Category: Health

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By Scott Bullock, MSW, LISW-S

Lindner Center of HOPE, Clinical Director and Family Therapist Child/Adolescent Services, Harold C. Schott Foundation Eating Disorders Program Clinical Consultant, Cincinnati Children’s Hospital and Medical Center at The Lindner Center of HOPE University of Cincinnati, Department of Psychiatry and Behavioral Neuroscience, Adjunct Instructor

Despite numerous recent advances in the field of brain research, our understanding of the principles that guide the development and operation of the brain and its complex functioning remains elusive. This is particularly true when attempting to understand a multi-faceted illness as anorexia nervosa (AN), however having a comprehensive grasp on the neurobiology on AN brain is mandatory for successful treatment. Thus, with the narrative below, we will be providing some fundamental assumptions about the neurobiology of AN brain, as researched extensively by Dr.W.Kaye.

In AN all body organs, including the brain suffer from malnutrition. Malnutrition affects all parts of the brain and especially the anterior insula. This region acts as the “brain switchboard” assuring that all parts of the brain adequately communicate with each other. The anterior insula plays a key role in the brain’s ability to recognize and process the connection between emotions and cognition and when affected in AN patient, presents with typical symptoms of altered taste, abnormal response to pleasurable foods and body distortions. The neurotransmitters dysregulations in AN are very complex and involve many systems, circuits and brain regions. To date, most research has focused on serotonin function and dopamine/reward systems function that are found to be compromised in AN as briefly outlined below.

Serotonin

Brain imaging studies suggest alterations of 5-HT1A and 5-HT2A receptors and the 5-HT transporterin AN. Dysfunctions of these circuits may affect mood and impulse control as well as the motivating and pleasurable aspects of food consumption leading to a dysphoric mood. In an attempt to reduce their dysphoric mood, the patients engage in dieting and exercise which results in malnourishment of the brain leading to the lowering of tryptophan and steroid hormone metabolism. This then reduces serotonin levels at these critical sites, further increasing dysphoric mood thus perpetuating starvation.This becomes a cyclical action as the patient tries to control their dysphoric mood while driving themselves deeper into the illness.

Dopamine and Reward System

Dopamine system dysfunction might contribute to altered reward and affect, decision-making and executive control, and decreased food ingestion in patients with AN. Dysregulation in this circuit might contribute to patients with AN not being able to correctly act on immediately important tasks but rather focusing on planning and remote consequences.

In conclusion, this is just a glimpse of the complex function of the Anorexic brain. Genetics, puberty, stress, trauma, cultural and social expectations as well as the temperament of the individual also play important roles in the development of AN in adolescents.

 

Ref: Kaye, Walter H., Fudge, Julie L., and Paulus, Martin. New Insights into symptoms and neurocircuit function of Anorexia Nervosa. Nature Reviews/ Neuroscience. 10, 573-587 (2009)

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HP-PIC-green-ribbonWhen we think about cancer, heart disease, or diabetes, we don’t wait years to treat them. We start before Stage4—we begin with prevention. When people are in the first stage of those diseases, and are beginning to show signs of symptoms like a persistent cough, high blood pressure, or high blood sugar, we try immediately to reverse these symptoms. We don’t ignore them. In fact, we develop a plan of action to reverse and sometimes stop the progression of the disease.

So why aren’t we doing the same for individuals who are dealing with potentially serious mental illness?

When you or someone close to you starts to experience the early warning signs of mental illness, knowing what the risk factors and symptoms are will help to catch them early. Often times, family and friends are the first to step in to support a person through these early stages. Experiencing symptoms such as loss of sleep, feeling tired for no reason, feeling low, feeling anxious, or hearing voices, shouldn’t be ignored or brushed aside in the hopes that they go away. Like other diseases, we need to address these symptoms early, identify the underlying disease, and plan an appropriate course of action on a path towards overall health. Mental health conditions should be addressed long before they reach the most critical points in the disease process—Before Stage 4.

