Recent developments in our understanding of the biological and neural networks involved in substance abuse disorders and psychological theories of behavioral change, coupled with the rapid evolution of technology-assisted therapy mean that the pivotal time is now.

As we speak, over 30 of the World’s leading experts on ending addiction and facilitating life-long recovery—including expert scientists and therapists, TED speakers, thought-leaders, and international best-sellers—are speaking at the online Healing Addiction Summit.

And that is what it is going to take: The knowledge from the best minds in their respective fields, being united at the frontline in creating holistic, multipronged, therapeutic systems that adapt to the individual and their support network to effectively prevent relapse round the clock and reliably promote lifelong, successful recovery.

We are failing addiction sufferers and their families

Most addicts in the US never receive treatment (estimated at 10% or less), and although heatedly debated it is clear that most conventional addiction recovery programs alone do not result in lifelong recovery for the majority of people. Tragically, this equates to lifelong suffering that ripples through the addict’s lives to their loved ones and our communities and society as a whole. As put by Summer Felix-Mulder, co-founder of Clear Health Technologies and host of the currently running Healing Addiction Summit

Addiction doesn’t just affect the addict, it affects families, it affects friends, it affects every relationship.

Ultimately, the seemingly endless addiction cycle of sobering up, relapsing, and hitting rock bottom often ends in drug-related death. In the US, a shocking 100> people die every single day from the number one cause of injury-related death, drug overdoses and poisoning.

With such high stakes at risk, failing to treat and heal those suffering from addiction, the addicts themselves, and their families, is not an option.

Why do addicts relapse?

Behavioral change maintenance, also known as sustainable behavior change, is the ultimate goal in addiction recovery, where a recovering addict refrains from old addiction sustaining behaviors (e.g., drug seeking and use) and maintains new abstinent behaviors (e.g., use of craving coping and wellness strategies).

Think of a Jenga tower as the power to resist cravings and desires to use. It is made of many useful, interconnected blocks that represent the perhaps 100s of factors that can help prevent relapse:

• Some of these blocks are red. They represent the emotional and physiological resources (e.g., good sleep, low stress, neutral/positive mood) needed to start entraining a new behavior to make it an automatic habit while resisting an old habit.
• Some of these blocks are green. They represent the tools and abilities one has to self-regulate and exercise self-control over old addiction habits and behaviors.
• Some of these blocks are blue. They represent the good habits that prevent drug relapse. Self-control requires fewer resources the more that the behaviors that prevent relapse and promote recovery are entrained in the brain and become a habit.
• And then add contextual factors into the mix. Changes to the addict’s physical and social environment can shake things up. An emotional rock of a friend moves away, having to attend a wedding with an open-bar, or a new club opens next door and it’s like pointing a power fan at the Jenga tower. You better hope the right blocks are in the right places!

In reality, some of the blocks can be removed without too much fuss. One night’s bad sleep, so what? The tower might sway, cravings might even go through the roof in stressful moments throughout the day, but balance is regained and relapse is resisted—the tower stands strong. Remove a few more blocks and another couple fall off, create weak patches, or remove some of those important foundational blocks and, very quickly, when just a second ago the tower stood steady, it all comes tumbling down.

This is how falling off the wagon seems to creep up on addicts and their support network. No one can monitor all of these blocks all of the time, not even the addict, and certainly not their counselors, therapists, friends, and family.

All it takes is the wrong block to be removed at the wrong time. For non-addicts wanting to start new healthy habits or quit bad ones this equates to an “off day” or moment of poor self-control, but for addicts, this can be devastating and life-threatening.

Why aren’t conventional drug rehab programs enough?

One of the current mainstays of drug and alcohol rehab treatments involves engagement in a 12-step program pioneered by Alcoholics Anonymous that the majority of rehabilitation centers rely upon.

About 60% of public treatment programs in the U.S. report that the 12-step model is their primary approach, and most encourage or mandate 12-step involvement, with about half holding 12-step meetings onsite.

Research on the effectiveness of these programs is controversial and is subject to widely divergent interpretations and will not be discussed in this article. Nonetheless, it is resoundingly clear from the latest reviews and meta-analysis that while there are undoubtedly recovery-related benefits for some people, the most effective programs of the future will NOT be based on the 12-steps.

And why should we expect 12-steps-based rehab programs and treatments to work across the board today? It was created in 1935 (when we knew next to nothing about addiction) and is essentially a set of religious/spiritual principles that have changed surprisingly little over the years. It is not a carefully crafted system based on proof of what works best for the majority of people or under various circumstances. And it is certainly not tailored to the individual to maximize effectiveness and ensure that the recovering addict has maximal protection against relapse 24/7.

There is not one single reason to expect such drug rehab programs to be universally effective.

And how can future drug rehab programs be better at preventing relapse and promoting recovery?

• By evidence-based design.
• By providing round the clock assessment and care.
• By developing holistic approaches that take into behavioral change theory and account for psychology (mind), biology (the body and brain), and, for some, spirituality (soul).
• By helping addicts use interventions and tools tailored to the individual’s needs at the exact moment they need them, not simply learning about them in a meeting and hoping they are used when times are tough. Prompts and guidance are needed to guarantee success under stress.
• By helping addicts maintain the healthy habits and quality of life needed to stay clean that even the most healthy and successful individuals can struggle to maintain on the daily.
• By being affordable, desirable, and accessible for all.

This can only be achieved realistically by designing programs that integrally capitalize on smart devices. Objective biosensors and mobile phone applications can be used to detect and tell the addict and their support network when one block has been removed from the tower, when two blocks go, and when that power fan is trying to blow the whole blooming tower down. And can provide the tools to prevent relapse both before and when the crisis moments strike.

With recent research demonstrating both the effectiveness of predicting relapse from wearables and smart device-derived data, as well as reports of high user compliance and adherence to wearables and mobile phone applications that are used to tackle and study addiction, the time is now to develop dynamic, research-based, person-centered, technology-assisted drug rehab programs.

The future of substance abuse disorder treatment is bright, is holistic, is personalized, is round the clock, and most importantly, will be designed to help heal from addiction, brick by brick.

References

Grant, B., Saha, T., Ruan, W., Goldstein, R., Chou, S., & Jung, J. et al. (2016). Epidemiology ofDSM-5Drug Use Disorder. JAMA Psychiatry, 73(1), 39. doi:10.1001/jamapsychiatry.2015.2132

Huhn, A., Harris, J., Cleveland, H., Lydon, D., Stankoski, D., & Cleveland, M. et al. (2016). Ecological momentary assessment of affect and craving in patients in treatment for prescription opioid dependence. Brain Research Bulletin, 123, 94-101. doi:10.1016/j.brainresbull.2016.01.012

Humphreys, K., Blodgett, J., & Wagner, T. (2014). Estimating the Efficacy of Alcoholics Anonymous without Self-Selection Bias: An Instrumental Variables Re-Analysis of Randomized Clinical Trials. Alcoholism: Clinical And Experimental Research, 38(11), 2688-2694. doi:10.1111/acer.12557

Kaskutas, L. (2009). Alcoholics Anonymous Effectiveness: Faith Meets Science. Journal Of Addictive Diseases, 28(2), 145-157. doi:10.1080/10550880902772464

Kwasnicka, D., Dombrowski, S., White, M., & Sniehotta, F. (2016). Theoretical explanations for maintenance of behaviour change: a systematic review of behaviour theories. Health Psychology Review, 10(3), 277-296. doi:10.1080/17437199.2016.1151372

McCarthy, M. (2015). Drug overdose has become leading cause of death from injury in US. BMJ, 350(jun22 3), h3328-h3328. doi:10.1136/bmj.h3328

Substance Abuse and Mental Health Services Administration. (2011) National Survey of Substance Abuse Treatment Services (N-SSATS): 2010. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.

Substance Aabuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.

Volkow, N., Wang, G., Fowler, J., & Tomasi, D. (2012). Addiction Circuitry in the Human Brain. Annual Review Of Pharmacology And Toxicology, 52(1), 321-336. doi:10.1146/annurev-pharmtox-010611-134625

Image via lechenie-narkomanii/Pixabay.

]]> /2018/02/06/the-future-of-healing-addiction-holistic-tech-assisted-rehabilitation/feed/ 0 /2016/12/06/the-science-of-raising-a-friendly-psychopath/ /2016/12/06/the-science-of-raising-a-friendly-psychopath/#respond Tue, 06 Dec 2016 16:00:24 +0000 /?p=22194 What makes someone a psycopath? Nature or nurture? And can we stop at risk children from growing up into dangerous adult psycopaths? One of the oldest queries in psychology — Nature Vs Nurture — asks if what makes us who we are is predisposed by our DNA, or by life experiences. It is a pretty poignant question when it comes to psychopaths, who are estimated to account for up to 50% of all serious crimes in the US.

Clinically known as anti-social personality disorder in the DMS-V, some troublesome psychopathic traits include:

• an egocentric identity
• an absence of pro-social standards in goal-setting
• a lack of empathy
• an incapacity for mutually intimate relationships
• manipulativeness
• deceitfulness
• callousness
• irresponsibility, impulsivity and risk taking
• hostility

Although these characteristics may be unpleasant, not all psychopaths are dangerous or criminals, and not all dangerous criminals are psychopaths. Counter-intuitively there are pro-social psycopaths too. Nonetheless, some psychopaths do pose a genuine threat for the safety of others.

The real unsolved problem when it comes to psychopathy is how to treat the personality disorder. Although certainly not to be considered impossible with the malleable brains we have even as adults, Dr. Nigel Blackwood, a leading Forensic Psychiatrist at King’s College London, has stated that adult psychopaths can be treated or managed, but not cured. Curing adult psycopathy is considered a near-impossible challenge.

Therefore, understanding when and how psychopathy develops from child to adult is an important part of the research engine that will hopefully identify what parents, caregivers and governments can do to prevent an at risk child from growing up to be a dangerous psycopath.

Development of psycopathic personalities is mainly due to genes

Enter new psychopathy research published in Development and Psychopathology by lead author Dr. Catherine Tuvblad from the University of Southern California. Her research was a twin-based study designed to overcome many previous drawbacks and limitations. Ultimately, the study was designed to provide a more reliable indication of the extent to which genes or the environment, that is nature or nurture, is responsible for the development of psychopathic personality features as a child grows into a young adult.

In the study, 780 pairs of twins and their caregivers filled out a questionnaire that allowed for measuring features of child psychopathy at ages 9–10, 11–13, 14–15, and 16–18. This included measuring psychopathic personality features indicative of future psychopathy, such as high levels of callous behavior towards peers and problems adhering to social norms.

The changes in the childrens’ psychopathic personality features between age groups was considered to be:

• 94% due to genetics between the ages of 9-10 and 11-13, and 6% environmental
• 71% due to genetics between the ages of 11–13 and 14–15, and 29% environemental
• 66% due to genetics between 14-15 and 16-18<, and 44% environmental This suggests that environmental factors may gradually play a greater part in changing the levels of psychopathic features a child develops in later teenage years, which is very promising for the development of future interventions for the prevention of psychopathy. It should be noted that while the childrens' test results pointed to the environment around them becoming increasingly important to their psycopathic behavior, their parents almost exclusively thought that the psycopathy they observed in their children was purely genetic. Considering parents are largely responsible for their child's environment, its not that surprising. Nurture is important at key developmental stages in psychopathy development

The analysis also revealed that there may be a key turning point in the development of psychopathy during the age range studied. The authors considered this turning point to be caused by the onset of puberty, when gene-environment interactions that are highly significant in inhibiting or promoting the development of psychopathy are at play.

Interestingly, the data also indicates that if these rapid gene-environment based changes in psychopathic traits occur early on (e.g. 11-13), any later additional environmental changes to psychopathic traits would be minimal. In other words, once the psychopathic personality traits are set during puberty, they tend to last into later years.

Other research has found that there may be other key turning points on route to becoming a psychopath much earlier in life. One study found that the total number of early negative life events between the ages of 0-4 were positively correlated with the emotion-based aspects of psychopathy. The findings suggest that early environmental factors could have important implications for the development of psychopathic traits and may also impact attachment to parents for children with genetic potential for psychopathy.

So although psychopathy is largely genetic, where it’s mostly down to if you have the right combination of genes needed to become a psychopath or not, life experiences during puberty and early infant years could make or break a potential psychopath.

The cure for psychopathy is love?

So what does science suggest as a successful environmental antidote to developing psychopathy? Believe it or not, love!

