WKPIC is thrilled to announce that former intern Danielle McNeill has completed licensure in the State of Kentucky! She’s all official now!
WAY TO GO, DR. MAC!!
<You are now free to recruit minions of your very own.>
Morgellons Disease is a controversial and poorly understood condition in which unusual thread-like fibers appear under the skin. The patient may feel like something is crawling, biting, or stinging all over. Some medical experts say Morgellons is a physical illness, while others suggest it is a type of psychosis called “delusional parasitosis,” in which a person thinks parasites have infected their skin. Patients with delusional parasitosis often present pieces of clothing lint, skin, or other debris and place them in plastic wrap, on adhesive tape, or in matchboxes. They typically state that these contain the parasites; however, these collections have no insects or parasites.
Symptoms that are typically associated with Morgellons are unpleasant skin sensations, feeling like bugs are crawling all over the skin, burning or stinging sensations under the skin, intense itching, skin sores that appear suddenly and heal slowly, sores that leave very red scars, and reports thread-like fibers stuck in the skin. People with Morgellons sometimes complain of other symptoms which may include extreme fatigue, hair loss, joint and muscle pain, nervous system problems, tooth loss, sleep problems, and short-term memory loss. Doctors often tell patients that this is an “unexplained dermopathy,” which means a skin condition that occurs without a known reason. Other medical professionals have called the condition a “fiber disease.”
In the past, few doctors had heard of Morgellons. But in response to scattered reports, the Centers for Disease Control and Prevention (CDC) worked together with several other health care agencies to investigate this condition. Most reports come from California, Texas, and Florida, although patients have been seen in all 50 states. A CDC study found that Morgellons is most likely to affect middle-aged white women. Oddly enough, delusions of parasitosis also occur primarily in white middle-aged or older women.
The question of whether Morgellons is a disease or a delusion has prompted debate and new research in recent years. The CDC states that the condition is not caused by an infection or anything in the environment. The CDC study also included a lab analysis of skin fibers in Morgellons patients. The analysis showed that these fibers were mostly cotton, such as typically found in clothing or bandages. From a 2012 study, neuropsychological testing revealed a substantial number of study participants who scored highly in screening tests for one or more co-existing psychiatric or addictive conditions, including depression, somatic concerns, and drug use.
Others researchers say that Morgellons results from an infectious process in the skin cells. Research also revealed that the skin sores seemed to be the result of long-term picking and scratching the skin. Previous case studies have suggested that Morgellons may be linked to Lyme disease. Some patients with signs and symptoms of Morgellons had tested positive for the bacteria that causes Lyme disease. But according to Morgellons researchers at Oklahoma State University, there is no evidence to prove this theory. Likewise, there was no evidence of Lyme infection in any of the people in the CDC study. A 2010 study found a potential link between Morgellons symptoms and hypothyroidism. More research needs to be done to further investigate the findings.
There is no known cure for Morgellons. Treating any medical or psychiatric problems that occur at the same time as Morgellons may help ease symptoms in some patients. Medical researchers usually recommend that patients with these symptoms should undergo psychiatric evaluation. Some people who suspect they have Morgellons disease claim they have been ignored or dismissed as fakers. It is not uncommon for people who report signs and symptoms of Morgellons disease to resist other explanations for their condition,
Ballatyne, C. (2009). “What is Morgellons Disease? Is it a physical or psychological condition?” Scientific American. Retrieved from http://www.scientificamerican.com/article/morgellons-disease-parasites-skin-psychiatric/
Pearson, M.L., Selby, J.V., Kenneth, K.A., Cantrell, V., Braden, C.R., Parise, M.E.,…Lewis, B. (2012). Clinical, Epidemiologic, Histopathologic and Molecular Features of an Unexplained Dermopathy. Plos One. Retrieved at http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0029908
The Morgellon Research Foundation. (n.d.)What is Morgellons Disease? Retrieved from http://www.morgellons-research.com
WKPIC Pre-doctoral Intern
A Friday Factoid was written by this writer in November 2015 about the research behind psychedelic-assisted therapy. Several studies have shown that positive results can come from short courses or single sessions of psychedelic-assisted psychotherapy.
