Author Archives: Rauh Psychiatry

Exercise and Mental Health

New Guidelines: Exercise Key Part of Mental Health Treatment

October 15, 2018

     

New guidelines from the European Psychiatric Association promote exercise as a core part of treatment for severe mental illnesses, including major depressive disorder and schizophrenia. The recommendations follow a review of existing research on the effect of physical activity on mental health disorders.

Findings from the meta-review and the resulting position statement and guidelines were published online in European Psychiatry.

“Our comprehensive review provides clear evidence that physical activity has a central role in reducing the burden of mental health symptoms in people with depression and schizophrenia,” said lead investigator Brendon Stubbs, PhD, King’s College London, and South London and Maudsley NHS Foundation Trust, London, United Kingdom.

Prescribing Exercise as an Intervention for Depression

“Our guidelines provide direction for future clinical practice. Specifically, we provide convincing evidence that it is now time for professionally-delivered physical activity interventions to move from the fringes of healthcare and become a core component in the treatment of mental health conditions.”

According to the analysis, moderate-intensity aerobic exercise 2 to 3 times a week, for a total of 150 minutes, eases symptoms of depression and schizophrenia. In people with schizophrenia spectrum disorders, such physical activity also improves cognition and cardiorespiratory health. Combining aerobic with resistance exercise, according to evidence, may also improve outcomes in people with major depression and schizophrenia spectrum disorders.

To better support the treatment of patients with severe mental illness, new association guidelines advocate for structural changes to mental health facilities to include exercise facilities and exercise specialists, as well as updated insurance reimbursement guidelines that support the recommended physical activity interventions.

Trivia: How Much Exercise Is Needed to Prevent Depression?

“Our systematic review of top-tier evidence has convincingly demonstrated that exercise training, delivered by physical activity professionals, does indeed provide an effective add-on treatment for improving both physical and mental health outcomes in people with mental illness,” Dr. Stubbs said.

The International Organization of Physical Therapists in Mental Health also endorsed the guidelines.

—Jolynn Tumolo

References

Stubbs B, Vancampfort D, Hallgren M, et al. EPA guidance on physical activity as a treatment for severe mental illness: a meta-review of the evidence and Position Statement from the European Psychiatric Association (EPA), supported by the International Organization of Physical Therapists in Mental Health (IOPTMH). European Psychiatry. 2018 October 1;[Epub ahead of print].

European Psychiatric Association (EPA) comprehensive review demonstrates that exercise is an effective treatment for major mental health conditions and should form a core part of treatment [press release]. Philadelphia, Pennsylvania: Elsevier; October 1, 2018.

Donald Rauh M.D., Ph.D., FAPA
Diplomate of the American Board of Psychiatry & Neurology
Board Certified in General Psychiatry and in  Child & Adolescent Psychiatry

Cured Meats and Mania

Eating Cured Meats May Increase Risk for Mania

Peter Roy-Byrne, MD reviewing Khambadkone SG et al. Mol Psychiatry 2018 Jul 18.
A specific association between ingestion of nitrate-cured meat products and mania is bolstered by behavioral and genetic findings in animals.
Although there is a significant genetic contribution to bipolar illness, environmental factors, including diet, are thought to be important. These researchers surveyed the dietary history (foods “ever eaten”) of a broad group of psychiatric patients receiving hospital or outpatient care (bipolar mania, 217 individuals; bipolar depression, 91; major depression, 79; schizophrenia, 371) and 343 healthy controls.
A history of eating nitrate-cured meat products specifically was associated with being in the mania group. A subgroup of 42 patients with mania and 35 controls were asked about the type of cured meat products eaten; meat sticks, beef jerky, and turkey jerky were specifically implicated.
In follow-up experimental studies of rats, a meat diet with added nitrates produced both overall hyperactivity and hyperactivity to novel stimuli. The diet was also associated with expressed gene dysregulation involving serotonin, nuclear factor signaling, and sphingosine-1-phosphate signaling and with increases in small-bowel bacteria species previously linked to cognitive and behavioral alterations in animals.
Donald Rauh M.D., Ph.D., FAPA
Diplomate of the American Board of Psychiatry & Neurology
Board Certified in General Psychiatry and in  Child & Adolescent Psychiatry

Heavy Metals found in some Baby Foods

Consumer Reports, an independent, nonprofit organization that works side by side with consumers to create a fairer, safer, and healthier world, writes regarding our recently completed testing of baby and toddler food for elements commonly known as “heavy metals,” including cadmium, lead, and inorganic arsenic. Based on our findings, we urge the Food and Drug Administration (FDA) to take several steps to protect the public from these potentially harmful contaminants in the food supply.

