Public feels more negative toward drug addicts than mentally ill

What do you think about this article from NIH? "While both are treatable health conditions, stigma of drug addiction much more pronounced, seen as 'moral failing' People are significantly more likely to have negative attitudes toward those suffering from drug addiction than those with mental illness, and don't support insurance, housing, and employment policies that benefit those dependent on drugs, new Johns Hopkins Bloomberg School of Public Health research suggests. A report on the findings, which appears in the October issue of the journal Psychiatric Services, suggests that society seems not to know whether to regard substance abuse as a treatable medical condition akin to diabetes or heart disease, or as a personal failing to be overcome. "While drug addiction and mental illness are both chronic, treatable health conditions, the American public is more likely to think of addiction as a moral failing than a medical condition," says study leader Colleen L. Barry, PhD, MPP, an associate professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. "In recent years, it has become more socially acceptable to talk publicly about one's struggles with mental illness. But with addiction, the feeling is that the addict is a bad or weak person, especially because much drug use is illegal." Between Oct. 30 and Dec. 2, 2013, Barry and her colleagues surveyed a nationally representative sample of 709 participants about their attitudes toward either mental illness or drug addition. The questions centered on stigma, discrimination, treatment and public policy. Not only did they find that respondents had significantly more negative opinions about those with drug addiction than those with mental illness, the researchers found much higher levels of public opposition to policies that might help drug addicts in their recovery. Only 22 percent of respondents said they would be willing to work closely on a job with a person with drug addiction compared to 62 percent who said they would be willing to work with someone with mental illness. Sixty-four percent said that employers should be able to deny employment to people with a drug addiction compared to 25 percent with a mental illness. Forty-three percent were opposed to giving individuals addicted to drugs equivalent health insurance benefits to the public at-large, while only 21 percent were opposed to giving the same benefits to those with mental illness. Respondents agreed on one question: Roughly three in 10 believe that recovery from either mental illness or drug addiction is impossible. The researchers say that the stories of drug addiction portrayed in the media are often of street drug users in bad economic conditions rather than of those in the suburbs who have become addicted to prescription painkillers after struggling with chronic pain. Drug addicts who fail treatment are seen as "falling off the wagon," as opposed to people grappling with a chronic health condition that is hard to bring under control, they say. Missing, they say, are inspiring stories of people who, with effective treatment, are able to overcome addiction and live drug-free for many years. Barry says once it would have been taboo for people to casually discuss the antidepressants they are taking, which is often the norm today. That kind of frank talk can do wonders in shaping public opinion, she says. "The more shame associated with drug addiction, the less likely we as a community will be in a position to change attitudes and get people the help they need," says another study author, Beth McGinty, PhD, MS, an assistant professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. "If you can educate the public that these are treatable conditions, we will see higher levels of support for policy changes that benefit people with mental illness and drug addiction." ### "Stigma, Discrimination, Treatment Effectiveness, and Policy: Public Views About Drug Addiction and Mental Illness," was written by Colleen L. Barry, PhD, MPP; Emma E. McGinty, PHD, MS; Bernice A. Pescosolido, PhD; and Howard H. Goldman, MD, PhD. The study was supported by grants from AIG Inc.; the National Institutes of Health's National Institute on Drug Abuse (R01 DA026414); the NIH's National Institute of Mental Health (1R01MH093414-01A1); the National Science Foundation and the College of Arts and Sciences, Indiana University." For more information on mental health topics, please visit Continuing Education for Counselors

