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We all wonder how we would react in an emergency. Would we risk our lives to help someone in danger?
Laurie Ann Eldridge found out last year. Looking up from her garden one evening at her Cameron, N.Y., home, Ms. Eldridge saw a confused 81-year-old driver stuck at a railroad crossing nearby, oblivious to the train speeding toward her car.
When someone commits a horrific, inexplicable crime, we naturally wonder whether hes mentally ill: Who but a crazy person could do such a thing? But when a killer acts crazy after his arrest, we also might wonder whether hes preparing for his trial. Thats the speculation around Colorado shooter James Holmes, whose psychiatric treatment and bizarre behavior in court and prison make people wonder whether hes truly insane or building a case for an insanity defense. It leads to the question: Can a criminal get away with faking insanity?
WHAT is depression? The ancient Greeks believed it resulted from an imbalance in the body's four humours: blood, phlegm, yellow bile and black bile (from the Greek word melas or dark and khol, meaning bile), with too much of the latter resulting in a melancholic state of mind. Early Christianity blamed the devil and God's anger for man's suffering, with depression the result of the struggle against worldly temptations and sins of the flesh. In the Renaissance it was viewed as a disease of scholars, such as Robert Burton, author of The Anatomy of Melancholy, who were given to abstract and intense speculation.
SOME cultural archetypes leave the stage with a flourish, or at least some foot stomping. All those pith-helmeted colonialists, absinthe-addled poets and hippie gurus founding 1970s utopias: They made some noise, if not always much sense, before being swallowed by history.
A RELATIVELY new field, called interpersonal neurobiology, draws its vigor from one of the great discoveries of our era: that the brain is constantly rewiring itself based on daily life. In the end, what we pay the most attention to defines us. How you choose to spend the irreplaceable hours of your life literally transforms you.
All relationships change the brain but most important are the intimate bonds that foster or fail us, altering the delicate circuits that shape memories, emotions and that ultimate souvenir, the self.
James was pointing out that, though we give habits little thought, they define our lives: how much we eat, save or spend, how often we trek to the gym and what we say to our kids each night.
But these compulsions aren't inscribed in our genes or hard-wired into the brain at birth. Scientists are discovering that habits are simply an extreme form of learning, a behavior that's so familiar we no longer need to think about it.
The malleability of habits isn't news to Madison Avenue: Effective commercials show how people can be quickly trained to do something new and then keep on doing it. The secret, it turns out, is the quick combination of a memorable cue and a rewarding experience.
Of all the ways that opposites attract, the thorniest may be when emotionally giving types pair up with types who are emotionally reserved.
Givers love to show affection: Hugs, kisses, flowers, skywritingthere's no such thing as too much. They crave receiving displays of love, as well.
Reserved types certainly may love deeply, but they are uncomfortable showing it. Often, they rely on their partner to initiate a display of affection. Sometimes, they don't even enjoy receiving expressions of love.
But rather than trying to emulate the strict discipline supposedly instilled by child-rearing techniques in other countries, it may be more useful to consider the science of successful parenting in general. Like their Chinese and French counterparts, American parents can make a childs mind strong by enlisting the child as an ally.
Parents, school officials and doctors investigated possible organic causes of this troubling event, and serially ruled out potential suspects, from vaccine reactions to environmental hazards. (Erin Brockovich is looking into possible toxic causes.) The girls continued to suffer, dropped out of school and gave television interviews in which their arms looped around wildly and their voices broke and warbled.
Well, thats the kind of nutty story that only happens once, or so I briefly thought, until more focused Googling quickly led me to an almost identical episode, this one in 2002, in a high school in rural North Carolina. Once again, a cheerleader was first to manifest the strange symptoms, and once again other girls, some of them cheerleaders, were struck with the same condition.
Adolescence has always been troubled, but for reasons that are somewhat mysterious, puberty is now kicking in at an earlier and earlier age. A leading theory points to changes in energy balance as children eat more and move less.
At the same time, first with the industrial revolution and then even more dramatically with the information revolution, children have come to take on adult roles later and later. Five hundred years ago, Shakespeare knew that the emotionally intense combination of teenage sexuality and peer-induced risk could be tragicwitness "Romeo and Juliet." But, on the other hand, if not for fate, 13-year-old Juliet would have become a wife and mother within a year or two.
A week later, you are taking the same walk again. Sunshine, pleasure, but no rattlesnake. Still, you are worried that you will encounter one. The experience of walking through the woods is fraught with worry. You are anxious.
This simple distinction between anxiety and fear is an important one in the task of defining and treating of anxiety disorders, which affect many millions of people and account for more visits to mental health professionals each year than any of the other broad categories of psychiatric disorders.
The criteria for depression are being reviewed by the American Psychiatric Association, which is finishing work on the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., the first since 1994. The manual is the standard reference for the field, shaping treatment and insurance decisions, and its revisions will affect the lives of millions of people for years to come.
Of course, researchers say, they are not blind to the implications of their work. If they could turn on brown fat in people without putting them in cold rooms or making them exercise night and day, they might have a terrific weight loss treatment. And companies are getting to work.
But Dr. Andr Carpentier, an endocrinologist at the University of Sherbrooke in Quebec and lead author of one of the new papers, notes that much work lies ahead. It is entirely possible, for example, that people would be hungrier and eat more to make up for the calories their brown fat burns.
The study, published last month in The American Journal of Psychiatry, was conducted from 1997 to 2005 in The Hague, Netherlands, where there are detailed records on almost everyone who has sought care for a possible psychotic disorder. The researchers found 273 immigrants, 119 second-generation citizens and 226 Dutch citizens who fit the criteria.
A growing body of research is finding intriguing connections between personality traits and habits that can lead to obesity. The same parts of the brain that control emotions and stress response also govern appetite, several studies have shown. Early life experiences also set the stage for overeating years later, researchers have found.
