High-fructose diet in adolescence may exacerbate depressive-like behavior

What do you think of this article? "Animal study shows that diet alters important pathways associated with brain's response to stress The consumption of a diet high in fructose throughout adolescence can worsen depressive- and anxiety-like behavior and alter how the brain responds to stress, according to new animal research scheduled for presentation at Neuroscience 2014, the annual meeting of the Society for Neuroscience and the world's largest source of emerging news about brain science and health. "Our results offer new insights into the ways in which diet can alter brain health and may lead to important implications for adolescent nutrition and development," said lead author Constance Harrell of Emory University in Atlanta. Harrell is presenting her work Saturday, Nov. 15, Halls A-C, 3-4 pm and participating in an "Unhealthy diet, unhealthy mind"-themed press conference on Tuesday, Nov. 18 at 12:30 pm. Harrell is a graduate student working with Gretchen Neigh, PhD, assistant professor of physiology, psychiatry and behavioral sciences at Emory University School of Medicine. Fructose, a sugar found naturally in fruits and vegetables but also added to many processed foods and beverages, can promote negative cardiovascular effects. It also stimulates neural pathways that affect how the brain responds to stress, which can have important behavioral effects, including the worsening of symptoms related to depression and anxiety. Such effects are of particular concern during the teen years, which is a critical time for the development of the brain's stress response. To determine whether fructose consumption has the potential to create long-term changes in metabolism and behavior during adolescence, Harrell and her colleagues gave both adolescent and adult rats either a standard or a high-fructose diet. After 10 weeks, the adolescent but not adult rats on the high-fructose diet had a different stress hormone response to an acute stressor, which was consistent with their depressed-like behavior. A genetic pathway in the brain that plays a key role in regulating the way the brain responds to stress was also altered. These findings indicate that consuming a diet high in fructose throughout adolescence may exacerbate depressive behaviors and affect the way the body and the brain respond to stress." ### For more mental health topics and Continuing education in 3 easy steps, please visit Online MFT Continuing Education

Veterans' alcohol problems linked to stress on the home front

Returning national guardsmen more likely to turn to alcohol than general public when faced with issues at home, according to new study in the American Journal of Preventive Medicine What do you think of this article? "Ann Arbor, MI, July 31, 2014 — Regardless of traumatic events experienced during deployment, returning National Guard soldiers were more likely to develop a drinking problem if faced with civilian life setbacks, including job loss, legal problems, divorce, and serious financial and legal problems — all commonplace in military families. Results of the study by researchers at Columbia University's Mailman School of Public Health are published online in the American Journal of Preventive Medicine. Alcohol abuse is a major concern for reservists returning home. Nearly 7% of Americans abuse or are dependent on alcohol, but among reserve soldiers returning from deployment, the rate of alcohol abuse is 14%, almost double that of the civilian population. The study looked at a group of 1,095 Ohio National Guard soldiers, who had primarily served in either Iraq or Afghanistan in 2008 and 2009. Over three years, the soldiers were interviewed three times via telephone and were asked about their alcohol use, exposure to deployment-related traumatic events and stressors like land mines, vehicle crashes, taking enemy fire, and witnessing casualties, and any stress related to everyday life since returning from duty. "Guardsmen who return home need help finding jobs, rebuilding their marriages and families, and reintegrating into their communities," says Karestan Koenen, PhD, Professor of Epidemiology at the Mailman School and senior author of the study. "Too many of our warriors fall through the cracks in our system when they return home. This is particularly true of Guardsmen who do not have the same access to services as regular military personnel. We need to support our soldiers on the home front just as we do in the war zone." More than half (60%) of the responding soldiers experienced combat-related trauma, 36% of soldiers experience civilian stressors, and 17% reported being sexually harassed during their most recent deployment. Among the group, 13% reported problems consistent with an alcohol use disorder in the first interview, 7% during the second, and 5% during the third. Alcohol use disorder is defined as alcohol abuse or dependence. The researchers found having at least one civilian stressor or a reported incident of sexual harassment during deployment raised the odds of alcohol use disorders. The effect of the stressors was restricted to cases of new-onset alcohol use disorders, and was not seen among those with a history of problem drinking. In contrast, combat-related traumatic events were only marginally associated with alcohol problems. The study highlights the important role civilian life and the accompanying stress play in cases of alcohol use disorder in the National Guard. "Exposure to the traumatic event itself has an important effect on mental health in the short-term, but what defines long-term mental health problems is having to deal with a lot of daily life difficulties that arise in the aftermath — when soldiers come home," explains lead investigator Magdalena Cerdá, DrPH, MPH, Assistant Professor of Epidemiology, Mailman School of Public Health, Columbia University. "The more traumatic events soldiers are exposed to during and after combat, the more problems they are likely to have in their daily life — in their relationships, in their jobs — when they come home. These problems can in turn aggravate mental health issues, such as problems with alcohol that arise during and after deployment." With high rates of alcohol abuse among soldiers, there is a critical need for targeted interventions to help soldiers handle stressful life events without alcohol, the investigators observe. More than 1.6 million service members have been deployed in support of war efforts Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn. ### The findings from this study are consistent with two reports the Institute of Medicine released this year, which call attention to the serious mental health issues faced by the military population upon return from Iraq and Afghanistan, and highlight the need for the Department of Defense to develop an evidence base on the effectiveness of prevention and treatment programs targeted at service members and their families. A co-author of the current study, Sandro Galea, MD, DrPH, chair of Epidemiology at the Mailman School, led the Commission that issued one of the reports; Dr. Koenen was a co-author of the same." For more information and free clinical resources on drug/alcohol abuse, please visit Alcoholism and Drug Abuse Counselors Continuing Education

