Friday, October 30, 2009

Bipolar Disorder 5


Hi Everyone, I hope your doing well. I am doing good. I have gotten a little behind on my blogging this week, but I am getting back on track. This week here in Boston there was an attack on a Doctor by her psychiatric patient. Well because it was someone with a mental illness it made big news. On my local news channel they had to call in a Doctor to discuss what Bipolar disorder is. Once again they don't get it. They talked about the disease but failed to mention that all murders are committed by only 5 percent of the mentally ill. Leaving the other 95 percent of murders committed by so called "normal people". I gets me so frustrated sometimes. So to end the Stigma I will fight on. Thanks for visiting my blog, Take Care, Janet :)

Bipolar disorder has no cure, but can be effectively treated over the long-term. It is best controlled when treatment is continuous, rather than on and off. In the STEP-BD study, a little more than half of the people treated for bipolar disorder recovered over one year's time. For this study, recovery meant having two or fewer symptoms of the disorder for at least eight weeks.

However, even with proper treatment, mood changes can occur. In the STEP-BD study, almost half of those who recovered still had lingering symptoms. These people experienced a relapse or recurrence that was usually a return to a depressive state.49 If a person had a mental illness in addition to bipolar disorder, he or she was more likely to experience a relapse.49 Scientists are unsure, however, how these other illnesses or lingering symptoms increase the chance of relapse. For some people, combining psychotherapy with medication may help to prevent or delay relapse.42

Treatment may be more effective when people work closely with a doctor and talk openly about their concerns and choices. Keeping track of mood changes and symptoms with a daily life chart can help a doctor assess a person's response to treatments. Sometimes the doctor needs to change a treatment plan to make sure symptoms are controlled most effectively. A psychiatrist should guide any changes in type or dose of medication.

Saturday, October 24, 2009

Life Lessons

Divine Light Pictures, Images and Photos

Hi Everyone, I hope you are doing well. I am doing good. I was introduced to this columnist Regina Brett through my friend Kim. You should take the time to visit Kim's blog, you will always be inspired. I liked this post so I thought I would share it with all of you. I think her words are so true, we simply need to remember to love life everyday. Hope you are having a good weekend. Thanks for visiting my blog, Take Care, Janet :)

To celebrate growing older, I once wrote the 45 lessons life taught me.

It is the most-requested column I've ever written. My odometer rolls over to 50 this week, so here's an update:

1. Life isn't fair, but it's still good.

2. When in doubt, just take the next small step.

3. Life is too short to waste time hating anyone.

4. Don't take yourself so seriously. No one else does.

5. Pay off your credit cards every month.

6. You don't have to win every argument. Agree to disagree.

7. Cry with someone. It's more healing than crying alone.

8. It's OK to get angry with God. He can take it.

9. Save for retirement starting with your first paycheck.

10. When it comes to chocolate, resistance is futile.

11. Make peace with your past so it won't screw up the present.

12. It's OK to let your children see you cry.

13. Don't compare your life to others'. You have no idea what their journey is all about.

14. If a relationship has to be a secret, you shouldn't be in it.

15. Everything can change in the blink of an eye. But don't worry; God never blinks.

16. Life is too short for long pity parties. Get busy living, or get busy dying.

17. You can get through anything if you stay put in today.

18. A writer writes. If you want to be a writer, write.

19. It's never too late to have a happy childhood. But the second one is up to you and no one else.

20. When it comes to going after what you love in life, don't take no for an answer.

21. Burn the candles, use the nice sheets, wear the fancy lingerie. Don't save it for a special occasion. Today is special.

