2016 - Western State Hospital Internship Program

July 07 2016

Friday Factoids: Are Schizophrenia and Dementia Related?

Individuals who have schizophrenia are known to be at a higher risk of developing diabetes, cardiovascular disease, obesity and hyperlipidemias, all of which are concomitant with an increased risk for dementia. Therefore, the question of whether or not schizophrenia and dementia are related has long been hypothesized. Throughout the years, numerous studies have been conducted hoping to finally provide an answer. Alas, they have all been inconclusive; that is, until now.

In a recent study, Dr. Anette Ribe and a host of others collected data from over 2.8 million Danes obtained thru national health registries in Denmark. The study spanned the years 1995-2013 (18 years). The data collected was for individuals who were age 50 or who turned 50 during the eighteen years being reviewed. More than 136,000 of those people acquired a progressive form of dementia during that time. Additionally, more than 20,600 of the individuals being followed were already diagnosed with schizophrenia or developed it during the 18 years being studied.

When the group began to compile the data, they found that before age 65 the risk of developing dementia was .6% for people without schizophrenia but 1.8% for those with it. Out of the 2.8 million studied, 944 individuals were diagnosed with schizophrenia. Of those 944 individuals, 211 of them were diagnosed with dementia before age 65. That’s a whopping 22.4%! However, once reaching age 80, the correlation is less impressive. It is still pertinent, though, with 5.8% chance for those without schizophrenia developing dementia and 7.4% for those with it.

Comparing the above data with currently known statistics better helped support the hypothesis that dementia and schizophrenia are related. The study found that 22.4% of those with schizophrenia would also be diagnosed with dementia before age 65 versus the current national average for those without schizophrenia developing dementia, which is 6.3%. That’s an increase of 16.1%. Currently, scientists have not been able to identify the reason for this increase but have begun research in hopes of finding an answer.

Work Cited
Ribe, A. R., Laursen, T. M., Charles, M., Katon, W., Fenger-Gron, M., Davydow, D., Vestergaard, M. (2015). JAMA Psychiatry. JAMA Psychiatry, 72(11), 1095-1101. Retrieved March 7, 2016, from http://archpsyc.jamanetwork.com

Rubin, E. (2016, March 7). The Relationship between Schizophrenia and Dementia. Retrieved March 07, 2016, from https://www.psychologytoday.com/blog/demystifying-psychiatry/201603/the-relationship-between-schizophrenia-and-dementia

Crystal Bray,
WKPIC Doctoral Intern

July 07 2016

Friday Factoids: Alien Hand Syndrome

Though it may sound like the title to a straight-to-DVD sci-fi movie, Alien Hand Syndrome (AHS), sometimes referred to as Alien Limb Syndrome, is a true disorder that it quite horrific and troublesome to those who suffer with it. This rare disorder is neurological in origin. The “alien” hand functions involuntarily without the owner’s awareness of its actions. Some of the lesser symptoms associated with AHS are involuntary grasping, pulling at clothing, and reaching or touching ones face. Some of the more serious symptoms are self-inflicted choking or pinching, inhibiting the “normal” hand from implementing tasks, and involuntarily forcing food into the owner’s mouth.

AHS was first documented in 1908 by Neuropsychiatrist, Kurt Goldstein. It is theorized by some that the cause of AHS is traumatic brain injury or lesions to the thalamus, supplementary motor cortex, posterior parietal cortex, anterior cingulate, anterior prefrontal cortex, or the corpus callosum. Several more believe they have linked AHS to a disconnect between differing sections of the brain that are responsible for conscious body movements. Others, however, hypothesize that the release of the primary motor cortex from conscious control is behind the unwanted or unplanned movements. Nonetheless, the exact cause of the neural contrivances has not been definitively identified.

There are “subtypes” of AHS which are linked to injuries/lesions in specific regions of the brain. The subtypes are callosal variant, frontal variant, and posterior variant. The callosal variant is usually associated with agonistic dyspraxia and diagnostic dyspraxia. Agnostic dyspraxia is the involuntary movements of the alien hand (AH) when commands of movement are given and made by the unafflicted hand (UH). An example would be a patient being told to touch their nose with their UH and their AH would involuntarily follow the action as well. Diagnostic dyspraxia is the interference by the AH in the actions of the UH. Good example of this action would be a patient trying to stir a pot and the AH trying to put a lid on the pot at the same time.

