First Published Wednesday, 11 March 2009

Psychiatry Weekly 2009 Mar 9;4(5)5

Van Ameringen M.

Social phobia typically starts in childhood or early adolescence, and it involves concerns about anxiety in social and performance situations.

“The primary concerns of those with social phobia are about doing something, or behaving in a way, that will lead to negative evaluation or embarrassment or humiliation,” says Dr Michael Van Ameringen. “There is no absolute known cause for this condition, although we know that there are familial and temperament-related predispositions that may be contributing factors.“

The estimated lifetime prevalence of social phobia in the US is 12.1%, a rate that has been replicated around the world-lifetime prevalence runs at around 10% across most cultures. Cross-sectionally, the rate of 12-month social phobia is 6.8%.

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© 2009 Psychiatry Weekly, LLC

First Published Tuesday, 17 March 2009

Tapering slowly is the mantra for pruning these regimens, but some patients may still experience withdrawal symptoms.

By Victoria Stagg Elliott, AMNews staff..

Not long after Thomas C. Bent, MD, a family physician in Laguna Beach, Calif., prescribes an antidepressant, patients start asking certain questions. “As soon as they’re feeling better they start saying, ‘How long do I have to take this? When can I stop this?’ They don’t say that about their blood pressure medicine,” said Dr Bent, who is the medical director and chief operating officer of the Laguna Beach Community Clinic. He is also president-elect of the California Academy of Family Physicians, although he was speaking personally.

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Copyright 2009 American Medical Association. All rights reserved.

Why some patients have extraordinary difficulty quitting antidepressants isn’t clear. It may be more than simple individual biology. Nor is it confined to psychotropic drugs such as antidepressants and benzodiazepines. Even aspirin can be very difficult to discontinue for some.

First Published Tuesday, 17 March 2009

By Teresa J. Foden | Interactive Autism Network

The ship descends on fiery thrusters, cushioned by a plume of methane gas, touching down on the surface of the strange planet. The hatch swings open and the alien crew files out, disembarking with a vague sense of shock and trepidation: Welcome to Earth (if you have autism, that is).

For many young people with autism, venturing out into the adult world is akin to Valentine Michael Smith’s journey to the planet Earth from outer space in the 1961 science fiction classic Stranger in a Strange Land, by Robert A. Heinlein. 1? Like Smith, a human raised by Martians on Mars who returns “home” to Earth as a young adult, today’s 20-somethings with autism often feel like strangers among their own species when they leave the legal protections afforded schoolchildren to enter the adult world of limited support services, long waiting lists, and scant funding. Those who become accomplished sometimes look back on their experiences to reflect on their sense of alienation in a society that doesn’t look favorably on those who don’t blend in easily.

The explorers

Research into the experiences of adults with autism spectrum disorders (ASDs) is in its infancy, and many researchers who want to know more are going to perhaps the richest source of data available: the adults with autism themselves. Among those on the leading edge will be IAN Research, which is developing a series of questionnaires for adults with autism. The questionnaires are expected to go live online this year, and data gleaned from IAN families will be available to researchers investigating the experiences of adults with autism.

One of the most high-profile and prolific of these accomplished people with autism is author, professor, and public speaker Temple Grandin, Ph.D., who describes herself as an “anthropologist on Mars.” In a paper featured in the book Asperger’s and Girls, 2? titled “For Me, a Good Career Gave Life Meaning,” she wrote: “As a young adult, some of the happiest days of my life were working in equipment design where I had to figure out how to design things. Using my mind…gave my life meaning.

“Unlike most people, I am what I do rather than how I feel.” 3

‘Grokking’ the third planet from the sun
*grokking, a Martian word generally meaning ‘gaining complete comprehension’

One 2005 study 4? focused on the discussions at three separate social group meetings for adults, ranging in age from 22 to 49, with ASDs. Investigators found many real-world examples of experiences perhaps summed up best by Thomas McKean in his essay “A Personal Account of Autism,” published in the book Asperger Syndrome or High-Functioning Autism? 5? As quoted by the investigators of the 2005 study, McKean likens his experiences with autism to that of “a space probe on an alien landscape, feeling ill-equipped to process the information he is receiving from a foreign and confusing social world.”

The common thread running through the social group’s discussions was a sense that autism’s social impairments, some of which may seem superficial in many of those with high-functioning autism or Asperger’s syndrome, permeate virtually every aspect of adult life: initiating intimate relationships, developing rewarding friendships, and sustaining challenging, fulfilling employment. Adults with autism are inclined to flounder in the face of ever-shifting social conventions, a tendency that can be particularly debilitating in the workplace. An employee’s lack of social prowess can make all the difference between success and failure, eventually limiting advancement opportunities, salary, or duration of employment. Studies and anecdotal reports from adults with ASDs describe social blunders with supervisors and coworkers, an inability to discern the political winds in the office, and struggles with recognizing and defusing interpersonal conflicts, any of which could lead to job loss.

“Young women and men know how to ‘do school.’ After all, they have been in school for most of their lives. But they often don’t know how to negotiate the complicated world of work…. Their inefficient nonverbal and verbal communication skills can interfere with every aspect of work, from the interview on,” according to “The Launch: Negotiating the Transition from High School to the Great Beyond,” 6 another essay featured in Asperger’s and Girls.

‘Houston, we have a problem’

On the surface, the issue of employment might appear to be easily addressed, given that government-funded employment support programs for other populations of adults with disabilities have been in place since at least the mid-1980s. However, many of these programs have been chronically under-funded and understaffed. The current limitations of these programs are only emphasized by the lack of expertise in ASDs. Both low- and high-functioning adults with ASDs need employment support, but like many others with disabilities, those seeking public assistance are likely to encounter a shortage of services and long waiting lists. As summed up by a 2004 article published in the United Kingdom: “People with Asperger syndrome often find themselves in a maze guided by disability specialists with limited knowledge of the disorder.” 7
As a result, many adults with ASDs are falling through the service gaps. They wander from job to job, often dismissed because of miscommunication and misunderstanding stemming from the social impairments central to their disability. Others cling to employment for which they are woefully overqualified in terms of education and IQ, and many suffer from depression or anxiety disorders caused, or exacerbated, by their inability to find a good fit in the world.

Adults with severe autism are unlikely to reach a high level of independence or social functioning, according to a 2003 study in Canada. 8? As for those considered high functioning, the study says, they are likely to find themselves in jobs beneath what would be expected given their education. “These children can often complete high levels of education, but their functioning in adult life is severely compromised by their lack of social ability.”

Without intensive support, high-functioning adults don’t tend to achieve much more in the workplace than those who are more severely affected by autism, researchers say. Among the most common employment supports is a “job coach,” usually provided by a local health services agency. This coach accompanies the employee to the job location, often daily for the first few months at least, and helps train him or her in job skills and in managing misunderstandings and conflicts as they arise among supervisors and coworkers. For high-functioning adults with disabilities, including some adults with autism, the goal may be to taper off the daily support from the job coach, with perhaps a coworker assuming the role of mentor and the job coach fading into the background and providing additional support only as needed.

Although some researchers consider IQ and degree of language impairment to be among the most important factors determining the long-term success of adults with autism, average to high IQ is clearly no guarantee — especially when psychiatric disorders compound the person’s disability. Although psychiatric resources were inadequate long before autism became prevalent, those very same resources will likely be called upon to become more “autism-friendly,” according to the 2004 U.K. study.

A 2003 U.S. study of outcomes of supported employment found that despite chronic problems with staff turnover, low staff pay, lack of funding, and long waiting lists, participation in employment-support programs was on the rise in the United States. The researchers noted that participants received more support than in the past and experienced better relationships with coworkers. However, they concluded: “There are no real increases in wages or hours worked, two important areas for outcomes. In addition, there is no real change in the types of jobs people are acquiring. People are still largely receiving entry-level jobs in service industries.” 9

Payloads

The lack of investment in adults with ASDs is costly, not only for the families but also for society, according to two studies, one in the United States and the other in the U.K. According to the U.S. study, 10? the estimated total cost of providing care and treatment for a single person with autism, over his or her lifetime, approaches $3.2 million. Costs associated with young adults with autism, ranging in age from 23 to 27, soar to a level rivaled only by the costs for 3- to 7-year-olds with autism. One of the largest components of that cost: lost productivity.

“Although autism is typically thought of as a disorder of childhood, its costs can be felt well into adulthood,” according to the U.S. researchers.

The U.K. study likewise found high costs associated with autism, with estimates exceeding £2.4 million (about US$4.7 million) over the lifetime of one person with autism. 11 For an individual with high-functioning autism, the cost of lost productivity contributed 17.5 percent to the total cost of lifetime care and treatment, according to the study. “Autism is a costly disorder, not only in terms of resources used and forgone, but also in terms of the suffering of people with autism and their relatives.”

