mental illness

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Inspired By Family Illness, Philanthropist Gives $650 Million For Psychiatric Research

The Broad Institute of Harvard and MIT  summer student Lydia Emerson and aesearch associate Aldo Amaya. (Courtesy/Kelly Davidson Photography)

Researchers at the Broad Institute plan to use Ted Stanley’s money to catalog all the genetic variations that contribute to severe psychiatric disorders. (Courtesy/Kelly Davidson Photography)

In the largest-ever donation to psychiatric research, Connecticut businessman Ted Stanley is giving $650 million to the Eli and Edythe Broad Institute of MIT and Harvard. The goal — to find and treat the genetic underpinnings of mental illnesses — was inspired by a family experience.

Ted Stanley made his fortune in the collectibles business. He founded The Danbury Mint, a company (later MBI, Inc.) whose first product was a series of medals commemorating the biggest scientific achievement of its time: the moon landing in 1969. While his business grew, his son Jonathan Stanley grew up as a normal Connecticut kid. Until, at age 19, Jonathan came down with bipolar disorder with psychosis, which got worse over the next three years.

“We’ll call it the epiphany from my dad’s standpoint at least,” Jonathan Stanley remembered of the turning point in his illness. “I went three days straight running through the streets of New York, no food, no water, no money, running from secret agents. And not surprisingly, after I stripped naked in a deli, ended up in a psychiatric facility.”

Jonathan was a college junior at the time.

“My dad came to visit, and he got to see his beloved son in a straitjacket,” Jonathan Stanley said.

The Stanleys were lucky. Jonathan responded well to the lithium, then a newly-approved drug. He went on to graduate from college and law school, too. Yet along the way, his father had met other fathers whose sons did not respond to treatment. He met other families who had to keep living with uncontrolled mental illness.

Ted Stanley said that gave him a focus for his philanthropy.

There was something out there that our son could take, and it made the problem go away,” he said. “And I’d like to see that happen for a lot of other people. And that’s why I’m doing what I’m doing.”

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5 Ways The Brain Stymies Scientists And 5 New Tools To Crack It

Dr. Steven Hyman (Maria Nemchuk/Broad Institute)

Dr. Steven Hyman (Maria Nemchuk/Broad Institute)

In past lives, Dr. Steven Hyman has been the director of the National Institute of Mental Health and the provost of Harvard. He’s currently the president-elect of the Society for Neuroscience, and he directs the Stanley Center for Psychiatric Research at the Broad Institute in Cambridge, where we spoke, and where he demonstrated a preternatural professorial ability to speak off-the-cuff in structured outlines. Our conversation, lightly edited and broken down into what seemed to be its natural numbering scheme:

The Obama BRAIN initiative. We’ve had a ‘decade of the brain’ before, in the 1990s —

It accomplished nothing. Because it was a media blitz, it wasn’t based on new science.

So — Why this? Why now? What’s different?

Part of the growing public interest in the brain, and certainly much media attention, is a little bit unfortunate because it focuses on people applying tools, such as brain imaging, in ways that are untutored and underpowered but yield interesting — if not really scientifically valid — ideas about say, why a certain person is liberal or conservative, or why a certain person takes risks or is very self-protective. A subset of those may be scientifically addressable questions, but we’re a long way from understanding them deeply. Nonetheless they’re irresistible to the public and then of course it’s given rise to a new generation of debunkers — fair enough. So maybe we can set aside this false interest, this prurient interest in the brain and focus on the serious matters at hand.

In terms of political will, the question is not why now but why so late?

The bottom line is the brain is well recognized to be the linchpin of being human in the sense that it is the substrate of thought, emotion, control of behavior, and therefore, undergirds our life trajectories, our actions, our morality. And when the brain gets sick in any way we realize that it exacts an extraordinarily severe toll on the sufferer, on families, on society. Just think about Alzheimer’s disease, heroin addiction, major depression, schizophrenia, autism, intellectual disability — these are common conditions in which people can no longer exert reliable, effective agency on their own behalf and therefore society often has to step in for them at great cost and often really great pain.

