Health Check: PANDAS | pandas, childhood disorder

A little known childhood disorder dramatically attacks a child physically and emotionally, and it’s not on many doctors’ radar screens so often it goes mis- or undiagnosed.

Jeanne Muto-Kyle said her son, T.J., changed drastically in February 2010.

“I couldn’t leave the house. I was seeing things. I went a whole day without speaking,” T.J. said.

Muto-Kyle said her son went through three years of doctors and testing.

“I was afraid for myself,” T.J. said. “I thought I was literally insane.”

“One day at school and all of a sudden I was going like this a lot in school. I didn’t know why,” Austin Teixeira said, demonstrating a tic.

“He stopped eating. He had sensory issues. He developed really strong tics, blinking of his eyes,” Moira Teixeira, Austin’s mother, said. “Out of nowhere.”

It took many months for 10-year-old Austin and 14-year-old T.J. to get accurate diagnoses. They have PANDAS.

“It’s Pediatric Autoimmune Neuropsychological Disorder Associated with Streptococcus. But, you know, you wake up one day and the child that you’ve known is someone else,” Moira Teixeira said.

Common childhood ailments can trigger this complex disorder, like strep throat and pneumonia. And PANDAS strikes without warning. The symptoms can be many or few.

T.J. had anxiety, tics and severe obsessive-compulsive disorder.

“He was fearful of everything,” Muto-Kyle said.

That is why parents of children with PANDAS in Southern New England come together each month in person and almost daily on Facebook.

The disorder takes a toll on the entire family, and getting together provides a source of comfort.

“We can laugh about it. You know it’s kind of like, ‘I’ll trade you some rage for some OCD.’ Because it’s like I’ve had enough rage now for the last couple months,” Moira Teixeira said. “Austin went four weeks this summer afraid to eat.”

The stories are similar to varying degrees, and all of them are challenging. T.J. was treated with antibiotics and prednisone.

“Within a month it was night and day,” his mother said.

He’s back to school full time.

As for Austin?

“For the past like month or two I’ve felt great,” he said.

The problem with PANDAS is it really never goes away. There are flare-ups that can be triggered by being around someone with pneumonia or strep throat.

National experts in PANDAS are gathering in Providence this weekend to talk about the latest research and treatments.

Cannabidiol (CBD) May Help Treat Obsessive-Compulsive Disorder

Brazilian Researchers Investigated OCD Cannabidiol

As we know, medical marijuana has long been used to help treat various types of anxiety. Cannabidiol (CBD), in particular, has received a great deal of attention for it’s anti-anxiety potential and a number of high-CBD products are making their way into the market with increased regularity.

That being said, no two forms of anxiety are alike. One suffering from social anxiety has a vastly different experience than that of a PTSD patient. The same is true of those suffering from obsessive-compulsive disorder.

Their experience is unique – OCD patients have obsessive thoughts and worries that trigger anxiety. The only way to compensate for this anxiety is to act out their compulsions. We all, at some point, question whether we left our front door open; most of us are able to go on with the day, forgetting all about it until later. With OCD patients, however, anxiety levels often skyrocket if unable to complete their compulsions (check the front door in the example above).

Cannabidiol (CBD) Could Help Patients Manage OCD Symptoms

Presently, obsessive-compulsive patients are often treated with selective serotonin re-uptake inhibitors (SSRIs), like the antidepressant Prozac, in addition to psychotherapy. With that said, a team of researchers published a study in the journal Fundamental Clinical Pharmacology earlier this month that investigated cannabidiol (CBD) and its ability to help treat rats with OCD.

The research team, which represented the Department of Pharmacology at the University of Sao Paolo, was led by Dr. Francisco Guimarães. First, they administered Meta-chloro-phenyl-piperazine (mCPP) – a psychoactive drug that is often found in ecstasy pills. It is known to induce panic attacks in those prone to having them and has been determined make symptoms of OCD worse. Further, the study adds that mCPP is been known to inhibit the anti-compulsive effects of SSRIs.

“Even a low dose of CBD decreased the marble-burying behavior without a change in the rats overall activity level.”

Once mCPP was administered, the researchers conducted a “marble-burying test” with the rats in order to evaluate OCD activity. Low doses of the drug, according to the study, was found to increase marble-burying tendencies in rats, while large dosages seemed to decrease them. There was, however, no difference in noticeable anxiety behaviors.

The researchers then administered two levels (30mg/kg or 15mg/kg) of cannabidiol (CBD) and evaluated the obsessive-compulsive activity in each rat. Interestingly, even a low dose of CBD decreased the marble-burying behavior without a change in the rats’ overall activity level.

According to the study, its results reinforce the possible anti-compulsive effect of cannabidiol (CBD). More research will be necessary before CBD is used to treat obsessive-compulsive disorder in a clinical setting, but findings such as these suggest that cannabis may be a valuable tool in OCD treatment.

