Smoking during pregnancy may increase risk of bipolar disorder in offspring

A study published today in the American Journal of Psychiatry suggests an association between smoking during pregnancy and increased risk for developing bipolar disorder (BD) in adult children. Researchers at the New York State Psychiatric Institute and the Department of Epidemiology at the Mailman School of Public Health at Columbia University, in collaboration with scientists at the Kaiser Permanente Division of Research in Oakland, California, evaluated offspring from a large cohort of pregnant women who participated in the Child Health and Development Study (CHDS) from 1959-1966. The study was based on 79 cases and 654 comparison subjects. Maternal smoking during pregnancy was associated with a twofold increased risk of BD in their offspring. Smoking during pregnancy is known to contribute to significant problems in utero and following birth, including low birth weight and attentional difficulties. This is the first study to suggest an association between prenatal tobacco exposure and BD, a serious psychiatric illness marked by significant shifts in mood that alternate between periods of depression and mania. Symptoms typically become noticeable in the late teens or early adulthood. "These findings underscore the value of ongoing public health education on the potentially debilitating, and largely preventable, consequences that smoking may have on children over time," said Alan Brown, MD, MPH, senior author and Professor of Clinical Psychiatry and Epidemiology at the New York State Psychiatric Institute, Columbia University and Mailman School of Public Health. The authors wrote: "Much of the psychopathology associated with prenatal tobacco exposure clusters around the 'externalizing' spectrum, which includes attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD), and substance abuse disorders. Although not diagnostically classified along the externalizing spectrum, BD shares a number of clinical characteristics with these disorders, including inattention, irritability, loss of self-control, and proclivity to drug/alcohol use." In effect, children who were exposed to tobacco smoke in utero may exhibit some symptoms and behaviors that are found in BD. A previous study by Dr. Brown and colleagues found that flu virus in pregnant mothers was associated with a fourfold increased risk that their child would develop BD LCSW Continuing Education ### Funding for the study was provided by the National Institute of Mental Health and the National Institute on Child Health and Development. The authors declare no financial or other conflicts of interest. About Columbia University's Mailman School of Public Health Founded in 1922, Columbia University's Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master's and doctoral degree programs. The Mailman School is also home to numerous world-renowned research centers including the International Center for AIDS Care and Treatment Programs (ICAP), and the Center for Infection and Immunity. For more information, please visit http://www.mailman.columbia.edu Columbia University Department of Psychiatry & NYS Psychiatric Institute Columbia Psychiatry is ranked among the best departments and psychiatric research facilities in the nation and has contributed greatly to the understanding and treatment of psychiatric disorders. It is home to distinguished clinicians and researchers noted for their clinical and research advances in the diagnosis and treatment of depression, suicide, schizophrenia, BD and anxiety disorders, eating disorders, and childhood psychiatric disorders. Visit http://columbiapsychiatry.org/ for more information. Founded in 1959 by Jacob Yerushalmy at the University of California, Berkeley, The Child Health and Development Studies (CHDS) enrolled 15,000 families who were members of the Kaiser Permanente Medical Care Plan between 1959 and 1967. CHDS scientists discovered ways to make pregnancy safer for mothers and their babies. Now they are discovering connections between early life and cancer, heart disease, diabetes, fertility and mental illness. The National Institute of Child Health and Development of the National Institutes of Health makes this unique research possible through continuing support over 40 years. The CHDS is now a part of the Public Health Institute, Berkeley California. About the Kaiser Permanente Division of Research The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the society at large. It seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, the Division's 550+ staff are working on more than 350 ongoing research studies in behavioral health and aging, cancer, cardiovascular and metabolic conditions, health care delivery and policy, infectious diseases, vaccine safety and effectiveness, and women's and children's health.

