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Online CBT is not a therapy substitute, but a step to help manage anxiety

Anxiety, one of the most common mental health problems, is a many-headed monster. Anxiety disorders include panic disorder, generalised anxiety disorder, phobias, social anxiety disorder, obsessive-compulsive disorder, separation-anxiety disorder and post-traumatic stress disorder. Anyone who experiences an anxiety disorder will tell you how acutely disabling it feels.

We all get anxious from time to time, particularly when we are about to do something we see as threatening or frightening. In the short term, anxiety is functional, making us feel alert while improving our performance. However, acute or chronic anxiety is unhelpful. It negatively affects our thinking, behaviour and emotional reactions, and can have a significant physical impact, leading to disorder. In addition, more than half of individuals with an anxiety disorder will have a coexisting diagnosis of depression.

Overall, 30% of Britons will experience an anxiety disorder during their lifetime. The Adult Psychiatric Morbidity Survey (APMS), published by NHS Digital in 2016, indicates that depression and anxiety disorders are the most common mental health problems, affecting one in six adults. More recent figures from NHS Digital confirmed that emotional disorders, which include depression and anxiety, are the most prevalent conditions in children and young people, affecting 8.1% of five-to-19-year-olds. Anxiety disorders reach a peak in girls between the ages of 17 and 19, affecting 20.9% of this age group.

However, even with such high prevalence and impact, anxiety disorders are under-diagnosed and under-treated in the UK. The NHS crisis in the provision of adequate mental health care is well publicised. Years of underfunding have left mental health services poorly resourced. This creates a bottleneck for treatment; the long wait for treatment is also likely to lead to more complex problems, which in turn necessitates more specialist and longer-term intervention. The NHS is at breaking point, especially so in child and adolescent mental health services (Camhs).

The recent survey by stem4, the youth mental health charity I founded, shows that 90% of GPs in the survey think mental health services for young people are inadequate, with nearly all (99%) fearing that children in their care could come to harm while waiting for specialist treatment.

In such circumstances the NHS has had to unofficially perform triage when it comes to crisis-level mental health conditions. As a result, people suffering from anxiety disorders lose out. Under current government funding proposals, new services to tackle rising mental ill health among children and young people are being developed, but the wait is long in the face of an urgent need for good-quality, comprehensive services. Even under these new funding proposals, it is unlikely that a robust programme for anxiety disorders will be rolled out in the near future. Anxiety disorders are very responsive to early intervention in the form of evidence-based treatments such as cognitive behavioural therapy (CBT), but in many local areas services of this kind have been cut, denying young people access to expert treatment.

Stem4 offers early detection through education in secondary schools and early digital intervention. Based on the requests made by many students, and on awareness of need observed in the course of my own clinical practice, I developed Calm Harm, a mobile phone app to help young people manage their urge to self-harm.Since its launch 18 months ago, Calm Harm has had close to 900,000 downloads. It is mainly used by young people under the age of 19, and 93% of them report that their urge to self-harm passed after each use of the app.

More recently I have developed Clear Fear, an app to help children and young people manage symptoms of anxiety using the principles of CBT. It aims to provide them with tools to help them negotiate some of the challenges they may face. It does this by offering them relaxation training, self-monitoring and ways of challenging negative thoughts and solving problems. It also harnesses the benefits of humour, feeds them inspirational quotes and examples of inspirational people, and helps them find the “grit” they need to keep going when the going gets tough.

Digital therapies should not be seen as a substitute for face-to-face engagement, assessment and treatment. But a handful of studies confirm that online CBT is as effective as face-to-face treatment for anxiety and depression. It therefore constitutes a first step in helping young people self-monitor and benefit from simple techniques for anxiety management.

Why are so many people anxious and are there common threats? Although digital connections are now flourishing, our relationships and community links are weaker. Our connection with nature is reduced, while an atmosphere of increased competition leads to less collaboration and unity. The world appears divided – a good example is the current state of UK politics. Fomo (fear of missing out) has become a prevalent term. In my opinion, the fear of being left behind is even higher. Social support is a vital contributor to recovery from major stress, and social connectivity is an essential factor in resilience. In addition to treating anxiety, perhaps we need to listen to the message it imparts and get to the heart of the problem.

  • Dr Nihara Krause is a consultant clinical psychologist and the founder and CEO of stem4, a youth mental health charity

Study: OCD in top three mental disorders, sufferers seeking help later

Afraid that someone would break into his house, he would check the locks on his front gate and door.

He was so anxious about making a mistake and letting a burglar slip through that he would repeat this 50 to 60 times.

“He would end up not being able to do anything else because he would be terribly late for appointments.

“It came to a point where he seldom could make it for work,” said senior psychologist at The Therapy Room Lawrence Tan, 40.

He was describing the debilitating effect an obsessive compulsive disorder (OCD) can have on a sufferer.

His comments came in the wake of the latest national mental health study, which showed that OCD remains one of the top three mental illnesses here.

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It affects one in 28 people living here in their lifetime, behind alcohol abuse (one in 24) and depression (one in 16).

Spearheaded by the Institute of Mental Health (IMH), the second Singapore Mental Health Study found that in 2016, the median number of years that OCD sufferers delayed treatment was 11 years.

This is up from nine years in 2010 when the first Singapore Mental Health Study was done.

In contrast, findings from the latest study, released yesterday, showed that those with other mental disorders have been seeking help from healthcare professionals, counsellors, even religious and spiritual advisers earlier.

For example, the median number of years that people who abuse alcohol delayed treatment fell from 13 years to four.

Mental health professionals told The New Paper that denial, shame and guilt about their obsessions and illness, as well as the lack of awareness of the symptoms are some reasons why OCD sufferers can take a long time to seek help.

POORLY UNDERSTOOD

Dr Bhanu Gupta, a senior consultant at IMH’s Department of Mood and Anxiety, told TNP that despite its high prevalence, OCD is poorly understood and public awareness about the signs and symptoms, which can be hard to recognise, is lacking.

“Quite a lot of times, the symptoms are seen as normal behaviour, excessive normal behaviour. So it is understandable that some people don’t seek help early.”

He said that it is common to see patients who have had symptoms for 15 years or longer before they got help, adding: “OCD usually starts quite insidiously… So initially, most people are not affected so much that they think it requires any kind of treatment.”

