Category Archives: Mental Health

How animals can help autistic children

Jacqueline Boyd, Nottingham Trent University

Daniel the “emotional support duck” is a pretty big deal, both in the animal and human world. His 15 minutes of fame began after he was spotted on a flight in the US – from Charlotte to Asheville, North Carolina – waddling around the plane in a nappy and some stylish red shoes.

He is said to help his 37-year-old owner, Carla Fitzgerald, battle the post traumatic stress disorder (PTSD) she has had since an accident in 2013.

The use of “emotional support animals” has become big business recently – particularly in the US – and it’s not just ducks like Daniel that humans have claimed make a helpful addition to their day-to-day lives.

There have also been reports of emotional support pigs, cats, turkeys, chickens and even miniature horses. It seems that all types of animals are increasingly being used to assist patients – in the belief they can help people with autism, PTSD and other conditions function in their everyday lives.

But of course, despite this new wave of popularity, interacting with animals has long been considered to be good for people. There has also been issues raised with the number of animals used in this way – with some animal researchers raising animal welfare concerns. Therapists have also expressed their concern at the rise of “emotional support animals” – with many in the profession feeling not all of the animals used are legitimate “support animals”.

Loving pets

“Emotional support animal” or “pet” aside, it is maybe obvious that one of the main benefits that comes from a friendship with animals is that they are a source of “non-verbal” and “non-judgmental” companionship for both adults and children. These are friends who will be there for us day in day out. Friends who will always be up for a walk or a chin rub, or a game of fetch.

Many pet owners also describe the “social lubricant” effect of their pet – reporting lower incidences of loneliness and depression.

Dog owners typically – but not always – have higher levels of physical exercise than non-owners. And animal contact is often associated with exposure to the outdoors and natural stimuli – which is considered to be beneficial for human health and welbeing.

Novel situations and experiences also often result from animal interactions – which can create enjoyable and motivational learning opportunities for children.

Fiver

Contact with animals is also widely regarded as an essential and natural part of childhood. I still remember my very first pet rabbit with deep affection. That rabbit “Fiver” – yes, I was a Watership Down fan – represented my first real responsibility for another living being. She was also a great friend and confidant.

And it is this realisation, that animals can be good for children’s development that explains why so many recent studies have focused on animal and children interactions.

This has led to animals increasingly being viewed and employed as useful partners in the educational and emotional development of children. There are now, for example, many schemes where children read to dogs to develop their reading skills with a canine “listener”.

Dogs can be great listeners and play pals.
Pexels

But while dogs and horses are the most commonly used species for therapeutic and educational interactions, a range of other animals – ducks and miniature horses aside – have also been used successfully.

A recent study, for example, examined how interactions with classroom guinea pigs impacted on children with autism. And it was shown that for these children, spending time with the guinea pigs resulted in significantly improved social skills and motivation for learning.

Animal attributes

There are also other identified developmental benefits for children interacting with animals. Evidence suggests that children exposed to animals may have improved immune systems and a reduced incidence of allergies.

Therapy animals have also been shown to reduce pain in hospitalised children. And animals appear to enhance the social, emotional and cognitive development of children and aid the development of empathy. Exposure to companion animals has additionally been shown to boost levels of responsibility, self esteem and autonomy in children.

But of course, despite the benefits to both children and adults, the welfare of animals used in therapeutic, educational or other interactions, is also important.

Swimming with dolphins and direct encounters with other exotic species has previously attracted attention for therapeutic value – especially for children with physical and intellectual disabilities – though recent gudielines now strongly advise against the use of such species. This is both due to animal welfare concerns and concerns for human participants.

This is why any animal involved in such interactions needs positive and ethical training, along with high health and welfare standards. All of which will help to make sure that the animals people are engaging with in these environments are happy animals – which can then in turn help to create happy humans.

Jacqueline Boyd, Lecturer in Animal Science, Nottingham Trent University

Is there really a link between owning a cat and mental illness?

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Francesca Solmi, UCL and James Kirkbride, UCL

Over the past few years, cats have increasingly attracted media attention due to a number of scientific studies reporting that a Toxoplasma Gondii (T. Gondii) infection is linked with mental health issues, including schizophrenia, suicide and intermittent rage disorder. Since domestic cats are the primary hosts of T. Gondii – that is, they provide an environment within which this parasite can reproduce – it is often speculated that cat ownership may put people at increased risk of mental illness, by exposing them to it.

However, only a handful of small studies have found evidence to support a link between owning a cat and psychotic disorders, such as schizophrenia. And most of these investigations have serious limitations. For instance, they relied on small samples, did not specify how participants were selected, and did not appropriately account for the presence of missing data and alternative explanations. This can often lead to results that are born out of chance or are biased.

