New York Times

By RICHARD A. FRIEDMAN, M.D.

Recently, one of my residents told me about a patient with bipolar disorder whose psychiatrist had prescribed an exotic cocktail of drugs — a sedative, a new mood stabilizer and the latest antipsychotic medication.

I was puzzled — not by her case, which the resident described as textbook manic depression, but by what was left out. This patient, it seems, was never offered lithium, the single most effective treatment for bipolar disorder.

When I met with my residents in their weekly seminar, I decided to make a big deal of this case. “What do you think about her treatment?” I asked them.

There was a long silence. “What’s wrong with it?” one resident replied. Finally, a resident offered that he knew the right answer was lithium, but that newer treatments were more popular.

Now I got it. Never mind that lithium has proved its safety and efficacy over decades of use; it’s passé — eclipsed by all the new and sexy blockbuster drugs.

Lithium salts have been used to counter bipolar disorder since the 1950s, when it was discovered that they greatly reduced the intensity and frequency of mood swings in about 70 percent of patients with the disorder. While lithium must be taken with care — it is therapeutic in a narrow range of blood levels, and overdoses can be toxic — it is also the only psychotropic drug that has ever been shown to have specific antisuicidal effects. That makes it especially valuable, given the high risk of suicide associated with mood disorders.

But lithium is cheap and unpatented, so drug companies have little interest in it. Instead, they have made a new generation of mood stabilizers, some more tolerable than lithium, but none more effective.

And lithium is hardly the only unsexy but effective drug to fall by the wayside. New medical treatments are a bit like the proverbial new kid on the block: they have an allure that is hard to resist.

Doctors and patients alike are inundated by drug company marketing. The companies like to say they are interested in educating the public and physicians about various illnesses, though I have yet to meet a single patient who learned anything informative about any disease from an advertisement.

Instead, I have seen scores of patients in my office, eager to get the latest antidepressant or mood stabilizer that promised them tranquility on their TV screens.

No wonder: drug company spending on consumer advertising skyrocketed 330 percent from 1996 to 2005, according to a 2007 study in The New England Journal of Medicine.

Unlike the public, physicians continue to believe that they are immune to the influence of drug companies, despite strong evidence to the contrary. Studies have shown that doctors with ties to industry are more likely to prescribe a brand-name drug over a cheaper generic version than doctors without such ties.

This is not to say that all influence is bad. If a new drug actually proves to be safer or more effective than its predecessors, then of course it should be prescribed for those whom it will benefit.

All too often, though, the new panacea is nothing more than a “me too” drug — a minor modification of an available drug, offering little or no advantage in safety or efficacy.

Not long ago I saw a patient who told me she had treatment-resistant depression. She had failed to respond to multiple trials of five new antidepressants, including two from the same class of drugs.

I called her psychiatrist, a smart young doctor whom I know, to ask if she had ever been given one of the older antidepressants, like a tricylic or a MAOI (for monoamine oxidase inhibitor). He had little experience with these highly effective older drugs, so he hadn’t thought to use them.

I suggested that she try an MAOI. After six weeks, she improved remarkably.

Now it’s true that the newer antidepressants are generally safer and more tolerable than older ones, which is an important advantage, but they are no more effective than older antidepressants.

My younger colleague had been trained recently and had tremendous knowledge about the latest research and drugs. But his training failed to provide him with the larger context in which to place all these exciting developments.

Specifically, how do all these new drugs stack up against older ones? That is not something that we know enough about. And it is not something drug companies have any interest in discovering. To earn approval from the Food and Drug Administration, a new drug just has to beat a placebo, not a standard drug, in two clinical trials.

But patients and doctors need to know not just whether a new drug outperforms a placebo, but whether it’s a real advance on what is already on the market. For that, we need head-to-head trials comparing new and standard treatments.

That is precisely the goal of comparative-effectiveness research, President Obama’s ambitious initiative to help determine which treatments really work. As you might expect, it has provoked strong resistance from the makers of drugs and devices who fear that their fancy new products may not be any better than current ones.

I don’t know about you, but I’d opt for an old drug with a known track record of efficacy and safety over an expensive newcomer with no added benefit — any day of the week.

Richard A. Friedman is a professor of psychiatry at Weill Cornell Medical College.

May 4, 2009

More than two-thirds of American women interviewed for a survey released by the American Psychiatric Association (APA) say that the nation's sagging economy has negatively affected their lives or the lives of their loved ones. The findings also indicate women may be neglecting their own needs while focusing on other concerns.

This two-pronged telephone survey examines the impact of the economic crisis on the mental well-being of women both nationally and in Clinton County, Ohio, where survey respondents report significantly higher levels of hardship amid deep job cuts by air freight giant DHL, which has devastated the local economy.

Women in the survey report sharp increases in stress, anxiety, frustration and other negative mental health indicators since the recession took hold last fall, with job loss pushing these increases even higher. And while more than three-quarters of these women report engaging in one or more positive coping strategies, most tend to prioritize family and other financial responsibilities ahead of their own needs - a tendency that can backfire despite the best of intentions.