Driven by anxiety, OCD has two parts – obsessions, which are persistent, recurring and intrusive thoughts that can increase that anxiety, and compulsions, repeated behaviours and rituals that relieve it.

“It becomes a bit of a feedback loop, where because the rituals take away the anxiety, (the sufferer) keeps doing them more and more,” Dr Bhanu said.

Patients are diagnosed with OCD when these obsessions and compulsions start to take up a significant length of time, more than an hour a day, or start to impair one’s day-to-day life, he added.

Medication and therapy help to break the vicious cycle and Dr Bhanu said the earlier OCD is treated, the better.

The latest Singapore Mental Health Study involved interviews with more than 6,000 Singaporeans and permanent residents aged 18 and above.

Michigan universities testing new Alzheimer’s drug

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New research suggests MRI brain scans are better at predicting Alzheimer’s disease than common clinical tests. Veuer’s Mercer Morrison has the story.
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Two Michigan universities will test a new drug designed to slow or stop the symptoms of Alzheimer’s disease in patients ages 50-85.

The University of Michigan and Michigan State University are among more than 30 academic medical centers and clinics nationwide conducting clinical trials of the drug troriluzole. The study, called T2 Protect AD, is being coordinated by the Alzheimer’s Disease Cooperative Study, or ADCS, a consortium of institutions that research interventions for the disease.

Dr. Judith Heidebrink, the principal investigator of the study at U-M, said the screening process started this month. Heidebrink said the study targets patients who already have developed mild to moderate dementia. 

“There are a lot of trials out there trying to prevent Alzheimer’s disease … and very few for those who have already established dementia,” she said. “We need to really have therapies for folks already showing symptoms, as well as prevent the following generation from showing symptoms.”

Patient eligibility

To qualify for the study, Heidebrink said patients must score within a certain range when taking memory and thinking tests to establish the severity of their condition and should be in otherwise generally good health. She saidother conditions or medications may affect eligibility. 

Dr. Andrea Bozoki, director for cognitive and geriatric neurology at MSU, said her team in East Lansing also has begun recruiting study participants. 

Bozoki, who is also an investigator with the ADCS, said the study requires participants to come in for visits every six weeks for a year. In addition, they must have a caregiver who can administer the drug and spend at least 10 hours a week with them. 

Read more:

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Macomb County man losing himself to disease — but never forgets this

According to the Alzheimer’s Association Michigan Great Lakes Chapter, there are more than 180,000 people in the state living with Alzheimer’s. 

Dr. Irfan Qureshi, the executive director of neurology at Biohaven — the New Haven, Connecticut-based biotech company sponsoring the study —  said that U-M and MSU are particularly important sites because of the large number of Alzheimer’s patients that they serve. 

A different kind of drug

Qureshi added that troriluzole is a particularly exciting drug to study because it has a “unique mechanism of action.”

Other medications that have been studied or have gotten “a lot of buzz” in the Alzheimer’s space target a protein called amyloid or another protein called tau, but Qureshi said troriluzole is different, because it targets a neurotransmitter called glutamate.

Glutamate is a chemical that nerve cells use to send signals to other cells.

Qureshi said researchers  believe troriluzole will improve symptoms of Alzheimer’s disease, like memory and other cognitive problems, as well as reduce the progression of the disease by normalizing the level of glutamate in the synapse — the space between neurons.

“We think that brain cells communicate with each other through the synapse … and if there’s too much glutamate there, then the neurons don’t communicate properly, and if there’s too much there for too long, they die,” Qureshi said. “In Alzheimer’s disease, (the level of glutamate in the synapse) is probably too high.”

Qureshi said that the U-M and MSU sites were identified as two leading members of the ADCS, which is coordinated nationally by T2 Project Director Dr. Howard Feldman at the University of California San Diego.

“We want to be able to run the study and provide the opportunity for patients to participate who are in Michigan,” Qureshi said.

The Mini-Mental State Examination, which is a scale used to examine the condition of Alzheimer’s disease patients, is part of the inclusion criteria, Qureshi said. 

Qureshi said Biohaven is also working on studies with troriluzole that target other diseases and disorders, including the neurodegenerative disease Spinocerebellar ataxia, obsessive compulsive disorder and generalized anxiety disorder. 

“Glutamate is probably involved in 90 percent of excitatory transmission or communication between brain cells. So it’s really, really important, and that’s why it has the potential across these different diseases to have a potential benefit,” he said. 

“This is an exciting time for research … for investigators, and more importantly, for patients and their families.”

More information about clinical trials can be found on the T2 Protect AD website: www.t2protect.org

Contact Aleanna Siacon: ASiacon@freepress.com. Follow her Twitter: @AleannaSiacon. 

OCD: Brain mechanism explains symptoms

A large review of existing neuroscientific studies unravels the brain circuits and mechanisms that underpin obsessive-compulsive disorder. The researchers hope that the new findings will make existing therapies more effective, “or guide new treatments.”

New research analyzes the brain scans of almost 500 people to unravel the brain mechanisms in OCD.

Obsessive-compulsive disorder (OCD) is a mental health condition that affects more than 2 million adults in the United States.

People with OCD often experience recurring, anxiety-inducing thoughts or urges — known as obsessions — or compulsive behaviors that they cannot control.

Whether it is repeatedly checking if the door is locked or switching lights on and off, OCD symptoms are uncontrollable and can severely interfere with a person’s quality of life.

Treatments for OCD include medication, psychotherapy, and deep brain stimulation. However, not everyone responds to treatment.

In fact, reference studies have found that only 50 percent of people with OCD get better with treatment, and just 10 percent recover fully.

This treatment ineffectiveness is partly down to the fact that medical professionals still do not fully understand the neurological roots of the condition. A new study, however, aims to fill this gap in research.

Scientists led by Luke Norman, Ph.D., a postdoctoral research fellow in the Department of Psychiatry at the University of Michigan (U-M) in Ann Arbor, corroborated and analyzed large amounts of data from existing studies on the neurological underpinnings of OCD.

The scientists published their meta-analysis in the journal Biological Psychiatry.

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Studying the brain circuitry in OCD

Norman and colleagues analyzed studies that scanned the brains of hundreds of people with OCD, as well as examining the brain images of people without the condition.

