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Mental Health

Behavioral Science, Medicine and Society, Men's Health, Mental Health, Research, Women's Health

Living with a partner boosts your health

lonely-273629_1280Partners help. They help with daily activities like dishwashing and dog-walking, but they also provide the all-valuable emotional support needed to cope with everything from a rough commute to the death of a family member.

And those without a partner, perhaps due to divorce, are more likely to suffer from depression or anxiety, according to a new study (in Spanish) in the Spanish Journal of Sociological Research. Women have it the hardest, says lead author Carlos Simó-Noguera from the University of Valencia, who is quoted in a recent Medical News Today article.

Women who have lost their partner “show poorer health than men with the same marital and cohabiting status, and are more likely to suffer from chronic anxiety and chronic depression,” Simó-Noguera said.

Men are also affected, however. Separated or divorced men “have higher risk for chronic depression than the rest of men,” he said.

The team gathered data from the European Health Survey on people between ages 25 and 64.

“The key is not marital status per se, but is found in the interaction between marital status and cohabitation status. Therefore, living with a new partner after the dissolution of marriage preserves the health of the people involved,”Simó-Noguera said.

Previously: Practicing forgiveness to sustain healthy relationships, “Love hormone” may mediate wider range of relationships than previously thought and Study offers clue as to why parents of daughters are more likely to divorce
Photo by cocoparisienne

Imaging, Immunology, Mental Health, Neuroscience, Research, Stanford News

Are iron, and the scavenger cells that eat it, critical links to Alzheimer’s?

Are iron, and the scavenger cells that eat it, critical links to Alzheimer's?

iron linkIf you’ve been riding the Alzheimer’s-research roller-coaster, brace yourself for a new twist on that wrenching disease of old age.

In a study published in Neurobiology of Aging, Stanford radiologists Mike Zeineh, MD, PhD,  and Brian Rutt, PhD, and their colleagues used a ultra-powerful magnetic-resonance-imaging (MRI) system to closely scrutinize postmortem tissue from the brains of people with and without Alzheimer’s disease. In four out of five of the Alzheimer’s brains they looked at, but in none of the five non-Alzheimer’s brains, they found what appear to be iron-containing microglia – specialized scavenger cells in the brain that can sometimes become inflammatory – in a particular part of the hippocampus, a key brain structure that’s absolutely crucial to memory formation as well as spatial orientation and navigation.

Zeineh and Rutt told me they don’t know how the iron gets into brain tissue, or why it accumulates where it does. But iron, which in certain chemical forms can be highly reactive and inflammation-inducing, is ubiquitous throughout the body. Every red blood cell that courses through our microvasculature is filled with it. So one possibility – not yet demonstrated – is that iron deposits in the hippocampus could result from micro-injury to small cerebral blood vessels there.

As surprising as the iron-laden, inflamed microglia Zeineh, Rutt and their associates saw in Alzheimer’s but not normal brains was what they didn’t see. Surprisingly, in the brain region of interest there was no consistent overlap of either iron or microglia with the notorious amyloid plaques that have been long held by many neuroscientists and pharmaceutical companies to be the main cause of the disorder. These plaques are extracellular aggregations of a small protein called beta-amyloid that are prominent in Alheimer’s patients’ brains, as well as in mouse models of the disease.

Because they weren’t able to visualize small, soluble beta-amyloid clusters (now believed to to be the truly toxic form of the protein), Rutt and Zeineh don’t rule out a major role for beta-amyloid in the early developmental stages of pathology in Alzheimer’s.

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Health Disparities, Mental Health, Pediatrics, Public Health

Stanford study of mental illness in incarcerated teens raises policy questions

Stanford study of mental illness in incarcerated teens raises policy questions

depressionMental illness is an even bigger problem for jailed teenagers than experts previously realized.

That’s the take-away message from a Stanford study, publishing today in the Journal of Adolescent Health, which compared 15 years’ worth of hospital stays for adolescents in California’s juvenile justice system with hospitalizations of other California kids and teens. Experts already knew that juvenile inmates are more likely than other young people to have mental health problems, but the new study gives fresh perspective on the scope of the issue.

