Recovery Michigan

Question  Is there an association between different levels of prenatal alcohol exposure and child craniofacial shape at 12 months?

Findings  This cohort study conducted an objective and sensitive craniofacial phenotype analysis of 415 children, which showed an association between prenatal alcohol exposure and craniofacial shape at almost every level of exposure examined. Differences in the midface and nose resemble midface anomalies associated with fetal alcohol spectrum disorder.

Meaning  Any alcohol consumption has consequences on craniofacial development, supporting advice that complete abstinence from alcohol while pregnant is the safest option; it remains unclear whether the facial differences are associated neurocognitive outcomes of prenatal alcohol exposure.

A vaccine developed at The Scripps Research Institute (TSRI) to block the “high” of heroin has proven effective in non-human primates. This is the first vaccine against an opioid to pass this stage of preclinical testing.

“This validates our previous rodent data and positions our vaccine in a favorable light for anticipated clinical evaluation,” said study leader Kim Janda, the Ely R. Callaway Jr. Professor of Chemistry and member of the Skaggs Institute for Chemical Biology at TSRI.

The two most exciting developments in psychopharmacology in the 21st century so far have been ketamine for depression and MDMA for PTSD.

Unlike other antidepressants, which work intermittently over a space of weeks, ketamine can cause near-instant remission of depression with a single infusion – which lasts a week or two and can be repeated if needed. Ketamine use may be successful in 50-70% of patients who have failed treatment with conventional antidepressants. Ketamine treatment has some issues right now, but the race is on to create an oral non-hallucinogenic version which could be the next big blockbuster drug and revolutionize depression treatment.

MDMA (“Ecstasy”) is undergoing FDA Phase 3 clinical trials as a treatment for PTSD. Preliminary research has been small and underpowered, but suggests response rates up to 80% and effect sizes greater than 1 in this otherwise-hard-to-treat condition. None of this is on really firm footing – that’ll have to wait for the Phase 3. But signs are looking very good.

I say these are the two most exciting developments mostly because no other developments have been exciting. In terms of normal psychiatric drugs, the best that the 21st century has given us has probably been pimavanserin and aripiprazole, modest updates to the standard atypical antipsychotic model. These drugs are probably a bit better than existing ones for the people who need them (especially pimavenserin for psychosis in Parkinson’s) but they don’t revolutionize the treatment of any condition and nobody ever claimed that they did. And most drugs aren’t even at this level – they’re new members of well-worn classes with slightly different side effect profiles. The landscape was so quiet that ketamine came in like a bolt from the blue, and MDMA is set to do the same in a couple of years when the trial results come out.

(if I’m wrong, and history decides these two drugs weren’t the biggest developments, the most likely failure mode is that psilocybin turned out to be more important than MDMA)

There’s a morality tale to be told here about how the War on Drugs choked off vital research on some of the most powerful psychiatric compounds and cost us fifty years in exploring these effects and treating patients. I agree with this morality tale as far as it goes, but I also think there’s another, broader morality tale beneath it.

Suppose that neither ketamine nor MDMA were illegal drugs. Ketamine was just used as an anaesthetic. MDMA was just used as a chemical intermediate in producing haemostatic drugs, its original purpose. Now the story is that, fifty years later, we learn that this anaesthetic and this haemostatic turn out to have incredibly powerful psychiatric effects. What’s our narrative now?

For me it’s about the weird inability of intentional psychopharmaceutical research to discover anything as good as things random druggies use to get high.

For decades, pharmaceutical companies have been coming out with relatively lackluster mental health offerings – aripiprazole, pimavanserin, and all the rest. And when asked why, they answer that mental health is hard, the brain is the most complicated organ in the known universe, we shouldn’t expect there to be great cures with few side effects for psychiatric diseases, and if there were we certainly shouldn’t expect them to be easy to find.

The tool works by comparing the baseline data, such as the height, sex, weight and blood pressure of trial participants, to known distributions of these variables in a random sample of the populations.

If the baseline data differs significantly from expectation, this could be a sign of errors or data tampering on the part of the researcher, since if datasets have been fabricated they are unlikely to have the right pattern of random variation. In the case of Japanese scientist, Yoshitaka Fuji, the detection of such anomalies triggered an investigation that concluded more than 100 of his papers had been entirely fabricated.