Tragically, for the longest time there wasn’t so much we could do about it. Using medications that were really discovered by luck, by prepared serendipity; using, in more recent years, the few psychotherapies, especially Cognitive Behavioral Therapies, which have been empirically tested, we have been able to help a lot of people manage their symptoms, in some cases to become better stoics. With imaging technologies we began some decades ago — though at really still very relatively poor resolution — to get spatial maps of what’s happening in the brain. But we were really stymied in terms of getting a deeper understanding, a better picture, for several reasons:

1. The brain is new

The first, which is really important, is that the human brain is evolutionarily very recent in terms of many of its higher functions. What this means is that although we can learn an enormous amount from studying animals the way we do in the rest of biology and medicine, animal models are ultimately limited. Anything that requires language, just to take one example, we can’t model in animals. I think I understand my dog, but I wouldn’t publish it. There are really very many important functions — language, morality, certain kinds of creativity, the arts, humor, not to mention human mental illnesses, that really have not been well modeled in animals.

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Empathy Lessons: Training Police To Understand People With Mental Illness

In a training exercise, Somerville Police Officer Eli Kim, left, tries to book Somerville Officer Samir Messaoudi -- playing the role of a man with schizophrenia -- while Cambridge Police Officer Fred Cabral does the sound effects of voices in Messaoudi's head. (Cambridge Police Department)

In a training exercise, Somerville Police Officer Eli Kim, left, tries to book Somerville Officer Samir Messaoudi — playing the role of a man with schizophrenia — while Cambridge Police Officer Fred Cabral does the sound effects of voices in Messaoudi’s head. (Cambridge Police Department)

Earlier this month, Somerville Police Officers Alan Monaco and Timothy Sullivan responded to a call about a fight between two young men. They found one of them, Mike, in an agitated state.

“He started flipping out — get your effing hands off me, don’t touch me!” Monaco recalled. “He was up and down, he would be screaming and yelling one minute, nice and talking and smoking cigarettes the next. We talked about what the issue is; he said the other kid said something detrimental about his mother, and his mother’s sick, and he spit in his face.”

Coincidentally, the two Somerville officers had just been in a training session on mental disorders — including Asperger’s, one of Mike’s diagnoses. So they knew people with Asperger’s can be hyper-sensitive about being touched and insensitive about how close to get to other people. Like Mike, who got far too close to the officers when he talked to them, right up into their faces.

“Normally for a police officer, if you invade our space, we have a safety zone where we don’t want people close to us,” Monaco said. “I would have pushed him away. I would have physically pushed him off me.”

But the officers thought pushing Mike back with their hands — their natural reaction — would backfire.

“I think in this case Mike would have reacted adversely,” Monaco said, “and he would have ended up in jail, where he didn’t need to be.”

“It also seemed to de-escalate Mike in a sense,” Officer Sullivan said. “He got to vent and calm down and talk to us in I guess what would be a normal voice for Mike, and it worked. … The class actually helped us a lot.”

The class they took was part of 40 hours of training to create “Crisis Intervention Teams” that serve as a police department’s go-to group for mental health crises.

With a state Department of Mental Health grant of $168,000, the Massachusetts chapter of the National Alliance on Mental Illness is working to help bring that advanced training to more police departments around the state.

Crisis teams have been catching on around the country; earlier this month, the Connecticut Legislature passed a bill to ensure that all the state’s police officers get such training. The need has been rising: Cuts in mental health services over recent years mean that police are called upon to deal with growing numbers of people with severe mental illness, who often end up in jail instead of treatment.

“What we know is that at least 10 percent of all calls to 911 involve people having a psychiatric crisis,” said June Binney, director of the Criminal Justice Project at NAMI Mass., who oversees the training. “What we think anecdotally, from what we hear from police departments, is that number is really more in the range of 25-35 percent of all 911 calls related to people in a psychiatric crisis.”

State government figures show Massachusetts spends relatively little on police training compared to other states, Binney noted. And when it comes to mental illness, a lack of police training can pose real risks, she said.

“The consequences at worst can be very dire,” she said. “They could be people dying, they could be a person with a mental health problem who is fighting back and strong and may get hurt, and police officers are at a huge risk of getting injured in some of these encounters. So the skill set is really critical to keep the situation calm and keep the situation safe, first and foremost, and to avoid unnecessary arrests and get people the treatment they need.”

