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Mental Health

Mental Health, Research

A look at how people endure a winter of Polar Night by embracing it

A look at how people endure a winter of Polar Night by embracing it

5235620899_00642f6d27_zWhen the weather is bad, many people seek solace in a good book or cup of marshmallow-speckled hot cocoa until brighter days return. But when gloomy weather swallows a whole season of the year, a bit of chocolate and a few paperbacks often aren’t enough to keep depression at bay.

Nearly 200 miles north of the Arctic Circle in Tromsø, Norway winters are, by my standards, brutal. This is not because of the cold (temperatures are often mild ranging from 20-35 degrees F) but because of a lack of sunlight. Every November to January Tromsø’s bit of earth is tipped away from the sun and the city is cloaked in Polar Night.

Despite the darkness, studies have shown that the people of Tromsø have lower rates of wintertime depression predicted for people living at this latitude (69°N). To learn how they fend off seasonal depression and if their strategies could be applied elsewhere, Stanford graduate student Kari Leibowitz traveled to Tromsø to conduct a series of interviews and surveys.

What she found surprised her, Leibowitz explains in a recent Christian Science Monitor article. The people she surveyed often failed to understand her questions about wintertime depression because they actually enjoyed the season.

Leibowitz states that further research is needed, but her work thus far suggests that the attitude people have about a stressful situation may dictate whether it causes mental distress or if it enhances their mood.

Her findings are in line with the work of Stanford psychologists Carol Dweck, PhD, and Alia Crum, PhD. Their research investigates the way people perceive a situation and how their mindset can help them flourish in what some may see as an undesirable situation, such as a long, sunless winter.

“Norwegians have a saying that ‘there’s no such thing as bad weather, only bad clothing,’ which typifies their ingrained belief that being active is part of a happy life – and, especially, a happy winter,” Leibowitz writes.

Image by Shandi-lee Cox

Mental Health, Patient Care, Rural Health

Horse therapy could help people cope with early-onset dementia

Duell and Paula HertelAs a kid growing up in rural Minnesota, I spent many of my waking hours searching for a reason to be near the five horses that roamed the 40 acres behind our house. Their methodical munching and tail-swishing put me at ease and learning how to ride a 1,200-pound animal that could easily wipe me off on a fence post taught me much of what I know about courage and persistence.

A similar sense of calm, accomplishment and fortitude are among the potential benefits of a new pilot study at Stanford University’s Red Barn called the Connected Horse Project. This project aims to help people learn how to manage the symptoms of early-stage dementia through a series of workshops where they participate in supervised activities with horses.

The project is the brainchild of Paula Hertel, Nancy Schier Anzelmo and Elke Tekin, three senior care practitioners and equestrians who work at the Senior Living Consult. For this study they worked with Stanford’s Dolores Gallagher Thompson, PhD, and Nusha Askari, PhD, and Jacqueline Hartman at the Stanford Red Barn Leadership Program.

In the pilot study, five individuals and their care partners participated in a three-week workshop. The study measures the workshop’s effect on the participants’ stress levels, their quality of sleep and their ability to relate to and communicate with others. The results will be presented at Stanford’s Annual Community Health Symposium on Jan. 14 and will be used to develop programs that can be implemented throughout the country, including in rural areas where support services are often lacking.

Hertel and Schier Anzelmo told me more about the program and its potential applications in an email interview:

What prompted you to start the Connected Horse Project?

A shared passion is the simple answer. We are practitioners in senior care and know firsthand that traditional models of care are not adequate. We have also experienced the power of the human/horse connection on a personal level.

Why horses? Do you think a program that pairs humans with dogs or cats could work as well or in the same way? 

Many of us smile when we think about our favorite dog or cat, or in my [Paula’s] case, my first pony. Interactions with animals spark emotional memories that stay intact. Horses can be particularly therapeutic for people because they have an innate ability to sense what others around them feel; they depend on the herd for survival.

In the workshop, the equine facilitators guide the participants through activities that showcase the horses’ characteristics and abilities. This helps the participants recognize their own strengths and the power of their relationships with others.

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Mental Health, Neuroscience, Research, Stanford News

Hyperactivity in brain’s “self-control” center may stifle the pleasure-seeking urge

Hyperactivity in brain's "self-control" center may stifle the pleasure-seeking urge

no fun signDiagnosing depression in a rodent is no mean feat. If you ask a rat how it’s feeling, it won’t tell you. But with a little ingenuity you can test that rat’s willingness to expend some energy in the quest for a pleasurable outcome.