"Women will take care of their families before making sure they have what they need to stay healthy. If at all possible, they should avoid spending cuts on activities and resources that can help maintain their own health," said APA President Nada L. Stotland, M.D., M.P.H. "For instance, keep up the gym membership, even if it means you can't give your kids the latest electronics. Take time to exercise and eat right. The bottom line is that taking care of your mental health is necessary to your ability to care for your family."

In this national telephone survey, women rank the ability to provide food, clothing and education for their families, relationships with family and friends, and personal finances such as mortgages and retirement savings, as more important than their own mental and physical health.

"Losing a job or taking a wage cut creates an ongoing source of anxiety for families. Women are particularly affected because they are often juggling the stress of their workplace demands with those of running a household and keeping their families healthy," Dr. Stotland said. "While this survey focused on women, the answers we found can be indicative of the health and well-being of the entire family. The challenge for each of us is to find effective ways to cope with the stress caused by the economic crisis. Reaching out to a support network can help."

The APA conducted the survey as part of its "Healthy Minds. Healthy Lives." campaign, which is designed to improve understanding of mental illnesses, psychiatry and successful treatment options, as well as to reduce the stigma sometimes associated with seeking mental health care.

Coping in One Devastated Community

While women across the country are greatly affected by these difficult times, the APA wanted to look at how the economic crisis was impacting communities more acutely affected by the stress and anxiety from job loss and wage cuts. Results from a telephone survey conducted in Clinton County, Ohio - where DHL's cutbacks have eliminated more than 5,000 jobs in recent months, and the unemployment rate among the county's roughly 43,000 residents to an estimated 10.5 percent in February - show that women in this hardhit community encounter greater levels of stress that seen in women nationally.

More than half of women in Clinton County say they are worried that they or a family member will lose a job in the near future compared with 40 percent nationally. And nearly two-thirds of women in Clinton County say the economy has had "a negative impact" on their mental health, versus just over half of women polled nationwide. Moreover, when compared with women nationally, the women of Clinton County are much more likely to be experiencing greater levels of stress (45% vs. 33%), frustration (38% vs. 27%), anxiety (34% vs. 24%), irritability (35% vs. 23%) and insomnia or oversleeping (29% vs. 20%). These feelings are natural, considering the reality of life in Clinton County: 30 percent of women in this hard-hit region say that wage cuts have affected their family, compared to 21 percent nationally. In addition, the incidence of job loss in the family is 9 percentage points higher in Clinton County than the national average.

"Even if people are working, it's emotionally draining to live with a constant fear of losing a job," said Ohio Psychiatric Physicians Association President, Joseph Locala, M.D. "To help get through these uncertain times, it's important to find positive ways to cope - whether it's spending time with friends and family, engaging in hobbies, exercising, or talking with a clergy member or mental health professional."

A Silver Lining

While women in communities across the country are facing the stresses brought on by the economic crisis, this survey demonstrates that women tend to be resilient and resourceful. More importantly, 76 percent of women polled nationally say they are participating in more positive activities than they were six months ago - including spending time with family or friends, praying or attending religious services, exercising, watching television, reading, or listening to music.

This survey also found that the majority of women view getting mental health care as a positive action. Eighty-five percent see the benefit in receiving support from a mental health professional for emotional or mental health concerns, and view it as a sign of strength. In addition, 80 percent of women are confident they could find mental health resources should they or family members require the services.

The American Psychiatric Association is a national medical specialty society whose more than 38,000 physician members specialize in diagnosis, treatment, prevention and research of mental illnesses including substance use disorders. Visit the APA at http://www.psych.org and http://www.HealthyMinds.org.

The national telephone survey of 1,000 women ages 30 to 54 was conducted by StrategyOne for the APA. The survey was conducted between March 13 and 23 and has a margin of error of plus or minus 3.1 percentage points. The Clinton County, Ohio, oversample of 617 interviews has a margin of error of plus or minus 4 percentage points.

Source
American Psychiatric Association

Psychiatr News March 20, 2009
Volume 44, Number 6, page 22
© 2009 American Psychiatric Association

Clinical & Research News

Joan Arehart-Treichel

Many accomplished people have been, or are, left-handed. But left-handedness also has another side, psychiatric research suggests.

On January 20, Barack Obama was sworn in as president of the United States. It was a triumphant day not just for Democrats, African Americans, and Americans who wanted a leadership change, but for left-handed Americans. The reason? Only 10 percent of the American population is left-handed, and Obama is one of this minority group.

In fact, four of the past six presidents—Gerald Ford, Ronald Reagan, George H.W. Bush, and Bill Clinton—were also left-handed, demonstrating that in spite of the age-old prejudice and discrimination against left-handed individuals, "lefties may have the right cerebral stuff." Moreover, many other famous people have been, or are, left-handed—the Roman general Julius Caesar, the Renaissance painter Michelangelo, American novelist Mark Twain, Beatle Paul McCartney, television mogul Oprah Winfrey, and Supreme Court Justice Ruth Bader Ginsberg.

Some scientific studies also attest to the positive mental aspects of being left-handed or ambidextrous.

Two Pakistani researchers explored the effect of handedness on the intelligence level of students. The sample included an equal number of left-handed and right-handed students drawn from various universities in Pakistan, altogether 150 subjects. Subjects were assessed for both handedness and intelligence. The researchers found no significant difference in intelligence between subjects from various educational levels, but they did find that left-handed subjects were significantly more intelligent than right-handed subjects. Results were published in the January 2007 Journal of the Indian Academy of Applied Psychology.

