Tag: mental health

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Ketamine’s Effect on Depression is Essentially Placebo Effect

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Over the years, studies have demonstrated the psychoactive drug ketamine’s effect on depression, providing profound and fast relief to many people. But these studies have a critical flaw: participants usually can tell whether they have been given ketamine or a placebo. Even in blinded trials in which participants are not told which they received, ketamine’s oftentimes trippy effects are a dead giveaway.

In a new study published in Nature Mental Health, Stanford Medicine researchers devised a clever workaround to hide the psychedelic, or dissociative, properties of the anesthetic first developed in 1962. They recruited 40 participants with moderate to severe depression who were also scheduled for routine surgery, then administered a single infusion of ketamine (0.5 mg kg−1) or placebo (saline) during usual anaesthesia.

All researchers and clinicians involved in the trial also were blinded to which treatment patients received. The treatments were revealed two weeks later.

The researchers were amazed to find that both groups experienced the large improvement in depression symptoms usually seen with ketamine.

“I was very surprised to see this result, especially having talked to some of those patients who said ‘My life is changed, I’ve never felt this way before,’ but they were in the placebo group,” said Boris Heifets, MD, PhD, assistant professor of anaesthesiology, perioperative and pain medicine, and senior author.

Just one day after treatment, both the ketamine and placebo groups’ scores on the Montgomery-Åsberg depression rating scale (MADRS) dropped, on average, by half. Their scores stayed roughly the same throughout the two-week follow-up.

“To put that into perspective, that brings them down to a category of mild depression from what had been debilitating levels of depression,” said Theresa Lii, MD, a postdoctoral scholar in the Heifets lab and lead author of the study.

What does it all mean?

The researchers concede that their study, having taken an unexpected turn, raises more questions than it answers.

“Now all the interpretations happen,” said Alan Schatzberg, MD, a co-author of the study. “It’s like looking at a Picasso painting.”

The researchers determined that it was unlikely the surgeries and general anaesthesia account for the improvements because studies have found that depression generally does not change after surgery; sometimes, it worsens.

A more likely interpretation, the researchers said, is that participants’ positive expectations may play a key role in ketamine’s effectiveness.

At their last follow-up visit, participants were asked to guess which intervention they had received. About a quarter said they didn’t know. Of those who ventured a guess, more than 60% guessed ketamine.

Their guesses did not correlate with their treatment – confirmation of effective blinding – but rather with how much better they felt.

Source: Stanford Medicine

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Plasma Protein Biomarkers Could Detect Early Mental Health Problems in Adolescents

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Researchers at the University of Eastern Finland have identified plasma protein-based biomarkers capable of identifying adolescents at risk of developing mental health issues. Such biomarkers could revolutionise early detection and prevention of mental health problems in young people.The results were published in Nature Mental Health.

Some 10–20% of adolescents struggle with mental health conditions, with the majority going undiagnosed and untreated. This points to a need for new, early indicators of mental health problems to catch these cases and intervene with treatment before the conditions progress.

In the study carried out in the research group of Professor Katja Kanninen, the researchers used self-reported Strengths and Difficulties Questionnaire (SDQ) scores to evaluate mental health risk in participants aged between 11 and 16 years. Blood sample analyses showed that 58 proteins were significantly associated with the SDQ score. Bioinformatic analyses were used to identify the biological processes and pathways linked with the identified plasma protein biomarker candidates. Key enriched pathways related to these proteins included immune responses, blood coagulation, neurogenesis, and neuronal degeneration. The study employed a novel symbolic regression algorithm to create predictive models that best separate low and high SDQ score groups.

According to Professor Kanninen, plasma biomarker studies in mental disorders are an emerging field.

“Alterations in plasma proteins have been previously associated with various mental health disorders, such as depression, schizophrenia, psychotic disorders, and bipolar disorders. Our study supports these earlier findings and further revealed that specific plasma protein alterations could indicate a high risk for mental dysfunction in adolescents,” Professor Kanninen notes.

According to the researchers, this pilot study will be followed by more specific investigations of the potential biomarkers for identification of individuals at risk of mental health problems, opening a new avenue for advancements in adolescent mental health care.