22. Overprepare, then go with the flow.

23. Be eccentric now. Don't wait for old age to wear purple.

24. The most important sex organ is the brain.

25. No one is in charge of your happiness except you.

26. Frame every so-called disaster with these words: "In five years, will this matter?"

27. Always choose life.

28. Forgive everyone everything.

29. What other people think of you is none of your business.

30. Time heals almost everything. Give time time.

31. However good or bad a situation is, it will change.

32. Your job won't take care of you when you are sick. Your friends will. Stay in touch.

33. Believe in miracles.

34. God loves you because of who God is, not because of anything you did or didn't do.

35. Whatever doesn't kill you really does make you stronger.

36. Growing old beats the alternative - dying young.

37. Your children get only one childhood. Make it memorable.

38. Read the Psalms. They cover every human emotion.

39. Get outside every day. Miracles are waiting everywhere.

40. If we all threw our problems in a pile and saw everyone else's, we'd grab ours back.

41. Don't audit life. Show up and make the most of it now.

42. Get rid of anything that isn't useful, beautiful or joyful.

43. All that truly matters in the end is that you loved.

44. Envy is a waste of time. You already have all you need.

45. The best is yet to come.

46. No matter how you feel, get up, dress up and show up.

47. Take a deep breath. It calms the mind.

48. If you don't ask, you don't get.

49. Yield.

50. Life isn't tied with a bow, but it's still a gift.

Thursday, October 22, 2009

NAMI: National Alliance on Mental Illness Stigma Alerts Archive

Hi Everyone, I hope your doing well. I am doing good. I recieved this in an email today and wanted to share it with you. Hope you will help by taking a stand against stigma. Thanks for visiting my blog, Take Care, Janet :)

NAMI StigmaBuster Alert: October 22, 2009

Halloween Horrors
It's trick or treat time again. We don't mind ghosts and goblins, but when "haunted house" attractions become "insane asylums," featuring "mental patients" as murderous ghouls, we protest.

Violent stereotypes are inaccurate and offensive and the U.S. Surgeon General has determined that stigma is a major barrier to people getting help when they need it. Help send the message!

Local Attractions
Here's an example. NAMI New Jersey is fighting an "Asylum of Terror" sponsored by a local museum and supported by a local Walmart and Dunkin' Donuts, to name a few. Please e-mail the museum to let them know that perpetuating stigma towards persons with a mental illness is a national — as well as local — concern.

In Your Own Communities:
If offensive Halloween attractions or products appear, contact sponsors, advertisers or sellers personally. Educate them. Ask them to remove offensive parts of any attraction, advertisements or merchandise that mock mental illness.
If dialogue fails, alert NAMI members, family and friends to phone, send letters or e-mail the sponsors or stores.
Contact local newspaper editors and television news directors. Educate them about stigma and your concerns. Make the protest a "news event" and a "teaching moment." Offer consumers and family members for personal interviews.


Cell Block Psycho
StigmaBusters report that Walmart stores are selling a "Cell Block Psycho" adult costume that is also sold online by other companies. The site also offers "psycho" costumes that include straitjackets and shackles.

These are only the tip of iceberg, but let's educate those we can.

For Wal-Mart
Mike Duke, CEO
Wal-Mart Stores, Inc.
702 SW 8th Street
Bentonville, AR 72716-8611
(479) 273-4000

Send a message also through Customer Service ("Other Comments & Questions").

Jalem Getz, CEO
BuyCostumes, Inc.
5915 S. Moorland Rd.
New Berlin, WI 53151
(262) 901-2000
(262) 901-3100 (fax)

Complaints also can be sent through the company's Web site or its toll free service line: (800) 459-2969.


Thank you to all StigmaBusters who contacted New Monic Books after last month's alert about the inappropriate vocabulary example in an SAT preparation book.

The company listened and is removing the example from the next edition of the book, which will be published soon.

We thank them.


Out of the Inbox
Because of the large number of StigmaBuster messages received, they cannot all be answered individually; however, we appreciate every e-mail and do review every stigma report and prioritize them for action.

We also appreciate receiving copies of responses. They are important in helping to coordinate strategy and pursue genuine dialogue. You are our eyes and ears! Your help makes a difference!

Please send reports of stigma to Stella March.

NAMI StigmaBuster Alerts are electronic newsletters provided free of charge as a public service. NAMI is the largest grassroots mental health organization dedicated to improving the lives of individuals and families affected by mental illness.

National Alliance on Mental Illness
3803 N. Fairfax Dr. ~ Suite 100
Arlington, VA 22203
NAMI: National Alliance on Mental Illness | Stigma Alerts Archive

Wednesday, October 21, 2009

Glenn Close and her Sister Speaks Out on Mental Illness

Hi Everyone,
I am so excited to see a celebrity use their fame to help the Mentally Ill. A new day is dawning I feel to end the stigma. Please share your story at
Thanks for visiting my blog, Take Care, Janet :)

Saturday, October 17, 2009

Bipolar Disorder 4

Hi Everyone, I hope you are doing well, I am doing good. I have gotten away from my posts about Bipolar Disorder. So today I wanted to continue with treatments for the disorder. I am sure this is what my mother had because Lithium worked well for her. I hope this information helps anyone who needs it. Thanks for visiting my blog,Take Care, Janet :)

To date, there is no cure for bipolar disorder. But proper treatment helps most people with bipolar disorder gain better control of their mood swings and related symptoms. This is also true for people with the most severe forms of the illness.

