Mental Health

All about mental illnesses

From depression to dementia, inflammation is medication’s new frontier|Edward Bullmore

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The barrier between mind and body appears to be crumbling. Clinical practice and public perception need to catch up

Unlikely as it may seem, #inflammation has become a hashtag. It seems to be everywhere suddenly, up to all sorts of tricks. Rather than simply being on our side, fighting infections and healing wounds, it turns out to have a dark side as well: the role it plays in causing us harm.

It’s now clear that inflammation is part of the problem in many, if not all, diseases of the body. And targeting immune or inflammatory causes of disease has led to a series of breakthroughs, from new treatments for rheumatoid arthritis and other auto-immune diseases in the 1990s, through to the advent of immunotherapy for some cancers in the 2010s. Even more pervasively, low-grade inflammation, detectable only by blood tests, is increasingly considered to be part of the reason why common life experiences such as poverty, stress, obesity or ageing are bad for public health.

Related: Joining a choir helped me combat anxiety and find a meditative state of pure joy

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Help APA Understand How Burnout Affects Different Groups

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APA’s Committee on Well-being and Burnout wants to know more about psychiatrists’ experiences with burnout and/or depression.

APA members are urged to complete a new survey/self-assessment tool developed by the committee that includes questions about demographics (age, gender, geographic location, minority status, and other variables) and practice setting (private practice, group practice, community mental health center, academic medical center, etc.). The survey also includes questions about burnout using the Oldenburg Burnout Inventory and the Patient Health Questionnaire-9 (PHQ-9) to screen for depression. The survey can be completed in under 20 minutes.

All data will be kept anonymous.

“We hope to learn more about well-being and burnout among psychiatrists in general and among minority and underrepresented psychiatrists, specifically,” said Uchenna Okoye, M.D., M.P.H., a member of the committee.

An earlier online survey created by the committee established that burnout was a significant issue among APA members. In a 2018 report to the Board of Trustees, the committee stated that of the more than 1,900 psychiatrists who had taken the survey, 73% scored above 35 on the Oldenburg Burnout Inventory—indicating they were at risk for burnout. The survey also found that 15% of the respondents had a PHQ-9 score greater than 10, which indicates the presence of moderate to severe depression. Burnout scores were correlated with gender (women typically had higher scores), recent medical school graduation, and perceived inability to control one’s schedule. Among non-depressed respondents, burnout scores were slightly lower for psychiatrists who worked in academic and academic-affiliated practice settings.

The new survey will help drill down further to understand whether burnout affects members of minority groups differently. “We know a lot about burnout, but we don’t know much about the rates or causes of burnout in minority and underrepresented psychiatrists,” Okoye said. “If you belong to one or more minority or underrepresented groups—for example, if you are a woman, belong to a racial or ethnic minority, are an international medical graduate, identify as LGBTQ+, or belong to another group—your voice may not have been heard in this national conversation.”

Past APA President Carol Bernstein, M.D., also a member of the committee, said research on how burnout affects particular groups will help all psychiatrists affected by the problem. “I urge members to log onto the survey,” she said. “Understanding more about this issue and developing potential strategies to address it are important for the field of psychiatry, and for all of us in it.”

Click here to learn more about what APA is doing to address burnout.

(Image: Adam Scott)

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Air Pollution in Childhood Tied to Greater Schizophrenia Risk

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A new Danish study shows that individuals who were exposed to a high level of air pollution during childhood are at greater risk of developing schizophrenia.

The findings are published in the scientific journal JAMA Network Open.

“The study shows that the higher the level of air pollution, the higher the risk of schizophrenia,”  said senior researcher Dr. Henriette Thisted Horsdal from Aarhus University. “For each 10 μg/m3 (concentration of air pollution per cubic metre) increase in the daily average, the risk of schizophrenia increases by approximately twenty per cent.”

“Children who are exposed to an average daily level above 25 μg/m3 have an approximately 60 percent greater risk of developing schizophrenia compared to those who are exposed to less than 10 μg/m3.”

To put these figures into perspective, the lifetime risk of developing schizophrenia is about 2 percent, which equates to two out of 100 people developing schizophrenia during their life. For those exposed to the lowest level of air pollution, the lifetime risk is just under 2 percent, while the lifetime risk for those exposed to the highest level of air pollution is about 3 percent.

“The risk of developing schizophrenia is also higher if you have a higher genetic liability for the disease. Our data shows that these associations are independent of each other,” Horsdal said. “The association between air pollution and schizophrenia cannot be explained by a higher genetic liability in people who grow up in areas with high levels of air pollution.”

The research involved a total of 23,355 people, of which 3,531 developed schizophrenia. Though the findings reveal an increased risk of schizophrenia when the level of air pollution during childhood increases, the researchers emphasize that more research is needed before they can identify what is driving this association.

The study combined air pollution data from the Department of Environmental Science with genetic data from iPSYCH, a Danish research project focused on finding the causes of major mental disorders. The study is the first of its kind to combine air pollution and genetics in relation to the risk of developing schizophrenia.

Source: Aarhus University



Higher Rates of Postnatal Depression Among Moms With Autism

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Moms with autism are more likely to experience postnatal depression compared with non-autistic moms, according to a new study from the University of Cambridge in the U.K.

The research, published in the journal Molecular Autism, offers a better understanding of the experiences of mothers with autism during pregnancy and the postnatal period.

“Autistic mothers face unique challenges during the perinatal period and parenthood,” said study leader Dr. Alexa Pohl. “Despite these challenges, an overwhelming majority of autistic mothers reported that parenting overall was a rewarding experience. This research highlights the need for increased awareness of the experiences of motherhood for autistic women and the need for more tailored support.”

The study involved 355 autistic mothers and 132 non-autistic mothers, each of whom had at least one autistic child. The participants completed an anonymous, online survey.

The results show that 60 percent of moms with autism reported that they had experienced postnatal depression, compared to only 12% of women in the general population. In addition, autistic moms had more difficulties in multitasking, coping with domestic responsibilities, and creating social opportunities for their child.

“This worryingly high number of autistic mothers who experience postnatal depression means we are failing them and their infants at a critical point in their lives,” said Professor Simon Baron-Cohen, Director of the Autism Research Centre at Cambridge.

“We now need more research into why the rates are so much higher, whether they are seeking help and not getting it, or if they are not seeking help and for what reasons. A new research priority is to develop autism-relevant screening tools and interventions for postnatal depression in these mothers.”

The researchers also discovered that when autistic mothers disclosed their autism diagnosis to a professional, they were not believed the majority of the time. Autistic women felt misunderstood by professionals more frequently during pre- and postnatal appointments and found motherhood an isolating experience.

Yet despite the challenges, autistic mothers reported they were able to act in the best interest of their child, putting their child’s needs first and seeking opportunities to boost their child’s self-confidence.

“This vital study was initiated by the autistic community, who collaborated as equal partners with researchers in the design, dissemination and interpretation of the survey. This is an excellent example of what can be achieved through such partnerships,” said Monique Blakemore, an autistic advocate and member of the team.

Source: University of Cambridge