Category: Mental Health

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Hyperbaric Oxygen Might be Effective Treatment for PTSD – Here’s How it Works

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Anders Kjellberg, Karolinska Institutet

Post-traumatic stress disorder (PTSD) is common in military veterans but can affect anyone who has suffered or witnessed an extreme physical or emotional event, and it is very hard to treat. More than two-thirds of people fail to respond to treatment with drugs and therapy. Novel treatments are urgently needed.

A recent study from Israel has been showing promise with an unusual treatment: hyperbaric oxygen therapy (HBOT). This involves breathing pure oxygen in a pressurised chamber. HBOT is conventionally used to treat various physical ailments, such as carbon monoxide poisoning and decompression sickness (also known as “the bends”).

The study, published in The Journal of Clinical Psychiatry, included 63 male veterans aged 25 to 60 who had suffered from PTSD for more than five years. Fifty-six subjects completed the study.

Participants in the study were randomly assigned (28 in each group) to either receive the active treatment with 60 sessions of hyperbaric oxygen at a pressure corresponding to diving 10 metres underwater, or a “sham treatment” (the control group), with air just above atmospheric pressure.

Treatments were 90 minutes a day, five days a week for 12 weeks and included air breaks, or simulated air breaks for people in the control group, every 20 minutes. The groups were similar (as expected in a randomised study) and could not correctly guess which treatment they received (this “blinding” helps remove bias from the study).

The group that received hyperbaric oxygen improved much more in self-reported symptoms related to PTSD and depression compared with the control group, immediately after the treatment and three months later.

Interestingly, changes could also be seen in certain areas of the brain associated with PTSD, with magnetic resonance imaging. The study reported some mild side-effects including resurfacing of traumatic memories, which in itself is very interesting and possibly part of the treatment effect.

The study is small but solid, with very interesting results.

More than half a century

Hyperbaric oxygen treatment has been used for more than half a century for its multiple effects on the immune system – in wound healing, infections and chronic inflammation. If we consider PTSD a wound with chronic inflammation, it is not difficult to imagine how it works, even if we do not fully understand the mechanisms involved.

In a wound, the damaged cells release molecules that trigger the immune system and attract stem cells involved in the healing process. This process uses lots of oxygen and the mitochondria that are the power plants of the cell need to work at full capacity.

If the healing is not completed, some cells close to the wound change their behaviour and close down power plants (mitochondria) to survive, instead of choosing to die and be replaced.

This is a natural survival mechanism, important for regeneration after an injury. Cells that are damaged but not lost go into survival mode that can be reversed when the imminent danger is over. But, for unknown reasons, some cells stay in survival mode.

This survival mode is called senescence or ageing. It happens normally as we age but with an injury, many cells can go into survival mode at the same time.

If we look at the body as an ecosystem or society, survival-mode cells are the elderly. The elderly cells are in a way smarter since they carry memories from previous traumas and do not work themselves to death when things get a bit rough. Unfortunately, they are also more sensitive to stress, are not as efficient, and still consume oxygen and energy.

The main reason for functional decline is that we gradually “rust” from the inside due to oxidative stress. We lose anti-oxidative capacity and get an increased number of elderly cells. The elderly cells have fewer mitochondria.

Many effective drugs are developed to reduce the symptoms of oxidative stress. However, since cells are programmed to preserve energy, the normal function may decline further if cells are not challenged. On the other hand, if we cannot reduce oxidative stress naturally, it may reduce our quality of life and lifespan.

When we induce short bursts of oxidative stress, such as during intense exercise the body reacts by producing protective substances in reaction to the stress. Interestingly, hyperbaric oxygen therapy has shown similar effects, something that has been called the hyperoxic-hypoxic paradox. Hyperbaric oxygen is brilliant for the brain since we can’t exercise the brain in the gym.

Nerve cells in the brain live much longer than any other cell in the body. A brain cell can live 70 years or more. Regions of the brain called the amygdala, hippocampus and prefrontal cortex are important areas that are sensitive to oxidative stress and become dysfunctional in PTSD.

The immune cells patrol the body and their communication with the brain is important in PTSD. In the brain, astrocytes are immune cells with a long lifespan and memory that support and protect the brain cells.

In survival mode, due to mitochondrial dysfunction, this support becomes dysfunctional. It helps the brain cells to survive but is not good for optimal performance and causes chronic inflammation.