The invisible obsessions ruining lives: Say ‘Obsessive Compulsive Disorder …

  • Physical acts are the most common forms of compulsion
  • But 10-15% of OCD sufferers carry out their rituals entirely in their minds
  • This form of the disorder is harder to treat and can go unnoticed for years
  • Almost half the UK population think they have mild OCD
  • The true incidence is between 1-3% of the population

By
Grace Mccann

17:58 EST, 4 November 2013


|

18:02 EST, 4 November 2013

Mental compulsions: David Bass is plagued by thoughts that he has said something offensive

Mental compulsions: David Bass is plagued by thoughts that he has said something offensive

The words ‘obsessive compulsive disorder’ usually conjure up a picture of someone constantly washing their hands, or checking they have locked the door or turned off the stove.

OCD, which affects one person in 100, causes obsessive, unwanted thoughts and images, which trigger compulsive, ritualistic behaviour.

Physical acts such as washing and checking are the most common compulsions, but 10 to 15 per cent of sufferers carry out their rituals purely internally, in their minds.

David Bass is one of them.

‘My OCD’s all going on in my head,’ says David, 25, who is from Bedfordshire and worked as a TV presenter before becoming ill.

David is plagued by thoughts that he has said something offensive – when talking to women, he panics needlessly that he has made sexually inappropriate remarks; when speaking to a black friend, he worries he has said something that could be construed as racist.

As a result, he scans over everything he has just said.

‘I feel compelled to replay everything I’ve said in my mind,’ says David.  ‘Ironically, this means I zone out and may end up seeming rude anyway.’

This form of the disorder is harder to treat – and because it’s less recognised and there is no visible behaviour, can go unnoticed for years. Sufferers may not even realise they have it.

Studies show there are many misconceptions surrounding OCD. Research published last month suggested that almost half the UK population believe they have mild obsessive compulsive disorder, when the true incidence is much lower – between 1 and 3 per cent of the population (ie, nearly a million people).

Experts note that people frequently say they are ‘a little bit OCD’, meaning they like routine or need to double-check they have locked the front door – but this is to misunderstand what can be a devastating mental illness.

‘Performing such rituals is not pleasurable,’ says a spokesman for the National Institute of Mental Health. ‘At best it provides temporary relief from the anxiety created by obsessive thoughts.’

The form of OCD that David suffers from has been described as ‘purely obsessional OCD’ or ‘pure O’ because there is no visible compulsive behaviour (the ‘C’) – but this is another misconception.

‘There’s a myth that OCD can exist without the “C”,’ says Professor David Mataix-Cols, a specialist in the disorder at the Institute of Psychiatry in London.

‘A patient may suggest that they have only the obsessive part of the disorder, but we find they are doing lots of the compulsive behaviour inside their heads – for example, praying silently in an effort to calm their anxiety.’

The stereotype: Hand-washing is one of the more common compulsions, but 10 to 15 per cent of those suffering from OCD carry out their rituals internally

The stereotype: Hand-washing is one of the more common compulsions, but 10 to 15 per cent of those suffering from OCD carry out their rituals internally

For these patients, such rituals perform the same function that handwashing does for others, adds Dr David Veale, a consultant psychiatrist and OCD expert at the South London and Maudsley NHS Trust.

He explains that they try to get rid of the obsessive thoughts by distracting themselves or ‘neutralising’ the thoughts by performing mental rituals to try to calm their anxiety.

‘But these ways of coping ultimately don’t work – or make things worse,’ says Dr Veale.

Doctors can’t explain why some people suffer only psychological symptoms, but Dr Veale says that such patients are often highly intelligent: ‘They are likely to be analytical types, trying to solve things in their heads.’

David Bass struggles with an exhausting range of mental compulsions. At the moment, he is suffering with an obsession that he may somehow end up  in prison.

‘I keep worrying that I’ve knocked someone over when driving,’ he says. ‘I repeat, “You haven’t, you haven’t, you haven’t” in my head to try to reassure myself.’

He often attempts to suppress the disturbing thoughts that trigger his anxieties. ‘I’ve done this a lot in church, where I’ve been plagued by the fear that I would shout out something blasphemous, such as “Jesus is a demon”,’ he says.

‘It’s an unbearable thought so I try not to think it.’

Unfortunately, this fuels the problem. It’s a phenomenon known as the white bear effect, after studies in which healthy people were asked not to think of white bears, and found they could not help thinking of exactly that.

Indeed, David is so overwhelmed by the thought of blaspheming in church that he no longer feels able to worship.

We are all occasionally struck by unwanted thoughts. But while most of us can think of something else and move on, OCD sufferers become consumed by them.

What causes the disorder is unknown but stress, genetics and childhood difficulties may all play a part.

David, who has suffered with the condition from the age of 12, suspects that it runs in his family. His mother and maternal grandmother have both displayed compulsive behaviour.