One neuroscientist, Dr. James Fallon, made a shocking discovery that on paper he is a psychopath. For example, he had a version of the monoamine oxidase A (MAOA) gene that is linked with violent crime and psychopathy. Also known as the warrior gene, MAOA encodes an enzyme that affects the neurotransmitters dopamine, norepinephrine, and serotonin.

His brain scans also resembled those of a psychopath. He had low activity in certain areas of the frontal and temporal lobes linked challenges with empathy, morality and self-control. In his family tree, there were also seven alleged murderers.

Although Dr. Fallon, in his own words, is obnoxiously competitive, kind of an asshole and won’t even let his grandchildren win games, he was certainly not a dangerous psychopath. So why not? His genes and even his brain screamed potential for antisocial psychopathy.

His answer was that the love he received from his mother led to him becoming a pro-social psycopath. And a newly published study tends to agree with him. OK love in itself is not enough. But, how a mother expresses that love in guiding the child’s pro-social behavior and in setting good examples of pro-social behavior might be the real key.

A new discovery coming from research on adopted infants suggests this is the case. Researchers found that the development of one of the largest child risk factors for psychopathy, that is highly heritable from biological mothers with severe antisocial behaviors — callous-unemotional behavior — was inhibited by high levels of positive reinforcement at 18 months by the adopted mother.

Further research will hopefully identify a whole repertoire of ways parents, schools and governments alike can lovingly nurture the development of at risk children through these key developmental stages. Ultimately, this could stop a large amount of future violent criminals literally in their diapers, before they even start.

References

Bartels, M., Hudziak, J. J., van den Oord, E. J. C. G., van Beijsterveldt, C. E. M., Rietveld, M. J. H., & Boomsma, D. I. (2003). Co-occurrence of Aggressive Behavior and Rule-Breaking Behavior at Age 12: Multi-Rater Analyses. Behavior Genetics, 33(5), 607–621. doi:10.1023/a:1025787019702

Hawes, S. W., Byrd, A. L., Waller, R., Lynam, D. R., & Pardini, D. A. (2016). Late childhood interpersonal callousness and conduct problem trajectories interact to predict adult psychopathy. Journal of Child Psychology and Psychiatry. doi:10.1111/jcpp.12598

Hyde, L. W., Waller, R., Trentacosta, C. J., Shaw, D. S., Neiderhiser, J. M., Ganiban, J. M., … Leve, L. D. (2016). Heritable and Nonheritable pathways to early callous-unemotional behaviors. American Journal of Psychiatry, 173(9), 903–910. doi:10.1176/appi.ajp.2016.15111381

Miller, J. D., Jones, S. E., & Lynam, D. R. (2011). Psychopathic traits from the perspective of self and informant reports: Is there evidence for a lack of insight? Journal of Abnormal Psychology, 120(3), 758–764. doi:10.1037/a0022477

Neumann, C. S., & Hare, R. D. (2008). Psychopathic traits in a large community sample: Links to violence, alcohol use, and intelligence. Journal of Consulting and Clinical Psychology, 76(5), 893–899. doi:10.1037/0022-006x.76.5.893

Rogers, T. P., Blackwood, N. J., Farnham, F., Pickup, G. J., & Watts, M. J. (2008). Fitness to plead and competence to stand trial: A systematic review of the constructs and their application. Journal of Forensic Psychiatry & Psychology, 19(4), 576–596. doi:10.1080/14789940801947909

Tuvblad, C., Wang, P., Bezdjian, S., Raine, A., & Baker, L. A. (2015). Psychopathic personality development from ages 9 to 18: Genes and environment. Development and Psychopathology, 28(01), 27–44. doi:10.1017/s0954579415000267

Image via jarmoluk / Pixabay.

]]> /2016/12/06/the-science-of-raising-a-friendly-psychopath/feed/ 0 /2016/11/30/your-brain-on-alcohol-blackouts/ /2016/11/30/your-brain-on-alcohol-blackouts/#respond Wed, 30 Nov 2016 16:00:44 +0000 /?p=22245 “Uuuuggh…no, no, no, no, noooo!?”

Like a scene out of Hangover 3, the moment you remember that you don’t remember the night before…is gut-wrenching! It’s perfectly normal to feel riddled with guilt and shame as you wrack your brain for any evidence you may have made a fool of yourself the night before. Memory seemingly wiped clean, the best you can do to piece together the evening’s events is rummage through your pockets for clues, call up your partners in crime and prepare for the worst.

In the past it was thought that a blackout from being on the bevy was strictly an alcoholics problem. However, today research shows that while blackouts are indeed more common in alcoholics, for at least 50% of non-alcoholics that engage in rapid and excessive drinking, blacking out is a real risk.

It was also a premature idea that alcohol disrupts brain function and depression of the central nervous system in general, but now we know blackouts involve the failing of specific networks in the brain.

A comprehensive and critical review of the blackout science research published in Alcoholism: Clinical and Experimental Research, provides the most detailed view yet as to what happens to memories when your brain is blacking out (see diagram below).

Alcohol has been shown thus far to generally interfere with practically all stages of the memory process.

Short term-memory for example, can still be relatively intact when on a blackout. When short-term memory is fully functioning it tells us what is going on around us for the last 15-30 seconds or so, i.e. it tells us where we are and what we are doing essentially right now. It does this by tapping into our sensory memory (see brown labels in diagram below), the super-short term memory that gives us the ability to look/hear/taste/touch something, and remember what it felt like with just a second of observation.

Largely stored in the prefrontal cortex , you can think of short-term memory like RAM in a computer (see yellow labels in diagram below), it temporarily holds the info we are currently needing to get things done. As short-term memory still ‘kind-of’ functions during a blackout, detailed conversations are not impossible, although they may get annoyingly repetitive. And although definitely not recommended, managing complex tasks like driving are still just about feasible.

Yet in order to truly learn and retain information and remember the events of a night out on the town, it must be transferred from short-term memory into more permanent, long-term memory structures for storage as long-term memories (see orange labels in diagram below). It is the failing of this memory storage process — called memory encoding — that is completely kaput in a brain on a blackout.

Basically, when you blackout, memory encoding is where it all goes wrong.

Three brain structures in particular — the hippocampus, the frontal lobe and the medial septal — contribute to the blackout brain’s failed encoding of the night’s events.

Sensory (brown), short-term (yellow) and long-term (orange) memory structure labels are colored accordingly. Red colored labels refer to those failing on blackouts. Grey colored transparent labels refer to structures connecting the hippocampus to the outlined regions of the cortex *adapted from Wetherill et al. (2016)

The Hippocampus – The Head Honcho

The hippocampus, the horse-shoe shape colored green in the diagram, is found deep in the center of the brain. Its the head honcho when it comes to long-term memories, and in the case of blackouts, their non-existence.

In order to successfully create a memory for long-term storage specialized neurons in the hippocampus, called CA1 pyramidal cells, communicate with other essential areas of the brain. This way the hippocampus can receive information associated with sensory and short-term memory, as well as the emotional content of the memory being processed, and relay processed information back out.

Much like human’s when drunk, CA1 cells’ communication skills break down when under the influence. More specifically, it is thought that ethanol (and other drugs) activate a signal protein inside the cell called striatal-enriched protein tyrosine phosphatase, or STEP, which is found in high quantities in the hippocampus and striatum.

When activated by alcohol, STEP switches off proteins important for synaptic activity (the receiving and transmission of signals between neurons in the brain). STEP also results in the production of steroids that block synaptic strengthening and plasticity known as long-term potentiation (i.e. the strengthening of connections between neurons due to increases in activity that is the basis of learning and memory).

In summary, when on a blackout, alcohol gets STEP stepping all over the proper functioning of synapses, specifically disrupting the hippocampal CA1 cell communication needed for the process of recording a memory (encoding), and it also inhibits the neuroplastic strengthening of connections needed to make a long-term memory long-term.

The Medial Septal – The Gate Keeper

The medial septal is like the gatekeeper to information entering the hippocampus. It sends a type of brainwave called theta waves to the hippocampus. These theta waves change the excitement level of pyramidal cells in the hippocampus, thereby decreasing or increasing the likelihood of them being able to receive information from other structures in the brain.

When the pyramidal cells are excited new information has a greater chance of being processed than if the cells are suppressed. Alcohol disrupts the theta rhythm largely through suppressing the signal coming from the medial septal to the hippocampus.

The theory goes that without the theta wave excitatory signals coming from the medial septal, the gates to incoming information are closed, and the hippocampus can’t communicate effectively with other parts of the brain that are needed for long-term memory encoding. In fact, simply putting alcohol directly onto the medial septum causes memory loss.

Frontal Lobe – Details, Details, Details!

Key areas of the frontal lobe play important roles in both short–term memory and the formation and retrieval of long–term memories, including the prefrontal cortex well-known for its roles in rational decision making.

In long-term memory the prefrontal cortex has multiple roles, isolated to different regions within the brain structure. For example, the ventrolateral prefrontal cortex’s is specifically involved in the controlled selection of goal-relevant information. In other words, when recording a memory this part of the prefrontal cortex is involved in remembering the important parts of an event, like the specific gift you gave at a friend’s party, and not the less relevant info like the color of the pair of pants you were wearing at the time.

While the prefrontal cortex has shown to have reduced activity that is associated with memory impairments when under the influence, those that abuse alcohol have a very real risk of essentially drinking away the neurons in the frontal lobe, including the prefrontal cortex.

In fact, alcohol-induced dementia, a disease caused by alcohol abuse similar to dementia, is characterized by the “shrinkage” of the frontal lobe that is associated with both short-term and long-term memory loss.

However, as of yet, it is poorly understood how even acute alcohol use can leave the prefrontal cortex’s short-term memory functions relatively intact (remember? like RAM), but impair the encoding functions on route to the hippocampus. It may likely be due to the different effects alcohol has on the different types of neurons in the prefrontal cortex that are specifically important to either long-term or short-term memory.

The Big Picture

Understanding how alcohol can lead to memory loss is not only relevant to cases of alcohol and drug-addiction. The malfunctioning mechanisms, brain structures, neurons and molecules involved (like STEP) are the same as those involved in memory loss as a result of anxiety, stress and trauma, as well as in neurodegenerative diseases like Alzheimer’s and dementia. Understanding alcohol’s impact on memory may lead to the development of therapeutics and interventions that can restore these mechanisms in a variety of diseases and disorders, and give back the previous gift of long-term memories.

References

Wetherill, R. R., & Fromme, K. (2016). Alcohol-induced blackouts: A review of recent clinical research with practical implications and recommendations for future studies. Alcoholism: Clinical and Experimental Research, 40(5), 922–935. doi:10.1111/acer.13051

White, A. (2003). What Happened? Alcohol, Memory Blackouts, and the Brain. Alcohol Research & Health, 27(2), 186–196.

Image via jarmoluk / Pixabay.

]]> /2016/11/30/your-brain-on-alcohol-blackouts/feed/ 0 /2016/11/24/discover-your-drunk-personality-type-nutty-naughty-or-nice/ /2016/11/24/discover-your-drunk-personality-type-nutty-naughty-or-nice/#respond Thu, 24 Nov 2016 16:00:12 +0000 /?p=22181 There are certainly different types of drunks. “Sober Dave is boring, you should hang out with Drunk Dave, he’s wild!” or “She is usually a sweetheart, but watch out, she’s a mean drunk”. Having documented the transition to our drunk alter-egos for 100s of years, we are no strangalers to the concept of drunk personality types. It doesn’t take a rocket scientist to see that alcohol can change our personalities from a sober type to a drunk type.

Today, research pioneered by University of Missouri graduate student, Rachel Winograd, supports the existence of at least 4 categories of drunk personalities. Importantly, she reveals if one’s type of drunk personality puts them at greater risk of alcohol-related harms (e.g. regrettable sexual encounters or drunken injuries), as well as alcohol addiction.

187 pairs of undergraduate drinking buddies answered questions linking their drunk personality to the “big five” personality traits (openness, conscientiousness, extraversion, agreeableness, and neuroticism). Cluster analysis of these answers led to the description of four main drunk personality types as outlined below.

Not only is it a bit of fun to ask, “What kind of drunk are you?”, the drunk personality research field holds promise for the development of novel interventions to help problem drinkers.

Drunk Personality Type 1: The Ernest Hemingway



As Ernest Hemingway wrote, he ‘‘can drink hells any amount of whiskey without getting drunk.” Thankfully, this is the most common drunk personality type shared by 42% of the undergrads, who reported behaving roughly the same and only slightly changing when intoxicated.

