TAG: "Mental health"

Study ID’s biological mechanisms for schizophrenia, depression

Genes relating to immune function and histone methylation are risk factors.

Daniel Geschwind, UCLA

By Mark Wheeler, UCLA

Common psychiatric disorders such as schizophrenia, bipolar disorder and major depression share genetic risk factors related to immune function and DNA regulation, according to new findings by a large collaborative research project from the Psychiatric Genomics Consortium involving UCLA, King’s College London, Cardiff University, Harvard and MIT.

The study was published online by the journal Nature Neuroscience.

Thousands of genetic differences in the human genome act together to increase the risk for psychiatric conditions such as schizophrenia. However, until now, it has not been clear how these genetic changes affect biological processes that then go on to alter brain function.

In the study the group analyzed genetic data from more than 60,000 participants, including individuals with schizophrenia, bipolar disorder, major depression, autism spectrum disorders and attention deficit hyperactivity disorder, as well as healthy individuals. The aim was to identify which biological and biochemical pathways caused risk for these disorders.

By grouping the genetic data together, the consortium found that genes relating to immune function and histone methylation — molecular changes that alter DNA expression — are risk factors associated with the development of all the disorders. Such biological pathways are important, they noted, because they are much broader drug targets than single genes or proteins.

“We took the hundreds of genes in the biological pathways identified by our collaborators and modeled them as a gene network,” said Daniel Geschwind, a UCLA professor of neurology, psychiatry and genetics, and a study author.

This approach allowed the researchers to explore the role of these pathways during brain development and aging. Geschwind said that this further enhanced their ability to detect shared biology across these diseases and identifies the points in time and regions of the brain that are most susceptible.

“The success of this approach supports the utility of pathway and network analyses in understanding psychiatric disease,” said Geschwind, who is also director of the Center for Autism Research and Treatment at the UCLA Semel Institute. “This is an approach that will only grow more powerful as more loci are identified with even larger studies in the next few years.”

The study is the result of many years of work by hundreds of investigators worldwide in the Psychiatric Genomics Consortium, an international, multi-institutional collaboration founded in 2007 to conduct broad-scale analyses of genetic data for psychiatric disease. The PGC is currently genotyping new samples to further study these and additional psychiatric diseases, including anorexia and post-traumatic stress disorder.

Core funding for the Psychiatric Genomics Consortium comes from the National Institute of Mental Health, along with grants from governmental and charitable organizations, as well as philanthropic donations. Work conducted at King’s College London was funded by the National Institute for Health Research Biomedical Research Centre and Dementia Unit at King’s and South London and Maudsley, the NHS Foundation Trust and Cardiff by the MRC and the Wellcome Trust. Work at the Broad Institute’s Stanley Center for Psychiatric Research was funded by Sylvan Herman Foundation and the Stanley Medical Research Institute.

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UCLA’s resilience-building programs for veterans, their families lauded

Research-based programs to enhance mental health help veterans, their families cope.

By Mark Wheeler, UCLA

A new report evaluating the impact of research-based programs designed to enhance the mental health of military families, has found compelling evidence that such programs help veterans and their families build resilience to cope with the effects of wartime service and combat-related physical and psychological injuries.

The report, issued by the nonprofit RAND Corp., a global think tank, assessed the impact of the Welcome Back Veterans Initiative, a joint project of philanthropic groups and six major academic centers, including the UCLA Nathanson Family Resilience Center, which provide an array of patient care, educational and other services to veterans and their families. The initiative, funded by Major League Baseball Charities and the Robert R. McCormick Foundation, was launched in 2008.

Between 2011 and 2013, the Welcome Back Veterans Initiative awarded grants totaling $5.4 million to support returning service members, veterans and their families. During that period, the six academic medical centers received funding. The RAND study found that initiative partners collectively provided screening, referral and treatment services to more than 3,600 individuals with military and veteran affiliations; networked with 188 organizations; and conducted 228 training sessions or workshops to build new skills and capacities among veterans, organizations that serve them, and community-based providers.