To tackle these limitations, we conducted a study using data from approximately 5,000 children who took part in the Avon Longitudinal Study of Parents and Children between 1991 and 1992. Since then, these children and their families have been followed up to gather information on their health, as well as on their demographic, social and economic circumstances.

So, unlike previous studies, we were able to follow people over time, from birth to late adolescence, and address a number of the limitations of previous research, including controlling for alternative explanations (such as income, occupation, ethnicity, other pet ownership and over-crowding) and taking into account missing data.

*T. Gondii* is found in domestic cats.
Kateryna Kon/Shutterstock.com

We studied whether mothers who owned a cat while pregnant; when the child was four years old; and 10 years old, were more likely to have children who reported psychotic symptoms, such as paranoia or hallucinations, at age 13 and 18 years of age. Although most people who experience psychotic symptoms in adolescence will not develop psychotic disorders later in life, these symptoms often indicate an increased risk for such disorders and other mental illnesses, including depression.

So are cats bad for your mental health? Probably, not.

We found that children who were born and raised in households that included cats at any time period – that is, pregnancy, early and late childhood – were not at a higher risk of having psychotic symptoms when they were 13 or 18 years old. This finding in a large, representative sample did not change when we used statistical techniques to account for missing data and alternative explanations. This means that it is unlikely that our results are explained by chance or are biased.

While this finding is reassuring, there is evidence linking exposure to T. Gondii in pregnancy to a risk of miscarriage and stillbirth, or health problems in the baby. In our study, we could not directly measure exposure to T. Gondii, so we recommend that pregnant women should continue to avoid handling soiled cat litter and other sources of T. Gondii infection, such as raw or undercooked meats, or unwashed fruit and vegetables. That said, data from our study suggests that owning a cat during pregnancy or in early childhood does not pose a direct risk for offspring having psychotic symptoms later in life.

Francesca Solmi, Research Associate, UCL and James Kirkbride, Reader, UCL

Finding solitude in an era of perpetual contact

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Being alone has many benefits. It grants freedom in thought and action. It boosts creativity. It offers a terrain for the imagination to roam. Solitude also enriches our connections with others by providing perspective, which enhances intimacy and fosters empathy.

To be sure, solitude is not always experienced positively. At times, and for certain people, it can lead to feelings of loneliness and isolation. In that sense, solitude is a two-sided coin, as is the case with other necessities in life, like food. As with food, we can benefit from being mindful of the quantity and quality of solitude we experience in daily life.

This is true of both deliberate solitude and those moments of being alone that are inadvertently stumbled upon. Both varieties of solitude have the capacity to deliver the benefits mentioned above, but the latter may be heading toward the endangered species list, at least for some folks.

In social psychology, solitude has traditionally been defined and measured as being physically alone, or in some cases not engaging with people who are also physically present. Since that foundation was laid, times have changed, as have the possibilities for “being with” others.

You are probably familiar with the old philosophical question: “If a tree falls in the forest and no one is around to hear it, does it make a sound?” After combing through the scholarly research on solitude last summer, I came up with a new version: “If a person is alone in the forest when a tree falls, but they don’t notice it because they’re texting, does it still count as solitude?”

Did you notice, or were you too busy texting?
nahidv/flickr, CC BY

What is it to be alone?

With mobile and social media, we now carry our networks around with us, and new possibilities for perpetual contact pose problems for solitude – not only for how it is experienced, but also for how it is studied. If all of our old ideas for thinking about and measuring solitude no longer apply, then we lack the scientific tools needed to further our understanding of it. Without accounting for the ways people connect in the digital realm through the Internet and mobile media, we have no way of knowing how much solitude people get, how they benefit or suffer from it, or different ways in which it is experienced. When I finished reading up on solitude last summer, I was left with the feeling that the study of it had hit a dead end, and was ready for a reboot.

That reboot began last fall when MIT professor Sherry Turkle’s book “Reclaiming Conversation” was published. Turkle’s book has garnered both high praise and rebuke for its critical view of digital media and the degradation of face-to-face conversation. Setting that debate aside for the moment, the book also makes some points that help push the conversation about solitude into the digital era.

One of Turkle’s arguments is that being able to connect anytime-anywhere means never having to experience unwanted solitude (see also Louis C.K.’s comedic rant on the topic). This is a problem because, as Turkle puts it, “In solitude we find ourselves; we prepare ourselves to come to conversation.” For her, the fundamental problem is how technology, especially mobile communication, makes it easy for us to avoid mundane boredom in daily life. Beyond boredom, we can talk about some other key reasons why someone might opt for a smartphone over their own thoughts during periods of downtime – and why there is a greater need for deliberate solitude for those interested in the benefits of being alone.

