Category: Mental Health

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Helping People With Depression Quit Smoking can Save Lives

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Source: Sabine R on Unsplash
Source: Sabine R on Unsplash

Giving the means to quit smoking to patients with depression could save as many as 125 000 lives over the next 80 years, researchers estimate. This number could be as high as 203 000 if people with depression who are not yet in mental health care settings are included.

The study, led by the Yale School of Public Health, shows the potential benefits that smoking cessation could have in a population suffering disproportionately from tobacco-related disease and death. Smokers with depression already find it harder to quit, and experience more negative withdrawal symptoms if they do, including increased depression. The study is also the first to estimate the population health effects of integrating smoking cessation treatments with standard mental health care.
Using more than a decade of data from the National Survey on Drug Use and Health, the researchers made a model to project the effectiveness of smoking-cessation treatments into the future. They assessed how the benefits varied based on different rates of treatment adoption over the next 80 years.

Simulating the health benefits reveals that, at least 32 000 deaths could be prevented by 2100 if a significant number of patients with depression adopted any kind of cessation treatment. Assuming 100% mental health service utilisation and pharmacological cessation treatment, the number of potential lives saved could rise to 203 000.

“We’ve known for a long time that people with depression smoke more than the general population, and that mental health care settings often don’t have cessation treatment as part of standard care. Our study asks: what is that missed opportunity? What do we have to gain when mental health care and smoking cessation treatment are fully integrated,” said lead author and assistant professor Jamie Tam, PhD. The findings are published in the American Journal of Preventive Medicine.

Such high benefits would be a best-case scenario, the researchers cautioned. Even so, the model’s results match public health experts’ long-standing predictions of the results of smoking-cessation treatment becoming a routine part of mental health care. The findings show that even less-optimal cessation treatments would greatly impact both quality and length of life for patients living with depression.

“Beyond reducing the risk of early death, smoking cessation improves quality of life and increases productivity,” Tam added. “Decision makers should remove barriers to mental health care and smoking cessation treatments for people with mental health conditions.”

The researchers concluded that while existing treatments, such as nicotine replacement therapy, varenicline, and bupropion, can raise cessation rates by nearly 60%, in the future there would be even larger health gains if there were better cessation treatments.

Source: Yale University

Categories : Hospitals Mental HealthTags :

Heavy Workload Reduces Outcomes and Turns Positives into Negatives

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Employee wellbeing in healthcare is reflected in patient satisfaction, and a new study found that a heavy workload, even positive challenges such as learning new things are experienced as increased stress.

Researchers from the Department of Psychology at the University of Jyväskylä in Finland explored how the staff of a healthcare district experienced increasing job demands, and how wellbeing at work was linked to these demands. The study also clarified whether the demands on employees were reflected in patient satisfaction.

More than a thousand employees took part in the study and evaluated their experiences in a survey measuring intensified job demands, work exhaustion, and work engagement. Additionally, nearly a thousand patients of the healthcare district evaluated their treatment by the healthcare staff.

In line with expectations, healthcare staff’s experiences of greater time pressure and workload were associated with greater exhaustion. An especially high risk of exhaustion was seen in those working in emergency care and nurses.

Additionally, experience of increased job planning demands shared by the working community was associated with greater exhaustion and lower customer satisfaction. This was particularly evident in the staff of leadership services.

“A surprising observation was that none of the intensification demands was positively connected with work engagement,” said Senior Lecturer Mari Huhtala. “In the light of previous studies, employees may find some demands such as learning new things positive challenges, especially when the demands are reasonable. However, this was not the case with the studied healthcare employees. It is possible the general workload in healthcare has led to these positive challenges being experienced as additional stress as well.”

Research data for the study were collected using an electronic survey in the third quarter of 2019. The study will continue in the third quarter of 2021 with the collection of follow-up data.

Source: University of Jyväskylä

Journal information: Huhtala, M., et al. (2021) Intensified job demands in healthcare and their consequences for employee well‐being and patient satisfaction: A multilevel approach. Journal of Advanced Nursing. doi.org/10.1111/jan.14861.

