Mental Rest and Reflection Boost Learning, Study Suggests

What do you think of this article supported by the NIH and published by University of Texas at Austin?: "The patterns of brain activity recorded in this fMRI scanner revealed how mental rest and reflection on past learning activities can boost future learning. Photo credit: Jeff Luci. AUSTIN, Texas — A new study, which may have implications for approaches to education, finds that brain mechanisms engaged when people allow their minds to rest and reflect on things they've learned before may boost later learning. Scientists have already established that resting the mind, as in daydreaming, helps strengthen memories of events and retention of information. In a new twist, researchers at The University of Texas at Austin have shown that the right kind of mental rest, which strengthens and consolidates memories from recent learning tasks, helps boost future learning. The results appear online this week in the journal Proceedings of the National Academy of Sciences. Margaret Schlichting, a graduate student researcher, and Alison Preston, an associate professor of psychology and neuroscience, gave participants in the study two learning tasks in which participants were asked to memorize different series of associated photo pairs. Between the tasks, participants rested and could think about anything they chose, but brain scans found that the ones who used that time to reflect on what they had learned earlier in the day fared better on tests pertaining to what they learned later, especially where small threads of information between the two tasks overlapped. Participants seemed to be making connections that helped them absorb information later on, even if it was only loosely related to something they learned before. "We've shown for the first time that how the brain processes information during rest can improve future learning," says Preston. "We think replaying memories during rest makes those earlier memories stronger, not just impacting the original content, but impacting the memories to come. Until now, many scientists assumed that prior memories are more likely to interfere with new learning. This new study shows that at least in some situations, the opposite is true. "Nothing happens in isolation," says Preston. "When you are learning something new, you bring to mind all of the things you know that are related to that new information. In doing so, you embed the new information into your existing knowledge." Preston described how this new understanding might help teachers design more effective ways of teaching. Imagine a college professor is teaching students about how neurons communicate in the human brain, a process that shares some common features with an electric power grid. The professor might first cue the students to remember things they learned in a high school physics class about how electricity is conducted by wires. "A professor might first get them thinking about the properties of electricity," says Preston. "Not necessarily in lecture form, but by asking questions to get students to recall what they already know. Then, the professor might begin the lecture on neuronal communication. By prompting them beforehand, the professor might help them reactivate relevant knowledge and make the new material more digestible for them." This research was conducted with adult participants. The researchers will next study whether a similar dynamic is at work with children. This work was supported by the National Institute of Mental Health of the National Institutes of Health, the National Science Foundation (NSF) through the NSF CAREER Award and the Department of Defense through the National Defense Science and Engineering Graduate Fellowship Program." For more information on mental health topics, please visit CEUs for Counselors

How Career Dreams are Born: Study shows how to convince those with low self-confidence to pursue their career choice

What do you think of this article by Jeff Grabmeier? Published on September 29, 2014 "COLUMBUS, Ohio – A new study shows just what it takes to convince a person that she is qualified to achieve the career of her dreams. Researchers found that it’s not enough to tell people they have the skills or the grades to make their goal a reality. Instead, many people need a more vivid and detailed description of just how pursuing their dream career will help make them successful. This is especially important for people who have the skills and potential to pursue a particular career, but lack the self-confidence, said Patrick Carroll, author of the study and associate professor of psychology at The Ohio State University’s Lima campus. Students who have chronic self-doubt may need an extra boost to pursue the dreams they are certainly able to achieve,” Carroll said. Dr. Patrick J. Carroll Patrick Carroll “This study finds that what they really need is a vivid picture of what will happen if they succeed.” The study was published online this week in the journal Basic and Applied Social Psychology. The study involved 67 undergraduate business and psychology students at Ohio State. The students signed up to meet with a career adviser to learn about a supposedly new master’s degree program in business psychology that would train them for “high-paying consulting positions as business psychologists.” However, the program didn’t actually exist. The goal was to get the students interested in the program, and see how they reacted when faced with varying levels of validation to their new dreams of becoming a business psychologist. (The researchers followed a protocol to help students who may have been disappointed that there wasn’t a real program. More on that below.) All the students read a brochure about the program and then filled out several questionnaires. They were asked to rate their self-confidence that they could become a business psychologist, whether they were excited about the possibility of becoming a business psychologist, whether they thought they could be admitted to the business psychology program and whether they intended to apply. They also reported their overall GPA. The students were then separated into four groups. Students in the control group were given an information sheet indicating no GPA requirement for the program. The other three groups were given sheets indicating the GPA requirement was .10 below whatever they had listed as their own GPA. In one of these groups, the “career adviser” –- who actually worked with the researchers -- simply pointed out that the students’ GPA was higher than the requirement. In another group, the validation was raised slightly: The adviser told the participants that they were exactly what the program was looking for and that it was unlikely they would be rejected if they applied. The last group received the strongest validation to their hopes of becoming a business psychologist: They were also told they were qualified and were unlikely to be rejected if they applied. But the adviser added that it was likely that the student would be accepted with full funding and excel in the program and would graduate with numerous job offers in business psychology. Afterward, the participants once again filled out forms asking how confident and excited they were about becoming a business psychologist and whether they expected they would be admitted. In addition, the students were given the opportunity to actually apply to the program. The results were striking. The students in the control group and those who were simply told their GPA exceeded the program requirements didn’t embrace the possible new goal of becoming a business psychologist. These participants did not show any elevations in self-confidence related to becoming a business psychologist and were unlikely to apply to the program or even ask for more information. Even when students learn that they exceed some external admissions requirement to become a business psychologist, they still have to decide whether that means they should pursue that career dream instead of any others,” Carroll said. “They may need more validation than that to pursue this career goal.” However, when the adviser clearly detailed the vivid prospect of success, the students were willing to embrace the pursuit of that new business psychology goal. Specifically, students given the most vivid validation had higher levels of self-confidence immediately after meeting with the adviser and were more likely to actually apply to the business psychology program. “Self-confidence played a key role here. Students felt more confident that they could really be successful as a business psychologist when they received a detailed picture from their adviser,” Carroll said. Following the study, the researchers thoroughly debriefed all participants on why it was necessary to use deception to study how students, like them, naturally respond to social validation to pursue new career goals. In addition, researchers provided all participants with detailed information on career counseling services that they could utilize on campus for help in making future career choices. This extensive debriefing was designed to remove any adverse influence of the study feedback on participants before they left, Carroll said. After the purpose of the study was explained to them, many participants were enthusiastic about the research and its relevance in revealing how others can shape their own career decisions, he said. Carroll said he sees the relevance of this research nearly every day, as students seek his input about career plans or the possibility of graduate school. “Sometimes students have the grades, the motivation and the ability but simply lack the necessary self-confidence to whole-heartedly invest in the pursuit of a realistic new goal,” he said. “This work shows how parents, teachers and counselors can steer students into the right direction to achieve their dreams.” The findings are especially relevant now as students prepare for an uncertain job market and they, along with their teachers and guidance counselors, try to find the best career choices for them. “Educators are trying to lead students to the most realistic career options,” Carroll said. “This research is important to understanding how students make revisions in their career goals and decide which career possibilities they should embrace.” This research was supported by a grant from the National Institute of Mental Health." For more informatio0n on mental health and social work topics, please visit Aspira Continuing Education and LPC Continuing Education