The research team, led by Arash Anoshiravani, MD, an adolescent medicine specialist at Lucile Packard Children’s Hospital Stanford, looked at 15 years of hospital-stay data for California’s 11- to 18-year-olds. From a total of almost 2 million hospitalizations, about 11,000 were for incarcerated youth.

Of these 11,000 hospital stays, 63 percent were due to mental-health diagnoses. In contrast, just under 20 percent of the hospital stays by adolescents from the general population were prompted by mental illness. Hospital stays were also longer for the incarcerated teens, suggesting more severe illness.

However, the kinds of diagnoses were pretty similar between the two groups, with depression and substance abuse the most common. From our press release about the new study:

The types of diagnoses suggest that many incarcerated teens’ mental health problems developed in response to stressful and traumatic childhood experiences, such as being abused or witnessing violence, Anoshiravani said.

“They’re regular kids who have had really, really horrible childhoods,” he said, adding that he hopes the new data will motivate social change around the problem.

“We are arresting kids who have mental health problems probably related to their experiences as children,” he said. “Is that the way we should be dealing with this, or should we be getting them into treatment earlier, before they start getting caught up in the justice system?”

Previously: Online health records could help high-risk teens, study finds, Lucile Packard Children’s Hospital partners with high schools on student mental health programs and Increasing awareness and advocacy of emotional disorders with mental health first-aid programs
Photo by ryan melaugh

Mental Health, Neuroscience

No time for a vacation? Take a break without leaving the office

No time for a vacation? Take a break without leaving the office

3863917188_4972c8fe11_zWhen you’re tired, overworked and stressed out, a good vacation can be just what the doctor ordered. The catch is that it’s not always easy to take a break when you need it most. If you’re nodding your head in agreement, check out this Harvard Business Review piece by Emma Seppälä, PhD, associate director of Stanford’s Center for Compassion and Altruism Research and Education.

As Seppälä explains in her piece, workers in the United States tend to have less vacation days than employees elsewhere. Moreover, many people find it hard to truly “unplug” when they finally do take a vacation because smartphones, Wi-Fi and other electronic devices are so readily available.

But, fewer vacation days and smartphones aren’t entirely to blame for the bloated work schedules that are ubiquitous here and elsewhere. As Seppälä explains, many salaried employees with ample vacation time sometimes feel they can’t take an extended holiday because vacations are not “productive” and being out of the office, and out of touch, can have negative repercussions.

“Unfortunately, the logic of both employees and employers is highly flawed,” Seppälä writes. “Both fail to realize that cutting into vacation time is actually detrimental to both organizations and their employees both in terms of financial and productivity costs.” One short-term solution that can help employees endure a long period of work is a “mini-break”— a vacation that’s compressed into a few hours and can be taken virtually anywhere. She elaborates:

Research by Sabine Sonnentag suggests that detaching from work is essential to enhanced productivity. Her work has shown that, while people who do not detach from work suffering from greater levels of exhaustion, those who do recover from job stress and are more likely to have higher engagement levels at work.

If you really can’t take a proper vacation, Adam Rifkin, successful Silicon Valley serial entrepreneur and founder of PandaWhale, suggests “taking a little downtime every day rather than pushing it off for some getaway week.” Sonnentag’s research also suggests that if you make an effort to completely disengage from work when the workday is over – by, for example, engaging in a hobby you enjoy, exercising, or taking a walk in nature – you will reap the benefits: you will feel less fatigued, more engaged at work, and more energized when you leave work.

Stopping to smell the roses can make a big difference in your overall well-being during periods of high work flow, but a mini-break is no substitute for the real thing. So, if you absolutely can’t take an extended vacation, make the most of the downtime you have. Just be sure you also find a way to take that long vacation you’ve been dreaming of.