Until recently, there had been no modern brain images of someone on lysergic acid diethylamide (LSD) to show exactly how this drug affects the brain’s connections.
Researcher David Nutt, a neuropsychopharmacologist at Imperial College London, performed a recent two-day study with twenty healthy volunteers. On one day volunteers got a 75-microgram injection of LSD, and on the second day, they got a placebo. Researchers used three different brain imaging techniques to measure and compare blood flow, brainwaves, and functional connections within and between brain networks in volunteers on the placebo and under the influence of the drug. David Nutt stated about the discovery, “This is to neuroscience what the Higgs boson was to particle physics.” Consider that neuroscientist have waited over 50 years for these images since the drug was banned in the 1960s.
What researchers found sheds lights on how people who have taken psychedelics have reported feeling they are “one with nature” and that the self “dissolved.” The regions of the brain responsible for higher cognition lit up and suddenly become hyper-connected with other networks in the brain that do not normally communicate with one another. The study’s volunteers on LSD reported experiencing their sense of self dissolve, which is what researchers’ call “ego dissolution.” For people, ego dissolution can be a positive experience leading to peace, acceptance, and a new perspective of things.
Volunteers taking LSD appeared to process their visual world in fundamentally different ways from people who were not given the drug. Typically, the activity in our brain flows along specific neural networks. Although the primary visual cortex usually communicates mainly with other parts of the vision system, many other brain areas contributed to the processing of images in volunteers who received LSD. The visual cortex became much more active with the rest of the brain, and blood flow to visual regions also increased, which the researchers believe correlates with the hallucinations reported by volunteers and the emotional experience they can take.
Enzo Tagliazucchi, a neuroscientist who helped lead the study said, “This could mean that LSD results in a stronger sharing of information between regions that deal with how we perceive ourselves and how we perceive the outer world.” For example, LSD appeared to trigger the frontoparietal cortex, which is an area of the brain associated with self-consciousness, and strongly connect it with areas of the brain that process sensory information about the world outside ourselves. That interconnectedness may be creating a stronger link between our sense of self, sense of the environment, and potentially diluting the boundaries of our individuality.
The study found that the increased interconnectedness of brain regions, while on LSD, makes the brain of an adult resemble something like the brain of a baby, which is more free and unconstrained. In the adult brain, networks that control vision, movement, and hearing function separately. LSD lifts the barriers between these networks and stimulates the unconstrained flow of information between them that leads to a hyper-imaginative state of thinking.
Researchers found that communication between the parahippocampus, a brain region important in memory storage and the visual cortex, is reduced when you take LSD. When you hear music the visual cortex receives more information from the parahippocampus, and this is associated with increases in imagery with your eyes closed. Music appears to enhance the LSD experience and might be important in therapeutic settings. This could have great implications in the treatment of depression, addiction, or other mental disorders that emphasize negative thoughts. The improvement of well-being does not appear to subside after the drug has worn off.
Brodwin, E. (2016, April 12). Mind-Blowing New Images Show How LSD Changes The Way Parts of the Brain Communicate. Business Insider. Retrieved from http://www.businessinsider.com/new-images-show-how-lsd-and-psychedelics-affect-the-brain-2016-4
Sample, I. (2016, April 11). LSD’s Impact On The Brain Revealed In Groundbreaking Images. The Guardian. Retreived from https://www.theguardian.com/science/2016/apr/11/lsd-impact-brain-revealed-groundbreaking-images
Schlanger, Z. (2016, April 12). Brain Scans Show Why LSD Makes You Feel One With Nature And Your Self Dissolve. News Week. Retrieved from http://www.newsweek.com/2016/04/22/lsd-brain-scan-nature-self-psychedelics-446513.html
Jonathan Torres, M.S.