To curb violent tendencies, start young Working with aggressive children prevents some from becoming violent, criminal adults

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DURHAM, N.C. -- Aggressive children are less likely to become violent criminals or psychiatrically troubled adults if they receive early intervention, says a new study based on more than two decades of research. "These findings from researchers at Duke, Pennsylvania State and Vanderbilt universities and the University of Washington are based on the Fast Track Project, a multi-faceted program that is one of the largest violence-prevention trials ever funded by the federal government. Beginning in 1991, the researchers screened nearly 10,000 5-year-old children in Durham, Nashville, Seattle and rural Pennsylvania for aggressive behavior problems, identifying those who were at highest risk of growing up to become violent, antisocial adults. Nearly 900 children were deemed at high risk, and of those, half were randomly assigned to receive the Fast Track intervention, while the other half were assigned to a control group. Participating children and their families received an array of interventions at school and at home. Nineteen years later, the authors found that Fast Track participants at age 25 had fewer convictions for violent and drug-related crimes, lower rates of serious substance abuse, lower rates of risky sexual behavior and fewer psychiatric problems than the control group. "We can prevent serious violence and psychopathology among the group of children who are highest-risk," said Duke's Kenneth Dodge. "That's the essential finding from this study. It provides the strongest evidence yet that, far from being doomed from an early age, at-risk children can be helped to live productive lives." Dodge directs the Duke Center for Child and Family Policy and is the William McDougall Professor of Public Policy at Duke's Sanford School of Public Policy. The program's positive effects held true across four different sites around the country, among both males and females and among both white and African-American children. The study appears online Sept. 15 in the American Journal of Psychiatry. From first through 10th grade, the Fast Track children received reading tutoring and specialized intervention aimed at improving self-control and social-cognitive skills. Parents learned problem-solving skills through home visits and parent training groups. When program participants turned 25, researchers reviewed court records and conducted interviews with participants and control group members, as well as individuals who knew the participants well. Along with fewer criminal convictions, Fast Track participants had lower rates of antisocial personality disorder and avoidant personality disorder, lower rates of risky sexual behavior and lower rates of harsh parenting. The latter finding suggests that the intervention may interrupt the inter-generational cycle of problem behavior. Fast Track is among very few studies to test the long-term effect of environment on children's development through a clinical trial. It provides strong evidence for the critical role environment plays in shaping a child's development. "This study adds to the experimental evidence for the important role that environment plays," Dodge said. "Genes do not write an inalterable script for a child's life. And not only does the environment matter greatly in a child's development, we've shown that you can intervene and help that child succeed in life." Fast Track's positive effects do not come cheap. The 10-year intervention costs $58,000 per child. However, that cost should be weighed against the millions of dollars that each chronic criminal costs society in imprisonment and harm to others, Dodge said. "Prevention takes a considerable investment, but that investment is worth it," Dodge said. "Our policies and practices should reflect the fact that these children can have productive lives." In future studies, Dodge and his colleagues plan to examine the cost-benefit question more closely. ### The research was supported by grants from the National Institute of Mental Health (NIMH R18 MH48043, R18 MH50951, R18 MH50952, R18 MH50953, K05MH00797 and K05MH01027), the Department of Education (grant S184U30002) and the National Institute on Drug Abuse (NIDA grants DA16903, DA017589, K05DA015226, and P30DA023026). The Center for Substance Abuse Prevention and the National Institute on Drug Abuse also provided support through a memorandum of agreement with the NIMH. Financial disclosure: Study authors Kenneth Dodge, Karen Bierman, John Coie, Mark Greenberg, John Lochman and Robert McMahon are the developers of the Fast Track curriculum and have a publishing agreement with Guilford Press. Greenberg is also an author of the PATHS curriculum, which is used in the Fast Track program. McMahon is a co-author of Helping the Noncompliant Child and has a royalty agreement with Guilford Publications. He is also a member of the Treatments that Work Scientific Advisory Board with Oxford University Press. The other authors have no financial relationships to disclose." CITATION: "Impact of Early Intervention on Psychopathology, Crime and Well-Being at Age 25," Kenneth A. Dodge and the Conduct Problems Prevention Research Group. American Journal of Psychiatry, September 15, 2014. DOI: 10.1176/appi.ajp.2014.13060786. For more information on mental health topis, please visit CEUs for Counselors

Combined drugs and therapy most effective for severe nonchronic depression

What do you think of this article released by NIMH?

