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The Serotonin Hypothesis, Informed Consent and SSRI Antidepressants

In Medication, Mood Disorders, Neuropsychology, Neuroscience, Psychiatry on Wednesday, 31 October 2012 at 15:36

The Serotonin Hypothesis, Informed Consent and SSRI Antidepressants.

happy birthday, glutamate.

In Medication, Neuropsychology, Neuroscience, Psychiatry, Psychopharmacology, Uncategorized on Wednesday, 31 October 2012 at 15:20

Twenty Five Years of Glutamate in Schizophrenia

Daniel C. Javitt

Schizophr Bull. 2012;38(5):911-913. © 2012 Oxford University Press

Abstract and Introduction

Abstract

At present, all medications for schizophrenia function primarily by blocking dopamine D2 receptors. Over 50 years ago, the first observations were made that subsequently led to development of alternative, glutamatergic conceptualizations. This special issue traces the historic development of the phencyclidine (PCP) model of schizophrenia from the initial description of the psychotomimetic effects of PCP in the early 1960s, through discovery of the link to N-methyl-D-aspartate-type glutamate receptors (NMDAR) in the 1980s, and finally to the development of NMDA-based treatment strategies starting in the 1990s. NMDAR antagonists uniquely reproduce both positive and negative symptoms of schizophrenia, and induce schizophrenia-like cognitive deficits and neurophysiological dysfunction. At present, there remain several hypotheses concerning mechanisms by which NMDAR dysfunction leads to symptoms/deficits, and several theories regarding ideal NMDAR-based treatment approaches as outlined in the issue. Several classes of agent, including metabotropic glutamate agonists, glycine transport inhibitors, and D-serine-based compounds are currently in late-stage clinical development and may provide long-sought treatments for persistent positive and negative symptoms and cognitive dysfunction in schizophrenia.

Introduction

The mid-20th century was an exciting period for drug development in psychiatry. Antipsychotics were developed based on the seminal observations of Delay and Deniker and linked to D2 blockade shortly thereafter. By 1971, clozapine, the current “gold standard” treatment for schizophrenia, had already been marketed. Antidepressants were developed based on clinical observations with isoniazid (INH) in the 1950s; benzodiazepines were developed based upon GABA receptor-binding assays in the 1960s; and definitive studies demonstrating efficacy of lithium were performed by the early 1970s. Decades later, these classes of compounds continue to form the core of today’s psychopharmacological armamentarium.

In the midst of this transformational period, initial reports appeared as well for a class of novel sedative agent termed “dissociative anesthetics” exemplified by the molecules phencyclidine (PCP, “angel dust”) and ketamine. In monkeys, these compounds produced behavioral symptoms closely resembling those of schizophrenia, including behavioral withdrawal at low dose and catalepsy at high dose (figure 1). Domino and Luby[1] describe the critical steps by which he and his contemporaries verified the unique clinical effects of these compounds in man. The initial characterizations of PCP as causing a centrally mediated sensory deprivation syndrome and producing electroencephalography changes similar to those in schizophrenia were, in retrospect, particularly critical.

Figure 1.

Effect of phencyclidine (PCP) on behavior in monkey, showing dissociation at low dose (A) and catatonia at high dose (B). From Chen and Weston.12

Although the clinical effects of PCP were well documented by the early 1960s, it took another 20 years to characterize these effects at the molecular level. As described by Coyle,[2] key milestones along the way included the pharmacological identification of the PCP receptor in 1979; demonstration of electrophysiological interactions between PCP and N-methyl-D-aspartate-type glutamate receptors (NMDAR) in the early 1980s followed shortly thereafter by pharmacological confirmation; identification of the glycine modulatory site of the NMDAR in 1987; and confirmation of the psychotomimetic effects of ketamine in the mid-1990s. Although researchers still disagree to the paths leading from NMDAR blockade to psychosis, few currently dispute the concept that NMDAR serve as the molecular target of PCP, ketamine, dizocilpine (MK-801), and a host of other clinical psychotomimetic agents.[2–4]

At their simplest, glutamatergic models predict that compounds stimulating NMDAR function should be therapeutically beneficial in schizophrenia.[2,4] Potential sites for intervention include the glycine/D-serine and redox sites of the NMDAR, as well as pathways regulating glutamate, glycine/D-serine, and glutathione synthesis/release.[4] D-Cycloserine, a partial NMDAR glycine-site agonist, may enhance learning and neural plasticity across a range of disorders, including schizophrenia.[5] In addition to providing new drug targets, glutamatergic models provide effective explanation for the hippocampal activation deficits,[6] positive and negative symptoms, distributed neurocognitive deficits, and sensory processing abnormalities[4] that are critical components of the pathophysiology of schizophrenia.

Since the original description, several variations have been developed with somewhat different treatment predictions. The term “NMDA receptor hypofunction” was originally developed to describe the vacuolization and neurodegeneration seen within specific brain regions following high-dose NMDAR antagonist administration.[7] In animal models, neurotoxic effects of PCP were reversed by numerous compounds, including benzodiazepines and α2 adrenergic agonists that ultimately proved ineffective in clinical studies. Nevertheless, this model may explain the pattern of persistent frontotemporal neurocognitive deficits observed in some ketamine abusers.[8] Subsequent hyperglutamatergic models focused on the excess glutamate release induced by NMDAR antagonists, particularly in prefrontal cortex, and prompted studies with compounds, such as lamotrigine or metabotropic glutamate receptor (mGluR) 2/3 agonists, that inhibit presynaptic glutamate release.[9] GABAergic models focus on NMDAR antagonist-induced downregulation of parvalbumin (PV) expression in interneurons and resultant local circuit level (gamma) dysfunction, and suggest use of subunit selective GABAA receptor modulators.[10]

More than 50 years after the initial characterization of PCP, and 25 years after the identification of NMDARs as the molecular target of PCP, we still do not know whether the novel pharmacology of dissociative anesthetics can be translated into effective clinical treatments. Encouraging small-scale single site studies have been published with NMDAR agonists, but have not yet been replicated in academic multicenter trials. Encouraging phase 2 results have also recently been reported by Roche with glycine transport inhibitors.[4] Nevertheless, phase 3 studies remain ongoing and results cannot be predicted. Additional beneficial effects may be observed in obsessive-compulsive disorder, substance abuse and Parkinsons disease.[4] Conversely, NMDAR antagonists, such as ketamine, may be therapeutically beneficial in treatment-resistant depression or autism, suggesting complementary pathology across a range of disorders.[11] More than anything else, 50 years of research shows that treatment development in neuropsychiatric disorders is a journey and not a destination, although fortunately one where the end now finally seems in sight.

Retrieved from: http://www.medscape.com/viewarticle/771599?src=nl_topic

References

  1. Domino EF, Luby ED. Phencyclidine/schizophrenia: one view toward the past, the other to the future Schizophr Bull. 2012.In press.
  2. Coyle JT. The NMDA receptor and schizophrenia: a brief history Schizophr Bull. 2012.In press
  3. Javitt DC, Zukin SR. Recent advances in the phencyclidine model of schizophrenia Am J Psychiatry 1991 148 1301–1308
  4. Javitt DC. Has an angel shown the way? Etiological and therapeutic implications of the PCP/NMDA model of schizophrenia. Schizophr Bull In press.
  5. Goff D. D-cycloserine: an evolving role in learning and neuroplasticity in schizophrenia.Schizophr Bull In press.
  6. Tamminga CA, Southcott S, Sacco C, Gao XM, Ghose S. Glutamate dysfunction in hippocampus: relevance of dentate gyrus and ca3 signaling.Schizophr Bull. 2012. In press
  7. Olney JW, Newcomer JW, Farber NB. NMDA receptor hypofunction model of schizophrenia J Psychiatr Res.1999 33 523–533
  8. Morgan CJ, Muetzelfeldt L, Curran HV. Consequences of chronic ketamine self-administration upon neurocognitive function and psychological wellbeing: a 1-year longitudinal study Addiction 2010 105 121–133
  9. Moghaddam B, Krystal JH. Capturing the angel in angel dust: twenty years of translational neuroscience studies of NMDA receptor antagonists in animals and humans Schizophr Bull. In press.
  10. Lewis DA, Gonzalez-Burgos G. NMDA receptor hypofunction, parvalbumin-positive neurons and cortical gamma oscillations in schizophrenia. Schizophr Bull In press.
  11. Javitt DC, Schoepp D, Kalivas PW, et al. Translating glutamate: from pathophysiology to treatment. Sci Transl Med. 2011;3:102mr102.
  12. Chen GM, Weston JK. The analgesic and anesthetic effects of 1-(1-phenylcyclohexyl)-piperidine HCl in the monkey Anesth Analg. 1960 39 132–137

questions in genomic medicine…

In Genes, Genomic Medicine on Wednesday, 31 October 2012 at 15:12

Whole Genomes, Small Children, Big Questions

Jeantine E Lunshof

Personalized Medicine. 2012;9(7):667-669. © 2012  Future Medicine Ltd.

Introduction

Whole-genome sequencing (WGS) is entering clinical practice. Expectations are high: a better understanding of disease, more accurate diagnosis and targeted therapies are hoped for; however, while some answers are being found, many new questions are arising. At the current stage, the dimensions of the -omics data sets in particular are overwhelming and physician–researchers are just starting to explore the ways in which they can be used. Apart from the bioinformatics challenges of genome data management there are the questions of meaningful interpretation of the emerging knowledge for health information users, both patients and professionals. At the individual and the societal level, questions are being asked about the extent and the usefulness of the newly available knowledge, for example: do whole-genome or -exome sequences tell us more than we want to know about ourselves, and doctors more than they need to know to treat their patients? In addition, do whole genomes tell parents more than they should know about their children? Since the early days of cytogenetic diagnosis, similar questions have been raised about the extent of the information yielded by testing, the communication of findings, and the ethical implications of testing.[1] Today, the availability of WGS and whole-exome sequencing (WES) for clinical diagnostics puts these old questions in a new context. Most recently, the feasibility of WGS was described for the application of noninvasive prenatal diagnosis.[2]

Diagnostics of Last Resort

WES and WGS are not routine diagnostic tools yet. However, while the introduction into the clinic of methods that are promising in the research setting is notoriously slow and usually accompanied by lengthy deliberations, medical emergencies can sometimes accelerate the process: a therapy of last resort that saves the life of an individual patient, may lead to a breakthrough in general clinical application. One striking example is the application of WES, coupled with meticulous bioinformatics analysis, that in a grand multidisciplinary effort saved the life of a little boy.[3]

The child was first seen at the age of 15 months presenting with an unusual, severe and progressive Crohn’s disease-like illness. A definitive diagnosis could not be made, restricting effective clinical management. The boy underwent more than 100 surgical procedures over 3 years. A hematopoietic progenitor cell transplant, that might be a therapy of last resort, was considered too risky without a clear diagnosis of the underlying disorder. Established genetic tests for known congenital immune disorders presenting with inflammatory bowel disease-like illness were not informative. Ultimately, with institutional review board approval, research-stage, nonvalidated, WES was performed to make a clinical diagnosis and guide the treatment decision. The identification of the causative mutation enabled treatment of the underlying immune disorder and of the child’s bowel disease as well.[3]

In a commentary article, alongside with the report describing the clinical and methodological details of the case, the Wisconsin group presents their ethical deliberations.[4] The authors raise some crucial questions – notwithstanding the impressive outcome and the indisputable huge benefit to the young patient – and suggest further discussion. This editorial aims to follow up on their suggestions.

The first issue raised is about the elusive boundary between research and clinical care. As this case shows, therapies of last resort can be considered a type of n = 1 studies and this is relevant from a regulatory point of view. n = 1 studies connect the bedside and the bench in a very specific and direct way.[5,6]

The other major issue, identified as an intrinsic concern by the Wisconsin group, is concerned with the data flood that results from WGS and WES and that greatly exceeds actual clinical needs. Inevitably, much of this information is ‘off target’ and may predict risks for late-onset disorders, which is considered particularly problematic when the genome analysis is performed in children.

Research & Clinical Care

Clinical application of research-stage procedures can save lives, as the exemplary case of the 15-month-old boy shows. In this case, the institutional review board-approved the use of nonvalidated experimental methods precisely because the primary purpose was to obtain a diagnosis for a patient; had the aim been gaining generalizable knowledge this would have turned it formally into research.[4] This reasoning, however, is based on a questionable and probably outdated distinction between research and clinical care that takes systematic recording of outcomes as the decisive criterion for research.[5,6] Moreover, can there be any instance of a diagnostic or therapeutic procedure – experimental or routine – that does not record results or yield generalizable knowledge? Also, clinical care and n = 1 studies are essentially connected. One could say that in ‘personalized’ medicine – and good medicine is always personalized – every medical intervention in an individual is a type of n = 1 study. The results from regular clinical care, however, will often hide in the patient’s medical record and potential new knowledge of general interest will remain with the attending physician unless so striking that it is shared through publication.

Revising the distinction between research and clinical care is urgent, now that WGS begins to enter the clinic.[7–9] For the development of personalized genomic medicine, a modified n = 1 study design is needed that enables resolving the old dichotomy and that also takes the normative (i.e., ethical and legal) aspects into account, as well as the translation in terms of health technology assessment.[5,6,10]

Small Children, Whole Genomes: Too Much Information?

The other key issue concerns the amount and extent of the data generated through WGS or WES: do we get too much information? And, what makes information too much?

One very simple answer to the latter question is that how much we need to know is determined by the problem that the sequencing was intended to solve. That problem seems to be clear at least in a clinical context, as the question there is: what is causing this disease in this patient, what is the actual diagnosis? This was actually the question the medical team in Wisconsin asked, desperate to know the cause of ther patient’s symptoms and to be able to make a diagnosis. Indeed, for their acute clinical purpose, the information about the XIAP deficiency was sufficient to balance potential harms and benefits of a risky intervention and to make a rational treatment decision. At this point, any further information from the patient’s exome could be regarded as redundant – ‘off target’ in the traditional clinical context.

In the context of systems biology-based medicine it is much harder to declare data as redundant or ‘off target’: the disease state of an individual results from particular network perturbations, and many known and unknown interactions between network components can play a role.[11] The interpretation is the problem, rather than the amount of data. Thus, information that may seem redundant today may later be found to be essential for a correct understanding of a disorder. For example, WGS data may contain clues about modifier genes (or non-coding RNAs)that seem of minor importance, but whose products do affect the disease phenotype.

Yet, the big question of how to handle the comprehensive genome information is still in the room, in the clinical context as well as in the research setting: what to communicate to patients, or to research participants? When children are concerned, the communication includes the parents and, depending on their age, the children themselves. From the ethical, legal and psychological point of view, WGS/WES in children is particularly interesting because areas of long-standing hot debate converge: children as research participants, genetic testing in children for clinical purposes, returning results to patients/study participants, and the major issue of generating predictive information.[12] The common denominator in these debates is the issue of data access and sharing information – in particular the sharing with the true data owners, namely, the participants, patients and with parents as caretakers. However, parents’ entitlement to access all of their child’s data is not undisputed, as it could be seen as a breach of the child’s privacy.[12] The inherent lack of informed consent – depending on age and maturity – for clinical interventions and research participation presents a major and unavoidable dilemma for which no generally valid solution exists.

On the Horizon: New Methods, Old Questions

In their commentary, the group from Wisconsin present the outline of a plan for returning results to parents that shall allow the parents to decide what type of ‘off-target’ information they want to receive.[4] Other researchers recently found in a focus group study among parents of children with serious conditions that these parents wished to receive all types of research results, not only those that would be actionable.[13] The early application of WGS/WES for solving clinical puzzles has shown great therapeutic benefit for a number of children with serious conditions.[7] Similar to the case of the young child described above, the stories about these children were not only published in scholarly journals but also fully disclosed in the general media.[101,102]

Beyond the clinical applications, WGS greatly advances more fundamental research, as demonstrated by the Pediatric Cancer Genome Project.[14]

New applications of WGS are on the horizon, even if they are not around the just corner yet. Noninvasive prenatal diagnosis through WGS is technically feasible.[2] The genome of a fetus was successfully predicted, based on inferences made from the genome of the mother, the father and the estimated fetal proportion of the cell-free DNA in the mother’s circulation. However, this was no more than a proof-of-principle at the moment, and the major technical difficulty in the future will be the data interpretation, as the authors conclude.

On the nontechnical side, however, the difficulties could be even bigger, as a decades-old debate on some deep and unsolvable moral issues in prenatal diagnosis will be rejuvenated.

Retrieved from: http://www.medscape.com/viewarticle/771374?src=nl_topic

References

  1. Hsu LY, Durbin EC, Kerenyi T, Hirschhorn K. Results and pitfalls in prenatal genetic diagnosis. J. Med. Genet.10,112–119 (1973).
  2. Kitzman JO, Snyder MW, Ventura M et al. Noninvasive whole-genome sequencing of a human fetus. Sci. Transl Med.4(137),137ra76 (2012).
  3. Worthey EA, Mayer AN, Syverson GD et al. Making a definitive diagnosis: successful clinical application of whole exome sequencing in a child with intractable inflammatory bowel disease. Genet. Med.13(3),255–262 (2011).
  4. Mayer AN, Dimmock DP, Arca MJ et al. A timely arrival for genomic medicine. Genet. Med.13(3),195–196 (2011).
  5. Tsapas A, Matthews DR. Using n-of-1 trials in evidence-based clinical practice. JAMA301(10),1022–1023 (2009).
  6. Chalmers I. Regulation of therapeutic research is compromising the interests of patients. Int. J. Pharm. Med.21(6),395–404 (2007).
  7. Bainbridge MN, Wiszniewski W, Murdock DR et al. Whole-genome sequencing for optimized patient management. Sci. Transl Med.3(87),87re3 (2011).
  8. Dixon-Salazar TJ, Silhavy JL, Udpa N et al. Exome sequencing can improve diagnosis and alter patient management. Sci. Transl Med.4(138),138ra78 (2012).
  9. Check Hayden E. Sequencing set to alter clinical landscape. Nature482,288 (2012).
  10. Becla L, Lunshof JE, Gurwitz D et al. Health technology assessment in the era of personalized health care. Int. J. Technol. Assess. Health Care27(2),118–126 (2011).
  11. Vidal M, Cusick ME, Barabási AL. Interactome networks and human disease. Cell144,986–998 (2011).
  12. Mand C, Gillam L, Delatycki MB, Duncan RE. Predictive genetic testing in monors for late onset conditions: a chronological and analytical review of the ethical arguments. J. Med. Ethics doi:10.1136/medethics-2011-100055 (2012) (Epub ahead of print).
  13. Harris ED, Ziniel SI, Amatruda JG et al. The beliefs, motivations, and expectations of parents who have enrolled their children in a genetic biorepository. Genet. Med.14(3),330–337 (2012).
  14. Downing JR, Wilson RK, Zhang J et al. The pediatric cancer genome project. Nat. Genet.44(6),619–622 (2012).

    Websites 
    101. One In A Billion: A boy’s life, a medical mystery. http://www.jsonline.com/features/health/111224104.html
    102. Genome Maps Solve Medical Mystery For Calif. Twins. http://www.npr.org/blogs/health/2011/06/18/137204964/genome-maps-solve-medical-mystery-for-calif-twins

obesity statistics for students in a philadelphia school…

In Education, Fitness/Health on Wednesday, 31 October 2012 at 15:06

Prevalence, Disparities, and Trends in Obesity and Severe Obesity Among Students in the Philadelphia, Pennsylvania, School District

Jessica M. Robbins, PhD, Giridhar Mallya, MD, MSHP, Marcia Polansky, ScD, MS, MSW, Donald F. Schwarz, MD, MPH

Prev Chronic Dis. 2012;9 © 2012 Centers for Disease Control and Prevention (CDC)

Abstract

Introduction Epidemic increases in obesity negatively affect the health of US children, individually and at the population level. Although surveillance of childhood obesity at the local level is challenging, height and weight data routinely collected by school districts are valuable and often underused public health resources.
Methods We analyzed data from the School District of Philadelphia for 4 school years (2006–2007 through 2009–2010) to assess the prevalence of and trends in obesity and severe obesity among public school children.
Results The prevalence of obesity decreased from 21.5% in 2006–2007 to 20.5% in 2009–2010, and the prevalence of severe obesity decreased from 8.5% to 7.9%. Both obesity and severe obesity were more common among students in grades 6 through 8 than among children in lower grades or among high school students. Hispanic boys and African American girls had the highest prevalence of obesity and severe obesity; Asian girls had much lower rates of obesity and severe obesity than any other group. Although obesity and severe obesity declined during the 4-year period in almost all demographic groups, the decreases were generally smaller in the groups with the highest prevalence, including high school students, Hispanic males, and African American females.
Conclusion Although these data suggest that the epidemic of childhood obesity may have begun to recede in Philadelphia, unacceptably high rates of obesity and severe obesity continue to threaten the health and futures of many school children.

Introduction

Childhood obesity increased dramatically in the latter part of the 20th century, making it a leading public health issue.[1] In 2009–2010, 18.2% of US children aged 6 through 19 years were obese, although national data suggest that the prevalence of childhood obesity is plateauing.[2] Arkansas data support this trend, while recent New York City data indicate that childhood obesity is decreasing;[3–7] however, the long-term trends and applicability to other parts of the United States are uncertain.

Recent efforts have been made to assess the epidemic increases in childhood obesity in the United States through public health surveillance methods. An important context in which such surveillance can take place is the school, because most children aged 5 through 18 years are enrolled in school and 90% of these students attend public schools.[8] Many schools have nurses or other trained health personnel on site, and increasing numbers of school districts have mandated routine weight screening for students. The Centers for Disease Control and Prevention commissioned a report to provide guidance for school-based body mass index (BMI) measurement programs;[9] Arkansas mandated school statewide BMI screening beginning in 2003, and as of 2009, a dozen other states had followed suit.[9] Nonetheless, few communities have obtained and analyzed their data to track childhood obesity at the local level.[10]

To identify the baseline prevalence and trends in childhood obesity locally, we analyzed height and weight data for students in kindergarten through grade 12 in the School District of Philadelphia. The school district includes approximately 300 public and charter schools, educating approximately 200,000 students. More than 80% of students are of racial/ethnic minorities, and more than 50% are eligible for free or reduced-price meals based on family income.

Our primary goals were to assess the prevalence of obesity and severe obesity among children in the School District of Philadelphia and to determine whether the prevalence of obesity and severe obesity changed between 2006–2007 and 2009–2010, the most recent school year for which data were available.

Methods

School District of Philadelphia records cover all students enrolled in Philadelphia public schools at any point during the year, a number that varied from 189,913 in 2006–2007 to 177,499 in 2009–2010 (T. Williams, written communication, April 2012). Students who attended charter schools exclusively were not included. Analyses were limited to students aged 5 through 18 for whom valid height and weight measurements were recorded. These students represented an increasing percentage of the total school population over the 4 school years included, from 61.6% in 2006–2007 to 70.4% in 2009–2010. The demographics of the total school population are presented in the Appendix.

Students’ heights and weights were measured by school nurses. Pennsylvania mandates that all children in kindergarten through grade 12 have their height and weight measured annually by a nurse or teacher. The Pennsylvania Department of Health’s Division of Chronic Disease Intervention and Division of School Health have developed a manual to provide guidance to school districts and other educational entities on best practices in measuring and reporting these data.[11] The measured heights and weights were entered into a secure school district database with the date of the examination. BMI measurements for girls whose records indicated a pregnancy were excluded from these analyses.

BMI was calculated as weight (kg)/height (m2) and compared with sex and age-specific norms from CDC growth charts[12] to determine BMI percentile. Obesity was defined as a BMI at or above the 95th percentile. Severe obesity was defined as a BMI of 35 or higher or 120% or greater of the threshold for obesity, based on the recommendation of Flegal et al.[13] The validity of the 99th percentile estimates that have been commonly used to characterize severe obesity among children is questionable; these estimates do not match well to the empirical data on which the CDC growth charts were based.[13] We conducted a secondary analysis of BMI values above the 99th percentile criterion to assess the sensitivity of the results to the differences in definition of severe obesity.

The demographic variables examined were sex; race/ethnicity; socioeconomic status, using eligibility for free or reduced-price school meals as a proxy; and grade. Race/ethnicity patterns were different for boys and girls and are therefore presented separately by sex. Data were weighted for nonresponse so that the measured population would more accurately represent the entire school population. Weights were calculated by grade and racial/ethnic group.

Although no intentional sampling was conducted, we conducted significance tests using SAS version 9.2 (SAS Institute, Inc, Cary, North Carolina) to assess the likelihood that changes over time represented chance findings. We assessed the significance of changes across time by testing a linear variable for school year in multivariable models that included a race/ethnicity–sex term, age in years, grade, and eligibility for free or reduced-price meals, adjusted for clustering within schools. Separate models were also conducted for each demographic group to assess time trends within groups.

To assess the possibility of bias associated with missing data, we identified a subsample of schools in which missing data were minimized (defined as at least 75% of all enrolled students having been measured during the school year), calculated the prevalence of obesity in this high-response sample, and compared the results with those of the total study population.

Results

Valid height and weight measurements were obtained for 61.6% of all students in 2006–2007, 66.4% in 2007–2008, 69.1% in 2008–2009, and 70.4% in 2009–2010. These figures exclude girls whose records indicated a pregnancy during the school year (n = 1,134 during all 4 school years, 0.48% of all measured female students).

The demographics of the study population were similar to those of the entire student population, except that a larger proportion of the total population was in grades 9 through 12 (31.5% in 2009–2010, compared with 26.4% of the measured population) and a smaller proportion was in kindergarten through grade 5 (46.7% compared with 51.0%) (Table 1). The demographic characteristics of the population were generally similar for all 4 years. Boys comprised approximately 51% of the student population throughout the study period. African Americans were the largest racial/ethnic group (60.1% of all students and 59.3% of those measured in 2009–2010), followed by Hispanics (17.6% of all students, 16.7% of those measured), non-Hispanic whites (13.6% of all students, 14.2% of those measured), and Asians (6.3% of all students, 7.2% of those measured). The most notable change over time was the increase in the proportion of students who were eligible for free or reduced-price meals (from 48.9% to 57.4% among all students and from 50.8% to 59.5% among those measured), a change that occurred primarily between the 2007–2008 school year and the 2008–2009 school year.

In 2009–2010, the prevalence of obesity among Philadelphia’s public school students was 20.5% (Table 2). The prevalence was higher among students in grades 6 through 8 (23.0%), compared with both kindergarten through fifth grade (19.1%) and high school students (20.8%). Among boys in 2009–2010, Hispanics had the highest prevalence of obesity (25.6%), followed by whites (20.7%); among girls in 2009–2010, African Americans had the highest prevalence (22.7%), followed by Hispanics (20.6%). The lowest prevalence by far—less than half that of any other group—was among Asian females, at 8.9% in 2009–2010.

Obesity declined slightly from 21.5% in 2006–2007 to 20.5% in 2009–2010, representing a 4.8% decrease (Table 2). Most of the decrease was between 2006–2007 and 2008–2009, followed by a leveling off in 2009–2010. This pattern varied by demographic group. At the beginning of the period, the prevalence of obesity was slightly higher among boys than girls (21.7% vs 21.3%); in the most recent school year this was reversed (20.4% among boys vs 20.6% among girls). Among high school students, the small decline in obesity was not significant. Trends within racial/ethnic–sex groups were significant for African American, non-Hispanic white, and Asian boys and for Hispanic girls. None of the subgroup changes between 2008–2009 and 2009–2010 was significant.

The prevalence of severe obesity in 2009–2010 was 7.9% (Table 3). Patterns of disparities in severe obesity were similar to those for obesity. Severe obesity was most prevalent among students in grades 6 through 8 (9.1% in 2009–2010), and the prevalence of severe obesity exceeded 9% among Hispanic boys and African American girls in 2009–2010. Trends over time in severe obesity were similar overall to those for obesity (Table 3). For the overall population, severe obesity prevalence decreased from 8.5% to 7.9% from 2006–2007 to 2009–2010, representing a 7.7% decrease. The largest significant changes were seen among African American boys and Hispanic girls. Results using the 99th percentile of BMI as a threshold (not shown) showed similar patterns, with slightly lower overall prevalence and somewhat larger declines over time (from 6.3% in 2006–2007 to 5.6% in 2009–2010).

Some groups that had shown declines in obesity, severe obesity, or both, including those with the highest prevalence of severe obesity, experienced small nonsignificant increases during the 2009–2010 school year. Most schools contributed at least 1 school year to the high-response subset with measurements for 75% or more of enrolled students. Analyses limited to this subset did not differ substantially from results for the complete data.

Discussion

Analyses of annually collected height and weight data on more than 100,000 public school children in Philadelphia from 2006–2007 to 2009–2010 demonstrated that the prevalence of obesity may be decreasing in small but potentially meaningful ways. However, trends were not consistent across subgroups, and obesity remains alarmingly high, particularly among some racial and ethnic minorities. Severe obesity, which confers the greatest short- and long-term risks to physical and emotional health, affects nearly 1 in 12 children in Philadelphia.

Some of these findings are consistent with national statistics on child overweight and obesity from the National Health and Nutrition Examination Surveys (NHANES),[2] although national rates of obesity in 2009–2010 were lower than those found among Philadelphia public school children. The differences were greatest for non-Hispanic whites, among whom 17.2% of boys and 13.0% of girls aged 6 to 19 years were obese nationally, compared with 20.7% of boys and 17.3% of girls aged 5 through 18 years in the School District of Philadelphia. This finding may reflect differences in socioeconomic status between whites in Philadelphia public schools and the US population overall. African Americans in the School District of Philadelphia had lower rates of obesity than those in the national data (19.1% for boys and 22.7% for girls in Philadelphia vs 25.4% for boys and 26.1% for girls nationally). In both the NHANES and School District of Philadelphia data, African American girls had higher rates of obesity than non-Hispanic white girls. In the NHANES data, African American boys also had higher rates of obesity than non-Hispanic white boys, although the opposite was true among Philadelphia public school children. This may again reflect the lower socioeconomic status of whites in the Philadelphia public schools compared with those in the national NHANES sample.

The NHANES study did not find evidence of any noticeable trends in obesity prevalence from 2007–2008 through 2009–2010. The differences seen between the School District of Philadelphia and NHANES data may reflect the different age ranges (5 through 18 in Philadelphia vs 6 through 19 in NHANES), different periods (2006–2010 vs 2007–2010), differences in measurement and methods, or genuine differences between Philadelphia public school children and national averages. The small size of the NHANES study population, which yielded 80% power to detect changes in obesity prevalence of 5% or more,[14] may have precluded detecting declines in obesity over this period.

Routinely collected BMI data for public school children have been published only for a few jurisdictions, including New York City and Arkansas. The prevalence, disparities, and trends in obesity among public school children in New York City were similar to those seen here, with generally consistent small declines in obesity, including an apparent leveling off in both cities in 2009–2010. Among students in kindergarten through eighth grade, the prevalence of obesity in Philadelphia public school children was between 0.2% and 0.7% lower than among those in New York City in the same period. In 2009–2010, the prevalence of obesity in these grades was 20.3% in Philadelphia and 21.0% in New York City.[7]

The prevalence of obesity found in Philadelphia public school children is also similar to statewide findings for public school children in Arkansas. The prevalence in the 2009–2010 school year was 21% in Arkansas and 20% in Philadelphia.[3] Trends were generally declining or flat during the last several years. Many of the specific racial/ethnic differences noted, such as the marked sex disparity among Asian students, are consistent.[3–6] Arkansas has not, however, reported the recent decline in obesity among African Americans noted in both Philadelphia and New York City.

Children affected by severe obesity face even greater health risks than obese children. Among children examined in the NHANES survey, those who were above the 99th percentile of BMI had higher mean blood pressures and insulin levels, lower mean high-density lipoprotein (HDL) cholesterol levels, and higher prevalence of metabolic syndrome than those who had BMI percentiles in the 95th to 97th range, putting them at greater risk of cardiovascular disease.[15] In the HEALTHY study, a survey of primarily low-income and minority sixth-graders, students with BMI at or above the 99th percentile had higher blood pressure and insulin levels, lower HDL cholesterol levels, and larger waist circumferences than those who were moderately obese.[16] Psychosocial comorbidities are also more severe among children and youth with severe obesity.[17] Although the prevalence and consequences of severe obesity in children have prompted widespread interest in various interventions, including bariatric surgery for adolescents[18] and child welfare involvement,[19] trends in severe obesity have been less widely studied or reported than those for overweight and obesity. Madsen et al, using different definitions of severe obesity (BMI ≥97th or ≥99th percentile), reported differing trends among subgroups of California students.[20] Some of the patterns they found, such as continuing increases in severe obesity among African American girls, are not consistent with those found from analysis of School District of Philadelphia data. This inconsistency could reflect regional differences; our secondary analysis indicated that using BMI at or above the 99th percentile to define severe obesity would not affect these trends.

Many of the strengths and limitations of these data originate from the routine screening assessments of student populations conducted by school nurses. The data represent large, unselected populations and were collected by experienced clinical professionals; conversely, they were not collected under rigorous protocols or with consistent equipment, nor were they validated. Research on the accuracy of measurements taken in schools suggests that measurements taken by school nurses are of reasonably high quality.[21] The substantial proportions of students that were not measured, especially in the higher grades, leave potential for selection bias, although our secondary analyses suggest that such bias is limited. Children who did not attend public schools during the school year, including those who attended private, parochial, and charter schools, were not included, and obesity prevalence and trends could differ in these groups. The similarities seen in both trends over time and disparities between racial/ethnic–sex groups when comparing the Philadelphia data with data from New York City and Arkansas strengthen our confidence in their accuracy.

Although these data do not allow us to say what is responsible for the apparent reversal of the trend toward increasing childhood obesity, greater attention has been paid to improving school health environments both nationally and in the School District of Philadelphia. Since 1999, the EAT.RIGHT.NOW. Pennsylvania Nutrition Education TRACKS program has provided nutrition education to all students and parents who are eligible for SNAP (the federal Supplemental Nutrition Assistance Program) and is now in more than 270 district schools (T.E. Wolford, written communication, March 2012). In 2004, the district beverage policy mandated the removal of all sodas and sugar-sweetened drinks from vending machines, and in 2006 snack standards were developed for á la carte and vending items. In 2006, the Philadelphia School Reform Commission passed a comprehensive School Wellness Policy with provisions for competitive foods, physical activity, and nutrition education. Finally, from 2009–2010, School Food Services began offering “universal” or free breakfast to all students, discontinued the use of fryers, and switched from 2% to 1% low-fat milk. In 2010, the Philadelphia Department of Public Health (PDPH) launched the Get Healthy Philly (www.foodfitphilly.org) initiative to improve nutrition and physical activity through citywide policy and systems changes. PDPH has partnered with public and private sector organizations, including the School District of Philadelphia, to decrease the population-level burden of obesity and related diseases, particularly among children. Such comprehensive efforts may help accelerate the decreases in BMI found in the study reported here.

The inconsistency of findings between subgroups and the small increases in obesity, severe obesity or both in some groups in the most recent year of data indicate that it is not yet certain that the epidemic increases in child obesity are over. Continued surveillance is required to clarify whether we are seeing minor inconsistencies in a continuing crisis or a true change in the epidemic.

In either case, the prevalence of unhealthy weight remains unacceptably high among public school children in Philadelphia, and the evidence that some groups are facing exceptionally high health risks associated with obesity is sobering. When almost 9% of all teenage students are severely obese, identifying effective means of preventing obesity in our children, helping those already affected to attain a healthier weight, and preventing the serious chronic health problems associated with obesity remain urgent public health responsibilities.

Appendix:

Appendix.  Demographic Characteristics of All Students Aged 5 Through 18 Years, Philadelphia School District, 2006–2010a

Characteristic School Year, n (%)  
2006–2007 2007–2008 2008–2009 2009–2010  
Total% 186,224 (100.0)% 180,479 (100.0)% 175,632 (100.0)% 172,975 (100.0)  
Grade  
K-5% 83,155 (44.7)% 81,395 (45.1)% 80,417 (45.8)% 80,723 (46.7)  
6–8% 43,591 (23.4)% 40,679 (22.5)% 38,288 (21.8)% 36,967 (21.4)  
9–12% 58,711 (31.5)% 57,677 (32.0)% 56,197 (32.0)% 54,533 (31.5)  
Ungraded% 728 (0.4)% 728 (0.4)% 730 (0.4)% 752 (0.4)  
Age, y  
5% 7,960 (4.3)% 7,819 (4.3)% 7,889 (4.5)% 7,904 (4.6)  
6–8% 40,298 (21.6)% 39,384 (21.8)% 39,720 (22.6)% 39,718 (23.0)  
9–12% 54,123 (29.1)% 52,048 (28.8)% 50,581 (28.8)% 50,435 (29.2)  
13–15% 47,144 (25.3)% 43,872 (24.3)% 40,576 (23.1)% 39,098 (22.6)  
16–18% 36,699 (19.7)% 37,356 (20.7)% 36,866 (21.0)% 35,820 (20.7)  
Sex  
Male% 96,119 (51.6)% 93,092 (51.6)% 90,583 (51.6)% 89,046 (51.5)  
Female% 90,105 (48.4)% 87,387 (48.4)% 85,049 (48.4)% 83,929 (48.5)  
Race/ethnicity  
African American% 117,064 (62.9)% 111,813 (62.0)% 107,887 (61.4)% 104,007 (60.1)  
Hispanic% 30,878 (16.6)% 30,948 (17.1)% 30,225 (17.2)% 30,536 (17.7)  
Non-Hispanic white% 25,502 (13.7)% 24,558 (13.6)% 23,830 (13.6)% 23,459 (13.6)  
Asian% 10,548 (5.7)% 10,539 (5.8)% 10,606 (6.0)% 10,901 (6.3)  
Other% 2,232 (1.2)% 2,621 (1.5)% 3,084 (1.8)% 4,072 (2.4)  
Eligibility for free/reduced-price meals  
Eligible% 91,016 (48.9)% 86,666 (48.0)% 99,829 (56.8)% 99,333 (57.4)  
Not eligible% 95,208 (51.1)% 93,813 (52.0)% 75,803 (43.2)% 73,642 (42.6)  

Abbreviation: K, kindergarten.
a Values may not sum to total due to missing data.

References

  1. Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among US children and adolescents, 1999–2000. JAMA 2002;288(14):1728–32.
  2. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010. JAMA 2012;307(5):483–90.
  3. Year eight assessment of childhood and adolescent obesity in Arkansas (fall 2010 – spring 2011). Little Rock (AK): Arkansas Center for Health Improvement; February 2012.
  4. Year seven assessment of childhood and adolescent obesity in Arkansas (fall 2009-spring 2010). Little Rock (AK): Arkansas Center for Health Improvement; December 2010.
  5. Year six assessment of childhood and adolescent obesity in Arkansas (fall 2008-spring 2009). Little Rock (AK): Arkansas Center for Health Improvement; December 2009.
  6. Year five assessment of childhood and adolescent obesity in Arkansas (fall 2007–spring 2008). Little Rock (AK): Arkansas Center for Health Improvement; September 2008.
  7. Centers for Disease Control and Prevention. Obesity in K-8 students — New York City, 2006–07 to 2010–11 school years. MMWR Morb Mortal Wkly Rep 2011;60(49):1673–8.
  8. Strizek GA, Pittsonberger JL, Riordan KE, Lyter DM, Orlofsky GF. Characteristics of schools, districts, teachers, principals, and school libraries in the United States: 2003–04 Schools and Staffing Survey (NCES 2006–313). Washington (DC): US Government Printing Office, US Department of Education, National Center for Education Statistics; 2006.
  9. Nihiser AJ, Lee SM, Wechsler H, McKenna M, Odom E, Reinold C, et al. BMI measurement in schools. Pediatrics 2009;124(Suppl 1):S89–S97.
  10. Sheon A, Katta V, Costello B, Longjohn M, Mantinan K. Registry-Based BMI Surveillance: A Guide to System Preparation, Design, and Implementation. Altarum Institute, June 2011. http://www.altarum.org/files/imce/Chomp_BMI_FINAL_060811lr.pdf.
  11. Johnson CB, Huff MK, Gray A. Procedures for the growth screening program for Pennsylvania’s school-age population. Harrisburg (PA): Pennsylvania Department of Health; 2004.
  12. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, et al. CDC growth charts for the United States: methods and development. Vital Health Stat 11 2002;(246):1–190.
  13. Flegal KM, Wei R, Ogden CL, Freedman DS, Johnson CL, Curtin LR. Characterizing extreme values of body mass index–for-age by using the 2000 Centers for Disease Control and Prevention growth charts. Am J Clin Nutr 2009;90(5):1314–20.
  14. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in US children and adolescents, 2007–2008. JAMA 2010;303(3):242–9.
  15. Skelton JA, Cook SR, Auinger P, Klein JD, Barlow SE. Prevalence and trends of severe obesity among US children and adolescents. Acad Pediatr 2009;9(5):322–9.
  16. Marcus MD, Baranowski T, DeBar LL, Edelstein S, Kaufman FR, Schneider M, et al. Severe obesity and selected risk factors in a sixth grade multiracial cohort: the HEALTHY study. J Adolesc Health 2010;47(6):604–7.
  17. Zeller MH, Modi AC. Predictors of health-related quality of life in obese youth. Obesity (Silver Spring) 2006;14(1):122–30.
  18. Brandt ML, Harmon CM, Helmrath MA, Inge TH, McKay SV, Michalsky MP. Morbid obesity in pediatric diabetes mellitus: surgical options and outcomes. Nat Rev Endocrinol 2010;6(11):637–45.
  19. Murtagh L, Ludwig DL. State intervention in life-threatening childhood obesity. JAMA 2011;306(2):206–7.
  20. Madsen KA, Weed AE, Crawford PB. Disparities in peaks, plateaus, and declines in prevalence of high BMI among adolescents. Pediatrics 2010;126(3):434–42.
  21. Stoddard SA, Kubik MY, Skay C. Is school-based height and weight screening of elementary students private and reliable? J Sch Nurs 2008;24(1):43–8.