“By combining data from 10 studies, and nearly 500 patients and healthy volunteers, we could see how brain circuits long hypothesized to be crucial to OCD are indeed involved in the disorder,” explains the study’s lead author.

Specifically, the researchers zeroed in on a brain circuit called the “cingulo-opercular network.” This network involves several brain regions that are interconnected by neuronal pathways in the center of the brain.

Studies have previously associated the cingulo-opercular network with “tonic alertness” or “vigilance.” In other words, areas in this brain circuit are “on the lookout” for potential errors and can call off an action to avoid an undesirable outcome.

Most of the functional MRI studies included by Norman and colleagues in their review had volunteers respond to errors while inside the brain scanner.

An analysis of data from the various studies revealed a salient pattern: Compared with people who did not have OCD, those with the condition displayed significantly more activity in brain areas associated with recognizing an error, but less activity in the brain regions that could stop an action.

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Study co-author Dr. Kate Fitzgerald of U-M’s Department of Psychiatry explains the findings, saying “We know that [people with OCD] often have insight into their behaviors, and can detect that they’re doing something that doesn’t need to be done.”

She adds, “But these results show that the error signal probably isn’t reaching the brain network that needs to be engaged in order for them to stop doing it.”

The researcher continues using an analogy.

It’s like their foot is on the brake telling them to stop, but the brake isn’t attached to the part of the wheel that can actually stop them.”

Dr. Kate Fitzgerald

“This analysis sets the stage for therapy targets in OCD because it shows that error processing and inhibitory control are both important processes that are altered in people with the condition,” says Fitzgerald.

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Findings may boost existing treatments

The researcher also explains how the findings may enhance current treatments for OCD, such as cognitive behavioral therapy (CBT).

“In [CBT] sessions for OCD, we work to help patients identify, confront, and resist their compulsions, to increase communication between the ‘brake’ and the wheels, until the wheels actually stop. But it only works in about half of patients.”

“Through findings like these, we hope we can make CBT more effective, or guide new treatments,” Dr. Fitzgerald adds. The team is currently recruiting participants for a clinical trial of CBT for OCD.

In addition to CBT, Dr. Fitzgerald also hopes that the results will enhance a therapy known as “repetitive transcranial magnetic stimulation” (rTMS).

“If we know how brain regions interact together to start and stop OCD symptoms, then we know where to target rTMS,” she says. “This is not some deep dark problem of behavior,” Dr. Fitzgerald continues.

OCD is a medical problem, and not anyone’s fault. With brain imaging, we can study it just like heart specialists study EKGs of their patients — and we can use that information to improve care and the lives of people with OCD.”

Dr. Kate Fitzgerald

Obsessive-compulsive disorder may offer protection from obesity


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Abramovitch et al., 2015 A. Abramovitch, D.A. Pizzagalli, D.A. Geller, L. Reuman, S. Wilhelm Cigarette smoking in obsessive-comp; Abramovitch et al., 2014 A. Abramovitch, D.A. Pizzagalli, L. Reuman, S. Wilhelm Anhedonia in obsessive-compulsive disorder: beyo; Albert et al., 2013 U. Albert, A. Aguglia, A. Chiarle, F. Bogetto, G. Maina Metabolic syndrome and obsessive-compulsive disorder; American Psychiatric Association 2013 American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders: DS; Bejerot and Humble, 1999 S. Bejerot, M. Humble Low prevalence of smoking among patients with obsessive-compulsive disorder; Deng, 2013 C. Deng Effects of antipsychotic medications on appetite, weight, and insulin resistance; Drummond et al., 2011 M.L. Drummond, A. Kham Hameed, R. Ion Physical complications of severe enduring obsessive-compulsive disor; Figee et al., 2011 M. Figee, M. Vink, F. de Geus, N. Vulink, D.J. Veltman, H. Westenberg, D. Denys Dysfunctional reward circuitr; First et al., 2002 M.B. First, R.L. Spitzer, M. Gibbon, J.B.W. Williams Structured Clinical Interview For DSM-IV-TR Axis I Disor; Fontenelle et al., 2011 L.F. Fontenelle, S. Oostermeijer, B.J. Harrison, C. Pantelis, M. Yucel Obsessive-compulsive disorder, im; Gariepy et al., 2010 G. Gariepy, D. Nitka, N. Schmitz The association between obesity and anxiety disorders in the population: a; Garvey et al., 2016 W.T. Garvey, J.I. Mechanick, E.M. Brett, A.J. Garber, D.L. Hurley, A.M. Jastreboff, K. Nadolsky, R. Pessah-P; Gibson-Smith et al., 2016 D. Gibson-Smith, M. Bot, Y. Milaneschi, J.W. Twisk, M. Visser, I.A. Brouwer, B.W. Penninx Major depres; Goodman et al., 1989 W.K. Goodman, L.H. Price, S.A. Rasmussen, C. Mazure, R.L. Fleischmann, C.L. Hill, G.R. Heninger, D.S. Charn; Hasnain et al., 2012 M. Hasnain, W.V. Vieweg, B. Hollett Weight gain and glucose dysregulation with second-generation antipsycho; Henninghausen et al., 1999 K. Henninghausen, B. Rischmuller, H. Heseker, H. Remschmidt, J. Hebebrand Low body mass indices in ad; Husky et al., 2018 M.M. Husky, C.M. Mazure, A. Ruffault, C. Flahault, V. Kovess-Masfety Differential associations between excess; Jung et al., 2013 W.H. Jung, D.H. Kang, E. Kim, K.S. Shin, J.H. Jang, J.S. Kwon Abnormal corticostriatal-limbic functional conne; Kessler et al., 2013 R.C. Kessler, J.R. Calabrese, P.A. Farley, M.J. Gruber, M.A. Jewell, W. Katon, P.E. Keck, A.A. Nierenberg,; Lee et al., 2016 S.H. Lee, G. Paz-Filho, C. Mastronardi, J. Licinio, M.L. Wong Is increased antidepressant exposure a contributo; Luppino et al., 2010 F.S. Luppino, L.M. de Wit, P.F. Bouvy, T. Stijnen, P. Cuijpers, B.W. Penninx, F.G. Zitman Overweight, obesi; Penninx et al., 2008 B.W. Penninx, A.T. Beekman, J.H. Smit, F.G. Zitman, W.A. Nolen, P. Spinhoven, P. Cuijpers, P.J. De Jong, H.; Petry et al., 2008 N.M. Petry, D. Barry, R.H. Pietrzak, J.A. Wagner Overweight and obesity are associated with psychiatric disor; Pizzagalli, 2014 D.A. Pizzagalli Depression, stress, and anhedonia: toward a synthesis and integrated model; Rodriguez-Monforte et al., 2016 M. Rodriguez-Monforte, E. Sanchez, F. Barrio, B. Costa, G. Flores-Mateo Metabolic syndrome and d; Ruscio et al., 2010 A.M. Ruscio, D.J. Stein, W.T. Chiu, R.C. Kessler The epidemiology of obsessive-compulsive disorder in the Na; Schuurmans et al., 2012 J. Schuurmans, A.J. van Balkom, H.J. van Megen, J.H. Smit, M. Eikelenboom, D.C. Cath, M. Kaarsemaker, D.; Simon et al., 2006 G.E. Simon, M. Von Korff, K. Saunders, D.L. Miglioretti, P.K. Crane, G. van Belle, R.C. Kessler Association b; Subramaniam et al., 2013 M. Subramaniam, L. Picco, V. He, J.A. Vaingankar, E. Abdin, S. Verma, G. Rekhi, M. Yap, J. Lee, S.A. Ch; Wittchen, 1994 H.U. Wittchen Reliability and validity studies of the WHO–Composite International Diagnostic Interview (CIDI): a; Xie et al., 2017 C. Xie, L. Ma, N. Jiang, R. Huang, L. Li, L. Gong, C. He, C. Xiao, W. Liu, S. Xu, Z. Zhang Imbalanced functiona

