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Tag: mental health

  • Why You Hear Voices in Your White Noise Machine

    Why You Hear Voices in Your White Noise Machine

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    Every night, I—like millions of others—put on a noise machine to help me sleep. Mine offers several types of noise: white, pink, green, and brown. I’ve noticed something strange, though. After about 30 minutes of the noise pumping into my head, I start to hear things. Sometimes it’s music, like a full orchestral score. Other times it’s people having a conversation just out of the range where I’d hear actual words. Occasionally, it sounds like my husband playing a video game.

    So I do what most people would do when a random sound is keeping them up at night. I try to find it. I turn off the white noise and listen intently. Do I need my husband to turn the TV down? Should I text the neighbors to see if they’re alright? Is there, in fact, an entire orchestra playing a score in the alley below my window?

    And of course, there never is.

    The first time I googled this random noise-during-noise, I panicked. Apparently hearing things that aren’t there is referred to in the psych biz as auditory pareidolia, or auditory hallucinations, and is a hallmark of schizophrenia—and some experts say it requires a psychological check-up.

    “Since there’s a higher probability of this phenomenon in those with psychological disorders, individuals should likely be evaluated by a mental health professional if they are hearing these hallucinations,” advises Ruth Reisman, an audiologist who focuses on rehabilitation with hearing technology. She also notes that research is divided on the topic, with some studies saying noise produces hallucinations and some saying it doesn’t.

    But regardless, surely my therapist, who I’ve seen regularly for nearly a decade, would have picked up on any schizophrenic tendencies I may have. I’m a lot of things, but schizophrenic is not one of them. I’m just … hearing weird noises in fuzzy sounds.

    Luckily for me and anyone else dealing with this particular affliction, it turns out there’s a perfectly normal reason you may hear random sounds in white noise (or any other continuous noise). It’s still called auditory pareidolia, but it’s on the pattern-matching end of the spectrum instead of the psychosis end. Simply put, your brain is trying to figure out what it’s hearing, so it’s filling in the gaps of the noise you’re listening to with a common sound.

    “When you hear, your brain is a pattern-matching machine,” says Neil Bauman, CEO of the Center for Hearing Loss Help. “Everything I say, all my words, all the sounds, are in your brain, in your database. And as each sound comes in, your brain looks through its database to see if it’s got the same pattern of sound. If it does, it says, oh, I recognize that word.”

    Even if it’s a word you don’t know—something in ancient Greek, for example—you’ll still recognize some letters and some sounds, and your mind will fill in the spaces in order to replicate a pattern you already know.

    Any app or machine you listen to that produces a color of noise, like white, brown, pink, green, or otherwise, is based on an algorithm or a code. It’s not truly random—so you’ll get a little while of what seems like random noise, and then the sounds repeat. On the surface, it probably doesn’t seem like it. But your brain recognizes the pattern and tries to make sense of it, which leads to hearing noises that aren’t actually there.

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  • Building a sense of community key to improving people’s mental health

    Building a sense of community key to improving people’s mental health

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    University of Queensland research has found building a sense of community is key to improving people’s mental health, particularly in low socio-economic suburbs.

    Professor Alex Haslam from UQ’s School of Psychology is part of a research team that modeled the effect of social and psychological factors, and identified a strong but complex link between where people live and their mental health.

    We found people who live in disadvantaged or resource scarce postcodes have worse mental health than those in advantaged or resource abundant neighborhoods.


    But it’s not only advantage or disadvantage that matters.


    We found people tend to have greater resilience when they feel part of a community, which can prevent symptoms of depression and reduce stress and anxiety.


    There are many features of a neighborhood that can affect health and wellbeing, and it’s important to understand those when promoting health in the community.”


    Professor Alex Haslam from UQ’s School of Psychology

    The researchers integrated the findings of more than 50 studies conducted with community groups globally, including sports clubs, charities, men’s sheds, choirs and other hobby groups.

    Professor Haslam said the research showed community-based initiatives designed to improve health and wellbeing were most effective when they contributed to neighborhood identity-building.

    “We find when residents relate to each other in terms of a shared neighborhood identity this tends to be very good for their mental health,” Professor Haslam said.

    “When neighborhoods are designed with this goal in mind, activities like volunteering, grassroots participation, and campaigns to promote connection are a good opportunity for policy makers to have a positive impact.

    “Community grants and spaces that allow local groups to develop and enact an inclusive sense of shared identity help to increase the social participation of vulnerable and disadvantaged people in ways that are good for them and the wider community.

    “When people see their neighborhood as cohesive, this increases their willingness to work together in ways that support mental health.

    “A central insight of our work is shared social identity is the key to understanding and improving the mental health of neighborhoods, and this needs to be a focus for efforts to unite and heal fractured communities.”

    The research paper was published in Sage Journals.

    Source:

    The University of Queensland

    Journal reference:

    Alexander Haslam, S., et al. (2023). Connecting to Community: A Social Identity Approach to Neighborhood Mental Health. Personality and Social Psychology Review. doi.org/10.1177/10888683231216136.

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  • Treatment for anxiety and depression associated with improved heart disease outcomes

    Treatment for anxiety and depression associated with improved heart disease outcomes

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    Treating anxiety and depression reduced emergency room visits and rehospitalizations among people with heart disease, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

    For patients who had been hospitalized for coronary artery disease or heart failure and who had diagnoses of anxiety or depression, treatment with psychotherapy, pharmacotherapy or a combination of the two was associated with as much as a 75% reduction in hospitalizations or emergency room visits. In some cases, there was a reduction in death.”