Many people do not seek treatment in the early stages of mental illnesses because they don’t recognize the symptoms. Up to 84% of the time between the first signs of mental illness and first treatment is spent not recognizing the symptoms.

Mental Health America’s screening tools can help. Taken online at www.mhascreening.org, a screening is an anonymous, free and private way to learn about your mental health and see if you are showing warning signs of a mental illness. A screening only takes a few minutes, and after you are finished you will be given information about the next steps you should take based on the results. A screening is not a diagnosis, but it can be a helpful tool for starting a conversation with your doctor or a loved one about your mental health.

This May is Mental Health Month; Lindner Center of HOPE is raising awareness of the important role mental health plays in our lives and encouraging members of the community to learn more about their own mental health and to take action immediately if they are experiencing symptoms of a mental illness.

Mental illnesses are not only common, they are treatable. There is a wide variety of treatment options for mental illnesses ranging from talk therapy to medication to peer support, and it may take some time for a person to find the right treatment or combination of treatments that works best for them. But when they do, the results can be truly amazing and life changing. Lindner Center of HOPE wants to help people learn what they can do both to protect their mental health and know the signs of mental illness #B4Stage4.

It’s up to all of us to know the signs and take action so that mental illnesses can be caught early and treated, and we can live up to our full potential. We know that intervening effectively during early stages of mental illness can save lives and change the trajectories of people living with mental illnesses. Be aware of your mental health and get screened #B4Stage4 today!

 

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By: Lynn Gordon, ThD, Spiritual Care Coordinator Lindner Center of HOPE

There was a popular television series in the 1970’s called, “Kung Fu.” I recall an episode when Kwai Chang Caine, the main character played by David Carradine was revisiting a disappointing and sad moment in his youth. In providing support to Caine, Master Po told him, “Ah, grasshopper, you must realize that at every ending lies a new beginning.” I’ve never forgotten that quote and have reminded myself of its truth throughout my life.

2014 is now history and we are now launched into 2015! Many, if not all of us have experienced disappointing and sad moments this past year. Difficulty is no respecter of persons. Consider what the late inventor, Thomas Edison so profoundly stated as he watched his life’s work go up in flames, as he witnessed his house and laboratory being destroyed by a fire in 1917, “All my mistakes are now up in flames, but with God’s help, we can start anew.” After experiencing such a tragic loss at the age of 67, Mr. Edison could have easily quit and retired but, he chose to put his words into action – and started anew! Then, just three weeks after the fire, Thomas Edison invented the phonograph.

When it comes to certain disappointments and setbacks experienced in 2014, one must realize that most things cannot be changed. However, the good news is that one can choose to take action in 2015 – and start anew! The following are some suggestions on How to Delve in 2015 to make it a more positive year:

1. Choose to forgive – Forgiveness is a choice. Forgiveness is not forgetting the hurt or pain caused by someone else – sometimes this is impossible. Rather, it’s remembering that the offense has been forgiven. This allows the offended to take his/her power back that someone has taken from them. Forgiveness can unlock the chains that hold us hostage in life, even when the offense took place years before.

2. Increase my laughter – There is a proverb that says, “A merry heart doeth good like a medicine.” Life can be overwhelming with all its serious issues and events. Consider including humor in your daily activities. Jump start your day by reading a humorous joke, watch a good comedy show or movie on television, and allow laughter to brighten your day and lighten the load of the cares of the world. Laughter can also be contagious and can benefit others around you.

3. Say, “Thank you”, “I’m sorry”, and “I need your help”. These important phrases will strengthen one’s attitude of gratitude, ensure harmony in relationships, and is always a good reminder that there is support out there when needed.

