Blog

September 09 2016

Goodbye . . . And Hello!

It is with great fondness and lots of sadness that we bid farewell to this crop of minions . . . I mean, interns. Jon Torres headed home to Kansas City for a post-doctoral position at an inpatient facility, while Rain Smith started a post-doctoral slot at Pennyroyal Center in Hopkinsville. Crystal Bray is staying on with the crew here at Western State as a post-doc, and we’re glad to have her.

BUT, amidst all the parting sorrow, there is joy, because we have sparkly new arrivals!!!

Welcome, Dannie, Dianne, and Jennifer!!

And though she has never read Harry Potter, 50 points to Gryffindor on behalf of Dianne, who has already expertly trolled Dr. Greene with a New York Yankees poster. Come on, Dr. G. Expand those sports horizons.

We look forward to an awesome year–and I am impatiently waiting to see what this year’s group comes up with for intern office decorations…

Susan R. Vaught, Ph.D.
Director, WKPIC

August 08 2016

Friday Factoids Catch-Up: Schizophrenia Symptoms Reduced Through Exercise

Schizophrenia symptoms in the acute phase are often characterized by hallucinations and delusions, which are usually treatable with medication. However, most patients are still troubled with pervasive cognitive deficits, which include poor memory, impaired information processing, and loss of concentration. Antipsychotic medications have little impact on improving cognition, and other pharmacological approaches towards treating cognitive deficits have demonstrated limited efficacy thus far. Non-pharmacological interventions have been developed to specifically target cognitive symptoms, including cognitive remediation therapy (CRT). This therapeutic approach involves completing tasks designed to train various cognitive functions such as memory, attention, and problem-solving skills. However, CRT has only a small effect on psychiatric symptoms, and improvements are lost over time.

A number of recent meta-analyses have shown that structured exercise can significantly improve positive symptoms, negative symptoms, and social functioning in this population. A meta-analysis study combined the data from ten independent clinical trials with a total of 385 patients diagnosed with Schizophrenia. According to a new study from University of Manchester researchers, around 12 weeks of aerobic exercise training can significant improve patients’ brain functioning. The research showed that patients who are treated with aerobic exercise programs, such as treadmills and exercise bikes, in combination with their medication, will improve their overall brain functioning more than those treated with medications alone. There was also evidence among the studies that programs, which used greater amounts of exercise and those which were most successful for improving fitness, had the greatest effects on cognitive functioning.

Furthermore, by increasing cardiorespiratory fitness and metabolic health, exercise may also reduce the physical health problems associated with Schizophrenia, such as obesity and diabetes, which contribute towards reduced life expectancy and adversely affect cognitive functioning. Exercise has also been found to increase hippocampal volume and white matter integrity in healthy older adults and those with Schizophrenia. Additionally, cross-sectional research has demonstrated that physical activity and fitness are associated with better cognitive performance and higher levels of neurotrophic factors which promote brain plasticity. Results from cognitive outcomes showed that exercise improves global cognition significantly more than control conditions. Analyses suggested that supervision from physical health instructors results in better cognitive outcomes. This may be due to increased exercise engagement among participants or better program delivery resulting in more favorable outcomes.

Meta-regression analyses indicated that higher weekly duration of exercise tends to be associated with greater improvement in cognition. The amount that an individual exercises appears to be an important factor for achieving cognitive enhancement. Previous studies have shown that the amount of exercise achieved by participants during an intervention is a significant predictor of cognitive improvements. Additional studies have previously examined the relative influence of exercise duration, frequency, and intensity on cognitive improvements following a 12-week exercise program. The result indicated that exercise intensity was the best predictor variable. This also suggests that aerobic exercise may be more effective for cognition in Schizophrenia than yoga, which previous meta-analyses have found to only be effective for long-term memory.

This meta-analysis study indicated that exercise has similar effects on cognition in Schizophrenia to CRT. Individual studies have shown significantly greater improvements from combining CRT with aerobic exercise for various cognitive subdomains, along with significantly greater reductions in negative symptoms of Schizophrenia. There is also some preliminary evidence supporting the role of brain-derived neurotrophic factor (BDNF) as a mediating factor for cognitive improvements from exercise.