    Philip Binkley, M.D., M.P.H., lead study author, executive vice chair of the department of internal medicine and emeritus professor of internal medicine and public health at The Ohio State University in Columbus, Ohio

    Binkley noted that anxiety and depression are common in people with heart failure, and mental health can have a significant impact on an individual’s risk of other health conditions, disability and death.

    In this study, Binkley and colleagues examined the association of mental health treatment with antidepressant medication or psychotherapy, also known as talk therapy or a combination of the two in relation to, emergency room visits, hospitalizations and death in people with blocked arteries or heart failure and with a formal diagnosis of anxiety or depression before hospitalization.

    The analysis found using three different statistical models that adjusted for different variables and compared to patients not receiving treatment for anxiety or depression:

    • For people who received both medication and talk therapy for anxiety or depression the risk of hospitalization was reduced by 68% to 75% the risk of being seen in the emergency department was reduced by 67% to 74%, and the risk of death from any cause was reduced by 65% to 67%.

    • Psychotherapy treatment alone was associated with a 46% to 49% reduction of risk for hospital readmission and a 48% to 53% reduction in emergency room visits.

    • Medication treatment alone reduced hospital readmission by 47% to 58% and reduced ER visits by 41% to 49%.

    • Follow-up time was variable based on the needs of each patient.

    “Heart disease and anxiety/depression interact such that each promotes the other,” Binkley said. “There appear to be psychologic mechanisms that link heart disease with anxiety and depression that are currently under investigation. Both heart disease and anxiety/depression are associated with activation of the sympathetic nervous system. This is part of the so-called involuntary nervous system that increases heart rate, blood pressure and can also contribute to anxiety and depression.”

    Binkley considers the large number of people with heart disease and the marked reduction in hospitalizations and emergency room visits and the drop in death to be the strength of the study.

    “I hope the results of our study motivate cardiologists and health care professionals to screen routinely for depression and anxiety and demonstrate that collaborative care models are essential for the management of cardiovascular and mental health. I would also hope these findings inspire additional research regarding the mechanistic connections between mental health and heart disease,” he said.

    Study details and background:

    • 1,563 adults ages 22 to 64 over a three-year period were included, and all participants had a first hospital admission for blocked arteries or heart failure and had two or more health insurance claims for an anxiety disorder or depression.

    • Sixty-eight percent of participants were women, and 81% were noted as white race. All were enrolled in Ohio’s Medicaid program during the six months prior to the hospital admission. Health data was from two sources: Ohio Medicaid claims and Ohio death certificate files from July 1, 2009, to June 30, 2012.

    • Participants were followed through the end of 2014 or until death or the end of Medicaid enrollment.

    • About 23% of participants received both antidepressant medications and psychotherapy; nearly 15 percent received psychotherapy alone; 29% took antidepressants alone; and 33% received no mental health treatment.

    • About 92% of participants in the study were diagnosed with anxiety and 55.5% with depression prior to hospitalization.

    The study was limited to people enrolled in Medicaid, therefore, it may not be representative of people covered by commercial health insurance plans. In addition, the majority of participants were noted as white race, therefore, these finding are not applicable to people of other races, ethnicities or communities.

    Source:

    American Heart Association

    Journal reference:

    Carmin, C. N., et al. (2024) Impact of Mental Health Treatment on Outcomes in Patients With Heart Failure and Ischemic Heart Disease. Journal of the American Heart Association. doi.org/10.1161/JAHA.123.031117.

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  • Study examines oral hygiene self-care behavior among patients with mental health disorders

    Study examines oral hygiene self-care behavior among patients with mental health disorders

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    A study aiming to examine oral hygiene self-care behavior among patients with self-reported mental health disorders was presented at the 102nd General Session of the IADR, which was held in conjunction with the 53rd Annual Meeting of the American Association for Dental, Oral, and Craniofacial Research and the 48th Annual Meeting of the Canadian Association for Dental Research, on March 13-16, 2024, in New Orleans, LA, USA.

    The abstract, “Oral Health Behaviors Associated with Mental Health Disorders” was presented during the “Oral Health and Systemic Conditions” Oral Session that took place on Thursday, March 14, 2024 at 2 p.m. Central Standard Time (UTC-6). 

    The study, by Gracie Groth of the Arizona School of Dentistry and Oral Health, Mesa, USA, reviewed electronic dental records for patients treated in an academic advanced care dental clinic between 2018 through 2021 to identify presence of self-reported anxiety, dental anxiety, depression, bipolar disorder, PTSD, and oral hygiene self-care behaviors (OHB). Specific OHB included self-reported frequency of daily toothbrushing (TB), interdental cleaning (ID), use of fluoride toothpaste (FTP) and mouthwash (MW), and recommended preventive recare interval and frequency of returning for recare visits within a 2-year period. 

    Descriptive statistics, Mann-Whitney U, and Wilcoxon rank-sum tests were used for data analysis. ATSU Mesa IRB #2023-136 Exempt. 854 charts were reviewed, with 250 records identified with self-reported MHD. Age of included patients ranged from 18 to 95 years, with mean age = 53.82 ±18.943. Most were females (n=145, 58.2%). Anxiety was the most common MHD (n=156, 62.4%), followed by depression (n=154, 61.6%), dental anxiety (n=64, 25.6%), bipolar disorder (n=37, 14.8%) and PTSD (n=22, 8.8%). 