In a study of 250 healthy undergraduate students, ambidextrous individuals were found to engage in more magical ideation than either left-handed or right-handed persons were. Such ideation, the researchers proposed, may reflect heightened creativity. Study results appeared in the January 2002 Laterality: Asymmetries of Body, Brain, and Cognition.

Then Johns Hopkins economists determined, in a nationally representative sample of 5,000 men and women, that left-handed college-educated men earned 15 percent more than right-handed college-educated men did, even after possibly confounding factors such as age, race, IQ, level of education, and marital status were considered.

"Our findings are quite contrary to expectations," they acknowledged in their study report, which was published by the National Bureau of Economic Research in 2006. However, they did not find the same wage differential for women in the sample.

Nonetheless, some studies reported in the psychiatric research literature suggest that being left-handed or ambidextrous has another side—that left-handed or ambidextrous persons are more likely to have certain mental disorders than right-handed persons are. Moreover, the number of these studies, as well as their quality, intimate that the links they have made between left-handedness or ambidexterity and mental disorders are not simply related to chance.

During the 1970s and 1980s, for instance, some studies noted what appeared to be an unusually large percentage of left-handed or ambidextrous people among those with autism, dyslexia, stuttering, or neurodevelopmental disorders. Much more recently, DSM-IV developmental coordinational disorder (DCD), which can impair both large and fine motor skills and make everyday activities such as getting dressed, writing by hand, and participating in sports difficult, has also been coupled with left-handedness. In the February 2008 Journal of Child Neurology, two Israeli scientists reported that out of 98 children with DCD, 31 percent were left-handed, and 13 percent were ambidextrous. In the October 2008 Canadian Journal of Psychiatry, Canadian researchers reported that out of 19 children with DCD, 37 percent were left-handed.

An unusually large number of persons with schizophrenia also appear to be left-handed. In one study, some 400 subjects with schizophrenia, major depression with psychosis, bipolar psychosis, or no psychiatric illness were evaluated on handedness. The schizophrenia subjects were left-handed significantly more often than the other groups were, the researchers reported in the May 1994 Journal of Abnormal Psychology.

Tyrone Cannon, Ph.D., a professor of psychiatry at the University of California at Los Angeles, and coworkers have since discovered, while comparing the childhood neurocognitive test results of individuals with schizophrenia with those of their siblings or controls—altogether 258 subjects—that 32 percent of those with schizophrenia were left-handed, compared with only 12 percent of their siblings and only 9 percent of the controls. These results were published in the November 2003 American Journal of Psychiatry.

Further, Clyde Francks, Ph.D., of the University of Oxford in England, and his team reported something intriguing in the July 31, 2007, Molecular Psychiatry—that they had found a gene that increases the odds of being left-handed. The gene, dubbed LRRTMI, appears to be the first gene discovered that has an effect on handedness. They also found that the gene might slightly increase the risk of developing schizophrenia.

PTSD: A View From the Left

Posttraumatic stress disorder (PTSD), too, has been coupled with left-handedness. Two Scottish researchers—Carolyn Choudhary, Ph.D., and Ronan O'Carroll, Ph.D., of the University of Stirling—screened a general population sample of some 600 people for handedness and PTSD. They found that 11 percent of the sample was left-handed, that 9 percent of the sample met all DSM-IV criteria for PTSD, and that significantly more left-handers than right-handers comprised the PTSD group. Results were reported in the June 2007 Journal of Traumatic Stress.

PTSD has likewise been associated with ambidexterity. A study of some 2,500 U.S. Army veterans found that veterans who were extremely ambidextrous (about 3 percent of the study sample) were twice as likely to have developed PTSD after combat as were veterans who were not extremely ambidextrous. Veterans who were extremely ambidextrous and who experienced especially high combat exposure were nearly five times as likely to have developed PTSD after combat as were those who were not extremely ambidextrous and who experienced especially high combat exposure. Study results, published in the May 17, 2007, Psychosomatic Medicine, held firm even when some possibly confounding factors such as age, race, intelligence, and age at entry into the Army were considered.

But perhaps the greatest surprise is that left-handedness has been linked with a mental disorder considered more psychosocial than biological in origin—pedophilia. James Cantor, Ph.D., an assistant professor of psychology at the University of Toronto in Canada, and colleagues found, in a study of some 400 sexual offenders, that the odds of being left-handed were about two times greater among pedophiles than among sexual offenders targeting adults as their victims. In fact, more than 30 percent of the pedophiles were left-handed, that is, three times the rate in the general population. Results were published in the August 2005 Archives of Sexual Behavior.

Researchers Offer Theories

So, since left-handedness and ambidexterity have been linked with certain neurodevelopmental disorders, schizophrenia, PTSD, and pedophilia, what might that link be?

Left-handedness and ambidexterity may share some underlying biological origins with them, some researchers contend.

For example, Choudhary and O'Carroll do not believe that the reason why left-handed persons are more likely to develop PTSD is because they are more at risk of trauma in a right-handed world than are right-handed people. The reason why is because they found no significant difference between the number of traumas experienced by left-handed subjects and by right-handed ones. However, the researchers do suspect that the reason that left-handed individuals may be more likely to develop PTSD is because their brains are responding to, or processing, emotional events differently from the brains of right-handers.