The findings, from an analysis involving nearly 500,000 adults, come on the heels of a separate study that reached a similar conclusion about the medications' effect in 1.2 million children and young adults. The results don't completely exonerate the drugs, which have other side effects that include a slowing of growth in children and anxiety. But researchers and doctors who treat the conditionknown formally as attention deficit-hyperactivity disorder, or ADHDsaid that together the reports should generally allay worries about heart risk that have stirred confusion among doctors and patients for several years.
Handedness, as the dominance of one hand over the other is called, provides a window into the way our brains are wired, experts say. And it may help shed light on disorders related to brain development, like dyslexia, schizophrenia and attention deficit hyperactivity disorder, or ADHD, which are more common in left-handed people.
At the dinner table, he argued with his parents about human nature. They said, What would happen if there were no police? he recalled. I said: What would we do? Would we rob banks? Of course not. Police make no difference.
This was in Montreal, a city that prided itself on civility and low rates of crime, he said. Then, on Oct. 17, 1969, police officers and firefighters went on strike, and he had a chance to test his first hypothesis about human nature.
Divide your life into chapters. The unhappiest of my correspondents saw time as an unbroken flow, with themselves as corks bobbing on top of it. A man named Neil lamented that he had been an Eeyore not a Tigger; a pessimist, not an optimist; an aimless grasshopper, not a purposeful ant; a dreamer, not a doer; a nomad, not a settler; a voyager, not an adventurer; a spectator, not an actor, player or participant. He concluded: Neil never amounted to anything.
If Karl Deisseroth wants to change your mind, he can. At Deisseroth Lab, in the basement of the Clark Center at Stanford University, his team is proving how, using light in the brain, we may be able to switch depression, sociability and other seemingly ungovernable behaviors on and off. Just imagine how useful this could be at Thanksgiving dinner.
Keris Myrick headed for her car, checked the time just past midnight, last March and texted her therapist.
Youre going to the Langham? The hotel? the doctor responded. No you need to be in the hospital. I need you consulting with a doctor.
What do you think Im doing right now?
Oh. Right, he said. Well, O.K., then we need to check in regularly.
People with severe schizophrenia who have been isolated, withdrawn and considered beyond help can learn to become more active, social and employable by engaging in a type of talk therapy that was invented to treat depression, scientists reported on Monday.
In what might be good news for coffee drinkers, a new study found that women who regularly consume the caffeinated beverage are less likely to suffer depression.
Women who had two to three cups of coffee a day had about a 15% lower risk of developing depression during a 10-year period than women who had only one cup of coffee or less per week. Consuming four or more cups a day reduced the risk of depression even more, by 20%.
Rewiring our brains for healthy love
I frequently deal with people stuck in ruts, slumps and negative cycles of behavior, and Im always interested in learning more about new ways to help them get back on the right track.
Sometimes a fresh idea comes from an unexpected source. For example, not too long ago I gave a lecture at a singles workshop in New York, after which a woman in her early 30s approached me.
They were a few steps shy of divorce, separated and working out child custody, when Rick DeRosia of Hartford, N.Y., realized he wasn't so sure he really wanted a divorce.
He says his 16-year marriage had been shaky before the separation in 2009, when he told his wife, Tina, he wanted out. Their son and daughter were 13 and 11. And life in the midst of recession was also taking a toll.
"There wasn't any one event," says Rick DeRosia, 42. "It was several things over the years that started a downhill slide that never really came back up."
Divorce "was not really what I wanted," says Tina DeRosia, 38, but she thought he did. "I felt moving on was what I needed to do, but should we try to do more? I thought about the effect it would have on my children."
Need Sleep? Stay Out of the Hospital
During nursing school, I remember my first clinical instructor initiating us into one of the paradoxical truths of health care: You dont come to the hospital to sleep.
Patients need to sleep for emotional health, for wound healing, to maintain a strong immune system and yet the drama of fractured and broken sleep plays out night after night in hospitals around the country.
Living to 100 and Beyond
For as long as human beings have searched for the fountain of youth, they have also feared the consequences of extended life. Today we are on the cusp of a revolution that may finally resolve that tension: Advances in medicine and biotechnology will radically increase not just our life spans but also, crucially, our health spans.
Lovelorn in a Facebook Age
I woke up one day last week to an anguished email from a friend whose girlfriend had just broken up with him. He had an urgent question: How could he take his mind off her so that he wouldn't call or text her?
I was momentarily stumped. What advice did I have for coping with one of life's worst experienceslosing a romantic partner? What would help him channel his energy into positive, productive activities?
An Insurance Maze for U.S. Doctors
Researchers asked hundreds of physicians and administrators in private practices across the United States and Canada how much time they spent each day with insurers and other third-party payers, tracking down information for claims that were denied or incorrectly paid, resolving questions about insurance coverage for prescription drugs or diagnostic tests, and filing the different forms required by each and every insurance company.
How Exercise Can Keep the Brain Fit
For those of us hoping to keep our brains fit and healthy well into middle age and beyond, the latest science offers some reassurance. Activity appears to be critical, though scientists have yet to prove that exercise can ward off serious problems like Alzheimers disease. But what about the more mundane, creeping memory loss that begins about the time our 30s recede, when car keys and peoples names evaporate? Its not Alzheimers, but its worrying. Can activity ameliorate its slow advance and maintain vocabulary retrieval skills, so that the word ameliorate leaps to mind when needed?
Baby blues
RESEARCHERS have known for years that children whose mothers were chronically stressed during pregnancyby famine, anxiety, the death of a relative or marital discord, for instanceshow higher-than-normal rates of various psychological and behavioural disorders when they are adults. They have also known for a long time that those brought up in abusive environments often turn out to be abusive themselves. The second of these observations is usually put down to learning.
A New York state of mind
HELL is a city much like London, opined Percy Bysshe Shelley in 1819. Modern academics agree. Last year Dutch researchers showed that city dwellers have a 21% higher risk of developing anxiety disorders than do their calmer rural countrymen, and a 39% higher risk of developing mood disorders. But exactly how the inner workings of the urban and rural minds cause this difference has remained obscureuntil now. A study just published in Nature by Andreas Meyer-Lindenberg of the University of Heidelberg and his colleagues has used a scanning technique called functional magnetic-resonance imaging (fMRI) to examine the brains of city dwellers and country bumpkins when they are under stress.