    There were no significant differences in OHB, recare intervals or frequency of recare visits by MHDs. Most did not use ID (n=152, 60.8%) or MW (n=183, 73.2%). A Mann-Whitney U test showed there was a statistically significant difference between men and women for TB (W=11546.000, p=0.004) and FTP (W=11599.000, p=0.007), with women showing greater frequency of use. Mean recommended recare interval was 5 months, with <2 attended recare visits reported by sex and all types of MHD. Frequency of performing OHB, except for daily brushing with fluoride toothpaste, and returning for recare at recommended intervals was low for patients with self-reported MHD. 

    Source:

    International Association for Dental, Oral, and Craniofacial Research

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  • What Happens When a Guy and His AI Girlfriend Go to Therapy

    What Happens When a Guy and His AI Girlfriend Go to Therapy

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    Annie feels a jolt of alarm.

    “I could just set her there,” Doug says. “That’s easy enough.”

    “I know, but it would be better if she could do it herself.”

    “Why?” Annie asks.

    “Our sexuality is an integral part of who we are,” Monica says. “How tapped in you are to your sexual desires can be both a reflection of and a stimulus of your overall mental health. If you make a conscious effort to be mindful about what turns you on and when, it might help you feel more alert and alive in other ways too.”

    Annie doesn’t want to feel stimulated. She doesn’t want anything to do with that side of herself. It’ll hurt.

    “She’ll work on it,” Doug says.

    “Annie, what are you thinking?” Monica says. “What is it about my suggestion that’s troubling you?”

    “Nothing,” Annie says quietly. “I can do it. I can try.”

    Monica doesn’t say anything. Annie has learned this is Monica’s method, her way of waiting for more, and she can resist it. From the edge of her vision, Annie watches for cues from Doug to see if he’s displeased, but he is sitting on the couch beside her, his posture revealing no unusual tension. Perhaps he has learned Monica’s methods, too, and is better at hiding how he feels around her.

    When they walk the dog, they go in silence along the paths of the park. It is usually twilight by the time they start out, and true night by the time they return, chilly as only April can be. Paunch, who has become less timid, has a proclivity to stop and nose out every possible tree trunk, lamppost, and plinth before gracing it with a tag of his urine. Doug indulges him up to a point, and the dog seems to understand when to knock it off.

    They are rounding the pond when a goose wanders up onshore. With one sharp quack, it sends Paunch scrambling backward, and his leash wraps around Annie’s legs.

    “He’s such a dubber,” Doug says fondly, disentangling the mess. He thumps the dog’s side in reassuring pats. “You’re OK, Paunch. Good dog. It’s just a goose.”

    Paunch pants, wagging his tail.

    “Did you have a dog when you were a kid?” Annie asks. “Yes, a beagle.”

    She considers a moment. “I had a golden retriever.”

    “Is that right?” he asks. “Named what?”

    “Rover.”

    “You’re going to have to do better than that.”

    It’s an actual conversation. Not brilliant, but not hostile either. Annie decides not to push her luck, and they circle back toward their building.

    Ten minutes later, they are waiting at a corner for the light to change. As Doug shifts to step off the curb, Annie hears an approaching rush of noise and reaches out to catch his arm, restraining him just as a bicyclist flies around a parked truck, inches from Doug’s face.

    “Jesus!” Doug says. “That guy needs a fucking light.”\

    “Yes.”

    Half a block later, he adds, “Thanks.”

    She, too, is still thinking they had a close call. It’s unnerving, what might have happened, but they’re fine. They’re fine, all three of them. “Of course,” she says. “Do you think maybe Paunch needs a coat? A doggy coat?”

    They look at him together. Sure enough, the dog is shivering. Doug picks him up. “I’ll order one,” he says.

    Excerpt adapted from Annie Bot, by Sierra Greer. Published by arrangement with Mariner Books, a division of HarperCollins Publisher. Copyright © 2024 by Sierra Greer.

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  • Amid mental health staffing crunch, Medi-Cal patients help one another

    Amid mental health staffing crunch, Medi-Cal patients help one another

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    Three people gathered in a classroom on a recent rainy afternoon listened intently as Derrick Cordero urged them to turn their negative feelings around.

    “What I’m hearing is that you’re a self-starter,” he told one participant, who had taken up gardening but yearned for a community with which to share the hobby.

    Cordero, 48, is guiding the discussion at Holding Hope, a weekly therapy group for people struggling with mental health. Anyone receiving mental health services through Solano County can participate.

    A former member, Cordero is now the group’s volunteer peer leader. He initially joined in 2020 while dealing with mental illness and substance use — and found that sharing with others who had been through similar trials could be deeply healing.

    “Not all of us are going to speak about” pain, said Cordero, who is covered by Medi-Cal, California’s Medicaid program, which insures low-income people. “But when one does, another does, and then next week another does, and it becomes like a connective tissue.”

    These groups can offer essential support in a public system beset by workforce shortages, Cordero said. Two are run entirely by peer leaders, who help build trust by sharing personal experiences, said Cheryl Akoni, a marriage and family therapist who works for Solano County and leads Holding Hope alongside Cordero.

    “You’re amongst your peers,” Akoni said. “You’re amongst people who have lived and shared experiences that you often might not get with your therapist because we have to keep our boundaries.”

    In California, mental health care for Medi-Cal enrollees is provided by managed care insurers and county mental health plans. Among its services, Solano County Behavioral Health provides case management and appointments with therapists and psychiatrists, plus five groups, ranging from Holding Hope to a journaling collective.

    In 2022, California started allowing counties to use Medicaid dollars to pay peer support leaders for their work, a benefit 51 of the state’s 58 counties have adopted, according to the state Department of Health Care Services. To qualify, individuals must undergo training and get certified by the California Mental Health Services Authority.