Astrocytes form a protective shield of antioxidants for elderly brain cells, which is difficult to overcome under normal circumstances. Hyperbaric oxygen has been shown to stimulate astrocytes to deliver new mitochondria to neurons in a cell model.

By challenging cells with hyperbaric oxygen, they gain enough energy for elderly cells to close down and die, and healthy cells become stronger and more efficient, which leaves room and energy for the next-generation workers (new stem cells). This reconditioning process may be what is at work in healing people with PTSD.

Anders Kjellberg, Researcher, Hyperbaric Medicine, Karolinska Institutet

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Categories : Mental HealthTags :

Three Quarters of People Who Have Taken Antidepressants Say They Were Helpful

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About 75% of a sample of nearly 20 000 people who have taken selective serotonin reuptake inhibitors (SSRIs) report they found them helpful, according to new research from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London.

Published in Psychological Medicine, the study explored different factors that could explain why SSRIs work for some people with major depressive disorder, but not others.

Researchers analysed data from UK Biobank on 19 516 participants who had tried at least one SSRI, such as citalopram, fluoxetine, paroxetine or sertraline, for at least two weeks. Participants reported whether the SSRI helped them “feel better” using a single item questionnaire with possible responses “yes, at least a little”, “no”, “do not know”, or “prefer not to answer”. This is the first detailed analysis of this large-scale study which assesses SSRIs using self-reported experiences rather than clinician-reported remission from symptoms.

Overall, 74.9% felt SSRIs helped them feel better. 18.8% said the prescribed drug was not helpful.

Using a range of data collected by UK Biobank, the study analysed what factors might influence whether people found SSRIs helpful.

It found that sociodemographic factors such as age, gender and household income were linked to differences in how people perceived the effectiveness of SSRIs. Those participants who were older, male, had lower incomes, and reported alcohol or illicit drug use were more likely to say that they did not find antidepressants helpful.

Participants who had experienced no mood improvement even when positive events occurred or whose worst episode of depression lasted more than two years, were also less likely to report that SSRIs were helpful. Lastly those who had a greater genetic risk for depression, calculated using polygenic risk scores, were less likely to report that SSRIs were helpful.

The use of antidepressants, and the rate at which they are prescribed in the UK, has been the source of much debate both in the public and media. While antidepressants don’t work for every user, this research provides reassuring evidence that many people report that this common type of medication is helping them manage what can be a severe illness.

Dr Michelle Kamp, Postdoctoral Research Associate at King’s IoPPN and first author on the study

We know that not all people respond to antidepressants prescribed, but most studies have focussed on clinician’s perspectives of response. Using participant reports, we found a strong support for antidepressants, with three quarters of people saying the drugs had helped them. The factors that make people more likely to respond to antidepressants mirror findings in clinical trials which use measures reported by clinicians. This suggests that patient-focussed responses can capture valuable insights into the effectiveness of antidepressants.

Professor Cathryn Lewis, Professor of Genetic Epidemiology & Statistics at King’s IoPPN and senior author on the study

Professor Andrew McIntosh, Professor of Biological Psychiatry at the University of Edinburgh’s Centre for Clinical Brain Sciences and co-investigator on the study, said: “The findings from this large study show that nearly three-quarters of people in UK Biobank who were treated with antidepressants found them helpful. There is already excellent evidence from clinical trials that antidepressants work for people with depression. However those studies focus on addressing only whether they are more effective than placebos, and not why they are more effective in some people than others. We must now focus on developing a better understanding of how antidepressants work and how we can predict which people are most likely to benefit from these treatments.”

The study offers key insights into antidepressant response, however the sample may not fully represent the general population and reliance on retrospective self-reports can lead to inaccurate recollection.

Source: King’s College London

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Social Skills not as Relevant for Autism Diagnosis than Thought

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People with autism are typically diagnosed by clinical observation and assessment. To deconstruct the clinical decision process, which is often subjective and difficult to describe, researchers used a large language model (LLM) to synthesize the behaviours and observations that are most indicative of an autism diagnosis. Their results, publishing in the Cell Press journal Cell, show that repetitive behaviours, special interests, and perception-based behaviours are most associated with an autism diagnosis.

These findings have potential to improve diagnostic guidelines for autism by decreasing the focus on social factors – which the established guidelines in the DSM-5 focus on but the model did not classify among the most relevant in diagnosing autism.