Retrieved from: http://www.medscape.com/viewarticle/771896?src=nl_topic

 

two sides of a very important coin. be informed, people!

In Politics on Wednesday, 31 October 2012 at 13:42

Why Romney Would Be Good For Doctors

Harris Meyer

Some physicians who favor Romney say that he will bring positive changes for physicians and the practice of medicine:

Introduction

Mitt Romney’s healthcare approach would be better for America’s physicians because it would unleash free-market forces to let doctors deliver quality healthcare, give consumers more private insurance choices, and drive down costs in both private and public insurance programs, say many conservative physicians.

• Many physicians backing Romney ardently support his call for repealing President Obama’s Affordable Care Act (ACA), which they see as destructive to US healthcare.

• Doctors like Romney’s proposal to encourage individual ownership of health insurance by giving people an income tax deduction for premium payments.

• They favor his ideas for deregulating insurance by letting out-of-state insurers sell policies nationally without having to meet state benefits, and boosting high-deductible health plans by letting people pay premiums out of their tax-free health savings accounts.

• And they love that Romney wants to curb medical malpractice lawsuits and reduce defensive medicine by capping noneconomic damages.

These conservative doctors may represent the majority view of physicians. A randomized national survey of 3660 doctors in September 2012, conducted by healthcare staffing firm Jackson & Coker, headquartered in Alpharetta, Georgia, found that 55% of physicians said that they would vote for Romney while 36% would vote for Obama.[1] Male doctors, who comprised 72% of respondents, were far more likely to support Romney, while female doctors, who comprised 28%, were evenly split between the 2 candidates. The percentage who said that the ACA should be repealed and replaced was 55%, with 40% saying that it should be implemented and improved.

Romney supporters admit to some reservations because as Governor of Massachusetts, Romney passed a state healthcare reform law that served as the model for the federal law. Still, supporters say that, on balance, he would be far better than Obama for doctors.

Indeed, some conservatives admit that their presidential vote on November 6 will be as much anti-Obama as pro-Romney. “We have to repeal that monstrous law [the ACA],” says Robert Sewell, MD, a solo practice surgeon in Southlake, Texas, who represents the American Society of General Surgeons in the American Medical Association (AMA) House of Delegates. “I have to take Gov. Romney at his word that, if elected, he would do that. In that case I’m a supporter of his.”

Physicians Who Are Staunch Romney Supporters

Others are more ardent in their support for Romney. “Romney wants to restore the doctor-patient relationship and have healthcare decisions made by patients in conjunction with their doctor, not by a panel of government-appointed bureaucrats,” says Scott Atlas, MD, a Stanford University neuroradiologist and Hoover Institution senior health policy fellow who is advising the Romney campaign.

“He focuses on improving private insurance options rather than shifting millions of people into government insurance. That’s good, because doctors in general don’t want to practice in an environment where their hands are tied in how to diagnose and treat patients,” says Dr. Atlas.

They also much prefer Romney’s positions on taxes, deregulation, and the economy. While Obama proposes to end the Bush tax cuts on family incomes over $250,000 and says that wealthier Americans should pay more, Romney proposes to keep the Bush tax cut for higher incomes, maintain the lower capital gains rate, reduce income tax rates by 20% across the board, and eliminate the estate tax.

“Rich people are already paying the vast majority of taxes,” Dr. Sewell says. “Romney believes that the solution is to increase the number of people with jobs paying taxes. It should be a disgrace that 47% of people don’t pay federal income taxes.”

No Benefit From Redistributing Wealth

That’s echoed by Jane Orient, MD, a Tucson general internist and executive director of the Association of American Physicians and Surgeons, which promotes the private practice of medicine. “Romney believes in free enterprise and he doesn’t believe we can solve problems by redistributing wealth, which is what Obamacare is about. Obama believes we can make people better by taking from people who are successful. That’s totally destructive to the economy.”

Conservative physicians express confidence that Romney’s approach would give doctors greater freedom to practice medicine in the way they think is best for patients. They believe Obama’s healthcare law puts too much emphasis on trying to keep people healthy through preventive care at the expense of providing high-tech tests and treatments for sick people. They think that it favors primary care physicians over specialists. And they believe that it creates mechanisms that would tell doctors how to practice and limits access to state-of-the-art services.

“Obama’s plan shifts spending priorities from specialty care to generalist care, and that’s rolling back the clock to the 1950s and dumbing down healthcare,” Dr. Atlas contends. “All doctors know that the key to healthcare improvement has been more and more specialist care and more access to technology and innovative drugs.”

Dr. Orient says, “The Romney plan boils down to giving people more freedom and doing away with impediments put in place by intellectuals who think they know everything, and that if the federal government sets the rules then everything will be fine.”

She believes that Romney’s approach is better than Obama’s from an overall clinical perspective. “If you put all of the resources into checking blood pressure and free contraceptives and telling patients not to smoke, it takes resources away from taking care of people who are old and sick.”

More Freedom to Negotiate Fees

Conservative doctors believe that Romney also would give doctors greater freedom to negotiate fees with insurers and patients and get out from under government-set prices, along the lines of Medicare private contracting legislation introduced by Republican lawmakers. That’s because Romney says that he would encourage the growth of health insurance plans that put more financial responsibility on consumers, including high-deductible health savings account (HSA) plans.

“Romney’s general attitude is that he’s a free-market businessman and that if you bring free-market principles back to medicine, it will be good for everyone, including doctors and patients,” Dr. Sewell says.

Dr. Orient argues that Romney’s proposals would create a virtuous cycle that would help physicians in smaller practices remain independent. Giving consumers a tax deduction for buying individually owned insurance, allowing out-of-state sales of health insurance policies without state-mandated benefits, and encouraging high-deductible policies all would boost smaller insurers. In turn, independent doctors would have greater negotiating power with those insurers than with larger insurers. In contrast, she says, under Obamacare, independent doctors are “targeted for extinction.”

Dr. Atlas argues that the greater competition between insurers will lower premiums and lead to more Americans having insurance — even without the ACA’s refundable tax credits to help people afford coverage, which he calls a “fantasy handout.” Romney’s plan “reduces prices; more people will have insurance, and that’s good for doctors,” he says.

Hopefully an Improvement in the Malpractice Madness

Even physicians leaning toward Obama say that Romney’s approach toward medical liability is better for doctors. Romney has proposed a federal cap on noneconomic damages in malpractice lawsuits — a change long sought by organized medicine — along with alternative dispute resolution of malpractice cases.

“The Affordable Care Act falls way short of what’s needed on medical liability. It just kicks the can down the road, and the problem needs to be fixed,” says Mario Motta, MD, a Salem, Massachusetts, cardiologist and member of the AMA House of Delegates who generally supports Obama’s healthcare policies.

Dr. Robert Sewell strongly favors Romney’s damage cap proposal, which his state, Texas, passed in 2003. He says that the Texas cap has resulted in fewer “frivolous” lawsuits, a sharp decline in liability premiums, and an influx of doctors into the state — though he acknowledges that it still hasn’t reduced defensive medicine or overall healthcare costs. “What’s driving up the cost of care is defensive medicine, but [the impact of the cap] hasn’t filtered into the real world yet,” he says.

Doctors who back Romney also say that their candidate’s Medicare and Medicaid proposals would help doctors and patients by preserving the fiscal solvency of those programs. Romney wants to turn Medicare into a defined-contribution program in which seniors receive a fixed amount and pick either a private health plan or traditional Medicare. On Medicaid, he would give states a capped block grant and let them run the program with greater flexibility. Dr. Atlas believes that moving more Medicare patients into private health plans would boost payments to doctors and give patients better access to care. “Romney’s plan would save Medicare and Medicaid,” he says.

A Better Philosophical Fit

Overall, conservative physicians simply find Mitt Romney’s philosophical approach a better fit with their own personal and professional worldview. They see themselves as independent physicians and entrepreneurs, and they prefer Romney’s vision of expanding free-market medicine over President Obama’s model of competition within a more regulated framework.

“I think Romney’s platform is right: It’s short and it’s nonintrusive,” Dr. Sewell says. In contrast, he believes that Obama’s approach will “make us into employees of the government. I didn’t go to medical school, do a surgical residency, and spend 30 years in practice to become a government employee. I’ll retire before I allow that to happen.”

Retrieved from: http://www.medscape.com/viewarticle/773048_2

Why Obama Would Be Good For Doctors

Harris Meyer

Introduction

Re-electing President Barack Obama and continuing his policies would be better for physicians because millions more Americans will have insurance and be able to pay for healthcare and preventive services, say many physicians who support Obama. Additionally, administrative costs and hassles of dealing with insurers will be reduced, and doctors will play a leading role in new delivery systems to improve care and reduce costs.

Many physician Obama supporters also believe that Obama’s economic and tax policies are better for doctors overall — even if some doctors have to pay higher income taxes — because those policies will help build a society with a stronger middle class and fewer social problems. And they believe that he would protect public investments in medical research and public health while Mitt Romney’s budget plan might slash such spending.

Physicians who back Obama base their support largely on his comprehensive healthcare reform law, the Affordable Care Act (ACA). Although some would have preferred a single-payer, Medicare-for-all model, they say that the ACA finally will move the nation forward in addressing the longstanding problems of lack of healthcare coverage and access, rising costs, quality-of-care gaps, and poorer population health than in other advanced countries.

Like it or not, they say, there’s no way to ensure that Americans with preexisting medical conditions can get private insurance without the controversial ACA provision requiring nearly everyone to have insurance, just as there’s no way to make insurance affordable to lower-income people without the ACA’s subsidies.

“I firmly believe what’s best for physicians is getting everyone insured,” says Mario Motta, MD, a Salem, Massachusetts, cardiologist who’s a member of the American Medical Association House of Delegates. “Whatever person or party gets us to universal healthcare, that’s who I have to support because that’s what’s best in the long run.” He believes that the ACA’s private insurance expansion is the only way to avoid a “complete government takeover” of health insurance, which he opposes.

In contrast, Mitt Romney’s proposals to repeal the ACA and deregulate health insurance would sharply increase the number of uninsured and put even greater financial pressure on physicians. A recent Commonwealth Fund study[1] projects that the number of uninsured Americans under Romney’s proposals would soar to 72 million by 2022, while dropping to 27 million under Obama’s ACA law. Among nonelderly Americans, 22% would be uninsured in 2022 under Romney’s plan, compared with 10% under Obama’s law.

Taking Care of Ill Patients

Many pro-Obama physicians were appalled at Romney’s recent comments that uninsured Americans can always get care in the hospital emergency room and that “we don’t have people that become ill, who die in their apartment because they don’t have insurance.”

“It’s really hard to take care of patients when they can’t afford their pills or their treatment plan; they delay care until they have to go to the ER, and they skip doctor visits,” Dr. Motta says. “All of that is directly attributable to the fact that they don’t have insurance. We’ve pretty much solved that in Massachusetts.”

He leans toward Obama but appreciates the Massachusetts coverage expansion law that Romney as governor helped pass, which was the model for the ACA. He’s greatly disappointed that Romney has distanced himself from the Massachusetts reform model.

“The president’s health plan is certainly better for doctors than having 72 million people without health insurance,” agrees Rep. Jim McDermott, MD (D-Wash), a psychiatrist who represents the Seattle area and is a longtime sponsor of Medicare-for-all legislation. “It makes it possible for another 30 million people to have insurance and get preventive care. Doctors don’t want to just treat catastrophes; they want to help people be well. That’s a major step forward. Romney’s alternative is a disaster.”

Controlling Costs vs Free Market

Doctors who back Obama believe that the president’s regulated-market reform model stands a better chance of controlling costs and preserving smaller physician practices than Romney’s deregulated, free-market approach. They note that under the current competitive system, large hospital systems and insurers already are squeezing out independent doctors. And they contend that healthcare can never be a normal market because people don’t have enough information to shop for plans and providers, and sick people aren’t in a position to shop around.

Obama’s reform law establishes a regulated competition system for private insurers who, starting in 2014, will sell standardized benefit plans to individuals and small groups through new state health insurance exchanges. Insurers will have to accept all applicants regardless of preexisting conditions, with limited price variations based on age. In contrast, Romney wants to encourage more insurers to compete and offer a wide range of benefit packages, without having to meet state benefit mandates or accept applicants who haven’t had continuous coverage.

“The insurance exchange is good for doctors because then you’ve got a couple of health plans people will buy, and that cuts down on doctors’ back-office work,” Dr. McDermott says. “It’s a big drag on your office to have to take care of 25 different insurance firms and have all this paperwork. Doctors just want to take care of their patients and get paid.”

Independent Doctors

Other Obama supporters note that the current free-market model is hurting independent doctors who lack bargaining leverage, with many opting to work for hospital systems and larger groups. “Left on its own, the market will kill small private practice, no matter what doctors want to believe,” says Robert Berenson, MD, a general internist and health policy fellow at the Urban Institute in Washington, DC.

In contrast, he points to the Accountable Care Organization (ACO) demonstrations launched under the ACA, which lets groups of private physicians band together to streamline care for beneficiaries in traditional Medicare and share in any cost savings if they meet quality targets. Many ACOs have been started by physician-led groups without hospital involvement.

“The ACA set up tests of alternative payment approaches that put doctors back in control of their fate,” Dr. Berenson says. “So I think the law provides promise of a better healthcare system in which doctors will have greater satisfaction in their practice.”

Obama’s approach to Medicare and Medicaid is also better for doctors, Obama supporters argue, because he will preserve the programs as guaranteed benefits, providing patients with certainty that they’ll have access to care when they need it. In addition, his reform law enhanced Medicare’s preventive and drug coverage and extended the solvency of the program. In contrast, Romney’s Medicare voucher proposal means that people “don’t know whether they’ll have access to affordable care when they are old and sick,” says Steve Kagen, MD, an Appleton, Wisconsin, allergist and former Democratic congressman who’s proud of his vote for the ACA, which he calls the most important legislation in a century.

Similarly, he adds, Romney’s Medicaid block grant plan would “allow states to turn their back on people in need. What kind of nation would we be if we turned our back on children who are ill? By not paying providers their overhead for taking care of people in need, you’re turning your back on the community and on providers delivering lifesaving care.”

Effect on Society Beyond Doctors

More broadly, physicians who support Obama feel that his economic policies are better for all Americans, and that’s good for doctors. “As doctors, we’re dependent on a successful middle class, and our best opportunity is expanding the middle class,” Dr. Kagen says. “In my view, Obama has the best plan to expand the middle class, by investing in education, clean energy, and infrastructure. Then I’ll do better.”

Dr. Berenson adds that even though physicians might benefit financially from Romney’s proposals to cut taxes for wealthier Americans, “they wouldn’t be very happy with a society marked by increasing disparities between the rich and poor, more crime, and more demands on public funding for food and shelter. That’s not a world I want to live in.”

Regardless of their tax bills, he says that doctors’ professional interests lie more with Obama and the Democrats because “at least Democrats are trying to do something about the obvious problems in the healthcare system, while I’ve seen no evidence that Romney and the Republicans have any views of what should happen. Romney passed a very good law in Massachusetts, he’s proud of it, but he can’t tell anyone because his party is so Neanderthal on the issue.”

The bottom line is that doctors who back President Obama strongly prefer his focus on ensuring that all Americans have access to healthcare and a way to pay for it. “I assume doctors mostly go into the profession because they want the personal satisfaction of improving the health of the public,” Dr. Berenson says. “The obvious benefit of Obama’s law is that it sets up an environment where doctors can feel proud that they are working in the health system.”

Retrieved from: http://www.medscape.com/viewarticle/773050?src=mp

important information regarding child abuse

In Child/Adolescent Psychology, Psychiatry, School Psychology on Wednesday, 31 October 2012 at 08:12

please be proactive if you suspect child abuse.  you are not determining that there is definitive abuse if you report, that determination is made by the respective agencies responsible for child welfare.  ignoring it will not make the problem go away and can have deleterious effects for children.

How Child Abuse Primes the Brain for Future Mental Illness

By: Maia Szalvitz

Child maltreatment has been called the tobacco industry of mental health. Much the way smoking directly causes or triggers predispositions for physical disease, early abuse may contribute to virtually all types of mental illness.

Now, in the largest study yet to use brain scans to show the effects of child abuse, researchers have found specific changes in key regions in and around the hippocampus in the brains of young adults who were maltreated or neglected in childhood. These changes may leave victims more vulnerable to depression, addiction and post-traumatic stress disorder (PTSD), the study suggests.

Harvard researchers led by Dr. Martin Teicher studied nearly 200 people aged 18 to 25, who were mainly middle class and well-educated. They were recruited through newspaper and transit ads for a study on “memories of childhood.” Because the authors wanted to look specifically at the results of abuse and neglect, people who had suffered other types of trauma like car accidents or gang violence were excluded.

MORE: Study: How Chronic Stress Can Lead to Depression

Child maltreatment often leads to conditions like depression and PTSD, so the researchers specifically included people with those diagnoses. However, the study excluded severely addicted people and people on psychiatric medications, because brain changes related to the drugs could obscure the findings.

Overall, about 25% of participants had suffered major depression at some point in their lives and 7% had been diagnosed with PTSD. But among the 16% of participants who had suffered three or more types of child maltreatment  — for example, physical abuse, neglect and verbal abuse — the situation was much worse. Most of them — 53% — had suffered depression and 40% had had full or partial PTSD.

The aftermath of that trauma could be seen in their brain scans, whether or not the young adults had developed diagnosable disorders. Regardless of their mental health status, formerly maltreated youth showed reductions in volume of about 6% on average in two parts of the hippocampus, and 4% reductions in regions called the subiculum and presubiculum, compared with people who had not been abused.

That’s where this study begins to tie together loose ends seen in prior research. Previous data have suggested that the high levels of stress hormones associated with child maltreatment can damage the hippocampus, which may in turn affect people’s ability to cope with stress later in life. In other words, early stress makes the brain less resilient to the effects of later stress. “We suspect that [the reductions we saw are] a consequence of maltreatment and a risk factor for developing PTSD following exposure to further traumas,” the authors write.

Indeed, brain scans of adults with depression and PTSD often show reductions in size in the hippocampus. Although earlier research on abused children did not find the same changes, animal studies on early life stress have suggested that measurable differences in the hippocampus may not arise until after puberty. The new study suggests that the same is true for humans.

MORE: Nurturing Moms May Boost Children’s Brain Growth

The findings also help elucidate a possible pathway from maltreatment to PTSD, depression and addiction. The subiculum is uniquely positioned to affect all of these conditions. Receiving output from the hippocampus, it helps determine both behavioral and biochemical responses to stress.

If, for example, the best thing to do in a stressful situation is flee, the subiculum sends a signal shouting “run” to the appropriate brain regions. But the subiculum is also involved in regulating another brain system that, when overactive during chronic high stress such as abuse, produces toxic levels of neurotransmitters that kill brain cells — particularly in the hippocampus.

It can be a counterproductive feedback loop: high levels of stress hormones can lead to cell death in the very regions that are supposed to tell the system to stop production.

What this means is that chronic maltreatment can set the stress system permanently on high alert. That may be useful in some cases — for example, for soldiers who must react quickly during combat or for children trying to avoid their abusers — but over the long term, the dysregulation increases risk for psychological problems like depression and PTSD.

MORE: Boxer Quanitta Underwood’s Inspiring Fight Against Sexual Abuse — and for Olympic Gold

The subiculum also regulates the stress response of a key dopamine network, which may have implications for addiction risk. “It is presumably through this pathway that stress exposure interacts with the dopaminergic reward system to produce stress-induced craving and stress-induced relapse,” the authors write.

In other words, dysregulation of the stress system might lead to intensified feelings of anxiety, fear or lack of pleasure, which may in turn prompt people to escape into alcohol or other drugs.

With nearly 4 million children evaluated for child abuse or neglect in the U.S. every year — a problem that costs the U.S. $124 billion in lost productivity and health, child welfare and criminal justice costs — child maltreatment isn’t something we can afford to ignore.

Even among the most resilient survivors, the aftereffects of abuse may linger. Not only are such children at later risk for mental illness, but because of the way trauma affects the stress system, they are also more vulnerable to developing chronic diseases like diabetes, high blood pressure, heart attack and stroke.

We can do better for our kids.

The study was published in the Proceedings of the National Academy of Sciences.

Maia Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland’s Facebook page and on Twitter at @TIMEHealthland.
Retrieved from: http://healthland.time.com/2012/02/15/how-child-abuse-primes-the-brain-for-future-mental-illness/#ixzz2AsTNhYSB

if you want to make lasting memories, get moving!

In Fitness/Health, Neuroscience on Tuesday, 30 October 2012 at 08:04

How Exercise Can Help You Master New Skills

By: Dr. Mercola

Just as your mind forms intellectual memories, it also forms what are known as muscle or “motor” memories.

Have you ever marveled at how well you can still ride a bike, even if you haven’t been on one in 20 years?

This is an example of motor memory at its best; while your muscles don’t actually “remember” how to ride a bike, your brain does, and sends a complex, though seemingly effortless, array of signals to your muscles instructing them how to perform the proper movements to keep you upright and pedaling.

Motor memory is obviously extremely important for everyday tasks like walking and climbing stairs, but it’s also crucial for more specialized skills – like mastering your golf swing or tennis serve.

If you’re in the process of mastering a new skill, research has revealed a novel way to “cement” that knowledge into your brain for later recollection – so you can remember how to get that “hole-in-one” the same way you remember how to ride a bike…

Exercising Right After Learning Makes Long-Term Memories Stronger

Researchers at the University of Copenhagen asked men to learn a tracking skill on a computer, which required them to use a joystick to trace a red line as it squiggled across the screen. A portion of the men exercised before learning the new task, some of the men did not exercise at all, and another group exercised just after learning the new skill.

At follow-up testing an hour later, the men performed basically the same, but as time went on, those who exercised gained a clear advantage. Those who fared the best belonged to the group who exercised just after learning the task. At testing sessions one day, and then one week, later, they traced the line more accurately and with greater agility. The group that exercised before learning the new skill also performed better than those who didn’t exercise (though not as well as the group that exercised after).

It appears, then, that if you want to help strengthen your memories, and be sure new information you’re receiving is successfully imprinted into your brain for later use and recall, a workout just after the learning may be very beneficial. The researchers concluded:1

“These findings indicate that one bout of intense exercise performed immediately before or after practicing a motor task is sufficient to improve the long-term retention of a motor skill. The positive effects of acute exercise on motor memory are maximized when exercise is performed immediately after practice, during the early stages of memory consolidation.”

Exercise Even Builds New Brain Cells

The hippocampus is a major component of your brain. It belongs to the more ancient part of your brain known as the limbic system and plays an important role in the consolidation of information from your short-term memory to long-term memory and spatial navigation. An animal study found that not only does mild exercise activate hippocampal neurons, it actually promotes their growth. In the brain, this also, in turn, helps with the creation of new brain cells.2

Another study, for instance, revealed that when mice exercised, they grew an average of 6,000 new brain cells in every cubic millimeter of tissue sampled.3 The growth occurred in the hippocampus, which, as mentioned, is considered the memory center of your brain, and the mice showed significant improvements in the ability to recall memories without any confusion.

During exercise, nerve cells in your brain also release proteins known as neurotrophic factors. One in particular, called brain-derived neurotrophic factor (BDNF), triggers numerous other chemicals that promote neural health, and has a direct benefit on cognitive functions, including memory consolidation and enhanced learning.

So while the featured study focused on exercise to benefit motor memory, research also supports its benefit for intellectual memories as well. If you want to have a memory like an elephant’s… it’s time to hit the gym. Some of the research highlights include:4

  • Among elementary school students, 40 minutes of daily exercise increased IQ by an average of nearly 4 points
  • Among 6th graders, the fittest students scored 30 percent higher than average students, and the less fit students scored 20 percent lower
  • Among older students, those who play vigorous sports have a 20 percent improvement in Math, Science, English and Social Studies
  • Fit 18-year-olds are more likely to go on to higher education and get full-time jobs
  • Students who exercise before class improved test scores 17 percent, and those who worked out for 40 minutes improved an entire letter grade

Even once you’re in the workforce, exercise can be an invaluable tool to increase your performance and productivity. Research shows an employee who exercises regularly is 15 percent more efficient than those who do not, which means a fit employee only needs to work 42.5 hours in a week to do the same work as an average employee does in 50.5

Think You Don’t Have Enough Time to Exercise?

I understand that you are busy, but if you take time out of your day to eat and sleep, it is equally important in the long term to make time to exercise (and not in lieu of sleeping, either!). If you neglect to exercise, you are literally passing up dozens of benefits to your health, the value of which simply cannot be measured. Do you want to slow down your aging process? Lower your risk of heart disease, diabetes and cancer? Relieve pain? Fight depression? Cure insomnia?

Exercise may be the answer you’ve been searching for.

As for the time element, it does take some practice to make exercise part of your routine. It’s generally said that it takes 3-4 weeks to turn an action into a habit, but some estimates put it at closer to 66 days, or just over two months. I find that it’s easiest to schedule exercise into my day the way I would any other important event or meeting. Write it down on your calendar, add it to your smartphone reminders… do whatever you need to do to set aside the time, and then stick with it.

The time you need to devote may actually be far less than you think, too, as short periods of intense exercise, such as Peak Fitness, are proving to be even better for you than longer sessions of traditional cardio. Here’s a summary of what a typical high-intensity Peak Fitness routine might look like:

  • Warm up for three minutes
  • Exercise as hard and fast as you can for 30 seconds. You should feel like you couldn’t possibly go on another few seconds
  • Recover at a slow to moderate pace for 90 seconds
  • Repeat the high intensity exercise and recovery 7 more times

As you can see, the entire workout is only 20 minutes. That really is a beautiful thing. And within those 20 minutes, 75 percent of that time is warming up, recovering or cooling down. You’re really only working out intensely for four minutes. If you have never done this, it’s hard to believe that you can actually get that much benefit from only four minutes of intense exercise, but that’s all it is. You can see a demonstration in the video below.

Since it’s so intense, you only need to do Peak Fitness two or three times a week. Then, round out your exercise program with strength training, core exercises and stretching to give your brain, and body, a wonderful, healthy boost.

Retrieved from: http://fitness.mercola.com/sites/fitness/archive/2012/10/12/exercise-improves-memory.aspx

New York Times and Wall Street Journal Warns That Hospitals Are Killing Us

In Fitness/Health on Sunday, 28 October 2012 at 09:16

New York Times and Wall Street Journal Warns That Hospitals Are Killing Us

By Dr. Mercola

If medical errors were a disease, they would be the sixth leading cause of death in America, writes surgeon Dr. Marty Makary in the Wall Street Journal.1

By some estimates, they may actually be the leading cause… These errors kill the equivalent of four jumbo jets’ worth of passengers… every week, Dr. Makary says, and this is likely a conservative estimate.

According to the 2011 Health Grades Hospital Quality in America Study, the incidence rate of medical harm occurring in the United States is estimated to beover 40,000 harmful and/or lethal errors each and EVERY day.2

What’s most shocking is that the harm often is preventable.

Shocking Medical Errors are All Too Common

Dr. Andrew Saul, co-author of Hospitals and Health: Your Orthomolecular Guide to a Shorter Hospital Stay (which is available on Amazon), recently explained that the lowest estimate makes hospitals one of the top 10 causes of deaths in the United States… and the highest estimate makes hospital and drugs the number one cause of death in the United States. Some of the top 10, and most lethal, medical mishaps are mistakes that should be extremely rare, but happen with shocking regularity:

1. Preventable Adverse Drug Reactions

An estimated 450,000 preventable medication-related adverse events of mostly correctly prescribed drugs occur in the U.S. every year. A large part of the problem is simply because so many drugs are used and prescribed – and many patients receive multiple prescriptions at varying strengths, some of which may counteract each other or cause more severe reactions when combined. Dosage errors, medication mix-ups and even giving the wrong medication to the wrong person are all too common.

2. Avoidable Infections

Hospital-acquired infections are alarmingly common, and sadly they’re often deadly. In the United States, more than 2 million people are affected byhospital-acquired infections each year, and a whopping 100,000 people die as a result. According to the 2011 Health Grades Hospital Quality in America report,3 analysis of approximately 40 million Medicare patients’ records from 2007 through 2009 showed that 1 in 9 patients developed such hospital-acquired infections!

The saddest part is, most of these cases could likely have been easily prevented with better infection control in hospitals – simple routines such as doctors and nurses washing their hands between each patient, for example.

3. Surgical Souvenirs

Surgical tools or other objects are left inside people after surgery far more often than you’d like to think. This is often the result of surgical staff failing to count, or miscounting, equipment during the procedure. Unexpected pain, fever and swelling after surgery are all indications that you could have a surgical tool or piece of a tool still inside you.

Just how often does this occur? One study in the New England Journal of Medicine found that about 1,500 Americans have objects left inside of them following surgery every year.4

Overtreatment is Taking its Toll

Too many medications, unnecessary surgeries, inappropriate medical screening… there is perhaps no other society that is subjected to as much excessive medical care, and often the “treatment” ends up being worse than the disease.

It’s estimated that up to 30 percent of all medical procedures, tests and medications may be unnecessary5 – at a cost of at least $210 billion a year6 (plus the cost of emotional suffering and related complications and even death – which are impossible to put numbers on). The New York Times recently highlighted several examples of this epidemic of overtreatment, including:7

  • A woman who received a CT scan and an MRI for a black eye (and was told she might have a brain tumor as a result, which resulted in an agonizing two-week wait for the results… she was fine and had no tumor)
  • An elderly man who was put on two antidepressants after having a stroke, and subsequently began suffering from dementia and hallucinations (the drugs are associated with cognitive problems); after his son persuaded doctors to change the medications, the man’s mental health quickly improved
  • A new mom who said she felt “bullied” by doctors to perform a battery of tests on her 3-month-old daughter, who was born premature – even though her prior doctor had ruled her symptoms as normal

In her book, Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, Shannon Brownlee also explained that as much as a third of the medical care received in hospitals does nothing to improve your health! What happens is that you often get certain medical tests because of what your physician’s specialty is, not because that’s necessarily the test you need. For example if you have low back pain and see different specialists you will get different tests: rheumatologists will order blood tests, neurologists will order nerve impulse tests, and surgeons will order MRIs and CT scans.

But no matter what tests you get, you’ll probably end up with a spinal fusion because it’s one of the “more lucrative procedures in medicine,” Brownlee says – even though the best success rate for spinal fusions is only 25 percent!

Angioplasties and certain types of chemotherapy with similar low success rates are just as prone to be ordered, Brownlee says, because that’s where hospitals’ investments lie. You see, they have all this equipment and they need to use it to get a return on it – but they also need to get you out of there as quickly as possible, so they can get the next patient in. What ensues is a type of aggressive patient therapy where an unacceptable number of people will be harmed every year as a result of the medical treatments they received in the hospital.

5 Ways to Stop the Madness…

In the Wall Street Journal, Dr. Makary went on to explain five simple reforms that could make health care much safer:

  1. Online “Informational” Dashboards: This would include easily accessible hospital ratings for people to check out prior to choosing where to receive care. Information on rates of infection, readmission, surgical complications and “never events” (mistakes that should “never” happen, such as operating on the wrong body part), as well as annual volume for each type of surgery it performs, and patient satisfaction scores, would be available.

By being held publically accountable, it would prompt hospitals with low scores to make changes – or business would suffer.

  1. Safety Culture Scores: Anonymous surveys of hospital employees (including doctors, nurses, technicians, etc.) can reveal valuable information that correlates with better patient care, such as whether teamwork is good or bad, or whether employees feel they can speak up if they see a medical error in progress. These scores should be readily available to the public.
  2. Cameras: If health care workers know they’re being filmed, it greatly improves compliance with established safety practices, such as hand washing, and even has been found to improve the quality of medical procedures. It also provides a way for doctors to review, critique and improve their surgical skills.
  3. Open Notes: Certain hospitals have begun using “open notes,” which gives patients online access to their doctors’ notes. Not only does this allow patients to correct any inaccurate information, it also sometimes prompts people to remember a crucial piece of their health care history that they left out during the appointment.
  4. No More Gagging: If you’re a victim of a medical mistake, you will likely be ordered to not speak about it publicly as part of any settlement you receive. Some doctors are even asking patients to sign forms promising not to post anything negative online regarding their care before their first appointment. In hospitals, many health care workers feel they cannot speak up about medical errors, for fear of putting their jobs in jeopardy or suffering retaliations from co-workers.

But as Dr. Makary said, “We need more open dialogue about medical mistakes, not less.”

You’re Being Admitted to the Hospital: Tips for Staying Safe

In my recent interview (above) with Dr. Saul, he shared potentially life-saving tips in the event you find yourself in a hospital. Knowing how to prevent disease so you can avoid hospitals in the first place is clearly your best bet. But knowing what to do to make your hospital stay as safe as possible is equally important. Understand that you, the patient, are the most powerful entity within the entire hospital system. However, the system works on the assumption that the patient will not claim that power. Knowing your rights and responsibilities can help ensure your hospital stay is a safe and healing one.

One of the reasons I am so passionate about sharing the information on this site about healthy eating, exercise, and stress management with you is because it can help keep you OUT of the hospital. But if you do have to go there, you need to know how to play the game.

Many believe training hospitals will provide them with the latest and greatest care, but they can actually be far more dangerous.

As a general rule, avoid elective surgeries and procedures during the month of July because this is when brand new residents begin their training. According to a 2010 report in the Journal of General Internal Medicine,8 lethal medication errors consistently spike by about 10 percent each July, particularly in teaching hospitals, due to the inexperience of new residents. Also be cautious of weekends.

My primary suggestion is to avoid hospitals unless it’s an absolute emergency and you need life-saving medical attention. In such cases, it’s worth taking one of Dr. Saul’s recommendations, which is to bring a personal advocate – a relative or friend who can speak up for you and ensure you’re given proper care if you can’t do so yourself. If you’re having an elective medical procedure done, remember that this gives you greater leeway and personal choice – use it!

The other KEY is to be proactive and start pursuing a healthy lifestyle today so you don’t become a victim. I have compiled my best tips in a customized 100-page report on how you can Take Control of Your Health. It is customized to three different levels and you can start at any level, but be sure and read from the beginning, as reviewing the basics is the best way to reinforce healthy patterns.

Download Interview Transcript

Retrieved from: http://articles.mercola.com/sites/articles/archive/2012/10/27/medical-errors-kill.aspx?utm_source=dlvr.it&utm_medium=linkedin

 

Area of the Brain that Processes Empathy Identified

In Brain imaging, Brain studies, Neuropsychology, Neuroscience on Sunday, 28 October 2012 at 08:49

Area of the Brain that Processes Empathy Identified

ScienceDaily (Oct. 24, 2012)

An international team led by researchers at Mount Sinai School of Medicine in New York has for the first time shown that one area of the brain, called the anterior insular cortex, is the activity center of human empathy, whereas other areas of the brain are not. The study is published in the September 2012 issue of the journal Brain.

Empathy, the ability to perceive and share another person’s emotional state, has been described by philosophers and psychologists for centuries. In the past decade, however, scientists have used powerful functional MRI imaging to identify several regions in the brain that are associated with empathy for pain. This most recent study, however, firmly establishes that the anterior insular cortex is where the feeling of empathy originates.

“Now that we know the specific brain mechanisms associated with empathy, we can translate these findings into disease categories and learn why these empathic responses are deficient in neuropsychiatric illnesses, such as autism,” said Patrick R. Hof, MD, Regenstreif Professor and Vice-Chair, Department of Neuroscience at Mount Sinai, a co-author of the study. “This will help direct neuropathologic investigations aiming to define the specific abnormalities in identifiable neuronal circuits in these conditions, bringing us one step closer to developing better models and eventually preventive or protective strategies.”

Xiaosi Gu, PhD, who conducted the research in the Department of Psychiatry at Mount Sinai, worked with researchers from the United States and China, to evaluate Chinese patients, at Beijing Tiantan Hospital, who were shown color photographs of people in pain. Three patients had lesions caused by removing brain tumors in the anterior insular cortex; nine patients had lesions in other parts of the brain and 14 patients (the controls) had neurologically intact brains. The research team found that patients with damage restricted to the anterior insular cortex had deficits in explicit and implicit empathetic pain processing.

“In other words, patients with anterior insular lesions had a hard time evaluating the emotional state of people in pain and feeling empathy for them, compared to the controls and the patients with anterior cingulate cortex lesions.” said Dr. Jin Fan, corresponding author of this study and an assistant professor at the Department of Psychiatry at Mount Sinai.

According to Dr. Gu, this study provides the first evidence suggesting that the empathy deficits in patients with brain damage to the anterior insular cortex are surprisingly similar to the empathy deficits found in several psychiatric diseases, including autism spectrum disorders, borderline personality disorder, schizophrenia, and conduct disorders, suggesting potentially common neural deficits in those psychiatric populations.

“Our findings provide strong evidence that empathy is mediated in a specific area of the brain,” said Dr. Gu, who now works at University College London. “The findings have implications for a wide range of neuropsychiatric illnesses, such as autism and some forms of dementia, which are characterized by prominent deficits in higher-level social functioning.”

This study suggests that behavioral and cognitive therapies can be developed to compensate for deficits in the anterior insular cortex and its related functions such as empathy in patients. These findings can also inform future research evaluating the cellular and molecular mechanisms underlying complex social functions in the anterior insular cortex and develop possible pharmacological treatments for patients.

The study was funded by the National Institute of Health, the James S. McDonnell Foundation and a Brain and Behavior Research Foundation NARSAD young investigator award.

Retrieved from: http://www.sciencedaily.com/releases/2012/10/121024175240.htm?utm_source=twitterfeed&utm_medium=linkedin&utm_campaign=Feed%3A+sciencedaily%2Fmind_brain%2Fdisorders_and_syndromes+%28ScienceDaily%3A+Mind+%26+Brain+News+–+Disorders+and+Syndromes%29

***

 

Anterior insular cortex is necessary for empathetic pain perception

Xiaosi Gu,  Zhixian Gao, Xingchao Wang, Xun Liu,  Robert T. Knight,  Patrick R. Hof, and

Jin Fan

Summary

Empathy refers to the ability to perceive and share another person’s affective state. Much neuroimaging evidence suggests that observing others’ suffering and pain elicits activations of the anterior insular and the anterior cingulate cortices associated with subjective empathetic responses in the observer. However, these observations do not provide causal evidence for the respective roles of anterior insular and anterior cingulate cortices in empathetic pain. Therefore, whether these regions are ‘necessary’ for empathetic pain remains unknown. Herein, we examined the perception of others’ pain in patients with anterior insular cortex or anterior cingulate cortex lesions whose locations matched with the anterior insular cortex or anterior cingulate cortex clusters identified by a meta-analysis on neuroimaging studies of empathetic pain perception. Patients with focal anterior insular cortex lesions displayed decreased discrimination accuracy and prolonged reaction time when processing others’ pain explicitly and lacked a typical interference effect of empathetic pain on the performance of a pain-irrelevant task. In contrast, these deficits were not observed in patients with anterior cingulate cortex lesions. These findings reveal that only discrete anterior insular cortex lesions, but not anterior cingulate cortex lesions, result in deficits in explicit and implicit pain perception, supporting a critical role of anterior insular cortex in empathetic pain processing. Our findings have implications for a wide range of neuropsychiatric illnesses characterized by prominent deficits in higher-level social functioning.

Retrieved from: http://brain.oxfordjournals.org/content/135/9/2726

autism and schizophrenia…kissing cousins.

In Autism Spectrum Disorders, Genes, Genomic Medicine, Neuroscience on Thursday, 25 October 2012 at 16:29

http://www.eurekalert.org/pub_releases/2012-10/afot-asa102312.php

Are autism and schizophrenia related?

Posted on October 23, 2012 by Stone Hearth News

Autism Spectrum Disorders (ASD), a category that includes autism, Asperger Syndrome, and Pervasive Developmental Disorder, are characterized by difficulty with social interaction and communication, or repetitive behaviors. The U.S. Centers for Disease Control and Management says that one in 88 children in the US is somewhere on the Autism spectrum — an alarming ten-fold increase in the last four decades.

New research by Dr. Mark Weiser of Tel Aviv University’s Sackler Faculty of Medicine and the Sheba Medical Center has revealed that ASD appears share a root cause with other mental illnesses, including schizophrenia and bipolar disorder. At first glance, schizophrenia and autism may look like completely different illnesses, he says. But closer inspection reveals many common traits, including social and cognitive dysfunction and a decreased ability to lead normal lives and function in the real world.

Studying extensive databases in Israel and Sweden, the researchers discovered that the two illnesses had a genetic link, representing a heightened risk within families. They found that people who have a schizophrenic sibling are 12 times more likely to have autism than those with no schizophrenia in the family. The presence of bipolar disorder in a sibling showed a similar pattern of association, but to a lesser degree.

A scientific leap forward, this study sheds new light on the genetics of these disorders. The results will help scientists better understand the genetics of mental illness, says Dr. Weiser, and may prove to be a fruitful direction for future research. The findings have been published in the Archives of General Psychiatry.

All in the family

Researchers used three data sets, one in Israel and two in Sweden, to determine the familial connection between schizophrenia and autism. The Israeli database alone, used under the auspices of the ethics committees of both the Sheba Medical Center and the Israeli Defense Forces, included anonymous information about more than a million soldiers, including patients with schizophrenia and ASD.

“We found the same results in all three data sets,” he says, noting that the ability to replicate the findings across these extensive databases is what makes this study so significant.

Understanding this genetic connection could be a missing link, Dr. Weiser says, and provides a fresh direction for study. The researchers are now taking this research in a clinical direction. For now, though, the findings shouldn’t influence the way that doctors treat patients with either illness, he adds.