‘Work anywhere’ – but you’d better be working 24/7!
Working person on cliff via shutterstock.com

Always connected, and more automatic

We live in a time when expectations for being accessible are high. Sociologist Rich Ling attributes this to mobile communication’s transition from something new into a taken-for-granted assumption, like telling time. When mobile communication was a novelty, it was special to be able to connect “on the fly.” No longer. Ling’s theoretical argument about high expectations of accessibility is well-supported by a recent survey in the U.S. in which 80 percent of teens reported checking their phone hourly, and 72 percent said they feel the need to respond to messages immediately.

As mobile communication becomes embedded at the social level, it also moves toward the background of cognitive processing. People do not put as much conscious thought into their use of common artifacts, such as watches, staplers, and now mobile devices, when they become a taken-for-granted part of everyday life. In fact, habitual (i.e., less conscious) mobile phone use is part of the explanation for why people text while driving.

Mobile communication is now more like a second skin than a new innovation. When it beckons, people respond, often automatically. Even when our mobile devices do nothing at all, we sometimes automatically react to “phantom vibrations.” Mobile habits can also be triggered by emotional states and the environment.

A few years ago I was part of a small group visiting a primate sanctuary near Miami. The gimmick was that the monkeys roamed free while the humans were caged. The management set us free for a few moments, and we found ourselves completely covered in spider monkeys who wanted to make friends (friends who had nuts and raisins). Our initial impulse was to pull out our mobile devices to take photos and video. We didn’t even think about it.

If people turn to these devices without thinking during life’s amazing moments, it makes sense that we would do the same during those moments of unintended solitude. This tendency is exacerbated by the pull of expectations to be accessible anytime and anywhere. I am not arguing that everyone needs more solitude in their life. However, with unintentional solitude no longer mandatory, it might be a good idea for us to direct more thought into intentionally carving out times, places, and activities for being alone, not just in the realm of atoms and molecules, but in the realm of bits and bytes as well.

Scott Campbell, Constance F. and Arnold C. Pohs Professor of Telecommunication, University of Michigan

This article was originally published on The Conversation. Read the original article.

Early Celebrity Deaths Related To Stress and Overworking

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When the medical journal Circulation printed a study last year about stress and depression being the cause of early deaths, it was generally overlooked by the public as being somewhat obvious and a given. What most people seem to forget is that the celebrities they love who die early are most likely the result of the stress their career puts on their bodies.

Seven researchers from the Department of Medicine at Columbia University wrote in their study Perfect Storm: Concurrent Stress and Depressive Symptoms Increase Risk of Myocardial Infarction or Death that patients with coronary heart disease are more at risk of early death if their mental state is also ill due to depression and stress. Considering one out of every four people that die in the United States every year suffer from coronary heart disease, this isn’t surprising at first, but when you also consider that stress affects the same number of adults, all you need to add to the mix for the “perfect storm” that leads to an early death is depression.

Depression is known to affect around 7% of American adults, although the definition of depression is often controversially discussed as being ambiguous to laymen. This study, however, assessed its 4487 participants based on showing signs of stress and signs of depression over a five year period, being categorized as either low stress/low depression or high stress/high depression, and the subjects with the most heart attacks happened to be the ones with high stress and high depression.

With the recent deaths of Prince and David Bowie, it might make sense to assume that Prince, known for being a workaholic, spiritually disrupted (for lack of a better explanation) and argumentative or “difficult” person, was prone to an early death despite being clean and sober — that is if he also had heart disease (reports are uncertain as this writing). Bowie, on the other hand, may have made it further if he hadn’t succumbed to liver cancer, most likely caused by a lifetime of alcohol and oral drug use (pills).

Of course this is just speculation, but it’s still may help to dispel the notion that celebrities, with all their millions and fan love, live longer, healthier lives then the rest of us..

No smoke without fire – the link between smoking and mental health

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A recent study suggested a causal association between smoking tobacco and developing psychosis or schizophrenia, building on research about the relationship between the use of substances and the risk of psychosis. While cannabis is one of the usual suspects, a potential link with tobacco will have come as a surprise to many.

The report was based on a review of 61 observational studies and began with the hypothesis that if tobacco smoking played a part in increasing psychosis risk, rather than being used to deal with symptoms that were already there, people would have higher rates of smoking at the start of their illness. It also posited that smokers have a higher risk of developing psychosis and an earlier onset of symptoms to non-smokers. They found that more than half of people with a first episode of schizophrenia were already smokers, three times higher than that of a control group.

However, one of the limitations of the study, as the authors admit, is that many of the studies in their review did not control for the consumption of substances other than tobacco, such as cannabis. As many people combine tobacco with cannabis when they smoke a joint, the extent to which tobacco is the risk factor is still unclear.

