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Medical Education, Medical Schools, Mental Health, SMS Unplugged

Free from school

Free from school

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category

Editor’s note: After today, SMS Unplugged will be on a limited publishing schedule until September.

girls running

Summer. It beckons with strawberry warm rays of sunlight, afternoons spent splashing in a pool, and the joys of watermelon-flavored popsicles. We, second-year medical students around the country, look out our windows and see children, newly freed from school, frolicking in the playground next door – and feel miserable. For this is the time when we are experiencing the worst of medical school.

We have completed the pre-clinical curriculum, some of us barely crawling across the finish line. We have spent weeks cramming for the USMLE, an exam described in no softer terms than “the most important exam you will take in your life.” And we are becoming familiar with a new kind of anxiety as we prepare to enter clinics for the first time. Or, rather, my classmates are – I chose to take time off between second and third year.

In the midst of Stanford-high expectations for our professional performance, we are seldom taught exactly how to take care of ourselves. I knew that I needed to change something halfway through second year when I found myself outlining a novel instead of studying during finals week. I nearly failed two exams. But I was happy.

I felt satisfied.

And so, I set about finding a way to incorporate more of writing into my medical school experience. Stanford has funding called Medical Scholars, which is set aside for every medical student to take a year off to work on a significant project or research experience. Their office willingly helped me apply for and receive this funding to work on my novel full-time for a year. I can’t imagine this level of support for an artistic endeavor from any other medical school. And so very soon, I too will be frolicking in the grass, newly freed from school.

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Autism, Mental Health, Neuroscience, Research, Science, Stanford News, Stem Cells

Brain cell spheres in a lab dish mimic human cortex, Stanford study says

Brain cell spheres in a lab dish mimic human cortex, Stanford study says

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Mental disorders like autism and schizophrenia are notoriously difficult to study at the molecular level. Understandably, people are reluctant to donate pieces of living brain for study, and postmortem tissue lets researchers see the structure, but not the function, of the cells.

Now researchers in the laboratories of psychiatrist Sergiu Pasca, MD, and neurobiologist Ben Barres, MD, PhD, have found a way to make balls of cells that mimic the activity of the human cortex. They use a person’s skin cells, so the resulting “human cortical spheroid” has the same genetic composition as the donor. The research was published in Nature Methods yesterday.

According to our release:

Previous attempts to create patient-specific neural tissue for study have either generated two-dimensional colonies of immature neurons that do not create functional synapses, or required an external matrix on which to grow the cells in a series of laborious and technically difficult steps.

In contrast, the researchers found they were able to easily make hundreds of what they’ve termed “human cortical spheroids” using a single human skin sample. These spheroids grow to be as large as 5 millimeters in diameter and can be maintained in the laboratory for nine months or more. They exhibit complex neural network activity and can be studied with techniques well-honed in animal models.

The researchers, which include neonatology fellow Anca Pasca, MD, and graduate student Steven Sloan, hope to use the technique to help understand how the human brain develops, and what sometimes goes wrong. As described by Barres:

The power and promise of this new method is extraordinary. For instance, for developmental brain disorders, one could take skin cells from any patient and literally replay the development of their brain in a culture dish to figure out exactly what step of development went awry — and how it might be corrected.

The research is starting to garner attention, including this nice article from Wired yesterday. Pasca’s eager to note, however, that he’s not working to create entire brains, which would be ethically and technically challenging, to say the least. But simply generating even a few of the cell types in the cortex will give researchers a much larger canvas with which to study some devastating conditions. As Pasca notes in our release:

I am a physician by training. We are often very limited in the therapeutic options we can offer patients with mental disorders. The ability to investigate in a dish neuronal and glial function, as well as network activity, starting from patient’s own cells, has the potential to bring novel insights into psychiatric disorders and their treatment.

