all Psychiatry Department stories

Getting to obesity’s bottom line

50443248 — Tue, 02 Oct 2007 09:43:20 -0400

Hunter-gatherer instincts set loose in a world of modern food abundance are at the root of today’s obesity crisis, according to a Harvard psychologist.

Deirdre Barrett, psychologist with the Harvard-affiliated Cambridge Health Alliance and assistant clinical professor of psychology in Harvard Medical School’s Psychiatry Department, says food manufacturers and advertising campaigns play to our Paleolithic instincts. They overemphasize the qualities of certain food items that appeal to the hunter-gatherer in us, creating “supernormal stimuli,” cues on an unnatural object that make it more desirable — and harder to resist — than the natural object it mimics.

Ursano: Stopping post-traumatic stress disorder before it happens

50443248 — Tue, 02 Oct 2007 13:44:30 -0400

Mental health professionals are aware of the importance of understanding the kinds of illnesses — such as depression and post-traumatic stress disorder (PTSD) — that can result from disasters both natural and human-made. But perhaps even more crucial, according to Robert J. Ursano, is that they understand the behaviors associated with such events.

I know just how you feel

Wed, 11 Jul 2007 09:40:37 -0400

When people talk with psychotherapists, the best results occur if both feel similar emotions, when both “like” each other. But do most therapists really connect with patients this way? No one has ever tried to directly measure the biology of empathy between the two.

To fill this gap, a group of researchers at Harvard Medical School and Massachusetts General Hospital measured involuntary biological reactions by both patients and therapists during a regular psychotherapy session. Attention and inattention, expressions of pleasure and satisfaction, and words of care and understanding also were caught on videotape.

Adjusting to death of a loved one

Wed, 11 Jul 2007 10:37:38 -0400

"Is my grief normal?" That is one of the most common questions posed by people who have lost a loved one. A new study by Dana-Farber Cancer Institute researchers has helped answer that question by affirming the commonly accepted stages of grief - disbelief, yearning, anger, depression, and acceptance - and the sequence in which these emotions occur. The findings appear in the Feb. 21 issue of the Journal of the American Medical Association (JAMA).

Professor shines light on shadowy condition

70652986 — Mon, 26 Mar 2007 06:24:28 -0400

Sandra Fallman avoided mirrors. Walking down sidewalks during dates, she would avoid bright storefront lights, walking near the curb to stay in the shadows. She put 25-watt bulbs in her apartment lights, not to set the mood, but to provide cover. Fallman suffers from a little-known mental condition called body dysmorphic disorder (BDD). Sufferers are ashamed of certain aspects of their physical appearance because of exaggerated or imagined defects. But, unlike most of us who have flaws that we live with, these blemishes take over sufferers' lives, force them indoors, and cause them to shun contact with others.

"We don't just think we're ugly. We think we're grotesque and disfigured," said Fallman, a Marblehead resident who has been treated at the Massachusetts General Hospital (MGH) Body Dysmorphic Disorder Clinic.

The clinic, one of just a few in the United States, is run by Sabine Wilhelm, an associate professor of psychology in Harvard Medical School's Psychiatry Department and the clinic's founder and director.

The clinic provides drug therapy and a combination of cognitive and behavioral therapy that helps sufferers slowly remake their self-image and reform the behavior that goes with it.

Teen suicide and antidepressants

70652986 — Mon, 26 Mar 2007 06:23:16 -0400

With the recent FDA warning about the use of antidepressants with children and adolescents, doctors and patients are more cautious about treating youth with antidepressants. Parents and doctors are challenged to make a balanced assessment of risk and benefits. Dr. Nancy Rappaport, Dr. Jefferson B. Prince, and Dr. Jeff Q. Bostic of the psychiatry department of Harvard Medical School in their article in the December 2005 issue of The Journal of Pediatrics "Lost in the Black Box: Juvenile Depression, Suicide and the FDA's Black Box" encourage clinicians to pay careful attention to identify and address modifiable risk factors for suicide that include treating depression/ anxiety, storing guns safely, and treating substance abuse. Important risk factors for suicide include depression, stressful life events, substance use/abuse, irritability, agitation, and impulsivity.

The authors detail the FDA concern about the possible association between selective serotonin re-uptake inhibitors (SSRIs-a class of antidepressants) and worsening of suicidal thoughts and/or new onset of increased suicidal behavior. In the FDA review of suicidal data, there are limitations; many of the patients seen in the office of pediatricians and psychiatrists were excluded from the 24 studies (patients who were very sick with depression and were significantly suicidal, and patients with other disorders present, such as ADHD). The FDA examined past records of the patients (rather than interviews), and it was difficult to identify /assess and classify the suicidal intent of the patients. Interestingly, examining large databases between 1990 and 2000 for the changes in antidepressant prescription and adolescent suicides showed that geographical areas where SSRI prescriptions increased, there were reductions in adolescent suicide. In another study, Valuck identified 24,119 adolescents diagnosed with depression and/ or receiving antidepressants. Adolescents treated for longer periods with antidepressants (more than 180 days) were less likely to make suicide attempts than those treated for less than 55 days.