New evidence that chronic stress predisposes brain to mental illness

By Robert Sanders, Media Relations | February 11, 2014 BERKELEY — University of California, Berkeley, researchers have shown that chronic stress generates long-term changes in the brain that may explain why people suffering chronic stress are prone to mental problems such as anxiety and mood disorders later in life. myelin stained blue Myelin is stained blue in this cross section of a rat hippocampus. Myelin, which speeds electrical signals flowing through axons, is produced by oligodendrocytes, which increase in number as a result of chronic stress. New oligodendrocytes are shown in yellow. Image by Aaron Friedman and Daniela Kaufer. Their findings could lead to new therapies to reduce the risk of developing mental illness after stressful events. Doctors know that people with stress-related illnesses, such as post-traumatic stress disorder (PTSD), have abnormalities in the brain, including differences in the amount of gray matter versus white matter. Gray matter consists mostly of cells – neurons, which store and process information, and support cells called glia – while white matter is comprised of axons, which create a network of fibers that interconnect neurons. White matter gets its name from the white, fatty myelin sheath that surrounds the axons and speeds the flow of electrical signals from cell to cell. How chronic stress creates these long-lasting changes in brain structure is a mystery that researchers are only now beginning to unravel. In a series of experiments, Daniela Kaufer, UC Berkeley associate professor of integrative biology, and her colleagues, including graduate students Sundari Chetty and Aaron Freidman, discovered that chronic stress generates more myelin-producing cells and fewer neurons than normal. This results in an excess of myelin – and thus, white matter – in some areas of the brain, which disrupts the delicate balance and timing of communication within the brain. “We studied only one part of the brain, the hippocampus, but our findings could provide insight into how white matter is changing in conditions such as schizophrenia, autism, depression, suicide, ADHD and PTSD,” she said. The hippocampus regulates memory and emotions, and plays a role in various emotional disorders. Kaufer and her colleagues published their findings in the Feb. 11 issue of the journal Molecular Psychiatry. Does stress affect brain connectivity? Kaufer’s findings suggest a mechanism that may explain some changes in brain connectivity in people with PTSD, for example. One can imagine, she said, that PTSD patients could develop a stronger connectivity between the hippocampus and the amygdala – the seat of the brain’s fight or flight response – and lower than normal connectivity between the hippocampus and prefrontal cortex, which moderates our responses. “You can imagine that if your amygdala and hippocampus are better connected, that could mean that your fear responses are much quicker, which is something you see in stress survivors,” she said. “On the other hand, if your connections are not so good to the prefrontal cortex, your ability to shut down responses is impaired. So, when you are in a stressful situation, the inhibitory pathways from the prefrontal cortex telling you not to get stressed don’t work as well as the amygdala shouting to the hippocampus, ‘This is terrible!’ You have a much bigger response than you should.” white matter fibers in human brain White matter fiber architecture of the brain. Human Connectome Project. She is involved in a study to test this hypothesis in PTSD patients, and continues to study brain changes in rodents subjected to chronic stress or to adverse environments in early life. Stress tweaks stem cells Kaufer’s lab, which conducts research on the molecular and cellular effects of acute and chronic stress, focused in this study on neural stem cells in the hippocampus of the brains of adult rats. These stem cells were previously thought to mature only into neurons or a type of glial cell called an astrocyte. The researchers found, however, that chronic stress also made stem cells in the hippocampus mature into another type of glial cell called an oligodendrocyte, which produces the myelin that sheaths nerve cells. The finding, which they demonstrated in rats and cultured rat brain cells, suggests a key role for oligodendrocytes in long-term and perhaps permanent changes in the brain that could set the stage for later mental problems. Oligodendrocytes also help form synapses – sites where one cell talks to another – and help control the growth pathway of axons, which make those synapse connections. The fact that chronic stress also decreases the number of stem cells that mature into neurons could provide an explanation for how chronic stress also affects learning and memory, she said. Kaufer is now conducting experiments to determine how stress in infancy affects the brain’s white matter, and whether chronic early-life stress decreases resilience later in life. She also is looking at the effects of therapies, ranging from exercise to antidepressant drugs, that reduce the impact of stress and stress hormones. Kaufer’s coauthors include Chetty, formerly from UC Berkeley’s Helen Wills Neuroscience Institute and now at Harvard University; Friedman and K. Taravosh-Lahn at UC Berkeley’s Department of Integrative Biology; additional colleagues from UC Berkeley and others from Stanford University and UC Davis. The work was supported by a BRAINS (Biobehavioral Research Awards for Innovative New Scientists) award from the National Institute of Mental Health of the National Institutes of Health (R01 MH087495), a Berkeley Stem Cell Center Seed Grant, the Hellman Family Foundation and the National Alliance for Research on Schizophrenia and Depression. RELATED INFORMATION •Stress and glucocorticoids promote oligodendrogenesis in the adult hippocampus (2/11/14 Molecular Psychiatry) •Daniela Kaufer’s web site •Researchers find out why some stress is good for you (4/16/13 press release) For more information on this and other mental health topics, please visit Counselor CEUs

Bradley Hospital researchers link lack of sleep in teens to higher risk of illness