Previously: More than just glue, glial cells challenge neuron’s top slot and Star-shaped cells nab new starring role in sculpting brain circuits
Photo of spheroid cross-section by Anca Pasca

Events, Mental Health, Sexual Health, Stanford News, Women's Health

Women’s health experts tackle mood disorders and sexual assault

Women's health experts tackle mood disorders and sexual assault

3131235412_fa7f528735_zEarlier this week I reported from the Women’s Health Forum, held on Monday for the sixth year running. The hardest part about attending the event was deciding which among all the interesting talks to attend.

Among the many sessions, the two that most piqued my interest focused on women’s mental health. Katherine (Ellie) Williams, MD, spoke about mood disorders related to the menstrual cycle, and Laraine Zappert, PhD, discussed the psychological impact of sexual assault. Both are from the school’s Department of Psychiatry and Behavioral Sciences.

Williams’ talk began with a cartoon of a dishwasher bursting with dishes, clothes, a phone, a vacuum – above a caption quip about PMS. The out-of-control energy of the sketch conveys the affective thundercloud often associated with women and their “hormones.” Williams identified three periods when this thundercloud may be an actual mood disorder, as opposed to “normal” fluctuations: pre-menstrual, perinatal, and perimenopausal.

Technically speaking, “PMS” is about physical symptoms and is fairly common, whereas pre-menstrual dysphoric disorders (PMDDs) is all about mood and affects less than 5 percent of women. The disruption happens in the luteal phase of a woman’s cycle, usually the two weeks after ovulation – this is a big chunk of time we’re talking about, nearly 50 percent! Treatments for disorders in all periods include exercise, acupuncture, and diet supplements, and pharmaceuticals like certain birth control pills and antidepressants (which interestingly work differently for women with PMDD than for people in general – when taken only during that luteal phase, they have fast onset time and cause no withdrawal symptoms).

Researchers are learning more about how to predict and prevent cycle-related mood disorders, and increasingly it is clear that life context plays a major role. Stressful life events, interpersonal conflicts, marital tension, and previous mental-health instabilities (from being a perfectionist to having suffered childhood abuse or major depressive breakdowns) are the primary risk factors. This knowledge means clinical practitioners have to think much more broadly about how to help women, particularly in terms of prevention, Williams said.

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Behavioral Science, In the News, Mental Health, Neuroscience, Research, Science

Inside the brain of optogenetics pioneer Karl Deisseroth

Inside the brain of optogenetics pioneer Karl Deisseroth

brain-494152_1280Lighting the brain,” a recent New Yorker profile, offers insight into the brain of Karl Deisseroth, MD, PhD, the well-known innovator of both optogenetics and CLARITY. (Optogenetics is a genetic engineering feat that allows researchers to control neurons in living animals using light. CLARITY is a technique that makes individual neural connections visible.)

Deisseroth, readers of the article learn, is a guy who shows up to his leading scientific laboratory wearing jeans and a t-shirt and who doesn’t let a little fender bender tweak his mood.

Yes, he’s brilliant. His ability to instantly memorize information morphed into a “circus act” of sorts when he was in elementary school. He began medical school at age 20. But, he’s also driven and hard working. When optogenetics encountered early resistance and doubt after its initial publication in 2005, Deisseroth “began working furiously,” the article states. Into work before 6 a.m., Deisseroth slaved over his brainchild often until 1 a.m., his wife, Michelle Monje, MD, PhD, reported.

It took a few more papers — and demonstrations of the applicability of optogenetics to examine real diseases — for the scientific community to catch on. But then, like a contagion of scientific glee, optogenetics rocked the neuroscience community.

Monje realized its popularity at a recent scientific conference:

“People were stopping us at the airport asking to take a picture with him, asking for autographs,” she said. “He can’t walk through the conference hall—there’s a mob. It’s like Beatlemania. I realized, I’m married to a Beatle. The nerdy Beatle.”

For more on the “nerdy Beatle,” and the science behind both optogenetics and CLARITY, check out the article for yourself. It’s well worth your brain power.

