Select memories can be erased, leaving others intact

Different types of memories stored in the same neuron of the marine snail Aplysia can be selectively erased, according to a new study by researchers at Columbia University Medical Center (CUMC) and McGill University and published today in Current Biology.

The findings suggest that it may be possible to develop drugs to delete memories that trigger anxiety and post-traumatic stress disorder (PTSD) without affecting other important memories of past events.

During emotional or traumatic events, multiple memories can become encoded, including memories of any incidental information that is present when the event occurs. In the case of a traumatic experience, the incidental, or neutral, information can trigger anxiety attacks long after the event has occurred, say the researchers.

“The example I like to give is, if you are walking in a high-crime area and you take a shortcut through a dark alley and get mugged, and then you happen to see a mailbox nearby, you might get really nervous when you want to mail something later on,” says Samuel Schacher, PhD, a professor of neuroscience in the Department of Psychiatry at CUMC and co-author of the paper. In the example, fear of dark alleys is an associative memory that provides important information — e.g., fear of dark alleys — based on a previous experience. Fear of mailboxes, however, is an incidental, non-associative memory that is not directly related to the traumatic event.

“One focus of our current research is to develop strategies to eliminate problematic non-associative memories that may become stamped on the brain during a traumatic experience without harming associative memories, which can help people make informed decisions in the future — like not taking shortcuts through dark alleys in high-crime areas,” Dr. Schacher adds.

Brains create long-term memories, in part, by increasing the strength of connections between neurons and maintaining those connections over time. Previous research suggested that increases in synaptic strength in creating associative and non-associative memories share common properties. This suggests that selectively eliminating non-associative synaptic memories would be impossible, because for any one neuron, a single mechanism would be responsible for maintaining all forms of synaptic memories.

The new study tested that hypothesis by stimulating two sensory neurons connected to a single motor neuron of the marine snail Aplysia; one sensory neuron was stimulated to induce an associative memory and the other to induce a non-associative memory.

By measuring the strength of each connection, the researchers found that the increase in the strength of each connection produced by the different stimuli was maintained by a different form of a Protein Kinase M (PKM) molecule (PKM Apl III for associative synaptic memory and PKM Apl I for non-associative). They found that each memory could be erased — without affecting the other — by blocking one of the PKM molecules.

In addition, they found that specific synaptic memories may also be erased by blocking the function of distinct variants of other molecules that either help produce PKMs or protect them from breaking down.

The researchers say that their results could be useful in understanding human memory because vertebrates have similar versions of the Aplysia PKM proteins that participate in the formation of long-term memories. In addition, the PKM-protecting protein KIBRA is expressed in humans, and mutations of this gene produce intellectual disability.

“Memory erasure has the potential to alleviate PTSD and anxiety disorders by removing the non-associative memory that causes the maladaptive physiological response,” says Jiangyuan Hu, PhD, an associate research scientist in the Department of Psychiatry at CUMC and co-author of the paper. “By isolating the exact molecules that maintain non-associative memory, we may be able to develop drugs that can treat anxiety without affecting the patient’s normal memory of past events.”

“Our study is a ‘proof of principle’ that presents an opportunity for developing strategies and perhaps therapies to address anxiety,” said Dr. Schacher. “For example, because memories are still likely to change immediately after recollection, a therapist may help to ‘rewrite’ a non-associative memory by administering a drug that inhibits the maintenance of non-associative memory.”

Future studies in preclinical models are needed to better understand how PKMs are produced and localized at the synapse before researchers can determine which drugs may weaken non-associative memories.

No place like home

New research by Steve Posavac, E. Bronson Ingram Professor of Marketing at Vanderbilt’s Owen Graduate School of Management, uncovers another consequence of anxiety symptoms: susceptibility to certain marketing themes.

According to a paper recently published in the Journal of Social and Clinical Psychology, individuals with relatively elevated symptoms of Adult Separation Anxiety Disorder (ASAD) are more favorable to advertisements with home concepts.

“Importantly, our research suggests a vulnerability to persuasion among those with adult separation anxiety disorder symptoms that goes beyond simply the appeal of a product itself,” Posavac and co-author, psychologist Heidi Posavac, write. “Featuring the concept of home as an advertising theme leads to more favorability towards the persuasive attempt.”