TMS Associates of Pennsylvania First Facility in the State to Treat Obsessive-Compulsive Disorder (OCD) with Deep Transcranial Magnetic Stimulation (Deep TMS)

HAVERFORD, Pa., Nov. 27, 2018 (GLOBE NEWSWIRE) — TMS Associates of Pennsylvania LLC, Haverford’s leading mental health provider specializing in mood disorders, announced today that it is now offering BrainsWay’s latest FDA-cleared Deep Transcranial Magnetic Stimulation (Deep TMS) therapy to patients with Obsessive-Compulsive Disorder (OCD). The facility has been offering Deep TMS therapy for the treatment of depression since 2016. As the first medical device to be FDA cleared for OCD, Deep TMS can be effective for the many patients in need of relief.

“We have seen firsthand how much people with OCD can suffer without effective treatment, and Deep TMS can provide them with the relief they’ve been seeking,” said Deborah Kim, M.D., co-founder of TMS Associates of Pennsylvania. “We have seen very impressive response and remission rates when treating depression with Deep TMS. Bolstered by the effectiveness of the treatment for depression, we are confident that Deep TMS will help provide better outcomes for our patients with OCD.”

TMS Associates of Pennsylvania was co-founded by Dr. Kim and Susan Rushing, M.D., J.D., who use their respective specialties to treat patients with mood and anxiety disorders. Dr. Kim focuses her work on treating pregnant and postpartum women, in addition to women suffering from depression and anxiety. As a clinical and forensic psychiatrist, Dr. Rushing specializes in developing therapies for treatment-resistant OCD, engaging patients in medication management and therapy.

“As an illness where achieving remission is difficult with standard psychiatric medications, psychiatrist have been searching for an effective neuromodulation option to treat OCD,” said Dr. Rushing. “BrainsWay’s FDA cleared coil to treat OCD is the solution we have been waiting for. We are excited to provide this innovative treatment to our patients in need of relief.”

Deep TMS has no systemic side effects, allowing patients to continue with their daily activities immediately following treatment.

About BrainsWay
BrainsWay Ltd./ BrainsWay USA (TASE:BRIN), is engaged in the research, development and sales and marketing of a medical system for non-invasive treatment of common brain disorders. The medical system developed and manufactured by the company is based on a unique breakthrough technology called Deep TMS, which can reach significant depth and breadth of the brain and produce broad stimulation and functional modulation of targeted brain areas. In the U.S., the Company’s device has been FDA cleared for the treatment of major depressive disorder (MDD) since 2013, and is now FDA cleared (De-Novo) for the treatment of Obsessive Compulsive Disorder (OCD). The Company’s systems have also received CE clearance and are sold worldwide for the treatment of various brain disorders.

About TMS Associates of Pennsylvania
TMS Associates of Pennsylvania was founded by Dr. Susan Rushing and Dr. Deborah Kim in 2016. The practice specializes in mood disorders including: treatment refractory depression, anxiety disorders, post-traumatic stress disorder (PTSD), OCD, bipolar disorder, mood disorders during pregnancy and neuromodulation using TMS.

TMS Associates of Pennsylvania Media Contact:
Susan Rushing, M.D., J.D.
610-726-1020

BrainsWay Media Contact:
Nechama Feuerstein
BrainsWay@antennagroup.com
201-373-2228

Stuck in a loop of wrongness: Brain study shows roots of OCD

No one knows exactly what drives people with obsessive-compulsive disorder to do what they do, even when they’re fully aware that they shouldn’t do it, and when it interferes with their ability to live a normal life.

That lack of scientific understanding means about half of them can’t find an effective treatment.

But a new analysis of brain scans from hundreds of people with OCD, and people without the condition, may help. Larger than any previous study, it pinpoints the specific brain areas and processes linked to those repetitive behaviors.

Put simply, the study suggests that the brains of OCD patients get stuck in a loop of “wrongness,” that patients can’t stop even if they know they should.

Errors and stop signals

Researchers from the University of Michigan gathered together the largest-ever pool of task-based functional brain scans and other data from OCD studies around the world, and combined them for a new meta-analysis published in Biological Psychiatry.

“These results show that, in OCD, the brain responds too much to errors, and too little to stop signals, abnormalities that researchers had suspected to play a crucial role in OCD, but that had not been conclusively shown due to small numbers of participants in the individual studies,” says Luke Norman, Ph.D., lead author of the new study and a postdoctoral research fellow in the U-M Department of Psychiatry.

“By combining data from ten studies, and nearly 500 patients and healthy volunteers, we could see how brain circuits long hypothesized to be crucial to OCD are indeed involved in the disorder,” he says. “This shows the power of doing this kind of research more collaboratively.”

