Raj Persaud in conversation - the podcasts ((6) psychiatry at the cutting edge academic psychiatrists and psychologists discuss the latest research findings)
Some surprising causes of mental illness - interview with Ardesheer Talati Assistant Professor of Clinical Neurobiology (Psychiatry) at Columbia University Medical Center

Raj Persaud talks to Ardesheer Talati.

Ardesheer Talati’s research focuses on understanding long-term clinical, behavioral, and neurobiological problems in offspring that result from prenatal exposures.  Two particular areas of interest are tobacco and selective serotonin reuptake inhibitor (SSRI) antidepressant exposures during pregnancy. Although the rates of smoking have decreased in the general population, about 5-10% of women smoke during pregnancy today. On the other hand, the rates of antidepressant medication use have been rising. When used in pregnancy, both nicotine and SSRIs cross the placental and the blood-brain barriers and thus can enter the developing fetal brain.  His research focuses on trying to understand what (if any) the long term consequences of these exposures are, with a particular focus on brain development. For example, he tests whether maternal smoking or use of SSRIs during pregnancy impairs normative development of fetal brain structure, connectivity, and circuitry; and if so, whether those alterations persist through childhood development and increase risk for clinical or behavioral disorders.

American Journal of Psychiatry Volume 170, Issue 10, October 2013, pp. 1178-1185

Maternal Smoking During Pregnancy and Bipolar Disorder in Offspring

Ardesheer Talati, Ph.D., Yuanyuan Bao, M.S., Jake Kaufman, B.A., Ling Shen, Ph.D., Catherine A. Schaefer, Ph.D., and Alan S. Brown, M.D., M.P.H

 


Why are the children of depressed parents more likely to die earlier and from unnatural causes?

Dr Raj Persaud talks to Professor Myrna Weissman about what happens to the children of depressed people

HEADLINE FINDING OF THIS MAJOR NEW STUDY:

There was increased mortality in the children whose parents had serious depression (5.5% compared with 2.5%) due to unnatural causes, with a nearly 8-year difference in the mean age at death (38.8 years compared with 46.5 years in the control group - children of parents without depression).

 

From The American Journal of Psychiatry Volume 173, Issue 10, October 01, 2016, pp. 1024-1032

 

Offspring of Depressed Parents: 30 Years Later

 

Myrna M. Weissman, Ph.D., Priya Wickramaratne, Ph.D., Marc J. Gameroff, Ph.D., Virginia Warner, Dr.P.H., Daniel Pilowsky, M.D., M.P.H., Rajni Gathibandhe Kohad, M.D., M.P.H., Helena Verdeli, Ph.D., Jamie Skipper, M.A., Ardesheer Talati, Ph.D.

 

While the increased risk of psychological problems in the biological offspring of depressed parents has been widely studied and replicated, the long-term outcome through their full age of risk is less known. The authors present a 30-year follow-up of biological offspring (mean age=47 years) of depressed (high-risk) and nondepressed (low-risk) parents.

One hundred forty-seven offspring of moderately to severely depressed or non-depressed parents selected from the same community were followed for up to 30 years.

The risk for major depression was approximately three times as high in the high-risk offspring. The period of highest risk for first onset was between ages 15 and 25 in both groups. Pre-pubertal onsets were uncommon, but high-risk offspring had over 10-fold increased risk. The increased rates of major depression in the high-risk group were largely accounted for by the early onsets, but later recurrences in the high-risk group were significantly increased. The high-risk offspring continue to have overall poorer functioning and receive more treatment for emotional problems. There was increased mortality in the high-risk group (5.5% compared with 2.5%) due to unnatural causes, with a nearly 8-year difference in the mean age at death (38.8 years compared with 46.5 years).

The authors of the study conclude that the offspring of depressed parents remain at high risk for depression, morbidity, and mortality that persists into their middle years. While adolescence is the major period of onset for major depression in both risk groups, it is the offspring with family history who go on to have recurrences and a poor outcome as they mature. In the era of personalized medicine, until a more biologically based understanding of individual risk is found, a simple family history assessment of major depression as part of clinical care can be a predictor of individuals at long-term risk.


Could warming up the body cure depression?

Raising Body Temperature Relieves Depression Symptoms, Small Study Finds

 

www.med.wisc.edu/news-events/raising-body-temperature-relieves-depression-symptoms-small-study-finds/48472

 

Madison, Wisconsin — Raising the body temperature of depressed volunteers to the equivalent of a mild fever improved their symptoms of major depression for as long as six weeks after a single treatment, results from a new study show.