Compared to the other personality types, the personality factors that tend to change the most when drunk — i.e. conscientiousness (being prepared, organized, prompt) and intellect ( understanding abstract ideas, being imaginative) — do not change drastically. It is no surprise then that this drunk personality type was not linked with experiencing more negative consequences or alcoholism symptoms.

Drunk Personality Type 2: The Mr Hyde



Unfortunately, the second most common drunk personality type (23% of the sample) is the monster of a drunk named after the twisted alter-ego of Dr. Jeckyll, Mr. Hyde. They are characterized by being less conscientious, less intellectual and less agreeable than their sober selves or other drunk personality types.

Their drunk personality being the perfect recipe for increased hostility when under the influence, they are statistically more likely to have alcohol use disorder symptoms (i.e. have a higher risk of alcohol addiction). They also suffer a whole range of negative consequences from drinking, from blacking out to being arrested for drunken behavior.

Drunk Personality Type 3: The Nutty Professor



This type of drunk, comprising 20% of the study participants, does a personality 360 when they get drunk. They are particularly quiet and introverted when sober, but their drunken persona has a large increase in extraversion and decrease in conscientiousness (compared to the other drunk types and their sober self). This is likened to the the Disney character, Shermen Clump, when he transforms from taking his secret chemical formula in The Nutty Professor.

Despite having the most drastic personality change, Nutty Professors were not associated with experiencing more negative alcohol-related consequences from drinking.

Drunk Personality Type 4: The Mary Poppins




The least common drunk personality type in the study, found in 15% of the participants, was ‘The Mary Poppins. They are not only particularly agreeable (i.e. embodying traits of friendliness) when sober, they are also agreeable and friendly when drunk. Like Hemmingways, they also decrease less than average in conscientiousness and intellect when getting drunk.

Their drunken sweetness sets them apart from less agreeable Hemmingways. They are essentially the opposite of the Mr Hyde drunk type of drunk, resulting in significantly less negative consequences from getting drunk.

REFERENCES

Hemingway, E., & Baker, C. (1981). Ernest Hemingway, selected letters, 1917-1961. New York: Macmillan Pub Co.

Winograd, R. P., Littlefield, A. K., Martinez, J., & Sher, K. J. (2012). The drunken self: The Five-Factor model as an organizational framework for characterizing perceptions of One’s own drunkenness. Alcoholism: Clinical and Experimental Research, 36(10), 1787–1793. doi:10.1111/j.1530-0277.2012.01796.x

Winograd, R. P., Steinley, D., & Sher, K. (2015). Searching for Mr. Hyde: A five-factor approach to characterizing “types of drunks.” Addiction Research & Theory, 24(1), 1–8. doi:10.3109/16066359.2015.1029920

Images via accsalgueiro0, skeeze, Alexas_Fotos and RyanMcGuire / Pixabay.

]]> /2016/11/24/discover-your-drunk-personality-type-nutty-naughty-or-nice/feed/ 0 /2016/11/21/homosexuality-link-to-child-sex-abuse-confirmed-gender-nonconformity/ /2016/11/21/homosexuality-link-to-child-sex-abuse-confirmed-gender-nonconformity/#respond Mon, 21 Nov 2016 16:00:01 +0000 /?p=22189 Can sexual abuse make you gay? The short answer according to new research is, no. Child sexual abuse is not a common cause of being gay. But, new research says that the opposite is true. There is something common in the childhood of homosexual men that makes them a target for pedophilia and sexual abuse — gender non-conformity.

Many homophobic religious institutions make unfounded claims about same-sex sexual child abuse causing homosexuality, like those coming from the pro-heterosexual, anti-gay activist group, Heterosexuals Organized for a Moral Environment (HOME):

We can see that sexual abuse can theoretically account for every case of homosexuality…

Under the lens of science these claims are considered ridiculous and laughable at best, often followed by outrageous and scientifically unfounded claims that being gay is the cause of pedophilia.

Nonetheless, non-heterosexuals with a history of same-sex sexual abuse as a child often ask if this made them desire the same-sex as an adult. Similarly, gay men and women who were sexually abused by the opposite sex as a child, ask if this caused a sexual fear and revulsion towards the opposite sex that ‘made’ them gay.

Whether the pedophile or child molester was gay or straight, gay victims tend to ask the same question at some point, “Did sexual abuse make me gay?”

Research indicates that this isn’t true of straight people abused as children, they are less likely to question if being abused made them straight. Thus it is often argued that it is the culturally ingrained negative views of gay people, particularly of gay men, or simply belonging to a minority group, that the question is even asked in the first place.

Even so, it is still a common view that sexual abuse can ‘turn’ a child gay despite no convincing or reliable evidence that premature sexual activity or child sexual abuse grossly changes sexual orientation.

The main withstanding argument in support of this view is that child sexual abuse is more common in the gay community than the straight community. In fact, meta-analysis indicates that sexual minority school children were on average almost 4 times more likely to experience sexual abuse than heterosexual children.

The latest research stands against this argument, providing the most convincing causal evidence yet that it is a common aspect of many gay men’s childhoods that is linked with higher rates of sexual abuse in boys who later identify as gay in adulthood — not sexual abuse ‘making’ a child gay.

Published in Sexual Abuse: A Journal of Research and Treatment the new research suggests that a child’s gender nonconformity, which is more common for non-heterosexuals, that may make them more desirable targets for pedophiles and child abusers.

To clarify, gender nonconformity you may also know as gender bending. Gender nonconformity is when people identify with or behave like what is culturally considered typical for the opposite sex, going against the gender grain if you will. For example, boys that like to play dress-up, or girls that prefer rough play.

In the study, 1753 participants filled out an online survey that regarding their sexual orientation, history of child abuse, and the degree of gender nonconformity they recall from childhood, including the activities and kinds of play and types of clothes they liked.

Although other research has suggested a link between gender nonconforming and sexual abuse in children, whether nonconforming caused abuse, or abuse caused nonconforming had not previously been assessed this directly. By using a special type of analysis called instrumental variable analysis, the new study was able to estimate causal relationships. It is therefore study able to more confidently address the complex question “Can sexual abuse make you gay?”

In line with other research, gay participants (being male or female homo and bisexuals) in the new study had greater odds (~45% greater) of being sexually abused in childhood than heterosexual participants.

They also found that heterosexual and non-heterosexual men who are more gender nonconforming (i.e. ‘feminine’) in childhood had higher chances of abuse than sexual orientation matched boys who are more gender conforming (i.e. ‘masculine’). In other words being gay or not had nothing to do with it. It was whether boys behaved like stereotypical boys or not that was key.

However, gender non-conforming girls were not at higher risk of sexual abuse than conforming girls in the present study. It is research supported factoid that gender nonconformity in girls, like being a ‘tomboy’, is generally more socially accepted, approved of and tolerated in Western cultures than gender nonconforming in boys, who are often considered as mama’s boys, sissies or brats.

The authors suggest that gender nonconforming boys are less generally approved of partly due to cultural femi-negativity. Cultural femi-negativity being where femininity is particularly devalued when it does not adhere to gender norms. The idea that abusers target children with feminine qualities as to make for more compliant and less socially valued abuse targets fits well with the study and the body of research as a whole considering more girls are targets of pedophilia and child molestation than boys, and that more gender non-conforming feminine boys are targeted more than masculine conforming ones, whether they are gay or not.

This also makes sense when considering research suggesting that most abusive pedophiles are generally aroused by youth, and that the child’s sex, at the core of their desires, is pretty immaterial. Whether they abuse mainly boys or girls, it’s about a child being a child, ease of access to that child and avoiding getting caught through ease of controlling the child.

Whereas adult child molesters, who can be a pedophiles (i.e. someone specifically attracted to children) but are not necessarily pedophiles, get a sexual kick out of domination, power and control, marking those with more feminine qualities as being easier and less risky targets.

Importantly, the research suggests that it is having feminine personality traits and behaviors more common to gay boys, i.e. gender nonconforming, that leads to such high rates of child abuse cases in gay men. There is no credible research as of yet that indicates that it is common that child sexual abuse is a cause of being gay.

It seems that there is something, or somethings, about gender-non-conforming in boys that puts them at an increased risk of sexual abuse. If research now focuses on exploring further what those somethings are we can better protect children from the traumas of sexual abuse.

References

Bailey, M. J., Vasey, P. L., Diamond, L. M., Breedlove, M. S., Vilain, E., & Epprecht, M. (2016). Sexual orientation, controversy, and science. Psychological Science in the Public Interest, 17(2), 45–101. doi:10.1177/1529100616637616

Coyle, E. F., Fulcher, M., & Trübutschek, D. (2016). Sissies, mama’s boys, and Tomboys: Is children’s gender Nonconformity more acceptable when Nonconforming traits are positive? Archives of Sexual Behavior, 45(7), 1827–1838. doi:10.1007/s10508-016-0695-5

Friedman, M. S., Marshal, M. P., Guadamuz, T. E., Wei, C., Wong, C. F., Saewyc, E. M., & Stall, R. (2011). A Meta-Analysis of disparities in childhood sexual abuse, parental physical abuse, and peer Victimization among sexual minority and sexual nonminority individuals. American Journal of Public Health, 101(8), 1481–1494. doi:10.2105/ajph.2009.190009

Xu, Y., & Zheng, Y. (2015). Does sexual orientation precede childhood sexual abuse? Childhood gender Nonconformity as a risk factor and instrumental variable analysis. Sex Abuse. doi:10.1177/1079063215618378

Image via Unsplash / Pixabay.

]]> /2016/11/21/homosexuality-link-to-child-sex-abuse-confirmed-gender-nonconformity/feed/ 0 /2016/09/12/best-and-worst-in-psychology-and-psychiatry-august-2016/ /2016/09/12/best-and-worst-in-psychology-and-psychiatry-august-2016/#respond Mon, 12 Sep 2016 15:25:29 +0000 /?p=22196 Every month we scour the 1000s of new research publications in psychology and psychiatry for trending and field progressing findings. Making the top five best findings this month include the influence our bank balance has on our mental state, and how our mental state can also help empty our bank balance. The worst findings, the bearers of bad news, include how Youtube may add to misunderstanding schizophrenia, the lack of advantages from giving children antidepressants, and the longterm psychological effects of earthquake disasters.

August 31st also marks the birthdate of American psychologist, the late Edward Lee “Ted” Thorndike (1874 – 1949). Celebrated for his work on comparative psychology (studying the psychology and behavior of animals) that led to the theory of connectionism in 1940, it forever changed the fields of artificial intelligence, neuroscience, philosophy of mind, and of course, psychology. The main principle of connectionism is that functions of the mind and cognition can be described by interconnected networks of simple units. Low and behold, today, neural networks and their role in making us who we are, both in health and disease, is bordering on common knowledge.

BEST: Higher Spiritual Intelligence for Improved General Health and Happiness

384 students from Shahid Bahonar University of Kerman in Iran filled out questionnaires that are established measured of one’s level of spirituality, overall health and happiness. Researchers looked for links between spirituality level, health and happiness and found levels of spiritual intelligence are related to general health and happiness.

However, not all aspects of spirituality lead to greater health and happiness. In particular, an aspect of spiritual intelligence called, existential critical thinking (i.e. the capacity to critically contemplate the nature of metaphysical issues (e.g. reality, universe, time, and death) predicted poorer health but greater happiness.

In addition, the researchers suggest that a high sense of personal meaning may create resilience even in the face of hardship, which would account for a strong sense of personal meaning being correlated with higher levels of happiness.

BEST: Compassion Meditation Increases Charitable Donation

Two studies were designed to identify the “active ingredients” of compassionate meditation, and to see if these active ingredients influence charitable donations. In a randomized-controlled trial, relative to control conditions, compassionate mediation increased charitable donations via meditation changing certain feelings and attributions.

The feelings that compassion mediation can change that then lead to greater charitable donations are tenderness, personal distress, instrumentality (how much would a donation help the sufferer), and blamelessness (how much the sufferer is to blame for their position). A sense of similarity towards the person in need can lead to increased helping behaviour, but this was only if associated with the aforementioned prosocial feelings.

BEST: Mindfulness During Pregnancy Improves Mental Health, Well-being and Self-Confidence Towards Childbirth

The review assessed 8 studies examining mindfulness intervention effects on prenatal well-being in expecting mothers. Findings indicate potential benefits of mindfulness interventions for reducing levels of depression, anxiety, and negative moods during pregnancy. There is also evidence for improved self-compassion and perceived childbirth self-efficacy.

Importantly, expecting mothers practicing mindfulness that are at risk of low wellbeing during pregnancy had even greater positive results from mindfulness interventions.