The paper says consumer advertising regularly invokes the idea of home, citing recent Super Bowl ads by Jeep and Budweiser as examples.

Adult Separation Anxiety Disorder is a psychological condition in which an individual has excessive anxiety regarding separation from places or people to whom he or she has a strong emotional attachment. The lifetime incidence of adult separation anxiety disorder in the United States is estimated to be 6.6 percent, but a much higher percentage may experience symptoms.

In a study conducted at Vanderbilt Business’ Behavioral Research Lab, participants completed a questionnaire to measure ASAD published by the American Psychiatric Institute. Later, they read an internet advertisement for a fictitious airline: one version incorporated a theme of “coming home to family,” the other promoted a message of “seeing new things.” Participants with high ASAD symptoms had more favorable attitudes toward the home-themed ad, while those with little to no symptoms offered no preference.

While the Posavacs’ findings may suggest an opportunity for marketers, they caution that it may also reflect a threat for sufferers of adult separation anxiety disorder. Should marketers be able to identify and target a subgroup of consumers with ASAD or ASAD symptoms, home-themed advertising might increase sales, but the impact on the consumers themselves might not be so positive.

“Whether in individual treatment sessions, or with a psychoeducational approach, individuals experiencing chronic adult separation anxiety may be well served by clinicians who help to inoculate them against the possibility of coming under undue influence by savvy marketers,” the authors write.

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Materials provided by Vanderbilt University. Original written by Ryan Underwood / Nathaniel Austin Luce. Note: Content may be edited for style and length.

AI that can shoot down fighter planes helps treat bipolar disorder

The artificial intelligence that can blow human pilots out of the sky in air-to-air combat accurately predicted treatment outcomes for bipolar disorder, according to a new medical study by the University of Cincinnati.

The findings open a world of possibility for using AI, or machine learning, to treat disease, researchers said.

David Fleck, an associate professor at the UC College of Medicine, and his co-authors used artificial intelligence called “genetic fuzzy trees” to predict how bipolar patients would respond to lithium.

Bipolar disorder, depicted in the TV show “Homeland” and the Oscar-winning “Silver Linings Playbook,” affects as many as six million adults in the United States or 4 percent of the adult population in a given year.

“In psychiatry, treatment of bipolar disorder is as much an art as a science,” Fleck said. “Patients are fluctuating between periods of mania and depression. Treatments will change during those periods. It’s really difficult to treat them appropriately during stages of the illness.”

The study authors found that even the best of eight common models used in treating bipolar disorder predicted who would respond to lithium treatment with 75 percent accuracy. By comparison, the model UC researchers developed using AI predicted how patients would respond to lithium 100 percent of the time. Even more impressively, the UC model predicted the actual reduction in manic symptoms after lithium treatment with 92 percent accuracy.

The study authors found that even the best of the eight most common treatments was only effective half the time. But the model UC researchers developed using AI predicted how patients would respond to lithium treatment with 88 percent accuracy and 80 percent accuracy in validation.

It turns out that the same kind of artificial intelligence that outmaneuvered Air Force pilots last year in simulation after simulation at Wright-Patterson Air Force Base is equally adept at making beneficial decisions that can help doctors treat disease. The findings were published this month in the journal Bipolar Disorders.

“What this shows is that an effort funded for aerospace is a game-changer for the field of medicine. And that is awesome,” said Kelly Cohen, a professor in UC’s College of Engineering and Applied Science.

Cohen’s doctoral graduate Nicholas Ernest is founder of the company Psibernetix, Inc., an artificial intelligence development and consultation company. Psibernetix is working on applications such as air-to-air combat, cybersecurity and predictive analytics. Ernest’s fuzzy logic algorithm is able to sort vast possibilities to arrive at the best choices in literally the blink of an eye.

“Normally the problems our AIs solve have many, many googolplexes of possible solutions — effectively infinite,” study co-author Ernest said.

His team developed a genetic fuzzy logic called Alpha capable of shooting down human pilots in simulations, even when the computer’s aircraft intentionally was handicapped with a slower top speed and less nimble flight characteristics. The system’s autonomous real-time decision-making shot down retired U.S. Air Force Col. Gene Lee in every engagement.