The frontal variant subtype is almost always associated with injury/damage to the frontal lobe. The actions of the AH with this subtype are involuntary grasping, reaching, and other purposeful movements. Often times, these movements can also be exploratory as the AH seeks an external object to grasp. Once an object has been grasped, it is extremely difficult for the patient to voluntarily release the item. They may have to resort to prying or peeling their fingers away from the item. These grasping actions can and do take place without the patient even noticing that it is occurring. Many who suffer from this subtype choose to bind or restrict the movements of the AH.

The posterior variant subtype is most usually associated with injury/damage to the occipital lobe and/or the posterolateral parietal lobe. The actions of the AH of this type are quite different from the frontal variant form. These movements tend to be more like pulling away or withdrawing the palm of the hand from contact to any surface. Any contact to that palm is undesirable. The AH will generate movements and actions to prevent or eliminate the contact all together.

Presently, the exact cause(s) of AHS is unknown. Thus, a cure for the syndrome has not been developed. Continued research to identify the correct theory/theories or exact cause as well as a functional treatment are needed.

Work Cited

Alien hand syndrome. (n.d.). Retrieved June 13, 2016, from http://www.medicinenet.com/script/main/art.asp?articlekey=12655

Harris, S. V. (n.d.). Alien Hand Syndrome sees woman attacked by her own hand. Retrieved June 13, 2016, from http://www.bbc.com/news/uk-12225163

Mark, V. W. (n.d.). Alien Hand Syndrome. 5th Annual International Conference on Education & E-Learning (EeL 2015). doi:10.5176/2251-1814_eel15.8

Crystal Bray
WKPIC Doctoral Intern

June 06 2016

Article Review: Comparative Efficacy And Tolerability Of Antidepressants For Major Depressive Disorder in Children and Adolescents: A Network Meta-Analysis

Major Depressive Disorder (MDD) is one of the most common mental disorders in children and adolescents. The researchers noted estimates suggesting it affects about 3 percent of children aged 6 to 12, and 6 percent of teens aged 13 to 18. Whether to use pharmacological interventions in this population and which drug should be preferred are still matters of controversy. The use of antidepressants among U.S. and U.K. children and teenagers up to age 19 has continued to increase. Antidepressant use among children and teens rose from 1.3 to 1.6 percent between 2005 and 2012, according to a separate study published in The Lancet. The U.S National Institutes of Health estimates that some 2.8 million children (or about 11 percent) between the ages of 12 and 17 have suffered from at least one episode of depression.

Depressive symptoms in children and adolescents are rather undifferentiated. You notice more irritability, aggressive behavior and problems at school. Consequences of depressive episodes in children and adolescents are dramatic because they include impairments in their social functioning, but also an increased risk of suicidal ideation and attempts. According to a study conducted by researchers from McGill University in Montreal, and published in the Journal of the American Medical Association (JAMA), nearly half of people taking depressants are not suffering from depression at all. After researchers analyzed a decade of antidepressant prescription records, they concluded that only 55 percent were given for depression, while the remaining 45 percent was written for conditions such as anxiety, sleeping problems, pain, panic disorders and Attention Deficit Hyperactivity Disorder (ADHD).

For this study, researchers of the University of Oxford conducted a systematic meta-analysis of both published and unpublished randomized control trials on the use of antidepressants for the treatment of major depression in children and young adults up to May 31, 2015. They examined trials on fourteen different antidepressants: amitriptyline, citalopram, clomipramine, desipramine, duloxetine, escitalopram, fluoxetine, imipramine, mirtazapine, nefazodone, nortriptyline, paroxetine, sertraline, and venlafaxine. They aimed to compare and rank antidepressants and placebo for MDD in young people. The study also used the Cochrane risk of bias measures to account for the quality of the included studies. The bias analysis was essential to their conclusions as 88 percent of all of the trials were found to have a risk for bias and 65 percent of all of the trials were funded by drug companies.