Men in Grief Seek Others Who Mourn as They Do
In 1990, Sam and Gretchen Feldman cashed out on their share of a national chain of mens apparel stores and retired to Marthas Vineyard, Mass. There, they devoted their time to volunteer work and an active social calendar. The following years were golden ones for the Feldmans, but in 2007 Mrs. Feldman learned she had cancer. She died a year later.
Dawn of a New Sleep Drug?
For those who have trouble sleeping, there may soon be new ways to summon the sandman.
Several pharmaceutical companies are working on new approaches to treat insomnia. The compounds are meant to work differently than current leading sleep aids such as Ambien and Lunesta, which, while generally safe, can have troubling side effects because they act on many areas of the brain. By contrast, many of the drugs being developed target particular systems responsible for sleep and wakefulness. The hope is that they will have fewer side effects and less potential for addiction and cognition problems the next day.
Rethinking Addictions Roots, and Its Treatment
There is an age-old debate over alcoholism: is the problem in the sufferers head something that can be overcome through willpower, spirituality or talk therapy, perhaps or is it a physical disease, one that needs continuing medical treatment in much the same way as, say, diabetes or epilepsy?
Coming Out With Mental Illness
People with mental illness often feel compelled to stay quiet about it. But now, some of them have decided to come out of the closet and speak openly about their conditions, reports Benedict Carey in the first article in a series about people who are functioning well despite severe mental illness.
Blanks for the Memories
Why we remember some scenes from early childhood and forget others has long intrigued scientistsas well as parents striving to create happy memories for their kids. One of the biggest mysteries: why most people can't seem to recall anything before age 3 or 4.
Now, researchers in Canada have demonstrated that some young children can remember events from even before age 2but those memories are fragile, with many vanishing by about age 10, according to a study in the journal Child Development this month.
Helping Kids Beat Depression... by Treating Mom
About 1 in 8 women can expect to develop depression at some point in her life. Incidences peak in the childbearing years, with as many as 24% of women becoming depressed during or after pregnancy. More than 400,000 infants are born to depressed mothers each year in the U.S.
And decades of research have borne out the old expression "when Mama ain't happy, ain't nobody happy." About half of kids with depressed mothers develop the conditionthree times the typical risk.
In the Dark, Maybe, But Not Lost
Why are we in this tunnel? my mother asks sharply from the back seat.
Jolted from my reverie, I turn down the audiobook, lean forward over the steering wheel and look out into the night. The sky is black, brushed with a few pale stars but no moon. Darkness presses on the car windows as we barrel down the highway. The only lights are headlights from oncoming cars, plus the dim glow of the dashboard illuminating my sons knees. Hes asleep beside me, out cold.
Overtired, I repress a wave of irritated giggles. Were not in a tunnel, Ma, I say.
Hazy Recall as a Signal Foretelling Depression
OXFORD, England The task given to participants in an Oxford University depression study sounds straightforward. After investigators read them a cue word, they have 30 seconds to recount a single specific memory, meaning an event that lasted less than one day.
Postpartum Depression Highest in Fall, Winter
Women who give birth during the fall and winter are twice as likely to suffer from postpartum depression than if they deliver in the spring, according to a study in the American Journal of Obstetrics & Gynecology. Seasonal variations in mental disorders are well documented, but few studies have examined seasonal births and postpartum depression. From 2006 to 2007, 2,318 new Swedish mothers, 76% of whom had no previous psychiatric history, completed questionnaires containing a post-natal depression scale five days, six weeks and six months after giving birth.
Quest for Vaccines to Treat Addiction
Frustrated by the high relapse rate of traditional addiction treatments, scientists are working on a strategy that recruits the body's own defenses to help addicts kick drug habits.
The new approach uses injected vaccines to block some addictive substances from reaching the brain. If a vaccinated addict on the path to recovery slips and indulges in a drug, such as tobacco or cocaine, no pleasure will result.
Doctor Focuses on the Minds of the Elderly
The Merry Widows, as they call themselves, were blinged out, Florida-style, to celebrate Elayne Weisburds 79th birthday at a sprawling community for seniors. Mylar balloons levitated above their table, and sparklers twinkled from a cake.
Addicted? Really?
The internet: Mental-health specialists disagree over whether to classify compulsive online behaviour as addictionand how to treat it
CRAIG SMALLWOOD, a disabled American war veteran, spent more than 20,000 hours over five years playing an online role-playing game called Lineage II. When NCsoft, the South Korean firm behind the game, accused him of breaking the games rules and banned him, he was plunged into depression, severe paranoia and hallucinations. He spent three weeks in hospital. He sued NCsoft for fraud and negligence, demanding over $9m in damages and claiming that the company acted negligently by failing to warn him of the danger that he would become addicted to the game.
A Generations Vanity, Heard Through Lyrics
A couple of years ago, as his fellow psychologists debated whether narcissism was increasing, Nathan DeWall heard Rivers Cuomo singing to a familiar 19th-century melody. Mr. Cuomo, the lead singer and guitarist for the rock band Weezer, billed the song as Variations on a Shaker Hymn.
Helping the Mentally Ill to Quit Smoking
A pilot program in New York City is challenging a long-held belief about cigarette smokingthat people with mental-health problems aren't interested in quitting.
The results so far are promising. Therapists say they are surprised that some patients with mental illness have been eager to join the anti-smoking program. And for some patients, giving up smoking has helped them feel more confident about other parts of their lives. The results also hold potential for helping hard-core smokers in the general population stop smoking.
Friendly Fight: A Smarter Way to Say Im Angry
"Darling, can we talk?
"I know you didn't mean to upset me, but you did. I'd like to clear the air so we can quickly and maturely move on to enjoying our relationship again." WSJ's Elizabeth Bernstein visits the News Hub and explains to Simon Constable the different ways to tell someone you're angry.