"The odds that a person who suffers from severe, nonchronic depression will recover are improved by as much as 30 percent if they are treated with a combination of cognitive therapy and antidepressant medicine rather than by antidepressants alone. However, a person with chronic or less severe depression does not receive the same additional benefit from combining the two. That is the result of a major new clinical trial published online by the journal JAMA Psychiatry on Aug. 20. In North America, about one in five women and one in 10 men suffer from major depression in her or his lifetime. "Our results indicate that combining cognitive therapy with antidepressant medicine can make a much bigger difference than we had thought to about one-third of patients suffering from major depressive disorder," said Steven Hollon, the Gertrude Conaway Professor of Psychology at Vanderbilt University, who directed the study. "On the other hand, it does not appear to provide any additional benefit for the other two-thirds." Previous studies have found that about two-thirds of all patients with major depressive disorder will improve on antidepressant medications and about one-third of patients will achieve full remission, but half then relapse before fully recovering. Cognitive therapy has proven to be about as effective as medication alone but its effects tend to be longer lasting. Combining the two has been estimated to improve recovery rates by 6 to 33 percent. "Now, we have to reconsider our general rule of thumb that combining the two treatments keeps the benefits of both," said Hollon. The new study was a randomized clinical trial involving 452 adult outpatients with chronic or recurrent major depressive disorder. Unlike previous studies that followed subjects for a set period of time, this study treated them for as long as it took first to remission (full normalization of symptoms) and then to recovery (six months without relapse), which in some cases took as long as three years. "This provided us with enough data so that we could drill down and see how the combined treatment was working for patients with different types and severity of depression: chronic, recurrent, severe and moderate," Hollon said. According to the psychologist, the results could have a major impact on how major depressive disorder is treated. The most immediate effect is likely to be in the United Kingdom, which, he said, is 10 years ahead of the United States in treatment of depression. The use of combined cognitive therapy and antidepressive medicine is standard for severe cases in the UK, and the English National Health Service is actively training its therapists in cognitive therapy and other empirically supported psychotherapies." ### Collaborators in the study were Robert DeRubeis and Jay Amsterdam from the University of Pennsylvania; Jan Fawcett from the University of New Mexico, Albuquerque; Richard Shelton from the University of Alabama, Birmingham; John Zajecka and Paula Young from Rush University; and Robert Gallop from West Chester University. The study was supported by grants MH60713, MH01697, MH60998 and MH060768 from the National Institute of Mental Health. For more information on mental health and counseling related topics, please visit Counselor CEUs

Most teen mental health problems go untreated

Less than half of teenagers with mental health problems receive any sort of treatment DURHAM, N.C. -- More than half of adolescents with psychiatric disorders receive no treatment of any sort, says a new study by E. Jane Costello, a Duke University professor of psychology and epidemiology and associate director of the Duke Center for Child and Family Policy. When treatment does occur, the providers are rarely mental health specialists, says the study, which was based on a survey of more than 10,000 American teenagers LPC Continuing Education The country's mental health system has come under scrutiny in recent years, following a string of mass shootings, such as the murders at Columbine High in Colorado, in which mental illness seems to have played a role. The new study underlines the need for better mental health services for adolescents, Costello said. "It's still the case in this country that people don't take psychiatric conditions as seriously as they should," Costello said. "This, despite the fact that these conditions are linked to a whole host of other problems." Costello noted that not all teens in the study fared the same. Treatment rates varied greatly for different mental disorders, for instance. Adolescents with ADHD, conduct disorder or oppositional defiant disorder received mental health care more than 70 percent of the time. By contrast, teens suffering from phobias or anxiety disorders were the least likely to be treated. Results also varied greatly by race, with black youths significantly less likely to be treated for mental disorders than white youths. The care that teenagers received also varied greatly. In many cases, care was provided by pediatricians, school counselors or probation officers rather than by people with specialized mental health training. There simply are not enough qualified child mental health professionals to go around, Costello said. "We need to train more child psychiatrists in this country," Costello said. "And those individuals need to be used strategically, as consultants to the school counselors and others who do the lion's share of the work." The study draws on data from the National Comorbidity Survey Adolescent Supplement, a nationally representative face-to-face survey of 10,148 adolescents between the ages of 13 and 17. It was published online Nov. 15 in Psychiatric Services Youth with Co-occuring Substance Abuse and Mental Health Disorders CE Course ### The research was supported by NIDA (grants U01-DA024413, DA011301, and DA022308), NIMH (grant MH083964), and the NIMH Intramural Research Program. CITATION: "Services for Adolescents With Psychiatric Disorders: 12-Month Data From the National Comorbidity Survey–Adolescent," E. Jane Costello, Jian-ping He, Nancy A. Sampson, Ronald C. Kessler and Kathleen Ries Merikangas. Psychiatric Services 2013. doi: 10.1176/appi.ps.201100518

