Tuesday, 10 November 2015

Social Isolation and Mental Illness | Brain Blogger

Social Isolation and Mental Illness | Brain Blogger














Lone tree on an island
Think about what it would be like to spend
most of your time alone because being around other people is just too
difficult. You feel that others are judging you for your mental illness,
and so you are scared to face the world. You withdraw to avoid this
stigmatization. This social withdrawal is emotionally very costly. But
this is a two-way street — the mentally ill withdraw from
society–society withdraws from them.


An Australian survey reported that two-thirds of people affected by a
mental illness feel lonely “often” or “all of the time”. The research
says in contrast, just 10 per cent of the general population reported
feelings of loneliness. (1)


Social relationships are important for anyone in maintaining health,
but for the mentally ill it is especially important. People with mental
illness value contact with family. But families may be unwilling to
interact with their mentally ill family member. Social isolation is also
sometimes due to the unwillingness of others to befriend the mentally
ill. The public may avoid them altogether. The stigma associated with
mental illness creates huge barriers to socialization.


People with severe mental illness are probably the most isolated
social group of all. They are judged, disrespected and made into
pariahs. They fear rejection from others, who may be afraid of the
mentally ill, so the mentally ill person may feel overwhelmed by the
thought of attempting to form new friendships. Just avoiding any contact
is often the choice. Or, they may make a great effort to conceal their
condition from others, which results in additional stress from worrying
about their true condition being discovered.


It is sometimes the case that the severely mentally ill person
becomes homeless. This in itself is isolating, and they then must suffer
the double stigmatization of being homeless as well as mentally ill.


Another reason the person with mental illness may experience social
isolation is the nature of their mental illness. Social phobias like
agoraphobia, or severe anxiety or depression often cause the suffering
person to be afraid to venture out into society.


When anyone, mentally ill or not, does not have enough social
contact, it affects them mentally and even physically. Loneliness
creates stress, taking a toll on health. Other things affected can be
the ability to learn and memory function. High blood pressure is also
seen. It can be the trigger of depression and alcoholism. (2) Imagine
the consequences, then, if you are already depressed or have other
mental illnesses? Loneliness can make you worse. Loneliness and loss of
self-worth lead many mentally ill to believe that they are useless, and
so they live with a sense of hopelessness and low self-esteem.


Social isolation is both a cause and an effect of mental distress.
When the person isolates more, they face more mental distress. With more
mental distress, they want to isolate. This vicious cycle relegates
many people with severe mental illness to a life of social segregation
and isolation.


Many people with severe psychiatric disabilities say that the stigma
associated with their illness is as distressing as the symptoms
themselves. This stigmatization not only prevents them from interacting
with others, but may prevent them from seeking treatment, which in turn
exposes them to a greater risk of suicide.


Too often the public does not understand the challenges of the
mentally ill and doesn’t want to try. It is therefore necessary to
confront biased social attitudes in order to reduce the discrimination
and stigma of people who are living with mental illness.


References


1. Mentally Ill ‘neglected by communities’. (05/08/2002). Yahoo. AU.

Phobias Part II, New Social Anxiety Treatments — MDMA, Testosterone & Less Serotonin | Brain Blogger

Phobias Part II, New Social Anxiety Treatments — MDMA, Testosterone & Less Serotonin | Brain Blogger














shutterstock_256961368
Radical new research is not only giving cause
to stop prescribing currently popular medications for social anxiety
disorder (also known as social phobia), it’s pointing to new treatments,
from sex hormones to popular street drugs, with the potential to
rapidly speed up and ensure successful recovery.


Some of you may have a specific social phobia, such as the all too
common fear of public speaking, which may involve gelotophobia, the fear
of laughter discussed in Phobias Part I. Yet for millions around the globe this fear is a generalized social phobia, also known as social anxiety disorder, where even a simple wedding invitation, never mind the big day itself, could spark severe anxiety and panic attacks.


Research suggests that in America at least, social anxiety is on the
rise, with current estimates of prevalence in the US range from a
staggering 20 to 40 million. It certainly seems like living in the age
of social networking
isn’t helping. Yet, with a mixed-bag of research results, we aren’t
exactly sure if social sites like Facebook are actually more of a help
or a hindrance to those with social phobia.


It is very early explorative days for the new social anxiety
treatments described below. However, with current evidence-based
treatments failing to provide any benefit for 40-50% of those diagnosed
with social anxiety disorder, exploring these new treatments avenues
further is not only imperative, they may lead to revolutionizing the
treatment of social phobias.


Serotonin overload: SSRIs a problem, not a solution


Science seems to have got it all backwards.


Research in the past promoted the idea that social phobia is related to low levels of the neurotransmitter serotonin. This view has been turned on its head by a new study published in JAMA Psychiatry
that shows the exact opposite; individuals with social phobia make too
much serotonin. The more serotonin they produce, the more anxious they
are in social situations.


Seeing as the most popular social anxiety treatment protocols involve
a combination of psychological counseling and antidepressants, the most
popular being serotonin reuptake inhibitors, this is cause for concern
and psychiatrists should take heed.