With Dr. Rappaport's experience as a doctor working with high- risk adolescents at school-based health centers and assistant professor of psychiatry at HMS, she was asked about guidelines for parents dealing with depressed teenagers: " It is key that they know that they are not alone, and that probably one of the most stressful problems for parents is to deal with a teenager who has an 'invisible disease' - major depression - that can make it hard for their adolescent to function or want to be alive. Given the recent events, pediatricians and child psychiatrists, families, and patients need to weigh the risk and benefit of treatment to promote growth and avert the debilitating impact of juvenile depression. Medication may be one important aspect (consideration) of treatment," said Rappaport.

Size of brain structure could signal vulnerability to anxiety disorders

70652986 — Mon, 26 Mar 2007 06:20:56 -0400

Individuals respond with physical and emotional distress to situations that recall traumatic memories. Such responses usually diminish gradually, as those situations are repeated without unpleasant occurrences; this is called "extinction memory." But some people continue to respond fearfully and develop post-traumatic stress disorder (PTSD).

Studies in animals have suggested that the ventromedial prefrontal cortex (vmPFC) - an area of the brain - may be involved in extinction memory.

Over two days, study participants viewed a series of photos of two rooms. Each room contained a blue or red light. On day one, participants viewed the photos several times, and then viewed them again with a mild electric shock delivered to their hands right after a blue light appeared. They then viewed a series of the photos with no shocks administered.

On day two, measurements of skin conductance were taken while the volunteers viewed the photos with both colors of lights displayed but no shocks given. The volunteers then had structural magnetic resonance (MR) images taken of their brains.

The MR studies showed that those participants who demonstrated less anxiety response to the blue lights the second day also had a thicker vmPFC. "That was the only area of the brain that correlated with extinction memory," says Mohammed Milad, Ph.D., a research fellow in the MGH Department of Psychiatry and the study's lead author.

Kudzu cuts alcohol consumption

70652986 — Mon, 26 Mar 2007 06:18:27 -0400

Scott Lukas, professor of psychiatry at McLean, a psychiatric hospital affiliated with Harvard Medical School, says these results inspired his team to test on humans. The study was conducted on 14 men and women, average age 24 years, in a "laboratory" apartment where each person was allowed to drink as many as six beers. After determining how much each person drinks normally, half were given a capsule of kudzu or an inactive pill, or placebo.

"Those who took kudzu drank significantly less than those on placebo," says Lukas. "[The kudzu group] downed an average of one or two beers while the placebo group finished three or four. Alcohol consumption was almost cut in half."

Those on kudzu also drank more slowly. "They needed more gulps to finish each beer," Lukas continues. "That tells us they are responding to cues from their brains telling them they don't need to drink so much."

Kudzu also causes few side effects. "We gave our subjects a low dose for one week," Lukas explains. "Then we gave them blood and urine tests and physical exams. No changes were found. If we raised the dose and gave it for a longer period, alcohol consumption might be decreased even more."

Although no one knows exactly why kudzu increases sobriety, researchers theorize that the herb speeds alcohol's effect on the head.

Study finds women hesitant to take tamoxifen as preventive measure

70652986 — Mon, 26 Mar 2007 07:10:04 -0400

"Our study underscores the need [for medical professionals] to address psychological factors that may influence decision- making, in order to help women feel confident and satisfied with their treatment choice," says the study's lead author, Sharon Bober, PhD, staff psychologist at Beth Israel Deaconess Medical Center (BIDMC) and Dana-Farber Cancer Institute (DFCI) and clinical instructor in the Department of Psychiatry at Harvard Medical School.

While effective in preventing breast cancer, tamoxifen can also increase the risk of developing other serious health problems.

BIDMC researchers evaluated the factors in decision-making in women with a high risk for breast cancer. The subjects were counseled about the possible risks and benefits of tamoxifen, and post-menopausal women were allowed either to take tamoxifen or to enroll in an alternate study comparing five years of use of tamoxifen and raloxifene, a similar drug.

Researchers found that personal health history affected women's decisions. Physician recommendations influenced women's choice to take the drug, and researchers also found that women who declined treatment were more likely to report skeptcism about tamoxifen; women who felt uninformed about their options were more likely to remain undecided; and women who were more anxious about cancer were more likely to choose tamoxifen.

Study says therapy better than pills in treating sleep-onset insomnia

70652986 — Mon, 26 Mar 2007 07:09:56 -0400

The findings show non-drug techniques yield better short- and long-term results than the most widely prescribed sleeping pill, zolpidem, commonly known as Ambien. "Sleeping pills are the most frequent treatment for insomnia, yet CBT techniques clearly were more successful in helping the majority of study participants to become normal sleepers," said study leader Gregg Jacobs.

