NDAR Federation Creates Largest Source of Autism Research Data to Date

NIH-funded Database Sets Standard for Collaboration and Data Sharing

Source: NDAR

A data partnership between the National Database for Autism Research (NDAR), and the Autism Genetic Resource Exchange (AGRE) positions NDAR as possibly the largest repository to date of genetic, phenotypic, clinical, and medical imaging data related to research on autism spectrum disorders (ASD)LPC Continuing Education

“The collaboration between AGRE and NDAR exemplifies the efforts of government and stakeholders to work together for a common cause,” said Thomas R. Insel, M.D., director of the National Institute of Mental Health, part of NIH. “NDAR continues to be a leader in the effort to standardize and share ASD data with the research community, and serves as a model to all research communities.”

NDAR is supported by the National Institutes of Health; AGRE is an Autism Speaks program.

NDAR’s mission is to facilitate data sharing and scientific collaboration on a broad scale, providing a shared common platform for autism researchers to accelerate scientific discovery. Built around the concept of federated repositories, NDAR integrates and standardizes data, tools, and computational techniques across multiple public and private autism databases. Through NDAR, researchers can access results from these different sources at the same time, using the rich data set to conduct independent analyses, supplement their own research data, or evaluate the data supporting published journal articles, among many other uses.

Databases previously federated with NDAR include Autism Speaks’ Autism Tissue Program, the Kennedy Krieger Institute’s Interactive Autism Network (IAN), and the NIH Pediatric MRI Data Repository. AGRE currently houses a clinical dataset with detailed medical, developmental, morphological, demographic, and behavioral information from people with ASD and their families.

Approved NDAR users will have access to data from the 25,000 research participants represented in NDAR, as well as 2,500 AGRE families and more than 7,500 participants who reported their own information to IAN.

NDAR is supported by NIMH, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute of Neurological Disorders and Stroke, the National Institute of Environmental Health Sciences, and the NIH Center for Information Technology.

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The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit the NIMH website.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit the NIH website.

Intervention Shows Promise in Treating Depression Among Preschoolers

Source: NIMH

A new psychosocial approach shows promise in helping preschoolers with symptoms of depression function better and learn to regulate their emotions, according to an NIMH-funded study published online ahead of print October 31, 2011, in the Journal of Child Psychology and Psychiatry.

Background

Recent studies have shown that symptoms of clinical depression can arise in children as young as 3, and may in fact be an early manifestation of a childhood mood disorder. However, no studies have investigated the best way to treat the disorder among children so young. In addition, many established psychosocial treatments for depression in adults and older youth, such as cognitive behavioral therapy or interpersonal therapy, might not be a good fit to the developmental needs of very young children.

Yet research has shown that very early behavioral interventions can have a significant impact on the trajectory of conduct problems and neuro-developmental disorders like autism or some developmental delays. These findings suggest that very early intervention for a mood disorder could potentially head off depression later in life lpc continuing education

Toward that end, Joan Luby, M.D., of Washington University and colleagues conducted a preliminary pilot study comparing a novel form of psychotherapy called Parent Child Interaction Therapy -Emotion Development (PCIT-ED) with a psycho-educational program. PCIT includes hands-on components aimed at strengthening the parent-child relationship by teaching positive play techniques and coaching parents through the process, and training parents in methods for handling noncompliance and disruptive behavior. PCIT has already been shown to be effective for treating disruptive disorders among preschoolers. The Emotion Development component was designed to help the parent enhance the child’s ability to recognize emotions in self and others and more effectively regulate intense emotions.

The psycho-education program—the control condition—educated parents in small groups about child development. It emphasized emotional and social development but did not include individual coaching or practice sessions with the parents and their children.

The researchers randomly assigned 54 preschoolers (aged 3-7) and their parents to either PCIT-ED or to the psycho-education program. Each program was conducted over a 12-week period.

Results of the Study

After 12 weeks, depression symptoms among the preschoolers significantly declined in both groups. The group receiving PCIT-ED also showed improvements in levels of anxiety, hyperactivity, conduct problems, hostility and inattention, whereas the group receiving the psycho-education program showed improvements in separation anxiety. In addition, the PCIT-ED group showed improvements in a child’s executive functioning and his or her ability to recognize and regulate emotions, compared to the control condition. The PCIT-ED group also reported reduced parenting stress and decreases in maternal depression, whereas the psycho-education group did not.

Significance

The results indicate that PCIT-ED is acceptable to families and may be beneficial. The researchers conclude that a full-scale randomized controlled trial is warranted.

What’s Next

While intriguing, the findings are preliminary only and should be interpreted with caution until further research can be conducted.

Reference

Luby J, Lenze S and Tillman R. A novel early intervention for preschool depression: findings from a pilot randomized controlled trial. Journal of Child Psychology and Psychiatry. Online ahead of print Oct. 31, 2011.

Psychologists Stress the Importance of Memory in Preventing Relapse after Therapy

Addictions, phobias, post-traumatic stress disorder—such painful and harmful problems are recalcitrant to treatment. In the clinic, a person may suppress the association between the stimulus and the response—say, a bar with ashtrays and smoking—by learning to pair the stimulus with a new memory not involving smoking. But once out in the world, faced with bars and ashtrays aplenty, he relapses into the old behavior. Some treatment aims at helping the patient avoid locations and stimuli that trigger the harmful behavior LPC Continuing Education

A new article in Current Directions in Psychological Science, a journal published by the Association for Psychological Science, says this is not the most effective route. “The therapist really has little control over the context in which the patient finds himself,” says Ralph R. Miller, distinguished professor of psychology at the State University of New York at Binghamton, who wrote the article with SUNY colleague Mario A. Laborda. A more promising method, then, is: “Make the treatment memory stronger.”

Experimentalists like the authors use the term “extinction” for the process, as Miller puts it, of “teaching the subject new memories that oppose the old memories.” Clinicians call it “exposure therapy.”

