Category: Mental Health

Categories : Cancer Mental HealthTags :

Coping with the Fear of Breast Cancer Recurrence

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Breast cancer is the world’s most prevalent cancer. Although earlier detection and targeted treatment have resulted in high survival rates, many breast cancer survivors experience fear of cancer recurrence. For some survivors this fear is occasional, for others it is persistent and often debilitating.

A new study of breast cancer survivors has found this psychosocial challenge impacts almost every important domain of their lives – the emotional, behavioural, cognitive, relational and professional. A larger number of domains was affected, and they were affected more frequently in those with greater fear of recurrence.

“Study participants were reportedly disease free and trying to rebuild their lives during their post-treatment survivorship,” said senior author Shelley Johns, PsyD, a researcher-clinician with the Regenstrief Institute, the Indiana University School of Medicine and the IU Melvin and Bren Simon Comprehensive Cancer Center. “Our findings provide clarity about how breast cancer survivors are impacted by fear of recurrence and insight into how they cope with this understandable fear.”

The study was published in Supportive Care in Cancer.

The impact of fear of recurrence ranged from mildly to severely disruptive. Women experiencing mild fear reported sporadic occurrences. Those with significant fear described it as persistent and/or easily triggered across multiple life domains.

Disturbed sleep prior to mammograms was reported by survivors with mild fear, while frequent need to absent themselves from social activities, get into bed and pull the blanket over their eyes to avoid thinking about cancer was an example of severe, also known as clinical, fear of recurrence. Approximately 74 percent of study participants were experiencing clinical fear of recurrence.

347 women completed the study’s open-ended survey:

  • Many reported feelings of stress, irritability and sadness.
  • Some said fear of recurrence frequently interrupted their train of thought, for example interfering with their job when their disease popped into their mind.
  • Survivors who thought that they were more worried than they should be compared to other breast cancer survivors reported feelings of embarrassment.
  • Some indicated it was too hard to be around their family because they were constantly wondering how many more Christmases and birthdays they were going to have with their children.

The paper’s title includes the phrase, “out of a dark place,” a direct quote from a breast cancer survivor who said that she joined the study to support “getting out of a dark place.”

Other survivors noted the specific impact of fear of cancer recurrence on daily life:

  • “It motivates me to maintain healthy habits. Such as eating five servings of fruits and vegetables, working out and drinking less alcohol. It also motivates me to maintain mental health and physical health.”
  • “Whenever I feel any kind of pain or discomfort in the area where I had cancer it concerns me and I feel anxious and irritable.”
  • “Cancer is all around us. Everything is a trigger. Anniversaries, other family/friends’ diagnosis, commercials about drugs, social media, etc. …it’s a daily thought or a daily emotion.”
  • “Sit for hours doing nothing, do not turn on TV, sleepless, find hours pass by and I am in the same place just thinking, do not participate in activities, get lost driving because I’m deep in thought, compulsive online shopping, collecting things.”

Survivors offered specifics on their coping mechanisms:

  • “Just trying to be positive, eat healthy, take my meds, get enough sleep, exercise three times a week, and hope for the best.”
  • “I try to avoid things that make me think about recurrence. For example, unfollowing social media accounts, fast forwarding or leaving the room when commercials about cancer medications are on.”
  • “I try not to focus on it. I also speak with family members who have lived with cancer longer than myself.”
  • “Prayer, meditation, staying in the moment, and focusing on making the best of each day.”

While many survivors cited avoidance of thoughts and feelings as their primary coping behaviour, Dr Johns, a health services researcher and clinical health psychologist, observes that research is needed to probe the function of various coping behaviours’ to determine if they are helpful.

In a question seldom posed to participants in a clinical trial, when asked what they hoped to gain by participating in the study, the majority indicated that they sought senses of purpose, belonging, control and connection with others.