One clear message the research highlighted was the high level of smoking among those with mental health problems and that smoking is not necessarily simply something that alleviates symptoms – the so-called “self-medication hypothesis”.

Almost half of all cigarettes

The figure is stark: 42% of all cigarettes smoked in England are consumed by people with mental health problems. So while the life expectancy of the general population continues to climb, those with a severe mental health problem have their lives cut short by up to 30 years – in part due to smoking.

Since the 1950s, rates of smoking have dramatically reduced in the population while the number of people with psychosis has remained constant. So why has the incidence of psychosis not mirrored the reduction in the overall numbers of smokers? Two factors might explain this. First institutional neglect has held up efforts and resources employed to reduce smoking for people with mental health problems – until recently public health campaigns have ignored this group with justifications that “surely they have enough to worry about without nagging about smoking” or “it’s one of the few pleasures they have”.

A more sinister role is also played by the tobacco industry, who have not been passive or unaware of one of their most loyal consumer groups: people with mental health problems. The industry has been active in funding research that supports the self-medication hypothesis, pushing the idea that people with psychosis need tobacco to relieve their symptoms, rather than tobacco having any link to those symptoms. The industry has also been a key player in obstructing hospital smoking bans which they perceive as a threat to tobacco consumption. Worse still they have marketed cigarettes specifically to people with mental health problems.

Combining substances

People with psychosis use substances for the same reasons you and I do: relax or feel less stressed. And the good news is, counter to many people’s preconceptions, individuals with mental health problems are no different to anyone else in their desire and ability to quit smoking.

This is welcome given the clear links between smoking and physical health. But there are particular issues when it comes to smoking and those with psychosis. For example, smoking impacts on the medical treatment of psychosis, as tobacco is known to interact with Clozapine, one of the drugs used to treat the condition. Because smoking interferes with the therapeutic action of Clozapine and some other anti-psychotics, requiring higher doses of the drug.

Then there’s the cannabis question. People with mental health problems are more likely to use drugs such as cannabis. This is usually combined with tobacco when smoked in a joint. So initiation into cannabis and its continued use contributes to higher rates of tobacco dependence for people with mental health problems.

The relationship between cannabis and psychosis has preoccupied researchers, policy makers and clinicians for decades. Unfortunately most of this evidence which has influenced and underpinned public health messages about cannabis is either outdated or methodologically flawed.

Since many of the seminal studies on this issue were carried out, there has been a marked change in the type of cannabis that is available. These studies were recruiting and investigating users who were exposed to lower potency varieties of cannabis. Over the past decade, higher potency forms of cannabis such as “skunk” have become dominant on the streets. This has been compounded by research being done by simply enquiring whether research participants currently use or have ever used cannabis. This assumes cannabis is a single type of drug, rather than a range of substances with varying strengths and constituent ingredients. To make matters worse, we rely on proxy measures of cannabis potency drawn from seizures made by the police. Such seizures may not be representative of contemporary cannabis availability.

Many people are exposed to a combination of drugs, whether prescribed, recreational or a mix of both. This raises the potential for interactions, where the effect of one drug alters the effects of another. This raises a further possibility in the smoking, cannabis and psychosis story. Could some people’s psychosis be attributed to an interaction between cannabis and tobacco? Information about drug interactions is scarce and pharmaceutical research has routinely excluded people who use substances from drug trials. This does not reflect reality as many people will combine medication with recreational drug use.

All of these factors serve as a useful reminder how little we know about the causes of psychosis, the role drugs play and the many vested interests that direct the route we take in trying to understand how we can prevent or treat people who are affected by mental health problems.

Ian Hamilton is Lecturer in Mental Health at University of York.

This article was originally published on The Conversation.
Read the original article.

Psychiatrists Unveil Plain-English Guide For Patients

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As mental health professionals, policy makers and advocates focus on taking steps to mend the fragmented mental health care system, the role of patients and their friends and families is sometimes overlooked.

That’s why the American Psychiatric Association is releasing a first-of-its-kind book to decode in plain English the Diagnostic and Statistical Manual of Mental Disorders – a guide for mental health providers that is also used to determine insurance coverage. The resource, Understanding Mental Disorders: Your Guide To DSM-5, includes in-depth explanations of risk factors, symptoms and symptom management, treatment options and success stories.

This gets at one of APA’s reasons for releasing this volume — to help create a more accurate picture of what a particular illness or disorder might involve.

Jeff Bornstein, a psychiatrist and spokesman for APA, said empowering patients with a better understanding of what they are facing will enable them to better advocate for themselves.

APA understanding mental
A new resource, Understanding Mental Disorders: Your Guide To DSM-5, from the American Psychiatric Association attempts to help patient better understand their symptoms and diagnoses.