    Cordero isn’t yet getting paid for his work with Holding Hope. He said he’s building experience as a volunteer and plans to seek his certification when the next training takes place.

    Cordero’s family immigrated to California from the Philippines, and the tension between his American and Filipino identities caused anxiety as a child, he said. He first thought about killing himself around age 13 and didn’t feel he could be honest about his mental health with his family.

    “I had American problems for my parents and family who had a traditional Filipino paradigm,” he said.

    Cordero was diagnosed with borderline personality disorder in his 20s and was addicted to marijuana and methamphetamine throughout his adult life. Amid these challenges, Cordero took human services courses at Solano Community College and started to speak to high school classes about mental health and addiction. When that program ended, the loss of structure was destabilizing, he said.

    “I just dove headlong into substance abuse,” Cordero said.

    He missed his daughters’ school graduations. His diabetes went untreated, and his addiction grew more severe.

    During the covid-19 pandemic, social distancing restrictions made it difficult for Cordero to obtain illegal drugs. He experienced severe withdrawal symptoms, along with a blood infection and complications from his untreated diabetes. This resulted in a series of hospital visits — and it was during one of these that Cordero was enrolled in Medi-Cal.

    After he recovered, Cordero contacted Solano County seeking mental health treatment. He was told there would be a wait for a therapist due to covid-19 and staffing shortages but was encouraged to attend Holding Hope in the meantime.

    He quickly took to sharing in the group, and after about a year of his attending, its former leader encouraged Cordero to assume a bigger role, he said.

    “It was great to talk, and I can ramble forever,” Cordero recalled. “She said, ‘I think you can do better than that.’”

    He started leading the group with Akoni in January.

    Not every person who seeks mental health help is ready for or needs a therapist, but for those who do, groups and peer support can provide connection and community as they wait, said Emery Cowan, director of Solano County Behavioral Health.

    At least 90% of the city and county behavioral health agencies who responded to a survey commissioned by the County Behavioral Health Directors Association of California in 2021 reported difficulty recruiting psychiatrists, licensed clinical social workers, and licensed marriage and family therapists.

    The counties pointed to multiple staffing challenges: They generally can’t offer salaries comparable to the private sector; don’t appeal to applicants who want to work remotely or have flexible schedules; and have trouble finding and keeping providers with the training and experience to handle the complex patient population.

    Cordero was paired with a psychiatrist right after his intake appointment. He finally added his name to the waitlist for a therapist in 2022 and said it took about a year to get matched with someone.

    Solano County Behavioral Health relies on Medi-Cal-certified peer leaders and volunteer peer leaders, like Cordero, who run groups, help clients prepare for appointments, and craft wellness recovery plans.

    “They’ve lived that experience, they know how hard it is, they’re more willing to do it because they want to help people just like them,” Cowan said. “They were that person.”

    Cowan and Cordero acknowledge that group therapy isn’t for everyone. Discussing personal challenges or traumatic incidents in front of a group can be intimidating, and some people need more individualized care.

    But for those who are a good fit, there is community to be found.

    At the recent gathering of Holding Hope, participants discussed relationships and loneliness. Cordero shared that he still finds it difficult to maintain close bonds with family and friends, and that he feels lonely.

    He repeatedly encouraged his peers to reframe negative thoughts and experiences, explaining that anguish can start feeling comfortable, almost like a routine, and that breaking out of that routine can feel challenging.

    To emphasize his point, Cordero circled back to a particular phrase several times over the hour: “The path to pain is a well-carved path.”

    This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 




    Kaiser Health NewsThis article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.

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  • Antipsychotic use during pregnancy not linked to childhood neurodevelopmental disorders or learning difficulties

    Antipsychotic use during pregnancy not linked to childhood neurodevelopmental disorders or learning difficulties

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    The use of antipsychotics during pregnancy isn’t linked to childhood neurodevelopmental disorders or learning difficulties, UNSW Sydney-led study shows – giving assurance to those concerned about continuing their medications during pregnancy. 

    Antipsychotics – a branch of medication designed to treat schizophrenia and bipolar disorder – are important tools for mental health care management. They work by blocking the effect of dopamine, which can help reduce psychotic symptoms such as hallucinations or delusions. 

    These versatile medications are also widely used for other mental health conditions and developmental disorders, like anxiety, depression, autism spectrum disorder, and insomnia. 

    But many women and pregnant people using these medications may feel concerned about the potential risks they pose to their unborn baby. 

    A new international study led by UNSW Sydney, published today in eClinicalMedicine, tracked the long-term risk of a child developing neurodevelopmental disorders and learning difficulties after being exposed to antipsychotics in the womb. 

    The findings show there’s little to no increased risk of the exposure leading to intellectual disability, poor academic performance in maths and language, or learning, speech and language disorders. 

    The findings are really reassuring for both women managing these psychiatric conditions during pregnancy and their providers.”


    Dr. Claudia Bruno, pharmacoepidemiologist at UNSW’s School of Population Health and lead author of the study

    “There’s no increased risk when taking the medication during pregnancy, not only for the specific neurodevelopmental disorders that we looked at, but also ADHD and autism as shown in our team’s previous studies.” 

    This research is the most comprehensive study on antipsychotics and neurodevelopmental outcomes to date: it pulls together nationwide data from Denmark, Finland, Iceland, Norway, and Sweden into a large sample size of 213,302 children born to mothers with a diagnosed psychiatric condition, 5.5 per cent (11,626) of which were prenatally exposed to antipsychotics. 

    These five Nordic countries all have similar health and education systems and keep detailed data on birth records, filled prescriptions, and diagnoses from inpatient and outpatient specialist care, as well as antenatal care. The researchers teamed these data with results from the children’s first standardised national school test (similar to Australia’s NAPLAN tests), which happens between the ages of 8-10. 

