TAG: "Psychiatry"

Psychotic hallucinations, delusions rarely precede violence

UC Berkeley study reviews 305 violent incidents in U.S.; 12 percent preceded by psychosis.

By Yasmin Anwar, UC Berkeley

Mass shootings at the hands of unhinged loners – such as those in Aurora, Colorado; Santa Barbara, California; and Newtown, Connecticut – perpetuate a commonly held belief that mental illness triggers violent crimes.

But a new study from UC Berkeley shows that hallucinations and delusions associated with psychiatric disorders seldom foreshadow acts of aggression.

In a painstaking review of 305 violent incidents in the United States, the researchers found that only 12 percent were preceded by psychosis. While numerous studies have found that brutality and bloodshed are more likely to be sparked by anger, access to firearms and substance abuse, this latest analysis is the first to look at the regularity of psychosis-induced violence among the mentally ill.

The results, recently reported in the online edition of the journal Clinical Psychological Science, challenge the media-fueled stereotype of homicidal mayhem.

“High-profile mass shootings capture public attention and increase vigilance of people with mental illness. But our findings clearly show that psychosis rarely leads directly to violence,” said study lead author Jennifer Skeem, a clinical psychologist and associate dean of research at UC Berkeley’s School of Social Welfare.

Skeem and fellow researchers at the University of Virginia and Columbia University focused on the most violent patients tracked in the MacArthur Violence Risk Assessment study, a major 1998 analysis of more than 1,100 offenders who had been discharged from psychiatric facilities.

Specifically, the researchers looked at a subgroup of 100 high-risk patients, who had been involved in two or more violent incidents in the year after they were discharged from a psychiatric facility, to establish their mental states at the time they committed acts of violence.

“We wanted to examine the small group of people with repeated violence and see how consistently these violent incidents were caused by hallucinations and delusions,” Skeem said.

In addition to reviewing records, they interviewed former patients about what they were thinking and feeling immediately before they engaged in violence, and sought the perspectives of their friends and family members. The results revealed that psychosis preceded only 12 percent of the violent acts they committed following their release. Moreover, while psychosis drove one violent incident, it was rarely implicated in subsequent ones, the study found.

The study defines violence as battery resulting in physical injury, sexual assault, and assaults or threats with a weapon. Mental illnesses ranged from schizophrenia and bipolar disorder to severe anxiety and depression.

While mass shootings account for a fraction of U.S. gun deaths, each one can influence public policy. For example, the 2014 shooting spree in Isla Vista near Santa Barbara, in which 24-year-old Elliot Rodger killed six people, spurred the U.S. House of Representatives to pass an amendment to boost funding to add more mental health records to the nation’s background check system for firearm purchases.

And, after the 2013 Sandy Hook Elementary shooting in Newtown, in which 20-year-old Adam Lanza killed his mother, 20 children and six school staff members, New York passed the Secure Ammunition and Firearms Enforcement Act, which requires mental health professionals to report clients who could harm themselves or others so those names can be matched against a gun permit database.

Meanwhile, a murder trial is currently under way for 27-year-old James Holmes, who opened fire on a “Batman” movie audience in Aurora in 2012, killing 12. He has pleaded not guilty by reason of insanity. In the wake of that mass shooting, Colorado Gov. John Hickenlooper signed a bill allocating $20 million for an expansion of mental health services, including walk-in crisis centers and a 24-hour hotline. That bill also created a task force to look at strengthening existing laws for involuntary commitment for mental health treatment.

Mental health professionals and advocates warn that these high-profile cases perpetuate the stigma of mental illness, and keep people who are suffering from psychiatric disorders from disclosing their condition and seeking help. In fact, they say, people with mental illness are more likely to be victims of violence than vice versa.

A study published in February in the American Journal of Public Health found that fewer than 5 percent of the 120,000 gun-related killings in the United States between 2001 and 2010 were perpetrated by people diagnosed with mental illness, and that the mentally ill are far more likely than the average person to be the victims of violent crime.

