Parkinson's Disease May Start in the Digestive Tract

Now there is evidence that there could be a relationship between the functioning of the digestive tract and the development of Parkinson’s disease. New research suggests that Parkinson's disease may actually start in the gastrointestinal tract and spread through the vagus nerve to the brain.  The vagus nerve (X cranial nerve or 10th cranial nerve) is a highly complex cranial nerve which runs from the brain to the abdomen.

One of the studies that indicates the importance of the vagus nerve in Parkinson’s disease examined the records of 15,000 patients who had the vagus nerve severed. This was a common treatment for ulcers between 1970-1995.  Researchers determined that patients were protected from developing Parkinson’s disease when they had the entire vagus nerve severed but not when it was only partially severed. Patients with a severed vagus nerve had half the risk of developing Parkinson’s disease compared to those with a fully or partially intact vagus nerve.  

Many patients are known to experience gastrointestinal symptoms sometimes long before being diagnosed with Parkinson's disease.  It is now thought that the common symptom of constipation which often occurs many years before they are diagnosed could be an early indicator of the relationships between neurologic and gastroenterologic pathology associated with the vagus nerve.

This research is important in helping to discover the causes of the disease and to identify risk factors for Parkinson’s so they can develop prevention models.  

Elisabeth Svensson, one of the researchers, stated, "Now that we have found an association between the vagus nerve and the development of Parkinson's disease, it is important to carry out research into the factors that may trigger this neurological degeneration, so that we can prevent the development of the disease. To be able to do this will naturally be a major breakthrough."

References

Elisabeth Svensson, Erzsébet Horváth-Puhó, Reimar W Thomsen, Jens Christian Djurhuus, Lars Pedersen, Per Borghammer, Henrik Toft Sørensen. Vagotomy and subsequent risk of Parkinson's disease. Annals of Neurology, 2015

CDC Reports Rise in Autism in the U.S.

In 1998, The Centers for Disease Control and Prevention (CDC) started tracking the prevalence rates of Autism (now called Autism Spectrum Disorders or ASD) along with the characteristics of those children diagnosed with with ASD in the United States. The first study conducted in Brick Township, New Jersey demonstrated a higher prevalence of ASD but similar characteristics compared with other studies. The second CDC study, which was conducted in Atlanta, Georgia showed similar estimates to other studies but a lower prevalence of ASD compared with the Brick Township study.

 Hypothesizing that ASD rates could be different in different areas of the country, CDC established the Autism and Developmental Disabilities Monitoring (ADDM) Network to collect data in different states.  The network was created in order to provide better estimates of the prevalence of ASD and other developmental disabilities in the United States. Currently, data is collected at 11 sites which include Arizona, Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina, Tennessee, and Wisconsin.  All children included in the study are 8 years old since this represents the peak of when children with ASD are identified.

Tracking the prevalence of ASD poses unique problems due to the heterogeneity of symptoms, the lack of biologic diagnostic markers, and changing diagnostic criteria. Although symptoms may appear in early childhood, the social problems characteristic of the disorder may not be noticed until the child is old enough to display significant difficulties in normal life stage demands.  Also, signs of ASD often overlap with those of other psychiatric disorders, making them difficult to distinguish.

CDC estimates of ASD prevalence among children aged 8 years in 11 U.S. communities have increased from approximately one in 150 children during 2000–2002 to one in 68 during 2010–2012. However, prevalence estimates varied widely based on the community, from a low of 13.1 in Arkansas to an high of 29.3 in New Jersey.

With rates more than doubling overall during this time, the need for continued tracking using reliable and consistent methods to evaluate the changing prevalence of ASD and the associated characteristics is clear.  It will also be important to determine the reason significantly different rates have been observed in different communities.

CDC has also used ADDM data to determine what characteristics are associated with ASD in the U.S. and to describe how these features vary over time and among communities.  Estimates have consistently estimated that there is a 4.5 to 1 male to female ratio of ASD during 2006–2012. Other characteristics that have remained relatively stable over time include the median age of earliest ASD diagnosis, which remained close to 53 months during 2000–2012 and the proportion of children receiving a comprehensive developmental evaluation by age 3 years, which remained close to 43% during 2006–2012.  

