The Mental Health Social Worker

Only about half of American children and teenagers who have certain mental disorders receive professional services, according to a nationally representative survey funded in part by the National Institute of Mental Health (NIMH). The survey also provides a comprehensive look at the prevalence of common mental disorders.

The results are part of the National Health and Nutrition Examination Survey (NHANES), a collaboration between NIMH and the National Center for Health Statistics of the Centers for Disease Control and Prevention. The survey conducted from 2001 to 2004 had 3,042 participants. These most recent results include data from children and adolescents ages 8 to 15, and were published online ahead of print December 14, 2009, in the journal Pediatrics.

“Data on the prevalence of mental disorders among U.S. youth have been varied, making it difficult to truly understand how many children and teens are affected,” said NIMH Director Thomas R. Insel, M.D. “These data from the NHANES survey can serve as an important baseline as we follow trends of mental disorders in children.”

In the study, the young people were interviewed directly. Parents or caregivers also provided information about their children’s mental health. The researchers tracked six mental disorders—generalized anxiety disorder (GAD), panic disorder, eating disorders (anorexia and bulimia), depression, attention deficit hyperactivity disorder (ADHD) and conduct disorder. The participants were also asked about what treatment, if any, they were receiving.

Overall, 13 percent of respondents met criteria for having at least one of the six mental disorders within the last year. About 1.8 percent of the respondents had more than one disorder, usually a combination of ADHD and conduct disorder. Among the specific disorders,

• 8.6 percent had ADHD, with males more likely than females to have the disorder;
• 3.7 percent had depression, with females more likely than males to have the disorder;
• 2.1 percent had conduct disorder;
• 0.7 percent had an anxiety disorder (GAD or panic disorder);
• 0.1 percent had an eating disorder (anorexia or bulimia).

“With the exception of ADHD, the prevalence rates reported here are generally lower than those reported in other published findings of mental disorders in children, but they are comparable to other studies that employed similar methods and criteria,” said lead author Kathleen Merikangas, Ph.D., of NIMH.

Those of a lower socioeconomic status were more likely to report any disorder, particularly ADHD, while those of a higher socioeconomic status were more likely to report having an anxiety disorder. Mexican-Americans had significantly higher rates of mood disorders than whites or African-Americans, but overall, few ethnic differences in rates of disorders emerged.

Merikangas and colleagues also found that overall, 55 percent of those with a disorder had consulted with a mental health professional, confirming the trend of an increase in service use for childhood mental disorders, especially ADHD. However, only 32 percent of youth with an anxiety disorder sought treatment, a finding consistent with other studies. Moreover, African-Americans and Mexican-Americans were significantly less likely to seek treatment than whites, reiterating the need to identify and remove barriers to treatment for minority youth, noted the researchers.

“Until now, there has been a dearth of reliable data on the magnitude, course and treatment patterns of mental disorders among U.S. youth,” said Dr. Merikangas. “When combined with data from other nationally representative surveys, the data will provide a valuable basis for making decisions about health care for American youth,” she concluded.

The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit the NIMH website.

The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit the NIH website.

WASHINGTON, DC—Nerve cells transplanted into brain-damaged rats helped them to fully recover their ability to learn and remember, probably by promoting nurturing, protective growth factors, according to a new study.

Building on previous investigation of transplants in the nervous system, this critical study confirms that cell transplants can help the brain to heal itself. Ultimately, it may lead to new therapies to help dementia patients. More generally, scientists can now develop and test new ways to help repair an injured nervous system — whether through new drugs, genetically modified cells, transplanted neural (nerve) and non-neural brain cells, or other means.

The discovery was announced in the December issue of Behavioral Neuroscience, published by the American Psychological Association. The findings, according to the authors, confirm the potential of cell grafts to stimulate the release of growth factors for neurons, regenerate or reorganize a part of the brain, and restore cognitive function, in a process called neural plasticity.

This study focused on the hippocampus, considered to be the seat of learning and memory, whose shrinkage in Alzheimer’s disease causes steadily worsening symptoms. The study’s authors targeted a key player in the hippocampal “learning system,” which includes the hippocampus itself, the subiculum (the major output structure connected to the cortex, the self-aware “thinking” part of the brain), and the adjacent entorhinal cortex.

Previously, these scientists had demonstrated that damage to the subiculum in rats led to deterioration of the hippocampus, and problems with learning. The next question was obvious: Could researchers do the opposite, repair the hippocampus and restore the memory functions?

They sought the answer at India’s National Institute for Mental Health and Neuro Sciences and National Centre for Biological Sciences (Tata Institute for Fundamental Research), both in Bangalore. First, the scientists injected a neuron-destroying chemical into the subiculum area of 48 adult rats.

Next, again using precise micro-injections, the scientists transplanted hippocampal cells that had been taken from newborn transgenic mice and cultured in an incubator into the hippocampi of about half the rats. These special cells had a green fluorescent protein used to “label” and track them after transplantation. (Transgenic mice are bred with a little extra DNA that allows their cells to be grown in glass plates in incubators.)

Two months later, the scientists measured how well both the transplant and non-transplant rats learned and remembered, using two well-established maze tests of spatial learning. The rats given cell transplants had recovered completely: On both mazes, they performed as well as those rats which had not had their subiculums damaged. The rats without transplants did not recover: They had many problems learning their way through the mazes.

After studying behavior, the scientists examined what happened in the brain. Under the microscope, it appeared that the transplanted cells had settled mainly in a sub-area of the hippocampus called the dentate gyrus. There, the transplants appeared to promote the secretion of two types of growth factors, namely brain-derived neurotrophic factor and fibroblast growth factor, which boost the growth and survival of the cells that give rise to neurons. In the hippocampi of rats with cell transplants, the expression of brain-derived growth factor went up threefold.

It is significant that transplants can provide more neural growth factors in the hippocampus, because the formation of new neurons there may be critical for cognitive function.

Neural growth factors, also called neurotrophic factors, hold great promise for treating neurological problems. These specialized chemicals “provide an ideal micro-environment for making new neurons,” said co-author Bindu Kutty, PhD. “They also protect existing brain cells, especially following an injury or other neurological insult.”

Further study is needed, especially to understand the underlying repair mechanism and the apparent starring role of growth factor in brain health. Although the current study shows in the lab that brain-cell transplants can restore function, “more studies along these lines using appropriate animal models are required to find definitive answers about the safety and efficacy of such approaches,” said Kutty. “We are still some way from achieving a new therapy based on these findings.”

Article: “Transplantation of Hippocampal Cell Lines Improves Spatial Learning in Rats with Ventral Subicular Lesions,” J. Rekha, PhD, National Institute of Mental Health and Neuro Sciences (NIMHANS), Deemed University, India; Sridhara Chakravarthy, PhD, National Centre for Biological Sciences, Tata Institute for Fundamental Research (NCBS, TIFR), India; L. R. Veena, master’s student in biotechnology, NIMHANS; People’s Education Society Institute of Technology, India; Vani P. Kalai, master’s student in biotechnology, NIMHANS; Rupam Choudhury, Junior Research Fellow, NCBS, TIFR; Harsha N. Halahalli, PhD student, Phalguni Anand Alladi, PhD, Anandh Dhanushkodi, PhD, and M. Nirmala, PhD student, NIMHANS; Geetha M. Swamilingiah; PhD, NCBS, TIFR; Maulishree Agrahari, PhD, People’s Education Society Institute of Technology, India; T. R. Raju, PhD, NIMHANS; M. M. Panicker, PhD, NCBS, TIFR; Bindu M. Kitty, PhD, NIMHANS; Behavioral Neuroscience, Vol. 123, No. 6.

(Full text of the article is available from the APA Public Affairs Office)

Bindu Kutty can be reached by e-mail or at the following numbers: 091-80-2656 5075 or 091-80-2656 0431 (residence), 091-94-4978 9375 (mobile), or 091-80-2699 5170 (office).

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world’s largest association of psychologists. APA’s membership includes more than 150,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.

Recalling Emotional Memory Opens Window of Opportunity to Re-Write It

Scientists have for the first time selectively blocked a conditioned fear memory in humans with a behavioral manipulation. Participants remained free of the fear memory for at least a year. The research builds on emerging evidence from animal studies that reactivating an emotional memory opens a 6-hour window of opportunity in which a training procedure can alter it.

“Our results suggest a non-pharmacological, naturalistic approach to more effectively manage emotional memories,” said Elizabeth Phelps, Ph.D., of New York University, a grantee of the National Institutes of Health’s National Institute of Mental Health (NIMH).