Study also finds consistent sleep pattern can reduce risk of illness EAST PROVIDENCE, R.I. – Newly released findings from Bradley Hospital published in the Journal of Sleep Research have found that acute illnesses, such as colds, flu, and gastroenteritis were more common among healthy adolescents who got less sleep at night. Additionally, the regularity of teens' sleep schedules was found to impact their health. The study, titled "Sleep patterns are associated with common illness in adolescents," was led by Kathryn Orzech, Ph.D. of the Bradley Hospital Sleep Research Laboratory CEUs For Nurses Orzech and her team compared three outcomes between longer and shorter sleepers: number of illness bouts, illness duration, and school absences related to illness. The team found that bouts of illness declined with longer sleep for both male and female high school students. Longer sleep was also generally protective against school absences that students attributed to illness. There were gender differences as well, with males reporting fewer illness bouts than females, even with similar sleep durations. Orzech's team analyzed total sleep time in teens for six-day windows both before and after a reported illness and found a trend in the data toward shorter sleep before illness vs. wellness. Due to the difficulty of finding teens whose illnesses were spaced in such a way to be statistically analyzed, Orzech also conducted qualitative analysis, examining individual interview data for two short-sleeping males who reported very different illness profiles. This analysis suggested that more irregular sleep timing across weeknights and weekends (very little sleep during the week and "catching up" on sleep during the weekend), and a preference for scheduling work and social time later in the evening hours can both contribute to differences in illness outcomes, conclusions that are also supported in the broader adolescent sleep literature. "Some news reaches the general public about the long-term consequences of sleep deprivation, such as the links between less sleep and weight gain," said Orzech. "However, most of the studies of sleep and health have been done under laboratory conditions that cannot replicate the complexities of life in the real world. Our study looked at rigorously collected sleep and illness data among adolescents who were living their normal lives and going to school across a school term." "We showed that there are short-term outcomes, like more acute illness among shorter-sleeping adolescents, that don't require waiting months, years or decades to show up," Orzech continued. "Yes, poor sleep is linked to increased cardiovascular disease, to high cholesterol, to obesity, to depression, etc., but for a teenager, staying healthy for the dance next week, or the game on Thursday, may be more important. This message from this study is clear: Sleep more, and more regularly, get sick less." Mary Carskadon, Ph.D., director of the Bradley Hospital Sleep Research Laboratory, commented on Orzech's study, "We have long been examining the sleep cycles of teenagers and how we might be able to help adolescents - especially high school students - be better rested and more functional in a period of their lives where sleep seems to be a luxury." Carskadon continued, "In the future, these findings identifying specific issues in individual sleep patterns may be a useful way to help adolescents begin to prioritize sleep." ### Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under award numbers MH45945 and MH79179, and T32 training grant MH19927. Direct financial and infrastructure support for this project was received through the Lifespan Office of Research Administration. The principal affiliation of Carskadon is Bradley Hospital (a member hospital of the Lifespan health system in Rhode Island). She is also a professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University. Orzech was a postdoctoral fellow in the Bradley Hospital Sleep Research Laboratory at the time of the research, and is currently a postdoctoral fellow with the Charting the Digital Lifespan project based at the University of Dundee in Scotland, UK. About Bradley Hospital Founded in 1931, Bradley Hospital, located in East Providence, R.I., was the nation's first psychiatric hospital devoted exclusively for children and adolescents. It remains a nationally recognized center for children's mental health care, training and research. Bradley Hospital was awarded the distinction of 'Top Performer on Key Quality Measures' for both 2011 and 2012 by The Joint Commission, the leading accreditor of health organizations in the U.S. Bradley Hospital is the only hospital in Rhode Island and the only psychiatric hospital in New England to receive this designation. Bradley Hospital is a member of the Lifespan health system and is a teaching hospital for The Warren Alpert Medical School of Brown University. Follow us on Facebook and on Twitter (@BradleyHospital).

Regenstrief and IU study: Older adults with severe mental illness challenge healthcare system