Because bipolar disorder is a lifelong and recurrent illness, people with the disorder need long-term treatment to maintain control of bipolar symptoms. An effective maintenance treatment plan includes medication and psychotherapy for preventing relapse and reducing symptom severity.

Bipolar disorder can be diagnosed and medications prescribed by people with an M.D. (doctor of medicine). Usually, bipolar medications are prescribed by a psychiatrist. In some states, clinical psychologists, psychiatric nurse practitioners, and advanced psychiatric nurse specialists can also prescribe medications. Check with your state's licensing agency to find out more.

Not everyone responds to medications in the same way. Several different medications may need to be tried before the best course of treatment is found.

Keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events can help the doctor track and treat the illness most effectively. Sometimes this is called a daily life chart. If a person's symptoms change or if side effects become serious, the doctor may switch or add medications.

Some of the types of medications generally used to treat bipolar disorder are listed on the next page. Information on medications can change. For the most up to date information on use and side effects contact the U.S. Food and Drug Administration (FDA).
1. Mood stabilizing medications are usually the first choice to treat bipolar disorder. In general, people with bipolar disorder continue treatment with mood stabilizers for years. Except for lithium, many of these medications are anticonvulsants. Anticonvulsant medications are usually used to treat seizures, but they also help control moods. These medications are commonly used as mood stabilizers in bipolar disorder:
* Lithium (sometimes known as Eskalith or Lithobid) was the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) in the 1970s for treatment of mania. It is often very effective in controlling symptoms of mania and preventing the recurrence of manic and depressive episodes.
* Valproic acid or divalproex sodium (Depakote), approved by the FDA in 1995 for treating mania, is a popular alternative to lithium for bipolar disorder. It is generally as effective as lithium for treating bipolar disorder. Also see the section in this booklet, "Should young women take valproic acid?"
* More recently, the anticonvulsant lamotrigine (Lamictal) received FDA approval for maintenance treatment of bipolar disorder.
* Other anticonvulsant medications, including gabapentin (Neurontin), topiramate (Topamax), and oxcarbazepine (Trileptal) are sometimes prescribed. No large studies have shown that these medications are more effective than mood stabilizers.

Valproic acid, lamotrigine, and other anticonvulsant medications have an FDA warning. The warning states that their use may increase the risk of suicidal thoughts and behaviors. People taking anticonvulsant medications for bipolar or other illnesses should be closely monitored for new or worsening symptoms of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior. People taking these medications should not make any changes without talking to their health care professional.

Lithium and Thyroid Function
People with bipolar disorder often have thyroid gland problems. Lithium treatment may also cause low thyroid levels in some people. Low thyroid function, called hypothyroidism, has been associated with rapid cycling in some people with bipolar disorder, especially women. Because too much or too little thyroid hormone can lead to mood and energy changes, it is important to have a doctor check thyroid levels carefully. A person with bipolar disorder may need to take thyroid medication, in addition to medications for bipolar disorder, to keep thyroid levels balanced.