Francks suspects that the gene LRRTMI might set the stage for both left-handedness and schizophrenia by influencing the development of brain asymmetry. Asymmetry is an important feature of the human brain, with the left side usually controlling speech and the right side controlling emotion. In left-handers, this pattern is usually reversed. Iris Sommer, M.D., Ph.D., of the University of Utrecht in the Netherlands, agreed with Francks. In fact, she has found that, just as speech often originates in the right side of the brain in left-handed persons, it is also the case for persons with schizophrenia.

And as for why left-handed persons may be disproportionately represented among known pedophiles, Cantor believes that the answer may lie in brain characteristics common to both conditions.

In any event, even if left-handedness and ambidexterity share common biological pathways with some mental disorders, left-handed individuals should not conclude that they will necessarily develop these mental disorders, authorities on the subject stress.

For example, regarding the finding that Francks and his colleagues have made—that the gene that predisposes to left-handedness may also increase the risk of schizophrenia—"People really should not be concerned by this result," he said. "There are many factors which make individuals more likely to develop schizophrenia, and the vast majority of left-handers will never develop the problem."

As for Choudary and O'Carroll's finding that left-handers are significantly more at risk of PTSD, Choudhary said, "The development of PTSD is multi-factorially determined and incompletely understood. In this context, left-handedness seems to be an important part of the jigsaw and one previously neglected, but though apparently important, is only one determinant of who might develop PTSD following trauma."

All in all, Choudhary stressed, "The majority of left-handers are not going to develop mental health problems because of their left-handedness."

Cantor agreed: "The association between left-handedness and disease is very complex.... Being left-handed does not make a person appreciably more likely to have any given disease."

So being left-handed or ambidextrous, like virtually everything in life, has both its pluses and minuses. And if you are left-handed or ambidextrous, why not try to capitalize on your mental strengths—say, exceptional intelligence, economic shrewdness, or creativity? Who knows, you might even become president! Joan Arehart-Treichel is left-handed.

 

May 4, 2009

More than two-thirds of American women interviewed for a survey released by the American Psychiatric Association (APA) say that the nation's sagging economy has negatively affected their lives or the lives of their loved ones. The findings also indicate women may be neglecting their own needs while focusing on other concerns.

This two-pronged telephone survey examines the impact of the economic crisis on the mental well-being of women both nationally and in Clinton County, Ohio, where survey respondents report significantly higher levels of hardship amid deep job cuts by air freight giant DHL, which has devastated the local economy.

Women in the survey report sharp increases in stress, anxiety, frustration and other negative mental health indicators since the recession took hold last fall, with job loss pushing these increases even higher. And while more than three-quarters of these women report engaging in one or more positive coping strategies, most tend to prioritize family and other financial responsibilities ahead of their own needs - a tendency that can backfire despite the best of intentions.

"Women will take care of their families before making sure they have what they need to stay healthy. If at all possible, they should avoid spending cuts on activities and resources that can help maintain their own health," said APA President Nada L. Stotland, M.D., M.P.H. "For instance, keep up the gym membership, even if it means you can't give your kids the latest electronics. Take time to exercise and eat right. The bottom line is that taking care of your mental health is necessary to your ability to care for your family."

In this national telephone survey, women rank the ability to provide food, clothing and education for their families, relationships with family and friends, and personal finances such as mortgages and retirement savings, as more important than their own mental and physical health.

"Losing a job or taking a wage cut creates an ongoing source of anxiety for families. Women are particularly affected because they are often juggling the stress of their workplace demands with those of running a household and keeping their families healthy," Dr. Stotland said. "While this survey focused on women, the answers we found can be indicative of the health and well-being of the entire family. The challenge for each of us is to find effective ways to cope with the stress caused by the economic crisis. Reaching out to a support network can help."

The APA conducted the survey as part of its "Healthy Minds. Healthy Lives." campaign, which is designed to improve understanding of mental illnesses, psychiatry and successful treatment options, as well as to reduce the stigma sometimes associated with seeking mental health care.

Coping in One Devastated Community

While women across the country are greatly affected by these difficult times, the APA wanted to look at how the economic crisis was impacting communities more acutely affected by the stress and anxiety from job loss and wage cuts. Results from a telephone survey conducted in Clinton County, Ohio - where DHL's cutbacks have eliminated more than 5,000 jobs in recent months, and the unemployment rate among the county's roughly 43,000 residents to an estimated 10.5 percent in February - show that women in this hardhit community encounter greater levels of stress that seen in women nationally.

More than half of women in Clinton County say they are worried that they or a family member will lose a job in the near future compared with 40 percent nationally. And nearly two-thirds of women in Clinton County say the economy has had "a negative impact" on their mental health, versus just over half of women polled nationwide. Moreover, when compared with women nationally, the women of Clinton County are much more likely to be experiencing greater levels of stress (45% vs. 33%), frustration (38% vs. 27%), anxiety (34% vs. 24%), irritability (35% vs. 23%) and insomnia or oversleeping (29% vs. 20%). These feelings are natural, considering the reality of life in Clinton County: 30 percent of women in this hard-hit region say that wage cuts have affected their family, compared to 21 percent nationally. In addition, the incidence of job loss in the family is 9 percentage points higher in Clinton County than the national average.

