Archive | August, 2015

European College of Neuropsychopharmacology study: How to prevent suicide?

31 Aug

People of all ages may have feelings of profound sadness, loss, and depression. There is no one on earth, despite what the ads attempt to portray, who lives a perfect life. Every life has flaws and blemishes, it is just that some cope better than others. For every person who lives to a ripe old age, during the course of that life they may encounter all types of loss from loss of a loved one through death, divorce or desertion, loss of job, financial reverses, illness, dealing with A-holes and twits, plagues, pestilence, and whatever curse can be thrown at a person. The key is that they lived THROUGH whatever challenges they faced AT THAT MOMENT IN TIME. Woody Allen said something like “90% of life is simply showing up.” Let moi add a corollary, one of the prime elements of a happy life is to realize that whatever moment you are now in, it will not last forever and that includes moments of great challenge. A person does not have to be religious to appreciate the story of Job. The end of the story is that Job is restored. He had to endure much before the final victory, though.

Science Daily reported in How can we prevent suicide? Major study shows risk factors associated with depression:

A major multi-national study of suicides has identified the behaviour patterns which precede many suicide attempts. This may lead to changes in clinical practice in the care of patients affected with depression, as it shows the clinical factors which confer major risk of suicide attempts.

The statistics for suicide are frightening. According to the WHO, more than 800,000 people commit suicide every year, with perhaps 20 times that number attempting suicide. Suicide is one of the leading causes of death in the young (in the UK for example, it is the leading cause of death in men under 35) see notes, below. Effective measures of suicide prevention are urgently needed.

The BRIDGE-II-MIX study is a major international study looking at depression and suicide. The researchers evaluated 2811 patients suffering from depression, of whom 628 had already attempted suicide. Each patient was interviewed by a psychiatrist as if it were a standard evaluation of a mentally-ill patient. The parameters studied included previous suicide attempts, family history, current and previous treatment, patients’ clinical presentation, how they scored on the standard Global Assessment of Functioning scale, and other parameters. The study looked especially at the characteristics and behaviours of those who had attempted suicide, and compared these to depressed patients who had not attempted suicide. They found that certain patterns recur before suicide attempts.

According to author Dr. Dina Popovic (Barcelona):
‘We found that “depressive mixed states” often preceded suicide attempts. A depressive mixed state is where a patient is depressed, but also has symptoms of “excitation,” or mania. We found this significantly more in patients who had previously attempted suicide, than those who had not. In fact 40% of all the depressed patients who attempted suicide had a “mixed episode” rather than just depression. All the patients who suffer from mixed depression are at much higher risk of suicide.
We also found that the standard DSM criteria identified 12% of patients at showing mixed states, whereas our methods showed 40% of at-risk patients. This means that the standard methods are missing a lot of patients at risk of suicide.”

In a second analysis of the figures, they found that if a depressed patient presents any of the following symptoms:

• risky behaviour (e.g. reckless driving, promiscuous behaviour)
• psychomotor agitation (pacing around a room, wringing one’s hands, pulling off clothing and putting it back on and other similar actions)
• impulsivity (acting on a whim, displaying behaviour characterized by little or no forethought, reflection, or consideration of the consequences),
then their risk of attempting suicide is at least 50% higher.
http://www.sciencedaily.com/releases/2015/08/150830152601.htm

Citation:

How can we prevent suicide? Major study shows risk factors associated with depression
Date: August 30, 2015

Source: European College of Neuropsychopharmacology

Summary:

A major multi-national study of suicides has identified the behavior patterns which precede many suicide attempts. This may lead to changes in clinical practice in the care of patients affected with depression, as it shows the clinical factors which confer major risk of suicide attempts.

• Abstract

Send to:
J Clin Psychiatry. 2015 Mar;76(3):e351-8. doi: 10.4088/JCP.14m09092.
Mixed features in patients with a major depressive episode: the BRIDGE-II-MIX study.
Perugi G1, Angst J, Azorin JM, Bowden CL, Mosolov S, Reis J, Vieta E, Young AH; BRIDGE-II-Mix Study Group.
Author information

Abstract

OBJECTIVE:

To estimate the frequency of mixed states in patients diagnosed with major depressive episode (MDE) according to conceptually different definitions and to compare their clinical validity.