‘My mum once went on holiday and had to drive 50 miles back to check she hadn’t left the gas on,’ he recalls.

‘I keep worrying that I’ve knocked
someone over when driving. I repeat, “You haven’t, you
haven’t, you haven’t” in my head to try to reassure myself.’

The disorder is generally very treatable. The standard treatments are drug therapy with antidepressants known as selective serotonin reuptake inhibitors, and cognitive behavioural therapy (CBT), a psychological method for helping people change their thinking and behaviour.

But OCD with purely mental compulsions can be harder to overcome, says Dr Veale.

This is because the standard CBT technique – gradually exposing patients to what they fear, and teaching them how to respond – is harder to apply.

David overcame an obsession with hygiene when he was a teenager using this approach.

‘I was particularly scared of dog muck,’ says David, who became so unwell that he would feel  compelled to open doors with his feet and wash his hands until they bled.

As part of his therapy, he had to hold a shoe and not wash his hands afterwards. ‘It sounds strange but it worked,’ he says. He was well between the ages of 14 and 16. But then the illness returned, this time with purely mental compulsions.

OCD symptoms often change in this way, according to Dr Veale.

Unfortunately, David is struggling to apply exposure therapy to his ‘What if I’ve said or done something awful?’ thoughts. Exposing oneself to something tangible, such as dirt, is easier.

David is taking the antidepressant sertraline and being encouraged by his therapist to face his fears by, for example, telling himself that he has actually knocked over a cyclist, and picturing the scene in as much detail as possible.

He must then resist the urge to neutralise the frightening thought or image with his mental rituals of saying to himself ‘you haven’t, you haven’t’.

‘Being properly frightened, and learning that you can calm down on your own without ritualising is essential,’ says Professor Mataix-Cols.

Dr Veale says it’s also important to help patients understand the context in which the obsessions are occurring. ‘It’s usually at a time of great stress or linked to some emotional memory,’ he says.

Perhaps the most important therapy for patients like David, whose anguish has often left him unable to leave the house, is to try to lead as normal a life as possible.

‘It’s crucial to get out there and do the things that are important to you,’ says Dr Veale.

n For more information, see ocdaction.org.uk and ocduk.org

 


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Jo,

London, United Kingdom,

1 hour ago

This is me!! Glad to see I am already doing what the doctors say I should do. I allow the thoughts to come and try not to react because that makes it worse. You have to focus on what is good in your life.

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Obsessions, Compulsions and Fear: Film Director R. Shanea Williams Gives a … | obsession, compulsion

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New York, NY (PRWEB) November 03, 2013

If OCD was an American city, it would be the second most populated city in the country. Health officials believe there are 4 million adults and children in the U.S. living with Obsessive Compulsive Disorder. Now a new short film, Contamination, is putting a face on the often-misunderstood anxiety disorder.

“I had an idea about this character for a long time, a woman who was struggling with severe germaphobia which resulted in her having OCD,” said the film’s director, R. Shanea Williams. “Soon the voice for this character became louder and louder and I created a story around her. I felt it’d work as a short film due to it being a contained environment.”

Actress Cherise Boothe plays the lead actress, Jade. The Obie Award winner, who was featured in the film 42 and the Pulitzer Prize-winning play Ruined, explained why she felt compelled to participate in the project. “Jade’s life circumstances have her battling with a condition by which she feels completely overwhelmed and controlled. Her condition was one I knew little about and wondered how someone gets to the place where we find her in the film,” said Boothe. “The journey of getting inside Jade’s character, experiencing the world from her perspective, was an intriguing, challenging and daunting endeavor, three great draws for any artist.”

Williams said she wanted to give a voice to people we do not often see struggling with OCD. “If people are going to learn something from this film, it is that mental health issues are universal and affect people of all races, ages, and backgrounds.”

Contamination will make the rounds at several film festivals next year.

###

About the director:

R. Shanea Williams is a native of Richmond, Virginia and currently lives in Queens, New York. She graduated from the University of Virginia in 2003 with a BA in English and received her MFA in dramatic writing (with a concentration in screenwriting) from New York University in 2008. Williams was a quarterfinalist in the 2007 Slamdance Screenwriting Competition, and in 2011, she was a top 5 screenplay finalist in the Urbanworld Film Festival Screenwriting Competition. Contamination is her second short film.

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Gain knowledge during OCD Awareness Week

This year, OCD Awareness Week runs Oct. 14 through Oct. 20. Obsessive-compulsive disorder (OCD) is a treatable, neurobiological anxiety disorder with very distinct signs and symptoms. A person suffering with OCD has persistent thoughts and fears (obsessions) associated with repetitive behaviors (compulsions), which typically result in a short-lived relief of anxiety.