Retrieved from: http://www.stonehearthnewsletters.com/are-autism-and-schizophrenia-related/autism/

i can’t decide if this is just sad. or ironic. or sad and ironic…

In Uncategorized on Thursday, 25 October 2012 at 16:07

i could make many inappropriate comments here…suffice it to say, this is an interesting commentary on society

http://www.huffingtonpost.com/2012/10/24/catarina-migliorini-sells-virginity-780k_n_2010260.html?utm_campaign=102512&utm_medium=email&utm_source=Alert-weird-news&utm_content=FullStory

genes, genes, genes…more awesomeness in genomic medicine!

In Autism Spectrum Disorders, Genes, Genomic Medicine, Neuroscience on Thursday, 25 October 2012 at 14:26

http://boards.medscape.com/forums?128@410.Oln9aayNn1L@.2a35a68e!comment=1

Multiple papers recently published have documented links between de novo mutations and autism, schizophrenia, and intellectual disability. Here, I review the topic and raise some of the key questions on this issue going forward.

References:
– Kong A, et al. Rate of de novo mutations and the importance of father’s age to disease risk. Nature. 2012;488:471-475.
– Wang J, et al. Genome-wide single-cell analysis of recombination activity and de novo mutation rates in human sperm. Cell. 2012;150:402-412.
– Rauch A, et al. Range of genetic mutations associated with severe non-syndromic intellectual disability: an exome sequencing study. Lancet. 2012 Sept 26. [Epub ahead of print]
– de Ligt J, et al. Diagnostic exome sequencing in persons with severe intellectual disability. N Engl J Med. 2012 Oct 3. [Epub ahead of print]

______________________

Below is a transcript of Dr. Topol’s post “De Novo Mutations and the Implications for the Father’s Biological Clock.” We look forward to your feedback.
Our topic is de novo mutations and the implication of these new mutations for expectant fathers. This is a really important topic that was highlighted by the cover article in August 2012 in Nature. It was also in recent multiple papers in Cell, where sperm was sequenced for the first time, as well as in multiple papers on de novo mutations in Nature and Nature Genetics.

While we have known about the possibility for new mutations to occur that are not heritable, the quantification of this has become possible now that we can do sequencing of sperm and compare that to the germline DNA of the father. What is fascinating is that there have been now multiple papers that have come out in recent weeks to demonstrate the link between de novo mutations and intellectual disability, schizophrenia, and autism — and especially the paper coming from the Icelandic group DECODE, which linked the father’s age with the incidence of de novo mutations.

These new mutations are not frequent, of course, but if there’s just one per exome, that is, throughout the coding elements of the genome, that can be quite damaging. In fact, it is characteristic of de novo mutations that they tend to be bad and have adverse consequences.

While there are many more in a typical genome, somewhere around 70 or more of various types of mutations, whether they’re single nucleotide polymorphisms or insertions/deletions, most of them do not fall in protein coding elements. But when they do, the data we have so far from this collective work suggest that they can be damaging.

The big issue going forward is — what can we do about this? Is this de novo mutation related to our environment? Can we try to reduce the age of fathers and set up the “male biological clock,” which, for all of the years, has been largely restricted to the mother’s story? Can we someday screen sperm for de novo mutations, screen them out or at least get a sense of the frequency? It seems unlikely that we would sequence and then use the sperm for in vitro fertilization, but perhaps we can leverage this knowledge. Of course, the age relationship is tricky because, so far, we don’t have much data to suggest an age range, but clearly there is a relationship with age of the father as it extends to 40 and beyond with a higher rate of de novo mutations.

We also know that, concurrently, the rate of diagnosis of autism is increasing. Could this have something to do with this de novo mutation increase and the overall trend of a higher paternal age?

There is a lot here to consider on a theme that is showing up in multiple papers: the way to quantify de novo mutations, understand their increased frequency as fathers age, and this very interesting link to multiple neurologic, neurocognitive, and neuropsychiatric conditions.

Over time, it’s likely that these de novo mutations will exert a phenotype that is beyond the neurology world. It will also be interesting to see how de novo mutations could potentially have a beneficial role. But one thing for sure is that this is part of the story about missing heritability: we couldn’t account for things that were happening in a new generation that were not present from the parents, and de novo mutations are certainly a part of that story.

Thanks for your attention. I look forward to your comments about de novo mutations and especially the father’s biological clock phenomenon.

Retrieved from: http://boards.medscape.com/forums?128@410.Oln9aayNn1L@.2a35a68e!comment=1

dream a little dream of me…

In Neuropsychology, Neuroscience, Psychiatry, Psychopharmacology on Tuesday, 23 October 2012 at 09:51

What Physicians Need to Know about Dreams and Dreaming

James F. Pagel

Abstract

Purpose of review: An overview of the current status of dream science is given, designed to provide a basic background of this field for the sleep-interested physician.

Recent findings: No cognitive state has been more extensively studied and is yet more misunderstood than dreaming. Much older work is methodologically limited by lack of definitions, small sample size, and constraints of theoretical perspective, with evidence equivocal as to whether any special relationship exists between rapid eye movement (REM) sleep and dreaming. As the relationship between dreams and REM sleep is so poorly defined, evidence-based studies of dreaming require a dream report. The different aspects of dreaming that can be studied include dream and nightmare recall frequency, dream content, dreaming effect on waking behaviors, dream/nightmare associated medications, and pathophysiology affecting dreaming.

Summary: Whether studied from behavioral, neuroanatomical, neurochemical, pathophysiological or electrophysiological perspectives, dreaming reveals itself to be a complex cognitive state affected by a wide variety of medical, psychological, sleep and social variables.

Introduction

As most individuals experience the cognitive mentation that we call dreams during sleep, any physician treating sleep needs to have at least a basic understanding of dreaming. It was just 50 years ago that polysomnography allowed for sleep to be electrophysiologically staged. Although sleep had yet to be examined, a huge literature existed on dreaming and, through psychoanalysis, the use of dreams in the treatment of the spectrum of mental illness. Today, the scientific study of dreams has come full circle. We now know a huge amount about sleep, its associated pathophysiology, and treatment, yet what we know scientifically about the dream state is far less than what we thought we knew a generation ago. Much older work was not evidence based, and was methodologically limited by lack of definitions, small sample size, and the constraints of theoretical perspective. After 50 years of dogmatic insistence that rapid eye movement (REM) sleep is dreaming, most researchers in the field now accept that the evidence is overwhelming that REM sleep occurs without dreaming and dreaming without REM sleep.[1] Evidence remains equivocal as to whether any special relationship exists between REM sleep and dreaming.[2•] It is unclear as to what part, if any, of the highly developed neuroanatomical and neurochemical model for REM sleep is applicable to the cognitive state of dreaming.

Definitions: What is a Dream?

Early in the 20th century, Sigmund Freud and his adherents developed the psychoanalytic techniques of free association and dream analysis for use in diagnosing and treating individuals with psychiatric illnesses. Freud focused on the psychopathologic associations of bizarre and unusual dreams, eventually giving us a definition of dreaming as ‘wish fulfillment.’ Psychoanalysts stretched the definition of dreaming to include parasomnias and the REM sleep-associated states of narcolepsy, defining dreams as bizarre, hallucinatory mental activity that can occur in either sleep or wake.[3] This psychoanalytic definition of dreaming became the generally accepted definition for this phenomenon among many psychiatrists and neuroscientists.

From its initial discovery, REM sleep = dreaming was proof of the correlate between psychoanalysis and brain structure, a postulate at the basis of grand theories of dreaming including Activation, Input, Modulation (AIM), now termed protoconsciousness theory and the most developed and widely accepted theory of central nervous system (CNS) functioning.[4] It is a primary postulate of AIM that the neurons and neurochemicals that modulate REM sleep alter dreaming and other conscious states in a similar manner. The AIM model has been adopted and extended into proposals that REM sleep dreaming is the process that organizes neural nets in higher cortical regions.[5] These theories postulate that the cognitive activity of dreaming is based on the CNS activation associated with REM sleep, with dreaming an upper cerebral cognitive process utilizing the CNS activation associated with a primitive electrophysiological state of activation that we call REM sleep. If REM sleep is dreaming, animal models and scanning studies of REM sleep as reported in the popular and scientific press can be construed to be studies of the cognitive state of dreaming. Such studies must be considered suspect, however, as dreaming occurs throughout sleep in forms (except for nightmares) indistinguishable from REM sleep dreaming.[6]

Most sleep medicine physicians consider dreaming to be mentation reported as occurring in sleep by a human participant. This definition contradicts the psychoanalytic definition for dreaming, restricting dreaming to sleep irrespective of content. This definition also differs from the REM sleep = dreaming model in requiring a dream report. Because of this conflation of contradicting definitions, it is important for anyone interested in perusing either scientific or popular literature to note what the author may be referring to in any discussion of dreams and dreaming.[7]

Evidence-based Research Into Dreaming

Characteristics of the dream state amenable to scientific study include recall, content, dream incorporation into waking, and associated pathophysiology.

Dream Recall

Collection methodology including time since waking, process, and defined state characteristics affect reported dream recall frequency. Sleep stage of origin is a primary variable known to affect dream recall frequency. Multiple studies indicate that dream recall reported from REM sleep and sleep onset is in the range of 80%. Although recall from stage 2 varies through the night, recall approximates the 40% recall from stage 3.[8] Recall is generally higher for women and in the young.[9] Increased dream salience and intensity, typical of nightmares, also results in an increase in recall. Significant subjective and objective insomnia is associated with diminished dream recall.[10] Bi-basilar frontal CNS damage can be associated with a loss of dreaming.[11] Although some individuals report that they do not dream, most have experienced dreams at some point in their lives. The much smaller percentage of sleep laboratory patients that have never experienced dreaming (0.038%) do not report dreams in the laboratory when awakened from either REM sleep or non-REM sleep.[12] Despite their lack of dream recall, these individuals have no obvious memory impairment and function normally in our society.

Dream Content

Guttenberg’s first printed book was the Bible, but his second was the Oneirocritica, an interpretation of the meaning of dream symbols.[13] Mankind’s focus on dream content likely predates the development of either printing or writing.[2•] Dream content has been incorporated into the worlds’ major religions, philosophies, literature, and science. The argument can cogently be made that the structure and narrative form of language itself is derived from our attempts to organize and share our dreams. Most dreams are narratives occurring, and often presented without applied organization, grammar, or expectation of critique. In the dream, we can literally observe the ‘thinking of the body,’ and with it, the birth of the literary process. Our dreams can be considered an exercise in pure storytelling whose end is nothing more (or less) than the organization of experience into set patterns that help to maintain order for the thinking system.[14]

Freud postulated that an individual’s psychic structure could be inferred from information derived from the associative interpretation of dreams, and then could be utilized in developing a therapeutic plan for the treatment of psychiatric symptoms.[15] He stated, ‘Psychoanalysis is related to psychiatry approximately as histology is related to anatomy’.[16] For more than a generation, psychiatrists were trained in the method, with the data derived from psychoanalytic techniques used to make diagnoses and form treatment plans. Although psychoanalysis was utilized with occasional success in treating psychiatric illness, most of the evidence attesting to its therapeutic efficacy was anecdotal and subjective.[3]

More recent studies of dream content have attempted to address the significant methodological problems of transference, collection and interpretation that led to the nonreplicable characteristics of dream content studies. Methodologically sound studies have been developed that utilize computerized analysis of the validated Hall and Van de Castle content system.[17] Such studies have shown few, if any, significant differences in dream content between personality types, psychopathologic diagnoses, or socio-ethnic groups.[18] The primary significant correlate for dream content has proven to be waking experience, supporting the so-called continuity hypothesis – dream content reflects our waking experience.[18] Dream researchers have persisted in developing alternative content scales in order to support theoretical perspectives.[19] Although few of these scales have been validated or subjected to independent analysis, the best data is for Hartmann’s analysis of personality correlates (boundaries) that affect both dream recall frequency and content.[20]

Studies have also started to address other aspects of dream content. Visual imagery, the primary characteristic of most reported dreams, follows an operative pattern in dreaming that can be studied and applied externally to filmmaking methodology.[6] Memories follow characteristic patterns in both dream-associated sleep and varied waking states.[21•] Emotions, particularly negative emotions, are routinely incorporated into dreaming.[22]

Dream Incorporation Into Waking Behavior

Many individuals use their dreams. As in recall, dream-use tends to be sex-based and age-based (higher in women and the young).[23] Although ethnic and cultural differences in dream-use exist, such variations do not tend to be present in general population samples.[24] Dream use is significantly higher among individuals reporting creative interests.[25] Among successfully creative individuals, dream and nightmare recall, as well as dream incorporation into work and waking behavior is much higher than in the general population, suggesting that one function of dreaming may be in the creative process.[6,26]

Medications Inducing Disturbed Dreaming and Nightmares

Until recently, neurochemists interested in dreaming focused their studies on the effects of various neurochemicals on REM sleep based on the belief that medications affecting dreaming would be the same ones known to affect REM sleep. Acetylcholine is the primary neuromodulator affecting REM sleep.[27] A wide variety of pharmaceutical agents have anticholinergic activity, and the reported side effects of some of these agents include nightmares, disordered dreaming and hallucinations. This has led some authors to postulate that cholinergic effects of medications induce nightmares, hallucinations, and psychosis.[28] Based on this theoretical construct, the anticholinesterase agents in widespread use for the treatment of the cognitive effects of Alzheimer’s disease should alter dreaming. These agents, however, are reported to induce the side effect of disturbed dreaming or nightmares in only 0.4% of clinical trial participants.[29]

Agents that suppress REM sleep such as ethanol and benzodiazepines induce episodes of REM sleep rebound on withdrawal. These REM sleep rebound episodes have been associated with reports of nightmares and disturbed dreaming, and were considered the primary mechanism for drug-induced disordered dreaming and nightmares. However, nightmares and disordered dreaming are often reported as part of the withdrawal syndrome from addictive medications such as cannabis, cocaine and opiates that, which are not known to affect REM sleep. This suggests that during withdrawal from addictive agents, disturbed dreaming and nightmares may be an intrinsic part of that process rather than occurring secondary to REM sleep rebound.[29,30]

Data based on clinical trials and case reports of effects and side effects of clinically utilized pharmaceutical agents indicate that a much different pattern of medications induce disordered dreaming and nightmares than those known to affect REM sleep.[29] The spectrum of medications affecting dreaming indicates that the state is neurochemically complex with medications influencing the neurotransmitters/neuromodulators dopamine, nicotine, histamine, GABA, serotonin, nicotine, and norepinephrine altering dreaming and reported nightmare frequency in 1–5% of patients using these medications.[29] Medications with clinical cognitive effects and/or side-effects of arousal (insomnia) and/or sedation are those that most commonly alter the reported frequency of disordered dreaming and nightmares ( ).

Among drug classes of prescription medications in clinical use, β-blockers affecting norepinephrine neuroreceptors are most likely to result in patient complaints of disturbed dreaming. The strongest clinical evidence for a specific drug to induce disordered dreaming or nightmares is for the selective serotonin reuptake inhibitor paroxetine – a medication known to suppress REM sleep. Because of the high frequency of use of over-the-counter preparations containing type-1 antihistamines for sleep induction and the treatment of allergies, such preparations are likely responsible for most reports of drug-induced disordered dreaming and nightmares.[29]

Table 1.  Cognitive effects and side effects of medications: neurotransmitter/neuromodulator-associated central nervous system effects

Basis for central nervous system activity Sleepiness Insomnia Alterations in dreaming
Neuromodulator and/or neurotransmitter mediated effects
   Serotonin +++ ++ +++
   Norepinephrine ++ ++ +++
   Dopamine +++ +++ +++
   Histamine +++ + ++
   GABA +++ + ++
   Acetylcholine ++
   Adenosine + +++
   Nicotine +++ +++
Other medication effects
   Effects on inflammation ++ ++ ++
   Addictive drug withdrawal + +++ +++
   Altered conscious interaction with environment +++ + ++
   Alterations in sleep associated disease +++ +++ +

+++, majority of drugs with this activity cause this effect in more than 5% of patients; ++, some drugs with this activity induce this effect in 1–5% of patients; +, an idiosyncratic effect for some agents in this group or withdrawal effect; −reported in less than 1% of patients using agents affecting this neurotransmitter/neuromodulator [29]

Pathophysiology of Dreaming And Nightmares

Although changes in dreaming are sometimes reported, most reports of pathophysiological correlates for dreaming are reports of nightmares – coherent dream sequences usually occurring in REM sleep that become increasingly more disturbing as they unfold and usually resulting in awakening.[31]

Dream-like Parasomnias

Dreaming (cognitive narrative, feeling, or awareness of dreaming on awakening) occurs in association with many parasomnias – unwanted behaviors occurring during sleep.

Parasomnias are in general classified based on sleep stage of origin.

Disorders of Arousal

The disorders of arousal occurring out of deep sleep are associated with dream mentation up to 40% of the time. Somambulism is characterized by autonomic and inappropriate behaviors, frantic attempts to escape a perceived threat, and fragmentary recall. Sleep terrors and confusional arousals are associated with incoherent vocalizations, intense autonomic discharge, confusion and disorientation, and fragmentary dream recall.[32]

Hypnogognic Phenomena

The sleep onset nightmares typical of posttraumatic stress disorder (PTSD) and sleep onset sleep paralysis can occur without the classic REM sleep association. Sleep onset PTSD nightmares often induce distress that interferes with the initiation of sleep. Hypnogogic hallucinations are primarily visual and have coherent dream storylines that are perceived as potentially real. Although commonly experienced (prevalence rates vary from 25 to 37%), such experiences are also a part of the classic tetrad of narcolepsy.[33] The regularly experienced hypnogogic hallucinations reported by 40–60% of individuals carrying the diagnosis of narcolepsy with cataplexy may have more complex storylines than those reported in the general population.[3,34] Sleep starts, most commonly experienced at sleep onset, can be associated with the impression of falling.

Rapid Eye Movement Sleep-associated Parasomnias 

REM sleep is classically associated with dream-like parasomnias. Some of these parasomnias can also occur outside REM sleep. PTSD nightmares and sleep paralysis can occur at sleep onset. REM sleep behavior disorder (RBD) phenomena can also occur in association with arousal disorders.

Nightmare Disorder

Nightmare disorder is characterized by recurrent nontrauma-related REM sleep dreams that result in intense anxiety, fear or terror, and a coherent dream story usually involving imminent physical danger for the dreamer. Associated insomnia and difficulty returning to sleep are usually present. As in most parasomnias, arousals associated with obstructive sleep apnea (OSA) or periodic limb movement disorder can result in increased symptomatology; however, in patients with the disordered sleep associated with moderate to severe OSA, normal dreaming is maintained while reported nightmares actually decline in frequency.[35] Personality patterns typically present in individuals with frequent nightmares include fantasy proneness, psychological absorption, dysphoric daydreaming and ‘thin’ boundaries.[20] Such individuals are more likely to have a creative or artistic focus in their daily lives. Some of these individuals may utilize their dreams and nightmares in highly successful creative careers in writing, acting and film.[36 

Posttraumatic Stress Disorder-associated Nightmares

Frequent nightmares are the most common symptom of PTSD, affecting approximately 25% of individuals who have experienced severe emotional or physical trauma.[37] The nightmares that characterize PTSD are frightening and sometimes stereotypic dreams that can include re-experiencing of the individual’s trauma. Nightmares may be a failure of emotional processing systems that are active during sleep, particularly REM sleep.[22,38] Significant improvement in both sleep onset and maintenance insomnia has been achieved in PTSD patients with the use of both cognitive/behavioral and medication approaches that demonstrably reduce the frequency and distress associated with these disturbing dreams.[39]

Rapid Eye Movement Sleep Behavior Disorder (RBD) and Sleep Paralysis

In patients with RBD, vivid dreams are often ‘acted out.’ Such dream-related behavior can be violent and can result in injury to the victim or bedpartner. In contrast to those who experience sleep terrors, the victim will often recall coherent dream stories that, in a minority of cases, correlate with observed RBD behaviors.[40] RBD events can occur outside the sleep stage for which it is named.[41] During REM sleep associated with sleep paralysis, the inability to perform voluntary movements on waking, with full recall of dreaming, can lead to intense anxiety.

Other Dream-like Parasomnias

Sleep talking (somniloquy), which usually occurs in stage-2 non-REM sleep but which can accompany any stage of sleep, may include embarrassing waking content. Anxiety and panic attacks, also predominately occurring in stage-2, may also include coherent dream content. Sleep related dissociative disorder occurring in individuals with waking dissociative disorders is characterized by re-experiencing of trauma that presents during nighttime awakenings. Nocturnal partial epileptic seizures can include thoughts and hallucinations.[42]

Conclusion 

The recent progress that researchers have made in understanding dreams has been incremental, and is not nearly as exciting as the simplified insights, at the time regarded as breakthroughs into the process of consciousness, that were once attributed to dreaming. This recent work indicates that dreaming is a complex cognitive state whether viewed from behavioral, neuroanatomical, neurochemical, pathophysiological or electrophysiological perspectives. Our dreams are what we remember in the morning of the cognition taking place in our CNS during sleep. It is recommended that physicians treating sleep and its disorders be familiar with current knowledge of the science of dreaming. 

Sidebar

Key Points

  • Dreaming is not limited to rapid eye movement (REM) sleep, but rather occurs throughout sleep.
  • Dreaming defined as cognitive narrative, feeling, or awareness of dreaming on awakening occurs in association with many parasomnias.
  • Dreaming is a complex cognitive state whether viewed from behavioral, neuroanatomical, neurochemical, pathophysiological or electrophysiological perspectives.
  • Medications affecting the neurotransmitters/neuromodulators dopamine, nicotine, histamine, gamma-aminobutyric acid (GABA), serotonin, nicotine, and norepinephrine alter dreaming and reported nightmare frequency.

References

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    • This book providesa state of the art analysis of the highly developed neuroanatomic and neurochemical model for REM sleep.
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  4. Hobson J. Dream life: an experimental memoir. Cambridge, MA: MIT Press; 2011.
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  6. Pagel JF. The limits of dream – a scientific exploration of the mind/brain interface. Oxford, UK: Academic Press (Elsiever); 2008.
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  8. Foulks D. Data constraints on theorizing about dream function, In: Moffitt A, Kramer M, Hoffmann R, Albany, editors. The functions of dreaming. New York: SUNY Press; 1993. pp. 11–20.
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  11. Kaplan-Solmes K, Solmes M. Clinical studies in neuro-psychoanalysis: introduction to depth neuropsychology. New York & London: Karnac Books; 2000.
  12. Pagel JF. Nondreamers. Sleep Med 2003; 4:235–241.
  13. Hunt H. Dreams as literature/science: an essay. Dreaming 1991; 1:235–242.
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  18. Domhoff GW. The scientific study of dreams; neural networks, cognitive development and content analysis. Washington DC: American Psychological Association; 2003.
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  34. Scrima L. Dreaming epiphenomina of narcolepsy, In: Pagel JF, editor. Dreaming and nightmares – sleep medicine clinics, vol. 5. Philadelphia, PA: Saunders; 2010. pp. 261–276.
  35. Pagel JF. The nightmares of sleep apnea: nightmare frequency declines with increasing Apnea Hypopnea Index (AHI). J Clin Sleep Med 2010; 6:69–74.
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Curr Opin Pulm Med. 2012;18(6):574-579

Retrieved from: http://www.medscape.com/viewarticle/772192_2

 

adhd…under and over diagnosed.

In ADHD, ADHD Adult, ADHD child/adolescent, Psychiatry, School Psychology on Sunday, 21 October 2012 at 09:47

Attention Deficit Hyperactivity Disorder is Both Under and Over Diagnosed, Study Suggests

ScienceDaily (Oct. 19, 2012)

Attention Deficit Hyperactivity Disorder is both under and over diagnosed. That’s the result of one of the largest studies conducted on ADHD in the United States, published in the Journal of Attention Disorders.

A substantial number of children being treated for ADHD may not have the disorder, while many children who do have the symptoms are going untreated, according to the 10-year Project to Learn about ADHD in Youth (PLAY) study funded by the National Center on Birth Defects and Developmental Disabilities of the Centers of Disease Control and Prevention

“Childhood ADHD is a major public health problem. Many studies rely on parent reporting of an ADHD diagnosis, which is a function of both the child’s access to care in order to be diagnosed, and the parent’s perception that there is a problem,” said Robert McKeown, of the University of South Carolina’s Arnold School of Public Health, who led the South Carolina portion of the study.

“Further complicating our understanding of the prevalence of ADHD and its treatment is that the diagnosis often is made by a clinician who has little experience assessing and diagnosing mental disorders. As a result, ADHD is both under and over diagnosed,” said McKeown, distinguished professor emeritus in the department of epidemiology and biostatistics.

The study, conducted between 2002-2012, was a collaborative research project with the University of South Carolina’s Arnold School and School of Medicine and the University of Oklahoma’s Health Sciences Center.

“To our knowledge, this is the largest community-based epidemiologic study of ADHD to date,” McKeown said.

The study found that 8.7 percent of children in the community sample in South Carolina had enough symptoms to fit the ADHD diagnosis at the time of the initial assessment. The percentage was 10.6 in Oklahoma.

The report also revealed that the number of parents in the community sample who reported that their children were taking ADHD medication was 10.1 percent in South Carolina and 7.4 percent in Oklahoma. Yet, of the children taking ADHD medication, only 39.5 percent in South Carolina and 28.3 percent in Oklahoma actually met the case definition of ADHD.

“ADHD is not a snap diagnosis. It requires data from several sources and across several domains and considerable expertise to diagnose accurately and differentiate from other possible problems,” McKeown said.

The CDC reports that ADHD is one of the most common neurobehavioral disorders of childhood. Often first diagnosed in childhood, ADHD affects a child’s ability to do well in school and his or her ability to make and keep friends. While many children “outgrow” the disorder, ADHD can continue into adulthood, impacting the individual’s ability to work and function in society.

McKeown said the study found that many children taking ADHD medication did not meet the ADHD diagnostic criteria.

“These children had more ADHD symptoms, on average, than the other comparison children. Many children meeting case criteria had not been previously identified and were not receiving medication treatment, suggesting that the condition remains underdiagnosed,” he said.

The study was designed to follow children from elementary school through adolescence (ages 5 — 13) and investigate the short- and long-term outcomes of children with ADHD. Teachers screened 10,427 children in four school districts across the two states where the study was conducted. ADHD ratings by teacher and parent reports of diagnosis and medication treatment were used to determine whether children were high or low risk for ADHD.

Study questions focused on the prevalence and treated prevalence of ADHD in children; the existence of other health problems in children with ADHD, and the types and rates of health risk behaviors in children with ADHD. The study also looked at treatment patterns, both past and current, of children with ADHD.

“The findings of our study suggest that a fair number of children are being treated who do not meet case criteria and that there are children who do meet criteria but are not being treated,” McKeown said. “ADHD is not a snap diagnosis. It requires data from several sources and across several domains and considerable expertise to diagnose accurately and differentiate from other possible problems.”

Children and adolescents with ADHD also were found to have high rates of other disorders, including oppositional defiant disorder and conduct disorder. They also were more likely to engage in risky or impulsive behaviors, he said.

“We will follow up on these initial reports as the children age to determine what, if any, changes have occurred in the symptom patterns, as well as in the types of health risk behaviors,” McKeown said.

“We hope that this will shed light on the prevalence and the treatment of ADHD and will lead practitioners to seek consultation if they are not trained to assess, diagnose and treat ADHD,” he said. “We also hope it will lead parents and practitioners to assess all the treatment options to determine what works best for each child.”

USC researchers involved in the study included Dr. Steven Cuffe of the University of Florida College of Medicine-Jacksonville, formerly of the USC School of Medicine; Arnold School doctoral student Lorie L. Geryk; and Matteo Botai of the Karolinska Institutet in Sweden and Joseph R. Holbrook of the CDC, both formerly at the Arnold School.

University of South Carolina (2012, October 19). Attention deficit hyperactivity disorder is both under and over diagnosed, study suggests.ScienceDaily. Retrieved October 21, 2012, from http://www.sciencedaily.com­ /releases/2012/10/121019141124.htm

Retrieved from: http://www.sciencedaily.com/releases/2012/10/121019141124.htm

exercise and adhd…

In ADHD, ADHD Adult, ADHD child/adolescent, Fitness/Health, Neuropsychology, Psychiatry, School Psychology, Special Education on Sunday, 21 October 2012 at 09:43

Exercise May Lead to Better School Performance for Kids with ADHD

ScienceDaily (Oct. 16, 2012)

A few minutes of exercise can help children with attention deficit hyperactivity disorder perform better academically, according to a new study led by a Michigan State University researcher.

The study, published in the current issue of the Journal of Pediatrics, shows for the first time that kids with ADHD can better drown out distractions and focus on a task after a single bout of exercise. Scientists say such “inhibitory control” is the main challenge faced by people with the disorder.

“This provides some very early evidence that exercise might be a tool in our nonpharmaceutical treatment of ADHD,” said Matthew Pontifex, MSU assistant professor of kinesiology, who led the study. “Maybe our first course of action that we would recommend to developmental psychologists would be to increase children’s physical activity.”

While drugs have proven largely effective in treating many of the 2.5 million school-aged American children with ADHD, a growing number of parents and physicians worry about the side effects and costs of medication.

In the study, Pontifex and colleagues asked 40 children aged 8 to 10, half of whom had ADHD, to spend 20 minutes either walking briskly on a treadmill or reading while seated. The children then took a brief reading comprehension and math exam similar to longer standardized tests. They also played a simple computer game in which they had to ignore visual stimuli to quickly determine which direction a cartoon fish was swimming.

The results showed all of the children performed better on both tests after exercising. In the computer game, those with ADHD also were better able to slow down after making an error to avoid repeat mistakes — a particular challenge for those with the disorder.

Pontifex said the findings support calls for more physical activity during the school day. Other researchers have found that children with ADHD are less likely to be physically active or play organized sports. Meanwhile, many schools have cut recess and physical education programs in response to shrinking budgets.

“To date there really isn’t a whole lot of evidence that schools can pull from to justify why these physical education programs should be in existence,” he said. “So what we’re trying to do is target our research to provide that type of evidence.”

Pontifex conducted the study for his doctoral dissertation at the University of Illinois before joining the MSU faculty. His co-investigators included his adviser, kinesiology professor Charles Hillman, and Daniel Picchietti, a pediatrician at the Carle Foundation Hospital in Champaign, Ill. The research was funded by the National Institute of Child Health and Human Development.

Michigan State University (2012, October 16). Exercise may lead to better school performance for kids with ADHD. ScienceDaily. Retrieved October 21, 2012, from http://www.sciencedaily.com­ /releases/2012/10/121016132109.htm

Retrieved from: http://www.sciencedaily.com/releases/2012/10/121016132109.htm

crazily creative…

In Brain imaging, Brain studies, Neuropsychology, Neuroscience on Sunday, 21 October 2012 at 09:38

Link Between Creativity and Mental Illness Confirmed in Large-Scale Swedish Study

ScienceDaily (Oct. 16, 2012)

People in creative professions are treated more often for mental illness than the general population, there being a particularly salient connection between writing and schizophrenia. This according to researchers at Karolinska Institutet, whose large-scale Swedish registry study is the most comprehensive ever in its field.

Last year, the team showed that artists and scientists were more common amongst families where bipolar disorder and schizophrenia is present, compared to the population at large. They subsequently expanded their study to many more psychiatric diagnoses — such as schizoaffective disorder, depression, anxiety syndrome, alcohol abuse, drug abuse, autism, ADHD, anorexia nervosa and suicide — and to include people in outpatient care rather than exclusively hospital patients.

The present study tracked almost 1.2 million patients and their relatives, identified down to second-cousin level. Since all were matched with healthy controls, the study incorporated much of the Swedish population from the most recent decades. All data was anonymized and cannot be linked to any individuals.

The results confirmed those of their previous study, that certain mental illness — bipolar disorder — is more prevalent in the entire group of people with artistic or scientific professions, such as dancers, researchers, photographers and authors. Authors also specifically were more common among most of the other psychiatric diseases (including schizophrenia, depression, anxiety syndrome and substance abuse) and were almost 50 per cent more likely to commit suicide than the general population.

Further, the researchers observed that creative professions were more common in the relatives of patients with schizophrenia, bipolar disorder, anorexia nervosa and, to some extent, autism. According to Simon Kyaga, Consultant in psychiatry and Doctoral Student at the Department of Medical Epidemiology and Biostatistics, the results give cause to reconsider approaches to mental illness.

“If one takes the view that certain phenomena associated with the patient’s illness are beneficial, it opens the way for a new approach to treatment,” he says. “In that case, the doctor and patient must come to an agreement on what is to be treated, and at what cost. In psychiatry and medicine generally there has been a tradition to see the disease in black-and-white terms and to endeavour to treat the patient by removing everything regarded as morbid.”

Simon Kyaga, Mikael Landén, Marcus Boman, Christina M. Hultman, Niklas Långström, Paul Lichtenstein. Mental illness, suicide and creativity: 40-Year prospective total population studyJournal of Psychiatric Research, 2012; DOI: 10.1016/j.jpsychires.2012.09.010

Retrieved from: http://www.sciencedaily.com/releases/2012/10/121016084934.htm

the brain in love…

In Brain imaging, Brain studies, Well-being on Sunday, 21 October 2012 at 09:30

Love, Sex, Relationships and the Brain

Does neuroscience hold the key to a lifetime of passionate love?

Published on October 18, 2012 by Melanie A. Greenberg, Ph.D. in The Mindful Self-Express

Let me not to the marriage of true minds Admit impediments. Love is not loveWhich alters when it alteration finds, Or bends with the remover to remove:O no! it is an ever-fixed mark That looks on tempests and is never shaken;It is the star to every wandering bark,Whose worth’s unknown, although his height be taken. Shakespeare, Sonnet 116

The qualities of true, romantic love have inspired playwrights, poets, and philosophers throughout the ages. Love is an ideal; an inspiration — a feeling of passion and commitment that adds richness and joy to life. A loving relationship provides a secure base from which to grow, expand and explore the world. Yet, until recently, we did not know for sure whether romantic love could last, or whether it inevitable transformed into companionate love — enduring friendship characterized more by shared interests, commitments and values than passion and excitement. Or, even more disappointing, perhaps love inevitably fades and couples stay together in miserable or passionless relationships because of social convention, convenience, and duty.

Are Kids Relationship Ruiners?

Research suggests that all of these patterns are possible. First, the bad news! Researchers at Bar Ilan University in Israel studied couples with children from pregnancy to 14.5 years after the child’s birth in two overlapping large-scale studies.  Overall, marital satisfaction decreased following the birth of the first child and continued to decline steadily, reaching an all-time low when the kids became teenagers. The more kids, the greater the decline in marital satisfaction. Dissatisfied couples did not inevitably divorce, however. Marital dissatisfaction was not significantly related to breaking up, except if husbands had especially low satisfaction during the first child’s transition to school.  Those couples with stronger relationships to begin with had less decrease in satisfaction.  The take home message is that marriage with kids is not just a bed of roses. While children can provide much pleasure and meaning, they can also take time away from couple bonding activities, place stress and emotional demands on parents, and lead to fights over parenting strategies and division of labor. Financial stress and a routine of errands and driving kids around can further erode relationship glamor and romance. Parents may be too tired for sex or even, conversation.  Thus, romantic love between parents, if left untended will diminish in intensity during childrearing years, most of the time. Shared commitment to parenthood, pride in kid’s achievements, and involvement in kids’ social, academic, and sporting activities can provide alternative sources of fulfillment and friendship during these years. When kids leave the home and couples have more time together, they can often rebuild closeness and intimacy.

Can Romantic Love Last?

At the other end of the spectrum,brain imaging studies provide proof that romantic love can last, at least for around 5-12 percent of couples, according to researcher Art Aron, the romantic love guru from Stony Brook University, in New York, whose studies look inside the brains of couples in love.  In a touching side-note, Aron often collaborates in these studies with his wife of 37 years, Elaine Aron, also a researcher at Stony Brook.

The Brain in Love

A groundbreaking study by Aron and his colleagues, published last year in the journal Social Cognitive and Affective Neuroscience sought to uncover the mysteries of how our brains process love. The researchers recruited couples that had been together more than 20 years as well as those recently fallen in love. After completing questionnaires assessing closeness, romantic love intensity, and sexual frequency, the couples entered brain scanning machines. Using functional magnetic resonance imaging to look inside the brain in real-time, the researchers compared the reactions of new, and long-time lovers, while they viewed pictures showing faces of their loved ones, and faces of close friends, and long-time acquaintances. This methodology was used to make sure that the brain effects seen were due to romantic love, rather than to affection or familiarity. Results showed that indeed, love can last, and has a unique physiological profile in the brain.  The brain scans of both long-term and recent couples showed activity in the ventral tagmental area (VTA), an area with high dopamine concentration, which is associated with reward and motivation. Partner pictures produced distinct and more powerful responses than friend and acquaintance pictures. Romantic partners, therefore, appear to have unique and lasting reward value! Also, those long-term couples that reported the highest levels of romantic love and closeness on questionnaires had levels of brain VTA activity similar to those of newly in love partners.

Sex and the Brain

This study also revealed some interesting findings related toattachment and sexuality. Compared to new partners, long-term partners showed activity in brain areas associated with attachment that demonstrated greater calmness and less tension. Thus, long-term partners may become more securely attached and less likely to fear abandonment.  Higher sexual frequency was associated with greater activity in the posterior hippocampus — an area associated withhunger, cravings, and obsession. Thus, romantic love appears to be different than sexual attraction, although this may be a component of it. Taken together these findings suggest it is important to build a strong romantic bond early on, so that love can withstand the challenges ofaging and family development. Since we know that our brains can change in adulthood and possess neuroplasticity, it is also likely that we can rebuild and renew love in relationships that have deteriorated.

How Do We Keep the Spark of Love Alive?

Research findings suggest we can rebuild or enhance love in relationships by:

  1. Generosity – Being helpful and considerate in small and large ways, doing our fair share of chores, stepping in to allow our partner to take a break.
  2. Positivity – Focusing on and communicating about our partner’s positive qualities. Showing appreciation and affection on a regular basis.
  3. Attachment – Allowing our partners to turn to us and depend on us when they are vulnerable; providing a secure emotional base and reassurance of worth.
  4. Expansion – Helping our partners to expand their worlds by engaging in novel and challenging activities together and bringing in our own passion for life.

My next post will provide concrete tools for using these research-based strategies to strengthen your own romantic relationships.

About The Author 

Melanie Greenberg, Ph.D. is a Clinical Psychologist, and expert onMindfulness, Attachment. & Relationships with expertise in the Gottman approach and Emotion-Focused Therapy for couples. Dr Greenberg provides workshops and speaking engagements for organizations and nonprofits, and coaching and therapy for individuals and couples in person or via skype.

Visit my website:

 http://melaniegreenbergphd.com/marin-psychologist/

Retrieved from: http://www.psychologytoday.com/blog/the-mindful-self-express/201210/love-sex-relationships-and-the-brain

 

STOP…and be happy!

In Fitness/Health, Inspiration, Mindfulness, Well-being on Saturday, 20 October 2012 at 07:50

Be Happier: Ten Things to Stop Doing Right Now

Jeff Haden

Sometimes the route to happiness depends more on what you don’t do.

Happiness–in your business life and your personal life–is often a matter of subtraction, not addition.

Consider, for example, what happens when you stop doing the following 10 things:

1. Blaming.

People make mistakes. Employees don’t meet your expectations. Vendors don’t deliver on time.

So you blame them for your problems.

But you’re also to blame. Maybe you didn’t provide enough training. Maybe you didn’t build in enough of a buffer. Maybe you asked too much, too soon.

Taking responsibility when things go wrong instead of blaming others isn’t masochistic, it’s empowering–because then you focus on doing things better or smarter next time.

And when you get better or smarter, you also get happier.

2. Impressing.

No one likes you for your clothes, your car, your possessions, your title, or your accomplishments. Those are all “things.” People may like your things–but that doesn’t mean they like you.

Sure, superficially they might seem to, but superficial is also insubstantial, and a relationship that is not based on substance is not a real relationship.

Genuine relationships make you happier, and you’ll only form genuine relationships when you stop trying to impress and start trying to just be yourself.

3. Clinging.

When you’re afraid or insecure, you hold on tightly to what you know, even if what you know isn’t particularly good for you.

An absence of fear or insecurity isn’t happiness: It’s just an absence of fear or insecurity.

Holding on to what you think you need won’t make you happier; letting go so you can reach for and try to earn what you want will.

Even if you don’t succeed in earning what you want, the act of trying alone will make you feel better about yourself.

4. Interrupting.

Interrupting isn’t just rude. When you interrupt someone, what you’re really saying is, “I’m not listening to you so I can understand what you’re saying; I’m listening to you so I can decide what I want to say.”

Want people to like you? Listen to what they say. Focus on what they say. Ask questions to make sure you understand what they say.

They’ll love you for it–and you’ll love how that makes you feel.

5. Whining.

Your words have power, especially over you. Whining about your problems makes you feel worse, not better.

If something is wrong, don’t waste time complaining. Put that effort into making the situation better. Unless you want to whine about it forever, eventually you’ll have to do that. So why waste time? Fix it now.

Don’t talk about what’s wrong. Talk about how you’ll make things better, even if that conversation is only with yourself.

And do the same with your friends or colleagues. Don’t just be the shoulder they cry on.

Friends don’t let friends whine–friends help friends make their lives better.

6. Controlling.

Yeah, you’re the boss. Yeah, you’re the titan of industry. Yeah, you’re the small tail that wags a huge dog.

Still, the only thing you really control is you. If you find yourself trying hard to control other people, you’ve decided that you, your goals, your dreams, or even just your opinions are more important than theirs.

Plus, control is short term at best, because it often requires force, or fear, or authority, or some form of pressure–none of those let you feel good about yourself.

Find people who want to go where you’re going. They’ll work harder, have more fun, and create better business and personal relationships.