The article reviews the psychological literature supporting four ways to make the extinction memory stronger and therefore more enduring: Give more therapy (or in the experimental context, more trials). Conduct the therapy in different locations and contexts—for instance, different rooms rather than always the same office. Space the extinction exercises—or in the lab, the experimental trials—over the therapeutic session. And finally, provide the treatment sessions separated by more time. These methods exploit established principles of learning: that increased practice enhances learning, and “spaced practice results in better memory than when the learning trials are massed,” says Miller.

Miller stresses the importance of animal laboratory research in finding new treatment methods. “We are developing excellent means in the animal lab to model human psychopathology, not just for screening drugs but for screening behavioral treatments. We additionally now have models of the treatment and the limitations of the treatments,” he says. Determining how to reduce those limitations using rats rather than humans is faster and requires fewer subjects, he says. Numerous clinical studies, moreover, “certify that our findings with rats also apply to humans.”

The research cited in Miller and Laborda’s paper is suggestive of a powerful theory: “It appears that memories are forever,” says Miller. It then ratifies those proven facts about learning. “We are providing alternate memories that compete with the deleterious memory”—say, a new, automatic mental image of having a drink and a conversation in a bar without picking up a cigarette, perhaps accompanied by a feeling of relaxation. “The trick is that the newer memory when it is retrieved will be stronger than the deleterious memory.”

Current Directions in Psychological Science, a journal of the Association for Psychological Science, publishes concise reviews on the latest advances in theory and research spanning all of scientific psychology and its applications. For a copy of "Preventing Recovery From Extinction and Relapse: A Product of Current Retrieval Cues and Memory Strengths"

National Survey Dispels Notion that Social Phobia is the Same as Shyness

Source: NIMH

Normal human shyness is not being confused with the psychiatric anxiety disorder known as social phobia, according to an NIMH survey comparing the prevalence rates of the two among U.S. youth. The study was published online ahead of print October 17, 2011, in the journal Pediatrics.

Background

Social phobia is a disabling anxiety disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social or performance situations. Critics of the diagnosis have suggested that psychiatrists and pharmaceutical companies publicize social phobia, also known as social anxiety disorder, in order to increase sales of psychotropic medications, especially among youth. In addition, some have debated whether social phobia is just a “medicalization” of a normal variation in human temperament.

In response, Marcy Burstein, Ph.D., and colleagues at NIMH examined the rate of normal shyness among youth and its overlap with social phobia using data from the National Comorbidity Survey-Adolescent Supplement (NCS-A), a nationally representative, face-to-face survey of more than 10,000 teens aged 13-18 sponsored by NIMH. Social phobia was assessed using standard diagnostic criteria set by the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV). To assess shyness, teens were asked to rate how shy they felt around peers that they did not know well.

Results of the Study

The authors found that while about half of youth identified themselves as shy, only 12 percent of shy youth also met criteria for social phobia in their lifetime. Moreover, among youth who did not identify themselves as shy, about 5 percent met criteria for social phobia, suggesting that social phobia and shyness are not necessarily directly related. Rather, the presence of social phobia may be independent of shyness in some instances.

In addition, those with social phobia were consistently more likely to also have another psychiatric disorder in their lifetime, like depression or a behavior or drug use disorder, compared to those who identified themselves as shy. Those with social phobia also showed higher levels of impairment in work or school, or among family or peers, though they were no more likely to be receiving professional treatment than those who were shy.

Finally, rates of prescribed medication use were low for all groups. Only about 2.3 percent of those with social phobia were taking the antidepressant paroxetine (commonly used to treat anxiety disorders), while 0.9 percent who described themselves as shy were taking it. In addition, those with social phobia were no more likely to be taking any prescribed psychiatric medication compared to the other groups.

Significance

The results suggest that social phobia is not simply shyness that has been inappropriately medicalized. Rather, social phobia affects a minority of youth and only a fraction of those who consider themselves to be shy. In addition, despite the greater disability that youth with social phobia experience and the greater likelihood that they will have another disorder, they are not more likely to be getting treatment compared to their peers, questioning the notion that these youth are being unnecessarily medicated continuing education for counselors

Citation

Burstein M, Ameli-Grillon L, Merikangas M. Shyness versus social phobia in U.S. youth. Pediatrics. Online ahead of print Oct 17, 2011.

Thinking Globally to Improve Mental Health

Source: NASA Jet Propulsion Laboratory (NASA-JPL)

Mental health experts are calling for a greater world focus on improving access to care and treatment for mental, neurological, and substance use (MNS) disorders, as well as increasing discoveries in research that will enable this goal to be met LPC Continuing Education

The Grand Challenges in Global Mental Health Initiative, led by the National Institutes of Health and the Global Alliance for Chronic Diseases, has identified the top 40 barriers to better mental health around the world. Similar to past grand challenges, which focused on infectious diseases and chronic, noncommunicable diseases, this initiative seeks to build a community of funders dedicated to supporting research that will significantly improve the lives of people living with MNS disorders within the next 10 years.

Twenty-five of the specific challenges and the process used to derive them are described in an article that will be published on July 7, 2011, in the journal Nature.

"Participating in global mental health research is an enormous opportunity, a means to accelerate advances in mental health care for the diverse U.S. population, as well as an extension of our vision of a world where mental illnesses are prevented and cured," said Thomas R. Insel, M.D., director of the National Institute of Mental Health (NIMH), the NIH institute heading this effort.

According to the paper's authors, the disorders targeted by the Grand Challenges in Global Mental Health—for example, schizophrenia, depression, epilepsy, dementia, and alcohol dependence—collectively account for more years of life lost to poor health, disability, or early death than either cardiovascular disease or cancer. Yet, compared to illnesses like cardiovascular disease and cancer, there are far fewer effective treatments or preventive methods. In addition, interventions are not widely available to those who need them most.

In recognizing the need to address this imbalance, Pamela Collins, M.D., M.P.H., of the NIMH Office for Research on Disparities and Global Mental Health, and colleagues assembled an international panel of experts to identify research priorities using the Delphi method, a widely accepted consensus-building tool. The panel consisted of 422 experts in fields such as neuroscience, basic behavioral science, mental health services, and epidemiology, and represented more than 60 countries.