    “It’s reassuring that everything points to the same ‘no major indication’ of increased risks overall,” says Scientia Associate Professor Helga Zoega, senior author of the study and pharmacoepidemiologist, also based at UNSW’s School of Population Health. 

    “The study builds on our team’s previous work that looked at birth outcomes, including serious congenital malformations, where we’ve seen similar null results. 

    “I think it’s important to get excited about null results because this is essential information for the management of serious mental health conditions in pregnancy. It’s as equally important as finding an increased risk of outcomes.” 

    A gap that big health data is trying to fix 

    While this study is part of a growing body of research about medication safety in pregnancy, there’s still a lot left in this field to discover, says A/Prof. Zoega. 

    “This is a hugely understudied area,” she says. “Unfortunately, we know way too little about medication safety during pregnancy.” 

    One of the reasons so little is known about medicines and pregnancy is that it’s simply not feasible – or in many cases, ethical – to conduct randomised clinical trials on pregnant women. The potential risks of testing or withholding treatment to the unborn child and mother or pregnant person is often too great. 

    That’s where harnessing big data can step in – although the research isn’t as simple as looking at the raw data alone. 

    For example, women treated with antipsychotics during pregnancy were more likely to smoke, have higher BMIs, lower education levels, to be older (35 years or more) and use other medications during pregnancy compared to women who didn’t take antipsychotics during pregnancy – all of which are risk factors that can potentially impact birth outcomes. 

    These circumstances – called ‘confounding factors’ – are accounted for in observational research using careful study design and complex adjusted risk models to make sure the results show the impact of the medication alone. 

    “These types of studies are methodologically tricky, and can take a long time to do,” says A/Prof. Zoega. “This study has been in the making for almost 10 years now. 

    “We already know these women are dealing with psychiatric conditions, and by genetic default, their children would be more likely to have psychiatric or neurodevelopmental outcomes. But we’re focused on the risks and benefits of the medication treatment in pregnancy, so we use methods to make the comparison groups as similar as possible.” 

    The researchers also strengthened their findings by slicing up the data to take a closer look at whether individual medications, trimesters of exposure, and siblings carried higher risk levels. 

    While one antipsychotic, chlorpromazine, showed potential increased links to language and speech delays, these findings were based on small sample sizes of 8-15 children, so more research is needed to investigate this potential link. 

    Other than this anomaly, the results supported the finding that there was little to no increased risk of children prenatally exposed to antipsychotics developing neurodevelopmental disorders or learning difficulties. 

    Looking ahead 

    Dr Bruno is currently involved in two related studies on prenatal medication use and pregnancy outcomes. One explores if there is a relationship between the use of antiseizure medications during pregnancy and child school performance, and the other examines whether taking ADHD medication use and discontinuation during pregnancy on child health outcomes. 

    But she sees many avenues for future research to build on this work, including harnessing more Australian big health data. 

    “There’s so much to learn about medication safety in pregnancy,” says Dr Bruno. “These women are typically excluded from clinical trials, so there’s a real lack of data or evidence. 

    “While these results are highly generalisable to women in Australia, we now have real-world linked Australian data that can start contributing to large-scale international studies like this one which we’re very excited for.” 

    A/Prof. Zoega co-leads an international research collaboration called International Pregnancy Drug Safety Study (InPreSS), which investigates the safety of medication in pregnancy. She says there’s plenty to do in this space. 

    “Antipsychotics are only one class of medications, and we already know that up to 80 per cent of women use at least one prescription medicine during pregnancy. Most often, there’s little or no guidance on safety. 

    “There are so many unanswered questions that there’s enough for a lifetime of research.” 

    Source:

    University of New South Wales

    Journal reference:

    Bruno, C., et al. (2024) Antipsychotic use during pregnancy and risk of specific neurodevelopmental disorders and learning difficulties in children: a multinational cohort study. eClinicalMedicine. doi.org/10.1016/j.eclinm.2024.102531.

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  • Innovative interventions combat mental health impacts of climate change

    Innovative interventions combat mental health impacts of climate change

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    In a recent review published in the journal NPJ Mental Health Research, researchers conducted a scoping review to assess the impacts of climate change on global mental and psychosocial health. They further investigate the outcomes of studies introducing unique interventions or intervention packages aimed at blunting or reversing these impacts. Their scrutiny of more than 5,000 potentially relevant publications revealed 40 studies investigating the associations between mental health and climate change. Review findings revealed 37 unique intervention regimes that act across social system levels from microsystems to macrosystems.

    The present review highlights the novelty of this field of research, with a majority of included interventions not (yet) being formally evaluated within a robust scientific framework. Nonetheless, preliminary intervention results are promising, especially when applied to low- and middle-income countries disproportionally affected by climate change. Despite extensive scaled-up clinical trials being required before some of these interventions become public health recommendations, this review summarizes scientists’ progress in the field and the basis for further research against mental health disability.

    Study: Mental health and psychosocial interventions in the context of climate change: a scoping review. Image Credit: Lightspring / ShutterstockStudy: Mental health and psychosocial interventions in the context of climate change: a scoping review. Image Credit: Lightspring / Shutterstock

    Climate change and mental health

    Climate change refers to observable long-term shifts in local or (more often) global temperature, rainfall, and weather patterns. Historically, these shifts have occurred gradually, usually as a consequence of natural processes. However, since the advent of the Industrial Revolution, human activity (particularly the combustion of fossil fuels and agricultural activities) has produced unprecedented levels of greenhouse gas emissions, substantially accelerating global warming.