Categories : Mental HealthTags :

Excess Body Fat Associated with Dementia Risk

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Photo by Siora Photography on Unsplash
Photo by Siora Photography on Unsplash

Researchers at the University of South Australia are warning that high levels of body fat can add to the risk of dementia and stroke.

Having examined grey brain matter from about 28 000 people, the reseachers’ study demonstrated that increased body fat incrementally leads to increased atrophy of grey matter in the brain, resulting in greater risk of declining brain health. Obesity is a major and growing issue worldwide; World Health Organization data shows that more than 1.9 billion adults are overweight, with 650 million being obese. 

The lead researcher, Dr Anwar Mulugeta of UniSA, said the findings add to the growing number of issues known to be associated with being overweight or obese.

“Obesity is a genetically complex condition characterised by the excessive body fat,” Dr Mulugeta said. “Commonly linked to cardiovascular disease, type 2 diabetes, and chronic inflammation (a marker of dementia), obesity currently costs Australia’s economy about $8.6 billion dollars each year.

“While the disease burden of obesity has increased over the past five decades, the complex nature of the disease means that not all obese individuals are metabolically unhealthy, which makes it difficult to pinpoint who is at risk of associated diseases, and who is not.

“Certainly, being overweight generally increases your risk for cardiovascular disease, type 2 diabetes, and low-grade inflammation, but understanding the level of risk is important to better direct supports.

“In this study, we investigated the causal relationships of individuals within three metabolically different obesity types* ­– unfavourable, neutral and favourable – to establish whether specific weight groups were more at risk than others.”

These three obesity subtypes are:

  • ‘unfavourable’ – people who tend to have fat around their lower torso and abdominal area. These people have a higher risk of type 2 diabetes and heart diseases.
  • ‘favourable’ – people who have have wider hips but a lower risk of type 2 diabetes and heart diseases.
  • ‘neutral’ – people who have relatively low or very low risk of the cardiometabolic diseases.

Dr Mulugeta continued, “Generally, the three obesity subtypes have a characteristic of higher body mass index, yet, each type varies in terms of body fat and visceral fat distribution, with a different risk of cardiometabolic diseases.

“We found that people with higher levels of obesity especially those with metabolically unfavourable and neutral adiposity subtypes had much lower levels of grey brain matter, indicating that these people may have compromised brain function which needed further investigation.

“However, we did not find conclusive evidence to link a specific obesity subtype with dementia or stroke. Instead, our study suggests the possible role of inflammation and metabolic abnormalities and how they can contribute to obesity and grey matter volume reduction.”

The study analysed the genetic data of up to 336 000 individual records in the UK Biobank, along with self-reported information and linked hospital and death register records to connect dementia and stroke.

It found that, in middle to elderly age groups (37-73), grey brain matter decreased by 0.3 percent for every extra 1 kg/m2, which is equivalent of an extra 3 kg of weight for persons of average height (173 cm).

Senior investigator Professor Elina Hyppönen, Director of UniSA’s Australian Centre for Precision Health based at SAHMRI, said keeping to a healthy weight is important for general public health.

“It is increasingly appreciated that obesity is a complex condition, and that especially excess fat which is located around the internal organs have particularly harmful effects on health,” Prof Hyppönen said.

“Here, we used the individuals’ genetic and metabolic profiles to confirm different types of obesity. In practice, our findings very much support the need to look at the type of obesity when assessing the type of likely health impact.

“Even in a relatively normal weight individual, excess weight around the abdominal area may be a cause of concern.”

Source: University of South Australia

Categories : Mental HealthTags :

Researchers Hit upon a Possible Biomarker for Schizophrenia

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Investigators at Sanford Burnham Prebys have discovered that a certain protein circulating in blood could be a potential biomarker for schizophrenia. The activity of this protein, present in both the brain and blood, affects neural connections in human brains and is uniquely imbalanced in people with schizophrenia. 

The study, an international collaboration among groups at Yokohama City University Graduate School of Medicine in Japan and the Department of Psychiatry at Harvard Medical School in Belmont, Massachusetts, was recently published in PNAS.