INDIANAPOLIS – Although older adults with serious mental illness didn't have more recorded physical illness and had fewer outpatient visits to primary care physicians, they made more medical emergency department visits and had considerably longer medical hospitalizations than older adults without mental illness according to a study conducted by researchers from the Regenstrief Institute and the Indiana University Center for Aging Research. "Our comparison of health care utilization between seriously mentally ill patients and age-matched primary-care patients provides critical data for the physicians, health care systems and policy makers who will be caring for the growing number of older adults, many of whom have mental illness," said Regenstrief Institute investigator Hugh C. Hendrie, M.B., Ch.B., D.Sc., Indiana University Center for Aging Research center scientist and professor of psychiatry at the IU School of Medicine. Dr. Hendrie, who is a geriatric psychiatrist and health services researcher, is the first author of the study. The study, "Comorbidity Profile and Healthcare Utilization in Elderly Patients With Serious Mental Illnesses," is published in the December issue of The American Journal of Geriatric Psychiatry. A 2012 report from the Institute of Medicine estimated that as many of one in five older adults have one or more mental health conditions or problems stemming from substance misuse or abuse. The IOM report authors included Regenstrief Institute investigator Christopher Callahan, M.D., Cornelius and Yvonne Pettinga Professor of Medicine at the IU School of Medicine who is also a co-author of the new study. Dr. Callahan is founding director of the IU Center for Aging Research Social Worker Continuing Education The American Journal of Geriatric Psychiatry study notes, "The increased likelihood of falls together with the significantly greater number of emergency department visits and length of hospitalization also suggest that those with severe mental illness represent a vulnerable elderly population that deserve more intensive studies, leading hopefully to a better integrated model of medical and psychiatric care including consideration of psychosocial factors." Individuals with severe mental illness in the study were patients of Eskenazi Health Midtown Community Mental Health. The patients had severe chronic depression (48 percent), schizophrenia (39 percent) and bipolar disorder (14 percent). Others in the study were patients from Wishard-Eskenazi primary care sites. "This study highlights a major challenge faced by older adults with severe mental illnesses and the increased burden it places on our health care system," said Julie L. Szempruch, RN, CNS, associate vice president of Eskenazi Health Midtown Community Mental Health. ### Authors of "Comorbidity Profile and Healthcare Utilization in Elderly Patients With Serious Mental Illnesses," in addition to Drs. Hendrie and Callahan, are Donald Lindgren, LCSW, Donald P. Hay, M.D., Kathleen A. Lane, M.S., Sujuan Gao, Ph.D., Christianna Purnell, B.A., Stephanie Munger, M.P.H., Faye Smith, M.A., Jeanne Dickens, M.D., and Malaz A. Boustani, M.D., M.P.H. The study was supported by National Institute of Mental Health grant MH080827-01A1.

New Data Reveal Extent of Genetic Overlap Between Major Mental Disorders

Schizophrenia, Bipolar Disorder Share the Most Common Genetic Variation Press Release • August 12, 2013 The largest genome-wide study of its kind has determined how much five major mental illnesses are traceable to the same common inherited genetic variations. Researchers funded in part by the National Institutes of Health found that the overlap was highest between schizophrenia and bipolar disorder; moderate for bipolar disorder and depression and for ADHD and depression; and low between schizophrenia and autism. Overall, common genetic variation accounted for 17-28 percent of risk for the illnesses. “Since our study only looked at common gene variants, the total genetic overlap between the disorders is likely higher,” explained Naomi Wray, Ph.D., University of Queensland, Brisbane, Australia, who co-led the multi-site study by the Cross Disorders Group of the Psychiatric Genomics Consortium (PGC), which is supported by the NIH’s National Institute of Mental Health (NIMH). “Shared variants with smaller effects, rare variants, mutations, duplications, deletions, and gene-environment interactions also contribute to these illnesses.” Dr. Wray, Kenneth Kendler, M.D., of Virginia Commonwealth University, Richmond, Jordan Smoller, M.D., of Massachusetts General Hospital, Boston, and other members of the PGC group report on their findings August 11, 2013, in the journal Nature Genetics. “Such evidence quantifying shared genetic risk factors among traditional psychiatric diagnoses will help us move toward classification that will be more faithful to nature,” said Bruce Cuthbert, Ph.D., director of the NIMH Division of Adult Translational Research and Treatment Development and coordinator of the Institute’s Research Domain Criteria (RDoC) project, which is developing a mental disorders classification system for research based more on underlying causes. Earlier this year, PGC researchers – more than 300 scientists at 80 research centers in 20 countries – reported the first evidence of overlap between all five disorders. People with the disorders were more likely to have suspect variation at the same four chromosomal sites. But the extent of the overlap remained unclear. In the new study, they used the same genome-wide information and the largest data sets currently available to estimate the risk for the illnesses attributable to any of hundreds of thousands of sites of common variability in the genetic code across chromosomes. They looked for similarities in such genetic variation among several thousand people with each illness and compared them to controls – calculating the extent to which pairs of disorders are linked to the same genetic variants. The overlap in heritability attributable to common genetic variation was about 15 percent between schizophrenia and bipolar disorder, about 10 percent between bipolar disorder and depression, about 9 percent between schizophrenia and depression, and about 3 percent between schizophrenia and autism. The newfound molecular genetic evidence linking schizophrenia and depression, if replicated, could have important implications for diagnostics and research, say the researchers. They expected to see more overlap between ADHD and autism, but the modest schizophrenia-autism connection is consistent with other emerging evidence. The study results also attach numbers to molecular evidence documenting the importance of heritability traceable to common genetic variation in causing these five major mental illnesses. Yet this still leaves much of the likely inherited genetic contribution to the disorders unexplained – not to mention non-inherited genetic factors. For example, common genetic variation accounted for 23 percent of schizophrenia, but evidence from twin and family studies estimate its total heritability at 81 percent. Similarly, the gaps are 25 percent vs. 75 percent for bipolar disorder, 28 percent vs. 75 percent for ADHD, 14 percent vs. 80 percent for autism, and 21 percent vs. 37 percent for depression. Among other types of genetic inheritance known to affect risk and not detected in this study are contributions from rare variants not associated with common sites of genetic variation. However, the researchers say that their results show clearly that more illness-linked common variants with small effects will be discovered with the greater statistical power that comes with larger sample sizes. “It is encouraging that the estimates of genetic contributions to mental disorders trace those from more traditional family and twin studies. The study points to a future of active gene discovery for mental disorders” said Thomas Lehner, Ph.D., chief of the NIMH Genomics Research Branch, which funds the project.