The paper concludes, “Fear of cancer recurrence is one of the most common psychological challenges for cancer survivors. Understanding affected life domains, coping strategies employed prior to intervention, and reasons for seeking guidance can inform the development and implementation of evidence-based interventions to effectively address fear of cancer recurrence among persons living with breast cancer.”

Source: Regenstrief Institute

Categories : Mental Health Metabolic DisordersTags :

What’s the Mechanism behind Behavioural Side Effects of GLP1RAs?

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Glucagon-like peptide 1 receptor agonists (GLP1RA) – medications for type 2 diabetes and obesity that have recently been making headlines due to a rise in popularity as weight loss agents – have been linked with behavioural side effects. A large population-based analysis in Diabetes, Obesity and Metabolism assessed whether certain genetic variants might help explain these effects.

GLP1RA mimic the GLP-1 hormone in the body that helps control insulin and blood glucose levels and promotes feelings of satiety. GLP-1 binds to GLP1R on cells in the brain and pancreas.

Observational and epidemiological studies have shown that there may be neutral or protective effects of GLP1RAs on mental health symptoms. However, a study based on individuals taking GLP1RA suggests there is increased prescription of anti-depressants when used for treatment of diabetes. Early evidence in animal models suggest GLP1RA may decrease depressive and anxious symptoms, potentially presenting new treatment pathways; however, comparing these studies to human clinical evidence will not be possible for some time.

For the analysis, investigators examined common genetic variants in the GLP1R gene in 408 774 white British, 50 314 white European, 7 667 South Asian, 10 437 multiple ancestry, and 7641 African-Caribbean individuals.

Variants in the GLP1R gene had consistent associations with cardiometabolic traits (body mass index, blood pressure, and type 2 diabetes) across ancestries. GLP1R variants were also linked with risk-taking behavior, mood instability, chronic pain, and anxiety in most ancestries, but the results were less consistent. The genetic variants influencing cardiometabolic traits were separate from those influencing behavioral changes and separate from those influencing expression levels of the GLP1R gene.

The findings suggest that any observed behavioral changes with GLP1RA are likely not acting directly through GLP1R.

“Whilst it is not possible to directly compare genetic findings to the effects of a drug, our results suggest that behavioural changes are unlikely to be a direct result of the GLPRAs. Exactly how these indirect effects are occurring is currently unclear,” said corresponding author Rona J. Strawbridge, PhD, of the University of Glasgow, in the UK.

Source: Wiley

Categories : Mental Health NeurologyTags :

Elevated Opioid Neurotransmitter Activity Seen in Patients with Anorexia

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A study conducted at Turku PET Centre in Finland and published in showed that changes in the functioning of opioid neurotransmitters in the brain may underlie anorexia.

Anorexia nervosa is a serious psychiatric disorder characterised by restricted eating, fear of gaining weight, and body image disturbances, which may lead to severe malnutrition, depression and anxiety. This new study from Turku PET Centre, published in Molecular Psychiatry, shows how changes in neurotransmitter function in the brain may underlie anorexia.

“Opioid neurotransmission regulates appetite and pleasure in the brain. In patients with anorexia nervosa, the brain’s opioidergic tone was elevated in comparison with healthy control subjects. Previously we have shown that in obese patients the activity of the tone of this system is lowered. It is likely that the actions of these molecules regulate both the loss and increase in appetite,” says Professor Pirjo Nuutila from the University of Turku.

Number of opioid receptors in the brain (top row) and sugar intake (bottom row) in patients with anorexia nervosa. Credit: University of Turku

In addition, the researchers measured the brain’s glucose uptake. The brain accounts for about 20% of the body’s total energy consumption, so the researchers were interested in how a reduction in the energy intake affects the brain’s energy balance in anorexia.

“The brains of patients with anorexia nervosa used a similar amount of glucose as the brains of the healthy control subjects. Although being underweight burdens physiology in many ways, the brain tries to protect itself and maintain its ability to function for as long as possible,” says Professor Lauri Nummenmaa from Turku PET Centre and continues:

“The brain regulates appetite and feeding, and changes in brain function are associated with both obesity and low body weight. Since changes in opioid activity in the brain are also connected to anxiety and depression, our findings may explain the emotional symptoms and mood changes associated with anorexia nervosa.”