Further research is undoubtedly underway and drugs that lower levels of serotonin are likely to be of interest.


Testosterone injection: A study in women


Common submissive behavior in social phobia, such as avoidance of eye
contact (gaze avoidance) is thought to play a crucial role in the
persistence of social anxiety disorder by hindering the extinction of
fear in social situations.


In a double-blind, within-subject design, medication-free women
diagnosed with social anxiety disorder where administered with a single
dose of testosterone and their eye-movement was monitored as they viewed angry, happy or neutral faces.


They found that testosterone specifically enhances the number of
first fixations toward the eyes, and decreases the amount of eye-area
avoiding, even for the most avoided type, angry eyes. This is in line
with research suggesting that testosterone influences early automatic
social mechanisms whereby it biases the brain toward social dominance.


These results are promising and researchers suggest investigating
whether testosterone can act as an adjunct in exposure therapies by
boosting prosocial behavior in the first few sessions.


MDMA (ecstasy): A study in adults with autism


As discussed in a recent BrainBlogger article, Psychedelic-Assisted Therapy – The Mental Health Trip of the Future?,
the use of psychedelic drugs as a tool for mental health therapy has
the potential to revolutionize the future of psychiatry and
pharmacotherapy.


The first ever study of 3,4-methylenedioxymethamphetamine
(MDMA/Ecstasy)-assisted therapy for the treatment of social anxiety in
autistic adults began in the spring of 2014 using a placebo-controlled,
double-blind methodology, and is still underway.


Regarding social anxiety treatment in general, researchers and therapists alike hope to cash in on MDMA catalyzing
a profound shift toward openness and introspection that will not
require ongoing administration to achieve lasting therapeutic benefits.
Hopes are that by administrating MDMA on only one to several occasions
within the context of a supportive and integrative psychotherapy
protocol will side-line the higher frequency of adverse events and
side-effects that come with daily dosing, as in most psychiatric drugs.


Along with ongoing Phase II pilot studies of MDMA-assisted
psychotherapy for treatment of chronic PTSD (following pilot studies
whose benefits were maintained an average of 3.8 years later), the
potentially game-changing results of the pilot study for social anxiety
in autistic adults are eagerly anticipated.


References


Danforth,
A., Struble, C., Yazar-Klosinski, B., & Grob, C. (2016).
MDMA-assisted therapy: A new treatment model for social anxiety in
autistic adults Progress in Neuro-Psychopharmacology and Biological Psychiatry, 64, 237-249 DOI: 10.1016/j.pnpbp.2015.03.011



Enter,
D., Terburg, D., Harrewijn, A., Spinhoven, P., & Roelofs, K.
(2016). Single dose testosterone administration alleviates gaze
avoidance in women with Social Anxiety Disorder Psychoneuroendocrinology, 63, 26-33 DOI: 10.1016/j.psyneuen.2015.09.008



Frick,
A., Åhs, F., Engman, J., Jonasson, M., Alaie, I., Björkstrand, J.,
Frans, ?., Faria, V., Linnman, C., Appel, L., Wahlstedt, K., Lubberink,
M., Fredrikson, M., & Furmark, T. (2015). Serotonin Synthesis and
Reuptake in Social Anxiety Disorder JAMA Psychiatry, 72 (8) DOI: 10.1001/jamapsychiatry.2015.0125



Mithoefer,
M., Wagner, M., Mithoefer, A., Jerome, L., & Doblin, R. (2010). The
safety and efficacy of  3,4-methylenedioxymethamphetamine-assisted
psychotherapy in subjects with chronic, treatment-resistant
posttraumatic stress disorder: the first randomized controlled pilot
study Journal of Psychopharmacology, 25 (4), 439-452 DOI: 10.1177/0269881110378371



Mithoefer,
M., Wagner, M., Mithoefer, A., Jerome, L., Martin, S., Yazar-Klosinski,
B., Michel, Y., Brewerton, T., & Doblin, R. (2012). Durability of
improvement in post-traumatic stress disorder symptoms and absence of
harmful effects or drug dependency after
3,4-methylenedioxymethamphetamine-assisted psychotherapy: a prospective
long-term follow-up study Journal of Psychopharmacology, 27 (1), 28-39 DOI: 10.1177/0269881112456611



Terburg,
D., Aarts, H., & van Honk, J. (2012). Testosterone Affects Gaze
Aversion From Angry Faces Outside of Conscious Awareness Psychological Science, 23 (5), 459-463 DOI: 10.1177/0956797611433336



Is Placebo More Powerful Than Antidepressants and Psychotherapy? | Brain Blogger

Is Placebo More Powerful Than Antidepressants and Psychotherapy? | Brain Blogger










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This might be a hard pill to swallow for both
those in treatment for depression and those giving treatment to
clients: both psychotherapy and antidepressant medications are beginning
to be considered to have rather limited contributions to the
effectiveness of treating depression. Some researchers and clinicians
alike are considering that for some, the placebo effect might be the
most powerful treatment of all.