Neurobiologists find chronic stress in early life causes anxiety, aggression in adulthood

Cold Spring Harbor, NY -- In recent years, behavioral neuroscientists have debated the meaning and significance of a plethora of independently conducted experiments seeking to establish the impact of chronic, early-life stress upon behavior – both at the time that stress is experienced, and upon the same individuals later in life, during adulthood. These experiments, typically conducted in rodents, have on the one hand clearly indicated a link between certain kinds of early stress and dysfunction in the neuroendocrine system, particularly in the so-called HPA axis (hypothalamic-pituitary-adrenal), which regulates the endocrine glands and stress hormones including corticotropin and glucocorticoid. Yet the evidence is by no means unequivocal. Stress studies in rodents have also clearly identified a native capacity, stronger in some individuals than others, and seemingly weak or absent in still others, to bounce back from chronic early-life stress. Some rodents subjected to early life stress have no apparent behavioral consequences in adulthood – they are disposed neither to anxiety nor depression, the classic pathologies understood to be induced by stress in certain individuals. Today, a research team led by Associate Professor Grigori Enikolopov of Cold Spring Harbor Laboratory (CSHL) reports online in the journal PlOS One the results of experiments designed to assess the impacts of social stress upon adolescent mice, both at the time they are experienced and during adulthood. Involving many different kinds of stress tests and means of measuring their impacts, the research indicates that a "hostile environment in adolescence disturbs psychoemotional state and social behaviors of animals in adult life," the team says. The tests began with 1-month-old male mice – the equivalent, in human terms of adolescents -- each placed for 2 weeks in a cage shared with an aggressive adult male. The animals were separated by a transparent perforated partition, but the young males were exposed daily to short attacks by the adult males. This kind of chronic activity produces what neurobiologists call social-defeat stress in the young mice. These mice were then studied in a range of behavioral tests. "The tests assessed levels of anxiety, depression, and capacity to socialize and communicate with an unfamiliar partner," explains Enikolopov. These experiments showed that in young mice chronic social defeat induced high levels of anxiety helplessness, diminished social interaction, and diminished ability to communicate with other young animals. Stressed mice also had less new nerve-cell growth (neurogenesis) in a portion of the hippocampus known to be affected in depression: the subgranular zone of the dentate gyrus. Another group of young mice was also exposed to social stress, but was then placed for several weeks in an unstressful environment. Following this "rest" period, these mice, now old enough to be considered adults, were tested in the same manner as the other cohort. In this second, now-adult group, most of the behaviors impacted by social defeat returned to normal, as did neurogenesis, which retuned to a level seen in healthy controls. "This shows that young mice, exposed to adult aggressors, were largely resilient biologically and behaviorally," says Dr. Enikolopov. However, in these resilient mice, the team measured two latent impacts on behavior. As adults they were abnormally anxious, and were observed to be more aggressive in their social interactions. "The exposure to a hostile environment during their adolescence had profound consequences in terms of emotional state and the ability to interact with peers," Dr. Enikolopov observes. ### The research described in this release was supported by the Russian Foundation for Basic Research and by the National Institute of Mental Health. "Extended Effect of Chronic Social Defeat Stress in Childhood on Behaviors in Adulthood" appears online in PlOS One Tuesday, March 25, 2014. The authors are: Irina L. Kovalenko, Anna G. Galyamina, Dmitry A. Smagin, Tatyana V. Michurina, Natalia N. Kudryavtseva and Grigori Enikolopov. About Cold Spring Harbor Laboratory Founded in 1890, Cold Spring Harbor Laboratory (CSHL) has shaped contemporary biomedical research and education with programs in cancer, neuroscience, plant biology and quantitative biology. CSHL is ranked number one in the world by Thomson Reuters for the impact of its research in molecular biology and genetics. The Laboratory has been home to eight Nobel Prize winners. Today, CSHL's multidisciplinary scientific community is more than 600 researchers and technicians strong and its Meetings & Courses program hosts more than 12,000 scientists from around the world each year to its Long Island campus and its China center LCSW Continuing Education