Previously: Stanford’s Karl Deisseroth awarded prestigious Albany Prize, Lightning strikes twice: Optogenetics pioneer Karl Deisseroth’s newest technique renders tissues transparent, yet structurally intact and New York Times profiles Stanford’s Karl Deisseroth and his work in optogenetics
Image by Tumisu

AHCJ15, Applied Biotechnology, Imaging, Mental Health, Neuroscience, Technology

Talking about “mouseheimers,” and a call for new neuroscience technologies

Talking about "mouseheimers," and a call for new neuroscience technologies

3723710203_1b8c9d96ed_zOur ability to technologically assess the brain has room for improvement, according to panelists at the recent Association of Health Care Journalism 2015 conference. Amit Etkin, PhD, MD, a neuropsychiatrist at Stanford, summed it up when he said, “We need to develop tools to answer questions we want to ask, rather than ask questions we can answer with the tools we have.”

Etkin asserted that there have been no fundamental advances in psychiatry since 1987; all the medications put out now are basically the same, and the treatments work partially, sometimes, and for only some people. Interdisciplinary work combining psychiatry, neuroscience, and radiology is the frontier: Researchers are just getting a sense of how “interventional neuroscience,” such as that pioneered at the interdisciplinary NeuroCircuit initiative at the Stanford Neurosciences Institute, can identify which brain regions control various processes. This involves looking at brain signatures that are common across disorders, instead of dividing and parsing symptoms, which is the approach of the Diagnostic and Statistical Manual of Mental Disorders.

Researchers are searching for an ideal marker for Alzheimer’s: something predictive (will you get the disease?), diagnostic (do you have the disease?), and dynamic (how severe is your disease right now?)

Michael Greicius, MD, MPH, professor of neurology and neurological sciences at Stanford, researches Alzheimer’s and has a bone to pick with media hype about Alzheimer’s research conducted in mice. What the mice have shouldn’t be considered the same condition, he says, so he’s termed it “mouseheimer’s.” Only 2 percent of the Alzheimer’s population has the dominant, inherited, exceedingly potent genetic form, which is the form used in research on rodents. Further, the mice are double or even triple transgenic. We still use these improbable biological hosts because we need an artificial model: Alzheimer’s is really just a human thing, and even great apes don’t get it. The next best modeling possibility, he suggested, are flies.

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Behavioral Science, Events, Mental Health, Stanford News

From suffering to compassion: Meditation teacher-author Sharon Salzberg shares her story

From suffering to compassion: Meditation teacher-author Sharon Salzberg shares her story

20150416-CCARE-Sharon Salzberg-0434Mediatation master and author Sharon Salzberg showed her recent Stanford audience that she could field even the toughest questions about the nature of compassion.

“What about the beheadings in the Middle East?” one audience member called out. Is it really possible to feel compassion for the perpetrators?

“It’s not easy,” Salzberg admitted. “But I also think it’s possible and important… Hatred will never cease with hatred.”

For models and proof it can be done, there are examples of great leaders who have suffered deeply such as Aung San Suu Kyi, Nelson Mandela, Desmond Tutu and the Dalai Lama, Salzberg and James Doty, MD, pointed out.

Salzberg joined Doty, the director of the Stanford Center for Compassion and Altruism Research and Education, at a Conversation on Compassion last week on campus.

She had a tough start in life; her parents separated when she was 4 years old and her mother died soon after. Yet it was through suffering that she gained the motivation, and experience, to pursue the study of meditation, she said.

After taking an Asian philosophy course — on a whim — at the State University of New York at Buffalo, Salzberg traveled to India in 1970 to experience Buddhism firsthand. “The course completely changed my life,” she told the audience. She said she was attracted by the Buddha’s acknowledgment of the existence of suffering.

“Like many people, mine was a family system where this was never spoken about,” Salzberg said. “Buddha’s saying right out loud, ‘Suffering is a part of life,’ you don’t have to feel isolated or abhorrent.”

