Category Archives: Mental Health

Gene’s effect on brain connections may play role in schizophrenia, study

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Suspect gene may trigger runaway synaptic pruning during adolescence

From the National Institutes of Health

Versions of a gene linked to schizophrenia may trigger runaway pruning of the teenage brain’s still-maturing communications infrastructure, NIH-funded researchers have discovered.

“Normally, pruning gets rid of excess connections we no longer need, streamlining our brain for optimal performance, but too much pruning can impair mental function,”

The site in Chromosome 6 harboring the gene C4 towers far above other risk-associated areas on schizophrenia’s genomic “skyline,” marking its strongest known genetic influence. The new study is the first to explain how specific gene versions work biologically to confer schizophrenia risk. — Psychiatric Genomics Consortium

People with the illness show fewer such connections between neurons, or synapses.  The gene switched on more in people with the suspect versions, who faced a higher risk of developing the disorder, characterized by hallucinations, delusions and impaired thinking and emotions.

“Normally, pruning gets rid of excess connections we no longer need, streamlining our brain for optimal performance, but too much pruning can impair mental function.”

“Normally, pruning gets rid of excess connections we no longer need, streamlining our brain for optimal performance, but too much pruning can impair mental function,” said Thomas Lehner, Ph.D., director of the Office of Genomics Research Coordination of the NIH’s National Institute of Mental Health (NIMH). “It could help explain schizophrenia’s delayed age-of-onset of symptoms in late adolescence/early adulthood and shrinkage of the brain’s working tissue. Interventions that put the brakes on this pruning process-gone-awry could prove transformative.” Continue reading

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New Washington State plan outlines impact of suicide, proposes solutions

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From the Washington State Department of Health

Suicide is preventable – and everyone has a role in stopping it

More than 5,000 people in Washington took their own lives during the five-year period of 2010 to 2014.

Washington’s new Suicide Prevention Plan aims to reduce that toll through unified efforts involving people and groups across the state.

For many years, the state’s suicide rate has been above the national average, prompting Governor Jay Inslee to address the tragedy of suicide in an executive order last week.

“We can stop these tragic deaths, but it’ll take coordination and cooperation,” said Washington’s Secretary of Health John Wiesman. “We know there are ways we can make a difference and this plan maps out strategies to save lives in our state.”

“Suicide is a preventable public health problem, not a personal weakness or family failure,” asserts the first core principle in the plan, which the Washington State Department of Health created in response to 2014 legislation. “Everyone in Washington has a role in suicide prevention. Suicide prevention is not the responsibility of the health system alone.”

Other core principles include:

  • Silence and stigma create harm by isolating people at risk and discouraging help- seeking.
  • Suicide prevention requires changing contributing factors such as childhood trauma, isolation, access to lethal means, and lack of access to appropriate behavioral health care.
  • Suicide doesn’t affect all communities equally, so prevention programs need to address local needs and cultures.
  • People experiencing issues associated with suicide deserve dignity, respect and the right to make decisions about their care.

The plan divides the work of suicide prevention into four strategic directions based on the National Strategy for Suicide Prevention.

Those are:

    • Empowering people, families and communities to understand their roles in preventing suicide “upstream,” before a crisis.
    • Directing suicide prevention programs toward those who need them most, helping identify people at risk and keeping them safe.
    • Making treatment accessible, appropriate and respectful for people at risk.
    • Using research, data and evaluation as a basis for suicide prevention work.

Washington has already made headway in battling suicide with a network of coalitions, student- led clubs, support groups, behavioral health treatment, culturally tailored initiatives, trainers, and community leaders.

The state has groundbreaking suicide prevention training requirements for health professionals. The Department of Health has been involved in youth suicide prevention work for more than two decades.The new plan builds on that base to address a problem that claims an average of three lives in Washington each day.

The intent of the plan is to use data and community input to customize short- and long-term prevention and intervention tactics to best serve specific populations, avoiding a one-size-fits-all approach.