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

Mental stress + heart disease: Stronger presence in women under 50

Patients with recent heart attack tested with public speaking task Researchers have found that women younger than 50 with a recent heart attack are more likely to experience restricted blood flow to the heart (myocardial ischemia) in response to psychological stress. The finding may partly explain why younger women who are hospitalized after a heart attack face a greater risk of complications and dying, compared to men of the same age. The results are scheduled to be presented Wednesday, Nov. 20 at the American Heart Association Scientific Sessions meeting in Dallas. Researchers at Emory University have been studying the responses of patients who recently had a heart attack to exercise stress and mental stress, in the form of public speaking on an emotional topic. They have found that women age 50 and below are more likely to experience mental stress-induced ischemia, compared to men of the same age (52 percent compared to 25 percent). The MIMS (Myocardial Infarction and Mental Stress) study included 49 men and 49 women, age-matched pairs who all had a heart attack in the last six months. Their ages ranged from 38 to 59. Among study participants older than 50, there were no significant sex differences in mental stress-induced ischemia;, however, men older than 50 had a rate of exercise-induced ischemia that was twice as high as women of a similar age. "This is the first study to examine the cardiovascular effects of psychological stress as a possible mechanism for the greater mortality after myocardial infarction among younger women," says study leader Viola Vaccarino, MD, PhD, professor and chair of the Department of Epidemiology, Rollins School of Public Health. "We saw a dramatic difference in mental stress-induced ischemia specifically in younger women. In addition, when ischemia was graded in a continuous way, we saw that it was twice as severe among the younger women." Women who experience a heart attack before age 50 are relatively rare, suggesting that perhaps those who do simply have more severe heart disease. However, even when investigators adjusted for different rates of traditional heart disease risk factors such as smoking and diabetes, the disparity remained. In fact, women tended to have less severe coronary artery disease, measured by examining the degree of blockage in their coronary arteries. One possible explanation the Emory investigators considered was a higher burden of psychosocial stress, Vaccarino says. In the study, the younger women were more often poor, of minority race, with a history of sexual abuse and with higher levels of depressive symptoms. "Yet if we look at the statistics, factors such as poverty, race and depression do not explain the difference," she says. "Yes, women have more stressors. But our data show that women also may be more vulnerable to the effects of mental stress on the heart." "This could be an added stimulus to the medical community to pay more attention to the emotional factors in cardiac patients. We are now taking a closer look at potential physiological factors that account for the additional susceptibility in younger women." Emory researchers working with Vaccarino have identified two areas where there are specific differences in younger women who had a recent heart attack: inflammation and heart rate variability, a measure of the responsiveness of the autonomic nervous system. Low heart rate variability has been previously linked to greater heart disease risk. The inflammation data is being presented in a poster by postdoctoral researcher Cherie Rooks, PhD on Sunday, Nov. 17 and the heart rate variability data in a poster by assistant professor Amit Shah, MD on Tuesday, Nov. 19. Interleukin-6 is a marker of inflammation that goes up and down quickly depending on someone's environmental exposures including mental stress, even in healthy individuals. In the MIMS study, women age 50 and below had much higher levels of IL-6 in their blood, compared to age-matched men, both before the mental stress test and afterwards. Women and men older than 50 had similar levels of IL-6. Heart rate goes up in response to physical or psychological stress, but the beats also become more evenly spaced. Heart rate variability is a measure of how much moment-to-moment fluctuation is present; higher heart rate variability is a marker of a more flexible, and thus healthier, autonomic system. In the MIMS study, younger women had their heart rate variability dip more in response to stress, compared to men the same age. This is additional evidence that young women after a heart attack may be more vulnerable to the adverse effects of psychological stress on the heart. Vaccarino and her colleagues are continuing to investigate mental stress-induced ischemia, including how it affects mortality and complication rates, in a second phase of the MIMS study at Emory, which will include a larger sample with patient follow-up Alcoholism and Drug Abuse Counselors Continuing Education ### How the study was conducted The mental stress test part of the study was a public speaking task involving an emotional topic. Participants were asked to imagine a real-life stressful situation, such as a close relative been mistreated in a nursing home. They had to quickly prepare a speech and deliver it in front of a video camera and an audience wearing white coats, while their blood pressure and other vital signs were monitored. Immediately afterwards, cardiac imaging was performed to assess blood flow within the heart via SPECT (single photon emission computed tomography). On a separate day, study participants performed a standard exercise test on a treadmill; a few were unable to exercise at a high heart rate and had to have a "pharmacological" stress test with a drug that dilates coronary arteries. The research was supported by the National Heart Lung and Blood Institute and the National Institute for Mental Health (R21HL093665, R21HL093665-01A1S1, R01 HL109413, K24HL077506, and K24 MH076955).