Bipolar and pregnant

Bipolar drugs lose effect during pregnancy, so women need higher doses to stay well CHICAGO --- New Northwestern Medicine® research offers one of the first in-depth studies of how physiological changes during pregnancy reduce the effects of a commonly used drug to treat bipolar disorder, making women more vulnerable to recurring episodes. The new findings will help psychiatrists and physicians prevent bipolar manic and depressive symptoms during pregnancy, which are risky for the health of the mother and her unborn child. When a woman with bipolar disorder becomes pregnant, she and her physician often don't realize her medication needs adjusting to prevent the symptoms from coming back – a higher risk during pregnancy. There also is little information and research to guide dosing for psychiatric medications during pregnancy Social Worker Continuing Education Approximately 4.4 million women in the U.S. have bipolar disorder with women of childbearing age having the highest prevalence. The new study shows the blood concentration of the commonly used drug lamotrigine decreases in pregnant women. About half of the women in the study had worsening depressive symptoms as their lamotrigine blood levels dropped. The drug levels fall because women have increased metabolism during pregnancy. "Now physicians change the dose of the drug in response to women's symptoms worsening," said lead investigator Crystal Clark, M.D., an assistant professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine and a psychiatrist at Northwestern Memorial Hospital. "We need to optimize their medication dosing so they stay well." The study results will help physicians understand how to increase their patients' doses during pregnancy and then reduce them postpartum to avoid toxicity, Clark said. Guidelines for prescribing the drug for pregnant women with the disorder also are included. The study was published Nov. 1 in the American Journal of Psychiatry. Depressive episodes -- as opposed to manic -- are most likely to recur in pregnant women with bipolar disorder. "The safety of the fetus is at risk," Clark said. "Pregnant women that are depressed are less likely to take care of themselves which often leads to poor nutrition, lack of compliance with prenatal care and isolation from family and friends. It has also been linked to premature births and babies with low birth weights among other poor birth outcomes." ### The study was supported by grant R01 MH 075921 from the National Institute of Mental Health of the National Institutes of Health. NORTHWESTERN NEWS: http://www.northwestern.edu/newscenter/

Gene found to foster synapse formation in the brain

Implications for language development, autism, epilepsy Researchers at Johns Hopkins say they have found that a gene already implicated in human speech disorders and epilepsy is also needed for vocalizations and synapse formation in mice. The finding, they say, adds to scientific understanding of how language develops, as well as the way synapses — the connections among brain cells that enable us to think — are formed. A description of their experiments appears in Science Express on Oct. 31. A group led by Richard Huganir, Ph.D., director of the Solomon H. Snyder Department of Neuroscience and a Howard Hughes Medical Institute investigator, set out to investigate genes involved in synapse formation. Gek-Ming Sia, Ph.D., a research associate in Huganir's laboratory, first screened hundreds of human genes for their effects on lab-grown mouse brain cells. When one gene, SRPX2, was turned up higher than normal, it caused the brain cells to erupt with new synapses, Sia found. When Huganir's team injected fetal mice with an SRPX2-blocking compound, the mice showed fewer synapses than normal mice even as adults, the researchers found. In addition, when SRPX2-deficient mouse pups were separated from their mothers, they did not emit high-pitched distress calls as other pups do, indicating they lacked the rodent equivalent of early language ability. Other researchers' analyses of the human genome have found that mutations in SRPX2 are associated with language disorders and epilepsy, and when Huganir's team injected the human SRPX2 with the same mutations into the fetal mice, they also had deficits in their vocalization as young pups. Another research group at Institut de Neurobiologie de la Méditerranée in France had previously shown that SRPX2 interacts with FoxP2, a gene that has gained wide attention for its apparently crucial role in language ability. Huganir's team confirmed this, showing that FoxP2 controls how much protein the SRPX2 gene makes and may affect language in this way. "FoxP2 is famous for its role in language, but it's actually involved in other functions as well," Huganir comments. "SRPX2 appears to be more specialized to language ability." Huganir suspects that the gene may also be involved in autism, since autistic patients often have language impairments, and the condition has been linked to defects in synapse formation. This study is only the beginning of teasing out how SRPX2 acts on the brain, Sia says. "We'd like to find out what other proteins it acts on, and how exactly it regulates synapses and enables language development." Roger Clem of the Mount Sinai School of Medicine also participated in the study CADC I & II Continuing Education ### This study was supported by the National Institute of Mental Health (grant number P50MH084020) and the National Institute of Neurological Disorders and Stroke (grant number NS050274). Related stories: Study Refutes Accepted Model of Memory Formation Johns Hopkins Scientists Reveal Molecular Sculptor of Memories Johns Hopkins Researchers Discover How to Erase Memory