“Our goal was not to suggest that we could replace clinicians with AI tools for diagnosis,” says senior author Danilo Bzdok of the Mila Québec Artificial Intelligence Institute and McGill University in Montreal. “Rather, we sought to quantitatively define exactly what aspects of observed behaviour or patient history a clinician uses to reach a final diagnostic determination. In doing so, we hope to empower clinicians to work with diagnostic instruments that are more in line with their empirical realities.”

The scientists leveraged a transformer language model, which was pre-trained on about 489 million unique sentences. They then fine-tuned the LLM to predict the diagnostic outcome from a collection of more than 4000 reports written by clinicians working with patients considered for autism diagnosis. The reports, which were often used by multiple clinicians, included accounts of observed behaviour and relevant patient history but did not include a suggested diagnostic outcome.

The team developed a bespoke LLM module that pinpointed specific sentences in the reports that were most relevant to a correct diagnosis prediction. They then extracted the numerical representation of these highly autism-relevant sentences and compared them directly with the established diagnostic criteria enumerated in the DSM-5.

“Modern LLMs, with their advanced natural language processing capabilities, are natively suited to this textual analysis,” Bzdok says. “The key challenge we faced was in designing sentence-level interpretability tools to pinpoint the exact sentences, expressed by the healthcare professional themselves, that were most essential to a correct diagnosis prediction by the LLM.”

The researchers were surprised by how clearly the LLM was able to distinguish between the most diagnostically relevant criteria. For example, their framework flagged that repetitive behaviours, special interests, and perception-based behaviour were the criteria most relevant to autism. While these criteria are used in clinical settings, current criteria focus more on deficits in social interplay and lack of communication skills.

The authors note that there are limitations to this study, including a lack of geographical diversity. Additionally, the researchers did not analyse their results based on demographic variables, with the goal of making the conclusions more broadly applicable.

The team expects their framework will be helpful to researchers and medical professionals working with a range of psychiatric, mental health, and neurodevelopmental disorders in which clinical judgement forms the bulk of the diagnostic decision-making process.

“We expect this paper to be highly relevant to the broader autism community,” Bzdok says. “We hope that our paper motivates conversations about grounding diagnostic standards in more empirically derived criteria. We also hope it will establish common threads that link seemingly diverse clinical presentations of autism together.”

Source: ScienceDaily

Categories : Mental HealthTags :

Potential Risk Biomarkers Found for Schizophrenia from Cannabis Use

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A new study, recently published in the journal Scientific Reports, has analysed and compared the fatty acids in the blood of individuals with schizophrenia, of those with cannabis use disorder and of those with both diagnoses, with the aim of shedding light on new biomarkers and improving the understanding of the biological relationship between the two disorders. The study also offers a powerful tool for identifying new biomarkers.

Cannabis is one of the most widely used substances in the world, with some 228 million users between the ages of 15 and 64. The risk of developing schizophrenia increases significantly with cannabis use, especially when it starts at a young age. What is more, it is estimated that approximately 10% of cannabis users will develop cannabis use disorder during their lifetime. Curiously, almost a third of individuals diagnosed with schizophrenia also meet the criteria for cannabis use disorder; and cannabis use disorder affects up to 42% of people with schizophrenia.

In this bid to shed light on the biological mechanisms that determine why some individuals develop schizophrenia while others only experience cannabis use disorder, despite similar levels of exposure to cannabis, the UPV/EHU’s Neuropsychopharmacology group has managed to detect “potential biomarkers in the blood that could help predict the risk some people have of developing a psychiatric disorder such as schizophrenia if they use cannabis”, explained Leyre Urigüen, coordinator of the study.

So, the research group compared the fatty acid content in the blood of samples taken from “a group of individuals with schizophrenia who did not use cannabis, a group who used cannabis and have developed a cannabis use disorder, a group with a dual pathology of schizophrenia with cannabis abuse, and a control group of individuals with neither a psychiatric disorder nor drug use”, explained Dr Urigüen. In the study they wanted to shed light on what happens “with people who use cannabis and develop schizophrenia; how do they differ from those who use cannabis and never develop a psychiatric disorder?” she added.

“We found considerable differences between these groups of individuals. By comparing the quantities of certain metabolites (fatty acids), we were able to perfectly differentiate between the three patient populations,” stressed the UPV/EHU researcher. “This indicates that there is an altered or different metabolism between these three groups.” In this study the Neuropsychopharmacology research group at the UPV/EHU detected “that some fatty acids differentiate between the cannabis-using group and the groups with schizophrenia and dual-diagnosis patients. These molecules could potentially be biomarkers”, said Urigüen.