Phelps and NIMH grantee and NYU colleague Joseph LeDoux, Ph.D., led the research team that reports on their discovery online Dec. 9, 2009 in the journal Nature.

“Inspired by basic science studies in rodents, these new findings in humans hold promise for being translated into improved therapies for the treatment of anxiety disorders, such as post-traumatic stress disorder (PTSD),” said NIMH Director Thomas R. Insel, M.D.

The results add support to the hypothesis that emotional memories are reconsolidated – rendered vulnerable to being modified – each time they are retrieved. That is, reactivating a memory opens what researchers call “reconsolidation window,” a time-limited period when it can be changed.

“This adaptive update mechanism appears to have evolved to allow new information available at the time of retrieval to be incorporated into the brain’s original representation of the memory,” explained Phelps.

Earlier this year, LeDoux and colleagues exploited this potentially clinically important insight to erase a fear memory in rats. They first conditioned rats to fear a tone by pairing it with intermittent shocks. A day later, the rats were re-exposed to the tone, reactivating the fear memory. They then underwent a process to rewrite the fear, called extinction training, in which the tone was repeatedly presented without shocks.

However, the timing of this extinction training proved critical. Fear of the stimulus was erased only in rats trained within a 6-hour reconsolidation window after re-exposure to the feared tone. Fear responses returned in animals trained after the window closed, when the memory had apparently already solidified.

Normally, extinction training suppresses but does not erase the original fear memory. By first reactivating it – sounding the tone – just prior to extinction training, LeDoux and colleagues permanently erased the fear memory. In the new study, Phelps and colleagues similarly conditioned human participants to fear colored squares by intermittently pairing them with mild wrist shocks.

As with the rats, a day later, the memory was first reactivated by re-exposing participants to the feared squares. A measure of nervous system arousal confirmed that they experienced a fear response. Extinction training – repeated trials of exposure to the colored squares without shocks – followed.

Again as in the rats, a day later, the fear response was banished only in human participants who underwent the extinction training soon after the fear reactivation. Those trained after the 6-hour consolidation window remained afraid of the squares – as did a control group that received extinction training without first experiencing reactivation of the fear memory.

In a follow-up experiment to gauge long-term effects a year later, 19 of the original participants received a potent regimen to re-instate the fear: four shocks followed by presentations of the colored squares.

Remarkably, those who had undergone extinction training within the reconsolidation window were largely spared significant effects. By contrast, those whose training had been delayed 6 hours or who hadn’t experienced fear memory reactivation prior to extinction training experienced significant reinstatement of the fear response.

In a similar experiment, the researchers also confirmed that the fear memory was blocked only for the specific colored square for which fear memory was reactivated prior to extinction training. The effect did not generalize to a differently colored square associated with the shocks. This indicated that memory re-writing during reconsolidation is highly specific and that prior reactivation with the specific stimuli is critical.

“Timing may have a more important role in the control of fear than previously appreciated,” Phelps suggested. “Our memory reflects our last retrieval of it rather than an exact account of the original event.”

Evidence suggests that the behavioral manipulation may work through the same molecular mechanisms as experimental medications under study for quelling traumatic emotional memories.

“Using a more natural intervention that captures the adaptive purpose of reconsolidation allows a safe and easily implemented way to prevent the return of fear,” suggest the investigators.

References

Preventing the return of fear in humans using reconsolidation update mechanisms. Schiller D, Monfils MH, Raio CM, Johnson DC, LeDoux JE, Phelps EA. Nature. 2009 December 9.

Extinction-reconsolidation boundaries: key to persistent attenuation of fear memories. Monfils MH, Cowansage KK, Klann E, LeDoux JE. Science. 2009 May 15;324(5929):951-5. Epub 2009 Apr 2.PMID: 19342552

Children with poor reading skills who underwent an intensive, six-month training program to improve their reading ability showed increased connectivity in a particular brain region, in addition to making significant gains in reading, according to a study funded in part by the National Institute of Mental Health (NIMH). The study was published in the Dec. 10, 2009, issue of Neuron.

“We have known that behavioral training can enhance brain function.” said NIMH Director Thomas R. Insel, M.D. “The exciting breakthrough here is detecting changes in brain connectivity with behavioral treatment. This finding with reading deficits suggests an exciting new approach to be tested in the treatment of mental disorders, which increasingly appear to be due to problems in specific brain circuits.”

For the study, Timothy Keller, Ph.D., and Marcel Just, Ph.D., both of Carnegie Mellon University, randomly assigned 35 poor readers ages 8-12, to an intensive, remedial reading program, and 12 to a control group that received normal classroom instruction. For comparison, the researchers also included 25 children of similar age who were rated as average or above-average readers by their teachers. The average readers also received only normal classroom instruction.

Four remedial reading programs were offered, but few differences in reading improvements were seen among them. As such, results for participants in these programs were evaluated as a group. All of the programs were given over a six month schooling period, for five days a week in 50-minute sessions (100 hours total), with three students per teacher. The focus of these programs was improving readers’ ability to decode unfamiliar words.

Using a technology called diffusion tensor imaging (DTI), the researchers were able to measure structural properties of the children’s white matter, the insulation-clad fibers that provide efficient communication in the central nervous system. Specifically, DTI shows the movement of water molecules through white matter, reflecting the quality of white matter connections. The better the connection, the more the water molecules move in the same direction, providing a higher “bandwidth” for information transfer between brain regions.

At the outset of the study, poor readers showed lower quality white matter than average readers in a brain region called the anterior left centrum semiovale. Six months later, at the completion of the intensive training, the poor readers showed significant increases in the quality of this region. Children who did not receive the training did not show this increase, suggesting that the changes seen in the remedial training group were not due to natural maturation of the brain.

In an effort to further pinpoint the mechanism underlying this change, the researchers deduced that a process called myelination may be key. Myelin is akin to electrical insulation, allowing for more rapid and efficient communication between nerve cells in the brain. However, the directional association between brain changes and reading improvements remains unclear—whether intensive training brings about increased myelination that results in improved word decoding skills, or whether improved word decoding skills leads to changes in reading habits that result in greater myelination.

“Our findings support not only the positive effects of remediation and rehabilitation for reading disabilities, but may also lead to improved treatments for a range of developmental conditions related to brain connectivity, such as autism,” noted Just.

Source: Timothy Keller, Ph.D.; Marcel Just, Ph.D.

Left brain image shows the area of lower quality white matter (blue area) among poor readers relative to good readers at the beginning of the study.

Center brain image shows the area where the white matter quality increased (red/yellow area) among poor readers who received the remedial reading instruction.

Right brain image shows that following the instruction, there were no differences between the poor and average readers with respect to the quality of their white matter.

Reference

Keller TA, Just MA. Altering cortical connectivity: Remediation-induced changes in the white matter of poor readers. Neuron.

WASHINGTON, DC—As Black Friday nears and national unemployment levels push into double digits for the first time in decades, the American Psychological Association’s (APA) newest Stress in America survey finds that Americans continue to cite financial concerns as leading sources of stress.

Approximately seven in ten Americans report that money is a significant source of stress (71 percent), according to APA’s 2009 Stress in America survey, with similarly high percentages reporting stress resulting from work (69 percent) and the economy (63 percent). More than half of adults (55 percent) also cited family responsibilities as a significant source of stress in their lives.

“According to our survey three quarters of adults in this country already report moderate to high levels of stress,” says psychologist Katherine Nordal, PhD, APA’s executive director for professional practice. “The holiday season can bring with it additional emotional and financial stressors that can negatively impact both physical and mental health.”

Psychologists urge parents to pay particular attention to the stress their children may experience during the holidays. APA’s Stress in America survey found that children are nearly two times more likely to worry about financial concerns than their parents realize. Specifically, 30 percent of youth say they worry about their family having enough money, while only 18 percent of parents report that this is a source of stress for their child.

“While the holidays are stressful for many people, there are some things we can all do to manage that stress and enjoy the season,” says Dr. Nordal. “Given the concerns our young people are reporting about stress and money, parents need to be good models for managing stress in healthy ways.”

