psychiatry

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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.”

Continue reading

In Search Of ‘Computational Psychiatry:’ Why Is It A Hot New Field?

By Suzanne Jacobs
WBUR Intern

It’s around 10 a.m. on a weekday when I walk into a coffee shop that apparently doubles as the preferred study spot of every student on the Boston University campus. My instinct is to leave immediately and find a quieter place to caffeinate, but I’m not here for the coffee. I’m here for information — information on what I’m hearing is one of the hottest new trends in brain science.

Winding my way through tables of frazzled co-eds, I search every face for that “Are you who I’m looking for?” stare, but no one acknowledges me. So I step back out onto the sidewalk and wait. I’m early anyway.

About five minutes later, a young man who would have otherwise been indistinguishable from the crowd of students locks eyes with me from about 20 feet away. “That’s my guy,” I think to myself.

Lights of Ideas (Andrew Ostrovsky)

(Andrew Ostrovsky)

Minutes later, coffees in hand, we’re seated at a small back table, and I put my digital recorder down on it. “Is it okay if I record this?” I ask. He says that’s fine.

At this point, what I really want to do is grab him by the shoulders and yell, “What are you people doing? Let me into your world!” For weeks, I’ve been looking into this new field of research called computational psychiatry, but for the life of me, I can’t figure out what it is. More frustratingly, I can’t figure out why I can’t figure it out, despite a strong science background and hours of reading what little I could find about the topic on the Internet.

But I hold back, press the little red circle on my digital recorder and let the man speak.

In computational psychiatry, “What you try to do is come up with a toy world…,” he begins.

This all started a few weeks earlier when I was perusing the latest edition of Current Opinion in Neurobiology. Don’t ask me why I was perusing Current Opinion in Neurobiology — I don’t know. To avoid doing something else, probably.

One article caught my eye. It was titled “Computational approaches to psychiatry.” A longtime subscriber to the drugs-and-therapy stereotype of psychiatry, I found the idea of new “computational approaches” intriguing, so I read on. Continue reading

‘Did You Ever Kill Anyone?’ 5 Things Not To Say To A Veteran

U.S. Soldiers depart Forward Operating Base Baylough, Afghanistan, June 16, 2010, to conduct a patrol.  (Photo: Staff Sgt. William Tremblay, U.S. Army/Released)

U.S. Soldiers depart Forward Operating Base Baylough, Afghanistan, June 16, 2010, to conduct a patrol. (Photo: Staff Sgt. William Tremblay, U.S. Army/Released)

By Tommy Furlong and Dr. Paula K. Rauch
Guest contributors

“So, did you ever kill anyone?”

It’s not a question you would ask a police officer, but it’s one that many veterans get all the time. Most people have good intentions, but that doesn’t seem to be enough to guide people in what to say and what not to say to a returning veteran. It has become commonplace to say, “Thank you for your service,” but then what?

So here, in advance of our most patriotic holiday, is a brief guide for speaking with post-9/11 veterans and their families. We begin with five things not to say, and end with five that maybe you should:

1. I can’t understand why anyone would join the military.

Oftentimes, people hear the word “military” and immediately think of warfare. In reality, that is just one of the components. The military puts a lot of its resources toward humanitarian efforts. And if you list almost any civilian job, that same position can be found in the military.

So why would someone join the military? They might enjoy the structure. The job security is alluring, as are the benefits. Many young people also choose to serve for educational or economic opportunity, family tradition, seeking a challenge or as a path out of a difficult situation.

Serving our nation is an intense and rewarding career choice. So is being a firefighter, a nurse or a surgeon. Different individuals are drawn to different vocations. Choosing military service is one choice — and it’s not a crazy one.

Family members often hear “Why did you let him (or her) enlist?” or “I would never let one of my kids join the military.” The suggestion is that loving parents don’t let their children serve in the armed forces. These types of comments leave parents and spouses of veterans feeling isolated and unappreciated because, as any military family knows, when one member serves, the entire family serves. Family members have pride in their service member, but they also live with anxiety during the years of service. But all that aside, most parents don’t get to choose their adult child’s life path — and that includes career, partner and place to live.

2. How could you leave your children? Continue reading

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

When Shrinks Put Mindfulness On The Couch

By Alexandra Morris
CommonHealth intern

Can medications and meditation co-exist?

Or, put another way, does mindfulness — the deliberate act of paying attention to the present moment and observing your thoughts drift by — have a place in psychiatric care?

The answer, according to some doctors: yes, maybe, at least for some patients.

At a conference held earlier this month at the University of Massachusetts Medical School, psychiatrists David Lovas of Dalhousie University and Zev Schuman-Olivier of Harvard Medical School and the Cambridge Health Alliance made the case for and against mindfulness and psychiatric drugs in treating patients with depression, anxiety, schizophrenia, bipolar disorder, and other mental illnesses.

Over the past twenty years or so, the number of patients taking antidepressants and antipsychotics has increased substantially. And in many cases, patients are on multiple drugs at once: one third of psychiatric outpatients are on three or more drugs, according to one study.