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.

Male mice exposed to chronic social stress have anxious female offspring

BOSTON (August 22, 2012) —A study in mice conducted by researchers at Tufts University School of Medicine (TUSM) suggests that a woman's risk of anxiety and dysfunctional social behavior may depend on the experiences of her parents, particularly fathers, when they were young. The study, published online in Biological Psychiatry, suggests that stress caused by chronic social instability during youth contributes to epigenetic changes in sperm cells that can lead to psychiatric disorders in female offspring across multiple generations. "The long-term effects of stress can be pernicious. We first found that adolescent mice exposed to chronic social instability, where the cage composition of mice is constantly changing, exhibited anxious behavior and poor social interactions through adulthood. These changes were especially prominent in female mice," said first author Lorena Saavedra-Rodríguez, Ph.D., postdoctoral fellow in the Larry Feig laboratory at Tufts University School of Medicine (TUSM). The researchers then studied the offspring of these previously-stressed mice and observed that again female, but not male, offspring exhibited elevated anxiety and poor social interactions. Notably, even though the stressed males did not express any of these altered behaviors, they passed on these behaviors to their female offspring after being mated to non-stressed females. Moreover, the male offspring passed on these behaviors to yet another generation of female offspring LSW Continuing Education "We are presently searching for biochemical changes in the sperm of stressed fathers that could account for this newly appreciated form of inheritance" said senior author Larry A. Feig, Ph.D., professor of biochemistry at Tufts University School of Medicine and member of the biochemistry and neuroscience program faculties at the Sackler School of Graduate Biomedical Sciences at Tufts University. "Hopefully, this work will stimulate efforts to determine whether similar phenomena occur in humans." ### This research was supported by award numbers AA019317 from the National Institute on Alcohol Abuse and Alcoholism, and MH083324 from the National Institute of Mental Health, both part of the National Institutes of Health (NIH). The research was also supported by award number NS047243 from National Institute of Neurological Disorders and Stroke (NIH) to the Tufts Center for Neuroscience Research. Saavedra-Rodríguez L, Feig LA. Biological Psychiatry. "Chronic Social Instability Induces Anxiety and Defective Social Interactions Across Generations." Available online August 20, 2012. http://dx.doi.org/10.1016/j.biopsych.2012.06.035 About Tufts University School of Medicine and the Sackler School of Graduate Biomedical Sciences Tufts University School of Medicine and the Sackler School of Graduate Biomedical Sciences at Tufts University are international leaders in innovative medical education and advanced research. The School of Medicine and the Sackler School are renowned for excellence in education in general medicine, biomedical sciences, special combined degree programs in business, health management, public health, bioengineering and international relations, as well as basic and clinical research at the cellular and molecular level. Ranked among the top in the nation, the School of Medicine is affiliated with six major teaching hospitals and more than 30 health care facilities. Tufts University School of Medicine and the Sackler School undertake research that is consistently rated among the highest in the nation for its effect on the advancement of medical science.

Exposure to violence has long-term stress effects among adolescents

UNIVERSITY PARK, Pa. -- Children who are exposed to community violence continue to exhibit a physical stress response up to a year after the exposure, suggesting that exposure to violence may have long-term negative health consequences, according researchers at Penn State and University College London. "We know that exposure to violence is linked with aggression, depression, post-traumatic stress symptoms and academic and cognitive difficulties in the short term, but little is known about the long-term effects of such exposure," said Elizabeth Susman, Jean Phillips Shibley Professor of Biobehavioral Health, Penn State. "Our data show that the stress reaction to violence exposure is not just immediate. There's an effect that endures." The scientists recruited 124 adolescents, ranging in age from 8 to 13 and living in small city and rural communities, to participate in the study social worker continuing education "Most studies of the effects of exposure to violence look at children who live in inner cities and urban communities," said Melissa Peckins, biobehavioral health graduate student, Penn State. "Our study is unique because we focused on children who live in small towns, so they are not children you would normally expect to be exposed to a lot of violence. Also, these were healthy children without a history of reported maltreatment." The researchers gave each of the adolescents a questionnaire, which identified their lifetime exposure to violence and exposure within the past 12 months. They then gave the adolescents the beginning of a story and asked them to complete it in front of two mock judges, whom they were told were evaluating their responses and performances for later comparison to those of other children the same age. Following the story-completion task, adolescents were also given a serial subtraction task. "The story completion task and mental arithmetic task are commonly used to elicit a stress response in laboratory settings," Peckins said. "Our hypothesis was that children who have been exposed to more violent events in the past year will have an attenuated response to the laboratory stressor -- even 12 months after the incidence -- compared with children who experienced fewer violent events." The team measured the children's stress responses by comparing the cortisol levels present in samples of their saliva collected before and after the stress test was administered. "In males, we found that as exposure to violence increased, cortisol reactivity decreased, so cortisol reactivity was attenuated; it was a habituation effect," Peckins said. The finding was not present in females. The results were published online in a recent issue of the Journal of Adolescent Health. "In enduring stressful conditions, we may have adapted evolutionarily to suppress our cortisol levels because higher and more prolonged levels of cortisol in the bloodstream can lead to negative health consequences, such as autoimmune disorders, lowered immunity, arthritis and atypical depression. This may explain why cortisol reactivity was lower for males," Susman said. "However, there is a theory that females may react to stressful situations by talking about it, which may be their way of reducing the negative effects of cortisol in the bloodstream. If parents and other adults are available to discuss episodes of violence with children, it might help the children, especially females, to reduce their cortisol levels." In the future, the team hopes to examine the role of duration of exposure to violence and time elapsed after exposure to violence on cortisol reactivity. ### Other researchers on this project were Samantha Dockray, research fellow, University College London, and Jacey Eckenrode, graduate student in biobehavioral health and Jodi Heaton, administrative assistant, biobehavioral health, both at Penn State. The National Institute of Mental Health, the General Clinical Research Center of the National Institutes of Health and Penn State supported this work.

