August 28, 2012
LSW Continuing Education "We are presently searching for biochemical changes in the sperm of stressed fathers that could account for this newly appreciated form of inheritance" said senior author Larry A. Feig, Ph.D., professor of biochemistry at Tufts University School of Medicine and member of the biochemistry and neuroscience program faculties at the Sackler School of Graduate Biomedical Sciences at Tufts University. "Hopefully, this work will stimulate efforts to determine whether similar phenomena occur in humans." ### This research was supported by award numbers AA019317 from the National Institute on Alcohol Abuse and Alcoholism, and MH083324 from the National Institute of Mental Health, both part of the National Institutes of Health (NIH). The research was also supported by award number NS047243 from National Institute of Neurological Disorders and Stroke (NIH) to the Tufts Center for Neuroscience Research. Saavedra-Rodríguez L, Feig LA. Biological Psychiatry. "Chronic Social Instability Induces Anxiety and Defective Social Interactions Across Generations." Available online August 20, 2012. http://dx.doi.org/10.1016/j.biopsych.2012.06.035 About Tufts University School of Medicine and the Sackler School of Graduate Biomedical Sciences Tufts University School of Medicine and the Sackler School of Graduate Biomedical Sciences at Tufts University are international leaders in innovative medical education and advanced research. The School of Medicine and the Sackler School are renowned for excellence in education in general medicine, biomedical sciences, special combined degree programs in business, health management, public health, bioengineering and international relations, as well as basic and clinical research at the cellular and molecular level. Ranked among the top in the nation, the School of Medicine is affiliated with six major teaching hospitals and more than 30 health care facilities. Tufts University School of Medicine and the Sackler School undertake research that is consistently rated among the highest in the nation for its effect on the advancement of medical science.
August 27, 2012
CADCA Continuing Education Earnshaw and her colleagues interviewed 420, 14- to 21-year-old black and Latina women at 14 community health centers and hospitals in New York, during the second and third trimesters of their pregnancies, and at six and 12 months after their babies had been born. They measured their reported experiences of discrimination. They also measured their depressive symptoms, pregnancy distress and pregnancy symptoms. Levels of everyday discrimination reported were generally low. However, the impact of discrimination was the same in all the participants regardless of age, ethnicity or type of discrimination reported. Women reporting greater levels of discrimination were more prone to depressive symptoms, and ultimately went on to have babies with lower birth weights than those reporting lower levels of discrimination. This has implications for healthcare providers who work with pregnant teens and young women during the pre-natal period, while they have the opportunity to try and reduce the potential impacts discrimination on the pregnancy. The authors conclude that "Given the associations between birth weight and health across the life span, it is critical to reduce discrimination directed at urban youth of color so that all children are able to begin life with greater promise for health. In doing so, we have the possibility to eliminate disparities not only in birth weight, but in health outcomes across the lifespan." Data for this study came from the Centering Pregnancy Plus project, funded by the National Institute of Mental Health, and conducted in collaboration with Clinical Directors’ Network and the Centering Healthcare Institute. References 1. Earnshaw VA, Rosenthal L, Lewis JB, Stasko EC, Tobin JN, Lewis TT, Reid AE and Ickovics JR (2012). Maternal experiences with everyday discrimination and infant birth weight: a test of the mediators and moderators among young, urban women of color. Annals of Behavioral Medicine; DOI 10.1007/s12160-012-9404-3
August 21, 2012
LSW Continuing Education "We hope the upshot of our studies will lead to new treatment approaches and strategies for care," Miller said, including the kind of personalized, multi-drug therapies that are becoming the standard for controlling other chronic conditions such as diabetes and hypertension. "We want to attack the disease from as many directions as possible." To get a better handle on how IL-6 levels correspond to disease status, they are looking at levels in blood samples taken multiple times over several years in 305 patients enrolled in a study comparing injectable to oral medication. They also are taking one-time measurements in 80 healthy controls and comparing those to levels in 240 patients who are acutely ill, stable outpatients or stable outpatients who smoke marijuana, a drug