Common inherited genetic variation (single nucleotide polymorphisms, or SNPs) accounted for up to about 28 percent of the risk for some disorders, such as ADHD (dark green). Among pairs of disorders (light green), schizophrenia and bipolar disorder (SCZ-BPD) shared about 16 percent of the same common genetic variation (coheritabilities). Source: Cross-Disorder Group of the Psychiatric Genomics Consortium Professional Counselor Continuing Education Reference Cross-Disorder Group of the Psychiatric Genomics Consortium. Genetic relationship between five psychiatric disorders estimated from genome-wide SNPs. Nature Genetics, August 11, 2013 Grants R01MH065562, R01MH43518, R01MH065554, R01MH65707, R01MH065571, R01MH65588, R01MH65578, R01MH65558 ### 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. Press Contact(s) Jules Asher NIMH Press Office 301-443-4536 NIMHPress@nih.gov More Science News about: Attention Deficit Hyperactivity Disorder (ADHD) Autism Bipolar Disorder Depression Schizophrenia Contact the Press Office Phone: 301-443-4536 Email: NIMHpress@mail.nih.gov Press Resources Mental Health Information Statistics on Mental Disorders Summaries of Scientific Meetings Information about NIMH RePORTER: Research Portfolio Online Reporting Tool Expenditures and Results PubMed Central: An Archive of Life Sciences Journals Recommendations for Reporting on Suicide News from the Field News from the Field NIMH-Funded Science on EurekAlert Teen Eating Disorders Increase Suicide Risk The Love Hormone is 2-Faced Fear Factor: Missing Brain Enzyme Leads to Abnormal Levels of Fear in Mice, Reveals New Research More news from the field... Bookmark & Share Newsletters RSS Feeds Facebook

NIH Study Shows People with Serious Mental Illnesses Can Lose Weight

People with serious mental illnesses such as schizophrenia, bipolar disorder and major depression can lose weight and keep it off through a modified lifestyle intervention program, a National Institute of Mental Health (NIMH)-funded study reported online today in The New England Journal of Medicine. Over 80 percent of people with serious mental illnesses are overweight or obese, which contributes to them dying at three times the rate of the overall population. They succumb mostly to the same things the rest of the population experiences—cardiovascular disease, diabetes and cancer. Although antipsychotic medications increase appetite and cause weight gain in these patients, it is not the only culprit. Like the general population, sedentary lifestyle and poor diet also play a part. Lifestyle modifications such as diet and exercise should work for these patients, yet they are often left out of weight loss studies. “People with serious mental illnesses are commonly excluded from studies to help them help themselves about their weight,” said Gail L. Daumit, M.D., of Johns Hopkins University, Baltimore, and the study’s lead author. “We’re showing that serious mentally ill patients can make successful, sustained changes with proper interventions.” This study could usher in new forms of weight loss treatment for people with serious mental illness. “Until now, obesity among those with serious mental illnesses has not received adequate attention,” said NIMH Director Thomas R. Insel, M.D. “People with serious mental illnesses need more attention to their physical health. This study provides convincing evidence these individuals can make substantial lifestyle changes and therefore should suffer fewer medical complications as they age.” Other factors that preclude people with serious mental illnesses from losing weight include memory impairments or residual psychiatric symptoms that impede learning and adopting new behaviors such as counting calories. Socioeconomics are also a factor as many can’t afford or can’t get to physical activity programs like fitness gyms. Some patients additionally suffer from social phobia or have poor social interactions, and are simply afraid to work out in a public area. Daumit’s group attempted to solve these issues by bringing the gyms and nutritionists to places most of these patients frequent—psychiatric rehabilitation outpatient programs. Under the trial name ACHIEVE, the researchers randomized 291 participants in 10 rehab centers around Maryland to receive the usual care, consisting of nutrition and physical activity information, or six months of intensive intervention consisting of exercise classes three times a week along with individual or group weight loss classes once a week. Both groups were followed for an additional year, during which the weight loss classes of the intervention arm tapered down but the exercise classes remained constant. The intervention arm included goals such as reducing caloric intake by avoiding sugar-sweetened beverages and junk food; eating five servings of fruits and vegetables daily; choosing smaller portions and healthy snacks; and moderate intensity aerobic exercise. Participants in the specially tailored weight loss program lost seven pounds more than the controls—and continued to lose weight and did not regain, despite the reduced frequency of classes and counseling sessions. In contrast, the general population tends to experience peak weight loss in the first six months and then rebound and gain part or all of their weight back. On average, each participant was on three psychotropic medications, with half on lithium or mood stabilizers, all known to cause weight gain. But no matter what they were on, they lost the weight. “We’re showing behavioral interventions work regardless of what they’re taking,” Daumit said. Her group is now looking for ways to spread the program. VIDEO Project Achieve is the first weight loss clinical trial to include people with serious mental illnesses. Reference Effects of a behavioral weight loss intervention in persons with serious mental illness. Daumit GL, Dickerson FB, Wang N-Y, Dalcin A, Jerome GJ, Anderson CAM, Young DR, Frick KD, Yu A, Gennusa III JV, Oefinger M, Crum RM, Charleston J, Casagrande SS, Guallar E, Goldberg RW, Campbell LM, Appel LJ. NEJM, March 21, 2013 Professional Counselor Continuing Education Grant number: MH080964 ### 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.