The obsessions and compulsions can be extremely time-consuming, causing significant emotional distress, and may greatly interfere with day-to-day functioning and interpersonal relationships. Individuals with OCD may go to great lengths to hide their obsessions and compulsions due to embarrassment and shame.

It is estimated that one in every 40 adults, and one in every 100 children suffer with OCD.

Support groups are an important tool for individuals with OCD, their family members and friends. Making a connection with others who are impacted by OCD provides a sense of community, and lets you know you are not alone in this struggle. You can gain valuable insight, practical ideas and support from other OCD sufferers in your area.

I am recovered from severe OCD and have been co-managing a page on Facebook, “Obsessive Compulsive Disorder / OCD Awareness” (17,000-plus “Likes”) for nine months. I also have my own page (“OCD Anxiety Awareness ‘Recovery Coach’”). You may connect with us for information, support or our online group.

I am in the process of starting an in-person group in Napa. Please contact me if you have interest.

Mee Rhorer / Napa

What Is OCD? | ocd, obsessive compulsive disorder

ocd, obsessive compulsive disorder

ocd


Frequent, repetitive handwashing may be a sign of obsessive-compulsive disorder, or OCD.
Credit: caimacanul / Shutterstock.com

Obsessive compulsive disorder, or OCD, is a mental disorder characterized by recurrent, persistent thoughts (obsessions) and ritualistic behaviors (compulsions) that interfere with a person’s daily life and relationships, according to the “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition” (DSM-5).

People with OCD often realize their compulsive behavior is irrational, but they feel powerless to stop, since that only increases their level of anxiety.

The International OCD Foundation estimates that about 1 in 100 adults in the United States — and 1 in 200 children — has OCD. The condition often appears first during childhood or the teen years, and it tends to occur in men and women in roughly equal numbers. [Hypersex to Hoarding: 7 New Psychological Disorders]

Symptoms of OCD

OCD has many manifestations, but commonly, the obsessions of a person who has OCD are in some way linked to his or her compulsions. A child who obsesses about germs or contamination, for example, might compulsively wash his hands. Other common obsessions and compulsions include the constant need to “check” things, like that the front door is locked or the oven is turned off; an obsession with counting or arranging things in a particular order; or compulsive hoarding.

While OCD symptoms show up differently in each individual, those who have the disorder have at least one thing in common: Their obsessive-compulsive tendencies get in the way of everyday life. This is what separates OCD from the day-to-day anxiety and habits that are deemed “normal.”

A small amount of obsessive thinking or compulsive behavior is not necessarily a symptom of OCD; these are normal responses to real stress that serve a valuable purpose. The ability to foresee — and then worry about — possible dangers allowed early humans to take precautionary measures and survive difficult situations. But those with OCD may worry and compulsively perform “precautionary” behaviors even after they have determined that no danger exists.

Causes of OCD

Researchers have many theories about the causes of OCD in humans, ranging from childhood trauma to bacterial infection to genetics — the condition often runs in families. But scientists agree that OCD coincides with abnormalities in certain brain processes.

When exposed to threatening or frustrating situations, most people with OCD experience hyperactivity in the parts of the brain regulating external stimuli, including the amygdala — the part of the brain where danger is evaluated and processed — and the orbital frontal cortex, which performs cognitive processing and decision-making functions.

Serotonin is a neurotransmitter (a chemical that relays messages within the brain) that may play a part in OCD. People with the condition who take medication that modifies serotonin levels have fewer symptoms of OCD (see Treatments, below).

Diagnosis of OCD

While not all perfectionist behaviors are symptomatic of OCD, the disorder can become so severe and time-consuming that it becomes dysfunctional, preventing a person from normal day-to-day activities.

Only a qualified physician or mental-health provider can make an accurate diagnosis of OCD. The condition is often present with other mental-health disorders, such as depression, eating disorders or other anxiety disorders.

Treatment for OCD

There are several methods of treating OCD; most involve some kind of medication, psychotherapy or a combination of both.

Cognitive-behavioral therapy (CBT) has been shown to be effective in treating OCD by teaching the individual with the disorder to try a different approach to those situations that trigger their obsessive-compulsive behavior. One type of CBT, known as exposure and response prevention, can help people with OCD by teaching them healthy ways to respond when exposed to a feared object (dirt or dust, for example).

Selective serotonin reuptake inhibitor (SSRI) antidepressants are the medications most commonly prescribed for treating OCD. Anti-anxiety medication may also be prescribed.

Both types of medications may take several weeks to begin to work, according to the National Institutes of Health. In addition to side effects such as headache, nausea and insomnia, antidepressants have been shown to cause suicidal thoughts and behaviors in some people. People taking antidepressants need to be monitored closely, especially when starting their treatment.

Follow Elizabeth Palermo on Twitter @techEpalermo, Facebook or Google+. Follow LiveScience @livescience. We’re also on Facebook Google+.