Studies like these, and rising numbers of children and adults diagnosed with ASDs, have contributed to a growing sense of urgency among service providers, the community, and legislators. One of the most promising legislative initiatives in the United States is the proposed Expanding the Promise for Individuals with Autism Act of 2007 (EPIAA), which would provide about $350 million in new federal funding for community programs and services for people with autism — including adults.

As one autism advocate put it: “This is an important and compassionate piece of legislation for many reasons, but perhaps most of all because it remembers those who are most frequently forgotten and that is the adults, be they 22 or 72, who are struggling daily with the challenges of autism.” 12

‘That’s one small step for man…’

Failure to provide employment support to people with autism, or withdrawing it prematurely, can be “tantamount to neglect,” according to the book Autism: Identification, Education, and Treatment. 13? “Sometimes, the support needs are not as obvious, because the behavioral and communication challenges are more sporadic and less noticeable. However, when they do occur, they can be job threatening in the short term, and lead to a sporadic history of job success over the long term.”

Employment assistance may be short term or long term, with the highest costs likely to come at the front end of the process, when employees are most likely to require full-time oversight from a job coach or other government-paid staff person. But later, supervision may drop back to a visit once a month or so, with telephone calls and additional visits as needed. Enlisting the aid of supervisors and coworkers in training and mentoring, rather than having the job coach go it alone, tends to considerably enhance the job fit for the employee. One option that fosters involvement of coworkers is “job sharing,” with the new employee sharing duties with a coworker who does not have a disability. The coworker takes on the role of mentor, providing training and support between visits from an agency job coach.

One social aspect that must be addressed with many people with autism is a misperception of the motives of others in the workplace, says Grandin in her article “Making the Transition from the World of School into the World of Work,” posted on the Autism Research Institute’s website (see Additional Resources). She says: “Many people with autism expect all people to be good. It is a rude awakening to learn that some people are bad, and they may try to exploit them. This is a lesson that an independent person with autism must learn. For people with autism who take lower level manufacturing jobs, the other employees should be involved and trained to help the person. The co-workers need to be trained to understand autism.”

A good job fit saves everyone money in the long term: overburdened agencies save the high costs associated with providing coaches for employees in one new job after another; employers save the training costs that go hand in hand with staff turnover; and families save the cost of providing sole financial support for their adult children and siblings. Most of all, a good job fit makes for a more satisfied employee, resulting not only in a sense of personal fulfillment but also increased productivity.

An ‘eccentric education’

Researchers who designed the study of the social skills group mentioned previously, which explored ASDs from the perspective of the adults themselves, asked a series of questions relating to work and social experiences. Discussions were far ranging, with some participants reciting cut-and-dried rules and others speaking as though they were researchers themselves, perhaps studying a foreign species, as illustrated in the following statement: “If they’re staring or spaced out, that means they’re not paying attention.”

Group members said they use a variety of strategies to fit in at work, from following directions as closely as possible, to keeping a journal of feelings to enhance processing, to developing a sense of humor. When they were asked how they get along with people, responses ranged from “I try not to hit people and to not grab people and to keep your hands to yourself” to “Just be friendly and nice and real upbeat and be in a good mood and have a good attitude.”

Participants found some questions puzzling, and resorted to rules to explain the unexplainable. To the question, “Why do some people object to people joining in on a conversation between them even if the conversation is not private?” one man stated, “Technically, according to manners that is not what you are supposed to do.”

Another’s explanation was based on close observation: “You have to look for a sound cue or look for hints that some people give to get in [the conversation] and are they going to get mad or is this something you can get in on and it’s not going to bother them. It’s difficult.”

Closing remarks from the Science Minister and…

ASDs are lifelong developmental disabilities. The children who needed support in school mature into adults who need support in the workplace and in society. Their ongoing struggles interacting with people can leave them employed in unsatisfying jobs that waste their talents and skills, or perhaps leave them unemployed altogether. Satisfying relationships are also out of reach for many adults with ASDs. Frustration and feelings of alienation leave many of them vulnerable to depression, anxiety, and stress-related disorders.

With estimates at more than half a million people aged 21 and younger with ASDs, researchers and professionals are taking a hard look at how they will fare as adults — and at the cost to society when their potential is left to languish. Researchers of one study in Sweden, which found poorer adjustment than expected in men with Asperger’s, captured the growing sense of urgency in their conclusion: “…given their good intellectual capacity, the outcomes must be regarded as sub-optimal. Medical, social and occupational services must find ways to achieve more individually adjusted solutions so as to be more successful in meeting the needs of individuals with autism spectrum disorders.” 14

…the Colonist

From the researcher, to the advocate, to the parent, it is generally agreed that more research needs to focus on how to best prepare the adult with ASD for the real world. Which early interventions stand the test of time? Which transition programs in high school transform adolescents into motivated and productive adults? Which services need to be tweaked, or expanded, to maximize adjustment in these adults?

The bottom line, from one of the participants in the autism social skills group, echoes the sentiments of those with other once-misunderstood disabilities that society has come to recognize as its own: “Just because you’re handicapped doesn’t mean you can’t be a productive member of society.

In his essay in the book High-Functioning Individuals with Autism, 15 Jim Sinclair wrote of his experiences as a young man with autism entering the adult world. “…I needed an orientation manual for extraterrestrials. Being autistic does not mean being inhuman. But it does mean being alien. It means that what is normal for other people is not normal for me, and what is normal for me is not normal for other people.”

View References for this Article

Reproduced with permission of Kennedy Krieger Institute, Baltimore, MD.

By Interactive Autism Network , Share. Research. Discover.

Source:   http://www.opposingviews.com/articles/opinion-autism-and-the-workplace-strangers-in-a-strange-land

First Published Tuesday, 17 March 2009

As the economic outlook becomes gloomier and gloomier and the credit crunch bites even harder, experts at the Priory Group, one of Europe’s leading independent providers of acute mental health service, are warning that they are seeing an increasing number of patients suffering from the symptoms of ‘recession depression’.

People facing unemployment, mounting debts and losing their homes can be overwhelmed by negative feelings and this can manifest itself in a serious depressive episode. This is very different to the normal, brief periods of feeling down that everyone suffers occasionally in response to circumstances in their day-to-day lives.

Dr Jeremy Broadhead, Medical Director and Consultant Psychiatrist at The Priory Hayes Grove, identifies a number of symptoms to look out for which indicate a depressive episode:

• *Low mood for most of the day, nearly every day. Things always seem ‘black’.
• *Loss of enjoyment and interest in life, even for activities that you normally enjoy.
• *Abnormal sadness, often with weepiness.
• *Feelings of guilt, worthlessness, or uselessness.
• *Poor motivation. Even simple tasks seem difficult.
• *Poor concentration. It may be difficult to read, work, etc.
• *Sleeping problems.
• *Lacking in energy and extreme feelings of tiredness.
• *Difficulty with affection, including going off sex.
• *Poor appetite and weight loss or the reverse with comfort eating.
• *Irritability, agitation, or restlessness.
• *Physical symptoms such as headaches, palpitations, chest pains.
• *Recurrent thoughts of death.

Dr Broadhead said: “The current financial crisis is almost certainly having a significant impact on mental health, particularly the issues of unemployment and debt. Money worries don’t just keep people awake at night; they can cause stress, depression and in more extreme cases self harm and suicidal thoughts. At a time when people across the country are anxious about their jobs and their finances, recession-depression is a real and growing concern.

“Depression can be a disabling and potentially serious condition but it can be treated through medication and therapy. Psychological treatments for depression are many and varied. They range from the emotional support provided by the regular opportunity to talk about feelings to a professional, right through to specialised forms of psychotherapy such as cognitive behavioural therapy.

“At a time when depression is striking more and more people it is important that the medical profession acts quickly to identify and treat the illness, allowing the sufferer to regain the positivity in their lives and tackle the issues which caused the problems initially.“

Maintaining your mental health in tough economic times

To help millions of Americans deal with the stress created by the tough economic times, Mental Health America is recommending strategies to help people feel better and protect their mental health.

One recent poll reported that nearly 60 percent of respondents said the current economic situation is a cause of stress in their lives. And one-quarter indicated that anxiety is serious.

“This is a terribly challenging time for many people,” said David L. Shern, PhD, president and CEO of Mental Health America. “But there are things people can do to take care of themselves during stressful times such as leaning on the people who care about them and focusing on the positives in life.“

Here are some simple steps people can take to protect their mental health:

Take a problem solving approach:

Sit down and list your problems and some possible solutions. Weigh pros and cons, and once you have some possible solutions, break them into manageable chunks. This process not only can produce concrete answers, but offers a sense of organization and control at a time that may feel chaotic and confusing.

Shift your thinking:

Review the skills and strengths that have helped you rise to challenges in the past. You can rely on those abilities again now. Try not to blame yourself for matters that may not have been in your control.

Get support:

You may feel like you don’t want to worry your loved ones. But chances are they want to help. You can just enjoy each other’s company or, if you’re in a relationship, work with your partner to solve financial problems together instead of isolating yourself and struggling alone.

