DR ELLIE CANNON: Why won’t anyone fix these upsetting marks on my face?

I have suffered from acne since the age of 12 – I am now 78. As I’ve got older, I’ve also developed skin tags on my eyelids, and brown marks. 

My GP tried to refer me to a dermatologist, but they wouldn’t see me as my problems are cosmetic. I get really upset at the state of my face. Is there anything I could buy to help?

Skin problems on the face are particularly hard to cope with because they are so visible and cause a lot of distress, no matter how old they are.

Acne is known to be linked with depression and anxiety, as is psoriasis, and that’s why it’s not just cosmetic. A GP should be able to offer treatments. If these aren’t a success, a referral might be appropriate.

That being said, procedures for things such as skin tags – which are entirely harmless – are not routinely offered on the NHS, and I expect waiting lists and rationing will become even more stringent after Covid due to pressure on resources.

Skin problems on the face are particularly hard to cope with because they are so visible and cause a lot of distress, no matter how old they are, writes Dr Ellie Cannon. Pictured: Stock image

Skin problems on the face are particularly hard to cope with because they are so visible and cause a lot of distress, no matter how old they are, writes Dr Ellie Cannon. Pictured: Stock image

Benign growths and marks can be treated if they are proven to cause pain or have an effect on bodily function. 

So the removal of eyelid skin tags may be permitted, as they can affect vision and be uncomfortable.

Brown marks on the face are a normal sign of ageing and are known as liver spots, although they have nothing to do with the liver. 

They are thought to be related to sun exposure over the years and are considered benign, although this should always be checked with a doctor.

These brown age spots do respond well to laser treatment, which is generally not available on the NHS but is offered in some NHS dermatology clinics for fee-paying patients at a sensible price. 

There is a vast array of creams available at the pharmacy that claim to resolve pigmentation or brown marks on the skin. 

Whether these work, I can’t say, but the pharmacist should be able to advise.

It is also worth exploring camouflage creams which can cover skin lesions or correct colours on the face. These can offer an effective solution when treatment is not possible.

My husband in 69 and has type 1 diabetes. Recently, his leg have started giving way and he ends up on the floor. 

It can occur at any time and doesn’t seem linked to his blood sugar level. 

Type 1 diabetics are unable to produce enough of the hormone insulin, which is needed to stop the amount of glucose – sugar – in the blood from getting too high.

Patients use regular injections of insulin to keep levels normal.

But one of the longer-term complications of diabetes, both type 1 and the more common type 2, is damage to the nerves – a condition known as neuropathy.

Type 1 diabetics are unable to produce enough of the hormone insulin, which is needed to stop the amount of glucose – sugar – in the blood from getting too high. Pictured: Stock image

Type 1 diabetics are unable to produce enough of the hormone insulin, which is needed to stop the amount of glucose – sugar – in the blood from getting too high. Pictured: Stock image

Over the years, high levels of sugar in the blood affect the tiny blood vessels that feed the nerves, starving them of nutrients and ultimately destroying them. This can occur anywhere in the body.

We see this in middle-aged or older diabetes patients, and even in those who have very good control of their condition.

In the legs, neuropathy can cause weakness and wasting of the muscles, which may trigger falls. It can also affect sensory nerves, causing numbness and affecting co-ordination and balance. Both of these may lead to legs giving way and falls.

These types of attacks can also be a symptom of heart problems, which are common in type 1 diabetics, as well as blood-pressure changes or even side effects from medication.

If anyone is falling regularly, diabetic or not, it is important they are investigated. In many areas, a GP can refer a patient to a falls clinic with specialists who can give treatment or advice.

I have a rash on the inside of my right ankle, which my doctor diagnosed as varicose veins after looking at a photo. He prescribed a steroid cream and, when that didn’t work, antibiotics. Nothing’s changed. What could it be?

The inside of the ankle is a common place to see a skin condition called varicose eczema.

Your tips to soothe itchy scalp 

My advice on itchy scalps a couple of weeks ago elicited a fair few emails and letters, which didn’t surprise me – it’s a common problem. 

I’m a firm believer in patients sharing advice, particularly on issues that prove hard to tackle.

Many readers wrote in to say how good Betacap Scalp Application is. This is a steroid liquid that a GP can prescribe for itchiness and is applied directly to the scalp.

And it might sound strange, but many people recommended avoiding shampoo. 

It can be very drying and often contains irritants that people can be allergic to, including sodium lauryl sulphate – known as SLS, which creates the foam and is also found in toothpaste. 

So it’s a good idea to use it far less, in favour of just conditioner.

It’s worth trying both these things to stop the scratching.

Also known as venous eczema, it occurs in people who have problems with their circulation – it’s often seen alongside varicose veins, spider veins and swollen ankles. 

The poor movement of blood within the leg veins causes the skin to become inflamed and damaged, which is seen as an eczema rash: dry, red, cracked, sore or itchy skin.

The eczema may be the only sign on the outside that there are vein problems. There might also be a brown rash or staining, which is from leaky veins. This can mimic the appearance of an infection, so antibiotics are sometimes wrongly prescribed.

But as with all eczema, if the skin is broken it can be prone to infection. At this point the area would feel hot, tight and appear more swollen and red.

Skin infections must be treated very quickly as they get worse fast, and this can lead to serious complications. Emollients which soften and hydrate the skin are key to keeping the skin healthy. If it is very dry, an ointment is best, while a cream is usually used for mild cases or if the skin is weeping.

Steroid creams that treat the inflammation and calm down the rash are used for short courses of up to two weeks. These can be used in combination with an emollient for the best regime.

With any skin rash, it is useful to keep a photo diary to judge objectively how it is progressing.

But these alone are unlikely to completely solve the problem, and ultimately a referral to a vein specialist – a vascular doctor – may well be required.

No, you don’t need brain scan if you’ve had AZ jab

I have been fielding calls from patients worried they might have a blood clot. 

The news that our medical regulators won’t be giving under-30s the AstraZeneca jab due to a minute, one-in-250,000 chance of developing one has really spooked some people. 

I totally understand why – but there’s also a risk of blood clots from taking ibuprofen. However, it’s so rare that we don’t really think about it.

I have been fielding calls from patients worried they might have a blood clot, writes Dr Ellie Cannon

I have been fielding calls from patients worried they might have a blood clot, writes Dr Ellie Cannon

More than one person has asked for a brain scan ‘just to check’, despite having no symptoms. We can’t do this.

The most important thing is to be aware of these symptoms: a headache appearing from day four to 28 after your vaccine that is not relieved with painkillers, or feels worse when you lie down or bend over. 

Also look out for blurred vision, feeling sick, problems speaking, weakness or drowsiness. 

Most people will have a normal vaccine headache that starts and finishes within a couple of days of their jab, and that is fine.

I had my first AstraZeneca jab in December, above, and I’d have it again. When you get the call, go for your vaccine. 

It’s the only way we’re going to get out of this pandemic.

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‘Safe’ Z-drug sleeping tablets given to MILLIONS each year are as addictive as Valium

Zopiclone is the so-called ‘safer’ sleeping pill dished out by doctors to millions of Britons each year. 

When it was launched in the 1990s, it was touted as a user-friendly alternative to older and notoriously addictive tranquillisers.

And in the short-term, zopiclone causes few problems. Indeed, it can be a lifeline to those battling the agony of sleeplessness.

But there are growing concerns, and mental health experts now warn that the drug could be just as risky as older tablets and can trigger severe withdrawal symptoms that make it impossible for patients to stop taking it.

Support workers and sufferers, speaking to this newspaper, have described a raft of disturbing symptoms linked to long-term use of zopiclone, many of which begin as soon as a dose is missed. 

These include crushing anxiety and agoraphobia, flu-like aches and pains and distressing digestive problems.

Zopiclone is the so-called 'safer' sleeping pill dished out by doctors to millions of Britons each year. Pictured: Stock image

Zopiclone is the so-called ‘safer’ sleeping pill dished out by doctors to millions of Britons each year. Pictured: Stock image

Studies indicate that patients may even have suicidal thoughts.

Professor Joanna Moncrieff, author of several books on psychoactive drugs, said: ‘Zopiclone was originally meant to be a safer version of benzodiazepine medicines, but it’s become obvious it is not.’

Benzodiazepines include, among others, tramadol, given for sleep, and Valium, or diazepam, which is mainly an anti-anxiety medicine. 

Widely prescribed from the late 1950s, they became associated with dependence, severe withdrawal symptoms, worsening mental health and other problems. Zopiclone was supposed to be different. 

It has become the most commonly taken member of the family of ‘Z’ drugs, which includes zolpidem, also known by the US brand name Ambien.

Like benzodiazepines, Z drugs work by boosting levels of a chemical messenger in the brain called gamma-aminobutyric acid, which produces a feeling of calm and drowsiness. 

There were initial suggestions they weren’t as addictive and had fewer downsides, even when used longer term.

Last month it was reported that a number of Premier League footballers were hooked on zopiclone and zolpidem. 

Team doctors had originally prescribed the drugs to help players sleep before midweek matches, but it was claimed some were mixing the medication with alcohol to increase its effect.

Ian Govendir (seen above) has been unable to break his addiction to zopiclone

Ian Govendir (seen above) has been unable to break his addiction to zopiclone

It is a dangerous game: the combination of sleeping pills and alcohol can be deadly.

There were 539 deaths from sleeping pills, including Z drugs, in 2019, of which 139 were linked to alcohol. This is twice the number of such incidents in 2009.

Professor Owen Bowden-Jones, a consultant psychiatrist for Central and North West London NHS Foundation Trust, said: ‘We have seen people from 15 years old to pensioners, from every walk of life, addicted to Z drugs.’

The NHS bill for sleeping pills now stands at £10 million a year, and in 2020 more than 14 million prescriptions were given out for zopiclone alone. 

This is, perhaps, unsurprising as insomnia – broadly defined as long-term problems getting to or staying asleep – is incredibly common, believed to affect between ten and 30 per cent of the population.

The drugs watchdog, the National Institute for Health and Care Excellence, suggests that sleeping pills should be prescribed only in cases of severe insomnia and for between two and four weeks. 

Yet recent research suggests more than 300,000 Britons have been on a Z drug or other sleeping pill for a year or longer.

Melanie Davis, of addiction recovery charity Change Grow Live, says: ‘Patients manage fairly well on zopiclone to begin with, but the pills stop working after a year or so and they start taking higher doses.

‘The drug can cause side effects – drowsiness, poor concentration, a low or flat mood and even amnesia. But the biggest problems arrive when people try to come off it and get hit by withdrawal symptoms. 

They can be worse than we see with illegal drugs: panic attacks and severe, unrelenting anxiety, flu-like symptoms and cramps. Some people say their body feels like jelly.’

If a patient is dependent on zopiclone, doctors are now advised not to pressure them to stop straight away but instead will reduce their dose gradually. However, this process may take months, or longer.

It’s a painful process that 60-year-old Ian Govendir knows all too well – he is unable to quit zopiclone, having been first prescribed it almost two decades ago. 

The charity boss says: ‘My partner at the time worked in the hotel business, which meant getting up at ungodly hours.

‘I’d never been a great sleeper but the disturbance made it impossible, and I felt constantly tired and grouchy at work.

‘I went to my doctor, told him I’d been having trouble sleeping and he prescribed zopiclone. I didn’t think it was anything unusual, to be honest.’

Support workers and sufferers have described a raft of disturbing symptoms linked to long-term use of zopiclone, many of which begin as soon as a dose is missed. Pictured: Stock image

Support workers and sufferers have described a raft of disturbing symptoms linked to long-term use of zopiclone, many of which begin as soon as a dose is missed. Pictured: Stock image

The drugs worked, and Ian began sleeping well. He adds: ‘I carried on taking them every night for about a year, until that relationship ended. 

At that point I knew I wasn’t going to be disturbed at night, so I stopped, and that was it. After that, I had no difficulty getting to sleep without them.’

In 2017, the combination of a stressful house move, family illness and demanding work travel meant Ian began struggling to sleep again. 

‘I was travelling internationally every six weeks for charity work,’ he says. 

‘There was a period where I flew to Africa, Australia, Malaysia and the States in quick succession. My body clock became completely messed up.’

By the time he visited his GP, Ian admits: ‘I was on the floor, physically and emotionally. I had another trip coming up and told my doctor there was no way I could cope without sleeping pills. He prescribed me a one-month supply, even though my trip was just two weeks.

‘When I got back I carried on taking the pills, and my doctor kept giving me prescriptions. There was no discussion about side effects or withdrawals. If I wasn’t travelling there were the everyday stresses, and I didn’t want to risk not sleeping on top of those.

‘I had every intention to stop taking them at some point, but I just didn’t.

‘There were side effects. Although the pills make you sleep, it’s not proper sleep. So you go about feeling tired and in a sort of fog.

‘But it just seemed better than the alternative, which was not sleeping.

‘After about 18 months the pills stopped working so well, so without telling my doctor I began taking two rather than the recommended one. That was when I realised I might have a problem.’

Covid Q&A: Is it jabs or lockdown helping, and am I safe in a pub garden? 

Have cases fallen because of the national lockdown or because of the vaccine rollout? 

Lockdown has been the biggest driving force behind the fall in Covid cases, but vaccines have helped too.

On Wednesday, commentators questioned Prime Minister Boris Johnson’s assertions that lockdown restrictions had done ‘the bulk of the work’ in reducing the disease.

But analysis of the data shows this to be largely true. 

The decline in cases since the peak in early January has followed roughly the same trajectory as the fall in cases during the first wave, when there were no vaccines. 

What’s more, at the point at which cases began to decline across all ages in early January, vaccinations were being offered to only the over-80s.

Even now, cases have plummeted in the under-60s, even though only one in every three people in this age group have had one vaccine dose. 

But for those over 60, there are clear signs that the vaccines have led to a marked decline in cases. 

Since the beginning of March, cases in over-60s have fallen at a faster rate than in the under-60s.

As increasing numbers develop Covid-19 antibodies via vaccination, it is hoped the rate of decline will accelerate further and across all age groups. 

Professor Tim Spector, epidemiologist at King’s College London, said vaccines ‘should prevent future large-scale outbreaks’ and ensure any sudden surges were ‘smaller’ and ‘manageable’.

What’s the risk of catching Covid in a pub garden? 

Low, but it is still important to be cautious. 

A study published last week found that outdoor transmission accounted for just 0.1 per cent of all Covid cases in Ireland. 

So, of the 232,164 Covid infections seen in Ireland since the beginning of the pandemic, only 262 were caught outdoors.

Scientists have for some time believed the risk of catching Covid outdoors to be low, due to the fact that even a small wind can disperse Covid particles, making it near-impossible for them to travel from one person’s mouth to another’s.

Paul Hunter, professor of medicine at the University of East Anglia, said: ‘Personally I do not worry about the risk of Covid outdoors and I don’t wear a mask outdoors unless I am in a particularly crowded place.’

In June last year, Ian told his GP he wanted to come off zopiclone.

He says: ‘He suggested I try one day on, one day off. But when I didn’t take the zopiclone I just lay in bed in a sort of twilight, not really sleeping at all. 

‘I was completely exhausted the next day and unable to function. After a few attempts, I couldn’t handle it any more and started taking them every night again.’

Next, again on his GP’s advice, he began reducing his dose by splitting his tablets.

He adds: ‘I managed to get down to half a tablet, although on that dose I sleep for about five hours a night rather than the seven I had been getting.

‘If my dose goes any lower, I can’t sleep at all. So I’ve been stuck. In fact, recently, I’ve actually had to start increasing what I take. The lockdown hasn’t helped, as not being able to see friends has left me more anxious than usual.

‘At one point I felt so desperate and agitated I called the Samaritans, and speaking to them helped calm me down. Now I don’t know what to do.’

Another patient unable to quit zopiclone is Diana Grieves, 45, a marketing consultant from Hertfordshire. She was initially prescribed the drug eight years ago alongside antidepressants after her mother died in a car accident.

She says: ‘Even though I wasn’t sleeping, I was hesitant about taking it as my mum had been hooked on temazepam, which is a bit like Valium, for as long as I can remember. But the GP told me, ‘Don’t worry, these aren’t nearly as addictive.’

‘They really helped at first. I was out like a light, every night. There were no side effects, either. After nine months or so I decided I felt strong enough to come off the zopiclone. My GP told me to gradually cut down over two weeks, which I did, shaving a bit off my pill each night.

‘After a week I’d got down to less than half. But then I suddenly stopped sleeping. I felt like I did after Mum had died – exhausted, unable to cope or concentrate. I was getting angry for no reason.

‘I had some zopiclone tablets left and took one. I slept well, and all the symptoms stopped.’

Diana says she has taken the tablets ever since, as the same pattern repeats every time she tries to stop. She admits: ‘I want to quit them but I’m scared to even try.’

So what is it about zopiclone that makes it so difficult to give up?

The answer is not simple. Like most sleeping pills, zopiclone and other Z drugs slow down the nervous system to induce sleep. 

Patients often report that when they stop taking the tablets, they find it harder than ever to sleep – so-called rebound insomnia.

Some have theorised that the brain becomes dependent on the drug and can’t function normally when it is withdrawn. 

But studies into this, which involved giving patients either a real pill or a dummy placebo, without them knowing which they were getting, have thrown up intriguing results.

Most reveal that rebound insomnia is seen just as commonly, if not more so, in patients given a placebo, which contains no active drug at all. This suggests that other factors might be leading to the dependence seen in so many patients.

King’s College London’s Professor Dinesh Bhugra, a former president of the Royal College of Psychiatrists, says: ‘Zopiclone is short-acting – it stays in the body for only about six hours, which means it shouldn’t cause addiction. But we know people do find it difficult to come off it.

‘Like all sleeping pills, zopiclone helps patients sleep, but it doesn’t treat whatever is causing that insomnia. And if that underlying cause isn’t tackled, it will still be there when the pills are stopped.’

The reasons people suffer severe, long-term insomnia are varied. Mental health problems such as anxiety and depression can ‘play havoc’ with sleep patterns, says Prof Bhugra. 

But, he adds, doctors may need to look further to find the triggers. 

‘Many patients have money or housing worries or feel trapped in a job or relationship that is causing them unhappiness, so it’s no surprise they’re stressed, anxious and find it hard to sleep.

‘A pill might help treat some of the symptoms, but they won’t solve these problems. If doctors are committed to helping these patients, they need to think about their whole life. The focus needs to shift on what we can offer to help them stay well.’

In recent years there has been an NHS drive to promote social prescribing – also known as community referral. GPs are able to refer patients to local exercise classes or gyms, volunteering organisations and even gardening clubs. 

Studies have shown these approaches can have a positive impacts on patient wellbeing – reducing stress and their need for medication and other health services.

Dr Mark Horowitz, from University College London, who has studied Z drug dependence, said: ‘Insomnia is often a response to stress or grief, and sleep problems improve when the stress lessens or improves.’

With concerns growing about addiction to other prescription tablets, such as antidepressants and anxiety drugs, Prof Moncrieff and Dr Horowitz both hope that further training will be given to GPs and nurses in supporting ‘deprescribing’ – offering patients support and advice in safely coming off medications.

Current NHS guidance stresses that patients dependent on Z drugs should not be pressured into stopping, and should be allowed to set the timescale for cutting down themselves. 

For the time being Ian Govendir and Diana Grieves, like many thousands of others, are in limbo – not wanting to be on zopiclone but not able to stop. Ian says: ‘I wish I’d never started taking these pills in the first place.’ 

  • For help and advice on the issues raised in this article, Change Grow Live offer a live chat support service at changegrowlive.org.

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New measure to predict stress resilience — ScienceDaily

Researchers at the University of Zurich show that increased sensitivity in a specific region of the brain contributes to the development of anxiety and depression in response to real-life stress. Their study establishes an objective neurobiological measure for stress resilience in humans.

Some people don’t seem to be too bothered when it comes to handling stress. For others, however, prolonged exposure to stress can lead to symptoms of anxiety and depression. While stress resilience is a widely discussed concept, it is still very challenging to predict people’s individual response to increased levels of stress. Lab experiments can only go so far in replicating the chronic stress many people experience in their day-to-day lives, as stress simulated in the lab is always limited in exposure time and intensity.

It is possible, however, to observe a group of medical students who are all about to face real-life stress for an extended period — during their six-month internship in the emergency room. This is precisely the real-life situation on which a team of researchers involving Marcus Grueschow and Christian Ruff from the UZH Zurich Center for Neuroeconomics and Birgit Kleim from the Department of Psychology and the University Hospital of Psychiatry Zurich based their study.

Stress as a response to cognitive conflict and loss of control

Before starting their internship, the subjects were given a task that required them to process conflicting information. This conflict task activates the locus coeruleus-norepinephrine (LC-NE) system, a region of the brain associated with regulating our response to stress and resolving conflict. However, the intensity of LC-NE activation — often referred to as the “firing rate” — varies from one person to the next.

Subjects with a higher LC-NE responsivity showed more symptoms of anxiety and depression following their emergency room internships. “The more responsive the LC-NE system, the more likely a person will develop symptoms of anxiety and depression when they’re exposed to prolonged stress,” Marcus Grueschow summarizes their findings.

Objective measure predicting stress resilience

With their study, the scientists have identified an objective neurobiological measure that can predict a person’s stress response. This is the first demonstration that in humans, differences in LC-NE responsivity can be used as an indicator for stress resilience. “Having an objective measure of a person’s ability to cope with stress can be very helpful, for example when it comes to choosing a profession. Or it could be applied in stress resilience training with neuro-feedback,” Marcus Grueschow explains.

This does not mean that aspiring doctors or future police officers will all have to have their brain scanned. “There might be an even more accessible indicator for stress resilience,” Christian Ruff says. Research with animals suggests that stimulation of the LC-NE system correlates with pupil dilation. “If we could establish the same causal link between pupil dilation and the LC-NE system in humans, it would open up another avenue,” he adds.

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Brain scans reveal special case in frontotemporal dementia — ScienceDaily

People with early-onset dementia are often mistaken for having depression and now Australian research has discovered the cause: a profound loss of ability to experience pleasure — for example a delicious meal or beautiful sunset — related to degeneration of ‘hedonic hotspots’ in the brain where pleasure mechanisms are concentrated.

The University of Sydney-led research revealed marked degeneration, or atrophy, in frontal and striatal areas of the brain related to diminished reward-seeking, in patients with frontotemporal dementia (FTD).

The researchers believe it is the first study to demonstrate profound anhedonia — the clinical definition for a loss of ability to experience pleasure — in people with FTD.

Anhedonia is also common in people with depression, bipolar disorder and obsessive-compulsive disorder and can be particularly disabling for the individual.

In the study, patients with FTD — which generally affects people aged 40-65 — displayed a dramatic decline from pre-disease onset, in contrast to patients with Alzheimer’s disease, who were not found to show clinically significant anhedonia.

The results point to the importance of considering anhedonia as a primary presenting feature of FTD, where researchers found neural drivers in areas that are distinct from apathy or depression.

The findings were published today in the leading neuroscience journal, Brain.

The paper’s senior author, Professor Muireann Irish from the University of Sydney’s Brain and Mind Centre and School of Psychology in the Faculty of Science, said despite increasing evidence of motivational disturbances, no study had previously explored the capacity to experience pleasure in people with FTD.

“Much of human experience is motivated by the drive to experience pleasure but we often take this capacity for granted.

“But consider what it might be like to lose the capacity to enjoy the simple pleasures of life — this has stark implications for the wellbeing of people affected by these neurodegenerative disorders.

“Our findings also reflect the workings of a complex network of regions in the brain, signaling potential treatments,” said Professor Irish, who also recently published a paper in Brain about moral reasoning in FTD.

“Future studies will be essential to address the impact of anhedonia on everyday activities, and to inform the development of targeted interventions to improve quality of life in patients and their families.”

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People want to improve mental health by exercising, but stress and anxiety get in the way — ScienceDaily

New research from McMaster University suggests the pandemic has created a paradox where mental health has become both a motivator for and a barrier to physical activity.

People want to be active to improve their mental health but find it difficult to exercise due to stress and anxiety, say the researchers who surveyed more than 1,600 subjects in an effort to understand how and why mental health, physical activity and sedentary behavior have changed throughout the course of the pandemic.

The results are outlined in the journal PLOS ONE.

“Maintaining a regular exercise program is difficult at the best of times and the conditions surrounding the COVID-19 pandemic may be making it even more difficult,” says Jennifer Heisz, lead author of the study and an associate professor in the Department of Kinesiology at McMaster.

“Even though exercise comes with the promise of reducing anxiety, many respondents felt too anxious to exercise. Likewise, although exercise reduces depression, respondents who were more depressed were less motivated to get active, and lack of motivation is a symptom of depression,” she says.

Respondents reported higher psychological stress and moderate levels of anxiety and depression triggered by the pandemic. At the same time, aerobic activity was down about 20 minutes per week, strength training down roughly 30 minutes per week, and sedentary time was up about 30 minutes per day compared to six months prior to the pandemic.

Those who reported the greatest declines in physical activity also experienced the worst mental health outcomes, the researchers reported, while respondents who maintained their physical activity levels fared much better mentally.

Researchers also found economic disparities played a role, particularly among younger adults.

“Just like other aspects of the pandemic, some demographics are hit harder than others and here it is people with lower income who are struggling to meet their physical activity goals,” says Maryam Marashi, a graduate student in the Department of Kinesiology and co-lead author of the study. “It is plausible that younger adults who typically work longer hours and earn less are lacking both time and space which is taking a toll.”

After analysing the data, the researchers designed an evidence-based toolkit which includes the following advice to get active:

  • Adopt a mindset: Some exercise is better than none.
  • Lower exercise intensity if feeling anxious.
  • Move a little every day.
  • Break up sedentary time with standing or movement breaks.
  • Plan your workouts like appointments by blocking off the time in your calendar.

“Our results point to the need for additional psychological supports to help people maintain their physical activity levels during stressful times in order to minimize the burden of the pandemic and prevent the development of a mental health crisis,” says Heisz.

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Stress does not lead to loss of self-control in eating disorders — ScienceDaily

A unique residential study has concluded that, contrary to perceived wisdom, people with eating disorders do not lose self-control — leading to binge-eating — in response to stress. The findings of the Cambridge-led research are published today in the Journal of Neuroscience.

People who experience bulimia nervosa and a subset of those affected by anorexia nervosa share certain key symptoms, namely recurrent binge-eating and compensatory behaviours, such as vomiting. The two disorders are largely differentiated by body mass index (BMI): adults affected by anorexia nervosa tend to have BMI of less than 18.5 kg/m2. More than 1.6 million people in the UK are thought to have an eating disorder, three-quarters of whom are women.

One prominent theory of binge-eating is that it is a result of stress, which causes individuals to experience difficulties with self-control. However, until now, this theory has not been directly tested in patients.

To examine this theory, researchers at the University of Cambridge, working with clinicians at Cambridgeshire and Peterborough NHS Foundation Trust, invited 85 women — 22 with anorexia nervosa, 33 with bulimia nervosa and 30 healthy controls — to attend a two-day stay at Wellcome Trust-MRC Institute of Metabolic Science Translational Research Facility (TRF). The facility, which includes an Eating Behaviour Unit, is designed so that a volunteer’s diet and environment can be strictly controlled and their metabolic status studied in detail during a residential status. The setting is intended to be as naturalistic as possible.

During their stay, each morning the women would receive controlled meals provided by a nutritionist. The women then underwent a fasting period during which they were taken to the next door Wolfson Brain Imaging Centre, where they performed tasks while their brain activity was monitored using a functional MRI scanner.

The first tasks involved stopping the progression of a bar rising up a computer screen by pressing a key. The main task involved stopping the moving bar as it reached the middle line. On a minority of trials, stop-signals were presented, where the moving bar stopped automatically before reaching the middle line; participants were instructed to withhold their response in the event of a stop-signal.

The women then performed a task aimed at raising their stress levels. They were asked to carry out a series of mental arithmetic tests while receiving mild but unpredictable electric shocks, and were told that if they failed to meet the performance criterion, their data would be dismissed from the study. They were given feedback throughout the task, such as ‘Your performance is below average’.

The women then repeated the stop-signal task again.

Once the tasks had been completed — but while the volunteers might still be expected to be in a heightened state of stress — they returned to the Eating Behaviour Unit, where they were offered an ‘all you can eat’ buffet in its relaxing lounge and were told they could eat as much or as little as they would like.

On the second day of their study, the volunteers carried out the same tasks, but without the added stress of unpleasant electric shocks and pressure to perform. (For some participants, the order of the days was reversed.)

Dr Margaret Westwater, who led the research while a PhD student at Cambridge’s Department of Psychiatry, said: “The idea was to see what happened when these women were stressed. Did it affect key regions of the brain important for self-control, and did that in turn lead to increases in food intake? What we found surprised us and goes counter to the prevailing theory.”

The team found that even when they were not stressed, those women with bulimia nervosa performed worse on the main task, where they had to stop the rising bar as it reached the middle bar — but this was not the case for those women affected by anorexia nervosa. This impairment occurred alongside increased activity in a region in the prefrontal cortex, which the team say could mean these particular women were unable to recruit some other regions required by the brain to perform the task optimally.

Interestingly — and contrary to the theory — stress did not affect the actual performance in any way for either of the patient groups or the controls. However, the patient groups showed some differences in brain activity when they were stressed — and this activity differed between women with anorexia and those with bulimia.

While the researchers observed that the patients in general ate less in the buffet than the controls, the amount that they ate did not differ between the stress and control days. However, activity levels in two key brain regions were associated with the amount of calories consumed in all three groups, suggesting that these regions are important for dietary control.

Dr Westwater added: “Even though these two eating disorders are similar in many respects, there are clear differences at the level of the brain. In particular, women with bulimia seem to have a problem with pre-emptively slowing down in response to changes in their environment, which we think might lead them to make hasty decisions, leaving them vulnerable to binge-eating in some way.

“The theory suggests that these women should have eaten more when they were stressed, but that’s actually not what we found. Clearly, when we’re thinking about eating behaviour in these disorders, we need to take a more nuanced approach.”