The two other domains, which showed significant changes in response to exercise, were attention and working memory. Since these factors are strong predictors of functional recovery after a first episode of Schizophrenia, implementing exercise interventions from the early stages of illness may facilitate functional recovery. Indeed, exercise may confer even greater benefits in the early psychosis, as cognitive enhancement interventions are more effective at this time than later in the illness. Consistent with this, three recent studies in young patients with first-episode psychosis (aged 23–26) have observed large cognitive improvements from moderate/vigorous exercise after just 10–12 weeks. With the currently limited evidence, it is unclear whether this high level of responsiveness to exercise among first-episode patients is due to their younger age or their earlier stage of illness.

References:
Firth, J., Stubbs, B., Rosenbaum, S., Vancampfort, D., Malchow, B., Schuch, F.,…Yung, A.R. (2016). Aerobic exercise improves cognitive functioning in people with schizophrenia: a systematic review and meta-analysis. Schizophrenia Bulletin. DOI: 10.1093/schbul/sbw115

Jonathan Torres, M.S.
WKPIC Doctoral Intern

(Director’s Note: We have come to our final Friday Factoids post from the 2015-2016 intern class. Stay tuned for the first offerings of the 2016-2017 crew!)

August 08 2016

Friday Factoids Catch-Up: Effects of Multitasking

Many business leaders think of multitasking as a great asset and they envision employees who can get more work accomplished. People also believe that the Millennial generation (ages 18 to 34) is better equipped to juggle multiple tasks. For the most part this is true. Millennials are known for being adept with all forms of technology and moving from one job to another, shifting between priorities with relative ease. Most employers post “The ability to multitask” as a skill on several job openings. Unfortunately, the latest research conducted in psychology and business productivity suggests we have gotten it all wrong.

The average Millennial switches their attention among media platforms 27 times per hour. Research shows that performing a mental task while multitasking yields similar results to performing the same task if you got no sleep the previous night. Additionally, prolonged multitasking will actually damage your brain. Regular multitaskers have less brain density in areas controlling cognitive and emotional functions. Alternating between tasks will lower your emotional intelligence. If you are switching your gaze from your laptop to your smartphone to a TV screen and back again, you stand to miss a lot of subtle nonverbal signals from the person you are talking with simultaneously. Researchers revealed that the brain cannot effectively handle more than two complex related activities at once.

Multitasking doesn’t always live up to the dream. Instead, it tends to mean a lack of focus and an increase in impulsivity. Experts predicted that the impact of networked living on youth today will increase their desire for instant gratification, cause them to settle for quick choices, and cause them to lack patience. Researchers at Stanford University conducted a famous experiment 50 years ago where children were given the chance to eat a single marshmallow immediately, or wait until someone returned later, at which point they would receive a second marshmallow. The kids were tracked later in life and it turns out those who waited for that second marshmallow fared much better than those who chose instant gratification. The participants who did not wait were more likely to have behavioral problems, be obese, use drugs and spend time in jail.

There’s a financial cost, too. Lack of productivity due to multitasking equates to global losses of $450 million per year and Millennial job-hopping costs the U.S. economy more than $30 million per year. Nearly nine out of ten Millennials plan to stay in a job less than three years and 21 percent say they have changed jobs in the past year. While the average job tenure for all workers 25 and older is 5.5 years, it is only three years for Millennials. The cost of job-hopping to employers is not marginal, either. The loss of one Millennial employee runs between $15,000 to $25,000, for most companies.

In terms of the turnover issue, employers can discourage Millennials from leaving too soon by offering finite terms of employment from the get-go. Giving Millennials a sense of purpose through meaningful work and projects that require a variety of skills has been shown to deter job-hopping. To help reduce the effects of multitasking, you should schedule blocks of uninterrupted time. There is time management method called the Pomodoro Technique that allows you to work for 25-minute chunks of time and then take a five-minute break. During this time you focus all your attention on a single task and take short breaks as a way to increase focus and productivity. Lastly, you can increase the ability to focus, concentrate, and reduce stress throughout the day by practicing either (or better yet, both) yoga or meditation. However you choose to do it, cutting back on or eliminating multitasking is well worth the effort. You will work more productively and finish tasks more quickly.

References:
Clapp, W., Rubens, M., Sabharwal, J., Gazzaley, A. (2011). Deficit in switching between functions underlies the impact of multitasking memory in older adults. Proceedings of the National Academy of Sciences of the United States of America. 108(17), 7212-7217.

Sanbonmatsu, D., Strayer, D., Medeiros-Ward, N., Watson, J. (2013). Who multi-tasks and why? Multi-tasking ability, perceived multi-tasking ability, impulsivity, and sensation seeking. PLOSOne. 8(1), e54402.