Focus on positive aspects of your life:

Sure you have worries, but you are likely to have a lot to be grateful for. Thinking about those positives-or writing them down-can boost your mood.

Take good care of yourself:

Exercising, eating right, getting enough sleep and taking time to relax are essential. You’ll be able to cope better with stress and take care of those who depend on you if you find even a few minutes each day to refuel. Beware of turning to alcohol to relax. It may seem to offer a release but actually puts more stress on your body and can drag down your mood.

Watch for signs of excessive stress:

Be aware of irritability, difficulty concentrating, headaches, stomach pain and fatigue. You might also see if you’ve developed some unhealthy behaviors, like repeatedly checking the economic news that mostly feed your fears.

Get professional help if you need it:

Some people feel it’s a sign of weakness to see a mental health professional, but it can be a sign of great strength to take the steps necessary to get your life back on track.

First Published Tuesday, 17 March 2009

‘Drop hacker case’ – Terry Waite

Human rights campaigner and former hostage Terry Waite has called on the US to drop charges against British computer hacker Gary McKinnon.

Glasgow-born Mr McKinnon, 42, from Wood Green, north London, faces up to 70 years in prison if found guilty in the US of breaking into military computers.

He has Asperger’s Syndrome and claims he was looking for details of UFOs.

Mr Waite, a hostage in Lebanon for four years, called the motives “harmless” and said “common sense” was needed.

He said the Pentagon ought to thank the self-confessed hacker for “exposing” the vulnerability of its computer security.

Mr Waite said Mr McKinnon’s illness, a form of autism, made him “irrationally obsessive” and added that it was a waste of time to pursue him.

“No nation under the sun ought to convict an individual whose behaviour is occasioned by illness,” he said.

“Gary is clearly a very clever chap.

“He has that unique ability to find his way through the internet jungle and enter the inner recesses of the Pentagon. Full marks for his ingenuity.

Campaigner Terry Waite was held hostage for more than four years

“Was Gary a spy? Was he attempting to bring down the mighty military force of the USA? As far as I know he was not. He was simply looking for little green men.

“Anyone who has the slightest acquaintance with [Asperger’s Syndrome] will know that while the sufferer can be, and indeed often is, brilliant in certain logical processes they can become irrationally obsessive in other directions.”

However, Mr Waite – who was kidnapped in Lebanon in 1987 – said he supported the efforts of the authorities to “track down and stop illegal activity” on the web.

Mr McKinnon’s lawyers have appealed for him to be prosecuted in the UK on lesser charges, but the CPS said the best place for the case to be heard was the US.

In total, he hacked into 97 government computers belonging to organisations including the US Navy and Nasa during 2001 and 2002.

The US government says this caused damage costing $800,000 (£550,000) at a time of heightened security in the wake of the 11 September 2001 terror attacks.

Mr McKinnon, who was arrested by British police in 2002, has already appealed unsuccessfully to the House of Lords and the European Court of Human Rights to avoid extradition.

His battle now rests on a judicial review of the government’s decision to extradite him. His lawyers have claimed he is at risk of suicide if extradited.

Source:   http://news.bbc.co.uk/2/hi/uk_news/7946393.stm

US authorities pursuing Gary McKinnon to the end

Tuesday, March 17, 2009 at 10:12 by Mark Benson

Gary McKinnon, a Scottish born hacker who managed to gain access to the US government computer system, is today staring at the possibility that he will be extradited to the US over the next few weeks. However, he has gained a strong ally in Terry Waite the former Beirut hostage who believes the US authorities should be thanking Mr McKinnon for exposing weaknesses in their system rather than looking to put him behind bars for a large proportion of its remaining life.

For those who have followed the case, Gary McKinnon claims that he hacked into the US government computer system looking for information about UFOs although the US authorities claim that he caused significant damage and left a string of messages with regards the fight against terror. There is dismay in the McKinnon camp at the apparent lack of interest shown by the UK government in protecting a UK civilian.

The Home Office has neither stood in the way of the US extradition request nor asked for sight of evidence against Mr McKinnon. The situation has taken a turn for the worse as Gary McKinnon has recently been diagnosed with Asperger’s syndrome and there are serious concerns about his physical and mental health, should he be placed behind bars in the US.

Source:   http://itvibe.com/news/4616/

Pink Floyd’s Gilmour backs McKinnon protest gig

UFO hacker gets support from Dark Side of the Moon

By John Leyden

26th March 2009

Updated Legendary Pink Floyd guitarist David Gilmour has agreed to participate in a musical protest against attempts to extradite UFO enthusiast turned hacker Gary McKinnon to the US.

Janis Sharp, McKinnon’s mum, is organising a sing-in protest to coincide with President Barack Obama’s upcoming visit to London for the G20 conference on the global economic crisis at the beginning of April. News of Gilmour’s involvement gives a massive publicity boost to these efforts.

“Dave Gilmour of Pink Floyd is going to sing Graham Nash’s ‘Chicago’ for our son Gary McKinnons ‘Sing In’ for World Autism Day 2nd April yea,” Sharp excitedly announced via micro-blogging service Twitter on Wednesday.

Sharp added that the offer came by email and that Gilmour had agreed to “sing/record Chicago on our backing track for Gary’s ‘Sing In’”. The Pink Floyd legend will not be able to attend the demo itself, however.

“Dave Gilmour can’t come to the live “sing in” because he’s going on half term holiday on Friday with his wife and children,” Sharp told El Reg.

In a follow-up message, Sharp explained how Glmour came to offer his help.

“We’ve known Joe, Dave Gilmour’s brother-in-law, since Gary was a child and Joe knows Gary is a good person,” she writes. “Joe told David Gilmour and his sister Polly (Polly is David Gilmour’s wife) and Dave immediately offered and emailed me to say he is happy to sing on our ‘Sing In’ recording/cd for Gary.”

Gilmour’s email, Ma McKinnon tells us, also said: “I agree that your son Gary should not be being extradited to the USA for his naïve hacking. It is hard to understand that our so-called fair justice system could not be more effectively used to prevent this.”

Shine on you crazy diamond

Gilmour, legendary singer and guitarist with Pink Floyd needs little introduction, but what’s not-so well known is that the rocker has supported charities including the European Union Mental Health and Illness Association and Amnesty International over the years, something that’s probably made him more receptive to McKinnon’s plight.

Sharp has rewritten the lyrics (but not the tune) of Graham Nash’s Chicago so that it serves as a protest anthem against long-running attempts to haul her self-confessed UFO evidence hunter turned US military hacker son over to the US. The protests seeks to draw attention to the “one-sided” UK-US extradition treaty more generally.

Nash is famous as a member of Crosby, Stills & Nash. Sharp choose the song partly because it harked back to the era of the Vietnam War protests as a mechanism to “rekindle the spirit of protest” of those times. The title of the song also references Obama’s adopted home city.

Crank up the volume

Music has been a feature in McKinnon’s long-running campaign against extradition. Celebrity supporters of McKinnon’s include former Police frontman Sting and wife Trudie Styler.

Ross Hemsworth, managing director of Glastonbury Radio and UK director of the International UFO Congress, suggested plans to organise a benefit gig on McKinnon’s behalf back in November but the idea never came to fruition. Kayleigh-admirers Marillion inititally supported the idea of a gig but later pulled out, partially out of fears of upsetting their US fanbase.

Hemsworth also floated the idea of bringing musicians together to make a recording of a song written by McKinnon, called Only a Fool, with the proceeds going to autism charities. So far that idea is yet to come together, either.

Samples of McKinnon’s other musical work can be found below, via YouTube.

McKinnon’s team obviously have the prog rock, folk and new age music scenes well covered. Sharp adds that “Cliff Williams the Bass Player of AC/DC is an old friend from Muswell Hill”, so metal may get covered too.

Newer genres – such as rap and techno – seem to be a bit more tricky.

The planned ‘sit-in’ musical protests will take place two months before judicial review on whether the Home Secretary was right to allow extradition proceedings against McKinnon to continue in spite of his recent diagnosis with Asperger’s Syndrome. The hearing represents McKinnon’s best hopes of avoiding extradition and trial following earlier failed appeal to the House of Lords and elsewhere last year, prior to the diagnosis of McKinnon with a mild form of autism. ®

Source:   http://www.theregister.co.uk/2009/03/26/pink_floyd_mckinnon_protest_gig/

Related Articles

Gary McKinnon Updates:

http://aspie-editorial.blog-city.com/gary_mckinnon_updates_latest_round_in_extradition_battle_lo.htm

First Published Wednesday, 18 March 2009

First Published Thursday, 19 March 2009

Sean Wagner

A new study published in Epilepsia finds that the prevalence of depression is almost twice as high in people with epilepsy compared to the general population. Among those with epilepsy, racial minorities have seven times the odds of depression in comparison to the majority Caucasian population. The findings also show that 40 percent of depressed respondents with epilepsy were not accessing mental healthcare services.