Klein said that in some cases the anomalies could be put down to “misinterpretation, statistical error or plain simple mistakes”, such as transcribing data wrongly or mislabelling a column.

The latest study identified 90 trials that had skewed baseline statistics, 43 of which with measurements that had about a one in a quadrillion probability of occurring by chance.

Preschool age girls exposed to phthalates, a class of endocrine-disrupting chemicals found in plastics and shampoos, showed signs of depressed thyroid function, according to a study of inner-city mothers and children.

Hi, my name is Amy and I have Multiple Chemical Sensitivity, Mold Allergies, and Electromagnetic Hypersensitivity.  My husband, Jesse, our seven children, and I all moved to Arizona from Missouri in 2014. (You can read about that transition here: From the Dairy to the Desert  Since then, we have been hoping to build both homes and trailers for chemically sensitive people, giving them a chance to rest and heal and enjoy life again.

I expect biologics that are more or less specific to brain immune processes in the next 5 years...

https://goo.gl/o8QNJ5

Scientists have, for the first time, characterized the molecular markers that make the brain’s front lines of immune defense—cells called microglia—unique. In the process, they discovered further evidence that microglia may play roles in a variety of neurodegenerative and psychiatric illnesses, including Alzheimer’s, Parkinson’s and Huntington’s diseases as well as schizophrenia, autism and depression.

“Microglia are the immune cells of the brain, but how they function in the human brain is not well understood,” says Rusty Gage, professor in Salk’s Laboratory of Genetics, the Vi and John Adler Chair for Research on Age-Related Neurodegenerative Disease, and a senior author of the new work. “Our work not only provides links to diseases but offers a jumping off point to better understand the basic biology of these cells.”

Genes that have previously been linked to neurological diseases are turned on at higher levels in microglia compared to other brain cells, the team reported in Science on May 25, 2017. While the link between microglia and a number of disorders has been explored in the past, the new study offers a molecular basis for this connection.

“These studies represent the first systematic effort to molecularly decode microglia,” says Christopher Glass, a Professor of Cellular and Molecular Medicine and Professor of Medicine at University of California San Diego, also senior author of the paper. “Our findings provide the foundations for understanding the underlying mechanisms that determine beneficial or pathological functions of these cells.”

The research, published in Translational Psychiatry, shows that the proportion of adolescents who experience depression is higher than previous studies have reported; 36 percent for girls and 14 percent for boys. These depressive episodes are associated with poor outcomes - problems with school, relationships, suicide attempts - even with depression that started recently.

"Since we found that many more adolescents go through periods of depression than previously thought, it is important that we find ways to identify those individuals most likely to suffer the most severe consequences to make sure they are prioritized for treatment," said Joshua Breslau, Ph.D., Sc.D., researcher at the RAND Corporation and lead author of the study.

The researchers examined data from 2009 to 2014 collected annually from nationally representative samples of adolescents ages 12 to 17. They noted gender differences in the incidence of depression by age and compared recent first-onset and persistent depression with respect to impairment, suicide attempts, conduct problems and academic functioning.

Has anyone ever looked at the impact of involuntary commitment on suicidal ideation?

https://goo.gl/ji0pbU

Patients recently discharged from psychiatric facilities were at particular risk of suicide, however all discharged patients face a high suicide rate and should have ongoing access to healthcare resources, Australian researchers reported.

According to a meta-analysis of 100 studies on post-discharge suicides, the pooled estimate discharge suicide rate was 484 per 100,000 person-years (95% CI 422-555, 95% prediction interval 89-2641, P<.001) with high between-sample heterogeneity, according to Daniel Thomas Chung, of University of New South Wales in Australia, and colleagues.

The suicide rate was highest within 3 months after discharge (1,132, 95% CI 874-1467) and among patients admitted with suicidal ideas or behaviors (2,078, 95% CI 1512-2856), they wrote in JAMA Psychiatry.

They noted that these rates were approximately 100 times and 200 times the global suicide rates, respectively.