“This study examined the activity of CRMP2, a protein found in the brain (called a ‘cytoskeletal protein’) that regulates how neurons make connections with each other,” said co-senior author of the study Evan Y Snyder, MD, PhD, director of the Center for Stem Cells and Regenerative Medicine at Sanford Burnham Prebys. “CRMP2 also happens to be expressed in lymphocytes in the blood and can therefore be readily sampled in people by doing nothing more than a simple venipuncture.

“There was an abundance of CRMP2 levels in samples from people with schizophrenia compared to people without the disorder. We also saw structural abnormalities in the dendrites of neurons that could potentially be disabling because dendrites play an important role in receiving impulses from other nerve cells in the brain.”

In previous research, most people were found to maintain an even proportion of the two forms of CRMP2: its active, non-phosphorylated form and its inactive, phosphorylated form. Postmortem brain tissue and then blood samples from people with schizophrenia were examined and compared these levels to those in people without the disorder.

The findings indicated that the amount of active CRMP2 was too high in people with schizophrenia and, at least in young people with schizophrenia, was not balanced by an appropriate amount of increased inactive CRMP2. That imbalance between active and inactive CRMP2 could account for some dysfunctions in neural connections.

Testing blood for high levels of active CRMP2, along with low levels of inactive CRMP2, could support schizophrenia diagnosis.

“Schizophrenia can be challenging to diagnose early on or in young patients for a number of reasons,” explained Dr Snyder. “Pairing a blood test with psychiatric and neurobehavioral exams could help doctors distinguish schizophrenia from other conditions that have somewhat similar symptomologies, such as the manic phase of bipolar disorder or other behavioral, personality, or thought disorders.

“Our results were most striking in people under the age of 40, and even more so in people under the age of 30. An early diagnosis could improve the clinical management of affected individuals as well as accelerate the development of new therapeutic options,” Dr Snyder added.

As a next step, the researchers want to delve into the molecular biology of the disease to discover the ‘regulator’  that balances most people’s CRMP2 levels. They also want to conduct a larger, multi-centre clinical study that compares schizophrenia with other psychiatric disorders, which would include participants from more ethnicities and age groups.

Source: Sanford Burnham Prebys Medical Discovery Institute

Journal information: Munetaka Nomoto el al., “Clinical evidence that a dysregulated neural network modulator may aid in diagnosing schizophrenia,” PNAS (2021). www.pnas.org/cgi/doi/10.1073/pnas.2100032118

Categories : Injury & Trauma Mental Health PaediatricsTags :

Self-inflicted Firearm Injuries Among Rural Youth Three Times Urban Rates

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Photo by Annie Spratt on Unsplash
Photo by Annie Spratt on Unsplash

Emergency Department visits by youth for self-inflicted firearm injuries were three times more common in rural areas compared to urban ones, a national study has found.
The study, published in the Journal of Pediatrics found that Emergency Department (ED) visits by youth for self-harm were nearly 40 percent higher in rural areas compared to urban settings. Youth from rural areas presenting to the ED for suicidal ideation or self-harm also were more likely to need to be transferred to another hospital for care, which underscores the insufficient mental health resources in rural hospitals.

“Our study used pre-pandemic data, and we know that increased attention to youth mental health is even more pressing now everywhere, but especially in rural settings to prevent self-harm in youth,” said lead author Jennifer Hoffmann, MD, pediatric emergency medicine physician at Ann & Robert H. Lurie Children’s Hospital of Chicago and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “We need universal screening for suicidal ideation for all children and adolescents age 10 and up who present in the ED to identify youth at risk and intervene before tragedy occurs.”

The study drew on national data on suicidal ideation or self-harm in youth (ages 5-19 years) from a sample of EDs across the country, including those in general hospitals and children’s hospitals. The researchers extrapolated the results to arrive at national estimates.

Dr Hoffmann explained that a number of factors contribute to higher suicide rates and self-harm in rural youth. One of these is access to mental healthcare, which she said is a huge challenge. A lack of paediatric mental health professionals in rural areas is another factor, forcing patients to travel long distances for help. In addition, poor insurance coverage resulting from lower family income and unemployment. Small towns also have anonymity concerns, possibly delaying seeking care until a crisis brings the child to the ED. Firearm ownership is higher in rural firearms, so increased access to firearms may account for the high degree of disparity in self-inflicted firearm injuries.

