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Psychiatry Newsletter - Our Variety's Showing: A Sampler of New Work

Hopkins BrainWise - Fall 2012

Our Variety's Showing: A Sampler of New Work

Date: November 1, 2012

Count Sheep Instead

Have chronic pain? Insomnia too? The best bet, say Luis Buenaver and Michael Smith may be not to dwell on it. “We’ve found that people who ruminate about their pain and have more negative thoughts about it don’t sleep as well,” says Buenaver, “with the result that they feel more pain.” Their multicenter group surveyed 214 patients with the chronic pain of temporomandibular disorder (TMD), then relied on sophisticated data-crunching that could validate indirect effects.

Those who “catastrophized” about their pain were far more likely to have disrupted sleep and, caught in a vicious cycle, they rated subsequent pain as more intense, thanks to the insomnia. Mulling over misery, it would seem, only cements that circular path.

For information: 410-550-6337.

Stimulating Possibility for Mild Alzheimer’s?

A study of six patients with probable mild Alzheimer’s disease suggests that a year of continuous electrical impulses to specific memory regions via deep brain stimulation (DBS) improves the workings of key brain circuits. The research, at the safety-determining stage, highlights a new use of DBS as a circuit activator. “And it may offer hope for at least some people with AD,” says first author, Gwenn Smith.

The Hopkins/University of Toronto team performed PET scans to detect changes in brain cells’ metabolism of glucose. Sophisticated analysis of the featured brain networks told them that the integrity of neural connections had been bumped up, closer to pre-illness levels and more than current Alzheimer’s drugs could achieve. Most important: patients’ improved abilities mirrored their improved biology.

For information: 410-550-8696.

Wired for Less Stress?

You feel threatened in some way and your stress-responding HPA-axis snaps into action. But how much action varies from person to person. Why? That answer’s important, since an over- or underactive HPA axis can affect the onset and course of some major psychiatric disorders.

Recently, Gary Wand, Pamela Mahon and others looked for signs that personality traits played a part in the response of 381 healthy young adults to a high-stress mock job interview and performing mental arithmetic. With levels of the hormone cortisol as an indicator, the researchers found that having an open, agreeable or conscientious nature had no effect on cortisol level. But in assertive men and women—those high in extraversion—cortisol output stayed significantly low.

Are there clinical implications? Yes, for less assertive people, low in extraversion: They tend to have a higher stress response and may be more at risk of depression.

For information: 410-614-0056.

In ADHD, Less Is More

Multitasking truly tests brainpower in all of us, but for kids with ADHD, it’s especially difficult, a new study suggests. Years of experience told Mark Mahone and colleagues there’s an ADHD difference, but a lack of hard data kept them unsure. So they engaged 19 schoolchildren with ADHD and 25 controls, showing them two separate images sequentially on a video screen and asking for an immediate response, via push buttons, to each. Normally, there’s a lag in responding to the second image due to cognitive “bottleneck” that occurs in the brain. But in the ADHD group, the bottleneck lasted even longer. “Multitasking is on the rise in schools,” says Mahone, “and awareness that some students are truly challenged by it asks us to find ways to ease the problem.”

For information: 443-923-4446 or 4469.

Cognitive Circuits Awry in SZ

In schizophrenia, cognitive problems consistently derail patients’ lives. “Troubles with short-term memory and attention are common and typically come before psychotic symptoms appear,” says Paul Unschuld. “That makes cognition a promising field of research when you’re trying to catch things early.” 

Recently, Unschuld, David Schretlen and colleagues shored up the idea that these changes come just as key prefrontal brain circuits go awry, notably in the so-called default network—neurons normally at a low-level hum of activity in the healthy brain at rest. The team’s study of 100 patients, their close relatives and healthy controls began with sophisticated cognitive testing to confirm problems. Then, using functional MRI, the researchers showed abnormalities in suspected brain circuits that reflect patients’ performance on cognitive tests. Ultra-potent MR spectroscopy confirmed those areas as injured.

Surprisingly, abnormal circuitry was also found, to a lesser degree, in patients’ immediate relatives. “These signs,” Unschuld says, “could help us tell who’s at risk.” 

For information: 410-614-6341 and 410-614-0011.

Autism and Wayward Metabolism?

A not-insignificant number of children with autism spectrum disorders (ASD) likely have an undiagnosed problem with the way their bodies create cholesterol or related sterol compounds, says psychiatrist Elaine Tierney. Tierney’s team checked the blood serum of 100 kids with autism—not the only ones in their families to have it—for problems with cholesterol metabolism. Up to 20 percent had “substantially” low cholesterol.

Because sterols are a key element in nerve membranes and the neuroactive steroids in the brain that affect behavior, Tierney says this possible connection between metabolic upset and at least some ASD warrants much more study. A new clinical trial should see if added cholesterol helps children with ASD.

For information: 443-923-7657.

ICU Stays Can Wreak Family Havoc

It’s called post-intensive care syndrome—family, the cluster of complications that can waylay people knotted around a relative who’s critically ill. In this family member version of PICS, there’s a high risk of acute stress disorder, PTSD, depression, complicated grief and more.

Recently Joe Bienvenu reviewed research on the condition. It’s far from rare: Close to a quarter of adult relatives of someone severely ill show depression symptoms; a third of those with children in the ICU court acute stress disorder. The risk of PICS rises with a family history of psychiatric illness, being the sick person’s spouse or having the loved one’s illness strike suddenly.

One strength of the review is its suggestions for prevention, including how ICU staff can improve things before and after a patient’s discharge.

For information: 410-614-9063.

Articles in this Issue

The Bench. The Bedside

Highlight on Medical Psychology