 

Researchers led by Dr. Charles Raison of the University of Wisconsin-Madison conducted a small, double-blind trial to test whole-body hyperthermia as a novel treatment for major depression.

 

They evaluated the depressed volunteers on the Hamilton Depression Rating Scale (HDRS) and found that 60 percent of them had a response and 40 percent met the criteria for remission of depression during at least one assessment after having received the treatment.

 

“Our hope is to find better and faster-acting treatments for depression than the antidepressants currently in use,’’ says Raison. “We think that using heat to stimulate the skin activates serotonin-producing cells in the mid-brain, which then produce a change in how the brain functions. In a way, one might think of this pathway from the skin to the brain as a deep-brain stimulator crafted by evolution. We tap into this pathway because heat makes the brain feel happy.”

 

The researchers used a whole-body hyperthermia device to raise the body temperatures of 16 volunteers to 38.5 Celsius, the equivalent of about 101.3 degrees Fahrenheit. Another 14 were randomized to a “sham” procedure that had them lie inside the hyperthermia device with fans and lights, but only a small amount of heat, not the intense infrared heat that produced the full treatment.

 

“Our sham intervention was so realistic that most of the participants (10 of 14) thought they were receiving the real treatment,’’ says Raison. That is important, because it suggests the antidepressant response was not due primarily to placebo factors associated with the treatment.

 

The real hyperthermic treatment improved depression scores by a mean of 5.67 points more than the sham at week one and a mean difference of 4.83 points at six weeks after the treatment. The HDRS rates scores of 0 to 7 to be normal, 8 to 13 to indicate mild depression, 14 to 18 to indicate moderate depression and 19 and above to indicate severe and very severe depression.

 

Researchers screened 338 volunteers and wound up with 34 patients with HDRS scores of 16 and above. The two arms began with 17 volunteers each, but with dropouts, 15 wound up completing the whole-body hyperthermia and 14 the sham treatment.

 

Those receiving the active treatment were in a type of tent, and were heated on their chest by infrared lights and on their legs with infrared heating coils. After their body core temperature reached 38.5 degrees Celsius (usually after about an hour and half) the heat was turned off and they were allowed to cool for an hour.

 

A week after treatment, researchers who were blinded to whether the volunteers had the real treatment or not assessed their depression levels using HDRS. Further assessments were made at two, four and six weeks. Self-reports also showed lessening of symptoms, although not as dramatic. Both groups reported only mild adverse effects.

 

“We were surprised to see that the effect (of reduced depression symptoms) was still present six weeks after the initial treatment,’’ Raison says.

 

Co-author Christopher Lowry, associate professor of integrative physiology at the University of Colorado-Boulder, showed in an earlier study that whole-body heating activates neurons in the brain that synthesize the neurochemical serotonin, an effect that is shared by antidepressant drugs. In addition, Lowry said, “We know that warming the skin activates areas of the brain where activity is low in depressed patients.”

 

One brain area activated by heating the skin, the medial orbitofrontal cortex, is involved in the regulation of mood. This area of the brain responds to pleasant sounds, smells, images, tastes and other stimuli. A premise of the research is that certain sensory pathways evolved to mediate antidepressant-like responses. Lowry says depression is associated with over-activity of the brain’s default-mode network, which is engaged when a person is ruminating.

 

But throughout evolution, certain conditions made such a state of mind “extremely maladaptive,” Lowry observes. Extreme heat would demand that people shift their attention from internal thoughts to the external world.

 

Raison says that the current study extends results from an earlier open-treatment study his group did in Switzerland in inpatient volunteers with major depression. Hyperthermia has been used for many years, primarily in Europe, as part of a cancer-fighting regimen, although whole-body hyperthermia to treat cancer typically raises the body temperature to temperatures much higher than used in the depression studies.

 

According to Raison, the results of the small study are encouraging, but he cautions that because the sample size was small, more research is needed to determine how hyperthermia should be optimally delivered in terms of the temperature used and the amount of time patients are exposed to the heat. Additionally, the results may have been confounded by volunteers’ expectations that the treatment would work.

 

Raison is the Mary Sue and Mike Shannon Chair for Healthy Minds, Children & Families in the UW School of Human Ecology. He is also a member of the psychiatry faculty in the UW School of Medicine and Public Health.

 

The study was conducted at the University of Arizona and funded by the Brain & Behavior Research Foundation, the Depressive and Bipolar Disorder Alternative Treatment Foundation, the Institute for Mental Health Research, the Braun Foundation and Barry and Janet Lang and Arch and Laura Brown.