National Institute of Mental Health (NIMH) Grantees To Receive 2013 Lasker Award

A current and a former National Institute of Mental Health (NIMH) grantee recently collected the prestigious 2013 Albert Lasker Basic Medical Research Award for their meticulous mapping of the molecular mechanisms involved in neurotransmitter release, the process by which the brain sends and receives chemical messages. Richard H. Scheller, Ph.D. Richard H. Scheller, Ph.D Genentech Thomas C. Südhof, M.D., at Stanford University School of Medicine, and Richard H. Scheller, Ph.D., at Genentech, parsed the proteins that enable one neuron to speak to another. This communication occurs across the synapse, a gap that separates the two neurons. Collectively called the “SNARE complex,” these proteins include vesicle-associated membrane protein (VAMP/synaptobrevin), synaptogamin, syntaxin, and SNAP-25. The complex allows for the preparation and release of the neurotransmitters into the synapse. Defects in this process contribute to mental disorders such as schizophrenia, depression, bipolar disorder, epilepsy, and many other pathological conditions. Thomas C. Südhof, M.D. Thomas C. Südhof, M.D. Stanford University School of Medicine Dr. Südhof is a current NIMH grantee and has served on several study sections at the NIH Center for Scientific Review, in addition to the Molecular, Cellular, and Developmental Neuroscience study section at NIMH. Dr. Scheller received research support from NIMH, and served on both the NIMH Molecular, Cellular, and Developmental Neuroscience study section, and the National Advisory Mental Health Council. Both have received the NIMH MERIT Award. Known as “America’s Nobels” because many recipients go on to win the Nobel Prize, the Lasker Awards are among the most respected science prizes in the world. Congratulations, Drs. Südof and Scheller Aspira Continuing Education Online Courses

DSM-5 and RDoC: Shared Interests

Thomas R. Insel, M.D., Director, NIMH Jeffrey A. Lieberman, M.D., President-elect, APA NIMH and APA have a shared interest in ensuring that patients and health providers have the best available tools and information today to identify and treat mental health issues, while we continue to invest in improving and advancing mental disorder diagnostics for the future. Today, the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM), along with the International Classification of Diseases (ICD) represents the best information currently available for clinical diagnosis of mental disorders. Patients, families, and insurers can be confident that effective treatments are available and that the DSM is the key resource for delivering the best available care. The National Institute of Mental Health (NIMH) has not changed its position on DSM-5. As NIMH's Research Domain Criteria (RDoC) project website states, "The diagnostic categories represented in the DSM-IV and the International Classification of Diseases-10 (ICD-10, containing virtually identical disorder codes) remain the contemporary consensus standard for how mental disorders are diagnosed and treated." Yet, what may be realistically feasible today for practitioners is no longer sufficient for researchers. Looking forward, laying the groundwork for a future diagnostic system that more directly reflects modern brain science will require openness to rethinking traditional categories. It is increasingly evident that mental illness will be best understood as disorders of brain structure and function that implicate specific domains of cognition, emotion, and behavior. This is the focus of the NIMH’s Research Domain Criteria (RDoC) project. RDoC is an attempt to create a new kind of taxonomy for mental disorders by bringing the power of modern research approaches in genetics, neuroscience, and behavioral science to the problem of mental illness ceus for social workers The evolution of diagnosis does not mean that mental disorders are any less real and serious than other illnesses. Indeed, the science of diagnosis has been evolving throughout medicine. For example, subtypes of cancers once defined by where they occurred in the body are now classified on the basis of their underlying genetic and molecular causes. All medical disciplines advance through research progress in characterizing diseases and disorders. DSM-5 and RDoC represent complementary, not competing, frameworks for this goal. DSM-5, which will be released May 18, reflects the scientific progress seen since the manual's last edition was published in 1994. RDoC is a new, comprehensive effort to redefine the research agenda for mental illness. As research findings begin to emerge from the RDoC effort, these findings may be incorporated into future DSM revisions and clinical practice guidelines. But this is a long-term undertaking. It will take years to fulfill the promise that this research effort represents for transforming the diagnosis and treatment of mental disorders. By continuing to work together, our two organizations are committed to improving outcomes for people with some of the most disabling disorders in all of medicine.