In findings published last year, the team took blood samples from the women as they performed their tasks, to look at metabolic markers that are important for our sense of feeling hungry or feeling full. They found that levels of these hormones are affected by stress.

Under stress, patients with anorexia nervosa had an increase in ghrelin, a hormone that tells us when we are hungry. But they also had an increase in peptide tyrosine tyrosine (PYY), a satiety hormone. In other words, when they are stressed, people with anorexia nervosa produce more of the hunger hormone, but contradictorily also more of a hormone that should tell them that they are full, so their bodies are sending them confusing signals about what to do around food.

The situation with bulimia nervosa was again different: while the team saw no differences in levels of ghrelin or PYY, they did see lower levels of cortisol, the ‘stress hormone’, than in healthy volunteers. In times of acute stress, people who are chronically stressed or are experiencing depression are known to show this paradoxical low cortisol phenomenon.

Professor Paul Fletcher, joint senior author at the Department of Psychiatry, said: “It’s clear from our work that the relationship between stress and binge-eating is very complicated. It’s about the environment around us, our psychological state and how our body signals to us that we’re hungry or full.

“If we can get a better understanding of the mechanisms behind how our gut shapes those higher order cognitive processes related to self-control or decision-making, we may be in a better position to help people affected by these extremely debilitating illnesses. To do this, we need to take a much more integrated approach to studying these illnesses. That’s where facilities such as Cambridge’s new Translational Research Facility can play a vital role, allowing us to monitor within a relatively naturalistic environment factors such as an individual’s behaviour, hormone levels and, brain activity.”

The research was funded by the Bernard Wolfe Health Neuroscience Fund, Wellcome, the NIH-Oxford-Cambridge Scholars Program and the Cambridge Trust. Further support was provided by the NIHR Cambridge Biomedical Research Centre.

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COVID-19 pandemic may have increased mental health issues within families — ScienceDaily

When the COVID-19 pandemic hit in early 2020, many families found themselves suddenly isolated together at home. A year later, new research has linked this period with a variety of large, detrimental effects on individuals’ and families’ well-being and functioning.

The study — led by Penn State researchers — found that in the first months of the pandemic, parents reported that their children were experiencing much higher levels of “internalizing” problems like depression and anxiety, and “externalizing” problems such as disruptive and aggressive behavior, than before the pandemic. Parents also reported that they themselves were experiencing much higher levels of depression and lower levels of coparenting quality with their partners.

Mark Feinberg, research professor of health and human development at Penn State, said the results — recently published in the journal Family Process — give insight into just how devastating periods of family and social stress can be for parents and children, and how important a good coparenting relationship can be for family well-being.

“Stress in general — whether daily hassles or acute, crisis-driven stress — typically leads to greater conflict and hostility in family relationships,” Feinberg said. “If parents can support each other in these situations, the evidence from past research indicates that they will be able to be more patient and more supportive with their children, rather than becoming more harsh and angry.”

Feinberg added that understanding what can help parents maintain positive parenting practices, such as a positive coparenting relationship, is key for helping protect children during future crises — whether those crises are pandemics, economic shocks or natural disasters.

While cross-sectional studies have suggested there has been a negative impact of the pandemic on families, the researchers said this study is one of the first to measure just how much these factors have changed within families before and after the pandemic hit.

According to the researchers, previous research has found that periods of financial stress, such as the Great Depression and the 2008 recession, have led to higher levels of parent stress, mental health problems and interparental conflict, which can all lead to more harsh, and even abusive, parenting.

When the COVID-19 pandemic hit, Feinberg said it led to not only financial stress within families, but also problems related to being isolated together, issues managing work and childcare, and general fear related to the sudden health threat that was poorly understood.

“When the pandemic hit, like many people, I was very anxious and worried,” Feinberg said. “I saw the tensions and difficulties my daughter and I were having being home together 24/7. So, when I realized that our existing studies and samples of families gave us an opportunity to learn something about how families would cope during the crisis, my team and I moved into action.”

For the study, the researchers used data from 129 families, which included 122 mothers and 84 fathers, with an average of 2.3 children per family. The parents answered an online questionnaire that asked them about their depressive symptoms, anxiety, the quality of their relationship with their coparent, and externalizing and internalizing behavior they observed in their children, among other measures.

Because the participants were part of a longer study measuring these factors over prior years, the researchers already had data on these parents and children from before the pandemic.

The researchers found that parents were 2.4 times more likely to report “clinically significant” high levels of depression after the pandemic hit than before. They were also 2.5 times and 4 times more likely to report externalizing and internalizing problems, respectively, in their children at levels high enough that professional help might be needed.

Feinberg said that while it makes sense that families would experience these difficulties, he was shocked at the magnitude of the declines in well-being.

“The size of these changes are considered very large in our field and are rarely seen,” Feinberg said. “We saw not just overall shifts, but greater numbers of parents and children who were in the clinical range for depression and behavior problems, which means they were likely struggling with a diagnosable disorder and would benefit from treatment.”

Feinberg put the size of the declines in parent and child well-being in perspective by pointing out that the increase in parents’ levels of depressive symptoms in the first months of the pandemic was about twice as large as the average benefit of antidepressants.

The researchers said that as the risk of future pandemics and natural disasters increases with the effects of climate change, so will the likelihood of families facing stressful conditions again in the future

“Getting ready for these types of crises could include helping families prepare — not just by stocking up on supplies, but also by improving family resiliency and psychological coping resources,” Feinberg said. “In my view, that means providing the kinds of family prevention programs we’ve been developing and testing at the Prevention Research Center for the past 20 years.”

For example, Feinberg explained that their research shows that the Family Foundations program helps new parents develop stronger capacities for cooperation and support in their relationship with each other as coparents, which is a key dimension of family resiliency.

Feinberg said future research will examine whether families who went through Family Foundations or other programs were more resilient, maintained better family relationships, and experienced smaller declines in mental health during the pandemic.

Jacqueline Mogle, Jin-Kyung Lee, Samantha L. Tornello, Michelle L. Hostetler, Joseph A. Cifelli and Sunhye Bai, all at Penn State; and Emily Hotez, University of California, also participated in this work.

The National Institute of Child Health and Development and The Huck Institutes of the Life Sciences at Penn State helped support this research.

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Eat your way to a dreamy sleep: The secret to a good night’s rest lies in the ‘brain’ in your gut

What you eat and when you eat it has an enormous effect on your body clock, your sleep and, by extension, how many years you will live. 

By ‘eat’ we mean pretty much anything you take in — food, beverages, alcohol, caffeine, nicotine, medication, herbal remedies and supplements.

Each play a role in either keeping you from deep, restful sleep or nudging your body that much closer to your optimal rhythm.

One of the latest discoveries in sleep research is the link between gut health and a good night’s rest. It makes sense. 

What you eat and when you eat it has an enormous effect on your body clock, your sleep and, by extension, how many years you will live

What you eat and when you eat it has an enormous effect on your body clock, your sleep and, by extension, how many years you will live

Your entire body — including your digestive system — is designed to have predictable cycles of sleep, wakefulness and eating. And by upsetting that pattern, you throw your body off-kilter, gut and all.

An out-of-rhythm life can create an out-of-rhythm gut, but an out-of-rhythm gut can also create an out-of-rhythm life.

Conversely, good gut health can lead to good sleep. So, the healthier your gut, the easier it is to nod off and stay slumbering.

Getting your gut in order is therefore the place to start when it comes to ensuring the right amount and quality of sleep.

Trillions of microorganisms, mainly bacteria, live in your gastrointestinal tract. This is called your microbiome.

Some of these bacteria are beneficial, or health-promoting, while others trigger disease and inflammation. The goal is to keep this constantly shifting balance in favour of the good guys.

Far from only digesting your food, the gut is also home to a second nervous system, which is constantly communicating with your brain and the rest of the central nervous system.

It influences hormone production, immune system function, appetite, digestion, metabolism, behaviour, mood and stress responses.

This connection is known as the microbiome-gut-brain axis. The gut is the largest endocrine organ in the body and regulates the secretion of neurotransmitters [brain chemicals] such as cortisol, tryptophan and serotonin.

It’s also central to the immune system. Seventy per cent of the cells that make up your immune system surround your gut, and your gut flora interact with these cells to help regulate your immune response.

For that reason, you mess with your microbiome at your peril — an unbalanced gut is linked to everything from bloating, trapped wind and constipation, to anxiety, depression and skin conditions such as acne and eczema.

Good gut health can lead to good sleep. So, the healthier your gut, the easier it is to nod off and stay slumbering

And it can affect your sleep. This is because your body’s master clock works in synergy with your microbiome’s clock.

If one of these rhythms is disrupted, the other goes, too. Jet lag, for example, disrupts the diversity of gut flora.

And when either the circadian rhythm [the natural cycle of your body clock] or microbiome rhythm is upset, it creates a vicious cycle. Glucose intolerance, weight gain and metabolic changes can occur — all of which affect sleep and further distort the overall rhythm of your system.

The good news is that a malfunctioning gut can be healed. Your microbiome, like your body, is designed for predictable cycles of sleep, wakefulness and eating. So as you bring yourself back into rhythm by adopting new habits, your gut will follow suit.

And one of the biggest influences on your microbiome’s health is your diet. 

Think about what you are eating 

Firstly, avoid sugary, starchy and processed foods. Those with lots of sugar and easily digested starch, such as pastries and processed breads, are mostly broken down in the small intestine. This can result in the proliferation of harmful bacteria, leading to bacterial overgrowth there.

Secondly, try to avoid glyphosate-sprayed crops. Glyphosate is a herbicide applied to a range of crops to kill weeds. It is also used as a drying agent before wheat and barley are harvested. Shop organic where you can, or grow your own.

The habits that are designed to keep you in rhythm and improve your overall health ¿ exercising, cutting back on alcohol, quitting smoking ¿ will ultimately benefit your microbiome, and your sleep, at the same time

The habits that are designed to keep you in rhythm and improve your overall health — exercising, cutting back on alcohol, quitting smoking — will ultimately benefit your microbiome, and your sleep, at the same time

Also, where possible, bypass the overuse of antibiotics. Sure, every so often a raging infection may warrant such treatment, but much of the time they’re unnecessary and can lead to potentially dangerous antibiotic resistance.

Inside the gut, they can be indiscriminate killers, taking out the good bacteria along with the bad. If your doctor prescribes them, ask whether alternative treatments are available.

Prebiotics are fibres in food that most of our digestive system can’t break down, but the bacteria in our microbiome certainly can.

They are like microflora superfoods, giving your ‘good’ bacteria the high-octane fuel they need to do all the things that keep your gut healthy. This includes protecting the gut wall, digesting your food, keeping the bad guys in check, contributing to your immune system and coordinating with your central nervous system.

Foods rich in prebiotic fibre include garlic, onions, radishes, leeks, asparagus, Jerusalem artichokes, broccoli, lentils and chickpeas.

Fermented foods are also good news. Sauerkraut, yoghurt, kimchi (Korean fermented cabbage), miso and kefir (fermented milk) are loaded with beneficial bacteria that join forces with the good stuff in your gut.

Research suggests that the newcomers help the long-time residents do a better job of protecting your health, so try to have a few servings every week.

Although it’s always best to get your probiotics from food, you can also enjoy the advantages of fermented foods in easy supplement form, as a capsule or powder. If you are taking an antibiotic, balance it out with a high-quality probiotic to help keep your belly on an even keel.

Remember, your gut is a microcosm of your body as a whole. The habits that are designed to keep you in rhythm and improve your overall health — exercising, cutting back on alcohol, quitting smoking — will ultimately benefit your microbiome, and your sleep, at the same time. 

Get off the sugar roller coaster 

In our advice on sleeping, we make it clear it is all about picking habits that work for you, and that there’s no need to adopt a monk-like existence. But when it comes to sugar, all that changes.

Today really should be when you get this sleep-sabotaging, brain-distorting, hormone-skewing, health-bombing rubbish out of your life.

Sugary foods and drinks take your hormones on a roller-coaster ride so you don’t register hunger the way you should, making you eat more — and more often — and then store those calories as fat.

It jacks up your reward hormones so you need increasingly bigger hits just to get that nice, tasty high.

Sound familiar? It should — sugar is as addictive as tobacco and alcohol. And speaking of alcohol, sugar in the form of fructose [fruit sugar] can be just as hard on your liver, which converts it into fat.

Sugary foods and drinks take your hormones on a roller-coaster ride so you don¿t register hunger the way you should, making you eat more ¿ and more often ¿ and then store those calories as fat

Sugary foods and drinks take your hormones on a roller-coaster ride so you don’t register hunger the way you should, making you eat more — and more often — and then store those calories as fat

When eaten repeatedly, sugar can set you up for weight gain, high blood-sugar levels, inflammation, type 2 diabetes, heart disease, cancer, dementia, depression and infertility.

A 2016 study confirmed that a higher sugar intake is also associated with lighter, less restorative sleep and more night waking. Another study from Columbia University in the U.S. concluded that a diet high in refined carbs — particularly added sugars — is linked to a risk of insomnia, especially in women aged 50-plus.

And metabolising sugar uses up lots of magnesium, which you need to support levels of GABA, a neurotransmitter that promotes sleep.

The truth is, you’re probably eating more sugar than you think. Anything that comes in a packet probably has some hidden in there, whether it’s for taste, as a cheap preservative, or just to keep you hooked.

These tend to be labelled as ‘added sugars’ and include cane sugar, high-fructose corn syrup, and ‘natural’ sweeteners such as honey, agave, maple syrup and fruit juice. 

But unless a sugar is bound by fibre (as occurs naturally in fruit and vegetables), there’s no such thing as ‘healthy’ or ‘natural’.

Always check the labels before buying food products, especially condiments, snack bars and drinks, where sugar often lurks.

Why happy hour is the best time for a tipple 

Studies have shown that our bodies process alcohol more effectively at certain times of the day.

It turns out they are attuned to Happy Hour, metabolising alcohol best in the early to middle hours of the evening rather than later at night. Certain types of alcohol, such as vodka and gin — without sugary mixers — may also be tolerated better.

The same applies to caffeine, so think about when you decide to drink anything containing it.

When you are feeling tired, what could be more inviting than caffeine? It gives you an almost instant second wind, laser-focuses your mind and potentially helps you burn more calories at the gym. But when it comes to sleep? Total disaster.

That is because caffeine is a stimulant — and the way it revs you up is by blocking the receptors in your brain that recognise the sleep-inducing neurotransmitter [or brain chemical] adenosine.

Adenosine is what builds up in your system during your waking hours, creating sleep pressure or the urge to sleep.

Caffeine basically stops that happening, tricking the brain into believing it’s not tired. But the longer caffeine blocks adenosine, the more it builds up in your system. When the effects of caffeine eventually wear off, all that backlogged adenosine comes rushing back into the brain, making you feel even more tired than before you had that coffee/black tea/energy drink.

Caffeine inhibits melatonin production even more than bright light does, further disrupting sleep.

So now you need caffeine to wake up and function, which makes you sleepier, which makes you need more caffeine — a circular process known as the ‘caffeine causality loop’.

If you want to aid sleep, you must catch that loop mid-stream and reset the rhythm. The way to do that is to be smarter about how much caffeine you are having and when.

Set a caffeine cut-off. We recommend having your last hit no later than 1pm.

Caffeine has a half-life of roughly five to seven hours, meaning that five to seven hours after you drink a coffee, half the caffeine is still in your body.

If you are a slow metaboliser, this could take even longer. Try cutting back on the number, or size, of coffees you drink — or have a decaf one instead of one of your normal drinks.


Meal planner for a peaceful night

In order to fully resync your sleep rhythm, you have to change your eating patterns to support your body’s digestive cycle. 

Consider this your new menu for sleep:

Keep to regular mealtimes. Your body learns to anticipate feeding time, releasing enzymes and hormones to help with digestion. 

Eating at the same time every day not only ensures that you’re digesting properly, but it also guarantees that the ebb and flow of your metabolism is in sync with your master clock. 

In order to fully resync your sleep rhythm, you have to change your eating patterns to support your body¿s digestive cycle

In order to fully resync your sleep rhythm, you have to change your eating patterns to support your body’s digestive cycle

This goes for the weekends, too. If you change your habits for just those two days, you’re inflicting social ‘jet lag’ on your rhythm. And suffice to say that your body functions don’t observe the days of the week.

Break the fast gently. The morning is when your body is shifting back into day mode, but hasn’t fully hit its stride. Gently introduce food to your digestive system with a light, nutrient-rich breakfast.

Smoothies are a particularly great way to deliver maximum nutrition without putting a lot of stress on digestion. Another sleep-promoting option is to not eat a morning meal and follow an intermittent fasting protocol (see below).

Eat your biggest meal at noon. Your digestive system is primed to receive the majority of its fuel in the middle of the day, between 10am and 2pm. 

Feed your system with a robust (ideally whole-food, veg-filled) lunch that delivers most of your daily nourishment. This will alleviate how much you feel the need to eat in the evening, when your digestive flame begins to dim.

Redefine dinner. Eating a large meal in the evening is a relatively new idea. Yes, it’s a nice time to socialise and reflect on the day, but eating a lot of food late on is not doing your digestion, or your waistline, any favours.

By the time the sun starts to set, your digestive tract is preparing for its night-time shift. So the later in the day you eat, the higher the chance that your food won’t be properly digested, leading to problems such as acid reflux, cramp and an upset digestion.

Feed your system with a robust (ideally whole-food, veg-filled) lunch that delivers most of your daily nourishment

Feed your system with a robust (ideally whole-food, veg-filled) lunch that delivers most of your daily nourishment

It’s also making your digestive system work overtime, giving you less restful sleep and skewing the balance of microflora that inhabit the gut at night-time. Also, when you routinely eat your biggest meal at night, you are prompting your body to produce ghrelin, the hunger hormone, when production would normally be waning.

This ultimately trains your body to become hungry when it wouldn’t normally be and interrupts an important hormonal rhythm, while also causing your body to store abdominal fat.

So the bottom line is: eat a light evening meal, at least two to three hours before you go to bed. 

Even better, go for four. But if you do eat late one night, don’t stay up trying to hit the two-hour mark. Just go to bed and start afresh the next day.

When to give your digestion a break

Brief, periodic fasts should be the norm for humans — it wasn’t exactly like we had food on demand back in the day. 

And we now know that observing a longer period without eating, also known as intermittent fasting, is beneficial for a number of reasons:

  • It makes your digestive system more resilient.n Your metabolism and hormones can resync their 24-hour cycle.n the metabolism is made to burn fat stored in the body.
  • It allows your body to experience a longer-than-normal period of having low insulin in the blood, which tells your body to burn energy to keep insulin low (the opposite of what happens when you’re eating food continually).
  • It’s a great way to gently stress your body in order to stimulate its renew and repair systems.
  • It triggers autophagy, a body-wide cellular repair process that removes waste material from cells, quells inflammation, slows ageing and optimises mitochondria function, which gives you greater protection against disease.
  • Work towards 16 hours between your last meal of the day and your first meal of the next. If you finish dinner at 8pm, you’ll break the fast around 12pm the following day. (Studies show that autophagy kicks in after about 16 hours.) If you need to, build up over time. Start with 12 hours (the ideal for good digestion and overnight detoxification).
  • Drink water. Or, as a second-best option, tea. Third best would be black coffee. Water is ideal because anything besides it will call your liver into action and can put an end to autophagy. The counterargument is that as long as you don’t trigger an insulin response (which is what eating carbohydrates would do), then you’re still technically fasting.
  • Skip all of the above if you are pregnant, nursing, on medication, an athlete doing rigorous training, underweight, or under the age of 18. Also, if you would describe yourself as extremely stressed or emotionally distraught, give it a miss — your body doesn’t need the extra burden.As always, consult your doctor if you have any concerns.

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Spanking may affect the brain development of a child — ScienceDaily

Spanking may affect a child’s brain development in similar ways to more severe forms of violence, according to a new study led by Harvard researchers.

The research, published recently in the journal Child Development, builds on existing studies that show heightened activity in certain regions of the brains of children who experience abuse in response to threat cues.

The group found that children who had been spanked had a greater neural response in multiple regions of the prefrontal cortex (PFC), including in regions that are part of the salience network. These areas of the brain respond to cues in the environment that tend to be consequential, such as a threat, and may affect decision-making and processing of situations.

“We know that children whose families use corporal punishment are more likely to develop anxiety, depression, behavior problems, and other mental health problems, but many people don’t think about spanking as a form of violence,” said Katie A. McLaughlin, John L. Loeb Associate Professor of the Social Sciences, director of the Stress & Development Lab in the Department of Psychology, and the senior researcher on the study. “In this study, we wanted to examine whether there was an impact of spanking at a neurobiological level, in terms of how the brain is developing.”

According to the study’s authors, corporal punishment has been linked to the development of mental health issues, anxiety, depression, behavioral problems, and substance use disorders. And recent studies show that approximately half of parents in U.S. studies reported spanking their children in the past year and one-third in the past week. However, the relationship between spanking and brain activity has not previously been studied.

McLaughlin and her colleagues — including Jorge Cuartas, first author of the study and a doctoral candidate in the Harvard Graduate School of Education, and David Weissman, a post-doctoral fellow in the Department of Psychology’s Stress & Development Lab — analyzed data from a large study of children between the ages of three and 11. They focused on 147 children around ages 10 and 11 who had been spanked, excluding children who had also experienced more severe forms of violence.

Each child lay in an MRI machine and watched a computer screen on which were displayed different images of actors making “fearful” and “neutral” faces. A scanner captured the child’s brain activity in response to each kind of face, and those images were analyzed to determine whether the faces sparked different patterns of brain activity in children who were spanked compared to those who were not.

“On average, across the entire sample, fearful faces elicited greater activation than neutral faces in many regions throughout the brain… and children who were spanked demonstrated greater activation in multiple regions of PFC to fearful relative to neutral faces than children who were never spanked,” researchers wrote.

By contrast, “(t)here were no regions of the brain where activation to fearful relative to neutral faces differed between children who were abused and children who were spanked.”

The findings are in line with similar research conducted on children who had experienced severe violence, suggesting that “while we might not conceptualize corporal punishment to be a form of violence, in terms of how a child’s brain responds, it’s not all that different than abuse,” said McLaughlin. “It’s more a difference of degree than of type.”

Researchers said the study is a first step towards further interdisciplinary analysis of spanking’s potential effects on children’s brain development and lived experiences.

“These findings aligned with the predictions from other perspectives on the potential consequences of corporal punishment,” studied in fields such as developmental psychology and social work, said Cuartas. “By identifying certain neural pathways that explain the consequences of corporal punishment in the brain, we can further suggest that this kind of punishment might be detrimental to children and we have more avenues to explore it.”

However, they noted that their findings are not applicable to the individual life of each child.

“It’s important to consider that corporal punishment does not impact every child the same way, and children can be resilient if exposed to potential adversities,” said Cuartas. “But the important message is that corporal punishment is a risk that can increase potential problems for children’s development, and following a precautionary principle, parents and policymakers should work toward trying to reduce its prevalence.”

Ultimately, added McLaughlin, “we’re hopeful that this finding may encourage families not to use this strategy, and that it may open people’s eyes to the potential negative consequences of corporal punishment in ways they haven’t thought of before.”

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DR MICHAEL MOSLEY: It’s official: If you’re over 60, you’re HAPPIER than ever! 

What is happiness? It’s one of those questions that’s vexed great minds down the ages, including the Peanuts creator, Charles M. Schulz, who famously said: ‘Happiness is a warm puppy.’

I hate to contradict one of my favourite philosophers but, thanks to the World Happiness Report, produced every March by the United Nations Development Network, we now have more reliable ways of measuring happiness than the ‘warm puppy index’, as well as predicting what will make us happy.

The report is based on surveys carried out by Gallup World Poll involving more than 1.6 million people from 156 countries. 

Although we all have our ups and downs, the average scores for countries doesn’t usually change much from year to year — except for last year when the UK became a markedly less happy place

One of the questions people are asked is to place themselves on a ladder, depending on how happy they feel about their lives — imagine the top of the ladder scores ten (i.e. you’re blissfully happy), the bottom is zero.

Without thinking too hard, try it yourself. I gave myself an eight, lucky enough to have a supportive wife, great kids, good friends, decent health and a job I enjoy, all things that predict happiness.

The average score for people in the UK is normally around seven, compared to 7.9 if you live in Finland and 2.5 if you live in Afghanistan. 

Although we all have our ups and downs, the average scores for countries doesn’t usually change much from year to year — except for last year when the UK became a markedly less happy place.

In 2020, as it has for the past four years, Finland was at the top of the happiness league, followed closely by Iceland, Denmark and Switzerland.

The UK, which normally comes in at around number 13, slid down to 18, overtaken by Ireland, Germany, the Czech Republic, Belgium and the U.S. Worldwide, people proved to be remarkably resilient in the face of what has been a truly disastrous year.

One of the questions people are asked is to place themselves on a ladder, depending on how happy they feel about their lives ¿ imagine the top of the ladder scores ten (i.e. you¿re blissfully happy), the bottom is zero

One of the questions people are asked is to place themselves on a ladder, depending on how happy they feel about their lives — imagine the top of the ladder scores ten (i.e. you’re blissfully happy), the bottom is zero

According to the report, this is largely because the pandemic has broadened our perspective and made us appreciate that we’re part of a wider society.

Threatened by a common enemy, we’ve shown a willingness to volunteer and help others through the hard times.

Being supported, and supporting others, is one of the best ways to boost happiness, and we’ve seen lots of examples of that over the past 12 months. 

My elderly mother, who has been sheltering alone, has been really touched by all the offers of help from her neighbours, and I think that things such as clapping for the NHS have also brought people together.

Interestingly, the countries that have, over the years, consistently scored highest on the happiness index are also those that have handled the Covid-19 crisis particularly well. That seems to be because of ‘trust’. 

Whether it is trust in your government or trust in your fellow humans, this is both a major predictor of happiness and a predictor of whether you’ll follow the rules and do things such as wear face masks and wash your hands.

Why has the UK been overtaken by other countries? There does seem to have been a drop in trust, caused by the Government’s early mishandling of the pandemic. It will be interesting to see if, thanks to the vaccine success, we make up ground next year.

The UK also saw a significant rise in anxiety and depression, particularly amongst young people. Studies suggest that around one in five of the population now suffers from mental health problems they didn’t have a year ago.

That said, 2020 was clearly a bad year for young people everywhere, with high rates of unemployment and far fewer opportunities to socialise. And this is reflected in the one of the report’s most striking findings.

Previous research has suggested that happiness follows a U-shaped curve, with people reporting being pretty happy in their 20s, then become glummer as they begin to approach middle age, before hitting rock bottom at around 50. Then they typically start to become perkier, until they reach old age.

Threatened by a common enemy, we¿ve shown a willingness to volunteer and help others through the hard times. Being supported, and supporting others, is one of the best ways to boost happiness, and we¿ve seen lots of examples of that over the past 12 months

Threatened by a common enemy, we’ve shown a willingness to volunteer and help others through the hard times. Being supported, and supporting others, is one of the best ways to boost happiness, and we’ve seen lots of examples of that over the past 12 months

This pattern probably reflects the fact that, in our 20s, we see the world as our oyster, but that as we get older we realise many of our dreams aren’t going to come true. By our late 50s, we’ve come to terms with how our lives have turned out, and increasingly find happiness in friends and family.

This year, however, the age-happiness graph looks very different. Young people are less happy than those in their 30s, who are less happy than those in their 40s, and so on. But the over 60s, despite the threat of Covid, seem to be remarkably cheerful.

One of the main reasons seems to be that they say they feel healthier, even though the evidence shows they’re not!

Perceived health is a big predictor of happiness and the percentage of men over 60 who say they have a health problem fell from 46 per cent previously to 36 per cent in 2020. For women, the percentage fell from 51 to 42.

It seems that for people over 60, like me, the threat of Covid has put everything else into perspective.

Knowing we’ve so far dodged the bullet is cause for celebration. As I said at the outset, happiness is not fixed, so I fervently hope we are heading for happier times, particularly for the young.


Too much time spent sitting in front of screens is not good for our eyes — not only can it be tiring, but it can leave your eyes feeling gritty and red, as I’ve found after so many video meetings.

Staring at a screen means your blink rate drops to around a third of normal, from 15 to 18 times a minute to just five: and this is a problem because blinking lubricates and cleans your eyes.

One of the best ways to counteract digital eye strain is the 20/20/20 rule: every 20 minutes, get up and stare out at an object 20 feet away, for 20 seconds.

This relaxes your eye muscles and increases your blink rate, giving your eyeballs a good wash.

The latest weapon against aches and pain? Leeks…

I’ve had plenty of injuries in my time, including breaking my leg and falling off my bike, so I’m quite familiar with pain. I count my blessings that, unlike an estimated 30 million Britons, I’ve not had to endure chronic pain.

And, tragically, the pandemic is making things worse for them. A survey from Edinburgh University last week found that the number of NHS patients waiting for hip and knee replacements (usually for arthritis), with pain which they classified as ‘worse than death’, doubled over the past year.

What can be done? There’s now an understandable reluctance to prescribe powerful painkillers thanks to publicity about the over-use of opioids. Nor are these drugs particularly effective for chronic pain. 

What’s urgently needed are new ways of treating pain. This is where a non-surgical procedure called genicular artery embolization (GAE) comes in.

Another step is a diet rich in prebiotics, found in onions, garlic and leeks, which are converted by the ¿good¿ bacteria in the gut into anti-inflammatory chemicals

Another step is a diet rich in prebiotics, found in onions, garlic and leeks, which are converted by the ‘good’ bacteria in the gut into anti-inflammatory chemicals

The idea is that rather than replace the knee joint, a doctor inserts a tube into the arteries that supply it, then squirts in tiny plastic particles.

When cartilage starts to break down, it releases enzymes that cause local inflammation and pain. The theory is that the plastic particles reduce blood flow to the lining of the knee, which reduces inflammation and pain.