Source: University of Turku

Categories : Mental HealthTags :

Challenges in Caring for Adopted Patients with Limited Family Medical History

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A study based on interviews with primary care physicians has found that treating patients who were adopted is challenging due to limited access to their family medical history. The study, published in Annals of Family Medicine, also found that there was a desire by physicians to fill the information using genetic testing.

Adopted individuals often only have limited information about their biological family, or even none at all, complicating their treatment. The growing availability and popularity of direct-to-consumer genetic testing kits amplifies the need for physicians to be prepared to address genetic testing for adoptees with limited family medical history. To address this, the present study explored the approaches of primary care physicians when caring for adult adopted patients with limited family medical history.

In-depth interviews were conducted by the researchers, including hypothetical clinical scenarios,  with 23 primary care physicians from Rhode Island and Minnesota to understand their experiences, practices, knowledge, and training gaps when addressing limited family medical history and adoption-related issues.

The researchers found that primary care physicians report knowledge gaps and receive little training or resources on adult adoptees with limited family medical history. As a result, they seek guidance around appropriate preventative screening and genetic testing. Limited interaction with adoptees compared to non-adopted patients also influenced perceptions. There was also an over-reliance on stereotypes and the danger of inaccurate media representation affecting how physicians interacted with adoptee patients. Likewise, those physicians who had experience with adoption might be at risk of over-generalising those experiences, especially given how heterogeneous adoptees are as a population.

Furthermore, the researchers found that mental illness and trauma are under-recognised and under-addressed. Care for adoptees includes trauma-informed care which can address factors such as loss, grief, identity development, and to helping adoptees in searching for biological family, reunion, or with complex family dynamics.

To make matters worse, primary care physicians often obtain family medical history imprecisely, risking miscommunication, microaggressions, and damage to the patient-physician relationship.

The findings of this study highlight the significant gaps in knowledge and training for primary care physicians caring for adult adopted patients with limited family medical history. Addressing these gaps may improve the quality of care and strengthen physician-patient relationships. 

Source: EurekAlert!

Categories : Mental Health Obstetrics & GynaecologyTags :

PTSD and Anxiety may Affect Reproductive Health in Female Firefighters

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Source: CC0

A new study led by University of Arizona researchers in collaboration with fire service partners and other researchers around the country through the Fire Fighter Cancer Cohort Study showed that post-traumatic stress disorder and anxiety are associated with lower levels of anti-Müllerian hormone, a marker of ovarian reserve, among women firefighters.

The ovarian reserve, a measure of fertility, is the number of healthy eggs in a woman’s ovaries that could potentially be fertilised.

“These findings highlight the negative effect that mental health conditions can have on health – specifically, reproductive health,” said first author Michelle Valenti, MPH, a doctoral student in epidemiology at the Zuckerman College of Public Health and program coordinator of the Fire Fighter Cancer Cohort Study’s Women Firefighter Studies.

The paper was published in the Journal of Women’s Health.

Firefighters are exposed to high stress and traumatic situations in addition to chemical exposures and have a higher prevalence of PTSD compared with the general population. Previous research showed that women firefighters have lower levels of anti-Müllerian hormone compared with women who are not firefighters; however, the reason why was unknown.

The research team, which included personnel at the Zuckerman College of Public Health’s Center for Firefighter Health Collaborative Research, led this analysis to determine whether anxiety, depression or PTSD were associated with anti-Müllerian hormone levels. They found that clinical diagnoses of PTSD and anxiety among women firefighters were associated with reductions in anti-Müllerian hormone levels of 66% and 33%, respectively.

These findings highlight a potential mechanism through which adverse mental health conditions could lead to adverse reproductive outcomes. Further research is needed to identify potential areas for intervention.