And all of you will be happier.

7. Criticizing.

Yeah, you’re more educated. Yeah, you’re more experienced. Yeah, you’ve been around more blocks and climbed more mountains and slayed more dragons.

That doesn’t make you smarter, or better, or more insightful.

That just makes you you: unique, matchless, one of a kind, but in the end, just you.

Just like everyone else–including your employees.

Everyone is different: not better, not worse, just different. Appreciate the differences instead of the shortcomings and you’ll see people–and yourself–in a better light.

8. Preaching.

Criticizing has a brother. His name is Preaching. They share the same father: Judging.

The higher you rise and the more you accomplish, the more likely you are to think you know everything–and to tell people everything you think you know.

When you speak with more finality than foundation, people may hear you but they don’t listen. Few things are sadder and leave you feeling less happy.

9. Dwelling.

The past is valuable. Learn from your mistakes. Learn from the mistakes of others.

Then let it go.

Easier said than done? It depends on your focus. When something bad happens to you, see that as a chance to learn something you didn’t know. When another person makes a mistake, see that as an opportunity to be kind, forgiving, and understanding.

The past is just training; it doesn’t define you. Think about what went wrong, but only in terms of how you will make sure that, next time, you and the people around you will know how to make sure it goes right.

10. Fearing.

We’re all afraid: of what might or might not happen, of what we can’t change, or what we won’t be able to do, or how other people might perceive us.

So it’s easier to hesitate, to wait for the right moment, to decide we need to think a little longer or do some more research or explore a few more alternatives.

Meanwhile days, weeks, months, and even years pass us by.

And so do our dreams.

Don’t let your fears hold you back. Whatever you’ve been planning, whatever you’ve imagined, whatever you’ve dreamed of, get started on it today.

If you want to start a business, take the first step. If you want to change careers, take the first step. If you want to expand or enter a new market or offer new products or services, take the first step.

Put your fears aside and get started. Do something. Do anything.

Otherwise, today is gone. Once tomorrow comes, today is lost forever.

Today is the most precious asset you own–and is the one thing you should truly fear wasting.

Retrieved from: http://www.inc.com/jeff-haden/how-to-be-happier-work-10-things-stop-doing.html

Homework Help, Timing is Vital: Setting Yourself and Your Child Up For Success!

In ADHD, ADHD Adult, ADHD child/adolescent, Education, School Psychology, Special Education on Friday, 19 October 2012 at 15:52

Homework Help, Timing is Vital: Setting Yourself and Your Child Up For Success!.

a mother’s letter to the principal…

In Education, Education advocacy, School Psychology, Special Education on Friday, 19 October 2012 at 15:47

http://www.cnn.com/2012/10/03/living/parenting-special-needs-letter/index.html

yet another piece about teacher evaluations…

In Education, Education advocacy, School reform on Friday, 19 October 2012 at 15:14

Los Angeles Times Sues LAUSD Over Teacher Performance Data

By Barbara Jones Posted: 10/19/2012 2:17 pm EDT

The Los Angeles Times has asked a judge to order the Los Angeles Unified School District to release records that would allow the newspaper to update its online database which uses student test scores to rate the performance of individual teachers.

In its lawsuit filed Oct. 12 in Los Angeles Superior Court, the Times claims the school district illegally denied or omitted details of the information it requested under the California Public Records Act.

Although Los Angeles Unified provided updated test scores it used to gauge a teacher’s performance — a formula known Academic Growth over Time — the district withheld the teachers’ names and the schools where they worked, citing privacy concerns, the suit said.

The district also changed the teacher identification numbers it had used to release test scores from 2002-2009, making it impossible for the Times to connect teachers with AGT scores for subsequent years, the suit said.

Los Angeles Unified has not yet responded to the suit, and official had no comment.

The Times’ attorney was unavailable for comment.

The newspaper created its database in 2009, using information collected under the state’s Public Records Act.

It created a so-called “value-added system,” using previous test scores to predict how students would perform in the future, then rating the teacher’s effectiveness based on the difference between projected and actual test results.

The suit says the Times has tried for more than 15 months to get the information. The district initially used its own attorneys in the dispute but in May hired retained outside lawyers to negotiate with the Times.

barbara.jones@dailynews.com

818-713-3710

twitter.com/LADNSchools

___

(c)2012 Daily News (Los Angeles)

Visit the Daily News (Los Angeles) at www.dailynews.com

 

Retrieved from: http://www.huffingtonpost.com/2012/10/19/los-angeles-times-sues-lausd_n_1986952.html?ir=Education

 

The Hill and the Concrete Stairs

In Inspiration, Mindfulness, Well-being on Friday, 19 October 2012 at 06:57

The Hill and the Concrete Stairs

Posted by: Anoop Alex

I climbed up the stairs. Well, I have been climbing for a long time now. Still, the top was not seen. I was tired, moody and desperate. They call it the stairs to success and happiness. I read many books, articles and listened to great people talking about life and its intricacies. I was inspired, and really wanted to reach those heights they talked about. I wanted to realize my dreams, be happy and then fulfil myself. No time to rest, there was much more to go…

The sky was grey, the clouds were limping over the stairs as if they were old and impaired. I looked back at my shadow; it was long and reached many steps down. I wondered, “Is there really a topmost step? What happens when I reach there? Will I be really happy? Enlightened, shall I be?!”

No time for distractive thoughts, I lifted my legs as high as I could and consumed more of my strength and agility up the stairs. Still nothing in reach, I sat down and for once I looked around. That was the first time I looked somewhere else other than up and down.

Life unfurled around me. There were people, funny, nice, rude and all sorts; all of them around everywhere, but far from me. I did not care, for all I wanted to look was at me in the mirror on the topmost step, where I can be seen happy and successful.

As I rushed ahead, I became tired and frustrated. I was forced to sit down once more. I was so angry at all those who inspired me to become great and known. I wanted to despise all those who tried to motivate people. What do they give all those glowing quotes for? I sat in desperation; hopeless and sad. The night fell, and I did not know when my eyes closed.

The morning light knocked my eyes open; I could still see all those around me. I was not amused or astonished to see that they were not climbing. Well, everyone is not ambitious! For a second, their shadows caught my eyes; much shorter than mine! They looked joyous and in high spirits!

The next moment, I took a decision. Risky, but at least it should turn out adventurous!

For the first time, I took a step aside the stair. The moist clouds helped me down. The environment changed, so different from the concrete stairs! The ground felt less solid and rigid.  My feet were on soil, green and fertile. I started walking towards the house afar, feeling affluent and comfortable with every step I took.

The house looked familiar. The door was old and plain but had a soothing impression on me. I smiled and knocked on the door.

My parents were surprised but happy to see me. They have become old. Their loving eyes appraised me and I was in a warm embrace, one after another. My wife’s graceful eyes prayed silently how much she missed me. My kids’ cheers were genuine music to me.

My life so far had been very busy, and after a long time I got time for free. My breathing was slow and calm. The air I breathed in was soothing and replenishing. The food, homely and the moments were splendid.

My parents were very happy to see me, and half-heartedly let me go for a stroll. Not often I realized how patient and lovely my woman could be, she reminded me with a soft kiss. My children grew up fast I thought; they too understood me well and left me for a walk alone!

I walked, round and around the land. There were no specific lanes or roads. Far ahead, the vastness of the plain led me to a small hill. The hill was a favourite spot for me in childhood; my friends and I used to raid the area for different amusements then.

I was not ready for another climb up, but this time there was nothing impending. I felt light and the hill-top was awaiting me. The blue sky spread vast, as esteemed as always, and misted the horizon. Clouds, fair and white giggled tenderly at my coming.

The hilltop gave a wonderful panoramic view of the hemisphere. The breeze atop was refreshing and brushed past me gently. I closed my eyes for a while and all those lovely moments of life rushed in; my life in vista. The memories were sweet and I missed all my friends, teachers, neighbours, relatives and… myself. The bitter turned sweet, what I used to perceive hard became soft and comfortable, the anxious and worried times made me smile and the heaviness was lifted away. I accepted all that was left behind, the happy moments, those embarrassing incidents, irritating comments, fleeting love, hurtful breakups, sad and upsetting thoughts, the shame and pain. I no longer resisted. I accepted who I was. I forgave all those who hurt me. I cherished those memories where I felt nice, happy, confident and proud. I felt my body becoming relaxed, my heart was beating smooth and I breathed easily.

It was noon when I opened my eyes. I looked down. The rock where I stood bore no shadow on it! Once I was amazed, then I understood! The sun was just above me and I was enlightened. Realizing what I had missed, I felt happy and content in claiming what was mine – my own self.

Far in the horizon the concrete stairs were visible and I could see someone climbing up. More than the person, I could see a long shadow. The stairs were leading farther from the sun!

Striding down the hill, my legs carried me faster and further. The flowers smiled, the grass swayed at my go as if they were dancing and my feet were well welcomed by the mud. The stretch ahead was to home, I ran faster, gaining more and more upon myself and it was real. I was once again myself and the leap I took kept me happy and content.

Retrieved from: http://mindmattersindia.com/the-hill-and-the-concrete-stairs/

The Lab Rat: A Better Way to Diagnose ADHD

In ADHD, ADHD Adult, ADHD child/adolescent, ADHD stimulant treatment on Thursday, 18 October 2012 at 08:03

an adhd diagnosis should be made after a number of assessment techniques (tests, questionnaires, observations, reports from others, etc.).  i am wary of any “one” measure that gives a valid diagnosis.  there are MANY disorders that mimic adhd and have the same constellation of symptoms.  while this system appears valid and reliable, i feel it should still be used in conjunction with other sources of information.

The Lab Rat: A Better Way to Diagnose ADHD

By: John Cloud

Does your child have ADHD, or is he merely rambunctious? Few questions divide parents, teachers, and mental-health professionals as often as this one. Some 5.4 million children ages 4 to 17 had ever been diagnosed with ADHD as of 2007, according to the most recent data available from the Centers for Disease Control and Prevention. The previous year, the total was 4.6 million, meaning 17.4% of all recorded ADHD cases were diagnosed in a single calendar year. There is little hard evidence to suggest that the pace of growth since 2007 has slowed.

The surge in ADHD diagnoses has worried mental-health clinicians because diagnosis of the disorder can be highly subjective. And yet between 1992 and 2000, production of the stimulant methylphenidate — which is marketed as Ritalin — increased 730%, according to the British Medical Journal. But there is a better way to diagnose ADHD — an objective, widely available test developed at McLean Hospital, the psychiatric arm of Harvard Medical School. The test is so good that it could settle the ADHD-diagnosis debate.

Diagnosing any mental illness is difficult. Except in rare cases, specific gene mutations causing mental disorders haven’t been discovered (and may not exist). And while physical injuries and illnesses sometimes trigger mental problems, most of the time psychiatrists play guesswork. They use questionnaires and rating scales to try to determine whether symptoms add up to illness.

Most of these questionnaires have been vetted through psychometric analysis to ensure test-retest reliability, meaning your score on one day is about the same as your score two months later. But any questionnaire is only as reliable as the clinician administering it. In one typical diagnostic interview, the Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime (K-SADS-PL), the clinician is asked to pose the following set of questions to a child:

  • Do your teachers complain that you don’t follow instructions?
  • When your parents or your teacher tell you to do something, is it sometimes hard to remember what they said to do? Does it get you into trouble?
  • Do you lose points on your assignments for not following directions or not completing the work?
  • Do you forget to do your homework or forget to turn it in?
  • Do you get into trouble at home for not finishing your chores or other things your parents ask you to do? How often?

Believe it or not, that’s just one of 29 sets of questions on the K-SADS-PL that can be used to diagnose ADHD. Although not every set of questions is asked of every child, the diagnostic interview can take up to three hours, according to Dr. Martin Teicher, director of the developmental biopsychiatry research program at McLean and a leading ADHD researcher. Never mind that a typical 10-year-old has a difficult time focusing on anything for more than 10 min. except, say, Toy Story 3.

And even if the child can manage to remember with accuracy all the answers, the clinician might be biased before the interview begins by parent or teacher reports that the child is hyperactive, inattentive or impulsive (the three main signs of ADHD). Past studies have shown that parents sometimes over-predict diagnosis of ADHD in their kids because the parents misremember their own childhoods as times of attentive and tranquil learning. Teachers also sometimes over-predict ADHD diagnosis because they expect ADHD treatment to result in quieter classrooms. And children often under-predict ADHD diagnosis because the kids have no reference point beyond their own behavior, which — even if wildly hyperactive — they see as normal. In any given case, the parents, the teacher, and the child rarely agree on whether the kid has ADHD.

Because of these diagnostic shortcomings, Teicher began experimenting 20 years ago with a test that could more objectively diagnose ADHD. At the time, many researchers were already using continuous-performance tests (CPTs) to help diagnose the disorder. CPTs require test subjects to focus on a boring task — say, pressing the space bar when a random shape appears on-screen but not when another random shape appears — for approximately 15 to 20 min.

CPTs accurately capture whether a student is inattentive (meaning he doesn’t focus on the task) or impulsive (meaning he presses the space bar too often). But they don’t measure how much kids fidget when they take the test, and restlessness (a.k.a. hyperactivity) is a key component of an accurate ADHD diagnosis. An older tool called the actigraph was widely used in the 1990s to measure body movements during tests. Actigraphs use sensors attached to body parts (usually wrists and ankles) to quantify movements.

But at a Society for Neuroscience meeting in the mid-’90s, Teicher learned of a far more sophisticated technology for gauging body movements. The new technology used infrared signals to record movements 50 times per sec. to a resolution of 0.002 in. (0.04 mm). By 1996, Teicher and his colleagues had not only developed a device that combined a CPT with the infrared analysis but published the results of a study showing that it could predict with near-perfect accuracy which students would be diagnosed with ADHD and which ones would not.

Today his device is being marketed as the Quotient ADHD System. Pediatric practices and even school districts would be wise to invest in one of the devices if they want to quell bitter debates among parents, teachers, and counselors over whether a child really has ADHD and needs to take potentially dangerous stimulants or simply has another condition known as “being 10 years old.” Although the devices cost $19,500 apiece, peer-reviewed studies have shown that they are far better than parent, teacher, or clinician evaluations alone at determining whether a child is truly disordered.

Not long ago, I visited Teicher at the bosky McLean campus and underwent the Quotient test, which is also used for adults who think they may have attention-deficit problems. A habitual fidgeter, I get bored easily and tend to spend beyond my salary. All these are traits associated with attention-deficit disorders.

The Quotient device is a bit smaller than one of those arcade games in which you get to shoot Nazis or zombies. But instead of a fake gun, there’s just a keyboard. You are asked to press the space bar whenever you see one a five-pointed star but not when you see an eight-pointed one. The test, which takes 20 min. for adults and 15 min. for kids, is excruciatingly dull. By minute 15 or so, my brain was screaming that the test end.

 

For all that, I didn’t do so badly. I scored 90% in accuracy, although I showed significant impulsiveness by pressing the space bar too fast before registering that the star that had just appeared had eight points, not five. My test results coincide with my scores on a diagnostic interview Teicher conducted with me. The interview had picked up my propensity to act before thinking when I’m bored. In the end, I didn’t meet the threshold for an ADHD diagnosis. But the Quotient system confirmed that I fidget a lot. The infrared sensors showed that for many periods during the 20-min. test, I moved incessantly — far more than most of my fellow 40-year-olds.

I was impressed by the Quotient system because it generates such a large body of statistics and because it’s nearly impossible to cheat.

At some point in the future, we will have an ADHD diagnostic test that accurately measures catecholamine transmission and dopamine D2-receptor density, two neurotransmitter gauges that predict an ADHD diagnosis. Until then, the Quotient system is the best diagnostic tool in the psychiatric armamentarium. Parents and teachers should stop squabbling over which kids are ADHD and which are merely unruly. Before any meds are administered, kids should be seated in front of a Quotient device that can settle almost any quarrels with solid data.

Retrieved from: http://healthland.time.com/2011/02/25/the-lab-rat-a-better-way-to-diagnose-adhd/#ixzz29ePyOeUE

fake it ’til you make it???

In ADHD, ADHD Adult, ADHD child/adolescent, ADHD stimulant treatment on Thursday, 18 October 2012 at 07:54

one of the reasons it is so important to be evaluated in a comprehensive manner by someone who is specifically trained in the diagnosis of adhd.

Faking it.  Why Nearly 1 in 4 Adults Who Seek Treatment Don’t Have ADHD

By: Meredith Melnick

A new survey of patients’ medical records finds that nearly a quarter of adults who seek treatment for attention deficit hyperactivity disorder may be exaggerating or faking their symptoms. Why would someone fake a psychological disorder? In a word, Adderall.

The authors of the study, published in The Clinical Neuropsychologist, said there were actually a variety of reasons people exaggerated their symptoms: some legitimately had ADHD, but just wanted to make sure their doctor gave them the diagnosis; others really thought they had ADHD, but didn’t (rather they were stressed or depressed). But in many cases, the reason for claiming symptoms of ADHD was to obtain the drugs — like Adderall and Ritalin — that are used to treat it.

These drugs are stimulants, which work by boosting levels of the neurotransmitters dopamine and norepinephrine in the brain. In people who have ADHD, the drugs calm behavior and help maintain focus. In healthy people, the drugs serve as performance enhancers. College students, journalists, scientists and baseball players, amongothers, have been known to use the drugs to increase their ability to concentrate, improve attention, memory and learning, and get ahead.

“There are big cultural pressures to get these drugs,” Dr. Anjan Chatterjee, a professor of neurology at the University of Pennsylvania, told MSNBC. “That’s because everyone is in an arms race of accomplishment.”
For the new study, lead researcher Paul Marshall, a clinical neuropsychologist at Hennepin Faculty Associates in Minneapolis, and colleagues analyzed patients’ responses in in-person interviews and questionnaires. Within the questionnaires were inserted certain red-flag-raising tests specifically designed to pinpoint fakers and exaggerators.Reported MSNBC:

Ultimately, Marshall and his colleagues found patients who not only exaggerated their symptoms but also scored much more poorly on the embedded tests than people with actual ADHD symptoms would have.

A doctor in [an MSNBC-commissioned] Truth On Call poll summarized the fakers like this: “Patients try to describe typical symptoms with a request for specific ADHD drugs. With standard symptom questionnaires, they will push the responses to the extreme and try to request specific medications when prescribed alternatives.”

The problem is that there is no single guaranteed test for ADHD. Diagnoses depend on individual physicians’ assessments. So how reliable are doctors — and the measures they use — generally?

A study by University of Kentucky psychologists, published in June 2010 in Psychological Assessment, sought an answer by asking college kids to try to fake ADHD symptoms on a series of tests. There were actually three groups of students who took the tests: some who legitimately had ADHD and were temporarily off their medication, others who didn’t have ADHD and weren’t asked to fake it, and those who didn’t have ADHD but were told they’d get $45 if they could convince the assessor they did. To prepare, they were given five minutes to look over ADHD information obtained from Google.

 

Regarding the assessment measures, Psychology Today reported:

Tests for detecting ADHD fall into two broad categories. Firstly, and most simply, there is self-report, where the patient describes their symptoms in response to structured questioning. Second there are neuropsychological tests, where the patient is asked to perform a particular task. These often appear much like a simple computer game and are structured such that persons with ADHD will make certain types of mistakes on the game due to impulsivity, inattention or other ADHD symptoms.

The self-reports couldn’t tell the real ADHD sufferers from the fakers, and the computer tests weren’t much more effective either, the study found.

ADHD diagnoses in adults may be trickier than in kids. For children, there are at least multiple sources of information and observation — parents, teachers, doctors. With adults, physicians can rely only on self-reporting. The Centers for Disease Control and Prevention estimates that 2% to 4% of adults actually have ADHD, many of whom were initially diagnosed as children.

If healthy adults continue to exaggerate symptoms for personal gain, the fallout could affect those who really need help, should doctors become increasingly wary of handing out diagnoses. Worse, legitimate patients are having a hard enough time getting their medication as it is, without fakers filching pills for performance enhancement. Finally, as the MSNBC story points out, if misused the medications could become habit forming — and a surefire way to ruin performance is misusing prescription drugs.

Retrieved from: http://healthland.time.com/2011/04/28/faking-it-why-nearly-1-in-4-adults-who-seek-treatment-dont-have-adhd/#ixzz29eOxxERR

more on men and adhd…

In ADHD, ADHD Adult, ADHD child/adolescent, Psychiatry on Thursday, 18 October 2012 at 07:49

Men Diagnosed with Childhood ADHD Struggle More with Jobs, Relationships

ADHD can have lingering effects among men

By: Alexandra Sifferlin

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder among children, and as incidence of the condition continue to rise, parents and patients are asking what happens next. How does ADHD affect children as they become teens and adults and start to form relationships, find jobs and establish families of their own? Does the condition put them at a disadvantage for coping with life’s inevitable challenges?

With 5.4 million children ever diagnosed with ADHD in the U.S., and 3% to 7% of school-aged children currently struggling with the condition, it’s worth considering how ADHD affects their adult lives. Rachel Klein of the Child Study Center at New York University Langone Medical Center and her colleagues studied the potentially long-term effects of ADHD among men who were diagnosed as kids. In their 33-year follow-up study, Klein and her team looked at 135 middle-aged men with childhood ADHD who were referred to the study by their teachers when they were between six to 12 years old. The researchers compared this group to 136 men without ADHD and found that  men with ADHD struggled more in occupational, educational, economic and social arenas later in life compared to men without the diagnosis.

At the 33-year follow-up, when the men were in their forties, those with childhood-diagnosed ADHD without conduct disorders had about 2.5 years fewer years of education compared to the other men; only 3.7% had higher degrees compared to nearly 30% of the control group. The majority (84%) were holding jobs, but at significantly lower positions than peers without ADHD and were therefore at a financial disadvantage. On average, the researchers say, the ADHD group earned $40,000 less in salary than their unaffected counterparts.

Socially, men with ADHD also struggled with higher divorce rates, more antisocial personality disorders and substance abuse. On the positive side, however, they did not have higher rates of mood and anxiety disorders, like depression.

Overall, the ADHD adults showed higher rates of psychiatric hospitalizations and incarcerations, which the authors conclude supports a continued need for monitoring and treatment of kids with ADHD, even when a conduct disorder is not present. Dr. Klein says even when children with ADHD are not disruptive, they may still be at a higher risk for developing antisocial behaviors later on, like lying, stealing and cheating.
But addressing the needs of children with ADHD, by providing academic support in school to help them overcome their frustrations and challenges in paying attention and retaining what they learn, and by giving them emotional support from the family, can given these students the coping skills they need to meet their adult challenges — in the workplace, in relationships and in social interactions —as well.

“One of the very important messages [from our findings] is that most kids [with ADHD] do OK, and some do very well. As a group they did well,” says Klein. While ADHD’s effect can linger into adulthood, it doesn’t have to be either debilitating or inevitable. “It does affect their lives, but not to the point that they’re very badly off,” she says.

The study was published online in the journal Archives of General Psychiatry.

Retrieved from: http://healthland.time.com/2012/10/16/men-diagnosed-with-childhood-adhd-struggle-more-with-jobs-relationships/#ixzz29eNljos5

another piece on teacher evaluations…

In Education, Education advocacy, Pedagogy, School Psychology, School reform, Special Education on Wednesday, 17 October 2012 at 08:25

Seeking Aid, More Districts Change Teacher Evaluations

By: Motoko Rich

LONGMONT, Colo. — In an exercise evoking a corporate motivation seminar, a group of public school teachers and principals clustered around posters scrawled with the titles of Beatles songs. Their assignment: choose the one that captured their feelings about a new performance evaluation system being piloted in their district.

Jessicca Shaffer, a fifth-grade teacher in this suburban community northeast of Boulder, joined the group assembled around “Eight Days a Week.” (Other options: “We Can Work It Out” and “Help!”)

“If we truly had 52 weeks of school a year, we still would not have enough time to do everything we have to do,” Ms. Shaffer said, sounding a common note of exasperation. “I am supersaturated.”

An elementary school literacy coach wondered whether the evaluations would produce anything other than extra paperwork. “Are they going to be giving us true feedback?” she asked. “Or are they just going to be filling out a form?”

The teachers and administrators, who gathered last month in the boardroom of the St. Vrain Valley School District for a daylong training session on evaluating teachers through classroom observations, echoed anxieties that are rippling through faculty lounges across the nation.

Fueled in part by efforts to qualify for the Obama administration’s Race to the Top federal grant program or waivers from the toughest conditions of No Child Left Behind, the Bush-era education law, 36 states and the District of Columbia have introduced new teacher evaluation policies in the past three years, according to the National Center on Teacher Quality, a nonprofit research and advocacy group. An increasing number of states are directing districts to use these evaluations in decisions about how teachers are granted tenure, promoted or fired.

Proponents say that current performance reviews are superficial and label virtually all teachers “satisfactory.” “When everyone is treated the same, I can’t think of a more demeaning way of treating people,” Arne Duncan, the secretary of education, said in a telephone interview. “Far, far too few teachers receive honest feedback on what they’re doing.”

So far, attention has focused mainly on one element of the new evaluation systems, the requirement that districts derive a portion of a teacher’s rating from student performance on standardized tests. Anger over the use of test results exploded during the strike by the Chicago Teachers’ Union last month. But most of the new state policies also include a component based on classroom observations by principals, peers or outside evaluators.

Advocates of the new evaluations, including Secretary Duncan, have repeatedly emphasized the importance of professional reviews including “multiple measures” of performance.

During the St. Vrain seminar, officials from the Colorado Department of Education walked administrators and teachers through a model rubric for classroom observations that the Education Department had developed to guide principals in assessing teachers. At 24 pages, the rubric serves as a checklist of broad ideals, asking whether a teacher “motivates students to make connections to prior learning” or “provides instruction that is developmentally appropriate for all students.”

The new Colorado evaluation system was developed in response to a 2010 bill requiring that all principals, teachers and other licensed school staff be reviewed annually. Half of a teacher’s score is determined by student achievement on a range of tests; the other half is based on an evaluation of “professional practice” — what can be observed in class as well as gleaned from lesson plans and other instructional materials.

Even those who are skeptical about the value of using test scores to rate teachers say that classroom observations, done well, can help teachers improve.

“It can be very powerful and it is more stable and reliable” than measures that look at test scores, said Linda Darling-Hammond, an education professor at Stanford University. But, she added, “one of the big challenges we have is to create systems that are manageable, doable and not overwhelming.”

For teachers, the biggest fear is that a poor evaluation could lead to job loss. Under the new Colorado law, teachers can be rated highly effective, effective, partially effective or ineffective. Starting in the 2014-15 school year, anyone who receives an “ineffective” or “partially effective” rating for two consecutive years will be stripped of the state’s equivalent of tenure status, said Katy Anthes, the executive director of educator effectiveness at the state Education Department. To qualify for tenure, a new teacher must be rated at least “effective” for three consecutive years.

During the St. Vrain training session, officials from the state Education Department sought to tamp down fears that the new evaluations were designed to weed out or shame underperforming teachers. “It is not about a ‘gotcha’ game,” Mike Gradoz, a consultant with the department, told the teachers and principals. “It is about elevating the game so you get better at what you already do.”

To help acquaint the principals and teachers with the state’s rubric, Mr. Gradoz and another trainer walked them through a mock scoring exercise. In one case study, the phantom teacher earned a “partially proficient” rating for failing to establish a “safe, inclusive and respectful learning environment” and showing weak evidence of lesson planning.

Mr. Gradoz asked the group how they would respond to such a rating. Joe Mehsling, a veteran principal, got right to the point. “If it is a rookie, there is hope,” he said. “If it is a veteran, time to start counseling out.”

During a break, Mr. Mehsling said the new system — and the mandated consequences — would indeed make it easier for principals to fire low-performing teachers. “The elephant in the room that we are dancing around is the fact that public education has not done a good job on our own dismissing ineffective teachers,” Mr. Mehsling said.

But, he added, such teachers represented only 1 or 2 percent of those in classrooms. The new systems, he said, could subject the best teachers to onerous observation and bureaucracy so that principals could justify firing a few bad eggs. “It is taking a sledgehammer where an ice pick would have been effective,” he said.

Still, Mr. Mehsling said the new evaluation systems could result in more objective reviews. “I think it is going to be more work,” he said. “But I think it is going to be more meaningful.”

In that, he was joined by many principals and teachers at the training session.

“The current system has no rubric so it is harder to know what you are checking for,” said Janis Hughes, a principal who attended the training.

The following day, Ms. Hughes, who has been the principal for more than a decade at Burlington Elementary, a diverse neighborhood school where about 41 percent of the students qualify for free and reduced-price lunches, dropped by to observe Brian Huey, a fourth-grade teacher.

Mr. Huey, who shaves his head and wears a tiny silver hoop in each ear, began by asking the children to define the word of the day: “disposition.”

Quietly segueing into a math lesson, he wrote a multiplication word problem on a whiteboard. The students worked independently, and then Mr. Huey helped guide them through several strategies that would help them arrive at the right answer.

Next the class gathered on the rug for a review of geometry concepts. “What are the dimensions of that rectangle?” Mr. Huey asked one boy.

The boy paused. A girl who had piped up several times during the lesson was eager to showcase her knowledge again. “It is also known as a perimeter!” she blurted.

“Let’s not cheat his thinking,” Mr. Huey said gently.

Ms. Hughes, watching from the back of the room, noticed. “He engaged Janelle but did it in a respectful, nice way,” she said. “But it also let her know she can’t dominate the conversation.”

Such observations, Ms. Hughes said, would easily fit into the state’s model rubric. (Page 10: The teacher “ensures that all students participate with a high level of frequency.”)

In general, Mr. Huey said, “when I looked over what the criteria are, they sound fair.”

“It’s just good teaching,” he added.

Retrieved from: http://www.nytimes.com/2012/10/16/education/seeking-aid-more-districts-change-teacher-evaluations.html?src=un&feedurl=http%3A%2F%2Fjson8.nytimes.com%2Fpages%2Fnational%2Findex.jsonp&_r=0&pagewanted=all

 

Raising a Child with Special Needs…the Psychic Toll on Families

In School Psychology, Special Education on Tuesday, 16 October 2012 at 08:36

The Psychic Toll Paid in a Special Needs House

Ron Leiber

October 12, 2012

Most people caring for a family member with special needs eventually assemble a financial checklist of sorts.

They put together a team of health, legal and financial experts who understand their family member’s condition. Then comes the estate plan and making sure they understand the eligibility rules for any state or federal benefits.

Checking these items off, however, as I did in a column last week, often proves to be the easier part of special needs planning. The harder part springs from two challenges that are ultimately rooted in emotion and behavior. It’s the psychological side, after all, that often plays a big role in just about every major financial decision.

The first is the question of where a special needs child or sibling should live. The second is not letting the stress of managing the affairs of a special needs family member contribute to the end of a marriage or other long-term romantic partnership.

When Alice Walther’s son was small and experiencing developmental delays, she and her husband took him to a major children’s hospital in the St. Louis area. A top doctor there told them that he was severely retarded. “He said to put him in a home, that it will ruin your family,” she recalled.

Her son Sean is now 43 and he never left his family’s home. He works part time at a library and pursues his passion for golf in his spare time, watching tournaments on television and maintaining a collection of scorecards from all over the world that is so large it takes up three bookshelves.

“He’s gotten so used to his own room and his own bathroom that he wouldn’t fit into a group home, quite honestly,” Ms. Walther said.

Mary Anne Ehlert, a financial planner in Lincolnshire, Ill., who specializes in advising people with family members who have special needs, has heard versions of this before. Her own late sister, who had cerebral palsy, lived with her parents as an adult before her parents finally decided to have her move out.

“You want to keep them totally in a bubble,” she said. “But it’s not in their best interest, and it’s not what they want. The problem is, if the parents die, then what?”

Ms. Walther’s other son Michael, a financial planner himself, has thought through every angle of his younger brother’s situation. He sees things as Ms. Ehlert does and thinks his brother should move out of his parents’ home sooner rather than later.

“Change is not something he does well with,” he said. “If we were to introduce it at the same time as the loss of a parent, that’s going to be an awful lot to swallow. ”Their parents have a plan for this. “The minute one of us goes, the two who are left will move into assisted living,” Ms. Walther said. Meanwhile, they’re building a financial war chest for that moment, in part by living in the same house they have been in for 45 years.

Once Sean’s other parent dies or is close to death, Mike plans to move his brother to the Chicago area where he lives. He’s made peace, more or less, with his parents’ decision about where Sean will do best in the meantime. “They’re going to win this argument while they’re alive,” he said. “And I’m going to win it when they’re dead.”

The elder Walthers will celebrate their 49th wedding anniversary next month, but not every couple is so lucky. Just how many couples never make it that long while caring for a family member with special needs is a bit uncertain, though. Families I’ve spoken to in the last two weeks have repeated a statistic that about 75 percent of parents with a special needs child end up getting divorced or splitting up.

There does not seem to be any data backing this up, but it’s clear why people may fear the financial consequences of a divorce in a family that is caring for a child or live-in relative with special needs.

Christopher Currin, a financial planner in Dallas who has an 18-year-old son with Down syndrome, knows of a family that ended up paying for three residences after a divorce. One is for the mother, one for the father and one is the house they used to share. They didn’t think their child with special needs could easily move back and forth from one residence to another, so the parents trade off moving back in.

Mr. Currin’s marriage is intact, but as someone who has counseled many families with special needs relatives, he understands why many partnerships do not. “One person in a couple with a child whose disability was unexpected may have difficulty accepting it,” he said. “A deeper wellspring of love may open up in one of them, while the other goes to that well and finds it empty.”

Some people also turn to a higher power when faced with a different sort of parenting challenge. “It can reinforce or cause someone to rediscover religious feelings,” he said. “But others might be cast into doubt that can lead to losing faith.”

The one advantage to frightening, if exaggerated, divorce data is that it might nudge people into some preventive marriage counseling. Or if not that, the persistent, low-grade fear of a failed partnership may at least encourage people to invest in some quality time as a couple.

Mr. Currin said he was particularly grateful for the respite programs that Methodist churches in his area have offered over the years. There, special needs children and their siblings can spend an evening with others like them while their parents get a few hours alone.

“We don’t ever use the D word,” said Matt Syverson, a financial planner in Overland Park, Kan. He and his wife have twins and a younger daughter, Lily, who has Down syndrome. “We don’t ever need to go there. We make the best with what we’ve been dealt, and with God’s help we keep getting through it.”

In fact, now that Lily is in kindergarten, the Syversons have decided to add another child to their family. In the spring, they hope to adopt a boy they’ve named Levi and bring him home from China. He has a severe heart ailment, and once he’s moved in, they will cross their fingers when the time comes for the surgery that will give him the best chance at a long life.

Retrieved from: http://www.nytimes.com/2012/10/13/your-money/the-psychic-toll-paid-in-a-special-needs-house.html?smid=li-share&_r=0

adhd…a longitudinal follow-up

In ADHD, ADHD Adult, ADHD child/adolescent, ADHD stimulant treatment, Brain imaging, Brain studies, Neuropsychology, Neuroscience, Psychiatry, School Psychology on Tuesday, 16 October 2012 at 07:34

Men Diagnosed with ADHD as Children had Worse Outcomes as Adults, Study Says

ScienceDaily (Oct. 15, 2012) — Men who were diagnosed as children with attention-deficit/hyperactivity disorder (ADHD) appeared to have significantly worse educational, occupational, economic and social outcomes in a 33-year, follow-up study that compared them with men without childhood ADHD, according to a report published Online First by Archives of General Psychiatry, a JAMA Network publication.

ADHD has an estimated worldwide prevalence of 5 percent, so the long-term outcome of children with ADHD is a major concern, according to the study background.

Rachel G. Klein, Ph.D., of the Child Study Center at NYU Langone Medical Center in New York, and colleagues report the adult outcome (follow-up at average age of 41 years) of boys who were diagnosed as having ADHD at an average age of 8 years. The study included 135 white men with ADHD in childhood, free of conduct disorder (probands), and a comparison group of 136 men without childhood ADHD.

“On average, probands had 2½ fewer years of schooling than comparison participants … 31.1 percent did not complete high school (vs. 4.4 percent of comparison participants) and hardly any (3.7 percent) had higher degrees (whereas 29.4 percent of comparison participants did). Similarly, probands had significantly lower occupational attainment levels,” the authors note. “Given the probands’ worse educational and occupational attainment, their relatively poorer socioeconomic status at [follow-up at average age of 41 years] is to be expected. Although significantly fewer probands than comparison participants were employed, most were holding jobs (83.7 percent). However, the disparity of $40,000 between the median annual salary of employed probands and comparisons is striking.”

In further comparisons of the two groups, the men who were diagnosed with ADHD in childhood also had more divorces (currently divorced, 9.6 percent vs. 2.9 percent, and ever been divorced 31.1 percent vs. 11.8 percent); and higher rates of ongoing ADHD (22.2 percent vs. 5.1 percent, the authors suspect the comparison participants’ ADHD symptoms might have emerged during adulthood), antisocial personality disorder (ASPD, 16.3 percent vs. 0 percent) and substance use disorders (SUDs, 14.1 percent vs. 5.1 percent), according to the results.

During their lifetime, the men who were diagnosed with ADHD in childhood (the so-called probands) also had significantly more ASPD and SUDs but not mood or anxiety disorders and more psychiatric hospitalizations and incarcerations than comparison participants. And relative to the comparison group, psychiatric disorders with onsets at 21 years of age or older were not significantly elevated in the probands, the study results indicate.

The authors note the design of their study precludes generalizing the results to women and all ethnic and social groups because the probands were white men of average intelligence who were referred to a clinic because of combined-type ADHD.

“The multiple disadvantages predicted by childhood ADHD well into adulthood began in adolescence, without increased onsets of new disorders after 20 years of age. Findings highlight the importance of extended monitoring and treatment of children with ADHD,” the study concludes.

Retrieved from: http://www.sciencedaily.com/releases/2012/10/121015162407.htm

 

                                                                                             

Brain Gray Matter Deficits at 33-Year Follow-up in Adults With Attention-Deficit/Hyperactivity Disorder Established in Childhood

Erika Proal, PhD; Philip T. Reiss, PhD; Rachel G. Klein, PhD; Salvatore Mannuzza, PhD; Kristin Gotimer, MPH; Maria A. Ramos-Olazagasti, PhD; Jason P. Lerch, PhD; Yong He, PhD; Alex Zijdenbos, PhD; Clare Kelly, PhD; Michael P. Milham, MD, PhD; F. Xavier Castellanos, MD

Arch Gen Psychiatry. 2011;68(11):1122-1134. doi:10.1001/archgenpsychiatry.2011.117.

 

Context  Volumetric studies have reported relatively decreased cortical thickness and gray matter volumes in adults with attention-deficit/hyperactivity disorder (ADHD) whose childhood status was retrospectively recalled. We present, to our knowledge, the first prospective study combining cortical thickness and voxel-based morphometry in adults diagnosed as having ADHD in childhood.

Objectives  To test whether adults with combined-type childhood ADHD exhibit cortical thinning and decreased gray matter in regions hypothesized to be related to ADHD and to test whether anatomic differences are associated with a current ADHD diagnosis, including persistent vs remitting ADHD.

Design  Cross-sectional analysis embedded in a 33-year prospective follow-up at a mean age of 41.2 years.

Setting  Research outpatient center.

Participants  We recruited probands with ADHD from a cohort of 207 white boys aged 6 to 12 years. Male comparison participants (n = 178) were free of ADHD in childhood. We obtained magnetic resonance images in 59 probands and 80 comparison participants (28.5% and 44.9% of the original samples, respectively).

Main Outcome Measures  Whole-brain voxel-based morphometry and vertexwise cortical thickness analyses.

Results  The cortex was significantly thinner in ADHD probands than in comparison participants in the dorsal attentional network and limbic areas (false discovery rate < 0.05, corrected). In addition, gray matter was significantly decreased in probands in the right caudate, right thalamus, and bilateral cerebellar hemispheres. Probands with persistent ADHD (n = 17) did not differ significantly from those with remitting ADHD (n = 26) (false discovery rate < 0.05). At uncorrected P < .05, individuals with remitting ADHD had thicker cortex relative to those with persistent ADHD in the medial occipital cortex, insula, parahippocampus, and prefrontal regions.

Conclusions  Anatomic gray matter reductions are observable in adults with childhood ADHD, regardless of the current diagnosis. The most affected regions underpin top-down control of attention and regulation of emotion and motivation. Exploratory analyses suggest that diagnostic remission may result from compensatory maturation of prefrontal, cerebellar, and thalamic circuitry.

Retrieved from: http://archpsyc.jamanetwork.com/article.aspx?articleid=1107429

Depression 101…

In Mood Disorders, Psychiatry, School Psychology on Tuesday, 16 October 2012 at 07:15

Depression 101: Treatment & Tips To Ward Off Depression

Depression is a common mental health illness in the US and around the world. In fact, the Center for Disease Control and Prevention states that 1 in 10 adults in the US report experiencing depression. What is most troubling to me is that only about 51% of those people suffering from depression seek out treatment according to the National Institute of Mental Health. Depression may begin at any age and may be caused by any number of triggers such as bullying, parental or marital conflict, sense of isolation, loss, seasonal causes, etc.

As a result, I wanted to write a blog post specifically on depression, its treatment, and offer wellness tips to ward off depression. Please note that depression is one of several mood disorders and is different than bipolar, dysthymia, and other mood disorders. This blog post will focus on depression technically known as Major Depressive Disorder. I also want to make it very clear that depression is a treatable illness but, like many illnesses, it can require ongoing “maintenance.”

First let me review the symptoms of depression, followed by the treatment, and then offer some tips to ward off depression.

Symptoms of Depression: To meet criteria, five or more symptoms must be present for at least a 2 week period according to the Diagnostic and Statistical Manual of Mental Disorders. It is also very important to rule out physiological effects of a substance/drug, other psychiatric disorders such as bereavement, and medical conditions such as thyroid problems that may cause depressive symptoms.