“None of this detracts from the message that people with mental illness need access to psychiatric services,” Skeem said. “But it’s important to remember that risk factors for violence – such as substance abuse, childhood maltreatment, neighborhood disadvantage – are mostly shared by people with and without mental illness, and that’s what we should be focused on if maximizing public safety is our goal.”

Other co-authors and researchers on the study are Patrick Kennealy of the University of South Florida, John Monahan of the University of Virginia, Gillian Peterson of Metropolitan State University and Paul Appelbaum of Columbia University.

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PTSD linked to accelerated aging

UC San Diego study is first of its type to link PTSD with aging.

By Scott LaFee and Heather Buschman, UC San Diego

In recent years, public health concerns about post-traumatic stress disorder (PTSD) have risen significantly, driven in part by affected military veterans returning from conflicts in the Middle East and elsewhere. PTSD is associated with number of psychological maladies, among them chronic depression, anger, insomnia, eating disorders and substance abuse.

Writing in today’s (May 7) online issue of American Journal of Geriatric Psychiatry, researchers at the UC San Diego School of Medicine and Veterans Affairs San Diego Healthcare System suggest that people with PTSD may also be at risk for accelerated aging or premature senescence.

“This is the first study of its type to link PTSD, a psychological disorder with no established genetic basis, which is caused by external, traumatic stress, with long-term, systemic effects on a basic biological process such as aging,” said Dilip V. Jeste, M.D., Distinguished Professor of Psychiatry and Neurosciences and director of the Center on Healthy Aging and Senior Care at UC San Diego, who is the senior author of this study.

Researchers had previously noted a potential association between psychiatric conditions, such as schizophrenia and bipolar disorder, and acceleration of the aging process. Jeste and colleagues determined to see if PTSD might show a similar association by conducting a comprehensive review of published empirical studies relevant to early aging in PTSD, covering multiple databases going back to 2000.

There is no standardized definition of what constitutes premature or accelerated senescence. For guidance, the researchers looked at early aging phenomena associated with non-psychiatric conditions, such as Hutchinson-Gilford progeria syndrome, HIV infection and Down syndrome. The majority of evidence fell into three categories: biological indicators or biomarkers, such as leukocyte telomere length (LTL), earlier occurrence or higher prevalence of medical conditions associated with advanced age and premature mortality.

In their literature review, the UC San Diego team identified 64 relevant studies; 22 were suitable for calculating overall effect sizes for biomarkers, 10 for mortality.

All six studies looking specifically at LTL found reduced telomere length in persons with PTSD. Leukocytes are white blood cells. Telomeres are stretches of protective, repetitive nucleotide sequences at the ends of chromosomes. These sequences shorten with every cell replication and are considered a strong measure of the aging process in cells.

The scientists also found consistent evidence of increased pro-inflammatory markers, such as C-reactive protein and tumor necrosis factor alpha, associated with PTSD.

A majority of reviewed studies found increased medical comorbidity of PTSD with several targeted conditions associated with normal aging, including cardiovascular disease, type 2 diabetes, gastrointestinal ulcer disease and dementia.

Seven of 10 studies indicated a mild-to-moderate association of PTSD with earlier mortality, consistent with an early onset or acceleration of aging in PTSD.

“These findings do not speak to whether accelerated aging is specific to PTSD, but they do argue the need to re-conceptualize PTSD as something more than a mental illness,” said first author James B. Lohr, M.D., professor of psychiatry. “Early senescence, increased medical morbidity and premature mortality in PTSD have implications in health care beyond simply treating PTSD symptoms. Our findings warrant a deeper look at this phenomenon and a more integrated medical-psychiatric approach to their care.”

Barton Palmer, Ph.D., professor of psychiatry and a coauthor of the study, cautioned that “prospective longitudinal studies are needed to directly demonstrate accelerated aging in PTSD and to establish underlying mechanisms.”

Other co-authors include Carolyn A. Eidt, Smitha Aailaboyina, and Steven R. Thorp, Veterans Affairs San Diego Healthcare System Center of Excellence for Stress and Mental Health and UCSD Department of Psychiatry and Stein Institute for Research on Aging; Brent T. Mausbach, UCSD Department of Psychiatry and Stein Institute for Research on Aging; and Owen M. Wolkowitz, UC San Francisco.

Funding for this research came, in part, from the Veterans Affairs San Diego Healthcare System Center of Excellence for Stress and Mental Health, National Institutes of Health grants R01MH099987, R01MH094151, T32MH019935, and U.S. Department of Defense, UC San Diego Center for Healthy Aging and Sam and Rose Stein Institute for Research on Aging.

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ADHD program selected for new PEER patient portal by Genetic Alliance

‘This is citizen science at its best.’

Julie Schweitzer, UC Davis

By Phyllis Brown, UC Davis

The ADHD Program at the UC Davis MIND Institute has been selected to participate in an initiative that will link people with the condition in Sacramento and beyond with clinicians, researchers, advocates, support groups and each other, through an innovative privacy-assured online platform called Platform for Engaging Everyone Responsibly, or PEER.

The PEER program will create a customized portal for people with attention-deficit/hyperactivity disorder, funded by a $500,000 grant from the Robert Wood Johnson Foundation, which is underwriting the development of the ADHD site along with approximately 15 others.

PEER is a project of Genetic Alliance, which already has managed the development of portals for a wide array of diseases, many of which are rare genetic conditions, such as Gaucher disease or Joubert syndrome, and others that are more common, such as sickle cell disease and hepatitis.

The PEER platform creates a Web presence that allows people to share their health data, selecting privacy settings with which they are comfortable and that “strike a balance between the desire for solutions to their medical needs and their [concerns] about privacy.”

“The goal is to make the development of registries simple and easy,” said Sharon Terry, president and chief executive officer of Genetic Alliance and co-creator of PEER. “The members of community organizations will just sign up online, create their own instance of the software, and get to work. That is our plan for PEER.”

ADHD is one of several new PEER portals to be developed by PEER/Genetic Alliance. The condition is anything but rare. In fact, it is the most commonly diagnosed psychiatric disorder among children in the United States. Other new PEER collaborators will include the Asthma and Allergy Foundation of America, Celiac Support Association and the Center for Jewish Genetics.

“We’re grateful that the Genetic Alliance and PEER selected the ADHD Program and the MIND Institute as partners in this exciting endeavor,” said program Director Julie Schweitzer. “Through this partnership we can encourage families of people with ADHD to participate in research to help find treatments and possible preventive measures for the condition.”

The ADHD Program will partner with local and national ADHD support groups, including the Parent Education Network (PEN) and Children and Adults with Attention-Deficit Hyperactivity Disorder (CHADD).

“This is citizen science at its best,” Schweitzer said. “Families affected by ADHD will be able to learn information from one another by using a computer from their own homes. And, by sharing their health information, they will help researchers seeking improved treatments for people with ADHD.”

The ADHD Program offers clinical programs for people with ADHD across the lifespan, and conducts research into treatments for the condition.

Schweitzer will collaborate with Nick Anderson, UC Davis professor of informatics.

“We are very enthused to be partners in  this unique network – we greatly value advocacy groups’ participation, and the PEER platform provides the best privacy support currently available,” Anderson said.

More information about the institute is available on the Web at mindinstitute.ucdavis.edu.

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Mood, anxiety disorders common in Tourette patients, emerge at young age

OCD, ADHD shown to be risk factors for additional psychiatric disorders, study finds.

By Pete Farley, UC San Francisco

A new study of Tourette syndrome (TS) led by researchers from UC San Francisco and Massachusetts General Hospital (MGH) has found that nearly 86 percent of patients who seek treatment for TS will be diagnosed with a second psychiatric disorder during their lifetimes, and that nearly 58 percent will receive two or more such diagnoses.

It has long been known that TS, which emerges in childhood and is characterized by troublesome motor and vocal tics, is often accompanied by other disorders, especially attention-deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). In many patients these “co-morbid” conditions cause more distress and disability for patients than TS tics themselves.

But the size and rigor of the new study, conducted by an international group of researchers known as the Tourette Syndrome Association International Consortium for Genetics (TSAICG) and published in the Feb. 11 online edition of JAMA Psychiatry, provides the most comprehensive and reliable picture of TS comorbidities to date, said Carol A. Mathews, M.D., professor of psychiatry at UCSF and co-senior author of the new report.

“This is the biggest data set of its kind that I know of,” Mathews said. “We’ve interviewed thousands of people and collected a huge wealth of clinical data, which has given us the opportunity to say something meaningful about the clinical presentation of Tourette syndrome.”

Co-senior author Jeremiah Scharf, M.D., Ph.D., of the MGH Psychiatric and Neurodevelopmental Genetics Unit (PNGU), an assistant professor of neurology at Harvard Medical School and TSAICG co-chair, said that the new findings should prove useful to his fellow neurologists, who often treat TS patients but may not be aware of the full spectrum of possible psychiatric comorbidities seen in the disorder.

“The origin of TS is in a part of the brain that is the overlap between neurology and psychiatry,” said Scharf. “Knowing the range of diagnostic possibilities and forming collaborative teams with psychiatrists is important to successfully treat TS.”

Led by first authors Matthew E. Hirschtritt, M.D., M.P.H., a psychiatry resident at UCSF, and Paul C. Lee, M.D., M.P.H., a former postdoctoral fellow at the MGH PNGU, the researchers analyzed diagnostic data for more than 1,300 TS patients gathered in consistent, highly structured interviews completed over the 16-year period from 1992 to 2008. In addition, to determine how co-morbid conditions that are frequently seen in TS patients might run in families, the analysis also included diagnostic information from parents, siblings and other relatives unaffected by TS.

As expected, the report found that ADHD and OCD are common among those with TS. Seventy-two percent of the TS patients studied received one of these two diagnoses, and nearly one-third were diagnosed with both ADHD and OCD. ADHD was seen to emerge as early as age 5 in TS patients, and OCD before 10 years of age.

But the results also show that mood disorders, anxiety disorders and disruptive behavior disorders are quite common in TS patients — about 30 percent of patients received one of these diagnoses — and that mood and anxiety disorders appear much earlier in life in TS patients than is typical in the general population.

“Anxiety and depression, which in the general population often emerge in adolescence and adulthood, are more likely to emerge early in life with TS, sometimes as early as age 5,” said Scharf. “Social anxiety and ADHD often start in TS patients before tics even arise, which emphasizes the importance of screening young patients for these conditions.”

Moreover, the researchers found that the risk of mood and anxiety disorders is related to OCD and ADHD diagnoses: both mood and anxiety disorders are significantly more common in TS patients with a concomitant diagnosis of OCD or of combined OCD and ADHD.

These observations are presumably a consequence of intertwined genetic relationships between these conditions, said Mathews.

“We found that, while OCD and ADHD directly shared genetic relationships with TS, the other psychiatric disorders, such as mood and anxiety disorders, appear to share genetic relationships with ADHD and/or OCD, but not directly with TS. Perhaps of more relevance for clinicians, parental history of ADHD — but not tics or OCD — is associated with a nearly twofold increase in the risk of having more than one co-occurring psychiatric disorder.”

The researchers found relatively low rates of other psychiatric conditions, including eating disorders, psychosis and substance abuse, among TS patients.

Mathews and Scharf cautioned that their results are potentially skewed because many TS patients never seek medical attention for the disorder.

“This is a somewhat biased sample, because the patients we studied came to a clinic or through the Tourette Syndrome Association. People who come to a clinic for treatment tend to have more severe TS or they have other psychiatric symptoms,” said Mathews. “But this work still gives clinicians a good idea of what they should be on the lookout for.”

The research was funded by the Tourette Syndrome Association (TSA), the National Institute of Neurological Disorders and Stroke, the National Institute of Mental Health, a TSA Research Fellowship to Lee, and a Doris Duke Clinical Research Fellowship to Hirschtritt.

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Darrell Steinberg joins UC Davis Behavioral Health Center of Excellence

Former Senate pro tempore will direct policy and advocacy for the new center.

Darrell Steinberg

By Phyllis Brown, UC Davis

Darrell Steinberg, former Senate pro tempore for the state of California, has joined the faculty of the UC Davis School of Medicine as director of policy and advocacy for the recently launched UC Davis Behavioral Health Center of Excellence.

Steinberg, who will be visiting professor in the Department of Psychiatry and Behavioral Sciences, was well known during his legislative career as a champion of the mental health needs of the people of Sacramento and California. His crowning achievements include the passage and implementation of groundbreaking mental health legislation that dramatically increased access to care for millions of Californians. Steinberg’s partnership with UC Davis continues this longstanding commitment to greater access to mental health services statewide.

“With UC Davis as a partner, my goal is to strengthen and unite our voice for mental and behavioral health in California,” Steinberg said. “We will connect and inform the next generation of policy leaders, researchers, health professionals, providers and our communities.”

Among his many accomplishments, Steinberg is the author of Proposition 63, the California Mental Health Services Act, approved by voters in November 2004. To date it has raised more than $1 billion in state and federal funds for mental-health programs. Steinberg also served as chair of the ballot measure steering committee formed to pass the initiative.

His more than 20 years in public life include six as a member of the California Assembly and six as a member of the Sacramento City Council. He left the state Senate after being termed out in 2014.

Steinberg will help develop the behavioral health center’s policy arm, by providing consultation and advice related to its goals and initiatives and by meeting with community, university and state leaders to advocate for mental-health programs, said center Director Cameron Carter.

“Sen. Steinberg’s leadership role as director of policy and advocacy will serve as a much-needed bridge between research and policy and between the mental- and behavioral-health communities,” Carter said.

The Behavioral Health Center of Excellence is UC Davis Health System’s hub for bringing together its wide-ranging research, education, clinical and community engagement programs as they relate to neuroscience, mental health and public health improvement. The unique academic research center is designed to improve scientific investigations into mental and behavioral health, and engage with communities around the state to improve treatment options.

Funded by Proposition 63, the $7.5 million UC Davis center will be a catalyst for expanding the understanding of problems surrounding behavioral health, and serve as a national model for finding answers for individuals, their families and their communities. It is mirrored by a $7.5 million sister center at UCLA.

“We already are expanding research to better understand all facets of mental and behavioral health through a pilot award program,” said Frederick J. Meyers, vice dean of the School of Medicine, who launched the new center. “We are honored to add Sen. Steinberg’s leadership in policy and advocacy.”

Steinberg is a shareholder in the Sacramento office of the international law firm of GreenbergTraurig LLP, where he is chair of the California Government Law and Policy Practice. In 2010, he was honored with the John F. Kennedy Profile in Courage Award from the Kennedy Library Foundation in recognition of his leadership during the 2008 bipartisan budget negotiations. His work enabled California’s fiscal recovery from a $42 billion dollar deficit following the most recent recession.

In addition to mental health care, Steinberg is highly regarded for advancing health causes on multiple fronts, including autism care, foster care and homeless services.

“Sen. Steinberg will add a public mental health perspective to a variety of our educational courses for psychiatry residents,” said Robert Hales, chair of the Department of Psychiatry and Behavioral Sciences. “He will enable us to expand our recruitment efforts for future residents interested in community-based and public mental health services.”

As visiting professor, Steinberg will not receive a salary.

For more information, please visit UC Davis School of Medicine at medschool.ucdavis.edu.

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Tips for keeping the ‘happy’ in holidays

UC Irvine’s Jody Rawles says key to reducing seasonal stress is setting realistic expectations.

By Shari Roan, UC Irvine

Roast the turkey. Bake the pies. Decorate the house. Buy the gifts. The list goes on.

Sometimes the demands of the holiday season can overshadow the enjoyment. A survey by the American Psychological Association found that more than 8 in 10 Americans anticipate excessive stress during the upcoming holidays.

How can you enjoy the season amid the anxiety? It helps to remember that the days between Thanksgiving and Jan. 1 are not typically life-altering, says Dr. Jody M. Rawles, associate professor and interim chair of psychiatry & human behavior at UC Irvine.

“June is usually considered by the psychiatric community to be a more stressful month than December,” he explains. “June usually carries more monumental changes – people get married or move or graduate and have to find jobs. The holidays are just days. They shouldn’t be as disruptive as people think.”

Adults tend to become overwhelmed, frustrated or sad during the holiday period because of heightened expectations.

“Our culture and the media set a high bar,” Rawles says. “We’re supposed to be this ideal cross between Norman Rockwell and Martha Stewart. We have to have this incredible meal for family and friends, and everyone is supposed to have a wonderful time. But life is complicated.”

In reality, family members don’t always get along. The turkey is dry. The kids have the flu.

“Not every husband orders a Lexus for his wife and has it shipped in two days with a big bow on it,” Rawles notes. (Does anyone actually do that?)

Set realistic expectations for the holidays, he suggests. If money is an issue, establish a budget and stick to it. Enlist your spouse and kids in holiday decisions so that everyone is on the same page.

Some people may need to do extra planning to avoid holiday pitfalls. High stress levels can trigger bad health habits, such as eating or drinking too much. Strategize in advance how to deal with such temptations, Rawles advises.

Individuals who are recently separated, divorced or widowed might have to be proactive to ensure that they aren’t alone or lonely. Adults with mood issues, particularly seasonal affective disorder, should consider tactics to ward off sadness or depression – adhering to an exercise regimen, for example, or seeing a mental health professional on a regular basis.

“As a society, we do value holidays,” Rawles says. “But we may have to take preventive measures to make sure they don’t become depressing days.”

Tips for holiday stress-busting

  • Don’t worry about your weight. Studies show that most people gain less than a pound during the holiday season. Try using a small plate to sample holiday buffet dishes. Don’t skip meals or allow yourself to become overly hungry before a party or big meal. Take a walk after a dinner or celebration. Hit the gym extra hard in January.
  • Pace yourself when drinking. Have “drink spacers,” or nonalcoholic beverages, between cocktails. Enlist a designated driver.
  • Talk to kids about realistic expectations for gifts and holiday activities.
  • Take small steps to deal with the demands of the holidays instead of trying to do everything at once. Shop online.
  • Spend a few hours doing volunteer work, or buy a gift for a toy drive. Helping others who are less fortunate helps put things in perspective.
  • Take time for yourself, such as a daily walk or a soak in the tub.
  • Get plenty of rest and make sure kids get plenty of rest.
  • Don’t be afraid to say no. Set limits.

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Doctors with early-life stress at risk for professional challenges

Study identifies how childhood stress impacts career performance.

A study conducted by the UC San Diego Physician Assessment and Clinical Education program (PACE) found that childhood adversity could potentially play a role in a physician’s later professional relationships.

The findings were published online today (Oct. 31) in General Hospital Psychiatry.

Although UC San Diego is the site for PACE, an education and quality improvement program for health care professionals, physicians from across the nation and representing different specialties were referred to and enrolled in the course that was part of the study.

“We wanted to wrap our heads around some of the reasons why certain physicians may have challenges maintaining professional boundaries,” said Kai MacDonald, M.D., lead author of the study and associate physician in the departments of psychiatry and family medicine at UC San Diego School of Medicine. “Physicians are held to higher standards, so it’s critical they provide the highest quality of care with the utmost professionalism.”

The four-year study revealed that nearly two of three participating physicians reported having experienced a moderate or severe level of emotional neglect during childhood; one out of five described a moderate or severe level of overall childhood trauma and one-third said they had experienced another type of adversity, such as parental divorce or death.

“We were surprised at the prevalence of early life adversity encountered by the physicians in this study,” said MacDonald. “Through PACE, the physicians were able to develop insight into how the past can influence the present and discuss strategies to become more compassionate and respectful caregivers.”

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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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Federal grant awarded to treat psychosis in traumatized youth

UC Davis receives $570K grant.

Anthony Urquiza, UC Davis

The UC Davis CAARE Center and UC Davis Psychiatry’s SacEDAPT Clinic have received funding to improve the assessment and treatment of underserved traumatized youth who are experiencing the early signs of psychosis.

The $570,000 grant comes from the Graduate Psychology Education Program: Workforce Training to Improve Access to Mental Health Services, a program of the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA).

The funding will be used to train predoctoral psychology interns in a family-based intervention known as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and recovery-based treatment approaches used at the SacEDAPT Clinic. The training will be integrated into the internship that currently is offered at the CAARE Center.

Pediatric medical residents will also receive specialized training to identify trauma and early psychosis. Improving patient care through collaboration between primary care and behavioral health professionals will be a key focus of the grant.

The project director will be Anthony Urquiza, director of the UC Davis CAARE Center, and will be supported by Dawn Blacker, UC Davis CAARE Center; Albina Gogo, UC Davis Department of Pediatrics; and Cameron Carter and Tara Niendam, UC Davis Department of Psychiatry.

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Healthy lifestyle may reduce stress-related cell aging

UCSF study suggests healthy diet, sleep and exercise can mitigate impacts of stress.

Eli Puterman, UC San Francisco

A new study from UC San Francisco is the first to show that while the impact of life’s stressors accumulate over time and accelerate cellular aging, these negative effects may be reduced by maintaining a healthy diet, exercising and sleeping well.

“The study participants who exercised, slept well and ate well had less telomere shortening than the ones who didn’t maintain healthy lifestyles, even when they had similar levels of stress,” said lead author Eli Puterman, Ph.D., assistant professor in the department of psychiatry at UCSF. “It’s very important that we promote healthy living, especially under circumstances of typical experiences of life stressors like death, caregiving and job loss.”

The paper will be published in Molecular Psychiatry, a peer-reviewed science journal by Nature Publishing Group.

Telomeres are the protective caps at the ends of chromosomes that affect how quickly cells age. They are combinations of DNA and proteins that protect the ends of chromosomes and help them remain stable. As they become shorter, and as their structural integrity weakens, the cells age and die quicker. Telomeres also get shorter with age.

In the study, researchers examined three healthy behaviors – physical activity, dietary intake and sleep quality – over the course of one year in 239 post-menopausal, non-smoking women. The women provided blood samples at the beginning and end of the year for telomere measurement and reported on stressful events that occurred during those 12 months. In women who engaged in lower levels of healthy behaviors, there was a significantly greater decline in telomere length in their immune cells for every major life stressor that occurred during the year. Yet women who maintained active lifestyles, healthy diets and good quality sleep appeared protected when exposed to stress – accumulated life stressors did not appear to lead to greater shortening.

“This is the first study that supports the idea, at least observationally, that stressful events can accelerate immune cell aging in adults, even in the short period of one year. Exciting, though, is that these results further suggest that keeping active, and eating and sleeping well during periods of high stress are particularly important to attenuate the accelerated aging of our immune cells,” said Puterman.

In recent years, shorter telomeres have become associated with a broad range of aging-related diseases, including stroke, vascular dementia, cardiovascular disease, obesity, osteoporosis diabetes, and many forms of cancer.

Research on telomeres, and the enzyme that makes them, telomerase, was pioneered by three Americans, including UCSF molecular biologist and co-author Elizabeth Blackburn, Ph.D. Blackburn co-discovered the telomerase enzyme in 1985. The scientists received the Nobel Prize in Physiology or Medicine in 2009 for their work.

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Researchers find epigenetic tie to neuropsychiatric disorders

Flawed dopamine signaling linked to mass alteration of gene activity in prefrontal cortex.

“Our work presents new leads to understanding neuropsychiatric disorders,” UC Irvine's Emiliana Borrelli said.

Dysfunction in dopamine signaling profoundly changes the activity level of about 2,000 genes in the brain’s prefrontal cortex and may be an underlying cause of certain complex neuropsychiatric disorders, such as schizophrenia, according to UC Irvine scientists.

This epigenetic alteration of gene activity in brain cells that receive this neurotransmitter showed for the first time that dopamine deficiencies can affect a variety of behavioral and physiological functions regulated in the prefrontal cortex.

The study, led by Emiliana Borrelli, a UCI professor of microbiology & molecular genetics, appears online in the journal Molecular Psychiatry.

“Our work presents new leads to understanding neuropsychiatric disorders,” Borrelli said. “Genes previously linked to schizophrenia seem to be dependent on the controlled release of dopamine at specific locations in the brain. Interestingly, this study shows that altered dopamine levels can modify gene activity through epigenetic mechanisms despite the absence of genetic mutations of the DNA.”

Dopamine is a neurotransmitter that acts within certain brain circuitries to help manage functions ranging from movement to emotion. Changes in the dopaminergic system are correlated with cognitive, motor, hormonal and emotional impairment. Excesses in dopamine signaling, for example, have been identified as a trigger for neuropsychiatric disorder symptoms.

Borrelli and her team wanted to understand what would happen if dopamine signaling was hindered. To do this, they used mice that lacked dopamine receptors in midbrain neurons, which radically affected regulated dopamine synthesis and release.

The researchers discovered that this receptor mutation profoundly altered gene expression in neurons receiving dopamine at distal sites in the brain, specifically in the prefrontal cortex. Borrelli said they observed a remarkable decrease in expression levels of some 2,000 genes in this area, coupled with a widespread increase in modifications of basic DNA proteins called histones – particularly those associated with reduced gene activity.

Borrelli further noted that the dopamine receptor-induced reprogramming led to psychotic-like behaviors in the mutant mice and that prolonged treatment with a dopamine activator restored regular signaling, pointing to one possible therapeutic approach.

The researchers are continuing their work to gain more insights into the genes altered by this dysfunctional dopamine signaling.

Borrelli is affiliated with UCI’s Center for Epigenetics & Metabolism and manages the INSERM/UCI U904 laboratory there. Karen Brami-Cherrier, Andrea Anzalone, Maria Ramos and Fabio Macciardi of UCI, as well as Ignasi Forne and Axel Imhof of Ludwig Maximilian University of Munich, contributed to the study, which received support from the National Institutes of Health (grant DA024689) and INSERM (grant 44790).

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Understanding the basic biology of bipolar disorder

Scientists from UCLA, UCSF take steps to ID genetic component to mental illness.

Brain regions

Scientists know there is a strong genetic component to bipolar disorder, but they have had an extremely difficult time identifying the genes that cause it. So, in an effort to better understand the illness’s genetic causes, researchers at UCLA tried a new approach.

Instead of only using a standard clinical interview to determine whether individuals met the criteria for a clinical diagnosis of bipolar disorder, the researchers combined the results from brain imaging, cognitive testing, and an array of temperament and behavior measures. Using the new method, UCLA investigators — working with collaborators from UC San Francisco, Colombia’s University of Antioquia and the University of Costa Rica — identified about 50 brain and behavioral measures that are both under strong genetic control and associated with bipolar disorder. Their discoveries could be a major step toward identifying the specific genes that contribute to the illness.

The results are published in today’s (Feb. 12) edition of the Journal JAMA Psychiatry.

A severe mental illness that affects about 1 to 2 percent of the population, bipolar disorder causes unusual shifts in mood and energy, and it interferes with the ability to carry out everyday tasks. Those with the disorder can experience tremendous highs and extreme lows — to the point of not wanting to get out of bed when they’re feeling down. The genetic causes of bipolar disorder are highly complex and likely involve many different genes, said Carrie Bearden, a senior author of the study and an associate professor of psychiatry and psychology at the UCLA Semel Institute for Neuroscience and Human Behavior.

“The field of psychiatric genetics has long struggled to find an effective approach to begin dissecting the genetic basis of bipolar disorder,” Bearden said. “This is an innovative approach to identifying genetically influenced brain and behavioral measures that are more closely tied to the underlying biology of bipolar disorder than the clinical symptoms alone are.”

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