And with the right technology, you can manipulate the rat’s so-called reward circuitry – a network of brain areas collectively responsible for enjoyment – and see what happens. That provides strong clues about how the reward circuitry works in us people, because rats’ reward circuitry looks and functions very much like ours.

Practiced wisely, the pursuit of happiness ennobled by Thomas Jefferson in the Declaration of Independence is a successful species-survival strategy. It gets us to do more of exactly the kinds of things that keep us alive and result in our having more offspring: food-seeking and ingestion, hunting and hoarding, selecting a mate and, last but not least, actually mating.

The reward circuitry includes nerve bundles that run from deep inside the brain to numerous spots including, for example, the nucleus accumbens (associated with pleasure) and the more recently evolved prefrontal cortex, an executive-control center that guides our planning and decision-making, focuses our attention and generally keeps us organized. It’s also the case that nerve bundles convey signals in the opposite direction, from the prefrontal cortex to various components of the reward circuitry.

The medial prefrontal cortex, with its portfolio of high-level “executive function” activities, plays its own obvious role in survival. After all, what if all we did was seek momentary pleasures, ignoring our top-down control center’s “hey, cool it!” or “skip dessert!” or “get back to work!” commands? (When the reward circuitry escapes from this kind of control, the result can be addictive behavior.)

But Stanford neuroscientist and Howard Hughes Medical Institute investigator Karl Deisseroth, MD, PhD, in a study conducted with help from numerous other Stanford researchers and recently published in Science, has shown in rats that hyperactivity in the medial prefrontal cortex reduces signaling between key components of the reward circuitry and impairs rats’ reward-seeking behavior. In humans, this dulling of the drive to pursue pleasure, known as anhedonia, is seen in a number of psychiatric conditions including, notably, depression.

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Behavioral Science, Mental Health, Pediatrics, Research, Stanford News

Stanford ingenuity + big data = new insight into the ADHD brain

Stanford ingenuity + big data = new insight into the ADHD brain

ask-the-brainAttention-focusing brain networks interact more weakly than usual in kids with attention deficit hyperactivity disorder, new Stanford research shows.

The research, published online today in Biological Psychiatry, is part of an ongoing effort to figure out how the brain differs from normal in people with ADHD. The disorder is both serious and common: It’s characterized by impulsiveness, hyperactivity and difficulty paying attention, and it has been diagnosed in more than 6 million U.S. children.

The new study focused on a particular set of linked brain regions called the salience network. From our press release:

“A lot of things may be happening in one’s environment, but only some grab our attention,” said Vinod Menon, PhD, a professor of psychiatry and behavioral sciences and the study’s senior author. “The salience network helps us stop daydreaming or thinking about something that happened yesterday so we can focus on the task at hand. We found that this network’s ability to regulate interactions with other brain systems is weaker in kids with ADHD.”

The research could lead to better diagnostics for ADHD, Menon said. That’s a big deal because, right now, diagnosis is based on subjective assessment of a child’s behaviors, and the threshold of behavior considered sufficient for diagnosis varies quite widely. Doctors worry about the risks of diagnosing ADHD in kids who don’t have it, or who actually suffer from a different psychiatric problem, and also about missing children who really should get a diagnosis.

But prior efforts to find an ADHD biomarker have been hampered by weak science. Many papers reporting brain-scan features of ADHD have not withstood attempts to replicate their findings.

The new study is different: Not only did Menon’s team find that their analysis could distinguish ADHD patients from controls with brain scans, it did so in three independent data sets. The data, from an open-source database of fMRI scans called the ADHD-200 Consortium, was collected using a different MRI scanner and slightly different clinical assessments at each site.

“We could use biomarkers developed from one site — New York — to classify ADHD children in another site, Beijing,” Menon said. The biomarkers also worked for the data from the third study site, which was Portland, Oregon. The fact that the findings held for all three sites gives an important level of real-world assurance that they’re meaningful.

More research is still needed to investigate whether brain scans can distinguish children with ADHD from those with other psychiatric conditions. But Menon thinks the work is on track to making a practical difference for better ADHD diagnostics.