Should young women take valproic acid?
Valproic acid may increase levels of testosterone (a male hormone) in teenage girls and lead to polycystic ovary syndrome (PCOS) in women who begin taking the medication before age 20. PCOS causes a woman's eggs to develop into cysts, or fluid filled sacs that collect in the ovaries instead of being released by monthly periods. This condition can cause obesity, excess body hair, disruptions in the menstrual cycle, and other serious symptoms. Most of these symptoms will improve after stopping treatment with valproic acid. Young girls and women taking valproic acid should be monitored carefully by a doctor.
2. Atypical antipsychotic medications are sometimes used to treat symptoms of bipolar disorder. Often, these medications are taken with other medications. Atypical antipsychotic medications are called "atypical" to set them apart from earlier medications, which are called "conventional" or "first-generation" antipsychotics.
* Olanzapine (Zyprexa), when given with an antidepressant medication, may help relieve symptoms of severe mania or psychosis. Olanzapine is also available in an injectable form, which quickly treats agitation associated with a manic or mixed episode. Olanzapine can be used for maintenance treatment of bipolar disorder as well, even when a person does not have psychotic symptoms. However, some studies show that people taking olanzapine may gain weight and have other side effects that can increase their risk for diabetes and heart disease. These side effects are more likely in people taking olanzapine when compared with people prescribed other atypical antipsychotics.
* Aripiprazole (Abilify), like olanzapine, is approved for treatment of a manic or mixed episode. Aripiprazole is also used for maintenance treatment after a severe or sudden episode. As with olanzapine, aripiprazole also can be injected for urgent treatment of symptoms of manic or mixed episodes of bipolar disorder.
* Quetiapine (Seroquel) relieves the symptoms of severe and sudden manic episodes. In that way, quetiapine is like almost all antipsychotics. In 2006, it became the first atypical antipsychotic to also receive FDA approval for the treatment of bipolar depressive episodes.
* Risperidone (Risperdal) and ziprasidone (Geodon) are other atypical antipsychotics that may also be prescribed for controlling manic or mixed episodes.
3. Antidepressant medications are sometimes used to treat symptoms of depression in bipolar disorder. People with bipolar disorder who take antidepressants often take a mood stabilizer too. Doctors usually require this because taking only an antidepressant can increase a person's risk of switching to mania or hypomania, or of developing rapid cycling symptoms. To prevent this switch, doctors who prescribe antidepressants for treating bipolar disorder also usually require the person to take a mood-stabilizing medication at the same time.
Recently, a large-scale, NIMH-funded study showed that for many people, adding an antidepressant to a mood stabilizer is no more effective in treating the depression than using only a mood stabilizer.
* Fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and bupropion (Wellbutrin) are examples of antidepressants that may be prescribed to treat symptoms of bipolar depression.Some medications are better at treating one type of bipolar symptoms than another. For example, lamotrigine (Lamictal) seems to be helpful in controlling depressive symptoms of bipolar disorder.

What are the side effects of these medications?
Before starting a new medication, people with bipolar disorder should talk to their doctor about the possible risks and benefits. The psychiatrist prescribing the medication or pharmacist can also answer questions about side effects. Over the last decade, treatments have improved, and some medications now have fewer or more tolerable side effects than earlier treatments. However, everyone responds differently to medications. In some cases, side effects may not appear until a person has taken a medication for some time. If the person with bipolar disorder develops any severe side effects from a medication, he or she should talk to the doctor who prescribed it as soon as possible. The doctor may change the dose or prescribe a different medication. People being treated for bipolar disorder should not stop taking a medication without talking to a doctor first. Suddenly stopping a medication may lead to "rebound," or worsening of bipolar disorder symptoms. Other uncomfortable or potentially dangerous withdrawal effects are also possible.

FDA Warning on Antidepressants
Antidepressants are safe and popular, but some studies have suggested that they may have unintentional effects on some people, especially in adolescents and young adults. The FDA warning says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment. Possible side effects to look for are depression that gets worse, suicidal thinking or behavior, or any unusual changes in behavior such as trouble sleeping, agitation, or withdrawal from normal social situations. Families and caregivers should report any changes to the doctor. For the latest information visit the FDA website.
The following sections describe some common side effects of the different types of medications used to treat bipolar disorder.

1. Mood Stabilizers
In some cases, lithium can cause side effects such as:
* Restlessness
* Dry mouth
* Bloating or indigestion
* Acne
* Unusual discomfort to cold temperatures
* Joint or muscle pain
* Brittle nails or hair.
Lithium also causes side effects not listed here. If extremely bothersome or unusual side effects occur, tell your doctor as soon as possible. If a person with bipolar disorder is being treated with lithium, it is important to make regular visits to the treating doctor. The doctor needs to check the levels of lithium in the person's blood, as well as kidney and thyroid function. These medications may also be linked with rare but serious side effects. Talk with the treating doctor or a pharmacist to make sure you understand signs of serious side effects for the medications you're taking.
Common side effects of other mood stabilizing medications include:
* Drowsiness
* Dizziness
* Headache
* Diarrhea
* Constipation
* Heartburn
* Mood swings
* Stuffed or runny nose, or other cold-like symptoms.32-37

2. Atypical Antipsychotics
Some people have side effects when they start taking atypical antipsychotics. Most side effects go away after a few days and often can be managed successfully. People who are taking antipsychotics should not drive until they adjust to their new medication. Side effects of many antipsychotics include:
* Drowsiness
* Dizziness when changing positions
* Blurred vision
* Rapid heartbeat
* Sensitivity to the sun
* Skin rashes
* Menstrual problems for women.