METHOD:

This multicenter, multinational cross-sectional Bipolar Disorders: Improving Diagnosis, Guidance and Education (BRIDGE)-II-MIX study enrolled 2,811 adult patients experiencing an MDE. Data were collected per protocol on sociodemographic variables, current and past psychiatric symptoms, and clinical variables that are risk factors for bipolar disorder. The frequency of mixed features was determined by applying both DSM-5 criteria and a priori described Research-Based Diagnostic Criteria (RBDC). Clinical variables associated with mixed features were assessed using logistic regression.

RESULTS:

Overall, 212 patients (7.5%) fulfilled DSM-5 criteria for MDE with mixed features (DSM-5-MXS), and 818 patients (29.1%) fulfilled diagnostic criteria for a predefined RBDC depressive mixed state (RBDC-MXS). The most frequent manic/hypomanic symptoms were irritable mood (32.6%), emotional/mood lability (29.8%), distractibility (24.4%), psychomotor agitation (16.1%), impulsivity (14.5%), aggression (14.2%), racing thoughts (11.8%), and pressure to keep talking (11.4%). Euphoria (4.6%), grandiosity (3.7%), and hypersexuality (2.6%) were less represented. In multivariate logistic regression analysis, RBDC-MXS was associated with the largest number of variables including diagnosis of bipolar disorder, family history of mania, lifetime suicide attempts, duration of the current episode > 1 month, atypical features, early onset, history of antidepressant-induced mania/hypomania, and lifetime comorbidity with anxiety, alcohol and substance use disorders, attention-deficit/hyperactivity disorder, and borderline personality disorder.

CONCLUSIONS:

Depressive mixed state, defined as the presence of 3 or more manic/hypomanic features, was present in around one-third of patients experiencing an MDE. The valid symptom, illness course and family history RBDC criteria we assessed identified 4 times more MDE patients as having mixed features and yielded statistically more robust associations with several illness characteristics of bipolar disorder than did DSM-5 criteria.
© Copyright 2015 Physicians Postgraduate Press, Inc.
Comment in
• “Mixed” depression: drawbacks of DSM-5 (and other) polythetic diagnostic criteria. [J Clin Psychiatry. 2015]
• Mixed depression: a farewell to differential diagnosis? [J Clin Psychiatry. 2015]
PMID:
25830457
[PubMed – indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/25830457

Here is the press release from the European College of Neuropsychopharmacology:

Public Release: 29-Aug-2015 How can we prevent suicide? Major study shows risk factors associated with depression

European College of Neuropsychopharmacology

A major multi-national study of suicides has identified the behaviour patterns which precede many suicide attempts. This may lead to changes in clinical practice in the care of patients affected with depression, as it shows the clinical factors which confer major risk of suicide attempts.

The statistics for suicide are frightening. According to the WHO, more than 800,000 people commit suicide every year, with perhaps 20 times that number attempting suicide. Suicide is one of the leading causes of death in the young (in the UK for example, it is the leading cause of death in men under 35) see notes, below. Effective measures of suicide prevention are urgently needed.

The BRIDGE-II-MIX study is a major international study looking at depression and suicide. The researchers evaluated 2811 patients suffering from depression, of whom 628 had already attempted suicide. Each patient was interviewed by a psychiatrist as if it were a standard evaluation of a mentally-ill patient. The parameters studied included previous suicide attempts, family history, current and previous treatment, patients’ clinical presentation, how they scored on the standard Global Assessment of Functioning scale, and other parameters. The study looked especially at the characteristics and behaviours of those who had attempted suicide, and compared these to depressed patients who had not attempted suicide. They found that certain patterns recur before suicide attempts.

According to author Dr. Dina Popovic (Barcelona):
‘We found that “depressive mixed states” often preceded suicide attempts. A depressive mixed state is where a patient is depressed, but also has symptoms of “excitation”, or mania. We found this significantly more in patients who had previously attempted suicide, than those who had not. In fact 40% of all the depressed patients who attempted suicide had a “mixed episode” rather than just depression. All the patients who suffer from mixed depression are at much higher risk of suicide.

We also found that the standard DSM criteria identified 12% of patients at showing mixed states, whereas our methods showed 40% of at-risk patients. This means that the standard methods are missing a lot of patients at risk of suicide”.

In a second analysis of the figures, they found that if a depressed patient presents any of the following symptoms:

• risky behaviour (e.g. reckless driving, promiscuous behaviour)
• psychomotor agitation (pacing around a room, wringing one’s hands, pulling off clothing and putting it back on and other similar actions)
• impulsivity (acting on a whim, displaying behaviour characterized by little or no forethought, reflection, or consideration of the consequences),
then their risk of attempting suicide is at least 50% higher.
Dr Popovic continued:

“In our opinion, assessing these symptoms in every depressed patient we see is extremely important, and has immense therapeutical implications. Most of these symptoms will not be spontaneously referred by the patient, the clinician needs to inquire directly, and many clinicians may not be aware of the importance of looking at these symptoms before deciding to treat depressed patients.