“The work of this AMH study within the broader context of the FFCCS is imperative to taking care of all of our firefighters,” said Captain Caitlin St. Clair of the Puget Sound Regional Fire Authority. “These findings provide scientific leverage to fire departments to implement programs to reduce stress and improve the lives of our firefighter women.”

The Women Firefighter Study, a subgroup of the Fire Fighter Cancer Cohort Study, aims to identify causes of stress, cancer and adverse reproductive health effects in women firefighters that would inform effective interventions to mitigate these conditions.

“This study demonstrates the power of the Fire Fighter Cancer Cohort Study’s Women Firefighter Study to evaluate exposures that lead to adverse gynaecologic conditions,” Valenti said. “The Women Firefighter Study would not be possible without our amazing fire service partners who have championed women firefighter research.”

Source: University of Arizona Health Sciences

Categories : Mental HealthTags :

New Research Reveals Recent Trends in ADHD Diagnoses

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Source: Paul, et al. 2024, Psychiatric Research and Clinical Practice

New research has identified differing trends in attention-deficit/hyperactivity disorder (ADHD) diagnoses among adolescents and adults, including an increase among adults from 2020 to 2023. The study, published in the American Psychiatric Association Journal Psychiatric Research and Clinical Practice, found a significant downward trends in ADHD incidence among adults from 2016 to 2020 and adolescents from 2016 to 2018. The ADHD incidence rate remained stable for adolescents in subsequent years.

ADHD is a neurodevelopmental disorder involving inattention and/or hyperactivity and impulsivity that interferes with a person’s functioning and ability to perform daily activities, including at school or work. ADHD is often viewed as a condition primarily impacting childhood and adolescence; however, it can also affect adults. Research on the prevalence of ADHD in adults remains limited, with findings varying considerably.

The large retrospective cohort study, conducted by researchers at Saint Louis University and SSM Health, involved more than 140 000 adolescents and adult patients who used services with a large healthcare system located in four states. New ADHD diagnoses were identified using patient charts. Regression analysis was used to determine incidence rates and trends in ADHD diagnoses by age group.

They found a significant downward trend in ADHD incidence among adults from 2016 to 2020 and an upward trend from 2020 to 2023. Among adolescents, a significant downward trend was observed between 2016 and 2018, and the incidence rate remained stable between 2018 and 2023.

“Fluctuations in incidence rates are likely due to a complex interplay of various factors,” the authors write. For example, increased awareness and destigmatisation of ADHD can lead to more diagnoses. Changes in diagnostic criteria, such as the expansion of ADHD criteria in the DSM-5 compared to previous editions, may have contributed to an increase in diagnoses. Variations in diagnostic practices and assessment methods can contribute to differences in incidence rates. In addition, there are some indications, the authors note, that the COVID-19 pandemic may have contributed to new ADHD diagnoses and worsening symptoms.

The authors suggest that this research can support future efforts to identify modifiable risk factors, ensure sufficient treatment resources, develop targeted interventions, and address diagnostic disparities.

Source: American Psychiatric Association

Categories : Mental HealthTags :

Job Strain Compromises Sleep Quality Years Later

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Photo by Andrea Piacquadio

In a recent study published in the American Journal of Industrial Medicine, middle aged workers in the US who reported high job strain at the start of the study experienced significantly more sleep disturbances over an average follow-up of nine years.

The study analysed data from 1721 workers, with an average age of 51 years, who participated in the Midlife in the United States (MIDUS) study. Sleep disturbances were assessed with an established scale, based on four sleep-related symptoms: trouble falling asleep, waking up during the night and having difficulty going back to sleep, waking up too early in the morning and being unable to get back to sleep, and feeling unrested during the day no matter how many hours of sleep.

The team used six different formulations to quantify job strain based on Karasek’s Job‐Demand‐Control model, which defines job strain as a combination of high job demand and low job control. All formulations showed significant associations between higher job strain at baseline and increased sleep disturbances over time.