Atypical antipsychotic medications can cause major weight gain and changes in a person's metabolism. This may increase a person's risk of getting diabetes and high cholesterol.38 A person's weight, glucose levels, and lipid levels should be monitored regularly by a doctor while taking these medications. In rare cases, long-term use of atypical antipsychotic drugs may lead to a condition called tardive dyskinesia (TD). The condition causes muscle movements that commonly occur around the mouth. A person with TD cannot control these moments. TD can range from mild to severe, and it cannot always be cured. Some people with TD recover partially or fully after they stop taking the drug.

3. Antidepressants
The antidepressants most commonly prescribed for treating symptoms of bipolar disorder can also cause mild side effects that usually do not last long. These can include:
* Headache, which usually goes away within a few days.
* Nausea (feeling sick to your stomach), which usually goes away within a few days.
* Sleep problems, such as sleeplessness or drowsiness. This may happen during the first few weeks but then go away. To help lessen these effects, sometimes the medication dose can be reduced, or the time of day it is taken can be changed.
* Agitation (feeling jittery).
* Sexual problems, which can affect both men and women. These include reduced sex drive and problems having and enjoying sex. Some antidepressants are more likely to cause certain side effects than other types. Your doctor or pharmacist can answer questions about these medications. Any unusual reactions or side effects should be reported to a doctor immediately.For the most up-to-date information on medications for treating bipolar disorder and their side effects, please see the online NIMH Medications booklet.
Should women who are pregnant or may become pregnant take medication for bipolar disorder?
Women with bipolar disorder who are pregnant or may become pregnant face special challenges. The mood stabilizing medications in use today can harm a developing fetus or nursing infant. But stopping medications, either suddenly or gradually, greatly increases the risk that bipolar symptoms will recur during pregnancy. Scientists are not sure yet, but lithium is likely the preferred mood-stabilizing medication for pregnant women with bipolar disorder. However, lithium can lead to heart problems in the fetus. Women need to know that most bipolar medications are passed on through breast milk. Pregnant women and nursing mothers should talk to their doctors about the benefits and risks of all available treatments.

In addition to medication, psychotherapy, or "talk" therapy, can be an effective treatment for bipolar disorder. It can provide support, education, and guidance to people with bipolar disorder and their families. Some psychotherapy treatments used to treat bipolar disorder include:
1. Cognitive behavioral therapy (CBT) helps people with bipolar disorder learn to change harmful or negative thought patterns and behaviors.
2. Family-focused therapy includes family members. It helps enhance family coping strategies, such as recognizing new episodes early and helping their loved one. This therapy also improves communication and problem-solving.
3. Interpersonal and social rhythm therapy helps people with bipolar disorder improve their relationships with others and manage their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.
4. Psychoeducation teaches people with bipolar disorder about the illness and its treatment. This treatment helps people recognize signs of relapse so they can seek treatment early, before a full-blown episode occurs. Usually done in a group, psychoeducation may also be helpful for family members and caregivers. A licensed psychologist, social worker, or counselor typically provides these therapies. This mental health professional often works with the psychiatrist to track progress. The number, frequency, and type of sessions should be based on the treatment needs of each person. As with medication, following the doctor's instructions for any psychotherapy will provide the greatest benefit.For more information, see the Substance Abuse and Mental Health Services Administration web page on choosing a mental health therapist. Recently, NIMH funded a clinical trial called the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). This was the largest treatment study ever conducted for bipolar disorder. In a study on psychotherapies, STEP-BD researchers compared people in two groups. The first group was treated with collaborative care (three sessions of psychoeducation over six weeks). The second group was treated with medication and intensive psychotherapy (30 sessions over nine months of CBT, interpersonal and social rhythm therapy, or family-focused therapy). Researchers found that the second group had fewer relapses, lower hospitalization rates, and were better able to stick with their treatment plans. They were also more likely to get well faster and stay well longer.

NIMH is supporting more research on which combinations of psychotherapy and medication work best. The goal is to help people with bipolar disorder live symptom-free for longer periods and to recover from episodes more quickly. Researchers also hope to determine whether psychotherapy helps delay the start of bipolar disorder in children at high risk for the illness.