“We need to improve mental health training for ED providers, allocate more resources and implement policies in rural hospitals on managing young patients who present with suicidal ideation or self-harm,” said Dr Hoffmann. “More widespread use of tele-psychiatry also might help prevent unnecessary transfers to other hospitals. But even more importantly, we need to train primary care providers to help diagnose and treat mental health issues earlier, so we can prevent self-inflicted injuries and death.”

Source: Ann & Robert H. Lurie Children’s Hospital of Chicago

Categories : Mental HealthTags :

Social Media Breaks Don’t Relieve Boredom or Stress

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A team of researchers has found that workers using their smartphone to take short breaks do not find reductions in boredom or fatigue. 

Smartphones have had an inescapable impact on society, and allow users to engage with a variety of apps. Anecdotal evidence also suggests that people use their phones in other ways as well, such as to alleviate boredom or to reduce stress. The researchers noted that many people use their smartphones to take short breaks from their work—and they wondered if doing so actually helped with boredom or reduced stress.

To find out, researchers at Radboud University’s Behavioural Science Institute in The Netherlands recruited 83 PhD candidates, each of whom were asked to report their level of boredom and fatigue every hour while they were working. They also received a smartphone app that logged its usage.

In comparing phone usage with self-reported levels of boredom and fatigue, the researchers were able to track the volunteers’ use of their phones to deal with boredom or fatigue. They found that not only did using their phones in such a manner not alleviate boredom or fatigue, in many cases it in fact made things worse. Volunteers who described themselves as more bored or more fatigued than others in the study did not take longer smartphone breaks than those feeling less bored or fatigued.

The researchers acknowledged that their study was small but their results suggest that workers might consider fatigue or boredom reducing alternatives. They noted also that some prior research has shown that boredom can sometimes be alleviated by engaging in activities that bring some degree of joy. They suggest that rather than mindlessly scrolling, they find ways to use their phones to bring them joy, such as by looking at pictures of loved ones.

Source: Medical Xpress

Journal information: Jonas Dora et al, Fatigue, boredom and objectively measured smartphone use at work, Royal Society Open Science (2021). DOI: 10.1098/rsos.201915

Categories : Mental HealthTags :

Psychedelic Compound Treats Depression by Growing Neural Connections

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In a new study, researchers have shown that a single dose of psilocybin, a psychedelic compound with potential applications for depression, prompted long-lasting increase in connections between neurons in mice. 

For some people, psilocybin, an active compound in ‘magic mushrooms’, can produce a profound mystical experience. The psychedelic was a staple of religious ceremonies among indigenous populations of the Americas and is also a popular recreational drug. It has been the subject of some interest in treating depression. But exactly how it works in the brain and how long beneficial results might last is still unclear.
“We not only saw a 10% increase in the number of neuronal connections, but also they were on average about 10% larger, so the connections were stronger as well,” reported senior author Alex Kwan, associate professor of psychiatry and of neuroscience at Yale.

Earlier work had found promising evidence that psilocybin, as well as the anaesthetic ketamine, could decrease depression. This new study found that these compounds increase the density of dendritic spines, which are small protrusions found on nerve cells which aid in the transmission of information between neurons. The number of these neuronal connections are known to be reduced by chronic stress and depression.


Prof Kwan and first author Ling-Xiao Shao, a postdoctoral associate, imaged dendritic spines in high resolution with a laser-scanning microscope, and tracked them for multiple days in living mice. They found increases in the number of dendritic spines and in their size within 24 hours of administration of psilocybin. These changes were still evident a month later. Also, mice subjected to stress showed behavioural improvements and increased neurotransmitter activity after being given psilocybin.

It may be the novel psychological effects of psilocybin itself that spurs the growth of neuronal connections, Kwan said.

“It was a real surprise to see such enduring changes from just one dose of psilocybin,” he said.  “These new connections may be the structural changes the brain uses to store new experiences.”