Stress about wife's breast cancer can harm a man's health

COLUMBUS, Ohio – Caring for a wife with breast cancer can have a measurable negative effect on men's health, even years after the cancer diagnosis and completion of treatment, according to recent research. Men who reported the highest levels of stress in relation to their wives' cancer were at the highest risk for physical symptoms and weaker immune responses, the study showed. The researchers sought to determine the health effects of a recurrence of breast cancer on patients' male caregivers, but found that how stressed the men were about the cancer had a bigger influence on their health than did the current status of their wives' disease. The findings imply that clinicians caring for breast cancer patients could help their patients by considering the caregivers' health as well, the researchers say. This care could include screening caregivers for stress symptoms and encouraging them to participate in stress management, relaxation or other self-care activities, said Sharla Wells-Di Gregorio, lead author of the study and assistant professor of psychiatry and psychology at Ohio State University. "If you care for the caregiver, your patient gets better care, too," said Kristen Carpenter, a postdoctoral researcher in psychology at Ohio State and a study co-author LSW Continuing Education The research is published in a recent issue of the journal Brain, Behavior and Immunity. Thirty-two men participated in the study, including 16 whose wives had experienced a breast cancer recurrence an average of eight months before the study began and approximately five years after the initial cancer diagnosis. These men were matched with 16 men whose wives' cancers were similar, but who remained disease-free about six years after the initial diagnosis. The participants completed several questionnaires measuring levels of psychological stress related to their wives' cancers, physical symptoms related to stress, and the degree to which fatigue interfered with their daily functioning. Researchers tested their immune function by analyzing white-blood-cell activation in response to three different types of antigens, or substances that prompt the body to produce an immune response. The men's median age was 58 years and they had been married, on average, for 26 years. Almost all of the participants were white. In general, the men whose wives had experienced a recurrence of cancer reported higher levels of stress, greater interference from fatigue and more physical symptoms, such as headaches and abdominal pain, than did men whose wives had remained disease-free. The subjective stress assessment used in the study, called the Impact of Events Scale, measures intrusive experiences and thoughts, as well as attempts to avoid people and places that serve as painful reminders. The scale produces a score between 0 and 75; in this case, the higher the score, the more stressed the men were in relation to their wives' cancer. Overall, the men in the study produced an average score of 17.59. Men whose wives' cancer had recurred scored 26.25 as a group, and men whose wives were disease-free scored 8.94. According to the scale, scores above nine suggest a likely effect from the events, and scores between 26 and 43 indicate an event has had a powerful effect on a person's stress level. Scores over 33 suggest clinically significant distress. "The scores reported here are quite high, substantially higher than we see in our cancer patient samples outside the first year," Carpenter said. "Guilt, depression, fear of loss – all of those things are stressful. And this is not an acute stressor that lasts a few weeks. It's a chronic stress that lasts for years." The participants also reported, on average, a total of approximately seven stress-related physical symptoms. Men with wives with recurrent cancer reported nine symptoms, on average, and those whose wives were disease-free reported fewer than five symptoms, on average. These symptoms varied, but included headaches, gastrointestinal problems, coughing and nausea. When the analysis took into consideration the impact of men's perceived stress in relation to their wives' cancer, higher stress was associated with compromised immune function: Specifically, men with the highest scores on the stress scale also showed the lowest immune responses to two of the three antigens. Previous research has suggested that people with an impaired immune response are more susceptible to infection and might not respond well to vaccines. "Caregivers are called hidden patients because when they go in for appointments with their spouses, very few people ask how the caregiver is doing," said Wells-Di Gregorio, who works in Ohio State's Center for Palliative Care. "These men are experiencing significant distress and physical complaints, but often do not seek medical care for themselves due to their focus on their wives' illness." In these men undergoing chronic stress, the researchers said that it remains unclear whether the immune dysregulation causes more physical symptoms, or stress causes the symptoms and the impaired immune response. Wells-Di Gregorio noted that the stress effect might have been even more pronounced than what they observed because disease-free spouses were more reluctant to participate in the study. "We found that many were not willing to participate because they said they didn't want to think about cancer again," she said. This research was supported by the Ann and Herbert Siegel American Cancer Society Postdoctoral Fellowship, the Longaberger Company-American Cancer Society Grant for Breast Cancer Research, the U.S. Army Medical Research Acquisition Activity Grants, the National Institute of Mental Health and the National Cancer Institute. Co-authors included Caroline Dorfman and Hae-Chung Yang of Ohio State's Department of Psychology; Laura Simonelli of the Christiana Care Health System; and William Carson III of Ohio State's Department of Surgery and Comprehensive Cancer Center