New targets for therapy

Norman works with U-M psychiatry faculty members Kate Fitzgerald, M.D., M.S., and Stephan Taylor, M.D. Fitzgerald co-directs the Pediatric Anxiety Program at Michigan Medicine, U-M’s academic medical center and leads a clinical trial that is currently seeking teens and adults with OCD to test the ability of targeted therapy sessions to treat OCD symptoms.

“This analysis sets the stage for therapy targets in OCD, because it shows that error processing and inhibitory control are both important processes that are altered in people with the condition,” says Fitzgerald.

“We know that patients often have insight into their behaviors, and can detect that they’re doing something that doesn’t need to be done,” she adds. “But these results show that the error signal probably isn’t reaching the brain network that needs to be engaged in order for them to stop doing it.”

Zeroing in on brain differences

In their paper, the researchers focus on the cingulo-opercular network. That’s a collection of brain areas linked by highways of nerve connections deep in the center of the brain. It normally acts as a monitor for errors or the potential need to stop an action, and gets the decision-making areas at the front of the brain involved when it senses something is “off.”

The pooled brain scan data used in the new paper was collected when OCD patients and healthy people were asked to perform certain tasks while lying in a powerful functional MRI scanner. In all, the new analysis included scans and data from 484 children and adults, both medicated and not.

Norman led the combining of the data in a carefully controlled way that allowed for the inclusion of brain scan data from studies conducted as far apart as the Netherlands, the United States and Australia.

It’s the first time a large-scale analysis has included data about brain scans performed when participants with OCD had to respond to errors during a brain scan, and when they had to stop themselves from taking an action.

A consistent pattern emerged from the combined data: Compared with healthy volunteers, people with OCD had far more activity in the specific brain areas involved in recognizing that they were making an error, but less activity in the areas that could help them stop.

Disconnected brakes

The researchers recognize that these differences alone aren’t the full story — and they can’t tell from the available data if the differences in activity are the cause, or the result, of having OCD.

But they suggest that OCD patients may have an “inefficient” linkage between the brain system that links their ability to recognize errors and the system that governs their ability to do something about those errors. That could lead their over-reaction to errors to overwhelm their under-powered ability to tell themselves to stop.

“It’s like their foot is on the brake telling them to stop, but the brake isn’t attached to the part of the wheel that can actually stop them,” Fitzgerald says. “In cognitive behavioral therapy sessions for OCD, we work to help patients identify, confront and resist their compulsions, to increase communication between the ‘brake’ and the wheels, until the wheels actually stop. But it only works in about half of patients. Through findings like these, we hope we can make CBT more effective, or guide new treatments.”

Translating the findings to clinical care

While OCD was once classified as an anxiety disorder, and patients are often anxious about their behavior, it’s now seen as a separate mental illness.

The anxiety that many OCD patients experience is now thought to be a secondary effect of their condition, brought on by recognizing that their repetitive behaviors are not needed but being unable to control the drive to do them.

The U-M team will test techniques aimed at taming that drive, and preventing anxiety, in its clinical trial of CBT for OCD. The study is currently seeking teens and adults up to age 45 who have OCD, and healthy teens and adults who do not. It involves two brain scans at U-M’s research fMRI facility, and 12 weeks of free therapy between the first and last scan.

Fitzgerald notes that rTMS (repetitive transcranial magnetic stimulation) which was recently approved by the FDA to treat OCD, targets some of the circuits that the U-M team has been working to identify.

rTMS focuses magnetic fields on certain areas of the brain from outside the skull. “If we know how brain regions interact together to start and stop OCD symptoms, then we know where to target rTMS,” she says.

For severe cases of OCD, brain surgery techniques have emerged in the last decade as an option — and the new results are consistent with their effects. In such cases, neurosurgeons either disconnecting certain brain areas from one another with tiny burst of energy or cuts, or insert a permanent probe that can stimulate activity in a particular area.

The authors of the new paper call for neurosurgeons to consider the new findings about the role of the brain areas involved in the cingulo-opercular network in both inhibitory control and error processing when deciding whether and where to intervene.

The bottom line for patients

The researchers also call for studies that use genetic tests and repeated fMRI brain imaging of the same OCD patients over time, in what’s called a longitudinal study. That could help researchers piece apart the “chicken and egg” issue of whether the problems with error processing and inhibitory control lie at the heart of OCD, or whether they’re the effects of the symptoms of OCD.

In the meantime, Norman, Fitzgerald and Taylor hope that people who currently have OCD, and parents of children with signs of the condition, will take heart from the new findings.

“We know that OCD is a brain-based disorder, and we are gaining a better understanding of the potential brain mechanisms that underlie symptoms, and that cause patients to struggle to control their compulsive behaviors,” says Norman.

Adds Fitzgerald, “This is not some deep dark problem of behavior — OCD is a medical problem, and not anyone’s fault. With brain imaging we can study it just like heart specialists study EKGs of their patients — and we can use that information to improve care and the lives of people with OCD.”

The study was funded by the National Institutes of Health (MH102242).

Stuck in a loop ‘of wrongness’: Brain study shows roots of OCD

Zeroing in on brain differences

In their paper, the U-M researchers focused on the cingulo-opercular network — a collection of brain areas linked by highways of nerve connections deep in the center of the brain. The area normally acts as a monitor for errors or the potential need to stop an action, and gets the decision-making areas at the front of the brain involved when it senses something is “off.”

The pooled brain scan data used in the new paper was collected when OCD patients and healthy people were asked to perform certain tasks while lying in a powerful functional MRI scanner. In all, the new analysis included scans and data from 484 children and adults, both medicated and not.

Norman led the combining of the data in a carefully controlled way that allowed for the inclusion of brain scan data from studies conducted as far apart as the Netherlands, the United States and Australia.

It’s the first time a large-scale analysis has included data about brain scans performed when participants with OCD had to respond to errors during a brain scan, and when they had to stop themselves from taking an action. 

A consistent pattern emerged from the combined data: Compared with healthy volunteers, people with OCD had far more activity in the specific brain areas involved in recognizing that they were making an error, but less activity in the areas that could help them stop.

Disconnected brakes

The researchers recognize that these differences aren’t the full story — and they can’t tell from the available data if the differences in activity are the cause, or the result, of having OCD.