Nurturing may protect kids from brain changes linked to poverty

Growing up in poverty can have long-lasting, negative consequences for a child. But for poor children raised by parents who lack nurturing skills, the effects may be particularly worrisome, according to a new study at Washington University School of Medicine in St. Louis. Among children living in poverty, the researchers identified changes in the brain that can lead to lifelong problems like depression, learning difficulties and limitations in the ability to cope with stress. The study showed that the extent of those changes was influenced strongly by whether parents were nurturing. The good news, according to the researchers, is that a nurturing home life may offset some of the negative changes in brain anatomy among poor children. And the findings suggest that teaching nurturing skills to parents — particularly those living in poverty — may provide a lifetime benefit for their children. The study is published online Oct. 28 and will appear in the November issue of JAMA Pediatrics. Using magnetic resonance imaging (MRI), the researchers found that poor children with parents who were not very nurturing were likely to have less gray and white matter in the brain. Gray matter is closely linked to intelligence, while white matter often is linked to the brain's ability to transmit signals between various cells and structures. The MRI scans also revealed that two key brain structures were smaller in children who were living in poverty: the amygdala, a key structure in emotional health, and the hippocampus, an area of the brain that is critical to learning and memory. "We've known for many years from behavioral studies that exposure to poverty is one of the most powerful predictors of poor developmental outcomes for children," said principal investigator Joan L. Luby, MD, a Washington University child psychiatrist at St. Louis Children's Hospital. "A growing number of neuroscience and brain-imaging studies recently have shown that poverty also has a negative effect on brain development. "What's new is that our research shows the effects of poverty on the developing brain, particularly in the hippocampus, are strongly influenced by parenting and life stresses that the children experience." Luby, a professor of psychiatry and director of the university's Early Emotional Development Program, is in the midst of a long-term study of childhood depression. As part of the Preschool Depression Study, she has been following 305 healthy and depressed kids since they were in preschool. As the children have grown, they also have received MRI scans that track brain development. "We actually stumbled upon this finding," she said. "Initially, we thought we would have to control for the effects of poverty, but as we attempted to control for it, we realized that poverty was really driving some of the outcomes of interest, and that caused us to change our focus to poverty, which was not the initial aim of this study." In the new study, Luby's team looked at scans from 145 children enrolled in the depression study. Some were depressed, others healthy, and others had been diagnosed with different psychiatric disorders such as ADHD (attention-deficit hyperactivity disorder). As she studied these children, Luby said it became clear that poverty and stressful life events, which often go hand in hand, were affecting brain development. The researchers measured poverty using what's called an income-to-needs ratio, which takes a family's size and annual income into account. The current federal poverty level is $23,550 for a family of four. Although the investigators found that poverty had a powerful impact on gray matter, white matter, hippocampal and amygdala volumes, they found that the main driver of changes among poor children in the volume of the hippocampus was not lack of money but the extent to which poor parents nurture their children. The hippocampus is a key brain region of interest in studying the risk for impairments. Luby's team rated nurturing using observations made by the researchers — who were unaware of characteristics such as income level or whether a child had a psychiatric diagnosis — when the children came to the clinic for an appointment. And on one of the clinic visits, the researchers rated parental nurturing using a test of the child's impatience and of a parent's patience with that child. AUDIO: Poverty can interfere with healthy development in children and can have long-lasting, negative consequences. Now researchers at Washington University School of Medicine in St. Louis have found that if poor... Click here for more information. While waiting to see a health professional, a child was given a gift-wrapped package, and that child's parent or caregiver was given paperwork to fill out. The child, meanwhile, was told that s/he could not open the package until the caregiver completed the paperwork, a task that researchers estimated would take about 10 minutes. Luby's team found that parents living in poverty appeared more stressed and less able to nurture their children during that exercise. In cases where poor parents were rated as good nurturers, the children were less likely to exhibit the same anatomical changes in the brain as poor children with less nurturing parents. "Parents can be less emotionally responsive for a whole host of reasons," Luby said. "They may work two jobs or regularly find themselves trying to scrounge together money for food. Perhaps they live in an unsafe environment. They may be facing many stresses, and some don't have the capacity to invest in supportive parenting as much as parents who don't have to live in the midst of those adverse circumstances." The researchers also found that poorer children were more likely to experience stressful life events, which can influence brain development. Anything from moving to a new house to changing schools to having parents who fight regularly to the death of a loved one is considered a stressful life event. Luby believes this study could provide policymakers with at least a partial answer to the question of what it is about poverty that can be so detrimental to a child's long-term developmental outcome. Because it appears that a nurturing parent or caregiver may prevent some of the changes in brain anatomy that this study identified, Luby said it is vital that society invest in public health prevention programs that target parental nurturing skills. She suggested that a key next step would be to determine if there are sensitive developmental periods when interventions with parents might have the most powerful impact. "Children who experience positive caregiver support don't necessarily experience the developmental, cognitive and emotional problems that can affect children who don't receive as much nurturing, and that is tremendously important," Luby said. "This study gives us a feasible, tangible target with the suggestion that early interventions that focus on parenting may provide a tremendous payoff." Aspira Continuing Education Online Courses ### Funding for this research comes from the National Institute of Mental Health (NIMH) of the National Institutes of Health (NIH). NIH grant numbers 2R01 MH064769-06A1, PA-07-070 NIMH R01 and 5K01 MH090515-04. Luby J, Belden A, Botteron K, Marrus N, Harms MP, Babb C, Nishino T, Barch D. The effects of poverty on childhood brain development: The mediating effect of caregiving and stressful life events. JAMA Pediatrics vol. 167 (11), November 2013, published online Oct. 28, 2013. http://archpedi.jamanetwork.com/journal.aspx Washington University School of Medicine's 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked sixth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.