The report concluded that the Welcome Back Veterans Initiative could provide a model for similar efforts should federal officials decide to expand privately provided health care as part of its reform of the Veterans Affairs health system.

“Wartime military experience can be psychologically challenging for both service members and their families,” said Dr. Patricia Lester, the Jane and Marc Nathanson Family Professor of Psychiatry at the UCLA Semel Institute for Neuroscience and Human Behavior and director of the Nathanson Center. “As a nation, we owe these families the best possible mental health care services, supported by the latest research, to strengthen their ability to cope with the separations, reintegrations and traumatic events. That is what we have built at the Nathanson Center, thanks to the support of the Welcome Back Veterans Initiative.”

The UCLA Nathanson Family Resilience Center used the financial support from the Welcome Back Veterans Initiative to adapt, evaluate and disseminate innovative programs that decrease the negative effects of deployment among Iraq and Afghanistan war veterans and their families. Significant numbers of military personnel who served in those wars suffer from mental health issues such as post-traumatic stress, anxiety, trauma and even traumatic brain injury.

Since 2006, the Nathanson Center has partnered with the U.S. military to provide an array of evidence-informed programs in resiliency training that have touched the lives of thousands of military families facing the challenges of deployment and reintegration. The programs aim to build on strengths and reduce stress through communication, problem-solving skills and proactive strategies that include learning how to recognize and cope with emotional triggers.

Housed within the Semel Institute, the Nathanson Center’s Welcome Back Veterans program works closely with local, state and national military and veteran leadership, community agencies, health and mental health systems, educational institutions and policy-makers. Combining research, practice and innovative technologies, the center develops family and community interventions — including web-based tools, education and training materials — that can be implemented in a variety of contexts. Programs include:

  • FOCUS (Families OverComing Under Stress) Family Resilience Training. FOCUS strengthens families and couples facing stressful or traumatic events with a skill-building program that helps to clarify misunderstandings, enhances communication and supports collaborative problem-solving through the expression of a shared family story. FOCUS can be customized, with specialized services available for wounded warriors, female veterans and families with children of any age.
  • TeleFOCUS. Adapted for wounded warriors and their families, TeleFOCUS provides family resilience training at a distance, via a remote videoconferencing system, to help the entire family heal from the visible and invisible wounds of war.
  • National Military Family Association Operation Purple Family Retreats and Healing Adventures. Operation Purple supports military families during the reunification process by bringing them together in beautiful national park settings to strengthen and renew relationships using the FOCUS model. Healing Adventures offers a similar experience with adaptive activities for families of a wounded, ill, or injured service member.
  • Project FOCUS. Contracted by the Navy Bureau of Medicine and Surgery and the Office of Military Family and Community Policy, Project FOCUS provides an embedded psychological health and resilience program for military couples and families affected by transitions, combat stress and physical injuries. FOCUS is currently available on 24 military installations throughout the United States and Pacific Rim.
  • Operation Mend-FOCUS for wounded warriors and their families. Operation Mend-FOCUS extends mental health care and FOCUS services to patients with combat-related injuries and their families. The program collaborates with expert surgeons at UCLA’s Operation Mend program to heal physical wounds while recognizing that comprehensive care requires loving attention to the needs of both the service member being treated and the family.

The RAND report, “Enhancing Capacity to Address Mental Health Needs of Veterans and Their Families: The Welcome Back Veterans Initiative,” is available at www.rand.org. More information about the Welcome Back Veterans Initiative is available at www.welcomebackveterans.org.

Other centers funded by the Welcome Back Veterans Initiative include BraveHeart Southeast Veterans Initiative at Emory University; Duke University Veteran Culture and Clinical Competencies (V3C) initiative; Massachusetts General Hospital’s Home Base Program; the University of Michigan’s Military Support Programs and Networks; and Weill Cornell Medical College Department of Psychiatry’s Program for Anxiety and Traumatic Stress.