Visit the NIMH Web site for more information on psychotherapy.
Other treatments
1. Electroconvulsive Therapy (ECT)—For cases in which medication and/or psychotherapy does not work, electroconvulsive therapy (ECT) may be useful. ECT, formerly known as "shock therapy," once had a bad reputation. But in recent years, it has greatly improved and can provide relief for people with severe bipolar disorder who have not been able to feel better with other treatments.
Before ECT is administered, a patient takes a muscle relaxant and is put under brief anesthesia. He or she does not consciously feel the electrical impulse administered in ECT. On average, ECT treatments last from 30–90 seconds. People who have ECT usually recover after 5–15 minutes and are able to go home the same day.
Sometimes ECT is used for bipolar symptoms when other medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severely depressive, manic, or mixed episodes, but is generally not a first-line treatment.
ECT may cause some short-term side effects, including confusion, disorientation, and memory loss. But these side effects typically clear soon after treatment. People with bipolar disorder should discuss possible benefits and risks of ECT with an experienced doctor.
2. Sleep Medications—People with bipolar disorder who have trouble sleeping usually sleep better after getting treatment for bipolar disorder. However, if sleeplessness does not improve, the doctor may suggest a change in medications. If the problems still continue, the doctor may prescribe sedatives or other sleep medications. People with bipolar disorder should tell their doctor about all prescription drugs, over-the-counter medications, or supplements they are taking. Certain medications and supplements taken together may cause unwanted or dangerous effects.

Herbal Supplements
In general, there is not much research about herbal or natural supplements. Little is known about their effects on bipolar disorder. An herb called St. John's wort (Hypericum perforatum), often marketed as a natural antidepressant, may cause a switch to mania in some people with bipolar disorder. St. John's wort can also make other medications less effective, including some antidepressant and anticonvulsant medications. Scientists are also researching omega-3 fatty acids (most commonly found in fish oil) to measure their usefulness for long-term treatment of bipolar disorder. Study results have been mixed.48 It is important to talk with a doctor before taking any herbal or natural supplements because of the serious risk of interactions with other medications.

This page last reviewed: September 17, 2009

Wednesday, October 14, 2009

Brain Emotion Circuit Sparks as Teen Girls Size Up Peers

Hi Everyone,
I hope you are all doing well. I am doing good. I thought this information might be helpful if any of you have a teenage daughter. I remember being in the 7th grade and feeling not part of a group of friends, that may have added my anxiety disorder. Thank God for modern medicine, that is all I can say! Thanks for visiting my blog, Take Care, Janet :)


What is going on in teenagers' brains as their drive for peer approval begins to eclipse their family affiliations? Brain scans of teens sizing each other up reveal an emotion circuit activating more in girls as they grow older, but not in boys. The study by Daniel Pine, M.D., of the National Institute of Mental Health (NIMH), part of National Institutes of Health, and colleagues, shows how emotion circuitry diverges in the male and female brain during a developmental stage in which girls are at increased risk for developing mood and anxiety disorders.

"During this time of heightened sensitivity to interpersonal stress and peers' perceptions, girls are becoming increasingly preoccupied with how individual peers view them, while boys tend to become more focused on their status within group pecking orders," explained Pine. "However, in the study, the prospect of interacting with peers activated brain circuitry involved in approaching others, rather than circuitry responsible for withdrawal and fear, which is associated with anxiety and depression."

Pine, Amanda Guyer, Ph.D., Eric Nelson, Ph.D., and colleagues at NIMH and Georgia State University, report on one of the first studies to reveal the workings of the teen brain in a simulated real-world social interaction, in the July, 2009 issue of the Journal Child Development.

Thirty-four psychiatrically healthy males and females, aged 9 to 17, were ostensibly participating in a study of teenagers' communications via Internet chat rooms. They were told that after an fMRI (functional magnetic resonance imaging) scan, which visualizes brain activity, they would chat online with another teen from a collaborating study site. Each participant was asked to rate his or her interest in communicating with each of 40 teens presented on a computer screen, so they could be matched with a high interest participant (see picture below).

Two weeks later, the teens viewed the same faces while in an fMRI scanner. But this time they were asked to instead rate how interested they surmised each of the other prospective chatters would be in interacting with them.

Only after they exited the scanner did they learn that, in fact, the faces were of actors, not study participants, and that there would be no Internet chat. The scenario was intended to keep the teens engaged –– maintain a high level of anticipation/motivation –– during the tasks. This helped to ensure that the scanner would detect contrasts in brain circuit responses to high interest versus low interest peers.

Although the faces were selected by the researchers for their happy expressions, their attractiveness was random, so that they appeared to be a mix of typical peers encountered by teens.

As expected, the teen participants deemed the same faces they initially chose as high interest to be the peers most interested in interacting with them. Older participants tended to choose more faces of the opposite sex than younger ones. When they appraised anticipated interest from peers of high interest compared with low interest, older females showed more brain activity than younger females in circuitry that processes social emotion.