Past weight loss an overlooked factor in disordered eating

PHILADELPHIA (September 24, 2013)— Dieters and weight loss researchers are familiar with the principle: The more weight you've lost, the harder it is to keep it off. A complex and vicious cycle of biological and behavioral factors make it so. But eating disorder research has largely overlooked this influence, and Dr. Michael Lowe, a professor of psychology at Drexel University, has published a flurry of research studies showing that needs to change. "The focus of eating disorder research has very much been on the state of patients' thoughts, beliefs, emotions and personalities," Lowe said. "And while these mental influences are undoubtedly part of the problem, historically there has been very little focus on how their current and past body weights contribute to their eating disorder." Lowe and colleagues' studies – about a dozen on bulimia nervosa have been published in the past several years – show that having an elevated past body weight, and being at a body weight well below highest past weight, may help cause and perpetuate disordered eating. The latest of Lowe's studies was just published in The Journal of Abnormal Psychology, the top journal for eating disorder research, and is the team's first to address this principle in anorexia nervosa. The findings, Lowe says, show that researchers and clinicians need to start taking into account how a person's historical and current body weight contribute to disordered eating. "This fundamentally changes the assumption that the problem is primarily psychological or emotional," Lowe said. The new study, led by doctoral student Laura A. Berner, was based on data collected at the Renfrew Center for eating disorders in Philadelphia, where Lowe is also a consultant. The researchers found that the level of eating disorder symptoms, as well as degree of improvement during treatment, depends on how much weight patients with anorexia nervosa had lost from their previous highest weight (a measure called "weight suppression"), how much they currently weigh and the interaction between the two LSW Continuing Education After controlling for patients' body mass index (BMI, which is a known indicator of disease severity), they found that patients with greater weight suppression had more severe symptoms of anorexia than patients whose low weight was closer to their historical highest weight. Standard measures of disordered eating such as shape concerns, eating concerns, binge eating, depression and menstrual abnormalities were correlated with weight suppression, current BMI, or both. Lowe said that researchers and clinicians who already use weight or BMI as an absolute measure of eating disorder severity should also consider weight suppression as a relative measure. These findings also may have important implications for treatment. "The standards for treating anorexia nervosa are all about 'how much weight do they need to gain to meet a minimally healthy body weight for their height,'" Lowe said. "What we've rarely asked, is 'what is this patient's weight history?'" Lowe said his ongoing research suggests that the answer is that many patients weighed more than their peers before developing anorexia nervosa. "If the patient's body somehow 'remembers' that past higher weight, then even at the minimally healthy body weight she is still going to be struggling mightily to maintain her weight," Lowe said. "That perspective is new. It suggests that future treatments might work toward finding a healthier 'balance point' between what patients once weighed and what they currently weigh." "It is really helpful to have more than one way to look at weight in the eating disorders; we now have evidence that absolute weight and relative