5 Most Common Mental Illnesses Share the Same Genes

From Autism to Depression: Largest Genetic Study Shows Mental Disorders Share Genetic Kinks --Associated Press Mental Illnesses Share Common DNA Roots, Study Finds --nbcnews.com An NIMH-funded study published online today in Lancet reveals that the five most common disorders—autism, attention deficit hyperactivity disorder, bipolar disease, schizophrenia, and major depression—all share similar genetic components. “These disorders that we thought of as quite different may not have such sharp boundaries,” said Dr. Jordan W. Smoller of Massachusetts General Hospital, one of the lead study authors. The results suggest that a rethink in how these disorders are defined might be in order. Rather than focusing on symptoms, which can be attributed to one or more disorder, physicians could one day start to rely on specific gene mutations or biologic pathways to make a formal diagnosis Aspira Continuing Education Online Courses And it also could lead to better treatments, said Dr. Bruce Cuthbert, director of the NIMH’s Division of Adult Translational Research and Treatment Development. “We are finally starting to make inroads where we have actual physiological mechanisms that we can target,” he said. “We can really start to understand the biology instead of having to guess at it.” Reference Cross-Disorder Group of the Psychiatric Genomics Consortium. Identification of Risk Loci with Shared Effects on Five Major Psychiatric Disorders: A Genome-wide Analysis. Lancet, published online February 28, 2013.

Simple tool may help evaluate risk for violence among patients with mental illness

Mental health professionals, who often are tasked with evaluating and managing the risk of violence by their patients, may benefit from a simple tool to more accurately make a risk assessment, according to a recent study conducted at the University of California, San Francisco. The research, led by psychiatrist Alan Teo, MD, when he was a UCSF medical resident, examined how accurate psychiatrists were at evaluating risk of violence by acutely ill patients admitted to psychiatric units. The first part of the study showed that inexperienced psychiatric residents performed no better than they would have by chance, whereas veteran psychiatrists were moderately successful in evaluating their patients' risk of violence. However, the second part of the study showed that when researchers applied the information from the "Historical, Clinical, Risk Management󈞀–Clinical" (HRC-20-C) scale – a brief, structured risk assessment tool – to the patients evaluated by residents, accuracy in identifying their potential for violence increased to a level nearly as high as the faculty psychiatrists', who had an average of 15 years more experience. "Similar to a checklist a pilot might use before takeoff, the HRC-20-C has just five items that any trained mental health professional can use to assess their patients," Teo said. "To improve the safety for staff and patients in high-risk settings, it is critical to teach budding psychiatrists and other mental health professionals how to use a practical tool such as this one." The study was published Aug. 31 in the journal Psychiatric Services. The HCR-20-C was developed several years ago by researchers in Canada, where it is used in a number of settings such as prisons and hospitals. However, in the United States, structured tools such as the HCR-20-C are only beginning to be used in hospitals. "This is the first study to compare the accuracy of risk assessments by senior psychiatrists to those completed by psychiatric residents," said senior author Dale McNiel, PhD, UCSF professor of clinical psychology. "It shows that clinicians with limited training and experience tend to be inaccurate in their risk assessments, and that structured methods such as HCR-20-C hold promise for improving training in risk assessment for violence." "The UCSF study was unusual," Teo added, "in applying a shorter version of the tool that could be more easily incorporated into clinical practice." Teo and his team assessed the doctors' accuracy by comparing the risk assessments that they made at the time patients were admitted to the hospital, to whether or not patients later became physically aggressive toward hospital staff members, such as by hitting, kicking or biting. The study included 151 patients who became violent and 150 patients who did not become violent mhc continuing education The patients in the study had severe mental illnesses, often schizophrenia, and had been involuntarily admitted to the hospital. ### The study was partly supported by the National Institute of Mental Health, a Minority Fellowship sponsored by the American Psychiatric Association and the Clinical and Translational Science Award from the National Institute of Health (NIH). When this study was conducted, all of the authors were affiliated with the UCSF Department of Psychiatry. Teo now is with the Department of Psychiatry, University of Michigan, Ann Arbor, and Sarah Holley, PhD, a co-author, now is with the Department of Psychology, San Francisco State University. Mark Leary, MD, of the UCSF Department of Psychiatry, also is a co-author. UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.