APA suggests the following strategies to manage holiday stress and enjoy the season:

1. Take time for yourself. Taking care of yourself helps you to take better care of others in your life. Go for a long walk or take time out to read or listen to your favorite music. By slowing down you will actually have more energy to accomplish your goals.
2. Volunteer. Many charitable organizations face new challenges as a result of the ongoing economic downturn. Find a local charity, such as a soup kitchen or a shelter, where you and your family can volunteer together. Helping others who are less fortunate can put hardships in perspective and can build stronger family relationships.
3. Set realistic expectations. No holiday celebration is perfect; view inevitable missteps as opportunities to demonstrate flexibility and resilience. Create a realistic budget and remind your children that the holidays aren’t about expensive gifts.
4. Remember what’s important. Commercialism can overshadow the true sentiment of the holiday season. When your holiday expense list is running longer than your monthly budget, scale back. Remind yourself that family, friends and the relationships in our lives are what matter most.
5. Seek support. Talk about stress related to the holidays with your friends and family. Getting things out in the open can help you navigate your feelings and work toward a solution. If you continue to feel overwhelmed, consider talking with a professional such as a psychologist to help you develop coping strategies and better manage your stress. A psychologist has the skills and professional training to help people learn to manage stress and cope more effectively with life problems, using techniques based on best available research and their clinical skills and experience, and taking into account an individual’s unique values, goals and circumstances. Psychologists have doctoral degrees and are licensed by the state in which they practice. They receive one of the highest levels of education of all health care professionals, spending an average of seven years in education and training after they receive their undergraduate degrees.

Stress in America is part of APA’s Mind/Body Health public education campaign. For additional information on stress and lifestyle and behavior, visit www.apahelpcenter.org, read the campaign blog www.yourmindyourbody.org, and follow @apahelpcenter on Twitter.

Psychologists are available immediately for interviews related to holiday stress prevention and management. To request an interview, contact Angel Brownawell or Luana Bossolo at Luana Bossolo.

Methodology

The 2009 Stress in America Survey was conducted online within the United States by Harris Interactive on behalf of the American Psychological Association, between July 21, 2009 and August 4, 2009 among 1,568 adults aged 18+ who reside in the U.S. This report also includes the results of a YouthQuery survey conducted between August 19 and 27, 2009 among 1,206 young people aged 8-17 years old. Results were weighted as needed for age, sex, race/ethnicity, education, region, and household income. Propensity score weighting was also used to adjust for respondents’ propensity to be online. No estimates of theoretical sampling error can be calculated; a full methodology is available.

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world’s largest association of psychologists. APA’s membership includes more than 150,000 researchers, educators, clinicians, consultants, and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession, and as a means of promoting health, education, and human welfare.

Harris Interactive is a global leader in custom market research. With a long and rich history in multimodal research that is powered by our science and technology, Harris Interactive assists clients in achieving business results. Harris Interactive serves clients globally through its North American, European, and Asian offices and a network of independent market research firms. For more information, please visit www.harrisinteractive.com.

ARLINGTON, Va. (Nov. 16, 2009) – Persons convicted of serious crimes by age 23 did not have the normal heightened response to cues associated with loud, unpleasant noise when they were tested at 3 years of age, according to a new study published in The American Journal of Psychiatry.

The finding strengthens evidence that early brain dysfunction increases the risk for criminal offending, since learning to associate a cue with a frightening outcome, known as fear conditioning, relies on the amygdala and prefrontal cortex.

Nearly 1,800 children were studied over 20 years by Yu Gao, Ph.D., and colleagues in the United States and the United Kingdom. When subjects were 3 years of age, fear conditioning was assessed by measuring electrical activity of the skin after presentation of two types of long auditory tones. One tone was usually followed by a short, loud, unpleasant sound, conditioning the child’s reaction to this tone due to anticipation of the unpleasant noise. The other tone served as a control tone, which was deeper in pitch and had no unpleasant association. Skin conductance measures the nervous system’s control over sweat secretion that is part of the body’s fear response.

Normal fear conditioning would result in greater skin responses to the conditioned tone than to the control tone. According to the authors, poor fear conditioning is hypothesized to predispose to crime because “individuals who lack fear are less likely to avoid situations, contexts, and events that are associated with future punishment—resulting in a lack of conscience.”

By age 23, 137 subjects had convictions for serious crimes. These individuals showed a lack of fear conditioning at age 3 whereas noncriminal subjects with similar characteristics, including social adversity, exhibited normal fear conditioning.

The report will appear online on November 16 at AJP in Advance, the online advance edition of The American Journal of Psychiatry (AJP), the official journal of the American Psychiatric Association. Data collection was supported by the Medical Research Council (U.K.), Wellcome Trust (U.K.), and National Institute of Mental Health.

The American Journal of Psychiatry is the oldest continuously published medical specialty journal in the United States and was recently named one of the “Most Influential Journals in Biology & Medicine of the Last 100 Years.” Statements in this press release or the articles in the Journal are not official policy statements of the American Psychiatric Association.

The American Psychiatric Association is a national medical specialty society whose more than 38,000 physician members specialize in diagnosis, treatment, prevention and research of mental illnesses including substance use disorders. Visit the APA at www.psych.org and www.HealthyMinds.org.

Sound Therapy Program Currently Prescribed for Treatment of PTSD,

Stress, Compassion Fatigue in VA and U.S. Army Hospitals

Contacts: Steve Vetzner, (703) 797-2588 or svetzner@mentalhealthamerica.net

Jared Klose, (302) 434-8707 or jklose@stargroup1.com

ALEXANDRIA, Va. (November 10, 2009)-Mental Health America today announced it is partnering with Prescription Audio, a Philadelphia-area based firm (Voorhees, N.J.), to make the company’s scientifically based sound therapy available without charge as a download to veterans, active duty servicemen and women, their family members and health care providers.

“We applaud Prescription Audio for making this therapy available for free and are proud to partner with them,” said David Shern, Ph.D., president and CEO of Mental Health America. “It is a valuable stress management and anxiety reduction tool that can immediately help our active duty troops, veterans, their families and caregivers.”

Similar Prescription Audio sound therapy is currently being prescribed within the Department of Veterans Affairs and US Army hospitals to aid in the treatment of Post-Traumatic Stress Disorder (PTSD), insomnia, high stress and compassion fatigue.

In honor of Veterans Day, and in light of recent events including the Fort Hood shootings, 250,000 copies of the download are being made available at no charge to any veteran, active duty servicemen and women, their families, as well as compassion fatigued healthcare providers suffering from mental health symptoms related to the treatment of PTSD and other related conditions. The value of the products and services being donated is approximately 5 million dollars.

“In these trying times, we felt like we had to do something to support our warriors, veterans, their families and the mental health professionals that serve them,” said Jill Slane, CEO of Prescription Audio. Individuals can learn more about sound therapy, discover how it can start helping them and access the download by going to Mental Health America’s Operation Healthy Reunion’s site at http://www.mentalhealthamerica.net/reunions/resources.cfm or by clicking here.

Prescription Audio was developed by Jill and Rod Slane, a husband-wife team, in 2005. Rod Slane has used his more than 40 years experience as a composer and innovative sound engineer to create the Life Program, followed by Natural Wellness Therapy in 2006.

One of the company’s early aims was to help ease the anguish of veterans suffering from PTSD.  By using proprietary sound technology, Prescription Audio’s array of MP3 and CD programs provide natural mental and general health solutions that diminish anxiety and its many detrimental manifestations, while enabling anyone to quickly and easily achieve a meditative state of mind.

Prescription Audio provides products and services through its Life Program^TM to the U.S. military’s Institute of Surgical Research Stress Management Program for Healthcare Providers, a strong testament to the power and effectiveness of their approach. In this application, vibrational sound therapy is utilized to help reduce the high rate of turnover in trauma healthcare workers within military hospitals by teaching stress management tactics, leading to improved mental health and increased resiliency.

About Mental Health America

Mental Health America is the country’s leading nonprofit dedicated to helping all people live mentally healthier lives. With our century of service to America and our more than 300 affiliates nationwide, we represent a national movement that promotes mental wellness for the health and well-being of the nation – everyday and in times of crisis.

About Prescription Audio

Prescription Audio is the developer of Sound Solutions for a Healthier Life. By using proprietary sound technology, Prescription Audio provides natural mental and physical health solutions that diminish stress and its many detrimental manifestations, while enabling anyone to quickly and easily achieve a meditative state of mind.  The company offers a wide variety of portable MP3 and CD programs that promote healthy living through natural wellness.  Prescription Audio’s natural wellness solutions utilize audio vibrations embedded within a proprietary multi-layered sound technology to assist with positive metamorphosis in total mind-body well-being.  Please visit www.PrescriptionAudio.com to learn more.

The National Institute of Mental Health (NIMH) has announced that an interdisciplinary team of four research institutions will carry out the largest study of suicide and mental health among military personnel ever undertaken, with $50 million in funding from the U.S. Army. Study investigators aim to move quickly to identify risk and protective factors for suicide among soldiers and provide a science base for effective and practical interventions to reduce suicide rates and address associated mental health problems.