“Sometimes when there is a disagreement with a managed care company, the clinician speaks on behalf of the patient,” Bornstein said. ”But it’s[also] helpful to have family [members] or the patient talk and say ‘I’m telling you, I have this symptom, it’s part of diagnosis X, Y and Z. Why are you not letting me have the treatment I need?’”

Former Rhode Island Congressman Patrick Kennedy, a mental health advocate, said the book is designed to help families and patients overcome stigma and get more involved in treatment. He said it would have helped him in his own experience with bipolar disorder and alcoholism. “I was the last one to know I had a problem, and that’s often the case for those of us in crisis. … The people around me would have benefited from this,” he said at an event marking the book’s launch.

When people think they may have an issue, or are faced with a diagnosis, they often go to the Internet where misinformation and “horror stories” are widespread, said Paul Gionfriddo, president of mental health advocacy group Mental Health America. “This [book] lays out in clear terms [what a mental disorder diagnosis means] so we don’t have to live in fear of the unknown.”

Take the experience of Melanie Carlson, 33, who suffered a psychotic episode in 2007 when she was 25. She ended up in a hospital, frightened and confused.

“It was a very traumatic incident. I was afraid of my own thoughts and what I was capable of,” said Carlson, who lives outside Ann Arbor, Mich., and manages her bipolar disorder with medication, exercise, therapy and abstaining from alcohol. But for almost a year-and-a-half she was in denial and refused treatment, mainly because she says her only knowledge of her condition came from media reports about high-profile, often violent events involving mental illness.

She says having more straight-forward information could have helped her understand that she could take care of her disorder and still live a normal life – with a job, friends and family.

“It felt like a hopeless situation,” Carlson said, who is now a social worker helping chronically homeless people get housing. “If I’d had a resource that explained my symptoms … and explained how complying with treatment could produce long-term stability I would not have been … resistant.”

It’s all part of the steady process of removing the taboo from treatment, said Jorge Petit, a psychiatrist and founder of Quality Healthcare Solutions Group, a health care and behavioral health consulting firm in New York City. “It’s no different than diabetes and hypertension — it requires awareness and understanding of how to maintain wellness and not to relapse,” he said.

However, he added that the playing field is still not even. “It’s hard for people to call the insurance company and say, ‘Why are you sending me a prior authorization notice? It’s the same as having a medical issue.’”

NYC Respite Centers Help Keep Mentally Ill Out Of Hospitals

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NEW YORK – It is a busy Friday afternoon. Staff members check in guests at the front desk. Other employees lead visitors on tours of the upstairs bedrooms, or field calls from people considering future stays. Aromas of garlic and roasted chicken seep out of the kitchen.

Community Access is not a bed and breakfast, although it feels that way when you walk through its unmarked door off Second Avenue on Manhattan’s Lower East Side. Also known as Parachute NYC, this quiet seven-bedroom facility is one of four publicly funded mental health centers in New York City (located in Manhattan, Brooklyn, Queens and the Bronx) that provide an alternative to hospital stays for people on the verge of a mental health crisis.

Parachute’s respite centers have no medical staff, no medications, no locks or curfews and no mandatory activities. They are secure, welcoming places where people willingly go to escape pressure in their lives and talk to trained “peer professionals” who can relate to what guests are going through because they are recovering from mental illness themselves.

Without places like this, New Yorkers who suffer from serious mental illness would have little choice but to check into a hospital or a hospital-like crisis center when their lives spin out of control. Some people need to be hospitalized for severe psychosis and depression, but many others end up in the hospital because they have no other options.

Relatively rare in the U.S., respite centers like this one cost a fraction of the price of a hospital stay, and can be far more effective at helping people avoid a psychotic break, severe mood swing or suicidal episode.

Community-based mental health services are particularly vital at a time when the number of beds in state psychiatric hospitals has declined sharply. Nationwide, psychiatric hospitals shed 3,222 beds from 2009 to 2012 amid recession-related budget cuts, and the number has continued to decline even as the economy has improved. According to the U.S. Substance Abuse and Mental Health Services Administration, 55 percent of U.S. counties have no practicing behavioral health workers and 77 percent have reported an unmet need.

Launched in 2013 by the city’s public health department, Parachute NYC includes mobile treatment units and phone counseling in addition to the four brick-and-mortar respite centers. A collaboration of city and state mental health agencies, the project received a three-year $17.6 million innovation grant from the U.S. Department of Health and Human Services. Its financial goal is to save $50 million in hospital expenses.

In addition, New York state’s Medicaid agency plans to use a federal waiver to pay for respite services and other community mental health services for 140,000 state residents under a managed care program for people with behavioral health needs. Separately, New York state’s mental health office has invested $60 million since last year on the creation and expansion of community-based services throughout the state, including child and adult respite programs.