WKPIC Pre-Doctoral Intern
I admit it. WE’RE BEHIND.
But, we’re starting our catch-up today! With something very, very, very important.
Former intern Brittany Best (2014-2015) is one step closer to being official!
It is safe to say that a good majority of the population has heard of postpartum depression. Many may even know a new mother who has experienced this condition. However, far fewer have heard of or truly understand postpartum psychosis, this writer included.
Postpartum psychosis, also referred to as postnatal psychosis, is very rare. It develops in only 0.1% of all women after they give birth. Women who have experienced the condition previously are said to have a much higher rate of 30% with each additional pregnancy. Those who already have a serious mental illness, such as bipolar disorder or schizophrenia, are also at an increased risk.
Postpartum psychosis can present with a rapid onset of a few days to that of a few weeks following child birth. A limited number of women do not exhibit symptoms, however, until they cease breast feeding, or until their menstrual cycles resume. Most all cases develop within two weeks, though. It is important to note that it is a medical emergency and should be treated immediately to help reduce the severity of symptoms.
The most common symptoms of postpartum psychosis include hallucinations and delusions. Secondary symptoms may vary. They can include paranoia, mania, loss of inhibitions, low mood, agitation, restlessness, anxiety, trouble sleeping, loss of appetite and/or severe confusion. Rapidly fluctuating moods can also occur. A minimal percentage of women effected by this condition may even experience mania and depression simultaneously.
Due to the presentation of symptomatology, the psychiatric condition may be a severe emergency that requires admission to hospital for treatment. When at all possible, it is best for the patient to be admitted with her newborn, into special psychiatric care options referred to as a mother-and-baby units. This helps to facilitate the continued bonding of mother and baby. Medication management figures largely included in symptom reduction. The medications chosen often consist of a blend of neuroleptic (s), antidepressant(s) and mood stabilizers. Most women who follow medical protocol make a full recovery within several months.
K. K. (2013, October 6). Postpartum Psychosis: What You Might Not Know. Retrieved March 14, 2016, from https://www.psychologytoday.com/blog/isnt-what-i-expected/201310/postpartum-psychosis-what-you-might-not-know
Sit, D., ROTHSCHILD, A. J., & WISNER, K. L. (2011, June 7). A Review of Postpartum Psychosis. Retrieved March 14, 2016, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109493/ doi: 10.1089/jwh.2006.15.352
Crystal K. Bray,
WKPIC Doctoral Intern
In the field of mental health, both clinical and research efforts have focused on the importance of early detection and intervention in psychosis. Research has shown that this strategy might lead to an increased chance of preventing, delaying the onset of, or reducing problems resulting from psychosis. In addition, treatment delays may add to the burden experienced by the individuals and their family, and may have social, educational and occupational consequences.
Reluctance to accept a stigma-laden diagnosis and fear of mental health services may delay help seeking. Families, friends or the individual’s broader social network might be the first to recognize pathological changesbut may lack the ability to correctly identify these changes as symptoms of psychosis. The aim of this study was to gain knowledge about factors that prevent or delay patients with a long duration of psychosis from accessing psychiatric healthcare services at an earlier stage and their personal views on the impact of ongoing informational campaigns on help-seeking behavior.
In this study, eight patients who experienced duration of untreated psychosis lasing for more than six months were interviewed. Participants included four men and four women who were both students and full-time employees, with age ranging from 17 to 44 years. The patients must meet the DSM-IV-TR criteria for first-episode schizophrenia, schizophreniform disorder, schizoaffective disorder, brief psychotic episode, delusional disorder, drug-induced psychosis, affective psychosis with mood incongruent delusions, or psychotic disorder not otherwise specified. The interview format focused on the following main topics: symptom awareness, help-seeking behavior, family and professional involvement, awareness and feedback. Each topic was introduced with an open-ended question and follow-up questions were asked depending on how much the patient elaborated. The interviews were conducted by the first author and lasted 40 minutes on average.