  Sad or depressed mood most of the day, almost every day.

  Anhedonia, which is loss of interest in previously enjoyed activities.

  Sleep problems, usually hypersomnia but can also be insomnia.

  Weight gain or loss not due to diet or exercise.

  Low of energy or fatigue even with sufficient rest.

  Psychomotor agitation or retardation, which is usually moving or talking slower.

  Poor concentration or ability to think.

  Feeling of worthlessness or excessive guilt.

  Thoughts of death or suicide, which could be the most serious of all the symptoms and must be taken seriously even in children.

Here are some other symptoms to look for that are frequently present in depression:

  Thoughts of helplessness

  Thoughts of hopelessness

  Isolation

  Changes in appetite

  Irritability

  Crying

  Decrease in sex drive

Treatment for Depression

Treatment for depression begins with an evaluation by a licensed mental health professional to determine severity of depression, to rule out other possible issues, and to refer for appropriate services. Treatment usually entails either counseling or psychotropic medication or a combo of both, depending on severity. Severe depression usually requires a psychiatric evaluation by a psychiatrist for psychotropic medication to help improve symptoms enough for counseling to be effective, while mild to moderate depression can usually be treated with counseling alone. It is important to know there are a countless approaches to counseling such as cognitive behavior, psychodynamic, humanistic, and many more. Many approaches explore the person’s feelings, thoughts, and behaviors. The trust developed between the client-therapist relationship is what many approaches have in common and what research has found to be an essential ingredient to effective treatment. That is why it is imperative that one choose a therapist that is a good fit.

In addition, there are other interventions or activities such as exercise and meditation that have been found to be effective treatment for mild to moderate depression. Family therapy can also be helpful at alleviating tensions at home that may be impacting one’s depression and hindering treatment progress.

Tips to Ward Off Depression

  Exercise Regularly as it has been found to be fantastic not only for managing stress and preventing physical problems but also at reducing depression and anxiety.

  Be Present is where people often report being happy while being in the future can create anxiety and being in the past can lead to feelings of regret, guilt, and depression. Focus on being more mindful about how you are feeling right now rather than how you felt weeks or years ago.

  Seek Support from licensed mental health professionals, friends, family and even animals, whom can be helpful. Surround yourself with people that are positive and validating.

  Know the Signs of depression so that you know when you or someone you in your life needs help.

  Know your Depression and be proactive. If you know that you happen to be extra susceptible to depression during the winter months, prepare for it by scheduling regular activities or seeking extra support during this time.

  Get Outside because sunlight can be helpful and so can nature. Experiencing the grandeur nature can help put one’s problems into perspective and when our problems seem small they don’t bother us as much.

  Find Meaning or a reason for living as it can be a powerful motivation to keep living. One’s meaning can be their partner, children, or even a cause.

  Sleep is vital to good health and mental functioning. Avoid sleep problems by having a regular bedtime even on weekends, keeping distractions from the bedroom (e.g., TV), and creating a bedtime that is conducive for relaxation.

  Visit Your Primary Care Doctor regularly to prevent, catch, or treat medical illnesses early that can create depressive symptoms.

  Eat Healthy meals to improve physical, mental, and emotional functioning. Eating unhealthy foods erodes your physical health, impairs cognitive functioning, and also impacts how you feel about yourself.

  Respect your Emotions rather than stuffing them. Bottling your feelings can be toxic to your body while expressing how you feel can be very relieving especially when your feelings are validated.

Author: Yoendry Torres, Psy.D., Clinical Psychologist

Retrieved from: http://www.intuitionwellness.com/blog/2012/10/12/depression-101-treatment-tips-to-ward-off-depression/

The Unfulfilled Promises of Psychotropics

In Brain studies, Medication, Neuropsychology, Neuroscience, Psychiatry, Psychopharmacology on Sunday, 14 October 2012 at 11:33

The Unfulfilled Promises of Psychotropics

By Richard Kensinger, MSW

I remember thinking over 40 years ago when I began my clinical career, that with the rapid advances made in psychotropic agents, psychotherapy would become a venture of the past. A recent editorial published in Schizophrenia Bulletindispels my myth of becoming unemployed.

Psychopharmacology is in crisis. The data are in, and it is clear that a massive experiment has failed: despite decades of research and billions of dollars invested, not a single mechanistically novel drug has reached the psychiatric market in more than 30 years. Indeed, despite enormous effort, the field has not been able to escape the “me too/me (questionably) better” straightjacket. In recent years, the appreciation of this reality has had profound consequences for innovation in psychopharmacology because nearly every major pharmaceutical company has either reduced greatly or abandoned research and development of mechanistically novel psychiatric drugs. This decision is understandable because pharmaceutical and biotechnology executives see less risky opportunities in other therapeutic areas, cancer and immunology being the current pipeline favorites. Indeed, in retrospect, one can wonder why it took so long for industry to abandon psychiatry therapeutics. So how did we get here and more importantly, what do we need to do to find a way forward?

The discovery of all three major classes of psychiatric drugs, antidepressants, antipsychotics, and anxiolytics, came about on the basis of serendipitous clinical observation. At the time of their discoveries, the mechanisms by which these molecules produce their effects were unknown, and it was only later that antipsychotics were shown to be D2 receptor antagonists, antidepressants monoamine reuptake inhibitors, and anxiolytics GABA receptor modulators. It is interesting and perhaps instructive to consider whether any of these classes of drugs could have been discovered by current drug discovery strategies. For example, what genetic or preclinical data exist that point to the D2 dopamine receptor as a likely target for antipsychotic activity? Presently there are no genetic data that suggest that this receptor is expressed or functions abnormally in psychotic disorders (emphasis added). And without the benefit of the prior clinical validation, it is difficult to see how preclinical data alone would point to the D2 receptor as an interesting potential target for the treatment of psychotic disorders. The same can be said for monoamine transporters with respect to depression where, like psychosis, there are no animal models based on disease pathophysiology and no compelling preclinical data pointing to these as potential targets for antidepressant drugs. This raises a troubling question: if in retrospect the three major classes of currently prescribed psychiatric drugs would likely never have been discovered using current drug discovery strategies, why should we believe that such strategies are likely to bear fruit now or in the future?

Given that there cannot be a coherent biology for syndromes as heterogeneous as schizophrenia, it is not surprising that the field has failed to validate distinct molecular targets for the purpose of developing mechanistically novel therapeutics. Although it has taken our field too long to gain this insight, we seem to be getting there. For example, at the 2011 meeting of the American College of Neuropsychopharmacology, the need for change and the need for new strategies were predominant themes.

In summation the excitement in the past two decades about the “Decades of the Brain” are fading to realism. Our human genome is much more complex than we can imagine. Half of our genes are devoted to brain form and function. The interaction between geneotype and phenotype is also more complex that we realize. Thus, we are approaching this science with more skepticism and realism.

Reference

Fibiger HC (2012). Psychiatry, the pharmaceutical industry, and the road to better therapeutics. Schizophrenia bulletin, 38 (4), 649-50 PMID: 22837348

Retrieved from: http://brainblogger.com/2012/10/08/the-unfulfilled-promises-of-psychotropics/

 

Cannabis and the Adolescent Brain

In Brain studies, Fitness/Health, Neuropsychology, Neuroscience on Sunday, 14 October 2012 at 11:23

Cannabis and the Adolescent Brain

By India Bohanna, PhD

For some time, people have known that using cannabis during adolescence increases the risk of developing cognitive impairment and mental illness (e.g. depression, anxiety or schizophrenia) later in life. Importantly however, the mechanisms responsible for this vulnerability are not well understood. A new study, published in Brain, shows that long-term cannabis use that starts during adolescence damages the neural pathways connecting brain regions, and that this may cause the later development of cognitive and emotional problems.

The authors used diffusion tensor imaging (DTI), a MRI technique that measures water diffusion, to examine the microstructure of white matter in 59 heavy cannabis users, who used cannabis at least twice a month for three years or longer, as well as 33 non-users. In the human brain, white matter pathways are formed by bundles of axons, which carry the neural signals, and myelin, which coat the axons and speeds up signal transfer. These white matter pathways are crucial for normal brain function as they enable disparate regions of the brain to communicate, and act together.

When the authors investigated white matter microstructure in the cannabis users, they found damage in the white matter pathways of the hippocampus, crucial for memory, and the corpus callosum, which connects the brain’s two hemispheres. Both pathways are critical for normal brain function. The authors suggest that impaired connectivity due to damage in these pathways may be the cause of the cognitive impairment and vulnerability to schizophrenia, depression and anxiety seen in long-term users.

The authors also show an inverse relationship between the amount of white matter damage and the age of first use. That is, participants who started using cannabis younger had more white matter damage and showed poorer brain connectivity. Adolescence is a critical period in the development of white matter in the brain, when the neural connections we rely on in adulthood are being finally formed. The authors point out that white matter cells have cannabinoid receptors (those susceptible to cannabis) during adolescence, which disappear as the brain matures. This new study demonstrates a mechanism that may help explain how cannabis use in adolescence causes long-term changes in brain function. The cannabis users in the study had significantly higher levels of depression and anxiety compared to the non-users.

This important new study suggests that young people’s brains are at risk of white matter injury due to cannabis, and that cannabis exposure during adolescence may permanently damage white matter development. Future research must address the question; can white matter pathways and connectivity recover when a person quits using cannabis?

References

Zalesky A, Solowij N, Yücel M, Lubman DI, Takagi M, Harding IH, Lorenzetti V, Wang R, Searle K, Pantelis C, & Seal M (2012). Effect of long-term cannabis use on axonal fibre connectivity. Brain : a journal of neurology, 135 (Pt 7), 2245-55 PMID: 22669080

Retrieved from: http://brainblogger.com/2012/08/18/cannabis-and-the-adolescent-brain/

Smoking and the Adolescent Brain

In Fitness/Health, Neuropsychology, Neuroscience on Sunday, 14 October 2012 at 11:18

Smoking and Adolescent Brain Development

By Shefali Sabharanjak, PhD

When it comes to substance abuse like smoking or abuse of intoxicating drugs, it is very difficult to determine what a “safe” limit of exposure is.  Quite often, the initial exposure to mood altering substances like nicotine occurs during the teenage years. The period ofadolescence is marked by a tendency towards risk-taking behavior which often results in ‘experimental’ exposure to psychedelic substances. Adolescents who tend to flirt with danger in this fashion are often convinced that a small trial will not actually have lasting damaging effects. However, research on the development of prefrontal cortex in similarly age-matched animals says otherwise.

The prefrontal cortex in teenagers is in a state of growth and development. Contrary to established notions, brain development continues well into the teenage years and changes in synapses (connections between brain cells that facilitate the transmission of chemical messengers between cells) occur well into adolescence.  Research on adolescent mice and rats shows that exposure to nicotine during this period has long-lasting effects. For starters, nicotine is known to be able to excite neurons bearing nicotinic acetylcholine receptors. In the prefrontal cortex, nicotine has been shown to induce greater expression of a specific subset of nicotinic acetylcholine receptors, by 34%.  In the normal course of development, the number of acetylcholine receptors declines in these cells. This phenomenon is specific to the period of adolescence since a similar increase in the number of receptors is not seen when the initial exposure to nicotine occurs in adulthood, in these animals. Research has also shown that exposure to nicotine in early adolescence enhances the nicotinic ‘reward’ feeling during adulthood. It is therefore surmised that early exposure to smoking is likely to set the stage for long-term addiction and perhaps it also explains why addiction to nicotine is so prevalent, worldwide.

One might argue that since the teenage years are a short period in the life-span of a person, occasional exposure to nicotine is not likely to leave lasting damage. Here’s the catch. Exposure to nicotine also changes the pattern of synaptic connectivity between neurons in the prefrontal cortex.  The ability of neurons to establish new synaptic connections and develop new firing patterns in response to different stimuli is also known as “synaptic plasticity”. Neuroscientists have shown that all “learning” as well as  information analysis and assimilation in the brain is a net result of the pattern of exchange of neurotransmitter molecules (also referred to as pattern of ‘firing’) between neurons which respond to training stimuli. So, the more you learn, the better you get at learning by stimulating your neurons to make new synaptic connections. However, exposure to nicotine in early adolescence, changes the pattern of firing of neurons in the prefrontal cortex. Now this change reduces the capability of neurons in the prefrontal cortex to make new synaptic connections. Therefore exposure to psychedelic and addictive substances like nicotine results in reduced synaptic plasticity and has a negative impact on cognitive processes in adult life.

All these significant changes take place in early adolescence and perhaps parental guidance may play a huge role in preventing nicotine addiction and associated cognitive deficits.

References

Adriani W, Macrì S, Pacifici R, & Laviola G (2002). Peculiar vulnerability to nicotine oral self-administration in mice during early adolescence. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 27 (2), 212-24 PMID: 12093595

Counotte DS, Goriounova NA, Moretti M, Smoluch MT, Irth H, Clementi F, Schoffelmeer AN, Mansvelder HD, Smit AB, Gotti C, & Spijker S (2012). Adolescent nicotine exposure transiently increases high-affinity nicotinic receptors and modulates inhibitory synaptic transmission in rat medial prefrontal cortex. FASEB journal : official publication of the Federation of American Societies for Experimental Biology, 26 (5), 1810-20 PMID: 22308197

Goriounova NA, & Mansvelder HD (2012). Nicotine exposure during adolescence alters the rules for prefrontal cortical synaptic plasticity during adulthood. Frontiers in synaptic neuroscience, 4 PMID: 22876231

Goriounova NA, & Mansvelder HD (2012). Nicotine exposure during adolescence leads to short- and long-term changes in spike timing-dependent plasticity in rat prefrontal cortex. The Journal of neuroscience : the official journal of the Society for Neuroscience, 32 (31), 10484-93 PMID: 22855798

Kawai HD, Kang HA, & Metherate R (2011). Heightened nicotinic regulation of auditory cortex during adolescence. The Journal of neuroscience : the official journal of the Society for Neuroscience, 31 (40), 14367-77 PMID: 21976522

Kota D, Robinson SE, & Imad Damaj M (2009). Enhanced nicotine reward in adulthood after exposure to nicotine during early adolescence in mice. Biochemical pharmacology, 78 (7), 873-9 PMID: 19576867

Retrieved from: http://brainblogger.com/2012/10/14/smoking-and-adolescent-brain-development/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+GNIFBrainBlogger+%28Brain+Blogger%29

 

autism and asanas…new information

In Autism Spectrum Disorders, Fitness/Health, Meditation, Mindfulness on Saturday, 13 October 2012 at 09:50

Yoga Helps Children With Autism Remain Calm, Improves Social Bonding

BY AMBER MOORE

New York University researchers say that daily yoga can boost social bonding and focus in children who have been diagnosed with autism.

The intervention program, “Get Ready to Learn,” (GRTL) uses yoga and breathing techniques to calm children who have Autism Spectrum Disorder. The program has five steps that are done for 17 minutes each day. According to NYU researcher Kristie Koenig, this program can lower the levels of aggression, social withdrawal and anxiety in children with ASD.

“We found that teachers’ ratings of students who participated in the daily yoga routine showed improved behavior compared with teachers’ ratings of students who did not. Our aim in this research was to examine the effectiveness of an occupational therapy yoga intervention,” said Koenig, assistant professor of occupational therapy at NYU.

Currently, there is no cure for autism. However, studies suggest that certain intervention programs may help improve a child’s development. Interventions are most efficient when started early, before age 3.

Another study published last year in the Journal of Alternative and Complementary Medicine had also said that movement-based therapy including yoga and dance can help treat some behavioral problems associated with autism.

“Children with Autism often exhibit characteristics of ‘fight-or-flight’ response. They are in a constant state of stress and struggle with staying calm, trying to concentrate, communicating clearly, or even controlling their movements,” said Anne Buckley-Reen occupational therapist and yoga instructor.

The present study was published in The American Journal of Occupational Therapy.
Retrieved from:  http://www.medicaldaily.com/articles/12640/20121011/yoga-helps-children-autism-remain-calm-improves.htm#5Uri5TY1f6SU5fUp.99

more awesomeness in neuroscience…

In Education, Neurogenesis, Neuropsychology, Neuroscience, School Psychology on Saturday, 13 October 2012 at 09:30

Brain Scans Can Detect Children’s Reading Ability

BY AMBER MOORE

Stanford researchers say that brain scans can help detect whether or not a child will develop reading-related problems in the future, a discovery that opens up possibility of intervention programs for helping children improve their reading ability.  In a study, conducted over a period of three years, researchers at Stanford University assessed children’s reading skills with the help of standardized tests. They observed and analyzed the participants’ brain scans taken during the study.

Researchers found that in each of the 39 children, the rate of development in the white matter region accurately predicted the child’s score on a reading test. The white matter regions of the brain are associated with reading; the rate of development in the brain region is measured by fractional anisotropy, or FA.

Further, children who displayed above-average reading skills had FA in two regions, the left hemisphere arcuate fasciculus and the left hemisphere inferior longitudinal fasciculus. Interestingly, in children who develop good reading skills, the initial FA was lower but increased over time. In children that had lower reading abilities, the FA was higher initially but declined afterwards.

According to researchers, a child’s ability to read at seven years of age can predict hisor her reading ability at 17 years of age. But, detecting if the child has problems with reading can be a challenge. “By the time kids reach elementary school, we’re not great at finding ways of helping them catch up,” said Jason D. Yeatman, a doctoral candidate in psychology at Stanford and the lead author on the study.

The great news is the study could one day lead to an early warning system for struggling students and this could help children improve their reading ability as the brain is young and is still developing.

“Once we have an accurate model relating the maturation of the brain’s reading circuitry to children’s acquisition of reading skills, and once we understand which factors are beneficial, I really think it will be possible to develop early intervention protocols for children who are poor readers, and tailor individualized lesson plans to emphasize good development. Over the next five to 10 years, that’s what we’re really hoping to do,” Yeatman said.

The study was published in the Proceedings of the National Academy of Sciences.

Retrieved from: http://www.medicaldaily.com/articles/12666/20121012/brain-scans-detect-childrens-reading-ability.htm#go5H3ZzSAe1jtK0g.99

Development of white matter and reading skills

PNAS Plus – Biological Sciences – Psychological and Cognitive Sciences

Jason D. Yeatman, Robert F. Dougherty, Michal Ben-Shachar, and Brian A. Wandell

White matter tissue properties are highly correlated with reading proficiency; we would like to have a model that relates the dynamics of an individual’s white matter development to their acquisition of skilled reading. The development of cerebral white matter involves multiple biological processes, and the balance between these processes differs between individuals. Cross-sectional measures of white matter mask the interplay between these processes and their connection to an individual’s cognitive development. Hence, we performed a longitudinal study to measure white-matter development (diffusion-weighted imaging) and reading development (behavioral testing) in individual children (age 7–15 y). The pattern of white-matter development differed significantly among children. In the left arcuate and left inferior longitudinal fasciculus, children with above-average reading skills initially had low fractional anisotropy (FA) that increased over the 3-y period, whereas children with below-average reading skills had higher initial FA that declined over time. We describe a dual-process model of white matter development comprising biological processes with opposing effects on FA, such as axonal myelination and pruning, to explain the pattern of results.

PNAS Plus: Development of white matter and reading skillsPNAS 2012 ; published ahead of print October 8, 2012,doi:10.1073/pnas.1206792109

Retrieved from: http://www.pnas.org/search?fulltext=reading&go.x=0&go.y=0&go=GO&submit=yes

 

 

adhd… a “made up” disorder, redux

In ADHD, ADHD Adult, ADHD child/adolescent, ADHD stimulant treatment, Medication, Psychiatry, Psychopharmacology on Friday, 12 October 2012 at 17:38

and here we go, folks! on the heels of my post, 10 October 2012, regarding the good doctor anderson (http://wp.me/p2IpfL-9p), the debate is starting yet once again.  sigh.  you know, this gets a bit boring after a while.   but i do believe we have vastly improved mechanisms of study (fmri, genomic medicine…fantastic stuff!) and robust set of data and literature to support that it’s a valid disorder.  and, i hesitate to even take a stand as to which i ascribe to.  in the end, you are allowed to believe what you want, as long as you aren’t hurting anybody else (if you are hurting yourself) by holding those beliefs.  i would just like to see the actual data that these people base their opinions on.  i don’t believe there is a place for opinions is science.  and diagnosing and prescribing is done based mostly on quantitative data.  

the data (quantitative) speaks for itself , imo.  and to me, the best decisions are made when examining QUANTITATIVE data.  but, as i’ve told you in something i wrote at some point (one musing or another…), i am a ‘quantoid.’  i will always be biased towards quantifiable data.  that’s me.  come to your own conclusions.  i just prefer to come to mine quantifiably.    and that’s a WHOLE other post!  at any rate, as you see below, the debate continues…pick a side.

Should Children Take ADHD Drugs — Even If They Don’t Have The Disorder?

Emily Willingham, Contributor

The discussion is at least twice as old as my 10-year-old son with attention deficit/hyperactivity disorder (ADHD): Should we medicate children with ADHD drugs just to keep order in the classroom or help the child be competitive among peers? I know it’s at least 20 years old, this argument, because it was a subject of almost daily discussion in teachers’ lounges when I taught middle school in the ’90s, and because the tension among teachers, parents, and the children taking the drugs often spilled into the hallways. And this all was in private schools. I can only imagine that the intensity was multifold in the public school setting.

The age of a controversy, as anyone in public health can tell you, doesn’t necessarily diminish its relevance or the passions it inspires. That’s why this piece by Alan Schwarz in the New York Times has yielded some serious angst in many circles. It takes as its center a doctor who, Schwarz writes, prescribes ADHD drugs off-label for children he avers don’t have ADHD, saying that because the schools won’t do what they should to help low-income kids learn, we “have to modify the kid.”

This physician, Dr. Michael Anderson, also happens to be among those who dismiss ADHD is a “made-up” disorder, in spite of considerable evidence linking specific gene variants to ADHD and suggesting a large genetic component [PDF]. He’s another contributor to the ever-present backlash against ADHD as a diagnostic entity, but instead of blaming lazy parents this time, he blames the school system, one that neglects children whose behaviors in a classroom might be ameliorated by an appropriate environment, in the absence of which, medications have to do the job. He certainly has a point … to a point.

His attitude about ADHD, though, is what’s fueled the concerns I’ve seen about this article, particularly from people who love someone with ADHD. ADHD, you see, has a terrible reputation, one that suffers in large part because of abuse of drugs used to treat the condition. Many, many drugs exist that people use off-label to self medicate or boost performance. But I can’t think of drugs whose abuse stigmatizes the disorder for which they’re actually used as much as ADHD drugs do. And abuse of ADHD meds is inextricably linked with skepticism about the ADHD diagnosis: neurobiological conditions that overlap with the typical zones of behavior suffer from this kind of skepticism, but ADHD stands out. Blame for the drug abuse and diagnostic overuse heaps on doctors, parents, teachers, society, and people diagnosed with it. Are any of these groups to blame for the existence of ADHD? Generally, no. But some are to blame for its bad reputation and the abuse of the drugs used to treat it.

Drugs to treat ADHD work, as I’ve written before, but they carry known risks, and we still won’t know for some years what the long-term outcomes are following their use in childhood. Schwarz describes in his article a child taking the medication Adderallwho begins see people and hear voices that aren’t there, a rare side effect of the drug. That child is no longer on Adderall and instead is now takingRisperdal, a psychotropic medication with indications for schizophrenia and irritability associated with autism. It is not an “ADHD drug,” and it too carries potential risks that need to underweigh its benefits to warrant its use. One of the primary benefits of ADHD medications for children with the condition, in addition to the academic, is that the perceived improvement in behavior can translate into better social relationships and a reduction in the constant messages that they receive that they are a “bad person.” Whether or not they ultimately absorb that message as an inherent part of themselves remains to be seen.

In addition to prescribing Adderall to this boy, Anderson also prescribed it to two of the child’s siblings. In the article, the parents think that this prescription is an off-label use of Adderall, and the article holds up these two children as examples of using this drug to improve behavior and classroom performance in the absence of an ADHD indication. Yet Anderson then is reported as saying that all of the children for whom he has prescribed ADHD medications have met the criteria for ADHD, including these two children, whose parents don’t seem to know that. In other words, this story is about children who meet the ADHD criteria receiving drugs to treat ADHD and experiencing benefits, not about a broader use of ADHD drugs off-label to level the classroom playing field.

Forbes writer Matthew Herper blogged today that the NYT piece “hits the problem with ADHD drugs: they work.” Yes, they do. They work for ADHD, based on the only examples provided in this article, not more broadly for low-income children who just need more drug-induced focus in the classroom. Whether the doctor “rails” against the diagnostic criteria or not, the children taking–and responding to–Adderall in this article all met the criteria for an ADHD diagnosis. Indeed, low-income children are most likely to meet the diagnostic criteria for ADHD yet least likely to receive appropriate pharmaceutical intervention for it.  So whether he likes it or not, the doctor, by applying existing criteria, might have appropriately identified and treated children with ADHD who otherwise would have fallen through the cracks.

That doesn’t mean that we’re not still facing a brave new world in which college students pop Adderall for exams or driven high-school students are torn between the med boost and simply making it on their own, as they are. As Herper notes, there’s an important national conversation to be had around ADHD drugs and their off-label use to level the field or give an advantage. In his post, Herper asks, “Can we avoid a world in which thinkers are forced into brain-doping in the same way athletes have been pushed to chemically modify their bodies?” In neither case do we know the long-term positive or negative outcomes for the individuals being doped, whether for brain or brawn. I can’t speak about athletes, but as someone who has taught thousands of students from ages 5 to 65, I can say this: What we, in our short-sightedness, view as a childhood deficit because of its interference with classroom function can often yield our most beautiful manifestations of human thought and diversity later in life. Do medications help children with ADHD? Yes, they do. But … and I think this is the real point of the Schwarz piece, even as the examples simply bear out efficacy of ADHD meds for ADHD: We can’t look to the children for what needs “fixing.” For that, we must look to ourselves, and the depth and breadth of our problems with education in this country aren’t something even a full-scale, population-wide pill can fix.

Retrieved from: http://www.forbes.com/sites/emilywillingham/2012/10/09/adhd-drugs-for-children-who-dont-have-adhd-is-it-ok/

 

ketamine isn’t just for kitties anymore…

In Medication, Mood Disorders, Neuroscience, Psychiatry, Psychopharmacology on Thursday, 11 October 2012 at 14:43

Ketamine a Viable Option for Severe Depression?

Megan Brooks

October 11, 2012 — The discovery that ketamine produces rapid antidepressant effects in patients with severe treatment-resistant depression is fueling basic neuroscience research, leading to a greater understanding of the neurobiology of depression and maybe more effective treatments, a new review suggests.

Ketamine, an N-methyl-D-aspartate (NMDA) glutamate receptor antagonist, is best known in medicine as an anesthetic but also has some notoriety as a street drug, sometimes dubbed “Special K,” and is taken illicitly for its psychedelic effects.

However, recently ketamine has gained interest among researchers for its potential as a unique, rapid-acting antidepressant.

Typical antidepressants such as the serotonin selective reuptake inhibitors (SSRIs) take weeks to months to have an effect and are only moderately effective, leaving more than one third of depressed patients resistant to drug therapy.

“The rapid therapeutic response of ketamine in treatment-resistant patients is the biggest breakthrough in depression research in half a century,” review author Ronald Duman, PhD, professor of psychiatry and neurobiology at Yale University in New Haven, Connecticut, said in a statement.

However, Dr. Dunham told Medscape Medical News, although clearly promising for depression, ketamine does have some roadblocks.

“It produces transient side effects [for about 1 hour], including mild hallucinations and dissociative effects in some patients, subsequent to the antidepressant response. Ketamine is also a drug of abuse, so caution is needed when considering widespread use of this agent.”

“Nevertheless, there are millions of depressed patients who do not respond to conventional antidepressants and are in dire need of a drug like ketamine,” Dr. Duman added.

With Dr. Duman and coauthor George Aghajanian, MD, professor emeritus of psychiatry at Yale University, the review was published October 5 in Science.

Timely, Authoritative

Commenting for Medscape Medical News, James W. Murrough, MD, from Mount Sinai School of Medicine’s Mood and Anxiety Disorders Program in New York City, described the article as a “timely, well written, and authoritative review by 2 neuroscience researchers who have really done the bulk of the work looking at the biological basis for how ketamine might bring about a rapid antidepressant effect.”

The original link between ketamine and relief of depression was made by John Krystal, MD, chair of the Department of Psychiatry at Yale, and Dennis Charney, MD, formerly of Yale, now professor of psychiatry, neuroscience, and pharmacology and dean at Mount Sinai School of Medicine.

In 2000, they published results of a small, double-blinded, placebo-controlled study showing that intravenous infusions of ketamine produced significant and rapid antidepressant effects (Berman et al; Biol Psychiatry, 2000;47:351-354).

“That was the first controlled study that showed that ketamine had sort of an unexpected rapid antidepressant effect in patients,” said Dr. Murrough. “We knew it was a glutamate antagonist, but at this time (in 2000), the role of glutamate in depression was not at all on the radar.”

That study was followed by an article published in 2006 that also showed rapid (within 2 hours) and significant antidepressant effects after a single infusion of ketamine in 18 patients with treatment-resistant depression (Zarate Jr et al; Arch Gen Psychiatry, 2006;63:856-864).

Since then, a number of studies replicated and extended the findings — including a study by Carlos Zarate Jr, MD, and colleagues published in 2010 in Archives of General Psychiatry and reported by Medscape Medical News at the time.

These studies sent neuroscientists on a quest to figure out at a cellular level, using animal models, how ketamine worked and what it could reveal about depression.

Jury Still Out

The literature suggests that depression is caused by disruption of homeostatic mechanisms that control synaptic plasticity, resulting in destabilization and loss of synaptic connections in mood and emotion circuitry, the authors note. Ketamine appears to target synaptic dysfunction in depression.

The findings highlight the “central importance of homeostatic control of mood circuit connections and form the basis of a synaptogenic hypothesis of depression and treatment response,” the review authors write.

Is ketamine currently used to treat refractory depression?

“A year ago, I would have said no, it’s not being used clinically. But in the last year, I’ve run into patients who’ve said they had been treated with low-dose ketamine by their psychiatrist, and doctors at national meetings who’ve said they’ve used it in their practice, but it’s very sparse, it’s far from widespread,” said Dr. Murrough.

It is important to note, he added, that to date, most of the research has been limited to the effects of a single dose.

At a medical conference in June, as reported by Medscape Medical News, Dr. Murrough and colleagues demonstrated that administration of 6 low-dose infusions of ketamine over 2 weeks improved symptoms in a small study of patients with treatment-resistant depression.

It helped “at least while they were getting the ketamine, then there was a relapse that came in as few as a couple days to several months or longer in a few cases,” he said.

Dr. Murrough said he and his colleagues are now “closing out” another study of ketamine that should be published in a couple of months. Other trials are ongoing.

“The jury is still out on whether ketamine itself could be developed into a bona fide treatment. We happen to believe that it can be. We advocate a cautious approach, but we are cautiously optimistic that ketamine could be a treatment option for severe refractory depression,” he said.

“The benchmark treatment right now for severe refractory depression is electroconvulsive therapy [ECT],” Dr. Murrough pointed out, “so you’d have to believe that ketamine has a worse risk-benefit profile than ECT, and so far, we don’t see that; it appears to be very well tolerated.”

Dr. Duman and Dr. Aghajanian have disclosed no relevant financial relationships. In the past 2 years, Dr. Murrough has received research support from Evotec Neurosciences and Janssen Research & Development. Dr. Charney has been named as an inventor on a use patent of ketamine for the treatment of depression. If ketamine were shown to be effective in the treatment of depression and received approval from the US Food and Drug Administration for this indication, Dr. Charney and Mount Sinai School of Medicine could benefit financially.

Science. 2012;338:68-72. Abstract

Retrieved from: http://www.medscape.com/viewarticle/772467?src=nl_topic

Occurrence and Family Impact of Elopement in Children With Autism Spectrum Disorders

In Autism Spectrum Disorders, School Psychology, Special Education on Thursday, 11 October 2012 at 11:58

Running Away Common with Autism

By Genevra Pittman

NEW YORK (Reuters Health) Oct 08 – Almost half of children with autism in a new study had run away at least once – and many of them were missing long enough to cause concern.

Researchers found that kids most often wandered off from their home, school or a store, and some tried to run away multiple times a day.

But rather than being confused about where they were, kids typically left to find a place they enjoyed, to explore or to avoid an anxious or uncomfortable situation, based on their parents’ reports.

“It’s rooted in the very nature of autism itself,” said Dr. Paul Law, who worked on the study.

“Kids don’t have the social skills to check in with their parents, and to have that communication and social bond that most children have when they’re approaching a road or at a park.”

Dr. Law directs the Interactive Autism Network Project at the Kennedy Krieger Institute in Baltimore. With funding from a number of autism research and advocacy groups, he and his colleagues used their registry to survey the parents of 1,218 kids with an autism spectrum disorder.

Of those kids, 598 – or 49% – had tried to run away at least once, their parents reported. And 316 were missing long enough to cause concern – an average of more than 40 minutes.

In comparison, the same parents reported 13% of their non-autistic children had ever wandered off after age four.

Most of the kids with autism who went missing were in danger of getting hit by cars, and others could have drowned. Police had to be called for one-third of missing children.

“Amongst the families we did interview, there were many reports of injuries, close calls with drowning (and) close calls with traffic accidents,” Dr. Law told Reuters Health.

“There’s an enormous burden that all families are undergoing to keep their families safe. The amount of diligence, and not going out in public, and staying up late at night… just the general anxiety that families live under because of concerns with this is just torturous.”

Children with more severe autism were more likely to have bolted, according to findings published Monday in Pediatrics.

Autism researcher Russell Lang from Texas State University-San Marcos said the prevalence of running away or “eloping” in children with autism “absolutely surprised” him.

“It’s a very dangerous behavior, and it’s a little bit deceptive because it can seem somewhat benign compared to other challenging behaviors,” Lang, who wasn’t involved in the new study, told Reuters Health.

Those other “challenging behaviors” common in kids with autism include self-injury and property destruction, he said. They often get lumped together with running away, which is why researchers haven’t had a good estimate of the prevalence of elopement until now.

The new study couldn’t estimate how many children with autism die every year due to running away and getting into danger, the researchers said.

“This is not simply a case of parents being remiss in some way regarding their supervision of their children,” Lang said. “The child with autism doesn’t realize what danger they’re putting themselves in. They have a propensity to elope, it seems, regardless of parental care.”

He said therapy that rewards kids for not wandering off may help prevent them from disappearing in the future.

Dr. Law advises parents to reach out to advocacy groups to learn about safe locks for their doors and tracking devices for kids. And emergency responders can be better prepared for getting the call when a child with autism goes missing.

Still, he added, “we haven’t totally come to consensus on what some of the best practices are” to prevent running away.

SOURCE: http://bit.ly/RLrO7s

Retrieved from: http://www.medscape.com/viewarticle/772243?src=nl_topic

Occurrence and Family Impact of Elopement in Children With Autism Spectrum Disorders

Connie Anderson, PhDaJ. Kiely Law, MDa,bAmy Daniels, PhDa,c Catherine Rice, PhDdDavid S. Mandell, ScDeLouis Hagopian, PhDa,b, and Paul A. Law, MD, MPHa,b

 ABSTRACT:

OBJECTIVES: Anecdotal reports suggest that elopement behavior in children with autism spectrum disorders (ASDs) increases risk of injury or death and places a major burden on families. This study assessed parent-reported elopement occurrence and associated factors among children with ASDs.

METHODS: Information on elopement frequency, associated characteristics, and consequences was collected via an online questionnaire. The study sample included 1218 children with ASD and 1076 of their siblings without ASD. The association among family sociodemographic and child clinical characteristics and time to first elopement was estimated by using a Cox proportional hazards model.

RESULTS: Forty-nine percent (n = 598) of survey respondents reported their child with an ASD had attempted to elope at least once after age 4 years; 26% (n = 316) were missing long enough to cause concern. Of those who went missing, 24% were in danger of drowning and 65% were in danger of traffic injury. Elopement risk was associated with autism severity, increasing, on average, 9% for every 10-point increase in Social Responsiveness Scale T score (relative risk 1.09, 95% confidence interval: 1.02, 1.16). Unaffected siblings had significantly lower rates of elopement across all ages compared with children with ASD.

CONCLUSIONS: Nearly half of children with ASD were reported to engage in elopement behavior, with a substantial number at risk for bodily harm. These results highlight the urgent need to develop interventions to reduce the risk of elopement, to support families coping with this issue, and to train child care professionals, educators, and first responders who are often involved when elopements occur.

Retrieved from: http://pediatrics.aappublications.org/content/early/2012/10/02/peds.2012-0762.abstract

 

ADHD…a “made up” disorder???

In ADHD, ADHD Adult, ADHD child/adolescent, ADHD stimulant treatment, Medication, Neuropsychology, Psychiatry, Psychopharmacology, School Psychology on Thursday, 11 October 2012 at 10:37

while i do think adhd is the “diagnosis of the day” and it may be over-diagnosed, i DO NOT agree that it is a “made up”  disorder or “an excuse.”  you only have to look at the latest studies that compare treated and untreated brains of those diagnosed with adhd to see that there are real neurological and neuroanatomical deficits that can arise if adhd is left untreated (for one example, see: Adult ADHD: New Findings in Neurobiology and Genetics ; Scott H. Kollins, Ph.D.  http://www.medscape.org/viewarticle/765528).  

if you think you or someone you know has adhd, the following lists suggestions to make sure you receive a valid diagnosis and what to help to facilitate that*:

A good evaluation may consist of many of the following:

  • Collection of rating scales and referral information before or during the evaluation  
  • An interview with the student and parents
  • A review of previous records that may document impairments (i.e. problems in school, socially, or at home that you believe can be attributed to ADHD.  A good doctor knows exactly what questions to ask.
  • A general medical examination when medication might be part of treatment or coexisting medical conditions need to be evaluated (if the physician hasn’t already done this). 

 What to take along to facilitate these steps:  

  • Any records from schools you.your child attended and any other documentation of problems that could be related to ADHD or another disorder 
  • A list of family members with mental health known disorders
  • A description of impairments during childhood (i.e. elementary school), as well as more recent ones (i.e. middle school).  This can be done via SST notes, progress reports, psychological evaluations, IEP’s, etc.

*adapted from: Barkley, Russell A. (2011-04-04). Taking Charge of Adult ADHD (Kindle Locations 464-483). Guilford Press. Kindle Edition.

Attention Disorder or Not, Pills to Help in School

Alan Schwarz

CANTON, Ga. — When Dr. Michael Anderson hears about his low-income patients struggling in elementary school, he usually gives them a taste of some powerful medicine: Adderall.

The pills boost focus and impulse control in children with attention deficit hyperactivity disorder. Although A.D.H.D is the diagnosis Dr. Anderson makes, he calls the disorder “made up” and “an excuse” to prescribe the pills to treat what he considers the children’s true ill — poor academic performance in inadequate schools.

“I don’t have a whole lot of choice,” said Dr. Anderson, a pediatrician for many poor families in Cherokee County, north of Atlanta. “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

Dr. Anderson is one of the more outspoken proponents of an idea that is gaining interest among some physicians. They are prescribing stimulants to struggling students in schools starved of extra money — not to treat A.D.H.D., necessarily, but to boost their academic performance.

It is not yet clear whether Dr. Anderson is representative of a widening trend. But some experts note that as wealthy students abuse stimulants to raise already-good grades in colleges and high schools, the medications are being used on low-income elementary school children with faltering grades and parents eager to see them succeed.

“We as a society have been unwilling to invest in very effective nonpharmaceutical interventions for these children and their families,” said Dr. Ramesh Raghavan, a child mental-health services researcher at Washington University in St. Louis and an expert in prescription drug use among low-income children. “We are effectively forcing local community psychiatrists to use the only tool at their disposal, which is psychotropic medications.”

Dr. Nancy Rappaport, a child psychiatrist in Cambridge, Mass., who works primarily with lower-income children and their schools, added: “We are seeing this more and more. We are using a chemical straitjacket instead of doing things that are just as important to also do, sometimes more.”

Dr. Anderson’s instinct, he said, is that of a “social justice thinker” who is “evening the scales a little bit.” He said that the children he sees with academic problems are essentially “mismatched with their environment” — square pegs chafing the round holes of public education. Because their families can rarely afford behavior-based therapies like tutoring and family counseling, he said, medication becomes the most reliable and pragmatic way to redirect the student toward success.

“People who are getting A’s and B’s, I won’t give it to them,” he said. For some parents the pills provide great relief. Jacqueline Williams said she can’t thank Dr. Anderson enough for diagnosing A.D.H.D. in her children — Eric, 15; Chekiara, 14; and Shamya, 11 — and prescribing Concerta, a long-acting stimulant, for them all. She said each was having trouble listening to instructions and concentrating on schoolwork.

“My kids don’t want to take it, but I told them, ‘These are your grades when you’re taking it, this is when you don’t,’ and they understood,” Ms. Williams said, noting thatMedicaid covers almost every penny of her doctor and prescription costs.

Some experts see little harm in a responsible physician using A.D.H.D. medications to help a struggling student. Others — even among the many like Dr. Rappaport who praise the use of stimulants as treatment for classic A.D.H.D. — fear that doctors are exposing children to unwarranted physical and psychological risks. Reported side effects of the drugs have included growth suppression, increased blood pressure and, in rare cases, psychotic episodes.

The disorder, which is characterized by severe inattention and impulsivity, is an increasingly common psychiatric diagnosis among American youth: about 9.5 percent of Americans ages 4 to 17 were judged to have it in 2007, or about 5.4 million children, according to the Centers for Disease Control and Prevention.