“A hospital is the last place you want to be if your life is unraveling,” said Community Access CEO Steve Coe. “They put you in a room, check your blood pressure and walk away and leave you for hours. You need to put your life back together, not be held in a place where you can’t do anything or talk to anyone,” he said.

Nevertheless, there is broad agreement that nonmedical services such as Community Access are not for everyone.

“The caution is that while this approach is good for some people, others really need medication and structure, so it has to be a good match for the person who is coming into it,” said Sita Diehl, director of state policy at the National Alliance on Mental Illness. “The advantage is that you get an expert listener working with you, really delving into who you are, rather than someone slapping a diagnosis on you and handing you a prescription.”

Averting Crisis

Parachute NYC provides a non-threatening environment where people who are coming undone can take a break from their turbulent lives and think through their problems before they reach a crisis point. Many who shun hospitals and crisis stabilization units will voluntarily seek help at respite centers.

In fact, Community Access insists that all prospective guests check in on their own, without coercion from a doctor, friend or family member. They also screen applicants to ensure that respite is their best option. Some may need medication and more intensive treatment from medical professionals.

“We’re not against medication,” assistant director Keith Aguiar explained. “If they come in with their own medications and they want to take them, that’s fine. But we do not tell them they have to.”

Many guests have full-time jobs and continue working and seeing friends during their stay. They can come and go any time of day or night. Unlike a hospital, Coe stressed, respite centers allow people to maintain their lives and relationships instead of putting everything on hold. Guests can also continue seeing their regular mental health providers during their stay.

The maximum length of stay at Parachute NYC respite centers is 10 days, soon to be shortened to one week under new Medicaid rules. But guests can return up to three times per year as needed. They also can visit weekly and monthly as “alumni” and take part in group activities and talk to staff.

To qualify for any of Parachute’s respite centers, guests must be New York City residents who are 18 or older. They must also have a clinical evaluation (within the last 48 hours) and a referral from a mental health provider stating they are not an imminent risk to themselves or others and would benefit from respite care. Guests also must have stable housing to go back to.

The Guest List

“We have a wide diversity of guests, from a Columbia University professor and an art critic to people who have been chronically homeless much of their lives,” Aguiar said. “We see men and women of all ages and all walks of life.”

In the last month, the guest list at Community Access included a 28-year-old woman who was living in mental health support housing and believed her roommates were practicing witchcraft on her. She was referred by her housing counselor. Another 24-year-old woman with a diagnosis of schizoaffective disorder needed to escape mounting conflicts at home with her brother, who had a diagnosis of schizophrenia. She was referred by a community psychiatric team.

A 70-year-old jazz musician who suffered from drug and alcohol addiction came to get away from his chaotic living situation. He talked to peers about his struggle with addiction, played his trumpet and napped a lot during his stay. “It was the best sleep I’ve had in years,” he told the center’s director Lauren D’Isselt, who is a psychologist.

Another woman, 25, applied to become a guest without a referral (the center arranged for Parachute’s mobile unit of clinical professionals to provide an assessment.) She’d heard about Community Access from a friend. A native New Yorker who left college because of severe depression, Maggie (not her real name) spoke calmly about her history of mental illness while sitting on a bench on the center’s sunny back courtyard.

“I wanted to finish college,” she said, “but I kept ending up on the tops of buildings.” Diagnosed with depression when she was seven, Maggie has been in psychiatric care most of her life. She spent the better part of the last six months in hospitals.

Now that she’s back in New York temporarily living with her parents, she said she wants to find the right kind of treatment and get on her feet so she can return to school. “Living at home is not very comfortable because my parents are the source of my problem. They abused me when I was a child,” Maggie said. She said she could stay with friends, but they don’t understand what she’s going through.

Five days into her stay, Maggie said it’s been good for her. She’s been able to make plans for future treatment. “It makes a lot of sense,” she said. “At a typical hospital, they take depressed people and lock them up and away from everyone and expect them to get better. Here you can go out and have coffee with a friend and no one has to go through double-locked doors to see you.”

“When I feel really anxious or sad, I can talk to a peer. Places like this are rare,” Maggie said. “But they shouldn’t be.”

A National Need

One in four adults, about 62 million Americans, experiences some form of mental illness during the course of a year. Of those, about 14 million live with a serious mental illness such as schizophrenia, major depression or bipolar disorder, according to data from the National Alliance on Mental Illness. More than half of them do not seek treatment, in many cases because they don’t know where to find help.

For those who do seek treatment, the direct medical costs total more than $100 billion per year, according to estimates from the National Institute of Mental Health. Community mental health services such as respite centers may make it possible to reduce those costs and relieve the demand for psychiatric hospital beds, which are in short supply in most communities.