They found 34 trials eligible, including 5,260 participants ages 9 to 18. Researchers discovered, for efficacy, only fluoxetine was statistically significantly more effective than placebo. In terms of tolerability, fluoxetine was also better than duloxetine and imipramine. Children taking venlafaxine actually showed an increased risk of suicidal thoughts and attempts. Nortriptyline was less effective than seven other antidepressants and the placebo. Imipramine, venlafaxine and duloxetine were the least tolerable, with many patients discontinuing them.

When considering the risk–benefit profile of antidepressants in the acute treatment of MDD, these drugs do not seem to offer a clear advantage for children and adolescents. Fluoxetine is probably the best option to consider when a pharmacological treatment is indicated. The lack of individual-level data from trials makes it difficult to get accurate estimates of just how these drugs affect patients, and how many become suicidal. The authors warn that this doesn’t paint a full picture, since a lack of reliable data did not allow them to fully assess the risk of suicidality for all drugs. That’s partly because 65 percent of the trials they reviewed were funded by pharmaceutical companies. So those reports could have overestimated how well their drugs worked and minimized the side effects.

The authors suggest that parents and medical professionals monitor children and adolescents taking antidepressants closely, regardless of the drug chosen. The brains in children and teens are not yet developed, so it’s important to lead with caution when prescribing medication.

Reference:
Cipriani, A., Zhou, X., Giovane, C.D.; Hetrick, S.E.; Qin, B., Whittington, C.,…Coghill, D. (2016). Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis. The Lancet. DOI: http://dx.doi.org/10.1016/S0140-6736(16)30385-3

Jonathan Torres, M.S.
WKPIC Doctoral Intern

June 06 2016

Friday Factoids Catch-Up: Binge-Eating Disorder

We have all heard or used the phrase “binge eating” or “binging.” It is a phrase that gets thrown around often, especially during the Thanksgiving and Christmas holiday seasons. Most of us use it to describe eating more than normal portions at a meal or continuing to take a few more bites because it tastes so good! However, true binge eating can be a psychological disorder.

Binge-Eating Disorder (BED) is a new diagnosis added to the category of Feeding and Eating Disorders found in the DSM-5. It is the most common eating disorder in the United States. The number of those suffering from BED outnumbers individuals experiencing anorexia and bulimia combined by more than three times. Current estimates suggest that 3.5% of women and 2% of men suffer from this disorder. While the estimated number of people experiencing BED might not initially seem large, when calculated it comes out to be 2.8 million American adults. That puts it into perspective.

So what exactly is BED? It is considered to be, “Eating in response to something other than physical hunger in an attempt to numb unwanted or uncomfortable emotions that goes beyond emotional eating or compulsive overeating,” (Binge-Eating Disorder, 2016). During these binge episodes, individuals have uncontrollable and unstoppable urges to eat. They will even eat to the point of discomfort and/or actual pain. Additionally, during an episode, a BED sufferer may consume several thousand calories which can be very unhealthy. Afterwards, they often feel shameful and guilty. Many desperately try to hide their binge eating from others.

The DSM-5 lists the following official criteria for a BED diagnosis:

A. Recurrent episodes of binge eating characterized by both 1.) Eating in a discrete period of time an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances 2.) a sense of lack of control over eating during the episode

B. The episodes are associated with three or more of the following 1.) Eating much faster than usual 2.) Eating to the point of discomfort or pain 3.) Eating large amounts of food even though you are not physically hungry 4.) Eating alone due to embarrassment resulting from the large amount of food consumed 5.) Feeling guilty, shameful and/or disgusted after the episode.

C. Increased stress due to binge eating

D. Experiencing binge eating episodes at least once a week for three months

E. Binge eating is not followed by unsuitable, compensatory actions (such as bulimia) and does not occur in concurrence with anorexia or bulimia nervosa.

While approximately 30% of individuals with BED fall within normal weight categories for their height, 70% are considered overweight. Bullying, shaming and stigmas surrounding weight can often trigger more intense and/or more frequent episodes of binge eating as well as additional emotional distress. Some additional, common psychological issues that those who suffer from BED experience are OCD, anxiety, and depression. Common physical health issues also experienced are type 2 diabetes, heart disease, sleep apnea, high blood pressure, and osteoarthritis.