commonly abused by patients. While many previous studies have excluded drug abusers, marijuana may increase inflammation, so they want to explore the relationship between IL-6 levels and its use, Miller said. Miller received a five-year, $920,000 National Institute of Mental Health Mentored Patient-Oriented Research Career Development Award to measure IL-6 levels as a potential indicator of how well treatment is working to control disease in these vulnerable patients and whether they are headed to relapse. Amazingly the contributions of "immune disturbances" to schizophrenia have been debated for about 100 years yet anti-inflammatory drugs aren't routinely given to patients in addition to their antipsychotic medication, Miller said. Part of the problem is physicians still have no idea what percentage of patients with this very heterogeneous disease have evidence of increased inflammation. In fact, no two patients have the exact constellation of symptoms considered disease hallmarks, such as hallucinations, delusions, disorganized speech and thinking, he said. But mounting evidence suggests inflammation's impact in schizophrenia. A British study of 50 patients experiencing their first episode of schizophrenic behavior found a handful had indicators of an immune response to their brains, called autoantibodies, and no other conditions, such as a brain infection, to explain them. What amounts to a chronic low-grade flu has been found in some patients and rare immune system disorders such as Sjögren's syndrome, which attacks moisture-producing glands resulting in dry eyes and mouth, also tend to be more common in schizophrenics. Additionally, a handful of clinical trials has shown – not surprisingly – that patients with the highest levels of pro-inflammatory factors had the best response to anti-inflammatory drugs. "It's likely we are talking about a subset of people with this illness who would be most likely to respond to anti-inflammatory therapy – in addition to standard anti-psychotics – so part of our work is to begin to piece out who those people are (and whether) they have a particular clinical picture," Miller said. "Even being able to predict relapse or improve therapy in 25 percent of patients would be a tremendous advance," he said, noting that the vast majority of schizophrenia drugs work essentially by the same mechanism. Once patients can be identified, ideally with a blood test of their IL-6 levels, the next questions are which drugs to use and for how long. Miller's primary mentor for the studies is Dr. Andrew Mellor, a molecular geneticist and immunologist who leads the Cancer Immunology, Inflammation Tolerance Program at the GHSU Cancer Center. Mellor also is Bradley-Turner & Georgia Research Alliance Eminent Scholar in Molecular Immunogenetics. Co-secondary mentors are schizophrenia experts Dr. Peter F. Buckley, Dean of the Medical College of Georgia at GHSU, and Dr. Mark Rapaport, Chair of the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine. Schizophrenia affects about 1 percent of the population, or some 2.4 million American adults. Hallucinations are a disease hallmark: patients hear voices and can even see, touch and taste things that are not real. They can become depressed, reclusive and suicidal and have an increased risk of cardiovascular and other health conditions. Patients die on average15-20 years younger than the general population. Miller, a recipient of the 2011 National Alliance on Mental Illness Exemplary Psychiatrist Award, said he felt a calling to psychiatry and specifically schizophrenia as a medical student at The Ohio State University. "The patients are wonderful and their stories are fascinating," he said, noting that the field is "wide open" to improve their care. ###
August 19, 2012
MHC continuing education Major depressive disorder is the leading cause of disability in Americans age 15-44, affects about 14.8 million adults and is more prevalent in women, according to the National Institute of Mental Health. ###
August 17, 2012
LPC continuing education "Like boys with ADHD, girls continue to have problems with academic achievement and relationships, and need special services as they enter early adulthood," said Stephen Hinshaw, UC Berkeley professor of psychology and lead author of a study that reports after 10 years on the largest-ever sample of girls whose ADHD was first diagnosed in childhood. "Our findings of extremely high rates of cutting and other forms of self-injury, along with suicide attempts, show us that the long-term consequences of ADHD females are profound," he added. The study is published today (Tuesday, August 14) in the Journal of Consulting and Clinical Psychology. Its results are consistent with earlier findings by the UC Berkeley team that, as girls with ADHD grow older, they show fewer visible symptoms of the disorder, but continue to suffer in hidden ways. The findings challenge assumptions that girls can "outgrow" ADHD, and