Research highlights need for responsible development of ketamine for severe depression

https://goo.gl/JCR8mG

A new paper published in The Lancet Psychiatry sets out principles for responsibly testing innovative treatments for severe depression, based on treating more than 100 patients with approximately 1,000 infusions of ketamine over six years in Oxford.

Ketamine is known to be an effective antidepressant for people whose depression has not responded to other treatment.

The paper highlights the need for ethical and innovative professional action by setting out key qualities of the responsible clinician in providing ketamine treatment.

Professor Ilina Singh from the Oxford University Department of Psychiatry and lead author on the paper, said: 'Our approach balances the potential harms of ketamine use for treatment-resistant depression, such as its misuse potential, with a focus on reporting structures that promote the broad benefits of clinical innovation and the ethical judgment of the clinician. We argue that the clinician who exemplifies inventiveness, humility and responsibility can contribute to innovation and promote justice for patients who seek ketamine treatment.'

The paper also recommends that clinics should routinely submit data to a national registry about each patient treated with ketamine, and that professional bodies should provide regularly updated guidance on the details of clinical protocols in the light of emerging evidence.


Yeast extract may boost brain function

It isn't easy to increase GABA. There are some nutritional tools for doing so, and some epilepsy drugs increase it. Never tried this, but maybe?

https://goo.gl/92RRqg

Marmite is far from one of the most popular foods in the United States. In fact, many Americans are unlikely to have heard of it. A new study, however, suggests that when it comes to boosting brain function, Marmite triumphs over peanut butter.

Researchers from the University of York in the U.K. found that adults who ate a teaspoon of Marmite every day experienced a reduced response to visual stimuli, which is an indicator of increased levels of gamma-aminobutyric acid (GABA) in the brain.

Previous studies have associated low GABA levels with an increased risk of numerous neurological and mental healthdisorders, including anxiety, depression, autism, and epilepsy. As a result, researchers have been investigating ways to boost GABA levels in the brain.

The new study - recently published in the Journal of Psychopharmacology - suggests that dietary modulation may be one way to reach this feat.

Common antibiotic may help to prevent or treat PTSD

https://goo.gl/jpTWmj

"We have demonstrated a proof-of-principle for an entirely new treatment strategy for PTSD," explains Professor Bach. "The theory is based on the recent discovery that our brains need proteins outside nerve cells, called matrix enzymes, to form memories. Matrix enzymes are found throughout the body, and their over-activity is involved in certain immune diseases and cancers. To treat such diseases, we already have clinically approved drugs that block these enzymes, including the antibiotic doxycycline, so we wanted to see if they could help to prevent fear memories from forming in the brain. Our results support this theory, opening up an exciting avenue of research that might help us to find treatments for PTSD.

"Using drugs to prevent PTSD would be challenging, since in the real world we don't know when a traumatic event is about to occur. However, there is growing evidence that people's memories and associations can be changed after the event when they experience or imagine similar situations. This is called 'reconsolidation', and we now plan to test the effect of doxycycline on reconsolidation of fear memories. If this is successful, we would hope to apply the technique to more clinically realistic models of PTSD within a few years."


Balance test improves insight into illness in schizophrenia

The most astounding article I've read in quite a while.......

https://goo.gl/OCTrC3

A common symptom of schizophrenia - not knowing that you're ill - can be temporarily alleviated using a balance test that stimulates part of the brain with cold water, an exploratory study at the Centre for Addiction and Mental Health (CAMH) has shown. The study was published in Psychiatry Research.

More than 50 percent of people with schizophrenia experience impaired insight into their illness, which is a key reason they refuse medication or don't seek treatment, says Dr. Philip Gerretsen, Clinician-Scientist in the Campbell Family Mental Health Research Institute at CAMH. Lack of insight is extremely difficult to treat because it doesn't respond to psychological therapies or medication. The result is poorer health, as well as a higher likelihood of being hospitalized or experiencing housing instability.

Dr. Gerretsen devised the idea of using this test for schizophrenia based on research in paralyzed patients with stroke damage who lacked awareness of their paralysis. The test, caloric vestibular stimulation, involves irrigating the ear canal with water at varying temperatures and is commonly used in tests of the body's vestibular or balance system. The procedure can stimulate different areas of the brain, including areas associated with a lack of insight, which has been confirmed by brain imaging studies. In stroke patients with right hemisphere damage, cold water temporarily led to awareness of their paralysis.

"Cold water in the left ear significantly increased patients' insight and awareness of their schizophrenia, which we measured 30 minutes after the test, compared with the sham or placebo treatment using room temperature water," says Dr. Gerretsen. Shortly afterward this insight had diminished. In the right ear, however, the cold water treatments appeared to worsen insight.

