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November 19, 2018 by Benedict Carey | The New York Times

When Will We Solve Mental Illness?

Biology was supposed to cure what ails psychiatry. Decades later, millions of people with mental disorders are still waiting.

(The New York Times) – Nothing humbles history’s great thinkers more quickly than reading their declarations on the causes of madness. Over the centuries, mental illness has been attributed to everything from a “badness of spirit” (Aristotle) and a “humoral imbalance” (Galen) to autoerotic fixation (Freud) and the weakness of the hierarchical state of the ego (Jung).

The arrival of biological psychiatry, in the past few decades, was expected to clarify matters, by detailing how abnormalities in the brain gave rise to all variety of mental distress. But that goal hasn’t been achieved — nor is it likely to be, in this lifetime.

Still, the futility of the effort promises to inspire a change in the culture of behavioral science in the coming decades. The way forward will require a closer collaboration between scientists and the individuals they’re trying to understand, a mutual endeavor based on a shared appreciation of where the science stands, and why it hasn’t progressed further.

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November 18, 2018 by Medical Press

Group therapy most effective treatment for anxiety in young people

(JAMA Psychiatry) – Group cognitive behavioural therapy (CBT) could be the best choice of psychotherapy for anxiety disorders in children and adolescents, according to a new network meta-analysis study from Oxford University, Department of Psychiatry.

CBT is a talking therapy designed to help people manage problems by encouraging positive changes in the way they think and behave. It is widely used to treat anxiety and depression, as well as other mental and physical health problems, especially in adults, as it is designed to help people to deal with overwhelming problems in a more positive way by breaking them down into smaller parts.

The new study showed that only group CBT was significantly more effective in reducing  than other psychotherapies and all control conditions immediately after treatment and at short term follow up.

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November 17, 2018 by Anna Moore | The Guardian

Matt Haig: ‘I wanted to end it all, but surviving and thriving is the lesson I pass on’

At 24, he wanted to kill himself. Now a novelist, he teaches the readers of his books – and his children – how to get through when the future looks bleak

(The Guardian) – On a September day in Ibiza, the air scented with sea and pine, Matt Haig – then 24 – walked to a cliff edge planning to kill himself. He stopped one step away.

Reasons to Stay Alive, his account of this unravelling, the strange hell of depression and anxiety and his journey back from the edge, would become a bestseller 16 years later. Already a novelist by the time he wrote it, Haig saw the book as a “side project”, though it was anything but. Within weeks, he was getting 1,000 emails a day from grateful readers. Strangers stopped him on the street to thank him. Celebrity admirers included Steven Fry, Jo Brand and Ruby Wax – and Haig was catapulted into the role of mental health campaigner.

This year has seen the publication of Haig’s Notes on a Nervous Planet, which explores the effects of 24/7 modern life on mental health, and The Truth Pixie, a message of hope for his younger readers. Meanwhile, back at home, Haig’s own children, Lucas, 10, and Pearl, 9, have been learning about their dad’s illness at the same time as the public.

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November 15, 2018 by JASON CHERKIS | Highline

The Best Way To Save People From Suicide

“What if this is what we should be doing?
What if it’s that simple?”

It was still dark outside when Amanda woke up to the sound of her alarm, got out of bed and decided to kill herself. She wasn’t going to do it then, not at 5:30 in the morning on a Friday. She told herself she would do it sometime after work.

Amanda showered. She put on khakis and a sweater. She fed Abby, her little house cat. Before walking out the door, she sent her therapist an email. “Not a good night last night, had a disturbing dream,” she wrote. “Got to try and get through the day, hope I can shift my mind enough to focus. Only plan tonight is to come home and take a nap.”

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November 14, 2018 by Florida Institute for Human & Machine Cognition

EPISODE 74: ROBERT WHITAKER: THE DRUG-BASED PARADIGM OF PSYCHIATRIC CARE IN THE U.S.

Today’s guest is a science journalist and author who has written extensively about the pharmaceutical industry. Robert Whitaker is also the founder of Mad in America, a nonprofit organization that focuses on getting people to rethink psychiatric care in the United States.

As you will learn in today’s episode, one in six Americans takes a psychiatric drug. More than 130,000 children under the age of five are taking addictive anti-anxiety drugs prescribed by doctors.

Whitaker has spent most of his career focused on changing the current drug-based paradigm of psychiatric care in the U.S. He has written three books about the pharmaceutical industry and the psychiatric profession. He has looked at how drugs used for depression, bipolar disorder and schizophrenia are causing a spike in America’s disability numbers. He also has investigated the history of medications prescribed for these disorders, how they are marketed, and why they’ve grown in popularity.

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November 13, 2018 by Gary Greenberg | The New York Times

What if the Placebo Effect Isn’t a Trick?

New research is zeroing in on a biochemical basis for the placebo effect — possibly opening a Pandora’s box for Western medicine.

(The New York Times) – The Chain of Office of the Dutch city of Leiden is a broad and colorful ceremonial necklace that, draped around the shoulders of Mayor Henri Lenferink, lends a magisterial air to official proceedings in this ancient university town. But whatever gravitas it provided Lenferink as he welcomed a group of researchers to his city, he was quick to undercut it. “I am just a humble historian,” he told the 300 members of the Society for Interdisciplinary Placebo Studies who had gathered in Leiden’s ornate municipal concert hall, “so I don’t know anything about your topic.” He was being a little disingenuous. He knew enough about the topic that these psychologists and neuroscientists and physicians and anthropologists and philosophers had come to his city to talk about — the placebo effect, the phenomenon whereby suffering people get better from treatments that have no discernible reason to work — to call it “fake medicine,” and to add that it probably works because “people like to be cheated.” He took a beat. “But in the end, I believe that honesty will prevail.”