Individuals suffering from the symptoms of BED often feel like they are out of control. Through repetition of binge eating, their brains have actually been altered to respond to food in a very comparable way to that of the brain of a substance user/drug addict. Unfortunately, though, they can’t just stop eating. Therefore, the goal of treatment for BED is a reduction or complete cessation of binging episodes. Treatment teams consisting of an individual’s PCP, psychologist and dietician have proven to be more effective then utilizing one of the services alone. Support groups for individuals suffering from BED as well as additional resources can now be found online.

Works Cited
“Binge-Eating Disorder.” Binge-Eating Disorder. N.p., n.d. Web. 02 June 2016. http://www.niddk.nih.gov/health-information/health-topics/weight-Control/binge_eating/Pages/binge-eating-disorder.aspx

“Binge-eating Disorder.” Overview. N.p., 2016. Web. 03 June 2016. http://www.mayoclinic.org/diseases-conditions/binge-eating-disorder/home/ovc-20182926 – 37k

“Eating Disorders: About More Than Food.” NIMH RSS. N.p., n.d. Web. 03 June 2016. https://www.nimh.nih.gov/health/publications/eating-disorders-new trifold/index.shtml

“Info about Binge-Eating Disorder in Adults.” Binge-Eating Disorder. N.p., n.d. Web. 02 June 2016. http://www.bingeeatingdisorder.com/

Crystal Bray
WKPIC Doctoral Intern

June 06 2016

Friday Factoids Catch-Up: Understanding Naltrexone

Unfortunately, in the world we all live in today, most of us know someone who is suffering from opioid and/or alcohol addiction. That or we are struggling with it in our own lives. Regardless of the initial purpose behind using either substance, finding a true cure for those who have become addicted to these substances has become vital, and even more urgent. Enter Naltrexone.

Naltrexone is a prescription drug that is predominantly used in the management of opioid and alcohol dependence. It is sold under the legal trade names of Revia, Depade, and Vivitrol (a once-monthly, extended-released, injectable formulation). Naltrexone is also being used to help save the lives of individuals who have overdosed on opioids. EMS units, ER’s, and even pharmacies carry it for this exact purpose. It literally reverses the effects of opioids within minutes, but how does it work for addiction?

For opioid addiction, naltrexone acts as a blocking agent. It attaches itself to opioid receptors in the brain. It then prevents the receptors from up-taking any the substance which in turn prevents the pleasurable feelings caused by the opioids. However, it does not prevent good feelings that come from other naturally pleasurable activities. This action makes it very beneficial, along with therapy, to assist with opioid relapse prevention.

For alcohol addiction, scientists and doctors are not certain how Naltrexone works but do know it decreases the cravings for alcohol. It is hypothesized that, as with opioid addiction, it works as a blocking agent and prevents the pleasurable feelings drinking alcohol promotes because it partially prevents the uptake of endorphins associated with euphoric inebriation.

Whether taken for alcohol or opioid addiction, Naltrexone does have serious side effects. These include confusion, auditory and/or visual hallucinations, blurred vision, severe vomiting and/or diarrhea, and liver damage. The less severe and more common side effects are nausea, difficulty falling or staying asleep, increased or decreased energy, drowsiness. muscle or joint pain, rash, vomiting, stomach pain or cramping, mild diarrhea, constipation, loss of appetite, headache, dizziness, anxiety, nervousness, irritability and/or tearfulness.

Any individual interested in obtaining a prescription for Naltrexone would need to consult with their medical doctor and be undergoing outpatient/inpatient therapy for substance abuse treatment.

Work Cited
Naltrexone: MedlinePlus Drug Information. (n.d.). Retrieved May 30, 2016, from https://www.nlm.nih.gov/medlineplus/druginfo/meds/a685041.html

VIVITROL® Official Site | VIVITROL® (Naltrexone for extended-release injectable suspension). (n.d.). Retrieved May 30, 2016, from https://www.vivitrol.com/

Crystal Bray,
WKPIC Doctoral Intern

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Yearly Archives: 2016

Friday Factoids: Are Schizophrenia and Dementia Related?

Friday Factoids: Alien Hand Syndrome

Article Review: Comparative Efficacy And Tolerability Of Antidepressants For Major Depressive Disorder in Children and Adolescents: A Network Meta-Analysis

Friday Factoids Catch-Up: Binge-Eating Disorder

Friday Factoids Catch-Up: Understanding Naltrexone

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