In contrast, the ASD prevalence rate according to race/ethnicity has varied more over time in the 8 year olds sampled in the 11 communities. Although traditionally ASD prevalence estimates have been greater among white children compared with black or Hispanic children, the most recent CDC study reported that differences in prevalence rates between white and black children and white and Hispanic children have declined.  This has been attributed to the greater increases in ASD prevalence rates among black and Hispanic children compared with the increase observed in white children. Previous reports from the ADDM Network estimated ASD prevalence among white children to exceed that among black children by approximately 30% in 2002, 2006, and 2010, and by approximately 20% in 2008 and 2012.

CDC estimates of ASD prevalence have also differed by socioeconomic status (SES). Consistently, there has been a higher estimate of the prevalence of ASDA identified for children coming from higher SES backgrounds.  The prevalence of ASD has increased over time for all SES levels.

Finally, CDC estimates of ASD have shown greater increases in prevalence of these disorders in children with higher intellectual ability.  The proportion of children with ASD whose intelligence quotient (IQ) scores fell within the range of scores which are defined as indicating intellectual disability has gradually decreased over time. During 2000–2002, about half of children in the sample with ASD had IQ scores in the range of intellectual disability, while during 2006–2008, this proportion was around 40 percent and during 2010–2012, the rate had decreased further to less than one third of the children with ASD scoring in the intellectual disability range. This decrease was more pronounced for girls as compared with boys. The proportion of males with ASD and intellectual disability decreased from about 40 percent during 2000–2008 to 30 percent during 2010–2012. The proportion of females with ASD and intellectual disability decreased from approximately 60% during 2000–2002 to 35% during 2010–2012.

This report provides the latest available ASD prevalence estimates from CDC based on the ADDM Network data underscoring the need for continued tracking of ASD prevalence rates and for improving early diagnosis of ASD. These data can be used to help plan services, guide research into risk factors and effective interventions, and inform policies that promote improved outcomes in health and education settings.  It is important to remember however, that these statistics are based on data from a relatively small sample, consisting exclusively of 8 year olds in only 11 communities in the country. Future research should expand this population to include children of all ages in more communities to improve generalizability and appropriate methods of identification and treatment.

New Study Identifies 44 Genes Linked to Depression

There has always been a question about why all of the different antidepressants, with a few
exceptions, have been found to work more or less well in treating Major Depressive Disorder.
While some studies have suggested that different medications are significantly more effective, all
of these medications were better than placebo and differences in clinical significance as opposed
to statistical significance have resulted in similar findings. While some classes or individual
medications work better with some individual people, there has been no clear explanation for
similar effectiveness rates found despite different classes working on different systems. This
question has underscored just how much variance exists in depression.  

Now, new cutting edge research examining the genetic foundations of depression in detail has
increased the hope of identifying better effective treatments for this mental difficulty. Researchers
have identified no fewer than 44 gene variations that have been associated with an increased risk
of developing depression.  Of the variations identified, 30 have never been associated with the
condition previously. At the same time, it has been reiterated that there are thousands of genes
related to depression, each with a very small effect on the actual development of the disorder. This
research provides additional information on other genes that may be more significantly related to
the disorder or that may affect groups of other genes to increase or decrease the risk.

This research has tripled the number of genetic regions that have been linked to major depression.
In addition to providing new targets for possible treatment, these findings may help explain why
some people are affected by the disorder and others aren’t, even when they have similar life
experiences.   This research may also help explain broader depression related phenomena. For
example, it might help determine whether when genetic predispositions to the disorder are low this
indicates a greater ability to resist the effects of life stress.

Investigations into different contributors to depression have indicated that genetic factors account for
about 40 percent of the risk factor while other biological factors, environment and life experiences
account for the remaining 60 percent.  This emphasizes the importance of remembering that there are
a number of areas that can be targeted when treating depression. While genetics appears to contribute
a great deal to the development of depression, life experiences and environmental influences contributing
to and maintaining the disorder cannot be ignored.

References

Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., & Egger, M.
(2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of
adults with major depressive disorder: a systematic review and network meta-analysis. The Lancet.