“It seemed to be aware of my intentions and reacting instantly to my changes in flight and my missile deployment,” Lee said last year. “It knew how to defeat the shot I was taking. It moved instantly between defensive and offensive actions as needed.”

The American Institute of Aeronautics and Astronautics honored Cohen and Ernest this year for their “advancement and application of artificial intelligence to large scale, meaningful and challenging aerospace-related problems.”

Cohen spent much of his career working with fuzzy-logic based AI in drones. He used a sabbatical from the engineering college to approach the UC College of Medicine with an idea: What if they could apply the amazing predictive power of fuzzy logic to a particularly nettlesome medical problem?

Medicine and avionics have little in common. But each entails an ordered process — a vast decision tree — to arrive at the best choices. Fuzzy logic is a system that relies not on specific definitions but generalizations to compensate for uncertainty or statistical noise. This artificial intelligence is called “genetic fuzzy” because it constantly refines its answer, tossing out the lesser choices in a way analogous to the genetic processes of Darwinian natural selection.

Cohen compares it to teaching a child how to recognize a chair. After seeing just a few examples, any child can identify the object people sit in as a chair, regardless of its shape, size or color.

“We do not require a large statistical database to learn. We figure things out. We do something similar to emulate that with fuzzy logic,” Cohen said.

Cohen found a receptive audience in Fleck, who was working with UC’s former Center for Imaging Research. After all, who better to tackle one of medical science’s hardest problems than a rocket scientist? Cohen, an aerospace engineer, felt up to the task.

Ernest said people should not conflate the technology with its applications. The algorithm he developed is not a sentient being like the villains in the “Terminator” movie franchise but merely a tool, he said, albeit a powerful one with seemingly endless applications.

“I get emails and comments every week from would-be John Connors out there who think this will lead to the end of the world,” Ernest said.

Ernest’s company created EVE, a genetic fuzzy AI that specializes in the creation of other genetic fuzzy AIs. EVE came up with a predictive model for patient data called the LITHium Intelligent Agent or LITHIA for the bipolar study.

“This predictive model taps into the power of fuzzy logic to allow you to make a more informed decision,” Ernest said.

And unlike other types of AI, fuzzy logic can describe in simple language why it made its choices, he said.

The researchers teamed up with Dr. Caleb Adler, the UC Department of Psychiatry and Behavioral Neuroscience vice chairman of clinical research, to examine bipolar disorder, a common, recurrent and often lifelong illness. Despite the prevalence of mood disorders, their causes are poorly understood, Adler said.

“Really, it’s a black box,” Adler said. “We diagnose someone with bipolar disorder. That’s a description of their symptoms. But that doesn’t mean everyone has the same underlying causes.”

Selecting the appropriate treatment can be equally tricky.

“Over the past 15 years there has been an explosion of treatments for mania. We have more options. But we don’t know who is going to respond to what,” Adler said. “If we could predict who would respond better to treatment, you would save time and consequences.”

With appropriate care, bipolar disorder is a manageable chronic illness for patients whose lives can return to normal, he said.

UC’s new study, funded in part by a grant from the National Institute of Mental Health, identified 20 patients who were prescribed lithium for eight weeks to treat a manic episode. Fifteen of the 20 patients responded well to the treatment.

The algorithm used an analysis of two types of patient brain scans, among other data, to predict with 100 percent accuracy which patients responded well and which didn’t. And the algorithm also predicted the reductions in symptoms at eight weeks, an achievement made even more impressive by the fact that only objective biological data were used for prediction rather than subjective opinions from experienced physicians.

“This is a huge first step and ultimately something that will be very important to psychiatry and across medicine,” Adler said.

How much potential does this have to revolutionize medicine?

“I think it’s unlimited,” Fleck said. “It’s a good result. The best way to validate it is to get a new cohort of individuals and apply their data to the system.”

Cohen is less reserved in his enthusiasm. He said the model could help personalize medicine to individual patients like never before, making health care both safer and more affordable. Fewer side-effects means fewer hospital visits, less secondary medication and better treatments.

Now the UC researchers and Psibernetix are working on a new study applying fuzzy logic to diagnosing and treating concussions, another condition that has bedeviled doctors.

“The impact on society could be profound,” Cohen said.