Paving the way forward

The researcher is very hopeful about this finding: “I think it is important to be capable of finding blood biomarkers that can help predict the risk of developing a psychiatric disorder, such as schizophrenia due to cannabis use, and this study has proven to be the start of this way forward. Now this has to be disproved by studies with a larger cohort of people than the one we have analysed.”

In this respect, the researcher stressed that another of the strengths of the study is “the fine-tuning of plasma lipidomics in patients; in other words, the complete study of fatty acids (lipids). We are proposing a way of working that can be replicated by other groups, and that way, headway can be made in the specification of these metabolites”. This approach has been developed by the IBeA research group under the direction of the UPV/EHU professor Nestor Etxebarria. Both groups are working side by side on “various approaches to the study in which they are trying to find answers to these and many other questions”.

Source: University of the Basque Country

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Nearly Half of Depression Diagnoses Could be Considered Treatment-resistant

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Almost half of patients diagnosed with depression classify as being ‘treatment-resistant’ as new research suggests that many don’t respond to multiple antidepressant options.

The new study, published in the British Journal of Psychiatry was led by academics from the University of Birmingham and Birmingham and Solihull Mental Health NHS Foundation Trust. The study found that 48% of patients whose electronic healthcare records reported a diagnosis of depression had tried at least two antidepressants, and 37% had tried four or more different options.

Treatment-resistant depression (TRD) is typically defined as a form of depression that isn’t effectively managed after a patient tries two different antidepressants. There are currently few guidelines for treating TRD.

Patients who experience TRD were also invited to take part in interviews to share their experiences. Patients talked about a “sense of hopelessness” after trying multiple treatment options for the condition, and many shared their frustrations with a “one size fits all” approach to what works with treatment.

PhD researcher Kiranpreet Gill from the School of Psychology at the University of Birmingham and corresponding author of the study said:

“This paper highlights how widespread treatment-resistant depression is among those who are diagnosed with depression. With nearly half of all patients not responding to multiple drug options, we need better treatment options to be able to support patients for whom first line antidepressant medications don’t make a difference.

“Furthermore, the experiences of patients who took part in this study shows that more awareness and options for treating depression when first line antidepressant medications don’t work well is urgently needed.

“There is an irony that the experience of struggling to treat depression is in itself a risk factor for a worsening sense of ‘hopelessness’ as one patient described it. This should be a clarion call to recognise that treatment-resistant depression needs to be factored into clinical decision making and the ongoing support that patients are offered.”

There are increased risks of other psychiatric disorders among those with TRD such as anxiety, self-harm, and personality disorders, and physical health issues such as heart disease. Data analysis suggests that patients with TRD have 35% higher odds of having a personality disorder and 46% higher odds of cardiovascular disease and the combination with qualitative data suggests that patients have multiple and considerable barriers to achieving good health.

Professor Steven Marwaha, Clinical Professorial Fellow at the Institute for Mental Health at the University of Birmingham, a Consultant Psychiatrist at Birmingham and Solihull Mental Health NHS Foundation Trust, and co-author of the study said:

“This study is important as the data demonstrates people with TRD are at a higher risk of a range of poorer outcomes, and that we need better defined care pathways for helping this population, and are in urgent need of developing and testing new treatments for this group.”

Source: University of Birmingham

Categories : Mental Health NeurologyTags :

What Drives Mood Swings in Bipolar Disorder? Study Points to a Second Brain Clock

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A brain rhythm working in tandem with the body’s natural sleep-wake cycle may explain why bipolar patients alternate between mania and depression, according to new research.

The McGill University-led study published in Science Advances marks a breakthrough in understanding what drives shifts between the two states, something that, according to lead author Kai-Florian Storch, is considered the “holy grail” of bipolar-disorder research.

“Our model offers the first universal mechanism for mood switching or cycling, which operates analogously to the sun and the moon driving spring tides at specific, recurring times,” said Storch, an Associate Professor in McGill’s Department of Psychiatry and a researcher at the Douglas Research Centre.

The findings suggest that regularly occurring mood switches in bipolar disorder patients are controlled by two “clocks”: the biological 24-hour clock, and a second clock that is driven by dopamine-producing neurons that typically influence alertness. A manic or depressed state may arise depending on how these two clocks, which run at different speeds, align at a given time.

Notably, the authors say this second dopamine-based clock probably stays dormant in healthy people.