Previously: A visual deluge may provide clues to ADHD treatment, Scientists reveal link between dopamine receptor subtype and ADHD diagnosis and Study finds many teachers, doctors mistaking immaturity for ADHD
Photo by Thomas Hawk

Health and Fitness, Mental Health

Tips to survive — and thrive during holiday family events

Tips to survive — and thrive during holiday family events

6982000222_6fff88e3c8_zEvery year, in the interim between the last bites of my Thanksgiving meal and my first cup of coffee on Black Friday, a gnawing uneasiness begins in the pit of my stomach. The holiday season has now, undeniably, begun and it’s time to start the mental Jenga that is arranging my vacation travel so I can visit multiple families in different states.

I know a perfect holiday with each family isn’t possible. I also understand that I’ll burn myself out if I try to please everyone. Yet, every year, I struggle to put this knowledge into practice.

So, to bolster my resolve to have a healthier holiday, I did some research on the topic and found this post by BeWell @Stanford. In the Q&A, marriage and family therapist Mary Foston-English, explains that the holidays are hard for many people because they’re often coupled with uncomfortable situations, reminders of a lost loved one or unpleasant memories. She also describes how unrealistic expectations can can contribute to holiday stress. We may think:

  • “Holidays are supposed to be joyous and happy.”
  • “Holidays are times when families come together.”
  • “If you don’t have family, then there’s no reason to celebrate.”
  • “There’s no place like home for the holidays.”
  • “The bigger the gift and/or the more we spend, the better.”
  • “Everything has to be perfect.”

And we couldn’t be more wrong.

Foston-English offers several sanity-saving tips on how to communicate better with our families, how to deal with ‘that’ relative and how to avoid overextending ourselves emotionally, financially and emotionally. Here are a few of Foston-English’s nuggets of wisdom:

  • Have realistic expectations of yourself and others.
  • Become aware of how unhappy/traumatic memories impact the holidays. If you associate the holidays with unhappy times, then the holidays can bring it all back.
  • Try to accept family members and friends as they are, even if they don’t live up to all of your expectations. It’s not a good idea to use the holidays to “confront.”
  • Establish “healthy” boundaries for yourself: It’s OK to say “no.”

I highly recommend reading and sharing the article. Here’s to a healthier holiday season for all of us.

Previously: Health psychologist responds to questions on coping with holiday stress and Ask Stanford Med: David Spiegel answers your questions on holiday stress and depression
Photo by eren {sea+prairie}

Ethics, Mental Health, Stanford News

Stanford psychiatrist’s varied pursuits garner her a top ethics prize

Stanford psychiatrist's varied pursuits garner her a top ethics prize

LSN_8739Imagine being terrified you might kill yourself. Then imagine driving 300 miles to the nearest city for psychiatric care because you’re even more afraid someone in your town will find out about your depression. Or worse yet, being so afraid of being labeled “crazy” that you don’t seek care at all.

Psychiatrists like Laura Roberts, MD, deal with situations like this frequently. Roberts, who chairs the Department of Psychiatry and Behavioral Sciences, has learned not to underestimate the strength, or pervasiveness, of the stigma that surrounds mental health issues.

“You can build resources, but stigma is such a strong and visible barrier to care. If we do not work on that issue,” we are not able to effectively treat patients, Roberts said.

Battling stigma is just one of Roberts’ passions. She is known for her work with vulnerable and often neglected populations. She has conducted extensive research on improving mental health care in isolated rural and tribal communities in New Mexico and Alaska. And she has a long history of championing patients who have been marginalized, including victims of sexual trauma, sex workers, veterans, and elders with dementia.

Roberts is also committed to improving the well-being of her fellow psychiatrists and the health of the field of psychiatry as a whole. But while her scholarly and research interests are varied, they are all united by one common focus: ethics.

Her mentor, Mark Siegler, MD, has known Roberts since she was a medical student at the University of Chicago. “From the beginning of her medical career, her central focus and commitment has been on improving the care and outcomes of her patients,” Siegler said. “She is a brilliant patient-centered physician whose scholarly work has improved the care not just of her own patients but of sick and vulnerable patients everywhere.”

He was in attendance when Roberts recently received the 2015 MacLean Center Prize in Clinical Ethics and Health Outcomes, the largest prize in clinical ethics, which includes a $50,000 award.

“The prize honors these individuals who teach us about medicine, and about life, as they face great sorrow and injustices with courage and generosity,” Roberts said in a release.

The award was given during the Dorothy J. MacLean Fellows Conference on ethics in medicine at the University of Chicago.