Source: Yale University

Categories : Mental Health Substance UseTags :

The Delicate Balance of the Endocannibinoid Pathway

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Scientists have uncovered an unexpected link between a synapse protein that has been implicated in neuropsychiatric disorders and the endocannabinoid pathway.

These findings suggest a role for the endocannabinoid system in conditions including bipolar disorder, according to Peter Penzes, PhD, the Ruth and Evelyn Dunbar Professor of Psychiatry and Behavioral Sciences, professor of Physiology and Pharmacology, and senior author of the study.

“The endocannabinoid system could be disrupted in patients with bipolar disease, or it could be the opposite: medical marijuana could have therapeutic potential for these patients,” said Prof Penzes, who is also director of the Center for Autism and Neurodevelopment. “These are the questions that need to be answered.”

Cannabis mimics naturally occurring endocannabinoids in the brain, which is how it produces its effect in humans. Since the specific function of endocannabinoids is still not fully understood, the legalisation of marijuana in many US states has prompted more investigation into its biological pathways, Prof Penzes said. The endocannabinoid system is a widespread neuromodulatory system that plays important roles in central nervous system (CNS) development, synaptic plasticity, and the response to endogenous and environmental insults.

Endocannabinoids are produced by an enzyme known as diacylglycerol lipase alpha (DAGLA), which is concentrated in synapses. Endocannabinoids dampen synaptic strength, which is why marijuana has calming effects.

Prof Penzes and colleagues have previously studied ankyrin-G, another synapse protein which regulates transmission speed across synapses. Aberrant over- or under-expression of ankyrin-G has been associated with disorders such as bipolar disorder, schizophrenia and autism.

Studying mice with ankyrin-G genetically deleted, they made a surprising discovery: Ankyrin-G seemed to stabilise DAGLA at synapses, increasing the efficiency of DAGLA.

“It’s a delicate mechanism that regulates dendritic spine morphology,” said lead author Sehyoun Yoon, PhD, research assistant professor of Physiology.

These findings comport with another recent study, led by investigators at Icahn School of Medicine at Mount Sinai and published in Nature Genetics. The study showed that both DAGLA and ankyrin-G (ANK3) are risk genes for bipolar disorder in a genome analysis of over 40,000 patients.

“It’s almost like somebody who is leading a double life, Dr. Jekyll and Mr. Hyde,” Prof Penzes said. “Ankyrin-G has this entire separate function.”

The convergence of ankyrin-G with the endocannabinoid pathway opens up an entire new world of possibilities, both for investigating disease risk and possible therapies.

“Cannabis may contribute to increased risk for mental disorders, which has actually been shown in schizophrenia,” Prof Penzes said. “Conversely, cannabis could be beneficial in some brain disorders, which prompted trials of medical marijuana in patients with autism.”

Prof Penzes said in future he plans to examine the downstream effects of this biological pathway, both in normal subjects and in disease.

Source: Northwestern University

Journal information: Sehyoun Yoon et al, cAMP Signaling–Mediated Phosphorylation of Diacylglycerol Lipase α Regulates Interaction With Ankyrin-G and Dendritic Spine Morphology, Biological Psychiatry (2021). DOI: 10.1016/j.biopsych.2021.03.023

Categories : Mental HealthTags :

Half of GP Staff Face Abuse as a Result of Vaccinations

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A survey published in The BMJ has found that in UK practices, over half (52%) of GP staff face abuse while working on the COVID vaccination programme.

The Medical Protection Society (MPS) survey of 222 GP practice staff , which included GPs, nurses, and practice managers, also found that over half (53%) of staff said that their surgery or vaccination centre had been defaced by anti-vaccination material. GP practices in the UK had been offering COVID vaccinations since December 2020.

One respondent said, “Staff of all disciplines are leaving the profession in droves because of the behaviour of the public creating unbearable working situations. Morale is the lowest I have ever known, anyone near retirement is retiring early.” Another said, “Abuse—especially written and posted in the prescription box on the gate—has resulted in staff being very concerned for their safety at the surgery.”

About two-thirds of respondents (60%) said that abuse and complaints relating to the UK’s COVID vaccination programme had affected their own or their team’s mental wellbeing. A further 71% said that the increased workload resulting from the programme has impacted their wellbeing.