 

Lingering risk of suicide after discharge from psychiatric facilities

A study that synthesized more than 50 years of research into suicide rates for patients after discharge from psychiatric facilities suggests the immediate period after discharge was a time of marked risk and that the risk remained high years after discharge, according to a new article published by JAMA Psychiatry.

Suicide is among the top 20 causes of death worldwide. The World Health Organization estimated the global suicide rate was 11.4 per 100,000 person-years in 2012. (A person-year is a unit of time.) Mentally ill individuals discharged from psychiatric hospitals and wards appear to have a greater risk for suicide than other mentally ill individuals, although there are no accepted benchmarks for postdischarge suicide rates, according to the article.

The work by Matthew Michael Large, B.Sc., M.B.B.S., F.R.A.N.Z.C.P., D.Med.Sci., of the University of New South Wales, Australia, and coauthors quantified rates of suicide after discharge from psychiatric facilities and included 100 studies reporting 17,857 suicides.

The pooled estimate discharge suicide rate was 484 per 100,000 person-years, according to the results, with the suicide rate the highest within three months after discharge (1,132 per 100,000 person-years) and among those patients admitted with suicidal ideas or behaviors.

Pooled suicide rates were 654 per 100,000 person-years in studies with follow-up from three months to one year; 494 per 100,000 person-years in studies with follow-up from one to five years; 366 per 100,000 person-years in studies with follow-up of five to 10 years; and 277 per 100,000 person-years in studies with follow-up greater than 10 years, the authors report.

The study details its limitations and notes that factors associated with increased suicide risk at an aggregate level should be interpreted with caution and may not necessarily be applicable to individual patients.

“Discharged patients have suicide rates many times that in the general community. Efforts aimed at suicide prevention should start while patients are in hospital, and the period shortly after discharge should be a time of increased clinical focus. However, our study also suggests that previously admitted patients, particularly those with prior suicidality, remain at a markedly elevated risk of suicide for years and should be a focus of efforts to decrease suicide in the community,” the article concludes.

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Am I normal? You asked Google. Here’s the answer | Eleanor Morgan

Every day millions of internet users ask Google life’s most difficult questions, big and small. Our writers answer some of the commonest queries

“The camera has the power to catch so-called normal people in such a way as to make them look extremely disturbed,” writes Susan Sontag in an essay from 1973 called Freak Show. “The camera chooses oddity, chases it, names it, elects it, frames it, develops it, titles it.” Sontag was talking about photography, but this concept of naming-and-framing is a useful analogy for how we view one another in society at large.

We muscle through life constantly framing the “normality” of others against our own patchwork of knowledge, life experiences, values and opinions. We can’t help it. Yet normality is probably the most subjective concept human beings can ponder.

Related: Is mental illness real? You asked Google – here’s the answer | Jay Watts

Related: Why don’t people like me? You asked Google – here’s the answer | Anouchka Grose

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Risk of psychotic disorders up to five times greater for people from ethnic minorities – UK study

Although psychosis is rare, factors including stress related to migration and discrimination could contribute to increased risk, say researchers

People from ethnic minorities have up to a five times greater risk of psychotic disorders than the white British population, researchers say.

A new study reveals that the trend holds in both urban and rural settings, with first-generation migrants who arrive in the UK in childhood among those at increased risk.

Related: It’s time to tackle mental health inequality among black people

Related: Kwame McKenzie: Being black in Britain is bad for your mental health

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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

12 Jours review – a devastating glimpse into broken souls

Raymond Depardon’s documentary follows a judge who must decide whether psychiatric hospital patients can be allowed back into society

A young woman stares across a table at the judge who is reviewing her case. Her gaze is both searingly intense and curiously blank. Holding herself preternaturally still, muscles tensed against the turmoil of emotions, she pleads to see the two-year-old daughter who has been removed from her care. “Not all the time, I accept that. But just to change her diaper, to love her.” If there’s a more achingly sad moment in any film of the 2017 Cannes film festival, it’s hard to imagine what it could be. For 12 Jours, veteran documentarian Raymond Depardon (Modern Life, Journal de France) turns his lens on to the desperate, broken souls of the patients who have been involuntarily committed into the care of a Lyon psychiatric institution.