Genetic analysis reveals insights into the genetic architecture of OCD … | genetic, ocd

An international research consortium led by investigators at Massachusetts General Hospital (MGH) and the University of Chicago has answered several questions about the genetic background of obsessive-compulsive disorder (OCD) and Tourette syndrome (TS), providing the first direct confirmation that both are highly heritable and also revealing major differences between the underlying genetic makeup of the disorders. Their report is being published in the October issue of the open-access journal PLOS Genetics.

“Both TS and OCD appear to have a genetic architecture of many different – perhaps hundreds in each person – acting in concert to cause disease,” says Jeremiah Scharf, MD, PhD, of the Psychiatric and Neurodevelopmental Genetics Unit in the MGH Departments of Psychiatry and Neurology, senior corresponding author of the report. “By directly comparing and contrasting both disorders, we found that OCD heritability appears to be concentrated in particular chromosomes – particularly chromosome 15 – while TS heritability is spread across many different chromosomes.”

An anxiety disorder characterized by obsessions and compulsions that disrupt the lives of patients, OCD is the fourth most common psychiatric illness. TS is a chronic disorder characterized by motor and vocal tics that usually begins in childhood and is often accompanied by conditions like OCD or attention-deficit hyperactivity disorder. Both conditions have been considered to be heritable, since they are known to often recur in close relatives of affected individuals, but identifying specific genes that confer risk has been challenging.

Two reports published last year in the journal Molecular Psychiatry, with leadership from Scharf and several co-authors of the current study, described genome-wide association studies (GWAS) of thousands of affected individuals and controls. While those studies identified several gene variants that appeared to increase the risk of each disorder, none of the associations were strong enough to meet the strict standards of genome-wide significance. Since the GWAS approach is designed to identify relatively common gene variants and it has been proposed that OCD and TS might be influenced by a number of rare variants, the research team adopted a different method. Called genome-wide complex trait analysis (GCTA), the approach allows simultaneous comparision of genetic variation across the entire genome, rather than the GWAS method of testing sites one at a time, as well as estimating the proportion of disease heritability caused by rare and common variants.

“Trying to find a single causative gene for diseases with a complex is like looking for the proverbial needle in a haystack,” says Lea Davis, PhD, of the section of Genetic Medicine at the University of Chicago, co-corresponding author of the PLOS Genetics report. “With this approach, we aren’t looking for individual genes. By examining the properties of all genes that could contribute to TS or OCD at once, we’re actually testing the whole haystack and asking where we’re more likely to find the needles.”


Using GCTA, the researchers analyzed the same genetic datasets screened in the Molecular Psychiatry reports – almost 1,500 individuals affected with OCD compared with more than 5,500 controls, and nearly TS 1,500 patients compared with more than 5,200 controls. To minimize variations that might result from slight difference in experimental techniques, all genotyping was done by collaborators at the Broad Institute of Harvard and MIT, who generated the data at the same time using the same equipment. Davis was able to analyze the resulting data on a chromosome-by-chromosome basis, along with the frequency of the identified variants and the function of variants associated with each condition.

The results found that the degree of heritability for both disorders captured by GWAS variants is actually quite close to what previously was predicted based on studies of families impacted by the disorders. “This is a crucial point for genetic researchers, as there has been a lot of controversy in human genetics about what is called ‘missing heritability’,” explains Scharf. “For many diseases, definitive genome-wide significant variants account for only a minute fraction of overall heritability, raising questions about the validity of the approach. Our findings demonstrate that the vast majority of genetic susceptibility to TS and OCD can be discovered using GWAS methods. In fact, the degree of captured by GWAS variants is higher for TS and OCD than for any other complex trait studied to date.”

Nancy Cox, PhD, section chief of Genetic Medicine at the University of Chicago and co-senior author of the PLOS Genetics report, adds, “Despite the fact that we confirm there is shared genetic liability between these two disorders, we also show there are notable differences in the types of genetic variants that contribute to risk. TS appears to derive about 20 percent of genetic susceptibility from rare variants, while OCD appears to derive all of its susceptibility from variants that are quite common, which is something that has not been seen before.”

In terms of the potential impact of the risk-associated variants, about half the risk for both disorders appears to be accounted for by variants already known to influence the expression of genes in the brain. Further investigation of those findings could lead to identification of the affected genes and how the expression changes contribute to the development of TS and OCD. Additional studies in even larger patient populations, some of which are in the planning stages, could identify the biologic pathways disrupted in the disorder, potentially leading to new therapeutic approaches.

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SUBNETS aims for systems-based neurotechnology and understanding for the …

Despite the best efforts of the Departments of Defense and Veterans Affairs to protect the health of U.S. servicemembers and veterans, the effects of neuropsychological illness brought on by war, traumatic injuries and other experiences are not always easily treated. While current approaches can often help to alleviate the worst effects of these illnesses, they are imprecise and not universally effective. Demand for new therapies is high as mental disorders are the leading cause of hospital bed days and the second leading cause of medical encounters for active duty servicemembers. Among veterans, ten percent of those receiving treatment from the Veterans’ Health Administration are provided mental health care or substance abuse counseling.