Toward that end, a broad range of contributors and steering committee members participated in drafting, reviewing and completing the plan. As the document makes clear, suicide is a serious public health problem that everyone can play a role in solving.

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Learning soft skills in childhood can prevent problems later

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Pat-a-cake,_pat-a-cake,_baker's_man_1_-_WW_Denslow_-_Project_Gutenberg_etext_18546 (1)By Lynne Shallcross

Academic learning is usually in the spotlight at school, but teaching elementary-age students “soft” skills like self-control and how to get along with others might help to keep at-risk kids out of criminal trouble in the future, a study finds.

Duke University researchers looked at a program called Fast Track, which was started in the early 1990s for children who were identified by their teachers and parents to be at high risk for developing aggressive behavioral problems.

The students were randomized into two groups; half took part in the intervention, which included a teacher-led curriculum, parent training groups, academic tutoring and lessons in self-control and social skills.

The academic skills turned out to have less of an impact on crime and delinquency rates than did the soft skills, which are associated with emotional intelligence.

The program, which lasted from first grade through 10th grade, reduced delinquency, arrests and use of health and mental health services as the students aged through adolescence and young adulthood, as researchers explained in a separate study published earlier this year.

In the latest study, researchers looked at the “why” behind those previous findings. In looking at the data from nearly 900 students, the researchers found that about a third of the impact on future crime outcomes was due to the social and self-regulation skills the students learned from ages 6 to 11.

The academic skills that were taught as part of Fast Track turned out to have less of an impact on crime and delinquency rates than did the soft skills, which are associated with emotional intelligence. Soft skills might include teaching kids to work cooperatively in a group or teaching them how to think about the long-term consequences when they make a decision. Teaching physics is an example of a hard skill.

“The conclusion that we would make is that these [soft] skills should be emphasized even more in our education system and in our system of socializing children,” says Kenneth Dodge, a professor of public policy and of psychology and neuroscience at Duke who was a principal investigator in this study as well as in the original Fast Track project. Parents should do all they can to promote these skills with their children, Dodge says, as should education policymakers. Continue reading

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Depressed? Look for help from a human, not a computer

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Computer Circuit BoardBy Lynne Shallcross
KHN/NPR

Almost 8 percent of Americans 12 and older dealt with depression at some point between 2009 and 2012. With that many of us feeling blue, wouldn’t it be nice if we could simply hop on the computer in our pajamas, without any of the stigma of asking for help, and find real relief?

Online programs to fight depression are already commercially available, and while they sound efficient and cost-saving, a study out of the U.K. reports that they’re not effective, primarily because depressed patients aren’t likely to engage with them or stick with them. Continue reading

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States look for help with bilingual mental health

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From a string of public suicides in Alaska to assimilation anxiety among young Hispanics in Cleveland, states are faced with the need for more bilingual and culturally sensitive mental health care professionals

Illustration of the skull and brainBy Tim Henderson
Stateline

The U.S. is grappling with a severe shortage of mental health professionals. But the situation is particularly dire for some minority communities, where barriers of language and culture can make it hard to seek and get help.

Most good mental health care requires subtle, intimate conversation with patients. But too often, mental health experts say, professionals lack the language skills needed to serve those who struggle with English.

The greatest mental health needs are often in remote, rural areas with scattered populations.

“It’s difficult to trust that translation will capture nuances in the soul-baring process of mental health treatment,” said Sita Diehl, director of state policy at the National Alliance on Mental Illness (NAMI).

The greatest mental health needs are often in remote, rural areas with scattered populations. Continue reading

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Coping with autism and puberty

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Alexander Brown, 14, sits in his living room on Thursday, May 14, 2015. He was diagnosed with autism at 18 months. Alexander is having a hard time with puberty and is lashing out physically (Photo by Heidi de Marco/KHN).