Source: University of Eastern Finland

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Obesity Raises Lifetime Risk of Mental Disorders

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Being obese significantly increases the chances of also developing mental disorders. This applies to all age groups, with women at higher risk than men for most diseases, as a recent study of the Complexity Science Hub and the Medical University of Vienna shows. The results were published in the specialist journal Translational Psychiatry.

“We analysed a population-wide national registry of inpatient hospitalisations in Austria from 1997 to 2014 in order to determine the relative risks of comorbidities in obesity and identify statistically significant sex differences,” explains Elma Dervic of the Complexity Science Hub. Consequently, it became evident that an obesity diagnosis significantly enhances the likelihood of a wide range of mental disorders across all age groups – including depression, nicotine addiction, psychosis, anxiety, eating and personality disorders. “From a clinical point of view, these results emphasise the need to raise awareness of psychiatric diagnoses in obese patients and, if necessary, to consult specialists at an early stage of diagnosis,” says Michael Leutner of the Medical University of Vienna.

First diagnosis: obesity

“In order to find out which illness typically appeared prior and subsequently to the obesity diagnosis, we had to develop a new method,” explains Dervic. This allowed the researchers to determine if there were trends and typical patterns in disease occurrence.

In case of all co-diagnoses, with the exception of the psychosis spectrum, obesity was in all likelihood the first diagnosis made prior to the manifestation of a psychiatric diagnosis. “Until now, physicians often considered psychopharmacological medications to cause the association between mental disorders and obesity as well as diabetes. This may be true for schizophrenia, where we see the opposite time order, but our data does not support this for depression or other psychiatric diagnoses,” explains Alexander Kautzky from Department of Psychiatry and Psychotherapy of the Medical University Vienna. However, whether obesity directly affects mental health or whether early stages of psychiatric disorders are inadequately recognised is not yet known.

Women more impacted

Surprisingly, the researchers found significant gender differences for most disorders — with women showing an increased risk for all disorders except schizophrenia and nicotine addiction.

While 16.66% of obese men also suffer from nicotine abuse disorder, this is only the case in up to 8.58% of obese women. The opposite is true for depression. The rate of diagnosed depressive episodes was almost three times higher in obese women (13.3% obese; 4.8% non-obese). Obese men were twice as likely to be affected (6.61% obese; 3.21% non-obese).

Early intervention is key

Since this study now also shows that obesity often precedes severe mental disorders, the findings reinforce its importance as a pleiotropic risk factor for health problems of all kinds. This is especially true for young age groups, where the risk is most pronounced, and for whom the researchers strongly recommend obesity screening.

Source: Complexity Science Hub Vienna

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Regular Physical Activity can Improve Mental Health of Young Adolescents

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Regular physical activity can improve young adolescents’ mental health and help with behavioural difficulties, suggests research published in Mental Health and Physical Activity. Investigators found that engaging in regular moderate to vigorous physical activity at age 11 was associated with better mental health between the ages of 11 and 13.

Physical activity was also associated with reduced hyperactivity and behavioural problems, such as loss of temper, fighting with other children, lying, and stealing, in young people.

Researchers from the Universities of Edinburgh, Strathclyde, Bristol, and Georgia in the United States explored data from the Children of the 90s study (also known as the Avon Longitudinal Study of Parents and Children; ALSPAC). They looked at the levels of physical activity of 4755 11-year-olds which was measured using devices.

The devices recorded levels of moderate physical activity, typically defined as brisk walking or cycling, as well as vigorous activity which boosts heart rate and breathing, such as aerobic dancing, jogging or swimming.

The young people and their parents reported on their levels of depressive symptoms from age 11 and at age 13 years. Participants’ parents and teachers were also quizzed about the young people’s general behaviour and emotional difficulties.

In analysing the impact of moderate to vigorous exercise on the young people’s mental health and behaviour, the team also considered factors such as age, sex and socio-economic status.

They found that higher levels of moderate or intense physical activity had a small but detectable association with decreases in depressive symptoms and emotional difficulties.

Regular exercise had a small but detectable association with reduced behavioural problems, even after controlling for other possible influences, the study found.

The findings suggest regular moderate and intense physical activity may have a small protective influence on mental health in early adolescence, researchers say.