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Perceptions, referrals by providers affect mental health treatment disparities

Asian-American patients least likely to be assessed or counseled for mental health problems.

Oanh Meyer, UC Davis

By Phyllis Brown, UC Davis

Disparities in mental health treatment are known to be associated with patients’ racial and ethnic backgrounds. Now, a large study by researchers with UC Davis has found one possible reason for those disparities: Some racial and ethnic minorities are less likely to be assessed and referred for treatment by their medical providers.

The study of more than 9,000 diverse individuals, including Latinos, African Americans, Asian Americans and non-Hispanic whites, found that patients of different racial and ethnic backgrounds reported experiencing differing treatment approaches from medical providers, such as primary care physicians and specialists, including referrals to mental health care and medications, and that these differences were associated with race.

The research, “Disparities in Assessment, Treatment, and Recommendations for Specialty Mental-Health Care: Patient Reports of Medical Provider Behavior,” is published online today (Dec. 1) in Health Services Research, a journal of the Health Research and Educational Trust of the American Hospital Association.

It found that when compared with non-Hispanic white patients, Asian-American patients were the least likely to be assessed or counseled for mental health or substance abuse problems, and also were less likely to receive recommendations for treatment with medication. These differences were resolved after factors such as education, income and clinical diagnosis were taken into account, said Oanh Meyer, a postdoctoral scholar in the UC Davis Department of Neurology.

“These findings are especially important for medical providers treating racial and ethnic minorities,” Meyer said. “Minorities are far more likely to seek treatment for their mental health problems from their primary care physicians. Since these providers are the source of referrals to mental health professionals, they serve as the gatekeepers.”

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UC Davis launches Research Center for Behavioral Health

Sacramento campus receives $7.5M for new research hub; UCLA launching similar center.

The launch of the Behavioral Health Center of Excellence at UC Davis featured a ceremonial ribbon-cutting. Pictured (from left) are UC Davis Provost Ralph Hexter, patient advocate Bonnie Hotz, UC Davis Vice Dean Fred Meyers, Sen. Darrell Steinberg, UC Davis Vice Chancellor and Dean Julie Freischlag, and UCLA professor Peter Whybrow. Hidden from view is UC Davis professor Cameron Carter, who's expected to become the executive director of the new center.

UC Davis Health System officials and California Senate leader Darrell Steinberg today (Oct. 1) announced the founding of a unique academic research center designed to improve mental health in California and serve as a national model for advancing innovative research in neuroscience, as well as the prevention of and early interventions in mental illness.

Known as the Behavioral Health Center of Excellence at UC Davis, the $7.5 million project will become the university’s hub for bringing together its wide-ranging research, education, clinical care and community engagement as they relate to neuroscience, mental health and public health improvement.

The new center will be located on the university’s Sacramento campus. It will complement a similar, $7.5 million center that is being established in Southern California at UCLA.

“Mental health is an issue that knows no partisan lines. Its impacts and suffering escape no race, class, gender, age, or sexual orientation. It affects every other agenda we address in the Legislature.” Steinberg said. “Having dedicated behavioral health centers in the state will be the catalyst for improving our understanding of the human mind and finding answers for individuals and their families.”

Grant funding for the two centers was approved by the state’s Mental Health Services Oversight and Accountability Commission earlier this year. UC Davis plans call for researchers to explore everything from telehealth delivery of behavioral health care and the economics of prevention to how medical and mental-health services might be better integrated in clinical settings.

“This center is so promising because it enables UC Davis to work from its core strengths in brain research, new technologies for clinical care, reducing health disparities and effectively engaging communities,” said Frederick Meyers, vice dean of UC Davis School of Medicine and who will serve as director of the new center. “We plan to closely measure and evaluate our research results so that we can identify and translate into practice the best ways to achieve behavioral-health improvement.”

Meyers said the UC Davis center will be a catalyst for developing more research expertise in behavioral health, as well as better techniques and training to address wellness, recovery and resilience to mental illness. The university plans to partner in its research efforts with other health organizations and government-related institutions, including counties throughout Northern California.