For the study, researchers conducted a clinical trial involving young and middle-aged adults with chronic sleep-onset insomnia. Interventions included behavioral and relaxation techniques, pharmacotherapy, or combined therapy compared with placebo.

Researchers measured sleep over an eight-week period: at mid- treatment, when pharmacotherapy subjects were still taking a nightly dose of Ambien, and at the end of the period, when Ambien subjects gradually tapered their medication and then discontinued it entirely. The main measure was sleep-onset latency.

CBT and combination groups showed the greatest changes in sleep-onset latency at mid-treatment, followed by the pharmacotherapy group, which showed a slight improvement. The moderate improvements observed in the Ambien group at mid-treatment, however, were not maintained after the drug was discontinued. CBT and combined therapy also produced the best sleep efficiency and number of normal sleepers by the end of treatment. There was no advantage of combined therapy over CBT alone.

Stages of memory described in study

70652986 — Mon, 26 Mar 2007 05:32:09 -0400

“To initiate a memory is almost like creating a word processing file on a computer,” explains researcher Matthew Walker, instructor of psychiatry at Beth Israel Deaconess Medical Center and Harvard Medical School. “Once the file has been created, if you don't hit the ‘save' button before shutting off the computer it will be lost. Our new research helps explain the process in our brains that enables us to first create the memories and then to stabilize and ‘save' the memories we've created.” The findings then go on to explain how memories can later be “edited” once they've been saved. “We first discovered that in order for a memory to be stabilized – and therefore become less vulnerable to competing information – it requires somewhere in the region of six waking hours,” he explains. “So, this is when your brain is hitting the ‘save' key and putting the file on the ‘hard drive,' but instead of being saved in a matter of seconds like your computer file, a memory needs several hours to be saved.” The research findings were published in the Oct. 9, 2003 issue of the journal Nature.

Hypnosis helps healing

70652986 — Mon, 26 Mar 2007 05:29:16 -0400

"Hypnosis has been used in Western medicine for more than 150 years to treat everything from anxiety to pain, from easing the nausea of cancer chemotherapy to enhancing sports performance," says researcher Carol Ginandes of Harvard Medical School. A list of applications she provides includes treatment of phobias, panic, low self-esteem, insomnia, sexual dysfunction, stress, smoking, colitis, warts, headaches, and high blood pressure. "All these functional uses may help a person feel better," Ginandes continues. "I am also interested in using hypnosis to help people get better physically.

Study reveals how child abuse can lead to substance abuse

70652986 — Mon, 26 Mar 2007 05:18:14 -0400

It's a common-sense notion that those who have been abused as children may became drug abusers later in life. But why is this so? Carl Anderson, a Harvard instructor in psychiatry and a research associate in McLean Hospital's Developmental Biopsychiatry Research Laboratory and Brain Imaging Center, and his colleagues investigated. They found that repeated sexual abuse affects the blood flow and function of a key brain region related to substance abuse, the cerebellar vermis. This part of the brain has been recently implicated in the coordination of emotional behavior, is strongly affected by alcohol, cocaine, and other drugs of abuse, and may help regulate dopamine, a neurotransmitter critically involved in addiction. "Damage to this area of the brain may cause an individual to be particularly irritable, and to seek external means, such as drugs or alcohol, to quell this irritability," said Anderson. Anderson said the team's findings enhance understanding of the developmental mechanisms of childhood sexual abuse, which may result in new methods of treatment for child-abuse survivors.

Researchers identify genes that trigger depression

70652986 — Mon, 26 Mar 2007 05:16:21 -0400

A substance known as CREB controls gene expression in the brain. It also appears to be active in mood disorders. A group of Harvard researchers at McLean Hospital in Belmont, Mass., have developed methods that allowed them to selectively activate or deactivate CREB in the brains of rats. They found that activation of CREB in frontal portions of the brain caused signs of depression that normally occur only in response to stressful situations. The findings were published in the September 2001 issue of The Journal of Neuroscience. "Stress causes many changes in the brain," said William Carlezon, director of McLean's Behavioral Genetics Laboratory and an assistant professor of psychiatry at Harvard Medical School. "We have identified CREB as a critical element in a chemical pathway that, when activated, can cause certain symptoms of depression." Carlezon's group also found that blocking CREB lessened the effects of stress, and made rats behave as if they were being treated with antidepressant drugs.

Researchers learn to control dreams

70652986 — Mon, 26 Mar 2007 05:04:48 -0400

For years, scientists have been stymied in their quest to understand dreams because they are unique events that cannot be replicated. Robert Stickgold and his Harvard Medical School colleagues reported in the Oct. 13, 2000 issue of Science that they were able to get 17 different people to see the same dream images. "Here we have a case where with high reliability we can get people to have predictable dreams," said Stickgold, assistant professor of psychiatry based at the Massachusetts Mental Health Center. The researchers elicited the carbon-copy images by training 27 subjects to play the computer game Tetris over the course of three days. The game involves assembling geometric puzzle pieces. The researchers then monitored the subjects' dreams on the first two evenings.