a combination of CBTI for insomnia and antidepressant medication for depression.

“A seven-hour, objective sleep duration of patients prior to entering treatment increased their chances of achieving both depression and insomnia remission by their treatment endpoints,” said lead author and co-principal investigator Jack D. Edinger, PhD, professor in the Section of Sleep Medicine at National Jewish Health in Denver, Colorado.

The study involved 104 adults, including 75 women, who enrolled in the Treatment of Insomnia and Depression Study and completed one baseline night of polysomnography. Participants received 16 weeks of anti-depressant medication and were randomly assigned either to CBTI or sham insomnia therapy. The Hamilton Rating Scale for Depression (HAMD-17) and Insomnia Severity Index were administered at baseline and then bi-weekly during treatment to determine depression and insomnia remission.

The study was part of a larger research project for which Edinger was co-investigator along with co-investigators Daniel Buysse, MD, from the University of Pittsburgh; Andy Krystal, MD, from Duke University and the University of California, San Francisco; and lead principal investigator Rachel Manber, PhD, professor of psychiatry and behavioral sciences at the Stanford University Medical Center.

“Our findings highlight the importance of adequate objective sleep in the recovery from depression and insomnia,” said Manber. “The data suggest that short sleep duration may be a risk for refractory depression.”

The research abstract was published recently in an online supplement of the journal Sleep and will be presented Monday, June 5, in Boston at SLEEP 2017, the 31st Annual Meeting of the Associated Professional Sleep Societies LLC (APSS), which is a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society.

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Who has better mental health: Public or private college students?

Using information gleaned from social media, researchers from the Georgia Institute of Technology have created a mental health index for the nation’s highest-ranked colleges and universities. Their study looked at five years of data on Reddit, scanning it for comments about issues that included depression, financial and academic anxiety and thoughts of suicide. Schools were given a score based on the frequency of those threads and robustness of the conversations.

The research found that students at higher-ranked schools have better mental health than those at lower-ranked colleges. The well-being index is also better at universities with higher tuition. It’s lower at large public schools with a majority of female students.

The study doesn’t identify schools individually for privacy reasons.

“Online conversations about mental health issues are definitely increasing,” said Munmun De Choudhury, Georgia Tech’s assistant professor, from the School of Interactive Computing, who led the study. “We saw it rise 16 percent from 2011 to 2015, even after we took into account that Reddit has become more popular in recent years.”

The study focused on the top 150 universities as ranked by U.S. News & World Report, gathering data from the 109 of them with active Reddit accounts.

De Choudhury suggests that the reason there are less posts about tuition anxiety at more expensive colleges is because their students tend to be more affluent than the average public school attendee. Therefore, the stresses of paying for college or going into debt aren’t as great. De Choudhury also thinks that the wider variety of backgrounds at large public schools likely lends itself to a more robust sharing of stress and anxiety issues.

“As for more posts about mental health at universities with more females, I don’t think it’s necessarily because women have more anxiety,” De Choudhury said. “Research has traditionally shown that females are more likely to express their emotions and feelings whether in an offline setting or social media. It’s not that they have poorer mental health — it’s that they’re more likely to talk about their troubles while online.”

The study also found an overall increase in mental health posts as the academic year progressed. It peaked in the fall in November and was even higher in May. It gradually decreased each summer.

The Georgia Tech team used a method called transfer learning to mine the data. First, they created a model to scan subreddit threads about depression, bipolar disorder and other issues to learn patterns of what is written when people discuss mental health. Then the model was used on the higher education subreddit communities.

The algorithm scanned the five years of discussions, day by day, looking for clues. Once it found keywords and phrases, it measured the breadth of the conversations. The more frequent the posts and depths of the discussions, the lower the respective mental health indexes.

Overall, three percent of the threads on the 109 sites were about mental health topics.

De Choudhury has previously done similar social media research to help identify expressions of eating disorders, postpartum depression and suicide.

“I’ve always wondered if there are things about college students and mental health that we could learn by using these same social media research tactics,” De Choudhury said. “We wanted to see if we could do something more collectively at the campus level before digging deeper to understand the challenges individuals might be facing. Perhaps this data can be used to help campus administrators as they create policies in real-time to benefit student bodies dealing with stress and anxieties.”

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Racial Discrimination during Adolescence Predicts Mental Health Deterioration in Adulthood: Gender Differences among Blacks

Shervin Assari, Ehsan Moazen-Zadeh, Cleopatra Howard Caldwell, Marc A. Zimmerman

Rock climbing envisioned as new treatment for depression

A growing body of research suggests that bouldering, a form of rock climbing, can help build muscle and endurance while reducing stress — and a new study co-led by a University of Arizona doctoral student of psychology suggests that the activity also may be used to effectively treat symptoms of depression.