Data from the 2000/2001 Canadian Community Health Survey was used to determine prevalence of epilepsy and depression. 13 percent of those with epilepsy were found to suffer from depression, compared to 7 percent of those without the disorder. Epilepsy was also associated with 43 percent higher odds of depression when adjusting for demographic factors. The odds were higher not only for minorities, but also for females, older adults and individuals experiencing food insecurity. Minority status and advanced age appear to be unique risk factors for depression in those with epilepsy, as these factors are not associated with depression in the general population.

Previous research indicates that, on average, individuals with epilepsy suffer from a greater number of chronic conditions, have worse self-reported health and experience increased pain. They are also more likely to have a lower quality-of-life, related to both health and other factors. Individuals with epilepsy have also been found to exhibit higher levels of recent psychological distress, a greater likelihood for a variety of psychiatric conditions and a higher prevalence of suicidal thoughts. Sufferers also typically have lower incomes, less education and are less likely to have full- or part-time employment.

“Individuals with epilepsy are vulnerable to depression , yet we have identified an important gap in mental health service provision,” says Esme Fuller-Thomson an associate professor at the University of Toronto, a co-author of the study. “Routine screening and targeted interventions for depression are needed to help serve those with epilepsy.“

Fuller-Thomson E, Brennenstuhl S. The association between depression and epilepsy in a nationally representative sample Epilepsia 2008; doi:10.1111/j.1528-1167.2008.01803.x   [Abstract]

First Published Thursday, 19 March 2009

Facts & Statistics

• Families of those who suffer extreme traumatic stress can also develop Post-Traumatic Stress Disorder. (U.S. Surgeon Generalís Report, 1999).
• Approximately 9% of those exposed to extreme trauma develop Post-Traumatic Stress Disorder. (U.S. Surgeon Generalís Report, 1999)
• Approximately 15% of Vietnam veterans are suffering from Post-Traumatic Stress Disorder 19 years after combat exposure (U.S. Surgeon Generalís Report, 1999)
• Women who are victims of crime, and torture and concentration camp survivors suffer the highest rates of Post-Traumatic Stress Disorder (U.S. Surgeon Generalís Report, 1999)
• Approximately 50% of Post-Traumatic Stress Disorder cases remit within one year (U.S. Surgeon Generalís Report, 1999)
• An estimated 8% of those who served in the Persian Gulf War in 1991 have developed Post-Traumatic Stress Disorder (National Institutes of Mental Health)
• Approximately 30% of those who have spent time in war zones experience Post-Traumatic Stress Disorder. (National Institutes of Mental Health)
• About 5.2 million U.S. adults ages 18 to 54 have Post-Traumatic Stress Disorder in any given year. (National Institutes of Mental Health)
• The prevalence of Post-Traumatic Stress Disorder in women is twice that of men, 10% v. 5% (National Comorbidity Survey).
• 61% of men and 51% of women have experienced traumas linked to Post-Traumatic Stress Disorder. (National Comorbidity Survey).

Source:  http://www.apahelpcenter.org/articles/topic.php?id=6#Post-Traumatic%20Stress%20Disorder

Latest Research

Weakening Traumatic Memories By Disrupting The Emotional Bond

Imagine that you have been in combat and that you have watched your closest friend die in front of you. The memory of that event may stay with you, troubling you for the rest of your life. Posttraumatic stress disorder (PTSD) is among the most common and disabling psychiatric casualties of combat and other extremely stressful situations. People suffering from PTSD often suffer from vivid intrusive memories of their traumas.

Current medications are often ineffective in controlling these symptoms and so novel treatments are needed urgently. In a recent issue of the journal Biological Psychiatry a group of basic scientists shed new light on the biology of stress effects upon memory formation. In so doing, they suggest new approaches to the treatment of the distress related to traumatic memories. Their work is based on the study of a drug, RU38486, that blocks the effects of the stress hormone cortisol.

Using an animal model of traumatic memory, investigators at the Mount Sinai School of Medicine show that treatment with RU38486 selectively reduces stress-related memories, leaving other memories unchanged. They also found that the effectiveness of the treatment is a function of the intensity of the initial “trauma.” Although this particular study was performed in rats, their findings help to set the stage for trials in humans.

Cristina Alberini, PhD, corresponding author on this article, explains how their findings will translate into developing clinical parameters: “First, the drug should be administered shortly before or after recalling the memory of the traumatic event. Second, one or two treatments are sufficient to maximally disrupt the memory. Third, the effect is long lasting and selective for the recalled memory. Finally, the time elapsing between the traumatic experience and the treatment seems to be an important parameter for obtaining the most efficacious treatment.“

Dr John Krystal, Editor of Biological Psychiatry and affiliated with both Yale University School of Medicine and the VA Connecticut Healthcare System, said of the findings: “When treating PTSD, clinicians often attempt to reduce the negative distortions of traumatic memories so that people can better cope with their traumas. The new study by Taubenfeld and colleagues suggests that blocking the effects of cortisol may be one strategy to promote the ‘normalization’ of traumatic memories.” Dr Alberini agrees, noting that “these results suggest that carefully designed combinations of behavioral and pharmacological therapies may represent novel, effective treatments for PTSD or other anxiety disorders.“

Taubenfeld SM, Riceberg JS, New AS, Alberini CM. Preclinical assessment for selectively disrupting a traumatic memory via postretrieval inhibition of glucocorticoid receptors. Biol Psychiatry. 2009 Feb 1;65(3):249-57   [Abstract]

Quetiapine monotherapy provides benefit for patients with chronic post-traumatic stress disorder: Presented at ADAA

By Mary Beth Nierengarten

SANTA ANA PUEBLO, NM — March 16, 2009 — Monotherapy with quetiapine may provide benefit to patients with chronic post-traumatic stress disorder (PTSD), researchers reported here at the Anxiety Disorders Association of America (ADAA) 29th Annual Conference.

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Copyright © 1995-2009 Doctor’s Guide Publishing Limited. All rights reserved.

Ecstasy may enhance psychotherapy for PTSD

Treatment with a pharmacological version of the drug ecstasy makes PSTD patients more receptive to psychotherapy, and contributes to lasting improvement say Norwegian researchers.

People who have survived severe trauma – such as war, torture, disasters, or sexual assault – will often experience after-effects such as posttraumatic stress disorder (PTSD). The symptoms can include anxiety, uncontrolled emotional reactions, nightmares, intrusive memories, sleep and concentration difficulties, evasion of situations that resemble the trauma, and feelings of shame or amnesia.

For many, the condition gradually goes away by itself. Other individuals experience PTSD as a chronic condition that needs treatment, which typically involves drugs that help with anxiety and depression, and/or psychotherapy.

A type of psychological treatment called exposure therapy – where the patient repeatedly recalls the traumatic experience or is repeatedly exposed to situations that are safe but still trigger their traumatic feelings – can be effective in relieving stress responses in patients with post-traumatic stress disorder (PTSD) and other anxious conditions. The therapy works by helping the patient to re-learn the appropriate response to the trigger situation, a process known as extinction learning. The patient realizes that the memories of the traumatic event and the situation surrounding it are not dangerous and learns to to deal with the traumatic incident as a painful memory, and not as if it will happen again.

“Studies show that exposure therapy can be a very effective treatment of post traumatic disorders. Yet far too many patients receive treatment only with drugs. But anxiety reducing drugs and antidepressants may work against our efforts and reduce the patient’s emotional learning,” says PÃ¥l-Ørjan Johansen, a psychologist at the Norwegian University of Science and Technology.

However, psychotherapy can take some time, and 40% of patients continue to experience post-traumatic stress even after treatment.

To improve outcomes, scientists have been investigating the use of drug therapies to enhance the effect of exposure therapy, making the result of exposure to the fear trigger easier, faster, and more effective. MDMA (the pharmaceutical version of Ecstasy) is one such drug.

Psychiatrists that have administered MDMA to anxiety patients have noted that it promotes emotional engagement; strengthens the bond between the patient and doctor, known as the therapeutic alliance; decreases emotional avoidance; and improves tolerance for recall and processing of painful memories.

Along with neurobiologist Teri Krebs, Johansen is now exploring what happens when chronic trauma patients are treated with a combination of psychotherapy and pharmacological versions of ecstasy, MDMA (3,4 methylenedioxy-N-methyl-amphetamine). A U.S. study, recently conducted by psychiatrist Michael Mithoefer, has shown remarkable success with this combination.

Mithoefer took 21 people with chronic PTSD, all of whom had been subjected to documented abuse. All had also been through six months of treatment with traditional therapy, in addition to a three-month treatment with drugs. None, however, had shown any improvement from the treatment.

Under Mithoefer’s treatment, the patients stopped their usual anxiety-reducing drugs, and began a new treatment with twelve sessions of psychotherapy. During two of these therapy sessions, some patients were given doses of MDMA, while the others were given a placebo.