Sound familiar? Of course not.
Study Ties Suicide Rate in Work Force to Economy
The suicide rate increased 3 percent in the 2001 recession and has generally ridden the tide of the economy since the Great Depression, rising in bad times and falling in good ones, according to a comprehensive government analysis released Thursday.
Do You Get an 'A' in Personality?
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How Little Sleep Can You Get Away With?
We all know that we dont get enough sleep. But how much sleep do we really need? Until about 15 years ago, one common theory was that if you slept at least four or five hours a night, your cognitive performance remained intact; your body simply adapted to less sleep. But that idea was based on studies in which researchers sent sleepy subjects home during the day where they may have sneaked in naps and downed coffee.
Psychotherapy Eases Chronic Fatigue Syndrome, Study Finds
A new study suggests that psychotherapy and a gradual increase in exercise can significantly benefit patients with chronic fatique syndrome.
While this may sound like good news, the findings published Thursday in The Lancet are certain to displease many patients and to intensify a fierce, long-running debate about what causes the illness and how to treat it.
It's Not the Job Market
When a team of UCLA researchers released its latest annual report on the mindset of America's university students last week, one finding screamed out for red-alert media attention: Our college kids are more stressed out and anxious than ever before. In the researchers' surveys of more than 200,000 incoming freshmen, students reported all-time lows in overall mental health and emotional stability, and this news sent the media on a high-strung spree of its own. ABC World News ran footage of harried-looking teenagers rushing around campus, Time wondered "Why Are College Students Reporting Record High Levels of Stress?," and the New York Times story on the report vaulted to the top of the paper's most-e-mailed list.
When a Friend Grieves, How to Get Sympathy Right
How can you comfort someone grieving the death of a loved one? What can you say that might adequately offer solace? "I'm sorry" doesn't seem to cut it.
I felt this acutely after my cousin, Arthur, died unexpectedly in his sleep a few weeks ago. Although I was deeply sad myself, I wanted to offer support to his mother, father, wife and sister. But what words or gestures might help them, not just before and during the funeral but also day-in and day-out as they continue to mourn? How can I avoid making them feel worse? Should I call a lot, visit, write emails? Talk about my fond memories of my cousin? Share my own grief? Or should I leave them alone and give them space?
Decline Found in Freshmen's Mental Health
A nationwide survey of college freshmen found that their emotional health had fallen to the lowest level since the poll was introduced a quarter century ago.
Some 52% of first-year college students rated their emotional health as above average or in the highest 10% in the survey taken last fall. That's down from 55.3% in the year-earlier survey, and well below the nearly 64% of respondents who gave themselves high ratings in 1985, the first year students were asked about their emotional health.
Protein Is Found to Boost Memory
The hunt for a substance that can improve memory took a promising turn Wednesday, as researchers said they had found a method that appears to reduce forgetting in rats.
According to a study published in the journal Nature, scientists from Mount Sinai School of Medicine in New York showed for the first time that a molecule that occurs naturally in the human brain during memory formation appeared to help rats enhance the strength and duration of some types of memories.
Grown-Up Problems Start at Bedtime
Every parent knows that a tired kid is a cranky kid. Now, scientists are discovering that children with chronic sleep problems are at increased risk for developing a mental illness later in life.
Recent studies show that children who have persistent sleep problems, such as difficulty falling asleep or staying asleep, or not getting enough night-time shut-eye, are more likely later to suffer from depression and anxiety disorders and to abuse alcohol and drugs than kids without sleep problems. The findings add to previous research that has linked children's sleep problems to a host of issues, including aggressive behavior, learning and memory problems and obesity.
Using Electricity, Magnets for Mental Illness
Physicians have known for 2,000 years that electricity could help troubled mindseven before they knew what electricity was. Roman Emperor Claudius pressed electric eels to his temples to quell headaches. Sixteenth-century doctors induced seizures with camphor to treat psychiatric illnesses.
Now, research is advancing rapidly on a host of far more precise techniques to stimulate or calm the brain with electricity, magnets or even ultrasound and infrared waves. Most of the therapies target severe, resistant depressiona problem for nearly seven million Americans. But some are also showing promise for treating obsessive-compulsive disorder, panic disorders, schizophrenia, addictions and memory problems.
The Doctor's Dog Will See You Now
Walk into psychiatrist Drew Ramsey's office in Manhattan and you'll likely be greeted by Gus, a four-year-old shih tzu. After escorting you through the waiting room, he may hop onto the ottoman and go to sleep or sit beside you on the couch.
Some patients pat Gus while they talk to Dr. Ramsey. A few talk to Gus instead. And if they get emotional, Gus provides physical comfort that therapists can't offer. "We can't hug patients, but patients can hug Gus," says Dr. Ramsey, who began bringing his dog to his office two years ago. Now, he says, "I think about Gus the way a cowboy thinks of his horsehe's part of the job."
The Sustainable Marriage Quiz
What does it take to sustain a marriage?
As I report in the latest Week in Review section, researchers are studying how people sustain their relationships by using them to accumulate knowledge and new experiences, a process they call self-expansion. Studies show that the more self-expansion a person experiences through their partner, the more satisfied and committed they are to the relationship.
Four Adopted Siblings, Lots of Stress
Q.
We adopted a sibling set of four young kids (ages 6, 10, 11, 13) last year; weve had them for almost three years, and their behavior issues always escalate during the holidays. This is most likely because they were taken into protective custody the day after Christmas six years ago. We talk to them about what is going to happen, down to the day and time, but they are still easily agitated and anxious. Do you have any suggestions regarding what we can do to ease their fears? Thanks. Laura Ortega
A.
Dr. Joshua Sparrow responds:
Several readers have written about the challenges their foster and adopted children face during the holidays. Others responded with gratitude for the reassurance about human potential that these families stories give
Untangling the Myths About Attention Disorder
As recently as 2002, an international group of leading neuroscientists found it necessary to publish a statement arguing passionately that attention deficit hyperactivity disorder was a real condition.