BEST: Having “Cash On Hand” is Important for Life Satisfaction

In a field study using 585 bank customers in the UK, researchers looked for connections between liquid wealth (the cash you have on hand) and responses to the Satisfaction With Life Scale questionnaire. It was found that individuals with higher liquid wealth were found to have more positive perceptions of their financial well-being, which, in turn, predicted higher life satisfaction, suggesting that liquid wealth is indirectly associated with life satisfaction.

This relationship remained even for those in debt or in the green, for big spenders or frugal spenders, and investors or non-investors. Therefore, to improve the well-being of citizens, the researchers suggest that policymakers should focus not just on boosting incomes but also on increasing people’s immediate access to money.

BEST: Uncalculating Cooperation is a Sign of Trustworthiness

Humans often help one another as there are benefits for everyone involves, but sometimes people are helpful without any obvious benefit for themselves. A study published in PNAS asked why people help others when presumably there is no obvious worthwhile benefit for them to do so?

Participants in the study played economic game experiments, and were shown to be more likely to engage in seemingly selfless uncalculating cooperation when their decision-making process was observable to others. Additionally people who help out of the kindness of their hearts were seen as more trustworthy than people who help in a calculating way.

Researchers in the present study took these combined findings to suggest that reputation concerns provide an answer as to the motives behind uncalculating cooperation: people cooperate in an uncalculating way to signal their trustworthiness to observers.

WORST: Schizophrenia Presentations on YouTube Offer a Distorted Picture of the Disorder

The accuracy of depictions of schizophrenia in 4,200 YouTube videos was rated independently by two consultant psychiatrists. Only 35 of the 4,200 videos were non-duplicates and actually claimed to involve a patient with schizophrenia.

Out of the 35 videos that met the eligibility and adequacy criteria, only 12 accurately depicted acute schizophrenia. Accurate videos were characterized by persecutory delusions (83%), inappropriate affect (75%), and negative symptoms (83%).

Despite 10 of the 12 accurate videos having good educational utility, the 23 inaccurate videos had similar view counts. Finding a truly educational and accurate depiction of schizophrenia on YouTube is a bit like finding a needle in a haystack.

WORST: Poor Efficacy and Tolerability of Antidepressants for Major Depressive Disorder in Children

Meta-analysis of 34 research trials, including 5260 participants and 14 antidepressant treatments, was used to compare and rank the effectiveness of antidepressants and placebo for treating major depressive disorder in young people.

Trials of amitriptyline, citalopram, clomipramine, desipramine, duloxetine, escitalopram, fluoxetine, imipramine, mirtazapine, nefazodone, nortriptyline, paroxetine, sertraline, and venlafaxine were included.

The quality of evidence for use of antidepressants was rated as very low due to low efficacy and high levels of adverse effects, with only fluoxetine (Prozac) being statistically significantly more effective than placebo.

WORST: Exercise Addicts are Similar to Workaholics

Currently, it is uncertain what truly constitutes an exercise addiction, despite an increasing need for understanding addictive exercise behaviour in order to develop effective interventions.
The study in question, involving participants from sport and exercise relevant domains, including physicians, physiotherapists, coaches, trainers, and athletes, identified 63 features of exercise addiction, and found that these fit well with a model that describes workaholics, the Work Craving model.

The features fit well with the three components of the model: the learned component, negative perfectionism; the behavioral component, an obsessive – compulsive drive; and the hedonic component, involving improving self-worth and reducing negative mood and withdrawal symptoms.

Additionally and importantly, there was a strong consensus among experts that excessive exercise can exist without a concurrent eating disorder.

WORST: Link Between Inflammatory IL-7 and Depression Differs with Gender

Interleukin 7 (IL-7), a protein involved in B and T cell development and differentiation, has been shown to be altered in depression, although the role between inflammation, the immune system and depression is poorly understood.

Lower levels of IL-7 were found to be associated with higher scores for depression in both men and women. However, this depended on the fraction of blood used. Low IL-7 in the serum of blood (the clear liquid that blood cells and clotting factors float in) was linked with depression in men, while low Il-7 in the plasma (the red fluid composed of blood cells and clotting factors) was linked with depression in women.

While researchers can only speculate what this gender difference means, it may be important when considering development of targeted therapeutic interventions utilizing anti-inflammatory medications for individuals with depression.

WORST: Long-term Psychological Consequences Among Adolescent Survivors of the Wenchuan Earthquake in China

The study assessed the longer-term psychological consequences of teenage survivors of natural disasters through analyzing data from secondary school students who were living in Sichuan province 6 years after the Wenchuan earthquake.

Having two or more kinds of traumatic experiences was associated with higher psychological symptom scores and suicidal ideation as compared with having no traumatic experience.

Although causality could not be inferred, severely traumatized adolescent survivors of the earthquake were found to suffer from psychological symptoms even 6 years after the disaster, indicating a need for long-term psychological support.

References

Amirian, M.-E. and Fazilat-Pour, M. (2015) ‘Simple and Multivariate relationships between spiritual intelligence with general health and happiness’, Journal of Religion and Health, 55(4), pp. 1275–1288. doi: 10.1007/s10943-015-0004-y.

Ashar, Y.K., Andrews-Hanna, J.R., Yarkoni, T., Sills, J., Halifax, J., Dimidjian, S. and Wager, T.D. (2016) ‘Effects of compassion meditation on a psychological model of charitable donation’, Emotion, 16(5), pp. 691–705. doi: 10.1037/emo0000119.

Cipriani, A., Zhou, X., Del Giovane, C., Hetrick, S.E., Qin, B., Whittington, C., Coghill, D., Zhang, Y., Hazell, P., Leucht, S., Cuijpers, P., Pu, J., Cohen, D., Ravindran, A.V., Liu, Y., Michael, K.D., Yang, L., Liu, L. and Xie, P. (2016) ‘Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: A network meta-analysis’, The Lancet, . doi: 10.1016/s0140-6736(16)30385-3.

Hall, J.R., Wiechmann, A., Edwards, M., Johnson, L.A. and O’Bryant, S.E. (2016) ‘IL-7 and depression: The importance of gender and blood fraction’, Behavioural Brain Research, 315, pp. 147–149. doi: 10.1016/j.bbr.2016.08.026.

Jordan, J.J., Hoffman, M., Nowak, M.A. and Rand, D.G. (2016) ‘Uncalculating cooperation is used to signal trustworthiness’, Proceedings of the National Academy of Sciences, 113(31), pp. 8658–8663. doi: 10.1073/pnas.1601280113.

Macfarlane, L., Owens, G. and Cruz, B. del P. (2016) ‘Identifying the features of an exercise addiction: A Delphi study’, Journal of Behavioral Addictions, , pp. 1–11. doi: 10.1556/2006.5.2016.060.

Matvienko-Sikar, K., Lee, L., Murphy, G. and Murphy, L. (2016) ‘The effects of mindfulness interventions on prenatal well-being: A systematic review’, Psychology & Health, , pp. 1–20. doi: 10.1080/08870446.2016.1220557.

Nour, M.M., Tsatalou, O.-M. and Barrera, A. (2016) ‘Schizophrenia on YouTube’, Psychiatric Services, , p. appi.ps.2015005. doi: 10.1176/appi.ps.201500541.

Ruberton, P.M., Gladstone, J. and Lyubomirsky, S. (2016) ‘How your bank balance buys happiness: The importance of “cash on hand” to life satisfaction’, Emotion, 16(5), pp. 575–580. doi: 10.1037/emo0000184.

Tanaka, E., Tsutsumi, A., Kawakami, N., Kameoka, S., Kato, H. and You, Y. (2016) ‘Long-term psychological consequences among adolescent survivors of the Wenchuan earthquake in china: A cross-sectional survey six years after the disaster’, Journal of Affective Disorders, 204, pp. 255–261. doi: 10.1016/j.jad.2016.08.001.

]]> /2016/09/12/best-and-worst-in-psychology-and-psychiatry-august-2016/feed/ 0 /2016/09/11/happy-retirement-5-ways-to-prolong-the-golden-years/ /2016/09/11/happy-retirement-5-ways-to-prolong-the-golden-years/#respond Sun, 11 Sep 2016 15:00:53 +0000 /?p=22071 After a lifetime of hard work, thousands of baby boomers are retiring in record numbers across the globe. Like any life transition, embarking on the transition from working life to retirement can be wrought with challenges and stressors, especially for those forced into retirement. Yet, it also opens up a window of opportunity to take a few simple steps to secure a healthy and happy retirement.

After retirement, some people plummet down the slippery slope to physical and mental health decline and premature death, while others are rejuvenated by the positive health effects of retirement and protect themselves from the bad, bolstering health and happiness and prolonging a vivacious and meaningful life into ripe old age.

The good news is that science is gradually unearthing the many secrets to a happy retirement, providing the retirement planning blueprints needed to capitalise on the health benefits of promoting positive lifestyle change on the healthy transition to retirement.

The power of belief in the golden years

Believe the hype; believe the stereotype… well the positive one anyway. Research shows that people that believe in positive and happy retirement stereotypes (e.g. living a hopeful, active, involved, healthy and meaningful life with more time for family, friends and pleasurable activities) have been shown to live up to 7.5 years longer than those who believe in negative retirement stereotypes (e.g. living a hopeless, inactive, uninvolved, lonely and meaningless life).

Some estimates indicate that simply believing in the golden years being golden provides a 41% decreased mortality risk and reinforces a happy retirement being a reality.

Other research indicates that fear of being lumped into an ‘old and unhealthy’ stereotype, known as healthcare-stereotype threat, can lead to healthcare avoidance and is linked with poorer global physical and mental health.

It has been suggested that simply knowing the powerful effects of believing and/or fearing stereotypes is half the battle. Reading this blog article may be enough to help people beat the negative effects of stereotypes down and invite the golden years in.

The power of world views

The hostile world scenario (HWS) is a personal belief system regarding the perceived threat to one’s own physical and mental health and wellbeing, which is more severe among minorities that suffer from stigma, such as members of the LGBT community.

Healthy uses of the HWS system include serving as an internal monitor of both actual and potential threats and adverse circumstances in the individual’s life, allowing vigilance towards dangers and maintenance of a sense of safety and wellbeing.

If this system is over activated however, it can lead to an overwhelming sense of a catastrophic world and is associated with a whole load of negative health outcomes that put both mental and physical health in jeapordy.

These include:

• having increased difficulties in activities of daily living (e.g. eating, dressing, bathing, preparing a hot meal, shopping in a store, managing money etc.)
• movement difficulties (e.g. reaching or extending one’s arms above shoulder level, lifting or carrying weights over 5 kilos such as a heavy bag of groeceries)
• worse physical symptoms (e.g. resistant cough, swollen leg etc.)
• worse medical conditions (e.g. diabetes, osteoporosis etc.)
• worse depression symptoms
• less satisfaction with life
• less social activities

What makes having an overactive and negative HWS system be strongly predictive of poor mental and physical health in old age is currently unknown. Some suggest that an overactive HWS may amplify stress-related thinking leading to ill health, and/or that the HWS is actually a reflection of future predictions of the self and therefore may be like a self-fulfilling prophecy, a route to self-sabotage and self-defeat.

Conscious aging practices have been shown to help transform negative world views into positive ones that benefit health and wellbeing in retirement years. Conscious aging and world view transformation involves exploration of the pivotal role that our world view plays in how we see, understand and behave by using a multitude of exercises, such as meditation and nature-walks, that encourage self-reflection, self-discovery and reshaping of our world view.

The power of exercise

Research shows that some people get more physically fit after retirement, while others put their physical and mental health and wellbeing at risk, as well as their families, due to further increases in sedentary behaviour after stopping work.

For those that exercise regularly, benefits include: lower blood pressure; improved balance and reductions in mobility difficulties; improved health for those with conditions like diabetes, heart disease or arthritis; stress management and improved mood; an improved memory and prevention of cognitive decline.

However, research cannot yet tell us with any confidence what exactly helps some people get into healthy exercise habits after retirement compared to others. Nonetheless, it is resoundingly clear that adopting daily lifestyle habits, hobbies and activities that promote physical activity and avoid sitting down for long periods of time is a must for those wanting a healthy and happy retirement.

The power of socializing

It has been shown that how long a person expects to live is linked with future mental and physical health. Sadly but fortuitously, for lonely older adults, reminding themselves they have not so many years left protects against their feelings of loneliness fueling depression.

Rather than adopting this otherwise bleak outlook on life to keep one’s sanity, multiple lines of research indicate that working on having a thriving social life doesn’t only prevent the negative impact of loneliness, it can truly do wonders for health and happiness following retirement.