Dr Josie Booth, of the University of Edinburgh’s Moray House School of Education and Sport, said: “This study adds to the increasing evidence base about how important physical activity is for all aspects of young people’s development – it can help them feel better, and do better at school. Supporting young people to lead healthy active lives should be prioritised.”

Researchers say the study is the first to offer such a comprehensive approach to examining mental health and exercise in young people.

Professor John Reilly, at the University of Strathclyde, said: “While it might seem obvious that physical activity improves mental health the evidence for such a benefit in children and young people has been scarce, so the study findings are important. The findings are also important because levels of moderate-to-vigorous intensity activity globally are so low in pre-teens globally – less than a third achieve the 60 minutes per day recommended by the WHO and UK Health Departments.”

The study is a long-term health-research project that enrolled more than 14 000 pregnant women in 1991 and 1992.

Children of the 90s has been following the health and development of the parents and their children in detail and is currently recruiting the children and the siblings of the original children into the study. It receives core funding from the Medical Research Council, the Wellcome Trust and the University of Bristol.

Source: University of Edinburgh

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Health MEC Liable for Patient Who Fell to His Death, Court Rules

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By Tania Broughton for GroundUp

The High Court in Gqeberha has found that the Eastern Cape MEC for Health and Livingstone Hospital are liable to pay damages to the widow of a man who died after falling from the fifth floor of the hospital.

In the ruling last week, Acting Judge Ivana Bands found that the patient, George Williams, had not been properly medicated or monitored. She said that had this been done, Williams would not have been “pacing up and down the ward, in confused, restless and disoriented state”, and would not have fallen to his death from the window.

Judge Bands said the conduct of the medical and nursing personnel who treated Williams after he was admitted to the hospital on 3 October 2013, “fell far short of what is regarded as sound practice” in dealing with patients suffering from alcohol withdrawal – delirium tremens which involves sudden and severe mental or nervous system changes – and secondary schizophrenia.

“Had he been properly medicated, it cannot be gainsaid [denied] that he would have been reduced to a calm and lightly dozing state. This would have enabled the medical and nursing staff to monitor his vital signs and his condition appropriately until such time that delirium tremens had abated,” Judge Bands said.

Read the judgment

Judge Bands’s finding of negligence means that Williams’s widow Jeanine can now pursue a monetary damages claim against the MEC and hospital. This could be determined at another trial or through negotiation.

Jeanine Williams, in her papers, contended that the hospital staff were under a legal duty to provide her husband with adequate and timeous medical treatment; that they had not properly sedated him, restricted his movements and monitored his condition.

The defendants, however, argued that Williams had been treated with sedatives, including diazepam (Valium) and that he had been put in an “enclosed locked ward” close to the nurses’ station.

Bands said Wiliams was a known alcoholic who was admitted to the hospital late on 3 October 2013. In the early hours of the morning, he had been given diazepam, with little effect. During the evening of 4 October, he was given more sedatives and an antipsychotic agent, also with no effect.

Soon after, at about 10:30pm, Williams broke the outside entrance glass door of the nurses’ tearoom and fell from the fifth floor. He died about an hour later.

Two key witnesses during the trial were Dr Candice Harris, a professional nurse and general practitioner, who testified for Williams, and Dr Michelle Walsh, a general surgeon, who testified for the MEC and the hospital.

In her evidence, Harris had said delirium tremens was a “medical emergency” and, according to guidelines, immediate management of the condition was necessary. She had stressed the importance of re-orientating the patient and said it was the nurse’s duty to inform the doctor if the patient was not responding to medication.

The judge said Walsh’s evidence was that it was not that the hospital was doing nothing – “they were doing something”.

“She said the sedation prescribed is usually based on what the assessing doctor thinks will have the desired effect to calm the patient to the extent that they would sit calmly in a chair. It is common cause that this desired state was never reached,” the judge said.

“Not only was he under-sedated, there is no evidence that the initial dose, which had no effect, was ever increased as per the published guidelines, in spite of multiple entries in the hospital records that he remained confused, disorientated, restless and walking up and down – and that he had become so agitated that the nursing staff feared he would assault them,” the judge said.