As the FDA is aware, exposure to even small amounts of these elements may, over time, increase the risk of several serious health problems, including those involving carcinogenic, cognitive, and reproductive effects. Babies and young children are the most at risk, particularly given the potential harms of heavy metal exposure on developing brains in the form of lower IQ and behavior problems.

As we report in a major story published today on CR.org, Consumer Reports’ food safety team analyzed 50 nationally distributed foods made for babies and toddlers, including baby cereals, packaged fruits and vegetables, packaged entrées, and packaged snacks. We found:

  • Every product had measurable levels of at least one of these heavy metals: cadmium, lead, or inorganic arsenic.
  • Around two-thirds (68%) had worrisome levels of at least one heavy metal.
  • Among the 50 foods tested, 15 would pose potential health risks to a child regularly eating just one serving or less per day.
  • Snacks and products containing rice and/or sweet potatoes were particularly likely to have high levels of heavy metals.
  • Certified organic foods were as likely to contain heavy metals as conventional ones.

We are concerned by these results, especially because a recent nationwide survey we conducted of over 3,000 respondents found misconceptions among parents about the safety of baby food. Four in 10 of the parents we surveyed believe children’s packaged foods are lower in heavy metals than other packaged foods. This is despite our testing that showed worrisome levels in many children’s food products. About half of respondents think baby food is already regulated more stringently than other packaged food, and an even larger 72% think it should be.

Accordingly, as a part of our published story, Consumer Reports provides several recommendations to parents. We lay out several steps parents can take to reduce heavy metals exposure, including to eat a broad array of healthful whole foods; limit intake of infant rice cereal and packaged snacks and be conscious of intake of fruit juices; and to choose rice that generally contains less inorganic arsenic. We also encourage them not to panic, and to remember that significant exposure to heavy metals does not guarantee that a child will have health problems, merely that it increases the chance of them.

As parents seek to reduce children’s exposure to heavy metals and its associated risks, they should not be left to fend for themselves. Food companies and the FDA have essential roles to play, particularly given another, more encouraging finding of ours: among the 50 products tested, 16 had less concerning levels of the heavy metals. Indeed, for some products, there were some of the metals that were not measurable at all. This suggests that baby food manufacturers across the industry should be able to achieve similar results. We encourage these companies to implement strong, recognized best practices—such as the Codex Alimentarius Code of Practice for the Prevention and Reduction of Lead Contamination in Foods—and urge the FDA to ensure they do so. We appreciate the important, ongoing work of the FDA’s Toxic Elements Working Group in this area, and recognize the agency’s ability to take enforcement action on a case-by-case basis and its efforts to prevent contaminated food from being imported.

However, we also recognize that the FDA has no specific limits in place to restrict contaminants in the vast majority of children’s food. With the agency’s own data and the work of Consumer Reports and other public interest groups in mind, it is critically important for the FDA to take the following additional steps to protect the public and assist parents nationwide:

  • Establish aggressive targets. Because there are no established safe levels of heavy metals like lead, we urge the FDA to set a goal of having no measurable amounts of cadmium, lead, or inorganic arsenic in baby and children’s food—and to use the most sensitive testing methods to determine the presence of those elements.
  • Create and enforce benchmarks. To limit heavy metals in baby and children’s food, the FDA should set incremental targets for industry to meet along the way, while continually recognizing that the end goal must be always to have no measurable amounts. The agency also should insist that manufacturers meet strong, recognized best practices as described above.
  • Finalize proposed guidelines. By the end of 2018, the agency’s planned deadline, the FDA should finalize its guidances limiting inorganic arsenic in apple juice to 10 ppb, and limiting inorganic arsenic in infant rice cereal to 100 ppb. Also, it should revise existing guidance for lead in fruit juice to reduce the limit from 50 to 5 ppb, the standard for bottled water.

We appreciate your consideration of these critical issues, and kindly request your response to this letter at your earliest convenience. Consumer Reports looks forward to working with you to prevent contamination, reduce levels of heavy metals in food made for babies and children, and limit the risk of food safety harm to consumers nationwide.

For the full letter, click here.