This is an important message for all clinicians, from the GPs who see depressed patients and may not pay enough attention to these symptoms, which are not always reported spontaneously by the patients, through to secondary and tertiary level clinicians. In highly specialized tertiary centres, clinicians working with bipolar patients are usually more aware of this, but that practice needs to extent to all levels.

The strength of this study is that it’s not a clinical trial, with ideal patients – it’s a big study, from the real world”.
Commenting ECNP President, Professor Guy Goodwin (Oxford) said:

The recognition of increased activation in the context of a severe depression is an important practical challenge. While many psychiatrists recognize that this constitutes an additional risk for suicide, and would welcome better scales for its identification, the question of treatment remains challenging. We need more research to guide us on best practice. http://www.eurekalert.org/pub_releases/2015-08/econ-hcw082615.php

What Should You Do if You Know Someone Who Thinking About Suicide?

If you are thinking of suicide or you know someone who is thinking about suicide, GET HELP, NOW!!!! The Suicide Prevention Resource Center http://www.sprc.org/basics/roles-suicide-prevention has some excellent advice about suicide prevention http://www.sprc.org/basics/roles-suicide-prevention
Resources:

Suicide Prevention
http://www.cdc.gov/violenceprevention/pub/youth_suicide.html

Teen Suicide Overview
http://www.teensuicidestatistics.com/

Teen’s Health’s Suicide
http://kidshealth.org/teen/your_mind/feeling_sad/suicide.html

American Academy of Adolescent Psychiatry http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Teen_Suicide_10.aspx

Suicide Prevention Resource Center
http://www.sprc.org/basics/roles-suicide-prevention

Teen Depression
http://helpguide.org/mental/depression_teen.htm

Jared Story.Com
http://www.jaredstory.com/teen_epidemic.html

CNN Report about suicide                                                                                                                                    http://www.cnn.com/2009/LIVING/10/20/lia.latina.suicides/index.html

American Foundation for Suicide Prevention
http://www.afsp.org This group is dedicated to advancing the knowledge of suicide and the ability to prevent it.

SA\VE – Suicide Awareness\Voices of Education
http://www.save.org SA\VE offers information on suicide prevention. Call (800) SUICIDE

About.Com’s Depression In Young Children                                                                                            http://depression.about.com/od/child/Young_Children.htm

Psych Central’s Depression In Young Children                                                                                          http://depression.about.com/od/child/Young_Children.htm

Psychiatric News’ Study Helps Pinpoint Children With Depression
http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=106034

Family Doctor’s What Is Depression?
http://familydoctor.org/familydoctor/en/diseases-conditions/depression.html

WebMD’s Depression In Children
http://www.webmd.com/depression/guide/depression-children

Healthline’s Is Your Child Depressed?
http://www.healthline.com/hlvideo-5min/how-to-help-your-child-through-depression-517095449

Medicine.Net’s Depression In Children                                                                                                             http://www.onhealth.com/depression_in_children/article.htm

If you or your child needs help for depression or another illness, then go to a reputable medical provider. There is nothing wrong with taking the steps necessary to get well.

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com/

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http://drwildareviews.wordpress.com/

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https://drwilda.com/

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Stanford School of Medicine study: Brain scans may predict math ability

25 Aug

Jacob Vigdor wrote the interesting Education Next article, Solving America’s Math Problem:

American public schools have made a clear trade-off over the past few decades. With the twin goals of improving the math performance of the average student and promoting equality, it has made the curriculum more accessible. The drawback to exclusive use of this more accessible curriculum can be observed among the nation’s top-performing students, who are either less willing or less able than their predecessors or their high-achieving global peers to follow the career paths in math, science, and engineering that are the key to innovation and job creation. In the name of preparing more of the workforce to take those jobs, we have harmed the skills of those who might have created them. Although there is some evidence of a payoff from this sacrifice, in the form of marginally better performance among average students, some of the strategies used to help these students have in fact backfired…

Not all children are equally prepared to embark on a rigorous math curriculum on the first day of kindergarten, and there are no realistic policy alternatives to change this simple fact. Rather than wish differences among students away, a rational policy for the 21st century will respond to those variations, tailoring lessons to children’s needs. This strategy promises to provide the next generation of prospective scientists and engineers with the training they need to create jobs, and the next generation of workers with the skills they need to qualify for them. http://educationnext.org/solving-america%E2%80%99s-math-problem/#.UG25FCk_6rE.email

One way of looking at Vigdor’s conclusions is to ask whether high performance preschool programs and early intervention can affect student achievement?