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Elizabeth Wassenaar, MS, MDDuring a recent episode of One Hour At A Time, Lindner Center of HOPE staff psychiatrist, Elizabeth Wassenaar, MS, MD, offered insight into the adolescent brain. The episode focused on the following:

Adolescence is a time of enormous change and growth. The conversation offered a closer look at the unique developmental tasks of adolescence and an exploration of what is known so far about the way the adolescent brain changes. When all goes well, children leave adolescence as adults. However, when mental illness creates a barrier, development can go off course. The conversation also discussed the ways that teens experience mental illness and substance use disorders that are distinct to this time in one’s life. Finally, the show explored various diagnostic interventions that can help with accurate diagnosis and the appropriate choice of treatment intervention to restore hope.

To listen to the show, click here.

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November, 2014—For many people, the comfortable fall air marks the end of daylight savings time and the start of a busy holiday season. However, the dark reality of less daylight, the approaching winter months, and heightened holiday stress can lead to depression.

According to the American Academy of Family Physicians, nearly six out of 100 people in the U.S. experience winter depression or Seasonal Affective Disorder (SAD). Research shows it is more common for those living in areas where winter days are very short. Common symptoms include a change in appetite, weight gain, fatigue, tendency to oversleep, irritability and avoidance of social situations. Researchers believe the lack of bright light during winter makes a difference on brain chemistry.

A study published in the Archives of General Psychiatry cites researchers from the University of Toronto, who performed brain scans on 88 healthy people over the course of a year. The scans showed that the serotonin system fluctuates in activity based on the season. The lowest levels of activity tend to be in the fall and winter, suggesting that less serotonin circulates in the brain during the darker, colder time of the year. The researchers believe that the serotonin levels may help explain why people have a change in mood and behavior during the darker seasons.

According to Dr. John Hawkins, Chief of Psychiatry and Deputy Chief of Research for Lindner Center of HOPE, “Many people develop cabin fever during the winter months. Individuals may find themselves eating more or sleeping more when the temperature drops and days offer less light.” These reactions are common and normal due to the change in season, however, people with SAD experience a much more serious reaction when summer shifts to fall and on to winter, he says. “Those at risk may have feelings of depression, lethargy, fatigue and other problems. If the symptoms are severely impairing daily life, they should be taken seriously and professional help should be considered.”

According to Dr. Hawkins, treatments such as light therapy or bright light treatment and medication are commonly used to treat SAD. Psychotherapy can also be helpful, reinforcing coping and support interventions. Preventative and coping tips include:

  • Exercising and eating well
  • Letting light in through windows
  • Participating in Stress Management classes
  • Seeking the help of a clinician if symptoms persist

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By:  Erik Messamore, MD, PhD

Dr. Messamore is both a clinical psychiatrist and psychiatric researcher at the Lindner Center of HOPE. He reviews new or little-known clinical research findings at his website – DrErik.com

 

Borderline personality disorder is characterized by mood disturbance and impulsivity. Moods in borderline personality can shift rapidly and are often intense. Anger problems are common. In its most severe forms, people with borderline personality may dissociate or experience brief episodes of psychosis. Self-injury (often from cutting) and frequent suicide attempts are common. Borderline personality disorder affects about 3% of the adult population and accounts for over 20% of outpatient psychiatric visits.

Psychotherapy is the treatment of choice for borderline personality disorder, and Dialectical Behavior Therapy (DBT) is often the most well suited form of therapy for patients with borderline personality. DBT fosters mindful awareness and teaches coping skills that can significantly improve emotional regulation.

Unfortunately, there are no medications specifically designed to treat borderline personality disorder. Antidepressants, or “mood-stabilizing” agents, or antipsychotic medications may help reduce the severity of some of the symptoms. However the response to these treatments is highly variable. There is strong need for more options with less risk for side effects. Emerging research points to a possible benefit from omega 3 fatty acids.