A new study, from the University of California, Los Angeles, with 40 patients, found that within a week of having GAE, their average pain scores dropped from eight out of ten, to three — and patients who’d previously been unable to walk more than a few hundred yards could now walk several miles daily. A year later, 70 per cent still had massive reductions in their pain.

Prevention is better than cure, so to help avoid arthritis — or reduce the pain — losing weight is key, reducing the load on the joint and inflammation.

Simple, daily exercise can also help, building up the muscle to support the joint. 

Another step is a diet rich in prebiotics, found in onions, garlic and leeks, which are converted by the ‘good’ bacteria in the gut into anti-inflammatory chemicals.

Studies with mice have shown prebiotics can prevent arthritis, even in severely overweight animals, and human studies are under way.

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How to defuse the male fertility timebomb

Could a toxic soup of chemicals in everyday life be destroying men’s ability to father children? 

That is the latest claim from a U.S. expert, Dr Shanna Swan, who made headlines in 2017 with research that suggested human sperm counts are plummeting.

Dr Swan, a professor of environmental medicine and public health at the Icahn School of Medicine, New York, made her original claim in the journal Human Reproduction Update. 

Her analysis of previous research evidence concluded that men’s reproductive problems are increasing by at least 1 per cent a year in Western countries. 

Dr Swan blames this crisis on male babies being harmed in the womb by their mothers' exposure to hormone-altering chemicals in food and many consumer items

Dr Swan blames this crisis on male babies being harmed in the womb by their mothers’ exposure to hormone-altering chemicals in food and many consumer items

These problems include declining sperm counts, falling testosterone levels and increasing rates of testicular cancer.

Now, in a new book entitled Count Down, Dr Swan blames this crisis on male babies being harmed in the womb by their mothers’ exposure to hormone-altering chemicals in food and many consumer items.

These chemicals include phthalates (used to make plastics more flexible and found in hundreds of products including toys, detergents, food packaging, personal-care products and electronic devices), bisphenol A (in plastic food containers) and flame retardants (used in furnishings, carpets and cars).

Dr Swan says these chemicals began to be produced in increasing quantities from 1950, after which male fertility began to drop.

‘Sperm counts have declined by 50 per cent in just 40 years,’ she says. ‘It’s difficult to deny how alarming this is.’

She explains that the chemicals effectively block the action of boy foetuses’ male hormones during the first trimester of pregnancy. This, she suggests, can damage the natural development of boys’ reproductive organs in numerous ways.

Plastics may affect foetal development

Dr Swan argues that the chemicals may not only be harming male reproductive health and causing genital abnormalities such as undescended testicles, which can render men infertile, and smaller penises. 

But, more controversially, she says they also seem to be altering the nature of human gender identity — with worldwide increases in the number of people reporting gender fluidity, gender dysphoria (where people feel their biological sex does not match their gender identity), non-binary status (where people feel neither conventionally male nor female), or being trans, non-sex, or intersex (the older term for this last condition is hermaphroditism).

‘One scientific theory suggests that in-utero exposure to hormone-disrupting chemicals, particularly phthalates — which can lower a foetus’s exposure to testosterone — may play a role,’ she says.

Dr Swan argues that the chemicals may not only be harming male reproductive health and causing genital abnormalities such as undescended testicles, which can render men infertile, and smaller penises

Dr Swan argues that the chemicals may not only be harming male reproductive health and causing genital abnormalities such as undescended testicles, which can render men infertile, and smaller penises

‘Another theory is that hormone-disruptors can interfere with complex biochemical pathways in the brain in ways that may affect how a person associates with his or her physiological sex at birth or expresses their gender through behaviour, either of which may result in gender dysphoria.’

She writes: ‘In one of my studies we asked mums about how their four to seven-year-olds played. We found that boys exposed in the womb to higher levels of the potent chemical DEHP (di-2-ethylhexyl phthalate) the most common member of the class of phthalates, which can lower foetal testosterone levels, scored significantly lower on the ‘masculine scale’ — in other words, they were more likely to play with dolls and less likely to play with trucks and guns.’

Is heavy industry the real culprit?

Fears about environmental chemicals were bolstered this month by a French study which suggests that pollution from heavy industries may cause boys to be born with undescended testicles.

The study, published in the journal Human Reproduction, looked at data from nearly 90,000 boys and found that significant clusters were born with undescended testicles in regions that had high levels of mining or metalworking.

With this condition, known as cryptorchidism, one or both testes have not descended into the scrotum around the time of birth. This usually corrects itself within six months, but about one boy in 100 has testes that stay undescended.

When this occurs, surgery is needed to move them. This is carried out ideally before the age of one. Boys with untreated cryptorchidism may later have fertility problems (because the higher temperature of testes inside the body affects sperm production) and are at higher risk of testicular cancer, warn the French researchers.

Dr Joelle Le Moal, a medical epidemiologist at Public Health France, who led the study, says the incidence of cryptorchidism increased by more than a third between the years 2002 and 2014.

She adds: ‘The industrial activities identified in the clusters are potentially the source of persistent environmental pollution by metals, dioxins and polychlorinated biphenyls (PCBs). These are suspected to play a role in cryptorchidism by disrupting hormones.’

To halt the decline in male fertility, Dr Swan suggests a ban on hormone-disrupting chemicals. ‘We also need better testing and regulation so only safe chemicals can enter the market and our bodies,’ she says.

But this would require a complete change in the manufacture of almost all consumer goods.

The French findings suggest that research should focus more on exposure to major industrial pollutants than to low-level exposure to chemicals in food, such as bisphenol A and phthalates, suggests Richard Sharpe, the principal investigator at the Medical Research Council (MRC) Centre for Reproductive Health at the University of Edinburgh.

Professor Sharpe told Good Health: ‘Bisphenol A and phthalates should be towards the bottom of the list of suspects. Phthalates, for example, seem to have no effect on primates’ fertility in laboratory tests. Yes, they affect rats. But not primates — so by implication they do not affect humans.’

He also points to the discovery 13 years ago by the MRC reproductive health team that there is a time window of only a few days — at around eight to 12 weeks of gestation — in which a male foetus’s developing testes release a vital burst of testosterone.

‘This must be sufficient to set up their male reproductive systems properly, even though those systems don’t come into function until puberty,’ he says. ‘If you don’t have enough testosterone expressed at this time, then the adult reproductive system won’t work well.’

One sign that this development has gone awry is an unusually short anogenital distance (AGD). This is the distance from the midpoint of the anus to the underside of the scrotum, which is set at the same time as the foetus releases its burst of testosterone — a short AGD (the average is 2 in) is not a problem in itself but is a sign that development has been disrupted.

Professor Sharpe adds: ‘Everything that can interfere with testosterone production during this period of time has the potential to cause reproductive disorders.’ 

Obesity could be part of the problem 

Professor Sharpe is at pains to explain that we cannot point with certainty to any particular culprit or physical mechanism, be it chemical or lifestyle, having an impact on male fertility. ‘We still don’t really understand what causes these problems and not enough research has been done,’ he says

Professor Sharpe is at pains to explain that we cannot point with certainty to any particular culprit or physical mechanism, be it chemical or lifestyle, having an impact on male fertility. ‘We still don’t really understand what causes these problems and not enough research has been done,’ he says

But while he thinks heavy industrial chemicals have played a part in causing male reproductive problems, Professor Sharpe points out that this type of pollution is becoming increasingly rare, thanks to better regulation and the disappearance of heavy industry. 

Instead, he believes junk-food diets may be the prime culprit.

‘The biggest changes to have occurred during the period when male reproductive problems have become common are in our diet and lifestyle,’ says Professor Sharpe. Indeed, study evidence suggests large amounts of oestrogen in dairy products and meat can affect reproductive development in boys.

The obesity epidemic may also play a role. 

‘Obesity is associated with impaired reproductive function in men, even young men,’ says Professor Sharpe.

‘The most consistent effect is the lowering of testosterone levels, which can itself lead to a range of consequences, including potential lowering of libido.’

Studies show that fat cells metabolise testosterone into oestrogen, which in turn lowers testosterone levels. Also, hormonal changes caused by obesity reduce levels of sex hormone binding globulin (SHBG), a protein that carries testosterone in the blood. Less SHBG means lower levels of circulating testosterone.

But Professor Sharpe is at pains to explain that we cannot point with certainty to any particular culprit or physical mechanism, be it chemical or lifestyle, having an impact on male fertility.

‘We still don’t really understand what causes these problems and not enough research has been done,’ he says.

Some experts are sceptical about whether sperm counts really are plummeting. Allan Pacey, a professor of andrology at the University of Sheffield, told Good Health: ‘I don’t think the scientific evidence shows sperm counts have declined.’

He argues that Dr Swan’s 2017 paper amalgamated a muddle of studies that used different methods to try to count sperm.

‘Counting sperm reliably is very difficult even if you use the same technique each time,’ he says. 

‘If you were going to prove sperm counts have declined, you wouldn’t do it in Dr Swan’s way of aggregating studies that used different methods.’

He adds: ‘To do it right, you would run a study where you controlled for all the variables and examined large populations of men consistently and reliably over decades, in order to see if this is a real phenomenon.

‘The Danes did this in 2011, in the journal Epidemiology, by studying 5,000 men’s sperm over a 15-year period. Their results showed that there was no change in men’s sperm counts. Everyone ignores this well-constructed study and goes back to the more flawed data such as Dr Swan has used.’ 

Try to conceive earlier in life 

Professor Pacey also argues the evidence does not support a cause-and-effect link between obesity and male fertility.

‘Our large study in 2012 in the journal Human Reproduction failed to find any association,’ he says. 

‘Common sense would suggest that men should try to be within the range of normal BMI, but the evidence is conflicting.’

So why are growing numbers of couples having to resort to fertility clinics for help? 

‘That’s about the age of the people going to these clinics,’ says Professor Pacey. 

‘Couples are trying to start families later rather than in their 20s, when they are most fertile.’

Warnings of doom do not help, Professor Pacey argues. ‘A few years ago the Royal College of Obstetricians and Gynaecologists published a long list of potential risks that people should avoid, such as perfume, clingfilm and canned food. This can make people who are finding it hard to conceive feel guilty and very unhappy.

‘If you want to be a parent, try to do it early in life. Try to be as healthy as possible and avoid drinking, smoking and taking drugs,’ he suggests. 

‘If you don’t get pregnant after a year, seek medical advice.’

Count Down, by Shanna Swan, is published on April 1 (Simon & Schuster, £20).

Why Covid-19 can play havoc with men’s love lives 

By Libby Galvin and Pat Hagan for the Daily Mail

Men who contract Covid-19 treble their risk of developing erectile dysfunction, according to new research.

Doctors at the University of Rome asked 100 men, with an average age of 33, to report recent problems with sexual function. Nine per cent of those who had not had Covid said they’d had difficulties. But among those who had been infected the figure was 28 per cent, according to a report in the journal Andrology.

Researchers said the virus is known to cause inflammation in the endothelium — the inner lining of blood vessels throughout the body. Arteries supplying the genitals are small and narrow, so any inflammation is likely to disrupt blood flow and impede a man’s sexual response.

This is the latest piece of research to find that, in many ways, men aspak worse with a Covid infection than women — they are more prone to serious symptoms and 1.7 times more likely to die of the virus.

Some experts have suggested differences in levels of the sex hormones oestrogen and testosterone may partly explain this.

On average, women in the UK live 3.7 years longer than men, even in non-Covid times — and oestrogen is thought to be key, improving women’s immune function and helping to protect the cardiovascular system. High testosterone levels may increase some risks to the cardiovascular system, which is put under huge pressure by coronavirus.

But new research offers another insight: not about how our sex hormones may help us fight Covid, but how the virus may interfere with their production, causing knock-on effects.

‘One of the devious ways the virus gets into the body is by its spike protein binding to a receptor found at quite high concentrations not only in the lungs but in the reproductive organs,’ explains Dr Channa Jayasena, a consultant in reproductive endocrinology and andrology at Hammersmith Hospital in London.

‘When Covid-19 binds to these receptors, they can no longer perform their normal function.’

These ACE2 receptors are found throughout the body, most widely in the lungs and cardiovascular system as well as at high levels in the testes.

While the evidence is thin, Dr Jayasena suggests Covid-19 may leave men with lowered testosterone levels and could affect women’s menstrual cycles and menopause, too. All this has a potential impact on both fertility and general health, as sex hormones are involved in processes throughout the body, from muscle growth to immune function.

A review of 24 studies on male fertility and Covid-19, published last year in the World Journal of Men’s Health, noted that patients who had suffered a moderate Covid infection had significantly lower sperm concentration, often for months after recovery, compared with those whose infection had been only mild.

But what came first, the low sperm count or the infection? Shortly afterwards, another study, published in the journal The Aging Male, showed that not only might men with lower testosterone levels be at higher risk of getting Covid-19, but that the virus could indeed lower men’s testosterone levels.

Mike Kirby, a former professor of general practice in Hertfordshire and editor of The Aging Male, suggests this means doctors should be ready to check testosterone levels in male Covid patients and, if necessary, provide testosterone replacement.

He says that without it, those men are at higher risk of cardiovascular problems, type 2 diabetes, muscular weakness and depression, and loss of sexual desire, function and fertility.

While this may be true, it is not yet clear whether coronavirus is affecting sex-hormone levels more than any other viral infection might, says Dr Jayasena, adding that in any case, any lowering of those hormones may well be temporary.

‘If you had severe flu, then it might take at least another several weeks for your testes to start working properly,’ he says.

‘A man’s sperm count can drop to zero during flu and it can take three months to recover fully. So I think it’s reasonable to suggest a similarly severe illness such as Covid would do at least that.’ 


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What can I do about my burning mouth? DR MARTIN SCURR answers your health questions

I’ve suffered from burning mouth syndrome for about 25 to 30 years. No one seems to be able to help. I am 78 years old. Can you suggest anything?

Margaret Wheddon, via email.

Burning mouth syndrome is a poorly understood condition and your experience with it must be debilitating. 

As there are no tests for it, the diagnosis is based on the symptom of a superficial burning sensation (mainly in the tongue) that lasts for at least two hours every day, for longer than three months.

Research shows those affected also tend to have depression and/or anxiety — I believe the mood changes are the result of the unrelenting discomfort rather than the cause, though not all agree. 

Burning mouth syndrome is a poorly understood condition and your experience with it must be debilitating [File photo]

The condition is more common in postmenopausal women — again, we don’t know why, but I do wonder if oestrogen plays a role.

There are two theories about the possible cause. The first is that the pain is due to a form of neuropathy, or abnormal function, of nerves that branch off from the trigeminal nerve, which is responsible for feeling in the face. 

This is not dissimilar to the burning pain experienced in the soles of the feet by some patients with type 2 diabetes, due to nerve damage.

The second theory relates to receptors in the putamen, an area at the front of the brain. In some patients with painful conditions, including chronic lower back pain, the putamen has been found to contain a higher number of receptors for dopamine (a ‘happy’ hormone) — quite why this relates to pain is far from clear. 

Research shows burning mouth syndrome can be improved when treated with pramipexole, a drug that stimulates dopamine receptors.

Most patients are treated with low-dose tricyclic antidepressants, gabapentin (an anti-epilepsy drug) or clonazepam (a sedative used to treat some forms of epilepsy) — these dampen nerve activity.

It may be that you have tried some or all of these in the past, although it is most unlikely that you will have received pramipexole. If your GP has not been able to help with the above, then referral to a neurologist might be helpful.

My nosebleeds can last for up to 40 minutes and occur at any time. Is there a way to alleviate or stop them?

Bob Berrett, Cheltenham, Glos.

An occasional nosebleed affects up to 60 per cent of people, typically without any complications. The bleed can be eased by sitting, leaning forward and pinching the lower, soft part of the nose for 15 minutes.

Leaning back and pinching the bridge of your nose will not benefit you, as you need the blood to clot, and not just pour down your throat.

Given that you have had recurrent symptoms for some time, a diagnosis is essential.

Almost all nosebleeds (90 per cent) occur at a point on the nasal septum, the partition that divides the two sides of the nose. It is also known as ‘Little’s area’, and is where three large arteries meet.

Bleeding from this region, known as anterior (i.e. at the front) epistaxis (nasal bleeding) is often the result of trauma such as a blow, or irritation of the nasal mucosa (lining). Habitual nose picking is the most common cause.

An occasional nosebleed affects up to 60 per cent of people, typically without any complications. The bleed can be eased by sitting, leaning forward and pinching the lower, soft part of the nose for 15 minutes

An occasional nosebleed affects up to 60 per cent of people, typically without any complications. The bleed can be eased by sitting, leaning forward and pinching the lower, soft part of the nose for 15 minutes

Excessively dry air, such as from air conditioning or heating, can also play a role. So, too, can the increase in blood supply throughout the nasal membranes caused by allergic rhinitis, where the inside of the nose becomes inflamed as a result of an allergy.

Indeed, chronic allergic rhinitis might also help explain your runny nose, which you mention in your longer letter. This can be confirmed with allergy testing.

More rarely, the nosebleed occurs far back in the nose. This is known as posterior epistaxis, and can result in severe haemorrhage.

Recurrent bleeding, whether at the front or back of the nose, is either due to a local cause, or a systemic disorder such as problems with blood clotting, leukaemia, hypertension (high blood pressure) or heart failure.

To rule these out, ask your GP to refer you to an ear, nose and throat (ENT) consultant. They will inspect the nasal lining and likely identify a bleeding point, which can be cauterised to prevent bleeds. They can also identify if the bleeds are due to an allergy.

You have not said whether you are on any regular medication, but I should mention that patients taking anticoagulants for conditions such as atrial fibrillation (a heart rhythm disorder) are at high risk of nosebleeds, because these drugs reduce clotting. So are those who use nasal steroid sprays for allergies, as these can make the nasal lining more fragile.

Write to Dr Scurr 

Write to Dr Scurr at Good Health, Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk — include your contact details. 

Dr Scurr cannot enter into personal correspondence. Replies should be taken in a general context and always consult your own GP with any health worries.

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Coronavirus: Musician, 29, left housebound for a year because of the effects of long Covid

A musician in his twenties claims he has been left housebound for a year because of the debilitating effects of long Covid.

Reece Jacob, 29, from Whalley Range, Manchester, was infected with Covid in March last year.

He says the crippling fatigue he has endured ever since means he can no longer play guitar for more than 20 minutes at a time.

Mr Jacob was diagnosed with myalgic encephalomyelitis (ME) or chronic fatigue syndrome — a long-term condition causing extreme exhaustion, pain and brain fog — last summer by his GP after never fully recovering from the initial infection.

But he has now been referred to a clinic specially designed to treat long Covid, with scientists working round-the-clock to improve their understanding of the condition. 

Up to a fifth of all survivors suffer long-term symptoms, according to the All-Party Parliamentary Group (APPG) on Coronavirus. Other estimates are slightly lower. 

Long Covid is the term given to a group of symptoms that linger for months after a a patient recovers from the illness. The most common side effects are fatigue and ‘brain fog’ — but others can be more serious such as depression and anxiety.

Mr Jacob said he is unable to do anything ‘requiring any cognitive effort’ for more than two hours and 45 minutes a day, or he risks crashing.

Housework is ‘out of the question’ and the most he can cook is meals that take five or ten minutes because that’s the maximum amount of time he can be on his feet for. It has led to him being completely dependent on those around him for simple day-to-day tasks.

Musician Reese, 29, has been left housebound for a year because of the effects of long Covid

Musician Reese, 29, has been left housebound for a year because of the effects of long Covid

He told the BBC: ‘I suffer a range of different symptoms. Fatigue, breathlessness, tight-chested. It often feels like I’m not getting enough air.

‘It’s a real sensation of heaviness, almost like you’re being crushed under the weight of something.

‘When I crash, it’s almost as if somebody has piled sandbags on top of me. 

‘Sometimes the breathlessness goes way out of  control and it feels like I’m going back into that acute phase of the virus again.’ 

Mr Jacob is currently unable to walk for more than 10 minutes at a time and cannot even play video games for more than half an hour, he said.

His first long Covid appointment will be done over the phone on a hands-free handset — so he does not have to hold a phone up for too long — and his girlfriend Alice Phelps will be on hand to help.

Information no longer ‘goes in the same way’, he said, so he needs help comprehending advice from doctors.  

Reece (pictured before he contracted the virus) was infected with Covid in March last year and can no longer play guitar for more than 20 minutes at a time because of its continued symptoms

Reece (pictured before he contracted the virus) was infected with Covid in March last year and can no longer play guitar for more than 20 minutes at a time because of its continued symptoms

He told the BBC: ‘Sometimes the symptoms are so profound I feel like I can’t do anything. I can’t even watch TV.

‘I used to be very active in my work. Being a musician and performing on stage, you’re exerting a huge amount of energy entertaining people.

‘Now, I can play guitar sat down for maybe 20, 30 minutes. This is something I love doing, I miss it.’

But the uncertainty around whether he is going to get better or not have been most distressing part of the illness, he said.

Not knowing whether he will ever be able to return to how he was before Covid feels ‘almost like a grieving process’.

Miss Phelps said: ‘I think you know there are questions that are going to come up if Reece’s health problem sort of stays as it is then we’re going to have to address new issues.

‘The kind of thing that most couples our age would be planning are going to be harder for us at the moment.’

More than 90 per cent of people continue to suffer symptoms at least three months after being hospitalised with Covid, a paper presented to the Scientific Advisory Group for Emergencies (SAGE) has suggested

More than 90 per cent of people continue to suffer symptoms at least three months after being hospitalised with Covid, a paper presented to the Scientific Advisory Group for Emergencies (SAGE) has suggested

The Government is now pumping £18.5million into studying long Covid and has set up 69 clinics specifically for patients with the condition.

It comes after a study presented to No10’s top advisers last month claimed nine in 10 Covid hospital patients suffer lingering symptoms for months after being discharged.

Of 325 survivors across the UK, 93 per cent reported suffering at least one ‘long Covid’ symptom at least three months after recovering.

The most common symptoms were fatigue (77 per cent) and shortness of breath (54 per cent) but nearly a quarter suffered more serious problems with their sight, memory or brain function.

The study, led by Glasgow University, was submitted to the Government’s Scientific Advisory Group for Emergencies (SAGE) on February 25.

SAGE said the study showed that there were three different syndromes associated with long Covid.

It said: ‘The first of these clusters includes fatigue, being breathless on exertion, headache, dizziness, muscle pain, joint pain, disturbance of balance and limb weakness.

‘The second is nested within the first and includes muscle pain, joint pain, disturbance of balance and limb weakness.

‘The third includes loss of smell, taste, difficulty passing urine, weight loss and disturbance of appetite.’ 

What are the long-term symptoms of Covid-19?

Most coronavirus patients will recover within a fortnight, suffering a fever, cough and losing their sense of smell or taste for several days.

However, evidence is beginning to show that the tell-tale symptoms of the virus can persist for weeks on end in ‘long haulers’ — the term for patients plagued by lasting complications.

Data from the COVID Symptom Study app, by King’s College London and health company Zoe, suggests one in ten people may still have symptoms after three weeks, and some may suffer for months.

Long term symptoms include:

  • Chronic tiredness
  • Breathlessness 
  • Raised heart rate
  • Delusions
  • Strokes
  • Insomnia
  • Loss of taste/smell
  • Kidney disease 
  • Mobility issues
  • Headaches
  • Muscle pains
  • Fevers 

For those with more severe disease, Italian researchers who tracked 143 people who had been hospitalised with the disease found almost 90 per cent still had symptoms including fatigue two months after first falling unwell.

The most common complaints were fatigue, a shortness of breath and joint pain – all of which were reported during their battle with the illness. 

Another study in Italy showed one in ten people who lose their sense of taste and smell with the coronavirus – now recognised as a key sign of the infection – may not get it back within a month.

The study, published in the journal JAMA Otolaryngology – Head and Neck Surgery, involved 187 Italians who had the virus but who were not ill enough to be admitted to hospital.

The UK’s Chief Medical Officer Professor Chris Whitty has said the longer term impacts of Covid-19 on health ‘may be significant’.

Support groups such as Long Covid have popped up online for those who ‘have suspected Covid-19 and your experience doesn’t follow the textbook symptoms or recovery time’.

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DNA markers in cells of MDD sufferers appear 2 years older than in healthy controls, researchers say — ScienceDaily

Cells from individuals with Major Depressive Disorder (MDD) were found to have higher than expected rates of methylation at specific sites on their DNA, when compared to cells from healthy individuals without MDD, according to a study by a multidisciplinary team of UC San Francisco scientists, in collaboration with others. Methylation is a process by which DNA is chemically modified at specific sites, resulting in changes in the expression of certain genes. Methylation of particular sets of genes, called “DNA methylation clocks,” typically change in predictable ways as people age, but the rate of these changes varies between people. Methylation patterns in individuals with MDD suggested that their cellular age was, on average, accelerated relative to matched healthy controls.

In the study, published April 6, 2021 in Translational Psychiatry, blood samples from individuals with MDD were analyzed for methylation patterns using the ‘GrimAge’ clock — a mathematical algorithm designed to predict an individual’s remaining lifespan based on cellular methylation patterns. Individuals with MDD showed a significantly higher GrimAge score, suggesting increased mortality risk, compared to healthy individuals of the same chronological age — an average of approximately two years on the GrimAge clock.

The individuals with MDD showed no outward signs of age-related pathology, as they and the healthy controls were screened for physical health before entry into the study. The methylation patterns associated with mortality risk persisted even after accounting for lifestyle factors like smoking and BMI. These findings provide new insight into the increased mortality and morbidity associated with the condition, suggesting that there is an underlying biological mechanism accelerating cellular aging in some MDD sufferers.

“This is shifting the way we understand depression, from a purely mental or psychiatric disease, limited to processes in the brain, to a whole-body disease,” said Katerina Protsenko, a medical student at UCSF and lead author of the study. “This should fundamentally alter the way we approach depression and how we think about it — as a part of overall health.”

MDD is one of the most prevalent health concerns globally. According to the World health Organization, some 300 million people (4.4% of the population) suffer from some form of depression. MDD is associated with higher incidence and mortality related to increased rates of cardiovascular disease, diabetes, and Alzheimer’s disease among sufferers.

“One of the things that’s remarkable about depression is that sufferers have unexpectedly higher rates of age-related physical illnesses and early mortality, even after accounting for things like suicide and lifestyle habits,” said Owen Wolkowitz, MD, professor of psychiatry and a member of UCSF’s Weill Institute for Neurosciences, co-senior author of the study. “That’s always been a mystery, and that’s what led us to look for signs of aging at the cellular level.”

The researchers collected blood samples from 49 individuals with MDD who were unmedicated prior to the study and 60 healthy control subjects of the same chronological age. They analyzed the methylation rates of both groups using the GrimAge clock. While there are numerous methylation-based longevity algorithms, GrimAge is the only one based specifically on methylation patterns associated with mortality.

The researchers say that they don’t yet know if depression causes altered methylation in certain individuals, or if depression and methylation are both related to another underlying factor. It is possible that some individuals may have a genetic predisposition to produce specific methylation patterns in response to stressors, but this has not been well-studied. Alterations in methylation patterns have previously been observed in individuals with Post-Traumatic Stress Disorder.

Moving forward, the researchers hope to determine whether pharmacological treatments or therapy may mitigate some methylation changes related to MDD in hopes of normalizing the cellular aging process in affected individuals before it advances. Although the GrimAge methylation clock has been associated with mortality in other populations, no studies have yet determined whether this methylation pattern also predicts mortality in MDD.

“As we continue our studies, we hope to find out whether addressing the MDD with anti-depressants or other treatments alters the methylation patterns, which would give us some indication that these patterns are dynamic and can be changed,” said Synthia Mellon, PhD, professor in the Department of Ob/Gyn & Reproductive Sciences at UCSF and co-senior author of the study.

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Materials provided by University of California – San Francisco. Original written by Alan Toth. Note: Content may be edited for style and length.

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My sister was a devoted doctor… but I couldn’t help her heal herself

'I was 18 months older but my cheeky little sister was the leader,' says Esther, who is now 31. 'She was confident and fiercely intelligent, with a smile that lit up a room'. Esther is pictured left while Rebecca is pictured right

‘I was 18 months older but my cheeky little sister was the leader,’ says Esther, who is now 31. ‘She was confident and fiercely intelligent, with a smile that lit up a room’. Esther is pictured left while Rebecca is pictured right

As children, Esther and Rebecca Marshall were often mistaken for twins. 

‘I was 18 months older but my cheeky little sister was the leader,’ says Esther, who is now 31. 

‘She was confident and fiercely intelligent, with a smile that lit up a room.’

Their parents, both busy London GPs, also worked in hospital outpatient clinics, so the two girls and their sister Sara, who is five years younger than Esther, would often go there after school, chatting to staff while they waited for their parents to finish their shifts.

‘There was no question that Rebecca would follow them into medicine,’ says Esther. 

‘She had an amazing brain — she could memorise whole textbooks — combined with a deep desire to help people.’

But the perfectionism, drive and compassion that marked Rebecca out as a gifted medical student were the very traits that would send her mental health spiralling.

In February last year, Rebecca, who had been diagnosed with bipolar disorder eight months before, took her own life at the age of 28. 

She thought she would never be able to follow her dream of being a doctor and could see no other future for herself, her sister says.

Bipolar disorder affects about 1.3 million people in the UK. Once called manic depression, it is characterised by mood swings, from manic highs to suicidal lows, with each cycle typically lasting several weeks.

It is thought people are born with a genetic predisposition towards bipolar, but lifestyle factors such as stress and poor sleep play a part. As sufferers all experience it differently, it is very difficult to recognise and treat. The charity Bipolar UK estimates that, on average, those affected wait eight years for a diagnosis.

Rebecca’s symptoms began in 2010 in her first year at medical school, but it was eight years and a series of depressive and manic episodes before the condition was diagnosed.

Whether Rebecca would still be alive if her bipolar had been recognised earlier is impossible to know. 