Maggie Fox of NBC News reported in the story, Brain Scans May Predict Math Gains in Children, Study Finds:

Brain scans may be able to predict which kids are likely to improve their math skills in school and which ones are not, and they do it better than IQ or math tests, researchers reported Tuesday.
The researchers have been working with a group of kids who started getting brain scans at the age of 8, and who have followed up with tests into their mid-teens.

To their surprise, the researchers found that certain patterns of brain activity when the kids were not doing anything at all at age 8 predicted how much they would improve their math skills over the years. And these scans did so with far more accuracy than did intelligence tests, reading tests or math tests, they report in the Journal of Neuroscience.
While it’s far too soon to stick every kid into a brain scanner, the findings may eventually lead to ways to identify the children who’d benefit most from intensive math coaching, the researchers said…. http://www.nbcnews.com/health/kids-health/brain-scans-may-predict-math-gains-study-finds-n412141

Citation:

• Abstract

J Neurosci. 2015 Aug 19;35(33):11743-50. doi: 10.1523/JNEUROSCI.0216-15.2015.
Brain Structural Integrity and Intrinsic Functional Connectivity Forecast 6 Year Longitudinal Growth in Children’s Numerical Abilities.
Evans TM1, Kochalka J2, Ngoon TJ2, Wu SS2, Qin S2, Battista C2, Menon V3.
Author information
Abstract
Early numerical proficiency lays the foundation for acquiring quantitative skills essential in today’s technological society. Identification of cognitive and brain markers associated with long-term growth of children’s basic numerical computation abilities is therefore of utmost importance. Previous attempts to relate brain structure and function to numerical competency have focused on behavioral measures from a single time point. Thus, little is known about the brain predictors of individual differences in growth trajectories of numerical abilities. Using a longitudinal design, with multimodal imaging and machine-learning algorithms, we investigated whether brain structure and intrinsic connectivity in early childhood are predictive of 6 year outcomes in numerical abilities spanning childhood and adolescence. Gray matter volume at age 8 in distributed brain regions, including the ventrotemporal occipital cortex (VTOC), the posterior parietal cortex, and the prefrontal cortex, predicted longitudinal gains in numerical, but not reading, abilities. Remarkably, intrinsic connectivity analysis revealed that the strength of functional coupling among these regions also predicted gains in numerical abilities, providing novel evidence for a network of brain regions that works in concert to promote numerical skill acquisition. VTOC connectivity with posterior parietal, anterior temporal, and dorsolateral prefrontal cortices emerged as the most extensive network predicting individual gains in numerical abilities. Crucially, behavioral measures of mathematics, IQ, working memory, and reading did not predict children’s gains in numerical abilities. Our study identifies, for the first time, functional circuits in the human brain that scaffold the development of numerical skills, and highlights potential biomarkers for identifying children at risk for learning difficulties.
SIGNIFICANCE STATEMENT:
Children show substantial individual differences in math abilities and ease of math learning. Early numerical abilities provide the foundation for future academic and professional success in an increasingly technological society. Understanding the early identification of poor math skills has therefore taken on great significance. This work provides important new insights into brain structure and connectivity measures that can predict longitudinal growth of children’s math skills over a 6 year period, and may eventually aid in the early identification of children who might benefit from targeted interventions.
Copyright © 2015 the authors 0270-6474/15/3511743-08$15.00/0.
• Received January 15, 2015.
• Revision received July 15, 2015.
• Accepted July 15, 2015.

Here is the press release from Stanford:

Brain scans better forecast math learning in kids than do skill tests, study finds
Gray matter volume and connections between several brain regions better forecast 8-year-olds’ acquisition of math skills than their performance on standard math tests.
Vinod Menon and his colleagues found that scans of brain structures indicated which childen would be the best math learners over the next six years.

Brain scans from 8-year-old children can predict gains in their mathematical ability over the next six years, according to a new study from the Stanford University School of Medicine.
The research tracked 43 children longitudinally for six years, starting at age 8, and showed that while brain characteristics strongly indicated which children would be the best math learners over the following six years, the children’s performance on math, reading, IQ and memory tests at age 8 did not.

