Published by
Stanford Medicine

Category

Mental Health

Mental Health, Pediatrics, Public Health, Stanford News

Stanford psychiatrist: It’s my “mission to help people develop to their full potential”

Carrion talking to patientHow can a person fully develop his or her potential, regardless of life circumstances? This is the question that brought Stanford child and adolescent psychiatrist Victor Carrion, MD, to his work on child anxiety and mood disorders. Carrion, who also directs the Stanford Early Life Stress and Pediatric Anxiety Research Program at Lucile Packard Children’s Hospital, just won the Silicon Valley Business Journal‘s Excellence in Healthcare award for his dedication to this question.

In an article describing this honor, Carrion says he’s always wanted to go into medicine and explore human behavior. While he’s very proud of the advances his lab has made in understanding the impact of early life stress on behavior, he also notes that there remain significant barriers to mental health in the region, including stigma and accessibility of treatment.

One of the innovative programs Carrion has been involved in is a study on the effectiveness of a health and wellness program in the Ravenswood City School District in East Palo Alto. The program teaches kids about mindfulness and positive habits that encourage calm, focused attitudes; Carrion and his colleagues will follow student participants over the next four years, tracking cognitive function, academic strengths and weaknesses, behavior, and stress-related hormone levels.

Previously: Stanford researchers use yoga to help underserve youth manage stress and gain focusProlonged fatigue and mood disorders among teensYoga classes may boost high school students’ mental well-beingLucile Packard Children’s Hospital partners with high schools on student mental health programs and More evidence that chronic stress may increase children’s risk of obesity
Photo courtesy of Stanford Medicine News

In the News, Medical Education, Mental Health, Stanford News

An Rx for physician burnout

An Rx for physician burnout

artsy stethoscope - 250Burnout, which is characterized by emotional exhaustion, a sense of depersonalization and a lack of a sense of personal accomplishment, is on the rise among physicians and medical residents and students in the United States. A lengthy article (subscription required) published Friday in Time examines the growing problem and the movement to save physicians’ mental health:

Experts warn that the mental health of doctors is reaching the point of crisis—and the consequences of their unhappiness go far beyond their personal lives. Studies have linked burnout to an increase in unprofessional behavior and lower patient satisfaction. When patients are under the care of physicians with reduced empathy—which often comes with burnout—they have worse outcomes and adhere less to their doctors’ orders. It even takes people longer to recover when their doctor is down.

Many factors contribute to physician burnout, including long-hours, a high-pressure work environment, the stigma against weakness and mistreatment from higher-ranking physicians. Efforts are underway to change the culture of medicine and alleviate these sources of stress, and much of the story focuses on what’s happening here at Stanford:

In 2011, [Ralph Greco, MD, professor of surgery a Stanford,] Chaplain [Bruce Feldstein, MD,] and a few other colleagues, including [Arghavan Salles, MD, former chief resident of general surgery at Stanford], got together to discuss how to change things. “When people go somewhere new, they lose everything that was around them that supported them, and it’s very natural to doubt them- selves,” says Salles. “I had this idea that we could have sessions where people talk to each other, and then it wouldn’t be so lonely.”

They put together a program at Stanford to promote psychological well-being, physical health and mentoring. Every week, one of the six groups of surgery residents has a mandatory psychotherapy session with a psychologist. Each senior resident mentors a junior resident, and residents are given time for team bonding. Young doctors rarely have time to go see a doctor of their own, so the wellness team issues lists of doctors and dentists it recommends. And there’s now a refrigerator in the surgery residents’ lounge, stocked with healthy foods. They call the program Balance in Life.

“We knew we couldn’t necessarily prevent suicide—too complicated for us to solve it,” Greco says. “But we needed to feel we did everything we could do to prevent it, if we could.”

Previously: Stanford’s “time banking” program helps emergency room physicians avoid burnoutKeeping an even keel: Stanford surgery residents learn to balance work and lifeA call to action to improve balance and reduce stress in the lives of resident physicians and Program for residents reflects “massive change” in surgeon mentality
Photo by Lidor

Emergency Medicine, Health and Fitness, Mental Health

Stanford’s “time banking” program helps emergency room physicians avoid burnout

Stanford's "time banking" program helps emergency room physicians avoid burnout

saving_timeFor emergency room doctors, few things are more important than time. They’re trained to work quickly and efficiently to gain the moments, minutes and hours that can be the difference between life or death for a patient. Yet, few ER doctors have the luxury of time in their personal lives.

According to a 2012 study, physicians’ work weeks are roughly ten to 20 hours longer than that of other professionals. This means that it would take the average professional about a year and a half to accomplish what a hard-working physician does in a single year. With a schedule like this, it’s no wonder that burnout is an issue for many physicians.

So, Stanford’s Department of Emergency Medicine adopted a “time banking” program that allows doctors to log the time they spend doing often under-valued activities, such as mentoring and covering colleagues’ shifts, to earn credits for the work and home-related services that would normally gobble up their free time.