The reported prevalence of the disorder has risen steadily for more than a decade, with some doctors gratified by its widening recognition but others fearful that the diagnosis, and the drugs to treat it, are handed out too loosely and at the exclusion of nonpharmaceutical therapies.

The Drug Enforcement Administration classifies these medications as Schedule II Controlled Substances because they are particularly addictive. Long-term effects of extended use are not well understood, said many medical experts. Some of them worry that children can become dependent on the medication well into adulthood, long after any A.D.H.D. symptoms can dissipate.

According to guidelines published last year by the American Academy of Pediatrics, physicians should use one of several behavior rating scales, some of which feature dozens of categories, to make sure that a child not only fits criteria for A.D.H.D., but also has no related condition like dyslexia or oppositional defiant disorder, in which intense anger is directed toward authority figures. However, a 2010 study in the Journal of Attention Disorders suggested that at least 20 percent of doctors said they did not follow this protocol when making their A.D.H.D. diagnoses, with many of them following personal instinct.

On the Rocafort family’s kitchen shelf in Ball Ground, Ga., next to the peanut butter and chicken broth, sits a wire basket brimming with bottles of the children’s medications, prescribed by Dr. Anderson: Adderall for Alexis, 12; and Ethan, 9; Risperdal (an antipsychotic for mood stabilization) for Quintn and Perry, both 11; and Clonidine (a sleep aid to counteract the other medications) for all four, taken nightly.

Quintn began taking Adderall for A.D.H.D. about five years ago, when his disruptive school behavior led to calls home and in-school suspensions. He immediately settled down and became a more earnest, attentive student — a little bit more like Perry, who also took Adderall for his A.D.H.D.

When puberty’s chemical maelstrom began at about 10, though, Quintn got into fights at school because, he said, other children were insulting his mother. The problem was, they were not; Quintn was seeing people and hearing voices that were not there, a rare but recognized side effect of Adderall. After Quintn admitted to being suicidal, Dr. Anderson prescribed a week in a local psychiatric hospital, and a switch to Risperdal.

While telling this story, the Rocaforts called Quintn into the kitchen and asked him to describe why he had been given Adderall.

“To help me focus on my school work, my homework, listening to Mom and Dad, and not doing what I used to do to my teachers, to make them mad,” he said. He described the week in the hospital and the effects of Risperdal: “If I don’t take my medicine I’d be having attitudes. I’d be disrespecting my parents. I wouldn’t be like this.”

Despite Quintn’s experience with Adderall, the Rocaforts decided to use it with their 12-year-old daughter, Alexis, and 9-year-old son, Ethan. These children don’t have A.D.H.D., their parents said. The Adderall is merely to help their grades, and because Alexis was, in her father’s words, “a little blah.”

”We’ve seen both sides of the spectrum: we’ve seen positive, we’ve seen negative,” the father, Rocky Rocafort, said. Acknowledging that Alexis’s use of Adderall is “cosmetic,” he added, “If they’re feeling positive, happy, socializing more, and it’s helping them, why wouldn’t you? Why not?”

Dr. William Graf, a pediatrician and child neurologist who serves many poor families in New Haven, said that a family should be able to choose for itself whether Adderall can benefit its non-A.D.H.D. child, and that a physician can ethically prescribe a trial as long as side effects are closely monitored. He expressed concern, however, that the rising use of stimulants in this manner can threaten what he called “the authenticity of development.”

“These children are still in the developmental phase, and we still don’t know how these drugs biologically affect the developing brain,” he said. “There’s an obligation for parents, doctors and teachers to respect the authenticity issue, and I’m not sure that’s always happening.”

Dr. Anderson said that every child he treats with A.D.H.D. medication has met qualifications. But he also railed against those criteria, saying they were codified only to “make something completely subjective look objective.” He added that teacher reports almost invariably come back as citing the behaviors that would warrant a diagnosis, a decision he called more economic than medical.

“The school said if they had other ideas they would,” Dr. Anderson said. “But the other ideas cost money and resources compared to meds.”

Dr. Anderson cited William G. Hasty Elementary School here in Canton as one school he deals with often. Izell McGruder, the school’s principal, did not respond to several messages seeking comment.

Several educators contacted for this article considered the subject of A.D.H.D. so controversial — the diagnosis was misused at times, they said, but for many children it is a serious learning disability — that they declined to comment. The superintendent of one major school district in California, who spoke on the condition of anonymity, noted that diagnosis rates of A.D.H.D. have risen as sharply as school funding has declined.

“It’s scary to think that this is what we’ve come to; how not funding public education to meet the needs of all kids has led to this,” said the superintendent, referring to the use of stimulants in children without classic A.D.H.D. “I don’t know, but it could be happening right here. Maybe not as knowingly, but it could be a consequence of a doctor who sees a kid failing in overcrowded classes with 42 other kids and the frustrated parents asking what they can do. The doctor says, ‘Maybe it’s A.D.H.D., let’s give this a try.’ ”

When told that the Rocaforts insist that their two children on Adderall do not have A.D.H.D. and never did, Dr. Anderson said he was surprised. He consulted their charts and found the parent questionnaire. Every category, which assessed the severity of behaviors associated with A.D.H.D., received a five out of five except one, which was a four.

“This is my whole angst about the thing,” Dr. Anderson said. “We put a label on something that isn’t binary — you have it or you don’t. We won’t just say that there is a student who has problems in school, problems at home, and probably, according to the doctor with agreement of the parents, will try medical treatment.”

He added, “We might not know the long-term effects, but we do know the short-term costs of school failure, which are real. I am looking to the individual person and where they are right now. I am the doctor for the patient, not for society.

Retrieved from: http://www.nytimes.com/2012/10/09/health/attention-disorder-or-not-children-prescribed-pills-to-help-in-school.html?pagewanted=all&pagewanted=print

Special Ed complaints to Office of Civil Rights reach new heights

In Education, Education advocacy, School Psychology, School reform, Special Education on Thursday, 11 October 2012 at 08:49

Special Ed complaints to Office of Civil Rights reach new heights

OCTOBER 7, 2012

GREGORY BRANCH

The federal Office of Civil Rights (OCR)has just released a new report, Disability Rights Enforcement Highlights, and it reveals among other interesting findings that during the three year period from 2009-2011, it received more disability complaints than during any other three year period in its history. During this time, OCR received over 11,700 disability complaints, which comprised 55% of the total overall complaints received. The other 45% of the claims received were related to other areas of OCR enforcement in areas such as national origin, race, age, and sex.

Based on the report, it is clear that the vast majority of disability complaints were in the area of FAPE, Free and Appropriate Public Education. FAPE questions concern whether a district has offered a special needs child an educational program from which the student can obtain at least some minimal benefit. If not, the student has been denied FAPE. Of the 11,700 disability complains, 4678 were devoted to FAPE questions, or roughly 40%. Other high complaint areas were exclusion, retaliation, and academic adjustment. During this three year span, the OCR launched 15 FAPE related investigations of its own.

Another important function that OCR noted it played over this same time span was protecting the educational rights of “wounded warriors.,” our nation’s soldiers who have returned home from battle with permanent injuries that qualify them for educational protection. OCR noted that often these former soldiers are not familiar with the educational protections provided for them under federal law.

Similarly, educational institutions are not uniformly prepared to serve an influx of veterans with combat-related disabilities such as Traumatic Brain Injury and Post-Traumatic Stress Disorder. OCR’s technical assistance has informed veterans, educators and service providers from institutions such as the Veterans Administration about how the protections afforded to post-secondary students with disabilities apply to those returning from war.

Here are examples of some of the investigations based on complaints received by OCR.

Academic Adjustment: An HIV positive student alleged that his college discriminated against him by dismissing him from its medical office technology program. One of the required classes for it mandated that the students draw blood from one another, and the school dropped the young man due to safety concerns. In order to resolve the complaint, the school agreed to re-enroll the student, consider the student’s request for the academic adjustment of not having other students draw his blood, and provide the college’s staff with training on the necessity of providing academic adjustments to disabled students.

FAPE: OCR facilitated Early Complaint Resolution where parents alleged that a school district had not faithfully implemented their child’s IEP (individualized educational program) who qualified for services due to a mood disorder. Based on these efforts, the district agreed to schedule an IEP to discuss the parent’s concerns and to provide notice to the teachers of the requirement that they implement the IEP.

Harassment: Parents filed a complaint based on harassment they alleged their student had received due to a disability related body odor issue. The child had been previously diagnosed due to Fragile X Syndrome, ADD, Asperger’s Syndrome, and Tourette’s Syndrome. The complaint alleged that based on the body odor issue, the student had been detained by school staff who made her take a shower prior to attending class, had staff spray air freshener on her in front of other students, and be sent home prior to the end of the day due to her body odor. After OCR facilitated Early Complaint Resolution, the school district agreed to train staff regarding the student’s disabilities, enroll the student in its Senior Life Skills course, offer weekly social work services, and assist the student in finding community employment.

Retrieved from: http://www.examiner.com/article/special-ed-complaints-to-office-of-civil-rights-reach-new-heights

Mixed Signals on Eating Fish While Pregnant

In ADHD, ADHD Adult, ADHD child/adolescent on Wednesday, 10 October 2012 at 15:46

 

Mixed Signals on Eating Fish While Pregnant

 

By Janice Wood Associate News Editor

 

Reviewed by John M. Grohol, Psy.D. on October 9, 2012

 

New research has linked low-level mercury exposure in pregnant women to an increased risk of attention deficit hyperactivity disorder (ADHD) in their children.

 

But the same research also found that eating fish during pregnancy can help reduce the risk of ADHD-related behaviors in children.

 

The scientists who led the study, Susan Korrick, M.D., M.P.H., of Brigham and Women’s Hospital, and Sharon Sagiv, Ph.D., M.P.H., of Boston University School of Public Health, said this “duality” is possible because many types of fish have low levels of mercury, so it is possible for a pregnant woman to eat nutritionally beneficial fish without being exposed to much mercury.

 

“These findings underscore the difficulties pregnant women face when trying to balance the nutritional benefits of fish intake with the potential detriments of low-level mercury exposure,” said Korrick.

 

“Women need to know that nutrients in fish are good for the brain of a developing fetus, but women need to be aware that high mercury levels in some fish pose a risk,” added Sagiv.

 

This study involved approximately 400 children born in New Bedford, Mass., between 1993 and 1998. Shortly after their mothers gave birth, researchers collected hair samples from the mothers and analyzed them for mercury.

 

They also gave the mothers a questionnaire to determine their fish consumption during pregnancy. Eight years later, researchers followed up with the children and administered standardized tests to determine behaviors related to ADHD.

 

Researchers found an increased risk of childhood ADHD-related behaviors with increasing maternal hair mercury levels.

 

These mercury levels were lower than levels shown to be potentially hazardous in previous studies, the researchers noted.

 

Additionally, researchers found a reduced risk of ADHD-related behaviors in children whose mothers reported eating more than two servings of fish per week, which is a higher number of servings than is currently recommended by the United States Food and Drug Administration and Environmental Protection Agency.

 

The study did not examine what types of fish are best for a pregnant woman to eat, but previous studies have shown women should avoid fish that are high in mercury, such as shark, swordfish, king mackerel and fresh tuna.

 

Fish that are low in mercury, such as flounder, haddock, and salmon, are safer to eat and good sources of nutrition, the researchers concluded.

 

The study was published in the online version of the Archives of Pediatrics & Adolescent Medicine.

 

APA Reference
Wood, J. (2012). Mixed Signals on Eating Fish While Pregnant. Psych Central. Retrieved on October 10, 2012, from http://psychcentral.com/news/2012/10/09/mixed-signals-on-eating-fish-while-pregnant/45755.html

 

Retrieved from: http://psychcentral.com/news/2012/10/09/mixed-signals-on-eating-fish-while-pregnant/45755.html

 

 

 

this is not very awesome…

In Education, Education advocacy, School reform, Special Education on Wednesday, 10 October 2012 at 15:32

this isn’t any good for anyone…

http://www.huffingtonpost.com/2012/10/10/lawsuit-alleges-georgia-s_n_1952258.html?utm_campaign=101012&utm_medium=email&utm_source=Alert-education&utm_content=FullStory

 

 

in honor of bullying prevention month

In Education, School Psychology on Tuesday, 9 October 2012 at 06:54

Dealing with bullying: What parents and teachers can do to help

BY: ALICIA FRANKS GIBSON

When a child reports a problem with teasing or bullying, it can leave both parents and teachers feeling frustrated and helpless. Parents may feel helpless because they are not with their child all day at school and they cannot be there to protect their child. Teachers and other school staff such as school psychologists, teacher aides and special education teachers are in a position to intervene, however, school staff cannot always be there to witness every interaction and instance of bullying. Children with disabilities in particular are more likely to be bullied because they are physically different or because they have learning or behavioral difficulties.

Adams County School District 50 in Westminster, CO, began a district-wide bully prevention program during the 2011-2012 school year which features three steps: Stop, walk and talk. The program, Bully Prevention in Positive Behavior Support, is one anti-bullying program that teaches students how to deal with teasing, bullying and gossip. The program relies partially on bystanders, those students who witness the bullying, to step in and help when appropriate. Students learn to tell the bully to stop (paired with a stop hand signal) as a first defense, and then if the bullying or teasing continues they are taught to walk away calmly and confidently to remove the attention that the bully is seeking. As a last step, the students are taught to talk to an adult to report the problem if the other strategies fail and the bullying continues.

The most effective bully prevention program involves students, teachers, parents and communities. Parents can encourage their child not to take the teasers comments personally. Teasers and bullies are out for power, control and attention. Walking away or ignoring the comments takes away the attention that they are seeking. It is important to note that ignoring is taught only as a first strategy and the student should report the problem to an adult if the bullying continues.

Parents can also talk to their child about being assertive and dealing with peers in a confident manner. Bullies are more likely to pick on students who look intimidated and who seem unable to stand up for themselves. Talk to your child about choosing appropriate friends and encourage them to stay close to friends who treat them with respect. Many instances of bullying can be prevented when the child is surrounded by friends who can stick up for them and tell the bully to stop.

Teachers can increase supervision in areas of the school where bullying incidents are more likely to happen such as hallways, lunchrooms and buses. Reassure students that they can report bullying and that they will remain confidential. Adults should respond immediately to reports of teasing or bullying and should follow up with students to determine whether the bullying has stopped or if it is continuing.
Organizations such as the U.S. Department of Health and Human Services and Kidpower have excellent bullying prevention resources and tips for parents and professionals.

Retrieved from: http://www.examiner.com/article/dealing-with-bullying-what-parents-and-teachers-can-do-to-help?cid=db_articles

 

School psychologists and autism training

In Autism Spectrum Disorders, Education, School Psychology on Tuesday, 9 October 2012 at 06:47

no matter how good we think we are, how many ‘letters’ are behind our names, or  long we have been practicing, in this ever-evolving field, we ALWAYS need to keep up with the latest research and literature and adapt.  when we stop learning, we stop living.  there are lessons all around us…

School Psychologists Need More Training to Meet the Needs of Students with Autism Spectrum Disorders (ASD)

Lee Wilkinson, Ph.D.

More children than ever before are being diagnosed with autism spectrum disorders (ASD). The U.S. Centers for Disease Control and Prevention (CDC) now estimates that 1 in 88 eight year-old children has an ASD. The occurrence of autism is also evident in the number of students with ASD receiving special educational services. Data collected for the Department of Education indicate that the number of children ages 6 through 21 identified with autism served under the Individuals With Disabilities Act (IDEA) quadrupled between 2000-01 and 2009-10; rising from 93,000 to 378,000 students and increasing from 1.5 to 5.8 percent of all identified disabilities.

Given the dramatic increase in ASD, school psychologists and other school-based professionals are now more likely to be asked to participate in the screening, identification, and educational planning for students with ASD than at any other time in the past. Moreover, the call for greater use of evidence-based practice has increased demands that school psychologists be knowledgeable about evidence-based assessment and intervention strategies for students with ASD. Guidelines and standards have been developed recommending best practice procedures for the assessment and treatment of ASD. There is a large and expanding scientific literature base that documents the existence of two major elements of evidence-based practice: assessments shown to be psychometrically sound for the populations on whom they are used and interventions with sufficient evidence for their effectiveness. Although school psychologists are often called on to assume a leadership role in evaluating, identifying, and providing interventions for students with ASD in our schools, there is little research to show how closely school psychologists align their practices with the parameters of best practice. Due to the increase in the number of children receiving special education services under the classification of autism, research is needed regarding the preparedness of school psychologists and schools to address the needs of children with ASD.

Recent Surveys

Although there is a paucity of research focusing on the delivery of school psychological services for students with ASD, there are several national and state-wide surveys which provide exploratory information regarding school psychologists’ level of knowledge in the area of autism assessment and intervention; assessment methods, measures, and techniques; level of training; and perceived level of preparation and confidence.

  • Aiello & Ruble (2011) investigated school psychologists’ knowledge and skills in identifying, evaluating, and providing interventions for students with ASD. A total of 402 participants from 50 states completed their survey. Results indicated that despite a limited amount of training received during their graduate education or pre-service training for working with the autism population, most school psychologists’ self-reported knowledge of ASD was in the expected direction for agreement. However, there were gaps in knowledge regarding the differences between emotional and behavioral disorders and autism, developmental delays and autism, and special education eligibility versus DSM-IV diagnoses that need to be addressed through more training. The survey also indicated the need for additional training opportunities in providing interventions, strategies, and supports for students with autism in the following areas: developing family-centered educational plans; training peer mentors; and translating assessment information into teaching goals and activities.
  • Rasmussen (2009) also completed a national survey of school psychologists to determine their level of knowledge in the area of autism assessment; level of training; and perceived preparation and confidence in providing services to children with ASD. Results indicated that training positively affected school psychologists’ knowledge about autism; their levels of involvement with students with autism; and their perceived levels of preparation to work with this population. Of the 662 participants, the majority accurately identified diagnostic features and true and false statements about autism, suggesting an adequate understanding of autism. Participants with more training reported an increased level of involvement on multidisciplinary teams and an ability to diagnose autism when compared to those with less training. Brief rating scales were among the most commonly used instruments, while more comprehensive and robust instruments were among the least-often employed, suggesting school psychologists are either not trained or are limited in the time and resources needed to use evidence-based instruments. Participants felt more prepared to provide consultation and assessment services and less prepared to provide interventions. Although a majority (96.5%) of the respondents reported they had attended workshop presentations or in-service trainings on autism, less than half (43.7%) had completed formal course work in autism in their training program and less than one third (32.3%) had internship or residency experience with autism. These data and previous research suggest school psychologists need more formal training and experience in meeting the needs of individuals identified with autism.
  • Singer (2008) surveyed 199 school psychologists regarding the frequency with which they were called upon to provide services to students with an autism spectrum disorder (ASD); services they actually provided to those students; and their perceptions of the training and experience they had pertaining to the assessment and treatment of ASD. Additionally, the study surveyed 72 graduate programs in school psychology to determine the extent to which these programs prepared new school psychologists to work with children who have ASD. A majority of respondents (64%) reported using only brief screening instruments to identify students. Although able to identify the “red flag” indicators of ASD, very few school psychologists perceived their training as adequate. Only 12.6 % of respondents indicated that they had sufficient coursework in ASD and only 21% indicated that they had sufficient practicum experience. Just 15% indicated that their overall training with ASD was “completely adequate.” Only 5 of the 72 (16.9%) school psychology programs surveyed offered a specific course in ASD; most indicating that the topic was addressed in other courses. According to the author, the survey data suggest that school psychologists lack adequate knowledge about evidence-based instruments and procedures available to screen, assess, and intervene for ASD.
  • Pearson (2008) surveyed a group of Pennsylvania school psychologists regarding their training, knowledge and evaluation practices when assessing and diagnosing ASD. The aim of the study was to determine the extent to which school psychologists are prepared to meet the rapidly increasing demand for using best practice procedures when assessing and diagnosing ASD. An electronic survey was sent to 1,159 certified school psychologists with 243 completed surveys returned. Survey results found the majority of respondents indicated that they rely on the use of brief screening instruments and do not use or recommend “gold standard” instruments with students suspected of having ASD. Only 32.2% of the respondents reported they were very much prepared to recommend an IDEA classification of Autism. Less than 5% of the school psychologists surveyed received formal training in ASD at graduate institutions or internships. The overwhelming majority of school psychologists surveyed believed there is         a need for more training for school psychologists concerning the characteristics of ASD, best practice in the assessment of ASD, and differentiating ASD from other developmental or coexisting disorders.
  • Small (2012) used an online survey of 100 members of the Massachusetts School Psychology Association (MSPA) to obtain information pertaining to demographics, participants’ experiences with the ASD population, participants’ knowledge of ASD, as well as their use, competency, and feelings of usefulness of various assessment techniques and treatments/interventions. The results indicated that overall, school psychologists demonstrated adequate knowledge of ASD, felt competent conducting assessments, and reported that the assessment tools were useful. School psychologists spent less time on treatment/intervention and while they considered many of the treatments/interventions helpful, they did not feel competent implementing them. The results suggest that school psychologists need more training in ASD, especially regarding treatments/interventions, at the pre-service level through graduate school training and experiences (e.g., practica and internships), as well as at the practitioner level through professional development opportunities.

Conclusion and Recommendations

As more and more children are being identified with ASD and placed in general education classrooms, school psychologists will play an ever increasingly important role in identification and intervention, as well as offer support, information, consultation, and recommendations to teachers, school personnel, administration, and families. Therefore, it is essential that they be knowledgeable about evidence-based assessment and intervention strategies for this population of students.  Despite the limitations inherent in survey research, the data from these studies suggest that school psychologists are not adequately prepared to provide evidence-based assessment and intervention services to children with ASD. The survey research illustrates a significant discrepancy between best practice (evidence-based) parameters and reality when it comes to the practice of school psychology and ASD in the schools. Federal statutes require that school districts ensure that comprehensive, individualized evaluations are completed by school professionals who have knowledge, experience, and expertise in ASD. Although surveys indicate sufficient knowledge of the signs and symptoms associated withASD, there is a critical need for school psychologists to be trained and develop competency in evidence-based assessment and identification practices with children who have or may have an ASD. For example, a majority of survey respondents reported using brief screening measures such the GARS and/or GADS in assessment and identification, both of which are not recommended for use in decision-making (Brock, 2004; Norris, M., & Lecavalier, 2010; Pandolfi, Magyar & Dill, 2010; Wilkinson, 2010). In contrast, evidence-based tools such as the ADOS, ADI-R, CARS, and SCQ were used less a third of the time in ASD assessment. Thus, while evidence-based instruments are available for the reliable, thorough assessment of students with ASD, school psychologists either do not have access or lack sufficient training to make them a part of their practice in the schools.

Because the knowledge base in ASD is changing so rapidly, it is imperative that school psychologists remain current with the research and up to date on scientifically supported approaches that have direct application to the educational setting. School psychologists can help to ensure that students with ASD receive an effective educational program by participating in training programs designed to increase their understanding and factual knowledge about best practice assessment and intervention /treatment approaches. Recommendations culled from the survey findings include the following: (a)school psychologists need more in-depth, formal training complete with supervision and consultation; (b) school psychology training programs should focus more energy on teaching intervention strategies for students with autism and include a separate course in ASD as part of the curriculum; (c) increase the use of more psychometrically sound autism instruments such as the ADOS and ADI-R in schools to provide better identification and more complete intervention strategies; (d) consider resident ASD specialists within the school and train teams of school professionals to work as a unit with the autism-related cases to ensure that the personnel are well-trained and have the experience necessary to conduct reliable and valid assessments and treatment planning; (e) provide training for all school psychologists on best practice guidelines for screening and assessment of ASD and identify measures with and without empirical support; and (g) develop closer relationships with ASD experts and service providers in the community. School districts may also want to consider levels of training, levels of education, and years of experience when assigning school psychologists who work with children who have ASD.  Finally, the National Association of School Psychologists (NASP) may consider developing guidelines and recommendations regarding the minimal competencies needed in order to work with special populations such as students with ASD.

Aiello, R., & Ruble, L. A. (2011, February). Survey of school psychologists’ autism knowledge, training, and experiences. Poster presented at the annual convention of the National Association of School Psychologists, San Francisco, CA.

Brock, S. E. (2004). The identification of autism spectrum disorders: A primer for the school psychologist. California State University, Sacramento, College of Education, Department of Special education, Rehabilitation, and School Psychology.

Norris, M., & Lecavalier, L. (2010). Screening accuracy of level 2 autism spectrum disorder rating scales: A review of selected instruments. Autism, 14, 263-284.

Pandolfi V., Magyar C. I., & Dill C. A. (2010). Constructs assessed by the GARS-2: factor analysis of data from the standardization sample. Journal of Autism & Developmental Disorders, 40, 1118-30.

Pearson, L. M. (2008). A survey of Pennsylvania school psychologists’ training, knowledge and evaluation practice for assessing and diagnosing autism spectrum disorders. PCOM Psychology Dissertations. Paper 112. http://digitalcommons.pcom.edu/psychology_dissertations/112

Rasmussen, J. E. (2009). Autism: Assessment and intervention practices of school psychologists and the implications for training in the united states. Ball State University). ProQuest Dissertations and Theses, 192. UMI Number: 3379197

Small, S. H. (2012). Autism spectrum disorders (ASD): Knowledge, training, roles and responsibilities of school psychologists. University of South Florida). ProQuest Dissertations and Theses, 220. ISBN: 9781267519658 UMI Number 3308958

Wilkinson, L. A. (2010). A best practice guide to assessment and intervention for autism and Asperger syndrome in schools. London: Jessica Kingsley Publishers.

© Lee A. Wilkinson, PhD

Posted by Lee A. Wilkinson Lee Wilkinson at Sunday, October 07, 2012

Retrieved from: http://bestpracticeautism.blogspot.com/2012/10/school-psychologists-need-more-training.html

 

Young Adults With Autism Seek Out White-Collar Careers For First Time

In Autism Spectrum Disorders on Tuesday, 9 October 2012 at 06:40

Young Adults With Autism Seek Out White-Collar Careers For First Time

Posted: 09/27/2012 9:16 am EDT Updated: 09/27/2012 9:16 am EDT

Christina Wilkie

A few weeks ago, Matthew Koenig, 24, was doing data entry for below minimum wage at a supervised employment center for people with disabilities in St. Paul, Minn.

Koenig, who has autism, was happy to have a job in a tough economy, but soon realized the workplace wasn’t well suited to him. His co-workers “had too broad of a range of [disabilities],” he said. “Some people had really serious problems.”

Moreover, employees were graded using “a time study to measure efficiency,” he said, “but the nature of my disability means I lack certain kinds of motor skills, so I can’t type as quickly as other people.”

A sleep disorder caused Koenig to be late a few times, and since then, “they haven’t asked me to come in for a few weeks.” He acknowledged that “part of it was my fault,” but the combination of a menial job and an abrupt dismissal “made me feel like I’m not worth anything.”

Koenig, who scored a 1450 out of 1600 on his SATs, knows this isn’t true. “Despite my autism, I have good instincts about people, and I try to do the right thing,” he said in a self-assured staccato. “I’m perfectly willing to stick around, and ultimately my goal in my career is to make sure the job gets done.”

The simple, repetitive tasks of his last job didn’t match his intelligence, needs or aspirations. Instead, he said he wants to use the unusual outlook afforded by autism to build a meaningful career in the tech sector.

“I’d like to help come up with ideas for entertainment and video games,” he said, “because one of my strengths is that I have an unconventional train of thought that other people don’t have.”

Mindful and ambitious, Koenig is one of a growing number of young people with high-functioning autism who are increasingly focused on building meaningful careers. A cadre of groups have begun developing new ways to prepare these young people for white-collar jobs.

AN ‘AUTISM TSUNAMI’

They face a daunting set of obstacles. Job prospects for adults with autism in the U.S. are crushingly bleak. Nationwide, their combined unemployment and underemployment rate is around 90 percent.

The employment situation owes much to the basic nature of autism spectrum disorders (ASDs). Typically diagnosed in early childhood, autism is a developmental disability that can impair communication skills, speech, fine motor skills and behavior. In very mild cases, symptoms may be limited to impaired social skills and difficulty registering empathy. In severe cases, individuals face enormous challenges with verbal communication, show little interest in other people, exhibit extreme sensitivity to light and sound, and develop obsessive behaviors.

Some researchers estimate that up to 1 percent of U.S. adults have ASDs — about 3 million people — but the range in severity and the historical stigmas surrounding autism have made it hard for scientists to collect population data. The unemployment estimates take the entire population into account, including those with severe symptoms.

There is currently no established cause of autism (though theories abound), nor is there a cure.

Another pressing mystery for researchers is why diagnoses of autism among children in the U.S. jumped 70 percent between 2002 and 2008 — from one in every 150 kids to one in every 88. Autism Speaks, a large national nonprofit, has estimated that during the next 10 years, more than 500,000 young people with ASDs will turn 18.

But if current trends continue, many of them won’t receive the basic education required to join the competitive workforce.

According to a 2011 study, only 56 percent of young adults with autism in the U.S. graduated from high school, and only 14 percent started college. How many graduated from college is unknown, but experts say it’s likely to be fewer than half of those who started.

The high dropout rates among students with ASDs are due in part to the structure of school itself. People with autism often have difficulty meeting deadlines, managing their time and asking for help when they’re confused — all basic academic skills.

“Schools still struggle to understand autism and how it’s different from other disabilities,” said Peter Bell, executive vice president of programs at Autism Speaks. “One of the fallacies we have to overcome is that IQ is a meter of disabilities. In 2003, we learned that 60 to 70 percent of people with autism have average or above average intelligence, up from what was thought for decades to have been only 30 to 40 percent.”

Despite the evidence, Bell said, some educators are still unequipped to address the needs of kids with developmental disabilities and above-average IQs.

“We clearly have a crisis looming,” said Brenda Weitzberg, the founder of Aspiritech, a Chicago nonprofit that employs young adults with autism. She warns that unless there are adequate jobs available, even the most effective skills training will be of little use.

“I have no doubt that more of these kids are going to be better prepared” for high school and college, Weitzberg said. “But after they finish school, then what’s going to happen to them?”

“Some people refer to it as the ‘autism tsunami,'” said Bell. Unless more employment opportunities are created for people with autism in the coming years, hundreds of thousands of young adults with autism will join the ranks of the unemployed or underemployed.

THE NEXT BEST HOPE

The news isn’t all bad. Two decades of well-funded research and treatment have produced young adults with autism who are better prepared to join the workforce now than ever before.

“The skill sets of these kids are so much higher than we ever gave them credit for and what people in the norm tend to give them credit for,” said Gary Moore, founder of a recently opened autism career-training school, the nonPareil Institute, in Plano, Texas.

Bell at Autism Speaks noted much the same thing. “There’s no question that there’s a segment of the [autism] population that has tremendous skills and that can be quite successful in sectors that we never considered before,” he told The Huffington Post.

For workplace disability researcher Laurie Gutmann Kahn at the University of Oregon, it’s all part of a broader trend toward viewing “people with ASD as having a different way of navigating the world, which can be extremely useful in a variety of professions,” she said.

Marc Lazar, program director at Aspiritech, takes it a step further. “There’s a growing recognition that high-functioning ASD individuals have qualities that neurotypicals don’t,” he said. (The autism community coined the term “neurotypical” to describe someone who is not on the autism spectrum.) “They can find details that most people miss, they’re able to focus for long periods of time, and they really savor specific kinds of work like software testing, lab work and proofreading.”

All of which leads to one conclusion, in Bell’s view: “The autism population represents a pool of potential employees that corporate America needs to explore.”

This is where autism career-training programs come in. By focusing on those young people with autism who appear best suited to function in a competitive workplace, organizations like Aspiritech and the nonPareil Institute are offering a small group of high-functioning adults the opportunity to decide for themselves whether to integrate into the neurotypical world.

In Chicago, Aspiritech aims to prepare people for competitive workplace demands while they hone their skills on software testing. Since it was founded in 2008, Aspiritech has employed more than two dozen adults with high-functioning autism, most of whom still work out of its main offices. Weitzberg, the founder, said she is proud of the fact that they have 18 corporate clients, including a number of large U.S. companies with which Aspiritech has competitive contracts.

In Plano, a different model is being developed with the same goal: to prepare each of the school’s students, who have high-functioning autism, for an individualized, personally fulfilling white-collar career. Founded in 2009, the nonPareil Institute operates as part university campus, part vocational center. Students learn the finer points of video game and computer app design, while also building up their social skills and life strategies.

Both programs are also designed to create cultures of self-determination and healthy personal ambition.

“I didn’t have a professional life before I came to nonPareil,” said Renee McMurtry, a 21-year-old student from Fort Worth, Texas, who was diagnosed with Asperger’s syndrome. Today, she has “opportunities that didn’t exist before. … I see myself doing a lot in the next few years, making money and being successful.”

SILENT BARRIERS

As the autism community rallies together to prepare young people for the workforce and for white-collar careers, many of the nation’s biggest employers have yet to return the favor. A number of them are still wrestling with basic questions about hiring individuals on the autism spectrum.

As Matthew Koenig, the young man in Minnesota, put it, “the conveyor belt of traditional employment puts you at a huge disadvantage with high-functioning autism, because you talk the way you do, and that’s an automatic strike one.”

Under the Americans with Disabilities Act, it is illegal to discriminate against qualified job applicants because they have autism, but experts say widespread discrimination continues. “They still do it. They’ll just find another reason not to hire the person [with autism],” said an autism advocate, one of a half-dozen activists and autism experts who spoke to HuffPost about the slow pace of integrating people with autism into the white-collar workforce. None were willing to speak about employment barriers on the record, however, citing the sensitive nature of the subject. Employers were equally reluctant to be identified as having hired people with ASDs for white-collar jobs, noting issues of employee privacy and potential legal liability.

The conversations revealed three distinct concerns about hiring people with ASDs that persist for some employers, serving as silent barriers despite the law.

First, employers worry that they don’t know enough about autism in adults to wade into the community, lest they make a mistake. Two people also said some employers don’t know how to discuss job expectations, performance issues and potential limitations comfortably and respectfully with employees who have autism.

Second, some white-collar employers expressed hesitation about the administrative steps in providing “reasonable accommodation” for someone with autism, a requirement under the Americans with Disabilities Act.

One such accommodation in particular was cited more than once as a source of frustration: autism-related “job coaches.” People with autism often need more help adjusting to new jobs and responsibilities than neurotypical workers do, and the coaches help them navigate new workplaces and learn their tasks.

Coaches are typically paid for by state employment agencies, not the employers themselves. But in interviews with HuffPost, autism advocates relayed complaints they had received that job coaches were “disruptive and didn’t fit in with the rest of the staff” and “didn’t know their way around the office.” In one situation, an employer said, “the coach just came in and did the guy’s job for him, while he sat there.”

Kahn, the University of Oregon researcher, defended the provision of additional support for people with autism early in a new job, even if it is sometimes inconvenient. “A person with autism might not understand that you’re supposed to talk to people at the water cooler. In those situations, they need someone who can explain it to them,” said Kahn, “and maybe coach them and say, ‘People are going to ask you about your weekend when you’re at the water cooler. If you want to, you can tell them, “I’m really busy and need to get back to work.”‘ That’s what they need to hear.”

The third silent barrier to hiring people with autism is by far the thorniest. Employers said privately that company lawyers suggested that hiring someone with autism could put them at a greater risk for legal liabilities, as well as higher health care costs.

Last year, a San Diego-area Comfort Suites hotel paid $132,500 to settle an Equal Employment Opportunity Commission lawsuit filed on behalf of a front-desk clerk with autism, who said he had been illegally denied a job coach when he requested one. Cases like this one have apparently bolstered the myth that hiring people with autism is especially complicated or that people with autism are somehow less reliable and more risky than neurotypical employees.

“ASDs still carry the ‘Rain Man’ stigma for a lot of the general public,” said an autism advocate who requested anonymity to speak frankly. “[Employers] are just covering their asses.”

To this day, many Americans have never met a person with autism, and millions rely on stereotypes and movies for the bulk of their opinions about people with ASDs.

Yet a huge wave of high-functioning young people with autism, like Matthew Koenig, are beginning to explore the possibility of meaningful work. Members of this new generation have learned to view their diagnoses less as disabilities per se and more as different sets of abilities. As they push the limits of their potential, one at a time, they simultaneously push the ball forward for the entire autism community.

“The reality of having autism is that in order to find our strengths, you’ve got to get to know us,” Koenig said. “It’s like an onion. You have to peel back the layers.”

Retrieved from: http://www.huffingtonpost.com/2012/09/27/autism-employment-white-collar-jobs_n_1916611.html

 

autism and schizophrenia…a collision

In Autism Spectrum Disorders, Psychiatry, School Psychology on Tuesday, 9 October 2012 at 06:35

When the autism and schizophrenia spectrums collide

Spectrum. The name conjures up white light separating out through a prism, the multi-coloured rainbow, and even that wonderful 8-bit computer made by Sir Clive Sinclair (yes, I had one of those you Commodore people).

When it comes to autism and schizophrenia,the concept of a spectrum invokes similar ideas of different variations or colours on a theme, separate but linked, patterns of symptoms which stem from a single source but diffuse outwards with fuzzy boundaries. It almost sounds a little bit ‘Sixties’ if I’m truly honest.

For quite a few people, including those on the DSM-V ‘how are we going to redefine autism‘ committee, spectrum is something really being taken on board as the ever-approaching deadline for revision comes closer and closer into view. That’s not to say everyone is particularly happy with the formal spectrum-ing of autism as per this recent review by Luke Tsai* (open-access) who prefers the term ‘autism continuum disorder’, but there you go. Indeed scroll down to the descriptor of autism at the bottom of this blog and I use the word ‘tapestry’ which also might be a good description of the heterogeneity present. (Note to self: this description will need updating next year).

You’re probably wondering why I’m going on about spectrum; well its all to do with this paper by Prof. Kenneth Gadow** and how the autism spectrum and the schizophrenia spectrum might be colliding a little more than we perhaps first thought.

This is not the first time that I’ve talked about autism and schizophrenia overlapping as per this post on some very interesting research indicating that around about 40% of one cohort of people with schizophrenia also presented with symptoms congruent with an autism diagnosis.

Prof. Gadow reports a few interesting things from the other direction insofar as his cohort of children diagnosed with an autism spectrum disorder (ASD) presenting with quite a few characteristics more usually associated with the schizophrenia spectrum disorders (SSDs). In a little more detail (sorry that I can’t link to the full-text paper):

  • Building on previous research by the author***, the aim of the study was multi-fold primarily looking at the risk of SSD symptoms in ASD and also looking at how a comorbid diagnosis of ADHD may moderate that risk of SSD symptoms.
  • Consecutive child referrals (aged 6-12 years) to a developmental or child psychiatry outpatient clinic were included for study.
  • Samples were divided up as follows: Autism (N=147) of which n=50 were diagnosed with an ASD only and n=97 diagnosed with ASD & attention-deficit hyperactivity disorder (ADHD). Controls (N=335) included n=146 asymptomatic and n=188 (I assume the missing participant was excluded for some important reason).
  • The primary schedule of choice was the Child and Adolescent Symptom Inventory-4R (CASI-4R) completed by mums and teachers of participants. In particular, the subscales on Schizoid Personality and Schizophrenia and their combining to form a global SSD score were a focus for this study.
  • Results (a few of them anyway): well, mums and teachers showed some overlap in their scoring of participants (always a relief for a questionnaire) bearing in mind contextual differences. Both children with ASD with and without ADHD “had more severe global SSD ratings than their respective controls” but as with many things linked to autisms, there was quite a bit of variability among participant scores.
  • A diagnosis of ADHD whether associated with ASD or not, seemed to confer a greater risk of SSD symptoms pointing to a likely link between ADHD and SSD.
  • An interesting finding this one: the combination of ASD and ADHD and the pattern of SSD symptoms appearing (e.g. disorganised behaviour and negative symptoms – inappropriate laughter, crying and little interest in doing things) “supports the more general notion that certain combinations of disorders may be better conceptualized as unique clinical conditions“. Now think back to that spectrum – continuum argument and the DSM-5 move away from discrete diagnoses….?
  • Another quote from the paper: “findings provide additional support for an interrelation between ASD and SSD symptoms“.

A few things come to mind from these results. First is this suggestion that some cases of childhood ASD present with patterns of symptoms more readily tied into SSD. As per my previous post on this ‘overlap’, the great scientific machine seems to be doing yet another revolution as autism, once considered to be pretty ‘similar’ to schizophrenia (remember childhood schizophrenia) then departed on it’s own journey, and now appears to be heading back towards schizophrenia or at least SSD.

I’m making no value judgements either way on this process given the likely opinions that might be raised on this matter in terms of diagnostic identity, management options and indeed how autism and schizophrenia have tended to become represented among the general population. If there is an upside to this partial reunification, I suppose it is that shared genetics (and epigenetics), biochemistry (see this post for example) and other areas might open up some interesting avenues for further study. With my own research hat on, I’m thinking Dohan and his hypotheses on gluten in cases of schizophrenia and autism. There are most likely going to be others.

Second is this issue of discrete clinical conditions potentially being present from the current study. Again its all about historical trends in science, and whether people talk about specific clinical entities (diagnostic boxes with names and formal criteria) or ‘lumping things together’ as per the use of terms like spectrum. I admit also to being pretty intrigued by the suggestion of a possible new clinical entity represented by ASD, ADHD and SSD symptoms. I’m no expert, and please don’t take my word as Gospel, but there seem to be some hints of diagnoses like pathological demand avoidance (PDA) also being detailed here. Just a thought.

Finally bearing in mind the Gadow study was based on a paediatric population, one has to wonder how this complex pattern of symptoms will eventually play out into adulthood. Bearing in mind that autism is seemingly protective of nothing when it comes to comorbidity, I think many working at the coalface will know of people diagnosed with autism who seem to develop clinical signs and symptoms more readily associated with the schizophrenia spectrum disorders as maturity sets in. The question is whether the criteria used in the current study could somehow be predictive of those who are at greater risk and whether plans and processes could be set in place to moderate this risk.