(Synergy by Jasmine/flickr)

(Synergy by Jasmine/flickr)

So researchers have begun to examine whether mindfulness, which can include walking meditation, body scan meditation (to bring awareness to each part of the body in turn), mindful eating or yoga, or mindful listening can significantly reduce some of the anxiety and distress associated with such illnesses.

“We’re witnessing a culture that is focused and organized in some ways around medication as a primary form of treatment,” said Schuman-Olivier. “On the other hand, people can overstate the power of mindfulness intervention.”

It’s a careful balancing act, they say: for some, mindfulness-based therapy may be more effective at relieving stress and addressing mental health symptoms, while others may benefit more from medications or a combination of medication and meditation.

In some cases, mindfulness can produce negative side effects – it has been shown to draw out negative memories of past events.

Still, mindfulness meditation is being adopted more and more as a practice to improve health and mental well-being. The U.S. Marines, for example, are using these meditation practices to improve their attention and working memory, according to a recent New York Times report.

Earlier this year, JAMA Internal Medicine published a paper that looked at how mindfulness meditation programs affect stress and well-being. Continue reading

Marathon Reflection: How To Raise Secure Children In An Insecure World?

Police clear the area at the finish line of the 2013 Boston Marathon as medical workers help injured following the explosions. (Charles Krupa/AP)

Police clear the area at the finish line of the 2013 Boston Marathon as medical workers help the injured following the explosions. (Charles Krupa/AP)

One year ago, on the day of the Boston Marathon bombing, Dr. Gene Beresin shared advice on how to talk to children about the frightening event. Here, a year later, he and Dr. Paula Rauch, a fellow professor of psychiatry at Harvard Medical School, help parents draw broader lessons about how best to help children face such stresses and even grow through them.

By Drs. Paula K. Rauch and Gene Beresin
Guest contributors

For the most affected families, April 15th, 2013 was a life-changing event. For many in our community it produced a lesser, but still significant, set of challenges, and for some facing other family adversity or chronic stresses, it may have seemed like a minor event with little personal impact.

Regardless of how personal or significant the marathon bombing and its aftermath were for you, every one of us will face life challenges within our families and in the larger community. How can we face stressful experiences in ways that support our children’s resilience, and help them grow through those challenges? How do we raise secure, confident children in an uncertain world?

Start small

Children develop confidence and competence by facing new experiences, difficult transitions and unavoidable frustrations throughout childhood. Life continually presents a child with developmental challenges, such as falling asleep alone in a crib, saying goodbye at a new preschool, facing the first day of school with a sea of unfamiliar faces, dealing with a relentlessly annoying peer, being cut from the travel team, and, for some teens, making this month’s tough decisions about college.

It is often tempting as a parent to want to smooth over these challenges, alleviate uncertainty and facilitate a child’s comfort and success. But it is important to recognize that these age-appropriate frustrations and disappointments are essential for building lifelong coping skills. Children need to learn how to manage new and difficult situations, and while parents cannot solve the challenges for a child, they can provide appreciation and emotional support for that child’s efforts. Living through a multitude of such experiences makes the normal feelings of distress more familiar and less frightening.

Face serious challenges together 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

In Defense Of 12 Steps: What Science Really Tells Us About Addiction

The chips AA members receive to mark sobriety. (Randy Heinitz/Flickr)

The chips AA members receive to mark sobriety. (Randy Heinitz/Flickr)

Last week, Radio Boston featured an interview with Dr. Lance Dodes, author of “The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry.” Here, two Harvard Medical School professors of psychiatry respond, arguing that Dr. Dodes misrepresents the evidence and that 12-step programs have among the strongest scientific underpinnings of any addiction treatment.

By John F. Kelly and Gene Beresin
Guest Contributors

In a recent WBUR interview, Dr. Lance Dodes discussed his new book, which attempts to “debunk” the science related to the effectiveness of 12-step mutual-help programs, such as Alcoholics Anonymous, as well as 12-step professional treatment. He claims that these approaches are almost completely ineffective and even harmful in treating substance use disorders.

What he claims has very serious implications because hundreds of Americans are dying every day as a result of addiction. If the science really does demonstrate that the millions of people who attend AA and similar 12-step organizations each week are really deluding themselves as to any benefit they may be getting, then this surely should be stated loud and clear.

In fact, however, rather than support Dr. Dodes’ position, the science actually supports the exact opposite: AA and 12-step treatments are some of the most effective and cost-effective treatment approaches for addiction.

In his book, Dr. Dodes commits the same misguided offenses he condemns. His critique of the science behind treatment of addiction is deeply flawed, and ironically, his own psychoanalytic model of an approach to solve the “problem of addiction” has no independent scientific proof of effectiveness, particularly in comparison to other methods of treatment.

Below, we address some of the specific pronouncements he made on Radio Boston and in his book in order to convey what well-conducted science actually tells us about how to treat addiction.

What he says: 12-Step programs do not work, are not backed by science, and are probably harmful.