Meta-analytic evidence shows that people’s social relationships can predict how long they will live, and in fact, is a stronger predictor than other health behaviours such as physical exercise, smoking or alcohol consumption. Other studies also link vibrant social lives in older years with reduced depression and enhanced cognitive health.

A brand new study found that social group memberships in retirement, like book and lunch clubs, or arts or exercise groups, are associated with reduced risk of premature death. Specifically, retirees who had two group memberships prior to retirement had a 2% risk of death in the first 6 years of retirement if they maintained membership in the two groups, a 5% risk if they stopped attending one group and a 12% risk if they lost both groups. Furthermore, for every group membership that participants lost in the year following retirement, their experienced quality of life 6 years later was approximately 10% lower.

All in all, joining social groups and engaging in social activities is a smart move to ensure happy retirement. Also, if the social activity also happens to be physical, reinforce positive beliefs in retirement and reinforce positive views of the world it’s a win, win, win, win in support of healthy and happy retirement.

The power of driving

There is no legal age at which you must stop driving, but driving cessation is beginning to be considered an inevitable transition in the years around or following retirement, depending on one’s health. Some people may have decades of retirement years before stopping driving is on the cards, for others it may come hand in hand with retirement.

However, very few plan to stop driving and those that don’t make plans are at higher risk of poorer health, depression, institutionalization, attending less out-of-home activities and reduced productive social engagement, and the kicker, death. In fact, in one study, nondrivers were found to be four to six times more likely to die than drivers during the subsequent 3-year period following driving cessation.

Finding ways to maintain a future nondrivers’ productive roles and out-of-home activities may be key to preventing the negative effects of driving cessation.

References

Abdou, C., Fingerhut, A., Jackson, J., & Wheaton, F. (2016). Healthcare Stereotype Threat in Older Adults in the Health and Retirement Study American Journal of Preventive Medicine, 50 (2), 191-198 DOI: 10.1016/j.amepre.2015.07.034

Bodner, E., & Bergman, Y. (2016). Loneliness and depressive symptoms among older adults: The moderating role of subjective life expectancy Psychiatry Research, 237, 78-82 DOI: 10.1016/j.psychres.2016.01.074

Cacioppo, J., Hughes, M., Waite, L., Hawkley, L., & Thisted, R. (2006). Loneliness as a specific risk factor for depressive symptoms: Cross-sectional and longitudinal analyses. Psychology and Aging, 21 (1), 140-151 DOI: 10.1037/0882-7974.21.1.140

Curl, A., Stowe, J., Cooney, T., & Proulx, C. (2013). Giving Up the Keys: How Driving Cessation Affects Engagement in Later Life The Gerontologist, 54 (3), 423-433 DOI: 10.1093/geront/gnt037

Edwards, J., Perkins, M., Ross, L., & Reynolds, S. (2009). Driving Status and Three-Year Mortality Among Community-Dwelling Older Adults The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 64A (2), 300-305 DOI: 10.1093/gerona/gln019

Ertel, K., Glymour, M., & Berkman, L. (2008). Effects of Social Integration on Preserving Memory Function in a Nationally Representative US Elderly Population American Journal of Public Health, 98 (7), 1215-1220 DOI: 10.2105/AJPH.2007.113654

Feng, X., Croteau, K., Kolt, G., & Astell-Burt, T. (2016). Does retirement mean more physical activity? A longitudinal study BMC Public Health, 16 (1) DOI: 10.1186/s12889-016-3253-0

Holt-Lunstad, J., Smith, T., & Layton, J. (2010). Social Relationships and Mortality Risk: A Meta-analytic Review PLoS Medicine, 7 (7) DOI: 10.1371/journal.pmed.1000316

Mosca I, & Barrett A (2016). The Impact of Voluntary and Involuntary Retirement on Mental Health: Evidence from Older Irish Adults. The journal of mental health policy and economics, 19 (1), 33-44 PMID: 27084792

Ng, R., Allore, H., Monin, J., & Levy, B. (2016). Retirement as Meaningful: Positive Retirement Stereotypes Associated with Longevity Journal of Social Issues, 72 (1), 69-85 DOI: 10.1111/josi.12156

Shenkman, G., & Shmotkin, D. (2013). The hostile-world scenario among Israeli homosexual adolescents and young adults Journal of Applied Social Psychology, 43 (7), 1408-1417 DOI: 10.1111/jasp.12097

Shmotkin, D., Avidor, S., & Shrira, A. (2015). The Role of the Hostile-World Scenario in Predicting Physical and Mental Health Outcomes in Older Adults Journal of Aging and Health, 28 (5), 863-889 DOI: 10.1177/0898264315614005

Steffens, N., Cruwys, T., Haslam, C., Jetten, J., & Haslam, S. (2016). Social group memberships in retirement are associated with reduced risk of premature death: evidence from a longitudinal cohort study BMJ Open, 6 (2) DOI: 10.1136/bmjopen-2015-010164

Image via PublicDomainPictures / Pixabay.

]]> /2016/09/11/happy-retirement-5-ways-to-prolong-the-golden-years/feed/ 0 /2016/09/08/can-you-improve-physical-skills-while-dreaming/ /2016/09/08/can-you-improve-physical-skills-while-dreaming/#respond Thu, 08 Sep 2016 15:00:52 +0000 /?p=22073 Can we significantly improve physical skills by practicing them while we sleep? Yes, scientists say. New research published in the Journal of Sports Sciences confirms that practicing motor skills while lucid dreaming can lead to real life improvements in skill performance that can be equivalent to practice in waking life.

Lucid dreaming is when the dreamer becomes aware that they are actually dreaming. This awareness typically comes hand in hand with greater control of what one’s dream self is doing, as well as the content of the dream.

A meta-analysis of the past 50 years of research (1966–2016) revealed that 55% of study participants have experienced one lucid dream or more in their lifetime, with 23% experiencing lucid dreams once a month or more.

Despite being a common phenomenon experienced in similar frequencies around the globe, the many challenges that come with investigating and understanding lucid dreaming make it a very mysterious state of consciousness indeed.

To help solve the many mysteries of lucid dreaming, Dr. Tadas Stumbrys, lead author of the study, and co-researchers, Associate Professor Daniel Erlacher and Professor Michael Schredl, analyzed data from 64 adults (average age 31) that completed the online experiment.

The experiment was a simple online version of a well-known sequential finger tapping exercise. Put simply, participants are shown a simple sequence of five numbers (e.g. 4-1-3-2-4) and are asked to type this sequence repeatedly “as quickly and accurately as possible” for 30 seconds.

The participants were split into four groups: frequent lucid dreamers (25%), a mental practice group (23%), a physical practice group (24%) and a control (no practice) group (24%).

In the middle of the night, alarms were set so that either lucid dreaming practice, mental rehearsal practice or real life physical practice of the finger tapping exercise could be completed at approximately the same time. They were then assessed the following day to see if practice in whatever form had improved their finger tapping performance.

Following statistical analysis the researchers found that:

All three types of practice increased performance speed without compromising accuracy – the error rate did not significantly differ between the two tests [i.e. the test during practice, and the follow up test].

Amazingly, no significant differences were found when comparing the improvements in performance gained from lucid dreaming practice whilst asleep (+20%), or physical practice (+17%) or mental rehearsal practice during waking life (+12%), with all three types of practicing having similarly large performance influencing effect sizes.

The only other comparable past research did find a difference in performance-boosting benefits between lucid dreaming (+43%) and physical practice (+88%), when aiming to improve the motor skill of flicking a coin into a plastic cup. However, when correcting the data and refining the analysis, physical practice and lucid dreaming practice actually had similar motor skill improving effect sizes as found for the most recent study.

Authors of the new study suggest that the physical practice group in the coin-flicking experiment had an unfair advantage seeing as they got to practice in the evening with their sleep undisturbed, unlike the lucid dreaming group. In the present study, practice times were matched which presumably evened the playing field, which is reflected in the similar rating of sleep quality between the practice groups and similar effects on motor skill learning.

Currently, research shows that the neural mechanisms that create physical movement are highly similar between waking, imagining and lucid dreaming states of consciousness. In fact, a recent brain imaging study showed that brain activity in the sensorimotor cortex that is responsible for controlling our physical movements is similar during imagined and lucidly dreamed movement, thereby allowing motor learning to occur.

Although not supported by the latest study, lucid dreaming is thought to hold the potential to be better than mental rehearsal.

It looks promising for athletes and those in physical rehabilitation from injury, and perhaps anyone that wants to learn or refine a new motor skill, or practicing something dangerous. Of course, further research with more complex skills is very much needed. First point of call perhaps, should be developing and researching lucid dream induction techniques so that we have reliable and consistent ways to allow for larger numbers of participants and to take lucid dreaming from fringe science into everyday reality.

References

Dresler M, Koch SP, Wehrle R, Spoormaker VI, Holsboer F, Steiger A, Sämann PG, Obrig H, & Czisch M (2011). Dreamed movement elicits activation in the sensorimotor cortex. Current biology : CB, 21 (21), 1833-7 PMID: 22036177

Saunders DT, Roe CA, Smith G, & Clegg H (2016). Lucid dreaming incidence: A quality effects meta-analysis of 50years of research. Consciousness and cognition, 43, 197-215 PMID: 27337287

Stumbrys T, Erlacher D, & Schredl M (2016). Effectiveness of motor practice in lucid dreams: a comparison with physical and mental practice. Journal of sports sciences, 34 (1), 27-34 PMID: 25846062

Image via Wokandapix / Pixabay.

]]> /2016/09/08/can-you-improve-physical-skills-while-dreaming/feed/ 0 /2016/09/05/could-targeting-mitochondria-be-the-key-to-treating-psychosis/ /2016/09/05/could-targeting-mitochondria-be-the-key-to-treating-psychosis/#respond Mon, 05 Sep 2016 15:00:51 +0000 /?p=22090 One of the hottest cellular organelles of the year so far has to be mitochondria. Deleting them has been shown to reverse cellular aging, mitochondria transplants have been shown to reverse pulmonary hypertension, and they are promising targets for developing cures for and understanding neurodegenerative diseases like Parkinson’s, Alzheimer’s and dementia.

To add to the list, scientists the world over are revealing that mitochondrial dysfunction may be a central component of major psychosis (schizophrenia, and in particular bipolar disorder) and perhaps other mental illnesses. Importantly, this means that re-establishing healthy mitochondrial function may be the key to successful treatments and therapies.

Once free-living bacteria that were engulfed by another cell over a billion years ago, mitochondria are now best known as the energy providing powerhouses of our cells. They are also vital to other cellular processes including the formation of reactive oxygen species, cell cycle/growth and survival, balancing calcium ion levels, and neurotransmission.

Multiple lines of scientific evidence indicate that mitochondrial abnormalities and dysfunction are critically involved in psychosis, but what exactly is going on in a cell to create this dysfunction is not yet fully understood.

There are many complex, intertwined molecular pathways that collectively support the healthy functioning of mitochondria, and that is why multiple different abnormalities and mutant molecules can cause mitochondrial dysfunction that impairs neuronal functioning and can cause death of neurons in schizophrenia and bipolar disorder.

Authors of a recent review published in the Canadian Journal of Psychiatry state that:

Bipolar disorder and schizophrenia are complex diseases that cannot be characterized by a singular narrow pathway. Rather, numerous subtle alterations likely converge upon particular pathways (i.e., mitochondrial function) to produce functional alterations.

Some of the earliest points in these mitochondrial function-linked pathways that something could go wrong with and promote psychosis include:

1. Mutations and altered expression of nuclear and mitochondrial genes

   Mitochondria have their own DNA called mtDNA that we inherit from our mothers, and our cells have their own double stranded DNA, one strand inherited from our mother, the other our father. There are many heritable mutations in both mtDNA and DNA that have been reported in bipolar disorder and schizophrenia that can alter mitochondrial function. Similarly, gene-environment interactions, where our life experiences and stresses can epigenetically alter how genes are expressed, have been identified for genes that are necessary for healthy mitochondrial function in people with major psychosis.