Corfield, E. C., Yang, Y., Martin, N. G., & Nyholt, D. R. (2017). A continuum of genetic liability for
minor and major depression. Translational psychiatry, 7(5), e1131.

Harris, J. D., Brand, J. C., Cote, M. P., Faucett, S. C., & Dhawan, A. (2017). Research pearls: The
significance of statistics and perils of pooling. Part 1: Clinical versus statistical significance. Arthroscopy,
33(6), 1102-1112.

Monden, R., Roest, A. M., van Ravenzwaaij, D., Wagenmakers, E. J., Morey, R., Wardenaar, K. J.,
& de Jonge, P. (2018). The Comparative Evidence Basis for the Efficacy of Second-Generation
Antidepressants in the Treatment of Depression in the US: A Bayesian Meta-Analysis of Food and
Drug Administration Reviews. Journal of affective disorders.

Wray, N. R., & Sullivan, P. F. (2017). Genome-wide association analyses identify 44 risk variants and
refine the genetic architecture of major depression. bioRxiv, 167577.

Is Perspective Taking Always a Good Thing?

We are often told that in order to better understand others we should put ourselves in their shoes.  

The ability to take another’s perspective is associated with empathy and both empathy and taking

others points of view are thought to be important skills for human relationships.  It is generally

believed that perspective taking develops in childhood and those who are not able to see things

from others points of view are thought of as narcissistic or worse. Yet new research suggests that

perhaps taking other people’s perspectives isn’t always good advice.

A new paper, examines 25 studies that look at what happens when people are told to take another’s

perspective compared to when they are no asked to do so. Fifteen of the studies explored people’s

judgments about strangers. Eleven of these asked people to determine the mood of pictures of people

from their facial expression, posture, or their eyes. Three studies asked people to rate whether people’s

smiles were genuine and fake smiles on videos. The last study had people listen to a story told by

strangers about their memories and to determine whether the person was telling the truth or lying.

Participants for these studies were recruited from many different populations including universities

in the U.S. and other countries and online samples.  Analysis of these studies showed that there was

a tendency for those told to take others perspectives to be less accurate than those not told to do so.

In the other ten studies, participants were told to make judgments about the attitudes and beliefs of

either their romantic partner or strangers they had just met. The studies asked people to judge whether

the other individual liked specific activities, jokes, videos, or art or whether they were likely to hold

certain opinions.  Again, people told to take the other person’s perspective did slightly worse on the

task than people in the control condition. Minimally, the findings from these 25 studies suggest that

when making judgments about others, taking their perspective doesn’t seem to help.

While this paper states it examines perspective taking the experiments included largely require snap

judgments of pictures or videos of strangers.  Simply instructing someone to take the perspective of

others when judging certain characteristics does not they did so or even that they knew how to do so,

and the conditions did not provide the opportunity to be able to do this.  While there are different types

of perspective taking, some more complex than others, this article was about social judgments and thus,

should have included social perspective takings. This however, would require some type of relationship

that existed before the participant could possibly take another person’s perspective.

Therefore the conclusion reached in this research, specifically that perspective taking does not help us

when making judgments or interpreting emotions or social attitudes about others is not well founded.  

The ability to see things from another person’s perspective allows us to bond with and relate to each

other and to share positive and negative emotions and experiences. These are aspects that make us

human and that enable us to fully appreciate and enjoy life, our world and those who are in it.

Reference

Eyal, T., Steffel, M., & Epley, N. (2018). Perspective mistaking: Accurately understanding the mind of another requires getting perspective, not taking perspective. Journal of Personality and Social Psychology, 114(4), 547-571.

Musical Hallucinations in People with Psychiatric Problems

Musical hallucinations are more often found in people who are older, but several conditions may also be associated with developing this type of problem.  In particular, people who suffer from hearing impairment, brain damage, epilepsy, drug abuse and specific psychiatric disorders such as depression, schizophrenia and obsessive-compulsive disorder are more likely to experience this type of auditory hallucination.