Previously: Exposure to nature helps quash depression – so enjoy the great outdoors!Seven ways laughter can improve your well-beingWhat email does to your brain and How social connection can improve physical and mental health and Out-of-office autoreply: Reaping the benefits of nature
Photo by Joe Penniston

Mental Health, Research, Stanford News

Animal study hints at potential treatment for skin-picking disorder

Animal study hints at potential treatment for skin-picking disorder

A condition known as skin-picking disorder may sound obscure but it’s one of the more common mental health disorders and can have devastating effects on its sufferers. An estimated 4 percent of the population – or roughly 1 in 25 people – suffer from the condition, in which they repeatedly pick or scratch the skin, sometimes leading to scarring or disfigurement.

People suffer in complete silence. They think they are the only one who has it, despite the fact that it’s very common, and it kills people.

“Skin-picking disorder is a surprisingly common condition, yet many patients avoid seeking help because of the shame and embarrassment,” says Joseph Garner, PhD, associate professor of comparative medicine at Stanford. “People suffer in complete silence. They think they are the only one who has it, despite the fact that it’s very common, and it kills people.”

The condition may lead to serious infection, requiring oral or intravenous treatment with antibiotics, he says. Patients may benefit from cognitive behavioral therapy, but there are precious few practitioners in the United States who are equipped to do this form of therapy, he says.

In a new study, Garner and his colleagues tested two antioxidants in mice with a form of skin-picking and found both compounds to be effective in treating the condition. Laboratory mice commonly suffer from ulcerative dermatitis, in which they excessively groom themselves, often leading to serious infection. These mice serve as a good model for the disease in humans.

In the study, mice who were fed the antioxidant N-acetylcysteine (NAC) all showed some improvement,   and some 40 percent were cured, though the results took up to eight weeks. Another group of mice given glutathione, the body’s naturally occurring antioxidant, got better much faster; about half who got this treatment were fully cured, the researchers found.

NAC has been used in humans in a number of experimental settings, and some case reports suggest it could be useful in people with skin-picking disorder. However, it can be hard to tolerate, as it causes gastrointestinal side-effects, Garner says. Intranasal glutathione, on the other hand, bypasses the gut and liver and goes directly to the brain. In doing so, it may avoid these potential side-effects.

“It’s clearly working differently, or at least more directly,” Garner says. “This different response profile gives us some hope that there may be some non-responders, or people who can’t tolerate NAC, who may be helped by glutathione.”

He says it represents the first potential new treatment for the condition in years. He now hopes to test intranasal glutathione in a clinical trial among human patients with skin-picking disorder.

The latest study appears online in the journal PLOS ONE. The experiments were conducted by researchers at the University of North Carolina at Chapel Hill.

More on skin picking and related disorders can be found at www.trich.org.

Autoimmune Disease, In the News, Mental Health, Pediatrics, Research, Stanford News

Stanford doctors unraveling mysterious childhood psychiatric disease

Stanford doctors unraveling mysterious childhood psychiatric disease

BrainModel2A story in Sunday’s Wall Street Journal highlights Stanford’s leadership in treating a mystifying disease in which a child suddenly develops intense psychiatric problems, often after an infection. The disease, called pediatric acute-onset neuropsychiatric syndrome, can be terribly disabling, altering kids’ personalities, interfering with their school work and making it hard for families to function.

As the story (subscription required) explains, some physicians question whether PANS is actually a separate disease from the psychiatric diagnoses it resembles, which include obsessive-compulsive disorder and anorexia nervosa. But doctors at Lucile Packard Children’s Hospital Stanford suspect something else is truly going on, likely an autoimmune attack on the brain. The team, led by Jennifer Frankovich, MD, and Kiki Chang, MD, is working to learn more about the disease:

In an effort to establish the science of PANS, the Stanford clinic is collecting extensive data on the patients. Doctors try to piece together what is driving symptoms from pediatric records, parent reports, even teacher interviews. They are analyzing DNA samples from each patient and looking for clues in their immune systems. If they find strep, they bank the strain for further research. “It is easier to study something that is established,” Dr. Frankovich said. “To build something new is really hard.”