2. Altered mitochondrial dynamics and trafficking
   Initial investigations suggest a role for altered mitochondrial dynamics and trafficking in schizophrenia, although these processes have not yet been extensively explored in schizophrenia or bipolar disorder. Impairment in mitochondrial trafficking (i.e. the movement and localization of mitochondria within neurons) can produce alterations in neurotransmitter release and synaptic function. Impairment in mitochondrial dynamics (i.e. how mitochondria divide and multiply as well as fuse together in the formation of large networks of 1000s of mitochondria per cell) has been suggested to lead to altered neural connectivity.
3. Perturbed calcium ion flux and cell signalling
   Calcium ions are essential to the synchronization of neuronal electric activity, which is mediated by mitochondria. It also acts as an intracellular signal integral to the functioning of neurons, eliciting responses such as altered gene expression, cell death/survival, cell metabolism and neurotransmitter release at neuronal synapses. It’s a cyclic relationship in the brain of those with psychosis, where disruptions in either mitochondrial function or calcium ion flux have the potential to exacerbate one another. Impairments in calcium signalling can lead to mitochondrial dysfunction, while impairments in mitochondrial function can lead to problems with calcium signalling.

The future: Mitochondria as a target for treating psychosis

Much more intensive research is required to better understand the complex processes involved in the dysfunction of mitochondria in mental disorders, and how treatments can restore their function.

Although not confirmed in patients with psychosis, physical exercise may be one of the best non-pharmacological strategies used to reverse brain dysfunction. Endurance training involves adaptations that can lead to the upregulation of tissue-protective mechanisms, including increased mitochondrial biogenesis and function, and improvement in antioxidant networks, leading to more effective control of free radical production.

Ultimately, further research could lead to the prescription of lifestyle changes, interventions, therapies and even mitochondria-protecting drugs. It may be that by helping restore mitochondrial biogenesis and function, this can improve the chances of successfully treating psychosis, and, if preliminary research findings are valid, perhaps mood disorders and other mental illnesses too.

References

Anglin, R. (2016). Mitochondrial Dysfunction in Psychiatric Illness The Canadian Journal of Psychiatry, 61 (8), 444-445 DOI: 10.1177/0706743716646361

Correia?Melo, C., Marques, F., Anderson, R., Hewitt, G., Hewitt, R., Cole, J., Carroll, B., Miwa, S., Birch, J., Merz, A., Rushton, M., Charles, M., Jurk, D., Tait, S., Czapiewski, R., Greaves, L., Nelson, G., Bohlooly?Y, M., Rodriguez?Cuenca, S., Vidal?Puig, A., Mann, D., Saretzki, G., Quarato, G., Green, D., Adams, P., von Zglinicki, T., Korolchuk, V., & Passos, J. (2016). Mitochondria are required for pro?ageing features of the senescent phenotype The EMBO Journal, 35 (7), 724-742 DOI: 10.15252/embj.201592862

Di Maio, R., Barrett, P., Hoffman, E., Barrett, C., Zharikov, A., Borah, A., Hu, X., McCoy, J., Chu, C., Burton, E., Hastings, T., & Greenamyre, J. (2016).  -Synuclein binds to TOM20 and inhibits mitochondrial protein import in Parkinsons disease Science Translational Medicine, 8 (342), 342-342 DOI: 10.1126/scitranslmed.aaf3634

Hollis, F., van der Kooij, M., Zanoletti, O., Lozano, L., Cantó, C., & Sandi, C. (2015). Mitochondrial function in the brain links anxiety with social subordination Proceedings of the National Academy of Sciences, 112 (50), 15486-15491 DOI: 10.1073/pnas.1512653112

Machado, A., Pan, A., da Silva, T., Duong, A., & Andreazza, A. (2016). Upstream Pathways Controlling Mitochondrial Function in Major Psychosis: A Focus on Bipolar Disorder The Canadian Journal of Psychiatry, 61 (8), 446-456 DOI: 10.1177/0706743716648297

Mill J, Tang T, Kaminsky Z, Khare T, Yazdanpanah S, Bouchard L, Jia P, Assadzadeh A, Flanagan J, Schumacher A, Wang SC, & Petronis A (2008). Epigenomic profiling reveals DNA-methylation changes associated with major psychosis. American journal of human genetics, 82 (3), 696-711 PMID: 18319075

Radak Z, Chung HY, & Goto S (2008). Systemic adaptation to oxidative challenge induced by regular exercise. Free radical biology & medicine, 44 (2), 153-9 PMID: 18191751

Scaini, G., Rezin, G., Carvalho, A., Streck, E., Berk, M., & Quevedo, J. (2016). Mitochondrial dysfunction in bipolar disorder: Evidence, pathophysiology and translational implications Neuroscience & Biobehavioral Reviews, 68, 694-713 DOI: 10.1016/j.neubiorev.2016.06.040

van der Wijst, M., & Rots, M. (2015). Mitochondrial epigenetics: an overlooked layer of regulation? Trends in Genetics, 31 (7), 353-356 DOI: 10.1016/j.tig.2015.03.009

Wang C, Du W, Su QP, Zhu M, Feng P, Li Y, Zhou Y, Mi N, Zhu Y, Jiang D, Zhang S, Zhang Z, Sun Y, & Yu L (2015). Dynamic tubulation of mitochondria drives mitochondrial network formation. Cell research, 25 (10), 1108-20 PMID: 26206315

Image via DasWortgewand / Pixabay.

]]> /2016/09/05/could-targeting-mitochondria-be-the-key-to-treating-psychosis/feed/ 0 /2016/09/02/electroshock-therapy-for-mental-illness-it-depends-on-your-genes/ /2016/09/02/electroshock-therapy-for-mental-illness-it-depends-on-your-genes/#respond Fri, 02 Sep 2016 15:00:48 +0000 /?p=22085 Scientists in Italy have pinpointed an important gene that could be used to predict the chances of success of electric shock treatment, especially for those with major depressive disorder and bipolar disorder that are resistant to other treatments.

Psychotherapy and lifestyle changes works for some people, drugs work for others, and for those less fortunate, nothing seems to work to treat their depression. For these treatment resistant individuals, one of the most effective treatments is electroconvulsive therapy, also known as electroshock treatment.

Despite demonstrating relatively high effectiveness in treating various mental disorders in multiple studies, sticking electrodes to someone’s head and electrocuting their brain is clearly controversial to say the least, especially seeing as it can come with serious side effects including both short-term and long-term memory loss, prolonged seizures and stroke. Knowing in advance from analyzing someone’s genes if electroconvulsive therapy will work or not is a definite, risk-avoiding and cost-effective plus.

In fact, researchers are approaching a consensus that it is each individual’s unique neurobiology, formed from genetic pot luck and a lifetime of gene-environment interactions shaping the networks in our brains and neuronal gene expression, that ultimately decides which type of treatment will work.

This is simply because some treatments affect certain brain regions and cellular processes differently than other treatments do. It’s a very complex key (i.e. a treatment’s unique neurobiological effects) meets a vastly complex lock (i.e. a person’s unique neurobiology) scenario.

For example one study published in JAMA psychiatry reports that patients with major depression that have low activity in a brain region called the anterior insula before treatment will respond better to cognitive behavioural therapy (CBT) than those with high activity in this brain region before treatment, who respond better to the antidepressant Lexapro.

The latest electroconvulsive therapy research concerns genetic biomarkers for responsiveness to electroshock treatment for people with major depressive disorder and bipolar disorder, who have already been deemed resistant to treatment.

As is done routinely in Ireland, Britain, northern Europe and North America, a series of electric shocks were given three times per week, for 2-3 weeks. Out of the 100 patients in the study, 69% had reduced depression symptoms and were considered responsive to treatment with electroconvulsive therapy, while the remaining 31% where considered non-responsive.

The STAR*D study

The hunt for genes predictive of electroconvulsive therapy success was guided by results from the largest and longest study ever conducted to evaluate depression treatment, the NIMH-funded Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. The researchers in the present study focussed on Glutamate Receptor Ionotropic Kainate 4 (GRIK4) gene variants (i.e. single DNA nucleotide mutations) as they were found to be associated with being non-responsive to antidepressant therapy.

The glutamate system and its components, like GRIK4, are a large part of the neurobiology and treatment of major depressive disorder, which is characterized by brain region-specific imbalances and dysfunctional metabolism of the neurotransmitters glutamate and GABA (gamma-amino-butyric acid).

There were statistically significant results found for two GRIK4 gene variants, with particular mutations being predictive of electroconvulsive therapy success or failure. For the first gene variant (rs11218030), simply the presence of one G allele, irrespective of the second allele, presented five times the risk of non-response to electroconvulsive therapy compared to AA homozygotes. For the second gene variant (rs1954787) the opposite was true, GG homozygous patients had double the risk of non-response than compared with having at least one A allele.

Moreover, the researchers had shown in previous research that the G allele carriers of rs11218030 GG homozygotes of rs1954787 have a higher risk of developing a psychotic symptomatology during a depressive episode, which in itself is the strongest negative predictive factor regarding treatment success.

The GRIK4 gene is particularly relevant to response to electroconvulsive therapy for depression as it encodes a protein found in specific brain areas like the hippocampus that makes it critical for rapid excitatory neurotransmission, learning and memory, complex cognitive behaviours, mood and personality, and can negatively impact neuroplasticity, i.e. the death of neurons from overactivaton of glutamate receptors and signalling pathways.

Interestingly, electroconvulsive therapy in humans and animal models has been shown to result in the normalization of glutamate deficits and GABAergic neurotransmission, particularly in the hippocampus as well as other brain areas.

It therefore looks like electroconvulsive therapy works through these neurochemical changes to renurture neuroplasticity and produce the neuronal remodelling required to overcome depression. Importantly, as the results suggest, variants of glutamate signalling genes, like the GRIK4 gene, either hinder or facilitate these neurochemical changes, where facilitation promotes neuroplastic recovery from depression and perhaps other mental illnesses.

Treating patients resistant to electroconvulsive therapy

So what about the 31 treatment resistant individuals in the study that were also resistant to electroconvulsive therapy. How do we treat them?

Another study reported that for the three severely treatment resistant patients included in the research, all responded well to a novel therapeutic regimen combining electroconvulsive therapy with injections of the drug ketamine. This is very interesting, as ketamine mainly acts through binding to NMDA (N-methyl-D-aspartate) receptors, which results in an increase in glutamate neurotransmission in GABAergic interneurons.

Combined, the two aforementioned studies suggest that by altering glutamate signalling pathways in the brain of treatment-resistant depressed patients using specialised drugs, this can create a window of opportunity for electroconvulsive therapy treatment to exert its effects in normalizing glutamate deficits and neurotransmitter imbalances, and stimulating neurogenesis.

Finding a genetic biomarker for electroconvulsive therapy response in the glutamate signalling system, adds to the slowly growing library that includes two dopamine-related genes and a serotonin-related gene.

By furthering this research, there may come a day in the not too distant future where specialized algorithms will consider genetic, clinical and other biological data in accurately predicting treatment response and prescribe the best treatment regimen from specific to the individual, and their unique presentation of depression or any other mental illness.

References

Anttila, S., Huuhka, K., Huuhka, M., Rontu, R., Mattila, K., Leinonen, E., & Lehtimäki, T. (2006). Interaction between TPH1 and GNB3 genotypes and electroconvulsive therapy in major depression Journal of Neural Transmission, 114 (4), 461-468 DOI: 10.1007/s00702-006-0583-6

Chen, Z., Yu, H., Yu, W., Pawlak, R., & Strickland, S. (2008). Proteolytic fragments of laminin promote excitotoxic neurodegeneration by up-regulation of the KA1 subunit of the kainate receptor The Journal of Cell Biology, 183 (7), 1299-1313 DOI: 10.1083/jcb.200803107

Huuhka, K., Anttila, S., Huuhka, M., Hietala, J., Huhtala, H., Mononen, N., Lehtimäki, T., & Leinonen, E. (2008). Dopamine 2 receptor C957T and catechol-o-methyltransferase Val158Met polymorphisms are associated with treatment response in electroconvulsive therapy Neuroscience Letters, 448 (1), 79-83 DOI: 10.1016/j.neulet.2008.10.015

Kautto, M., Kampman, O., Mononen, N., Lehtimäki, T., Haraldsson, S., Koivisto, P., & Leinonen, E. (2015). Serotonin transporter (5-HTTLPR) and norepinephrine transporter (NET) gene polymorphisms: Susceptibility and treatment response of electroconvulsive therapy in treatment resistant depression Neuroscience Letters, 590, 116-120 DOI: 10.1016/j.neulet.2015.01.077

Kallmünzer B, Volbers B, Karthaus A, Tektas OY, Kornhuber J, & Müller HH (2016). Treatment escalation in patients not responding to pharmacotherapy, psychotherapy, and electro-convulsive therapy: experiences from a novel regimen using intravenous S-ketamine as add-on therapy in treatment-resistant depression. Journal of neural transmission (Vienna, Austria : 1996), 123 (5), 549-52 PMID: 26721476

Lowry ER, Kruyer A, Norris EH, Cederroth CR, & Strickland S (2013). The GluK4 kainate receptor subunit regulates memory, mood, and excitotoxic neurodegeneration. Neuroscience, 235, 215-25 PMID: 23357115

Mathews, D., Henter, I., & Zarate, C. (2012). Targeting the Glutamatergic System to Treat Major Depressive Disorder Drugs, 72 (10), 1313-1333 DOI: 10.2165/11633130-000000000-00000

Minelli, A., Congiu, C., Ventriglia, M., Bortolomasi, M., Bonvicini, C., Abate, M., Sartori, R., Gainelli, G., & Gennarelli, M. (2016). Influence of GRIK4 genetic variants on the electroconvulsive therapy response Neuroscience Letters, 626, 94-98 DOI: 10.1016/j.neulet.2016.05.030

Sanacora G, & Saricicek A (2007). GABAergic contributions to the pathophysiology of depression and the mechanism of antidepressant action. CNS & neurological disorders drug targets, 6 (2), 127-40 PMID: 17430150

Yüksel C, & Öngür D (2010). Magnetic resonance spectroscopy studies of glutamate-related abnormalities in mood disorders. Biological psychiatry, 68 (9), 785-94 PMID: 20728076

Image via wilhei / Pixabay.