Alexander Brown, 14, sits in his living room on Thursday, May 14, 2015. He was diagnosed with autism at 18 months. Alexander is having a hard time with puberty and is lashing out physically (Photo by Heidi de Marco/KHN).

By Heidi de Marco

SHERRILL, N.Y. — Alexander Brown swings back and forth on a makeshift hammock bolted to a wooden beam in his living room. The swaying seems to soothe the otherwise uneasy 14-year-old. His mother gazes at him from the couch and their eyes briefly connect.

“I would love to be in Alexander’s head just for a few hours,” said Diane Brown, her head slumped against her hand. “He’s having a hard time going through puberty right now.”

Alexander is confused, moody and frustrated – all very typical for a teen during adolescence. But Alexander’s transition is especially difficult for the Browns, a family of six in Sherrill, N.Y., because he is severely autistic.

Puberty is causing chaos in Alexander’s once-predictable world. He can’t talk and struggles to express himself. “He’s angry and he’s sad . . . and he doesn’t understand why,” Brown said. “I truly feel for him.”

Alexander, the third of four children, rarely sleeps through the night. He gets up at all hours to wander the kitchen, take a shower or throw a tantrum. He’s begun lashing out physically.

Brown, 45, is exhausted. She averages four hours of sleep a night and powers through most days with the help of Red Bull. Continue reading

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From pills to pins: Oregon is changing how it deals with back pain

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Doris Keene (right) at Portland’s Quest Center for Integrative Health. (Photo by Kristian Foden-Vencil/Oregon Public Broadcasting)

By Kristian Foden-Vencil
Oregon Public Broadcasting

When Portland resident Doris Keene raised her four children, she walked everywhere and stayed active. But when she turned 59, she says, everything fell apart.

“My leg started bothering me. First it was my knees.” She ignored the pain, and thinks now it was it the sciatic nerve acting up, all along. “I just tried to deal with it,” Keene says.

But eventually, she went to a doctor who prescribed Vicodin and muscle relaxants. In 2012, about one in four Oregonians received an opioid prescription – more than 900,000 people. The state currently leads the nation in nonmedical use of opioids. And about a third of the hospitalizations related to drug abuse in Oregon are because of opioids.

Keene says the drugs helped her, but only to a degree. Continue reading

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Texas strives to lure mental health providers to rural counties

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200px-Flag-map_of_TexasBy Lauren Silverman, KERA

In her third year of medical school, Karen Duong found herself on the other side of Texas.

She had driven 12 hours north from where she grew up on the Gulf Coast to a panhandle town called Hereford.

“Hereford is known for being the beef capital of the world,” she says, laughing. “There’s definitely more cows than people out there.”

Medical student Karen Duong worked in Hereford, Texas, with Dr. Akinyele Lovelace, an instructor with the University of North Texas Health Science Center's rural medical education program.

Medical student Karen Duong worked in Hereford, Texas, with Dr. Akinyele Lovelace, an instructor with the University of North Texas Health Science Center’s rural medical education program.

It’s even named after a breed of cattle. Out here, there aren’t many people who provide mental health care. In fact, there aren’t any psychiatrists.

That’s the reason Duong went there – she’s studying psychiatry as a medical student at the University of North Texas Health Science Center. This assignment showed her just how severe the state’s mental health care shortage is.

“You have a patient that comes in and they need immediate care or something more acute, and then you tell them that the soonest they can get in for an appointment is six months from now,” Duong says. “It’s not really what we want to tell our patients.”

Hereford is one of many areas in Texas lacking adequate access to mental health care.

Of the 254 counties in Texas, 185 have no psychiatrist, according to Travis Singleton, who tracks physician shortages for Merritt Hawkins, a Texas-based consulting firm. “That’s almost 3.2 million [people],” he says. Continue reading

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When rehab might help an addict, but insurance won’t cover it – WITF-Fm

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Federal law requires insurance firms to cover treatment for addiction as they do treatment for other diseases. But some families say many drug users aren’t getting the inpatient care they need.