"This developmental shift suggested a change in socio-emotional calculus from avoidance to approach," noted Pine. The circuit is made up of the nucleus accumbens (reward and motivation), hypothalamus (hormonal activation), hippocampus (social memory) and insula (visceral/subjective feelings).

By contrast, males showed little change in the activity of most of these circuit areas with age, except for a decrease in activation of the insula. This may reflect a waning of interpersonal emotional ties over time in teenage males, as they shift their interest to groups, suggest Pine and colleagues.

"In females, absence of activation in areas associated with mood and anxiety disorders, such as the amygdala, suggests that emotional responses to peers may be driven more by a brain network related to approach than to one related to fear and withdrawal," said Pine. "This reflects resilience to psychosocial stress among healthy female adolescents during this vulnerable period."

Brain areas activated in approach circuit

Nodes of a brain circuit for social emotion and approach behavior activated more in teenage girls than in boys with age. Functional MRI data (red) superimposed on anatomical MRI images.

Source: NIMH Emotion and Development Branch
teens rated interest in peers.
Teenage participants were first asked to rate their interest in peers with whom they might communicate in an internet chat room (left). Two weeks later, while in a brain scanner, they were asked to rate how interested the same peers were in interacting with them (right).

Source: NIMH Emotion and Development Branch
Probing the neural correlates of anticipated peer evaluation in adolescence. Guyer AE, McClure-Tone EB, Shiffrin ND, Pine DS, Nelson EE. July 2009, Child Development.

Saturday, October 10, 2009

PTSD Treatment Efforts for Returning War Veterans

the eye Pictures, Images and Photos

Hi Everyone,
I hope you are doing well. I am doing good. I was happy to read this update to help our veterans. They need all the support they can get when they return. If you know a veteran who needs help they may be able to get this therapy at a local mental health facility. Thanks for visiting my blog, Take Care, Janet :)

Science Update
September 30, 2009

PTSD Treatment Efforts for Returning War Veterans to be Evaluated
man and woman in individual therapy

Joan Cook, Ph.D., of Yale University and colleagues have been awarded funds from the American Recovery and Reinvestment Act of 2009 to evaluate the implementation of two evidence-based psychotherapies for treating post traumatic stress disorder (PTSD) among veterans. The grant addresses the NIH Challenge Grant topic "Strategies to Support Uptake of Interventions within Clinical Community and Settings."

Strategies for promoting evidence-based PTSD treatments in the military are urgently needed as more and more soldiers returning from Iraq and Afghanistan struggle with this disorder. The research team will characterize and assess the implementation of two types of therapy—prolonged exposure (PE) therapy and cognitive processing therapy (CPT)—within the U.S. Department of Veterans Affairs (VA) residential PTSD treatment programs. PE involves helping people confront their fear and feelings about the trauma they experienced in a safe way through mental imagery, writing, or other ways. In CPT, the patient is asked to recount his or her traumatic experience, and a therapist helps the patient redirect inaccurate or destructive thoughts about the experience.

Dr. Cook and colleagues will partner with the Northeast Program Evaluation Center, which monitors all VA mental health programming and patient outcomes, and the National Center for PTSD, which oversees the dissemination of PE and CPT nationally among VA providers. They plan to monitor and assess the efforts of more than 250 mental health providers in residential PTSD treatment settings via online questionnaires, semi-structured interviews, and on-site observations.

The researchers note that the project may help improve the dissemination of other evidence-based treatments in federally-funded mental health systems.

The NIH Challenge Grants in Health and Science Research program is a new initiative funded through the American Recovery and Reinvestment Act of 2009 (Recovery Act). This program will support research on 15 broad Challenge Areas that address specific scientific and health research challenges in biomedical and behavioral research that would benefit from an influx of significant two-year funds to quickly advance the area.

Within these Challenge Areas, NIMH has identified 35 topics of particular funding interest that will advance the Institute's mission and the objectives outlined in the NIMH Strategic Plan, the Trans-NIH Plan for HIV-Related Research, and the National Advisory Mental Health Council report on research training. These topics can be found at NIMH's Challenge Grant web page.