DARPA created the Systems-Based Neurotechnology for Emerging Therapies (SUBNETS) program to pursue advances in neuroscience and neurotechnology that could lead to new clinical understanding of how neuropsychological illnesses manifest in the brain and to advanced therapies to reduce the burden and severity of illness in afflicted troops and veterans. The program will pursue a new investigative approach that establishes the characteristics of distributed neural systems and attempts to develop and apply therapies that incorporate near real-time recording, analysis and stimulation in next-generation devices inspired by current Deep Brain Stimulation (DBS).

DBS already exists as a therapy option for certain neurologic and neuropsychological illnesses in patients who are not responsive to other therapies. Approximately 100,000 people around the globe live with a DBS implant, a device that delivers electrical stimulation to reduce the motor impairment caused by Parkinson’s disease and dystonia. These devices are also being studied as therapy for depression, obsessive compulsive disorder, Tourette’s and epilepsy.

Despite recent advances, clinicians and researchers remain limited by the tools available to study, understand and treat systems of the brain. To achieve maximum benefit, clinicians are often forced to complete a slow, repetitive and imprecise cycle of observing behaviors and fine-tuning drug or behavioral therapy until the effects of a disease are reduced. The science has, to this point, been largely based on a century of identifying associations between features of complex behaviors and diffuse understanding of the brain.

SUBNETS aims for systems-based neurotechnology and understanding for the treatment of neuropsychological illnessesEnlarge

SUBNETS seeks to move beyond this limited understanding to create new interventions based on new insights that can be gained from the intersection of neuroscience, neurotechnology and clinical therapy. While there is no question that brain activity, anatomy and behavior are functionally linked, there is a growing body of evidence to suggest that many neural and behavioral processes are not localized to specific anatomical regions, but are emergent from systems that span several regions of the brain. SUBNETS will attempt to establish the capability to record and model how these systems function in both normal conditions, among volunteers4 seeking treatment for unrelated neurologic disorders, as well as among impaired clinical research participants.


DARPA is specifically interested in evaluating the underlying systems which contribute to the following conditions as described by the Diagnostic and Statistical Manual of Mental Disorders: Post-Traumatic Stress Disorder, Major Depression, Borderline Personality Disorder and General Anxiety Disorder. DARPA also seeks to evaluate the representation in the central nervous system of: Traumatic Brain Injury, Substance Abuse/Addiction and Fibromyalgia/Chronic Pain.

“If SUBNETS is successful, it will advance neuropsychiatry beyond the realm of dialogue-driven observations and resultant trial and error and into the realm of therapy driven by quantifiable characteristics of neural state,” said Justin Sanchez, DARPA program manager. “SUBNETS is a push toward innovative, informed and precise neurotechnological therapy to produce major improvements in quality of life for servicemembers and veterans who have very few options with existing therapies. These are patients for whom current medical understanding of diseases like chronic pain or fatigue, unmanageable depression or severe post-traumatic stress disorder can’t provide meaningful relief.”

As described in a broad agency announcement, the work will require development of novel medical hardware, complex modeling of human , clinical neurology and animal research. DARPA expects that successful teams will span across disciplines including psychiatry, neurosurgery, neural engineering, microelectronics, neuroscience, statistics and computational modeling.

“We’re talking about a whole systems approach to the brain, not a disease-by-disease examination of a single process or a subset of processes,” Sanchez said. “SUBNETS is going to be a cross-disciplinary, expansive team effort and the program will integrate and build upon historical DARPA research investments.”

Because programs like SUBNETS push the leading edge of science, they are sometimes society’s first encounter with the dilemmas associated with new technologies. DARPA pursues these technologies because of their promise, but the Agency understands that it is important to consider ethical, legal, societal and policy questions. For that reason, DARPA has convened an Ethical, Legal and Social Implications (ELSI) panel to inform and advise SUBNETS and other emerging neuroscience efforts. The panel’s membership represents the academic community, medical ethicists, and clinical and research scientists. ELSI panelists will provide guidance in addition to the standard oversight provided by DARPA and Department of Defense internal review boards that govern human and animal use and the Presidential Commission for the Study of Bioethical Issues that will oversee SUBNETS as part of the BRAIN Initiative.

More information: Armed Forces Health Surveillance Center, Summary of Mental Disorder Hospitalizations, Active and Reserve Components, U.S. Armed Forces, 2000-2012, Medical Surveillance Monthly Report, 2013 Jul; 20(7):4-11.