UA researcher Eva-Maria Stelzer and Katharina Luttenberger of the University of Erlangen-Nuremberg led a team that involved more than 100 individuals in a bouldering intervention in Germany, where some hospitals have begun to use climbing as a therapeutic treatment.

The participants were randomly split into two groups. One immediately began the intervention, while the other group had to wait to start bouldering, which involves climbing rocks or walls to a moderate height without ropes or a harness. Each participant bouldered for three hours a week over the course of eight weeks.

The research team measured the depression of group members at different points in the study using the Beck’s Depression Inventory and the depression subscale of the Symptom Check List Revised, known as SCL-90-R.

The team’s major finding was that, during the therapy, the immediate intervention group’s Beck’s Depression scores improved by 6.27 points, but for the same time period the group that was initially wait-listed improved by only 1.4 points. This drop in score reflects an improvement of one severity grade from moderate to mild depression levels.

“Bouldering, in many ways, is a positive physical activity,” said Stelzer, who began researching the benefits of bouldering while completing her master’s in psychology at the University of Erlangen-Nuremberg in Germany and is now completing her doctorate at the UA. “There are different routes for your physical activity level, and there’s a social aspect along with the feeling of an immediate accomplishment when bouldering.”

Stelzer will present the study and findings during the 29th annual Association for Psychological Science Convention, to be held Thursday through Sunday in Boston.

In addition to Stelzer and Luttenberger, University of Erlangen-Nuremberg researchers involved were Stefan Först, Elmar Gräßel, Matthias Schopper, Johannes Kornhuber and Stephanie Book. The team has since expanded the study to compare the bouldering intervention with cognitive behavior therapy involving individuals in Erlangen, Munich and Berlin.

“I hope this study and future studies are able to impact a life,” Stelzer said. “Depression is a severe illness. It is one of the most common mental disorders in the United States and worldwide. Even though a variety of treatment options exist, less than one-third of people receive treatment for their symptoms.”

The National Institute of Mental Health reports that anxiety disorders, including depression, are the most common mental illnesses in the U.S. About 18 percent of the nation’s adult population, or about 40 million people, cope with anxiety disorders.

Invested in improving interventions to aid with such conditions, Stelzer, Luttenberger and Schopper, who have offered bouldering sessions for patients at a care center in Germany, drew on their own experiences as avid rock climbers and boulderers to investigate the benefits the sport could provide to those dealing with anxiety, depression, social isolation and self-esteem issues.

“Patients enjoyed the bouldering sessions and told us that they benefited greatly,” said Luttenberger, a psychometrics expert at the University of Erlangen, located just north of Nuremberg in Germany, about the sessions Schopper offered. “Since rumination is one of the biggest problems for depressed individuals, we had the idea that bouldering could be a good intervention for that.”

For the study, most of the patients involved were new to bouldering.

Also during the study, both groups were taught about how to cultivate positive social interactions and about meditation and mindfulness throughout the study. All told, the study involving the intervention and follow-up lasted 24 weeks.

Stelzer explained that bouldering has a number of other important characteristics that make it especially beneficial for the treatment of depression, namely that it helps boost self-efficacy and social interactions — both of which hold innate benefits for dealing with depression.

“You have to be mindful and focused on the moment. It does not leave much room to let your mind wonder on things that may be going on in your life — you have to focus on not falling,” Stelzer said.

“Bouldering not only has strong mental components, but it is accessible at different levels so that people of all levels of physical health are able to participate,” she said, adding that because many people who are depressed deal with isolation, bouldering as a treatment could bolster physical activity and be used as a social tool allowing people to interact with one another.

Given the positive results, the team believes that bouldering may be used to complement traditional care for clinical depression. Team members are now working to develop a manual that could be adopted for an eight-week program integrating bouldering and psychotherapeutic interventions for groups.

Said Luttenberger: “I’d always encourage patients to do the sport they like — may it be climbing or something else — as sport is a wonderful possibility to prevent all possible sorts of illnesses, mental and physical.”

Mindfulness-focused childbirth education leads to less depression

Mindfulness may be good for new moms.

A study this month from researchers at the University of Wisconsin-Madison and the University of California, San Francisco (UCSF) shows mindfulness training that addresses fear and pain during childbirth can improve women’s childbirth experiences and reduce their depression symptoms during pregnancy and the early postpartum period.

“Fear of the unknown affects us all, and perhaps none more so than pregnant women,” says lead author Larissa Duncan, UW-Madison professor of human development and family studies. “With mindfulness skills, women in our study reported feeling better able to cope with childbirth and they experienced improved mental well-being critical for healthy mother-infant adjustment in the first year of life.”