]]> /2016/09/02/electroshock-therapy-for-mental-illness-it-depends-on-your-genes/feed/ 0 /2016/08/16/best-and-worst-of-psychology-and-psychiatry-july-2016/ /2016/08/16/best-and-worst-of-psychology-and-psychiatry-july-2016/#respond Tue, 16 Aug 2016 15:00:05 +0000 /?p=22094 It’s a meta-analysis month again. Meta-analysis, when approached rigorously, can provide much more confidence in research findings by combining and analysing data from multiple studies. This month I will report more than the standard number of 10 studies because some meta-analytic findings from different papers complimented one another, painting a bigger, more detailed picture.

THE BEST

Therapists perceived as empathic and genuine have a strong relationship with clients

The first meta-analysis of its kind assessed how therapist empathy and genuineness contribute to the therapeutic alliance (i.e. the relationship between client and therapist). Analysis of 53 studies found that therapeutic alliance was significantly related to perceptions of therapist empathy as well as therapists’ genuineness.

Effect sizes for the relationships were large, highlighting the importance of therapists cultivating an empathetic and genuine relationship with their clients, particularly seeing how the strength of the therapeutic alliance is integral to therapeutic effectiveness.

MDMA-assisted therapy best for adults and trauma-focused CBT best for children with PTSD

Two meta-analyses assessed the efficacy of various interventions for the treatment of post-traumatic stress disorder, one in adults, one in children.

For children and adolescents, the analysis compared psychological and psychopharmacological interventions for the PTSD treatment. In particular, trauma-focused cognitive behavioural therapy (CBT) had a large effect on PTSD symptoms, however there was very little evidence to support the use of drugs in psychopharmacological interventions. Again this points to the need to severely limit the prescription of drugs for mental health problems in youth populations.

For adults, the analysis compared the efficacy of the most widely accepted treatment for PTSD, prolonged exposure therapy, and ±3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy. MDMA-assisted psychotherapy had a larger therapeutic effect as observed by the therapist and the patient, and a lower percentage of patients dropping out of therapy than prolonged exposure therapy. This meta-analysis is rather groundbreaking as it gives very solid grounds for popularizing MDMA-assisted psychotherapy as the “go to” therapy for treating adult PTSD.

Psychotherapy can reduce stomach problems in IBS even 12 months after treatment

Forty-one trials were included in a meta-analysis, comprising data from 2,290 individuals (1,183 assigned to psychotherapy and 1,107 assigned to a control condition), to assess the immediate, short-term, and long-term effictiveness of psychotherapy for reducing gastrointestinal problems in adults with irritable bowel syndrome (IBS).

It was found that psychotherapy had a medium effect immediately after therapy, with this medium strength effect being maintained after short-term follow-up periods (1-6 months after treatment) and long-term follow-up periods (6-12 months after treatment). This indicates that psychotherapy should be an essential part of IBS treatment.

Being a conscientious, open introvert is best recipe for preventing cognitive decline in old age

Certain personality traits have been linked with risk of dementia. Although the slowing of our brain in its use to understand the world is a natural part of aging, there are tremendous differences in the rate of decline from person to person, which is partly due to personality and psychology.

Using a collective sample of over 13,000 participants, the analysis found that higher neuroticism was associated with worse performance on global cognitive function and greater decline in memory. Conversely, conscientiousness and openness were associated with better memory performance and less cognitive decline over time. Additionally conscientiousness and lower extraversion (i.e. higher introversion) were associated with better cognitive status and less decline.

Exercise improves physical and psychological quality of life in people with depression

It has been stated that pharmacological antidepressants on average have a 50:50 chance of having any clinical benefit. Even for those that there is a benefit, the impairment of their quality of life in the physical, psychological, social and environmental domains typically remains.

The meta-analysis of the 6 studies meeting strict inclusion criteria found exercise to be a useful strategy to improve the physical and psychological domains of quality of life but not the social and environmental domains. Much more rigorous research is needed to find out what aspects of exercise (e.g., duration, intensity, modality and group or individualized sessions) work best depending on the individual (e.g., age, gender, depression severity).

THE WORST

Higher levels of depression in female sex workers linked to increased risk of STIs

The paper explored the associations between the psychological health of female sex workers and HIV risk by analyzing eight publications. They found that the prevalence of probable depression was as high as 62.4%. The majority of studies showed that higher scores in psychological health problems were associated with increased HIV risk behavior, in particular inconsistent condom use, or sexually transmitted infections.

Meta-analysis was used to examine the association between depression and inconsistent condom use and found that higher scores in depression put women at 2-3 times higher risk of inconsistent condom use, which puts them at greater risk of HIV and other sexually transmitted diseases.

Transition to menopause and menopause linked with double risk of depression symptoms

In an analysis of 11 studies, a women had double the risk of depressive symptoms during the perimenopause as compared to the premenopause, but not compared to the postmenopause. Moreover, symptoms were much more severe during perimenopause when compared to the premenopause. However, it is important to note that the odds of developing clinical depression were not significantly different between the stages of menopause.

Premenopause simply means when a woman is still having her typical menstrual cycle. Perimenopause refers to when women are going through the transition to menopause (i.e. when menstruation ceases and a women becomes infertile).

This means that women transitioning to menopause (i.e. perimenopause) and postmenopausal women have double the risk of depression symptoms than in their younger more fertile years, where perimenopause may offer a window of opportunity for early recognition and prevention of depression.

Additionally, a link between severity of vasomotor symptoms (e.g. hot flashes) and depressive symptoms was found during perimenopause, making vasomotor symptoms another early indicator or depression risk.

Conception-assisted mothers of twins and multiple births have higher depression risk than mothers of singletons

Eight papers constituting 2,993 mothers were included in the meta-analysis. Mothers of assisted reproductive technology (ART) multiple births were significantly more likely to have depression and stress than mothers of ART singletons, but were no different from mothers of naturally conceived multiples.

Further research is necessary to discover what makes depression and stress risks higher for multiple births specific to assisted reproductive technology to find ways to prevent post-natal distress, and negative consequences for fetal growth and development, and possibly develop an international framework to improve support for families of multiples.

Feeling unaccomplished linked with doubting of self-efficacy and job burnout

A meta-analytical review of 57 studies totalling over 20,000 participants found the effect that one’s level of self-efficacy (i.e. belief in one’s ability to succeed in specific situations or accomplish a task) has on increasing levels of job burnout (i.e. a special form of job stress involving physical, emotional or mental exhaustion combined with doubts about your competence and the value of your work) was of medium size.

One component of burnout in particular was heavily affected by personal beliefs of one’s level of self-efficacy, beliefs in one’s level of personal accomplishment. Belief in your ability to get the job done is linked with feeling proud and satisfied with your personal achievements at work. This protects from burnout. Whereas feeling unaccomplished is linked with feeling unable to perform well; this exacerbates burnout.

The effect of beliefs of accomplishment on burnout was strongest in teachers (compared to health-care providers), older workers, and those with longer work experience. Interestingly, personal accomplishment was previously proposed to be removed from burnout level tests, which is not supported by this meta-analysis.

Paternal depression in new fathers relatively common, more so if mum is depressed too

While postnatal depression in mothers is extensively researched and documented, little attention has been paid to depression in fathers. A total of 74 studies from 1980 to 2015 totalling over 40,000 participants found an average of 8% of men experience paternal depression during the transition to parenthood, with higher rates of maternal depression coinciding with higher rates of paternal depression, and the highest rates (13%) found in North America. Meanwhile, prevalence rates were not found to be affected by paternal age, education, parity, history of paternal depression, and timing of assessment. Considering how common paternal depression is, screening policies and interventions are recommended, especially when maternal depression is also present.

It should be noted that there was a large difference in rates from study to study indicating the importance of standardizing the measurement method. In fact, over 50 additional studies have been published since the analysis was conducted, increasing the likelihood of obtaining more accurate prevalence rates in the near future.

References

Amoroso, T., & Workman, M. (2016). Treating posttraumatic stress disorder with MDMA-assisted psychotherapy: A preliminary meta-analysis and comparison to prolonged exposure therapy Journal of Psychopharmacology, 30 (7), 595-600 DOI: 10.1177/0269881116642542

Cameron, E., Sedov, I., & Tomfohr-Madsen, L. (2016). Prevalence of paternal depression in pregnancy and the postpartum: An updated meta-analysis Journal of Affective Disorders, 206, 189-203 DOI: 10.1016/j.jad.2016.07.044

de Kruif, M., Spijker, A., & Molendijk, M. (2016). Depression during the perimenopause: A meta-analysis Journal of Affective Disorders, 206, 174-180 DOI: 10.1016/j.jad.2016.07.040

Laird, K., Tanner-Smith, E., Russell, A., Hollon, S., & Walker, L. (2016). Short-term and Long-term Efficacy of Psychological Therapies for Irritable Bowel Syndrome: A Systematic Review and Meta-analysis Clinical Gastroenterology and Hepatology, 14 (7), 937-9470000 DOI: 10.1016/j.cgh.2015.11.020

Luchetti, M., Terracciano, A., Stephan, Y., & Sutin, A. (2016). Personality and Cognitive Decline in Older Adults: Data From a Longitudinal Sample and Meta-Analysis The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 71 (4), 591-601 DOI: 10.1093/geronb/gbu184

Morina, N., Koerssen, R., & Pollet, T. (2016). Interventions for children and adolescents with posttraumatic stress disorder: A meta-analysis of comparative outcome studies Clinical Psychology Review, 47, 41-54 DOI: 10.1016/j.cpr.2016.05.006

Nienhuis, J., Owen, J., Valentine, J., Winkeljohn Black, S., Halford, T., Parazak, S., Budge, S., & Hilsenroth, M. (2016). Therapeutic alliance, empathy, and genuineness in individual adult psychotherapy: A meta-analytic review Psychotherapy Research, 1-13 DOI: 10.1080/10503307.2016.1204023

Schuch, F., Vancampfort, D., Rosenbaum, S., Richards, J., Ward, P., & Stubbs, B. (2016). Exercise improves physical and psychological quality of life in people with depression: A meta-analysis including the evaluation of control group response Psychiatry Research, 241, 47-54 DOI: 10.1016/j.psychres.2016.04.054

Shoji, K., Cieslak, R., Smoktunowicz, E., Rogala, A., Benight, C., & Luszczynska, A. (2015). Associations between job burnout and self-efficacy: a meta-analysis Anxiety, Stress, & Coping, 29 (4), 367-386 DOI: 10.1080/10615806.2015.1058369

van den Akker, O., Postavaru, G., & Purewal, S. (2016). Maternal psychosocial consequences of twins and multiple births following assisted and natural conception: a meta-analysis Reproductive BioMedicine Online, 33 (1), 1-14 DOI: 10.1016/j.rbmo.2016.04.009

Yuen, W., Tran, L., Wong, C., Holroyd, E., Tang, C., & Wong, W. (2016). Psychological health and HIV transmission among female sex workers: a systematic review and meta-analysis AIDS Care, 28 (7), 816-824 DOI: 10.1080/09540121.2016.1139038

Image via johnhain / Pixabay.