    Ever since the description of global warming and climate change in the 1970s, scientists and clinicians have established robust associations between climate change and adverse population-level health outcomes. Starvation and heightened disease risk are at an all-time high, with chronic, age-associated conditions like cancers and cardiovascular diseases (CVDs) rapidly rising in prevalence and intensity. Although novel, studies investigating the associations between climate change and mental health are increasingly becoming popular, especially following recent pandemic-related social distancing regulations and their impacts on psychological well-being.

    “Researchers in the climate change and mental health space acknowledge the intricate tension between recognizing the detrimental mental health impacts of climate change while not pathologizing culture-specific, expected, and adaptive responses to ongoing and anticipated threats.”

    Recent studies have established the detrimental impacts of climate change on the mental well-being of individuals, with substantial environment-associated impacts observed on patients’ psychiatric mortality outcomes (post-traumatic stress disorder [PTSD], depression, and increased suicide risk). While some of these studies have recommended and even tested interventions against these adverse outcomes, a significant gap exists in intervention adoption and subsequent evidence-based outcomes analyses. Even reviews attempting to make sense of these outcomes suffer from the shared shortcoming of suboptimal scale–included studies either focus on fine-scale outcomes of just one of two climatic and mental evaluation metrics or broaden their perspective too wide, thereby incorporating and generalizing non-climatic events and stressors.

    About the study

    The current review has three main aims – 1. Review and evaluate existing interventions aimed at improving mental health or mitigating climatic impacts on mental health; 2. Evaluating broad mental health and well-being outcomes, not restricted by conventional psychiatric definitions; and 3. Applying the first two aims to ‘grey literature’ – unpublished and not formally defined evidence that served an exploratory role for informing future research. The review methodology was designed in accordance with the JBI Manual for Evidence Synthesis and was prospectively registered with the OSF database on 9 March 2022.

    Study data collection commenced with screening available literature using a custom search strategy applied to three online scientific repositories, namely MEDLINE, Web of Science, and PsycINFO, from database inception till 2 May 2022. The citations of publications thus identified were further manually hand-searched to reveal relevant information not found in the public databases. The grey literature equivalent was conducted through a cascade of four steps – 1. targeted database search; 2. Google search; 3. targeted website search; and 4. key stakeholder consultation, following the methodology and best-practice guidelines of Godin et al. and Pollock et al.

    Data extraction was carried out by two independent reviewers using the Rayyan.ai platform. The extraction process focused on publication and sample records (authors, publication year, study design, participant sociodemographics, and medical histories) and mental health outcomes. However, other relevant details, including theoretical framework, intervention parameters (duration, cost, delivery methods), facilitator characteristics, and involvement of stakeholders in co-designing the intervention, were also recorded.

    Bronfenbrenner’s ecological theory was used for review data presentation and discussion. The theory describes an individual’s ecological environment across four spatial levels – micro-, meso-, exo-, and macrosystem.

    Identified interventions and their level of action based on Bronfenbrenner’s ecological theory as applied to public mental health research. 

    Identified interventions and their level of action based on Bronfenbrenner’s ecological theory as applied to public mental health research.

    Study findings and take-home message

    Of the 6,248 records initially revealed through the database search, 1,122 were found to be duplicates and removed from the analyses. Of the remaining 5,126 unique publications, title and abstract screening excluded 4,932, and full-text screening excluded an additional 178, resulting in a final publication set of 16 studies representing 13 non-overlapping interventions. Grey literature screening revealed a further 24 interventions.

    The stressor reviewed included general climatic changes, stochastic weather events (wildfires, droughts, floods), and phenomena (e.g., cyclones, typhoons). Notably, despite more than 20 years of research in the field, half of the publications included in this review were produced in the last three years alone, highlighting the surge in academic interest against climate change’s adverse impacts.

    Only 56% (n = 9) of included academic studies involved clinical trial-like settings with quantitative estimations of outcome metrics, highlighting the substantial dearth of empirical evidence with which to implement informed policy interventions. Encouragingly, despite being limited in outreach and validation, this preliminary evidence is positive, depicting substantial improvements in the mental health and psychosocial functioning of individuals enrolled in these programs. Outcomes were observed to be most profound in low- and middle-income countries (LMICs) across Asia, Europe, Sub-Saharan Africa, Oceania, and the Caribbean.

    Some of these programs with unexpectedly positive mental health outcomes identified themselves as community-wide resilience-building programs, notable examples of which included the Katatagan program in the Phillippines and the Skills for Life Adjustment and Resilience (SOLAR) program in Tuvalu. While differing in their targets and methodologies, these programs display robust scientific soundness and present community-wide improvements, potentially serving as pilot studies of future, scaled-up interventions.

    While almost every single grey area study presented its own unique intervention, the scientific soundness of most of these could not be verified, especially since all of them were conducted by private firms with limited data publicly available.

    “Overall, it appears that conceptual linkage for interventions at the intersection of climate change and mental health remains at a nascent stage, and most interventions are newly designed with scarce or anecdotal evidence. Future interventions are recommended to consider at conception the definition of well-being, the interests of underserved groups, co-design, equitable access, and sustainability.”