Related: A Gentle Creature review – brutally realist drama offers up a pilgrimage of suffering

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Tai chi significantly reduces depression symptoms in Chinese-Americans

A 12-week program of instruction and practice of the Chinese martial art tai chi led to significantly reduced symptoms of depression in Chinese Americans not receiving any other treatments. The pilot study conducted by investigators at Massachusetts General Hospital (MGH) and published in the Journal of Clinical Psychiatry enrolled members of Boston’s Chinese community who had mild to moderate depression.

“While some previous studies have suggested that tai chi may be useful in treating anxiety and depression, most have used it as a supplement to treatment for others medical conditions, rather than patients with depression,” explains Albert Yeung, MD, ScD, of the Depression Clinical and Research Program in the MGH Department of Psychiatry, lead and corresponding author of the report. “Finding that tai chi can be effective is particularly significant because it is culturally accepted by this group of patients who tend to avoid conventional psychiatric treatment.”

Participants were recruited through advertisements offering tai chi for stress reduction, and their eligibility for the study was determined based on in-person interviews and assessments of overall health and depression symptoms. Eligible participants were Chinese-American adults fluent in either Cantonese or Mandarin, with a diagnosis of major depressive disorder in the mild to moderate range, no history of other psychiatric disorders, no recent practice of tai chi or other mind-body interventions, and no current use of other psychiatric treatments.

Participants were randomized into three groups — one that received the tai chi intervention; an active control group that participated in educational sessions that included discussions on stress, mental health and depression; and a passive control, “waitlist” group that returned for repeat assessments during and after the study period. The tai chi intervention involved twice weekly sessions for 12 weeks, in which participants were taught and practiced basic traditional tai chi movements. They were asked to practice at home three times a week and to document their practice. The education group also met twice weekly for 12 weeks, and sessions for both groups were offered in Cantonese or Mandarin. Members of both the education and waitlist groups were able to join free tai chi classes after the initial study period, something they were informed of at the study’s outset.

Of the 50 participants who completed the 12-week intervention period, 17 were in the tai chi group, 14 in the education group and 19 in the waitlist group. The 12-week assessments showed that the tai chi group had significantly greater improvement in depression symptoms than did members of either control group. Follow-up assessment at 24 weeks showed sustained improvement among the tai chi group, with statistically significant differences remaining compared with the waitlist group.

“If these findings are confirmed in larger studies at other sites, that would indicate that tai chi could be a primary depression treatment for Chinese and Chinese American patients, who rarely take advantage of mental health services, and may also help address the shortage of mental health practitioners,” says Yeung, who is an associate professor of Psychiatry at Harvard Medical School. “We also should investigate whether tai chi can have similar results for individuals from other racial and ethnic groups and determine which of the many components of tai chi might be responsible for these beneficial effects.”

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Rates of suicide ‘worrying’ among people with autism, say experts

Suicide rates among people with autism in England have reached “worryingly” high levels, according to experts writing in the Lancet Psychiatry.

Writing ahead of a world-first international summit on suicidality in autism, the researchers — from Coventry and Newcastle universities — say the issue remains poorly understood and that action is urgently needed to help those most at risk.

Dr Sarah Cassidy from Coventry University cites a clinical study she led in 2014 — also published in the Lancet Psychiatry — in which 66% of adults newly diagnosed with Asperger Syndrome (AS) reported having contemplated suicide.

In the same study — which remains the most recent clinical research into suicidality in autism — 35% of the 365 respondents newly diagnosed with AS said they had planned or attempted to end their own life, with 31% reporting that they suffered depression.

A 2016 population study in Sweden also concluded that suicide is a leading cause of premature death in people with autism spectrum disorder.

Dr Cassidy from Coventry University’s Centre for Research in Psychology, Behaviour and Achievement said,”What relatively little we know about suicidality in autism points to a worryingly high prevalence of people with the condition contemplating and attempting to take their own life.

“More concerning still, the small body of research that does exist exposes serious shortcomings in how prepared we are to intervene and provide effective support to those with autism who are most at risk of dying by suicide.

“There are significant differences, for example, in the risk factors for suicide in autism compared with the general population, meaning the journey from suicidal thoughts to suicidal behaviours might be quite different.