Over the course of two months, NIMH staff pared the panel's initial list of 1,565 challenges down to 154, with input from a scientific advisory board. From this list, the expert panel selected the top 40, of which the top five challenges identified after the third and final round of ranking are:
Integrate screening and core packages of services into routine primary health care
Reduce the cost and improve the supply of effective medications
Improve children's access to evidence-based care by trained health providers in low- and middle-income countries
Provide effective and affordable community-based care and rehabilitation
Strengthen the mental health component in the training of all health care personnel.

These top five challenges were ranked according to the ability to reduce the burden of disease, ability to reduce inequalities in health and health care, length of time until results can be observed, and the ability for the topic to be researched effectively.

"Addressing these challenges could have far-reaching effects, including increasing access to services and ultimately, reducing the treatment gap associated with these disorders," said Dr. Collins.

The Grand Challenges in Global Mental Health Initiative is led by NIMH and the Global Alliance for Chronic Diseases, in partnership with the Wellcome Trust, the McLaughlin-Rotman Centre for Global Health, and the London School of Hygiene and Tropical Medicine. Other NIH components participating in the Grand Challenges in Global Mental Health include the Fogarty International Center; the National Heart, Lung, and Blood Institute; and the National Institute of Neurological Disorders and Stroke.

Reference

Collins PY, Patel V, Joestl SS, March D, Insel TR, Daar A, on behalf of the Grand Challenges in Global Mental Health Scientific Advisory Board and Executive Committee. Grand Challenges in Global Mental Health. Nature. 2011 July 7. 474(7354):pp.

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The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit the NIMH website.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit the NIH website.

Manic Phase of Bipolar Disorder Benefits from Breast Cancer Medication

The medication tamoxifen, best known as a treatment for breast cancer, dramatically reduces symptoms of the manic phase of bipolar disorder more quickly than many standard medications for the mental illness, a new study shows. Researchers at the National Institutes of Health's National Institute of Mental Health (NIMH) who conducted the study also explained how: Tamoxifen blocks an enzyme called protein kinase C (PKC) that regulates activities in brain cells. The enzyme is thought to be over-active during the manic phase of bipolar disorder. Professional Counselor Continuing Education.

By pointing to PKC as a target for new medications, the study raises the possibility of developing faster-acting treatments for the manic phase of the illness. Current medications for the manic phase generally take more than a week to begin working, and not everyone responds to them. Tamoxifen itself might not become a treatment of choice, though, because it also blocks estrogen — the property that makes it useful as a treatment for breast cancer — and because it may cause endometrial cancer if taken over long periods of time. Currently, tamoxifen is approved by the Food and Drug Administration for treatment of some kinds of cancer and infertility, for example. It was used experimentally in this study because it both blocks PKC and is able to enter the brain.

Results of the study were published online in the September issue of Bipolar Disorders by Husseini K. Manji, MD, Carlos A. Zarate Jr., MD, and colleagues.

Almost 6 million American adults have bipolar disorder, whose symptoms can be disabling. They include profound mood swings, from depression to vastly overblown excitement, energy, and elation, often accompanied by severe irritability. Children also can develop the illness.

During the manic phase of bipolar disorder, patients are in "overdrive" and may throw themselves intensely into harmful behaviors they might not otherwise engage in. They might indulge in risky pleasure-seeking behaviors with potentially serious health consequences, for example, or lavish spending sprees they can't afford. The symptoms sometimes are severe enough to require hospitalization.

"People think of the depressive phase of this brain disorder as the time of risk, but the manic phase has its own dangers," said NIMH Director Thomas R. Insel, MD. "Being able to treat the manic phase more quickly would be a great asset to patients, not just for restoring balance in mood, but also because it could help stop harmful behaviors before they start or get out of control."

The three-week study included eight patients who were given tamoxifen and eight who were given a placebo (a sugar pill); all were adults and all were having a manic episode at the time of the study. Neither the patients nor the researchers knew which of the substances the patients were getting.

By the end of the study, 63 percent of the patients taking tamoxifen had reduced manic symptoms, compared with only 13 percent of those taking a placebo. Patients taking tamoxifen responded by the fifth day — which corresponds with the amount of time needed to build up enough tamoxifen in the brain to dampen PKC activity.

The researchers decided to test tamoxifen's effects on the manic phase of bipolar disorder because standard medications used to treat this phase, specifically, are known to lower PKC activity — but they do it through a roundabout biochemical route that takes time. Tamoxifen is known instead to block PKC directly. As the researchers suspected would happen, tamoxifen's direct actions on PKC resulted in much faster relief of manic symptoms, compared with some of the standard medications available today.

"We now have proof of principle. Our results show that targeting PKC directly, rather than through the trickle-down mechanisms of current medications, is a feasible strategy for developing faster-acting medications for mania," said Manji. "This is a major step toward developing new kinds of medications."

Findings from another recent NIMH study strengthen the results. This previous study showed that the risk of developing bipolar disorder is influenced by a variation in a gene called DGKH. The gene makes a PKC-regulating protein known to be active in the biochemical pathway through which standard medications for bipolar disorder exert their effects - another sign that PKC is a promising direct target at which to aim new medications for the illness.

"Mania isn't just your average mood swing, where any of us might feel upbeat in response to something that happens. It's part of a brain disorder whose behavioral manifestations can severely undermine people's jobs, relationships, and health," said Zarate. "The sooner we can help patients get back on an even keel, the more we can help them avoid major disruptions to their lives and the lives of people around them."



Reference
Zarate Jr. CA, Singh JB, Carlson PJ, Quiroz J, Jolkovsky L, Luckenbaugh DA, Manji HK. Efficiency of a Protein Kinase C Inhibitor (Tamoxifen) in the Treatment of Acute Mania: A Pilot Study. Bipolar Disorders, online ahead of print, September 2007.
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The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit the NIMH website.

The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit the NIH website.