The evidence is overwhelming that AA, and treatments that facilitate patients’ engagement with groups like AA, are among the most effective and best studied treatments for helping change addictive behavior. Continue reading

What Your Shrink Thinks? Pilot Study Opens Psych Records To Patients

(Life Mental Health/Flickr via Compfight)

(Life Mental Health/Flickr via Compfight)

Here’s how far we’ve come beyond the old stereotype of the inscrutable psychiatrist who refuses to do anything more than nod and hum. If you’re a patient in a pilot program just now getting under way at Boston’s Beth Israel Deaconess Medical Center, you’ll soon have a whole new window into your psychiatrist’s thoughts: the mental health notes in your own medical record.

Patient access to personal medical records is a growing trend, but the pilot takes it a pioneering next step, into mental health records that are often kept closed to patients. The program’s rationale — the expectation that the tactic will lead to better care — is laid out in “Let’s Show Patients Their Mental Health Records,” an article in this week’s Journal of the American Medical Association.

I spoke with its first author, Dr. Michael Kahn, a psychiatrist at Beth Israel Deaconess. Our conversation, lightly edited:

CG: Here’s my colleague’s response to the idea of patients reading their psychiatrists’ notes: ‘Omigod, that’s terrifying! Do you really want to know what they think of you, especially if you already have issues?’ How would you respond?

MK: My main response would be that ‘what they think of you’ might actually be a great relief. Many patients are quite frightened that the doctor ‘will think I’m crazy,’ and the meaning of that varies from patient to patient. Mostly, those patients are not out of touch with reality; they’re just overwhelmed, and they’re often very reluctant to ask their doctor about it because they’re afraid their doctor will say, ‘Yes, you are crazy.’

So when they read in the note that “The patient is struggling with anxiety or depression, and should get better with this treatment,” that’s often a great relief to them, because they often see they’re not as impaired or deficient or defective as they feared.

I imagine the response from many psychiatrists would also be, ‘Omigod, that’s terrifying.’ You write in JAMA that this ‘feels like entering a minefield, triggering clinicians’ worst fears about sharing notes with patients.’ And you mention specific fears — how will a patient with a personality disorder react upon learning of that diagnosis? What if patients are outraged by the terms used? How do you respond to doctors’ fears?

The first thing is to recognize that it’s a totally natural, understandable and honest fear. I think we all learn in our professional development to use these terms — you might call them jargon — that are often but not always accurate, and often but not always have more pejorative connotations.

I think clinicians know this and are concerned that if patients read, for example, that they have Borderline Personality Disorder, then they will feel insulted, shocked, demeaned. I think this is a totally understandable and reasonable anxiety on the clinician’s part, but I think for many patients — and I’ve seen this many times — if it’s introduced to them in a tactful way, they can get the message that “The reason your life is in such turmoil is not because you’re a bad person but because you have this thing we call Borderline Personality Disorder that has these features.” And patients often say, ‘Oh my God, that’s me!’ and that’s actually a relief; they feel less alone and stigmatized.

So overall, the expectation is that patients being able to see these notes would far more often be helpful than harmful? Continue reading

Study Ignites Debate Over Non-Drug Treatment For Schizophrenia

Antipsychotic medications (Wikimedia Commons)

Antipsychotic medications (Wikimedia Commons)

By Alexandra Morris
CommonHealth intern

Antipsychotic drugs are typically the first-line treatment for the roughly one percent of people who have schizophrenia — often in conjunction with psychotherapy. But for patients who are not helped by the drugs or cannot tolerate their side effects, what’s left?

Last month, the Lancet published a study looking at the effects of cognitive therapy on patients with schizophrenia who refused to take medication – and prompted a heated debate within the mental health community.

Cognitive therapy involves one-on-one meetings between a patient and a therapist to discuss ways to change thinking and behavior in response to their symptoms.

Patients in the study were randomly assigned to receive either treatment as usual — ranging from no treatment at all to psychosocial support and other methods — or treatment as usual plus cognitive therapy. The researchers found that by the end of the study, the patients who received cognitive therapy had reduced psychiatric symptoms as compared to those who did not receive cognitive therapy.

Sounds reasonable, no? But initial media coverage included headlines claiming that cognitive therapy was an effective alternative to antipsychotic treatment. The Guardian posted “At last, a promising alternative to antipsychotics for schizophrenia,” and Science magazine wrote, “Schizophrenia: Time to flush the meds?” BBC News reportedly posted a headline “Schizophrenia: Talking therapies ‘effective as drugs.’”

Shortly after the study hit the press, bloggers were off and running (from PLOS to The Mental Elf), highlighting the limitations in the study design, such as the small sample size of 74 patients and the fact that nearly a third of these patients dropped out of the study partway through. They urged readers not to generalize the effect of cognitive therapy on schizophrenia based on limited evidence.

In fact, cognitive therapy was never compared to antipsychotics in the study. Some patients were even prescribed antipsychotics during the trial as part of their routine treatment. Several of the media reports also failed to mention an important caveat – that the trial was conducted in a specific patient population: those with mild to moderate psychiatric symptoms, as compared to those with severe illness who require hospitalization. The findings therefore cannot be extrapolated to all patients suffering from schizophrenia.

Lead study author Dr. Tony Morrison of the University of Manchester attested to the high drop-out rate. Continue reading