Zetlin, M. (2016, July 30). Constant Multitasking Is Damaging Millennial Brains, Research Shows. Retrieved from: http://www.inc.com/minda-zetlin/constant-multitasking-is-damaging-millennial-brains-research-shows.html

Jonathan Torres, M.S.
WKPIC Doctoral Intern

August 08 2016

Friday Factoids Catch-Up: What Exactly Does Psychosomatic Mean?

When patients who are presenting to physicians for treatment hear the word “psychosomatic” they usually feel immediately discredited. This term is often followed by a referral to see a psychologist, which patients often do not choose to do.

First, the term psychosomatic means something different to physicians and most patients than it does to psychologists and mental health professionals. When physicians resort to telling patients they feel their condition is psychosomatic, it is often after much frustration and perceived treatment failures. Physicians note that these patients report very high levels of symptomatology, but testing and evaluations cannot identify concrete pathology. Physicians may also notice that patients seem to be reporting higher levels of symptoms than what seems to make sense in light of physical findings. The model that many physicians were trained in (Cartesian Model) creates a mindset that all medical conditions can be diagnosed with a methodical and logical approach. If this approach yields no solid support to reported symptoms, the problem is determined to be psychosomatic—or essentially not real. Laypeople (patients) typically identify the term psychosomatic in the same context. It can be a painful word for patients to hear and understand, and they often feel insulted by the resultant referral to see a psychologist.

Psychologists do not identify the term psychosomatic the same way as physicians and patients may define it. Many psychologists conceptualize health problems from a multi-faceted approach in which physical and biological conditions interact with their environment. “Somatic” research generally approaches physical conditions as inseparable from the mind. This under no circumstances means that psychologists think “every problem” is in the mind. In fact, it means that all systems in which a person functions interact with each other. Chronic pain is an example of a problem in which many systems interact. Emotions have been identified as one factor in decreasing pain tolerance, and biological changes can result from emotional state. So, feelings can make pain worse, and worsening pain increases emotional issues—and the problems can spiral.

Explaining to patients that seeing a psychologist is a part of treatment for medical conditions and not a result of practitioners deciding that patients are “faking” or “just emotional,” may help facilitate following up with recommendations. Patients who experience chronic illnesses often feel very misunderstood and disrespected, and more could be done to help patients understand that psychologists may be an instrumental part of their healthcare. This simple step could result in significant improvements in overall outcome for many conditions.

Rain Smith, MS
WKPIC Doctoral Intern

August 08 2016

Article Review: The role of psychological symptoms and social group memberships in the development of post-traumatic stress after traumatic injury [Jones et. al. British Journal of Health Psychology(2012) 17, 798-811]

Jones et. al (2012) points out that traumatic injury can be linked with later development of PTSD. It does not seem surprising that PTSD is common after a major physical trauma resulting in orthopedic injuries (OI) or acquired brain injury (ABI). Unknown variables included which factors might mitigate or limit the development of PTSD after traumatic injury.

Jones et.al. discussed the social identity model. The social identity approach looks at how one’s social group memberships contribute to health outcomes. Jones et. al. evaluated two injury groups (OI and ABI) at 2 weeks and again at three months after discharge. The participants were given The General Health Questionnaire (GHQ) to assess somatic symptoms. The Exeter Identity Transition Scales (EXITS) were utilized to assess sense of belonging, connection and support. Finally the Trauma Screening Questionnaire (TSQ) was given to assess post traumatic symptomatology.

The researchers found that group memberships seemed to effect OI and ABI differently. Injuries that caused long term life changes seemed to have reduced trauma symptoms when new group membership after the injury was developed. An example of “new group membership” would be joining an ABI support group. The authors theorized that membership in a group that facilitated the changes involved allowed patients to better adjust to their new life circumstances.

Jones et. al suggested that for injuries with higher levels of long term disabilities, trauma symptoms may be reduced by health care personnel making appropriate referrals to community services and groups.

References
Jones et. al (2012). The role of psychological symptoms and social group memberships in the development of post-traumatic stress after traumatic injury. British Journal of Health Psychology, 17, 798-811

Rain Smith, MS
WKPIC Doctoral Intern

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Friday Factoids Catch-Up: Schizophrenia Symptoms Reduced Through Exercise

Friday Factoids Catch-Up: Effects of Multitasking

Friday Factoids Catch-Up: What Exactly Does Psychosomatic Mean?

Article Review: The role of psychological symptoms and social group memberships in the development of post-traumatic stress after traumatic injury [Jones et. al. British Journal of Health Psychology(2012) 17, 798-811]

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