To carry out their study, the scientists activated the second clock in mice to create behavioral rhythms similar to the mood swinging in bipolar disorder. When they disrupted dopamine-producing neurons in the brain’s reward centre, these rhythms ceased, highlighting dopamine as a key factor in the mood swings of bipolar disorder.

Hope for new treatments: Silencing the clock

Current treatments for bipolar disorder focus on stabilizing moods but often don’t address the root causes of mood swings, the researchers said.

“Our discovery of a dopamine-based arousal rhythm generator provides a novel and distinct target for treatment, which should aim at correcting or silencing this clock to reduce the frequency and intensity of mood episodes,” said Storch.

What remains unknown is the exact molecular workings of the dopamine clock, as well as the genetic and environmental factors that may activate it in humans. The research team’s next step will be to focus on these molecular “gears” and investigate these potential triggers.

Source: McGill University

Categories : Cardiovascular Disease Mental HealthTags :

In Younger Women, Stress is Associated with an Increased Stroke Risk

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Credit: American Heart Association

Some people living with chronic stress have a higher risk of stroke, according to a study published on online in Neurology®, the medical journal of the American Academy of Neurology. The study looked at younger adults and found a correlation between stress and stroke, with no known cause, in female participants, but not male participants.

“Younger people often experience stress due to the demands and pressures associated with work, including long hours and job insecurity, as well as financial burdens,” said Nicolas Martinez-Majander, MD, PhD, of the Helsinki University Hospital in Finland.

“Previous research has shown that chronic stress can negatively affect physical and mental health. Our study found it may increase the risk of stroke in younger women.”

For the study, researchers looked at 426 people aged 18 to 49 who had an ischaemic stroke with no known cause. They were matched for age and sex with 426 people who did not have stroke. Participants completed a questionnaire about stress levels over a one-month period. Those with stroke were asked after their stroke to record stress levels in the month prior to their stroke.

Participants were asked 10 questions, such as “In the last month, how often have you felt that you were unable to control the important things in your life?” Scores for each question ranged from zero to four, with four meaning “very often.” A total score of 0 to 13 represented low stress; 14 to 26, moderate stress; and 27 to 40, high stress.

Those with stroke had an average score of 13 compared to those without stroke who had an average score of 10. People with stroke were more likely to have at least moderate stress levels. Of those with stroke, 46% had moderate or high stress levels compared to 33% of those who did not have stroke. After adjusting for factors that could affect risk of stroke such as education level, alcohol use and blood pressure, researchers found for female participants, moderate stress was associated with a 78% increased risk of stroke and high stress was associated with a 6% increased risk.

Researchers did not find a link between stress and stroke in male participants. “More research is needed to understand why women who feel stressed, but not men, may have a higher risk of stroke,” said Martinez-Majander.

“In addition, we need to further explore why the risk of stroke in women was higher for moderate stress than high stress. Knowing more about how stress plays a role could help us to create better ways to prevent these strokes.”

A limitation of the study was that people experiencing higher levels of stress may have been less likely to enrol in the study, which could have affected the results.

Source: American Academy of Neurology

Categories : Hospitals Mental HealthTags :

Simple Ways to Improve the Wellbeing of Paediatric Critical Care Staff

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Paediatric critical care (PCC) staff are known to experience high levels of moral distress, symptoms of post-traumatic stress disorder (PTSD) and burnout, but often feel little is offered to help them with their mental health. The SWell team at Aston University, led by Professor Rachel Shaw from the Institute of Health and Neurodevelopment, realised following a literature review that there are no existing, evidence-based interventions specifically designed to improve PCC staff wellbeing. Initial work by SWell identified the ‘active ingredients’ likely to create successful intervention designs.

Together with a team from NHS England, the Aston University researchers set up the SWell Collaborative Project: Interventions for Staff Wellbeing in Paediatric Critical Care, in PCC units across England and Scotland. The aim of the project was to determine the feasibility and acceptability of implementing wellbeing interventions for staff working in PCC in UK hospitals. In total, 14 of the 28 UK PCC units were involved. One hundred and four intervention sessions were run, attended by 573 individuals.