"Even if people are working, it's emotionally draining to live with a constant fear of losing a job," said Ohio Psychiatric Physicians Association President, Joseph Locala, M.D. "To help get through these uncertain times, it's important to find positive ways to cope - whether it's spending time with friends and family, engaging in hobbies, exercising, or talking with a clergy member or mental health professional."

A Silver Lining

While women in communities across the country are facing the stresses brought on by the economic crisis, this survey demonstrates that women tend to be resilient and resourceful. More importantly, 76 percent of women polled nationally say they are participating in more positive activities than they were six months ago - including spending time with family or friends, praying or attending religious services, exercising, watching television, reading, or listening to music.

This survey also found that the majority of women view getting mental health care as a positive action. Eighty-five percent see the benefit in receiving support from a mental health professional for emotional or mental health concerns, and view it as a sign of strength. In addition, 80 percent of women are confident they could find mental health resources should they or family members require the services.

The American Psychiatric Association is a national medical specialty society whose more than 38,000 physician members specialize in diagnosis, treatment, prevention and research of mental illnesses including substance use disorders. Visit the APA at http://www.psych.org and http://www.HealthyMinds.org.

The national telephone survey of 1,000 women ages 30 to 54 was conducted by StrategyOne for the APA. The survey was conducted between March 13 and 23 and has a margin of error of plus or minus 3.1 percentage points. The Clinton County, Ohio, oversample of 617 interviews has a margin of error of plus or minus 4 percentage points.

Source
American Psychiatric Association

Psychiatr News March 20, 2009
Volume 44, Number 6, page 22
© 2009 American Psychiatric Association

Clinical & Research News

Joan Arehart-Treichel

Many accomplished people have been, or are, left-handed. But left-handedness also has another side, psychiatric research suggests.

On January 20, Barack Obama was sworn in as president of the United States. It was a triumphant day not just for Democrats, African Americans, and Americans who wanted a leadership change, but for left-handed Americans. The reason? Only 10 percent of the American population is left-handed, and Obama is one of this minority group.

In fact, four of the past six presidents—Gerald Ford, Ronald Reagan, George H.W. Bush, and Bill Clinton—were also left-handed, demonstrating that in spite of the age-old prejudice and discrimination against left-handed individuals, "lefties may have the right cerebral stuff." Moreover, many other famous people have been, or are, left-handed—the Roman general Julius Caesar, the Renaissance painter Michelangelo, American novelist Mark Twain, Beatle Paul McCartney, television mogul Oprah Winfrey, and Supreme Court Justice Ruth Bader Ginsberg.

Some scientific studies also attest to the positive mental aspects of being left-handed or ambidextrous.

Two Pakistani researchers explored the effect of handedness on the intelligence level of students. The sample included an equal number of left-handed and right-handed students drawn from various universities in Pakistan, altogether 150 subjects. Subjects were assessed for both handedness and intelligence. The researchers found no significant difference in intelligence between subjects from various educational levels, but they did find that left-handed subjects were significantly more intelligent than right-handed subjects. Results were published in the January 2007 Journal of the Indian Academy of Applied Psychology.

In a study of 250 healthy undergraduate students, ambidextrous individuals were found to engage in more magical ideation than either left-handed or right-handed persons were. Such ideation, the researchers proposed, may reflect heightened creativity. Study results appeared in the January 2002 Laterality: Asymmetries of Body, Brain, and Cognition.

Then Johns Hopkins economists determined, in a nationally representative sample of 5,000 men and women, that left-handed college-educated men earned 15 percent more than right-handed college-educated men did, even after possibly confounding factors such as age, race, IQ, level of education, and marital status were considered.

"Our findings are quite contrary to expectations," they acknowledged in their study report, which was published by the National Bureau of Economic Research in 2006. However, they did not find the same wage differential for women in the sample.

Nonetheless, some studies reported in the psychiatric research literature suggest that being left-handed or ambidextrous has another side—that left-handed or ambidextrous persons are more likely to have certain mental disorders than right-handed persons are. Moreover, the number of these studies, as well as their quality, intimate that the links they have made between left-handedness or ambidexterity and mental disorders are not simply related to chance.

During the 1970s and 1980s, for instance, some studies noted what appeared to be an unusually large percentage of left-handed or ambidextrous people among those with autism, dyslexia, stuttering, or neurodevelopmental disorders. Much more recently, DSM-IV developmental coordinational disorder (DCD), which can impair both large and fine motor skills and make everyday activities such as getting dressed, writing by hand, and participating in sports difficult, has also been coupled with left-handedness. In the February 2008 Journal of Child Neurology, two Israeli scientists reported that out of 98 children with DCD, 31 percent were left-handed, and 13 percent were ambidextrous. In the October 2008 Canadian Journal of Psychiatry, Canadian researchers reported that out of 19 children with DCD, 37 percent were left-handed.

An unusually large number of persons with schizophrenia also appear to be left-handed. In one study, some 400 subjects with schizophrenia, major depression with psychosis, bipolar psychosis, or no psychiatric illness were evaluated on handedness. The schizophrenia subjects were left-handed significantly more often than the other groups were, the researchers reported in the May 1994 Journal of Abnormal Psychology.