Gatekeeper of brain steroid signals boosts emotional resilience to stress

PHILADELPHIA - A cellular protein called HDAC6, newly characterized as a gatekeeper of steroid biology in the brain, may provide a novel target for treating and preventing stress-linked disorders, such as depression and post-traumatic stress disorder (PTSD), according to research from the Perelman School of Medicine at the University of Pennsylvania. Glucocorticoids are natural steroids secreted by the body during stress. A small amount of these hormones helps with normal brain function, but their excess is a precipitating factor for stress-related disorders. Glucocorticoids exert their effects on mood by acting on receptors in the nucleus of emotion–regulating neurons, such as those producing the neurotransmitter serotonin. For years, researchers have searched for ways to prevent deleterious effects of stress by blocking glucocorticoids in neurons. However, this has proved difficult to do without simultaneously interfering with other functions of these hormones, such as the regulation of immune function and energy metabolism. In a recent Journal of Neuroscience paper, the lab of Olivier Berton, PhD, assistant professor of Psychiatry, shows how a regulator of glucocorticoid receptors may provide a path towards resilience to stress by modulating glucocorticoid signaling in the brain. The protein HDAC6, which is particularly enriched in serotonin pathways, as well as in other mood-regulatory regions in both mice and humans, is ideally distributed in the brain to mediate the effect of glucocorticoids on mood and emotions. HDAC6 likely does this by controlling the interactions between glucocorticoid receptors and hormones in these serotonin circuits ceus for social workers Experiments that first alerted Berton and colleagues to a peculiar role of HDAC6 in stress adaptation came from an approach that reproduces certain clinical features of traumatic stress and depression in mice. The animals are exposed to brief bouts of aggression from trained "bully" mice. In most aggression-exposed mice this experience leads to the development of a lasting form of social aversion that can be treated by chronic administration of antidepressants. In contrast, a portion of mice exposed to chronic aggression consistently express spontaneous resilience to the stress and do not develop any symptoms. By comparing gene expression in the brains of spontaneously resilient and vulnerable mice, Berton and colleagues discovered that reducing HDAC6 expression is a hallmark of naturally resilient animals. While aggression also caused severe changes in the shape of serotonin neurons and their capacity to transmit electrical signals in vulnerable mice, stress-resilient mice, in contrast, escaped most of these neurobiological changes. To better understand the link between HDAC6 and the development of stress resilience, Berton and colleagues devised a genetic approach to directly manipulate HDAC6 levels in neurons: Deletion of HDAC6 in serotonin neurons -- the densest HDAC6-expressing cell group in the mouse brain -- dramatically reduced social and anxiety symptoms in mice exposed to bullies and also fully prevented neurobiological changes due to stress, fully mimicking a resilient phenotype. Using biochemical assays, Berton's team showed it is by promoting reversible chemical changes onto a heat shock chaperone protein, Hsp90, that HDAC6 deletion is able to literally switch off the effects of glucocorticoid hormones on social and anxiety behaviors. Chaperones are proteins that help with the folding or unfolding and the assembly or disassembly of protein complexes. The way in which glucocorticoid receptor chaperoning and stress are linked is not well understood. Yet, genetic variations in certain components of the glucocorticoid receptor chaperone complex have been associated with the development of stress-related disorders and individual variability in therapeutic responses to antidepressants. "We provide pharmacological and genetic evidence indicating that HDAC6 controls certain aspects of Hsp90 structure and function in the brain, and thereby modulates protein interactions, as well as hormone- and stress-induced glucocorticoid receptor signaling and behavior," explains Berton. Together, these results identify HDAC6 as a possible stress vulnerability biomarker and point to pharmacological inhibition of HDAC6 as a potential new strategy for antidepressant interventions through regulation of Hsp90 in glucocorticoid signaling in serotonin neurons. Co-first-authors are Julie Espallergues and Sarah L. Teegarden, along with Avin Veerakumar, Janette Boulden, Collin Challis, Jeanine Jochems, Michael Chan, Tess Petersen, Chang-Gyu Hahn, Irwin Lucki, and Sheryl G. Beck, all from Penn. Other authors are Evan Deneris, from Case Western Reserve University, Cleveland, Ohio, and Patrick Matthias, Miescher Institute for Biomedical Research, Basel, Switzerland. This work was funded by the National Institute of Mental Health grants MH087581 and MH0754047 and grants from the International Mental Health Research Organization and the National Alliance for Research on Schizophrenia and Depression. Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $4.3 billion enterprise. The Perelman School of Medicine is currently ranked #2 in U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $479.3 million awarded in the 2011 fiscal year. The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania -- recognized as one of the nation's top 10 hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; and Pennsylvania Hospital - the nation's first hospital, founded in 1751. Penn Medicine also includes additional patient care facilities and services throughout the Philadelphia region. Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2011, Penn Medicine provided $854 million to benefit our community.