In 1953, Irving Berlin wrote a song for a new musical he had created, Call Me Madam.  The song, You’re Just in Love included the lyrics,

"I hear singing and there's no one there I smell blossoms and the trees are bare"

The lyrics are meant to reflect the state of being in love but for some the experience of hearing music when there isn’t any playing has nothing to do with love.  Musical hallucinations do exist and the research in the area has demonstrated that while no always the case, they do occur at higher rates in psychiatric patients than in the general population.

In 2004, Hermesh and colleagues noticed that subjects in some of their research were reporting musical hallucinations.  Up until then, this symptom was rarely mentioned by psychiatric patients and when it was, it was dismissed as something that wasn’t particularly troubling.  These researchers decided to further explore this symptom in psychiatric patients who had been diagnosed with bipolar disorder, major depressive disorder, obsessive-compulsive disorder, panic disorder, schizophrenia, schizoaffective disorder, and social phobia. They ruled out any individuals who had significant hearing loss or known brain damage.

The researchers determined that there was an increase in prevalence rates of musical hallucinations in these psychiatric populations.  Overall, the prevalence rate of this symptom was 20 percent higher in the psychiatric subjects although there were different rates based on diagnosis.  These hallucinations were experienced by 26 percent of subjects with schizophrenia and 41 percent of those with obsessive-compulsive disorder (OCD). In fact, OCD subjects were found to have experienced musical hallucinations to a much greater degree than had all of the other diagnostic groups combined.  The prevalence rate for the OCD group was 30 higher and for subjects who were diagnosed with OCD and one additional psychiatric disorder the prevalence rate increased to 50 percent.

Later research supported these finding and it has been concluded that while musical hallucinations are rare, among psychiatric patients, especially those with OCD,  they aren’t entirely uncommon.

It is important to note that all cases of musical hallucinations are related to mental disorders.  Research has demonstrated that about .16 percent of people who do not suffer from a psychiatric illness report having experienced musical hallucinations at some time in their life.  A number of brain disorders have also been associated with auditory hallucinations, including temporal lobe epilepsy, delirium, dementia, focal brain lesions, cerebral tumors, Parkinson’s Disease and neurological infections such as encephalitis. Musical hallucinations have  occurred as a side effect of several medications including pentoxifylline, tramadol and Bromocriptina and as the result of liver transplantation. Drug abuse, intoxication and withdrawal from substances such as alcohol, cocaine, and amphetamines have also been associated with these types of hallucinations.

However, how all these disorders, including the psychiatric conditions, may contribute to the development of musical hallucinations or whether there are other factors that may cause both the hallucinations as well as the associated conditions is unclear at this time.  Additional information about this interesting phenomenon can be found in the article, Musical Hallucinations: Blessing & Curse.

References

Baird, A., & Thompson, W. F. (2018). The Impact of Music on the Self in Dementia. Journal of Alzheimer's Disease, 61(3), 827-841.

Bortolon, C., & Raffard, S. (2015). Self-reported psychotic-like experiences in individuals with obsessive-compulsive disorder versus schizophrenia patients: characteristics and moderation role of trait anxiety. Comprehensive psychiatry, 57, 97-105.

Focseneanu, B. E., & Marian, G. (2015). Musical hallucinations–a challenge for psychiatric therapeutical management. Case report. Journal of medicine and life, 8(4), 533.

Hermesh, H., Konas, S., Shiloh, R., Reuven, D., Marom, S., Weizman, A., & Gross-Isseroff, R. (2004). Musical hallucinations: prevalence in psychotic and nonpsychotic outpatients. The Journal of clinical psychiatry.

Kobayashi, Y. (2018). A Case of Traumatic Brain Injury Presenting with Musical Hallucinations. Case Reports in Neurology, 10(1), 7-11.

Naskar, S., Victor, R., Nath, K., & Choudhury, H. A. (2017). “Radio inside my head”: A curious case of early onset “stuck song syndrome” or obsessive-compulsive disorder with predominant musical obsession. Indian journal of psychological medicine, 39(3), 373.

Perez, P. A., Garcia-Antelo, M. J., & Rubio-Nazabal, E. (2017). “Doctor, I Hear Music”: A Brief Review About Musical Hallucinations. The open neurology journal, 11, 11.