The study is a direct response to the Army’s request to NIMH to enlist the most promising scientific approaches for addressing the rising suicide rate among soldiers. A memorandum of agreement between NIMH and the Army, signed in October 2008, authorized NIMH to undertake the investigation with Army funding. Suicide rates among Army personnel have risen substantially since the beginning of the current conflicts in Iraq and Afghanistan despite major surveillance and intervention efforts introduced by the Army to prevent suicides over this period.

“This is an extraordinary opportunity to assist the Army in addressing a pressing military health issue,” said NIMH Director Thomas R. Insel, M.D. “In addition to helping our armed forces serve the mental health needs of servicemen and women, the study will generate information on suicide risk and protective factors in a large population that will help us better understand suicide, and how to prevent it, in the public at large.”

Suicide is the fourth leading cause of death among 25- to 44-year-olds in the United States. Historically, the suicide rate has been lower in the military than among civilians. In 2008 that pattern was reversed, with the suicide rate in the Army exceeding the age-adjusted rate in the civilian population (20.2 out of 100,000 vs. 19.2). While the stresses of the current wars, including long and repeated deployments and post-traumatic stress, are important potential contributors for research to address, suicidal behavior is a complex phenomenon. The study will examine a wide range of factors related to and independent of military service, including unit cohesion, exposure to combat-related trauma, personal and economic stresses, family history, childhood adversity and abuse, and overall mental health.

Four institutions will collaboratively conduct an epidemiologic study of mental health, psychological resilience, suicide risk, suicide-related behaviors, and suicide deaths in the U.S. Army. The consortium brings together research teams that are internationally known for their expertise and experience in research on military health, health and behavior surveys, epidemiology, and suicide, including genetic and neurobiological factors involved in suicidal behavior. Project director Robert Ursano, M.D., is at the Uniformed Services University of the Health Sciences, Bethesda, Md. Consortium principal investigators are Steven Heeringa, Ph.D., at the University of Michigan, Ann Arbor; Ronald Kessler, Ph.D., Harvard Medical School, Cambridge, Mass.; and John Mann, M.D., at Columbia University, New York City.

The study will use several strategies to generate information on risk and protective factors:

• The Army already has a rich archive of data on its personnel. Study investigators will work to consolidate information from different databases and use this resource to identify possible suicide risk and protective factors.
• Investigators will undertake a retrospective case-control study in which individual soldiers who have attempted suicide with or without fatal outcomes (cases) will be matched with individuals with similar demographic characteristics (controls). Comparison of information gathered on cases and controls should provide clues to risk and protective factors.
• A survey for which 90,000 active Army personnel representative of the entire Army will be contacted will provide information on the prevalence of suicide-related behavior and risk and protective factors. When possible, saliva and blood samples will be collected for genetic and neurobiologic studies.
• All 80,000 to 120,000 recruits who enter the Army in each of the first three years of the study will be asked to participate in a survey similar to the all-Army survey above.

This research will encompass active duty Army personnel across all phases of service, including members of the National Guard and Reserves. Soldiers’ confidentiality will be protected as investigators explore the nature of risk and protective factors and the timing of events that could influence risk, such as time since enlistment and deployment status and history.

Although planned to continue for 5 years, the study is designed to be able to identify quickly potential risk factors that can inform the continuing research project and the Army’s ongoing efforts to prevent suicide among its personnel. Identification of risk and protective factors-including existing prevention strategies that show effectiveness in reducing suicide risk—is a means to the end of developing evidence-based interventions that are readily applicable in a military context and can be put into action quickly to reverse the increase in suicide rates.

Additional Information

• Visit the NIH website for more information about its programs.
• Visit NIMH for more information on suicide prevention

The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit the NIMH website.

The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical, and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. NIH has protocols which it applies to all research studies it funds or conducts that assure compliance with the requirements of the Common Rule (Federal Policy for the Protection of Human Subjects) and the Privacy Rule.

The National Institutes of Health Blueprint for Neuroscience Research is launching a $30 million project that will use cutting-edge brain imaging technologies to map the circuitry of the healthy adult human brain. By systematically collecting brain imaging data from hundreds of subjects, the Human Connectome Project (HCP) will yield insight into how brain connections underlie brain function, and will open up new lines of inquiry for human neuroscience.

Investigators have been invited to submit detailed proposals to carry out the HCP, which will be funded at up to $6 million per year for five years. The HCP is the first of three Blueprint Grand Challenges, projects that address major questions and issues in neuroscience research.

The Blueprint Grand Challenges are intended to promote major leaps in the understanding of brain function, and in approaches for treating brain disorders. The three Blueprint Grand Challenges to be launched in 2009 and 2010 address:

• The connectivity of the adult, human brain
• Targeted drug development for neurological diseases
• The neural basis of chronic pain disorders

“The HCP is truly a grand and critical challenge: to map the wiring diagram of the entire, living human brain. Mapping the circuits and linking these circuits to the full spectrum of brain function in health and disease is an old challenge but one that can finally be addressed rigorously by combining powerful, emerging technologies,” says Thomas Insel, M.D., director of the National Institute of Mental Health (NIMH), which is part of the NIH Blueprint.

Scientists have studied the relationship between the structure and function of the human brain since the 1800s. Some parts of the brain serve basic functions such as movement, sensation, emotion, learning and memory. Others are more important for uniquely human functions such as abstract thinking. The connections between brain regions are important for shaping and coordinating these functions, but scientists know little about how different parts of the human brain connect.

“Neuroscientists have only a piecemeal understanding of brain connectivity. If we knew more about the connections within the brain – and especially their susceptibility to change – we would know more about brain dysfunction in aging, mental health disorders, addiction and neurological disease,” says Story Landis, Ph.D., director of the National Institute of Neurological Disorders and Stroke (NINDS), also part of the NIH Blueprint.

For example, there is evidence that the growth of abnormal brain connections during early life contributes to autism and schizophrenia. Changes in connectivity also appear to occur when neurons degenerate, either as a consequence of normal aging or of diseases such as Alzheimer’s.

In addition to brain imaging, the HCP will involve collection of DNA samples, demographic information and behavioral data from the subjects. Together, these data could hint at how brain connectivity is influenced by genetics and the environment, and in turn, how individual differences in brain connectivity relate to individual differences in behavior. Primarily, however, the data will serve as a baseline for future studies. These data will be freely available to the research community.

The complexity of the brain and a lack of adequate imaging technology have hampered past research on human brain connectivity. The brain is estimated to contain more than 100 billion neurons that form trillions of connections with each other. Neurons can connect across distant regions of the brain by extending long, slender projections called axons – but the trajectories that axons take within the human brain are almost entirely uncharted.

In the HCP, researchers will optimize and combine state-of-the-art brain imaging technologies to probe axonal pathways and other brain connections. In recent years, sophisticated versions of magnetic resonance imaging (MRI) have emerged that are capable of looking beyond the brain’s gross anatomy to find functional connections. Functional MRI (fMRI), for example, uses changes in blood flow and oxygen consumption within the brain as markers for neuronal activity, and can highlight the brain circuits that become active during different behaviors. Three imaging techniques are suggested, but are not required, for carrying out the HCP:

• High angular resolution diffusion imaging with magnetic resonance (HARDI), which detects the diffusion of water along fibrous tissue, and can be used to visualize axon bundles.
• Resting state fMRI (R-fMRI), which detects fluctuations in brain activity while a person is at rest, and can be used to look for coordinated networks within the brain.
• Electrophysiology and magnetoencephalography (MEG) combined with fMRI (E/M fMRI), which adds information about the brain’s electrical activity to the fMRI signal. In this procedure, the person performs a task so that the brain regions associated with that task become active.

Since this is the first time that researchers will combine these brain imaging technologies to systematically map the brain’s connections, the HCP will support development of new data models, informatics and analytic tools to help researchers make the most of the data. Funds will be provided for building an on-line platform to disseminate HCP data and tools, and for engaging and educating the research community about how to use these data and tools.

“Human connectomics has been gaining momentum in the research community for a few years,” says Michael Huerta, Ph.D., associate director of NIMH and the lead NIH contact for the HCP. “The data, the imaging tools and the analytical tools produced through the HCP will play a major role in launching connectomics as a field.”

The field of neuroscience emerged in the late 19th century, when scientists observed individual brain cells for the first time. Since then, researchers have made breathtaking progress in understanding the anatomy, cell biology, physiology and chemistry of the brain in both health and disease. Yet many fundamental questions remain unanswered, including how brain function translates into mental function and why brain function declines with age. Advances in neuroimaging, genomics, computational neuroscience and engineering have put us on the brink of another great era in neuroscience, when we can expect to make unprecedented discoveries regarding normal brain activity, disorders of the brain and our very sense of self.