New study shows that most substance abuse treatment programs accept private health insurance

Study indicates that most will be ready to adapt to greater health care coverage provided by the Affordable Care Act and Mental Health Parity and Addiction Equity Act
A new nationwide survey of substance abuse treatment facilities reveals that in 2008 nearly two thirds (65 percent) accepted some private health insurance payment. The survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) also indicated that there were significant differences in the level of private insurance payment acceptance among different types of substance abuse treatment facilities. Professional Counselor Continuing Education
For example, private insurance payment was accepted by 85 percent of facilities with a primary focus on mental health services, 82 percent of facilities offering general health care, and 78 percent of facilities offering a mix of mental health and substance abuse treatment services. On the other hand, private insurance payment was accepted by only 56 percent of facilities primarily focused on substance abuse treatment services and 37 percent of facilities focused on other services (e.g., providing shelter for people experiencing homelessness).

"The ability to bill third party payers including private insurers and Medicaid is critical to the survival of treatment facilities," said SAMHSA Administrator Pamela S. Hyde, J.D. "The dramatic increase in numbers of people covered with health insurance that includes coverage for mental and substance use disorders will revolutionize the behavioral health field. Treatment facilities need to be preparing now and SAMHSA has technical assistance resources available to help."

The study noted that substance abuse treatment facilities that accepted private insurance payments were far more likely than those that did not to accept payment from other sources such as Medicaid (68 percent versus 31 percent), state-financed health insurance (53 percent versus 14 percent) and Medicare (48 percent versus 12 percent).

This capacity of substance abuse programs to bill Medicaid may become more critical as Medicaid’s coverage of substance abuse services becomes more comparable to its coverage of mental health services.

Other significant differences between treatment programs that accepted private insurance payment and those that did not include the use of cognitive-behavioral therapy services at their facilities (70 percent versus 58 percent). Facilities accepting private insurance were more likely than others to accept adolescents into their programs (58 percent versus 33 percent).

The study also showed that treatment facilities located in more central large urban areas were less likely than rurally situated facilities to accept private insurance payment (54 percent versus 78 percent). In general the further away facilities were from central city areas, the more likely they were to accept private insurance payment.

The study, Acceptance of Private Health Insurance in Substance Abuse Treatment Facilities is based on data from SAMHSA’s Treatment Episode Data Set (TEDS) -- a reporting system involving treatment facilities from across the country. The study was developed as part of SAMHSA’s strategic initiative on data, outcomes, and quality -- an effort to inform policy makers and service providers on the nature and scope of behavioral health issues

Social Phobia Patients Have Heightened Reactions to Negative Comments

In a study using functional brain imaging, NIMH scientists found that when people with generalized social phobia were presented with a variety of verbal comments about themselves and others ("you are ugly," or "he's a genius," for example) they had heightened brain responses only to negative comments about themselves. Knowledge of the social cues that trigger anxiety and what parts of the brain are engaged when this happens can help scientists understand and better treat this anxiety disorder. LPC Continuing Education
Background

Generalized social phobia (GSP) is the most common of all anxiety disorders. It is marked by overwhelming anxiety and self-consciousness in social situations. One approach to understanding anxiety disorders is to use functional brain imaging (fMRI) to explore how the brain responds to different types of social signals. fMRI can provide information on the relative activity—and thus the engagement—of different parts of the brain by tracking the local demands made for oxygen delivered by circulating blood. Scientists using this technology have reported, for example, that people with GSP have heightened responses to a variety of positive, negative, and neutral facial expressions, not just expressions that others perceive as threatening.

Results of this Study

People with GSP had heightened responses to negative comments (relative to a comparison group without the disorder) in two brain areas: the first, the medial prefrontal cortex (MPFC), is involved in the sense and evaluation of self; the second, the amygdala, is central to emotional processing. The responses revealed by scanning paralleled the participants' self-report of how they felt after seeing the various positive, negative, and neutral comments presented.

Significance

This work, conducted by NIMH intramural investigators Karina Blair, Ph.D., Daniel Pine, M.D., and colleagues, provided information on the specific social cues that trigger anxiety in people with GSP. It adds to previous evidence that the amygdala is involved and, in implicating the MPFC, gives clues for further research to explore on how people with GSP interpret social cues. Functional brain scanning can thus help to define patterns of brain functioning that underlie anxiety disorders, providing information that can inform treatment.

What's Next?

A previous study by these investigators found that the reaction of the brain to facial expressions was different in people with GSP than in those with general anxiety disorder (GAD). This suggests that the two disorders do not represent mild and severe forms in a single spectrum of anxiety disorders, but two neurologically different disorders.

Continuing research will reexamine these differences to see if they occur across different tasks, providing confirmation for understanding them as different disorders, which could lead to more targeted and effective forms of treatment for each disorder. Future studies will also explore more deeply the nature of the thought process underlying the reaction of people with GSP to negative comments about themselves and the interaction of the amygdala and MPFC. Finally, brain scanning offers a means to study the effects of treatment; scanning can, for example, provide information on the effects of medications in these parts of the brain.


Left amygdala (left) and medial prefrontal cortex (circled in yellow, right) activated strongly in people with social phobia (in comparison to those without GSP) in response to criticism of themselves.

References
Blair, K. et al. American Journal of Psychiatry. 2008 Sep;165(9):1193-202. Epub 2008 May 15. PMID: 18483136

Blair, K. et al. Archives of General Psychiatry. 2008 Oct;65(10):1176-1184.

Runaway Vigilance Hormone Linked to Panic Attacks

Translational Experiments in Rats, Humans Suggest New Medication Target
A study has linked panic disorder to a wayward hormone in a brain circuit that regulates vigilance. While too little of the hormone, called orexin, is known to underlie narcolepsy, the new study suggests that too much of it may lead to panic attacks that afflict 6 million American adults. LPC Continuing Education
"Targeting the brain's orexin system may hold promise for a new generation of anti-anxiety treatments," said Thomas R. Insel, M.D., Director of the National Institute of Mental Health (NIMH), part of the National Institutes of Health. "This is a good example of how translational experiments in rats and humans can potentially yield clinical benefits."

NIMH grantee Anantha Shekhar, M.B., Ph.D., and colleagues at Indiana University and Lund University, report on their findings online Dec. 27, 2009 in the journal Nature Medicine. They showed that blocking orexin gene expression or its receptor prevented panic attack-like responses in rats. The study also revealed that panic disorder patients have excess levels of the hormone.