Salzberg went on to co-found one of the first meditation centers in the United States, the Insight Meditation Society in Massachusetts.

Her conversation at Stanford was informal: Doty confessed he had spilled coffee on the business shirt he planned to wear, and the pair fielded questions from the audience throughout the talk.

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Behavioral Science, Mental Health, Research

Type of verbal therapy could reduce PTSD risk among trauma victims

Type of verbal therapy could reduce PTSD risk among trauma victims

217849066_f011b26437_zTurning on the bedroom light can knock the teeth out of all kinds of terrors. This same concept – seeing things as they are, not as we fear them to be – also forms the basis for many therapies used to treat the estimated 5.2 million people living in the U.S. with post-traumatic stress disorder (PTSD). Now, research shows that treating a victim of trauma with a certain type of therapy within six hours of the event – when most memories are formed – can reduce his or her risk of developing PTSD.

In the study, researchers from King’s College London and the University of Oxford investigated the effect of two treatments: “updating” therapy, where the patient talks about traumatic memories to update them with more factual information, and “exposure” therapy where the patient revisits the source of fear to decrease its emotional effect. These two techniques were applied to 115 participants after they watched six film clips containing real-life footage of humans and animals in distress.

The researchers found giving the participants “information about the fate of the films’ protagonists” (i.e., using the updating technique) significantly reduced the occurrence of fearful feelings, and it reduced these intrusive thoughts better than the exposure treatment and no treatment at all.

As psychologist and lead author Victoria Pile, PhD, explains in a press release, this study is important because there are currently no established therapies to help victims of trauma fend off PTSD. And, she said, “this research implies that finding out what actually happened as soon as possible after the trauma might change the way the memory is stored and so limit the devastating effects of PTSD.”

The researchers note that these findings could be especially helpful for people who are routinely exposed to traumatic situations, such as emergency service workers, military personnel and people working in conflict zones.

Previously: Study shows benefits of breathing meditation among veterans with PTSDExamining the scientific evidence behind experimental treatments for PTSDUsing mindfulness therapies to treat veterans’ PTSD and In animal study, sleep deprivation after traumatic events lowers risk of PTSD symptoms
Image by Capture Queen

In the News, Mental Health, Research, Sleep

The importance of screening soldiers for sleep problems to combat mental-health conditions

The importance of screening soldiers for sleep problems to combat mental-health conditions

Watching over

A new report from the RAND Corporation suggests that treating military members’ sleep disturbances early on may be an important step in preventing serious mental-health conditions, including post-traumatic stress disorder, depression, and traumatic brain injury.

The two-year multi-method study examined sleep-related policies and programs across the U.S. Department of Defense and surveyed almost 2,000 veterans from various branches of the military to evaluate their sleep habits. The findings emphasized the negative effects of poor sleep on soldiers’ mental health, daytime impairment and perceived operational readiness; and it outlined interventions for helping identify and prevent sleep problems for service members.

The Huffington Post reports:

The researchers recommended that the military improve screening for sleep disturbance, and develop guidelines for doctors on how to identify and treat sleep disorders in the military. Apps on mobile phones might be one new way to identify and monitor sleep problems so they do not become chronic and debilitating, the researchers said.

Although the new report focused on activity-duty troops, studies show that sleep problems are often missed in veterans as well, [Wendy Troxel, PhD, co-author of the report] said, so there is also a need to develop guidelines for treating this population. In a previous survey of 3,000 veterans, 74 percent had symptoms of insomnia, but only 28 percent had talked with their doctor about it, Troxel said.

The researchers also recommended improving policies and programs to educate military personnel about the importance of sleep, and provide guidance on how to help military members get better sleep.