The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit the NIMH website.

The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. Visit the NIH website for more information about NIH and its programs.

The NIH Blueprint for Neuroscience Research is a cooperative effort among the NIH Office of the Director and the 15 NIH Institutes and Centers that support research on the nervous system. By pooling resources and expertise, the Blueprint supports transformative neuroscience research, and the development of new tools, training opportunities, and other resources to assist neuroscientists.

CHAMPAIGN, Ill.—We swim in a sea of information, but filter out most of what we see or hear. New analysis of data from dozens of studies sheds new light on how we choose what we do and do not hear. The study found that while people tend to avoid information that contradicts what they already think or believe, certain factors can cause them to seek out, or at least consider, other points of view.

The analysis, reported this month in Psychological Bulletin published by the American Psychological Association and led by researchers at the University of Illinois and the University of Florida, included data from 91 studies involving nearly 8,000 participants. It puts to rest a longstanding debate over whether people actively avoid information that contradicts what they believe, or whether they are simply exposed more often to ideas that conform to their own because they tend to be surrounded by like-minded people.

“We wanted to see exactly across the board to what extent people are willing to seek out the truth versus just stay comfortable with what they know,” said University of Illinois psychology professor Dolores Albarracín, PhD, who led the study with University of Florida researcher William Hart, PhD. The team also included researchers from Northwestern University and Ohio University.

The studies they reviewed generally asked participants about their views on a given topic and then allowed them to choose whether they wanted to view or read information supporting their own or an opposing point of view.

The researchers found that people are about twice as likely to select information that supports their own point of view (67 percent) as to consider an opposing idea (33 percent). Certain individuals, those with close-minded personalities, are even more reluctant to expose themselves to differing perspectives, Albarracín said. They will opt for the information that corresponds to their views nearly 75 percent of the time.

The researchers also found, not surprisingly, that people are more resistant to new points of view when their own ideas are associated with political, religious or ethical values.

“If you are really committed to your own attitude – for example, if you are a very committed Democrat – you are more likely to seek congenial information, that is, information that corresponds with your views,” Albarracín said. “If the issues concern moral values or politics, about 70 percent of the time you will choose congenial information, versus about 60 percent of the time if the issues are not related to values.”

Perhaps more surprisingly, people who have little confidence in their own beliefs are less likely to expose themselves to contrary views than people who are very confident in their own ideas, Albarracín said.

Certain factors can also induce people to seek out opposing points of view, she said. Those who may have to publicly defend their ideas, such as politicians, for example, are more motivated to learn about the views of those who oppose them. In the process, she said, they sometimes find that their own ideas evolve.

People are also more likely to expose themselves to opposing ideas when it is useful to them in some way, Albarracín said. “If you’re going to buy a house and you really like the house, you’re still going to have it inspected,” she said. Similarly, no matter how much you like your surgeon, you may seek out a second opinion before scheduling a major operation, she said.

For the most part, it seems that people tend to stay with their own beliefs and attitudes because changing those might prevent them from living the lives they’re living,” Albarracín said. “But it’s good news that one out of three times, or close to that, they are willing to seek out the other side.”

Article: “Feeling Validated Versus Being Correct: A Meta-Analysis of Selective Exposure to Information,” Dolores Albarracín, PhD, University of Illinois at Urbana-Champaign; William Hurt, PhD, Inge Brechan, PhD, and Lisa Merrill, PhD, University of Florida; Alice H. Eagly, PhD, Northwestern University, Matthew J. Lindberg, PhD, Ohio University; Psychological Bulletin, Vol. 135, No. 4.

(Full text of the article is available from the APA Public Affairs Office and at http://www.apa.org/journals/releases/bul1354555.pdf.)

Contact Dolores Albarracín by e-mail and by phone at 217-244-7019

New Look at Data Confirms Strong Association between Depression and Stressful Life Events

Stressful life events are strongly associated with a person’s risk for major depression, but a certain gene variation long thought to increase risk in conjunction with stressful life events actually may have no effect, according to researchers funded by the National Institute of Mental Health (NIMH), part of the National Institutes of Health. The study, published in the June 17, 2009, issue of the Journal of the American Medical Association, challenges a widely accepted approach to studying risk factors for depression.

“Rigorous re-evaluations of published studies provide the checks and balances necessary for scientific progress,” said Thomas R. Insel, M.D., director of NIMH. “We are still in the early days of understanding how genes and environment interact to increase the risk for depression.”

Most mental disorders are thought to be caused by a combination of many genetic risk factors interacting with environmental triggers. However, finding the exact combinations continues to present significant challenges to research.

Advances in scientific understanding and technologies during the past decade have led to powerful tools for studying how genetic and environmental factors can affect a person’s risk for disease. Such advances allowed mental health researchers in 2003 to show that a gene involved in serotonin activity increased the risk of major depression in people who had a number of stressful life events over a five-year period (see “More About the Science” below for more information about this gene and serotonin). Coming at a time of heightened research interest in these gene-environment interactions and the relative lack of progress in the field for mental disorders, this study received wide acclaim and had a far-reaching influence. Not only have considerable resources been invested in subsequent studies that built on this finding, but also some researchers have proposed marketing the gene test to the public, claiming to be able to predict a person’s risk for depression.

However, efforts to replicate the 2003 study’s findings—a key step in scientific progress that helps show whether a particular finding was a chance event—have had inconsistent results.

To examine whether the 2003 study’s finding had been confirmed, a group of scientists from NIMH and six universities with expertise in epidemiology, biostatistics, genetics, and psychiatry reviewed the status of relevant replication studies. Led by Kathleen Merikangas, Ph.D., of the NIMH Intramural Research Program, the workgroup did a meta-analysis, re-analyzing data on 14,250 participants in 14 studies published from 2003 through March 2009. Of these, the researchers also re-analyzed original data, including unpublished information, on 10,943 participants from 10 studies published before 2008. The workgroup analyzed these original data to see whether there were gender differences in the associations between the serotonin genotype, stressful life events, and depression.

By applying the same definitions of study variables and data analysis methods used in the 2003 study, the workgroup found a strong association between the number of stressful life events and risk of depression across the studies. However, the presumed high-risk version of the serotonin transporter gene did not show a relationship to increased risk for major depression, alone or in interaction with stressful life events, in the analysis of the 14 studies. Their findings were the same in men and women alone in the analysis of original data from 10 studies.

The workgroup noted that their analysis had some limitations. Individual level data were available for only 10 of the 14 studies published before 2008. However, these limitations would have had little effect on the overall findings because the number of participants in the studies not included was only a small proportion of the total sample.

These findings may account for the difficulty many researchers have faced in attempting to replicate the 2003 study. This analysis confirms some earlier reviews that had also questioned the validity of the gene’s effect on depression risk. However, the workgroup emphasized that the intent of its analysis was not to deter research on gene-environment interactions for mental disorders.

“Identifying gene-environment interactions is most successful when studies can focus on a single gene with a major effect, or when the environmental exposure has a strong effect,” said lead author Neil Risch, Ph.D., University of California, San Francisco and Kaiser Permanente Northern California. “In the case of modest gene effects or environmental impacts, the statistical power to detect an interaction will be low, and thus weak positive results should be interpreted carefully.”

The authors concluded that incorporating environmental exposures in candidate gene studies (those that study a particular gene) may be as likely to yield false positive findings as the candidate gene studies themselves. Therefore, the results of other studies using the same approach as the 2003 study also deserve thorough review and meta-analysis.

“Even though our re-analysis did not confirm an association between the serotonin gene and depression, the finding that the environmental factor was strongly associated with depression in several studies reminds us that environmental factors are also involved in the complex pathways leading to mental disorders,” noted Merikangas. “Future progress will require thoughtful integration of the tools of genetics, epidemiology, and clinical and behavioral sciences.”

The authors on the paper include Neil Risch, Ph.D., University of California at San Francisco and Kaiser Permanente Northern California; Richard Herrell, Ph.D., NIMH; Thomas Lehner, Ph.D., NIMH; Kung-Yee Liang, Ph.D., Johns Hopkins University; Lindon Eaves, Ph.D., Virginia Commonwealth University; Josephine Hoh, Ph.D., Yale University; Andrea Griem, NIMH; Maria Kovacs, Ph.D., University of Pittsburgh; Jurg Ott, Ph.D., Rockefeller University; Kathleen Ries Merikangas, Ph.D., NIMH.

Reference

Risch N, Herrell R, Lehner T, Liang KY, Eaves L, Hoh J, Griem A, Kovacs M, Ott J, Merikangas KR. Interaction between the Serotonin Transporter Gene, Stressful Life Events and Risk of Depression: A Meta-Analysis. JAMA. 2009 Jun 17;301(23):2462-71.