While Esther studied geography at the University of Leeds and then pursued a corporate career, Rebecca began her medical training at University College Hospital in London. They are pictured above together as children

While Esther studied geography at the University of Leeds and then pursued a corporate career, Rebecca began her medical training at University College Hospital in London. They are pictured above together as children

‘That’s something that keeps me awake at night,’ says Esther, ‘because I will forever feel responsible. I was her big sister. I’d kept her alive all those years she was ill — why couldn’t I stop her killing herself?’

Grief counselling has helped, she says, ‘as has talking to hospital consultants and to other people with bipolar, who have assured me that as soon as Rebecca made the decision to end her life, there was nothing anyone could have done’.

Esther believes the signs Rebecca was struggling were there while she was still at school. At 16, she passed her GCSEs with top marks — but Esther noticed she had started to withdraw and was losing some of her natural spark.

‘She was at a highly pressurised private school and felt a constant drive to achieve,’ says Esther. ‘She worked herself into a frenzy, never believing she was good enough.’

While Esther studied geography at the University of Leeds and then pursued a corporate career, Rebecca began her medical training at University College Hospital in London. 

‘That was when things really started to unravel,’ says Esther. ‘She became extremely fastidious about what she ate; and she began to self-harm. The first time I saw what she’d done, I was so horrified by the sight of it that I threw up.

‘I felt so helpless. I remember sitting with her and asking: ‘Do you think going into medicine is the best thing for you?’ I thought she might be worried that if she quit, she would feel she’d let everyone down. She seemed utterly lost.’

The perfectionism, drive and compassion that marked Rebecca out as a gifted medical student were the very traits that would send her mental health spiralling

The perfectionism, drive and compassion that marked Rebecca out as a gifted medical student were the very traits that would send her mental health spiralling

Esther persuaded Rebecca to talk to her GP, who prescribed the antidepressant sertraline, and to their parents, who were desperately sad and worried.

‘I felt I was the mediator,’ says Esther, ‘constantly trying to understand what she was feeling and how we could help.’

In the summer of 2017, Rebecca qualified as a doctor. But she found the following three months working in A&E difficult to cope with.

‘It’s a place where, as hard as she tried to save people, they still died,’ says Esther. ‘If you have a predisposition to mental illness, anxiety around making the right call, and the guilt and stress when you feel you haven’t got it right, can send you spiralling.’

That November, Rebecca was at a conference when she began to behave in a way that alarmed her friends, all fellow doctors. ‘She was talking very fast and not making sense,’ says Esther.

Realising things weren’t right, her friends took her home.

With their parents away in New Zealand, it fell to Esther to look after her sister. She managed to coax Rebecca to go to a nearby hospital — but as it was a Sunday, there was no psychiatrist on duty and they were sent home.

‘There were moments of complete lucidity when she’d say, ‘Esther, I know what’s happening. I’m having a psychotic episode; these are the drugs I need . . .’ ,’ recalls Esther. ‘The next moment she had no idea who I was and she’d be reciting a 30-page medical paper word for word. It was terrifying and terrorising. I’ve never felt so out of my depth in my life.’

Psychosis is where you believe things are happening that aren’t real, and see and hear things that aren’t there. It is initially treated with anti-psychotic drugs, but it would be five days before a bed on a psychiatric ward became available for Rebecca.

‘She was awake for five days and nights,’ says Esther. ‘She paced the flat, regurgitating medical jargon, while I hounded local hospitals to find her a bed and crisis teams called me to tell me what I had to do to keep her safe.

‘The only thing that seemed to help was playing classical music. For short periods she would sit in a corner, rocking to and fro, making the most painful, piercing screams I’ve ever heard.’

In hospital, Rebecca was given various drugs to help her sleep. ‘They stopped the psychosis but, depending on the drug she’d been given and the dose, I might get a very emotional sister when I visited, or someone who was incredibly angry,’ says Esther. ‘Then she’d shout: ‘Why have you come? Leave me alone!’ I’d sit outside and cry my eyes out.’

After a month, Rebecca was well enough to move back in with her parents. ‘We learnt very quickly during that year to recognise the signs of anxiety and sleeplessness which were often the triggers for mania,’ says Esther. ‘Rebecca hated the anti-psychotic medication because it made her put on weight, so she’d secretly stop taking it, then spiral again.’

The birth of Esther’s baby boy with husband Adam in August 2018 was a high point in a year of almost unremitting worry.

‘The depressive periods were hard,’ says Esther. ‘Rebecca would become extremely self-deprecating. She’d mention suicide. She would stop seeing friends and stop drawing and painting, which she had found very therapeutic.’

Rebecca was there on the day Asher was born and loved to be with him. But over the next 18 months, she was in and out of hospital. She was diagnosed with depression, then anxiety, then psychotic depression — depression with episodes of psychosis. ‘It wasn’t until a wonderful consultant said ‘I need to look at you in a holistic way’ that she was finally diagnosed with bipolar disorder,’ says Esther.

Rebecca was prescribed an anti-psychotic drug and lithium, a mood stabiliser.

Guy Goodwin, an emeritus professor of psychiatry at Oxford University, explains why bipolar is so often not recognised earlier.

‘It tends to begin in young people at a time when there is an awful lot going on in their lives,’ he says. 

‘It may co-exist with eating disorders or alcohol abuse or self-harm, so a complex, fraught picture can develop which masks what is really going on. Since it usually starts as depression, true bipolarity only emerges later when the patient experiences mood elevation.

‘Added to that, we have a system that isn’t well-adapted to recognising bipolar disorder. It is given no priority in early intervention and there are few NHS services specialised in its treatment.

‘When young people with severe illness are treated for a manic episode, they often recover well initially but don’t get adequate care after discharge from hospital, even though it takes them a long time to recover fully.

‘Sufferers have to learn to live within their emotional means.’

This takes knowledge and experience (‘psychoeducation’), which good services may provide. It also means regular habits of sleep and exercise and avoiding stressors such as irregular working hours. 

And it often also requires long-term use of medication, Professor Goodwin says. ‘The objective is to prevent relapse either to depression or mania, which is common and disruptive to relationships and occupational success.’

Although most people with bipolar do eventually learn to manage their condition, it is known to increase the risk of suicide substantially, particularly in the first ten years after diagnosis.

On a new combination of drugs, Rebecca’s condition seemed to stabilise; by January last year she had been well for eight months and was working at a GP practice, in an admin role where she could use her medical knowledge.

‘She was seeing friends and joining family dinners,’ says Esther. ‘And she’d come over to see me and Asher most days. I felt things were looking up.’

But on January 27, a day when she knew both her parents had evening surgeries, Rebecca stripped the sheets from her bed and the pictures from the walls in her room, then left the house with the things she needed to end her life.

Esther had just put Asher to bed when her mum called to say Rebecca was missing.

‘I was sure she wanted to be found,’ says Esther, ‘so when the police knocked on the door, I wasn’t expecting them to tell us they had discovered her body.

‘I remember standing up and screaming, then ringing Adam to say: ‘She’s actually done it.’ I would have cared for my wonderful sister for the rest of her life — but that isn’t what she wanted.’

On the day Rebecca died, Esther composed an email to friends. ‘It was one of the hardest things I have ever done and I cried and cried,’ she says. ‘But as soon as I hit ‘send’, the sky went dark and a rainbow came out. When I looked out on this beautiful sight, I thought: she’s telling us that after all she has suffered, she’s safe.’

Studies of suicide among doctors suggest that female doctors are up to four times more likely to take their own lives. 

Dame Clare Gerada, a GP and medical director of the NHS Practitioner Health programme, which provides confidential advice for doctors and dentists, chairs the charity Doctors in Distress set up after cardiologist Jagdip Sidhu took his own life in 2018. 

‘I run a group for families of doctors who killed themselves — one of the universal factors is shame,’ she says. 

‘There is an unwritten rule that doctors don’t get sick. Admitting you have a serious mental illness is still taboo.’

Dame Clare explains that the very personality traits that predict whether people will make good doctors — including competitiveness, perfectionism and drive — can act against them.

‘They blame themselves for not being able to deliver the care required by their patients, and feel guilty for events beyond their control,’ she says.

Soon after Rebecca’s death, Esther decided to leave her high-powered corporate job (improving diversity at a multinational company) to focus on the series of books for children that the two sisters had discussed writing and illustrating when Rebecca was ill.

‘We couldn’t find books for Asher that promoted good mental health and diversity, so we decided we’d write some together,’ she says. The Sophie Says series, in which a young girl explores her feelings, are a way for Esther to continue her sister’s legacy.

Last year, Esther was invited to Buckingham Palace to speak to Meghan and Harry about her work. She has also won several awards.

Last week, Bipolar UK launched a commission on the problems around recognition, diagnosis and treatment of bipolar disorder, in hope that it can focus the minds of policymakers at a time when there are promises to increase the mental health budget.

The loss of Rebecca remains intensely raw for Esther, her parents and her youngest sister. In the books the two elder sisters dreamed up together, rainbows feature on every page.

‘Rebecca is also in every NHS rainbow in every window,’ Esther says. ‘And in the middle of the night when I can’t sleep, she is by my side, telling me everything is going to be OK.’

Esther Marshall is a mental health activist and the author of the Sophie Says children’s books (£5.99, from sophiesaysofficial.com or amazon.co.uk). For confidential support, call the Samaritans on 116 123 or visit samaritans.org

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Study findings may help explain patients’ complaints of poor concentration and other cognitive symptoms that accompany sinusitis — ScienceDaily

The millions of people who have chronic sinusitis deal not only with stuffy noses and headaches, they also commonly struggle to focus, and experience depression and other symptoms that implicate the brain’s involvement in their illness.

New research links sinus inflammation with alterations in brain activity, specifically with the neural networks that modulate cognition, introspection and response to external stimuli.

The paper was published today in JAMA Otolaryngology-Head & Neck Surgery.

“This is the first study that links chronic sinus inflammation with a neurobiological change,” said lead author Dr. Aria Jafari, a surgeon and assistant professor of Otolaryngology-Head & Neck Surgery at the University of Washington School of Medicine.

“We know from previous studies that patients who have sinusitis often decide to seek medical care not because they have a runny nose and sinus pressure, but because the disease is affecting how they interact with the world: They can’t be productive, thinking is difficult, sleep is lousy. It broadly impacts their quality of life. Now we have a prospective mechanism for what we observe clinically.”

Chronic rhinosinusitis affects about 11% of U.S. adults, according to the Centers for Disease Control and Prevention. The condition can necessitate treatment over a span of years, typically involving antibiotics. Repeated cycles of inflammation and repair thicken sinus tissues, much like calloused skin. Surgery may resolve the issue, but symptoms also can recur.

The researchers identified a study cohort from the Human Connectome Project, an open-access, brain-focused dataset of 1,206 healthy adults ages 22-35. Data included radiology image scans and cognitive/behavioral measurements.

The scans enabled them to identify 22 people with moderate or severe sinus inflammation as well as an age- and gender-matched control group of 22 with no sinus inflammation. Functional MRI (fMRI) scans, which detect cerebral blood flow and neuronal activity, showed these distinguishing features in the study subjects:

  • decreased functional connectivity in the frontoparietal network, a regional hub for executive function, maintaining attention and problem-solving;
  • increased functional connectivity to two nodes in the default-mode network, which influences self-reference and is active during wakeful rest and mind-wandering;
  • decreased functional connectivity in the salience network, which is involved in detecting and integrating external stimuli, communication and social behavior.

The magnitude of brain-activity differences seen in the study group paralleled the severity of sinus inflammation among the subjects, Jafari said.

Despite the brain-activity changes, however, no significant deficit was seen in the behavioral and cognitive testing of study-group participants, said Dr. Kristina Simonyan, a study co-author. She is an associate professor of otolaryngology-head & neck surgery at Harvard Medical School and director of laryngology research at Massachusetts Eye and Ear.

“The participants with moderate and severe sinus inflammation were young individuals who did not show clinically significant signs of cognitive impairment. However, their brain scans told us a different story: The subjective feelings of attention decline, difficulties to focus or sleep disturbances that a person with sinus inflammation experiences might be associated with subtle changes in how brain regions controlling these functions communicate with one another,” said Simonyan.

It is plausible, she added, that these changes may cause more clinically meaningful symptoms if chronic sinusitis is left untreated. “It is also possible that we might have detected the early markers of a cognitive decline where sinus inflammation acts as a predisposing trigger or predictive factor,” Simonyan said.

Jafari sees the study findings as a launch pad to explore new therapies for the disease.

“The next step would be to study people who have been clinically diagnosed with chronic sinusitis. It might involve scanning patients’ brains, then providing typical treatment for sinus disease with medication or surgery, and then scanning again afterward to see if their brain activity had changed. Or we could look for inflammatory molecules or markers in patients’ bloodstreams.”

In the bigger picture, he said, the study may help ear-nose-throat specialists be mindful of the less-evident distress that many patients experience with chronic sinusitis.

“Our care should not be limited to relieving the most overt physical symptoms, but the whole burden of patients’ disease.”

Study funding was provided by the National Institute on Deafness and Other Communication Disorders (R01DC011805), part of the National Institutes of Health (NIH). Data were provided in part by the Human Connectome Project, which is funded by 16 NIH institutes and centers (1U54MH091657).

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Blood test for depression, bipolar disorder — ScienceDaily

Worldwide, 1 in 4 people will suffer from a depressive episode in their lifetime.

While current diagnosis and treatment approaches are largely trial and error, a breakthrough study by Indiana University School of Medicine researchers sheds new light on the biological basis of mood disorders, and offers a promising blood test aimed at a precision medicine approach to treatment.

Led by Alexander B. Niculescu, MD, PhD, Professor of Psychiatry at IU School of Medicine, the study was published today in the high impact journal Molecular Psychiatry . The work builds on previous research conducted by Niculescu and his colleagues into blood biomarkers that track suicidality as well as pain, post-traumatic stress disorder and Alzheimer’s disease.

“We have pioneered the area of precision medicine in psychiatry over the last two decades, particularly over the last 10 years. This study represents a current state-of-the-art outcome of our efforts,” said Niculescu. “This is part of our effort to bring psychiatry from the 19th century into the 21st century. To help it become like other contemporary fields such as oncology. Ultimately, the mission is to save and improve lives.”

The team’s work describes the development of a blood test, composed of RNA biomarkers, that can distinguish how severe a patient’s depression is, the risk of them developing severe depression in the future, and the risk of future bipolar disorder (manic-depressive illness). The test also informs tailored medication choices for patients.

This comprehensive study took place over four years, with over 300 participants recruited primarily from the patient population at the Richard L. Roudebush VA Medical Center in Indianapolis. The team used a careful four-step approach of discovery, prioritization, validation and testing.

First, the participants were followed over time, with researchers observing them in both high and low mood states — each time recording what changed in terms of the biological markers (biomarkers) in their blood between the two states.

Next, Niculescu’s team utilized large databases developed from all previous studies in the field, to cross-validate and prioritize their findings. From here, researchers validated the top 26 candidate biomarkers in independent cohorts of clinically severe people with depression or mania. Last, the biomarkers were tested in additional independent cohorts to determine how strong they were at predicting who is ill, and who will become ill in the future.

From this approach, researchers were then able to demonstrate how to match patients with medications — even finding a new potential medication to treat depression.

“Through this work, we wanted to develop blood tests for depression and for bipolar disorder, to distinguish between the two, and to match people to the right treatments,” said Niculescu. “Blood biomarkers are emerging as important tools in disorders where subjective self-report by an individual, or a clinical impression of a health care professional, are not always reliable. These blood tests can open the door to precise, personalized matching with medications, and objective monitoring of response to treatment.”

In addition to the diagnostic and therapeutic advances discovered in their latest study, Niculescu’s team found that mood disorders are underlined by circadian clock genes — the genes that regulate seasonal, day-night and sleep-wake cycles.

“That explains why some patients get worse with seasonal changes, and the sleep alterations that occur in mood disorders,” said Niculescu.

According to Niculescu, the work done by his team has opened the door for their findings to be translated into clinical practice, as well as help with new drug development. Focusing on collaboration with pharmaceutical companies and other doctors in a push to start applying some of their tools and discoveries in real-world scenarios, Niculescu said he believes the work being done by his team is vital in improving the quality of life for countless patients.

“Blood biomarkers offer real-world clinical practice advantages. The brain cannot be easily biopsied in live individuals, so we’ve worked hard over the years to identify blood biomarkers for neuropsychiatric disorders,” said Niculescu. “Given the fact that 1 in 4 people will have a clinical mood disorder episode in their lifetime, the need for and importance of efforts such as ours cannot be overstated.”

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US coronavirus: US health leaders are preparing for all scenarios — including another wave of Covid-19 cases

But now is no time to let up on safety measures — for several reasons — according to experts.

More than 54,000 people remain hospitalized with the virus nationwide, according to the COVID Tracking Project. And more than 57,000 Covid-19 deaths have been recorded this month alone. On Wednesday, California became the first state to surpass 50,000 virus-related deaths, Johns Hopkins data showed — a grim reminder of the state’s brutal battle against the virus.

In fact, health officials are preparing for a possible third wave that will be driven by a rapidly spreading variant that was first identified in the UK: B.1.1.7. Data from the CDC shows more than 1,880 cases of the variant have been detected across the US — but scientists have warned that number likely doesn’t represent the total of cases in the country.

Experts worry variant-fueled Covid-19 surge may be weeks away but cases will likely fall again by summer

“CDC scientists estimate that the B.1.1.7 variant will be the predominant form of the virus by mid to late March,” CDC Director Dr. Rochelle Walensky said Wednesday during a webinar held by the American Public Health Association.

One report, from Mike Osterholm and his colleagues at the University of Minnesota’s Center for Infectious Disease Research and Policy, says with cases of the variant rapidly increasing in some areas, “a major peak in cases, hospitalizations and deaths in the near future remains a strong possibility.”
Meanwhile, two separate teams of researchers said they’ve found a worrying new variant in New York City and other areas in the Northeast that carries mutations helping it evade the body’s natural immune response — as well as the effects of monoclonal antibody treatments.
And two studies due to come out soon raise concerns about a variant that scientists have been keeping an eye on in California, hinting the variant might not only be more contagious, but may also cause more severe disease.
Vanessa Garnes, head supervisor of Nurse's Heart Medical Staffing based in Columbus, Ohio administers a Covid-19 test on  February 21, 2021

A third vaccine for US could be just days away

But there is good news. The US could be just days away from getting another vaccine on the market.
Vaccine advisers to the Food and Drug Administration will meet on Friday to determine if the Johnson & Johnson vaccine works and if it’s safe. They will make a recommendation to the FDA and the agency could give the vaccine the green light as early as Friday or Saturday. Then, advisers to the CDC are scheduled to meet Sunday to discuss recommendations surrounding the vaccine’s potential rollout — recommendations that would have to be formally accepted by the CDC.
Johnson & Johnson Covid-19 vaccine is safe and effective, FDA analysis finds
And things are already looking good: In an analysis released on Wednesday, the FDA said the Johnson & Johnson vaccine has met the requirements for an emergency use authorization.

The efficacy of the vaccine against moderate to severe/critical Covid-19 across all geographic areas was 66.9% at least 14 days after the single-dose vaccination and 66.1% at least 28 days after vaccination, according to the analysis.

“There were no specific safety concerns identified in subgroup analyses by age, race, ethnicity, medical comorbidities, or prior SARS-CoV-2 infection,” the analysis said.

Millions more vaccine doses on their way

And while the US has struggled with supply shortages as it works to get Americans vaccinated, numbers will ramp up in the coming months.

Questions remain on J&J Covid-19 vaccine rollout as authorization decision approaches
Pfizer and Moderna — whose vaccines were already authorized for emergency use — have pledged to make a combined total of 220 million doses available for shipment by the end of March. Meanwhile, Johnson & Johnson, if it secures an emergency use authorization, has pledged to make 20 million doses available in the same time frame.
And a fourth Covid-19 vaccine could become available in the US in April — which could add millions more doses to the country’s supply by the end of that month.
President Joe Biden has previously said the US will have enough vaccines for 300 million Americans by the end of July.

Other challenges faced by national and state leaders are the issues of vaccine hesitancy and racial inequalities.

Kentucky Gov. Andy Beshear announced Wednesday an initiative in collaboration with the Lexington chapter of the National Association for the Advancement of Colored People (NAACP) to provide equitable access to vaccines and tackle hesitancy.

According to a news release from the governor’s office, while Black people make up about 8.4% of the state’s population, they account for about 4.6% of people who have been vaccinated so far.
Lack of equity within priority groups leaves Covid-19's most vulnerable without vaccine, analysis suggests

Rev. Jim Thurman, president of the NAACP Lexington-Fayette County Branch, said he understands the hesitancy in his community, saying he himself was initially reluctant to get vaccinated for historical reasons.

“I soon realized that it was safe and that you couldn’t get the virus from the vaccine,” Thurman said. “COVID-19 was, and still is, hitting the African-American community and other communities of people of color, much harder. We need the vaccine.”

California officials, meanwhile, said they will make changes to the statewide Covid-19 vaccine appointment system after access codes distributed to underserved communities were used by outsiders to secure vaccine appointments.

Recent data shows Black and Latino residents collectively have received a combined 19% of the state’s vaccine doses while accounting for nearly 60% of California’s Covid-19 cases. In contrast, White residents have been given 32.7% of vaccine doses while making up about 20% of the state’s cases.

A new initiative for long-haulers

Meanwhile, a major announcement came this week for those who may still be dealing with Covid-19 aftermath for a long time after their bout with the virus.

Almost a third of people with 'mild' Covid-19 still battle symptoms months later, study finds
The National Institutes of Health announced a new initiative to study “Long Covid” and “to identify the causes and ultimately the means of prevention and treatment of individuals who have been sickened by Covid-19, but don’t recover fully over a period of a few weeks,” NIH Director Dr. Francis Collins said in a statement.

The director said “large numbers of patients” who were infected with the virus continue to experience a range of symptoms long since they’ve recovered, which can include sleep disorders, shortness of breath, fatigue and depression.

Clinics are springing up around the country for what some call a potential second pandemic: Long Covid

“While still being defined, these effects can be collectively referred to as Post-Acute Sequelae of SARS-CoV-2 infection (PASC),” the statement said.

“We do not know yet the magnitude of the problem, but given the number of individuals of all ages who have been or will be infected with SARS-CoV-2, the coronavirus that causes COVID-19, the public health impact could be profound,” it added.

The statement says that back in December, Congress provided $1.15 billion in funding over four years for NIH to support research into the prolonged effects of an infection.

Some of the questions the initiative hopes to answer, Collins said, include, what are the underlying biological causes of the prolonged symptoms and what makes some people vulnerable to them but not others.

CNN’s Ben Tinker, Naomi Thomas, Amanda Watts, Jen Christensen, Maggie Fox, Cheri Mossburg and Christopher Rios contributed to this report.

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Congressional Republicans risk backlash as they unite against Biden’s Covid relief plan

After losing control of the White House and the US Senate in November, and still relegated to the minority in the US House, Republican leaders hope to win back suburban voters in 2022, in part by earning their trust that they would do a better job than Democrats easing the transition back to normal life after the Covid-19 pandemic. One area the GOP has been heavily focused on is getting kids back into school, for example, because they see it as a winning issue at the ballot box in 2022. Yet their opposition to Biden’s legislation could complicate those efforts, since many members will likely end up on the record voting against a Covid relief bill that would provide money for exactly that purpose.
Republicans are attempting to sharpen their arguments against legislation that is intended to help speed up the delivery of vaccines; send direct payments of up to $1,400 to Americans making up to $75,000 annually; extend key pandemic unemployment programs; provide aid to struggling small business owners; and dedicate nearly $130 billion for K-12 schools to make safety improvements aimed at allowing them to reopen (or stay open).
The thorniest issue within the bill is the proposed increase of the federal minimum wage to $15 an hour by 2025, which Republicans argue would cripple small businesses. The minimum wage proposal is also dividing Democratic senators, with both Sens. Joe Manchin of West Virginia and Kyrsten Sinema of Arizona expressing concerns about what the effect of the proposal would be. Democrats have thin margins in both chambers, relying on Vice President Kamala Harris to break ties in the evenly divided Senate, so they cannot afford to lose any Democratic support for the relief package.

House Minority Leader Kevin McCarthy described the legislation Wednesday as too expensive and riddled with projects that amount to gifts to Democrats’ liberal constituencies. Senate Minority Leader Mitch McConnell has amplified that argument by alleging that the Democrats’ bill contains “hundreds of millions of dollars for pet projects without a shred of relevance to the pandemic or the recovery.”

“I think all Americans agree (with) exactly what Republicans wanted to have happen,” McCarthy said during a GOP news conference Wednesday, where he noted that he hadn’t spoken to any GOP House members who support the bill. “We want to go back to work, back to school, back to health. Unfortunately this bill is too costly, too corrupt, and too liberal.”

“This is the wrong path and this is not what President Biden said he would do at the inaugural,” McCarthy said. “This seems like a payout for those who agree with them politically,” he said of Democrats.

One strategy that McConnell, McCarthy and House GOP Whip Steve Scalise are now deploying is to draw attention to funding projects within the bill that are tied to the districts and states of key Democratic leaders. The House GOP leaders singled out two examples on Wednesday: a $100 million rapid transit project in the Bay Area in the home state of House Speaker Nancy Pelosi and $1.5 million that would be spent on the Seaway International Bridge over the St. Lawrence River between Canada and upstate New York, which is Senate Majority Leader Chuck Schumer’s home state.

Democrats' struggles to stay united are just beginning on Covid relief and Cabinet watch

“Who said a subway to Silicon Valley has anything to do with Covid?” Scalise said. McCarthy argued that Americans were watching “the swamp come back to Washington” — echoing a favorite phrase of former President Donald Trump. But CNN’s Alex Rogers reports that Democratic aides argue the money is needed for both infrastructure projects because local revenue and money from tolls has decreased during the pandemic.

Schumer warned that Republicans were proceeding at their own political peril, pointing to a letter sent to congressional leaders from more than 150 business leaders, and first obtained by CNN, arguing that Congress should pass Biden’s American Rescue Plan. The letter noted that “more than 10 million fewer Americans are working today than when the pandemic began, small businesses across the country are facing bankruptcy, and schools are struggling to reopen.”

“The Covid pandemic is the worst economic crisis since the Great Depression, the worst public health crisis our nation has faced in 100 years,” Schumer said in a floor speech where he sought to use that letter from business leaders as a cudgel.

“But our Republican colleagues say all these groups demanding the $1.9 trillion American rescue plan — business leaders, government officials from both parties, economists from across the spectrum and seven in 10 Americans — Republicans say all of them are wrong.”

If the GOP still wants to oppose the bill despite that broad support, the Democratic leader said, “My response is: good luck.”

Promising news on Johnson & Johnson vaccine

While the Biden administration may not be making much headway in their quest for bipartisan agreement on Covid relief, they did get some welcome news on Wednesday about the single-dose Johnson & Johnson vaccine, which they hope will expand the number of doses available to Americans at a time when demand still is vastly outstripping supply.

Before he took office, Biden promised that his administration would oversee 100 million shots in arms in his first 100 days — a goal that his aides described as “ambitious.” But the US was already on track to hit that goal by the time Biden took office on January 20, leading to debate over whether his administration was setting the bar too low. When asked Wednesday how the Johnson & Johnson vaccine doses coming on line would affect that goal, White House Covid-19 response coordinator Jeff Zients acknowledged that they are “pacing ahead of that goal” and said the President “pushes us every day” to do more.

“We view the 100 million shots in a 100 days as a floor and we intend to exceed that goal,” Zients said.

The US Food and Drug Administration released an analysis on Wednesday stating that the Johnson & Johnson vaccine has met requirements for emergency use authorization, a decision that the FDA is expected to make soon. The clinical trials showed that the vaccine was 85% effective in preventing severe disease.

The company is prepared to ship nearly 4 million doses of the vaccine immediately, according to testimony from Johnson & Johnson’s vice president of US medical affairs, Dr. Richard Nettles, to the House Energy and Commerce Oversight and Investigations panel Tuesday. Company officials have said they can deliver enough doses through the end of the March to vaccinate 20 million Americans, once the vaccine is authorized for emergency use.

Initially White House officials and advisers expected to receive more doses of the Johnson & Johnson vaccine sooner, but the explanation for the delay has not been clear. The company has said it will fulfill its contractual obligation to deliver 100 million doses by the end of June.

“We will waste no time getting this lifesaving vaccine into the arms of Americans,” Zients said at Wednesday’s virtual Covid response team briefing.

Though Johnson & Johnson was behind on manufacturing when the Biden team arrived at the White House five weeks ago, Zients said they “are in a better place now.” He said the administration has helped the company with equipment and raw materials to increase their capacity to produce the vaccine more quickly.

“It was disappointing when we arrived,” Zients said. “I think the progress is real and we look forward to continuing to work with the company to accelerate their delivery and their capacity.”

White House press secretary Jen Psaki also acknowledged Wednesday that the amount of initial doses that will be available is less than half than what the administration originally expected.

“We were surprised to learn that Johnson & Johnson was behind on their manufacturing,” Psaki said during her press briefing. “As you noted, it was kind of reported earlier to be about 10 million and now it’s more like 3 to 4 million doses that they would be ready to ship next week if they are moved through the FDA process, which is not yet concluded.”

While the Biden administration does not have full control over the schedule of vaccine manufacturers or what changes Congress may make to their Covid-19 relief bill, they are still taking some steps unilaterally to try to ramp up the nation’s Covid-19 response.

On Wednesday White House officials said they will begin delivering millions of masks in the month of March to food banks and community health centers, stating that many low-income Americans still lack affordable access to masks. Ultimately about 25 million cloth masks will be delivered to 1,300 community health centers and about 60,000 food pantries and soup kitchens at a cost of about $86 million, officials said. The Trump administration had considered distributing masks to Americans, but the move was blocked by the former President.