“The models we currently consider best practise for assessing and treating suicidality need to be rethought for those with autism, and policy adjusted accordingly so new approaches are reflected across services.”

Co-author Dr Jacqui Rodgers from Newcastle University’s Institute of Neuroscience said,”This unique event is of huge importance. For the first time researchers and clinicians from the fields of autism and suicide research will come together, along with members of the autism community and those bereaved by suicide, to learn from each other and identify clinical and research priorities to address this urgent issue.”

Jon Spiers, chief executive of autism research charity Autistica, said, “For years society and the healthcare system have ignored the voices of families who have lost autistic loved ones unnecessarily, and far too young. Recent research revealing the sheer scale of the problem proves that we cannot let that continue.

“National and local government, research funders and industry, as well as the NHS and service providers all have a responsibility to tackle the issue of suicide in autism. Autistica is committed to playing a major part by funding mental health research programmes. This suicide summit will kick-start our campaign for change in this severely overlooked area.”

Coventry and Newcastle universities are running the international summit on suicide in autism — the first of its kind anywhere in the world — over the next two days, with funding from Autistica and the James Lind Alliance.

The aim is to develop recommendations for changes in government policy and practise that can be implemented quickly to reduce suicide in autism, and to decide on priorities for future research in the field.

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Parent training on ADHD using volunteers can help meet growing treatment needs

Using volunteers to train parents concerned about attention deficit/hyperactivity disorder (ADHD) in their children can improve capacity to meet increasing ADHD treatment needs, finds a new study by NYU’s Steinhardt School of Culture, Education, and Human Development.

The study, published in the Journal of Abnormal Child Psychology, highlights an innovative approach to embracing community resources — tapping volunteers to act as therapists.

“Given the prevalence of ADHD in many countries and the limited access to evidence-based, non-medication treatment, there is a pressing need to expand service delivery systems. Our findings demonstrate that the service model of behavioral parent training we studied can effectively provide training to many families of youth with concerns about ADHD and is likely highly sustainable,” said Anil Chacko, associate professor of counseling psychology at NYU Steinhardt and the study’s author.

Behavioral parent training is a well-established therapeutic approach in which parents are taught how to improve interactions with their child, increase a child’s desirable behavior, and reduce misbehavior. Research has looked at behavioral parent training for addressing the problems associated with ADHD among youth. Behavioral parent training has been shown to improve parenting behavior and stress, as well as children’s disruptive behavior. The American Academy of Pediatrics advises that behavioral parent training be used as the first line approach to treating preschoolers with ADHD.

While behavioral parent training is a widely accepted intervention for children with ADHD, there are limited therapists available to provide this training. When compounded with the growing prevalence of ADHD, models to improve access to behavioral parent training are needed, particularly those that can be readily implemented in community settings.

“Given the well-documented benefits of behavioral parent training as an intervention for ADHD, widespread availability and access to behavioral parent training delivered by volunteers and paraprofessionals should have direct public health benefits in bending the curve on costs and outcomes associated with ADHD,” Chacko said.

ADHD-foreningen, a Danish ADHD advocacy organization, developed and delivered Caring in Chaos, a parenting intervention drawn from evidence-based behavioral parent training approaches. It focuses on three core elements: education about ADHD, positive behavior, and tools for managing disruptive behavior and conflict prevention. The model relies on trained volunteers, who meet with parents in small groups over 12 weekly evening sessions.

The current study evaluated Caring in Chaos for parents with concerns about their children’s ADHD. (Unlike other studies of ADHD, the children did not undergo an assessment for an ADHD diagnosis, and as such, included children with a range of ADHD symptoms).

The study included 161 Danish families who were randomized to either receive Caring in Chaos or were put on a waitlist, acting as a control group. The researchers collected data on the families before the intervention, immediately after, and four months later. Parents rated their own parenting behavior, competence, stress, and depressive symptoms, as well as their child’s ADHD symptoms and functional impairments at home, such as getting dressed independently or doing chores.

The researchers found that Caring in Chaos resulted in significant improvement in all parenting measures — behavior, competence, stress, and depressive symptoms — as well as children’s functional impairment compared to the wait-listed families immediately after the intervention. Most of the gains were maintained at the four-month follow-up.