Family Health: Holiday Health and Safety Tips

The holidays are a time to celebrate, give thanks, and reflect. They are also a time to pay special attention to your health. Give the gift of health and safety to yourself and others by following these holiday tips.

Wash your hands often.
Keeping hands clean is one of the most important steps you can take to avoid getting sick and spreading germs to others. Wash your hands with soap and clean running water for at least 20 seconds. If soap and clean water are not available, use an alcohol-based product.

Clean Hands Save Lives


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Stay warm.
Cold temperatures can cause serious health problems, especially in infants and older adults. Stay dry, and dress warmly in several layers of loose-fitting, tightly woven clothing.


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Manage stress.
The holidays don’t need to take a toll on your health. Keep a check on over-commitment and over-spending. Balance work, home, and play. Get support from family and friends. Keep a relaxed and positive outlook.


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Travel safely.
Whether you're traveling across town or around the world, help ensure your trip is safe. Don’t drink and drive, and don’t let someone else drink and drive. Wear a seat belt every time you drive or ride in a motor vehicle. Always buckle your child in the car using a child safety seat, booster seat, or seat belt according to his/her height, weight, and age.

Available through the CDC:
Extreme Cold: A Prevention Guide to Promote Your Personal Health and Safety

Impaired Driving

Keep Kids Safe on the Road

Stay Safe and Healthy in Winter Weather

Traumatic Brain Injury

Travelers’ Health


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Be smoke-free.
Avoid smoking and breathing other people's smoke. If you smoke, quit today! Call 1-800-QUIT-NOW or talk to your health care provider for help.


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Get check-ups and vaccinations.
Exams and screenings can help find problems before they start. They can also help find problems early, when the chances for treatment and cure are better. Vaccinations help prevent diseases and save lives. Schedule a visit with your health care provider for a yearly exam. Ask what vaccinations and tests you should get based on your age, lifestyle, travel plans, medical history, and family health history.

Available through the CDC:
Things to Do Before Your Next Check-Up

Family Health History Resources and Tools

Get Smart: Know When Antibiotics Work

Vaccines and Immunizations

Safety of 2010-2011 Flu Vaccines

Women: Stay Healthy at Any Age (AHRQ)

Men: Stay Healthy at Any Age (AHRQ)


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Watch the kids.
Children are at high risk for injuries that can lead to death or disability. Keep a watchful eye on your kids when they’re eating and playing. Keep potentially dangerous toys, food, drinks, household items, choking hazards (like coins and hard candy), and other objects out of kids' reach. Learn how to provide early treatment for children who are choking. Make sure toys are used properly.

Injuries among Children and Adolescents
Toy Safety Tips (CPSC)

Counselor Continuing Education
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Prevent injuries.
Injuries can occur anywhere and some often occur around the holidays. Use step stools instead of furniture when hanging decorations. Leave the fireworks to the professionals. Wear a bicycle helmet to help prevent head injuries.

Most residential fires occur during the winter months. Keep candles away from children, pets, walkways, trees, and curtains. Never leave fireplaces, stoves, or candles unattended. Don't use generators, grills, or other gasoline- or charcoal-burning devices inside your home or garage. Install a smoke detector and carbon monoxide detector in your home. Test them once a month, and replace batteries twice a year.