Bands said Williams had not been treated according to the guidelines, thus the MEC and the hospital are liable for any proven damages.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

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Forced Retirement a Major Factor in Physician Suicides

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Forced retirement is a major factor when it comes to physician suicides, according to a study by Dr Kristin Kim and colleagues. Physicians also neglect to discuss physical health concerns as work stressors, the authors noted, but these are still detrimental to wellbeing – especially when it renders physicians unable to work.

The study was published in the journal Suicide and Life-Threatening Behavior.

“Medicine must dispel the myth of never-ill physicians who place the needs of their patients before their own to the detriment of their own health.”

Kim et al., 2022

While physicians are known to be more likely than non-physicians to experience work-related stressors prior to suicide, the specific nature of these stressors was not known. The present study therefore aimed to better characterise job-related problems prior to physician suicide.

Using a mixed methods approach, researchers combined thematic analysis and natural language processing to develop themes representing death investigation narratives of 200 physician suicides with implicated job problems in the National Violent Death Reporting System database between 2003 and 2018.

The thematic analysis identified six overarching themes: incapacity to work due to deterioration of physical health, substance use jeopardising employment, interaction between mental health and work-related issues, relationship conflict affecting work, legal problems leading to work-related stress, and increased financial stress. Natural language processing analysis confirmed five of these themes and elucidated important subthemes.

Clinicians often neglect physical health when identifying work stressors, but poor physical health affects work performance and increases work stress, the authors said, noting that legal and psychological supports, particularly during malpractice investigations and “fit for duty” evaluations, are sorely needed.

“Medicine must dispel the myth of never-ill physicians who place the needs of their patients before their own to the detriment of their own health,” the researchers wrote.

First author Kristen Kim, MD, told Medpage Today that she hopes that this research will help physicians “give ourselves permission to attend to those needs … to prevent the dire consequences that we may see.”

The findings highlight the importance of bolstering systemic support for physicians experiencing job problems associated with their physical and mental health, substance use, relationships, legal matters, and finances in suicide prevention efforts.

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The Mental Health Benefits of Going on Holiday

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For better mental health, music and other forms of relaxation have been shown to have positive benefits. Now, researchers have identified a previously overlooked way to improve mental health – going on holiday, a luxury many have abandoned since COVID.

In a new cross-disciplinary paper, researchers from Edith Cowan University (ECU) propose that we view tourism, as not just as a recreational experience but as an industry that can provide real health benefits.

The interdisciplinary collaboration found that many aspects of going on holiday could have a positive impact on those with mental health issues or conditions.

Led by researcher Dr Jun Wen, a diverse team of tourism, public health and marketing experts investigated how tourism could benefit those living with dementia.

“Medical experts can recommend dementia treatments such as music therapy, exercise, cognitive stimulation, reminiscence therapy, sensory stimulation and adaptations to a patient’s mealtimes and environment,” Dr Wen said.

“These are all also often found when on holidays. This research is among the first to conceptually discuss how these tourism experiences could potentially work as dementia interventions.”

According to Dr Wen, the varied nature of tourism meant there were many opportunities to incorporate treatments for conditions such as dementia. Being in new environments and having new experiences could provide cognitive and sensory stimulation, for example.

“Exercise has been linked to mental wellbeing and travelling often involves enhanced physical activity, such as more walking,” Dr Wen said.

“Mealtimes are often different on holiday: they’re usually more social affairs with multiple people and family-style meals have been found to positively influence dementia patients’ eating behaviour.

“And then there’s the basics like fresh air and sunshine increasing vitamin D and serotonin levels. Everything that comes together to represent a holistic tourism experience, makes it easy to see how patients with dementia may benefit from tourism as an intervention.”

Dr Wen said COVID’s impact on travel in recent years had raised questions about tourism’s value beyond lifestyle and economic factors.

“Tourism has been found to boost physical and psychological wellbeing,” he said. So, after COVID, it’s a good time to identify tourism’s place in public health — and not just for healthy tourists, but vulnerable groups.”

Dr Wen said he hoped that new research could begin to examine how tourism can enhance the lives of people with various conditions.

“We’re trying to do something new in bridging tourism and health science,” he said. “There will have to be more empirical research and evidence to see if tourism can become one of the medical interventions for different diseases like dementia or depression.