Citalopram, a medication commonly prescribed to children with autism spectrum disorders (ASD), was no more effective than a placebo at reducing repetitive behaviors, according to researchers funded by the National Institute of Mental Health (NIMH) and other NIH institutes. The study was published in the June 2009 issue of Archives of General Psychiatry.

“Parents of children with autism spectrum disorders face an enormous number of treatment options, not all of which are research-based,” said NIMH Director Thomas R. Insel, M.D. “Studies like this help us to better understand which treatments are likely to be beneficial and safe.”

The researchers say their findings do not support using citalopram to treat repetitive behaviors in children with ASD. Also, the greater frequency of side effects from this particular medication compared to placebo illustrates the importance of placebo-controlled trials in evaluating medications currently prescribed to this population.

Citalopram is in a class of antidepressant medications called selective serotonin reuptake inhibitors (SSRIs) that is sometimes prescribed for children with ASD to reduce repetitive behaviors. These behaviors, a hallmark of ASD, include stereotypical hand flapping, repetitive complex whole body movements (such as spinning, swaying, or rocking over and over, with no clear purpose), repetitive play, and inflexible daily routines.

Past research suggested that some children with ASD have abnormalities in the brain system that makes serotonin, a brain chemical that, among many other functions, plays an important role in early brain development. Children with obsessive compulsive disorder (OCD) may also have serotonin abnormalities and have repetitive or inflexible behaviors. OCD is effectively treated with SSRIs, leading some researchers to wonder whether similar treatment may reduce repetitive behaviors in children with ASD. So far, studies have produced mixed results, but SSRIs remain among the most frequently prescribed medications for children with ASD.

Researchers in the Studies to Advance Autism Research and Treatment (STAART) network, funded by five NIH institutes, conducted a six-site, randomized controlled trial comparing the effectiveness and safety of using the SSRI citalopram (Celexa) versus placebo to treat repetitive behaviors in children with ASD. The study included 149 participants, ages 5–17, who had autism, Asperger disorder, or pervasive developmental disorder-not otherwise specified (PDD-NOS).

After 12 weeks of treatment, roughly 1 out of 3 children in both groups—32.9 percent of those treated with citalopram and 34.2 percent those treated with placebo—showed fewer or less severe repetitive symptoms.

“Adverse symptoms were common in both groups, probably reflecting common childhood ailments as well as the changing nature of symptoms associated with ASD,” according to Bryan King, M.D., director of child and adolescent psychiatry at Seattle Children’s Hospital and lead author on the study. “However, reports of increased energy, impulsiveness, decreased concentration, hyperactivity, diarrhea, insomnia, and dry skin were more common in the citalopram group.”

According to the researchers, the study results may challenge the underlying premise that repetitive behaviors in children with ASD are similar to repetitive and inflexible behaviors in OCD.

The authors on the paper include Bryan H. King, M.D., Seattle Children’s Hospital; Eric Hollander, M.D., Mount Sinai School of Medicine; Linmarie Sikich, M.D., University of North Carolina, Chapel Hill; James T. McCracken, M.D., University of California Los Angeles; Lawrence Scahill, M.S.N., Ph.D., Yale University; Joel D. Bregman, M.D., North Shore Long Island Jewish Health System; Craig L. Donnelly, M.D., Dartmouth Medical School; Evdokia Anagnostou, M.D., Mount Sinai School of Medicine (currently at the University of Toronto); Kimberly Dukes, Ph.D., DM-STAT; Lisa Sullivan, Ph.D., Boston University; Deborah Hirtz, M.D., National Institute of Neurological Disorders and Stroke (NINDS); Ann Wagner, Ph.D., NIMH; Louise Ritz, M.B.A., NIMH (currently at NINDS); and the STAART Psychopharmacology Network.

The STAART network is jointly funded by NIMH, NINDS, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Institute on Deafness and Other Communication Disorders (NIDCD), and the National Institute of Environmental Health Sciences (NIEHS), all part of the National Institutes of Health (NIH).

WASHINGTON—Children who suffer traumatic brain injuries can experience lasting or late-appearing neuropsychological problems, highlighting the need for careful watching over time, according to two studies published by the American Psychological Association.

In one study, a team of psychologists used a longitudinal approach to gain a better idea of what to expect after traumatic brain injury (TBI). The researchers found that severe TBI can cause many lasting problems with day-to-day functioning. Some children may recover academically but then start acting up; other children do surprisingly well for unknown reasons.

In the second study, the first systematic meta-analysis summarizing the collective results of many single studies, the researchers found that problems lasted over time and, in some cases, worsened with more serious injury. Some children with severe TBI started to fall even further behind their peers than one would normally expect, in a snowball effect that requires further study.

The results of both studies were reported in the May issue of Neuropsychology, published by the American Psychological Association.

The Centers for Disease Control in 2000 cited traumatic brain injury as the single most common cause of death and disability in children and adolescents.

Long-Term Study Digs Out Individual Differences

In the first study, researchers at The Ohio State University, Case Western Reserve University, and hospitals in Columbus and Cleveland followed 37 children after severe TBI, 40 children after moderate TBI, and 44 children after musculoskeletal injury (a common way to control for trauma and the hospital experience). All of the children were injured between the ages of 6 and 12, and assessed six months, 12 months, and three to five years following their injuries.

As expected, the children with severe brain injuries showed greater problems than children with other injuries in the areas of mental processing, learning and memory, behavior, adaptation and academics. Children whose comas were longer and more severe had more, and more serious, problems.

Some children seemed at first to be doing all right on cognitive tests and in the classroom, but then developed significant behavioral problems. Parents and doctors should watch children who’ve had traumatic brain injury closely because something may come up later – perhaps, the authors suggested, as a secondary reaction to the disruption caused by the injury, or because the family has not functioned very well, especially in response to the injury.

Generally, one year after injury, nearly 60 percent of the severe TBI group had problems in at least one area, compared with 25 percent of the controls. Four years after injury, 40 percent of children suffering severe TBI and 20 percent of the controls showed deficits. At both intervals, the share of brain-injured children with cognitive problems was at least twice that of the control group members with problems.

Even so, the researchers were intrigued that many children with moderate to severe TBI showed no significant weaknesses from six months to four years after the injury, in one or more of the areas measured.

Perhaps, they speculated, that was because in previous long-term studies, group averages may have hidden the fact that some individual children can do well over time. This team, by tracking individuals, revealed that some children are more mentally resilient. If researchers can learn why, they may be able to help more children to recover more fully from this type of injury.

“It’s probably a complex interplay of child, family and broader environmental/cultural factors. The care and treatment children receive may make a difference, such as whether they have access to rehabilitation and special-education services,” said co-author Keith Yeates, PhD, who also mentioned genetic differences in the brain’s ability to heal itself.

Meta-Analysis Shows Problems Grow Over Time

In the second study, conducted by Talin Babikian, PhD, and Robert Asarnow, PhD, at the University of California-Los Angeles, the authors analyzed 28 carefully selected articles published between 1988 and 2007. The children were sorted by TBI severity and time since injury. Severity levels were mild, moderate or severe TBI, and follow-ups were on average 0-5 months, 6-23 months, or 24+ months, for 14 key aspects of neurocognition.

According to their analysis:

• The worse the injury, the worse the neurocognitive outcome, especially on measures of general intellectual functioning and processing speed.

• Time didn’t heal all. The moderate and severe groups were even more similar by the third time band, especially on general intellectual functioning and attention/executive skills.

• Most problems stick. Despite modest recovery in intellectual functioning and attention, weaknesses in many children with moderate TBI persist even two years after the injury, compared to the children in control groups.

• Memory and visual-spatial skills seemed more or less normal by two-plus years, with even the moderately injured performing in the same range as controls.

• Children with severe TBI needed more help, showing robust and significant problems within months on IQ, executive functioning (processing speed, attention), and verbal memory (both immediate and delayed). After two or more years, all areas studied were impaired.

“It appears that there are significant, persistent neurocognitive impairments in a subset of children with severe TBI,” the authors concluded. Despite some recovery during the first two years, children in this group not only failed to catch up to peers, but appeared to fall further behind over time. Thus, severe traumatic brain injury may throw off children’s normal developmental timetable. The authors noted that well-controlled longitudinal studies evaluating the same children over time are necessary to confirm these findings.

That makes severe brain injuries at younger ages a “double hazard,” the authors noted. Because younger children have more development ahead of them, the same injury can affect a 4-year-old and a 12-year-old very differently. This finding highlights the importance of targeted treatment developed specifically for children with severe TBI.