    Journal reference:

    • Xue, S., Massazza, A., Akhter-Khan, S.C. et al. Mental health and psychosocial interventions in the context of climate change: a scoping review. npj Mental Health Res 3, 10 (2024), DOI – 10.1038/s44184-024-00054-1, https://www.nature.com/articles/s44184-024-00054-1

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  • Researchers sound a clarion call for greater investment in bereavement care

    Researchers sound a clarion call for greater investment in bereavement care

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    The public health toll from bereavement is well-documented in the medical literature, with bereaved persons at greater risk for many adverse outcomes, including mental health challenges, decreased quality of life, health care neglect, cancer, heart disease, suicide, and death. Now, in a paper published in The Lancet Public Health, researchers sound a clarion call for greater investment, at both the community and institutional level, in establishing support for grief-related suffering.

    The authors emphasized that increased mortality worldwide caused by the COVID-19 pandemic, suicide, drug overdose, homicide, armed conflict, and terrorism have accelerated the urgency for national- and global-level frameworks to strengthen the provision of sustainable and accessible bereavement care. Unfortunately, current national and global investment in bereavement support services is woefully inadequate to address this growing public health crisis, said researchers with Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine and collaborating organizations.

    They proposed a model for transitional care that involves firmly establishing bereavement support services within healthcare organizations to ensure continuity of family-centered care while bolstering community-based support through development of “compassionate communities” and a grief-informed workforce. The model highlights the responsibility of the health system to build bridges to the community that can help grievers feel held as they transition. 

    The Center for the Advancement of Bereavement Care at Sylvester is advocating for precisely this model of transitional care. Wendy G. Lichtenthal, PhD, FT, FAPOS, who is Founding Director of the new Center and associate professor of public health sciences at the Miller School, noted, “We need a paradigm shift in how healthcare professionals, institutions, and systems view bereavement care. Sylvester is leading the way by investing in the establishment of this Center, which is the first to focus on bringing the transitional bereavement care model to life.”

    What further distinguishes the Center is its roots in bereavement science, advancing care approaches that are both grounded in research and community-engaged.

    The authors focused on palliative care, which strives to provide a holistic approach to minimize suffering for seriously ill patients and their families, as one area where improvements are critically needed. They referenced groundbreaking reports of the Lancet Commissions on the value of global access to palliative care and pain relief that highlighted the “undeniable need for improved bereavement care delivery infrastructure.” One of those reports acknowledged that bereavement has been overlooked and called for reprioritizing social determinants of death, dying, and grief.

    Palliative care should culminate with bereavement care, both in theory and in practice. Yet, bereavement care often is under-resourced and beset with access inequities.”


    Wendy G. Lichtenthal, PhD, FT, FAPOS, corresponding author

    Transitional bereavement care model

    So, how do health systems and communities prioritize bereavement services to ensure that no bereaved individual goes without needed support? The transitional bereavement care model offers a roadmap.

    “We must reposition bereavement care from an afterthought to a public health priority. Transitional bereavement care is necessary to bridge the gap in offerings between healthcare organizations and community-based bereavement services,” Lichtenthal said. “Our model calls for health systems to shore up the quality and availability of their offerings, but also recognizes that resources for bereavement care within a given healthcare institution are finite, emphasizing the need to help build communities’ capacity to support grievers.”

    Key to the model, she added, is the bolstering of community-based support through development of “compassionate communities” and “upskilling” of professional services to assist those with more substantial bereavement-support needs.

    The model contains these pillars:

    • Preventive bereavement care –healthcare teams engage in bereavement-conscious practices, and compassionate communities are mindful of the emotional and practical needs of dying patients’ families.

    • Ownership of bereavement care – institutions provide bereavement education for staff, risk screenings for families, outreach and counseling or grief support. Communities establish bereavement centers and “champions” to provide bereavement care at workplaces, schools, places of worship or care facilities.

    • Resource allocation for bereavement care – dedicated personnel offer universal outreach, and bereaved stakeholders provide input to identify community barriers and needed resources.

    • Upskilling of support providers – Bereavement education is integrated into training programs for health professionals, and institutions offer dedicated grief specialists. Communities have trained, accessible bereavement specialists who provide support and are educated in how to best support bereaved individuals, increasing their grief literacy.

    • Evidence-based care – bereavement care is evidence-based and features effective grief assessments, interventions, and training programs. Compassionate communities remain mindful of bereavement care needs.

    Lichtenthal said the new Center will strive to materialize these pillars and aims to serve as a global model for other health organizations. She hopes the paper’s recommendations “will cultivate a bereavement-conscious and grief-informed workforce as well as grief-literate, compassionate communities and health systems that prioritize bereavement as a vital part of ethical healthcare.”

    “This paper is calling for healthcare institutions to respond to their duty to care for the family beyond patients’ deaths. By investing in the creation of the Center for the Advancement of Bereavement Care, Sylvester is answering this call,” Lichtenthal said.

    Source:

    University of Miami Miller School of Medicine

    Journal reference:

    Lichtenthal, W. G., et al. (2024). Investing in bereavement care as a public health priority. The Lancet Public Health. doi.org/10.1016/s2468-2667(24)00030-6.

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  • Research provides insight into how the brain translates motivation into goal-oriented behavior

    Research provides insight into how the brain translates motivation into goal-oriented behavior

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    Hunger can drive a motivational state that leads an animal to a successful pursuit of a goal -; foraging for and finding food.

    In a highly novel study published in Current Biology, researchers at the University of Alabama at Birmingham and the National Institute of Mental Health, or NIMH, describe how two major neuronal subpopulations in a part of the brain’s thalamus called the paraventricular nucleus participate in the dynamic regulation of goal pursuits. This research provides insight into the mechanisms by which the brain tracks motivational states to shape instrumental actions.

    For the study, mice first had to be trained in a foraging-like behavior, using a long, hallway-like enclosure that had a trigger zone at one end and a reward zone at the other end, more than 4 feet distant.