This study aligns with other studies demonstrating that behavioral parent training has a consistent impact on key parenting outcomes and children’s functional impairments.

The results of the study suggest that efficient behavioral parent training models, such as Caring in Chaos, can be implemented by a variety of individuals in the community — not just therapists. These models have potential for increasing access to behavioral parent training, which is necessary for addressing the growing and often unmet needs of families of youth with ADHD.

“The model we studied in Denmark can and should be translated here in the United States, given the large disparities in access to evidence-based treatments and significant number of children with ADHD,” said Chacko.

Popular social media sites ‘harm young people’s mental health’

Poll of 14- to 24-year-olds shows Instagram, Facebook, Snapchat and Twitter increased feelings of inadequacy and anxiety

Four of the five most popular forms of social media harm young people’s mental health, with Instagram the most damaging, according to research by two health organisations.

Instagram has the most negative impact on young people’s mental wellbeing, a survey of almost 1,500 14- to 24-year-olds found, and the health groups accused it of deepening young people’s feelings of inadequacy and anxiety.

Related: Social media and bullying: how to keep young people safe online

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Chronic childhood illness linked with later life mental health problems

A new study into the effects of chronic physical illness in children on their life-long mental health has found that such experiences appear to increase the chances of them having depression and anxiety in adulthood.

Researchers at the University of Sussex and University College London systematically reviewed evidence from a large number of medical studies, looking for associations between eight chronic physical illnesses in childhood, such as arthritis, asthma and cancer, and emotional problems experienced by the sufferers in later life.

The paper, published today in the Journal of Child Psychology and Psychiatry (JCPP), reveals that the sufferers of all chronic conditions reviewed were at increased risk of developing depression or anxiety, emotional problems that persisted beyond childhood and adolescence and into adult life.

The results suggest that mental health prevention and intervention strategies which specifically target chronic illness sufferers in youth could be vital in treating mental health issues before they develop into more serious long term conditions.

Speaking about the findings, psychologist Dr Darya Gaysina, senior researcher on the project at the University of Sussex said: “Very little is known about life-long effects of childhood chronic physical illness on mental health. Our results show that childhood chronic physical illness was significantly associated with adult depression in the total sample of more than 45,000 participants we studied.

“In particular, we found that cancer was significantly associated with adult depression. Although the research on other chronic conditions is very limited, when we removed cancer from the sample, the link was still there. So it is not only cancer that’s associated with adult emotional problems.”

Dr Gaysina feels that this connection could help mental health practitioners approach young patients with chronic conditions in a different way.

“It seems that if there is a higher risk of mental health issues in adulthood for those with childhood-onset chronic physical illnesses, further in-depth research in this area could help change the way practitioners work with youth with chronic conditions, ensuring that there is as much a focus on the patient’s mental health as their physical health.”

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It’s hard to talk about mental health at the best of times, which these are not

‘Nobody, even Trump, should be blamed for being mentally ill. But nor should we pretend mental illness affects only the nice’

Should we talk more openly about mental illness, or should we shut up? It depends which side of the Atlantic you’re on. In Britain, the future head of state has thrown his weight behind an admirable campaign for more conversation, but in America, where the current head of state seems profoundly psychologically disordered, the official position is to zip it. The American Psychiatric Association (APA) is standing firm on the “Goldwater Rule”, which prohibits members from offering opinions, let alone formal diagnoses, on those they haven’t evaluated in person. (It was devised after a poll of psychiatrists deemed Barry Goldwater, the 1964 Republican presidential candidate, unfit for office.) Needless to say, the rule hasn’t stifled media speculation about celebrity mental health; instead, it precludes precisely those who might bring some credibility and sobriety to the discussion.

The best argument for the royal family’s Heads Together initiative is that it could reduce the stigma surrounding mental illness, yet the APA’s best argument for not talking about Trump’s problems is also to avoid stigmatising other mentally ill people through association with the Orange Horror. There’s something amiss here: we claim we want to acknowledge that mental illness affects pretty much everyone, but at the same time, we don’t want to acknowledge that it affects some highly unsavoury people. And we certainly don’t want to acknowledge that their illness and bad actions might be intertwined.

Related: Want to live twice as long? Meditation might help | Oliver Burkeman

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