A Novel Brief Therapy for Patients Who Attempt Suicide

http://goo.gl/5jjycz

ASSIP Treatment Protocol

ASSIP was administered in three 60- to 90-min sessions, usually on a weekly basis. A fourth session was added if necessary. These face-to-face therapy sessions were supplemented by regular, personalized letters to the participants for 24 months. The manual used throughout the study was first published in German [39] in May 2013; the translation in English [40] followed in June 2015. The manual is highly structured, and interventions for each session are described in detail.

First session.

A narrative interview [41] was conducted in which patients were asked to tell their personal stories about how they had reached the point of attempting suicide. The aim of the narrative interview is to reach—in a biographical context—a patient-centered understanding of the individual mechanisms leading to suicidal behavior and to elicit specific vulnerability factors and trigger events. All interviews were video-recorded, with the patients’ written consent. Suicide risk was assessed using the SSF-III [31].

Second session.

Patient and therapist, seated side-by-side, watched sequences of the video-recorded first session. The aim of the video playback [42] is to reactivate the patient’s mental state during the suicidal crisis, in a safe environment, and provide a detailed reconstruction of the transition from an experience of psychological pain and stress to the suicidal action. Automatic thoughts, emotions, physiological changes, and contingent behavior were identified. Patients received a psychoeducative handout (“Suicide Is Not a Rational Act”) as a homework task (S2 Text), to be returned with personal comments at the next session. Following the session, the therapist prepared a written draft of the case conceptualization.

Third session.

The patients’ comments to the handout were discussed. The case conceptualization was revised collaboratively. A list of long-term goals, individual warning signs, and safety strategies was developed in close cooperation with the patient. The written case conceptualization and the personal safety strategies were printed out and given to the patient, with additional copies for other health professionals involved in treatment. Long-term goals, warning signs, and safety strategies were copied to a credit-card-size folded leaflet and given to the patient. In addition, participants received a crisis card with a list of telephone numbers of private and professional helpers who could be contacted in case of a suicidal crisis. Patients were instructed to carry both with them at all times, and to use them in the event of a crisis.

Letters.

Participants were sent semi-standardized letters over a period of 24 months, every 3 months in the first year and every 6 months in the second year. The letters reminded participants of the long-term risk of future suicidal crises and the importance of the safety strategies. Letters were signed personally by the ASSIP therapist. Usually, one or two personal sentences were added, and participants were invited to give feedback about how things were going.


Imaging shows impact of PTSD in earthquake survivors

http://goo.gl/iyBq6o

The findings revealed the PTSD patients had greater cortical thickness in certain brain regions and reduced volume in other brain regions compared to healthy earthquake survivors. PTSD severity was positively correlated with cortical thickness in the left precuneus region of the brain.

"Our results indicated that PTSD patients had alterations in both gray matter and white matter in comparison with other individuals who experienced similar psychological trauma from the same earthquake," Dr. Gong said. "Importantly, early in the course of PTSD, gray matter changes were in the form of increased rather than decreased cortical thickness, as opposed to most reported observations from other studies of PTSD. This might result from a neuroinflammatory or other process that could be related to endocrine changes or a functional compensation."

Dr Gong added that the left precuneus is well known to be important in visual processing and is more active in PTSD patients during memory tasks. "It's possible that changes in the precuneus may comprise a neural alteration related to visual flashback symptoms in PTSD," he said.


New twist in addiction crisis: Deadly painkiller impostors

http://goo.gl/5aXKDb

Authorities are sounding the alarm about a new and deadly twist in the country's drug-addiction crisis in the form of a potent painkiller disguised as other medications.

Tennessee officials say they've seen two dozen cases in recent months of pills marked as the less potent opiates oxycodone or Percocet that turned out to contain fentanyl, a far more powerful drug. One official likened the danger to users playing Russian roulette each time they buy a pill on the street.

In San Francisco, the health department blamed several overdoses last summer on lookalike Xanax containing fentanyl, while Canada has issued warnings about multiple recent cases of lookalike oxycodone pills containing fentanyl.


Behavioral Health Quality of Life Tool

http://goo.gl/C1C6Ap

Take our Behavioral Health Quality of Life Questionnaire here to receive health plans to help you manage your physical and mental health. 