“Not all Americans are wearing masks regularly. Not all Americans have access. And not all masks are equal,” Zients said. “With this action, we are helping to level the playing field, giving vulnerable populations quality well-fitting masks.”

It was a gesture that Biden administration officials said demonstrated their commitment to equity and a focus on the most vulnerable populations, but the simplicity of the move also highlighted the limits of the remaining actions that Biden may be able to take on his own without assistance from Congress.

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Man dies after police kneel on his neck for nearly 5 minutes, family says in wrongful death claim

Angelo Quinto had been “suffering from anxiety, depression, and paranoia for the previous few months,” his family’s attorneys said in a wrongful death claim, filed on February 18.

His sister Isabella Collins called police to their Antioch, California, home on December 23 because she feared he would hurt their mother, family lawyer John L. Burris said during a February 18 press conference.

Before police arrived, Quinto’s mother had been holding him to her chest with her hands clasped around his back for a few minutes, and “he had already started to calm down,” the claim stated. When two officers from the Antioch Police Department arrived, Burris said they made no attempt to understand the situation and instead, immediately grabbed Quinto from his mother’s arms.

Quinto lost consciousness and was taken to a local hospital, where he was pronounced dead three days later, family attorneys say in the claim.

Maria Quinto-Collins, Quinto’s mother, used her cell phone to record part of the incident.

“What happened?,” she says breathlessly as Quinto is seen not moving and laying on his front. Officers roll him over to carry his body out, and his face is bloody. He is moved to a gurney and paramedics administer chest compressions on Quinto as his mother records on her phone, asking questions.

Quinto's mother and sister.

It was not clear from the video if the officers were wearing body cameras.

“As far as we know, they were not,” Burris said last week.

In the nearly two months since Quinto’s death, police have not issued a press release on the incident. The Antioch Police Department and the Contra Costa County Sheriff’s Coroner’s Division did not respond to requests for comment Monday.

“These Antioch police officers had already handcuffed Angelo but did not stop their assault on the young man and inexplicably began using the ‘George Floyd’ technique of placing a knee on the back and side of his neck, ignoring Mr. Quinto pleas of ‘please don’t kill me,'” Burris said.

Quinto’s cause of death is still pending, the Contra Costa County Sheriff Coroner’s office told CNN on Monday. His death is under investigation by the Contra Costa County District Attorney’s office.

Isabella Collins said she called police in hopes they would help de-escalate the situation.

“I don’t think I will ever not feel bad,” she told CNN affiliate KGO. “If it was the right thing to do, it wouldn’t have killed my brother.”

The Antioch city clerk and attorney’s office did not respond to requests for comment.

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Pandemic stress is causing paranoia

“What do you need it for? What are you going to do with it?” my colleague asked me, Zoom eyes wide with fear.

“Whoa there,” I wanted to say. There was no need to get concerned.

I had simply asked a coworker for a straightforward piece of information that in normal times would have evoked little more than an “OK, no problem,” in response.

Of course, these aren’t normal times.

It wasn’t just my coworker. I noticed that so many people in my life — friends, family, even myself since I’m being honest — had taken a pill from the paranoid jar. Everyone seemed jumpier, more nervous, frightened, even when it came to topics that had little to do with the deadly contagion knocking on doors all around us. I talked to an immunocompromised ICU nurse, a schoolteacher, a transit worker’s spouse. All agreed they were more paranoid since Covid-19 overtook daily life.

Mental health is one of the biggest pandemic issues we'll face in 2021

“Especially with having a kiddo with a medical history,” said Stefani Seeley, a stay-at-home mom who lives in Texas. “We scrutinize every little thing we do now. Add to that the anxiety I have that our kids won’t get over the trauma of the experience,” she said.

Paranoia, it seemed, was just as widespread as the coronavirus, perhaps more.

Pandemic paranoia is a real thing

“The pandemic has brought on great uncertainty and stress,” said Dr. Bandy X. Lee, a New York City-based forensic psychiatrist and violence expert with a long list of achievements, including having taught at Yale School of Medicine and Yale Law School and served as a fellow of the National Institute of Mental Health and consultant to the World Health Organization. Lee is currently president of the World Mental Health Coalition.

The John Hopkins Psychiatry Guide defines paranoia as “a response to perceived threats that is heavily influenced by anxiety and fear, existing along a continuum of normal, reality-based experience to delusional beliefs.”

The symptoms of paranoia can range from the very subtle to completely overwhelming and can exist with or without other mental conditions, according to Lee and major medical associations. People don’t need to have diagnosable mental health disorders to have paranoid thoughts or feelings.

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“Given the stress and uncertainty and the misinformation that is being provided by news outlets and different sources, it is difficult for people to feel a sense of calm, increasing people’s anxiety, which can lead to paranoid thoughts,” said Adam Borland, a Cleveland-based clinical psychologist who has seen an uptick in patients who are experiencing paranoid thoughts and feelings since Covid-19 became widespread.

The trifecta of the pandemic, required social isolation and social unrest has driven many of us to more extreme behavior and worries, including paranoia. The pandemic has also brought on an uncertain economic environment, where people worry about whether they might be on the verge of losing their livelihood (and with good reason, as many have lost their jobs). The active disinformation environment about both the pandemic and other issues perpetuated by historically trusted institutions, like the US government and office of the President, has also caused people to distrust the information they are receiving and the people disseminating it.
People with multiple mental disorders may age several years faster, study finds

“The exceptionally prolonged lockdown because of ineffective management and the subsequent social disruptions and economic misery — in many ways worse than the Great Depression, with tremendous inequities, hunger, homelessness, unemployment, and despair — are already leading to rampant drug addiction, depression, suicides, and homicides,” Lee said.

“Meanwhile, we now have a large segment of the population that has been encouraged and conditioned to avoid reality. When living in delusion, detached from reality, one naturally becomes paranoid because facts and evidence are constantly ‘attacking’ these false, cherished beliefs,” she said.

Learning to identify the paranoia

Paranoia isn’t new to me. I grew up in a house with a parent who had severe paranoia. I constantly questioned whether the information I was being fed was real or fantastical.

Keep paying attention to your kids' mental health in this pandemic

I have always been hyperaware of how paranoid thinking can take over your reality and have fought hard not to become that person who can no longer draw the line between fact and fiction.

That said, I have inherited the tendency to take any situation and imagine its extreme worst-case outcome. For many, that may feel like a terrible place to be mentally. For me, it has been justification for why I am always prepared, why I am at the leading edge of whatever may come next.

It’s why I stocked up on toilet paper and N95 masks when my wife was still telling me not to be ridiculous that Covid-19 would hit US shores. Still, when I feel the anxiety seize up in me, I have learned to acknowledge it. Then I work on envisioning swallowing it like a giant rock that no longer sits in my throat but is merely passing through.

Learning to identify your paranoia is the first step to mitigating it, Borland said. Intervention can range from self-applied to seeking professional medical help, depending on the severity of your symptoms and how much they are interfering with your ability to function in your daily life.

12 lifestyle habits to reduce stress

“This is really going to come down to communication between the individual and hopefully whatever sources of support they have in their life. It’s very easy for a thought to be planted like a seed. And it’s easy to water that, give it sunshine, even if the facts or information contradict that thought,” Borland said.

How to bat back the paranoid thoughts

The good news is that it’s possible to combat paranoia, at least the kind that is not medically diagnosable or connected to other mental health issues, on your own.

“Human beings are resilient and capable of handling great adversities, if we are in them together and have consistent guidance as well as psychological and social support,” Lee said.

'Revenge bedtime procrastination' could be robbing you of precious sleep time
You can start by acknowledging the paranoid thoughts and then work to create healthy daily routines, according to Borland. Set small, attainable goals like walking one mile every day or spending one hour connecting with your feelings or with someone else. Sleep, diet and social interaction are all important factors that feed good mental health.

“We underestimate the effects of boredom. And given news outlets and social (media) and having so much info at our fingertips, it’s easy to go down that rabbit hole,” Borland said.

If you observe a loved one experiencing paranoid thoughts, be careful about how you approach them, Borland said. Try to avoid the finger-pointing approach, and instead use “I statements” to let them know what you are noticing so that they are less defensive and more receptive to your help.

Still, it may be hard to fend off paranoid thoughts in ourselves or others.

“In a paranoid state, one will not be amenable to logic or evidence,” Lee said. The best bet is to work on changing the circumstances that put that person in a paranoid state to begin with.

Worried about your toddler right now? Take a deep breath

Of course, one can’t magically make Covid-19 disappear, but we can work on creating distance between the influences that seem to exacerbate the paranoia. In the longer term, we can work on “fixing the socioeconomic conditions that led to the psychological vulnerability in the first place — which may include economic, racial, and gender inequalities,” Lee said via email.

If paranoia gets to the level where you feel you or a loved one might be a danger to themselves or others, seek professional help immediately.

Is paranoia ever good?

Too much of a good thing could be bad, but what about a little bit of a bad thing? Is there such a thing as healthy paranoia?

“Healthy paranoia or healthy anxiety can keep us aware and alert as a defense mechanism and protect ourselves from potential threats,” Borland said. (I’m glad I stocked up on masks and toilet paper.)

Researchers at the University of Cambridge, for instance, have found that worry about climate change has led to behavioral changes that may actually drive solutions to the problem.

We must, though, remain aware that paranoia can take us to a place where those feelings can become problematic. Where we draw the line is not always clear.

Allison Hope is a writer and native New Yorker who favors humor over sadness, travel over television, and coffee over sleep.

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This ballerina alleged racism at her company. Now, Chloé Lopes Gomes says it’s time for change

Written by Chloé Lopes Gomes

In 2018 I became the first Black ballet dancer to join Berlin’s principal ballet company, the Staatsballett. Joining this kind of ballet institution was my dream — it’s one of the best in the world.

But last October, I was told that my contract would not be renewed this summer. I believe it’s because of the complaints I have made about the racist comments and unfair treatment that I have endured from my ballet mistress, though the company has said the decision was made for “artistic reasons.” After trying to handle the issue internally, I went public with my story to Der Spiegel, The Guardian and the New York Times.

I have suffered depression and humiliation — and I am far from the only dancer who has experienced derogatory comments and verbal abuse during my career. Such behavior is institutionalized within ballet, from the time that we are children and begin our training. We don’t talk about it because we are taught not to.

Chloé Lopes Gomes became the first Black dancer at Berlin's prestigious Staatsballett in 2018.

Chloé Lopes Gomes became the first Black dancer at Berlin’s prestigious Staatsballett in 2018. Credit: Chloé Desnoyers

We start ballet very young, often when we are just seven or eight years old. The teachers instill in us discipline and rigor, but they also teach us not to complain — to suffer in silence and to be “polite.” Many young dancers are trained to believe that, to become a ballerina, pain is part of the process. Ballet masters should treat dancers respectfully and with kindness.

The silence is pervasive as well because we often don’t have enough support or protection. The power that institutions give to the ballet masters is undeniable — at the end of the day, they are the ones who are with us in the studio and they are the ones who give us the opportunity to improve within the company. We only have one- or two-year renewable contracts. And the ballet world is very small. Speaking out against an esteemed company can ruin a career.

My experience with racism is not isolated. I have heard over and over the damaging stereotypes that Black dancers aren’t flexible enough or don’t have the right feet, or that Asian dancers aren’t expressive enough. Ballet is still designed for White dancers, down to the shoes and makeup we wear. Nude-colored ballet shoes for Black dancers didn’t exist until 2018. I’ve always had to buy my own makeup, because the foundation provided has always been for White skin. I’ve always been the only dancer to do my own hair, because the hair stylists don’t know how to work with my texture. At Staatsballett, there are 95 dancers and I was the only one spending my own money on makeup. It makes you feel excluded. And it reminds me that when you are Black, you have to work harder to have the same opportunities.

"I've always had to buy my own makeup, because the foundation provided has always been for White skin," writes Gomes.

“I’ve always had to buy my own makeup, because the foundation provided has always been for White skin,” writes Gomes. Credit: Dean Barucija

The ballet world needs to change, and we have the chance to do so now, while the art form has been thrown into crisis during the coronavirus pandemic. In order for the performing arts to survive, they have to reach new audiences. In ballet, which is still primarily White and elitist, we have to make it more accessible, and we can do that by making it a more inclusive and equitable art form.

We should attract talented and diverse young dancers in ballet schools and begin to remake ballet companies from the ground up to reflect the multicultural world we live in. We should put an end to the dangerous belief that dancers must always remain silent, which is drilled into us at a young age. And we should give dancers proper avenues of recourse when their teachers or directors abuse their power.

The Classical arts in general have long excluded ethnic minorities because they are prohibitively expensive for underprivileged communities. It is expensive to attend the theater — and it is even more expensive to train in the arts. It is much cheaper to go to the cinema or to play sports. I was raised in France with a very modest upbringing. My mother is a cleaning lady, and my father is a construction worker. They took out loans for what my scholarship didn’t cover when I attended the Bolshoi Ballet Academy in Russia, following in the footsteps of two of my siblings, who are also dancers. I had to be successful; there was so much pressure on me to excel.

"I have a different vision for the future of the stage," Gomes writes. "Diversity isn't detrimental to the visuals of ballet."

“I have a different vision for the future of the stage,” Gomes writes. “Diversity isn’t detrimental to the visuals of ballet.” Credit: Dean Barucija

I believe we have to democratize ballet in order to ensure its future. If ballet companies welcome more people of all backgrounds to attend its shows, more young people will fall in love with it. If ballet school directors make it their duty to seek out and nurture those aspiring dancers, and level the playing field regardless of race or income level, diverse dancers will enter the ranks. They will eventually become ballet masters, attracting and educating more dancers of color. And then the cycle continues — more children will see themselves represented on stage; they will see a future in pointe shoes.

Ballet prizes uniformity within its dancers. We have to transform into swans or spirits, to become part of a greater whole of movement and form. But I have a different vision for the future of the stage. It’s so beautiful to see a blonde girl next to a Black girl, or a brown girl next to an Asian girl, all following the same choreography. Diversity isn’t detrimental to the visuals of ballet — it can instead be its greatest strength.

Editor’s note: CNN Style contacted the Staatsballett for comment ahead of publication. The company provided the following statement on the claim that Gomes must buy her own makeup: “This is the first time this issue was brought to the attention of the Staatsballett Berlin. We are currently looking into the matter, having reached out to Chloé and the make up departments.” The Staatsballett did not offer further comment on the reason for Gomes’ dismissal or the assertions against her ballet master, but the following statement is published on the company’s website.

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Coping with chronic disease: Q&A with Tessa Miller

Over the next several years, Miller tried dozens of medications, was hospitalized more times than she can remember and required three fecal transplants. She visited gastroenterologists, allergists, oncologists, pain medicine specialists, endocrinologists, gynecologists and neurologists.

Her ultimate diagnosis of Crohn’s disease finally explained the “inflammation, ulceration, bleeding, fissures, abscesses, intestinal narrowing and all kinds of gnarly stuff” throughout her digestive tract.

But the diagnosis also meant that she had to come to terms with being chronically ill, caught in what Miller wrote is “that foggy space between the common cold and terminal cancer.” Six in 10 adults in the United States suffer from chronic disease, and due to Covid-19, researchers expect that number to rise.
Tessa Miller's book "What Doesn't Kill You: A Life With Chronic Illness — Lessons From a Body in Revolt" was released February 2 by Henry Holt & Co.

This conversation has been edited and condensed for clarity.

CNN: You paint a vivid picture of the complexities of grief. What have you learned about loss that may be helpful to others?

Tessa Miller: After my dad died in 2008 from liver failure due to long-term alcoholism, I felt what I considered “classic grief.” I was unreachably sad and thought I would spend the rest of my life just spinning on my own little grief planet.

When I was diagnosed with Crohn’s, I was angry — just rage all the time. Feeling like no one else could understand what it was like for me compounded the rage. I squashed and buried my rage, which led to massive anxiety and eventual panic attacks.

How to deal with grief -- and persevere -- mid-pandemic

Today, whether we’ve lost a loved one or lost our own health to Covid-19, many of us are grieving a world that no longer exists or the loss of our work, our homes or any sense of routine or normalcy. We’re mourning a lot of things at the same time.

It’s time to throw the “stages of grief” out the window. People often expect grief to be a singular emotion when it’s really five, eight or 12 emotions, sometimes all at once. Take time to reflect on all those feelings and understand that you’re in mourning.

CNN: In times of struggle, many of us cling to what you refer to as the “illusion of control.” Why is it important to pierce that illusion with realism — even when the truth hurts?

Miller: When I was first diagnosed with chronic illness, I experienced what Joan Didion calls “magical thinking.” I convinced myself that if I could search back through my whole life history to find what caused this, I could find the cure. But as a science writer, I knew that my disease stems from some combination of genetics and environment. There was nothing I could have done to prevent myself from getting Crohn’s disease. But I still went looking for a cause, which led to a lot of self-blame. This is common among people newly diagnosed with a long-term illness.

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Oddly, that self-blame also reflects false hope: If I caused this, then I can fix it. I got stuck in that phase for a long time. It left me both mentally and physically sicker. I wasn’t taking care of my body. Once I accepted that I was going to have this disease for the rest of my life, I started being able to manage it through proper care, like finding a team of doctors who I trusted and pursuing the right treatments. Acceptance was a big step toward my starting to feel physically and mentally better.

CNN: Let’s talk about the link between mental and physical symptoms. What has chronic illness taught you about mind-body interconnections?

Miller: Over and over in conversations I’ve had with fellow chronically ill people, they’ve said they could understand their physical symptoms, but they couldn’t come to terms with why they felt crushingly depressed, anxious all the time, or like they had PTSD.

It’s such a disservice to not talk to chronically ill people about the fact that they need mental health care from the get-go. Both doctors and patients seem to dismiss the fact that your body — the very thing that’s carrying you around in the world — has become unrecognizable, changed, unpredictable.

Then there is the scientific reality that there’s an intimate partnership between your body and your brain. Depression can worsen chronic illness. In addition to causing fatigue, brain fog and body aches and pains, it can make you not want to take your medications.

CNN: How does the US health care system impact the care that people with chronic illnesses receive?

Miller: As I wrote in “What Doesn’t Kill You,” this book isn’t about the health care system, but this book is entirely about the health care system because chronically ill people in America are at its mercy. We know that certain categories of people suffer worse outcomes depending on socioeconomic group, if you’re Black or brown, a woman, fat, trans.

These variables affect whether you live, die or get help during the pandemic

Something like Covid illuminates all the cracks in the system. We have to consider: Who lives in historically redlined neighborhoods, which still today report higher rates of asthma? And who, racially and by gender, makes up the population of essential workers?

Black and brown people are dying from Covid at much higher rates than White people for no reason other than systemic racism, which is deeply entrenched in our medical system.

When it comes to any illness, including chronic illness, consider who can go into a hospital and feel like they’re going to be taken care of, rather than abandoned or treated poorly.

CNN: You have learned a lot about advocating for yourself. What tips can you share?

Miller: Yes, I’ve learned a lot over the past 10 years, but I want to make it clear that it’s easier for me because I have privilege and power. I’m White, thin and my illness is mostly invisible.

Advocating is a skill that can be learned. First, I recommend bringing an advocate — a trusted friend or family member who knows your health history and can communicate for you to the doctors if you’re unable.

Redefining Covid-19: Months after infection, patients report breathing difficulty, excessive fatigue

Second, always come prepared with a list of notes and questions. For chronically ill people whose flare-ups can be unpredictable, it helps to carry a packet of health records with you. If you wind up at a hospital where you’ve never been before, these can clarify that you’re not just in the ER seeking painkillers.

If a health care provider is being negligent, dismissive or isn’t taking your concerns seriously, then demand that they write everything in your chart, including that they’re not continuing care or not sending you for further testing. If they won’t, send an email to the office to create your own paper trail.

CNN: As the pandemic continues, “long Covid” has become a chronic condition for more and more people. What advice do you have for those struggling with the uncertainty of this new diagnosis?

Miller: Before Crohn’s was identified in the 1930s, people were disbelieved about their symptoms. They suffered and died because their illness was still a mystery. Long Covid is so new and the symptoms are so different from patient to patient. Some people have memory loss and brain fog or mysterious body pains and fatigue while others have long-term heart or lung damage or even psychosis.

The first thing to do is find your community. That will help you find other resources, including doctors who will believe you. As with all health care, this can be more difficult if you’re not in a city. But there is telehealth. Tell your community what you need, and people will help.

I think about this Viktor Frankl quote all the time: “Survival is a community event.” Community support can’t remedy chronic illness, but it can make it easier to carry.

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Si ta kuptoni që qeni juaj po vuan ose po kalon një periudhë depresioni

Qentë s’ kanë gojë, ata s’ mund t’ju tregojnë saktësisht se çfarë ndjejnë, por mund të tregojnë sjellje të ngjashme me depresionin njerëzor. Nëse veterineri i ka përjashtuar kushte të tjera shëndetësore, mund të keni një rast të depresionit të qenushit tuaj. Shenjat janë këto:
s’ dëshiron më të luajë: Një qen i dëshpëruar ose i trishtuar s’ do të ketë të njëjtat nivele të energjisë dhe lojrat e ndryshme që ju mund ti ofroni s’ do të kenë efektin e zakonshëm.

Do të shihni ushqim në tasin e tij: Nëse qeni juaj s’ tregon gatishmërinë e tij të zakonshme për ushqimin e preferuar dhe po humbet peshë, mund të ketë depression.
Fjetja me opë të zgjatura: Nëse qeni juaj shpenzon më shumë kohë në shtrat se zakonisht ka diçka që s’ shkon. P.sh një qenush 15-vjeçar normalisht fle 14 orë në ditë dhe tani është rritur ky orar në 20 orë, ky është një ndryshim i madh .
Një vdekje në familje: Ju s’ jeni i vetmi që mban zi për humbjen e një anëtari të familjes ose të një kafshe tjetër qeni juaj do të mërzitet njësoj si ju. Kështu dhe ai kalon një periudhë jot të mirë.
I vetëm në shtëpi: Qeni juaj do të ndihet me patjetër i vetmuar nqs ju kaloni më shumë kohë jashtë shtëpisë se sa brënda. Ato janë qënie sociale dhe s’ janë të kënaqur kur qëndrojnë vetëm.
Ndërrimi i shtëpisë: Mos u habisni Nëse qeni juaj ka vepruar çuditshëm që kur keni ndërruar shtëpinë. Ndryshimi mund të jetë i vështirë për kafshët dhe qeni juaj mund të ndihet i depresuar derisa të mësohet me mjedisin e ri.

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Shenjat e Fshehura Të Depresionit – Si T’i Dalloni

Depresioni është një sëmundje mjekësore që shfaqet me disa simptoma të cilat ndikojnë në mënyrën e të menduarit, ndjenjave dhe përballjes me aktivitetet ditore.

Shpesh këto simptoma janë të fshehura dhe njeriu s’ e kupton nivelin e dëshpërimit.

Mësoni në AgroWeb.org disa prej shenjave më të zakonshme të depresionit që shpesh qëndrojnë të fshehura.

Ndryshimet Në Oreks

Ngrënia e tepruar ose e pakët e ushqimeve mund të sinjalizojë praninë e depresionit.

Disa njerëz e kanë ushqimin si ngushëllim ndërsa tek disa të tjerë humori largon mendjen nga ushqimi.

Këto ndryshime në ushqyerje mund të shkaktojnë rënie ose shtim në peshë.

Ndryshimet Në Cilësinë e Gjumit

Gjumi dhe humori janë të lidhura fort me njëri tjetrin.

Mungesa e gjumit mund të kontribuojë tek shfaqja e depresionit dhe ky i fundit e bën gjumin shumë të vështirë.

Sipas specialistëve, njerëzit që vuajnë nga pagjumësia janë 10 herë më të rrezikuar nga depresioni.

Edhe gjumi i tepërt mund të sinjalizojë praninë e depresionit, thonë specialistët.

Përdorimi i Alkolit Dhe Drogës

Njerëzit me çrregullime të humorit mund të përdorin alkolin dhe drogërat e ndryshme për tu përballur me ndjesinë e vetmisë, mërzisë dhe mungesës së shpresës.

Nga ana tjetër, njerëzit që pijnë shumë alkol apo konsumojnë substanca narkotike janë më të prirur të vuajnë nga çrregullimet e humorit.

Lumturia e Sforcuar

Në shumë raste, njerëzit e fshehin depresionin me buzëqeshje.

Kjo njihet si depresioni i buzëqeshur.

Njerëzit i maskojnë simptomat me një buzëqeshje sidomos kur janë në praninë e të tjerëve.

Megjithatë kjo lumturi e sforcuar s’ zgjat shumë dhe mërzia, vetmia dhe mungesa e shpresës dalin sërish në sipërfaqe.


Plogështia e madhe dhe lodhja është një simptomë e përhapur e depresionit.

Studimet tregojnë se 90% e njerëzve që vuajnë nga depresioni ndihen shumë të lodhur.

Lodhja e vazhdueshme bashkë me simptoma të tjera siç janë këto që përmendëm më lartë mund të tregojnë një depression të fshehur.

Mungesa e Përqendrimit

Njerëzit që humbasin fillin e mendimeve apo kanë vështirësi të përqendrohen janë të prekur nga depresioni.

Ky i fundit e bën më të vështirë përqendrimin dhe mund të jetë sfidojë marrëdhëniet e punës dhe ato personale.

Përpos të tjerave, depresioni mund të shkaktojë edhe probleme fizike siç janë: dhembjet e shpinës, dhembjet kronike, problemet me tretjen dhe dhimbjen e kokës./AgroWeb.org

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ER visits, long waits climb for kids in mental health crisis

When children and teens are overwhelmed with anxiety, depression or thoughts of self-harm, they often wait days in emergency rooms because there aren’t enough psychiatric beds.

The problem has only grown worse during the pandemic, reports from parents and professionals suggest.

With schools closed, routines disrupted and parents anxious over lost income or uncertain futures, children are shouldering new burdens many are unequipped to bear.

And with surging numbers of hospitalized COVID-19 patients, bed space is even scarcer.

By early fall, many Massachusetts ERs were seeing about four times more children and teens in psychiatric crisis weekly than usual, said Ralph Buonopane, a mental health program director at Franciscan Hospital for Children in Boston.

“I’ve been director of this program for 21 years and worked in child psychiatric services since the 1980s and it is very much unprecedented,” Buonopane said. His hospital receives ER transfers from around the state.

While ER visits for many health reasons other than COVID-19 declined early in the pandemic as people avoided hospitals, the share that were for kids’ mental health-related visits climbed steadily from mid-April through October, according to a recent federal Centers for Disease Control and Prevention report. Of the kids who showed up, more were for mental health than in the same period last year, although that might reflect that others stayed away, the authors cautioned.

Claire Brennan Tillberg’s 11-year-old daughter was one of those kids who sought care. The Massachusetts girl has autism, depression and anxiety, and has been hospitalized twice in recent months after revealing that she’d had suicidal thoughts. The second time, in September, she waited a week in an ER before being transferred to a different hospital. The first time, in July, the wait was four days.

She’d been hospitalized before, but Tillberg said things worsened when the pandemic hit and her new school and therapy sessions went online. Suddenly the structure and rituals that many children with autism thrive on were gone.

“She’d never met the teacher, never met the kids,” said Tillberg, a psychotherapist. “She felt more isolated, more and more like things aren’t getting better. Without the distraction of getting up and going to school or to camp … sitting at home with her own thoughts all day with a computer has allowed that to worsen.”

Studies and surveys in Asia, Australia, the U.S., Canada, China and Europe have shown overall worsening mental health in children and teens since the pandemic began. In a World Health Organization survey of 130 countries published in October, more than 60% reported disruptions to mental health services for vulnerable people including children and teens.

Emergency rooms are often the first place kids facing a mental health breakdown go for help. Some are stabilized there and sent home. Some need inpatient care but many hospitals don’t offer psychiatric treatment for kids and transfer these children elsewhere.

Some treatment centers won’t take kids without proof they don’t have COVID-19, ”which is hard because you can’t always find a rapid test,” said Ellie Rounds Bloom. Her 12-year-old son has “significant mental health issues” including trauma, and has experienced several crises since the pandemic began. The Boston-area boy has been hospitalized since October, after spending 17 days in ER.

Many mental health advocates consider these waits unacceptable. For parents and their kids, they are that, and more.

“There have been moments of frustration and moments of sheer pulling your hair out,” Rounds Bloom said.

State health insurance covers her son’s treatment but not all providers accept it. Deficiencies in the U.S. health care system can leave families feeling helpless, she said.

“You can’t give up, because it’s your kid,” Rounds Bloom said.

There are no national studies on kids’ ER waits for mental health treatment, a practice called “boarding,” according to a recent review published in the journal Pediatrics. The review included small studies showing that between 23% and almost 60% of U.S. kids who need inpatient care have to wait in ERs to receive it. They are kept stable but often receive little or no mental health care during those waits.

Yale-New Haven Children’s Hospital has started offering teletherapy to kids waiting in its emergency room for mental health care, said Dr. Marc Auerbach, a pediatric ER physician.

One in 6 U.S. children have a diagnosed mental, behavioral or developmental disorder, according to the CDC. Data show problems like depression become more prevalent in teen years; 1 in 13 high school students have attempted suicide and at least half of kids with mental illness don’t get treatment.

Shortages of psychiatrists in some areas and hospital closures have worsened the problem and contributed to rising ER mental health visits, the Pediatrics review said.

The number of U.S. children’s mental health hospitals dropped to 38 from 50 between 2008 and 2018. The number of U.S. hospitals reporting that they offer any inpatient psychiatric services to adults or children dropped by almost 200 from 2008 to 2018, when the tally was 1,487, American Hospital Association data show.

Children who need to be admitted for complex mental issues and behavior outbursts often have the longest ER waits. Kids like Laura Dilts’ 16-year-old son, who is chronically suicidal, has mild autism, anxiety, severe depression and attention deficit disorder.

“Hospitals often refuse to take him,” said Dilts, a human resources recruiter who lives near Worcester, Massachusetts.