 

Clint Talbott, communications director at CU-Boulder’s College of Arts and Sciences, contributed to this report.


Does Extremism Protect You From Depression?

Professor Jeremy Coid completed medical training at Sheffield University and training in Forensic Psychiatry at the Maudsley and Broadmoor Hospitals.

 

He was trained in research at the Institute of Psychiatry, King's College London, where he completed his MD.

 

As Consultant Forensic Psychiatrist he established the medium secure service to East London for mentally disordered offenders.

 

He has extensive experience of giving evidence in court as an expert witness in cases of serious violence, sexual offending, and on childcare. He has been an advisor to the Department of Health, Ministry of Justice and Ministry of Defence on management of high risk offenders.

 

He was appointed Senior Lecturer in Forensic Psychiatry in 1987 and awarded a personal chair in 1995.

 

This Podcast focuses on the recently published paper entitled: ‘Extremism, religion and psychiatric morbidity in a population-based sample of young men’ published in the British Journal of Psychiatry by Jeremy W. Coid, Kamaldeep Bhui, Deirdre MacManus, Constantinos Kallis, Paul Bebbington and Simone Ullrich

Background (from the paper)

There is growing risk from terrorism following radicalisation of young men. It is unclear whether psychopathology is associated. Aims: To investigate the population distribution of extremist views among UK men. Method: Cross-sectional study of 3679 men, 18–34 years, in Great Britain. Results: Pro-British men were more likely to be White, UK born, not religious; anti-British were Muslim, religious, of Pakistani origin, from deprived areas. Conclusions: Men at risk of depression may experience protection from strong cultural or religious identity.

FROM THE PAPER:

 

The prevalence of depression was significantly higher among Pakistani and Black minority groups than UK-born White men...

The key finding was that men... with neutral or undecided views, were more likely to be depressed. Anti-British extremist views may have offered protection against depression, specifically among men of Pakistani origin. These findings correspond to the hypothesis that lack of personal identity and meaning, with unfulfilled need for belonging, create psychological vulnerability both to extremism and anxiety and depression. Within this theoretical framework, attributing blame, identifying responsible perpetrators, strong national or other cultural identity, and active support for or opposition to a cause, may protect against depression. For some men, depression may be a precursor to ‘mobilisation’, leading to active support for and consideration of involvement in terrorism or armed conflict along a pathway of radicalisation. Lack of identity and uncertainty, together with depression, may contribute to a vulnerable state in which personal crisis can act as a trigger, resulting in an opening for new beliefs and values, encouraged by people holding similar values that legitimise violence. Relatives’ and friends’ experiences of social exclusion, including poverty and reported experiences of racism, may have influenced these individuals to take a more active position. Factors such as turning to religion or new political beliefs triggered by a war (against people with similar cultural and religious characteristics) could result in a protective sense of empowerment involving new meaning, belief systems and identity along a pathway ultimately leading to violent action. However, since we cannot determine the direction of association in this cross-sectional survey, respondents with depression may simply have been less likely to fight for or against their country or to hold extreme views because of their depression.

 


If you hear voices - does that mean you are going to go insane?

Dr Kelly Diederen is a neuroscience researcher based at the University of Cambridge and has recently published a paper in the academic journal ‘Psychological Medicine’ which follows up a group of adults who hear voices but who are not formally diagnosed as psychotic – what happens to these people over a period of time?

 

Daalman K, Diederen KMJ, Hoekema L, van Lutterveld R, Sommer IEC (2016), “Five year follow-up of non-psychotic adults with frequent auditory verbal hallucinations: are they still healthy?” Psychological Medicine 1-11


Does Eating More Fish Cure or Prevent Depression?

Walk into any health food shop and you would think that  omega-3 highly unsaturated fatty acids (HUFAs) were a panacea for all ills - the hype for these dietary supplements arises from recent research which appeared to find various benefits but now a study published by Brian Hallahan and colleagues attempts to pool all the data accumulated on the subject and cut through to the truth.

From the original recently published paper by Brian Hallahan and colleagues

Efficacy of omega-3 highly unsaturated fatty acids in the treatment of depression* Brian Hallahan, Timothy Ryan, Joseph R. Hibbeln, Ivan T. Murray, Shauna Glynn, Christopher E. Ramsden, John Paul SanGiovanni and John M. Davis

The British Journal of Psychiatry 1–10. doi: 10.1192/bjp.bp.114.160242

Many randomised controlled trials (RCTs) have reported beneficial effects for omega-3 highly unsaturated fatty acids (HUFAs) in bipolar and major depressive disorder, but others have reported essentially no effect.... possible explanatory factors: (a) that only eicosapentaenoic acid (EPA)-predominant formulations of omega-3 HUFA have an antidepressant effect;37,38 and (b) that the putative antidepressant effects of omega-3 HUFAs only occur in episodes of diagnosed clinical depression...