The training isn’t just classroom lectures. It’s acting out explosive situations in a simulation room with a giant interactive screen. It’s role-playing and practicing “de-escalation” of fraught encounters, responding calmly even when faced with yelling and aggression. Continue reading

The OCD In Us All: Study Finds Almost Everyone Has Intrusive Thoughts

Some people with OCD wash their hands compulsively. (Wikimedia Commons)

Some people with OCD wash their hands compulsively. (Wikimedia Commons)

Confession: Every time I flush the toilet, I have to be out of the bathroom before the last of the water goes down the pipe. If I’m not — well, I don’t know. Something bad will happen. And when I’m choosing a spoon for breakfast — only breakfast, not later meals — sometimes I’m seized by the feeling that I’ve chosen the wrong spoon. If I use it, I doom the day. I put it back into the silverware tray and choose another.

I knew that I was far from alone — that Obsessive-Compulsive Disorder-type thoughts and behaviors are extremely widespread. But not this widespread. A study just out in the Journal of Obsessive-Compulsive and Related Disorders suggests to me that if you don’t have any of these thoughts and behaviors, you’re the weird one.

The study looked at 777 university students in 13 countries, including Canada, Israel, Iran and the United States. From the press release:

International study finds that 94 percent of people experience unwanted, intrusive thoughts

Montreal, April 8, 2014 — People who check whether their hands are clean or imagine their house might be on fire are not alone. New research from Concordia University and 15 other universities worldwide shows that 94 per cent of people experience unwanted, intrusive thoughts, images and/or impulses. Continue reading

Study: Primary Care May Be Path To More Effective Suicide Prevention

The unanswerable question, “What If?” often dominates the talk when it comes to illness. What if the tumor had been caught earlier; what if the child’s ache taken more seriously? When it comes to suicide, the agonizing “What Ifs?” can run rampant.

Recently, following three suicide deaths by high school students in Newton, Mass. there has been much talk about what, if anything, might have been done to prevent these acts.

A new national study offers no easy answers — indeed, many people who die by suicide do so without any prior mental health diagnosis, researchers report. But this new research does suggest there may be opportunities — through primary care doctors, and other specialists, for instance — to more accurately identify people at risk for suicide, and perhaps intervene before it’s too late.

The new federally-funded study — based on a longitudinal review of more than 5,800 people who died by suicide from 2000 to 2010 — found that nearly all of these individuals (83 percent) saw a doctor or received some kind of health care in the year prior to their death, but half of those individuals did not have a mental health diagnosis. Moreover, researchers report: “Only 24% had a mental health diagnosis in the 4-week period prior to death.”

Also, strikingly, one in every five people who died by suicide “made a health care visit in the week before their death,” says the paper’s lead author Brian K. Ahmedani, Ph.D., assistant scientist in the Center for Health Policy and Health Services Research at Henry Ford Health System in Detroit, who speaks about the work in an accompanying video.

The study, published online in the Journal of General Internal Medicine, concludes that: “Greater efforts should be made to assess mental health and suicide risk. Most visits occur in primary care or medical specialty settings, and suicide prevention in these clinics would likely reach the largest number of individuals.”

Of course, that’s easier said than done. Anyone familiar with a typical primary care visit knows it can be, well, a bit rushed — not quite the perfect venue for dwelling on complicated emotional issues that may be difficult to articulate. Unless specific psychiatric symptoms are raised, they are often not part of routine care, says Massachusetts General Hospital psychiatrist Steven C. Schlozman, Continue reading

Parent View: Adam Lanza’s Mother Would Have No Better Help Today

Flowers, candles and stuffed animals make up a makeshift memorial in Newtown, Conn., days after the 2012 shooting. (Reuters/Landov)

Flowers, candles and stuffed animals make up a makeshift memorial in Newtown, Conn., days after the 2012 shooting. (Reuters/Landov)

Soon after the Newtown shooting, a viral blog post titled “I am Adam Lanza’s mother” captured one mother’s anguish over having a mentally ill and violent child. Lisa Lambert, the executive director of the Parent/Professional Advocacy League — subtitled “The Massachusetts Family Voice For Children’s Mental Health” — responded by eloquently describing the public silence that usually prevails among such parents in the face of widespread stigma and hostility, and the damage it does. Her post was titled Parents of Mentally Ill Children: ‘We Don’t Tell You And Here’s Why.