Omega-3 fatty acids are important components of cell membranes, and they seem to be particularly important in brain function. Omega-3s such as EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are present in the brain and exist in relatively high concentrations in the nerve terminal regions, where most cell-to-cell communication takes place. Depression is less common in people whose regularly consume omega-3-rich foods such as fish. Even schizophrenia appears to be less disabling in countries with higher consumption of vegetables or fish. Laboratory research has firmly established that experimental creation of omega-3 deficiency causes abnormal behavior in lab animals. And in human studies, researchers have repeatedly discovered associations between omega-3 fatty acid levels and symptoms of psychosis, depression, impulsivity and self-harm.

Emerging research suggests that omega-3 fatty acids can be used therapeutically in borderline personality disorder. In treatment studies, researchers rely on just two omega-3 components: EPA and DHA. Silvio Bellino and colleagues from the University of Turin in Italy showed that EPA (1200 mg per day) plus DHA (800 mg per day), when added to therapeutic doses of Depakote, reduced impulsivity, anger, and self-harm in a group of patients with borderline personality disorder. In a separate study from Harvard University, Mary Zanarini and Frances Frankenburg showed that an 8-week course of treatment with EPA (1000 mg per day) outperformed placebo treatment in reducing depression and aggression in women with borderline personality. Research from Brian Hallahan’s group in Dublin, Ireland showed substantial reductions in suicidal thoughts and depression among patients with a history of multiple self-injury attempts (70% of the study sample had borderline personality disorder). Treatment in this study consisted of 12 weeks of daily EPA (1,220 mg per day) and DHA (908 mg per day). And finally, Paul Amminger led a study at the University of Vienna in Austria. The study focused on a group of adolescents with borderline personality disorder whose symptoms also suggested high risk of progression to psychosis. Volunteers in the study received either placebo capsules or active treatment with daily EPA (700 mg) plus DHA (480 mg) for twelve weeks. The EPA+DHA produced large decreases measures of depression, tension, anxiety, and impulsivity. The omega-3 fatty acids also prevented psychosis in the high-risk patients.

Side effects from omega-3 fatty acids are usually very mild. They are “generally regarded as safe” in the eyes of the FDA at the doses used in these studies. Scientists still have much work to do in figuring out which types of patients may most benefit from this kind of treatment, and what would be the best doses or durations of treatment.

Borderline personality disorder is a potentially severe condition that can be improved substantially with treatment. Psychotherapy is the most effective evidence-based treatment for borderline personality. It is encouraging to learn that EPA and DHA may help to reduce symptoms. These natural substances may prove to be useful parts of a combined biological and psychological treatment approach.

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When we talk about wellness and the mind/body connection, we often think of the importance of exercise and healthy eating for good physical and mental health.  But did you know that one of the most helpful activities for promoting total wellness dates back thousands of years?  It’s the ancient practice of meditation, and its use is showing surprising results among 21st century researchers.

Because of its benefits, an increasing number of physicians are prescribing meditation as part of their patients’ healthcare routines.  Clinics and hospitals across the nation now integrate meditation and related mind/body techniques into their clinical practice.

Physical Health Benefits of Meditation

The daily practice of meditation has been associated with improvements in a variety of health problems, including hypertension, insomnia, irritable bowel syndrome, and chronic pain.  Just 20 minutes twice each day is sufficient.

Over 500 research studies have been conducted to determine the effect of regular meditation on health problems.  Current research is examining more long-term effects and looking at the role of meditation in preventing chronic diseases and increasing longevity.

Mental Health Benefits of Meditation

Because of its relaxing effects upon the mind and body, meditation has long been used to reduce stress and anxiety.  Meditation appears to help activate the parasympathetic nervous system.  As it slows the release of stress hormones as well as heart and breathing rates, it improves the body’s overall relaxation response.

Research now shows that meditation can also reduce depression in affected individuals.  In one study of family caregivers, it was found that research participants who meditated had lower levels of depression than those who only listened to relaxing music.

Additionally, meditation may increase brain alertness. Meditation appears to improve people’s cognitive abilities, including attention and memory.  Research using medical imaging has demonstrated that meditation improves the functioning of certain circuits in the brain, as well as potentially reducing shrinkage in older adults’ critical brain centers.