underscore the need for long-term monitoring and treatment of the disorder, Hinshaw said. The longitudinal study, which began when the girls were ages 6 to 12, is funded by grants from the National Institute of Mental Health. Since 1997, Hinshaw and his team have tracked a racially and socio-economically diverse group of girls with ADHD in the San Francisco Bay Area through early childhood summer camps, adolescence and now early adulthood. In addition to this new study, many others have been published by the team about the girls every five years. In the United States, more than 5 million children ages 3-17 – approximately one in 11 – have been diagnosed with ADHD, according to the Centers for Disease Control and Prevention. ADHD is characterized by poor concentration, distractibility, hyperactivity, impulsiveness and other symptoms that are inappropriate for the child's age. Evidence-based treatment includes stimulant medications and various forms of behavior therapy. The new UC Berkeley study, assessing the girls 10 years after it began, examined 140 of them, ages 17-24, comparing their behavioral, emotional and academic development to that of a demographically similar group of 88 girls without ADHD. It also gauged the symptoms of two major ADHD subtypes: Those who entered the study with poor attention alone versus those who had a combination of inattention plus high rates of hyperactivity and impulsivity. The study's major finding was that the group with combined inattention and hyperactivity-impulsivity during childhood was by far the most likely to manifest self-injury and suicide attempts in early adulthood. In fact, the study pointed out, more than half of the members of this subgroup were reported to have engaged in self-injurious behavior, and more than one-fifth had attempted suicide, Hinshaw said. "A key question is why, by young adulthood, young women with ADHD would show a markedly high risk for self-harm … Impulse control problems appear to be a central factor," the study said. In the first study on this group, published in 2002, the 6- to- 12-year old girls attended five-week camps where they were closely monitored as they partook in art and drama classes and outdoor activities. Those taking ADHD medication volunteered to go off the drug treatment for much of the summer camp study. The counselors and staff observing all the participants did not know which of them had been diagnosed with ADHD. That study found that girls with ADHD were more likely to struggle academically and to be rejected by their peers, compared to the comparison peer group. The five-year follow-up study, when the girls were 12 to 17 and experiencing early to mid-adolescence, found that the fidgety and impulsive symptoms tended to subside in the early teen years, but that the learning gap between girls with ADHD and their non-ADHD peers had widened, and eating disorders and substance abuse had surfaced. For the latest study, in which 95 percent of the original sample of girls participated, the researchers conducted intensive interviews with the subjects and their families. Those interviews include personal reports on behaviors such as self-harm and suicide attempts, drug use, eating habits and driving behavior. Researchers also measured key cognitive functions such as executive planning skills, which include goal-setting and monitoring, planning and keeping on task despite distractions. While many girls in the study showed improvement in ADHD symptoms during the 10-year period, certain problems persisted and new ones emerged, suggesting that careful monitoring and treatment are essential, Hinshaw said. "The overarching conclusion is that ADHD in girls portends continuing problems, through early adulthood," the study concluded. "Our findings argue for the clinical impact of ADHD in female samples, the public health importance of this condition on girls and women, and the need for ongoing examination of underlying mechanisms, especially regarding the high risk of self-harm in young adulthood." That said, Hinshaw added, "ADHD is a treatable condition, as long as interventions are monitored carefully and pursued over a number of years." ### In addition to Hinshaw, authors and researchers of the study are Elizabeth Owens, Christine Zalecki, Emily Schrodek and Erika Swanson at UC Berkeley; Suzanne Perrigue Huggins at the University of Maryland and Adriana Montenegro-Nevado at Palo Alto University
August 15, 2012
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August 13, 2012