The study also suggests that pregnant women who practice mindfulness may use less medication for pain during labor. Many women and their healthcare providers are concerned about the use of medications during pregnancy, labor and while breastfeeding because of the potential risks to infants. Yet, left untreated, maternal mental health problems also pose a significant risk to infants.

“A mindfulness approach offers the possibility of decreasing the need for these medications and can reach women who may not know they are at risk for perinatal depression or can’t access mental health services,” Duncan says.

The new study, published in the journal BMC Pregnancy and Childbirth, is a randomized, controlled trial called Prenatal Education About Reducing Labor Stress (PEARLS), compares mainstream childbirth education with childbirth education that includes mindfulness skills focused on reducing fear among first-time mothers. Fear of childbirth has been shown in previous studies to be linked to poorer labor-and-delivery outcomes and to depression.

While many consider childbirth education classes a primary resource for pregnant women and their partners to learn information and strategies for the birthing process and remedies for coping with labor pain, there is limited data that demonstrates they achieve these goals for the more than 2 million pregnant women who attend them each year in the United States.

In fact, Duncan says, “sometimes women report that the information in childbirth education actually increases their fear of childbirth.”

For the study, considered a pilot because funding limited participation to 30 women and their partners, first-time mothers late in their third trimester of pregnancy were offered either a standard childbirth preparation course lacking a mind-body focus or an intensive weekend workshop called Mind in Labor: Working with Pain in Childbirth.

The workshop was based on the Mindfulness-Based Childbirth and Parenting education course developed by study co-author, Nancy Bardacke, a certified nurse-midwife and senior mindfulness teacher at UCSF. It focused on practices like mindful movement, walking meditation, and pain coping strategies. Previous research shows that mindfulness training can be an effective way to manage both chronic and acute pain.

Participants represented a diversity of ethnic and socioeconomic backgrounds. They completed self-reported assessments before and after taking part in a childbirth education course and after giving birth. The mindfulness group also received handouts and guided audio materials so they could practice mindfulness on their own. The study team collected medical record data from each woman.

The researchers found a reduction in depression symptoms in the mindfulness group, which continued through their post-birth follow up at approximately six weeks. In contrast, depression symptoms worsened among women who participated in the standard childbirth education courses.

While mothers in the mindfulness group sought epidurals at similar rates to those in the control group and retrospectively reported similar levels of perceived pain during labor, the study did see a trend toward lower use of opioid-based pain medication during labor. While these results were not statistically significant, the rate of narcotic use during labor was around 62 percent in the control group and just 31 percent in the mindfulness group. A larger study is needed to better understand this effect.

“The encouraging results of this small study point to the possibility that mindfulness skills can transform the way expectant parents prepare for this profound life change,” says Bardacke. “In addition to supporting moms and babies, we may also be benefiting fathers, who are themselves experiencing the birth of their child and becoming parents. While more research is clearly needed, the larger public health implications of this work are motivating.”

Probiotic use linked to improved symptoms of depression

Probiotics may relieve symptoms of depression, as well as help gastrointestinal upset, research from McMaster University has found.

In a study published in the medical journal Gastroenterology, researchers of the Farncombe Family Digestive Health Research Institute found that twice as many adults with irritable bowel syndrome (IBS) reported improvements from co-existing depression when they took a specific probiotic than adults with IBS who took a placebo.

The study provides further evidence of the microbiota environment in the intestines being in direct communication with the brain said senior author Dr. Premysl Bercik, an associate professor of medicine at McMaster and a gastroenterologist for Hamilton Health Sciences.

“This study shows that consumption of a specific probiotic can improve both gut symptoms and psychological issues in IBS. This opens new avenues not only for the treatment of patients with functional bowel disorders but also for patients with primary psychiatric diseases,” he said.

IBS is the most common gastrointestinal disorder in the world, and is highly prevalent in Canada. It affects the large intestine and patients suffer from abdominal pain and altered bowel habits like diarrhea and constipation. They are also frequently affected by chronic anxiety or depression.

The pilot study involved 44 adults with IBS and mild to moderate anxiety or depression. They were followed for 10 weeks, as half took a daily dose of the probiotic Bifidobacterium longum NCC3001, while the others had a placebo.

At six weeks, 14 of 22, or 64%, of the patients taking the probiotic had decreased depression scores, compared to seven of 22 (or 32%) of patients given placebo.

Functional Magnetic Resonance Imaging (fMRI) showed that the improvement in depression scores was associated with changes in multiple brain areas involved in mood control.

“This is the result of a decade long journey — from identifying the probiotic, testing it in preclinical models and investigating the pathways through which the signals from the gut reach the brain,” said Bercik.

“The results of this pilot study are very promising but they have to be confirmed in a future, larger scale trial,” said Dr. Maria Pinto Sanchez, the first author and a McMaster clinical research fellow.

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