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Clinical Trials, Mental Health, Parenting, Pediatrics, Research, Stanford News

Parents can help their teens recover from bulimia, say Stanford researchers

Parents can help their teens recover from bulimia, say Stanford researchers

Mom&teenTeenagers with bulimia nervosa benefit from their parents’ help in stopping their eating disorder. In fact, a therapy that involves parents works better for teens than one that does not, according to the first large head-to-head comparison in adolescents of two well-known bulimia treatments.

The findings are described in a study of 130 young people with bulimia that was published last week in the Journal of the American Academy of Child and Adolescent Psychiatry.

The research, which was jointly led by Stanford’s James Lock, MD, PhD, and a longtime collaborator, Daniel Le Grange, PhD, compared an approach tailored to teens with one commonly used in adults. In family-based therapy, the bulimia patient and a parent work together to stop the disordered eating behavior. In contrast, in cognitive behavioral therapy, which is widely recognized as the best approach for bulimic adults, there is more focus on changing abnormal thoughts about food and less emphasis on behavior change.

At the end of six months of treatment, 39 percent of patients in family-based therapy had abstained from the binge-and-purge cycle of bulimia for at least four weeks. Only 20 percent of those in the cognitive behavioral therapy group had done the same. The gap persisted six months after treatment ended, though it seemed to have closed by a year after the end of treatment.

Lock, who directs the Comprehensive Eating Disorders Program at Lucile Packard Children’s Hospital Stanford, said the findings are not surprising, given that teens are at a different stage of the illness and have different cognitive capabilities than adults with bulimia. But they are very important, since they suggest that the family-based approach is a faster way for young patients to recover from bulimia. From our press release about the study:

“The strategy for cognitive behavioral therapy requires a fair amount of abstract reasoning, motivation and persistence that often has not reached full capacity in teens,” [Lock] said, adding that doctors may need to decide on a case-by-case basis whether a teen would benefit from one treatment versus the other. “The cognitive and developmental context is very different for teens than for adult patients,” he said.

And it’s normal for teenagers to need their parents’ assistance in navigating difficult situations, he added. “The big take-home message is that families can really help their kids with bulimia nervosa.”

Previously: Family therapy an effective way to treat anorexic teens, Incorporating the family to help teens overcome eating disorders and Families can help their teens recover from anorexia, new study shows
Photo by J.K. Califf

Aging, Medicine and Society, Mental Health, Patient Care

Stanford longevity design winner brings dementia place setting into production

Stanford longevity design winner brings dementia place setting into production

eatwellprimaryHelping people live not just longer but better lives is the goal of Stanford’s Center on Longevity, and last year it held a Design Challenge to scope out great ideas for doing so. The winner of that competition is no longer just a design; Eatwell is moving into production.

Eatwell, a place setting for those with cognitive and motor impairments from dementia, features subtle alterations to the colors, textures, weight, and shape of traditional dishes and cutlery. For example, bright colors make food more appetizing, and blue surfaces make it less likely that users will confuse their food with the dish. Slanted bottoms help keep food together and make it easier to scoop, and weighted bottoms with skid-resistant texture make spills less likely. There are even placemat attachments for a napkin to catch drips.

I recently corresponded with Eatwell’s designer, Sha Yao, via email while she was in Asia overseeing the manufacturing of her innovative product. The 20 design features of the 9-piece set emerged from a four-year research process involving one-on-one observation and volunteering in adult day care centers. “Along the way,” Yao told me, “I had many opportunities to come in contact with people who work with people with Alzheimer’s. I did more than a hundred mock-ups and asked my target users to give me feedback.”

Yao was surprised by the number of things caregivers have to be aware of. “Our loved ones may have visual impairment, and they may have depth perception problems with gripping things in front of them. Simple tasks can become difficult for them and I didn’t even know that before I did research on it and watched them struggle to eat.”

Although Yao has worked on a variety of products while completing her MFA in industrial design, this is the first project she developed from an idea to mass-production. Her impetus was a close connection with her grandmother, who took care of Yao and her sister as children while their parents worked.

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Clinical Trials, Health Disparities, Mental Health, Research, Stanford News

How people with mental illness get left out of medical research studies

How people with mental illness get left out of medical research studies

One of the enduring challenges of evidence-based medicine is that the characteristics of people who participate in clinical trials can differ markedly from those of patients who ultimately access the treatment which the trial evaluates. One of the many reasons this occurs is that researchers often exclude patients with certain characteristics from participating in clinical trials.  In a new study in Journal of Psychiatric Research, my colleagues Laura Roberts, MD; Janet Blodgett, and I examine a particular population to whom this occurs: People with mental health and/or substance use disorders.

If scientists are to live up to their laudable commitment to sharing the benefits of health research with all citizens, they’ll have to more consistently include people with psychiatric problems in studies

In a sample of 400 highly-cited randomized trials across 20 common chronic disorders, we found that half had eligibility rules that prevented people with psychiatric problems from enrolling.   Those disease research areas with high rates of reported psychiatric exclusion criteria in clinical trials included low back pain (75 percent), osteoarthritis (57 percent), COPD (55 percent), and diabetes (55 percent).  People with conditions such as depression, anxiety disorders, alcohol problems and schizophrenia thus may face some added risk when they seek health care: People like them were often left out of the research that tells doctors what medical treatments work.