Bicycle Related Injuries

Carbon Monoxide (CO) Poisoning Prevention

Fall-Related Injuries during the Holiday Season- United States, 2000-2003

General Injury Related Information

Fire Deaths and Injuries: Prevention Tips

Fireworks-Related Injuries


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Handle and prepare food safely.
As you prepare holiday meals, keep you and your family safe from food-related illness. Wash hands and surfaces often. Avoid cross-contamination by keeping raw meat, poultry, seafood, and eggs (including their juices) away from ready-to-eat foods and eating surfaces. Cook foods to the proper temperature. Refrigerate promptly. Do not leave perishable foods out for more than two hours.

It's Turkey Time: Safely Prepare Your Holiday Meal

Seasonal Food Safety: Fact Sheets (USDA)


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Eat healthy, and be active.
With balance and moderation, you can enjoy the holidays the healthy way. Choose fresh fruit as a festive and sweet substitute for candy. Select just one or two of your favorites from the host of tempting foods. Find fun ways to stay active, such as dancing to your favorite holiday music. Be active for at least 2½ hours a week. Help kids and teens be active for at least 1 hour a day.

Alcohol: Frequently Asked Questions

Get Smart Entertaining

Healthy Weight

Be Physically Active in the New Year

Managing Diabetes During the Holidays

Physical Activity for Everyone


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Protect pets from rabies.
Pets are also considered family members by many. Keep them healthy. There are several things you can do to protect your pet from rabies. First, visit your veterinarian with your pet on a regular basis and keep rabies vaccinations up-to-date for all cats, ferrets, and dogs.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

RESOURCES

Licensed Professional Counselor LPC Continuing Education

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

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

The Holidays: Here They Come, Ready or Not

When the weather changes and the leaves begin to wither, it starts. By Halloween, it’s gathering momentum and by Thanksgiving, it has us in a full-body press. “It” is The Holidays, and whether you celebrate Hanukkah, Christmas, Kwanzaa or simply “the season,” what everybody has in common this last quarter of the year is stress with a capital S. No wonder. All those events and activities, family gatherings. The kids are out of school again, house guests are coming, or you’re planning a trip. Don’t even mention shopping for gifts, sending greeting cards or decorating the house. The credit cards are maxed out, you’ve got more chores than you can shake a stick at and your “to do” list is longer than Santa’s beard. And you swore it would all be different this year. Take heart. It’s not too late. With intention, it really can be different this year. First thing to remember: take good care of yourself: Eat healthfully, get plenty of rest, exercise, drink lots of water. Breathe deeply. Relax and have fun. During the holidays when already too-busy lives become even more hectic, some serious time management is in order. Write down a list of all the things you want to do. Prioritize. Assign some chores to the children. Consider scratching a few items off your list. Make a budget and stick to it. Remember, it’s not the price, but the thoughtfulness of the gift. Use gift certifi- cates if you’re unsure of what to give. Remember, adults aren’t the only ones who feel more stress during the holiday season. Children experience it, too. Keep communications lines open and spend quality time with your youngsters. This is a wonderful time to share your family’s holiday traditions through storytelling or special seasonal activities. Getting the young ones outside the house, for full body exercise will help them and you to work off stress. Go out and play together. Having house guests? Try to make them as self-suf- ficient as possible. Ask for help. And even though it might be fun, don’t wear yourself out by staying up late every night, or stuffing each day as full as a Christmas goose.

Family gatherings may be complex, given blended families and special holiday arrangements. Conflicting family expectations and demands can create guilt and resentment. If family gatherings cause tension and anxiety, consider alternatives that can lessen the effects. Make plans well enough in advance to avoid any last minute surprises or disappointments. Finally, take time for yourself. Find a place where you can be quiet and restful. Take a walk, breathe in the fresh air. Look around you, notice nature’s response to the season and let yourself be amazed. Those Holiday Blues Are Real It’s not unusual to feel down during the holidays. In fact, so many people experience feelings of sadness or loss, of being overwhelmed at this time of year, even the name for it has become a cliché: the Holiday Blues. As the name implies, these blues are seasonal. When the holidays are over, they’ll probably disappear right along with the decorations and last of the Christmas cookies. But they are real and their symptoms can dampen an otherwise joyous holiday experience. Here are some symptoms and some solutions:
• Feelings of loss or separation from loved ones may be intensified during the holidays.
• Fatigue from holiday stress affects you emotionally as well as physically.
• Families and family traditions change. Are you hanging onto old ideas or pictures?
• Media images of the perfect holidays seldom match anyone's real life. Check your expectations against the reality of your situation.
• Over-indulging in food and drink will have aftereffects. So will lack of physical exercise, sleep and rest.
• If you're feeling "the blues," get support from friends and family. Don't isolate.
• These feelings are real and valid. Acknowledge them.
• Make time to refill yourself.
• Understand that this is a stressful time. And that it will be over. Experiencing the holiday blues is part of the common experience.
Feelings beyond "the blues" and feelings that are more debilitating, or that extend beyond the holiday season, may signal depression. If this is true for you, don't hesitate to ask for help.