The study found that:  

Among participants with diagnosed depression, eicosapentaenoic acid (EPA)-predominant formulations (450% EPA) demonstrated clinical benefits compared with placebo... whereas docosahexaenoic acid (DHA)-predominant formulations (450% DHA) did not. EPA failed to prevent depressive symptoms among populations not diagnosed for depression.

 


Being A Syrian Refugee - is this the toughest test of anyone's mental health?

Interview with Ruth Wells - lead author on new paper on mental health of Syrian Refugees published in the British Journal of Psychiatry - From the introduction in the paper:

The United Nations (UN) has labelled the current Syrian conflict as the worst humanitarian crisis that has occurred within the first part of the 21st century. It is estimated that there are in excess of 4 million displaced Syrian refugees in the Middle East and over 629 000 who have been displaced to Jordan, the focus of this review. Although many displaced Syrians live in refugee camps, the largest being Za’atari camp which is home to over 120 000 people, the vast majority live in the host community. In Jordan, people from Syria have limited access to work permits and are often required to work in the informal sector to secure livelihood. Those registered with the UN are eligible to access some cash assistance, food vouchers and education and health systems, although the health system has struggled to keep up with demand. Stressors inherent in forced displacement,5 combined with exposure to potentially traumatic events (PTEs) during conflict, are likely to contribute to the development of heightened mental health difficulties in such settings.

 

From the introduction to this new paper

Psychosocial concerns reported by Syrian refugees living in Jordan: systematic review of unpublished needs assessments Ruth Wells, Zachary Steel, Mohammad Abo-Hilal, Abdul Halim Hassan and Catalina Lawsin

The British Journal of Psychiatry 1–8. doi: 10.1192/bjp.bp.115.165084

Ruth Wells, BSc, University of Sydney, Australia; Zachary Steel, PhD, MClinPsych, School of Psychiatry, University New South Wales, The Black Dog Institute, Hospital Road, Prince of Wales Hospital, New South Wales, Australia; Mohammad Abo Hilal, MD, Syria Bright Future; Abdulhalim Hasan, MD, American Medical Center, Erbil, Iraq; Catalina Lawsin, PhD, Department of Behavioral Sciences, RUSH Medical Center, Chicago, USA


Prof Richard Bentall - can delusions be explained? Talking to Dr Raj Persaud

Raj Persaud talks to Richard Bentall at the Royal College of Psychiatrists Annual Conference and International Congress - Birmingham 2015. Professor Bentall was taking part in a session on the very latest developments in thinking about delusions and discussed his presentation after the conference session.

The conversation begins with Professor Bentall reminding us that how to understand what a delusion is, and what it isn't, in terms of strange beliefs, is not so straightforward, in certain 'tricky cases'.

Richard Bentall is Professor of Clinical Psychology at Liverpool University and has previously held chairs at Manchester University and Bangor University. He graduated with a BSc and then a PhD in experimental psychology at the University College of North Wales (now Bangor University) and then completed his clinical training at Liverpool University. He also holds an MA in philosophy applied to health care awarded by University College Swansea (now Swansea University). His research interests have mainly focused on psychosis. He has studied the cognitive and emotional mechanisms involved in psychotic symptoms such as hallucinations, paranoid delusions and manic states, using methods ranging from psychological experiments, and experience sampling to functional magnetic resonance imaging. Most recently, his research has focused on why social risk factors (for example childhood adversities such as poverty, abuse, and bullying) provoke the cognitive and emotional changes that lead to these symptoms. In collaboration with colleagues at Manchester and elsewhere he has also conducted large scale randomized controlled trials of psychological interventions for people diagnosed with schizophrenia, bipolar disorder and prodromal psychosis. He has published over 200 peer-review papers and a number of books including Madness explained: Psychosis and human nature (Penguin, 2003) and Doctoring the mind: Why psychiatric treatments fail (Penguin, 2009).