But they suggest that OCD patients may have an “inefficient” linkage between the brain system that links their ability to recognize errors and the system that governs their ability to do something about those errors. That could lead their overreaction to errors to overwhelm their underpowered ability to tell themselves to stop.

“It’s like their foot is on the brake telling them to stop, but the brake isn’t attached to the part of the wheel that can actually stop them,” Fitzgerald says. “In cognitive behavioral therapy sessions for OCD, we work to help patients identify, confront and resist their compulsions, to increase communication between the ‘brake’ and the wheels, until the wheels actually stop. But it only works in about half of patients. Through findings like these, we hope we can make CBT more effective, or guide new treatments.”

Translating the findings to clinical care

While OCD was once classified as an anxiety disorder — and patients are often anxious about their behavior — it’s now seen as a separate mental illness.

The anxiety that many OCD patients experience is now thought to be a secondary effect of their condition, brought on by recognizing that they are unable to control repetitive behaviors.

The U-M team will test techniques aimed at taming that drive, and preventing anxiety, in its clinical trial of CBT for OCD. The study is currently seeking teens and adults up to age 45 who have OCD, and healthy teens and adults who do not. It involves two brain scans at U-M’s research fMRI facility, and 12 weeks of free therapy between the first and last scan.  

Fitzgerald notes that rTMS (repetitive transcranial magnetic stimulation), which was recently approved by the FDA to treat OCD, targets some of the circuits that the U-M team has been working to identify.

rTMS focuses magnetic fields on certain areas of the brain from outside the skull. “If we know how brain regions interact together to start and stop OCD symptoms, then we know where to target rTMS,” she says.

For severe cases of OCD, brain surgery techniques have emerged in the last decade as an option – and the new results are consistent with their effects. In such cases, neurosurgeons either disconnect certain brain areas from one another with tiny bursts of energy or cuts, or insert a permanent probe that can stimulate activity in a particular area.

The authors of the new paper call for neurosurgeons to consider the new findings about the role of the brain areas involved in the cingulo-opercular network in both inhibitory control and error processing when deciding whether and where to intervene.

The bottom line for patients

The researchers also call for studies that use genetic tests and repeated fMRI brain imaging of the same OCD patients over time, in what’s called a longitudinal study. That could help researchers piece apart the “chicken and egg” issue of whether the problems with error processing and inhibitory control lie at the heart of OCD, or whether they’re the effects of the symptoms of OCD.

In the meantime, Norman, Fitzgerald and Taylor hope that people who currently have OCD, and parents of children with signs of the condition, will take heart from the new findings. “We know that OCD is a brain-based disorder, and we are gaining a better understanding of the potential brain mechanisms that underlie symptoms, and that cause patients to struggle to control their compulsive behaviors,” says Norman.

Adds Fitzgerald, “This is not some deep dark problem of behavior – OCD is a medical problem, and not anyone’s fault. With brain imaging we can study it just like heart specialists study EKGs of their patients – and we can use that information to improve care and the lives of people with OCD.”

For more information about the clinical trial of CBT for OCD being conducted at U-M, call (734) 232-0443 or psych-ocd-study@med.umich.edu.

The study was funded by the National Institutes of Health (MH102242).

Hope TMS Center Offering Obsessive-Compulsive Disorder (OCD) Treatment with BrainsWay’s Deep Transcranial Magnetic Stimulation (Deep TMS)

FORT WORTH, Texas, Dec. 18, 2018 /PRNewswire/ — Hope TMS Center, one of the premier mental health facilities in the Dallas-Fort Worth area, announced today that it is now treating Obsessive-Compulsive Disorder (OCD) with BrainsWay’s Deep Transcranial Magnetic Stimulation (Deep TMS), following its recent FDA clearance. Deep TMS became the first FDA-cleared medical device for the treatment of OCD in August, making it the first TMS system to be cleared to treat multiple brain disorders.

“We’ve always prioritized helping those that could not find an effective treatment for mental illness elsewhere,” said Dr. Diana Ghelber, the head psychiatrist at Hope TMS Center. “By offering this groundbreaking new OCD treatment in our area, we can offer BrainsWay’s revolutionary therapy to our patients who remain resistant to conventional therapies.”

In Texas, 3.8 percent suffered from a serious mental illness from 2013-2014, according to the Behavioral Health Barometer. OCD is a mental illness that causes patients to have long-lasting and uncontrollable obsessions and behaviors, that affects about 2.2 million Americans according to the American Psychiatric Association. Typically, patients suffering from OCD undergo a regimen of antidepressants and Exposure Response Prevention Therapy (ERP Therapy) to manage symptoms. However, roughly half of OCD patients do not respond to these conventional treatments. BrainsWay developed the first patented treatment that could have life changing benefits for patients suffering from OCD.

Deep TMS therapy for OCD is a minimally invasive treatment that targets the anterior cingulate cortex in the brain, known to be responsible for OCD. The treatment is applied through a padded helmet, with waves similar to the frequency of an MRI.

Hope TMS Center, previously known as the Institute for Advanced Psychiatry, specializes in the alternative treatment of mental health ailments, such as depression and OCD. The facility specializes in the application of Brain Music Therapy to treat insomnia, depression, anxiety disorders, ADHD and migraines. Dr. Ghelber is a Board-Certified Psychiatrist who worked in Israel for 18 years with patients suffering from post-traumatic stress disorder (PTSD) in various capacities including victims of terror attacks and Holocaust survivors. She is currently a principal investigator in a number of studies targeting depression. In 2017, Dr. Ghelber was a recipient of America’s Most Honored Professionals. In 2018, she was honored with the America’s Most Honored Professionals – Top 1 Percent award, and was also a Compassionate Doctor 5 Year Honoree.

About Hope TMS Center
Hope TMS Center is a mental health facility providing patients in the Dallas-Fort Worth area the latest depression and OCD treatments. It offers an integrative approach to patients including Deep TMS, ketamine infusions, medication, treatment of addiction to opioids, Brain Music Therapy and psychotherapy, with a special focus on patients with severe and treatment resistant disorders.