“So, tourism is not just about travelling and having fun; we need to rethink the role tourism plays in modern society.”

The article ‘Tourism as a dementia treatment based on positive psychology’ was published in Tourism Management.

Source: Edith Cowan University

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Changes in Brain Structures Found in Patients with Anorexia Nervosa

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A major study published in the journal Biological Psychiatry has revealed key differences in brain structure between people with and without anorexia nervosa.

Anorexia nervosa is an eating disorder defined by restriction of energy intake relative to requirements, leading to a significantly low body weight. Patients will have an intense fear of gaining weight and distorted body image and are unable to recognise the seriousness of their significantly low body weight.

Little is known about why some people develop anorexia whilst others do not, although biological factors are widely recognised. The findings from the study, which was coordinated by neuroscientists at the University of Bath with international partners, draws on extensive analyses of brain scans taken from patients around the world and goes some way to answering the question.

They reveal that people with anorexia demonstrate ‘sizeable reductions’ in three critical measures of the brain: cortical thickness, subcortical volumes and cortical surface area. Brain size reductions are significant due the implied loss of brain cells or the connections between them.

The results are some of the clearest yet to show links between structural changes in the brain and eating disorders. The team says that the effect sizes in their study for anorexia are in fact the largest of any psychiatric disorder investigated to date.

This means that people with anorexia showed reductions in brain size and shape two to four times greater than people with conditions such as depression, ADHD, or OCD. The changes observed in brain size for anorexia may be attributable to reductions in body mass index (BMI).

The team emphasised the importance of early treatment to help people with anorexia avoid long-term, structural brain changes. Existing treatment typically involves forms of cognitive behavioural therapy and, critically, weight gain. Many people with anorexia are successfully treated and these results show the positive impact such treatment has on brain structure.

Their study pooled nearly 2000 pre-existing brain scans for people with anorexia, including people in recovery and ‘healthy controls’ (people neither with anorexia nor in recovery). For people in recovery from anorexia, the study found that reductions in brain structure were less severe, suggesting that, with appropriate early treatment and support, brain self-repair is possible.

Lead researcher, Dr Esther Walton of the Department of Psychology at the University of Bath explained: “For this study, we worked intensively over several years with research teams across the world. Being able to combine thousands of brain scans from people with anorexia allowed us to study the brain changes that might characterise this disorder in much greater detail.

“We found that the large reductions in brain structure, which we observed in patients, were less noticeable in patients already on the path to recovery. This is a good sign, because it indicates that these changes might not be permanent. With the right treatment, the brain might be able to bounce back.”

“The international scale of this work is extraordinary,” said Paul Thompson, a professor of neurology and lead scientist for the ENIGMA Consortium, an international effort to understand the link between brain structure, function and mental health. “Scientists from 22 centres worldwide pooled their brain scans to create the most detailed picture to date of how anorexia affects the brain. The brain changes in anorexia were more severe than in other any psychiatric condition we have studied. Effects of treatments and interventions can now be evaluated, using these new brain maps as a reference.”

He added: “This study is novel in term of the thousands of brain scans analysed, revealing that anorexia affects the brain more profoundly than any other psychiatric condition. This really is a wake-up call, showing the need for early interventions for people with eating disorders.”

Source: University of Bath

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Older Siblings Confer Healthy Development

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Children
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Being a younger sibling in a family can have more benefits than simply being spoiled by the parents. A new study, published in BMC Public Health, reveals that older siblings confer a protective effect on the behaviours of their younger brothers and sisters.

Exposure environmental stressors during critical periods of life, especially to maternal stress while in the womb, can have negative long-term consequences for children’s development.

In a new study, researchers used longitudinal data from the LINA cohort (Lifestyle and environmental factors and their Influence on the Newborn Allergy risk) to test 373 German mother-child pairs, from pregnancy until 10 years of age. 

Mothers were asked to fill in three validated questionnaires, to assess their stress levels and their child’s behavioural problems. First, the researchers assessed which social and environmental factors were linked to an increase in maternal stress levels during pregnancy, and the long-term consequences of maternal stress on the occurrence of child behavioural problems. Second, the researchers assessed whether the presence of siblings had a positive effect on the occurrence of child behavioural problems, by directly reducing stress levels and increasing children’s psychological well-being, or by indirectly buffering the negative consequences of maternal stress. 