Background
Orexin, also called hypocretin, is secreted exclusively in a circuit emanating from the brain's hypothalamus, known to regulate arousal, wakefulness and reward.

Panic attacks can be experimentally-induced by infusing susceptible humans with a normally innocuous salt called sodium lactate. The salt similarly triggers panic-like anxiety behaviors in susceptible rat strains, suggesting that something is altered in their arousal circuit. Since sodium lactate activated orexin-secreting neurons in panic-prone rats but not in control rats, the researchers hypothesized that something might be orexin.

Results of This Study
The investigators first discovered that increased gene expression in orexin-secreting neurons correlated with increases in anxiety-like behavior in panic-prone rats following sodium lactate infusions. Using a technique called RNA interference, they then protected the panic-prone rats from developing anxiety behaviors following the infusions by first injecting them with a genetically-engineered agent that prevented orexin genes from turning on. Blocking orexin receptors with a drug that specifically binds to it also blocked the anxiety like behavior following the infusions. This mirrored effects, seen in both rats and humans, of benzodiazepine medications used to treat panic disorder.

The excess sleepiness of narcolepsy, traced a decade ago to loss of orexin-secreting neurons in the arousal circuit, might seem to be an opposite state of a panic attack. However, the researchers demonstrated in rats that such sedation could not account for orexin's effects on anxiety. Also in rats, they traced orexin neurons to their end target to pinpoint the specific brain site that accounts for the anxiety effects, disentangled from cardio-respiratory components of the panic response.

Finally, by measuring orexin in cerebrospinal fluid of 53 patients, the researchers showed that those with just panic disorder had higher levels of orexin than those with both panic disorder and depression.

Significance
Taken together, these results and other evidence suggest a critical role for an overactive orexin system in producing panic attacks, say the researchers.

What's Next?
Medications that block the orexin receptor may provide a new therapeutic approach for the treatment of panic disorder, they add.

The research was also supported, in part, by NIH's National Center for Research Resources.

Reference
A key role for orexin in panic anxiety. Johnson PL, Truitt W, Fitz SD, Kelley PE, Dietrich A, Sanghani S, Traskman-Bendz L, Goddard AW, Brundin, L, Shekhar A. Nature Medicine. Epub 2009 Dec 27.

Managing Stress: Popular New Year's Resultions

Manage Stress

The Basics
Preventing and managing stress can help lower your risk of serious health problems like heart disease, high blood pressure, and depression. You can prevent or lessen stress by:

Planning ahead
Preparing for stressful events
Some stress is hard to avoid. You can find ways to manage stress by:

Noticing when you feel stressed
Taking time to relax
Getting active and eating healthy
Talking to friends and family
What are the signs of stress?
When people are under stress, they may feel:

Worried
Irritable
Depressed
Unable to focus
Stress also affects the body. Physical signs of stress include:

Headaches
Back pain
Problems sleeping
Upset stomach
Weight gain or loss
Tense muscles
Frequent or more serious colds
Use this tool to better understand your stress (http://www.mentalhealthamerica.net/llw/stressquiz.html).

What causes stress?
Stress is often caused by some type of change. Even positive changes, like marriage or a job promotion, can be stressful. Stress can be short-term or long‑term. LPC Continuing Education
Common causes of short-term stress:


Too much to do and not much time
Lots of little problems in the same day (like a traffic jam or running late)
Getting lost
Having an argument

Common causes of longer-term stress:


Divorce or problems in a marriage
Death of a loved one
Illness
Caring for someone who is sick
Problems at work
Money problems

What are the benefits of managing stress?
Managing stress can help you:

Sleep better
Control your weight
Get sick less often and heal faster
Lessen neck and back pain
Be in a better mood
Get along better with family and friends
Take Action!
Being prepared and in control of your situation will help you feel less stress. Follow these 9 tips for preventing and managing stress.

1. Plan your time.
Think ahead about how you are going to use your time. Write a to-do list and decide which tasks are the most important. Be realistic about how long each thing will take.

2. Prepare yourself.
Prepare ahead of time for stressful events like a job interview or a hard conversation with a loved one.

Picture the event in your mind.
Stay positive.
Imagine what the room will look like and what you will say.
Have a back-up plan.
3. Relax with deep breathing.
Find out how easy it is to use deep breathing to relax (http://www.helpguide.org/mental/stress_relief_meditation_yoga_relaxation.htm#deep).

4. Relax your muscles.
Stress causes tension in your muscles. Try stretching or taking a hot shower to help you relax. Check out these stretches you can do at your desk (http://dohs.ors.od.nih.gov/ergo_computers.htm#muscular).

5. Get active.
Physical activity can help prevent and manage stress. It can also help relax your muscles and improve your mood.

Aim for 2 hours and 30 minutes a week of moderate aerobic activity, like walking fast or biking.
Be sure to exercise for at least 10 minutes at a time.
Do strengthening activities (like sit-ups or lifting weights) at least 2 days a week.
6. Eat healthy.
Give your body plenty of energy by eating fruits, vegetables, and protein.

7. Drink alcohol only in moderation.
Don’t use alcohol and drugs to manage your stress. If you choose to drink, drink only in moderation. This means no more than 1 drink a day for women or 2 drinks a day for men.

8. Talk to friends and family.
Tell your friends and family if you are feeling stressed. They may be able to help.

9. Get help if you need it.
Stress is a normal part of life. But if your stress doesn’t go away or keeps getting worse, you may need help. Over time, stress can lead to serious problems like depression, post-traumatic stress disorder (PTSD), or anxiety.

If you are feeling down or hopeless, talk to a doctor about depression.
If you are feeling anxious, find out how to get help for anxiety (http://www.nimh.nih.gov/health/publications/anxiety-disorders/how-to-get-help-for-anxiety-disorders.shtml).
A mental health professional (like a psychologist or social worker) can help treat these conditions with talk therapy (called psychotherapy) or medicines.

Lots of people need help dealing with stress – it’s nothing to be ashamed of!



Learn more about how you can keep your heart healthy.