Based on the results, the authors identified five main themes, which include: failure to recognize symptoms of psychosis, difficulties expressing their experiences, concerns about stigma, poor psychosis detection skills among healthcare professionals, and lack of awareness or understanding of available community resources. The five themes identified suggest participants were unable to recognize or understand the severity of their symptoms. Further, although family members or others sometimes recognized the initial symptoms of psychosis development, these symptoms were attributed to reasons other than psychosis. Participants reported that healthcare professionals also had trouble identifying emerging signs of psychosis. Lastly, information about available resources needs to be carefully tailored to relay information to people who do not consider themselves as currently experiencing signs of psychosis.
The majority of participants reported they failed to understand that they needed help at the time of the onset of their psychosis. Instead, they believed or hoped the symptoms and changes they experienced would eventually pass without intervention. Many participants reported that family and friends were the first to notice changes in mood and behavior. Family or friends attributed these changes to difficulty concentrating, “teenage behavior,” or introverted personality rather than the development of a psychiatric illness. In cases where family members suspected the presence of a psychiatric illness, depression was suspected rather than psychosis. Half of the participants reported having no knowledge about psychosis at the time of onset and attributed their symptoms to depression or an anxiety disorder.
An additional obstacle to seeking treatment was uncertainty about how to ask for help. Many participants had trouble explaining their symptoms to healthcare professionals. When they first entered psychiatric treatment, healthcare professionals initially misinterpreted symptoms as depression or anxiety. One participant reported that although she knew where to go to seek help, she did not know how to express herself. Another reason for not seeking help involved concerns that family and others might consequently find out about the mental illness. Many of the participants reported that they deliberately hid their symptoms due to concerns about the reaction of others.
More than half of the participants reported that healthcare professionals had failed to recognize their symptoms as related to psychosis. One of the participants raised concerns about his symptoms with his general practitioner (GP) on several occasions over a period of 1 year before they were correctly identified. Some participants had sought help repeatedly from their GPs or the school nurse during periods when they experienced troubling symptoms. At times, they received treatment from GPs, psychologists, psychiatrists and school nurses for symptoms of anxiety and depression, but healthcare professionals failed to correctly detect and diagnose psychosis. One participant had described the presence of auditory hallucinations upon admission to an adolescent outpatient clinic. Still, he was not offered assessment for psychosis.
The majority of participants said they had seen mental health treatment ads in newspapers or as posters at school. The majority of participants who had seen the ads, however, did not seek help despite awareness of the programs. One participant mentioned that the ads failed to help him understand the true nature or experience of psychosis. Others did not consider themselves as belonging to the target group mainly due to feeling ‘not sick enough.’ The only participant who did seek help reported that he eventually made contact many years after seeing treatment ads.
At first, he did not think he belonged to the target group. As his condition worsened and he experienced all the symptoms mentioned in one of the ads. One participant believed she was actually too sick to get help and felt treatment was not worthwhile. Participants also stated they did not want to unnecessarily bother mental health staff. Others were worried that making contact might lead to a hospital admission.
Although this study utilized a small sample size, it nevertheless represents many of the fears individuals with first-episode psychosis experience. In our communities emphasis should be placed on having more information and education readily available at schools for students and parents. Students, teachers and school nurses should receive information sessions from mental health professionals about signs and symptoms and how to refer students to available treatments. Additionally, information about mental health should start at an earlier point, for example, in junior high school. National newspapers, journal articles, and the Internet may be beneficial channels for communication of available resources in the community.
Bay, N.; Bjornestad, J.; Johannessen, J. O., Larsen, T. K., & Joa, I. (2016). Obstacles to care in first-episode psychosis patients with a long duration of untreated psychosis. Early Intervention in Psychiatry, 10, 71-76.
Jonathan Torres, M.S.