About BrainsWay
BrainsWay Ltd./ BrainsWay USA, is engaged in the research, development and sales and marketing of a medical system for non-invasive treatment of common brain disorders. The medical system developed and manufactured by the company is based on a unique breakthrough technology called Deep TMS, which can reach significant depth and breadth of the brain and produce broad stimulation and functional modulation of targeted brain areas. In the U.S., the Company’s device has been FDA cleared for the treatment of major depressive disorder (MDD) since 2013, and is now FDA cleared (De-Novo) for the treatment of Obsessive Compulsive Disorder (OCD). The Company’s systems have also received CE clearance and are sold worldwide for the treatment of various brain disorders.

Hope TMS Contact:
Kumud Khanal
kumudtms@gmail.com
281-619-8329

Media Contact:
Nechama Feuerstein
Brainsway@AntennaGroup.com
201-373-2228

SOURCE Hope TMS Center

Related Links

http://www.myhopetms.com

6 Thoughts People With OCD Have—According to Women Diagnosed With This Mental Health Condition

Obsessive-compulsive disorder is sheer anguish for those who struggle with it. Vexing thoughts or images—things that are distressing or sexual in nature, for instance—are a hallmark of OCD. To counteract their anxious feelings, people with this mental health diagnosis may feel compelled to perform certain behaviors over and over, such as extreme handwashing, or mental rituals, like excessive counting.

Yet people who don’t know any better sometimes make light of OCD, equating it with perfectionistic personality traits. It’s true that some people with OCD have persnickety habits, like the freakishly neat Monica Geller played by Courteney Cox on Friends. But life with OCD is much more complex than stereotypes make it out to be.

As many as 2 to 3 million U.S. adults and half a million kids are living with this disorder, according to the International OCD Foundation. Symptoms can subside or go into remission with treatment. But it takes courage to confront one’s obsessions and compulsions and “break the cycle,” asserts Anne, one of three women with OCD who agreed to share intimate details of the specific thoughts and compulsions they live with. “For those of us who have it,” she says, “it’s not a joke.”

RELATED: 10 Signs You May Have OCD

“I had these terrifying thoughts of taking a bag and, ugh, holding it over my son’s head”

Anne began struggling with cycles of anxiety and depression in 2004. When a licensed clinical social worker mentioned OCD in passing, the now 38-year-old dismissed the idea, believing you had to be fastidiously clean (which she assures me she is not) to meet the diagnosis.

Then her thoughts turned grim (and I can hear the angst in her voice as she reflects on the horror of it all). She’d see scissors or a knife and think of stabbing her toddler. She’d see the atrium at her workplace and imagine herself taking a leap to her death.

She enlisted friends at work and family at home to sit with her so she would never be alone. “That was my compulsion,” she explains. “If I had somebody with me who was normal, then they would stop me from doing anything abnormal.”

I sometimes find myself “getting reassurance to the point of ridiculousness”

Terrifying, intrusive thoughts no longer haunt Anne, who sees a clinical psychologist specializing in OCD. But she still has a habit of seeking reassurance, a common trait among people with OCD.

The Connecticut mom realizes she shouldn’t have to call others to decide how many rolls to buy for a large family dinner. But she is compelled to gather their opinions because what if people really like rolls, or different types of rolls?

“If I can’t find somebody to talk to,” she explains, “I’ll end up doing a compulsive buy.” This past Thanksgiving, she purchased 100 rolls for 37 people.

RELATED: 15 Things People With OCD Want You to Know

“I’m doing these things; I can’t stop doing them; I realize they’re irrational”

Laura, a 35-year-old blogger, says her compulsions are mostly mental: She repeats phrases or sentences in her head. (When I asked for an example, her voice rose in pitch, as if she were panicked, telling me that reciting them aloud might trigger an OCD episode.) But she did recall one vivid event from her adolescence.

“My brother noticed me knocking on my head, because in my head I was saying, ‘knock on wood,’ and he was wondering why I did it,” she recounts. To stop her, he sat on her hands. “It was just excruciating,” says Laura, “because I felt this compulsion, this need to do it.”

“I couldn’t stop the brain loop, sort of like a broken record”

It was during a college psych course that the pieces of Laura’s life—intrusive sexual thoughts that made her feel ashamed, plus other obsessions and compulsions over the years—instantly fit together. She was relieved to attribute her symptoms to a chemical imbalance, not “a moral failing.”

Actually, researchers have yet to pinpoint the cause of OCD. But risk factors include genetics, physical or sexual abuse in childhood, and differences in brain structure and function. A recent review of studies involving brain scans of people with OCD suggests a brain circuitry problem may be to blame for repetitive behaviors.

RELATED: Do You Have Social Anxiety—or Are You Just Awkward at Parties?

“I’ll find myself pushing down the faucet even though no water is coming out”

Laura is a compulsive checker of door locks, ovens, and faucets. Repeatedly checking on things is something some folks with OCD do to ease the fear and stress of perceived harms to themselves or others.

“I’ll watch myself turn off heat from cooking or making a pot of tea, but then sometimes I’ll still stare at it—like, ensure that it’s off,” says Laura.

“I’ll spend hours in bed before my brain will let me sleep”

By all outward appearances, 33-year-old Diana is a supermom. She’s the one who bakes the prettiest cakes and plans for every contingency. Before a Yellowstone vacation, she assembled kits containing just-in-case supplies for her immediate family members and others going on a hike.

The truth is that Diana strives to do her best, but not because she’s trying to one up anyone. Her obsessions are related to perfectionism. Every night, she scours Pinterest articles for ideas on how to be more tidy and organized. “I’ll spend hours in bed (seeking tips and making lists) before my brain will let me sleep,” she confesses.

And that family vacation? At one point she was physically ill because she couldn’t give herself permission to relax.

“I’m so overwhelmed, but I need to clean my bathroom”

Diana feels compelled to clean house. But it’s not easy for her, and the more she has on her plate, the less she’ll get done. When things get cluttered, she’ll lose focus. Paperwork is her nemesis because she can’t decide on a system for handling it.

The one thing she’s driven to do each day is wipe down and disinfect each of the four toilets in her three-story home. “Even when I’m sick, if I don’t do anything else that day, my bathrooms will be clean.”