Tyrone Cannon, Ph.D., a professor of psychiatry at the University of California at Los Angeles, and coworkers have since discovered, while comparing the childhood neurocognitive test results of individuals with schizophrenia with those of their siblings or controls—altogether 258 subjects—that 32 percent of those with schizophrenia were left-handed, compared with only 12 percent of their siblings and only 9 percent of the controls. These results were published in the November 2003 American Journal of Psychiatry.

Further, Clyde Francks, Ph.D., of the University of Oxford in England, and his team reported something intriguing in the July 31, 2007, Molecular Psychiatry—that they had found a gene that increases the odds of being left-handed. The gene, dubbed LRRTMI, appears to be the first gene discovered that has an effect on handedness. They also found that the gene might slightly increase the risk of developing schizophrenia.

PTSD: A View From the Left

Posttraumatic stress disorder (PTSD), too, has been coupled with left-handedness. Two Scottish researchers—Carolyn Choudhary, Ph.D., and Ronan O'Carroll, Ph.D., of the University of Stirling—screened a general population sample of some 600 people for handedness and PTSD. They found that 11 percent of the sample was left-handed, that 9 percent of the sample met all DSM-IV criteria for PTSD, and that significantly more left-handers than right-handers comprised the PTSD group. Results were reported in the June 2007 Journal of Traumatic Stress.

PTSD has likewise been associated with ambidexterity. A study of some 2,500 U.S. Army veterans found that veterans who were extremely ambidextrous (about 3 percent of the study sample) were twice as likely to have developed PTSD after combat as were veterans who were not extremely ambidextrous. Veterans who were extremely ambidextrous and who experienced especially high combat exposure were nearly five times as likely to have developed PTSD after combat as were those who were not extremely ambidextrous and who experienced especially high combat exposure. Study results, published in the May 17, 2007, Psychosomatic Medicine, held firm even when some possibly confounding factors such as age, race, intelligence, and age at entry into the Army were considered.

But perhaps the greatest surprise is that left-handedness has been linked with a mental disorder considered more psychosocial than biological in origin—pedophilia. James Cantor, Ph.D., an assistant professor of psychology at the University of Toronto in Canada, and colleagues found, in a study of some 400 sexual offenders, that the odds of being left-handed were about two times greater among pedophiles than among sexual offenders targeting adults as their victims. In fact, more than 30 percent of the pedophiles were left-handed, that is, three times the rate in the general population. Results were published in the August 2005 Archives of Sexual Behavior.

Researchers Offer Theories

So, since left-handedness and ambidexterity have been linked with certain neurodevelopmental disorders, schizophrenia, PTSD, and pedophilia, what might that link be?

Left-handedness and ambidexterity may share some underlying biological origins with them, some researchers contend.

For example, Choudhary and O'Carroll do not believe that the reason why left-handed persons are more likely to develop PTSD is because they are more at risk of trauma in a right-handed world than are right-handed people. The reason why is because they found no significant difference between the number of traumas experienced by left-handed subjects and by right-handed ones. However, the researchers do suspect that the reason that left-handed individuals may be more likely to develop PTSD is because their brains are responding to, or processing, emotional events differently from the brains of right-handers.

Francks suspects that the gene LRRTMI might set the stage for both left-handedness and schizophrenia by influencing the development of brain asymmetry. Asymmetry is an important feature of the human brain, with the left side usually controlling speech and the right side controlling emotion. In left-handers, this pattern is usually reversed. Iris Sommer, M.D., Ph.D., of the University of Utrecht in the Netherlands, agreed with Francks. In fact, she has found that, just as speech often originates in the right side of the brain in left-handed persons, it is also the case for persons with schizophrenia.

And as for why left-handed persons may be disproportionately represented among known pedophiles, Cantor believes that the answer may lie in brain characteristics common to both conditions.

In any event, even if left-handedness and ambidexterity share common biological pathways with some mental disorders, left-handed individuals should not conclude that they will necessarily develop these mental disorders, authorities on the subject stress.

For example, regarding the finding that Francks and his colleagues have made—that the gene that predisposes to left-handedness may also increase the risk of schizophrenia—"People really should not be concerned by this result," he said. "There are many factors which make individuals more likely to develop schizophrenia, and the vast majority of left-handers will never develop the problem."

As for Choudary and O'Carroll's finding that left-handers are significantly more at risk of PTSD, Choudhary said, "The development of PTSD is multi-factorially determined and incompletely understood. In this context, left-handedness seems to be an important part of the jigsaw and one previously neglected, but though apparently important, is only one determinant of who might develop PTSD following trauma."

All in all, Choudhary stressed, "The majority of left-handers are not going to develop mental health problems because of their left-handedness."

Cantor agreed: "The association between left-handedness and disease is very complex.... Being left-handed does not make a person appreciably more likely to have any given disease."

So being left-handed or ambidextrous, like virtually everything in life, has both its pluses and minuses. And if you are left-handed or ambidextrous, why not try to capitalize on your mental strengths—say, exceptional intelligence, economic shrewdness, or creativity? Who knows, you might even become president!

Footnotes

 

February 5, 2009

Like Russell Crowe's character in A Beautiful Mind, life is often difficult for the 2.4 million Americans with schizophrenia. A late or incorrect diagnosis and the lack of effective treatment options can destroy a sufferer's quality of life.

Schizophrenia usually emerges between the ages of 18 and 30, but diagnosis before the disease manifests could be the key to developing more successful treatments, says Prof. Talma Hendler of Tel Aviv University's Department of Psychology.

Until now, detecting mental illness before symptoms appear has been nearly impossible. Building on her groundbreaking work on facial recognition and brain imaging, Prof. Hendler is hoping to make early diagnosis a reality by identifying the physical markers of mental illness - particularly schizophrenia - inside the brain.

"With better diagnosis, plus earlier and more disease-specific treatment, we can make a real difference in the lives of these patients," Prof. Hendler says.

Mapping The Brain

For years, the mechanism behind the abnormal social behavior that characterizes many schizophrenic patients has been a mystery. To study the physical manifestation of schizophrenia, Prof. Hendler used brain imaging to illustrate differences between the brain activity of schizophrenic patients and healthy adults. Her work is part of the Functional Human Brain Mapping project at Tel Aviv University.

Prof. Hendler's findings, published recently in the journal Human Brain Mapping, showed that when presented with photographs of emotional faces with "bizarre" characteristics, the brains of schizophrenic patients were much less reactive than established norms.

In her previous research published in the journal Neuron, when shown a bizarre "funny face", healthy minds respond with selective activity within the brain, sounding the alarm that there is something disturbing about the image. Prof Hendler then posited that although this selective response is found in visual areas, it has distributed effects in the brain; "The visual areas of the brain are highly connected to other areas, including the prefrontal cortex and the amygdala, but in schizophrenic patients, there is a diminished connection between the various parts, leading to disturbed integration of information - and thus to distorted experiences," she says.

Developing Early Screening Processes and Better Treatments

"Recognizing facial emotions is a very early process, so young children could be screened for a predisposition to mental disease by measuring their brain connectivity while detecting emotional cues," Prof. Hendler explains. An objective early marker of the disease would be especially useful for those already considered high risk, such as children with an immediate family member with the disease. With early diagnosis to guide individually tailored treatment, it may be possible to reduce the effect of the disease and, in some cases, even prevent its outbreak.

By identifying the physical characteristics of a mental disorder, Prof. Hendler is also paving the way for new types of treatment. "Current drugs treat the abnormal behavior, not the brain disorder that is causing the behavior," she says, "We want to be able to develop more specific treatments based on objective brain markers, which are the actual characteristics of the disease."

Prof. Hendler's work has been published in leading journals in the field of cognitive neuroscience such as the Journal of Neuroscience and the Journal of Cognitive Neuroscience, Neuroimage and Neuron. She is currently also working on using brain imaging to characterize and identify predispositions for post-traumatic stress disorder in soldiers.

Future work with "funny faces" will also look at basic human emotions such as shame, envy and guilt. Having a neural marker for these emotions might give clinicians an early-detection tool to spot abnormalities in social interactions. Problems in socializing are a hallmark of schizophrenia.

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Article URL: http://www.medicalnewstoday.com/articles/138024.php

Time Magazine
Thursday, Dec. 04, 2008

That's the conclusion of researchers from Harvard and the University of California at San Diego, who report in the British Medical Journal online that happiness spreads among people like a salubrious disease. Dr. Nicholas Christakis and James Fowler studied nearly 5,000 people and their more than 50,000 social ties to family, friends and co-workers, and found that an individual's happiness is chiefly a collective affair, depending in large part on his or her friends' happiness — and the happiness of their friends' friends, and even the friends of their friends' friends. The merriment of one person, the researchers found, can ripple out and cause happiness in people up to three degrees away. So if you're happy, you increase the chance of joy in your close friend by 25%; a friend of that friend enjoys a 10% increased chance. And that friend's friend has a 5.6% higher chance.

"This is a very serious piece of research. It's pioneering," says Dr. Richard Suzman, director of the division of behavioral and social research at the National Institute on Aging. "We are barely beginning to understand its translational and applied aspects."

The authors analyzed data from the Framingham Heart Study, a historic study of heart disease among nearly 5,000 people begun in 1948. Because it was designed to follow participants and their offspring over several generations, the study's creators recorded detailed information about each person's closest relatives and friends, to better keep tabs on the original participants. That database served as an ideal social laboratory for Christakis and Fowler, who questioned each participant and his or her friends and family about their emotional state three times over 20 years.

The idea of mood transfer is not exactly revolutionary. It makes sense, after all, that your happiness will affect your closest friends, and that their emotional state will influence your own. (Interestingly, the same association was not found with unhappiness, despite the old adage about misery and company, and the contagion effect was weaker among family members than friends, possibly because while people take a cue from friends, they take for granted their families and spouses.) What was less expected was that the effect was sustained up to three degrees of separation away, among people who may not necessarily know one another. You may owe your good cheer to your friend's brother's girlfriend, even if you don't know her name.