Early Birds Are Healthier and Live Longer, Study Says

Maybe you have heard of the dichotomy believed to exist in people where some are more alert and productive in the morning and others in the evening.  This tendency is often presented as a personality characteristic, genetic or physiological predisposition or differences in circadian rhythms. It has also been assumed it is just a preference or style and has no effect on our health or well-being.  

A new study published this week in the journal Chronobiology International, suggests our tendency of being more active in the morning or evening may actually be tied to a number of physical and psychological factors.  The study followed half a million adults for six and a half years and found that people who stated they were “definitely evening types” had a 10% increased risk of mortality compared those who identified as "definite morning types."  This increased risk of death may operate through a number of associated disorders. In particular, night owls were more likely to suffer from diabetes, neurological disorders, psychological disorders, gastrointestinal disorders and respiratory disorders. It is also important to note that night owls were not just displaying a preference for staying up late, their body clocks and circadian rhythms were actually set to later times.

Once explanation for these findings is that our world is generally designed for early morning starts and this is potentially throwing off the circadian rhythms night owls forced to operate on a schedule that is counter to their internal clock.  The results of this study fit with other findings that have demonstrated that people who routinely stay up late are at increased risk of developing diabetes, high blood pressure and certain types of cancer.

The researchers have determined that the problem is not related to a lack of sleep.  Both groups got similar amounts of sleep. Instead, lead researcher Knutson, said,

“I think the problem arises because a night owl is trying to live in a morning lark world.. If the body is expecting you to do something at a certain time like sleep or eat and you're doing it at the quote ‘wrong’ time, then your body's physiology may not be working as well.”

Researchers know the body clock is important.  For example, forcing the body to change time suddenly can be detrimental.  Studies have shown, for example, that switches to and from daylight savings time can increase the  risk of death over the next several days. Other studies show that shift workers forced to routinely take drastically different shifts have multiple increased health risks.

The World Health Organization has even stated that shift work likely contributes to the development of cancer, linking it to breast cancer and other types of cancers.  Shift work has also been associated with diabetes and severe sleep disorders. Forcing people to work shifts that are opposite to their natural circadian rhythm has also been associated with depression and anxiety as well as social isolation and loss of pleasure in normally enjoyable activities.

These studies taken together make an important point.  If you know that you are definitely more active and alert at morning or evening, choose jobs and activities that are consistent with your bodies preference.  It is clear that that working against your body’s natural inclination can be harmful to both your physical and mental health. Some strategies proven to help people who want to switch to an earlier schedule include gradually advancing your bedtime and avoiding the use of technology at night. General sleep hygiene strategies are also helpful.

The researchers were careful to emphasize that it isn’t just circadian rhythm tendencies that put someone at risk. It is a mismatch between your internal clock and society that’s the problem.  Finding creative ways to take care of your needs, participate in the world around you and while being consistent with your our internal clock is not always easy but it can be done.

References

Abbott, S. M., Knutson, K. L., & Zee, P. C. (2018). Health implications of sleep and circadian rhythm research in 2017. The Lancet Neurology, 17(1), 17-18.

Remarkable CEO Response to Employee Request for Mental Health Day

Have you ever felt the need to take time off for a mental health difficulty but feared the response from your boss so you just called in sick?  Usually, when we ask for a sick day, it is due to a physical illness, such as a cold or severe allergy.  While mental health issues are often just as serious we are hesitant to ask for the day off because there are usually no sick days for emotional problems.  Even when there are, frequently we still won’t call in and ask to take the day for something mentally health related.

However, the communication of one employee and her boss recently went viral for calling attention to this problem.  The woman Madelyn Parker, age 26, is a software developer in Ann Arbor Michigan, working for Olark, a live-chat platform that helps businesses communicate with customers. It is a relatively small firm with about 40 employees.

Parker had been experiencing several nights of insomnia and was having suicidal thoughts. She suffers from chronic depression and anxiety, which had built up to a point she didn't feel she'd be effective in her position without some time off for herself. She decided to take two sick days, and explained the reasons for doing so to her team. In an email she said she was taking the time to "focus on my mental health."  