Recently, the Washington Post highlighted this time-saving initiative in a story featuring emergency physician Gregory Gilbert, MD. “This gives me more bandwidth at work,” Gilbert said. “And because I can hang out with my kids and not be exhausted all the time, I’m able to be the kind of parent I’d always hoped to be.” From the Washington Post story:

Stanford’s time bank, part of a two-year, $250,000 pilot funded largely by the Sloan Foundation, showed big increases in job satisfaction, work-life balance and collegiality, in addition to a greater number of research grants applied for and a higher approval rate than Stanford faculty not in the pilot.

And for the first time, this year there are no openings for new fellows in the Department of Emergency Medicine. “All our spots have been retained,” Gilbert said. “There’s been no turnover.”

Previously: Surgeon offers his perspective on balancing life and workProgram for residents reflects “massive change” in surgeon mentalityLess burnout, better safety culture in hospitals with hands-on executives new study shows and Using mindfulness interventions to help reduce physician burnout
Photo by: mbgrigby

Mental Health, Pregnancy, Research, Women's Health

Study shows mothers receiving fertility treatments may have an elevated risk of depression

Study shows mothers receiving fertility treatments may have an elevated risk of depression

5088785288_9f7a23f17a_zAn estimated one in four couples in developing countries encounter difficulties trying to conceive. In the United States, more than 7 million women have undergone fertility treatments and, as a result, millions of babies have been born through in-vitro fertilization.

While many may assume that failed fertility treatments would increase a woman’s risk of depression more than successful attempts that resulted in a live birth, research recently published in the journal ACTA Obstetricia et Gynecologica Scandinavica shows that the opposite may be true.

In the study, researchers from the University of Copenhagen analyzed data on 41,000 Danish women who had undergone fertility treatments. PsychCentral reports that “investigators discovered women who give birth after receiving fertility treatment are five times more likely to develop depression compared to women who don’t give birth.”

Lead author Camilla Sandal Sejbaek, PhD, discusses the results in the story:

The new results are surprising because we had assumed it was actually quite the opposite. However, our study clearly shows that women who become mothers following fertility treatment have an increased risk of developing depression in the first six weeks after birth compared to women who did not have a child.

Our study has not looked at why the depression occurs, but other studies indicate that it could be caused by hormonal changes or mental factors, but we cannot say for sure. We did not find any correlation between the number of fertility treatments and the subsequent risk of depression.

Previously: Stanford-developed fertility treatment deemed a “top medical breakthrough” of the year, Ask Stanford Med: Expert in reproductive medicine responds to questions on infertility, Image of the Week: Baby born after mom receives Stanford-developed fertility treatment and NIH study suggests progestin in infertility treatment for women with PCOS may be counterproductive
Photo by Big D2112

Behavioral Science, Mental Health, NIH, Public Health, Research

Developing certain skills may help you cultivate a positive outlook

34835574_9e61cfe6bb_zMany of us have heard that having a positive outlook on life can improve our mental and physical health. Yet, if you’re like me, you’ve noticed that it can be hard to focus on the bright side of things when you’re feeling anything but positive.

That’s why I was drawn to this article in the National Institutes of Health (NIH) newsletter. It discusses several NIH-funded studies on the topic and explains what it means to have a positive outlook and how a positive mood can affect your health. The really helpful information, from my perspective, is it also explains how developing certain skills, like meditation and self-reflection, can make you can feel more positive more often. From the NIH story:

Having a positive outlook doesn’t mean you never feel negative emotions, such as sadness or anger, says Dr. Barbara L. Fredrickson, a psychologist and expert on emotional wellness at the University of North Carolina, Chapel Hill. “All emotions—whether positive or negative—are adaptive in the right circumstances. The key seems to be finding a balance between the two,” she says.

The research teams used a variety of techniques to learn about the underlying mechanisms of positive and negative emotions and what it is that enables people to bounce back from difficult times.

Among those who appear more resilient and better able to hold on to positive emotions are people who’ve practiced various forms of meditation. In fact, growing evidence suggests that several techniques—including meditation, cognitive therapy (a type of psychotherapy), and self-reflection (thinking about the things you find important)—can help people develop the skills needed to make positive, healthful changes.

“Research points to the importance of certain kinds of training that can alter brain circuits in a way that will promote positive responses,” Davidson says. “It’s led us to conclude that well-being can be considered as a life skill. If you practice, you can actually get better at it.”

Previously: Navigating a rare genetic disorder with a positive attitudePromoting healthy eating and a positive body image on college campusesWhen life gives you lemons: Study suggests the benefits of a positive outlook are context dependent and The power of positive moods in improving cognitive function among older adults
Photo by: premasagar

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.

Continue Reading »

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.

Stanford Medicine Resources: