TAG: "Psychiatry"

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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Brain trauma raises risk of later PTSD in active-duty Marines


Deployment-related injuries are biggest predictor, but not the only factor.

Dewleen Baker

Dewleen Baker

In a novel study of U.S. Marines investigating the association between traumatic brain injury (TBI) and the risk of post-traumatic stress disorder (PTSD) over time, a team of scientists led by researchers from the Veterans Affairs San Diego Healthcare System and UC San Diego School of Medicine report that TBIs suffered during active-duty deployment to Iraq and Afghanistan were the greatest predictor for subsequent PTSD, but found pre-deployment PTSD symptoms and high combat intensity were also significant factors.

The findings are published in the Dec. 11 online issue of JAMA Psychiatry.

The team, headed by principal investigator Dewleen G. Baker, M.D., research director at the VA Center of Excellence for Stress and Mental Health, professor in the Department of Psychiatry at UC San Diego and a practicing psychiatrist in the VA San Diego Healthcare System, analyzed 1,648 active-duty Marines and Navy servicemen from four infantry battalions of the First Marine Division based at Camp Pendleton in north San Diego County. The servicemen were evaluated approximately one month before a scheduled 7-month deployment to Iraq or Afghanistan, one week after deployment had concluded, and again three and six months later.

PTSD is a psychiatric condition in which stress reactions become abnormal, chronic and may worsen over time. The condition is linked to depression, suicidal tendencies, substance abuse, memory and cognition dysfunction and other health problems.

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Kids whose bond with mother was disrupted early in life show changes in brain


UCLA researchers examine impact on amygdala.

Nim Tottenham, UCLA

Nim Tottenham, UCLA

Children who experience profound neglect have been found to be more prone to a behavior known as “indiscriminate friendliness,” characterized by an inappropriate willingness to approach adults, including strangers.

UCLA researchers are now reporting some of the first evidence from human studies suggesting that this behavior is rooted in brain adaptations associated with early-life experiences. The findings appear in the Dec. 1 issue of the peer-reviewed journal Biological Psychiatry.

The UCLA group used functional magnetic resonance imaging (fMRI) to demonstrate that youths who experienced early maternal deprivation — specifically, time in an institution such as an orphanage prior to being adopted — show similar responses to their adoptive mother and to strangers in a brain structure called the amygdala; for children never raised in an institutional setting, the amygdala is far more active in response to the adoptive mother.

This reduced amygdala discrimination in the brain correlated with parental reports of indiscriminate friendliness. The longer the child spent in an institution before being adopted, the greater the effects.

“The early relationship between children and their parents or primary caregivers has implications for their social interaction later in life, and we believe the amygdala is involved in this process,” said Aviva Olsavsky, a resident physician in psychiatry at the Semel Institute for Neuroscience and Human Behavior at UCLA and the study’s first author. “Our findings suggest that even for children who have formed attachments to their adoptive parents, this early period of deprivation has led to changes in the brain that were likely adaptations and that may persist over time.”

Indiscriminate friendliness is in some sense a misnomer. The behavior is not characterized by a deep friendliness but simply by a lack of reticence that most young children show toward strangers.

“This can be a very frightening behavior for parents,” said Nim Tottenham, an associate professor of psychology at UCLA and the study’s senior author. “The stranger anxiety or wariness that young children typically show is a sign that they understand their parents are very special people who are their source of security. That early emotional attachment serves as a bedrock for many of the developmental processes that follow.”

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For anxious children and teens, context counts


Specific area of the brain linked to anxiety disorders in youth.

Tara Peris, UCLA

Tara Peris, UCLA

Anxiety disorders are common in children and adolescents, affecting up to 25 percent of the youth population. Anxiety causes distress and functional impairment and, if left untreated, can result in bad grades, problems at home and increased rates of psychiatric disorders in adulthood.

These risks constitute a significant public health burden, and they underscore the importance of continued efforts to understand the cause and course of the disorder.

While earlier research found that anxious youths are apt to interpret neutral or ambiguous information as threatening, fueling the feelings of distress that characterize anxiety disorders, what happens in the brain and how the brain may be impacted has been unclear. In particular, where in the brain neutral information is transformed into “threatening” information in anxious youth has remained unknown.

Now researchers at UCLA have shown that teenagers with anxiety disorders show increased activity in a specific part of the brain, the medial prefrontal cortex, when they are interpreting a situation negatively. The results appear in the current online edition of the journal Biology of Mood and Anxiety Disorders.