Early this year, before the pandemic hit, he waited for a hospital bed twice, once for a week, the second time for over two weeks. He had been living at an intensive residential treatment center and has been back there since April.

Dilts worries about what will happen if he has another crisis.

“There weren’t enough beds before COVID and there really aren’t enough beds now,” she said.

At the 66-bed Clarity Child Guidance Center in San Antonio, demand has been surging, says CEO Jessica Knudsen. About half their patients are Hispanic and 60% receive some form of public health insurance.

Some nights, there have been five or six kids sleeping in an observation area waiting for beds, she said.

”I feel OK once they get to us,” even if in the observation room, she said. “They’re getting eyes on them by a mental health professional.”

Kids left waiting idly in ERs, or who don’t seek emergency care, ”that’s my real worry,” Knudsen said.

Building resiliency in children as the COVID-19 pandemic continues through the holidays

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ER visits, long waits climb for kids in mental health crisis (2020, December 5)
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Major Depression kann durch ein spezifisches Darmmikrobiom definiert werden


In einer Studie mit 311 Teilnehmern haben Wissenschaftler drei Bakteriophagen, 47 Bakterienarten und 50 Metaboliten im Stuhl identifiziert, die bei Menschen mit Major Depression (MDD) im Vergleich zu gesunden Kontrollen signifikant mehr oder weniger häufig vorkommen.

Die Ergebnisse der Untersuchung liefern laut den Forschern Hinweise darauf, dass eine MDD durch Störungen des Darmmikrobioms gekennzeichnet sein kann. Studienautor Jian Yang und Kollegen entwickelten zudem ein Marker-Panel, das auf den von ihnen identifizierten bakteriellen, viralen und metabolischen MDD-Signaturen basiert und effektiv zwischen Patienten mit MDD und Kontrollen unterschied. Ein ähnliches auf Biomarkern basierendes Diagnosewerkzeug kann dazu beitragen, eine MDD besser zu diagnostizieren, und kann klinische Interviews ergänzen, die häufig zu Fehldiagnosen führen.

Zwar waren bereits in früheren Studien Störungen des Darmmikrobioms bei MDD beobachtet worden, doch hatte man in diesen die Bakterienarten, die sich bei Menschen mit dieser häufigen psychischen Störung unterscheiden, noch nicht identifiziert oder untersucht, ob auch eine Störung des viralen Darmmikrobioms vorliegt. Um mehr darüber zu erfahren, wie MDD spezifisch mikrobielle und virale Gemeinschaften im Darm sowie die Stoffwechselsignaturen im Stuhl beeinflusst, analysierten Yang und Kollegen genetisches Material aus 311 Stuhlproben von 156 Patienten mit MDD sowie von 155 gesunden Kontrollen. Die Wissenschaftler führten eine groß angelegte, auf Gas-Chromatographie und Massenspektrometrie basierende Analyse der Stoffwechselprodukte im Darm durch.

Die Forscher fanden deutliche Unterschiede in der bakteriellen Zusammensetzung des Mikrobioms von MDD-Patienten im Vergleich zu Kontrollen und beobachteten, dass größere Mengen an Bakterienarten der Gattung Bacteroides vorhanden waren sowie geringere Konzentrationen von Blautia- und Eubacterium-Arten. Eine größere Menge von Bacteroides im Darmmikrobiom könnte für frühere Beobachtungen verantwortlich sein, laut denen Menschen mit MDD höhere Zytokinspiegel und vermehrt Entzündungen aufweisen und eine geringere Menge Blautia zu einem Verlust der entzündungshemmenden Vorteile führt.

Yang und Kollegen beobachteten zwar keine signifikanten Unterschiede in der viralen Zusammensetzung des Mikrobioms zwischen der MDD- und der Kontrollgruppe, identifizierten aber drei Bakteriophagen, die bei MDD-Patienten weniger häufig vorkamen. Die Autoren schlagen vor, dass die Rolle dieser Phagen in weiteren Studien untersucht werden sollte.

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Gen Z teens dieting and worrying about weight more than previous generations

Gen Z teens dieting and worrying about weight more than previous generations
Teenagers who dieted and thought they were overweight had greater symptoms of depression than those in previous generations. Credit: dotshock/ Shutterstock

The proportion of teenagers who are overweight or obese has risen over the past 30 years. In parallel, there has been an increase in societal focus on weight loss and dieting—namely in the form of “anti-obesity” public health campaigns, the expansion of the weight-loss and fitness industry, and weight-focused media content—from TV shows to social media trends. We know that these messages have not translated in a decrease in the prevalence of obesity, which has remained relatively stable over the past 15 years. However, what we don’t know is whether dieting behaviors and weight concerns have increased—and what impact this might have had on teenagers’ mental health.

Our study found that teenagers born in 2000-2002 (often called “Generation Z”) are more concerned about their weight and losing weight than previous generations. We also found that Gen Z teenagers who dieted and thought of themselves as being overweight had greater symptoms of depression than those who did in previous generations.

Dieting and exercise

To conduct our study, we used data from 22,503 adolescents who took part in three large UK general population cohorts. This included the British Cohort Study of people born in 1970, the Avon Longitudinal Study of Parents and Children, which looked at children born in 1991-92, and the Millennium Cohort study of children born in 2000-2002. In 1986, 2005, and 2015, when participants were aged 14-16, these studies collected information on weight loss behaviors and weight perception in early adolescence.

We found that compared to teenagers from 1986 and 2005, more teens in 2015 were trying (or had tried) to lose weight by dieting or exercising, or described themselves as overweight. Although these behaviors were more common in girls, their prevalence increased more in boys over these 30 years.

Gen Z teens dieting and worrying about weight more than previous generations
Changes in weight loss behaviours. Credit: Francesca Solmi and Praveetha Patalay, Author provided

We also observed that more teens in this generation were exercising to lose weight. This is interesting, because we know from other research that the proportion of young people engaging in physical activity has remained relatively stable. So although today’s teens aren’t necessarily exercising more than past generations, our findings suggest that teens today are increasingly exercising with the aim of losing or controlling their weight.

Finally, we found that adolescents who were trying to lose weight or described themselves as overweight had greater symptoms of depression. For girls in particular, these symptoms have become more severe in Gen Z compared to prior generations.

Crucially though, none of the differences that we observed in this study were explained by higher BMI in the more recent cohorts.

Weight worries

It’s well known that pressures to lose weight and weight stigma are associated with increased risk of body dissatisfaction and dieting. Our study adds to existing evidence that making weight loss the main focus of public health campaigns might create more harm than good by increasing mental health problems in teenagers.

Gen Z teens dieting and worrying about weight more than previous generations
More teens showed depressive symptoms. Credit: Francesca Solmi and Praveetha Patalay, Author provided

Public health campaigns aimed at reducing the prevalence of obesity often focus on calorie labeling and exercise as means to achieve or maintain a healthy weight. Yet evidence suggests that dieting is ineffective for long-term weight loss.

Obesity is also known to be influenced by a number of social determinants such as being from a socio-economically disadvantaged background. Framing weight loss as a personal responsibility, as it has been done so far, is therefore not only ineffective, but also dangerous. Pressures to lose weight can lead to internalizing weight stigma, body dissatisfaction, and disordered eating behaviors, all known to increase mental health as well as physical health problems.

Praising young people for weight loss or showing concerns for them depending on their BMI ignores the fact that disordered eating behaviors and body dissatisfaction are associated with negative mental health outcomes at all levels of BMI, which is what we observed in our study.

It’s therefore crucial that good physical and mental health are promoted above healthy weight and weight loss—and that children are taught to enjoy exercise as a time to learn new skills, and spend time with friends, as opposed to as justification for eating. It will also be important for anti-obesity campaigns to consider how they can prevent adverse mental health outcomes or disordered eating when they’re designed.

Dieting and weight worries on rise in teens

Provided by
The Conversation

This article is republished from The Conversation under a Creative Commons license. Read the original article.The Conversation

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UN, France urge Lebanon to form new government amid pledges of aid

Issued on:

France and the United Nations vowed Wednesday to keep providing humanitarian aid to Lebanon but urged the country’s leaders to form a new government as a political deadlock in Beirut has blocked billions of dollars in assistance for the cash-strapped country hit by multiple crises.

A meeting organized by the U.N. and France was the second since the disastrous Aug. 4 explosion that destroyed Beirut‘s port and wrecked large parts of the capital. The blast, which killed over 200 people and wounded thousands, was caused by the detonation of nearly 3,000 tons of ammonium nitrates that had been stored unsafely at a port warehouse for years. 

The explosion came amid an unprecedented financial meltdown — worsened by pandemic-related closures — that has brought soaring inflation, poverty and unemployment. 

French President Emmanuel Macron and U.N. Secretary-General Antonio Guterres announced the creation of a fund handled by the World Bank, the U.N. and the European Union to provide support for Lebanon, including food, healthcare, education and the reconstruction of the Port of Beirut.

“We can, together, help the Lebanese people move beyond the emergency phase and onto the path for longer-term recovery and reconstruction,” Guterres said. 

The plan also calls for “a targeted set of reforms, which are essential to facilitate recovery and reconstruction,” he added.

Macron said Wednesday’s conference would “make it possible to complete the emergency response and provide an early recovery response.”

But the French leader warned that the promised aid “won’t replace the commitment of Lebanese political forces and institutions to form a government as quickly as possible and implement a roadmap for reforms without which the (long-term) international economic help won’t be released.”

‘Arduous and prolonged depression’

In a dire report published Tuesday, the World Bank said Lebanon’s economy faces an “arduous and prolonged depression,” with real GPD projected to plunge by nearly 20% because its politicians refuse to implement reforms that would speed up the country’s recovery.

Macron, whose country once governed Lebanon as a protectorate, supported pushing ahead with an aid program despite frustration with the Lebanese ruling class. Lebanon’s leaders continue to resist reforms and have been unable to form a government after the last one resigned in the wake of the explosion. 

“Commitments have not been met,” Macron said. 

Representatives from 27 countries participated in Wednesday’s meeting, including 12 heads of state and local Lebanese aid groups which have a central role as trusted partners, according to the French presidency.

A new government would be the first step toward implementing a French roadmap for reforms to enable the release of billions of dollars of international aid. Another key international demand is a Central Bank audit. U.S. consultancy firm Alvarez & Marsal withdrew last month from a forensic audit it was tasked with, saying it had not received the information required to carry out its work.

Lebanese President Michel Aoun said that “despite the obstacles facing the French initiative, it must succeed because the crises the country is facing have reached their maximum.”

“I am determined, no matter what it costs, to follow through with the financial audit to the end to liberate the state from the corrupt economic, political and administrative systems to which it has become hostage,” he added. 

Aoun said Lebanon is negotiating a $246 million loan from the World Bank to deal with the economic fallout of the coronavirus pandemic and Lebanon’s emergency needs. The talks end this week.

The Aug. 4 explosion, widely blamed on the negligence of Lebanese politicians and security agencies, has brought world attention to the corruption that has plagued the country for decades and left it on the brink of bankruptcy with hollowed out institutions. 

World leaders and international organizations pledged nearly $300 million in emergency humanitarian aid after the blast but warned that no money for rebuilding the capital will be made available until Lebanese authorities commit themselves to serious political and economic reforms.

The donors pledged the aid will be coordinated by the U.N. and delivered directly to the Lebanese people, in a clear rebuke of the country’s entrenched and notoriously corrupt leaders.

The aid money is expected to go directly to NGOs and other organizations to distribute to the public, bypassing the Lebanese government. 


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How are older adults coping with the mental health effects of COVID-19?

How are older adults coping with the mental health effects of COVID-19?
McLean researchers indicate that older adults may be withstanding the mental health strains of the COVID-19 pandemic better than other age groups. Credit: McLean Hospital

Older adults are especially vulnerable to the effects of the COVID-19 pandemic—with higher risks of severe complications and death, and potentially greater difficulties accessing care and adapting to technologies such as telemedicine. A viewpoint article published in the Journal of the American Medical Association notes that there’s also a concern that isolation during the pandemic could be more difficult for older individuals, which could exacerbate existing mental health conditions. Information gathered over the past several months suggests a much more nuanced picture, however.

“Over the spring and summer of 2020, we were struck by a number of individual studies from all over the world that reported a consistent theme: Older adults, as a group, appeared to be withstanding the strains on mental health from the pandemic better than all other age groups,” said lead author Ipsit Vahia, MD, medical director of the Geriatric Psychiatry Outpatient Services and the Institute for Technology in Psychiatryat McLean Hospital. “In this article, we highlight some of these studies and discuss resilience in older adults and what factors may be driving it.”

Resilience may reflect an interaction among internal factors—such as an individual’s stress response, cognitive capacity, personality traits, and physical health—and external resources like social connections and financial stability. For older adults experiencing isolation during the pandemic, having more meaningful relationships seems to be more important than having more interactions with others, and maintaining these relationships may require the use of technology to connect with loved ones.

Resilience can be supported through increased physical activity, enhanced compassion and emotional regulation, and greater social connectivity. Technology can play an important role in achieving these. “It can help maintain social connectivity, provide access to care via telemedicine, and also facilitate a range of other activities that may help cope with isolation,” said Vahia. “It is increasingly becoming important for clinicians to assess patients’ access and proficiency with technology as a part of care.”

The authors stressed that although findings from the early months of the pandemic are encouraging and provide cause for cautious optimism, they may not reflect individual realities. “Older adults are a highly diverse group, and each person’s response to the stresses of the pandemic depends on a unique set of circumstances,” Vahia explained. “In addition, the current studies may not reflect specific high-risk populations with unique stressors, such as those living in underserved areas or those suffering with dementia or caregivers for people with dementia.”

Importantly, the pandemic continues without a defined timeline or clear end in sight. The longer-term effects of COVID-19 on older adults’ mental health, especially in countries with very high rates of disease, are unclear.

Older adults with existing depression show resilience during the pandemic

More information:
Ipsit V. Vahia et al, Older Adults and the Mental Health Effects of COVID-19, JAMA (2020). DOI: 10.1001/jama.2020.21753

Provided by
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How are older adults coping with the mental health effects of COVID-19? (2020, December 1)
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Swallowing alcohol-based hand sanitizer can kill, warns analysis of coroners’ reports

hand sanitizer
Credit: Pixabay/CC0 Public Domain

Swallowing alcohol-based hand sanitiser can kill, warns an analysis of two such deaths identified in coroners’ reports, and published in the journal BMJ Evidence Based Medicine.

But the public is largely unaware of the potential safety hazards of this form of hand hygiene, which has become commonplace in homes, hospitals, schools, workplaces and public venues in the wake of the coronavirus pandemic, argues the researcher.

More needs to be done to protect those at risk of unintentional and intentional swallowing of this chemical, such as children, people with dementia/confusion, and those with mental health issues, urges the researcher, in the first of a series of Coroners’ Concerns to Prevent Harms articles published in the journal.

Alcohol-based hand sanitisers are available in liquid, gel or foam formulations. They contain 60-95% ethyl alcohol (ethanol) or 70-95% isopropyl alcohol (isopropanol).

In the UK alone, alcohol-based hand sanitiser poisonings reported to the National Poisons Information Service (NPIS) rose by 61% between 2019 and 2020, from 155 (January 1 to September 16) to 398 (January 1 to September 14).

Two such cases of unintentional poisonings in children at home have already been reported in Australia and the USA during the pandemic, says the researcher, who describes two other deaths that occurred in hospitals in England before the pandemic.

In one case, a young woman, detained in a psychiatric unit and given the antidepressant venlafaxine, was found dead in her hospital bed 3 days later with a container of hand sanitising gel beside her.

The gel was readily accessible to patients on the ward from a communal dispenser, and patients were allowed to fill cups or other containers with it to keep in their rooms.

A high level of alcohol was found in her blood, and her death was attributed to “ingestion of alcohol and venlafaxine.” The coroner concluded that the combination of these substances had fatally suppressed her breathing.

In line with regulations, the coroner reported the incident to the Department of Health and Social Care, but isn’t aware of any further action having been taken to prevent further deaths.

After a Freedom of Information request, the hospital trust concerned said that it had taken steps to prevent a recurrence and had raised awareness with staff of the potential risks associated with the use of hand sanitisers.

But, says the researcher: “there are no mechanisms for verifying or monitoring the implementation of these actions, nor is it possible to determine whether the actions became standard practice and are still being endorsed across the Trust.”

The second case involved a 76 year old man who unintentionally swallowed an unknown quantity of alcohol-based hand sanitiser foam, which had been attached to the foot of his hospital bed.

He had a history of agitation and depression, which was being treated with antidepressants. He had become increasingly confused over the preceding 9 months, possibly as a result of vascular dementia.

He was admitted to intensive care, with the intention of allowing the high level of alcohol in his blood to be naturally metabolised. But he developed complications and died 6 days later. The primary causes of death were recorded as pneumonia and acute alcohol poisoning secondary to acute delirium and coronary artery disease.

After the coroner’s inquest, a news article reported that the Trust had introduced lockable dispensers and that staff were carrying their own portable sanitisers.

In another related news article the medical director of NHS England stated that it couldn’t directly influence the public’s use of alcohol-based sanitisers, but that the risks would be flagged up with the medicines regulator, the MHRA. But it’s not clear if this has been done, says the researcher.

Had appropriate government actions been taken at a national level when the first case was reported, the second death and the hundreds of associated poisonings reported to the NPIS in 2019 and 2020 might have been prevented, she suggests.

Hand sanitisers have an important role in infection control. But these two deaths have serious safety implications for healthcare facilities, the public and other private venues, she points out.

“The combination of increased demand and exposure to alcohol-based hand sanitisers, and the negative impacts of the COVID-19 outbreak on mental health, social support, financial security and health services is a cause of serious concern,” she writes.

“This complex interplay of issues may lead to a further increase in poisonings and deaths that could be mitigated if recommendations from these deaths were implemented,” she adds.

The raft of recommendations she makes to better protect the public, include the need for a public health campaign to raise awareness of the potential harms caused by swallowing alcohol-based hand sanitisers and the mandating of clear warning labels on these products.

“While governments and public health authorities have successfully heightened our awareness of, and need for, better hand hygiene during the COVID-19 outbreak, they must also make the public aware of the potential harms and encourage the reporting of such harms to poisons information centres,” she concludes.

Substandard hand sanitizers readily available on market, confirm pharmacists

More information:
Alcohol-based hand sanitisers: a warning to mitigate future poisonings and deaths, BMJ Evidence Based Medicine, DOI: 10.1136/bmjebm-2020-111568

Swallowing alcohol-based hand sanitizer can kill, warns analysis of coroners’ reports (2020, December 1)
retrieved 1 December 2020
from https://medicalxpress.com/news/2020-12-swallowing-alcohol-based-sanitizer-analysis-coroners.html

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COVID-19 may deepen depression, anxiety, and PTSD among pregnant and postpartum women

Credit: CC0 Public Domain

Though childbirth is often anticipated with optimism and enthusiasm, approximately 10 to 20 percent of pregnant individuals also experience mental health challenges during the weeks immediately before and after birth. Depression, anxiety and trauma-related disorders can all be exacerbated by increased stress related to pregnancy and postpartum experiences. But it’s unknown how the stressors of a significant health pandemic can impact these complications. In a new study published in Psychiatry Review, researchers from Brigham and Women’s Hospital surveyed pregnant women and those who had recently given birth, finding concerning rates of depression, generalized anxiety and post-traumatic stress disorder (PTSD) symptoms, which were found to be exacerbated by COVID-19-related grief and health worries.

“We know the perinatal period is already a time in which women are particularly vulnerable to mental health concerns,” said corresponding author Cindy Liu, Ph.D., of the Department of Pediatric Newborn Medicine and the Department of Psychiatry. “We primarily wanted to see what factors related to the pandemic might be associated with mental health symptoms.”

The researchers launched the Perinatal Experiences and COVID-19 Effects Study (PEACE) to better understand the mental health and well-being of pregnant and postpartum individuals within the U.S. during the COVID-19 pandemic. Among 1,123 of these women surveyed between May 21 and August 17, 2020, the researchers found that more than 1-in-3 (36.4 percent) reported clinically significant levels of depression. Before the pandemic, rates of perinatal depression (depression occurring during or after pregnancy) were generally considered to be 15-20 percent. Furthermore, 1-in-5 (22.7 percent) reported clinically significant levels of generalized anxiety, and 1-in-10 (10.3 percent) reported symptoms above the clinical threshold for PTSD.

In particular, the researchers found that approximately 9 percent of participants reported feeling a strong sense of grief, loss, or disappointment as a result of the pandemic. This group was roughly five times more likely to experience clinically significant measures of mental health symptoms. More respondents (18 percent) reported being “very worried” or “extremely worried” about COVID-19-related health risks. This group was up to over four times more likely to experience clinically significant psychiatric symptoms.

The researchers recruited participants for the PEACE survey primarily via word-of-mouth, using posts on email lists and in social media groups. They noted that as a result, the sample population was fairly homogenous: 89.9 percent were white, 92.1 percent were at least college educated, and 98 percent were living with their spouse or partner. The household income for 45 percent of the participants was over $150,000.

“People who are working from home, who have maternity leave, or who simply have the time to do a survey like this are disproportionately white and well-off,” Liu said. “That is a limitation to this work. Through a survey, we can get in-depth information very quickly, but we are missing the perspectives of various important segments of the population.”

The researchers used standardized measures for evaluating COVID-19-related health worries and experiences of grief. “We were looking for associations that inform what we can do as clinical providers to better support families during this time,” said co-author Carmina Erdei, MD, of the Department of Pediatric Newborn Medicine. “We wanted to know what is being taken away when a new mother is not able to participate in the usual rituals around birth and welcoming a new family member. The survey responses offer valuable insight into that and help guide what we as health care professionals can do better.”

The researchers were able to examine how previous mental health diagnoses, as self-reported by the respondents, impacted these rates. They found that those with pre-existing diagnoses were 1.6-to-3.7 times more likely to have clinically significant measures of the three conditions analyzed. But elevated psychiatric distress was observed in participants regardless of their mental health histories.

Qualitative data gathered through the survey have also provided the team with striking insights into the perinatal experience, but these findings have not yet been analyzed systematically. The researchers note that the mental health experiences of those surveyed match what they observed clinically during the early months of the pandemic, when many of the usual perinatal supports, like assistance from a partner, family member or peer group, were limited due to fears surrounding COVID-19 infection risks and halting of support services.

“Obstetric practices weren’t able to screen for mental health symptoms as well, all while people’s mental health was under the most pressure,” said co-author Leena Mittal, MD, of the Department of Psychiatry. “Mental health supports have persisted and come back in new ways, and the amount of innovation surrounding delivering group and individual care, especially using virtual platforms, is phenomenal. On the psychiatry side of things, we have never been busier, and individuals and families who feel they need mental health care should seek it.”

Follow the latest news on the coronavirus (COVID-19) outbreak

More information:
Cindy H. Liu et al, Risk factors for depression, anxiety, and PTSD symptoms in perinatal women during the COVID-19 Pandemic, Psychiatry Research (2020). DOI: 10.1016/j.psychres.2020.113552

COVID-19 may deepen depression, anxiety, and PTSD among pregnant and postpartum women (2020, December 1)
retrieved 1 December 2020
from https://medicalxpress.com/news/2020-12-covid-deepen-depression-anxiety-ptsd.html

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Study finds some primary school-aged children self-harm, as experts call for earlier intervention

Credit: Pixabay/CC0 Public Domain

New research reveals that some primary school-aged children have self-harmed, prompting calls for intervention efforts to start earlier.

Led by researchers at the Murdoch Children’s Research Institute (MCRI) and the University of Melbourne, the study assessed more than 1200 children living in Melbourne, Australia, each year from age 8-9 years (wave 1) to 11-12 years (wave 4).

Data were drawn from the MCRI Childhood to Adolescence Transition Study, a longitudinal study with a broad focus on health, education and social adjustment as children make the transition from childhood to adolescence.

The recent study is published today in PLOS ONE and found 3% of students (28/1059) reported self-harm in grade 6, at age 11 and 12 years. Of those who self-harmed, two thirds (64.3%) were females and one third (35.7%) were males.

In the first three waves of the study (grades 3-5), predictors of future self-harm in grade 6 included persistent symptoms of depression or anxiety, bullying and alcohol consumption.

In the more recent survey (wave 4), associations with self-harm were having few friends, poor emotional control, engaging in anti-social behavior and being in mid-late puberty.

Participants who reported having few friends, and those who had experienced bullying victimization, were seven and 24 times more likely to have self-harmed at age 11-12 years, respectively.

In terms of mental health, participants who self-harmed were also more than seven times more likely to report depressive symptoms and five times more likely to report anxiety than their peers who had not self-harmed.

Lead researcher Dr. Rohan Borschmann said the findings suggested that mental health, puberty and peer relationships were most strongly associated with self-harm among primary school-aged children.

“Previous studies have focused specifically on children who have sought treatment for mental health problems, or focused on adolescents and young people,” Dr. Borschmann said.

“Ours is the first study to estimate the prevalence of self-harm among primary school-aged children in the general community, and it sheds light on the impact of peer relationship (including bullying), mental health problems, and puberty on children.

“The transition from childhood to adolescence is a critical time for kids and challenging experiences can have a huge impact on their self-esteem and friendships during this development phase.”

Senior author Professor George Patton said the study highlighted the importance of early intervention strategies being introduced in primary school.

“These days many high schools participate in mental health and resilience programs, but our research shows that prevention strategies are needed much earlier,” Professor Patton said. “Promoting and nurturing better relationships with other students is also particularly important.”

The researchers note that the sample was slightly skewed towards higher socioeconomic status and had a higher percentage of participants who identified as Indigenous than the general Australian population.

If you or someone you know needs additional support, please don’t hesitate to reach out to one of these helpful contacts.

A group of friends is better protection against bullying than one best friend

More information:
Rohan Borschmann et al. Self-harm in primary school-aged children: Prospective cohort study, PLOS ONE (2020). DOI: 10.1371/journal.pone.0242802

Study finds some primary school-aged children self-harm, as experts call for earlier intervention (2020, December 1)
retrieved 1 December 2020
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Depression in der Pupille sehen

Neurologie & Psychiatrie

Können Menschen etwas gewinnen oder verlieren, so erweitert sich ihre Pupille leicht. Forscher haben herausgefunden, dass diese Reaktion bei akut depressiven Patienten geringer ausfällt als bei Gesunden. Je schwerer die Patienten erkrankt waren, desto weniger weitete sich sogar das Augeninnere. 

Seit Jahrzehnten versuchen Wissenschaftler herauszufinden, ob depressive Patienten Belohnungen weniger wertschätzen als nicht depressive Probanden. Studienteilnehmer im Max-Planck-Institut für Psychiatrie (MPI) absolvierten jetzt im Magnetzresonanztomographen (MRT) ein einfaches Spiel, bei dem sie einen kleinen Geldbetrag gewinnen konnten. Ein klarer Anreiz, der bei Gesunden zur Erweiterung der Pupille führt.

Während des Spiel vermaßen die Forscher die Pupillen ihrer Studienteilnehmer extrem genau und mit extrem hohem Tempo: Mit einem speziellen Versuchsaufbau konnten sie 250 Bilder pro Sekunde aufnehmen und damit erstmals die Verbindung zwischen einer Pupillen-Erweiterung als Reaktion auf eine zu erwartende Belohnung und dem Schweregrad der Depression der jeweiligen Testperson nachweisen. Je schwerer die Symptome waren, desto weniger weit öffneten sich die Pupillen.

Die Studie zeige, so das Fazit der Forscher, dass die Aussicht auf eine Belohnung bei schwer depressiven Patienten nicht zur gleichen Verhaltensaktivierung führt wie bei Gesunden. Ihr Nervensystem kann sich selbst bei so einer positiven Erwartung weniger stark aktivieren. „Wir vermuten, dass dahinter ein physiologisches System steht, das die oft berichtete Antriebsstörung bei Patienten teilweise erklären kann“, sagt Studienleiter Victor Spoormaker.

Die Forscher am MPI gehen davon aus, dass psychiatrische Erkrankungen anders aufgeteilt werden sollten als in die bisherigen Diagnose-Gruppen. Maßgebend wären biologische Faktoren wie die Pupillenerweiterung, die klar messbar sind. Depressive Patienten, die mit ihren Pupillen weniger stark reagieren, würden eine eigene Untergruppe bilden. „Dann könnten wir diese Patienten medikamentös auch zielgerichteter behandeln“, so die Einschätzung von Spoormaker. Um diesen Ansatz zu verfeinern, bedarf es allerdings noch weiterer Forschung.

Schneider M et al. Pupil Dilation during Reward Anticipation Is Correlated to Depressive Symptom Load in Patients with Major Depressive Disorder. Brain Sci 2020;10(12):906.

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Why an antidepressant could be used to treat COVID-19

Why an antidepressant could be used to treat COVID-19
Credit: Volodymyr TVERDOKHLIB/Shutterstock

A commonly used drug called fluvoxamine was recently tested as a treatment for COVID-19 in the United States. The 152 patients enrolled in the trial had been confirmed to have COVID-19 using a PCR test, and had seen symptoms appear within the past seven days.

Patients who already required COVID-19 hospitalisation, or who had an underlying lung condition, congestive heart failure or other immune conditions, were excluded. The study looked only at those who at the time had a relatively mild form of the disease.

Among these patients, the study found that taking fluvoxamine reduced the incidence of developing a serious COVID-19 condition over a 15-day period. None of the 80 patients treated with fluvoxamine deteriorated, whereas six (8.3%) of the 72 patients given a placebo saw their condition get worse. Their symptoms included shortness of breath, pneumonia and reduced blood oxygen.

The second week of COVID-19 infection is when clinical deterioration is normally seen—which suggests fluvoxamine could be a useful tool in stopping mild COVID-19 from getting worse.