Expert

Author

Jean Halloran and James Rogers

DNA testing

STAT (9/28, Robbins) reported that “several dozen companies” are now “probing patients’ DNA in search of insights to help inform decisions about what psychiatry medications patients should take,” and are even “touting applications for depression, bipolar disorder, attention deficit hyperactivity disorder, and post-traumatic stress disorder.
” Now, “some top psychiatrists say the evidence doesn’t support the commercial rush.” In fact, in a review published online April 25 in the American Journal of Psychiatry, “a task force of the American Psychiatric Association’s research council concluded that such genetic testing is not ready for prime time in their field.” The members of the task force wrote, “Although some of the preliminary published data sound promising…there is insufficient evidence to support widespread use of combinatorial pharmacogenetic decision support tools at this point in time.”
Donald Rauh M.D., Ph.D., FAPA
Diplomate of the American Board of Psychiatry & Neurology
Board Certified in General Psychiatry and in  Child & Adolescent Psychiatry

Brain Development and Preschoolers

Atypical brain development observed in preschoolers with ADHD symptoms

NIH-funded study uses high-resolution brain scans to uncover structural changes.

Children as young as 4 years old with symptoms of attention deficit hyperactivity disorder (ADHD) may have significant differences in brain structure, compared to children without such symptoms, according to researchers funded by the National Institutes of Health.

Their study is the first comprehensive examination of brain structure changes in preschoolers with signs of ADHD, a disorder marked by a pattern of inattention, hyperactivity and impulsive behavior. The study appears in the Journal of the International Neuropsychological Society.

“Researchers were expecting to find the beginning signs of possible atypical brain development,” said James A. Griffin, Ph.D., deputy chief of the Child Development and Behavior Branch at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, which supported the research. “What they found in their high-resolution scans was solid evidence that these structural changes already are prominent by age 4 or 5.”

Previous studies have documented brain differences in adolescents with ADHD. However, few studies have looked for such differences in preschoolers, despite research citing ADHD as the most commonly diagnosed psychological disorder among young children.

The research, led by E. Mark Mahone, Ph.D., was conducted at the Kennedy Krieger Institute in Baltimore. The study included 90 young children: 38 typically developing preschoolers and 52 preschoolers with symptoms of ADHD.

The children’s scans revealed that those with ADHD symptoms had multiple areas with less brain matter volume than their typical peers, and these differences were consistent with parent reports of hyperactive and impulsive behaviors.

The researchers cited challenges collecting data, mainly getting youngsters to lie still during the brain scan, particularly children with ADHD-associated behavior. It is possible that the children who were eventually scanned had more moderate symptoms and, therefore, were better suited to participate in the study. The authors speculated that children with more severe ADHD may have more pronounced brain differences.

The research offers a greater understanding of brain development in children with ADHD symptoms, Griffin said. Researchers will continue to follow the children, monitoring brain changes or differences as the they grow older. The study provides the groundwork for future analysis of structural and functional brain changes in ADHD, which the researchers hope will provide new insights into how symptoms of the disorder relate to differences in the brain.

About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): NICHD conducts and supports research in the United States and throughout the world on fetal, infant and child development; maternal, child and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit https://www.nichd.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH…Turning Discovery Into Health®

Reference

Jacobson, L.A., et al. Anomalous Brain Development is Evident in Preschoolers with Attention Deficit Hyperactive Disorder. Journal of the International Neuropsychology Society. 2018; doi:10.1017/S1355617718000103

Teens Who Suffer from Anxiety

Anxiety.img

University of Texas at Arlington researchers have found that low attention control in early adolescence is related to a genetic risk factor for four different anxiety disorders. Young teens who suffer from anxiety are also more vulnerable to additional problems like depression, drug dependence, suicidal behavior and educational underachievement.    

The National Institutes of Mental Health reports that 8 per cent of teens ages 13 to 18 have an anxiety disorder, with anxiety-related problems often peaking during this time. Most adults diagnosed with anxiety or mood disorders also report the presence of symptoms earlier in their lives.

“Appropriate and earlier intervention could really assist these patients and improve their outlooks on the long-term,” said Jeffrey Gagne, UTA assistant professor of psychology and lead author of the study. “Having a visible marker like low attention control, which usually appears and can be identified before anxiety, could improve the treatment of these disorders.”

Gagne and UTA graduate student Catherine Spann recently published their research as “The Shared Etiology of Attentional Control and Anxiety: An Adolescent Twin Study” in the Journal of Research on Adolescence. Deirdre O’Sullivan, Nicole Schmidt and H. Hill Goldsmith, all of the University of Wisconsin-Madison, also participated in the study, which was supported by several grants from the National Institute of Mental Health including a Silvio O. Conte Center for Neuroscience grant.