Dr. Gerretsen and his colleagues tested the water procedure with 16 patients with schizophrenia spectrum disorder, who had moderate to severe lack of insight into their illness. The study participants were given, in a random order, one of three conditions: cold water at 4°C in their left ear, cold in their right ear, and sham procedure, in which the water was at body temperature. Patients' insight into their illness was assessed at 30 minutes after the test, using the VAGUS Insight into Psychosis Scale. This scale is designed to capture subtle changes in insight over a short period of time.


PTSD 'should be viewed as a systemic disorder'

https://goo.gl/CIWbhK

 A new study finds that adults with post-traumatic stress disorder are much more likely to experience sleep disorders, gastrointestinal problems, cardiovascular diseases, and numerous other health conditions. As such, researchers say that post-traumatic stress disorder should be considered a systemic disorder, as opposed to just a psychological condition.

The final sample included 108 veterans who had been diagnosed with PTSD, and 106 controls who were trauma-exposed veterans without PTSD.

The results of the analysis - recently published in the Medical Journal of Australia - revealed that the mean total number of comorbidities was higher among veterans with PTSD than the controls, at 17.7 and 14.1, respectively.

"For 24 of 171 assessed clinical outcomes, morbidity was greater in the PTSD group, including for conditions of the gastrointestinal, hepatic, cardiovascular, and respiratory systems, sleep disorders, and laboratory pathology measures," explain McLeay and colleagues.

"In regression analyses including demographic factors, PTSD remained positively associated with 17 adverse outcomes; after adjusting for the severity of depressive symptoms, it remained significantly associated with ten," they add.

Based on their findings, the researchers believe that PTSD should not be solely perceived as a mental health disorder. The team concludes that:

"The higher frequency of comorbid physical conditions suggests that PTSD be conceptualized not as a purely mental disorder, but rather as a systemic disorder.

Integrated healthcare strategies directed at the psychological and physical health of patients with PTSD, as well as rigorous control of risk factors, are likely to improve their quality of life and their survival."

In an editorial linked to the study, Prof. Alexander McFarlane, director of the Centre for Traumatic Stress Studies at the University of Adelaide in Australia, notes that treatments that only focus on psychological aspects of PTSD have "not served patients well."

"The limited effectiveness of evidence-based psychological interventions in people with PTSD, particularly in veteran populations, highlights the need to develop biological therapies that address the underlying neurophysiological and immune dysregulation associated with PTSD," adds Prof. McFarlane.


An old drug with new potential: WWII chemical-weapon antidote shows early promise as treatment for spinal cord injuries

https://goo.gl/H57mQ9

A drug developed during World War II as an antidote for a chemical warfare agent has been found to be effective at suppressing a neurotoxin that worsens the pain and severity of spinal cord injuries, suggesting a new tool to treat the injuries.

The neurotoxin, called acrolein, is produced within the body after nerve cells are damaged, increasing pain and triggering a cascade of biochemical events thought to worsen the injury's severity.

Researchers have now found that the drug, dimercaprol, removes the toxin by attacking certain chemical features of acrolein, neutralizing it for safe removal by the body. The findings, detailed in a paper published online in the Journal of Neurochemistry, involved research with cell cultures, laboratory animals and other experiments.

"Dimercaprol may be an effective acrolein scavenger and a viable candidate for acrolein detoxification," said Riyi Shi (pronounced Ree Shee), a professor of neuroscience and biomedical engineering in Purdue University's Department of Basic Medical Sciences, College of Veterinary Medicine and Weldon School of Biomedical Engineering.

"An extensive body of evidence exists suggesting the toxic nature of acrolein and its pathological role in a variety of disease processes, prompting the use of acrolein scavengers as a new therapeutic approach for alleviating symptoms and curtailing tissue damage in neuropathic disorders," Shi said. "Previous studies have shown that acrolein levels increase significantly after spinal cord injury. It may be a key factor of secondary injury, which can expand the damage to adjacent tissue."

The drug, also called 2,3-dimercaptopropanol, was developed by British biochemists during World War II as an antidote for lewisite, an obsolete arsenic-based chemical warfare agent. It is now used primarily to treat poisoning by arsenic, mercury, gold, lead, antimony, and other toxic metals. The drug also is used to treat Wilson's disease, a genetic disorder in which the body retains copper.


Preventing intrusive memories after trauma via a brief intervention involving Tetris computer game play in the emergency department

Interesting notion. Could the same approach work with current intrusive memories?????

https://goo.gl/RwMAlS

After psychological trauma, recurrent intrusive visual memories may be distressing and disruptive. Preventive interventions post trauma are lacking. Here we test a behavioural intervention after real-life trauma derived from cognitive neuroscience. We hypothesized that intrusive memories would be significantly reduced in number by an intervention involving a computer game with high visuospatial demands (Tetris), via disrupting consolidation of sensory elements of trauma memory. 