Article 1: “Predicting Longitudinal Patterns of Functional Deficits in Children With Traumatic Brain Injury,” Taryn B. Fay, PhD, Ohio State University and Nationwide Children’s Hospital; Keith Owen Yeates, PhD, Nationwide Children’s Hospital; Shari L Wade, PhD, University of Cincinnati; Dennis Drotar, PhD, Case Western Reserve University and Rainbow Babies & Children’s Hospital; Terry Stancin, PhD, Case Western Reserve University and MetroHealth Medical Center; and H. Gerry Taylor, PhD, Case Western Reserve University and Rainbow Babies & Children’s Hospital; Neuropsychology, Vol. 23, No. 3.

(Full text of the article is available from the APA Public Affairs Office and at http://www.apa.org/journals/releases/neu233271.pdf)

Taryn Fay can be reached via e-mail or via e-mail, or by phone at her office (403) 955-7097, mobile (403) 797-4014, or home (403) 289-0983. Keith Owen Yeates, in Australia in mid-May; can be reached in that time zone via e-mail. His administrative assistant, Pat Davis, is at (614) 722-4673. Gerry Taylor can be reached via e-mail or at (216) 844-6227 or mobile (216) 338-5679.

Article 2: “Neurocognitive Outcomes and Recovery After Pediatric TBI: Meta-Analytic Review of the Literature,” Talin Babikian, PhD, and Robert Asarnow, PhD, David Geffen School of Medicine at UCLA; Neuropsychology, Vol. 23, No. 3.

(Full text of the article is available from the APA Public Affairs Office and at http://www.apa.org/journals/releases/neu233283.pdf)

Talin Babikian can be reached via e-mail or at (310) 267-2659.

WASHINGTON–Children who can stay focused and don’t sweat the small stuff have a better shot at good health in adulthood — and this is especially true for girls, according to a new study.

“Certain characteristics already evident early in life are likely to spark positive or negative emotions, and also influence biological and behavioral responses to stress,” said lead author Laura D. Kubzansky, PhD, of the Harvard School of Public Health. “Some traits may contribute to developing healthier behaviors and better social relationships, and ultimately more resilience in mid-life.

“Supporting this idea, we found that children who were able to stay focused on a task and react less negatively to situations at age 7 reported better general health and fewer illnesses 30 years later.”

These findings are reported in the May issue of Health Psychology, published by the American Psychological Association.

Kubzansky and co-authors tracked 569 individuals from the National Collaborative Perinatal Project from age 7 to their mid-30s to see if certain personality traits influenced later health. Trained observers rated the 7-year-olds on 15 different behaviors. These behaviors were then assigned to three different personality attributes: attention (the ability to stay focused on a task and persist in solving a problem), distress-proneness (the tendency to react negatively to situations), and behavior inhibition (the tendency toward shyness, acting withdrawn and having difficulty communicating).

To determine adult health, the participants rated their health and reported whether they had any of the following illnesses: heart disease, diabetes, cancer, asthma, arthritis, stroke, bleeding ulcer, tuberculosis or hepatitis.

For all the participants, superior attention spans and having a more positive outlook in youth affected health the most. These effects were greater for women, the researchers found. The authors suggest that women may be more sensitive to interactions among emotion, behavior and biology and, therefore, be more predisposed to certain health risks, such as heart disease, although additional research is needed to understand this more completely.

The authors found no differences in these effects across race or ethnicity; they also controlled for childhood health and socicoeconomic status.

The sample consisted of 60 percent men and 40 percent women; 80 percent of participants were white and 20 percent were black. Of the sample, 76 percent reported good or excellent health and 18 percent reported illnesses.

“This longitudinal study provides more evidence that behavior and emotions generally linked to certain temperaments play a crucial role in long-term health,” Kubzansky said. “Fortunately, early childhood characteristics can be shaped and guided by social, family and peer interactions. Interventions can focus on altering certain ways of responding and behaviors that frequently accompany particular traits to prevent certain diseases.”

Article: “Early Manifestations of Personality and Adult Health: A Life Course Perspective,” Laura D. Kubzansky, PhD, Harvard School of Public Health; Laurie T. Martin, PhD, Rand Corporation; Stephen L. Buka, PhD, Brown University; Health Psychology, Vol. 13, No. 1.

(Full text of the article is available from the APA Public Affairs Office and at http://www.apa.org/journals/releases/hea283364.pdf)

Contact Todd R. Datz via e-mail and by phone at 617.432.3952

Blocking Errant Protein Could Stem Runaway Brain Activity in Psychosis

A study on schizophrenia has implicated machinery that maintains the flow of potassium in cells and revealed a potential molecular target for new treatments. Expression of a previously unknown form of a key such potassium channel was found to be 2.5 fold higher than normal in the brain memory hub of people with the chronic mental illness and linked to a hotspot of genetic variation.

An extensive series of experiments suggest that selectively inhibiting this suspect form could help correct disorganized brain activity in schizophrenia — without risk of cardiac side effects associated with some existing antipsychotic medications. Scientists at the National Institutes of Health and European colleagues report on threads of converging evidence in the May, 2009 issue of the journal Nature Medicine.

“The end game in linking genes with complex disorders like schizophrenia requires that we not only demonstrate statistical association, but also show how a gene version acts biologically to confer risk,” explained Daniel Weinberger, M.D., director of National Institute of Mental Health’s (NIMH) Genes Cognition and Psychosis Program, who led the research. “We found schizophrenia-like effects in brain circuitry and mental processing in perfectly healthy people who carry the risk-associated version of this potassium channel gene, even though they don’t show any psychotic behavior.”

Evidence suggests that schizophrenia stems from complex interactions between multiple genes and environmental factors. Several candidate genes have recently been statistically linked to the illness in large genome-wide association studies.

“Our study goes further, spanning discovery of a new gene variant, confirmation of its association with the illness, and multi-level probes into how it works — in human post mortem brain tissue, the living human brain, and neurons,” added Weinberger.

By regulating the flow of potassium ions into the cell, potassium channels control when neurons fire — electrically discharge and release a chemical messenger that signals neighboring neurons in a circuit. This flow is regulated, in part, by activity of the chemical messenger dopamine, the main target of antipsychotic medications used to treat schizophrenia.

One type of potassium channel, called KCNH2, attracted the researchers’ interest for its potential role in sustaining the type of neuronal firing that supports the higher mental functions disturbed in schizophrenia. Spurred by hints from postmortem studies of genetic variation linked to schizophrenia in the genomic neighborhood of KCNH2, the researchers analyzed the gene’s association with the illness in 5 independent samples comprising hundreds of families. This pinpointed 4 variations associated with schizophrenia within a small region of the KCNH2 gene.

“Yet this statistical association didn’t imply a mechanism,” said Weinberger. “It didn’t explain how KCNH2 might increase risk for schizophrenia. So we went back to the post-mortem brain tissue in search of an answer.”

It was only then that the researchers discovered a previously unknown version of KCNH2, called Isoform 3.1, that soared to levels 2.5 times higher-than-normal in the hippocampus (memory hub) of people who had schizophrenia — especially those with the risk-associated variations. Isoform 3.1 was also higher-than-normal in healthy individuals who carried the risk-associated variations. This signaled the existence of a risk-associated version of the KCNH2 gene.

Healthy controls carrying the risk gene version also:

• Performed significantly worse-than-normal on measures of IQ and mental processing speed. Previous studies have linked similar performance with genetic risk for schizophrenia.
• Inefficiently processed memory in the hippocampus and working memory in the prefrontal cortex, as revealed by functional MRI (magnetic resonance imaging) scans. Although they performed similarly to controls on these tasks, their brains had to work harder to compensate for disordered tuning of circuitry — a phenomenon previously implicated in schizophrenia.
• Showed significantly decreased volume in the hippocampus — a heritable trait — in anatomical MRI scans.

In addition, Isoform 3.1:

• Showed levels 1,000 times lower in the heart than the other main form of KCNH2 and does not exist in lower animals, suggesting that it has evolved a unique role in the primate brain. Mutant forms of KCNH2 in the heart can lead to arrhythmias and even sudden death — a rare risk of taking antipsychotic medications, many of which interact with KCNH2. So targeting this brain-specific form potentially opens the way to development of new treatments free of such cardiac side-effects.
• Dramatically changed activity in rodent brains toward a neuronal firing pattern that may be important for thinking and memory tasks unique to primates.
• Is expressed much more prior to birth, compared to the other main form of KCNH2, suggesting that it plays a prominent role in the early stages of brain development.
• Is associated with a hotspot of variation in an area that controls gene expression, hinting that the suspect variations may contribute to schizophrenia risk by over-expressing Isoform 3.1.