Start Today: Small Steps
Find out how positive thinking can lower your stress (http://www.mayoclinic.com/health/positive-thinking/SR00009/METHOD=print).
Test your stress smarts (http://www.apa.org/helpcenter/stress-smarts.aspx).
Check out these tips for dealing with stress (http://familydoctor.org/online/famdocen/home/common/mentalhealth/stress/167.printerview.html).
You May Also Be Interested In
Content last updated on: December 20, 2010


National Health Information Center
P.O. Box 1133, Washington, DC 20013-1133
healthfinder@nhic.org

FAA Certifies Santa’s NextGen-Equipped Sleigh for Christmas Eve

Press Release – FAA Certifies Santa’s NextGen-Equipped Sleigh for Christmas Eve
PrintEmailFor Immediate Release
December 20, 2010
Contact: FAA Press Office
Phone: 202-267-3883


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WASHINGTON – Federal Aviation Administration (FAA) safety inspectors at the North Pole certified Santa One, the reindeer-powered sleigh piloted by Santa Claus, for its Christmas Eve round-the-world delivery mission.

Santa One, led by Rudolph the Red-Nosed Reindeer, is outfitted with new satellite-based NextGen technology, which will allow Santa to deliver more toys to more children with improved safety and efficiency.

“Children around the world will get their gifts on time, regardless of the weather, thanks to NextGen,” said U.S. Transportation Secretary Ray LaHood. “We’re proud to say NextGen is bringing Santa Claus to town.”

Rudolph’s red nose has been outfitted with avionics that will broadcast Santa One’s position via satellites to air traffic controllers around the world with improved accuracy, integrity and reliability.

“Santa’s cockpit display will help improve his situational awareness by showing him and his reindeer flight crew their precise location in relation to other aircraft, bad weather and terrain,” said FAA Administrator Randy Babbitt. “NextGen will help make this an extra-safe Christmas Eve.”

The sleigh’s onboard systems have been upgraded with state-of-the-art, NextGen technology that will allow Santa One to maintain cruising altitude for as long as possible before making a continuous descent into cities and towns around the world. While maneuvering on rooftops, an advanced, onboard runway safety system will help reduce the risk of incursions between the sleigh and chimneys.

Santa’s reindeer-powered sleigh is already energy-efficient, but the NextGen technologies will further reduce Santa One’s carbon hoofprint. The shorter, faster routings means that Rudolph and the other reindeer will consume less hay, resulting in fewer greenhouse gases.

Unlike any other pilot, Santa has special permission from the FAA to fly thousands of domestic and international short-haul and long-range flights in one night. In keeping with the FAA's science-based proposal to give pilots more rest, Santa will arrange his flight plan based on his circadian rhythm. Mrs. Claus also assured FAA safety inspectors that she’ll make sure he gets plenty of rest before the flight on Christmas Eve.

Follow Santa’s progress on Christmas Eve at the NORAD Tracks Santa website: www.noradsanta.org

See how NextGen is going to improve the safety and efficiency of Santa’s rooftop descents: http://www.faa.gov/go/santa

LPC Continuing Education

Easy Ways to Reduce Holiday Stress

For many families, the holiday season can feel more stressful than joyful. Stress comes from many directions at this time of year: too much rich food and drink, not enough exercise or sleep and all the rushing around to find the perfect gifts at the lowest prices.

“Although stress is common at this time of year, it is not inevitable,” says registered dietitian Crystelle Fogle of the Cardiovascular Health Program for the Montana Department of Public Health and Human Services. “Virtually every mental health expert agrees that lifestyle habits can help with stress reduction. This is the perfect time to step back from the holiday hustle and find ways to insure that your family is getting daily physical activity, plenty of nutrient-rich foods, and enough sleep every night.”

The typical holiday pattern of overindulgence and sleep deprivation combined with low activity actually adds stress in multiple layers. First, there is the actual physical stress from your body not getting what it needs for optimal health and energy. On top of that stress is layers of guilt and frustration brought on because you’re doing things that are unhealthy. Then, these feelings often lead back to more overeating or additional alcohol consumption.

Fogle points out that stopping this vicious cycle is easier than you may think. “It starts with setting priorities for your family – like fitness, nutrition, and sleep – and then saying ‘no’ to some of the holiday events that interfere with these healthy habits,” Fogle said. “The simple act of taking more control over your daily life can lower stress levels almost immediately.”

Here are a few real easy ways to have your holiday fun and reduce your stress too:

•Eat well. Family meals and nutrient-rich foods are even more important at this time of year. Enjoy simple meals, like steaming soup with salad and rolls, together as often as possible. Take time to establish new family traditions, like making bread from scratch.
•Play well. Being active together creates special memories and improves moods at the same time. Holiday fitness fun is as easy as a family game of Twister® or a stroll around the neighborhood to sing some holiday songs or carols for friends.
•Sleep well. Most adults do best with seven to eight hours sleep a night, while young children need significantly more. Develop family routines that promote healthy sleep habits, like reading holiday stories or listening to calming music together before bedtime.
“The ‘togetherness’ of these stress reduction tips is an important aspect of healthy, happy holidays,” Fogle notes. Connections to family and friends are much more important to holiday comfort and joy than lots of new stuff or plates of high-calorie treats. Starting new family traditions that reduce stress, such as cooking a meal or playing active games together, are gifts that will truly keep on giving for years to come.

Five Easy Ways to Enjoy More Tasty Holiday Nutrition
Although calorie-rich treats and overflowing tables can be the norm during holidays, you can get the nutrition that your body needs. The key is to concentrate on nutrient-rich foods. With bright colors and delicious flavors, nutrient-rich foods are a gift on any holiday table.

Calorie for calorie, these stars of the nutrition world offer more of the vitamins, minerals, protein and fiber that your whole family needs to maintain weight, enhance health, and reduce stress during this hectic time of year. Here are five easy ways to add nutrient-rich foods to all your seasonal feasts and treats.