weight are both important in predicting difficulties in our work towards full recovery," said Dr. Susan Ice, vice president and chief medical officer of The Renfrew Center. "And it is immensely satisfying to find that science has discovered that there is physical memory or a kind of 'wisdom' in the body." ### Lowe and his research team were recently funded by the National Institute of Mental Health to further investigate the role of these weight-related variables on bulimia nervosa. Individuals with symptoms of bulimia who are interested in participating in this federally funded study may call 215-762-1313 or email TEDS@drexel.edu for additional information. Another research laboratory at Drexel, the Laboratory for Innovations in Health-Related Behavior Change, is recruiting participants who have experienced binge eating problems but do not engage in compensatory behaviors such as self-induced vomiting or laxative use. One project is investigating a new smartphone app for binge eating and the other is evaluating an in-person treatment. Individuals who are interested in participating in these research studies may call 215-762-4900. Paper in the Journal of Abnormal Psychology: http://dx.doi.org/10.1037/a0033930

Alcoholism and Drug Abuse Counselors Continuing Education

Alcoholism and Drug Abuse Counselors Continuing Education (CADC CEUs, CPS CEUS, CCS CEUs, CADCA CEUs) Aspira Continuing Education is a California Association of Alcoholism and Drug Abuse Counselors-Approved Continuing Education Provider (ACEPTM) and offers CAADAC-approved clock hours for events that meet CAADAC requirements. The ACEP solely is responsible for all aspects of the program. (Provider # 2C-09-123-0811). Aspira Continuing Education offers online CE courses for the various certifications provided by CAADAC. Such as CADC I, CADC II, CPS, CCS and CADCA. View our Board Approvals and Accreditations page for provider numbers. Click here for: CAADAC Website View Aspira’s CE courses to see the variety options you have to satisfy your CAADAC requirements. View Aspira's CEU Pricing page to see how to pay for Aspira's CE courses. View Aspira's CEU Offers page to see the latest offers and discounts available. Also, see how to earn free CEUs. **CADC I & II Continuing Education For your information, here is an excerpt from the CAADAC website: “Certified Alcohol and Drug Counselor (CADC I & II) Requirements: •Meet all requirements of the CADCA formerly (RADI) •Provide documentation of 4,000 hours or two (2) years full-time supervised work experience as an alcohol and drug counselor (supervised by at least a CADC-II) •Pass IC&RC Case Presentation Method of Oral Review Examination (see manual for additional information and requirements) •Submit appropriate fees Download the CADC I & II Manual and Handbook now! CADC I/II Manual CADC I/II Handbook Click here for: CADC I & II Certification Requirements Aspira Continuing Education is an approved CE Provider for CAADAC licensees. Some of the online courses Aspira offers can be used toward necessary CE requirements others can be used toward Professional Development requirements. View the table on each course description page to see if that particular course is approved for Certified Alcohol and Drug Counselors CADC I & II. If the course is indicated as approved for CAADAC professionals, then that course can be applied toward CE requirements. If not, then that course can be applied toward Professional Development requirements. View our CE Courses today! View Aspira's CEU Pricing page to see how to pay for Aspira's CE courses. View Aspira's CEU Offers page to see the latest offers and discounts available. Also, see how to earn free CEUs. View our Board Approvals and Accreditations page for provider numbers.