Today, a year after the shooting, NPR reports that promises to fix the mental health system after Newtown remain unfilfilled. And USA Today reporter Liz Szabo tweeted from Capitol Hill this week: “Mental health reform struggles to get attention. Rep. Tim Murphy announced major bill. Almost no one showed up.”

Here, Lisa Lambert looks at the effects of the Newtown shooting — and the lack thereof — on children with mental illness and their families, one year later.

By Lisa Lambert
Guest contributor

Dec. 14 will be the first anniversary of the Newtown school shootings that took the lives of 20 young children and six school staff. Adam Lanza also shot his mother, Nancy, and later shot himself. In the aftermath of those 28 deaths, intense conversations took place both publicly and privately about mental health, guns and prevention. We asked ourselves what went wrong and what needed to change so this wouldn’t happen again.

Twelve months later, not much has changed.

Last December, many families whose children have mental health needs were optimistic that there would be a renewed focus and the will to take a hard look at the children’s mental health “system.”

Those of us who use it, work in it or navigate it realized that while there might not be a wholesale fix, even some patching up could make an impact.  Many of us told our stories and shared our worries in an effort to keep this important discussion on the front burner. We were hopeful. Finally mental health, especially children’s mental health, was getting the attention it needed.

The early reports about Adam Lanza and his mother, Nancy, highlighted his bizarre behavior and isolation and their slow drift into accepting these things as the new normal. Those reports sounded a lot like the personal stories many families tell when they call my organization for help, as well as the story of my own son.

When he was younger, I watched him become wildly enraged at trivial slights and fearful of ordinary things. Once, in a movie theatre, he ran screaming to the lobby because an adult character became out of control, which mirrored the way he was feeling. We all hoped these stories would point out his dire needs — and our own.

Instead, the conversation about mental health and children has focused on training teachers, creating a registry of people who have been hospitalized and, of course, guns. There are new funding and education programs for teachers and other school employees to recognize the signs of “mental illness.”

While it’s always a welcome idea to invest more money into children’s mental health, most parents will tell you that they notice something worrisome going on with their child long before the teacher does. But there’s no funding to teach parents the same skills and facts, and no recognition that we can be valuable “first responders,” even though most parents are pretty expert about their children. For parents, not much has changed. Continue reading

The Checkup: Meltdown U. And Mental Health Tips For Parents Of College Kids

For all those freshman just settling into dorm life this fall, college can be exhilarating, mind-blowing, the best years of their lives. But many parents don’t realize that their children are also facing a potential double whammy. Not only must new students navigate an entirely unfamiliar social, emotional and intellectual landscape, but they’re also entering a time in their lives — the ages between 18 and 21 — when many mental illnesses, from anxiety to depression to eating disorders, peak.

This week, The Checkup, our podcast on Slate, explores the mental health of college students. Here’s one sobering statistic: up to 50% of college-age kids have had or will have some kind of psychiatric disorder. That’s why we’re calling this episode “Meltdown U.” (To listen to The Checkup now, click on the arrow above; to download and listen later, press Download; and to get it through iTunes click here.)

The Checkup

Consider some more scary numbers:

–80% of college students who need mental health services won’t seek them

–50% of all college students say they have felt so depressed that they found it difficult to function during the last school year

–Suicide is the second leading cause of death among college-age youth – over 1000 deaths per year.

–The rate of student psychiatric hospitalizations has tripled in the past 20 years.

We asked Dr. Eugene Beresin, M.D., a child psychiatrist at Massachusetts General Hospital and professor of psychiatry at Harvard Medical School, to offer some guidance on what parents should know about helping their college-age kids cope with the high stress of undergraduate life. Here’s his advice: Continue reading

Caffeine Withdrawal As A Mental Illness? Really?

I’ve had the headaches and grumpiness and desperate yearnings that accompany giving up my beloved daily Americano. But come on, caffeine withdrawal as a mental illness? Isn’t that just a wee bit farfetched?

Brietta Mengel/Health Care Savvy

(Source: Topcounselingschools.org — click to view full version)

Apparently not. Caffeine use disorder is right there in Section III of the DSM-5, the latest edition of the bible of psychiatric disorders formally known as the Diagnostic and Statistical Manual of Mental Disorders.