Previously: How people with mental illness get left out of medical research studies, “Every life is touched by suicide:” Stanford psychiatrist on the importance of prevention and Starting a new career in academic medicine? Here’s a bible for the bedside: The Academic Medicine Handbook
Photo by Bruce Powell

Chronic Disease, Clinical Trials, Mental Health, Research, Stanford News

Treating insulin resistance may speed recovery from major depression

Treating insulin resistance may speed recovery from major depression

depressionIn a randomized, placebo-controlled clinical trial detailed in this study in Psychiatry Research, pioglitazone – a generically available drug that’s approved for type 2 diabetes – helped to relieve symptoms of major depression in patients whose blues had withstood an assault by standard therapeutic regimens for six months or longer.

But this beneficial effect was seen only in depressed patients who were also insulin-resistant.

Depression is remarkably common. Stanford psychiatric researcher Natalie Rasgon, MD, PhD, the study’s senior author, told me that close to one in five Americans are diagnosed with depressive illness at some point in their lives.

Insulin resistance, a stepping stone on the path to type 2 diabetes (not to mention cardiovascular disease and probably Alzheimer’s), is even more common: About one in three otherwise healthy Americans – and an even greater share of people with depression – are insulin-resistant. Especially prevalent among overweight people, insulin resistance also occurs more often than one might expect even among thinner folks, a lot of whom don’t have the faintest idea that’s the case.

Insulin, released by the pancreas in response to food intake, alerts cells throughout the body to the presence of glucose, the body’s primary energy source, in the blood. Insulin-resistant people’s cells fail to take up glucose adequately, leaving high residual blood levels of the sugar to wreak havoc on the body’s tissues. Because the brain is a glucose glutton – it soaks up about 20 percent of all glucose consumption in a healthy, active person – it’s easy to imagine that lousy glucose uptake in the brain would have all kinds of deleterious effects, including effects on mood. Food for thought, anyway.

Here’s how my news release described the study:

[R]esearchers were blinded as to which patients were receiving pioglitazone versus a placebo. The patients didn’t know which they were getting, either. … All the patients had been experiencing episodes of depression lasting, on average, more than one year. Their symptoms had failed to remit under standard treatment regimens. They remained on these regimens for the duration of the Stanford study and, in addition, were given either pioglitazone or a placebo. … The patients were tested for depression severity and insulin resistance at the study’s outset and then roughly every two weeks from the beginning of the trial to the end.

A total of 37 patients – 29 women and eight men – completed the 12-week study. The insulin-sensitive subjects did about as well on the drug as they did on placebo. But among the insulin-resistant group, those given pioglitazone showed a much greater improvement than those who got a placebo. They also showed more improvement than insulin-sensitive patients did.

The more insulin-resistant a participant was at the beginning of the study, the better the drug’s antidepressant effect. Possible, but not proven, explanation: It could be that for some patients standard antidepressant therapies can kick into gear only once these patients’ insulin resistance is reduced. Hungry brains gotta eat.

Previously: Survey shows nearly a quarter of U.S. workers have been diagnosed with depression in their lifetime, Revealed: the brain’s molecular mechanism behind why we get the blues, and International led by Stanford researchers identifies gene linked to insulin resistance
Photo by S.Hart Photography

Behavioral Science, Mental Health, Patient Care

Take it from me: To improve compliance with psychiatric meds, we must educate patients

Take it from me: To improve compliance with psychiatric meds, we must educate patients

We’ve partnered with Inspire, a company that builds and manages online support communities for patients and caregivers, to launch a patient-focused series here on Scope. Once a month, patients affected by serious and often rare diseases share their unique stories; this month’s column comes from mental health advocate Gabe Howard.

3926259585_5f265f6683_zWhenever I give a speech to psychiatric practitioners, I start by giving the group index cards and pens and asking them to write down their most important goal for their patients.

Answers like “be med-compliant,” “miss fewer appointments,” and “follow my instructions” are always the most popular. Patients’ answers are much different. They write “live well,” “go to Hawaii,” or “get back to work.” This exercise serves as a reminder to physicians that taking medication is not a final goal, but a step toward the ultimate goal of living well.

It’s important to realize that patients aren’t failing to take their medication as prescribed because they are incompetent, lazy, or intentionally self-sabotaging. Patients often skip doses or skew directions because they are scared of something, often due to a misunderstanding.