The team’s insights from 47 of their patients were published earlier this year in a special PANS-focused issue of the Journal of Child and Adolescent Psychopharmacology, and the researchers are currently working to expand the capacity of their PANS clinic, the first of its kind in the country. More information about PANS and its effect on children and families is also available in a Stanford Medicine magazine story I wrote last year about Frankovich and Chang’s work.

Previously: What happens when the immune system attacks the brain? Stanford doctors investigate and My descent into madness — a conversation with author Susannah Cahalan
Photo by GreenFlames09

Health Policy, Mental Health, Patient Care, Pediatrics, Stanford News

Stanford expert on new treatment guidelines for teens’ eating disorders

Stanford expert on new treatment guidelines for teens' eating disorders

eatingdisorder-plateEating disorders often begin in the teenage years, but, surprisingly, the medical community long lacked a teen-specific set of guidelines for treating these serious illnesses.

That changed in May with the publication of a set of practice parameters co-authored by Stanford eating disorder expert James Lock, MD, PhD, who also directs the Comprehensive Eating Disorders Program at Lucile Packard Children’s Hospital Stanford. The parameters were based on an extensive review of the current scientific evidence around eating-disorder treatment, including recent studies by Lock and his colleagues that show that teens’ parents can play an active role in helping their children recover from anorexia nervosa. That’s a big shift from traditional thinking about eating disorders, which held that young patients’ families should be shut out of treatment.

In a new Q&A, I talked with Lock about why the parameters were needed. He told me:

There have never been practice parameters that address eating disorders in children and adolescents, and expertise in treating these disorders has been sort of sequestered. Yet eating disorders are so prevalent and are such a severe problem: Lifetime prevalence in adolescent girls is around 1 percent, and the disorders have among the highest fatality rates of all mental illnesses.

Teens need treatment approaches that account for their level of physical and emotional development, the fact that their parents generally want and need to be involved in their recovery, and the fact that they have not usually had eating disorders for as long as adult patients with the same diagnoses.

Lock also discusses how he hopes the new guidelines will improve training of psychiatrists, how recent changes to eating disorder diagnostic criteria are making it easier for doctors to get their patients the help they need, and why outpatient treatment is the new front line for young people with eating disorders.

Previously: Patient tells how social media helped her overcome the “shame” of her eating disorder, Incorporating family into helping teens overcome eating disorders and Story highlights need to change the way we view and diagnose eating disorders in men
Photo by Darren Tunnicliff

Addiction, Mental Health, Pain, Public Health, Technology

Student engineers unveil tamper-proof pill bottle

Student engineers unveil tamper-proof pill bottle

Pill-dispenserThe United States has been battling a prescription painkiller epidemic for years. The statistics from the Centers for Disease Control and Prevention are chilling: The number of painkillers prescribed has quadrupled since 1999; more than two million people abused painkillers in 2013; every day, 44 people die from a prescription opioid overdose.

In response, faculty at the Center for Injury Research and Policy at the Johns Hopkins Bloomberg School of Public Health issued a challenge to seniors in the university’s mechanical engineering program: build a pill bottle that would protect against theft and tampering.

One team of students came up with a design that worked so well that their team’s mentors Andrea Gielen, ScD, and Kavi Bhalla, PhD, submitted a proposal to the National Institutes of Health for further testing.

The device is about the size of a can of spray paint, much larger than the average pill bottle. It can only be opened with a special key, which pharmacists can use to refill with a month’s supply of OxyContin. A fingerprint sensor ensures only the prescribed patient can access the pills at prescribed intervals and doses. In a story on the Johns Hopkins website earlier this month, Megan Carney, one of the student engineers described how the pill dispenser works:

The device starts to work when the patient scans in his or her fingerprint. This rotates a disc, which picks up a pill from a loaded cartridge and empties it into the exit channel. The pill falls down the channel and lands on a platform where the patient can see that the pill has been dispensed. The patient then tilts the device and catches the pill in their hand.

A short video about the pill dispenser shows it in action, too. The dispenser still has to undergo additional testing, but the team hopes to bring it to market soon — and help prevent future opioid overdoses.

Previously: Unmet expectations: Testifying before Congress on the opioid abuse epidemic, The problem of prescription opioids: “An extraordinarily timely topic”, Assessing the opioid overdose epidemic, Why doctors prescribe opioids to patients they know are abusing them and Stanford addiction expert: It’s often a “subtle journey” from prescription-drug use to abuse
Photo courtesy of Johns Hopkins University

Behavioral Science, Health and Fitness, Mental Health, Public Health, Research, Stanford News

Exposure to nature helps quash depression – so enjoy the great outdoors!

Exposure to nature helps quash depression - so enjoy the great outdoors!


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Walking is good for your health. But walking somewhere natural is even better, according to a new Stanford-led study.

Study participants who walked in a natural area for 90 minutes showed less activity in a brain region associated with depression than those who walked through a city or other urban area, a Stanford News story states. From the piece:

“These results suggest that accessible natural areas may be vital for mental health in our rapidly urbanizing world,” said co-author Gretchen Daily, the Bing Professor in Environmental Science and a senior fellow at the Stanford Woods Institute for the Environment. “Our findings can help inform the growing movement worldwide to make cities more livable, and to make nature more accessible to all who live in them.”

Even further, the research supports — but does not prove — a link between urbanization and growing rates of mental illness, said co-author James Gross, PhD, a professor of psychology.

The researchers had one group of participants walk in a grassland with oak trees and shrubs. The other group walked along a traffic-clogged four-lane road. They then measured heart and respiration rates, performed brain scans and had the participants answer a series of questions. The results showed that:

Neural activity in the subgenual prefrontal cortex, a brain region active during rumination – repetitive thought focused on negative emotions – decreased among participants who walked in nature versus those who walked in an urban environment.

Evidence that supports the knowledge you’ve had since grade school: The outdoors really can make you feel better.

Previously: To get your creative juices flowing, start movingA look at the effects of city living on mental health and Out-of-office autoreply: Reaping the benefits of nature
Photo by Linda A. Cicero/Stanford News Service

Mental Health, Neuroscience, Research, Women's Health

When dementia hits home: The global impact of dementia on women

When dementia hits home: The global impact of dementia on women

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A report released last week by Alzheimer’s Disease International calls attention to the disproportionate effects of dementia on women worldwide.

As noted in the report, women are more at risk for dementia than men for two primary reasons: age and genetics. Women’s longer lifespans leave them more vulnerable to the age-related condition. In addition, there are biological factors that make women more likely to suffer from dementia.

Women are also more likely to be the caregivers to those with the disease. Women care not only for family members — they’re often also employed in low-paid caregiving professions. This is particularly true in lower income countries, where as many as 62 percent of people with dementia live, according to the report.

The burden of dementia strains family structures and community dynamics in these disadvantaged nations. In the report, Faraneh Farin, who is involved with the Iran Alzheimer Association, describes the situation in countries like Iran:

Nowadays, more women are working to support their families but should they need to care for a family member, then it is expected that they quit their jobs resulting in their marginalization. It seems that either way, whether a woman has dementia or she cares for a loved one, she is trapped in the cycle which has been constructed by the society. Dementia is an issue that engages a woman’s entire life.

The global costs of dementia amount to more than $600 billion, yet many sufferers, caregivers and programs lack adequate funds. The report calls for additional resources for female dementia victims and caregivers, and it highlights the need for additional research on dementia’s effects, especially in countries with lower incomes. These countries also need to develop national strategies that consider the needs of women, the report states.

Alzheimer’s Disease International aims to elevate the awareness of dementia’s impact on women globally and to spur national efforts to improve care. As Executive Director Mark Wortmann wrote in the Foreward: “I hope the report will find its way onto the desks of policy makers to help improve the quality of life for women living with dementia, as well as the millions of women all around the world who provide care and support for them.”

Alex Giacomini is an English literature major at UC Berkeley and a writing and social media intern in the medical school’s Office of Communication and Public Affairs.  

Previously: Study suggests yoga may help caregivers of dementia patients manage stressStanford neuroscientist discusses the coming dementia epidemic, and Science Friday explores women’s heightened risk for Alzheimer’s
Photo by Valerie Everett

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