LA BioMed researchers remain at the forefront of mental health initiatives

The month of May recognized as Mental Health Awareness Month LOS ANGELES (April 30, 2012) – With the month of May recognized nationally as Mental Health Awareness Month, the physician-researchers at the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (LA BioMed) continue to be at the forefront of mental health initiatives, engaging in clinical trials to help find therapies and treatments for individuals who suffer from mood and anxiety disorders. According to the National Institute of Mental Health (NIMH), mental health concerns affect 1 in 10 Americans today, but fewer than 25 percent of people with a diagnosable mental disorder seek treatment. Ira Lesser, M.D., is a principal investigator at LA BioMed and Chair, Department of Psychiatry, at Harbor-UCLA. At LA BioMed, he has led a number of clinical trials on mood and anxiety disorders, including the largest ever conducted on depression – Sequenced Treatment Alternatives to Relieve Depression (STAR*D) – a study funded by the NIMH. LA BioMed was one of 41 clinical sites participating, enrolling the greatest number of individuals and was the highest primary care enrolling site in the country. "With a growing number of individuals being diagnosed with a mental health disorder, it's imperative that we educate these individuals as to the options available to them, and also encourage them to seek treatment," said Dr. Lesser. "At LA BioMed, we are working to develop treatments and therapies that will not only help to cure but also help individuals cope with their existing conditions in the long term." In addition to STAR*D, Dr. Lesser and his staff (Karl Burgoyne, M.D., Benjamin Furst, M.D., Deborah Flores, M.D.) are working on other clinical trials including Biomarkers for Rapid Identification of Treatment Effectiveness in Major Depression (BRITE) and Biomarkers for Outcomes in Late-Life Depression (BOLD). Working alongside Dr. Lesser is LA BioMed investigator Michele Berk, Ph.D., who is directing a multi-site, randomized clinical trial that tests the effects of dialectical behavior therapy (DBT) on teenagers who have attempted suicide or engaged in self-harm behaviors, such as cutting. Suicide now ranks as the third leading cause of death in the U.S. among youth ages 10-19. DBT has been shown to be effective in reducing suicidal behavior in adults with depression and personality disorders. Sponsored by the NIMH, this study is the first such clinical trial in the U.S. to test the effectiveness of DBT in adolescents. John W. Tsuang, M.D., in conjunction with Steven J. Shoptaw, Ph.D., from the UCLA Department of Family Medicine, is spearheading a Phase I clinical safety trial that for the first time examines the effects of Ibudilast when administered with metamphetamine (MA), an addictive stimulant that is closely related to amphetamine. Funded by the National Institutes of Health National Institute on Drug Abuse (NIDA), this study will help to determine the effects of Ibudilast - combined with relevant doses of MA - on heart rate and blood pressure, and whether or not Ibudilast alters the way in which the body absorbs, distributes, and metabolizes MA. The development of one or more medications to reduce MA abuse, when implemented with evidence-based behavioral and counseling interventions, would have obvious public health significance. Dr. Tsuang is hoping that following the initial safety trial, physicians will be able to utilize Ibudilast in treating patients with MA dependence to help them improve memory and reduce the damage done to their central nervous system due to MA abuse social worker continuing education About LA BioMed Founded in 1952, LA BioMed is one of the country's leading nonprofit independent biomedical research institutes. It has approximately 100 principal researchers conducting studies into improved treatments and cures for cancer, inherited diseases, infectious diseases, illnesses caused by environmental factors and more. It also educates young scientists and provides community services, including prenatal counseling and childhood nutrition programs. LA BioMed is academically affiliated with the David Geffen School of Medicine at UCLA and located on the campus of Harbor-UCLA Medical Center. For more information, please visit www.LABioMed.org