The new center’s leadership team, which includes Cameron Carter, a UC Davis professor of psychiatry and behavioral sciences specializing in the early diagnosis and treatment of schizophrenia and other cognitive mental disorders, will also study community programs, alternatives to hospitalization, shared services with jails, hospitals and courts, and identify new approaches to reducing mental health stigmas.

“The center of excellence in behavioral health is one product of the work we started many years ago with Proposition 63 and the state’s Mental Health Services Act,” said Steinberg, a longtime leader on mental health issues. “Like the UC Davis’ MIND Institute, which has earned international recognition for its work in autism, the Behavioral Health Center of Excellence at UC Davis can bring together in one place the academic skills, talent and experience that we need to address some of the most challenging problems that many California families are facing.”

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Project launched to develop depression care for older adults

UC Davis and University of Washington receive $2.5M grant from Archstone Foundation.

Ladson Hinton, UC Davis

UC Davis and the University of Washington are implementing a project to develop innovative new models of care for depression in older adults through a $2.5 million grant from the California-based Archstone Foundation, a private grant-making organization whose mission is to contribute toward the preparation of society in meeting the needs of an aging population. The grant launches Archstone Foundation’s Depression in Late Life Initiative to improve the quality of life for older adults suffering from depression.

The work of this grant is based on a one-year systematic review of the literature and current practice. It will advance care for late-life depression by supporting innovative approaches to promote partnership and collaboration among primary care clinics, family members, friends and community-based organizations. Through the Archstone Foundation’s Depression in Late Life Initiative, a number of organizations will also be funded to carry out this effort in California.

Depression is common among older adults and comes at a high cost to patients and their families. Major depression affects 2 to 5 percent of older adults in the community, 5 to 10 percent of older adults in primary-care settings, and as many as 50 percent in nursing homes.

The UC Davis group will be led by Ladson Hinton, professor in the Department of Psychiatry and Behavioral Sciences and a nationally recognized expert in minority mental health and aging. Hinton is the director of the Latino Aging Research Resource Center and the education core of the UC Davis Alzheimer’s Disease Center. The University of Washington group is led by Jürgen Unützer, chair of the Department of Psychiatry at the University of Washington, and the developer of the Improving Mood–Promoting Access to Collaborative Treatment (IMPACT) model, the leading collaborative care program for late-life depression, which has been implemented in more than 500 clinics around the country.

“This initiative will help build on the success of collaborative care and include important partners, such as family members and community-based organizations,” Hinton said.

“While we have evidence-based treatments for depression in primary care, such as collaborative care, very little work has been done to mobilize community agencies (i.e. adult-day health programs, senior centers, meals on wheels, faith-based organizations) and families to help in the process,” he said. “Archstone Foundation’s Depression in Late Life Initiative addresses this important gap in the field, and may also help to engage groups at risk for under-treatment of their depression, such as ethnic minority elders and older men.”

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Depression questionnaires could lead to unneeded antidepressant prescriptions

Study highlights need for research to determine how best to apply such questionnaires.

Anthony Jerant examines a patient in the Family & Community Medicine Clinic of UC Davis Health System.

Short questionnaires used to identify patients at risk for depression are linked with antidepressant medications being prescribed when they may not be needed, according to new research from UC Davis Health System to be published in the September-October issue of the Journal of the American Board of Family Medicine.

Known as “brief depression symptom measures,” the self-administered questionnaires are used in primary care settings to determine the frequency and severity of depression symptoms among patients. Several questionnaires have been developed to help reduce untreated depression, a serious mental illness that can jeopardize relationships, employment and quality of life and increase the risks of heart disease, drug abuse and suicide.

The UC Davis team was concerned that the questionnaires might lead to prescriptions for antidepressant medication being given to those who aren’t depressed. Antidepressants are effective in treating moderate-to-severe depression but can have significant side effects, including sexual dysfunction, sedation and anxiety. They also have to be taken over several months to be effective.