Nearly 20 percent of suicidal youths have guns in their home

Researchers say emergency department doctors should screen all pediatric patients for suicide risk WASHINGTON, DC – Nearly one in five children and teens found to be at risk for suicide report that there are guns in their homes, and 15 percent of those at risk for suicide with guns in the home know how to access both the guns and the bullets, according to a study to be presented Monday, May 6, at the Pediatric Academic Societies (PAS) annual meeting in Washington, DC. Suicide is the second leading cause of death among young people ages 10 to 24 years in the United States, according to Centers for Disease Control and Prevention data. Nearly half of youths who die by suicide use a firearm. Researchers conducted a study to create a suicide risk screening tool that health care professionals in emergency departments (EDs) could use to figure out which youths need further mental health evaluation to keep them from harming themselves. As part of that study, researchers asked youths about access to guns in or around their home and about gun/bullet storage. "For more than 1.5 million adolescents, the ED is their primary point of contact with the health care system, which makes the ED an important place for identifying youth at risk for suicide," said Stephen J. Teach, MD, MPH, FAAP, associate chief in the Division of Emergency Medicine at Children's National Medical Center in Washington, DC, and co-author who will be presenting the study at the PAS meeting. Many clinicians and parents do not know how to ask youth about suicide, so they require screening tools to assist in detection, added study senior author Lisa M. Horowitz, PhD, MPH, staff scientist/pediatric psychologist at the National Institute of Mental Health, National Institutes of Health, Bethesda, Md. "According to our data, when asked their opinion, nearly all of the kids in our study were in favor of suicide screening in the ED. Our study shows that if you ask kids directly about suicide, they will tell you what they are thinking." Study participants included 524 patients ages 10 to 21 who were seen for medical/surgical or psychiatric complaints at one of three pediatric EDs. They were asked to fill out a 17-item questionnaire that the researchers used to develop the Ask Suicide-Screening Questions (ASQ), a four-question screening tool that can be used for all pediatric patients visiting the ED. The ASQ has been validated against a longer more in-depth suicide assessment tool. "While many youths who kill themselves have mental health disorders, up to 40 percent of youths who kill themselves have no known mental illness," said co-author and youth suicide expert Jeffrey A. Bridge, PhD, principal investigator at The Research Institute at Nationwide Children's Hospital and associate professor of pediatrics at The Ohio State University. "Therefore, it is important to screen all children and adolescents for suicide, regardless of the reason they are visiting the ED." Of the patients who completed the screening tools, 151 (29 percent) were found to be at risk for suicide, and 17 percent of them reported guns in or around the home. Of those at risk for suicide and reporting guns in the home, 31 percent knew how to access the guns, 31 percent knew how to access the bullets, and 15 percent knew how to access both the guns and the bullets. "This study highlights the importance of parents understanding the risks of having guns in their homes," said Dr. Bridge. "Being at risk for suicide and having access to firearms is a volatile mix. These conversations need to take place in the ED with families of children at risk for suicide." Suicide Prevention CE Course ### To view the abstract, "Access to Firearms among Patients Screening Positive for Suicide Risk in Pediatric Emergency Departments," go to http://www.pas-meeting.org/2013DC/Abstracts/LB%20Pub%20All%202013.pdf The research was supported by the Intramural Research Program of the National Institute of Mental Health, the National Institutes of Health (Drs. Horowitz & Pao); institutional research funds from the Research Institute at Nationwide Children's Hospital and grant K01 MH-69948 from the National Institute of Mental Health (Dr. Bridge); institutional research funds from the Program for Patient Safety and Quality at Boston Children's Hospital Boston (Dr. Wharff). The Pediatric Academic Societies (PAS) are four individual pediatric organizations that co-sponsor the PAS Annual Meeting – the American Pediatric Society, the Society for Pediatric Research, the Academic Pediatric Association, and the American Academy of Pediatrics. Members of these organizations are pediatricians and other health care providers who are practicing in the research, academic and clinical arenas. The four sponsoring organizations are leaders in the advancement of pediatric research and child advocacy within pediatrics, and all share a common mission of fostering the health and well-being of children worldwide. For more information, visit http://www.pas-meeting.org. Follow news of the PAS meeting on Twitter at http://twitter.com/PedAcadSoc.

Forced exercise may still protect against anxiety and stress, says CU-Boulder study

Being forced to exercise may still help reduce anxiety and depression just as exercising voluntarily does, according to a new study by researchers at the University of Colorado Boulder. Past studies have shown that people who exercise are more protected against stress-related disorders. And scientists know that the perception of control can benefit a person's mental health. But it has been an open question whether a person who feels forced to exercise, eliminating the perception of control, would still reap the anxiety-fighting benefits of the exercise. People who may feel forced to exercise could include high school, college and professional athletes, members of the military or those who have been prescribed an exercise regimen by their doctors, said Benjamin Greenwood, an assistant research professor in CU-Boulder's Department of Integrative Physiology. "If exercise is forced, will it still produce mental health benefits?" Greenwood asked. "It's obvious that forced exercise will still produce peripheral physiological benefits. But will it produce benefits to anxiety and depression?" To seek an answer to the question Greenwood and his colleagues, including Monika Fleshner, a professor in the same department, designed a lab experiment using rats. During a six-week period, some rats remained sedentary, while others exercised by running on a wheel. The rats that exercised were divided into two groups that ran a roughly equal amount of time. One group ran whenever it chose to, while the other group ran on mechanized wheels that rotated according to a predetermined schedule. For the study, the motorized wheels turned on at speeds and for periods of time that mimicked the average pattern of exercise chosen by the rats that voluntarily exercised. After six weeks, the rats were exposed to a laboratory stressor before testing their anxiety levels the following day. The anxiety was quantified by measuring how long the rats froze, a phenomenon similar to a deer in the headlights, when they were put in an environment they had been conditioned to fear. The longer the freezing time, the greater the residual anxiety from being stressed the previous day. For comparison, some rats were also tested for anxiety without being stressed the day before. "Regardless of whether the rats chose to run or were forced to run they were protected against stress and anxiety," said Greenwood, lead author of the study appearing in the European Journal of Neuroscience in February. The sedentary rats froze for longer periods of time than any of the active rats. "The implications are that humans who perceive exercise as being forced — perhaps including those who feel like they have to exercise for health reasons — are maybe still going to get the benefits in terms of reducing anxiety and depression," he said. Anxiety Disorders CE Course ### Other CU-Boulder authors include Katie Spence, Danielle Crevling, Peter Clark and Wendy Craig. All the authors are members of Monika Fleshner's Stress Physiology Laboratory in the Department of Integrative Physiology. The research was funded by the National Institutes of Mental Health and the Defense Advanced Research Projects Agency.