Ability to delay gratification may be linked to social trust, new CU-Boulder study finds

A person's ability to delay gratification—forgoing a smaller reward now for a larger reward in the future—may depend on how trustworthy the person perceives the reward-giver to be, according to a new study by researchers at the University of Colorado Boulder. A body of research that stretches back more than a half-century has shown that the ability to delay gratification is linked to a number of better life outcomes. On average, people who were able to delay gratification as children go on to have higher SAT scores, for example. They also tend to be more socially conscious as adolescents, less obese as adults, and less likely to abuse drugs or alcohol. But despite the long history of studying delayed gratification, little research has focused on the role of social trust in a person's ability to wait for a larger payoff in the future. "Most of the time, when people talk about delaying gratification, they talk about basic processes of evaluation and self-control," said Laura Michaelson, a CU-Boulder doctoral student in the Department of Psychology and Neuroscience and co-lead author of the new study appearing in the online journal Frontiers in Psychology. In general, people who choose not to delay gratification have often been characterized as irrational and as having poor impulse control. But if the role of social trust is considered, it introduces the possibility that the person who is choosing not to delay gratification may be acting rationally after all, the researchers said. "If you don't trust someone, it's rational not to wait for them to give you $20 in a month instead of $15 now," said study co-lead author Alejandro de la Vega, also a doctoral student in CU-Boulder's Department of Psychology and Neuroscience. To determine the role of social trust, the research team—which also included Christopher Chatham, a former CU-Boulder doctoral student now at Brown University, and psychology and neuroscience Professor Yuko Munakata—recruited participants using Amazon's Mechanical Turk, an online tool that can be used by scientists to quickly connect with a large number of people from a broad range of backgrounds. The researchers paid participants up to $1 to participate in an experiment in which they were asked to read the profiles of three fictional characters and then rate them on their trustworthiness. Participants were then asked whether they would opt to take a smaller amount of money offered immediately from each character or a larger amount of money that they would have to wait to collect. The results showed that the participants were less likely to delay gratification when they distrusted the person who was offering the reward. A second experiment—which relied on a larger group but asked each participant to read the profile of only one character—had similar results. The second study also paired one of three sketches of a face with each character. "This offers an alternative explanation for why certain populations might be notoriously bad at delaying gratification or notoriously impulsive, like criminals and addicts," Michaelson said. "It had been chalked up to a lack of self-control. But it may be the case that they are poor at delaying gratification because they have low social trust." The findings could have implications for determining the best intervention strategies to use with children who find it difficult to delay gratification. Creating environments in which children can develop social trust, for example, could be more effective than having those children work solely on self-control, Michaelson said. The findings also may be important for adults, especially in terms of economic decision-making, de la Vega said. Economists are interested in delayed gratification as it relates to making investments or building up savings instead of spending money immediately. The new CU-Boulder study suggests that how much a person trusts an investment banker or an economic adviser could affect the person's decisions about saving and spending Social Worker Continuing Education "These economic decisions are not being made in a complete vacuum," de la Vega said. "They might really be affected by how you perceive the person you're interacting with." The research team plans to follow up this study with research that involves participants interacting in person with the people who are offering the rewards. "There is a very real possibility the this relationship between social trust and delaying gratification might be even more strong and even more salient when you're in a real situation," Michaelson said. ### Read the full study online at http://www.frontiersin.org/Cognition/10.3389/fpsyg.2013.00355/abstract.