Previously: Study shows benefits of breathing meditation among veterans with PTSD, The promise of yoga-based treatments to help veterans with PTSD and Using mindfulness therapies to treat veterans’ PTSD
Photo by DVIDSHUB

Behavioral Science, Complementary Medicine, Mental Health, Stanford News

Stanford law professor uses behavioral psychology to promote stress reduction in students

Stanford law professor uses behavioral psychology to promote stress reduction in students

6145155310_258dc36f9e_zGoing back to school inspired Stanford law professor Joseph Bankman, JD, with more than new perspectives on his legal work. Through his experience in the Palo Alto University/Stanford School of Medicine joint PsyD (doctor of psychology) program, Bankman thought of a way to connect what he was learning about behavioral psychology with what he sees everyday in his students. He started a program that offers first-year law students an emotional health seminar using cognitive behavioral therapy (CBT) to help them positively respond to situations that induce stress and anxiety.

Stanford News has the story, in which Bankman is quoted:

I have all these brilliant students whom I can help by giving them some useful knowledge and improving their analytical skills. But, as I came to realize over the years, if they crash and burn it will not be because they lack these necessary skills.  It will be because they lack emotional resilience to cope with the stresses and challenges of a demanding professional career.  Like millions of others, they need help with anxiety and, for some, depression.

The two-hour course includes an introduction to the principles of CBT and some simple exercises, and it has been offered on a voluntary basis for the past two years. Student response has been overwhelmingly positive: in one course, 100 percent said it should be offered again, and many reported that the benefits extended past school and into their personal lives.

In the news report, Bankman says he is observing a new focus on the emotional well-being of students in both research and  institutions, and he hopes the trend will continue.

Previously: A conversation with Scott Stossel, author of My Age of Anxiety, Benefits of mindfulness program for med students, Reframing reactions could reduce symptoms of social anxiety disorder, Stanford study shows and A closer look at depression and distress among medical students
Photo by Tulane Public Relations

Mental Health, Neuroscience, Rural Health

Seven ways laughter can improve your well-being

Seven ways laughter can improve your well-being

3336353424_df38db0c8a_zEveryone enjoys a good laugh, but who actually makes time for it in their lives? Sure, we like hearing a funny joke, talking to people with a good sense of humor and watching comedies. But few of us take our laughs seriously (no pun intended!) nor do we make a concerted effort to laugh more. But we should! The science of laughter – though still preliminary – suggests that it has tremendous benefits for our health and psychological well-being.

Laughter can improve your relationships. According to a recent study led by research assistant Alan Gray of University College London, the act of laughing can make you more open to new people and can help you build relationships.

Laughter may also boost memory and lower stress. A study by researchers at Loma Linda University found that laughter can sharpen your ability to remember things while also reducing the stress hormone, cortisol, especially in older people.

Laughter may make you more resilient. Ever had nervous laughter in an awkward or difficult situation? That’s because laughter may help you regulate your emotions in the face of challenge, according to a study led by Yale psychologist Erica J. Boothby, PhD.

Laughter can improve your health. A study of diabetic patients by Lee S. Berk, PhD, and Stanley A. Tan, MD, of Loma Linda University found that laughing can lower stress and inflammation and increase good cholesterol. Ever found yourself laughing while telling a joke or funny story? Maybe you were anticipating the ending and laughed your way through the end of the joke? Another study by Berk and Tan suggests that just anticipating a funny event boosted immune function while decreasing stress-related hormones.

Laughter can make you a better learner. When we are trying to learn something new, we usually are pretty serious, but research by Mark Shatz, PhD, and Frank LoSchiavo, PhD, of Ohio University show that a good laugh while learning new material will help you engage with it more!

Laughter can make you more attractive.  Another recent study by Shatz and LoSchiavo shows that humor and playfulness are highly valued traits in potential romantic partners.

Laughter can help you make the world a better place. Why? It’s contagious. At least on the level of the brain, according to research by Sophie Scott, PhD, of University College London.

Emma Seppala, PhD, is associate director of Stanford’s Center for Compassion and Altruism Research and Education and a research psychologist at the School of Medicine. She is also a certified yoga, pilates, breath work and meditation instructor. A version of this piece originally appeared on Psychology Today.
Photo by Arnet Gill

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