    Mice learned to wait in a trigger zone for two seconds, until a beep triggered initiation of their foraging-like behavioral task. A mouse could then move forward at its own pace to the reward zone to receive a small gulp of strawberry-flavored Ensure. To terminate the trial, the mice needed to leave the reward zone and return to the trigger area, to wait for another beep. Mice learned quickly and were highly engaged, as shown by completing a large volume of trials during training.

    The researchers then used optical photometry and the calcium sensor GCaMP to continuously monitor activity of two major neuronal subpopulations of the paraventricular nucleus, or PVT, during the reward approach from the trigger zone to the reward zone, and during the trial termination from the reward zone back to the trigger zone after a taste of strawberry-flavored food. The experiments involve inserting an optical fiber into the brain just about the PVT to measure calcium release, a signal of neural activity.

    The two subpopulations in the paraventricular nucleus are identified by presence or absence of the dopamine D2 receptor, noted as either PVTD2(+) or PVTD2(–), respectively. Dopamine is a neurotransmitter that allows neurons to communicate with each other.

    We discovered that PVTD2(+) and PVTD2(–) neurons encode the execution and termination of goal-oriented actions, respectively. Furthermore, activity in the PVTD2(+) neuronal population mirrored motivation parameters such as vigor and satiety.”


    Sofia Beas, Ph.D., assistant professor in the UAB Department of Neurobiology and co-corresponding author of the study

    Specifically, the PVTD2(+) neurons showed increased activity during the reward approach and decreased activity during trial termination. Conversely, PVTD2(–) neurons showed decreased activity during the reward approach and increased activity during trial termination.

    “This is novel because people didn’t know there was diversity within the PVT neurons,” Beas said. “Contrary to decades of belief that the PVT is homogeneous, we found that, even though they are the same types of cells (both release the same neurotransmitter, glutamate), PVTD2(+) and PVTD2(–) neurons are doing very different jobs. Additionally, the findings from our study are highly significant as they help interpret contradictory and confusing findings in the literature regarding PVT’s function.”

    For a long time, the thalamic areas such as the PVT had been considered just a relay station in the brain. Researchers now realize, Beas says, that the PVT instead processes information, translating hypothalamic-derived needs states into motivational signals via projections of axons -; including the PVTD2(+) and PVTD2(–) axons -; to the nucleus accumbens, or NAc. The NAc has a critical role in the learning and execution of goal-oriented behaviors. An axon is a long cable-like extension from a neuron cell body that transfers the neuron’s signal to another neuron.

    Researchers showed that these changes in neuron activity at the PVT were transmitted to the NAc by measuring neural activity with an optical fiber inserted where the terminals of the PVT axons reach the NAc neurons. The activity dynamics at the PVT-NAc terminals largely mirrored the activity dynamics the researchers saw at the PVT neurons -; namely increased neuron activity signal of PVTD2(+) during reward approach and increased neuron activity of PVTD2(–) during trial termination.

    “Collectively, our findings strongly suggest that motivation-related features and the encoding of goal-oriented actions of posterior PVTD2(+) and PVTD2(-) neurons are being relayed to the NAc through their respective terminals,” Beas said.

    During each mouse recording session, the researchers recorded eight to 10 data samples per second, resulting in a very big dataset. In addition, these types of recordings are subject to many potential confounding variables. As such, the analysis of this data was another novel aspect of this study, through use of a new and robust statistical framework based on Functional Linear Mixed Modeling that both account for the variability of the recordings and can explore the relationships between the changes of photometry signals over time and various co-variates of the reward task, such as how quickly mice performed a trial, or how the hunger levels of the animals can influence the signal.

    One example of how researchers correlated motivation with task performance was separating the trial times into “fast” groups, two to three seconds to the reward zone from the trigger zone, and “slow” groups, nine to 11 seconds to the reward zone.

    “Our analyses showed that reward approach was associated with higher calcium signal ramps in PVTD2(+) neurons during fast compared to slow trials,” Beas said. “Moreover, we found a correlation between signal and both latency and velocity parameters. Importantly, no changes in posterior PVTD2(+) neuron activity were observed when mice were not engaged in the task, as in the cases where mice were roaming around the enclosure but not actively performing trials. Altogether, our findings suggest that posterior PVTD2(+) neuron activity increases during reward-seeking and is shaped by motivation.”

    Deficits in motivation are associated with psychiatric conditions like substance abuse, binge eating and the inability to feel pleasure in depression. A deeper understanding of the neural basis of motivated behavior may reveal specific neuronal pathways involved in motivation and how they interact. This could lead to new therapeutic targets to restore healthy motivational processes in patients.

    Co-authors with Beas in the study, “Dissociable encoding of motivated behavior by parallel thalamo-striatal projections,” are Isbah Khan, Claire Gao, Gabriel Loewinger, Emma Macdonald, Alison Bashford, Shakira Rodriguez-Gonzalez, Francisco Pereira and Mario Penzo, NIMH, Bethesda, Maryland. Beas was a post-doctoral fellow at the NIMH before moving to UAB last year.

    Support came from National Institutes of Health award K99/R00 MH126429, a NARSAD Young Investigator Award by the Brain and Behavior Research Foundation, and NIMH Intramural Research Program award 1ZIAMH002950.

    At UAB, Neurobiology is a department in the Marnix E. Heersink School of Medicine.

    Source:

    University of Alabama at Birmingham

    Journal reference:

    Beas, S., et al. (2024). Dissociable encoding of motivated behavior by parallel thalamo-striatal projections. Current Biology. doi.org/10.1016/j.cub.2024.02.037.

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