But what’s unusual is that fluvoxamine is a selective serotonin reuptake inhibitor, or SSRI. SSRIs are the first-line medicine of choice for treating depression, not viral infections. Fluvoxamine is also commonly used to treat obsessive compulsive disorder. So why might it work in a respiratory disease?

A not so selective SSRI

SSRIs work to treat depression by blocking a protein found on brain cells called the serotonin transporter. When the serotonin transporter is blocked, the amount of serotonin floating around in the brain is increased, which is the important first step its antidepressant mechanism.

Treatment with an SSRI for a few weeks markedly reduces symptoms of depression in about half of patients. These drugs are very safe, with the most common side-effects being sexual dysfunction, constipation, headache, sleep disturbance and tiredness.

Despite their name (selective serotonin reuptake inhibitors), some of these drugs are not entirely selective. In fact, fluvoxamine also binds to another brain cell protein called the σ-1 receptor (S1R). Fluvoxamine potently activates this protein, which has various functions, including inhibition of the production of cytokines – small signalling molecules that help direct the actions of immune cells. Cytokines are one of the most important chemical mediators of the immune response.

Thus, it is likely that the effect seen with fluvoxamine in COVID-19 patients has nothing to do with serotonin but everything to do with inhibiting the inflammatory response through the S1R. We know from studies in mice that fluvoxamine can decrease a sepsis-induced inflammatory response and the toxicity that comes with it.

And it’s becoming increasingly clear that the serious complications seen with COVID-19 are primarily down to an out-of-control inflammatory response to the virus, the so-called “cytokine storm”. Here, the body’s defence mechanism goes into a dangerous state, where the overactive immune system leads to a toxic inflammatory response, which can lead to death.

Why an antidepressant could be used to treat COVID-19
In some patients with severe COVID-19 is it the body’s overzealous response to the virus that is most damaging. Credit: Photocarioca/Shutterstock

Old drugs, new tricks?

It’s not uncommon for drugs used in psychiatric illnesses to be helpful in treating other conditions.

The first antidepressant discovered, iproniazide, a monoamine oxidase inhibitor (MAOI), was initially used to treat tuberculosis. In the 1950s, doctors noticed that the mood of patients taking the drug improved, and so iproniazide and other MAOIs were tested for depression. Serendipity is quite common in drug discovery—remember Fleming’s lucky discovery of the antibiotic penicillin.

More recent examples of drugs with other uses include SSRIs that can also be effective against anxiety or migraine. It’s less common, though, for such a drug to be useful in a systemic illness like COVID-19.

SSRIs have, however, been found to be helpful in cardiovascular disease. These cardiovascular effects may be mediated by the SSRIs’ anti-anxiety effects, through reducing blood pressure, or by reducing platelet activation and clot formation.

Another a cross-over medication currently gathering a lot of attention is ketamine. Traditionally used as an anaesthetic agent (and as a recreational drug), it’s now generating considerable interest as a fast-acting antidepressant. As such, the findings of the current study perhaps aren’t as surprising as they first seem.

What next for fluvoxamine?

It’s worth noting that the research does have some limitations. These include a relatively small sample size and the fact that the most seriously affected COVID-19 patients were excluded from the study—we don’t know whether it can help control the illness of severely afflicted patients. Certainly, the results need to be tested in a larger sample size over a longer period.

Nevertheless, in the race to find treatments to prevent and treat coronavirus infections, fluvoxamine could be a useful addition. If given during the initial fever and coughing phase of COVID-19, the drug could reduce the number of patients who develop the dangerous second phase of COVID-19, characterised by the cytokine storm and subsequent lung damage.

Given that the drug’s therapeutic effects in COVID-19 may be mediated via the S1R, it would certainly be worth testing other S1R activators in COVID-19 patients. There are a variety of S1R activators already in clinical use. These include donepezil (used in Alzheimer’s disease), citalopram, opipramol and amitriptyline (all used in depression and anxiety), dextromethorphan (used for coughs and colds) and pentazocine (used for pain relief).

Other anti-inflammatory drugs, such as colchicine and corticosteroids, have already been tested in COVID-19 patients with some positive effects. The potential repurposing of already approved drugs, especially cheap and orally active drugs like fluvoxamine, which we know to be safe, could speed up getting treatments to COVID-19 patients.

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New Guidelines Cover Opioid Use After Children’s Surgery

Some adolescents may be particularly at risk for problems with opioids, especially those who have had substance use problems in the past, and those who have mental health problems.

With patients at higher risk, Dr. Hadland said, such as those with anxiety or depression or those who have had substance abuse issues, opioids can still be prescribed when they’re needed, but “we should take great care.”

When a patient of his, a young adult who had alcohol use disorder, needed surgery, Dr. Hadland said, “I and the patient themselves were both concerned about the potential misuse of opioids because of the history of addiction.” He and the surgeon partnered, he said, and agreed that Dr. Hadland would do the postoperative pain management because he was more readily available and more comfortable working with a patient who had this history. He prescribed very small amounts of oxycodone, he said, discussing at every stage with the patient how it felt to be taking the medication. “We had open communication around it and things went really well.”

The guidelines go beyond the discussion of when opioids should be used and cover the importance of educating both children and their parents and caregivers about the possible side effects of opioids (oversedation and respiratory depression), about the importance of following medical instructions carefully, about the need for storing these medications securely (that is, in a locked area) and getting any unused doses out of the home in a safe and secure way (they should be returned to a secure opioid disposal bin).

None of the other specialists I spoke with suggested changing the specific recommendations for multimodal pain relief, for using opioids when other drugs are insufficient for effective pain control, and for good parent education leading to careful oversight, locked storage and safe disposal of unused doses.

“The spirit behind these guidelines is correct,” Dr. Hadland said. “Prescribing the lowest effective dose for the shortest period of time, use only short acting formulations, and talk to families about risks and monitoring dosing and locking up medication.”

Parents and physicians can feel safe that if kids are using these medications as prescribed to manage their pain, Dr. Kirkpatrick said, they are “not at significantly greater risk for developing opioid use related problems.”

“If your child needs surgery, talk to your doctor, ask questions about what pain should be expected,” Dr. Kelley-Quon said. Ask if opioids will be used, and if so, how should they be used, and how can they be safely disposed of, she said. “We want to be at the sweet spot, treating pain appropriately, maximizing benefit and minimizing risk.”

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What is palliative care and who needs it?

DEAR MAYO CLINIC: My 65 year-old-mother was diagnosed recently with Parkinson’s disease. A friend mentioned that we should see a palliative care doctor to develop a care plan. I don’t think my mother is dying anytime soon. Can you explain palliative care and why we might need a consultation?

ANSWER: I am sorry to hear about your mother’s diagnosis. It can be challenging to have a loved one with a neurodegenerative disease like Parkinson’s disease, but it is wonderful that she has you to assist her.

Palliative care is a specialty that focuses on improving quality of life for people who have chronic, serious or advanced medical conditions. It can benefit patients and families at any point along the disease course, even at the time of diagnosis.

While you mentioned that your mother is not dying anytime soon, there is a role for palliative care throughout the disease trajectory, from the time of diagnosis until the end of life. Palliative care is not synonymous with hospice care, which is specialized care for people who are near the end of their lives.

A palliative care consult focuses on the physical, spiritual, social and psychological aspects of care for the patient, and his or her caregiver. The palliative care team may include a combination of physicians, nurses, advanced-practice providers, chaplains, social workers, therapists and pharmacists. The team assesses and manages symptoms, supports caregivers, helps establish care goals, and discusses advance-care planning.

Suboptimal control of symptoms can negatively affect quality of life. Thus, the palliative care provider aims to maximize function and quality of life by reviewing symptoms and offering options. The types of symptoms that are assessed include pain, nausea, anxiety, depression, constipation, diarrhea, fatigue and insomnia.

The palliative care team also cares for caregivers. Caregiver stress can negatively affect patients, so the team tries to identify and alleviate caregiver stressors and burdens. This may include making recommendations for additional assistance in the home, or increasing support services, such as physical or occupational therapy, or respite care.

The team inquires about the patient’s medical, personal and family goals. For instance, one person may want to plant and tend to a garden, and another patient may want to travel to see family members. The role of the palliative team is to help patients meet their goals and ensure that their medical goals align with available therapeutic options.

Advance-care planning is the process of discussing one’s preferences for care when they are at the end of his or her life. It is a topic that some people are hesitant to discuss, but it is important, particularly when people have a serious or advanced medical condition. Making decisions in advance of when they are needed guides family members and the medical team.

In addition to discussion, patients are encouraged to complete an advance directive. The advance directive includes two parts: designation of a health care surrogate and a living will.

A health care surrogate is a person who would help make medical decisions if one is unable to make his or her own decisions. This person can be anyone who would feel comfortable carrying out the person’s wishes, such as a family member, friend or co-worker.

The living will is a document that outlines one’s wishes for life-prolonging care at the end of life. Another topic that may be covered is whether a person would want CPR when his or her heart stops or when he or she stops breathing, or if he or she would want to allow for a natural death. The latter option is often referred to as a do-not-resuscitate order, or DNR.

Palliative care is a complementary service to a person’s general or specialty medical care, and it can be provided while people are receiving medical therapies, chemotherapy, dialysis, surgical procedures or other life-prolonging therapies. People often appreciate the additional support that the palliative care team provides.

— Dr. Maisha Robinson, Neurology, Mayo Clinic, Jacksonville, Florida

Outpatient palliative care improves Parkinson outcomes

©2020 Mayo Foundation for Medical Education and Research
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Q&A: What is palliative care and who needs it? (2020, November 29)
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Ways to Get Your Kids Moving

As any parent overseeing homeschool knows: Zoom P.E. is hardly a hard-driving Peloton class. It’s more like your kid lying on the floor of the living room doing halfhearted leg-lifts by the light of her laptop.

Many students, particularly tweens and teens, are not moving their bodies as much as they are supposed to be — during a pandemic or otherwise. (60 minutes per day for ages 6 to 17, according to the Centers for Disease Control and Prevention.) A March 2020 report in The Lancet offers scientific evidence as to why your kids won’t get off the couch: As children move through adolescence, they indeed become more sedentary, which is associated with greater risk of depression by the age of 18. Being physically active is important for their physical health as well as mental health.

Yet with many organized team sports on hiatus and athletic fields, playgrounds and climbing gyms closed or restricted to smaller groups during shorter hours, what’s an increasingly lazy child to do? More accurately: What’s a mother or father of an increasingly lazy child to do?

Many parents are taking charge, finding informal and creative ways to entice their isolated tweens and teens off their screens and outside — with others, safely. To get your own younger ones moving, here are a few ideas from families around the country, all almost-guaranteed hits, even with winter coming.

In San Francisco, under rain, fog or blue skies (or even the infamous orange one), a group of sixth graders have been gathering in Golden Gate Park two times a week to run two miles. Their unofficial motto: “Safe Distance, Minimal Distance.” Masks are required and photo breaks are frequent, as is post-run ice cream. Started on a whim by local parents in late-August, the club has been such a hit, attracting anywhere from six to 20 kids each run, that some occasionally call for a third afternoon per week, even a 7 a.m. before-school meet-up (in which case they serve doughnuts). But treats are not the ultimate draw.

“I like the experience of being with my peers and actually doing something, all at the same time,” 11-year-old Henry Gersick said. “Instead of just sitting there.”


One of the most accessible, inexpensive, socially distanced sports is something you may not even realize is a sport. Since the pandemic began, jump-roping has become “a TikTok craze,” according to Nick Woodard, a 14-time world-champion jump-roper and founder of Learnin’ the Ropes, a program designed to teach kids and adults the joy of jumping. “All you need is time, some space and a $5 jump rope, and you’re good to go,” Mr. Woodard said.

Based in Bowling Green, Ky., Mr. Woodard and his wife, Kaylee (a six-time world champion in her own right), have been leading virtual workshops for children as young as 6, from Malaysia to Germany. A 30-minute class costs $35 for one child, and includes spiderwalk warmups, instruction, and challenges. (How many jumps can you do in 30 seconds?)

“They have so much fun, they don’t even realize they’re getting exercise,” Ms. Woodard said. But a selling point right now is that jumping rope — unlike team sports — is something you can do together, apart.


“My kids are reluctant to do anything outdoors, unless we’re meeting up with another family, then they’re totally into it!” said Ginny Yurich, founder of 1000 Hours Outside, a family-run Instagram account with over 112,000 followers that challenges youth to spend an average of 2.7 hours a day outdoors per year. “Make sure you have food, a first-aid kit and friends — friends are the linchpin,” she said. (Masks, too.)

Ms. Yurich, a Michigan mother of five, drags her children on day hikes, yes, but also on evening lantern-lit hikes, rainy hikes and snowy walks. She was inspired, she said, by the 2017 book “There’s No Such Thing as Bad Weather,” by the Swedish-American author-blogger Linda McGurk, who espouses the Scandinavian concept of friluftsliv, or “open-air living.” For Ms. Yurich and Ms. McGurk, experiencing the outdoors is paramount to children’s development and well-being.

If you prefer not to pod during the pandemic, follow the lead of Dave Rubenstein, a father of two in Lawrence, Kan., by enacting “Forced Family Fun Time.”

“We call it F.F.F.T.,” Mr. Rubenstein said of the weekly activity. “It usually involves a hike around the lake in town, but it could be any outdoor activity teenagers typically hate. And if they complain, the punishment is more F.F.F.T.”


“Kids are biking like never before,” said Jon Solomon, a spokeman for the Aspen Institute’s Sports & Society Program, the nonprofit’s initiative to help build healthy communities through sports. Over the year, leisure bike sales grew 203 percent year over year, he said.

In one neighborhood in Denver, one neighbor has opened up a half-mile dirt bike track on his property to all the kids on the block. Wyatt Isgrig, 14, and his friends tackle it often by mountain bike, scooter or motorized dirt bike.

Ali Freedman, a mother of two in Boston’s Roslindale neighborhood, has loved watching children of all ages on her street playing together. “Every day around 3:30 p.m., kids we never knew before Covid come biking by our house asking ‘Can you play?’” Ms. Freedman said.

The young crew all wear masks — “Moms have a text thread going to check on enforcement when masks become chin diapers,” said Ms. Freedman, who peers out the window every so often — and best of all: “They stay out until dinner.”


In a September survey conducted by the Aspen Institute and Utah State University in response to the coronavirus pandemic, 71 percent of parents said “individual games” (like shooting baskets solo) were the form of sport with the highest comfort level for their kids, followed by classic neighborhood pickup games like basketball or tennis.

But inventing your own game has its own rewards. One otherwise boring day in suburban Maryland, Mr. Solomon and his son, 11, came up with something they call hock-ball. It involves a hockey stick and a tennis ball and an empty sidewalk or street.

Mr. Solomon attempted to explain. “You roll the tennis ball like a kickball — it could be smooth, or slow, or bouncy — and the person with the stick tries to hit it past the pitcher, then runs back and forth to home plate.” There are points and innings and it’s apparently fun for all ages. “Only problem is, the ball inevitably rolls under a parked car, ” Mr. Solomon said.


In Milwaukee, where daily high temperatures in winter often hover below freezing, Kendra Cheng said her seventh grader will be doing much of the same as she did over the summer, only wearing more clothes: kickball, trampoline tag or even “water-skiing on land” — which calls for two kids, a broken hammer, a rope, and Rollerblades (or cross-country skis).

But the hot new thing in Ms. Cheng’s neighborhood, she said, will be snow yoga, led by a certified yogi friend. Once it starts snowing, 10 to 20 people will gather twice a week at a safe distance in a private backyard with a backdrop of Lake Michigan. “In Wisconsin, we love the cold,” Ms. Cheng said. “We love snowpants. We love barely being able to move because we have five layers on. And we’re all excited to do downward dog outdoors to create our sweat.”

Pay your kid — a dollar, a quarter, a penny — per minute to walk the pandemic puppy you just got.

“It gets them out of the house and out of my hair — and they earn some money,” said Murray Isgrig, parent of Wyatt in Denver. “Even though they don’t have anywhere to spend it.”

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A.A. to Zoom, Substance Abuse Treatment Goes Online

Until the coronavirus pandemic, their meetings took place quietly, every day, discreet gatherings in the basements of churches, a spare room at the YMCA, the back of a cafe. But members of Alcoholics Anonymous and other groups of recovering substance abusers found the doors quickly shut this spring, to prevent the spread of Covid-19.

What happened next is one of those creative cascades the virus has indirectly set off. Rehabilitation moved online, almost overnight, with zeal. Not only are thousands of A.A. meetings taking place on Zoom and other digital hangouts, but other major players in the rehabilitation industry have leapt in, transforming a daily ritual that many credit with saving their lives.

“A.A. members I speak to are well beyond the initial fascination with the idea that they are looking at a screen of Hollywood squares,” said Dr. Lynn Hankes, 84, who has been in recovery for 43 years and is a retired physician in Florida with three decades of experience treating addiction. “They thank Zoom for their very survival.”

Though online rehab rose as an emergency stopgap measure, people in the field say it is likely to become a permanent part of the way substance abuse is treated. Being able to find a meeting to log into 24/7 has welcome advantages for people who lack transportation, are ill, juggling parenting or work challenges that make an in-person meeting tough on a given day and may help keep them more seamlessly connected to a support network. Online meetings can also be a good steppingstone for people just starting rehab.

“There are so many positives — people don’t need to travel. It saves time,” said Dr. Andrew Saxon, an addiction expert and professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine. “The potential for people who wouldn’t have access to treatment easily to get it is a big bonus.”

Todd Holland lives in northern Utah, and he marvels at the availability of virtual meetings of Narcotics Anonymous around the clock. He recently checked out one in Pakistan that he heard had a good speaker, but had trouble with some delay in the video and in understanding the speaker’s accent.

Some participants say the online experience can have a surprisingly intimate feel to it.

“You get more a feel for total strangers, like when a cat jumps on their lap or a kid might run around in the background,” said a 58-year-old A.A. member in early recovery in Portland, Ore., who declined to give his name, citing the organization’s recommendations not to seek personal publicity. Plus, he added, there are no physical logistics to attending online. “You don’t go into a stinky basement and walk past smokers and don’t have to drive.”

At the same time, he and others say they crave the raw intensity of physical presence.

“I really miss hugging people,” he said. “The first time I can go back to the church on the corner for a meeting, I will, but I’ll still do meetings online.”

Mr. Holland, who for decades abused drugs until Narcotics Anonymous helped him stay sober for eight years, said the online meetings can “lack the feeling of emotion and the way the spirits and principles get expressed.”

It is too early for data on the effectiveness of online rehabilitation compared to in-person sessions. There has been some recent research validating the use of the technology for related areas of treatment, like PTSD and depression that suggests hope for the approach, some experts in the field said.

Even those people who say in-person therapy will remain superior also said the development has proved a huge benefit for many who would otherwise have otherwise faced one of the biggest threats to recovery: isolation.

The implications extend well beyond the pandemic. That’s because the entire system of rehabilitation has been grappling for years with practices some see as both dogmatic and insufficiently effective given high rates of relapse.

“It’s both challenging our preconceived concerns about what is necessary for treatment and recovery but also validating the need for connection with a peer group and the need for immediate access,” said Samantha Pauley, national director of virtual services for the Hazelden Betty Ford Foundation, an addiction treatment and advocacy organization, with clinics around the country.

In 2019, Hazelden Betty Ford first tried online group therapy with patients in San Diego attending intensive outpatient sessions (three-to-four hours a day, three -to-four hours a week). When the pandemic hit, the organization rolled out the concept in seven states, California, Washington, Minnesota, Florida, New York, Illinois and Oregon — where Ms. Pauley works — and has since expanded to New Jersey, Missouri, Colorado and Wisconsin.

Ms. Pauley said 4,300 people have participated in such intensive therapy — which entails logging into group or individual sessions using a platform called Mend that is like Zoom. Preliminary results, she said, show the treatment is as effective as in-person meetings at reducing cravings and other symptoms. An additional 2,500 people have participated in support groups for family members.

If not for Covid, Ms. Pauley said, the “creative exploration” of online meetings would still have happened but much more slowly.

One hurdle to intensive online rehab involves drug testing of patients, who would ordinarily give saliva or urine samples under in-person supervision. A handful of alternatives have emerged, including one in which people spit into a testing cup while being observed onscreen by a provider who verifies the person’s identity. The sample then gets dropped at a clinic or mailed in, though the risk of trickery always remains. In other cases, patients can visit a lab for a drug test.

Additionally, some clinical signs of duress can’t be as easily diagnosed over a screen.

“You can’t see the perspiration that might indicate the person suffering mild withdrawal. There are limitations,” said Dr. Christopher Bundy, president of the Federation of State Physician Health Programs, a group representing 48 state physician health programs that serve doctors in recovery. He said that hundreds of physicians in these programs are attending regular virtual professionally monitoring meetings in which they meet with a handful of specialists for peer support and to assess their progress.

“This sort of thing has challenged our assumptions,” he said of the pandemic and the use of the internet for these therapies. “There’s a sense it’s not the same, but it’s close enough.”

Other participants in drug rehab and leaders in the field say that while online has been a good stopgap measure, they also hope that in-person meetings will return soon.

“It’s been a mixed blessing,” said David Teater, who wears two hats: he’s in recovery himself since the 1980s, and he’s executive director of Ottagan Addictions Recovery, a residential and outpatient treatment center serving low-income patients in western Michigan whose therapy typical gets paid through Medicaid.

In that capacity, he said online tools have been a godsend because, simply, they allowed service to continue. Through $25,000 in grants, the center got new computers and other technology that allowed it to do telemedicine, and set up a “Zoom room.” It includes a 55-inch monitor so that people who are Zooming in can see the counselor as well as the people who feel comfortable enough to come in-person and sit at a social distance wearing masks.

“We think it works equally well, we really do,” Mr. Teater said.

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Scientists reveal regions of the brain where serotonin promotes patience

Scientists reveal regions of the brain where serotonin promotes patience
Serotonin-releasing neurons (green arrows) from the dorsal raphe nucleus (DRN) penetrate many other areas of the brain, including the nucleus accumbens (NAc), orbitofrontal cortex (OFC) and medial prefrontal cortex (mPFC). Credit: OIST

We’ve all been there. Whether we’re stuck in traffic at the end of a long day, or eagerly anticipating the release of a new book, film or album, there are times when we need to be patient. Learning to suppress the impulse for instant gratification is often vital for future success, but how patience is regulated in the brain remains poorly understood.

Now, in a study on mice conducted by the Neural Computation Unit at the Okinawa Institute of Science and Technology Graduate University (OIST), the authors, Dr. Katsuhiko Miyazaki and Dr. Kayoko Miyazaki, pinpoint specific areas of the brain that individually promote patience through the action of serotonin. Their findings were published 27th November in Science Advances.

“Serotonin is one of the most famous neuromodulators of behavior, helping to regulate mood, sleep-wake cycles and appetite,” said Dr. Katsuhiko Miyazaki. “Our research shows that release of this chemical messenger also plays a crucial role in promoting patience, increasing the time that mice are willing to wait for a food reward.”

Their most recent work draws heavily on previous research, where the unit used a powerful technique called optogenetics—using light to stimulate specific neurons in the brain—to establish a causal link between serotonin and patience.

The scientists bred genetically engineered mice which had serotonin-releasing neurons that expressed a light-sensitive protein. This meant that the researchers could stimulate these neurons to release serotonin at precise times by shining light, using an optical fiber implanted in the brain.

The researchers found that stimulating these neurons while the mice were waiting for food increased their waiting time, with the maximum effect seen when the probability of receiving a reward was high but when the timing of the reward was uncertain.

“In other words, for the serotonin to promote patience, the mice had to be confident that a reward would come but uncertain about when it would arrive,” said Dr. Miyazaki.

In the previous study, the scientists focused on an area of the brain called the dorsal raphe nucleus—the central hub of serotonin-releasing neurons. Neurons from the dorsal raphe nucleus reach out into other areas of the forebrain and in their most recent study, the scientists explored specifically which of these other brain areas contributed to regulating patience.

The team focused on three brain areas that had been shown to increase impulsive behaviors when they were damaged—a deep brain structure called the nucleus accumbens, and two parts of the frontal lobe called the orbitofrontal cortex and the medial prefrontal cortex.

“Impulse behaviors are intrinsically linked to patience—the more impulsive an individual is, the less patient—so these brain areas were prime candidates,” explained Dr. Miyazaki.

Good things come to those who wait (or not…)

In the study, the scientists implanted optical fibers into the dorsal raphe nucleus and also one of either the nucleus accumbens, the orbitofrontal cortex, or the medial prefrontal cortex.

The researchers trained mice to perform a waiting task where the mice held with their nose inside a hole, called a “nose poke,” until a food pellet was delivered. The scientists rewarded the mice in 75% of trials. In some test conditions, the timing of the reward was fixed at six or ten seconds after the mice started the nose poke and in other test conditions, the timing of the reward varied.

Scientists reveal regions of the brain where serotonin promotes patience
The scientists studied the effect of stimulating serotonin-releasing neurons (black arrows) in the medial prefrontal cortex (mPFC), the orbitofrontal cortex (OFC) and nucleus accumbens (NAc) on waiting time, under variable time trials (e.g. food delivered after 2,6 or 10 seconds) and under fixed time trials (e.g. food delivered after 6 seconds). No effect was seen when neurons in the NAc were stimulated. A weak effect led to a small increase in waiting time when neurons in the mPFC were stimulated in variable time trials. A strong effect was seen when neurons in the OFC were stimulated in variable time trials and a weak effect was seen in fixed time trials. The thickness of the dashed arrows indicate the strength of the effect. Credit: OIST

In the remaining 25% of trials, called the omission trials, the scientists did not provide a food reward to the mice. They measured how long the mice continued performing the nose poke during omission trials—in other words, how patient they were—when serotonin-releasing neurons were and were not stimulated.

When the researchers stimulated serotonin-releasing neural fibers that reached into the nucleus accumbens, they found no increase in waiting time, suggesting that serotonin in this area of the brain has no role in regulating patience.

But when the scientists stimulated serotonin release in the orbitofrontal cortex and the medial prefrontal cortex while the mice were holding the nose poke, they found the mice waited longer, with a few crucial differences.

In the orbitofrontal cortex, release of serotonin promoted patience as effectively as serotonin activation in the dorsal raphe nucleus; both when reward timing was fixed and when reward timing was uncertain, with stronger effects in the latter.

But in the medial prefrontal cortex, the scientists only saw an increase in patience when the timing of the reward was varied, with no effect observed when the timing was fixed.

“The differences seen in how each area of the brain responded to serotonin suggests that each brain area contributes to the overall waiting behavior of the mice in separate ways,” said Dr. Miyazaki.

Modeling patience

To investigate this further, the scientists constructed a computational model to explain the waiting behavior of the mice.

The model assumes that the mice have an internal model of the timing of reward delivery and keep estimating the probability that a reward will be delivered. They can therefore judge over time whether they are in a reward or non-reward trial and decide whether or not to keep waiting. The model also assumes that the orbitofrontal cortex and the medial prefrontal cortex use different internal models of reward timing, with the latter being more sensitive to variations in timing, to calculate reward probabilities individually.

The researchers found that the model best fitted the experimental data of waiting time by increasing the expected reward probability from 75% to 94% under serotonin stimulation. Put more simply, serotonin increased the mice’s belief that they were in a reward trial, and so they waited longer.

Importantly, the model showed that stimulation of the dorsal raphe nucleus increased the probability from 75% to 94% in both the orbital frontal cortex and the medial prefrontal cortex, whereas stimulation of the brain areas separately only increased the probability in that particular area.

“This confirmed the idea that these two brain areas are calculating the probability of a reward independently from each other, and that these independent calculations are then combined to ultimately determine how long the mice will wait,” explained Dr. Miyazaki. “This sort of complementary system allows animals to behave more flexibly to changing environments.”

Ultimately, increasing our knowledge of how different areas of the brain are more or less affected by serotonin could have vital implications in future development of drugs. For example, selective serotonin reuptake inhibitors (SSRIs) are drugs that boost levels of serotonin in the brain and are used to treat depression.

“This is an area we are keen to explore in the future, by using depression models of mice,” said Dr. Miyazaki. “We may find under certain genetic or environmental conditions that some of these identified brain areas have altered functions. By pinning down these regions, this could open avenues to provide more targeted treatments that act on specific areas of the brain, rather than the whole brain.”

Serotonin and confidence underlie patience in new study

More information:
“Serotonergic projections to the orbitofrontal and medial prefrontal cortices differentially modulate waiting for future rewards” Science Advances (2020). advances.sciencemag.org/lookup … .1126/sciadv.abc7246

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Sitting for turkey? WHO reminds all to get more active

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As the coronavirus leaves many people housebound and many Americans sit to feast for Thanksgiving, the World Health Organization says people need to get more active, insisting that up to 5 million deaths worldwide could be avoided each year if people would run, walk and simply move more.

The U.N. health agency, launching updated guidelines on physical activity and its first advice on sedentary behavior, is pointing to figures that one in four adults—and four in five adolescents—don’t get enough physical activity, a situation that’s complicated by the COVID-19 crisis that has shut up many people indoors.

It recommends at least 2 1/2 hours of “moderate to vigorous aerobic activity” for adults per week, and an hour per day for kids and teens. A lack of physical activity leads to extra health care costs of $54 billion per year, plus another $14 billion in lost productivity, WHO said.

The findings come as the Geneva-based agency released an update on “WHO Guidelines on physical activity and sedentary behavior”—building upon, revising and expanding recommendations in the previous guidelines published a decade ago.

“Physical activity of any type and any duration can improve health and well-being, but more is always better,” said Dr. Ruediger Krech, WHO’s director of health promotion. “If you must spend a lot of time sitting still, whether at work or school, you should do more physical activity to counter the harmful effects of sedentary behavior.”

“The old adage—prevention is better than cure—really applies here,” Krech said. “WHO urges everyone to continue to stay active through the COVID-19 pandemic. If we do not remain active, we run the risk of creating another pandemic of ill-health as a result of sedentary behavior.”