Parachute NYC has so far served about 700 people at its respite centers, 600 through its mobile treatment teams and more than 20,000 through its peer-operated telephone support service. The city’s health department intends to analyze the program to determine whether it has resulted in a reduction in the city’s 100,000 annual psychiatric emergency room visits.

“We don’t perform miracles here,” D’Isselt said. “But we do help people find joy in their lives.” Most guests forge new friendships and leave with a new life plan, she said. “A lot can happen in a week.”

Does publication bias make antidepressants seem more effective at treating anxiety than they really are?

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In scientific literature, studies with “good” results are more likely to be published than studies with results that are unclear or negative. A study with a new, exciting finding (a positive result) is likely to see the light of day, even if the finding is not in line with the authors hypothesis. But a study that doesn’t have a new finding (a negative result), or has an unclear finding is far less likely to be published.

The fact that positive results are more likely to be published is called publication bias and unfortunately it’s quite common. Since science is about acquiring knowledge, when scientific literature is distorted as a result of publication bias this “knowledge” becomes less trustworthy.

In medicine this can have serious consequences. Patients may be prescribed therapies that are based on biased results, and physicians and policymakers might not know that the information they are basing these decisions on has flaws.

For example, we know that the scientific literature has overestimated the efficacy of antidepressants to treat depression. These drugs are also used to treat anxiety disorders. We wanted to find out if the the efficacy of antidepressants for these conditions had also been overestimated because of publication bias.

What causes publication bias?

Before we look at our study on antidepressants and anxiety, let’s take a look at why positive results are more likely to be published than results that are negative or unclear.

Researchers may suffer from “cognitive bias,” which means they are more likely to interpret findings to be consistent with their own hypotheses. In short, people may find what they expect (or want) to find.

Or what if you find something, but it just doesn’t seem that significant? Cognitive bias may lead researchers to look at other, sometimes less significant, outcomes from their research when they don’t find what they were expecting to. Or they may analyze their data with a new statistical technique or combine different outcomes into a new endpoint that lets them arrive at a result that is consistent with their hypothesis.

Researchers may decide not to publish negative results. This happens for a lot of reasons, but money tends to be a big one. Finding “nothing” is simply less likely to lead to funding for follow-up research, than finding “something.” That isn’t the only financial reason for why negative results might not be published. Prescription and non-prescription therapies are big money around the world and negative results do not help to sell drugs.

And sometimes it’s out of the researchers’ hands. Trials with negative results are less likely to be accepted for publication at major journals. A journal sends submitted manuscripts out for peer review. Experts in the field review the work and provide feedback as to whether it should be accepted for publication or not.

Peer review allows outside reviewers to express their own opinions and ideas regarding the research. Ultimately, the decision to accept or reject the manuscript may depend on these revisions.

In this setting, positive results tend to be reviewed more favorably since they often correspond better to the peer reviewer’s opinions. Positive findings also attract more widespread attention than negative results, which can increase the visibility and reputation of the journal.

In research, finding nothing is as valuable as finding something.
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Publication bias and antidepressants for anxiety

Other studies have found cases of publication bias in trials investigating how effective antidepressants are in the treatment of depressive disorder, and on the use of antipsychotics, as well.

We wanted to find out whether publication bias was also present in trials on the efficacy of second-generation antidepressants to treat anxiety disorders. These drugs, selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), are the primary pharmacological treatment choice for anxiety. You might have seen commercials for these drugs – Cymbalta and Effexor, for example are SNRIs and Zoloft and Prozac are SSRIs.

We looked at trials examining SSRIs and SNRIs in the treatment of generalized anxiety disorder, panic disorder, social anxiety disorder, post-traumatic stress disorder and obsessive-compulsive disorder.

We compared the trials submitted to the Food and Drug Administration (FDA) by pharmaceutical companies to the resulting publications in scientific journals. We wanted to see how many of the trials were published in articles and if those published articles portrayed the results of the trials accurately.

Of the 57 trials that were registered with the FDA, 41 had positive results and 16 did not. In our study, published in JAMA Psychiatry, we found that of the 45 journal articles that reported on these trials, 43 were positive. That means that 96% of journal articles were positive as opposed to 72% of the FDA reviews.

In further examination, we found that trials with “not-positive results” (results that were negative or unclear) were less likely to be published than trials with positive results. Of the 41 positive trials registered with the FDA, 40 were published in journal articles. But of the 16 trials with not-positive results, just nine were published.

Overestimated?
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Turning negative results into positive results

Of the nine published trials with not-positive results, three were published with positive results in the accompanying journal article. This is called outcome reporting bias. These studies usually reported the results for a secondary, less important outcome or used creative statistical approaches to make the primary outcome seem positive, when the true result was negative or unclear.