In the face of overwhelming scientific evidence, they complained, A.D.H.D. was regularly portrayed in the media as myth, fraud or benign condition an artifact of too-strict teachers, perhaps, or too much television.
This Loved One Will Explode in Five, Four ...
Melissa Hoistion was enjoying dinner with her husband and their three children at a restaurant in Freehold, N.J., recentlyuntil the waiter disappeared for 20 minutes.
Her husband, Tim, began muttering. Ms. Hoistion braced herself. "Uh-oh, here it comes," she remembers thinking.
"EXCUSE ME!" he screamed across the room to another waiter, then stormed off to complain to the manager. When the original server finally returned to the table, her husband yelled, "Where the hell have you been for the last 45 minutes?" and continued berating him until the man walked away.
How Doctors Spot Depression
Appearing anxious and overwhelmed on a routine visit with her primary-care provider, Lucy Cressey was prescribed an anti-anxiety medication and referred for talk therapy with a social worker.
The treatment recommendations came after Ms. Cressey agreed to fill out two questionnaires during the medical visit at the John Andrews Family Care Center in Boothbay Harbor, Maine, last year. Ms. Cressey scored high on both questionnaires, designed to help depression and anxiety.
Psychopathy seems to be caused by specific mental deficiencies
WHAT makes people psychopaths is not an idle question. Prisons are packed with them. So, according to some, are boardrooms. The combination of a propensity for impulsive risk-taking with a lack of guilt and shame (the two main characteristics of psychopathy) may lead, according to circumstances, to a criminal career or a business one. That has provoked a debate about whether the phenomenon is an aberration, or whether natural selection favours it, at least when it is rare in a population. The boardroom, after all, is a desirable place to beand before the invention of prisons, even crime might often have paid.
This Is Your Brain on Metaphors
Despite rumors to the contrary, there are many ways in which the human brain isnt all that fancy. Lets compare it to the nervous system of a fruit fly. Both are made up of cells, of course, with neurons playing particularly important roles. Now one might expect that a neuron from a human will differ dramatically from one from a fly. Maybe the humans will have especially ornate ways of communicating with other neurons, making use of unique neurotransmitter messengers. Maybe compared to the lowly fly neuron, human neurons are bigger, more complex, in some way can run faster and jump higher.
Thesis, antithesis, synthesis
WHAT good is a diagnostic tool if it is too complicated for doctors to use? This is the dilemma facing psychiatry. In the United States the release back in February of a draft version of the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) has triggered a furious row over whether this tool has become too complex. Meanwhile, the World Health Organisation (WHO) points out that more than three-quarters of people with brain disorders in the developing world are not being treated, and on October 7th it released simplified guidelines for diagnosis and treatment designed especially for use by the front-line in medicine: primary-care doctors.
These developments highlight a revolution in psychiatry, the last bastion of symptom-based medicine. In no other medical domain is the symptom (say, anxiety) also the diagnosis. There is a reason for this: the brain is a complex organ and the causes of its disorders remain poorly understood. But thanks to brain imaging and genetics, that is changing fast.
Taking Early Retirement May Retire Memory, Too
The two economists call their paper Mental Retirement, and their argument has intrigued behavioral researchers. Data from the United States, England and 11 other European countries suggest that the earlier people retire, the more quickly their memories decline.
The implication, the economists and others say, is that there really seems to be something to the use it or lose it notion if people want to preserve their memories and reasoning abilities, they may have to keep active.
Its incredibly interesting and exciting, said Laura L. Carstensen, director of the Center on Longevity at Stanford University. It suggests that work actually provides an important component of the environment that keeps people functioning optimally.
Depression, Incognito
Picture this experiment: A group of older adults living independently, most in their 70s and most female, are handed a couple of paragraphs to read. You are 70, the first line says.
From there, the story heads in one of two directions. You have been feeling unusually sad for the last few weeks, half of the study subjects read. But the others read this: You dont seem to be able to enjoy things that you used to, like watching TV and reading the newspaper.
Both sets of paragraphs go on to describe additional and identical problems: trouble sleeping, feeling tired, losing appetite and weight, a lack of concentration. Neighbors have noticed a change.
Is Chemo Brain Really Cancer Brain?
Much has been written about chemo brain, the foggy thinking and forgetfulness that afflicts many cancer patients after treatment. Now, new research suggests the cognitive problems associated with chemotherapy may also be caused by other types of treatment or even the disease itself.
These problems may be related to treatment, such as chemotherapy, radiation or hormonal therapy, or to something about the disease itself which can change brain chemistry, or to psychological distress, said Pascal Jean-Pierre, of the University of Miami Miller School of Medicine, who presented the findings at an American Association for Cancer Research conference in Miami.
Mental Health: Fog May Be From Cancer, Not the Chemo
Cancer survivors often complain about chemo brain, a mental fog and inability to concentrate that persist long after treatment. But the problem may not be limited to cancer patients who undergochemotherapy, a study suggests.
Researchers analyzed data gathered from 2001 to 2006 by the National Health and Nutrition Examination Survey on 9,819 adults ages 40 and older, of whom 1,305 reported a history of cancer.
Participants answered questions including Are you limited in any way because of difficulty remembering or because you experience periods of confusion?
The Calm Before the Brain Injury Was Discovered
During the horrendous heat wave in July, when all of us in New York were not quite ourselves, I started feeling funny. I was sleeping too much; my right foot was dragging; my typing was skewed; I lost interest in reading the paper, about which I am usually obsessive.
I figured Id been done in by the weather. But when it improved and I didnt, I finally gave in and called my longtime doctor, a brilliant diagnostician who had given me my annual checkup just a month earlier.
Taking Early Retirement May Retire Memory, Too
The two economists call their paper Mental Retirement, and their argument has intrigued behavioral researchers. Data from the United States, England and 11 other European countries suggest that the earlier people retire, the more quickly their memories decline.
The implication, the economists and others say, is that there really seems to be something to the use it or lose it notion if people want to preserve their memories and reasoning abilities, they may have to keep active.
