Friday Factoids: Have Your Chocolate, and Eat It, Too!

 

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.

 

Work Cited
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.

 

Crystal Bray
WKPIC Doctoral Intern

Friday Factoids: Schizophrenia and Premature Death

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.

 

Crystal Bray
WKPIC Doctoral Intern

 

Article Review: Nancy McWilliams, Psychoanalytic Diagnosis. Chapter 3: Developmental Levels of Personality Organization

 

Psychologists work with complex diagnostic and treatment issues on a daily basis. Current standards of care (and reimbursement) have guided diagnosis and treatment to seem focused on DSM-5 categories and ICD-10 codes. Clinicians I have interacted with seem to appreciate the aspects of continuum versus strictly categorical diagnoses added to DSM-5. This may open avenues into helping psychologists better describe, understand and treat their patients with compassion.

 

A continuum model of personality organization is outlined in chapter 3 of Nancy McWillam’s book, Psychoanalytic Diagnosis. This model has important implications in the work clinicians do with patients regardless of their chosen theoretical orientation. The psychodynamic concepts in this particular chapter apply to any overriding theoretical orientation just as the concept of transference does. In the middle of the 20th century and beyond, many analysts followed in the tradition of Freud in differentiating psychopathological conditions as either neurotic or psychotic. Neurotics were described as having some insight into their difficulties of which, a source of reality based stress was likely being managed poorly. Conversely, psychotics who were having psychological difficulties experienced distress based on misinterpretations of reality. At the same time other clinicians began to question these discrete categories because they noticed patients who seemed to fall on a borderline between neurosis and psychosis. It is a crucial point to understand that this concept is NOT describing Borderline Personality Disorder. We all have a unique personality that has developed for a variety of biological and psychological reasons. The model described in McWilliams’s book and by many other modern psychodynamic theorists, organizes personality in a thermometer like fashion with three overall categories: Neurotic, Borderline and Psychotic. Levels of personality organization tend to lend themselves to the idea of fixation in a particular developmental stage.

 

Neurotic Personality Organization
When a patient with Neurotic Personality Organization (NPO) presents to psychotherapy, it is more likely that they see their distress as ego dystonic or ego alien. NPO typically relies on repression as a defense mechanism as opposed to more primitive defenses such as splitting, or projective identification. If you ask a neurotically organized patient to tell you about themselves, they can describe a person who has an integrated sense of identity on some level. They can tell you enduring traits about themselves and have some insight into what parts of themselves have been more constant over time. It requires a severe biological or traumatic event for Neurotically Organized personalities to lose touch with reality. Schizophrenia as well as any Axis I disorder can exist in a neurotically organized individual. Neurotically organized individuals with psychotic disorders will be able to identify psychotic symptoms as not reality based and quickly access mental health services as a result. They tend to be individuals who will demonstrate a stronger recovery from psychosis due to remaining on prescribed medications, being able to identify stressful triggers, and most important reality testing remains intact even when the individual begins to experience symptoms. The patient knows they are sick and seeks help long before psychiatric hospitalization occurs.

 

Borderline Personality Organization
Borderline Personality Organization (again I cannot stress enough this is NOT the personality disorder), relies on a less developed defensive repertoire. Splitting occurs frequently at this general borderline personality organization (BPO) as well as with borderline personality disorders. Black and white thinking can be a part of those organized at this level. There are only good and bad, “my” way or the wrong way. If a BPO is asked to describe who they are the description may seem to vacillate based on the situation they are in. Their own sense of identity is not formed so it is more likely to be shaped as a result of the current relationship or environmental situation. Those with BPO are more prone to “micropsychotic” dips in times of stress. One diagnostic consideration this can be particularly helpful with is major depression. A depressed NPO will likely be able to identify stressors and respond to psychotherapy and medication in an expected manner. A depressed BPO is likely to have psychotic features. The patient is less likely to be able to explain what preceded the depression and much less likely to identify any time in their life they were not depressed. They are more likely to see any pathology as ego syntonic and be brought in for treatment by family members or others. Depressed BPO patients have great difficulty identifying a gray area between depressed and non-depressed states. They may describe themselves as “bipolar” when the actual problem is their inability to identify and label affect. Patients who report they have been diagnosed as bipolar but do not respond to “any” medications should raise some suspicion for this particular organizational level. BPO is unstable and ever changing which can give the impression of a bipolar element. Those functioning at this level may have times of calmer more successful neurotic level functioning coupled with dips into psychotic level function.