She was somewhat apprehensive about how the CEO of the company would react and whether it might hurt her reputation in the future with the company. However, she felt a responsibility to let the other employees know that there should be no shame in taking a mental health day when needed to feel better and be better able to do their job. She wasn't sure the CEO would see it that way however.

The CEO of the company sent a response which was not what she expected to receive and which brought Parker to tears. In it, he thanked her for being honest about the reason behind her need for time off.  He further stated that her email reminded him of the importance of mental health time, and helped decrease the stigma associated with mental health needs. He stated that he would be work to make mental health time an accepted part of the self care model and encourage others to take this time when needed.

The tweet of a screenshot of the emails, have been “liked” over 50,000 times and retweeted more than 25,000 times.  There was an immediate surge of replies. Many disclosed stories of the negative response they received when attempting to legitimately take mental health days. Some people stated that requests to take a mental health day were refused despite having mental health days included in their benefits.  

The employee summed up the reason she felt it was important to be open about the reason she was taking two days off.

"I'm specific to be an example so my team knows that they can feel comfortable taking sick leave for mental health, even if they don't say it."

It is people like these, who have the courage to admit to vulnerabilities and the need to take care of themselves when these difficulties present who change the way companies respond to such situations.  By treating this type of concern as important but able to be handled with time off, employees and managers both can help decrease the negative attitudes and automatic judgmental assumptions that often occur when someone discloses that they need time off to handle an emotional difficulty. 

We need to make it  safe for employees and managers as well to feel they can trust the reaction of their supervisors when they are feeling emotionally vulnerable and in need of time off.  This can only occur in an atmosphere of acceptance, allowing those who are having transient mental health difficulties that can be handled in a short period to feel confident in the response they will receive such that they are comfortable asking for the time off.

Your Stress is Hurting My Brain

It has been known for some time that stress and emotions can be contagious, especially when they occur in people we are particularly close to and care about.  When someone is stressed out, those around them can feel the stress and come to experience it themselves. Similarly with emotions. When we are constantly around people experiencing negative emotions we begin to feel the same way.  One of the most researched area looking at these types of associations has shown that living with someone who is depressed or anxious can lead us to become depressed or anxious. The effects of stress has been shown to not just be emotional in nature.  Stress has been shown to permanently alter our brains in terms of brain chemistry, structure and function.

Now, a new study suggest that we should be more concerned about second hand
stress.  The study, conducted by a team at the Cumming School of Medicine's
Hotchkiss Brain Institute (HBI), at the University of Calgary suggests that stress in
one person can alter the brain of another person the same way that real stress does.  
Using a mouse model, the study also indicated that the effects of stress on the brain
were reversed in female mice after a social interaction. However, this was not the case
for the male mice.

Using pairs of mice, one mouse from the pair was exposed to a stressor then returned
to its partner who had not been exposed.  They responses of CRH neurons which
control the brain’s reaction to stress were then examined in both mice. It was found
that the brains of both mice were affected in exactly the same way.

This study was found to be particularly important because brain changes associated
with stress are thought to underlie  many mental disorders including PTSD, depression
and anxiety disorders. It is not known at this time whether stress experienced through
contagion has lasting or permanent effects on the brain.  

Jaideep Bains, the lead researcher for the study said,  "We readily communicate our stress to others, sometimes without even knowing it. There is even evidence that some symptoms of stress can persist in family and loved ones of individuals who suffer from PTSD. On the flip side, the ability to sense another's emotional state is a key part of creating and building social bonds."

This study demonstrates that stress and social interactions are closely connected. The
outcomes of these relationships can be long-lasting.  They may alter our emotions,
physiology, neurology and behaviors over a lengthy period or the effects may resurface
at a later time. The degree to which the changes may be irreversible is unclear and the
question needs further study. 

Resources

Toni-Lee Sterley, Dinara Baimoukhametova, Tamás Füzesi, Agnieszka A. Zurek,
Nuria Daviu, Neilen P. Rasiah, David Rosenegger, Jaideep S. Bains (2018). Social
transmission and buffering of synaptic changes after stress. Nature Neuroscience.
DOI: 10.1038/s41593-017-0044-6