Two months after the treatment, 92 percent of MDMA patients had clinically significant improvement in their conditions: They were more open to therapy and were able to process the trauma. They managed to escape from their shells and shame, and to see lifelong patterns of behavior. They were less dispirited, evasive and afraid. In contrast, only 25 percent of the patients in the placebo group showed progress. Everyone in this group was subsequently offered treatment with MDMA, and the results have been good, with no serious or lasting side effects.

Neuropsychological tests suggested that patients had improved mental ability after treatment. None of MDMA patients continued to take the drug after treatment. But many of them had managed to transform a crippling trauma into “only” a memory — a painful memory, but still more manageable than before.

“This was a small study, and it must be followed up by more. But the results are promising, both in terms of safety and the effects of treatment. It is also important to stress that this is not about daily medication, but short-term, controlled use,” Johansen and Krebs say.

The Norwegian scientists have investigated both this and a number of other studies, and suggest the following explanation:

Firstly, “MDMA contributes to increasing the level of oxytocin in the brain. This hormone stimulates emotions such as connection, proximity and trust. In a therapeutic context, it means that the patient may be better able to open up and have confidence in the therapist.

Secondly, “MDMA increases activity in the ventromedial prefrontal cortex. This is an area in the anterior part of the brain that processes fear, lowers stress, and enables us to see events in perspective. This is where decisions are taken and feelings are regulated. Activity here is closely linked to activity in the amygdala, the area of the brain that is the center for feeling fear. You could say that fear is formed in the amygdala, but is processed in the ventromedial prefrontal cortex. While activity in the cortex is increased with MDMA, the drug simultaneously reduces activity in the amygdala. We believe this will help improve the regulation of emotions, allay fears and reduce evasive behaviors in a therapy situation.“

Thirdly, “MDMA triggers the ‘stress’ hormones noradrenalin and cortisol. These hormones are necessary to activate the emotional learning that leads to long-term reduction of fear.

In summary, we suggest that MDMA is an emotional enhancer that helps the patient feel safer and in control, better able to connect with memories, and more capable of the emotional processing that is needed for improvement.“

The use of MDMA might also help ameliorate feelings of being emotionally disconnected and unable to benefit from the supportive presence of family and friends which are often reported by people with PTSD.

P Johansen PØ, Krebs TS. How could MDMA (ecstasy) help anxiety disorders? A neurobiological rationale. J Psychopharmacol 2009 Mar 9; doi:10.1177/0269881109102787   [Abstract]

Comment:

While MDMA may prove to be a beneficial adjunct to therapy under controlled conditions, self-medication with illicit ecstasy is unwise. Not only is this illegal in most jurisdictions, the street grade drug is often adulterated with other chemicals. Even pharmaceutical grade MDMA may permanently damage neurons if taken incorrectly

How to help when smoking, alcohol complicate PTSD

By LAURAN NEERGAARD, AP Medical Writer

WASHINGTON – Reaching for a cigarette to cope with a flashback is all too common among sufferers of post-traumatic stress disorder. The nicotine hit may feel good but scientists say its brain action probably makes their PTSD worse in the long run.

Here’s the rub: At least half of PTSD sufferers smoke, and others wind up dependent on alcohol, anti-anxiety pills, sometimes even illegal drugs. Yet too few clinics treat both PTSD and addictions at the same time, despite evidence they should.

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© 2009 Associated Press

Medication for PTSD: A Leap of Faith?

By Sherry Boschert, [CPS] San Francisco Bureau

Conflicting reports about the efficacy of pharmacologic therapy for posttraumatic stress disorder leave clinicians in limbo, with more questions than answers on the subject.

Two selective serotonin reuptake inhibitors (SSRIs)-paroxetine (Paxil) and sertraline (Zoloft)-are the only medications approved in the United States specifically to treat posttraumatic stress disorder (PTSD).

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© 2009 Elsevier Inc. All rights reserved.

Abstract+: Risk factors predict PTSD differently in men and women

Christiansen DM, Elklit A.

Background: About twice as many women as men develop post-traumatic stress disorder (PTSD), even though men as a group are exposed to more traumatic events. Exposure to different trauma types does not sufficiently explain why women are more vulnerable.

Methods: The present work examines the effect of age, previous trauma, negative affectivity (NA), anxiety, depression, persistent dissociation, and social support on PTSD separately in men and women. Subjects were exposed to either a series of explosions in a firework factory near a residential area or to a high school stabbing incident.

Results: Some gender differences were found in the predictive power of well known risk factors for PTSD. Anxiety predicted PTSD in men, but not in women, whereas the opposite was found for depression. Dissociation was a better predictor for PTSD in women than in men in the explosion sample but not in the stabbing sample. Initially, NA predicted PTSD better in women than in men in the explosion sample, but when compared only to other significant risk factors, it significantly predicted PTSD for both men and women in both studies. Previous traumatic events and age did not significantly predict PTSD in either gender.

Conclusions: Gender differences in the predictive value of social support on PTSD appear to be very complex, and no clear conclusions can be made based on the two studies included in this article.

Source… Full text… ()

© 1999-2008 BioMed Central Ltd

Suicide Risk 15 Times Higher for PTSD Patients: Survey of 36,000 French citizens supports psychotraumatism screening in psychiatric evals.

Clinical Psychiatry News 2008 Oct;36(10):5

MICHELE G. SULLIVAN

BARCELONA – The risk of attempting suicide increases by up to 15 times for patients with posttraumatic stress disorder, compared with those in the general population, a national French mental health survey has found.

Although the survey of 36,000 citizens found a low rate of full-blown posttraumatic stress disorder (PTSD), those with any lifetime exposure to psychotraumatic events were significantly more likely to have had suicidal thoughts or attempts in the previous month, Dr Louis Jehel said at the annual congress of the European College of Neuropsychopharmacology.

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© 2008 Elsevier Inc. All rights reserved.

NAMI releases new PTSD brochure

The U.S. National Alliance on Mental Illness (NAMI) has released a new 14-page brochure on posttraumatic stress disorder (PTSD), treatment and recovery for Veterans Day.

It is intended to help individuals experiencing symptoms or diagnosed with the illness, along with their families and caregivers.

“PTSD affects individuals and families,” said NAMI medical director Ken Duckworth, MD “Traumatic events produce biological responses that affect the mind, brain, and body. Those changes involve everyone.“

“Over a lifetime, approximately 5 percent of men and 10 percent of women are diagnosed with PTSD,” Duckworth said. “Risk factors include the type of trauma, degree of exposure and any prior history of trauma. In most cases, there is a direct physical impact. Proximity in witnessing violent, life-threatening events also makes a difference.“

An estimated 14 percent of American soldiers returning from Afghanistan and Iraq will experience PTSD. Symptoms include poor concentration, sleeplessness, nightmares, flashbacks, heightened fear, anxiety and disassociation (feeling “unreal” or cut off from emotions).

But PTSD is not limited to military veterans.

Natural disasters and sexual assault, including child abuse, are among other examples of traumatic events that can cause PTSD. Following Hurricane Katrina, many children in Gulf Coast communities experienced the same kinds of symptoms as soldiers who fought in war.

Family members often are distressed to find loved ones “different” following a traumatic experience. Many feel overwhelmed and experience “caregiver burnout.” Others, especially children, may find themselves developing similar fears or symptoms, in what sometimes has been called the “transmission of trauma” across generations.

Treatment may involve a combination of medication and therapy, including group therapy. “Support systems are critical to healing,” Duckworth said.

The NAMI brochure includes the following sections:

• *Psychological Trauma & PTSD
• *Risk Factors for Developing PTSD
• *The Neurobiology of PTSD
• *What is PTSD?
• *PTSD & Co-Occurring Disorders
• *Combat Veterans & Trauma
• *Children & Trauma
• *Trauma & the Mental Health System
• *Family Impact of PTSD
• *Recovery and Coping
• *Treatment for PTSD
• *Medications
• *Resources, including Family-to-Family Education and NAMI Connection programs.

NAMI is America’s largest grassroots organization dedicated to improving the lives of individuals and families affected by serious mental illnesses.

Understanding Posttraumatic Stress Disorder and Recovery

Fewer criteria needed to detect PTSD in children

News Author: Pauline Anderson
CME Author: Laurie Barclay, MD

October 16, 2008 – New research suggests an alternative approach to diagnosing posttraumatic stress disorder (PTSD) that requires fewer avoidance and numbing criteria is more sensitive than standard Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), criteria in detecting this condition in preschool children.

However, the DSM-IV criteria are still preferable for children older than 7 years as are symptom reports from both the parent and child.

More… (Medscape – Free registration required)

Childhood abuse, hippocampal atrophy and PTSD

While debate continues over the effects of post-traumatic stress disorder, a new study indicates traumatic events and PTSD symptoms may be followed in some cases by a size reduction in the hippocampus, a part of the brain that regulates emotions and short term memory.

Though most attention surrounding PTSD focuses on war veterans, the advance by Brigham Young University researchers examined a larger population at risk: abused children.