“It is important to treat depression, but equally important to make sure those who get treatment actually need it,” said Anthony Jerant, professor of family and community medicine at UC Davis and lead author of the study.

The exploratory study included 595 patients of primary care offices affiliated with Kaiser Permanente in Sacramento, San Francisco VA Medical Center, Sutter Medical Group in Sacramento, UC Davis, UC San Francisco and VA Northern California Healthcare System.

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Schizophrenia and happiness

UC San Diego research suggests that mental illness doesn’t preclude enjoying life.

Dilip Jeste, UC San Diego

Schizophrenia is among the most severe forms of mental illness, yet some people with the disease are as happy as those in good physical and mental health according to a study led by researchers at the UC San Diego School of Medicine.

The study is published online this week in the journal Schizophrenia Research.

“People tend to think that happiness in schizophrenia is an oxymoron,” said senior author Dilip V. Jeste, M.D., Distinguished Professor of Psychiatry and Neurosciences.

“Without discounting the suffering this disease inflicts on people, our study shows that happiness is an attainable goal for at least some schizophrenia patients,” said Jeste, who is also the Estelle and Edgar Levi Chair in Aging and director of the Sam and Rose Stein Institute for Research on Aging at UC San Diego.  “This means we can help make these individuals’ lives happier.”

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3 of 4 California children with mental health needs don’t get treatment

Barriers to care persist, even though 95 percent have health insurance.

More than 300,000 California children between the ages 4 and 11 need mental health care, but only one in four is treated, according to a new policy brief from the UCLA Center for Health Policy Research — this, despite the Centers for Disease Control and Prevention recommending early-childhood intervention as a critical step in reducing the severity of mental health problems in adulthood.

“Without early assessment, you miss warning signs, as well as opportunities to intervene,” said D. Imelda Padilla-Frausto, a researcher at the center and lead author of the study. “Waiting can lead to more serious problems later.”

While about 8.5 percent of all California children in the 4-to-11 age group are identified as having mental health care issues — including conduct problems, emotional symptoms, hyperactivity and problems with peers — parents reported that 70.8 percent of these children went without emotional or psychological counseling over the previous year, according to the study, which used California Health Interview Survey (CHIS) data from 2007–09.

The study looked at a number of factors that contribute to mental health needs among children and obstacles that may contribute to a lack of treatment.

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New direction suggested for treating mental health disorders

Experts urge new discipline combining benefits of neuroscience, psychology treatments.

Michelle Craske, UCLA

When a patient talks with a psychological therapist, what changes occur in the patient’s brain that relieve mental disorders? UCLA psychology professor Michelle Craske says the honest answer is that we don’t know. But, according to Craske and two colleagues, we need to find out.

Mental health disorders — such as depression, schizophrenia, post-traumatic stress disorder, obsessive–compulsive disorder and eating disorders — affect 1 in 4 people worldwide. Psychological treatments “hold the strongest evidence base for addressing many such conditions,” but they need improvement, according to a study by Craske, Cambridge University professor Emily Holmes and MIT professor Ann Graybiel.

Their article was published online July 16 in the journal Nature.

For some conditions, such as bipolar disorder, psychological treatments are not effective or are in their infancy, the life scientists report, and a “culture gap” between neuroscientists and clinical scientists has hindered the progress of mental health treatments. The authors call on scientists from both disciplines to work together to advance the understanding and treatment of psychological disorders.

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Depression associated with lower survival rates in men with prostate cancer

UCLA study finds patients are often diagnosed later, receive less effective therapies.

Jim Hu, UCLA

Depressed men with localized prostate cancer are more likely to be diagnosed with more aggressive cancer, receive less effective treatments and survive for shorter times than prostate cancer patients who are not depressed, a UCLA study has found.

The study’s lead author, UCLA professor Dr. Jim Hu, said the negative outcomes may be the result of several factors, including bias against people with mental illness, depression’s impact on cancer’s biological processes, the patient’s lack of investment in his general health and disinterest in more effective care, and missed opportunities by physicians to educate patients about prostate cancer screening and treatment.