I’m going to stop there save any charges of over-analysing the paper from Prof. Gadow and its important findings. Reiterating the complex nature of both ASD and SSD and the areas of overlap which seem to be present, how we understand such conditions and indeed label them actually might turn out to be an important point not just from a identity point of view but also conceptually, onward to planning for / mitigating risk and improving overall quality of life.

Without trying to make light of spectrums, may be you remember this theme tune by the Spectrum?

*Tsai L. Sensitivity and specificity: DSM-IV versus DSM-5 criteria for autism spectrum disorder. Am J Psychiatry. 2012; 169: 1009-1011.

** Gadow KD. Schizophrenia spectrum and attention-deficit/hyperactivity disorder symptoms in autism spectrum disorder and controls. J Am Acad Child Adolesc Psychiatry. 2012; 51: 1076-1084.

*** Gadow KD. & Devincent CJ. Comparison of children with autism spectrum disorder with and without schizophrenia spectrum traits: gender, season of birth, and mental health risk factors. JADD. February 2012.

Gadow KD (2012). Schizophrenia spectrum and attention-deficit/hyperactivity disorder symptoms in autism spectrum disorder and controls. Journal of the American Academy of Child and Adolescent Psychiatry, 51 (10), 1076-84 PMID: 23021482

Retrieved from: http://questioning-answers.blogspot.co.uk/2012/10/when-autism-and-schizophrenia-spectrums.html

40 things to say before you die

In Meditation, Mindfulness, Well-being on Tuesday, 9 October 2012 at 06:27

40 Things To Say Before You Die

Before you’re sprawled on your deathbed, there are some things you really have to say. They’re not complicated. They’re not poetry.

They’re just short sentences with big meaning.

I hope they get you talking.

http://www.forbes.com/sites/jessicahagy/2012/10/04/40-things-to-say-before-you-die/

Dalai Lama on education…

In Education, Mindfulness, Pedagogy on Monday, 8 October 2012 at 07:30

“Education is the proper way to promote compassion and tolerance in society. Compassion and peace of mind bring a sense of confidence that reduce stress and anxiety, whereas anger and hatred come from frustration and undermine our sense of trust. Because of ignorance, many of our problems are our own creation. Education, however, is the instrument that increases our ability to employ our own intelligence.”~HH 14 Dalai Lama

The Energetic Brain…a great reference for ADHD

In ADHD, ADHD Adult, ADHD child/adolescent, ADHD stimulant treatment, Medication, Neuropsychology, Psychiatry, Psychopharmacology, School Psychology on Sunday, 7 October 2012 at 09:27

everything you ever wanted to know about adhd. a wonderful reference!

http://www.amazon.com/The-Energetic-Brain-Understanding-ebook/dp/B006RDCF0M/ref=sr_1_1?s=digital-text&ie=UTF8&qid=1349616011&sr=1-1&keywords=the+energetic+brain

Background TV…when you’re not even actively watching.

In Education, School Psychology, Special Education, Uncategorized on Sunday, 7 October 2012 at 07:22

U.S. kids exposed to 4 hours of background TV daily

By Michelle Healy

A number of studies have found evidence that too much television is bad for children’s development, even when it’s playing in the background and kids are not watching. Now a study has tracked just how much background TV kids get and it’s a lot — 232.2 minutes or nearly 4 hours worth every day.

The average amount is even greater among some, especially children who are younger, African-American or from the poorest families, finds the study in today’sPediatrics.

The nearly four hours of background TV exposure “easily dwarfs” the 80 minutes of active TV viewing the average child in this age group absorbs daily, says the study.

“You’re looking at three times the amount, which is enormous,” says Matthew Lapierre, one of the study authors, an assistant professor of communication studies at the University of North Carolina-Wilmington. “It’s really kind of shocking,” he says.

The study was presented in May at a meeting of the International Communication Association. It was conducted using a nationally representative telephone survey of 1,454 parents with at least one child between the ages of 8 months and 8 years old.

Among questions that parents were asked: how often their TV was on when no one was watching; whether their child had a TV in their bedroom and the number of TVs in the home.

It found that in addition to actual TV viewing, children under age 2 and African-American children were exposed to an average of 5.5 hours a day of a TV playing in the background; children from the poorest families were exposed to nearly 6 hours per day.

The finding among African-Americans “wasn’t unexpected,” says Lapierre noting that statistically, their households “are often found to be more TV-centric,” compared with other groups, with more TVs per household and more of those TVs in bedrooms.

He suspects that the high rate of background TV among very young children may have to do with parents and caregivers leaving the television on, even when they’re not actively watching, to “break up the monotony” of being with an infant or toddler for long stretches of the day.

The study notes that background television exposure has been “linked to lower sustained attention during playtime, lower quality parent-child interactions, and reduced performance on cognitive tasks.”

Heather Kirkorian, an assistant professor of human development and family studies a researcher at the University of Wisconsin-Madison who has published studies on background television’s impact on both parent-child interaction and children’s play patterns, says “until now we could only guess at the extent of the impact in children’s day-to-day lives.” The new study “documents just how great the real-world impact may be, particularly for very young children.”

The American Academy of Pediatrics recommends that children under age 2 not be exposed to any television.

To reduce background TV exposure, the study recommends turning off the TV when no one is watching and at key points during a child’s day, such as bedtime and mealtime.

Retrieved from: http://www.usatoday.com/story/news/nation/2012/10/01/background-tv-viewing-pediatrics/1599995/

Treating autism with a supplement? New research says yes.

In Autism Spectrum Disorders, Genes, Genomic Medicine on Sunday, 7 October 2012 at 07:18

New Form of Autism May Be Treatable With Supplement

Pam Harrison

October 1, 2012 — A homozygous mutation that silences the gene involved in the metabolism of branched-chain amino acids (BCAAs) has been identified in a group of children who have autism and either epilepsy or abnormalities on electroencephalogram (EEG), an international team of investigators has reported.

Gaia Novarino, PhD, from the University of California, San Diego, and multicenter colleagues identified a mutation in the branched-chain ketoacid dehydrogenase kinase (BCKDK) gene in families among whom parents were cousins and whose children had autism, epilepsy, and intellectual disability.

“The normal role of the BCKDK gene is to shut off the metabolism of the BCAAs,” coauthor Joseph Gleeson, MD, University of California, San Diego, told Medscape Medical News. “And the end result of these mutations is hypermetabolism of the BCAAs and their depletion in patients who carry them.”

In mice, the researchers were able to show that a BCAA-enriched diet abolished the neurologic deficits within a week.

The study was published online September 6 in Science.

Related Families

As Dr. Gleeson noted, investigators set out specifically to study families in which parents were related to each other to allow them to identify recessive causes of disease.

They identified 2 consanguineous families, one of Turkish descent and a second of Egyptian ancestry, in which children had autism, intellectual disability, and either seizure or abnormal electroencephalograms (EEGs). Whole-exome sequencing was carried out in both families.

Researchers focused on the identification of homozygous variants that were predicted to result in loss of protein function, which would be consistent with the presumed mode of recessive inheritance.

“In each of these families, we identified a distinct, null, homozygous mutation in the [BCKDK] gene,” investigators write, “and no other homozygous loss-of-function mutations segregating with affected status were identified in either family.”

Investigators also studied the effect of a chow diet containing 2% BCAAs or a BCAA-enriched diet, consisting of 7% BCAAs, on Bckdk mice deficient in the same gene. These mice have reduced levels of BCAAs in various tissues.

“Mice raised on the BCAA-enriched diet were phenotypically normal,” the authors observed, “[whereas] on the 2% BCAA diet…Bckdk mice and not wildtype had clear neurological abnormalities such as seizures…that appeared within 4 days of instituting the 2% BCAA diet.”

The same neurologic deficits were completely abolished within a week of the same mice starting the BCAA-enriched diet, suggesting that Bckdk mice have an inducible yet reversible phenotype.

“What was really surprising to us is that the children [we studied] could have come into any autism clinic because they looked like any child with autism, there was no way to differentiate them clinically,” Dr. Gleeson said. “The only way we were able to make the discovery was by sequencing the DNA, which was where we found the mutation.”

Dr. Gleeson added, too, that it was “very surprising” to find mutations in a potentially treatable metabolic pathway specific for autism, namely through BCAAs supplementation in patients with this specific mutation.

Investigators would welcome any parents whose children have the same constellation of autism with accompanying epilepsy or EEG abnormalities into their screening program.

Translation Medicine

Valerie Hu, PhD, from George Washington University, Washington, DC, told Medscape Medical News that she liked how the study translated novel genetic findings from exome sequencing to a functional/biochemical phenotype, demonstrating reversibility in the mouse model through nutritional supplementation.

“I think that recent research in the field is really opening up new horizons,” she added.

Dr. Hu is herself pursuing research related to the genetic underpinnings of autism.

The study was funded in part by the National Institutes of Health. Dr. Gleeson and his co-investigators have filed for a patent on the genetic diagnosis and potential treatment of this particular form of autism. Dr. Hu has no disclosed no relevant financial relationships.

Science. Published online September 6, 2012. Abstract

Retrieved from: http://www.medscape.com/viewarticle/771886?src=nl_topic

FDA approves liquid, extended-release ADHD medication

In ADHD, ADHD Adult, ADHD child/adolescent, ADHD stimulant treatment, Medication, Psychiatry, Psychopharmacology on Sunday, 7 October 2012 at 07:14

FDA Approves Liquid, Extended-Release ADHD Med

Caroline Cassels

October 1, 2012 — The US Food and Drug Administration (FDA) has approved a once-daily liquid medication for the treatment of attention-deficit/hyperactivity disorder (ADHD).

In a news release, drug manufacturer NextWave Pharmaceuticals announced FDA approval of its drug Qullivant XR (methylphenidate hydrochloride), the first once-daily, oral-suspension medication for the treatment of ADHD.

According to the company, the central nervous system stimulant is the first extended-release, once-daily liquid ADHD medication on the market. It helps control ADHD symptoms within 45 minutes of administration and lasts for 12 hours.

“The approval of Quillivant XR fills a void that has long existed in the treatment of ADHD. We routinely see the struggles of patients who have difficulty swallowing pills or capsules. Having the option of a once-daily liquid will help alleviate some of these issues while still providing the proven efficacy of methylphenidate for 12 hours after dosing,” said Ann Childress, MD, president of the Center for Psychiatry and Behavioral Medicine, Las Vegas, Nevada, who was also an investigator in a clinical trial that tested the drug.

The company notes that the drug’s efficacy was evaluated in a randomized, double-blind , placebo-controlled, crossover, multicenter classroom study of 45 children with ADHD.

Quillivant XR is a federally controlled substance (CII) because of its potential for abuse and/or dependence.

The drug is expected to be available in pharmacies in January 2013.

Retrieved from: http://www.medscape.com/viewarticle/771878?src=nl_topic

 

New Depression Guidelines

In Psychiatry on Thursday, 4 October 2012 at 11:52

New Depression Guideline Goes Beyond Symptom Relief

Kate Johnson

October 2, 2012 (Montreal, Canada) — The treatment of major depressive disorder (MDD) should go beyond the goal of symptom relief to include a more global target of improving patients’ overall and occupational functioning.

This shift is reflected in new consensus recommendations currently being finalized by the Canadian Network for Mood and Anxiety Treatments (CANMAT).

“The focus on symptoms doesn’t necessarily make sense for our patients because they’re primarily concerned about their functioning. And so we think we need to move the bar now — raise the bar — in terms of our assessment of outcomes. The ideal outcome really should be functional recovery,” Raymond Lam, MD, executive chair of the network, told delegates attending the Canadian Psychiatric Association (CPA) 62nd Annual Conference.

Studies show that MDD has a significant impact on work functioning, yet roughly 70% of people with MDD remain at work.

“Our view is that unless there are safety issues, it’s better for patients to be trying to stay at work while they’re being treated rather than being off work. The longer they’re off work, the harder it is to get them back,” said Dr. Lam, who is also professor of psychiatry and head of the Mood and Anxiety Disorders Program, University of British Columbia in Vancouver, Canada.

Because “the trajectory and time course of functional improvement may not mirror that of symptom improvement,” treatment that addresses symptoms alone may miss an important part of the picture, he said.

Subtle Outcomes

According to a needs assessment survey done primarily with family physicians, although most physicians recognize that functioning is a major determinant in treating people with depression, “there is a knowledge gap in terms of how functioning issues present,” Dr. Lam added.

To rate and monitor improvement in work functioning outcomes, the CANMAT statement recommends the use of clinician-rated scales such as the Health and Work Performance Questionnaire (HPQ) and the Lam Employment Absence and Productivity Scale (LEAPS) (BMC Psychiatry 2009;9:78-85), which was developed by Dr. Lam.

A new study by Dr. Lam’s group, which is currently under review, shows how such work performance scales are able to pick up subtle outcomes that can be missed on general symptom scales such as the Montgomery-Åsberg Depression Rating Scale (MADRS).

The Worker Outcome Research and Knowledge about Escitalopram and Related Treatments (WORKER) study is the first randomized controlled trial of pharmacotherapy and psychotherapy focusing specifically on work productivity outcomes, said Dr. Lam.

Better Productivity

A total of 105 employed patients with MDD were randomly assigned to undergo treatment with either escitalopram (10 – 20 mg/day) for 12 weeks plus 8 one-half-hour sessions of telephone cognitive-behavioral therapy (CBT) or escitalopram alone with adherence reminder calls.

Symptom response and remission were measured on the MADRS, and functioning was measured on both the HPQ and the LEAPS as well as a third functioning scale, the Sheehan Disability Scale (SDS).

After 12 weeks, there was no significant difference between the groups in terms of symptom outcome, with MADRS responder rates at 56% for patients in the combination therapy group vs 53% for patients receiving escitalopram alone (MADRS scores, 15.7 vs 14.3).

However, on the outcome of work functioning, participants receiving combination therapy had greater improvements than those receiving escitalopram alone on both the HPQ (1.2 vs 0.5, P < .05) and the LEAPS (3.9 vs 2.5, P < .04).

“We think these are clinically relevant differences in work productivity,” he said.

There were no differences between the groups on the SDS, “but the SDS is really a global measure and only has 1 item on overall work and role function,” he explained. “Using a 1-item scale may not be sensitive enough in a relatively small sample.”

The findings show that although symptoms can resolve with medication alone, there was residual functional impairment

“People’s occupational functioning obviously improved when they were on the antidepressant alone, it’s just they got a bump-up in terms of productivity with the combined treatment…. This is why we feel it’s so important to incorporate functional outcome measures, because we may be missing the fact that some treatments are going to be better for functioning than others.”

A “Practical Goal”

After attending the presentation, conference delegate Derryck Smith, MD, clinical professor of psychiatry, University of British Columbia, who is also a psychiatrist in private practice in Vancouver, said he agreed with the recommendations.

“We’re trying to get people better, not just get rid of symptoms. We have to work towards a practical goal,” he told Medscape Medical News.

“We need to help make people more successful in their life in general, in their relationships, as well as how they’re doing in their job…and maybe even in the physical aspects — are they back to running, for example? Are they back to their hobbies? Are they doing well socially?

“Even if their symptoms are reduced, you may have to find out why they’re not back at work. Maybe it’s because they’re not sleeping, maybe it’s because they’re having cognitive difficulties,” he said.

He added that the current DSM-IV diagnostic criteria include “a unique cluster of symptoms that defines an illness, but you always have to have functional impairment to make the diagnosis, and it doesn’t define what functional impairment is.”

He said that objective functional outcome measures are much needed for this assessment.

Canadian Psychiatric Association (CPA) 62nd Annual Conference. Abstracts Ps5b and S11. Presented September 29, 2012.

Retrieved from: http://www.medscape.com/viewarticle/771998?src=nl_topic

 

the bar just got set very, very high…it’s all about ACTION!

In Inspiration, Mindfulness on Wednesday, 3 October 2012 at 17:35

what an amazing example of a man.  he didn’t wait for reports to be written or the government to act, he acted.  he took initiative.  not to mention all his OTHER accomplishments.  i am humbled completely…

L.A.’s richest man ups the ante in fight against cancer

Published October 03, 2012

Reuters

Read more: http://www.foxnews.com/health/2012/10/03/la-richest-man-ups-ante-in-fight-against-cancer/?test=latestnews#ixzz28H2MY1RW

As owner of 5 percent of the Los Angeles Lakers, Patrick Soon-Shiong could walk into the locker room of the storied basketball franchise any time for a chat with stars like Kobe Bryant. But the richest man in Los Angeles chooses to sit with the rest of his team’s fans.

“He’s not one of those owners who wants to be seen everywhere. He’s just one of the fans,” said Bryant. The NBA star gives his owner a hug before every game for luck “and maybe some of the success” of the slender Los Angles surgeon who built a fortune exceeding $7 billion as a biotechnology entrepreneur.

For all Soon-Shiong’s success, the South African émigré and son of a Chinese herbal doctor remains relatively unknown in Los Angeles, a city that thrives on status and celebrity.

That’s likely to change soon.

In recent weeks, he emerged as a likely bidder for fellow billionaire Philip Anschutz’s sports and entertainment unit AEG, owner of 100 venues worldwide and sports teams like the Los Angeles Kings hockey franchise and the L.A. Galaxy soccer team, not to mention a 20 percent stake in the Lakers.

And on Wednesday in Washington DC, Soon-Shiong and his L.A.-based NantHealth will unveil a joint venture with Verizon, Intel, Blue Shield of California and others to create a nationwide system for doctors to share DNA and other data on cancer patients. It will enable doctors to do genetic analysis of a patient’s tumor in less than a minute — a job that now can take from eight to 10 weeks.

“This is something the federal government should have done, but we waited and waited for them,” Soon-Shiong told Reuters in an interview.

“It’s unconscionable that cancer patients get the wrong diagnosis 30 percent of the time and that it takes so long to treat them with appropriate drugs for their cancer.”

Soon-Shiong emigrated to the United States more than three decades ago with his wife Michele Chan, an actress who had a starring role in 80’s CBS show “Danger Bay” and guest roles on ” MacGyver.” Since then, he has methodically climbed the ladder of success by adroitly mixing science and business.

He created drugs to fight diabetes and breast cancer and then sold the companies that produced them for a combined $8.6 billion.

In the four years since selling those companies, he quietly spent more than $400 million of his own money to build a national fiber optic network that would link cancer clinics throughout the country — the groundwork for the health superhighway.

High spending, low profile

Soon-Shiong’s philanthropy was in evidence at his West Los Angeles office. The new superhighway was illustrated on a flow chart in a conference room where staffers edited a video of it on a nearby TV set.

In the lobby was a model of the campus surrounding the Saint John’s Health Center, to which he has given $135 million to build a biotech research center and sports medicine clinic.

“There are few Patrick Soon-Shiongs in this world,” said retired General Wesley Clark, who has served with him on non-profit boards. “A brilliant doctor, a great businessman and someone who is very patriotic. He understands what it means to give back to his country.”

Elsewhere, Los Angeles bears the mark of Soon-Shiong’s largesse and his fixation on healthcare. He and his wife operate the Chan Soon-Shiong Family Foundation, which last year endowed a chair at the University of Southern California Viterbi School of Engineering to support research in engineering and medicine.

In 2009, after watching TV footage of a woman dying on the emergency room floor because doctors didn’t notice her, he guaranteed $100 million to underwrite efforts to reopen Martin Luther King Hospital. The hospital, which has since reopened, serves the city’s low-income population.

The coming months may mark the public convergence of his private passions: health, sports, philanthropy and his adopted city.

He wants to buy AEG in large part because he plans to build a $1.2 billion football stadium to return pro football to the nation’s second largest city.

A diehard basketball fan, Soon-Shiong is not particularly keen on football. But he said owning a National Football League team would give him a platform to promote wellness by having players mentor younger fans on exercise and healthy eating, and sharing training and medical techniques with local doctors.

Until recently, Soon-Shiong kept a low profile. He and his wife did not want their name in a press release when they first donated $23 million to Saint John’s in 2007 to build a biomedical facility, recalled medical center president Lou Lazatin.

“Finally, they agreed when I told them it would help my marketing,” Lazatin said.

Surgical eye for detail

Soon-Shiong’s business career started in the early 1980s with the help of the National Aeronautics and Spac e Administration, which gave him $2 million for stem cell research that could one day help treat injuries during space travel.

At the time, he was a surgeon at a hospital affiliated with the University of California, Los Angeles. With the money, he opened a small lab near a veteran’s hospital, where he developed treatments to reduce diabetes in pancreatic transplant patients and a cancer-fighting drug that doubled the response rate for the treatment of breast cancer.

His climb was not without bumps. In 1999, his brother Terrence filed a complex suit claiming Patrick Soon-Shiong neglected work on a diabetes drug being developed by a startup in which Terrence had invested. But an arbitrator found in Patrick Soon-Shiong’s favor, and he declined to answer questions about the matter.

By 2008, Patrick Soon-Shiong controlled 82 percent of APP Pharmaceuticals, the company he started to develop injectable drugs to treat cancer and other illnesses. Soon-Shiong sold the company for $5.6 billion to Germany’s Fresenuis Kabi Pharmaceuticals, netting him $4.6 billion.

In 2010, he sold Abraxis BioScience, which he had spun off from APP in 2007, to pharmaceutical company Celgene Corp. for $2.9 billion. His 82 percent stake was worth $2.4 billion.

Soon-Shiong paid Celgene $135 million for NantWorks, where he had begun the work of creating his planned high-tech health delivery network. He also bought or provided seed money to small technology companies to aid in that effort.

He paid $20 million to buy a controlling interest in KeyOn Communications, which provides wireless broadband service for rural markets, and another $10 million to a stake in Raptor Networks Technology, which makes switching equipment for high speed networks.

“He watches every detail. I get emails from him at 2:30 in the morning, said Stephen Berman, CEO of toy maker JAAKS Pacific, which is licensing technology from one of Soon-Shiong’s companies to make interactive toys.

He gives more than just money, says songwriter Burt Bacharach, whose son went to private school with Soon-Shiong’s daughter. Soon-Shiong showed up unannounced at Cedars Sinai Hospital one day, says Bacharach, to help doctors find the right combination of drugs to treat the musician’s son, who had a persistent staph infection.

For L.A.’s richest man, that patient visit was a brief return to the role of physician that he insists he one day will resume.

Read more: http://www.foxnews.com/health/2012/10/03/la-richest-man-ups-ante-in-fight-against-cancer/?test=latestnews#ixzz28H2GmBuy

rock the vote!

In Uncategorized on Wednesday, 3 October 2012 at 16:55

be informed, people…and rock the vote. otherwise, you don’t get an opinion.

http://news.yahoo.com/blogs/ticket/truth-few-facts-may-hear-debate-131955840–election.html

Ideally, when the curtain rises on the first presidential debate at the University of Denver on Wednesday night, President Barack Obama and GOP presidential nominee Mitt Romney will spar over the issues shaping this election with honesty and clarity.

But let’s face it, the debates are yet another chance to deliver campaign talking points in 60-second, uninterrupted bursts—pitches, according to a recent Y!/Esquire poll, which many Americans think stray from the truth.

In anticipation of the spin, we’ve rounded up some of the debate’s top topics and fact-checked the candidates’ tropes in advance.

Taxes

Romney: Before either candidate muddles this up, ere are the key planks of Romney’s tax plan:

–       Bush-era income tax cuts and capital gains tax cuts become permanent.

–       All income tax rates are cut by an additional 20 percent.

–       The Alternative Minimum Tax and the estate tax are repealed.

To paraphrase Bill Clinton at the DNC, the problem is arithmetic: While Romney denies this,FactCheck.org notes the idea that his plan can somehow “slash individual income tax rates without losing federal revenue or favoring the wealthy remains at best unproven and, in our judgment based on available evidence, impossible.”

GOP vice presidential nominee Paul Ryan recently had to dance around this fact when pressed on it by Fox News. Exasperated, he sighed and said, “I don’t have time—it would take me too long to go through all the math.”

Romney should probably have a better answer ready—he’s likely to be grilled on the plan thanks to his recently released 2011 tax return, which revealed a 14 percent tax rate. Obama has questioned whether that’s a fair rate, claiming Romney pays less in taxes than many middle- and low-income Americans (a claim that itself is true only if payroll taxes are included in the comparison).

The president will likely try to paint the 14 percent tax rate as an omen of things to come under Romney’s plan, alleging that it would benefit the wealthy.

Jobs

Romney: As soon as you hear the former Massachusetts governor assure you of his plan to create 12 million jobs in only four years, remember this: Moody’s Analytics and Macroeconomic Advisors predict that no matter who wins this election, broader economic factors ensure that level of growth by 2016.

Romney is dressing up an apolitical projected figure as something his jobs plan could uniquely generate. It’s a bit like promising a plan to keep the Earth rotating around the sun for the next four years.

Obama: The president, for his part, will take credit for creating an impressive “4.5 million jobs.” He’s playing a bit fast and loose to get that number, however, citing only private-sector job growth, and only over the past couple of years, without mentioning the job losses on his watch.

Obama has actually presided over a net increase of about 300,000 private-sector jobs and, including the straggling public sector, a net decrease of about 300,000 total jobs. But you probably won’t hear that from him onstage tonight.

Medicare

 

Romney: The GOP’s “Medicare raid” meme alleges that Obama is about to rob Medicare to the tune of $700 billion in order to pay for the Affordable Care Act (ACA). This line earned Ryan a storm of jeers at a recent AARP conference—but Romney may still try to float it for its sheer scare value.

In fact, the oft-cited $700 billion figure represents the savings the ACA yields over 10 years by reducing Medicare spending, and it’s chiefly the providers rather than beneficiaries who pony up to finance the long-term spending cut.

Obama: If during the debate, however, the president starts bashing the “Romney-Ryan plan” on Medicare, claiming it costs seniors an extra $6,400, know that he’s actually referring to the obsolete Ryan budget from 2011, not the plan backed by the Republican ticket. The actual plan shares the Democrats’ goals of capping Medicare spending.

 

Health care

Romney: Ever since the Supreme Court ruled the Affordable Care Act constitutional, Romney has backed off from his more hyperbolic criticisms of the law, now stating that he’ll repeal it and keep the good bits. He has yet to say, however, how he’d pay for those select parts.

Also during the debate, Romney will likely try to fuse Americans’ concerns over jobs with lingering doubts about the ACA by repeating the old, standard line that “Obamacare” is “killing jobs in small business.” As FactCheck.org notes, this line is a serious misreading of a report by the Congressional Budget Office, which actually says that due to the subsidies provided by the ACA, about 800,000 workers will retire earlier or juggle fewer jobs.

Deficit

Obama: The president is correct when he says that he “inherited the biggest deficit in our history,” as he recently told Steve Kroft on “60 Minutes.” But he tends to use that fact as a shield against any Republican criticism about his own contributions to the deficit, which are considerable. To both Kroft and the AARP he stretched the premise to its limit, claiming that all his policies, from the stimulus to the rebooted war in Afghanistan, account for only about 10 percent of the nation’s deficit over the past four years. He blames the rest on President Bush.

That’s what some would call a whopper—but because Romney is probably eager to hammer the president on runaway spending, Obama might end up slipping this line into the debate anyway. The facts, however, are these:

–      In fiscal year 2009 Obama was responsible for adding at most $203 billion to the deficit, which in the end topped $1.4 trillion that year. But FactCheck.org reminds us that “this was just the first of four years of trillion-plus deficits.”

–      The last three budgets fall squarely under Obama. And, during that time, the federal government ran up deficits of “$1.3 trillion in 2010, $1.3 trillion in 2011, and about $1.2 trillion in the fiscal year that ends Sept. 30—for a total of nearly $5.2 trillion in deficit spending,” also according to FactCheck.org.

Energy

 

Obama: The president likes to say he’s “doubled” a lot of things, most notably the generation of renewable energy and, in the long term, fuel efficiency of cars and trucks—and is likely to do so again on Wednesday night. These boasts will sound great, but unfortunately for him, they’re heavily exaggerated.

Since Obama took office, only a certain division of renewable energy, that of wind and solar power, has doubled; overall, the increase in capacity is under 30 percent. And while the EPA is indeed raising fuel standards for increased efficiency by 2025, FactCheck.org has noted that, contrary to the president’s rhetoric, our cars will hardly take us “twice as far” by that point.

Romney: The GOP nominee has his own favorite talking points on energy, starting with his misleading claim about what the president has “doubled”: gas prices. This statement is technically true, but should be qualified by the fact that prices were extraordinarily low when Obama took office due to the recession.

Also hyped up is the nominee’s talk about Keystone XL, the pipeline project to transport oil from Canada to plants in the Gulf Coast. The Romney refrain is that Obama botched a crucial energy project by wholly trashing the plans to import more oil from our neighbor to the north.

What Obama did was delay the assembly of the northern part of the new pipeline that was set through Nebraska’s Sandhills, and he did so with bipartisan support from the state’s lawmakers. A new, more environmentally sensitive route is set to be approved in a few months, and the whole thing should be up by 2015.

Immigration

Romney: When the hot-button issue of immigration rears its head, be ready for the candidates to resort to political hit-and-runs. Romney is likely to toss out the charge that Obama “did nothing” to tackle immigration in his first three years. But while the Obama administration certainly hasn’t reached a comprehensive plan, the president lobbied for the DREAM act—which would qualify undocumented youth for a conditional path to citizenship—while the Democrats controlled the House and was met with opposition once the Republicans took over.

Romney might also complain that Obama’s deferred-action plan—granting some children born in the U.S. to undocumented immigrants a reprieve from deportation—doesn’t offer a permanent solution for aspiring immigrants. Yet in his own plan only young illegal immigrants who join the military would have access to that solution.

Obama: Meanwhile, Obama may claim that during the Republican primary season Romney endorsed Arizona’s controversial SB1070 law—requiring police to determine detainees’ immigration status, some argue through racial profilingand called the law a “model for the nation.”

But Romney was actually talking about Arizona’s e-verify law, which more modestly requires employers to check a job candidate’s immigration status on an online database.

get up! get moving!

In Fitness/Health, Uncategorized on Wednesday, 3 October 2012 at 16:24

http://www.huffingtonpost.com/2012/10/03/sitting-chronic-kidney-disease-risk-_n_1929684.html#slide=1586572

the real gay agenda…

In Gay rights, LGBTQI on Wednesday, 3 October 2012 at 07:09
The Real Gay Agenda

Posted by Samantha Ray (cause leader )

Your pledge matters

SIGN THE PLEDGE

This is not complicated…
1. Freedom from discrimmination in employment and housing in all 50 states.
2. The right to visit partners in hospitals.
3. The right for gay youth to grow up free from intimidation, bullying, and violence.
4. The right to serve openly and proudly in the military.
5. The right to obtain health care benefits, pensions, and social security through our spouses.
6. The right to adopt, and the right to have custody of our own children, no matter our sexual orientation.
7. Immigration rights for foreign spouses of gay Americans.
8. Inheritance rights for our partners or spouses.
9. The right to marry.
10. Equality and respect for all individuals and their families.

Psychostimulant treatment and the developing cortex

In ADHD, ADHD child/adolescent, ADHD stimulant treatment, Medication, Psychiatry, Psychopharmacology on Wednesday, 3 October 2012 at 06:19

a brief report on stimulant treatment in children and adolescents.  2008 publication but still useful information.

Psychostimulant Treatment and the Developing Cortex in Attention Deficit Hyperactivity Disorder

Shaw P, Sharp WS, Morrison M, et al
Am J Psychiatry. 2008 Sep 15.

http://www.medscape.org/viewarticle/583251

This study examined whether stimulants for attention-deficit/hyperactivity disorder (ADHD) were associated with differences in cerebral cortex development.

Study Design: Neuroanatomic MRI was used to assess the change in cortical thickness in 43 youths with ADHD; mean age at the first scan was 12.5 years, mean age at the second scan was 16.4 years. Of the 43 adolescents, 24 were treated with stimulants between scans while 19 were not treated between scans. Investigators included an additional comparison to a large sample of (n=294) of typically developing control youths.

Results: The rate of change of the cortical thickness in the right motor strip, the left middle/inferior frontal gyrus, and the right parieto-occipital region was different between the adolescents taking stimulants as compared with those not taking stimulants. Specifically, the study found more rapid cortical thinning in the group of patients not taking stimulants (mean cortical thinning of 0.16 mm/year [SD=0.17], compared with 0.03 mm/year [SD=0.11] in the group taking stimulants). Furthermore, comparison against the controls without ADHD showed that cortical thinning in the group not taking stimulants was in excess of age-appropriate rates.

Conclusion: These findings show no evidence that stimulant treatment is associated with slowing of overall growth of the cortical mantle.

Commentary: This is a remarkable paper from the Child Psychiatry Branch, National Institute of Mental Health, Bethesda, Maryland, and the Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada. The authors suggest that psychostimulant-induced improvements in cognition and action might foster cortical development within the normative range, as an example of activity-dependent neuroplasticity. The authors note that a randomized trial would be a better scientific design, but in the interim, this study shows the importance of comparisons with controls/normative data.

television exposure and kids

In School Psychology, Special Education on Wednesday, 3 October 2012 at 05:57

U.S. kids exposed to 4 hours of background TV daily

By Michelle Healy

A number of studies have found evidence that too much television is bad for children’s development, even when it’s playing in the background and kids are not watching. Now a study has tracked just how much background TV kids get and it’s a lot — 232.2 minutes or nearly 4 hours worth every day.

The average amount is even greater among some, especially children who are younger, African-American or from the poorest families, finds the study in today’s Pediatrics.

The nearly four hours of background TV exposure “easily dwarfs” the 80 minutes of active TV viewing the average child in this age group absorbs daily, says the study.

“You’re looking at three times the amount, which is enormous,” says Matthew Lapierre, one of the study authors, an assistant professor of communication studies at the University of North Carolina-Wilmington. “It’s really kind of shocking,” he says.

The study was presented in May at a meeting of the International Communication Association. It was conducted using a nationally representative telephone survey of 1,454 parents with at least one child between the ages of 8 months and 8 years old.

Among questions that parents were asked: how often their TV was on when no one was watching; whether their child had a TV in their bedroom and the number of TVs in the home.

It found that in addition to actual TV viewing, children under age 2 and African-American children were exposed to an average of 5.5 hours a day of a TV playing in the background; children from the poorest families were exposed to nearly 6 hours per day.

The finding among African-Americans “wasn’t unexpected,” says Lapierre noting that statistically, their households “are often found to be more TV-centric,” compared with other groups, with more TVs per household and more of those TVs in bedrooms.

He suspects that the high rate of background TV among very young children may have to do with parents and caregivers leaving the television on, even when they’re not actively watching, to “break up the monotony” of being with an infant or toddler for long stretches of the day.

The study notes that background television exposure has been “linked to lower sustained attention during playtime, lower quality parent-child interactions, and reduced performance on cognitive tasks.”

Heather Kirkorian, an assistant professor of human development and family studies a researcher at the University of Wisconsin-Madison who has published studies on background television’s impact on both parent-child interaction and children’s play patterns, says “until now we could only guess at the extent of the impact in children’s day-to-day lives.” The new study “documents just how great the real-world impact may be, particularly for very young children.”

The American Academy of Pediatrics recommends that children under age 2 not be exposed to any television.

To reduce background TV exposure, the study recommends turning off the TV when no one is watching and at key points during a child’s day, such as bedtime and mealtime.

Retrieved from: http://www.usatoday.com/story/news/nation/2012/10/01/background-tv-viewing-pediatrics/1599995/

 

the state of anxiety in the united states

In ADHD, Anxiety, Medication, Psychiatry, Psychopharmacology on Wednesday, 3 October 2012 at 05:51

Some Facts about Anxiety in the United States:

Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States age 18 and older (18% of U.S. population).

Anxiety disorders are highly treatable, yet only about one-third of those suffering receive treatment.

Anxiety disorders cost the U.S. more than $42 billion a year, almost one-third of the country’s $148 billion total mental health bill, according to “The Economic Burden of Anxiety Disorders,” a study commissioned by ADAA (The Journal of Clinical Psychiatry,60(7), July 1999).

More than $22.84 billion of those costs are associated with the repeated use of health care services; people with anxietydisorders seek relief for symptoms that mimic physical illnesses.

People with an anxiety disorder are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than those who do not suffer from anxiety disorders.

Anxiety disorders develop from a complex set of risk factors, including genetics, brain chemistry, personality, and life events.

 

Facts: Anxiety and Stress-Related Disorders

Generalized Anxiety Disorder (GAD)

GAD affects 6.8 million adults, or 3.1% of the U.S. population.
Women are twice as likely to be affected as men.

Obsessive-Compulsive Disorder (OCD)
2.2 million, 1.0%
Equally common among men and women.
The median age of onset is 19, with 25 percent of cases occurring by age 14. One-third of affected adults first experienced symptoms in childhood.

  • Hoarding is the compulsive purchasing, acquiring, searching, and saving of items that have little or no value.

Panic Disorder

6 million, 2.7%
Women are twice as likely to be affected as men.
Very high comorbidity rate with major depression.

Posttraumatic Stress Disorder (PTSD)
7.7 million, 3.5%
Women are more likely to be affected than men.
Rape is the most likely trigger of PTSD: 65% of men and 45.9% of women who are raped will develop the disorder.
Childhood sexual abuse is a strong predictor of lifetime likelihood for developing PTSD.

Social Anxiety Disorder
15 million, 6.8%
Equally common among men and women, typically beginning around age 13.
According to a 2007 ADAA survey, 36% of people with social anxiety disorder report experiencing symptoms for 10 or more years before seeking help.

Specific Phobias
19 million, 8.7%
Women are twice as likely to be affected as men.

Related Illnesses 

Many people with an anxiety disorder also have a co-occurring disorder or physical illness, which can make their symptoms worse and recovery more difficult. It’s essential to be treated for both disorders.

Children 

Anxiety disorders affect one in eight children. Research shows that untreated children with anxiety disorders are at higher risk to perform poorly in school, miss out on important social experiences, and engage in substance abuse.

Anxiety disorders also often co-occur with other disorders such as depression, eating disorders, and attention-deficit/hyperactivity disorder (ADHD).

Older Adults

Anxiety is as common among older adults as among the young. Generalized anxiety disorder (GAD) is the most common anxiety disorder among older adults, though anxiety disorders in this population are frequently associated with traumatic events such as a fall or acute illness. Read the best way to treat anxiety disorders in older adults.

Treatment Options

Anxiety disorders are treatable, and the vast majority of people with an anxiety disorder can be helped with professional care. Several standard approaches have proved effective:

Retrieved from: http://www.adaa.org/about-adaa/press-room/facts-statistics

 

The United States of Anxiety

By Ben Michaelis, Ph.D.

America is in an acute state of anxiety. For those of you who were concerned during the debt ceiling discussions, have been fearful during the stock market gyrations and are now panicking about your job, family and future, take a moment, take a deep breath and imagine that there is a better way. Because there is.

As human beings, our minds are prewired to react more strongly to negative information than positive information. This makes sense from an evolutionary psychology perspective: Negative information may mean threats to our survival, such as predators who may try to eat us. This is the reason that when a stranger gives you a nasty look it stays on your mind longer than when someone flashes a smile at you. This natural bias towards focusing on the negative becomes even more pronounced during times of uncertainty. When we don’t know where to turn, anything that seems potentially dangerous grabs our attention and activates our primitive survival instincts.

The fight or flight system is quite useful when you are facing a specific physical threat, but it is not helpful when you are facing general uncertainty, which is really what this is about. In fact, our survival instincts actually steer us in the wrong direction and can quickly make the situation worse. What is needed during periods of uncertainty is not this primitive instinct toward biological survival, which drove investors to “sell, sell sell!” on Monday, but rather the capacity to use our higher brain centers to imagine a different future.

As a clinical psychologist, I don’t treat nations, I treat people. In my work, I often see patients who experience intense, runaway anxiety (not unlike what happened on Monday) at just the time of a triumph or when things are about to turn for the better. Giving into the fear of the moment is both psychologically unpleasant and socially contagious. When other people see, or sense, that you are afraid, they focus on their instinctive reaction to seeing your fear and begin to experience terror themselves. Societal fear can quickly create an environment where your fears can come true simply by people behaving as though they are true. Regardless of the headlines suggesting the end is nigh, try taking a beat and doing something different: Imagine that all is not lost. Consider the ways that the future might actually be better than the present or the past.

When I am with a patient who is in the grip of such a panic, I suggest following these three steps in order to shift from fear to faith:

  1. Recognize: If you can recognize that you are in a state of panic, you are, frankly, more than halfway to stopping it. If you are not sure if you are in a state of panic, ask yourself this question: “Can I choose to stop these unpleasant, spiraling thoughts if I want to?” If the answer to the question is, “Yes,” then go ahead and do it. If the answer is “No,” then you have just realized that you are panicking.
  2. Refocus: Focus your energy on your five senses. Ask yourself: “What am I smelling?” “What am I seeing?” “What am I hearing?” “What are the tastes in my mouth?” and “How is my body feeling?” If you intentionally bring your focus away from the scenarios of Armageddon (not the Bruce Willis version) that you are cooking up and unto your present circumstances, you will break the chain of runaway thinking, because you can’t do both simultaneously. Even if you only get a brief respite any break, no matter how small, is enough to change the direction of your anxiety and help you take an active approach to problem solving.
  3. Re-imagine: Take your doomsday scenario and re-write it so that you are not stuck with the same old script. Write a Hollywood ending if you like. If you are scared that you will lose all of your money in the stock market, imagine the opposite. Picture the market changing direction, and that you will have more than you will ever need. If you have been out of work and are afraid that you will never get another job, imagine that you will be inundated with job offers. I am not suggesting that by simply imagining these things that they will happen, only that by doing so you can stop the spiral of anxiety and start thinking and planning for your next steps. That shift can make all of the difference between fueling the contagion of panic and returning to a more balanced state where you can actually effect real change in your life.