For the study, 16 teenagers with anxiety disorders and 15 non-anxious teens underwent functional MRI while being shown pictures of people with a neutral look on their face. The faces were paired with either of two sentences: one that was viewed as neutral (“She is watching a presentation”) and one that might be viewed as more intimidating (“She is about to give a presentation”).

Teenagers without anxiety disorders were unaffected by the context when they interpreted the faces. But those with anxiety disorders often found neutral faces more threatening when they were presented in an “anxiety-provoking” situation — one in which they might feel judged by peers. This was not a great surprise. But when researchers measured brain activity in these situations, they found increased activity in the medial prefrontal cortex.

“We know that the medial prefrontal cortex plays a role in social and emotional processes, and it is an area of the brain that is still developing through childhood and adolescence, so it was a natural candidate for examination,” said co-author Tara Peris, an assistant professor of psychiatry at the Semel Institute for Neuroscience and Human Behavior at UCLA. “The role this area of the brain plays is of particular interest, then, given prior research that implicates it in inferring what another person is feeling.”

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Let’s be friends: Book, app help socially challenged youth make, keep friends


Strategies are based on research done at UCLA.

Elizabeth Laugeson, UCLA

Elizabeth Laugeson, UCLA

Socially challenged teens and young adults, such as those with autism, often have trouble making and keeping friends and can become easy targets for bullying, a situation that challenges their coping skills.

Now, a new book written by a UCLA researcher can guide parents in helping their children become more adept at establishing meaningful connections with their peers. An accompanying DVD and mobile application called FriendMaker is designed to provide real-time advice and video demonstrations of appropriate behavior for the teens and young adults when they find themselves in a challenging social situation.

The book, “The Science of Making Friends,” and the app are based on research done in the UCLA Program for the Education and Enrichment of Relational Skills (PEERS) Clinic, the only evidence-based social skills intervention available for teens and young adults with autism, attention deficit hyperactivity disorder, anxiety, depression and other social impairments.

The strategies in the book, while geared toward the socially challenged, could also apply to any teen who is trying to fit in or is being bullied, said author Dr. Elizabeth Laugeson, director of the PEERS Clinic and an assistant clinical professor of psychiatry at the Semel Institute for Neuroscience and Human Behavior at UCLA.

“Kids with special needs are already at a disadvantage. They have trouble reading social cues and interpreting the thoughts and feelings of others,” Laugeson said. “Because of this, they are more likely to be teased and bullied, and they don’t always know how to respond appropriately. Kids with autism in particular often exhibit odd behavior, which sets them up to be teased and bullied. They also tend to be isolated and alone, making them even easier targets.”

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Psychiatric patients who quit smoking less likely to be rehospitalized


UCSF study debunks myth that smoking can be helpful in mental health treatment.

Patients who participated in a smoking-cessation program during hospitalization for mental illness were able to quit smoking and were less likely to be hospitalized again for their psychiatric conditions, according to a new study by researchers at Stanford and UC San Francisco.

The findings counter a longstanding assumption held by many mental-health experts that smoking serves as a useful tool in treating some psychiatric patients.

Smoking among such patients has been embedded in the culture for decades, with cigarettes used as part of a reward system. Indeed, clinicians sometimes smoke alongside patients as a way of creating a rapport with them, said Judith Prochaska, Ph.D., M.P.H., associate professor of medicine at the Stanford Prevention Research Center who led the study while an associate professor at UCSF. The result is that psychiatric patients are among the country’s most prolific smokers and among those most likely to die of smoking-related ailments, Prochaska said.

Nearly half of the cigarettes sold in the United States are to people with psychiatric or addictive disorders, according to data from the U.S. Centers for Disease Control and Prevention. And the average life expectancy for people with severe mental illness is 25 years less than that of the general population, and their leading cause of death is chronic illness, mostly tobacco-related.

The study is the first to examine the impact of a stop-smoking intervention in adult psychiatric patients. It was published online Aug. 15 in the American Journal of Public Health.

Co-authors of the study are Stephen Hall, M.D., director of acute services at Langley Porter Psychiatric Institute; Kevin Delucchi, Ph.D., professor of biostatistics in psychiatry; and Sharon Hall, Ph.D., professor of psychiatry, all of UCSF.

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