They may misunderstand the prescription instructions or the way the drugs work and this misinformation quickly becomes fact in a patient’s mind. They may already be confused by their diagnosis and lack knowledge about their condition.

Once I understood how difficult it was to find the correct combination of medications, I felt much more hopeful.

More often than not, patients suffer from side effects or even a perceived moral failure by taking psychiatric medications. I’m surprised that many clinicians aren’t aware of the stigma patients feel about taking medication. They believe it means they are “less of a man,” “not capable of being a good mother,” or other such nonsense. Psychiatric medications are often first prescribed to people in their early 20s who are not used to taking medication. Most 20-somethings are still in the “I’m invincible” phase.

I believe this can be remedied with education.

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Bioengineering, Events, Mental Health, Research, Stanford News, Videos

Stanford’s Karl Deisseroth talks about the work he was “destined to do”

Stanford's Karl Deisseroth talks about the work he was "destined to do"

Earlier this week we announced the exciting news that Stanford bioengineer Karl Deisseroth, MD, PhD, had won a $3 million 2016 Breakthrough Prize in Life Sciences. Before he took the stage to accept his award during a star-studded Academy Awards-like ceremony Sunday evening, the video above was shown to highlight the significance of his work. One of Deissoroth’s quotes:

There are deep questions about the brain that may never be answered, but we’re making headway with optogenetics… We’re headed down a path that gets us to understanding [questions like] why does one person feel the way they do and why does it create a disease when they do a particular way, and what can be done to correct it?

Noting that the suffering of people with psychiatric disease “is a very, very serious and pervasive matter,” he also says “the nature of the illnesses – their complexity, the amount of suffering and the mystery – has made this what I was destined to do.”

Previously: Stanford bioengineer Karl Deisseroth wins 2016 Breakthrough Prize in Life SciencesInside the brain of optogenetics pioneer Karl DeisserothLightning strikes twice: Optogenetics pioneer Karl Deisseroth’s newest technique renders tissues transparent, yet structurally intact and An in-depth look at the career of Stanford’s Karl Deisseroth, “a major name in science”
Video courtesy of National Geographic Channel

Education, Mental Health, Research, Surgery, Women's Health

Stereotype perception linked to psychological health in female surgeons

Stereotype perception linked to psychological health in female surgeons

8116089104_be12619731_oFemale surgeons who believe there’s a stereotype that men are better doctors are more likely to suffer from psychological distress, according to a recent study led by a former Stanford resident.

First author Arghavan Salles, MD, PhD, looked at the correlation between the perception of a stereotype — whether individuals think others believe certain groups are superior physicians — and the overall mental well-being of residents.

The team surveyed 382 residents from 14 medical specialties. To examine views on stereotypes, participants were asked: “Do you think residents in your program expect men or women to generally be better [doctors]?” They were also given standard psychological assessments.

Female surgeons were the only group where stereotype perception was correlated with psychological health. Surgery has traditionally been dominated by men and remains a specialty chosen by about twice as many men as women, leading to the persistence of gender stereotypes.

“As a surgical resident, I was aware of the stereotype that men are better surgeons than women. Although I found the stereotype upsetting, I didn’t think about it too much,” Salles told me. Then, after studying stereotype perception while pursuing a doctorate in education, Salles decided to combine her two specialties to determine whether residents experience stereotype threat; a question that no one had asked before.

The link she found has implications for physician productivity and patient care, Salles said.

“I think it’s important to realize that in the world of medicine, although the ratio of males to females is changing, some of these old stereotypes still have an impact on the practitioners,” said co-senior author Claudia Mueller, MD, PhD.

The belief that others think women aren’t good enough adds an unnecessary stressor to the female residents’ already harried lives, Mueller said. It could also contribute to the high attrition rate of females in surgical disciplines, the study states.

Mueller said the study, which appears in the Journal of the American College of Surgeonsis noteworthy for its rare integration of two quite disparate fields, surgery and psychology.

The authors suggest that simply increasing the number of female surgeons may help dissipate the stereotype. Sharing information about the stereotype may also help, as could investigating any practices that may have a differential effect on men and women, the researchers write.

Salles is now querying residents, faculty members and members of the public to see how prevalent stereotypes about gender-based differences in ability actually are.

Previously: How two women from different worlds are changing the face of surgery, Keeping an even keel: Stanford surgery residents learn to balance work and life and Stanford Medicine magazine opens up the world of surgery
Photo by Phalinn Ooi

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