Your imagination is your greatest cognitive gift. It is also our greatest national asset. The ability to imagine a different and better future is the first step toward creating one. By recognizing, refocusing and re-imagining your circumstances you will feel better in the moment and shift from fear to faith. Using your mind’s eye to envision a positive outcome can help calm you down and make better momentary decisions. Plus, you might just inspire others to do the same.

Retrieved from: http://www.huffingtonpost.com/ben-michaelis-phd/americans-anxiety-stress_b_925420.html

 

are we over-medicating?

In ADHD, Anxiety, Brain imaging, Brain studies, Medication, Psychiatry, Psychopharmacology on Wednesday, 3 October 2012 at 05:39

this is one author’s opinion on anxiety and “the little blue pill.”  while anxiety is a VERY REAL and often debilitating condition for some, many wonder if anxiety medications (such as xanax and valium) are too readily prescribed and taken.  in my work as a school psychologist, i am asked constantly if i think adhd is over-diagnosed and children are over-medicated.  my answer is based in my belief that most psychological conditions are brain-based (this is becoming especially evident in light of new ways to examine the brain, i.e. genomic medicine, advanced brain imaging, etc.).  not treating those who have a REAL diagnosis has deleterious effects, but do i think that there are many physicians who will prescribe medications without possibly doing a full evaluation?  yes, i do.  but, i also think there are some VERY savvy parents who know what to say to get their kids medication that they *think* will give them an advantage over others.  while stimulants have a paradoxical effect on those with adhd (meaning they are stimulants but do not act as a stimulant behaviorally, i.e. not hyping kids up, but stimulating parts of the brain that are responsible for attending, focus, etc., thus appearing to calm them down), they also act as true stimulants for those that do not have a valid adhd diagnosis.  there are many stories of all-night study sessions in college and kids who use stimulants to stay awake and keep studying (i have even heard about kids who purchase stimulants just as they would marijuana or other drugs and crush it up and snort it for a cocaine-like effect).  the effect of a stimulant on someone without adhd is much like that of someone on cocaine.  they are ‘stimulated.’  so, while i believe the author has some valid points related to medication, i also believe that people who TRULY have a diagnosis of anxiety, adhd, depression, etc., do more harm than good when they do not take medication.  that is my personal opinion based on the many studies of those with treated issues versus those who do not seek treatment or were not treated until adulthood.  the differences in neuroanatomy and structural changes in the brain show that medication does work IF properly prescribed.  my personal opinion is if you think you are suffering from a brain-based disorder (adhd, anxiety, etc.), do yourself a favor and go to a PSYCHIATRIST.  while pediatricians and general practitioners are good at what they do and are knowledgeable about so many things, you wouldn’t go to an ophthalmologist for a broken leg, so why would you go to a pediatrician for a psychiatric issue?  psychiatrists’ entire business is of the mind and it is their job to keep up with the latest research and medications.  why go to anyone BUT a specialist?  once again, this is nothing more than my PERSONAL opinion.  

Valium’s Contribution to the New Normal

OPINION

By Robin Marantz Henig

IT wasn’t funny, really, but everybody laughed at the scene in the 1979 film “Starting Over” when Burt Reynolds’s character had a panic attack in the furniture department of Bloomingdale’s (something to do with terror at the prospect of buying a couch). “Does anyone have a Valium?” his brother called out as Burt hyperventilated. The punch line: Every woman in the store reached into her purse and pulled out a little vial of pills.

Nor was it surprising that all those Bloomie’s shoppers could be so helpful, since by that time Valium, which had been introduced in 1963, was the best-selling prescription drug in America, with billions of blue or yellow or white pills, each stamped with a trademark V, sold every year.

Valium was, significantly, one of the first psychoactive drugs to be used on a large scale on people who were basically fine. It has since been surpassed by other drugs, like the popular tranquilizer Xanax. But with the pharmaceutical giant Roche announcing that it will soon close the Nutley, N.J., plant where Valium and its predecessor, Librium, were developed, it’s a good time to remember how revolutionary these “minor tranquilizers” were half a century ago. These were the drugs that gave us a new way to slay our inner demons, medicating our way to a happier life.

How did Roche convince physicians that it was O.K. to offer their patients a bottled form of serenity? How did the physicians persuade their patients? And how did the company’s success in this venture shape our collective attitudes toward normal versus abnormal, stoic versus foolhardy, and the various ways available to cope with the ups and downs of daily life?

Marketing, essentially — which was first put into action with Librium, one of those evocative drug names that pharmaceutical companies invent. Librium was introduced in 1960 and promptly outsold its predecessors, the barbiturates, because it had fewer side effects. (Barbiturates were serious downers, making people sleepy and zombielike, and they were habit-forming; Marilyn Monroe died from an overdose.)

“A Whole New World … of Anxiety” read one of the early Roche ads for Librium, featuring a young woman with a pageboy hairdo holding an armload of books, wearing a short stadium coat and heading off to college. The copy made it sound as though every step in this “whole new world” called out for a tranquilizer. “The new college student may be afflicted by a sense of lost identity in a strange environment … Her newly stimulated intellectual curiosity may make her more sensitive to and apprehensive about unstable national and world conditions.”

The ad lists other sources of “anxiety” in a college student’s life — new friends, new influences, stiff competition for grades and tests of her moral fiber — that could just as easily be seen as growing pains, or as a healthy response to the turbulent world of the 1960s, when this ad appeared in The Journal of the American College Health Association. But Roche wanted doctors to believe that they were problems, not adventures, and that they warranted a prescription for Librium.

The next step was to develop something better — stronger, faster acting, less toxic. The Roche chemist who had originally stumbled upon Librium, Leo Sternbach, went back to the lab and tweaked the compound. Then he tested the drug on humans — in this case, the mothers-in-law of a few Roche executives. The executives thought that the new drug, Valium, rendered their mothers-in-law significantly less annoying.

In retrospect, Librium turned out to be a great first act, teaching Roche how to pitch a psychoactive drug to doctors of healthy patients who just needed a little something to unjangle their nerves. By the time Valium arrived, Roche was poised to dominate the field. In 1974, Americans filled nearly 60 million prescriptions for Valium.

Taking a pill to feel normal, even a pill sanctioned by the medical profession, led to a strange situation: it made people wonder what “normal” really was. What does it mean when people feel more like themselves with the drug than without it? Does the notion of “feeling like themselves” lose its meaning if they need a drug to get them there?

At the same time that Valium became famous for being in everyone’s medicine chest (or in every department store shopper’s purse), it also became famous for ruining lives. Elizabeth Taylor said she was addicted to Valium plus whiskey, Jack Daniel’s in particular. Tammy Faye Bakker said she was addicted to Valium plus nasal spray. Elvis Presley’s personal poison was Valium mixed with an assortment of other prescriptions. And Karen Ann Quinlan, the young woman languishing in a chronic vegetative state while her parents fought all the way to the New Jersey Supreme Court for the right to remove her from life support, originally lapsed into a coma in 1975 from a combination of Valium and gin.

Nearly 50 years after Valium was introduced and aggressively marketed, we’ve learned its lessons well. My generation of aging baby boomers does its brain styling, by and large, with antidepressantsProzac, Wellbutrin, CelexaPaxilZoloft. And for my daughters’ generation, the millennials, the pills of choice tend to be Ritalin and Adderall, for mental focus.

But when Americans are feeling out of sorts, we are still more likely to turn to anti-anxiety drugs than to any other kind. The leading successor to Valium, Xanax, outsells every other psychiatric drug on the market (48.7 million prescriptions last year). And even Valium is still out there, the classic little-black-dress of tranquilizers. In 2011, 14.7 million prescriptions were written for the drug that first made its cultural mark as a Rolling Stones song (“Mother’s Little Helper”) back in 1966.

As Roche closes its New Jersey headquarters, it plans to open a smaller research facility in Manhattan in late 2013, part of a wave that city officials hope will turn New York into a biotech mecca. The company’s transition reminds us of a phenomenon that’s become so common we no longer even think of it as weird: the oxymoronic attainment, through using drugs to make you feel more like yourself, of an artificially induced normal.

Robin Marantz Henig is a contributing writer for The New York Times Magazine and the co-author, with her daughter Samantha Henig, of the forthcoming “Twentysomething: Why Do Young Adults Seem Stuck?”

Retrieved from: http://www.nytimes.com/2012/09/30/sunday-review/valium-and-the-new-normal.html?ref=opinion&_r=0

The hangover…and I’m NOT talking about the movie.

In Education, Education advocacy, School reform on Tuesday, 2 October 2012 at 06:31

below is the link to the paper that my post, “unintended consequences” came from.  you can download and read in its entirety here:

http://www.aei.org/files/2012/09/25/-the-hangover-thinking-about-the-unintended-consequences-of-the-nations-teacher-evaluation-binge_144008786960.pdf

full pdf of the report.

a summary from http://www.aei.org/papers/education/k-12/teacher-policies/the-hangover-thinking-about-the-unintended-consequences-of-the-nations-teacher-evaluation-binge/

The hangover: Thinking about the unintended consequences of the nation’s teacher evaluation binge

Sara Mead, Andrew J. Rotherham, Rachael Brown | American Enterprise Institute

September 26, 2012

Over the past three years, more than twenty US states have passed legislation establishing new teacher evaluation requirements and systems, and even more have committed to do so in Race to the Top or Elementary and Secondary Education Act Flexibility Waiver applications. These new evaluation systems have real potential to foster a more performance-oriented public education culture that gives teachers meaningful feedback about the quality and impact of their work. But there are pitfalls in states’ rush to legislate new systems, and there are real tensions and trade-offs in their design.

Unfortunately, much of the current policy debate has been framed in stark ideological terms that leave little room for adult discussion of these tensions. This paper seeks to move the debate beyond ideology and technical issues by highlighting four key tensions that policymakers, advocates, and educators must consider in the development of new teacher evaluations:

  • Flexibility versus control: There is a temptation to prescribe and legislate details of evaluations to ensure rigor and prevent evaluations from being watered down in implementation. But overly prescriptive policies may also limit school autonomy and stifle innovation that could lead to the development of better evaluations.
  • Evaluation in an evolving system: Poorly designed evaluation requirements could pose an obstacle to blended learning and other innovative models in which it is difficult or impossible to attribute student learning gains in a particular subject to a particular teacher.
  • Purposes of evaluations: New evaluation systems have been sold as a way both to identify and dismiss underperforming teachers and to provide all teachers with useful feedback to help them improve their performance. But there are strong tensions between these purposes that create trade-offs in evaluation system design.
  • Evaluating teachers as professionals: Advocates argue that holding teachers responsible for their performance will bring teaching more in line with norms in other fields, but most professional fields rely on a combination of data and managerial judgment when making evaluation and personnel decisions, and subsequently hold managers accountable for those decisions, rather than trying to eliminate subjective judgments as some new teacher evaluation systems seek to do.

Recognizing these tensions and trade-offs, this paper offers several policy recommendations:

  • Be clear about the problems new evaluation systems are intended to solve.
  • Do not mistake processes and systems as substitutes for cultural change.
  • Look at the entire education ecosystem, including broader labor-market impacts, pre- and in-service preparation, standards and assessments, charter schools, and growth of early childhood education and innovative school models.
  • Focus on improvement, not just deselection.
  • Encourage and respect innovation.
  • Think carefully about waivers versus umbrellas.
  • Do not expect legislation to do regulation’s job.
  • Create innovation zones for pilots—and fund them.

Article Highlights

  • Over past three years, more than 20 U.S. states have passed legislation establishing new teacher evaluation requirements and systems.
  • As the Chicago teachers’ strike illustrates, policymakers often treat evaluation systems as though they were being implemented in a vacuum.
  • We must examine the education ecosystem as a whole, clarify the pain points of the evaluation system and encourage and respect innovation.

 

 

i am saddened and sickened that this is allowed to carry on…

In Gay rights, LGBTQI on Tuesday, 2 October 2012 at 06:20

http://www.huffingtonpost.com/thor-halvorssen/united-nations-its-okay-t_b_787024.html

an interesting perspective on medication…

In Medication, Psychiatry on Monday, 1 October 2012 at 17:18

while there is DEFINITELY a need for medication (imo), do some abuse it?  and, if so, isn’t that the war on drugs  we should be waging?

Fighting the Wrong War on Drugs

By Allen Frances, MD | August 29, 2012


Since Richard Nixon was president, we have been fighting a drug war we can’t possibly win. Meanwhile, we have barely begun to fight a different drug war we couldn’t possibly lose.

The losing battle is against illegal drugs. Interdiction has been as big a bust as Prohibition of alcohol(Drug information on alcohol) in the 1930s. Occasionally arresting a drug kingpin or confiscating a few million of dollars worth of contraband heroin or cocaine makes for a nice headline, but this doesn’t stop the flow.

The beneficiaries of our war on drugs have been the cartels and the narco-terrorists; the casualties are the failing states they can buy or bully. The Mexican government is fighting what amounts to an undeclared civil war against cartels armed to the teeth and flowing with money—both from north of the border. We have unwittingly created a terrific business model for the drug dealers and a disaster for the states where they deal.

That other drug war, which we couldn’t possibly lose, is against the excessive use of legal drugs that is promoted by our own pharmaceutical companies. Astounding fact: prescription drugs are now responsible for more accidental overdoses and deaths than street drugs.

Polypharmacy is rampant and uncontrolled with military personnel, the elderly, and children particularly vulnerable to its risks. Michael Jackson is just the most high–profile poster victim of this growing epidemic of legal drug abuse. The drug cocktails are sometimes prescribed by dangerous high-flying doctors, sometimes by multiple doctors who just aren’t aware of the other’s existence, and prescription drugs are also widely available for purchase on the street.

There is no one cause of this mess, and there won’t be one cure. Doctors, drug companies, patients, politicians, and our fragmented health care system are all to blame. But the elephant in the room is Big Pharma. It has hijacked the practice of medicine, using its enormous profits to unduly influence physicians, physician groups, academics, consumer advocacy groups, the Internet, the press, and the government. Misleading “disease mongering” promotional programs saturate the media with direct-to-consumer drug advertising that is illegal everywhere else in the world except New Zealand and the developing nations.

The result: a ridiculously high proportion of people have come to rely on antidepressants, antipsychotics, antianxiety agents, sleeping pills, and pain meds. Psychiatric meds are among the very top best sellers for the drug companies—over $16 billion for antipsychotics; almost $12 billion for antidepressants, and more than $7 billion for ADHD drugs. One in 5 Americans takes a psychiatric drug, 1 in 5 women is on an antidepressant.

Seventy percent of these pills are prescribed by primary care doctors with little training in their proper use, under intense pressure from drug salespeople and misled patients, after rushed 7-minute appointments and subject to no systematic auditing.

The free market in drug salesmanship has led to promiscuous drug use, needless side effects, and wasted resources—a kind of societal overdose. The government has unwittingly aided and abetted Pharma. The cash-strapped FDA is beholden to industry for funding.

And it gets worse. Big Pharma all too often also goes illegal to push even more product. The multi-billion dollar criminal and civil penalties recently levied on several different drug companies provide clear evidence of the pervasive extent of drug company wrongdoing—but have not been big enough to deter it. A billion dollars must seem like chump change—just the cost of doing business.

Pretty bleak. But if we ever had the political will to begin it, we couldn’t possibly lose a war to tame the dangerous use of legal drugs. The solutions are crystal clear and a cinch to implement—if we were really determined to solve the problem:

(1) Sharply restrict drug company marketing and lobbying. Pharma now spends almost twice as much money pushing drug sales as on research—we would have better medicines and less legal drug abuse if this were reversed.

(2) Make the punishments for marketing malfeasance much more of a deterrent to underhanded drug pushing. This could be done by levying much bigger megafines on the companies and also by holding the executives personally responsible and perhaps by reducing the period of product patent protection.

(3) Develop a computerized real-time national system to identify and prevent polypharmacy. Credit card companies can abort a suspicious $100 transaction before the fact. Why can’t we apply the same technology preemptively to prevent a patient from collecting potentially lethal pills?

(4) Closely monitor the prescribing habits of doctors to correct or eject the “Dr Feelgoods.”

(5) It would greatly improve the quality of our health care system and greatly reduce its costs if all doctors, professional associations, consumer groups, and politicians were prevented from accepting drug company funding. Do drug companies really need this much “free speech”? It makes no sense to have the FDA funded by drug companies.

What are the political prospects of my twin proposals—to begin the winable war against the overuse of legal drugs and to drop the losing war against illegal drugs?

You guessed it—zero and zero. The first will be doomed by Pharma’s political punch; the latter by the irrational victory of hope and ideology over experience.

Retrieved from: http://www.psychiatrictimes.com/blog/frances/content/article/10168/2099456

The effect of hate…~be love~.

In Inspiration, Mindfulness, Well-being on Monday, 1 October 2012 at 08:22

The Effect of Hate on Children

Dr. Asa Don Brown, Ph.D., C.C.C.

 “I have decided to stick to love…Hate is too great a burden to bear.”~ Dr. Martin Luther King, Jr.

Webster’s Dictionary (2012) defines hate as an “intense hostility and aversion usually deriving from fear, anger, or sense of injury.  It is an extreme dislike or antipathy (and in most cases, there is) an object of hatred.”

Children who are exposed to hate are prone to a world of disorder, conflict, turmoil, strife, and an array of injustices.  Hate is the catalyst for human depravity and personal decay.  The typical foundations of hate begin in adolescence, they begin to blossom in the early life of a child.  Hate is rarely founded and always based on an indifference between peoples.

DEFINING HATE CRIMES

The National Association of Social Workers definition is:  “Hate violence crimes are those directed against persons, families, groups, or organizations because of their racial, ethnic, religious, or sexual identities or their sexual orientation or condition of disability.” (Barnes & Ephross, 2012, Online)

Hate knows no friend; it breaches the wellbeing of both the hated and the hater. Children who are taught to hate, whether implied or through an act of projection, are forced to live lives in constant opposition.   Hate stifles their ability to fully live a life engulfed with love and security.  Hate not only permanently skews their cognitive perceptions of the world, but it causes personal distress leaving a stain on one’s ideological viewpoints of that world.  Fortunately, while the senseless act of hate can have a permanent effect upon the emotional welfare of the individual; those who hate, or are being groomed to hate, can experience lifelong reprieve from the shackles of hate.

HATE’S ROTTING EFFECT

Hate’s effect can be passed down through the generations of a family, a community, or a civilization.  It is hate that acts as rust on the human mind and spirit.  Hate slowly causes an oxidation on the natural process of love, peace, and acceptance from within a person.  It is hate that transforms the natural order of the human condition, causing an internal and external strife within the very fabric of humanity.

Hate has caused wars and created rumors of wars; it has pitted children against children and adult against adult; it is hate that allows for teachers to bully their students and student’s to bully one-another.  Hate is often confused with pride, while genuinely positive pride, is “the consciousness of one’s own dignity,” (Webster’s Dictionary, 2012), as well as, having a source of intense approval for one’s achievements and personal successes.  Hate has no relationship to pride.

While hate is the decayer, love and acceptance are the cure.  Hate cannot know the light of the world, rather hate itself is an opponent of darkness.  What does darkness symbolize?  Darkness is the unknowing, the instigator of our greatest fears, the promoter of our worse nightmares, and the master of human dysfunction.   Darkness emphasizes our insecurities, our worries, our negative contemplations, and in general, anything contrary to our positive nature.  Hate in itself cannot force the hand of humankind, rather it entices the worst of the human condition to become the prominent player in one’s overall life.

OVERCOMING HATE

Overcoming any negative emotion or thought pattern takes deliberate effort.  Children who are either taught or influenced to hate have a greater chance of changing their ideological viewpoints, than someone who has reached adulthood.  Sadly, adults who have hate as the foundation of their personal character; are all too often imprisoned by their hate.  Hate is the ultimate virus, infecting the very essence of the person.  However, hate is not a totalitarian regime, and fortunately because of human resiliency, hate can be overcome.  Overcoming hate starts with the individual.  Through a deliberate and conscious effort on the part of the individual, hate can be eliminated from the mind and very conscious of that individual.

The Steps to Overcoming Hate 

  1. Unconditional Acceptance:  Accept as though you were the recipient.  Do not place acceptance in a fish bowl, otherwise you are always limiting the amount with which you offer your hand.
  2. Unconditional Forgiveness:  When you forgive, forgive.  Do not shelter hateful thoughts, otherwise you have not allowed your unconscious and conscious minds to be free of the negative event or person.
  3. Unconditional Love:  Unconditional love knows no rights or wrongs.  Unconditional love says, I will love you beyond all words, deeds, actions, or reactions.  It is the sort of love that a father or mother should have for their child.  This sort of love is not offered up only in the good times, but excels to be exhibited in the bad times.
  4. Review your thought patterns.  How do you perceive the world around you?  What are the guidelines with which you judge your corner of the world?  Are you hyper critical of others?  Do you wear your emotional sleeve on your shoulder?  Do you see yourself as better than or superior to others?  If so, reevaluate your thought patterns, and consciously make an effort to eliminate them from your mindset.  Be a good steward of your thoughts, and helpful steward of your children’s thoughts.
  5. Move Forward: Do not be combative with the negative event or person, rather consciously drive your virtual mind down an opposite path of positivity.  Therefore, intentionally seeking positive messages, images, and solutions for your life.
  6. Be Diverse:   Be a model of diversity; teach your children through your verbal and nonverbal messages to be diverse.  Allow them to see you positively interact with others of cultural and gender diversities.  Do not limit your friendships, your acquaintances, or your associates to one cultural paradigm.
  7. Challenge Negative Thought Patterns:  Be willing to consciously and unconsciously challenge thoughts that are skewed or indifferent to others.  Question, the whybehind your biases or subtle discriminatory thoughts.
  8. Correct Negative Thoughts in Your Children:  If you become privy of a negative thought that your children may hold; be diligent to help your children to review their negative or hateful thoughts, replacing them with a more positive ideological viewpoint.
  9. Be a Proponent of Positivity:  Everyone deserves a right to live in a positively influential environment.
  10. Offering an Environment of Safety and Care:  The environment with which care and safety are provided should make a profound difference.

When there is hate, a child’s right of safety and care is breached.  Schools should intentionally and purposefully foster an environment of safety and care.  When a school avoids advocating for its children, it extinguishes their individual rights.  It is vital to recognize that “All students are harmed by being in a school environment where discriminatory behavior is allowed, not just those students who are singled out for such harassment and victimization.”  (Wieland, 2007, p. 241)  Children should always be provided an environment of unconditional love, acceptance, and approval.  Remember, what occurs in one’s childhood is often indicative of things to come.   If we avoid addressing messages of hate in childhood, then there is little deterrence for children from amplifying the same messages of hate in their adulthood.

Helping your children to recognize the verbal and nonverbal messages is critical for combating the hate.  Be certain to teach your children to recognize the key features ofhateful and violent messages; whether they are communicated verbally or nonverbally; casted disparagingly through stereotypes, stigmas, guilt, or shame; it is essential to know and recognize when other’s are offering us platters of hate.

“What are some general ways that hate speech can be used in the offline (or online) world? Sample responses:

  • Calling people names based on their race, religion, national origin, disability, gender, sexual orientation, or any other type of group that is disenfranchised in our society
  • Saying things about people that are based on social identity stereotypes.”  (Common Sense Media, 2012, Online)

Children who are not taught to recognize the clutches of hate, will often fall prey unto such messages.  As parents and teachers, we are obligated to gird up the loins of our children to protect them from the possibility of harm.  Moreover, it is equally important for children not only be taught to protect themselves, but to play a critical in offering positive lessons unto their classmates.  If so, such children will prove advocates not only for themselves, but for the lives of everyone they encounter.

We must be hyper-vigilant when training our children.  As parents and teachers, we should keep a watchful eye out for danger and difficult times.  It should be expected that teachers and parents use due diligence to protect their children.

Author:   Dr. Asa Don Brown, Ph.D., C.C.C.

REFERENCES

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, (4th ed., text rev.). Washington, D.C.: Author

Barnes, A. & Ephross, P. H. (2012) The impact of hate violence on victims, Emotional and behavioral responses to attacks.  Retrieved September 22, 2012 fromhttp://www.socialworkers.org/pressroom/events/911/barnes.asp

Common Sense Media (2012) Lesson: Breaking down hate speech. Retrieved September 22, 2012 fromhttp://www.commonsensemedia.org/educators/lesson/breaking-down-hate-speech-11-12

Wieland, J. (2007) Peer-on-Peer hate crime and hate-motivated incidents involving children in California’s public schools:  Contemporary issues in prevalence, response and prevention.  UC Davis Journal of Juvenile Law & Policy 11(2), 235-269

Retrieved from: http://www.ccpa-accp.ca/blog/?p=2454

Pet loss

In Life with dogs, Pets on Monday, 1 October 2012 at 06:22

When my dog Lucky died, I disappeared too

By Bob Sullivan, TODAY

Among the cruelest truths of biology is this: A dog’s life is considerably shorter than a human’s life. The math is unforgiving; if you love a dog, you will lose a dog, and you will suffer the pain and biting lessons that death brings — probably several times over.

A million things are wrong when your dog dies. Here’s just one: You become invisible.

My Lucky passed away a year ago this spring and my loss was profound; those of you who’ve been through this understand; those of you who haven’t, I’m not nearly a good enough writer to describe it to you. My grief was complicated because, as my reporting sidekick for many years, Lucky was a mini-celebrity. He had completed several cross-country trips with me as we chronicled American life. We even had a theme song (“It’s Bob and Lucky’s/Hidden Fee Tour of America!”). He was a fantastic journalist. And he died suddenly, just as we were going to leave on a new trip, so I had the task of disappointing readers and sources from coast to coast, telling them that Lucky wouldn’t be sticking his head out my Jeep window this time.

But my sadness grew even deeper as I realized that my entire life, right down to how I interact with the world, had changed. Pet owners know the “You’re Fido’s owner!” phenomenon well. Plenty of neighborhood folks knew me only by my dog. They knew his name, not mine. When he passed away suddenly, I felt like I’d disappeared.

I wrote a column about turning to social media for comfort in my time of grief. It was among the most popular pieces I’d ever written, even though it had nothing to do with my day job. No question, the Internet helped.

But Facebook friends and retweets are a meager replacement for the dozens smiles and laughs from strangers that spoiled me daily, thanks to Lucky. They were gone now.

When my dog Lucky died, I disappeared too

By Bob Sullivan, TODAY

Walking my old Lucky around the block was like going to a never-ending cocktail party. Everyone would stop for a pet, and a chat, and 30 minutes later I had 10 new friends. Now, I would arrive home from work, dreading the thought of walking into an empty apartment, and set out to walk around the block. I got in the habit of taking the slowest stroll I could, as if I’d become the aging geriatric dog that Lucky never got to be. It wasn’t just my heart that hurt; it felt like every muscle of my body suffered a dull ache, as if my blood didn’t really have the heart to push its way through my veins any more. But that wasn’t the worst of it.

The worst was the blank stares. If I did, occasionally, work up the strength to smile at a sidewalk passer-by, I’d get an odd look, if I got any response at all. There certainly was no stopping for idle chat. Sure, some neighbors I knew better did pause and ask me how I was doing, but it wasn’t nearly the same. The party was over.

In the 1960s, psychiatrist Eric Berne introduced a new model of psychology that he ultimately called Transactional Analysis. It has many components, but the simplest is this: Our days and nights are filled with small and large “transactions” between people. A quick hello from a friend is a small, positive transaction, while a dirty look from another driver is a negative one. A deep conversation with a lover is a large transaction — it might be positive or negative, depending on the outcome. Berne believed that people’s happiness was a function of how these transactions went, and how many positive interactions a person piled up during the day. He believed that positive transactions were as important to mental health as water and food are to physical health. Chart a few days of your interactions with people, and I think you’ll become convinced that Berne was onto something.

When Lucky died, I lost probably 100 or more happy transactions every day. The ache I felt was primal. Berne would say I was starving. OK, I’ll say that.

Enter Rusty.

As pet owners know, you can’t just replace your lost loved one. Pets aren’t like cars or refrigerators. The timing is different for everyone, but you must wait until the time is right, lest you cheat yourself out of that critical soul-searching “in-between time,” and you cheat your new dog by expecting the pup to be too much like your old dog.

So I waited a year….past the point when every day was a sad anniversary…and mentioned to a friend that after a long summer vacation, I thought I’d be ready to love again. During my trip, she found Rusty at a shelter, facing an uncertain end. When I got home, he was, essentially, waiting at my door for me.

There are a million reasons not to get a dog, and anyone who’s ever thought about it can cite them all chapter and verse. You travel too much; your apartment is too small; you don’t want your stuff destroyed, peed on, or chewed up, you don’t want to miss after-work happy hours; you don’t want to disturb the neighbors. All those can be good reasons, as taking on a pet is a serious, life-long commitment to be made with both head and heart. The problem is that while the reasons not to get a dog are specific, and easy to cite, the benefits of having a dog are far more subtle, and hard to count. Let me clumsily offer one:

You become visible. Dogs make you somebody in the eyes of the universe.

Maybe the isolation I felt after Lucky died says something about alienation in modern life, and the fact that people would rather text than smile while walking; or about the cruelness of urbanity, the heavy social armor city-dwellers must wear to protect themselves. Or maybe it just says people in some places aren’t friendly enough. Whatever — dogs are the world’s best icebreakers, and that can’t be argued.

I don’t know a lot about Rusty’s past, but I do know he hadn’t been on a leash very much before meeting me, and I’m pretty sure no one had ever told him to lie down. As a roughly 8-month-old golden retriever, Rusty is at the age that often gets dogs in trouble. Dogs’ bodies grow much faster than their brains. Rusty is almost full-grown, but he’s still very much a puppy. That means he has puppy fits, when he wants to jump on everything and everyone, he wants to steal food, socks, remote controls, and anything else that I don’t want him to steal.  If he’s not getting what he wants, he literally bats people — in the face, even! — with his paw. He can’t resist trying to wrestle with every dog we encounter. In short, he’s doing things that would be adorable if he were 15 pounds, but are dreadful now that he’s 50 pounds. This is the age at which many dogs end up in shelters.

But Rusty is also a beautiful, auburn-red golden retriever who melts hearts as easy as he chases tennis balls. Passers-by can’t resist patting the fur on his soft, soft head. The second someone shows the slightest bit of interest (“What a cute dog! He’s so red! What is he?), he hurls himself onto his back, on his “victim’s” shoes, and demands a belly rub. One block=30 minutes. At least. And at least 100 or more smiles, hellos, handshakes, how-do-you-dos, etc.  An NBC colleague often reminds me that golden retrievers are the bartenders of the dog world. True, but I know Rusty isn’t just being friendly for the tips.

Transactional therapy has few real advocates now. It’s viewed as old-fashioned and incomplete. But you’ll find fewer more thought-provoking books than Berne’s “Games People Play,” which describes the stunts people pull (rackets, Berne calls them) to fill their emotional needs when they aren’t being filled through normal daily life. Since learning about it years ago, I’ve often thought about the troubles of suburban life in America. It’s possible to walk from your house into your garage, drive to work, pull into the office garage, and take the elevator to the cubicle without ever interacting with another human being. That life might not be sad, but it’s certainly not happy. Berne would say it’s like trying to get through the day without eating.

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I’ll just say that, according to the American Humane Society, 61 percent of U.S. Households are dogless, and that number is creeping up slightly because of the recession, as some people give up their pets for financial reasons. Those folks might not know what they’re missing.

It’s been about a month now, and Rusty has changed everything. I’m unmistakably visible —particularly to friendly folks my dog pees on when he gets so excited as they are petting him that he literally can’t contain himself. Last Sunday, walking down the block, a small puppy and his companion walked towards Rusty and me. Our dogs played, while we chatted. Then, a man walking two other dogs arrived. More playing, more talking. A petless woman we’d met the day before, who missed her childhood dog, strolled up and joined the fun. Then, an older woman and a pug nicknamed “Piggy” snorted their way towards our dogpile. I mean, our spontaneous cocktail party. I loved every minute of it; my heart was filling up.

I’m sure Lucky paused from chasing a tennis ball in heaven to smile down at the scene.

To those who walked this walk with me, who contributed to my So Lucky dog memorial page, thank you. To anyone who feels invisible, or even sad — the ASPCA estimates that 3 to 4 million dogs and cats are euthanized every year in the United States. The life you save may be your own.

Retrieved from: http://animaltracks.today.com/_news/2012/09/12/13825121-when-my-dog-lucky-died-i-disappeared-too#.UFEgvqZGedM.email

When Lucky died: A grief observed, on social media

By Bob Sullivan, TODAY

In fact, finding others who understand is probably the only way to get through it. This story will explain how this devoted skeptic of social media found it to be a great source of comfort during my time of great need.GOLDEN, Colo. — There’s a reason the expression goes “You look like your dog just died.” Losing a dog is a sadness so profound that it’s useless to explain to anyone who hasn’t been through it.

Many of you know that last year I traveled America with my golden retriever, sniffing out scams and ripoffs as part of “Bob and Lucky’s Hidden Fee Tour of America.” (There was even a theme song.) Naturally, Lucky stole the show, getting on national TV twiceand appearing live on local TV in several towns along the way from Washington to Seattle. His pawprint was far more popular than my signature at every book signing. We made hundreds of friends in dozens of newsrooms, bookstores, hotels and rest stops along the way. He spent nearly all of those 3,000 miles with his head nudged onto my right shoulder, leaving drool stains on the right arm of every shirt I had brought for the trip.

We were all set to make the same trip this summer, but Lucky decided to go on a longer road trip instead, taking the expressway to dog Heaven on June 11. He was roughly 10 years old — he was a rescue, and he landed in my life eight years ago — and the calendar said I should be ready for this. I was not. He acted like a puppy until the day he died. Right to his last afternoon, every muscle of his oversize body was desperate to say hello to every man, woman and squirrel we encountered. So it was a complete shock when he died of heart trouble — an enlarged heart, to no surprise — during one horrible night at the vet a few weeks ago.

I am writing this piece in Golden, Colo. — that’s an accident, but a good one. Lucky sure would have liked it here: My hotel is crawling with dogs.

* * *

Comparing personal tragedies is a game you should never play, and I would never dare say my sadness is equal to that of anyone who’s lost a job, a home or a child. I will say simply that in losing Lucky this month, my sorrow is complete. When I finally got home to my family about 5 a.m. that awful night, I lay in bed wide awake and could feel every cell of my body hurt. I can still feel that as I type now. No one, nowhere, will ever love me like Lucky did. He was typically food-obsessed, scarfing every meal in seconds, but there was one time he wouldn’t eat — if I were rushing in the morning and threw food in his bowl on my way out the door. On those occasions, when I came home after work, I would find his food still in the bowl. In the morning, he’d followed me to the door, laid down and waited there for me all day. The second I opened the door, he’d say a quick hello, and then the poor starved animal would run to eat his breakfast at 6 p.m. He just couldn’t eat without me. Now, I feel the same way.

This kind of loss leaves you searching for answers, and in the sleepless nights that followed I spent a lot of time fruitlessly reading about enlarged hearts, alternatively looking for an explanation that might calm my racing analytical mind or an excuse to blame myself for the ailment to distract my aching heart.

You probably know the ending to that trip. I found no answers. But I did find a lot of places to share. For all its faults, the Internet is very good at sharing. In particular, for all the scary things about social media — Facebook’s consistent abuse of privacy and the Twitterverse’s self-absorption — I found these tools indispensible in my grief.

Sharing makes nothing better. It doesn’t replace a wet nose, a joyful face, the endless presence of love that follows you everywhere. But still, sharing eases pain.

* * *

Of course, there’s nothing new about online grieving. People have been finding new and sometimes strange ways to express loss and mourning since the arrival of the Internet. Virtual wakes appeared almost as soon as Web pages did.

Among the newest forms of digital mourning: following someone on Twitter who has recently died. Ryan Dunn, a TV personality made famous through the TV and movie franchise Jackass, had 30,000 followers before he died in an automobile crash June 22. Now, he has 145,000 after a surge of followers arrived when the news hit. Why would someone follow a recently deceased person? The urge to connect, and the Internet’s ability to deliver it, sometimes both seem to be stronger than even mortality itself.

Online mourning raises sticky issues. You might have noticed not all Web users maintain a sense of decorum or class. Posting a page describing your grief opens you up to hurtful sarcasm, or worse. For that reason, Facebook now offers a “memorial” state for accounts of the deceased that blocks strangers from making posts.

Still, the urge to virtually eulogize — even among strangers — is strong, as evidenced by the success of a relatively new site named 1000Memories.com, which makes it easy for loved ones to create a memorial page for the deceased. It promises to never allow advertising or to charge a subscription fee. Bring your Kleenex if you click.

* * *

As in “real” life, mourning the loss of a pet doesn’t get quite the same regard as mourning the loss of a person, and perhaps it shouldn’t. You can’t tell me that right now, however.

When Lucky first died, I spent a lot of time reading Web sites that offer advice on surviving the loss of a beloved pet. There’s many places offering tips on how to cope. I suspect some would find them helpful. I did not. The sheer amount of people discussing the problem helped me hang on to my sanity, however. A couple of the better sites are here and here.

There are also a number of sites that allow grieving pet owners to post memorials of their lost dogs, with pictures and paragraphs that serve as online odes to the beloved pets. Some of these post advertisements; some promise not to. I chose not to put Lucky on any of these sites, but reading through the stories there, I found,  helped a little. Misery loves company. Here’s a few:

http://www.dogquotations.com/write-a-memorial.html

http://www.critters.com/

http://www.ilovedmypet.com/

http://www.pets-memories.com/

http://www.petsremembrance.com/

But using the Internet as part of the mourning process, rather than just a source of information, was much more effective, I learned. Plus, I was facing an immediate problem. Lucky was a social butterfly and had hundreds of close friends. And I’d already promised readers another Red Tape road trip with Lucky as the mascot for my blog. How would I tell everyone?

When someone you love dies, there is always the complicated and painful affair of telling others about the tragedy. The conversations often force you relive the horrible moments, when people naturally ask questions like “How did it happen?” No one knows what to say, and you, as the recipient of the kindness, always sense that and spend your energy trying to make sympathizers feel better instead of saving your strength for you.

When a dog dies, less sensitive non-dog-owners will inevitably ask a dumb question like “So, are you going to get another dog now?” as if you were trading in a used car. Others will just breeze past the sadness with a trite “He had a good life,” and change the subject.

It all begins to feel like piling on, and sometimes you just can’t face all that pain at once.

Facebook turned out to be a powerful friend in this dilemma.  I wrote a simple status update that explained the basics and created a photo album for Lucky. I was able to tell most of my friends and family at once. It was the most effective way I could avoid telling and re-telling the story hundreds of times. As is custom now, I changed my Facebook avatar picture to an image of Lucky, which signals to Facebook users that something might be wrong. I did the same with my professional Facebook page, letting readers know that he wouldn’t make my coming trip for the saddest of reasons; I called attention to the notice by Tweeting it.

I was surprised that pressing “share” on Facebook turned out to be another one of those painful goodbye moments, like packing up his dog toys or placing his dog collar around my car’s rear-view mirror. I knew it would set off another chain reaction of sadness, but I was committed to getting that part over with as soon as I could.

I expected to cry again.  I didn’t expect the incredible outpouring of love that came flying through the Internet during the next 48 hours. There is just something about losing a dog, and either you know about it or you don’t. I heard from hundreds of people who did, strangers who expressed deep sympathy and then sent me their own tales about their beloved pets who’d passed away. One woman I heard from was even named Sullivan and had lost her dog named Lucky.

The notes I got from friends touched my heart even more. Many confessed to secretly giving treats to my dog when I wasn’t watching (I was very strict) or reminded me of long-forgotten sweet moments. I won’t tire you with stories of how special Lucky was. Your dog is just as special, no doubt. But Lucky lived an amazing life and brought not just joy but healing everywhere he went.  Indulge me this one tale:

A friend and co-worker told me a secret I’d never heard that was seven years old. She’d lost a baby to a rare childhood illness, and would often seek out Lucky when the depths of her sadness were unbearable. “Things just seemed better” after playing with him, she said. “He just seemed to get people, intuit what they needed and purely, simply offered love.”

My dog was able to comfort a woman grieving the loss of her baby, and I never even knew about it. Oh, did that make me cry. Every time I re-read her note, I cry.

But somehow, things seemed better. All these kind thoughts, these memories, these well-wishes — they felt as important as food and water to me during this time.

I think this point is particularly important for men, who in are society are neither well equipped to give nor to receive this kind of emotional outpouring in public. I was able to privately read these notes over and over when I needed to, particularly when a wave of sadness came, and somehow, it did make things better. I was in awe of how much good Lucky did in his short life.

None of this has made hotel rooms less lonely as I make my way across country now. I miss the way Lucky would charge into each new room, taking complete inventory of the place with his nose and then try to beat me to the toilet bowl. His breathing at night —even his snoring — was more powerful than any sleeping pill. It’s so strange not having to wake up early and run outside to search for just the right patch of grass so Lucky can  do his business.

Sharing things on social networks is hardly foolproof. Despite how it seems, not everyone reads Facebook every day. Plenty of readers and sources I’ve encountered on this road trip have still asked me why Lucky wasn’t with me. Then they felt bad, and I felt bad.

But Facebook and Twitter saved me hundreds of these dreadful encounters and eased my pain. For me, it was the perfect tool for tastefully sharing bad news and for facing grief head on. Social media 1, social media critic 0.

I know I will get another dog someday, probably sooner than seems right now. As another friend put it, “another fellow will just wander up to your campfire when the time is right.” But that’s not until I get over the irrational anger I feel every time I see a healthy dog running, jumping and wagging his tail. I’m going to be sad for a while, and that’s how this is supposed to work. For now, I will hope and pray that whatever family has my future rescue pet today is taking good care of him and that whatever the reason they will eventually put him up for adoption, the pain of separation will not be too great for them or him.

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