]]> /2016/08/16/best-and-worst-of-psychology-and-psychiatry-july-2016/feed/ 0 /2016/07/12/how-to-boost-vacation-health-benefits-and-avoid-exhaustion/ /2016/07/12/how-to-boost-vacation-health-benefits-and-avoid-exhaustion/#respond Tue, 12 Jul 2016 15:00:01 +0000 /?p=21872 Multiple new research studies indicate that there are many physical and mental health benefits to gain from taking a holiday, some reportedly remaining even two months after we have returned to the daily grind. However, research also shows that certain habits and attitudes can neutralize these benefits, and even leave you more tired, stressed out, unhealthy and overwhelmed than how you started out.

With the average vacation time a year typically being less than 20 days per year, thankfully recent science research suggests how we can get the greatest health benefits from this short and sweet holiday time and how to avoid needing a vacation to recover from your vacation!

The benefits of taking a vacation

1) Life satisfaction

Vacations can contribute to psychological wellness, where positive holiday experiences have spill-over effects how individuals evaluate their overall satisfaction with life, particularly boosting satisfaction with social life, leisure life, family life, love life, work life, spiritual life, intellectual life, culinary life, and travel life.

A Canadian study suggests that these improvements in life satisfaction are influenced by holidays promoting improved work-life balance, decreased time pressure and better mental health.

2) Physical improvements

Improvements in sleep quality, mood, physical complaints and blood pressure have also been reported to persist after returning from vacation and getting back to reality.

3) Mental health

On top of vacations being a great emotional wellbeing and mood booster, another study reported that the anxiety creating tendency to focus on something causing us distress, instead of thinking of solutions or getting over it, called rumination, lessens during vacations, and stays low even two weeks after vacation.

4) Creativity

Cognitive flexibility, i.e. the component of creativity that bestows the ability to adapt our thinking to face new and unexpected conditions in the environment, has been shown to be boosted after a long summer holiday.

Ideas generated at work after a holiday were more diverse than before going on vacation, showing more ingenuity by avoiding a reliance on conventional ideas and routine solutions.

5) Career

A higher degree of job involvement coupled with decreased job stress and work burnout makes for a happier and harder worker when returning to work.

How to boost vacation benefits and avoid pitfalls

The Vacation Deprivation Survey, conducted for Expedia, indicates that in 2013, 10% of Americans felt they could never relax while on vacation. Such negative vacation experiences have been shown to detract from overall life satisfaction, particularly in social life, family life, love life, work life, health and safety, financial life, spiritual life, and culinary life.

And even for those that have the time of their lives when they are away, some habits can counteract the good that those positive holiday experiences achieved:

1) Make the most of the pre-vacation high

You can ride the pre-trip high, where research on the ‘rosy view’ phenomenon suggests the pre-trip high may have an even more positive impact on one’s well-being, presumably even stronger than the actual experience itself or post trip memories.

2) Don’t let pre-vacation workload and homeload get out of control

The rosy view phenomenon can counterbalance the all-too-common pre-vacation stress that comes with the piling up of homeload (e.g. packing, tidying, arranging pet care etc.) and workload need to finish work on time. However, this is not always the case and women in particular are at higher risk of missing out on vacation benefits due to generally having a larger increase in homeload (on top of an increased workload) when compared to their partner.

3) Plan an easy return to work

High work demands after vacation have been shown to eliminate positive vacation effects and speed up the fade-out process. Preparing in advance for a gently easing in to work, and preventing overwhelming workloads, is a good move.

4) Choose leisure goals wisely

Many people make goals on holiday that they don’t keep like ‘I’ll run on the beach every morning’ or ‘visit every touristic sight there is too see’. Well, research suggests if you set more attractive and realistic travel goals and take actions to implement them, you are more likely to experience higher levels of subjective wellbeing from your vacation.

5) Leave narcissism at the door

Particularly in men, higher levels of narcissism are linked with larger differences between what one expects from a holiday and what is actually experienced. Researchers suggest that this may be due to when something doesn’t go to plan, the positive vacation illusions of narcissistic individuals are burst, challenging their sense of control over events in their lives.

6) Workaholics…work a little less please!

If you work compulsively, you might get a greater boost in wellbeing during your holiday, but when you return, the drop in wellbeing is much greater than for non-workaholics. Being a workaholic is associated with many nasty problems with physical and mental health and best avoided anyway, but making an active choice to change workaholic habits could generate an even greater vacation-induced wellbeing boost than ever experienced.

6) Make healthy eating choices

These findings should be taken with a pinch of salt due to the absence of a control group. Nonetheless, one study found a very small, but statistically significant, weight gain of 0.3 kg after the vacation period that persisted 6 weeks after vacation. They suggested that cumulatively, year on year, this could contribute to obesity. Taking a healthy approach to eating and exercising habits while on vacation should do the trick.

References

Besser, A., Zeigler-Hill, V., Weinberg, M., & Pincus, A. (2016). Do great expectations lead to great disappointments? Pathological narcissism and the evaluation of vacation experiences Personality and Individual Differences, 89, 75-79 DOI: 10.1016/j.paid.2015.10.003

Cooper, J., & Tokar, T. (2016). A prospective study on vacation weight gain in adults Physiology & Behavior, 156, 43-47 DOI: 10.1016/j.physbeh.2015.12.028

de Bloom, J., Radstaak, M., & Geurts, S. (2014). Vacation Effects on Behaviour, Cognition and Emotions of Compulsive and Non-compulsive Workers: Do Obsessive Workers Go ‘Cold Turkey’? Stress and Health, 30 (3), 232-243 DOI: 10.1002/smi.2600

de Bloom, J., Ritter, S., Kühnel, J., Reinders, J., & Geurts, S. (2014). Vacation from work: A ‘ticket to creativity’? Tourism Management, 44, 164-171 DOI: 10.1016/j.tourman.2014.03.013

Hilbrecht, M., & Smale, B. (2016). The contribution of paid vacation time to wellbeing among employed Canadians Leisure/Loisir, 40 (1), 31-54 DOI: 10.1080/14927713.2016.1144964

Nawijn, J., De Bloom, J., & Geurts, S. (2013). Pre-Vacation Time: Blessing or Burden? Leisure Sciences, 35 (1), 33-44 DOI: 10.1080/01490400.2013.739875

Rosenkilde, M. (2016). Vacation weight gain — Is it really that bad? Physiology & Behavior, 158 DOI: 10.1016/j.physbeh.2016.02.030

Image via Stevebidmead / Pixabay.

]]> /2016/07/12/how-to-boost-vacation-health-benefits-and-avoid-exhaustion/feed/ 0 /2016/07/10/being-an-adult-virgin-a-modern-day-relationship-curse/ /2016/07/10/being-an-adult-virgin-a-modern-day-relationship-curse/#respond Sun, 10 Jul 2016 15:00:14 +0000 /?p=21869 Irrespective of the reason for being an adult virgin, new research coming from The Kinsey Institute indicates that it can be tough in the modern day, thanks to a ménage à trois of negative stigma and discrimination coming from more experienced adults, other adult virgins, and themselves.

Being a virgin until married, not so many moons ago, was regarded near enough the world over as a symbol of purity and respectability, and premarital sex was typically shunned. But today in Western societies in particular, premarital sex in adolescence is generally the norm. Yet an approximate minimum of 1.1 million American men and 800,000 women between 25 and 45 years old characterize as heterosexual virgins.

The three studies, published in The Journal of Sex Research, assessed perceptions of, and attitudes toward, heterosexual adult virgins — defined as the absence of experiencing vaginal penetrative intercourse.

Study 1: Virgins and non-virgins perceptions of stigma & discrimination

Study 1 involved a survey of 560 heterosexual American adults revealing that 141 participants were virgins (25.2%; 79 women, 62 men), with an age range of 18 to 52 years old.

Incorporating a stigma assessment scale in the survey also revealed that adult virgins feel more stigmatized for being a virgin than non-virgin’s feel stigmatized for being sexually experienced, irrespective of if they had 8 or 38 previous sexual partners.

This suggests that relative to non-virgins, being a virgin feels less like a social blessing and more like a social curse.

Study 2: Virgin discrimination in the form of limited serious relationship opportunities

A U.S. nationally representative sample of 4,934 single, heterosexual adults (21-76+ years old) were asked: How likely are you to consider getting into a committed relationship with someone who is a virgin?

The response? Chances look slim.

There was a low likelihood of considering getting into a relationship with a virgin across all participants, yet particularly with:

• younger participants (particularly women)
• sexually experienced participants (particularly men)
• virgins themselves (particularly women)

Seeing as participants in the same situation of relative inexperience discriminate against other virgins, the authors suggested that relationship opportunities for sexually inexperienced adults may be pretty limited.

Relatedly, another study found that women experience more sexual guilt compared to men, with levels of guilt increasing the more religious the woman is.

On the flip side, by process of elimination, one could loosely hypothesize that those most likely to enter a long-term heterosexual relationship with an adult virgin may be older virgin males or older sexually experienced females, cougars some might say.

Study 3: Less discrimination observed on online dating websites

To reduce bias, 353 heterosexual young adults aged 18 to 26 were misled into thinking they were helping test a new online dating website. Each participant was presented with a single online dating profile that included the usual demographics and personality profile. Additionally, the only notable varying item viewed from participant to participant was level bars that indicated how romantically or sexually experienced the potential match was.

The participants were then asked what they thought about their potential as a partner with a series of questions. A few findings emerged:

• Sexually experienced participants found both experienced and inexperienced potential dates equally attractive.
• Virgins found a sexually inexperienced participant more attractive than those with more experience.
• Having greater romantic experience did not influence the effects that sexual experience has on datability. Nonetheless romantic experience was an important factor in evaluating partners.

So in relation to the second study, when asked about a virgin’s potential as a partner in a serious committed relationship, virgins were not considered popular by both non-virgins and virgins. But in this study, in the context of rating a potential date on an online dating website, being a virgin doesn’t appear to register on the radar and actually attracts virgins?

It could simply be that generally, online dating websites are more increasingly viewed as a path leading to sexually orientated, yet noncomitant, experiences or a quick route to a one night stand or fling. Indeed, research has shown this is particularly true for the young Tinder-savvy adult generation, like the participants in this experiment.

This may imply that flings with virgins via online dating are considered more likely than a committed relationship is. However, the way responses to the questionnaire were manipulated in the experiment does not allow the assessment of this, and further research is required to get a more detailed understanding.

Although other research indicates it is possible for one to have too much sexual experience, the study in question indicates that adult virginity is linked with social stigma and discrimination, where virgins are considered as less desirable partners in committed intimate relationships.

In conclusion the authors suggest that:

Because intimate relationships are essential to wellbeing, especially across the adult life course, it seems that being a late bloomer with sexual debut could lower chances of healthy intimate relationship development even when one is open to such relationships and thereby have a negative impact on wellbeing.

References

Abbott, E., & Abbott, E. (2000). A history of Celibacy: From Athena to Elizabeth I, Leonardo DA Vinci, Florence Nightingale, Gandhi, and Cher. New York: Simon & Schuster.

Eisenberg, M., Shindel, A., Smith, J., Lue, T., & Walsh, T. (2009). Who is the 40-Year-Old Virgin and Where Did He/She Come From? Data from the National Survey of Family Growth The Journal of Sexual Medicine, 6 (8), 2154-2161 DOI: 10.1111/j.1743-6109.2009.01327.x

Gesselman, A., Webster, G., & Garcia, J. (2016). Has Virginity Lost Its Virtue? Relationship Stigma Associated With Being a Sexually Inexperienced Adult The Journal of Sex Research, 1-12 DOI: 10.1080/00224499.2016.1144042

Lipman, C., & Moore, A. (2016). Virginity and Guilt Differences Between Men and Women. Butler Journal of Undergraduate Research.

Regan, P., Durvasula, R., Howell, L., Ureño, O., & Rea, M. (2004). GENDER, ETHNICITY, AND THE DEVELOPMENTAL TIMING OF FIRST SEXUAL AND ROMANTIC EXPERIENCES Social Behavior and Personality: an international journal, 32 (7), 667-676 DOI: 10.2224/sbp.2004.32.7.667

Vrangalova, Z., Bukberg, R., & Rieger, G. (2013). Birds of a feather? Not when it comes to sexual permissiveness Journal of Social and Personal Relationships, 31 (1), 93-113 DOI: 10.1177/0265407513487638

Wellings, K. (1995). The Social Organization of Sexuality: Sexual Practices in the United States; Sex in America: A Definitive Survey BMJ, 310 (6978), 540-540 DOI: 10.1136/bmj.310.6978.540

Image via seagul / Pixabay.

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