This research constitutes the first twin study-based examination of genetic and environmental factors that contribute to both low attention control and four distinct anxiety symptoms in early adolescence.

The researchers used a combination of self-ratings and mother ratings to assess scores for obsessive, social, separation and generalized anxiety symptoms in 446 twin pairs with a mean age of 13.6 years, all enrolled in the Wisconsin Twin Project.

They then explored the extent to which links between low levels of attention and anxiety symptoms are genetically and environmentally mediated in adolescence.

Non-shared environmental influences were significant across attention control and all anxiety variables. Genetic correlations ranged from 36 to 47 per cent, a pattern that suggests that low attention can be considered a phenotypic and genetic risk factor for anxiety.

Risk level varied, however, depending on the specific type of disorder, with the highest correlations being for generalized and separation anxieties, and the lowest for obsessive-compulsive disorder.

Perry Fuchs, chair of UTA’s department of Psychology in the College of Science, emphasized the importance of this work in the context of the university’s increasing focus on health and the human condition within the Strategic Plan 2020: Bold Solutions|Global Impact.

“Adolescence is clearly an important development period,” Fuchs said. “Better assessment of teens’ ability to concentrate could facilitate the identification of those at risk of anxiety and could also inform molecular genetic studies, which would be the logical next stage for research.”

If you believe that your teenager may be experiencing forms of anxiety, call our office.  Dr. Rauh’s extensive experience in this field can help.  The sooner he/she is diagnosed, the better their chances are to improve their long term overall mental health.  (215).860.6101

Story Source:  The above post is reprinted from materials provided by University of Texas at Arlington.

Journal Source: http://onlinelibrary.wiley.com/doi/10.1111/jora.12260/abstract;jsessionid=D82A226EBD011613D6FF4B18CD9F80C1.f02t04

ADHD and the Impact on Quality of Life

                Social and Emotional Impairment in Children and Adolescents with ADHD  and the Impact on QUALITY OF LIFE

ADHD is associated with impairment of psychosocial functioning that goes beyond the core symptoms of attention-deficit, hyperactivity, and impulsivity.

Children and adolescents with ADHD have problems with peer relationships, lack friendships, or have limitations in their activities with friends if they do have friends. They often interact with their peers in a self-centered, impulsive, intrusive, commanding, and hostile behavior. As a result, up to 70% of these children with ADHD may have no close friends by third grade. They also tend to express their anger and frustration, especially when provoked, more than others and show reduced empathy and guilt.

The emotional impairments of children and adolescents with ADHD may include poor self-regulation of emotion, greater excessive emotional expression, especially anger and aggression, greater problems coping with frustration, reduced empathy, and decreased arousal to stimulation, while anxiety or depression are also common comorbid disorders of ADHD.  Relationships within the family can be impaired as well. However, there is increasing evidence that quality of life improves with effective treatment.

Another common class of comorbid disorders associated with ADHD are learning disabilities which may result in lowered self-esteem. These as well as other impairments affect the quality of life (QoL) of both patients and their families.

READ MORE:   [WORDdoc.format/(you may need to check your download folder)]  Social and Emotional Impairment in Children and Adolescents with ADHD and the Impact on Quality of Life

Journal of Adolescent Health 46 (2010) 209–217

All authors contributed equally to this work.

© 2010 Society for Adolescent Medicine. Published by Elsevier Inc. All rights reserved.

To make sure that you are diagnosed and treated professionally contact Dr. Donald A. Rauh

ADHD 101

The Basics of ADHD

adhd

Attention Deficit Hyperactivity Disorder (ADHD) affects nearly 8% of all children in the U.S. But we’re not the only ones.  Climate seems to be the only ameliorating factor. Incidence of ADHD is lowest in areas with a higher solar index, that is, a sunny climate.  This applies both inside and outside the U.S.

The frequency of diagnosis as well as the prevalence of American research has led to the assumption that Attention Deficit Hyperkinetic Disorder is largely an “American disorder,” stemming from behaviors and cultural norms not found in other cultures.  But in a study of the “Worldwide prevalence of ADHD” published in 2003, Stephen V. Faraone and his investigative team conclude that this is not the case.

After identifying 50 studies of ADHD worldwide (20 based on U.S. populations and 30 based on non-U.S. populations), Faraone et al conclude that the prevalence of ADHD is at least as high in many non-US children as in US children with the highest prevalence being seen when the DSM-IV diagnoses are used.