WSU researchers find the missing link between mental health disorders and chronic diseases in Iraq war refugees

October 15, 2012Subjects who fled Iraq after Gulf War were 43 times more likely to suffer from obstructive sleep apneaDETROIT – Wayne State University School of Medicine researchers may have discovered why people exposed to war are at increased risk to develop chronic problems like heart disease years later. And the culprit that links the two is surprising.Beginning in the mid-2000s, WSU researchers interviewed a random sample of 145 American immigrants who left Iraq before the 1991 Gulf War, and 205 who fled Iraq after the Gulf War began. All were residing in metropolitan Detroit at the time of the study. Study subjects were asked about socio-demographics, pre-migration trauma, how they rated their current health, physician-diagnosed and physician-treated obstructive sleep apnea, somatic disorders and psychosomatic disorders. Those who left Iraq after the war began and suffered from mental disorders such as post-traumatic stress disorder (PTSD) and depression, and self-rated their physical health as worse than their actual health, were 43 times more likely than pre-Gulf War immigrants to report obstructive sleep apnea (30.2 percent versus 0.7 percent) and later develop major chronic health issues such as cardiovascular disease.“I was surprised, but we had a specific theory we wanted to test. Changes in the stress system would contribute to sleep apnea. What happens? Maybe it’s the stress that leads to this fractured sleep,” said Bengt Arnetz, M.D., Ph.D., M.P.H., School of Medicine professor of occupational and environmental health, deputy director of the Institute of Environmental Health Sciences at Wayne State, and the study’s principal investigator and first author. “No one had explored this possible link before, although basic research suggests it as plausible.”The results are featured in the October 2012 issue of Psychosomatic Medicine, the peer-reviewed journal of the American Psychosomatic Society.According to the article, “Obstructive Sleep Apnea, Post-traumatic Stress Disorder, and Health in Immigrants,” obstructive sleep apnea occurs when the muscles supporting the soft palate at the back of the throat relax, but less is known about the reasons behind this neuromuscular malfunctioning.“It’s a known fact that the more exposure to violence you have, the more likely you are to report PTSD and depression, and the worse your self-rated health is, the more likely your actual health will suffer in five to 10 years,” Arnetz said.Hikmet Jamil, M.D., Ph.D., professor of occupational and environmental health in WSU’s School of Medicine, and Thomas Templin, Ph.D., research professor in WSU’s College of Nursing, also contributed to the article.The obstructive sleep apnea and chronic disase link has been observed among many trauma-exposed populations, including refugees, Arnetz said.“Iraqis were exposed to harsh conditions during the entirety of Saddam Hussein’s more than 20 years of reign. However, trauma and environmental exposures increased measurably and dramatically after the initiation of the 1991 Gulf War,” the article states.The study can now be used as a model for other populations, including U.S. soldiers returning home from battle.The multidisciplinary study brought together mental health research, sleep research and chronic disease research, Arnetz said.He and Jamil were partially supported by the National Institute of Mental Health of the National Institutes of Health (award number R01MH085793).To further test their ideas, the researchers plan to apply for funding from the National Institutes of Health to collaborate with Safwan Badr, M.D., professor and chief of the School of Medicine’s Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, and Thomas Roth, Ph.D., director of the Henry Ford Sleep Disorders and Research Center.###Wayne State University is one of the nation’s pre-eminent public research universities in an urban setting. Through its multidisciplinary approach to research and education, and its ongoing collaboration with government, industry and other institutions, the university seeks to enhance economic growth and improve the quality of life in the city of Detroit, state of Michigan and throughout the world. For more information about research at Wayne State University, visit http://www.research.wayne.edu.Founded in 1868, the Wayne State University School of Medicine is the largest single-campus medical school in the nation, with more than 1,000 medical students. In addition to undergraduate medical education, the school offers master’s degree, Ph.D. and M.D.-Ph.D. programs in 14 areas of basic science to about 400 students annually Professional Counselor Continuing Education

Study identifies factors related to violence in veterans

CHAPEL HILL, N.C. – A national survey identifies which U.S. military veterans may be at most risk of aggression after deployment and what strategies could potentially help reduce likelihood of violence when service members return home counselor ceus The study examined protective factors that are important in preventing violence, including employment, meeting basic needs, living stability, social support, spiritual faith, ability to care for oneself, perceived self-determination, and resilience (ability to adapt to stress). Veterans with these factors in place were 92 percent less likely to report severe violence than veterans who did not endorse these factors. The majority of veterans (over three-quarters of those studied) did endorse most of these protective factors and thus posed a low threat of violence. These findings are reported in an article published June 25, 2012 in the Journal of Clinical Psychiatry of a National Institute of Mental Health-funded study led by Eric B. Elbogen, PhD, Research Director of the Forensic Psychiatry Program in the University of North Carolina School of Medicine and Psychologist in the U.S. Department of Veterans Affairs. "When you hear about veterans committing acts of violence, many people assume that post-traumatic stress disorder (PTSD) or combat exposure are to blame," Elbogen said. "But our study shows that is not necessarily true." The national survey revealed that other factors are just as important to understanding violence in veterans, including alcohol misuse, criminal background, as well as veterans' living, work, social, and financial circumstances. In fact, the survey found that veterans who didn't have enough money to cover basic needs were more likely to report aggressive behavior than veterans with PTSD. "Our study suggests the incidence of violence could be reduced by helping veterans develop and maintain protective factors in their lives back home," Elbogen said. The survey was conducted between July 2009 and April 2010. Responses were collected from 1,388 veterans who served in the Iraq and Afghanistan War era and theater after Sept. 11, 2001. The sample included veterans from all branches of the U.S. military and all 50 states. One-third of survey respondents self-identified committing an act of aggression towards others in the past year, most of which involved relatively minor aggressive behavior. Eleven percent of the sample reported more severe violence. Elbogen noted, "Although the majority of study participants did not report aggression, the potential for violence does remain a significant concern among a subset of returning veterans." Dr. Sally Johnson, co-author and Professor in the UNC Forensic Psychiatry Program, points out "Some veterans do not cope well with the loss of the structure, social, and financial support available in the military environment. Attention to helping veterans establish psychosocial stability in the civilian environment can help reduce post-deployment adjustment problems including aggression." ### The other co-authors H. Ryan Wagner, PhD, Virginia M. Newton, PhD Christine Timko, PhD, Jennifer J. Vasterling, PhD, and Jean C. Beckham, PhD are affiliated with the Department of Veterans Affairs.