Prenatal stress can cause behavioural problems in the child

The results of the study showed that socio-environmental stressors, like the lack of sufficient social areas in the neighbourhood, were clearly linked to an increase in maternal stress levels during pregnancy. Moreover, mothers who had experienced high stress levels, like worries, loss of joy or tension, during pregnancy were also more likely to report the occurrence of behavioural problems when their children were 7, 8 or 10 years old. “These results confirm previous findings about the negative impact that even mild forms of prenatal stress might have on child behaviour, even after several years, and highlight the importance of early intervention policies that increase maternal wellbeing and reduce the risks of maternal stress already during pregnancy,” explained Federica Amici, one of the researchers involved in the project.

On a more positive note, the study also found a lower occurrence of behavioural problems in children with older siblings. “Children who have older brothers or sisters in their households are less likely to develop problems, which suggests that siblings are crucial to promote a healthy child development,” explained Gunda Herberth, coordinator of the LINA study. 

Higher social competence thanks to older siblings?

This study further suggests that the presence of older siblings directly reduced the risk of developing behavioural problems, but did not affect negative effects of maternal stress on child behaviour. How could older siblings reduce the occurrence of behavioural problems in children? By interacting with their older siblings, children may develop better emotional, perspective taking and problem solving skills, which are linked to higher social competence and emotion understanding. Moreover, the presence of older siblings may provide learning opportunities for parents, who might thus develop different expectations and better parental skills. 

“We were especially impressed by the important role that siblings appear to play for a healthy child development,” concluded researcher Anja Widdig. “We hope that our findings will draw attention to the importance of public health policies that directly target children and their siblings, and promote a healthy environment for their well-being and the development of high-quality sibling relationships”.

Source: Helmholtz Centre for Environmental Research

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Mental Health Conditions Disrupt Blood Pressure and Heart Rate

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A new study published in BioMedical Engineering has revealed that mental health is closely aligned to blood pressure and heart rate variations. The researchers found that mental illness could cause widely fluctuating blood pressure, which can lead to cardiovascular disease and organ damage.

University of South Australia researcher Dr Renly Lim and colleagues said there is clear evidence that mental illness interferes with the body’s autonomic functions, including blood pressure, heart rate, temperature and breathing.

“We reviewed 12 studies on people with anxiety, depression and panic disorders and found that, regardless of age, mental said is significantly associated with greater blood pressure variations during the day,” Dr Lim says.

“We also found that for people who are mentally ill, their heart rate does not adapt to external stressors as it should.

“Contrary to what many people think, a healthy heart is not one that beats like a metronome. Instead, it should adjust to withstand environmental and psychological challenges. A constantly changing heart rate is actually a sign of good health.”

Reduced heart rate variation (HRV) is common in people with mental illness and indicates that the body’s stress response is poor, exacerbating the negative effects of chronic stress.

Unlike normally consistent heart rates, HRV is more complex and is the time between two heartbeats, which should change according to external stressors.

“What we aim for is not a constantly changing heart rate but a high heart rate variation. This is achieved through a healthy diet, exercise, low stress and good mental health.”

Low HRV occurs during ‘fight-or-flight’ mode, or in those who are easily stressed and is common in people with chronic diseases, including cardiovascular and mental health problems.

While large blood pressure variations (BPV) during the day are not ideal, at night the systolic pressure should dip by between 10–20% to allow the heart to rest. People with mental health issues were found to have an insufficient BP drop at night, dropping less than 10%.

The reduced dipping can be caused by many factors, including autonomic dysfunction, poor quality of sleep and disrupted circadian rhythms that regulate the sleep-wake cycle.

“The takeout from this study is that we need to pay more attention to the physical impacts of mental illness,” Dr Lim said.

“It is a major global burden, affecting between 11–18 per cent (one billion) of people worldwide. Since mental illness can contribute to the deterioration of heart and blood pressure regulation, early therapeutic intervention is essential.”

Source: University of South Australia