•Start every day (and holiday) with breakfast. For a high-energy day, always include protein in your morning meal. Enjoy an egg or two, a serving of low-fat yogurt, a handful of nuts on whole grain cereal, or some lean meat, like a sliced turkey and Swiss on whole wheat wrap or bread.
•Snack smart throughout the holidays. Nutrient-rich snacks provide energy, while reducing the tendency to overeat at your next meal. Start with a piece of fresh fruit or some sliced veggies. Add a serving of protein, like a string cheese, a glass of low-fat milk, or leftover meats.
•Feature festive holiday salads at every meal. Fruit salads (any combo of canned, dried, frozen, or fresh fruit) are delicious any time of day. Green salads, bean salads, and veggie salads add color and crunch to lunch and dinner (and they make tasty leftovers for super smart snack times).
•Pack your holiday breadbasket with nutrition. The nutrient-rich goodness of whole grains, nuts, seeds, and dried fruits makes for tasty breads, rolls, and muffins. Bake some at home or check grocery shelves for sunflower whole wheat bread or bran muffins with raisins and walnuts.
•Warm up the holiday with winter vegetables. Root veggies (sweet potatoes, beets, and carrots) and hard winter squashes, like acorn, butternut, pumpkin, and spaghetti, are some the least expensive and most nutritious produce options. Enjoy them roasted, mashed, and made into soup!
Five Ways to Enjoy 10 Minutes of Holiday Fitness Fun
Physical activity is even more important during the holidays than other times of the year. Being active helps relieve holiday stress – and helps balance out the usual increase in holiday calories. To maintain fitness levels and emotional well-being, enjoy at least three 10-minute activity breaks a day – preferably with family or friends.

•Take a brisk 10-minute stroll with a loved one. Something as simple as a 10-minute walk can make all the difference in your physical and mental state. A brisk walk around the block at work or around your neighborhood can improve your mood and kick-start your metabolism in just a few simple steps. For extra holiday fun, invite someone you’ve been missing!
•Play a child’s favorite active game for 10 minutes. It’s often said that holidays are “all about the children.” What better way to be active than to have festive fun with one or more young people! Children often have extra energy to burn during the holidays and even serious adults can enjoy some sledding, get tied up in game of Twister®, or toss around a Koosh® ball.
•Dance for 10 minutes to your favorite holiday tunes. You could “Rock around the Christmas Tree” and just go “Walkin’ in a Winter Wonderland.” Use music to pick up the pace when you are walking or working outside with headphones – or cleaning up the house for a holiday gathering. For the best holiday break of all, take a spin on the dance floor with your sweetie.
•Walk for 10 minutes between stores. You can even fit fitness into a busy shopping day. Take a 10-minute ‘breather’ between each store on your list. Enjoy a quick lap around the perimeter of the mall or a walk around a couple of downtown blocks. You’ll have more energy – and you just might make more reasonable spending decisions too!
•Take a 10-minute stretch break at home or work. Holiday tension can take a toll on backs, shoulders, and jaws. A quick break can relieve physical and mental stress. Check these sites for gentle moves that can be done anywhere you need a stretch: www.lib.msu.edu/ergomsu/stretch.htm and www.will-harris.com/yoga/everyday_yoga.html
BRN Continuing Education http://www.aspirace.com
LPC Continuing Education http://www.aspirace.com

Holiday Safety Tips

National Crime Prevention Council
1000 Connecticut Avenue, NW
13th Floor
Washington, DC 20036
www.ncpc.org

This holiday season, don’t let the spirit of giving lull you into giving burglars, muggers, nor pickpockets a chance to do their dirty work.

Criminals love the holidays as much as everyone else, chiefly because it’s a perfect opportunity to commit a crime.

Keep these tips in mind for a safe and happy holiday season.


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If You’re Traveling . . .
* Set an automatic timer for your lights.

* Ask your neighbor to watch your home, pick up newspapers, collect mail, and park in the driveway from time to time.

* Be sure to hide any gifts that may be left in the house while you’re gone.


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If You’re Out for the Evening . . .
* Turn on lights and a radio or the TV so that it appears that someone is home.


* Lock all doors and windows while you’re out, even if you’ll be gone for just a few minutes.


* Do not place packages or gifts near windows or in other high-visibility sites.


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If You’re Shopping . . .
* Don’t let your guard down just because you are rushing.


* Stay alert and be aware of everything around you at all times.


* Park in well-lighted spaces and as close to the store as possible, lock your car doors, and hide packages in the trunk or under the seats.


* Do not carry large amounts of cash; pay with a check or credit card if possible.


* Make sure that you do not carry all your packages at the same time.


* Carry your purse close to your body, not dangling by the straps. Put a wallet in an inside coat or front pants pocket.


* If you take your children shopping, teach them to go to a police officer or a store security guard if they get separated or get lost.


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If a Stranger Comes to the Door . . .
* Stay alert to suspicious-looking couriers delivering packages to you or your neighbors.


* Many con artists take advantage of holiday generosity by going door-to-door. Ask for identification and get specifics to how and where the donations will be spent/used.


* If you feel uncomfortable, just say “no thank you” and shut the door.


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If You’re at Home . . .
* Turn on outside lights to deter burglars.


* Report any suspicious behavior to the police or local community watch groups.


* Make sure your homeowners (or renters) insurance is up-to-date and everything is inventoried properly.

LPC Continuing Education http://www.aspirace.com

Avoiding Holiday Depression

The holiday season is a time of joy, cheer, parties and family-oriented gatherings. But it can also be a time of self-evaluation, loneliness and anxiety about an uncertain future, causing "holiday blues."

Many factors cause holiday blues such as increased stress and fatigue, unrealistic expectations, over-commercialization, financial constraints and the inability to be with family and friends. Increased demands of shopping, parties and houseguests can also cause tension. Even people who do not become depressed can develop other stress reactions during the holidays, such as headaches, excessive drinking, overeating and difficulty sleeping.

Although many people become depressed during the holiday season, even more respond to the excessive stress and anxiety once the holidays have passed. This post-holiday letdown can be the result of emotional disappointments experienced during the preceding months, as well as the physical reactions caused by excess fatigue and stress.