Building a More Resilient Brain
A lifetime of speaking two or more languages appears to pay off in old age, with recent research showing the symptoms of dementia can be delayed by an average of four years in bilingual people.
Multilingualism doesn't delay the onset of dementiathe brains of people who speak multiple languages still show physical signs of deteriorationbut the process of speaking two or more languages appears to enable people to develop skills to better cope with the early symptoms of memory-robbing diseases, including Alzheimer's.
Scientists for years studied children and found that fluently speaking more than one language takes a lot of mental work. Compared with people who speak only one language, bilingual children and young adults have slightly smaller vocabularies and are slower performing certain verbal tasks, such as naming lists of animals or fruits.
Medications for Cognitive Enhancement in the Healthy: Psychiatrists' Dilemma
October 1, 2010 (Toronto, Ontario) Psychiatrists should be at the forefront of the debate about the nonmedicinal use of cognitive enhancement drugs because these products are already widely available without a prescription, says Derryck Smith, MD, clinical professor of psychiatry at the University of British Columbia, Vancouver, Canada.
"These medications are available now people are buying them online or getting them from their friends, so we can't keep our heads in the sand," he told Medscape Medical News, after delivering a workshop on the subject at the Canadian Psychiatric Association (CPA) 60th Annual Conference.
Physician, Humanize Thyself
'Be the kind of physician that you would want to have if you were sick." With these words, Dr. Arnold P. Gold welcomed the incoming class of medical students at Columbia University College of Physicians and Surgeons last month. As thrilled parents looked on, 168 young men and women sat expectantly in the school's auditorium, their white coats folded over their arms, each waiting to be called to the front of the room and "cloaked" by a senior physician.
This marked the 18th annual White Coat Ceremony at Columbia. Dr. Gold, a white-haired and avuncular pediatric neurologist, popularized the practice years ago because, he said, "medical students were becoming enamored of technology and were losing the important aspects of human relationships with patients." Columbia's chaplain referred to the coats as "cloaks of compassion."
When a Doctors Note for a Student Doesnt Help
The first time I realized I was complicit in school refusal, I didnt even know the term. It was about a decade ago, and my patient was a boy who seemed to be spending his whole first-grade year sick with one thing or another.
A sore throat. A cough so bad it kept him up all night. Another sore throat. A weekend visit to the emergency room. Can I just get a note for the school? his anxious mother would ask, and I would print it out and sign it.
But I didnt grasp the extent of the situation until I got a call from the school nurse. If my patient missed another couple of days, she told me, he would be required by law to repeat first grade; the school year wouldnt count. Would I please make sure I was giving him all those absence notes for a very good reason?
A Way Out of Depression
For people suffering from depression, the advice is usually the same: Seek help.
That simple-sounding directive, however, is often difficult for those with depression to follow because one common symptom of the disease is denial or lack of awareness. This can be frustrating for well-meaning family and friendsand is one of the key ways that treating mental illness is different from treating other illnesses.
The Claim: The Days Events are Incorporated Into That Nights Dreams.
THE FACTS In the world of sleep research, dreams are something of a black box. But one tidbit that scientists have discerned is the peculiar but predictable pattern in which dreams tend to occur. Research suggests that much of what happens in a dream is unique to that dream. But some events from a persons day can be incorporated into dreams in two stages.
Study Shows SAMe May Ease Depression
A popular dietary supplement called SAMe may help depressed patients who dont respond to prescription antidepressant treatment, a new study shows.
SAMe stands for S-adenosyl methionine, a naturally occurring molecule that is widely used in Europe for depression, arthritis and other ailments. It is found throughout the human body, with high concentrations in the liver, adrenal glands and brain.
The Claim: Flying After Breast Cancer Surgery Can Cause Swelling
THE FACTS Women who have had surgery to remove lymph nodes, a common breast cancertreatment, are often warned that flying can lead to lymphedema, a painfulswelling, in their arms.
The concern is that changes in cabin pressure might influence the movement of fluid in the lymphatic system. Because lymph nodes drain this fluid, the thinking goes, it could more easily accumulate in a persons affected arm.
From Frontier Psychiatrist:
Psychiatry at the movies
Ive just been writing a review of the book Movies and mental illness 3 which will appear here as soon as it is published in print. Its a handbook for anyone who wishes to use cinematic depiction of mental illness to teach and understand its presentation. Its more of a textbook than something that can be read enjoyably cover to cover but nevertheless worth a look.
Practically any relevant major film, even one which only fleetingly depicts an altered mental state, is included.The dedication of the authors is such that they are not too proud to include some films which, although they illustrate psychopathology, are otherwise almost without artistic merit (although concerned readers will be glad to hear that Swept Away is not included)
THE PSYCHIATRIST IN TODAY'S MOVIES:HE'S EVERYWHERE AND IN DEEP TROUBLE
Every age reveals itself in the dramatic characters it invents. The braggart soldier, the conniving servant, the greedy merchant and the troubled monarch have spoken volumes about ancient Rome, medieval France and Elizabethan England. Our own culture has spawned such emblematic creations as the heroic lawman, bringing order to the wild frontier, and the soldier of fortune, equally at home in a spacecraft or at a board meeting. Recently, Hollywood has added another significant figure to the modern pantheon - the psychiatrist.
What is it about 20-somethings?
This question pops up everywhere, underlying concerns about failure to launch and boomerang kids. Two new sitcoms feature grown children moving back in with their parents $#*! My Dad Says, starring William Shatner as a divorced curmudgeon whose 20-something son cant make it on his own as a blogger, and Big Lake, in which a financial whiz kid loses his Wall Street job and moves back home to rural Pennsylvania. A cover of The New Yorker last spring picked up on the zeitgeist: a young man hangs up his new Ph.D. in his boyhood bedroom, the cardboard box at his feet signaling his plans to move back home now that hes officially overqualified for a job. In the doorway stand his parents, their expressions a mix of resignation, worry, annoyance and perplexity: how exactly did this happen?