“Our findings also suggest that the continuous formulations of job strain demonstrate better model performance with consistent and robust results, offering empirical evidence for future psychosocial occupational health research in the United States,” said the first author Yijia Sun, an MS candidate at the University of California, Los Angeles.

Corresponding author Jian Li, MD, PhD, a professor of Work and Health at the University of California, Los Angeles, noted that there is an urgent need for workplace interventions to reduce stress. “Strategies such as redesigning workloads and promoting worker autonomy could play an important role in improving sleep health and workers’ well-being,” he said.

Source: Wiley

Categories : Mental Health OphthalmologyTags :

Is Paranoia Partly a Visual Problem?

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Could complex beliefs like paranoia have roots in something as basic as vision? A new Yale study finds evidence that they might. 

When completing a visual perception task, in which participants had to identify whether one moving dot was chasing another moving dot, those with greater tendencies toward paranoid thinking (believing others intend them harm) and teleological thinking (ascribing excessive meaning and purpose to events) performed worse than their counterparts, the study found. Those individuals more often – and confidently – claimed one dot was chasing the other when it wasn’t.

The findings, published in the journal Communications Psychology, suggest that, in the future, testing for illnesses like schizophrenia could be done with a simple eye test.

“We’re really interested in how the mind is organised,” said senior author Philip Corlett, an associate professor of psychiatry at Yale School of Medicine and member of the Wu Tsai Institute. “Chasing or other intentional behaviours are what you might think of as experiences perceived at a very high-level in the brain, that someone might have to reason through and deliberate. In this study, we can see them low down in the brain, in vision, which we think is exciting and interesting – and has implications for how those mechanisms might be relevant for schizophrenia.”

Paranoia and teleological thinking are similar in that they are both misattributions of intention, but paranoia is a negative perception while teleological thinking tends to be positive. Both patterns of thinking are linked to psychosis and schizophrenia.

Hallucinations are associated with psychosis as well and are often about other people, said Corlett, suggesting there may be a social component to these visual misperceptions.

“So we wondered whether there might be something related to social perception – or misperception, what we refer to as social hallucination – that we could measure and that relate to these symptoms of psychosis,” he said.

For the task, participants were shown dots moving on a screen. Sometimes one dot was chasing another; other times there was no chase. Across different trials of the task, participants had to say whether a chase was occurring or not.

Those with higher degrees of paranoia and teleological thinking (as measured through questionnaires) were more likely than others to say with confidence that a chase was happening when one wasn’t. Essentially, they perceived a social interaction that wasn’t occurring.

In additional experiments, the researchers asked participants to identify which dot was doing the chasing and which dot was being chased. In these results, paranoia and teleological thinking began to diverge.

“People with paranoia were particularly bad at detecting which dot was being chased,” said Santiago Castiello, lead author of the study and a postdoctoral researcher in Corlett’s lab. “And people with high teleology were particularly bad at detecting which dot was doing the chasing.”

That these two types of beliefs differed in this way highlights that they are distinct and may have implications for diagnosis or treatment, said the researchers. The connection to vision may also shift thinking around how the brain gives rise to psychotic symptoms.

“Very few people with congenital blindness develop schizophrenia,” said Castiello. “Finding these social hallucinations in vision makes me wonder if schizophrenia is something that develops through errors in how people sample the visual world.”

While there are no immediate therapeutic implications from these findings, deeper understanding of these beliefs could aid in pharmacological treatment development and risk assessment. 

“One thing we’re thinking about now is whether we can find eye tests that predict someone’s risk for psychosis,” said Corlett. “Maybe there is some very quick perceptual task that can identify when someone might need to talk to a clinician.”

Source: Yale University

Categories : Environmental Effects Mental HealthTags :

The Sound of Traffic Increases Stress and Anxiety

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People experienced less stress and anxiety while listening to nature soundscapes, but the addition of road traffic noise increased their stress and anxiety

Photo by Lucas Davies on Unsplash

Manmade sounds such vehicle traffic can mask the positive impact of nature soundscapes on people’s stress and anxiety, according to a new study published November 27, 2024, in the open-access journal PLOS ONE by Paul Lintott of the University of the West of England, U.K., and Lia Gilmour of the Bat Conservation Trust, U.K.