“The size reduction in the hippocampus seems to occur sometime after the initial exposure to stress or trauma in childhood, strengthening the argument that it has something to do with PTSD itself or the stress exposure,” said Dawson Hedges, a BYU neuroscientist and an author on the study.

The study, which appears in the August issue of the neuroscience journal Hippocampus, provides further evidence for a neurological component for this mental disorder.

“Most people exposed to traumatic events do not develop PTSD,” Hedges said. “However, those that do may show certain changes in their brains.“

The hippocampus is involved with learning and memory. More than a decade ago, neuroscientists noted that it could be smaller in some people with post-traumatic stress disorder. Since then they have puzzled over which came first, the small hippocampus or the traumatic events leading to PTSD.

The question is not easily answered because brain scans are expensive and usually only performed after the fact.

That’s why Hedges and grad student Martin Woon combined analyses of two groups: abused children with PTSD and adults with PTSD stemming from childhood abuse. The BYU researchers pooled data from 19 previously published studies in which MRIs were obtained from people who had experienced childhood trauma.

“The big question about which came first, much like the chicken and the egg, has persisted,” said Woon, the lead author on the paper. “We found children’s hippocampi were intact after the onset of abuse, but somehow there was shrinkage in the group that had reached adulthood.“

The federal government reported 905,000 children were victims of abuse or neglect in 2006. That figure is considered lower than the actual total because it does not include unreported cases of abuse.

“The prevalence of abuse in this country is staggering,” Hedges said. “With what we have found, the effects of childhood abuse may have neurological ramifications well into adult life. Boiling it down, people should be nice to their children.“

The extent to which the lost brain matter affects brain functioning is still unknown. Hedges plans to examine whether PTSD relates to learning and memory deficits in a follow-up study. While he sees the potential for intervention to lessen the consequences of PTSD, other priorities include prevention and early identification.

Woon FL, Hedges DW. Hippocampal and amygdala volumes in children and adults with childhood maltreatment-related posttraumatic stress disorder: A meta-analysis. Hippocampus 2008 Aug;18(8):729-736   [Abstract]

PTSD common after serious injury

PTSD linked to substantial functional impairment including difficulties returning to work

Suffering a traumatic injury can have serious and long-lasting implications for a patient’s mental health, according to the largest-ever U.S. study evaluating the impact of traumatic injury.

Researchers from the Harborview Injury Prevention and Research Center, the University of Washington, and the John Hopkins Bloomberg School of Public Health found that post-traumatic stress disorder and depression were very common among patients assessed one year after suffering a serious injury. They also found that injured patients diagnosed with PTSD or depression were six times more likely to not have returned to work in the year following the injury.

The study followed 2707 injured patients from 69 hospitals across the country, and found 20.7% had post-traumatic stress disorder and 6.6% had depression one year after the injury. Both disorders were independently associated with significant impairments across all functional outcomes: activities of daily living, health status, and the return to usual activities, including work. Patients who had one disorder were three times less likely to be working one year after injury, and patients with both disorders were five to six times less likely to have returned to work.

The findings have important implications for acute care hospitals. Smaller scale investigations in acute care medical settings suggest that evidence-based psychotherapy and collaborative care interventions can reduce the symptoms of PTSD and related conditions among injured trauma survivors. “This study highlights the importance of ongoing studies of PTSD and depression screening, and intervention procedures for injured patients treated in acute care hospitals nationwide,” said Douglas Zatzick, MD, principal investigator and a psychiatrist at the University of Washington. “If studies of PTSD and depression establish the effectiveness of screening and intervention procedures, American College of Surgeons policy requirements similar to the recent mandate for alcohol screening and brief intervention could be considered.“

The American College of Surgeons currently requires that level I trauma centers must have on-site alcohol screening and brief intervention services as a requisite for trauma center accreditation.

The research was funded by the National Center for Injury Prevention and Control and the Centers for Disease Control and Prevention, the National Institute of Aging, and the National Institute of Mental Health.

Zatzick D, Jurkovich GJ, Rivara FP, et al. A National US Study of Posttraumatic Stress Disorder, Depression, and Work and Functional Outcomes After Hospitalization for Traumatic Injury. Ann Surg. 2008 Sep;248(3):429-437   [Abstract]

Sudden parental death can be double whammy for children’s mental health

Children who had a parent who died suddenly have three times the risk of depression than those with two living parents, along with an increased risk for post-traumatic stress disorder (PTSD) according to a report in the May issue of Archives of Pediatrics & Adolescent Medicine.

About 4 percent of children in Western countries experience the death of a parent, according to background information in the article.

Parents who have psychiatric disorders, including mood disorders and substance abuse, are more likely to die from suicide, accidents and heart disease. The same psychiatric factors that increase parents’ risk of sudden death also predispose their children to developing similar mental health problems.

Nadine M. Melhem, PhD, of the University of Pittsburgh School of Medicine, and colleagues identified 140 families in which one parent died of suicide, accident or sudden natural death. They were compared with 99 control families in which two parents were living and no first-degree relatives had died within the past two years. The offspring, ages 7 to 25, underwent interviews and assessments for psychiatric disorders, as well as a review of their parents’ psychiatric history.

Children whose parents had died, along with their surviving caregivers, were at higher risk for depression and post-traumatic stress disorder (PTSD) than those in control families. This association remained after controlling for psychiatric disorders in the deceased parent. Children and caregivers bereaved by suicide showed similar outcomes compared with those bereaved by other types of death. Children’s symptoms of depression, anxiety, PTSD, suicidal behavior and complicated grief (severe, lasting unhappiness) were associated with similar symptoms in surviving caregivers.

“Our findings have important clinical and public health implications,” the authors conclude. “The best way to attenuate the effect of parental bereavement among offspring is to prevent early death in their parents by improving the detection and treatment of bipolar illness, substance and alcohol abuse and personality disorders, and by addressing the lifestyle correlates of these illnesses that lead to premature death.“

When parents die, surviving caregivers should be monitored for depression and PTSD, since their psychiatric health affects that of children. “Given the increased risk of depression and PTSD, bereaved offspring should be monitored and, if needed, referred and treated for their psychiatric disorder,” the authors write. “Further studies are needed to examine the course and long-term effect of bereavement on offspring and their surviving caregivers, to test the mechanisms by which parental bereavement exerts these effects and to identify the subset of bereaved families who may require treatment, which can then frame targets for intervention and prevention efforts.“

The study authors’ “findings that sudden parental death is associated with an increased risk for child mental health problems as well as increased mental health problems for the surviving parent have significant implications for pediatric practice,” write Irwin Sandler, Ph.D, and Thomas F. Boat, M.D., of Arizona State University, Tempe, in an accompanying editorial.

“First, a pediatrician should be aware that parental death, as well as other family adversities, is a risk factor for childhood mental disorders,” they write. “The second implication for pediatric practice is that once the pediatrician becomes aware of increased risk of children due to parental death or other family adversities, the pediatrician may have a responsibility to help link children and/or their parents with appropriate services. To do this effectively, pediatricians should become familiar with the kinds of services offered in their community and the evidence for their effectiveness.“

The study was supported by a grant from the National Institute of Mental Health (Dr Brent) and a Young Investigator Award and a Travel Award from the American Foundation for Suicide Prevention (Dr Melhem). Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Melhem NM, Walker M, Moritz M, Brent DA. Antecedents and Sequelae of Sudden Parental Death in Offspring and Surviving Caregivers. Arch Pediatr Adolesc Med. 2008 May;162(5):403-410. [Full text]

Bereaved children may develop PTSD

Post traumatic stress disorder is commonly thought to effect victims of major trauma and those who witness violence, but a new University of Georgia study finds that it also can affect children who have lost a parent expectedly to diseases such as cancer.

The study has major implications for helping children cope with grief, said lead author Rene Searles McClatchey.

“Often children who have lost a parent are given grief therapy, and we’ve found that grief therapy doesn’t help if you don’t take care of post-traumatic stress disorder (PTSD) symptoms first,” said McClatchey, an adjunct professor in the UGA School of Social Work. McClatchey co-authored the study with UGA associate professor Elizabeth Vonk and University of California, Riverside assistant professor Gregory Palardy.

McClatchey is also founder and director of Camp Magik, a non-profit organization that provides weekend camps for children that blend traditional camp activities such as canoeing and hiking with therapy for PTSD and grief. McClatchey and her colleagues studied 100 children to test the effectiveness of the camp-based intervention.

They found that:

• *The odds of continuing to experience severe PTSD were 4.5 times higher for children who did not attend the camp compared to those who did; and
• *The odds of experiencing severe grief were 3.6 times greater for children who did not attend the camp than for those who did.

McClatchey said that in addition to showing that camp-based interventions work, the study found a link between post-traumatic stress disorder and grief. She explains that a previous study she conducted in 2005 in which children attended camp and underwent grief counseling without PTSD treatment found that the children didn’t improve or, in some cases, fared worse after the camp.