The Tetris-based intervention (trauma memory reminder cue plus c. 20 min game play) vs attention-placebo control (written activity log for same duration) were both delivered in an emergency department within 6 h of a motor vehicle accident. The randomized controlled trial compared the impact on the number of intrusive trauma memories in the subsequent week (primary outcome). Results vindicated the efficacy of the Tetris-based intervention compared with the control condition: there were fewer intrusive memories overall, and time-series analyses showed that intrusion incidence declined more quickly. There were convergent findings on a measure of clinical post-trauma intrusion symptoms at 1 week, but not on other symptom clusters or at 1 month. 

Results of this proof-of-concept study suggest that a larger trial, powered to detect differences at 1 month, is warranted. Participants found the intervention easy, helpful and minimally distressing. By translating emerging neuroscientific insights and experimental research into the real world, we offer a promising new low-intensity psychiatric intervention that could prevent debilitating intrusive memories following trauma.

Fishing as Therapy

Mr. Fishing, Tom B. taught me that fishing was therapy....

https://abilitymagazine.com/fishing-is-therapy/

The road to Freedom began in 1967 in the central highlands of Vietnam. A predawn attack by the North Vietnamese left me with a paralyzed right arm, and a 60% paralyzed right leg. I was unable to speak, and suffering from PTSD that wouldn’t be diagnosed until 2015. I was medevacked from Vietnam to Japan and finally to Letterman’s General Hospital in San Francisco where I ended my Army career at 19.

My wife and I moved to Seattle in 2005 where I became interested in fishing. There was something about being on the water that was peaceful and relaxing to me; fishing was as good of a reason as any to be out. Fishing with one arm can be a stressful experience, trying to manage the rod while reeling in a fish can be terrifying. If you hook a big enough fish it can be expensive as you rod is pulled over the side of the boat. I soon discovered that I needed a rod holder to manage the rod while I managed the fish. There were no rod holders on the market that I could find that would meet my needs. The decision to make my own equipment was an easy one to make.

Lucky for me, my dad was a DIY kinda guy and he taught me all about how things worked. It didn’t take long before we had a successful design, we called the Barracuda. The Barracuda met all the requirements we had for fishing. It worked so well that my wife and I decided to make it available to others that had a similar disability

Even Healthy-Looking Suburbs Are Dying From Drugs

https://goo.gl/h45f0Z

Released Wednesday, the Robert Wood Johnson Foundation’s 2017 County Health Rankings and an accompanying report analyze county-level data from all 50 states on more than 30 public health outcomes and behaviors. The report finds there’s been a clear flip in the geography of addiction: One decade ago, large suburban areas experienced the lowest rates of premature deaths due to drug overdoses. In 2015, they had the highest.

The Johnson Foundation’s analysis doesn’t pinpoint which counties experienced the most dramatic gains in drug-induced death. What it does is rank every county in the U.S., by state, using data that reflects local health conditions, such as diabetes and obesity, as well as measures that can predict health outcomes, including teen birth, smoking rates, and grocery store access.

Some composite information about drug-related deaths is included in the Johnson Foundations’ county “report cards,” but it’s not factored into each county’s overall ranking. To understand the kinds of suburbs experiencing spikes in overdoses, I analyzed CDC mortality data online.

Comparing those numbers to the Johnson Foundation report, I found startling disconnects between deadly drug problems and places that have an otherwise fairly “healthy” facade. For example, Essex County ranks sixth out of the 14 counties in the Bay State by the new report—middle-of-the-road when it comes to the chronic health conditions that normally wave red flags for public health researchers. Yet it’s increasingly afflicted by drug-related deaths.


This is interesting to me because there is a long history of using pacemaker stimulators in the cerebellum to help manage neurological symptoms from brain injury. It was noted back then that the stimulation improved emotional symptoms and concentration that wasn't supposed to be part of the neurological profile......

https://goo.gl/KwZSv6

"A beautiful, lobular structure," is how Krystal Parker describes the cerebellum - a brain region located at the base of the skull just above the spinal column. The cerebellum is most commonly associated with movement control, but work from Parker's lab and others is gradually revealing a much more complex role in cognition that positions the cerebellum as a potential target for treating diseases that affect thinking, attention, and planning, such as schizophrenia.

A new study from Parker's lab and the lab of Nandakumar Narayanan at the University of Iowa Carver College of Medicine finds that stimulating the cerebellum in rats with schizophrenia-like thinking problems normalizes brain activity in the frontal cortex and corrects the rats' ability to estimate the passage of time - a cognitive deficit that is characteristic in people with schizophrenia.

"Cerebellar interactions with the frontal cortex in cognitive processes has never been shown before in animal models," says Parker, UI assistant professor of psychiatry and the first faculty hire of the new Iowa Neuroscience Institute. "In addition to showing that the signal travels from the cerebellum to the frontal cortex, the study also showed that normal timing behavior was rescued when the signal was restored."

The UI study, which was published online in the journal Molecular Psychiatry, adds to the accumulating evidence, including recent human studies from Harvard University, that suggests cerebellar stimulation might help improve cognitive problems in patients with schizophrenia.