Cris and Valerie Fiore hold one of their favorite pictures of their sons Anthony (with the dark hair) and Nick. Anthony died from a heroin overdose in May 2014 at the age of 24. Cris Fiore’s eulogy described his son’s death as a shock, but “not a surprise.” Anthony had been addicted to heroin for years.

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Achieving mental health parity: Slow going even in ‘pace car’ state

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Flag_of_CaliforniaBy Jenny Gold
KHN

After the state of California fined her employer $4 million in 2013 for violating the legal rights of mental health patients, Oakland psychologist Melinda Ginne expected her job — and her patients’ lives — to get better.

Instead, she said, things got worse.

Within months, Ginne, a whistleblower in the 2013 case, was back to writing her supervisors at Kaiser Permanente about what she considered unconscionable delays in care.

Patients who were debilitated or dying from physical diseases for which they were receiving regular medical treatment had to wait months for psychological help, she said.

Some patients, she said, might not live long enough to make the next available appointment.

Psychologist Melinda Ginne, 65, at her house in Oakland, California on Tuesday, May 26, 2015 (Photo by Heidi de Marco/KHN).

Psychologist Melinda Ginne, 65, at her house in Oakland, California on Tuesday, May 26, 2015 (Photo by Heidi de Marco/KHN).

“I can’t tell a family whose elderly mother is declining that I can’t provide treatment until 2014,” she wrote to her managers at the Kaiser Medical Center in Oakland in September 2013. In February, two years after assessing the second largest fine in its history, the California Department of Managed Health Care stepped in again, finding that Kaiser Foundation Health Plan had improved somewhat but still was short-changing patients on mental health care. The state is considering another fine against the health maintenance organization, which is not affiliated with Kaiser Health News.

“Every time the DMHC has an edict, Kaiser Permanente has a way around it,” said Ginne, who retired in September 2014. Continue reading

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Insurers must cover residential mental-health care – Kriedler

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Washington MapFrom the Office of the Insurance Commissioner

Washington State Insurance Commissioner Mike Kreidler has clarified to insurance companies in Washington that mental-health services must now be offered in parity with medical services.

The commissioner updated rules on mental-health parity in 2014 and asked insurers to review previous mental-health claims that had been denied under a blanket exclusion. He asked insurers to rectify those denials.

The need for clarification arose after a consumer filed a complaint with Office of the Insurance Commissioner after being denied for residential mental-health treatment. The individual said this violated federal laws regarding mental-health parity. Continue reading

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Telephone therapy helps older people in underserved rural areas, study finds

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red-telephoneBy Lisa Gillespie
KHN

Therapy provided over the phone lowered symptoms of anxiety and depression among older adults in rural areas with a lack of mental health services, a new study shows.

The option is important, one expert said, because seniors often have increased need for treatment as they cope with the effects of disease and the emotional tolls of aging and loss.

“Almost all older adults have one chronic medical condition, and most of these have been found to be significantly associated with anxiety disorder,” Eric Lenze, a psychiatrist and professor at the Washington University School of Medicine in St. Louis, said in an interview.

The study, by researchers at Wake Forest University and published Wednesday in JAMA Psychiatry, examined 141 people over the age of 60 living in rural counties in North Carolina who were experiencing excessive and uncontrollable worry that is brought on by a condition called generalized anxiety disorder.

The participants had up to 11 phone sessions between January 2011 and October, 2013. Half of them received cognitive behavioral therapy, which focused on the recognition of anxiety symptoms, relaxation techniques, problem solving and other coping techniques.

The other study participants got a less intensive phone therapy in which mental health professionals provided support for participants to discuss their feelings but offered no suggestions for coping.

The researchers found that severity of the patients’ worries declined in both groups, but the patients getting cognitive therapy had a significantly higher reduction of symptoms from generalized anxiety disorder and depressive symptoms. Continue reading

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