That's the power of the social network, which, the authors argue, may impact our emotional state even more than our individual choices and environments. And it is not merely a result of like seeking like. The authors compared their observed network with a control network in which they randomly assigned feelings of happiness to individuals, and were able to rule out the possibility that happy people were simply clustering together by choice. Indeed, in another study in the same issue of the BMJ, researchers from Yale University and the Federal Reserve of Boston showed a similar tendency to cluster among people who, for example, are the same height, or suffer from acne, or headaches. But once the researchers adjusted for confounding factors, the network dissolved; in Christakis and Fowler's paper, the happiness link remained unbroken.

But the effect was limited by space and time. Researchers found that the risk of catching happiness increased with proximity: so a next-door neighbor enjoys a 34% increased chance of happiness by living near a happy person, but a friend who lives across town is less affected. And the best-connected social networkers — those who were at the center of their social nodes — were more likely to become happy than people on the fringes. Viral happiness was relatively short lived, however, lasting about a year.

This is the authors' third such networking study suggesting that the social group is a powerful super-organism that wields much influence over individuals' well-being. Previous analyses by Christakis and Fowler, based on the same pool of data, have shown that obesity is similarly contagious, as is the act of quitting smoking.

The researchers' hope is that a better understanding of how people pick up and pass on behaviors will help health officials create more targeted public-health messages. Antismoking campaigns aimed at teens, for example, might be more powerful if they were geared toward the most socially connected students in a high school — rather than individual smokers. "We are always looking for areas to invest in, promising new areas of research that will give us new levels of ability to help people, and without a doubt I see this as a very promising area," says Suzman.

October 15, 2008

UCLA scientists have found that for computer-savvy middle-aged and older adults, searching the Internet triggers key centers in the brain that control decision-making and complex reasoning. The findings demonstrate that Web search activity may help stimulate and possibly improve brain function.

The study, the first of its kind to assess the impact of Internet searching on brain performance, is currently in press at the American Journal of Geriatric Psychiatry and will appear in an upcoming issue.

"The study results are encouraging, that emerging computerized technologies may have physiological effects and potential benefits for middle-aged and older adults," said principal investigator Dr. Gary Small, a professor at the Semel Institute for Neuroscience and Human Behavior at UCLA who holds UCLA's Parlow-Solomon Chair on Aging. "Internet searching engages complicated brain activity, which may help exercise and improve brain function."

As the brain ages, a number of structural and functional changes occur, including atrophy, reductions in cell activity, and increases in deposits of amyloid plaques and tau tangles, which can impact cognitive function.

Small noted that pursuing activities that keep the mind engaged may help preserve brain health and cognitive ability. Traditionally, these include games such as crossword puzzles, but with the advent of technology, scientists are beginning to assess the influence of computer use - including the Internet.

Additional details on the study and further research on the impact of computer technologies on the aging brain are highlighted in Small's new book, "iBrain: Surviving the Technological Alteration of the Modern Mind."

For the study, the UCLA team worked with 24 neurologically normal research volunteers between the ages of 55 and 76. Half of the study participants had experience searching the Internet, while the other half had no experience. Age, educational level and gender were similar between the two groups.

Study participants performed Web searches and book-reading tasks while undergoing functional magnetic resonance imaging (fMRI) scans, which recorded the subtle brain-circuitry changes experienced during these activities. This type of scan tracks the intensity of cell responses in the brain by measuring the level of cerebral blood flow during cognitive tasks.

All study participants showed significant brain activity during the book-reading task, demonstrating use of the regions controlling language, reading, memory and visual abilities, which are located in the temporal, parietal, occipital and other areas of the brain.

Internet searches revealed a major difference between the two groups. While all participants demonstrated the same brain activity that was seen during the book-reading task, the Web-savvy group also registered activity in the frontal, temporal and cingulate areas of the brain, which control decision-making and complex reasoning.

"Our most striking finding was that Internet searching appears to engage a greater extent of neural circuitry that is not activated during reading - but only in those with prior Internet experience," said Small, who is also the director of UCLA's Memory and Aging Research Center.

In fact, researchers found that during Web searching, volunteers with prior experience registered a twofold increase in brain activation when compared with those with little Internet experience. The tiniest measurable unit of brain activity registered by the fMRI is called a voxel. Scientists discovered that during Internet searching, those with prior experience sparked 21,782 voxels, compared with only 8,646 voxels for those with less experience.

Compared with simple reading, the Internet's wealth of choices requires that people make decisions about what to click on in order to pursue more information, an activity that engages important cognitive circuits in the brain.

"A simple, everyday task like searching the Web appears to enhance brain circuitry in older adults, demonstrating that our brains are sensitive and can continue to learn as we grow older," Small said.

Small added that the minimal brain activation found in the less experienced Internet group may be due to participants not quite grasping the strategies needed to successfully engage in an Internet search, which is common while learning a new activity."With more time on the Internet, they may demonstrate the same brain activation patterns as the more experienced group," he said.

Researchers noted that additional studies will address both the positive and negative influences of these emerging technologies on the aging brain.

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Article adapted by Medical News Today from original press release.
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The study was funded by the Parvin Foundation.

Additional study authors include Teena D. Moody, Ph.D., a senior research associate at UCLA's Semel Institute, and Susan Y. Bookheimer, Ph.D., a professor of psychiatry and biobehavioral sciences at the Semel Institute.

Source: Rachel Champeau
University of California - Los Angeles

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Article URL: http://www.medicalnewstoday.com/articles/125563.php

 

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