WKPIC Doctoral Intern
Many of us have long been waiting for a justifiable reason to indulge in chocolate that did not first involve having a migraine. It is with great excitement that this writer must announce that our day is coming nearer. A fairly recent trial found that older adults who have a high dietary intake of flavanols, like those found in cocoa, have heightened memory performance on object-recognition tasks. Additionally, it also increased neural activity in the dentate gyrus of our hippocampi as measured by a fMRI.
Brickman et al. tracked 38 individuals over a period of 12 weeks. During that time, half of the sample population received a high intake diet of flavanols and the remaining sample followed the low intake diet. The team found that those receiving high intakes of flavanols had measurably improved neural activity, increased blood flow in the dentate gyrus and increased memory functioning on object recognition tasks. They noted that the increased blood flow was a direct correlation to improvement in memory functioning but needed to go a step further to prove this theory.
In addition to a massive amount of data collection, the team created a digital test called the ModBent. They designed the ModBent to be an extremely difficult memory recognition task that activated the dentate gyrus. It was designed to activate this region of the brain without triggering other areas known to be specific to memory. To establish the validity of the ModBent, Brickman et al. organized a double-dissociation study using the tool in healthy adults. The study confirmed that the measure did in fact only activate the dentate gyrus but that it also was receptive to the age of the examinee. The group used this information and designed two different versions of the ModBent. They administered one test at the beginning of their study and one at the end. Having two versions of the assessment prevented the participants from potentially experiencing repeat assessment practice effects.
The study found that high-flavanol group’s performance was on average 630 ms higher than the low-flavanol group. They compared the difference in performance to knock-out mice studies measuring for memory loss. It was noted that such a difference paralleled the results of aging in the brain by approximately three decades. This correlation was extremely significant to their findings. Brickman et al. established clear evidence that including flavanols in one’s diet would be beneficial to degree in reversing cognitive decline in memory.
Brickman, Adam M., Khan, Usman A., Provenzano, Frank A., Yeung, Lok-Kin, Suzuki, Wendy, Schroeter, Hagen, Wall, Melanie, Sloan, Richard P., & Small, Scott A. Enhancing dentate gyrus function with dietary flavanols improves cognition in older adults. Nature Neuroscience. 12, 1978-1806 (2014).
It should be noted that Brickman et al. hypothesized that combining a high-flavanol diet with the added benefits of exercise (peak oxygen levels in our blood) would produce even greater results on the ModBent. However, in collecting data and measures for the comparison, they found that there was no difference in the aerobic group versus non-exercise group when measuring for peak oxygen intake. Therefore, they did not move forward with the study and the effects of a high-flavanol diet combined with exercise are still currently unknown.
WKPIC Doctoral Intern
Schizophrenia has long been one of mental health’s most studied disorders. Our knowledge base regarding the diagnosis has grown by leaps and bounds over many years of research. Most people are aware of the cognitive, negative and psychotic symptoms associated with schizophrenia. However, far fewer realize that premature death can also be a distinctive feature of the disorder.
Statistically speaking, adults who have schizophrenia are typically expected to live only 70% of a normal lifespan when compared to same age peers. Essentially this means they will live 15-25 years less than the average person. Striking as it may be to some, this is information that we have known for some time. However, researchers have recently updated this data to include all age groups and demographics.
Researcher Mark Olfson and his team recently studied a group of one million people with schizophrenia. During their study period, 74,000 individuals passed away. Of those 74,000, Dr. Olfson and team were able to identify the cause of death for 65,500 of them. They then compared the identified cause and age with that of same age peers. Their findings indicated that the increased rate of premature death crossed all age ranges as well as demographics, leaving no one group/age immune.
The data revealed that unnatural as well as natural causes of death were both increased by more than three times when compared to normative mortality rates of the same nature. Natural causes of death by far accounted for the majority of causes. Lung cancer, other cancers, cardiovascular disease, influenza, and diabetes accounted for most of the natural causes. Suicide and accidental deaths were deemed to be the majority of unnatural causes.
WKPIC Doctoral Intern