Research shows that the death rate for people with mental disorders is, on average, 2.22 times higher than that of people in the general population, and those with a serious mental illness (typically defined as schizophrenia, bipolar disorder and major depression) have a 10-25 year life expectancy reduction. The majority of these untimely deaths are blamed on natural causes, such as acute or chronic illnesses (heart diseases, pulmonary diseases, infectious diseases) and is due, in part, to lifestyle choices. You can read more about the supportive research here.

"This Behavioral Health Quality of Life tool plays a key role in the overall health of patients with bipolar disorder. We've learned that the physical health of the person with bipolar disorder directly influences their ability to function day-to-day, largely due to the effect of physical health and diet on their thinking processes and their ability to regulate their mood. The care of bipolar disorder must involve both careful attention to mental and physical health aspects. This tool will assist the person in taking positive steps towards overall health." - Roger S. McIntyre, M.D., FRCPC. Professor of Psychiatry and Pharmacology at the University of Toronto, Executive Director of the Brain and Cognition Discovery Foundation, and Head of the Mood Disorders Psychopharmacology Unit at the University Health Network. 


Complaint demands accessible Medicaid and Medicare documentation

Really! This is somehow still an issue?

http://goo.gl/tZCbZ8

The National Federation of the Blind and three individuals sued the Center for Medicare and Medicaid Services in federal court February 10, calling on the agency to make its documentation, including key materials relating to benefit changes and denials, accessible to people with visual disabilities.

As detailed in the complaint, most CMS notices are provided only in standard-print formats. Most of these documents are unavailable in accessible formats, such as in Braille, large print or an audio recording, or compatible with screen-access software.

The CMS’ official guidance to contractors allegedly provides “no information” on making notices accessible, nor does it provide much guidance to beneficiaries. Moreover, the CMS’ hotline often makes it difficult to leave messages and is otherwise confusing, the lawsuit alleges, filed in the U.S. District Court for the District of Massachusetts.

“Receiving (Medicare Summary Notices) in inaccessible formats thus compromises blind beneficiaries’ ability to independently and privately verify their co-payment obligations, address billing discrepancies and denials of service, or to dispute billing decisions through appeals, as can their sighted peers,” the lawsuit states. “As a result, failure by CMS to communicate in accessible formats ensures that…NFB members must sacrifice their privacy and independence to participate as Medicare recipients and puts them at risk of financial liabilities or penalties if a particular service or necessary medical equipment has not been covered by Medicare, or of exceeding Medicare service limits such as hospitalization days.”

The filing follows an investigation by the Disability Rights Education and Defense Fund, which is assisting the NFB in the lawsuit.


Study of Holocaust survivors finds trauma passed on to children's genes

Note that the genes do not change. Rather, epigenetic change reduces or increases the function of the genes...

https://goo.gl/K79sZH

Genetic changes stemming from the trauma suffered by Holocaust survivors are capable of being passed on to their children, the clearest sign yet that one person’s life experience can affect subsequent generations.

The conclusion from a research team at New York’s Mount Sinai hospital led by Rachel Yehuda stems from the genetic study of 32 Jewish men and women who had either been interned in a Nazi concentration camp, witnessed or experienced torture or who had had to hide during the second world war.

They also analysed the genes of their children, who are known to have increased likelihood of stress disorders, and compared the results with Jewish families who were living outside of Europe during the war. “The gene changes in the children could only be attributed to Holocaust exposure in the parents,” said Yehuda.

Her team’s work is the clearest example in humans of the transmission of trauma to a child via what is called “epigenetic inheritance” - the idea that environmental influences such as smoking, diet and stress can affect the genes of your children and possibly even grandchildren.

The idea is controversial, as scientific convention states that genes contained in DNA are the only way to transmit biological information between generations. However, our genes are modified by the environment all the time, through chemical tags that attach themselves to our DNA, switching genes on and off. Recent studies suggest that some of these tags might somehow be passed through generations, meaning our environment could have and impact on our children’s health.

Longer, intense rehabilitation boosts recovery after brain injury

I've been following this issue since the 70s when the conventional wisdom was that it you didn't spontaneously become well in 3 months you never would. Although studies have always continued to show that significant effort to rehabilitate would produce significant and useful functional improvement (including the article linked below), medicine has insisted that rehabilitation is a pipe dream. It is hard for me not to believe that this reticence to support recovery isn't part of a general pattern of medicine devaluing people with disabilities...

http://goo.gl/c2B9RG

Cognitive and functional recovery after a stroke or traumatic injury requires intense rehabilitative therapy to help the brain repair and restructure itself. New findings by researchers at University of California, San Diego School of Medicine report that not only is rehabilitation vital - in an animal model, rats with cortical injury that did not receive intensive rehab did not rebuild brain structure or recover function - but that a longer, even more intense period of rehabilitation may produce even greater benefit.