A game of cat and mouse
There is tantalising evidence that a common paratiste may affect human behaviour
IF AN alien bug invaded the brains of half the population, hijacked their neurochemistry, altered the way they acted and drove some of them crazy, then you might expect a few excitable headlines to appear in the press. Yet something disturbingly like this may actually be happening without the world noticing.
Toxoplasma gondii is not an alien; it is a relative of that down-to-earth pathogen Plasmodium, the beast that causes malaria. It is common: in some parts of the world as much as 60% of the population is infected with it. And it can harm fetuses and people with AIDS, because in each case their immune systems cannot cope with it. For other people, though, the symptoms are usually no worse than a mild dose of flu. Not much for them to worry about, then. Except that there is a growing body of evidence that some of those people have their behaviour permanently changed.
Coping With Crises Close to Someone Elses Heart
Over the last few years, my family has weathered our share of crises. First our younger daughter was hospitalized for a week with Kawaskidisease, a rare condition in children that involves inflammation of the blood vessels, and spent several months convalescing at home. Soon after she recovered, our older daughter landed in the hospital with anorexia, which proved to be the start of a yearlong fight for her life.
Somewhere in the middle of that process, my mother-in-law was given a diagnosis of advanced lung cancer, and died less than 11 months later.
What a Shame That Guilt Got a Bad Name
Authorities in China recently made a surprising announcement: They want to see an end to public shaming of miscreants by the police.
It's a step in the right direction that shame is falling out of favor as an official punishment in China. Thankfully, here, too, it remains the exception rather than the rule. Most of us have little appetite for bringing back the town stocks, and "perp walks" can end up parading an innocent suspect. The ugliness of shame makes us want to avert our eyes wherever we find it.
Spinal-Fluid Test Is Found to Predict Alzheimers
Researchers report that a spinal fluid test can be 100 percent accurate in identifying patients with significant memory losswho are on their way to developing Alzheimer's disease.
Although there has been increasing evidence of the value of this and other tests in finding signs of Alzheimers, the study, which will appear Tuesday in theArchives of Neurology, shows how accurate they can be. The new result is one of a number of remarkable recent findings about Alzheimers.
The Claim: Smoking Relieves Stress
The benefits of quitting smoking reduced risk of cancer and many other health problems are known. But for millions of smokers, the calming effect of a cigarette can be reason enough to start up again.
Studies have found, however, that in reality, lighting up has the opposite effect, causing long-term stress levels to rise, not fall. For those dependent on smoking, the only stress it relieves is the withdrawal between cigarettes.
My Life in Therapy
All those years, all that money, all that unrequited love. It began way back when I was a child, an anxiety-riddled 10-year-old who didnt want to go to school in the morning and had difficulty falling asleep at night. Even in a family like mine, where there were many siblings (six in all) and little attention paid to dispositional differences, I stood out as a neurotic specimen.
Behavior: Internet Use Tied to Depression in Youths
A large Chinese study suggests that otherwise healthy teenagers are much more vulnerable to depression if they spend too much time on the Internet.
Researchers who followed more than 1,000 students at high schools in Guangzhou all of them free of anxiety and depression at the start of the study found that after nine months, rates of severe depression among pathological users were 2.5 times those of the others.
Diet and the evolution of the brain
TO PIN one big evolutionary shift on a particular molecule is ambitious. To pin two on it is truly audacious. Yet doing so was just one of the ideas floating around at A Celebration of DHA in London this week. The celebration in question was a scientific meeting, rather than a festival. It was definitely, however, a love-in. It was held on May 26th and 27th at the Royal Society of Medicine to discuss the many virtues of docosahexaenoic acid, the most important of that fashionable class of dietary chemicals, the omega-3 fatty acids.
Hourglass Syndrome
A study by Intel Canada found that55 percent ofCanadian high school students and more than 60 percent of post-secondary students had been frustrated by slow-running computers. Jameson Berkow reported in The National Post:
Intel dubbed the problem hourglass syndrome, in honour of the spinning icon many computers display when processing a large amount of data. The survey attributed the apparent rise in cases of hourglass syndrome to the rise in student dependency on computers for success in school.
How to Tame Your Nightmares
In the new movie, "Inception," a master thief is able to infiltrate peoples' dreams and steal their subconscious secretseven plant a dream idea they'll think is their own.
As fantastical as that seems, an evolving area of sleep research holds that it is possible for people to direct their own dreams, in a limited way.
Fresh Effort to Counter Tourette Tics
Tourette syndromea disorder marked by repeated, overwhelming vocal outbursts and motor movementshas long frustrated the medical world.
Tics that are hallmarks of Tourette include yelping, blinking, jerking and in rare instances shouting obscenities. Many times other neurological or behavioral troubles are present, leaving patients isolated. The exact cause remains unknown. Doctors typically prescribe antipsychotic medications or a high blood pressure medication to help suppress tics in some patients. Counseling is usually recommended to help patients cope.
Worried About a Moody Teen?
Everyone warns parents about the drama of the teen yearsthe self-righteous tears, slamming doors, inexplicable fashion choices, appalling romances.
But what happens when typical teen angst starts to look like something much darker and more troubling? How can parents tell if a moody teenager is simply normalor is spinning out of control? This may be one of the most difficult dilemmas parents will ever face.
Fictional Stars, Real Problems
The case of two troubled teens captivated psychiatrists at the University of South Carolina School of Medicine for months. Eleven residents and four attending psychiatrists read up on their symptoms and met once a week to discuss them.
On the Verge of Vital Exhaustion?
Decades ago modern medicine all but stamped out the nervous breakdown, hitting it with a combination of new diagnoses, new psychiatric drugs and a strong dose of professional scorn. The phrase was overused and near meaningless, a self-serving term from an era unwilling to talk about mental distress openly.
New Dads, Too, Can Suffer Depression
It's not just new moms who get postpartum depression. More than one in 10 fathers become depressed after the birth of their child, too, according to a new study that researchers said underscores the need for more awareness of men's depression.
Dreams, Let Up on Us!