Adaptable decision making in the brain

Front-most part of the cortex involved in making short-term predictions about what will happen next Researchers at the University of Iowa, together with colleagues from the California Institute of Technology and New York University, have discovered how a part of the brain helps predict future events from past experiences. The work sheds light on the function of the front-most part of the frontal lobe, known as the frontopolar cortex, an area of the cortex uniquely well developed in humans in comparison with apes and other primates. Making the best possible decisions in a changing and unpredictable environment is an enormous challenge. Not only does it require learning from past experience, but it also demands anticipating what might happen under previously unencountered circumstances. Past research from the UI Department of Neurology was among the first to show that damage to certain parts of the frontal lobe can cause severe deficits in decision making in rapidly changing environments. The new study from the same department on a rare group of patients with damage to the very frontal part of their brains reveals a critical aspect of how this area contributes to decision making. The findings were published June 19 in the Journal of Neuroscience. "We gave the patients four slot machines from which to pick in order to win money. Unbeknownst to the patients, the probability of getting money from a particular slot machine gradually and unpredictably changed during the experiment. Finding the strategy that pays the most in the long run is a surprisingly difficult problem to solve, and one we hypothesized would require the frontopolar cortex," explains Christopher Kovach, Ph.D., a UI post-doctoral fellow in neurosurgery and first author of the study. Contrary to the authors' initial expectation, the patients actually did quite well on the task, winning as much money, on average, as healthy control participants. "But when we compared their behavior to that of subjects with intact frontal lobe, we found they used a different set of assumptions about how the payoffs changed over time," Kovach says. "Both groups based their decisions on how much they had recently won from each slot machine, but healthy comparison subjects pursued a more elaborate strategy, which involved predicting the direction that payoffs were moving based on recent trends. This points towards a specific role for the frontopolar cortex in extrapolating recent trends." Kovach's colleague and study author Ralph Adolphs, Ph.D., professor of neuroscience and psychology at the California Institute of Technology, adds that the study results "argue that the frontopolar cortex helps us to make short-term predictions about what will happen next, a strategy particularly useful in environments that change rapidly -- such as the stock market or most social settings." Adolphs also hold an adjunct appointment in the UI Department of Neurology. The study's innovative approach to understanding the function of this part of the brain uses model-based analyses of behavior of patients with specific and precisely characterized areas of brain damage. These patients are members of the UI's world-renowned Iowa Neurological Patient Registry, which was established in 1982 and has more than 500 active members with selective forms of damage, or lesions, to one or two defined regions in the brain. "The University of Iowa is one of the few places in the world where you could carry out this kind of study, since it requires carefully assessed patients with damage to specific parts of their brain," says study author Daniel Tranel, Ph.D., UI professor of neurology and psychology and director of the UI Division of Behavioral Neurology and Cognitive Neuroscience. In a final twist to the finding, the strategy taken by lesion patients was actually slightly better than the one used by comparison subjects. It happened that the task was designed so that the trends in the payoffs were, in fact, random and uninformative. "The healthy comparison subjects seemed to perceive trends in what was just random noise," Kovach says. This implies that the functions of the frontopolar cortex, which support more complex and detailed models of the environment, at times come with a downside: setting up mistaken assumptions. "To the best of my knowledge this is the first study which links a normal tendency to see a nonexistent pattern in random noise, a type of cognitive bias, to a particular brain region," Kovach notes. The researchers next want to investigate other parts of the frontal cortex in the brain, and have also begun to record activity directly from the brains of neurosurgical patients to see how single cells respond while making decisions. The work is also important to understand difficulties in decision making seen in disorders such as addiction. ### The study, "Anterior prefrontal cortex contributes to action selection through tracking of recent reward trends," also included authors David Rudrauf from the University of Iowa, John O'Doherty from the California Institute of Technology, and Nathaniel Daw from New York University. The research was funded in part by grants from the National Institute of Neurological Disorders and Stroke (Grant P50 NS19632), the National Institute on Drug Abuse (Grant DA022549), the National Institute of Mental Health (Grant MH080721) and the Tamagawa University Global Centers of Excellence Program of the Japanese Ministry of Education, Culture, Sports, and Technology CADC I & II Continuing Education

Perceived racism may impact black Americans' mental health

For black American adults, perceived racism may cause mental health symptoms similar to trauma and could lead to some physical health disparities between blacks and other populations in the United States, according to a new study published by the American Psychological Association (APA). While previous studies have found links between racism and mental health, this is the first meta-analysis on the subject focusing exclusively on black American adults, according to the study published online in APA's Journal of Counseling Psychology. "We focused on black American adults because this is a population that has reported, on average, more incidents of racism than other racial minority groups and because of the potential links between racism and not only mental health, but physical health as well," said lead author Alex Pieterse, PhD, of the University at Albany, State University of New York. Researchers examined 66 studies comprising 18,140 black adults in the United States. To be included in the analysis, a study must have been published in a peer-reviewed journal or dissertation between 1996 and 2011; include a specific analysis of mental health indicators associated with racism; and focus specifically on black American adults in the United States. Black Americans' psychological responses to racism are very similar to common responses to trauma, such as somatization, which is psychological distress expressed as physical pain; interpersonal sensitivity; and anxiety, according to the study. Individuals who said they experienced more and very stressful racism were more likely to report mental distress, the authors said. While the researchers did not collect data on the impacts on physical health, they cite other studies to point out that perceived racism may also affect black Americans' physical health. "The relationship between perceived racism and self-reported depression and anxiety is quite robust, providing a reminder that experiences of racism may play an important role in the health disparities phenomenon," Pieterse said. "For example, African-Americans have higher rates of hypertension, a serious condition that has been associated with stress and depression." The authors recommended that therapists assess racism experiences as part of standard procedure when treating black Americans, and that future studies focus on how discrimination is perceived in specific settings, such as work, online or in school MFT Ceus

Antipsychotic drug may be helpful treatment for anorexia nervosa

Mouse model of anorexia offers opportunity to study drugs effective for disorder

Low doses of a commonly used atypical antipsychotic drug improved survival in a mouse model of anorexia nervosa, University of Chicago researchers report this month. The result offers promise for a common and occasionally fatal eating disorder that currently lacks approved drugs for treatment.