“Delving into their grief without addressing their PTSD got them thinking about their loss,” McClatchey said, “but we didn’t teach them the coping mechanisms to deal with the PTSD symptoms that were stirred up.“

Few studies have examined the effectiveness of camp-based interventions and most studies on overcoming grief have focused on children who have lost family members to sudden death resulting from violence or accidents. Until now, researchers have overlooked the post-traumatic stress and grief of children whose parents died expectedly after a long illness. The new study finds that both groups can benefit from PTSD treatment followed by grief counseling.

Vonk said the PTSD treatment consisted of exposure therapy, in which the children talk about their loss repeatedly until their fear diminished, and cognitive restructuring, in which children learn to modify negative thoughts, such as feelings of guilt, about their loss. The grief treatment portion included cognitive restructuring as well as lessons on coping skills.

“The camp allows kids to process their grief and go on with their lives,” Vonk said. “They can attend to everyday activities in a way that they weren’t able to before and can concentrate better in school.“

McClatchey said the average cost per camper is about $250 for the three-day weekend, making it more cost effective than individual counseling, which costs an average of $100 per hour and requires multiple sessions to be effective (Camp Magik is supported by donations so that children and their families never pay to attend).

Another benefit of the camp setting is that it gives children around-the-clock access to counselors so that those who don’t open up during group sessions can have their needs addressed individually. The researchers add that attending such camps with other children that have experienced a loss has benefits that individual therapy can’t provide.

“They see that other kids are having the same kinds of thoughts and feelings,” Vonk said, “and that in and of itself is healing.“

The study gives statistical evidence that the campers benefit from the intervention, but numbers don’t tell the whole story. McClatchey recalls one child who left Camp Magik and told her parents that she learned that it was okay to have fun again. Another went home and told her family that it was okay to talk about their loss. One child hadn’t spoken for a year before going to camp but went home talking. One young boy had refused to leave his mother’s side after the sudden heart attack of his father six months earlier. He returned home from camp insisting on sleeping in his own bed again. He went off to school without objection and resumed play dates with his friends.

“There’s really no way of describing the difference between how they are when they arrive on Friday and how much better they are when they leave on Sunday,” McClatchey said.

McClatchey IS, Vonk ME, Palardy G. Efficacy of a Camp-Based Intervention for Childhood Traumatic Grief. Soc Work Practise 2008 May;doi:10.1177/1049731508314276   [Abstract]

Jury duty may be PTSD risk

A new report by psychologists at the University of Leicester warns of the dangers of jurors facing trauma because of their exposure to harrowing and gruesome evidence.

In the first study of its kind, the research highlights how women jurors are more vulnerable, particularly if the trial covers material that resonates with their personal histories.

The research confirms that jury service, particularly for crimes against people, can cause significant anxiety, and for a vulnerable minority it can lead to severe clinical levels of stress or the symptoms of post traumatic stress disorder.

The study led by clinical psychologist Dr Noelle Robertson has been published in The Howard Journal of Criminal Justice. It warns of the perils of undergoing jury service- and the fact that people cannot talk about their experiences for fear of being held in contempt of court.

Dr Robertson, with University of Leicester colleagues Professor Emeritus Graham Davies and graduate student Alice Nettleingham, is the first UK exploratory study to look at the possible traumatisation of jurors.

The report claims jury service can be a significant stressor for a vulnerable minority and goes on to debate whether screening might be employed to eliminate jurors from potentially traumatizing trials.

Dr Robertson said: “Recent research on post-traumatic stress disorder has revealed that it is not only victims of violence or crime that suffer trauma, but that those who interact with them may also be affected.

“If called to jury service, citizens of Britain, as well as the US and most Commonwealth countries, are obliged to serve and may be exposed to gruesome exhibits and harrowing stories, which, the study shows, can lead to traumatization for some of them.“

An average of 390,000 British citizens serve on juries each year and, after no other preparation than a film outlining their duties, may be exposed to the distress of witnesses or required to handle repellant exhibits and examine graphic and shocking photographs.

When they retire to reach their verdict they have to discuss and weigh up the evidence and may be under pressure to change their own views or to try and change the views of others.

All this can lead to short-term or long-term distress.

The times during trials when jurors were required to make decisions were cited as the most stressful, but having to deal with evidence that might be horrific was also a source of concern, particularly for women, who were also more adversely affected by dissension and questioning in the jury room.

While Dr Robertson urges caution in the interpretation of what was a small-scale Leicester study, it does bear out research from North America, and confirms that jury service can be a source of stress, which for some people can be overwhelming.

The report recommends more support for jurors, including more comprehensive preparation, briefing and clear directions, as well as guidelines for the decision process in the jury room. It also recommends that Crown Courts could provide a supporter for jurors, who might lessen the sense of isolation jurors can feel, since they are unable to discuss the court case outside the jury room.

Currently, people called for jury service are allocated by lot to juries, and the report also calls for use of a questionnaire highlighting past experiences which would save jurors from the trauma of cases that might resonate with their own past experiences.

Dr Robertson commented: “Jury service is a civic duty, yet we know little about its consequences for the individual. At present, anyone who talks openly about their experiences runs the risk of being charged with contempt of court.“

Robertson N, Davies G, Nettleingham A. Vicarious Traumatisation as a Consequence of Jury Service. Howard J Crim Justice 2009;48(1):1-12   [Abstract]

Differential Diagnosis of PTSD Symptoms

By Harold Cohen, Ph.D.

While the symptoms of posttraumatic stress disorder (PTSD) may seem similar to those of other disorders, there are differences. For example, PTSD symptoms may seem similar to those of anxiety disorders, such as acute stress disorder or obsessive-compulsive disorder. However, there are distinct differences between these disorders.

In general, the symptoms of acute stress disorder must occur within four weeks of a traumatic event and come to an end within that four-week time period. If symptoms last longer than one month and follow other patterns common to PTSD, a person’s diagnosis may change from acute stress disorder to PTSD.

While both PTSD and obsessive-compulsive disorder have recurrent, intrusive thoughts as a symptom, the types of thoughts are one way to distinguish these disorders. Thoughts present in obsessive-compulsive disorder do not usually relate to a past traumatic event. With PTSD, the thoughts are invariably connected to a past traumatic event.

PTSD symptoms can also seem similar to adjustment disorder because both are linked with anxiety that develops after exposure to a stressor. With PTSD, this stressor is a traumatic event. With adjustment disorder, the stressor does not have to be severe or outside the “normal” human experience.

Related Posts

• Myths and Facts about PTSD
• Frequently Asked Questions about PTSD
• Symptoms and Diagnosis of PTSD
• Associated Conditions of PTSD
• Who is Typically Diagnosed with PTSD?

Source:  http://psychcentral.com/lib/2006/differential-diagnosis-of-ptsd-symptoms/

Brain Scan for PTSD on the Horizon?

By Rick Nauert, Ph.D.
Senior News Editor
Reviewed by John M. Grohol, Psy.D. on April 3, 2009

Friday, Apr 3 (Psych Central) —

A new report provides preliminary research on the difference in brain activity between soldiers with post-traumatic stress disorder and those without it. The findings move scientists a step closer to the possibility of being able to use brain scans to help diagnose the condition.

The search for the footprints left in the brain by psychiatric disorders such as depression and post-traumatic stress disorder (PTSD) is a growing area of research. Scientists hope it will lead to the identification of brain patterns that could be used to improve diagnosis and track the effectiveness of treatment.

The latest study was presented Friday at the World Psychiatric Association congress “Treatments in Psychiatry” by Dr. Florin Dolcos, an Assistant Professor of Psychiatry and Neuroscience at the University of Alberta in Edmonton, Canada.

“As technology improves, imaging research is increasingly providing insights into the brains of people with post-traumatic stress disorder, pointing to potential biological markers distinguishing the PTSD-affected brain,” said Dolcos, a co-author of the study, performed at Duke University in Durham, USA.

“The field is still in its infancy, but this raises the possibility that one day we may be able to see the disorder in the body as plainly as we now can see conditions such as heart disease and cancer.”

Several studies have examined the brain patterns of emotion processing in PTSD by provoking symptoms, but very few have investigated the significant cognitive processing problems associated with the condition.

PTSD is as an anxiety disorder triggered by exposure to traumatic events. Symptoms include intrusive memories of the trauma, avoidant behavior and hyperarousal, where those affected are more likely to perceive a threat in seemingly neutral situations or people. Impaired concentration is also characteristic.

The disorder is currently diagnosed using an interview by a mental health professional.

The study involved 42 American soldiers (52% men) who had recently served in Iraq or Afghanistan. There were two groups with comparable levels of combat exposure. One group of 22 had developed PTSD and the other group of 20 had not. The scientists used functional magnetic resonance imaging scans (fMRI) to examine the brain patterns of each soldier while they performed a three-part short-term memory task that included distractions. The test is indicative of the ability to stay focused, which is reduced in PTSD.

In the first stage, the soldiers were shown photographs of three similar faces. After a delay period to give their brains time to retain the information, they were shown a single photograph of a face and had to press a button indicating whether the face was one of those they had seen earlier or whether it was new.