Moving Forward

At the National Institutes of Health, the Center for Complementary and Alternative Medicine has provided funding for several new studies to determine the effect of meditation on many health conditions.  It is anticipated that further research will bring new findings on the best types and frequency of meditation, along with other practice issues.

Most clinical practices today use meditation techniques based on Mindfulness-Based Stress Reduction.  This type of meditation was developed by the University of Massachusetts’ medical school and utilizes yoga, stretching exercises, and mindfulness meditation.  Mindfulness meditation pays close attention to breathing techniques while the individual sits in a restful posture.

Whatever the approach, making a commitment of no more than 40 minutes each day may be a small price to pay for improved physical and mental health.

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You may have heard the expression: “healthy mind, healthy body.”  But do you know what it really means?  For centuries, a connection has been theorized to exist between physical and mental health.  Modern science has now demonstrated that such a connection really does exist.

The role of a healthy diet, proper sleep, regular exercise, and other lifestyle practices in promoting better mental health is at the core of many behavioral health treatment regimens.  Such practices may also play a role in preventing future mental health problems.

Conversely, physical health is dependent upon one’s state of mind, as the body responds to the ways in which each of us feels, thinks, and acts.  This fact is at the heart of the mind-body connection. Emotional or mental imbalance creates physical symptoms, from aches and pains to elevated blood pressure.  These in turn can lead to chronic health problems and disease.

Ideally, an individual should strive for a state of total wellness, one in which there is a sense of balance in the mental, physical, spiritual, and social elements of his or her life. Following wellness principles can help one achieve increased resiliency, greater longevity, and overall better physical and mental health.

The Role of the Mind upon the Body

Mental or emotional problems are associated with the development of physical disease. An estimated 95% of all illnesses can be caused or aggravated by stress. Individuals with high stress levels are even more likely to catch colds. It is not uncommon for individuals to develop hypertension or an ulcer after particularly stressful life events.

Depression has been linked to a range of disorders, including strokes, heart disease, and diabetes.  Other mood and emotional problems can also take a toll. In one study, people who had difficulty coping with anger were found to have a ten times greater risk for the development of heart arrhythmias.  Anger-prone physicians have been found to have higher risks of heart attacks than even smokers or individuals with high blood pressure.

The right attitude and social supports can affect health in more positive ways, however. The old saying, “Laughter is the best medicine” is true, as it has been found to reduce pain, speed healing, and increase creativity. Being active in a group—even something as simple as a bowling club—can actually increase one’s longevity, regardless of other health habits. Social networks also provide needed support. In one study of women with metastatic breast cancer, participation in support groups doubled survival rates.

Scientists have found that individuals with mental health or substance abuse problems have a life expectancy decades lower than the general population.  Taking care of one’s physical health is a critical part of the recovery process for those with behavioral health problems.

The Role of the Body upon the Mind

Research supports the role of physical activity in helping manage mental disorders. Active people have been found to be less depressed than inactive ones, and people with chronic depression are more like to go into remission with regular exercise.

Due to increased levels of oxygen and endorphins, individuals who exercise regularly feel more alert and have more energy, better memory retention, and a greater sense of wellbeing. As little as 20-30 minutes of vigorous physical activity daily is sufficient to achieve results.

Yoga, meditation, and other relaxation strategies have been found to ease stress, depression, and sleep problems. There is growing evidence that the practice of meditation can even slow cognitive decline in older adults.

Eating healthy foods in moderation can increase emotional well-being and reduce many of the physical problems often associated with mental illness, such as fatigue and obesity.

Getting approximately eight hours sleep per night is a goal few adults achieve, but the benefits are worth the effort.  Adequate sleep improves mood and concentration, as well as decreasing physical health risks.

By following these healthy lifestyle practices, individuals may significantly improve both their mental and physical health.