"This has implications for medical practice and medical insurance," said senior study author Mark Tuszynski, MD, PhD, professor in the Department of Neurosciences and director of the Center for Neural Repair at UC San Diego School of Medicine, and a neurologist with the VA San Diego Healthcare System. "Typically, insurance supports brief periods of rehab to teach people to get good enough to go home. These findings suggest that if insurance would pay for longer and more intensive rehab, patients might actually recover more function."


One third of eating disorder sufferers face discrimination at work

http://goo.gl/mbMfEr

Eating disorders are serious mental illnesses affecting 725,000 men and women of all ages and backgrounds in the UK. The charity surveyed more than 650 people with experience of an eating disorder and found other failings by employers:
  • 40% said their employers' impact on their recovery was 'unhelpful'
  • Two thirds of people were unable to access support for their eating disorder at work
  • 38% told us they used annual leave to attend medical appointments for their eating disorder
  • More than four out of five said they didn't think or didn't know whether their employers and colleagues were 'informed' about eating disorders.

Andrew Radford, Chief Executive of Beat said "Employers can play an important role in supporting recovery. The stigma and misunderstanding experienced by so many in the workplace must be replaced with support and compassion championed by a formal mechanism of support.


New Alzheimer’s treatment fully restores memory function

http://goo.gl/mrCd9V

Publishing in Science Translational Medicine, the team describes the technique as using a particular type of ultrasound called a focused therapeutic ultrasound, which non-invasively beams sound waves into the brain tissue. By oscillating super-fast, these sound waves are able to gently open up the blood-brain barrier, which is a layer that protects the brain against bacteria, and stimulate the brain’s microglial cells to activate. Microglila cells are basically waste-removal cells, so they’re able to clear out the toxic beta-amyloid clumps that are responsible for the worst symptoms of Alzheimer’s.

The team reports fully restoring the memory function of 75 percent of the mice they tested it on, with zero damage to the surrounding brain tissue. They found that the treated mice displayed improved performance in three memory tasks - a maze, a test to get them to recognise new objects, and one to get them to remember the places they should avoid.


Benzodiazepine overdose death rate 'has increased four-fold'

http://goo.gl/gCf1l2

Patients are prescribed benzodiazepines for conditions such asanxiety, mood disorders and insomnia; in the US each year, an estimated 1 in 20 adults fill a prescription for a benzodiazepine.

These sedatives are considered a safe and effective treatment, but their long-term use can lead to addiction. Furthermore, there are certain side effects attached to them, including daytime drowsiness and a "hung-over feeling," increasing risk of automobile accidents.

They can also make breathing problems worse and can lead to falls in the elderly.

When used with alcohol, benzodiazepines can be dangerous, and overdoses can be serious.

In 2013, overdoses from the class of drugs made up 31% of the 23,000 prescription drug overdose deaths in the US. However, little was known about benzodiazepine prescribing trends or fatalities.

To further investigate, the researchers, led by Dr. Marcus Bachhuber, looked at data from 1996-2013, using the Medical Expenditure Panel Survey and multiple-cause-of-death data from the Centers for Disease Control and Prevention (CDC).

They found that the number of adults who filled a benzodiazepine prescription increased by 67% during the study period, which spanned 18 years; it went from 8.1 million prescriptions in 1996 to 13.5 million in 2013.

And for those adults who filled a prescription, the average quantity that was filled during each year more than doubled from 1996-2013.

Furthermore, the overdose rate increased four-fold, from 0.58 deaths per 100,000 adults in 1996 to 3.14 deaths per 100,000 adults in 2013.

"We found that the death rate from overdoses involving benzodiazepines, also known as 'benzos,' has increased more than four-fold since 1996 - a public health problem that has gone under the radar," says Dr. Bachhuber. He adds:

"Overdoses from benzodiazepines have increased at a much faster rate than prescriptions for the drugs, indicating that people have been taking them in a riskier way over time."