Monday, October 5, 2009

New Approach to Reducing Suicide Attempts Among Depressed Teens


Science Update
September 29, 2009

Hi Everyone, I hope you are doing well. I am doing great. Our week in Aruba was beautiful. I felt this update was important to post about. I remember during my teen years I did lose a few friends to suicide. At the time I was still naive about mental illness even though I was living with it. As a grew I realized my friends were suffering from a mental illness as well. I felt sad that there was no recognition of this disorder in teenager back then. Today I am glad to see that more and more teenagers are getting treatment but I am glad that they are still working in ways to prevent the attempts in the first place. Thanks for visiting my blog, Take Care, Janet :)

A novel treatment approach that includes medication plus a newly developed type of psychotherapy that targets suicidal thinking and behavior shows promise in treating depressed adolescents who had recently attempted suicide, according to a treatment development and pilot study funded by the National Institute of Mental Health (NIMH). The study, described in three articles, was published in the October 2009 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Youth who attempt suicide are particularly difficult to treat because they often leave treatment prematurely, and no specific interventions exist that reliably reduce suicidal thinking and behavior (suicidality). In addition, these teens often are excluded from clinical trials testing depression treatments. The Treatment of Adolescent Suicide Attempters Study (TASA) was developed to address this need and identify factors that may predict and mediate suicide reattempts among this vulnerable population. A novel psychotherapy used in the study—cognitive behavioral therapy for suicide prevention (CBT-SP—was developed to address the need for a specific psychotherapy that would prevent or reduce the risk for suicide reattempts among teens. CBT-SP consisted of a 12-week acute treatment phase focusing on safety planning, understanding the circumstances and vulnerabilities that lead to suicidal behavior, and building life skills to prevent a reattempt. A maintenance continuation phase followed the acute phase.

In the six-month, multisite pilot study, 124 adolescents who had recently attempted suicide were either randomized to or given the option of choosing one of three interventions—antidepressant medication only, CBT-SP only, or a combination of the two. Most participants preferred to choose their intervention, and most (93) chose combination therapy. Participants were assessed for suicidality at weeks six, 12, 18 and 24.

Results of the Study
During the six-month treatment, 24 participants experienced a new suicidal event, defined as new onset or worsening of suicidal thinking or a suicide attempt. This rate of recurrence is lower than what previous studies among suicidal patients have found, suggesting that this treatment approach may be a promising intervention. In addition, more than 70 percent of these teens—a population that is typically difficult to keep in treatment—completed the acute phase of the therapy. However, many participants discontinued the treatment during the continuation phase, suggesting that treatment may need to include more frequent sessions during the acute phase, and limited sessions during the continuation phase.

The study revealed some characteristics that could predict recurrent suicidality, including high levels of self-reported suicidal thinking and depression, a history of abuse, two or more previous suicide attempts, and a strong sense of hopelessness. In addition, a high degree of family conflict predicted suicidality, while family support and cohesion acted as a protective factor against suicide reattempts. Other studies have found similar results, according to the researchers.

Although the study cannot address effectiveness of the treatment because it was not randomized, it sheds light on characteristics that identify who is most at risk for suicide reattempts, and what circumstances may help protect teens from attempting suicide again. In addition, the study found that 10 of the 24 suicide events occurred within four weeks of the beginning of the study—before they could receive adequate treatment. This suggests that a "front-loaded" intervention in which the most intense treatment is given early on, would likely reduce the risk of suicide reattempt even more.

What's Next
The effectiveness of CBT-SP—alone or in conjunction with antidepressant medication—will need to be tested in randomized clinical trials. In the meantime, because many suicide events occurred shortly after the beginning of the trial, the researchers suggest that clinicians emphasize safety planning and provide more intense therapy in the beginning of treatment. In addition, they note that therapy should focus on helping teens develop a tolerance for distress; work to improve the teen's home, school and social environment; and rigorously pursue coping strategies for teens who experienced childhood trauma such as abuse.

Vitiello B, Brent D, Greenhill L, Emslie G, Wells K, Walkup J, et al.. Depressive symptoms and clinical status during the treatment of adolescent suicide attempters. Journal of the American Academy of Child and Adolescent Psychiatry 2009;48(10):997-1004.

Brent D, Greenhill L, Compton S,Emslie G, Wells K, Walkup J, et al. The treatment of adolescent suicide attempters (TASA): predictors of suicidal events in an open treatment trial. Journal of the American Academy of Child and Adolescent Psychiatry. 2009;48(10):987-996.

Stanley B, Brown G, Brent D, Wells K, Poling K, Curry J, et al. Cognitive behavior therapy for suicide prevention (CBT-SP): treatment model, feasibility and acceptability. Journal of the American Academy of Child and Adolescent Psychiatry. 2009;48(10):1005-1013.