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My Anxiety Landed Me In The ER Over & Over Again. Here’s How I Finally Regained Control

If you don’t quite understand how the brain can formulate illnesses when they’re not there, it’s OK—it’s still hard even for me to understand the workings of my mind, even after doing tireless research on the subject and attending biweekly therapy sessions for over a year. It’s especially hard to wrap your head around hypochondria if you haven’t experienced it firsthand. “It’s an obsession, and oftentimes people don’t want to listen to someone’s obsessions,” Gail Martz-Nelson, a Denver psychologist specializing in anxiety disorders told Psychology Today. “‘I’m terrified I have HIV, I’m terrified I have cancer, I’m terrified I have lymphoma.’ People hear that and dismiss it or laugh it off. But being a hypochondriac can be crippling. It’s not a joke.”

My very real paranoia and fear were rarely acknowledged; my obsession shrugged off as irrationality since, physically, I seemed to be the picture of health. This is partly due to the fact that women’s pain is routinely ignored, both by themselves and (more pressingly) by medical professionals. Historically, women have been disparaged from coming forward with their health concerns, as reported in great detail in a recent Medium essay from Eileen Pollack, author of The Only Woman in the Room: Why Science Is Still a Boys’ Club. Pollack exhaustively demonstrates how the medical establishment undermines, misdiagnoses, and gaslights women. For example, she cites research that’s shown how doctors and nurses consider female patients “more demanding” than male patients because they “ask too many questions and ‘communicate too diffusively.'”

“Though we have come a long way since the days of Victorian medicine and women being diagnosed with hysteria, research suggests there is still a gender gap when it comes to medical treatment,” Laura Albers, a certified master wellness coach by The International Association of Wellness Professionals and licensed professional counselor, tells me. “Some stereotypes persist around women being overly emotional and irrational, making it easier for some doctors to react more dismissively when a female patient comes to them in pain.”

This is precisely where the misdiagnosis of hypochondriasis comes into play: “Medical professionals tend to dismiss as hypochondriacs people who visit doctors frequently, use pain medications excessively, ask for surgery, and generally act in ways an invalid would act—all of which correspond with the behavior of someone who suffers from a real disease no one believes she has,” Pollack writes. This is offensive—especially to me, a woman who actually suffers from IAD—and unacceptable.

A potential IAD diagnosis isn’t permission for dismissal from medical professionals. It’s this behavior that’s seemingly heralded the modern comeback of the “female hysteria” prescription. As we push for the medical establishment to start taking women’s pain more seriously, we also need a better system in place for recognizing and sensitively treating possible IAD. For me, my hypochondriasis is my pain, and it’s very, very real.

The fact that I have hypochondria doesn’t mean that I should stop advocating for my own health. No matter their diagnosis or lack thereof, women are not “difficult” for asking questions. We are each our own spokeswoman in a complicated system of frequent, unfortunate oppression and dismissal.

Albers says that women commonly tend to be more in tune with their bodies, and they notice more when they are having symptoms or when something seems “out of balance”—like an intuitive gut feeling that something isn’t quite right. But “if you are continually gaslighted about what your body is telling you, you grow less and less able to trust those signals,” Pollack writes.

Just because I’ve struggled intensely with IAD in the past and more mildly in the present doesn’t mean that I haven’t learned to trust my body’s intuition when it comes to pain and to know when something’s actually wrong with my health. Just like so many women, what I need at the end of the day is to be taken seriously. To be heard.

Anxiety disorders, PTSD, and OCD linked to inflammatory dysregulation, study finds

Post-traumatic stress disorder, obsessive-compulsive disorder, and anxiety disorders are all positively associated with high levels of inflammation markers in the blood, according to new research published in the journal Depression Anxiety.

“Broadly, my research program examines the ways that emotions and physiology influence and relate to one another — that is, when someone experiences negative emotions (e.g., sadness, anxiety, anger) frequently and/or intensely what does that do to their physical health?” said study author Megan E. Renna of Columbia University.

“There has been a well-established link between chronic illness and anxiety in the literature over the years. But, it still has been unclear as to what processes, both psychologically and physically, contribute to this association, so I wanted to examine if inflammation may be one of these processes among people with anxiety, traumatic stress, and obsessive-compulsive related disorders.”

“Inflammation is associated with a whole host of chronic illnesses (HIV, cancer, cardiovascular disease, Alzheimer’s disease, etc.), so it felt especially important to see if chronic and pervasive anxiety increases inflammation. It is my hope that we can build interventions to better address the physical impact of anxiety and increase the quality of life and improve the physical health of people with anxiety and related disorders, and so this meta-analysis was one step in that direction.”

In the study, Renna and her colleagues examined 41 previous studies on individuals diagnosed with PTSD, OCD, or an anxiety disorder. All of the studies included control groups and had at least one measure of inflammation in the blood.

The researchers found people diagnosed with these disorders tended to have significantly higher level of pro-inflammatory markers compared to healthy control subjects. But there was no significant differences between people with PTSD, OCD, or an anxiety disorder.

“Anxiety, regardless of the specific type (e.g., fear, worry, hypervigilance) can not only take a toll on someone psychologically, but physically as well. In terms of the physical implications, systemic inflammation is something that is relatively invisible — meaning that the things that we feel can impact our bodies in ways that we may not fully be aware of,” Renna told PsyPost.

“Although we don’t yet necessarily know if this leads to health issues in the long term, it may be important to get treatment for your anxiety to better not only your mental health but your physical health as well.”

The study — like all research — includes some limitations.

“Two big questions still remain: First, PTSD seems to be driving the difference in inflammation between people with anxiety and healthy controls. But, there also seems to be much less research on other disorders compared to PTSD. I think it is important for the field to continue trying to understand how other types of anxiety increases inflammation. Also, it will be important to understand what makes PTSD different from the other disorders in terms of its impact on inflammation.”

“Second, this meta-analysis did not look at the processes contributing to greater inflammatory dysregulation in people with these disorders — many of the included studies did not measure what connects anxiety to inflammation. It is important in terms of next steps to be more mechanistic in our understanding of how anxiety is associated with inflammation in order to better learn how to intervene on this relationship and promote better long term health for people suffering from these disorders.”

The study, “The association between anxiety, traumatic stress, and obsessive–compulsive disorders and chronic inflammation: A systematic review and meta‐analysis“, was authored by Megan E. Renna, Mia S. O’Toole, Phillip E. Spaeth, Mats Lekander, and Douglas S. Mennin.

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