 

You can listen to the interview via a free app on iTunes and google play store entitled 'Raj Persaud in conversation', which includes a lot of free information on the latest research findings in mental health, plus interviews with top experts from around the world. Download it free from these links

 

https://play.google.com/store/apps/details?id=com.rajpersaud.android.rajpersaud

 

 

https://itunes.apple.com/us/app/dr-raj-persaud-in-conversation/id927466223?mt=8

 

 

 


Direct Current Stimulation as a treatment in Psychiatry

Dr Philip Wilkinson talks to Dr Raj Persaud about Transcranial Direct Current Stimulation - a new promising treatment in Psychiatry?

from http://www.psych.ox.ac.uk/team/senior-researchers/philip-wilkinson

Dr Philip Wilkinson: I am a consultant old age psychiatrist with Oxford Health NHS Foundation Trust. Related to my work with inpatients, I have an interest in the management of late life depression and am currently working with colleagues in the Neurobiology of Ageing Group on transcranial direct current stimulation (tDCS).

 

I have an interest in psychological treatments with older people. I have recently worked with the Oxford Mindfulness Centre on developing a mindfulness intervention in dementia care and am a Trustee of the Oxford Mindfulness Foundation.

 FROM:  http://www.hopkinsmedicine.org/psychiatry/specialty_areas/brain_stimulation/tdcs.html

Transcranial Direct Current Stimulation

Transcranial direct current stimulation (tDCS), is a non-invasive, painless brain stimulation treatment that uses direct electrical currents to stimulate specific parts of the brain. A constant, low intensity current is passed through two electrodes placed over the head which modulates neuronal activity. There are two types of stimulation with tDCS: anodal and cathodal stimulation. Anodal stimulation acts to excite neuronal activity while cathodal stimulation inhibits or reduces neuronal activity. 

Although tDCS is still an experimental form of brain stimulation, it potentially has several advantages over other brain stimulation techniques. It is cheap, non-invasive, painless and safe. It is also easy to administer and the equipment is easily portable. The most common side effect of tDCS is a slight itching or tingling on the scalp.

Several studies suggest it may be a valuable tool for the treatment of neuropsychiatric conditions such as depression, anxiety, Parkinson’s disease, and chronic pain. Research has also demonstrated cognitive improvement in some patients undergoing tDCS. Currently, tDCS is not an FDA-approved treatment.

 

You can listen to the interview with Dr Philip Wilkinson via a free app on iTunes and google play store entitled 'Raj Persaud in conversation', which includes a lot of free information on the latest research findings in mental health, plus interviews with top experts from around the world. Download it free from these links

 

https://play.google.com/store/apps/details?id=com.rajpersaud.android.rajpersaud

 

 

https://itunes.apple.com/us/app/dr-raj-persaud-in-conversation/id927466223?mt=8

 


How to Explain Delusions

Raj Persaud talks to Phillip Corlett Associate Professor of Psychiatry at Yale University about the latest thinking on delusions.

From http://psychiatry.yale.edu/people/philip_corlett.profile:

Dr. Philip Robert Corlett trained in Experimental Psychology, Cognitive Neuroscience and Psychiatry with Professors Trevor Robbins and Paul Fletcher at the University of Cambridge. He won a Wellcome Trust Prize Studentship and completed his PhD on the brain bases of delusion formation in the Brain Mapping Unit, Department of Psychiatry. After a short postdoc, he was awarded the University of Cambridge Parke- Davis Exchange Fellowship in Biomedical Sciences which brought him to the Yale University Department of Psychiatry to explore the maintenance of delusions with Professors Jane Taylor and John Krystal. He was named a Rising Star and Future Opinion Leader by Pharmaceutical Marketing Magazine and joined the Yale faculty in 2011 where he will continue to explore the cognitive and biological mechanisms of delusional beliefs as well as predictive learning, habit formation and addiction.

From: http://medicine.yale.edu/lab/corlett/

Delusions are odd beliefs. They accompany many psychiatric illnesses, notably schizophrenia. A major challenge is to understand delusions in terms of changes in brain function. 

Our lab attempts to meet this challenge by investigating the neural basis of human associative learning and belief formation, relating these processes to the formation of delusional beliefs. 

Dr. Corlett’s findings have shaped the development of a novel mechanistic model of delusion formation.

 

You can listen to the interview via a free app on iTunes and google play store entitled 'Raj Persaud in conversation', which includes a lot of free information on the latest research findings in mental health, plus interviews with top experts from around the world. Download it free from these links

 

https://play.google.com/store/apps/details?id=com.rajpersaud.android.rajpersaud

 

https://itunes.apple.com/us/app/dr-raj-persaud-in-conversation/id927466223?mt=8