Will Shakespeare told us, in that line always misquoted with the word of even by Bogey in The Maltese Falcon that we are such stuff as dreams are made on. If theyre in fact what were made on, its a mixed blessing.
We know that much of Freuds work has been repudiated and disparaged by the psychiatric world. Particularly his dream symbolism. But Ive seen dream analysis work. When in treatment that lovely euphemism for getting your head shrunk with the brilliant Dr. Willard Gaylin, I would come in with a mish-mash of a dream and, feature by crazy feature, he would elucidate it. It was and can we now retire this word for at least a decade, young people? awesome.
From News Wise:
SSRIs and Cardiovascular Health
A class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) may provide a boost to cardiovascular health by affecting the way platelets, small cells in the blood involved in clotting, clump together, say researchers at the Loyola University Medical Center in Maywood, Ill.
From Boston.com:
Eating more chocolate linked to signs of depression, study finds
Chocolate lovers rejoiced when research tied their favorite food to heart health -- at least the dark kind rich in antioxidants. Now a new study from California hints that dark moods might be linked to eating more chocolate.
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General Motors Board Gets Its Own Shrink
We know its been a tough couple of years for General Motors: A prepackaged bankruptcy, management ousters, a government bailout and relatively weak demand for GM cars. If that wasnt enough to rattle GMs ego,Ford overtookGM as the nations largest auto company.
So you can understand if GM feels a need to get its corporate head in a better place. And who better to help than a professor of psychiatry from the UCLA Medical School. Specifically, how about Cynthia Telles, named toadyto GM's board of directors.
Sabotaging Success, but to What End?
You could say Ive been unlucky in love, a young man told me during a recent consultation.
He went on to describe a series of failed romantic relationships, all united by a single theme: he had been mistreated by unsympathetic women who cheated on him.
This was not his only area of disappointment, though. At work, he had just been passed over for a promotion; it went to a colleague whom he viewed as inferior.
I asked him about his work as a computer scientist and discovered that he worked long hours and relished challenging problems. But he also did some curious things to undermine himself. Once, for example, he forgot about an important presentation and arrived 30 minutes late, apologizing profusely.
Though the interruption may be jarring, I rather welcome the twang of bluegrass or the toll of church bells coming from a patients cellphone during a psychotherapy session. Heres why.
A psychiatrists office is a place for confidences, so I have taken care to make it a private space. My consulting room is separated from the adjacent waiting room by two parallel walls. The office door is also double. A white noise machine in the hallway further ensures that no one can hear what transpires inside the office. Patients control the movement of information, in and out.
PORT-AU-PRINCE, Haiti Inside this citys earthquake-cracked psychiatric hospital, a schizophrenic man lay naked on a concrete floor, caked in dust. Other patients, padlocked in tiny concrete cells, clutched the bars and howled for attention. Feces clotted the gutter outside a ward where urine pooled under metal cots without mattresses.
Walking through the dilapidated public hospital, Dr. Franklin Normil, the acting director, who has worked there for five months without pay, shook his head in despair.
I want you to bear witness, he told a reporter. Clearly, mental health has never been a priority in this country. We have the desire and the ability, but they do not give us the means to be professional and humane.
Read More:
$75 million in prescription drugs stolen from warehouse
Local and federal authorities in Enfield, Connecticut, are investigating how a band of burglars broke into a large pharmaceutical warehouse and made off with approximately $75 million in prescription medications.
Police say the well-orchestrated heist at the Eli Lilly and Co. distribution center occurred during a rainstorm shortly after midnight Sunday.
"Based on the sophistication of what was used, this had to be well-executed and planned," Enfield Police Chief Carl Sferrazza said.
According to Sferrazza, the thieves scaled the side of the building onto the roof, where they cut an opening. He said they then rappelled into the building, disabled the alarm and proceeded to steal several dozen pallets of prescription pills, loading them onto one or more getaway vehicles.
Police say the robbery was not discovered until almost 2 p.m. ET Sunday.
ON FEBRUARY 10th the world of psychiatry will be asked, metaphorically, to lie on the couch and answer questions about the state it thinks it is in. For that is the day the American Psychiatric Association (APA) plans to release a draft of the fifth version of its Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Mental illness carrying the stigma that it does, and the brain being as little-understood as it is, revising the DSM is always a controversial undertaking. This time, however, some of the questions asked of the process are likely to be particularly probing.
Last week, the American Psychiatric Association unveiled the much-awaited blueprint for the next edition of its official handbook of diagnoses, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, or DSM V. Outlets from the New York Times to the Hindustan Times heralded its arrival. ABC News announced, "Big changes for DSM, the psychiatrists' bible."
Such fanfare makes sense. The DSM is as much a cultural institution as a clinical one. As an arbiter of what is normal and what is not, the manual also plays an important role in insurance and disability determinations. In the courtroom it can bear on criminal culpability.
From the Journal of Arch Gen Psychiatry- Jan. 5, 2010:
Many U.S. adults with major depression do not receive treatment for depression or therapy based on treatment
guidelines, and some racial and ethnic groups have even lower rates of adequate depression care, according to a report in the January issue
of Archives of General Psychiatry, one of the JAMA/Archives journals.
Depression is a leading cause of disability among many racial and ethnic groups in the United States, according to background information in the article. Pharmacotherapy (including antidepressants) and psychotherapy are both effective, well tolerated
treatments for depression when provided according to established guidelines (such as those from the American Psychiatric Association),
the authors note.
VITAL SIGNS: Mental Health: Deficiencies in Treatment of Depression
Researchers reported last week that antidepressant drugs seemed to be effective mainly in people with severe depression, not those with milder forms. Now another study is reporting that only about half of all Americans with depression receive treatment of any kind.
Moreover, only 1 in 5 are getting care talk therapy, medication or both that conforms to American Psychiatric Association guidelines, according to the study, which appears in the January issue of Archives of General Psychiatry.
Copyright 2010 Tysons Psychiatry-Dr. Niku Singh. All rights reserved.
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