Dr. Fiona Bull, who heads the physical activity unit at WHO, said the guidelines offer advice on “sedentary behavior” for the first time.

She added that experts previously believed physical activity should be done in blocks of at least 10 minutes. But the increasing use of fitness-monitoring devices has generated new science showing that it’s really most important to get 150 minutes at least per week.

“In fact, that 10-minute minimum is not so important and every move counts,” she said. “It’s the total amount we all achieve: Reaching 150 (minutes) and extending.”

Bull said only 78 countries, based on WHO’s most recent survey, have national guidelines on physical activity. She encouraged nations to leverage the new guidelines “as the basis for fast-tracking their policy development.”

Regular physical activity is important to help prevent heart disease, diabetes and cancer while also reducing symptoms of depression and anxiety, and “boosting brain health,” WHO said. People aged over 65 should focus on balance, coordination and muscle strength to help prevent falls, it said.

Aim to exceed weekly recommended physical activity level to offset health harms of prolonged sitting

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Genetic discovery could lead to better prediction of suicide risk within families

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Every 11 minutes, an American dies by suicide. That’s 132 people a day or more than 48,000 annually. For those left behind, the haunting question is why.

One emerging factor is family history. Perhaps the most famous example is Ernest Hemingway’s family. In addition to his own suicide in 1961, the novelist’s father, sister, brother, and niece took their own lives—in all, five deaths by suicide in three generations. But there are also thousands of families worldwide with similar histories that are compelling researchers to investigate the genetics of suicidal acts.

In a new analysis of this risk, researchers at University of Utah Health’s Huntsman Mental Health Institute have detected more than 20 genes that could have a role in these deaths. The study, among the first comprehensive genome-wide analyses of suicide death, also found significant genetic cross-connections to psychiatric diseases and behaviors associated with suicide, including bipolar disorder, schizophrenia, and autism spectrum disorder.

The researchers say the study establishes that suicide death is partially heritable and that it tracks in families independent of the effects of a shared environment. Identifying these genetic risk factors, they say, could lead to better ways to predict who might be at risk of suicide and inform new strategies for preventing the worst from happening.

“What is important about this study is that, using the whole genome, we have created a genetic risk score for suicide that predicts case-control status in the lab,” says Anna R. Docherty, Ph.D., lead author of the study, quantitative geneticist at the Huntsman Mental Health Institute, and assistant professor of psychiatry at U of U Health. “It can also help us study how genetics and environment interact to increase suicide risk. We are far from using any genetic risk score in the clinic, but this is the first step to quantifying biological risk for suicide in an individual.”

The study appears in the American Journal of Psychiatry.

Although stress, loneliness, financial strains, childhood trauma and other environmental issues can contribute to death by suicide, scientists have long thought that other factors must be involved.

“When I tell people that suicide risk is estimated to be 45% to 55% genetic, they look very surprised,” says Douglas Gray, M.D., co-author of the study and a professor of child psychiatry who specializes in suicide prevention. “They say, ‘No, it’s caused by losing a job, feeling helpless, or experiencing a romantic breakup.’ Well, if romantic breakup was the cause of suicide, we’d all be dead.”

Previously, the U of U Health team identified four gene variants that could amplify the risk of suicide based on a close examination of 43 high-risk families. But that research, like many other genetic suicide studies, focused on specific genetic segments of the human genome.

To get a more comprehensive picture of the genes potentially involved in suicide, Docherty and colleagues used computer technology to analyze millions of DNA variants in 3,413 samples obtained from the Utah Office of the Medical Examiner. Some of these subjects who had died by suicide had a family history of suicide, but others didn’t.

This is the largest suicide death sample in the world, a major improvement on previous genetic studies. These samples were compared to DNA from more than 14,000 individuals with matched ancestry from outside of the state who did not die by suicide. They also examined medical records for mental and physical health conditions.

Using a procedure called genome-wide association study (GWAS), the researchers looked at genetic variants known as SNPs (pronounced “snips”), which are essentially pieces of the genetic code. These millions of SNPs helped them identify 22 genes potentially implicated in an increased risk of suicide death located on four chromosomes. But using the millions of SNPs together in one formula, they were also able to score and predict suicide status across two separate datasets.

They then also scored suicide deaths for genetic risks for other problems, to see whether people who died from suicide may have had risks for conditions not seen in their medical records. People who died from suicide had significantly elevated genetic risks for impulsivity, schizophrenia, and major depression—critical risk factors for suicide death.

However, the researchers stress that genetics is just one of many factors that can contribute to death by suicide.

“Death by suicide typically requires a cascade of events,” Gray says. “That cascade could include a genetic predisposition combined with untreated or undertreated mental illness, substance abuse, the strains of daily life when your brain isn’t functioning well, firearm availability, and final instigating stressor, such as a romantic breakup, that leads to tragedy.”

Among the study’s limitations are that the majority of suicide cases were from Northern European ancestry. Not every individual with a DNA sample in the analysis had available medical record data to clarify presence or absence of a mental health diagnosis. Missing data may mean an absence of a diagnosis due to care outside the state, lack of insurance, cultural factors, or stigma.

Moving forward, the researchers plan to conduct larger and more diverse suicide death studies that will include people of Mexican and Native American ancestries.

“This study and others that follow are going to allow us to better understand the constellation of risk factors associated with suicide and to help decrease stigma relating to it,” Docherty says. “It will hopefully encourage families with a history of suicide to learn more and discuss risk and protective factors, as they would talk about other medical conditions like high blood pressure or cardiovascular disease.”

US suicide rate fell last year after decade of steady rise

More information:
Anna R. Docherty et al. Genome-Wide Association Study of Suicide Death and Polygenic Prediction of Clinical Antecedents, American Journal of Psychiatry (2020). DOI: 10.1176/appi.ajp.2020.19101025

Genetic discovery could lead to better prediction of suicide risk within families (2020, November 26)
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DGN-Leitlinie zum “Schleudertrauma”: Einer Chronifizierung entgegenwirken

Neurologie & Psychiatrie

Zwölf von 100 Betroffenen haben sechs Monate nach einem Unfall mit Beschleunigungstrauma der Halswirbelsäule („Schleudertrauma“) noch Beschwerden. Eine neue S1-Leitlinie der Deutschen Gesellschaft für Neurologie thematisiert daher auch Mechanismen der Schmerzchronifizierung.

Ein unaufmerksamer Moment, der nachfolgende Wagen fährt auf, wenig später schmerzt der Nacken. Die meisten Beschleunigungstraumata der Halswirbelsäule sind als leicht bis moderat einzustufen, schwere Verletzungsfolgen bleiben in der Regel aus. Dennoch: Es kommt zu muskelkaterähnliche Nackenschmerzen und Nackensteife, was für die Betroffenen sehr unangenehm sein kann. Denn neben den Schmerzen kann es auch zu Schwindel, Tinnitus (Ohrensausen) oder Kopf- und Kieferschmerzen kommen.

Was genau die Schmerzen und Begleitsymptome auslöst, ist nicht abschließend geklärt. In der Bildgebung wie Computertomographie oder Kernspintomographie sind in der Regel keine Verletzungen sichtbar, weshalb ExpertInnen von einer entzündlich-reparativen Gewebereaktion nach der mechanischen Gewebeschädigung ausgehen.

Bei den meisten Betroffenen gehen die Beschwerden nach einigen Tagen zurück. „Doch bei einem Teil der Patientinnen und Patienten werden diese Beschwerden chronisch“, erklärt Prof. Martin Tegenthoff, Bochum, federführender Autor der neu überarbeitete DGN-S1-Leitlinie „Beschleunigungstrauma der Halswirbelsäule“.

Chronisch, so definiert es die neue Leitlinie, heißt, dass die Beschwerden über sechs Monate anhalten. „Während der Großteil der Betroffenen spätestens nach einem Monat wieder ‚fit‘ ist und keine Beschwerden mehr hat, muss leider konstatiert werden, dass etwa zwölf Prozent der Patientinnen und Patienten nach sechs Monaten noch nicht beschwerdefrei sind“, so der Experte.

Die Gefahr der Schmerzchronifizierung in Folge einer HWS-Beschleunigungsverletzung ist also gegeben, und die Leitlinie fokussiert daher auch auf Strategien, einer Chronifizierung entgegenzuwirken. So sollten ein traumatisches Erleben des Unfalls, beispielsweise im Sinne einer akuten Belastungsreaktion nach dem Unfall, ebenso wie psychische Störungen in der Vorgeschichte vom behandelnden Arzt mit erfasst werden, da es sich hierbei um Risikofaktoren für die Entwicklung chronischer Schmerzen handle. Psychische Komorbiditäten sollten abgeklärt und gegebenenfalls behandelt werden – beispielsweise seien Menschen mit Depression deutlich gefährdeter, chronische Schmerzerkrankungen zu erleiden.

„Für eine erfolgreiche Therapie spielen Verhalten, Erwartungen und Einstellungen des Patienten, aber auch des Therapeuten eine wesentliche Rolle. Es ist deshalb wichtig, auf bestimmte Risikofaktoren zu achten: etwa dysfunktionale Schmerzbewältigungsstrategien oder eine depressive Stimmungslage“, erklärt Tegenthoff.

Kommt es zu einem langwierigen und komplizierten Verlauf, empfehlen die neuen Leitlinien eine interdisziplinäre multimodale Therapie, in der die medikamentöse Behandlung, beispielsweise mit Antidepressiva, und eine kognitive Verhaltenstherapie und Physiotherapie kombiniert werden. „Zwar fehlen noch definitive Wirksamkeitsbeweise des multimodalen Ansatzes, aber die Erfolge in der Praxis sind sehr gut, so gut, dass auch viele Unfallversicherer zu dieser Therapie, die aktuell überwiegend in Spezialambulanzen und Schmerzkliniken angeboten wird, raten.“

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Mental health issues more likely to affect communities of color during the holidays

family dinner
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For Listiner Martinez, the holiday season never brought feelings of merriment. Coming from an abusive home, she said, she never really celebrated the holidays. Martinez said she tried to move past that feeling when she had children, but sadness around the holidays still lingers.

“I typically look forward to when the holidays are over with,” said the West Ridge mom of three who has been diagnosed with depression, anxiety and seasonal affective disorder—a mood disorder that occurs at the same time each year. Diet and exercise are tools Martinez uses in her mental health journey, but so is therapy.

Before the pandemic, the mental health advocate said she was seeing her therapist once a month. Then Martinez was diagnosed with breast cancer in January. After surgery, the stay-at-home order meant Martinez wasn’t allowed to bring someone with her during chemotherapy, which started in April.

“I tried to adjust … but it really took a toll on me emotionally,” she said. “I had people who would check in on me. Friends would video chat … but it was just overwhelming.”

Dr. Aderonke Bamgbose Pederson, instructor of psychiatry and behavioral sciences at the Northwestern University Feinberg School of Medicine, said mental health challenges are more likely to have an impact on people of color, especially in Black communities.

Public stressors created by the pandemic often worsen for people in the communities most impacted, she added. Data has shown that people of color for example are more likely to get the coronavirus.

“When we look at this year, racial trauma is a compound stressor,” she said. “You have multiple different stressors in terms of the pandemic that disproportionately affects these communities already at greater risk.”

Multigenerational family households are also more common in Black and Hispanic communities, she said. The pandemic adds pressure in families with members at high risk, creating different levels of burden.

Adrienne McCue, founder and CEO of Step Up For Mental Health, realizes people are struggling. As the child of a late parent who had schizophrenia, McCue created the nonprofit to help families dealing with mental health issues. Step Up volunteers offer one-on-one peer support to clients by phone or video conference once a week for an hour in four-week or eight-week timeframes. The organization assists different populations with small grants and resources, including the bisexual community.

“This is the time where people can bottom out through situational depression and anxiety about jobs, about how I’m going to feed my family,” McCue said. “And if you had somebody who could talk to you just for a stretch of time, that would get you over the hump. … We believe that peer support facilitators are so important to start the process of thinking about talking to someone. We want to say, ‘It’s OK, you can talk to somebody.’ Once they get that eight weeks of peer support, they’re like: ‘You know, what? This wasn’t so bad. Can you help me find (a therapist)?'”

Martinez agrees and says people should not go through this difficult time of year alone. She said her support system of family and friends “showed up and showed out” during her breast cancer treatment. Now she shares her mental health journey with others full time to help them move through trauma. Her next virtual conference is Dec. 19; panelists will touch on mental health and self-care.

“I always tell people: I love God, but therapy is important too,” she said. “I recommend it, even when you’re not in a bad place. Like how you have a lawyer on hand? You should have a therapist on hand.”

“It’s an understatement to say that this holiday season will look different,” said Tytannie Harris, CEO of TMH Behavioral Services. When the Bronzeville practitioner talks to her clients—kids as young as 4 and adults as old as 90—about how to cope, she offers this advice:

Acknowledge how you feel and know that it’s OK to take time to cry or express how you feel. “And don’t feel like you have to force yourself to be happy just because it’s the holiday season, especially now,” said the licensed clinical social worker.

People should reach out to family members and friends, especially those who live alone. “Technology has to be our best friend during this time,” she said. “If you’re feeling distressed, it’s OK to reach out with a text, call or video chat.”

Be realistic. Don’t put pressure on yourself and feel like it has to be perfect, or “I have to try to re-create last year,” because we can’t. “This may be a new time to develop new rituals within your families,” Harris said. “I think one thing we don’t talk about enough, especially now, is sticking to a budget. We may feel guilty because we can’t be with family, and we may want to overindulge in gift giving. I tell my clients: Don’t buy happiness with an array of gifts, with the overhaul of gifts. Make sure you’re doing what’s within your budget.”

And when feeling sad is affecting your day-to-day functioning in a negative way, that’s when you know you should talk to someone. “If you’ve gone from ‘this is something minor,’ to ‘this is something that could potentially be more significant,’ I would encourage folks to seek mental health services,” she said.

TMH is staffed with Black clinicians, and Harris said she knows people want to talk to people who look like them. The practice has programs for Black men and their mental health, and she is touching base with her senior clients more frequently, as well as sending them self-care packages, Harris said.

“Don’t wait till things are extreme or severe. Get support, and get help early,” Bamgbose Pederson said. “Create spaces for yourself and remember that this, too, shall pass.”

Q&A: For some older adults, a pandemic of loneliness

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New paper proposes framework for eliminating defects in psychiatric care

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A new paper from the Department of Psychiatry and the Population Health program at University Hospitals (UH) Cleveland Medical Center, proposes a framework for eliminating defects in behavioral health treatment.

Entitled “Eliminating Defects in Behavioral Health Treatment,” the paper was published online on Nov. 19 in the journal Psychiatric Services and was written by Patrick Runnels, M.D., M.B.A., Heather M. Wobbe, D.O., M.B.A., and Peter J. Pronovost, M.D., Ph.D.

The authors cite that a large majority of defects are the result of system failures rather than due to the individual psychiatrist, and they propose that psychiatrists need to function as “systems engineers” to help eliminate these defects in healthcare organizations.

“The job of building and transforming behavioral health at the system level will require psychiatrists to adopt a new set of skills and a willingness to think differently about their identity as clinicians,” said Dr. Runnels, Chief Medical Officer, Population Health—Behavioral Health at UH and Associate Professor of Psychiatry at Case Western Reserve University School of Medicine.

“Beyond assessment and treatment skills, psychiatrists who act as systems engineers must be experts in quality improvement, implementation science, resonant leadership, and design-based thinking,” he said.

Dr. Pronovost, UH Chief Quality and Clinical Transformation Officer, said that they define “defect” as “anything clinically, operationally, or experientially that a provider would not want to happen, including in diagnosing, initiating treatment, adjusting treatment, nurturing therapeutic alliances at the individual provider and system level, and avoiding preventable service utilization.”

“The ultimate goal is to provide “defect-free care” that we believe will empower clinicians to engage in quality improvement initiatives at whatever level is most accessible to them,” said Dr. Pronovost.

“Despite our best intentions and efforts, defects happen every day in every field of medicine, said Dr. Pronovost, who is also Clinical Professor of Anesthesiology and Critical Care Medicine at CWRU School of Medicine. “Despite clear evidence-based screening tools and criteria for diagnosis, patients are rarely screened appropriately for common behavioral health issues, with barely half of identified individuals having received any care during the prior year and less than 15 percent having received appropriate evidence-based care. Even when prescribed a medication, only 23 percent of patients with depression received evidence-based psychopharmacology and appropriate symptom tracking.”

The authors trace defects back to incentives that are poorly aligned with goals, within and across health care systems, often leading to inefficient, suboptimal behavioral health care delivery. To a large extent, this deficit occurs because clinicians and the systems in which they practice are incentivized almost entirely by volume and throughput rather than by quality and outcomes.

They write: “Traditional payment models, information systems, and treatment paradigms fail to incentivize keeping people healthy, managing chronic conditions, or coordinating care across the continuum of services. This is not an indictment of clinicians, who are clearly motivated to improve the lives of the patients they serve. Nor is it an indication that high-quality work is not happening. Pockets of excellence are all around. A discussion with almost any psychiatrist will yield multiple stories highlighting the positive impact they have had on those they serve, stories that motivate them to continue their work as healers. Yet, despite clinicians’ best efforts, the constraints imposed by misaligned incentives negatively affect system design and lead to widespread defects in care.”

“Our observation and experience are that we providers have become so accustomed to working in low-reliability environments that we accept defects in the system as the norm. Indeed, most defects are invisible or are accepted as the cost of caring for patients with complex issues,” said Dr. Runnels.

In the paper, the authors provide scenarios to illustrate their points. In one such example, they describe a patient with major depressive disorder prescribed a starting dose of 20 mg of fluoxetine and scheduled for a follow-up appointment in four weeks. The patient picked up the medication but did not take the first pill for two weeks, then took two pills and stopped because of side effects. The patient called the office to report the trouble, but no one answered, and the phone call was never returned because no one checked the voicemail (no one had been assigned to check). When the patient arrived in the office four weeks later, the symptoms had not improved, and the patient ended up paying a second copayment of $50 to receive an alternative treatment. The patient described feeling angry with the system for not responding and for necessitating more time and money to receive the alternative treatment. The patient canceled the next appointment and did not return.

“If we instead made sure someone called patients one or two weeks after starting treatment and simply asked whether they had picked up the medication, tried it, and were still taking it, might we prevent this kind of outcome?” the authors ask.

They conclude with the belief that their framework to visualize and systematically eliminate defects in behavioral health care ultimately offers a hopeful approach to improving care—one that can drive large-scale success more effectively than trying to pick away at pieces of the system independently or berating clinicians about performance on individual quality metrics.

“This new narrative, which builds on much of the wisdom accumulated by our field over decades, can succeed only if clinicians see their core responsibility as focusing on eliminating defects and delivering the care that individuals with mental illness and addictions deserve, that clinicians are hungry for, and that payers increasingly demand,” they write.

Cancer patients, clinicians find value in electronic real-time symptom reporting system

More information:
Patrick Runnels et al, Eliminating Defects in Behavioral Health Treatment, Psychiatric Services (2020). DOI: 10.1176/appi.ps.202000255

New paper proposes framework for eliminating defects in psychiatric care (2020, November 24)
retrieved 25 November 2020
from https://medicalxpress.com/news/2020-11-paper-framework-defects-psychiatric.html

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part may be reproduced without the written permission. The content is provided for information purposes only.

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French rugby legend Christophe Dominici found dead in park near Paris

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Former French rugby international Christophe Dominici has been found dead at the age of 48 in a park near Paris, police said Tuesday.

Dominici, who played 67 times for France, was seen by a witness jumping from the roof of a disused building in the Saint-Cloud park, police said.

The diminutive Dominici — he was 1.72m and 82kg — scored 25 tries in 67 Tests for France, including eight tries across three World Cups. 

He had a deceptive change of pace and a shimmy that could lose and confuse defenders.

His most celebrated moment came in the 1999 World Cup semi-final against New Zealand when his second-half try, grabbing a bouncing ball one-handed and then skating down the left touchline, put the French ahead as they reached the final with a remarkable comeback. 

Dominici enjoyed a glittering club career, first with Toulon in southeast France, where he was born, and then at Paris-based Stade Francais with whom he won the French championship five times. 

After he retired, then-national coach Bernard Laporte gave Dominici a coaching role. He also worked as a media pundit.

Off the field, Dominici suffered bouts of depression. In his 2007 autobiography, he admitted a personal loss had triggered depression and that he had been abused as a child.

He returned to the public eye in the summer when he fronted an Emirates-based bid to take over Beziers rugby club which petered out with a financial investigation into its viability.

The French Rugby Federation said Dominici had “left his imprint on an entire generation of rugby”.

“Today, the rugby family has lost a legend and an emblematic player,” it added in a statement.


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350,000+ women likely missing out on key postnatal check-ups in the UK every year

Credit: CC0 Public Domain

Every year more than 350,000 women in the UK may be missing out on key formal health and wellbeing check-ups following the birth of a child, reveals the largest study of its kind, published in the online journal BMJ Open.

Teen mums and those living in the most deprived areas of the country are least likely to get these check-ups, which offer timely opportunities for health promotion and for important postnatal health needs to be picked up, say the researchers.

In the UK women have automatic access to midwives and health visitors for the first few days after a birth. They should then be invited by their family doctor for a formal check-up 6-8 weeks later in line with national (NICE) and World Health Organization guidance.

These postnatal check-ups are crucial for picking up any physical and mental health issues and for assessing how well women are recovering after pregnancy and birth. They also provide an opportunity to discuss breastfeeding, contraception, smoking cessation, return to physical activity, and diet.

While it is thought that most new mothers do attend these check-ups, there are no official published data on patterns of primary care use for women following childbirth.

To try and plug this knowledge gap, the researchers drew on entries to The Health Improvement Network (THIN) database which contains anonymised health records for 16 million patients from 730 general practices across the UK.

They extracted information on postnatal check-ups in person or by phone and use of primary care in the 12 months following a birth by 15-49 year olds who gave birth between 2006 and 2015. In all, 309,573 births to 241,662 women were included in their analysis.

A third (32%) of the women were aged 30-34 at the time of the birth. Around 1 in 5 (21%) lived in areas of least deprivation while around 1 in 6 (16%) lived in the most deprived.

Three out of four women (76%) had a vaginal delivery; the rest had a caesarean birth. Nearly half the births (48%) were to first time mums; 22% were second births. Nearly half the women didn’t smoke (46%); 11% were current smokers.

Only just over half the women (56%) had a structured postnatal check-up; for four in 10 there was no record of this within the first 10 weeks of giving birth. Younger women and those living in the most deprived areas were least likely to get a check-up.

After excluding those women with fewer than 5 weeks of follow-up information and missing information on deprivation, 275,577 women were included in further analysis.

This showed that 15-19 year olds were 12% less likely to get a postnatal check-up between weeks 5 and 10 than were 30-35 year olds. Similarly, women from the most deprived areas were 10% less likely to get a postnatal check than were those from the least deprived.

Yet in the 12 months following childbirth, most of the total sample (95%) had at least one appointment with a clinician, averaging around 5, rising to around 6 for smokers, and to around 8 for those who had had a C-section delivery.

Based on their findings, and the fact that around 800,000 women give birth in the UK every year, the researchers estimate that up to 350 400 new mothers may be missing out on formal postnatal check-ups within 10 weeks of giving birth each year.

There are several possible explanations for their findings, say the researchers.

“It is possible that women do not want or feel they need advice from GPs; or invitations from the GP are not taken up either because women do not respond to them, or may find it difficult to access appointments. Alternatively, a lack of recording in electronic health records may explain the apparently low rate,” they suggest.

But this matters, they insist. “The postnatal period is a potentially vulnerable time for women and there could be serious consequences to not identifying [those] at risk of poor health or harm after childbirth.

“The postnatal check has been shown to be a key contact to identify serious health needs such as postnatal depression, which affects one in six women after childbirth.”

They continue: “Our findings suggest practices may need to implement systems for follow-up of women who have declined or missed a postnatal check. There is a need for better promotion of the benefits of attending the postnatal check at other times in the maternity pathway.

“Additionally, there are currently no known financial or quality based incentives to document primary care activity in the postnatal period.”

Are women getting the support they need after giving birth?

More information:
Postnatal checks and primary care consultations in the year following childbirth: an observational cohort study of 309573 women in the UK, 2006-2016, BMJ Open (2020). DOI: 10.1136/bmjopen-2020-036835

350,000+ women likely missing out on key postnatal check-ups in the UK every year (2020, November 23)
retrieved 23 November 2020
from https://medicalxpress.com/news/2020-11-women-key-postnatal-check-ups-uk.html

This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no
part may be reproduced without the written permission. The content is provided for information purposes only.

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Premature Birth Tied to Increased Depression Risk

Girls born extremely prematurely may have an increased risk of depression from childhood through young adulthood.

Using Finnish birth and health registries, researchers studied 37,682 people diagnosed with mild, moderate or severe depression, comparing them with 148,795 healthy controls. The children were born between 1987 and 2007, and their average age at diagnosis was 16.

After adjusting for parents’ age, depression, substance abuse, smoking, socioeconomic status and other factors, they found that in girls, but not boys, younger gestational age was strongly associated with a diagnosis of depression in childhood, adolescence or young adulthood. Girls born before 28 weeks’ gestation were at roughly three times the risk for depression as those born at full term. After 28 weeks gestation, the association was no longer significant. The study is in the Journal of the American Academy of Child & Adolescent Psychiatry.

The authors suggest that the limited age range in the study of 5 to 25 years means that it was primarily early onset depression that was detected, and this may underestimate the effect in boys, who are typically diagnosed with depression at older ages.

“This is a huge sample,” said a co-author, Dr. Andre Sourander, a professor of child psychiatry at the University of Turku in Finland, “and we had many covariates for both mothers and fathers.” Even after considering all these other factors that may contribute to depression, “the findings remained significant” he said.

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Studie: Ärzte sehen Gesundheits-Apps als hilfreich an


Die Akzeptanz von Gesundheits-Apps ist in den vergangenen sechs Jahren erheblich gestiegen – das zeigt die aktuelle Studie „Ärzte im Zukunftsmarkt Gesundheit 2020/2“ der Stiftung Gesundheit. So halten 72,3 Prozent der Ärzte Gesundheits-Apps vor allem bei gezieltem Einsatz für hilfreich.

„Während sich vor sechs Jahren das Gros der Ärzte skeptisch bis kritisch zeigte, stimmen heute mehr als 70 Prozent von ihnen zu, dass gezielt eingesetzte Gesundheits-Apps hilfreich sein können“, berichtet Prof. Konrad Obermann, Forschungsleiter der Stiftung. Etwa ein Drittel der Ärzte habe ihren Patienten bereits entsprechende Apps empfohlen.

Nicht alle Gesundheits-Apps kommen bei Ärzten gleich gut an

Den größten Nutzen sehen Ärzte bei somatischen Anwendungen: Mehr als 80 Prozent können sich einen sinnvollen Einsatz in der Sportberatung und –anleitung, bei Tagebuchanwendungen zum Beispiel für Allergiker, zur Aufzeichnung von Vitalparametern, zur Ernährungsberatung oder Verhaltenskontrolle vorstellen. So werden etwa Tagebuchanwendungen von 44,4 Prozent der Befragten als „sehr wirksam“ und von 41,7 Prozent als „sehr wirksam“ eingeschätzt.

Eher zurückhaltend fällt das Urteil für Gesundheits-Apps zur gesundheitlichen Aufklärung, Gesundheitsinformation oder zu speziellen Erkrankungen wie etwa Tinnitus oder Migräne aus: Letztere schätzen nur 16,4 beziehungsweise 40,3 Prozent als „sehr wirksam“ beziehungsweise „sehr wirksam“ ein. 8,3 Prozent der Befragten beurteilen diese Anwendungen als „unwirksam“ und 3,6 Prozent halten sie für „kontraproduktiv“. Kritisch beurteilen sie dagegen Apps in psychischen Anwendungsgebieten wie Depression oder Sucht.

Ärzte wünschen sich mehr Testmöglichkeiten für Behandler

Aus der Studie ergeben sich zudem Hinweise auf ungeklärte Fragen und organisatorische Hürden. So kritisierten zahlreiche Ärzte einen Mangel an Testmöglichkeiten für Behandler: „Es ist sehr zu begrüßen, dass Ärzte Gesundheits-Apps zunächst selbst kennenlernen und testen möchten, bevor sie sie Patienten empfehlen“, so Obermann: „Das zeugt von einem verantwortungsvollen Umgang der Ärzte mit diesem neuen Instrument.“ Industrie und Krankenversicherer seien gut beraten, solche Handlungsempfehlungen aufzugreifen und entsprechende Möglichkeiten zu schaffen.

Die Studie ist Teil der Reihe „Ärzte im Zukunftsmarkt Gesundheit“, mit der die Stiftung Gesundheit seit 2005 jährlich Trends und Entwicklungen im Gesundheitssektor untersucht.

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Election outcome hasn’t lowered Americans’ stress levels: poll

Election outcome hasn't lowered americans' stress levels: poll

(HealthDay)—The U.S. presidential election may be over, but many Americans remain stressed about it, as well as a number of other worries, a new poll finds.

The online Harris Poll survey from the American Psychological Association (APA)—which included more than 2,000 adults aged 18 and older—was conducted Nov. 12-16. It found that 27% of respondents said their stress has actually increased since Election Day, while just 17% said it has decreased.

Specific sources of stress cited by the majority of respondents include the election outcome, the current political climate, the future of the nation and the coronavirus pandemic.

“There is no doubt that we continue to face significant challenges in 2020, from the election to the pandemic. These findings demonstrate that we are not doing enough as a country to bring our stress under control, which means we are going to be less effective in our various personal and professional roles,” said APA CEO Arthur Evans Jr.

Eight in 10 respondents said the future of the nation is a significant source of stress, compared with 66% in a survey conducted in January 2017.

Seven in 10 respondents said the outcome of the 2020 presidential election is a significant source of stress, compared with 49% who said the same in 2017.

The current political climate was cited as a significant source of stres