Professor Shaw said: “The significance of healthcare staff wellbeing was brought to the surface during the COVID-19 pandemic, but it’s a problem that has existed far longer than that. As far as we could see researchers had focused on measuring the extent of the problem rather than coming up with possible solutions. The SWell project was initiated to understand the challenges to wellbeing when working in paediatric critical care, to determine what staff in that high-pressure environment need, and what could actually work day-to-day to make a difference. Seeing PCC staff across half the paediatric critical care units in the UK show such enthusiasm and commitment to make the SWell interventions a success has been one of the proudest experiences in my academic career to date.”

The two wellbeing sessions tested are low-resource and low-intensity, and can be delivered by staff for staff without any specialist qualifications.

In the session ‘Wellbeing Images’, a small group of staff is shown images representing wellbeing, with a facilitated discussion using appreciative inquiry – a way of structuring discussions to create positive change in a system or situation by focusing on what works well, rather than what is wrong.

In the ‘Mad-Sad-Glad’ session, another small group reflective session, participants explore what makes them feel mad, sad and glad, and identify positive actions to resolve any issues raised.

The key ingredients in both sessions are social support – providing a psychologically safe space where staff can share their sensitive experiences and emotions without judgement, providing support for each other; self-belief – boosting staff’s self-confidence and ability to identify and express their emotions in response to work; and feedback and monitoring – encouraging staff to monitor what increases their stress, when they experience challenging emotions, and what might help boost their wellbeing in those scenarios.

Feedback from staff both running and participating in the SWell interventions was very positive, with high satisfaction and feasibility ratings. Participants like that the session facilitated open and honest discussions, provided opportunities to connect with colleagues and offered opportunities for generating solutions and support.

One hospital staff member responsible for delivering the sessions said:

“Our staff engaged really well, and it created a buzz around the unit with members of the team asking if they could be ‘swelled’ on shift. A really positive experience and we are keeping it as part of our staff wellbeing package.”

The team concluded that even on busy PCC units, it is feasible to deliver SWell sessions. In addition, following the sessions, staff wellbeing and depression scores improved, indicating their likely positive impact on staff. Further evaluations are needed to determine whether positive changes can be sustained over time following the SWell sessions.

Donna Austin, an advanced critical care practitioner at University Hospital Southampton paediatric intensive care unit, said: “We were relatively new to implementing wellbeing initiatives, but we recognised the need for measures to be put in place for an improvement in staff wellbeing, as staff had described burnout, stress and poor mood. SWell has enabled our unit to become more acutely aware of the needs of the workforce and adapt what we deliver to suit the needs of the staff where possible. Staff morale and retention has been the greatest outcomes from us participating in the SWell study and ongoing SWell related interventions.”

Read the paper about the SWell interventions in the journal Nursing in Critical Care.

Source: Aston University

Categories : Diet and Nutrition Mental HealthTags :

Calorie Labels on Menus could Make Eating Disorders Worse

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Calorie labels on restaurant menus are negatively impacting people with eating disorders, according to a new study published in the BMJ Public Health.

The review, which is the first of its kind, is led by researchers at King’s College London. It found that individuals who have been diagnosed with an eating disorder changed their behaviours if presented with a menu featuring calorie labels.

This included avoiding restaurants, triggering eating disorder thoughts and paying more attention to calorie labels as identified by eye tracking research.

The research found that some people with eating disorders reported that seeing menu labels reinforced their eating disorder beliefs.

The study evaluated existing research to help build a picture of how nutritional labels on menus impact people with a lived experience of eating disorders or disordered eating. It reviewed 16 studies from the UK, US, Canada and Saudi Arabia which included 8,074 participants in total.

The study highlights that people with eating disorders can feel that eating disorders are perceived as less important in the light of obesity prevention policies.

However, physical health cannot be measured by a single indicator such as weight. Some argue that calorie labels can be seen as a blunt instrument to fix a complicated problem and that people with eating disorders could be losing out.

Food labelling came into force in England in 2022. Restaurants, take-aways and cafes with 250 employees or more must display the calories of the food and drink they sell on menus, online menus and take-away platforms. The measure was an attempt to curb rising obesity levels. The United States and Canada have also made calorie displays mandatory, however, few policies targeting obesity have considered the potential impact on eating disorders.

The eating disorder charity Beat estimates that at least 1.25 million people in the UK have an eating disorder. The number of people admitted to hospital with an eating disorder has risen approximately 7% each year since 2005 – 2006.

Senior author Dr Tom Jewell, Lecturer in Mental Health Nursing at King’s College London, said: “Our study highlights that people with lived experience of eating disorders are frustrated at being left out of the conversation around calorie labels.”