nursing ceus "There is a lot of research that studies the victim of intimate partner violence, but not the perpetrator," said Julia Babcock, department of psychology and co-director of the Center for Couples Therapy, a clinical research center at UH that offers therapy for couples. "The predominant model for IPV intervention is based on what was gleaned from women in battered women shelters and focuses on men's patriarchal attitudes about power and control. Since most domestic violence occurs in the context of an argument, the experiment I conducted evaluated whether I could change how the communication goes during an argument with the batterer and his partner. The findings indicated the batterers could learn communications skills and when they applied them in an argument with their female partners, the argument improved and the participants felt better about the argument and more understood." Babcock notes this research is significant in that it breaks new ground in applying experiments to domestic violence and may improve batterers' intervention programs. In a review of the research studies on the efficacy of batterers' intervention programs, Babcock found the results disappointing. There was a small change when a perpetrator completed a batterers intervention program and only a 5 percent reduction rate in repeat offenses. "There is definitely a need to improve batterers' intervention programs, since research suggests that they're largely ineffective, but frequently prescribed by courts as a remedy for convicted IPV perpetrators," said Babcock. Babcock's research focuses on male batterers because men are the perpetrators in about 85 percent of the abuse cases, and women are 10 times more likely to be murdered by an intimate than are men. By listing an advertisement in local papers that said, "couples experiencing conflict," the research team recruited 120 couples in the Houston area qualified for the experiment. Candidates for the study were screened over the telephone to make sure they met criteria. To meet the criteria to participate in the study, two acts of violence had to occur in the last year that might include: pushing, shoving, choking, using a weapon or a beating. If there was no physical abuse, but the couple scored low for marital satisfaction, Babcock included them as a comparison group. The couples were then invited to participate in an experiment in the "Emotions in Marriage Lab," where the research team observed a couple in a 15-minute argument. Both male and female partner were connected to monitors to measure heart rate, respiration, skin conductance, movement, pulse, transit time of blood flow from the periphery to the heart, skin temperature while affect (such as anger, contempt, fear, disgust, etc.) was noted. Midway during the 15-minute argument, the researchers interrupted the argument at 7½ minutes and randomly assigned the male batterer to one of three conditions: 1) a time out; 2) a request to edit out the negative, where he makes the same points in a more neutral fashion; or, 3) a request to accept influence, where he listens to the female's ideas, trusts that the partner may be right and validates her idea even if his idea is different. The male batterer was taught these communication skills then asked to use them in the second half of the argument. "What we found is that the interventions worked to make the second half of the argument better," said Babcock. "Batterers could learn these communication skills and when they applied them in arguments with their female partner, it decreased aggressive attacks on the female partner, contemptuous behavior, criticism and put downs in both the woman and the man. The idea is that reducing such psychological abuse may reduce intimate partner violence. Whereas most therapies are built top down from theory, the new technology allows us to build a therapy package--technique by technique--from the lab up." Babcock's article based on this UH experiment, "A Proximal Change Experiment Testing Two Communication Exercises with Intimate Partner Violent Men," won the "Best of 2011 Violence Research" award for the most exemplary research being conducted on violence and aggression. Five senior researchers convened by the Psychology of Violence Journal selected articles they believe have the potential to advance the field and direct the future research on violence. About the Center for Couples Therapy The Center for Couples Therapy is a clinical research center to provide state- of-the-art services for couples in committed relationships. The services are appropriate for couples experiencing specific relationship difficulties as well as those who want to make an already good relationship even better. For more information, see www.psychology.uh.edu/couples/ or contact The Center for Couples Therapy at 713-743-8600 or firstname.lastname@example.org. About the University of Houston The University of Houston is a Carnegie-designated Tier One public research university recognized by The Princeton Review as one of the nation's best colleges for undergraduate education. UH serves the globally competitive Houston and Gulf Coast Region by providing world-class faculty, experiential learning and strategic industry partnerships. Located in the nation's fourth-largest city, UH serves more than 39,500 students in the most ethnically and culturally diverse region in the country.