There are several ways to identify potential sources of holiday depression that can help you head off the blues:

s Keep expectations manageable. Set realistic goals for yourself. Pace yourself. Organize your time. Make a list and prioritize the most important activities. Be realistic about what you can and cannot do.

s Remember that the holiday season does not automatically banish reasons for feeling sad or lonely. There is room for these feelings to be present, even if you choose not to express them.

s Let go of the past. Don’t be disappointed if your holidays are not like they used to be. Life brings changes. Each holiday season is different and can be enjoyed in its own way. Look toward the future.

s Do something for someone else. It is an old remedy, but it can help. Try volunteering some time to help others.

s Enjoy holiday activities that are free, such as driving around to look at holiday decorations. Go window shopping without buying anything.

s Don’t drink too much. Excessive drinking will only make you more depressed.

s Don’t be afraid to try something new. Celebrate the holidays in a way you have not done before.

s Spend time with people who are supportive and who care about you. Reach out to make new friends if you are alone during special times. Contact someone you have lost touch with.

s Find time for yourself. Don’t spend all of your time providing activities for your family and friends.

Signs of depression can also include: noticeable weight loss/gain, difficulty sleeping, lack of energy, loss of interest in usual activities and thoughts of suicide. If someone exhibits any of these signs, a Primary Care Manager at Keller should be contacted immediately for proper treatment.
LPC Continuing Education http://www.aspirace.com

Editor’s note: The information in this article came from a Sierra Military Health Care article and from information provided by the Mental Health Association.

Tips for Smart Holiday Shopping

In these tough economic times, smart shopping during the holiday season is more important than ever. Whether consumers are shopping online, by phone, or in stores, the Federal Trade Commission, the nation’s consumer protection agency, has some advice to avoid both debt and unneeded stress.

First, make as accurate and comprehensive a budget as possible – don’t forget to include the cost of incidentals like postage, gift wrap, and decorations. Then, learn to navigate holiday sale ads, make sure to keep careful track of your spending, and make the best of layaway opportunities.

To learn more about smart holiday shopping, see the consumer alert “Holiday Shopping, Circa 2008: Tips from the Federal Trade Commission,” at
http://www.ftc.gov/bcp/edu/pubs/consumer/alerts/alt082.shtm. For more general information about wise money management and savvy shopping, visit ftc.gov/consumer.

The Federal Trade Commission works for consumers to prevent fraudulent, deceptive, and unfair business practices and to provide information to help spot, stop, and avoid them. To file a complaint in English or Spanish, visit the FTC's online Complaint Assistant or call 1-877-FTC-HELP (1-877-382-4357). The FTC enters complaints into Consumer Sentinel, a secure, online database available to more than 1,500 civil and criminal law enforcement agencies in the U.S. and abroad.
LPC Continuing Education http://www.aspirace.com

ADMH OFFERS INFORMATION AND TIPS TO BEAT STRESS AND THE HOLIDAY BLUES

Thoughts of the upcoming holidays usually bring a smile to most people’s face when they think of the family gatherings, food, and presents that will be in abundance. But some may feel stressed or depressed for a host of reasons surrounding the holidays. However, with some practical tips, you can minimize the stress and
depression that sometimes accompany the holidays.

Recognize Holiday Triggers
According to the Mayo Clinic, one of the most important things to do is learning to recognize some of the more common holiday triggers that lead to stress and depression. This will help you feel more in control and be prepared
to disarm them.

 Relationships. They can cause turmoil, conflict or stress at any time, but tensions are sometimes heightened during the holidays. Family misunderstandings and conflicts can intensify. On the other hand, facing the holidays without a loved one can leave you feeling lonely and sad.

 Finances. In this time of economic uncertainty, everyone is feeling the pinch. With the added expenses of gifts, travel, food, and entertainment, the holidays can put a strain on your budget and peace of mind.

 Physical demands. The extra parties, shopping, baking, cleaning, and entertaining, can leave many wiped out. Being exhausted increases stress and makes you more susceptible to colds and other unwelcome guests.

Tips to Combat Holiday Stress and Depression
These practical tips from the Mayo Clinic and Mental Health America can help you find the balance you need to prevent yourself from feeling overwhelmed.

 Acknowledge your feelings. Remember that the holiday season does not banish reasons for feeling sad or lonely.
There is room for these feelings to be present, and it is okay to express your feelings. Conversely, allow yourself
to also experience joy and happiness as you celebrate special times.

 Keep expectations for the holiday season manageable. Know what you can and cannot do. Try to set realistic
goals, prioritize the important activities, plan accordingly, and pace yourself.

 Be realistic. The holidays don’t have to be perfect or just like last year. Be open to creating new ways to celebrate
the holidays.

 Reach out. Spend time with supportive and caring people. Reach out and make new friends, contact someone you
haven’t heard from in a while, and try volunteering some of your time to help others. It will lift your spirits and
broaden your friendships.

 Stick to a budget. Don’t try to buy happiness with an avalanche of gifts. Before gift and food shopping, decide how much you can afford and then stick to it. You can also enjoy activities that are free, such as taking a drive to
look at holiday decorations.

 Make some time for yourself. Recharge your batteries and let others share in the responsibility of planning activities. Dr. Richard Powers, chief medical director for ADMH offers some additional tips related to diet, exercise and sleep.

 Consider your dietary targets for the day. But do not become distressed over dietary failures from the previous day. You have the entire next year to work off those extra pounds.

 Make a resolution to get exercise on every day that you are off from work. Walking is fine, especially if you walk more than 45 minutes per day.

 Get enough sleep especially when you are off work and avoid heavy drinking late at night or the use of caffeinated beverages after 5 p.m. Both alcohol and calories disrupt your sleep. Being well rested helps you to have positive relationships with your family.

Dr. Powers states, “Experts like myself remind everybody that you might get depressed or stressed out during the holidays; no big news flash to most people. This year, ADMH encourages everyone to take a proactive, positive approach towards the holidays. Decide whether you want to be in control of your emotions or if your emotions will be in control of you.”

RESOURCES

Licensed Professional Counselor LPC Continuing Education

MFT Continuing Education ceus http://www.aspirace.com

For more information about the Mayo Clinic, visit www.mayoclinic.com
For more information about Mental Health America, visit www.nmha.org