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Obsessive-compulsive disorder and Tourette syndrome are highly heritable – News

An international research consortium led by investigators at Massachusetts General Hospital (MGH) and the University of Chicago has answered several questions about the genetic background of obsessive-compulsive disorder (OCD) and Tourette syndrome (TS), providing the first direct confirmation that both are highly heritable and also revealing major differences between the underlying genetic makeup of the disorders. Their report is being published in the October issue of the open-access journal PLOS Genetics.

“Both TS and OCD appear to have a genetic architecture of many different genes – perhaps hundreds in each person – acting in concert to cause disease,” says Jeremiah Scharf, MD, PhD, of the Psychiatric and Neurodevelopmental Genetics Unit in the MGH Departments of Psychiatry and Neurology, senior corresponding author of the report. “By directly comparing and contrasting both disorders, we found that OCD heritability appears to be concentrated in particular chromosomes – particularly chromosome 15 – while TS heritability is spread across many different chromosomes.”

An anxiety disorder characterized by obsessions and compulsions that disrupt the lives of patients, OCD is the fourth most common psychiatric illness. TS is a chronic disorder characterized by motor and vocal tics that usually begins in childhood and is often accompanied by conditions like OCD or attention-deficit hyperactivity disorder. Both conditions have been considered to be heritable, since they are known to often recur in close relatives of affected individuals, but identifying specific genes that confer risk has been challenging.

Two reports published last year in the journal Molecular Psychiatry, with leadership from Scharf and several co-authors of the current study, described genome-wide association studies (GWAS) of thousands of affected individuals and controls. While those studies identified several gene variants that appeared to increase the risk of each disorder, none of the associations were strong enough to meet the strict standards of genome-wide significance. Since the GWAS approach is designed to identify relatively common gene variants and it has been proposed that OCD and TS might be influenced by a number of rare variants, the research team adopted a different method. Called genome-wide complex trait analysis (GCTA), the approach allows simultaneous comparision of genetic variation across the entire genome, rather than the GWAS method of testing sites one at a time, as well as estimating the proportion of disease heritability caused by rare and common variants.

“Trying to find a single causative gene for diseases with a complex genetic background is like looking for the proverbial needle in a haystack,” says Lea Davis, PhD, of the section of Genetic Medicine at the University of Chicago, co-corresponding author of the PLOS Genetics report. “With this approach, we aren’t looking for individual genes. By examining the properties of all genes that could contribute to TS or OCD at once, we’re actually testing the whole haystack and asking where we’re more likely to find the needles.”

Using GCTA, the researchers analyzed the same genetic datasets screened in the Molecular Psychiatry reports – almost 1,500 individuals affected with OCD compared with more than 5,500 controls, and nearly TS 1,500 patients compared with more than 5,200 controls. To minimize variations that might result from slight difference in experimental techniques, all genotyping was done by collaborators at the Broad Institute of Harvard and MIT, who generated the data at the same time using the same equipment. Davis was able to analyze the resulting data on a chromosome-by-chromosome basis, along with the frequency of the identified variants and the function of variants associated with each condition.

Is It The ‘Baby Blues’ or Something More?

Is It The Baby Blues or Something More?A friend texted me the other morning that a woman she went to high school with was suffering from postpartum depression and hanged herself. The baby was five weeks old.

Extremely upsetting. Tragic. Untimely.

Before I was a parent, I absorbed these stories from a social work perspective. Not enough resources, support groups, coping mechanisms.

Now, as a new mom, there is a part of me that understands the pain, the confusion, the insane hormones.

For most women, pregnancy is a joyful time. Strangers are nicer, food is plentiful and you spend your spare time picking out furniture and baby clothes. For the few days after your birth, whether you choose to birth in a hospital, birthing center or at home, you are cared for. Doctors, nurses and midwives are checking in on your well-being. Then it stops. Abruptly.

Prior to giving birth you may have been a lawyer, a marketing executive, a salesperson, a teacher. Once maternity leave begins, your sole job in life (without any training) is to make sure the fetus-like creature who just came out of your body survives. Of course new moms feel stress. Add to that crazy hormonal changes, sleep deprivation, a crying baby, a childbirth recovery, a new body and possible family conflict.

Baby Center says “Up to 80 percent of new mothers experience the baby blues, an emotional reaction that begins a few days to a week after delivery and generally lasts no longer than two weeks. If you have the blues, you may be weepy, anxious, and unable to sleep. You may also be irritable or moody. About 10 to 15 percent of new mothers experience clinical depression, anxiety, or obsessive-compulsive disorder (OCD).”

Most women know about “the baby blues,” but we may not realize when those blues escalate to something worse, especially if friends and family are telling us it’s “normal.” More so, our spouses or partners are not educated on the signs of postpartum and antenatal depression, anxiety and mood disorders.

Why isn’t there more preventative education on this topic?