August 08, 2012
Alcoholism and Drug Abuse Counselors Continuing Education ### Other co-authors include Tal Yarkoni, PhD, a postdoctoral fellow in the Department of Psychology and Neuroscience at the University of Colorado at Boulder; Grega Repovs, PhD, professor of psychology at the University of Ljubljana, Slovenia; and Alan Anticevic, an associate research scientist in psychiatry at Yale University School of Medicine. Funding from the National Institute of Mental Health supported the study (National Institutes of Health grants MH66088, NR012081, MH66078, MH66078-06A1W1, and 1K99MH096801).
August 07, 2012
LPC Continuing Education Source: David Tolin, Ph.D., Hartford Hospital Reference Neural Mechanisms of Decision Making in Hoarding Disorder Tolin DF, Stevens, MC, Villavicencio AL, Norberg MM, Calhoun VD, Frost RO, Steketee G, Rauch SL, Pearlson GD. Arch Gen Psychiatry. 2012;69(8):832-841. doi:10.1001.
August 06, 2012
A comprehensive behavioral intervention is more effective than supportive therapy and education in helping adults control the tics associated with Tourette syndrome, according to an NIMH-funded study published in the August 2012 issue of the Archives of General Psychiatry. The study follows a previous study involving children with the disorder, which showed similar results. Background Tourette syndrome (TS) is a chronic neurological disorder associated with motor or vocal tics that can be disruptive and difficult to control. Tics begin in childhood, typically peak in early adolescence and often decrease by adulthood. For some adults, the tics persist and can be difficult to control. Many individuals with TS describe an unwanted urge or sensation prior to the tic that is relieved by performing the tic. TS is commonly treated with an antipsychotic medication such as pimozide or risperidone. But these medications rarely eliminate tics entirely and can cause troubling side effects such as weight gain and sedation. Because of these adverse side effects, many patients decline or discontinue use of these medications. Until now, few large-scale studies have examined the effectiveness of behavioral interventions for TS. A team of investigators from Massachusetts General Hospital/Harvard Medical School; Yale University; University of Texas Health Science Center at San Antonio; University of California, Los Angeles; the University of Wisconsin-Milwaukee; Johns Hopkins Medical Institutions; and the Tourette Syndrome Association tested the effectiveness of a Comprehensive Behavioral Intervention for Tics (CBIT), a therapy based on habit reversal training that includes two concepts: Tic-awareness training, which teaches how to recognize early signs that a tic is about to occur, and Competing-response training, which teaches how to engage in a voluntary behavior that is physically incompatible with the impending tic. For example, a person feeling an urge to jerk his or her shoulder may be taught to tense arm muscles while pushing the elbow against the torso (a competing response). This combination of awareness training and competing response training is intended to disrupt the cycle of premonitory urge and performance of the tic. The researchers randomized 122 adults at three research centers to either CBIT or a control treatment that included supportive therapy and education about TS. Each group received eight sessions over a 10-week period. Those who responded to therapy were assessed three months and six months after the end of the study period to determine if the therapy’s benefits persisted. Results of the Study Overall, 38 percent of patients receiving CBIT showed significant symptom improvement compared to 6 percent receiving the control treatment. The results complement the earlier CBIT study in children, which found that 52 percent of the children who received CBIT showed significant symptom improvement compared to 18.5 percent receiving the control treatment. social worker ceus Reference Wilhelm S, Peterson AL, Piacentini J, Woods DW, Deckersbach T, Sukhodolsky DG, Chang S, Liu H, Dziura J, Walkup JT, Scahill L. Randomized trial of behavior therapy for adults with Tourette syndrome. Archives of General Psychiatry. 2012 August.