Striking a balance between the positive and harmful impacts of calorie labels on menus is vital in any public health policies.Dr Tom Jewell, Senior author and Lecturer in Mental Health Nursing at King’s College London

“Policymakers should consider the impact on both obesity and eating disorders when making decisions about nutrition labelling. A recent review found that calorie labelling has a modest effect on people’s behaviour but this needs to be counterbalanced with the potential harm it does for people with eating disorders.”

Co-author Dr Nora Trompeter, Research Fellow University College London, said: “Our study provides an important addition to the evidence base around calorie labels.”

Typically, there is a lot of focus on whether policies are effective in reducing obesity, but it is also critical to investigate whether these policies inadvertently harm people with eating disorders.

“Our review also shows that more research is needed to fully understand the impact of calorie labels on individuals with eating disorders. For example, none of the studies included young people.”

Source: King’s College London

Categories : Mental Health NeurologyTags :

Scientists Discover Brain Mechanism that Helps Override Fear

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Coronal brain slice showing projections from different visual areas in the cerebral cortex to the ventrolateral geniculate nucleus (vLGN). These pathways are part of the circuit identified as mediating the suppression of instinctive fear responses.

Researchers at the Sainsbury Wellcome Centre (SWC) at UCL have unveiled the precise brain mechanisms that enable animals to overcome instinctive fears. Published today in Science, the study in mice could have implications for developing therapeutics for fear-related disorders such as phobias, anxiety and post-traumatic stress disorder (PTSD).

The research team, led by Dr Sara Mederos and Professor Sonja Hofer, mapped out how the brain learns to suppress responses to perceived threats that prove harmless over time. 

“Humans are born with instinctive fear reactions, such as responses to loud noises or fast-approaching objects,” explains Dr Mederos, Research Fellow in the Hofer Lab at SWC. “However, we can override these instinctive responses through experience – like children learning to enjoy fireworks rather than fear their loud bangs. We wanted to understand the brain mechanisms that underlie such forms of learning”.

Using an innovative experimental approach, the team studied mice presented with an overhead expanding shadow that mimicked an approaching aerial predator. Initially, the mice sought shelter when encountering this visual threat. However, with repeated exposure and no actual danger, the mice learned to remain calm instead of escaping, providing researchers with a model to study the suppression of fear responses. 

Based on the lab’s previous work, the team knew that the ventrolateral geniculate nucleus (vLGN) could suppress fear reactions when active and was able to track knowledge of previous experience of threat. The vLGN also receives strong input from visual areas in the cerebral cortex, and so the researchers explored whether this neural pathway had a role in learning not to fear a visual threat. 

The study revealed two key components in this learning process: (1) specific regions of the visual cortex proved essential for the learning process, and (2) a brain structure called the ventrolateral geniculate nucleus (vLGN) stores these learning-induced memories.

“We found that animals failed to learn to suppress their fear responses when specific cortical visual areas were inactivated. However, once the animals had already learned to stop escaping, the cerebral cortex was no longer necessary,” explained Dr Mederos.

“Our results challenge traditional views about learning and memory,” notes Professor Hofer, senior author of the study. “While the cerebral cortex has long been considered the brain’s primary centre for learning, memory and behavioural flexibility, we found the subcortical vLGN and not the visual cortex actually stores these crucial memories. This neural pathway can provide a link between cognitive neocortical processes and ‘hard-wired’ brainstem-mediated behaviours, enabling animals to adapt instinctive behaviours.”

The researchers also uncovered the cellular and molecular mechanisms behind this process. Learning occurs through increased neural activity in specific vLGN neurons, triggered by the release of endocannabinoids – known to regulate mood and memory. This release decreases inhibitory input to vLGN neurons, resulting in heightened activity in this brain area when the visual threat stimulus is encountered, which suppresses fear responses. 

The implications of this discovery extend beyond the laboratory. “Our findings could also help advance our understanding of what is going wrong in the brain when fear response regulation is impaired in conditions such as phobias, anxiety and PTSD. While instinctive fear reactions to predators may be less relevant for modern humans, the brain pathway we discovered exists in humans too,” explains Professor Hofer. “This could open new avenues for treating fear disorders by targeting vLGN circuits or localised endocannabinoid systems.”

The research team is now planning to collaborate with clinical researchers to study these brain circuits in humans, with the hope of someday developing new, targeted treatments for maladaptive fear responses and anxiety disorders.

Source: Sainsbury Wellcome Centre