Pallavi Bradshaw, medicolegal lead for risk prevention at MPS, said that GP practices were in the firing line over patient frustrations with the vaccination programme. “GPs are mentally and physically exhausted, with the risk of disillusionment and burnout higher than ever,” Bradshaw said. “Wellbeing support must be provided to all GP surgery staff who are feeling overwhelmed and demoralised, and a zero tolerance policy of abuse must be enforced across the NHS so healthcare workers feel their safety is a priority.”

Source: The BMJ

Categories : Mental Health Substance UseTags :

Possible Cannabis Link to Suicidality in Young Adults

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Cannabis use among young adults was associated with increased risks of thoughts of suicide (suicidal ideation), suicide plan, and suicide attempt, according to a population analysis.

These associations remained regardless of whether someone was also experiencing depression, and the risks were greater for women than for men. The study was conducted by researchers at the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.

“While we cannot establish that cannabis use caused the increased suicidality we observed in this study, these associations warrant further research, especially given the great burden of suicide on young adults,” said senior author NIDA Director Nora Volkow, MD. “As we better understand the relationship between cannabis use, depression, and suicidality, clinicians will be able to provide better guidance and care to patients.”

The number of cannabis-using adults in the US more than doubled from 22.6 million in 2008 to 45.0 million in 2019. Over the same period the number of adults with depression also increased, as did those reported suicidal ideation or who committed suicide. However the link between cannabis and suicidality is not well understood. 

Setting out to address, NIDA researchers examined data from the 2008-2019 National Surveys on Drug Use and Health (NSDUH). NSDUH collects nationally representative data among the US civilian population age 12 or older on cannabis use and use disorder, depression, suicidality, and other behavioural health indicators. In addition to determining the associations between these factors, the researchers examined whether the associations varied by gender. They examined data from 281 650 young adults ages 18 to 35 years, the age range where most mood and substance use disorders emerge.

Four levels of past-year cannabis use were compared: no cannabis use; nondaily cannabis use; daily cannabis use (use on at least 300 days per year); and presence of cannabis use disorder, assessed on specific criteria for a pattern of continued cannabis misuse. The prevalence of major depressive episodes based on specific diagnostic criteria measured through the survey was used to measure depression. To identify suicidality trends, the tean separately assessed the trends in the prevalence of past-year suicidal ideation, plan, and attempt as reported in the 2008-2019 NSDUH surveys.

The study found that even nondaily cannabis users were more likely to have suicidal ideation and to plan or attempt suicide than complete non-users. These associations remained regardless of comorbid depression. In people without a major depressive episode, about 3% of those who did not use cannabis had suicidal ideation, compared with about 7% of those with nondaily cannabis use, about 9% of those with daily cannabis use, and 14% of those with a cannabis use disorder. In people with depression, 35% of non-users had suicidal ideation, compared to 44% of nondaily cannabis users, 53% of daily cannabis users, and 50% of those with cannabis use disorder. Similar trends existed for the associations between different levels of cannabis use and suicide plan or attempt.

Additionally, the researchers found that women with any cannabis use were more likely to have suicidal ideation or report a suicide plan or attempt than men with the same levels of cannabis use. For example, among individuals without major depressive episode, the prevalence of suicidal ideation for those with vs without a cannabis use disorder was 13.9% vs. 3.5% among women and 9.9% vs. 3.0% among men. In individuals with both cannabis use disorder and major depressive episode, the prevalence of past-year suicide plan was 52% higher for women (23.7%) than men (15.6%).

“Suicide is a leading cause of death among young adults in the United States, and the findings of this study offer important information that may help us reduce this risk,” explained lead author Beth Han, MD. PhD, MPH, from NIDA. “Depression and cannabis use disorder are treatable conditions, and cannabis use can be modified. Through better understanding the associations of different risk factors for suicidality, we hope to offer new targets for prevention and intervention in individuals that we know may be at high-risk. These findings also underscore the importance of tailoring interventions in a way that take sex and gender into account.”

Source: National Institutes of Health