The population-based observational study used data from the Surveillance, Epidemiology and End Results Medicare database. Researchers focused on 41,275 men diagnosed with localized prostate cancer between 2004 and 2007 and observed through 2009, of whom 1,894 had a depressive disorder that had been discovered in the two years before the cancer was diagnosed.

“Men with intermediate- or high-risk prostate cancer and a recent diagnosis of depression are less likely to undergo definitive treatment and experience worse overall survival,” said Hu, UCLA’s Henry E. Singleton Professor of Urology and director of robotic and minimally invasive surgery at the David Geffen School of Medicine at UCLA. “The effect of depressive disorders on prostate cancer treatment and survivorship warrants further study, because both conditions are relatively common in men in the United States.”

The study was published online by the Journal of Clinical Oncology, a peer-reviewed journal of the American Society of Clinical Oncology.

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Gun violence and mental illness: Study addresses perception vs. reality

Gun violence can be reduced with risk-based approach to firearms possession, purchases.

Vickie Mays, UCLA

Recent mass killings in Isla Vista and elsewhere have again raised concern among lawmakers and the media about the possible connection between mental illness and gun violence. A new study sets the record straight and recommends an evidence-based approach to limiting firearms fatalities.

A group of international scholars, including co-author Vickie Mays of UCLA, analyzed dozens of epidemiological studies on gun violence and mental illness and compared the results to media-fueled public perceptions about the dangerousness of mentally ill individuals.

The researchers found that mass murderers with mental health problems, while they receive a tremendous amount of media attention, are not typical of those who commit violent crimes, and the vast majority of those with serious mental illness do not engage in violent acts.

Still, the study authors stress, gun violence can be reduced by instituting policies at the federal and state level that prohibit firearms possession among individuals who display clear risk factors for violence.

The new research is published online in the journal Annals of Epidemiology and will be published in an upcoming print edition.

“We need more evidence-based policies to effectively prevent gun violence,” said Mays, a professor of psychology and health services who directs the Center for Research, Education, Training and Strategic Communication on Minority Health Disparities in the UCLA College. “We also need to expand mental health services and improve access to treatment — some people are slipping through the cracks. But mental illness is not the main cause of violence in society. Policies should focus more on limiting access to firearms for people with behavioral risk factors for violence during specific times when there is evidence that risk is elevated.”

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Poor health, lifestyle factors linked to memory complaints

Early complaints often precursors to significant decline in later life, UCLA/Gallup study says.

Gary Small, UCLA

If you’re depressed, don’t get enough exercise or have high blood pressure, you may find yourself complaining more about memory problems, even if you’re a young adult, according to a new UCLA study.

UCLA researchers and the Gallup organization polled more than 18,000 people about their memory and a variety of lifestyle and health factors previously shown to increase the risk of Alzheimer’s disease and dementia. They found that many of these risk factors increased the likelihood of self-perceived memory complaints across all adult age groups.

The findings, published in today’s (June 4) edition of the journal PLOS ONE, may help scientists better identify how early lifestyle and health choices impact memory later in life. Examining these potential relationships, researchers say, could also help to pinpoint interventions aimed at lowering the risk of memory issues.

The 18,552 individuals polled ranged in age from 18 to 99. The known risk factors the researchers focused on included depression, lower education levels, physical inactivity, high blood pressure, diabetes, obesity and smoking. They were surprised by the prevalence of memory issues among younger adults, said the study’s senior author, Dr. Gary Small, UCLA’s Parlow–Solomon Professor on Aging and director of the UCLA Longevity Center.

“In this study, for the first time, we determined these risk factors may also be indicative of early memory complaints, which are often precursors to more significant memory decline later in life,” said Small, who is also a professor of psychiatry and biobehavioral sciences at the Semel Institute for Neuroscience and Human Behavior at UCLA.

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