Even though it is normally important for our higher order executive functioning, such over expression of Isoform 3.1 in schizophrenia could result in “abnormally increased neuronal excitability, runaway circuit activity and inefficient information processing,” suggested Stephen Huffaker, Ph.D., the article’s lead author, now a medical student at Harvard. The researchers propose that a treatment designed to inhibit just Isoform 3.1, might spare any heart-related side effects while improving the disorganized neural firing characteristic of the brain in schizophrenia.

In addition to the NIMH, researchers from the NIH’s National Institute on Child Health and Human Development (NICHD) also participated in the research.

Reference:

A primate-specific, brain isoform of KCNH2 affects cortical physiology, cognition, neuronal repolarization and risk of schizophrenia. Huffaker SJ, Chen J, Nicodemus KK, Sambataro F, Yang F, Mattay V, Lipska BK, Hyde TM, Song J, Rujescu D, Giegling I, Mayilyan K, Proust MJ, Soghoyan A, Caforio G, Callicott JH, Bertolino A, Meyer-Lindenberg A, Chang J, Ji Y, Egan MF, Goldberg TE, Kleinman JE, Lu B, Weinberger DR.Nat Med. 2009 May 3.

MEMORY GROWS LESS EFFICIENT VERY EARLY IN ALZHEIMER’S DISEASE

When learning new things, people with emerging symptoms find it harder to separate what’s important from what’s not

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WASHINGTON—Even very early in Alzheimer’s disease, people become less efficient at separating important from less important information, a new study has found.

Knowing this, clinicians may be able to train people in the early stages of Alzheimer’s to remember high-value information better, according to a report in the May issue of Neuropsychology, published by the American Psychological Association.

Remembering what’s most important is central to daily life. For example, if you went to the grocery store but left your shopping list at home, you’d at least want to remember the milk and bread, if not the jam. Or, when packing for a trip, you’d want to remember your wallet and tickets more than your slippers or belt.

Participants in the study were recruited from the Washington University in St. Louis Alzheimer’s Disease Research Center. They included 109 healthy older adults (average age of almost 75), 41 people with very mild (very early) Alzheimer’s disease (average age of almost 76), 13 people with mild (early) Alzheimer’s (average age of almost 77), and 35 younger adults (all 25 or under, average age of almost 20).

The researchers asked participants to study and learn neutral words that were randomly assigned different point values. When asked to recall the items, participants were asked to maximize the total value. All participants, even those with Alzheimer’s, recalled more high-value than low-value items. However, the Alzheimer’s groups were significantly less efficient than their healthy age peers at remembering items according to their value. It meant they no longer maximized learning and memory, which in healthy people are fairly efficient processes.

The authors speculated that Alzheimer’s disease makes it harder for people to encode what they learn in a strategic way. Because encoding is the first step in long-term memory, this affects their ability to remember things according to their value.

The findings also demonstrate that value-directed learning stays intact in healthy aging. Older adults might not remember as much as younger adults, but when healthy, they remain able to distinguish what’s important.

This research suggests the potential for improved memory training. People with early-stage Alzheimer’s might remember important information better by learning to be more strategic and selective when encoding high-value information, even though it comes at the expense of neglecting less-important information, the authors said.

Article: “Memory Efficiency and the Strategic Control of Attention at Encoding: Impairments of Value-Directed Remembering in Alzheimer’s Disease,” Alan D. Castel, PhD, University of California, Los Angeles; David A. Balota, PhD, Washington University in St. Louis; and David P. McCabe, PhD, Colorado State University; Neuropsychology, Vol. 23, No. 3.

(Full text of the article is available from the APA Public Affairs Office and at http://www.apa.org/journals/releases/neu233297.pdf)

Alan Castel can be reached by by e-mail or by phone at (310) 206-9262 or cell (310) 254-6555.

WASHINGTON—Living in another country can be a cherished experience, but new research suggests it might also help expand minds. This research, published by the American Psychological Association, is the first of its kind to look at the link between living abroad and creativity.

“Gaining experience in foreign cultures has long been a classic prescription for artists interested in stimulating their imaginations or honing their crafts. But does living abroad actually make people more creative?” asks the study’s lead author, William Maddux, PhD, an assistant professor of organizational behavior at INSEAD, a business school with campuses in France and Singapore. “It’s a longstanding question that we feel we’ve been able to begin answering through this research.”

Maddux and Adam Galinsky, PhD, from the Kellogg School of Management at Northwestern University, conducted five studies to test the idea that living abroad and creativity are linked. The findings appear in the May issue of the Journal of Personality and Social Psychology, published by the American Psychological Association.

In one study, master of business administration students at the Kellogg School were asked to solve the Duncker candle problem, a classic test of creative insight. In this problem, individuals are presented with three objects on a table placed next to a cardboard wall: a candle, a pack of matches and a box of tacks. The task is to attach the candle to the wall so that the candle burns properly and does not drip wax on the table or the floor. The correct solution involves using the box of tacks as a candleholder – one should empty the box of tacks and then tack it to the wall placing the candle inside.

The solution is considered a measure of creative insight because it involves the ability to see objects as performing different functions from what is typical (i.e., the box is not just for the tacks but can also be used as a stand). The results showed that the longer students had spent living abroad, the more likely they were to come up with the creative solution.

In another study, also involving Kellogg School MBA students, the researchers used a mock negotiation test involving the sale of a gas station. In this negotiation, a deal based solely on sale price was impossible because the minimum price the seller was willing to accept was higher than the buyer’s maximum. However, because the two parties’ underlying interests were compatible, a deal could be reached only through a creative agreement that satisfied both parties’ interests.

Here again, negotiators with experience living abroad were more likely to reach a deal that demanded creative insight. In both studies, time spent traveling abroad did not matter; only living abroad was related to creativity.

Maddux and Galinsky then ran a follow-up study to see why living abroad was related to creativity. With a group of MBA students at INSEAD in France, they found that the more students had adapted themselves to the foreign cultures when they lived abroad, the more likely they were to solve the Duncker candle task.

“This shows us that there is some sort of psychological transformation that needs to occur when people are living in a foreign country in order to enhance creativity. This may happen when people work to adapt themselves to a new culture,” said Galinsky.

Although these studies show a strong relationship between living abroad and creativity, they do not prove that living abroad and adapting to a new culture actually cause people to be more creative. “We just couldn’t randomly assign people to live abroad while others stay in their own country,” said Maddux.

To help get at this question of what causes someone to be creative, the authors tried a technique called “priming.” In two experiments, they asked groups of undergraduate students at the Sorbonne in Paris to recall and write about a time they had lived abroad or adapted to a new culture; other groups were asked to write about other experiences, such as going to the supermarket, learning a new sport or simply observing but not adapting to a new culture.

The results showed that priming students to mentally recreate their past experiences living abroad or adapting to a new culture caused students, at least temporarily, to be more creative. For example, these students drew space aliens and solved word games more creatively than students primed to recall other experiences.

“This research may have something to say about the increasing impact of globalization on the world, a fact that has been hammered home by the recent financial crisis,” said Maddux. “Knowing that experiences abroad are critical for creative output makes study abroad programs and job assignments in other countries that much more important, especially for people and companies that put a premium on creativity and innovation to stay competitive.”

Article: “Cultural Borders and Mental Barriers: The Relationship Between Living Abroad and Creativity,” William W. Maddux, PhD, INSEAD; Adam D. Galinsky, PhD, Kellogg School of Management at Northwestern University; Journal of Personality and Social Psychology, Vol. 96, No. 5.

(Full text of the article is available from the APA Public Affairs Office and at http://www.apa.org/journals/releases/psp9651047.pdf)

Contact William Maddux via e-mail; his phone number is (+33) 680-30-7369.

Contact Adam Galinsky via e-mail; his phone number is 773-495-2999.

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world’s largest association of psychologists. APA’s membership includes more than 150,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting human welfare.

Chronic stress from growing up poor appears to have a direct impact on the brain, impairing working memory, researchers at Cornell University in New York report that The 14-year study of 195 children from households both above and below the poverty line found that chronic stress played a major role in their cognitive development. The study suggests that greater proportion a child in a family spent in poverty, the poorer their working memory, and that link is largely explained by this chronic physiologic stress.  The findings have implications for education where stress at home may have to be included as a factor in teachers’ efforts to help underachieving children. (The Washington Post, 4/6/09)

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WASHINGTON—Spending time with a grandparent is linked with better social skills and fewer behavior problems among adolescents, especially those living in single-parent or stepfamily households, according to a new study. (more…)