And for another three of the not-positive trial results were reported accurately but the authors concluded that the results were really positive – this is called spin. Just three of the nine not-positive trials were published without any bias.

Overestimation of treatment effects

When we compared the results between the FDA-reviewed trials and the published literature, the literature overestimated the effects of the drugs by 15%, which isn’t statistically significant.

In this case, we found that publication bias contributed more to an overabundance of positive results than to the estimates of how well these drugs actually worked.

This overabundance of positive trials creates a skewed representation of the efficacy of these drugs for anxiety disorders. And this in turn may create unrealistic expectations about how well these drugs work among prescribers and patients.

Openness about research results

Publication bias is not limited to psychiatry – it’s a problem across medicine. Because so much medical research is publicly funded, researchers and the public should have easy access to reliable results from the studies which current medical therapies are based on. Unfortunately, the current system relies heavily on voluntary reporting, which facilitates publication bias.

Now that the scientific community is paying more attention to publication bias and the problems it creates, various initiatives have begun including trial registrations, journals that explicitly welcome studies with negative results, and open access initiatives in which data becomes publicly available regardless of the outcome of the study.

These initiatives, combined with increasing awareness among researchers, study participants and government agencies will hopefully aid in increasing the accuracy and completeness of reporting of clinical study results.

Annelieke Roest is Postdoctoral Researcher, Psychiatry at University of Groningen.
Craig Williams is Professor of Pharmacy at Oregon State University.

This article was originally published on The Conversation.
Read the original article.

Memetic Warfare and the Sixth Domain Part Three

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Can an image, sound, video or string of words influence the human mind so strongly the mind is actually harmed or controlled? Cosmoso takes a look at technology and the theoretical future of psychological warfare with Part Three of an ongoing series.

Click here for Part One.

Click here for Part Two.

A lot of the responses I got to the first two installments talked about religion being weaponized memes. People do fight and kill on behalf of their religions and memes play a large part in disseminating the message and information religions have to offer.

Curved bullet meme is a great one. Most of the comments I see associated with this image have to do with how dumb someone would have to be to believe it would work. Some people have an intuitive understanding of spacial relations. Some might have a level of education in physics or basic gun safety and feel alarm bells going off way before they’d try something this dumb. It’s a pretty dangerous idea to put out there, though, because a percentage of people the image reaches could try something stupid. Is it a viable memetic weapon? Possibly~! I present to you, the curved bullet meme.

The dangers here should be obvious. The move starts with “begin trigger-pull with pistol pointed at chest (near heart)” and anyone who is taking it seriously beyond is Darwin Award material.

Whoever created this image has no intention of someone actually trying it. So, in order for someone to fall for this pretty obvious trick, they’d have to be pretty dumb. There is another way people fall for tricks, though.

There is more than one way to end up being a victim of a mindfuck and being ignorant is part of a lot of them but ignorance can actually be induced. In the case of religion, there are several giant pieces of information or ways of thinking that must be gotten all wrong before someone would have to believe that the earth is coming to an end in 2012, or the creator of the universe wants you to burn in hell for eternity for not following the rules. By trash talking religion in general, I’ve made a percentage of readers right now angry, and that’s the point. Even if you take all the other criticisms about religion out of the mix, we can all agree that religion puts its believers in the position of becoming upset or outraged by very simple graphics or text. As a non-believer, a lot of the things religious people say sound as silly to me as the curved bullet graphic seems to a well-trained marksman.

To oversimplify it further: religions are elaborate, bad advice. You can inoculate yourself against that kind of meme but the vast majority of people out there cling desperately, violently to some kind of doctrine that claims to answer one or more of the most unanswerable parts of life. When people feel relief wash over them, they are more easily duped into doing what it takes to keep their access to that feeling.

There are tons of non-religious little memes out there that simply mess with anyone who follows bad advice. It can be a prank but the pranks can get pretty destructive. Check out this image from the movie Fight Club:

Thinking no one fell for this one? For one thing, it’s from a movie, and in the movie it was supposed to be a mean-spirited prank that maybe some people fell for. Go ahead and google “fertilize used motor oil”, though, and see how many people are out there asking questions about it. It may blow your mind…

Jonathan Howard
Jonathan is a freelance writer living in Brooklyn, NY

Against ‘Nature-Deficit Disorder’

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Earlier this year, 28 authors wrote to the Oxford Junior Dictionary objecting to the disappearance of nature words from its pages: catkins and kingfishers were making way for chatrooms and broadband. The authors were worried that “disconnection from nature” leads to “social ills”—a concern loudly shared by nature writer Rob Cowen. His first book, Skimming Stones… Continue reading →