August 01, 2012
professional counselor continuing education "It's important to understand why having a mutation in this gene predisposes someone to Parkinson's," said Ellen Sidransky, M.D., co-senior author and senior investigator in NHGRI's Medical Genetics Branch. "Clinically, we've seen that people with Gaucher mutations are at increased risk of developing Parkinson's and have noted that these patients can have earlier and more progressive symptoms, but these new findings provide biological evidence to support those differences." Gaucher disease is an inherited disease caused by mutations in the GBA gene, which codes for the enzyme glucocerebrosidase, which breaks down fatty molecules in the cell for disposal. When this housekeeping enzyme doesn't work properly, the fatty molecules pile up and ultimately can damage the spleen, liver, bones and other organs. The most severe form results in severebrain damage and early death. People affected by Gaucher disease inherit two defective gene copies; those who carry only one gene mutation do not have the disease. Parkinson's disease is a neurodegenerative disorder that affects about 1.5 million Americans, causing tremors and motor impairment. It results from a combination of age, environmental factors and genetic susceptibility. Both patients with Gaucher disease and those who carry one mutation in this gene are at increased risk for developing Parkinson's. In 2009, Dr. Sidransky and her team coordinated a large, international study of the association between the two disorders. The results, published in The New England Journal of Medicine, showed that those with Gaucher-related gene mutations had a five-times greater risk of developing Parkinson's. "We didn't expect this metabolic disorder to be linked to an unrelated neurodegenerative disorder, and we've been working to understand the mechanisms involved and their implications," Dr. Sidransky said. Previous research showed that people with GBA mutations and Parkinson's tend to develop the disease earlier and have more cognitive difficulties than generally seen in Parkinson's. In the current study, the researchers set out to determine if the brain biology of GBA-associated Parkinson's is different from that observed in others with Parkinson's disease. Investigators looked at 107 study participants divided into four groups: people with both diseases; those with Parkinson's and no Gaucher mutations; people with Gaucher disease and a family history of Parkinson's; and healthy GBA-mutation carriers with a family history of Parkinson's. Each test group was matched with a comparison group of healthy people who were examined the same way. The researchers used two types of an imaging technique called positron emission tomography (PET) to study the brains of participants. One type measured the amount and distribution of dopamine, an important message-carrying brain chemical lacking in people with Parkinson's. The second technique gauged blood flow in the brain, which reflects brain function. The researchers found that people with Parkinson's disease — both those with and those without Gaucher disease — had a similar reduction in dopamine levels, indicating damage to certain nerve cells in the brain in both groups. "We're fairly early along in understanding how mutations in the GBA gene predispose people to Parkinson's," said Karen Berman, M.D., co-senior author and chief of NIMH's Clinical Brain Disorders Branch. "We now need to investigate the mechanisms by which mutations in this gene may affect dopamine function and the health of dopamine neurons in the brain." They also found striking differences in blood flow, which was significantly reduced in the people with GBA mutations. They saw this blood flow reduction in specific brain regions where people with different forms of dementia, including Alzheimer's disease, are affected. "This different blood flow distribution has been seen in other disorders that involve cognitive impairment," Dr. Sidransky said. "This provides biologic confirmation of our clinical impression of problems with cognition in some patients with GBA-associated Parkinson's disease. This observation may help us to better understand the causes of dementia that can develop in Parkinson's disease and related disorders and could ultimately lead to strategies to target these problems." The investigators also examined dopamine distribution and brain blood flow/brain activity in the two groups thought be at high-risk for developing Parkinson's — people with a family history of Parkinson's who either have Gaucher disease or are healthy yet carry a GBA mutation. They looked at the PET scans to identify any significant, early brain changes compared to people in the study control groups. Among seven mutation carriers and 14 patients with Gaucher without Parkinson's, only two had reduced dopamine levels. Dr. Sidransky said that while long-term follow-up is needed to see if any of these people develop Parkinson's, the observation that most of the patients with GBA mutations didn't have early signs of Parkinson's may be reassuring to those considered at risk. "Not everyone with GBA alterations will develop Parkinson's," Dr. Sidransky said. "Identifying an early marker associated with disease may show us who might go on to develop Parkinson's, and help identify a population that could benefit from pre-symptomatic management. In addition, discovering why other at-risk individuals do not develop Parkinson's disease may also help us to understand factors that protect people from developing this disease." The researchers plan to continue to follow people in their study with GBA mutations and a family history of Parkinson's to monitor their dopamine levels and cerebral blood flow to see whether they develop Gaucher disease. The researchers also will assess whether these clinical data might predict which patients will eventually develop Parkinson's disease.