Mice treated with small doses of the drug olanzapine were more likely to maintain their weight when given an exercise wheel and restricted food access, conditions that produce activity-based anorexia (ABA) in animals. The antidepressant fluoxetine, commonly prescribed off-label for anorexic patients, did not improve survival in the experiment.

"We found over and over again that olanzapine was effective in harsher conditions, less harsh conditions, adolescents, adults — it consistently worked," said the paper's first author Stephanie Klenotich, graduate student in the Committee on Neurobiology at the University of Chicago Biological Sciences.

The study, published in Neuropsychopharmacology, was the product of a rare collaboration between laboratory scientists and clinicians seeking new treatment options for anorexia nervosa. As many as one percent of American women will suffer from anorexia nervosa during their lifetime, but only one-third of those people will receive treatment.

Patients with anorexia are often prescribed off-label use of drugs designed for other psychiatric conditions, but few studies have tested the drugs' effectiveness in animal models.

"Anorexia nervosa is the most deadly psychiatric disorder, and yet no approved pharmacological treatments exist," said Stephanie Dulawa, PhD, assistant professor of Psychiatry & Behavioral Neuroscience at the University of Chicago Medicine and senior author of the study. "One wonders why there isn't more basic science work being done to better understand the mechanisms and to identify novel pharmacological treatments."

One challenge is finding a medication that patients with anorexia nervosa will agree to take regularly, said co-author Daniel Le Grange, PhD, professor of Psychiatry & Behavioral Neuroscience and director of the Eating Disorders Clinic at the University of Chicago Medicine. Drugs that directly cause weight gain or carry strong sedative side effects are often rejected by patients.

"Patients are almost uniformly very skeptical and very reluctant to take any medication that could lower their resolve to refrain from eating," Le Grange said. "There are long-standing resistances, and I think researchers and clinicians have been very reluctant to embark on that course, since it's just littered with obstacles."

Both fluoxetine and olanzapine have been tried clinically to supplement interventions such as family-based treatment and cognitive-behavioral therapy. But their direct effect on anorexia nervosa behavior — in humans or animals — is lacking in sufficient data.

To test the effectiveness of these drugs in laboratory mice, Klenotich adapted the ABA protocol from previously published rat studies: Mice given 24-hour access to a running wheel but only six hours a day of food access become hyperactive, eat less and rapidly lose weight, with a 25 percent reduction from baseline considered to be the "drop-out" survival point.

In Klenotich's study, mice were pretreated with fluoxetine, olanzapine or saline before starting the ABA protocol, and treatment continued throughout the ABA period. Researchers then measured how many mice in each group reached the drop-out point for weight loss over 14 days of food restriction and exercise wheel access. Treatment with the antipsychotic olanzapine significantly increased survival over the control group, while fluoxetine treatment produced no significant effects on survival.

Importantly, a low dose of olanzapine did not decrease overall running activity in the mice, indicating that sedative effects of the drug were minimal. In future experiments, the researchers hope to use different drugs and genetic methods to determine exactly how olanzapine is effective against symptoms of anorexia nervosa, perhaps pointing toward a better drug without the negative image or side effects of an antipsychotic.

"We can dissect the effect of olanzapine and hopefully identify the mechanisms of action, and identify what receptor systems we want to target," Klenotich said. "Hopefully, we can develop a newer drug that we can aim towards the eating disorders clinic as an anorexic-specific drug that might be a little more acceptable to patients."

The study offers support for the clinical use of olanzapine, for which clinical trials are already under way to test in patients. Le Grange said the development of a pharmacological variant that more selectively treats anorexia nervosa could be a helpful way to avoid the "stigma" of taking an antipsychotic while giving clinicians an additional tool for helping patients.

"I think the clinical field is certainly very ready for something that is going to make a difference," Le Grange said. "I'm not saying there's a 'magic pill' for anorexia nervosa, but we have been lacking any pharmacological agent that clearly contributes to the recovery of our patients. Many parents and many clinicians are looking for that, because it would make our job so much easier if there was something that could turn symptoms around and speed up recovery."

Additionally, the study demonstrated the innovative experimental design and translational results that can come from a collaboration of laboratory and clinical experts.

"We don't talk to one another often enough in basic science and clinical science," Le Grange said. "More of that would be helpful for clinicians to understand the neurobiology of this disease. I'm very excited about the way this project is going, and I think it's going to be clinically very informative."


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The paper, "Olanzapine, but not fluoxetine, treatment increases survival in activity-based anorexia in mice," was published online March 7 by Neuropsychopharmacology (doi: 10.1038/npp.2012.7). In addition to Klenotich, Dulawa and Le Grange, authors include Mariel Seiglie and Priya Dugad of the University of Chicago and Matthew S. McMurray and Jamie Roitman of the University of Illinois at Chicago. Funding for the research was provided by the National Institute of Mental Health.

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