A series of both research and opinion-based articles are suggesting
that we may have been focussing on the wrong thing all along. Research
into the placebo effect
and spontaneous recovery from depression, and indeed other mental
health problems, may be the way forward for both pharmacotherapy and
psychotherapy.

Hot in the news at the moment is a position emission tomography (PET)
study suggesting that some people are indeed more responsive to the intention to treat their depression, as opposed to the treatment itself.

The results indicate that those who can muster their brain’s own chemical forces against depression when
receiving a placebo, also appear to have a head start in overcoming its
symptoms with help from an approved antidepressant.

But those whose brain chemistry didn’t react as much to the placebo
pill given in the study, struggle even after getting an official antidepressant.
Although unexplored this could involve internal positive or negative
beliefs about treatment, either promoting or inhibiting the placebo
effect respectively.

The findings support scientific perspectives and opinions discussed in a series of placebo effect articles published in World Psychiatry,
including highly acclaimed scientists such as the President of the
European College of Neuropsychopharmacology, Dr. Stuart Montgomery, who
authored the article “Antidepressants or antidepressants plus placebo?”

While public opinion is certainly suspicious about the ability of
antidepressants to treat depression, as well as the pharmaceutical
industry’s intentions in finding rewarding outcomes in efficacy studies,
researchers have also grown increasingly skeptical regarding treatment
efficacy studies over the years.

There is a realization that the we need even greater accuracy in
distinguishing treatment effects from placebo in order to determine the
true efficacy of the treatment. Our current general standard of
randomized, placebo-controlled trials just doesn’t quite cut it.

In one article entitled, “What if a placebo effect explained all the
activity of depression treatments?” the key problem is posed:

“Due to the discrepancy between the relatively high rate
of spontaneous remission and the low additional value of specific
(pharmacological and psychological ) treatments, several important
issues arise. One question is whether these treatments do in fact have
any effects.”
This may initially sound absurd to some, but there are sound
arguments behind this line of thinking, only some of which are mentioned
in this article.

Some of the most recent meta-analyses reveal relatively small effect sizes of 0.30 for antidepressants and 0.25 for psychotherapies,
with only the highest quality of studies being able to show these small
effects. This roughly equates to only 15% of the variance in treatment
outcome being a result of the treatment itself, which is in the same
range as many accepted treatments in general medicine.

Dr. Montgomery suggests that even though these studies aim to remove
all biases, many may still remain. He used an example supported by a
recent article exploring differences between active placebos (those that
produce side-effects) and antidepressants for depression. A placebo
pill that does not produce noticeable side-effects may make the test
subject aware that they are indeed receiving placebo and reduce their
expectations of success, thus biasing results in favor of the treatment
being assessed.

With further advancements in the tweaking of methodologies to remove
remaining biases, perhaps there is almost no effect from the actual
treatment itself.

Indeed, there has been a constant increase in placebo response to
fake antidepressants in efficacy trials over the last decade, especially
in the US. This is thought to be due to many combinatorial factors,
such as more effective and intensified marketing of antidepressants and
the increased contact between study participants and clinical staff in
more modern and rigorous studies where participants are closely
monitored. This enhanced placebo effect may in fact be making it hard to
differentiate placebo from drug responses, and make antidepressants
appear to have a small effect size when they may be greater.

While research has been fervently focusing on the neurological and
psychological changes in response to various therapies, perhaps research
into spontaneous remission and the placebo effect should at least be of
equal importance.

As put by Dr. Marta Pecina, lead author of the PET study and research assistant professor in the U-M Department of Psychiatry:

“We can envision that by enhancing placebo effects, we might be able to develop faster-acting or better antidepressants.”
The same can be said for psychotherapy treatments, were aspects of
interventions that facilitate the placebo effect, on top of any true
treatment effects, may be more effective than current treatments.

References

Cuijpers P, & Cristea IA (2015). What if a placebo effect explained all the activity of depression treatments? World psychiatry : official journal of the World Psychiatric Association (WPA), 14 (3), 310-1 PMID: 26407786

Cuijpers
P, Turner EH, Mohr DC, Hofmann SG, Andersson G, Berking M, & Coyne J
(2014). Comparison of psychotherapies for adult depression to pill
placebo control groups: a meta-analysis. Psychological medicine, 44 (4), 685-95 PMID: 23552610


Khan A, & Brown WA (2015). Antidepressants versus placebo in major depression: an overview. World psychiatry : official journal of the World Psychiatric Association (WPA), 14 (3), 294-300 PMID: 26407778

Montgomery SA (2015). Antidepressant or antidepressant plus placebo effect? World psychiatry : official journal of the World Psychiatric Association (WPA), 14 (3), 303-4 PMID: 26407781

Peciña,
M., Bohnert, A., Sikora, M., Avery, E., Langenecker, S., Mickey, B.,
& Zubieta, J. (2015). Association Between Placebo-Activated Neural
Systems and Antidepressant Responses JAMA Psychiatry DOI: 10.1001/jamapsychiatry.2015.1335


Walsh
BT, Seidman SN, Sysko R, & Gould M (2002). Placebo response in
studies of major depression: variable, substantial, and growing. JAMA, 287 (14), 1840-7 PMID: 11939870