About two seconds into the delay period, the soldiers were randomly shown photos irrelevant to the faces – either two photos depicting combat scenes from Iraq or Afghanistan, two photos of noncombat (neutral) scenes such as a man playing the trombone, or two digitally scrambled pictures depicting nothing. After a break to allow brain activity to return to normal, the test was repeated 40 times, with no repetition in the photos.

In an area of the brain involved in the ability to stay focused (the dorsal lateral prefrontal cortex), the scientists observed that while the group without PTSD was far more distracted by the traumatic photos than by the neutral ones, the PTSD group was equally affected by the two types of photos.

The findings were reflected in the results of the memory test, with the PTSD group performing more poorly in identifying whether the final faces were new or old regardless of whether the photos that distracted them were traumatic or neutral.

“This sensitivity to neutral information is consistent with the PTSD symptom of hypervigilance, where those afflicted are on high alert for threats and are more distracted by not only threatening situations that remind them of the trauma, but also by benign situations,” said the study’s leader, Dr. Rajendra Morey, an Assistant Professor of Psychiatry at Duke University and director of the neuroimaging lab at Durham Veterans Administration Medical Center.

“This has not been seen at the brain level before. If further research confirms this preliminary finding, this pattern could be useful in distinguishing the PTSD brain.”

The researchers also found marked differences between the two groups in an area of the brain governing the sense of self. When the soldiers were shown the combat photos, this area, found in the medial prefrontal cortex, lit up remarkably in the PTSD group, but very little in the non-PTSD group.

“This is consistent with what we see behaviorally in PTSD, where people with the disorder are much more likely than others to connect traumatic triggers to events that have increased personal relevance, such as the combat situations in war veterans,” Dolcos said.

Previous findings by the same group indicate that activity in the medial prefrontal cortex also predicts the severity of PTSD symptoms. “Collectively, these findings raise the possibility of another brain pattern being potentially useful for distinguishing PTSD,” Dolcos said.

Consistent with previous studies, the researchers also found that the combat photos produced much greater activity in the brain region governing emotion processing (the amygdala) in the PTSD group than in the control group.

Morey said further research confirming the findings, as well as studies comparing brain patterns in PTSD with those in other psychiatric disorders such as depression, are necessary before brain scans can be used as an additional diagnostic tool for the disorder.

Dolcos added it is also important to further investigate differences between individuals in the sensitivity to emotional challenge, to see whether brain scans can help flag increased susceptibility to conditions such as depression and anxiety-related disorder.

Source: World Psychiatric Association

http://psychcentral.com/news/2009/04/03/brain-scan-for-ptsd-on-the-horizon/5145.html

Latest Research (From Most Recent)

“PTSD: Cannabis Science Officially Begins Its First Pre-IND FDA Application Process For PTSD”:

http://aspie-editorial.blog-city.com/ptsd_cannabis_science_officially_begins_its_first_preind_f.htm

“Moderate Drinking Before Trauma Leads To More Flashbacks”:

http://aspie-editorial.blog-city.com/moderate_drinking_before_trauma_leads_to_more_flashbacks.htm

MindApps Releases eCBT Trauma”:

http://aspie-editorial.blog-city.com/mindapps_releases_ecbt_trauma.htm

“Virtual Reality For PTSD”:

http://aspie-editorial.blog-city.com/virtual_reality_for_ptsd.htm

“PTSD: Intrusive Images and Intrusive Verbal Thoughts Are Different Phenomena”:

http://aspie-editorial.blog-city.com/ptsd_intrusive_images_and_intrusive_verbal_thoughts_are_dif.htm

“PTSD: Trauma: A Mindful Dialogue”:

http://aspie-editorial.blog-city.com/ptsd_trauma_a_mindful_dialogue.htm

“By Measuring Magnetic Fields In Brain, Researchers Identify PTSD Biomarker”:

http://aspie-editorial.blog-city.com/by_measuring_magnetic_fields_in_brain_researchers_identify_.htm

“APA Offers Resources On Managing Traumatic Stress In Wake Of Haiti Earthquake”:

http://aspie-editorial.blog-city.com/apa_offers_resources_on_managing_traumatic_stress_in_wake_of.htm

“Coping With Trauma – Lessons From Resilient Individuals”:

http://aspie-editorial.blog-city.com/coping_with_trauma__lessons_from_resilient_individuals.htm

“LA Times: Morphine Shows Promise Against PTSD”:

http://aspie-editorial.blog-city.com/latimes_morphine_shows_promise_against_ptsd.htm

“Itchy Skin Linked To Psychological Stress”:

http://aspie-editorial.blog-city.com/itchy_skin_linked_to_psychological_stress.htm

“PTSD: New Techniques To Assess PTSD, Smaller Brain Linked To PTSD Risk, Military Children Face Challenges & Children’s PTSD”:

http://aspie-editorial.blog-city.com/ptsd_new_techniques_to_assess_ptsd_smaller_brain_linked_to.htm

“Abstract: Empirically Supported Psychological Treatments For Adult Acute Stress Disorder”:

http://aspie-editorial.blog-city.com/abstract_empirically_supported_psychological_treatments_for.htm

“In Honor of Veterans, 2009/Most Returning Veterans Won’t Seek Treatment”:

http://aspie-editorial.blog-city.com/in_honor_of_veterans_2009.htm

“PTSD: Forget All About It: Erasing Traumatic Memories”:

http://aspie-editorial.blog-city.com/ptsd_forget_all_about_it_erasing_traumatic_memories.htm

“Synthetic Cannabinoids May Help PTSD Patients”:

http://aspie-editorial.blog-city.com/synthetic_cannabinoids_may_help_ptsd_patients.htm

“PTSD: Genes & Environment May Interact To Influence Risk For Post-Traumatic Stress Disorder/Associated Conditions of PTSD”:

http://aspie-editorial.blog-city.com/ptsd_genes__environment_may_interact_to_influence_risk_for.htm

“PTSD: Scientists Find New Research On The Brain And Fear That Could Help Victims Of PTSD”:

http://aspie-editorial.blog-city.com/ptsd_scientists_find_new_research_on_the_brain_and_fear_tha.htm

“In Future, Science Could Erase Traumatic Memories”:

http://aspie-editorial.blog-city.com/in_future_science_could_erase_traumatic_memories.htm

“PTSD: Ground Zero-Scale Trauma Can Spur Psychological Growth”:

http://aspie-editorial.blog-city.com/ptsd_ground_zeroscale_trauma_can_spur_psychological_growth.htm

“Abstract: Reliving and Disorganization in PTSD and Panic Disorder Memories”:

http://aspie-editorial.blog-city.com/abstract_reliving_and_disorganization_in_ptsd_and_panic_dis.htm

“Psychological Interventions Deemed Ineffective at Preventing PTSD”:

http://aspie-editorial.blog-city.com/psychological_interventions_deemed_ineffective_at_preventing.htm

“[Australia] University Pioneers Online PTSD Therapy”:

http://aspie-editorial.blog-city.com/australia_university_pioneers_online_ptsd_therapy.htm

“Research brings diagnostic brain scans for PTSD, depression a step closer”:

http://aspie-editorial.blog-city.com/research_brings_diagnostic_brain_scans_for_ptsd_depression_.htm

“PTSD Can Attack Years Later”:

http://aspie-editorial.blog-city.com/ptsd_can_attack_years_later.htm

“PTSD: Concussed, Stressed Or Just Sick Of War?”:

http://aspie-editorial.blog-city.com/ptsd__concussed_stressed_or_just_sick_of_war.htm

“Mental Health Needs Must Not Be Neglected After A Disaster”:

http://aspie-editorial.blog-city.com/mental_health_needs_must_not_be_neglected_after_a_disaster.htm

PTSD Combat: Winning the War Within

http://ptsdcombat.blogspot.com/

Post Traumatic Stress Disorder Gateway

http://www.ptsdinfo.org/

Award Winning Site

David Baldwin’s Trauma Information Pages

Comprehensive Resources on Traumatic-Stress, PTSD & Dissociation

http://www.trauma-pages.com/

Mayo Clinic – PTSD

http://www.mayoclinic.com/health/post-traumatic-stress-disorder/DS00246

Army Behavioral Health: PTSD Information

http://www.behavioralhealth.army.mil/ptsd/index.html

Gift From Within – Article: “Partners With PTSD”

http://www.giftfromwithin.org/html/partners.html

Dissociation

http://www.panicanxietydisorder.org.au/7_Dissociation symptoms.htm

1. Nora left…

Don’t know that i see what is likely to be the biggest PTSD creator of all, childhood abuse : physical, sexual and even psychological mentioned by those who track such things. Children have not the psychological resources notr the understanding of the world to cope and so many adult have unresolved PTSD and are treated for all sorts of other diagnoses when treating the PTSD would be more valuable. Interesting

First Published Friday, 20 March 2009

The power of (synthetic) speech

Jill Clark