Lenferink might not have been so glib had he attended the previous day’s meeting on the other side of town, at which two dozen of the leading lights of placebo science spent a preconference day agonizing over their reputation — as purveyors of sham medicine who prey on the desperate and, if they are lucky, fool people into feeling better — and strategizing about how to improve it. It’s an urgent subject for them, and only in part because, like all apostate professionals, they crave mainstream acceptance. More important, they are motivated by a conviction that the placebo is a powerful medical treatment that is ignored by doctors only at their patients’ expense.

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November 13, 2018 by Psychiatric News | APA

Antipsychotics May Increase Risk of Pneumonia, Meta-Analysis Suggests

(Psychiatric News) – Patients who take antipsychotics may be at an increased risk of pneumonia, according to a systematic review and meta-analysis published in the Journal of Psychopharmacology.

After performing a search of several databases, Olubanke Dzahini, B.Pharm., M.Sc., of the Institute of Pharmaceutical Science at King’s College London and colleagues included 14 studies with a total of 206,899 patients in the meta-analysis. By compiling, comparing, and contrasting data from these studies, the researchers sought to assess the overall risk of pneumonia in patients who took first- or second-generation antipsychotics compared with those who did not take antipsychotics. They also examined the risk of pneumonia in patients who took one of six antipsychotics (clozapine, haloperidol, olanzapine, quetiapine, risperidone, and zotepine) compared with those who did not take these medications.

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November 13, 2018 by Michael A. Steinman, MD & C. Seth Landefeld, MD | JAMA

Overcoming Inertia to Improve Medication Use and Deprescribing

(JAMA) – Inertia is a powerful force. Stopping or starting is difficult in health care as well as in other sciences. Ineffective or potentially harmful treatments are often not stopped, even years after they have been started, and effective treatments are too often not started at all.

Once started, medications can be difficult to stop. It takes time for office-based clinicians to reassess use of medications prescribed to patients with chronic diseases, particularly therapies that are not clearly related to the symptoms or conditions that are the focus of a given patient encounter. Even if a clinician recognizes a medication as potentially inappropriate and a candidate for discontinuation, both the clinician and the patient may be concerned that “the devil they know is better than the devil they don’t know,” and that stopping a medication may worsen symptoms or biomarkers or may be perceived as giving up. Clinicians also may be unsure about how to best taper different medications or how to recognize and manage adverse drug withdrawal events. Thus, use of unnecessary and potentially harmful medications is common among older adults.1

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November 12, 2018 by Ricki Lewis, PhD | Medscape

Nearly Half of Patients Have Rx Longer Than Needed

(Medscape) – Nearly half of primary care patients were prescribed antidepressants, bisphosphonates, or proton pump inhibitors (PPIs) for longer than necessary, according to findings of a study published in Annals of Family Medicine.

“Legacy prescribing” refers to the prescribing of drugs for a longer period than is typically needed to treat a condition. In the study, it was defined as a period longer than 3 months but not indefinitely. The practice of extended prescribing may contribute to “inappropriate polypharmacy,” the taking of multiple medications simultaneously.

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November 11, 2018 by Norbert Müller | Schizophrenia Bulletin

Inflammation in Schizophrenia: Pathogenetic Aspects and Therapeutic Considerations

Schizophr Bull. 2018;44(5):973-982.

Abstract

This paper discusses the current evidence from animal and human studies for a central role of inflammation in schizophrenia. In animal models, pre- or perinatal elicitation of the immune response may increase immune reactivity throughout life, and similar findings have been described in humans. Levels of pro-inflammatory markers, such as cytokines, have been found to be increased in the blood and cerebrospinal fluid of patients with schizophrenia. Numerous epidemiological and clinical studies have provided evidence that various infectious agents are risk factors for schizophrenia and other psychoses. For example, a large-scale epidemiological study performed in Denmark clearly showed that severe infections and autoimmune disorders are such risk factors. The vulnerability-stress-inflammation model may help to explain the role of inflammation in schizophrenia because stress can increase pro-inflammatory cytokines and may even contribute to a chronic pro-inflammatory state. Schizophrenia is characterized by risk genes that promote inflammation and by environmental stress factors and alterations of the immune system. Typical alterations of dopaminergic, serotonergic, noradrenergic, and glutamatergic neurotransmission described in schizophrenia have also been found in low-level neuroinflammation and consequently may be key factors in the generation of schizophrenia symptoms. Further support for the relevance of a low-level neuroinflammatory process in schizophrenia is provided by the loss of central nervous system volume and microglial activation demonstrated in neuroimaging studies. Last but not least, the benefit of anti-inflammatory medications found in some studies and the intrinsic anti-inflammatory and immunomodulatory effects of antipsychotics provide further support for the role of inflammation in this debilitating disease.

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The contents of this Headlines page are provided for informational purposes. Any material, conclusions, or opinions presented in the linked articles are not necessarily endorsed by the Foundation for Excellence in Mental Health Care.