We may be hearing about it now in record proportions but ADHD is not new.  The first case of what appears to be ADHD was reported by the Scottish physician Sir Alexander Crichton in 1798. Earlier descriptions may be lost to us simply because mental issues were not discussed from a physiological perspective prior to the 19th century.  Even today the connection between mental and physical health is not always fully understood or appreciated.

Self control in children has long been associated with obedience, an aspect of morality that grows with the child’s perception of the rights of others and the importance of societal norms.  In 1844 the German physician Heinrich Hoffmann created the character of “Fidgety Phil” as a cautionary tale about a little boy who can’t sit still and brings the dinner table down on himself and his family. His book was meant to entertain and instruct but the underlying message is clear. Fidgeting means trouble for you and your family: Get over it!

Today we recognize that many children just can’t get over it.  Medical Resonance Imaging (MRI) has added greatly to our understanding of brain structure and function. Because MRI does not involve exposure to ionizing radiation, it enables us to see and study the developmental differences between the typical and the ADHD brain. These images indicate that, in addition to improving behavior, psycho-stimulant medications can help normalize brain development.

Won’t They Outgrow It?  Children are naturally active, even hyperactive. Some mature more slowly than others.  Why not let nature take its course and wait for so-called “hyperactives” to catch up with their peers?

But what if they don’t?  Some children do outgrow ADHD.  Their symptoms recede in late adolescence, but the effects of the disorder remain, both physically and psychologically.  It doesn’t take a lot of imagination to realize that the experience of being the “class clown,” the kid who can’t sit still, will affect the child’s self image and travel with him into adulthood. For example see:  Social-and-Emotional-Impairment-in-Children-and-Adolescents-with-ADHD-and-the-Impact-on-Quality-of-Life

The long-term physical effects are still being explored.  Untreated, the ADHD brain grows and develops more slowly ending with a decreased volume of grey matter.  Psycho-stimulants can restore the deficit. Recent studies suggest that these medications improve behavior by normalizing the chemistry of the brain by increasing dopamine and, in some cases, norepinephrine in the synapse.  The normalized chemistry results in near normal amounts of grey matter . Researchers believe that these brain effects parallel and underlie the widespread clinical benefits.

Not Just Kids’ Stuff.  ADHD can persist to adulthood as well. Estimates vary widely –from 35-85% with estimates being highest for those who were not treated in childhood.  In adulthood symptoms change from hyperactivity to more sophisticated issues of attention and impulse control. Inattentiveness, misplacing items, and procrastination can substantively impair performance and reduce earing power recently estimated at between roughly $90 Billion and $140 Billion per year.  This issue has become substantial enough to generate commentary in the Wall Street Journal (Young Workers With Dyslexia, ADD Find Office Less Accommodating Than School October 12, 2006; Page D1 Sue Shellenbarger).  Currently ADHD is believed to affect 10% of children and 5% of adults worldwide.

Safety:  For many years physicians and opinionated members of the media and some social organizations debated the effects of potential cardiovascular effects of stimulants.  Many of the studies were small and frequently repudiated by major medical organizations.  Finally, the FDA decided to conduct a thorough investigation.  Note that the studies were not sponsored by industry.  They conducted two studies, one in children and young adults  and one in Adults  Both studies showed that the use of stimulants did not increase the risk of serious cardiovascular events compared to non-users.  In fact, when the incidence of events in non-users was normed to 1, the incidence in users was 0.75 in the first study and 0.81 in the second.  That is the incidence in those using stimulants was lower than that in those not using stimulants.  These were huge studies with the first comprising about 2.5 million patient-years and the second about 800,000 patient-years.

 

To Fish or Not to Fish

A recent study on the relationship of  EPA DHA  fish oils to increased Prostate Cancer risk has raised alarm and created confusion.

yellow_gel_caps

I am reprinting here a statement by my esteemed colleague Dr. Robert Rountree, MD, Chief Medical Officer at Thorne Research which helps us to clearly understand how to interpret the results that have been sensationalized and distorted. Dr. Rountree concludes, …it would be premature to stop eating fish or to discontinue taking omega-3 nutritional supplements on the basis of this study. The first line of the study actually states “Studies of dietary Omega 3 fatty acid intake and prostate cancer risk are inconsistent.” The bottom line here is that this study shows NO CAUSE AND EFFECT relationship.                                                                                                                                               For more information see:  http://www.integrativecanceranswers.com/do-fish-oils-really-cause-prostate-cancer/