The study, published online Aug. 18 in The Journal of Neuroscience, moves scientists closer to their goal of helping children who struggle to acquire math skills.
“We can identify brain systems that support children’s math skill development over six years in childhood and early adolescence,” said the study’s lead author, Tanya Evans, PhD, postdoctoral scholar in psychiatry and behavioral sciences.

“A long-term goal of this research is to identify children who might benefit most from targeted math intervention at an early age,” said senior author Vinod Menon, PhD, professor of psychiatry and behavioral sciences. “Mathematical skills are crucial in our increasingly technological society, and our new data show which brain features forecast future growth in math abilities.”
At the start of the study, the children received structural and functional magnetic resonance imaging brain scans. None of the kids had neurological or psychiatric disorders, and their intelligence fell in a range considered normal for their age. The scans were conducted while the children lay quietly in the scanner; the scans measured brain structure and intrinsic functional connections between brain regions, and were not tied to performance on any particular math task.

The 8-year-olds also took standardized tests (given outside the scanner) to measure IQ, as well as reading, math and working-memory skills. All of the children returned for at least one follow-up assessment of these skills before age 14, and many children had other additional follow-ups.

Surprising results

The scientists were surprised by the extent and nature of the connections between brain regions that predicted the development of the children’s math skills. Greater volume and connectivity of two areas forecast skill development: the ventro-temporal occipital cortex, which is a brain region that supports visual object perception, and the intra-parietal sulcus, which helps people compare and make judgements about numbers, such as understanding that four is more than three. The strength of these regions’ interconnections with the prefrontal cortex was also predictive. The work identifies a network of brain areas that provides a scaffold for long-term math skill development in children, Menon said.

The 8-year-olds’ initial IQ, reading, working-memory and math scores did not predict long-term learning in math. The lack of predictive ability of standard math tests taken at age 8 suggests that brain features more precisely predict children’s math learning, Evans said. The brain scans capture many different aspects of information processing, thus better forecasting which children will fall behind and which will excel, Menon added.
Just because a child is currently struggling doesn’t necessarily mean he or she will be a poor learner in the future.
“Next, we are investigating how brain connections change over time in children who show large versus small improvements in math skills, and designing new interventions to help children improve their short-term learning and long-term skill acquisition,” Menon said. Although it is still impractical to give brain scans to children on a large scale, the team’s studies provide a baseline understanding of normal development that will help experts develop and validate remediation programs for children with learning disabilities, he noted.
In the meantime, the team’s findings suggest that parents and teachers should encourage children to exercise their mental math muscles. “Just because a child is currently struggling doesn’t necessarily mean he or she will be a poor learner in the future,” Evans said.

Other Stanford co-authors were research assistants John Kochalka, Tricia Ngoon and Sarah Wu; instructor Shaozheng Qin, PhD; and postdoctoral scholar Christian Battista, PhD.

All brain scans were conducted at the Richard M. Lucas Center for Imaging at the School of Medicine.
The research was funded by grants from the National Institutes of Health (grants HD047520, HD059205 and HD080367), Stanford’s Child Health Research Institute, the Lucile Packard Foundation for Children’s Health, Stanford’s Clinical and Translational Science Award (NIH grant UL1RR025744) and the Netherlands Organization for Scientific Research. Menon is a member of Stanford’s Child Health Research Institute.
Information about Stanford’s Department of Psychiatry and Behavioral Sciences, which also supported the research, is available at http://med.stanford.edu/psychiatry.html.

Because the ranks of poor children are growing in the U.S., this study portends some grave challenges not only for particular children, but this society and this country. Adequate early learning opportunities and adequate early parenting is essential for proper development in children. https://drwilda.wordpress.com/2011/12/18/jonathan-cohns-the-two-year-window/
https://drwilda.com/2012/08/08/oregon-state-university-study-ability-to-pay-attention-in-preschool-may-predict-college-success/

Related:

Study: Gender behavior differences lead to higher grades for girls
https://drwilda.com/2013/01/07/study-gender-behavior-differences-lead-to-higher-grades-for-girls/

Girls and math phobia
https://drwilda.com/2012/01/20/girls-and-math-phobia/

University of Missouri study: Counting ability predicts future math ability of preschoolers
https://drwilda.com/2012/11/15/university-of-missouri-study-counting-ability-predicts-future-math-ability-of-preschoolers/

Is an individualized program more effective in math learning?                                                                                     https://drwilda.com/2012/10/10/is-an-individualized-program-more-effective-in-math-learning/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©
http://drwildareviews.wordpress.com/

Dr. Wilda ©
https://drwilda.com/