Existing research shows that natural sounds, like birdsong, can lower blood pressure, heart, and respiratory rates, as well as self-reported stress and anxiety. Conversely, anthropogenic soundscapes, like traffic or aircraft noise, are hypothesized to have negative effects on human health and wellbeing in a variety of ways.

In the new study, 68 student volunteers listened to three 3-minute soundscapes: a nature soundscape recorded at sunrise in West Sussex, U.K., the same soundscape combined with 20 mile per hour road traffic sounds, and the same soundscape with 40 mile per hour traffic sounds. General mood and anxiety were assessed before and after the soundscapes using self-reported scales.

The study found that listening to a natural soundscape reduced self-reported stress and anxiety levels, and also enhanced mood recovery after a stressor. However, the benefits of improved mood associated with the natural soundscape was limited when traffic sounds were included. The natural soundscape alone was associated with the lowest levels of stress and anxiety, with the highest levels reported after the soundscape that included 40 mile per hour traffic.

The authors conclude that reducing traffic speed in urban areas might influence human health and wellbeing not only through its safety impacts, but also through its effect on natural soundscapes.

The authors add: “Our study shows that listening to natural soundscapes can reduce stress and anxiety, and that anthropogenic sounds such as traffic noise can mask potential positive impacts. Reducing traffic speeds in cities is therefore an important step towards more people experiencing the positive effects of nature on their health and wellbeing.”

Provided by PLOS

Categories : Mental HealthTags :

Psychotic-like Experiences in Teens Linked to Depression, Self-destructiveness

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Photo by Inzmam Khan: https://www.pexels.com/photo/man-in-black-shirt-and-gray-denim-pants-sitting-on-gray-padded-bench-1134204/

A study by researchers at the University of Helsinki and HUS Helsinki University Hospital found a significant association among adolescents between having psychotic-like experiences and depressive symptoms, as well as with self-destructive behaviours.

Psychotic-like experiences resemble symptoms of psychosis, but are milder, less frequent and much more common than psychotic disorders. While these symptoms do not constitute a disorder diagnosed as psychosis, they can still be disruptive, distressing or detrimental to functional capacity. Typical psychotic-like experiences include perceptual distortions and hallucinations, suspicious paranoid thinking, delusions and bizarre, unusual thoughts.

Psychotic-like experiences are abundant among adolescents referred to care, but are generally considered fairly neutral, with only some of the adolescents reporting them as frightening, worrisome or harmful. In the study, published in the journal Psychosis, the correlation between psychotic-like experiences and depressive symptoms turned out to be strong. This link was not explained by connections between individual psychotic-like experiences and depressive symptoms, but by factors that more broadly measure paranoia and unusual thoughts. In addition to depressive symptoms, paranoid thoughts and unusual thought content were also associated with self-destructive thinking.

Making questions about psychotic-like experiences part of care

The findings show that psychotic-like experiences should be systematically surveyed in all adolescents seeking psychiatric care. It should also be assessed how frightening, worrisome or harmful they are considered to be. Particularly in the case of responses emphasising bizarre thinking and exaggerated suspiciousness, attention should also be paid to assessing mood and self-destructive thinking, as these factors can remain hidden without further enquiry.

“Our findings provide a clear recommendation for treatment practices: psychotic-like experiences should be assessed as part of routine procedures, but it is also important to determine how they are perceived. These phenomena cannot be uncovered unless separately and systematically asked,” says the principal investigator, Docent Niklas Granö.

It should be clearly explained to adolescents and their families that these symptoms are common and often manageable. In addition, applications of cognitive psychotherapy, even brief interventions, can help adolescents understand their symptoms and alleviate the strain they cause.

Source: University of Helsinki