“Caffeine is a drug, a mild stimulant, used by almost everybody on a daily basis,” explains Charles O’Brien, MD, PhD, chair of the substance-related disorders work group of the American Psychiatric Association, which publishes the DSM. “But it does have a letdown afterwards.”

Indeed, and for some more than others. (For the full rationale behind caffeine withdrawal’s elevated status as a disorder worthy of further discussion, watch the video here.) Continue reading

Study: Seasons May Affect Mental Health More Than Previously Thought

It may truly feel like summer today, which could bode well for people with a range of mental illness (and not just those of us with seasonal affective disorder desperately awaiting warmth and sunshine).

A new analysis of mental health inquiries in the U.S. and Australia found that Google searches for specific mental illnesses — including eating disorders, schizophrenia and bi-polar disorder, were all down in summertime compared to winter. This led researchers to surmise that mental illness of all varieties may have stronger links to the seasons than previously thought. The new work (with funding from Google.org) is published in the May issue of the American Journal of Preventive Medicine.

sunbatherFrom the news release:

Using Google’s public database of queries, the study team identified and monitored mental health queries in the United States and Australia for 2006 through 2010. All queries relating to mental health were captured and then grouped by type of mental illness, including ADHD (attention deficit-hyperactivity disorder), anxiety, bipolar, depression, eating disorders (including anorexia or bulimia), OCD (obsessive compulsive disorder), schizophrenia, and suicide. Using advanced mathematical methods to identify trends, the authors found all mental health queries in both countries were consistently higher in winter than summer.

The research showed eating disorder searches were down 37 percent in summers versus winters in the U.S., and 42 percent in summers in Australia. Schizophrenia searches decreased 37 percent during U.S. summers and by 36 percent in Australia.

Bipolar searches were down 16 percent during U.S. summers and 17 percent during Australian summers; ADHD searches decreased by 28 percent in the U.S. and 31 percent in Australia during summertime. OCD searches were down 18 percent and 15 percent, and bipolar searches decreased by 18 percent and 16 percent, in the U.S. and Australia respectively.

Searches for suicide declined 24 and 29 percent during U.S. and Australian summers and anxiety searches had the smallest seasonal change – down 7 percent during U.S. summers and 15 percent during Australian summers.

While some conditions, such as seasonal affective disorder, are known to be associated with seasonal weather patterns, the connections between seasons and a number of major disorders were surprising. “We didn’t expect to find similar winter peaks and summer troughs for queries involving every specific mental illness or problem we studied, however, the results consistently showed seasonal effects across all conditions – even after adjusting for media trends,” said James Niels Rosenquist, MD, PhD, a psychiatrist at Massachusetts General Hospital. Continue reading

Why Has Psychiatric Drug Development Stalled Lately?

colorpills
Just because drug companies get a lot of flak for pushing psychiatric medications, that doesn’t mean anyone wants them to stop developing better ones.

But that is what’s happening: investment in new psychiatric treatments is on the decline, reports Dr. Steven Hyman, former head of the National Institute of Mental Health and now director of the Stanley Center for Psychiatric Research at the Broad Institute. And that decline has hit even though psychiatric drugs have been highly profitable and one in five American adults now takes at least one, he says.

Hyman writes in the latest issue of Cerebrum, the Dana Foundation magazine:

During the past three years the global pharmaceutical industry has significantly decreased its investment in new treatments for depression, bipolar disorder, schizophrenia, and other psychiatric disorders. Some large companies, such as GlaxoSmithKline, have closed their psychiatric laboratories entirely. Others, such as Pfizer, have markedly decreased the size of their research programs. Yet others, such as AstraZeneca, have brought their internal research to a close and are experimenting with external collaborations on a smaller scale.

What’s going on? Read the full article here — a well-written history of attempted progress despite the lack of fundamental understanding of how mental illnesses actually work. And — in keeping with this week’s widespread talk of the new federal brain mapping initiative — Hyman remains optimistic that new scientific advances will bear fruit. He writes:

Our best hope is that the genetics will unfold over the next several years, due to the efforts of large international consortia that have formed to recruit and to study patients. Continue reading