Gene Regulator in Brain’s Executive Hub Tracked Across Lifespan – NIH study

Mental illness suspect genes are among the most environmentally responsive

For the first time, scientists have tracked the activity, across the lifespan, of an environmentally responsive regulatory mechanism that turns genes on and off in the brain’s executive hub. Among key findings of the study by National Institutes of Health scientists: genes implicated in schizophrenia and autism turn out to be members of a select club of genes in which regulatory activity peaks during an environmentally-sensitive critical period in development. The mechanism, called DNA methylation, abruptly switches from off to on within the human brain’s prefrontal cortex during this pivotal transition from fetal to postnatal life. As methylation increases, gene expression slows down after birth.

Epigenetic mechanisms like methylation leave chemical instructions that tell genes what proteins to make – what kind of tissue to produce or what functions to activate. Although not part of our DNA, these instructions are inherited from our parents. But they are also influenced by environmental factors, allowing for change throughout the lifespan.

“Developmental brain disorders may be traceable to altered methylation of genes early in life,” explained Barbara Lipska, Ph.D., a scientist in the NIH’s National Institute of Mental Health (NIMH) and lead author of the study. “For example, genes that code for the enzymes that carry out methylation have been implicated in schizophrenia. In the prenatal brain, these genes help to shape developing circuitry for learning, memory and other executive functions which become disturbed in the disorders. Our study reveals that methylation in a family of these genes changes dramatically during the transition from fetal to postnatal life – and that this process is influenced by methylation itself, as well as genetic variability. Regulation of these genes may be particularly sensitive to environmental influences during this critical early life period.”

Lipska and colleagues report on the ebb and flow of the human prefrontal cortex’s (PFC) epigenome across the lifespan, February 2, 2012, online in the American Journal of Human Genetics.

“This new study reminds us that genetic sequence is only part of the story of development. Epigenetics links nurture and nature, showing us when and where the environment can influence how the genetic sequence is read,” said NIMH director Thomas R. Insel, M.D.

In a companion study published last October, the NIMH researchers traced expression of gene products in the PFC across the lifespan. The current study instead examined methylation at 27,000 sites within PFC genes that regulate such expression. Both studies examined post-mortem brains of non-psychiatrically impaired individuals ranging in age from two weeks after conception to 80 years old CADC I and II Continuing Education

In most cases, when chemicals called methyl groups attach to regulatory regions of genes, they silence them. Usually, the more methylation, the less gene expression. Lipska’s team found that the overall level of PFC methylation is low prenatally when gene expression is highest and then switches direction at birth, increasing as gene expression plummets in early childhood. It then levels off as we grow older. But methylation in some genes shows an opposite trajectory. The study found that methylation is strongly influenced by gender, age and genetic variation.

For example, methylation levels differed between males and females in 85 percent of X chromosome sites examined, which may help to explain sex differences in disorders like autism and schizophrenia.

Different genes – and subsets of genes – methylate at different ages. Some of the suspect genes found to peak in methylation around birth code for enzymes, called methytransferases, that are over-expressed in people with schizophrenia and bipolar disorder. This process is influenced, in turn, by methylation in other genes, as well as by genetic variation. So genes associated with risk for such psychiatric disorders may influence gene expression through methylation in addition to inherited DNA.

Scientists worldwide can now mine a newly created online database of PFC lifespan DNA methylation from the study. The data are accessible to qualified researchers at: http://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/study.cgi?study_id=phs000417.v2.p1. BrainCloud, a web browser application developed by NIMH to interrogate the study data, can be downloaded at http://BrainCloud.jhmi.edu.

Two representative genes show strikingly opposite trajectories of PFC methylation across the lifespan. Each dot represents a different brain. Usually, the more methylation, the less gene expression.
Source: Barbara Lipska, Ph.D., NIMH Clinical Brain Disorders Branch


A representative gene showing how sex can influence levels of methylation across the lifespan. Each dot represents a different brain.
Source: Barbara Lipska, Ph.D., NIMH Clinical Brain Disorders Branch

Reference:

Numata S, Ye T, Hyde TM, Guitart-Navarro X, Tao R, Wininger M, Colantuoni C, Weinberger DR, Kleinman JE, Lipska BK. DNA Methylation Signatures in Development and Aging of the Human Prefrontal Cortex. American Journal of Human Genetics, 2011. Feb 2.

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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.