The study also raises questions about whether some clinical trials make much of a contribution to knowledge. For example, now that psychiatric and other substance use problems are virtually normative among smokers, what is the point of smoking cessation studies that continue to exclude the very populations that do most of the smoking?

Including people with psychiatric problems in medical research may require extra resources for researchers (e.g., people with serious mental illness may be harder to follow up) or pose other challenges in completing clinical trials. But if scientists are to live up to their laudable commitment to sharing the benefits of health research with all citizens, they’ll have to meet these challenges and more consistently include people with psychiatric problems in medical research studies.

Addiction expert Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences at Stanford and a career research scientist at the Palo Alto VA. He has served in the past as a senior advisor in the Office of National Drug Control Policy in Washington, DC. He can be followed on Twitter at @KeithNHumphreys.

Mental Health, Parenting, Pediatrics, Pregnancy, Public Health, Research, Women's Health

Sleep-deprivation and stress among factors contributing to smoking relapse after childbirth

Sleep-deprivation and stress among factors contributing to smoking relapse after childbirth

2473235415_0584b78298_zSmoking can make it more difficult to get pregnant and it can contribute to complications after conception and endanger the health of babies as they grow. For these reasons, many women quit smoking when they are trying to conceive and during pregnancy. But an estimated 40 percent of women in the United States who kick the nicotine habit for the health of their unborn child relapse within six months after delivery.

New research published in the journal Addiction suggests that the stress of becoming a parent could be a significant factor in why some moms resume smoking after childbirth. In the study, British researchers interviewed 1,000 mothers about factors that influenced their relapse or contributed to them staying smoke-free. Lead researcher Caitlin Notley, PhD, discussed the findings in a PsychCentral article:

One of the most striking things that we found is that women’s beliefs about smoking are a major barrier to remaining smoke-free. Many felt that smoking after the birth of their child was acceptable provided they protected their babies from secondhand smoke.

Their focus is, admirably, on the health of the baby, but they often do not think about the long-term health consequences for themselves as mothers.

We also found that women who saw smoking as a way of coping with stress were more likely to relapse. And that feeling low, lonely, tired, and coping with things like persistent crying were also triggers. Women reported that cravings for nicotine, which had lessened or stopped during pregnancy, returned.

The majority of women who had successfully remained smoke free said that the support of their partner was a strong factor. Partners who gave up smoking, or altered their own smoking behaviors, were a particularly good influence. And those who helped ease the stress of childcare were also praised by women who had resisted the urge to light up

In addition to receiving help from their partners, moms said support from health professionals was another positive contributor to them being able to resist urges to smoke and manage stress.

Previously: Study shows mothers receiving fertility treatments may have an elevated risk of depression, Examining how fathers’ postpartum depression affects toddlers, A telephone lifeline for moms with postpartum depression, What other cultures can teach us about managing postpartum sleep deprivation and Is postpartum depression more of an urban problem?
Photo by Samantha Webber

Mental Health, Research, Science

Optimizing work breaks for health, job satisfaction and productivity

5187630414_6102463a6c_zThink about the breaks you take during the day. Perhaps you hit pause midday to grab lunch and to run errands. Or maybe you step away from your desk frequently to briefly socialize with co-workers, get coffee or satisfy a sugar craving. Have you ever wondered what might be the optimal length and type of break?

Researchers at Baylor University asked themselves that question and discovered new insights into what constitutes a “better break.” In a study involving employees ages 22 to 67, researchers asked participants to document their breaks from work and analyzed their responses. Psych Central reports that study results suggest not all breaks are created equal, and that the type of breaks we take could potentially affect our health and job satisfaction.

Findings showed a mid-morning break can help boost your concentration, motivation and energy and that doing things you either choose or like to do during a break can help aid in recovery from stress or fatigue. According to the story:

People who take “better breaks” experience better health and increased job satisfaction.

The employee surveys showed that recovery of resources — energy, concentration, and motivation — following a “better break” (earlier in the day, doing things they preferred) led workers to experience less somatic symptoms, including headache, eyestrain, and lower back pain after the break.

These employees also experienced increased job satisfaction and organizational citizenship behavior as well as a decrease in emotional exhaustion (burnout), the study shows.

Longer breaks are good, but it’s beneficial to take frequent short breaks.

While the study was unable to pinpoint an exact length of time for a better workday break (15 minutes, 30 minutes, etc.), the research found that more short breaks were associated with higher resources, suggesting that employees should be encouraged to take more frequent short breaks to facilitate recovery.

Researchers believe breaks are an essential intervention to help a person stay sharp and energized.

“Unlike your cellphone, which popular wisdom tells us should be depleted to zero percent before you charge it fully to 100 percent, people instead need to charge more frequently throughout the day,” [said Emily Hunter, PhD, associate professor of management in Baylor University’s Hankamer School of Business.]

Previously: No time for a vacation? Take a break without leaving the officeHow Stanford and Silicon Valley companies are fostering “work-life integration”, Workplace stress and how it influences health and Stanford class teaches students how to live a happier, healthier life,
Photo by Daniil Kalinin

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

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