WebMD says “Close monitoring after childbirth is important. If you are worried about developing (postpartum depression), have your first postnatal checkup 3 or 4 weeks after childbirth rather than the typical 6 weeks.” Whose responsibility is it to schedule an earlier appointment? Most of us just follow doctor’s orders. Someone in the hospital tells us to make a 6 week appointment, and so we do. Six weeks is an extremely long time if you are experiencing symptoms of depression and anxiety.

It’s not fair that new moms are expected to find their own resources. It is hard enough to seek out and connect with a good therapist or support group when you aren’t postpartum. I wish there were more preventative measures – a class in the hospital or a social worker working in all gynecological offices who spoke to women during pregnancy and then followed up after birth for the first two months.

I also wish there were more local support groups. In my neighborhood in Brooklyn, there is a wonderful resource called Park Slope Parents. Park Slope Parents is a group of local parents dedicated to supporting the families of Brooklyn. This group provides resources on many topics, such as breastfeeding, going back to work, and hiring a nanny, but the most useful aspect was the new moms group.

Park Slope Parents essentially builds you a local support system. In the weeks following childbirth, when you may or may not be able to leave your home, you can send an email to women who have just gone through the same experience and say “I’ve been a weepy mess.” “Didn’t think it would be this stressful.” “I’m not sleeping.” It may seem insignificant, but most women in my area will say that the new mom support groups is what got them through postpartum. Just feeling that you are not alone can make a big difference.

Katherine Stone, a PsychCentral contributor, writes a wonderful blog, Postpartum Progress, which has resources, information and stories from survivors of postpartum depression. Postpartum Progess “is the world’s most widely-read blog on postpartum depression and all other mental illnesses related to pregnancy and childbirth, including: postpartum anxiety, postpartum OCD, depression during pregnancy (antenatal depression), post-adoption depression, postpartum PTSD, depression after miscarriage or perinatal loss and postpartum psychosis. We focus on positive messages of empowerment and recovery, because PPD is temporary and treatable with professional help.”

I don’t know the details about the woman who hung herself. Did she seek help? Did she have a history of depression? I wish she knew she could get better; I wish she would have felt less alone. I hope her story can somehow help others

 

References

BabyCenter Medical Advisory Board. (n.d.). Postpartum depression and anxiety

WebMD. (2011, November 2). Postpartum Depression Health Center

 

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    Last reviewed: By John M. Grohol, Psy.D. on 22 Oct 2013
    Published on PsychCentral.com. All rights reserved.

 

Obsessive Compulsive Disorder (OCD) and the urge to wash clean hands | obsessive compulsive anxiety

Typically a person’s OCD will fall into one of the four main categories:

 

1) Checking: This could be because of a fear of causing a fire at home or a fear of the car being stolen, for instance. There will be constant checking whether doors are locked or the stove knob is turned off. There will be constant reading of words in a book in the fear of missing something in the book. The checking will be done many, many times.

 

2) Contamination/Mental Contamination: The compulsion here is to be clean and that a door knob or a water tap could be contaminated. There will be a fear of using public phones, or public toilets and even shaking hands, or being in a crowd due to the fear of getting germs from other people. There will be constant cleaning of the bathroom or kitchen or brushing teeth many times and washing hands or showering again and again. The feelings of ‘Mental Contamination’ arise when the person thinks he or she is badly treated and made to feel like dirt, and that again evokes the compulsion to be clean and wash repeteadly.

 

3) Hoarding: The person will buy and save things over long periods of time, even when the stuff becomes useless, and finds it difficult to get rid of these items. The person genuinely feels that the item will be needed later. Sometimes, the items are not thrown away due to a fear of harming others, as it could contaminate them. The hoarding happens also because of an emotional attachment to certain things, where you cannot let go.

 

4) Ruminations/Intrusive Thoughts: The person will dwell on religious or philosophical questions such as what happens after death. He or she will think these questions through for a long period of time. The intrusive part is when the person thinks of causing others harm, but they go to extreme lengths not to let that happen.

 

(While there are four main categories of OCD, there are numerous forms of the disorder within each category).

 

 

 

OCD is diagnosed when the obsessions and compulsions:

1) Consume excessive amounts of time (approximately an hour or more).

2) Cause significant distress and anguish to the individual.

3) Interfere with daily functioning at home, school or work, including social activities and family life and relationships.

(Clare Smart)

 

 

Common Compulsions in OCD

 

• Washing hands excessively.

• Excessive showering, bathing, or toilet routines.

• Cleaning household items or other objects excessively.

• Checking that you did not or will not harm others.

• Checking that you did not or will not harm yourself.

• Checking that you did not make a mistake.

• Rereading or rewriting.

• Repeating routine activities.

• Repeating body movements (such as tapping, touching, blinking).

• Praying to prevent harm (to oneself, others, to prevent terrible consequences).

• Counting while performing a task to end on a “good”, “right”, or “safe” number

• “Cancelling” or “Undoing” (example: replacing a “bad” word with a “good” word to cancel it out).

(Courtesy: International OCD Foundation)