 

Psychotic Personality Organization
Like the other organizational levels this is not a psychotic “disorder.” Psychotically Organized Personalities are less likely to respond to standard treatment and more difficult to build rapport with. They often will not know how to begin describing themselves or any personality traits they have. Psychotic level individuals have lacking insight into their difficulties. If they have a psychotic disorder they may even seem at times to be unaware of it. They are not distressed by what others from the outside may conceptualize as distress. It is rare for this personality organization to be able to assess reality. This is the patient that may seem to make one bad decision after another based on a fact pattern others cannot identify. Psychotically organized patients are more likely to use schizoid retreat as a defense. They isolate from others and engage in an internal fantasy world that becomes difficult for them to differentiate from reality. This inevitable leads to interpersonal difficulties and more frequent interaction with law enforcement. A depressed psychotically organized patient is more likely to act out violently and see this as a viable solution to their discomfort. This patient will be disorganized and unable to identify why they are depressed or if they ever have been before. Some have learned to state they “always” have been depressed in some effort at interacting with treating clinicians. Further evaluation may identify few things that make sense in the patient’s behavior. It is important to gain an understanding of what it is that this individual (not the clinician) describes as reality and start working from that point.

 

Understanding
When treating patients many clinicians identify that not all depressed patients are alike. Why it is some seem to have insight and respond to treatment while others seem much more difficult? Identifying a patient’s personality organization can help clinicians in a variety of ways. It is less difficult to understand why a psychotically organized depressed patient will need a longer length of treatment and repeated treatment exposures. Understanding the personality context of a disorder may help decrease the clinician’s frustrations when treatment seems more difficult. The patient can be saved some degree of distress when they are aware of what their treatment may look like. The patient who is at a psychotic level of organization will need treatment patiently described over and over to understand the realities of treatment. Lapses in treatment make more sense when the clinician understands that they may be a result of the patient’s organizational level.

 

Reference
McWilliams, N. (1994) Psychoanalytic Diagnosis. Guilford Press, New York, NY.

 

Rain Blohm, MS
WKPIC Doctoral Intern

 

Friday Factoids: Where Do the 2016 Presidential Candidates Stand on Mental Health Issues?

 

In an election often dominated by worries about the economy and national security, mental health gets comparatively little exposure as a serious issue on the presidential campaign trail. In fact, during my search for information it was difficult to find clear and concise information about the candidates’ stance on mental health issues in America. During this election season, the issue of mental health services has been brought up most frequently when candidates have discussed mass shootings. Candidates on both sides of the aisle have stressed the need to prevent mentally ill people from acquiring guns. Democrats have advocated for gun control and Republicans argued that the lack of treatment for mental health issues should be blamed for mass shootings rather than the gun industry.

 

The heroin epidemic has provided an opportunity for candidates to link drug addiction and mental health, with candidates like Bernie Sanders arguing that the nation’s prison system must stop being used as a substitute for treatment. In addition, mental health is also commonly mentioned in regards to the Department of Veterans Affairs, with many candidates promising to reform the agency and give veterans access to proper mental health care. It is even rarer for candidates to mention mental health as its own issue, one that is not prompted by a national crisis or by a question from an audience member.

 

Out of all the 2016 candidates, Hillary Clinton and John Kasich are perhaps the most vocal advocates for mental health care. Clinton has called for mental health to be treated with parity to physical health issues. During the run-up to the Iowa caucus, Clinton frequently criticized the state’s Republican governor, Terry Branstad, for closing two of the state’s four mental hospitals. Kasich, who is often attacked by conservatives for expanding Medicaid in his home state of Ohio, has argued that the move helped treat the mentally ill. Bernie Sanders occasionally speaks about mental health as a part of his health care plan, and has called for a “mental health revolution,” usually in regards to making sure people are treated in light of the national conversation on mental health and guns.

 

Marco Rubio has talked about the stigma surrounding mental health issues when asked about it by voters. Some candidates have taken a different approach and have joked about the issue. Ted Cruz has said multiple times that he has “a lot of experience with mental health” issues because he’s dealt with Congress. One day after a man shot two journalists on live television Donald Trump said he is opposed to tightening gun laws in the U.S. but is in favor of addressing mental health to prevent shootings. Trump did not offer specific solutions to addressing the mental health problem, but said there are “so many things that can be done.”

 

When candidates do talk about mental health, what they say falls very clearly along party lines. Republican candidates who do address the issue tend to do so in the context of veterans affairs or to recommend institutionalizing certain mentally ill people rather than focusing on gun control. Democratic candidates who bring up mental health tend to do so in the context of reducing the flow in the prison pipeline and addressing substance use disorders. In other words and not surprisingly, mental health gets a mention where it seems to be politically expedient.

 

For more information, you can view each candidate’s political website.

 

References:
Willingham, E. (2015, September 6).What does your 2016 Presidential Candidate Say about Mental Health? Forbes. Retrieved from http://www.forbes.com/sites/emilywillingham/2015/09/06/what-does-your-2016-presidential-candidate-say-about-mental-health/#6ccc3de6884d

 

Witkin, R. (2016, February 24)Where the 2016 Candidates Stand on Mental Health Issues. NBCNews. Retrieved from http://www.nbcnews.com/politics/first-read/where-2016-candidates-stand-mental-health-issues-n524826

 

Jonathan Torres, M.S.
WKPIC Doctoral Intern